Hypnosis interventions for reducing test anxiety among students: A systematic review

Figures & data

Table 1. Definition of terms in hypnosis treatment

Term	Definition
Hypnosis	A state of consciousness involving focused attention and reduced peripheral awareness characterised by an enhanced capacity for response to suggestions.
Hypnotic induction	A procedure designed to induce hypnosis (Eye roll induction, Hartland’s Progressive Muscle Relaxation induction, etc)
Hypnotisability	An individual’s ability to experience suggested alterations in physiology, sensations, emotions, thoughts, or behaviour during hypnosis
Hypnotherapy	The use of hypnosis in the treatment of a medical or psychological disorder or concern

Figure 1. PRISMA flow chart.

The PRISMA guidelines include a flowchart outlining the criteria for the identification, selection, eligibility, and inclusion of articles covered by the review. Finally, 12 studies were considered in this review.

Table 2. Summary of key characteristics of all included articles

Author or Year	Study Settings/ Sample size	Study Design	Type of group	Instrument/ HS	Hypnosis technique/Duration	Hypnosis/SH Intervention	Theory	Data Analysis	Challenges/ issues	Findings/strength
Ainsworth et al. (2010)	24 first-year nursing students Avg: 26 years UK 22 F 2 M	Quan: Randomised Pre and Post-Test	H: 12 C: 12 NT	SSTEAS	Hypnosis NOSW: 1 NOW: 3 TNOS: 3 NOMPS: 60 -90 minutes 5 in a group	Prior to Numeracy test Relaxation suggestions CD 3 hypnotherapists	NA	DS/T-test	Not wanting to be hypnotised Choosing the right type of exam No follow up	Hypnosis is useful and helpful
Dadashi et al. (2018)	60 high school students 17–19 years Iran All F	Quan: Randomised Pre and Post-Test	R: 20 H: 20 C: 20; NT	TAQ HS: Eye roll Test	Hypnosis NOSW: 2 NOW: 2 TNOS: 4 NOMPS: 40 minutes	Anxiety management/ PS	Briefly on test anxiety and hypnosis	DS/T-test ANCOVA/	Busy school/lack of facilities/ No follow up	Hypnosis intervention decreases test anxiety and is the most significant treatment compared to the Relaxation technique
Dogan et al. (2018)	33 nursing students 20–24 years Turkey 32 F 1 M	Quan: Non-randomised Pre and Post-Test	Single group SH:33 C: NA	VAS BAQ HS: NA (Prior to exam)	Self-hypnosis NOSW: 5 NOW: 1 TNOS: 5 NOMPS: 40 minutes	5 days before the exam Relaxation suggestions mp3	NA	DS	No control Group, No follow up	Self-hypnosis decreases anxiety and stress before the exam
Dundas et al. (2009)	36 university students 19–46 years Norway 27 F 9 M	Qual: Interview	CB: 18 CB and SH:18 C: NA	NA HS: NA	CBH/Self-hypnosis NOS: 3 1^st session; CB, 3 hours 2^nd and 3^rd session: CBH 2 hours TNOHS: 2 POT: 1 year	CBH/SH training Relaxation/ Positive self-suggestions	NA	Interview NVivo	Theme: “Making exam a manageable task” cannot be linked to SH training (limited analysis). Could not be generalised, No follow up	Students have their own individual way of making exams manageable. Mixed results Detailed interview analysis may describe a clinical tool for test anxious students
Dundas et al. (2013)	73 university students 18–46 years Norway 81% F	Quan: Randomised Pre and Post-Test	CB 39 CB and SH: 34 C: 85; NT	RTA STAI SDQ GSE (Prior to exam) HS: HGSHSA	Self-hypnosis NOS: 3 1^st session; 3 hours 2^nd and 3^rd session: CBH; 2 hours TNOHS: 2 POT: 3.5 years	CBH/SH training Relaxation/ positive self-suggestions	NA	DS/T-test /ANOVA/ANCOVA/	Lack of random assignment to the control group/2 hypnosis sessions/No follow up	Self-hypnosis training may not add to the effectiveness of CB intervention.
Gruzelier et al. (2001)	28 volunteer pre-clinical medical students, mean age 20.1 London 17 M 11 F	Quan: Randomised Pre and Post-Test	SH:12 HS.8, LS, 8 C: 16; NT	HS: HGSHSA SAS LV FCA (Prior to exam)	Self-hypnosis HT: 1 NOSW: 3 NOW: 3 (Tape recorded) TNOS: 9 + 1;10	Relaxation, immune imagery, suggestions	NA	DS/T-test /ANOVA/ correlations	The self-hypnosis practice is questionable No follow up	Self-hypnosis training proved to be effective in buffering the immune compromise, which accompanied the distress of examinations in medical students. The use of HGSHSA Hypnotic relaxation may help in boosting immune disorders and for promoting health
