1. psychology fourth edition Psychology, Fourth Edition, AP Edition Saundra K. Ciccarelli J. Noland White © 2015, 2012, 2009 by Pearson Education, Inc. All rights reserved. Chapter 13 psychological disorders

2. Psychology, Fourth Edition, AP Edition Saundra K. Ciccarelli J. Noland White © 2015, 2012, 2009 by Pearson Education, Inc. All rights reserved. Learning Objectives 13.1How has mental illness been explained in the past and how is abnormal behavior and thinking defined today? 13.2What are some of the models used to explain psychological disorders? 13.3What are the different types of psychological disorders, and how common are they? 13.4What are different types of anxiety disorders, obsessive-compulsive disorder, and stress-related disorders, and what are their symptoms and causes? 13.5What are different types of disorders of mood and their causes? 13.6How do the various dissociative disorders differ, and how do they develop? 13.7What are the main symptoms and causes of schizophrenia? 13.8How do the various personality disorders differ, and what is thought to be the cause of personality disorders? 13.9 What are some ways to overcome test anxiety?

3. Psychology, Fourth Edition, AP Edition Saundra K. Ciccarelli J. Noland White © 2015, 2012, 2009 by Pearson Education, Inc. All rights reserved. AP Learning Objectives XVII. Abnormal Behavior –Describe contemporary and historical conceptions of what constitutes psychological disorders. –Discuss the intersection between psychology and the legal system. –Evaluate the strengths and limitations of various approaches to explaining psychological disorders: medical model, psychoanalytic, humanistic, cognitive, biological, and sociocultural. –Recognize the use of the Diagnostic and Statistical Manual of Mental Disorders (DSM) published by the American Psychiatric Association as the primary reference for making diagnostic judgments. –Identify the positive and negative consequences of diagnostic labels. –Discuss the major diagnostic categories including anxiety and somatoform disorders, mood disorders, schizophrenia, organic disturbance, personality disorders, and dissociative disorders, and their corresponding symptoms.

4. Psychology, Fourth Edition, AP Edition Saundra K. Ciccarelli J. Noland White © 2015, 2012, 2009 by Pearson Education, Inc. All rights reserved. What Is Abnormality? Psychopathology: the study of abnormal behavior and psychological dysfunction

5. Psychology, Fourth Edition, AP Edition Saundra K. Ciccarelli J. Noland White © 2015, 2012, 2009 by Pearson Education, Inc. All rights reserved. Early Explanations of Mental Illness In ancient times holes were cut in an ill person’s head to let out evil spirits in a process called trephining Hippocrates believed that mental illness came from an imbalance in the body’s four humors –phlegm, black bile, blood, and yellow bile During the Renaissance, the mentally ill were labeled as witches LO 13.1 Explanations of Mental Illness and Defining Abnormal Behavior AP: Conceptions of What Constitutes Psychological Disorders

6. Psychology, Fourth Edition, AP Edition Saundra K. Ciccarelli J. Noland White © 2015, 2012, 2009 by Pearson Education, Inc. All rights reserved. Definitions of Abnormality Deviance from statistical or social norms –Not all variations from the norm are labeled as negative or abnormal –Situational context: the social or environmental setting of a person’s behavior  E.g., a man suspects people are spying on him –Suffering from thoughts of persecution? –Or legitimate concerns due to his situation? LO 13.1 Explanations of Mental Illness and Defining Abnormal Behavior AP: Conceptions of What Constitutes Psychological Disorders

7. Psychology, Fourth Edition, AP Edition Saundra K. Ciccarelli J. Noland White © 2015, 2012, 2009 by Pearson Education, Inc. All rights reserved. Definitions of Abnormality Subjective discomfort: emotional distress or discomfort in certain contexts –E.g., experiencing intense anxiety when trying to leave the house Inability to function normally –maladaptive thinking or behavior: anything that does not allow a person to fit into society or function normally Risk of harm to self or others LO 13.1 Explanations of Mental Illness and Defining Abnormal Behavior AP: Conceptions of What Constitutes Psychological Disorders

8. Psychology, Fourth Edition, AP Edition Saundra K. Ciccarelli J. Noland White © 2015, 2012, 2009 by Pearson Education, Inc. All rights reserved. Definitions of Abnormality Psychological disorder: any pattern of behavior that causes people significant distress, causes them to harm themselves or others, or harms their ability to function in daily life AP: Conceptions of What Constitutes Psychological Disorders LO 13.1 Explanations of Mental Illness and Defining Abnormal Behavior

