Coping with test anxiety using imagery rescripting: A two-session randomized controlled trial

BACKGROUND

Up to 55 % of students experience test anxiety (TA), which is characterized by intense physiological and psychological symptoms before or during exams, such as anxiety, fear of failure, sweating, or increased heart rate. Furthermore, TA increases graduation times and can result in discontinuance of the graduate program all together. Previous research demonstrated the beneficial effects of combining cognitive behavioral therapy with imagery rescripting, however, treatment programs are comparably long. Hence, they do not account for the students´ time-sensitive schedules. Therefore, the present study investigates a two-session short-intervention using imagery rescripting to treat TA.

METHODS

44 students and pupils were randomly assigned to either the two-session imagery rescripting intervention (22 participants) or the waitlist-control condition (22 participants). One week before the intervention clinical interviews were conducted and self-report questionnaires on TA, self-efficacy, symptoms of depression, and intrusive prospective images were completed (T1). The same questionnaires were completed one week (T2) and six months after the intervention (T3).

RESULTS

Test anxiety significantly decreased from T1 to T2, as well as from T1 to T3 within the intervention group. Furthermore, there were medium to large within and between group effects for situational test anxiety, self-efficacy, symptoms of depression, as well as prospective intrusive images, showing significant improvements for the intervention group at six months follow-up.

LIMITATIONS

The study is limited to the comparably small sample size, as well as the sole usage of self-report measurements.

CONCLUSIONS

The presented short-intervention provides a feasible treatment technique, which can be easily applied within school and university counseling centers.

The relationship between COVID-19 stress and test anxiety in art students: the chain mediating roles of intolerance of uncertainty and sleep quality

BACKGROUND

The global spread of COVID-19 has brought immense physiological and psychological distress to students, such as test anxiety and poor sleep quality. This study aims to explore the relationship between COVID-19 stress and test anxiety and the mediating roles of intolerance of uncertainty and sleep quality between them.

METHODS

A study was conducted in China during the late stage of the pandemic. A total of 936 Chinese art students (age M = 18.51, SD = 2.11, 46.6% female) completed the Coronavirus Stress Measure (CSM), the 12-item Intolerance of Uncertainty (IUS-12), the Brief Version of the Pittsburgh Sleep Quality Index (B-PSQI), and the Test Anxiety Inventory (TAI). A chain mediation model analysis was conducted to examine the mediating effects of intolerance of uncertainty and sleep quality on the association with COVID-19 stress and test anxiety.

RESULTS

COVID-19 stress was positively associated with test anxiety (β = 0.50, p < 0.001). The intolerance of uncertainty and sleep quality partially and serially mediated the relationship between COVID-19 stress and test anxiety (β = 0.01, 95% CI = 0.01 to 0.02).

CONCLUSION

These findings suggest that art students' intolerance of uncertainty and sleep quality partially and serially mediate the relation between COVID-19 stress and test anxiety. The results have significant implications for the intervention and prevention of test anxiety, providing additional evidence for the relationship between COVID-19 stress and test anxiety.

Examining attentional control deficits in adolescents with test anxiety: An evidential synthesis using self-report, behavioral, and resting-state EEG measures

Attentional control theory suggests that test anxiety hinders individuals' attentional control, aiding our understanding of how test anxiety may impair cognitive function. However, various methods used to assess attentional control have yielded inconsistent findings. Moreover, past studies, especially on adolescents, that examine the distinct impacts of worry and the emotional components of test anxiety on individuals' attentional control capacity are scarce. This study, using self-report, behavioral, and resting-state EEG measures, explores how worry and emotionality, impact attentional control in adolescents. It enhances our understanding of the link between test anxiety and cognitive function. Referring to the effect size from prior studies, a total of 42 adolescents took part in the study. We used the Test Anxiety Inventory, due to it can assess worry and emotionality components. We employed three widely-utilized measures of attentional control: the Attentional Control Scale (ACS), the Go/Nogo task, and resting-state electroencephalography measures (alpha oscillation and the theta/beta power ratio). Both worry and emotionality components were significantly and negatively correlated with the ACS scores. Unlike worry, emotionality demonstrated a significant positive correlation with response times for the Go trials and alpha power in the parietal cortex. These results suggest that, emotionality, but not worry, is highly correlated with attentional control deficits in adolescents. This study underscores the significance of distinguishing between the components of test anxiety, which aids in comprehending the negative impacts of test anxiety on adolescents' academic performance.

Test Anxiety Among US Medical Students: A Review of the Current Literature

Purpose

Medical students experience anxiety at higher rates than the general public and many are uniquely affected by additional test anxiety throughout their medical education. Although test anxiety has been studied for decades, little evidence has been published suggesting interventions improve examination performance in medical education. Therefore, we set out to review the current literature to elucidate efforts so far and establish trends in research.

Methods

Databases searched included PubMed, EMBASE, PsychINFO, ERIC, SCOPUS, and CINAHL. English language articles published between 2010 and 2021 were loaded into a reference manager to screen out duplicate articles. During the full-text screen and data extraction phase, reference lists were also inspected to identify additional articles for inclusion in the study.

Results

Of 883 studies identified, 860 were excluded resulting in 22 studies for extraction and analysis. First-year (n = 15) and second-year (n = 12) students were primarily tested. Less than 10 included third- or fourth-year students. Self-help and wellness interventions were employed, though interventions ranged from dog therapy to deep breathing techniques to fish oil supplementation. Test anxiety was evaluated using self-report questionnaires, such as the Westside Test Anxiety Scale, Beck Anxiety Inventory, and State-Trait Anxiety Inventory. None of the studies reported improved examination scores.

Conclusion

This review identifies a variety of measurement tools and interventions attempting to mitigate test anxiety. As far as improving examination performance, none of the interventions reported was successful. Further research addressing test anxiety that results in improved medical student academic performance should be conducted and also use established assessment tools.

Open-label placebos enhance test performance and reduce anxiety in learner drivers: a randomized controlled trial

Passing the driving school test can be very challenging, especially in big cities, where up to 52% of all students fail this test. Consequently, many learner drivers experience stress and anxiety. For some learner drivers these feelings can be extreme and negatively affect the performance in the driving test. Different strategies to face anxiety and stress are known, including, for example, psychological or pharmacological approaches and even placebo pills. Recent intriguing findings have also demonstrated that placebos without deception, so-called open-label placebos, successfully reduce anxiety. Here we aimed to test effects of this novel treatment for learner drivers. We investigated whether open-label placebos affect test performance and feelings of anxiety in learner drivers. Sixty-eight healthy participants (mean age 21.94 years, 26 females) were randomized into two groups. The open-label placebo group received placebo pills two weeks before the driving test (two pills each day). The control group received no treatment. Results revealed that the open-label placebo group experienced significantly less anxiety than the control group before the test (measured with the State-Trait-Anxiety-Inventory, STAI-S, and the German Test Anxiety Inventory, PAF). Moreover, in the open-label placebo group less learner drivers failed the driving test (29.41% vs. 52.95%). The results suggest that open-label placebos may provide an ethical unproblematic way to experience less anxiety and might also enhance the probability to pass the driving test. We discuss possible mechanisms of open-label placebos and limitations of our findings.

Integrative neuro-cardiovascular dynamics in response to test anxiety: A brain-heart axis study

Test anxiety (TA), a recognized form of social anxiety, is the most prominent cause of anxiety among students and, if left unmanaged, can escalate to psychiatric disorders. TA profoundly impacts both central and autonomic nervous systems, presenting as a dual manifestation of cognitive and autonomic components. While limited studies have explored the physiological underpinnings of TA, none have directly investigated the intricate interplay between the CNS and ANS in this context. In this study, we introduce a non-invasive, integrated neuro-cardiovascular approach to comprehensively characterize the physiological responses of 27 healthy subjects subjected to test anxiety induced via a simulated exam scenario. Our experimental findings highlight that an isolated analysis of electroencephalographic and heart rate variability data fails to capture the intricate information provided by a brain-heart axis assessment, which incorporates an analysis of the dynamic interaction between the brain and heart. With respect to resting state, the simulated examination induced a decrease in the neural control onto heartbeat dynamics at all frequencies, while the studying condition induced a decrease in the ascending heart-to-brain interplay at EEG oscillations up to 12Hz. This underscores the significance of adopting a multisystem perspective in understanding the complex and especially functional directional mechanisms underlying test anxiety.

