by Will Baum, LCSW
Each year, thousands of social workers find themselves with heightened irritability, sensitivity, and exhaustion. They bite their nails. They lose sleep. They worry, fret, and frown. They’re preparing for the social work licensing exam.
It’s not as if social work isn’t tricky enough. Social workers face every manner of crisis all day every day. But the licensing exam can be the thing that pushes hard-driving social workers past the reach of their own coping skills.
Does this sound familiar?: You’ve earned your degree. You’ve met all the requirements. And now you find yourself expected to add one more item to your already overfilled plate - getting ready to pass the big test. On the other side of the exam, long-desired letters to follow your name. LCSW! LMSW! LSW! Maybe even a raise, new responsibilities, or some additional job security. Those are high stakes. As all social workers know all too well, big feelings follow.
The way those feelings present is familiar. They show up in clients all the time - feeling overwhelmed, stressed out, burnt out. Tests can tap into our deeply rooted misgivings about our self-worth, about being judged, about the conditionality of the affection we receive. That’s a lot to carry into the licensing exam. And once you really start preparing and realize that the exam is 170 questions administered in a strange place over four hours...well, you know the result. It’s anxiety and it doesn’t feel good. Happily, as we tell clients, anxiety is treatable. There is help.
It was once believed that test anxiety doesn’t affect test performance. How great would that be? You worry, you lose sleep, and it doesn’t make any difference. You breeze through the exam, and you’re licensed. As appealing as that idea may be, the science behind it didn’t hold up. A meta-analysis by Hembree (1988) found that, “contrary to prior perceptions, improved test performance...consistently [accompanies] TA [test anxiety] reduction.” Test anxiety studies that followed, such as one by Andrews and Wilding (2004), endorse that common-sense notion. If you’re dizzy with worry about how you’re going to do on a test, you’re less likely to be able to focus on the test. Diminished results follow.
A social worker sees a client who is struggling with anxiety regarding a licensing exam she has to take in a few months. She reports difficulty focusing on test preparation and ruminating about failure. What type of therapy is MOST likely to be helpful in this situation?
A. Psychodynamic psychotherapy
B. Dialectical behavior therapy
C. Gestalt therapy
D. Cognitive behavioral therapy
Although there are studies indicating that all types of therapy are all effective at more-or-less the same rate, there are still more studies showing that one of these therapies is particularly useful when it comes to reducing anxiety: cognitive behavioral therapy (CBT).
CBT is so broad that it’s hard to find approaches to managing test anxiety that don’t fit under the CBT umbrella. These tips from the Anxiety and Depression Association of America are no exception. Their sage advice:
- Be prepared.
- Develop good test-taking skills.
- Maintain a positive attitude.
- Stay focused.
- Practice relaxation techniques.
- Stay healthy.
- Visit the counseling center.
You can probably fill in the details yourself - avoid all-nighters, eat well, get sleep, take deep breaths, get therapy as needed. Their wisdom regarding preparation: “Try to simulate exam conditions by working through a practice test, following the same time constraints.” This is easier to do for the licensing exam than it may have been for exams in high school, college, and grad school. Exam prep sites stand at the ready to provide realistic, real-time licensing exam practice.
While the above can be loosely defined as CBT, if you want to try CBT - the kind practiced in social work settings (and elsewhere) worldwide - read on.
In CBT, the interaction between thoughts, feelings, and behaviors is a focus of attention. Between our experience and our emotional reaction, there is always cognition. That is, between the looming exam and your anxiety, there are thoughts - usually a lot of them. One helpful way to examine your thoughts is by doing a thought log. I like an ABCD thought log. It’s not pure CBT, but it’s simple and easy to remember and seems to help. Okay, have that pen and paper handy? Time to start scribbling.
In an ABCD thought log, A is an activating event - for example, “Exam approaching.” Something simple and specific.
The B is beliefs (aka thoughts). Like these: “I’m a bad test-taker,” or “It’s been so long since school, I don’t know how to take a test anymore.” In therapy, talking through beliefs, a therapist might ask a client, “If that’s the case, then what happens?” For both of these thoughts, the consequence is the same: failing the exam. Fear of failure is at the core of most test anxiety. “And then what happens?” Specific fears may be different from person to person, but the dreaded consequence tends to be the same for most people: ending up out of work, unable to pay bills or maintain relationships...alone and destitute. It can be unpleasant to stare at these thoughts, but hang tight. The relief part is coming up in a minute.
