Exam AnxietyMandalaNCT07116005
Mandala Art Therapy on Practical Examination Anxiety
A study testing Mandala Coloring in people with Exam Anxiety, run by Near East University, Turkey at 1 site in Cyprus.
Trial summary
This randomized clinical trial aimed to evaluate the effectiveness of Mandala Art Therapy in reducing practical examination anxiety among undergraduate nursing students. The primary goal was to determine whether a brief Mandala coloring session prior to the Objective Structured Clinical Examination (OSCE) could… Read more about this study
- Who is it for?
- Any ageHealthy volunteers can take part
- Conditions the study is for
- Exam Anxiety
- What is being tested?
- Mandala Coloring
- Type of treatment
- Lifestyle or therapy programme
- Could I receive a placebo?
- No, everyone receives an active treatment
- How many people
- 100 participants
- Where
- 1 siteCyprus
- Study dates
- 1 May 2024to 30 May 2024
- Phase
- Interventional
- Are there results?
- None posted in the registry
Key requirements
Who can take part, as listed by the sponsor. Only the study team can confirm whether you are eligible, so take this list to your doctor.
- Ages Any age
- All sexes
- Healthy volunteers accepted
- Child, Adult, Older adult
Who may be able to join
- All students, both female and male, first semester of bachelor's degree, studying in nursing department of Near East University.
- Not using other stress reduction methods including progressive muscle relaxation, drug therapy, etc. to control exam anxiety.
- Those willing to participate in the project.
Who cannot join
- Unwilling to continue cooperation in the project,
- Using any psycho medicines (anti-depressants ...), mental health
- Mourning, especially the death of loved ones or relatives in the 1st phase.
Trial locations and contacts
1 site in 1 country.
Cyprus1 site
Near East University
Nicosia, KKTC (Turkish Republic of Northern Cyprus
About this study
Official title: The Influence of Mandala Art Therapy on Practical Examination Anxiety Among Undergraduate Nursing Students
This randomized clinical trial aimed to evaluate the effectiveness of Mandala Art Therapy in reducing practical examination anxiety among undergraduate nursing students. The primary goal was to determine whether a brief Mandala coloring session prior to the Objective Structured Clinical Examination (OSCE) could significantly reduce students' state anxiety. The study focused on the therapeutic potential of this low-cost, non-invasive, and easily implemented intervention in academic settings.
The main research questions guiding the study were:
Read more
Does Mandala coloring reduce pre-examination anxiety among undergraduate nursing students?
Can Mandala Art Therapy be considered a feasible and effective complementary strategy for managing academic stress in clinical evaluation contexts?
To address these questions, participants were randomly assigned to either an experimental group, which engaged in a 20-minute Mandala coloring session before the OSCE, or a control group, which received no intervention beyond standard exam preparation. Pre- and post-intervention anxiety levels were measured using the Spielberger State-Trait Anxiety Inventory (STAI) to assess the impact of the intervention.
Read the detailed description
Study Title:
The Influence of Mandala Art Therapy on Practical Examination Anxiety Among Undergraduate Nursing Students
Study Purpose:
The aim of this study was to evaluate the effectiveness of Mandala Art Therapy-a creative, mind-body intervention rooted in complementary and alternative medicine-in reducing practical examination (OSCE) anxiety among undergraduate nursing students. The intervention was implemented as part of a holistic approach to psychological well-being in a randomized, double-blind clinical trial.
Sample Size Determination:
The statistical population included undergraduate nursing students at Near East University. Out of 120 eligible students, 100 participants who met inclusion criteria were enrolled in the study after providing informed consent.
Participants were randomly assigned to either the experimental or control group using a simple randomization technique: 100 numbered cards were placed in a glass container and drawn alternately to assign participants to the two groups.
Based on parameters from a previous similar study (α = 0.05, power = 80%, S1 = 9.61, S2 = 10.4, μ1 = 42.03.5, μ2 = 47.7), the minimum required sample size was 48 per group. To allow for a 5% dropout rate, 50 students were ultimately placed in each group.
A double-blind design was used to reduce bias. The data collector was blinded to group allocations, and the statistician analyzing the data received anonymized variables coded as x1 and x2.
