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  • Sarah Pospos, MD, MS

How to Overcome Test Anxiety

Updated: Apr 24, 2023

As a psychiatrist and lifelong learner, I help many students who are overwhelmed with test anxiety; here I’ll help you recognize symptoms of test anxiety and discover some evidence-based relaxation techniques and other tips to help you feel focused and well-rested again.

What Causes Test Anxiety

A few facts:

  • 25-40% of US students experience test anxiety

  • 31-39% of college and graduate students have anxiety

  • Anxiety is the #1 mental disorder in the US

  • Only 37% of those who are anxious receive treatment

You may have test anxiety if you experience distress before, during or after a test to the point that it interferes with your performance or learning. It’s a type of performance anxiety, which happens in situations where performance really counts - the stakes are high and there is intense pressure to do well.

Your mind may perceive the exam as a threat to survival, interpret your worry as a sign of danger, and trigger your body to react accordingly. You may also believe that you will perform poorly, which leads to having low self-esteem all around.

Relaxation Techniques and Other Tips for Test Anxiety

#1 Deep Breathing

Slowly and intentionally breathe with your belly/diaphragm. Count to 6 as you inhale, 6 as you pause, and 6 as you exhale. Repeat several times.

This resets your autonomic nervous system: steering away from the sympathetic system (i.e., your fight or flight response) and stimulates the opposite, your parasympathetic system, which makes you feel calmer.

#2 Progressive Muscle Relaxation

Start with the muscle group on the top of your head, gradually making your way down to the bottom of your feet. Tense one muscle group for 10 seconds, then relax it for 20 seconds. Focus on the different feelings between tension and relaxation.

Muscle tension often accompanies anxiety. Thus, muscle relaxation will not only activate your parasympathetic nervous system (the opposite of your fight or flight response), but also reduce tension and anticipatory anxiety, increase concentration and sense of control, create a pleasant mental state, and improve your energy and sleep.

#3 Mindfulness Meditation

Mindfulness means bringing full awareness to the present moment and NOT blocking out all thoughts. Just like the way your physical muscles get stronger with each exercise repetition, your mindfulness muscle gets stronger with practice, too.

Mindfulness affects brain areas that regulate awareness, attention, and emotion (reducing negative mood), improves energy, and stimulates brain-derived neurotrophic factor (BDNF), which is the Miracle-Gro to our brain.

For these relaxation techniques, you can also use your Apple watch (Mindfulness app), phone (Calm or IntervalTimer apps), or the 5-20 minutes guided sessions here.

#4 Limit Caffeine (coffee, tea, energy drinks, soda, chocolate, etc.)

Caffeine can overstimulate your sympathetic nervous system (i.e., fight or flight response), leading to anxiety and jitteriness. However, if you’re a chronic caffeine drinker, avoid quitting cold turkey on the day of the exam as you may experience some withdrawal symptoms (headache, difficulty concentrating, irritability, tiredness, etc.).

#5 Do Practice Tests in a Similar Exam Condition

Let’s take the US Medical Licensing Examination (USMLE) as an example. Practice doing the 8-hour, 7-block of multiple-choice questions back-to-back in real-time. If you’re planning to take the test at 9 a.m., do a few trial runs at 9 a.m. To ease your anxiety, visualize everything - including things that may go wrong - on your test day, and plan or troubleshoot accordingly. For example, try to get in the habit of sleeping and waking up at the intended time and get used to eating the exact meals that you’re planning to eat on test day.


When to See a Doctor for Anxiety

If test anxiety starts impacting your grades and causes distress that keeps you from completing your daily responsibilities, help is needed.

Psychiatrists are specialized medical doctors who require at least 12 years in higher education and 15,000 hours of clinical training before being allowed to independently diagnose, treat, or prescribe medications. In comparison, nurse practitioners (NP) require 500 clinical hours (typically supervised by a medical doctor); and physician assistants (PA) require 2,000 clinical hours.

One major hesitation for students is that medication may cause daytime sleepiness or brain fog that interfere with their learning or grades. Some antidepressants, like trazodone, can be sedating and help with sleep. However, in the case of trazodone, you may also watch out for morning grogginess. Additionally, certain health conditions, like hyperthyroidism, may mimic anxiety. It’s important to rule this out by checking your thyroid level.

Every patient is different, and my recommendations are always made on a case-by-case analysis. If together we determine that medication is beneficial, I’ll walk you through different options, thoroughly explaining the risks, benefits, alternatives, and potential side effects, so you can be fully informed and content with the next steps. My Masters Degrees in Psychopharmacology and Applied Psychology add even more insight on all things medication and human behavior.

Book a free 15-minute initial phone call to become the best version of yourself again.

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