Nervous and anxious...need advice

Hello all,

I’ve begun studying for the January (or most likely, April) 2007 sitting of the MCAT. This will be my second time after scoring only 21S last year.

I have a serious problem with anxiety (requiring treatment in my twenties). I am no longer using anything for the related symptoms but I have a difficult time breathing properly (at all?) when anxious not to mention others like shaking, faintness and fear. When doing the MCAT last year, I missed about 10 minutes in each of the PS and BS sections to catch my breath outside. My grades showed it.

Just beginning to study has me all anxious again. I am highly functional as a technical writer and have run my own consulting business for about 3 years now. I tend to set my own hours and work at a certain pace with deadlines.

This timed test is a nightmare for me because all the coping skills I’ve picked up in the last 10 years don’t help me when I think of the minutes passing. My breathing got so bad in the BS section, the world started to dim and I barely crawled out of the room before I passed out.

Has anyone dealt with this type of problem during a testing session? What could I do to write the 5 hour test without leaving the room?

Thanks in advance.

If this is a medically documented and diagnosed condition, the AAMC may be able to accomodate you under the Americans with Disabilities Act of 1990.

Read this CAREFULLY to see if you qualify for extra time or an untimed exam.…


I had some pretty annoying test anxiety as a teenager (Jr. High until early college), but never anything like that which you described. If you’ve been treated in the past for anxiety, maybe some professional help might be in order once more. A good behavioural therapist might be able to help you quite a bit. My advice is to get whatever help you need to be able to perform at your peak… not just on the MCAT, but also for your life in general. If I were in your shoes (maybe I’ve tried them on for size), I’d be wondering if this anxiety could be a potential obstacle on into medical school and beyond. One of the things my clinical opportunities have taught me is that working on real people (starting IVs, pushing medications, or just doing assessments on really sick people) can generate a great deal of anxiety. Many people get over this hump quickly, and others take a little longer (some thrive on it!). For some, it becomes an obstacle that causes them to rethink their career path. I’m not saying you should bail out on your dream. Something NJBMD(?) wrote in another post reminded me of a term that found a lot of use during my behavioral health career – “reality testing.” Put yourself in some relatively benign situations that will test your anxiety limits a little at a time. Spend a few weekends tackling timed, full-length MCATs from the AAMC site to see if you can increase your tolerance and performance. Also, expose yourself to a volunteer activity that puts you in close contact with sick or bed-ridden people. A community clinic, a nursing home, or a local urban ministry are places where you can contribute “experimentally” just to get a sense of being involved. You might even find this motivating enough to propel you past those specially crafted hours of hell called the MCAT. :wink:

I hope something helps!

Good luck,


It sounds like you’ve made progress in your treatment - for instance, referring to your 10 years of developed coping skills. That is indeed a good thing.

The MCAT next year will be computerized, reducing the overall time and increasing the invividual control of it. That may be a good thing for you.

That said, as you stated, you have a diagnosed anxiety disorder. In looking at my DSM-IV-TR, and the AAMC information Gabe linked - that appears to be the primary thing they’re looking for : demonstrable evidence that special circumstances are necessary for you. I believe that, provided the proper information, they should provide appropriate testing services to meet your needs.

I do wish to ask - if I may be so potentially inconsiderate, and I stress that I am sincerely asking with no implications or connotations - how does your concern about clinical practice compare to your concern about standardized testing?

Hi Gabe,

Thanks for the AAMC link. I am hoping to avoid any special treatment for the MCAT testing session because schools are aware of those circumstances, and it is only fair to other students. I guess I’m concerned because I’m already a geezer (33) and have a shaky UG average (will be doing a postbacc this year). It may be foolish and unnecessary but I’m worried that I’m piling on exceptions that would make them raise an eyebrow (or 2) on my potential for success in medical school. Even as a nontrad., I must compete with accomplished people who show strength in most application areas.

Hi Tim,

Thanks so much for the encouraging words and advice. I think (obssess?) about my anxiety and dealing with the sick and injured all the time. Luckily, I have spent a great deal of time doing clinical volunteer work including 6 years in a rehabilitation center. The first couple of years I stayed away from patient contact but was able to engage and regularly help patients who are in wheelchairs and even bedridden.

