Table 2 Interventional studies on somatization in healthcare students
From: A scoping review of somatization: characteristics and implications among health profession students
Study/ Location | Design | Objective & Intervention | Participant Characteristics | Primary outcome measures & resultsa |
|---|---|---|---|---|
Aksoy & Ozturk, 2024 [77] Turkey | RCT | Comparing the effect of music vs. white noise vs. silence on anxiety and vital signs. Students either listened to their favorite music, white noise, or silence for 5 mins prior to and during a skills test on intramuscular injections | n = 50 first-year nursing students, 26 per group x3 groups Mean age: 19.11 – 19.68 % Female: 68.7 – 83.3 | STAI, BP, HR; Music (t = 5.8, p < .001) and silence (t = 4.6, p < .001) both had positive effects on anxiety during an intramuscular injection skills test; white noise had a negative effect (t = -2.5, p = .02). No difference between skills test scores between the three groups (p < .05). No significant difference in the means of HR or diastolic BP, but systolic BP of the white noise group increased significantly compared to the music group (F = 3.9, p < .05). HR significantly decreased in the music group from pre to post (t = 3.3, p < .01). |
Alhawatmeh et al., 2022 [78] Jordan | RCT | Determine the effect of mindfulness meditation for 30 mins, 5 days in a row, on perceived stress, trait mindfulness, and serum cortisol and C-reactive protein. Small in-person groups of 10-11 students. 3-hr educational workshop preceded the intervention. | n = 108 nursing students, 54 per group Mean age: 19.7 (0.99) intervention group, 19.9 (0.76) control group % Female: 66.7 intervention group, | MAAS, PSS, serum cortisol, serum C-reactive protein; Perceived stress (F(1) = .16, p <.001, partial η2 = .08) and cortisol (F (1) =17.10, p<.001, partial η2= .14) were significantly better in the intervention group. |
Andrabi et al., 2023 [79] United States | Pre/post quasi-experimental feasibility | The effect of 50 mins weekly yoga x8 weeks with a focus on health promotion such as coping with stress, health, wellness, and spirituality, on stress, anxiety, BP, and HR. | n = 19 nursing students Age: 95% between 18-25 % Female: NR | PSS, DASS-21, BP, HR; Stress dropped from M = 25 (5.02) to M = 25 (6.9) and anxiety dropped from M = 15 (8.8) to M = 13 (10.8); significance tests were not done as was a feasibility study. BP and HR did not change. |
Artemiou et al., 2017 [80] West Indies | Quasi-experimental pilot, AB/BA cross-over | Effect of slow piano music vs. silence during 60-min physical exam skills practice on BP, HR, depression, anxiety, and stress. After 7 days, cross-over trial was done. | n = 17 veterinary students Mean age: NR % Female: NR | DASS-21, POMS, BP, HR; Both groups had significantly lower HR posttest compared to pretest (music group p < .001, no-music group p = .02). No significant difference between groups on other outcomes. |
Bhagat et al., 2023 [81] India | One-group pre/post | Effect of Raj Yoga meditation on systolic and diastolic BP, HRV, baroreflex sensitivity (BRS), and stress. Intro week of 1 hr per day for 7 days, then students continued practicing 1 hr per day for the next month + 30 mins per day of stress physiology instruction | n = 80 medical students Mean age: 18.70 (0.77) % Female: NR | BP, HRV, baroreflex sensitivity, BMI, ECG, MSSQ; Raj Yoga meditation significantly decreased DBP (p = .01) and stress (p = .04) after one month. |
Brubaker et al., 2020 [82] United States | One-group pre/post feasibility | Feasibility and effect of sunrise alarm clock for 2 weeks on stress, burnout, and sleep quality. Included turning off iPhone/devices at bedtime. | n = 55 medical students Mean age: 24.8 (1.9) % Female: 50.9 | MBI, PSS-4, PSQI, Smart phone addiction scale-short form, BMI; Perceived stress (p = .01), all facets of burnout (p = .001 – .02), and all facets of sleep/insomnia (p < .001 – .02) improved significantly |
