test anxiety research paper topics

ORIGINAL RESEARCH article

How to reduce test anxiety and academic procrastination through inquiry of cognitive appraisals: a pilot study investigating the role of academic self-efficacy.

• Department of Psychology, University of Mannheim, Mannheim, Germany

Background and Objectives: Test anxiety can impair learning motivation and lead to procrastination. Control-value theory of achievement emotions ( Pekrun, 2006 ) assumes test anxiety to be a result of students’ appraisals of the testing situation and its outcomes. Modification of cognitive appraisals such as low self-efficacy beliefs is thus assumed to reduce test anxiety and subsequent procrastination. In the present study, we tested the effects of an inquiry-based stress reduction (IBSR) intervention on students’ academic self-efficacy, their test anxiety, and subsequent procrastination in the final stages of an academic term.

Design: Longitudinal quasi-randomized intervention control trial.

Methods: University students identified worry thoughts regarding a specific and frightening testing situation. Intervention participants ( n = 40) explored their worry thoughts with the IBSR method. Participants of an active waitlist control group ( n = 31) received the intervention after the study was completed. Dependent variables were assessed before and after the intervention as well as at the end of the term.

Results: Data-analyses revealed that the IBSR intervention reduced test anxiety as well as subsequent academic procrastination in comparison to the control group. The effect on test anxiety was partly due to an enhancement of self-efficacy.

Conclusion: Our findings provide preliminary evidence that IBSR might help individuals to cope with their test anxiety and procrastination.

Introduction

Test anxiety is a phenomenon well known to many students of different ages. For example, Putwain and Daly (2014) reported 16.4% of English secondary students to suffer from test anxiety. Further, according to Ergene (2003) , up to 20% of college students are test anxious. Roughly similar rates were reported by Thomas et al. (2018) who found about 25% of undergraduate university students to be highly test anxious. These prevalence rates are alarming because test anxiety may debilitate academic performance and impair subjective well-being (e.g., Steinmayr et al., 2016 ). Test anxiety is experienced in achievement contexts that are perceived as potentially threatening to one’s self-esteem (e.g., important exams). Test anxiety is a multidimensional construct ( Pekrun, 2006 ): On a physiological level, test anxious students might experience sweating, palpitations, trembling, and nausea. Cognitively, test anxiety comes along with specific worry thoughts including negative cognitive self-statements regarding academic failure. Additionally, test anxious individuals might experience social worry thoughts as they fear to be negatively judged by teachers, parents, and others ( Lowe et al., 2008 ). On an affective level, test anxiety is associated with unpleasant feelings of agitation, insecurity, and helplessness, which may evoke certain motivational consequences such as avoidance tendencies.

Test anxiety is often accompanied by academic procrastination (e.g., Van Eerde, 2003 ) – the voluntary delay of important and intended actions or decisions against one’s better knowledge and despite the expected negative consequences of the delay and subjective discomfort (e.g., Ferrari et al., 2005 ). In academic contexts, procrastination occurs for tasks like learning for an exam or writing an essay ( Patzelt and Opitz, 2014 ). It can have serious consequences for students’ academic achievement such as lower grades, longer study periods, as well as premature study drop-out. Helping students to deal with their test anxiety and subsequent procrastination hence seems an effort worth taking. Studies show that self-efficacy ( Bandura, 1977 ) – the appraisal of one’s own capabilities to accomplish a specific task (e.g., studying successfully for an exam) – might play an important role in the causation of test anxiety and subsequent procrastination (e.g., Yerdelen et al., 2016 ). Based on these ideas, the aim of the present paper is to investigate the effectiveness of an intervention in reducing students’ test anxiety and subsequent procrastination by enhancing students’ academic self-efficacy.

The Relationship Between Test Anxiety and Self-Efficacy

According to control-value theory of achievement emotions ( Pekrun, 2006 ), test anxiety results from an interaction of cognitive control and value appraisals regarding a specific achievement situation (e.g., an upcoming exam). While value appraisals refer to the value students subjectively attribute to achievement activities (e.g., learning for the exam) and their outcomes (e.g., passing the exam), control appraisals refer to students’ assessment of their subjective control regarding these achievement activities and their respective outcomes. In particular, test anxiety is assumed to arise when students focus on a pending achievement situation of high personal value (e.g., a final exam) while only feeling medium in control of their achievement activities. Such anxiety-causing control appraisals can be a consequence of low self-efficacy expectations: As students with low self-efficacy expectations do not believe that they can accomplish a specific learning task ( Bandura, 1977 ), their control expectancy regarding the respective achievement situation is also assumed to be negatively affected. This theoretical notion is supported by empirical studies showing that students with lower self-efficacy expectations also report higher levels of test anxiety ( Haycock et al., 1998 ; Yerdelen et al., 2016 ).

The Relationship Between Procrastination and Self-Efficacy

According to temporal motivation theory (TMT; Steel, 2007 ), procrastination is (just as test anxiety) a function of expectancy and value appraisals regarding the respective learning task and its outcomes. In particular, procrastination is assumed to be more likely for tasks of low value and low expectancy. Further, the expectancy component of procrastination is theoretically predicted to be most strongly influenced by students’ self-efficacy expectancies. In line with these assumptions, empirical studies show that procrastination is more likely for students who do not believe to have the capabilities to study successfully for an exam ( Yerdelen et al., 2016 ).

To sum up, both control-value theory ( Pekrun, 2006 ) as well as TMT ( Steel, 2007 ) assume that low self-efficacy expectancies – amongst other variables – might cause test anxiety and procrastination as they strongly influence students’ perceived control over achievement activities and their outcomes.

The Causal Relationship Between Test Anxiety and Procrastination

Test anxious students experience increased states of unpleasant physical arousal as well as aggravating worry thoughts ( Pekrun, 2006 ). As a consequence, test anxious students often feel the desire to withdraw from the situation ( Geen, 1987 ; Matthews et al., 1999 ). Accordingly, meta-analytical studies find a moderate positive association between test anxiety and procrastination ( Van Eerde, 2003 ; Steel, 2007 ) – students experiencing higher test anxiety also report higher levels of procrastination. However, these results stem from correlational studies, in which test anxiety and procrastination were only measured at single points in time. From a longitudinal perspective (i.e., over the course of an academic term), the causal interplay between test anxiety and procrastination might be more complex ( Pekrun et al., 2007 ). In particular, TMT ( Steel, 2007 ) suggests that procrastination is not always a mandatory consequence of test anxiety. In particular, TMT assumes students to procrastinate primarily when deadlines and exams are still far ahead (e.g., at the beginning of an academic term). The validity of this assumption is supported by results of longitudinal studies. For example, Tice and Baumeister (1997) found procrastinators to report lower stress than non-procrastinators, but only in the early stages of the academic term. Further, Yerdelen et al. (2016) found a negative association between students’ individual trajectories of test anxiety and procrastination throughout 8 weeks of an academic term. While participants’ anxiety significantly decreased over these weeks, their procrastination significantly increased over the same time interval. The authors concluded that the participants might have used procrastination as an emotional coping strategy to help them deal with their initial test anxiety. Unfortunately, the study of Yerdelen et al. (2016) does not provide any information about the causal interplay of test anxiety and procrastination at the last stages of the academic term. However, according to TMT, for this time period, students are assumed to procrastinate less : As deadlines approach, they are forced to engage in more active coping strategies (such as studying for the exam) if they want to avoid failing due to poor preparation. In line with these assumptions, studies found students to experience higher levels of anxiety ( Lay et al., 1989 ) and stress ( Tice and Baumeister, 1997 ) before exams when they had delayed studying earlier in the semester. Summing up, delaying learning activities (i.e., procrastination) might help students to emotionally cope with their test anxiety in the short run. However, students’ procrastination should decrease at the last stage of an academic term when deadlines and exams are approaching.

Interventions to Reduce Test Anxiety and Procrastination

There is a wide variety of interventions focusing on test anxiety and/or procrastination. In their review of recent test anxiety interventions, Von der Embse et al. (2013) found that students with high test anxiety can be best supported by multi-method cognitive-behavioral interventions as well as more specific cognitive or behavioral interventions. With regard to procrastination interventions, recent meta-analyses ( Rozental et al., 2018 ; Van Eerde and Klingsiek, 2018 ) showed that cognitive-behavioral therapy may help students showing high rates of procrastination. From the perspective of control-value theory ( Pekrun, 2006 ) and TMT ( Steel, 2007 ), a cognitive modification of low self-efficacy expectancies seems promising in order to reduce both test anxiety and procrastination. Accordingly, some interventions for test anxiety and procrastination focus on the change of (irrational) beliefs and thought patterns ( Pekrun and Stephens, 2009 ). For example, in rational-emotive behavioral therapy ( Ellis, 2002 ), students are encouraged to question their own thinking patterns with techniques such as direct cognitive debate and logical persuasion in order to replace dysfunctional and irrational beliefs with more realistic ones. However, a permanent modification of cognitive appraisals (such as low self-efficacy expectancies) should not be restricted to rational (i.e., conscious, logical, and reason oriented) debate only. Rather, dual-process models such as cognitive-experiential self-theory (CEST; Epstein, 2003 ) assume that rational information processing is always – mostly preconsciously and automatically – influenced by implicit schemas learned from past experiences. Thus, cognitive appraisals are never completely based on rational considerations but always biased by experience-based information processing. In accordance with these assumptions of CEST, self-efficacy theory ( Bandura, 1977 ) posits that self-efficacy beliefs stem not only from verbal persuasion, but also from experiential knowledge such as (vicarious) mastery experiences and the current experience of physical arousal. Consequently, the successful modification of cognitive appraisals (such as low self-efficacy beliefs) needs to include rational debate as much as new (self-efficacy enhancing) experiences.

A standardized method that combines an experiential and a rational approach to modify cognitive appraisals is inquiry-based stress reduction (IBSR; Mitchell and Mitchell, 2003 ). The IBSR method uses a specific set of questions to allow for the identification and exploration of stressful cognitions (e.g., “I am not able to study sufficiently”). In a first step, participants reflect on the emotions (e.g., test anxiety), effects (e.g., procrastination), causes (e.g., negative experiences in school), benefits (e.g., short-term relief from anxiety), and dysfunctionality (e.g., lower achievement) of their stressful cognition in an experiential manner. In a second step, participants are encouraged to imagine reality without the distortions caused by the stressful cognition, this way allowing for a new and potentially more positive experience (e.g., feelings of relief or curiosity). In a last step of the IBSR method, participants are guided to find concrete evidence for the validity of the opposite of their stressful cognitions (e.g., “I am able to study sufficiently”) and to explore whether the opposite could also be true. This is done in order to help them overcome the tendency to seek or interpret evidence in ways that are biased by already existing beliefs (i.e., the confirmation bias; Nickerson, 1998 ). This approach can be assumed to be effective as the new-found arguments are self-created and this way more convincing ( Briñol et al., 2012 ). In sum, IBSR should allow for a debate of stressful cognitions through experiential self-exploration and rational persuasion.

First empirical evidence points to the potential of IBSR to reduce anxiety. In a single-group study ( Leufke et al., 2013 ), participants of a non-clinical sample received an IBSR intervention. Results revealed that participants’ anxiety (amongst other psychopathological symptoms) declined for at least 3 months after the intervention. Similarly, Smernoff et al. (2015) found participants’ anxiety to decline after an IBSR intervention. However, in both studies a control group and randomization were missing. Thus, it remains unclear if the anxiety-reducing effects were caused by the IBSR intervention or if they were due to other factors. Further, in all the reported studies participants received a 9-day IBSR intervention, making participation very time-consuming. This could be a possible obstacle preventing individuals from attendance. These hindrances were overcome in a study by Krispenz and Dickhäuser (2018) , who assessed the effects of a short computer-based IBSR intervention on test anxiety in a sample of university students. Using a short-term longitudinal randomized control trial, the treatment group received a 20-min IBSR intervention in which they investigated one individual worry thought regarding an upcoming exam. Results showed that individuals who had received the IBSR short intervention demonstrated significantly lower thought-related test anxiety than participants from the pooled control groups who had either reflected on their worry thought or were distracted from it. However, the study did not allow to test if the effects hold longer than 2 days. Also, some IBSR participants reported difficulties in applying the IBSR method via computer and without further assistance.

The Present Research

The present research overcomes the impediments of previous studies. In an experimental control trial with a longitudinal design, for the first time, we investigate the effects of a short IBSR intervention on test anxiety and procrastination over the last part of an academic term in a sample of university students suffering from both phenomena. While all study participants learned to identify their worry thoughts regarding their most frightening exam, intervention participants were additionally taught to use the IBSR method to explore and investigate their worry thoughts. Participants’ test anxiety, procrastination, and self-efficacy were assessed immediately before and after the intervention (i.e., in the middle of the academic term) as well as immediately before exams (i.e., at the end of the academic term).

For participants of the intervention group (who did receive an IBSR intervention), we firstly expected an increase in self-efficacy (H 1 ) as compared to the control group. This increase in self-efficacy in the intervention group was expected to emerge immediately after the IBSR intervention and to last until the end of the semester for the following reasons: Self-efficacy theory ( Bandura, 1977 ) assumes that a permanent modification of low self-efficacy beliefs may follow from rational debate (i.e., verbal persuasion) as well as from new – self-efficacy-enhancing – experiences. Self-efficacy should thus increase for IBSR participants (but not for control participants) due to the IBSR intervention as IBSR allows for a debate of cognitive appraisals such as low self-efficacy beliefs through experiential self-exploration (e.g., by imagination of the testing situation without the distortions caused by participants’ low self-efficacy beliefs) and rational verbal persuasion (e.g., through exploration of the validity of high self-efficacy beliefs). Second, based on the assumptions of control-value theory ( Pekrun, 2006 ) and TMT ( Steel, 2007 ), the predicted increase in self-efficacy was expected to decrease participants’ test anxiety (H 2 ) and – as a consequence – their procrastination (H 3 ).

In contrast, for participants of the control group (who did not receive any real intervention), we had the following predictions: Regarding the last part of the academic term, we expected an increase in test anxiety and a corresponding decrease in procrastination (H 4 ). These predictions were based on the theoretical rationales of TMT ( Steel, 2007 ). According to TMT, students should use more active coping strategies than procrastination at the late stages of an academic term to deal with their test anxiety. This notion is further supported by empirical results which show students to experience higher levels of anxiety before exams when they had delayed studying earlier in the semester ( Lay et al., 1989 ). To sum up, we expected a reduction in procrastination for both groups, but through different underlying mechanisms: For the intervention group, the reduced procrastination was assumed to be caused by a decrease in test anxiety, while for the control group the reduced procrastination was expected be a consequence of an increase in test anxiety.

Materials and Methods

Participants.

The IBSR intervention seminars were held on the campus of the University of Mannheim (Germany). Therefore, participants were recruited via posters, flyers, lecture announcements, and mass-emails at different German universities either in or close to Mannheim (Germany). The study was explicitly announced as an intervention study for students with test anxiety and/or academic procrastination. In total, 84 students were interested in participating. These individuals were pre-screened via telephone in order to provide them with all the necessary information (e.g., possible intervention dates, basic information about the intervention, participants’ chances of being assigned to the waitlist control group). Ultimately, N = 71 students ( M age = 21.85, SD = 2.94, range = 18–36 years, 63.1% women) with different study subjects decided to actually participate in the study. Regarding this sample, most participants studied economic sciences (47.6%). Participants’ mean study duration was M = 3.76 terms ( SD = 2.00). Participants indicated to have at least one academic exam at the end of the actual term ( M = 3.95 exams, SD = 1.23).

The study had a 2 × 3 mixed-factors design with the between-subjects-factor intervention (IBSR vs. an active control group). Measures of self-efficacy, test anxiety, and procrastination were taken pre-intervention (time 1), post-intervention (time 2) 1 , and immediately before exams (time 3, follow-up).

By the time we conducted the study and acquired the data, it was neither compulsory nor customary at the University of Mannheim to seek explicit ethical approval for an experimental study including only participants’ self-reports on test anxiety and procrastination. Nevertheless, we carefully ensured that the study was conducted in line with the ethical guidelines of the American Psychological Association (APA) and in full accordance with the ethical guidelines of the German Association of Psychologists (DGPs): (1) We did not induce test anxiety/procrastination or any other negative states in the participants but merely assessed their thoughts and affect regarding their upcoming exams. We thus had no reasons to assume that our study would induce any negative states in the participants exceeding the normal risks of studying at a university and preparing for exams. (2) The first author is now working at a Swiss university. At this university, she conducted a follow-up study, which explicitly targeted participants with test anxiety and/or procrastination. The human research ethics committee of the respective Swiss university approved this new study. This can be considered as a clear sign that there are no ethical concerns with regard to the procedure of the present study. (3) The study exclusively made use of pseudonymized questionnaires. The data was matched for the analyses using codenames only. Written informed consent was obtained according to the guidelines of the German Psychological Society. Informed consent included information about (a) research object, (b) study and intervention procedure, (c) duration and allowance, (d) possible benefits of participation, (e) anonymity of data collection, and (f) possible risks of participation. Also, participants were explicitly informed that participation was voluntary and could be terminated at any time without any reason or negative consequences for the participant. Participants had to declare that they were at least 18 years old, had read the informed consent, and agreed to the rules of participation.

Participants were pre-screened via telephone interview to ensure they had time to participate on one of the four pre-determined intervention dates. For the first two dates, the control group treatment was scheduled. For the second two dates, the IBSR intervention treatment was scheduled. Participants were assigned to the conditions (IBSR vs. control group) by choosing from the four possible dates without knowing, which treatment was scheduled for the respective dates. Therefore, participants assignment to experimental groups was quasi-randomized. Baseline measures were taken in the middle of the academic term (time 1) and lasted about 45 min. All measures and instructions were paper-pencil based. Assessed were participants’ demographic data as well as study related variables. Then, participants were asked to think of the upcoming academic exams and to consider which of these exams frightened them the most. Next, participants were asked to describe their most frightening exam in detail. Also, participants were asked to rate the exams’ personal value to ensure that participants had actually chosen an exam that was relevant to them. Then, initial levels of self-efficacy, test anxiety, and procrastination regarding the most frightening exam were assessed. One to 2 weeks after baseline-measures were taken, participants of both groups attended a first 3-h group seminar held by the first author and another certified IBSR coach. This way, all study participants were given personal attention by the IBSR coaches and participated in social interactions with other participants. In this first 3-h seminar, participants focused on a specific frightening testing situation and in a systematic way wrote down their individual beliefs (e.g., “I am not able to study sufficiently”).

Additionally, participants of the intervention group attended another 3-h IBSR seminar (i.e., the actual intervention) and learned to investigate their stressful cognitions with the IBSR method by means of the four questions and several sub-questions (see Table 1 ). In a first sub-step, the validity of the stressful cognitions was questioned (Questions 1 and 2). Guided by Question 3 and the respective sub-questions, participants reported the mental pictures they associate with the stressful cognitions, their emotions, and bodily sensations. Also, they reflected on the belief’s specific effects, causes, and benefits as well as its functionality. Guided by Question 4, participants were then enabled to perceive reality without the distortions caused by the stressful cognitions and to experience, how they would feel without them. In the third step, participants learned to explore the opposite of their initial beliefs by turning them around to possible opposites. For example, the initial belief “I am not able to study sufficiently” may be turned around to the opposite “I am able to study sufficiently.” by omitting the word “not” included in the initial belief. Then, participants were asked to find genuine proof of how the opposite could also be true for them.

Table 1. IBSR instructions.

After the respective seminars, participants of both groups received a diary. While participants of the control group were asked to further identify stressful situations and respective cognitions on a daily basis for 7 days, intervention participants were asked to explore their worry thoughts with the IBSR method for the same time interval. After the 7 days (i.e., approximately 1 week after the seminars; time 2) as well as immediately before the exams (time 3), dependent variables were measured again. After the exams, participants of the control group also received the IBSR intervention. All participants were debriefed and received additional information and materials regarding IBSR.

To test if participants had chosen an exam that was actually important to them, we assessed the most frightening exams’ value with one item (“How important is this exam for you?”). Ratings were made using a 10-points scale ranging from 1 ( not at all important ) to 10 ( extremely important ).

Academic self-efficacy was assessed with a slightly modified version of the German Scale for the Assessment of Study Specific Self-Efficacy ( Jerusalem and Schwarzer, 1986 ) using seven items (e.g., “Even though a test might be difficult, I know that I will pass it”). According to Bandura (1977) , self-efficacy should be measured with a scale indicative of the academic behaviors necessary to accomplish the specific task at hand (i.e., passing a specific exam). The scale was thus modified to address students’ self-efficacy beliefs regarding a specific exam (e.g., “Even though the test might be difficult, I know that I will pass it“). All statements were rated using a 4-point scale from 1 ( absolutely not correct ) to 4 ( absolutely correct ). A mean self-efficacy score was calculated with high scores indicating high levels of self-efficacy. The items showed satisfactory internal consistencies (Cronbach’s α time 1 = 0.81, time 2 = 0.79, time 3 = 0.77).

Test anxiety was assessed with the German short version of the state scale of the State-Trait Anxiety Inventory (STAI-SKD; Bertrams and Englert, 2013 ). The STAI-SKD allows for the assessment of state test anxiety with five items (e.g., “I am tense”). Ratings were made using four-point scales from 1 ( not at all ) to 4 ( very much ). We used a mean score including all five items, with high scores indicating a high level of test anxiety. The items showed good internal consistencies (Cronbach’s α time 1 = 0.84, time 2 = 0.86, time 3 = 0.89).

Academic procrastination was measured with the German version of the Academic Procrastination State Inventory (APSI-d; Patzelt and Opitz, 2014 ). With its 23 items, the APSI-d asks how often certain procrastination thoughts and behaviors occurred during the previous week (e.g., “I have stopped learning prematurely to do something more pleasurable”). Participants rated these statements using a five-point scale from 0 ( never ) to 4 ( always ). A mean procrastination score was calculated with high scores indicating a high level of academic procrastination. The items showed excellent internal consistencies (Cronbach’s α time 1 = 0.90, time 2 = 0.93, time 3 = 0.93).

Attrition Rate and Missing Data

Seventy-one participants completed baseline measures and attended the training modules ( n IBSR = 40 vs. n control = 31). At the post-intervention measure, data of 66 participants ( n IBSR = 38 vs. n control = 28) was assessed, while at the follow-up measure data of 57 participants was attained ( n IBSR = 33 vs. n control = 24). Overall, there was an attrition rate of 19.7%. To test if the dropout was systematic, we created a dummy variable (code 1 = dropout, 0 = no dropout). A multivariate analysis of variance (MANOVA) with exam’s personal value, initial self-efficacy, initial test anxiety, and initial procrastination as dependent variables revealed a statistically non-significant overall multivariate effect of the dummy variable, F (4, 66) = 0.77, p = 0.550, η 2 partial = 0.04. Also, there were no statistically significant univariate effects of the dummy variable, all p s > 0.160. A statistically insignificant χ 2 -test further showed, that dropout rates did not systematically differ between intervention group and control group, χ 2 (1) = 0.28, p = 0.593. These results indicate that the dropout was non-systematic.

Allover, 17.25% of data values were missing. Missing data ranged from a low of 1.2% to a high of 32.1% (e.g., for items assessing test anxiety at follow-up). To analyze the pattern of missing data, we calculated Little’s (1988) MCAR test, which resulted in a χ 2 (635) = 434.31, p = 0.999, indicating that data values were missing completely at random. In the following analysis, missing data was handled with the Full Information Maximum Likelihood Imputation (FIML) provided by Mplus ( Muthén and Muthén, 1998-2012 ) for two reasons. First, the FIML procedure is preferable to listwise or pairwise deletion of missing data, which generally create biased parameter estimates as well as biased significance testing ( Schlomer et al., 2010 ). Second, using the FIML procedure allows to retain the maximum amount of possible statistical power despite missing data.

Data Analyses

Based on the theoretical assumptions of control-value theory ( Pekrun, 2006 ) and TMT ( Steel, 2007 ), we expected participants of the intervention group to report less test anxiety (H 2 ) and less procrastination (H 3 ) due to specific causal mechanisms (i.e., increased self-efficacy; H 1 ). However, instead of investigating separate mediation models, we chose to use a path analysis including all variables and mediation paths (see Figure 1 ) due to the following reasons. Firstly, there is evidence that structural equation models perform better than simple regression models when it comes to investigate causal mechanisms via mediation analyses ( Iacobucci et al., 2007 ). Secondly, the path analysis used in the present study allowed us to embed the focal mediation models into a longitudinal and nomological perspective. As a consequence, the path analysis was conducted with the software Mplus ( Muthén and Muthén, 1998-2012 ). For the analysis, we applied the ML-estimator. When investigating the model fit, we relied on the guidelines given by Schermelleh-Engel et al. (2003) (acceptable model fit: RMSEA ≤ 0.08, CFI ≥ 0.95, SRMR ≤ 0.10; good model fit RMSEA ≤ 0.05, CFI ≥ 0.97, SRMR ≤ 0.05).

