Test anxiety is a combination of physiological over-arousal, tension and somatic symptoms, along with worry, dread, fear of failure, and catastrophizing, that occur before or during test situations. [1] It is a psychological condition in which people experience extreme stress, anxiety, and discomfort during and/or before taking a test. This anxiety creates significant barriers to learning and performance. [2] Research suggests that high levels of emotional distress have a direct correlation to reduced academic performance and higher overall student drop-out rates. [2] [3] [4] Test anxiety can have broader consequences, negatively affecting a student's social, emotional and behavioural development, as well as their feelings about themselves and school. [5]
Highly test-anxious students score about 12 percentile points below their low anxiety peers. [6] [7] [8] Test anxiety is prevalent amongst the student populations of the world. [9] [10] It has been studied formally since the early 1950s beginning with researchers George Mandler and Seymour Sarason. [11] Sarason's brother, Irwin G. Sarason, then contributed to early investigation of test anxiety, clarifying the relationship between the focused effects of test anxiety, other focused forms of anxiety, and generalized anxiety. [12]
Test anxiety can also be labeled as anticipatory anxiety, situational anxiety or evaluation anxiety. Some anxiety is normal and often helpful to stay mentally and physically alert. [13] When one experiences too much anxiety, however, it can result in emotional or physical distress, difficulty concentrating, and emotional worry. Inferior performance arises not because of intellectual problems or poor academic preparation, but because testing situations create a sense of threat for those experiencing test anxiety; anxiety resulting from the sense of threat then disrupts attention and memory function. [14] [15] [16] [17] Researchers suggest that between 25 and 40 percent of students experience test anxiety. [18] Students with disabilities and students in gifted educations classes tend to experience high rates of test anxiety. [19] Students who experience test anxiety tend to be easily distracted during a test, experience difficulty with comprehending relatively simple instructions, and have trouble organizing or recalling relevant information. [1]
Researchers believe that feelings of anxiety arise to prepare a person for threats. [20] In humans, anxiety symptoms are distributed along a continuum and different symptom levels of anxiety predict outcomes. Responses consist of increased heart rate, stress hormone secretion, restlessness, vigilance, and fear of a potentially dangerous environment. [20] Anxiety prepares the body physically, cognitively, and behaviourally to detect and deal with threats to survival. As a result, a person's body begins to hyperventilate to allow more oxygen to enter the bloodstream, divert blood to muscles, and sweat to cool the skin. [20] In individuals, the degree to which an anxiety response is developed is based on the probability of bad things happening in the environment and the individual's ability to cope with them. In the case of test taking, this might be a failing exam grade that prevents the student from being accepted to a post-secondary institution. A person's beliefs about their own competencies are a form of self-knowledge, which plays an important role in analyzing situations that might be threatening. When a person has feelings of low competence about their abilities they are likely to anticipate negative outcomes such as failure, under uncertain conditions. Thus, evaluative situations including tests and exams, are perceived as more threatening by students who have low competencies. [21]
There is a difference between generalized anxiety disorders (GAD) and test anxiety. GAD is characterized by "trait anxiety" which results in a person experiencing high levels of stress across a wide range of situations. In contrast, people with test anxiety have a "state anxiety" which results in high levels of nervousness specific to testing. [22]
Symptoms of test anxiety can range from moderate to severe. "Students who exhibit moderate symptoms are still able to perform relatively well on exams. Other students with severe anxiety will often experience panic attacks." [23]
Bad physical symptoms include: headache, upset stomach, feeling of fear, feeling of dread, shortness of breath, sweating, pacing or fidgeting, crying, racing thoughts and blanking out.
During states of excitement or stress, the body releases adrenaline. Adrenaline is known to cause physical symptoms that accompany test anxiety, such as increased heart rate, sweating, and rapid breathing. [24] In many cases having adrenaline is a good thing. It is helpful when dealing with stressful situations, ensuring alertness and preparation; [25] but for some people, the symptoms are difficult or impossible to handle, making it impossible to focus on tests.
Test anxiety consists of:
Research shows that parental pressure is associated with greater worry, test irrelevant thoughts, and stronger bodily symptoms relating to anxiety during a test. [21]
Other causes of test anxiety may include fear of failure, procrastination, and previous poor test performance. [27] As well, characteristics of the test environment such as: nature of the task, difficulty, atmosphere, time constraints, examiner characteristics, mode of administration and physical setting can affect the level of anxiousness felt by the student. [5] [21] Researchers Putwain & Best (2011), [28] examined test performance among elementary children when the teacher put pressure on the students in an attempt to create a more high stress environment. Their findings showed that students performed worse in high threat situations and experienced more test anxiety and worrisome thoughts than when in a low threat environment.
