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Toolbox: Technology Anxiety Resource for University Students

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05 June 2023

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06 June 2023

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Abstract
Entering University is an important transition for students. Requires adaptation and can influence academic success. Psychological disorders might emerge when difficulties like anxiety occur due to insecurity about emotions in a student's life. We are currently living in post-pandemic conditions where pressure is increasing. The project "Toolbox: University Student – Web-interactive Platform", a platform for learning anxiety management, was developed to address this problem among university students. The main objective is to understand whether using the platform (based on cognitive behavioral theory) has effectively managed anxiety among students. It is a case study with a sample of 31 students from two Portuguese Universities, aged between 19 and 47 years. They were divided into two groups: intervention (n=17) and control (n=13). The results show that participants subjected to intervention with the interactive platform decreased their anxiety.
Keywords: 
Subject: Social Sciences  -   Psychology

1. Introduction

Entering University is an emotional moment. Young people (re)define goals, strengthening identities (Le Gallès, 1995). Separation from high-school friends can lower self-esteem (Almeida et al., 2000; Lent et al., 2009; Paul & Brier, 2011). Anxiety may trigger phobias, obsessive-compulsive disorders, deviant behavior (Gonçalves & Cruz, 1988), cause lower attendance or dropping out (Almeida et al., 2006; Almeida, 2014; Andrews & Wilding, 2004; Hysenbegasi et al., 2005; Kessler et al., 2005;). Post-pandemic situations lead to costs to mental health and socioeconomic consequences.
Students face requirements for overcoming assessments, time management and relationships (Mondardo & Pedon, 2005). Anxiety is the body’s response that alerts them with strategies to deal with adverse periods (Barriga, 2007). However, it is pathological when disproportionate (Castillo & Schwartz, 2013).
These studies frame the “Toolbox: Student University—Web-interactive Platform.” It aims to promote personal, social, and academic skills and well-being, providing psychoeducational materials and relaxation exercises for anxiety. The intervention exercises are based on cognitive behavioral theory (CBT). The study evaluates the effectiveness of psychoeducation in managing anxiety (using a platform) and to understand if there are differences in pre and post-test between the target of psychological intervention and the control group. It Intends to answer the question/problem: Is using the interactive web platform effective in managing anxiety among university students? Which is a work field part of a specific research team of the university about mental health.