Figure 1. Path model of academic self-efficacy, test anxiety, and academic procrastination for all times of measurement. Depicted in gray color are first- and second-order autoregressive paths. Depicted in black color are direct effects of the IBSR intervention (dummy coded IBSR = 1 vs. control group = 0) on the dependent variables at time 2 and time 3, causal paths from academic self-efficacy measured at time 2 on test anxiety and academic procrastination measured at time 3, and from test anxiety measured at time 2 on academic procrastination measured at time 3. For increased readability, correlations between (residuals of) dependent variables were omitted in the graphical presentation of the model. Model fit: χ 2 (19) = 19.817, p = 0.406; CFI = 0.997; RMSEA = 0.025; SRMR = 0.081. All continuous variables were z -standardized. All reported parameter estimates are unstandardized. N = 71. † p ≤ 0.10, ∗ p ≤ 0.05, ∗∗ p ≤ 0.01, ∗∗∗ p ≤ 0.001. Reported are significance levels based one-tailed p -values.

To account for the longitudinal design, we first included respective first order autoregressive paths for all three dependent variables and additionally second order autoregressive paths for the dependent variables between measures at time 1 and time 3 as suggested by Geiser (2013) and Newson (2015) . Regarding time 1 and in accordance with previous empirical studies (e.g., Van Eerde, 2003 ; Steel, 2007 ) we further assumed positive correlations between test anxiety and procrastination as well as negative correlations between test anxiety/procrastination and self-efficacy. Additionally, we included correlations between residuals for time 2 and time 3 to account for individuals’ tendency to evaluate themselves as less effective (in terms of less self-efficacy and higher procrastination) when reporting higher test anxiety (and vice versa) at the same time of measurement (see Geiser, 2013 ).

To test for the experimental effects of the IBSR intervention, we coded a dummy variable (d) for which the control group was selected as the reference group (coded 0), while the IBSR group (coded 1) was contrasted with this reference group. In a first step, to investigate the immediate direct effects of IBSR on self-efficacy, test anxiety, and procrastination, we allowed for paths from the dummy variable (d) on all dependent variables measured at time 2. Secondly, to test the predicted causal interplay of self-efficacy, test anxiety, and procrastination between time 2 and time 3, we used a half longitudinal mediation design ( Kline, 2016 ). To account for the direct effects of IBSR on all dependent variables immediately before the exams, we allowed for paths from the dummy variable d on all dependent variables measured at time 3. To investigate the expected indirect effects of IBSR on test anxiety (H 2 ) before the exams via an increase in self-efficacy (H 1 ), we included a path between self-efficacy measured at time 2 and test anxiety measured at time 3. To test for the expected indirect effects of IBSR on procrastination (H 3 ) before the exams via an increase in self-efficacy and a decrease in test anxiety, we further included respective paths between self-efficacy/test anxiety measured at time 2 and procrastination measured at time 3.

Additionally, as we expected test anxiety to decrease for IBSR participants (due to the intervention) but to increase for control participants (due to approaching exams) at the last stages of the academic term (H 4 ), we further included the two-way interaction of Group × Test Anxiety (measured at time 2) as a moderating variable for the path between test anxiety (time 2) and procrastination measured at time 3. To avoid the problems associated with multicollinearity between the predictor variable (i.e., Group), the moderator variable (i.e., Test Anxiety measured at time 2) and the respective interaction term (i.e., Group × Test Anxiety), all continuous variables were z -standardized as suggested by Frazier et al. (2004) .

Descriptive Statistics

Participants indicated the personal value of their most frightening exam to be very high ( M = 8.15, SD = 1.52;

M intervention = 8.21, SD = 1.27; M control = 8.06, SD = 1.81). The respective frequency distribution was negatively skewed (–1.41, SE 0.029). Before the intervention, participants reported test anxiety of M = 2.80 ( SD = 0.67), self-efficacy of M = 2.49 ( SD = 0.56), and procrastination of M = 2.95 ( SD = 0.64). Corresponding to the quasi-randomization, a multivariate analysis of variance with the factor Group (IBSR vs. control group) as independent variable revealed a non-significant overall multivariate effect, F (4, 66) = 0.87, p = 0.490, η 2 partial = 0.05 on exam’s value, self-efficacy, test anxiety, and procrastination as dependent variables. Further, there were only non-significant univariate effects (all p s > 0.184), indicating that conditions did not differ regarding baseline levels of the analyzed variables. Zero-order correlations for the variables used in the path analyses are depicted in Table 2 . As expected and in line with previous studies ( Van Eerde, 2003 ; Steel, 2007 ), at all three times of measurement, these correlations suggest negative associations between self-efficacy and test anxiety, positive associations between procrastination and test anxiety, as well as negative relationships between self-efficacy and procrastination. Descriptive statistics for the dependent variables are reported separately for conditions and all points of measurement in Table 3 .

Table 2. Zero-order correlations of dependent variables.

Table 3. Means and standard deviations for academic self-efficacy, test anxiety, and academic procrastination for IBSR intervention and control group.

Preliminary Data Analyses

We had expected the IBSR intervention to increase participants’ self-efficacy, to reduce participants’ test anxiety as well as their procrastination in comparison to the control group. Thus, as preliminary analyses, we conducted three separate analyses of covariance with Group (IBSR vs. control group) as between-subjects factor and with self-efficacy, test anxiety, and procrastination measured after the intervention as respective dependent variables. As recommended by Van Breukelen (2006) , we also included the baseline values of each respective dependent variable as a covariate. Results revealed a statistically significant effect of the IBSR intervention on participants’ self-efficacy, F (1/63) = 5.49, p = 0.022, η 2 partial = 0.08, on participants’ test anxiety F (1/63) = 6.56, p = 0.013, η 2 partial = 0.09, and their procrastination F (1/62) = 5.85, p = 0.019, η 2 partial = 0.09. These results provide first preliminary evidence for the expected effects of the IBSR intervention.

Data Screening Procedure

As structural equation modeling procedures are susceptible to abnormalities in the data ( Kline, 2016 ), we examined if the data met the necessary requirements. To identify potential outliers, we first inspected the frequency distribution of the z -scores for all variables used in the statistical analyses. Applying the rule of | z | > 3.29 ( Tabachnick and Fidell, 2014 ), we did not detect any outliers in the data. Second, we relied on the variance inflation factor (VIF) to test for extreme collinearity. VIF values for all variables were lower than the threshold of 10.00 (all VIFs < 5.15). Therefore, extreme collinearity did not occur in the data. Third, to ensure the requirement of multivariate normality, we inspected the univariate frequency distributions for all variables (for all results see Table 4 ). Shapiro–Wilk tests were statistically non-significant for all variables except for test anxiety measured at time 2. However, visual inspection of the respective frequency distribution showed that it was close to normality. Based on the suggestion by Kline (2016) we proceeded to analyze that data using structural equation modeling without transformation of the respective variable.

Table 4. Univariate statistics for academic self-efficacy, test anxiety, and academic procrastination.

Direct and Indirect Effects of IBSR

The fit statistics of the model were acceptable to good, χ 2 (19) = 19.817, p = 0.406; CFI = 0.997; RMSEA = 0.025; SRMR = 0.081. Following the suggestion of Hayes (2013) , we only report unstandardized coefficients for all paths as standardized coefficients are not meaningful due to the dichotomous character of the group variable d (IBSR vs. control group). In the following, we report one-tailed p -values. Results provide evidence for the stability of all three dependent variables over time. With the exception of the second order autoregressive path for self-efficacy time 3 ( b = 0.158, SE = 0.118, p = 0.091), all other coefficients of first and second order autoregressive paths were statistically significant at a p -level of 0.05. As expected and in line with previous studies ( Van Eerde, 2003 ; Steel, 2007 ), at all three times of measurement, we found self-efficacy and test anxiety to be negatively correlated (time 1: b = –0.334, SE = 0.123, p = 0.004; time 2: b = –0.213, SE = 0.062, p < 0.001; time 3: b = –0.208, SE = 0.074, p = 0.003), procrastination and test anxiety to be positively associated (time 1: b = 0.439, SE = 0.137, p < 0.001; time 2: b = 0.273, SE = 0.089, p = 0.001; time 3: b = 0.126, SE = 0.052, p = 0.008), and negative relationships between self-efficacy and procrastination (time 1: b = –0.428, SE = 0.136, p = 0.001; time 2: b = –0.172, SE = 0.065, p = 0.004; time 3: b = –0.122, SE = 0.046, p = 0.004).

Direct and Indirect Effects of IBSR on Self-Efficacy (H 1 )

Right after the intervention, in line with our prediction, IBSR participants reported statistically significantly enhanced self-efficacy ( a 1 = 0.458, SE = 0.190, p = 0.008) in comparison to the control group. At the end of the term, the IBSR intervention no longer directly affected self-efficacy ( c 1 ’ = –0.192, SE = 0.173, p = 0.133). However, participants who had reported higher self-efficacy immediately after the intervention also reported higher self-efficacy at the end of the academic term ( b 11 = 0.669, SE = 0.120, p < 0.001). A bias-corrected 95% bootstrap confidence interval (BCI) for the indirect effect ( a 1 b 11 = 0.306) based on 10.000 bootstrap samples was entirely above zero (0.069 to 0.613). This indicates the IBSR intervention indirectly enhanced self-efficacy and that this effect lasted until the end of the term.

Direct and Indirect Effects of IBSR on Test Anxiety (H 2 )

Right after the intervention, IBSR participants reported statistically significantly less test anxiety ( a 2 = –0.545, SE = 0.221, p = 0.007) than participants of the control group. At the end of the term, the IBSR intervention no longer directly affected test anxiety ( c 2 ’ = –0.215, SE = 0.225, p = 0.170). However, we found an indirect effect of the IBSR intervention. Firstly, participants who had reported less test anxiety after the intervention also reported less test anxiety at the end of the academic term ( b 22 = 0.311, SE = 0.121, p = 0.005). A bias-corrected 95% BCI for the indirect effect ( a 2 b 22 = –0.169) was entirely under zero (–0.453 to –0.030). Secondly and as expected, participants who reported more self-efficacy after the intervention also reported statistically significant less test anxiety later on ( b 21 = –0.206, SE = 0.118, p = 0.040). A bias-corrected 90% BCI for the indirect effect ( a 1 b 21 = –0.094) was entirely under zero (–0.252 to –0.013). The total indirect effect of IBSR on test anxiety was also statistically significant ( b 2 = –0.264, SE = 0.115, p = 0.011), with its 95% BCI completely under zero (–0.542 to –0.078). Thus, the IBSR intervention reduced test anxiety at the end of the academic term indirectly via an immediate increase in self-efficacy and an immediate decrease in test anxiety.

Direct and Indirect Effects of IBSR on Procrastination (H 3 )

Right after the intervention, IBSR participants reported statistically significantly less procrastination ( a 3 = –0.520, SE = 0.199, p = 0.005) than participants of the control group. Even though the IBSR intervention no longer directly affected procrastination ( c 3 ’ = 0.085, SE = 0.146, p = 0.279) at the end of the term, we found an indirect effect of the IBSR intervention on procrastination, which is – as predicted – more complex in its nature. Firstly, the initial reduction of procrastination resulted in a lasting reduction of procrastination as participants who had reported less procrastination after the intervention also reported less procrastination at the end of the term ( b 33 = 0.680, SE = 0.107, p < 0.001). A bias-corrected 95% BCI for this specific indirect effect of IBSR ( a 3 b 33 = –0.354) was entirely under zero (–0.682 to –0.104). Secondly, and in contrast to our hypotheses, results revealed that participants with increased self-efficacy did not report statistically significant less procrastination at the end of the academic term ( b 31 = –0.035, SE = 0.088, p = 0.348). Accordingly, the specific indirect effect ( a 1 b 31 = –0.016) was statistically non-significant as confirmed by the bias-corrected 90% BCI (–0.107 to 0.040).

Thirdly, we predicted IBSR to indirectly reduce procrastination via an immediate reduction of test anxiety for participants of the intervention. Also, we had predicted that participants of the control group should demonstrate an increase of test anxiety and this increase in test anxiety to reduce procrastination (H 4 ). Thus, a significant coefficient was expected for the two-way interaction of Group × Test Anxiety (time 2). Results revealed that participants who had reported more test anxiety at time 2, reported statistically significant less procrastination at the end of the academic term ( b 32 = –0.296, SE = 0.098, p = 0.002). This effect was qualified by the predicted effect of the interaction of Group × Test Anxiety ( b 34 = 0.301, SE = 0.156, p = 0.027) which shows that experimental conditions had a differential effect on the causal relationship between test anxiety measured at time 2 and procrastination measured at time 3 (see Figure 2 ). For the control group, simple slopes analyses revealed a statistically significant effect of test anxiety (time 2) on procrastination (time 3) [ b 34 ( 0 ) = –0.296, SE = 0.098, p = 0.002, 95% BCI (–0.491 to –0.103)], while there was no effect for the IBSR group [ b 34 ( 1 ) = 0.005, SE = 0.145, p = 0.487, 90% BCI (–0.233 to 0.232)]. Altogether, for the IBSR group, we found a statistically significant total indirect effect of IBSR on procrastination [ b 3 ( 1 ) = –0.372, SE = 0.169, p = 0.014, 95% BCI (–0.751 to –0.083)], but not for the control group [ b 3 ( 0 ) = –0.208, SE = 0.130, p = 0.055, 90% BCI (–0.423 to 0.005)]. Thus, the IBSR intervention reduced procrastination at the end of the academic term indirectly, mainly via an immediate reduction of procrastination. For all results of the mediation analyses see Table 5 .

Figure 2. Conditional Parallel Multiple Mediation Models for Academic Procrastination Measured at Time 3. All continuous variables were z -standardized. All reported parameter estimates are unstandardized. N = 71. † p ≤ 0.10, ∗ p ≤ 0.05, ∗∗ p ≤ 0.01, ∗∗∗ p ≤ 0.001. Reported are significance levels based one-tailed p -values.

Table 5. Regression coefficients, standard errors, and model summary information for the conditional parallel multiple mediation models for academic procrastination measured at time 3.

In the present research, we investigated the effects of an IBSR short intervention on test anxiety, procrastination, and self-efficacy as well as their causal interplay in the last part of an academic term in a sample of university students suffering from test anxiety and procrastination. We had predicted the IBSR intervention to enhance self-efficacy (H 1 ) and this increase in self-efficacy – subsequently – to reduce test anxiety (H 2 ) and procrastination (H 3 ) for participants of the IBSR intervention. In contrast, we had also expected a decrease in procrastination for participants of the control group, but this decrease rather to be a consequence of an increase in test anxiety due to the approaching exams and deadlines (H 4 ). Results of the data analyses mostly support our hypotheses. Firstly, in accordance with our first hypothesis, results showed that the IBSR intervention increased participants’ self-efficacy and this effect to be stable until the end of the academic term. We interpret these results in accordance with the theoretical assumptions of CEST ( Epstein, 2003 ) and self-efficacy theory ( Bandura, 1977 ). Based on the rationale of both theories, we assume that information processing leading to cognitive appraisals (such as self-efficacy beliefs) is not only informed by conscious and rational reasons (i.e., verbal persuasion), but also by experience-based information stemming from experiential schemas and knowledge such as (vicarious) mastery experiences and current experience of physical arousal. Following from this, a permanent modification of cognitive appraisals (such as low self-efficacy beliefs) is assumed to follow from rational debate as well as from new – efficacy-enhancing – experiences. As IBSR allows for a debate of cognitive appraisals such as low self-efficacy beliefs through experiential self-exploration (e.g., by imagination of the testing situation without the distortions caused by participants’ low self-efficacy beliefs) and rational persuasion (e.g., through exploration of the validity of high self-efficacy beliefs), individuals should show increased self-efficacy after participation in an IBSR intervention. Secondly, we found a stable decrease in test anxiety for participants of the IBSR intervention, which was partly due to increased self-efficacy. This result is in line with control-value theory ( Pekrun, 2006 ), which states that test anxiety is caused by cognitive appraisals including (low) self-efficacy beliefs and matches existing empirical evidence showing the potential of IBSR to reduce test anxiety ( Krispenz and Dickhäuser, 2018 ). Thirdly, and for all participants, we found a lasting decrease in academic procrastination. However, in line with our assumptions, data analyses revealed this decrease in procrastination to be caused by different mechanisms for the respective groups. For the control group and as predicted by our fourth hypothesis, the reduction of procrastination was due to an increase in test anxiety [ b 34 ( 0 ) = –0.296, SE = 0.098, p = 0.002]. We interpret this effect in line with studies which found students to experience higher levels of anxiety ( Lay et al., 1989 ) before exams when they had delayed studying earlier in the semester and in accordance with TMT ( Steel, 2007 ), which assumes students to procrastinate less in the last stages of an academic term – as deadlines approach, students are forced to study for their exams if they want to avoid failing due to poor preparation. For intervention participants, results also revealed a long-term decrease in procrastination. However, this effect was – contrary to our third hypothesis – neither caused by an increase in self-efficacy nor by a (subsequent) decrease in test anxiety. Rather, the decrease in procrastination was caused by an immediate effect of the IBSR intervention on procrastination. In particular, we found the relationship between test anxiety and procrastination to completely vanish for IBSR participants in the time between the intervention till the end of the academic term [ b 34 ( 1 ) = 0.005, SE = 0.145, p = 0.487]. From this, we conclude that the IBSR method might have provided participants of the IBSR intervention with new means for emotional coping: As test anxiety is accompanied by states of unpleasant physical arousal and worry thoughts ( Pekrun, 2006 ), students often feel the desire to withdraw from the anxiety-causing situation ( Geen, 1987 ; Matthews et al., 1999 ). However, during the IBSR intervention seminars, test anxious students were taught to investigate their worry thoughts and to explore any accompanying unpleasant feelings and sensations with the IBSR method (Question 3; see Table 1 ). Additionally, students were enabled to mentally experience the anxiety-causing situation without the distortions caused by their worry thoughts (Question 4; see Table 1 ), which should allow them a new and potentially more positive experience (e.g., feelings of relief or curiosity). Therefore, when confronted with the unpleasant state of test anxiety after the IBSR intervention, IBSR participants might have no longer felt the need to withdraw from the situation through procrastination. Rather, they might have applied the IBSR method as an alternative coping strategy to deal with unpleasant physical arousal and worry thoughts. Nevertheless, additional data is needed to confirm this assumption.

The results of our study significantly contribute to the literature on IBSR. For the first time, they show that IBSR is potent not only in reducing test anxiety ( Krispenz and Dickhäuser, 2018 ), but also in enhancing academic self-efficacy and reducing academic procrastination. Our research also demonstrates that these effects last longer than 2 days and remain stable especially in the last stage of an academic term. The present study also overcomes the limitations of previous studies on IBSR. On the one hand and in contrast to Krispenz and Dickhäuser (2018) , we assisted IBSR participants in their first practice of IBSR, thereby avoiding any difficulties participants unfamiliar with IBSR might encounter when applying the IBSR method for the first time. On the other hand, in previous studies (e.g., Smernoff et al., 2015 ), participants usually attended a 9-day IBSR intervention making participation extremely time-consuming. In our study, the IBSR intervention lasted only 3 h which shows that participants can be trained to use the IBSR method more effectively.

Limitations

There are limitations to the present study which need to be acknowledged. Firstly, and even though we found IBSR to decrease procrastination, we did not find this decrease to be caused by the found increase in self-efficacy as TMT ( Steel, 2007 ) would predict. This result might be due to the fact that participants were not explicitly instructed to investigate only (low) self-efficacy beliefs but anxiety causing worry thoughts per se . Hence, future studies interested in further investigating the positive effects of IBSR on procrastination via an enhancement in self-efficacy could profit from guiding participants in identifying and exploring self-efficacy beliefs only. Also, at first view, the causal interpretation of the found effects is limited due to the fact that the present study did use a quasi-randomized control trial. Due to practical reasons, participants were assigned to the conditions (IBSR vs. control group) by choosing from the four possible intervention dates without knowing on what dates the IBSR intervention was actually scheduled. However, there is no reason to assume that participants preferences for dates was systematically associated with one of the outcome variables. This is also confirmed by the results showing that experimental groups did not statistically differ in their initial levels of the dependent variables. Further, the design of the present study allows for a rather conservative estimation of the effects of IBSR. We included an active control group instead of a neutral inactive control group. In particular, participants in the control group were completing activities (i.e., a 3-h seminar and a diary) which could have helped them to increase their self-efficacy and reduce their test anxiety and procrastination long-term. This might explain why some of the long-term direct effects of the IBSR intervention were not statistically significant when compared to the control group. To exclude this alternative explanation of the present results, future studies should use a 3-group design including an intervention group, an active control group, and a neutral control group. Also, instead of a general student population (see Krispenz and Dickhäuser, 2018 ), the present study explicitly addressed university students suffering from test anxiety and/or academic procrastination. Nevertheless, the IBSR intervention was given to all students who were interested in participating regardless of their initial levels of test anxiety. Future studies should investigate if the effects found in the present study are replicable in a sample of highly test anxious students.

Another important limitation of the present study is that we used complex path analysis to investigate the relationships among the variables of interest by using a sample of N = 71. As a consequence of the sample size, we were not able to specify latent variables in the model. Thus, future research should replicate the results of the present study by repeating the procedure with a larger sample to allow for analyzes of both observed and latent variables. Furthermore, the measurement of the dependent variables was restricted to the second part of an academic term. Accordingly, future studies should on the one hand investigate the causal interplay between self-efficacy, test anxiety, and procrastination over the course of a whole academic term. On the other hand, they should include an even longer follow-up period to investigate if the found effects hold even over a longer time period. Finally, future research should include additional measures related to self-efficacy, test anxiety, and procrastination such as academic performance (e.g., grades).

The present study provides preliminary evidence that IBSR is potent in enhancing self-efficacy as well as in reducing test anxiety and procrastination in a sample of university students suffering from test anxiety and procrastination. These findings have important practical implications for educational settings as students suffering from both phenomena might easily profit from learning the IBSR method considering that the method is guided by a simple and clear defined set of questions, allowing for a structured way of self -inquiry. As a consequence, the practice of IBSR does not require a therapeutic setting. This makes the IBSR method easily available and potentially helpful to anyone who wants to change their negative thinking.

Data Availability

The datasets generated for this study are available on request to the corresponding author.

Ethics Statment

Ethical review and approval was not required for the study on human participants in accordance with the local legislation and institutional requirements. The patients/participants provided their written informed consent to participate in this study.

Author Contributions

AK, CG, and LS developed the study concept and design, and collected the data. AK and OD analyzed and interpreted the data. AK drafted the manuscript. OD, CG, and LS critically revised the manuscript. All authors approved the final version to be published, and agreed to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.

The publication of this article was funded by the Ministry of Science, Research and the Arts of Baden-Württemberg and the University of Mannheim, Germany.

Conflict of Interest Statement

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

• ^ Note that test anxiety and self-efficacy were also assessed immediately after the initial intervention. Since there was no matching score for procrastination due to the specifics of the APSI-d ( Patzelt and Opitz, 2014 ) those data were not included in the data analyses. Further, since the present study was part of a bigger research project, additional data was collected measuring moderating variables such as self-compassion, mindfulness, and the big five personality traits. The results of the respective data will be published in another paper and were also not included in the present data analyses.

Bandura, A. (1977). Self-efficacy: toward a unifying theory of behavioral change. Psychol. Rev. 84, 191–215. doi: 10.1037/0033-295X.84.2.191

CrossRef Full Text | Google Scholar

Bertrams, A., and Englert, C. (2013). Validierung des STAI-SKD zur Messung von Zustandsangst in echten Prüfungssituationen [validation of the STAI-SKD for the assessment of state anxiety in real testing situations]. Psychologie in Erziehung und Unterricht 60, 112–120. doi: 10.2378/peu2013.art09d

Briñol, P., McChaslin, M. J., and Petty, R. E. (2012). Self-generated persuasion: effects of the target and direction of arguments. J. Pers. Soc. Psychol. 102, 925–940. doi: 10.1037/a0027231

PubMed Abstract | CrossRef Full Text | Google Scholar

Ellis, A. (2002). “Rational emotive behavior therapy,” in Encyclopedia of Psychotherapy , eds M. Hersen and W. Sledge (Amsterdam: Elsevier).