Tools of Data Collection:
- Demographic Questionnaire:
Collected data on age, gender, marital status, and educational level.
- Spielberger State-Trait Anxiety Inventory (STAI):
A validated 40-item tool assessing state and trait anxiety using a 4-point Likert scale. Higher scores indicated greater anxiety. The STAI has demonstrated strong psychometric properties, with a Cronbach's alpha of 0.96.
Intervention:
Experimental Group:Students participated in a 20-minute unstructured Mandala coloring session in a quiet room, one hour before the OSCE. Each student was provided with a Mandala outline and six colored pencils. The session aimed to foster mindfulness and reduce pre-exam anxiety.
Control Group:Students followed the standard university OSCE preparation routine without any additional intervention.
Implementation Phase:
The trial was conducted within the Nursing Department of Near East University. All students were briefed about the procedures and gave written informed consent. Mandala sessions were conducted in a distraction-free environment, and all participants completed STAI questionnaires before and after the intervention period.
Ethical Considerations: The study was approved by the Near East University Ethics Review Board (Approval No. NUE/2024/124-1854) and registered on ClinicalTrials.gov (NCT06571357). Ethical standards followed the Declaration of Helsinki (1964). All participants were informed of their right to withdraw at any time. Confidentiality and data protection were strictly maintained.
Statistical Analysis: All statistical analyses were conducted using SPSS version 25. The Kolmogorov-Smirnov test was used to assess normality. Data were analyzed using: Descriptive statistics (mean, SD, frequencies) Paired t-test (within-group pre-post comparison) Independent t-test (between-group comparison) Chi-square test (for categorical variables) A P-value < 0.05 was considered statistically significant.
- Conditions
- Exam Anxiety
- Being tested
- Mandala Coloring
- Keywords
- Art Therapy, Exam Anxiety, Complementary Therapies
What participants receive
What participants receive. In a randomised study each person is assigned to one group by chance.
Mandala ColoringBehavioural
Participants in this group receive the Mandala Art Therapy intervention, a creative, mindfulness-based activity rooted in complementary and alternative medicine. The intervention is designed to reduce exam-related anxiety by fostering visual focus, emotional calm, and self-expression. The Mandala protocol includes the following components:
- Distribution of printed Mandala outlines on A4 paper
- Provision of six colored pencils (red, orange, yellow, green, blue, and purple)
- A 20-minute individual coloring session in a quiet and relaxed setting
- No prescribed patterns-participants color freely to encourage self-directed engagement The Mandala coloring session is conducted exactly one hour before the Objective Structured Clinical Examination (OSCE). The activity is supervised by the researcher to ensure a supportive and distraction-free environment. Participants are encouraged to concentrate on the process of coloring to promote psychological grounding and reduce pre-exam stress.
| Study group | Role | What they receive |
|---|---|---|
| Mandala Art Therapy | Experimental | Behavioral: Mandala Coloring Participants in this group receive the Mandala Art Therapy intervention, which involves a 20-minute session of free-form Mandala coloring conducted one hour prior to their Objective Structured Clinical Examination (OSCE). The intervention is designed to reduce exam-related anxiety by promoting mindfulness, visual focus, and emotional self-regulation through creative expression. Receives: Behavioral: Mandala Coloring |
| Routine Academic Preparation | No intervention | Participants in this group continue with their usual academic preparation and receive no additional interventions. |
What is being measured
The primary outcome is the main question the study is designed to answer.
Practical Exam Anxiety Levels
The primary outcome measure assesses changes in anxiety levels related to the Objective Structured Clinical Examination (OSCE) among undergraduate nursing students. Anxiety is measured using the State-Trait Anxiety Inventory (STAI), a validated psychological instrument that evaluates both situational (state) and general (trait) anxiety. The STAI comprises two subscales with 20 items each, rated on a 4-point Likert scale. Higher total scores indicate greater levels of anxiety.
Measured: Anxiety levels are measured at two time points-immediately before and immediately after the intervention session, conducted one hour prior to the OSCE
Timeline
From the start of the study to its completion; the mark is today. Estimated dates are the sponsor’s plan.
