Exploring Test Anxiety Treatments

Feeling anxious before an important test is normal for many people, and a little nervousness has been shown to help students improve test performance. However, when your anxiety becomes so severe that it interferes with your ability to perform well on the exam—even when you are adequately prepared—you may have issues effectively processing your feelings of anxiety. Read on to learn more about test anxiety, practical tips for overcoming its effects, and how therapy can provide support.   

What is test anxiety?

The American Psychological Association defines test anxiety as feelings of apprehension and tension related to taking a test to the point of interfering with your ability to function and often resulting in decreased performance. Test anxiety can significantly impact an individual’s academic performance, emotional well-being, and self-esteem. In a systematic review of 76 studies, researchers found that test anxiety was correlated with lower scholastic achievement, reduced self-efficacy, and increased depression and general anxiety. 

Test anxiety is a form of performance anxiety involving fear and apprehension of the consequences if you do meet expectations or follow through with a task. You may also worry that if you perform too well, others will raise their expectations and consider you a failure if you do not continue improving. Other common forms of performance anxiety include the fear of public speaking, group projects, participation in meetings or classes, public performance, or eating in public. 

If your fears are related more toward worry about negative judgment from others, humiliation, or embarrassment rather than your ability to perform, your symptoms may be better described as social anxiety. It is possible to experience more than one type of anxiety, and anxiety disorders are often seen alongside other mental health conditions, such as depression. 

Mental and physical symptoms of test anxiety

Many people who have text anxiety experience a combination of emotional, cognitive, and physical symptoms. These symptoms can impair motivation and concentration, ultimately interfering with a person’s ability to learn and display the knowledge they worked to obtain. However, as with many mental health symptoms, the presentation can vary significantly from one person to another. 

Cognitive

• Constantly comparing yourself to others

• Intrusive thoughts and pressure to work harder or study more

• The inability to concentrate, remember test material, or having your mind go blank during the test

• Persistent negative thoughts about yourself and your ability to do well

• Certainty that you will fail, no matter how much you study to prepare

• Dread about the consequences when you do fail

• Feeling overwhelmed due to racing thoughts 

• Fixating on past tests where you performed poorly

Emotional

• Excessive worry, apprehension, or fear about the exam

• Shame

• Intense disappointment in yourself

• Feelings of helplessness and being inadequate

• Sadness

• Anger or irritation with yourself or the teacher

Physical

• Headaches

• Racing heartbeat

• Nausea

• Shortness of breath, hyperventilation, or other trouble breathing

• Muscle tension

• Dizziness

• Panic attack

• Sweating and shaking

• Flashes of hot and cold

What causes test anxiety?

Test scores play a primary role in students’ ability to succeed. Students are often acutely aware of the consequences of their grades; and the pressure to excel academically can cause or increase anxiety in their lives. From elementary school through college and beyond, people experience test anxiety every day. There is no one reason that causes a person to experience test anxiety. However, as with most mental health conditions, medical professionals believe a complex interaction of biological and environmental factors may cause test anxiety. 

• Fear of failure

• Anxiety disorders

• Lack of preparation

• Previous struggles with the subject

• External pressures to perform well

• Unrealistic fears about the consequences of failure

Diagnosing test anxiety

Studies have shown that a high percentage of people experience anxiety before and during testing events. However, while some are able to take the exam without anxious symptoms interfering performance, others will experience feelings that greatly impede their ability to test. Despite the prevalence and psychological burden of test anxiety, it is not listed in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5-TR). Clinically, test anxiety is often diagnosed as a specific phobia, as related to the test itself, or social phobia as related to fear of poor performance or judgment. 

If you experience debilitating anxiety when taking a stressful test, consider speaking to a medical or mental health professional about assessment and treatment for an anxiety disorder. Studies have shown that people who are highly test anxious are more likely to meet the criteria for an anxiety disorder. 

Test anxiety is also common among people with ADHD (attention deficit hyperactive disorder) or other learning disabilities. If you or your child is struggling beyond concerns about performance, consider speaking to your healthcare provider about whether there are indications that a learning disability may be present. 

Coping skills to overcome test anxiety

Understanding some helpful test anxiety tips can help students stay calm, focus, and build confidence leading up to—and on—exam day. If you feel anxious around test time, giving yourself adequate prep time, employing good study habits, and fostering positive thoughts can improve your academic performance and lower your stress level. Try these methods to cope with your nervousness, ensure you’re well prepared, and overcome the effects of test anxiety. 