Google Scholar

Epstein, S. (2003). “Cognitive-experiential self-theory of personality,” in Handbook of Psychology: Personality and Social Psychology , eds T. Millon and M. J. Lerner (Hoboken, NJ: Wiley).

Ergene, T. (2003). Effective interventions on test anxiety reduction: a meta-analysis. Sch. Psychol. Int. 24, 313–328. doi: 10.1177/01430343030243004

Ferrari, J. R., O’Callaghan, J., and Newbegin, I. (2005). Prevalence of procrastination in the United States, United Kingdom, and Australia: arousal and avoidance delays among adults. N. Am. J. Psychol. 7, 1–6.

Frazier, P. A., Tix, A. P., and Barron, K. E. (2004). Testing moderator and mediator effects in counseling psychology research. J. Counsel. Psychol. 51, 115–134. doi: 10.1037/0022-0167.51.1.115

Geen, R. G. (1987). Test anxiety and behavioral avoidance. J. Res. Personal. 21, 481–488. doi: 10.1016/0092-6566(87)90034-1

Geiser, C. (2013). Data Analysis with Mplus. New York, NY: Guilford Press.

Haycock, L. A., McCarthy, P., and Skay, C. L. (1998). Procrastination in college students: the role of self-efficacy and anxiety. J. Counsel. Dev. 76, 317–324. doi: 10.1002/j.1556-6676.1998.tb02548.x

Hayes, A. F. (2013). Introduction to Mediation, Moderation, and Conditional Process Analysis. New York, NY: The Guilford Press.

Iacobucci, D., Saldanha, N., and Deng, X. (2007). A meditation on mediation: evidence that structural equations models perform better than regressions. J. Consum. Psychol. 17, 139–153. doi: 10.1016/s1057-7408(07)70020-7

Jerusalem, M., and Schwarzer, R. (1986). “Selbstwirksamkeit (Self-efficacy),” in Skalen Zur Befindlichkeit und Persönlichkeit , ed. R. Schwarzer (Berlin: Freie Universität Berlin).

Kline, R. B. (2016). Principles and Practices of Structural Equation Modeling , 4th Edn. New York, NY: The Guilford Press.

Krispenz, A., and Dickhäuser, O. (2018). Effects of an inquiry-based short intervention on state test anxiety in comparison to alternative coping strategies. Front. Psychol. 9:201. doi: 10.3389/fpsyg.2018.00201

Lay, C. H., Edwards, J. M., Parker, J. D. A., and Endler, N. S. (1989). An assessment of appraisal, anxiety, coping, and procrastination during an examination period. Eur. J. Personal. 3, 195–208. doi: 10.1002/per.2410030305

Leufke, R., Zilcha-Mano, S., Feld, A., and Lev-ari, S. (2013). Effects of “The Work” meditation on psychopathological symptoms. Altern. Complement. Ther. 19, 147–151. doi: 10.1089/act.2013.19303

Little, R. J. A. (1988). A test of missing completely at random for multivariate data with missing values. J. Am. Stat. Assoc. 83, 1198–1202. doi: 10.1080/01621459.1988.10478722

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). J. Psychoeduc. Assess. 26, 215–230. doi: 10.1177/0734282907303760

Matthews, G., Hillyard, E. J., and Campbell, S. E. (1999). Metacognition and maladaptive coping as components of test anxiety. Clin. Psychol. Psychother. 6, 111–125.

Mitchell, B. K., and Mitchell, S. (2003). Loving What is: Four Questions That Can Change Your Life , 2nd Edn. New York, NY: Three Rivers Press.

Muthén, L. K., and Muthén, B. O. (1998–2012). Mplus User’s Guide , 7th Edn. Los Angeles, CA: Muthén & Muthén.

Newson, J. T. (2015). Longitudinal Structural Equation Modeling. New York, NY: Routledge.

Nickerson, R. S. (1998). Confirmation bias: a ubiquitous phenomenon in many guises. Rev. Gen. Psychol. 2, 175–220. doi: 10.1037/1089-2680.2.2.175

Patzelt, J., and Opitz, I. (2014). “German version of the academic procrastination state inventory (APSI-d),” in Compilation of Social Science Items and Scales , eds J. Patzelt and I. Opitz (Germany: GESIS – Leibniz Institute for the Social Sciences).

Pekrun, R. (2006). The control-value theory of achievement emotions: assumptions, corollaries, and implications for educational research and practice. Educ. Psychol. Rev. 18, 315–341. doi: 10.1007/s10648-006-9029-9

Pekrun, R., Frenzel, A. C., Goetz, T., and Perry, R. P. (2007). “The control-value theory of achievement emotions: an integrative approach to emotions in education,” in Educational Psychology: Emotion in Education , eds P. Schutz and R. Pekrun (Burlington, MA: Academic Press).

Pekrun, R., and Stephens, E. J. (2009). Goals, emotions, and emotion regulation: perspectives of the control-value theory. Hum. Dev. 52, 357–365. doi: 10.1159/000242349

Putwain, D., and Daly, A. L. (2014). Test anxiety prevalence and gender differences in a sample of english secondary school students. Educ. Stud. 40, 554–570. doi: 10.1080/03055698.2014.953914

Rozental, A., Bennett, S., Forsström, D., Ebert, D. D., Shafran, R., Andersson, G., et al. (2018). Targeting procrastination using psychological treatments: a systematic review and meta-analysis. Front. Psychol. 9:1588. doi: 10.3389/fpsychg.2018.01588

Schermelleh-Engel, K., Moosbrugger, H., and Müller, H. (2003). Evaluating the fit of structural equations models: tests of significance and descriptive goodness-of-fit measures. Methods Psychol. Res. 8, 23–74.

Schlomer, G. L., Bauman, S., and Card, N. A. (2010). Best practices for missing data management in counseling psychology. J. Counsel. Psychol. 57, 1–10. doi: 10.1037/a0018082

Smernoff, E., Mitnik, I., Kolodner, K., and Lev-ari, S. (2015). The effects of “The Work” meditation (byron katie) on psychological symptoms and quality of life – a pilot clinical study. Explore 11, 24–31. doi: 10.1016/j.explore.2014.10.003

Steel, P. (2007). The nature of procrastination: a meta-analytic and theoretical review of quintessential self-regulatory failure. Psychol. Bull. 133, 65–94. doi: 10.1037/0033-2909.133.1.65

Steinmayr, R., Crede, J., McElvany, N., and Wirthwein, L. (2016). Subjective well-being, test anxiety, academic achievement: testing for reciprocal effects. Front. Psychol. 6:1994. doi: 10.3389/fpsyg.2015.01994

Tabachnick, B. G., and Fidell, L. S. (2014). Using Multivariate Statistics , 6th Edn. Harlow: Pearson Education Limited.

Thomas, C. L., Cassady, J. C., and Finch, W. H. (2018). Identifying severity standards on the cognitive test anxiety scale: cut score determination using latent class and cluster analysis. J. Psychoeduc. Assess. 36, 492–508.

Tice, D. M., and Baumeister, R. F. (1997). Longitudinal study of procrastination, performance, stress, and health: the costs and benefits of dawdling. Psychol. Sci. 8, 454–458. doi: 10.1111/j.1467-9280.1997.tb00460.x

Van Breukelen, G. J. P. (2006). Ancova versus change from baseline had more power in randomized studies and more bias in nonrandomized studies. J. Clin. Epidemiol. 59, 920–925. doi: 10.1016/j.jclinepi.2006.02.007

Van Eerde, W. (2003). A meta-analytically derived nomological network of procrastination. Personal. Individ. Differ. 35, 1401–1418. doi: 10.1016/S0191-8869(02)00358-6

Van Eerde, W., and Klingsiek, K. B. (2018). Overcoming procrastination? A meta-analysis of intervention studies. Educ. Res. Rev. 25, 73–85. doi: 10.1016/j.edurev.2018.09.002

Von der Embse, N., Barterian, J., and Segool, N. (2013). Test anxiety interventions for children and adolescents: a systematic review of treatment studies from 2000–2010. Psychol. Sch. 50, 57–71. doi: 10.1002/pits.21660

Yerdelen, S., McCaffrey, A., and Klassen, R. M. (2016). Longitudinal examination of procrastination and anxiety, and their relation to self-efficacy for self-regulated learning: latent growth curve modeling. Educ. Sci. Theory Pract. 16, 5–22. doi: 10.12738/estp.2016.1.0108

Keywords : educational psychology, test anxiety, academic self-efficacy, academic procrastination, cognitive appraisals, inquiry-based stress reduction

Citation: Krispenz A, Gort C, Schültke L and Dickhäuser O (2019) How to Reduce Test Anxiety and Academic Procrastination Through Inquiry of Cognitive Appraisals: A Pilot Study Investigating the Role of Academic Self-Efficacy. Front. Psychol. 10:1917. doi: 10.3389/fpsyg.2019.01917

Received: 14 June 2019; Accepted: 05 August 2019; Published: 20 August 2019.

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Copyright © 2019 Krispenz, Gort, Schültke and Dickhäuser. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY) . The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.

*Correspondence: Ann Krispenz, [email protected]

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Test Anxiety and Physiological Arousal: A Systematic Review and Meta-Analysis

• Review Article
• Published: 16 August 2020
• Volume 33 , pages 579–618, ( 2021 )

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• Anna-Lena Roos 1 ,
• Thomas Goetz 2 ,
• Martin Voracek 3 ,
• Maike Krannich 4 ,
• Madeleine Bieg 5 ,
• Amanda Jarrell 6 &
• Reinhard Pekrun 7 , 8 , 9  

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Test anxiety is a widespread and mostly detrimental emotion in learning and achievement settings. Thus, it is a construct of high interest for researchers and its measurement is an important issue. So far, test anxiety has typically been assessed using self-report measures. However, physiological measures (e.g., heart rate or skin conductance level) have gained increasing attention in educational research, as they allow for an objective and often continuous assessment of students’ physiological arousal (i.e., the physiological component of test anxiety) in real-life situations, such as a test. Although theoretically one would assume self-report measures of test anxiety and objective physiological measures would converge, empirical evidence is scarce and findings have been mixed. To achieve a more coherent picture of the relationship between these measures, this systematic review and meta-analysis investigated whether higher self-reported test anxiety is associated with expected increases in objectively measured physiological arousal. A systematic literature search yielded an initial 231 articles, and a structured selection process identified 29 eligible articles, comprising 31 studies, which met the specified inclusion criteria and provided sufficient information about the relationship under investigation. In line with theoretical models, in 21 out of the 31 included studies, there was a significant positive relationship between self-reported test anxiety and physiological arousal. The strengths of these correlations were of medium size. Moderators influencing the relation between these two measures are discussed, along with implications for the assessment of physiological data in future classroom-based research on test anxiety.

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Theory of Human Motivation—Abraham Maslow

The Impact of Peer Assessment on Academic Performance: A Meta-analysis of Control Group Studies

Allen, G., Elias, M., & Zlotlow, S. (1980). Behavioral interventions for alleviating test anxiety: a methodological overview of current therapeutic practices. In I. G. Sarason (Ed.), Test anxiety: Theory, research and applications (pp. 155–185). Hillside: Erlbaum.

Google Scholar  

Alpert, R., & Haber, R. N. (1960). Anxiety in academic achievement situations. Journal of Abnormal and Social Psychology, 61 (2), 207–215. https://doi.org/10.1037/h0045464 .

Article   Google Scholar  

Avram, R., Kuhar, P., Vittinghoff, E., Aschbacher, K., Tison, G., Pletcher, M., et al. (2018). Redefining normal resting heart rate values using Big Data. Circulation, 138 (Suppl_1), A15098. https://doi.org/10.1161/circ.138.suppl_1.15098 .

Barrett, L. F. (2014). The conceptual act theory: a précis. Emotion Review, 6 (4), 292–297.

Beidel, D. C. (1988). Psychophysiological assessment of anxious emotional states in children. Journal of Abnormal Psychology, 97 (1), 80–82. https://doi.org/10.1037/0021-843X.97.1.80 .

Beidel, D. C., & Turner, S. M. (1988). Comorbidity of test anxiety and other anxiety disorders in children. Journal of Abnormal Child Psychology, 16 (3), 275–287. https://doi.org/10.1007/BF00913800 .

Beidel, D. C., Turner, M. W., & Trager, K. N. (1994). Test anxiety and childhood anxiety disorders in African American and white school children. Journal of Anxiety Disorders, 8 (2), 169–179. https://doi.org/10.1016/0887-6185(94)90014-0 .

Berntson, G. G., Norman, G. J., Hawkley, L. C., & Cacioppo, J. T. (2008). Cardiac autonomic balance versus cardiac regulatory capacity. Psychophysiology, 45 (4), 643–652. https://doi.org/10.1111/j.1469-8986.2008.00652.x .

Bigger, J. T., Fleiss, J. L., Steinman, R. C., Rolnitzky, L. M., Kleiger, R. E., & Rottman, J. N. (1992). Frequency domain measures of heart period variability and mortality after myocardial infarction. Circulation, 85 (1), 164–171. https://doi.org/10.1161/circ.85.1.1728446 .

Borenstein, M. (2019). Common mistakes in meta-analysis and how to avoid them . Englewood: Biostat.

Borenstein, M., Hedges, L., Higgins, J., & Rothstein, H. (2013). Comprehensive meta-analysis, version 3 [computer software] . Englewood: Biostat.

Boucsein, W. (2012). Electrodermal activity (2ed.) . New York: Springer Science & Business Media.

Book   Google Scholar  

Bouma, E. M., Riese, H., Ormel, J., Verhulst, F. C., & Oldehinkel, A. J. (2009). Adolescents’ cortisol responses to awakening and social stress; effects of gender, menstrual phase and oral contraceptives. The TRAILS study. Psychoneuroendocrinology, 34 (6), 884–893.

Buehler, R., & McFarland, C. (2001). Intensity bias in affective forecasting: the role of temporal focus. Personality and Social Psychology Bulletin, 27 (11), 1480–1493. https://doi.org/10.1177/01461672012711009 .

Cacioppo, J. T., Berntson, G. G., Larsen, J. T., Poehlmann, K. M., & Ito, T. A. (2000). The psychophysiology of emotion. In M. Lewis & J. Haviland-Jones (Eds.), The handbook of emotions (pp. 173–191). New York: Guildford Press.

Calvo, M. G., & Miguel-Tobal, J. J. (1998). The anxiety response: concordance among components. Motivation and Emotion, 22 (3), 211–230. https://doi.org/10.1023/A:1022384022641 .

Campbell, S. B. (1986). Developmental issues in childhood anxiety. In R. Gittelman (Ed.), Anxiety Disorders of Childhood (pp. 24–57). New York: Guilford.

Carlson, N. (2013). Physiology of behavior . New Jersey: Pearson Education, Inc..

Cassady, J. C., & Johnson, R. E. (2002). Cognitive test anxiety and academic performance. Contemporary Educational Psychology, 27 (2), 270–295. https://doi.org/10.1006/ceps.2001.1094 .

Carver, C. S., Scheier, M. F. (1994). Situational coping and coping dispositions in a stressful transaction.. Journal of Personality and Social Psychology, 66 (1):184–195

Chorot, P., & Sandin, B. (1985). The Anxiety State Bahavioral-Scale. PSIQUIS, 6 (3), 60–65.

Cohen, J. (1988). Statistical power analysis for the behavioral sciences (2ed.) . Hillsdale: Erlbaum.

Cohen, M., & Khalaila, R. (2014). Saliva pH as a biomarker of exam stress and a predictor of exam performance. Journal of Psychosomatic Research, 77 (5), 420–425. https://doi.org/10.1016/j.jpsychores.2014.07.003 .

Conley, K. M., & Lehman, B. J. (2012). Test anxiety and cardiovascular responses to daily academic stressors. Stress and Health, 28 (1), 41–50. https://doi.org/10.1002/smi.1399 .

Curran, J. P., & Cattell, R. B. (1976). Manual for the eight state questionnaire: 8SQ . Champaign: Institute for Personality and Ability Testing.

Daly, A. L., Chamberlain, S., & Spalding, V. (2011). Test anxiety, heart rate and performance in A-level French speaking mock exams: an exploratory study. Educational Research, 53 (3), 321–330. https://doi.org/10.1080/00131881.2011.598660 .

Darley, S. A., & Katz, I. (1973). Heart Rate Changes in Children as a Function of Test versus Game Instructions and Test Anxiety. Child Development, 44 , 784–789.

Deffenbacher, J. L. (1986). Cognitive and physiological components of test anxiety in real-life exams. Cognitive Therapy and Research, 10 (6), 635–644. https://doi.org/10.1007/BF01173751 .

Deffenbacher, J. L., & Hazaleus, S. L. (1985). Cognitive, emotional, and physiological components of test anxiety. Cognitive Therapy and Research, 9 (2), 169–180. https://doi.org/10.1007/BF01204848 .

Dickerson, S. S., & Kemeny, M. E. (2004). Acute stressors and cortisol responses: a theoretical integration and synthesis of laboratory research. Psychological Bulletin, 130 (3), 355–391. https://doi.org/10.1037/0033-2909.130.3.355 .

D'Mello, S., & Calvo, R. A. (2013). Beyond the basic emotions: what should affective computing compute? In CHI'13 Extended Abstracts on Human Factors in Computing Systems, 2013 (pp. 2287-2294): ACM

D'Mello, S. K., Kappas, A., & Gratch, J. (2018). The affective computing approach to affect measurement. Emotion Review, 10 (2), 174–183.

Dorn, L. D., Lucke, J. F., Loucks, T. L., & Berga, S. L. (2007). Salivary cortisol reflects serum cortisol: analysis of circadian profiles. Annals of Clinical Biochemistry, 44 (3), 281–284. https://doi.org/10.1258/000456307780480954 .

Endler, N. S., & Magnusson, D. (1977). The interaction model of anxiety: an empirical test in an examination situation. Canadian Journal of Behavioural Science, 9 (2), 101–107. https://doi.org/10.1037/h0081612 .

Endler, N. S., & Okada, M. (1975). A multidimensional measure of trait anxiety: the SR inventory of general trait anxiousness. Journal of Consulting and Clinical Psychology, 43 (3), 319–329.

Endler, N. S., Edwards, J. M., & Vitelli, R. (1991). Endler multidimensional anxiety scales (EMAS) . Los Angeles: Western Psychological Services.

Fredrickson, B. L., & Kahneman, D. (1993). Duration neglect in retrospective evaluations of affective episodes. Journal of Personality and Social Psychology, 65 (1), 45–55. https://doi.org/10.1037/0022-3514.65.1.45 .

Glazeski, R. C., Hollandsworth, J. G., & Jones, G. E. (1986). An investigation of the role of physiological arousal in test anxiety. Educational & Psychological Research, 6 (2).

Goetz, T., Bieg, M., Lüdtke, O., Pekrun, R., & Hall, N. C. (2013). Do girls really experience more anxiety in mathematics? Psychological Science, 24 (10), 2079–2087.

Gordon, M. E., Slade, L. A., & Schmitt, N. (1986). The “science of the sophomore” revisited: from conjecture to empiricism. Academy of Management Review, 11 (1), 191–207. https://doi.org/10.5465/amr.1986.4282666 .

Hansen, Å. M., Garde, A. H., & Persson, R. (2008). Sources of biological and methodological variation in salivary cortisol and their impact on measurement among healthy adults: a review. Scandinavian Journal of Clinical and Laboratory Investigation, 68 (6), 448–458. https://doi.org/10.1080/00365510701819127 .

Harleston, B. W. (1962). Test anxiety and performance in problem-solving situations. Journal of Personality, 30 (4), 557–573. https://doi.org/10.1111/j.1467-6494.1962.tb01689.x .

Harleston, B. W., Smith, M. G., & Arey, D. (1965). Test-anxiety level, heart rate, and anagram problem solving. Journal of Personality and Social Psychology, 1 (6), 551–557. https://doi.org/10.1037/h0021991 .

Harley, J. M. (2015). Measuring emotions: a survey of cutting-edge methodologies used in computer-based learning environment research. In S. Tettegah & M. Gartmeier (Eds.), Emotions, technology, design, and learning (pp. 89–114). London: Academic Press, Elsevier.

Hembree, R. (1988). Correlates, causes, effects, and treatment of test anxiety. Review of Educational Research, 58 (1), 47–77. https://doi.org/10.2307/1170348 .

Herbert, J., Moore, G., De La Riva, C., & Watts, F. (1986). Endocrine responses and examination anxiety. Biological Psychology, 22 (3), 215–226. https://doi.org/10.1016/0301-0511(86)90027-X .

Hodges, W. (2015). The psychophysiology of anxiety. In M. Zuckerman & C. D. Spielberger (Eds.), Emotions and anxiety (PLE: Emotion): new concepts, methods, and applications (pp. 175–192). Psychology Press.

Hollandsworth, J. G., Glazeski, R. C., Kirkland, K., Jones, G. E., & Van Norman, L. R. (1979). An analysis of the nature and effects of test anxiety: cognitive, behavioral, and physiological components. Cognitive Therapy and Research, 3 (2), 165–180. https://doi.org/10.1007/BF01172603 .

Holroyd, K. A., Westbrook, T., Wolf, M., & Badhorn, E. (1978). Performance, cognition, and physiological responding in test anxiety. Journal of Abnormal Psychology, 87 (4), 442.

Houtveen, J. H., & de Geus, E. J. (2009). Noninvasive psychophysiological ambulatory recordings: study design and data analysis strategies. European Psychologist, 14 (2), 132–141. https://doi.org/10.1027/1016-9040.14.2.132 .

Hugdahl, K. (1995). Psychophysiology: the mind-body perspective . Cambridge: Harvard University Press.

Humphrey, S. P., & Williamson, R. T. (2001). A review of saliva: normal composition, flow, and function. The Journal of Prosthetic Dentistry, 85 (2), 162–169. https://doi.org/10.1067/mpr.2001.113778 .

Huwe, S., Hennig, J., & Netter, P. (1998). Biological, emotional, behavioral, and coping reactions to examination stress in high and low state anxious subjects. Anxiety, Stress & Coping, 11 (1), 47–65. https://doi.org/10.1080/10615809808249313 .

Jamieson, J. P., Nock, M. K., & Mendes, W. B. (2012). Mind over matter: reappraising arousal improves cardiovascular and cognitive responses to stress. Journal of Experimental Psychology . General, 141 (3), 417–422. https://doi.org/10.1037/a0025719 .

Janke, W., & Debus, G. (1978). Die Eigenschaftswörterliste: EWL; Eine mehrdimensionale Methode zur Beschreibung von Aspekten des Befindens . Goettingen: Hogrefe.

Johnston, D. W., Anastasiades, P., & Wood, C. (1990). The relationship between cardiovascular responses in the laboratory and in the field. Psychophysiology, 27 (1), 34–44. https://doi.org/10.1111/j.1469-8986.1990.tb02175.x .

Kajantie, E., & Phillips, D. I. (2006). The effects of sex and hormonal status on the physiological response to acute psychosocial stress. Psychoneuroendocrinology, 31 (2), 151–178.

Kantor, L., Endler, N. S., Heslegrave, R. J., & Kocovski, N. L. (2001). Validating self-report measures of state and trait anxiety against a physiological measure. Current Psychology, 20 (3), 207–215. https://doi.org/10.1007/s12144-001-1007-2 .

Kaplan, S., Dalal, R. S., & Luchman, J. N. (2013). Measurement of emotions. In Research methods in occupational health psychology: measurement, design, and data analysis (pp. 61–75). New York: Routledge.

King, N. J., Ollendick, T. H., & Prins, P. J. (2000). Test-anxious children and adolescents: psychopathology, cognition, and psychophysiological reactivity. Behaviour Change, 17 (3), 134–142. https://doi.org/10.1375/bech.17.3.134 .

Kissel, S., & Littig, L. W. (1962). Test anxiety and skin conductance. The Journal of Abnormal and Social Psychology, 65 (4), 276.

Kleinginna, P. R., & Kleinginna, A. M. (1981). A categorized list of emotion definitions, with suggestions for a consensual definition. Motivation and Emotion, 5 (4), 345–379.