The impact of mentorship program on the level of anxiety and pre-internship exam scores among Iranian senior nursing students

BACKGROUND

Mentorship involves a voluntary, collaborative, and non-hierarchical relationship where an experienced individual shares knowledge with a less-experienced individual. This study aimed to evaluate the effects of a mentorship program on anxiety levels and pre-internship exam scores among senior nursing students.

METHODS

This quasi-experimental research was conducted on 37 nursing students in the sixth semester of the School of Medical Sciences in Saveh in the year 2023. Participants were selected based on initial criteria using a census method and were then randomly assigned to two groups: the control group (19 participants) and the intervention group (17 participants). The mentoring program for the intervention group was implemented one month before the pre-internship exam and consisted of six sessions, each lasting two hours, over two weeks (three sessions per week). Data collection tools included a demographic questionnaire, the Sarason Anxiety Questionnaire, and pre-internship exam scores. SPSS software version 23 was utilized for data analysis.

RESULTS

The mean anxiety exam scores in the two control and intervention groups did not exhibit a statistically significant difference before the intervention (P = 0.34). However, the mean anxiety exam score of the intervention group students after the intervention (5.89 ± 15.11) was significantly lower than that of the control group students (7.04 ± 21.42) (P = 0.007). Additionally, the results showed that the mean anxiety exam scores of the intervention group students before (5.77 ± 17.53) and after the intervention (5.89 ± 15.11) had a statistically significant difference (P = 0.013). Furthermore, the mean pre-internship exam scores of the intervention group students (1.71 ± 17.72) were significantly higher than those of the control group students (1.15 ± 16.46) (P = 0.014).

CONCLUSION

The mentorship program resulted in a reduction of exam anxiety in nursing students and improved their performance in the pre-internship exam to the extent that the exam scores of the participating students were higher than those of other students.

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.

Emotion dynamics of clients with test anxiety before and after an imagery-based treatment

BACKGROUND AND OBJECTIVES

Imagery-based techniques have become a promising means in the treatment of test anxiety (TA). Although previous studies have demonstrated the effectiveness of imagery-based treatment, not all clients seem to benefit from it. The present study compares clients' pre- as well as post-treatment emotion dynamics between responders and non-responders. Furthermore, it examines treatment-related changes in emotion dynamics in both subgroups.

METHODS

The results are based on 44 clients suffering from TA who underwent a six-session imagery-based treatment and include Ecological Momentary Assessment (EMA). Emotions were assessed with the Profile of Mood States four times a day over the course of two weeks before and after the treatment. Temporal networks were computed to index emotion dynamics.

RESULTS

Pre-treatment emotion dynamics differed between responders and non-responders. Similarly, post-treatment emotion dynamics differed as well between both groups. Some changes were also observed between pre-treatment and post-treatment networks: for responders, fatigue no longer predicted anger, and depression predicted itself; for non-responders, calmness predicted fatigue, anger, depression, contentment, and anxiety. In addition, fatigue no longer predicted itself and anxiety predicted vigor.

LIMITATIONS

The investigation is marked by several limitations: a liberal inclusion threshold of at least a 50% response to EMA prompts, and a relatively homogenous sample.

CONCLUSION

These results provide first evidence for the idea that emotion dynamics may be associated with response to treatment for TA. Furthermore, effective imagery-based treatments may be tied to changes within these dynamics.

Prevalence of test anxiety and its determinants among nursing students in Selangor, Malaysia

The current education system significantly emphasizes tests and evaluations as crucial factors in determining a student's future career path. It has been shown that nursing students have moderate to high levels of Test Anxiety (TA), which results in decreased academic performance, low self-esteem, and an inability to complete the program and pursue a career in nursing successfully. This study aimed to determine nursing students' level of TA and its relationship with demographic characteristics. Four hundred twenty-one nursing students at seven private universities and colleges in Selangor participated in this cross-sectional study. The level of TA was measured using the TA Inventory (TAI). A total of 62.5% of the respondents had mild TA, 25.4% had moderate TA and 2.1% had severe TA. There were significant relationships between TA level and household income (χ2 = 6.70, p = 0.035) and ethnic groups (F (3,417) = 5.20, p = 0.002) where Chinese and Indians are protective from TA compared to the Malays and other ethnic groups and high anxiety was significant in the Ringgit Malaysia (RM 3000) and below group. The study's findings indicate that a significant percentage of nursing students involved in the research had mild to moderate levels of test anxiety (TA) and there is a significant association between TA and demographic characteristics. The results indicate the importance of early identification of TA and the need for interventions to overcome TA to ensure they are emotionally, physically, and academically successful.

The effect of working memory training on test anxiety symptoms and attentional control in adolescents

OBJECTIVE

The percentage of adolescents with test anxiety is increasing rapidly. Working memory (WM) training has been demonstrated to reduce anxiety levels and enhance attentional control in individuals. Therefore, we investigated whether adaptive dual n-back WM training could lower test anxiety level and improve attentional control in adolescents.

METHODS

Forty adolescents were allocated to either adaptive dual n-back WM training (n = 21) or non-adaptive dual 1-back WM training (n = 19) for 10 days. The Test Anxiety Scale was applied to measure individuals' test anxiety symptoms. The Attentional Control Scale (ACS), the flanker task, and the Go/Nogo task were used to measure attentional control.

RESULTS

Compared with the control group, the training group reported significantly relief of test anxiety symptoms; however, there were no significant differences between the two groups in pre-to-post changes in ACS scores or performance on the flanker task and Go/Nogo task.

CONCLUSION

In sum, adaptive dual n-back WM training effectively reduced adolescents' level of test anxiety but did not improve their attentional control.

Reducing Test Anxiety During the COVID-19 Pandemic: A Comparison of the Effectiveness of Cognitive Behavioral Therapy and Acceptance and Commitment Therapy

Educational assessments can affect students' mental health, particularly during a pandemic. Acceptance and Commitment Therapy (ACT) and Cognitive Behavioral Therapy (CBT) are widely efficacious for reducing test anxiety, as well as general anxiety and rumination. However, the effectiveness of these two therapies for students during COVID-19 is unclear. We measured the effectiveness of ACT and CBT for managing test anxiety, general anxiety, and rumination during COVID-19 for 77 students taking Türkiye's national university entrance exam, assigned to either the ACT or CBT psychoeducation programs. Both programs reduced test anxiety, general anxiety, and rumination, and showed similar levels of effectiveness. This suggests that ACT and CBT are both important for improving students' mental health during COVID-19 and either may be beneficial.

Validity and reliability of the short Test Anxiety Inventory (TAI-5) in Dutch adolescents

The present study examined the psychometric properties of the short Test Anxiety Inventory (TAI-5) in a Dutch adolescent sample. The sample consisted of 2063 secondary school students (mean age 13.6 years, 48% girls) who filled out a battery of screening questionnaires for a routine health check. We investigated structural validity with a confirmatory factor analysis, scale reliability with internal consistency coefficients, and construct validity with hypotheses testing and convergent validity. The proposed one-factor structure fitted well in the present sample. However, there was an indication of measurement variance for gender. Scale reliability was high (ω = 0.88), and sufficient positive correlations were found between TAI-5 scores and anxiety, depression, worry, executive functioning, and sleep problems (r ranging from 0.36 to 0.56). Girls had significantly higher test anxiety scores than boys (d = 0.47). The present study provided evidence for the validity and reliability of TAI-5 scores in a general population of Dutch adolescents.

