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ACT-Based Psychoeducation Program for Reducing Test Anxiety: A Mixed Method Case Study of Economically Disadvantaged Students

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Title: ACT-Based Psychoeducation Program for Reducing Test Anxiety: A Mixed Method Case Study of Economically Disadvantaged Students
Language: English
Authors: Fatma Zehra Ünlü Kaynakçi (ORCID 0000-0002-9491-2750), Gökçen Aydin (ORCID 0000-0003-0781-7817), S. Burcu Özgülük Üçok (ORCID 0000-0001-7464-6136)
Source: Psychology in the Schools. 2025 62(9):3727-3735.
Availability: Wiley. Available from: John Wiley & Sons, Inc. 111 River Street, Hoboken, NJ 07030. Tel: 800-835-6770; e-mail: cs-journals@wiley.com; Web site: https://www.wiley.com/en-us
Peer Reviewed: Y
Page Count: 9
Publication Date: 2025
Document Type: Journal Articles
Reports - Research
Education Level: High Schools
Secondary Education
Grade 10
Descriptors: Foreign Countries, Test Anxiety, Psychoeducational Methods, High School Students, Grade 10, Intervention, Therapy, Economically Disadvantaged, Program Effectiveness
Geographic Terms: Turkey
DOI: 10.1002/pits.23583
ISSN: 0033-3085
1520-6807
Abstract: University entrance exams in Türkiye often generate significant test anxiety among high school students. This study investigates the effectiveness of a psychoeducational intervention based on Acceptance and Commitment Therapy (ACT) in reducing test anxiety among 10th-grade students. Employing a mixed-methods sequential explanatory design, the study included nine economically disadvantaged high school students (aged 15-17), two of whom were female and seven males, who participated in a six-session intervention. The quantitative phase utilized a quasi-experimental one-group pretest-posttest design, with measurements conducted using the Cognitive Test Anxiety Scale, the Mindful Attention Awareness Scale--Adolescent Form, and the Multidimensional Psychological Flexibility Inventory--Short Form. The qualitative phase comprised focus group interviews guided by semi-structured questions to explore participants' perspectives on the ACT-based psychoeducation program. The results demonstrated a statistically significant reduction in test anxiety and an increase in psychological flexibility, while no significant changes were observed in mindfulness levels. Qualitative analysis revealed three central themes: perceived benefits, most and least useful aspects, and suggestions for improvement. These findings suggest that ACT-based psychoeducation is an effective intervention for reducing test anxiety. Implications for future research and practical applications in educational and psychological contexts are discussed.
Abstractor: As Provided
Entry Date: 2025
Accession Number: EJ1479987
Database: ERIC
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  Value: <anid>AN0187257446;pis01sep.25;2025Aug14.01:14;v2.2.500</anid> <title id="AN0187257446-1">ACT‐Based Psychoeducation Program for Reducing Test Anxiety: A Mixed Method Case Study of Economically Disadvantaged Students </title> <p>University entrance exams in Türkiye often generate significant test anxiety among high school students. This study investigates the effectiveness of a psychoeducational intervention based on Acceptance and Commitment Therapy (ACT) in reducing test anxiety among 10th‐grade students. Employing a mixed‐methods sequential explanatory design, the study included nine economically disadvantaged high school students (aged 15–17), two of whom were female and seven males, who participated in a six‐session intervention. The quantitative phase utilized a quasi‐experimental one‐group pretest‐posttest design, with measurements conducted using the Cognitive Test Anxiety Scale, the Mindful Attention Awareness Scale–Adolescent Form, and the Multidimensional Psychological Flexibility Inventory–Short Form. The qualitative phase comprised focus group interviews guided by semi‐structured questions to explore participants' perspectives on the ACT‐based psychoeducation program. The results demonstrated a statistically significant reduction in test anxiety and an increase in psychological flexibility, while no significant changes were observed in mindfulness levels. Qualitative analysis revealed three central themes: perceived benefits, most and least useful aspects, and suggestions for improvement. These findings suggest that ACT‐based psychoeducation is an effective intervention for reducing test anxiety. Implications for future research and practical applications in educational and psychological contexts are discussed.</p> <p>Summary: Acceptance and Commitment Therapy (ACT)‐based psychoeducation significantly reduced test anxiety among high school students from lower socioeconomic backgrounds preparing for university entrance exams.ACT‐based interventions can be used to improve psychological flexibility, which helps students better manage the emotional challenges associated with test preparation.School counselors can utilize this ACT‐based psychoeducation program to increase the psychological flexibility of high school students.</p> <p>Keywords: mindfulness; psychological flexibility; school counselors; test anxiety</p> <hd id="AN0187257446-2">Introduction</hd> <p>The well‐being of young people has gained significant attention in policy discussions. Test anxiety—which is defined as the fear and discomfort connected to performance reviews—is a global issue and a focus of research because of its significant effects on both academic performance and psychological well‐being. A mix of cognitive, emotional, and physiological variables frequently contribute to test anxiety. Apprehension and dread are examples of emotional components. A rapid heartbeat, sweating, and shaking are signs of physiological reactions, whereas performance worries and the fear of getting a bad grade are examples of cognitive problems. Cognitive test anxiety is "associated with a broader range of behaviors and beliefs that impact the learning and testing experiences for students" (Cassady and Finch [<reflink idref="bib9" id="ref1">9</reflink>], p. 14).</p> <p>Research indicates that test anxiety is a prevalent issue across various educational contexts globally. In the North West of England, approximately 16.4% of adolescents report high test anxiety (Putwain and Daly [<reflink idref="bib33" id="ref2">33</reflink>]), while in the Midwestern United States, this rate is reported as 22% (Thomas et al. [<reflink idref="bib41" id="ref3">41</reflink>]). In a broader study, von der Embse et al. ([<reflink idref="bib16" id="ref4">16</reflink>]) found that 35% of students in England and Wales experienced elevated levels of test anxiety. Internationally, the OECD ([<reflink idref="bib30" id="ref5">30</reflink>]) reported that 59% of students often worry about taking tests.