Kreibig, S. D. (2010). Autonomic nervous system activity in emotion: a review. Biological Psychology, 84 (3), 394–421. https://doi.org/10.1016/j.biopsycho.2010.03.010 .

Kudielka, B. M., Hellhammer, D. H., & Kirschbaum, C. (2000). Sex differences in human stress response. In Stress Consequences: Mental, Neuropsychological and Socioeconomic (Vol. 3). San Diego: Academic Press.

Larsen, R. J., & Prizmic-Larsen, Z. (2006). Measuring emotions: implications of a multimethod perspective. In M. Eid & E. Diener (Eds.), Handbook of multimethod measurement in psychology (pp. 337–351). Washington, DC: American Psychological Association.

Chapter   Google Scholar  

Lench, H. C., Flores, S. A., & Bench, S. W. (2011). Discrete emotions predict changes in cognition, judgment, experience, behavior, and physiology: a meta-analysis of experimental emotion elicitations. Psychological Bulletin, 137 (5), 834–855. https://doi.org/10.1037/a0024244 .

Lench, H. C., Bench, S. W., & Flores, S. A. (2013). Searching for evidence, not a war: Reply to Lindquist, Siegel, Quigley, and Barrett (2013). Psychological Bulletin, 113 (1), 264–268.

Liebert, R. M., & Morris, L. W. (1967). Cognitive and emotional components of test anxiety: a distinction and some initial data. Psychological Reports, 20 (3), 975–978. https://doi.org/10.2466/pr0.1967.20.3.975 .

Lindquist, K. A., Siegel, E. H., Quigley, K. S., & Barrett, L. F. (2013). The hundred-year emotion war: are emotions natural kinds or psychological constructions? Comment on Lench, Flores, and Bench (2011). Psychological Bulletin, 139 (1), 264–268.

Lipsey, M. W., & Wilson, D. B. (2001). Practical meta-analysis . Thousand Oaks: Sage.

Liu, J. J. W., Ein, N., Peck, K., Huang, V., Pruessner, J. C., & Vickers, K. (2017). Sex differences in salivary cortisol reactivity to the Trier Social Stress Test (TSST): A meta-analysis. Psychoneuroendocrinology, 82 , 26–37. https://doi.org/10.1016/j.psyneuen.2017.04.007 .

Lundberg, U. (2005). Stress hormones in health and illness: the roles of work and gender. Psychoneuroendocrinology, 30 (10), 1017–1021. https://doi.org/10.1016/j.psyneuen.2005.03.014 .

Mandler, G., & Kremen, I. (1958). Autonomic feedback: a correlational study. Journal of Personality, 26 (3), 388–399. https://doi.org/10.1111/j.1467-6494.1958.tb01594.x .

Mandler, G., & Sarason, S. B. (1952). A study of anxiety and learning. The Journal of Abnormal and Social Psychology, 47 (2), 166–173.

Marques, A. H., Silverman, M. N., & Sternberg, E. M. (2010). Evaluation of stress systems by applying noninvasive methodologies: measurements of neuroimmune biomarkers in the sweat, heart rate variability and salivary cortisol. Neuroimmunomodulation, 17 (3), 205–208. https://doi.org/10.1159/000258725 .

Martin, B. (1961). The assessment of anxiety by physiological behavioral measures. Psychological Bulletin, 58 (3), 234–255. https://doi.org/10.1037/h0045492 .

Matthews, G., Hillyard, E. J., & Campbell, S. E. (1999). Metacognition and maladaptive coping as components of test anxiety. Clinical Psychology & Psychotherapy, 6 (2), 111–125.

Matthews, K. A., Salomon, K., Brady, S. S., & Allen, M. T. (2003). Cardiovascular reactivity to stress predicts future blood pressure in adolescence. Psychosomatic Medicine, 65 (3), 410–415. https://doi.org/10.1097/01.PSY.0000057612.94797.5F .

Mauss, I. B., & Robinson, M. D. (2009). Measures of emotion: a review. Cognition and Emotion, 23 (2), 209–237. https://doi.org/10.1080/02699930802204677 .

Mauss, I. B., Levenson, R. W., McCarter, L., Wilhelm, F. H., & Gross, J. J. (2005). The tie that binds? Coherence among emotion experience, behavior, and physiology. Emotion, 5 (2), 175–190. https://doi.org/10.1037/1528-3542.5.2.175 .

McCraty, R., & Zayas, M. A. (2014). Cardiac coherence, self-regulation, autonomic stability, and psychosocial well-being. Frontiers in Psychology, 5 , 1090. https://doi.org/10.3389/fpsyg.2014.01090 .

McCraty, R., Atkinson, M., Tiller, W. A., Rein, G., & Watkins, A. D. (1995). The effects of emotions on short-term power spectrum analysis of heart rate variability. The American journal of cardiology, 76 (14), 1089–1093. https://doi.org/10.1016/S0002-9149(99)80309-9 .

McDonald, A. S. (2001). The prevalence and effects of test anxiety in school children. Educational Psychology, 21 (1), 89–101. https://doi.org/10.1080/01443410020019867 .

McGlynn, F. D., Bichajian, C., Giesen, J. M., Rullan, C. M., & Pulver, L. (1981). Factorial study of component procedures in desensitization treatment of test anxiety among college students. Psychological Reports, 49 (2), 351–362. https://doi.org/10.2466/pr0.1981.49.2.351 .

Montgomery, G. K. (1977). Effects of performance evaluation and anxiety on cardiac response in anticipation of difficult problem solving. Psychophysiology, 14 (3), 251–257. https://doi.org/10.1111/j.1469-8986.1977.tb01170.x .

Morris, L. W., & Liebert, R. M. (1970). Relationship of cognitive and emotional components of test anxiety to physiological arousal and academic performance. Journal of Consulting and Clinical Psychology, 35 (3), 332–337. https://doi.org/10.1037/h0030132 .

Morris, L. W., Davis, M. A., & Hutchings, C. H. (1981). Cognitive and emotional components of anxiety: literature review and a revised worry–emotionality scale. Journal of Educational psychology, 73 (4), 541–555. https://doi.org/10.1037/0022-0663.73.4.541 .

Morse, D. R., Schacterle, G. R., Furst, M. L., Esposito, J., & Zaydenburg, M. (1982). Stress, relaxation and saliva: relationship to dental caries and its prevention, with a literature review. Annals of Dentistry, 42 (2), 47–54.

Myrtek, M., Dieterle, W., & Brügner, G. (1990). Psychophysiological response patterns to variations of the experimental load of a reaction time task. Journal of Psychophysiology, 4 ( 3 ), 209–220.

Obrist, P. A. (1976). The cardiovascular-behavioral interaction—as it appears today. Psychophysiology, 13 (2), 95–107. https://doi.org/10.1111/j.1469-8986.1976.tb00081.x .

Pekrun, R., & Bühner, M. (2014). Self-report measures of academic emotions. In R. Pekrun & L. Linnenbrink-Garcia (Eds.), International handbook of emotions in education (pp. 561–579). New York: Taylor & Francis.

Pekrun, R., Goetz, T., & Titz, W. (2002). Academic emotions in students’ self regulated learning and achievement: a program of quantitative and qualitative research. Educational Psychologist, 37 (2), 91–106. https://doi.org/10.1207/S15326985EP3702_4 .

Pekrun, R., Goetz, T., Perry, R. P., Kramer, K., Hochstadt, M., & Molfenter, S. (2004). Beyond test anxiety: development and validation of the Test Emotions Questionnaire (TEQ). Anxiety, Stress & Coping, 17 (3), 287–316. https://doi.org/10.1080/10615800412331303847 .

Pekrun, R., Goetz, T., Frenzel, A. C., Barchfeld, P., & Perry, R. P. (2011). Measuring emotions in students’ learning and performance: The Achievement Emotions Questionnaire (AEQ). Contemporary Educational Psychology, 36 (1), 36–48. https://doi.org/10.1016/j.cedpsych.2010.10.002 .

Podsakoff, N. (2003). Common method biases in behavioral research: a critical review of the literature and recommended remedies. Journal of Applied Psychology, 88 (5), 879–903.

Pollard, T. M. (1995). Use of cortisol as a stress marker: practical and theoretical problems. American Journal of Human Biology, 7 (2), 265–274. https://doi.org/10.1002/ajhb.1310070217 .

Putwain, D. (2007). Researching academic stress and anxiety in students: some methodological considerations. British Educational Research Journal, 33 (2), 207–219. https://doi.org/10.1080/01411920701208258 .

Raphelson, A. C. (1957). The relationships among imaginative, direct verbal, and physiological measures of anxiety in an achievement situation. The Journal of Abnormal and Social Psychology, 54 (1), 13–18. https://doi.org/10.1037/h0041374 .

Ringeisen, T., Lichtenfeld, S., Becker, S., & Minkley, N. (2019). Stress experience and performance during an oral exam: the role of self-efficacy, threat appraisals, anxiety, and cortisol. Anxiety, Stress, & Coping, 32 (1), 50–66.

Ringeisen, T., & Buchwald, P. (2010). Test anxiety and positive and negative emotional states during an examination. Cognition, Brain, Behavior, 14 (4), 431.

Robinson, M. D., & Clore, G. L. (2002). Belief and feeling: evidence for an accessibility model of emotional self-report. Psychological Bulletin, 128 (6), 934–960. https://doi.org/10.1037/0033-2909.128.6.934 .

Rosenberg, E., & Ekman, P. (1994). Coherence between expressive and experiential systems in emotion. Cognition & Emotion, 8 (3), 201–229.

Rothstein, H. R., Sutton, A. J., & Borenstein, M. (Eds.). (2005). Publication bias in meta-analysis: prevention, assessment and adjustments . Chichester: Wiley.

Saito, M., & Nakamura, Y. (1995). Cardiac autonomic control and muscle sympathetic nerve activity during dynamic exercise. The Japanese Journal of Physiology, 45 (6), 961–977. https://doi.org/10.2170/jjphysiol.45.961 .

Sandin, B., & Chorot, P. (1985). Changes in skin, salivary, and urinary pH as indicators of anxiety level in humans. Psychophysiology, 22 (2), 226–230.

Sarason, I. G. (1972). Experimental approaches to test anxiety: attention and the uses of information. Anxiety: Current Trends in Theory and Research, 2 , 383–403.

Sarason, I. G. (1978). The Test Anxiety Scale: concept and research. In C. D. Spielberger & I. G. Sarason (Eds.), Stress and Anxiety (pp. 193–216). Washington, DC: Hemisphere.

Sarason, S. B., Davidson, K., Lighthall, F., & Waite, R. (1958). A test anxiety scale for children. Child Development, 29 (1), 105–113. https://doi.org/10.2307/1126274 .

Scherer, K. R. (1984). On the nature and function of emotion: a component process approach. In K. R. Scherer & P. Ekman (Eds.), Approaches to Emotion (p. 317). Hilsdale: Erlbaum.

Scherer, K. R. (2000). Emotions as episodes of subsystems synchronization driven by nonlinear appraisal processes. In M. D. Lewis & I. Granic (Eds.), Emotion, development, and self-organization (pp. 70–99). Cambridge: Cambridge University Press.

Schlosberg, H. (1954). Three dimensions of emotion. Psychological Review, 61 (2), 81–88. https://doi.org/10.1037/h0054570 .

Schwartz, E. B., Granger, D. A., Susman, E. J., Gunnar, M. R., & Laird, B. (1998). Assessing salivary cortisol in studies of child development. Child Development, 69 (6), 1503–1513. https://doi.org/10.1111/j.1467-8624.1998.tb06173.x .

Scollon, C. N., Prieto, C.-K., & Diener, E. (2009). Experience sampling: promises and pitfalls, strength and weaknesses. In Assessing well-being (pp. 157–180). Dordrecht: Springer.

Selye, H. (1976a). The stress concept. Canadian Medical Association Journal, 115 (8), 718.

Selye, H. (1976b). Stress without distress. In Psychopathology of human adaptation (pp. 137-146): Springer.

Setz, C., Arnrich, B., Schumm, J., Marca, R. L., Tr, G., et al. (2010). Discriminating stress from cognitive load using a wearable EDA device %J Trans. Info. Tech. Biomed., 14 (2), 410–417. https://doi.org/10.1109/titb.2009.2036164 .

Shaffer, F., McCraty, R., & Zerr, C. L. (2014). A healthy heart is not a metronome: an integrative review of the heart’s anatomy and heart rate variability. Frontiers in Psychology, 5 , 1040. https://doi.org/10.3389/fpsyg.2014.01040 .

Shen, W., Kiger, T. B., Davies, S. E., Rasch, R. L., Simon, K. M., & Ones, D. S. (2011). Samples in applied psychology: over a decade of research in review. Journal of Applied Psychology, 96 (5), 1055–1064. https://doi.org/10.1037/a0023322 .

Shuman, V., & Scherer, K. R. (2014). Concepts and structures of emotions. In R. Pekrun & E. A. Linnenbrink-Garcia (Eds.), International handbook of emotions in education (pp. 13–35). New York: Taylor & Francis.

Singh, J. P., Larson, M. G., Tsuji, H., Evans, J. C., O’Donnell, C. J., & Levy, D. (1998). Reduced heart rate variability and new-onset hypertension. Hypertension, 32 (2), 293–297. https://doi.org/10.1161/01.HYP.32.2.293 .

Sloan, R., Shapiro, P., Bagiella, E., Boni, S., Paik, M., Bigger, J., et al. (1994). Effect of mental stress throughout the day on cardiac autonomic control. Biological Psychology, 37 (2), 89–99. https://doi.org/10.1016/0301-0511(94)90024-8 .

Smith, T. W., Houston, B. K., & Zurawski, R. M. (1984). Finger pulse volume as a measure of anxiety in response to evaluative threat. Psychophysiology, 21 (3), 260–264.

Spangler, G., Pekrun, R., Kramer, K., & Hofmann, H. (2002). Students’ emotions, physiological reactions, and coping in academic exams. Anxiety, Stress & Coping, 15 (4), 413–432. https://doi.org/10.1080/1061580021000056555 .

Spielberger, C. D., Gorsuch, R. L., & Lushene, R. E. (1970). Manual for the state-trait anxiety inventory . Palo Alto: Consulting Psychologists Press.

Spielberger, C. D., Gonzalez, H. P., Taylor, C. J., Anton, W. D., Algaze, B., & Ross, G. K. (1980). Test anxiety inventory . Palo Alto: Consulting Psychologists Press.

Spodick, D. H. (1993). Survey of selected cardiologists for an operational definition of normal sinus heart rate. The American journal of cardiology, 72 (5), 487–488.

Stern, R. M., & Higgins, J. D. (1969). Perceived somatic reactions to stress: sex, age and familial occurrence. Journal of Psychosomatic Research, 13 (1), 77–82. https://doi.org/10.1016/0022-3999(69)90022-1 .

Strohmaier, A. R., Schiepe-Tiska, A., & Reiss, K. M. (2020). A comparison of self-reports and electrodermal activity as indicators of mathematics state anxiety. An Application of the Control-Value Theory. Frontline Learning Research, 8 (1), 16–32.

Szafranski, D. D., Barrera, T. L., & Norton, P. J. (2012). Test anxiety inventory: 30 years later. Anxiety, Stress, & Coping, 25 (6), 667–677. https://doi.org/10.1080/10615806.2012.663490 .

Taylor, J., & Deane, F. P. (2002). Development of a short form of the Test Anxiety Inventory (TAI). The Journal of General Psychology, 129 (2), 127–136. https://doi.org/10.1080/00221300209603133 .

Tennes, K., & Kreye, M. (1985). Children's adrenocortical responses to classroom activities and tests in elementary school. Psychosomatic Medicine, 47 (5), 451–460.

Turner, J. R., Carroll, D., Hanson, J., & Sims, J. (1988). A comparison of additional heart rates during active psychological challenge calculated from upper body and lower body dynamic exercise. Psychophysiology, 25 (2), 209–216. https://doi.org/10.1111/j.1469-8986.1988.tb00990.x .

Uchino, B. N., Holt-Lunstad, J., Bloor, L. E., & Campo, R. A. (2005). Aging and cardiovascular reactivity to stress: longitudinal evidence for changes in stress reactivity. Psychology and Aging, 20 (1), 134–143. https://doi.org/10.1037/0882-7974.20.1.134 .

Uchino, B. N., Berg, C. A., Smith, T. W., Pearce, G., & Skinner, M. (2006). Age-related differences in ambulatory blood pressure during daily stress: evidence for greater blood pressure reactivity with age. Psychology and Aging, 21 (2), 231–239. https://doi.org/10.1037/0882-7974.21.2.231 .

Van Yperen, N. W. (2007). Performing well in an evaluative situation: the roles of perceived competence and task-irrelevant interfering thoughts. Anxiety, Stress, and Coping, 20 (4), 409–419. https://doi.org/10.1080/10615800701628876 .

Wilhelm, F. H., & Grossman, P. (2010). Emotions beyond the laboratory: theoretical fundaments, study design, and analytic strategies for advanced ambulatory assessment. Biological Psychology, 84 (3), 552–569. https://doi.org/10.1016/j.biopsycho.2010.01.017 .

Wilhelm, F. H., & Roth, W. T. (2001). The somatic symptom paradox in DSM-IV anxiety disorders: suggestions for a clinical focus in psychophysiology. Biological Psychology, 57 (1-3), 105–140. https://doi.org/10.1016/S0301-0511(01)00091-6 .

Zanstra, Y. J., & Johnston, D. W. (2011). Cardiovascular reactivity in real life settings: measurement, mechanisms and meaning. Biological Psychology, 86 (2), 98–105. https://doi.org/10.1016/j.biopsycho.2010.05.002 .

Zeidner, M. (1998). Test anxiety: the state of the art . New York: Plenum Press.

Zeidner, M. (2014). Anxiety in education. In R. Pekrun & E. A. Linnenbrink-Garcia (Eds.), International handbook of emotions in education (pp. 265–288). New York: Taylor & Francis.

Zeidner, M., & Matthews, G. (2005). Evaluation anxiety: current theory and research. In A. J. Elliot & C. S. Dweck (Eds.), Handbook of Competence and Motivation (pp. 141–163). New York: Guilford Publications.

Zeidner, M., & Matthews, G. (2011). Anxiety 101 . New York: Springer.

Zhang, Z., Su, H., Peng, Q., Yang, Q., & Cheng, X. (2011). Exam anxiety induces significant blood pressure and heart rate increase in college students. Clinical and Experimental Hypertension, 33 (5), 281–286. https://doi.org/10.3109/10641963.2010.531850 .

Zung, W. W. (1976). SAS, self-rating anxiety scale. ECDEU assessment manual for psychopharmacology, revised edition. Rockville, Maryland , 337-340.

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Anna-Lena Roos

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Thomas Goetz

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Test Anxiety

• Categories: Engaging with Courses , Self-Regulation

Test anxiety can appear before, during, or after an exam. When it rears its ugly head, remember to practice self-compassion, to focus on helpful strategies for success, and to seek help when needed. 

Ahead of an exam, students experience test anxiety for many reasons. Perfectionism leads some students to believe that their test performance won’t be good enough to meet their exacting standards. For other students, they are not familiar enough with the test material, resulting in a lack of confidence about their abilities. Some students might not have studied at all because their belief that they will never understand the material well enough has led to procrastination. 

While there are many contributors to test anxiety, arming yourself with strategies can help you work your way through it. Preparation, organization, and practice can boost confidence by helping you focus on what you have control over rather than on the “unknowns” posed by your exam.    

Strategies for dealing with anxiety before an exam:

At the beginning of the semester, add test dates to your calendar. Taking the time to do this step will enable you to see what assessments are on the horizon and to prepare for them intentionally.

When a test is still a long way out, studying is less likely to make you feel anxious because the stakes of your learning don’t feel as intense or immediate. Even just knowing that you’ve started studying early can do a lot to relieve test anxiety.  

Check out the ARC webpage on Memory and Attention for some memorization tips; practicing some of these memorization strategies can help you feel more confident about the effectiveness of your studying. 

Take practice tests regularly to check your understanding. Seek out support if you encounter concepts that confuse you, and keep your studies focused on the areas that are most challenging for you. 

The teaching staff are there for you – to answer questions and to help you understand the material better.

Take advantage of ARC Peer Tutoring for an additional layer of one-on-one support. 

During an exam, it’s natural to feel the effects of increased adrenaline as you try to complete your work. Negative thoughts might circulate, your mind might go blank, or you might fear that you’ll run out of time. To mitigate the impact of these events, come prepared with some strategies to enact in the moment. 

Strategies for dealing with anxiety during an exam:

When you start to struggle with a particular problem or feel your mind go blank, it can be easy to imagine the whole test turning into a disaster. When this kind of negative thinking hits you, close your eyes, take a deep breath, and try to imagine seeing your score at the end and being satisfied with the outcome. Give your brain the opportunity to reset. Then, turn back to your exam, but not immediately to the place that made you feel anxious. Instead, try starting a new problem, or look back over one you feel you’ve answered successfully.  

It may be that you will have more success by reframing your anxiety than trying to eliminate it. Try to think of your exam as a game! Anxiety and excitement are two sides of the same coin: they both involve high levels of adrenaline. Come up with a “prize” for yourself when you finish the game so that your focus is on winning the prize and not on the grade you will receive on the exam.

One way to combat anxiety during a test is to practice mindful breathing, which is the opposite of the shallow breathing that comes with anxiety and increases distress. Close your eyes, take a deep breath in and out through your nose, and focus on the feeling of the air passing through your nasal passages and lungs. Do this slowly a few times, always pulling your attention back to your breath when it tries to wander to the source of your anxiety. After a few breaths, you will likely feel able to move forward with your exam. Reconnect with your breath as often as you need (and time allows!). 

A lot of test anxiety arises from negative self-talk: from telling yourself that you aren’t good enough or smart enough to succeed. When that arises, have some affirmations in mind ahead of time to recite to yourself:  “I am prepared for this exam” or “I know this material” or “This is just a test.” 

After a test, it’s not uncommon for students to dwell in uncertainty about their grade, experience regret about a lack of preparation, or beat themselves up for a mistake.

Tackling post-test anxiety:

You can’t go back in time and change how you prepared for this exam, but you can change what you will do for future exams. If you were dissatisfied with your preparation for the last exam, figure out what is causing your dissatisfaction. (Did you fail to meet with a tutor? Did you cram the night before? Did you skip some of the reading?) Now devise a plan for addressing those causes before the next exam. 

An exam is only a snapshot of your understanding of a specific set of information at a specific moment; it is not a measure of your value or intelligence in an enduring way. Instead of allowing your exam performance to define you, see your tests for what they are: opportunities to learn, not only about the material in question, but also how to approach assessments more successfully in the future!  

Grades are a kind of feedback: they tell you how well you understand the material based on what the course wants you to be able to do with it. It can be hard to move on from a grade you’re unhappy with if you don’t understand precisely what you did wrong. Although you can’t change the grade you received (unless the instructor clearly made an error when assessing your work), you can seek more feedback on it. Go to office hours and ask questions about what you missed. Go with an open mind – imagine how the answers might help you do better on a future assessment. Sometimes, you may get information that helps you feel better about your performance (e.g., perhaps most of the class missed the question you’re seeking feedback on). Regardless, if you understand your grade better, you will increase your odds of getting a higher one next time.  

Sometimes test anxiety can stem from something more serious.

If you are concerned that your learning and engagement with coursework might be affected by depression, anxiety, or other sources of chronic stress, please reach out to Harvard’s Counseling and Mental Health Services (CAMHS) or another trusted health professional to discuss additional support.  

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Factors affecting test anxiety: a qualitative analysis of medical students’ views

1 Medical Education Department, College of Medicine, Qassim University, Buraidah, Saudi Arabia

2 Medical Education Department, School of Medical Sciences, Universiti Sains Malaysia, Kota Bharu, Kelantan Malaysia

Muhamad Saiful Bahri Yusoff

Ahmad fuad abdul rahim, nik ahmad zuky nik lah.

3 Obstetrics and Gynecology Department, School of Medical Sciences, Universiti Sains Malaysia, Kota Bharu, Kelantan Malaysia

Associated Data

Due to privacy concerns, the transcripts of the interviews are not available to the public. On reasonable request, the corresponding author can provide transcript information.

Medical students are vulnerable to test anxiety (TA), which impacts their professional lives and jeopardizes the optimal health care of their patients. The qualitative exploration of TA among medical students is crucial to understanding the problem. Hence, this study examined medical students’ insights into TA and their suggestions on how to reduce it.

