Effect of Self-Hypnosis on Test Anxiety among Secondary School Students in Malaysia

ABSTRACT

Test anxiety comprises cognitive, physiological, and behavioral reactions due to anxiety about failure or a lower academic performance score on an exam or evaluation. This study examined the effect of self-hypnosis on reducing test anxiety among upper secondary school students using a quantitative methodology with a pre-experimental design. The prevalence of test anxiety was measured using the Friedben Test Anxiety Scale (FTAS) and students’ demographic data were collected. Twenty-two 16-year-old students with moderate to high test anxiety were selected for a self-hypnosis intervention over a period of 5 weeks. The FTAS questionnaire was administered 4 times: at baseline, 3rd week, 5th week, and at follow-up (3 weeks after the intervention). Students’ test anxiety differences were statistically significant across 4 time points. Self-hypnosis intervention decreased students’ overall test anxiety scores and in the 3 constructs: social, cognitive, and tenseness. The outcomes indicate that self-hypnosis training can help students cope with test anxiety and should be further explored for managing test anxiety in school settings.

KEYWORDS:

• Effectiveness
• hypnosis
• self-hypnosis
• test anxiety

Introduction

Test/examination anxiety and stress are distinct from generalized anxiety manifestations because they focus on the evaluative environment (Zeidner, 1998). In his essay on test anxiety, Putwain noted two trends that emerged from earlier research. First, test anxiety arises only in the context of performance assessments, and second, it includes a social component of how performance is evaluated by others (Putwain, 2008). In addition, test anxiety is associated with changes in physiological, emotional, and cognitive reactions to an examination or assessment, with symptoms including rapid heart rate and worry about performing poorly that occur before, during, or after an assessed performance (Howard, 2020). It has been acknowledged that test anxiety is generally a problem that affects students adversely and should be treated (Ergene, 2003; Hembree, 1988; Jerrim, 2022). Previous literature reviews and meta-analyses have demonstrated that high test anxiety negatively affects students’ academic performance and general well-being (Huntley et al., 2019; Soares & Woods, 2020; Von der Embse et al., 2018).

Regarding the prevalence of test anxiety, it has been estimated that 12 to 18% of students have high prevalence rates (Howard, 2020). Additionally, a recent study of 2,158 Indian schoolchildren revealed that approximately 66% of the children (aged 9 to 18 years) had moderate to high test anxiety and approximately 18% had high test anxiety (Lohiya et al., 2021). Test anxiety interventions for students in schools remain scarce because past research has concentrated more on college students (Ergene, 2003; Soares & Woods, 2020).

However, studies have shown that hypnosis may be beneficial in assisting university and school students struggling with test anxiety (Baker et al., 2009; Dogan et al., 2018; Hammer et al., 2020; Mathur & Khan, 2011; Pourhamidi et al., 2019; Valentine et al., 2019). In addition, evidence has suggested that hypnotic techniques, also known as relaxation-mental imagery, are employed to treat typical challenges in school-age children (Perfect et al., 2013). The current definition of hypnosis is “a state of consciousness involving focused attention and reduced peripheral awareness characterized by an enhanced capacity for response to suggestions” (Elkins et al., 2015, p. 6), and is consistent with these previous hypnosis interventions reported in studies.

Several theories of test anxiety have emerged with complex constructs (Friedman & Bendas-Jacob, 1997; Roos et al., 2021; Von der Embse et al., 2018; Zeidner, 1998). However, both historical and current research shows that evaluative settings are primarily responsible for students’ physiological and cognitive elements of test anxiety (Roos et al., 2021; Thomas et al., 2018). Simultaneously, Huntley et al. (2019) found two components in the meta-analysis review: an emotional dimension called “emotionality,” characterized as bodily arousal (such as muscle tension, sweating, and heart rate accelerations) in test situations; and a cognitive dimension referred to as “worry,” consisting of persistent thoughts about the implications of failure and test-irrelevant thinking (Huntley et al., 2019). Lowe et al. (2008) articulated a biopsychosocial model of test anxiety. According to this model, test anxiety incorporates a social component connected to a person’s concerns about how parents, teachers, and peers judge and evaluate their academic performance.

