Does test anxiety increase as the exam draws near? – Students' state test anxiety recorded over the course of one semester

Academic Stress Interventions in High Schools: A Systematic Literature Review

The experience of academic stress is common during high school and can have significant negative consequences for students' educational achievement and wellbeing. High school students frequently report heightened levels of school-related distress, particularly as they approach high-stakes assessments. Programs designed to reduce or prevent academic stress are needed, and their delivery in school settings is ideal to improve treatment access. The current review aimed to examine the effectiveness of high school-based programs in reducing or preventing academic stress. A systematic search returned 31 eligible studies across 13 countries. Programs were categorised according to intervention type, format, and facilitator. Results showed that the methodological quality of most studies was poor, and many used an inactive control group. As predicted by theories of academic stress, the strongest evidence was for programs grounded in cognitive-behavioural therapy (CBT). There was evidence that both universal and targeted approaches can be beneficial. The unique implementation issues for these two formats are discussed. Most programs were delivered by psychologists and were generally effective, but almost all of these were CBT programs. A smaller proportion of programs delivered by teachers were effective. Therefore, future studies should evaluate the implementation success of programs to improve the rate of effective delivery by school staff. Overall, the field will benefit from more randomised controlled trials with comparisons to active control groups, larger sample sizes and longer-term follow-ups.

Examining Motivation of First-Year Undergraduate Anatomy Students Through the Lens of Universal Design for Learning (UDL): A Single Institution Study

Motivation is critical for meaningful learning among healthcare students studying anatomy. Learners are highly variable, and it is important to ensure learners are equally supported in the diverse aspects of an anatomy curriculum. The implementation of the educational framework, Universal Design for Learning (UDL), in anatomy curricula could potentially enhance student motivation. The multiple means of engagement principle of UDL refers to the enhancement of motivation among students. This study aimed to identify healthcare students' motivation levels at the start and end of their anatomy module and whether there was any change in motivation. The Motivated Strategies for Learning Questionnaire (MSLQ) was distributed to gather the self-reported motivation levels of first-year undergraduate medical, dental and occupational therapy (OT) and speech and language therapy (SLT) students studying anatomy at the start of their respective anatomy modules and again at the end of the module. The overall response rate was 74% and 69%, at the start and end of the study, respectively. Responses were analysed by the respective programme of study. Motivation to study anatomy among medical, dental, OT and SLT students ranged from medium to high on the MSLQ at the start of their respective anatomy modules. By the end of the anatomy modules, dental students reported high levels of motivation to study anatomy, whereas motivation among medical, OT and SLT students ranged from medium to high. A change in students' self-reported motivation levels while studying anatomy was identified. The study emphasises the benefits of UDL and its flexible nature to enhance motivation.

Self-regulation mediates effects of adapted mindfulness-based stress reduction on anxiety among college students

Objective: Mindfulness-based stress reduction (MBSR) reduces anxiety among undergraduate students; however, there is limited evidence demonstrating mechanistic underpinnings. Theoretical models implicate cognitive self-regulation as a mechanism. This study explored whether an adapted MBSR embedded in a college course reduced anxiety and if self-regulation mediated any intervention effects. Participants: 144 undergraduate students participated in the study; 34 completed a MBSR course and 110 served as a matched control group. Methods: Mindfulness, self-regulation, and anxiety were measured at pre-MBSR, post-MBSR, and 1-month follow-up. Results: Repeated-measure ANOVAs indicated significant effects of MBSR for self-regulation and anxiety. Longitudinal mediation models indicated significant mediation effects of self-regulation on anxiety at post-intervention and 1-month follow-up. Conclusions: MBSR can be implemented within a college course to indirectly affect anxiety mechanistically via self-regulation. Given increasing rates of anxiety in college students and reduced capacity for counseling centers to meet need, MBSR holds promise for future clinical study.

