Exam panic attacks

A panic attack is a severe experience of acute anxiety. Panic attacks come unexpectedly and if you do not know what is happening, you may think you are going mad, having a heart attack or about to die. Although panic attacks can be very frightening, they are not actually harmful. What happens in your body is in response to, not the cause of, a sudden, excessive amount of adrenaline and other hormones in your bloodstream. If you wait the symptoms of panic subside and you will return to normal. As this can take a few minutes most people find it extremely difficult to just wait. Your own fear of what is happening sets off further panic and more adrenaline is produced. You can become hypersensitive to your own bodily sensations and catastrophically misinterpret normal reactions to anxiety thus prolonging the panic.

Symptoms of panic

  • Fast, shallow breathing
  • Thumping, rapid heartbeat
  • Feeling dizzy or faint
  • Trembling
  • Breathlessness
  • Dry mouth or throat
  • Chest pain or tightness in the chest
  • Sweating profusely
  • Ringing in the ears
  • Feeling, or being, sick
  • Feeling very hot or very cold and shivery
  • Pins and needles
  • Feeling distant and disconnected from what is going on around you

Some of these sensations can be due to other things, such as sitting in a stuffy room or being hungry, dehydrated or in love! Remember, panic attacks are extremely unpleasant but not dangerous.

Dealing with panic

The best tactic is to try recognising what is happening and explain it to yourself in a more realistic way. In exams people panic because they tell themselves they do not have time to do this. But it is much better to spend five minutes calming down than 25 minutes fighting yourself and working ineffectively. It can be helpful to understand the physiology of panic attacks. Panic attacks are cyclical self fulfilling prophecies: "I am panicking so I won’t be able to do my exam, which makes me more panicky." It is important not to engage with the panic but to find ways to distract yourself and calm down.

Always with anxiety there is a trigger (e.g. the thought I am going to fail the exam).

Managing Exam Anxiety

All of us experience physical symptoms of anxiety. This might be sweaty palms, dry mouth, increased heart rate, shaking, feeling sick

And we all have a cognitive process which when anxious is skewed heavily in favour of the critical and negative. E.g. 'I will fail', 'I’ve not done enough', 'What if my questions don’t come up'? We can call these thoughts Negative Automatic Thoughts or NATS. Keeping hold of your NATS is vital to avoid panic but they are usually ingrained tricky little blighters so knowing what they are and where they lurk before the exam will help you enormously.

We then misinterpret these dual physical and cognitive symptoms in a catastrophic manner e.g. ‘Because my hands are shaking and because I think I will fail this clearly is absolute proof that I am unable to do my best so I will fail'. This then reinforces your physical symptoms, which reinforces your Negative Automatic Thoughts, which further hardens the evidential proof of your catastrophic misinterpretation, which makes you more anxious......And the painful cycle continues.

In an exam you may be tempted to leave the room to break the anxiety cycle. But there are other ways of breaking this cycle. It is helpful to have tried and tested these ways before the exam so you know which strategies work best for you. It is also important to remember that the strategies you have work quite well some of the time. None of them are always going to work all of the time so practising a few will hold you in good stead.

Ways to calm yourself down

  • Focus on the present - think about what the person in front of you is wearing and whether it suits them, ponder whether you would do their hair differently
  • Remind yourself that your panic will end
  • Set aside 3 minutes to divert your attention away from the panic with a difficult unemotional question (e.g. 'how many invigilators would it take to change all the light bulbs'? 'Why is it much harder for you to straighten your ring finger compared to your other digits'? 'What do the French say for Déjà Vu'?)
  • Use the mini relaxation exercises you have been practising
  • Fight back against the panic: "Forget it, you are not winning, now go away"
  • Use the breathing exercises you have been practising
  • If you’ve forgotten them try this one. Cup your hands over your nose and mouth to breathe in more carbon dioxide.
  • Observe and explain your symptoms to yourself as mere anxiety reactions (e.g. "I'm dizzy because panic leads to constriction of the blood flow to my brain")
  • Remind yourself that panic attacks are not actually dangerous, just unpleasant (like exams)
  • Think positive, coping thoughts such as "I know I can deal with this panic" or “I am going to relax my body and get through this"
  • Remind yourself of a similar situation which you survived and what helped then
  • Visualise a calm place or person and let yourself spend two minutes thinking about this
  • Stretch yourself physically –clasp your hands and stretch them out on front of you, roll your shoulders, lean back or look at the ceiling

Control your breathing

The most common cause of a panic attack is hyperventilation (over breathing). As our body tries to take in more oxygen (historically for the fight or flight response) our breathing rate increases as it would if we were running. But when anxious we tend to tense up, making our breathing shallower and faster such that our lungs cannot fully inflate with each breath. Shallow, rapid breathing and over breathing disturb the balance of carbon dioxide in our bodies and can bring on symptoms of panic.