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(https://www.psypost.org/better-oral-health-linked-to-lower-risk-of-depression-and-anxiety-in-older-adults/) Better oral health linked to lower risk of depression and anxiety in older adults
Apr 25th 2025, 10:00

A study of elderly adults in China found that individuals with better oral health were less likely to suffer from depression and anxiety. Those who brushed their teeth at least twice a day had 28% lower odds of developing anxiety compared to individuals who brushed their teeth rarely or only occasionally. Participants who had received dental surgery had 42% lower odds of developing depression than those with missing or unrepaired teeth. The research was published in Frontiers in Nutrition.
Oral health refers to the condition of the mouth, including the teeth, gums, tongue, and surrounding tissues. It plays a vital role in overall health, as poor oral hygiene can lead to infections, tooth loss, and may contribute to conditions such as heart disease and diabetes. Maintaining good oral health involves regular brushing and flossing, a balanced diet, and routine dental checkups. Common oral health problems include cavities, gum disease, bad breath, and oral infections.
Healthy gums are essential for supporting the teeth and preventing periodontal disease, which can lead to tooth loss if left untreated. Oral health also involves being free from pain, sores, or other conditions that interfere with chewing, speaking, or smiling. Children, older adults, and people with certain medical conditions are at greater risk of experiencing oral health problems.
Study author Chan Huang and his colleagues sought to explore the relationship between oral health, dietary behavior, and mental health in elderly Chinese adults. They hypothesized that poor oral health might be associated with depression, anxiety, and cognitive decline.
The researchers analyzed data from the Chinese Longitudinal Healthy Longevity Survey (CLHLS), a long-term tracking project conducted by the Center for Healthy Aging and Development Studies at the National School of Development, Peking University. The survey spans 23 provinces, municipalities, and autonomous regions in China and focuses on individuals aged 60 and older, as well as their offspring. The full survey included 15,874 individuals.
For this analysis, the researchers used data from participants aged 65 and above who had provided information about their oral health, mental health, and general characteristics. This subset included 3,188 individuals, 179 of whom were 100 years old or older. Approximately 44% of the participants were over the age of 80.
The study relied on participants’ responses regarding their nutritional habits—covering 17 categories of food items—as well as information on their oral health status, cognitive function, and symptoms of anxiety and depression.
The results showed that individuals with more missing teeth were more likely to experience dementia. Those who brushed their teeth two or more times a day had 22% lower odds of experiencing anxiety compared to those who brushed infrequently. Similarly, participants who reported eating fruits and vegetables daily were significantly less likely to develop anxiety than those who ate them less often.
Individuals who had undergone dental procedures to repair missing teeth had 42% lower odds of experiencing depression compared to those with unrepaired tooth loss. Participants who ate vegetables daily had more than twice the odds of avoiding depression compared to those who consumed them less frequently. Individuals who brushed their teeth regularly and ate fruits and vegetables daily were also less likely to suffer from dementia.
“Oral health and dietary behavior are closely related to the susceptibility of middle-aged and elderly individuals to depression, anxiety, and dementia,” the study authors concluded.
This research adds to the growing body of evidence suggesting a link between oral health, nutrition, and mental well-being. However, the cross-sectional design of the study limits the ability to draw conclusions about cause and effect. While poor oral health may contribute to mental health problems, it is also possible that depression and anxiety reduce a person’s ability to maintain good oral hygiene.
The paper, “(https://doi.org/10.3389/fnut.2025.1486987) Modelling analysis of dietary behaviors and oral health status to assess the impact on the mental well-being of elderly individuals: a cross-sectional survey study,” was authored by Chan Huang, Mingzhu Song, Xiao Wei, Xingyan Wang, Honglin Dai, Zhiqiong Gou, Feiyang Chenwu, Yanqiu Jiang, Jie Wan, Yurun Guo, and Xiaoping Yu.

