Internet-Based EMDR Flash Intervention for Test Anxiety in University Students

Test anxiety is a common problem among university students, often linked to academic pressure, limited access to professional support, and stigma around seeking help. Students with high levels of test anxiety may experience stress, concentration problems, and reduced academic performance. While face-to-face psychological interventions can be effective, many students cannot benefit from them due to financial, logistical, or accessibility barriers.

This study introduces SKY-Flash, an internet-based version of the EMDR Flash technique. The program was designed as a self-help intervention that students can use independently, without therapist guidance. The aim is to reduce test anxiety and improve psychological well-being by adapting EMDR Flash procedures into an online format that is accessible, private, and user-friendly.

The research will be conducted as a randomized controlled trial with two groups: an intervention group and a wait-list control group. A total of 168 university students will be recruited and randomly assigned to one of the groups. Participants in the intervention group will complete a six-module online program based on EMDR Flash principles. The modules include interactive exercises, multimedia elements, and gamification features to support engagement and reduce dropout. The control group will not receive any intervention during the study period but will gain access to the program after follow-up assessments.

Data will be collected at three time points: pre-test, post-test, and one-month follow-up. Primary outcomes will be test anxiety, measured by the Westside Test Anxiety Scale. Secondary outcomes will include psychological well-being and usability feedback. In addition, semi-structured interviews will be conducted with a subgroup of participants to gather in-depth information about usability and user experience.

The study is expected to show whether an online EMDR Flash intervention can effectively reduce test anxiety and improve well-being in university students. If effective, SKY-Flash may serve as a scalable, cost-effective, and stigma-free resource for students who struggle with test anxiety and have limited access to psychological services.

• Internet-Based EMDR-Flash Program (Behavioral): Self-guided, internet-based EMDR-Flash program (SKY-Flash) tailored to reduce test anxiety in university students. Delivered via a secure web platform with no live therapist involvement. The intervention comprises six \~40-minute modules completed independently during the study. Each module includes brief psychoeducation and step-by-step EMDR-Flash procedures (focus on a positive engaging image with brief "flash" cues), guided practice, and in-platform exercises. Gamification (progress tracking, badges) and automated prompts support adherence. Unlike CBT-based online programs or clinician-delivered EMDR, this is a fully automated, low-intensity Flash protocol adapted to exam-related distress. Safety messaging and referral resources are embedded; access is via individual login and usage is recorded for adherence.

Primary outcomes

• Change in Test Anxiety (Westside Test Anxiety Scale Scores) [participants will be assessed at baseline (Week 0), immediately after the intervention (Week 6), and again at a follow-up point 10 weeks later]: The primary outcome is the change in test anxiety levels, assessed with the Westside Test Anxiety Scale (WTAS). The WTAS is a validated self-report measure specifically developed to assess test-related anxiety and performance-impairing worry. Higher scores indicating greater test anxiety. This outcome will determine whether the internet-based EMDR-Flash intervention reduces participants' test anxiety compared to the control condition.
• Change in Test Anxiety [participants will be assessed at baseline (Week 0), immediately after the intervention (Week 6), and again at a follow-up point 10 weeks later]: The primary outcome is the change in test anxiety levels, assessed with the Westside Test Anxiety Scale (WTAS). The WTAS is a validated self-report measure specifically developed to assess test-related anxiety and performance-impairing worry. . This outcome will determine whether the internet-based EMDR-Flash intervention reduces participants' test anxiety compared to the control condition.

Secondary outcomes

• Change in Psychological Well-Being (Psychological Well-Being Scale) [From baseline (Week 0) to post-intervention (Week 6), with follow-up assessments at Week 10.]: Psychological well-being will be measured using the Ryff Psychological Well-Being Scale. The total score reflects overall well-being, with higher scores indicating greater psychological well-being. This outcome will evaluate whether the intervention improves students' well-being in addition to reducing test anxiety.

Sex: All, ages: 18 Years to any

Inclusion Criteria:

Voluntary participation in the study Being older than 18 years and currently enrolled as a university student Having a valid e-mail address Having internet access (computer or mobile device) Scoring above the average on the Test Anxiety Scale Scoring below 15 on the Patient Health Questionnaire-9 (PHQ-9), based on established cutoff points

Exclusion Criteria:

Currently receiving psychological help from a psychologist, counselor, or psychiatrist Having any diagnosed psychiatric disorder

• Burak Köksal, Dr., Principal investigator, Tokat Gaziosmanpaşa University