Effects of smartphone-based hypnotic intervention for undergraduate students’ shyness during the COVID-19 pandemic: A randomized controlled trial

Abstract

BACKGROUND:

Since the outbreak of the COVID-19 pandemic, university students have been exposed to a heightened vulnerability towards developing psychological issues, such as psychological distress and shyness. Internet-based interventions offer a convenient avenue for scalability, thus prompting the development of a smartphone-based hypnotic intervention aimed at addressing shyness among university students.

OBJECTIVE:

We devised an innovative smartphone-based hypnotic intervention called mHypnosis to examine its impact on shyness among undergraduate students. Furthermore, we aimed to investigate whether the apprehension of negative evaluations before treatment could serve as a predictor for the effectiveness of the intervention on shyness.

METHODS:

Eighty students with high shyness scores were randomly assigned to the experimental group and the control group. Another 40 participants with low shyness score were selected as the baseline group. The Shyness Scale (SS), Fear of Negative evaluation scale (FNE), Self-Acceptance Questionnaire (SAQ), and Self-Esteem Scale (SES) were used to evaluate the effect of hypnotic intervention.

RESULTS:

Before the intervention, the scores of the experimental and control groups on the SS, FNE, SAQ, and SES were higher than those in the baseline group (p < 0.05). There was no significant difference in scores between the experimental and control group (p > 0.05). After the intervention, the scores of the SS, FNE, SAQ, and SES were significantly lower in the experimental group than those in the control group (p < 0.05). The pretest score of FNE could predict the shyness score after hypnotic intervention (B = 0.35, p < 0.05).

CONCLUSION:

Smartphone-based hypnotic intervention had a significant effect on ameliorating shyness during the COVID-19 pandemic; fear of negative evaluation can be a target for treating shyness.

Keywords

COVID-19 hypnotherapy randomized controlled trial shyness mind smartphone app university student

1 Introduction

At the conclusion of 2019, the initial instances of pneumonia emerged in Wuhan, China, prompting the World Health Organization (WHO) to declare the COVID-19 outbreak a global pandemic [1]. Given the potential risks associated with COVID-19 infection, the unemployment rate has surged, leading to a decline in social interaction and severe disruptions in the daily lives of many individuals [2]. Furthermore, the pandemic has had a detrimental impact on mental well-being. A study conducted at the onset of the outbreak revealed a rise in anxiety, self-reported stress, and depression within the population [3].

To reduce the risk of infection, people are encouraged to isolate themselves at home and reduce social interaction. And many students study online courses at home without leaving home, and their opportunities to interact with others are correspondingly reduced. Related studies have shown that interacting with others is one of the important factors that increase our sociality and long periods of lack of interaction with others can lead to psychological symptoms such as depression and anxiety [4]. At the same time, if they face social situations again, it may make them more likely to feel shy [5]. Reducing social interaction also increases the difficulty of seeking psychological assistance [6]. Meanwhile, during this period, distance education was widely applied in various countries, and it is found that digital instrument is particularly suitable for treating psychological distress under COVID-19, since it can support long-distance communication and easy to expand [7].

Shyness is defined as “the inclination to feel embarrassed, anxious or nervous in social situations, particularly when facing unfamiliar people” [8]. Shy individuals are more pessimistic about the role of social interactions and often attribute their social failures to their social ability defects, leading to excessive shame. A survey conducted in China identified shyness as the predominant factor impeding interpersonal communication among university students. Out of the 100 surveyed students, only one individual reported never experiencing shyness, while 48% of students acknowledged frequently feeling somewhat shy [9]. Severe shyness can elevate the likelihood of developing avoidant personality disorder, social phobia, or social anxiety disorder [10]. Within the student community, shyness can pose challenges to their adjustment and acclimatization to school [11].

Many studies on the relevant factors of shyness have been conducted. In terms of the cognitive theory of social–evaluative anxiety, fear of negative evaluation is a critical cognitive element of shyness, because those with high motivation to seek approval and fear of not being recognized tend to score higher in shyness [12]. Watson and Friend defined the fear of negative evaluation as concerns about others’ evaluations, worrying about others’ negative evaluations, and anticipating that the individual will be negatively evaluated [13]. university students’ shyness has a significant relationship with a fear of negative evaluation. Students who were more afraid of negative evaluations had a higher degree of shyness. Fear of negative evaluation was a prominent predictor of shyness [14].