</p> <p>In countries where high‐stakes assessments are highly recognized as a turning point for future careers and opportunities for students, test anxiety is an inevitable problem. For example, China is internationally recognized for its test‐centered education system, and nearly one in two adolescents experiences test anxiety (Chen et al. [<reflink idref="bib11" id="ref6">11</reflink>]). In the same vein, the Turkish educational system places significant emphasis on testing, culminating in the mandatory university entrance exam, which is essential for admission to and completion of a college degree program and has to be taken after high school graduation. Therefore, test anxiety in high school is a critical issue for school counselors in Türkiye because the prevalence of test anxiety level is quite high due to nationwide university entrance exams. In very recent research, the percentage of children aged 13–17 who reported feeling very anxious before exams, even when well prepared for exams, was 50.5%. This rate was 43.9% among boys and 57.6% among girls in the same age group (Türkiye İstatistik Kurumu [<reflink idref="bib45" id="ref7">45</reflink>]). In another study, Kavakci et al. ([<reflink idref="bib25" id="ref8">25</reflink>]) reported that 48% of high school students had test anxiety and girls had higher anxiety than boys.</p> <p>High‐stakes assessments, where adolescents experience significant test‐related pressure, are believed to contribute notably to stress and anxiety among teenagers. Interestingly, Yerkes‐Dodson's law (Teigen [<reflink idref="bib40" id="ref9">40</reflink>]) posits that extremely high or low anxiety can result in worse outcomes than moderate levels of anxiety. However, there are contradictory findings regarding the level of anxiety for better performance. Even though anxiety over a test could boost motivation, concentration, and effort, which would result in better grades (Kader [<reflink idref="bib24" id="ref10">24</reflink>]), a meta‐analysis on test anxiety showed that regardless of testing format, a high level of test anxiety was associated with low performance for students (von der Embse et al. [<reflink idref="bib15" id="ref11">15</reflink>]). On the other side, Jerrim et al. ([<reflink idref="bib23" id="ref12">23</reflink>]) found that test anxiety—whether very high, very low, or moderate—does not seem to have a strong relationship with performance. The results suggest that the common belief that high anxiety negatively affects grades might not always hold true, as the differences were small and did not change based on factors like past performance or socioeconomic status.</p> <p>Test anxiety influences not only educational performance but also the mental health of young people. This type of anxiety has a variety of negative effects on psychological health (Putwain and von der Embse [<reflink idref="bib35" id="ref13">35</reflink>]). Students who have a higher level of test anxiety tend to have beliefs regarding the uncontrollability and perceived danger of worry (Fergus et al. [<reflink idref="bib17" id="ref14">17</reflink>]). Adolescents are required to manage both inevitable external evaluations and internal self‐judgments in high school (Dundas and Nygård [<reflink idref="bib14" id="ref15">14</reflink>]).</p> <p>For adolescents, a high level of anxiety is especially concerning because worries about failing and expectations that are not met may play a role in shaping their development and thus may have an influence on their future lives (Salvador et al. [<reflink idref="bib37" id="ref16">37</reflink>]). Certain factors in adolescence, such as socioeconomic status, may have an impact on these outcomes. Putwain ([<reflink idref="bib34" id="ref17">34</reflink>]) found that the anxiety levels observed among high school students were linked to their socioeconomic classes. Additionally, research suggests that there is a positive correlation between income inequality and high levels of test anxiety (King et al. [<reflink idref="bib26" id="ref18">26</reflink>]). On the other hand, Jerrim ([<reflink idref="bib22" id="ref19">22</reflink>]) found that adolescents' socioeconomic statuses did not lead to a significant difference in the level of test anxiety. Contradictory findings need to be taken into consideration while drawing conclusions about test anxiety.</p> <hd id="AN0187257446-3">Psychological Flexibility, Mindfulness, and Cognitive Test Anxiety</hd> <p>Contemporary approaches provide insight into the solution of certain problems, including test anxiety. To illustrate, Acceptance and Commitment Therapy (ACT), which is part of the third wave of cognitive behavioral therapies has been used to decrease test anxiety. ACT promotes evidence‐based practices. Its main goal is to increase psychological flexibility, which encourages people to accept negative feelings and thoughts instead of rejecting them while focusing on values‐based action (Hayes et al. [<reflink idref="bib21" id="ref20">21</reflink>]).</p> <p>Psychological flexibility has six core concepts: acceptance, present moment awareness, cognitive defusion, self‐as‐context, values, and committed action (Hayes et al. [<reflink idref="bib19" id="ref21">19</reflink>]). Enhancing psychological flexibility involves cultivating awareness of the present moment, particularly in addressing anxiety—specifically test anxiety in the context of the current study through experiential exercises. Employing mindfulness techniques plays a crucial role in calming the body and redirecting focus to the present, rather than allowing attention to be consumed by future‐oriented thoughts. The present‐moment focus of mindfulness sheds light on the relationship between psychological flexibility and test anxiety.</p> <p>Mindfulness and psychological flexibility have been recently considered as future promising test anxiety management techniques, both in individual or group treatments as well as psychoeducation training. That is, the literature pointed out that test anxiety was predicted by mindfulness and psychological flexibility and applying psychoeducation training in reducing test anxiety provided significant results (e.g., Aydın and Aydın [<reflink idref="bib2" id="ref22">2</reflink>]; Aydın and Yerin Güneri [<reflink idref="bib3" id="ref23">3</reflink>]; Lothes et al. [<reflink idref="bib28" id="ref24">28</reflink>]; Pires et al. [<reflink idref="bib31" id="ref25">31</reflink>]; Priebe and Kurtz‐Costes [<reflink idref="bib32" id="ref26">32</reflink>]). Research suggests that higher levels of psychological flexibility are associated with lower levels of test anxiety (e.g., Türk [<reflink idref="bib44" id="ref27">44</reflink>]). In a recent study, ACT was found effective in reducing test anxiety among male adolescents (Habibollahi et al. [<reflink idref="bib18" id="ref28">18</reflink>]). However, there has been limited research addressing both test anxiety and Acceptance and Commitment Therapy in Türkiye. To illustrate the limited number of studies, Ulubay and Güven ([<reflink idref="bib46" id="ref29">46</reflink>]) systematically analyzed 53 studies conducted in Türkiye, including 16 full‐text articles, 21 master's theses, 11 doctoral dissertations, and 5 medical specialty theses, focusing on Acceptance and Commitment Therapy (ACT) and psychological flexibility; and among these, only two studies specifically address test anxiety, revealing a negative relationship between test anxiety and psychological flexibility.