What’s Test Anxiety?

At this time of year, most teachers and parents are highly aware of the pressure and stress that tests and exams bring. What many may not realise is that Test Anxiety is an actual recognised type of performance anxiety that has real physical, as well as mental symptoms that can impact our children’s ability to ‘perform’ well in exam conditions.

According to research carried out in the UK, affects 16.4% of 14-16 year old students. These students were reportedly highly ‘test anxious’ before and during exams with female students scoring 22.5% and male students, 10.3%, of those who reportedly suffered.

Since the COVID-19 pandemic, it is likely that these figures have increased. According to the UK charity Young Minds Summer 2020 report, 81% of young people with mental health needs agreed that the coronavirus pandemic had damaged their mental health. In September 2021, the NHS published a report in which one in six children aged five to 16 were found to have probable mental health problems. In March 2022, the World Health Organisation issued a news release stating that the pandemic had triggered a 25% rise in anxiety and depression globally. These are just the reported cases. COVID-19 has impacted communities and individuals on a global scale. This includes our young people and students with pre-existing mental health problems, and those who had not experienced mental health issues previously.

We can feel mild performance anxiety such as before an important interview, delivering a presentation, or playing a solo in a concert. It’s normal to feel a bit nervous sometimes. However, moderate to severe Test anxiety can provoke a range of troublesome cognitive and emotional responses. The cognitive aspect refers to a cycle of negative thoughts. The emotional aspect involves a sense of distress, and tension accompanied by physical symptoms, such as stomach cramps, a racing heart, headaches/migraines, shortness of breath and feeling faint. 

Self-Worth attached to high marks

Tests and exams are an essential part of learning and school life. They provide key information to teachers, students, parents and carers, and employers, about academic progress and potential future outcomes. They also prepare us for adult life, equipping us with helpful skills ready for life situations in which our talents and abilities will be analysed and reviewed by others.

How we think, our self-talk, our self-expectations, our self-concept all contribute to how we feel before, during and after an exam. A student may have the expectation of themself that in all exams in all subjects they must achieve a high mark, any less would be failure. Some students internalise this mind-set to the extent that the irrational belief is formed that any less than perfect, or near perfect is not good enough and therefore, as an individual they are not ‘worthy,’ ‘competent,’ or ‘adequate.’ They end up attaching their self-worth to their test score, ‘In order to be a worthwhile person, I need to be good at everything.’  (p.249, Hough, 2020)

As a teacher of 9 to 18 year olds, I see this often, usually amongst hard-working, conscientious female students which correlates with the aforementioned research. There was an occasion recently where I intervened to assist a student who was sobbing uncontrollably because she scored 60% in a Maths test. She feared disappointing her parents and felt that this result was not as good as her friends even though she had revised. Having also felt nervous before the exam, the release of tears and emotions was the natural product of her anxiety, fear, shame and the irrational belief that she was ‘inadequate.’ Many students layer this type of pressure upon themselves, ‘If I achieve high marks I will be valued. I will be a good and worthy person/student/daughter…’

Defeatist Self-Talk

Another irrational belief that I regularly encounter is negative self-conditioning based on past events, in this case, past test scores and exams.  In my experience, affecting a different type of student. These individuals, usually boys, are more often than not withdrawn at times and have difficulties with appropriate social interaction. Typically, this type of student will tell me, ‘there’s no point me even trying, I’m not going to do very well even if I do. I’m not very good at this subject. I always get a rubbish mark.’ Whilst this rationale is a protective defence mechanism, it also represents an anxiety based response to tests and exams.

This type of student, recalling past test ‘failures,’ finds the present situation very stressful. Unfortunately, by taking refuge in this negative self-talk, unless effective intervention and help is provided, the individual can become sucked into a self-destructive spiral which inevitably results in low test scores. Worryingly, when left unacknowledged and unmanaged during adolescence, this irrational belief can become a repeated self-fulfilling prophecy which embeds itself in the young person’s mind influencing their personality development, lowering their self-esteem and following them into adult life.

It is often far more challenging to undo such harm in adulthood than it is to support, help or treat a child through this type of anxiety whilst their brain and personality are still developing. Prevention is always better than cure.

As a student mentor for twenty years, I recognise and have assisted many individuals who for various reasons have found themselves caught in this defeatist cycle, but with the right support, skills and techniques from those ‘intervening,’ not all, but many, have been able to move out of this victim mentality into an altogether brighter and more rational self-concept and belief system by the time they leave school.

