Five Weeks of Racing Heart
Sana, 17, is in Class XII and preparing for board examinations. For five weeks she has slept only four to five hours, wakes with a racing heart, and checks her answers repeatedly until she is late for school. She has stopped meeting friends, cries easily, and has lost three kilograms because she eats little before tests. She still attends school and completes homework, but her concentration has fallen and she says, 'I feel something bad will happen.' Her symptoms are worst on test days and she has no history of panic attacks, substance use, or medical illness. Her father says, 'This is normal exam stress-just be strong.' Her mother wants to know whether this is a disorder or ordinary stress, and the school counsellor must decide whether to refer her. The counsellor also wants to help Sana plan the next four weeks.
1. Use Lazarus's appraisal theory and Selye's general adaptation syndrome to explain Sana's reactions, and distinguish them from a simple 'weakness'.
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Lazarus's appraisal theory Stress depends on how a person appraises a situation. Sana makes a primary appraisal of the board examinations as a threat: failure, shame and an uncertain future are at stake. Her secondary appraisal is that her resources are insufficient-she has little time, poor sleep and repeated checking that consumes her day. The imbalance between perceived demands and perceived resources produces stress. Her thought 'something bad will happen' is part of this appraisal, not evidence of weakness.
Selye's general adaptation syndrome
- Alarm: her racing heart and wakefulness reflect initial physiological arousal.
- Resistance: for five weeks she has kept attending school and doing homework while sleeping four to five hours. This is effortful adaptation, but it is costly.
- Exhaustion: weight loss, crying, poor concentration and social withdrawal suggest that her resources are becoming depleted.
The GAS explains why prolonged stress affects the body and why symptoms appear even when she is still functioning. Calling her 'weak' is inaccurate: her reactions are a predictable response to sustained demand and insufficient recovery. However, not every stressed student develops a disorder. The counsellor should assess duration, impairment and risk before deciding whether this is ordinary exam stress or a clinical condition.
2. What information would you use to judge whether Sana's condition warrants referral, and what would make you more concerned?
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The counsellor should assess several areas, not just the label 'exam stress':
- Duration and course: symptoms have lasted five weeks and are worsening or stable?
- Functional impairment: she still attends school, but concentration, sleep, eating and friendships are affected. Is she completing work, or only barely coping?
- Severity of distress: crying easily, racing heart and a persistent sense that something bad will happen.
- Physical signs: three kilograms of weight loss, sleep of four to five hours, possible medical causes.
- Cognitive and behavioural signs: repeated checking, avoidance of friends, difficulty concentrating.
- Risk: any thoughts of self-harm, hopelessness or suicide must be asked about directly and sensitively.
More concern if she reports panic attacks, cannot attend school, stops eating, has suicidal thoughts or self-harm, has symptoms unrelated to exams and persisting for months, or shows signs of obsessive checking that takes hours. Less concern would be justified if symptoms are mild, limited to the week before exams and resolve afterwards.
The counsellor should not diagnose but should refer to a clinical psychologist or psychiatrist if impairment or risk is significant. Referring is not an overreaction; it is a way to get an accurate assessment. The parents should be included carefully, with Sana's consent where possible.
3. Plan a four-week coping plan for Sana using problem-focused and emotion-focused coping, and evaluate the father's advice.
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Problem-focused coping
- Set a realistic study timetable with fixed sleep and meal times; sleep is not optional recovery.
- Replace repeated checking with a time limit: one review, then close the book. This is a practical response to the checking habit.
- Practise one full paper under exam-like conditions to reduce novelty.
- Ask teachers for help with specific topics rather than trying to cover everything.
- Reduce social withdrawal by scheduling one short contact with a friend each day.
Emotion-focused coping
- Use slow breathing or relaxation before study and at bedtime.
- Reappraise the exams: they matter, but they are not a final judgment of her worth.
- Use exercise, journalling or music to discharge tension.
- Talk to a trusted adult about fear of failure rather than keeping it secret.
Evaluation of the father's advice 'Just be strong' is well intentioned but insufficient. It implies that her distress is a character flaw, which can increase shame and stop her from seeking help. It also ignores the physical signs-sleep loss and weight loss-that need attention. A better message is: 'This is hard, and we will help you make a plan.' If Sana's sleep, eating or mood do not improve, or if she expresses hopelessness, the counsellor should refer her for professional assessment. The plan should be reviewed weekly, not simply given once.