INTRODUCTION:

Test anxiety can also be termed as anticipatory anxiety, examination anxiety that occurs in situation like facing exam. Indeed, there is a stirred up state in physiological level causing over-arousal, tension and somatic symptoms and psychological level causing poor attention, deterioration in perception and thought fluency this can lead to worry, dread, fear of failure, and catastrophic experiences before or during test situations among the students. At the same time normal anxiety is helpful in preparing the students to face the exam. The current review analysis is often helpful to stay mentally and physically alert.^[1]

Examination stress experienced by students ‘cause test anxiety however, experiencing too much anxiety can result in emotional and physical distress leads to difficulty in concentrating, and emotional worry. Inferior performance arises not because of intellectual problems or poor academic preparation, but because testing situations create a sense of threat for those experiencing test anxieties; further this anxiety disrupts attention and memory function.^[1]

Test anxiety is one of the common problems among first year university students’ the number studies regarding test anxiety is carried out over the globe. The current study analyses the past literature on test anxiety has been studied uni-dimensionally and bi-dimensionally learned its edifice components such as worry and emotions that’s apart of cognition and affective behaviour respectively. The current study had analysed this fact in the previous research that indicate test anxiety was a singular attribute, which could be measured with uni-dimensional scales. However, observing one of the past researches conducted in the early 1970s found with consensus that test anxiety (TA) is a bi-dimensional construct, consisting of the components worry and emotionality.^{[2, 3]}

Current research analysis also observes the stated fact that the ‘worry’ has been referred as cognitive test anxiety, cognitive reaction or internal dialogue during and after evaluative situations.^[4]Current research analysis further indicates that individuals with high level of cognition reported regarding their thoughts of comparing self-performance with their peer group, worries related consequences of failure, loss of self-esteem and self-worth, low levels of confidence, underestimating their own abilities as well as excessive worry over evaluation increases the frequently test anxiety.^[5,6] The anxiousness is a part of emotionality referring to the physiological responses to the examination had studied in the current review analysis. Further examining the past reviews indicate that test anxiety causing physiological manifestations include increased galvanic skin response and heart rate, dizziness, nausea, or becoming panicky.^[4,7] Current study had revealed the fact reported by one of the previous literature that the emotionality is a component of test anxiety that refers not only the physiological arousal but also to the individual’s subjective interpretation of internal events. This study also observes the subjective arousal of individuals with high test anxiety moderately correlated with objective arousal.^[8] It is a learned fact that role of cognition impacting test anxiety. Current study had examined this fact in the past literature had revealed that the relationship between these two components of test anxiety; the cognitive component directly impacts performance in evaluative situations and the emotional component though it is related but does not directly influence test performance. Another literature with this regard on the cognitive aspect of anxiety indicates that students with high, medium and low cognitive test anxiety differed considerably in their performance in the examinations and scholastic assessment test.^{[6, 9]}

The current study in its review analysis makes an effort to examine the test anxiety causing performance error; examining the past literature with the correlational studies had revealed that experimental data demonstrated students with high test anxiety make more performance errors than that of students with low test anxiety.^[10] This study also observes that absence of evaluative stress and there were no differences in performance between the students; here cognitive aspect of test anxiety was indicated as causal determinant of poor performance.^[10] Current study had analysed in its review examination on the past studies that discloses the fact studied regarding poor performance during evaluation is due to students being unable to retrieve previously learned information during the evaluative situation. This fact had further analysed the reasons for inability for retrieval during the assessment is due to intruding thoughts and interfering thoughts include fears of failure, self-critical thoughts and comparing self to peers.

Current study examined facts indicates that conceptualization of test anxiety is said to be naïve approach that fails to take into consideration that the effect of interfering thoughts in the preparation and lead up to an examination.^{[11, 12]} Further analysed fact reveals that students with high levels of test anxiety experienced problems at all levels of information processing, that is encoding, storage and retrieval. ^[13] Current study supplements with explored facts found in the previous research model that includes different stages of information processing model of test anxiety.^[14] Further examining the previous researches in the literature study revealed that information processing model, is thought to be the most comprehensive and widely accepted theoretical model for understanding test anxiety and its relation to exam performance though it does not address the self-critical thought patterns which interfere with information retrieval. Further it is understood that importance of self-criticism in the development and maintenance of test anxiety. ^[13,
15]