Hammer et al. (2021)	104 medical students 17–27 years Germany F:69.2% M: 30.8%	Quan: Non-randomised Pre and Post-Test	H: 52 C: 52; NT	PAF (Prior to oral test) HS: NA	Hypnosis TNOS: 2 NOMPS: 1 hour	Individually chosen induction/ resources/ audio file	NA	DS/T-test /ANOVA/ANCOVA/	Whether students listen to audio-recording of their hypnosis session is questionable/ No treatment for the control group/ No follow up	Hypnosis helped in reducing test anxiety in all dimensions. (emotionality, worry, interference, lack of confidence) Individualised hypnosis sessions for every student
Hammer et al. (2020)	46 Medical students 22 years F:78.3% M:21.7%/ Germany	Quan: Non-randomised Pre and Post-Test	H: 23 C: 23; NT	PAF (Prior to oral test)	Hypnosis TNOS: 2 NOMPS: 1 hour	Individual hypnosis session/audio file	NA	DS/T-test	Whether students listen to audio-recording of their hypnosis session is questionable/ No treatment for the control group/ No follow up	The global test anxiety and lack of confidence scores were reduced significantly over time in the group that underwent clinical hypnosis but not in the control group. Direct comparisons of hypnosis vs control group yielded no statistically significant differences in the test anxiety scores. Small sample size and limited time Individualised hypnosis sessions for every student
Laidlaw et al. (2003).	48 university students 19–23 years London 22 M 26 F	Quan: Randomised Pre and Post-Test	SH:16 J; 16 C; R: 15	POMS STAI PEI PSS TAS (Prior to exam) HS: HGSHSA	Self-hypnosis NOSW: 2 NOW: 4 TNOS: 8	Relaxation/immune imagery, tape recording given & SH 3 times a day	NA	DS/T-test /ANOVA/	a 3-weeks and a 3-month post hoc data	Self-hypnosis helps in reducing test anxiety, depression and tension Relaxation training for the control group
Mathur and Khan (2011)	10 school children 13–14 years India 5F 5 M	Quan and Qual Case study One group pre and Post-test	Single group H: 10 C: NA	TAQ AP (Prior to exam) HS: NA	Hypnosis NOSW: 2 NOW: 4 TNOS: 8	Relaxation/ Positive self-suggestions	NA	DS	No control Group, No Follow up	Hypnosis is effective in reducing exam anxiety and improving academic performance
Pourhamidi et al. (2019)	50 High school students Iran 100% M	Quan: Randomised Pre and Post-Test	H: 25 C: 25; NT	FTAS HS: NA	Hypnosis NOSW: 1 NOW: 9 TNOS: 9 NOMPS: 1.5 hours	Concentration/dissociation and suggestibility	Briefly on test anxiety and hypnosis	DS/T-test /ANOVA/	a 3-month post hoc data Only Male students	CBH reduced students’ test anxiety scores in three dimensions: social humiliation, cognitive error and stress The link between TA and HY explained Discussion of validity and reliability of the scales
Yu (2006)	3 university students Age: NA Hong Kong/London 1 M 2F	Quan and Qual Case study Pre and Post-Test	Single group CBH/SH	SUDS AAT (Prior to exam) HS: NA	Self-Hypnosis NOW: 2 TNOS: 4	Progressive Relaxation/Special place Positive self-suggestions/rapid hypnosis	NA	DS: mean score Interview transcript discussion	No control Group, No follow up Four sessions were finished within two weeks Near to examination The self-hypnosis practice is questionable	Improvement in managing test anxiety and academic performance Detailed hypnosis intervention procedure

F: Female; M: Male; Quan: Quantitative; Qual: Qualitative; H: Hypnosis; C: Control; CB: Cognitive behaviour; SH: Self-hypnosis; CBH cognitive-behavioural-based hypnotic treatment; R: Relaxation; NOW: Number of weeks; NOSW: Number of sessions in a week; TNOS: Total number of sessions; TNOHS: Total number of hypnosis sessions; NOMPS: Number of minutes per session; POT: Period of time; SUDS: Subjective units of discomfort scale; AAT: Achievement Anxiety Test; NA: not available; TAQ: Test Anxiety Questionnaire; VAS: Visual Analogue Scale; BAQ: Beck Anxiety Inventory; RTA: Revised Test Anxiety scale; SSTEAS: Spielberger State-Trait Exam Anxiety Scale; STAI: State Trait Anxiety Inventory; SDQ: Self-Description Questionnaire; GSE: General Self Efficacy scale; TAS: Friedben Test Anxiety Scale; HGSHSA: Harvard Group Scale of Hypnotic Susceptibility; HS: Hypnotic Susceptibility; PAF: “Prüfungsangstfragebogen” or German for “test anxiety questionnaire”; AP: Academic performance; NT: No Treatment; DS: Descriptive statistics, PS: Positive suggestion.

