The Impact of Self-Knowledge and Meditation Education in Pharmacy Doctoral Training

The Impact of Self-Knowledge and Meditation Education in Pharmacy Doctoral Training | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Article The Impact of Self-Knowledge and Meditation Education in Pharmacy Doctoral Training Sundas Azim, Naz Fatah, Saloumeh DeGood, Shahrzad Movafagh This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-7149377/v1 This work is licensed under a CC BY 4.0 License Status: Under Review Version 1 posted 10 You are reading this latest preprint version Abstract Recent literature highlights the inadequacy of stress reduction and self-awareness skills in the professional development of healthcare students. Pharmacy educational programs report high rates of burnout and stress-related psychological impact on student well-being and academic performance. Meditative practices have been shown to reduce stress and anxiety in pharmacy students. M.T.O. Sufi Psychology ® and the Tamarkoz ® meditation method are based on Sufism, a unique discipline of self-knowledge tested with college students and shown to be superior to standard stress management methods in reducing stress and improving positive emotions. This study aims to determine the effect of a 15-week Sufi Psychology and Tamarkoz elective course on pharmacy student self-awareness, perceived stress, and mindfulness. The hypothesis is that self-knowledge didactics and routine Tamarkoz practice will improve student scores on the Perceived Stress Scale (PSS10), Self-Awareness Outcomes Questionnaire (SAOQ), Mindfulness Attention Awareness Scale (MAAS), and a Lifestyle Questionnaire. The course comprised mandatory weekly didactics on Sufi Psychology and meditation sessions. Pre-, post, and five-week follow-up course scores were used to evaluate the course impact. Significant improvements were found in the PSS10 and three of the SAOQ subscales, and no significant change in the MAAS scores. The lifestyle survey showed increased frequency and duration of weekly meditation practices post-course. Follow-up results confirmed the longitudinal benefits of the course in the PSS10 and the three SAOQ subscales. This study concludes that incorporating Sufi Psychology and Tamarkoz meditation skills training in the pharmacy curriculum can significantly improve student self-awareness and stress levels during pharmacy education. Health sciences/Health care Biological sciences/Psychology Social science/Psychology Stress healthcare education Sufi Psychology self-awareness Tamarkoz Figures Figure 1 Figure 2 Figure 3 Introduction Self-awareness is a critical skill in pharmacy professional education. The Center for the Advancement of Pharmacy Education and Entrustable Professional Activities (COPEPA) Outcomes requires self-awareness and professional development within its educational guidelines' "Attitudes" domain. Recent reports have identified variations and gaps in self-awareness education in pharmacy professional programs (Babal et al., 2020; Fulford et al., 2022; Medina et al., 2017; Mnatzaganian et al., 2023; Murry et al., 2023). Self-awareness skills are integrated within professional development courses and assessed during clinical rotations (Fulford et al., 2022; Mnatzaganian et al., 2023; Murry et al., 2023). These evaluations focus on student strengths and weaknesses, professional behavior, and social interactions (Fulford et al., 2022; Medina et al., 2017; Mnatzaganian et al., 2023; Murry et al., 2023). There are few objective methods for teaching and assessing higher-order self-awareness skills, such as evaluating self-perceptions, intelligence, creativity, and achievements (Vallacher & Solodky, 1979). Meanwhile, higher-order self-awareness skills are paramount in students' emotional, social, and moral development. Aside from self-awareness, wellness and stress reduction are critical during high-stress healthcare education. Burnout levels have been reported to be as high as 40–61% among pharmacists and pharmacy students (Abraham et al., 2021; Babal et al., 2020; El-Ibiary et al., 2017; Malcom & Boyle, 2023; Shangraw et al., 2021). Pharmacy students face academic demands, financial pressure, family needs, time management, and personal challenges (Geslani & Gaebelein, 2013). Recent reports highlight the need for incorporating wellbeing support in pharmacy curricula to combat burnout and anxiety (Abraham et al., 2021; Geslani & Gaebelein, 2013; Shangraw et al., 2021; Zeeman et al., 2024). Numerous studies have shown that yoga and meditative techniques can significantly improve mindfulness and self-awareness as well as reduce anxiety and stress in health science students (Brown & Ryan, 2003; Durand et al., 2023; Erogul et al., 2014; Lemay et al., 2019; Vago & Silbersweig, 2012). These experiential practices include mindfulness-based stress Reduction (MBSR), relaxation response, and Transcendental Meditation. Meditative techniques founded in Eastern cultures provide an alternative approach to self-awareness, focusing on reconstructing mindful self-views and attitudes instead of empowering self-esteem and self-image in Western psychology (Xiao et al., 2017). Although many studies have examined the practices mentioned above, very few have studied the benefits of Sufism, a 1400-year-old discipline of self-knowledge. Sufism is a spiritual tradition that focuses on each individual knowing the reality of their being and the entirety of their existence. M.T.O. Sufi Psychology® fuses the teachings of Sufism with contemporary psychological practices to create a practical and experiential way for individuals to better understand themselves and their biopsychosocial/spiritual influences. Recent research on Sufi Psychology has shown that its use significantly decreased levels of distress- "specifically therapeutic, relationship, psychological, spiritual, and critical distress" among a cultural, religious, and racially diverse population (Bozorgzadeh & Grasser, 2022). Sufi Psychology provides a didactic, psychoeducational component of self-knowledge and awareness. Teaching theories (Kolb, 1984) and current research have demonstrated that an experiential component is necessary for didactic teachings to be more impactful (Boos et al., 2022; Karimi et al., 2010; Yu et al., 2020). One such experiential technique, the Tamarkoz® method, is a meditative practice founded by the M.T.O. Shahmaghsoudi® School of Islamic Sufism® with various components, including mental relaxation, meditative movements (Movazeneh®), breathing exercises, deep relaxation, and imagery. Multiple components allow it to be utilized with various individuals since not everyone reacts to stress in a similar fashion. As such, it is used in multiple settings, including hospitals, patient care, and universities (Amjadi, 2021). A recent study with college students showed the effectiveness of the Tamarkoz method of meditation in reducing perceived stress and heart rate, in addition to increasing positive emotions and daily spiritual experiences. Their findings suggested the benefits of implementing a course that integrates meditation and self-awareness while fostering opportunities for their application and growth (Bahadorani et al., 2021). This study aimed to evaluate the effects of a 15-week-long Sufi Psychology and Tamarkoz elective course on self-awareness and stress in Doctor of Pharmacy Students. We hypothesized that the structured meditation sessions and self-awareness didactics would improve student stress levels and increase self-awareness and mindfulness. Methods Study Design The Shenandoah University Institutional Review Board approved this study. The study design was an experimental study with a follow-up phase conducted over three consecutive academic semesters. Each student served as their control. Participants and Enrollment Pharmacy students in their 2nd and 3rd years at Shenandoah University Bernard J. Dunn School of Pharmacy participated in the study. Students aged 22–43 years old enrolled in the meditation course, fulfilling the three required elective credit hours. Students could only register for the course once per university restrictions. Students were recruited via emailed course sign-up invitations. Enrollment was open for the Fall and Spring semesters. Course Structure The course was taught in collaboration with a Licensed Clinical Psychologist from the Sufi Psychology Association® (SPA), who is also a certified Tamarkoz instructor. SPA is a non-profit organization that provides psychoeducation incorporating Sufi self-knowledge principles with contemporary psychological practices. The course was a hybrid, synchronous model, allowing flexibility and student participation via Zoom or in person. Weekly sessions consisted of 120-minute lectures on self-knowledge and meditation concepts for healthcare providers, followed by 45-minute Tamarkoz sessions. Attendance was mandatory, and excused absences required makeup work. The final assignment involved applying Tamarkoz methods to a patient case as a non-pharmacological approach. The course comprised three modules: Wellness Principles, Strategies, and Wellness in Healthcare. The "Wellness Principles" module consisted of evidence-based psychoeducational didactics focusing on physical, mental, emotional, social, and spiritual health. The course contained many experiential components, including journaling, cognitive behavioral exercises, discussions, and reflective assignments that promoted self-awareness and wellness. In the "Strategies" module, students learned stress relieving techniques, including evidence-based components of the Tamarkoz method, such as mental relaxation, breathing exercises, deep relaxation, visualization, meditative movements, and concentration as coping mechanisms during challenging personal experiences. Finally, the "Wellness in Healthcare" module covered strategies for healthcare students on compassion fatigue, imposter syndrome, burnout prevention, and implementing the learned non-pharmacological techniques like meditation and journaling with patients. Data Collection A pre- and post-questionnaire was administered to students at the start and end of the semester. Five weeks after the semester, the same survey was conducted as a follow-up. Questionnaires Four different questionnaires were used to assess the study outcomes. The questionnaires were composed of three standard scales, including the Perceived Stress Scale 10 (PSS10), Self-Awareness Outcomes Questionnaire (SAOQ), and Mindfulness Attention Awareness Scale (MAAS), as well as a lifestyle questionnaire. Perceived Stress Scale. The Perceived Stress Scale 10 (PSS10), developed by Cohen et al., is a validated 10-item questionnaire designed to measure the level of stress individuals experience in unpredictable situations (Cohen et al., 1983). PSS10 has 10 items on a 5-point Likert scale (0 = never , 1 = almost never , 2 = sometimes , 3 = fairly often , and 4 = very often ). Six of the items are negatively worded (e.g., "How often have you been upset because of something that happened unexpectedly?") and four are positively worded (e.g., "How often have you felt that you were on top of things?"). The total PSS10 score is calculated by adding the scores for all 10 items. Scores ranging from 0 to 13 denote low-stress levels, 14 to 26 indicate moderate stress, and the range of 27 to 40 signifies high perceived stress. Self-Awareness Outcomes Questionnaire. The Self-Awareness Outcomes Questionnaire ( SAOQ) is a validated survey designed to measure the outcomes of improving self-awareness (Sutton, 2016). It comprises four subscales: Reflective Self-Development (RSD), Acceptance (ACC), Proactivity at work (PRO), and Emotional Cost (EC). RSD measures attention to self and