Impact of Test Anxiety

Test Anxiety can have a negative impact on academic performance as well as mental and physical health among college students. According to Damer and Melendres (2011), the pressure to perform well is increasing for students because test performance has become a deciding factor in admittance to a specific class, major, program, or school. Studies show that a large portion of students develop some level of test anxiety (Dan et al., 2014). Those who are affected do not perform up to their potential, and test scores misrepresent their level of knowledge and understanding (Damer & Melendres, 2011).

In addition, test anxiety also affects mental and physical health, causing depression, hopelessness, and increased alcohol consumption. For these reasons, it is important to find suitable and effective treatment, as it is essential to overcome fears of anxiety (Reiss et al., 2017).

Test anxiety is defined as a perceived arousal, reported worry, self-degenerating thoughts, tension, and reports of somatic symptoms before and during exams or similar evaluative situations (Damer & Melendres, 2011). Group treatments constitute an effective method of treating test anxiety (e.g. university settings) (Reiss et al., 2017). The group, Managing Test Anxiety (MTA), is designed for college students who feel overwhelmed during test preparation and/or in test settings, but who still want to achieve. This group is for college students who want to learn the skills and strategies needed to manage their test anxiety utilizing cognitive-behavioral anxiety techniques in a supportive group environment. The purpose and outcome of this group is not to eliminate test anxiety, but to identify and develop new strategies that will not affect test performance yet also promote a change in cognitive behavior.

Goals & Objectives

If anxiety exceeds a certain threshold (as is the case with test anxiety) it results in decrease performance (Damer & Melendres, 2011). Students do not exactly know beforehand what the exam and its outcome are like (Lotz & Sparfeldt, 2017). This group will provide a safe and supportive environment for college students with test anxiety to address common issues and strategies that have been tried that results in an decrease or increase of anxiety. Identifying mechanisms for enhancing student coping with stressors inherent to college life, is an important goal (Nelson & Knight, 2010). The goals of the group are discussed below:

1. To develop an awareness of the possible causes of test anxiety

• Addressing the different ways that test anxiety can develop
• Participants will reveal the thoughts they have associated with test taking and test preparation and identify how that impacts their daily life
• Group leaders will use CBT to help participants identify how their thinking influences behavior

2. To identify strategies that can be used prior and during test taking that can decrease feelings of anxiety

• Participants will participate in exercises that include strategies for managing test anxiety
• Participants will gain knowledge and strategies from one another on decreasing feelings of anxiety

3. To develop relaxation techniques to cope with test anxiety

• Participants will target positive emotions and thoughts through group discussion and exercises
• Deep breathing and guided imagery techniques will be used to promote relaxation and participants will develop an array of skills as a result that can promote maintaining test anxiety

Organization

Recruiting: Since this group will take place in a college setting, there are a number of recruiting strategies that can be implemented to inform students of the Managing Test Anxiety (MTA) group. Advertisements on the counseling center website, flyers across campus, and emails to academic advisors and other campus departments (Damer & Melendres, 2011) can assist in getting the word out to college students who are not aware of the opportunity to be a part of the group. The group description will highlight students' interest by presenting questionnaires in a Yes/No question format. For example, there will be questions such as, "Do you experience fear, anxiety, or helplessness before or during a test? Do you "blank out" or have trouble concentrating during a test? and Do you experience nausea, sweating, racing heart, shortness of breath, or dizziness during a test?". These specific questions will help to identify the college students who actually go through these emotions and not students who are just doing poorly in school for reasons unrelated to test anxiety.

Next, information sessions will be held before the formation of the group. This will help the college students learn more about the group itself and determine if it is the best option for them. Participants will choose to participate in this study with the knowledge that it includes content related to test anxiety (O'Donnell, 2017). In these information sessions, students will complete an information form that describes the how test anxiety affects them and what would they would like to gain as a result of being a part of the group. Once the group information session is completed, each potential group member will then meet with one of the group leaders individually to further discuss information about what he/she wants to gain from being in the group, whether any other factors may hinder the group process (e.g. depression, schedule), and whether or not the student will be able to participate.

Group Size, length, & Format: The Managing Test Anxiety group will run for 4 weeks and will last 1.5 hours per session/One session a week. 6 to 10 group members will participate in the MTA group. Since this is a brief group settings and college students' schedules are so unpredictable, this group will hold sessions several times a semester to serve a greater number of students (Damer & Melendres, 2011). Each group session will be led by a lead and co-lead (e.g. licensed staff member or trainee). As stated by Damer & Melendres (2011), each group will be involved in psychoeducation and skill building regarding test anxiety. Also, throughout each session, group members will be encouraged to share their own experiences and provide feedback to fellow group members to facilitate support and cohesion. In relation to the research of Damer & Melendres (2011), the skills and topics that will be incorporated into this intervention will include: cognitive restructuring, study skills, study habits, self-care, mindfulness, relaxation and breathing techniques.

Theoretical Orientation

Cognitive Theory: Cognitive Behavioral Therapy. Group leaders will design the group focus on Cognitive-behavioral therapy by helping the students identify, challenge, and adjust current beliefs and behaviors relating to test anxiety. Cognitive Behavioral Therapy, which was developed by Beck, explores the links between thoughts, emotions and behavior in a time limited setting (Fenn & Byrne, 2013). According to Reiss et al. (2017), treatments combining skill focused approaches with behavioral and cognitive interventions seem to be the most effective in reducing test anxiety. By identifying the negative thoughts associated with test anxiety, "those in positive thought condition-were more likely to experience positive emotion and optimism, and less likely to experience negative emotions and test anxiety" (Nelson & Knight, 2010).

