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The effect of hypnotherapy on exam anxiety and exam performance: A pilot randomised controlled trial

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Background: Hypnotherapy is used to treat a range of anxiety disorders. A systematic review in 2009 by Baker, Ainsworth, Torgerson and Torgerson showed that hypnotherapy is effective in reducing exam anxiety; however it was only able to locate five small randomised controlled trials. A full‐scale randomised trial is therefore needed to assess whether hypnosis is effective in both reducing exam anxiety and in increasing exam performance. The purpose of this pilot trial was, therefore, to investigate the acceptability of such a trial to both participants and examination providers, and the feasibility of conducting a full‐scale trial. Methods: A pragmatic two‐armed individually randomised controlled pilot trial was conducted. Participants, all first year nursing students, were randomised to receive hypnotherapy sessions preceding a numeracy test or to a control group which did not receive hypnotherapy. Outcomes included the recruitment rate and the number of participants completing the trial, as well as the experiences of participants taking part in the trial and the reasons why some students decided not to participate. Results: Two thirds of participants approached to take part in the pilot trial agreed to take part and remained in the trial until completion. The two main reasons expressed for not taking part included not wanting to be hypnotised and not feeling anxious about the exam. Attendance at the hypnotherapy sessions was high and almost all those who received hypnotherapy reported that they found it helpful and useful. Conclusion: This study has shown that a trial of hypnotherapy among UK nursing students is possible, although it is important that a suitable exam is identified. Given the potential of hypnotherapy shown in other settings we feel that a larger trial using exam scores as the primary outcome is both timely and feasible.
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The effect of hypnotherapy on exam anxiety and exam performance: a
pilot randomised controlled trial
Hannah R. Ainswortha; David J. Torgersona; Carole J. Torgersonb; Janos Benec; Celia Grantd; Sue Fordd;
Ian Watte
a York Trials Unit, Department of Health Sciences, University of York, York, UK b School of Education,
University of Birmingham, Birmingham, UK c Independent hypnotherapist, d Department of Health
Sciences, University of York, York, UK e Department of Health Sciences and Hull York Medical School,
University of York, York, UK
Online publication date: 13 December 2010
To cite this Article Ainsworth, Hannah R. , Torgerson, David J. , Torgerson, Carole J. , Bene, Janos , Grant, Celia , Ford,
Sue and Watt, Ian(2010) 'The effect of hypnotherapy on exam anxiety and exam performance: a pilot randomised
controlled trial', Effective Education, 2: 2, 143 — 154
To link to this Article: DOI: 10.1080/19415532.2010.522799
URL: http://dx.doi.org/10.1080/19415532.2010.522799
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Effective Education
Vol. 2, No. 2, September 2010, 143–154
ISSN 1941-5532 print/ISSN 1941-5540 online
© 2010 Taylor & Francis
DOI: 10.1080/19415532.2010.522799
http://www.informaworld.com
The effect of hypnotherapy on exam anxiety and exam
performance: a pilot randomised controlled trial
Hannah R. Ainswortha*, David J. Torgersona, Carole J. Torgersonb, Janos Benec,
Celia Grantd, Sue Fordd and Ian Watte
aYork Trials Unit, Department of Health Sciences, University of York, York, UK; bSchool of
Education, University of Birmingham, Birmingham, UK; cIndependent Hypnotherapist;
dDepartment of Health Sciences, University of York, York, UK; eDepartment of Health
Sciences and Hull York Medical School, University of York, York, UK
Taylor and FrancisREFE_A_522799.sgm
(Received 15 February 2010; final version received 1 July 2010)
10.1080/19415532.2010.522799Effective Education1941-5532 (print)/1941-5540 (online)Original Article2010Taylor & Francis22000000September 2010HannahAinsworthhrp500@york.ac.uk
Background: Hypnotherapy is used to treat a range of anxiety disorders. A
systematic review in 2009 by Baker, Ainsworth, Torgerson and Torgerson showed
that hypnotherapy is effective in reducing exam anxiety; however it was only able
to locate five small randomised controlled trials. A full-scale randomised trial is
therefore needed to assess whether hypnosis is effective in both reducing exam
anxiety and in increasing exam performance. The purpose of this pilot trial was,
therefore, to investigate the acceptability of such a trial to both participants and
examination providers, and the feasibility of conducting a full-scale trial. Methods:
A pragmatic two-armed individually randomised controlled pilot trial was
conducted. Participants, all first year nursing students, were randomised to receive
hypnotherapy sessions preceding a numeracy test or to a control group which did
not receive hypnotherapy. Outcomes included the recruitment rate and the number
of participants completing the trial, as well as the experiences of participants taking
part in the trial and the reasons why some students decided not to participate.