learning approaches to self-improvement. ACC measures self-esteem and self-worth based on how individuals maintain self-positivity and self-confidence and how this contributes to accepting others. PRO measures behavior and attitude in the workplace. EC measures the acknowledgment of emotional experiences associated with self-awareness. Responses are based on a 5-point Likert scale (1- never , 2- rarely , 3- occasionally , 4- frequently , 5- almost alway s, and not applicable). Responses to each sub-section are scored separately, and group means were compared. Mindfulness Attention Awareness Scale. The Mindfulness Attention Awareness Scale (MAAS) is a validated scale to assess state of mind across 15 items, including general and specific scenarios (Brown & Ryan, 2003). It is the most extensively researched measure of trait mindfulness, evaluating conscious awareness of individuals to facilitate and apply interventions toward benefiting mental health, stress, and emotional regulation. Responses are recorded on a 6-point Likert scale ranging from (1- almost always , 2- very frequently , 3- somewhat frequently , 4- somewhat infrequently , 5- very infrequently , and 6- almost never ). Lifestyle Questionnaire. The lifestyle questionnaire was formulated by the study investigators to assess student life experiences during pharmacy school that could potentially create confounds to the outcomes. Each item addresses stressors such as daily commutes, financial, social, family, health-related, or academic demands, and utilization of counseling services in addition to the frequency and duration of weekly meditation practices. Statistical Analysis The PSS10 was analyzed using previously defined methods (Cohen et al., 1983; Smith et al., 2014). Four questions were formulated in a positively oriented manner, requiring the reversal of the scale scores, where 4-never, 3- almost never , 2-fairly often , and 1-very often . Some responses were collapsed and aggregated for comparison. PSS10 responses 'fairly often' and 'very often' were combined into 'often,' and 'almost never' was combined with 'never.' One outlier was excluded in the analysis due to deviating three standard deviations from the mean. The pre-and post-data were examined for normality using the Shapiro-Wilk test and were found to be normally distributed. The means of pre-course and post-course results were then compared using a 2-tailed paired student t-test with p < 0.05. SAOQ was analyzed by computing averages for each subscale separately pre- and post-course based on previously defined methods (Sutton, 2016). The SAOQ response 'never' was combined with 'rarely.' The pre-and post-data were examined for normality using the Shapiro-Wilk test and were found to be normally distributed. The group means were then compared using a 2-tailed paired student t-test with p < 0.05. For MAAS, the average score was computed for all fifteen scenarios based on previously described methods (Vallacher & Solodky, 1979). MAAS responses' almost always' and 'very frequently' were combined with 'frequently,' and 'somewhat infrequently' was combined with 'somewhat frequently.' The pre-and post-data were examined for normality using the Shapiro-Wilk test and were not found to be normally distributed. The group means were then compared using a Wilcoxon Signed Rank test with p < 0.05. Lifestyle questionnaire interval data such as the number of organizational, research activities, and duration of time (in hours/minutes per week) spent working, caring for others, studying outside of class, and physical activity were collapsed and combined into fewer categories for simplified data analysis. Pre- and post-scores for each question were averaged for all respondents and compared using Pearson's Chi-Square test with p < 0.05 indicating significance. For the follow-up survey analysis, data was analyzed using repeated measures ANOVA test, comparing pre-, post, and follow-up results using p < 0.05 to assess significant changes over time. Results A total of fifty students over three semesters completed the study from Spring 2023 (N = 25), Fall 2024 (N = 6) and to Spring 2024 (N = 19) (Fig. 1 ). The follow up phase of the study included twenty two students; Spring 2023 (N = 7), Fall 2024 (N = 5), and Spring 2024 (N = 10). Table 1 represents the demographic information of the participating students. There were thirty-eight female participants (76%) and twelve male participants (24%). Twenty-eight students were second-year students (56%), and twenty-two were third-year students (44%). The mean age was 27.5 years. Twenty-three students (46%) were single, fourteen (28%) were married, and thirteen (26%) students were in a relationship. Ethnic distribution of the participants was relatively even across races, with African American (20%), Caucasian (28%), Hispanic/Latino (16%), Southeast Asian (18%), and Middle Eastern/North African (16%), and other (2%). Table 1 Demographic Characteristics (N = 50) Characteristic N(%) Gender Female 38(76) Male 12(24) Age 20–24 14 (28) 25–29 26 (52) 30–34 6 (12) 35 and above 4 (8) Relationship Status Single 23(46) Married 14(28) In a relationship 13(26) Race African-American 10(20) Caucasian 14(28) Southeast Asian 9(18) Hispanic/Latino 8(16) Middle Eastern/North African 8(16) Prefer not to disclose/Other 1 (2) Pharmacy Year P2 28(56) P3 22(44) Table 2. Pre- and post-course Lifestyle Questionnaire Pre-course (N = 50) Post-course (N = 50) P-value a Please indicate your agreement with the following statements (agree responses) * My daily commute to the University increases my level of stress. 24 21 0.54 My financial burden increases my level of stress (e.g., loans, childcare, housing, etc.) 35 35 1 The COVID-19 pandemic has increased my current level of stress 18 16 0.67 The COVID-19 pandemic has increased my current academic stress. 15 12 0.50 My current health condition has increased my current level of stress 26 16 0.07 How many hours a week do you work? 0 5 7 0.53 1–20 hours 40 36 0.34 21 + hours 5 7 0.53 How many hours a week do you spend caring for others (e.g., childcare, elder care, etc.)? 0 14 15 0.82 1–20 hours 29 27 0.69 21 + hours 8 8 1 How many hours a week do you spend studying outside of class time? 0–15 hours 29 29 1 16–20 hours 13 13 1 21 + hours 8 8 1 How many organizations are you a member of? 0 5 6 0.74 1–3 40 37 0.47 4+ 5 5 1 How many leadership positions do you currently have? 0 14 10 0.31 1–3 34 34 1 4+ 2 6 0.14 How many research projects are you involved in outside of classroom assignments? 0 41 39 0.61 1 8 8 1 2 1 3 0.31 Describe any stress you are experiencing due to factors related to your social identity (e.g., gender, gender identity, sexual orientation, race/ethnicity, nationality, religion, age). If none, write N/A. N/A 27 38 0.02 b Race/ethnicity 3 4 0.70 Gender 0 1 0.30 Health 0 3 0.07 Religion 0 1 0.07 How many minutes per week do you participate in physical activity (ex, yoga, brisk walking, running, etc.)? 0 minutes 5 6 0.70 15–59 minutes 21 29 0.12 60–149 minutes 17 15 0.66 150 + minutes 7 10 0.66 How many times a week do you practice meditation (e.g., mindful breathing, visualizations, etc)? 0 x week 24 3 < 0.0001 b 1 x week 18 19 0.83 2 x week 2 10 0.013 b 3 x week 5 13 < 0.0001 b 4 x week 1 2 0.56 5 x week 0 3 0.16 If you practice meditation, how many minutes do you meditate per session (write N/A if you do not practice meditation)? N/A 28 4 < 0.0001 b 5–10 minutes 5 15 0.01 b 11–20 minutes 10 15 0.25 21–30 minutes 2 8 0.04 b 31 + minutes 2 8 0.04 b Within the last 3 months, how many times have you participated in counseling to help cope with or manage stress (in-school and/or outside counseling)? 0 40 43 0.40 1–3 8 6 0.60 4+ 2 1 0.60 a Statistical analysis performed using the Pearson Chi-square test b Statistical significance defined at P < 0.05. * Cronbach’s alpha (α = 0.70) Perceived stress scale Figure 2 a represents the results of the PSS10. The Shapiro-Wilk test for the pre-course ( W(49) = 0.97, p = 0.3 ) and post-course ( W(49) = 0.96, p = 0.07 ) data did not show a significant departure from normality. Collective responses showed a significant decrease in the average PSS10 scores post-course ( t(49) = 2.37, p = 0.02) . Mindfulness Attention Awareness Scale Figure 2 b illustrates MAAS results, with average scores decreased from 3.9 ± 0.93 to 3.8±0.89 post-course. The Wilcoxon signed-rank test indicated no significant difference between pre-and post-course results in this questionnaire ( z=-0.49, p = 0.60 ). Self-Awareness outcomes questionnaire The SAOQ displayed significant change in three of the four subscales. Figure 2 c represents the results of SAOQ subscales pre- and post-course. For the RSD subscale, the pre-course ( W(49) = 0.96, p = 0.06 ) and the post-course (W(49) = 0.98, p = 0.4 ) Shapiro-Wilk test did not show a significant departure from normality and the average score in this subscale significantly increased from pre- to post-course ( t(48) = 3.64, p = 0.0006) . Similarly, for the ACC subscale, the pre-course ( W(50) = 0.96, p = 0.1 ) and the post-course ( W(50) = 0.96, p = 0.05 ) Shapiro-Wilk test did not show a significant departure from normality. The average scores increased significantly from pre-course to post-course values ( t(49) = 2.21, p = 0.03) . For the PRO subscale, the Shapiro-Wilk test showed no significant departure from normality in pre-course ( W(50) = 0.97, p = 0.3 ) and the post-course ( W(50) = 0.95, p = 0.05 ) values. The PRO subscale average scores significantly increased from pre-course to post-course ( t(49) = 2.14, p = 0.04) . Finally, for the EC subscale, the Shapiro-Wilk test pre-course W(50) = 0.96, p = 0.1 ) and post-course ( W(50) = 0.97, p = 0.245 ) values did not show a significant departure from normality. The EC subscale slightly decreased from pre- to post-course ( t(48)= -1.16, p = 0.25); however, the difference between groups was not statistically significant. Lifestyle Questionnaire Table 2 illustrates the lifestyle survey questions and responses pre- and post-course. Significance levels are shown for specific survey items. The survey validity was examined with a Cronbach's alpha test (α = 0.70). Overall, there were no significant differences between pre-and post-course results in items addressing academic activities, financial, social, and lifestyle stressors, physical activity, and the use of psychological counseling. However, there were significant changes in meditation practices post-course. Students were asked, "How many times a week do you practice meditation (e.g., mindful breathing, visualizations, etc)? " The proportion of students meditating " zero times a week " post-course differed significantly ( X 2 (1, N = 50) = 22.37, p = .00001 ), followed by an increase in the frequency of practices of " 2 times a week ," and " 3 times a week ," ( X 2 (1, N = 50) = 6.06, p = .013 , X 2 (1, N = 50) = 22.62, p = 0.0001 respectively). Students were also asked, " If you practice meditation, how many minutes do you meditate per session (write N/A if you do not practice meditation) ?" There was a decrease in N/A response post-course ( X 2 (1, N = 50) = 26.47, p < .0001 ). The proportion of students practicing meditation for 5–10 minutes and those who meditated for 21–30 minutes increased post-course ( X 2 (1, N = 50) = 6.25, p = .012 and X 2 (1, N = 50) = 4, p = 0.04 respectively). Follow-up Surveys Twenty-two students completed the follow-up questionnaire over the three semesters (Spring 2023 (N = 7), Fall 2023 (N = 5), and Fall 2024 (N = 10)). A repeated-measures ANOVA was performed to examine the effect of taking the course on the PSS10 and the four subscales of SAOQ. Figure 3 a displays the results of perceived stress measured by the PSS10 beyond the completion of the course. The