Understanding and managing test anxiety: an evidence-based guide

What is test anxiety?

Test anxiety refers to the serious and sometimes overwhelming feeling experienced before or during exams - it’s a specific form of performance anxiety experienced by students who know their performance is being evaluated and where they have concerns regarding the outcome i.e. passing the exam or assessment.

Test (or exam) anxiety is NOT the same as the exam stress which many (if not all) of us feel when preparing for or undertaking an exam, perhaps worrying that we might not pass or achieve the grade we would like to. We can experience exam stress but still feel like we can handle the situation, while exam anxiety is generally associated with more exaggerated thoughts that you won’t pass which may be accompanied by a physical response to the anxiety.

The well documented difference between ‘state’ and ‘trait’ anxiety also relates to test anxiety. That is, individuals with trait anxiety are generally anxious as a consistent personality trait which exists regardless of the task at hand, while state anxiety would apply to someone who feels anxious in relation to specific triggers such as exams or public speaking. Test anxiety is more often a situation-specific emotion you feel when you’re being evaluated in some way than it is a general trait. While test anxiety occurs in students at all stages of education it peaks in higher education, with higher likelihood of burnout.

?

What is retest anxiety?

Retest anxiety is a specific type of anxiety where students are anxious about resitting a test or exam they’ve already failed in the past (some people might be thinking of their driving tests right now). Retest anxiety is related to generalisations you might make about yourself or social experiences based on past experience (also called affective schemata). Retest anxiety can be a significant distraction when preparing for or re-taking an exam, it’s also likely to impact a students’ confidence. In educational research, confidence is generally described as self-efficacy and relates specifically to a given task like educational performance, not your general sense of self-confidence.

?

What’s the impact of test anxiety?

Regardless of whether test anxiety is caused by state or trait factors, students can experience:

• significant worry
• intrusive and irrelevant thoughts which are unrelated to the test itself
• low self-belief leading to negative thoughts about yourself and your performance
• feeling like you’re generally less emotionally stable
• physical symptoms typical of anxiety disorders such as sweating, nausea, headaches, tachycardia, light-headedness and insomnia

?

When studying for exams and during the exam itself test anxiety can lead to:

• poor retrieval of information, even if you previously knew the information well
• reduced intrinsic motivation to study
• challenges in using strategies which facilitate deep learning
• increased use/dependency of surface learning strategies which are typically less effective

How does test anxiety impact performance and what are the implications?

The evidence that test anxiety impacts exam performance is definitive but how this occurs is still unclear. A popular theory is the ‘interference hypothesis’ which suggests that issues around task processing and knowledge retrieval during an exam impacts performance. Often task-irrelevant thoughts (“I don’t have the knowledge to answer this question” or “what’s going to happen if I fail this exam”) use up working memory capacity needed for task-execution and knowledge retrieval.

Research on interference isn’t conclusive, though it’s likely to have some impact during the exam, and recent high-quality research (Theobald, Breitwieser & Brod 2022) has suggested that the effects of test anxiety before exams is more important. This well-designed study showed that students with higher levels of test anxiety showed a smaller increase in knowledge over time in the run up to their exam. This means that students entered the exam with less knowledge which then impacted their performance, rather than interference effects during the exam being the main contributing factor.

The reason being that due to their test anxiety, students struggled to absorb and retain information as effectively. Test anxious students are also likely to experience lower motivation causing them to give up earlier during a study session.

?

Some reassurance on test anxiety

Reading the information shared already it would be easy to assume that any test anxiety you’re feeling is going to cause problems in studying effectively for the exam you’re already nervous about, fortunately there’s good news too.

Moderate amounts of anxiety which is kept at a manageable level can support motivation and task completion, helping students to feel more alert and prepared to study for the exam ahead of them. One of the most important points to note is that it’s not a foregone conclusion that test anxiety will reduce performance on the day and there are steps you can take to address test anxiety before it becomes a problem.

Research indicates that training sessions aimed at enhancing study strategies can benefit students experiencing exam-related anxiety. However, since test anxiety impacts students early in exam preparation, effective interventions should also be implemented at an early stage to offset knowledge deficits which would occur otherwise.?

?

Specific reassurance on retest anxiety

Retest anxiety can actually be helpful in the same way that test anxiety supports motivation. Although a student may have failed an exam during their previous attempt, they shouldn’t approach the next exam thinking they will face the same challenges. While the test content will be different the format will be the same and students will be aware of any challenges this caused previously, there are some questions which will be familiar, and the student will have been able to prepare for specific topic areas or questions which tripped them up last time. Learners will also be able prioritise and manage their time more effectively than they did before. Remember that high-stakes exams are carefully designed for validity and reliability so if you’ve learned your lesson(s) from the previous attempt and prepared effectively, you’ll be fine.

?

Managing test anxiety according to the evidence-base

For pre-existing anxiety disorders or depression unrelated to test anxiety, interventions designed specifically for students aren’t proven to be any more effective than the usual support readily available from an appropriate healthcare professional such as medication or CBT.