Imaginary pills and open-label placebos can reduce test anxiety by means of placebo mechanisms

Placebos have been shown to be beneficial for various conditions even if administered with full transparency. Hence, so-called open-label placebos (OLPs) offer a new way to harness placebo effects ethically. To take this concept one step further, this study aimed at evaluating placebo effects without the use of a physical placebo, i.e., by imagining taking a pill. Healthy students (N = 173) with self-reported test anxiety were either randomized to an imaginary pill (IP; n = 55), an OLP (n = 59) or a control group (CG; n = 59). Both intervention groups were instructed to take two pills daily for three weeks. Primary outcome was test anxiety, secondary outcomes were sleep quality, general well-being and test performance. Groups test anxiety differed at study-endpoint, F(2,169) = 11.50, p < .001. Test anxiety was lower in the intervention groups compared to the CG, t(169) = - 4.44, p < .001, d = - 0.71. The interventions did not differ significantly, i.e., both were similarly efficacious, t(169) = 0.61, p = .540, d = 0.11. The interaction between group and time in explaining test anxiety was significant, F(5,407.93) = 6.13, p < .001. OLPs and IPs reduced test anxiety in healthy participants compared to the CG. This finding opens the door for a novel and ethical method to harness placebo effects.

Using latent profile analysis to uncover the combined role of anxiety sensitivity and test anxiety in students' state anxiety

Background

Studies report a growing tendency for students to experience state anxiety in schools. However, the combination of individual susceptibilities likely to trigger students' anxious states remains unclear.

Aims

This study examined whether distinct profiles of students emerge regarding their susceptibility to anxiety sensitivity and/or test anxiety and evaluated whether students' profile predicted anxious states. We also verified whether susceptibility profiles varied across gender, school level, and school type.

Sample and methods

In total, 1,404 Canadian students in Grades 5 and 10 (589 boys; M _age = 15.2, SD = 2.1) from 13 public and private schools completed self-reported measures of state/trait anxiety, anxiety sensitivity, and test anxiety.

Results

Latent profile analyses identified four susceptibility profiles: (1) Double-susceptibility: highest anxiety sensitivity and test anxiety scores; (2) Unique-susceptibility to test anxiety: high test anxiety score and low anxiety sensitivity score; (3) Unique-susceptibility to anxiety sensitivity: high anxiety sensitivity score and low test anxiety score; and (4) No-susceptibility: lowest anxiety sensitivity and test anxiety scores. The profiles comprised 12, 9, 6, and 73% of the sample, respectively, and their membership varied across gender and school type, but not across school levels. A linear mixed-effect model showed that state anxiety varied significantly between profiles, where the Double-susceptibility profile predicted the highest state anxiety scores, followed by the two Unique-susceptibility profiles (indifferently), and the No-susceptibility profile.

Conclusion

Beyond their theoretical contribution to the state-trait anxiety literature, these findings suggest that selective interventions designed more specifically for students with the Double-susceptibility profile may be worthwhile. Results also highlight the high proportion of students with the No-susceptibility profile and shed light on the reassuring portrait regarding students' anxiety.

The Effect of Mindfulness Programs on Collegiate Test Anxiety

Objectives

Affecting approximately one-fifth of college students, test anxiety is a source of academic failure that leads to worse exam performance and academic retention. The present study assessed the efficacy of online mindfulness-based interventions at reducing collegiate test anxiety.

Methods

Undergraduate college students (N = 71) were randomly assigned to a six-week mindfulness condition (n = 24), a three-week mindfulness condition (n = 21), or a six-week sham mindfulness active control condition (n = 26). Participants in each condition were assigned five weekly meditations and written reflections. Responses to online surveys captured participants’ reported levels of test anxiety and mindfulness pre- and post-intervention.

Results

Increases in mindfulness were associated with decreased reports of test anxiety, r(69) =  − .48. Across all conditions, self-reported mindfulness increased, and self-reported test anxiety decreased from pre- to post-test, F(1, 68) = 19.5 and 28.9, p’s < .001, η² = .06 and .05 respectively.

Conclusions

Changes in the primary variables did not differ by condition, offering no empirical support for greater efficacy of a six-week as compared to a three-week intervention. The sham mindfulness control group also reported increases in mindfulness and decreases in test anxiety, raising questions about what intervention benefits are specific to mindfulness trainings. These findings suggest that online interventions are effective at reducing test anxiety in college students, though more research will inform how intervention length and content lead to changes in test anxiety and mindfulness.

Supplementary Information

The online version contains supplementary material available at 10.1007/s12671-022-02002-6.

