Prepare for the NCMHCE with Techniques from the Special Forces
Prepare for the NCMHCE with Techniques from the Special Forces

Prepare for the NCMHCE with Techniques from the Special Forces

In April we conducted an interview with Alyson M. Carr about some of the common factors that impede successful performance on the counseling exam. Dr. Carr explained that exam anxiety is among the most common obstacles. Out of the hundreds of people she has spoken with, Dr. Carr has never encountered a single person who believed his or her performance hadn’t been negatively impacted by test-taking anxiety. This isn’t surprising, Carr explains, for “whether an intern is a first time test taker or a re-taker, this process is emotionally and mentally challenging for everyone to some degree.”

But why is the NCMHCE so emotionally and mentally draining? One reason is because the structure of the NCMHCE is so unlike any other exam. It includes 10 simulated cases which test a person’s information-gathering and decision-making skills. These simulated cases consist of between five and eight sections, each of which have multiple sections with various questions. Each correct answer selection reveals further information needed to answer additional questions about the scenario. These simulated cases require a candidate to think like a counselor and weed out irrelevant information. If a test-taker makes a wrong answer early on in the selection process, he or she may not get the information needed to make the right selection in a future section of the simulation. This can be nerve-racking and lead to information processing impairment. In some cases, the candidate may completely freeze up.

Another reason a person may find the NCMHCE so stressful is because his or her career may hinge on obtaining a passing score. The high stakes can cause natural test-taking anxiety to be amplified, resulting in a person forgetting the information and procedures previously rehearsed.

In many ways, the high-pressure context of the NCMHCE is similar to situations people encounter when training to be part of the special forces. One of the activities in Navy SEAL training is “pool comp,” a highly stressful activity that involves being put underwater with scuba gear and then subject to controlled harassment. An instructor will repeatedly swim up behind the candidate, yank the regulator out of his mouth and then proceed to tie his oxygen lines in a knot. This dreaded procedure is repeated over and over again for 20 minutes. Although students are trained in the procedures to untangle their gear and resume breathing, the natural reaction is to panic and fail the test. Candidates only get four attempts at pool comp before being disqualified from the program.

Psychologists working for the special forces have been integrating techniques used by Olympic athletes for performing under stress. These techniques, which have helped increase the pass rate of the Navy SEALS from a quarter to a third, may also be of help to NCMHCE candidates preparing for test-day.

Eric Barker, author of the bestseller Barking Up the Wrong Tree, shared about some of the techniques used by special operations in an article on how to increase mental toughness. These techniques include the following.

Mental rehearsal/Visualization. Eric Barker shares how Olympic athletes and special forces “used imagery to prepare themselves to get what they wanted out of training, to perfect skills within the training sessions, to make technical corrections, to imagine themselves being successful in competition, and to see themselves achieving their ultimate goal.”

It’s important to realize that this type of visualization is not just positive thinking; on the contrary, you have to imagine the negatives that might arise and visualize yourself overcoming those obstacles. This is what members of special operations did before raiding Bin Laden’s compound in Pakistan: They extensively imagined all the situations that might go wrong and then conceptualized how they would respond to those problems.

In the context of studying for and taking the NCMHCE, this might mean imagining yourself in the testing center and how you will respond if you are overwhelmed with anxiety, or what you will do if you freeze up. Imagine yourself responding by practicing your breathing exercises, implementing the anti-anxiety techniques you have practiced, and calmly focusing on the task at hand. You should engage in this type of visualization dozens of times before test-day so that you are fully prepared to respond to the challenges you encounter.

It is also helpful to visualize yourself achieving a passing score, how you will feel when you get the news, and what your friends will say when they learn that you’ve passed. This type of visualizing will help you remain positive during the long hours of studying and will help propel you forward towards your goal.

Simulate. Visualization is only part of the picture: you also have to simulate the conditions you are preparing to face in the real world. The U.S. Navy SEAL team did this by constructing full-scale replicas of Osama bin Laden’s compound. They rehearsed in this replica for three weeks before the actual raid on May 2011.

