Editor's Note: This is another article in a series written by students who are dealing first-hand with an anxiety disorder - and who want to help other students by sharing their experience and success – or failure – in coping and living with their condition. Haley Blank is a rising high school junior. She has consulted with Dr. Michele Cascardi who guided her in researching and writing this article. As a licensed clinical psychologist and university professor, Dr. Cascardi validates what Haley has experienced. You might also be interested in the story of Kathryn Dewitt. -wnt

Final Exam – Question #1 (Multiple choice): What are the primary components of anxiety associated with tests or other academic evaluations?

      1. Thoughts
      2. Emotions
      3. Physical sensations
      4. Behaviors
      5. All of the above

Final Exam – Question #2 (Essay): Name 5 action steps to take to deal with test anxiety.

(Answer Sheet: See below)

I remember my first attack crystal clear. I was in my freshman year of high school and it was the weekend before midterms. I was putting immense pressure on myself to succeed; I told myself I had to get all A's or I'd never be considered "smart" and "successful".

I was lying in my bed attempting to slowly fall asleep as I tried calming my nerves. It was Saturday night, and the first midterm was Tuesday. However, I was unable to fall asleep due to my sporadic breathing. I felt like I couldn't catch my breath, a wave of intense darkness had cast over my mind consuming my thoughts and air. I started breathing faster and faster feeling my oxygen escape me. I tried again to fall asleep while struggling to conquer the idea that if I fell asleep my body would forget to breathe, and I would die. I ran into my parents' room freaking out, unable to understand what was happening to my body and mind. I thought whatever was going on had to correlate to a physical illness.

Next I knew I was in the car driving to the hospital. My heart had never beaten faster in my life. I wrestled in the back seat of the car on the 20-minute drive to the emergency room feeling as if I wanted to jump out of my body. The trip felt like an eternity and we finally arrived at 3 AM; my dad and I ran into the emergency room. I was put through a series of tests with many different doctors. They all came to the same conclusion: I have anxiety.

This was the first of the many recurring anxiety attacks I've had before assessments or major papers. I've learned how to handle them much better, but before handing in an essay or taking a test I always slightly feel jittery and lose my breath. A little bit of anxiety is good; it motivates you to try your best. But too much, I learned, can be crippling.

Going through life with anxiety for tests or major assignments, you may feel as if no one understands you. However, there is a huge community of people with anxiety, like the performer Adele, who know what it's like. For those who don't know, anxiety makes you feel helpless and completely out of control of your own body. Most fail to understand that anxiety leads to many other mental disabilities. It's a serious disorder that affects people from all different age groups. It's not just something you can fix easily. Seeking the necessary help and learning how to calm yourself down will tremendously assist your mental state. I decided to write this article to give high school students like me more information about test anxiety and how to overcome it.

What is test anxiety?

More than four decades ago, Spielberger1 defined test anxiety as an "unpleasant state characterized by feelings of tension and apprehension, worrisome thoughts and the activation of the autonomic nervous system when an individual faces evaluative achievement-demanding situations." 1 Modern day definitions describe test anxiety as excessive fear or worry about situations involving formal evaluation, like tests or major papers. Worry often involves thinking that self-worth, motivation, or even acceptance by peers, parents, or teachers depends on academic achievement. 2 This anxiety may be experienced before a testing situation, during preparation for testing, and/or during the testing situation itself. Test anxiety can be broken down into four parts:

1) Thoughts: Worry and doubts about the ability to succeed. This includes exaggerated beliefs that academic failure or low achievement is very likely. Pressure to do well while believing success is not possible, or thinking that you are not good enough, can cause trouble concentrating which negatively affects academic performance.

2) Emotions: Some may experience intense feelings of distress, and discomfort surrounding testing situations, including negative emotions of fear, helplessness, anger, irritability, and disappointment, while others may only be affected physically.

3) Physical sensations: Heightened awareness of physiological arousal, which can include headache, nausea, diarrhea, excessive sweating, shortness of breath, rapid heartbeat, light-headedness, and feeling faint.

4) Behaviors: Avoidance of tests, difficult assignments or challenging tasks as well as restlessness when preparing or taking assessments.

How common is test anxiety?