The current study had reviewed the past literature indicates that self-criticism can be described as scrutiny and censorship of personal behaviours, thoughts and emotions. It has been learned through analysed fact that criticism arises when there is a gap between the individual’s perception of reality and their own expectations; this fact has been observed in one of the studies on high school students, showed that test anxiety was highly correlated with self-criticism.^[16] This review analyses the fact in the previous studies conducted on individuals with high test anxiety students who reported higher levels of helplessness over test performance than low test anxiety students.^[17]This analysis of literature study identified some of the facts such as the low level of self-efficacy among students with high test anxiety is associated with learned helplessness, failure, avoidance and low personal goal setting, these students are less likely to find coping strategies for their anxiety which reinforces the cycle of low self-expectations, high levels of cognitive test anxiety and poor performance on tests.^[17] Literature review analyse by the present study had found that self-efficacy and learned helplessness plays an important part in the self-critical thinking of students with high levels of test anxiety thus role of both self-esteem and self-criticism in the development and persistence of test anxiety is vital to our understanding of this concept and should be considered when thinking about possible intervention strategies.^[17] Furthermore explored facts by current review analysis among high test anxiety students identified higher feelings of inadequacy, feelings of self-disgust, a lower capacity for self-acceptance, self-compassion and also other aspects such as influence of self-expectations, self-efficacy on test anxiety,^[18] one of the analysed studies also found with negative correlation between test anxiety and self-efficacy.^[19]

The current study had made an effort to explore different procedures that can help the students with test anxiety. This review study had identified a range of different therapeutic procedures employed in the attempt to treat test anxiety; one of the most commonly used behavioural techniques for reducing exam anxiety is found as systematic desensitization which is made up of two components where the students are taught relaxation techniques and trained them for using these techniques to remain calm when in an anxiety provoking situation (test) is encountered, students are then exposed to of the situation which evoke anxiety hierarchically, for example imagine walking in to an exam hall, when they grow anxious they need to practice using these relaxation techniques. This teaching is repeated until the individual is able to imagine the testing situation with considerably reduced amount of anxiety. Further it also found that students with test anxiety who took part in a systematic desensitization intervention showed significant drop in levels of test anxiety. ^[20]Current review analysis of the previous studies had found that systematic desensitization and cognitive-behavioural techniques such as cognitive modification, attention training and insight therapy were shown to significantly reduce test anxiety.^[7]

Test anxiety promoting students’ performance:

Anxiousness is a one of the normal emotional states, is experienced in varying degrees and intensities, it is helpful for individuals to cope with the stressors. As a fact anxiety is structured into individuals brain plays an important role in preparing individuals for fight-or-flight response and to face threatening situations. Test anxiety is normal phenomenon for the students facing examination. It helps the students to prepare for their mind set to face exam related stress. The current study has found in the literature that the anxiety is an obvious element in human being’s life that affect their performance and effectiveness in different situations, an average level of anxiety is useful in keeping people hardworking and responsible for their work and also helpful for people to be more workable for their affluent life.^[21,22]It is an understandable fact that first year university students in their adaptation process to the new environment distracted from the main stream of academics. The motivation to do well in their academic performance is one of the important cognitive content they need to cling on along with their adaptation process. Their normal anxiety level or the mild to moderate anxiety to do better in their academic performance makes them to work heard this paves a way for positive performance in their examination. One of the previous literature analysis reveals that a little anxiety during exams is required that will help students to get motivated and learn.^[23] Test anxiety has its can affect students positively or negatively. Indeed, anxiety is an important element of emotion that that drives the students’ towards their academic achievement. Thus it has been constantly studied the relationship between test anxiety and academic achievement among undergraduate nursing students. The review analysis of previous studies shows that the test anxiety undeniably plays an important role in students' performance.^{[23, 24]}

It is also understood that some level of anxiety is important for achievement motivation that is an important aspect of behaviour needed to enhance students’ performance in the examination. Review analysis done by the current study has found an acceptable level of test anxiety in students motivates them to work hard and provides them with its positive consequences.^[25] The relationship between test anxiety and academic performance is challenging; current study had analysed this fact indicates that important aspect of a student’s life influenced by one of the factors is anxiety level leading to hard work or preparations done prior to the examination.^[26] Present study had observed in one of the previous study that showing the results indicating positive relationship between students’ high level of academic achievement and anxiety as predictor of aspiration among the achievers.^[27] It is a learnt fact that anxiety varies its level and intensity in individuals when they face challenges. It differs person to person. Review analysis of the past literature observes anxiety as a conceivable factor that affects a person’s academic ability and achievement. It varies markedly from one individual to another.^[28]Current study had also observed in the past reviews indicates that anxiety as a predictor of aspiration among the students who are going to face examination. Further analysis of this review reveals that aspirations of high grades are an additional locomotive that could affect student motivation and academic achievement. It is also found that this determination of learning is an important psychological construct that provides two aspects of the effort, namely anxiety and motivation.^[29]

Test anxiety is a serious problem among student population:

It is a normal response of an individual being anxious when individuals face ambiguity and unprepared to cope with stressful situations. Preparedness for taking exam makes students less anxious than that of the students who are unprepared. The current review analyses of past literature study conducted on nursing students had observed that higher level of test anxiety experienced by the students affecting their emotional wellbeing. The further analysis of the past review had also indicated the test anxiety effecting among nursing student’s more than general public and high school students in their comparison.^[30]

It is common fact that the exams that may leave individuals upset. The stress converts into distress when the individuals’ adhere constantly regarding unsubstantiated worry about the exams can distress them that can lead them to high level of anxiety that disturbs their social life and interferes with their performance. Generally the stress converting in to distress is commonly seen in first year students who are newly adapting to university are more anxious during their examination. The current review study reveals the facts observed in the past literature that the students’ psychological changes that often correlate multi factors like financial, academic and adaption difficulties to the new environment and adjusting to university life indicated higher level of anxiety.^[31,32]

The adjustment period among the year one students who study in the university take longer period in adapting to the new environment and there is a proclivity to pile up their academic work till the foot of the exam dates thus commonly find them over anxious during examination. This literature review examines the fact that university is a totally new environment for the students therefore there is a delay in their adjustment to the academic, social, personal and lifestyle encounters.^[33] Generally the everyday events that demanding more adjustment lead to persistent anxiety that can interfere with life this kind of interference in students’ life that may cause poor performance in their examinations. This fact had observed in the past review had analysed by the current study that reveals high demands of nursing curriculum, workload and family responsibilities with the long hours of studying are the demanding aspect of the nursing students life that causes test anxiety in them.^[34]

The reviewed fact by the current study indicates that the individuals’ negative thoughts about the threatening situations contribute higher level of anxiety in them. One of the reviewed studies also revealed that the factors contributing of test anxiety that include psychological factors, thinking negatively about test causes higher level of anxiety among the students.^[35] Students’ transiting from the school to the university need to mend their already set habits and study patterns to fit in university patterns this adjustment may threaten them during exams and cause test anxiety among many of them. The current review analyses the results of one of the previous study about habits among undergraduate students causing test anxiety.^[36]It is a learned fact that anxiety is a normal emotion significant aspect needed for survival. Thus students to prepare for their examination need to have this normal anxiety. However, there is an individual difference that some become highly anxious with the least provocation that can trigger emotional disturbances in them. Analysing the past reviews on this aspect it has been observed that students who have on-going and excessive fear get and distressed leads to poor performance in the examination thus this study indicates that physical, emotional, cognitive state had proven detrimental to their achievement.^[37]

The anticipation is generally reflects in anxiety and fear that signifies need adaption to challenge the fear-provoking circumstance. The anxious state has its own significance in readying individuals to cope with a future problem situation. If anticipation cause over anxiousness may cause harm if not prevented. The current review study had examined the chronicity of this higher level anxiety leading to ill health particularly perceived stress causing unhealthy behaviours among university students, such as substance abuse, poor psychological health, poor physical health, reduced social involvement, and poor academic performance.^{[38, 39]}

Current review study basing the past literature had learned that physiological changes and HPA axis activity changes when individuals experience anxiety.^[38]Further this review analysis on several other studies indicates that stress and anxiety can stimulate psychological and physiological responses in cardiovascular, hypothalamic-pituitary-adrenal axis activity^[40,41]and observed that changes in blood pressure and increased heart rate in situations like examinations.^[42] Over anxiousness among students who are preparing for their exam is led by their own thoughts concerning passing or failing in their exam. The current study analysis of past literature reveals that regarding fear and anxiety hipping students that prepares their mind and body for automatic action. However, it has been noticed that they are also at risk for very serious negative consequences. The experience of fear or anxiety may at times unpleasant and may lead to loss of physical and psychological homeostasis that may cause anxiety that leads to autonomic changes such as increase heart rate, blood pressure and changes in breathing pattern and also the body changes HPA activity with increased serum cortisol. These facts are analysed in the current review analysis of the past literature that had indicated the increased level of cortisol from relaxed state to stress state during viva examination among the students.^[43]

The presence of test anxiety is needed to be focused. The current review analysis principally focused on the element studied in the past literature found that test anxiety contributes to poor examination performance.^{[8, 44,45]} The current review analysis indicates the importance also of having test anxiety to keep the students motivational spirit during examination. Observation of the past literature is also found that exam anxiety maintains students’ alertness that they are able to change examination answers from incorrect to correct.^[46] Test anxiety is the emotional reaction when students’ need to cope with examination. However it varies among students depends on their preparedness and certainty to facing the exam. One of the past researches identified test anxiety emotional reaction that experienced by some students that they faced before exams; this emotional reaction consists of two components; “worry” identified as cognitive expression students concern about performance and “emotional” identified as an autonomic reactions which tend to occur examination stress.^[47] One of the negative aspects of test anxiety observed by the current study of past reviews reveals that the effects of anxiety on student concentration impacts performance prior to the examination, preparatory time of examination and also completion time of examination.^[2,48]