Test anxiety is known to develop into a vicious cycle. After experiencing test anxiety on one test, the student may become so fearful of it happening again they become more anxious and upset than they would normally, or even than they experienced on the previous test. If the cycle continues without acknowledgement, or the student seeking help, the student may begin to feel helpless in the situation. [29]
People who experience test anxiety often have parents or siblings who have test anxiety or other types of anxiety. Anxiety does seem to have some genetic components. [30]
Test anxiety can be diagnosed using the Diagnostic and Statistical Manual-IV, under the classification of social phobia. [8] Social phobias are characterized by a marked and persistent fear of social or performance situations in which embarrassment may occur. In order to be diagnosed as suffering from a social phobia, the DSM-IV states that the individual must present four different factors. [8]
Other variables related to test anxiety are:
Anxiety is defined as the "psychological mechanism whereby the current intensification of a dangerous drive results in the elicitation of defenses." [32] George Mandler and Seymour Sarason (1952), developed the theory that anxiety present in testing situations is an important determinant of test performance. Individuals that become highly anxious during tests typically perform more poorly on tests than low-test anxious persons, especially when tests are given under stressful evaluative conditions such as a post-secondary exam. The feelings of forgetfulness, or drawing a "blank" are developed because of anxiety-produced interference between relevant responses and irrelevant responses generated from the person's anxious state. The difference in performance of a high-anxious test taker compared to a low-anxious test taker is largely due to the difference in their ability to focus on the tasks required. [33] A low-anxious test taker is able to focus greater attention on the tasks required of them while taking the test, while a high-anxious test taker is focused on their internal self, and the anxiety they are feeling. Anxious test takers do not perform adequately on the test as their attention is divided between themselves and the test. Therefore, students with high test anxiety are unable to focus their full attention on the test. Furthermore, anxiousness is evoked when a student believes that the evaluative situation, such as an assessment, exceeds his or her intellectual, motivational, and social capabilities. [21]
Psychologists Liebert and Morris (1967) analyzed the structure of test anxiety given on two distinct factors: Cognitive Test Anxiety and Emotionality. [7] Emotionality means that the individual shows high levels of several different symptoms related to test anxiety that can be seen through physiological responses experienced during situations where they are being evaluated; such as an exam. [7] Some of the physiological manifestations include: increased galvanic skin response and heart rate, dizziness, nausea, or feelings of panic. [7] There is evidence that emotionality is a distinct part of test anxiety; however, it can be seen that when an individual displays high emotionality it means that it is mostly associated with declining performance, but only when the individual is also experiencing high levels of worry. [7]
The other factor mentioned is Cognitive Test Anxiety, also known as worry. It is mostly composed of the individuals cognitive reactions to situations where they are being evaluated, in the times prior to, during, and after those tasks. [7] Some of the thoughts that individuals with high cognitive test anxiety are constantly dealing with are comparing self performance to peers, considering the consequences of failure, low levels of confidence in performance, excessive worry about grades, feeling that they are unprepared for tests, and loss of self-worth. [7]
Researchers Putwain, Woods & Symes (2010), found that a low academic self-concept was associated with higher worry and tension about their abilities to do well on a test. A student's metacognitive beliefs play an important role in the maintenance of negative self-beliefs. [21]
Anxiety reactions can be generalized from previous experiences to testing situations. [34] Feelings of inadequacy, helplessness, anticipations of punishment or loss of status and esteem manifest anxiety responses. As well, the presence of an audience can debilitate the performance of high anxious test takers and increase the performance of low anxious test takers. Persons who score high on anxiety scales tend to describe themselves in negative, self-devaluing terms. Highly anxious test takers also blame themselves for their failure significantly more than low anxious test takers.
