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Testing anxiety treatment


Treating Test Anxiety (Guide) | Therapist Aid

Most people feel some stress when it comes to taking a test. Moderate levels of stress can actually improve motivation, memory, and attention, and enhance test performance. Test anxiety, however, involves stress and worry that interferes with test performance, well-being, and attitudes toward school.

Symptoms of test anxiety may be physical and mental, and can include sweating, nausea, stomachache, shaking, muscle tension, nervousness, feeling overwhelmed, and the feeling of one’s mind going blank.

Most treatments for test anxiety are similar to treatments for other types of anxiety, with a couple unique differences. In addition to relaxation skills and cognitive restructuring techniques, treatment for test anxiety also includes practical study tips and test-taking skills.

Practical Skills

Treating test anxiety begins with teaching study tips and test-taking skills. Research shows that using these skills can help students stay relaxed, focused, and motivated to do well on a test (5).

Study Tips

Good study habits are important for students at all levels. Discuss these tips with your client and develop plans for integrating the tips into students’ current study habits.

  • Establish a study routine. Creating a routine–such as studying for an hour after dinner, or for a half hour each morning–will encourage consistency. When getting started, create a study schedule and set reminders on your phone to help build the habit.
  • Create a dedicated study area. Choose an area that is free of distractions where you can set up your study materials, and leave them between sessions. When it’s time to study, you won’t spend time searching for something you need. Just sit down, and you’re ready to go.
  • Focus on the quality of studying, not the quantity. It’s more effective to space out many short study sessions, rather than having one marathon session. Try studying in half-hour to hour-long blocks, with breaks in between. This way, you can stay alert and focused the whole time.
  • Make studying a priority. When it’s time to study, take it as seriously as you would take a job. Don’t skip study sessions, start on time, and give the task 100% of your attention.
  • Set specific study goals. Goals give direction to a study session and provide a sense of accomplishment when completed. Create goals that can realistically be completed in a single study session, such as: Learn the terms in chapter 1, pass the chapter 2 practice quiz, take notes on chapter 4, or review class notes for 30 minutes.
  • Don’t stop at reading–write down what you learn. By typing or hand-writing information, you will engage in active learning, which can improve retention and understanding. Try making flashcards, writing chapter summaries, or creating an outline of the material. As a bonus, you can refer back to what you’ve written to quickly review the material.
  • Quiz yourself to make information “stick”. Look for practice tests or discussion questions after each chapter you read. Another way to “quiz” yourself is to teach something you’ve studied to a friend, a pet, or even an inanimate object, without looking at the material.
  • A change of scenery can improve information retention. If you’re feeling unfocused, unmotivated, or just plain bored, try studying somewhere new. Libraries, parks and coffee shops are great alternatives for breaking out of your routine.
  • Take care of your mind and body. Healthy sleep habits, exercise, and a balanced diet will boost memory and brain function. Studying is most effective when it’s balanced with good habits.

Download Worksheet

Test Day

    Come Prepared
  • Get enough sleep. Forgoing sleep in order to study is actually associated with doing more poorly on the test (8).
  • Avoid caffeine. It might be tempting to consume a lot of caffeine in order to feel alert, but caffeine can exacerbate anxiety (4).
  • Arrive right on time. By doing this, you avoid anxiety-inducing situations, such as seeing others cramming for the test, discussing what will be on the test, and hearing others voice their own anxieties (5).
  • Get comfortable. Eat a good meal before the test, wear comfortable clothes, and choose your favorite seat in the classroom (5).

Tip: Don’t feel rushed by other students’ finishing the test early--just because someone finishes quickly, doesn’t mean they got everything right!

Relaxation Skills

Students may experience test anxiety before, during, and after a test. Relaxation skills—such as deep breathing and progressive muscle relaxation—can be used to manage this anxiety. For best results, students should practice these techniques regularly, rather than using them only on test day.

