Exam AnxietyMandalaNCT07470632
Effect of Twin Hearts Meditation and Mandala Coloring on Exam Anxiety in Nursing Students
A study testing Twin Heart Meditation and 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 compare the effectiveness of Mandala coloring and Twin Hearts Meditation in reducing exam anxiety among undergraduate nursing students. Participants were randomly assigned to either the Mandala coloring group or the Twin Hearts Meditation group. 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?
- Twin Heart Meditation and 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
- 5 Jan 2025to 20 Jan 2025
- 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 undergraduate nursing students in their first semester, male or female, enrolled in the English-language nursing program.
- Students not using other stress-reduction methods (e.g., progressive muscle relaxation, pharmacological therapy).
- Students who voluntarily agreed to participate and provided informed consent.
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.
About this study
Official title: Comparison of Mandala Coloring and Twin Hearts Meditation on Practical Exam Anxiety: A Randomized Clinical Trial
This randomized clinical trial aimed to compare the effectiveness of Mandala coloring and Twin Hearts Meditation in reducing exam anxiety among undergraduate nursing students. Participants were randomly assigned to either the Mandala coloring group or the Twin Hearts Meditation group. Both interventions were administered before a practical examination. Anxiety levels were measured before and after the intervention using the State-Trait Anxiety Inventory (STAI). The study evaluated which complementary and non-pharmacological intervention was more effective in reducing exam-related anxiety among nursing students.
Read the detailed description
Study Purpose
The purpose of this study was to compare the effectiveness of Mandala coloring and Twin Hearts Meditation as complementary and non-pharmacological interventions for reducing exam anxiety among undergraduate nursing students.
Study Design
This study was designed as a randomized clinical trial conducted among undergraduate nursing students. Participants were randomly assigned to two intervention groups: Mandala coloring and Twin Hearts Meditation.
Sample Size
Out of 110 eligible nursing students, 100 who met the inclusion criteria were recruited. Based on previous research and a mean comparison formula with a significance level of 0.05 and a statistical power of 80%, the required sample size was calculated as 48 participants per group. Considering possible dropout, 50 participants were included in each group.
Data Collection Tools
Data were collected using:
- A demographic questionnaire (age, gender, marital status, academic information)
- The State-Trait Anxiety Inventory (STAI), a validated 40-item self-report instrument measuring state and trait anxiety.
Intervention
Participants were randomly assigned to one of two groups:
Twin Hearts Meditation Group:
Participants received a guided Twin Hearts Meditation session lasting 30 minutes under the supervision of the researcher.
Mandala Coloring Group:
Participants engaged in mandala coloring for 30 minutes using printed mandala designs and colored pencils under the supervision of the researcher.
Both interventions were conducted before a practical examination.
Outcome Assessment
Anxiety levels were measured before and after the intervention using the State-Trait Anxiety Inventory (STAI).
Ethical Considerations
The research received approval from the Cyprus International University Ethics Review Board (Approval No: EKK23-24/012/07). The study followed the ethical standards of the Council of Ethics and adhered to the principles of the Declaration of Helsinki (1964).
Statistical Analysis
Data were analyzed using SPSS software. Descriptive statistics, paired t-tests, independent t-tests, and chi-square tests were used. A P value < 0.05 was considered statistically significant.
- Conditions
- Exam Anxiety
- Being tested
- Twin Heart Meditation, Mandala Coloring
- Keywords
- Complementary Therapies, Meditation, Art Therapy, Students, Nursing
What participants receive
What participants receive. In a randomised study each person is assigned to one group by chance.
Twin Heart MeditationBehavioural
Participants in this group receive Twin Hearts Meditation, a guided meditation technique based on the principles of loving-kindness and spiritual energy. The intervention aims to reduce exam-related anxiety by promoting emotional balance and relaxation.
Intervention:
Behavioral: Twin Hearts Meditation
Participants practice guided meditation sessions lasting 30 minutes under the supervision of the researcher. The meditation protocol includes:
Physical warm-up exercises
Activation of the heart chakra
Activation of the crown chakra
Blessing the Earth with loving-kindness
Silent meditation using the phrase "Amen"
Expression of gratitude
Closing exercises
Sessions are conducted in a quiet room using audio guidance.
Mandala ColoringBehavioural
Participants were provided with a printed mandala outline on A4 paper and six colored pencils (red, orange, yellow, green, blue, purple). They engaged in free, unstructured mandala coloring for 30 minutes
| Study group | Role | What they receive |
|---|---|---|
| Twin Hearts Meditation | Experimental | Behavioral: Twin Heart Meditation Participants in this group receive the Twin Heart Meditation intervention, a guided meditative technique based on the principles of loving-kindness and spiritual energy. The intervention is designed to reduce exam-related anxiety by promoting inner peace and emotional regulation. Receives: Behavioral: Twin Heart Meditation; Behavioral: Mandala Coloring |
| Mandala Coloring | Experimental | Participants in this group engage in mandala coloring, an art-based mindfulness activity designed to reduce exam anxiety and promote relaxation. Receives: Behavioral: Twin Heart Meditation; Behavioral: Mandala Coloring |
What is being measured
The primary outcome is the main question the study is designed to answer.