</p> <hd id="AN0187257446-4">The Current Study</hd> <p>There is existing research on interventions for test anxiety in adolescents (Lowe and Wuthrich [<reflink idref="bib29" id="ref30">29</reflink>]; Yale‐Soulière et al. [<reflink idref="bib49" id="ref31">49</reflink>]); however, the field remains underexplored. In Türkiye, studies investigating the effects of ACT‐based psychoeducation on adolescent test anxiety are similarly limited. For instance, a recent study found that ACT‐based psychoeducation effectively reduced psychological distress; however, it revealed no significant differences between 12th‐grade students who received ACT‐based psychoeducation and those who received CBT‐based (Cognitive Behavioral Therapy) psychoeducation (Uysal et al. [<reflink idref="bib47" id="ref32">47</reflink>]). Another study reported that students who participated in ACT‐based psychoeducation showed reduced test anxiety and increased psychological flexibility following the intervention (Aydın and Aydın [<reflink idref="bib2" id="ref33">2</reflink>]). It is worth noting that this study relied exclusively on qualitative assessments and included only female participants. Expanding on this existing literature, the present study aims to contribute to the field by examining the efficacy of an ACT‐based psychoeducation program in increasing mindfulness and psychological flexibility as well as reducing test anxiety among 10th‐grade students. Aligned with the relevant literature, in the quantitative part of the current study, three hypotheses were tested:</p> <hd id="AN0187257446-5">1 Hypothesis</hd> <p>(H1): There will be a significant increase in the mindfulness levels of the students as a result of the 6‐session psychoeducation program.</p> <hd id="AN0187257446-6">2 Hypothesis</hd> <p>(H2): There will be a significant increase in the psychological flexibility of the students as a result of the 6‐session psychoeducation program.</p> <hd id="AN0187257446-7">3 Hypothesis</hd> <p>(H3): There will be a significant decrease in the test anxiety of the students as a result of the 6‐session psychoeducation program.</p> <p>In addition to testing three hypotheses, the researchers aimed to answer the following qualitative research question:</p> <p>What are the perceptions of the students regarding the ACT‐based psychoeducation program?</p> <hd id="AN0187257446-8">Methods</hd> <p></p> <hd id="AN0187257446-9">Design</hd> <p>This mixed‐method research was based on Sequential Explanatory Design in which quantitative data collection was followed by qualitative data collection and analysis (Creswell and Plano Clark [<reflink idref="bib13" id="ref34">13</reflink>]). The explanatory design consists of two stages: First, quantitative data are collected and evaluated, followed by qualitative data that explain the quantitative data in greater detail (Creswell and Plano Clark [<reflink idref="bib13" id="ref35">13</reflink>]). The main advantage of the explanatory design is that it allows for in‐depth explanations of noteworthy and surprising outcomes revealed by quantitative findings through interviews or observations conducted later. In the present study, the first quantitative phase (Phase I) included quasi‐experimental research with a one‐group pre‐post test (Table 1) and in the second qualitative phase (Phase II), a focus‐group interview was conducted with participants by using a semi‐structured interview form to extend more on quantitative findings.</p> <p>1 Table Quasi‐experimental research with one‐group pre‐post test.</p> <p> <ephtml> <table><thead valign="bottom"><tr valign="bottom"><th>Group</th><th>Pretest</th><th>Treatment</th><th>Posttest</th></tr></thead><tbody valign="top"><tr><td>Experimental</td><td>O1</td><td>X</td><td>O2</td></tr></tbody></table> </ephtml> </p> <hd id="AN0187257446-10">Participants</hd> <p>The participants in this case study were nine high school students who were selected based on being a scholarship student in high school due to academic achievement or athletic abilities, obtaining parental consent, and volunteering to participate in the study. Although ten high school students participated in the study, the responses from one of them were missing in the measurements. Therefore, the sample comprised nine high school students who were in 10th grade in the capital city of Türkiye. Participants were recruited via purposive sampling. The students were taking scholarships due to having a low income but being high achievers in academic performance or sports facilities. The case study focuses on an ACT‐based psychoeducation to reduce test anxiety and the sample was intentionally selected to represent the economically disadvantaged students' test anxiety.</p> <p>Among participants, two were females (22.2%) and seven were males (77.8%). Their ages ranged between 15 and 17 (<emph>M</emph> = 16.33, SD = 0.70). Their GPA ranged from 60 to 95 (out of 100; <emph>M</emph> = 84.05, SD = 11.15). When examining the participants' parental education levels, it was found that three mothers were high school graduates, one was a middle school graduate, and three were elementary school graduates. In terms of fathers' education levels, five were high school graduates, one was a middle school graduate, and one was an elementary school graduate. One participant did not provide information on either parent's education level. In terms of parental employment statuses, it was found that only one participant's mother was a chef, one did not report the mother's employment status, and the others were not employed. For fathers, seven participants' fathers were working in the service sector, one was a civil servant, and one did not report the father's employment status.</p> <hd id="AN0187257446-11">Measures</hd> <p></p> <hd id="AN0187257446-12">Mindful Attention Awareness Scale‐Adolescents</hd> <p>The Mindful Attention Awareness Scale‐Adolescents (Brown et al. [<reflink idref="bib6" id="ref36">6</reflink>]) was developed to assess mindfulness levels in adolescents. The scale consists of 14 items and measures a single dimension on a 6‐point Likert scale from 0 (almost always) to 5 (almost never). The highest possible score on the scale is 70. Higher scores indicate higher levels of mindfulness. The Turkish adaptation of the scale was conducted by Turan ([<reflink idref="bib43" id="ref37">43</reflink>]). For the original version of the scale, Cronbach's alpha values were reported as 0.82 and 0.84 for two different adolescent samples (Brown et al. [<reflink idref="bib6" id="ref38">6</reflink>]). For the Turkish version of the scale, Cronbach's Alpha value was reported as 0.78 (Turan [<reflink idref="bib43" id="ref39">43</reflink>]).