Medication administration competency for clinical preparedness: Comparing testing modalities and test anxiety in undergraduate nursing students

BACKGROUND

Adverse drug events, which occur at various stages of the medication preparation and administration process, cause over half a million injuries or deaths yearly. Upon graduation, prelicensure nursing students lack the skill and competency required for safe medication administration. Therefore, it is essential to ascertain their medication administration proficiency throughout their curriculum prior to participation in clinical experiences. Historically, this has been a deeply embedded process of high-stakes testing. Aligned is cognitive test anxiety which can severely limit a student's performance. Thus, nursing student competency and control appraisal in medication administration can be linked to the Control Value Theory framework.

OBJECTIVES

The purpose of the research was to determine whether an e-simulated high-stakes medication administration test was associated with less anxiety than a standard high-stakes medication math assessment within and between two nursing tracks over three semesters to capture sequencing of medical-surgical clinical courses.

DESIGN

The prospective, quantitative, longitudinal study received Institutional Review Board approval.

PARTICIPANTS/SETTING

Students were recruited from a traditional BSN track and an online LPN-to-BSN track per course level over three semesters.

METHODS

Participants completed the State-Trait Anxiety Inventory prior to their course level high-stakes assessment modality.

RESULTS

For both tracks, testing anxiety remained a factor with no significant difference in the anxiety level between assessment modalities. There was a trend for anxiety scores to slightly decrease over time with each testing modality, but results were non-significant. There was a trend for traditional BSN students (n = 435) to have slightly lower anxiety scores than the LPN-to-BSN (n = 246) students.

CONCLUSIONS

Researchers must continue investigating teaching, learning, and testing modalities in medication calculation/administration that maintain rigor, enhance student self-efficacy, and provide accurate assessment. These can be aligned with research regarding study skills training and cognitive-behavioral interventions to help mitigate the challenge of cognitive test anxiety.

Perfectionism, test anxiety, and neuroticism determines high academic performance: a cross-sectional study

BACKGROUND

Academic performance is an important issue for Korean students. Various psychological factors contribute to academic performance. We aimed to evaluate the psychological factors that affect academic performance integratively.

METHODS

A total of 102 academic high achievers and 120 comparison participants were recruited. We evaluated psychological factors (test anxiety, perfectionism, personality traits, resilience, and self-efficacy) and measured academic performance using the College Scholastic Ability Test and the current college grade. We compared psychological factors and academic performance between the academic high achiever and comparison groups. Multiple linear regression was then conducted to identify the significant psychological factors for high academic performance. Further, we used cluster analysis to classify the comparison group by the significant psychological factors and compared them among clusters and academic high achievers to determine the psychological characteristics of academic high achievers.

RESULTS

The academic high achiever group showed lower test anxiety (p = .002), less neuroticism (p = .001), higher self-efficacy (p = .028), and less socially prescribed perfectionism (p < .001) than the comparison group. Multiple linear regression results (p = .020) clarified that neuroticism (p = .020), test anxiety level (p = .047), and perfectionism (p = .035) were important factors predicting better academic performance. Academic high achievers had moderate test anxiety and perfectionism levels, with the best performance on the College Scholastic Ability Test.

CONCLUSIONS

Neuroticism, test anxiety levels, and perfectionism are important psychological factors for high academic performance. Interventions targeting these factors may help to improve academic accomplishments.

Effects of auricular acupressure on test anxiety in medical students: a randomized parallel-group trial

BACKGROUND

Test anxiety is a prevalent issue among students, including those in the medical field. The present study aims to examine the impact of auricular acupressure on reducing test anxiety specifically among medical students.

METHODS

In this single-blind randomized parallel-group trial, a total of 114 medical students from Kermanshah, Iran, were allocated into two groups: intervention and control. Each group consisted of 57 students. The data collection instruments included a demographic information form and the Sarason Anxiety Inventory. In the intervention group, bilateral auricular acupressure was administered on the Shen Men point for a duration of 10 min. On the other hand, the control group received bilateral auricular acupressure on the Sham point, located in the earlobe, as a placebo, also for 10 min.

RESULTS

The mean test anxiety scores in the Shen Men acupressure group exhibited a significant reduction from 18.4 ± 5.3 before the intervention to 13.3 ± 4.8 after the intervention (P = 0.001). Conversely, in the Sham acupressure group, the mean test anxiety scores showed no significant change, with values of 16.36 ± 6.4 before the intervention and 16.4 ± 6.1 after the intervention (P = 0.963). Prior to the intervention, the majority of participants in both the intervention group (87.7%) and control group (86.0%) exhibited moderate to severe levels of test anxiety. Following acupressure, a significant improvement was observed in the intervention group, with 52.6% of participants experiencing a reduction to mild anxiety levels (P = 0.001); however, no notable change in anxiety levels was observed in the control group. Furthermore, a statistically significant difference in anxiety intensity after the intervention was found between the two groups (P = 0.001).

CONCLUSION

Shen Men auricular acupressure demonstrates efficacy in reducing test anxiety among medical students. However, to validate its effectiveness, further research using objective measures is warranted.

Test anxiety and reading comprehension: the key role of fluid reasoning

BACKGROUND

High test anxiety has been associated with poorer academic performance. Test anxiety may affect academic performance by disrupting cognitive processes required for complex academic tasks, such as reading comprehension.

OBJECTIVES AND METHOD

The objective of this cross-sectional study was to clarify the cognitive pathways through which test anxiety may affect reading comprehension performance using archival clinical data of adults (n = 94; Mage = 23.35, SD = 4.32) referred for a comprehensive psychological assessment for academic difficulties. Serial multiple indirect effects analysis was used to assess for the direct and indirect effects of test anxiety on reading comprehension through cognitive processing speed, working memory, fluid reasoning, and crystallized knowledge. A second serial multiple indirect effects analysis was conducted with trait anxiety as the antecedent.

RESULTS

Test anxiety had a significant indirect effect on reading comprehension through fluid reasoning (B = -.08, SE = .04; 95% CI [-.15 to -.01]), while trait anxiety exerted no significant effect.

CONCLUSION

Results suggest that test anxiety and fluid reasoning play unique roles in disrupting academic functioning among individuals referred for academic difficulties. It may be that test anxious adults struggle to reason effectively in testing situations, leading to downstream difficulty comprehending text.

Cognitive perspectives on maintaining physicians' medical expertise: V. Using a motivational framework to understand the benefits and costs of testing

We apply a motivational perspective to understand the implications of physicians' longitudinal assessment. We review the literature on situated expectancy-value theory, achievement goals, mindsets, anxiety, and stereotype threat in relation to testing and assessment. This review suggests several motivational benefits of testing as well as some potential challenges and costs posed by high-stakes, standardized tests. Many of the motivational benefits for testing can be understood from the equation of having the perceived benefits of the test outweigh the perceived costs of preparing for and taking the assessment. Attention to instructional framing, test purposes and values, and longitudinal assessment frameworks provide vehicles to further enhance motivational benefits and reduce potential costs of assessment.

Stress reappraisal improves the autonomic nervous system response of test anxious individuals: Evidence from heart rate variability

BACKGROUND

Stress belief plays an important role in stress response. This study investigated whether individuals with high test anxiety/low test anxiety (HTA/LTA) held different stress belief, and tested the effect of stress reappraisal on reducing test anxiety related autonomic nervous system (ANS) response.

METHODS

51 HTA students and 49 LTA students were recruited using the Test Anxiety Scale (TAS). They completed a 10-min intelligence test (including preparation, test, and recovery phases), then were randomly assigned to reappraisal group and control group to complete the test again. Heart rate variability (HRV) was recorded throughout the protocol. Beliefs about Stress Scale was obtained before and after the experiment. Stress belief were manipulated using a 2-min film clip that orienting participant to the enhancing nature of stress. Emotional changes were assessed.

