PROFORMA FOR REGISTRATION OF SUBJECTS FOR

DISSERTATION

MS. SUMA
M .Sc (N) I YEAR
PSYCHIATRIC NURSING
YEAR 2009-2010

ST. PHILOMENAS COLLEGE OF NURSING

#4 CAMPBELL ROAD, VIVEKNAGAR P.O
BANGALORE 560 047

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RAJIVGANDHI UNIVERSITY OF HEALTH SCIENCES
BANGALORE, KARNATAKA

PROFORMA FOR REGISTRATION OF SUBJECTS FOR

DISSERTATION

1. NAME OF THE CANDIDATE AND SUMA

ADDRESS I YEAR M.Sc NURSING ,
ST.PHILOMENAS COLLEGE OF
NURSING, BANGALORE-47
2. NAME OF THE INSTITUTION St. Philomena’s college of Nursing,
Bangalore.
3. COURSE OF STUDY AND SUBJECT 1st year M.Sc Nursing,
Psychiatric Nursing
4. DATE OF ADMISSION TO COURSE 8th June 2009
5. TITLE OF THE TOPIC A Study To Assess The Effectiveness O
Jacobson Progressive Muscle
Relaxation On Examination Anxiety
Among High School Students In
Selected High School At Bangalore.

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5. TITLE OF THE TOPIC

A STUDY TO ASSESS THE EFFECTIVENESS OF JACOBSON

PROGRESSIVE MUSCLE RELAXATION ON EXAMINATION
ANXIETY AMONG HIGH SCHOOL STUDENTS IN SELECTED HIGH
SCHOOL AT BANGALORE

6. BRIEF RESUME OF THE INTENDED WORK

6.1. NEED FOR THE STUDY

Every child born into this world is an alien with trillions of neurons waiting to be
filled and linked in order to construct his or her own perspective of understanding of this
new world. The child is full of potentials which help him or her to grow physically,
intellectually and socio-emotionally. An important dimension of this maturational
accomplishment is education. Examination is no doubt, an essential component of our
system of education and even a few marks here or there can turn a student’s dream topsy
– turvy. Flawed examination system and the highly competitive situation governed by
the market forces, tremendous competitions for every job and profession puts great
amount of strain on the individual appearing for examination.

Examination is the testing of proficiency or knowledge of students through oral or

written questions. Most of all, this kind of examination measures the individual as a
scholar but not as a human being during the course of study. The evaluation of education
and future prospects of individual wholly depends on the examination performance, so
the examinations bring more anxiety among students as well as family in the present
competitive world.

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 A conceptualized test anxiety in terms of two components emotionality and
worry.Emtionality refers to an individual’s perception of autonomic arousal when
confronted by a stressful testing situation worry, on the other hand, refers to the
cognitive manifestations of anxiety. It describes negative cognition about the individuals
performance e.g., harmful consequences of failure, evaluating one’s ability on the basis
relative to that of others, lack of confidence etc subsequent investigations indicated that
it is grief, more than emotionality that adversely affects task performance1.

In early days Examination Anxiety was understood as physiological and

emotional phenomenon. Hence, treatment was aimed at reducing the physiological
arousal through behavioral methods. Recently, different approaches have emerged to
reduce Examination Anxiety over a period of time. These approaches are the basically
Behavioral, Cognitive and Skill-deficit approaches and Progressive muscle relaxation
therapy. The eclectic approaches combining Cognitive, Behavioral and Skill-Focused
approaches have been used as Programme Intervention for reducing Examination
anxiety.

A study was done on assessing the (a) relationship of test anxiety to academic
performance among college students (b) difference in study related behavior between
high and low test anxious students and(c) differential effectiveness of study related
behavior for both groups. The subjects were 65 high and 31 low test anxious students of
first semester freshman. The grade point average for low test anxious students were 2.86
in contrast with 2.51 for the high test anxious group test was used for analysis. Results
demonstrated a significant decrement in grade point average associated with test anxiety2.

An expert stated that students at risk of examination crises should be identified and
helped prior to potentially overwhelming examinations. The main practical approaches to
examination crises include Emotional Support, Focused Exploration,

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Relaxation, Self-Instructions, and Study-Skills Training, Systematic-Desensitization used
singly or in combination3.

