Effect of the Students’ Test Anxiety Prevention Program on Students’ Experiences of Test Anxiety: A Mixed-Methods Experiment

Abstract

This study aims to introduce the Students’ Test Anxiety Prevention Program (STAPP), an intervention for test anxiety for university students in Iraq. We also evaluated its effectiveness against test and state anxiety. The STAPP is a short three-session intervention program comprising expressive emotional dialog, psychoeducation, and educational and cognitive–behavioral therapy techniques. Numerous studies have shown the effectiveness of cognitive–behavioral techniques among other populations; however, most interventions in Iraq focus on posttraumatic stress disorder. In this explanatory sequential mixed-methods study, we used an experimental design in the quantitative phase and conducted a focus group discussion in the qualitative phase. The study was conducted among a sample of Iraqi university students, as there is scarce research on test anxiety interventions among the Iraqi student population. Convenience sampling was used to select 60 participants—35 women and 25 men—randomly assigned to the control or intervention groups. The test-retest approach was used to compare test scores and state anxiety for both groups. The focus group discussion included seven members from the intervention group. The results suggest that STAPP is effective in reducing test anxiety. However, no significant changes were observed in state anxiety in the post-test phase. State anxiety is transient, whereas test anxiety represents a persistent trait. Participants displayed elevated levels of state anxiety, which may be attributed to coronavirus disease 2019-related stressors. Intervention programs should include exercises that facilitate transferring and generalizing learned material in various anxiety-provoking situations.

Plain language summary

The purpose of this study was to introduce and evaluate the effectiveness of the Students’ Test Anxiety Prevention Program (STAPP), an intervention designed to reduce test anxiety among Iraqi university students. The program consists of three sessions that employ education, psychoeducation, and cognitive-behavioral therapy techniques. The study utilized an explanatory sequential mixed-methods design, including an experimental quantitative phase and a qualitative phase involving a focus group discussion. A convenience sample of 60 participants, was randomly assigned to either the intervention or control group. Test scores and state anxiety were compared using a test-retest approach. The results revealed that the STAPP was effective in reducing test anxiety, while no significant changes were observed in state anxiety in the post-test phase. However, participants showed elevated levels of state anxiety, which could be attributed to the COVID-19 pandemic. The implications of this study suggest that the STAPP can be an effective intervention for reducing test anxiety among Iraqi university students. The study also highlights the importance of incorporating exercises that facilitate the transfer and generalization of learned material in various anxiety-provoking situations. The limitations of this study include the use of a convenience sample and the focus on two universities in Iraq. Future research could involve a larger and more diverse sample, and the program could be adapted to suit the cultural and contextual nuances of different student populations. In conclusion, this study contributes to the scarce research on test anxiety interventions among Iraqi university students. It provides evidence for the effectiveness of the STAPP in reducing test anxiety and highlights the need for interventions that address the specific stressors faced by university students in Iraq, such as the impact of the COVID-19 pandemic. Overall, the STAPP could be a valuable tool for university educators and mental health professionals in promoting student well-being and academic success.

Keywords

test anxiety state anxiety cognitive–behavioral interventions COVID-19 social interaction mixed-methods experiment

Introduction

Testing is a common feature in contemporary educational curricula. Test anxiety is a challenge experienced by 13%–70% of the student population, with up to 35% experiencing functionally impairing test anxiety (Hanfesa et al., 2020). Moderate levels of anxiety are associated with alertness and performance gains. However, high levels of anxiety incapacitate the individual, resulting in a reduction in concentration, cognitive functioning, recall, and performance. The prevalence of test anxiety has increased over time owing to an increase in academic tests, less time to complete tests, and the pressures for better performance (Hanfesa et al., 2020; McDonald, 2001; Talbot, 2016). Furthermore, with education systems being performance-based, little effort is made to alleviate test anxiety (Talbot, 2016). Many theories have been put forward to explain how test anxiety interferes with performance, from the interference model, deficits model, transactional model, self-referent executive processing model, the transactional model, and the most recent biopsychosocial model (Von Der Embse et al., 2017). According to Eysenck et al.’s attentional control theory, anxiety affects executive functioning by controlling attentional processes and working memory (Eysenck et al., 2007). The theory suggests that anxiety leads to selective attentional bias, where the individual pays more attention to threatening stimuli. Anxiety also results in limited inhibition of distracting responses and increases shifting between mental operations (Matthews, 2012). The biopsychosocial model states that interaction between psychological, biological, and social factors explains the experience of test anxiety among students (Löwe et al., 2008). Social factors dominantly refer to the educational context but also include community and family or parent-related factors. Psychological factors include trait anxiety, social-emotional functioning, self-efficacy, and study skills, while biological factors encompass academic aptitude and intelligence (Löwe et al., 2008). Löwe et al. (2008) allude that the proximal and distal social system plays a part in the development of test anxiety (Segool et al., 2013). The biopsychosocial model is based on a cognitive behavioral framework. It incorporates how previous experiences and negative performance stereotypes according to demographic variables, cognitive perceptions, academic expectations, and social factors, which mainly encompass the educational context. Anxiety causes cognitive interference in the form of test anxiety and affects student performance in several ways (Asghari et al., 2012), with cognitive, physiological, emotional, and behavioral impacts (Sakka et al., 2020). Cognitive effects are characterized by intrusive thoughts, memory impairments, challenges in paying attention (Sakka et al., 2020), and negative self-statements about academic performance (Krispenz et al., 2019). The physiological effects include excessive perspiration, heart palpitations, nausea, trembling, and tense muscles (Krispenz et al., 2019). Panic, fear, and the feeling of impending doom are emotional effects (Krispenz et al., 2019). Behavioral effects include reactions to anxiety, such as procrastination, absconding from school, and poor motivation to study (Sakka et al., 2020).

Test anxiety specifically relates to testing situations and the consequences of testing (Pekrun, 2001). It includes a fear of failure as well as a fear of the consequences of testing, suggesting that it can be present both before and after testing. Test anxiety can be viewed as a state emotion such that a specific test elicits anxiety, but it can also be seen as a trait if it is a frequently occurring feeling influenced by the student’s disposition (Pekrun, 2001). Trait test anxiety can be part of some students’ personalities. During the coronavirus disease 2019 (COVID-19) pandemic, the prevalence of anxiety in general increased. However, studies show that the stresses and restrictions linked with the COVID-19 pandemic increased students’ susceptibility to mental health challenges (Chen & Lucock, 2022). Naser et al. (2020) stated that students experienced more mental health challenges than other occupational groups during the pandemic.