The relationship between mindfulness and test anxiety:

In management of test anxiety students’ can get trained in mindfulness activities or related techniques of intervention. The current review study explores the relationship between mindfulness and test anxiety through analysing previous researches regarding this aspect. One of the analysed studies reveals the important mechanisms of mindfulness training and its benefits in mindfulness based interventions. Further analysed fact indicates there is an expanded interest in cultivating mindfulness activities in helping students with test anxiety. ^[16] Current study had analysed in its review on past literature indicates that students with high test anxiety \found with higher levels of negative self-criticism, high levels of self-critical thoughts is found to have an association with low levels of self-acceptance and lacking mindfulness skills this has played an important role in the development and maintenance of test anxiety. ^[16]

Current study has further explored the implications of mindfulness in its review analysis indicated interventions could be cultivated to help students with test anxiety identify and have an increased awareness of thoughts of self- criticism, and to accept these thoughts without judgment. It may be suggested that acknowledgement of negative, self-critical thoughts which maintain and exacerbate test anxiety this in turn could help to improve both psychological wellbeing and test performance in anxious students.^[49] The current review study also focus at the use of mindfulness interventions on test anxiety explored the effectiveness of a brief mindfulness intervention on maths test anxiety and exam scores in a high school population where the participants were trained for brief guided meditation directly before taking their math exam; the result of which is found with significant reductions in anxiety, as well as improvements in exam scores from before to after the intervention.^[50] Observation of past literature also explored the effectiveness of a classroom mindfulness colouring activity for test anxiety in primary school aged children.[51] Analysed past literature studies in the current study had identified the suggestions and thoughts that has been put forward by one of the past literature is that structured colouring of a reasonably complex geometric pattern may induce a meditative state that benefits individuals suffering from anxiety and mindfulness colouring pair the creative manipulation of materials of art making has the benefits of mindfulness meditation.^[52]

Mind- body interventions to help students with anxiety :

Mindfulness prospective interventions that can be introduced to first year university students; more specifically who face test anxiety and vulnerable to have negative impact on their examinations. Mindful breathing and cognitive reappraisal practices shown effective in reducing test anxiety. Review analysis had indicated that training students to be mindful and breathing exercise could increase s positive automatic thoughts more than that of cognitive reappraisal. ^[53] Tests and exams are vital part in people’s lives it’s though the significance differs person to person. Higher education in the university has an own demands to cope with. Students newly joined commonly find difficulties to adapt to these demands more commonly fist year students face stress and anxiety during their exams. Test anxiety can be described as a significantly unpleasant experience of worry and emotionality. Current review study analyses that the test anxiety is an important factor that has a negative impact reduces psychological wellbeing and hamper student’s academic achievement. This review analysis also indicates the potential use of a mindfulness intervention that has been delivered in an ad hoc basis, via an online mobile application, found to be useful in reducing test anxiety among university students. ^[54]

The current study had also focused on reviewing articles that is informative in indicating its benefit to the students who has high level of test anxiety; further this study had observed that last of decades there has been an outpouring interest in mindfulness working as psychological construct as well as a clinical intervention.^[55] Current studies reviewed that mindfulness is intentionally accepting and it is a non-judgmental focus of one's attention on the emotions, thoughts and sensations occurring in the present moment.^[56] Further analyses on literature done by the current study indicate that mindfulness is an ability to direct one’s attention in a way that has been practiced through meditation with regard to this concept current study had also reviewed the literature on mindfulness meditation thus finds its roots in ancient spiritual traditions of Buddhism which is over 2550 years old. Further it had been observed by the current study that mindfulness has been both theoretically and empirically associated with wellbeing of the people in general; study also indicates that despite its ancient roots currently the application of mindfulness also found in mental health practices in western psychology is a recent phenomenon. ^[57]Analyses done by the current study had found the elements of mindfulness that have been thought to be potentially effective tools to treat psychological distress, such as anxiety, stress and depression.^[58,59]Indeed the mindfulness has been cultivated to prevent maladaptive tendencies to avoid, suppress, or over-engage with distressing thoughts and emotions.^[58,59] Another identified fact by this research analysis is the positive correlations between self-reported mindfulness and psychological health.^{[58, 59, 60]}