Students who lack accountability

Linked to and often accompanying the ‘this always happens to me, what’s the point’ narrative, is the  irrational belief that I think of as the ‘lack of accountability’ story, a harmful belief that our ‘unhappiness’ is never of our own doing. It’s always someone or something else’s fault. It’s always an external factor making us feel low, causing us to experience negative, dysfunctional feelings and have a difficult time. Our own responses, choices, attitudes, emotions and behaviours are never part of the problem. It’s always the fault ‘others’ or the event itself.

In terms of Test Anxiety for a student about to take an exam, this victim mentality often affects those who didn’t revise or haven’t applied themselves in a subject and manifests itself through phrases like, ‘The teacher doesn’t like me anyway, I bet I fail.’ ‘I didn’t have time to study this week. I had something on every night.’ ‘I didn’t know we had an exam today.’  Not accepting responsibility for our choice not to study or prepare for an exam is, for many, still very stressful in the moment, and underneath all the excuses causes significant anxiety for some. This maladaptive behaviour should it become a lasting pattern, can lead to habitual distortion of facts and perspective, and as an adult, an entitled, ‘it’s not fair, poor me’ outlook, ‘I must have what I want and life must be easy, otherwise I cannot cope.’  (p.189, Ballentine Dykes, et al., 2014)

Students who catastrophise

The more a student worries, the more distracted they become, and the more likely it is that their exam grade will be adversely affected. I call this the ‘What if’ scenario. Worrying about something that may not happen to the extent that we actually cause it, or something else negative, to happen through excessively dwelling on the mere possibility of something negative occurring!

Students, and people like this, are quite challenging to be around, as it can be stressful for peers and friends to manage the overspill and effect that this ‘catastrophising’ and ‘awfulising’ has on their own mental health and ability to stay focused, and manage their own emotions during challenging moments.

In test situtions, these highly anxious inidivuals can become distressed before an exam by focusing on all the potential bad things that might happen and ‘what they stand to lose if they are unsuccessful and they worry about what will happen if it all goes wrong.’ (p.43, Busch & Watson, 2017) They’re preoccupied with thoughts like,  ‘What if the exam is too hard?’ ‘What if what I revised doesn’t come up?’  ‘What if I forget everything and fail?’ ‘What if I can’t study medicine/law/engineering?’ ‘My future will be ruined if I don’t pass this exam!’

It is important to note that it is our own internal, powerful irrational belief ‘self-talk’ that provokes our strong emotional disturbances rather than the actual external event itself. It is not the exam that is causing our anxiety, it’s our cognitive and emotional responses to it.

Neurobiological factors

Experts suggest that anxiety and panic disorders can be caused by chemical imbalances of naturally occurring chemical messengers in the brain known as neurotransmitters. A person is more susceptible to developing these disorders if these neurotransmitters are unbalanced. There is also solid evidence to suggest a familial link based on genetics.

Environmental factors such as problems in childhood, attachment issues, overprotective and anxious parents, and experiences of abuse or neglect, are also key influencers in the development of these disorders in adulthood. Experiencing difficult life stressors, like grief or other major life losses and changes, also increases the risk of developing these anxiety conditions.

Professionals who treat panic and anxiety disorders understand that one, or a combination of factors can be the root cause; chemical imbalance, genetics, environmental factors and current life stressors. Understanding why a person is experiencing these mental health conditions is key to their recovery. For teachers, whilst we cannot act as counsellors and psychotherapists to our students on top of everything else, it can greatly help us to have some deeper insight into this are of student mental health to better support them around and during exam season.

Cognitive and physical responses to anxiety

As we know, it’s natural to experience some anxiety, a range of physical responses to thoughts and emotions, from time to time. That is how biologically, our bodies and minds function, responding in synergy to perceived threats, dangers and trouble, the freeze, fight or flight scenario. Our pulse quickens, our body trembles, our hands shake,  we feel slightly nauseous, we can’t think clearly, and our minds go blank, all  reactions caused by surging levels of the 3 main stress chemicals, Adrenalin, Cortisol and  Norepinephrine.

We are also hopefully aware that in small, brief doses this can be motivating and energising, but as a frequent overstimulated, unnecessary and chronic response it is not. The continued presence of these neurotransmitters and hormones prevents healthy neurobiological chemical balance and therefore, damages our physical, mental and emotional wellbeing.

However, even when we know this, for many it can still be hard to face and control our anxiety. I asked my step-daughter, a 16 year old GCSE student, to summarise her recent experiences of test anxiety. ‘On the morning of my GCSEs, I woke up with stomach cramps. I tend to feel more physical anxiety as a precursor to any mental worry. I know it’s my body’s natural instincts warning me of upcoming “danger.” But it doesn’t stop the stomach pain, butterflies, tight chest and thumping heart. I tell my mind that the exam will be okay and that I’m prepared, and it usually listens.

