With exam season just around the corner, some students and teachers will feel the pressure more than others. But those enduring anxiety and stress needn't face it alone.
Even when sitting her SATs in year six at school, Rebekah Dussek would become physically ill through the stress of these early tests.
"I also have a tendency to be very hard on myself, and if an exam hasn't gone the way I wanted it to I will sometimes take it out on myself through self-harm or restricting my eating. During my AS levels in 2015 was the first time I started to self-harm."
Now 20, Dussek, originally from Nottingham, is studying French and History in her first year at the University of Southampton. It has been a tough personal journey to the south coast - including a gap year "to give myself time to try to recover before university" - but she has picked up coping mechanisms along the way to help deal with her upcoming exams.
"One thing that’s helpful for me is that I try not to be alone after an exam, so I don't engage in self-destructive behaviours," she says. "I've also registered with the enabling services at university, which means that I can sit my exams in a small room, and have rest breaks to calm down if I am feeling panicked."
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Exam stress on the rise
Dussek is not alone in her experiences. According to the NSPCC, more than 3,000 young people turned to the charity's Childline counselling service for exam stress in 2016/17 - a rise of 11% over the past two years.
Over a fifth of these counselling sessions took place in May, in the run-up to the exam period. While 12- to 15-year-olds formed the largest demographic, there was a 21% year-on-year rise in the 16-18 age group using the service, telling counsellors of struggles with depression, anxiety, panic attacks and even suicidal thoughts due to upcoming exams.
"We know from Childline that many teenagers struggle with exam stress, which can affect their ability to sleep and eat properly, and can trigger panic attacks, depression and low self-esteem," says an NSPCC spokesperson.
"Parents and schools can help by trying not to place unnecessary pressure on children to gain certain grades, and if they are disappointed with their performance let them know you are there to support them.
"Whatever results they get they will have a lot to think about and it's important to remind young people not to panic and that there are always options available."
All work and no play ...
Such is the crucible of the exam period, students often won't allow themselves to take breaks from their studies, opting for all work and no play instead. To do so can be of peril to their mental health. Instead, Dussek advocates a "quality over quantity approach".
"My advice would be to still make time for other relaxing activities outside of revision," she says. "Your brain can't work at its best every minute of the day. I found things like going for a dog walk or run, or going out for a coffee or lunch with friends or family were good, as they don't take up loads of time, but get you out of the house for a break and change of scenery."
"It's really important to take care of your well-being during exam season," agrees Emma Saddleton, helpline manager at YoungMinds.
"Schedule your time so that you have regular breaks and make sure you can go outside and get some fresh air, as well as scheduling for relaxation time at the end of the day. It's also a good idea to organise something for when exams end, to take your mind off them and as a reward for getting through them."
For first-year university students in particular, living away from home for the first time - as well as the pressure to make new friends and handle finances - can often exacerbate things, says Nicky Lidbetter, chief executive of Anxiety UK.
"Students now living away from home may also feel the urge to self-medicate with alcohol or cigarettes," she says.
"It’s important that you get enough sleep. Revising until 3 am might feel like you're going the extra mile, but it will leave you exhausted and less likely to absorb the information. Exercise, healthy eating and hydration are quick wins to ensure you're nurturing your body as well as your mind."
Recent times have also seen the advent of "de-stress" events held by student unions. Back in 2016, the University of Westminster made the Evening Standard when it was reported its student union had brought puppies and bunnies on to the campus to help students take their minds off exam pressures. Slots to pet the animals sold out within minutes.
The University of Leicester Students' Union has also incorporated a “puppy room” during the exam period, as well as providing free fruit, yoga classes and board games to students.
"We know how important it is for students to have opportunities to relax, de-stress and treat themselves during this time," said Harriet Smailes, well-being officer at Leicester Students' Union.
"Although a certain level of pressure will help drive motivation, there's no doubt that too much stress will be detrimental to performance, so the more we as a union can do to help students achieve what they need, the better!"
Not just students
Perhaps not so widely reported is the stress teachers can also undergo during the exam period. According to Joe Glamp, who teaches at a comprehensive school in North London, teachers fear poor results reflect negatively on their pedagogic abilities, leading to self-doubt and stress.
"We recently had our second round of mock exams and the results in my class were really quite poor for a lot of students," he explains. "Realising this took a toll on me, as I felt disheartened and attached my success as a teacher to their success in these exams.
"I would say that most of the pressure on me is self-inflicted. We are expected, however, to put a little more effort in with our year 11s since they are coming close to their exams, but I personally feel happy to put this effort in, as it's the most rewarding part of my job."
But for other teachers at schools with behaviour problems and low student engagement, exam stress can be just the tip of the iceberg, says Glamp.
"That's the biggest stress for me," he says. "Lessons are very difficult to teach, with student engagement being so low that it is a challenge to talk for more than 30 seconds without having to deal with disruption in the class. It's a huge drain on morale."
Time to talk
Ultimately, the best thing students can do - whether they are sitting their SATs or their finals - is to open up and talk about their troubles rather than go into self-isolation mode.
"The chances are that many of your classmates will feel the same way and are too nervous themselves to talk about it," says Lidbetter. "Reach out to your friends, discuss your apprehensions rather than struggling in silence."
"If you're struggling with your mental health, you're not alone," adds Saddleton. "Speak to a parent, teacher, or a helpline and explain how you're feeling."
Elliot Bush, a 20-year-old linguistics student at the University of Kent, who suffers from anxiety, and started hearing voices at 15, suggests making use of university drop-in counselling services, available to all students.
"Talking is the best coping mechanism," he says. "My university has an excellent drop-in counselling service on weekdays for when I am feeling overwhelmed. Sometimes, though, I simply need to talk to a good friend, even if it's just going for a walk or talking about the weather.
"I have also created an 'Elliot's well-being box', which I made on World Mental Health Day. In it, I have items which comfort or ground me, from photos of my dog to nutmeg, which I take a sniff of when I'm feeling stressed - I find the strong scent very grounding."
Talking. Yoga. Meditation apps. Petting dogs. Nutmeg. All remedies are valid - but what works for one student may well not work for others. "It's important not to compare yourself, as everyone has different needs," says Dussek.
What is an indisputable truth, however, is that studying for exams should never come at the expense of one's mental health.