Academic and Exam Anxiety from a Biological Perspective: An Integrative Review of Domestic and International Literature (Focusing on Neural, Hormonal, and Cognitive Mechanisms)

Introduction: Academic anxiety, particularly university entrance examination anxiety, is among the most prevalent psychological challenges experienced by students preparing for high-stakes examinations. This phenomenon can significantly affect academic performance, mental health, and overall quality of life. Although the majority of previous studies have focused on the psychological and educational dimensions of test anxiety, emerging scientific evidence suggests that examination anxiety is also rooted in distinct biological, neural, and cognitive mechanisms. Therefore, the present study aimed to investigate academic and university entrance examination anxiety from a biological perspective, with particular emphasis on the neural, hormonal, and cognitive processes involved in its development and manifestation.Materials and Methods: This study was conducted using the Integrative Review methodology. The study population consisted of national and international publications addressing academic anxiety, test anxiety, educational stress, and related biological mechanisms. A total of ۳۵ scientific articles, including ۱۷ domestic studies and ۱۸ international studies, met the inclusion criteria and were selected from reputable national and international scientific databases. The collected data were examined through qualitative content analysis and comparative synthesis of findings.Findings: The results indicated that university entrance examination anxiety emerges from the interaction of biological, cognitive, familial, and educational factors. The findings revealed that activation of the Hypothalamic–Pituitary–Adrenal (HPA) axis, increased secretion of cortisol, and functional alterations in brain regions such as the amygdala, hippocampus, and prefrontal cortex constitute the primary biological mechanisms associated with academic anxiety. Furthermore, elevated anxiety levels were found to impair working memory, reduce concentration, disrupt information retrieval, and weaken problem-solving abilities. Analysis of the reviewed studies demonstrated that cognitive factors (۳۵%) and biological factors (۳۰%) accounted for the largest proportion of variance in explaining university entrance examination anxiety.Conclusion: The findings suggest that university entrance examination anxiety is not merely an emotional reaction but rather a multidimensional phenomenon with well-defined biological and cognitive foundations. Consequently, effective management of academic anxiety requires a comprehensive and multidimensional approach that extends beyond study-skills training and incorporates stress management, emotional regulation, family support, and mental health promotion. Greater attention to the biological dimensions of anxiety may facilitate the development of more effective evidence-based interventions aimed at reducing anxiety and enhancing academic performance.