What the research says about test anxiety

by Gabe

Imagine we’ve got two people taking the MCAT, Person A and Person B. (Very creative naming, right?)

They both know the material equally well, they’re equally smart, they’ve been studying for the same amount of time, did the same practice tests, etc.

But when they take the MCAT, Person A scores great and Person B scores much worse.

What gives?

In my experience, 9 times out of 10 it’s confidence. Person A probably felt solid going in—a little anxious maybe, but just a healthy amount of anxiety.

But our other test-taker didn’t feel so good. They felt more anxiety during the test, didn’t feel confident in their answers, took longer on the questions, maybe had to rush a few parts.

The feelings of anxiety, the lack of confidence—that can make a big difference.

What can we do about this?

If you could just reach inside your brain and turn the anxiety dial down, maybe take it from an 8 to about a comfortable 3, that would do the trick. But obviously that’s not an option.

So I did a little digging.

And it turns out, there’s a whole bunch of research on test anxiety: what it is, where it comes from, and how to reduce it. There’s no miracle cures, but I did find some interesting techniques.

So I wrote up this summary of the ideas that sounded most promising to me. To be clear, I'm not claiming that the research 100% proves that all of these work. Some of it's pretty tentative. (If you want to read more about the research itself I've put that info at the bottom of this email.)

But I still thought it would be helpful to you to see what ideas are out there. After all, it can't hurt to try something.

One quick thing before we get into it: the first three sections here are based on a book by a guy named Marty Sapp that collects and analyzes dozens of papers. So when I say "Sapp says this" or "Sapp says that," you'll know why.

Relaxation therapy

This is the most basic approach that Sapp talks about, and it’s pretty much what it sounds like. You practice tensing and then relaxing one muscle group at a time until your whole body is relaxed. The rationale is that “If one can learn to relax during these sessions, he or she will be able to relax during a test situation and perform at his or her optimal level.”

In the first session you go through practically every muscle in your body: you start with one hand—you tense it for 5-7 seconds, let it relax for 10 seconds—then you do the same with the forearm, and then with the upper arm. At each group you tense the muscle group tightly, hold it for a bit and then relax. You do one arm, then the other, then the muscles of the face, the neck, the chest…you get the idea.

The sessions are long at first: you’re supposed to do 15-20 minutes twice per day. But I bet even less than that would still help. (Just my opinion.)

Over time, though, you group the muscles together so that it doesn’t take as long. First you reduce it to six groups: dominant arm, non-dominant arm, face muscles, neck muscles, stomach muscles, and leg muscles. Then eventually down to three: muscles of both arms, muscles of the center of the body (includes face, neck, and stomach), and muscles of both legs.

Towards the end, you're supposed to switch from actively tensing your muscles to just noticing the tension that’s already there. They say to “bring attention to tension in particular muscle groups without producing muscular tension” and then try to relax like you did before.

Systematic desensitization

Systematic desensitization is a pretty common way to treat phobias, and I think the way it’s applied to test anxiety makes a lot of sense.

As Sapp describes it, there’s three steps. In step number one, you have to learn relaxation therapy (see the previous section for that).

Step two, you make a list—called a “test hierarchy”—of all the test-related situations that produce anxiety, ranked from most to least stressful. He gives some hints for coming up with your list. What are the places or times that produce anxiety? Maybe that’s the moment that the first CARS passage pops up on your screen. Put that down on the list. And what are the themes that produce anxiety? The example they give of a theme is: “I have failed this exam; how are my parents going to react?”

So once you’ve made your list (the example list that they give has five items on it, by the way), you move onto the third step. In the third step, you get relaxed, and then you practice imagining the scenarios on your test hierarchy. You start with the one that produces the least anxiety and work your way up, until you can clearly imagine each one without anxiety.

So you relax (using your relaxation therapy techniques), and then imagine the scene as vividly as you can for about thirty seconds. If you can imagine it without anxiety, you move onto the next one. If not, imagine something different for a bit, something peaceful, and then when you’re feeling relaxed you try again at the stressful scene.

The rationale behind it all is that by mentally rehearsing these stressful scenarios, you can take the edge off them so you might not panic during the real exam. To me, it sounds fairly reasonable.

Cognitive behavioral therapy

This approach is based on the idea that test anxiety is fueled by what Sapp calls “irrational thoughts.” One of the examples he gives is, “my life is based on succeeding on this test.”

Now personally, I wonder if “irrational” is really the best word here. He defines irrational thoughts as, “ones that tend to prevent students from achieving their goals.” So maybe we could just think of them as “unhelpful” thoughts instead.

But whether they’re rational or not, they’re not helping you achieve your goal, so why not try to replace them with something more helpful? That’s the basic rationale behind this approach.

First you have to take stock of your irrational thoughts (I’ll just use the scientifically approved word for simplicity’s sake). Maybe you notice you tend to get stuck on hard questions for too long because you tell yourself, “I have to get this question right.” That thought isn't helping you.

