Colonoscopy is a routinely performed procedure for diagnosing and managing large bowel pathology. Despite its clinical value, pre-procedural anxiety remains common and can adversely affect patient experience, cooperation, and compliance with future screening. Non-pharmacological interventions offer promising, low-cost strategies for minimising procedural anxiety without introducing clinical risks. This study aimed to evaluate the effectiveness of selected non-pharmacological interventions in reducing patient anxiety during colonoscopy and to explore patients’ preferences and satisfaction with these interventions.

A quantitative cross-sectional study was conducted at the Royal Gwent Hospital between April and July 2025. From 1,324 colonoscopy patients, those receiving pharmacological sedation and non-consenting individuals were excluded. The final sample comprised 130 participants who completed the State-Trait Anxiety Inventory (STAI) before their procedure and a post-procedure satisfaction questionnaire. Participants voluntarily selected one of four anxiety-reducing interventions: conversation, breathing exercises, guided relaxation, or music therapy. Data were analysed using SPSS version 23. Descriptive statistics, reliability analyses, assumption tests, and both parametric (ANOVA) and non-parametric (Kruskal–Wallis) group comparisons were performed. Associations between demographic variables and high anxiety (top quartile, STAI ≥ 44) were assessed using chi-square tests.

Intervention preferences were as follows: 35% selected breathing exercises, 32% conversation, 20% guided relaxation, and 12% music therapy. The overall mean anxiety score was 37.04 (SD = 9.94, range = 17–65). Conversation was associated with the lowest mean anxiety (M = 34.19, SD = 8.87), followed by music (M = 36.63, SD = 10.31), breathing exercises (M = 38.62, SD = 9.56), and guided relaxation (M = 39.23, SD = 10.03). Internal consistency of the anxiety scale was good (Cronbach’s α = 0.82). Both Shapiro–Wilk and Levene’s tests indicated partial violations of normality and homogeneity assumptions; thus, results from both ANOVA and Kruskal–Wallis tests were considered. No statistically significant differences were found in total anxiety scores across the four intervention groups (p > .05), and post hoc Mann–Whitney U tests confirmed no significant pairwise differences.

In terms of satisfaction (0–10 scale), guided relaxation (M = 8.92, SD = 0.97) and breathing exercises (M = 8.78, SD = 0.86) received the highest ratings, followed by conversation (M = 8.17, SD = 1.14) and music therapy (M = 5.63, SD = 1.52). Perceived helpfulness ratings (1–4 scale) were generally high (~3/4) across interventions. Chi-square analyses revealed no significant association between gender and high anxiety (p > .05), although participants with school-level education showed a higher proportion of high anxiety scores compared with those with university-level education.

Breathing exercises and guided relaxation techniques demonstrated favourable patient satisfaction and potential in reducing anxiety during colonoscopy. Although mean anxiety scores did not differ significantly between intervention groups, the overall positive response and low cost highlight the feasibility of integrating such interventions into routine endoscopy practice. Implementing simple, non-invasive, patient-selected anxiety management strategies could enhance the overall patient experience, reduce reliance on sedative medication, and support more patient-centred care delivery in endoscopy units. Future studies with larger samples and controlled designs are warranted to verify these findings and further optimize tailored anxiety reduction interventions in gastroenterological settings.