19 year old, Tanya, had recently joined her MBBS course and was staying in the hostel, her first time away from home. She had her exams round the corner and was experiencing intense crying spells, calling her mother several times a day and asking her to come and stay with her as she could not face the exam without her mother’s support. She was preoccupied with the idea of failing her first exam and becoming a laughing stock and was finding it difficult to concentrate on or enjoy any activity.

Does that scenario sound familiar?  That’s a small snippet of how exam anxiety can manifest and what this article is going to be about. Exams are reality of a student’s life. Almost everyone experiences some stress related to exams which goes on to say that all stress is not bad. The brain needs to perceive some physical or psychological stress to start pumping the chemicals cortisol, epinephrine (adrenaline) and norepinephrine into the body to give us the burst of energy needed perform tasks more efficiently and improve memory. However, there is a tipping point beyond which stress becomes destructive instead of facilitative and performance gets affected negatively. This tipping often occurs when we perceive the demands on us to be beyond our abilities.


Fig. 1

The above diagram illustrates the general response to stress which applies to exam stress as well. There are certain signs which can alert us if stress is getting the better of us, like mental fogginess, forgetfulness, sleeplessness, lack of concentration, frequent colds, increase in our allergies and increased sensitivity to aches and pains. Psychologically stress is known to increase anxiety. Anxiety is a vague sense of apprehension and foreboding and it leads to worry and catastrophization. In a student it often translates into imagining the worst case scenario like failing or forgetting everything while taking the exam. Stress also increases frustration and there are several ways in which individuals respond to frustration. One response to frustration is passivity. If a student attempts to increase efforts at studying but can’t concentrate or keeps doing badly at exams, he or she is likely to give up or become disinterested and stop making an effort. Others may begin to show aggression and we often see students, especially boys, becoming irritable and losing their temper over relatively unimportant matters. They may become more negative, finding fault with everyone and everything. A third response to frustration is depression or getting dysphoric. A student may suddenly begin to confine himself or herself to the room, become pessimistic and lose self-confidence and self-esteem and become dependent on others. They may blame themselves for not living up to expectations, feel like a failure, and feel helpless and hopeless about things changing in the future. Sometimes, too much stress can be a trigger or fuel for other problems, including panic attacks, drug abuse, eating distress or self-harming behaviour. It's important to talk to someone about these, and to get appropriate help, if necessary. Suicide is an extreme response to stress.

So are we helpless in the face of exam stress? Absolutely not! Recognition of stress response is half the battle won against stress. But remember we don’t become anxious without a reason, or just out of the blue. Exam anxiety occurs due to many foreseeable reasons and most of them have workable solutions. Poor study habits, poor time management and ineffective strategies for organizing what we learn, worry about evaluation and effect of our results on our future all contribute to exam stress. Most students overestimate their preparation for an exam and in the process make themselves open to more exam stress! This is true! There are many active strategies we can adopt to cope with exam anxiety and this starts way before the time for an exam.

Pay adequate attention to the physical environment in which you are studying.

It is important that the place you use for studying is comfortable and free from distractions. Here is a checklist for selecting suitable study place: Is your study place accessible when you need it? Sometimes we need to share our space with others, in that case have alternative options rather than get frustrated. Is it free from distractions? Ringing phones, texting, TV sound or visitors are all interruptions you need to eliminate during your study hour. Does your study place have enough storage space to keep all your items - books, pens, rulers and other things you require? Does your study place have enough light and comfortable temperature? Are you comfortable sitting at that place for longer periods of time while studying?

Physical preparations while studying:

Studying is a mental and physical activity. Your brain like any other organ works best when it has had adequate fuel and adequate rest. Eating healthy meals and getting seven hours of sleep are required to keep the brain functioning optimally over a period of time. Long term memory consolidation occurs during sleep and therefore a good night’s sleep serves the vital function of storing information from your short term memory to long term memory. If you will eat junk food and skip regular meals, the brain output is going to be less desirable. Getting some form of exercise has been found to be one of the biggest contributors to mental sharpness and alertness. It helps reach oxygen to the brain and also keeps away the blues and uplifts the mood. It is imperative to try and incorporate at least 20 minutes of exercise in your everyday routine.

Discover when you study at your best:

We all have our most efficient time zones. Discover key periods when you are most focused and productive so that you can use such periods for your most difficult subjects. You may prefer to study late in the night, but remember to do this without compromising on your sleep.  It is also important to set aside a specified time each day and then stick to it. This can help in making you more self-disciplined and tuning the brain into being more focused.