Deep breathing. Deep breathing reduces anxiety by slowing heart rate, lowering blood pressure, and triggering a feeling of relaxation. Concentrating on breathing also distracts from negative thoughts related to testing. Deep breathing is discreet, effective, and easy to use. Here’s how to practice:

Deep Breathing Audio

audio exercise

Deep Breathing Handout

worksheet

    How to Use Deep Breathing
  1. Sit back in a comfortable position, and close your eyes if you feel comfortable doing so. TIP: When learning deep breathing, place one hand on your abdomen so you can feel it rise and fall with each breath.
  2. Breathe in slowly through your nose for 4 seconds.
  3. Hold the air in your lungs for 4 seconds (or less, if this becomes uncomfortable).
  4. Pucker your lips, and slowly exhale through your mouth. Time the exhalation to last 6 seconds. TIP: For practice, try exhaling through a straw. This will get you in the habit of exhaling slowly.
  5. Repeat the breathing cycle for at least two minutes.

Tip: Because deep breathing can be used discreetly, it is a great choice for anxiety reduction during a test.

Progressive Muscle Relaxation (PMR). In this technique, students learn to slowly tense and relax their muscles, one-by-one. By doing this, they learn the difference between the feelings of tension and relaxation, and learn to consciously relax their muscles in order to feel calm. Students are encouraged to practice this technique daily. Here’s how to use it:

Progressive Muscle Relaxation Audio

audio exercise

Progressive Muscle Relaxation Script

worksheet

    How to Use Progressive Muscle Relaxation
  1. Sit back or lie down in a comfortable position. You may close your eyes.
  2. Beginning at your feet, notice how your muscles feel. Are they tense, or relaxed?
  3. Tightly tense the muscles in your feet by curling your toes. Hold the tension for 5-10 seconds.
  4. Release the tension from your feet, and allow them to relax. Notice how different the states of tension and relaxation feel.
  5. Move up your body, repeating the cycle of tensing and relaxing each group of muscles. Be sure to practice on the following groups of muscles: legs, pelvis, stomach, chest, back, arms, hands, neck, and face.

Relaxation Skills

treatment guide

Cognitive Restructuring

Identify cognitive distortions. Cognitive distortions are irrational thoughts that tend to be negative in nature. Irrational thoughts lack evidence, but can still lead to feelings such as depression, anger, and anxiety. Students with test anxiety may hold a number of cognitive distortions related to test-taking.

Cognitive Distortions List

worksheet

What are Cognitive Distortions?

video

Below are some examples of test-related cognitive distortions:

  • “I’m going to fail!”
  • “If I don’t get an A, I’m worthless. ”
  • “All my classmates are smarter than me. There’s no way I’ll do well on this test.”
  • “I never do well on tests, so I won’t do well on this one.”
  • “I passed the first test, but only because it was easy.”
  • “If I don’t do well on this test, I’ll never get a job.”
  • “The teacher doesn’t like me, so he’ll probably give me a bad grade.”

Challenge cognitive distortions. Once students identify cognitive distortions that are harmful, they can challenge them by examining the evidence. Socratic questioning, decatastrophizing, and putting thoughts on trial are techniques that can be used for this purpose. Once cognitive distortions are challenged, they can be replaced with rational, adaptive thoughts.

Use these resources to learn more about cognitive restructuring, or to practice:

Cognitive Restructuring

treatment guide

Cog. Restructuring: Decatastrophizing

worksheet

Cog. Restructuring: Socratic Questions

worksheet

Cog. Restructuring: Thoughts on Trial

worksheet

Use positive self-talk. Self-talk refers to internal dialogue, or statements people say to themselves. Negative self-talk regarding test-taking ability leads to negative feelings about testing, which can lead to poorer test performance. Positive self-talk, on the other hand, leads to positive feelings about testing, and can improve test performance (1).

Below are some examples of positive self-talk:

  • “I’m well-prepared for this test.”
  • “I’m going to do my best.”
  • “I can get through this.”
  • “This is going to be okay.”
  • “Tests are never as bad as I think they’ll be.”
  • “Even though I’m anxious, I can still do well.”
  • “I’ll use relaxation skills to calm down.”
  • “I can see myself passing this test.”

