Auricular stimulation vs. expressive writing for exam anxiety in medical students – A randomized crossover investigation
Open accessAbstract
OBJECTIVE: Auricular stimulation (AS) is a promising method in the treatment of situational anxiety. Expressive writing (EW) is an established psychological method, which reduces test anxiety and improves exam results. The aim of this crossover trial was to compare AS with EW, and with the no intervention (NI) condition, for treatment of exam anxiety. METHODS: Healthy medical students underwent 3 comparable anatomy exams with an interval of one month, either performing EW, receiving AS or NI prior to the exam; the order of interventions was randomized. AS was applied using indwelling fixed needles bilaterally at the areas innervated mostly by the auricular branch of the vagal nerve on the day before the exam. Anxiety level, measured using State-Trait-Anxiety Inventory (STAI) before and after the interventions and immediately before exam, was the primary outcome. Quality of night sleep, blood pressure, heart rate and activity of salivary alpha-amylase (sAA) were analyzed across 3 conditions. RESULTS: All 37 included participants completed the study. Anxiety level (STAI) decreased immediately after AS in comparison with baseline (P = 0.02) and remained lower in comparison with that after EW and NI (P<0.01) on the day of exam. After EW and NI anxiety increased on the day of exam in comparison with baseline (P<0.01). Quality of sleep improved after AS in comparison with both control conditions (P<0.01). The activity of sAA decreased after EW and after AS (P<0.05) but not after NI condition. CONCLUSION: Auricular stimulation, but not expressive writing, reduced exam anxiety and improved quality of sleep in medical students. These changes might be due to reduced activity of the sympathetic nervous system.
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Expressive writing has been proven effective in patients with chronic diseases and cancer to reduce and manage psychophysical symptoms.
“This technique has also been proven effective in patients with chronic diseases and cancer, to reduce and manage psychophysical symptoms [14,15].”
From Effectiveness of Expressive Writing in Kidney Transplanted Patients: A Randomized Controlled Trial Study (2022) · cites this paper as [15]
The Introduction reports that expressive writing reduced depressive symptoms in people taking stressful exams, but it does not report effectiveness in patients with chronic diseases or cancer. The Discussion says expressive writing had no effect on anxiety or exam performance in this trial of medical students. Our copy therefore supports a narrower claim about depressive symptoms in exam-takers, not the claimed patient groups or range of symptoms. (LLM, conf=0.78)
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- Authors
- Usichenko, T., Wenzel, A., Klausenitz, C., Petersmann, A., Hesse, T., Neumann, N., & Hahnenkamp, K.
- Affiliations
- Universitätsmedizin Greifswald (DE)
- Corresponding author
- Usichenko, Taras
- Venue
- PLOS ONE
- Publisher
- Public Library of Science (PLoS)
- Published
- 2020-08-27
- Volume
- 15
- Issue
- 8
- Pages
- e0238307
- ISSN
- 1932-6203 (ISSN-L)
- PMC
- PMC7451547
- OpenAlex
- W3082077916
- Cited by
- 24
- References
- 28
- Citations by year
- 2026: 2 · 2025: 7 · 2023: 5 · 2022: 6 · 2021: 4
- FWCI
- 1.45
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Licence
- Locations
- PLoS ONE (publishedVersion, cc-by)
- PubMed Central (publishedVersion, cc-by)
- PubMed (publishedVersion)
- DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
- Topics
- Life Sciences › Neuroscience › Neurology › Vagus Nerve Stimulation Research
- Social Sciences › Psychology › Social Psychology › Music Therapy and Health
- Social Sciences › Psychology › Developmental and Educational Psychology › Student Stress and Coping
- Keywords
- auricular stimulation, expressive writing, test anxiety, medical students, auricular acupuncture, vagus nerve, salivary amylase, sleep quality, sympathetic nervous system, anxiety reduction
- MeSH terms
- Academic Performance, Adolescent, Adult, alpha-Amylases, Anxiety, Anxiety Disorders, Blood Pressure, Female, Heart Rate, Humans, Male, Students, Medical, Writing, Cross-Over Studies, Young Adult
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