Mindfulness, anxiety, and perceived stress in university students: Comparing a mindfulness-based intervention (MBI) against active and traditional control conditions

ObjectivesUniversity students experience heightened levels of stress and are seeking mental health services with increasing frequency. Mindfulness-based interventions (MBIs) may be an effective resource for managing stress. The present study examined the effectiveness of an MBI in reducing stress, anxiety, and rumination compared to active and traditional control conditions.MethodsUndergraduate students at a southeastern university participated in either a 4-week MBI, active control, or traditional control condition. Measures were collected pre- and post-intervention. Results: Overall the MBI had a significant impact on perceived stress over and above both traditional and active control conditions. The MBI also had a significant impact on trait mindfulness and anxiety compared to the traditional control condition. No significant differences were observed for rumination. Conclusions: The MBI significantly impacted trait mindfulness, perceived stress, and state anxiety. MBIs may be a useful approach to successfully alleviating stress in a highly stressed population.

Examining the relationship between academic stress and motivation toward physical education within a semester: A two-wave study with Chinese secondary school students

The present study aimed to investigate the relationship between academic stress and motivation toward physical education (PE) through a longitudinal design with cross-lagged panel analyses. A sample of 556 Chinese secondary school students participated in the research and completed Perceived Locus of Causality Scale and Educational Stress Scale for Adolescents at the beginning of the semester and 3 months later. The results demonstrated that academic stress factors were positively related to less self-determined motivations except that worry about grades was positively related to more self-determined motivations within each time point. In addition, we found that academic stress negatively predicted more self-determined motivations but positively predicted less self-determined motivations, whereas worry about grades negatively predicted amotivation 3 months later. Meanwhile, the influence of amotivation on despondency was also found. These results suggest that academic stress can obstruct students’ participation in PE through an impact on self-determined motivation. Our findings also indicate that self-determined students in PE will seek academic achievement as well, which in turn improves students’ academic status.

Stabilität und Prädiktion von Prüfungsangst bei Studierenden

Zusammenfassung. Theoretischer Hintergrund: Obwohl Prüfungsangst ein häufiges Anliegen in psychologischen Beratungsstellen ist, wissen wir wenig über ihren zeitlichen Verlauf sowie über Risikofaktoren für hohe Prüfungsangst kurz vor den Prüfungen. Fragestellung: Diese Studie untersucht, ob sich die Intensität von Prüfungsangst während eines Semesters verändert und wie Personen mit hoher Belastung kurz vor der Prüfung früh identifiziert werden können. Methodik: Zu Beginn und kurz vor den Prüfungen des Wintersemesters 2014/15 wurden Prüfungsangst, Depressivität und Prokrastination bei 427 Studierenden (88.3 % Erstsemester; 68.4 % weiblich; Altersdurchschnitt 20.0 Jahre) erfasst. Ergebnisse: Die Analyse auf Einzelfallebene zeigte, dass sich die Prüfungsangst bei den meisten Studierenden nicht signifikant veränderte. Bei der Vorhersage der Prüfungsangst zum Semesterende stellten Prüfungsangst und Depressivität zu Semesterbeginn signifikante Prädiktoren dar. Diese wurden anhand von 80 % der Gesamtstichprobe ermittelt und an den anderen 20 % validiert. Schlussfolgerungen: Erhöhte Prüfungsangst und Depressivität zu Semesterbeginn können die frühe Identifikation von Studierenden mit bedeutsamer Prüfungsangst kurz vor Prüfungen ermöglichen.

Sustained threat and phasic fear in the laboratory and cognitive-emotional processes of anxiety in everyday life - An ambulatory assessment study

Fear is a phasic state of apprehension to an imminent threat, whereas anxiety is a more sustained state of expecting a potential threat leading to tension and worry. The NPU-threat test is a laboratory startle paradigm allowing a reliable and valid assessment of both, fear- and anxiety-potentiated reactions. It is suggested to differentiate between anxiety disorders, but little is known on associations with everyday life experiences of cognitive-emotional processes regarding anxiety in non-clinical samples. In the present project, the NPU-threat test was applied in three studies with (1) unselected healthy individuals, (2) participants with extreme manifestations of trait anxiety (low vs. high) and (3) individuals preparing for a high-stakes exam. Self-reported states of emotionality and worry were assessed during a four-day ambulatory assessment (AA). Overall, NPU-threat test measures did not significantly differ between studies, while the AA dependent measures were sufficiently sensitive to capture differences between groups. However, there was no significant association between psychophysiological measures of the NPU-threat test and AA state measures across participants. In participants recruited for low vs. high trait anxiety we found an association with AA worry and emotionality, but no interaction with potentiated startle. The present findings do not support the idea of a link between our laboratory biomarker and adaptive regulation of cognitive-emotional states in everyday life in healthy individuals. We speculate that an association between laboratory physiological measures and everyday experience of anxious states may be detectable in clinical samples.