The study of the relationship between anxiety and performance can be understood by using the Yerkes-Dodson Law, where one can see the facilitating and debilitating effects of arousal on performance as an inverted "U". [8] An example of this correlation can be seen in terms of a child taking a test where the degree of arousal or anxiety that the child portrays can be seen as beneficial to the performance. Though, if the child doesn't have a feeling or fear or failure or some sort of encouragement to perform well on the test, then the child is unlikely to put the necessary effort into preparing or being motivated when taking the test and so he or she will not perform to their fullest potential. [8]
However, if before or during a test a child's level of anxiety is above the optimum level, they may also fail to demonstrate their true abilities. [8] Under these circumstances fear of the actual test may disrupt preparation and cause a great amount of distress during the test that it is more than likely to impair their performance. [8]
There are two main groups of attentional theories that attempt to explain compromised performance in pressured situations. [35]
One group of theories are the explicit monitoring theories. They state that when a person is expected to perform a specific skill, the pressure may cause an increased self-consciousness and inward focus, which can disrupt their ability to successfully perform that task. [36] Thinking about step-by-step procedures can inhibit one's ability to execute a task. [35] For example, a study by R. Gray found that baseball players put into the high-pressure condition had increased errors, and an increased ability to recall details like the direction their bat was moving. This indicates that the pressured players were monitoring themselves more, which impacted their ability to successfully hit the ball. [35]
A second group of theories are the distraction theories. These theories state that high-pressure environments create a dual-task situation, in which the person's attention is divided between the task at hand and unhelpful thoughts about the situation and possible negative consequences of poor performance. [36] Attention is an important part of working memory, [36] which is the system that actively holds several pieces of relevant information in the mind while inhibiting irrelevant information. [36] Working memory has a limited capacity, and the addition of stress and anxiety reduces the resources available to focus on relevant information. [37]
In situations in which individuals need to concentrate their attention on a specific task, emotional stimuli can divert their attention to a greater degree than non-emotional stimuli. [38] Emotional stimuli will often dominate a person's thoughts, and any attempt to suppress them will require additional working memory resources. [37] When working memory divides resources between the aversive cognitions and the task-relevant material, then the person's ability to use the relevant information on a test will suffer. [39]
People who suffer from test anxiety are more likely to experience negative cognitions while in evaluative situations. Furthermore, test anxious persons have been found to bias their attention towards threatening and anxiety related stimuli more than nonemotional stimuli. [40]
Research has accordingly found that tasks that rely heavily on working memory are the ones that suffer the most during pressure. [36] Shortfalls in performance that are caused by test anxiety seem to be related to the extent to which the student has full access to their working memory. [41]
When comparing these two theories in the context of academic performance, a majority of work supports distraction theories. [36] One reason for this is that many of the skills performed in the classroom require heavy demands on working memory. [36] However, there are different kinds of pressure situations. There is monitoring pressure, in which an individual's performance is impacted due to the presence of an audience, and outcome pressure, in which an individual's performance is influenced by the consequences of the testing results. [35] In a study, DeCaro et al. found that performance on a rule-based task, that relies heavily on working memory, was impaired by outcome pressure, but not monitoring pressure, whereas performance on an information-integration task, which does not require attentional control, was hurt by monitoring pressure, but not outcome pressure. [35] These findings indicate that performance is compromised in different ways depending on the type of task, and the types of pressure, and that both theories can be correct. [35]
Eysenck et al. [42] elaborate upon the distraction theories and propose the attentional control theory. [43] This theory uses Baddeley's model of working memory to explain the effects of anxiety on working memory and on performance. [44] In Baddeley's theory, working memory (WM) consists of four components, one of them the central executive that has a number of tasks such as coordination of the temporary stores of phonological and visual information (phonological loop and visuospatial sketchpad, respectively). [45]
The attentional control theory assumes that anxiety primarily affects attentional control, which is a key function of the central executive. [44] Attentional control is the balance between the two attentional systems, the goal-directed system, influenced by the individual's goals, and the stimulus-driven system, influenced by salient stimuli. [44] According to the attentional control theory, anxiety disrupts the balance between these two systems. The stimulus-driven system becomes stronger at the expense of the goal-directed system, thereby impairing the efficiency of the inhibition and shifting functions of the central executive. [44]
In support of this theory, there is strong evidence that anxiety largely impairs processing efficiency rather than performance effectiveness. [44] Performance effectiveness refers to the quality of performance whereas processing efficiency refers to the amount of resources used to attain an effective performance. [44] There is also evidence that anxiety impairs both the inhibition and the shifting function. [44] Therefore, this theory suggests that students high in test anxiety will have to allocate more resources to the task at hand than non-test anxiety students in order to achieve the same results. [39]
In general, people with higher working memory capacity do better on academic tasks, but this changes when people are under acute pressure. [36] Sian Beilock et al. found that pressure led individuals with a high working memory capacity to perform worse on a complicated task, whereas individuals with a low WM capacity got the same low results with or without pressure. This was because people with high WM could use more effective, but more demanding, problem solving strategies in the low pressure condition, which they had to abandon in the high pressure condition. The low WM people never used these demanding strategies in the first place. [36] Evidence for similar working memory effects in children has also been found. [46] Evidence that trait anxiety might have different effects on working memory than state or acute pressure situations comes from Johnson et al. who found individuals' performances on a task showed a decrease in accuracy due to trait anxiety for individuals with low or average WM capacity, but did not significantly decrease for individuals with high WM. [47]
Early scales, by authors such as Charles Spielberger, tended to focus on physiological and somatic features and on worry, commonly referred to as emotionality, [48] while more recent offerings, such as that by Cassady & Johnson, emphasize cognitive processes. [49] "Test anxiety" for these authors consists of physiological and mental processes, and impaired test performance is seen as the result.
