Test anxiety, a form of situational anxiety has been shown in research to affect somewhere between 10 to 40 percent of all school aged children (it’s hard to pinpoint the exact amount, but one study in 2010 attempted to do so) ^[1].

One review of 288 studies focusing on test anxiety, with the earliest going back to 1988, discovered that there is significant correlation between test anxiety and a wide range of negative educational performance outcomes; including standardized tests, university entrance exams, and grade point average. Correlations were most pronounced at the middle grades level, likely because self-esteem is a significant and strong predictor of test anxiety in students ^[2].

Maybe you’ve been in this sort of situation. You did everything you could to prepare for an important exam. You paid attention during class, took copious notes, studied hard, and likely even sacrificed time with friends and family. You wanted to be prepared as possible because the test results could have a significant impact on your further education, or even your career.

But even though you’ve prepared as much as possible, when it comes time to take the test; it feels like your brain has frozen and your mind goes completely blank.

Of course, as you fail to think of the answers during the test, your anxiety levels increase even more! This makes it even harder to think clearly. At this point you’re probably experiencing the physical symptoms like sweating, trembling, racing heart rate, and even nausea!

If any of this sounds familiar; you have probably experienced test anxiety for yourself.

Here, we’re going to take a deep-dive into the subject of test anxiety, and try to understand what it is, what causes it, what the symptoms are, who is at higher risk of suffering from test anxiety, and then look at some test anxiety medications and natural solutions that can be used to overcome test anxiety symptoms so that you can ace your next exam.

What is Test Anxiety?

Test anxiety, sometimes called exam anxiety, is a type of performance anxiety that only occurs before and/or during an exam. Test anxiety is most common amongst the student populations of the world (perhaps due to regularity with which students take exams), and highly test-anxious students have been shown in studies to score about 12 percentile points below their low (or typical) anxiety peers ^[1][3][4].

A little bit of anxiety and nervousness before an exam is normal, and some even like the small spike in adrenaline it provides as it helps them focus the mind during the test.

For some, however, their test anxiety is so severe that it makes the act of taking exams painful, often leading to extreme measures like skipping exams or even dropping out of studies completely.

It’s common for students to turn to measures like pharmaceutical drugs, relaxants or alcohol to help them “relax” before a test ^[5].

So while a student suffering from test anxiety may seem trivial, or like something that everyone goes through, it’s worth addressing and developing management techniques for early if more severe symptoms start to show.

Symptoms of Test Anxiety

Test anxiety, and performance anxiety in general, is a complex condition. The causes and symptoms of test anxiety can vary depending on the individual and the underlying causes that contribute to their stress. Test anxiety can have physical, mental, as well as emotional effects ^[6].

Physical Symptoms

• Trembling hands
• Elevated blood pressure
• Excessive sweating
• Rapid and irregular heart rate (arrhythmia)
• Dry mouth
• Nauseousness
• Dryness in the mouth

Mental Symptoms

• Trouble concentrating
• Not being able to think despite having prepared for an exam
• Use of substances like alcohol or beta-blockers
• Racing uncontrolled thoughts
• Increased anxiety

Emotional Symptoms

• Frustration
• Feeling of helplessness when it comes to education or career
• Low self-esteem
• Tendency for blaming oneself for poor test performances
• Negative self-talk, which makes test anxiety worse

Causes of Test Anxiety

In order to try and come our exam anxiety, we must first try to understand why we experience the condition in the first place.

As with the symptoms of anxiety (listed above), the specific causes of test anxiety tend to vary heavily depending on the individual experiencing it. Generally speaking, however, there can be both mental and biological causes of test anxiety.

If you have a history of poor past performances during exams, and especially if you were judged negatively for it by your teachers, parents, peers, etc., you likely have a significant amount of stress and anxiety built up around the subject of exams ^[7].

You fear the negative experiences of the past may repeat itself, and you worry that you’ll have to face the disappointment and humiliation all over again ^[5].