The COVID-19 pandemic can be viewed as a significant stressor, resulting in elevated test anxiety scores across populations (Alsaady et al., 2020; Cornine, 2020). The changes it brought to educational systems were one factor in increased test anxiety. According to Chen and Lucock (2022), more than 50% of students have anxiety scores that exceed clinical cut-off points, while test anxiety is estimated to have the following prevalence rates: 47.3% for severe or extreme anxiety, 18.2% for mild anxiety, and 34.5% for moderate anxiety (Abdullah & Al-Ameri, 2019). Considering this background, it is essential to investigate ways to alleviate state and test anxiety.

Huntley et al. (2016) outline three interventions to test anxiety, which include psychological, pharmacological as well as educational interventions. Among psychological interventions, they identify the three main interventions as cognitive therapy, behavioral therapy, and cognitive behavioral therapy. Educational interventions include study skills training and test-wiseness training (Huntley et al., 2016). The meta-analysis revealed that when used independently, educational and psychological interventions produced no mean effect. However, CBT and BT interventions were revealed to be superior interventions for test anxiety. Against this background, the current research employs an integration of psychological and educational intervention in the CBT intervention designed for this current study. Intervention programs can be administered in groups or through individual sessions (Ergene, 2003). Test anxiety interventions often aim to educate students about test anxiety and foster adaptive coping mechanisms. Cognitive–behavioral interventions aim to address an individual’s beliefs and thought processes about testing, as well as the resulting behavior. Cognitive–behavioral interventions are effective against test anxiety and could lead to a reduction in clinical anxiety (Putwain & Von Der Embse, 2020).

Cognitive behavioral therapy is a type of psychotherapy intervention that can be used for various mental health problems, including alcohol and drug use, depression, marital problems, eating problems as well as anxiety, among many other mental health problems (Nikpour et al., 2021). CBT has been revealed to be better or equivalent to other types of psychotherapy as well as psychopharmacological interventions (American Psychological Association [APA], 2017). This psychotherapy intervention was designed based on clinical experience and research. The first assumption of CBT is that effect and behavior are determined by perception and cognition. Furthermore, cognitions are based on the individual’s beliefs (Nikpour et al., 2021).

According to Santiago et al. (2021), the structure of learning in higher education institutions experienced key changes owing to the COVID-19 pandemic. Disruptions to learning included the closure of physical campuses, suspension of lectures, and introduction of online instructional methods. These changes required the adoption of educational and policy models that fit the current state of higher education. Most nations were ill-prepared for a shift to online education; in the year preceding the pandemic, exclusive online education was used by approximately 1% of the student population in seven countries (Santiago et al., 2021). When institutions and instructors are poorly prepared, they have a limited capacity to support students. Most institutions are challenged to adapt to the new online format and the need to change lesson delivery formats, assignments, examinations, and evaluations. This exerted extra pressure on instructors and, most importantly, students, who depend on school structure to support their learning and performance. Diminished support and students’ lower control over their learning process as a result of the pandemic increased anxiety levels among this population. Furthermore, universities are important for the socialization, self-esteem, and emotional well-being of students. This helps them develop a sense of community and belonging; however, the ability of higher education institutions to provide this support was reduced by the closure of physical campuses. Santiago et al. (2021) revealed that there was a 35.8% prevalence of anxiety among university students during the COVID-19 pandemic; similarly, Khoshaim et al. (2020) indicated that 35% of students reported moderate to extremely high levels of anxiety.

Among university students, there are gender disparities in test anxiety, where women have higher scores than men. This leads to poorer academic performance among women, particularly in math (Núñez-Peña et al., 2016). Higher anxiety scores among women are consistent across trait, test, and math anxiety and may be attributed to social roles that exert more pressure on women to excel in education. Increased pressure makes female students more afraid of testing. Furthermore, the masculine social role inhibits men from admitting to experiencing test anxiety, which can account for their lower scores (Núñez-Peña et al., 2016). It should also be noted that gender differences are observed in the effectiveness of different types of therapy (Ogrodniczuk et al., 2001), group therapy (Abouguendia et al., 2004), and commitment to psychotherapy (Cottone et al., 2002). Men respond better to interpretive therapy and women to support therapy; men benefit less from group therapy and are generally less committed to therapy. However, it should be noted that other research does not show gender differences in the outcomes of psychotherapy (Staczan et al., 2015). Furthermore, research consistently shows gendered differences in the experience of test anxiety (Von Der Embse et al., 2018). The current research investigates if such differences would affect the effectiveness of the STAPP across the two genders captured in the study.

Most studies on test anxiety conducted in Iraq did not introduce any interventions. Rather, they explored the coping mechanisms used by students, such as study preparation (Faqe et al., 2016; Shanshal et al., 2022; Yusefzadeh et al., 2019), or introduced physical interventions such as exercise (Srour & Al-Dulaimi, 2022). Studies have also revealed that the effectiveness of short-term therapy might differ by gender (Ogrodniczuk et al., 2001). Most cognitive–behavioral therapy (CBT) interventions have targeted Iraqi survivors of war and those with posttraumatic stress disorder (Wagner et al., 2011; Zemestani et al., 2022). Globally, cognitive–behavioral interventions have been implemented to assist students experiencing test anxiety (Ganaprakasam & Selvaraja, 2020; Putwain & Von Der Embse, 2020). Nevertheless, there is scarce literature on such interventions in Iraq and little evidence to support the effectiveness of such programs among the population of this study. Furthermore, most researchers have the qualitative phase concurrently with the quantitative phase, but the current study employs an explanatory sequential design. The qualitative phase is scheduled a year after the quantitative phase to evaluate the long-term effectiveness of the intervention.