We conducted a phenomenological study on medical students at a public university. We utilized focus group discussions (FGDs) to investigate their experiences of TA. The FGDs were transcribed verbatim, and these transcripts were analyzed using Atlas.ti software. The thematic analysis followed the recommended guidelines.

Seven FGD sessions were conducted with 45 students. Three major themes emerged: the students, their academic resources, and the examiner. Each theme comprised mutually exclusive subthemes. The “students” theme was divided into negative vs. positive thoughts and self-negligence vs. self-care, “academic recources” into heavy curriculum vs. facilitative curricular aids, and “examiner” into criticism vs. feedback and strict vs. kind approaches.

This study provides a solid foundation for policymakers and decision makers in medical education to improve current assessment practices and student well-being. Medical students will be able to significantly alter and reduce TA if they are provided with additional psychological support and their examiners are trained on how to deal with examinees.

Introduction

Test anxiety (TA) is integral to assessments. It ranges from simple worry to debilitating anxiety, which interferes with the cognitive process. Although a low level of TA can motivate students to study and prepare for assessment, an extreme level of TA alters their physiological functions, psychological status, or both. These changes impair concentration, interrupt working memory, and hinder academic achievement. Crucially, TA may result in chronic stress, which is associated with many adverse effects on wellbeing. These include burnout, depression, poor academic performance, poor clinical performance, impaired decision making, poor peer interaction, interpersonal conflict, academic dishonesty, and sleeping problems [ 1 , 2 ]. Furthermore, chronic stress is linked to substance abuse, alcohol consumption, and suicide [ 3 – 6 ].

TA has a significant effect on health professions’ students. In a meta-analysis, Quek, Tam [ 7 ] reported that 33.8% of medical students experience anxiety. Likewise, Macauley, Plummer [ 8 ] determined that 51% of female and 37.5% of male health care students have moderate to high TA. Several quantitative studies have explored the causative factors of TA among medical students. These factors included expansive curricular content [ 9 – 12 ], inappropriate study skills [ 9 – 12 ], difficult test formats (objective structured clinical examination [OSCE] in particular), negative thoughts [ 10 ], and female gender [ 9 , 10 , 12 ]. However, the few qualitative studies that have examined TA among medical students are limited in scope. For instance, Encandela et al. [ 13 ] assessed TA following the implementation of a United States Medical Licensing Examination (USMLE) preparation course, whereas Shen et al. [ 14 ] explored whether the introduction of expressive writing can reduce TA.

Qualitative research yields detailed insights, sheds light on the dynamics of various relationships, and generates themes and thus theoretical foundations for future research [ 15 ]. Therefore, the qualitative investigation of medical students’ TA is essential to understanding its implications. Such studies can clarify how to remodel TA and create a platform for early intervention into and improvement of medical students’ well-being. Hence, this qualitative study explored medical students’ thoughts on TA and what they believed should be done to reduce it.

This study employed a phenomenological approach to analyze the factors affecting TA from the perspectives of medical students. Data were collected using seven focus group discussions (FGDs) with a total of 45 medical students from the School of Medical Sciences, Universiti Sains Malaysia (USM). The study was approved by the Institutional Human Research Ethics Committee at USM, and all students were asked to sign a consent form upon their agreement to participate in this study. The researchers emphasized confidentiality, anonymity, and the right to withdraw at the start of each session. To maintain the participants’ confidentiality, we assigned a pseudonym to each one.

Participants, sampling, and recruitment

We selected groups of five to seven medical students from different academic years because we expected their experiences of stress and anxiety to differ accordingly [ 16 ]. We applied purposive sampling with consideration for student variety to obtain a wide range of experiences. Moreover, we intended to represent factors such as gender and race (e.g., Malay, Chinese, Indian, or other). We gave invitation letters to the group leaders of each academic year. We also used WhatsApp to disseminate information about the study and its consent forms. In addition, we assigned a token to each participant after their session.

Data collection

We piloted the FGD protocol with a group of students, and they reported that it was open-ended and stimulated discussion. Next, the FGD sessions were conducted in a quiet and comfortable room. We began each session by welcoming the group members and briefing them on the study’s purpose. Based on the predetermined probe questions, we initiated the audiotaped discussion with an open-ended cue: “Test anxiety to me is…”. We made notes to reflect non-verbal cues. Each FGD ended after 60 to 90 min. Data collection continued until theoretical saturation was reached, which occurred when no new information appeared [ 17 ]. We conducted all the FGD sessions in March 2019.

Data analysis

We started data analysis concurrently with data collection. This interim analysis helped us adjust and check the emerging themes alongside the consequent data.

We followed Braun and Clark’s six-phase thematic analysis [ 18 ]. In the first phase (familiarization with the data), the researcher (MW) transcribed the audio recording verbatim (including verbal and non-verbal cues), assigned pseudonyms to all the identifiable individuals, and cross-checked the transcript against the audio recordings. All the authors (MW, MSBY, AFAR, and NAZNL) then read the transcription several times to familiarize themselves with the data set and to immerse themselves in its meaning. Then, MW imported all the transcription files into Atlas.Ti (version 7.9) to initiate the second phase (generating initial coding), during which MW and MSBY independently identified open codes throughout the data set; these were either the participants’ own words (in vivo) or a descriptive word for their experience. We conducted frequent comparisons of the generated themes to resolve disagreements and reach consensus on the initial themes. In phase three (searching for themes), MW and MSBY conducted a high-level analysis by combining several related codes to create overarching themes. MW, MSBY, AFAR, and NAZNL held joint meetings to discuss potential themes. In the fourth phase (reviewing the themes), MW examined the quotations associated with each theme and determined their coherence (internal homogeneity). If a quotation did not fit, MW either redirected it to a more closely related theme or revised the theme. MW then reviewed all the themes to determine their relevance and to ascertain whether each theme was significantly different from the others (external heterogeneity). To ensure that potential themes reflected the entire data set, MSBY and AFAR compared them to the codes and to the entire data set. MW, MSBY, AFAR, and NAZNL discussed inconsistencies and refined potential themes. In the fifth phase (defining and naming themes), we gave each a name, a definition, and an explanation narrative. Additionally, MW, MSBY, AFAR, and NAZNL ascertained whether any complex theme required subthemes to be structured more effectively. Finally, in the sixth phase (writing the report), MW and AFAR assembled the selected quotes to illustrate key points. MSBY and NAZNL revised the report. We repeated this procedure until we reached unanimous agreement.

Table ​ Table1 1 highlights how we addressed Guba’s four criteria for detecting the trustworthiness of qualitative studies [ 19 ].

Provisions made to address the findings’ trustworthiness [ 19 ]

Table ​ Table2 2 displays the characteristics of the participants. Gender distribution was nearly equal among participants, and most were fourth-year students.

Characteristics of the participants

As depicted in Fig.  1 , three major themes emerged from the thematic analysis: students, academic resources, and examiners. Each theme was subdivided into subthemes that reflected increased and decreased TA.

Emerged themes and sub-themes in relation to increasing and decreasing test anxiety

Shown in gray, the themes were placed at the center of the figure. All subthemes that increased TA were grouped together and colored red, while those that decreased TA were grouped together and colored green. The arrows on either side of the figure denote the two primary probe questions asked during the FGD. Notably, we arranged the themes and their associated subthemes from external to internal to reflect the relationships and interactions between them.

Theme 1: students

Negative vs. positive thoughts Most students expressed how their negative and positive thoughts influenced TA:

Both [positively minded and negatively minded students] may make a mistake, but the positive [student] will go on with minor anxiety because they know what [is] done is done and they cannot change it, but the negative one will keep on dwelling [on] the past/mistakes, and hence [this student increases their] anxiety level. (Student E, Group 6)

Some students noted that their preconceptions of negative ideas occurred if they had to share a bad experience with their colleagues:

I [learned] that the malignant doctor will examine me the next day. Eight of the students failed. The day [that I learned this was] stressful[.] (Student B, Group 3) When I [learn that a] “malignant doctor” will become my examiner, it increases [my] test anxiety[.] (Student C, Group 6)

Moreover, because the students identified as A-level students and had pursued their education since childhood, these expectations further increased their anxiety. Crucially, some students noted that positive thoughts and maintaining their motivation reduced TA:

I always try to keep myself positive and constantly remind myself to be confident in myself and believe in God. (Student A, Group 5) My anxiety will decrease if I stay positive by […] telling myself that I will do well in the exam[.] (Student D, Group 2)

Self-negligence vs. self-care The more time that the students had for self-care and maintaining a healthy lifestyle, the more their positive thoughts increased. In particular, the students mentioned that adequate sleep, a balanced or fulfilling diet, and exercise lowered TA:

[W]hat helps me with stress or anxiety is good food and sleep[.] (Student C, Group 4) For me [,] I need food to focus. For this reason, food relie[ves] my stress. (Student F, Group 5) I tend to get anxious when I go [to take an] exam without having coffee and something to eat. (Student B, Group 3)

In contrast, self-negligence was associated with increased TA. The students reported many bad behaviors that impacted their health and exam preparedness:

I also tend to get anxious when I go for an exam without having coffee and something to eat[.] (Student E, Group 4) I went to sleep at 7:00 am and [woke] up at 1:00 pm. I drink two cups of coffee per day. I [know that] some of my friends drink 5–10 cups of coffee [per day]. These kinds of things are not usual to your body. (Student B, Group 1)

Theme 2: academic resources

Heavy curriculum vs. facilitative curricular aids The students pointed out that the heavy medical curriculum triggered their anxiety levels before their exams:

But the problem with medical school [is that] too [many things must] be prepared [for] before the exam[.] (Student D, Group 1) The one that [stresses me out] is the [number of things] we need to cover […] for major exams especially[.] (Student C, Group 3) I need to cover [so many things]. [All things] and [many things], and you do not have enough time[.] (Student A, Group 5)

Notably, supportive measures before the exam could ameliorate this burden. The suggested measures include increasing formative assessments, briefings on the exams’ formats,, and making class more fun:. In particular, the students emphasized the importance of formative assessments:

Give quiz[s]/homework based on[the] learning outline at the end of every lecture so the students know what exactly they have to cover for each subject[.] (Student A, Group 6) In our previous exam, there [was] no briefing, so we [did not] know how many questions [would] come in the exam […] [or] what [would] be assessed[.] (Student C, Group 2) Try to make the class more fun because fun and relaxing classes tend to increase one’s memory and focus during that class. To be honest, [the] lecturer[s]who make classes more fun and [use] more discussion tend to make me remember things easier. (Student A, Group 3)

Theme 3: examiner

Strict vs. kind approach The students believed that the examiner played an important role in aggravating TA. Most stated that due to the presence of an examiner, OSCE was the assessment format that raised their TA the most:

[T]he examiner will affect me [the] most. (Student B, Group 4) The examiner in OSCE is very strict about the answer scheme, and sometimes he/she is known as an examiner who always fail[s] the student[s]. (Student A, Group 2)

Most students agreed that the stricter the examiner, the worse their experience of TA. They identified some features of so-called “malignant examiners,” including their intention to fail students:

[My anxiety increases during the exam if] the examiner in OSCE is someone we know [who is] very strict about [the] answer scheme […] [or] known as an examiner who always fail[s] the student[s]. (Student B, Group 1)

Moreover, the students claimed that malignant examiners used certain facial expressions and body language during the exam:

[Examiners] who are grumpy and do not even answer back when I greet them make[] me more anxious during OSCE[.] (Student C, Group 1) The [examiner] who has a straight face without any expression increases anxiety during exam[.] (Student A, Group 2)

Correspondingly, the students believed that kind examiners significantly reduced TA, such as by smiling and establishing a rapport:

I will choose the examiners that are kind and soft spoken to the student[s] to avoid the students feeling [scared] when [answering] the question[,] especially [during] OSCE[.] (Student C, Group 3) Just a simple gesture such as a smile, talking nicely to student[s], [and focusing] on information given by students. All [of] these will help to reduce stress[.] (Student B, Group 6)

The students suggested that applying a unified scoring system will help in reducing TA:

I think [I would] I brief all examiners about the guidelines and make sure that examiners understand the guideline and what is actually expected of students[.] (Student E, Group 2) [The examiners should] have a proper guideline for the marking of the students[.] (Student A, Group 4) Everyone has a proper guideline, not given a bias of judgment. I think that is OK for me[.] (Student F, Group 3)

Criticism vs. feedback The students signified that the examiner’s response approach affected TA. Most participants described criticism as “scolding,” which increased TA:

I just fear […] being scolded during the exam. (Student A, Group 4) I think that some examiners should not be shouty because student[s] are not well prepared. So, the way [that they] treat students will affect them. (Student D, Group 2) Some […] examiners [scold students]. They usually compare [the] current situation with future work. Just [because] you are feeling stress now, this [does] not mean you cannot handle whatever [will come up] when you work. (Student D, Group 1)

Correspondingly, students agreed that giving effective and constructive feedback during exams reduced TA, supported their learning, and empowered them to prepare more for their upcoming exams:

[If the examiner feedbacks the student, he] will [be] happier[,] and after the exam[,] he will tell [his] other friends that [the] examiner [taught] him [well.](Student A, Group 1) Actually, for both exams, I got the same marks. But, I was feeling better during the first exam, where the lecture calm[ed] me, and after the exam, she guided me [on how to answer] the question[.] [E]ven though I [could not] answer it, she guided me on what to do after that rather than scold[ing] me and ask[ing] me to [leave.] (Student B, Group 4)

This qualitative study explored TA from the perspective of medical students and identified its precipitating and diminishing factors: the students, their academic resources, and the examiner.

Negative vs. positive thoughts The students had a major role in developing and depleting TA. This could be due to the nature of TA, which originates from a negative self-process that encodes the outer environment into personal responses. In this context, the process fixated on how the exam would be and how the examiners would interact with the examinees, and it was exaggerated by an individual’s negative self-thoughts, academic competence, and/or ability to cope with challenging evaluative situations. For example, many participants had developed self-expectations since childhood. These expectations were strengthened by the people surrounding them and continued to be enhanced during their medical education. Other studies have determined that parents’ academic expectations affect their offspring’s TA [ 20 – 22 ]. Notably, the participants in this study also worried about transmitting their bad experiences to their peers.

Our findings suggest that enriching positive thoughts and believing in self-efficacy reduces TA in medical students. In his investigation of the cognitive triad, Wong [ 23 ] proposed that rational beliefs will lead to neutral or positive emotional consequences. This assumption has been used by many researchers to build cognitive reconstructions to reduce TA [ 13 , 24 – 27 ]. Based on these findings, it is apparent that thoughts influence our behavior [ 28 ]. Hence, we argue that negative and positive thoughts are the most important factors in this study. They may be used to form interventions to resolve TA.

Self-negligence vs. self-care The students demonstrated a variety of self-negligence behaviors that may amplify TA and trap them in a vicious cycle, including sleep deprivation, excessive consumption of coffee and other stimulants, and avoidance of sports. Self-negligence affects psychological perception and weakens mental fortitude, thus resulting in TA. On the other hand, self-care improves personality characteristics and the mental ability to combat TA [ 29 , 30 ]. Hence, our results emphasize the critical state of self-care among medical students, and academic advisory programs, among others, should promote healthy lifestyle choices to rectify this.

Students can feel an exaggerated sense of pressure and increased TA if they have to face the difficulty of their medical curriculum from the beginning of their studies [ 9 – 12 ]. By incorporating facilitative curricular aids, the detrimental effects of the curriculum can be remedied. For example, classes should be enjoyable and employ more formative assessments. Another strategy is to promote group study, as this may establish a beneficial framework for discussing and illustrating ambiguous concepts. Group study has been shown to be an effective method for enhancing student learning and providing a welcoming environment for discussion [ 31 ].

Strict vs. kind approaches According to socioconstructive theory and the social aspect of anxiety [ 32 ], the presence of an examiner (or evaluator) is the primary cause of TA during clinical examinations. The situation deteriorates further as a result of ineffective communication and attempts to fail students based on biases and prejudices. McManus et.al [ 33 ] referred to this approach as “the hawk effect” or “stringency.” As Shashikala [ 34 ] noted, such a person is occasionally referred to as the “malignant examiner.” Typically, examiners become stringent to ensure the principle of patient safety, which is the ultimate goal of medical education, during clinical evaluation of medical students. However, students’ mental well-being should not be jeopardized. For this reason, standardized scoring (either checklist or rubric) tools helps to eliminate prejudice and personal bias [ 35 ]. Nevertheless, comprehensive training on using the standardized scoring assessment during OSCE is highly mandated and crucial to maximize fairness and assessment validity [ 36 ].

Criticism vs. feedback The students noted that when they received constructive feedback during an exam, this enhanced their learning and helped them improve in a subsequent exam or practice session. Many students worried that some examiners may neglect the most effective use of feedback. Some examiners hope to motivate students by critically increasing their awareness and fear of failure, and Putwain and Roberts [ 34 ] referred to such tactics as “fear appeals.” The present study suggests that extensive training and close monitoring of the examiner during the examination will help reduce TA. Students should be encouraged to express themselves without harming the exam environment.

Two limitations apply to this study. The first is that it is restricted to a single medical school, and the second is that the sampling frame does not include representative medical students from all academic years, as medical students in their first and fifth years are required to sit for exams at the time of data collection. Both of these constraints make generalization difficult. For these reasons, additional research is needed to broaden the sampling and expand its scope beyond medical schools to include groups from other disciplines of health professions education (HPE). This will provide a comprehensive understanding of the TA problem across multiple HPE disciplines.

This qualitative study shed light on the factors that affect TA from medical students’ perspectives. Three major factors affecting TA were identified: the students, their academic resources, and the examiner. Sub-factors were also identified for each of these factors. This study established a solid foundation for policymakers and decision makers in medical education to improve current assessment practices while also enhancing student well-being. The results indicate that the polar factors of the examiner and the student act in concert and shape TA. Thus, additional psychological support for students and training for examiners on how to deal with examinees will significantly reduce TA.

Acknowledgements

Not applicable.

Abbreviations

Authors' contributions.

Each researcher established a thematic framework and then coded (e.g., indexed, charted, and mapped) and interpreted the data within the framework of qualitative analysis. Each of them reviewed the manuscript and provided constructive feedback. Each author's contribution was described in detail in the method section. All authors read and approved the final manuscript.

This research is part of a larger project supported by Fundamental Research Grant Scheme (FRGS: 203.PPSP.6171219), Ministry of Education, Malaysia.

Availability of data and materials

Declarations.

We got ethical approval for this study from human research ethics committee with reference number (JEPeM USM Code: USM/JEPeM/18060286) which followed the Helsinki Declaration. All participants sign a written informed consent at the time of the FGD after receiving clear spoken information about the study's purpose and methods, as well as how data would be handled in a secure manner. They were also notified that they could orally or in writing withdraw from the study. Participants were informed that the discussion would be audiotaped, and the analysis of this discussion will be published. Every student who took part received a small token of appreciation.

The consent to publish is a part of ethical approval.

The authors declare no competing interests.

Publisher's Note

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Contributor Information

Majed Wadi, Email: [email protected] , Email: ym.msu.tneduts@idawdejam .

Muhamad Saiful Bahri Yusoff, Email: ym.msu@irhab_lufiasm .

Ahmad Fuad Abdul Rahim, Email: ym.msu@dauf .

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217 Anxiety Essay Topis & Examples

Looking for anxiety research topics? The issue of anxiety in psychology is hot, controversial, and worth studying!

🏆 Best Anxiety Essay Examples & Topic Ideas

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Anxiety is the emotion that causes severe physical changes, can negatively affect social contacts, and even lead to depression. Here we’ve gathered top research questions about anxiety disorder as a mental health issue, as well as anxiety essay examples. Get inspired with us!

