by Roy Gaskell, Email: rg.hypnosis@googlemail.com
A five year longitudinal study by Hill and Wigfield (1984) measured the impact of test anxiety on academic performance across time. Their study concluded that the higher a student scored on the test anxiety measurement (Test anxiety scale for children TASC) the worse their performance. This negative correlation increased as the students move up through the education system from Junior to High Schools. Ethnic and social backgrounds appeared to have little impact. It has been found in subsequent studies that students with high levels of test anxiety scored on average 15 points lower on standardised tests in maths and English than students with low test anxiety. A study by McDonald (2001) looked at the effect of pressure of exam expectation from parents and teachers on young children and concluded that the current climate of league tables for schools and teacher effectiveness being judged by their exam results was a cause for greater exam anxiety levels being seen in school children.
Test Anxiety is composed of two main variables, Worry and Emotionality. Worry is the cognitive component of test anxiety and generally shows itself as low self esteem, catastrophic thoughts, feelings of failure, worthlessness and dread. Emotionality consists of physiological symptoms such as increased heart rate, feeling nauseous, increased sweating, dry mouth and muscle spasms (Zeidner 1998) which would characterise an anxiety attack.
Having taught in both the secondary and primary school systems until recently I have noticed an increase not only in children’s anxiety levels relating to, in particular, the Key Stage 2 and Key Stage 3 exams but also an increase in teacher’s stress levels relating to these exams. The teachers' stress levels are due in the main from having to achieve specific, and increasing annually, targets for SAT levels. This often external pressure on teachers must also have a knock on effect on their dealings with the children they teach.
I still have close links with my old school and last year volunteered, along with an ex-colleague, to run a programme of interventions to try to reduce this exam anxiety. This was focused on 4 classes of Year 6 pupils who were due to take SAT exams in English, Maths and Science in May 2009. From the beginning of the year the children were given the opportunity to attend group sessions during the week where they would be taught relaxation techniques including breathing techniques, meditation, progressive muscle relaxation and mindfulness exercises. These sessions would take place during a couple of dinner breaks and an activity session on Friday afternoon. After mock SAT tests were carried out in January 2009 the children were also given the opportunity to talk to either of us during break times about the exams and the feelings of anxiety or worry that they had. I had hoped to be able to do a number of specific lessons on coping with exams with each class and a talk to the Year 6 parents explaining what we were offering. This didn’t happen as time couldn’t be found in the curriculum time and a lack of parental interest in the talk. The parents had been made aware of the interventions that we were offering by means of a newsletter and seemed to be happy to accept the information in the newsletter rather than attend a meeting. In the week leading up to the exam, and before the school sessions started during the exam week, the children who were feeling anxious about the exams were given the opportunity to attend relaxation classes and talk as a group about their feelings. At this point some CBT techniques were also taught. The whole process proved to be quite successful with a number of children stating that the sessions had definitely helped them be more confident and relaxed about the exams. Whether the interventions had any specific effect on the outcomes of the exam results couldn’t be assessed or judged as the focus of the programme had been anxiety reduction and not improving test results. It is hoped that we will be able to carry out the same programme this year but with a more structured and specific course that can be built into the children’s ‘Preparation for Life’ curriculum and that gives some possibility of staff training.
During a Year 6 assembly about the Year 6 SAT exams the children were taken through areas such as -
· the exam timetable in terms of how many exams they would have to do.
· examples of the sorts of questions that they might be expected to have to answer.
There had been a shift that year from knowledge based questions to questions that tested the children ability to use and apply their knowledge, particularly in science. It was also explained to them that during the year we would be offering the children the opportunity to learn relaxation and other skills that would help them in their exams. A lot of the children reported during the assembly that they were worried about the exams. It had been useful at this point to show the children that what they were feeling and worrying about wasn't only at an individual level but that a lot of the children had similar worries and feelings. Some ideas about exam preparation were discussed at this point as it is important to have a structure to this. Areas such as -
· Getting enough sleep
· Finding somewhere quiet to study
· Finding times when you study best
· Creating schedules for exam study and revision
· Taking breaks for relaxation and exercise
· Eating Healthily (this was also part of a school wide initiative at the time)
were all discussed and would be re-visited at other times during the year. Newsletter were also sent home to the parents re-iterating the points above.
