Improving academic performance and mental health through a stress management intervention: Outcomes and mediators of change
Introduction
The majority of children in the United Kingdom (UK) take the General Certificate of Secondary Education (GCSE) examinations around the age of 15–16 years. They are comprised of tests, and classroom-based assignments, both of which are nationally standardized. Potential employers use students’ overall GCSE grades as an important indicator of basic competence and these scores also largely determine whether or not children go onto higher education. Given the importance placed on GCSE results, it is perhaps not surprising to discover that many children report a high level of mental strain and worry when preparing for, and taking, GCSE exams (e.g., Denscombe, 2000). UK children are, of course, not the only ones to suffer such concerns. Studies in the United States (US) estimate that a large proportion of children report examination stress as well (e.g., Hill, 1984; Hill & Wigfield, 1984). For example, Hill (1984) estimates that between 25% and 30% of US students suffer adverse effects from examination stress and as many as 10 million school students underachieve because of anxiety-related performance impairments. Given such stark figures, it is perhaps not surprising that a branch of psychological research, known as test anxiety (TA), has developed to investigate this phenomenon (e.g., Sarason (1980), Sarason (1984); Spielberger & Vagg, 1995; Zeidner, 1998).
TA is viewed as a ‘situation-specific’ form of anxiety that predisposes people to perceive evaluative situations as threatening (Spielberger, 1972). Individuals high in TA are more likely to experience frequent and intense levels of state anxiety, which are in turn accompanied by worry and other test irrelevant thoughts, when being examined (Spielberger, Gonzalez, Taylor, Algaze, & Anton, 1978). Thus, TA consists of two distinct response sets: worry and emotionality. The former describes a cognitive response, where attention is focused on concerns about one's performance, ability or adequacy (Deffenbacher, 1980), and the latter refers to an affective response involving an over-awareness of bodily arousal and tension in the face of evaluative situations (Sarason, 1984).
Research indicates that individuals high in TA frequently experience performance decrements in evaluative situations, and that the cognitive component of TA (worry) contributes most to these deficiencies (Eysenck & Calvo, 1992; Hembree, 1988; Sarason (1980), Sarason (1984), Sarason (1988); Wine, 1971). For example, when Deffenbacher (1980) controlled for common variance between worry and emotionality, only worry was negatively associated with academic performance. Furthermore, we have recently shown that the worry component of TA best predicts examination performance amongst undergraduates (Keogh, Bond, French, Richards, & Davis, 2004).
Others argue that the cognitive interpretation, or appraisal, of emotionality determines the extent to which emotional arousal facilitates or debilitates performance (Hollandsworth, Glazeski, Kirkland, Jones, & Van Norman, 1979; Sarason (1984), Sarason (1988)). For example, Hollandsworth et al. (1979) found that during a mental ability task, arousal seemed to trigger distracting, task-irrelevant thinking (i.e., worry) in high TA individuals. In contrast, low test-anxious individuals spoke of getting ‘psyched up’ or of getting ‘in stride’ (i.e., engaging in task-relevant thinking). The importance of cognitive appraisal in evaluative contexts is further supported by research that shows that objective measures of physiological arousal cannot distinguish high and low TA individuals (Holroyd & Appel, 1980).
Progress in conceptualizing test anxiety is reflected in measurement developments of this construct. Contemporary measures such as the Revised Test Anxiety Scale view test anxiety as a hierarchical construct that consists of lower order domains such as tension, worry, bodily symptoms and test-irrelevant thinking, as well as a single higher-order factor (Benson & Bandalos, 1992; Benson & El-Zahhar, 1994; Hodapp & Benson, 1997).
Consistent with the apparent importance of cognition in TA, many interventions over the last 30 years have tried to change people's cognitive appraisals, as a means of reducing or preventing this problem (Flaxman et al., 2002). These “cognitive change” interventions are typically referred to as cognitive-behavior therapies (CBTs), and research indicates that they can improve general study skills and exam performance in university students (e.g., Algaze, 1995; Vagg & Papsdorf, 1995). Furthermore, these CBT strategies seem to be equally effective in reducing the cognitive and emotionality symptoms of TA. Unfortunately, most interventions have tended to address either the cognitive or emotional components of TA, so it is unclear whether or not an intervention that targeted both components would be more successful (Zeidner, 1998).
There are also a number of methodological and theoretical limitations with many of the studies conducted to date. For example, Algaze (1995) had eight participants per group, which provided only a small chance of finding a positive impact for the SMI on examination scores, if, indeed, there was one to find. A second limitation is that the effectiveness of such interventions can be dependent on the time clients are allowed to practice and improve their new skills. Less practice may result in weaker changes in TA (Zeidner, 1998). Third, few studies examine whether SMIs, including CBTs, impact school children's examination scores. Furthermore, of those that do, many use cognitive ability tests (see Zeidner, 1998), which may not necessarily determine future academic success. An improvement in assessing the impact of SMIs on school performance would be to use student grades based on reliable, nationally standardized examinations that have a large impact upon students’ academic progression. Examples of such examinations in the UK would be GCSE or Advanced-level exams. We are not aware of any SMI outcome study that has used such a rigorous, and potentially important, performance criterion.