Elementary school children with clinically significant test anxiety, as

determined by self-report and a clinical interview, were assessed for the incidence of
other fears and anxiety. The results indicated that test-anxious children reported more
fears and general worries than their non-test-anxious peers. As expected, the test-anxious
children experienced more negative cognitions and subjective distress when taking a test.
Furthermore, the fear of negative evaluation was not limited to an actual test, since these
children also reported identical symptoms when engaged in a second social-evaluative
task. Finally, 60% of the test-anxious sample met DSM-III criteria for an anxiety
disorder. The results are discussed in terms of the relationship of text anxiety to more
complex social-evaluative dysfunctions, more pervasive anxiety conditions, DSM-III
anxiety disorders, and the utility of test anxiety as an indicator of the presence of these
more pervasive anxiety states4.

6.1.1. Examination Anxiety among school students in India

Exam Anxiety is a common phenomenon negatively affecting the academic,

emotional, personal and social lives of almost 20% students across nationalities including
India. Test anxious students score poor grades/marks and have poor mental health in
comparison to others. It may be fatal at times. There are reports of deliberate self-harm
and suicide by students highlighting the need for timely intervention5.

Test anxiety is a learned behavior and a growing phenomenon ‘Beidel’ and

‘Turner’ say “Test anxiety has become for more prevalent over the past 30 years,
affecting up to 40% of third-through sixth-grades at levels ranging from moderate to

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severe. They attribute the increase to several factors, including greater pressure from
teachers and parents to succeed, more testing in the early grades and the high stakes
associated with many standardized test6.

Test anxiety is a prevalent and debilitating condition. Researchers have estimated

that 10 million students at pre-college levels and 15% of college students experience test
anxiety worldwide. The primary detrimental consequence of test anxiety is that it
decreases performance and leads to consistent misinterpretation of intelligence, aptitude
and progress of test anxious students7.

NIMHANS a leading Mental Health Institute reported that nearly 40% of the
students felt overwhelmed by the Examination and they were in need of guidance.

Many bright, talented, intelligent and hard working students perform very poorly
in the examination due to poor study habits and persistent examination anxiety, which
interferes with their mental power and keeps them away from doing their best. With the
aid of Jacobson progressive muscle relaxation, an intervention will be given in the
present study, with the goal of reducing examination anxiety among high school students.

6.2 REVIEW OF LITERATURE

Review of related literature is an essential part of the research study. It determines the
extent to which the topic has been investigated and thus helps the researcher to determine
the extent to which the topic has to be dealt. Here the literature reviewed is presented
under the following headings.
Review of the Literature in this study is organized under the following headings:

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 a.Literature related to the Examination Anxiety.
B.Literature related to factors influencing examination anxiety.
c.Literature related to the effectiveness of Jacobson progressive muscle
relaxation technique on examination anxiety.

a.Literature related to examination anxiety among the study.

A descriptive Study was conducted among 203 Students of Nursing School,

Peking Union Medical College, China on Stressors, Coping Strategies and Psycho- Social
states of the Students. The result revealed that the prevalence of Examination Anxiety is
43.8%.General Nursing and Midwifery Students are the pillars of the society’s health,
because they cover all the remotes areas of the world. This generation is facing a lot of
Examination Anxiety due to Globalization and extensive competitions8.

A descriptive Study on Examination Anxiety among 50 students of a recognized

School in Coimbatore. The result showed that 40% of the students were with the
moderate levels of Examination Anxiety, 36% of the students were with the low levels of
Examination Anxiety and 24% with the severe levels of Examination Anxiety9.

A Study was conducted on test anxiety among visually handicapped children the
sample consisted of 45 male visually handicapped students studied in VI, VII, and VIII
grade in 2 selected schools of Delhi. The Indian adaptation of sarasons test anxiety scale
for children (TASC) was used for data collection the data was analyzed using T test. The
results showed that VII grade children exhibited more test anxiety (mean=20.20) than VI
grade (mean=19.20) and VII grade (mean =14.40) children10.

