What are some grounding exercises to help with exam anxiety?

Hi, and thanks for your question.

First of all, as I understand it, even *getting into* nursing school is incredibly difficult, so I'd like to commend you for the accomplishments you've already achieved in getting to where you're currently at.

It would stand to reason that the NCLEX is even more challenging than getting into nursing school itself, and of course, that challenge may compounded by the realization of "knowing what you don't know" that comes with having completed a course of education in a very important profession. That being said, conscientious persons such as yourself might be especially prone to second-guessing themselves, "imposter syndrome" and the like. Knowing (and normalizing) that what you're going through is "a thing" (i.e., many nursing students and students of other healthcare professions experience a similar phenomenon) is half the battle, so to speak. The other half, as you may have already identified, is having some tools to keep those kinds of thoughts in check.

1. Be aware of your thoughts (and then control them before they control you)

This speaks to the tendency we all have to get into patterns of thinking that may perpetuate additional unhelpful thoughts and behaviors. Become aware of what you're thinking, what may have triggered those thoughts at that particular moment, stop yourself from any continued thinking of the unhelpful thought, and then develop a more reality-based, compassionate and helpful thought to replace the *un*helpful thought with. Here's an example...

Unhelpful thought: "I'm never going to pass this test."

To self: "STOP."

Helpful thought: "This test is important to me, and I'm going to try my best. The outcome beyond that is unknown at this time."

2. Focus on the present-moment

Anxious symptoms tend to be the consequence of too much "future living" (or in other words, focusing too much on things that haven't happened yet which you don't have control over) whereas depressive symptoms tend to be the consequence of too much "past living" (or in other words, focusing too much on things that already happened that you no longer have control over). When we're focused on the present moment, *that* is truly the only moment we have control over. Some ways to stay focused on the present moment are:

Focusing on the physical sensation of your body in space and time, by directing your attention to the feeling of your body in a chair; the feeling of your feet on the ground; the feeling of a cold or hot beverage on your lips, down your throat, and into your belly

Diaphragmatic breathing exercises in which you lay flat on the ground or a surface and place one hand on your upper chest and one hand on your belly, breathing in such a way as to *only* move your belly. Breathe in slowly for a count of 3, and breathe out slowly for a count of 5. Repeat this about three times. Repeat the same series of inhales and exhales, but breathe in for 4 and out for 6, repeating about three times. Some people find it helpful to repeat an encouraging/calming mantra to themselves while breathing in and out, or to visualize a flower opening and closing along with their inhale/exhale. Once you've gotten the hang of this exercise while laying down, it can be done anywhere, whether sitting or standing, and after mastering the belly breathing component, you needn't always put your hand on your belly and/or chest.

3. Transcend the Feeling/"Name It To Tame It"

When you notice yourself feeling anxious or depressed, instead of identifying with the feeling (e.g., "I'm anxious,"), note to yourself that "Anxiety is happening." Simply reframing the situation in a slightly depersonalized way can help you gain just enough objective distance to allow the more "long-range" view of yourself to step in and intervene, perhaps implementing one of the above strategies or otherwise engaging your behavioral activation system to disrupt the potential pattern of unhelpful thoughts.

4. Five Senses Grounding Techniques

In this approach, you'll focus your attention on your five senses (which is another way of accessing the present moment), and direct yourself to name:

5 things you can see

4 things you can hear

3 things you can feel

2 things you can smell

1 thing you can taste

Another other point of potential interest in your particular situation may be to avoid overthinking and second guessing during the actual test administration by allowing yourself a certain amount of time of consider the answer to a question, and if you're stuck between answers or find yourself frozen on a question, mark it and return to it later. Don't allow yourself to ruminate excessively on whether or not a particular answer is correct; if it's not readily apparent to you within a reasonable amount of time, accept that reality, and move forward to answer other questions (to keep your momentum going and to keep any test anxiety from creeping in), and return to the "stickier" questions later.

One other thing to consider is that your experience with this testing process can be valuable in helping you understand the experience others may have with anxiety and depression, as well as various processes for overcoming and working through difficulty. It's almost like a "laboratory" of sorts, and how you get through this particular challenge can be of benefit to you professionally if you remain curious, compassionate, and non-judgmental toward yourself along the way. You may even want to consider journaling about this time in your life, as it can not only help you solidify the lessons you're learning about the emotional/psychological/behavioral aspect of what you're going through, but it can also help you to maintain your eye on the bigger picture -- because some day, you'll look back on these times and how you get through it can become a resource to you in regard to other challenges that will come your way in the future.

Best wishes to you!