RESULTS

HTA individuals held more negative stress beliefs and showed greater emotional arousal during the test than the LTA individuals. Their negative stress belief was associated with higher TAS score and worse HRV response. (2) When facing an exam, LTA individuals exhibited increased low-frequency HRV and stable high-frequency HRV, while HTA individuals showed stable low-frequency HRV and decreased high-frequency HRV. (3) HTA individuals who underwent reappraisal showed a reduction in test anxiety and in low-frequency/high-frequency HRV ratio.

CONCLUSIONS

The ANS activity of HTA individuals is imbalanced in the test situations. Stress belief is a meaningful variable in anxiety related ANS activity. Stress reappraisal can effectively reduce test anxiety and improve the balance of ANS activity of HTA individuals.

The framework of Systematic Assessment for Resilience (SAR): development and validation

BACKGROUND

Burnout and depression among health professions education (HPE) students continue to rise, leading to unwanted effects that ultimately jeopardise optimal medical care and patient health. Promoting the resilience of medical students is one solution to this issue. Several interventions have been implemented to foster resilience, but they focus on aspects other than the primary cause: the assessment system. The purpose of this study is to develop a framework to promote resilience in assessment planning and practice.

METHODS

We followed the guidelines suggested by Whetten for constructing a theoretical model for framework development. There were four phases in the model development. In the first phase, different literature review methods were used, and additional students' perspectives were collected through focus group discussions. Then, using the data, we constructed the theoretical model in the second phase. In the third phase, we validated the newly developed model and its related guidelines. Finally, we performed response process validation of the model with a group of medical teachers.

RESULTS

The developed systematic assessment resilience framework (SAR) promotes four constructs: self-control, management, engagement, and growth, through five phases of assessment: assessment experience, assessment direction, assessment preparation, examiner focus, and student reflection. Each phase contains a number of practical guidelines to promote resilience. We rigorously triangulated each approach with its theoretical foundations and evaluated it on the basis of its content and process. The model showed high levels of content and face validity.

CONCLUSIONS

The SAR model offers a novel guideline for fostering resilience through assessment planning and practice. It includes a number of attainable and practical guidelines for enhancing resilience. In addition, it opens a new horizon for HPE students' future use of this framework in the new normal condition (post COVID 19).

Perceived Nexus Between Non-Invigilated Summative Assessment and Mental Health Difficulties: A Cross Sectional Studies

The COVID-19 pandemic rapidly led to changes in the mode of teaching, learning and assessments in most tertiary institutions worldwide. Notably, non-invigilated summative assessments became predominant. These changes heightened anxiety and depression, especially among individuals with less resilient coping mechanism. We explored the perceptions and experiences of mental health difficulties of students in tertiary education regarding non-invigilated alternative assessments in comparison to invigilated assessments. A pragmatic, mixed method cross sectional design was conducted online via Qualtrics. Thematic analysis of text was carried out using NVivo 12. In the quantitative analysis, univariable and multivariable ordinal logistic models were used to examine the potential factors for preference among students in higher education. A total of 380 Nursing and Social Science students responded to the survey. Approximately 77% of students perceived non-invigilated assessments to be less stressful compared to invigilated exams. Age, course of study, stage of studies, and number of units enrolled per semester were identified as significant drivers for students' perceived preference for non-invigilated assessments. There was an inverse relationship between the perception of stress associated with invigilated exams and the age of students. For instance, students aged between 18-24 were 5 times more likely to prefer non-invigilated exams compared to those aged 55 or more. Comparatively, students in early stages of studies had higher preference for non-invigilated assessments. However, there was a preference reversal for students enrolled in 2 or less units per semester. Social sciences students were two times more likely to prefer non-invigilated examinations to invigilated examinations compared to nursing students. The findings reinforce the use of alternative assessments in higher education as a mitigating agency to lessen the mental health burden of tertiary students in post COVID-19 era.

Supplementary Information

The online version contains supplementary material available at 10.1007/s10805-023-09472-w.

Electrophysiological and behavioral evidence for the attention capture and suppression failure of irrelevant singleton in test anxiety

Attention bias (ABs) and inhibition deficits play crucial roles in the development, maintenance, and recurrence of test anxiety. However, whether test-anxious individuals will show ABs and inhibition deficits of general task-irrelevant stimuli in a complex visual display is unclear. Thus, we used the additional singleton task (AST) and recorded event-related potentials (ERPs) indices of attentional selection (the N2 posterior contralateral, N2pc), suppression (distractor positivity, PD), and maintenance of working memory (the sustained posterior contralateral negativity, SPCN) to explore this issue. Twenty-eight participants in the high test-anxious (HTA) group and twenty-eight participants in the low test-anxious (LTA) group attended the experiment and were required to search for a target and synchronously ignore a singleton distractor on some trials. Consequently, HTA and LTA individuals had poorer accuracies and longer response times in the distractor-present condition than in the distractor-absent condition. The HTA group got larger interferences from singleton distractors than the LTA group. Electrophysiological results revealed a distractor N2pc and SPCN in the HTA group. Moreover, target N2pc and SPCN in the HTA group were larger when the singleton distractor and target were on the same side than on the opposite side. These results indicated that HTA individuals were captured attention by singleton distractors and failed to expel them from working memory. Accordingly, the present findings extended previous work by providing direct evidence that test anxiety could increase the effects of stimulus-driven attention systems and impair the function of goal-directed attention systems.

Factors associated with test anxiety among adolescents in Shenzhen, China

BACKGROUND

Test anxiety is prevalent among adolescents and may have long-term negative consequences on their physical and mental health. The aim of this study was to assess the prevalence of test anxiety and its related attributing factors among adolescents in Shenzhen, China.

METHODS

A cross-sectional study was conducted from November 18, 2020 to January 12, 2021 in Shenzhen, China. Test anxiety symptoms were measured by using the Test Anxiety Scale. Descriptive statistics and multivariate logistic regression were used to assess test anxiety and risk factors.

RESULTS

In total, 7047 students aged 10 to 19 were included for this survey. The prevalence of test anxiety was found to be 46.7 %. In multivariate analysis, gender, age, frequency of feeling lonely, parents' marital status, family functioning, emotional abuse, physical abuse, sexual abuse, academic performance level, relationship with classmates, school bullying and Internet addiction were positive related to test anxiety.

LIMITATIONS

This cross-sectional design limits the establishment of causal relationships. Reporting bias and recalling bias may be possible.

CONCLUSIONS

Our study suggested that a significant number of adolescents in Shenzhen had test anxiety symptoms. Also, we found some risk factors, which might help to provide new guidance of psychological interventions to promote adolescents' mental health.

Effects of a blended design of closed-book and open-book examinations on dental students' anxiety and performance

BACKGROUND

While closed-book examinations (CBEs) have traditionally been implemented in dental education, open-book examinations (OBEs) are being introduced for the purpose of acquiring higher levels of knowledge and promoting long-term memory. This study examines whether it is effective to use a blended assessment of CBEs and OBEs for dental students to reduce test anxiety and enhance academic performance.

METHODS

Using a quasi-experimental research method, a blended assessment that combined CBEs in class and OBEs online was designed for a dental course. In 2020, when the pandemic was at its peak, student assessment was ineffective, and the 2020 cohort was omitted for our study; instead, two cohorts of predoctoral dental students (N = 178) enrolled in Restorative Dentistry in the spring semesters of 2019 and 2021 were included in the study. These students were informed about the experimental design, and they provided written consent for data collection, thereby voluntarily participating in the survey. Their self-perceived responses to open-ended survey questions on assessment methods were qualitatively analyzed.