The Children's Test Anxiety Questionnaire is specifically designed to measure test anxiety in children 8–12 years of age. It provides scores for three dimensions of test anxiety: "worrisome thoughts concerning failure (i.e. 'when I take tests, I worry about failing'), automatic reactions concerning students' general and specific somatic indications of anxiety (i.e. 'when I take tests, my heart beats fast'), and off-task behaviours concerning nervous habits and distracting behaviours (i.e. 'when I take tests, I play with my pencil')" [50]
The Test Anxiety Inventory for Children and Adolescent (TAICA) is a way to measure and assess test anxiety in children and adolescents in Grades 4 through 12. Those individuals who are being assessed rate their responses on a 5-point Likert-type scale ranging from 1 (never true about me) to 5 (always true about me). The TAICA is a 45-item self-report measure which consists of four sub scales. [51]
Medication is not recommended to treat test anxiety; instead, standard suggestions include sleep, proper nutrition, exercise, meditation, studying without stress, and enacting habits to reduce stress during the test. [52] [53] Test anxiety remains a challenge for students and has considerable physiological and psychological impacts. The routine practice of slow, Device-Guided Breathing (DGB) is a major component of behavioral treatments for anxiety conditions. [54]
To gain an accurate assessment of student comprehension, instructors should be concerned with minimizing the effects of test anxiety. Instructors might offer "second chances" post test, familiarize students with test format and grading scheme, and lower the impact of any one test. [55] If students have greater confidence in their test-taking skills, they are more likely to be comfortable and relaxed when the testing does occur. Having an intentional thinking strategy should help student performance improve.[ citation needed ]
For some individuals, poor academic performance is due to skill deficits, which could include problems in encoding (learning),rehearsal (study skills) or retrieval during a test (test-taking strategies). [56] Skill deficits may lead to poor performance directly (failure to adequately learn the material) or indirectly (awareness of being ill-prepared causes anxiety that, in turn, leads to poor performance). Therefore, the most effective interventions are those that combine skill-focused strategies (i.e. study skills training, test-taking skills) with cognitive (i.e. cognitive restructuring) or behavioural approaches (i.e. relaxation training, systematic desensitization). [57]
Students also need to stay healthy in order to be able to deal with stress and anxiety. They need to eat healthy, and get enough sleep. [58]
Anxiety is an emotion which is characterised by an unpleasant state of inner turmoil and includes feelings of dread over anticipated events. Anxiety is different from fear in that fear is defined as the emotional response to a present threat, whereas anxiety is the anticipation of a future one. It is often accompanied by nervous behavior such as pacing back and forth, somatic complaints, and rumination.
Psychology is an academic and applied discipline involving the scientific study of human mental functions and behavior. Occasionally, in addition or opposition to employing the scientific method, it also relies on symbolic interpretation and critical analysis, although these traditions have tended to be less pronounced than in other social sciences, such as sociology. Psychologists study phenomena such as perception, cognition, emotion, personality, behavior, and interpersonal relationships. Some, especially depth psychologists, also study the unconscious mind.
Ergophobia is described as an extreme and debilitating fear associated with work, a fear of finding or losing employment, or fear of specific tasks in the workplace. The term ergophobia comes from the Greek "ergon" (work) and "phobos" (fear).
