The Effect of Emotional Freedom Technique on State Exam Anxiety Levels of Nursing Students: A Randomized Controlled Trial

Test anxiety is a set of phenomenological, physiological, and behavioral responses that accompany anxiety about possible negative outcomes or failure in an exam or assessment situation. Test anxiety is a form of situational anxiety and is an important factor affecting students' health and academic performance throughout their educational journey. It is stated in the literature that students' past experiences and beliefs, family attitudes, perceptions about course load, and time management skills can have an impact on test anxiety.

It is emphasized that low levels of anxiety support creativity and development in students, while high levels of anxiety can cause emotional and physiological arousal, leading to significant limiting behaviors such as excessive restlessness and anxiety.

It is stated that anxious students are easily distracted during exams and have difficulty understanding instructions. The severity of exam anxiety in students can reach clinical dimensions and negatively affect daily life, the educational process and career advancement . In the literature, it is stated that exam anxiety is associated with a number of negative variables such as increased risk of anxiety and depression in later life, difficulties in participating in teaching content, lack of attention, shorter concentration periods, decreased learning problems, low exam performance and decrease in academic achievement. Studies specifically link test anxiety to academic success and show that high test anxiety leads to a decrease in academic success. Nursing students also encounter various stressful situations throughout their academic journey.

Nursing education includes both theoretical and practical teaching processes, and this curriculum includes intense course loads, rigorous exams, and pressure to achieve a high GPA in a competitive environment. Clinical education, in which skill development is especially assessed, stands out as one of the first steps in acquiring professional skills and creates a significant source of stress and anxiety in nursing students, becoming a situation that needs to be managed. In the literature, it is stated that the test anxiety experienced by nursing students worldwide is one of the most important problems that prevent the acquisition of professional skills, and it is reported that 50% to 100% of nursing students experience test anxiety at least once during their undergraduate education. Therefore, there is a need for effective therapeutic interventions using complementary methods to reduce the negative effects of exam anxiety among nursing students. When the studies are examined, it is seen that many methods such as hand massage, music therapy, aromatherapy, auriculotherapy, gum chewing, trust training, coping program, animal-assisted intervention, guided imagery, expressive writing, mindfulness exercises, relaxation with cognitive behavioral methods are used to reduce exam anxietyç. It is known that another method used in the management of exam anxiety is the Emotional Freedom Technique (EFT).

EFT is an evidence-based therapeutic method that combines cognitive reframing and exposure therapies with light tapping on acupuncture points (acupressure) to induce relaxation. This method, which involves touching specific acupressure points while focusing on emotional concerns, stimulates the body's energy meridians to promote relaxation. EFT, which has a mechanism of action that alters emotional responses through limbic pathways by reactivating disturbing memories or triggers and allows the release of intense emotional experiences, is used to improve an individual's negative emotions and manage associated emotional and physical disorders. In the literature, EFT has been shown to be effective on depression, phobias, post-traumatic stress disorder, pain, insomnia, autoimmune diseases, professional performance, sports performance, anxiety, and exam anxiety. EFT studies on students show that this technique has a very therapeutic effect in overcoming anxiety and student motivation problems. Many other studies have also found that EFT significantly reduces exam anxiety in nursing students who receive clinical and theoretical training with an intensive curriculum.