Background: Attendance in educational settings such as schools is often accompanied by varying levels of anxiety for many students. One of the most significant types of anxiety in educational environments is exam anxiety. Objectives: This study aimed to investigate the efficacy of metacognitive therapy on social avoidance, distress, and academic persistence among students with exam anxiety in 2023. Methods: This quasi-experimental study utilized a pretest-posttest design to assess the efficacy of metacognitive therapy for female students with exam anxiety. All female second-grade high school students in Ahvaz city who reported experiencing exam anxiety during the 2022 - 2023 academic year were included in the study sample. A purposive sample of 36 female students was randomly divided into two groups: An experimental group receiving metacognitive therapy and a control group. The experimental group participated in seven 60-minute sessions of metacognitive therapy, conducted twice a week. The control group did not receive any intervention during the study period. The Social Avoidance and Distress Scale (SADS) and Academic Persistence Scale (APS) were administered to both groups before and after the intervention. Data were analyzed using analysis of covariance to control for baseline differences. Results: Metacognitive therapy was effective in reducing social avoidance and distress, as well as in improving academic persistence in high school students (P < 0.001). Specifically, the mean social avoidance and distress score decreased significantly from 19.67 ±1.68 to 10.11 ±2.13 in the metacognitive therapy group. Additionally, the mean academic persistence score increased significantly from 9.39 ±1.78 to 23.72 ±3.10 in the metacognitive therapy group. Conclusions: Metacognitive therapy effectively reduced social avoidance and distress while increasing academic persistence in female students with exam anxiety. This study highlights the therapy's potential as a valuable intervention for improving the overall well-being and academic performance of students facing similar challenges.