Self-esteem and self-acceptance are also related to shyness [15]. Ran, Zhang and Huang argue that people with lower self-esteem show higher shyness and social anxiety [16]. Some studies indicate that shyness is related to low self-esteem and loneliness [17]. To be more specific, low self-esteem is negatively correlated with shyness [16, 18]. Shy individuals often experience approach–avoidance conflict in social environments [19], because they are worried about being excluded and disapproved by society. Therefore, individuals with low self-esteem might believe that others will negatively appraise them, which would prevent them from contacting other people and thus have a shy mindset. Self-acceptance refers to an individual’s knowledge and acceptance of oneself, including one’s limitations [20]. Researchers found that among students, the higher the level of self-acceptance, the lower the degree of shyness [21].

The evaluation of the relationship between shyness, fear of negative evaluation, self-acceptance, and self-esteem holds significant importance in understanding the complex interplay between these psychological constructs. Exploring the connections among these constructs can provide valuable insights into how shyness and fear of negative evaluation impact an individual’s self-acceptance and self-esteem. It can shed light on the underlying mechanisms that contribute to these psychological phenomena and potentially inform interventions aimed at enhancing self-acceptance and self-esteem in individuals experiencing shyness and fear of negative evaluation.

Researchers have developed various approaches for addressing shyness, drawing upon different theoretical frameworks. These approaches encompass three primary dimensions of shyness treatment, as outlined by scholars [10]: biomedical and genetic methodologies, therapeutic interventions like cognitive-behavioral therapy [22] and exposure therapy [23], as well as self-help and self-monitoring strategies. However, biomedical and genetic approaches have limited efficacy in addressing shyness. Moreover, psychotherapeutic treatments necessitate in-person communication between the individual and therapist, which can potentially induce psychological distress in shy individuals. Furthermore, the impact of COVID-19 makes it challenging to carry out these treatments due to restrictions on face-to-face interactions.

As an important tool for modern people’s lives, smartphones have been used in various psychological interventions. It has been clinically proven that smartphone-based psychological interventions have a positive effect on improving depression [24] and relieving patients’ fears [25]. This type of intervention is also more cost-effective [26]. Moreover, the number of university students with smartphones is close to 100% [27] and it can help the experimenter to facilitate daily experimental intervention [28]. During the COVID-19 pandemic, people can use smartphones to communicate even if they stay at home. Currently, no relevant studies are reporting the difference in hypnotic effects between remote treatment formats and face-to-face. However, as a form of psychodynamics, hypnosis has been studied by research conducted in Austria targeting psychodynamic therapists, who believe more in the effectiveness of remote psychotherapy than behavioral therapists and are supported by data on the effectiveness of remote psychotherapy [29]. More importantly, the blockade required during the COVID-19 pandemic has led to an increase in demand for mental health care services. Many people do not want to see a therapist in person because they are afraid of COVID-19 infection, and online treatment will be more convenient.

Hypnosis is characterized as a social interaction wherein an individual responds to the suggestions of a hypnotist and subsequently undergoes automatic alterations in perception, memory, and behavior [30]. Hypnosis finds frequent application in interventions targeting diverse mental disorders and illnesses. Prior research has indicated the efficacy of hypnosis therapy in ameliorating depressive symptoms [31]. According to the American Academy of Pediatrics, employing hypnotic techniques during medical treatment can effectively alleviate pain [32]. A study conducted with veterans suffering from post-traumatic stress disorder demonstrated that hypnotic interventions facilitated the mitigation of these symptoms [33].

Our study designed a smartphone-based method that was used to perform hypnotic intervention on undergraduate students with a high degree of shyness. We posited the hypothesis that individuals engaging in a smartphone-delivered hypnotic intervention would exhibit more pronounced improvements in levels of shyness compared to those in the control group. Additionally, we postulated that the degree of fear related to negative evaluation, as well as the levels of self-esteem and self-acceptance, would be correlated with shyness.

