Mindfulness-based systematic desensitization is a technique used to gradually reduce test anxiety through relaxation and exposure to anxiety-provoking test situations. It involves two phases: 1) Practicing relaxation through automatic abdominal breathing exercises for 3 weeks to learn deep breathing. 2) Practicing systematic desensitization for 5 weeks by facing frightening test-related situations while remaining calm, to replace the anxiety response with relaxation through counterconditioning. The goal is to overcome test anxiety by gradually reducing fear when exposed to anxiety-provoking test situations while maintaining a calm, focused state of mind.

1. OVERCOMING FEAR
OF TESTS WITH
MINDFULNESS-BASED
SYSTEMATIC
DESENSITIZATION
Gradually reducing your fear of tests

2. WHAT IS TEST ANXIETY?
Do you feel really nervous when you have to take a math test –
so nervous that your palms sweat, your heart races, and you can’t
concentrate, even if you know how to do the problems? Do you
worry about your English midterm for weeks before the day of the
actual test?
Fear of tests, or what experts call test anxiety, is a common
condition that makes people feel extreme distress and
nervousness during testing and other performances that are
graded on how well you do. The stress and fear usually come from
a fear of failure and being judged negatively by others.
As a result, people with test anxiety don’t do as well as they
could on tests, and they feel upset, frustrated, and/or sad. All of
this can lead to negative feelings about school in general.

3. A COMMON FEAR
Nearly 40% of students report some fear of tests, or test
anxiety.
Ignoring your fear of tests can seriously affect your academic
performance. That’s why it’s so important to deal with your
anxiety as early as possible.
The good news is, test anxiety is a learned behavior. That
means it can be unlearned and treated successfully!

4. Two Phases
Mindfulness-based systematic
desensitization consists of:
I. 3 weeks of practicing relaxation
by learning to breathe deeply and
smoothly from the belly (which is
called automatic abdominal
breathing)
I. 5 weeks of practicing
systematic desensitization by
facing 20 frightening situations
while remaining calm and relaxed
➔

5. GRADUALLY REDUCING FEAR
The goal of mindfulness-based systematic
desensitization is to help you overcome your fear of
tests.
You will do this by facing 20 fear-producing situations
(one at a time) while you keep a steady, focused, and
calm state of mind.
Numerous studies show that gradually reducing fear in
this way – what is called systematic desensitization – is
effective for helping with test anxiety.

6. COUNTER-CONDITIONING
Systematic Desensitization works through something
called counter-conditioning – replacing your usual
negative response (fear and anxiety) to an event or
experience that seems scary (like a test) with a more
positive, useful response – like mindful calm!

7. Counter-Conditioning in Action
In the picture to the right, the scary
vacuum cleaner leads to barking (the
dog’s usual negative response)…until
the lady gives the dog a steak when
she vacuums.
Now the steak is associated with the
vacuum. This creates a positive
response – the vacuum isn’t scary
anymore because it means there will
be yummy steak!
YOU will use this idea to reduce your
usual negative response of test anxiety.
Let’s look at this more closely!

8. WHAT IS MINDFULNESS?
Being mindful basically means breathing automatically from the
abdomen in order to physically relax the body, and feel composed
and calm in order to help you to paying attention more effectively
to whatever you choose to pay attention to for as long as possible.
When you’re being mindful, you are aware of what you’re thinking
and feeling, but you’re not judging it as good or bad. Instead, you
gently accept it. Doing this is more effective than trying to force
thoughts or feelings away.

9. MINDFULNESS:
Example
As an example, just notice what happens if you try really hard not to
picture a blue elephant – now you can’t stop picturing it, and you might
even feel annoyed with yourself for picturing it! Then it really won’t go
away!
When you’re practicing mindfulness, you’ll notice that you’re picturing
a blue elephant, but you let yourself feel OK about experiencing it
(that’s what is meant by being “no-evaluation and thought”). Then you
gently let it go, and you can place your mind on something else more
useful instead.
This might either sound really easy or really hard – it’s kind of both! But
don’t worry, with practice, anyone can become more mindful. It’s a skill
that just takes a little time to develop.