Against this background, in this study, the aim was to introduce the Students’ Test Anxiety Prevention Program (STAPP), an intervention for test anxiety among university students in Iraq. Such an endeavor will be beneficial to students, teachers, and other education stakeholders as it has the potential to improve academic performance by reducing test anxiety. Considering the increase in test anxiety, the introduction of a CBT intervention for test anxiety is imperative in the Iraqi context. We also aimed to evaluate the program’s effectiveness. According to our research aim, the following hypotheses were proposed:

H₁. There will be a significant decrease in test anxiety scores after the STAPP.

H₂. There will be a significant decrease in state anxiety scores after the STAPP.

H₃. The STAPP is equally effective for reducing test anxiety for both genders.

Materials and Methods

Design

This study employed a mixed-methods explanatory sequential design. In the quantitative and qualitative phases, an experimental approach and a focus group discussion, respectively, were used to collect data. An explanatory sequential design aims to use the results of the qualitative study to confirm and explain the results of the quantitative phase (Edmonds & Kennedy, 2017). The test–retest method was used to measure the validity and effectiveness of the STAPP against test and state anxiety.

Participants

A convenience sample of 60 students (35 women) was recruited: 30 were selected from the Mathematics Department of Duhok University and another 30 from the Social Sciences Department at Zakho University. Thirty participants were randomly assigned to the experimental group, which completed the STAPP; the other 30 were assigned to the control group, which received no training in test anxiety prevention. The intervention and control groups comprised 15 students from each of the two sample departments. The sample size was calculated using the formula n = 1 + 2C(s/d)². This formula is used for comparisons between two groups in studies that collect continuous data (Sharma et al., 2019). The sample size determination method is similar to power analysis. However, it better incorporates findings from similar researchers. This allows the research to account for the complexity of the research to sampling and increase the generalizability of results. Inclusion criteria for participants were availability for all three sessions of the intervention, as well as the pre-and post-test.

A year after the quantitative phase of the study, a focus group discussion was conducted. Seven participants (four women and three men) from the experimental group who were willing to take part in both the STAPP and focus group discussion were purposively sampled. We recruited only seven participants to ensure that all members had a chance to interact effectively. Smaller sample sizes ensure a better dynamic, making groups easy to control (Krueger & Casey, 2014). No participant withdrew from the study.

Ethical Considerations

The researchers received ethical approval from NearEast University (no. YDÜ/EB/2020/466). All participants provided written informed consent. Permission was also sought from the Duhok and Zakho University to conduct research and introduce the STAPP to students. No identifying data were collected to safeguard participants’ anonymity. Announcements were made through the department administration to encourage students to participate in the study. Students from the mathematics and social science departments were included in the sample based on the criterion of volunteering to participate in all three STAPP sessions.

Workshop Procedure

After participants received the information sheet and signed the consent forms, a questionnaire was administered to collect baseline data. The baseline data represent the results of the pretest administered before the STAPP to determine students’ existing levels of state and test anxiety. The researcher and the respondents had not met before the pretest phase. They met on campus, where the data were collected. The STAPP was introduced only among the members of the intervention group. The intervention was administered by a researcher and a research assistant, both of whom are trained psychologists.

Intervention

The STAPP is an intervention designed to reduce test anxiety among university students based on updated research and theories such as Cognitive Test Anxiety Theory (Liebert & Morris, 1967), Skill Deficit Theory (Desiderato & Koskinen, 1969), Dual-Deficit Theory (Meichenbaum & Butler, 1980), Processing Efficiency and Attention Control Theory (Eysenck et al., 2007), and the Metacognitive Beliefs and Test Anxiety Theory (Wells, 2011). The intervention package comprised the STAPP structured sessions and guideline handbook.

The three STAPP sessions covered psychoeducation, education, and cognitive behavior. The psychoeducation sessions provided information about test anxiety, its symptoms, and triggers, while the educational sessions were meant to develop test-taking and learning skills. The cognitive behavior session aimed to provide skills and techniques to cope with and reduce test anxiety. Each session lasted for an hour. The STAPP guideline handbook is a psycho-educational guide that contains elements of students’ study skill development structured to prevent test anxiety.

The researchers designed the STAPP based on updated research on test anxiety that stresses the importance of expressing one’s feelings, being present and centered, skill development, and a cognitive–behavioral approach. A compilation of the origins of test anxiety among these theories was combined to produce an intervention that addresses maladaptive cognition, physiological arousal, and emotional arousal associated with test anxiety through a cognitive–behavioral approach.

STAPP Sessions

The STAPP was developed as a brief program based on a meta-analysis that showed that interventions with six to seven sessions have no incremental effects (Ergene, 2003). Each session lasted approximately 1 hr, and one session was administered each week.

First session: In this psychoeducation and CBT-based session, participants were encouraged to share their feelings. This session provided participants with information about what test anxiety is, its symptoms, and its causes. Participants were also taught skills like being present and centered, such as the 5-4-3-2-1 coping technique for anxiety (Msw, 2008) This coping technique begins with breathing exercises designed to calm the individual by encouraging them to take long and deep breaths slowly; they count down from five. At five, the individual acknowledges the five objects they see in their environment; at four, the participant acknowledges four things they can touch. Further, at three, they acknowledge three sounds in their external environment; at two, they acknowledge two things they can smell. Finally, they acknowledge one thing they can taste.

Second session: This session incorporated educational and cognitive–behavioral aspects. The purpose of this session was to explain the importance of skill development regarding lifestyle and its impact on test anxiety and the psychological well-being of students during the COVID-19 pandemic. Participants were taught the importance of a healthy lifestyle, incorporating physical activity, a healthy diet, good-quality sleep, social connection, and stress management strategies. At the end of this session, a guided practice of the deep breathing relaxation technique was used.

Third session: This was an education- and cognitive-behavior-based session. The purpose was to explain the importance of skill development in exam preparation and its impact on students’ test anxiety and self-confidence during the academic year. The main aim was to educate participants on how to prepare for their exams. The topics included time management, organizing a study space, using flow charts and diagrams, practicing with prior exams, explaining your answers to others, organizing study groups with friends, taking regular breaks, snacking on healthy foods, drinking plenty of water, and test-taking skills such as starting with easy questions as well as trying to reason out the answer when they cannot remember the answers. At the end of this session, a hypnosis technique was used to prevent the examination of nerves. During hypnosis, the students were asked to close their eyes and relax, focusing on the voice of the researcher as they were guided into a deeper state of relaxation before the researcher could effectively suggest that the participants should follow key points of avoiding test anxiety, which include test preparedness, healthy lifestyle, and test-wiseness. The STAPP guideline handbook was distributed for the daily practice of the learned material.

