A convenience sample of 204 students was recruited at the Technische Universität Dresden (TU Dresden), Germany, and contacted via email asking to complete an online survey. Students received course credits and/or randomly drawn cinema and bowling vouchers for participation. The ethics committee of the TU Dresden approved the study protocol.

Data from 105 students were not available for analyses, since e-mail addresses were incorrect (n = 14), students did not respond (n = 55), or filled in less than 50% of the questionnaire (n = 36, 18.9%).There were no systematic differences between participants responding only partly (n = 22) and those who responded completely (n = 99) (Table 1). Via skip rule, only participants who reported anxiety in or avoidance of at least one social situation listed in the Liebowitz Social Anxiety Scale (LSAS) (see below) were asked about trigger events, TA, cognitions, behavior, depersonalization and physical symptoms. Indication of TA based on the PAF [Prüfungsangstfragebogen, (TA Questionnaire), see below] was not required as a necessary condition (i.e., no skip rule when no TA was reported) because Knappe et al[6] observed that fear of taking tests occurred independently from SA but not vice versa. Three subjects were excluded because they skipped the survey after indicating no fear or avoidance of social situations. Accordingly, analyses were based on n = 96 subjects with complete data sets. The sample consisted of 23 males (24%) and 73 females (76%), aged 19 to 46 years (M = 22.9 years, SD = 3.6). Additional information was collected on the target degree (n = 32 state examination, n = 32 bachelor, n = 2 master, n = 30 diploma) and branch of study (n = 33 medicine, n = 31 psychology, n = 8 mechanical engineering, n = 7 biology, n = 6 architecture, n = 5 sociology, n = 6 other). Students were also asked to recall any event as a trigger for their anxiety in social situations, oral or written exams.

SA: The 24-item German self-report Version of the “LSAS”[12] was administered. Item 17 (“taking a test”) was splitted for detailed assessment of anxiety and avoidance during written or oral exam situations (namely: Taking a written test, taking an oral examination). The 27-item German “Fragebogen zu sozialphobischem Verhalten” [SPV (Questionnaire for Social Phobic Behavior)][13] was used to assess social anxious motivated safety behavior, e.g., “I try to behave as normal as possible”. Ratings were shown in inversed order for comprehensiveness with other measures.

TA: The German questionnaire “Prüfungsangstfragebogen” [PAF (TA Questionnaire), 20 items][14] was used to assess severity of TA. In addition, generic items asked for trigger events for fear of written and oral exams separately, as well as for test-anxious cognitions (TAC, 10 items) and test-anxious coping and safety behavior (TAB, 17 items). The subscale “physical symptoms” of the German “Brief Social Phobia Scale” (BSPS-G, 4 items)[15] was used to assess bodily symptoms of TA. All instructions were slightly modified to allow for separate self-assessment in written and oral exams.

Symptoms of depersonalization/derealization: The German version of the “Cambridge Depersonalisation Scale 9” (CDS-9, 9 items)[16] was used to assess symptoms of depersonalization/derealization. The instruction was slightly modified for separate assessment with regard to social situations, as well as written and oral exams. The items were presented following the numerical order of the full CDS (in contrast to Michal et al[16]). To increase reasonableness of the questionnaire, the duration scale of the CDS-9 was omitted.

The PAF, TAB TAC, BSPS-G und CDS-9 were administered twice for separate assessments in oral and written TA situations. Internal consistencies (Cronbach’s α) for scores of all modified scales ranged between 0.737 and 0.919 (Table 2). Convergent and discriminant validity of all modified scales were explored based on their correlation patterns, indicating sufficient validity (Table 3).

Dependent t-tests for paired samples were used to compare mean values of the number of trigger events, TA, test-anxious cognitions, test-anxious coping and safety behavior, symptoms of depersonalization/derealization and physiological symptoms (blushing, palpitation, tremor and sweating) in written exams to oral exams. Associations of SA (based on LSAS) with TA during written exams and TA during oral exams (based on PAF) were compared using Steiger’s Z[17], which allows to compare overlapping correlations. In absence of normally distributed data, Spearman correlations were computed. Pearson correlations were additionally computed since they are necessary for the computation of Steiger’s Z. The correlations were similar and therefore the Pearson correlations were compared within a sample using Steiger’s Z. Analyses were run using SPSS[18]. A Bonferroni correction (α_corr = 0.025) was applied for analyses on safety behaviors to account for multiple testing (i.e., comparison between SA and oral TA; comparison between SA and written TA). It was not applied for explorative analyses, where a higher α error can rather be tolerated than an increase of the β error[19].