I have to admit it was not easy. The first time, I helped a young man who was injured in a car accident and lost most feeling below the sternum and had little use of his hands. I was helping with moving him in and out of bed and I remember one moment I was being useful and the next moment, I was flat on my back with people hovering over me and trying to wake me up. I was devastated. Here was a guy my age struggling for breath because of paralysis and I can’t remind myself to bloody breathe when nervous.

I did get better, though, but I am still worried that I may have problems initially doing things some of what you’ve mentioned like drawing blood (just the thought brings a few beads of sweat on my girl moustache ). I don’t know. I’m thinking maybe emergency medicine is out of the question for me.

I think after some exposure, I do get better and I am able to control my anxiety. I haven’t been on meds for about 8 years and feel confident in most life situations. But you’re right, this can be an obstacle as I can’t compare my work and volunteering to examining, treating, and caring for sick and dying people. I have to think more about this.

Hi Adam

Thanks very much for the encouragement and advice. You’ve asked:

  • Quote:
how does your concern about clinical practice compare to your concern about standardized testing?


Worrying about clinical practice and my ability to go through medical school and residency made me delay writing the MCAT and even thinking about applying for about 5 years. I stopped taking medication for my anxiety when I was about 24/25 and several short term CBT sessions with a psychologist had helped me with major, stressful transitions. The biggest one was about 3.5 years ago when I opened my own consulting firm and took some of my clients with me. It was hard but not impossible.

My worry is that medical practice is not like what I do now and I may not have the luxury to take a half an hour here and there to calm myself down.

I don’t think you should apply for MCAT accommodations until you’ve exhausted all other possibilities. I am sorry to say it, but from the other side of the med school chase I have to tell you all that such advice is naive. If you aren’t in med school yet, you don’t know how hide-bound and conservative the medical establishment is. You would think that doctors would be far more understanding of disabling conditions than others, but that is NOT the case. Of course there are circumstances where you must receive accommodations, but if there are other ways to approach this problem, I highly recommend that you pursue those methods instead. (and note that there are plenty more standardized tests after the MCAT, and they become increasingly more thorny about accommodations - I have known several people whose petitions for USMLE accommodations were denied)

Okay, though, to the real question – and let me say that I am trying to phrase this the way I would if you were coming to see me as your family doctor, I do NOT mean for this to come off as confrontational –

To the OP, you mention several times that you were treated years ago with medication for your anxiety; you also mention that you benefitted from CBT. My question for you is, why are you not pursuing active treatment NOW? Perhaps in your day-to-day life you are functioning well, but if activities that are important to you are disrupted by your anxiety, then you aren’t being adequately treated. I submit that you would be well-advised to consider medication and/or further psychotherapy to help you tackle the particular problem of the MCAT. Unfortunately you may be self-reinforcing your anxiety by trying to deal with it yourself.

Again, I say this with respect and concern for what you’ve been through, and what you’re trying to do now. Because you felt so bad before, your relative well-being now seems much more secure - but this description of MCAT anxiety screams out to me for much, much better treatment. You are a consultant, right? That means that people pay you to have expertise in areas that they do not. Well, seeking help for this condition should be looked at the same way – you DID pay a consultant at one time, but now you are relying (forgive me) on an amateur (yourself) when you still need an expert. Please consider it.

Please keep us posted on your progress!


Hi Mary,

Thanks so much. I really appreciate your candid advice. I have decided not to ask for any special accommodation when sitting the MCAT. I agree that the establishment is pretty conservative and I don’t want to seem as though I cannot handle one of many standardized exams in any medical hopeful’s career. I would much rather seek other ways to improve my testing ability. I do hear what you’re saying and I am certain that it sounds foolish to complain of a treatable condition when help has been effective in the past. Preparing for and applying to medical is very important to me and I will exhaust all my resources to get in and get through.

When writing the August 2005 MCAT, I had been doing well for several years and thought I could handle the exam with no more than an average person’s apprehension. I was wrong. I don’t need meds on a day-to-day basis and haven’t sought CBT for some time but I am certain that I will not be able to do this without one or both. For the CBT, I will definitely be seeking it for the next MCAT sitting. For the meds, I am a little more apprehensive as I found them in the past to be less effective as time goes by. That’s probably something to worry about when the time comes.

I will be sure to post my progress!