9. Psychology, Fourth Edition, AP Edition Saundra K. Ciccarelli J. Noland White © 2015, 2012, 2009 by Pearson Education, Inc. All rights reserved. Definitions of Abnormality Abnormality differs from insanity –Psychologists and psychiatrists determine whether ways of thinking or behavior are abnormal –Lawyers and judges determine if a mentally ill person should be considered insane, which means s/he is not legally responsible for his/her actions LO 13.1 Explanations of Mental Illness and Defining Abnormal Behavior AP: Conceptions of What Constitutes Psychological Disorders/The Intersection Between Psychology and the Legal System

10. Psychology, Fourth Edition, AP Edition Saundra K. Ciccarelli J. Noland White © 2015, 2012, 2009 by Pearson Education, Inc. All rights reserved. Biology and Psychopathology Biological model: psychological disorders have biological or medical causes –biological changes in the chemical, structural, or genetic systems of the body LO 13.2 How Disorders Relate to Biological and Psychological Models AP: Approaches to Explaining Psychological Disorders

11. Psychology, Fourth Edition, AP Edition Saundra K. Ciccarelli J. Noland White © 2015, 2012, 2009 by Pearson Education, Inc. All rights reserved. Psychological Viewpoints of Psychopathology Psychodynamic theorists: abnormal behavior stems from repressed conflicts and urges that are fighting to become conscious Behaviorists: abnormal behavior is learned Cognitive theorists: abnormal behavior comes from irrational beliefs and illogical patterns of thought LO 13.2 How Disorders Relate to Biological and Psychological Models AP: Approaches to Explaining Psychological Disorders

12. Psychology, Fourth Edition, AP Edition Saundra K. Ciccarelli J. Noland White © 2015, 2012, 2009 by Pearson Education, Inc. All rights reserved. Definitions of Abnormality Sociocultural perspective: abnormal behavior is the product of family, social, and cultural influences –cultural relativity: the need to consider the unique characteristics of the culture in which behavior takes place –culture-bound syndromes: disorders found only in particular cultures Biopsychosocial model: incorporates biology, psychology, and culture into a single explanation of abnormal behavior LO 13.2 How Disorders Relate to Biological and Psychological ModelsAP: Approaches to Explaining Psychological Disorders

13. Psychology, Fourth Edition, AP Edition Saundra K. Ciccarelli J. Noland White © 2015, 2012, 2009 by Pearson Education, Inc. All rights reserved. DSM-5 Diagnostic and Statistical Manual, Fifth Edition, (DSM-5): manual of psychological disorders and their symptoms International Classification of Diseases (ICD): an international resource published by the World Health Organization (WHO) –currently in its tenth edition (ICD-10) LO 13.3 Types of Psychological Disorders AP: Recognize the Use of the DSM

14. Psychology, Fourth Edition, AP Edition Saundra K. Ciccarelli J. Noland White © 2015, 2012, 2009 by Pearson Education, Inc. All rights reserved. Types of Disorders The DSM-5 describes about 250 different psychological disorders In a given year, about 26.2 percent of American adults over age 18 suffer from a mental disorder –only about 5.8 percent suffer from a severe mental disorder –common to suffer from more than one disorder at a time LO 13.3 Types of Psychological Disorders AP: Recognize the Use of the DSM

15. Psychology, Fourth Edition, AP Edition Saundra K. Ciccarelli J. Noland White © 2015, 2012, 2009 by Pearson Education, Inc. All rights reserved.