On that morning, I didn’t have any negative thoughts, but my cramps continued right up until the exam started.Thankfully, once I was totally absorbed, the feelings eased. I can usually convince myself that I’m not anxious, but my body physically rebels, reminding me that I’m burying anxiety. I know I should face and embrace it as it is a normal evolutionary instinct to a perceived hazard.’

How can we help?

So how can we as teachers, parents and carers, employers, counsellors, social workers, health professionals, or indeed anyone who has a duty of care or who works regularly with young people, realistically help someone with mild, moderate or severe test anxiety? What mistakes do we need to avoid making and what do we need to add to our already diverse and well-stocked helping toolkit?

There are many ways to help, but calming someone with well-chosen words is often a good place to start. It would be a good idea to avoid phrases such as, ‘Calm down and stop overthinking.’  This implies that the person has the capacity to make a rational choice to control their anxiety, which of course as we’ve explored in depth, they do not. The more this is said, the more a person can feel ashamed and powerless, adding to their sense of failure and panic. ‘Worrying won’t change anything,’ is another undermining, counter-productive phrase. We know this! But our anxious thoughts and stomach cramps are not remedied away by a phrase that feels like a reprimand. This can exacerbate anxious feelings, invalidate our emotions and leave us more distressed than before.

Though meant with the best intention, the most mismatched ‘intervention’ that I have heard said to a student on the verge of tears and hyperventilation is ‘Have you tried some relaxation techniques or mindfulness exercises?’ When our pre-frontal cortex is being overwhelmed by a limbic system and amygdala in over-drive, we are neurologically indisposed to participate in a ‘sensible’ discussion about mindfulness techniques in that moment!

So, what can we say? How can we help? Below, is a list of suggested phrases we can use to try to calm a test anxiety sufferer;

“I’m here for you. How can I help?”

“I can tell you’re feeling really bad.”

“I know you can’t control it.”

“This feeling will pass.”

“I’m here to listen if you want to talk.”

“I’ll stay with you if you’d like.”

“Would you like to go for a walk?”

“Do you want to do something to take your mind off things before the exam?”

Applying some helpful counselling skills

If our role as teachers, mentors, counsellors or therapists means that we are working therapeutically with individuals with mild or moderate anxiety disorders, it would be wise and beneficial to have at our disposal a few simple techniques that effectively challenge these irrational beliefs and dysfunctional self-talk.

With an armoury of skills such as simple, but effective questioning techniques, we can help to make lasting and powerful improvements in the lives of these young people who need our help. ‘Cognitive-behavioural therapies, such as panic control treatment, have been shown to be highly efficacious with panic disorder, with as many as 85% of clients panic-free by the end of therapy (Roth and Fonagy, 2005) gains maintained at long-term follow-up, for instance, after seven years, 68% of clients were still in remission, (Emmelkemp 2004) and lower relapse rates than medication (Hollon and Beck, 2004)’  (p.39, Cooper, 2008)

In this context, whilst panic disorder is slightly different to anxiety disorder, the effectiveness of applying a few CBT skills is comparable, according to further studies and research papers. Below is a list of possible CBT questions to adapt and work with in order to begin to challenge and change the students’ response to triggering test anxiety scenarios.

Understanding the behaviour

Describe the ‘problematic behaviour’ to me

Describe when it happens

What events or triggers occur just before ‘problematic behaviour’ happens?

What was the outcome of the problematic behaviour?

Can you describe any early experiences linked to this ‘problematic behaviour?’

Irrational beliefs, thoughts and feelings

Describe the automatic thoughts you have before or when experiencing this ‘problematic behaviour’

When do these thoughts occur?

What was happening at the time and prior to the thought?

How does this make you feel at the time?

How intense were these feelings out of 100%?

Are you thinking this thought out of habit?

What thoughts would you like to think n triggering scenarios?

Challenging thoughts with evidence and facts

What facts can you think of the support the thoughts you have?

What facts can you think of that contradict the thoughts you have?

Which thoughts based on evidence and which are based on opinion?

Is the situation as black and white as it seems?

Could you be misinterpreting the facts?

Could others have different perspectives? Like what?

How likely is this scenario?

Coping strategies

How do you currently cope with these feelings?

What makes you feel better, at least temporarily?

How effective are these coping strategies? What are the pros? And cons?

Can you describe any maladaptive coping strategies you have?