(https://www.psypost.org/new-study-sheds-light-on-what-helps-nonbelievers-thrive-psychologically-in-a-religious-culture/) New study sheds light on what helps nonbelievers thrive psychologically in a religious culture
Apr 25th 2025, 08:00

A new study published in the Archive for the Psychology of Religion explores how nonbelievers in Poland maintain psychological well-being in a predominantly religious culture. The researchers found that greater clarity in self-beliefs, access to social support, and use of adaptive emotional strategies were strongly linked to meaning in life and overall well-being. Secular values such as humanism and belief in science were also associated with positive outcomes, but not as consistently.
The researchers conducted this study to address a long-standing gap in psychology. While many studies have examined the benefits of religious involvement, fewer have looked at what supports mental health in people who do not hold religious beliefs. This oversight has created a lopsided view of well-being, often suggesting that religion is essential to a meaningful or mentally healthy life. In response, the study sought to investigate the factors that support psychological functioning among people who do not believe in God or a higher power.
“Much of the existing psychological research on how beliefs relate to well-being has historically focused on religious believers, leaving nonbelievers underrepresented. This gap is particularly important in places like Poland, one of the fastest secularizing countries globally, where nonbelievers are becoming increasingly prominent,” said study author Paweł Łowicki, an
assistant professor at the University of Warsaw
“Many of these individuals hold meaningful secular beliefs—such as humanism or belief in science—which may be linked to different aspects of well-being. We wanted to explore these associations and better understand the factors connected to well-being in this growing but often overlooked group.”
Poland has traditionally been deeply religious but is now experiencing one of the fastest rates of secularization in the world. The researchers surveyed 500 Polish adults who stated they did not believe in a god or higher power. Of these participants, 38% reported no affiliation with any religious or secular group, 33% identified as Roman Catholic, and 22% identified as atheist. The rest were agnostic or identified with other labels. The participants ranged in age from 18 to 85 and were equally split by gender.
“What stood out most was the diversity within our sample,” Łowicki told PsyPost. “Although all participants identified as not believing in God or a higher power, a significant number still reported affiliation with religious groups, particularly Roman Catholicism. This highlights that belief and affiliation don’t always go hand in hand. People may identify with religious or secular communities for various personal, social, or cultural reasons, independent of supernatural belief. It speaks to the complexity and heterogeneity of the nonbeliever population and the importance of distinguishing between belief and group identity.”
To measure well-being and its potential predictors, the researchers used a series of questionnaires. These included tools to assess life satisfaction, happiness, meaning in life, perceived social support, emotion regulation strategies, clarity of self-beliefs, and endorsement of secular values like humanism and belief in science. Humanism was measured as a belief in human dignity and the importance of reducing suffering. Belief in science was defined as trust in science as the most effective way to understand reality.
The researchers found that social support and the use of adaptive emotion regulation strategies—such as acceptance, reappraisal, and problem-solving—were the strongest predictors of well-being. These strategies helped participants manage negative emotions in constructive ways and were consistently linked to higher levels of happiness and life satisfaction. People who reported having strong support from family and friends also reported greater meaning in life and overall well-being.
Clarity of self-beliefs—the degree to which people felt they had a stable and coherent understanding of who they are—was another important predictor. Individuals who were clear about their self-concept tended to score higher on measures of happiness and life satisfaction. This clarity was also related to a greater sense of meaning in life, suggesting that having a stable identity might be beneficial regardless of religious belief.
Secular beliefs played a more mixed role. Endorsing humanism was positively associated with meaning in life and, indirectly, with well-being. However, belief in science showed a more complex pattern. While it was linked to some measures of meaning and emotion regulation, it was negatively associated with overall well-being when other variables were taken into account. The researchers suggested that this could be partly explained by the timing of the study. It was conducted during the COVID-19 pandemic, when trust in science may have been challenged by widespread frustration and uncertainty.
Interestingly, the study found minimal differences in well-being between people of different (non)religious affiliations. Atheists and Roman Catholics reported similar levels of life satisfaction and happiness. The only statistically significant difference showed slightly higher well-being among Roman Catholics compared to those with no group affiliation, but the effect size was small. There were no differences between the groups in terms of social support or meaning in life.