Results: Two thirds of participants approached to take part in the pilot trial agreed
to take part and remained in the trial until completion. The two main reasons
expressed for not taking part included not wanting to be hypnotised and not feeling
anxious about the exam. Attendance at the hypnotherapy sessions was high and
almost all those who received hypnotherapy reported that they found it helpful and
useful. Conclusion: This study has shown that a trial of hypnotherapy among UK
nursing students is possible, although it is important that a suitable exam is
identified. Given the potential of hypnotherapy shown in other settings we feel that
a larger trial using exam scores as the primary outcome is both timely and feasible.
Keywords: pilot; randomised controlled trial; hypnotherapy; exam performance;
exam anxiety
Background
Exam anxiety has been defined as a situation specific anxiety trait (Spielberger, 1972a,
1972b). When exposed to evaluative situations individuals can react with tension,
excessive worry and mental disorganisation among other symptoms (Spielberger,
1972a, 1972b). Correlational investigations have shown that compared to subjects with
low scores, subjects with high scores on measures of exam anxiety tend to perform
*Corresponding author. Email: hannah.ainsworth@york.ac.uk
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144 H.R. Ainsworth et al.
relatively poorly on various types of ability tests (Sarason, 1972). However Sarason
(1972) noted that studies have suggested that highly anxious people are not academi-
cally less able (Sarason, 1972). The concern therefore is that reactions to evaluative
situations could lead to underperformance in examination situations; in other words
students who have the ability to achieve well academically may perform poorly
because of the effects of anxiety.
Exam anxiety appears to be a relatively widespread problem (Zeidner, 1998) and
finding ways to reduce its effects has become increasingly important. One possible
intervention which has been suggested as a treatment for exam anxiety is hypnosis
(Sapp, 1990). Hypnosis has been used to treat a number of anxiety disorders including
post-traumatic stress disorder (Solomon & Johnson, 2002). There are two major
features of hypnosis: the first is a cognitive component, and the second is a relaxation
component (Sapp, 1990). As Sapp notes (1990) it is a combination of these two
components that may make hypnosis effective in reducing exam anxiety. Relaxation
procedures may reduce exam related increases in self-reported distress symptoms, and
relaxation procedures have also been associated with immunologic changes in other
investigations (Whitehouse et al., 1996, p. 250).
Research to date suggests promising results of hypnotherapy in the treatment of
exam anxiety. A recent systematic review and meta-analysis conducted by some of the
authors of this paper (Baker, Ainsworth, Torgerson, & Torgerson, 2009) concluded that
hypnotherapy is effective in reducing exam anxiety (effect size 0.39 95%CI 0.662
to 0.005). However the systematic review located five small randomised controlled
trials, only one of which was conducted in the UK, making the results difficult to gener-
alise to a UK setting. Additionally, the primary outcome measure for the five trials
included in the review was reduction in anxiety; only two of the five trials included in
the review recorded the effect of hypnosis on exam performance, for which there was
no evidence of an effect.
Further research in a UK setting is, therefore, needed to confirm the effect of
hypnosis on exam anxiety and, crucially, to determine whether hypnosis improves
performance in exams. Hypnotherapy may reduce exam anxiety, which is very impor-
tant in itself, since the symptoms of exam anxiety can be debilitating. However if a
reduction in exam anxiety does not translate into improved exam performance, then
its impact is limited. It is also acknowledged that some level of anxiety may enhance
performance in examinations and it is therefore important to investigate the effects of
hypnotherapy on exam performance specifically.