The current study focused on using hypnosis, specifically self-hypnosis, to help students reduce and manage test anxiety. Self-hypnosis may be beneficial because the hypnotherapist’s suggestions concerning feelings, thoughts, and images may have an impact on a person’s physiological characteristics and establish a mind-body connection that aids in the treatment process (Lynn et al., 2019). The present study investigated the potential effects of self-hypnosis in alleviating test anxiety among form four secondary school students in Malaysia, as this intervention has not yet been researched in Malaysian schools.

Method

This study was conducted in a secondary school in Klang, Malaysia, and employed the quantitative approach involving a one-group pre- and posttest experimental design, whereby, upon administering the pretest questionnaire (FTAS), intervention (self-hypnosis) was conducted for 5 weeks, and a posttest was given to measure the dependent variable (FTAS).

Students for this study were recruited from a previous investigation on the prevalence of test anxiety among form four students (age: 16 years) involving 371 students (Pachaiappan et al., 2023). Nearly 56% of the participants were female. There were 43.2% Chinese, Malay 41.2% Malay, 13.7% Indian, and 1.9% of other ethnic categories. The results indicate that most of the students rate themselves with a low level of test anxiety, 45.8% (n = 170). However, close to 20% (n = 73) have a high level of test anxiety, while 34.5% (n = 128) rate themselves with a medium level. It was also found that students’ test anxiety level is significantly associated with students’ ethnicity, χ2 (2, N = 364) = 31.741, p < .001, whereby Malay students experience a high level of test anxiety compared to Chinese and Indian students.

Due to COVID-19, attendance was poor; each class typically had 10 or fewer students. Hence, researchers approached those with medium-to-high test anxiety. A total of 52 students with medium-to-high test anxiety were contacted; however, only 41 participated in the first session. The response rate was 78.8%, and the reasons for drop-out were “not interested,” and two students said due to “religious reasons.” Attendance was also low in the subsequent sessions because of the rise in COVID cases and year-end examinations. Finally, only 22 students participated in the self-hypnosis session, and the rest withdrew for reasons such as the rise in COVID cases (8), wanting to study for the exam at home (7), not being interested (2), and laziness in attending school (2). The response rate decreased from 78.8% to 42.3% in large part because of the COVID-19 situation as well as students wanting to prepare for their year-end examination.

Measures

Friedben Test Anxiety Scale (FTAS)

The FTAS comprises three subscales: social derogation (Items 1 to 8), cognitive obstruction (Items 9 to 17), and tenseness or physiological elements (Items 18 to 23). The students responded to each item on a four-point Likert scale ranging from strongly agree (SA) to agree (A), disagree (D), and strongly disagree (SD). The scores on the FTAS four-point Likert questionnaire were as follows: SA = 3, A = 2, D = 1, and SD = 0. Items with asterisks are reverse-scored as follows: SA = 0, A = 1, D = 2, and SD = 3. The scores for all 23 items were summed. A high total score indicated low test anxiety, whereas a low total score indicated high test anxiety.

Academics and school psychotherapists have demonstrated the FTAS as a reliable, valid, and efficient instrument (Thomas et al., 2018). In addition, the researchers in this study conducted a pilot study to verify that the FTAS instruments were translated into Malay. The questionnaires were given to an English-language and Bahasa Melayu expert to check the suitability of words to match the Malaysian context. The Malay version of the FTAS questionnaire was forward and backward translated from English to Malay. In addition, school counselors checked the questionnaires to determine the suitability of the words used in the Malaysian context. Fifty-four students from a secondary school in Klang participated in this pilot study, comprising 10% of the sample population of 500 students. A total of 43 questionnaires were collected, out of which five were excluded from the FTAS questionnaire due to missing data. The reliability analysis of the FTAS showed a Cronbach Alpha of .87.

For the FTAS scores, Putwain and Daly (2014) highlighted that test anxiety levels can be categorized as low, medium, or high based on students’ experiences rather than how well they score in contrast to other students. Hence, in this study, the 33.3 and 66.6% terciles of the scale anchors were selected as a priori boundaries for low, medium, and severe test anxiety, respectively.

