By Dr T Govender

South Africa is a very competitive environment. With a high unemployment rate and limited access to tertiary education, finding a place in a tertiary education facility is difficult. Places are awarded on exam performance. The better the results, the better the opportunity of selection. As a result, exams are a crucial part of the education process. This makes them a significant source of stress for students. And their parents.

What is the difference between stress and anxiety?

Anxiety is considered to be a mental health disorder. An anxious person is plagued by a constant sense of fear, uneasiness and apprehension even when there is no perceived threat. It may be caused by a chemical imbalance in the brain and is often genetic. This type of anxiety disorder requires treatment from a mental health professional. Stress is a temporary state of anxiety related to a threat or challenge in the environment. Chronic stress can result in a permanent state of anxiety which can complicate into a myriad of medical and mental health illnesses.

Is exam stress a problem?

Grade twelve results are considered to be the passport to the future. Possible poor study habits throughout the year cause learners and their parents to become very driven, and hyper-focussed, in order to achieve the best outcomes over a short time-frame. The suicide rate in adolescents is around 10% of those in the general population. This additional exam stress may become a risk factor in a vulnerable teenager. It is imperative that we determine the difference between normal functional stress experienced by learners going through an exam cycle, and the alarm bell sounded by a learner who needs urgent attention from a healthcare professional.

The definition of stress

Stress is a natural response to a challenge or a threat. Cortisol and adrenaline, the stress hormones, are activated which results in a fight or flight response. Stress is not always a negative experience. It is the mechanism with which we adapt to challenges in our environment, whether the challenges are slow-building, long-term stresses or sudden, confrontational ones. These physiological responses can help us improve our performance. Stress can cause you to completely lose control of a situation and be unable to concentrate or it can allow you to remain focused and alert and able to meet the challenge. If used correctly, stress can play a critical role in creating drive and motivation when it comes to study and exams.

Types of stress

There are two types of stress:

Acute episodic stress

This episode of stress is brief and related to a specific event such as writing exams or having too many deadlines or commitments. It is usually self-limiting and passes when the event is over.

Chronic stress

This is a harmful type of stress and lasts for a long time. A child living in a dysfunctional family, struggling with ongoing bullying at school, or an adult with chronic work and financial stress are three examples. Because the body remains in the heightened fight or flight response for a sustained period, the stress itself becomes dangerous. The complications associated with chronic stress include health issues such as worsening hypertension, heart attacks, strokes, gastric ulcers, substance abuse, depression and suicide.

Symptoms of chronic stress

How do you know if you, or your child, has chronic stress? There are four areas in which symptoms reveal themselves.

Cognitive symptoms

• Difficulty concentrating and short-term memory problems
• Constant anxiety and a racing of thoughts which are often worse at night and affect sleep
• Irrational and negative thoughts

Emotional symptoms

• Irritability and agitation
• Depressive mood
• Anxiety state

Physical symptoms

• Headaches
• Dizziness
• Nausea
• Chest discomfort
• Irritable bowel (diarrhoea and constipation)
• Low immunity – resulting in frequent infections

Behavioural symptoms

• Eating too much or too little
• Sleeping too much or too little
• Social withdrawal
• Substance abuse

These symptoms may or may not result in healthy solutions being sought by the family. Chronic stress and anxiety often result in cognitive challenges. Children often complain of the inability to focus and parents often have a knee-jerk reaction and seek a stimulant to assist their child to focus. It is often unwise to put the child on a course of drugs containing stimulants such as Ritalin at this point. Ritalin can increase anxiety symptoms in children who are not truly ADHD.

Cannabis oil and children – what you need to know

Cannabis oil has had a surge in popularity after it has been recently legalised for medicinal and domestic purposes. However, it is not legal for use by minors. We would advise extreme caution in giving your child any form of cannabis. Irrefutable proof from several scientific studies has demonstrated that cannabis can cause psychosis in individuals that are genetically susceptible, particularly in the vulnerable brain of a child. Your child may become paranoid and even more anxious on cannabis.

How to manage stress

Doctors do not prescribe long term medication for stress. A patient will only need a more permanent medication solution if the stress results in a physical or mental illness.

There are ways to reduce chronic stress without medication

Thankfully, there are non-medication solutions to reducing chronic stress. Here are a few.

Time management skills and organisation

Teaching your child to study correctly throughout the year means that the period just before exams will be revision and will not carry the weight it would otherwise. During the pre-exam revision time, help your child to prepare in advance, create study timetables and to prioritize. This will give them a sense of accomplishment. Teach them to prepare in small increments and not to become overwhelmed by mammoth tasks. Focus on areas of the curriculum that your child needs to improve on.

Nutrition

A healthy brain needs nutritious food. Children should not skip meals, not only from a nutrition point of view but also as a period of important break time. Mealtimes should be used by the student to engage with the family and verbalise their emotions. A healthy, moderately portioned meal will provide sustenance and not lead to over-eating and sleepiness. Avoid sugary foods that may impair concentration.

Exercise

Exercise should be given equal priority. There are several studies which show exercise can cause a flood of ‘feel good hormones’ into the brain. Children should be encouraged to engage in a physical activity in their break time. This activity could simply be putting on music and dancing, going for a walk or taking a cycle around the block.

Meditation, Mindfulness, Relaxation and Controlled Breathing

Several studies have shown improved outcomes by using techniques such as mindfulness. It gives a learner an opportunity to relax and refocus for the next study period. Ideally, your child should take a class to learn the art of mindfulness, but apps are available on smart devices. The classes help the student overcome the distracting worry that ‘doing nothing’ is a waste of time.

Study Groups

Constructive and supervised study groups allow children to develop a support network with which to share their experiences during examinations. A young learner will realise that she is not isolated in and, in fact, everyone else writing the exam feels the same way. That realisation makes your child realise the exam stress is normal. There is no doubt exams are an extremely stressful period for parents and children alike. It is important to remember, stress is a normal response and, used correctly, can enhance one’s performance. Our ability to cope with stress is determined by our constitution, coping skills and environmental exposure. It is important to keep the channels of communication open to assess your child’s adaptation to a stressful situation or environment. Pay attention when your child is asking for help or displaying signs of not coping. If you have any concerns, please make an appointment with your doctor immediately.

For more information concerning the side effects and management of stress, consult this article.

The lenmed Group is a world-class chain of Private Hospitals that brings quality healthcare to communities across Southern Africa.

For more information please contact:

Dr T Govender
(Specialist Psychiatrist)
MBCHB (MEDUNSA), FC PSYCH(SA)
DCH(SA) Ethekwini Hospital and Heart Centre
Tel: +27 (0) 31 581 2721
Email: [email protected]
Dr Theshenthree Govender has been in the medical field for the past 19 years. In addition to Dr Govender’s consulting from her practices, she also lectures at UKZN Medical School and is an executive on the local South African Society for Psychiatrists. Dr Govender’s interests are psychiatry, biopolar mood disorders, psychotic disorders and neuropsychiatry

Disclaimer: Any information contained here is merely a guideline. Always visit your healthcare practitioner for any health-related advice or diagnosis.