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Test Anxiety Treatment & Diagnostic Considerations

Test Anxiety Treatment & Diagnosis

Because many other conditions can mimic or exacerbate test anxiety, it is important to undergo a thorough diagnostic evaluation before beginning treatment.

When considering treatment for test-taking anxiety, make sure that you have a comprehensive diagnostic assessment to rule out other possible causes of your symptoms.  Not all cases of test anxiety are alike, and sometimes symptoms of test anxiety actually reflect a separate, underlying condition.  If you’re located in South Florida (Palm Beach Gardens, Jupiter, West Palm Beach, Fort Lauderdale, Boca Raton, Boynton Beach, & Miami), I would be happy to meet with you to conduct an assessment of your symptoms and provide treatment (if appropriate).

Regardless of where you live, here is a short list of factors to consider when getting help for your symptoms:

Test Anxiety Diagnosis & Treatment Strategies


1. Don’t assume that just because you have test anxiety that the problem is only test anxiety. Test performance issues may also have an independent panic component. If panic attacks are ignored or left unaddressed, treatment is likely to fail.

2. The very characteristics that make some individuals successful can serve as liabilities for others. Characteristics like perfectionism and other obsessive-compulsive traits can be associated with pathological doubt, which can induce panic attacks, increase test-taking time, and lead to procrastination and avoidance of essential test preparation. If this is the case, the most effective treatment would address these characteristics, not the test anxiety itself.

3. In the case of certifications or other high stakes situations that allow multiple pass attempts, work on your test anxiety prior to your first examination. Apply Ben Franklin’s famous adage, “An ounce of prevention is worth a pound of cure.” Previous examination failures can undermine (or decimate!) your confidence and make the situation into more of an uphill battle than it needs to be. If you have already failed your examination, make sure that treatment addresses any failure-related thoughts you might be experiencing.

4. The most evidence-based treatment for the above issues (test anxiety, panic, OCD traits) is cognitive behavioral therapy (CBT). CBT can also address any related depressive symptoms. Do not select a provider who practices in a different modality–go with the research evidence. Some providers may supplement CBT with mindfulness (which can be a nice adjunct), but mindfulness should not be the core of treatment.

5. Expanding on the previous idea, not all cognitive behavioral therapists are alike. Find a therapist who actually utilizes both cognitive AND behavioral interventions to treat your test-related anxiety. In addition to the cognitive therapy that needs to happen, treatment should be behaviorally-based. For test anxiety, this means completing simulated examinations in advance of your actual test date. These simulations should be designed to resemble (as closely as possible) all aspects of your upcoming examination.

6. In addition to psychotherapy, some medications can be helpful (e.g., SSRIs, etc) but it can take awhile for these medications to build up to therapeutic levels. If you want medication to be part of your treatment, it’s important to plan ahead (i.e., ~3 months) and work closely with your doctor. Furthermore, you should know that prescribing is not an exact science. Doctors cannot always predict in advance which medication will work best for you. Keep in mind that the first medication you try might have to be adjusted or replaced by another medication to help you achieve maximum benefit.

7. Although shorter-acting medications (e.g., benzodiazepines or “benzos”) can bring quick anxiety relief, they are not without significant cons. As such, it’s important to be very cautious when choosing them. Your doctor can advise you on these issues.

8. For individuals with test anxiety, preparation should not be focused solely on the facts or formulas that need to be memorized in order to succeed. Good preparation is essential, but it is only one component of getting ready for your exam. After all, the best preparation in the world is pretty useless if your mind goes blank. To overcome your test anxiety, you should work with a CBT psychologist who can help you develop a working knowledge of how your own thoughts and behaviors relate to your anxiety. Without these skills, you are likely to feel overwhelmed and frustrated.

Visit my companion post to learn about common test anxiety myths.

Agree? Disagree? Share your thoughts below.




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5 Comments

  1. As a college student who has suffered from severe text anxieties only since beginning my undergraduate career, these tips are wonderful. I’ve been in therapy for six months regarding this and several other issues, but we soon realized that my test anxiety was just a result of other things, such as mild depression, that were going on.

    My favorite strategy that we have developed is the use of white noise during studying and during the actual exam. If you’re taking the exam in a classroom with other students, the white noise is already built-in with all the sniffling, noisy pencil writers, and occasional coughing of others.

    During my study time, I use earbuds and Spotify to give myself something to keep my brain going. Typically, the music is just instrumental, like a soft piano, so that I’m not tempted to sing along.

    Thanks for this post! Keep ’em coming!

    • I really like Erin’s suggestion! When you’re studying or taking a practice exam, try to replicate the actual testing environment as closely as possible. In addition to music, you might also want to directly incorporate sounds like coughing/sniffling/pencil tapping/whispering/throat clearing/etc. If any sounds are particularly distracting for you, include them in the recording. If you’re tech savvy, you can try the following:

      1. Google “cough .wav” or “cough .mp3” (*note the space*) to find useful sound snippets. This same process can be used to discover other relevant sounds.
      2. Use an open source audio mixer like Audacity to combine your sounds in a random, non-predictable sequence.
      3. Export the result so that it plays in ITunes/WMP/etc.
      4. Loop your recording while you study.

  2. what can i do to help my test anxiety

    • Hi Rajeeyah,

      Your best bet is cognitive behavioral therapy (CBT), which can help you identify and change maladaptive thoughts that fuel test-related panic. It can also be helpful to schedule a large number of mock examinations in order to practice your skills.

      Good luck!

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