“Our findings suggest that nonbelievers’ well-being is not only related to secular beliefs like humanism, but also to broader psychological and social resources,” Łowicki explaiend. “In particular, perceived social support, the use of constructive emotion regulation strategies, and clarity of self-beliefs were all linked with greater well-being and a stronger sense of meaning in life. These results point to a range of factors—beyond religious belief—that may support well-being in secular populations.”
But there are some limitations to consider. The study focused exclusively on people living in Poland, a country with a unique cultural and religious history. As a result, the findings may not generalize to nonbelievers in other countries or cultural settings. The data were also collected at a single point in time.
“The main limitation of our study is that it was cross-sectional and correlational, meaning we cannot draw conclusions about causality,” Łowicki noted. “While we found several associations between well-being and factors such as secular beliefs, social support, and emotion regulation, we cannot determine the direction of these relationships. Future studies using longitudinal or experimental methods would be needed to examine how these dynamics develop over time.”
Despite these limitations, the study makes an important contribution to our understanding of mental health outside of religious frameworks. It highlights that nonbelievers are not a monolithic group and that their well-being is shaped by a range of psychological, social, and philosophical factors. The findings may be especially useful for counselors and therapists working with nonreligious clients, as they point to specific areas—like emotion regulation, self-clarity, and community connection—that can be strengthened to support well-being.
Looking forward, “I’d like to explore the diversity within nonbelieving populations more deeply,” Łowicki explained. “Our findings suggest there are meaningful differences in how individuals identify and what they value—even among those who share a lack of belief in God. Understanding these differences may offer a more nuanced picture of how various secular perspectives relate to psychological well-being. I’m also interested in applying methods such as longitudinal research or experience sampling to observe these patterns in daily life and over time.”
“I think this research highlights the importance of studying diverse belief systems—including secular ones—through a psychological lens. There is often a tendency to frame well-being research around religious belief, and while those studies are important, it’s equally important to recognize that many people find meaning, community, and psychological strength outside of religion. I believe that acknowledging and studying these paths can help support inclusive mental health practices and public understanding.”
The study, “If not belief in God, then what? Identifying factors that contribute to well-being among Polish nonbelievers,” was authored by Paweł Łowicki and Sally B. Barker.

(https://www.psypost.org/people-with-high-self-control-prefer-meaning-over-pleasure-study-finds/) People with high self-control prefer meaning over pleasure, study finds
Apr 25th 2025, 06:00

A new study published in (https://doi.org/10.1177/19485506251323948) Social Psychological and Personality Science sheds light on why some people are better at pursuing their long-term goals than others. The researchers found that individuals with high self-control tend to prefer engaging in activities that feel meaningful rather than those that are simply pleasurable. In contrast, people who are better at enjoying immediate pleasures tend to seek out experiences that are enjoyable in the moment. These preferences may help explain why self-controlled individuals often excel in areas like health, work, and relationships.
Self-control helps people resist temptation, avoid distraction, and stick to plans. Whether it’s saving money, following a diet, or maintaining a study routine, people with high self-control tend to succeed at tasks that require discipline. Traditionally, researchers thought this success stemmed from their ability to suppress impulses or tolerate discomfort. But the authors of the new study propose a different explanation: perhaps people with high self-control simply enjoy different kinds of experiences—ones that align with their goals.
“We found in previous studies that people with high trait self-control spend more time with what they call ‘work’ and people with higher trait hedonic capacity with more ‘leisure.’ I wanted to better understand whether these differences are self-chosen/motivated or rather have to do with external factors (e.g. their courses at uni, working besides studying),” explained study author (https://orcid.org/0000-0003-1432-9133) Katharina Bernecker, a research assistant at the (https://www.psychology.uzh.ch/en/areas/sob/motivation/team/katharinabernecker.html) University of Zurich and professor at (https://www.phbern.ch/ueber-die-phbern/personen/katharina-bernecker) Bern University of Teacher Education.
