Music Therapy and EFT: Integrative Medicine on Exam Anxiety in Turkish Nursing Students
Phase: NA
Conditions: Anxiety, Educational Problems
Sponsor: Istanbul Saglik Bilimleri University

 
Music Therapy and EFT: Integrative Medicine on Exam Anxiety in Turkish Nursing Students 
 
 
 
 
NCT Number: NCT03645811 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
10.10.2019 
 

STUDY PROTOCOL 
The literature highlights the importance of stress reduction for allowing students to maximize their 
learning of practical skills in the vocational education process. Techniques such as music therapy, 
cognitive therapy, emotional freedom techniques (EFT), breathing techniques, mind cleansing, 
aromatherapy, and relaxation of muscles have been used to reduce the anxiety levels of nursing 
students. However, to the best of our knowledge, no study has applied these interventions to reduce 
situational anxiety in nursing students before an OSCE or no study has compared these interventions.  
Taking these as a starting point, this paper aims to determine the effects of music therapy and EFT on 
situational anxiety and vital signs in nursing students before an OSCE and to compare these two 
methods. It is thought that through the results of the study, these techniques, which are easy, safe, 
and inexpensive to implement, can be used to reduce nursing students’ test anxiety and thus 
contribute to the improvement of their performance. 
This study was conducted with 90 volunteering students studying at the Faculty of Health Sciences, 
Department of Nursing, at a foundation university in Medipol University. The data was collected prior 
to the OSCE on May 31, 2017. Students included in the study were required to meet the eligibility 
criteria of (a) being 18 years old or above, (b) taking the theoretical course of Nursing Principles I and 
II, and (c) entering the OSCE on May 31 as part of the Nursing Principles Course. All students taking 
the exam were included in the study (n = 90). Using the website random.org, a randomly ordered 
class list was prepared with the student numbers in the classroom list. According to the newly 
created list, students were notified in writing one day before the exam about what time they were 
expected to arrive before the exam. Students who arrived on the day of the exam were assigned to 
the music therapy and EFT groups and the control group (Figure 1). Six students who did not 
volunteer to participate in the study, who arrived late, or who did not turn up, were not included in 
the study. Each group consisted of 15 students for more efficiency due to the insufficient number of 

supervisors to monitor them. The flow diagram created by the researchers was based on the 
Consolidated Standards of Reporting Trials (CONSORT) Checklist (Figure 1). 
According to a normal exam procedure, students show up in the place where the exam is held 
according to their student numbers at a time designated by the teacher. Before being summoned to 
the exam, they are required to wait in a room. In the study, however, during the waiting time, music 
therapy and EFT were applied to decrease students’ situational anxiety. Since researchers had 
received training on music therapy and EFT, these two interventions were applied. Accordingly, the 
study had two experimental groups and one control group. According to the randomly ordered class 
list, all students were notified in writing about what time they were required to arrive before the 
exam. All students who arrived on the specified time were assigned to one of the all groups. The 
students were taken to a 90m2 practice room. Each group was briefed for five minutes before 
obtaining their consent. The researchers and two assistants measured students’ vital signs. Five 
digital blood pressure monitors were used to measure the blood pressure, and three pulse oximeters 
were utilized to measure pulse and SpO2. The devices were calibrated before the measurements.  
The students were asked to fill out the Student Identification Form and the Situational Anxiety Scale. 
Afterwards, the interventions (music therapy and EFT) were applied for about 15 minutes. The 
interventions were applied by the authors, who are experts in their fields. Following the 
interventions, the researchers remeasured students’ vital signs and asked them to fill out the 
Situational Anxiety Scale again. For the control group, pre-measurements were taken, 15 minutes of 
free time was given, and then post-measurements were taken. 
Once each intervention was applied, the students were taken immediately to the OSCE rooms to 
prevent them from contacting each other. There were no disruptions to the exam flow. The whole 
process lasted approximately six hours for this study. No interaction was allowed between students 
leaving the exam and entering the exam. 
 

Figure 1. Study Protocol 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Note. n: Number of participants, M-G: Music therapy group, E-G: EFT (Emotional Freedom Techniques) Group C-G: Control 
group 
 
Analysis 
Analysed 
M-G (n=30 ) 
Assessed for eligibity (n=96)  
Excluded (n=6) 
 
Declined to 
participate  (n=3)* 
 
Analysed 
E-G (n=30 ) 
Allocation
Follow-Up 
Analysed 
C-G (n=30 ) 
Followed up 
M-G (n=30 ) 
Lost to follow-up 
M-G (n=0 ) 
Followed up 
C-G (n=30 )  
Lost to follow-up 
C-G (n=0 ) 
Followed up 
E-G (n=30 )  
Lost to follow-up 
E-G (n=0 ) 
Enrollment 
Randomized (n=96) 
Allocated to 
intervention (n= 32) 
➢ Received allocated  
M-G (n=30 ) **n=2 
Allocated to 
intervention (n= 32) 
➢ Received allocated       
E-G (n=30 ) *n=1 **n=1 
Allocated to 
intervention (n= 32) 
➢ Received allocated  
C-G (n=30 ) *n=2 

Data Analysis 
Licensed SPSS 16.0 (Statistical Package for the Social Sciences for Windows, Version 16.0) was used 
for the data analysis. The results were evaluated within 95% confidence intervals, at a significance 
level of p < .05. Nominal variables were rated for frequency and percentage; ordinal variables were 
rated for the mean, and standard deviation. Baseline demographic information among the groups was 
analyzed using the Kruskal Wallis H test and Mann-Whitney U test. Due to the non-normal 
distribution, the Kruskal Wallis H test was used to compare pre-post intervention (or free time for 
control groups) anxiety, separately, between the three groups and the Wilcoxon Signed-Rank test was 
used to compare pre/post anxiety and vital signs within groups. Also, the Wilcoxon Signed Rank test 
was conducted to compare the pairwise groups within 95% confidence intervals. 
 