Figure 2. Comparison between hypnosis and self-hypnosis studies’.

The chart shows that six studies used hypnosis and six studies used self-hypnosis interventions to reduce Test anxiety. The grouping was based on the study’s findings.

Ainsworth, H. R., Torgerson, D. J., Torgerson, C. J., Bene, J., Grant, C., Ford, S., & Watt, I. (2010). The effect of hypnotherapy on exam anxiety and exam performance: A pilot randomised controlled trial. Effective Education, 2(2), 143–154. https://doi.org/10.1080/19415532.2010.522799

 Google Scholar

Dadashi, M., Modirkhamaneh, S., & Dadashi, M. (2018). Hypnosis vs. progressive muscle relaxation as cognitive-therapeutic interventions: Insights into reducing EFL learners’ test anxiety. Journal of English Language & Translation Studies, 6(4), 69–97. http://www.eltsjournal.org/archive/value6%20issue4/9-6-4-18.pdf

 Google Scholar

Dogan, M. D., Agcay, B. Ç., & Gocke, T. (2018). The effect of self-hypnosis on exam anxiety and stress among university students. ARC Journal of Nursing and Healthcare, 4(1), 28–32. https://doi.org/10.20431/2455-4324.0401004

 Google Scholar

Dundas, I., Wormnes, B., & Hauge, H. (2009). Making exams a manageable task. Nordic Psychology, 61(1), 26–41. https://doi.org/10.1027/1901-2276.61.1.26

 Web of Science ®Google Scholar

Dundas, I., Hagtvet, K. A., Wormnes, B., & Hauge, H. (2013). Does self-hypnosis add to the effectiveness of a cognitive-behavioral intervention against test anxiety? Nordic Psychology, 65(3), 224–241. https://doi.org/10.1080/19012276.2013.824203

 Web of Science ®Google Scholar

Gruzelier, J. A., Smith, F., Nagy, A., & Henderson, D. C. (2001). Cellular and humoral immunity, mood and exam stress: The influences of self-hypnosis and personality predictors. International Journal of Psychophysiology, 42(1), 55–71. https://doi.org/10.1016/S0167-8760(01)00136-2

 PubMed Web of Science ®Google Scholar

Hammer, C. M., Scholz, M., Bischofsberger, L., Hammer, A., Kleinsasser, B., Paulsen, F., & Burger, P. H. M. (2021). Positive effects of medical hypnosis on test anxiety in first year medical students. Innovations in Education and Teaching International, 59(4), 472–482. https://doi.org/10.1080/14703297.2021.1886971

 Web of Science ®Google Scholar

Hammer, C. M., Scholz, M., Bischofsberger, L., Paulsen, F., & Burger, P. H. M. (2020). Feasibility of clinical hypnosis for test anxiety in first-year medical students. International Journal of Clinical and Experimental Hypnosis, 68(4), 511–520. https://doi.org/10.1080/00207144.2020.1799379

 PubMed Web of Science ®Google Scholar

Laidlaw, T. M., Naito, A., Dwivedi, P., Enzor, N. A., Brincat, C. E., & Gruzelier, J. H. (2003). Mood changes after self-hypnosis and Johrei prior to exams. Contemporary Hypnosis, 20(1), 25–39. https://doi.org/10.1002/ch.262

 Google Scholar

Mathur, S., & Khan, W. (2011). Impact of hypnotherapy on examination anxiety and scholastic performance among school children. Delhi Psychiatry Journal, 14(2), 337–342.

 Google Scholar

Pourhamidi, M., Sarvghad, S., Bagholi, H., & Rezaei, A. (2019). The effectiveness of cognitive behavioral hypnotherapy on reducing anxiety symptoms and improving the quality of life of first period high school male students with test anxiety. Report of Health Care, 5(4), 54–63. https://iranjournals.nlai.ir/handle/123456789/710523

 Google Scholar

Yu, C. K. (2006). Cognitive-behavioural hypnotic treatment for managing examination anxiety and facilitating performance. Contemporary Hypnosis, 23(2), 72–82. https://doi.org/10.1002/ch.310

 Google Scholar

Data availability statement

The authors confirm that the data supporting the findings of this study are available in the article and its supplementary materials (Appendices A, B and C).