Observed facts analysed by the current review study found that clinical psychology has developed therapeutic applications based on mindfulness that is most frequently cited mindfulness training for stress reduction.[61] Further it had been reviewed by the current study that the national health services in United Kingdom has adapted treatment of depression and anxiety using mindfulness based stress reduction programme that is a structured group program uses techniques such as the body scan and take part in group meditations. ^[62]It is also found that mindfulness based stress reduction course for patient with depression helped in decreasing levels of depression and anxiety; further basing on this mindfulness-based cognitive therapy has been structured.^[63] This therapeutic intervention has taken a base on mindfulness stress reduction intervention programmes.^[64]

The reviewed fact by the current study is the skill of intentional control on individuals thought in mindfulness meditation could be helpful in preventing relapse of major depression further incorporating elements of cognitive therapy, patients are taught to observe their thoughts and feelings without judgment and to view them as events that will come and go, rather than something which is part of themselves.^[65] It is also identified by current review analysis of past literature that the patients with more previous episodes of depression, mindfulness based cognitive therapy significantly reduced risk of relapse.^[66] One of the studies that had been analysed found with their attempt to explain the mechanisms of mindfulness skills and how they may lead to both reductions in symptoms and changes in behaviour.^[67] Further one another study comes out with thought that one of these mechanisms is cognitive change.^[68]

Anxiety related thoughts and feelings are not always reflection of reality it is resultant of our belief system thus do not need to be avoided in such cases mindfulness training can help the individuals in their self-management and coping skills. Awareness of cognitive and emotional events as they happens the mindfulness training can help individuals to recognise early signs of a problem so they can work non it. Analysed literature by the current study indicates that mindfulness training can allow and promote recognition of these early signs of a problem in individuals who are equipped with previously learned coping strategies and they can effectively manage this problem. ^[65] Analysing one of the past literature the current study indicates that mindfulness training teaches acceptance of self and experiencing events fully without using defence, as they are thus do not cling on faulty defensive behaviours.^[67]

Current review study had examined although beginning of mindfulness practice as a spiritual back ground it has been considerably changed in the last forty years mindfulness being used in a variety of different context from mental health to the work place. Further studying this issue analysing the past literature current study had found that the mindfulness as a flexible tradition that its use has been seen in various cultures further it has been observed that mindfulness ways changing and adapting in response to things has never encountered even in western psychology, technology and it has been accepted well.^[69]

The current study had observed the reviews of past literature in the current scenario there is increase in Mindfulness-based mobile apps as an alternative delivery medium for mindfulness training through mobile apps that state two major issues. Current study indicate these two issues observed in the literature; first is regarding mental health issues being able to provide services and support to the many millions of people, the second issue describes how mindfulness and technology are often presented as being in opposition to each other. ^[68] Mobile health is a new emerging field which utilizes technology such as smartphones to enhance and monitor physical and psychological health.^[69]

This study had observed that the highest quality apps attractively included in the mindfulness education as well as guided meditations indicated the effectiveness of the headspace mindfulness app used on happiness seekers’ found to be useful and that had paved a way for significant gains in reducing depressive symptoms.^[70] Current study reveals that the very few studies on mindfulness based mobile applications has been suggested that it is an acceptable and innovative method of delivering mindfulness that can bring the improvements in mental and emotional wellbeing. Current study finds the need for further research that can expand the scope for the researchers concerning the effectiveness of such mindfulness based mobile apps.

METHOD:

The purpose of this literature review was to identify mind- body interventions for the students’ facing test anxiety among first year university students. A literature search was conducted with electronic databases included Cumulative Index to Nursing and Allied Health Literature, Medline/ PubMed, EBSCO, SCOPUS, and Science Direct. Search terms used included therapy, test anxiety, exam anxiety, and examination anxiety, each paired with nursing students. Research articles explored from dating back to1961 to 2017, further articles were analysed finding the usefulness mindfulness’ throughout the historical development until current new advances in mindfulness interventions on test anxiety.

RESULTS:

A total reviewed by the current study seventy (n=70) articles that were found following database search. The current study had successfully analysed the past literature reviews had reviled the various aspects of test anxiety, test anxiety promoting students’ performance, test anxiety is a serious problem among student population, the relationship between mindfulness and test anxiety and mind- body interventions to help students with anxiety.

CONCLUSION:

Current study concludes that it is important to understand the fact that test anxiety is common among students but it varies in degree. For some students’ it may be beneficial, for others it may lead to poor performance and may cause negative effect on their health. The current literature study recommends that academicians and educationalists in the universities should have awareness about negative and positive aspects of this test anxiety and its impact on students. Further, it also suggests that introduction of mind- body interventional programmes in the university should be practiced to promote overall health and wellbeing among student population. The current review had analysed the benefits and advances seen in the research studies exhibits mindfulness from the ancient history to current advances in mindfulness based mobile apps. Thus suggest that landing with various mindfulness training programme for the first year students of university to promote emotional and psychological wellbeing can endorse overall healthiness in the educational system as well in the communities.

