Test-anxiety (TA) is conceptualised as a situation-specific type of anxiety involving excessive fear and worry about an assessment such as an examination (L. A. Brown et al., 2011; Putwain, 2009; Putwain, Langdale, Woods, & Nicholson, 2011). It has been reported that TA impairs academic performance in as many as 1 in 3 university students (Naveh-Benjamin, Lavi, McKeachie, & Lin, 1997) and impacts on career aspirations, self-esteem, motivation, relationships and well-being of students (Paul, 2013; Putwain, 2008).
However, Alpert and Haber (1960) have suggested that some students perceive that TA facilitates, rather than debilitates, their academic performance. Furthermore, there is evidence to suggest this perception is accurate. Munz, Costello, and Korabik (1975) gave 75 university students the Achievement Anxiety Test (AAT) developed by (Alpert & Haber), one week prior to an in-class examination. The AAT assessed whether the students believed the anxiety they typically experience during tests generally facilitates or debilitates their academic performance. Those students who reported that it generally facilitates their performance (facilitators) scored significantly higher on the examination, on average, than those who reported that it generally debilitates their performance (debilitators).
Selye (1956) coined the term “stressor” to refer to any agent that has the potential to evoke the stress response but, according to Lazarus and Folkman (1984), two people encountering the same stressor (such as an examination) can have significantly different reactions because of the subjectivity involved in evaluating (appraising) it. When confronted with an examination, students typically appraise it as a threat to well-being or a challenge to well-being. Although both appraisals result in the mobilisation of resources to cope with the stressor, the challenge-appraisal focuses on gain or growth and is associated with positive emotions such as eagerness, whereas the threat-appraisal focuses on potential harms and is associated with negative emotions such as anxiety.
Spielberger and Vagg (1995) adapted Lazarus and Folkman’s (1984) theory to explain individual differences in TA, proposing the reason some students typically experience high levels of state anxiety during assessments is because they have a tendency to appraise this particular type of stressor as being highly threatening. Because this tendency is considered to be a stable personality characteristic, TA is conceptualised as a situation-specific trait that, in the context of an assessment situation, is associated with high levels of state anxiety; that is, feelings of “tension, apprehension, nervousness, and worry, and associated physiological arousal resulting from the activation of the autonomic nervous system” (Spielberger & Vagg, 1995, p. 6). For the purpose of clarity, state anxiety in response to a test will be referred to hereafter as state test anxiety (STA); the personality trait that predicts this reaction to tests will be referred to as trait test anxiety (TTA).
Lazarus and Folkman (1984) elaborated on the appraisal of examinations by emphasising the role of self-coping in determining whether the stressor primarily represents a threat or a challenge. When confronted with an examination, the student must appraise whether his or her coping resources are likely to meet the demands of the stressor. If the student feels he or she will be able to cope, the examination will typically be perceived as more of a challenge than a threat; if the student perceives his or her coping resources are likely to prove inadequate, the stressor will be regarded predominantly as a threat. This appraisal also has a role in determining the coping strategy that will be employed.
According to Lazarus and Folkman (1984), the typically lower STA associated with the adequate-coping appraisal gives rise to problem-focussed strategies such as studying effectively (before the examination) and concentrating on answering the questions (during the examination). However, if the student perceives his or her coping resources are likely to prove inadequate, the stressor will be regarded predominantly as an uncontrollable threat and emotion-focussed coping strategies will subsequently be employed in an attempt to directly compensate for the associated increase in emotional distress and the perceived lack of pragmatic coping skills. Emotion-focussed strategies include externalising responsibility, avoidance, selective attention, using humour and taking tranquilisers; such strategies are considered to be detrimental to academic performance because they divert attention from adaptive, problem-focused strategies and, paradoxically, increase negative affect (Blankstein & Flett, 1992; Lazarus & Folkman, 1984).