Self-Hypnosis Intervention

The sessions for hypnosis and self-hypnosis took place once a week from January 21, 2022, to February 17, 2022. The hypnosis script was constructed by the first author with the support and guidance of the third author. The hypnosis script was adapted from Grade Power: The Complete Guide to Improving Grades Through Self-hypnosis (Alderson, 2004), Hartlands Medical and Dental Hypnosis (Heap, 2002), Exploring the Experiences of Participants Involved in a Hypnosis Intervention for Test-Anxious School Students (Patterson, 2014). Hypnosis was conducted from the second session until the last session, and self-hypnosis was taught from the third session onward. Students were guided on self-hypnosis, and an audio recording of the hypnosis conducted was given to each student to listen to after every session. In addition, the hypnosis script for each session was given to the students. The therapeutic outline of the hypnosis and self-hypnosis interventions is presented in Table 1.

Table 1. Therapeutic Outline of Hypnosis and Self-Hypnosis

Sessions/ Date	Descriptions of each session
Session 1	The researcher built a rapport with students Aim of rapport building: to instill trust and confidence Introduce hypnosis and clear the misconceptions Give examples of daily hypnosis experiences
Session 2	First hypnosis session Aim of induction: To induce hypnotic state Eye roll induction Ego strengthening Posthypnotic suggestions Homework: Listening to hypnosis audio
Session 3	Second hypnosis session Hartland’s Progressive Muscle Relaxation induction Ego strengthening Posthypnotic suggestions Homework: Listening to hypnosis audio Posttest: Fill up the FTAS
Session 4	Third hypnosis session Eye roll induction and a favorite place of relaxation Ego strengthening Post-hypnotic suggestions Teaching self-hypnosis Homework: Practising Self-hypnosis Listening to hypnosis audio
Session 5	Fourth hypnosis session Eye roll induction and progressive muscle Relaxation Ego strengthening Post-hypnotic suggestions Teaching Self-Hypnosis Conclusion and wrap-up session Posttest: Fill up the FTAS Homework: Practising self-hypnosis; Listening to hypnosis audio 3 weeks Follow-up posttest questionnaire

The effect of self-hypnosis was evaluated via the FTAS (Friedman & Bendas-Jacob, 1997), which was administered four times: before the intervention (pretest: Time 1), twice (posttest) during the intervention (Times 2 and 3), and 3 weeks (poståtest follow-up) after the intervention (Time 4).

Ethical approval was obtained from the Education Department of Selangor, Ministry of Education Malaysia, and the University Malaya Research Ethics Committee (UM. TNC2/UMREC 1455). Consent was obtained from the participants and their parents prior to the study.

Data Analysis

Data were analyzed using the 28.0 version of the IBM Statistical Package for Social Sciences (IBM, SPSS, 28: Ill Chicago). The descriptive analyses were used to compute the categorical variable, and to investigate the effectiveness of the self-hypnosis intervention, a repeated-measures ANOVA (RM. An ANOVA) was conducted for changes in students’ test anxiety from Time 1 to Time 4.

Results

The demographic of the 22 students were: 18 female (81.8%) and 4 male (18.2%). The majority were Chinese, followed by Malays and Indians. It is noteworthy that, despite the majority of the Malaysians being of Malay descent, only a limited number of Malay students participated in this intervention. This could be because COVID-19 caused low attendance at the time of the survey administration, and most Malay students were not interested in engaging in self-hypnosis interventions (Table 2).

Table 2. Demographic Profile of the 22 Students

Demographic	Categorical	Frequencies	Percentage %
Gender	Female	18	81.8
	Male	4	18.2
Ethnicity	Malay	4	18.2
	Chinese	15	68.2
	Indian	3	13.6

Students’ test anxiety was significantly reduced across four time points, F(3,60) = 19.747, p < .001, ηp2 = 0.5, as measured by the FTAS. Following the overall significant effect of time, a post hoc pairwise comparison was performed using the Bonferroni test, and the results indicated that students’ test anxiety was statistically reduced between Time 1 and Time 3, M = −.38, SE = .08, p < .01; Time 1 and Time 4, M = −.56, SE = .10, p < .001; and Time 2 and Time 3, M = −.19, SE = .05, p < .01. However, there were no statistically significant results between Time 1 and Time 2, M = −.19, SE = .08, p > 05.