RESULTS

There was no significant difference in test anxiety between the CBEs and OBEs at the p-values of 0.001 in all items. Traditional and blended assessment showed a similar trend of lower scores in midterm exams compared to higher scores in final exams, thus discriminating against students' performances. In particular, a low-achieving group was better predicted by a blended assessment. An analysis of the students' self-perceived responses produced highly topical themes, including exam burden, learning effects, and fairness issues.

CONCLUSIONS

This study confirmed the feasibility of blended assessment that can be implemented in online and in-person educational environments. Moreover, it can be used as the groundwork to develop new models of assessment in dental education.

EEG correlates of neutral working memory training induce attentional control improvements in test anxiety

Attentional control theory states that high test anxious (HTA) individuals suffer from impaired attentional control. However, through working memory training it may be possible to improve such individuals' attentional control ability. This study investigated whether 20 days of working memory training (with emotionally neutral stimuli) does result in improved HTA individuals' attentional control ability. Pre- and post-outcomes of attentional control were measured using Flanker and Go/Nogo experimental tasks in a test-related stress situation, and EEG data were also collected. Results only showed a significant decrease in Nogo alpha power in HTA individuals after neutral working memory training (i.e., post-outcome versus pre-outcome). However, we failed to provide evidence for beneficial transfer effects of neutral working memory training on enhanced task performance in both the Flanker and the Go/Nogo tasks. So, the present study demonstrates that neutral working memory training is clearly associated with important neurophysiological correlates while performing the Go/Nogo task, but the transfer effect is rather limited.

The effect of perfectionism on test anxiety and the mediating role of sense of coherence in adolescent students

BACKGROUND

Previous research has shown that perfectionism is closely associated with stress. However, limited research has examined the longitudinal relationship between perfectionism and test anxiety. In addition, no study has investigated the possible mediators for the effects of perfectionism on test anxiety in school contexts.

OBJECTIVE

Utilizing a three-wave longitudinal design, this study employed a sample of Chinese junior high school students as participants to examine the longitudinal relationship between perfectionism, sense of coherence, and test anxiety.

METHODS

427 Chinese junior high school students (212 girls, 215 boys) participated in all three measurement times. The Frost Multidimensional Perfectionism scale, sense of coherence scale (SOC), and Test Anxiety scale were administered to the participants. The students completed questionnaires about once every two months from the beginning of a school semester to the end of the semester.

RESULTS

Results from structural equation modeling indicated that negative perfectionism significantly contributed to test anxiety in the adolescent students. The lagged effect of perfectionism (T1) on SOC (T2) was significant, and the lagged effect of SOC (T2) on test anxiety (T3) was significant, indicating that SOC played a significant mediating role in the effect of perfectionism on test anxiety.

CONCLUSION

The longitudinal effects of negative perfectionism on test anxiety were mediated by sense of coherence. The findings of the study have general implications for mitigating test anxiety and improving school adjustment and academic achievement.

Medical science students' experiences of test anxiety: a phenomenological study

Introduction

The studies show test anxiety is a common disorder in students that causes academic failure. There are not enough studies and specific theoretical background about test anxiety and ways to deal with it, so the purpose of this study was to do a qualitative study to fully understand the ways to deal with test anxiety in medical Sciences students.

Materials and methods

This is a qualitative study. The participants are the students of the last 2 years of pharmacy, medicine and dentistry at Isfahan University of Medical Sciences. Ten students were selected by purposeful sampling, and interviews continued until the data saturation stage and the lack of access to new data. The data were analyzed by seven-level Colaizzi method.

Findings

After analyzing data, about 50 codes were extracted. These codes divided into 16 subclasses, and among them, ultimately five main themes are extracted: “Prayer and Dialogue with God”, “Interaction and communication with friends and relatives”, “studying strategies”, “Finding ways to relax and self-care” and “Negative strategies” were extracted.

Conclusions

The result of this study showed that students often use positive strategies to overcome the test anxiety and try to use positive strategies, but some students are advised of undesirable strategies such as misuse of authorized drugs and writing cheating that that lead to a lot of complex problems. The educational system should do its utmost effort to empower students to manage the anxiety by learning the best strategies.

The dysregulation of top-down control in individuals with high test anxiety: A resting state fMRI study

BACKGROUND

Individuals with high test anxiety (HTA) have deficits in attentional control and in stress responses when faced with tests. However, little is known about the underlying neural mechanism. Anterior cingulate cortex (ACC) is involved in both attention and emotion networks, therefore this study examined the neural functional dysregulation in test anxiety from the perspective of functional connectivity (FC) using bilateral ACC as the regions of interest.

METHODS

Fifty-one participants were divided into HTA (n = 23) and low test anxiety (LTA, n = 28) group according to their Test Anxiety Scale (TAS) scores. Brain imaging data in resting, preparing, and recovering phases of a modified social evaluative threat task were collected, and emotional changes were assessed.

RESULTS

Compared with the LTA group, the HTA group exhibited significantly lower FCs between the ACC and superior frontal gyrus (SFG) in all 3 phases, significantly lower FCs between the ACC and inferior parietal gyrus (IPG), and significantly higher FCs between the ACC superior temporal gyrus (STG) in the preparing phase. Moreover, in the HTA group, the resting state IPG-ACC FC was associated with their TAS score, the preparing state STG-ACC FC was associated with the increased anxiety.

CONCLUSIONS

Individuals with HTA have general prefrontal control deficits. When facing a test, they tend to recruit more resources to deal with high emotional interference. The dysregulated control of the ACC by the frontal-parietal network may underlie the pathophysiology of test anxiety.

Randomized trial estimating effects of hypnosis versus progressive muscle relaxation on medical students’ test anxiety and attentional bias

BACKGROUND

Test anxiety is prevalent among medical students and leads to impaired academic performance. Test-related attentional bias has been identified as an important maintaining factor in test-anxious individuals.

AIM

To evaluate whether hypnosis and progressive muscle relaxation (PMR) could modify medical college students’ test anxiety and attentional bias.

METHODS

A total of 598 medical students were screened. The participants were divided into higher and lower test anxiety groups according to their scores on the test anxiety scale (TAS). Ninety medical college students with high TAS score were randomly assigned to a hypnosis or PMR group. Another 45 students with low TAS score were included, forming a baseline control group. The intervention was conducted weekly for 6 wk, and each session lasted approximately 30 min. The total intervention time and the number of intervention sessions for the hypnosis and PMR groups were equal. Data were collected at the pretest, posttest, and 2-mo follow-up.

RESULTS

Hypnosis group participants had a significantly lower TAS score at posttest (t = -21.827, P < 0.001) and at follow-up (t = -14.824, P < 0.001), compared to that at pretest. PMR group participants also had a significantly lower TAS score at posttest (t = -10.777, P < 0.001) and at follow-up (t = -7.444, P < 0.001), compared to that at pretest. At the posttest level, the hypnosis group had a significantly lower TAS score than the PMR group (t = -3.664, P < 0.001). At the follow-up level, the hypnosis group also had a significantly lower TAS score than the PMR group (t = -2.943, P = 0.004). Clinically significant improvement was found in both the hypnosis and PMR groups (hypnosis = 64.0%; PMR = 62.22%). Hypnosis was more effective than PMR in reducing test anxiety among medical college students. Hypnosis could modify attentional bias toward threatening stimuli, but PMR could not.

CONCLUSION

These results suggest that attentional bias plays an important role in test anxiety treatment.

Testing times: the association of intolerance of uncertainty and metacognitive beliefs to test anxiety in college students

Background

Test anxiety has a detrimental effect on test performance but current interventions for test anxiety have limited efficacy. Therefore, examination of newer psychological models of test anxiety is now required. Two transdiagnostic psychological models of emotional disorders that can account for anxiety are the intolerance of uncertainty model (IUM) and the Self-Regulatory Executive Function (S-REF) model. Intolerance of uncertainty, the stable disposition to find uncertainty distressing, is central to the IUM, while beliefs about thinking, metacognition, are central to the S-REF model. We tested for the first time the role of both intolerance of uncertainty and metacognitive beliefs in test anxiety.

