Navigating Potential Test Anxiety Treatment Options

Feeling anxious before an important test is normal, and a little nervousness or anxiety may even improve test performance. However, when your symptoms of test anxiety become so severe that they interfere with your ability to perform well—even when you are adequately prepared—you may benefit from practical tips for addressing these feelings.

What is test anxiety treatment?

The American Psychological Association defines test anxiety as feelings of apprehension and tension related to taking a test, which may interfere with test performance. Test anxiety can significantly impact an individual’s academic performance, emotional well-being, and self-esteem. The findings of a systematic review of 76 studies, also suggest that test anxiety may correlate 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 or doing well. Other common forms of performance anxiety include the fear of public speaking, group projects, participation in meetings or classes, performing in public, or eating in public. 

Social anxiety symptoms and other anxieties

If your fears are related more to the possibility of negative judgment from others, humiliation, or embarrassment rather than your ability to perform, your symptoms may be a better fit for social anxiety, which must be diagnosed by a mental health professional. It’s also possible to experience more than one type of anxiety, and anxiety disorders are often seen alongside other mental health conditions, such as depression as well. 

Symptoms of test anxiety

Many people who have test anxiety experience a combination of emotional, cognitive, and physical symptoms, even if they’re well-prepared for the exam. These symptoms can impair motivation and concentration, ultimately interfering with a person’s ability to learn and display the knowledge they worked to obtain. As with many mental health symptoms, the presentation of the signs of test anxiety can vary significantly from one person to another. That said, a few of the most common are listed below.

Cognitive symptoms of test anxiety

• Constantly comparing yourself to others
• Intrusive thoughts and pressure to work harder or study more
• The inability to concentrate or remember test material, or having your mind go blank during the test
• Racing thoughts and trouble concentrating
• 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 if you do fail
• Feeling overwhelmed due to racing thoughts 
• Fixating on past tests where you performed poorly

Emotional symptoms of test anxiety

• 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 your teacher

Physical symptoms of test anxiety

• Headaches
• Racing heartbeat
• Nausea
• Shortness of breath, hyperventilation, or other trouble breathing
• Muscle tension
• Dizziness
• Panic attacks
• Sweating and shaking
• Flashes of hot and cold

Risk factors for test anxiety

In most education systems today, test scores play a key role in a student’s ability to succeed. That means 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. There is no one reason that causes a person to experience test anxiety, though societal factors likely play a significant role in many cases. Researchers believe the following may also contribute to a person’s likelihood of experiencing test anxiety. 

• Fear of failure
• An anxiety disorder
• Lack of preparation
• Previous struggles with a given subject
• External pressures to perform well
• Unrealistic fears about the consequences of failure

Diagnosing test anxiety

A high percentage of people likely experience anxiety before and during exams. However, while some are able to take the test without these anxious symptoms interfering with their performance, others will experience feelings that greatly impede their ability to perform—up to 35% of those who experience test anxiety, according to one study. Despite the prevalence and psychological burden of test anxiety, it is not currently listed in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5-TR) as a diagnosable disorder. Clinically, test anxiety that is diagnosable may be categorized as a specific phobia, a social phobia related to fear of judgment, or generalized anxiety disorder.

If you experience debilitating anxiety when taking a test, you might consider speaking to a medical or mental health professional about assessment and treatment for an anxiety disorder. Studies suggest 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 attention-deficit/hyperactivity disorder (ADHD) or other learning disabilities. If you or your child are experiencing significant test anxiety, meeting with a mental health professional for evaluation and a screening for ADHD or other conditions may be a helpful next step.

Coping skills for test anxiety

Implementing some of these test anxiety tips may help you stay calm, concentrate, and build confidence leading up to—and on—exam day. 

Discover how you learn best

Each person may find a certain learning style, or combination of styles more effective for them than others. It can be helpful for you to identify your learning style and use that information as you study for the test with adequate prep time. Learning in the way you find most logical or helpful could support you in remembering the information you absorb through good study habits, even if you feel anxious.

Visualize your success

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

Rather than staying up late for a last-minute study session, it’s usually better to spend that time getting a good night’s sleep. Starting your morning with a high-protein, low-sugar meal may also support brain function and reduce anxiety symptoms. Finally, you might try to avoid consuming excess amounts of caffeine through coffee, or energy drinks, which may make anxiety worse. 

Read test directions carefully

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 routine before the test

Discover what works best to help you feel confident and prepared, and then use those same methods every time you need to study for an exam so you can take your test feeling empowered and ready to succeed instead of having a stressful test experience. Feeling confident and prepared may reduce anxiety and stress 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 skim the test from beginning to end before answering any questions. 
• When you start to feel anxious, close your eyes for a moment and take one, deep belly breath and exhale slowly.

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 usually don’t need to get a perfect score on an exam. You can typically 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.    

It could help to personify the mood state of test anxiety and think of it as a deception that causes false intrusive thoughts and cognitive distortions telling you that you will fail. Then, you might try replacing those negative thoughts with positive thoughts and affirmations for anxiety to help reassure yourself when you feel tense during test time. Positive statements like, “I am intelligent and capable”, or, “I can answer any test questions I face” may help you reframe your thought patterns.

Journal

Practice deep breathing 

Deep breathing techniques may 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. 

Common test anxiety treatment

According to the Anxiety and Depression Association of America, test anxiety and diagnosable anxiety disorders are typically treated with psychotherapy, or talk therapy, sometimes in combination with medication.

Cognitive behavioral therapy to manage anxiety and stress reactions

Cognitive behavioral therapy (CBT) is the most common type of therapy for anxiety disorders and one of the most common forms of test anxiety treatment as well. In CBT sessions, a therapist works with clients to identify negative thought patterns and behaviors and replace them with more positive, realistic ones. A qualified cognitive behavioral therapist can also help you develop a repertoire of effective coping skills to manage your anxiety symptoms and stress reactions. In some cases, a psychiatrist may recommend medication in addition to talk therapy.

How therapy can help you overcome test anxiety and stress

If you experience overwhelming anxiety related to tests that interferes with your ability to take them, you may have test anxiety. Working with a licensed therapist in person or through an online therapy platform such as BetterHelp can be a valuable way to help you identify and address negative thought patterns and behaviors. A therapist can also teach you practical coping skills to help you manage your anxiety and stress reactions. 

Cognitive behavioral therapy is the most common type of therapy for anxiety disorders, and recent studies suggest that online CBT can be as effective as in-person treatment in many cases. Online therapy is often less expensive and usually involves shorter wait times than traditional in-office care, making it a more convenient option for many people.