2 Materials and methods

2.1 Overview, study design, and sample

The research was authorized by the Human Ethics Committee of the Anhui Medical University. All participants received detailed study information and written informed consent. The primary outcome was the change in the scores of the shyness scale (SS), fear negative evaluation scale (FNE), self-acceptance questionnaire (SAQ), and self-esteem scale (SES). The secondary outcome was the score of the fear negative evaluation scale (FNE) can predate the shyness score after the hypnotic intervention.

The inclusion criteria of participants consisted of: (a) being aged 18 or above; (b) having a shyness scale score above 41 or below 29; and (c) not having undergone psychotherapy or taken psychiatric medication. The exclusion criteria were as follows: (a) having a previous history of mental illnesses such as depression, obsessive-compulsive disorder, or schizophrenia; (b) experiencing alcohol or drug dependence; (c) having physical, linguistic, cognitive, or intellectual impairments that could interfere with assessments; and (d) having received previous hypnotic interventions.

To calculate the required sample size for this study involves a single-factor analysis of variance (ANOVA) to compare differences among three groups at the baseline level, followed by a mixed-design ANOVA to compare treatment effects between an experimental and control group, and finally, regression analysis to examine the predictive effect, with a significance level of 0.05 and a statistical power of 0.80, we can use G-power software. After calculation, it has been determined that each of the three groups should consist of 35 participants. Taking into account potential participant attrition, it has been finalized that each group will have 40 participants.

The entire experiment was completed online within 8 weeks. During the pretest, the experimental group and the control group were tested using the FNE, SAQ, and SES. The baseline group also accepted all of the tests as baseline controls. During the 6-week intervention, the experimental group received the smartphone-based hypnotic intervention, and no subjects in the experimental group withdrew. In the posttest, the experimental and control groups were again tested using the SS, FNE, SAQ, and SES.

The entire experiment was conducted online over 8 weeks. In the pretest phase, both the experimental and control groups underwent assessments utilizing the FNE, SAQ, and SES. The baseline group also participated in all the tests as baseline controls. Throughout the 6-week intervention period, the experimental group received a smartphone-based hypnotic intervention, and no participants in this group withdrew from the study. In the posttest phase, both the experimental and control groups were once again assessed using the SS scale, FNE, SAQ, and SES.

2.2 Participants

In this study, a total of 400 undergraduates from Anhui Medical University In the central part of China were selected using a convenient sampling method to complete the shyness scale between October 8, 2021, and October 24, 2021. One of 18 individuals declined to participate. The top 80 individuals with shyness scale scores exceeding 41 were chosen as the high shyness group and were randomly assigned to either the experiment or control group, with 40 students in each group (14 boys and 26 girls were in the experimental group, with an average age of 19.75±1.21 years old. Seventeen boys and 23 girls were in the control group, with an average age of 19.65±1.05 years old). There were no significant differences in gender (χ² = 0.326, p = 0.792), age (t = 0.33, p = 0.745), and educational level (t = 0.55, p = 0.58) between the experimental group and the control group. An additional 40 participants with low shyness scores were included in the baseline group (23 boys and 17 girls, with an average age of 19.70±1.22 years old). All subjects obtained their written informed consent before intervention.

2.3 Measures

2.3.1 Primary outcome

Participants completed the Shyness Scale (SS) before grouping, which served as a measure of their shyness. The primary outcome measure involved assessing the change in scores on the scale following the intervention. The revised version of the SS by Cheek and Buss consists of 13 items [34]. A five-level scoring system is utilized, with a total score range of 13 to 65 points. Higher scores indicate a greater level of shyness. The scale demonstrates good test-retest reliability (0.88) and internal consistency as measured by Cronbach’s alpha (0.90). The revised Chinese version of the SS exhibits favorable reliability and validity, making it suitable for implementation among university students [35].

2.3.2 Secondary outcome

Simultaneously, we also assessed the changes in scores on the Fear of Negative Evaluation Scale (FNE), Self-Acceptance Questionnaire (SAQ), and Self-Esteem (SES) following the intervention. The secondary outcome measure involved examining the predictive impact of these scale scores on the scores obtained from the Shyness Scale.