10. MINDFULNESS-BASED AUTOMATIC
ABDOMINAL BREATHING
The automatic abdominal breathing part of the training will help you to not
only relax your tense body but also regulating your Ph levels by balancing your
carbon dioxide and oxygen levels in the blood which is known to increase anxiety.
By effortlessly experiencing the sensations of each rising and falling of the
abdomen for three minutes in a no-evaluative way, you will be able to focus with
awareness sustained by deep physical relaxation and mindful calm.
The 4 mindfulness strategies will help you to reduce stressful, and fearful
thoughts, feelings and reactions by being fully present with them. Research
shows that when you run away from your fears, they actually get worse.
Mastery of the above three, will provide you with an effective counter
condition to test anxiety

11. MODULE I: Automatic Abdominal
Breathing
The Preparation
Each day for five days, you will practice for 3 five-minute
sessions, with one minute of rest in-between each session.
Put away anything in the room that can distract you. Silence
your phone and turn off the TV, computer, or whatever else
might tempt you away from focusing on this practice.
Find a comfortable place to sit – where you can have your feet
flat on the floor, legs uncrossed. Sit up as straight as you can,
but don’t tense up your back. It’s OK to lean against the back of
the chair, couch, etc.

12. Automatic Abdominal Breathing
Preparatory step: Get motivated first!
When you feel comfortable, take a few moments to remind
yourself why you are doing this practice: to let go of your fear
and develop internal, calm focus!
Give yourself some encouragement – keep your eye on the
goal. Remember, it’s normal to have moments of boredom,
frustration, mind wandering, etc. There is a reason mindfulness
is called a practice – it takes time to learn but don’t give up!

13. Automatic Abdominal Breathing
Practice Step 1: Abdominal Breathing
Now close your eyes. Place your left palm on your abdomen (lower
belly), and the right palm on your chest. Relax your belly – don’t suck it
in!
Whenever you are ready, recall your goal and motivation, and then
with what you feel is the right amount of effort needed, patiently begin
to deliberately breathe from your belly as naturally and comfortably as
you can.
Learn to match each in-breath (inhalation) with the rising (expanding)
of the belly, and each out-breath (exhalation) with the falling of the
belly. The palm on your belly should rise when you breathe in and fall
when you breathe out, while the palm on your chest should remain
pretty still during the entire process.

14. Automatic Abdominal Breathing
Practice Step 2: Abdominal
Breathing, cont.
As you let your palm on the abdomen rise
and fall accordingly with each inhalation and
exhalation, focus on letting each rising and
falling of the abdomen happen naturally and
comfortably.
Eventually find your most comfortable and
natural abdominal breathing pattern
Be patient, and just let the process unfold
– try not to put too much effort trying to
engage in abdominal breathing. At the same
time, do not be overly lax.

15. Automatic Abdominal Breathing
Practice Step 3: Deep relaxation, and composed calm
feeling
As the abdominal breathing gets more and more comfortable and natural, allow
yourself to notice and enjoy the deep relaxation that it creates in your body. With
each inhalation and rising of the abdomen imagine taking in O2 feeling energized and
with each exhalation and falling of the abdomen imagine yourself releasing Co2
feeling your body relax more and more. The more you relax your body, the more your
mind settles into a state of calm.
Allow yourself to experience this focused calm feeling. If it is hard for you to create
or hold on to the calm feeling, you may wish to think about a calm feeling that you
experienced recently. Focus on the feeling until you can experience it in the moment,
and then let it increase the deep relaxation in your body that comes from abdominal
breathing. When the feeling fades, you may wish to recall the experience again to
bring the feeling back. With repeated practice, the calm feeling becomes more
focused. You will now experience mindful calm.
When you can generate a mindful calm feeling, at some point you will notice that
your face will soften and relax into a serene smile like expression. Any time the
feeling wanes simply induce the serene expression in your face since research shows
that doing so will make it easier to experience focused mindful calm.