The relationship between the appraisal of being able to cope and the coping style subsequently employed has been supported by empirical research. Peacock, Wong, and Reker (1993) studied 185 university undergraduates confronted with the stressor of searching for employment (and the emotions this stressor evoked); self-reported challenge-appraisals significantly predicted problem-focussed coping strategies (such as focussing on searching for jobs and submitting applications), whereas self-reported threat-appraisals significantly predicted emotion-focussed coping strategies (such as focussing on trying to reduce worrying about the prospect of unemployment). Furthermore, Struthers, Perry, and Menec (2000) measured the relationship between students’ coping styles and academic achievement at the conclusion of the first year of university. A structural equation analysis showed that students who self-reported (at the start of the academic year) that they typically engage in problem-focussed coping were more likely to achieve higher grades (at the end of the academic year) than those who reported they use emotion-focused coping.
According to Lazarus and Folkman (1984), even if an examination is predominately appraised as a challenge and personal coping-resources are appraised as being capable of handling the demands of the stressor, a certain degree of threat will still be included in the appraisal; leading to a small proportion of negative affect. Coupled with the effect the appraisal is suggested to have on coping strategies (discussed above), this potentially sheds light on the observation made by Alpert and Haber (1960) that some university students report that the STA they typically experience during examinations is debilitating to their academic performance whereas others report it to be facilitating; STA will be present whether the examination is appraised as a threat or a challenge but predominantly emotion-focused or problem-focused coping strategies will result respectively (which will have differential effects on performance) and may affect students’ perceptions of their typical reaction to tests.
Liebert and Morris (1967) grouped the components of STA (that students with TTA typically experience) into two categories; worry and emotionality. Worry is defined as the “cognitive expression of concern about one’s own performance” (p. 975). Although Liebert and Morris originally used emotionality as a collective term for the physiological reactions that occur in test-anxious students during examinations, the concept has since been refined. As Schwarzer (1980) explains, “emotionality is not the arousal itself but the subjective perception of such internal events” (p. 2).
The legitimacy of the distinction between arousal and emotionality was demonstrated by Holroyd, Westbrook, Wolf, and Badhorn (1978). 72 university students; 36 with high TTA and 36 with low TTA, performed a modified Stroop color-word task and an anagrams task. In order to artificially simulate the stress of an examination in the laboratory, the students were given instructions designed to induce evaluation threat whilst performing the tasks. Heart rate and electro-dermal activity are commonly used measures of autonomic responses to stress and are generally considered to be valid indicators of anxiety (Holroyd et al., 1978; Morris & Liebert, 1970). It is worth noting for later that heart rate variability (the beat to beat changes in heart rate) has recently emerged as an objective measure of emotional responding.
Both groups in Holroyd et al.’s study showed sharp increases in these autonomic measures in response to the cognitive task, demonstrating the effectiveness of the artificial stressor and the validity of the measures. The students with high TTA reported higher levels of anxious arousal (emotionality) and worry than the students with low TTA. However, no significant, between-group differences in heart rate or electo-dermal activity were found. This suggests that students with high TTA over-estimate the intensity of the anxious arousal they experience during test-situations, relative to those with low TTA. The students in Holroyd et al.’s study who had high TTA also performed worse on the two cognitive tasks than those with low TTA. This suggests that the mechanism by which TTA impairs academic/cognitive performance during tests is not due to objective rises in physiological reactions, and therefore supports the theory that the mechanism is cognitive in nature.
The mechanism by which students experience facilitating or debilitating STA (comprising emotionality and worry) can be summarised as follows:
When confronted with an examination, students appraise its threat level and evaluate their ability to cope; students with high TTA (debilitators) typically perceive they are unable to cope and appraise the examination predominantly as a threat and employ emotion-focused strategies, motivated by large associated increases in STA, whereas students with low TTA (facilitators) typically perceive they are able to cope and appraise the examination predominately as a challenge and employ problem-focused strategies, motivated by the mild associated increase in STA and positive affect (Alpert & Haber, 1960; Lazarus & Folkman, 1984; Spielberger & Vagg, 1995).