Test anxiety, anxiety disorders, and school-related wellbeing: Manifestations of the same or different constructs?

Previous studies have shown that highly test anxious persons are more likely to meet criteria for an anxiety disorder and report more frequent symptoms of anxiety disorders than their low test anxious counterparts. However, it is unclear whether test anxiety should be treated as distinct to, or a manifestation of, anxiety disorders. Furthermore, the Dual Factor Model of Mental Health proposes that high subjective wellbeing cannot be solely inferred from the absence of psychopathology. To date, no studies have examined the Dual Factor Model in relation to test anxiety. In the present study, we examined how test anxiety, two common anxiety disorders (i.e., generalized anxiety disorder [GAD] and panic disorder [PD]), and subjective wellbeing in the school domain (i.e., school-related wellbeing) were related in a sample of 918 adolescents (M age = 15.77 years) using network analysis and latent profile analysis. Results from the network analysis indicated that test anxiety, GAD, PD, and school-related wellbeing were represented as distinct constructs. Bridge nodes were identified that linked test anxiety with GAD, PD, and school-related wellbeing. The latent profile analysis identified three of the four profiles predicted by the Dual Factor Model, including (a) troubled (i.e., low school-related wellbeing, high test anxiety, GAD, and PD), (b) complete mental health (i.e., high school-related wellbeing, low test anxiety, GAD, and PD), and (c) symptomatic but content (i.e., average school-related wellbeing, test anxiety, GAD, and PD). We concluded that test anxiety was distinct from, rather than a manifestation of, GAD and PD. We found support for the Dual Factor Model, albeit not unequivocal, using test anxiety as an additional indicator of psychopathology to that of GAD and PD.

Academic self-efficacy and test anxiety in high school students: A conditional process model of academic buoyancy and peer support

Based on social cognitive theory and ecological systems theory, this study constructed a conditional process model to explore the relationship between academic self-efficacy and test anxiety as well as underlying psychological mechanisms through academic buoyancy and peer support. A sample of Chinese high school students ( N = 560) completed questionnaires assessing academic self-efficacy, academic buoyancy, peer support, and test anxiety. Structural equation modeling (SEM) revealed an indirect effect of academic self-efficacy on test anxiety through academic buoyancy. Moreover, the results of the conditional process analysis demonstrated that this indirect effect was moderated by peer support. The findings suggested that both personal positive psychological characteristics (e.g., academic buoyancy) and school environmental factors (e.g., peer support) are protective factors for test anxiety in high school students. Limitations and implications for future research are discussed.

Manipulating Levels of Socially Evaluative Threat and the Impact on Anticipatory Stress Reactivity

Previous work suggests that relative increases in socially evaluative threat modulate the psychobiological stress response. However, few studies have compared stressors which manipulate the level of socially evaluative threat to which the participant is exposed. Here we present two studies. In the first, we assessed the integrity of an ecologically valid, laboratory stressor (direct socially evaluated multitasking) and its effects on acute psychobiological reactivity and ability to evoke an anticipatory response prior to participation. Specifically, we assessed whether the expectation and experience of direct social evaluation (multitasking while standing and facing an evaluator) evokes greater reactivity than indirect evaluation (over-the-shoulder evaluation). In the second study, we sought to replicate the findings regarding acute stress reactivity whilst extending the assessment window to assess the extent to which the stressor evokes anticipatory responses. As hypothesized, greater reactivity was observed following direct social evaluation compared with indirect observation. Increases in anxiety, heart rate and blood pressure were demonstrated across both studies and the paradigm therefore provides an ecologically valid technique for the activation of psychological and cardiovascular stress responding. Additionally, anticipation of experiencing socially evaluated multitasking led to increases in anxiety, tension, and worry prior to the event itself, supporting previous suggestions that threat anticipation may prolong the activation of stress mechanisms. In the present studies we assessed whether the expectation and experience of direct social evaluation evokes greater reactivity than indirect evaluation. The findings have demonstrated that direct social evaluation of multitasking is a more potent stressor than multitasking with indirect evaluation. Furthermore, our findings indicate that the period of anticipation of stressful events may be critical to understanding the process of stress regulation, and as such we recommend extending the sampling window to allow for the investigation of these processes.