The cognitive aspects of test anxiety include worry, negative thoughts that intrude into one's mind before or during the test and cognitive deficits in memory, retrieval, or attention (Dan et al., 2014). As the behavioral aspects of test anxiety may appear in an unseemingly unrelated manifestation, such as low motivation for studying or procrastination (Dan et al., 2014). According to Fenn & Byrne (2013), Cognitive behavioral therapy will teach participants to be their own therapist by focusing on the "here and now" and helping participants understand their current way of thinking and equipping them with tools to change these patterns.

Ethical Statement

This group, Managing Test Anxiety, will be constructed with full compliance of research ethical norms. Different interventions may be required to address different perceptions so it is an ethical responsibility to understand the test anxiety experience from the test takers' perspective (Bonaccio & Reeve, 2010). The research involves human participants in a face-to-face interaction(s) in a group setting. The research in relation to this group ensures that this group therapy setting should make a positive contribution to those who participate in the group, and it does not cause harm to society or any of the participants. Benefits and risks of the group will be well assessed in advance of the creation of the group. In addition, during screening, participants will be well aware of the overview of the group and are given details regarding informed consent to allow them to make a decision to participate in this group setting.

Participants have a right to agree to participate or not participate in the group. Group participants are also informed that they can terminate the session(s)/therapy whenever they decide to and participants are informed that the information they provide is confidential. Participants will also be informed of the guidelines of confidentiality and when confidentiality must be broken. Group leaders will respect confidentiality of each participant. Although it is highly favored in a group setting, participants must understand that though group leaders can discuss the importance of confidentiality throughout the group process, confidentiality cannot be guaranteed in a group setting.

Multicultural Awareness

This group, Managing Test Anxiety, will be constructed with the inclusion of the ADRESSNG model. The focus of this group highlights Test Anxiety and how to manage it. This group is open for anyone interested and prospective participants are encouraged to first attend the information session and then must go through the screening. Group leaders will also take into account the different cultural identities, experiences, and history of each group member. Group leaders and members must be respectful of each other regardless of age, disability, religion, ethnicity, socioeconomic status, sexual orientation, indigenous heritage, national origin, and gender. The ADRESSING model will also help gain complete understanding of one's cultural identity and how that influences the group process.

Outline of Content & Exercises

Identify causes of Test Anxiety: Mini Group Breakout Exercise

Group members will break up into smaller groups of 2/3 participants (depending on the larger group size) and discuss questions that have been created by group leaders related to test anxiety. Once complete, group members will get back in the larger group and go around the group circle and identify their responses to the possible causes of Test Anxiety. Once completed, Group leaders will facilitate connections by "pointing out connection between members". This exercise will allow group members to become comfortable within the group setting by sharing with a smaller group before the larger group (Damer & Melendres, 2011). This will also help participants identify that they are not alone and acknowledge that they all share a common concern. This exercise also gives group leaders the opportunity to gauge the needs and expectations of the group members (Damer & Melendres, 2011).

Cognitive Restructuring List Exercise

This exercise will reduce negative and/or irrational thoughts associated with test taking and test preparation. Group leaders will present a list of common thinking errors along with test anxiety specific examples (Damer & Melendres, 2011). Participants will identify which errors resonate with them and why. Participants will works as a group to change the negative thinking errors to positive coping responses. To process, group leaders will ask participants to share their reactions to completing this exercise and how they are feeling about their test anxiety before the exercise and after. Next group leaders will explain the reasoning for the exercise. For homework participants will journal in a notebook to monitor test anxiety thoughts and thinking errors that occur throughout the week until the next session.

Here and Now: Relaxation Imagery Exercise

Group members are introduced to a guided imagery technique that will help them focus on the here and now. This will help participants learn to manage and cope with their anxiety before, during, or after an exam (Damer & Melendres, 2011). Group members are asked to close their eyes and imagine a safe environment that they can experience relaxation while incorporating deep breathing. Next, participants will imagine themselves in a testing environment while using the relaxation strategy of self-control desensitization (Damer & Melendres, 2011). Participants will imagine themselves effectively managing the distractions and successful tackling their test. Once completed, the group will process feelings toward the exercise, likes or dislikes, and how it can be applied to their life. Next group leaders will explain the reasoning for the exercise. Homework is given for participants to continue to practice these relaxation strategies and deep breathing , to determine which is the most efficient for them.

Establishing a "test day routine" & Mock Exam Exercise

It is widely believed that Test Anxiety increases as an exam draws near (Lotz & Sparfeldt, 2017). Group leaders will introduce the group with basic test strategies and how establishing a test routine can help Manage Test Anxiety. Group members will then engage in a discussion that is focused around a "test day routine" and participants are encouraged to engage in what they would consider an effective test day routine. This can include their sleep and eating habits, managing time on that day, transportation on exam day. This exercise will give participants the opportunity to learn from one another. In addition to the group discussion, group leaders will introduce a "Mock Exam Exercise" that is highly encouraged for participation. This will provide exposure to a test taking setting that results in test anxiety. Group leaders encourage participants to use all they have learned throughout the sessions (e.g. strategies, deep breathing, cognitive restructuring, guided imagery etc.). Group leaders will act as professors and hand out a test. During test taking, group leaders will engage in distracting behaviors. Once testing is over, group members will process their experience and share their thoughts and feelings as a result of being in a mock exam setting.

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