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A survey was conducted on cognition in children with high, moderate, and test anxiety
under naturalistic test taking conditions. Sample consisted of 286 children with an
average age of 11.6yrs.The test anxiety was measured by the negative fear of failure
subscale of the achievement motivation test for children’s cognition Assessment
Questionnaire. On the basis of their scores on the negative fear of failure subscale of the
achievement motive, the children were divided into a low anxious group (n=98), a
moderate anxious group (n=128) and a high anxious group (n=60).The results showed
that high test anxious children reported more off task thoughts than low anxious children
but also reported more on task and coping thoughts11.

b.Literature related to factors influencing examination anxiety.

A cross sectional study using structured self-administered questionnaire was

carried out over four weeks in Dow Medical College using sample size of 120 students.
Survey questionnaire consisted of VAS to measure exam anxiety and seventeen questions
wee framed regarding life style, study style, psychological problems, and examination
system. The average maximum Exam Anxiety marked on VAS was 64+/-28. Among
different factors contributing to exam anxiety, extensive course loads (90.8%), lack of
physical exercise (90%) and long duration of exams (77.5%) were the most important
factors reported by the students. This study indicates moderate level of exam anxiety
based on a Visual Analogue Scale among the students of a medical college and also it
highlights that factors such as extensive course load, lack of exercise and long duration of
exams which contribute to Exam anxiety12.

A study was conducted to determine anxiety levels and coping strategies of on-
campus and distance education registered nursing students at three different times during
the competitions challenging examination process. Differences between the two groups of
nursing students on selected demographic variables, past academic performance, anxiety
levels and coping strategies were assessed. Significant differences were found in anxiety

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levels, coping strategies and past academic performance by age, marital status,
employment and work setting. However, problem solving was used extensively by both
groups while social support was used more by the on-campus students. The results are
discussed in terms of Folkman & Lazarus's theory of stress and coping, and implications
for nurse educators are presented.13

A study was conducted on the association between the high school certificate,
the reported distress and anxiety level of the adolescent student in sample of 445.The
most significant contribution to distress associated with the examination was made by
the personality trait, anxiety proneness. Lower socio-economic status, self-confidence,
academic and verbal self-concepts and perceived ability to cope were also found, to a
lesser extent, to be associated with increased distress. The interactions sex with ethnic
background and year with ethnic background were of particular interest. Students who
were males and had an English speaking background and the students in year 11 who had
an English speaking background were least likely to experience distress than others in the
context of the examination14.

c.Literature related to the effectiveness of Jacobson progressive

relaxation on examination anxiety

A study was done on comparing the effectiveness of galvanic skin resistance

biofeedback Training and progressive muscle relaxation training in reducing blood
pressure and respiratory rate among highly stressed individuals in sample about 120
female students. Out of the 120 females, only those whose anxiety scores were greater
than 40 and percentile greater than 70 were selected for the study. Ultimately, 30 highly
stressed females with high anxiety scores, who were free from any ailments and not
undergoing any kind of medication treatment were chosen for the study. Results indicate

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the effectiveness of GSR biofeedback training in reducing blood pressure after training
session. Progressive muscle relaxation group showed significant reduction in post test15.

An Experimental Study was conducted on effectiveness of Stress Management

Skills which includes, Progressive Relaxation, Deep Muscle Relaxation, Autogenic
Training, Visual Imagery and Modified Systematic Desensitization, among 18 Nursing
Students for five weeks. The result investigated a significant reduction in the
Examination Anxiety from mid-semester to final examinations, which was not evident in
the Control Group16.

A Quasi Experimental Study was conducted among Nursing Students to measure

the effects of six weeks of Coping Measures (Counseling, Nutrition, Exercise,
Progressive Relaxation, Cognitive Control, Time Management and Testing Skills) on
Students Examination Anxiety. The result revealed that the Coping Measures were
effective in increasing self - esteem and decreasing the Examination Anxiety17.

