Enhancing mindfulness interventions for test anxiety: A perspective based on the NIH stage model
2023, 31 (12):
Test anxiety directly impacts academic performance and can have extreme consequences, including school dropout, self-injury, and even suicide. Nevertheless, most current interventions for text anxiety focus on its individual components, which complicates achieving satisfactory results. Mindfulness, a method of consciousness training in Buddhist meditation, has been scientifically examined since being extracted from the Buddhist system and secularized. It has two core characteristics: (1) attention to and awareness of one’s inner experience of the present moment and (2) an open, accepting attitude toward one’s inner experience. In recent years, the academic community has applied mindfulness in interventions for test anxiety, which are collectively referred to as “Mindfulness Interventions for Test Anxiety” (MI-TA).
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The NIH stage model, originally proposed to promote the implementation and dissemination of psychological interventions, divides the development of interventions into six stages: basic research, intervention generation and refinement, efficacy testing, mixed efficacy-effectiveness testing, effectiveness testing, and implementation and dissemination. A closed-loop connection is formed between the stages, meaning that the development of any intervention following the model is an iterative, recursive process. Inspired by the model, we distinguished five attributes of intervention research: mechanism exploration, intervention model design, efficacy testing, effectiveness testing, and implementation and dissemination. By extension, we outlined three research orientations from past studies on MI-TA: initially testing efficacy, refining and optimizing the model, and promoting implementation and dissemination. The current status of each approach is presented and discussed in our review.
First, using target analysis, we conceptualized the mechanisms by which mindfulness training affects test anxiety. For one, mindfulness training emphasizes the awareness and acceptance of bodily sensations, which helps to relax physiological indicators and tensions induced by test anxiety and promotes emotional regulation. For another, mindfulness training emphasizes the awareness and acceptance of thoughts and emotions, which helps both to reduce worrying thoughts and cognitive interference caused by test anxiety and to sustain cognitive efficacy. Last, mindfulness training can promote de-reification and self-compassion, which can help to resist the self-depreciation caused by test anxiety and safeguard self-worth.
Second, by comparing the practical components and effects of single-session, short-duration mindfulness exercises with those of MI-TA of Mindfulness-Based Stress Reduction (MBSR) and Mindfulness-based Cognitive Therapy (MBCT), we found that such exercises mostly included only focused attention (FA) meditation and lacked open monitoring (OM) meditation. Whereas FA mainly acted on the physiological indications and tension-related components of test anxiety, OM acted on the components of worrying and cognitive interference. FA and OM are different components of complete mindfulness practice and cannot be biased or replaced by each other.
Regarding the core principles of MBSR, the requirements of teaching methods, and teaching objectives, we analyzed two optimized MI-TA models that integrate Dialectical Behavior Therapy (DBT) mindfulness skills and integrated self-leadership strategies. As a result, we found that both could be improved in by adhering core teaching intentions, valuing the practical experience, organically integrating the components of the intervention for test anxiety, and improving the ease of implementation. Future interventions should be designed to capture the pedagogical intention of mindfulness interventions, integrate components specific to test anxiety, and weigh the curricular structure for specific contexts of implementation.
Next, based on a review of two types of studies that promote the implementation and dissemination of MI-TA by approaching real-world target groups relying on multimedia and digital self-help interventions, we propose that future real-world-based interventions should take into account the external environment (e.g., regional economic, social, and cultural factors), the internal environment (e.g., schools’ organizational characteristics, cultural climate, and communication characteristics), stakeholders (e.g., intervention providers, school administrators, parents, and students), and the implementation process, including planning, participation, implementation, evaluation, and reflection. Likewise, studies on such interventions should vigorously adhere to the framework of implementation science.
Last, we propose three research perspectives in light of the original intention of the NIH stage model and the specificity of mindfulness interventions: (1) focusing on continuously testing and clarifying the efficacy mechanisms of MI-TA at each stage by following the basic guidelines for identifying efficacy mechanisms; (2) taking special consideration of the study design, intervention model, control measures, and selection and measurement of outcome indicators by using the PRagmatic Explanatory Continuum Indicator Summary(PRECIS) -2 tool; and (3) enhancing the accuracy and adequacy of the interpretation of effects in research on MI-TA by being sensitive to the basic tenets of mindfulness interventions (e.g., including open monitoring, collecting data on intervention adherence, emphasizing the learning of attitudes of mindfulness, and considering the influence of different understanding of self between Eastern and Western cultures).