This randomized clinical trial aimed to compare the effectiveness of Mandala coloring and Twin Hearts Meditation in reducing exam anxiety among undergraduate nursing students. Participants were randomly assigned to either the Mandala coloring group or the Twin Hearts Meditation group. Both interventions were administered before a practical examination. Anxiety levels were measured before and after the intervention using the State-Trait Anxiety Inventory (STAI). The study evaluated which complementary and non-pharmacological intervention was more effective in reducing exam-related anxiety among nursing students.

Study Purpose

The purpose of this study was to compare the effectiveness of Mandala coloring and Twin Hearts Meditation as complementary and non-pharmacological interventions for reducing exam anxiety among undergraduate nursing students.

Study Design

This study was designed as a randomized clinical trial conducted among undergraduate nursing students. Participants were randomly assigned to two intervention groups: Mandala coloring and Twin Hearts Meditation.

Sample Size

Out of 110 eligible nursing students, 100 who met the inclusion criteria were recruited. Based on previous research and a mean comparison formula with a significance level of 0.05 and a statistical power of 80%, the required sample size was calculated as 48 participants per group. Considering possible dropout, 50 participants were included in each group.

Data Collection Tools

Data were collected using:

• A demographic questionnaire (age, gender, marital status, academic information)
• The State-Trait Anxiety Inventory (STAI), a validated 40-item self-report instrument measuring state and trait anxiety.

Intervention

Participants were randomly assigned to one of two groups:

Twin Hearts Meditation Group:

Participants received a guided Twin Hearts Meditation session lasting 30 minutes under the supervision of the researcher.

Mandala Coloring Group:

Participants engaged in mandala coloring for 30 minutes using printed mandala designs and colored pencils under the supervision of the researcher.

Both interventions were conducted before a practical examination.

Outcome Assessment

Anxiety levels were measured before and after the intervention using the State-Trait Anxiety Inventory (STAI).

Ethical Considerations

The research received approval from the Cyprus International University Ethics Review Board (Approval No: EKK23-24/012/07). The study followed the ethical standards of the Council of Ethics and adhered to the principles of the Declaration of Helsinki (1964).

Statistical Analysis

Data were analyzed using SPSS software. Descriptive statistics, paired t-tests, independent t-tests, and chi-square tests were used. A P value < 0.05 was considered statistically significant.

Inclusion Criteria:

1. All undergraduate nursing students in their first semester, male or female, enrolled in the English-language nursing program.
2. Students not using other stress-reduction methods (e.g., progressive muscle relaxation, pharmacological therapy).
3. Students who voluntarily agreed to participate and provided informed consent.

Exclusion Criteria:

1. Unwilling to continue cooperation in the project.
2. Using any psycho medicines (anti-depressants ...), mental health.
3. Mourning, especially the death of loved ones or relatives in the 1st phase.

There is no plan to make IPD available to other researchers

To reduce bias, the investigator responsible for data collection and the statistician analyzing the data were blinded to group assignments. The intervention groups were coded as anonymous variables during data analysis.