The FNE comprises a total of 30 items, utilizing a five-level scoring system. The scale demonstrates a high level of internal consistency reliability (above 0.90), and the test-retest reliability after a one-month interval is 0.78 [36]. The total score on the scale ranges from 12 to 50 points. Participants who obtained higher scores were more likely to experience discomfort during evaluations and demonstrate agreement with the “unreasonable belief” that receiving praise is of utmost importance. Moreover, they exhibited heightened concerns regarding making a favorable impression. Similarly, individuals with higher scores reported increased anxiety when facing evaluations and expressed greater apprehension regarding potential negative evaluations.

The Self-Acceptance Questionnaire (SAQ) was developed by Chinese scholars and consists of 16 items [37]. It is further categorized into two factors: self-acceptance (comprising eight items) and self-evaluation (comprising eight items). The internal consistency reliability for the self-acceptance factor and self-evaluation factor are 0.93 and 0.91, respectively. Additionally, the test-retest reliability of the questionnaire is 0.77. The total score on the scale ranges from 16 to 64. Lower scores indicate higher levels of self-acceptance.

The SES was originally developed by Rosenberg in 1965 [38]. It comprises a total of 10 items. The score range on the scale is from 10 to 40 points, with higher scores indicating lower levels of self-esteem. The test-retest reliability of the scale is reported as 0.82, indicating good stability over time, while the internal consistency reliability is 0.83 [39], demonstrating a high level of internal coherence within the scale.

2.4 Hypnotic intervention

The experimental group underwent a smartphone-based hypnotic intervention utilizing the mHypnosis app for remote intervention. The app incorporated the Shyness Scale (SS), Fear of Negative Evaluation Scale (FNE), Self-Acceptance Questionnaire (SAQ), and Self-Esteem Scale (SES). The mHypnosis app consisted of eight modules, with the first and eighth modules serving as the pretest and posttest, respectively. The remaining six modules constituted the intervention phase, delivered sequentially over a span of six weeks. In the intervention modules, participants were induced into a hypnotic state using a standard hypnotic induction procedure [40], which lasted approximately 15 minutes. Subsequently, participants received hypnotic suggestions aimed at reducing shyness and enhancing self-confidence, accompanied by relaxation music. Supplementary Materials provide examples of the hypnotic suggestions employed.

The corresponding author has developed this hypnosis program. The hypnotherapist delivering the intervention is appropriately trained, experienced, and certified in hypnosis techniques. And we establish a standardized protocol for the hypnosis therapy, outlining specific procedures, techniques, and instructions to be followed consistently across participants in the experimental group.

The hypnotic intervention was conducted once a week for six weeks and lasted about 30 minutes each time. This was all done from the app on the smartphone. It also allowed reminders and a timely follow-up of participants through real-time investigator data monitoring. No participants in the experimental group withdrew from the entire hypnotic intervention.

2.5 Statistical analysis

Data analysis was conducted using SPSS 24.0. Initially, one-way ANOVAs were performed to assess baseline differences among the three groups. Subsequently, comparisons were made between groups with higher and lower levels of shyness, as well as between the experimental and control groups during the pretest. Next, the scores were subjected to a linear mixed model analysis, with treatment condition (hypnosis and control) as the between-group factor and time (pretest and posttest) as the repeated measure factor. In the third step, correlation coefficients were calculated to examine the relationship between each scale score. Finally, a stepwise hierarchical regression analysis was employed to investigate the predictive effect of independent variables on the dependent variables. Effect sizes were reported as partial eta-squared ( $η_{p}^{2}$ ), Eta squared (η²), or Cohen’s d. Significance was defined at α= 0.05.

3 Results

3.1 Baseline score difference test

The enrollment of participants and study flow can be found in Figure 1.

Fig. 1

Enrollment and study flow.