16. Automatic Abdominal Breathing
Practice Step 4: Breathing automatically and focusing
on the sensations of each rising and falling of
abdomen for 3 minutes
As you feel the relaxation and the mindful calm feeling
that goes along with it, you will notice at some point in your
practice that you can breathe smoothly and naturally from
your belly. You no longer have to deliberately focus on
matching your breathing with the movements of your belly –
it just happens!
You can now become aware of each naturally rising and
falling sensations of the abdomen. Your awareness will
follow each sensation of the rising and falling effortlessly
just like when your eyes can follow the rising and falling of
each wave in the ocean.
*

17. Automatic Abdominal Breathing
Practice Step 4: continuation
Should your continuous awareness on the sensations of each rising and falling
of the abdomen begins to wane, gently relax the amount of effort you are
putting into the task. However, do not relax too much since you may lose
awareness of the sensations of the abdominal movements. Simply follow the
sensation of each rising and falling of the abdomen just like following the rising
and falling of each ocean wave.
With increasing practice, it will become easier for you to maintain awareness,
and very soon you will not have much difficulty to maintain awareness for 3
minutes without distractions.
l*If you face any difficulties during training and mastering any of the automatic
abdominal breathing components, make sure you discuss the issue with the RA
during the weekly group session.*

18. REVIEW
Strategies 1-2(1)Breathe from the abdomen and not the chest by fully relaxing
the abdominal muscles to facilitate clean even smooth rising
and
falling of each abdominal movement.
(2)Find you most comfortable and natural breathing and balance each
inhalation and exhalation with each rising and falling of the abdomen.
Able to do so without difficulty… 8 – 10
Your reward: 5 stars Excellent work!
Able to do so only partially………. 4 – 6
Your reward: 3 stars Need more practice
Not able to do so at all……………….1 – 2
Your reward: 1 star Seek help from therapist
Move on to the next step (c) only when you score 8 – 10.

19. REVIEW
Strategy 3 Engage in automatic abdominal breathing to induce deep physical
relaxation and a focused calm feeling. Eventually you find find your face
experiencing a serene expression which makes it easier to focus your awareness
Able to do so without difficulty… 8 – 10
Your reward: 5 stars Excellent work!
Able to do so only partially………. 4 – 6
Your reward: 3 stars Need more practice
Not able to do so at all……………….1 – 2
Your reward: 1 star Seek help from therapist
Move on to the next step (d) only when you score 8 – 10 on this task.

20. REVIEW
Strategy 4
Increasingly awareness of the sensations of each rising and falling of the abdomen
becomes effortless, and can maintain it continuously for three minutes in a state of
deep physical relaxation and focused mindful calm in a state of serenity
Able to do so without difficulty… 8 – 10
Your reward: 5 stars Excellent work!
Able to do so only partially………. 4 – 6
Your reward: 3 stars Need more practice
Not able to do so at all……………….1 – 2
Your reward: 1 star Seek help from therapist
Move on to the next step (e) only when you score 8 – 10 on this task.

21. Strategy 5 Change your behavior if you need to
l When you score less than 8-10 on any of (a) - (d) during the training, first try to
figure out what didn’t go quite right, and what you need to do to improve in the
next session. Then make the correction and master it in the next session.
REVIEW

22. 6. Predict how you will react
Once you know what to do differently in the next session, predict what your score will
be after your next practice session. How confident are you in your prediction?
Fully confident……………………………8 – 10
Your reward: 5 stars Excellent work!
Partially confident …………………… 4 – 6
Your reward: 3 stars Need more practice
Not confident at all……………………1 – 2
Your reward: 1 star Seek help from therapist
Move on to the next stage when you score 8 – 10.
REVIEW

23. 7. Generalization
Generalize the mindfulness skill to daily anxiety provoking situations
Able to so without difficulty…….8 – 10
Your reward: 5 stars Excellent work!
Partially able to do so ……………..4 – 6
Your reward: 3 stars Need more practice
Unable to do so at all……………….1 – 2
Your reward: 1 star Seek help from therapist
Move on to the next stage when you score 8 – 10.
REVIEW

24. Things to keep in mind
ACCEPTANCE OF YOUR THOUGHTS
When you experience anxious thoughts and feelings, you can best deal
with them by learning to respond to them in a non-evaluative way;
therefore, accepting what you are experiencing.
Non-reactive means don’t freak out about them and instantly try to do
something about them.
Non-evaluative is just like it sounds: don’t figure out what it is about,
and don’t be negative about what you’re thinking or feeling. Both
reactivity and evaluative thinking increase negative thoughts and
feelings.
Acceptance means you’re OK with your thoughts and feelings as they
are, no matter how much they might make you trip. Remember, fear
makes them seem like facts, when in reality they are just exaggerated
thoughts! Accept and set them free!