So, how can students actually use positive self-talk? Start by creating a list of rational and believable positive statements (e. g. “I studied well”, rather than “I’m the smartest person in the world”). Statements should be rehearsed at least once a day, but more practice is better.

Here are some ways to use positive self-talk to reduce test anxiety:

  • Make a habit of using positive self-talk. Place the list of positive statements somewhere prominent—such as on a mirror, desk, or nightstand—and repeat the statements whenever you see the list.
  • Link statements to physical cues. Say a positive statement whenever you pick up your backpack, sit down at a desk, or put on headphones. With enough use, these actions come to trigger a positive thought.
  • Use positive self-talk during the test. Even if you have been practicing positive self-talk, the testing situation will still be stressful, and negative thoughts might return. Positive self-talk can counteract this negative thinking, and increase self-confidence (2).

1. Akinsola, E. F., & Nwajei, A. D. (2013). Test anxiety, depression and academic performance: assessment and management using relaxation and cognitive restructuring techniques. Psychology, 4(06), 18.

2. Hatzigeorgiadis, A., Zourbanos, N., Mpoumpaki, S., & Theodorakis, Y. (2009). Mechanisms underlying the self-talk–performance relationship: The effects of motivational self-talk on self-confidence and anxiety. Psychology of Sport and exercise, 10(1), 186-192.

3. Hong, E., Sas, M., & Sas, J. C. (2006). Test-taking strategies of high and low mathematics achievers. The Journal of Educational Research, 99(3), 144-155.

4. Ribeiro, J. A., & Sebastiao, A. M. (2010). Caffeine and adenosine. Journal of Alzheimer's Disease, 20(s1), S3-S15.

5. Salend, S. J. (2011). Addressing test anxiety. Teaching exceptional children, 44(2), 58-68.

6. Studying 101: Study Smarter Not Harder. (n.d.). Retrieved from https://learningcenter.unc.edu/tips-and-tools/studying-101-study-smarter-not-harder/.

7. Study Tips. (n.d.). Retrieved from http://uaap.mit.edu/tutoring-support/study-tips/mastering-tests/draft-study-plan.

8. Why Sleeping May Be More Important Than Studying. (2013, January 11). Retrieved from https://www.kqed.org/mindshift/26079/why-sleeping-may-be-more-important-than-studying.

Test Anxiety Tips | School of Medicine

What is Test Anxiety?

Test anxiety is a type of performance anxiety.  When there is pressure because of high expectations or the stakes are high, people can become so anxious that they are hindered from doing their best. 

It is sometimes helpful and normal to have nervousness around testing.  The energy can keep our minds alert and the arousal can help with focus.  However, there is a threshold and sometimes too much anxiety can begin to impair brain functioning.  When our emotional brain starts to feel fear and get activated, it can make it hard to remember what was studied and to maximize our prefrontal cortex functioning.

Symptoms of Test Anxiety

Test anxiety symptoms can range from mild to severe.  It is possible to have mild symptoms of test anxiety and still perform well on exams.   Others can feel so overwhelmed that they encounter panic attacks before or during exams.  The Anxiety and Depression Association of America describes symptoms of test anxiety as physical, behavioral, cognitive, and emotional.

Physical Symptoms
Physical symptoms can range from increased heart rate, sweating, dry mouth, to shaking, fainting, panic attacks, vomiting and nausea. 

Cognitive and Behavioral Symptoms
Cognitive and behavioral symptoms can include negative self-talk and cognitive distortions that lead students to avoid studying or testing situations.  Challenges with focus and concentration as well as racing thoughts or rumination can be common.

Emotional Symptoms
Emotional symptoms can include low self-esteem, depressive symptoms, frustration, irritability, feeling overwhelmed and a sense of hopelessness.