16. Psychology, Fourth Edition, AP Edition Saundra K. Ciccarelli J. Noland White © 2015, 2012, 2009 by Pearson Education, Inc. All rights reserved. Labeling Disorders Pros –provide a common language to professionals –establish distinct categories of diagnosis for treatment and understanding Cons –overly prejudicial –Rosenhan’s study at psychiatric hospitals “psychology student’s syndrome” LO 13.3 Types of Psychological Disorders AP: Consequences of Diagnostic Labels

17. Psychology, Fourth Edition, AP Edition Saundra K. Ciccarelli J. Noland White © 2015, 2012, 2009 by Pearson Education, Inc. All rights reserved. Disorders of Anxiety, Trauma, and Stress Anxiety disorders: the main symptom is excessive or unrealistic worry and fearfulness –free-floating anxiety: anxiety that is unrelated to any realistic, known source LO 13.4 Types and Symptoms of Anxiety Disorders AP: Diagnostic Categories and Their Symptoms

18. Psychology, Fourth Edition, AP Edition Saundra K. Ciccarelli J. Noland White © 2015, 2012, 2009 by Pearson Education, Inc. All rights reserved. Anxiety Disorders Phobia: an irrational, persistent fear of an object, situation, or social activity –social phobia (social anxiety disorder): fear of interacting with others or being in social situations that might lead to a negative evaluation –specific phobia: fear of objects or specific situations or events LO 13.4 Types and Symptoms of Anxiety Disorders AP: Diagnostic Categories and Their Symptoms

19. Psychology, Fourth Edition, AP Edition Saundra K. Ciccarelli J. Noland White © 2015, 2012, 2009 by Pearson Education, Inc. All rights reserved. Phobic Disorders Claustrophobia: fear of being in a small, enclosed space Acrophobia: fear of heights Agoraphobia: fear of being in a place or situation from which escape is difficult or impossible –diagnosis requires that one feels anxiety in at least two of five situations LO 13.4 Types and Symptoms of Anxiety Disorders AP: Diagnostic Categories and Their Symptoms

20. Psychology, Fourth Edition, AP Edition Saundra K. Ciccarelli J. Noland White © 2015, 2012, 2009 by Pearson Education, Inc. All rights reserved.

21. Psychology, Fourth Edition, AP Edition Saundra K. Ciccarelli J. Noland White © 2015, 2012, 2009 by Pearson Education, Inc. All rights reserved. Anxiety Disorders Panic disorder: panic attacks occur frequently enough to cause the person difficulty in adjusting to daily life –panic attack: sudden onset of intense panic in which multiple physical symptoms of stress occur, often with feelings that one is dying LO 13.4 Types and Symptoms of Anxiety Disorders AP: Diagnostic Categories and Their Symptoms

22. Psychology, Fourth Edition, AP Edition Saundra K. Ciccarelli J. Noland White © 2015, 2012, 2009 by Pearson Education, Inc. All rights reserved. Anxiety Disorders Generalized anxiety disorder: excessive anxieties and worries occur more days than not for at least 6 months LO 13.4 Types and Symptoms of Anxiety Disorders AP: Diagnostic Categories and Their Symptoms

23. Psychology, Fourth Edition, AP Edition Saundra K. Ciccarelli J. Noland White © 2015, 2012, 2009 by Pearson Education, Inc. All rights reserved. Obsessive-Compulsive Disorder Obsessive-compulsive disorder: intruding, recurring thoughts or obsessions create anxiety that is relieved by performing a repetitive, ritualistic behavior (compulsion) LO 13.4 Types and Symptoms of Anxiety Disorders AP: Diagnostic Categories and Their Symptoms

24. Psychology, Fourth Edition, AP Edition Saundra K. Ciccarelli J. Noland White © 2015, 2012, 2009 by Pearson Education, Inc. All rights reserved. Disorders of Trauma and Stress Acute stress disorder (ASD): a disorder resulting from exposure to a major, traumatic stressor –symptoms include anxiety, dissociation, recurring nightmares, sleep disturbances, problems in concentration, and moments in which people seem to relive the event in dreams and flashbacks –lasting as long as one month after the event LO 13.4 Types and Symptoms of Anxiety Disorders AP: Diagnostic Categories and Their Symptoms

25. Psychology, Fourth Edition, AP Edition Saundra K. Ciccarelli J. Noland White © 2015, 2012, 2009 by Pearson Education, Inc. All rights reserved. Disorders of Trauma and Stress Posttraumatic stress disorder (PTSD): the symptoms associated with ASD last for more than one month –symptoms of PTSD may not develop until more than 6 months after a traumatic event LO 13.4 Types and Symptoms of Anxiety Disorders AP: Diagnostic Categories and Their Symptoms