Dai & Yu, 2023 [83] China | One group pre/post. | Feasibility and effect of group psychological training augmented with individual counseling for some participants on somatization, anxiety, and depression. Group training included progressive relaxation, music therapy, and sleep therapy and occurred bi-weekly “online or offline.” Students with high scores also received one-on-one counseling. All participants were grouped together. | n = 121 3rd-year medical students Mean age: NR % Female: NR | SAS, SDS, SSS-8a, TCSQ; Somatization decreased from 21.49% to 9.92% after any intervention (p < .05). Anxiety (25.62% to 7.44%, p < .05) and depression (28.93% to 18.18%, p < .05) also decreased significantly. |
Eyüboğlu et al., 2021 [84] Turkey | RCT | Effect of music therapy on BP, anxiety, and exam success on structured clinical exams; intervention group completed five music therapy sessions two weeks before the exam. | n = 125 first-yr nursing students (61 experimental, 64 control) Mean age: NR % Female: NR | STAI, vital signs; BP values of experimental group before and after the exam were significantly lower than those of the control group (p < .05). No significant difference on exam success or anxiety levels between the two groups. |
Gebhart et al., 2019 [85] Austria | RCT | Effect of distraction-focused interventions (music therapy including body percussion, therapy dogs, or mandala painting for 45-60 min each vs. control group) on exam stress and biomarkers. | n = 57 nursing students (3 intervention groups and a control group) Median age: 20 % Female: 77 | STAI, visual stress scale 0-10, salivary cortisol and IgA; Salivary cortisol decreased and IgA increased significantly after interventions (p < .001); anxiety was significantly less in the dog therapy group (p < .01) compared to the mandala-painting or music therapy groups. Self-reported stress level was not significantly related to salivary cortisol. |
Kumar et al., 2014 [86] India | RCT | Effect of Pranayam breathing vs. Surayanamaskar yoga, 40 mins per day x6 weeks. Pranayam breathing includes rounds of alternate nostril breathing. | n = 96 medical students (50 per group) Mean age: 19 % Female: | PGI memory scale, Hamilton anxiety scale, general well-being, HRV; Pranayam breathing group had significantly increased memory scores (p < .001), and decreased anxiety (p < .001); HRV significantly increased (p < .001). Well-being significantly increased in the yoga group (p < .05); positive correlation between HRV measure and well-being (r = .98, p < .01) in both groups before and after the study; negative correlation between the HRV measure and anxiety (r = .95, p < .05). |
Oró et al. (2021) [87] Spain | Quasi-experimental repeated measures | Evaluate and compare effects of a mindfulness-based program involving 8 sessions of 2-hrs each, every other week, based on the Mindfulness-Based Stress Reduction (MBSR) protocol. | n = 143 medical students; Mean age: 20.28 (1.54); 73.4% female | SLC-90-Ra, PSS, MBI-SS; Psychological variable(s): stress, burnout, mindfulness; Somatization decreased after a mindfulness program in the intervention group compared to the control group (F(1, 141) = 6.22, p = .014), as did stress (F(1, 141) = 8.23, p = .005). Burnout not significantly affected. |
Ozturk & Tezel, 2021 [88] Turkey | RCT | Effect of laughter yoga, two sessions of 40-45 mins per week for 4 weeks, on mental health and salivary cortisol levels. Includes deep breathing, clapping warm-up exercises, childlike playfulness, and laughing exercises. | n = 75 nursing students (n = 38 intervention, n = 37 control) Mean age: NR % Female: 79.2 | BSI, salivary cortisol; Significant decrease in BSI scores between groups, with the intervention group showing reduced anxiety (p < .001), depression (p < .001), somatization (p = .003), and hostility (p = .002). Mean pre/post somatization scores 0.78/0.51 in intervention group, 0.65/0.70 in controls. In three out of the eight sessions, there was a significant decrease in the intervention group’s pre-test and post-test salivary cortisol levels (p < .05) compared to the control group. |
Valenica et al., 2024 [89] United States | RCT | Effects of 15 mins of weekly osteopathic manipulative treatment (OMT) for 6 weeks vs control group with no treatment | n = 10 first-year medical students Mean age: 25 % Female: 80 | Salivary cortisol, CSSS, cognitive function, optical density; No significant correlations found between stress and salivary cortisol. No difference in stress between treatment and control groups (p = .9). |