STAPP Guideline Handbook

The STAPP handbook is a psycho-educational guide that contains elements of students’ study skills development structured to prevent test anxiety. The guidebook was designed to motivate the students by explaining the research process, and it would continue to serve as a reference text to remind the students what they had learned from the STAPP. The main aims of the STAPP guideline handbook are to educate and assist students in becoming aware of their test anxiety experiences. It was designed to encourage students to deal with crisis situations, build adaptive behaviors, and develop daily well-being skills. The STAPP guideline handbook comprises three sections. The first section discusses test anxiety and its related concepts. The second section covers skills development—the first part is about a healthy lifestyle, such as physical activity, a nutritious diet, good-quality sleep, social connection, living in the moment, and stress management related to COVID-19 stressors; the second part deals with exam preparation tips. Finally, the third section includes psychological tools and relaxation techniques used to reduce test anxiety.

Measures

We also employed a questionnaire to collect demographic information, as well as information about test and state anxiety levels among participants. The demographic questionnaire included questions about students’ department and gender. The Westside Test Anxiety Scale (WTAS) and State–Trait Anxiety Inventory (STAI) were used to measure test and state anxiety, respectively. A focus group discussion was also conducted to collect qualitative data.

WTAS: This 10-item instrument was designed to identify anxiety-related impairments among students (Driscoll, 2007). The WTAS is scored using a five-point Likert scale. The data gathered through self-assessment included cognitions that negatively affected performance, as well as anxiety impairments. Driscoll (2007) viewed test anxiety as heightened physical arousal. Test anxiety also includes cognitive impairment owing to excessive worry and anticipation of failure. The scale focuses on the cognitive components of test anxiety and neglects its physiological dimensions of test anxiety. The WTAS comprises four worry and dread questions and six cognitive impairment questions. Sample items include the following: “The closer I am to a major exam, the harder it is for me to concentrate on the material,”“When I study, I worry that I will not remember the material on the exam,” and “During important exams, I think that I am doing awful or that I may fail.” students Anxiety scores provided by the WTAS have a 0.49 correlation with test performance among college students and 0.40 among fifth-grade. The scale has a correlation coefficient of .44 for criterion-related validity (Driscoll, 2007). It has a reliability coefficient of .88 (Talwar et al., 2019). The WTAS has been applied to an Iraqi population in previous research, and in a study by the WTAS had a reliability score of .89 Cronbach alpha and a test-retest reliability score of .87 (Faqe et al., 2016). In this study, the scale’s reliability, as depicted by Cronbach’s alpha, was .696.

STAI

The STAI is a self-report measure of state anxiety (Spielberger, 1983) that uses a Likert-type scale with four points ranging from not at all to very much. The scale has 20 items, such as “I feel satisfied,”“I feel nervous,” and “I feel upset” (Spielberger, 1983). A retest of the STAI revealed a Cronbach’s alpha of .85, indicating good internal consistency (Vitasari et al., 2011). The Cronbach alpha for state anxiety was .797 (Vitasari et al., 2011). The scale measures situation-specific transient anxiety levels. In this study, Cronbach’s alpha was .905. The construct validity of the STAI was established through factor analysis; the items have a correlation coefficient of .824 (Vitasari et al., 2011). The instrument has previously been applied to the Iraqi population in studies such as Bakr et al. (2014).

Focus Group Discussion

The focus group discussion was semi-structured, allowing the researcher to ask participants follow-up questions. The focus group discussion was designed according to the results of the quantitative phase of the study to confirm the effectiveness of the STAPP in reducing test-related anxiety. The interview schedule included questions about students’ prior experience with psychotherapy, how the pandemic affected their academic life, what they learned from the STAPP, and how it affected their academic life. It also included a discussion about their expectations before the STAPP and, having gone through the STAPP, what else they would expect from a test anxiety prevention intervention.

Data Collection Procedures

The research period comprised two semesters of the 2020 to 2021 academic year. The pre-test assessment and intervention took place before the final exam of the first semester—each group session intervention per week, with each session lasting an hour. The post-test assessment was conducted before the final exam in the second semester. During this period, the STAPP intervention was conducted for the experimental group. After the last session, they received the STAPP guideline handbook. The data were normally distributed; therefore, parametric tests were used for data analysis.

The focus group discussion was facilitated by a male researcher who is a Ph.D. candidate and a female assistant researcher who has received training in group interviews. The researcher facilitated the discussion while the assistant researcher took notes and operated a tape recorder. Focus group members were provided with an information sheet that outlined the study aims. The focus group discussion took 90 min to complete. Data were collected on campus. The study was conducted without bias by maintaining a diary that helped the researchers remain objective by outlining preconceptions and biases and their ideas and feelings throughout the study. It also helped account for nonverbal communication from participants.

Data Analysis

Quantitative data were analyzed using SPSS 26.0 (IBM Corp., Armonk, NY, USA). A frequency analysis was performed to outline the characteristics of the sample and the prevalence of test anxiety. Furthermore, a factorial analysis was performed to determine the effects of the STAPP, gender as well as the interception between treatment and gender on the test, and state anxiety analysis of covariance (ANCOVA) was performed to determine whether there were significant differences in pre-test and post-test scores after controlling for gender differences. An ANCOVA was also performed for state anxiety scores.