• Social Anxiety Disorder: Female 15-Year-Old Student Since she often downplays her achievements, then it may also be true that Joann expects to fail in the tests or classroom activities.
• Anxiety Disorders: Definition, Causes, Impacts and Treatment Negative reinforcement occurs since the avoidance behavior leads to the avoidance of the discomfort of the anxiety, which is a desirable reward to the individual with anxiety disorder.
• Freud’s Anxiety Neurosis – Psychology The objective of this study is to expose Freud’s anxiety neurosis and to provide a comprehensive approach as to the causes, treatments, and symptoms of the anxiety neurosis.
• The Generalized Anxiety Disorder According to Bourne, there are a number of treatments that one can refer to in order to curb the generalized anxiety behavior.
• How Can Students Manage Anxiety As a result, students do not recognize that their mental health state is a result of the anxiety they feel because of the drastic changes that happened in their life and their stress continues to […]
• Anxiety and Depression Among College Students The central hypothesis for this study is that college students have a higher rate of anxiety and depression. Some of the materials to be used in the study will include pencils, papers, and tests.
• Principal Component Analysis: Anxiety in Students Since students experience anxiety in the course of learning SPSS, the questionnaire aims to measure and ascertain the extent of SPSS anxiety. In essence, the study aims to use PCA in revealing principal variables that […]
• Abnormal Psychology Case Study: General Anxiety Disorder Generalized Anxiety Disorder is one of the anxiety disorders caused by abnormalities in the functioning of brain chemicals such as neurotransmitters.
• Conflict and Anxiety by Psychoanalysts and Behaviourists This paper shows that the main differences between the psychoanalytic and behavioural interpretations of conflict and anxiety are the conceptions, treatments, and perceived causes of both concepts.
• Social Anxiety Disorder Causes and Symptoms Also referred to as social phobia, social anxiety disorder is a psychological condition that is associated with the constant fear of surrounding social conditions.
• Exam Anxiety: A Descriptive Statistics Study The questionnaire assessed the quality and quantity of sleep because they are significant in determining the level of anxiety and students’ performance.
• Generalized Anxiety Disorder: Treatment Plan for J. N. As a result, J.N.will be ready to reshape the feeling about possible triggers of his anxiety, as well as actions and behaviors.
• Anxiety and Phobia in Dental Settings: Theories and Their Relations While external factors may lead to the creation of the anxiety pattern in a patient, the subsequent dental treatment and procedures and their experiences may either exacerbate or altogether nullify the condition.
• Anxiety Disorder: Cognitive Therapy vs. Medications In this essay, the researcher seeks to confirm the hypothesis that medication is not as successful in treating anxiety disorders as the use of cognitive therapy.
• Anxiety Disorders in Children and Adolescents The presentation of anxiety disorders in children to be just one of the factors to the disorders among adults as the children grow is an illustration of higher prevalence rate of the disorders in adults […]
• Diagnosis and Treatment of Anxiety Disorder The classifications of anxiety disorder include the phobias, the generalized anxiety disorder, panic disorder, agoraphobia, social anxiety disorder, obsessive-compulsive disorder, separation anxiety and post-traumatic stress disorder.
• Social Status Anxiety and the American Dream The pain of a loss and the status anxiety that came with being inferior to other students at Harvard instigated the urge to revenge and brought a desire to achieve success.
• The Reiss-Epstein-Gursky Anxiety Sensitivity Index However, the ASI-R is discussed as useful to make decisions regarding the patients’ level of the anxiety sensitivity and associated psychological disorders.
• Comprehensive Psychiatric Evaluation: Recurring Anxiety Attacks CC: The patient is suffering from recurring anxiety attacks whenever she has to leave her house, which is why she has been largely unable to perform basic tasks, as well as communicate with her family […]
• Exercise Eases the Symptoms of Anxiety The review of the literature generally demonstrates the significant effects of exercise in alleviating the symptoms of anxiety. In the future, one needs to focus on patients diagnosed with anxiety and investigate the types of […]
• Depression and Anxiety Among African Americans Finally, it should be insightful to understand the attitudes of friends and family members, so 5 additional interviews will be conducted with Black and White persons not having the identified mental conditions. The selected mental […]
• Generalized Anxiety Behavioral Modification In effect, the primary symptom of GAD is maintained by negative reinforcement such that: people with the disorder worry constantly about a negative event occurring despite its improbability and constant worry leads to distress.
• The Symptoms and Causes of a Social Anxiety Disorder Efforts in public health are required to increase understanding of social anxiety, the difficulties it presents, and the methods for overcoming it.
• School Anxiety and Phobia in Children Fear of school is a widespread phenomenon in the modern world, so it is essential to track the symptoms as quickly as possible and eradicate the cause of stress.
• Music Performance Anxiety Alleviation The workshop presentation majored in the discussion of the Music Performance Anxiety, the effect of the condition on violinists, and the therapeutic and medical means of alleviating the conditions.
• Jungian Psychotherapy for Depression and Anxiety They work as a pizza delivery man in their spare time from scientific activities, and their parents also send them a small amount of money every month.S.migrated to New York not only to get an […]
• How to Alleviate the Stage Performance Anxiety of Violinists It is practically due to the lack of a particular definition of MPA and probably the absence of a standard to assure randomized, well-conduct, controlled study trials.
• Meditation Effects on Anxiety and Stress My goal in this exercise was to use meditation to manage anxiety and stress and improve my general mental well-being. I am not accustomed to meditation and had to turn to YouTube for guidance.
• General Anxiety Disorder Pharmacological Treatment Hydroxyzine is the only antihistamine medication approved by the FDA for the treatment of GAD. Other drugs used in the world for the treatment of GAD are not approved for use by the FDA.
• Generalized Anxiety Disorder Diagnostics Were you unable to cope with the excitement and calm down on any occasion in the last 14 days? Was it difficult for you to relax in the last 14 days?
• Anxiety Disorders: Symptoms, Causes, and Classroom Strategies The focus of this paper is on one of the most common types of anxiety disorder, which is generalized anxiety disorder, characterized by a continuous feeling of fear or anxiety that might interfere with day-to-day […]
• Assessing and Treating Patients With Anxiety Disorders According to the provided background information and the results of the mental diagnosis, it is clear that the client is suffering from GAD.
• Psychiatric Evaluation: Sadness and Anxiety She kept up with her counseling sessions and remained on the medication prescribed for her depression well into her early twenties. She has found the cure to be beneficial in controlling her symptoms.
• Discussion: Anxiety Disorder and Obsessive-Compulsive Disorders To be diagnosed with a specific phobia, one must exhibit several symptoms, including excessive fear, panic, and anxiety. Specific phobias harm the physical, emotional, and social well-being of an individual.
• Exam Anxiety as Psychological Disorder The study also focused on finding the relationship between exam anxiety and revision time on the score of students. The findings in this research relate to the current study in that it seeks the relationship […]
• Depression and Anxiety Clinical Case Many of the factors come from the background and life experiences of the patient. The client then had a chance to reflect on the results and think of the possible alternative thoughts.
• Anxiety and Difficulty Concentrating Treatment His siblings have achieved much in their careers, and the self-comparison of Eric to his older brother is a source of anxiety and depressive moods for Eric.
• Anxiety in a Middle-Aged Caucasian Man The primary goal of this decision was to decrease the intensity of the generalized anxiety disorder symptoms in the patient. After four weeks, the client returned to the clinic for the evaluation and discussion of […]
• Generalized Anxiety Disorder and Self-Awareness Based on the article, Panayiotou et al.review the aspect of self-awareness in alexithymia and its correlation with social anxiety. The research provides insight into self-awareness and how it influences anxiety.
• Online Peer Support Groups for Depression and Anxiety Disorder The main objective of peer support groups is connecting people with the same life experiences and challenges to share and support each other in healing and recovery.
• Anxiety Disorder Diagnosis and Treatment Soyara suffered from anxiety disorder and a probable sleep disorder necessitating the comorbid diagnosis. CBT with routine counselling would be the most efficient method of treatment for the anxiety disorder.
• Anxiety Disorder: Pharmacology An increase in the concentration of ACTH and cortisol. Together with the norepinephrine and dopamine systems, the concentration of ACTH and cortisol provides an adequate emotional response to the body.
• The Manifestations of Anxiety: Case Study The nurse also makes frequent clarifications to get a complete picture of the patient’s problem. The nurse often summarizes the information she hears to help the patient keep track of the dialogue.
• Anxiety and Depression: The Case Study As he himself explained, he is not used to positive affirmation due to low self-esteem, and his family experiences also point to the fact that he was not comforted often as a child.
• Perceived Helpfulness of Treatment for Generalized Anxiety Disorder The research is based on the theory of the importance of perceived helpfulness in treatment adherence; the actual findings of the study are detailed and portrayed accurately.
• Moral Identities, Social Anxiety, and Academic Dishonesty In his works, the scholar establishes two explanations for why students indulge in malpractices; the Social anxiety hypothesis and the moral anxiety hypothesis.
• Glossophobia: The Public Speaking Anxiety The level of fear in public speaking among the male and female participants was determined using a percentage and frequency approach.
• Anxiety Disorders: Types and Defense Mechanisms To be diagnosed with an anxiety disorder, a person’s fear or anxiety must be out of proportion to the scenario or age-inappropriate or prevent them from functioning correctly.
• Anxiety Issues Amongst Teenagers One of the most notable stress sources is a feeling of anxiety a state of mind characterized by negative mood and overall tension.
• Generalized Anxiety Disorder and Potential Treatment With the usage of the Benzodiazepines, the drug therapy proved to be relatively efficient and fast-acting. In an example case supplied in the Barlow et al.study, the subject overcame the worst consequences of GAD, although […]
• The Use of Aromatherapy for Patients Anxiety Reduction The target group for intervention to solve the described problem is patients at high risk of anxiety. Question: Among the patients at risk for anxiety, does the aromatherapy reduce anxiety level compared to no aromatherapy […]
• Depression and Anxiety Among Chronic Pain Patients The researchers used The Depression Module of the Patient Health Questionnaire and the Generalized Anxiety Disorder Scale to interview participants, evaluate their answers, and conduct the study.
• The Impact of COVID-19 on Anxiety among Students To be more precise, the authors aimed to investigate whether the transition to a new lifestyle due to the pandemic has impacted the anxiety levels of university youth.
• Generalized Anxiety Disorder: Pharmacological Treatment According to its etiology, higher DNA methylation of corticotropin-releasing factor increases GAD risk and severity as do reduced “resting-state functional connectivity between the amygdala and prefrontal cortex” and overactivation of the sympathetic nervous system due […]
• Effective Ways to Address Anxiety and Depression Looking deep into the roots of the problem will provide a vast and detailed vision of it, and will help to develop ways to enhance the disorders.
• Separation Anxiety Disorder (SAD) A routine can help to ease the pain and enable a child to develop trust in both their independence and parents.
• The Implementation of Family-Based Therapy to Manage Anxiety Disorder in Adolescents This paper presents a critical analysis of five research articles related to the proposed PICOT question: In a group of patients between the ages of 13-18 with complaints of anxiety, does the implementation of a […]
• Emotional and Anxiety Disorders and Social Cognition Such disorders as obsessive-compulsive disorder, social anxiety disorder, and depression are rooted in childhood, with negative cognitive experiences being the underlying cause for their development.
• Depression and Anxiety Intervention Plan John’s Wort to intervene for her condition together with the prescribed anti-depressant drugs, I would advise and educate her on the drug-to-drug relations, and the various complications brought about by combining St. Conducting proper patient […]
• General Anxiety Disorder Case Stady Like in the case of James, it can be concluded that James is suffering from Generalized Anxiety Disorder, attributed mainly to the kind of pressure he got from his place of work as a resident […]
• Psychedelic Drugs and Their Effects on Anxiety and Depression The participants must also be willing to remain in the study for the duration of the experiments and consent to the drugs’ use.
• Anxiety and Depression in Hispanic Youth in Monmouth County Therefore, the Health Project in Monmouth County will help Hispanic children and adolescents between the ages of 10 and 19 to cope with anxiety and depression through behavioral therapy.
• Anxiety Disorders and Depression In her case, anxiety made her feel that she needed to do more, and everything needed to be perfect. She noted that the background of her depression and anxiety disorders was her family.
• Communication Strategies. Anxiety of Public Speeches The main problem with anxiety is the inability of an individual to persuade the audience. Therefore, the more an individual practices public speaking, the better they will be able to deliver to the audience.
• The Nature of Philosophy: Anxiety As was mentioned by Harry Frankfurt, philosophy is created through anxiety born of an understanding of the limitation of knowledge.
• Anxiety Diagnostics and Screening Have you noticed the changes in your health when you stopped using your HTN medications? Do you observe some changes or problems with your memory?
• Managing Social Anxiety Disorder: Clinical Trial in Psychiatry For instance, the location of the numerical correlation between the use of the identified types of medicine and the subsequent identification of the outcomes can be viewed as crucial to the assessment of the drug […]
• Mobile Addiction and Anxiety: The Relationship Analysis The purpose of the study is to establish the nature of the relationship that exists between mobile addiction and anxiety among students.
• Effect of Preoperative Education on Anxiety of Surgical Patients The education is believed by many medical practitioners to decrease the length of stay in a health facility by providing the patients with substantial information on strategies to adopt to endure and go through psychological […]
• “Effectiveness of Relaxation for Postoperative Pain and Anxiety” by Seers The problem statement and research questions have not been defined but the review of literature reveals that very little work has been done on the topic of effectiveness of relaxation for post operative pain and […]
• Anxiety Among Refugees and the Crucial Need for Professional Interpreters This review appraises three studies examining the issue of anxiety among refugees and the role of professional interpreters in reducing anxiety.
• Anxiety Among Us: How and Why, Drug Addiction As the effects of the drug are not long-lasting, people who take phenobarbital tend to use the medicine more often than it is allowed in the drug prescription.
• Children Healthcare-Induced Anxiety: Analysis Arguably the most crucial difference is that children are often distrustful of medical professionals and scared of physical examinations, and thus adjustments have to be made to make the exam more comfortable. To encourage engagement […]
• Daily Patterns of Anxiety in Anorexia Nervosa The researchers failed to indicate the distinct and important sections such as the study objectives and the significance of the study.
• Local and International Student’s Anxiety In addition to that, international students suffer from anxiety that is caused by the necessity to live in a new environment and culture.
• Depression and Anxiety in Dialysis Patients However, the study indicates the lack of research behind the connection of depression and cognitive impairment, which is a significant limitation to the conclusive statement.
• Social Anxiety. Affecting on Humans The next dependent variable included the revolutionary in the psychopharmacology that led to the production of tranquilizers that were used by the people as a relief of the social anxiety in the 1950s and 1960s. […]
• The Child-Mother Relations: Preventing of the Separation Anxiety Disorder It is important that the researchers defined the issue in the introductory part of the research, as it clarified the criteria for selection of the survey participants and analysis of the study results.
• Treating Adolescents With Social Anxiety At the end of treatment 59% of the SASS group no longer qualified for a diagnosis of social phobia versus 0% of the ESGF group.
• “Status Anxiety” by Alain de Botton Within the ego psychoanalytic theoretical context of the identity statuses, social status ought to refer to the similarity experienced between one’s personal attributes and one’s ego ideal standards, a match that should improve in adolescence […]
• Poor Body Image, Anxiety, and Depression: Women Who Undergo Breast Implants H02: There is no difference in overt attractiveness to, and frequency of intimacy initiated by, the husband or cohabitating partner of a breast implant patient both before and after the procedure.
• Abnormal Behavior: Anxiety, Mood-Affective, Dissociative-Somatoform Considering the abnormal behavior of people, the following disorders may be identified, such as anxiety, mood or affective, and dissociative or somatoform, which have different diagnoses, symptoms, and criteria, which may be analyzed from the […]
• Reducing Anxiety and Depression With Exercise Regardless of the type of results achieved, it is recommendable for people undergoing mental problems like depression and anxiety to exercise regularly.
• Anxiety and the Urge for Victory Among Athletes The challenges of sports presuppose some extent of anxiety and the urge for the victory in the name of a team or something/someone important for a sportsman.
• Aspects of Anxiety Disorders The symptoms of anxiety disorders are so commonly experienced and non-threatening that one is prompted to underestimate the occurrence of such disorders and therefore assume them to be just a minor stress-related anomaly.
• Anxiety and Depression Disorders The cognitive-behavioral model is different from the biological model in that anxiety and depression are seen as a manifestation of intense emotional distress and/or fear. The states of fear, anxiety, and panic are triggered in […]
• The Methods to Reduce Preoperational Anxiety Where as observation of Krohne et al [2005] from the perspective of extending social support appears to have a higher significance than that of the others.
• Relationships Between Anxiety, Perceived Support and Self-Esteem In particular, it sought to determine whether there is a relationship between anxiety, perceived support from friends, and self-esteem whereby anxiety and perceived support from friends act as predictors of the level of self-esteem.
• Anxiety About Statistics in Undergraduate Students The present study aims to investigate the impact of statistics anxiety on the academic performance of students enrolled in a statistics course.
• Anxiety Disorder in Pregnancy To be precise, the dangers of anxiety disorder during the pregnancy period can equally affect the mother and the unborn child.
• Depression and Anxiety Due to School and Work-Related Stress Many young students are not aware of the roots of their psychological problems and continue suffering from depression or anxiety, which results in low productivity, poor achievements, and a decreased quality of life.
• Anxiety in Children and Its Reasons Moreover, it features vital information about the potential causes of anxiety disorders in children, addressing the role of parents and the environment in the development of the symptoms.
• Anxiety Disorder: Symptoms and Treatment According to Burton, Westen and Kowalski, the common symptoms of panic disorder are the lack of breath, rapid heart rate and pain in the chest.
• Anxiety, Self-Efficacy, and College Exam Grades They conduct a study on 110 students in a variety of majors and gauge their test anxiety and self-efficacy, then collect their results on a test and analyze the results. Notably, they find that the […]
• Anxiety Disorder: Psychological Studies Comparison The research article is expected to investigate the topic of interest from the standpoint of theory and evidence while the pop culture article will give advice and recommendations to its readers.
• Patient’s Dental Fear: Managing Anxiety In order to find out the most effective ways to cope with the patient’s dental fear, one might consider those methods which will be applicable in accordance with the state of a client.
• Optimal Mental Health Approaches: Depression & Anxiety The work of a counselor implies the necessity to understand and recognize the signs and symptoms of mental health problems, as well as find “the missing pieces of reality” that impact innermost lives.
• Test Anxiety and Academic Performance The purpose of the study in question was to investigate the relationship between academic performance and test anxiety. The study was designed to determine causality between the level of test anxiety and average grades of […]
• Anxiety Influence on Studies and Concentration It is a proven fact that anxiety has a negative influence on cognition, which is the ‘information processing’ of a person.
• Generalized Anxiety Disorder and Its Nature For example, Locke et al.suggest that the combination of medication and physiotherapy is particularly effective in cases of moderate and severe GAD.
• General Anxiety Disorder Interventions The authors concluded that the combination of CBT and MI provides a method that allows to minimize possible risks and enhance the effects of CBT.
• Acute Anxiety Impairs Accuracy in Identifying Photographed Faces The researchers wanted to present the best ideas and practices towards improving the performance of eyewitnesses. The authors used the best methods to conduct their study.
• Interviewing the Patient: Stress and Anxiety Reasons Questions Effectiveness How are you, Jonathan? (B) This is a rather bad question, as it is very generic and does not invite the patient to share his emotions with the specialist. On the surface, the question itself is rather harmless; however, when considering it a bit deeper, especially in the given context, one must admit […]
• Anxiety and Depression in Children and Adolescents The effects of anxiety in children and adolescents are detrimental both to individuals and society. It is also said to contain a summary of the current research and theory that have been done by other […]
• Anxiety, Depressive and Personality Disorders There are several features of the depressive disorders, namely the presence of a bad mood, certain changes in the somatic and cognitive functions, and the significant deterioration of functioning.
• Generalized Anxiety Disorder in Female Patient In the client’s case, it is not possible to make a developmental diagnosis because the woman has a bachelor’s degree in journalism obtained at the University of Florida.
• Behaviorism and Anxiety Disorder Treatment Today the behaviorism theory is one of the most developed and reliable theories of psychology because of its methodology and approach that is evident in human behavior.
• Anxiety and Cultural Models in the Conflict The biological concept proposes that anxiety is normally caused by the chemical imbalance which in the long run leads contributes to a genetic panic disorder hence the disorder is likely to be passed down the […]
• Factors of Generalized Anxiety Disorder Prevalence Moreover, the citizens of the developed countries are more likely to observe generalized anxiety disorder than the citizens from nondeveloped countries. Unfavorable environmental factors also can increase the risk of generalized anxiety disorder.
• Anxiety Disorder: Mindfulness-Based Stress Reduction The researcher aims to use the tools suggested by Majid et al.and Hoge et al.to evaluate the levels of anxiety in the patient at the beginning of the intervention, during, and after it.
• Addressing the Needs of a Patient With Bipolar and Generalized Anxiety Disorders Furthermore, the patient should restore his connection to his family members since the specified issue contributes to the problem significantly. During the first crisis according to Eriksson’s theory, the patient has experienced abandonment from his […]
• Attention Bias Modification Program in Anxiety Disorder Treatment Thus, it can be argued that in Shana’s case ABM can be applied to reduce current symptoms with a follow up of the CBT to enhance the overall mental health state and minimize negative thinking.
• Anxiety Measurement: MASC and BAI Two of the most effective assessment tools are the Multidimensional Anxiety Scale for Children and the Beck Anxiety Inventory. The main goal of this paper is to analyze and compare two assessment tools: the Multidimensional […]
• Social Anxiety and Problematic Drinking Among College Students The article “Understanding Problematic Drinking and Social Anxiety among College Students” describes the impact of social anxiety disorder on the experiences of many students.
• Social Anxiety and Facebook Time Spending I chose social anxiety as the concept that might have an effect on the amount of time spent on Facebook each day because of the increasing number of teenagers and young adults who identify themselves […]
• Anxiety Evaluation in Rehabilitation Counseling The research study sought to demystify the facts on the relationships among the stress appraisal process, coping disposition and the level of acceptance of disability on a selected sample for study.
• Emotional Issues: Anxiety and Its Difficulties The patient, therefore, lacks the ability to manage his emotions and handle the pressure of his new responsibilities. Client B.C.is aware of his problems and recognizes the significance of learning.
• Definition of Dental Anxiety and Fear That way, studying the facts that contribute to the prevalence of anxiety in dental patients, the researchers should study the psychopathological profiles of anxious individuals.
• Descriptive Statistics and Statistics Anxiety For example, for the typical cases, the mode, the median, and the mean measures are recommended; for exploring the nature of the distribution of the variable, the test of Skewness or Kurtosis is applied; and […]
• Severe Anxiety Disorder: Diagnosis and Treatment The mental position of the patient explains why it was necessary to refer the patient to a psychiatrist. Family members should also “be equipped with appropriate communication skills in order to address the needs of […]
• Yoga for Depression and Anxiety A simple definition of yoga will lead people to generalize it as a system of exercise and a kind of mindset that would result in the union of mind and body.
• Sleep Disturbance, Depression, Anxiety Correlation The above imply that many questions are still unanswered with respect to the kinds of sleep complaints affecting undergraduates and the impact on their psychological health.
• Statistics: Anxiety and Sharing Feelings Correlation The means by genders are summarised in the table below. This correlation value was used to determine the nature and strength of the relationship.
• Cognitive Therapy for Anxiety and Addiction Withdrawal The clients’ irrational mindsets can be recuperated relying on three major concepts, which are the Rational Emotive Behavior Therapy, the ABCDE Model, and the Dysfunctional Thought Record.
• Various Anxiety Disorders’ Comparison Lochner explains that physical and emotional abuses suffered in the early years by the individual are predictive to the development of these two anxiety disorders.
• Therapy for Children and Young Patients With Anxiety Disorders This is where the therapists working with the young patients adjust the content and speed of the therapy so that it can match with the level of a particular child.
• Patient Anxiety From MRI Scans Due to the nature of the procedure, the patient can stay in the cylinder for up to an hour depending on the criticality of the examination.
• The Effect of Drug X on Self-Reports of Anxiety in a Sample of Undergraduate Psychology Majors The students will be from the same year of study and the issue of race and color will be considered. Upon the approval of their consent and that of the institution to carry out the […]
• Cognitive Behavioural Family Therapy With Anxiety Disordered Children In relation to definite scope family functioning, the study suggested that parents of anxiety-disordered children have meagre family functioning accompanied with reluctance in monitoring the disparate behaviours in the family.
• Globalization and Culture: Possibilities and Anxieties While the benefits of globalization to the economy cannot be overestimated, still statistics have proven that the world is at a worse state of inequality than it was prior to the emergence of the concept […]
• The Effects of Forgiveness Therapy on Depression, Anxiety and Posttraumatic Stress for Women After Spousal Emotional Abuse Enright forgiveness model applied in the study proved effective since it systematically addressed the forgiveness process identified the negative attributes caused by the abuse, and prepared the women for positive responses.
• Death Anxiety Is a Multidimensional Concept While concentrating on these dimensions of the death anxiety, it is possible to determine such concrete fears as the fear of dependency, the fear of the pain experienced in the dying process, the fear associated […]
• Acceptance-Based Behavioral Therapy The treatment was randomly administered to 15 of the 31 clients while the remaining 16 clients formed the waiting list control.
• Anxiety, Mood, and Dissociative Disorders The parasympathetic system reverses the activity of the sympathetic system when the danger passes, and restores the body to its resting, pre-anxiety state.
• Attention Biases in Anxiety For instance the primary role of the mechanism responsible for the fear emotion are to allow the identification of threat in the surrounding and to assist the organism react promptly an efficiently to the situation.
• Anxiety, Somatoform, and Dissociative Disorders The impact of these mental disorders varies from minor disturbance in the life of an individual to major problems in the daily activities of the person.
• Fundamentals of Abnormal Psychology: Anxiety Disorders This paper has gone on to reiterate the fact that anxiety disorders are indeed a reality in life and as such, we should brace ourselves for their occurrences.
• Frequent Tests as the Ways to Overcome Procrastination and Anxiety The problem can depend not only on the level of the students’ knowledge but also on the degree of the tension and anxiety which are associated with the preparation and review of the material during […]
• Personality, Mood and Anxiety Disorders The first method is used to distinguish personality disorders from anxiety and mood disorders and involves analysis of ego-syntonic features present, chronic causes and early onset of the disorders.
• Generalized Anxiety Disorder: Patient’s Psychological State He feels that his physical, emotional, personal and professional state is in decline, and that is indicative of the seriousness of this psychological disorder.
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• Published: 06 January 2022

Factors affecting test anxiety: a qualitative analysis of medical students’ views

• Majed Wadi 1 , 2 ,
• Muhamad Saiful Bahri Yusoff 2 ,
• Ahmad Fuad Abdul Rahim 2 &
• Nik Ahmad Zuky Nik Lah 3  

BMC Psychology volume  10 , Article number:  8 ( 2022 ) Cite this article

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Medical students are vulnerable to test anxiety (TA), which impacts their professional lives and jeopardizes the optimal health care of their patients. The qualitative exploration of TA among medical students is crucial to understanding the problem. Hence, this study examined medical students’ insights into TA and their suggestions on how to reduce it.

We conducted a phenomenological study on medical students at a public university. We utilized focus group discussions (FGDs) to investigate their experiences of TA. The FGDs were transcribed verbatim, and these transcripts were analyzed using Atlas.ti software. The thematic analysis followed the recommended guidelines.

Seven FGD sessions were conducted with 45 students. Three major themes emerged: the students, their academic resources, and the examiner. Each theme comprised mutually exclusive subthemes. The “students” theme was divided into negative vs. positive thoughts and self-negligence vs. self-care, “academic recources” into heavy curriculum vs. facilitative curricular aids, and “examiner” into criticism vs. feedback and strict vs. kind approaches.

This study provides a solid foundation for policymakers and decision makers in medical education to improve current assessment practices and student well-being. Medical students will be able to significantly alter and reduce TA if they are provided with additional psychological support and their examiners are trained on how to deal with examinees.

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Introduction

Test anxiety (TA) is integral to assessments. It ranges from simple worry to debilitating anxiety, which interferes with the cognitive process. Although a low level of TA can motivate students to study and prepare for assessment, an extreme level of TA alters their physiological functions, psychological status, or both. These changes impair concentration, interrupt working memory, and hinder academic achievement. Crucially, TA may result in chronic stress, which is associated with many adverse effects on wellbeing. These include burnout, depression, poor academic performance, poor clinical performance, impaired decision making, poor peer interaction, interpersonal conflict, academic dishonesty, and sleeping problems [ 1 , 2 ]. Furthermore, chronic stress is linked to substance abuse, alcohol consumption, and suicide [ 3 , 4 , 5 , 6 ].

