I suffer from terrible, insane, totally not normal, written test anxiety. Some people are scared of flowers (anthophobia), some are scared of sponges (trypophobia), I am scared of written tests. My phobia causes extreme anxiety which, in turn, clouds my vision and decision making processes. In medical MCQ many questions are phrased in a way that superficial reading can lead you down a false answer, while intense reading reveals answers. Well, bucko, am I hosed there…

One thing that does help, if only a little, is Box Breathing, also known as “SEAL breathing” or “Sniper Breathing” as it, anecdotally, is used by snipers before taking a shot.

Neuro-Physiology

There is method behind this. When we’re stressed, we drive our sympathetic nervous system into overdrive. This is the part of our body responsible for fight and flight, causing various physiological changes in our body. All of them have only one goal: increase peak defensive and offensive performance at the cost of subtlety and fine control. Someone fighting for their life or running for it does not need to concern themself with questions of Quantum Physics or Applied Algebra but, rather, needs to divert all energy to muscles and rapid release and availability of energy.

That’s why you’re sweating and shaking, why your vision narrows and becomes sharper, why your tummy feels weird. The latter, because no one needs to be digesting while fighting, so those things are temporarily stoppped.

Psychology

But many things in our body are feedback loops. While the systems in our brain take a few seconds or minutes more to signal the “all clear,” many autonomous systems also rely on external feedback. A person slowing down, breathing deeper and moving slower, is a good sign that the immediate threat is gone.

So, in a sort of a chicken and egg issue, being panicked and anxious causes exactly the kind of physiological things that signal the brain to be panicked and anxious.

The trick here is to use something to “break through” that cycle.

Breathing

And for me, that’s Box Breathing.

We’ve all heard or said “first, take a deep breath” in response to a panicked reaction. It works. And the, apparently, best way to make it work is to breathe in cadences of four.

  1. Breathe in for four seconds
  2. Hold your breath for four seconds
  3. Breath out, slowly again, for four seconds
  4. Hold it for four seconds
  5. ↑ back to start for a few more times

Over the years of test anxiety and applying this “patch” I have gone from needing ten of those (about 2.5 minutes) to four to six. It took a while, but it got gradually better.

Does it work?

Anecdotally, for me, yes. I did wire myself to a number of implements a few times and monitored my ECG, breathing, heart rate, perspiration, body temperature, and other things, and it works. For me.

Subjectively, I am calmer. Which, in my case, translates to “does not fail MCQ,” it does not mean “gets all As.” It is, in more medical speech, “ALARA,” “as low as reasonably allowable,” the bare minimum to make it. Not ideal, and I never was and never will be a star pupil, but enough to not fail.

User’s Manual Addendum :)

Not only is our autonomous nervous system reactive, it can also learn. By quickly dissipating anxiety moments, we teach it to become less sensitive to lesser stimuli. The first weeks of Box Breathing, I did it every morning, even when I was relaxed, just to remind myself that I was OK. Later, as my autonomous nervous system learned to be less of an unhinged bastard in some situations, it took less and less cycles, but I also added voluntary cycles after lights out in bed.

It’s not a panacea. And it won’t “cure” phobias. For this, and all anxiety and panic related issues, please see your physician or therapist. But in some cases it can be helpful and might be a harmless and non-invasive way to try, along all the other things your therapist prescribes.