Initial Interventions taught to the children -
1. Breathing Exercises – Children tend to be very dismissive when the topic of breathing is introduced. 'We breath all the time so why do we need to learn how to do it properly?' was a regular retort. It is important to go through the process of breathing and its function and physiology for the children to understand why it is important to breath properly and also how it can be used to treat anxiety and stress. If your breathing is not well enough regulated to keep your 'blood gases' in a steady state then all kinds of problems can occur. These problems are not serious enough to be life threatening but are severe enough to cause symptoms, such as hyperventilation. Breathing exercises are an ideal way to relieve stress in that they’re fast, simple, free, and can be performed by just about anyone (Asthmatics might have some problems with some of the techniques). They can also be done anywhere and at virtually any time. The children were taught abdominal breathing initially, followed by the calming breath (Bourne E). This allowed the children to understand that breathing from the abdomen was something that they needed to practise (quite a few breathed thoracically) and also gave them an easy method to practise at home. Abdominal breathing can help to reduce the bodily symptoms of panicin two ways -
· by slowing down your respiration and breathing you can counteract the two reactions associated with the 'fight/flight' response, namely increased respiration rate and increased constriction of the chest wall muscles.
· Slow abdominal breathing can reduce the sypmtoms of hyperventilation that may cause or aggravate a panic attack.
We followed this up at a later date with exercises from the 'RelaxChild' Programme which the children actually found more fun to do. These involved more of a visualisation of the breath than a mechanical technique. An example of this is 'Blowing Feathers' where the children were asked to visualise blowing feathers softly into the air on an exhalation breath. They were asked to visualise playing with the feathers while they were still in the air, seeing how high or how far they could blow them.
2. Relaxation Techniques - People who practice meditation or relaxation techniques become more adaptive to stressors in their environment showing a much quicker return to a non-stressed state than those who are not able to relax. Mills P (1999) states that the nerve cells in people who practice meditation or relaxation techniques becoming less sensitive to cortisol thereby reducing the likelihood of heightened physiological arousal. There also appears to be a link between the detection of stressors and the dismissal of these stressors by people who practise meditation or relaxation techniques. Practice of these techniques gives a greater reaction to stressful events, at first, but it takes less time for them to return to their initial state before the stressful event. This ability to be able to recognise a stressor and then be able to use techniques to alleviate the effects of this is a useful tool for a young child and one that will be useful in a variety of situations.
Relaxation techniques for children are essentially the same as those you would use for adults. The main difference in response between children and adults is that children often respond very quickly with total body relaxation. We decided at the outset to use meditation, the Benson Method and progressive muscle relaxation (PMR) as these were techniques that we were both skilled at teaching and had used successfully in the past. Research by Scheufele P.M. in 2000 showed that progressive muscle relaxation was more effective than playing classical music to students or giving the students attention control tasks. He states that these two methods only served to distract the students from their stressor whereas PMR 'not only served as a distraction but also assisted with receptivity, which is a component of relaxation'.
Meditation quietens the mind and can often offer a sense of balance and centerdness when your feeling stressed. It has also been practiced for over 3000 years and been the centre of a great deal of research into its effectiveness.
'In the long term, meditation is not about sitting in the lotus position or like a statue at the museum; meditation is about your entire life. The real practice in meditation is living your life as if it really mattered moment by moment.' John Kabat-Zinn
The children were given two Mp3's to listen to after they had had a short explanation of what meditation involved and how it could be used to reduce anxiety and stress. The Mp3's were 'Learn Meditation' and 'Exam stress busting' by Meditainment Ltd. These were used during the dinner time relaxation club and were given to the Year 6 teachers to use as and when needed in their classrooms.
3. Mindfulness – I was taught this technique on a hypnotherapy course and have used it regularly on myself to achieve a sense of inner calm. It is also linked to the meditation that we used which was mindfulness meditation. We decided to use this rather than other methods such as Transcendental or Zen meditation because of its effectiveness in dealing with negative thoughts. Mindfulness helps to halt the escalation of negative thoughts and teaches us to focus on the present moment, rather than reliving the past or pre-living the future. When we start to feel low, we tend to react as if our emotions were a problem to be solved and we start trying to use our critical thinking strategies. When these do not work, we re-double our efforts to use them. We end up over-thinking, brooding, ruminating, living in our heads. All of which are symptoms often shown in test anxiety. Mindfulness helps us to allow distressing moods, thoughts and sensations to come and go, without battling with them. We discover that difficult and unwanted thoughts and feelings can be held in awareness, and seen from an altogether different perspective. In studies involving brain imaging tecnology and EEG readings of brain electrical activity, researchers have found that regular practice of mindfulness meditation significantly increased activity in the left side of the brain's frontal area. Activity in this region of the brain is associated with lower anxiety and better mood. Grossman (2004)
4. Attentional Focus Control Exercise – The children were told that this is a very useful technique during an exam when you find your attention wavering or it is difficult to concentrate on the questions. 'Focussed daydreaming' was a much more acceptable term for the technique. The children were taught to scan around the room and concentrate solely on a single sound, image or feeling for a short period of time. They would then scan to find another interesting thing to concentrate on. This is similar to the Benson Relaxation Method (Benson 1975) but doesn't use words or phrases. When coupled with the breathing exercises already taught to the children this was a very effective method for focussing their attention back to the task and also helping to produce a sense of relaxation. It's a method I tend to use myself a lot and one that I teach clients who are having problems getting to sleep as by assuming a passive attitude and saying 'Oh well' to passing thoughts it is highly effective in calming the mind. Once the children had regained their focus and felt more relaxed they could then get on with their tasks. We told them to limit their use of this technique to no more than a couple of minutes. Daydreaming is a skill that most children have in abundance naturally!