It is widely agreed that the best research method to use when investigating the effec-
tiveness of an intervention is the randomised controlled trial (Torgerson & Torgerson,
2008). The possibility, therefore, of undertaking a large effectiveness trial, to assess
whether hypnosis is effective in both reducing exam anxiety and in increasing exam
performance, should be considered. However, before embarking on a large scale trial
it is important to determine the feasibility of undertaking such a trial using a pilot trial.
Hypnotherapy is generally accepted to be safe and widely used in the treatment of anxi-
ety disorders; however, it is not free from adverse effects (e.g feeling panicky) (Heap
& Aravind, 2002) and can be viewed with apprehension by some individuals. Consid-
ering the nature of the intervention, it is especially important that a pilot trial is
conducted in order to investigate both the acceptability of such a trial to potential partic-
ipants and participants’ experiences of taking part in a pilot trial.
A pilot trial also allows other issues which may arise to be addressed. In this case
it was felt that a potential issue was concern from examination providers. It is possible
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Effective Education 145
that examination providers may feel it is unethical to provide an intervention with
unknown consequences to some examinees and not others. Especially in high stakes
exams examination providers may be concerned about the possibility of an unfair
advantage or disadvantage for examinees.
The purpose of this pilot trial was, therefore, to investigate the acceptability of
such a trial to both participants and examination providers, and to consider how possi-
ble ethical issues could be overcome. It also provided an opportunity to address any
other issues that were raised during the conduct of the pilot trial, before designing a
large-scale effectiveness trial.
Methods
We have used the CONSORT statement for non-pharmacological trials (Boutron,
Moher, Altman, Schulz, & Ravaud, 2008) as a guideline for the reporting of the meth-
ods and results of this pilot trial. Ethics approval was received from the University of
York Health Sciences Ethics Committee (April 2009).
Objectives
The pilot trial was designed with the following objectives:
to measure the participant recruitment rate;
to record how many participants completed the trial;
to investigate participants’ experiences of taking part in the trial and attitudes
towards the hypnotherapy intervention;
to investigate reasons why people did not want to take part in the trial or any
reasons for withdrawal from the trial;
to assess students’ use of the resources provided; and
to estimate the pre- and post-test correlation in numeracy outcomes.
Trial design
The design was a pragmatic two-armed individually randomised controlled trial:
pragmatic in the sense that the trial was conducted in a real-life setting and the inter-
vention evaluated mirrored what could be offered in a non-trial setting. Participants
were randomly allocated either to the intervention group who received the hypnother-
apy intervention or to a control group who did not receive hypnotherapy but continued
to receive usual teaching support preceding the general numeracy test.
Participants
The participants were first year nursing students from the Department of Health
Sciences, University of York.
Inclusion and exclusion criteria
Participants were to be excluded from the study if any of the following criteria
applied:
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146 H.R. Ainsworth et al.
They were currently receiving hypnotherapy for any reason.
They were not a first year student nurse.
They could not give informed consent.
They were currently involved in any other trial assessing the effectiveness of
hypnotherapy for any condition.
They were already receiving treatment for anxiety.
They were taking any medication for anxiety or a related complaint and their
doctor believed hypnotherapy might not be appropriate for them.
Procedure
The trial was verbally explained to the students in a classroom setting. The students
were then provided with an information sheet and a consent form. Students were asked
to complete a baseline questionnaire and the consent form and return this to the trial
co-ordinator (HA). The baseline questionnaire collected information on the following:
age and gender; attitude toward and past experience of examination situations; past
GCSE/A level grades in maths; which arm of the trial they would prefer to be allo-
cated to if they had a choice (preference); whether they had used hypnotherapy in the
past to ease anxiety; whether they were taking any medication which could affect their
anxiety levels. We were also interested in reasons why students declined to partici-
pate; consequently we asked students who did not wish to take part to fill in a decline
form. After consent to take part in the trial had been gained, we collected students’
scores from a maths test which had been taken by the students about five months
previously as a normal part of the nursing course.