</p> <hd id="AN0187257446-13">Cognitive Test Anxiety Scale</hd> <p>The Cognitive Test Anxiety Scale (CTAS) (Cassady and Johnson [<reflink idref="bib10" id="ref40">10</reflink>]) was developed to measure the cognitive dimension of test anxiety. The scale includes 27 items and one dimension, and it is rated on a 4‐point Likert scale, ranging from 1, which represents "Not at all like me," to 4, which represents "Very much like me." Higher scores indicate higher levels of test anxiety. Cassady and Finch ([<reflink idref="bib9" id="ref41">9</reflink>]) revised the CTAS, and thus developed the 25‐item CTAS scale, which follows the same structure—it is a 4‐point Likert scale with one dimension—and does not include reverse‐coded items. The revised version of the CTAS was adapted into the Turkish language by Bozkurt et al. ([<reflink idref="bib5" id="ref42">5</reflink>]), and this version includes 23 items. The internal consistency coefficient of the Turkish version was determined to be 0.93.</p> <hd id="AN0187257446-14">Multidimensional Psychological Flexibility Inventory—Short Form</hd> <p>The Multidimensional Psychological Flexibility Inventory (MPFI) was developed by Rolffs et al. ([<reflink idref="bib36" id="ref43">36</reflink>]) to measure psychological flexibility and psychological inflexibility. The scale comprises 24 items, with items 1–12 measuring psychological flexibility and items 13–24 measuring psychological inflexibility. Responses are rated on a 6‐point Likert scale, ranging from 1 (never true) to 6 (always true). The scale has two subscales, which are psychological flexibility and psychological inflexibility. The subscale scores for psychological flexibility and psychological inflexibility are calculated by averaging the item scores within each subscale. Accordingly, the minimum and maximum scores for the subscales range from 1 to 6. The Turkish adaptation of the scale was carried out by Alkal and Çam ([<reflink idref="bib1" id="ref44">1</reflink>]). The Cronbach's alpha reliability coefficients for psychological flexibility were reported as 0.91 and for psychological inflexibility as 0.90 for the original version (Rolffs et al. [<reflink idref="bib36" id="ref45">36</reflink>]). For the Turkish version, Cronbach's alpha coefficients were 0.97 for psychological flexibility and 0.96 for psychological inflexibility (Alkal and Çam [<reflink idref="bib1" id="ref46">1</reflink>]). In this study, the psychological flexibility dimension of the scale was used.</p> <hd id="AN0187257446-15">Semi‐Structured Interview Form</hd> <p>The form consisted of open‐ended questions to evaluate the entire psychoeducation program to be used in a focus group interview attended by all students. The first researcher conducted the interview and took notes based on the students' answers. Example questions are, "What kind of contribution do you think participating in this training has provided for you?" and "Which part/topic in this psychoeducation did you find most and least beneficial? In what way?"</p> <hd id="AN0187257446-16">Evaluation Form for Psychoeducation Sessions</hd> <p>An evaluation form for psychoeducation sessions, consisting of three Likert scale statements, ranging from 1 (Strongly Disagree) to 5 (Strongly Agree), was administered at the end of each session in paper‐pencil format. The statements included: "Today, I benefited the group to achieve my goals," "I felt that the content of today's group session was aligned with my needs and goals," and "I found the activities in today's group session beneficial." The scores for each item, collected at the end of each session, were evaluated at the termination of the psychoeducation program. Means and standard deviations were calculated for each item based on the overall data.</p> <hd id="AN0187257446-17">Intervention and Procedure</hd> <p>Ethical approval (202427‐04.03.2024) was obtained by the Human Research Ethics Committee of TED University. Parental consent forms were obtained before the study. Furthermore, all participants provided consent by approving the voluntary participation form. The assessments were conducted at two time points: before and after the psychoeducation program.</p> <p>The psychoeducation program was designed based on the principles of Acceptance and Commitment Therapy (ACT), and six core themes were identified. In the development of the psychoeducation program, the relevant literature review (e.g., AYDIN and AYDIN [<reflink idref="bib2" id="ref47">2</reflink>]), and the sociodemographics were taken into consideration. The program was delivered in a group format, with sessions held twice a week over 3 weeks, resulting in a total of six sessions. Each session lasted approximately 50 min. Psychoeducation was started on April 20, 2024, in a class environment. The summary of the ACT‐based Psychoeducation for Cognitive Test Anxiety is presented in Table 2.</p> <p>2 Table Summary of the ACT‐based psychoeducation program.</p> <p> <ephtml> <table><thead valign="bottom"><tr valign="bottom"><th>Theme</th><th>Main objectives</th><th>Main exercises/Metaphors</th></tr></thead><tbody valign="top"><tr><td>Session 1—Test anxiety—ACT hexaflex</td><td><list list-type="Bullet"><list-item><p>Identifying personal goals for the group.</p></list-item><list-item><p>Understanding the concept of test anxiety and the ACT Hexaflex model.</p></list-item></list></td><td>Outlining the objectives of the psychoeducation programPsychoeducation about test anxiety and the ACT Hexaflex.</td></tr><tr><td>Session 2—Mindfulness</td><td><list list-type="Bullet"><list-item><p>Demonstrating simple mindfulness practices to reduce stress.</p></list-item></list></td><td>Mindful eatingMindful breathing practice.</td></tr><tr><td>Session 3—Acceptance</td><td><list list-type="Bullet"><list-item><p>Understanding the importance of using acceptance as a coping mechanism rather than avoidance.</p></list-item></list></td><td>"The Chocolate Cake task" (Hayes et al. (<xref ref-type="bibr" rid="bibr20">2012</xref>), pp. 185–186)".</td></tr><tr><td>Session 4— Cognitive defusion</td><td><list list-type="Bullet"><list-item><p>Applying cognitive defusion strategies to create distance from their anxiety.</p></list-item></list></td><td>Shape your anxiety!Color your anxiety!Name your anxiety!</td></tr><tr><td>Session 5—Self as context and values</td><td><list list-type="Bullet"><list-item><p>Recognizing that individuals are not defined by their thoughts or emotions, but rather serve as the observer of these internal experiences.</p></list-item><list-item><p>Clarifying core values.</p></list-item></list></td><td>Passenger on the Bus Metaphor.The sky and the weather metaphor.80th Birthday exercise.</td></tr><tr><td>Session 6—Committed action and termination</td><td><list list-type="Bullet"><list-item><p>Developing a concrete action plan using the Clarifying Values Worksheet (Walser and Westrup <xref ref-type="bibr" rid="bibr48">2007</xref>) to pursue goals that are aligned with participants' core values.