Exam Anxiety Levels
The primary outcome measure evaluates changes in exam-related anxiety levels among nursing students following the Mandala coloring and Twin Hearts Meditation interventions. Anxiety is measured using the State-Trait Anxiety Inventory (STAI), a validated psychological instrument that assesses both state and trait anxiety. The STAI consists of two subscales with 20 items each, scored on a 4-point Likert scale. Higher scores indicate greater levels of anxiety.
Both groups completed the State-Trait Anxiety Inventory (STAI) two hours before the Objective Structured Clinical Examination (OSCE), immediately prior to the intervention, and again immediately after the intervention.
Measured: Anxiety levels are assessed at two time points: before the intervention (two hours prior to the OSCE) and immediately after the intervention prior to the examination.
Test Anxiety Levels
The primary outcome measure evaluates changes in exam-related anxiety levels among nursing students following the Mandala coloring and Twin Hearts Meditation interventions. Anxiety is measured using the State-Trait Anxiety Inventory (STAI), a validated psychological instrument that assesses both state and trait anxiety. The STAI consists of two subscales with 20 items each, scored on a 4-point Likert scale. Higher scores indicate greater levels of anxiety.
Both groups completed the State-Trait Anxiety Inventory (STAI) two hours before the Objective Structured Clinical Examination (OSCE), immediately prior to the intervention, and again immediately after the intervention.
Measured: Anxiety levels are assessed at two time points: before the intervention (two hours prior to the OSCE) and immediately after the intervention prior to the examination.
Timeline
From the start of the study to its completion; the mark is today. Estimated dates are the sponsor’s plan.
- First posted13 Mar 2026
- Study start5 Jan 2025
- Primary completion20 Jan 2025
- Study completion20 Jan 2025
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 were randomly assigned to two intervention groups: Mandala Coloring and Twin Hearts Meditation. Both interventions were administered before the practical examination. Anxiety levels were measured before and after the intervention using the State-Trait Anxiety Inventory (STAI) to evaluate the effectiveness of each intervention in reducing exam anxiety among nursing students.
- 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, Cyprus International University
- Investigators
- Pouran Varvani Farahani, PhD, Principal investigator, PhD in Pediatric Nursing, Department of Nursing, Faculty of Health Science, Cyprus International University
IDs, dates and publications
- ClinicalTrials.gov ID
- NCT07470632
- Sponsor's protocol ID
- PVF2026Mandalamed
- Acronym
- Mandala
- Status last verified
- Mar 2026
- First submitted
- 10 Mar 2026
- Last updated
- 13 Mar 2026
- 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 13 Mar 2026. Recruitment status is as the sponsor reported it: confirm with the study team.
- Official title
- Comparison of Mandala Coloring and Twin Hearts Meditation on Practical Exam Anxiety: A Randomized Clinical Trial
- ClinicalTrials.gov ID
- NCT07470632
- Acronym / sponsor ID
- Mandala / PVF2026Mandalamed
- Conditions
- Exam Anxiety
- Keywords
- Complementary Therapies, Meditation, Art Therapy, Students, Nursing
- Study type
- Interventional
- Recruitment status
- Completed
- Enrolment
- 100 participants (actual)
- Lead sponsor
- Near East University, TurkeyUniversity, hospital or other
- Study start
- 5 Jan 2025 (actual)
- Primary completion
- 20 Jan 2025 (actual)
- Study completion
- 20 Jan 2025 (actual)
- First posted
- 13 Mar 2026 (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 compare the effectiveness of Mandala coloring and Twin Hearts Meditation in reducing exam anxiety among undergraduate nursing students. Participants were randomly assigned to either the Mandala coloring group or the Twin Hearts Meditation group. Both interventions were administered before a practical examination. Anxiety levels were measured before and after the intervention using the State-Trait Anxiety Inventory (STAI). The study evaluated which complementary and non-pharmacological intervention was more effective in reducing exam-related anxiety among nursing students.
Detailed description
Study Purpose
The purpose of this study was to compare the effectiveness of Mandala coloring and Twin Hearts Meditation as complementary and non-pharmacological interventions for reducing exam anxiety among undergraduate nursing students.
Study Design
This study was designed as a randomized clinical trial conducted among undergraduate nursing students. Participants were randomly assigned to two intervention groups: Mandala coloring and Twin Hearts Meditation.
Sample Size
Out of 110 eligible nursing students, 100 who met the inclusion criteria were recruited. Based on previous research and a mean comparison formula with a significance level of 0.05 and a statistical power of 80%, the required sample size was calculated as 48 participants per group. Considering possible dropout, 50 participants were included in each group.
Data Collection Tools
Data were collected using:
- A demographic questionnaire (age, gender, marital status, academic information)
- The State-Trait Anxiety Inventory (STAI), a validated 40-item self-report instrument measuring state and trait anxiety.
Intervention
Participants were randomly assigned to one of two groups:
Twin Hearts Meditation Group:
Participants received a guided Twin Hearts Meditation session lasting 30 minutes under the supervision of the researcher.