To test this idea, the researchers conducted a series of three studies. The first two examined what people did with unexpected free time and how they felt about those activities. The third study asked participants to make hypothetical choices between meaningful and pleasurable activities. In each study, the researchers assessed two personality traits: self-control and hedonic capacity, or the tendency to enjoy pleasurable experiences.
In Study 1a, 449 participants imagined having a few hours of free time and listed up to four activities they might do. They then rated how meaningful and how pleasurable those activities would feel. In Study 1b, a new sample of 231 participants was given an actual hour of free time during a study session and could choose how to spend it. They later reported what they did and how it felt. Both studies used established questionnaires to measure participants’ levels of self-control and hedonic capacity. Activities were then rated based on how much meaning or pleasure participants derived from them.
Study 2 involved 248 participants who completed a series of hypothetical choices. In each of 20 trials, they were shown two activity options—one described with a word suggesting meaning (such as “purposeful”) and the other with a word suggesting pleasure (such as “enjoyable”). Participants chose which activity they would prefer if they unexpectedly had a few hours of free time.
The findings were consistent across all three studies. People with higher self-control rated their chosen or imagined activities as more meaningful. This was true regardless of what activity they selected—whether it was gardening, reading, or working.
On the other hand, people with higher hedonic capacity experienced greater pleasure from their activities, again regardless of what those activities were. These relationships were not due to people with high self-control choosing different types of activities than those with high hedonic capacity. Instead, it seemed that individuals differed in how they experienced the same activity. For example, someone high in self-control might view studying as fulfilling, while someone else might see it as boring.
“Most surprising to me was that we did not find differences in the coded activities—what people spent their free time doing,” Bernecker told PsyPost. “It somehow suggests that either people with high trait self-control are construing the experience of productivity and meaning, or we just couldn’t detect differences in the codes because the activities did differ on some level (e.g., reading a tabloid vs. a newspaper). Or it might also be that the activity itself isn’t what causes the experience, but rather the reason behind it (doing it for pleasure vs. learning or self-development), which is something we didn’t assess.”
In the third study, participants with higher self-control consistently chose the activities described as meaningful, while those with higher hedonic capacity preferred the ones described as pleasurable. These preferences suggest that people are drawn to experiences that match their personality traits, even when they are making choices in hypothetical situations with no real stakes.
Interestingly, the researchers also found that both traits—self-control and hedonic capacity—were linked to greater satisfaction with how participants spent their time. However, the emotional tone of that satisfaction differed slightly. Hedonic capacity was more strongly linked to joy, while self-control was more associated with a sense of meaning.
The findings provide evidence “that a lot of self-control success might be due to people’s motivation to feel productive and engage in meaningful activities rather than avoid pleasure,” Bernecker explained. “People with high trait self-control seem to enjoy this experience more than something that is just fun. That means spending a weekend or holiday doing nothing is probably not for them. They need to do something that allows them to feel productive—like learning a new skill. When we think of holidays, we usually think of lying on the beach, doing nothing, but that might not be the most enjoyable way to spend free time, at least not for all of us.”
Still, the authors note that their studies were correlational and based on self-report. While the findings are consistent with their hypothesis, they cannot confirm that self-control causes people to prefer meaningful experiences, or the reverse.
“The studies are all correlational, which means we cannot tell which comes first—trait self-control or the preference for meaning,” Bernecker said. “This is a problem with basically all trait research because traits can’t be experimentally manipulated. For instance, perhaps the trait still means that people are better at controlling their impulses or persisting despite effort, which allows them to experience meaning. Or they are motivated by that feeling of meaning, and this is what gives them the extra push to choose and persist in effortful tasks.”
The long-term goal for this line of research is to “understand trait self-control, as it has so many positive outcomes,” Bernecker explained. “If we understand the processes, we can help people get better at it. And our findings suggest that there might be a rather enjoyable route to better self-control.”
