Read time: 6 minutes
You can know the material cold and still underperform if anxiety takes over on exam day. For a five-hour, high-stakes test like the NPTE, managing your nervous system is as much a skill as knowing your special tests. Here are nine strategies that genuinely help.
Before the exam
1. Over-prepare on simulation, not just content
Most test anxiety comes from uncertainty. The single best antidote is having already done the thing. Take at least two full-length, timed mock exams before test day so the format, pacing, and duration feel familiar rather than threatening.
2. Build a pre-exam routine and rehearse it
Decide in advance what you'll eat, when you'll arrive, what you'll bring. Rehearse the logistics so exam morning has zero surprises. Novelty spikes anxiety; routine lowers it.
3. Reframe the physical symptoms
A racing heart and shallow breathing are your body preparing for performance, not signs you're failing. Research on "stress reappraisal" shows that simply relabeling nerves as readiness measurably improves performance.
4. Sleep is a study strategy
Pulling a late night before the exam trades a few hours of low-value cramming for a large hit to memory recall and focus. Protect your sleep the two nights before — the night before and the night before that.
During the exam
5. Use box breathing between sections
At each section break, do a minute of box breathing: inhale 4 counts, hold 4, exhale 4, hold 4. It directly downshifts your nervous system and resets your focus.
6. Answer the easy questions first
On a hard question, flag it and move on. Banking a series of confident answers early builds momentum and calms the "I'm failing" spiral. Come back to the flagged ones with time remaining.
7. Have a scripted response for panic
When your mind goes blank, have a pre-planned move: take one slow breath, reread the last sentence of the question, and eliminate the two weakest options. A rehearsed action interrupts the freeze.
8. Don't keep score in your head
Trying to estimate your running score mid-exam is pure anxiety fuel and is wildly inaccurate anyway (remember, 50 questions don't even count). Focus only on the question in front of you.
9. Take the optional break
Use it. Stand up, stretch, get water, reset. Pushing straight through to save time is a false economy when fatigue is quietly eroding your accuracy.
When anxiety is more than nerves
If test anxiety is severe enough to cause panic attacks or has derailed exams before, talk to your program or a healthcare provider about accommodations and strategies. That is a sign of strength, not weakness.
PassPT's full-length mock exams let you rehearse real test conditions — including the section structure and break — so exam day feels like something you've already done. Free to start.
Found this useful? Share it with a classmate.
More articles →