26. Psychology, Fourth Edition, AP Edition Saundra K. Ciccarelli J. Noland White © 2015, 2012, 2009 by Pearson Education, Inc. All rights reserved. Causes of Anxiety Disorders Psychodynamic explanations point to repressed urges and desires that are trying to surface, creating anxiety that is controlled by the abnormal behavior –Phobia as displacement Behaviorists believe that disordered behavior is learned through both positive and negative reinforcement LO 13.4 Types and Symptoms of Anxiety Disorders AP: Diagnostic Categories and Their Symptoms

27. Psychology, Fourth Edition, AP Edition Saundra K. Ciccarelli J. Noland White © 2015, 2012, 2009 by Pearson Education, Inc. All rights reserved. Causes of Anxiety Disorders Cognitive psychologists believe that excessive anxiety comes from illogical, irrational thought processes –magnification: the tendency to interpret situations as far more dangerous, harmful, or important than they actually are –all-or-nothing thinking: the belief that one’s performance must be perfect or the result will be a total failure LO 13.4 Types and Symptoms of Anxiety Disorders AP: Diagnostic Categories and Their Symptoms

28. Psychology, Fourth Edition, AP Edition Saundra K. Ciccarelli J. Noland White © 2015, 2012, 2009 by Pearson Education, Inc. All rights reserved. Causes of Anxiety Disorders Irrational thought processes (continued) –overgeneralization: the interpretation of a single negative event as a never-ending pattern of defeat and failure –minimization: the tendency to give little or no importance to one’s successes or positive events and traits LO 13.4 Types and Symptoms of Anxiety Disorders AP: Diagnostic Categories and Their Symptoms

29. Psychology, Fourth Edition, AP Edition Saundra K. Ciccarelli J. Noland White © 2015, 2012, 2009 by Pearson Education, Inc. All rights reserved. Causes of Anxiety Disorders Biological explanations of anxiety disorders –genetics –more activity in amygdala and limbic system Cultural variations –ataque de nervios –taijin kyofusho (TKS) LO 13.4 Types and Symptoms of Anxiety Disorders AP: Diagnostic Categories and Their Symptoms

30. Psychology, Fourth Edition, AP Edition Saundra K. Ciccarelli J. Noland White © 2015, 2012, 2009 by Pearson Education, Inc. All rights reserved. Disorders of Mood Affect: in psychological terms, emotion or mood Mood disorders: disorders in which mood is severely disturbed –major depressive disorder: severely depressed mood that comes on suddenly and seems to have no external cause  may include thoughts of death or suicide  most common of diagnosed disorder of mood LO 13.5 Types of Mood Disorders and Their Causes AP: Diagnostic Categories and Their Symptoms

31. Psychology, Fourth Edition, AP Edition Saundra K. Ciccarelli J. Noland White © 2015, 2012, 2009 by Pearson Education, Inc. All rights reserved. Disorders of Mood Mood Disorders (cont’d) –seasonal affective disorder (SAD): a mood disorder caused by the body’s reaction to low levels of sunlight in the winter months –manic episode: a period of excessive excitement, energy, and elation –bipolar disorder: periods of mood that may range from normal to manic, with or without episodes of depression (bipolar I disorder), or spans of normal mood interspersed with episodes of major depression and episodes of hypomania (bipolar II disorder) LO 13.5 Types of Mood Disorders and Their Causes AP: Diagnostic Categories and Their Symptoms

32. Psychology, Fourth Edition, AP Edition Saundra K. Ciccarelli J. Noland White © 2015, 2012, 2009 by Pearson Education, Inc. All rights reserved. Figure 13.1 The Range of Emotions Most people experience a range of emotions over the course of a day or several days, such as mild sadness, calm contentment, or mild elation and happiness. A person with a mood disorder experiences emotions that are extreme and, therefore, abnormal.

33. Psychology, Fourth Edition, AP Edition Saundra K. Ciccarelli J. Noland White © 2015, 2012, 2009 by Pearson Education, Inc. All rights reserved. Causes of Mood Disorders Behavioral theories link depression to learned helplessness Cognitive theories see depression as the result of distorted, illogical thinking Biological explanations of mood disorders look at the function of serotonin, norepinephrine, and dopamine systems in the brain –genetic origins LO 13.5 Types of Mood Disorders and Their Causes AP: Diagnostic Categories and Their Symptoms