Association of Test Anxiety with Temporomandibular Disorder in Health Professions Students: A Cross-Sectional Study

Objective

To assess the prevalence of temporomandibular disorder (TMD) and its association with text anxiety among undergraduate medical, dental, and pharmacy students in Dammam, Saudi Arabia. Material and Methods. This cross-sectional study included health professions students who responded to Fonseca's questionnaire and Test Anxiety Inventory by Spielberger to evaluate TMD and test anxiety, respectively. TMD score was compared in different categories of students, and bivariate and multiple logistic regression analyses evaluated the influence of test anxiety on TMD.

Results

The study included 884 participants (44.8% males and 55.2% females) with a mean age of 21.46 ± 1.36 years. Regarding items of Fonseca's questionnaire, most students reported being tense/nervous (65.7%) and had headaches (57.5%). About 45.8% of the participants reported no TMD, and remaining had mild (40.4%), moderate (11.3%), and severe (2.5%) TMD. The mean TMD score was significantly higher in students with high test anxiety (25.6 ± 18.32) than those with low test anxiety (20.25 ± 16.97) (P < 0.001). Mean test anxiety scores significantly differed among TMD categories (P < 0.001) with the lowest score in the no TMD group and the highest in the moderate TMD group. Female gender (adjusted odds ratio 1.4, P 0.039) and high test anxiety (adjusted odds ratio 1.92, P < 0.001) were significantly associated with increased odds of having TMD.

Conclusions

The study revealed a high prevalence of TMD among students. There was a significant association between test anxiety and TMD. The data obtained may guide preventive policies and program on test anxiety and TMD.

State anxiety and cardiovascular activity in an academic examination

Exam is an academic stressor that frequently triggers the affective reaction of anxiety, as well as psychophysiological changes in the autonomic nervous system. Anxiety is a negative affective variable associated with a low level of performance. This study examined the impact of an academic exam on state anxiety (SA) levels and the effects on cardiovascular activity during its performance, as well as its possible influence on the score. The study group was composed of 122 female university students. Cardiovascular responses (heart rate [HR], diastolic blood pressure, and systolic blood pressure) were recorded continuously in three phases (before, during, and after the exam) for each participant. The SA was obtained with the State-Trait Anxiety Inventory (STAI) before the exam. Then, those with extremely low and high SA scores were assigned to the low and high anxiety groups, respectively. The exam score reflected the performance level. The results partially confirmed our hypotheses. The high SA group showed significant fluctuations in cardiovascular activity; in particular, the HRs were higher than in the low SA group during the exam (not in diastolic and systolic pressures, respectively). On the other hand, the high SA group showed lower performance expectations scores than the low SA group, and the level of performance was similar in the two groups. Therefore, the exam confirmed changes in the HR with respect to the SA level, with no significant impact on performance.

Students' Trait Emotional Intelligence and Perceived Teacher Emotional Support in Preventing Burnout: The Moderating Role of Academic Anxiety

The current study sought to investigate the role of trait emotional intelligence and perceived teacher emotional support in school burnout. Furthermore, the moderating role of academic anxiety in these relationships was examined. A sample of 493 Italian high school students (81.9% female) aged 14–19 years (M = 16.27, SD = 1.48) was involved in the study. A latent moderated structural equation approach was performed to test the hypothesized model. The results showed that both trait emotional intelligence and perceived teacher emotional support were negatively associated with school burnout. Moreover, academic anxiety moderated the relation between perceived teacher emotional support and school burnout. Specifically, when the level of anxiety was high, the protective role of perceived teacher emotional support toward burnout was weakened. Findings are discussed in light of the protective role of resources on burnout and considering the detrimental impact of academic anxiety in school settings.