Methods

A cross-sectional design was used, with college students (n = 675) completing questionnaires assessing their test anxiety, intolerance of uncertainty, and metacognitive beliefs. Hierarchical linear regressions examined if intolerance of uncertainty and metacognitive beliefs were associated with test anxiety, after controlling for age and gender.

Results

Females reported significantly more test anxiety than males. Partial correlations, controlling for gender, found intolerance of uncertainty and metacognitive beliefs were significantly and positively correlated with test anxiety. Hierarchical linear regressions found metacognitive beliefs explained an additional 13% of variance in test anxiety, after controlling for intolerance of uncertainty. When the order of entry was reversed, intolerance of uncertainty was only able to explain an additional 2% of variance, after controlling for metacognitive beliefs. In the final regression model, gender, intolerance of uncertainty and the metacognitive belief domains of ‘negative beliefs about the uncontrollability and danger of worry’ and ‘cognitive confidence’ were all significantly associated test anxiety, with ‘negative beliefs about the uncontrollability and danger of worry’ having the largest association.

Conclusions

Both intolerance of uncertainty and metacognitive beliefs are linked to test anxiety, but results suggest metacognitive beliefs have more explanatory utility, providing greater support for the S-REF model. Modification of intolerance of uncertainty and metacognitive beliefs could alleviate test anxiety and help students fulfil their academic potential.

Test anxiety impairs inhibitory control processes in a performance evaluation threat situation: Evidence from ERP

Attentional Control Theory proposes that test anxiety impairs inhibitory control, and high test anxiety (HTA) individuals often allocate greater top-down attentional control resources to maintain comparable task performance compared to low test anxiety (LTA) individuals. This study examined how test anxiety impairs inhibitory control. Eighty participants were required to perform a hybrid Go/Nogo Flanker task in the performance evaluation threat or no performance evaluation threat conditions, while behavioral and EEG data were recorded. The ERP results showed that HTA participants revealed significantly larger Nogo but not incongruent related N2 amplitude than LTA participants in the threat condition. In the threat condition, HTA individuals were associated with increased recruitment of top-down attentional control resources to perform the response inhibition task but not the interference suppression task.

Revisiting the Role of Worries in Explaining the Link Between Test Anxiety and Test Performance

The inverse relationship between test anxiety and test performance is commonly explained by test-anxious students' tendency to worry about a test and the consequences of failing. However, other cognitive facets of test anxiety have been identified that could account for this link, including interference by test-irrelevant thoughts and lack of confidence. In this study, we compare different facets of test anxiety in predicting test performance. Seven hundred thirty university students filled out the German Test Anxiety Inventory after completing a battery of standardized tests assessing general intelligence and mathematical competencies. Multiple regressions revealed that interference and lack of confidence but not worry or arousal explained unique variance in students' test performance. No evidence was found for a curvilinear relationship between arousal and performance. The present results call for revisiting the role of worries in explaining the test anxiety-performance link and can help educators to identify students who are especially at risk of underperforming on tests.

The effectiveness of affective compared to neutral working memory training in university students with test anxiety

BACKGROUND

Test anxiety (TA), defined as the emotional, physiological, and behavioural responses surrounding situations involving formal evaluation of performance, is a relatively common occurrence, and, when present, can be a disruptive factor in students' academic careers. Research indicates that working memory, in particular, affective working memory, is impaired in individuals with TA. The current study therefore explored whether training the application of working memory in affective contexts could reduce TA and associated cognitive and affective impairments.

METHOD

60 Iranian university students (50% female; 19-22 years) with TA symptoms were randomized to receive 20 sessions of affective working memory training (aWMT), neutral working memory training (nWMT) or to a no-training control group. Prior and immediately after training, all participants completed measures of TA, working memory, cognitive control, and emotion regulation.

RESULTS

Compared to the control group, both the aWMT and the nWMT groups demonstrated improved cognitive and affective functioning from pre-to post-training. However, the reduction in TA symptoms and improvement in emotion regulation was greater in the aWMT group compared to the nWMT group.

CONCLUSION

aWMT may be an effective means of not only reducing TA, but also enhancing cognitive and affective functioning. These preliminary findings are promising given the potential for free and easy dissemination of aWMT in schools and online settings, including low- and middle-income countries.

Does repetitive negative thinking mediate the relationship between perfectionistic concerns and cognitive test anxiety?

BACKGROUND AND OBJECTIVES

Test anxiety, particularly cognitive test anxiety, is negatively associated with academic performance. Previous research has demonstrated that higher levels of perfectionistic concerns predict higher levels of cognitive test anxiety but has not explored potential mediators of this relationship. This study investigated whether repetitive negative thinking mediated the relationship between perfectionistic concerns and cognitive test anxiety in a non-clinical, academic sample.

METHODS

Participants were Australian university students (N = 129, 32 male, 94 female, 3 non-binary), aged between 18 and 53 (M = 23.96; SD = 6.88), recruited through convenience and snowball sampling. Participants completed an online questionnaire assessing demographics, repetitive negative thinking, perfectionistic concerns, and cognitive test anxiety.

RESULTS

Mediation analysis yielded a total model accounting for 43.5% of variance in cognitive TA. Perfectionistic concerns significantly accounted for 10.6% of variance direction (F(1, 127) = 12.21, p < .001, R2 = .106), and 32.5% indirectly through RNT (F(2,126) = 30.81, p < .001, R2 = .329).

CONCLUSIONS

Findings demonstrate that RNT significantly mediates the relationship between perfectionistic concerns and cognitive test anxiety in this sample. Importantly, these findings may direct future studies towards investigating the effectiveness of targeting repetitive negative thinking in interventions to mitigate levels of cognitive test anxiety.

Applicability and validation of the Reaction to Tests Scale (RTT) in a sample of Portuguese medical students

Background

Test anxiety is a crucial factor in determining academic outcomes, and it may lead to poor cognitive performance, academic underachievement, and psychological distress, interfering specifically with their ability to think and perform during tests. The main objective of this study was to explore the applicability and psychometric properties of a Portuguese version of the Reactions to Tests scale (RTT) in a sample of medical students.

Method

A sample of 672 medical students completed the RTT. The sample was randomly split in half to allow for independent Exploratory Factor Analysis (EFA) and to test the best fit model—Confirmatory Factor Analysis (CFA). CFA was used to test both the first-order factor structure (four subscales) and second-order factor structure, in which the four subscales relate to a general factor, Test Anxiety. The internal consistency of the RTT was assessed through Cronbach’s alpha, Composite reliability (CR) and Average Variance Extracted (AVE) for the total scale and each of the four subscales. Convergent validity was evaluated through the correlation between RTT and the State-Trait Anxiety Inventory (STAI-Y).To explore the comparability of measured attributes across subgroups of respondents, measurement invariance was also studied.

Results

Results from exploratory and confirmatory factor analyses showed acceptable fits for the Portuguese RTT version. Concerning internal consistency, results indicate that RTT was found to be reliable to measure test anxiety in this sample. Convergent validity of the RTT with both state and trait anxiety STAI-Y’s subscales was also shown. Moreover, multigroup analyses showed metric invariance across gender and curriculum phase.

Conclusion

Our results suggest that the RTT scale is a valid and reliable instrument for the measurement of test anxiety among Portuguese Medical Students.

Supplementary Information

The online version contains supplementary material available at 10.1186/s40359-021-00656-w.

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.