25. YOU CAN RUN, BUT YOU CAN’T HIDE
Yep, accepting anxious thoughts and feelings is hard to do! You
may want to run away or distract yourself by texting your 100
closest friends. This won’t help you – you can run, but you
can’t hide!
When you have successfully applied and managed these
thoughts and feelings, come back to the even, smooth
abdominal breathing, along with the deep physical relaxation
and the mindful calm feeling that goes with it.

26. MODULE II: Mindfulness of Sensations, thoughts,
feelings and reactions
l1. Regarding anxious thoughts and feelings are not facts, and
l creating mental and spatial distance between the
l self as the observer, and sensations, thoughts,feelings and
l reactions as the observed
l2. Then engaging in automatic abdominal breathing and generating
l accompanying deep physical relaxation, and mindful calm
l3. Learning to let go of each sensation, thought, feeling and
l reaction
l4. Recalling and reliving the above three processes of mindfulness
step by step with curiosity and interest.

27. l
Mindfulness Strategy 1
As you begin practicing sustained awareness of the sensations of each
rising and falling of the abdomen, you might notice that your mind
starts to wander. Maybe you’re thinking about an upcoming test, or
you hear a text message come through, a car passing, etc. Don’t worry
when your mind strays – this is normal, just your brain being itself.
Try not to react strongly to your mind wandering or to judge yourself
for it.
Acceptance of anxious and negative thoughts and feelings takes time.
As a result, you might become frustrated when you don’t get it right
away. Don’t worry, this is normal.

28. Remind yourself that you are not your thoughts and feelings,
and you are free to choose not to participate in and react to them.
To develop conviction this is the case,you may recalling a past
situation where you were sure that you were going to fail, or
be fired, and you thought, “I won’t be able to face the world,”
but later things didn’t turn out that way.
Anxious thoughts and feelings are just thoughts and feelings,
not facts.
Mindfulness strategy I cont

29. Mindfulness Strategy 2
lNow that you have befriended your anxious thoughts and
feelings, engage in sustained awareness of sensations of
each rising and falling of the abdomen to induce the
laccompanying deep physical relaxation and
lmindful calm along with a calm facial expression

30. Mindfulness Strategy 3
lNow that you can relate to your anxious thoughts and feelings by
being able to be aware of them in a no-evaluative way. you may
wish to let them go when they have played out their course. Letting
go does not mean trying to get rid of them by expelling them out of
your mind.
lInstead, you simply take them and imagine putting them in a
mental box which you then store in a deep part of your memory. In
the future, when you are ready, you may the recover the
information to look into it further. Should that anxious thought
arises all of a sudden, you now know where it is coming from.

31. Mindfulness Strategy 4
lOnce you have mastered the strategies in managing your anxious thoughts
and feelings, shift to self-discovering about your mindfulness experiences
of anxious thoughts and feelings from a state of deep curiosity, openness and
interest.
lIn a state of curiosity, recall and relive your experiences of what you went
through during the preceding three mindfulness strategies as accurately as
possible step by step. Make sure you are in a state of relaxed, mindful calm
induced by engaging in automatic abdominal breathing.
lTo help you recall accurately, you may wish to remember something
significant such as how you were sitting, thinking, feeling or even something
about the room, or sounds you may have caught your attention when you
begin engaging in mindfulness.Recall the information and the context to
help you remember and relive the experience.

33. LEARN TO CUE
YOURSELF INTO
MINDFUL CALM
Finally, when you are able to experience mindful calm,
choose a word or expression that you can use as a cue to
instantly bring you back to this mindful state. A cue is a
word that can activate that desired state without you having
to go through each of the steps of the practice.
Choose a word or words that work for you, such as “mindful
calm,” to bring about the desired state. As soon as you say
the cue word(s), you should be able to go into the state of
mindful calm joined with deep relaxation of the body
created by automatic abdominal breathing.

34. REVIEW
Strategy 1. Your anxious thoughts, feelings and reactions are just thoughts,
feelings and reactions and not facts, and the conviction helps you to
maintain mental and spatial distance from and observe your thoughts,
feelings, and reactions in a non-evaluative way even as you let them unfold.
Can do so fully…………………...……. 8 – 10
Reward: 5 stars Excellent work!
Can engage in the process partly…………………………….4 – 6
Reward: 3 stars Need more practice
Can’t engage at all………………………………………………….1 – 3
Reward: 1 star Seek help from therapist
Move on to (c) only when you score at the level of 8 – 10.

