Biofeedback-Assisted Relaxation Training to Decrease Test Anxiety in Nursing Students

Article excerpt


Background. Nursing students experiencing debilitating test anxiety may be unable to demonstrate their knowledge and have potential for poor academic performance.

Method. A biofeedback-assisted relaxation training program was created to reduce test anxiety. Anxiety was measured using Spielberger's Test Anxiety Inventory and monitoring peripheral skin temperature, pulse, and respiration rates during the training. Participants were introduced to diaphragmatic breathing, progressive muscle relaxation, and autogenic training.

Results. Statistically significant changes occurred in respiratory rates and skin temperatures during the diaphragmatic breathing session; respiratory rates and peripheral skin temperatures during progressive muscle relaxation session; respiratory and pulse rates, and peripheral skin temperatures during the autogenic sessions. No statistically significant difference was noted between the first and second TAI. Subjective test anxiety scores of the students did not decrease by the end of training.

Conclusion. Autogenic training session was most effective in showing a statistically significant change in decreased respiratory and pulse rates and increased peripheral skin temperature.

Key Words Test Anxiety--Biofeedback--Diaphragmatic Breathing Progressive Muscle Relaxation--Autogenics--Nursing Students


NURSING IS ONE OF THE MOST DEMANDING AND STRESSFUL MAJORS WITHIN A UNIVERSITY SETTING (DEARY, WATSON, & HOSTON, 2003; GIBBONS, DEMPSTER, & MOUTRAY, 2008; WATSON ET AL., 2008). It requires the integration of large amounts of knowledge and technical skills, coupled with the development of appropriate attitudes and responses to highly emotional settings. Thus, nurse faculty demand high performance on examinations, with students subjected to the stress of testing and high threshold standards. Many programs require that students achieve certain percentages on every examination in order to progress. As testing has high consequences, nursing students who experience debilitating test anxiety may be unable to demonstrate their knowledge and have the potential for poor academic performance.

Schools of nursing should not decrease the requirements for progression within their programs and graduation. However, it is important to identify students who are struggling with test anxiety and implement interventions aimed at decreasing anxiety and alleviating the negative consequences. A biofeedback-assisted relaxation training (BART) program for nursing students may help students learn to control their physiological and psychological reactions associated with test anxiety and positively impact attrition rates.

The purpose of this study was threefold: 1) to identify which semester of an upper-division baccalaureate nursing program is associated with the highest test anxiety; 2) using participants from that semester, to determine if an intervention including diaphragmatic breathing, progressive muscle relaxation, and autogenic training assists students control their physiological responses; and 3) to determine if relaxation training decreases test anxiety.

Physiological Measures Related to Anxiety Test anxiety has been conceptualized in multiple ways throughout the years. Some researchers refer to the cognitive impairments involved and others to the emotional reactions. There is broad agreement that anxiety can be classified into two components, state and trait anxiety (Cheung, 2006). Trait anxiety is the stable individual differences in anxiety proneness (Spielberger, 1983) or a general way of responding to the world, which becomes stable over time (Zeidner, 2007). State anxiety is a transitory emotional condition that is characterized by subjective, consciously perceived feelings of tension, apprehension, nervousness, and worry (Spielberger). Spielberger defined test anxiety as an emotional state at a given moment in time and at a particular level of intensity that is characterized by "tension, apprehension, nervousness, and worry. …


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