Fight-or-flight Response

Due to the fear surrounding exams, you most likely experience a significant amount of stress when you’re about to take a test. This elicits a stress-response within your body, also known as the fight-or-flight response ^[8].

‘Fight-or-flight mode’ is a human response developed through thousands of years of evolution, where humans experience an acute stress response when faced with dangerous, potentially fatal, threats. Although society is, generally speaking, a lot safer today then when our ancestors lived amongst predatory animals with minimal defensive tools available to them — the stress response we experience in the face of perceived threats or dangers remains just as strong as if we were facing down an attacking lion ^[9].

When we are in this fight-or-flight mode, our bodies release a stress hormone known as adrenaline. As we explained previously, a slight adrenaline spike may even improve your testing abilities. But too much adrenaline puts your heart under increased pressure, resulting in the physical symptoms of test anxiety such as poor cognitive function, higher blood pressure, sweating, and more ^[5].

Anxiety before/during an exam can often become a self-fulfilling prophecy. When your test performance suffers due to worry, you might think that your fear was justified to begin with, and that you are indeed bad at tests. This negative self-talk can then increase your stress during future tests, or worse, stop you from pursuing your education or career advancement.

Who is at a Higher Risk of Test Anxiety?

Here are several factors that might increase ones odds of experiencing severe test anxiety ^[6]:

Patterns of Behavior During Previous Tests & Exams

As mentioned previously, if you have had negative outcomes during previous tests & exams, due to either anxiety or inadequate preparation (or some of both), you may be fearful of similar results going forward. The fear of being judged then makes your anxiety worse, and affects your ability to perform during the next exam.

Perfectionism

Perfectionism is “a propensity for being displeased with anything that is not perfect or does not meet extremely high standards.” ^[10]

If you’re a perfectionist by nature, then you may be more prone to test anxiety. It’s likely that you believe (and fear) that anything less than a perfect score will be considered a failure. The added pressure can exacerbate your stress.

If you had overcritical parents growing up, or if you were bullied as a child, you may be at a higher risk of social anxiety and test anxiety because of perfectionism.

Self-esteem Issues

If you suffer from self-esteem issues, then you may already doubt your ability to do well in tests, which could cause you to feel nervous during future exams.

If your test performance suffers due to anxiety, it could hurt your self-esteem even further, potentially making the problem worse and leading to a vicious cycle.

GABA Imbalance

Sometimes biology can play a larger role in test anxiety, more than mental and emotional causes. If specific neurotransmitters (chemical messengers in your nervous system) are out of balance, you may be at a higher risk of mental health conditions, including test anxiety ^[11].

Gamma aminobutyric acid (GABA) is a major neurotransmitter that plays a critical role when it comes to social anxiety and test anxiety. GABA reduces the level of activity in your nervous system and promotes alpha waves in your brain, both of which have been proven to increase calmness and relaxation.

In fact, one of the most effective ways to combat the symptoms of test anxiety is to boost GABA levels in your brain, as we’ll discuss later in this article.

Test Anxiety Medications

Although something like 18% of the adult US population suffer from anxiety disorders, only a quarter of those who do so actually seek medical treatment, according to the Anxiety and Depression Association of America (ADAA) ^[12].

An estimated 25% of the US population aged between 13 to 18 years old suffer from anxiety disorders, again with many cases going untreated ^[13].

With so many Americans suffering from anxiety symptoms, and many of those within school and further education age-ranges, it is estimated that many students are suffering from severe test anxiety. With severe test anxiety, symptoms are more intense and and persistent then usual. These students may be suffering from panic attacks in some cases, and are likely experiencing poor test performance despite preparing and studying thoroughly.

Doctors, pediatricians in some cases, might suggest and/or prescribe medications to help control severe test anxiety symptoms. While we always recommend counseling and trying mental and physical techniques to help overcome test anxiety first before using medication, if it is a path you are going down then let’s summarize the most common test anxiety medications used by students today, and attempt to understand how (and if) they work.

