Cognitive Behavioral Therapy to Reduce Academic Stress among Nursing Students: A Quasi-Experimental Study

Dya Sustrami; Ari Susanti; Ardhy Wahyu Ramadhana Putra; A.V. Sri Suhardiningsih

doi:10.30994/jnp.v9i2.997

Authors

Dya Sustrami STIKES Hang Tuah Surabaya, Indonesia
Ari Susanti STIKES Hang Tuah Surabaya, Indonesia https://orcid.org/0000-0003-0642-3170
Ardhy Wahyu Ramadhana Putra STIKES Hang Tuah Surabaya, Indonesia
A.V. Sri Suhardiningsih STIKES Hang Tuah Surabaya, Indonesia https://orcid.org/0009-0006-5120-8137

DOI:

https://doi.org/10.30994/jnp.v9i2.997

Keywords:

cognitive behavioral therapy, nursing student, stress academic

Abstract

Background: Academic stress was commonly experienced by university students as a result of high academic demands and workload. Cognitive Behaviour Therapy (CBT) is one of the methods that can help individuals identify irrational thought and replace them with adaptive cognitions so they can assess academic situation more realistically and rationally.

Purpose: The purpose of this study was to analyze the effectiveness of CBT in reducing academic stress among nursing students.

Methods: A quasi-experimental pre–post-test design was applied with 141 participants selected through simple random sampling, consisting of 70 respondents in the experimental group and 71 in the control group. The intervention group received a two-week CBT program based on the ABCDE model and cognitive restructuring techniques. The Student Life Stress Inventory (SSI) was administered before and after the intervention. Data were analyzed using the Wilcoxon Signed Rank Test and Mann–Whitney U Test. All procedures of this study were approved by the Research Ethics Committee of STIKes Hang Tuah Surabaya Number PE/50/II/2025/KEP/SHT

Results: The Wilcoxon test showed a significant reduction in stress levels in the experimental group (Z = –3.088, p = 0.002), while no significant difference was found in the control group (Z = –0.765, p = 0.444). The Mann–Whitney U Test revealed a significant difference in post–pre score changes between groups (U = –3.017, p = 0.003), indicating that CBT was effective in decreasing stress levels.

Conclusion: CBT effectively reduced academic stress among nursing students.CBT also can be used as an effective non-pharmacological nursing intervention in stress management.

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References

Alharbi, H. F., Abaoud, A. F., Almutairi, M., Alzahrani, N. S., Almarwani, A. M., Alenezi, A., & Alhowaymel, F. M. (2025). Gender differences in acute and perceived stress, bullying, and academic motivation among nursing and midwifery students. BMC Nursing, 24(1), 26. https://doi.org/10.1186/s12912-024-02666-6.

Bergvall, H., Linde, J., Alfonsson, S., Sunnhed, R., Barber, J. P., Lundgren, T., . . . Bohman, B. (2024). Quality of cognitive-behavioural therapy in routine psychiatric care: therapist adherence and competence, and patient outcomes for depression and anxiety disorders. BMC Psychiatry, 24(1), 887. https://doi.org/10.1186/s12888-024-06328-4.

Budiman, R., Purwanto, E., & Murtadho, A. (2020). Cognitive Behavioral Therapy to Improve Self-Efficacy and Reduce Academic Procrastination. Jurnal Bimbingan Konseling, 9(3), 145-151.

Cheng, R., Yang, L., & Kang, S.-J. (2025). A study on the relationship between high school students’ sleep quality, physical exercise, academic stress, and subjective well-being. BMC Psychology, 13(1), 180. https://doi.org/10.1186/s40359-025-02497-3.

Eneogu, N. D., Ugwuanyi, C. K., & Ugwuanyi, C. S. (2024). Efficacy of Cognitive Behavioral Therapy on Academic Stress Among Rural Community Secondary School Economics Students: A Randomized Controlled Evaluation. Journal of Rational-Emotive & Cognitive-Behavior Therapy, 42(2), 245-262. https://doi.org/10.1007/s10942-023-00508-z.

Gadzella, B. M. (1991). Student-Life Stress Inventory.

Jagiello, T., Belcher, J., Neelakandan, A., Boyd, K., & Wuthrich, V. M. (2024). Academic Stress Interventions in High Schools: A Systematic Literature Review. Child Psychiatry & Human Development. https://doi.org/10.1007/s10578-024-01667-5.

Khurshid, K., Mushtaq, R., Rauf, U., Anwar, N., Abbas, Q., Aljhani, S., . . . Shahzadi, M. (2025). Cognitive behavior therapy for academic burnout, procrastination, self-handicapping behavior, and test anxiety among adolescents: a randomized control trial. BMC Psychology, 13(1), 94. https://doi.org/10.1186/s40359-025-02371-2.