34. Psychology, Fourth Edition, AP Edition Saundra K. Ciccarelli J. Noland White © 2015, 2012, 2009 by Pearson Education, Inc. All rights reserved. Dissociative Disorders Dissociative disorders: disorders in which there is a break in conscious awareness, memory, the sense of identity, or some combination –dissociative amnesia: loss of memory for personal information, either partial or complete LO 13.6 Types of Dissociative Disorders AP: Diagnostic Categories and Their Symptoms

35. Psychology, Fourth Edition, AP Edition Saundra K. Ciccarelli J. Noland White © 2015, 2012, 2009 by Pearson Education, Inc. All rights reserved. Dissociative Disorders Dissociative Disorders (cont’d) –dissociative fugue: traveling away from familiar surroundings with amnesia for the trip and possible amnesia for personal information –dissociative identity disorder (DID): disorder occurring when a person seems to have two or more distinct personalities within one body LO 13.6 Types of Dissociative Disorders AP: Diagnostic Categories and Their Symptoms

36. Psychology, Fourth Edition, AP Edition Saundra K. Ciccarelli J. Noland White © 2015, 2012, 2009 by Pearson Education, Inc. All rights reserved. Dissociative Disorders Dissociative Disorders (cont’d) –depersonalization/derealization disorder: dissociative disorder in which sufferers feel detached and disconnected from themselves, their bodies, and their surroundings LO 13.6 Types of Dissociative Disorders AP: Diagnostic Categories and Their Symptoms

37. Psychology, Fourth Edition, AP Edition Saundra K. Ciccarelli J. Noland White © 2015, 2012, 2009 by Pearson Education, Inc. All rights reserved. Development of Dissociative Disorders Psychodynamic explanations point to repression of memories, seeing dissociation as a defense mechanism against anxiety Cognitive and behavioral explanations see dissociative disorders as a kind of avoidance learning LO 13.6 Types of Dissociative Disorders AP: Diagnostic Categories and Their Symptoms

38. Psychology, Fourth Edition, AP Edition Saundra K. Ciccarelli J. Noland White © 2015, 2012, 2009 by Pearson Education, Inc. All rights reserved. Development of Dissociative Disorders Biological explanations point to lower than normal activity levels in the areas responsible for body awareness in people with dissociative disorders LO 13.6 Types of Dissociative Disorders AP: Diagnostic Categories and Their Symptoms

39. Psychology, Fourth Edition, AP Edition Saundra K. Ciccarelli J. Noland White © 2015, 2012, 2009 by Pearson Education, Inc. All rights reserved. Schizophrenia Schizophrenia: psychotic disorder in which the person suffers from disordered thinking, bizarre behavior, and hallucinations, and is unable to distinguish between fantasy and reality –Psychotic: the break away from an ability to perceive what is real and what is fantasy LO 13.7 Main Symptoms, and Causes of Schizophrenia AP: Diagnostic Categories and Their Symptoms

40. Psychology, Fourth Edition, AP Edition Saundra K. Ciccarelli J. Noland White © 2015, 2012, 2009 by Pearson Education, Inc. All rights reserved. Schizophrenia Delusions: false beliefs held by a person who refuses to accept evidence of their falseness –delusions of persecution –delusions of reference –delusions of influence –delusions of grandeur (or grandiose delusions) Speech and thought disturbances –clanging –word salad LO 13.7 Main Symptoms, and Causes of Schizophrenia AP: Diagnostic Categories and Their Symptoms

41. Psychology, Fourth Edition, AP Edition Saundra K. Ciccarelli J. Noland White © 2015, 2012, 2009 by Pearson Education, Inc. All rights reserved. Schizophrenia Hallucinations: false sensory perceptions, such as hearing voices that do not really exist Flat affect: a lack of emotional responsiveness Catatonia: either wildly excessive movement or total lack thereof LO 13.7 Main Symptoms, and Causes of Schizophrenia AP: Diagnostic Categories and Their Symptoms

42. Psychology, Fourth Edition, AP Edition Saundra K. Ciccarelli J. Noland White © 2015, 2012, 2009 by Pearson Education, Inc. All rights reserved. Schizophrenia Positive symptoms: excesses of behavior or occur in addition to normal behavior –hallucinations, delusions, and distorted thinking Negative symptoms: less-than-normal behavior or an absence of normal behavior –poor attention, flat affect, and poor speech production LO 13.7 Main Symptoms, and Causes of Schizophrenia AP: Diagnostic Categories and Their Symptoms

