As students emerge from this year’s exam season – how might they have they been affected by exam stress, and how can we help?

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   Dr Vanessa Cooper and Finn Stevens. This article was prepared during Finn’s work experience with Sprout Health Solutions in June 2022.



What is exam stress?

Exam stress describes the emotional, physiological, and behavioural responses experienced by students in the lead up to a test or exam. Students may appraise exams as threatening, experience anxiety and secrete stress hormones such as cortisol.

Around 15% of students taking GCSEs (national exams typically taken by students aged 15-16 in England, Wales, and Northern Ireland) are highly test anxious.1


What is the impact of exam stress?

It is common to experience increased stress and anxiety before an exam, and some stress may be beneficial, especially if stress and anxiety decrease once the exam has begun and the student becomes familiar with the paper. However, sustained high levels of stress can lead to immune dysregulation which over time can have a negative impact on health.2 In addition, stress can impair performance in exams as it affects working memory and the ability to process and retrieve learned information.3

Finn’s experience of GCSEs last year illustrates the circular nature of exam stress, where stress led to delay to start revision which in turn, led to increased stress:

In the lead up to my GCSEs I felt really stressed about having to revise and prepare for the exams. I procrastinated a lot to take my mind of the stress. This resulted in me having a lot of revision and work to do in very little time before the exams and so it led to a lot more stress.”


What factors contribute to exam stress?

There are many potential causes of exam stress. To find out what contributes to exam stress, researchers interviewed secondary school students. One of the sources of stress identified in the interviews was not knowing what the exam would be like. Another was the importance that teachers placed on exams – the students reported repeated warnings from teachers that their futures depend on exam performance.4

People with specific learning differences (such as dyslexia) are more likely to report a high level of test anxiety than those without learning differences.5 This may be linked to pressures such as time restrictions in exams and having experienced problems with working memory and language processing which can affect exam performance.

Protective factors have also been identified. These include academic self-esteem or belief about academic competence and friendship support. For example, in one study, school children who assessed their self-esteem as low experienced a higher level of stress and an increase of cortisol levels during the test. Children who reported saying to themselves ‘I can solve this task’ had a lower increase in cortisol levels.6


How can we help with exam stress?

Teaching young people ways of coping with stress can help them to manage exams and may have benefits that extend beyond the exam season. In the long-term, learning effective stress management techniques may also help prevent diseases that can be caused by chronic immune dysregulation.

Mindfulness -based approaches may be beneficial. These approaches focus the attention to the present moment and adopt an attitude of kind and non-judgemental curiosity. These approaches may reduce the extent to which stressors such as exams are perceived as threatening, which in turn, could reduce the activation of the sympathetic nervous system and pro-inflammatory response.

A non-randomised, controlled feasibility study conducted with sixth form students (aged 16-18 years) found that a Mindfulness Based Stress Reduction (MBSR) intervention was acceptable to students (attendance was 94% and 90% of students said they would recommend the course to a friend) and was associated with a reduction in anxiety and increase in academic performance.7


Online resources for children and young people may also be helpful:




  1. Putwain, D., & Daly, A. L. (2014). Test anxiety prevalence and gender differences in a sample of English secondary school students. Educational Studies, 40(5),554–570.
  2. Turner, L. et al. Immune dysregulation among students exposed to exam stress and its mitigation by mindfulness training: findings from an exploratory randomised trial Sci Rep.2020;10:5812.
  3. Vogel & Schwabe Learning and memory under stress: implications for the classroom npj Science of Learning, 2016,1(16011)
  4. Keating, K (2019) What is it like to experience exam stress? A student perspective
  5. Nelson et al. Test Anxiety Among College Students With Specific Reading Disability (Dyslexia): Nonverbal Ability and Working Memory as Predictors J Learn Disabil. 2015;48(4):422-32
  6. Lindahl et al. Test performance and self-esteem in relation to experienced stress in Swedish sixth and ninth graders–saliva cortisol levels and psychological reactions to demands Acta Paediatr 2005 Apr;94(4):489-95.
  7. Benett & Dorjee The Impact of a Mindfulness-Based Stress Reduction Course (MBSR) on Well-Being and Academic Attainment of Sixth-form Student Mindfulness 2016,7:105–114