Frontiers in Medical Science Research, 2026, 8(4); doi: 10.25236/FMSR.2026.080403.
Qin Lei1, Ren Lisha2, Hao Zongji2
1Physical Education Teaching and Research Group, Liangjiang New District Chongguang Primary School, Chongqing, China
2Physical Education Teaching and Research Group, Chongqing Liangjiang Yucai Middle School, Chongqing, China
This study evaluated a 20-week pre-Gaokao Mental Imagery Training (MIT) by comparing its effects on depressive and healthy senior three students. It further explored MIT’s impacts on mental states, blood biomarkers and academic performance, as well as the joint mediating effects of COR and BDNF.A stratified randomized controlled trial was performed on 240 seniors (120 depressive, 120 healthy), randomly divided into MIT intervention and waitlist control groups at 1:1. MIT was conducted from February to May 2025. Psychological, biological and academic assessments were implemented at baseline, post-intervention and 6-month follow-up. Data were analyzed via repeated-measures ANOVA and mediation analysis (follow-up rate: 91.25%). Depressive students in the MIT group achieved significant mental improvements, reduced COR (5.57 μg/dL), elevated 5-HT (29.31 ng/mL) and BDNF (8.49 ng/mL), with a 30.91-point Gaokao score gain that persisted for six months. MIT only mildly relieved healthy students’ anxiety and academic stress with minor biomarker changes. The control groups showed no positive changes, and IL-6 remained stable. COR and BDNF jointly mediated 25.0%–26.9% of MIT’s beneficial effects on stress, depression and academic performance.The 20-week school-based MIT is a safe, durable intervention. It effectively reduces pre-Gaokao stress, optimizes stress biomarkers and improves Gaokao performance, with markedly better effects on depressive students. COR and BDNF are key biological mediators of MIT’s intervention efficacy.
Mental Imagery Training; senior three students; pre-Gaokao stress; depressive tendencies; HPA axis; BDNF; Gaokao academic performance
Qin Lei, Ren Lisha, Hao Zongji. Effects of 20-Week Mental Imagery Training on Chinese Senior Three Students' Psychology, Peripheral Biomarkers and Academic Performance Amid Pre-Gaokao Stress. Frontiers in Medical Science Research (2026), Vol. 8, Issue 4: 18-27. https://doi.org/10.25236/FMSR.2026.080403.
[1] Nexha A, Kuppens P, Houben M. Greater within- and between-day instability is associated with worse anxiety and depression symptoms[J]. Journal of Affective Disorders, 2024, 356: 215-223. https://doi.org/10.1016/j.jad.2024.04.014
[2] Engert V, Kok B E, Singer T. Exploring the multidimensionality of the endocrine stress response to academic examinations[J]. Psychoneuroendocrinology, 2022, 135: 105578. https://doi.org/10.1016/j.psyneuen.2021.105578
[3] Dong T, Wang X, Liu Y. Prevalence and determinants of depression, anxiety, and stress among secondary school students[J]. PLoS ONE, 2025, 20(9): e0328785. https://doi.org/10.1371/journal.pone.0328785
[4] Zhang R, Zhang W, Chen J. The association between depressive symptoms and cognitive function in adolescents: A longitudinal study[J]. Journal of Youth and Adolescence, 2022, 51(8): 1543-1555. https://doi.org/10.1007/s10964-022-01612-8
[5] Herhaus B, Heni M, Bloch W, et al. Dynamic interplay of cortisol and BDNF in males under acute and chronic psychosocial stress: a randomized controlled study[J]. Psychoneuroendocrinology, 2024, 165: 107192. https://doi.org/10.1016/j.psyneuen.2024.107192
[6] Lee B, Shin E, Kim J, et al. Depression in adolescence and brain-derived neurotrophic factor: the role of negative cognitive biases and baseline BDNF levels in stress vulnerability[J]. Frontiers in Molecular Neuroscience, 2022, 15: 947192. https://doi.org/10.3389/fnmol.2022.947192
[7] Kober S E, Wood G. Mental imagery training improves attentional control and reduces stress: A randomized controlled trial[J]. Frontiers in Psychology, 2022, 13: 845678. https://doi.org/10.3389/fpsyg.2022.845678
[8] Volanen S M, Lassander M, Hankonen N, et al. Healthy Learning Mind: Effectiveness of a mindfulness program on mental health and stress in school children[J]. BMC Public Health, 2020, 20(1): 123. https://doi.org/10.1186/s12889-020-09242-6
[9] Shomaker L B, Bruggink S, Pivarunas B, et al. Mindfulness-based intervention for stress and eating behavior in adolescents: A randomized trial[J]. Journal of Adolescent Health, 2021, 68(1): 134-141. https://doi.org/10.1016/j.jadohealth.2020.05.045
[10] Holmes E A, Mathews A. Mental imagery in emotion and emotional disorders[J]. Clinical Psychology Review, 2022, 92: 102125. https://doi.org/10.1016/j.cpr.2022.102125