</p></list-item></list></td><td>Clarifying Values Worksheet (Walser and Westrup <xref ref-type="bibr" rid="bibr48">2007</xref>)</td></tr></tbody></table> </ephtml> </p> <hd id="AN0187257446-18">Data Analysis</hd> <p>In this study, non‐parametric tests were utilized due to the small sample size. In the first phase, quasi‐experimental research with a one‐group pretest‐posttest was used to assess whether the students' test anxiety, mindfulness, and flexibility differed as a result of the psychoeducation program. A non‐parametric Wilcoxon Signed‐Rank test was used to determine the difference between mean values of rank obtained from pre and post measurement of a single group across the psychoeducation program (Phase I). All analyses were run in SPSS Version 28. Furthermore, in the second phase, a focus group interview was conducted to extend more on evaluating the psychoeducation program. The qualitative data were analyzed using the content analysis method to obtain themes (Phase II). The first author conducted the content analysis, and the findings of content analysis was discussed with the third author. The group evaluation forms were also analyzed based on their mean scores. It should also be noted that effect sizes were evaluated based on Cohen's criteria while analyzing the experimental results. Accordingly, effect sizes are categorized as 0.10 for a small effect, 0.30 for a medium effect, and 0.50 for a large effect (Cohen [<reflink idref="bib12" id="ref48">12</reflink>]).</p> <hd id="AN0187257446-19">Results</hd> <p></p> <hd id="AN0187257446-20">Phase I</hd> <p>The main aim of the current study was to assess the effectiveness of a psychoeducation program designed and applied for high school students to help them decrease their test anxiety and increase their mindfulness and flexibility to cope with their anxiety. The mean values and standard deviations obtained from the Cognitive Test Anxiety Scale (CTAS), Mindful Attention Awareness Scale Adolescent Form (MS), and Multidimensional Psychological Flexibility Inventory‐Short Form (MPFI) before and after the experiment (the psychoeducation program) were calculated as shown in Table 3.</p> <p>3 Table Descriptive statistics of pre‐and Posttest.</p> <p> <ephtml> <table><thead valign="bottom"><tr valign="bottom"><th>Measures</th><th>Pre‐test</th><th>Posttest</th></tr><tr valign="bottom"><th><italic>M</italic></th><th>SD</th><th>Skewness</th><th>Kurtosis</th><th><italic>M</italic></th><th>SD</th><th>Skewness</th><th>Kurtosis</th></tr></thead><tbody valign="top"><tr><td>Test anxiety</td><td>52</td><td>9.3</td><td>−0.20</td><td>−0.78</td><td>43.11</td><td>3.85</td><td>−1.37</td><td>1.48</td></tr><tr><td>Mindfulness</td><td>53.88</td><td>8.16</td><td>−0.16</td><td>1.03</td><td>52.77</td><td>10.99</td><td>−0.31</td><td>−0.77</td></tr><tr><td>Psychological flexibility</td><td>3.53</td><td>0.75</td><td>−0.19</td><td>−1.30</td><td>4.02</td><td>0.62</td><td>0.80</td><td>0.83</td></tr></tbody></table> </ephtml> </p> <p>As depicted in Table 4, the Wilcoxon Signed‐Rank Test displayed a significant decrease in the test anxiety of high school students subsequent to the psychoeducation program (<emph>z</emph> = −2.49, <emph>p</emph> = 0.01). The effect size was large (<emph>r</emph> = 0.59), proposing that the intervention had a meaningful effect on decreasing students' test anxiety. Specifically, the decline from pre‐test (<emph>Mpre</emph> = 53.88) to posttest (<emph>Mpost</emph> = 43.11) supports the effectiveness of the program alleviating students' test anxiety. On the contrary, no significant change was observed in the mindfulness scores of the high school students between the pre‐test and posttest (<emph>z</emph> = −0.14, <emph>p</emph> = 0.89). The psychoeducation did not have a significant effect on the mindfulness levels of students as evidenced by the negligible change (<emph>Mpre</emph> = 53.88, <emph>Mpost</emph> = 52.77). Besides, a significant increase in the psychological flexibility of the high school students was observed after the intervention (<emph>z</emph> = −2.03, <emph>p</emph> = 0.04), with a medium effect size (<emph>r</emph> = 0.48). The increase from pre‐test (<emph>Mpre</emph> = 3.53) to posttest (<emph>Mpost</emph> = 4.02) suggests that the program contributed to improving the psychological flexibility of the students.</p> <p>4 Table Results of the Wilcoxon Signed‐Rank Test regarding the pretest‐posttest.</p> <p> <ephtml> <table><thead valign="bottom"><tr valign="bottom"><th>Posttest‐Pretest</th><th /><th><italic>N</italic></th><th>Mean Rank</th><th>Sum of Ranks</th><th><italic>z</italic></th><th><italic>p</italic></th></tr></thead><tbody valign="top"><tr><td>Test anxiety</td><td>Negative ranks</td><td>8</td><td>5.44</td><td>43.50</td><td>−2.49</td><td>0.01<ext-link href="*" /></td></tr><tr><td>Positive ranks</td><td>1</td><td>1.50</td><td>1.5</td><td /><td /></tr><tr><td>Ties</td><td>0</td><td>—</td><td>—</td><td /><td /></tr><tr><td>Mindfulness</td><td>Negative ranks</td><td>4</td><td>4.75</td><td>19.00</td><td>−0.14</td><td>0.89</td></tr><tr><td>Positive ranks</td><td>4</td><td>4.25</td><td>17.00</td><td /><td /></tr><tr><td>Ties</td><td>1</td><td>—</td><td>—</td><td /><td /></tr><tr><td>Psychological flexibility</td><td>Negative ranks</td><td>1</td><td>2.00</td><td>2.00</td><td>−2.03</td><td>0.04<ext-link href="*" /></td></tr><tr><td>Positive ranks</td><td>6</td><td>4.33</td><td>26.00</td><td /><td /></tr><tr><td>Ties</td><td>0</td><td>—</td><td>—</td><td /><td /></tr></tbody></table> </ephtml> </p> <p>1 * <emph>p</emph> < 0.05.</p> <hd id="AN0187257446-21">Phase II</hd> <p>A semi‐structured focus group interview was conducted to evaluate overall psychoeducation. Accordingly, the findings fell under three themes: (<reflink idref="bib1" id="ref49">1</reflink>) Perceived Benefits of Participation; (<reflink idref="bib2" id="ref50">2</reflink>) Most and Least Useful Aspects of the Program; and (<reflink idref="bib3" id="ref51">3</reflink>) Suggestions for Further Improvement. In terms of perceived benefits of participating in psychoeducation, all participants highlighted the increasing awareness about acceptance and mindfulness skills. Several participants' explanations were offered: "Through this training, I was able to confront and stay with my pain rather than continually attempting to avoid it."; "I observe that I am living with more awareness."; "I realize that I am living with a focus on the present moment."; and "The mindful eating exercise was very interesting to me. Before, I wouldn't really notice the shape or smell of something I was eating, but this training helped me become more aware of these details."</p> <p>Furthermore, some of the participants mentioned that learning the importance of "values" was the most beneficial part of the psychoeducation. For instance, one of the participants stated that:</p> <p>Although there are challenges in my life, I have realized that focusing on my values can be beneficial. I also awarded myself the 'Advocacy for Justice' prize. I understand that while living in line with this value, I may stumble or encounter negative thoughts and emotions, but I have learned that I can continue despite them.