The interventions above were generally found to be sufficient to alleviate much of the worries and stress that the children reported. Where more profound stress or worry is encountered then the following techniques could be used. These are primarily CBT techniques due to my own expertise and knowledge in this area. Their has been a great deal of research about the use of CBT with children. (Friedberg 2000, Ronen 1997, Shirk 2001) The general thought is that children over the age of 7 can benefit from CBT if the techniques are appropriately adapted. Stark (1996) suggests that there is a need to make sure that the process of CBT is entertaining and not dull for it to be effective. There is also a need to match the methods, style and process of therapy to the child's developmental level.
Other Interventions that could be taught to the children -
Positive and Negative Self Talk - Children tend to believe negative assessments of them from teachers and parents, and develop a compromised self-concept when criticised on a regular basis. Researchers estimate that it’s necessary for the ratio of positive-to-negative comments be at least five to one for a relationship to be healthy and survive long-term. For these reasons, we’re taught not to let others put us down, but sometimes the person eroding our sense of self-worth and limiting our potential is us. Our self talk, or the words our inner dialogue uses when we think, can increase our stress levels, limit our potential, and colour our experience.
When your self talk is negative, you may perceive things as more stressful. For example, when you tell yourself something is ‘difficult’ or ‘unfair’, it becomes more stressful to deal with than if you tell yourself it’s a ‘challenge’, or even a ‘test’. Using self-talk that is optimistic rather than pessimistic has stress management benefits, productivity benefits and even health benefits that have been proven by research. Seligman M.(2005)
Guided Imagery - Guided imagery has been found to provide significant stress reduction benefits, including physically relaxing the body quickly and efficiently . This technique is great for people who feel a significant amount of general stress and would like to quickly feel more relaxed. It can work just about anywhere and takes only a few minutes. The studies demonstrating the health benefits of imagery are so numerous that many hospitals are incorporating imagery as an option to help with treatment. Guided Imagery is a convenient and simple relaxation technique that can help you quickly and easily manage stress and reduce tension in your body. The process requires the child to imagine and describe their restful, calming and happy place. The image is created in the present time and described in the first person. The role of the therapist is to help the child to create a vivid and powerful image by making it as detailed and as real as possible. Once developed and practised, the image can be used to counter and control any anxious or uncomfortable feelings.
Coping Imagery – Visualisation and imagery can be used therapeutically as a method of combating unpleasant and unhelpful emotions or to reappraise cognitions. While imagery can be used as a way of helping children to challenge distorted cognitions, it is more often used as a way of promoting control over unpleasant emotions such as anger or anxiety. Emotive imagery was described by Lazarus and Abramovitz (1962) as 'those classes of imagery, which are assumed to arouse feelings of self-assertion, pride, affection, mirth and similar anxiety-inhibiting responses.' Emotive imagery when used as part of systematic desensitisation allows the child to confront and overcome their problems by providing a method of countering any unpleasant emotions or a way of changing the emotional content of problematic situations.
Thought Stopping and Positive thoughts -
'Thought stopping is a method of changing cognitive behaviour that, unlike the cognitive correction procedures..., does not depend upon chnaging the meanings of words or the implications of situations. It is a way of eliminating day-to-day preoccupations with useless thoughts. It consists of training the patient to exclude at the earliest moment -even, if possible, before formulation – every undesireable or unproductive thought' Wolpe 1990
Thought stopping is usually followed by shiting focus onto a more positive thought, sometimes referred to as 'thought substitution'. This positive thought could be the restful, calming and happy place from the guided imagery exercise.
In conclusion, when using any of the interventions above with children it is important to be aware that complex abstract concepts and strategies need to be simplified and made concrete. Problem-solving techniques need to be based around real examples and problems from the child's everyday life rather than dealing with hypothetical situations and events.
Bibliography -
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P.Grossman, L.Niemann, S.Schmidt, H.Walach - Mindfulness-based stress reduction and health benefitsA meta-analysis Journal of Psychosomatic Research, Volume 57, Issue 1, Pages 35-43
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