 
 
 
 
 
 
 
 
 
 
 

Results 
Table. Distribution of descriptive characteristics of students by groups  
 Groups 
Characteristics 
Music  
Therapy 
(n = 30) 
EFT 
(n = 30) 
Control 
     (n = 30) 
 
x2 / Z 
p 
N 
% 
n 
% 
n 
% 
Age 
Mean±SD 
18.9 ± 0.88 
19.1 ± 0.88 
19.5 ± 1.07 
1.095 
.778* 
Gender 
Female 
27 
90.0 
23 
76.7 
24 
80.0 
3.163 
.367** 
Male 
3 
10.0 
7 
23.3 
6 
20.0 
Place of Residence  
With parents  
23 
76.7 
24 
80.0 
24 
80.0 
 
.301 
.960* 
Student 
dormitory 
4 
13.3 
5 
16.7 
5 
16.7 
With relatives 
3 
10.0 
1 
3.3 
1 
3.3 
Alone 
- 
- 
- 
- 
- 
- 
Economic status  
Poor 
- 
- 
1 
3.3 
- 
- 
 
3.084 
.379** 
Average 
19 
63.3 
12 
40.0 
15 
50 
Good  
11 
36.7 
17 
56.7 
15 
50 
Very good 
- 
- 
- 
- 
- 
- 
Total  
30 
100 
30 
100 
30 
100 
 
Note. *: Kruskal-Wallis H test, **: Mann-Whitney U test, n: Number of participants, %: Percentage, SD: Standard Deviation, 
EFT: Emotional Freedom Techniques, p < .05. 
 
 
 
 

Table. Comparison of score averages from the Situational Anxiety Scale Pre- and Post applications 
according to groups 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Note. *: Kruskal-Wallis H test, **: Wilcoxon Signed Rank test, n: Number of participants, SD: Standard Deviation, p < .05. 
 
 
 
 
 
 
 
 
 
 
 
 
 
 Groups 
 
Music 
Therapy 
(n = 30) 
EFT 
(n = 30) 
Control 
(n = 30) 
 
Test 
Median, 
25th/75th 
percentile 
Median, 
25th/75th 
percentile 
Median, 
25th/75th 
percentile 
 
x2* 
 
P 
 
Before 
 
55,00 
49,75/60,75 
 
56,5, 
49,5/61,25 
 
55,00 
41,75/59,00 
 
.284 
 
.868 
 
After 
 
44,50 
41,75/49,00 
 
43,00 
34,75/51,25 
 
56,00 
44,75/59,25 
 
8.328 
 
.016 
Z** 
p 
 
-3.850 
.000 
 
-3.212 
.001 
 
-.733 
.464 
 

Table. Comparison of vital signs pre- and post applications of groups 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Note. *: Wilcoxon Signed Rank test, n: Number of participants, EFT: Emotional Freedom Techniques, BP: Blood Pressure, p < 
.05. 
 
 
 
 
 
 
 
 
 
 
 
 
Groups 
 
 
Music Therapy 
(n = 30) 
EFT 
(n = 30) 
Control 
(n = 30) 
Pre / Post 
Median 
Pre / Post 
Median 
Pre / Post 
Median 
Systolic BP 
Z* 
p 
110 / 110 
-1.782 
.075 
116.5 / 110 
-.257 
.797 
110 /114 
-.415 
.678 
Diastolic BP 
Z* 
p 
70 / 65 
-.811 
.417 
69.5 / 70 
-.876 
.381 
70 / 72 
-.787 
.431 
Pulse 
Z* 
p 
 
89.5 / 88.5 
-1.540 
.124 
86 / 83  
-2.493 
.013 
89.5 / 89 
-.530 
.596 
SpO2 
Z* 
p 
 
98 / 98 
-2.360 
.018 
98 / 98 
-.717 
.473 
98 / 98 
-.180 
.857 

Conclusion 
In conclusion, it was observed that music therapy and EFT were effective in reducing nursing 
students’ test anxiety before the OSCE. Also, it was found that the methods had no superiority over 
one another. After the music therapy and EFT session, systolic and diastolic blood pressure and pulse 
averages of the students decreased, and the SpO2 rate increased. Therefore, we can say that these 
interventions, which are easy and safe to apply, can reduce test anxiety, which, in turn, can lead to 
an increase in students’ test performance. However, it must also be noted that there is a need for 
larger randomized controlled trials comparing music therapy with EFT as an intervention to reduce 
physiological parameters. We believe that the results of this study will contribute to the 
determination of effective methods for reducing test anxiety. Finally, we recommend that nursing 
educators acquire competency in integrative methods and apply these methods to help their 
students suffering from test anxiety.