Repeated Measures ANOVA test indicated that there is a significant difference in PSS10 scores between the pre-, post, and follow-up, F(2, 30) = 3.62, p = .039 , with a mean of 20.38 for pre-course, 19.06 for post course, 16.94 for follow-up. For these results, the Mauchly's test of sphericity indicated that the assumption of sphericity cannot be rejected; hence, the assumption had not been violated, χ2(2) = 0.511, p = 0.774 . In the SAOQ subscales (Fig. 3 b), the Repeated Measures ANOVA test indicated that there was a significant difference in three of the four subscales pre-, post, and follow up (Fig. 3 b). The RSD scores increased significantly between the pre-, post, and follow-up, F(1.35, 28.26) = 4.96, p = .025 , with a mean of 3.9 for pre-course, 4.11 for post-course, and 4.19 for follow up. Mauchly's test of sphericity indicated that the assumption of sphericity had been violated, χ2(2) = 13.314, p = .001 , and therefore a Greenhouse-Geisser correlation was used (ε = .673). For the ACC subscale, the Repeated Measures ANOVA test indicated that there was a significant difference between pre-, post, and follow-up responses, F(2, 42) = 4.47, p = .017 , with a mean of 3.66 for pre-course, 3.81 for post-course, and 3.98 for follow up. The Mauchly's test of sphericity indicated that the assumption of sphericity cannot be rejected; hence, the assumption had not been violated, χ2(2) = 4.44, p = .109 . For the PRO subscale, the Repeated Measures ANOVA test also indicated that there was a significant difference between pre-, post, and follow-up responses, F(2, 42) = 5.1, p = .010 , with a mean of 3.64 for pre-course, 3.81 for post-course, and 3.95 for follow up. Mauchly's test of sphericity indicated that the assumption of sphericity cannot be rejected; hence, the assumption had not been violated, χ2(2) = 0.224, p = .894 . Finally, for the EC subscale of the SAOQ scale, Mauchly's test of sphericity indicated that the assumption of sphericity could not be rejected, and the assumption had not been violated, χ2(2) = 0.768, p = .681 . The Repeated Measures ANOVA test indicated that there is a non-significant difference between pre-course and post-course and follow-up responses, F(2, 42) = 1.78, p = .181 , with a mean of 3.34 for pre-course, 3.3 for post course, 3.13 for follow up. The MAAS results were not statistically significant beyond the course completion, but there was an increase in overall scores, displayed in Fig. 3 c. The lifestyle questionnaire showed no change during follow-up for most of the questions. Sixty-eight percent of the students reported consistent or increased use of meditation in their daily routines, with session durations remaining the same or reverting to the pre-course status. Discussion The current study evaluated the impact of a 15-week elective course teaching M.T.O. Sufi Psychology® and the Tamarkoz® method of meditation in second and third-year pharmacy students. Several endpoints were examined to evaluate the effectiveness of the course in terms of stress reduction, self-awareness improvement, mindfulness, and lifestyle modifications. The study showed that engagement in a semester-long course with regular meditation practices significantly reduces perceived stress levels in students, even during high-stress finals week. Previous studies have indicated that elevated stress levels in pharmacy students can decrease their academic performance and quality of life (Lemay et al., 2019; Shangraw et al., 2021). Our results have shown that implementing Sufi Psychology teaching and the Tamarkoz method of meditation method effectively reduces pharmacy student stress levels. Our follow-up results continued to show a significant reduction in stress levels beyond course completion, emphasizing the efficacy of this practice. There are few objective methods for teaching and assessing self-awareness quantitatively in healthcare education. Our results, with three of the four SAOQ subscales showing significant improvement, exemplify a valid method of assessing self-awareness in the healthcare curriculum. A novel factor in our study is that the longitudinal improvement observed throughout semesters and the follow-up period indicates long-term effects. This study evaluated changes in student mindfulness resulting from the course. Our findings showed improvement but no statistically significant differences in the MAAS. This is partly due to the course contents and the Tamarkoz method, which focuses primarily on self-awareness, relaxation, and stress reduction, not mindfulness. Including more mindfulness content in future courses can enhance the outcomes of this scale. Regarding lifestyle questions, our results showed no significant differences with respect to external influences: academic activities, financial, social, and lifestyle stressors, physical activity, and the use of psychological counseling before and after taking the course. Given that there were no significant differences between the pre- and post-course results, this data suggests that the improvement in the PSS10 results is likely due to the course interventions enhancing the coping strategies for unchanging life stressors. Notably, the duration of the counseling sessions showed no significant differences pre- and post-course, indicating that the reduced stress levels were not due to increased psychological support. There was a significant increase in the utilization of meditation practice duration post-course. Our study incorporated mandatory meditation sessions as part of the course, guaranteeing students practiced 45 minutes during each class to ensure proper technique and adherence to the practice. Our follow-up results showed continued practice in 68% of the students. Additionally, the amount of time spent in meditation remained consistent or increased. These findings indicate that the effects of the course were persistent as lifestyle modifications. Results are consistent with a previous study at the University of California, Berkeley, which also utilizes the Tamarkoz method (Bahadorani et al., 2021). In both studies, the effects of the intervention persisted beyond course completion. This study had several strengths. Despite being an elective, a sample size of fifty participants completed the study, making it the highest enrollment elective course at the Shenandoah University pharmacy school. After course completion, students continued to demand follow-up courses. The inclusion of self-knowledge didactics using Sufi Psychology taught by a licensed psychologist and the unique practice of the Tamarkoz method contributed to the appeal of the course. Another strength is the duration of the study, which spans over three semesters. To our knowledge, this is the only report that has examined the effects of a wellness elective course longitudinally. Consistent results across two levels of professional years undergoing different environmental or lifestyle influences strengthened the findings and accounted for potential confounding variables. Lastly, the assessment tools utilized in this study validate their application as objective measures of self-awareness in healthcare education. There are several limitations to this study. One limitation is the potential for reporting bias due to self-reported outcomes by the participants. This is a general challenge in qualitative assessment tools. However, the consistency of the findings across three semesters and during the follow-up phase contributes to the validity of the study results. Another limitation is attrition during follow-up. Most follow-ups were lost after spring semesters, likely due to student departures during summer break. Another limitation is the lack of a separate control group. This limitation was partly addressed by comparing each student's scores to their own baseline. Students serving as their control also account for confounds such as the history of prior meditation experience or variation of lifestyle factors. Recruiting control group participants was challenging in the first three study rounds. Incentivizing students can enhance future participation. Conclusion This study demonstrates the benefits of incorporating Sufi Psychology and the Tamarkoz method of meditation on self-awareness and stress in Doctor of Pharmacy students. Very few health profession programs offer structured courses to teach self-awareness skills. Our elective course features a novel design integrating Sufi-based self-knowledge didactics and meditation techniques alongside opportunities to extend these skills in patient care. We advocate for other healthcare education programs to adopt similar courses, employing self-knowledge didactics and meditative techniques as a tool to improve self-awareness education in their professional programs. Declarations Ethical Approval and Informed Consent Human Ethics and Consent to Participate This study adhered to the standards set forth by the Declaration of Helsinki. The Human Ethics and Consent to Participate guidelines were determined by Shenandoah University Internal Review Board based on the protocol number 1238, approved on March 8th, 2023. Competing Interests The authors have no conflicts of interest to declare. Funding This study has no funding declaration. Author Contribution All authors whose names appear on the submission1) Made substantial contributions to the conception or design of the work; or the acquisition, analysis, or interpretation of data; or the creation of new software used in the work;2) Drafted the work or revised it critically for important intellectual content;3) Approved the version to be published; and4) Agree to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved. Data Availability The manuscript contains data acquired and analyzed; however, for the protection of the study participants, the data is not publicly available and will be provided to the journal upon request. References Abraham, O., Babal, J. C., Brasel, K. V., Gay, S., & Hoernke, M. (2021). Strategies first year doctor of pharmacy students use to promote well-being. 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Frontiers in Psychology, 8, 1752. https://doi.org/10.3389/fpsyg.2017.01752 Yu, A., Lambert, R. F., Alvarado, J. A., Guzman, C. A. F., & Seymour, B. (2020). Integrating Competency-Based Didactic and Experiential Global Health Learning for Dental Students: The Global Health Learning Helix Model. Journal of Dental Education, 84(4), 438–448. https://doi.org/10.21815/JDE.019.186 Zeeman, J. M., Nana, A. A., Pickering, E. S., & Harris, S. C. (2024). Assessing Factors That Influence Pharmacy Student Burnout and Identifying Recommendations to Support Student Well-Being. American Journal of Pharmaceutical Education, 88(9), 100741. https://doi.org/10.1016/j.ajpe.2024.100741 Additional Declarations No competing interests reported. Cite Share Download PDF Status: Under Review Version 1 posted Editorial decision: Revision requested 20 Apr, 2026 Reviews received at journal 15 Nov, 2025 Reviews received at journal 31 Oct, 2025 Reviewers agreed at journal 27 Oct, 2025 Reviewers agreed at journal 22 Oct, 2025 Reviewers invited by journal 21 Oct, 2025 Editor assigned by journal 23 Sep, 2025 Editor invited by journal 21 Aug, 2025 Submission checks completed at journal 17 Aug, 2025 First submitted to journal 17 Aug, 2025 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-7149377","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Article","associatedPublications":[],"authors":[{"id":535792715,"identity":"a6a8489d-283e-4f12-9fd2-749506b4df57","order_by":0,"name":"Sundas Azim","email":"","orcid":"","institution":"Shenandoah University","correspondingAuthor":false,"prefix":"","firstName":"Sundas","middleName":"","lastName":"Azim","suffix":""},{"id":535792716,"identity":"cef54324-58eb-45cd-939e-9b15520b8995","order_by":1,"name":"Naz Fatah","email":"","orcid":"","institution":"Shenandoah 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The Center for the Advancement of Pharmacy Education and Entrustable Professional Activities (COPEPA) Outcomes requires self-awareness and professional development within its educational guidelines' \"Attitudes\" domain. Recent reports have identified variations and gaps in self-awareness education in pharmacy professional programs (Babal et al., 2020; Fulford et al., 2022; Medina et al., 2017; Mnatzaganian et al., 2023; Murry et al., 2023). Self-awareness skills are integrated within professional development courses and assessed during clinical rotations (Fulford et al., 2022; Mnatzaganian et al., 2023; Murry et al., 2023). These evaluations focus on student strengths and weaknesses, professional behavior, and social interactions (Fulford et al., 2022; Medina et al., 2017; Mnatzaganian et al., 2023; Murry et al., 2023). There are few objective methods for teaching and assessing higher-order self-awareness skills, such as evaluating self-perceptions, intelligence, creativity, and achievements (Vallacher \u0026amp; Solodky, 1979). Meanwhile, higher-order self-awareness skills are paramount in students' emotional, social, and moral development.