Apart from small drops in TA, it also remains unclear whether such SMIs have a general impact on the mental health of students. Most studies simply do not consider general mental health. However, SMIs in adult workers have led to improvements in performance and mental health. Specifically, CBT-based SMIs have significantly improved mental health, absenteeism levels, motivation, and performance, in the adult work environment. They also seem particularly effective when these SMIs have used different techniques to promote cognitive change (e.g., problem solving, relaxation, belief modification) (Bond & Bunce, 2000; Bunce & West, 1996; van der Klink, Blonk, Schene, & van Dijk, 2001). These multi-method CBT interventions do not appear to have been systematically investigated using students in a school setting; there are no theoretical reasons, however, as to why they would be ineffective in this context.
Importantly, we are not merely interested in determining whether or not a SMI is effective in improving mental health and maximizing GCSE performance. We are also interested in identifying the mechanisms (or mediators) by which such benefits occur, if indeed they do so. Such assessment of potential mechanisms of change is necessary, as interventions of all kinds can be effective for reasons different from those hypothesized (Bond & Bunce, 2000). Moreover, by identifying mediators of change, one can improve interventions by trying to manipulate these mechanisms more effectively and, thus, better help people (Bond & Bunce, 2001).
Cognitive therapy theory (e.g., Beck, 1976) and achievement goal theory (e.g., Ames, 1992; Elliot, 1997) are used as the theoretical underpinnings of the current CBT SMI. As such, they inform our predictions as to what variables will mediate the proposed effects that the SMI has on these two outcomes. Flaxman et al. (2002) detail the intervention, which is based largely on Beck's (1976; Beck & Emery, 1985) version of CBT. It maintains that an intervention can best protect and promote people's mental health if it changes their dysfunctional cognitions, or beliefs (e.g., “I am bad at taking tests”) to functional ones (e.g., “I can take tests, if I prepare appropriately”). This multi-method SMI attempts to produce such cognitive change by showing people how their feelings and actions are linked to their cognitions, and most importantly, how they can intervene to make these beliefs more functional. Thus, we predict that the SMI will improve students’ mental health because it makes their cognitions more functional.
In addition to making beliefs more functional, the present multi-method SMI also uses didactic and experiential learning exercises in order to teach participants how to move their attention from their worries, self-defeating thoughts and images to their course material (see Flaxman, et al., 2002). These attention-directing exercises (see Borkovec, Hazlett-Stevens, & Diaz, 1999), in combination with problem solving, imagery, and progressive relaxation training, aim to develop, within participants, a learning goal set. Achievement Goal Theory maintains that people can improve their motivation to learn and gain knowledge by working under such a “learning-goal” set (Covington, 2000). This is a learning strategy in which the aim of knowledge acquisition is to increase one's competency, understanding, and appreciation of a subject area, as opposed to, for example, learning in order merely to outperform one's peers (e.g., Elliot & Church, 1997). Working under a learning goal set is thought to promote excitement and task absorption, which, in turn, helps people to process relevant information strategically and to a deep-level thus enabling increased school achievement (e.g., Covington, 2000; Elliot & Church, 1997). Research has generally supported this motivational theory of performance (e.g., Elliot, McGregor, & Gable, 1999; Meece & Holt, 1993; Schunk, 1996). Such a learning set, according to achievement goal theory, should function to motivate students to focus on, retain, and become more competent and knowledgeable about their course-related content. We predict, therefore, that an increase in motivation will mediate the relationship between our CBT SMI and GCSE performance.
The first aim of the current study was, therefore, to examine the effectiveness of an SMI administered during an academic school year on GCSE performance and the general mental health of 15–16 year old school children. We also sought to answer theoretically important, and to date unanswered, questions regarding the potential mechanisms that may explain any change found. We specifically hypothesized that this randomized controlled outcome experiment will show that:
- 1.
school children who received a multi-method CBT SMI will have better mental health (including reductions in test anxiety) and GCSE scores than those in a control group that did not receive this intervention;
- 2.
the increase in the functionality of students’ beliefs will mediate improvements in their mental health that the SMI produced;
- 3.
higher levels of motivation will account for the difference in GCSE results that will be seen between the SMI and control groups.
Section snippets
Design
To investigate the efficacy of our multi-method CBT SMI we used a repeated measures, randomized, matched-pairs design. Intervention group (intervention vs. no intervention) served as the between-groups variable, whereas time of testing served as the within-groups variable (before vs. after intervention). The dependent variables were various self-report measures of stress and exam performance. The latter was measured by students’ total GCSE grade points. Finally, in order to identify the
Results
As a result of participant attrition and consequent listwise deletion, the SMI group size was reduced to 40. This 50% attrition rate was due to participant absence at one of the two questionnaire administration points, or failure to attend to at least 60% (6 out of 10) of the training sessions (note that failure to attend occurred mostly towards the end of the intervention). In order to meet the statistical requirements of equal numbered groups, only 50% of the control group was selected (using
Discussion
The current study examined the ability of a brief multi-method CBT SMI (Flaxman et al., 2002) to impact GCSE performance and mental health in school children. Furthermore, it sought to establish the mechanisms, or mediators, by which these two benefits occurred. The above results indicate that we met these objectives, and we shall now discuss the findings.
Conclusions
In sum, the current study presents strong evidence that the CBT SMI outlined by Flaxman et al. (2002) has great efficacy and potential use in terms of improving educational performance, and the mental health of school children. This study also provides theoretically, and practically, important information as to why this intervention works. Examination performance seems to benefit from higher levels of motivation, whereas mental health improvements occur through a reduction in dysfunctional
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