Mandala Coloring Group:
Participants engaged in mandala coloring for 30 minutes using printed mandala designs and colored pencils under the supervision of the researcher.
Both interventions were conducted before a practical examination.
Outcome Assessment
Anxiety levels were measured before and after the intervention using the State-Trait Anxiety Inventory (STAI).
Ethical Considerations
The research received approval from the Cyprus International University Ethics Review Board (Approval No: EKK23-24/012/07). The study followed the ethical standards of the Council of Ethics and adhered to the principles of the Declaration of Helsinki (1964).
Statistical Analysis
Data were analyzed using SPSS software. Descriptive statistics, paired t-tests, independent t-tests, and chi-square tests were used. 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 were randomly assigned to two intervention groups: Mandala Coloring and Twin Hearts Meditation. Both interventions were administered before the practical examination. Anxiety levels were measured before and after the intervention using the State-Trait Anxiety Inventory (STAI) to evaluate the effectiveness of each intervention in reducing exam anxiety among nursing students.
| Arm | Type | Receives |
|---|---|---|
| Twin Hearts Meditation | Experimental | Behavioral: Twin Heart Meditation, Behavioral: Mandala ColoringBehavioral: Twin Heart Meditation Participants in this group receive the Twin Heart Meditation intervention, a guided meditative technique based on the principles of loving-kindness and spiritual energy. The intervention is designed to reduce exam-related anxiety by promoting inner peace and emotional regulation. |
| Mandala Coloring | Experimental | Behavioral: Twin Heart Meditation, Behavioral: Mandala ColoringParticipants in this group engage in mandala coloring, an art-based mindfulness activity designed to reduce exam anxiety and promote relaxation. |
Who may qualify
- Sex
- All
- Healthy volunteers
- Accepted
- Age groups
- Child, Adult, Older adult
Key inclusion criteria (3 listed)
- All undergraduate nursing students in their first semester, male or female, enrolled in the English-language nursing program.
- Students not using other stress-reduction methods (e.g., progressive muscle relaxation, pharmacological therapy).
- Students who voluntarily agreed to participate and provided informed consent.
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 |
|---|---|---|
| Twin Heart MeditationParticipants in this group receive Twin Hearts Meditation, a guided meditation technique based on the principles of loving-kindness and spiritual energy. The intervention aims to reduce exam-related anxiety by promoting emotional balance and relaxation. Intervention: Behavioral: Twin Hearts Meditation Participants practice guided meditation sessions lasting 30 minutes under the supervision of the researcher. The meditation protocol includes: Physical warm-up exercises Activation of the heart chakra Activation of the crown chakra Blessing the Earth with loving-kindness Silent meditation using the phrase "Amen" Expression of gratitude Closing exercises Sessions are conducted in a quiet room using audio guidance. | Behavioural | Mandala Coloring, Twin Hearts Meditation |
| Mandala ColoringParticipants were provided with a printed mandala outline on A4 paper and six colored pencils (red, orange, yellow, green, blue, purple). They engaged in free, unstructured mandala coloring for 30 minutes | Behavioural | Mandala Coloring, Twin Hearts Meditation |
Primary outcome
Exam Anxiety Levels
Time frame: Anxiety levels are assessed at two time points: before the intervention (two hours prior to the OSCE) and immediately after the intervention prior to the examination.
The primary outcome measure evaluates changes in exam-related anxiety levels among nursing students following the Mandala coloring and Twin Hearts Meditation interventions. Anxiety is measured using the State-Trait Anxiety Inventory (STAI), a validated psychological instrument that assesses both state and trait anxiety. The STAI consists of two subscales with 20 items each, scored on a 4-point Likert scale. Higher scores indicate greater levels of anxiety. Both groups completed the State-Trait Anxiety Inventory (STAI) two hours before the Objective Structured Clinical Examination (OSCE), immediately prior to the intervention, and again immediately after the intervention.
Test Anxiety Levels
Time frame: Anxiety levels are assessed at two time points: before the intervention (two hours prior to the OSCE) and immediately after the intervention prior to the examination.
The primary outcome measure evaluates changes in exam-related anxiety levels among nursing students following the Mandala coloring and Twin Hearts Meditation interventions. Anxiety is measured using the State-Trait Anxiety Inventory (STAI), a validated psychological instrument that assesses both state and trait anxiety. The STAI consists of two subscales with 20 items each, scored on a 4-point Likert scale. Higher scores indicate greater levels of anxiety. Both groups completed the State-Trait Anxiety Inventory (STAI) two hours before the Objective Structured Clinical Examination (OSCE), immediately prior to the intervention, and again immediately after the intervention.
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 13 Mar 2026.
- 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
PhD in Pediatric Nursing, 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 Twin Heart Meditation and 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 13 Mar 2026. 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?
Exam Anxiety Levels (time frame: Anxiety levels are assessed at two time points: before the intervention (two hours prior to the OSCE) and immediately after the intervention prior to the examination.). The study lists 2 primary outcomes in all. 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 13 Mar 2026.