# Motivation and emotion/Book/2019/Exam stress

* Multimedia presentation (3 min)

## Overview
### Focus questions

* What is exam stress?
* What causes exam stress?
* What are the effects of exam stress?
* Can the effects of exam stress be combated?
* How can specific emotion theories and research help?

## Exam stress

Stress is a person's natural response to situations that have a higher level of pressure than what is usual. Stress during exam periods can often be seen as a good thing,[grammar?] stress can motivate an individual to study and focus on their work. However, too much stress can also make the idea of studying unbearable and can lead to some negative effects taking hold.[factual?]

## Causes of exam stress

While the causes of everyone's stress is individual, there are some commonalities[factual?]:
* Competition with peers
* Pressure from parents, educators, etc. to do well
* Pressure from the individual to meet self-expectations
* Doubting of the individual's academic merit
The commonalities that are found in causes of exam stress are for the most part well researched, with many studies concluding that the aforementioned commonalities are leading causes of exam stress[factual?]. Lack of confidence in the individual's own abilities and in their previous academic success are prominent causes of exam stress, with pressure to perform successfully from parents and educators also being found to largely impact a student's pre-exam stress (Bedewy and Gabriel, 2016). A 2006 study into the causes of exam stress found that the main cause of stress is the idea of the exam itself and not the actual exam (Robotham and Julian, 2006). Another study conducted on Pakistani university students through a questionnaire found that the main causes of exam stress, as confirmed by the study’s participants, were the amount of pressure placed on the exam, a lack of clarity surrounding the exam and a lack of confidence (Malik, 2015). Lack of confidence is highlighted as a cause of pre-exam stress in a study that focused on how a student’s past failures affected their confidence levels in future endeavours (Kuang, 2019). The study found that when the student shifted their view of their past failures and instead focussed on a wider outlook, their pre-exam stress was largely reduced (Kuang, 2019). This concept of altering the student’s view of their past failures and its effect on exam stress should be explored in a broader range of people to further validate the findings.
While exam stress is most often caused by the exam directly, the events and situations occurring in a person’s day to day life may have an effect on their stress levels when it comes to exams (Marshall Jr, Agarwal, Lloyd, Cohen, Henninger, and Morris, 1998). A study into the levels of cytokines, a substance that is released by cells of the immune system, found that there was a significant correlation between cytokine levels and unpleasant day to day situations (Marshall Jr et al., 1998). As well as this correlation, the study also found that when exam stress was assessed in conjunction with the number of unpleasant situations a person had pre-exam, the person’s cytokine levels were more negatively affected as the pre-exam hassles increased (Marshall Jr. et al., 1998). This negative effect on the cytokine levels could lead to an immune dysregulation issue, meaning the person experiencing this could feel more run-down pre-exam, which would only add to the exam stress more (Marshall Jr et al., 1998).
For a more psychologically based perspective, a look at a 2013 study into the somatic symptoms, the physical representations of a psychiatric condition, that are brought about by exam stress in university students is suggested (Zunhammer, Eberle, Eichhammer, and Busch, 2013). The aforementioned study could not conclusively say that most of the psychiatric conditions they assessed were affected somatically by exams and exam stress (Zunhammer et al., 2013). However, the study did conclude that exams and exam stress had a significant somatic effect on psychiatric disorders that presented with more neurotic tendencies such as obsessive-compulsive disorder, anxiety disorders and phobias (Zunhammer et al., 2013). This study is pertinent to the question of what causes exam stress as it indicates that psychiatric disorders may have an effect on the levels of stress a person experiences during exam periods, therefore said disorders could be considered a cause of exam stress.

## Effects of exam stress

The effects that exam stress can have on an individual is often both physical and mental. The main effects discussed in this section, and the effects most commonly explored by studies are as follows, in no particular order:
* Sleep deprivation
* Exercise habits
* Mental health
* Somatization symptoms
Neuroticism and neurotic psychiatric disorders are commonly studied when looking at the effects of exam stress. The previously mentioned 2013 study into the increase of somatic symptoms leading up to exams concluded that said symptoms are more prevalent in people that have neurotic tendencies and neurotic psychiatric disorders (Zunhammer et al., 2013). Similarly, a study into the effects of exam stress on a person’s mood and how that effects[grammar?] immune functioning focussed on the influence of neuroticism in exam periods (Gilbert, Stunkard, Jensen, Detwiler, and Martinko, 1996). The findings of the study were that higher levels of tension were present pre-exam, with a correlation between neuroticism prevalence and high stress present, the effect of which is clearly negative (Gilbert et al., 1996). These studies outline the mental effect exam stress can have on an individual.
Sleep deprivation is another common effect exam stress can have, and one that is commonly coincided by a change in legal drug consumption i.e. alcohol and caffeine (Zunhammer, Eichhammer, and Busch, 2014). The study concluded that sleep quality and consumption of alcohol both decreased, whereas caffeine intake and what the participants perceived as stress increased ( Zunhammer et al., 2014). Considering this study and others, the effects that exam stress has on a person’s physical health is evident as increased caffeine consumption can lead to poor sleep quality and increased mental and physical fatigue during the daytime (Calamaro, Mason, and Ratcliffe, 2009). In addition to sleep deprivation, exam stress can cause a decrease in the substance released by immunity cells, cytokine, suggesting that exam stress has a negative heath effect on those experiencing it (Marshall et al., 1998).
Exam stress often leads to negative effects on academic performance such as concentration issues, memory loss, and poor management skills (Nekrouf, 2019). A case study produced in the United States of America found that changing the students[grammar?] view of past failures from a negative standpoint to a positive outlook benefited the student’s academic performance while decreasing pre-exam stress (Kuang, 2019). This study’s conclusion suggests that the mental effect that factors of exam stress can have are clearly negative but may be reversible and result in a positive outcome for the student experiencing exam stress (Kuang, 2019).