High stakes tests have become a regular part of the high school experience. Whether these tests are used to make sure schools are providing quality education, to mark important individual student milestones like high school graduation, or to gain acceptance to college, one thing is clear: they increase the pressure on students. Yet, there is remarkably little research on test anxiety among high school students, even though about 20-40% of students suffer anxiety that impairs test performance.4-7 Students do not outgrow test anxiety, 8 as it is also common among college students contributing to lower academic performance and grade point averages.9 Reducing test anxiety during the high school years has the potential to produce many positive benefits. In the short term, it may enhance emotional well-being, optimize school performance, and improve motivation and engagement in learning. In the long term, it may improve academic achievement in college and attainment of professional aspirations.

What causes test anxiety?

Although test anxiety has many different causes, it seems to be more common among those who have a tendency to interpret physical sensations of anxiety as threatening. These people feel pressured to maintain excessively high or perfectionistic standards, experience difficulty tolerating uncertainty, and/or have specific academic skill deficits.11,12 Test anxiety can worsen through a repeating cycle of worry, physical arousal, poor academic performance, and negative beliefs about the meaning of this performance.

First, worry interferes with concentration and memory, making it hard to learn material during test preparation and/or hard to remember information during test taking. Problems with concentration and memory contribute to low achievement or academic failure. This further decreases self-confidence, intensifies worry and anxious arousal, and fuels damaging beliefs that learning and academic success are unlikely. Over time, test anxiety may result in reduced effort, lower self-esteem, and loss of motivation for school-related tasks.13 Pressure and expectations for high achievement from parents, peers, school, or the community can also aggravate test anxiety.14

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Strategies to reduce test anxiety

Mental health professionals are trained to deliver a few different types of effective interventions to reduce test anxiety. Interventions are categorized based on their approach as behavioral, cognitive, cognitive-behavioral, or skill building.4,5 An important first step of any intervention is understanding how test anxiety gets in the way of test preparation, test taking, or both.

Behavioral interventions aim to reduce anxious arousal. Relaxation training (muscle relaxation and/or deep breathing exercises), biofeedback, and systematic desensitization are just a few ways to combat test anxiety with behavioral approaches. Reducing anxious arousal using relaxation training means learning how to release tension from different groups of muscles in the body or practicing deep breathing to avoid the shallow breathes that increase anxious feelings. Biofeedback teaches individuals to reduce anxiety by applying feedback on heart rate, skin temperature, and muscle tension to control these biological processes. With practice, individuals learn to apply relaxation techniques when worried or anxious. Systematic desensitization helps people overcome avoiding situations that make them feel anxious. By combining relaxation techniques with gradual exposure to increasingly unpleasant or fear-producing situations, individuals develop confidence in their ability to manage their fear and worry.

Cognitive interventions teach individuals to identify self-defeating or unrealistic thoughts that undermine confidence and concentration during test preparation and test taking situations. The specific thoughts that contribute to test anxiety differ from person to person, but there are some shared ideas. For example, thoughts like, "I am going to fail", "I'm not good at math/science/English", "If I don't succeed, it means I'm not smart enough or good enough", "Everyone else will do better than me", or "I will never be able to pass this class" tend to be fairly common. Mental health professionals help individuals by identifying three ways to prevent these negative thoughts. First, identify and replace the negative thoughts with ones that are more realistic ("I will study and try my best"). Second, focus on coping and problem-solving skills ("If I get anxious, I will try calm breathing"). Finally, emphasize positive affirmations ("I know I can do this"). Cognitive-behavioral approaches combine both cognitive and behavioral interventions.

Other interventions are based on the view that test anxiety arises from academic deficiencies or study skill deficits. Skill-based approaches are designed to remedy academic deficits and improve study habits with content-specific tutoring, training in time management and organization, improving reading comprehension, and note-taking methods among other tips during test-taking.

A recent review of research on interventions evaluated with high school students found that the most promising approaches for reducing test anxiety use biofeedback, deep breathing, guided progressive muscle relaxation, and systematic desensitization.4,5 These strategies work when used alone or in combination with cognitive interventions, such as counteracting self-defeating and unrealistic thoughts. Skill-building strategies have also been found to be effective, especially among college-age students. Acceptance based behavior therapy is a more recent innovation in intervention. Unlike cognitive and behavioral approaches, which prioritize reducing anxiety and challenging self-defeating thoughts, acceptance based approaches emphasize learning to accept and tolerate uncomfortable emotions, thoughts, and physical arousal without judging them or being distracted by them. This strategy has not been studied as much as other methods, but it has shown promise in reducing anxiety and improving academic performance. 15

Getting help from a mental health professional is important when anxiety feels unmanageable, gets progressively worse, or interferes with other activities, like spending time with friends or participating in clubs or sports.