Anxiety: Theoretical Overview

It influences individuals personally, professionally, and socially (Simões, 2014). Bauer (2002) suggests anxiety is a vague feeling expressed through fear, which may become dysfunctional (Cruz, 2008). It triggers psychological and physiological symptoms, with social and professional problems. Increased heart rate, sweating, high blood pressure, and crying may associate with the external situation (state anxiety) or an internal response (Queirós et al., 2020).
In 2008, the first study of mental disorders was done in Portugal and pointed to an incidence of 22.9% of the population (Conselho Nacional de Saúde, 2019). Psychiatric disorders were 12.0% of disability-adjusted years of life lost and 18.0% of years lived with disability in 2017. Anxiety in professionals resort to pharmacology to alleviate physical symptoms (Fávero et al., 2018), intensified in the last two years due to COVID-19. The pandemic is a risk factor for anxiety (Albuquerque et al., 2021): isolation, social distancing, unemployment (Barros et al., 2020), the high number of deaths, and fear of contracting disease and dying (Santana et al., 2021). At Family Health Unit in Portugal, a study by Santana et al. (2021) showed anxiety in patients during a pandemic. Of the 285 participants, 47% had anxiety, higher in females. Unemployed, lay-off workers had the highest prevalence.
Cognitive-Behavioral Theory (CBT), as psychoeducation, is used with mental disorders, training social skills, and restructuring negative thoughts. Ito et al. (2008) mainly use it for anxiety with pharmacological treatment (Ito et al., 2008; Del Rey & Pacini, 2006).
The 3rd generation therapies (Mindfulness) improve socio-emotional functioning, attention, concentration, and sleep (O’Driscoll et al., 2017; Weis, Ray & Cohen, 2021; Sheikhzadeh, Zanjani & Baari, 2021). It activates brain regions responsible for positive emotions, benefits the body’s immune functions (Davidson et al., 2003), and promotes body self-awareness. When aware of the “present moment,” avoids focusing on the past/future, which is what happens with anxiety. Bamber and Morpeth (2019) studied 1492 students who showed better concentration levels after mindfulness/meditation.
Successful adaptation reduces dropping out and increases well-being (Almeida et al., 2014; Lent et al., 2009; Paul & Brier, 2011). Reason et al. (2006) suggest that integrated students benefit from intellectual and personal growth. According to Almeida (2014), adaptation requires coping mechanisms and resilience. Kessler et al. (1995) concluded that 86% with mental health problems dropped out. Age of 18 and 25 are the peaks for developing mental health problems: depression, psychotic disorders, and schizophrenia (Kessler et al., 2005).
Most young people with anxiety do not seek help from a professional (Reavley & Jorm, 2010). Diagnoses of suicidal ideation/severe depression are the last resort to help (Cooke et al., 2006). An Australian investigation revealed that 83.9% suffered from mental health disorders, and only 34.3% sought professional help (Stallman, 2010). Alternatively, resort to drinking alcohol and harmful substances (Reavley & Jorm, 2010).
Many universities provide psychological services; however, it is necessary to complementary online interventions. According to Gonçalves and Cruz (1988), they should provide human development for their community. Faced with mental problems, universities promote psychological services to students (Santos, 2011). Responsible for training citizens, it is essential to consider their personal development (Tavares et al., 2007; Oliveira et al., 2016), develop students’ cognitive, academic, and professional skills, instilling responsibility and autonomy (Order Portuguese Psychologists, 2018). These services are scarce in Portugal, face difficulties in financial support, and have extensive waiting lists (RESAPES, 2002). During the confinement period, greater demand was in place compared to 2019. Video appointments increased, including new strategies according to community needs. Anxiety, academic demands, and distance learning were the main problems (RESAPES, 2021). Had positive performance, demonstrating it is possible to reinvent strategies while always maintaining scientific rigor. The lack of human resources was felt more after COVID-19, making it necessary for psychological services (RESAPES, 2021).
Literature supports the prevention of mental disorders held by new technologies (Oliveira et al., 2016). Over the last three decades, online support has grown, accessing more individuals. The pandemic contributed to reinventing new working methods (Simpson et al., 2021): psychotherapy by videoconference, psychoeducational websites, online support groups, blogs, self-guided interventions, and mobile health (Barak & Grohol, 2011; Clough & Casey, 2015). Research sustains beneficial results for that (Spek et al., 2007). Online psychotherapy promotes openness and facilitates disclosure (Fletcher-Tomenious & Vossler, 2009; Roy & Gillett, 2008; Simpson et al., 2021). Psychoeducational sites are informative but do not provide personalized information; they help learn topics on mental health. In online support groups, people communicate without professional intervention (Barak & Grohol, 2011). Ko and Kuo (2009) demonstrate that the more an individual reveals himself online, the more he changes his perception of social capital, promoting well-being. A study with 238 students (Freeman et al., 2008) who viewed websites about problems and had online support improved their well-being. Self-guided online interventions are a self-help CBT interactive exercise and personalized feedback (Barak et al., 2009; Barak & Grohol, 2011).
According to Oliveira et al. (2016), with Portuguese students, new technologies improve well-being. Most considered online anxiety programs relevant. A study from 2022, with medical students at a Brazilian university, showed satisfaction with the mobile application for monitoring well-being. All recommend it (Aquino Ferreira et. al., 2022). Interventions on online platforms based on CBT show positive results with adolescents (Clarke et al., 2014).
Compared to traditional interventions, new technologies are an asset: economic, easier to access, less stigmatizing, reach isolated communities, overcoming geographic and socioeconomic barriers (Barak & Grohol, 2011; Farrer et al., 2013). Suler (2004) argues that anonymity encourages self-reflection, emotional expression, and flexibility (Hanley & Reynolds, 2009). Despite the evidence, progress could be faster. After the pandemic, countries made efforts to implement online psychotherapy. Blumenstyk (2020) considers the quick response made is not just temporary. Mental health institutions respond well through technology, and there is no reason to abandon this. It is essential when unforeseen viruses and catastrophic events driven by climate change are frequent.

