Imagery-based treatment for test anxiety: A multiple-baseline open trial

Background: Many students are affected by test anxiety (TA), which involves considerable distress and can lead to reduced performance. Despite its prevalence, TA has been under-studied; specifically, few effective and brief interventions have been identified to date. In our work, we explore the adaptation of imagery, an emotion-focused treatment technique used widely in the treatment of other anxiety disorders, for addressing TA. Methods: In a two-site concurrent multiple-baseline pilot study (n = 31), we examined the effectiveness of a targeted six-session protocol developed for the treatment of TA, which integrates traditional cognitive behavioral techniques with imagery work. Results: The protocol was well-accepted by clients. We found that students’ test anxiety levels did not drop between the recruitment and pre-intervention assessments, but did drop significantly from recruitment or baseline to the delayed follow-up (Cohen's d = 0.75 and 0.84, respectively). We also found evidence for session-level processes tying the quality of the imagery work with session efficacy. Limitations: The study involved a relatively small sample size, leading to weaker power to detect treatment effects. Moreover, some clients did not have any exams scheduled before the delayed follow-up assessment. Due to the scheduling intensity of the sessions, some clients had insufficient time to implement or practice skills and to complete tasks discussed in the sessions. Conclusions: This study provides preliminary evidence for the utility of integrating imagery work with traditional cognitive-behavioral techniques for treating test anxiety.