\u003c/p\u003e\u003cp\u003eAside from self-awareness, wellness and stress reduction are critical during high-stress healthcare education. Burnout levels have been reported to be as high as 40\u0026ndash;61% among pharmacists and pharmacy students (Abraham et al., 2021; Babal et al., 2020; El-Ibiary et al., 2017; Malcom \u0026amp; Boyle, 2023; Shangraw et al., 2021). Pharmacy students face academic demands, financial pressure, family needs, time management, and personal challenges (Geslani \u0026amp; Gaebelein, 2013). Recent reports highlight the need for incorporating wellbeing support in pharmacy curricula to combat burnout and anxiety (Abraham et al., 2021; Geslani \u0026amp; Gaebelein, 2013; Shangraw et al., 2021; Zeeman et al., 2024).\u003c/p\u003e\u003cp\u003eNumerous studies have shown that yoga and meditative techniques can significantly improve mindfulness and self-awareness as well as reduce anxiety and stress in health science students (Brown \u0026amp; Ryan, 2003; Durand et al., 2023; Erogul et al., 2014; Lemay et al., 2019; Vago \u0026amp; Silbersweig, 2012). These experiential practices include mindfulness-based stress Reduction (MBSR), relaxation response, and Transcendental Meditation. Meditative techniques founded in Eastern cultures provide an alternative approach to self-awareness, focusing on reconstructing mindful self-views and attitudes instead of empowering self-esteem and self-image in Western psychology (Xiao et al., 2017).\u003c/p\u003e\u003cp\u003eAlthough many studies have examined the practices mentioned above, very few have studied the benefits of Sufism, a 1400-year-old discipline of self-knowledge. Sufism is a spiritual tradition that focuses on each individual knowing the reality of their being and the entirety of their existence. M.T.O. Sufi Psychology\u0026reg; fuses the teachings of Sufism with contemporary psychological practices to create a practical and experiential way for individuals to better understand themselves and their biopsychosocial/spiritual influences. Recent research on Sufi Psychology has shown that its use significantly decreased levels of distress- \"specifically therapeutic, relationship, psychological, spiritual, and critical distress\" among a cultural, religious, and racially diverse population (Bozorgzadeh \u0026amp; Grasser, 2022). Sufi Psychology provides a didactic, psychoeducational component of self-knowledge and awareness. Teaching theories (Kolb, 1984) and current research have demonstrated that an experiential component is necessary for didactic teachings to be more impactful (Boos et al., 2022; Karimi et al., 2010; Yu et al., 2020).\u003c/p\u003e\u003cp\u003eOne such experiential technique, the Tamarkoz\u0026reg; method, is a meditative practice founded by the M.T.O. Shahmaghsoudi\u0026reg; School of Islamic Sufism\u0026reg; with various components, including mental relaxation, meditative movements (Movazeneh\u0026reg;), breathing exercises, deep relaxation, and imagery. Multiple components allow it to be utilized with various individuals since not everyone reacts to stress in a similar fashion. As such, it is used in multiple settings, including hospitals, patient care, and universities (Amjadi, 2021).\u003c/p\u003e\u003cp\u003eA recent study with college students showed the effectiveness of the Tamarkoz method of meditation in reducing perceived stress and heart rate, in addition to increasing positive emotions and daily spiritual experiences. Their findings suggested the benefits of implementing a course that integrates meditation and self-awareness while fostering opportunities for their application and growth (Bahadorani et al., 2021).\u003c/p\u003e\u003cp\u003eThis study aimed to evaluate the effects of a 15-week-long Sufi Psychology and Tamarkoz elective course on self-awareness and stress in Doctor of Pharmacy Students. We hypothesized that the structured meditation sessions and self-awareness didactics would improve student stress levels and increase self-awareness and mindfulness.\u003c/p\u003e"},{"header":"Methods","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e\u003ch2\u003eStudy Design\u003c/h2\u003e\u003cp\u003e The Shenandoah University Institutional Review Board approved this study. The study design was an experimental study with a follow-up phase conducted over three consecutive academic semesters. Each student served as their control.\u003c/p\u003e\u003c/div\u003e\n\u003ch3\u003eParticipants and Enrollment\u003c/h3\u003e\n\u003cp\u003ePharmacy students in their 2nd and 3rd years at Shenandoah University Bernard J. Dunn School of Pharmacy participated in the study. Students aged 22\u0026ndash;43 years old enrolled in the meditation course, fulfilling the three required elective credit hours. Students could only register for the course once per university restrictions. Students were recruited via emailed course sign-up invitations. Enrollment was open for the Fall and Spring semesters.\u003c/p\u003e\n\u003ch3\u003eCourse Structure\u003c/h3\u003e\n\u003cp\u003eThe course was taught in collaboration with a Licensed Clinical Psychologist from the Sufi Psychology Association\u0026reg; (SPA), who is also a certified Tamarkoz instructor. SPA is a non-profit organization that provides psychoeducation incorporating Sufi self-knowledge principles with contemporary psychological practices. The course was a hybrid, synchronous model, allowing flexibility and student participation via Zoom or in person. Weekly sessions consisted of 120-minute lectures on self-knowledge and meditation concepts for healthcare providers, followed by 45-minute Tamarkoz sessions. Attendance was mandatory, and excused absences required makeup work. The final assignment involved applying Tamarkoz methods to a patient case as a non-pharmacological approach. The course comprised three modules: Wellness Principles, Strategies, and Wellness in Healthcare. The \"Wellness Principles\" module consisted of evidence-based psychoeducational didactics focusing on physical, mental, emotional, social, and spiritual health. The course contained many experiential components, including journaling, cognitive behavioral exercises, discussions, and reflective assignments that promoted self-awareness and wellness. In the \"Strategies\" module, students learned stress relieving techniques, including evidence-based components of the Tamarkoz method, such as mental relaxation, breathing exercises, deep relaxation, visualization, meditative movements, and concentration as coping mechanisms during challenging personal experiences. Finally, the \"Wellness in Healthcare\" module covered strategies for healthcare students on compassion fatigue, imposter syndrome, burnout prevention, and implementing the learned non-pharmacological techniques like meditation and journaling with patients.\u003c/p\u003e\n\u003ch3\u003eData Collection\u003c/h3\u003e\n\u003cp\u003eA pre- and post-questionnaire was administered to students at the start and end of the semester. Five weeks after the semester, the same survey was conducted as a follow-up.\u003c/p\u003e\n\u003ch3\u003eQuestionnaires\u003c/h3\u003e\n\u003cp\u003eFour different questionnaires were used to assess the study outcomes. The questionnaires were composed of three standard scales, including the Perceived Stress Scale 10 (PSS10), Self-Awareness Outcomes Questionnaire (SAOQ), and Mindfulness Attention Awareness Scale (MAAS), as well as a lifestyle questionnaire.\u003c/p\u003e\u003cp\u003e\u003cb\u003ePerceived Stress Scale.\u003c/b\u003e The Perceived Stress Scale 10 (PSS10), developed by Cohen et al., is a validated 10-item questionnaire designed to measure the level of stress individuals experience in unpredictable situations (Cohen et al., 1983). PSS10 has 10 items on a 5-point Likert scale (0\u0026thinsp;=\u0026thinsp;\u003cem\u003enever\u003c/em\u003e, 1\u0026thinsp;=\u0026thinsp;\u003cem\u003ealmost never\u003c/em\u003e, 2\u0026thinsp;=\u0026thinsp;\u003cem\u003esometimes\u003c/em\u003e, 3\u0026thinsp;=\u0026thinsp;\u003cem\u003efairly often\u003c/em\u003e, and 4\u0026thinsp;=\u0026thinsp;\u003cem\u003every often\u003c/em\u003e). Six of the items are negatively worded (e.g., \"How often have you been upset because of something that happened unexpectedly?\") and four are positively worded (e.g., \"How often have you felt that you were on top of things?\"). The total PSS10 score is calculated by adding the scores for all 10 items. Scores ranging from 0 to 13 denote low-stress levels, 14 to 26 indicate moderate stress, and the range of 27 to 40 signifies high perceived stress.\u003c/p\u003e\u003cp\u003e\u003cb\u003eSelf-Awareness Outcomes Questionnaire.\u003c/b\u003e The Self-Awareness Outcomes Questionnaire \u003cspan type=\"Underline\" class=\"Underline\" name=\"Emphasis\"\u003e(\u003c/span\u003eSAOQ) is a validated survey designed to measure the outcomes of improving self-awareness (Sutton, 2016). It comprises four subscales: Reflective Self-Development (RSD), Acceptance (ACC), Proactivity at work (PRO), and Emotional Cost (EC). RSD measures attention to self and learning approaches to self-improvement. ACC measures self-esteem and self-worth based on how individuals maintain self-positivity and self-confidence and how this contributes to accepting others. PRO measures behavior and attitude in the workplace. EC measures the acknowledgment of emotional experiences associated with self-awareness. Responses are based on a 5-point Likert scale (1-\u003cem\u003enever\u003c/em\u003e, 2-\u003cem\u003erarely\u003c/em\u003e, 3-\u003cem\u003eoccasionally\u003c/em\u003e, 4- \u003cem\u003efrequently\u003c/em\u003e, 5-\u003cem\u003ealmost alway\u003c/em\u003es, and not applicable). Responses to each sub-section are scored separately, and group means were compared.\u003c/p\u003e\u003cp\u003e\u003cb\u003eMindfulness Attention Awareness Scale.\u003c/b\u003e The Mindfulness Attention Awareness Scale (MAAS) is a validated scale to assess state of mind across 15 items, including general and specific scenarios (Brown \u0026amp; Ryan, 2003). It is the most extensively researched measure of trait mindfulness, evaluating conscious awareness of individuals to facilitate and apply interventions toward benefiting mental health, stress, and emotional regulation. Responses are recorded on a 6-point Likert scale ranging from (1-\u003cem\u003ealmost always\u003c/em\u003e, 2- \u003cem\u003every frequently\u003c/em\u003e, 3-\u003cem\u003esomewhat frequently\u003c/em\u003e, 4-\u003cem\u003esomewhat infrequently\u003c/em\u003e, 5- \u003cem\u003every infrequently\u003c/em\u003e, and 6- \u003cem\u003ealmost never\u003c/em\u003e).