Causes of Test Anxiety

In the medical student population, test anxiety can be heightened due to the intense nature of the academic environment.   Often times it is a combination of reasons that contribute to test anxiety. Here are some potential causes:

  • Perfectionistic tendencies/fear of failure.  Maladaptive perfectionism is prevalent amongst the medical student population.  Connecting one’s sense of worth and identity to performance can cause test anxiety. 
  • Stress around testing history.  If previous test experiences have been anxiety-provoking or led to unexpected poor outcomes, this can add more anxiety with each additional testing experience. 
  • Underlying anxiety. Often times, students have a history of anxiety that can be exacerbated around testing experiences.  This anxiety can contribute to one feeling like they haven’t studied enough, and it can cloud the academic journey leading to a sense of dread around studying and testing.

Overcoming Test Anxiety

Thankfully there are tools to support students in addressing and overcoming test anxiety. Each person’s needs will be different based on the reasons for test anxiety.   Here are some strategies:

Physical Strategies

  • Get enough restful sleep, especially before the test
  • Reduce caffeine intake
  • Consume nutritious foods
  • Get exercise and movement throughout the week
  • Spend time outdoors in nature
  • Take meaningful regular breaks while studying (not mindlessly scrolling through news, social media or YouTube)
  • Practice mindfulness or meditation at least once a day (Headspace is a helpful app to get started)
  • Practice progressive muscle relaxation

Cognitive, Behavioral and Emotional Strategies

  • Understand and address cognitive distortions
  • Remember your strengths and remind yourself of why you want to become a physician
  • Take a step back and reflect on who you are outside of being a medical student
  • Reconnect with hobbies you enjoy
  • Make time for social connection and reach out for social support
  • Ask for support and testing if you think you might have a learning disability (like ADHD)
  • Connect with a professional clinician who can help you come up with a successful plan, reduce negative self-talk, and feel more hopeful before exams
  • Reach out to faculty to better understand how to prepare
  • Get tutoring support from our learning specialist

Support Services 

We are here to support you in your medical school journey and want you to succeed.   Sometimes it is helpful to consult with a psychiatrist and/or to meet with a licensed therapist. We have many professional clinicians on campus and as well as in the community who are preferred providers for the Student Health Plan who are ready to support you.  See the Student Affairs webpage for counseling resources.  Student may make medical and counseling appointments without a referral or without involving the School of Medicine Dean’s Office or any faculty.  If you choose, you may contact Dr. Lamberton’s office for suggestions for counselors.

Cherry, K. (2020) Test anxiety symptoms, causes, and treatments.  https://www.verywellmind.com/what-is-test-anxiety-2795368

Anxiety disorder: symptoms, diagnosis and treatment

Psychotherapist

Krashkina

Irina Ivanovna

Experience 32 years

Psychotherapist, candidate of medical sciences, member of the Russian Professional Psychotherapeutic League

Make an appointment

Anxiety disorder is a type of neurotic condition in which a person experiences continuous anxiety about life circumstances, their appearance and relationships with people around them. Staying in this state for a long time creates uncomfortable living conditions for a person, which become the reason for him to withdraw into himself, not to develop his own abilities and limit his social circle.

Symptoms and signs

It is believed that when an anxiety disorder appears, the symptoms are as follows:

  • severe form of anxiety and emotional stress before the onset of panic attacks;
  • frequent mood swings;
  • persistent sleep disorder;
  • constant conflicts with others;
  • reduced acuity of reactions and inhibited thinking;
  • increased sweating, rapid pulse;
  • fatigue and weakness leading to decreased performance;
  • complaints about the appearance of pain in different parts of the body.

These symptoms of an anxiety disorder are signs of autonomic and mental disorders.

The hallmarks of symptoms of generalized anxiety disorder are:

  • total manifestation of anxiety before any life circumstances;
  • inability to concentrate on domestic activities or work;
  • constant motor voltage;
  • inability to relax;
  • indigestion and stomach pain;
  • heart disease.

Symptoms of an anxiety-depressive disorder occur against the background of constant depression:

  • lack of interest in the manifestations of life and close people;
  • lack of positive emotions;
  • sudden feeling of fear;
  • vegetative disorders - rapid pulse, shortness of breath, shortness of breath, increased sweating, proximity to fainting, etc.

