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Dealing with Anxiety

Test Anxiety

About 10% of students have significant test anxiety that warrants intervention. Students exhibiting greater test anxiety are more likely to have higher neuroticism with lower extraversion and lower conscientiousness. They take more medications. They have more social anxieties.

The term debilitating test anxiety (DTA) has been used to describe a reaction that occurs in the setting of high-stakes examinations, but not in other settings such as classroom or clinical activities (affected persons do just fine in learning exercises and with patients). DTA affects about 1 person in 50. DTA occurs most often with multiple-choice question (MCQ) formats, producing disabling worry, emotionality, and autonomic hyperarousal. There is usually a history of prior reactions when taking standardized MCQ tests. Such persons benefit from behavioral therapies to deal with anxiety.

If someone just gives you a "pep talk" or "pat on the back" and assures you "everything will be all right" then demand more. As physicians in training you should seek what physicians in practice do: develop and deploy a treatment plan with adherence. That is true health maintenance and promotion.

Low Threshold Interventions

Multiple interventions are available to address problems created by excessive anxiety. No one technique alone will reduce anxiety and boost performance, but combinations of therapies may prove effective. Such therapies may include:

  • Cognitive restructuring

  • Attentional training

  • Relaxation techniques

  • Systematic desensitization

  • Anxiety management

  • Self-control triad

  • Modeling (coping and learning strategies)

  • Study skills training

Holistic Approach

Student well-being may reach a nadir pre-exam. There are approaches to prevent this from happening. Elements of a program to deal with stress:

  • Develop a holistic approach to healthcare

  • Learn the importance of knowledge and reflection for personal self-care strategies to manage stress and maintain a healthy lifestyle

  • Understand the mind-body relationship and the role of meaning and/or spirituality on coping, health and illness

  • Schedule times to exercise with physical activity to enhance physical health

  • Develop healthy nutritional practices and eating patterns

  • Enhance connectedness for social support for wellbeing and healthcare

  • Create a healthy physical, emotional and social environment


Schaefer A, Mattheß H, Pfitzer G, Köhle K. Mental health and performance of medical students with high and low test anxiety. Psychother Psych Med. 2007;57:289-297.

Neuderth S, Jabs B, Schmidtke S. Strategies for reducing test anxiety and optimizing exam preparation in German university students. J Neural Transm. 2009;116:785-90.

Powell DH. Behavioral treatment of debilitating test anxiety among medical students. J Clin Psychol. 2004;60(8):853-65.

Hassed C, de Lisle S, Sullivan G, Pier C. Enhancing the health of medical students: outcomes of an integrated mindfulness and lifestyle program. Adv Health Sci Educ Theory Pract. 2009;14(3):387-98.

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