2. Methods

Evaluate the effectiveness of psychoeducation in managing anxiety among university students, using a web-interactive platform vs. without a web-interactive platform. The group that had access to the platform was the experimental group, and the students who did not have access to the interactive online platform were the control group.
The Project “ToolBox: University Student—Web-Interactive Platform” is a Web-Interactive Platform with three objectives (Lucas, Oliveira & Soares, 2010; Lucas, Santos, Soares, Baras & Oliveira, 2018; Santos, 2018):
1)
development of personal, social, and professional skills;
2)
academic success, help in the transition to a job;
3)
eliminate barriers to students’ psychological help, making requests more online.
Includes psychoeducational content, interactive exercises on CBT, ideas, and support personal reflection. Students create a user account (not mandatory). All have access to toolkits (anxiety management), quizzes and self-questionnaires. After informed consent, (registered) users start exercises. They access the “Thermometer of emotions”, to monitor emotional states and activate helping tips. There is a forum where registered users participate: with questions, suggestions, and psychologists’ moderation. They find daily tips and access them in the personal area of each user (Lucas, Santos Soares, Baras & Oliveira, 2018).
First, a joint action occurred between all elements to survey mental health problems and needs. Focus groups showed us perceptions before and during the platform testing phase, which topic they would look for in a website that could help them. Then, an online platform was disseminated, and registrations were collected.
The methodology is experimental analysis pre and post-intervention. The aim is to compare the pre and post-intervention, where anxiety management exercises were implemented via an online platform (intervention group), with a group that was not the target of intervention via an online platform (control group). A quantitative analysis was done, including research hypothesis, characterization sample, instruments, procedures, and analysis/discussion of results.

2.1. Research Hypothesis

Academic demands can lead to exhaustion (Cruz et al., 2020). Young people have difficulty recognizing disorders and do not seek help (Lopez et al., 1998; Komiya et al., 2000; Mackenzie et al., 2004 & Lucas et al., 2010). The study is on anxiety management supported by literature and students, as one of the problems they most ask for psychological help. The hypothesis is: to investigate the effectiveness of an interactive platform in managing anxiety in both groups (experimental/control). Did anxiety levels improve after intervention with an interactive web platform?
The convenience criterion was chosen for sample gathering, as subjects are selected considering availability/willingness criteria (Freitag, 2018). There were 49 students from two Portuguese public universities, with 18 missing cases (36% still need to answer pre and post-test).
The sample was 31 participants, 61.3% (n=19) female, 35% (n=11) from University 1 (U1) and 25.8% (n=8) from University 2 (U2); 38.7% (n=12) male, with 22.6% (n=7) attending U1 and 16.2% (n=5) U2. The intervention group is 35% (n=11) female and 19.4% (n=6) male. Control group, 25.8% (n=8) corresponds to females and 19.4% (n=6) males (Table 1). All participants complete both pre- and post-measures.
The age is 19 to 47, averaging 23.7 (M=23.7; SD= 1.17). The students attend undergraduate, master’s degrees in Engineering (n=16), Design (n=1), Psychology (n=2), Management (n=3), Cultural Management (n=1) Cultural Studies (n=1), Organic Agriculture (n=1), Economics (n=1), Basic Education (n=2), Educational Sciences (n=2) and Mathematics (n=1).
In pre-intervention, a questionnaire was applied to both groups: 1) sociodemographic/contextual data; 2) State-Trait Anxiety Inventory (STAI Y1/2; Spielberg, Gorsuch and Lushene 1970), validated for the Portuguese population by Silva and Campos (1998). After the intervention, the State-Trait Anxiety Inventory (STAY) was applied to both.
The State-Trait Anxiety Inventory (STAY) assesses anxiety. Two scales, 20 items, the State Scale (Y1) and Trait Scale (Y2), Likert type, vary between 1 (rarely) and 4 (almost always). Each Scale has a maximum score of 80 and a minimum of 20.
Adapted for Portuguese population by Silva and Campos (1998) items are: State Scale (Y1): 1) “calm”; 2) “safe”; 3) “tense”; 4) “exhausted”; 5) “at ease”; 6) “disturbed”; 7) “worried about misfortunes”; 8) “satisfied”; 9) “scared”; 10) “rested”; 11) “confident”; 12) “nervous”; 13) “restless”; 14) “indecisive”; 15) “relaxed”; 16) “happy”; 17) “worried”; 18) “confused”; 19) “stable”; 20) “good”; Trait Scale (Y2): 21) “good”; 22) “nervous”; 23) “satisfied”; 24) “happy”; 25) “like a failure”; 26) “calm”; 27) “calm,”; 28) “difficulties”; 29) “worry”; 30) “happy”; 31) “worrying thoughts”; 32) “don’t have confidence”; 33) “safe”; 34) “make decisions”; 35) “I am not capable”; 36) “happy”; 37) “unimportant thoughts”; 38) “take disappointments seriously”; 39) “stable person”; 40) “tense.”
Cronbach’s Alpha was more outstanding than .70, with values of α= .91 and α= .93 onY1 Scale and α= .89 and α= .90 on the Y2 Scale for men and women (Silva & Campos, 1998). In another study, high school, 112 males and 110 females obtained Cronbach’s Alpha of α=.89 on the State scale (Y1) and α=.88 on the Trait scale (Y2) (Silva & Campos, 1998). In 2000, Silva et al. performed a final validation for the Portuguese population, involving 1000 subjects. The results on Y1 Scale were α= .91 and .93 (female and male), and on Y2 Scale, α=.89 (female and male). Cronbach’s Alpha corresponds to α= .86 in the Y1 inventory and α= .89 in the Y2 inventory, revealing good internal consistency greater than .70 (Silva & Campos, 1998).

