Abstract
Auricular acupuncture (AA) is effective in the treatment of preoperative anxiety. The aim was to investigate whether AA can reduce exam anxiety as compared to placebo and no intervention. Forty-four medical students were randomized to receive AA, placebo, or no intervention in a crossover manner and subsequently completed three comparable oral anatomy exams with an interval of 1 month between the exams/interventions. AA was applied using indwelling fixed needles bilaterally at points MA-IC1, MA-TF1, MA-SC, MA-AT1 and MA-TG one day prior to each exam. Placebo needles were used as control. Levels of anxiety were measured using a visual analogue scale before and after each intervention as well as before each exam. Additional measures included the State-Trait-Anxiety Inventory, duration of sleep at night, blood pressure, heart rate and the extent of participant blinding. All included participants finished the study. Anxiety levels were reduced after AA and placebo intervention compared to baseline and the no intervention condition (p < 0.003). AA was better at reducing anxiety than placebo in the evening before the exam (p = 0.018). Participants were able to distinguish between AA and placebo intervention. Both AA and placebo interventions reduced exam anxiety in medical students. The superiority of AA over placebo may be due to insufficient blinding of participants.
Highlights
Exam anxiety is a type of situational anxiety and is reported to be a common problem among university students [1,2]
Anxiety levels measured with VAS 5 hours (2) after an intervention in the evening prior to the anatomy exam (Time II) decreased after Auricular acupuncture (AA) in comparison with baseline values at Time I (mean difference (MD) = 10.5; 95% CI 5.3, 15.8; t40 = 4.0, P < 0.001, d = 0.6, 95% CI 0.3, 1.0; Table 1, Fig 3)
Being asked after the exam about their opinion on allocation to the study condition, the participants could distinguish between AA and placebo intervention: for the AA condition, 34 participants thought that they had received acupuncture vs. 7 for the placebo condition (P < 0.001; Table 2). This randomized crossover trial demonstrated that both auricular acupuncture (AA) and placebo reduced exam anxiety in comparison with no intervention in medical students, whereas AA yielded stronger effects than placebo procedure
Summary
Exam (or test) anxiety is a type of situational anxiety and is reported to be a common problem among university students [1,2]. Exam anxiety often leads to undesirable physiological and mental symptoms and may negatively influence academic performance [2,3]. Various mindfulness-based behavioral interventions have been shown to be effective in reducing exam anxiety and stress among university students [4,5]. Some of these methods (e.g. expressive writing) have even been claimed to improve academic performance [6]. PLOS ONE | DOI:10.1371/journal.pone.0168338 December 29, 2016
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