One-way ANOVAs were used to analyze the scores of the four scales (SS, FNE, SAQ, and SES) in the pretest of the three groups (Table 1). The scores for the SS in the three groups were markedly different (F(2, 117) = 556.44, p < 0.001, η² = 0.905). Additionally, the post hoc multiple comparisons proved that there was no remarkable distinctness between the experimental and control groups (p = 0.86), while the distinctness between the experimental group and the baseline group was outstanding (p < 0.01). The diversity between the control group and the baseline group was also notable (p < 0.01). There was a remarkable difference in the FNE scores among the three groups (F(2, 117) = 46.11, p < 0.001, η² = 0.441). The post hoc multiple comparisons showed that there was no significant diversity between the experimental group and the control group (p = 0.93), while there was an outstanding diversity between the experimental and baseline groups (p < 0.05). There was also a notable distinguishment between the control group and the baseline group (p < 0.05). There was a striking distinguishment in the SAQ scores among the three groups (F(2, 117) = 80.63, p < 0.001, η² = 0.578). The post hoc multiple comparisons indicated that there was no remarkable divergence in the scores between the experimental group and the control group (p = 0.17), while there was an outstanding distinction between the experimental and baseline groups (p < 0.01). There was also a remarkable distinguishment between the control group and the baseline group (p < 0.01). There was a significant difference in the SES scores among the three groups (F(2, 117) = 40.07, p < 0.001, η² = 0.407). The post hoc multiple comparisons showed that there was non-significant distinguishment between the experimental and control groups (p = 0.33), while there was a notable diversity between the experimental and baseline groups (p < 0.01). There was also a remarkable diversity between the control group and the baseline group (p < 0.01). These results indicate that there is no significant difference in the pretest scores of the four scales between the experimental group and the control group, but there is a notable difference between them and the baseline group.

Table 1

Comparison of scores of three groups at pretest ( $\bar{x}$ ±s)

Variables	Experimental group	Control group	Baseline group	F	p	η ²
	(n = 40)	(n = 40)	(n = 40)
SS	45.98±3.14	45.85±3.28	22.98±4.15	556.44	<0.001	0.905
FNE	105.83±14.39	104.30±9.81	84.78±7.44	46.11	<0.001	0.441
SAQ	44.00±4.29	45.35±5.27	33.90±3.46	80.63	<0.001	0.578
SES	22.48±3.16	23.25±4.28	16.70±3.16	40.07	<0.001	0.407

Note: SS = shyness scale; FNE = fear negative evaluation scale; SAQ = self-acceptance questionnaire; SES = self-esteem scale.

3.2 Primary outcome: Score difference tests after intervention

To compare the scores of the four scales among the experimental and control groups before and after the hypnotic intervention, a two-factor mixed design ANOVA of 2 (group: experimental group, control group) × 2 (time: pretest, posttest) was conducted. The results proved that for the SS scores, the main effect of the group was outstanding (F(1, 78) = 5.56, p < 0.05, $η_{p}^{2}$ = 0.040), and the main effect of time was remarkable (F(1, 78) = 6.74, p < 0.05, $η_{p}^{2}$ = 0.232). In addition, the interaction between group and time was notable (F(1, 78) = 6.54, p < 0.05, $η_{p}^{2}$ = 0.227). For the FNE scores, the main effect of the group was non-significant (F(1, 78) = 1.37, p > 0.05, $η_{p}^{2}$ = 0.010), while the main effect of time was notable (F(1, 78) = 4.23, p < 0.05, $η_{p}^{2}$ = 0.147). The interaction between group and time was also notable (F(1, 78) = 4.06, p < 0.05, $η_{p}^{2}$ = 0.142). For the SAQ scores, the main effect of the group was outstanding (F(1, 78) = 16.26, p < 0.05, $η_{p}^{2}$ = 0.121), the main effect of time was noteworthy (F(1, 78) = 6.45, p < 0.05, $η_{p}^{2}$ = 0.147), and the interaction between group and time was prominent (F(1, 78) = 5.85, p < 0.05, $η_{p}^{2}$ = 0.135). For the SES scores, the main effect of group was prominent (F(1, 78) = 6.46, p < 0.05, $η_{p}^{2}$ = 0.042), the main effect of time was notable (F(1, 78) = 4.52, p < 0.05, $η_{p}^{2}$ = 0.191), and the interaction between group and time was marginally remarkable (F(1, 78) = 1.23, p = 0.076, $η_{p}^{2}$ = 0.047).