Sort out your priorities:

If you think there's too much work, and not enough time left to do it, write down everything you need to do, and sort it into order of priority. You need to take into account which topics are the most important or compulsory, which you already know best, and which you have enough information on. Then you can tackle your burden accordingly.

Always try to do one thing at a time:

In this day and age where multitasking is glorified, I’d like to stress ‘give undivided attention to one thing at a time’. Many students think that they can study and watch TV simultaneously, but as marvelous as the brain is, it is not good at doing more than one thing at a time efficiently, especially ones that require attention. Set a time period for one important task and during that time do only those without letting your attention wander to other things. When the time is up, move on to the next even if you have not completed it, you can go back to it later but now for habit's sake leave it.

Be a problem solver:

If you don’t understand a particular section or problem, don’t waste time getting frustrated over it and don’t entirely skip it! Do not hesitate to consult somebody person you are comfortable with, be it friend, teacher or sibling. Try and keep back up so that if one person is unavailable, you can ask somebody else. Remember asking for help is smart, not shameful!

Remember to take frequent breaks while studying:

Breaks are important in order to give your mind much needed rest so that it can come back fresh. If you study continuously without breaks then you may find your concentration and energy levels going down and burn-out. Break times can be 10 minutes or a little more.

Follow a study strategy: While reading any course material or textbook follow the SQ3R strategy. The SQ3R technique is a simple and effective tool to grasp the subject and remember it better.

S - Survey: Before starting to read something survey the chapter, read the title, introduction, headings, and the summary or conclusion. Also, examine all visuals such as pictures, tables, maps, and graphs. Look for bold face prints, italics, end-of-chapter questions etc. In some way it is similar to reading a novel; we read the synopsis, flip through the pages, even read a page here and there to give us an idea before we purchase it, don’t we?

Q - Question: This is an excellent way to prime your brain to store information better and categorise it in a way which makes it easily retrievable! Have questions in your mind before you begin to read and as you read. You can even look up the questions at the back of the chapter. The questions will give you a purpose for reading and will help you in staying focussed. Turn the headings and sub-headings into as many questions as you can think of and write them down. You can always try ‘What’, ‘How’, and ‘Why’ questions. This will stimulate your thinking.

R - Read: Read the information that follows each heading to find the answer to each question you formed. You may have to make up a lot of new questions as well and search for their answers too. This is active learning which is better than passive reading.

R - Recall: At the end of each section or sub-section, stop reading and recall your questions then try to answer them without looking at the textbook. See how many questions you can answer from memory. If you can't answer any question then look back into the section to refresh your memory. Don’t proceed to the next section until you can answer all questions about this section from memory.

R - Review: After you have finished the entire chapter using the above given suggestions, go back over all the questions from all sections. Check out whether you can still answer them, if not look it up and refresh your memory. One good thing about reviewing is that it can be done in any spare time, while you are waiting for breakfast or riding to school. You can mentally go over the questions or keep flash cards with the questions written on them.

You can add another two additional steps to the SQ3R. The additional two steps are optional and they are as follows:

W - Write: After you finish a topic using SQ3R strategy, write down all questions you had developed while studying and their answers in your notebook. This way you will have notes on this particular topic for future reference. These notes can also provide you with good points for class discussions. Those who are better at auditory learning can use their phones to record their answers and listen to them whenever needed.

T - Teach: The final step is teaching what you have just learnt to somebody. By teaching it, you are reinforcing in your mind what you have just studied and it will help you in remembering the information better. If you studying doing group studies then you can teach it to the entire group and this will be a good practice to field unsuspected questions.

Set targets and challenge yourself:

As you try out the above strategy to study, remember that competing with yourself is and more productive than competing with others. So don’t forget to set yourself new challenges as you proceed with your study plan. That will be the best motivation you can give yourself.

Improve emotional coping:

Learning how to improve your emotional coping is crucial. We can start with simple relaxation techniques.

Breathing techniques:

Stress can make you start breathing with quick, shallow breaths and make your heart beat faster than usual. Breathing deeply and using positive thoughts will activate the parasympathetic nervous system and help you to switch off your fight/flight reaction.

Sit down somewhere comfortable. Place one hand on your stomach and the other on your chest. Now take a deep, slow breath from your stomach allowing it to fill up like a balloon. Keep the hand on the chest as steady as possible. Now breathe out slowly and let your stomach deflate. Breathing from the stomach allows your lungs to fill up properly and discourages shallow breathing.  Do it as many times as you can and till you feel relaxed.

