Neuman Systems Model-Based Yoga Therapy for Test Anxiety in Secondary School Students

June 11, 2026 updated by: Azime Hacıoğlu Güven, Pamukkale University

The Effect of a Yoga Therapy Program Grounded in the Neuman Systems Model on Test Anxiety, Quality of Life, and Mindfulness Among Secondary School Students: A Cluster Randomized Controlled Trial

This cluster randomized controlled trial evaluates the effects of a yoga therapy program grounded in the Neuman Systems Model on test anxiety, quality of life, and mindfulness among eighth-grade students aged 13-14 years in Denizli, Türkiye. The study was conducted with students preparing for the national High School Entrance System (LGS) examination. A total of 166 eighth-grade students were allocated to intervention and control groups at the school level. The intervention consisted of a structured yoga therapy program delivered once weekly for four weeks. Outcomes were assessed using standardized measures of test anxiety, quality of life, and mindfulness at baseline, mid-intervention, and post-intervention. The study received ethics committee approval, institutional permissions, and written informed consent from parents or legal guardians.

Study Overview

Status

Completed

Conditions

Intervention / Treatment

Detailed Description

This cluster randomized controlled trial was designed to evaluate the effects of a yoga therapy program grounded in Neuman Systems Model on test anxiety, quality of life, and mindfulness levels among 13-14-year-old middle school students. The target population consisted of eighth-grade students attending schools in the central districts of Denizli province, Türkiye. In Türkiye, eighth-grade students prepare for the nationwide High School Entrance System (LGS) examination and may experience high academic pressure and test anxiety. Therefore, the study was conducted with eighth-grade students.

The inclusion criteria were defined as being an eighth-grade student, having no physical or mental disability, agreeing to participate voluntarily in the study, and providing parental consent. Students with prior regular yoga experience were excluded to minimize potential confounding factors that could influence the effects of the intervention.

Among 68 public middle schools in the central districts of Denizli, 27 schools that agreed to participate constituted the study pool. From this pool, two schools meeting the eligibility criteria were selected using simple random sampling. Each school was considered a cluster. The selected schools were then allocated to intervention and control groups by an independent researcher using a simple randomization method. Following randomization, two classes were randomly selected from seven eighth-grade classes in the intervention school, and two classes were randomly selected from nine eighth-grade classes in the control school. Cluster randomization at the school level was employed to minimize contamination due to potential information exchange between intervention and control groups.

The sample size was calculated using G*Power version 3.1.9.4. The calculation was based on a study design involving two groups and three measurement time points. A repeated-measures analysis of variance (ANOVA) was used with a medium effect size (f = 0.25), a significance level of 0.05, and a statistical power of 0.95. The minimum required sample size was determined to be 142 students. Considering potential attrition, it was planned to include 80 students in each group, for a total of 160 students. Ultimately, the study sample consisted of 166 students, with 81 in the intervention group and 85 in the control group.

The yoga therapy program was developed in collaboration with the researcher, who is certified in children's yoga, and two certified yoga experts with experience in adult yoga, children's yoga, and mindfulness-based practices. The intervention was delivered jointly by the researcher and one of the certified yoga instructors. The program was conducted over four weeks, with one 40-minute session per week. Each session consisted of breathing awareness and intention setting (5 minutes), warm-up exercises (5 minutes), yoga postures aimed at improving attention, balance, strength, and self-confidence (15 minutes), pranayama practices designed to reduce anxiety and enhance focus (5 minutes), and relaxation with mindfulness-based meditation (10 minutes).

Outcome variables were assessed using the Westside Test Anxiety Scale for test anxiety, the Quality of Life Scale for Children and Adolescents (13-18 years version) for quality of life, the BAU Mindfulness Scale for Children for mindfulness levels, and a researcher-developed Student Information Form for demographic characteristics. Data were collected at three time points: baseline assessment before the first intervention session, mid-assessment after the second session, and post-assessment after the fourth session.

The study was approved by the Non-Interventional Clinical Research Ethics Committee of Pamukkale University and conducted with the necessary institutional permissions from the Ministry of National Education. Participation was voluntary, and written informed consent was obtained from parents or legal guardians of all participating students.

Study Type

Interventional

Enrollment (Actual)

162

Phase

  • Not Applicable

Contacts and Locations

This section provides the contact details for those conducting the study, and information on where this study is being conducted.

Study Locations

  • Turkey (Türkiye)
    • Pamukkale
      • Denizli, Pamukkale, Turkey (Türkiye), 20070
        • Public Secondary Schools

Participation Criteria

Researchers look for people who fit a certain description, called eligibility criteria. Some examples of these criteria are a person's general health condition or prior treatments.