</p> <p>Regarding the least useful aspects of the program, although participants highlighted the positive aspects of mindful eating and mindful breathing exercise, one of the participants mentioned that he experienced shortness of breath during the breathing activity, and this type of breathing exercise was not beneficial for him. One of the participants also stated, "Since we did the mindful walking exercise in the classroom, I felt a bit tense instead of relaxed. It would have been much better if the weather had been nice, and we could have done this activity outside." Lastly, as suggestions, nearly all the participants suggested conducting some activities outside of the class. Additionally, participants highlighted that the activities were mostly individual‐based and suggested incorporating more group‐based activities.</p> <hd id="AN0187257446-22">Descriptive Evaluation of Psychoeducation Sessions</hd> <p>To extend more on the evaluation of psychoeducation sessions, a three‐question psychoeducational evaluation form, completed after each session was conducted and the analysis of responses yielded the following results. For the statement "Today, I benefited from the group to achieve my goals," the mean score ranged from 3.2 to 4.0, with a standard deviation of 0.3, indicating a relatively consistent perception of benefit among participants. Regarding the second statement, "I felt that the content of today's group session was aligned with my needs and goals," the mean score ranged between 3.8 and 4.3, with a standard deviation of 0.21, suggesting a moderately strong alignment of session content with participant needs and goals. Finally, for the statement "I found the activities in today's group session beneficial," the mean score varied from 3.5 to 4.5, with a standard deviation of 0.3, reflecting a generally favorable perception of the activities' utility. These findings suggest that the group sessions were perceived as beneficial in terms of goal achievement, content relevance, and activity value, with participants expressing consistent satisfaction across these domains.</p> <hd id="AN0187257446-23">Discussion</hd> <p>This study aimed to assess the effectiveness of an ACT‐based psychoeducation program provided for adolescents to decrease their test anxiety and increase mindfulness and psychological flexibility so that they could cope with their anxiety. Along with this aim of the current study, three hypotheses were tested, and the perceptions of the students regarding the ACT‐based psychoeducation program were explored. In the first hypothesis (H1), it was declared that there would be a significant increase in the mindfulness levels of the students as a result of the 6‐session psychoeducation program. In the second hypothesis, it was declared that there would be a significant increase in the psychological flexibility of the students as a result of the 6‐session psychoeducation program, and the third hypothesis posited that there would be a significant decrease in the test anxiety of the students as a result of the 6‐session psychoeducation program.</p> <p>Aligned with H1, the literature pointed out that mindfulness training has an influence in reducing test anxiety (Dundas and Nygård [<reflink idref="bib14" id="ref52">14</reflink>]; Priebe and Kurtz‐Costes [<reflink idref="bib32" id="ref53">32</reflink>]). However, as a surprising result, H1 was rejected, and mindfulness was not found to be significant in the current study, which may be attributed to the insufficient integration of mindfulness exercises into the psychoeducation program. Also, the literature focuses on the effectiveness of mindfulness‐based training in reducing test anxiety; however, the current research did not have a focus purely on mindfulness‐based psychoeducation but ACT‐based (namely psychological flexibility) psychoeducation. It should also be noted that although the quantitative results did not highlight a significant change in mindfulness, the qualitative findings suggested an increase in knowledge about mindfulness among participants.</p> <p>In this study, H2 and H3 were confirmed. The findings showed that adolescents participating in the ACT‐based psychoeducation program had lower levels of test anxiety and higher levels of psychological flexibility when compared to the levels they had before taking part in the psychoeducation program. ACT‐based psychoeducation contributed to this outcome with a large effect size for test anxiety and a middle effect size for psychological flexibility. ACT mainly aims to increase psychological flexibility. In accordance with this framework, the findings of this study indicated that a significant improvement in psychological flexibility was observed subsequent to participation in ACT‐based psychoeducation. Additionally, test anxiety was observed to decrease while psychological flexibility increased. A recent meta‐analysis that investigated the efficacy of ACT interventions in increasing psychological flexibility among adolescents also highlighted the critical role of such interventions in reducing depression and anxiety symptoms (López‐Pinar et al. [<reflink idref="bib27" id="ref54">27</reflink>]). The findings reveal that ACT interventions significantly increase psychological flexibility, and this may serve as an important factor in symptom reduction. Moreover, previous studies revealed a negative relationship between psychological flexibility and test anxiety (e.g., Aydın and Yerin Güneri [<reflink idref="bib3" id="ref55">3</reflink>]; Türk [<reflink idref="bib44" id="ref56">44</reflink>]), but experimental studies that directly examine this connection remain scarce. Most of the studies on ACT‐based psychoeducation have concentrated on the effects such as a decrease in psychological distress (e.g., Uysal et al. [<reflink idref="bib47" id="ref57">47</reflink>]), anxiety (e.g., Burckhardt et al. [<reflink idref="bib7" id="ref58">7</reflink>]), and stress (e.g., Binder et al. [<reflink idref="bib4" id="ref59">4</reflink>]) among adolescents without focusing on psychological flexibility. Therefore, this study contributes to the relevant research indicating the positive impact of ACT on psychological flexibility. Furthermore, the qualitative findings suggest that participants developed an awareness of acceptance and values, which aligns with the overall aim of enhancing psychological flexibility. This integration underscores the multifaceted benefits of ACT‐based psychoeducation among adolescents. Moreover, the qualitative findings also demonstrated the usefulness of ACT‐based psychoeducation in promoting mindfulness and acceptance for test anxiety, despite the fact that the primary goal was process evaluation.