ANOVA was conducted for changes in the levels of social, cognitive, and tenseness of students’ test anxiety from Time 1 to Time 4. Students’ differences were statistically significant in social test anxiety across four time points, F(1.78,3567) = 8.331, p < .002, ηp2 = 0.30. Similarly, with cognitive test anxiety, F(2.595,10.178) = 5.099, p < .021, ηp2 = 0.20, and tenseness, F(2.445,48.892) = 15.482, p < .001 ηp2 = .44. Thus, the self-hypnosis intervention helped reduce overall test anxiety and in the constructs of social, cognitive, and tenseness.

Discussion

Studies showed that test anxiety may have a negative impact on a student’s general academic performance and psychological health (Von der Embse et al., 2018). Moreover, test anxiety has become a major factor in why students frequently seek counseling treatment, as it is linked to depression as well as social anxiety (Huntley et al., 2019). Following the self-hypnosis intervention, the results of the score for overall test anxiety and for all three constructs of test anxiety showed that the level of test anxiety was reduced significantly. The results of this research showed that form four students’ test anxiety was significantly reduced by the self-hypnosis technique. The findings of this study concur with other studies showing a positive outcome of hypnosis in reducing and managing test anxiety among university students (Ainsworth et al., 2010; Boutin & Tosi, 1983; Dogan et al., 2018; Dundas et al., 2009; Hammer et al., 2020, 2022; Hamzah et al., 2021; Laidlaw et al., 2003; Zhang et al., 2022) and school students (Dadashi et al., 2018; Hart & Hart, 1996; Mathur & Khan, 2011; Pourhamidi et al., 2019). Self-hypnosis may help the students write and think clearly during the examination, boost their confidence, and feel energetic as it allows them to relax and appreciate the calmness and peace they learned in the hypnosis sessions to overcome test anxiety. In addition, suggestions given during the self-hypnosis session motivate and give them confidence (Mathur & Khan, 2011; Yu, 2006).

While most studies have found that hypnosis has a positive effect on test anxiety, one study that combined self-hypnosis with a cognitive behavioral (CB) intervention discovered that the CB intervention was preferable to a combination of self-hypnosis and the CB intervention. The potential causes include the fact that it was a brief intervention that involved a group of students; each individual’s self-fulfilling expectations of positive changes varied and the addition of self-hypnosis to a brief CB intervention might have been challenging for the student. Although self-hypnosis is highly calming, some students found it challenging and lacked confidence in using it (Dundas et al., 2013).

There have not been any previous studies in Malaysia on the use of hypnosis interventions to reduce test anxiety among students, but one study was conducted in Terengganu (Hamzah et al., 2021). Four hypnosis sessions were held 8 weeks before the exam. The participants were 60 first-year nursing students. Similar to our study, no control group was included. Physical characteristics, blood levels, and serum cortisol levels were assessed, in addition to a test anxiety questionnaire. Also similar to the current study, the worry and emotionality components of test anxiety and the overall test anxiety score decreased significantly. In addition, the students’ serum cortisol levels were significantly reduced. However, there were no significant differences in the students’ mean systolic and diastolic blood pressure, heart rate, or respiratory rate. The results demonstrated that nursing students’ test anxiety and serum cortisol levels decreased with hypnosis intervention (Hamzah et al., 2021).

The use of clinical hypnosis as a supplement to standard medical treatment for adolescents is a crucial mind-body technique (Sawni & Breuner, 2017). Self-directed therapeutic suggestions are used in clinical hypnosis to stimulate imagination and promote the mind-body connection, which enhances both emotional and physical well-being (Sawni & Breuner, 2017). Hence, in line with this, the researchers in this study feel that hypnosis, especially self-hypnosis, can help students manage their test anxiety. This study had several limitations. Internal validity, such as history, maturation, and testing, may be affected by a one-group pre-experimental design without a control group (Spurlock, 2018). In addition, the Hawthorne effect, which occurs when a participant modifies their behavior by knowing that they are part of a study or being watched, could influence the outcomes of the investigation.