Randomisation
Randomisation was conducted by one of the team (DT) who was only aware of the
gender of the participants and a unique identifying number. The allocation procedure
used the Statistical Package for the Social Sciences (SPSS) random sampling function
stratifying for gender of the participant. The unique identifying number of the student
and the gender were entered into SPSS. The data were split into two groups: males and
females. SPSS then took an exact random half of each group and placed them into the
intervention group. This procedure was undertaken independently with no knowledge
of students’ identities or their baseline characteristics (apart from gender). The result-
ing allocation was then returned to the trial co-ordinator (HA), who then informed the
students of their allocation.
Outcomes
Our primary outcome was the proportion of students who gave consent to take part in
the trial, accepted randomisation and completed the trial. The primary outcome in a
large effectiveness trial would be the exam score on the numeracy tests taken at the
end of the intervention period. In this pilot trial we did not anticipate having sufficient
power to be able to show anything but a very large difference between the groups.
However, we collected these data to observe the pre- and post-test correlations, which
will inform the sample size calculation for a larger effectiveness trial. Furthermore,
routine reporting of such data will allow future meta-analyses to include this
study’s results. The main secondary outcome in a large effectiveness trial would be the
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Effective Education 147
participants’ scores on the Spielberger state-trait exam anxiety scale (Spielberger,
1980), to assess whether the hypnotherapy reduced anxiety. Consequently we also
collected these data in the pilot.
The exam the students were being prepared for in this pilot study was a formative
numeracy test. This test was chosen to allay concerns from University authorities that
students should not be randomised to an intervention that could affect their results in
a summative exam (i.e., a test that could affect their chances of graduating as a qual-
ified nurse). It should be noted that the formative numeracy test was not a high stakes
exam and, therefore, might not have induced the same levels of anxiety in participants
as a summative exam might have done.
Intervention group – hypnosis
Participants who were randomised to the hypnosis intervention took part in three
group sessions of hypnotherapy, which were delivered in the three weeks preceding
the general numeracy test (which is a normal part of the nursing course). The groups
consisted of around five people and lasted approximately 1–1.5 hours.
Session 1 took participants through a physical and mental relaxation process that
lasted about 20 minutes, followed by some imagination exercises which introduced
positive suggestions. At the end of the session there was time for discussion of the
process. A CD containing the entire exercise was given to each participant to listen to
at home, in order to help reinforce what the participants had learned in the first session.
In sessions 2 and 3 additional relaxation techniques were introduced, and work on
confidence levels, memory retention and reducing excessive stress and anxiety was
conducted. If the participants had any specific items they wanted to address time was
allotted for individual attention, which was documented by the hypnotherapist leading
the session.
At the end of the sessions each participant received a second CD that they were
encouraged to listen to the night before their exam.
The hypnotherapy intervention was delivered by three hypnotherapists. Each small
group of participants remained with the same hypnotherapist. Participants in the inter-
vention group also had usual access to teaching staff for support, and were able to
access the numeracy work books and attend the numeracy drop-in sessions provided
by the teaching department.
Control group
Participants who were randomised to the control group did not receive any hypnother-
apy. They continued to have usual access to teaching staff for support, and were able
to access the numeracy workbooks and attend the numeracy drop-in sessions provided
by the teaching department. Participants in either group were able to seek additional
support outside of the trial. We sought to monitor this by asking the participants in the
final questionnaire if they had accessed any other support.
Sample size
For this pilot trial we used a convenience sample of nursing students. We estimated
that about 40 students would be eligible to be approached for our study, which, given
a correlation between maths scores of 0.80, would give us around 80% power to show
a standardised effect size of 0.54 (p = 0.05) in maths test scores. We did not believe
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148 H.R. Ainsworth et al.
that hypnotherapy would be likely to deliver such a large effect size as the previous
meta-analysis (Baker et al., 2009) showed only a 0.39 of an effect size on anxiety
outcomes. However, our main outcome was the proportion of randomised students
completing the trial.
Results
Fewer students than expected were available to be approached to take part in the trial.