- First posted11 Aug 2025
- Study start1 May 2024
- Primary completion30 May 2024
- Study completion30 May 2024
Resources
- Official record on ClinicalTrials.govThe registry entry this page is built from, with its full change history.
- Other trials for Exam AnxietyStudies of the same condition, open and under way.
- What the trial phases meanHow a treatment moves from first tests in people to approval.
More details
For doctors and researchers: how the study is designed, who runs it, and its registry IDs.
Study design
- Study type
- Interventional
- Phase
- Phase N/A
- Primary purpose
- Supportive care
- Allocation
- Randomised
- Intervention model
- Parallel groups
- Model description
- Participants in this clinical trial were randomly assigned to one of two groups: an experimental group that participated in Mandala Art Therapy (coloring a Mandala design for 20 minutes prior to the OSCE), and a control group that received standard academic preparation without any additional intervention. Both groups were observed in parallel throughout the study period to assess changes in exam anxiety levels.
- Masking
- Double blind
- Who is masked
- Investigator, Outcomes assessor
- Enrolment
- 100 participants (actual)
Sponsor and investigators
- Lead sponsor
- Near East University, Turkey
- Sponsor type
- University, hospital or other
- Responsible party
- Principal investigator, Pouran Varvani Farahani, Near East University, Turkey
- Investigators
- Pouran Varvani Farahani, PhD, Principal investigator, Department of Nursing, Faculty of Health Science, Cyprus International University
IDs, dates and publications
- ClinicalTrials.gov ID
- NCT07116005
- Sponsor's protocol ID
- PVF2025CAM003
- Acronym
- Mandala
- Status last verified
- Aug 2025
- First submitted
- 4 Aug 2025
- Last updated
- 11 Aug 2025
- Results posted
- No
- Data monitoring committee
- Yes
- FDA-regulated drug
- No
- FDA-regulated device
- No
- Individual data sharing
- No: There is no plan to make IPD available to other researchers
Study at a glance
From the registry record, last updated by the sponsor on 11 Aug 2025. Recruitment status is as the sponsor reported it: confirm with the study team.
- Official title
- The Influence of Mandala Art Therapy on Practical Examination Anxiety Among Undergraduate Nursing Students
- ClinicalTrials.gov ID
- NCT07116005
- Acronym / sponsor ID
- Mandala / PVF2025CAM003
- Conditions
- Exam Anxiety
- Keywords
- Art Therapy, Exam Anxiety, Complementary Therapies
- Study type
- Interventional
- Recruitment status
- Completed
- Enrolment
- 100 participants (actual)
- Lead sponsor
- Near East University, TurkeyUniversity, hospital or other
- Study start
- 1 May 2024 (actual)
- Primary completion
- 30 May 2024 (actual)
- Study completion
- 30 May 2024 (actual)
- First posted
- 11 Aug 2025 (actual)
- Results
- Not posted in the source record
Clinical summary
The research question as the sponsor registered it. This describes what the study plans to test, not what it found.
This randomized clinical trial aimed to evaluate the effectiveness of Mandala Art Therapy in reducing practical examination anxiety among undergraduate nursing students. The primary goal was to determine whether a brief Mandala coloring session prior to the Objective Structured Clinical Examination (OSCE) could significantly reduce students' state anxiety. The study focused on the therapeutic potential of this low-cost, non-invasive, and easily implemented intervention in academic settings.
The main research questions guiding the study were:
Does Mandala coloring reduce pre-examination anxiety among undergraduate nursing students?
Can Mandala Art Therapy be considered a feasible and effective complementary strategy for managing academic stress in clinical evaluation contexts?
To address these questions, participants were randomly assigned to either an experimental group, which engaged in a 20-minute Mandala coloring session before the OSCE, or a control group, which received no intervention beyond standard exam preparation. Pre- and post-intervention anxiety levels were measured using the Spielberger State-Trait Anxiety Inventory (STAI) to assess the impact of the intervention.
Detailed description
Study Title:
The Influence of Mandala Art Therapy on Practical Examination Anxiety Among Undergraduate Nursing Students
Study Purpose:
The aim of this study was to evaluate the effectiveness of Mandala Art Therapy-a creative, mind-body intervention rooted in complementary and alternative medicine-in reducing practical examination (OSCE) anxiety among undergraduate nursing students. The intervention was implemented as part of a holistic approach to psychological well-being in a randomized, double-blind clinical trial.