43. Psychology, Fourth Edition, AP Edition Saundra K. Ciccarelli J. Noland White © 2015, 2012, 2009 by Pearson Education, Inc. All rights reserved. Causes of Schizophrenia Biological explanations of schizophrenia focus on dopamine, structural defects in the brain, inflammation, and genetic influences –Neurodevelopmental model LO 13.7 Main Symptoms, and Causes of Schizophrenia AP: Diagnostic Categories and Their Symptoms

44. Psychology, Fourth Edition, AP Edition Saundra K. Ciccarelli J. Noland White © 2015, 2012, 2009 by Pearson Education, Inc. All rights reserved. Figure 13.2 Genetics and Schizophrenia This chart shows a definite pattern: The greater the degree of genetic relatedness, the higher the risk of schizophrenia in individuals related to each other. The only individual to carry a risk even close to that of identical twins (who share 100 percent of their genes) is a person who is the child of two parents with schizophrenia. Based on Gottesman (1991).

45. Psychology, Fourth Edition, AP Edition Saundra K. Ciccarelli J. Noland White © 2015, 2012, 2009 by Pearson Education, Inc. All rights reserved. Causes of Schizophrenia Stress-vulnerability model: assumes a biological sensitivity, or vulnerability, to a certain disorder that will develop under the right conditions of environmental or emotional stress LO 13.7 Main Symptoms, and Causes of Schizophrenia AP: Diagnostic Categories and Their Symptoms

46. Psychology, Fourth Edition, AP Edition Saundra K. Ciccarelli J. Noland White © 2015, 2012, 2009 by Pearson Education, Inc. All rights reserved. Personality Disorders Personality disorder: a disorder in which a person adopts a persistent, rigid, and maladaptive pattern of behavior that interferes with normal social interactions –Cluster A: seen as odd or eccentric (Paranoid, Schizoid, Schizotypal) –Cluster B: behavior is dramatic, emotional, or erratic (Antisocial, Borderline, Histrionic, Narcissistic) –Cluster C: the main emotion is anxiety or fearfulness (Avoidant, Dependent, Obsessive-Compulsive) LO 13.8 Types and Causes of Personality Disorders AP: Diagnostic Categories and Their Symptoms

47. Psychology, Fourth Edition, AP Edition Saundra K. Ciccarelli J. Noland White © 2015, 2012, 2009 by Pearson Education, Inc. All rights reserved. Personality Disorders Antisocial personality disorder: a person has no morals or conscience and often behaves in an impulsive manner without regard for the consequences of that behavior Borderline personality disorder: maladaptive personality pattern in which the person is moody and unstable, lacks a clear sense of identity, and often clings to others LO 13.8 Types and Causes of Personality Disorders AP: Diagnostic Categories and Their Symptoms

48. Psychology, Fourth Edition, AP Edition Saundra K. Ciccarelli J. Noland White © 2015, 2012, 2009 by Pearson Education, Inc. All rights reserved. Causes of Personality Disorders Cognitive-learning theorists see personality disorders as a set of learned behavior that has become maladaptive –bad habits learned early on in life –belief systems of the personality disordered person are seen as illogical Biological explanations look at genetic factors and stress hormones LO 13.8 Types and Causes of Personality Disorders AP: Diagnostic Categories and Their Symptoms

49. Psychology, Fourth Edition, AP Edition Saundra K. Ciccarelli J. Noland White © 2015, 2012, 2009 by Pearson Education, Inc. All rights reserved. Causes of Personality Disorders Other possible causes of personality disorders may include: –disturbances in family communications and relationships –childhood abuse, neglect, overly strict parenting, overprotective parenting, and parental rejection LO 13.8 Types and Causes of Personality Disorders AP: Diagnostic Categories and Their Symptoms

50. Psychology, Fourth Edition, AP Edition Saundra K. Ciccarelli J. Noland White © 2015, 2012, 2009 by Pearson Education, Inc. All rights reserved. Taking the Worry Out of Exams How to get test anxiety under control: –Find intrinsic reasons to do well on the text –Develop a strategy for controlling your cognitive state and behavior, both before and during the exam  Be prepared  Approach the exam with a positive mindset  Address one question at a time  Stay relaxed and breathe normally LO 13.9 What Are Some Ways to Overcome Test Anxiety?