Limitations and Recommendations for Future Research

The COVID-19 pandemic has caused delays and made it challenging to obtain timely approvals, which was the biggest obstacle to the implementation of this study. Additionally, throughout the pandemic, students were under stress and took turns attending class. Additional stress may have been aggravated by, among other things, significant changes in class schedules and delivery methods, delayed exams, health issues related to COVID-19, family financial difficulties due to lockdowns and closure of many workplaces, as well as loss of loved ones. This is referred to as the history effect or a threat to internal validity because it relates directly to incidents that occur outside an experiment and could influence crucial results (Park et al., 2020). Finally, a lack of understanding that results in misconceptions about hypnotherapy as a foreign and uncommon psychotherapy technique may affect students’ acceptance of the method.

Previous research has indicated that psychological treatments for secondary school students who experience test anxiety are insufficient (Ganaprakasam & Selvaraja, 2020; Huntley et al., 2019; Putwain & Pescod, 2018; Von der Embse et al., 2013). Therefore, it is crucial to develop intervention programs for school children, particularly those getting ready for high-stakes examinations. One form of intervention that can be initiated in schools is hypnosis, whereby self-hypnosis can be taught to students to develop their own skills (Perfect et al., 2013). This form of intervention should be explored more in the future as it can be faster, more effective, nondependent, and safer when compared to other types of treatment in addressing anxiety issues (Hammond, 2010).

The findings of this study call for further research with an enhanced design. First, future studies should use a more robust research design with a control group and a broader sample. A mixed-method design can be advantageous as it fully examines students’ test anxiety and their experiences in learning self-hypnosis in detail. Second, in a previous meta-analysis by Baker et al. (2009) on the effectiveness of hypnosis in reducing test anxiety, it was stated that although self-hypnosis can help with test anxiety, its influence is minimal if it does not boost exam performance. Future studies should examine how hypnosis affects students’ academic performance.

Conclusions

In a competitive school environment, the debilitating effects of test anxiety can be detrimental to the body and mind. The findings of this study suggest that test anxiety exists among form four secondary school students in Malaysia and that self-hypnosis training can help students cope with test anxiety. Furthermore, lower levels of test anxiety may lead to improved academic performance. Further studies will be needed to explore the potentials of self-hypnosis. These preliminary findings suggest that controlled studies should be carried out to further evaluate the effects of self-hypnosis training on test anxiety in secondary school students.

Wirkung von Selbsthypnose auf Prüfungsangst bei Sekundarschülern in Malaysia

Sukunah Pachaiappan, Meng Yew Tee, und Wah Yun Low

Zusammenfssung: Prüfungsangst umfasst kognitive, physiologische und verhaltensbezogene Reaktionen, die auf die Angst vor einem Misserfolg oder einer schlechteren akademischen Leistungsbewertung bei einer Prüfung oder Bewertung zurückzuführen sind. Daher wurde in dieser Studie die Wirkung der Selbsthypnose auf die Verringerung der Prüfungsangst bei Schülern der Sekundarstufe II anhand einer quantitativen Methodik mit präexperimentellem Design untersucht. Die Prävalenz der Prüfungsangst wurde mit Hilfe der Friedben Test Anxiety Scale (FTAS) gemessen, und es wurden demografische Daten der Studierenden erhoben. Zweiundzwanzig 16-jährige Schüler mit mäßiger bis starker Prüfungsangst wurden für eine Selbsthypnose-Intervention über einen Zeitraum von fünf Wochen ausgewählt. Der FTAS-Fragebogen wurde viermal ausgefüllt: zu Studienbeginn, in der dritten Woche, in der fünften Woche und beim Follow-up (drei Wochen nach der Intervention). Die Unterschiede in der Prüfungsangst der Schüler waren über vier Zeitpunkte hinweg statistisch signifikant. Die Selbsthypnose-Intervention verringerte die Gesamtwerte der Schüler in bezug auf ihre Prüfungsangst sowie in den drei Konstrukten: sozial, kognitiv und Anspannung. Die Ergebnisse deuten darauf hin, dass das Selbsthypnose-Training Schülern bei der Bewältigung von Prüfungsangst helfen kann und für die Bewältigung von Prüfungsangst im schulischen Umfeld weiter erforscht werden sollte.