35. REVIEW
Strategy 2 Induce deep physical relaxation, and focused mindful calm as you engage in
automatic abdominal breathing and mindful calm with a serene facial expression
Can do so fully………………………. 8 – 10
Reward: 5 stars Excellent work!
Can do so partly……………………. 4 – 6
Reward: 3 stars Need more practice
Can’t do so at all………………….. 1 – 3
Reward: 1 star Seek help from therapist
Move on to (d) only when you score at the level of 8 – 10.

36. REVIEW
Strategy 3 Let go of anxious, and distressing thoughts, feelings, and responses by
putting them in a mental box for storage ready for future recall.
Can let go fully………………………….8 – 10
Reward: 5 stars Excellent work!
Can let go partly……………………….4 – 6
Reward: 3 stars Need more practice
Can’t let go……………………………….1 – 3
Reward: 1 star Seek help from therapist
Move on to (e) only when you score at the level of 8 – 10.

37. REVIEW
Strategy 4 Recall and relive each detail of preceding mindfulness experiences step by
step with curiosity and openness leading to self discovery about how one
senses, thinks, feels and responds.
Able to do so fully…………………8 – 10
Reward: 5 stars Excellent work!
Able to do so partly………………4 – 6
Reward: 3 stars Need more work
Not able to do so at all………..1 – 3
Reward: 1 star Seek help from therapist
Move on to the next stage only when you score 8 – 10 on the task.

38. REVIEW
6: Modifying your practice
When you score less than 8 – 10 on any of (a) through (e) during the
training, first figure out what needs fixing, and then figure out what you
now need to do in order to improve in the next session.

39. 7. Predict how you will react
Once you know what to do differently in the next session, predict what your score
will be after your next practice session. How confident are you in your prediction?
Fully confident……………………………8 – 10
Your reward: 5 stars Excellent work!
Partially confident …………………… 4 – 6
Your reward: 3 stars Need more practice
Not confident at all……………………1 – 2
Your reward: 1 star Seek help from therapist
Move on to the next stage when you score 8 – 10.
REVIEW

40. 8. Generalization
Generalize the mindfulness skill to daily anxiety provoking situations
Able to so without difficulty…….8 – 10
Your reward: 5 stars Excellent work!
Partially able to do so ……………..4 – 6
Your reward: 3 stars Need more practice
Unable to do so at all……………….1 – 2
Your reward: 1 star Seek help from therapist
Move on to the next stage when you score 8 – 10.
REVIEW

41. CREATING A HIERARCHY
On the next screen, you will see a list of 20 test
anxiety-creating situations. Please rank these situations
that commonly cause test anxiety in order, from the
least anxiety-causing scenario to the most anxiety-
provoking scenario.
Use the numbers 1 to 20 to rate the situations, where 1
represents the scene that causes you the least fear and
20 represents the most anxiety-causing situation. Use
each number only once so that no two situations have
the same score.

42. 1.When you start studying for a test
2.Studying a couple of days before a test
3.The morning of the test
4.Waiting for the test to be passed out
5.First getting the test and looking it over
6.Thinking about how well you are doing compared to
others
7.Having the instructor walk around the room during the
exam
8.Seeing others finish the test while you are still taking
the test
9.Announcement of a pop quiz
10.The first time the teacher mentions a test, a few
weeks or a month before it is given
11.Reviewing your class notes one week before a
midterm exam
12.You enter the class just before the exam, and the
professor reminds everyone that a large percentage of
your grade will be based on this exam
1.The first question that you can't remember
answer to (even though you know it)
2.Seeing a question you do not know the answer
to
3.Looking at the test and not immediately
knowing the answer to the first couple of
questions.
4.Reviewing answers before handing in a test
5.The night before a test, trying to cram into
your head what you don't know and realizing
that time is almost up
6.Entering the classroom on the day of the test
7.Reviewing your notes just prior to the test and
still wondering if it is enough
8.Going back to the answers you didn't know at
first, and putting down an answer you're still not
sure of

43. GUIDED IMAGERY
Steps to conduct self-guided imagery of the test anxiety-provoking scenarios
The entire success of systematic desensitization depends on your
ability to imagine your anxiety-provoking situation as realistically
as possible. To do so, picture the scene vividly and in complete
detail.
Imagine the sensations, sights, and sounds in the scene as you
would actually experience them.
Imagine the facial expressions, gestures, body postures, and
movements of yourself and others.