Emotionality has been suggested to cause worry (Hembree, 1988) and worry has been suggested to cause emotionality (Spielberger & Vagg, 1995). The proposed cyclical relationship between emotionality and worry is likely to sustain the facilitating or debilitating reaction to tests. However, reappraisal of the student’s ability to cope with the threat of the examination can theoretically change debilitating STA to facilitating STA and vice-versa (Lazarus & Folkman, 1984; Zeidner, 1998) although the former is unlikely to occur without intervention as the tendency to over-evaluate the threat associated with examinations is considered to be the defining characteristic of students with high TTA (Spielberger & Vagg, 1995) .
The summary described above is depicted in figure 1.
The theoretical relationship between emotionality and worry depicted in figure 1 is supported by empirical research. For example, Finger and Galassi (1977) examined targeted TA interventions in university students and found that interventions targeting emotionality reduced both emotionality and worry. They also found that interventions targeting worry reduced both worry and emotionality.
Hembree (1988) conducted a meta-analysis of 562 TA studies comprising samples of university, high school and elementary students; outcome measures of academic performance were aptitude and achievement post-tests and course grade. Hembree found the emotionality component of typical STA was significantly, inversely related to performance. Because emotion-focused strategies give rise to increased emotionality (Blankstein & Flett, 1992), Hembree’s finding supports the theory that emotion-focused coping is detrimental to performance. However, the worry component of TA was found to have an even larger, inverse relationship to performance than the emotionality component. According to Hembree, the worry component is caused and sustained by the emotionality component; evidenced by the ineffectiveness of interventions cited in his meta-analysis that targeted the worry component exclusively, the effectiveness of those interventions that targeted the emotionality component exclusively, and the finding that interventions that targeted the emotionality component generalised to reduce the worry component as well. Because worry cannot be considered to be a method aimed at emotion-regulation, it is not strictly a type of emotion-focused strategy (Lazarus & Folkman, 1984). However, the mechanism by which it is suggested to impair academic performance is very similar to that of emotion-focused coping; specifically its ability to reduce problem-focussed strategies.
According to Eysenck and Derakshan (2009), worry is a type of task-irrelevant processing that impairs the processing efficiency of the working memory (specifically the central executive) by depleting the resources available for task-relevant processes (such as problem-solving during an examination). Furthermore, worrisome thoughts reduce the inhibition and shifting functions of the central executive which are required to inhibit attention from being diverted from task-relevant material and prevent attention being shifted in a positive way to cope with the dynamic demands of a complex task such as an examination. This leads to a bias towards focussing on, and processing, task-irrelevant material; specifically that which contains a threat (such as worrying about the consequences of failure). Therefore, during an examination, worrisome thoughts are given attention and this depletes working memory and performance. There is a substantial amount of empirical research to support this theory (see Eysenck & Derakshan, 2009; Eysenck, Derakshan, Santos, & Calvo, 2007 for a review).
As well as distracting attention from task relevant material during examinations, the retrieval of information stored in memory has also been suggested to be negatively affected by worry. For example, Naveh-Benjamin, McKeachie, Lin, and Holinger (1981) examined the relationship between TTA and performance in a high-stakes examination (delivered as part of a university academic course). Students with high TTA performed significantly more poorly than those with low TTA on short-answer questions and essay questions but not on multiple-choice questions. According to the authors, this is because the latter type of questions involved the recognition of the correct answer from a selection of possibilities and thus required less active retrieval; supporting the theory that worry impairs memory retrieval.
However, the theoretical understanding of the mechanism by which TTA impairs academic performance (described above) is contradicted by research that has demonstrated that university students with high TTA can display more problem-focussed strategies than those with low TTA (e.g., Kondo, 1997). This apparent contradiction might be explained by Hembree’s (1988) finding that interventions based on increasing academic skills (such as study skills) only increased the academic performance of students with high TTA and low study skills when the interventions were combined with those designed to reduce emotionality. This suggests that students with high TTA might attempt to use problem-focussed strategies before and during examinations, but that the effectiveness of these strategies is reduced by high emotionality.
