Effects of cognitive-behavioral therapy with relaxation vs. imagery rescripting on psychophysiological stress responses of students with test anxiety in a randomized controlled trial

Background and objectives: Psychophysiological measures were assessed in university students during a test simulation before and after group treatment for test anxiety based on cognitive behavioral therapy (CBT), including relaxation techniques (CBT + R) or imagery rescripting (CBT + ImRs) and a moderated self-help group (SH) to understand if psychophysiological stress responses change after treatment. Design: Students suffering from test anxiety were recruited (n = 180) and three different test anxiety treatments administered in 3-hr group sessions once a week over a period of five weeks. Methods: During an experimental socially evaluative situation state anxiety and physiological stress responses of participants were obtained before and after treatment. Results: In all treatment groups, self-reported state anxiety in a stressful socially evaluative situation declined after treatment. Contrary to our hypotheses no significant reduction of physiological reactivity scores after intervention was found in any of the three group treatments. Conclusions: CBT and SH treatments are successful in reducing self-reported state anxiety in a socially evaluative situation, but psychophysiological stress responses in test anxiety patients remained unchanged despite all treatments.