Simulations have also proved highly effective for Olympic athletics. As Barker explained,

The best athletes made extensive use of simulation training. They approached training runs, routines, plays, or scrimmages in practice as if they were at the competition, often wearing what they would wear and preparing like they would prepare.

In the context of the NCMHCE, you can simulate testing conditions by taking practice tests over and over again. Practice tests help with anxiety for the same reason that immersion therapy is effective when treating patients who suffer from phobias and various anxiety disorders: if you can normalize the object of your fears within a context that is safe and non-threatening, then you have the opportunity gradually to realize that your fears do not need to control you. That is why our package of NCMHCE preparation materials come with full access to practice tests. If you take enough NCMHCE practice tests, then when you arrive at the testing center on the day of your exam, your approach can be, “I got this.”

Self-Talk. In the Navy SEAL's Mental Training video below, it was suggested that the average person talks to him or herself at a rate of about 300 to 1,000 words a minute. Military leaders have found that if these words are positive, they can help override fear signals that might otherwise lead to a fight/flight/freeze response.


When special forces candidates find themselves unable to breathe during the dreaded pool comp test, positive self-talk can help them remain focused as they implement the emergency procedures they’ve been taught. The difference between pessimistic self-talk vs. optimistic self-talk can literally make a difference to whether a person fails or successfully completes the Navy SEAL training.

The basic principle of positive self-talk carry over to all the challenges we face. In Barker's article he gives examples of what this looks like in practice:

Pessimists tell themselves that bad events:

  1. Will last a long time, or forever. (“I’ll never get this done.”)
  2. Are universal. (“You can’t trust any of those people.”)
  3. Are their own fault. (“I’m terrible at this.”)

Optimists look at setbacks in the exact opposite way:

  1. Bad things are temporary. (“That happens occasionally but it’s no big deal.”)
  2. Bad things have a specific cause and aren’t universal. (“When the weather is better that won’t be a problem.”)
  3. It’s not their fault. (“I’m good at this but today wasn’t my lucky day.”)

This type of positive self-talk is very important as you prepare for the NCMHCE, especially as you work through practice exams. It is typical that you will score poorly in the first round of simulations; instead of being discouraged and trash-talking yourself, realize that you are making progress towards better understanding the exam and identifying areas of weakness to work on improving.

Goal Setting. Special operations training is so rigorous that people in the program can easily get overwhelmed if they allows themselves to think too far ahead. When every muscle in one’s body is screaming out to quit, the only thing that keeps a person going is setting goals in extremely short chunks. Perhaps your goal is simply not to quit until first light, or to survive until lunch, or to make it successfully to the top of the hill. As soon as a person reaches their goal, they are encouraged immediately to set a new one.

Those of us who are studying to take the NCMHCE can also benefit from setting short goals in small chunks. This might mean taking all your study materials and breaking them into small manageable steps. On days when you are feeling overwhelmed, set yourself a small goal and stick to it, even if that goal is only to study for fifteen minutes. After that goal is reached, you can make a new goal. These baby steps help to bring structure to chaos so that the reasoning and decision-making parts of the brain are not hijacked by the amygdala.

Arousal control. Deliberate slow breathing, especially long exhales, help to stop panic by activating the brain’s relaxation responses. This also helps to increase focus by allowing more oxygen to reach the brain. These types of arousal control techniques are not always sufficient to help someone stay calm in a frightening situation, but when combined with the other techniques they can be effective to lessen the likelihood of the brain being hijacked by a fight/flight/freeze response.

We recommend that candidates be prepared to implement arousal techniques on the day of the counseling exam. Read Alyson Carr's discussion of breathing techniques in National Clinical Mental Health Counseling Exam: Alyson Carr Interview. Practicing these techniques using the principles of visualization and simulation (see above) should be a regular part of your NCMHCE preparation.


Further Reading

National Clinical Mental Health Counseling Exam: Interview with Alyson Carr

How Navy SEAL Mental Training Helped Me Win the USA Memory Championships

NCMHCE: Where Do I Begin?

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