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Government Gazette


Compiled and coordinated by Edward Arambewela

Exam phobia in school children

A large number of school children undergo exam related fears. Sometimes these fears are overwhelming. It can cause low performance and failure in exams. As a matter of fact most of the children who are shattered by exam phobia have a good IQ and positive motivation.

They show favourable performances in the classroom. But when they go to the exam these students become highly stressed, have fear and they are unable to face the exam with confidence.

Exam in progress

Students with exam phobia feel extremely fearful and unsure. Following the increased fear they are unable to grasp theoretical material and find it difficult to remember.

Exam phobia is a form of anxiety condition which is common among school children. In the verge of the exam the fear increases and some manifest psycho somatic ailments such as abdominal pains, vomiting, headaches, dizziness, tremors, etc which have no apparent medical basis.

Some students with exam phobia manifest following anxiety related features during the exam period.

* Unable to relax
* Dizzy or light headed
* Heart pounding or racing
* Unsteadiness
* Feelings of choking
* Hands trembling
* Fear of losing control
* Difficulty breathing or chest pain
* Indigestion or discomfort in the stomach
* Feeling Faint
* Feelings or unreality or disorientation
* Amnesia or difficulty in remembering studied material

Self Revealed Story by Miss H

When I was doing my O/L exam I had an unexplainable fear and anxiety. I was not a mediocre of course. I worked very hard at school and at home. I could understand the study material when the teacher was explaining.

My teachers and parents thought that I was a bright student who would perform well in the exam. But one month before the exam I had headaches and loose motions.

My memory was fading. I could not memorize the material that I had learned. I was extremely afraid of facing the exam. At nights I could not sleep. I was weeping and thinking of giving a medical certificate without doing the exam.

Master L and his Fear

Two days before my A/L Chemistry paper I was confused. I could not recall the stuff that I had studied for the exam. I was frightened and helpless.

The chemistry formulas were roaming inside my mind. It was an unpleasant intrusion. I thought my life was over. Two years hard work and all the hopes my parents had about me would go for nothing if I had failed the exam. I was blank, totally blank. I did not know what to do.

How Miss K Fought Her Fear

Miss K was a bright student who had lost of hopes for the A/L exam. Her parents and the school teachers were so sure of her that she would enter the university at the first attempt. This premature hope on her became a big burden for her. Sometimes she had irrational feelings about her destiny.

She often asked from her self what my parents and the teachers would say if I get a lower grade in the exam? This very feeling gave her fear and a nxiety. Miss K had low appetite, suffered from headaches and experienced many sleepless nights. Sometimes she was unable to recall the studied material and write correct answers to the past papers.

Eventually her fear was liquidated via counselling and psychotherapy.

Imagery techniques helped her to simulate the artificial examination room atmosphere and build more and more confidence. Relaxation therapies reduced her outpouring anx iety. Miss K. was able to pass the exam with excellent marks and today she is a Medical student.

Treatment of Exam Phobia

Counselling and Psychotherapy are indicated in treating exam phobia. Counsellors who work with children and adolescents who suffer from exam phobia may be required to use effective counselling strategies to help them.

These interventions may be required to allow the students to achieve a greater academic autonomous functioning ability and face the exam with confidence. Empathetic listing to the student would ease his difficulties and create a growth promoting atmosphere.

The client will begin to trust his abilities and challenge the fright. In Psychotherapy it is necessary to establish a positive and functioning relationship with the therapist.

The therapist should help the client to become consciously aware and able to express their anxiety and fear about exam and performance situations. The therapist should direct the client to fight his fear.

Hence the student gets more confidence to face the exam. Simulating exam atmosphere in therapeutic sessions the fears and stresses can be reduced gradually.

Implementation of positive self-talk to reduce or eliminate the anxiety is vital. Instead of negative coping skills (Avoidance of the exam, expressing self directed anger, blaming others) healthy coping skills (avoidance of the exam, expressing self directed anger, blaming others) healthy coping skills must be taught.

While working with the student the therapist must increase client’s participation in educational activates, combating fear and building confidence.

Appropriate relaxation and diversion activities would decrease anxiety levels. Therefore relaxation techniques (especially breathing techniques) are indicated in exam phobia. To enhance the therapeutic purpose parents/guardians and teachers support should be taken.

Some therapists perform Hypnotherapy to reduce the fear. Hypnosis is an altered state of consciousness and heightened responsiveness to suggestions.

During the hypnotic sessions positive suggestions are given to build confidence and illuminate the exam fear.

The modern research indicates that EMDR or Eye Movement Desensitisation and Reprocessing is one of the effective modes of psychotherapy that can treat phobias successfully. These therapies should be performed by qualified and trained professionals.

Role of Medication

Some children who suffer from exam phobia go in to depression.

Depression can cause negative self image, low motivation, difficulty in concentrating and remembering things that would affect the learning process.

Therefore depression must be managed effectively. Sometimes depression and anxiety go hand in hand and students find difficult to cope. If the anxiety level is high and difficult to control anti anxiolitic or anti depressants are prescribed by a qualified medical practitioner.

These medications combined with psychological interventions accelerate the recovery process.


