By Karen van den Berg, Senior Psychologist at SCD

It’s exam time, and with that comes a lot of stress and anxiety. Although stress can often be good for you and act as a motivator, anxiety is the dark side of stress and can have a negative impact on how we function.

According to the World Health Organization, stress can be defined as a state of worry or mental tension caused by a difficult situation. Stress is a natural human response that prompts us to address challenges and threats in our lives. Everyone experiences stress to some extent, however, how we respond to stress makes a big difference to our overall well-being.

Anxiety, according to the American Psychological Association, refers to the negative feelings of worry, persistent thoughts even after the trigger has gone, and physiological responses associated with anxiety, such as increase in heart rate and increased breathing rate.

It does more harm than good and can have a negative impact on various areas of our lives, including our health. Anxiety can also affect the quality of sleep and can have a negative impact on interpersonal relationships.

Exams can create a healthy amount of stress, which can help you get started with your studies. But if the stress and worry become persistent, it can undermine effective studying.

So how do we know if our stress and worry is normal, or if it is anxiety?

Ask yourself if there is a normal trigger that causes this worry and fear, e.g. an upcoming exam, if you feel worried almost all the time, and if the anxiety affect different areas of your life.

What are the red flags that students need to look out for when worry and stress become anxiety (not related to a specific anxiety disorder)?

• The anxiety becomes more general and vague, infiltrating various areas of your life.
• Feeling so worried or afraid that you have trouble sleeping or concentrating.
• Strong avoidance of the trigger of the anxiety.
• Not being able to stop thinking about the problem.
• Feeling anxious about your anxiety, in addition to the worry and fear.
• Physiological symptoms such as shortness of breath, increased heart rate, sweating, tingling hands and feet, difficulty sleeping, constant nervousness, etc.

It is important to remember that anxiety does not refer to a disorder, but it is an umbrella term for several different disorders, including Social Anxiety Disorder, Specific Phobia, Panic Disorder and Generalised Anxiety Disorder. These disorders require diagnosis by mental health professionals or medical doctors, and for each diagnosis, a health care practitioner will need to determine whether you meet the necessary criteria.

How to manage your stress and anxiety

Get to understand your anxiety by asking yourself where the anxiety comes from, (e.g. a possible bad experience, pressure to perform, etc.), what your worst-case scenario thought is, and if you doubt you own abilities.

It is also important to try to understand how you react to anxiety and stress – your cognitions, physiological responses and emotions. Do you experience racing thoughts?  Do you feel that your heart is racing or that you are short of breath?

Exercises to manage your anxiety

Once you are aware of your anxiety and how it affects you, you can use the following exercises to help you manage anxiety in general:

1. Breathe … the magic of four
   Do each of the following for four counts: breath in through your nose, hold your breath, slowly exhale, and finally, relax. Start the process again and continue for two to three minutes. Remember - follow a comfortable breathing pace, and breath in through your nose and out through your mouth. Practise this every night before you go to sleep, when you wake up in the morning, somewhere during the day, and especially when you feel anxiety creeping in.
2. Mindfulness - anchor yourself in the here and now
   Focus on five things in your immediate environment you can see, hear, smell, feel and taste. Observe the colours, textures and shapes, hear your own breathing, distant voices or traffic sounds. And feel things such as your shoes pressing against the soles of your feet, the wind on your skin, etc.
3. Fact-check your own thoughts 

Ask yourself where the thought is coming from and critically evaluate your own worry thoughts. Is this worry thought a realistic thought? How likely is it that my worst-case scenario will come true? If my absolute worst-case scenario were to happen, would I be able to cope? Is the outcome of my worry something I can control, or is it beyond my control? Is there any evidence in my history that the worst outcome is very likely to happen?

4. Write it out - put your thoughts out on paper.
    
5. Stay physically active to help down-regulate the stress response system.
    
6. Do the opposite of trigger avoidance behaviour - when we avoid the trigger of anxiety, it can perpetuate the symptoms. In a safe intensity and safe space, expose yourself to the trigger of your anxiety.

Tips to help you manage stress and anxiety just before the exam

• Get enough sleep and avoid studying through the night - your brain uses sleep to consolidate information.
• Make the most of your study time by avoiding procrastination and other time-wasting behaviours. Consider downloading an app that blocks your phone during study times.
• Eat healthy, balanced meals, drink enough water, and avoid energy drinks and substances.
• Practice a stress management or relaxation exercise an hour or two before the exam.
• Plan your time well and get to the exam venue early.

Tips to help manage your anxiety while in the exam venue

• Remember the breathing and five senses exercises to help down-regulate your stress response.
• Peruse the exam paper before you start writing - read the questions and instructions carefully to ensure you know what is expected of you.
• Skip the questions you are unsure about and complete the ones you are sure of first. Then return to the questions you have skipped.
• Stay focused on your progress and manage your time effectively as you write.

Exam times can be tough. Remember to take good care of yourself and take time to rest and relax, catch up with friends and family, exercise, and do things you enjoy. Seek professional help if you feel you need it.