Breathing exercises reduce test anxiety in middle school students

A new study published in Personality and Individual Differences has found that a structured breathing exercise program helped lower test anxiety in eighth-grade students preparing for Turkey’s centralized high school placement exam. The findings suggest that incorporating breathing routines into school schedules may be a practical and low-cost way to support mental health during high-pressure academic periods.

In many countries, high-stakes standardized exams can determine a student’s educational future. In Turkey, the centralized high school placement exam plays a pivotal role in admissions to top schools and, by extension, access to prestigious universities. These exams often trigger high levels of stress and anxiety, especially among middle school students who are navigating academic pressure alongside significant developmental changes.

Test anxiety has been linked to lower academic performance, with studies suggesting it can account for as much as 20 percent of the variation in standardized test outcomes. Meanwhile, self-esteem—how positively a person views themselves—has been shown to act as a buffer against stress and anxiety. Prior research has identified a negative relationship between self-esteem and test anxiety, suggesting that improving one might help reduce the other.

While there is growing interest in school-based mental health interventions, most studies have focused on high school or university students. Research on middle schoolers preparing for high-stakes tests has been relatively limited. This study aimed to fill that gap by evaluating whether a breathing exercise program could reduce test anxiety and improve self-esteem in a younger, academically vulnerable population.

“Central exams play a significant role in shaping students’ future careers in the Turkish education system, making test anxiety a common experience among them. The study aims to address the intensification of test anxiety as exams approach, emphasizing the need for timely educator support to manage this uncertainty,” said study author Derya Uysal, an associate professor at Alanya Alaaddin Keykubat University.

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“To address this, the study incorporated breathing exercises into the routines of eighth-grade students during the three months leading up to Turkey’s high-stakes centralized exam—a period of peak anxiety. This intervention was scheduled to begin three months before the exam to ensure participation while students were still attending school. Given the exam’s significant impact on admission to top high schools and universities in Turkey, the study evaluates the effectiveness of the intervention in reducing test anxiety and enhancing self-esteem, which may serve as a protective factor in this high-stakes context.”

The research took place during the spring of the 2023–2024 school year in Alanya, Türkiye. The study involved 162 eighth-grade students (78 boys and 84 girls) from two academically high-performing public middle schools. Because randomly assigning students to different conditions was not feasible, the researchers used a quasi-experimental design with pre-test and post-test assessments.

Participants completed two psychological scales before and after the intervention: the Rosenberg Self-Esteem Scale, which measures overall self-worth, and the Spielberger Test Anxiety Scale, which assesses anxiety levels related to exams. The study also included a short questionnaire with two open-ended questions to capture students’ subjective experiences.

The intervention itself was an eight-week Breathing Exercise Program (BEP), delivered twice a week before morning classes. Each session lasted 15 to 20 minutes and was led by a physiotherapist with expertise in breathing techniques. The program featured 12 types of exercises, such as diaphragmatic breathing, lion’s breath, and affirmation breath, along with complementary strategies like cognitive restructuring and stress inoculation.

The researchers confirmed a statistically significant negative correlation between self-esteem and test anxiety before the intervention. Students with lower self-esteem tended to have higher levels of test anxiety, supporting earlier findings on the link between these two psychological traits.

After completing the eight-week breathing program, students showed a significant drop in test anxiety scores. On average, their scores decreased by 5.05 points—from 44.90 to 39.85—which represents a small to moderate effect size. Seventy percent of students said in their written responses that the breathing exercises helped them feel calmer and more focused during the exam.

However, the increase in self-esteem scores was relatively minor and not statistically significant. Students’ average scores rose from 28.39 to 29.09, but this change fell short of the threshold needed to be considered meaningful. This suggests that while the breathing exercises effectively reduced anxiety, they were less successful at shifting students’ overall self-perception in a short timeframe.

Qualitative data echoed these findings. Most students described feeling nervous or anxious before the exam, with common emotions including fear of failure, stress, and physical symptoms like nausea. After the breathing sessions, many said they felt more in control and better able to manage their stress, although a minority reported no noticeable change.

The study highlights the potential of integrating short, structured breathing exercises into school routines to reduce anxiety in students facing high-stakes exams. Unlike more resource-intensive interventions such as therapy or full-scale cognitive-behavioral programs, a breathing routine can be delivered by trained staff within existing class schedules, making it a feasible option for many schools.

“This study suggests that schools can easily incorporate structured breathing exercises into daily routines for meaningful psychological benefits at low cost,” Uysal told PsyPost. “Combining these exercises with CBT or social-emotional learning could enhance effectiveness for anxiety and self-esteem.”

As with all research, there are limitations to consider. Because it used a quasi-experimental design, the researchers cannot conclusively say that the breathing program caused the changes in anxiety. A randomized controlled trial would be needed to make stronger claims about effectiveness. Additionally, the study was limited to two schools in one Turkish city, which may affect how generalizable the findings are to other regions or educational systems.

The researchers suggest that future studies use randomized controlled trials to validate the breathing intervention’s effectiveness and examine its long-term effects. They also propose integrating breathing exercises with broader mental health strategies, such as cognitive-behavioral programs or social-emotional learning, to better address both anxiety and self-esteem.

There is also room to explore whether these benefits extend beyond test periods and into other areas of school life, such as classroom engagement or peer relationships. Understanding how breathing-based interventions interact with other psychological factors—like motivation, emotional regulation, and identity development—could help refine school-based mental health programs and make them more impactful.

“While the current study underscores the potential of breathing exercises to reduce test anxiety, future research must focus on more robust study designs and interventions that target both anxiety and self-esteem in this population,” Uysal said.

The study, “Breathing exercises’ impact on test anxiety and self-esteem in a high-stakes centralized exam setting,” was authored by Ayça Araci and Derya Uysal.