Supplementary file 1_The association between test anxiety, learning strategies, and open-label placebo effects on academic test performance: a secondary analysis of a randomized controlled trial.docx

IntroductionThe management of educational stressors and predictors of cognitive performance outcomes, such as test anxiety and learning strategies (LS), pose relevant challenges for students and educators. In a previously published single-blind randomized controlled trial (DRKS00013557), we reported on the impact of a 3-week open-label placebo (OLP) treatment compared to no intervention on results of a central examination and subjective well-being in healthy medical students. OLP treatment had a positive effect on students' subjective well-being, and test performance was better in those students in the OLP group with higher beliefs in benefits of medication. The present secondary analysis, conducted on a subgroup of the main study, aimed to explore whether further potential factors of exam performance influenced the impact of OLPs intake on cognitive outcomes.
MethodsThis secondary analysis investigated a subgroup of the main study's sample (N = 104) in which learning strategies were assessed. Here, we conducted an explorative analysis to investigate the effects of test anxiety, LS, and 3-week OLP intake on test performance.
ResultsOLP intake compared to no intervention was associated with improved test performance in those students with higher levels of test anxiety and those who adopted beneficial LS.
DiscussionThese findings provide preliminary evidence that psychological processes, such as anxiety or the application of cognitive strategies, modulate the effects of OLPs on cognitive performance in exam situations, framed within the context of self-efficacy. Further pre-registered, hypothesis-driven research is warranted, as harnessing these processes in the light of OLP applications could optimize students' well-being and maximize their academic success, including long-term potential for optimizing therapeutic outcomes in clinical settings.

引言：教育压力的应对以及认知表现结果的预测因素（如考试焦虑与学习策略（learning strategies, LS）），始终是学生与教育工作者面临的重要挑战。
在已发表的一项单盲随机对照试验（single-blind randomized controlled trial, DRKS00013557）中，我们曾报告了为期3周的开放标签安慰剂（open-label placebo, OLP）干预与无干预相比，对健康医学生的核心考试成绩与主观幸福感的影响。
开放标签安慰剂干预可改善学生的主观幸福感，且在该干预组中，对药物获益持有更高认知的学生，其考试表现更为优异。
本研究针对主试验的亚组样本开展二次分析，旨在探究考试表现的其他潜在影响因素是否会调节开放标签安慰剂摄入对认知结局的作用。

方法：本次二次分析纳入主试验样本中的104名亚组受试者，该亚组已完成学习策略的评估。
本研究采用探索性分析方法，探究考试焦虑、学习策略（LS）以及为期3周的开放标签安慰剂摄入对考试表现的影响。

结果：与无干预组相比，开放标签安慰剂摄入可提升高考试焦虑水平以及采用有益学习策略的学生的考试表现。

讨论：本研究结果提供了初步证据，表明在自我效能感的框架下，焦虑与认知策略运用等心理过程会调节开放标签安慰剂在考试场景中对认知表现的影响。
未来仍需开展预先注册的假设驱动型研究，因为基于开放标签安慰剂应用调控上述心理过程，或可改善学生的主观幸福感，最大化其学业成就，同时也有望为临床场景中的治疗结局优化提供长期潜力。