December 6, 2021

Test Anxiety and Academic Performance

by Arlesha N. Armstrong, Pharm.D., PGY-1 Pharmacy Practice Resident, Magnolia Regional Health Center

American educator Booker T. Washington once said that “Success is to be measured not so much by the position that one has reached in life as by the obstacles which he has overcome”. One obstacle that many students at all levels of formal schooling find difficult to overcome is test anxiety. It is often silent and yet incredibly loud. The first and most important step is recognizing test anxiety and the effects it can have on a student and their future. Test anxiety encompasses more than just being “worried about the test” or “hoping to get a good grade”. For some students, the level of anxiety negatively impacts performance and can become unbearable. Test anxiety encompasses two broad domains: emotionality (physiological components such as perspiration and headaches) and worry (psychological components such as heightened sense of threat, increased distraction, and motivational disturbances)1. Test anxiety is something that should be taken seriously and acted on. 

So how can educators notice the signs? The emotional symptoms in students might not be readily apparent, but the physical symptoms might be seen with close observation. Watching students and how they behave during “normal” classroom days compared to exam days may reveal subtle indications of their level of anxiety. Is the student quieter or more talkative than normal? Are they excessively sweating or noticeably breathing? Is the student shaking their leg, twitching, scratching and tapping, or pulling on clothes or hair? Although these can be normal behaviors, noticing differences in students’ behaviors surrounding exams can lead to conversations with them.

Text anxiety is surprisingly common.  Between 15 and 40% of students report experiencing some level of anxiety during examinations and other forms of assessment.3  Some students may have been told that they are overly dramatic or that they worry too much.  That they should learn to relax a little. After a while, the student may begin to think that this is just the way that they are and will have to just “live with it.” Although anxiety disorders are highly treatable, according to the Anxiety and Depression Association, only about one-third of people suffering from anxiety receive treatment. It is not a part of life. it is not a rite of passage.  It can be treated but far too often it’s not.

Physical Symptoms:

Emotional Symptoms:

·       Excessive sweating

·       Nausea, vomiting, or diarrhea

·       Stomach pain or “butterflies”

·       Rapid heartbeat

·       Shortness of breath

·       Headaches, Lightheaded or Faint

·       Restless or fidgety

·       Self-doubt

·       Fear

·       Stress

·       Hopelessness

·       Inadequacy

·       Anger

·       Nervousness

Test anxiety can have unfortunate detrimental effects on a student that leads to negative impacts on their performance. Anxiety can cause the student to procrastinate, reduce their ability to focus long enough to study, and lead to feelings of paralysis because they feel so overwhelmed. In some cases, the student might even become physically sick and cannot make it through the exam. These symptoms don’t just impact young children but can impact older students as well. Indeed, as a student advances in their education, the stressors can really add up.  Or it can be due to unresolved testing anxiety carried from childhood.

According to a study evaluating health professional students, there was a significantly positive correlation between test anxiety and procrastination on school-related work.2 Not surprisingly, students with test anxiety tend to have lower scores on standardized tests and lower GPAs.3 Unfortunately, many decisions such as college admission, scholarships, and career opportunities are influenced by test scores.3 Thus, those with test anxiety are the ones who suffer the most because there is no way to adjust for test anxiety. Until we move past standardized testing, we need to help students address and overcome test anxiety so they can achieve their full potential.  It’s true that academic performance is influenced by many factors, but teachers should always strive to identify and address the obstacles that hinder their performance. Address text anxiety may not only lead to improvement in the students’ test performance but it may also to improvements in the student’s sense of wellbeing and life satisfaction.

So how can you help students who are struggling with test anxiety? Here are some things that students and educators can do:

Advice for Students:

Advice for Educators:

·  Preparation

·  Develop a routine

·  Adequate sleep and rest

·  Decrease caffeine

·  Eat balanced meals

·  Exercise

·  Talk to the instructor

·  Learn relaxation techniques

·  Get a tutor

·  Seek counseling and support

·  Ask for accommodations

·  Teach and provide opportunities to engage in breathing exercises

·  Provide practice exams

·  Offer comprehensive review

·  Set clear expectations

·  Stagger test schedules

·  Refrain from time limits (when possible)

·  Try different exam formats and styles

·  Provide accommodations if necessary

·  Offer encouragement

The first step in helping students with test anxiety is recognizing its validity and legitimacy. Helping them realize their triggers and what induces anxiety can help a student learn how to address anxious thoughts. One way this can be done is by having the counselors come to do a general presentation about anxiety (including test anxiety) — that way every student gets the information but no student is singled out. This opens the door for a student to come forward in private. Every teacher should destigmatize anxiety and encourage students to seek counseling, engage in some form of cognitive therapy, and (when needed) take medication. This is not to say that even when a student receives therapy that anxiety will never be there. But therapy can help students take positive action, rather than letting anxiety have a hold and control over them.

Helen Keller once said “Be of good cheer. Do not think of today’s failures, but of the success that may come tomorrow. You have set yourself a difficult task, but you will succeed if you persevere, and you will find a joy in overcoming obstacles.” Addressing and overcoming anxiety is difficult to do. No one wakes up each day and chooses to have anxiety. However, addressing test anxiety can arm a student with new coping skills that can help in many other life situations.  It can really improve a student’s academic performance and quality of life.



  1. Pate AN, Neely S, Malcolm DR, et al. Multisite study assessing the effect of cognitive test anxiety on academic and standardized test performance. Am J Pharm Educ. 2021; 85(1): Article 8041.
  2. Sarvenaz R, Seyyed MA, and Alireza K. Investigating the relationship of test anxiety and time management with academic procrastination in students of health professions. Education Research International 2021; Article 1378774
  3. Myers S, Davis S, and Chan JCK. Does expressive writing or an instructional intervention reduce the impacts of test anxiety in a college classroom? Research 2021; 6:44.
  4. Harris H and Coy D. Helping students cope with test anxiety. ERIC Digest 2003.

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