Test anxiety

# Overview
Test anxiety is a psychological condition in which a person experiences distress before, during, or after an examor other assessment to such an extent that this anxiety causes poor performance or interferes with normal learning.

# Test Anxiety
Test anxiety is a combination of perceived physiological over-arousal, feelings of worry and dread, self-depreciating thoughts, tension, and somatic symptoms that occur during test situations. It is a physiological condition in which people experience extreme stress, anxiety, and discomfort during and/or before taking a test. These responses can drastically hinder an individual's ability to perform well and negatively affects their social emotional and behavioural development and feelings about themselves and school. Test anxiety is prevalent amongst the student populations of the world, and has been studied formally since the early 1950s beginning with researchers George Mandler and Seymour Sarason. Sarason's brother, Irwin G. Sarason, then contributed to early investigation of test anxiety, clarifying the relationship between the focused effects of test anxiety, other focused forms of anxiety, and generalized anxiety.
Test anxiety can also be labeled as anticipatory anxiety, situational anxiety or evaluation anxiety.  Some anxiety is normal and often helpful to stay mentally and physically alert. When one experiences too much anxiety, however, it can result in emotional or physical distress, difficulty concentrating, and emotional worry. Test anxiety has been shown to have a consistently negative relationship with test performance, and test-anxious students are found to perform about 12 percent below their non-anxious peers.  Inferior performance arises not because of intellectual problems or poor academic preparation, but because testing situations create a sense of threat for those experiencing test anxiety; anxiety resulting from the sense of threat then disrupts attention and memory function.
Researchers suggest that between 25 to 40 percent of students experience test anxiety. Students with disabilities and students in gifted educations classes tend to experience high rates of test anxiety. Students who experience test anxiety tend to be easily distracted during a test, experience difficulty with comprehending relatively simple instructions, and have trouble organizing or recalling relevant information.

## Symptoms
- Physical  headaches, nausea or diarrhea, extreme body temperature changes, excessive sweating, shortness or breath, light-headedness or fainting, rapid heart beat, and/or dry mouth.
- Emotional  excessive feelings of fear, disappointment, anger, depression, uncontrollable crying or laughing, feelings of helplessness
- Behavioral  fidgeting, pacing, substance abuse, avoidance
- Cognitive  racing thoughts, 'going blank', difficulty concentrating, negative self-talk, feelings of dread, comparing yourself to others, difficulty organizing your thoughts.

# Clinical Presentation
Researchers believe that feelings of anxiety arise to prepare a person for threats. In humans, anxiety symptoms are distributed along a continuum and different symptom levels of anxiety predict outcomes. Responses consist of increased heart rate, stress hormone secretion, restlessness, vigilance, and fear of a potentially dangerous environment. Anxiety prepares the body physically, cognitively, and behaviourally to detect and deal with threats to survival. As a result, a persons body begins to hyperventilate to allow more oxygen to enter the bloodstream, divert blood to muscles, and sweat to cool the skin. In  individuals, the degree to which an anxiety response is developed is based on the probability of bad things happening in the environment and the individuals ability to cope with them. In the case of test taking, this might be a failing exam grade that prevents the student from being accepted to a post-secondary institution. A person's beliefs about their own competencies are a form of self-knowledge, which plays an important role in analyzing situations that might be threatening. When a person has feelings of low competence about their abilities they are likely to anticipate negative outcomes such as failure, under uncertain conditions. Thus, evaluative situations including tests and exams, are perceived as more threatening by students who have low competencies.
There is a difference between generalized anxiety disorders (GAD) and test anxiety. GAD is characterized by "trait anxiety" which results in a person experiencing high levels of stress across a wide range of situations. In contrast, people with test anxiety have a "state anxiety" which results in high levels of nervousness specific to testing.
Symptoms of test anxiety can range from moderate to severe. "Students who exhibit moderate symptoms are still able to perform relatively well on exams. Other students with severe anxiety will often experience panic attacks."
Common physical symptoms include: headache, upset stomach, feeling of fear, feeling of dread, shortness of breath, sweating, pacing or fidgeting, crying, racing thoughts and blanking out
During states of excitement or stress, the body releases adrenaline. Adrenaline is known to cause physical symptoms that accompany test anxiety, such as increased heart rate, sweating, and rapid breathing. In many cases having adrenaline is a good thing. It is helpful when dealing with stressful situations, ensuring alertness and preparation. But for some people the symptoms are difficult or impossible to handle, making it impossible to focus on tests.
Test Anxiety consists of:
- Physiological Overarousal  often termed emotionality.  Somatic signs include headaches, stomach aches, nausea, diarrhea, excessive sweating, shortness of breath, light-headedness or fainting, rapid heartbeat and dry mouth. Test anxiety can also lead to panic attacks, in which the student may have a sudden intense fear, difficulty breathing, and extreme discomfort.
- Worry & Dread  maladaptive cognitions. This includes catastrophic expectations of gloom and doom, fear of failure, random thoughts, feelings of inadequacy, self-condemnation, negative self-talk, frustration and comparing oneself unfavorably to others.
- Cognitive/Behavioral  poor concentration, "going blank" or "freezing," confusion, and poor organization.  The inability to concentrate leads to impaired performance on tests. Fidgeting during or outright avoidance of the test. Students often report "blanking out" even though they have studied sufficiently for the test.
- Emotional  low self-esteem, depression, anger, and a feeling of hopelessness.