Based on the theory and research reviewed above, high TTA is characterised by the fear of failure tendency to underestimate one’s ability to cope with an examination; sustained by high levels of emotionality and ineffective emotion-focused coping strategies that are associated with such an appraisal. This suggests the most effective interventions would be those that confer the ability to self-regulate emotionality as this would reduce the need to focus on emotion-focused strategies; freeing up more resources to cope with problem-focused strategies. This could potentially result in the appraisal/reappraisal of being able to cope with the stress of examinations and lead to reduced STA reactions which would facilitate, rather than debilitate performance.
BIOFEEDBACK AND HEART RATE VARIABILITY
Biofeedback gives people real-time information about autonomic bodily processes such as heart rate, electro dermal activity (EDA), muscle tension and temperature and, with practise, facilitates cognitive recognition and regulation of autonomic or emotional arousal (von der Embse, Barterian, & Segool; Yahav & Cohen, 2008).
Empirical evidence has demonstrated the effectiveness of biofeedback in reducing TA in university studentswhen delivered either in tandem with relaxation training (Reed & Saslow, 1980; Spies, 1979), or on its own(Hurwitz, Kahane, & Mathieson, 1986; Romano & Cabianca, 1978; Thompson, Griebstein, & Kuhlenschmidt, 1980; Vitasari, Wahab, Othman, & Awang, 2009).
Although traditional biofeedback equipment can be effective, Ratanasiripong, Sverduk, Hayashino, and Prince (2010) report that it requires a trained practitioner to operate and that itcan cost between $1500 and $6000; vastly limiting its viability for university students. However, the authors also describe the recent expansion of commercial heart rate variability (HRV) biofeedback devices that are affordable, portable and simple and quick to use.
Studies have suggested HRV biofeedback may be beneficial in the symptomatic treatment of asthma (Lehrer et al., 2004), chronic obstructive pulmonary disorder (Giardino, Chan, & Borson, 2004), fibromyalgia (Hassett et al., 2007), hypertension (Herbs, 1994), PTSD (Tan, Dao, Farmer, Sutherland, & Gevirtz, 2011), depression (Karavidas et al., 2007), dysfunctional eating behaviour (Meule, Freund, Skirde, Vögele, & Kübler, 2012), anxiety (Henriques, Keffer, Abrahamson, & Horst, 2011) and TA (Bradley et al., 2010).
Reports indicate that commercial HRV biofeedback devices are already being applied informally in university settings to help students reduce anxiety before exams(Ratanasiripong et al., 2010; Vitasari et al., 2009). Although anecdotal reports indicate that students are finding them effective (Ratanasiripong et al., 2010), it is important that empirical research further investigates such claims.
Bradley et al. (2010) conducted a controlled pre- and post- intervention experiment on a large sample (N = 136) of North American school children using the Stroop colour word conflict test to “simulate the stress of taking a high-stakes test” (p. 261) in the laboratory. Students randomly assigned to the experimental group used the HeartMath Freeze-Framer Interactive Learning System that comprises a HRV device and an accompanying emotional-regulation technique. Bradley et al. (2010) reported there were significant pre-post differences in TA (emotionality and worry components) with a lower mean for the experimental group than the control group.
Although promising, the findings of this study are limited in their relevance to University students because the research was conducted on a different population (the results might not generalise). Furthermore, the intervention was delivered over a 5 month period as part of a wider emotional training program (TestEdge). Therefore, there are likely to be confounding variables.
A specific HRV biofeedback device used by Verdure Psychology to help clients with test anxiety (in tandem with therapy) is the emWave by HeartMath (as this has superseded the system used in Bradley et al.’s 2010 study and is a viable option for university students to use according to Ratanasiripong et al., 2010).