Tracking stress, depression, and anxiety across the final year of secondary school: A longitudinal study

Levels of distress, which include stress, depression, and anxiety, are often heightened during the final year of secondary school and have been linked to major examinations that occur during this time period. However, relatively little is known about how these symptoms change over the course of the year or what moderates symptom severity. Using a longitudinal survey design, we tracked student outcomes and potential moderators (i.e., gender, test anxiety, self-efficacy, connectedness with peers, school and family, perceived use of fear appeals by teachers) associated with stress, depression, and anxiety once per term (i.e., 4 times total) over the final year of high school in seven Australian high schools. We hypothesised that student symptoms would increase over time and that symptom severity would be moderated by individual and environmental factors. Six hundred and thirty-eight unique students (M age = 16.95 years, SD = 0.56, range = 15-18 years, female = 474 [74.29%]) participated in at least one of the four surveys administered during each term of the final year of high school. Linear mixed models indicated that stress (d = 0.2) and anxiety (d = 1.7) increased over time. When all potential moderators of distress were entered into the full model, gender, test anxiety, emotional self-efficacy, and peer connectedness were all significant unique predictors of stress. Similar patterns were found for symptoms of depression and anxiety. Time 3 stress was predicted by unique variance in baseline stress, higher test anxiety, and academic self-efficacy. Overall distress increased over time and was moderated by gender, as well as by test anxiety, self-efficacy, and peer connectedness, which are areas that can then be targeted by interventions designed to maintain distress at optimum levels for wellbeing and academic performance.

The relationship between test anxiety and emotion regulation: the mediating effect of psychological resilience

BACKGROUND

Test anxiety has been widely found in medical students. Emotion regulation and psychological resilience have been identified as key factors contributing to anxiety. However, studies on relationships were limited. This study investigated the links between psychological resilience, emotion regulation, and test anxiety in addition to exploring the differences about socio-demographic factors.

METHODS

A sample of 1266 medical students was selected through cross-sectional survey from a medical university in China during 2019. Data were obtained by network technique using designed questionnaire, which assesses the level of test anxiety, emotion regulation and psychological resilience, respectively.

RESULTS

Medical students experienced test anxiety at different levels, 33.7% of these were seriously. It revealed significant effects of the gender and academic performance on test anxiety. Results of logistic regression indicated that test anxiety was significantly associated with emotion regulation and psychological resilience (p < 0.01). Psychological resilience played a mediating role on the relationship between emotion regulation and test anxiety.

CONCLUSIONS

These findings highlight the importance of psychological resilience and emotion regulation in understanding how psychological resilience relates to test anxiety in medical students. Resilience-training intervention may be developed to support students encountering anxiety during the exam.

Test Anxiety among School-Going Children and Adolescents, Factors Affecting and Impact on Quality of Life: A Multicenter Study

OBJECTIVE

To assess test anxiety (TA) and factors affecting TA in school-going children. To observe the impact of TA on quality of life (QOL).

METHOD

A multi-centric cross-sectional observational study was conducted in Indian schools from 6 different states in both rural and urban settings. Indian school children 9 to 18-y-old were the subjects. Demographic data, including age, gender, and socioeconomic status, were obtained. Children were administered Test Anxiety Inventory (TAI) and PedsQL (Pediatric Quality of Life). TAI score (and factors affecting it in both rural and urban children) and QOL scores were assessed.

RESULTS

Data on 2158 children were analyzed (1162 boys). The mean age was 13.8 ± 1.8 y, and the mean TAI score was 48.3 ± 10.2. TAI score was significantly higher in girls and rural children (p < 0.05 for both). Based on the TAI score, high, medium, and low-anxiety clusters were generated. Proportion of children with high, medium and low-anxiety scores were 18%, 48%, and 34%, respectively. Children with low anxiety had better QOL in all subdomains (p < 0.05). Regression analysis indicated increasing age, low QOL, urban living, and lower maternal education as significant predictors of high anxiety (p < 0.05).

CONCLUSION

Girls and rural children had higher TA. Two-thirds of children studied had moderate to high TA. Increasing age, urban living, QOL, and maternal education had an impact on TA. Evaluating TA and developing appropriate strategies for stress-reduction in school children is necessary.

Test anxiety impairs filtering ability in visual working memory: Evidence from event-related potentials

Attentional control theory regards individuals with high anxiety as having deficits of inhibitory control when faced with distractors, especially under high-load conditions and with threatening distractors. Research on test anxiety has a long history, but the working memory (WM) characteristics of individuals with high test anxiety (HTA) remain unclear. We used two experiments to test the WM filtering ability of individuals with HTA, and the salient results were those of the contralateral delay activity amplitude rather than K score. The first experiment employed neutral distractors. HTA participants filtered distractors under low-load conditions but not under high-load conditions. Participants with low test anxiety (LTA) filtered distractors under high-load conditions but not under low-load conditions. The second experiment utilized threatening distractors. The participants with HTA exhibited deficits in their ability to filter neutral and threatening distractors, whereas the participants with LTA filtered both types of distractor.

Pre-Test Experience and Memory Performance in Older Adults: The Impact of Test Anxiety and Self-Efficacy

OBJECTIVE

The objective of this paper is to investigate the role of test anxiety and memory self-efficacy on memory performances in older adults.

METHOD

One hundred cognitively normal, community-dwelling older adults aged 65+ participated used in this experimental study. Participants completed baseline evaluations (including pre-test anxiety) prior to being assigned to one of two experimental conditions in which they experienced either success or failure on a verbal test. They subsequently completed post-test anxiety ratings, a measure of memory self-efficacy (Memory Self-Efficacy Questionnaire), and standardized tasks of working memory and verbal episodic memory.

RESULTS

Following experimental manipulation, participants in the pre-test failure condition demonstrated higher anxiety and lower memory performances. Hierarchical regression revealed that change in anxiety from pre-test to post-test predicted memory performances and mediation analyses demonstrated that these effects were explained by lower memory self-efficacy.

CONCLUSIONS

For older adults, experiencing test failure prior to memory testing may result in increased test anxiety and lower memory self-efficacy leading to poorer memory performance. This has implications for diagnostic cognitive assessment for older people.

Examining the Moderator Role of Sleep Quality in the Relationship Among Test Anxiety, Academic Success and Mood

This study explored associations among test anxiety, GPA, sleep quality, and mood in college students. Data were collected from undergraduate students (N = 316). Results revealed that higher levels of test anxiety and sleep impairment predicted negative mood in undergraduates. Findings suggest that prioritizing sleep could help improve overall mood among students with test anxiety. Future studies should work toward clarifying the complex and reciprocal relationship between sleep and test anxiety.

Does expressive writing or an instructional intervention reduce the impacts of test anxiety in a college classroom?

Test anxiety is a major concern in education because it causes uncomfortable feelings in test-anxious students and may reduce the validity of exam scores as a measure of learning. As such, brief and cost-effective interventions are necessary to minimize the negative impact of test anxiety on students’ academic performance. In the present experiment, we examine two such interventions: expressive writing (Experiment 1) and an instructional intervention (Experiment 2), with the latter developed from a similar intervention for stereotype threat. Across four authentic exams in a psychology class, students alternated between completing the intervention and a control task immediately before completing the exams. Neither intervention was effective at reducing test anxiety or improving exam performance. The present results suggest that these interventions may not be successful in addressing the impacts of test anxiety in all classroom settings.

