Clinical Trials Study
Copyright ©The Author(s) 2022. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Psychiatry. Jun 19, 2022; 12(6): 801-813
Published online Jun 19, 2022. doi: 10.5498/wjp.v12.i6.801
Randomized trial estimating effects of hypnosis versus progressive muscle relaxation on medical students’ test anxiety and attentional bias
Yang Zhang, Xin-Xin Yang, Jing-Yi Luo, Meng Liang, Ni Li, Qian Tao, Li-Jun Ma, Xiao-Ming Li
Yang Zhang, Affiliated Psychological Hospital, Anhui Medical University, Hefei 230032, Anhui Province, China
Yang Zhang, The Fourth People’s Hospital, Hefei 230032, Anhui Province, China
Yang Zhang, Anhui Mental Health Center, Hefei 230032, Anhui Province, China
Yang Zhang, Xin-Xin Yang, Jing-Yi Luo, Meng Liang, Ni Li, Li-Jun Ma, Xiao-Ming Li, Department of Medical Psychology, School of Mental Health and Psychological Science, Anhui Medical University, Hefei 230032, Anhui Province, China
Qian Tao, Department of Psychology, School of Basic Medicine, Jinan University, Guangzhou 510632, Guangdong Province, China
Li-Jun Ma, Department of Psychology, Anqing Normal University, Anqing 246011, Anhui Province, China
Author contributions: Zhang Y, Yang XX, and Luo JY collected the data; Liang M, Li N, and Ma LJ undertook the statistical analysis; Tao Q modified the manuscript; Li XM designed the study and wrote the first draft of the manuscript; and all authors contributed to and approved the final manuscript.
Supported by the Anhui Natural Science Foundation, No. 1808085MH291; the Project of human Social Science of Anhui Province, No. SK2016A047; Grants for Scientific Research of BSKY from Anhui Medical University, No. XJ201826.
Institutional review board statement: The study was reviewed and approved by the Human Ethics Committee of the Anhui Medical University (Approval No. 2019H019).
Clinical trial registration statement: This study is registered at http://www.chictr.org.cn/showproj.aspx?proj=41900. The registration identification number is ChiCTR1900025058.
Informed consent statement: All study participants, or their legal guardian, provided informed written consent prior to study enrollment.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
Data sharing statement: No additional data are available.
CONSORT 2010 statement: The authors have read the CONSORT 2010 statement, and the manuscript was prepared and revised according to the CONSORT 2010 statement.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Xiao-Ming Li, PhD, Adjunct Professor, Department of Medical Psychology, School of Mental Health and Psychological Science, Anhui Medical University, No. 81 Meishan Road, Shushan District, Hefei 230032, Anhui Province, China. psyxiaoming@126.com
Received: September 24, 2021
Peer-review started: September 24, 2021
First decision: January 12, 2022
Revised: January 26, 2022
Accepted: May 14, 2022
Article in press: May 14, 2022
Published online: June 19, 2022
Processing time: 263 Days and 6.4 Hours
ARTICLE HIGHLIGHTS
Research background

Test anxiety is prevalent among medical students and leads to impaired academic performance. Test-related attentional bias has been identified as an important maintaining factor in test-anxious individuals.

Research motivation

The present study aimed to evaluate whether hypnosis and progressive muscle relaxation (PMR) could modify medical college students’ test anxiety and attentional bias.

Research objectives

This study was designed as an initial pilot randomized clinical trial comparing the effects of hypnosis to the effects of PMR on test anxiety and its associated attentional bias. This study is the first to use hypnosis to help individuals reduce test anxiety and attentional bias toward threatening stimuli, and is also the first to use PMR to reduce attentional bias in students.

Research methods

A total of 598 medical students were screened. The participants were divided into higher and lower test anxiety groups according to their scores on the test anxiety scale (TAS). Ninety medical college students with high TAS scores were randomly assigned to a hypnosis or PMR group. Another 45 students with low TAS scores were included for baseline control group. The intervention was conducted weekly for 6 wk, and each session lasted approximately 30 min. The total intervention time and the number of intervention sessions were matched between the hypnosis and PMR groups. Data were collected at pretest, posttest, and 2-mo follow-up.

Research results

Hypnosis group participants had a significantly lower TAS score at posttest (t = -21.827, P < 0.001) and at follow-up (t = -14.824, P < 0.001), compared with that at pretest. PMR group participants also had a significantly lower TAS score at posttest (t = -10.777, P < 0.001) and at follow-up (t = -7.444, P < 0.001), compared with that at pretest. At the posttest level, the hypnosis group had a significantly lower TAS score than the PMR group (t = -3.664, P < 0.001). At the follow-up level, the hypnosis group also had a significantly lower TAS score than the PMR group (t = -2.943, P = 0.004). Clinically significant improvement was found in both the hypnosis and PMR groups (hypnosis = 64.0%; PMR = 62.22%). Hypnosis was more effective than PMR in reducing test anxiety among medical college students. Hypnosis could modify attentional bias toward threatening stimuli, but PMR could not.

Research conclusions

Hypnosis is more effective than PMR in reducing test anxiety in medical students; hypnosis could modify attentional bias toward threatening stimuli, but PMR could not. Additionally, hypnosis integrated with some form of therapy may have enhanced effects on mental disorders. Our findings have important implications for the design and optimization of hypnotic treatments for anxiety disorders.

Research perspectives

This study concluded that hypnosis is efficacious in treating test anxiety by reducing anxiety vulnerability and attentional bias to threatening stimuli. The findings imply that attentional bias can be an important target in future research on treating test anxiety or other anxiety disorders.