A study was conducted to test the multi-process theory which is an

investigation of the effect of two relaxation techniques includes Benson's relaxation
method , and progressive relaxation in sample of 76 undergraduate university students
using a modified version of the competitive state anxiety inventory-2 , competitive
anxiety in sport, human kinetics., Champaign. Results suggested that both relaxation
techniques were effective in reducing cognitive and somatic anxiety, and elevating self-
confidence. However, contrary to the predictions of the multi-process theory, there were
no significant differences between the effects of either technique. The findings were
discussed in light of the relaxation response and the cognitive-behavioral model. A New
System of Strategies for Treatment and Assessment, as alternatives in predicting the
effects of relaxation techniques on anxiety18.

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6.3 STATEMENT OF THE PROBLEM

A Study To Assess The Effectiveness Of Jacobson Progressive Muscle Relaxation On

Examination Anxiety Among High School Students In Selected High School At
Bangalore.

6.4 OBJECTIVES

1. To assess the level of examination anxiety seen among high school students.
2. Plan and administrate Jacobson progressive muscle relaxation regarding examination
anxiety among high school students.
3. To evaluate the effectiveness of Jacobson progressive muscle relaxation on
examination anxiety seen among high school students.
4. To find out the association between examination anxiety and selected demographic
variables.

6.5 HYPOTHESIS

There will be a significant reduction in the level of Examination Anxiety after

administration of the Jacobson progressive muscle relaxation technique.

6.6 RESEARCH VARIABLES

1) Dependent variable: Examination anxiety.

2) Independent variable: Jacobson’s progressive muscle relaxation.

6.7 OPERATIONAL DEFINITION

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1. Effectiveness: It refers to the outcome of the Coping Measures in reducing the
Examination Anxiety among high school students.
2. Jacobson’s progressive muscle relaxation technique: A technique for combating
tension and anxiety by systemically tensing and relaxing muscle groups. Each session
consist of 45 minutes duration for 7 days.
3.Examination Anxiety: It refers to a feeling of increased tension, nervousness,
pounding heart, stomach upset, going blank, failure and helplessness are experienced by
the students pertaining to the forth- coming examination.
4. Students: In this study refers to the students doing their 10th standard programme in
selected school at Bangalore.

6.8 ASSUMPTIONS

1. High school students would experience physiological and psychological stress

which may interfere in their exams.
2. High school students would experience certain amount of anxiety and fear before
examination.
3. Jacobson’s Progressive muscle relaxation may help the student to reduce to test
anxiety.

6.9 DELIMITATION

The sample was delimited only to the 10th standard girl’s students.

7. MATERIALS AND METHODS

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7.1. SOURCE OF DATA
10th standard students at selected high school students at Bangalore.

7.1.1 Research design

Experimental and control design with pre and post test.

7.1.2 Research setting

Our Lady of Bon Secours girls’ high school.

7.1.3 Population

10th standard girl’s students.

7.1.4 Sampling Procedure

Simple randomization techniques by using lottery methods. Subject will be allotted

randomly to control and experimental group.

7.1.5 Sample size.

Student who fulfills the inclusion criteria and the sample size is 60. (N=60) control group
30 (n=30) Experimental group 30 (n=30).

7. I.6 Inclusion criteria:

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 1. Girls Students of 10th std
2. The age group between 13-16 years.

7.1.7 Exclusion criteria:

1. The male students.

2. Students who are not willing to participate

7.2 METHOD OF DATA COLLECTION:

7.2.1 Instruments used for the study

The tool consists of

Section A: The Socio- Demographic Variables such as name, age, religious, education
examination board.
Section B: The Test Anxiety Inventory (Charles D. Spiel Berger, 1980).
A standardized tool, consist of twenty with two sub-scales, the worry and emotionality
scales.

7.2.2 Data collection method

Formal permission will be obtained from the head of the institution. After obtaining
the informed consent from the high school students and assuring about confidentiality of
the information obtained, the investigator will administer the Questionnaire to assess the
examination anxiety for about 30 minutes.

7.2.3 Data analysis plan

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Data collected on test anxiety will be recorded and analyzed through the following
statistical technique.
Descriptive statistics:
Frequency and percentage distribution of demographic data.
Mean and standard deviation used to assess the exam anxiety among high school
students.
Inferential statistics:
Paired ‘t’test is used to compare pre and post test anxiety for statistical analysis.
Chi square is used to bring out the association between demographic variables.