Relationships between test anxiety and metacognition in Chinese young adults with and without specific learning disabilities

The influence of test anxiety on academic difficulties has been investigated in typically developing students, but the mechanism underlying the influence remains unclear, especially for those with specific learning disabilities (SpLDs). This study examined the role of metacognition in the relationship between test anxiety and literacy difficulties among Chinese typically developing adolescents as well as those who have been identified as having an SpLD and significant literacy difficulties (i.e., typically functioning SpLD) and without significant literacy difficulties (i.e., high-functioning SpLD) in Taiwan. A total of 238 first-year undergraduate students were recruited from eleven universities in South Taiwan. Among 238 students, 105 were identified to have SpLDs, and 133 were typically developing students. These students were asked to complete questionnaires on demographics, test anxiety, metacognition, and literacy difficulties (i.e., reading and writing). Structural equation modeling analyses showed that test anxiety among Chinese adolescents was linked to literacy difficulties but that only high-functioning and typically functioning students with SpLDs experienced a direct effect (without mediation by other factors). For those without SpLDs, the influence of test anxiety on literacy difficulties was not direct but significantly mediated by metacognition. Various components of these students' metacognition had mediating effects on different literacy difficulties. Test anxiety might influence the reading and writing difficulties of typically developing adolescents and those with typically functioning and high-functioning SpLDs through different mechanisms. Moreover, teachers at the university level are encouraged to consider students' test anxiety and metacognition when preparing their teaching materials.

Enhanced or impoverished recruitment of top-down attentional control of inhibition in test anxiety

Controversy exists as to whether high test anxiety (HTA) individuals, when completing an inhibition task, increase or decrease top-down attentional control resources to maintain high task performance. In a flanker task experiment, individuals were confronted with a threat or no threat context in combination with a low or a high working memory load. The N2 measured top-down attentional control resource allocation. The results showed that, in comparison to low test anxiety (LTA) individuals, HTA individuals had larger N2 amplitudes in a no threat condition, especially for incongruent trials. Also, in a threat condition when under high working memory load, HTA individuals had smaller incongruent N2 amplitudes. These findings support the conclusion that HTA individuals tend to enhance recruitment of top-down attentional control of inhibition. Additionally, they may also fail to compensate for impaired inhibition as indicated by impoverished top-down attentional control resources when demands on attentional control are high.

Prevalence and characteristics of test anxiety in first year anatomy students

BACKGROUND

Test anxiety is a common phenomenon at universities with the potential to impair academic performance and student well-being. This study was conducted to investigate prevalence, characteristics, and development of the test anxiety categories "emotionality", "worry", "interference", and "lack of confidence" among first year medical students.

METHODS

Overall, 625 freshman medical students were enrolled. They were recruited from the participants of a first semester anatomy course. The participants were assessed four times with a validated psychological test anxiety questionnaire (Prüfungsangstfragebogen, PAF). The first assessment was conducted at the commencement of the first semester. All further assessments were performed two days prior to each of three mandatory oral anatomy tests in the course of one half year. Prevalence rates as well as mean global and subscale scores of the test anxiety dimensions "emotionality", "worry", "interference" and "lack of confidence" were determined and compared between assessments.

RESULTS

Approximately 50% of the study participants showed pronounced test anxiety in at least one dimension over the observation period. Only about 10% were considered test anxiety-positive according to the global PAF scale. Worry showed the highest (up to 48%) and interference the lowest (≈5%) prevalence rates. Emotionality had a stable prevalence of approximately 17%, whereas lack of confidence showed a rising trend over the observation period from 15.2% up to 24.0%.

CONCLUSION

Test anxiety is substantially more prevalent among medical students as commonly reported and deserves more detailed, dimension-specific exploration in future. Especially worry and lack of confidence give reason for concern, demanding further investigation.

Reducing Test Anxiety and Related Symptoms Using a Biofeedback Respiratory Practice Device: A Randomized Control Trial

Test Anxiety is a widespread psychological phenomenon. With prevalence rates of 20-40 percent of university students, it impedes adaptive functioning and life quality. Many available treatments for Test Anxiety involve the intervention of clinicians and usually a few months are required before symptom reduction is reported. The present randomized controlled trial examined a simple behavioral intervention-the use of breathing tools-as an exclusive therapy for Test Anxiety. Specifically, the efficacy of a biofeedback respiratory practice device was examined. 34 students were assigned to 3 treatment groups during their exam period: Biofeedback device group, self-directed breathing exercise group, and psychoeducation group. Self-report measures of Test Anxiety were collected pre- and post-intervention. Participants also reported additional exploratory measures such as depression and anxiety, quality of life, and their perceived adaptive functioning post-intervention. The results reveal that only participants from the biofeedback device group reported a significant reduction in Test Anxiety symptoms (p's < 0.05). Participants from the biofeedback device group also reported a decrease in depression and anxiety symptoms and an increase in psychological wellbeing (p's < 0.05), a subscale of the quality of life questionnaire. Findings support the notion that using biofeedback respiratory devices may reduce students' Test Anxiety symptoms. Indications for further research are discussed.

Systematic review of student anxiety and performance during objective structured clinical examinations

INTRODUCTION

Test anxiety is well studied in higher education, but studies primarily concern traditional assessments, such as written examinations. As use of objective structured clinical examination (OSCE) in pharmacy education increases, a closer examination of non-cognitive factors such as test anxiety is warranted. The purpose of this review was to determine the association between OSCE-associated test anxiety with OSCE performance in health professional students.

METHODS

A literature search was conducted to identify peer-reviewed literature concerning test anxiety in health professional students associated with OSCE. Investigators searched for a combination of OSCE-related terms with anxiety-related terms using PubMed. Articles were included if they assessed OSCE-related anxiety by quantitative or qualitative methods. Data extracted from eligible articles included demographic data, type of the anxiety survey, associations between OSCE-related anxiety and performance, and other student-factors associated with OSCE-related anxiety.

RESULTS

The literature search yielded 339 articles. Nine articles met eligibility criteria and were included in the review. Results included students from medical, pharmacy, dental, and nursing professional programs. Anxiety was assessed via multiple scales. Six out of the eight studies assessing the relationship OSCE-related anxiety and OSCE performance found no association between the two measures. Contrary to literature concerning test anxiety in higher education, female gender was not associated with OSCE-related anxiety.

CONCLUSION

OSCE-related anxiety appears to have minimal to no influence on student performance. Future studies should utilize standardized anxiety assessments and should seek to understand anxiety's effects on student wellbeing and burnout.

Academic Stress in the Final Years of School: A Systematic Literature Review

Heightened academic stress in the final years of schooling is a common concern, yet little is known about how stress changes over time and what individual, school and family factors are associated with distress. We conducted a systematic review to examine the nature of distress in students in their final two years of secondary school. Sixty studies were eligible for inclusion. The main findings indicated severity of distress differed across the 17 countries sampled and measures used. There was some consistencies suggesting about 1 in 6 students experienced excessive distress. Female gender and anxiety proneness were consistently associated with increased distress, and freedom from negative cognitions with reduced distress. There was some evidence that individual characteristics (perfectionism, avoidance, coping, self-efficacy, resilience), lifestyle (sleep, homework), school, family and peer connectedness were associated with distress. Overall at-risk students can be predicted by theoretical models of anxiety and distress targeted with psychological interventions.

Test anxiety components: an intra-individual approach testing their control antecedents and effects on performance

BACKGROUND AND OBJECTIVES

Although anxiety consists of multiple components, including cognitive, affective, motivational, and physiological, and some findings suggest that there might be differences regarding their control antecedents and effects on performance, previous studies have largely neglected to examine these components separately and for reasons of convenience often assessed test anxiety as a unified construct using a single-item. Therefore, this study investigated the different test anxiety components with the goal to: (1) examine the relative impact of the anxiety components in the mediating mechanism that connects control and performance - as proposed by Pekrun's control-value theory, and (2) determine which specific anxiety component is underlying common single-item anxiety measures.

METHODS

The research questions were investigated using an intra-individual approach in a sample of N = 137 German 8th graders during a mathematics exam.

RESULTS

As expected, control was negatively related to all anxiety components, but associations varied in strength. Additionally, the components differed in their relative impact on performance, with the cognitive component being central for this outcome. Furthermore, common single-item measures seem to specifically assess the affective component, and thus not the component most relevant for test performance.

CONCLUSION

Consequently, our study strongly recommends to distinguish between the anxiety components depending on the research question at hand.