## What can be done about it?

How can the effects of exam stress be combatted? There is an increasing number of solutions to the issues that exam stress can create as well as plenty of preventative options that can be taken. The following is just a small showcase of the options that could lead to lowered exam stress:
* counselling
* counselling alternatives
* educational institution provides de-stressing activities
* research into the stigma around mental health and the effects of stress on conditions
While some studies suggest that the ability of an individual to cope with high stress situations such as exams can be boiled down to that person’s personality (Austin, Saklofske, and Mastoras, (2010), other studies suggest that support and understanding, whether it be obvious or initially unnoticed, can have a positive effect in that it reduces stress levels (Shrout, Bolger, Iida, Burke, Gleason, and Lane, 2010).
Professional counselling can have significant positive effects for those seeking it, including lowered stress as a result of gaining greater insight into how the person seeking counselling is feeling (Gelso, Nutt Williams, and Fretz, 2014). However, it is becoming more apparent that the increase in demand for professional counselling services from students, especially during exam periods, is leading to a lack of availability of face to face counselling services (Kavalkli, Li, and Rudra, 2012). The implementation of new-age counselling alternatives that focus on an online presence could be the solution to the growing demand for professional support (Kavalkli et al., 2012). The proposition for services such as an artificially intelligent online counselling program that can provide advice similar to a professional may be the next step in the plight to decrease student stress (Kavalkli et al., 2012).
Similarly, online services that provide useful blog posts about tips to cope with exam stress are an excellent alternative for those short on time and for those that don’t have easy access to the more personalised alternatives (Reachout, 2019) (Headspace, 2019). Another more accessible way that student’s[grammar?] can ease their exam stress is by utilising the services that their institution may provide. For example, therapy dog sessions that aim to reduce student stress are becoming more and more commonplace (Ward-Griffin, Klaiber, Collins, Owens, Coren, and Chen, 2018). A study into the effects of therapy dog sessions on university campuses found that the students that participated in the sessions saw immediate stress reduction, as well as a greater sense of support in their exam period (Ward-Griffin et al., 2018).

## How can specific emotion theories and research help?

While there are several emotion theories and many research articles that can be discussed in relation to the question of how specific emotion theories and research can help relieve exam stress, the few that will be discussed here are as follows:
* Schachter-Singer Theory
* The role the sympathetic nervous system plays
* Research into the effects of insulin
* General Strain Theory
* A short discussion on Cannon-Bard theory as well as James-Lange Theory
Schachter-Singer theory suggests that physical reactions precede emotional responses (Schachter and Singer, 1962). To further explain it, a stimulus causes a physiological response, the response is labelled and associated with a certain emotion, and then the emotion is felt (Schachter and Singer, 1962). Current research supports this emotion theory as relevant to the human response, with Schachter-Singer theory being praised for integrating sympathetic nervous system activation, fight or flight, into emotional responses (Dror, 2016). Schachter-Singer theory is highly relevant when considering a person’s emotional response to an often high-stress situation like an exam. Using the previous explanation given for Schachter-Singer theory, the emotional response of stress to a situation like an exam is understandable. The individual experiences a physical response such as clammy hands, racing heart, inability to concentrate, to a stimulus, exams. That physiological response is labelled, panic, and then associated with an emotion, stress. The emotion of stress is then felt. This explanation can aid people in understanding the physical and emotional processes that the body may undergo that lead to feelings of exam stress.
Similar to emotion being related to the sympathetic nervous system (Dror, 2016), studies into how other bodily mechanisms influence emotion are emerging. A study into the role that the insular cortex plays in the regulation of emotion indicates that the body allows people to practice error-based learning (Singer, Critchley, and Preuschoff, 2009). This could be helpful when questioning why the body has such an uncomfortable response to exams. The ability to practice error-based learning allows the individual to subjectively assess the situation and produce an emotional response that may be appropriate (Singer, Critchley, and Preuschoff, 2009).
General strain theory is generally a theory associated with criminology, however one of its main conclusions is that stress can be the result of negative experiences (Agnew, 2007). While general strain theory isn’t explicitly an emotion theory, a 2015 study into the relation between academic stress, internet addiction, and negative emotions utilised the theory to explain the study’s findings (Jun and Choi, 2015). The study found that negative emotions were caused by academic stress, as well as academic stress being caused by negative emotions (Jun and Choi, 2015). The findings from this study and the inclusion of general strain theory suggest that exam stress and the negative emotions that coincide with it would benefit from practicing anti-stress techniques, pre and post stress.
Research into how emotion theory and the studies that utilise it would benefit from exploring a broader range of theories. The inclusion of Cannon-Bard theory and James-Lange theory would add an interesting perspective to the discussion, as well as further research into already presented theories.

## Quiz

Don't stress! It's only a small test.

## Conclusion

Exam stress is a feeling that many people experience, and in different ways. Stress can have an impact on both a person's physical and mental health, which is why it's so important to seek help when the stress of exams feels like it is too much. While seeing a professional face to face is extremely helpful, not everyone has the access or the time to see someone in person. The addition of online services such as Headspace are critical in the pursuit of a less stressful exam period.
Research suggests that through the study of emotion theories such as Schachter-Singer theory, an improved understanding of what causes exam stress and the best ways to combat it can be developed. Further study into how bodily processes such as cytokine levels impact on a person's level of stress would be beneficial. In addition, a strong look at how campuses and societies in general can provide elevated support to those feeling the pressure of exams would greatly improve the topic.
The takeaway message for this chapter is that if exam stress is a mounting pressure for those taking exams, always seek help, whether it is from friends, family, professionals, or an online robot, there is always a solution.