\u003c/p\u003e\u003cp\u003e\u003cb\u003eLifestyle Questionnaire.\u003c/b\u003e The lifestyle questionnaire was formulated by the study investigators to assess student life experiences during pharmacy school that could potentially create confounds to the outcomes. Each item addresses stressors such as daily commutes, financial, social, family, health-related, or academic demands, and utilization of counseling services in addition to the frequency and duration of weekly meditation practices.\u003c/p\u003e\u003cdiv id=\"Sec8\" class=\"Section2\"\u003e\u003ch2\u003eStatistical Analysis\u003c/h2\u003e\u003cp\u003eThe PSS10 was analyzed using previously defined methods (Cohen et al., 1983; Smith et al., 2014). Four questions were formulated in a positively oriented manner, requiring the reversal of the scale scores, where \u003cem\u003e4-never, 3- almost never\u003c/em\u003e, \u003cem\u003e2-fairly often\u003c/em\u003e, and \u003cem\u003e1-very often\u003c/em\u003e. Some responses were collapsed and aggregated for comparison. PSS10 responses \u003cem\u003e'fairly often'\u003c/em\u003e and \u003cem\u003e'very often'\u003c/em\u003e were combined into \u003cem\u003e'often,'\u003c/em\u003e and \u003cem\u003e'almost never'\u003c/em\u003e was combined with \u003cem\u003e'never.'\u003c/em\u003e One outlier was excluded in the analysis due to deviating three standard deviations from the mean. The pre-and post-data were examined for normality using the Shapiro-Wilk test and were found to be normally distributed. The means of pre-course and post-course results were then compared using a 2-tailed paired student t-test with p\u0026thinsp;\u0026lt;\u0026thinsp;0.05.\u003c/p\u003e\u003cp\u003eSAOQ was analyzed by computing averages for each subscale separately pre- and post-course based on previously defined methods (Sutton, 2016). The SAOQ response \u003cem\u003e'never'\u003c/em\u003e was combined with \u003cem\u003e'rarely.'\u003c/em\u003e The pre-and post-data were examined for normality using the Shapiro-Wilk test and were found to be normally distributed. The group means were then compared using a 2-tailed paired student t-test with p\u0026thinsp;\u0026lt;\u0026thinsp;0.05.\u003c/p\u003e\u003cp\u003eFor MAAS, the average score was computed for all fifteen scenarios based on previously described methods (Vallacher \u0026amp; Solodky, 1979). MAAS responses' \u003cem\u003ealmost always'\u003c/em\u003e and \u003cem\u003e'very frequently'\u003c/em\u003e were combined with \u003cem\u003e'frequently,'\u003c/em\u003e and \u003cem\u003e'somewhat infrequently'\u003c/em\u003e was combined with \u003cem\u003e'somewhat frequently.'\u003c/em\u003e The pre-and post-data were examined for normality using the Shapiro-Wilk test and were not found to be normally distributed. The group means were then compared using a Wilcoxon Signed Rank test with p\u0026thinsp;\u0026lt;\u0026thinsp;0.05.\u003c/p\u003e\u003cp\u003eLifestyle questionnaire interval data such as the number of organizational, research activities, and duration of time (in hours/minutes per week) spent working, caring for others, studying outside of class, and physical activity were collapsed and combined into fewer categories for simplified data analysis. Pre- and post-scores for each question were averaged for all respondents and compared using Pearson's Chi-Square test with p\u0026thinsp;\u0026lt;\u0026thinsp;0.05 indicating significance.\u003c/p\u003e\u003cp\u003eFor the follow-up survey analysis, data was analyzed using repeated measures ANOVA test, comparing pre-, post, and follow-up results using p\u0026thinsp;\u0026lt;\u0026thinsp;0.05 to assess significant changes over time.\u003c/p\u003e\u003c/div\u003e"},{"header":"Results","content":"\u003cp\u003eA total of fifty students over three semesters completed the study from Spring 2023 (N\u0026thinsp;=\u0026thinsp;25), Fall 2024 (N\u0026thinsp;=\u0026thinsp;6) and to Spring 2024 (N\u0026thinsp;=\u0026thinsp;19) (Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e). The follow up phase of the study included twenty two students; Spring 2023 (N\u0026thinsp;=\u0026thinsp;7), Fall 2024 (N\u0026thinsp;=\u0026thinsp;5), and Spring 2024 (N\u0026thinsp;=\u0026thinsp;10). Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e represents the demographic information of the participating students. There were thirty-eight female participants (76%) and twelve male participants (24%). Twenty-eight students were second-year students (56%), and twenty-two were third-year students (44%). The mean age was 27.5 years. Twenty-three students (46%) were single, fourteen (28%) were married, and thirteen (26%) students were in a relationship. Ethnic distribution of the participants was relatively even across races, with African American (20%), Caucasian (28%), Hispanic/Latino (16%), Southeast Asian (18%), and Middle Eastern/North African (16%), and other (2%).\u003c/p\u003e\u003cp\u003e\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eDemographic Characteristics (N\u0026thinsp;=\u0026thinsp;50)\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"2\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003eCharacteristic\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eN(%)\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e\u003cp\u003e\u003cb\u003eGender\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eFemale\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e38(76)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eMale\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e12(24)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eAge\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e20\u0026ndash;24\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e14 (28)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e25\u0026ndash;29\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e26 (52)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e30\u0026ndash;34\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e6 (12)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e35 and above\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e4 (8)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e\u003cp\u003e\u003cb\u003eRelationship Status\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eSingle\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e23(46)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eMarried\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e14(28)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eIn a relationship\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e13(26)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e\u003cp\u003e\u003cb\u003eRace\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eAfrican-American\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e10(20)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eCaucasian\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e14(28)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eSoutheast Asian\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e9(18)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eHispanic/Latino\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e8(16)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eMiddle Eastern/North African\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e8(16)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003ePrefer not to disclose/Other\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e1 (2)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e\u003cp\u003e\u003cb\u003ePharmacy Year\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eP2\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e28(56)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eP3\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e22(44)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"No\" id=\"Taba\" border=\"1\"\u003e\u003ccolgroup cols=\"4\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003eTable\u0026nbsp;2. Pre- and post-course Lifestyle Questionnaire\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003ePre-course (N\u0026thinsp;=\u0026thinsp;50)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003ePost-course (N\u0026thinsp;=\u0026thinsp;50)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003eP-value\u003csup\u003ea\u003c/sup\u003e\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003ePlease indicate your agreement with the following statements (agree responses)\u003cem\u003e*\u003c/em\u003e\u003c/p\u003e\u003cp\u003eMy daily commute to the University increases my level of stress.\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e24\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e21\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.54\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eMy financial burden increases my level of stress (e.g., loans, childcare, housing, etc.)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e35\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e35\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e1\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eThe COVID-19 pandemic has increased my current level of stress\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e18\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e16\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.67\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eThe COVID-19 pandemic has increased my current academic stress.\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e15\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e12\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.50\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eMy current health condition has increased my current level of stress\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e26\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e16\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.07\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eHow many hours a week do you work?\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e0\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e5\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e7\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.53\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e1\u0026ndash;20 hours\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e40\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e36\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.34\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e21\u0026thinsp;+\u0026thinsp;hours\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e5\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e7\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.53\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eHow many hours a week do you spend caring for others (e.g., childcare, elder care, etc.)?\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e0\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e14\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e15\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.82\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e1\u0026ndash;20 hours\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e29\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e27\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.69\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e21\u0026thinsp;+\u0026thinsp;hours\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e8\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e8\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e1\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eHow many hours a week do you spend studying outside of class time?