Qualitative data were analyzed using thematic analysis, a research process that involves the identification of themes and patterns within a data set (Braun & Clarke, 2006; Maguire & Delahunt, 2017). Thematic analysis was carried out using the six step framework put forward by Braun and Clarke (2006). The first step includes transcribing verbal and nonverbal interactions from the focus group and the research diary. The second phase is the generation of initial codes, and preliminary codes are attained for the important and interesting information gathered during the focus group study. Codes are generated for each of the questions prepared in the focus group schedule. In the third step, interpretive analysis is done by finding general themes gained from the codes in the previous stages. This step is designed to find the relationships between codes and themes. In the fourth step, the themes are reviewed to refine, discard, and combine themes. A thematic map is created in this stage. The fifth stage is defining and naming themes, where themes are defined and named to make the work coherent. The last step is producing the report that is integrated into the write-up (Braun & Clarke, 2006). Focus group discussion data underwent open coding using NVIVO software to identify common themes for each interview question. The researcher and research assistant worked together to identify the emerging codes in the data.

Results

Table 1 depicts the means cores of test and state anxiety in the pre- and post-test phases of the study.

Table 1.

Mean Test and State Anxiety Scores According to Gender.

	Male				Female				Total
	Pre-test		Post-test		Pre-test		Post-test		Pre-test		Post-test
Treatment	m	sd	m	sd	m	sd	m	sd	m	sd	m	sd
Test anxiety
Experimental group	2.854	0.584	2.00	0.354	2.988	0.518	2.06	0.453	2.93	0.542	2.033	0.407
Control group	2.65	0.438	2.70	0.467	2.622	0.528	2.336	0.577	2.633	0.486	2.67	0.528
State anxiety
Experimental group	48.307	6.369	45.615	4.70	49.118	5.183	49.00	6.393	48.767	5.637	47.533	5.882
Control group	49.33	5.466	45.44	7.008	49.167	4.962	49.11	6.764	49.233	5.077	47.567	7.011

The mean test anxiety score for the experimental group in the pretest phase was 2.93 ± 0.542, and the mean dropped to 2.033 ± 0.407 while the control group had a pretest mean of 2.633 ± 0.486. In the post-test phase, the mean for test anxiety in the control group increased to 2.67 ± 0.528.

For state anxiety, the experimental group had a pre-test mean of 48.767 ± 5.637, in the post-test phase, it decreased to 47.533 ± 5.882. Among the control group, the mean for state anxiety was 49.233 ± 5.077 in the pretest phase, and it reduced to 47.567 ± 7.011 in the post-test phase.

We investigated the effectiveness of the STAPP against test anxiety and its interaction with gender (Table 2).

Table 2.

Comparison of the Main Effects of Treatment and the Interaction of Gender on Test and State Anxiety.

	Test anxiety			State anxiety
Variable	F	P	Partial η²	F	P	Partial η²
STAPP	34.354	0.000	0.380	0.080	0.778	0.001
Gender	0.381	0.539	0.007	1.980	0.165	0.034
STAPP × gender	0.014	0.907	0.000	0.096	0.758	0.002

The factorial ANOVA table above reveals that there are significant differences in test anxiety between the experimental and control group. The experimental group experiences a significantly more reduction in test anxiety scores in the post-test phase. The STAPP accords for 38% differences in test anxiety scores.

However, there are no significant differences in state anxiety between the experimental and control group. Furthermore, there are no significant gender differences in test anxiety and state anxiety scores. The interaction between treatment and gender also produces no significant differences in test anxiety.

The Shapiro Wilk test shows that the data is normally distributed (0.201) for test anxiety and (0.955) for state anxiety. The Levenes test shows homogeneity of variance (p = .657) in the pretest phase and (p = .121) in the post-test phase (Table 3).

Table 3.

Comparison of the Distribution of Anxiety Ranges in Experimental and Control Groups.

Test anxiety	Cut-off points	Experimental group		Control group
Test anxiety	Cut-off points	Pre-test, n (%)	Post-test, n (%)	Pre-test, n (%)	Post-test, n (%)
Low test anxiety	1.0–1.9
Normal	2.0–2.5	1 (3.3)	13 (4,336)	4 (13.3)	4 (13.3)
High normal	2.5–2.9	5 (16.7)	14 (46.7)	7 (23.3)	8 (26.7)
Moderately high	3.0–3.4	9 (30.0)	2 (6.7)	10 (33.3)	9 (30)
High test anxiety	3.5–3.9	7 (23.3)	1 (3.3)	9 (30)	7 (23.3)
Extremely high-test anxiety	4.0–5.0	1 (3.3)	0 (0)		2 (6.7)
State anxiety
Normal	Under 40	1 (3.3)	3 (10.0)	5 (16.7)	25 (83.3)
Possibility of clinical level of anxiety	Above 40	29 (96.7)	27 (90.0)	30 (100)	5 (17.7)

The cut-off points were set according to Driscoll (2007) and Emons et al. (2019). The results in the table represent scores during the post-test phase. The table shows that 90% of the participants had considerably high state anxiety scores. Notably, only participants from the control group were found in the high normal, moderately high-, and high-test anxiety categories. Regarding test anxiety, 83.37% of the participants had a normal score in the post-test phase. There are significant differences in pre and post-test test anxiety ranges between the experimental and control group (.002). However, there are no significant differences in state anxiety ranges between the control and experimental group.

Results of the Focus Group Discussion

The first two were engagement questions designed to create rapport with participants. The first question asked about participants’ favorite section of the STAPP guidelines. Participants’ comments are listed in italics below (P = participant, F = female, M = male).

Engagement questions: Four codes were created for the first question: all sessions, the first session, the second session, and the third session. Two references were found for all sessions, one reference for the first session, three references for the second session, and three references for the third session. Three of the seven participants indicated that the third section was most beneficial to them because the techniques they learned here helped them feel more comfortable and reduced exam stress. Two of the participants stated that they also used the techniques they learned in their everyday lives.

…third section, when explains the tools and techniques that reduce exam stress and anxiety because I’ve learned the techniques that are used in my daily life for any psychological stress to feel comfortable. P5F

Another three participants indicated that the second section was their favorite because it helped organize their daily routine, especially academic work.

…the second section, capacity building, because it talks about mental and physical health. And this point, I think this is very important for any student to comply and follow such procedures. P6F

Only one participant chose the first section.

…the first section, because there is a lot of information in it about exam anxiety, and when we read this information, it helps me identify when I am experiencing exam anxiety. P4F

The second question enquired about participants’ previous knowledge or experience with counseling for test anxiety. Two codes were identified: yes, for those who had prior knowledge about counseling, and no, for those without prior knowledge. Five references were found for those who had never attended counseling and two for those who had some knowledge about counseling.

