By Martha A. Simpson, D.O., M.B.A.
Associate Professor of Family Medicine
Ohio University College of Osteopathic Medicine

SELF-HELP MEASURES, MEDICATIONS CAN SUCCESSFULLY TREAT ANXIETY

Question: My daughter is a very smart girl, but she doesn’t make grades that are as good as they could be. She tells me that when she has a test, she gets so nervous she makes silly mistakes that frequently cost her a good grade. Is this a medical issue or a school issue? I’m not sure who to talk to about this -- the doctor or the teacher?

Answer: Most of us experience a surge of energy when faced with a challenging situation like having to take a test or perform on stage. This surge can help us stay focused and perform at a peak level. However, for some people the surge of energy can be overwhelming and lead to extreme nervousness, nausea, sweating, vomiting and even fainting. This appears to be the case with your daughter. It’s a condition called test anxiety, which is caused by release of excessive amounts of adrenalin.

Adrenalin -- a natural body hormone -- can be very helpful in certain situations. For instance, a lot of adrenalin is released when you are confronted by a bully on the street. The adrenalin causes the heart to beat faster and the breathing rate to increase. In response to adrenalin, your body also sends more nutrients to the muscles and less blood to the digestive system. This is called the "fight or flight" reaction. It gives you the energy you need to fight off a threat or run away from it. This is helpful when you are facing an actual physical threat.

However, when the perceived danger is an emotional one like a test, too much adrenalin can still cause the same physical reaction. Unfortunately, once this type of nervous reaction starts, it can be hard to stop. The more nervous you are, the more you sweat and shake; the more you sweat and shake, the more nervous you get. This can become a vicious cycle that spirals upward.

Being aware that you have this problem is the first step toward resolving it. Once your daughter recognizes that an upcoming test is making her nervous, she might attempt a few self-help measures. She should try to calm yourself with deep breathing or other relaxation exercises. Many people find this very beneficial. Another way to get around test anxiety is to try to consciously redirect the nervous energy toward the task at hand. By redirecting that nervousness, your daughter may find that she can focus more sharply on test questions.

Being prepared for a test is a major anxiety reducer for most people. If a person is well prepared for a test, it can boost confidence to the point that it will override the fear response, hence less test anxiety. Also, learning to purposely replace negative thoughts in anticipation of a test with positive ones will also help prevent test anxiety. Avoiding stimulants, like caffeine-based drinks and foods, and getting a good night’s sleep before the test will also enhance a person’s ability to stay in control.

There may be help at school through the guidance counselor or a learning specialist. Your daughter should work with them to develop good study habits. If that’s not enough, she may require medicine to reduce her anxiety symptoms. An antidepressant in the SSRI category or a beta blocker used in a low dose the day of the test may help decrease test anxiety and, thus, improve performance. Medications would need to be prescribed by your family physician after a medical history and exam.

Family Medicine® is a weekly column. To submit questions, write to Martha A. Simpson, D.O., M.B.A., Ohio University College of Osteopathic Medicine, P.O. Box 110, Athens, Ohio 45701, or via e-mail to readerquestions@familymedicinenews.org. Medical information in this column is provided as an educational service only. It does not replace the judgment of your personal physician, who should be relied on to diagnose and recommend treatment for any medical conditions. Past columns are available online at www.familymedicinenews.org.