Find how you learn best and prepare for the test

Each person has a distinct learning style, or combination of styles. It can be helpful for you to identify your learning style and use that information as you study for the test. For example, listening to music during a study session—classical music in particular—may help your brain absorb, interpret, and remember new information. Try listening to the same music the morning before your test to help your brain recall the sensory memories you formed while studying.   

Visualize your success

Your mindset can influence your performance, so try visualizing your success. Imagine yourself calmly taking the test and succeeding on the exam. Spending a few minutes before you sit for the test picturing yourself doing well can help reshape your attitude about how you’ll perform. 

Sleep well and eat a filling breakfast

Rather than staying up late for last-minute studying, spend that time getting a good night’s sleep and start your morning with a healthy, balanced meal. Sleeping poorly can negatively impact your physical and emotional well-being, potentially negating any benefit of a late-night cram session. Additionally, consuming excess amounts of caffeine through coffee, energy drinks, or other sources can make anxiety worse. A balanced breakfast ensures that your body has the fuel it needs to function correctly so you can focus on the exam. 

Read test directions carefully and keep track of time

Avoid preventable mistakes by taking the time to read all test directions carefully and following them as closely as possible. If you are not clear on what something means, ask for clarification before you start working on the test. Keep track of time as you work but avoid constantly watching the clock.

Establish an empowering pretest routine

Discover what works best to help you feel confident and prepared. Use those same methods every time you need to study for an essential exam so you can take your test feeling empowered and ready to succeed. Feeling confident and prepared can reduce stress and anxiety levels, helping you perform better. For example, consider the following routine:

• When you receive the exam, close your eyes, take three slow and deep breaths, and relax your neck and shoulders.

• Review the directions carefully, then your test from beginning to end before answering any questions. 

• Give yourself a break every 15 minutes, even if this is simply a drink of water, standing up, or a moment of relaxation. 

Practicing a routine of your own can help you feel centered and relaxed, potentially reducing test anxiety before and during your exams. 

Avoid perfectionist thinking

Remember that you do not need to get a perfect score on the exam. You can miss several questions and still get a passing grade. Setting your goal on perfection may result in disappointment, frustration, and burnout. Before, after, and during the test, remind yourself that your goal is to pass the exam, not to perform perfectly.    

Replace negative thoughts with positive affirmations

One way to think of test anxiety is to personify the mood state and consider it as a deception that often causes cognitive distortions and unwanted intrusive thoughts telling you that you will fail. Try replacing those negative thoughts with positive affirmations for anxiety to help reassure yourself when you feel tense. Positive statements like, “I am intelligent and capable”, or, “I can answer any test questions I face”, can help you reframe your thought patterns.

Journal

Practice deep breathing

Deep breathing techniques can help you calm your nerves, slow your heart rate, and focus your attention on the task at hand. You can practice deep breathing during the test to center yourself if anxiety starts interfering with your exam performance. 

Test anxiety treatment

Test anxiety and other anxiety disorders are typically treated with a combination of medication and psychotherapy, which is also called talk therapy. 

Cognitive behavioral therapy (CBT)

CBT is the most common treatment for anxiety disorders. Patients in cognitive behavioral therapy work to identify negative thought patterns and behaviors to replace them with positive, practical choices. A qualified therapist can also help you develop a repertoire of effective coping skills to manage your anxiety symptoms and stress reactions. 

Medication

Many mental health professionals recommend medication as part of a comprehensive anxiety treatment plan. However, it is essential to note that medication will not cure anxiety disorders. It can target symptoms and help relieve some of the discomfort they cause. 

How therapy can help you manage test anxiety

If you experience overwhelming anxiety related to tests and performance-related situations to the point that it interferes with your ability to take the exam, you may have test anxiety. Working with a licensed therapist through an online therapy platform such as BetterHelp can be a valuable resource to help you identify and overcome negative thought patterns and behaviors. Therapy can also teach you practical coping skills to manage your anxiety and stress reactions. Flexible appointment formats make fitting treatment into your schedule easier than ever. 

Cognitive behavioral therapy is the most common treatment for anxiety disorders, and recent studies show that online treatment is as effective as in-person treatments. Online therapy is often less expensive and involves shorter wait times, making treatment available to people who did not previously have face-to-face consultations. Many patients said they found it easier to discuss personal details with the added physical distance, and the convenience of attending from home meant they made it to more sessions. Medical professionals agree that the effectiveness of psychotherapy increases with the number of sessions attended.