Sample Size Determination:
The statistical population included undergraduate nursing students at Near East University. Out of 120 eligible students, 100 participants who met inclusion criteria were enrolled in the study after providing informed consent.
Participants were randomly assigned to either the experimental or control group using a simple randomization technique: 100 numbered cards were placed in a glass container and drawn alternately to assign participants to the two groups.
Based on parameters from a previous similar study (α = 0.05, power = 80%, S1 = 9.61, S2 = 10.4, μ1 = 42.03.5, μ2 = 47.7), the minimum required sample size was 48 per group. To allow for a 5% dropout rate, 50 students were ultimately placed in each group.
A double-blind design was used to reduce bias. The data collector was blinded to group allocations, and the statistician analyzing the data received anonymized variables coded as x1 and x2.
Tools of Data Collection:
- Demographic Questionnaire:
Collected data on age, gender, marital status, and educational level.
- Spielberger State-Trait Anxiety Inventory (STAI):
A validated 40-item tool assessing state and trait anxiety using a 4-point Likert scale. Higher scores indicated greater anxiety. The STAI has demonstrated strong psychometric properties, with a Cronbach's alpha of 0.96.
Intervention:
Experimental Group:Students participated in a 20-minute unstructured Mandala coloring session in a quiet room, one hour before the OSCE. Each student was provided with a Mandala outline and six colored pencils. The session aimed to foster mindfulness and reduce pre-exam anxiety.
Control Group:Students followed the standard university OSCE preparation routine without any additional intervention.
Implementation Phase:
The trial was conducted within the Nursing Department of Near East University. All students were briefed about the procedures and gave written informed consent. Mandala sessions were conducted in a distraction-free environment, and all participants completed STAI questionnaires before and after the intervention period.
Ethical Considerations: The study was approved by the Near East University Ethics Review Board (Approval No. NUE/2024/124-1854) and registered on ClinicalTrials.gov (NCT06571357). Ethical standards followed the Declaration of Helsinki (1964). All participants were informed of their right to withdraw at any time. Confidentiality and data protection were strictly maintained.
Statistical Analysis: All statistical analyses were conducted using SPSS version 25. The Kolmogorov-Smirnov test was used to assess normality. Data were analyzed using: Descriptive statistics (mean, SD, frequencies) Paired t-test (within-group pre-post comparison) Independent t-test (between-group comparison) Chi-square test (for categorical variables) A P-value < 0.05 was considered statistically significant.
Study design
- Primary purpose
- Supportive care
- Allocation
- Randomised
- Intervention model
- Parallel groups
- Masking
- Double blind (investigator, outcomes assessor)
- Number of arms
- 2
- Model description
- Participants in this clinical trial were randomly assigned to one of two groups: an experimental group that participated in Mandala Art Therapy (coloring a Mandala design for 20 minutes prior to the OSCE), and a control group that received standard academic preparation without any additional intervention. Both groups were observed in parallel throughout the study period to assess changes in exam anxiety levels.
| Arm | Type | Receives |
|---|---|---|
| Mandala Art Therapy | Experimental | Behavioral: Mandala ColoringBehavioral: Mandala Coloring Participants in this group receive the Mandala Art Therapy intervention, which involves a 20-minute session of free-form Mandala coloring conducted one hour prior to their Objective Structured Clinical Examination (OSCE). The intervention is designed to reduce exam-related anxiety by promoting mindfulness, visual focus, and emotional self-regulation through creative expression. |
| Routine Academic Preparation | No intervention | –Participants in this group continue with their usual academic preparation and receive no additional interventions. |
Who may qualify
- Sex
- All
- Healthy volunteers
- Accepted
- Age groups
- Child, Adult, Older adult
Key inclusion criteria (3 listed)
- All students, both female and male, first semester of bachelor's degree, studying in nursing department of Near East University.
- Not using other stress reduction methods including progressive muscle relaxation, drug therapy, etc. to control exam anxiety.
- Those willing to participate in the project.