\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e0\u0026ndash;15 hours\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e29\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e29\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e1\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e16\u0026ndash;20 hours\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e13\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e13\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e1\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e21\u0026thinsp;+\u0026thinsp;hours\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e8\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e8\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e1\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eHow many organizations are you a member of?\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e0\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e5\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e6\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.74\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e1\u0026ndash;3\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e40\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e37\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.47\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e4+\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e5\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e5\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e1\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eHow many leadership positions do you currently have?\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e0\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e14\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e10\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.31\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e1\u0026ndash;3\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e34\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e34\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e1\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e4+\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e2\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e6\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.14\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eHow many research projects are you involved in outside of classroom assignments?\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e0\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e41\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e39\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.61\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e8\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e8\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e1\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e2\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e3\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.31\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eDescribe any stress you are experiencing due to factors related to your social identity (e.g., gender, gender identity, sexual orientation, race/ethnicity, nationality, religion, age). If none, write N/A.\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eN/A\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e27\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e38\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.02\u003csup\u003eb\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eRace/ethnicity\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e3\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e4\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.70\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eGender\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e0\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.30\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eHealth\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e0\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e3\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.07\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eReligion\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e0\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.07\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eHow many minutes per week do you participate in physical activity (ex, yoga, brisk walking, running, etc.)?\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e0 minutes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e5\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e6\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.70\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e15\u0026ndash;59 minutes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e21\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e29\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.12\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e60\u0026ndash;149 minutes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e17\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e15\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.66\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e150\u0026thinsp;+\u0026thinsp;minutes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e7\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e10\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.66\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eHow many times a week do you practice meditation (e.g., mindful breathing, visualizations, etc)?\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e0 x week\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e24\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e3\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;0.0001\u003csup\u003eb\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e1 x week\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e18\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e19\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.83\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e2 x week\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e2\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e10\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.013\u003csup\u003eb\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e3 x week\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e5\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e13\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;0.0001\u003csup\u003eb\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e4 x week\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e2\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.56\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e5 x week\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e0\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e3\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.16\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eIf you practice meditation, how many minutes do you meditate per session (write N/A if you do not practice meditation)?\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eN/A\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e28\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e4\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;0.0001\u003csup\u003eb\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e5\u0026ndash;10 minutes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e5\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e15\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.01\u003csup\u003eb\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e11\u0026ndash;20 minutes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e10\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e15\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.25\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e21\u0026ndash;30 minutes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e2\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e8\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.04\u003csup\u003eb\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e31\u0026thinsp;+\u0026thinsp;minutes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e2\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e8\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.04\u003csup\u003eb\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eWithin the last 3 months, how many times have you participated in counseling to help cope with or manage stress (in-school and/or outside counseling)?\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e0\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e40\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e43\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.40\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e1\u0026ndash;3\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e8\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e6\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.60\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e4+\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e2\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.60\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003ctfoot\u003e\u003ctr\u003e\u003ctd colspan=\"4\"\u003e\u003csup\u003ea\u003c/sup\u003e Statistical analysis performed using the Pearson Chi-square test\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd colspan=\"4\"\u003e\u003csup\u003eb\u003c/sup\u003e Statistical significance defined at P\u0026thinsp;\u0026lt;\u0026thinsp;0.05.\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd colspan=\"4\"\u003e\u003csup\u003e*\u003c/sup\u003e Cronbach\u0026rsquo;s alpha (α\u0026thinsp;=\u0026thinsp;0.70)\u003c/td\u003e\u003c/tr\u003e\u003c/tfoot\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\n\u003ch3\u003ePerceived stress scale\u003c/h3\u003e\n\u003cp\u003eFigure \u003cspan refid=\"Fig2\" class=\"InternalRef\"\u003e2\u003c/span\u003ea represents the results of the PSS10. The Shapiro-Wilk test for the pre-course (\u003cem\u003eW(49)\u0026thinsp;=\u0026thinsp;0.97, p\u0026thinsp;=\u0026thinsp;0.3\u003c/em\u003e) and post-course (\u003cem\u003eW(49)\u0026thinsp;=\u0026thinsp;0.96, p\u0026thinsp;=\u0026thinsp;0.07\u003c/em\u003e) data did not show a significant departure from normality. Collective responses showed a significant decrease in the average PSS10 scores post-course (\u003cem\u003et(49)\u0026thinsp;=\u0026thinsp;2.37, p\u0026thinsp;=\u0026thinsp;0.02)\u003c/em\u003e.\u003c/p\u003e\u003cp\u003e\u003c/p\u003e\u003cdiv id=\"Sec11\" class=\"Section2\"\u003e\u003ch2\u003eMindfulness Attention Awareness Scale\u003c/h2\u003e\u003cp\u003eFigure \u003cspan refid=\"Fig2\" class=\"InternalRef\"\u003e2\u003c/span\u003eb illustrates MAAS results, with average scores decreased from 3.9 \u0026plusmn; 0.93 to 3.8\u0026plusmn;0.89 post-course. The Wilcoxon signed-rank test indicated no significant difference between pre-and post-course results in this questionnaire (\u003cem\u003ez=-0.49, p\u0026thinsp;=\u0026thinsp;0.60\u003c/em\u003e).