2.2. Procedures

During the first phase, the platform was disseminated (Figure 1), inviting into the pilot project and collecting registration. They were assigned to groups (intervention and control). All ethical procedures were considered (informed consent/ anonymity). Students received a guide, and psychologists remained available. Then, it was disclosed to the intervention group for carrying exercises for one week. Participants completed the questionnaires, and, in the end, the platform was also made available to the control group, respecting equity and methodological ethics, but these results were not analyzed.
The database was in SPSS, version 28. Gender, age, University, and course characterized the sample. A descriptive analysis was done: means, standard deviations, and minimum/maximum response values. The normality was analyzed to decide which tests to use. The Paired Samples t-test was used for pre and post-test, an Anova, to compare students from two universities and genders. The reliability measurement was done by Cronbach’s alpha coefficients (α).

3. Results

Table 2 and Table 3 show descriptive statistics of the State-Trait Anxiety Inventory (Y1) (2) Anxiety in the intervention group. The mean results were lower in some items in the post-test phase compared to the pre-test, showing decreased anxiety. Item 3, “tense” (M pre-test = 2.71; M post-test = 2.12), item 7, “worried about misfortunes” (M pre-test = 2.18; M post-test= 1.59), reveal improvement in anxiety.
Table 4 and Table 5 show descriptive statistics of the Control group’s State-Trait Anxiety Inventory (Y1) (Y2). State Inventory (Y1) 5 items have lower average results in the post-test compared to the pre-test (items: 4, 7, 14, 16, 18). Items 7 (M pre-test= 2.43; M post-test= 2.07) and 18 (M pre-test=2.29; M post-test= 1.86) are significant. The control group was not subject to exercises on the interactive platform, and State Inventory data (Y1), considered the most modifiable, did not undergo significant changes. On the contrary, Trait Inventory (Y2) average response was lower in the post-test (11 items) when compared pre-test (items: 21, 22, 24, 25, 27, 28, 29, 30, 31, 34, 36).
For the normality sample (Table 6) Shapiro-Wilk test was applied, considering n<50 (Nascimento, Tibana, Melo & Prestes, 2015); it has a normal distribution according to sig=.609 and p-value >.05 (Pallant, 2005).

Originality

Did anxiety levels improve after intervention with an interactive web platform? Yes. The pre and post-test of the State-Trait Anxiety Inventory (the Paired Sample t-test) show that (Table 6). The State Inventory (Y1) intervention group average obtained in the post-test (M=44.00; SD=14.874) is lower than the pre-test (M=48.24; SD=12.602). So, after using the platform, students showed less anxiety, as Silva (2003) mentioned. In Trait Inventory (Y2) intervention group, despite improvement in the post-test (M=49.12; SD=13.724) compared to the pre-test (M=51.88; SD= 12,154), the differences are not significant (p> .05; sig= .09).
Exercise contributed to managing anxiety. Despite significant results only on the State scale (Y2; sig= .34), on the Trait scale (Y1) average result also indicates an anxiety reduction (M pre-test= 51.88; M post-test= 49,12), although not significant. The results obtained from State (Y1) Trait (Y2) Anxiety Inventory in the pre and post-test control group (Table 7) were not significant in any of the scales, with sig values of .21 and .46. These students were not the target of intervention. Back-end data regarding participants’ use of the toolbox was collected.