Liu, X., Li, Y., & Cao, X. (2024). Bidirectional reduction effects of perceived stress and general self-efficacy among college students: a cross-lagged study. Humanities and Social Sciences Communications, 11(1), 271. https://doi.org/10.1057/s41599-024-02785-0.

Mamlukah, M., & Kumalasari, I. (2022). Stress Level of University Students in West Java Indonesia During Early Covid-19 Pandemic. Journal of Educational, Health and Community Psychology, 11(2), 443-459. https://doi.org/10.12928/jehcp.v11i2.23887.

Manansingh, S., Tatum, S. L., & Morote, E.-S. (2019). Effects of relaxation techniques on nursing students' academic stress and test anxiety. Journal of Nursing Education, 58(9), 534-537.

Mulyati, S. (2023). Counseling with Cognitive Behavioral Therapy Approach to Manage Student Academic Stress. Proceedings of Siliwangi Annual International Conference on Guidance and Counselling, 2(1), 44-49. https://doi.org/10.64420/saicgc.v2i1.47.

Nuraeni, L., Samsudin, A., & Annisa, D. F. (2024). Penerapan Layanan Bimbingan Kelompok Dengan Teknik Cognitive Restructuring Dalam Menurunkan Stres Akademik Siswa Tingkat X Smkn 3 Cimahi. FOKUS: Kajian Bimbingan dan Konseling dalam Pendidikan, 7(3), 240-247.

Olson, N., Oberhoffer-Fritz, R., Reiner, B., & Schulz, T. (2025). Stress, student burnout and study engagement – a cross-sectional comparison of university students of different academic subjects. BMC Psychology, 13(1), 293. https://doi.org/10.1186/s40359-025-02602-6.

Ozdemir, E., Yazarkan, Y., & Pehlivanoglu, B. (2024). Medical Students’ Stress Levels Are Correlated with Their Sleep Quality and Life Satisfaction. International Journal of Medical Students, 12(1), 53-59. https://doi.org/10.5195/ijms.2024.2239.

Reavell, J., Hopkinson, M., Clarkesmith, D., & Lane, D. A. (2018). Effectiveness of Cognitive Behavioral Therapy for Depression and Anxiety in Patients With Cardiovascular Disease: A Systematic Review and Meta-Analysis. Psychosom Med, 80(8), 742-753. https://doi.org/10.1097/psy.0000000000000626.

Setyarini, K. I., Makaba, S., Hasmi, H., Bouway, D. Y., Tingginehe, R. M., & Anggai, M. M. (2024). Revealing Academic Stress in Medical Students of Cenderawasih University, Jayapura, Papua Province, Indonesia. Formosa Journal of Science and Technology, 3(8), 1727-1738. https://doi.org/10.55927/fjst.v3i8.10553.

Setyarini, K. I., & Sitanggang, P. A. (2024). The Correlation between Poor Sleep Quality with Academic Stress Level in Medical Profession Students of Cenderawasih University, Jayapura. Asian Journal of Healthcare Analytics, 3(2), 83-92. https://doi.org/10.55927/ajha.v3i2.12192.

Shafran, R., Myles-Hooton, P., Bennett, S., & Öst, L.-G. (2021). The concept and definition of low intensity cognitive behaviour therapy. Behaviour Research and Therapy, 138, 103803. https://doi.org/https://doi.org/10.1016/j.brat.2021.103803.

Turner, M. (2022). The rational practitioner: The sport and performance psychologist’s guide to practicing rational emotive behaviour therapy. Routledge.

Utami, M. S., Shalihah, M. a., Adhiningtyas, N. P., Rahmah, S., & Ningrum, W. K. (2020). Gratitude cognitive behavior therapy (G-CBT) to reduce college students’ academic stress. Jurnal Psikologi, 47(2), 137-150.

Zapata-López, J. S., Gutierrez-Arce, K., Bojórquez-Castro, L., & Betancourt-Peña, J. (2024). Academic stress and sleep quality in university students in two latin american countries Sociedad Española para el Estudio de la Ansiedad y el Estrés-SEAS.-Colegio …].

Zhang, S., Rehman, S., Zhao, Y., Rehman, E., & Yaqoob, B. (2024). Exploring the interplay of academic stress, motivation, emotional intelligence, and mindfulness in higher education: a longitudinal cross-lagged panel model approach. BMC Psychology, 12(1), 732. https://doi.org/10.1186/s40359-024-02284-6.