Only one participant had received counseling for exam anxiety, and six participants had some information about exam anxiety from seminars or personal searches.

No, I haven’t participated in counseling sessions about exam anxiety, but I’ve sometimes searched this topic; that is, I had some information about it, but not like this. P1M

No, this is the first time I’ve ever participated in such counseling sessions about exam anxiety, and I had little information on the subject. P3M

Yes, I participated in counseling sessions about exam anxiety, and I had information about it. P4F

Exploratory Questions

The third question was an exploratory question about participants’ expectations from the counseling program.

Two themes were identified: overcoming test anxiety and feeling confident during exams. The second theme was about the expectation for support and empowerment.

…to feel comfortable with taking exams after this counseling program. P3M

I don’t want to feel like a failure when I am taking the exam, and I want to feel calm. P4F

…to feel relaxed and self-confident during exams. P7F

…to feel empowered and supported. P5F

The fourth question was, “How did you benefit from this program?” Six themes were identified: better performance, less anxiety, more confidence, test anxiety knowledge, relaxation techniques, and test preparation and test-wiseness techniques. One reference was found for better performance, five for test anxiety knowledge, and two for test preparation and test-wiseness techniques.

Of course, after I participated in this program, my information increased about exam anxiety and got benefits from it, and I was able to pass the semester exam, but before participating in this program, I used to become anxious about it, that is why I couldn’t answer the exam well and failed in some subjects. P2M

This program helped me a lot; I got a lot of information about exam anxiety and the ways of preventing worry. Before participating in this program, I was confused and always worried. P7F

Six references were identified for more confidence.

After I participated and read the leaflet of the program, I felt positive changes within myself; I felt in control. Before participating, I didn’t know what to do and always felt worried about succeeding in exams. P6F

One reference was identified for relaxation techniques and less anxiety.

After I participated in this program, I found a great change within myself and felt better. I’ve got information and new solutions such as how to prepare for exams, the technique of 1, 2,3,4,5, and the technique of deep breathing. This helped reduce the worry and anxiety within me. P1M

I felt I removed a barrier while taking the exam and felt in control. I’ve learned to prepare well for the exam, but before that, it was difficult for me because it was just like when you have a problem and don’t know how to solve it, and this is difficult. P5F

Question 5 was, “What did you learn about test anxiety?” Nine themes were identified: the pros and cons of test anxiety, that is, test anxiety is good for performance if it is not excessive (one reference); causes of test anxiety (six references); symptoms of test anxiety (five references); coping mechanisms for test anxiety (three references); and effects of test anxiety (two references).

I’ve learned that exam anxiety is a mental disorder, and it’s common among students. It has some signs; to confirm exam anxiety, such signs must be there. They are physical, cognitive, behavioral, and emotional signs. I’ve also learned that there are solutions. P5F

There are some reasons why students suffer from exam anxiety, including the fear of failure. For example, if a student connects his/her value with the exam marks or bad experience of an exam, that is, if a student has answered badly because he/she didn’t prepare well or had a problem or was under pressure and doesn’t remember the required answers, this can lead to additional anxiety and negative situation upon the exam. This is instead of some other biological and mental reasons. P6F

I’ve learned that it’s better if there is a little anxiety to encourage students to prepare better, but if the anxiety exceeds its limits, it will negatively impact exam performance; here, it can be called exam anxiety, and this happened to me, at exam time I got uncomfortable and thought whatever I do I won’t pass the exam, that is why I was disappointed, but now I know there’s a solution as well. P3M

Exam anxiety is a kind of stress that happens to some students while doing the exam; this refers to some factors; the students might not prepare himself/herself and gets afraid if they don’t answer questions well. Or maybe the student had answered worse before, that is why he gets stressed and uncomfortable in the exam and forgets what has been studied for the exam. P1M

The sixth question inquired if the participants had noticed any differences in their test preparation and test-taking behavior since the pandemic started. Four themes were identified: stress and preoccupation with COVID-19 (six references), poor exam preparation (six references), insufficient learning practices (one reference), and loss of peer cooperation (three references).

Yes, I noticed some differences; during COVID-19, there has been a great fear among people, and this affected me because there were rumors that universities would be closed or studies would be postponed; that is why I didn’t prepare myself well for the exam as much as possible, and I paid more attention to news rather than preparing for the exam. P1M

The difference was that before COVID-19, we as friends studied together, but after the outbreak, we’ve lost this chance to work together to prepare well for the exam; that is why at exam time, I thought I couldn’t answer well. P2M

I think at the time of COVID-19, we were too discouraged to focus on school, even if we were unwillingly studying the exam or preparing for the exam because our mind was always busy with COVID-19 news that how many people have been infected with the virus. P3M

The seventh question investigated the changes the participants noticed in their test preparation and test-taking behavior after participating in the STAPP. Seven themes were identified for this question: better performance (one reference), care for physical and psychological health (one reference), confidence (four references), reduction in anxiety from using coping techniques (five references), test preparation changes (four references), test-wiseness changes (one reference), and time management (one reference).

All the participants stated that they had noticed changes in their test preparation or test-taking behaviors after being involved in the STAPP.

Yes, I’ve noticed; after I received the program, it became clearer how to prepare for the exam and how to pay attention to my physical and mental health, and after I followed the program’s procedures, I can now go to the exam hall more comfortably. P2M

Yes, I’ve noticed changes within myself, especially intellectual changes, because, before that, I thought I had less ability to do exams well, but after I participated in this program and followed the steps of it, I achieved better results, and it showed that they were only some negative thoughts in my mind. P5F

As classmates said, I felt changes because in this program, I was more able to organize and balance my daily routines, and I can organize my time more efficiently, and this was the reason to become confident of myself that I could do the exam successfully. P4F

Exit Question

The last question was about how the participants would improve the program and what they would like to be included in the STAPP. Four themes were outlined: STAPP for all first-year students (one reference), STAPP was an effective program (five references), the need for individual sessions (two references), and more techniques (one reference).

The participants stated that the program was sufficient and successful. One participant said more techniques would be useful and that the STAPP should be administered to all first-year students to prepare them for university education, and that there should be individual sessions for students with very high-test anxiety scores.