“With my research, I would like to inspire self-control researchers to think about the positive aspects of applying control—most studies center around withstanding effort or avoiding pleasure, but there are also positive aspects of activities like exercise, doing household tasks, learning, or taking care of others’ needs. These things make us feel productive, and sometimes they are meaningful. If we could teach people to focus more on these aspects, perhaps we could get them to engage in these activities more often—instead of just teaching impulse control.”
The study, “(https://doi.org/10.1177/19485506251323948) High Self-Control Individuals Prefer Meaning Over Pleasure,” was authored by Katharina Bernecker, Daniela Becker, and Aiste Guobyte.

(https://www.psypost.org/psychology-impaired-identity-and-negative-affectivity-predict-depression-and-anxiety-symptoms-study-finds/) Impaired identity and negative affectivity predict depression and anxiety symptoms, study finds
Apr 24th 2025, 14:00

A study conducted in Poland examined the relationship between maladaptive personality traits and symptoms of depression and anxiety. It found that impaired identity and negative affectivity were strong predictors of both depression and anxiety, while empathy and detachment were specifically associated with anxiety symptoms. The research was published in (https://www.nature.com/articles/s41598-025-96067-7) Scientific Reports.
Maladaptive personality traits are enduring patterns of thinking, feeling, and behaving that are inflexible, unhealthy, and interfere with a person’s ability to function effectively in daily life or maintain fulfilling relationships. These traits often cause distress to the individual or those around them and can create difficulties in work, social, and personal contexts. Unlike typical personality traits, maladaptive traits are extreme, rigid, and resistant to change. Although they are linked to personality disorders, they can also occur in less severe forms.
The main domains of maladaptive personality traits include negative affectivity, detachment, antagonism, disinhibition, and psychoticism. Negative affectivity involves frequent experiences of negative emotions such as anxiety and sadness. Detachment refers to social withdrawal and emotional coldness. Antagonism includes traits like hostility, manipulativeness, and grandiosity, while disinhibition involves impulsivity and poor self-control. Psychoticism reflects eccentric behaviors, unusual beliefs, and distorted perceptions of reality.
Researchers Monika Olga Jańczak and Emilia Soroko aimed to explore the relationship between the level of personality functioning, maladaptive personality traits, and symptoms of depression and anxiety in middle-aged and older adults. They hypothesized that individuals with lower personality functioning and more pronounced maladaptive traits would show higher levels of depression and anxiety. They also predicted that internalizing traits—such as negative affectivity and detachment—would be more strongly related to these symptoms than externalizing traits like disinhibition and dissociality.
The study included 530 Polish adults, 52% of whom were women. The average age was 47, with ages ranging from 30 to 97. Most participants had a university education, and 62% were married.
Participants completed several assessments: the Generalized Anxiety Disorder Questionnaire and the Patient Health Questionnaire to measure anxiety and depression symptoms; the Self and Interpersonal Functioning Scale to assess personality functioning; and the Personality Inventory for ICD-11 to evaluate maladaptive personality traits. Personality functioning in this context refers to a person’s capacity for stable identity, self-direction, empathy, and intimacy—core aspects that reflect healthy or impaired personality development.
The results revealed some gender differences. Men were more likely to show impairments in empathy, intimacy, detachment, and dissociality, while women tended to have greater impairments in identity and self-direction, along with higher levels of anxiety.
Almost all maladaptive traits and indicators of impaired personality functioning were associated with symptoms of depression and anxiety. These traits were also slightly more pronounced in younger participants within the sample.
Using statistical modeling, the researchers identified which traits were most predictive of anxiety and depression. Anxiety symptoms were best predicted by impairments in identity and empathy, elevated negative affectivity, and lower levels of detachment. Depression, on the other hand, was best predicted by impaired identity and negative affectivity.