What I’m keen to discuss in this article is evidence-backed advice on the most impactful interventions which will help students to specifically address their test anxiety and improve exam performance.

?

Intervention: Behavioural Therapy (BT)

Description: focuses on reducing the affective (emotional) aspect of test anxiety using relaxation techniques. Key interventions include progressive muscle relaxation (PMR) which involves sequentially relaxing muscle groups or systematic desensitisation involving muscle relaxation while visualizing a hierarchy of increasingly stressful TA-related situations.

Evidence says: as the preferred psychological intervention for test anxiety, behavioural therapy had the most evidence for demonstrating benefit in managing TA and improving exam performance.

?

Intervention: Cognitive Behavioural Therapy (CBT)

Description: CBT-based interventions focus on managing thinking and behaviour. The most prominent CBT approach for anxiety disorders involves identifying negative automatic thoughts (NATs) and cognitive distortions that contribute to and perpetuate anxiety.

An example of cognitive distortion is 'generalisation,' where individuals make sweeping conclusions from a single event, such as a student interpreting a low grade as a sign of complete incompetence. Therapists would guide clients to recognize and challenge NATs by initially labelling the cognitive distortion then using logical disputation to explore the evidence for and against the NAT.

Evidence says: evidence in reducing TA severity but less so than behavioural therapy and effects may not be as long lasting after treatment.

?

Intervention: Study Skills Training (SST)

Description: typically comprise two main components - the first component addresses optimal learning and encoding of study material, emphasizing deeper-level understanding over rote-learning (memorisation). The second component concentrates on strategic approaches during examinations, such as allocating more time to questions that carry a higher proportion of the total examination score.

Evidence says: this approach does not work when used in isolation but provides better outcomes than BT or CBT alone – a combination of CBT plus SST or BT plus SST would be the best approach for most students.

?

Intervention: Exercise

Description: aerobic exercise of any intensity has been shown to effectively manage test anxiety, but the minimum effective ‘dose’ is 20 minutes two to three times per week for at least four weeks. Exercise in combination with psychological interventions is proven to be more effective than either intervention alone.

Evidence says: the overall effect size for exercise was considerable with best results from: exercising for 30-60 minutes per session, exercising more than three times per week, and exercising for more than 8 weeks.

?

Intervention: Practise tests and quizzes

Description: practise tests or quizzes can be used as effective study tools and to reduce test anxiety. Students should recognize that tests or quizzes may induce more stress compared to alternative (‘low utility’) study techniques such as re-reading but it’s important to note the important benefits of practise testing in consolidating long-term retention of studied material, facilitating subsequent learning of new information, and fostering knowledge transfer.

More challenging practise tests improve learning by introducing desirable difficulty, so it’s not advised to regularly use easy tests when preparing for exams. A mix of easy and more challenging tests are likely to be most beneficial alongside other study techniques. Over 90% of students feel that being able to retake a practise test reduces anxiety so this format should be kept in mind – while practise tests are commonly used by students to identify knowledge gaps, re-taking tests can support retention through active learning, so there is value in undertaking the same test again.

Evidence says: Practice tests reduce test anxiety (TA) to a moderate degree. Easy tests provide more significant benefits while harder tests provide smaller, statistically non-significant positive benefits in reducing TA – most importantly they don’t cause consistently negative effects. Overall, the existing evidence suggests that the substantial learning benefits associated with practice tests outweigh potential temporary increases in TA, and that practise testing has the potential to alleviate test anxiety.

?

Intervention: Mindfulness breathing

Description: this is a useful zero-cost intervention that any student could undertake using popular YouTube videos, and where their exam is quickly approaching but they don’t have time to implement other interventions in this list.

Mindfulness breathing can help students focus on the present moment and reduce task irrelevant thoughts, as described earlier, which may impact performance during an exam or study session.

Evidence says: a mindful breathing practice for 30 minutes each day for seven days approaching an exam (with the exam date within 2 weeks) has been shown to significantly reduce test anxiety.

Separate research showed that the benefits of mindfulness-based interventions in adult learners can be maintained by practicing at least twice per week.

A useful alternative: not everyone enjoys mindfulness breathing or meditations and it can take time to develop the skill, time that learners don’t necessarily have. A useful alternative is breathwork (active regulation of your own breathing) such as box breathing or the physiological sigh. Although it wasn’t specific to test anxiety, a high-quality meta-analysis published in the journal Nature showed that different types of breathwork provided reductions in stress and anxiety comparable to cognitive behavioural therapy. The authors advised that while breathwork shouldn’t be considered a replacement for CBT it is a valuable addition to other interventions which could provide additive effects.

?

Intervention: Managing perfectionism

Description: The impact of perfectionism on test anxiety and performance varies based on whether it's adaptive or maladaptive, and its alignment with a learner's goal orientation (whether they set approach or avoidance goals). Key definitions are available below.