7.3. DOES THE STUDY REQUIRE ANY INVESTIGATIONS OR

INTERVENTIONS TO THE PATIENT OR OTHER HUMAN BEINGS

OR ANIMALS?

YES

7.4. HAS ETHICAL CLEARANCE OBTAINED FROM YOUR

INSTITUTION?

This study involves administration of intervention to the students.

The requisition letter for the setting permission to conduct the study in Our lady of Bon
Secours girls high school has been submitted, oral permission obtained and awaiting for
written permission and when received, a copy will be sent to Rajiv Gandhi University of
Health Sciences in future.Requistion letter has been enclose with the synopsis.

LIST OF REFERENCES

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1. Morris,L.W , Liebert , R.M.Relationship of cognitive and emotional components
of test anxiety to physiological arousal and academic performance. Journal of
consulting and clinical psychology.1967. 35 (3), 332-337.

2. Culler,R.E ,Hollahan,C.J. Test anxiety and academic performance. The effects of

study related behaviours.Journal of educational psychology.1980. 72 (1), 16-20.

3. Richard Nelson Jone.Examination Anxiety. The Theory and Practice of

Counseling Psychology. London: Cassell educational Ltd. 1982

4. Deborah.C.Bei.del, Samuel .M.Turner, comorbidity of test anxiety and other

anxiety disorders in children, Journal of abnormal child psychology, 1988
June;vol 16,No3, 275-287.

5. Putwain.D.W.School psychology international .2009 feb1; 30(1):56-74. Available

at http://examanxiety.blogspot.com.

6. Moshe Zedner .Perspectives on individual differences Test anxiety the state of the
art .1998.book.google.co.in/books?isbn.

7. Dendo,K.M , Diener. effectiveness of cognitive/relaxation therapy & study skills

training in reducing self reported anxiety & improving the academic performance
of test anxious students, Journal of counseling psychology.33 (2): 131-35.

8. Liy, et al. Stressors, coping strategies and psycho social state of children with
chronic illness, Zhonggyo Dang Dai Er Ke Za Zhi. 2008 10(3): 337-342.

9. Ponnusamy .A. Examination Anxiety, Journal of School Social Work, 2005 4 (2):
24-30.

10. Abdi,U ,Zaidi, D.Test anxiety among visually handicapped children,”Journal of

personality and clinical studies.1991 123-124.

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 11. Prins, P.J.M., Groot, M.J.M & Hanewald,G.J.F.P.congnition in test anxious
students, The role of on task and coping cognition reconsidered.Journal of
consulting and clinical psychology.1994 62 (2):404-409.

12. Hashmats,Hahmat M,Amanullah F,Azizs. Effectiveness of self administration

Questionnaire. Journal of Pakistan medical association.2008 April; vol 58 issues
(4) :167-70.

13. Rukholm, viverais,A multifactorial study of test anxiety and coping responses
during challenge exam. Nurse Education Today.1993 April13 ;( 2): 91-9.

14. Hodge .G.M,Mc Cornick J, Elliott R.Examination induced distress in a public

examination at the completion of secondary schooling.1997.(Pt2) :185-97.

15. Archana khanna,Mamanpaul, Jaspal Singh Sandha. Effectiveness of galvanic skin

resistance biofeedback training& progressive muscle relaxation training.Indian
Journal of nursing. 2007 51(3):296-300.

16. Charles worth,et al., Effectiveness of stress management. Journal of Clinical

Psychology.1981 37 (2): 284-290.

17. God bey, Courage. Effect of coping. Archives of Psychiatric Nurse. 2004. 8
(3):190-199.

18. S.Gill,G.Kolt, J.Keating .Examine the Multi-process theory an investigation of

the effects of two relaxation techniques on state anxiety. Journal of body work and
movement therapies. vol8, issues 4, 288-296.

9. Signature of the candidate

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10. Remarks of the guide

11. Name and Designation of

11.1 Guide

11.2 Signature

11.3 Co-guide (if any)

11.4 Signature

11.5 Head of the Department

11.6 Signature

12.12.1 Remarks of the principal

12.2 Signature

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