Beta Blockers for Test Anxiety

Beta blockers are a class of pharmaceutical drugs that work by blocking the effects of adrenaline hormone, which plays a vital role in triggering a fight-or-flight response in a stressful situation. Beta blockers reduce stress on the heart, while lowering the force with which it has to pump blood. This has a relaxing impact on the blood vessels found in the heart, brain, and around the body ^[4].

Doctors typically prescribe beta blockers for a variety of conditions such as abnormal heart rhythm, high blood pressure, angina, glaucoma, among others.

If a student uses a beta blocker like Propranolol (Inderal) or Metoprolol (Lopressor) prior to a test or exam, the drug would slow their heart rate, reduce trembling and sweating, and regulate their breathing and blood pressure (just as it would for someone using the medication to help with a cardiac condition). Beta blockers help the student to feel relaxed, essentially negating any stress response and helping them get through the exam ^[15].

Propranolol, the most prescribed beta blocker in the US, is typically used for short-term relief from the physical symptoms of social/performance/test anxiety. We compare Propranolol to Bisoprolol, another beta-blocker, in this article.

Atenolol is another beta blocker with longer lasting effects than Propranolol, but it carries some added risks. Metoprolol, which is also a popular beta blocker, is said to have (significantly) more side effects than the other beta blocker medications.

Beta-blockers are generally considered to be safe, especially if only used occasionally. But they do come with potential side effects, specifically ^[16]:

• Fatigue
• Mood disorders
• Digestive issues like gas, bloating, and constipation
• Nausea, and in some cases, vomiting
• Heartburn
• Dry mouth

In some rare, but severe cases, one might also experience the following side effects:

• Wheezing and/or shortness of breath
• Swelling of extremities like hands, feet, or ankles
• Fainting
• Pounding heartbeat

If you experience any of the side effects mentioned above, you should immediately notify your doctor.

The major issue for most with beta blockers is the convenience factor: they are prescription drugs that require you to visit and consult with a doctor every time you need more. This problem is partially solved through online services like Kick & Hims, but not completely.

Benzodiazepines for Test Anxiety

Benzodiazepines, typically prescribed under the brand names Valium, Xanax, Restoril, Ativan and Klonopin, are the oldest and most well-known controlled substances for anxiety ^[17].

Benzodiazepines like Xanax work by decreasing abnormal excitement within the brain. They act on the brain and central nervous system (CNS) to produce a calming effect ^[18].

Xanax, specifically, slows down the movement of brain chemicals that may have become unbalanced, resulting in a reduction in nervous tension and anxiety. Much like Ambien, Xanax does this by boosting the effects of a natural chemical called gamma-aminobutyric acid (GABA), which is made in the brain ^[19].

The issues with using benzo medications to help with your test anxiety are numerous ^[20]:

1. Benzodiazepine drugs reduces awareness and reaction times; a major issue for those completing an exam!
2. Benzodiazepines and similar prescription drugs have short term negative effects on memory, co-ordination, concentration and reaction times, and are (extremely) addictive if used for a long time, with withdrawal leading to fits, hallucinations, agitation and confusion. These drugs have also become widely used drugs of abuse since they first came on the market. The prescribing guidelines doctors have to follow say that use of benzos to treat short-term “mild” anxiety is inappropriate. Benzos are only supposed to be used short term for a ‘crisis in generalized anxiety’. Test anxiety in isolation is not a generalized anxiety disorder.
3. Benzodiazepine and similar controlled drugs are illegal in a number of countries. They may be confiscated or you may find yourself in trouble with law enforcement in some places.

Natural Test Anxiety Solutions That Don’t Require Medication

There are some things that you can do to overcome your test anxiety so that you can take exams confidently, and pursue your ideal life path without the use of medications.

Before we delve into the best natural techniques to overcome test anxiety, we should note that although all of these recommendations are natural, healthy, and backed by research, the person that can help you the best is a licensed therapist. He or she can evaluate your specific case and recommend a treatment plan based on your underlying issues.

That being said, all of the following methods will help you develop a more resilient body and brain, so you can handle your stress and anxiety better and get back to acing your exams.