# Causes
Test anxiety can develop for a number of reasons. There may be some prior negative experience with test taking that serves as the activating event. Students who have experienced, or have a fear of, blanking out on tests or the inability to perform in testing situations can develop anticipatory anxiety. Worrying about how anxiety will effect you can be as debilitating as the anxiety itself. This kind of anxiety can build as the testing situation approaches, and can interfere with the student's ability to prepare adequately. Lack of preparation is another factor that can contribute to test anxiety. Poor time management, poor study habits, and lack of organization can lead to a student feeling overwhelmed. Student's who are forced to cram at the last minute will feel less confident about the material covered than those who have been able to follow a structured plan for studying. Being able to anticipate what the exam will cover, and knowing all the information has been covered during the study sessions, can help students to enter the testing situation with a more positive attitude.  Text anxiety can also develop genetically.
Lack of confidence, fear of failure, and other negative thought processes may also contribute to test anxiety. The pressure to perform well on exams is a great motivator unless it is so extreme that it becomes irrational. Perfectionism and feelings of unworthiness provide unreasonable goals to achieve through testing situations. When a student's self-esteem is too closely tied to the outcome of any one academic task, the results can be devastating. In these situations, students may spend more time focusing on the negative consequences of failure, than preparing to succeed.
Parents are often perceived by students as being a source of pressure, especially when they place a strong emphasis on obtaining high achievement scores on examinations and assessments instead of on the effort made. Research shows that parental pressure is associated with greater worry, test irrelevant thoughts, and stronger bodily symptoms relating to anxiety during a test.
Other causes of test anxiety may include fear of failure, procrastination, and previous poor test performance. As well, characteristics of the test environment such as: nature of the task, difficulty, atmosphere, time constraints, examiner characteristics, mode of administration and physical setting can affect the level of anxiousness felt by the student. Researchers Putwain & Best (2011), examined test performance among elementary children when the teacher put pressure on the students in an attempt to create a more high stress environment. Their findings showed that students performed worse in high threat situations and experienced more test anxiety and worrisome thoughts than when in a low threat environment.
Test anxiety is known to develop into a vicious cycle. After experiencing test anxiety on one test, the student may become so fearful of it happening again they become more anxious and upset than they would normally, or even than they experienced on the previous test. If the cycle continues without acknowledgement, or the student seeking help, the student may begin to feel helpless in the situation.
People who experience test anxiety often have parents or siblings who have test anxiety or other types of anxiety. Anxiety does seem to have some genetic components.
Other variables related to test anxiety are:
- Obsessive compulsive disorder
- Perfectionist tendencies and unrealistic expectations
- Negative self-esteem, self-statements, and criticism
- Poor motivation or lack of confidence
- Stereotype threat
- Inadequate study and test-taking skills
- Poor eating, sleeping and exercising habits.

## Theories
Anxiety is defined as the psychological mechanism whereby the current intensification of a dangerous drive results in the elicitation of defences.  George Mandler and Seymour Sarason (1952), developed the theory that anxiety present in testing situations is an important determinate of test performance.  Individuals that become highly anxious during tests typically perform more poorly on tests than low-test anxious persons, especially when tests are given under stressful evaluative conditions such as a post-secondary exam. The feelings of forgetfulness, or drawing a blank are developed because of anxiety-produced interference between relevant responses and irrelevant responses generated from the persons anxious state. The difference in performance of a high-anxious test taker compared to a low-anxious test taker is largely due to the difference in their ability to focus on the tasks required. A low-anxious test taker is able to focus greater attention on the tasks required of them while taking the test, while a high-anxious test taker is focused on their internal self, and the anxiety they are feeling. Anxious test takers do not perform adequately on the test as their attention is divided between themselves and the test. Therefore, students with high test anxiety are unable to focus their full attention on the test. Furthermore, anxiousness is evoked when a student believes that the evaluative situation, such as an assessment, exceeds his or her intellectual, motivational, and social capabilities.
Psychologists Liebert and Morris (1967) originally attributed test anxiety to two main components: worry and emotionality. Worry refers to cognitive factors, such as negative expectations or feelings of inadequacy, and emotionality refers to the physical symptoms, such as increased heart rate, muscle tension, or butterflies. Both are aversive elements that can create anxiety, but it is the cognitive factors that have the strongest connection to performance.
Researchers Putwain, Woods & Symes (2010), found that a low academic self-concept was associated with higher worry and tension about their abilities to do well on a test. A student's metacognitive beliefs play an important role in the maintenance of negative self-beliefs.
Anxiety reactions can be generalized from previous experiences to testing situations. Feelings of inadequacy, helplessness, anticipations of punishment or loss of status and esteem manifest anxiety responses. As well, the presence of an audience can debilitate the performance of high anxious test takers and increase the performance of low anxious test takers. Interestingly, persons who score high on anxiety scales tend to describe themselves in negative, self-devaluing terms. Highly anxious test takers also blame themselves for their failure significantly more than low anxious test takers.

