Enhanced self-affirmation mitigated attentional bias toward test threat in high-anxiety youths in RCT

This randomized controlled trial investigated whether enhanced self-affirmation could reduce attentional bias toward test-related threat in youths. The study included 118 secondary school students aged 11 to 18 years, with 59 classified as having high test anxiety and 59 as low test anxiety. Participants were randomized to either an enhanced self-affirmation condition or a no self-affirmation condition. The primary outcome was attentional bias, measured by response time on an Emotional Stroop task using test-related threat words and neutral words.

In the main experiment, highly test-anxious youths who received no self-affirmation showed a clear attentional bias, with prolonged response times toward threat versus neutral words during upward performance comparison trials. In contrast, highly test-anxious youths who received the enhanced self-affirmation intervention did not exhibit this attentional bias. A pilot experiment with 85 students also suggested self-affirmation decreased response times for both anxiety groups, though specific effect sizes and absolute numbers were not reported for either experiment.

Safety and tolerability data were not reported. The study's key limitation is that the outcome is a laboratory-based cognitive measure (response time on a Stroop task), not a direct assessment of anxiety symptoms, academic performance, or functional improvement. The long-term effects and generalizability to real-world settings are also not reported. The practice relevance is restrained: while the findings suggest enhanced self-affirmation may influence a specific cognitive bias in a controlled setting, its utility as a clinical tool for managing test anxiety requires investigation with patient-centered outcomes.