The Role of the Hypothalamus–Pituitary–Adrenal (HPA) Axis in Test-Induced Anxiety: Assessments, Physiological Responses, and Molecular Details

Test anxiety may be a contributing factor to low-performing examination scores among students. There can be numerous physiological responses in the body that lead to test anxiety. One is the body’s response to stress, which activates the brain to release hormones that stimulate central and peripheral nervous responses. The hypothalamus–pituitary–adrenal (HPA) axis is a known responder during stress, causing an elevation of cortisol in the blood, a glucocorticoid (GC) hormone that affects sympathetic nervous responses. Stressors during testing include the method of information delivered, prior knowledge of the subject material, emotional state, or how accurately the student can retain knowledge. A student’s emotional state of mind is essential and may cause hyperactivation of the HPA axis during stress encountered during testing, exacerbating cortisol levels and nervous responsiveness. This review discusses the potential involvement of the HPA stress axis on an individual’s performance during testing and assessment.