</p> <p>Overall, these findings align with the studies that indicate greater effects of ACT‐based interventions among adolescents (e.g., Burley and McAloon [<reflink idref="bib8" id="ref60">8</reflink>]). This psychoeducation was planned as a 6‐h brief‐format intervention. Takahashi et al. ([<reflink idref="bib39" id="ref61">39</reflink>]) state that the brief‐format interventions need to be evaluated. The current study emphasizes the potential effectiveness of ACT even when it is delivered over a shorter period of time. The positive influence of this ACT‐based psychoeducation in addressing test anxiety may be linked to accepting test anxiety, evaluating thoughts in an objective and impartial way, and fostering constructive behavior. Likewise, the findings of the research about the effect of ACT‐based psychoeducation on test anxiety support the previous literature. For instance, the research results of Aydın and Yerin Güneri ([<reflink idref="bib3" id="ref62">3</reflink>]) and Habibollahi et al. ([<reflink idref="bib18" id="ref63">18</reflink>]) revealed the role of ACT‐based interventions in decreasing test anxiety.</p> <p>This study is worth considering in terms of the demographic characteristics of participants. The participants in this study came from socioeconomically disadvantaged backgrounds and were awarded scholarships based on their academic or athletic abilities and high performance. It is a known fact that lower socioeconomic status is a significant risk factor for adolescents' well‐being (Yoshikawa et al. [<reflink idref="bib50" id="ref64">50</reflink>]), and this risk may be exacerbated by test anxiety (King et al. [<reflink idref="bib26" id="ref65">26</reflink>]; Putwain and von der Embse [<reflink idref="bib35" id="ref66">35</reflink>]). While existing studies have demonstrated the positive effects of ACT‐based interventions on psychological health, there remains a lack of research specifically focusing on individuals from lower socioeconomic backgrounds (Thompson [<reflink idref="bib42" id="ref67">42</reflink>]). Sue et al. ([<reflink idref="bib38" id="ref68">38</reflink>]) emphasizes that "the values, assumptions, and goals underlying psychotherapy often align with the perspectives and life experiences of those with social class advantages, rather than individuals experiencing lower socioeconomic status" (p. 259). Therefore, this study provided preliminary evidence for the effectiveness of ACT among adolescents from lower socioeconomic backgrounds.</p> <hd id="AN0187257446-24">Limitations and Recommendations for Future Research</hd> <p>While this study offers valuable insights, it was not without its limitations. First, the study did not include a control group or a follow‐up procedure, which are limitations that affect the assessment of the psychoeducation program's effectiveness. Therefore, future researchers might consider using a control group pre‐post test analysis, including follow‐up testing. Second, this study was conducted with adolescents from the capital city of Türkiye who were scholarship students in high school due to their academic achievement or athletic abilities. Therefore, the findings may have limited generalizability. Considering this limitation, future studies can focus on the adolescent population, including other characteristics such as low‐achieving students, students with special needs, etc. Third, the relatively small sample size of the current study prevented us from running other analyses than non‐parametric Wilcoxon Signed‐Rank test like ANCOVA which could allow us to control for possible confounding variables such as age, GPA, socioeconomic status, etc. Hence, future research could focus on implementing this psychoeducation program with a larger sample size, controlling for possible confounding variables. Fourth, this psychoeducation did not include effective learning strategies, which are recommended for test anxiety interventions (Yale‐Soulière et al. [<reflink idref="bib49" id="ref69">49</reflink>]). Future studies may consider integrating effective learning strategies into the current psychoeducation program. Additionally, according to the qualitative findings, practitioners may incorporate exercises or metaphors that focus on interaction among group members because, although the exercises in this psychoeducation were conducted in a group process, they were mostly individual‐focused activities within a group setting. Also, psychoeducation can be designed to be conducted not only in enclosed settings, such as classrooms, but also in outdoor environments.</p> <p>Last but not least, this study focused on the test anxiety among 10th grade students as they begin preparing for university entrance exams at this stage. Their efforts to maintain high GPAs, complete practice tests, and attend private teaching institutions apart from school or take private lessons often contribute to increased anxiety. Implementing this program at this level serves a preventive counseling (role) in managing test anxiety before students reach 12th grade and can be considered a strength of this study. However, for sure, test anxiety tends to reach its highest levels during 11th and 12th grades, and psychoeducation programs such as the one in this study can serve adolescents to regulate their anxiety more via increased mindfulness and psychological flexibility. In this regard, future research should replicate the implementation of the psychoeducation program with 12th grade students to assess its effectiveness at the stage when test anxiety is at its peak.</p> <hd id="AN0187257446-25">Ethics Statement</hd> <p>All the ethical guidelines were followed in the current study, and the participants gave their consent to participate and for publication.</p> <hd id="AN0187257446-26">Conflicts of Interest</hd> <p>The authors declare no conflicts of interest.</p> <hd id="AN0187257446-27">Data Availability Statement</hd> <p>Data will be shared upon reasonable request.</p> <ref id="AN0187257446-28"> <title> References </title> <blist> <bibl id="bib1" idref="ref44" type="bt">1</bibl> <bibtext> Alkal, A., and S. Çam. 2024b. 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  Data: ACT-Based Psychoeducation Program for Reducing Test Anxiety: A Mixed Method Case Study of Economically Disadvantaged Students
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  Label: Language
  Group: Lang
  Data: English
– Name: Author
  Label: Authors
  Group: Au
  Data: <searchLink fieldCode="AR" term="%22Fatma+Zehra+Ünlü+Kaynakçi%22">Fatma Zehra Ünlü Kaynakçi</searchLink> (ORCID <externalLink term="https://orcid.org/0000-0002-9491-2750">0000-0002-9491-2750</externalLink>)<br /><searchLink fieldCode="AR" term="%22Gökçen+Aydin%22">Gökçen Aydin</searchLink> (ORCID <externalLink term="https://orcid.org/0000-0003-0781-7817">0000-0003-0781-7817</externalLink>)<br /><searchLink fieldCode="AR" term="%22S%2E+Burcu+Özgülük+Üçok%22">S. Burcu Özgülük Üçok</searchLink> (ORCID <externalLink term="https://orcid.org/0000-0001-7464-6136">0000-0001-7464-6136</externalLink>)
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  Label: Source
  Group: Src
  Data: <searchLink fieldCode="SO" term="%22Psychology+in+the+Schools%22"><i>Psychology in the Schools</i></searchLink>. 2025 62(9):3727-3735.