We approached 34 first year nursing students in the autumn of 2009 and these were
asked to take part in this pilot study; however, 10 refused to take part. In Figure 1 we
show the flow of students in the trial, from initial approach to the end of the trial, using
the CONSORT flow diagram (Moher, Schulz, & Altman, 2001).
Figure 1. CONSORT Diagram.
Table 1 shows the characteristics of the students in their allocated groups. The
majority of participants were female with an average age of 26.
In the baseline questionnaire only one participant reported that they had previously
received hypnotherapy.
In the baseline questionnaire we asked participants if they felt anxiety affected their
exam performance. A free text box was provided for participant responses. Most of
the participants stated that they did feel that anxiety affected their exam performance.
Participants noted the feeling of ‘mental block’, and struggling to get started with
Figure 1. CONSORT Diagram.
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Effective Education 149
papers. Participants also noted that anxiety affected performance in exams on topics
they found difficult anyway (maths was particularly noted by some participants). The
amount of revision done was also cited as a contributing factor. A few students stated
that anxiety did not affect their exam performance. (All responses can be found in
Appendix 1).
Intervention group – attendance and feedback
Attendance at the hypnotherapy sessions was high: two participants did not attend any
hypnotherapy sessions; two participants only attended one hypnotherapy session, the
remaining eight participants attended all three hypnotherapy sessions provided.
All participants in the intervention group who completed the end of trial question-
naire, except for one, said they had enjoyed the hypnotherapy sessions and found them
useful. Half of respondents also reported feeling more relaxed, more focussed and
more confident having taken part in the hypnotherapy sessions. All respondents stated
that they had used the hypnotherapy CDs. Use of the CDs appeared to be high with
most respondents reporting that they listened to the duration of the CD between three
and five times a week throughout the duration of the trial. Participants were also asked
to make any other comments about taking part in the trial. Among the responses,
Table 1. Baseline data.
Intervention Control
Gender 11 F, 1 M 11 F, 1 M
Age (mean) 26 26
Highest maths qualification (mode) G.C.S.E G.C.S.E
Grade of maths qualification (mode) C C
When maths qualification was achieved (mode) 2002/2003/2004 2004
Reported anxiety state when taking exams Very anxious 97
Few nerves 12
Rarely worried 00
Relaxed 10
Preference for allocation Hypnotherapy
sessions
99
No preference 00
Usual support 31
Mean baseline maths score (max 24) 15.18 15.75
Table 2. Self-reported feeling about the end of trial exam following hypnotherapy sessions.
Feeling about exam after hypnotherapy N
More relaxed 4
More focussed 4
More confident 4
Less relaxed 0
Less focussed 1
Less confident 0
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150 H.R. Ainsworth et al.
participants stated that they found the hypnotherapy sessions enjoyable, that they
seemed to be more focussed, and that they felt confident self hypnotising. One partic-
ipant also noted that the exam in the trial was not similar to a real exam setting. (All
responses can be found in Appendix 2.)
Feedback from the hypnotherapists
During the course of the pilot trial the three hypnotherapists conducting the hypno-
therapy sessions felt that it would be advantageous to both students and therapists in
future work to extend the number of sessions offered from three to four. Considering
the amount of information and participation by the students, four sessions would allow
the information and experiences (all quite new and unusual for the participants) to
soak in over a longer period, allowing for a deeper appreciation of the benefits. Four
sessions would also reduce the risk of overwhelming participants and allow for more
individual attention (in a group setting) in which all participants seemed keen, or at
least interested and willing to participate in.
Feedback from the control group
Participants in both the intervention and control group were asked if they had
accessed any support resources before their exam; their responses are provided below
(Table 3). Three respondents from the control group ticked ‘other’ and stated that
they had used textbooks and BBC Bitesize (online tutorials and exam revision
resources). We also asked participants in the control group to make any other
comments about the trial in general; one participant responded stating that ‘[I] would
be willing to take part again, [I] would have liked to have a hypnotherapy session’.