### Attentional Theories
There are two main groups of attentional theories that attempt to explain compromised performance in pressured situations.
- One group of theories are the explicit monitoring theories. They state that when a person is expected to perform a specific skill, the pressure may cause an increased self-consciousness and inward focus, which can disrupt their ability to successfully perform that task. Thinking about step-by-step procedures can inhibit ones ability to execute a task. For example, a study by R. Gray found that baseball players put into the high-pressure condition had increased errors, and an increased ability to recall details like the direction their bat was moving.  This indicates that the pressured players were monitoring themselves more, which impacted their ability to successfully hit the ball.
- A second group of theories are the distraction theories. These theories states that high-pressure environments create a dual-task situation, in which the persons attention is divided between the task at hand and unhelpful thoughts about the situation and possible negative consequences of poor performance.
Attention is an important part of working memory, which is the system that actively holds several pieces of relevant information in the mind while inhibiting irrelevant information. Working memory has a limited capacity, and the addition of stress and anxiety reduces the resources available to focus on relevant information.
- In situations in which individuals need to concentrate their attention on a specific task, emotional stimuli can divert their attention to a greater degree than non-emotional stimuli. Emotional stimuli will often dominate a persons thoughts, and any attempt to suppress them will require additional working memory resources. When working memory divides resources between the aversive cognitions and the task-relevant material, then the persons ability to use the relevant information on a test will suffer.People who suffer from test anxiety are more likely to experience negative cognitions while in evaluative situations. Furthermore, test anxious persons have been found to bias their attention towards threatening and anxiety related stimuli more than nonemotional stimuli.Research has accordingly found that tasks that rely heavily on working memory are the ones that suffer the most during pressure. Shortfalls in performance that are caused by test anxiety seem to be related to the extent to which the student has full access to their working memory.
- When comparing these two theories in the context of academic performance, a majority of work supports distraction theories. One reason for this is that many of the skills performed in the classroom require heavy demands on working memory. However, there are different kinds of pressure situations. There is monitoring pressure, in which an individuals performance is impacted due to the presence of an audience, and outcome pressure, in which an individuals performance is influenced by the consequences of the testing results. In a study, DeCaro et al. found that performance on a rule-based task, that relies heavily on working memory, was impaired by outcome pressure, but not monitoring pressure, whereas performance on an information-integration task, which does not require attentional control, was hurt by monitoring pressure, but not outcome pressure. These findings indicate that  performance is compromised in different ways depending on the type of task, and the types of pressure, and that both theories can be correct.

### Attentional Control
Eysenck et al. elaborate upon the distraction theories and propose the attentional control theory. This theory uses Baddeley's model of working memory to explain the effects of anxiety on working memory and on performance. In Baddeley's theory, working memory (WM) consists of four components, one of them the central executive that has a number of tasks such as coordination of the temporary stores of phonological and visual information (phonological loop and visuospatial sketchpad, respectively).
The attentional control theory assumes that anxiety primarily affects attentional control, which is a key function of the central executive. Attentional control is the balance between the two attentional systems, the goal-directed system, influenced by the individual's goals, and the stimulus-driven system, influenced by salient stimuli. According to the attentional control theory, anxiety disrupts the balance between these two systems. The stimulus-driven system becomes stronger at the expense of the goal-directed systsem, thereby impairing the efficiency of the inhibition and shifting functions of the central executive.
In support of this theory, there is strong evidence that anxiety largely impairs processing efficiency rather than performance effectiveness. Performance effectiveness refers to the quality of performance whereas processing efficiency refers to the amount of resources used to attain an effective performance. There is also evidence that anxiety impairs both the inhibition and the shifting function. Therefore, this theory suggests that students high in test anxiety will have to allocate more resources to the task at hand than non-test anxiety students in order to achieve the same results.
In general, people with higher working memory capacity do better on academic tasks, but this changes when people are under pressure. Beilock et al. found that pressure led individuals with a high working memory capacity to perform worse on a complicated task, whereas individuals with a low WM capacity got the same low results with or without pressure. This was because people with high WM could use more better but more demanding problem solving strategies in the low pressure condition, which they had to abandon in the high pressure condition. The low WM people never used these demanding strategies in the first place.  Evidence contrary to Beilock's results comes from Johnson et al. who found individuals' performances on a task showed a decrease in accuracy due to anxiety for individuals with low or average WM capacity, but did not significantly decrease for individuals with high WM.

