Treating test anxiety

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


    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


    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


What are Cognitive Distortions?


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


Cog. Restructuring: Socratic Questions


Cog. Restructuring: Thoughts on Trial


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

7. Study Tips. (n.d.). Retrieved from

8. Why Sleeping May Be More Important Than Studying. (2013, January 11). Retrieved from

Successful Strategies For Test Anxiety

News Article, 08/31/17

Here are some successful strategies for test anxiety!

We all experience some level of anxiety before a test. A little nervousness can actually help motivate us to perform our best. Too much anxiety can become a problem if it interferes with your performance on tests. Some strategies for dealing with test anxiety:

Before the test, take good care of yourself:

  • Be prepared. Study the material in advance; do not leave cramming for the day before your test. Do not do a last minute review.
  • Get plenty of sleep, it is hard to function at your best when overtired
  • Avoid any use of drugs and alcohol, they can interfere with your mental ability.
  • Exercise may increase your alertness and sharpen your mind.
  • Have a moderate breakfast, fresh fruits and vegetables help reduce stress; avoid caffeine, sugar and junk foods.
  • Allow yourself plenty of time; arrive at the test location early.
  • Choose a seat where you will not be easily distracted.
  • Use abdominal breathing to help reduce anxiety. Place one hand on your abdomen, right beneath your rib cage. Inhale through your nose and feel your abdomen fill like a balloon...count to three on your inhalation and then slowly exhale counting to four, feeling your abdomen contracting with the exhalation.
  • Do a reality check, how important is this exam in the grand scheme of things? Put it in perspective. 
  • Use positive affirmations, say a phrase to help keep things in perspective, "I've done this before, I can do it again." or "I have all the knowledge I need to get this done."

During the test take a few minutes to:

  • Review the entire test. Read the directions carefully.
  • Work on the easiest portions of the test first.
  • Pace yourself. Do not rush through the test.
  • If you go blank, skip the question and go on.
  • Multiple choice questions, read all the options first, eliminate the most obvious.
  • Essay questions, make a short outline. Beginand end with a summary sentence.
  • Take short breaks, tense and relax your muscles throughout your body.
  • Pause, do a few abdominal breaths, say your affirmation.
  • Stay in the present moment
  • There is no reward for being the first done.

After the test, reward yourself:

  • Try not to dwell on your mistakes.
  • Indulge in something relaxing for awhile.


for more information contact: OR The Center for Counseling and Human Development at 717-871-7821.

Anxiety disorder: symptoms, diagnosis and treatment



Irina Ivanovna

Experience 31 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.


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.


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.


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.


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.

What is a test alarm? - Drink-Drink



  • Test anxiety symptoms
  • Test anxiety statistics
  • Treatments and medications for test anxiety
  • Tips for dealing with exam anxiety
    • Tips


Performance anxiety is a type of exam anxiety. This can affect everyone, from kindergarteners to PhDs. If you have exam anxiety, you may have anxiety and stress even if you have prepared well for the exam you are about to take.

A number of different factors can cause anxiety before an exam. These may include:

  • generalized anxiety disorder
  • fear of failure
  • history of bad test performance

Anxiety before exams can lead to poor test performance. Here's how to recognize the symptoms and find ways to manage your anxiety.

Test anxiety symptoms

You may experience physical, emotional and cognitive symptoms if you experience test anxiety.

Physical symptoms may include:

  • increased sweating
  • Nausea, vomiting or diarrhea
  • pain in the abdomen
  • Rapid palpitations
  • Sleeping pain
  • SENTIONS OR SELECTIONS or weakness EMO 000 9000 9000. include feelings:

    • self-doubt
    • fear
    • stress
    • hopelessness
    • inadequacy
    • anger

    You may also feel nervous, restless or fidgety.

    Anxiety can also cause difficulty concentrating. It may seem to you that your thoughts are confused, and you have forgotten everything that you have learned. You may also become more indecisive and find it difficult to choose between two different answers.

    In severe cases of pre-test anxiety, these symptoms may be part or all of a panic attack.

    Test anxiety statistics

    Anxiety disorders are common, affecting about 18 percent of adults. But according to the Anxiety and Depression Association of America (ADAA), only about a third of people with anxiety seek treatment.

    Anxiety disorders affect approximately 25 percent of 13 to 18 year olds. Untreated childhood anxiety can cause children to perform poorly in school and fail tests.

    According to a 2010 study, text anxiety can affect 10 to 40 percent of all students. This percentage seems to have increased along with the increase in standardized testing.

    One study found that exam anxiety was more detrimental to academic performance in some people than in others. Students with good working memory actually performed better when they had exam anxiety. However, students with poor working memory had poor test scores associated with test anxiety.

    Learn more about Generalized Anxiety Disorder »

    Test Anxiety Treatments and Medications

    Some students experience severe anxiety before an exam. In severe test anxiety, the symptoms are more intense and persistent. These students may experience panic attacks. They may continue to have poor test results despite careful examination.

    Your doctor or your child's pediatrician may prescribe medicines to help control severe anxiety. Medications can also reduce panic attacks.

    Your doctor may refer you to a counselor to help you deal with stress. A counselor can help you learn techniques for coping with your anxiety. A counselor can also help you deal with any insecurities or low self-esteem that may be causing performance anxiety.

    If you or your child is experiencing severe anxiety before exams, you may be able to get permission to grant them special accommodations. Anxiety disorders are protected by the Americans with Disabilities Act. This includes a test alarm. Once you have submitted the required paperwork, you or your child will be able to take the exams in a private, quiet room and you may be given extra time to take the test.

    Exam Anxiety Tips

    There are several different methods you can use to deal with anxiety before and during an exam.

    To deal with exam anxiety, the best thing you can do is prepare as best you can.

    Learn more