FUNDING:

This study obtains Research Acculturation Grant Scheme (RAGS), Ministry of Education Malaysia.

REFERENCES:

1 Birjandi P and AlemiM.The impact of test anxiety on test performance among Iranian EFL learners" BRAIN. Broad Research in Artificial Intelligence and Neuroscience.1 (4); 2010:44 – 58.

2 Sarason IG. Test anxiety and the intellectual performance of college students. Journal of Educational Psychology.52(4);1961: 201-206.

3 Liebert RM and Morris LW. Cognitive and emotional components of test anxiety: a distinction and some initial data. Psychol Rep. 20(3); 1961: 975-958.

4 Cassady JC. The stability of undergraduate students’ cognitive test anxiety levels.20(7); 2001: 1-5.

5 Depreeuw AM. A profile of the test-anxious student. Applied Psychology. 33(2); 1984: 221–232.

6 Cassady JC and Johnson RE. Cognitive test anxiety and academic performance, Contemporary Educational Psychology.27; 2002: 270–295.

7 Hembree R. Correlates, causes, effects and treatment of test anxiety. Review of Educational Research. 58 (1); 1988: 47–77.

8 Schwarzer R. Worry and emotionality as separate components in test anxiety. International Review of Applied Psychology. 33 (2); 1994: 205–220.

9 Bandalos DL, Yates K, and Thorndike-Christ T. Effects of math self-concept, perceived self-efficacy, and attributions for failure and success on test anxiety. Journal of Educational Psychology. 87(4); 1995: 611–623.

10 Kurosawa Kand Harackiewicz JM. Test anxiety, self-awareness, and cognitive interference: A process analysis. Journal of Personality. 63(4); 1995: 931–951.

11 Sarason IG. Stress, anxiety, and cognitive interference: Reactions to tests. Journal of Personality and Social Psychology. 46(4); 1984: 929–938.

12 Schwarzer Rand Jerusalem M. Advances in anxiety theory: A cognitive process approach. In KA Hagtvet& TB Johnsen (Eds), Advances in test anxiety research Lisse, the Netherlands: Swets&Zeitlinger. 7: 1992: 2-31.

13 Benjamin M. A comparison of training programs intended for different types of test-anxious students: Further support for an information-processing model. Journal of Educational Psychology.83(1); 1991: 134–139.

14 Benjamin M, McKeachie WJ, Lin YGand Holinger DP. Test anxiety: Deficits in information processing. Journal of Educational Psychology. 73(6):1981; 816 – 824.

15 Sarason IG. Test anxiety, worry, and cognitive interference. In R Schwarzer (Ed.), Self-related cognitions in anxiety and motivation, Hillsdale, NJ: L. Erlbaum Associates. 1986: 19-34.

16 Cunha M and Paiva MJ. Text anxiety in adolescents: The role of self-criticism and acceptance and mindfulness skills. The Spanish Journal of Psychology.15(2); 2012: 533–543.

17 Cassady JC. The influence of cognitive test anxiety across the learning-testing cycle. Learning and Instruction.14; 2004: 569–592.

18 Bandura A. Self-efficacy In VS Ramachaudran (Ed), Encyclopedia of human behavior 4: 1984: 71-81. New York: Academic Press. (Reprinted in H. Friedman [Ed], Encyclopedia of mental health. San Diego: Academic Press, 1998). Available fromhttps://www.uky.edu/~eushe2/Bandura/BanEncy.html[Accessed: January 2017]

19 Preiss RW, Gayle BMand Allen M. Test anxiety, academic self-efficacy, and study skills: a meta-analytic review In BM Gayle, RW Preiss& M Allen (Eds) Classroom Interaction and Instructional Processes: A Meta-Analytic Review. Mahwah, NJ: Lawrence Erlbaum Associates. 2006: 99-111.

20 Katahn M, Stronger S, and Cherry N. Group counselling and behavior therapy with test-anxious college students. Journal of Consulting Psychology.50; 1966: 544-549.

21 Kahan LM. The correlation of test anxiety and academic performance of community college students. Capella University. United State. Pro Quest LLC journal. 9 (45); 2008: 68-93.

22 Donnelly R. Embedding interaction within a blend of learner centric pedagogy and technology. World Journal on Educational Technology.1(1); 2009: 6-29.

23 Dawood E, GhadeerHA, Mitsu R, Almutary N andAlenezi B. Relationship between test anxiety and academic achievement among undergraduate nursing students. Journal of Education and Practice. 7(2); 2016: 57-65.