Next comes C, for consequences. What happens when you think these thoughts? First, what are the physical responses (shortness of breath, heart racing, sweaty palms, tight shoulders, queasy stomach, etc.)? Next, what’s your emotional response? Social workers tend to know a lot of feeling words and can breeze through this part. A few obvious options: scared, nervous, worried...anxious. There’s often also anger at the process - the unfairness of the test, its expense, and so forth. It can be useful to voice these thoughts and feelings, too. Consequences part three: identify the behaviors that accompany these thoughts. When you think about failing the exam, what do you do? These behaviors may be mild. For example, some may report having a hard time concentrating when these thoughts come up. Usually there’s also some distraction, some escape, that follows anxious thinking about testing. These days, a lot of those distractions are right in your hand - texting, surfing the web, checking Facebook and Instagram... As a social worker, you’ve encountered face-to-face the full range of less mild escapes. Substances, risky behaviors, and the like. People tend to do just about anything rather than sit with unpleasant thoughts and feelings. This is no doubt not a newsflash to you.
Finally, here come D, disputes. In this final section, the one that can often bring some relief, you revisit your thoughts and see if they hold up to scrutiny. It’s often useful here to imagine what you might say to a friend voicing these thoughts. Or to imagine how the kindest, most compassionate, supportive person in your life might respond. Let’s take “I’m a bad test-taker” first. By the time you’ve gotten through an MSW program, there’s probably ample evidence that this just isn’t the case. You may struggle with test-taking, and you may have failed a number of exams (perhaps including the licensing exam). But you’ve made it this far.
This is as good a place as any to mention cognitive distortions - these are, in CBT, common, universal ways of thinking that tend to be flawed (thus, “distortions”). Take a look at the linked list. “I’m a bad test-taker” is probably generalizing; it’s certainly labelling. Nothing’s true all the time. So, you’ve had trouble with exams in the past. Who hasn’t? It doesn’t mean you’re always going to have that trouble. In CBT, absolutes come under heavy fire: always, never, must, should...all are regularly held up for inspection and found wanting. A more gentle way to voice this thought, “I’ve struggled with tests in the past and I’m looking for ways to change that as I approach the licensing exam.” Empowerment, change, recovery...social work!
With these tools, it’s easy to make short work of the next thought, “It’s been so long since school, I don’t know how to take a test anymore.” Stare down that absolute - ”don’t know how.” Does it really hold up? If you once knew how to take tests, your memory is most likely joggable. And it’s not as if test-taking is something you’re forbidden to practice while preparing for the exam. Taking mock tests is probably the best way to prepare for the exam. Reframed thought: “I’d like to refresh my memory about test-taking before sitting down for the licensing exam.”
This same approach can work regardless of what thoughts bubble up for you as you prepare for the exam, including that basic fear, “I’m going to fail.” Looking back at any list of cognitive distortions, you’ll see “Fortune Telling.” We can’t tell the future. The compassionate response to this is a gentle shrug, “Time will tell.”
So, managing test anxiety with CBT involves identifying the thoughts that stir your anxiety and exposing them to light, some gently scrutiny, and lots of compassion. Whether you think of yourself as a CBT practitioner or not, that process probably sounds familiar. It’s how social workers, licensed and not, help clients all the time.
Here’s hoping that you can turn some of that social work helpfulness on yourself, decrease your anxiety, and maybe even enjoy the exam preparation process some. (It can be a learning, growing experience - really!) Sooner or later, you’ll get that license. Then you’ll have to find something new to worry about and to thought-log away. Good luck!
Andrews, B., & Wilding, J. M. (2004), The relation of depression and anxiety to life-stress and achievement in students. British Journal of Psychology, 95: 509–521. doi: 10.1348/0007126042369802.
Hembree, R. (1988). Correlates, causes, effects, and treatment of test anxiety. Review of educational research, 58 (1), 47-77.
Will Baum, LCSW, is a Los Angeles-based social worker and part of the team at Social Work Test Prep, which provides practice exams and other social work licensing exam preparation services. Write Will with your questions at: firstname.lastname@example.org