\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec12\" class=\"Section2\"\u003e\u003ch2\u003eSelf-Awareness outcomes questionnaire\u003c/h2\u003e\u003cp\u003eThe SAOQ displayed significant change in three of the four subscales. Figure\u0026nbsp;\u003cspan refid=\"Fig2\" class=\"InternalRef\"\u003e2\u003c/span\u003ec represents the results of SAOQ subscales pre- and post-course. For the RSD subscale, the pre-course (\u003cem\u003eW(49)\u0026thinsp;=\u0026thinsp;0.96, p\u0026thinsp;=\u0026thinsp;0.06\u003c/em\u003e) and the post-course \u003cem\u003e(W(49)\u0026thinsp;=\u0026thinsp;0.98, p\u0026thinsp;=\u0026thinsp;0.4\u003c/em\u003e) Shapiro-Wilk test did not show a significant departure from normality and the average score in this subscale significantly increased from pre- to post-course (\u003cem\u003et(48)\u0026thinsp;=\u0026thinsp;3.64, p\u0026thinsp;=\u0026thinsp;0.0006)\u003c/em\u003e. Similarly, for the ACC subscale, the pre-course (\u003cem\u003eW(50)\u0026thinsp;=\u0026thinsp;0.96, p\u0026thinsp;=\u0026thinsp;0.1\u003c/em\u003e) and the post-course (\u003cem\u003eW(50)\u0026thinsp;=\u0026thinsp;0.96, p\u0026thinsp;=\u0026thinsp;0.05\u003c/em\u003e) Shapiro-Wilk test did not show a significant departure from normality. The average scores increased significantly from pre-course to post-course values (\u003cem\u003et(49)\u0026thinsp;=\u0026thinsp;2.21, p\u0026thinsp;=\u0026thinsp;0.03)\u003c/em\u003e. For the PRO subscale, the Shapiro-Wilk test showed no significant departure from normality in pre-course (\u003cem\u003eW(50)\u0026thinsp;=\u0026thinsp;0.97, p\u0026thinsp;=\u0026thinsp;0.3\u003c/em\u003e) and the post-course (\u003cem\u003eW(50)\u0026thinsp;=\u0026thinsp;0.95, p\u0026thinsp;=\u0026thinsp;0.05\u003c/em\u003e) values. The PRO subscale average scores significantly increased from pre-course to post-course (\u003cem\u003et(49)\u0026thinsp;=\u0026thinsp;2.14, p\u0026thinsp;=\u0026thinsp;0.04)\u003c/em\u003e. Finally, for the EC subscale, the Shapiro-Wilk test pre-course \u003cem\u003eW(50)\u0026thinsp;=\u0026thinsp;0.96, p\u0026thinsp;=\u0026thinsp;0.1\u003c/em\u003e) and post-course (\u003cem\u003eW(50)\u0026thinsp;=\u0026thinsp;0.97, p\u0026thinsp;=\u0026thinsp;0.245\u003c/em\u003e) values did not show a significant departure from normality. The EC subscale slightly decreased from pre- to post-course (\u003cem\u003et(48)= -1.16, p\u0026thinsp;=\u0026thinsp;0.25);\u003c/em\u003e however, the difference between groups was not statistically significant.\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec13\" class=\"Section2\"\u003e\u003ch2\u003eLifestyle Questionnaire\u003c/h2\u003e\u003cp\u003eTable\u0026nbsp;2 illustrates the lifestyle survey questions and responses pre- and post-course. Significance levels are shown for specific survey items. The survey validity was examined with a Cronbach's alpha test (α\u0026thinsp;=\u0026thinsp;0.70). Overall, there were no significant differences between pre-and post-course results in items addressing academic activities, financial, social, and lifestyle stressors, physical activity, and the use of psychological counseling. However, there were significant changes in meditation practices post-course. Students were asked, \u003cem\u003e\"How many times a week do you practice meditation (e.g., mindful breathing, visualizations, etc)?\u003c/em\u003e\" The proportion of students meditating \"\u003cem\u003ezero times a week\u003c/em\u003e\" post-course differed significantly (\u003cem\u003eX\u003c/em\u003e\u003csup\u003e\u003cem\u003e2\u003c/em\u003e\u003c/sup\u003e\u0026nbsp;\u003cem\u003e(1,\u0026nbsp;N\u0026nbsp;= 50)\u0026thinsp;=\u0026thinsp;22.37,\u0026nbsp;p\u0026nbsp;= .00001\u003c/em\u003e), followed by an increase in the frequency of practices of \"\u003cem\u003e2 times a week\u003c/em\u003e,\" and \"\u003cem\u003e3 times a week\u003c/em\u003e,\" (\u003cem\u003eX\u003c/em\u003e\u003csup\u003e\u003cem\u003e2\u003c/em\u003e\u003c/sup\u003e\u0026nbsp;\u003cem\u003e(1,\u0026nbsp;N\u0026nbsp;= 50)\u0026thinsp;=\u0026thinsp;6.06,\u0026nbsp;p\u0026nbsp;= .013\u003c/em\u003e, \u003cem\u003eX\u003c/em\u003e\u003csup\u003e\u003cem\u003e2\u003c/em\u003e\u003c/sup\u003e\u0026nbsp;\u003cem\u003e(1,\u0026nbsp;N\u0026nbsp;= 50)\u0026thinsp;=\u0026thinsp;22.62, p\u0026thinsp;=\u003c/em\u003e\u0026thinsp;0.0001 respectively). Students were also asked, \"\u003cem\u003eIf you practice meditation, how many minutes do you meditate per session (write N/A if you do not practice meditation)\u003c/em\u003e?\" There was a decrease in N/A response post-course (\u003cem\u003eX\u003c/em\u003e\u003csup\u003e\u003cem\u003e2\u003c/em\u003e\u003c/sup\u003e\u0026nbsp;\u003cem\u003e(1,\u0026nbsp;N\u0026nbsp;= 50)\u0026thinsp;=\u0026thinsp;26.47,\u0026nbsp;p\u0026nbsp;\u0026lt; .0001\u003c/em\u003e). The proportion of students practicing meditation for 5\u0026ndash;10 minutes and those who meditated for 21\u0026ndash;30 minutes increased post-course (\u003cem\u003eX\u003c/em\u003e\u003csup\u003e\u003cem\u003e2\u003c/em\u003e\u003c/sup\u003e\u0026nbsp;\u003cem\u003e(1,\u0026nbsp;N\u0026nbsp;= 50)\u0026thinsp;=\u0026thinsp;6.25,\u0026nbsp;p\u0026nbsp;= .012\u003c/em\u003e and \u003cem\u003eX\u003c/em\u003e\u003csup\u003e\u003cem\u003e2\u003c/em\u003e\u003c/sup\u003e\u0026nbsp;\u003cem\u003e(1,\u0026nbsp;N\u0026nbsp;= 50)\u0026thinsp;=\u0026thinsp;4, p\u0026thinsp;=\u0026thinsp;0.04\u003c/em\u003e respectively).\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec14\" class=\"Section2\"\u003e\u003ch2\u003eFollow-up Surveys\u003c/h2\u003e\u003cp\u003eTwenty-two students completed the follow-up questionnaire over the three semesters (Spring 2023 (N\u0026thinsp;=\u0026thinsp;7), Fall 2023 (N\u0026thinsp;=\u0026thinsp;5), and Fall 2024 (N\u0026thinsp;=\u0026thinsp;10)). A repeated-measures ANOVA was performed to examine the effect of taking the course on the PSS10 and the four subscales of SAOQ. Figure\u0026nbsp;\u003cspan refid=\"Fig3\" class=\"InternalRef\"\u003e3\u003c/span\u003ea displays the results of perceived stress measured by the PSS10 beyond the completion of the course. The Repeated Measures ANOVA test indicated that there is a significant difference in PSS10 scores between the pre-, post, and follow-up, \u003cem\u003eF(2, 30)\u0026thinsp;=\u0026thinsp;3.62, p\u0026thinsp;=\u0026thinsp;.039\u003c/em\u003e, with a mean of 20.38 for pre-course, 19.06 for post course, 16.94 for follow-up. For these results, the Mauchly's test of sphericity indicated that the assumption of sphericity cannot be rejected; hence, the assumption had not been violated, \u003cem\u003eχ2(2)\u0026thinsp;=\u0026thinsp;0.511, p\u0026thinsp;=\u0026thinsp;0.774\u003c/em\u003e.\u003c/p\u003e\u003cp\u003e\u003c/p\u003e\u003cp\u003eIn the SAOQ subscales (Fig.\u0026nbsp;\u003cspan refid=\"Fig3\" class=\"InternalRef\"\u003e3\u003c/span\u003eb), the Repeated Measures ANOVA test indicated that there was a significant difference in three of the four subscales pre-, post, and follow up (Fig.\u0026nbsp;\u003cspan refid=\"Fig3\" class=\"InternalRef\"\u003e3\u003c/span\u003eb). The RSD scores increased significantly between the pre-, post, and follow-up, \u003cem\u003eF(1.35, 28.26)\u0026thinsp;=\u0026thinsp;4.96, p\u0026thinsp;=\u0026thinsp;.025\u003c/em\u003e, with a mean of 3.9 for pre-course, 4.11 for post-course, and 4.19 for follow up. Mauchly's test of sphericity indicated that the assumption of sphericity had been violated, \u003cem\u003eχ2(2)\u0026thinsp;=\u0026thinsp;13.314, p\u0026thinsp;=\u0026thinsp;.001\u003c/em\u003e, and therefore a Greenhouse-Geisser correlation was used (ε\u0026thinsp;=\u0026thinsp;.673). For the ACC subscale, the Repeated Measures ANOVA test indicated that there was a significant difference between pre-, post, and follow-up responses, \u003cem\u003eF(2, 42)\u0026thinsp;=\u0026thinsp;4.47, p\u0026thinsp;=\u0026thinsp;.017\u003c/em\u003e, with a mean of 3.66 for pre-course, 3.81 for post-course, and 3.98 for follow up. The Mauchly's test of sphericity indicated that the assumption of sphericity cannot be rejected; hence, the assumption had not been violated, \u003cem\u003eχ2(2)\u0026thinsp;=\u0026thinsp;4.44, p\u0026thinsp;=\u0026thinsp;.109\u003c/em\u003e.\u003c/p\u003e\u003cp\u003eFor the PRO subscale, the Repeated Measures ANOVA test also indicated that there was a significant difference between pre-, post, and follow-up responses, \u003cem\u003eF(2, 42)\u0026thinsp;=\u0026thinsp;5.1, p\u0026thinsp;=\u0026thinsp;.010\u003c/em\u003e, with a mean of 3.64 for pre-course, 3.81 for post-course, and 3.95 for follow up. Mauchly's test of sphericity indicated that the assumption of sphericity cannot be rejected; hence, the assumption had not been violated, \u003cem\u003eχ2(2)\u0026thinsp;=\u0026thinsp;0.224, p\u0026thinsp;=\u0026thinsp;.894\u003c/em\u003e.\u003c/p\u003e\u003cp\u003eFinally, for the EC subscale of the SAOQ scale, Mauchly's test of sphericity indicated that the assumption of sphericity could not be rejected, and the assumption had not been violated, \u003cem\u003eχ2(2)\u0026thinsp;=\u0026thinsp;0.768, p\u0026thinsp;=\u0026thinsp;.681\u003c/em\u003e. The Repeated Measures ANOVA test indicated that there is a non-significant difference between pre-course and post-course and follow-up responses, \u003cem\u003eF(2, 42)\u0026thinsp;=\u0026thinsp;1.78, p\u0026thinsp;=\u0026thinsp;.181\u003c/em\u003e, with a mean of 3.34 for pre-course, 3.3 for post course, 3.13 for follow up.\u003c/p\u003e\u003cp\u003eThe MAAS results were not statistically significant beyond the course completion, but there was an increase in overall scores, displayed in Fig.\u0026nbsp;\u003cspan refid=\"Fig3\" class=\"InternalRef\"\u003e3\u003c/span\u003ec. The lifestyle questionnaire showed no change during follow-up for most of the questions. Sixty-eight percent of the students reported consistent or increased use of meditation in their daily routines, with session durations remaining the same or reverting to the pre-course status.\u003c/p\u003e\u003c/div\u003e"},{"header":"Discussion","content":"\u003cp\u003eThe current study evaluated the impact of a 15-week elective course teaching M.T.O. Sufi Psychology\u0026reg; and the Tamarkoz\u0026reg; method of meditation in second and third-year pharmacy students. Several endpoints were examined to evaluate the effectiveness of the course in terms of stress reduction, self-awareness improvement, mindfulness, and lifestyle modifications.\u003c/p\u003e\u003cp\u003eThe study showed that engagement in a semester-long course with regular meditation practices significantly reduces perceived stress levels in students, even during high-stress finals week. Previous studies have indicated that elevated stress levels in pharmacy students can decrease their academic performance and quality of life (Lemay et al., 2019; Shangraw et al., 2021). Our results have shown that implementing Sufi Psychology teaching and the Tamarkoz method of meditation method effectively reduces pharmacy student stress levels. Our follow-up results continued to show a significant reduction in stress levels beyond course completion, emphasizing the efficacy of this practice.\u003c/p\u003e\u003cp\u003eThere are few objective methods for teaching and assessing self-awareness quantitatively in healthcare education. Our results, with three of the four SAOQ subscales showing significant improvement, exemplify a valid method of assessing self-awareness in the healthcare curriculum. A novel factor in our study is that the longitudinal improvement observed throughout semesters and the follow-up period indicates long-term effects.\u003c/p\u003e\u003cp\u003eThis study evaluated changes in student mindfulness resulting from the course. Our findings showed improvement but no statistically significant differences in the MAAS. This is partly due to the course contents and the Tamarkoz method, which focuses primarily on self-awareness, relaxation, and stress reduction, not mindfulness. Including more mindfulness content in future courses can enhance the outcomes of this scale.