TA has a significant effect on health professions’ students. In a meta-analysis, Quek, Tam [ 7 ] reported that 33.8% of medical students experience anxiety. Likewise, Macauley, Plummer [ 8 ] determined that 51% of female and 37.5% of male health care students have moderate to high TA. Several quantitative studies have explored the causative factors of TA among medical students. These factors included expansive curricular content [ 9 , 10 , 11 , 12 ], inappropriate study skills [ 9 , 10 , 11 , 12 ], difficult test formats (objective structured clinical examination [OSCE] in particular), negative thoughts [ 10 ], and female gender [ 9 , 10 , 12 ]. However, the few qualitative studies that have examined TA among medical students are limited in scope. For instance, Encandela et al. [ 13 ] assessed TA following the implementation of a United States Medical Licensing Examination (USMLE) preparation course, whereas Shen et al. [ 14 ] explored whether the introduction of expressive writing can reduce TA.

Qualitative research yields detailed insights, sheds light on the dynamics of various relationships, and generates themes and thus theoretical foundations for future research [ 15 ]. Therefore, the qualitative investigation of medical students’ TA is essential to understanding its implications. Such studies can clarify how to remodel TA and create a platform for early intervention into and improvement of medical students’ well-being. Hence, this qualitative study explored medical students’ thoughts on TA and what they believed should be done to reduce it.

This study employed a phenomenological approach to analyze the factors affecting TA from the perspectives of medical students. Data were collected using seven focus group discussions (FGDs) with a total of 45 medical students from the School of Medical Sciences, Universiti Sains Malaysia (USM). The study was approved by the Institutional Human Research Ethics Committee at USM, and all students were asked to sign a consent form upon their agreement to participate in this study. The researchers emphasized confidentiality, anonymity, and the right to withdraw at the start of each session. To maintain the participants’ confidentiality, we assigned a pseudonym to each one.

Participants, sampling, and recruitment

We selected groups of five to seven medical students from different academic years because we expected their experiences of stress and anxiety to differ accordingly [ 16 ]. We applied purposive sampling with consideration for student variety to obtain a wide range of experiences. Moreover, we intended to represent factors such as gender and race (e.g., Malay, Chinese, Indian, or other). We gave invitation letters to the group leaders of each academic year. We also used WhatsApp to disseminate information about the study and its consent forms. In addition, we assigned a token to each participant after their session.

Data collection

We piloted the FGD protocol with a group of students, and they reported that it was open-ended and stimulated discussion. Next, the FGD sessions were conducted in a quiet and comfortable room. We began each session by welcoming the group members and briefing them on the study’s purpose. Based on the predetermined probe questions, we initiated the audiotaped discussion with an open-ended cue: “Test anxiety to me is…”. We made notes to reflect non-verbal cues. Each FGD ended after 60 to 90 min. Data collection continued until theoretical saturation was reached, which occurred when no new information appeared [ 17 ]. We conducted all the FGD sessions in March 2019.

Data analysis

We started data analysis concurrently with data collection. This interim analysis helped us adjust and check the emerging themes alongside the consequent data.

We followed Braun and Clark’s six-phase thematic analysis [ 18 ]. In the first phase (familiarization with the data), the researcher (MW) transcribed the audio recording verbatim (including verbal and non-verbal cues), assigned pseudonyms to all the identifiable individuals, and cross-checked the transcript against the audio recordings. All the authors (MW, MSBY, AFAR, and NAZNL) then read the transcription several times to familiarize themselves with the data set and to immerse themselves in its meaning. Then, MW imported all the transcription files into Atlas.Ti (version 7.9) to initiate the second phase (generating initial coding), during which MW and MSBY independently identified open codes throughout the data set; these were either the participants’ own words (in vivo) or a descriptive word for their experience. We conducted frequent comparisons of the generated themes to resolve disagreements and reach consensus on the initial themes. In phase three (searching for themes), MW and MSBY conducted a high-level analysis by combining several related codes to create overarching themes. MW, MSBY, AFAR, and NAZNL held joint meetings to discuss potential themes. In the fourth phase (reviewing the themes), MW examined the quotations associated with each theme and determined their coherence (internal homogeneity). If a quotation did not fit, MW either redirected it to a more closely related theme or revised the theme. MW then reviewed all the themes to determine their relevance and to ascertain whether each theme was significantly different from the others (external heterogeneity). To ensure that potential themes reflected the entire data set, MSBY and AFAR compared them to the codes and to the entire data set. MW, MSBY, AFAR, and NAZNL discussed inconsistencies and refined potential themes. In the fifth phase (defining and naming themes), we gave each a name, a definition, and an explanation narrative. Additionally, MW, MSBY, AFAR, and NAZNL ascertained whether any complex theme required subthemes to be structured more effectively. Finally, in the sixth phase (writing the report), MW and AFAR assembled the selected quotes to illustrate key points. MSBY and NAZNL revised the report. We repeated this procedure until we reached unanimous agreement.

Table 1 highlights how we addressed Guba’s four criteria for detecting the trustworthiness of qualitative studies [ 19 ].

Table 2 displays the characteristics of the participants. Gender distribution was nearly equal among participants, and most were fourth-year students.

As depicted in Fig.  1 , three major themes emerged from the thematic analysis: students, academic resources, and examiners. Each theme was subdivided into subthemes that reflected increased and decreased TA.

Emerged themes and sub-themes in relation to increasing and decreasing test anxiety

Shown in gray, the themes were placed at the center of the figure. All subthemes that increased TA were grouped together and colored red, while those that decreased TA were grouped together and colored green. The arrows on either side of the figure denote the two primary probe questions asked during the FGD. Notably, we arranged the themes and their associated subthemes from external to internal to reflect the relationships and interactions between them.

Theme 1: students

Negative vs. positive thoughts Most students expressed how their negative and positive thoughts influenced TA:

Both [positively minded and negatively minded students] may make a mistake, but the positive [student] will go on with minor anxiety because they know what [is] done is done and they cannot change it, but the negative one will keep on dwelling [on] the past/mistakes, and hence [this student increases their] anxiety level. (Student E, Group 6)

Some students noted that their preconceptions of negative ideas occurred if they had to share a bad experience with their colleagues:

I [learned] that the malignant doctor will examine me the next day. Eight of the students failed. The day [that I learned this was] stressful[.] (Student B, Group 3) When I [learn that a] “malignant doctor” will become my examiner, it increases [my] test anxiety[.] (Student C, Group 6)

Moreover, because the students identified as A-level students and had pursued their education since childhood, these expectations further increased their anxiety. Crucially, some students noted that positive thoughts and maintaining their motivation reduced TA:

I always try to keep myself positive and constantly remind myself to be confident in myself and believe in God. (Student A, Group 5) My anxiety will decrease if I stay positive by […] telling myself that I will do well in the exam[.] (Student D, Group 2)

Self-negligence vs. self-care The more time that the students had for self-care and maintaining a healthy lifestyle, the more their positive thoughts increased. In particular, the students mentioned that adequate sleep, a balanced or fulfilling diet, and exercise lowered TA:

[W]hat helps me with stress or anxiety is good food and sleep[.] (Student C, Group 4) For me [,] I need food to focus. For this reason, food relie[ves] my stress. (Student F, Group 5) I tend to get anxious when I go [to take an] exam without having coffee and something to eat. (Student B, Group 3)

In contrast, self-negligence was associated with increased TA. The students reported many bad behaviors that impacted their health and exam preparedness:

I also tend to get anxious when I go for an exam without having coffee and something to eat[.] (Student E, Group 4) I went to sleep at 7:00 am and [woke] up at 1:00 pm. I drink two cups of coffee per day. I [know that] some of my friends drink 5–10 cups of coffee [per day]. These kinds of things are not usual to your body. (Student B, Group 1)

Theme 2: academic resources

Heavy curriculum vs. facilitative curricular aids The students pointed out that the heavy medical curriculum triggered their anxiety levels before their exams:

But the problem with medical school [is that] too [many things must] be prepared [for] before the exam[.] (Student D, Group 1) The one that [stresses me out] is the [number of things] we need to cover […] for major exams especially[.] (Student C, Group 3) I need to cover [so many things]. [All things] and [many things], and you do not have enough time[.] (Student A, Group 5)

Notably, supportive measures before the exam could ameliorate this burden. The suggested measures include increasing formative assessments, briefings on the exams’ formats,, and making class more fun:. In particular, the students emphasized the importance of formative assessments:

Give quiz[s]/homework based on[the] learning outline at the end of every lecture so the students know what exactly they have to cover for each subject[.] (Student A, Group 6) In our previous exam, there [was] no briefing, so we [did not] know how many questions [would] come in the exam […] [or] what [would] be assessed[.] (Student C, Group 2) Try to make the class more fun because fun and relaxing classes tend to increase one’s memory and focus during that class. To be honest, [the] lecturer[s]who make classes more fun and [use] more discussion tend to make me remember things easier. (Student A, Group 3)

Theme 3: examiner

Strict vs. kind approach The students believed that the examiner played an important role in aggravating TA. Most stated that due to the presence of an examiner, OSCE was the assessment format that raised their TA the most:

[T]he examiner will affect me [the] most. (Student B, Group 4) The examiner in OSCE is very strict about the answer scheme, and sometimes he/she is known as an examiner who always fail[s] the student[s]. (Student A, Group 2)

Most students agreed that the stricter the examiner, the worse their experience of TA. They identified some features of so-called “malignant examiners,” including their intention to fail students:

[My anxiety increases during the exam if] the examiner in OSCE is someone we know [who is] very strict about [the] answer scheme […] [or] known as an examiner who always fail[s] the student[s]. (Student B, Group 1)

Moreover, the students claimed that malignant examiners used certain facial expressions and body language during the exam:

[Examiners] who are grumpy and do not even answer back when I greet them make[] me more anxious during OSCE[.] (Student C, Group 1) The [examiner] who has a straight face without any expression increases anxiety during exam[.] (Student A, Group 2)

Correspondingly, the students believed that kind examiners significantly reduced TA, such as by smiling and establishing a rapport:

I will choose the examiners that are kind and soft spoken to the student[s] to avoid the students feeling [scared] when [answering] the question[,] especially [during] OSCE[.] (Student C, Group 3) Just a simple gesture such as a smile, talking nicely to student[s], [and focusing] on information given by students. All [of] these will help to reduce stress[.] (Student B, Group 6)

The students suggested that applying a unified scoring system will help in reducing TA:

I think [I would] I brief all examiners about the guidelines and make sure that examiners understand the guideline and what is actually expected of students[.] (Student E, Group 2) [The examiners should] have a proper guideline for the marking of the students[.] (Student A, Group 4) Everyone has a proper guideline, not given a bias of judgment. I think that is OK for me[.] (Student F, Group 3)

Criticism vs. feedback The students signified that the examiner’s response approach affected TA. Most participants described criticism as “scolding,” which increased TA:

I just fear […] being scolded during the exam. (Student A, Group 4) I think that some examiners should not be shouty because student[s] are not well prepared. So, the way [that they] treat students will affect them. (Student D, Group 2) Some […] examiners [scold students]. They usually compare [the] current situation with future work. Just [because] you are feeling stress now, this [does] not mean you cannot handle whatever [will come up] when you work. (Student D, Group 1)

Correspondingly, students agreed that giving effective and constructive feedback during exams reduced TA, supported their learning, and empowered them to prepare more for their upcoming exams:

[If the examiner feedbacks the student, he] will [be] happier[,] and after the exam[,] he will tell [his] other friends that [the] examiner [taught] him [well.](Student A, Group 1) Actually, for both exams, I got the same marks. But, I was feeling better during the first exam, where the lecture calm[ed] me, and after the exam, she guided me [on how to answer] the question[.] [E]ven though I [could not] answer it, she guided me on what to do after that rather than scold[ing] me and ask[ing] me to [leave.] (Student B, Group 4)

This qualitative study explored TA from the perspective of medical students and identified its precipitating and diminishing factors: the students, their academic resources, and the examiner.

Negative vs. positive thoughts The students had a major role in developing and depleting TA. This could be due to the nature of TA, which originates from a negative self-process that encodes the outer environment into personal responses. In this context, the process fixated on how the exam would be and how the examiners would interact with the examinees, and it was exaggerated by an individual’s negative self-thoughts, academic competence, and/or ability to cope with challenging evaluative situations. For example, many participants had developed self-expectations since childhood. These expectations were strengthened by the people surrounding them and continued to be enhanced during their medical education. Other studies have determined that parents’ academic expectations affect their offspring’s TA [ 20 , 21 , 22 ]. Notably, the participants in this study also worried about transmitting their bad experiences to their peers.

Our findings suggest that enriching positive thoughts and believing in self-efficacy reduces TA in medical students. In his investigation of the cognitive triad, Wong [ 23 ] proposed that rational beliefs will lead to neutral or positive emotional consequences. This assumption has been used by many researchers to build cognitive reconstructions to reduce TA [ 13 , 24 , 25 , 26 , 27 ]. Based on these findings, it is apparent that thoughts influence our behavior [ 28 ]. Hence, we argue that negative and positive thoughts are the most important factors in this study. They may be used to form interventions to resolve TA.

Self-negligence vs. self-care The students demonstrated a variety of self-negligence behaviors that may amplify TA and trap them in a vicious cycle, including sleep deprivation, excessive consumption of coffee and other stimulants, and avoidance of sports. Self-negligence affects psychological perception and weakens mental fortitude, thus resulting in TA. On the other hand, self-care improves personality characteristics and the mental ability to combat TA [ 29 , 30 ]. Hence, our results emphasize the critical state of self-care among medical students, and academic advisory programs, among others, should promote healthy lifestyle choices to rectify this.

Students can feel an exaggerated sense of pressure and increased TA if they have to face the difficulty of their medical curriculum from the beginning of their studies [ 9 , 10 , 11 , 12 ]. By incorporating facilitative curricular aids, the detrimental effects of the curriculum can be remedied. For example, classes should be enjoyable and employ more formative assessments. Another strategy is to promote group study, as this may establish a beneficial framework for discussing and illustrating ambiguous concepts. Group study has been shown to be an effective method for enhancing student learning and providing a welcoming environment for discussion [ 31 ].

Strict vs. kind approaches According to socioconstructive theory and the social aspect of anxiety [ 32 ], the presence of an examiner (or evaluator) is the primary cause of TA during clinical examinations. The situation deteriorates further as a result of ineffective communication and attempts to fail students based on biases and prejudices. McManus et.al [ 33 ] referred to this approach as “the hawk effect” or “stringency.” As Shashikala [ 34 ] noted, such a person is occasionally referred to as the “malignant examiner.” Typically, examiners become stringent to ensure the principle of patient safety, which is the ultimate goal of medical education, during clinical evaluation of medical students. However, students’ mental well-being should not be jeopardized. For this reason, standardized scoring (either checklist or rubric) tools helps to eliminate prejudice and personal bias [ 35 ]. Nevertheless, comprehensive training on using the standardized scoring assessment during OSCE is highly mandated and crucial to maximize fairness and assessment validity [ 36 ].

Criticism vs. feedback The students noted that when they received constructive feedback during an exam, this enhanced their learning and helped them improve in a subsequent exam or practice session. Many students worried that some examiners may neglect the most effective use of feedback. Some examiners hope to motivate students by critically increasing their awareness and fear of failure, and Putwain and Roberts [ 34 ] referred to such tactics as “fear appeals.” The present study suggests that extensive training and close monitoring of the examiner during the examination will help reduce TA. Students should be encouraged to express themselves without harming the exam environment.

Two limitations apply to this study. The first is that it is restricted to a single medical school, and the second is that the sampling frame does not include representative medical students from all academic years, as medical students in their first and fifth years are required to sit for exams at the time of data collection. Both of these constraints make generalization difficult. For these reasons, additional research is needed to broaden the sampling and expand its scope beyond medical schools to include groups from other disciplines of health professions education (HPE). This will provide a comprehensive understanding of the TA problem across multiple HPE disciplines.

This qualitative study shed light on the factors that affect TA from medical students’ perspectives. Three major factors affecting TA were identified: the students, their academic resources, and the examiner. Sub-factors were also identified for each of these factors. This study established a solid foundation for policymakers and decision makers in medical education to improve current assessment practices while also enhancing student well-being. The results indicate that the polar factors of the examiner and the student act in concert and shape TA. Thus, additional psychological support for students and training for examiners on how to deal with examinees will significantly reduce TA.

Availability of data and materials

Due to privacy concerns, the transcripts of the interviews are not available to the public. On reasonable request, the corresponding author can provide transcript information.

Abbreviations

Focus group discussion

Objective structured clinical examination

Test Anxiety

Universiti Sains Malaysia

United States Medical Licensing Examination

Ribeiro ÍJS, Pereira R, Freire IV, de Oliveira BG, Casotti CA, Boery EN. Stress and quality of life among university students: a systematic literature review. Health Prof Educ. 2018;4(2):70–7.

Article   Google Scholar  

Frajerman A, Morvan Y, Krebs M-O, Gorwood P, Chaumette B. Burnout in medical students before residency: a systematic review and meta-analysis. Eur Psychiatry. 2019;55:36–42.

Flaherty JA, Richman JA. Substance use and addiction among medical students, residents, and physicians. Psychiatr Clin N Am. 1993;16:189–97.

Hays LR, Cheever T, Patel P. Medical student suicide, 1989–1994. Am J Psychiatry. 1996;153(4):553.

Newbury-Birch D, White M, Kamali F. Factors influencing alcohol and illicit drug use amongst medical students. Drug Alcohol Depend. 2000;59(2):125–30.

Pickard M, Bates L, Dorian M, Greig H, Saint D. Alcohol and drug use in second-year medical students at the University of Leeds. Med Educ. 2000;34(2):148–50.

Quek TTC, Tam WWS, Tran BX, Zhang M, Zhang Z, Ho CSH, et al. The global prevalence of anxiety among medical students: a meta-analysis. Int J Environ Res Public Health. 2019;16(15):2735.

Macauley K, Plummer L, Bemis C, Brock G, Larson C, Spangler J. Prevalence and predictors of anxiety in healthcare professions students. Health Prof Educ. 2018;4(3):176–85.

Khoshhal KI, Khairy GA, Guraya SY, Guraya SS. Exam anxiety in the undergraduate medical students of Taibah University. Med Teach. 2017;39(sup1):S22–6.

Guraya SY, Guraya SS, Habib F, AlQuiliti KW, Khoshhal KI. Medical students’ perception of test anxiety triggered by different assessment modalities. Med Teach. 2018;40(sup1):S49-s55.

Hashmat S, Hashmat M, Amanullah F, Aziz S. Factors causing exam anxiety in medical students. J Pak Med Assoc. 2008;58(4):167–70.

PubMed   Google Scholar  

Tsegay L, Shumet S, Damene W, Gebreegziabhier G, Ayano G. Prevalence and determinants of test anxiety among medical students in Addis Ababa Ethiopia. BMC Med Educ. 2019;19(1):423.

Encandela J, Gibson C, Angoff N, Leydon G, Green M. Characteristics of test anxiety among medical students and congruence of strategies to address it. Med Educ Online. 2014;19:25211.

Shen L, Yang L, Zhang J, Zhang M. Benefits of expressive writing in reducing test anxiety: a randomized controlled trial in Chinese samples. PLoS ONE. 2018;13(2):e0191779.

Queirós A, Faria D, Almeida F. Strengths and limitations of qualitative and quantitative research methods. Eur J Educ Stud. 2017;3(9):369–86.

Google Scholar  

Yusoff MSB, Rahim AFA, Yaacob MJ. Prevalence and sources of stress among Universiti Sains Malaysia medical students. Malays J Med Sci: MJMS. 2010;17(1):30.

PubMed   PubMed Central   Google Scholar  

Ritchie J, Lewis J, Nicholls CM, Ormston R. Qualitative research practice: a guide for social science students and researchers. Thousand Oaks: Sage; 2013.

Braun V, Clarke V. Using thematic analysis in psychology. Qual Res Psychol. 2006;3(2):77–101.

Guba EG. Criteria for assessing the trustworthiness of naturalistic inquiries. Ectj. 1981;29(2):75–91.

Peleg O, Deutch C, Dan O. Test anxiety among female college students and its relation to perceived parental academic expectations and differentiation of self. Learn Individ Differ. 2016;49:428–36.

Peleg-Popko O, Klingman A. Family environment, discrepancies between perceived actual and desirable environment, and children’s test and trait anxiety. Br J Guid Couns. 2002;30(4):451–66.

Fox NA, Henderson HA, Marshall PJ, Nichols KE, Ghera MM. Behavioral inhibition: linking biology and behavior within a developmental framework. Annu Rev Psychol. 2005;56:235–62.

Wong SS. The relations of cognitive triad, dysfunctional attitudes, automatic thoughts, and irrational beliefs with test anxiety: research and reviews research and reviews: research and reviews research and reviews. Curr Psychol. 2008;27(3):177–91.

Warshawski S, Bar-Lev O, Barnoy S. Role of academic self-efficacy and social support on nursing students’ test anxiety. Nurse Educ. 2019;44(1):E6–10.

Poorman SG, Mastorovich ML, Gerwick M. Interventions for test anxiety: how faculty can help. Teach Learn Nurs. 2019;14(3):186–91.

March AL, Robinson C. Assessment of high-stakes testing, hopeful thinking, and goal orientation among baccalaureate nursing students. Int J Nurs Educ Scholarsh. 2015;12(1):1–7.

Brodersen LD. Interventions for test anxiety in undergraduate nursing students: an integrative review. Nurs Educ Perspect. 2017;38(3):131–7.

Baumeister RF, Masicampo E, Vohs KD. Do conscious thoughts cause behavior? Annu Rev Psychol. 2011;62:331–61.

Zhang N, Walton DM. Why so stressed? A descriptive thematic analysis of physical therapy students’ descriptions of causes of anxiety during objective structured clinical exams. Physiother Can. 2018;70(4):356–62.

Slonim J, Kienhuis M, Di Benedetto M, Reece J. The relationships among self-care, dispositional mindfulness, and psychological distress in medical students. Med Educ Online. 2015;20(1):27924.

Edelman M, Ficorelli C. A measure of success: nursing students and test anxiety. J Nurses Staff Dev. 2005;21(2):55–9.

Zeidner M. Test anxiety: the state of the art. New York: Kluwer; 1998.

McManus IC, Thompson M, Mollon J. Assessment of examiner leniency and stringency ('hawk-dove effect’) in the MRCP(UK) clinical examination (PACES) using multi-facet Rasch modelling. BMC Med Educ. 2006;6(1):42.

Shashikala P. Are you benign or malignant examiner? J Educ Res Med Teach. 2014;2(2):35–6.

Donohoe CL, Reilly F, Donnelly S, Cahill RA. Is There variability in scoring of student surgical OSCE performance based on examiner experience and expertise? J Surg Educ. 2020;77(5):1202–10.

Yazbeck Karam V, Park YS, Tekian A, Youssef N. Evaluating the validity evidence of an OSCE: results from a new medical school. BMC Med Educ. 2018;18(1):313.

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This research is part of a larger project supported by Fundamental Research Grant Scheme (FRGS: 203.PPSP.6171219), Ministry of Education, Malaysia.

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Medical Education Department, College of Medicine, Qassim University, Buraidah, Saudi Arabia

Medical Education Department, School of Medical Sciences, Universiti Sains Malaysia, Kota Bharu, Kelantan, Malaysia

Majed Wadi, Muhamad Saiful Bahri Yusoff & Ahmad Fuad Abdul Rahim

Obstetrics and Gynecology Department, School of Medical Sciences, Universiti Sains Malaysia, Kota Bharu, Kelantan, Malaysia

Nik Ahmad Zuky Nik Lah

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Each researcher established a thematic framework and then coded (e.g., indexed, charted, and mapped) and interpreted the data within the framework of qualitative analysis. Each of them reviewed the manuscript and provided constructive feedback. Each author's contribution was described in detail in the method section. All authors read and approved the final manuscript.

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Wadi, M., Yusoff, M.S.B., Abdul Rahim, A.F. et al. Factors affecting test anxiety: a qualitative analysis of medical students’ views. BMC Psychol 10 , 8 (2022). https://doi.org/10.1186/s40359-021-00715-2

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351 Anxiety Research Topics & Essay Titles (Argumentative, Informative, and More)

According to statistics, approximately 40 million people in the United States struggle with anxiety disorders, constituting 19.1% of the population. Generalized anxiety disorder is a condition that is characterized by an excessive and constant feeling of worry about everyday things. Open conversations about anxiety help reduce the stigma associated with mental health issues. Moreover, it is a good way to educate people about the condition, its causes, symptoms, impact, and available treatments.

In this article, we’ll introduce 351 anxiety topics you can use for your essay or research paper ! Keep reading to find out more.

• 🔝 Top 12 Anxiety Essay Topics

📝 Anxiety Essay Prompts

🔍 anxiety research topics, 🤓 anxiety essay titles.