24 Sarason IG. The test anxiety scale: Concept and research. In CD Spielberger& I. G Sarason (Eds). Stress and anxiety, Washington DC: Hemisphere Publishing Corporation. 5; 1978: 193-216.

25 DordiNejad FG, Hakimi H, Ashouri M, Dehghani M, Zeinali Z, Sadegh-Daghighi M and Bahrami N. On the relationship between test anxiety and academic performance. Procedia Social and Behavioral Sciences.15; 2011: 3774-3778.

26 Derakshan N andEysenck MW. Anxiety, processing efficiency, and cognitive performance: new developments from attentional control theory. European Psychologist.14 (2); 2009: 168–176.

27 Kazmi SF. Anxiety as predictor of aspiration among academic achievers. The Online Journal of New Horizons in Education. 3(4): 2013:12-22.Retrievedfrom http://tojned.net/pdf/v03i04/v03CCi04-02.pdf [Accessed: January 2017]

28 Spielberger CD and Vagg PR. Test anxiety: A transactional process model. In CD Spielberger& PR Vagg (Eds), Test anxiety: Theory, assessment, and treatment Washington, DC: Taylor & Francis. 1995: 3-14.

29 McInerney DM, Yeung ASandMcInerney V Cross-cultural validation of the Inventory of School Motivation (ISM): Motivation orientations of Navajo and Anglo students. Journal of Applied Measurement.2 (2); 2001:135–153.

30 Driscoll R, Evans G, Ramsey G and Wheeler S. High test anxiety among nursing students. Online submission. Available from https://files.eric.ed.gov/fulltext/ED506526.pdf./2009[Accessed: January 2017]

31 Wright JJ. Reported personal stress sources and adjustment of entering freshmen. Journal of Counselling Psychology.14 (4); 1967: 371-373.

32 Cooke R, Bewick BM, Barkham M, Bradley M and Audin K. Measuring, monitoring and managing the psychological well-being of first year university students. British Journal of Guidance and Counselling. 34(4); 2006: 505-517.

33 Mudhovozi P. Social and academic adjustment of first year university students. Journal of Social Science.33(2); 2012: 251–259.

34 Beggs C, Shields Dand JaniszewskiGoodin H. Using guided reflection to reduce test anxiety in nursing students. Journal of Holistic Nursing.29(2); 2011: 140-147.

35 Alexender DA and Haldane JD. Medical Education: a student perspective. Journal of Medical Education.13(3); 1979: 36- 41.

36 Numan A andHasan SS.Effect of study habits on test anxiety and academic achievement of undergraduate students. Journal of Research and Reflection in Education.11(1); 2017: 1-14.

37 Shapiro A. Test anxiety among nursing students: a systematic review. Teaching and Learning in Nursing. 9 (4); 2014: 193–202.

38 Herbert J, Moore GF, de la Riva C, and Watts FN Endocrine responses and examination anxiety. Biological Psychology.22 (3); 1986: 215–226.

39 Backovic DV, ZivojinovicJI, Maksimovic J, and Maksimovic M. Gender differences in academic stress and burnout among medical students in final years of education. PsychiatriaDanubina.24(2); 2011: 175–181.

40 Conley KM and Lehman BJ. Test anxiety and cardiovascular responses to daily academic stressors. Stress and Health.28(1); 2011: 41–50.

41 Zhang Z, Su H, Peng Q, Yang Qand Cheng X. Exam anxiety induces significant blood pressure and heart rate increase in college students. Clinical and Experimental Hypertension.33(5); 2011: 281-286.

42 Bystritsky A andKronemyer D. Stress and anxiety: Counterpart elements of the stress/anxiety complex. Psychiatric Clinics of North America.37(4); 2014: 489-518.

43 Singh R, Goyal M, Tiwari S, Ghildiyal A, Nattu S and Das S. Effect of examination stress on mood, performance and cortisol levels in medical students. Indian J PhysiolPharmacol.56(1); 2012: 48- 55.

44 Seipp B. Anxiety and academic performance: a meta-analysis of findings. Anxiety Research.4(1); 1991: 27–41.

45 Richardson M, Abraham C and Bond R. Psychological correlates of university students’ academic performance: A systematic review and meta-analysis. Psychological Bulletin.138 (2); 2012: 353–387.

46 George T, Muller M and Bartz JA mixed-methods study of prelicensure nursing students changing answers on multiple choice examinations. Journal of Nursing Education.55(4); 2016: 220-223.

47 Williams MG. Attrition and retention in the nursing major: Understanding persistence in beginning nursing students. Nursing Education Perspectives.31(6); 2010: 362-367.

48 Powell DH. Behavioral treatment of debilitating test anxiety among medical students. Journal of Clinical Psychology. 60(8); 2004: 853-865.