Numeracy outcome
The linear regression analysis, adjusting for the pre test scores, showed no evidence
of a statistically significant effect of the hypnotherapy intervention on the numeracy
outcome, the numeracy test score (Mean 14.0 and 13.2 for intervention and control
respectively, adjusted difference 0.216, 95% CI 4.20 to 4.63, p=0.918).
Anxiety outcome
An independent samples T test showed no evidence of a statistically significant effect
of hypnotherapy on the anxiety outcome, anxiety score (mean 50.5 and 50.8 for inter-
vention and control group respectively, 95% CI 14.10 to 14.67, p = 0.790).
Table 3. Resources accessed during the trial.
Resources accessed during the trial Intervention (N) Control (N)
Staff support 1 2
Numeracy drop-in sessions 3 2
Numeracy workbooks in the virtual
learning environment
23
Online resources 8 4
Other 0 3
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Effective Education 151
Non-participants
Recruitment to the trial was high with two thirds of students approached agreeing to
take part. Students were asked if any of a set of reasons provided explained their
choice not to participate (respondents were able to tick more than one box). Results
are displayed below (Table 4). Respondents were also provided with a free text box to
make any other comments; these are shown in Table 5.
Some participants expressed a desire not to be hypnotised and therefore decided
not to take part in the trial. The main alternative reason for not taking part in the trial
expressed by the students was that they were not anxious about exams and for some,
they were particularly not anxious about the exam in this trial. As already mentioned,
due to the concerns of University authorities the exam used in this trial was only a
formative assessment rather than a summative assessment, not surprisingly therefore
some students were not feeling anxious about this exam and therefore did not feel an
intervention was necessary.
Conclusion
In this trial we recruited 24 nursing students (from a total of 34 eligible to take part in
the trial) and randomised them to receive hypnotherapy. Therefore, two thirds of those
approached consented to take part in the trial. Most students reported finding the
hypnotherapy sessions helpful and useful. We did not find a benefit either in terms of
anxiety, as measured by the Spielberger (1980) test, or exam scores. However, our
trial was very small and consequently had a high risk of a type II error, which is
Table 5. Other comments from non-participants.
Not anxious for this exam.
Don’t get stressed.
•I don’t feel this would suit me and would prefer not to take part.
Would [take part] if it [were] another exam, but not marked and don’t like maths.
If the exam was a summative exam I feel I would be more anxious, however as it is not I do
not feel I will that anxious. Also my last math test results would not be an accurate baseline
and may skew the results.
•I sometimes feel anxious before exams but I am fine once it has started and do not feel my
performance is affected.
•I don’t like the idea of being hypnotised and not being in control and not knowing about what
is going on around me.
Table 4. Non-participants reasons for not participating.
Reasons for not participating N
Not in attendance when the trial was explained 1
Did not want to be hypnotised 3
Do not feel I need additional support when taking exams 1
Not overly anxious about exams 5
Do not want to be randomised 0
Already receive hypnotherapy to ease anxiety 0
Already receive hypnotherapy for another reason 0
Already involved in a trial relating to hypnotherapy/exam anxiety/exam performance 0
Already receive other treatment for anxiety 0
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152 H.R. Ainsworth et al.
erroneously concluding there is no difference when actually there is a difference.
Furthermore, some of the students who took part did not cite exam anxiety as a major
issue for them.
We also faced some difficulties in identifying an exam which was both appropriate
for the purposes of the trial and with which the examination providers were comfort-
able. A further limitation of our pilot trial was that the exam in question was only used
for formative assessment and therefore may not have induced the same level of
anxiety as a more important summative assessment. Indeed this was one of the main
reasons why some students decided not to take part in the trial; they felt an interven-
tion was unnecessary since they were not anxious about this particular exam. Some
participants who did take part also noted that they were not anxious about this specific
exam and that it was not similar to a real exam setting. If a full scale trial was to be
conducted it would be important to find an appropriate exam which was both accept-
able to examiners and also important enough to induce a response in participants
which would be similar to their response to other examination settings.