Arousal is the physiological and psychological state of being awoken or of sense organs stimulated to a point of perception. It involves activation of the ascending reticular activating system (ARAS) in the brain, which mediates wakefulness, the autonomic nervous system, and the endocrine system, leading to increased heart rate and blood pressure and a condition of sensory alertness, desire, mobility, and reactivity.
In sports, choking is the failure of a person, or persons, to act or behave as anticipated or expected. This can occur in a game or tournament that they are strongly favoured to win, or in an instance where they have a large lead that they squander in the late stages of the event. It can also refer to repeated failures in the same event, or simply imply an unexpected failure when the event is more important than usual.
Metacognition is an awareness of one's thought processes and an understanding of the patterns behind them. The term comes from the root word meta, meaning "beyond", or "on top of". Metacognition can take many forms, such as reflecting on one's ways of thinking, and knowing when and how oneself and others use particular strategies for problem-solving. There are generally two components of metacognition: (1) cognitive conceptions and (2) cognitive regulation system. Research has shown that both components of metacognition play key roles in metaconceptual knowledge and learning. Metamemory, defined as knowing about memory and mnemonic strategies, is an important aspect of metacognition.
Social inhibition is the conscious or subconscious avoidance of a situation or social interaction. With a high level of social inhibition, situations are avoided because of the possibility of others disapproving of their feelings or actions. Related processes that deal with social inhibition are social evaluation concerns, anxiety in social interaction, social avoidance, and withdrawal. Also related are components such as cognitive patterns, anxious apprehension during social interactions, and internalizing problems. It also describes those who suppress anger, restrict social behavior, withdraw in the face of novelty, and have a long latency to interact with strangers.
Worrying is the mental distress or agitation resulting from anxiety, usually coming from a place of anticipatory fear (terror) or fear coming from a present threat (horror). With more understanding of the situation, worry becomes concern, the recognition of a future outcome that could be troubling, without necessarily having fear in that outcome.
Social anxiety is the anxiety and fear specifically linked to being in social settings. Some categories of disorders associated with social anxiety include anxiety disorders, mood disorders, autism spectrum disorders, eating disorders, and substance use disorders. Individuals with higher levels of social anxiety often avert their gazes, show fewer facial expressions, and show difficulty with initiating and maintaining a conversation. Social anxiety commonly manifests itself in the teenage years and can be persistent throughout life; however, people who experience problems in their daily functioning for an extended period of time can develop social anxiety disorder. Trait social anxiety, the stable tendency to experience this anxiety, can be distinguished from state anxiety, the momentary response to a particular social stimulus. Half of the individuals with any social fears meet the criteria for social anxiety disorder. Age, culture, and gender impact the severity of this disorder. The function of social anxiety is to increase arousal and attention to social interactions, inhibit unwanted social behavior, and motivate preparation for future social situations.
Nomophobia is a word for the fear of, or anxiety caused by, not having a working mobile phone. It has been considered a symptom or syndrome of problematic digital media use in mental health, the definitions of which are not standardized for technical and genetical reasons.
The self-regulation of emotion or emotion regulation is the ability to respond to the ongoing demands of experience with the range of emotions in a manner that is socially tolerable and sufficiently flexible to permit spontaneous reactions as well as the ability to delay spontaneous reactions as needed. It can also be defined as extrinsic and intrinsic processes responsible for monitoring, evaluating, and modifying emotional reactions. The self-regulation of emotion belongs to the broader set of emotion regulation processes, which includes both the regulation of one's own feelings and the regulation of other people's feelings.
Rumination is the focused attention on the symptoms of one's mental distress. In 1998, Nolen-Hoeksema proposed the Response Styles Theory, which is the most widely used conceptualization model of rumination. However, other theories have proposed different definitions for rumination. For example, in the Goal Progress Theory, rumination is conceptualized not as a reaction to a mood state, but as a "response to failure to progress satisfactorily towards a goal". According to multiple studies, rumination is a mechanism that develops and sustains psychopathology conditions such as anxiety, depression, and other negative mental disorders. There are some defined models of rumination, mostly interpreted by the measurement tools. Multiple tools exist to measure ruminative thoughts. Treatments specifically addressing ruminative thought patterns are still in the early stages of development.