Cognitive-behavioral Therapy (CBT)

Cognitive-behavioral therapy, abbreviated as CBT is a form of therapy designed to shift your thoughts around the idea of taking a test to make it less stressful for you.

CBT aims to take an idea that you find overwhelming, such as taking an exam or having a discussion with your family members about a sensitive issue, and break it down into smaller parts ^[21].

Instead of thinking of the entire exam process, which you may find scary, your CBT therapist will help you identify the numerous different aspects of an exam. He or she will then identify any negative thought patterns associated with each of the smaller elements, and work with you to replace them with more positive ones or be more prepared to face them down if they can’t be replaced.

Your therapist might give you mental exercises for practice, or even homework as a part of the CBT process. Studies have shown that if you’re enthusiastic and positive about CBT, there is a higher likelihood that it will be useful for you ^[5].

CBT has also been proven to be one of the more effective long-term solutions against mood disorders like anxiety and depression ^[22][23].

Improving Heart Rate Variability (HRV)

Broadly speaking, exercise in the form of cardiovascular or strength training (or other variations) is a very effective tool against anxiety.

Working out regularly strengthens your cardiovascular system, which could make you more resilient against the physical symptoms of test anxiety, such as higher blood pressure and palpitations. Exercise also promotes overall wellness, of course, while promoting relaxation.

Yoga, specifically, can be especially useful against test and exam anxiety. Yoga increases your heart rate variability (HRV), which is a measure of the variation in time between each heartbeat. HRV is also an indicator of your ability to respond to stress flexibly ^[24].

So, an increased HRV through yoga or other forms of exercise means that your body will be better equipped to handle any stress response, and combat the physical symptoms of test anxiety. If you can remain physically calm, you will be able to maintain focus during the exam.

Ideally, you should include strength training, cardiovascular exercises like cycling or swimming, as well as yoga, in your training plan throughout the week, especially in the run-up to a time period containing several tests and exams. Finding the time to regularly perform a well-rounded exercise routine will create a resilient mind and body that can combat stress and fight anxiety.

Visualization

Many students have success using the process of visualization to “practice” positive test outcomes in your mind prior to actually taking the exam. Having already experienced the situation in your mind, you might be less anxious when you’re going in for the actual test.

Visualization can reduce your anxiety by helping you manage your negative emotions. You put yourself in a relaxed state through mindfulness practice, or guided imagery, and then imagine a positive outcome in your mind.

For test anxiety, you could imagine yourself in the testing room, getting the test, seeing the questions, and instead of stress, you feel confident as you calmly answer all of the questions ^[5].

Visualization may take some time and practice to get used to, but it can be a powerful tool ^[25]. Some of the most successful people in the world like Oprah Winfrey, Will Smith, Arnold Schwarzenegger, and Michael Phelps, have all used visualization to achieve success ^[26].

Natural Supplement for Test Anxiety

Many of the clients I work with have had success using a supplement called PerformZen to help manage more severe test and exam anxiety issues. PerformZen is a natural supplement that is designed to promote calmness and mental focus, so you can perform at your optimal level, whether it’s during an exam, a performance, or at a social event. I even interviewed one of the founders of PerformZen and secured a limited-time discount for PerformanceAnxiety.com readers. Check that out here.

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So Is It Possible To Overcome Test Anxiety Using Medication?

If you feel like test and exam anxiety has been holding you back from pursuing the education or the career that you want, you should know that there are options and ways that you can overcome your fear of exams.

Yes, medications such as beta blockers or Benzodiazepines are one way to try and manage test anxiety, and if you do go this route you should consult with a licensed therapist or healthcare professional who can recommend a treatment plan based on your specific needs and health variables.

You can also try some of the research-backed tips mentioned in this article like exercise and yoga to improve HRV, cognitive behavioral therapy (CBT), and visualization to reduce your overall stress and promote calmness and confidence.

Best of luck in your upcoming exams, if you have them, and I hope these techniques mentioned here help you out! Leave a comment below sharing your experiences managing and overcoming test anxiety yourself.