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  Label: Availability
  Group: Avail
  Data: Wiley. Available from: John Wiley & Sons, Inc. 111 River Street, Hoboken, NJ 07030. Tel: 800-835-6770; e-mail: cs-journals@wiley.com; Web site: https://www.wiley.com/en-us
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  Label: Peer Reviewed
  Group: SrcInfo
  Data: Y
– Name: Pages
  Label: Page Count
  Group: Src
  Data: 9
– Name: DatePubCY
  Label: Publication Date
  Group: Date
  Data: 2025
– Name: TypeDocument
  Label: Document Type
  Group: TypDoc
  Data: Journal Articles<br />Reports - Research
– Name: Audience
  Label: Education Level
  Group: Audnce
  Data: <searchLink fieldCode="EL" term="%22High+Schools%22">High Schools</searchLink><br /><searchLink fieldCode="EL" term="%22Secondary+Education%22">Secondary Education</searchLink><br /><searchLink fieldCode="EL" term="%22Grade+10%22">Grade 10</searchLink>
– Name: Subject
  Label: Descriptors
  Group: Su
  Data: <searchLink fieldCode="DE" term="%22Foreign+Countries%22">Foreign Countries</searchLink><br /><searchLink fieldCode="DE" term="%22Test+Anxiety%22">Test Anxiety</searchLink><br /><searchLink fieldCode="DE" term="%22Psychoeducational+Methods%22">Psychoeducational Methods</searchLink><br /><searchLink fieldCode="DE" term="%22High+School+Students%22">High School Students</searchLink><br /><searchLink fieldCode="DE" term="%22Grade+10%22">Grade 10</searchLink><br /><searchLink fieldCode="DE" term="%22Intervention%22">Intervention</searchLink><br /><searchLink fieldCode="DE" term="%22Therapy%22">Therapy</searchLink><br /><searchLink fieldCode="DE" term="%22Economically+Disadvantaged%22">Economically Disadvantaged</searchLink><br /><searchLink fieldCode="DE" term="%22Program+Effectiveness%22">Program Effectiveness</searchLink>
– Name: Subject
  Label: Geographic Terms
  Group: Su
  Data: <searchLink fieldCode="DE" term="%22Turkey%22">Turkey</searchLink>
– Name: DOI
  Label: DOI
  Group: ID
  Data: 10.1002/pits.23583
– Name: ISSN
  Label: ISSN
  Group: ISSN
  Data: 0033-3085<br />1520-6807
– Name: Abstract
  Label: Abstract
  Group: Ab
  Data: University entrance exams in Türkiye often generate significant test anxiety among high school students. This study investigates the effectiveness of a psychoeducational intervention based on Acceptance and Commitment Therapy (ACT) in reducing test anxiety among 10th-grade students. Employing a mixed-methods sequential explanatory design, the study included nine economically disadvantaged high school students (aged 15-17), two of whom were female and seven males, who participated in a six-session intervention. The quantitative phase utilized a quasi-experimental one-group pretest-posttest design, with measurements conducted using the Cognitive Test Anxiety Scale, the Mindful Attention Awareness Scale--Adolescent Form, and the Multidimensional Psychological Flexibility Inventory--Short Form. The qualitative phase comprised focus group interviews guided by semi-structured questions to explore participants' perspectives on the ACT-based psychoeducation program. The results demonstrated a statistically significant reduction in test anxiety and an increase in psychological flexibility, while no significant changes were observed in mindfulness levels. Qualitative analysis revealed three central themes: perceived benefits, most and least useful aspects, and suggestions for improvement. These findings suggest that ACT-based psychoeducation is an effective intervention for reducing test anxiety. Implications for future research and practical applications in educational and psychological contexts are discussed.
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  Group: Date
  Data: 2025
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  Label: Accession Number
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  Data: EJ1479987
PLink https://search.ebscohost.com/login.aspx?direct=true&site=eds-live&db=eric&AN=EJ1479987
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        Value: 10.1002/pits.23583
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      – Text: English
    PhysicalDescription:
      Pagination:
        PageCount: 9
        StartPage: 3727
    Subjects:
      – SubjectFull: Foreign Countries
        Type: general
      – SubjectFull: Test Anxiety
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      – SubjectFull: Psychoeducational Methods
        Type: general
      – SubjectFull: High School Students
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      – SubjectFull: Grade 10
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      – SubjectFull: Intervention
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      – SubjectFull: Economically Disadvantaged
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      – SubjectFull: Turkey
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      – TitleFull: ACT-Based Psychoeducation Program for Reducing Test Anxiety: A Mixed Method Case Study of Economically Disadvantaged Students
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