Exam phobia is a self damaging factor which negatively affects the students and their performances. The student is unable to give is maximum productivity and the end result would be critical.

Usually exam phobia is a slowly developing factor and sometimes early signs like physical and mental fatigue, irritability, difficulty in concentrating and negative self talk can be detected by the teachers and parents.

School counsellors can do a lot to help the students with exam phobia. Counselling and building confidence, educational therapy help the students to gather mor strength and accomplish the exam.

Heavy school bags a mental strain too?

Heavy school bags which students are now carrying to schools daily are believed to be causing a mental strain on them affecting their studies to some extent. Healthwatch organised parent - doctor discussion was held on this in collaboration with Apollo Hospital in 2005.

In the picture in progress at Apollo auditorium with doctors. Neurologist and Sports Medicine Unit Head Dr. Githanjana Mendis, Family Physician and former SLMA Head Dr. Dennis J. Aloysius.

Colombo Medical Faculty also took up this issue later and the study report is due to be out shortly.

This picture was taken by Daily News photographer late Roland Perera.




President Doctors’ Wives Association writes

An efficient and cost effective system of management is an essential component of a well-organised Family Practice Unit. It is an asset to the Family Physician in the delivery of optimal care to his practice population.

A kind and caring Family Physician who has a good doctor-patient relationship, diagnostic and therapeutic skills, can work more effectively in a disciplined, orderly and patient-friendly environment. There should also be a patient centred approach and clinically competent and broad-spectrum care.

The Family Physician’s job is a multifaceted one. He has to provide personal, comprehensive and continuing care, have a dialogue with the patient, communicate with him, listen to him, explain the nature of his illness, make a plan of management and prescribe treatment.

The family physician is also expected to give advice on lifestyle, diet, provide health information and education.

He must be sensitive to the patient’s feelings, fears, and hopes and be aware of the socio-economic background and family dynamics.

The services of a Family physician must be


A Family Physician must be updated and keep abreast with fast evolving medical knowledge and technology.

This is achieved by attending lectures, seminars, participating in Continuing Medical Education programmes.

With this heavy workload, a family physician has very little free time to relax, take exercise, indulge in hobbies and spend quality time with his family.

With a varied and exhausting agenda a Family Physician requires the assistance of administrative staff to help him with the day-to-day running of the Practice Centre.

In Sri Lanka, genuine Family Medicine is practiced entirely in the private sector on a fee for service basis. Family Physicians are not paid by the State or National Health Service but by the patients.

The patient is the employer and the doctor is the employee.

There are about 550 Family Physicians practising in different parts of the country in the urban and rural areas but they are concentrated around the bigger towns.

News bites

Don’t eat and run

If you are not used to regular exercise, don’t try to run around the block immediately after that large New Year or Hari Raya dinner.

A study of nearly 2000 heart attack survivors presented at the American Heart Association’s Scientific Sessions 2000 found that the risk of a heart attack was four times greater within two hours after eating an unusually heavy meal.

The researchers suggested several ways in which a heavy meal may adversely affect the heart. Eating and digesting food increases heart rate, blood pressure and oxygen needs thereby placing an extra burden on the heart.

High blood pressure may trigger the formation of a clot that in turn could block a blood vessel or increased insulin secretion following a heavy meal may affect the normal relaxation function of the coronary arteries that supply blood to the heart.

This study is one of the first to show that overeating may increase the risk of heart attack and further studies are needed to confirm the findings.

More fluids

Current recommendations on fluid intake may need to be reviewed if the results from a study on hydration in healthy males are substantiated by further research.

A study by the University of Nebrasaka Medical Center, Oklahoma, has found that optimal fluid intakes in 18 healthy males may be higher than currently recommended intakes of 8 glasses (about 1.8 litres) a day.

The researchers used a counterbalanced crossover study using water or water plus varying combinations of fluids, including caffeinated drinks.

They found that there were no significant differences in the effect of various combinations of beverages on hydration status and concluded that “Advising people to disregard caffeinated beverages as part of the daily fluid intake is not substantiated by the results of this study.”

This is good news for those who enjoy coffee, tea and cola drinks. Further research is needed to confirm these results and to identify optimal fluid intakes.

Nutrition for Athletes

Knowledge in the area of nutrition and athletic performance continues to increase.

A point paper released by the American Dietetic Association, Dietitians of Canada and the American College of Sports Medicine reviews the most current science in this area.

The paper, which was published in the Dec 2000 issue of the journal of the American Medical Association, provides important guidance for nutrition and health professionals, athletes and coaches in optimising nutritional intake for both the elite and the recreational athlete.

Courtesy Food Facts Asia

Laughter the best Medicine

It was early morning, and the milkman rang the bell.

The wife was fast asleep, so the hubby put on her kimono for convenience and went to the door.

The milkman gave him two bottles of milk and a great big kiss. Hubby went back to bed chuckling to himself.

“Why are you laughing?” the wife asked.

“This is too funny” said the husband “I got the milk from the milkman wearing your kimono and he kissed me. I guess his wife has a kimono just like yours.”

Sent by Ahamed Sherrif, Maradana


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