• 📕 Essays on Anxiety: Guide

🔗 References

🔝 top 12 anxiety topics to write about.

• Types of anxiety disorders.
• Anxiety: Causes and treatment.
• How to deal with anxiety?
• Is there a connection between anxiety and depression?
• What are treatments for anxiety?
• Anxiety disorders in children.
• Physical symptoms of anxiety.
• Antidepressants as a way to overcome anxiety.
• Risk factors of anxiety.
• Symptoms of anxiety in teenagers.
• How do you prevent anxiety?
• Social anxiety disorder: My experience.

Have trouble writing a paper about anxiety disorder and related topics? Don’t worry—we’ve prepared some essay prompts to help you get an A for your writing assignment!

Social Anxiety Essay Prompt

Social anxiety disorder, formerly known as social phobia, is characterized by a persistent fear of being in unfamiliar social settings. It usually begins in youth and influences an individual’s adult life. In your essay on social anxiety, you may touch on the following aspects:

• Causes and risks of social anxiety.
• The main symptoms of social anxiety.
• Social anxiety in children and teenagers.
• Ways to prevent or overcome social anxiety.
• Available treatments for social anxiety.

Speech Anxiety Essay Prompt

Most people feel anxious when they have to present a speech in front of an audience. Even trained public speakers may experience anxiety before delivering a speech. People who look confident and relaxed while talking to an audience have mastered managing their feelings and using them to their advantage. While discussing speech anxiety, try finding answers to the following questions:

• What are the symptoms of speech anxiety?
• Why do people get nervous in front of an audience?
• What can help to overcome speech anxiety?
• Why does exercising help in reducing stress and anxiety?

Test Anxiety: Essay Prompt

It’s common for college students to feel anxious before exams. Yet, significant anxiety and stress before and during an important exam might have negative consequences. In your essay on test anxiety, you can provide detailed information on how to deal with it based on the tips listed below:

• Prepare for the test.
• Use study strategies to understand and remember your course material better.
• Take care of your physical health.
• Surround yourself with things that calm you.
• Talk with your teacher to know what to expect from the exam.

Overcoming Anxiety: Essay Prompt

Anxiety can stem from factors such as genetics, personality traits, and life experiences. Although psychotherapy and medication are often necessary for individuals with anxiety disorders to manage their emotional well-being, incorporating lifestyle adjustments and daily routines can also be beneficial. Consider centering your essay on practical daily actions that can help alleviate stress:

• Set goals to accomplish.
• Communicate with people.
• Stop smoking and reduce your consumption of caffeinated beverages.
• Solve any of your financial issues.
• Dedicate more time to your hobbies.
• Have some relaxation time .
• Identify and try to avoid your anxiety triggers.
• How is daily yoga effective for reducing anxiety?
• Does ethnicity and socioeconomic status have an effect on anxiety prevalence?
• Anxiety and acute pain related to the loss of vision.
• Divorce is the leading cause of children’s anxiety.
• The relation between the COVID-19 pandemic and increased anxiety rates.
• The impact of immigration on the growth of anxiety cases in society.
• The efficiency of open communication in overcoming anxious well-being.
• The efficacy of iron supplementation to reduce vulnerability to anxiety in women with heavy menses.
• Emotional issues anxiety causes and ways to cope with them.
• How does anxiety contribute to drug, alcohol, and nicotine consumption?
• The factors that provoke anxious states in college students.
• Generalized anxiety disorder in college students and potential treatment.
• Children and adolescents: age’s impact on increasing anxiety risks.
• The connection between anxiety disorder and fear.
• Stress at the workplace is a key provoker of anxiety in the 21st century.
• Frontline nurses’ burnout, anxiety, depression, and fear statuses.
• Triggers: the importance of finding causes of anxiety.
• The impact of anxiety on social relations with friends and relatives.
• The peculiarities of anxiety states in teenagers in high school.
• Anxiety as a result of perfectionism and fear of failure.
• Symptoms of anxiety, depression, and peritraumatic dissociation.
• The influence of anxiety on public speaking skills.
• Cultural differences in the expression and perception of anxiety.
• Psychological aspects of anxiety in situations of crisis.
• Digital detox is an effective method of anxiety reduction.
• The correlation between discrimination/prejudice and depression/anxiety.
• The relationship between social isolation and the development of anxiety disorders.
• Death anxiety: methods and strategies how to cope with the disorder.
• Quantitative properties of anxiety: magnitude and tone.
• The impact of economic instability on the level of anxiety in society.
• Evidence-based interventions for anxiety disorders.
• The types of anxiety disorder and their peculiarities.
• The key characteristics of anxiety disorder.
• The role of family relationships in the development of anxiety disorders.
• The symptoms of anxiety and ways to identify them at an early stage.
• Anxiety disorder treatment in an Afro-American boy.
• Psychological aspects of anxiety in adapting to a new culture or society.
• The relationship between the quality of sleep and the level of anxiety.
• Social media is a trigger of anxiety in the digital world.
• The role of gender stereotypes in the formation of anxiety in men and women.
• Depression and anxiety among college students.
• Anxiety is a result of the rapidly changing information society.
• The influence of literature on the perception of anxiety.
• Psychological fitness and its effectiveness in reducing anxiety.
• The use of therapy platforms in decreasing anxiety.
• Anxiety of musicians in music performance.
• Cyberbullying as a reason for emotional distress and anxiety.
• The role of childhood experiences in the development of anxiety later in life.
• Introversion and its contribution to a constant state of anxiety.
• The influence of religious and cult practices on reducing anxiety.
• Case studies of patients with anxiety and mood disturbances.
• The risk factors of anxiety in children with disabilities.
• Videogames are a key trigger of anxiety development.
• Mindful breathing strategy and its importance for reducing anxiety.
• The impact of psychological trauma on the development of chronic anxiety.
• Abnormal psychology: anxiety and depression case .
• Government support for mental health policy to reduce anxiety in the UK.
• The influence of ambition and high expectations on the level of anxiety.
• Managing anxiety in evidence-based practice.
• Political conflicts and their impact on the level of anxiety in society.
• The role of social support in managing and reducing anxiety.
• Anxiety and decision-making: literature review.
• Anxiety as a result of low self-esteem and problems with self-acceptance.
• The role of meditation and mental practices in anxiety management.

Social Anxiety Research Paper Topics

• Genetics is a leading cause of social phobia.
• The effects of social anxiety on professional and career development.
• Social anxiety disorder: diagnosis and treatment.
• Empathy and social anxiety: how understanding the feelings of others affects one’s own anxiety.
• The evidence-based pharmacotherapy of social anxiety disorder.
• The physical symptoms of social anxiety disorder.
• Prevalence rates of social anxiety disorder across different cultures.
• The impact of cultural factors on the development of social anxiety disorder.
• The public speaking anxiety analysis.
• Neural mechanisms that contribute to the resistance of social anxiety disorder.
• The potential of utilizing biomarkers to improve social anxiety treatments.
• The effective methods of anxiety disorder prevention.
• Cultural and social aspects of social anxiety: peculiarities and coping methods.
• The negative social experience is a trigger to social phobia.
• High anxieties: the social construction of anxiety disorders.
• Brain areas involved in the development of social anxiety.
• The peculiarities of treatment of social anxiety at an early age.
• Social anxiety at school or workplace: a way to overcome the phobia.
• Inclusive school environments as a way to support students with social anxiety.
• The role of self-esteem in the experience of social anxiety.
• School phobia: the anxiety disorder.
• The impact of social anxiety disorder on romantic relationships.
• The efficiency of technology-based interventions in the treatment of social anxiety.
• Social anxiety: Is there a way to overcome the fear of public speaking?
• The connection between social anxiety and fear of evaluation by others.
• Social anxiety and its consequences on cognitive processes .
• Social anxiety disorder and alcohol abuse in adolescents.
• The criteria for diagnosing social anxiety disorder.
• The role of parental expectations and pressure in the formation of social anxiety.
• Why do females more often experience social anxiety disorder than males?
• Social anxiety disorder is one of the most common anxiety disorders worldwide.
• Social aspects of depression and anxiety.
• Avoidance of social situations is a key symptom of social phobia.
• The influence of social anxiety on the expression of creativity and creative potential.
• Social anxiety and its consequences on the quality of life in adolescents.
• Metacognitive processes in the maintenance of chronic social anxiety.

Research Questions about Anxiety

• How does anxiety affect the body’s immune system?
• What are the peculiarities of the treatment of anxiety at a young age?
• Is acceptance and commitment therapy effective in fighting anxiety?
• How are inflammatory processes in the body related to anxiety disorders?
• What is the relationship between anxiety and gastrointestinal disorders?
• What effect does anxiety have on the cardiovascular system?
• What role do neurotransmitters like serotonin and GABA play in regulating anxiety?
• What are the stress and anxiety sources amongst students?
• How does genetics influence the likelihood of gaining medical anxiety disorders?
• What is the effectiveness of cannabis in treating anxiety disorders?
• How do gastrointestinal microbiota imbalances affect anxiety levels?
• How can specific allergies or sensitivities lead to increased anxiety?
• How does chronic anxiety disorder affect cortisol levels?
• How is emotion regulation therapy used for generalized anxiety disorder?
• What role may neuroimaging play in understanding communicative anxiety disorders?
• How is anxiety diagnosed in people with disabilities?
• How does anxiety disorder depend on a person’s eating habits?
• What are the effects of nootropics in treating anxiety disorders?
• What are the ways of managing general anxiety disorder in primary care?
• Why is family support an important part of the anxiety treatment?
• How do gender differences affect the manifestation of anxiety disorders?
• What are the effective methods of preventing anxiety disorder?
• How does post-traumatic stress disorder contribute to the development of anxiety?
• How do doctors differentiate anxiety symptoms from signs of other medical conditions?
• How does standardized testing affect an individual with test anxiety?
• What is the impact of chronic illnesses on the development of anxiety?
• How does alcohol impact an increasing level of anxiety?
• What methods of diagnosing anxiety disorders exist in medicine?
• Why certain medical conditions can trigger symptoms of anxiety?
• What is the role of emotional intelligence in overcoming social anxiety?
• What is the relationship between child maltreatment and anxiety?
• How did COVID-19 contribute to increased anxiety among people in the US?
• How effective is psychopharmacology in treating social anxiety?
• What are the most common physical symptoms of anxiety in children?
• How do sleep disorders provoke social anxiety?
• What are the long-term effects of chronic anxiety on human health?
• How can parents and teachers release anxiety in children?
• How can medical surgery affect anxiety levels in patients?
• How do hormonal imbalances contribute to heightened anxiety?
• What is the best way of treating adults with anxiety?
• Why benzodiazepines and SSRIs are often used in anxiety treatment?
• What brain areas are involved in the development of anxiety disorder?
• What is the holistic approach to anxiety disorder?
• How can virtual reality simulation treatment help with medical anxiety?
• Anxiety disorder and its risk factors.
• Why does physical exercise positively impact social anxiety treatment?
• What advice are most often given by psychologists for the prevention of anxiety?
• Is depression and anxiety run in the family ?
• How can targeted medication improve the effect of psychotherapy in anxiety disorders?

Argumentative Essay Topics about Anxiety

• Social anxiety disorder is highly comorbid with other psychiatric disorders.
• Is anger the side effect of anxiety?
• Social media: the rise of depression and anxiety .
• Women are twice as likely as men to develop anxiety disorder.
• Breathing into a brown paper bag decreases the level of anxiety.
• Educational institutions should support students with anxiety symptoms.
• Social networks contribute to the development of anxiety.
• Summarizing and evaluating the concept of anxiety.
• Is virtual reality exposure therapy effective in treating anxiety-related conditions?
• Dismissing someone’s anxiety exacerbates the problem.
• Negative thinking is a serious anxiety trigger.
• Do certain cultural customs impact how anxiety is expressed and handled?
• Social support plays a vital role in treating anxiety disorders.
• Overcoming separation anxiety in children.
• People with anxiety disorder should seek professional help.
• Employers should provide flexible work schedules for workers with anxiety disorders.
• Anxiety disorder increases the risk of health complications.
• Does anxiety create problems in relationships?
• Anxiety often causes or triggers depression .
• Adult depression and anxiety as a complex problem.
• Academic pressures can contribute to anxiety in young individuals.
• Parents should control the social media usage of their children to protect them from anxiety.
• Is social isolation a contributing factor to the development of anxiety in older adults?
• Perfectionism is a personality trait that often correlates with increased anxiety levels.
• Overcoming anxiety leads to personal growth and increased resilience.
• The anxiety related to the COVID-19 virus uncertainty: strategy.
• Anxiety hinders an individual’s ability to concentrate and make decisions.
• Are anxiety disorders the most common mental disorders in the modern world?
• The constant state of alertness in anxiety leads to mental exhaustion and burnout.
• Anxiety disorder is a leading cause of tension headaches.
• Political upheavals increase collective anxiety on a societal level.
• Cognitive-behavioral therapy for generalized anxiety disorder and depression.
• A family history of mental health issues is a spread cause of anxiety.
• Do smartphone notifications contribute to technology-induced anxiety?
• Regular exercising helps decrease symptoms of anxiety.
• Workplace support is critical for persons dealing with anxiety at work.
• Excessive use of social media contributes to heightened anxiety levels.
• Effective art therapies to manage anxiety.
• Should workplaces implement mental health programs to reduce employee anxiety?
• People with anxiety disorder should do regular follow-up sessions to monitor their condition.
• Do financial concerns trigger the development of anxiety?
• Stigma prevents individuals with anxiety from seeking help.
• Is social anxiety more spread with a strong emphasis on individual achievements?
• General anxiety disorder treatment plan.
• Do genetic factors play a role in predisposing individuals to anxiety disorders?
• Love from friends and family is the best treatment for anxiety disorder.
• Telling other people about your anxiety is one of the most uncomfortable things.
• Caffeine use increases the severity of anxiety symptoms.

Anxiety Essay Topics for Informative Papers

• The major symptoms and signs of social anxiety disorder.
• What is generalized anxiety disorder (GAD)?
• Anxiety disorders, their definition, and treatment.
• The effective methods of coping with separation anxiety disorder.
• The important takeaways about pathological anxiety.
• Dos and don’ts for overcoming post-argument anxiety.
• Coping with anxiety in romantic relationships.
• Anxiety: advanced assessment of a patient.
• What are the peculiarities of social anxiety disorder?
• Cognitive behavioral therapy is effective in treating people who feel anxious.
• The strategies for alleviating anxiety in your pets.
• Seven things you can do to help your friend cope with anxiety.
• Anxiety disorders: diagnoses and treatment.
• What are the risk factors for anxiety in children and adults?
• The characteristics of high-functioning anxiety.
• Cognitive Behavioral Therapy (CBT) for anxiety disorders: How it works.
• The main causes of generalized anxiety disorder (GAD).
• “Depression, Anxiety, and Stress in Diabetes” by Chlebowy.
• What are the methods of treating anxiety in old age?
• The importance of early intervention: how to prevent anxiety in children.
• What does anxiety disorder feel like?
• The value of stress management skills in preventing anxiety.
• Generalized anxiety disorder and its prevalence.
• The benefits anxiety disorder can bring.
• How can antidepressants aid in coping with anxiety disorder?
• Self-guidance: how to prevent an anxiety attack.
• The genetic and hereditary factors that contribute to anxiety disorders.
• Dual diagnosis: anxiety disorders & developmental disabilities.
• How small acts of kindness can help with anxiety?
• Psychological strategies to reduce general anxiety and stress.
• How do you understand that you need assistance in coping with anxiety?
• Foods that can help reduce anxiety.
• Anxiety disorders: cognitive behavioral therapy.
• The effective methods of coping with anxiety in learning a new language.
• Top 12 ways to reduce the risk of anxiety disorders.
• The power of yoga and meditation in managing anxiety.
• How friends and family can provide support to someone with anxiety?
• What is the anxiety?
• The troubling link between domestic violence and anxiety .
• Finding a good anxiety therapist: methods and strategies.
• How does anxiety affect teenagers in high school?
• The main types of anxiety and their peculiarities.
• Anxiety disorder and its characteristics .
• How do you prepare yourself to better handle anxiety-provoking situations?
• The power of positive thinking in overcoming anxiety.
• The effective ways of dealing with an anxious mindset at work.
• Coping with anxiety on your own: The possible consequences.
• Fight-or-flight response in anxiety disorders.
• Famous people with high-functioning anxiety.
• How can a regular sleep pattern protect you from anxiety development?

Anxiety Title Ideas for Cause-and-Effect Essays

• Muscle aches and breathing problems are the short-term effects of anxiety.
• Why does anxiety provoke memory issues?
• Effects of anxiety and ways to conquer it.
• Increased risk of developing migraines and headaches in people with anxiety.
• The role of chronic stress and traumatic events in the development of anxiety.
• Genetic links that increase a person’s risk of developing an anxiety disorder.
• What are psychosomatic manifestations of anxiety and their impact on the body?
• Substance abuse is a leading cause of anxiety.
• Generalized anxiety disorder’s impact on youth.
• The problems in interpersonal relationships are due to anxiety.
• Loss of a loved one and its impact on the development of anxiety.
• Are nail biting or skin picking the first signs of anxiety?
• Childhood experiences can cause the onset of anxiety disorders.
• What is the effect of anxiety on the nervous system and its functioning?
• DSM-5 anxiety disorders: causes and treatment.
• The key triggers of anxiety and their impact on a person’s overall well-being.
• The butterfly effect of anxiety: how small symptoms can become a disaster.
• Does a family history of anxiety disorder make you more prone to this disease?
• The physical consequences of anxiety: nausea, muscle tension, and fatigue.
• Reaction to stress: anxiety and yoga.
• How do the causes of anxiety change depending on the person’s age?
• Persistent and uncontrollable thoughts: how does anxiety impact people?
• The causes of anxiety among teachers giving face-to-face lessons.
• Chest and back pain are physical symptoms of anxiety.
• Relationship issues are the leading causes of anxiety disorder.
• The effects of marijuana on people with anxiety.
• Neurochemical imbalance and its connection with anxiety.
• What are the genetic causes of anxiety?
• The role of social media in triggering anxiety disorder.
• Migraines and headaches are concomitant manifestations of anxiety.
• How can daily tasks become the cause of anxiety?
• Anxiety disorders and their influence on daily life.
• Substance abuse and its impact on the development of anxious states.
• Decreased quality of life in people with anxiety disorders.
• The chain reaction of anxiety: From triggers to panic attacks.
• Hormonal changes in anxiety states and their impact.
• Trouble focusing on tasks due to racing thoughts in people with anxiety disorder.
• Causes and effects of anxiety in children .
• Procrastination and overthinking as behavioral effects of anxiety.
• Suicidal thoughts and their connection with high levels of anxiety.
• How does anxiety impact communication and collaboration at work?
• Social isolation as a result of anxiety disorders.
• Chronic stress is a factor contributing to anxiety disorder.
• Anxiety disorder: symptoms, causes, and treatment.
• Which social factors contribute to the appearance of anxiety?
• The fear of the unknown or unpredictable outcomes is a cause of anxiety.
• Why do people with anxiety disorder have problems with concentration and attention?
• Sociocultural factors that have an impact on the level of anxiety.

Titles for Anxiety Essays: Compare and Contrast

• How are anxiety disorders related to eating disorders like anorexia and bulimia?
• Psychotherapy or medication: what works better in treating anxiety?
• The behavioral, humanistic, and cognitive approaches to anxiety .
• The differences in how anxiety impacts children and adults.
• Stigma and shame of anxiety in different cultures.
• How do you differentiate anxiety from regular stress?
• What is the relationship between anxiety and anger?
• Panic attack vs. anxiety attack: key differences.
• George Kelly’s personal constructs: threat, fear, anxiety, and guilt .
• The peculiarities of anxiety disorder depend on the sexual orientation of the person.
• How is panic disorder related to anxiety?
• Meditation, prayer, traditional rituals: comparison of spiritual ways of anxiety treatment.
• How does the perception of anxiety differ in the US and Japan?
• Anxiety vs. post-traumatic stress disorder: main common features.
• The relationship between anxiety and sleep disorders .
• How does anxiety differ from stress in terms of physiological responses?
• The differences in anxiety symptoms in people of different ages.
• Developmental perceptions of death anxiety.
• How can gender-related cultural norms influence how anxiety is expressed?
• Aspects of anxiety: psychological and physiological sides.
• How does anxiety differ from schizophrenia?
• The comparison of social and generalized anxiety.
• Historical views on anxiety: antique and modern times.
• The difference in how anxiety affects females and males.
• What do anxiety and obsessive-compulsive disorder have in common?
• Anxiety and depression during childhood and adolescence.
• Anxiety treatment: self-help resources or support groups.
• The comparison of biological mechanisms activated during fear and anxiety states.
• The cultural differences of anxiety perception: Nigeria vs. Sweden.
• Anxiety and bipolar disorder and their main differences.
• The effective methods of coping with anxiety: yoga or antidepressants.
• What are the cultural differences in anxiety expression?
• Anxiety in first-world countries or developing nations.
• The differences in help-seeking behavior in people of different religions.
• The peculiarities of treatment anxiety in Australia and the United Kingdom.
• How is anxiety connected to eating disorders?
• Anxiety in veterans vs. civilians: key differences.
• How does anxiety management differ from anxiety prevention?
• Physical and mental anxiety consequences and their comparison.
• How is anxiety described in different academic disciplines?
• The manifestation of anxiety in different mental health disorders.
• How does anxiety in parents are similar to the one that children have?
• Anxiety in urban and rural environments: Key triggers.
• The comparison of genetic and environmental factors of anxiety.

📕 How to Write Essays on Anxiety

Need to write an essay on anxiety but don’t know where to start? Let us help you! We’ve prepared detailed instructions that will help you structure your paper.

Anxiety Essay Introduction

An essay’s introduction aims to provide the reader with a clear idea of the essay’s topic, purpose, and structure. It serves as a roadmap for what the paper will cover. To write an introduction, follow these steps:

• Grab readers’ attention with a hook .
• Introduce the theme or issue you will be discussing.
• Provide some background information.
• Create a thesis statement.

Hook: According to the National Institute of Mental Health, public speaking anxiety, or glossophobia, affects approximately 40% of the population.

Background information: A fear of public speaking is classified as a social anxiety disorder characterized by shaking, sweating, dry mouth, rapid heartbeat, and squeaky voice.

Anxiety Essay Thesis

A thesis statement is often a sentence in the first paragraph of an essay that summarizes the paper’s main idea. Several tips can assist you in creating a strong thesis statement :

• Be specific.
• Build a strong argument.
• Make your thesis statement arguable.
• Provide evidence.
• Be clear and concise.

Thesis statement: Although fully overcoming speech anxiety may be impossible, employing various strategies can help manage and harness it for personal growth and success.

Essay about Anxiety: Body Paragraphs

Body paragraphs in an essay develop, support, and elaborate on the thesis statement or argument presented in the introduction, offering evidence, examples, and explanations. They provide the substance and structure that make the essay’s ideas clear and convincing to the reader.

There are several components that each paragraph of the main body needs to include:

• Topic sentence.
• Supporting evidence.
• Detailed explanation of the main points.
• Transition to the next paragraph.

Topic sentence: Deep breathing techniques can effectively alleviate pre-performance anxiety, particularly before public speaking engagements.

Supporting evidence: Practicing slow, deep diaphragmatic breathing helps activate the relaxation response. Additionally, deep breathing increases oxygen supply to the cerebral cortex, responsible for cognitive functions and conscious thought processes.

Anxiety Essay Conclusion

The conclusion is an essential component of your essay. It allows you to encourage your readers to consider the implications and solutions to an issue. A strong essay conclusion should do the following:

• Restate the thesis.
• Summarize the main points.
• Provide a clear context for your argument.

Rephrased thesis: Though completely overcoming speech anxiety is challenging, using different strategies can help control it and benefit personal growth and success.

Summary : In conclusion, nobody is perfect, and even seasoned speakers make errors in public speaking. Instead of pressuring yourself to deliver a flawless speech, it’s essential to remember that minor mistakes won’t detract from your overall presentation.

We hope that you’ve found our article helpful! If so, feel free to share it with your friends and leave a comment below.

• Thesis Statements; The Writing Center • University of North Carolina at Chapel Hill
• How to Write a Five-Paragraph Essay, With Examples | Grammarly
• How To Write a Good Essay Introduction in 4 Simple Steps | Indeed.com
• Conclusions | Harvard College Writinf Center
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