Brandon Nabrotzky

Lethbridge, Ontario, Canada

Effet de l’auto-hypnose sur l’anxiété liée aux tests chez les élèves du secondaire en Malaisie

Sukunah Pachaiappan, Meng Yew Tee, et Wah Yun Low

Résumé: L’anxiété liée aux tests comprend les réactions cognitives, physiologiques et comportementales dues à l’anxiété face à l’échec ou à un score de performance scolaire inférieur à un examen ou à une évaluation. Cette étude a examiné l’effet de l’auto-hypnose sur la réduction de l’anxiété liée aux tests chez les élèves du secondaire supérieur en utilisant une méthodologie quantitative avec une conception préexpérimentale. La prévalence de l’anxiété liée aux tests a été mesurée à l’aide de l’échelle d’anxiété du test de Friedben (FTAS) et les données démographiques des étudiants ont été recueillies. Vingt-deux étudiants de 16 ans souffrant d’anxiété modérée à élevée lors des tests ont été sélectionnés pour une intervention d’auto-hypnose pendant une période de 5 semaines. Le questionnaire FTAS a été administré 4 fois: au démarrage de l’étude, à la 3e semaine, à la 5e semaine et lors du suivi (3 semaines après l’intervention). Les différences d’anxiété des étudiants mesurés par les tests étaient statistiquement significatives sur 4 points dans le temps. L’intervention d’auto-hypnose a diminué les scores d’anxiété globaux des étudiants et dans les 3 concepts: social, cognitif et stress. Les résultats indiquent que la formation à l’auto-hypnose peut aider les élèves à faire face à l’anxiété liée aux tests et devrait être explorée plus avant pour gérer l’anxiété liée aux tests en milieu scolaire.

Gérard Fitoussi, M.D.

President of the European Society of Hypnosis

El efecto de la autohipnosis en la ansiedad ante los exámenes entre estudiantes de secundaria en Malasia

Sukunah Pachaiappan, Meng Yew Tee, y Wah Yun Low

Resumen: La ansiedad ante los exámenes contiene reacciones cognitivas, fisiológicas y conductuales debido a la ansiedad por el fracaso o una puntuación de rendimiento académico más baja en un examen o evaluación. Este estudio examinó el efecto de la autohipnosis en la reducción de la ansiedad ante los exámenes entre estudiantes de secundaria superior utilizando una metodología cuantitativa con un diseño preexperimental. La prevalencia de la ansiedad ante los exámenes se midió utilizando la Escala de Ansiedad ante los Examenes de Friedben (FTAS) y se recopilaron los datos demográficos de los estudiantes. Veintidós estudiantes de 16 años con ansiedad ante los exámenes de moderada a alta fueron seleccionados para una intervención de autohipnosis durante un período de 5 semanas. El cuestionario FTAS se administró 4 veces: al inicio, 3a semana, 5a semana y en el seguimiento (3 semanas después de la intervención). Las diferencias de ansiedad ante los exámenes de los estudiantes fueron estadísticamente significativas en los 4 puntos temporales. La intervención de autohipnosis disminuyó las puntuaciones generales de ansiedad ante los exámenes de los estudiantes y en los 3 constructos: social, cognitivo y tensión. Los resultados indican que el entrenamiento de autohipnosis puede ayudar a los estudiantes a lidiar con la ansiedad ante los exámenes y debe explorarse más para manejar la ansiedad ante los exámenes en entornos escolares.

Vanessa Muñiz

Baylor University, Waco, Texas, USA

Acknowledgments

We thank all students who participated in the study and appreciate the cooperation of the schools.

Disclosure Statement

No potential conflict of interest was reported by the author(s).

Data Availability Statement

Data available on request due to privacy/ethical restrictions (contain photos and data with the student’s name).

Additional information

Funding

The authors received no financial support for the research of this article.