Key exclusion criteria (3 listed)
- Unwilling to continue cooperation in the project,
- Using any psycho medicines (anti-depressants ...), mental health
- Mourning, especially the death of loved ones or relatives in the 1st phase.
Eligibility is decided by the study team after screening; this overview does not establish that a patient qualifies. Full inclusion and exclusion criteria.
Interventions
| Intervention | Type | Arms |
|---|---|---|
| Mandala ColoringParticipants in this group receive the Mandala Art Therapy intervention, a creative, mindfulness-based activity rooted in complementary and alternative medicine. The intervention is designed to reduce exam-related anxiety by fostering visual focus, emotional calm, and self-expression. The Mandala protocol includes the following components: * Distribution of printed Mandala outlines on A4 paper * Provision of six colored pencils (red, orange, yellow, green, blue, and purple) * A 20-minute individual coloring session in a quiet and relaxed setting * No prescribed patterns-participants color freely to encourage self-directed engagement The Mandala coloring session is conducted exactly one hour before the Objective Structured Clinical Examination (OSCE). The activity is supervised by the researcher to ensure a supportive and distraction-free environment. Participants are encouraged to concentrate on the process of coloring to promote psychological grounding and reduce pre-exam stress. | Behavioural | Mandala Art Therapy |
Primary outcome
Practical Exam Anxiety Levels
Time frame: Anxiety levels are measured at two time points-immediately before and immediately after the intervention session, conducted one hour prior to the OSCE
The primary outcome measure assesses changes in anxiety levels related to the Objective Structured Clinical Examination (OSCE) among undergraduate nursing students. Anxiety is measured using the State-Trait Anxiety Inventory (STAI), a validated psychological instrument that evaluates both situational (state) and general (trait) anxiety. The STAI comprises two subscales with 20 items each, rated on a 4-point Likert scale. Higher total scores indicate greater levels of anxiety.
Results and safety
The study is completed, but results are not available in the source record. That does not mean the treatment did or did not work.
Research links
- Official record on ClinicalTrials.govLast updated by the sponsor 11 Aug 2025.
- Individual participant dataSharing planned: No. There is no plan to make IPD available to other researchers
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Referral and contact
AzTrials does not enrol participants or take referrals. Contact the study team or a site listed below; they decide who can take part. This study is not recruiting at the moment.
Pouran Varvani Farahani, PhD principal investigator
Department of Nursing, Faculty of Health Science, Cyprus International University
1 site in 1 country: see every site and its status.
Questions about this trial
What is this clinical trial studying?
A study testing Mandala Coloring in people with Exam Anxiety, run by Near East University, Turkey at 1 site in Cyprus.
The full registered description is in the About this study section and the official record.
Who may be eligible to take part?
The sponsor lists 3 inclusion and 3 exclusion criteria. Eligibility is decided by the study team after screening, so read the full criteria and contact a listed site.
Is this clinical trial currently recruiting?
The record says: finished, as of the sponsor's last update on 11 Aug 2025. Status can change between updates, so confirm with the study contact before making plans.
Where is the study taking place?
The record lists 1 site in Cyprus. Whether a site is taking part right now should be confirmed with that site. See every site.
What are the possible benefits and risks?
They depend on the study and the treatment, and no study can promise a benefit. The study team explains the known risks during informed consent, before anyone joins; the record itself does not list them.
Are results available for this study?
The study is completed, but results are not available in the source record. That does not mean the treatment did or did not work.
How can a doctor refer a patient or contact the research team?
The record lists no contact. The official record names the sponsor, who can be asked directly. AzTrials does not enrol participants or take referrals.
What does the primary outcome measure?
Practical Exam Anxiety Levels (time frame: Anxiety levels are measured at two time points-immediately before and immediately after the intervention session, conducted one hour prior to the OSCE). It is what the study was designed to measure, not a finding.
Where can I read the original study information?
Does a listing mean the treatment is approved or proven to work?
No. A listing means the study is registered. It does not show that the treatment is safe, works, or is approved by a regulator.
How often is this information updated?
AzTrials copies changed records from ClinicalTrials.gov every night and reloads the whole registry every week. The sponsor last updated this record on 11 Aug 2025.