Eligibility Criteria

Ages Eligible for Study

  • Child

Accepts Healthy Volunteers

Yes

Description

Inclusion Criteria:

  • Being enrolled as a secondary school student
  • Aged 13-14 years
  • Willing to participate in the study
  • Having parental consent and student assent

Exclusion Criteria:

  • Any physical or mental condition that interferes with participation in yoga-based activities
  • Previous regular experience with yoga or mindfulness practice
  • Absence during the intervention period or inability to complete study procedures
  • Refusal to participate in the study

Study Plan

This section provides details of the study plan, including how the study is designed and what the study is measuring.

How is the study designed?

Design Details

  • Primary Purpose: Prevention
  • Allocation: Randomized
  • Interventional Model: Parallel Assignment
  • Masking: None (Open Label)

Arms and Interventions

Participant Group / Arm
Intervention / Treatment
Experimental: School-Based Yoga Therapy Group
Participants in the experimental group received a school-based yoga therapy program developed in line with Neuman Systems Model. The intervention included structured yoga sessions focusing on breathing exercises, physical postures, relaxation techniques, and mindfulness practices. Sessions were delivered by the researcher during school hours for a specified intervention period. The aim of the program was to reduce test anxiety and improve mindfulness and quality of life among secondary school students.
Behavioral: School-Based Yoga Therapy Program
Participants received a structured school-based yoga intervention based on the Neuman Systems Model, including breathing exercises, physical postures, relaxation, and mindfulness practices. The intervention was delivered during school hours in structured sessions over a defined intervention period. The aim was to reduce test anxiety and improve mindfulness and quality of life among secondary school students.
No Intervention: Control Group
Participants in the control group received no additional intervention beyond the routine school curriculum. No yoga, mindfulness, or relaxation-based activities were implemented for this group during the study period. The group functioned as a no-intervention control condition for outcome comparison.

What is the study measuring?

Primary Outcome Measures

Outcome Measure
Measure Description
Time Frame
Test Anxiety (Westside Test Anxiety Scale score)
Time Frame: Baseline (prior to the first intervention session), Week 2 (after completion of Session 2), and Week 4 (after completion of Session 4)
Measured using the Westside Test Anxiety Scale (WSKÖ) to assess changes in students' exam-related anxiety levels in a school-based yoga intervention.
Baseline (prior to the first intervention session), Week 2 (after completion of Session 2), and Week 4 (after completion of Session 4)

Secondary Outcome Measures

Outcome Measure
Measure Description
Time Frame
Health-Related Quality of Life (PedsQL 13-18 Adolescent Form score)
Time Frame: Baseline (prior to the first intervention session), Week 2 (after completion of Session 2), and Week 4 (after completion of Session 4)
Measured using the Pediatric Quality of Life Inventory (PedsQL) Adolescent Form to evaluate changes in perceived quality of life among secondary school students receiving the intervention.
Baseline (prior to the first intervention session), Week 2 (after completion of Session 2), and Week 4 (after completion of Session 4)
Mindfulness Level (BAU Child and Adolescent Mindfulness Scale score)
Time Frame: Baseline (prior to the first intervention session), Week 2 (after completion of Session 2), and Week 4 (after completion of Session 4)
Measured using the BAU Child Mindfulness Scale (BAU-CMÖ) to assess changes in mindfulness and present-moment awareness in adolescents participating in the yoga intervention.
Baseline (prior to the first intervention session), Week 2 (after completion of Session 2), and Week 4 (after completion of Session 4)

Collaborators and Investigators

This is where you will find people and organizations involved with this study.

Sponsor

Pamukkale University

Publications and helpful links

The person responsible for entering information about the study voluntarily provides these publications. These may be about anything related to the study.

General Publications

Study record dates

These dates track the progress of study record and summary results submissions to ClinicalTrials.gov. Study records and reported results are reviewed by the National Library of Medicine (NLM) to make sure they meet specific quality control standards before being posted on the public website.

Study Major Dates

Study Start (Actual)

April 30, 2026

Primary Completion (Actual)

May 21, 2026

Study Completion (Actual)

May 21, 2026

Study Registration Dates

First Submitted

June 6, 2026

First Submitted That Met QC Criteria

June 11, 2026

First Posted (Actual)

June 12, 2026

Study Record Updates

Last Update Posted (Actual)

June 12, 2026

Last Update Submitted That Met QC Criteria

June 11, 2026

Last Verified

June 1, 2026

More Information

Terms related to this study

Keywords

Other Study ID Numbers

  • NSM-YT-2026
  • E-60116787-020-704556 (Other Identifier: Pamukkale University Non-Interventional Clinical Research Ethics Committee)

Plan for Individual participant data (IPD)

Plan to Share Individual Participant Data (IPD)?

NO

IPD Plan Description

Individual participant data will not be shared to ensure participant confidentiality and data protection.

Drug and device information, study documents

Studies a U.S. FDA-regulated drug product

No

Studies a U.S. FDA-regulated device product

No

This information was retrieved directly from the website clinicaltrials.gov without any changes. If you have any requests to change, remove or update your study details, please contact register@clinicaltrials.gov. As soon as a change is implemented on clinicaltrials.gov, this will be updated automatically on our website as well.

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