\u003c/p\u003e\u003cp\u003eRegarding lifestyle questions, our results showed no significant differences with respect to external influences: academic activities, financial, social, and lifestyle stressors, physical activity, and the use of psychological counseling before and after taking the course. Given that there were no significant differences between the pre- and post-course results, this data suggests that the improvement in the PSS10 results is likely due to the course interventions enhancing the coping strategies for unchanging life stressors. Notably, the duration of the counseling sessions showed no significant differences pre- and post-course, indicating that the reduced stress levels were not due to increased psychological support. There was a significant increase in the utilization of meditation practice duration post-course. Our study incorporated mandatory meditation sessions as part of the course, guaranteeing students practiced 45 minutes during each class to ensure proper technique and adherence to the practice. Our follow-up results showed continued practice in 68% of the students. Additionally, the amount of time spent in meditation remained consistent or increased. These findings indicate that the effects of the course were persistent as lifestyle modifications. Results are consistent with a previous study at the University of California, Berkeley, which also utilizes the Tamarkoz method (Bahadorani et al., 2021). In both studies, the effects of the intervention persisted beyond course completion.\u003c/p\u003e\u003cp\u003eThis study had several strengths. Despite being an elective, a sample size of fifty participants completed the study, making it the highest enrollment elective course at the Shenandoah University pharmacy school. After course completion, students continued to demand follow-up courses. The inclusion of self-knowledge didactics using Sufi Psychology taught by a licensed psychologist and the unique practice of the Tamarkoz method contributed to the appeal of the course. Another strength is the duration of the study, which spans over three semesters. To our knowledge, this is the only report that has examined the effects of a wellness elective course longitudinally. Consistent results across two levels of professional years undergoing different environmental or lifestyle influences strengthened the findings and accounted for potential confounding variables. Lastly, the assessment tools utilized in this study validate their application as objective measures of self-awareness in healthcare education.\u003c/p\u003e\u003cp\u003eThere are several limitations to this study. One limitation is the potential for reporting bias due to self-reported outcomes by the participants. This is a general challenge in qualitative assessment tools. However, the consistency of the findings across three semesters and during the follow-up phase contributes to the validity of the study results. Another limitation is attrition during follow-up. Most follow-ups were lost after spring semesters, likely due to student departures during summer break. Another limitation is the lack of a separate control group. This limitation was partly addressed by comparing each student's scores to their own baseline. Students serving as their control also account for confounds such as the history of prior meditation experience or variation of lifestyle factors. Recruiting control group participants was challenging in the first three study rounds. Incentivizing students can enhance future participation.\u003c/p\u003e"},{"header":"Conclusion","content":"\u003cp\u003eThis study demonstrates the benefits of incorporating Sufi Psychology and the Tamarkoz method of meditation on self-awareness and stress in Doctor of Pharmacy students. Very few health profession programs offer structured courses to teach self-awareness skills. Our elective course features a novel design integrating Sufi-based self-knowledge didactics and meditation techniques alongside opportunities to extend these skills in patient care. We advocate for other healthcare education programs to adopt similar courses, employing self-knowledge didactics and meditative techniques as a tool to improve self-awareness education in their professional programs.\u003c/p\u003e"},{"header":"Declarations","content":"\u003ch2\u003eEthical Approval\u0026nbsp;and Informed Consent\u003c/strong\u003e\u003c/h2\u003e\n\u003cp\u003e\u003cstrong\u003eHuman Ethics and Consent to Participate\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis study adhered to the standards set forth by the Declaration of Helsinki. The Human Ethics and Consent to Participate guidelines were determined by Shenandoah University Internal Review Board based on the protocol number 1238, approved on March 8th, 2023.\u003c/p\u003e\n\u003ch2\u003eCompeting Interests\u003c/h2\u003e\n\u003cp\u003eThe authors have no conflicts of interest to declare.\u003c/p\u003e\n\u003ch2\u003eFunding\u003c/h2\u003e\n\u003cp\u003eThis study has no funding declaration.\u003c/p\u003e\n\u003ch2\u003eAuthor Contribution\u003c/h2\u003e\n\u003cp\u003eAll authors whose names appear on the submission1) Made substantial contributions to the conception or design of the work; or the acquisition, analysis, or interpretation of data; or the creation of new software used in the work;2) Drafted the work or revised it critically for important intellectual content;3) Approved the version to be published; and4) Agree to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.\u003c/p\u003e\n\u003ch2\u003eData Availability\u003c/h2\u003e\n\u003cp\u003eThe manuscript contains data acquired and analyzed; however, for the protection of the study participants, the data is not publicly available and will be provided to the journal upon request.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eAbraham, O., Babal, J. 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The Mindful Self: A Mindfulness-Enlightened Self-view. Frontiers in Psychology, 8, 1752. https://doi.org/10.3389/fpsyg.2017.01752\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eYu, A., Lambert, R. F., Alvarado, J. A., Guzman, C. A. F., \u0026amp; Seymour, B. (2020). Integrating Competency-Based Didactic and Experiential Global Health Learning for Dental Students: The Global Health Learning Helix Model. Journal of Dental Education, 84(4), 438\u0026ndash;448. https://doi.org/10.21815/JDE.019.186\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eZeeman, J. M., Nana, A. A., Pickering, E. S., \u0026amp; Harris, S. C. (2024). Assessing Factors That Influence Pharmacy Student Burnout and Identifying Recommendations to Support Student Well-Being. American Journal of Pharmaceutical Education, 88(9), 100741. https://doi.org/10.1016/j.ajpe.2024.100741\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"humanities-and-social-sciences-communications","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"palcomms","sideBox":"Learn more about [Humanities \u0026 Social Sciences Communications](http://www.nature.com/palcomms/)","snPcode":"41599","submissionUrl":"https://submission.springernature.com/new-submission/41599/3","title":"Humanities and Social Sciences Communications","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"stoa","reportingPortfolio":"Nature AJ","inReviewEnabled":true,"inReviewRevisionsEnabled":false},"keywords":"Stress, healthcare education, Sufi Psychology, self-awareness, Tamarkoz","lastPublishedDoi":"10.21203/rs.3.rs-7149377/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-7149377/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003eRecent literature highlights the inadequacy of stress reduction and self-awareness skills in the professional development of healthcare students. Pharmacy educational programs report high rates of burnout and stress-related psychological impact on student well-being and academic performance. Meditative practices have been shown to reduce stress and anxiety in pharmacy students. M.T.O. Sufi Psychology\u003csup\u003e\u0026reg;\u003c/sup\u003e and the Tamarkoz\u003csup\u003e\u0026reg;\u003c/sup\u003e meditation method are based on Sufism, a unique discipline of self-knowledge tested with college students and shown to be superior to standard stress management methods in reducing stress and improving positive emotions. This study aims to determine the effect of a 15-week Sufi Psychology and Tamarkoz elective course on pharmacy student self-awareness, perceived stress, and mindfulness. The hypothesis is that self-knowledge didactics and routine Tamarkoz practice will improve student scores on the Perceived Stress Scale (PSS10), Self-Awareness Outcomes Questionnaire (SAOQ), Mindfulness Attention Awareness Scale (MAAS), and a Lifestyle Questionnaire. The course comprised mandatory weekly didactics on Sufi Psychology and meditation sessions. Pre-, post, and five-week follow-up course scores were used to evaluate the course impact. Significant improvements were found in the PSS10 and three of the SAOQ subscales, and no significant change in the MAAS scores. The lifestyle survey showed increased frequency and duration of weekly meditation practices post-course. Follow-up results confirmed the longitudinal benefits of the course in the PSS10 and the three SAOQ subscales. This study concludes that incorporating Sufi Psychology and Tamarkoz meditation skills training in the pharmacy curriculum can significantly improve student self-awareness and stress levels during pharmacy education.\u003c/p\u003e","manuscriptTitle":"The Impact of Self-Knowledge and Meditation Education in Pharmacy Doctoral Training","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-10-31 17:23:07","doi":"10.21203/rs.3.rs-7149377/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2026-04-20T04:45:49+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-11-15T17:54:12+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-10-31T13:10:03+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"100622788285609797605926311225474802965","date":"2025-10-27T14:25:59+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"41153893880230940332285984229954492604","date":"2025-10-22T09:52:08+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2025-10-21T13:37:19+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2025-09-23T11:15:06+00:00","index":"","fulltext":""},{"type":"editorInvited","content":"","date":"2025-08-21T11:32:34+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2025-08-17T17:11:52+00:00","index":"","fulltext":""},{"type":"submitted","content":"Humanities and Social Sciences Communications","date":"2025-08-17T17:08:53+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"humanities-and-social-sciences-communications","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"palcomms","sideBox":"Learn more about [Humanities \u0026 Social Sciences Communications](http://www.nature.com/palcomms/)","snPcode":"41599","submissionUrl":"https://submission.springernature.com/new-submission/41599/3","title":"Humanities and Social Sciences Communications","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"stoa","reportingPortfolio":"Nature AJ","inReviewEnabled":true,"inReviewRevisionsEnabled":false}}],"origin":"","ownerIdentity":"e66e53cb-d1ed-49a3-bff0-cca11f9af33b","owner":[],"postedDate":"October 31st, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"under-review","subjectAreas":[{"id":56966810,"name":"Health sciences/Health care"},{"id":56966811,"name":"Biological sciences/Psychology"},{"id":56966812,"name":"Social science/Psychology"}],"tags":[],"updatedAt":"2026-05-20T19:38:14+00:00","versionOfRecord":[],"versionCreatedAt":"2025-10-31 17:23:07","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-7149377","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-7149377","identity":"rs-7149377","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}