?

Adaptive perfectionism

Involves setting high standards for oneself while maintaining a healthy balance between striving for excellence and accepting imperfection. It motivates individuals to achieve their goals without being overly critical of mistakes, fostering resilience and growth.

Maladaptive perfectionism

Involves setting unrealistic standards, fear of failure, and excessive self-criticism. Learners with maladaptive perfectionism may procrastinate due to fear of not meeting their own or others' expectations, leading to increased stress, decreased productivity, and impaired well-being.

Approach goals

Involves striving towards positive outcomes, such as achieving high grades or mastering a subject. These goals focus on pursuing success and personal growth, motivating students to engage in learning activities and persevere through challenges.

Avoidance goals

Involves avoiding negative outcomes, such as avoiding failure or embarrassment. Students with avoidance goals may be driven by fear of failure or criticism, leading them to engage in behaviours aimed at preventing negative consequences rather than actively pursuing success.

Research consistently shows adaptively perfectionistic students prioritise approach goals over avoidance goals and prioritise mastery over performance. They’re more inclined towards intrinsic rather than extrinsic motivation for learning and demonstrate an interest in making the most of learning opportunities rather than how they might be perceived for getting things wrong.

In simpler terms, this means that students who embrace a growth mindset and are willing to contribute to group discussions or other learning opportunities, even though they might get things wrong and feel embarrassed in front of other people, will learn more from corrective feedback and reduce their anxiety in relation to exams.

Evidence says: Maladaptively perfectionistic students tend to endorse goals aligned with fear of failure and concerns about their competence in mastering material - these students are highly susceptible to cognitive test anxiety, whereas there’s essentially no association between anxiety and adaptive perfectionism.

Advice on managing maladaptive perfectionism in healthcare students is available from the paper Excellent vs Excessive: Helping Trainees Balance Performance and Perfectionism by Johnson et al (2023).

?

Take home message

It’s important for test anxious students to recognise that how their anxiety impacts their motivation and studying before an exam is generally more important than their stress on the day of the exam itself. While using breathing exercises before, or at the beginning of, an exam is likely to be useful in managing your nerves and reducing ‘interference’ effects, what you do in the weeks and months before the exam is most important and within your control.

Have a realistic plan in place for how you’re going to systematically study key topics for the exam, knowing that feeling well prepared (self-efficacy) actually reduces test anxiety in itself. The suggested interventions in this list are some of the most effective ways to reduce test anxiety. As you will have noticed, they need to be started early and used consistently to keep your anxiety at healthy levels to then improve how effectively you learn and retain new knowledge.

Reference

• Spielberger, C.D. (1983). Manual for the State-Trait Anxiety Inventory (STAI)
• Quinn & Peters (2017). Strategies to reduce nursing student test anxiety: A literature review. Journal of Nursing Education 56(3): 14–151
• Lang, Mueller & Nelson. Test anxiety and self-schemas.?Motiv Emot?7, 169–178 (1983).
• Artino AR Jr. Academic self-efficacy: from educational theory to instructional practice. Perspect Med Educ. 2012 May
• Theobald, Breitwieser & Brod (2022). Test Anxiety Does Not Predict Exam Performance When Knowledge Is Controlled For: Strong Evidence Against the Interference Hypothesis of Test Anxiety. Psychological Science, 33(12), 2073-2083.
• Barnett (2023). The efficacy of psychological interventions for university students: a systematic review and meta-analysis.?European Psychiatry,?66(S1), S17–S17.
• Huntley CD et al (2019). The efficacy of interventions for test-anxious university students: A meta-analysis of randomized controlled trials, Journal of Anxiety Disorders, Volume 63
• Zhang & Wang. Effects of Exercise Intervention on Students' Test Anxiety: A Systematic Review with a Meta-Analysis. Int J Environ Res Public Health. 2022 May.
• Yang, C., Li, J., Zhao, W.?et al.?Do Practice Tests (Quizzes) Reduce or Provoke Test Anxiety? A Meta-Analytic Review.?Educ Psychol Rev?35, 87 (2023).
• Cho et al. The Effectiveness of Daily Mindful Breathing Practices on Test Anxiety of Students. PLoS One. 2016 Oct.
• Repo et al. Comparison of two different mindfulness interventions among health care students in Finland: a randomised controlled trial. Adv Health Sci Educ Theory Pract. 2022 Aug.
• Fincham?et al.?Effect of breathwork on stress and mental health: A meta-analysis of randomised-controlled trials.?Sci Rep?13, 432 (2023).
• Eum K, Rice KG. Test anxiety, perfectionism, goal orientation, and academic performance. Anxiety Stress Coping. 2011 Mar.
• Johnson, Slavin & Takahashi. Excellent vs Excessive: Helping Trainees Balance Performance and Perfectionism. J Grad Med Educ. 2023 Aug.