Our pilot study achieved our a priori aims. Recruitment was relatively high;
student satisfaction for the service was good and we obtained good pre- and post-test
correlation data which will be helpful in future sample size calculations. Furthermore,
the pilot demonstrated that we need to adjust the hypnotherapy intervention to ensure
that it has maximum effect. For example, one hypnotherapist felt the intervention
should be started sooner because this would enable the participants to have more
confidence in the use of drop-in numeracy services and be more confident when
asking questions in class. Furthermore, the hypnotherapists felt that four sessions
rather than three would be optimal.
The results from our current trial enable us to update the meta-analysis by Baker
et al. (2009). Adding this study to the meta-analysis does not materially change the
results with the effect size on anxiety falling slightly from 0.39 to 0.36, which is
still statistically significant (95% CI 0.62 to 0.094, p = 0.008).
This study has shown that a trial of hypnotherapy among UK nursing students is
possible. Given the potential of hypnotherapy shown in other settings we feel that a
larger trial using scores from numeracy exams as the primary outcome is both timely
and feasible.
Acknowledgements
We would like to thank: Charles Martinez and Chris Habermehl for contributing to the inter-
vention design and delivering the hypnotherapy sessions; Trudi Neenan from the Department
of Health Sciences, University of York, for help conducting the numeracy tests; Jenny Baker
for provision of some of the background material; Vivien Hendry, from the Institute for Effective
Education, University of York for reading drafts; and the students for participating in the trial.
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154 H.R. Ainsworth et al.
Appendix 1. Baseline questionnaire: does anxiety affect your exam
performance? Participant responses
Depends on how much revision I’ve done.
• Slightly.
•I think it might help me focus.
Sometimes. I panic and my head can go empty until I relax.
Yes, feel like I get a mental block throughout exams.
Not significantly.
•I am pretty certain that anxiety affects my performance in exams.
Yes, particularly maths as I have always struggled with this topic and have previously failed
the numeracy exam.
Yes, especially during my GCSEs and A Levels I sometimes get a mental block during
exams.
Yes, often find it difficult to get started with papers and feel my maths is especially poor,
which is a huge contributing factor.
• Yes.
• Yes.
Yes, I forget what I revised even if I read through notes ten minutes before exam!
Yes – I feel under pressure and always reflect afterwards thinking of things I could have
added.
•I do not get exam anxiety.
• Yes.
• Sometimes.
Only in subjects I feel less confident about, e.g. maths.
No. I usually calm down within the first five minutes after reading the paper.
Sometimes, depending on anxiety level.
Not really.
Yes, sometimes.
Yes, sometimes I almost lose motivation to study due to nerves.
Appendix 2. Intervention group end questionnaire: intervention group
participants’ responses on the trial in general
It was very good and my mind has been opened to what hypnotherapy does.
Seem to be more focussed on studies in general.
•I enjoyed these sessions and I feel confident in deep relaxing myself which has helped in
university work and personal life.
The sessions were very enjoyable and I believe helped me focus on my learning I did more
study than I would have done normally and they relaxed me.
Not similar to a real exam setting.
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... Hypnotherapy, G 1 ES (Boutin & Tosi, 1983) 1 ES (Ainsworth et al., 2010) Rational stage-directed hypnotherapy, I (Boutin, 1978), G (Boutin & Tosi, 1983) 1 ES (Boutin & Tosi, 1983) 1 CS (Boutin, 1978) Relaxation training (progressive/deep muscle relaxation), G 1 ES (Zargarzadeh & Shirazi, 2014) 2 QES (Charlesworth et al., 1981;Topp. 1989) Systematic desensitization, G 1 ES (Dawley & Wienrich, 1973) 1 QES (Wald & Fish, 1983) Stress inoculation, G 1 QES (Wald & Fish, 1983) Counseling for nutrition, exercise, relaxation, study skills, test-taking strategies, I 1 ES (Godbey & Courage, 1994) Biofeedback-assisted relaxation training, I 1 QES (Prato & Yucha, 2013) Guided reflection, G 1 ES (Sharif et al., 2013) Guided imagery training, I 1 ES (Stephens, 1992) Guided imagery with relaxation training, I 1 ES (Stephens, 1992) Aerobic exercise, G 1 QES (Topp. ...
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