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

NCT07470632 | Completed DMC

• 1 other identifier: PVF2026Mandalamed
• Study Type: interventional
• Target: 100
• Locations: 1 country
• Sites: 1

Brief 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. 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.

Conditions

Exam Anxiety

Keywords

Complementary Therapies; Meditation; Art Therapy; Students, Nursing

Outcome Measures

Primary Outcomes (2)

• 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.

  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.

  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.

Study Arms (2)

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.

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.

Behavioral: Twin Heart Meditation; Behavioral: Mandala Coloring

Interventions

Twin Heart Meditation BEHAVIORAL

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 Coloring; Twin Hearts Meditation

Mandala Coloring BEHAVIORAL

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

Mandala Coloring; Twin Hearts Meditation

Eligibility Criteria

• Sex: all
• Healthy Volunteers: Yes
• Age Groups: Child (0-17), Adult (18-64), Older Adult (65+)

You may qualify if:

• 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.

You may not qualify if:

• 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.

Sponsors & Collaborators

• Near East University, Turkey: lead

Study Sites (1)

KKTC (Turkish Republic Of Northern Cyprus)

Nicosia, North Cyprus, Cyprus

Location

Study Officials

• Pouran Varvani Farahani, PhD

  PhD in Pediatric Nursing, Department of Nursing, Faculty of Health Science, Cyprus International University

  PRINCIPAL INVESTIGATOR

Study Design

• Study Type: interventional
• Phase: not applicable
• Allocation: RANDOMIZED
• Masking: DOUBLE
• Who Masked: INVESTIGATOR, OUTCOMES ASSESSOR
• Masking Details: To reduce bias, the investigator responsible for data collection and the statistician analyzing the data were blinded to group assignments. The intervention groups were coded as anonymous variables during data analysis.
• Purpose: SUPPORTIVE CARE
• Intervention Model: PARALLEL
• Sponsor Type: OTHER
• Responsible Party: PRINCIPAL INVESTIGATOR
• PI Title: PhD in Pediatric Nursing, Department of Nursing, Faculty of Health Science, Cyprus International University,

Model Details: 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.

Study Record Dates

• First Submitted: March 10, 2026
• First Posted: March 13, 2026
• Study Start: January 5, 2025
• Primary Completion: January 20, 2025
• Study Completion: January 20, 2025
• Last Updated: March 13, 2026

Record last verified: 2026-03

Data Sharing

• IPD Sharing: Will not share

Locations

CY (1)