Causes of the onset and development of the disease

Experts believe that the following factors contribute to the appearance of the disease:

  • persistent circulatory disorders, hormonal imbalances or chronic heart disease;
  • a chronic form of dependence on alcohol, drugs, psychoactive substances, as well as a sharp cessation of their use;
  • craniocerebral injuries and their consequences;
  • being in a situation of prolonged stress;
  • character traits - melancholic temperament, disturbing accents in the temperament of the character;
  • tendency to exaggerate dangers due to their high susceptibility;
  • neurotic and mental disorders: depression, neurasthenia, hysteria, schizophrenia, paranoia, various manias;
  • mental trauma in children at an early age and in adults in extreme situations - war, earthquake, being in a state close to death, loss of a loved one or his support, and others.

Psychologists view the process of anxiety in different ways:

  • adherents of psychoanalysis believe that the reason is the regular suppression of their own desires;
  • the second believe that the reason is the break in the connection between the stimulus and the response of the psyche to the stimulus;
  • still others believe that the reason is in the reaction of the psyche to the distorted mental images of a person.

Disease classification

Anxiety disorder according to the ICD is a neurotic disorder along with fears, suspiciousness and post-traumatic disorders. One of the main signs of an anxious personality disorder is the pathology of the origin of anxiety, the disproportionate degree of protection to the stimulus factor.

Pathological anxiety:

  • not caused by real danger;
  • is not proportionate to the significance of the situation;
  • is not associated with a lack of time and knowledge;
  • is being actively ousted;
  • brings significant discomfort to a person's life;
  • is much more pronounced than normal;
  • is long in time;
  • has satellites in the form of tension and expectation of consequences, concern and doubt, feelings of helplessness.

Types of anxiety disorder:

  • anxiety-depressive disorder is caused by the constant presence of anxiety without sources of danger, has pathological changes in the patient's personality;
  • phobic anxiety disorder is based on fixation on past unpleasant consequences;
  • social anxiety disorder is characterized by the patient's avoidance of contact with other people;
  • mixed anxiety disorder causes a simultaneous feeling of pathological anxiety and depressed mood;
  • anxiety-panic disorder is characterized by the presence of panic attacks;
  • Anxiety-neurotic disorder is associated with anxiety before any diseases, severe shyness and unrest;
  • generalized anxiety disorder is accompanied by excessive fussiness, anxiety without certain dangers and threats.

Risk factors and groups

Risk factors include child abuse, hereditary mental disorders, historical family poverty, or other antisocial manifestations.

The risk group includes people prone to neurotic diseases - depression, hysteria; people taking alcohol, drugs, psychotropic drugs; women between the ages of 20 and 30.

Complications

In the absence of adequate treatment, anxiety disorder leads to the following socio-psychological complications:

  • low self-esteem;
  • self-isolation from society;
  • insomnia;
  • the appearance of a feeling of hopelessness;
  • exhaustion of the organism.

Social complications are job loss, financial problems, relationship breakdown, alcoholism, drug addiction, substance abuse, and others. Physical complications - irritation in the intestines, heartburn, lack of interest in sex, weight loss or excess weight gain, headaches and muscle strain, decreased immunity, the development of allergies, accelerated aging, cancer, heart disease and many others.

Diagnostics

The accumulated information about this disease made it possible to test reliable methods of drug and psychotherapeutic treatment. This disease belongs to the areas of professional interest of a psychiatrist and a medical psychologist.

Specialists use the following methods for diagnosing a neurotic disease:

  • initial individual consultation involves a survey to identify emotional reactions, obtain information about the patient's lifestyle, motives and interests;
  • psychodiagnostic examination and projective testing aimed at identifying pathological anxiety and related disorders;
  • observations of the patient and his life, relationships with the outside world and with people.

Preparing to see a doctor

Before entering the psychotherapist's office, the patient is advised to formulate all his problems, report on the use of all psychoactive substances, including the start/end dates and the total duration of the use. In addition, the positive attitude of the patient to the treatment and the effect that it will bring is extremely important.