“Consistent with our hypothesis, both personality dysfunction (identity and empathy) and pathological traits (negative affectivity and detachment) emerged as significant predictors of these emotional disorders,” the authors concluded. “These findings highlight the critical role of both components of the dimensional model of personality disorders in understanding depression and anxiety symptoms.”
While the study contributes to a better understanding of the relationship between personality traits and emotional distress, the authors caution that the cross-sectional design does not permit causal conclusions. Additionally, all data were collected through self-report measures, which may introduce bias and affect the accuracy of the findings.
The paper, “(https://www.nature.com/articles/s41598-025-96067-7) Level of personality functioning and maladaptive personality traits in relation to depression and anxiety symptoms in middle and older adults,” was authored by Monika Olga Jańczak and Emilia Soroko.

(https://www.psypost.org/most-bereaved-people-dream-of-or-sense-the-deceased-study-finds-and-the-two-may-be-linked/) Most bereaved people dream of or sense the deceased, study finds — and the two may be linked
Apr 24th 2025, 12:00

A new study published in the journal (https://psycnet.apa.org/record/2025-33750-001?doi=1) Dreaming finds that the majority of bereaved individuals—whether grieving the death of a romantic partner or a pet—report vivid dreams or waking experiences involving the deceased. The research suggests these occurrences are more common than often assumed and may play a meaningful role in the grief process. Those who dream of the deceased are also more likely to report experiencing their presence while awake.
For years, researchers have examined the role of dreams in bereavement, as well as so-called “continuing bonds”—the ways in which people maintain a connection with lost loved ones. Many dying individuals also report comforting visions or dreams of deceased family members. Yet, few studies have explored the overlap between these sleep and waking experiences among the bereaved. The new study seeks to bridge that gap by exploring both types of experiences and examining how they may be related.
The authors conducted a post hoc analysis of previously unexamined data from two earlier studies. The first study involved 268 adults in the United States who had lost a romantic partner or spouse within the past two years. The second study included 199 participants who had lost a dog or cat in the prior six months. In addition to asking about dreams of the deceased, researchers had also included questions about waking experiences—such as seeing, hearing, or feeling the presence or touch of the deceased. These items had not been analyzed in earlier reports.
Participants in both studies were recruited through Mechanical Turk, a crowdsourcing platform frequently used in psychological research. Previous studies have found that data gathered from Mechanical Turk samples is comparable in quality to other non-randomized survey methods. In both samples, participants completed multiple standardized questionnaires, including the Continuing Bonds Scale, which measures the extent to which a person feels a continued presence of the deceased in their life, and a dream questionnaire that asked about recent experiences involving the deceased.
To assess waking experiences, participants were asked whether in the past month they had seen the deceased standing before them, heard the deceased’s voice, or felt their physical touch. Participants rated the frequency of each experience on a five-point scale. For analysis, any response indicating the event occurred at least once was coded as a positive occurrence.
The results showed that 73.5% of participants who had lost a romantic partner and 59.3% who had lost a pet reported dreaming of the deceased in the past month. Waking experiences were also common. Among those grieving a partner, 50.7% said they had at least one waking experience of the deceased in the same timeframe—whether seeing, hearing, or feeling them. In the pet loss group, 32.2% reported such experiences. When both dreaming and waking experiences were combined, the proportions rose to 82.5% in the partner loss group and 68.3% in the pet loss group.
Importantly, the researchers found a statistically significant relationship between dreaming of the deceased and experiencing their presence while awake. Among those who had dreamed of a deceased partner, 56.1% also reported a waking experience, compared to 36.2% of those who had not dreamed. In the pet loss group, 39% of those who dreamed of the deceased also had waking experiences, compared to just 22.5% of those who had not dreamed. This suggests that the two types of experiences may be related, possibly reflecting a more general openness to experiencing ongoing connections with the deceased.
