How to Manage Excessive Exam Anxiety

Stressed out about board prep? Osmosis learner Jane Zhang shares some techniques that can help you overcome your test anxiety. 

Osmosis is not only a medical education platform, but also a strong advocate of student wellness. As an Osmosis Medical Education Fellow and someone who has experienced exam anxiety, I’d like to share some strategies that I have found helpful.

First of all, remember: it’s completely normal for medical students to have anxiety before exams, especially high-stakes board exams. While a moderate amount of anxiety can often sharpen focus and enhance concentration, too much anxiety can worsen exam performance. Specifically, intense worrying or nervousness can cause racing thoughts, poor concentration, insomnia, anorexia, tiredness, headache, sweating, and many other problems. 

If you have uncontrollable anxiety for exams, the following techniques can minimize stress and improve test performance.

Challenge Distorted Thoughts

Anxiety is often triggered by distorted thoughts such as the following:

1. Overgeneralizing: "I didn't know the first question on the exam, so I definitely won’t know the rest of them."

2. Catastrophic thinking: “I will forget everything I learned as soon as I start the exam."

3. Self-critical comparisons: “I barely make the minimum passing level. I am a failure. Everyone else is smarter than me."

After identifying dysfunctional thoughts, replace them with rational responses, such as, “It's okay if I had a rough start to the exam,” and “I am able to do this if I just calm down and focus.” 

Set some time out for yourself each day leading up to your exam to practice voicing aloud these affirmative thoughts. Before the exam and during the exam as needed, silently repeat these phrases to yourself. Soon, these rational thoughts will prevail over the negative ones, and you will develop a habit of thinking positively and logically.

Deep Breathing

Adding a physical element to the aforementioned cognitive method can help further reduce anxiety. Try it with these steps:

1. Concentrate on breathing deeply in and out through your mouth, letting air fill your lungs and then your abdomen. 

2. Hold your breath for a few seconds. 

3. Exhale slowly. 

Deep breathing activates the parasympathetic nervous system (the “rest and digest” division of our nervous system), provides more oxygen to the brain, and distracts you from your worries. Osmosis has a great blog about it, which you can read here. 

Progressive Muscle Relaxation

Another tactic I have found helpful is progressive muscle relaxation. Start by tensing a group of muscles (usually beginning with the forehead, then shoulders, arms, and legs) for about 15 seconds. Gradually release the tension in that muscle group for about 20 seconds. Deep breathing is often combined with muscle relaxation in which muscle contraction is done with inhalation, and muscle relaxation  performed with exhalation.

Imagery Techniques

To practice guided imagery, imagine yourself in a calm, peaceful setting such as a garden or a beach. Think about what you see, hear, smell, and feel in that setting. This can help you relax and relieve stress. Imagery rescripting techniques are ideal for those who have had bad exam experiences such as failure, a panic attack, or passing out. Try substituting these negative memories with mental images of relaxing and successfully answering questions.

Thanks for reading this post, and I hope these help you for your next exam!

About Jane

Jane Zhang is a third year medical student at the University of Illinois College of Medicine at Peoria, located in her hometown of Peoria, IL. In her free time, Jane enjoys catching up with friends and family, listening to and playing music, and watching animal videos on YouTube.