In the simple effect analysis of the group variable, the independent-sample t-test was used to compare the dissimilar between the experimental group and the control group. The results (Table 2) indicated that the posttest SS score of the experimental group was markedly lower than that of the control group (t = –3.00, p < 0.05, Cohen’s d = 0.672) and that the FNE scale score for the experimental group was markedly lower than that of the control group (t = –2.46, p < 0.05, Cohen’s d = 0.550). The results also showed that the SAQ score for the experimental group was markedly lower than that of the control group (t = –4.21, p < 0.05, Cohen’s d = 0.940) and that the SES score for the experimental group was markedly lower than that of the control group (t = –2.71, p < 0.05, Cohen’s d = 0.603). The results showed that the scale scores of the experimental group after intervention decreased significantly compared to the control group.

Table 2
Comparison of posttest scores between the experimental and control group ( $\bar{x}$ ±s)

Variables Experimental group Control group t p Cohen’s d

(n = 40) (n = 40)

SS 42.75±5.60 45.83±3.27 –3.00 0.004 0.672

FNE 98.48±12.68 104.23±7.58 –2.46 0.017 0.550

SAQ 39.85±6.59 45.25±4.75 –4.21 0.000 0.940

SES 20.73±2.09 22.60±3.86 –2.71 0.009 0.603

Variables	Experimental group	Control group	t	p	Cohen’s d
SS	42.75±5.60	45.83±3.27	–3.00	0.004	0.672
FNE	98.48±12.68	104.23±7.58	–2.46	0.017	0.550
SAQ	39.85±6.59	45.25±4.75	–4.21	0.000	0.940
SES	20.73±2.09	22.60±3.86	–2.71	0.009	0.603

Note: SS = shyness scale; FNE = fear negative evaluation scale; SAQ = self-acceptance questionnaire; SES = self-esteem scale.

3.3 Correlation analysis of scale scores

A Pearson correlation analysis was performed on the pretest scores for the experimental group. The results demonstrated that there was a remarkable positive correlation between the SS, FNE, SAQ, and SES. The SAQ and SES had a notable positive correlation with the FNE, and the SES had a notable positive correlation with the SAQ (Table 3).

Table 3
Correlation between scores on the pretest in the experimental group

Variables M SD SS FNE SAQ SES

SS 45.98 3.14 –

FNE 105.83 14.39 0.31* –

SAQ 44.00 4.29 0.41 0.43 –

SES 22.48 3.16 0.35* 0.35* 0.50** –

Variables	M	SD	SS	FNE	SAQ	SES
SS	45.98	3.14	–
FNE	105.83	14.39	0.31*	–
SAQ	44.00	4.29	0.41**	0.43**	–
SES	22.48	3.16	0.35*	0.35*	0.50**	–

Note: SS = shyness scale; FNE = fear negative evaluation scale; SAQ = self-acceptance questionnaire; SES = self-esteem scale; ^*p < 0.05; ^**p < 0.01.

3.4 Secondary outcome: Predictive analysis of the effects of hypnotic intervention on shyness

The pretest scores based on gender, age, and education level, as well as the FNE, SAQ, and SES in the experimental group, were used as independent variables. The post-test shyness scores in the experimental group were used as dependent variables for the stepwise hierarchical regression analysis. The first step was to put the three variables of gender, age, and education level into the independent variable box. The post-test shyness score was used as the dependent variable for the regression analysis. The results proved that there was no remarkable regression effect between gender, age, education level, and SS scores (p > 0.05). In the second step, which was based on the first step, the pretest scores for the FNE, SAQ, and SES were added as independent variables. The post-test shyness score was again used as the dependent variable. The outcomes showed that the regression equation was notable (F = 2.60, p < 0.05). The main contribution was from the FNE score (B = 0.35, p < 0.05), which indicated that the fear of negative evaluation can predict the effect of the hypnotic intervention on shyness (Table 4).

Table 4
Hierarchical regression analysis

Variables Step 1 Step 2

B T B T

Gender 0.15 0.92 0.10 0.68

Age –0.26 –1.77 –0.23 –1.57

education level –0.19 –1.17 –0.09 –0.53

FNE 0.35 2.16^*

SAQ –0.10 –0.05

SES 0.22 1.27

F 1.57 2.60

R ² 0.04 0.20

Variables	Step 1	Step 2
Gender	0.15	0.92	0.10	0.68
Age	–0.26	–1.77	–0.23	–1.57
education level	–0.19	–1.17	–0.09	–0.53
FNE			0.35	2.16^*
SAQ			–0.10	–0.05
SES			0.22	1.27
F	1.57		2.60
R ²	0.04		0.20

Note: SS = shyness scale; FNE = fear negative evaluation scale; SAQ = self-acceptance questionnaire; SES = self-esteem scale; ^*P < 0.05.