The emWave provides a person with a visual representation of their beat-to-beat changes in heart rate (HRV) which proponents of psychophysiological models consider to be representative of the continuous interaction of the sympathetic and parasympathetic branches of the autonomic nervous system (ANS), with diminished HRV representing a less flexible ANS associated with reduced emotional and cognitive regulation (Bradley et al., 2010; Henriques et al., 2011; Lagos et al., 2008; Thayer & Lane, 2009).Theoretically, increasing HRV therefore has the potential to affect the emotional and cognitive symptoms of TA.
It is important to note that, although emWave users learn to exercise a degree of conscious control over their HRV (McGrady & Moss, 2013), the primary variable on which they receive biofeedback is their degree of coherence (Henriques et al., 2011). Coherence is defined as a state of optimum HRV; a relatively harmonic, sine-like wave signal which can be calculated approximately from the HRV power spectrum using the equation: low frequency/(very low frequency + high frequency) (Henriques et al., 2011; McCraty, Atkinson, Tomasino, & Bradley, 2009).
Bradley et al. (2010) used matched-pairs analysis to demonstrate the inverse association between coherence and TA which supportsHeartMath’s claim that coherence and anxiety are incompatible states.
The emWave instructions direct users to use a technique (the Quick Coherence technique) in tandem with biofeedback; the goal of which is to teach users how to sustain a state of coherence in everyday life (without requiring continuous biofeedback).
Henriques et al. (2011) reported significant reductions in university students’ (N= 35) self-reported anxiety symptom safter a four week emWave intervention. However, as Sarason (1984) pointed out, in non-test situations there is little difference (in terms of the symptoms associated with TA) between students with high TA and those with low TA, yet Henriques et al. highlighted a relevant, potential focus for future research using the emWave system. The authors questioned whether the biofeedback component was responsible for the observed reductions in anxiety, or whether it was the accompanying Quick Coherence technique and they called for emWave’s mechanism of action to be investigated. Previous research provides support for such an investigation as the individual components of the Quick Coherence technique have demonstrated associations with anxiety:
The first step of the technique (heart focus) instructs users to focus their attention on the heart area (in the centre of their chest). Focussed attention is the defining characteristic of most types of meditation(Cahn & Polich, 2013); meditation has proved effective in reducing TA (Linden, 1973).
The second step (heart breathing) instructs users to breathe at a rate of 5-6 breaths per minute. Breathing at this rate approximates resonance frequency; a technique that has been shown to increase HRV (McGrady & Moss, 2013); state/trait anxiety is associated with diminished HRV(Friedman, 2007).
The third step (heart feeling) instructs users to generate a positive emotion such as appreciation or care. Positive affect is inversely associated with anxiety(Novovic, Mihic, Tovilovic, & Jovanovic). Furthermore, a respiration rate of 6 breaths per minute has been shown to increase tidal volume and associated dyspnea; an effect that can be offset by positive affect (Allen & Friedman, 2012).
Intervention
The ‘Pro’ version of the emWave biofeedback system records data. The device connects to a computer via USB and measures HRV viaa plethysmographic pulse sensor attached to the ear. Using the HRV reading, the device is able to calculate real-time coherence.
The software that ships with the device offers a variety of ways of delivering biofeedback. A software utility called the Coherence Coach is chosen as the primary method of giving biofeedback for Verdure Psychology clients because a standalone version is also available which works in the absence of biofeedback.
The full version of the Coherence Coach software displays three elements of biofeedback:
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- The user’s real-time coherence score. This is a number between 1 and 10 that reflects, in ascending order, the user’s degree of coherence.
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- The user’s real-time coherence state. This is a colour-coded display: red represents low coherence, blue represents medium coherence and green represents high coherence. The software offers multiple challenge settings (with higher settings requiring higher coherence scores to activate the blue and green states).
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- The user’s real-time heart rate (BPM). Although this is displayed, the instructions give priority to the first two elements of biofeedback; little reference is made to the third.
The standalone version of the software includes none of the biofeedback elements listed above. Its primary function is to teach the Quick Coherence technique. Both versions of the software do this in exactly the same manner by offering a breathing pacer and a set of instructions.
Please contact us if you’d like to know more about HRV biofeedback sessions with Verdure Psychology.
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