What else could you try to do to cope?

Are there other potential solutions?

Let’s explore further strategies together

A safe and confidential environment for students

Of course, as with any therapy work, creating the right, safe and confidential environment in which to hold these sensitive discussions is key. As is, building a trusting relationship with the student whom we are helping. A one-off, ad-hoc 10 minute chat with a student we hardly know, is unlikely to yield results. Time, space and consistency is essential for a person to begin to modify their dysfunctional conditioning and beliefs, and replace them with rational thoughts and behaviours, more positive self-talk, and constructive coping mechanisms.

It is a skilful process. For students and individuals with moderate to severe anxiety, referral to an experienced counsellor is advised rather than taking on this responsibility ourselves as teachers. A CBT therapist could be an excellent choice for Test Anxiety sufferers due to the success rate of this type of therapy for anxiety cases.

I reiterate that as whilst as educators, parents and carers we can use these skills and techniques effectively with our students or children, it should not become our responsibility to step into the role of child psychologist or counsellor, even though quite often it feels as if we are providing that function in our school or family communities.

Our role is to supplement and support, whilst being cognisant of our own level of experience and training, referring young people on to highly trained professionals who have a deep understanding of the relationship between thoughts and emotions and can fully, effectively and safely apply the principals and skills of counselling and therapy.

Importance of funding and training for school communities

More funding, training and awareness is needed for school leaders, teachers and their communities to understand the importance of addressing these anxiety-based beliefs in childhood and their future mental health, health-care and social implications. Researchers Julia Sowislo and Ulrich Orth’s study ‘Does low self-esteem predict depression and anxiety? A meta-analysis of longitudinal studies’ looks into the relationship between self-esteem and depression, finding that if a person has low self-esteem, there’s significantly increased risk of developing depression. This is less likely the other way around. Depression isn’t always linked to low self-esteem. But low self-esteem often leads to depression.

It’s an area that interests me greatly, and one which I have studied to some extent over the years. I’ve learnt that improving an adolescent’s self-esteem not only makes him or her feel better and achieve greater academic success in the short and medium term, in the longer term this intervention can reduce the risk of a young person experiencing clinical depression in later in adult life. It is essential that those who hold the purse strings for educational budgets are aware of and act upon this vital piece of research. Many lives would be altered and improved if as first responders, educators like me, we able to create really robust, effective, consistent support systems to every child who needed it.

How can we make a difference?

To conclude, evidence shows that mental health disorders, mild, moderate and severe, were rising before the pandemic. Covid-19 has accelerated this fact. We know and understand that prevention is better than cure. School communities play a pivotal role in the mental health of young people both whilst they’re at school and in later life. School can either be a damaging experience or holistic, healthy preparation for the future.

Whilst it is not possible in the short term, to completely overhaul our education systems to streamline, adapt and homogenise them into more suitable learning experiences and environments, there is much that can be done. Money can be allocated to provide adequate mental health budgets in schools.

School mental health and wellbeing charters and policies can be carefully written and drawn up by those with training and who understand what they should look like and how they should realistically work. Congruent, in-person, mental health practical training and professional development can be delivered on a regular basis to empower educators in their roles. Adequate time can be given and safeguarded so all staff, not just a couple of designated ‘mental health first aider’ teachers, can efficaciously, calmly and competently help mentees and students in their care. As with most things, all of this, how we act and respond to a growing need in our communities is a question of priorities and choice.

Generally, as a society, we also need to be more aware. We need to step away from the view that most children who ‘make a fuss’ are attention seeking, drama queens rather than genuinely needing our help. We need to move towards applying more insightful, evidence based attitudes and approaches to distinguish between the two in the moment. It has regularly struck me as unsatisfactory that as educators of children, many of us enter the profession with little or no concept or understanding of child development or child psychology.

As parents, we’re often even more ill-equipped for this dimension of raising a child.  However, whilst it is our responsibility to be aware, and support the children in our care, we must also be prepared to look to other sources for support. There is no shame in asking for help as a teacher or parent. It would be potentially harmful not to. No one is judging us in our capacity to educate or raise our young people. We can turn to therapists and psychologists for help to increase our knowledge and parenting skills.

Empowering our young people, the next generation, with the skills and mind-sets required to cope and thrive in such an uncertain future is the key to a functional, healthier, happier society. It’s my hope that in some small way, through reading and applying helpful insights and strategies in this area of Test Anxiety, we can start to feel more empowered in our interactions with young people and adults alike, and perhaps even see some benefits in our own lives, as well as the lives of others.

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