4 Discussion

This study aimed to investigate the impact of smartphone-based hypnotic intervention on shyness among undergraduate students during the COVID-19 pandemic. To the best of our knowledge, this research is the first to employ hypnotic intervention to assist individuals with high levels of shyness in reducing their shyness mindset. The findings revealed that hypnotic intervention played a significant role in reducing shyness and fears of negative evaluation, enhancing self-acceptance and self-esteem. Importantly, the results indicated that the fear of negative evaluation could serve as a predictor for the effectiveness of hypnotic intervention in reducing shyness.

Before the intervention, we conducted comparisons of the pretest scores among the experimental, control, and baseline groups. The results showed no significant differences between the experimental and control groups in terms of the scores on the SS, FNE, SAQ, and SES scales. However, significant differences were observed between the experimental group and the baseline group, as well as between the control group and the baseline group. These findings suggest that the experimental grouping was appropriate, allowing for meaningful comparisons of the effects of hypnotic intervention.

The findings indicated that the scores on the SS, FNE, SAQ, and SES scales were notably lower in the experimental group compared to the control group, providing evidence for the significant impact of hypnotic intervention on reducing shyness, fear of negative evaluation, enhancing self-acceptance, and improving self-esteem. This effect may be attributed to the positive hypnotic suggestions incorporated within the intervention, which assist participants in overcoming feelings of inferiority and strengthening their self-confidence. Through specific and vivid scenarios created by the hypnotist, individuals are guided on how to feel, think, and act, effectively activating the positive aspects of their subconscious mind [41]. The efficacy of hypnosis in addressing challenges and overcoming obstacles has been widely acknowledged [42]. In the current study, participants were able to receive the intervention without the need for direct interaction with a psychotherapist. This is particularly beneficial for individuals with shyness, as face-to-face psychological interventions may induce embarrassment or anxiety. Additionally, in the context of the COVID-19 pandemic, where face-to-face interactions are limited, smartphone-based interventions offer enhanced acceptability and compliance among participants [43]. Such interventions represent a growing trend in the field.

Correlation analysis revealed a significant positive correlation between the scores on the SS and FNE scales, indicating that as individuals experienced a reduction in shyness, their fear of negative evaluation also decreased. This finding is consistent with previous research [44]. Furthermore, the scores on the SS were positively correlated with the scores on the SAQ. Higher SAQ scores were associated with lower levels of self-acceptance. This suggests that higher levels of shyness are linked to lower levels of self-acceptance. This relationship may be attributed to shy individuals frequently experiencing negative emotions in their daily lives, which subsequently affects their self-awareness and self-evaluation. Previous studies have also highlighted the influence of self-acceptance on shyness [45]. A significant correlation was observed between the scores on the SS and SES scales, indicating that individuals who frequently experience shyness tend to have lower levels of self-esteem. This finding is consistent with previous research [46]. Furthermore, previous studies have highlighted the significant role of self-esteem in the relationship between shyness and social anxiety. Individuals with lower self-esteem are more likely to exhibit shyness, which in turn contributes to increased anxiety in social situations [16]. The present study provides further support for these perspectives, confirming the association between shyness, self-esteem, and social anxiety.

The results of a stepwise hierarchical regression analysis revealed a significant regression relationship between the scores on the FNE pretest and the SS posttest. This suggests that the fear of negative evaluation has predictive value for the effectiveness of hypnotic intervention in reducing shyness. The fear of negative evaluation encompasses concerns about how others perceive and evaluate oneself, as well as anticipating negative evaluations from others [47]. Previous studies have shown that university students with higher FNE scores are more likely to experience negative emotions and exhibit maladaptive behavioral responses in interpersonal communication [48]. Furthermore, a strong association between anxiety and shyness has been established [49]. Therefore, addressing and reducing an individual’s fear of negative evaluation can be a targeted approach in treatment, facilitating the alleviation of shyness and even social anxiety.