These findings build on a growing body of research that has explored dreams of the deceased and so-called “externalized continuing bonds.” (https://www.psypost.org/why-do-some-people-dream-of-deceased-loved-ones-but-other-dont/) Past studies have found that such dreams are often comforting, and in most cases the deceased appear healthy and happy. For many people, these dreams serve a therapeutic role—providing a chance to say goodbye, feel a sense of closure, or reconnect with positive memories.
The idea that waking experiences of the deceased are pathological or signs of unresolved grief has also been challenged by recent work. While some studies have linked these experiences to avoidant attachment or trauma symptoms, others suggest they may support emotional regulation and healing, especially when the experiences are felt as comforting rather than distressing.
Still, this line of research is in its early stages, and there are important limitations. The study relied on retrospective self-reports, which can be influenced by memory biases or interpretation differences. Participants may have varying understandings of what it means to “see” or “hear” the deceased, making it difficult to draw firm conclusions about the nature of these experiences. Additionally, the sample was not representative of the general population, which may limit the generalizability of the findings.
The researchers emphasize that more investigation is needed to understand the causes and consequences of these phenomena. It remains unclear why some people have positive experiences while others do not, or whether these experiences help or hinder the process of adjusting to loss over time. Future studies may benefit from using longitudinal designs and more objective measures, such as dream diaries, to better understand when and why these experiences occur.
Despite the limitations, the findings have potential clinical value. Bereaved individuals often worry that dreaming of or sensing a deceased loved one means something is wrong. Clinicians and support providers may be able to reassure people that such experiences are common and not necessarily signs of mental health issues. Raising awareness about the frequency and emotional tone of these experiences could help reduce unnecessary distress and encourage open conversations about grief.
The study, “(https://psycnet.apa.org/doi/10.1037/drm0000291) The Bereavement Experience: Dreams and Waking Experiences of the Deceased,” was authored by Joshua Black, Kathryn Belicki, and Jessica Ralph.

(https://www.psypost.org/breathing-exercises-reduce-test-anxiety-in-middle-school-students/) Breathing exercises reduce test anxiety in middle school students
Apr 24th 2025, 10:00

A new study published in (https://doi.org/10.1016/j.paid.2025.113157) Personality and Individual Differences has found that a structured breathing exercise program helped lower test anxiety in eighth-grade students preparing for Turkey’s centralized high school placement exam. The findings suggest that incorporating breathing routines into school schedules may be a practical and low-cost way to support mental health during high-pressure academic periods.
In many countries, high-stakes standardized exams can determine a student’s educational future. In Turkey, the centralized high school placement exam plays a pivotal role in admissions to top schools and, by extension, access to prestigious universities. These exams often trigger high levels of stress and anxiety, especially among middle school students who are navigating academic pressure alongside significant developmental changes.
Test anxiety has been linked to lower academic performance, with studies suggesting it can account for as much as 20 percent of the variation in standardized test outcomes. Meanwhile, self-esteem—how positively a person views themselves—has been shown to act as a buffer against stress and anxiety. Prior research has identified a negative relationship between self-esteem and test anxiety, suggesting that improving one might help reduce the other.
While there is growing interest in school-based mental health interventions, most studies have focused on high school or university students. Research on middle schoolers preparing for high-stakes tests has been relatively limited. This study aimed to fill that gap by evaluating whether a breathing exercise program could reduce test anxiety and improve self-esteem in a younger, academically vulnerable population.
“Central exams play a significant role in shaping students’ future careers in the Turkish education system, making test anxiety a common experience among them. The study aims to address the intensification of test anxiety as exams approach, emphasizing the need for timely educator support to manage this uncertainty,” said study author Derya Uysal, an associate professor at Alanya Alaaddin Keykubat University.
“To address this, the study incorporated breathing exercises into the routines of eighth-grade students during the three months leading up to Turkey’s high-stakes centralized exam—a period of peak anxiety. This intervention was scheduled to begin three months before the exam to ensure participation while students were still attending school. Given the exam’s significant impact on admission to top high schools and universities in Turkey, the study evaluates the effectiveness of the intervention in reducing test anxiety and enhancing self-esteem, which may serve as a protective factor in this high-stakes context.”