An anxiety threshold is the level of anxiety that, when reached, can affect a person's performance. Anxiety is an emotion, similar to fear, that can be created by insecurities in one's abilities, concerns for the future, such as financial or situational circumstances, or past memories of frightening experiences. Anxiety can affect all age groups and if fears are irrational, it may cause mental disorders. An individual's anxiety threshold can be measured by the amount of anxiety consistently manifested from situation to situation.
The effects of stress on memory include interference with a person's capacity to encode memory and the ability to retrieve information. Stimuli, like stress, improved memory when it was related to learning the subject. During times of stress, the body reacts by secreting stress hormones into the bloodstream. Stress can cause acute and chronic changes in certain brain areas which can cause long-term damage. Over-secretion of stress hormones most frequently impairs long-term delayed recall memory, but can enhance short-term, immediate recall memory. This enhancement is particularly relative in emotional memory. In particular, the hippocampus, prefrontal cortex and the amygdala are affected. One class of stress hormone responsible for negatively affecting long-term, delayed recall memory is the glucocorticoids (GCs), the most notable of which is cortisol. Glucocorticoids facilitate and impair the actions of stress in the brain memory process. Cortisol is a known biomarker for stress. Under normal circumstances, the hippocampus regulates the production of cortisol through negative feedback because it has many receptors that are sensitive to these stress hormones. However, an excess of cortisol can impair the ability of the hippocampus to both encode and recall memories. These stress hormones are also hindering the hippocampus from receiving enough energy by diverting glucose levels to surrounding muscles.
Attentional control, colloquially referred to as concentration, refers to an individual's capacity to choose what they pay attention to and what they ignore. It is also known as endogenous attention or executive attention. In lay terms, attentional control can be described as an individual's ability to concentrate. Primarily mediated by the frontal areas of the brain including the anterior cingulate cortex, attentional control and attentional shifting are thought to be closely related to other executive functions such as working memory.
Fear of negative evaluation (FNE) or fear of failure, also known as atychiphobia, is a psychological construct reflecting "apprehension about others' evaluations, distress over negative evaluations by others, and the expectation that others would evaluate one negatively". The construct and a psychological test to measure it were defined by David Watson and Ronald Friend in 1969. FNE is related to specific personality dimensions, such as anxiousness, submissiveness, and social avoidance. People who score high on the FNE scale are highly concerned with seeking social approval or avoiding disapproval by others and may tend to avoid situations where they have to undergo evaluations. High FNE subjects are also more responsive to situational factors. This has been associated with conformity, pro-social behavior, and social anxiety.
Separation anxiety disorder (SAD) is an anxiety disorder in which an individual experiences excessive anxiety regarding separation from home and/or from people to whom the individual has a strong emotional attachment. Separation anxiety is a natural part of the developmental process. It is most common in infants and little children, typically between the ages of six to seven months to three years, although it may pathologically manifest itself in older children, adolescents and adults. Unlike SAD, normal separation anxiety indicates healthy advancements in a child's cognitive maturation and should not be considered a developing behavioral problem.
Emotional abandonment is a subjective emotional state in which people feel undesired, left behind, insecure, or discarded. People experiencing emotional abandonment may feel at a loss. They may feel like they have been cut off from a crucial source of sustenance or feel withdrawn, either suddenly or through a process of erosion. Emotional abandonment can manifest through loss or separation from a loved one.
Clutch performance in sports refers to the phenomenon where athletes excel under pressure, commonly known as "in the clutch". These moments typically occur later in the game, and involve plays that significantly impact the outcome of the game. Athletes are required to summon strength, concentration and any other qualities necessary to succeed and perform well. This phenomenon is observed in many sports including basketball, hockey, football, and esports, but the phrase is most commonly used in baseball.
Attachment and health is a psychological model which considers how the attachment theory pertains to people's preferences and expectations for the proximity of others when faced with stress, threat, danger or pain. In 1982, American psychiatrist Lawrence Kolb noticed that patients with chronic pain displayed behaviours with their healthcare providers akin to what children might display with an attachment figure, thus marking one of the first applications of the attachment theory to physical health. Development of the adult attachment theory and adult attachment measures in the 1990s provided researchers with the means to apply the attachment theory to health in a more systematic way. Since that time, it has been used to understand variations in stress response, health outcomes and health behaviour. Ultimately, the application of the attachment theory to health care may enable health care practitioners to provide more personalized medicine by creating a deeper understanding of patient distress and allowing clinicians to better meet their needs and expectations.
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