Effect of Twin Hearts Meditation and Mandala Coloring on Exam Anxiety in Nursing Students

Near East University, Turkey

Status: Completed

Conditions: Exam Anxiety

Treatments: Behavioral: Mandala Coloring; Behavioral: Twin Heart Meditation

Study type: Interventional

Funder types: Other

Identifiers

NCT07470632

PVF2026Mandalamed

Details and patient eligibility

About

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.

Full 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.

Enrollment: 100 patients

Sex: All

Volunteers: Accepts Healthy Volunteers

Inclusion criteria

1. All undergraduate nursing students in their first semester, male or female, enrolled in the English-language nursing program.
2. Students not using other stress-reduction methods (e.g., progressive muscle relaxation, pharmacological therapy).
3. Students who voluntarily agreed to participate and provided informed consent.

Exclusion criteria

1. Unwilling to continue cooperation in the project.
2. Using any psycho medicines (anti-depressants ...), mental health.
3. Mourning, especially the death of loved ones or relatives in the 1st phase.

Trial design

Primary purpose: Supportive Care

Allocation: Randomized

Interventional model: Parallel Assignment

Masking: Double Blind

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100 participants in 2 patient groups

Twin Hearts Meditation

Experimental group

Description:

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.

Treatment:

Behavioral: Twin Heart Meditation

Behavioral: Mandala Coloring

Mandala Coloring

Experimental group

Description:

Participants in this group engage in mandala coloring, an art-based mindfulness activity designed to reduce exam anxiety and promote relaxation.

Treatment:

Behavioral: Twin Heart Meditation

Behavioral: Mandala Coloring