The research took place during the spring of the 2023–2024 school year in Alanya, Türkiye. The study involved 162 eighth-grade students (78 boys and 84 girls) from two academically high-performing public middle schools. Because randomly assigning students to different conditions was not feasible, the researchers used a quasi-experimental design with pre-test and post-test assessments.
Participants completed two psychological scales before and after the intervention: the Rosenberg Self-Esteem Scale, which measures overall self-worth, and the Spielberger Test Anxiety Scale, which assesses anxiety levels related to exams. The study also included a short questionnaire with two open-ended questions to capture students’ subjective experiences.
The intervention itself was an eight-week Breathing Exercise Program (BEP), delivered twice a week before morning classes. Each session lasted 15 to 20 minutes and was led by a physiotherapist with expertise in breathing techniques. The program featured 12 types of exercises, such as diaphragmatic breathing, lion’s breath, and affirmation breath, along with complementary strategies like cognitive restructuring and stress inoculation.
The researchers confirmed a statistically significant negative correlation between self-esteem and test anxiety before the intervention. Students with lower self-esteem tended to have higher levels of test anxiety, supporting earlier findings on the link between these two psychological traits.
After completing the eight-week breathing program, students showed a significant drop in test anxiety scores. On average, their scores decreased by 5.05 points—from 44.90 to 39.85—which represents a small to moderate effect size. Seventy percent of students said in their written responses that the breathing exercises helped them feel calmer and more focused during the exam.
However, the increase in self-esteem scores was relatively minor and not statistically significant. Students’ average scores rose from 28.39 to 29.09, but this change fell short of the threshold needed to be considered meaningful. This suggests that while the breathing exercises effectively reduced anxiety, they were less successful at shifting students’ overall self-perception in a short timeframe.
Qualitative data echoed these findings. Most students described feeling nervous or anxious before the exam, with common emotions including fear of failure, stress, and physical symptoms like nausea. After the breathing sessions, many said they felt more in control and better able to manage their stress, although a minority reported no noticeable change.
The study highlights the potential of integrating short, structured breathing exercises into school routines to reduce anxiety in students facing high-stakes exams. Unlike more resource-intensive interventions such as therapy or full-scale cognitive-behavioral programs, a breathing routine can be delivered by trained staff within existing class schedules, making it a feasible option for many schools.
“This study suggests that schools can easily incorporate structured breathing exercises into daily routines for meaningful psychological benefits at low cost,” Uysal told PsyPost. “Combining these exercises with CBT or social-emotional learning could enhance effectiveness for anxiety and self-esteem.”
As with all research, there are limitations to consider. Because it used a quasi-experimental design, the researchers cannot conclusively say that the breathing program caused the changes in anxiety. A randomized controlled trial would be needed to make stronger claims about effectiveness. Additionally, the study was limited to two schools in one Turkish city, which may affect how generalizable the findings are to other regions or educational systems.
The researchers suggest that future studies use randomized controlled trials to validate the breathing intervention’s effectiveness and examine its long-term effects. They also propose integrating breathing exercises with broader mental health strategies, such as cognitive-behavioral programs or social-emotional learning, to better address both anxiety and self-esteem.
There is also room to explore whether these benefits extend beyond test periods and into other areas of school life, such as classroom engagement or peer relationships. Understanding how breathing-based interventions interact with other psychological factors—like motivation, emotional regulation, and identity development—could help refine school-based mental health programs and make them more impactful.
“While the current study underscores the potential of breathing exercises to reduce test anxiety, future research must focus on more robust study designs and interventions that target both anxiety and self-esteem in this population,” Uysal said.
The study, “(https://doi.org/10.1016/j.paid.2025.113157) Breathing exercises’ impact on test anxiety and self-esteem in a high-stakes centralized exam setting,” was authored by Ayça Araci and Derya Uysal.

Forwarded by:
Michael Reeder LCPC
Baltimore, MD

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