I think the program was well organized, and we benefited a lot from three sessions of the program. The three sections are enough to get benefits from it, to help reduce test anxiety. The program had an impact on us. P7F

I think the program was good, but it would be better if there were more techniques and psychological tools in the third section because these techniques are like a weapon whenever we can use them. P1M

I think the program is useful. I just want to say that it would be wonderful if the program is suggested for all students at the first stage of university. And I agree with my classmates. P5F

I think the program is successful, but students who have extreme exam anxiety need more follow-up even after the program. While the program will benefit them, the exam anxiety won’t be resolved completely; that is why I suggest identifying such students and conducting individual sessions with them to get more benefits. A section on individual sessions should be added to this program. P3M

The main themes identified in this study included the effectiveness of the STAPP in transferring test preparation skills as well as helping students develop relaxation skills and test-wiseness. The importance of the guidebook as a reference text and the need for more techniques within the program were also highlighted.

Triangulation of Results of the Quantitative and Qualitative Phases of the Study

The results of the quantitative phase can be triangulated through analysis of the qualitative phase. Both the quantitative and qualitative results reveal that the STAPP is an effective intervention against test anxiety, as seen from the factorial ANOVA and the cross-tabulation of test anxiety scores. The same theme is restated in the focus group discussion. The participants outlined many benefits they received from the program. Six themes were identified from the benefits of the STAPP, as explained by the participants of the focus group discussion. The themes include better performance, less anxiety, more confidence, test anxiety knowledge, relaxation techniques, and test preparation and test-wiseness techniques. The STAPP was seen to be interactive as different students enjoyed different elements of the program. This suggests that it appeals to multi-intelligences. All the focus group discussion members stated that they had noticed positive changes in test-taking behavior since taking the STAPP. The overarching theme was about the effectiveness of the STAPP. The participants recommended that the STAPP be applied among all first-year students to prepare them for the stressors associated with tertiary education. They also highlighted the need for more techniques to help students to cope with anxiety. Various techniques may help students generalize what they learn to other contexts outside the classroom environment.

Discussion

In this study, we assessed the effectiveness of the STAPP intervention. The results revealed a significant difference in test anxiety scores between the intervention and control groups. The test anxiety scores of the intervention group decreased significantly, which suggests that the STAPP is an effective intervention for trait test anxiety. This is similar to previous studies (Nikpour et al., 2021; Hernowo & Zulkaida, 2021; Putwain & Von Der Embse, 2020; Setyowati et al., 2019). CBT interventions are effective for test anxiety among elementary, secondary school, and university students. Ganaprakasam and Selvaraja (2020) state that CBT allows students to restructure faulty beliefs about testing, which frees up working memory for test-oriented problem-solving. Reiss et al. (2017) also suggest that the breathing and relaxation techniques used in CBT are associated with decreased test anxiety. Furthermore, the individual gains mastery over emotions and cognitions, which allows them to combat maladaptive thoughts. By going through CBT, the individual begins to view maladaptive thoughts as transient cognitive events that are not based on the reality of the stressor or the individual.

The outcomes of CBT on the behavior described by the literature above are congruent with the experience described by the participants in the current study. Most participants stated that they utilized the techniques learned in the STAPP to help them relax and be calm in preparation for and during testing. All participants stated that they noticed differences in either their test preparation or test-taking behaviors. Participants stated that their test preparation had improved, which reduced their anxiety during exams. They could organize their schedules better and study more. Furthermore, participants felt more confident in dealing with test anxiety because they had more information about how common test anxiety was, its causes, and its symptoms. This suggests that the STAPP is effective at reducing test anxiety. The model for both the experimental and control groups fell into the high normal range of test anxiety in the pretest phase. While the mode for the control group remained in that range (2.5–2.9), the experimental group dropped to the normal range of test anxiety (2.0–2.5). The STAPP is a cognitive–behavioral intervention; it also offers cognitive, behavioral, and skills training. Interventions that address test anxiety at the cognitive and behavioral levels have been reported to be successful in alleviating test anxiety (Putwain & Von Der Embse, 2020).

This study revealed no significant differences in state anxiety scores between the experimental and control groups. This suggests that the STAPP is not effective against state anxiety. This is contrary to other research on cognitive–behavioral interventions for test anxiety, which revealed that the interventions could be effective even against clinical anxiety (Von Der Embse et al., 2013). The STAPP intervention was specifically designed to help participants cope with test anxiety. Most of the coping mechanisms learned were specific to testing situations, which may be why there were no significant differences in state anxiety scores between groups. These results suggest that the main source of state anxiety experienced by students was not associated with testing situations. Both the pre-and post-test phases were conducted before exams; however, only test anxiety was affected by testing-related interventions. Therefore, state anxiety within the sample may have emanated from other life events; often, trait and state anxiety are assumed to be synonymous (Eysenck & Calvo, 1992). Nevertheless, there is a distinction between the two (Endler & Kocovski, 2001; Quigley et al., 2012).

According to Spielberger (1972), test anxiety is a disposition to perceive tests in a threatening manner. Individuals differ in their predisposition to test anxiety. Test anxiety is a type of trait anxiety. Conversely, state anxiety is a transient response to anxiety-provoking situations. An individual can have high-state anxiety, which is not accompanied by trait anxiety (Ng & Lee, 2015). According to Ng and Lee (2015), state anxiety does not mediate the effects of test anxiety on performance. State anxiety is associated with threat-detection areas of the brain, such as the amygdala; trait test anxiety deactivates the prefrontal cortex, a region associated with maintaining attention (Bishop, 2009). Both state and trait anxiety have a role in performance; however, they function in different ways. State anxiety is believed to exert more influence when a task requires alerting and orienting attention. This suggests that increased levels of state anxiety may lead to better performance, as it allows students to concentrate on the task better (Quigley et al., 2012). Nonetheless, high levels of trait test anxiety are associated with poorer performance because it diminishes the ability to concentrate. The cognitive component of test anxiety has been identified as a component with the highest association with achievement than social, behavioral, affective, and physiological components (Von der Embse et al., 2018). This suggests that high state anxiety scores in the pre and post-state anxiety scores may be because data was collected just before exams. In this line, the high state anxiety score would facilitate better performance.