Answers To Question #2

To sum things up, as a high school student approaching my junior year, I wish I had known more about test anxiety when I started my freshman year of high school. I decided to share some tips I've discovered after much research and personal experience that might help others going through similar experiences.

1. If anxiety comes with school evaluations, it is important to remind yourself that it's just a test or essay. Not doing as well as you want is not the end of the world, and it does not define you as a person or discredit your work ethic.

2. If you start to feel short of breath, remind yourself that it is okay; accept the discomfort and remain calm. Your body will not forget how to breathe.

3. There are many apps in the App Store on your phone to help you breathe regularly. These can be helpful when you feel an attack coming on or you are in the middle of one. Some examples include Breathe2Relax, Universal Breathing, Paced Breathing, Relax Stress and Anxiety Relief, and Breathing Zone.

4. Listen to relaxing music. Your body and mind synchronize with the music, and calming music slows your BPM (beats per minute) heart rate.

5. Tell someone and get help! I wish I'd told my teachers sooner about my issue, and gotten the in school help. Once the school administrators and teachers learned about my problem, they were much more accommodating and supportive.

Date of original publication:
Updated on: July 18, 2016


1. Spielberger, C. D. (1972). Anxiety as an Emotional State. In C. D. Spielberger (ed.) Anxiety: Current Trends in Theory and Research. New York: Academic Press.

2. Lowe, P. A.,&Lee, S.W. (2008). Factor structure of the TestAnxiety Inventory for Children and Adolescents (TAICA): Scores across gender among students in elementary and secondary school settings. Journal of Psychoeducational Assessment, 26(3), 231 – 246.

3. Lowe, P. A., Lee, S. W., Witteborg, K. M., Prichard, K. W., Luhr, M. E., Cullinan, C. M., et al. (2008). The Test Anxiety Inventory for Children and Adolescents (TAICA): Examination of the psychometric properties of a new multidimensional measure of test anxiety among elementary and secondary school students. Journal of Psychoeducational Assessment, 26(3), 215 – 230.

4. von der Embse, N., Barterian, J., & Segool, N. (2013). Test anxiety interventions for children and adolescents: A systematic review of treatment studies from 2000–2010. Psychology in the Schools, 50(1), 57-71.

5. Ergene, T. (2003). Effective interventions on test anxiety reduction a meta-analysis. School Psychology International, 24(3), 313-328.

6. Gregor, A. (2005). Examination anxiety: Live with it, control it or make it work for you? School Psychology International, 26, 617 – 635.

7. McGuire, D. P., Mitic, W. and Neumann, B. (1987) 'Perceived Stress in Adolescents: What Normal Teenagers Worry About?' Canadian Mental Health, June: 2–5.

8. Connor,M. J. (2003). Pupil stress and standard assessment tasks (SATs): An update. Emotional and Behavioural Difficulties, 8(2), 101 – 107.

9. Chapell, M.S., Blanding, Z., Silverstein, M.E., Takahashi, M., Newman, B., Gubi, A., & McCann, N. (2005). Test anxiety and academic performance in undergraduate and graduate students. Journal of Educational Psychology, 97(2), 268274.

10. Naragon-Gainey, K. (2010). Meta-analysis of the relations of anxiety sensitivity to the depressive and anxiety disorders. Psychological Bulletin, 136( 1), 128 - 150.

11. Eum, K., & Rice, K. G. (2011). Test anxiety, perfectionism, goal orientation, and academic performance. Anxiety, Stress, & Coping, 24(2), 167-178.

12. Berger, J. I. (2013). Cognitive vulnerabilities associated with test anxiety. Proquest: Dissertation UMI Number: 3578542.

13. Cassady, J. C., & Johnson, R. E. (2002). Cognitive test anxiety and academic performance. Contemporary Educational Psychology, 27(2), 270-295.

14. McDonald, A. S. (2001). The prevalence and effects of test anxiety in school children. Educational Psychology, 21(1), 89-101.

15. Brown, L. A., Forman, E. M., Herbert, J. D., Hoffman, K. L., Yuen, E. K., & Goetter, E. M. (2011). A randomized controlled trial of acceptance-based behavior therapy and cognitive therapy for test anxiety: A pilot study. Behavior Modification, 35(1), 31-53.