Isolated oral and written TA was reported in 14.6% (n = 14) and 2.1% (n = 2), respectively, of the sample. More than one third of the sample reported at least one condition out of SA, written TA or oral TA (36.5%, n = 35). Symptoms of depersonalization/derealization occurred most often in social situations (n = 13; 13.5%), followed by oral exams (n = 11; 11.5%) and written exams (n = 8; 8.3%) (Table 4).

As expected, SA was unrelated to written TA (Spearman’s r = 0.17, P > 0.05; Pearson’s r = 0.22, P > 0.05), but positively related to oral TA (Spearman’s r = 0.34, P < 0.001; Pearson’s r = 0.38, P < 0.001). Correlations of SA with written vs oral TA however did not differ (Steiger’s Z = -1.18, P > 0.05).

Analyses revealed substantial differences between oral and written TA in terms of trigger events, clinical characteristics and physiological symptoms (Table 5). Specifically, trigger events were more often reported for oral TA (30.3%) than written TA (18.2%) [t(95) = 2.78, P = 0.007]. As expected, the level of TA was higher among those reporting fear of oral exams than in those with fear of written exams (Table 5) [t(95) = -4.86, P < 0.001]. Further, TAC and TAB were reported more often for oral TA than for written TA. For symptoms of depersonalization/derealization, no differences between oral and written TA were observed. Physical symptoms were reported more often for oral TA than for written TA.

SA, based on the LSAS, was positively related to safety behaviors (Spearman’s r = 0.64, P < 0.001; Pearson’s r = 0.70, P < 0.001). Both forms of TA were moderately associated with safety behaviors (written: Spearman’s r = 0.31, P < 0.001; Pearson’s r = 0.28, P < 0.001; oral: Spearman’s r = 0.42, P < 0.001; Pearson’s r = 0.45, P < 0.001); these correlations were however lower than the correlation between LSAS and safety behaviors and did not differ (written TA: Steiger’s Z = 3.22, P < 0.001; oral TA: Steiger’s Z = 2.23, P < 0.005; written compared to oral TA: Steiger’s Z = -0.93, P > 0.05).

Symptoms of depersonalization/derealization were similarly frequent across all conditions (scale: 0 = never to 4 = constantly; SA: M = 3.7, SD = 2.7, oral TA: M = 3.2, SD = 5.2, written TA: M = 2.7, SD = 1.9), and only the difference between SA and written TA was statistically significant [t(95) = 2.95, P = 0.004].

The diagnostic category of social anxiety (SA) disorder spans from more or less isolated social fears to severe anxiety in social situations related to interactions with others and performance in public. Studies so far pointed to notable differences between fear of public speaking and test anxiety (TA) on the one hand, and other social fears and SA disorder on the other. Findings suggest that TA might be meaningfully distinguished from SA. Some suggest even an alternative diagnostic classification of TA apart from the SA spectrum, for example as a specific fear or phobia.

Little attention has been paid to the fact that TA can occur in oral and written exams and that these two types of situations imply differing cues for anxiety reactions. More details on the clinical features may help to inform the diagnostic classification of TA.

Compared to written TA, SA was more closely related to oral TA and oral TA was triggered more often by an event and accompanied more often by test-anxious cognitions, safety behavior and physical symptoms. In terms of safety behaviors and symptoms of depersonalization/derealization, TA conditions and SA were quite similar.

Because of the notable differences between oral and written TA, it may be concluded that TA could be rather used to describe anxiety in oral exams than in written exams, similar to the recently introduced DSM-5 “performance only” specifier for SA disorder.

TA refers to excessive stress, marked anxiety or fear and discomfort during and/or before taking a test or examination. Associated symptoms include physiological over-arousal, tension and somatic symptoms, cognitive symptoms such as worry, dread, fear of failure, and catastrophizing of anticipated consequences of the test situation.

Nice little study with a defined focus.