44. l Hear your own voice and words as well as those of other(s).
l While in a state of deep relaxation and inner calm , combine all of
the above processes and recall these details of the specific test
anxiety-causing situation as vividly as possible.
l When you have, use the state of deep relaxation and mindful
Calm with a serene facial expression to counter the anxiety-provoking
scene confidently and successfully. In particular, identify the
images that trigger the most anxiety and bring them into great detail.
GUIDED IMAGERY
Steps to conduct self-guided imagery of the test anxiety-
provoking scenarios

45. EXAMPLE OF GUIDED IMAGERY of an test anxiety
provoking situation:
Start imagining that you are at school, walking to class. It is a
clear day, and you can feel the sun beaming down on you. There is
a light breeze that allows you to pick up the scent of freshly cut
grass. As you get closer to your class, you hear a couple of
students walking near you, talking nervously about an exam they
are about to take. The students are going over last-minute
material, discussing and arguing about how hard the exam will be,
and wondering what topics the professor has decided to put on the
exam. You notice the anxious, worried looks on their faces and
their tense bodies fidgeting constantly. As you get close to them,
you see them sweating.
Picture yourself fully relaxed and visualize yourself in this
scenario as a confident and successful student by cueing
yourself into a state of mindful calm.

46. Time to Start Your Mindfulness-Based
Systematic Desensitization Treatment
Important factors to keep in mind before you begin:
In order for you to benefit from this program, you must make a
commitment to yourself and to the program. Please be honest in
your responses. This procedure requires you to dedicate time
and effort. Therefore, it is your responsibility to follow all
instructions.
This method is very successful in helping individuals with
certain types of phobias, fears, and anxieties. However, the
benefits you receive can only be as great as the effort you put
forth.
You are now ready to formally begin the program.

47. 4 Steps of Systematic Desensitization
(during each session)
Step I: Begin with a 5-minute practice of automatic abdominal
breathing to create the mindful calm accompanied with deep
relaxation of the body. Then cue yourself with the words
“mindful calm,” or any other words that work for you, to
maintain the state.
Step II: While maintaining the mindful calm accompanied with
deep relaxation of the body, engage in exposure to the each
detail and step of the relevant anxiety-provoking scene in the
list. Picture yourself being in a state of mindful calm
accompanied with deep relaxation of the body, going through
the situation confidently and successfully.

48. Step III: After the exposure, rate your level of anxiety. You will
do this at the end of each trial.
Step IV: Conclude the session with a 5-minute practice of
automatic abdominal breathing-based mindfulness to improve
your ability to generate and maintain the mindful calm
accompanied with deep relaxation of the body.
4 Steps of Systematic Desensitization
(during each session)

49. #2: 10-15 min. exposure to anxiety provoking
scenarios
STEPS OF SYSTEMATIC DESENSITIZATION
#1: 5 min. automatic abdominal breathing (deep
physical relaxation with mindful calm)
#3: Report anxiety level after each trial
#4: 5 min. automatic abdominal breathing (deep
physical relaxation with steady, composed mindful
calm

50. Practice Schedule for Systematic Desensitization
•You will practice for 25 minutes daily (two pre and post 5-minute
sessions of automatic abdominal breathing based mindfulness, and 10-
15 minutes of systematic desensitization) for 5 days each week for 5
weeks. The systematic desensitization will consist of sequential
exposure to 20 test anxiety-producing situations.
•
•You will engage in three 30-second trials to overcome your anxiety
associated with each of the 20 situations. After 3 trials in a row, if you
have overcome your anxiety as reflected by your score of 2 or less out
of 10, you will move on to the next scenario in the hierarchy.
However, if your score is above 2 during any of the three trials (that
is, you experience the slightest anxiety), you should do two additional
trials. When your scores in both are 2 or less, then move on to the
next scenario. Otherwise, go back to the preceding

51. Practice Schedule for Systematic Desensitization
•scenarios that you have successfully overcome and start again
•If during any of the 30-second trials you experience any kind of
distress, immediately press the key bar to STOP. Instructions, along
with a neutral, calm picture, will appear and cue you to induce the
mindful calm accompanied by deep relaxation of the body until
your distress is relieved, at which time you should return to the next
trial.
•It is recommended that you do not attempt to desensitize yourself to
more than three of your anxiety hierarchy items per session/day.