Deepen the relaxation by focussing on the entire body starting from your head to your toe and relaxing any part that is tense. Make that part lose and imagine the tension disappearing. As you focus on each part of your body, think that your body is becoming heavy and relaxed. Continue with the deep breathing and with every exhalation say to yourself ‘I am more relaxed’.

Decreasing negative self talk:

Our mind is like a tape recorder which is constantly on play mode and we tend to believe whatever it says. This self talk has a profound effect on our feelings and our actions. If your mind is constantly saying, “I will fail’, ‘I will forget all that I’ve studied during exams’, ‘I am so dumb’, etc., you are likely to feel anxious and depressed. Being aware of this negative ‘jabber’ and using positive reframing is extremely important to improve emotional coping. You can tell yourself ‘I’m studying hard and there is no reason why I should not do well’, ‘I am having these thoughts only because I am anxious. If I calm myself I will feel better’, ‘Let me identify what is making me anxious and work on it’. A good time to programme your mind is before you go to sleep or right after you wake up.

Coping with non-academic problems:

Often, exams aren't the only stressful event going on in people's lives. You may have ongoing personal or emotional problems like lack of confidence that are hampering you. Research reveals that up to a third of students have serious, non-academic problems. These include serious illness, interpersonal conflicts at home, coping with parental discord, divorce or separation, problems with peers, etc. Bottling up these feelings can make them worse and you may not see any solution to them. Discussing your problems can be a great relief and you may want to identify somebody who can help you find solution to these problems. A counsellor or therapist is somebody whom you can speak to in confidence and is professionally trained to help you cope and find solutions to your problems.

Support from family and friends:

Friends and family should be supportive and keep distractions to a minimum and do as much as possible to ease any additional pressures. Parents may unwittingly put the pressures of their own expectations on the student in subtle ways and need to be careful of this. There is a thin line between being motivating and becoming pushy. They may get frustrated with having to put a limit on their own but they need to be patient as it won’t be for long. If it does look as if the stress is getting too much for the person taking the exams, encouraging them to seek appropriate help could be vital. It's important to reassure them that this is a sign of strength, not weakness to seek help.

Prepare yourself for the exam day:

Give yourself mock examinations. Choose a spare day to give yourself a mock exam paper. Make sure the questions are typical of your exam pattern. Give yourself a set amount of time to finish your answers. Don’t cheat! At the end of the test, evaluate your paper and see which areas need more inputs. This process will help you think of unanticipated situations, assess if your writing is up to speed and keep a check on your anxiety.

Best approach to the actual exams:

Be sure you're clear about what exam is coming up when, so that you don't prepare for the wrong one! It is known to happen! Working through the night before an exam may save you on the day, but it's not a good strategy to rely on. You will have more than one exam and it is difficult to go without sleep for consecutive days. If you usually take the last-minute approach, it may be worth reflecting on why it's necessary for you to tackle exams this way. To reduce the scope for anxiety, have everything you need ready in advance. Do have something to eat before the exam. It doesn't need to be a huge amount, but you will function better with fuel inside. Set off in good time! Stay away from those who quiz you on your preparation right before the exam and make you more nervous. Try not to read new information minutes before exam starts as this will lead to information overload and confusion. Once in the exam, if you feel panic rising and your mind going blank, take a minute to do a breathing routine and give yourself time to calm down. Then read the questions carefully so that you don’t misunderstand the question or answer it only partially. After the exam is over, it is tempting to think about all the answers you gave and if they were good enough. This will only stress you further. Try to forget about the last exam, and focus on the next one, instead. Be realistic about what can be achieved. We are all different, achieve at different levels, and have different qualities and skills. Exam success isn't an evaluation of you as a whole person. Be positive about what makes you the individual you are. If you do end up doing badly, it won't be the end of the world. Facing up to the worst will enable you to look at how you might cope and what you can do to improve in the future. Getting all upset and blaming external factors does not help. Taking a calm approach to exams will definitely be more helpful than getting anxious and stressed out.

Remember any new habit takes up to 30 days to form. So you will have to keep up with these strategies for at least a month before you can see real change. So keep at it and happy studying!

The next article will be on time management and strategies to improve concentration, two extremely important tools for effective studying.

Mrigaya Sinha is a Clinical Psychologist with a PhD in Clinical Psychology from NIMHANS, Bangalore. She is from Patna and has done her graduation from Patna Women's College. She is one of the very few psychologists from Patna with training from a premier national institute and experience of working in several big institutes apart from NIMHANS including KMC, Manipal; VIMHANS, New Delhi; and Mahavir Cancer Santhan, Patna over a period of eight years, to name a few. She is currently setting up her private practice in the US.