4.1 Limitations

This study utilized smartphones as a medium for delivering hypnotic interventions to effectively alleviate tension and shyness in individuals with high levels of shyness. While the participants were able to monitor the intervention process using their mobile phones, the study lacked more direct participant observation methods, which could have provided further insights. Additionally, no follow-up procedures were conducted to examine the long-term changes in participants. Future research should include follow-up assessments to investigate behavioral changes and differences between the experimental and control groups, thereby enabling a deeper understanding of the long-term effects of hypnotic intervention.

5 Conclusion and implications for practice

The analysis results largely support our hypotheses as follows: 1) Hypnotic intervention has a significant impact on improving shyness, self-acceptance, self-esteem, and reducing the fear of negative evaluation; and 2) The fear of negative evaluation can predict the effectiveness of hypnotic intervention in reducing shyness. These findings indicate that targeting the fear of negative evaluation can be crucial in treatment, leading to the potential alleviation of shyness and even social anxiety.

For university students, a smartphone-based hypnosis intervention for shyness offers a convenient, user-friendly, and time-efficient psychotherapeutic approach, particularly in the context of the COVID-19 pandemic. This method holds promise as a viable treatment option for addressing specific mental health concerns among university students.

Ethical approval

The study was approved by Anhui Medical University’s Human Ethics Committee (Number: 2019H011).

Informed consent

All participants received written and verbal information about the study and provided written informed consent.

Conflict of interest

The authors have no known conflict of interest to disclose.

Footnotes

Acknowledgments

The authors appreciate the participation of all college students from Anhui Medical University. They also appreciate the support of the Anhui Natural Science Foundation and Key Laboratory of Philosophy and Social Science of Anhui Province.

Funding

This work was supported by the Anhui Natural Science Foundation (1808085MH291) and Key Laboratory of Philosophy and Social Science of Anhui Province on Adolescent Mental Health and Crisis Intelligence Intervention (SYS2023B08).

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Effects of smartphone-based hypnotic intervention for undergraduate students’ shyness during the COVID-19 pandemic: A randomized controlled trial

Abstract

BACKGROUND:

OBJECTIVE:

METHODS:

RESULTS:

CONCLUSION:

Keywords

1 Introduction

2 Materials and methods

2.1 Overview, study design, and sample

2.2 Participants

2.3 Measures

2.3.1 Primary outcome

2.3.2 Secondary outcome

2.4 Hypnotic intervention

2.5 Statistical analysis

3 Results

3.1 Baseline score difference test

Table 3 Correlation between scores on the pretest in the experimental group Variables M SD SS FNE SAQ SES SS 45.98 3.14 – FNE 105.83 14.39 0.31* – SAQ 44.00 4.29 0.41** 0.43** – SES 22.48 3.16 0.35* 0.35* 0.50** –

Table 4 Hierarchical regression analysis Variables Step 1 Step 2 B T B T Gender 0.15 0.92 0.10 0.68 Age –0.26 –1.77 –0.23 –1.57 education level –0.19 –1.17 –0.09 –0.53 FNE 0.35 2.16* SAQ –0.10 –0.05 SES 0.22 1.27 F 1.57 2.60 R 2 0.04 0.20

4.1 Limitations

5 Conclusion and implications for practice

Ethical approval

Informed consent

Conflict of interest

Footnotes

Acknowledgments

Funding

References

Table 3
Correlation between scores on the pretest in the experimental group

Variables M SD SS FNE SAQ SES

SS 45.98 3.14 –

FNE 105.83 14.39 0.31* –

SAQ 44.00 4.29 0.41 0.43 –

SES 22.48 3.16 0.35* 0.35* 0.50** –

Table 4
Hierarchical regression analysis

Variables Step 1 Step 2

B T B T

Gender 0.15 0.92 0.10 0.68

Age –0.26 –1.77 –0.23 –1.57

education level –0.19 –1.17 –0.09 –0.53

FNE 0.35 2.16^*

SAQ –0.10 –0.05

SES 0.22 1.27

F 1.57 2.60

R ² 0.04 0.20