53. Test Anxiety Scenario (#)
Visualize that you are (Scenario 1 Title will show up) right now. Picture yourself fully in
this anxiety-provoking scene in as great detail and as vividly as possible, while in the
mindful calm accompanied with deep relaxation of the body.
After the first 30-second trial, you will be asked to rate your level of anxiety on a scale
of 1 to 10.
After 3 trials in a row with little or no anxiety, as indicated by a score of 2 or less, you
will move onto the next scene in the hierarchy. If your score is above 2 during any of
the three trails, you should do two additional trials. It is very important that you
experience no noticeable form of anxiety, and in fact feel completely relaxed and
in a state of mindful presence and acceptance, during and after the entire imagery
process. When your scores on both are 2 or less, only then move on to the next
situation. Otherwise, go back to the last scene and start over again.
Press FORWARD when you are ready to begin the trial.

54. YOU ARE READY TO BEGIN!
Now, create mindful calm by doing the 5-minute practice of Automatic
Abdominal Breathing Mindfulness. Then, cue yourself with the words
“mindful calm,” or your choice of cue words, to help you maintain the state,
followed by pressing ENTER to begin the exposure to the relevant test
anxiety-provoking scene.
Remember to hit the spacebar if you experience discomfort at any time
during the 10-15minute exposure. This will pause the program, and you will
be cued with a calm, neutral picture to induce mindful calm accompanied
with deep relaxation of the body. If you find that the cue does not work,
you may wish to do 5 minutes of practice in automatic abdominal breathing-
based mindfulness. Hit the spacebar when you have created the desired
state, and then press the spacebar again to return to the systematic
desensitization process. When you are ready to begin, press FORWARD.

55. 5 Minutes of Automatic Abdominal Breathing-
Based Mindfulness
Conclude the session with 5 minutes of
automatic abdominal breathing to bring about
mindful calm accompanied with deep
relaxation of the body.

56. WHEN YOU RUN INTO PROBLEMS
A few major problems you could encounter during treatment
Experiencing little or no anxiety during the exposure to an anxiety
provoking scenario.Often this can occur because you may not be
imagining the scenario vividly enough, as if you are really in the scenario
at that moment. The more real the self-imagery of the scenario is, the
more likely you are to successfully overcome the related test anxiety.
When the scene you imagine creates less anxiety than one that
came before.
When you encounter these problems, please contact the research
assistant assigned to you via email or Skype for instructions to
resolve the problem. You are encouraged to discuss the issue during
the weekly group Skype conference.

57. HOMEWORK ASSIGNMENT (a)
Whenever you are studying, preparing for an exam taking an exam, or when you
encounter test-related anxiety thoughts or any type of stress in general, use these
techniques!
Examples of test anxiety thoughts that you may experience:
I can’t concentrate on this test.
I hate tests because I always get so anxious.
What’s going to become of me if I don’t do well?
My family will be so disappointed, they won’t love me as much if I don’t
do well on this.
If I blow this test, it’s my whole career, my whole life.
If I don’t know the answers to these first three questions, I’m probably
going to flunk.
Everyone else knows the right answers.
During weeks 2 – 8, you should start applying your mindfulness skills to help
you study better, and also to help you better manage test-anxiety-related
thoughts and feelings, as well as any type of stress you may experience.

58. HOMEWORK ASSIGNMENT (b)
Weeks 2-8
First, use a cue such as “mindful calm” to create mindful calm
accompanied with deep relaxation of the body. Then maintain that
state while studying.
When you experience test anxiety at any time, instantly cue and
maintain mindful calm accompanied with deep relaxation of the body.
Then use the 5 steps you have learned to manage anxious thoughts and
feelings. However, make sure you avoid test-anxiety-causing scenarios
that you encounter during real life that you have not been desensitized
to as yet.
If you face difficulties with any particular part of the practice, make sure you
address them with the Research Assistant and the group during your weekly
session.

59. Post-Session: Every third day of
Systematic Desensitization
After the training session, please take 15 minutes to complete:
Metacognitive Processing Questionnaire
Quiz on test preparation
Test-Taking Skills Questionnaire