The results show that 96% of the sample has an anxiety score that suggests a clinical level of anxiety. Anxiety problems are one of the most prominent mental health problems among university students (Pedrelli et al., 2015). Having poor mental health literacy is associated with poor mental health as well as poor engagement in social groups and learning also make the individual more susceptible to mental health problem (Campbell et al., 2022). Poor engagement in education and social networks was one of the most dominant problems during the COVID pandemic, which could have heightened anxiety scores among university students. The high state anxiety scores in both the experimental and control groups are possibly the result of the COVID-19 pandemic. Various studies have stated that the pandemic has increased anxiety among the general population (Naser et al., 2020; Salehiniya & Abbaszadeh, 2021). Anxiety was prevalent among university students during the pandemic: 21.5% of students reported experiencing increased anxiety as opposed to 11.3% of healthcare professionals and 8.8% of the general population (Naser et al., 2020). According to Karim et al. (2020), being a college student was associated with high levels of anxiety among the Iraqi population, as well as being female, having a degree, and residing in southern cities. The increase in anxiety among students could have been influenced by the move to distance learning, requiring technological resources and skills students may not have possessed. These changes affected both the learning experience and academic performance.

Furthermore, the Iraqi population has a history of internal and external conflicts that predispose the population to mental health problems (Alhasnawi et al., 2009). A systematic review of mental health among university students shows that childhood trauma is the most common predictor of mental health problems in this developmental stage. Considering the recent history of war and unrest in Iraq, the context is congruent with this assertion. Considering the history of civil unrest in Iraq, it is plausible that high anxiety score may be linked to the population’s history of trauma early in life. Karim et al. (2020) stated that Iraqi people might also have had concerns about the adequacy of their healthcare system in handling the pandemic, leading to increased anxiety about the pandemic. Other factors consistently linked to poor mental health include having autism and being a member of the LGBTQ population (Campbell et al., 2022).

The current results also revealed that the STAPP was effective across both sampled departments and produced similar improvements in test anxiety scores between the two genders. This suggests that the STAPP can be effectively applied in different contexts. Most studies among university students in Iraq have focused on medical students (Mizranita et al., 2021; Rasheed & Hussein, 2019). However, this study suggests that there is a need to address anxiety concerns among non-medical students. Students in tertiary institutions experience high levels of anxiety because of new responsibilities, migrating from home, changes in their social life, and greater academic workload (Ameen, 2020). Consistently, Ameen (2020) revealed that the levels of anxiety, stress, and depression experienced by students ranged from moderate to extremely severe.

Conclusion

We investigated the effectiveness of the STAPP intervention—a short intervention program structured to be completed in three sessions. The results revealed that the STAPP is effective against test anxiety but not state anxiety. Test anxiety can be viewed as a trait persistent across time, as opposed to state anxiety, which is transient and dependent on the current situation. Our results suggest that students have high anxiety scores because of the uncertainty and difficulties created by the COVID-19 pandemic and its related environmental stressors. This coincides with recent studies showing that university students are more likely to experience anxiety than other occupational groups. The intervention was also effective across departments and genders. The STAPP provided useful knowledge about test anxiety, helping participants change their test preparation and test-taking behaviors. Furthermore, participants stated that the techniques they learned during the STAPP helped them be calm and confident during testing.

Limitations

This study had some limitations. Owing to the small sample size, the results cannot be generalized to the entire student population. No studies have focused on preventive intervention for test anxiety, which delimits the comparison of results. The WTAS used to measure test anxiety, produced a low-reliability score that negatively affected the replicability of the results. Despite these limitations, the researchers believe that the results of the study offer important insights into the STAPP intervention’s potential to alleviate test anxiety challenges among students.

Recommendations

School policymakers should implement anxiety interventions to help students improve their potential. The STAPP should also include exercises that promote the transfer of learning techniques to nonacademic settings to reduce state anxiety. The STAPP should be applied at all higher education institutions in the first year of university to prepare students for tertiary education, which includes testing.

Pedagogical implications: Educators should structure testing in a less threatening manner. An example is a continuous assessment, which allows students to demonstrate learning over a longer period as opposed to one exam. Interventions should be designed to address the pandemic-related anxiety students may experience. Furthermore, incorporating a STAPP handbook is also instrumental in ensuring the long-term application of learned principles since students have a resource to refer back to in times of distress.

In sum, this study should be replicated using a larger representative sample. Student performance should also be measured to ascertain the benefits of reducing anxiety on test performance. Anxiety prevention programs should include multi-context practice to help students transfer the learned techniques to other situations. An integration of both qualitative and quantitative follow-up research should be carried out to understand the long-term effects of the STAPP program.

Footnotes

Acknowledgements

I would like to acknowledge and give my warmest thanks to my supervisor Assist. Prof. Dr. Gizem Öneri UZUN who made this work possible. Her guidance and advice carried me through all the stages of writing my project.

I would also like to give special thanks to my wife, children, and my family as a whole for their continuous support and understanding when undertaking my research and writing my project. Your prayer for me was what sustained me this far.

I would like to express my gratitude to the copyright holders of the State-Trait Anxiety Inventory (STAI) for granting me permission to use their instrument in this research study. Their support has been invaluable in facilitating my work.

Author Contributions

Study concept and design, experiment, data collection, data analysis, interpretation, and drafting of the manuscript were performed by Jvan Abdulbaqi. Revisions to scientific contend of manuscript, access to crucial research components, and study supervision were provided by Gizem Uzune.

Declaration of Conflicting Interests

The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Funding

The author(s) received no financial support for the research, authorship, and/or publication of this article.

Ethical Approval

This study received ethical approval from Near East University (no. YDÜ/EB/2020/466). Permission was also sought from the University of Duhok, College of Basic Education, and the heads of the sampled departments and the University of Zakho, Faculty of Humanity.

Informed Consent

Written informed consent was obtained from all participants prior to data collection.

ORCID iD

Jvan Abdulbaqi

Data Availability

The datasets generated during and/or analyzed during the current study are available from the corresponding author on reasonable request.

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