Next you have to work over time to change those irrational thoughts and replace them with more helpful ones. Maybe your new, more helpful thought is, “I don’t have to get every question right. I can miss some questions and still get a good score.” The research makes it clear that this is not a quick fix; it’s a long term process of working to change your beliefs.

(Side note: you might be wondering...isn't this something you're supposed to do with, say, a therapist helping you? In an ideal world, yes, but you can still apply the same principles on your own.)

Imagery rescripting

Proponents of imagery rescripting say that anxiety can be driven by recurring images of negative situations from the past. Maybe you can’t stop thinking about the last time you took the MCAT and you panicked and it all fell apart. That image, if it keeps coming up, can be part of what causes anxiety.

Imagery rescripting directly attacks that.

To do this technique you’re supposed to re-experience the memory as thoroughly as you can, thinking of the specific images and situations that come to mind and the feelings attached to them. And then you try to change those images. Essentially, you rewrite the memory in your head, this time with a better outcome. Let’s say the image that comes to mind is that you’re panicking during the exam, heart racing, and you can’t focus anymore. Now you try to reimagine it: you’re panicking, but you give yourself a quick break, close your eyes, take a few deep breaths, and after a minute you’re able to focus on the exam again.

When I was reading about this approach I thought maybe it sounded too simplistic. Can switching out the images in your head really do much? But there is research that suggests it’s effective, so it might be worth a shot.

Reappraising arousal

According to this model, your feelings of physiological arousal when taking a test can be interpreted in two ways. The first interpretation is as a threat. You feel the arousal as anxiety, and you worry it will decrease your performance. The second interpretation is to see arousal as a challenge. You interpret the arousal as something like excitement, and that actually increases your performance.

If you think about it, there is a sort of logic to it. The two distinct states—anxiety and excitement—have very similar feelings in your body. Rapid heart rate, sweating, increased breathing. The main difference is the cognitive component. In anxiety it’s a negative appraisal; in excitement, a positive appraisal.

In the study that I read, they had two groups: a control group that they didn’t give much instruction to, and a reappraisal group who they instructed to try to reinterpret their feelings of anxiety as something positive. Here’s part of what they told them: “[R]ecent research suggests that arousal doesn’t hurt performance on [standardized] tests and can even help performance…[I]f you find yourself feeling anxious, simply remind yourself that your arousal could be helping you do well.”

Six months later, both groups took the GRE and they found that the scores were significantly increased for the reappraisal group.

Mindfulness meditation

I have to at least put in a plug for my favorite method here. I actually couldn’t find any research specifically connecting it to test anxiety, but I have seen mindfulness meditation help a lot of my students to feel more confident for their exams. So I do think it works really well.

The basic procedure is this: you sit down and try to focus on your breathing. Inevitably (because you’re human) you get distracted. Your mind drifts away. When you notice that, you try to gently re-focus on your breath. That’s it.

If you’re doing a session for 10 minutes, then probably you’ll get distracted dozens of times during that period. And that’s fine. The goal is not to be perfectly focused the whole time, it’s to notice when you’re distracted and re-focus. Every time you do that, you’re building up your attention muscles.

When you’re taking the test, this can help you drop those anxious thoughts, calm down, and re-focus on the actual exam.

The Headspace app is a good way to learn this technique. (Their simplest, “Basic” course is the best one.)


Lastly, you can’t overlook the power of good, old-fashioned studying.

Sometimes you might be lacking confidence for legitimate reasons: you don’t know the material well enough, or you haven’t done enough practice. In that case, nothing beats drilling the material until you know it like the back of your hand.

Sometimes preparation is the best cure for anxiety.

Well…that’s a lot! I hope I haven’t overloaded you with all this.

If you don’t know where to start, then I’d suggest picking whichever method stood out to you, looking into it a bit more, and then giving it a try.


As I mentioned above, the main source I used is a book from 2014 by Marty Sapp called “Test Anxiety: Applied Research, Assessment, and Treatment Interventions.” That books collects and discusses all the available research on test anxiety.

The Sapp book seems like a pretty reliable source to me. He spends about 90 pages just describing how the research is typically conducted—the different variables measured, potential difficulties, common research designs, etc. And there’s a lengthy list of references for almost every chapter.

I’ve seen his name cited in a lot of other research, so I’m inclined to trust that the things he describes are well-supported.

The section on imagery rescripting is based primarily on a paper called “Effects of cognitive-behavioral therapy with relaxation vs. imagery rescripting on psychophysiological stress responses of students with test anxiety in a randomized controlled trial” by Reiss, N., Warnecke, I., Tibubos, A. N., Tolgou, T., Luka-Krausgrill, U., & Rohrmann, S. (2018).

The section on reappraising arousal is based on: “Turning the knots in your stomach into bows: Reappraising arousal improves performance on the GRE” by Jamieson, Jeremy & Mendes, Wendy & Blackstock, Erin & Schmader, Toni. (2010).

One last thing: most of the techniques I go through are described in the research as being performed along with a guide of some sort–a therapist, a psychologist, etc. But I've tried to present the ideas behind them in a way so that you can try them on your own. Probably it works best with someone helping you, but most of this don't have that luxury.

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