Completed

NCT Number: NCT07470632

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

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.

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Key information

Conditions

Exam Anxiety

Sex eligibility

All sexes

Study type

Interventional

Phase

Not applicable

Primary location

KKTC (Turkish Republic Of Northern Cyprus)

Nicosia, North Cyprus, Cyprus

About this study

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.

Who can participate

Healthy volunteers accepted: Yes

Only the study team can determine whether someone qualifies for participation.

Inclusion criteria

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.

Exclusion criteria

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.

Treatment and study plan

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

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

Primary outcomes

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.

Sponsors and collaborators

Lead sponsor

Near East University, Turkey

Other

Registry information

Official study title

Comparison of Mandala Coloring and Twin Hearts Meditation on Practical Exam Anxiety: A Randomized Clinical Trial

Acronym: Mandala

Important dates

Study start: 2025
Primary completion: 2025
Study completion: 2025
First posted: Mar 13, 2026
Registry last updated: Mar 13, 2026

OpenTrials presents study information sourced from ClinicalTrials.gov. The official registry record should be consulted for the latest information.

View the official ClinicalTrials.gov record (opens in a new tab)

This listing is for discovery and informational purposes only. It is not medical advice, does not guarantee that a study is recruiting, and does not determine eligibility. Contact the study team and a qualified healthcare professional when considering participation.

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Completed