4. Discussion

After the intervention, State-Trait Anxiety Inventory showed significant improvement in the post-test of Y1 Scale—intervention group when compared pre -the test. The same did not happen with Y2 Scale, although anxiety decreased post-test. Although not expressive, Y1 Scale expresses the student’s state and is modifiable with training; it shows an anxiety reduction. STAI results between genders were insignificant, although females showed higher levels in line with Silva and Campo’s (1998) study with secondary students, where higher anxiety levels occur in females. Although the sample size was limited, students who underwent intervention showed improvements.

5. Conclusions

Results encourage investments in online platforms that help students manage their anxiety levels. The Internet is growing exponentially, providing more access to people. Barak and Grohol (2011) highlight the importance of online groups, social interaction and well-being. Freeman et al. (2008) found that students who viewed websites about anxiety and had online support improved their well-being. The use of a platform like the one tested here is compelling. It helps decrease mental health problems, prevent academic dropouts, and promote career skills for a successful transition to the job (Lucas, Santos, Soares, Barras & Oliveira, 2018). Provides support to students who otherwise do not seek psychological help (Soares et al., 2018).
Investment in these approaches is highly recommended, after COVID-19, considering that stress experienced by students has intensified in the last two years. Despite the small sample size and the recognition that further studies with larger groups using stratified sampling to assign groups are needed, we point out that
it is crucial to meet students’ needs after adopting different pedagogical methods to understand their integration into their academic path and well-being.
All participants could access the forum when accessing the toolbox, but the frequency of the accesses was not counted for this study and as such one of the limitations of the study is the analysis of the insights about those that participated in the forum compared to others that didn’t. Also analyzing the reflections made by the students in the focus groups and how did that knowledge inform the intervention content should have been more deeply analyzed, beyond the thematic of Anxiety (which was the one more mentioned as concerning by the students).

Author Contributions

“Luisa Soares, Carla Vale Lucas; methodology, Carla Silva; Carla Silva; Luisa Soares, Carla Silva, Carla Vale Lucas.; formal analysis,Carla Silva; investigation, Carla Silva Luísa Soares.; Carla Silva, Luisa Soares, Carla Vale Lucas; data curation, Carla Silva; Carla Silva; Luísa Soares, Carla Vale Lucas.; Carla Lucas.;Luisa Soares. All authors have read and agreed to the published version of the manuscript.” Please turn to the CRediT taxonomy for the term explanation. Authorship must be limited to those who have contributed substantially to the work reported.

Funding

This research received no external funding.

Conflicts of Interest

“The authors declare no conflict of interest.”.

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Figure 1. Dissemination platform—intervention phase. (Lucas, et al., 2018; Santos, 2018).
Figure 1. Dissemination platform—intervention phase. (Lucas, et al., 2018; Santos, 2018).
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Table 1. Distribution of sample Intervention/Control group, Gender/University.
Table 1. Distribution of sample Intervention/Control group, Gender/University.
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Table 2. -Descriptive statistics State-Trait Anxiety Inventory (STAI)—intervention group Y1.
Table 2. -Descriptive statistics State-Trait Anxiety Inventory (STAI)—intervention group Y1.
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Table 3. Descriptive statistics State-Trait Anxiety Inventory (STAI)—intervention group Y2.
Table 3. Descriptive statistics State-Trait Anxiety Inventory (STAI)—intervention group Y2.
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Table 4. Descriptive statistics State-Trait Anxiety Inventory (STAI)—control group Y1.
Table 4. Descriptive statistics State-Trait Anxiety Inventory (STAI)—control group Y1.
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Table 5. Descriptive statistics State-Trait Anxiety Inventory (STAI)—control group Y2.
Table 5. Descriptive statistics State-Trait Anxiety Inventory (STAI)—control group Y2.
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Table 6. Results of Sample Normality- Shapiro-Wilk test.
Table 6. Results of Sample Normality- Shapiro-Wilk test.
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Table 7. Results Paired Sample t-test State (Y1) Trait (Y2) Anxiety Inventory (STAI) pre/post-intervention groups: intervention/control.
Table 7. Results Paired Sample t-test State (Y1) Trait (Y2) Anxiety Inventory (STAI) pre/post-intervention groups: intervention/control.
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