# Measurement Scales
Early scales, by authors such as Charles Spielberger, tended to focus on physiological and somatic features and on worry, commonly referred to as emotionality, while more recent offerings, such as that by Cassady & Johnson, emphasize cognitive processes. "Test anxiety" for these authors consists of physiological and mental processes, and impaired test performance is seen as the result.
The "Children's Test Anxiety Questionnaire" is specifically designed to measure test anxiety in children 812 years of age. It provides scores for three dimensions of test anxiety: "worrisome thoughts concerning failure (i.e. 'when I take tests, I worry about failing'), automatic reactions concerning students' general and specific somatic indications of anxiety (i.e. 'when I take tests, my heart beats fast'), and off-task behaviours concerning nervous habits and distracting behaviours (i.e. 'when I take tests, I play with my pencil')" 

# Accommodations
Test anxiety prevents students from demonstrating their knowledge on examinations. To be covered by the Americans with Disabilities Act, test anxiety must pass two legal tests. First, it must be a "mental impairment." As a form of Social Phobia, a mental disorder included in the Diagnostic and Statistical Manual of Mental Disorders, it meets this first test. Second, it must "substantially limit one or more of the major life activities." Individuals for whom test anxiety is one manifestation of Social Phobia-Generalized are substantially limited in the major life activities of interacting with others and working. Individuals for whom test anxiety is the only manifestation of their Social Phobia are substantially limited in the major life activities of thinking and working, the latter because they are excluded from any career requiring a test for application, credentialing, licensure, or training. Accommodations may include taking the test in a separate room or taking an untimed examination. Documentation supporting a diagnosis of test anxiety should include evidence of significant impairment in test performance.

# Management
To gain an accurate assessment of student comprehension, instructors should be concerned with minimizing the effects of test anxiety.  Instructors might offer "second chances" post test, familiarize students with test format and grading scheme, and lower the impact of any one test. If students have greater confidence in their test-taking skills, they are more likely to be comfortable and relaxed when the testing does occur. Having an intentional thinking strategy should help student performance improve.
For some individuals, poor academic performance is due to skill deficits, which could include problems in encoding (learning),rehearsal (study skills) or retrieval during a test (test-taking strategies).Skill deficits may lead to poor performance directly (failure to adequately learn the material) or indirectly (awareness of being ill-prepared causes anxiety that, in turn, leads to poor performance). Therefore, the most effective interventions are those that combine skill-focused strategies (i.e. study skills training, test-taking skills) with cognitive (i.e. cognitive restructuring) or behavioural approaches (i.e. relaxation training, systematic desensitization).
Research suggests that students do not gain as much from reading self-help material as students would from the same material received in therapy or in a participatory group setting.

# Treatment
Medication will not cure anxiety disorders but will keep them under control. Drug treatments for anxiety disorders work by downplaying threat detecting mechanisms in the body.
- Beta blockers  commonly used to treat performance anxiety. Propranolol (a beta blocker) blocks the physical manifestations of anxiety. It slows heart rate and reduces sweating. It is not to be taken on the first day of a test, as some people are shown to have adverse side effects which include, but are not limited to, lightheadedness and a very slow heart beat.
- Benzodiazepines  commonly used to treat test anxiety. Should be taken up to 30 minutes before the start of the test. Side effects include, but are not limited to, sleepiness and can impair memory and thought.
- Antidepressants  commonly used for general depression, which can accompany test anxiety. Side effects include, but are not limited to, the potential to cause agitation and suicidal thoughts. These need to be taken on a regular basis not when needed before an exam.
Another approach is the use of psychotherapy. Cognitive Behavioral Therapy (CBT) is very useful in treating anxiety disorders. CBT helps to change the pattern of thinking that support the fear and help the sufferer overcome the negative beliefs. CBT often lasts about two weeks and takes place in small groups.
Medication combined with psychotherapy has shown to be the most effective treatment approach for people suffering from anxiety disorders.
Cognitive interventions have only had limited results when it comes to improving test performance. Some cognitive strategies have even been shown to be detrimental to performance, particularly strategies such as thought suppression.One intervention that had promising results in a first study is "attentional cognitive bias modification" in which children learning to avoid paying attention to a threatening face.