49 Niss L. Brief Mindfulness Intervention on Math Test Anxiety and Exam Scores in a High School Population: University of Colorado Boulder. 2012.

50 Carsley D, Heath NL andFajnerovaS. Effectiveness of a classroom mindfulness coloring activity for test anxiety in children. Journal of Applied School Psychology. 31(3); 2015: 239-255.

51 Curry NA, Kasser T and Galesburg IL. Can coloring mandalas reduce anxiety? Journal of the American Art Therapy Association. 22(2); 2005: 81-85.

52 Cho H, Ryu S, Noh J and Lee J. The Effectiveness of Daily Mindful Breathing Practices on Test Anxiety of Students.11(10); 2016: 1-10.

53 Lyall H. Reduction of test anxiety by short, ad hoc use of a mindfulness based mobile app. Level 4 Maxi Project School of Psychology, University of Glasgow.2016.

54 Keng SL, Smoski MJ and Robins CJ. Effects of mindfulness on psychological health: A review of empirical studies. Clinical Psychology Review.31(6); 2011: 1041–1056.

55 Kabat-ZinnJ. Mindfulness-based interventions in context: Past, present, and future. Clinical Psychology: Science and Practice.10(2); 2003: 144–156.

56 Cardaciotto L, Herbert JD, Forman EM, Moitra E and Farrow V. The assessment of present-moment awareness and acceptance: The Philadelphia Mindfulness Scale. Assessment.15(2); 2008: 204–223.

57 Hayes AM and Feldman GC. Clarifying the construct of mindfulness in the context of emotion regulation and the process of change in therapy. Clinical Psychology Science & Practice.11(3); 2004: 255-262.

58 Baer RA, Smith GT, Hopkins J, Krietemeyer J and Toney L. Using self-report assessment methods to explore facets of mindfulness. Assessment.13(1); 2006: 27–45.

59 Brown KW, Ryan RM and Creswell JD Mindfulness: Theoretical foundations and evidence for its salutary effects. Psychological Inquiry.18(4); 2007: 211–237.

60 Chadwick P, HemberM, Symes J, Peters E, Kuipers E andDagnan D. Responding mindfully to unpleasant thoughts and images: reliability and validity of the Southampton mindfulness questionnaire (SMQ). Br. J. Clin. Psychol.47 (4); 2008: 451–455.

61 Kabat-Zinn J. An outpatient program in behavioral medicine for chronic pain patients based on the practice of mindfulness meditation: Theoretical considerations and preliminary results. General Hospital Psychiatry. 4(1); 1982: 33–47.

62 Reibel DK, Greeson JM, Brainard GC, and Rosenzweig S. Mindfulness-based stress reduction and health-related quality of life in a heterogeneous patient population. General Hospital Psychiatr.23(4); 2001: 183–192.

63 Teasdale JD, Segal ZV and Williams MG. How does cognitive therapy prevent depressive relapse and why should attentional control (mindfulness training) help? Behaviour Research and Therapy. 33(1); 1995: 25–39.

64 Kabat-Zinn J, Massion MD, Kristeller J, Peterson LG, Fletcher KE andPbert L. Effectiveness of a meditation-based stress reduction program in the treatment of anxiety disorders. American Journal of Psychiatry 149(7); 1992: 936-943.

65 Teasdale JD, Williams JM, Soulsby JM, Segal ZV, Ridgeway VA and Lau MA. Prevention of relapse/ recurrence in major depression by mindfulness-based cognitive therapy. Journal of Consulting and Clinical Psychology. 68(4); 2000: 615–623.

66 Baer RA. Mindfulness training as a clinical intervention: A conceptual and empirical review. Clinical Psychology: Science and Practice.10(2); 2003:125–143.

67 Linehan MM. Cognitive behavioral treatment of borderline personality disorder. New York: Guilford Press.1993.

68 Gunatillake R. Redesigning mindfulness for our very modern lives.Pan Macmillan Publishing. 2016.

69 Free C, Phillips G, Galli L, Watson L, Felix L, Edwards P, Patel V and Haines A. The Effectiveness of Mobile-Health Technology-Based Health Behaviour Change or Disease Management Interventions for Health Care Consumers: A Systematic Review. 10(1); 2013.

70 Howells A, Ivtzan I and Eiroa- Orosa JF. Putting the ‘app’ in Happiness: A Randomised Controlled Trial of a Smartphone-Based Mindfulness Intervention to Enhance Wellbeing.Journal of Happiness Studies 17(1); 2014: 163–185.

Received on 28.02.2018 Modified on 26.04.2018

Research J. Pharm. and Tech 2018; 11(6): 2220-2228.

DOI: 10.5958/0974-360X.2018.00411.0