Examining a training effect on the state anxiety response to an acute bout of exercise in low and high anxious individuals

BACKGROUND

An acute bout of exercise temporarily reduces state anxiety. The current study examined whether these benefits are greater for those with higher levels of anxiety, and whether these benefits are augmented with exercise training.

METHODS

Young adults were randomized to either a nine-week moderate-intensity exercise group or an inactive control group. We assessed changes in state anxiety in response to an acute bout of exercise each week.

RESULTS

State anxiety reductions following acute exercise increased in the exercise subgroup with high anxiety at baseline as training progressed (p = .029). No training effects were observed for the exercise subgroup with low baseline anxiety (p = .27).

LIMITATIONS

A predominantly female sample, a single state anxiety measure post exercise and a non-exercise control group should be addressed in future research.

CONCLUSIONS

The results support the use of regular physical activity as a method for managing state anxiety in young adults. In particular, regular physical activity may be especially beneficial for those experiencing higher levels of anxiety.

Leisten fachspezifische Studierfähigkeitstests im deutschsprachigen Raum eine valide Studienerfolgsprognose?

Zusammenfassung. Fachspezifische Studierfähigkeitstests werden in mehreren zulassungsbeschränkten Studiengängen als Auswahlinstrument eingesetzt. Eine Metaanalyse von Hell, Trapmann und Schuler (2007) ermittelte eine hohe prognostische Validität solcher Tests. Seitdem hat es allerdings umfassende Veränderungen des Bildungssystems (z. B. Bologna-Prozess, Änderungen der Schulsysteme) sowie eine stete Weiterentwicklung der Testverfahren gegeben. Zur Klärung der Frage, ob fachspezifische Studierfähigkeitstests nach wie vor eine gute Erfolgsprognose liefern, schreibt die vorliegende Arbeit die Metaanalyse von Hell et al. (2007) fort. Die prognostische Validität im deutschsprachigen Raum ist stabil geblieben (ρ = .427, K = 54 Stichproben, N = 8410 Personen). Es fanden sich höhere Validitäten bei neueren Studien, Zeitschriftenartikeln mit Peer-Review, universitären Stichproben sowie bei kürzerem Abstand zwischen Test und Studiennotenerfassung. Zudem zeigten sich Fachunterschiede bezüglich der prognostischen Validität beispielsweise zugunsten von Sozialwissenschaften (ρ = .510). Die Studierfähigkeitstests besitzen außerdem eine inkrementelle Validität über die Abiturnote hinaus (Δ R² = .081, k = 31, n = 3999). Die Befunde sprechen dafür, dass die Testverfahren einen hilfreichen Beitrag zur erfolgreichen Studierendenauswahl liefern (als Alternative oder Ergänzung zur Abiturnote).

ERP Evidence for Inhibitory Control Deficits in Test-Anxious Individuals

Introduction: Individuals with test anxiety [i.e., high test anxiety (HTA)] always treat tests/examinations as a potential threat. This cognitive mode impairs these individuals' ability of inhibitory control and leads to a high level of anxiety. However, characterizing aspects of HTA's impaired inhibitory control ability are unclear and need to be studied. Methods: Forty-six participants were recruited and divided into a HTA (N = 26) and low test anxiety (LTA; i.e., healthy control; N = 20) group. Self-reports (Test Anxiety Scale, State-Trait Anxiety Inventory for negative emotions) were obtained. An emotional Stroop (ES) task and a numerical Stroop (NS) task, causing different types of interferences, were used for assessing the emotional and cognitive aspects of attentional control ability (behavioral data). Event-related brain potentials (ERPs) were registered to further assess processing stages related to different aspects of attentional control ability. Results: Compared with the LTA group, the HTA group has inhibitory control deficits of both emotional (see ERP components P1-P2-N2 and P3) and cognitive (see ERP component P3) interference. Compared with the LTA group, the HTA doesn't have lower accuracy in neither ES nor NS but displays longer reaction times only in ES. Additionally, the HTA group's ES results also show that (1) the degree of emotional interference indicates the level of an individual's anxiety, and (2) the ERP component P2 may serve as an index of the level of test anxiety. Conclusion: HTA individuals have extensive inhibitory deficits for both emotional and cognitive aspects; however, impairment impacts more on emotional aspects than on cognitive aspects. Additionally, as compared to NS, the negative impact of more impaired processing stages on task performance is more substantial in ES.