Treatment

Anxiety disorders are treated with a complex of methods based on changing the patient's lifestyle, psychotherapy and taking medications. Treatment for generalized anxiety disorder is based on the use of psychoactive-type medications, such as antidepressants. In no case should you arbitrarily stop taking medications. Psychotherapy of anxiety disorder is carried out by various methods - individual, group, family. The main direction of the impact of therapy is an increased impact on the attitude towards the fears and anxieties that have appeared.

Among traditional medicine, it is possible to use medicinal herbs, infusions and decoctions from them, for example, lemon balm, chamomile. These herbs act on the human body, bringing a relaxing effect, thanks to this effect, anxiety disorders and their cause temporarily reduce their degree of activity.

Self-treatment of an anxiety disorder threatens with pains and neuroses of a different nature, which need to be treated more deeply.

Prevention

Experts argue that there are no effective means of preventing anxiety disorders, while being attentive to your fears and the reasons for their appearance in the early stages is easier to cure, giving positive predictions for the absence of relapses.

Need for help

Between the feeling of anxiety in normal and pathological conditions, a very thin, barely distinguishable line is drawn, due to the fact that anxiety is a natural protective reaction of the body to external stimuli. At the same time, it is not permissible to independently diagnose and treat the disease, since this entails a complication and aggravation of an already existing condition.

In the center of Moscow, in JSC "Medicine" (clinic of academician Roitberg), specialists provide the necessary assistance in the fight against anxiety disorders of any type and etiology. You can make an appointment by calling +7 (495) 775-73-60 or in person at the address: Moscow, 2nd Tverskoy-Yamskoy pereulok, 10, Mayakovskaya metro station.

Anxiety Disorder - Adamant Medical Clinic

Adamant
medical clinic

St. Petersburg, embankment of the Moika River, 78.

+7 (812) 740-20-90

Content:

Anxiety disorder is a mental disorder characterized by a state of generalized persistent anxiety. Unlike ordinary short-term stress, which, for example, is associated with public speaking, the disease lasts for a long time - for several months or more.

Excessive anxiety, tension and fear that patients with anxiety disorders experience can be accompanied by both psychological and physical ailments. In order to avoid dangerous complications such as paranoia, nervousness, etc. it is necessary to recognize the signs of the disease as early as possible and consult a doctor.

Symptoms of an anxiety disorder

Main symptoms of anxiety disorder:

  1. Psychological:

    • excessive anxiety and tension in connection with current affairs or for no particular reason;
    • unreasonable fear for your life and the lives of loved ones;
    • stress, inability to relax;
    • decreased performance, difficulty concentrating;
    • irritability.

  2. Physical:

    • constant feeling of fatigue and weakness;
    • muscle tension;
    • pain in the head and abdomen;
    • trembling, chills;
    • sleep disorders;
    • increased sweating;
    • shortness of breath up to a feeling of suffocation;
    • nausea and vomiting;
    • stool disorders.

The degree of manifestation of symptoms or their combinations depends on the form of anxiety disorder and the degree of neglect of the disease.

Forms of anxiety disorder

The following forms of anxiety disorder are distinguished:

  • Adaptive Anxiety Disorder - Excessive anxiety and other emotional reactions arise from the difficulty of adapting to a particular stressful situation.
  • Generalized anxiety disorder (also known as anxiety-depressive disorder) - excessive anxiety persists constantly and is associated with a large number of life circumstances - the patient regularly experiences unreasonable fear for his life, work, family, etc.
  • Anxiety-phobic disorder - causes panic attacks that cause extreme fear and a sense of impending death; fear of people and their large crowds; fear of some serious illness.

All these obsessive thoughts are unpleasant and alien to patients, often they themselves are not aware of the cause of their occurrence. Seeing a doctor as soon as possible will solve this problem and return the person to a normal life.

Anxiety treatment

Treatment of anxiety disorder is carried out in a complex, in several directions. It includes:

  1. Drug therapy - based on the characteristics of the patient's body and the disease, the doctor will prescribe a set of medications to eliminate symptoms: