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Article

Awakened Awareness Online: Results from an Open Trial of a Spiritual–Mind–Body Wellness Intervention for Remote Undergraduate Students

by
Elisabeth J. Mistur
1,2,*,
Abigail A. Crete
1,2,
Suza C. Scalora
1,2,3,
Micheline R. Anderson
1,2,4,
Amy L. Chapman
1,5 and
Lisa Miller
1,2
1
Spirituality Mind Body Institute, Teachers College, Columbia University, New York, NY 10027, USA
2
Department of Counseling and Clinical Psychology, Teachers College, Columbia University, New York, NY 10027, USA
3
Department of Psychiatry, Weill Cornell Medicine, New York, NY 10065, USA
4
Department of Psychiatry & Human Behavior, Warren Alpert Medical School of Brown University, Providence, RI 02903, USA
5
Mary Lou Fulton Teachers College, Arizona State University, Tempe, AZ 85281, USA
*
Author to whom correspondence should be addressed.
Psychol. Int. 2025, 7(2), 32; https://doi.org/10.3390/psycholint7020032
Submission received: 6 February 2025 / Revised: 17 March 2025 / Accepted: 1 April 2025 / Published: 5 April 2025
Browse Figures
Versions Notes

Abstract

:
This study aimed to assess the feasibility and acceptability of the online delivery of a spiritual–mind–body (SMB) wellness intervention previously delivered and validated in person, Awakened Awareness for Adolescents (AA-A), designed for spiritual individuation among emerging-adult undergraduates. Undergraduates aged 18–25 (N = 39) participated in an open trial study. Enrollment, retention, and engagement rates were calculated to assess the feasibility of delivering AA-A online. Thematic analysis on qualitative feedback was conducted to assess acceptability. Clinical and spiritual well-being were assessed before and after AA-A delivery using self-report measures and pre-to-post-intervention changes examined. Results were compared to previous findings from AA-A delivered in person. Interactions between sexual and gender minority (SGM) status and AA-A delivery method on spiritual well-being change scores were explored. Significant improvements were seen in anxiety and post-traumatic stress symptoms and spiritual well-being. Affordances and constraints of the online format were identified across three themes. SGM students showed significantly greater improvements than non-SGM students in depression and anxiety symptoms and spiritual well-being. AA-A is feasible and acceptable in an online format and can support students’ spiritual individuation and mental health in a way that is comparable to its in-person format. Furthermore, the online format may be particularly beneficial for SGM students to actively participate and engage.

1. Introduction

From 2003 to 2019, the percentage of U.S. college students completing their degrees entirely online rose from 4.9% to 14.8% (U.S. Department of Education, 2018, 2021). In 2020, this figure spiked to 44.4% due to the COVID-19 pandemic, which necessitated a shift to online classes (U.S. Department of Education, 2021). The rising demand for online learning pre-pandemic, coupled with post-pandemic student preferences, suggests a sustained relevance for remote education (McKenzie, 2021; Wotto, 2020). This increased normativity of virtual learning has also heightened the need for virtual mental health and wellness programs for remote students (Radwan, 2022).
U.S. Surgeon General Dr. Vivek Murthy issued a health advisory on the “diseases of despair” among adolescents and young adults, including depression, suicide, anxiety, and traumatic stress, emphasizing the urgent need for prevention and intervention approaches to alleviating distress in this population (Office of the U.S. Surgeon General, 2021). The Healthy Minds Study, the largest study of college student mental well-being in the United States reported that 38% of college students suffer from moderate to severe depression (Healthy Minds Network, 2024). The shift to virtual learning during the COVID-19 pandemic exacerbated students’ mental distress, significantly increasing depression, anxiety, and post-traumatic stress (PTS), which was associated with heightened loneliness (Liu et al., 2020; Martinez & Nguyen, 2020).
Rates of the diseases of despair and access to support differ across demographic sub-groups of youth in the United States. Sexual and/or gender minority (SGM) students often face non-affirming family environments in which their SGM status is not accepted, highlighting the need for online support (Fish et al., 2020; Ryan et al., 2010). However, accessing remote mental health services has proved difficult, with many students underutilizing available resources (Lee et al., 2021; Salimi et al., 2023; Seidel et al., 2020). Students of color, who have lower rates of mental health service utilization and comprise a higher proportion of remote learners, highlight the necessity for online mental health resources to address inequalities (Barr, 2014; Lipson et al., 2022). Obstacles such as long wait lists and state line restrictions hinder telehealth services. Universities are working to improve accessibility by increasing funding and training for telehealth services (Salimi et al., 2023). Providing clinical and non-clinical wellness resources to remote students can offer multiple avenues for mental health support.

1.1. Remote Wellness Resources

Wellness needs assessments for remote learners have revealed the necessity of spiritual, emotional, and other wellness resources. Studies suggest creating Online Wellness Resource Centers and support ecosystems, but few programs have been implemented by colleges and universities (Scheer & Lockee, 2003; Zapata-Ospina et al., 2021). Evidence indicates that online mental health and wellness services can support remote students’ mental health and well-being (Fischer-Grote et al., 2024; Ierardi et al., 2022; Pender et al., 2006; Sriati et al., 2024; Stuifbergen et al., 2010; Swarbrick, 2006; Zhou et al., 2021). Wellness interventions often encompass a continuum of support, addressing mild to moderate psychopathology and promoting personal development (Pender et al., 2006; Stuifbergen et al., 2010; Swarbrick, 2006).
Existing online interventions are very often self-guided mindfulness meditation programs, leading to increased mindfulness, self-regulation, and self-efficacy, and reduced stress, anxiety, and depression (Cavanagh et al., 2013; Williams, 2020). A self-guided intervention incorporating mindfulness for college students with interpersonal trauma led to reduced levels of stress, anxiety, and depression (Nguyen-Feng et al., 2017). Another self-guided online wellness program, Living Your Values, was feasible to implement and helped students live closer to their values, but it did not affect psychological well-being (Firestone et al., 2019). While these self-guided programs have been shown to help the college students who use them, students have reported a preference for live support over self-guided resources (Levin et al., 2018), indicating a need to increase access to live online wellness support programming.

1.2. Barriers to Mental Health Services for SGM Students

SGM emerging-adult students frequently seek social and mental health support online. Social media, chat-based LGBTQIA+ support groups, and online forums are crucial for their social connectedness, sense of belonging, mental well-being, and identity development (Austin et al., 2020; Bond & Miller, 2024; Craig & McInroy, 2014; Fish et al., 2020; Jackson, 2017). These online communities provide SGM students with a sense of safety and belonging, often unavailable in their local communities. SGM students’ sense of safety and fluency with online communities reduces barriers to accessing and engaging with online university-affiliated communities and resources. Online support effectively engages some minority groups that typically underutilize mental health resources (Chang et al., 2001; Watkins & Jefferson, 2013).
Online interventions are particularly helpful for minorities with negative attitudes toward mental health services, those who, due to views of stigmatization, are less likely to disclose mental health struggles in person, or those who benefit from a gradual introduction to professional support through perceived anonymity (Chang & Wong, 2011; Chang & Yeh, 2003; Watkins & Jefferson, 2013). SGM students may allocate their internal resources more effectively toward growth and healing in the safety of online environments. These interventions reduce barriers to help-seeking due to their lower cost, ease of access, and privacy, providing a non-stigmatizing way to reach at-risk, trauma-exposed college students (Nguyen-Feng et al., 2017; Ray et al., 2021).
Research indicates that as psychological distress increases, students are less likely to seek offline help but more inclined to use online interventions (Ryan et al., 2010). Online interventions may, therefore, increase help-seeking behaviors among emerging adults, especially minority groups and those with high levels of psychological distress (Pretorius et al., 2019). SGM populations often have valid concerns about their safety when seeking wellness and mental health resources (Dunbar et al., 2017; McAleavey et al., 2011; Ray et al., 2021) and are fluent in engaging online (Austin et al., 2020; Bond & Miller, 2024; Craig & McInroy, 2014; Fish et al., 2020; Jackson, 2017). The anonymity and safety of online support groups can reduce barriers to engagement (Chang & Wong, 2011; Chang & Yeh, 2003; Watkins & Jefferson, 2013). Barriers to on-campus mental health services highlight the need for SGM-inclusive wellness support both in person and online. SGM students benefit from both community-tailored and generalized mental health and wellness services when offered online.

1.3. Spirituality and Its Protective Effects on Mental Health

Spirituality is defined in this context as “an inner sense of living relationship to a higher power (whatever your word is for the ultimate loving, guiding life force)” (Miller, 2016). The association between spirituality and mental health has been examined in empirical research, with findings indicating a protective effect. Studies have shown that spirituality is linked to lower rates of completed suicides, as well as reduced alcohol and drug use (Beraldo et al., 2019; Čepulienė & Skruibis, 2022; Nayak et al., 2023; Rosmarin et al., 2022). A recent meta-analysis evaluating the impact of spirituality-based interventions on depression and anxiety in randomized clinical trials identified 23 studies, demonstrating significant reductions in stress, depression, anxiety, and alcohol use (Gonçalves et al., 2015). Furthermore, research suggests that spirituality during adolescence serves as a protective factor against adult depression, with findings indicating a 40% decreased risk for depression and an 80% decreased risk for substance abuse later in life (Bonelli et al., 2012; Miller, 2013, 2016; Miller et al., 1997, 2000).
Recent studies emphasize the importance of spirituality and strong interpersonal relationships in supporting undergraduates’ mental health and highlight building community in online spaces to prevent isolation (Eloff, 2021; Lister et al., 2023). During the pandemic, there was a particular need for online spiritual–mind–body (SMB) wellness programs incorporating relational aspects and community building. SMB wellness programs focus on building students’ inner resources through an integrative approach to health and wellness that includes the spiritual dimension (Chan et al., 2002; Fenzel & Richardson, 2022; Mastropieri et al., 2015). Studies suggest that spirituality can positively affect mental and physical health and psychological well-being (Captari et al., 2018; Shahina & Parveen, 2020) and foster social support and resilience through meaning-making, purpose, and the awareness of a lived transcendent relationship with a loving and guiding Higher Power (Miller, 2013, 2021; Paloutzian & Park, 2014). Given the increasing research on the benefits of spirituality, its inclusion in psychotherapy treatment contexts has prompted a new wave of SMB interventions (Breitbart et al., 2018; Scalora et al., 2020; Sperry, 2018).
An online spiritual counseling intervention focusing on cultivating an individual’s spiritual experiences and strengths for self-care and healing, including real-time weekly sessions, reduced anxiety, and enhanced self-esteem among deaf and hard-of-hearing university students (Pandya, 2021). A web-based 8-week Mindfulness Virtual Community intervention reduced depression and anxiety in undergraduates during the pandemic (El Morr et al., 2020). Awakened Awareness for Adolescents (AA-A), the intervention examined in this study, also utilizes a live group format delivered online (Mistur et al., 2022).

1.4. Awakened Awareness for Adolescents

Awakened Awareness for Adolescents and Emerging Adults (AA-A) is an 8-week SMB wellness intervention consisting of 90-min weekly group sessions. Each session includes three meditations, an introduction to awakened awareness concepts, written reflection, and paired and group sharing, led by two co-facilitators. AA-A supports emerging adults in developing a spiritual perspective to improve their relationships with themselves, others, the Transcendent, and the world. In the context of the age-related diseases of despair, the AA-A program was adapted from awakened awareness for adults (Miller, 2011) specifically for adolescents and emerging adults to address the natural spiritual individuation process and identify development that often is expressed as an existential, developmental depression (Barton et al., 2017; Miller, 2013, 2016; Miller & Barton, 2015).
Spirituality and religion can go hand in hand for some youth, but for many other people do not. While inherently spiritual, the program is inclusive of all university students, including those who identify as non-religious and/or non-spiritual. The full program curriculum was made available only to trained AA-A facilitators involved in the study and delivered verbally to participants. For more information on the design of the previously published study of AA-A delivered in person, as well as its constituent themes and adaptations, see (Scalora et al., 2022).
AA-A, delivered in person, demonstrated feasibility based on enrollment, engagement, and retention rates and acceptability based on qualitative program feedback analysis. Findings indicate that subclinical to moderate symptoms of depression, anxiety, and PTS can be reduced by enhancing personal spirituality, awakened awareness, and the reversal of spiritual decline (Scalora et al., 2022), with the benefits found to be stable or amplified at three-month follow-up (Crete et al., 2025). In-person findings also revealed a pattern of physiological recovery from stress as measured through heart rate variability, related to spiritual recovery, indicating that AA-A supports mental health and resilience against stressors (Anderson et al., 2023). SGM students participating across in-person and online AA-A groups showed higher utilization rates, lower well-being scores initially, and greater improvement in psychological well-being measures compared to their non-SGM peers (Mistur et al., 2024). During the COVID-19 pandemic, AA-A transitioned to an online format, providing a spiritual community that fostered connection and facilitated personal growth, identity development, and spiritual individuation amid collective trauma (Mistur et al., 2022).
The unplanned yet timely transition of theAA-A delivery to online aimed to maintain access to SMB wellness. Facilitators offered AA-A via Zoom, using screen sharing, breakout rooms, and chat to resemble an in-person group experience. The efficacy of the online delivery of the AA-A program has yet to be assessed or compared to the results of the in-person delivery, nor has it been determined whether the online delivery differed by SGM status.
This study aimed to assess the feasibility and acceptability of delivering AA-A online for undergraduate students by evaluating the constraints and affordances of the online platform. Further, the study aims to examine pre-post changes in spiritual well-being and mental health variables of AA-A delivered online as compared to AA-A delivered in person and, finally, compare the benefits for SGM students and non-SGM students between online and in-person formats. Results are discussed in the context of the previous findings from the in-person AA-A open trial study.

2. Materials and Methods

Six online AA-A groups were offered across the fall 2020 and spring 2021 semesters in an open trial format. The study received approval from the University Institutional Review Board (IRB), and all students provided voluntary informed consent. Feasibility, practicality, and likelihood of successful program implementation were assessed using the same calculations of enrollment, retention, and engagement rates as used in the in-person study. Acceptability was assessed via qualitative student feedback. Clinical and spiritual well-being outcomes were assessed using pre-post analysis of self-report measures. Interactions between SGM status and the delivery method across the combined in-person and online sample were analyzed to determine whether SGM identity and delivery method interacted to predict changes in well-being.

2.1. Participants and Procedures

Participants were undergraduates aged 18–25 attending two sister universities in the urban northeast United States (see Table 1 for demographics). Inclusion criteria were current enrollment at the university and informed consent, while exclusion criteria were previous participation in the AA-A study. Recruitment was conducted via university social media and wellness emails, inviting students to a “free 8-week workshop” on meditation, finding meaning, stress reduction, healthier relationships, and self-awareness. Students registered online for a required informational session and were provided a secure Zoom link. The previously validated AA-A program was not changed in content or duration as we aimed to specifically investigate implications of its online delivery.
Pretest and post-test self-report measures were administered online through the technology survey platform, QualtricsXM (Qualtrics, Provo, UT, USA), within one week before the first session and within one week after the final session. AA-A groups were conducted on Zoom at various times to accommodate different time zones, with group sizes ranging from seven to fourteen participants. Sessions were facilitated by two pre-doctoral authors supervised by a licensed clinical psychologist. Participants who attended at least one session and completed pretest and post-test measures were included in the analyses (n = 39). Demographics and baseline outcome measures were statistically compared to those of in-person participants (n = 77) enrolled in a previous study (Scalora et al., 2022).

2.2. Measures

2.2.1. Clinical Symptoms

Depression symptoms were measured using the Patient Health Questionnaire (PHQ-9) (Kroenke et al., 2001). The PHQ-9 consists of 9 items corresponding to depression symptoms, rated from zero (“not at all”) to three (“nearly every day”) for the past two weeks. Total scores range from 0 to 27, with a score of 10 or higher indicating moderate levels of depression. The PHQ-9 has been validated as a community screener for major depressive disorder and has been used to assess depression symptoms in college student populations (Cranford et al., 2009; Garlow et al., 2008; Wang et al., 2014).
Anxiety symptoms were measured using the Generalized Anxiety Disorder Questionnaire (GAD-7) (Spitzer et al., 2006). The GAD-7 is a validated measure consisting of 7 items, rated from zero (“not at all”) to three (“nearly every day”) for the past two weeks. Total scores range from 0 to 21, with a score of 10 or higher indicating moderate anxiety levels. The GAD-7 has been validated as a community screener for generalized anxiety disorder and has been used to assess anxiety in college student populations (Holt et al., 2014; Lipson et al., 2018).
PTS symptoms were measured using The Post-Traumatic Stress Disorder Checklist-Civilian Version (PCL-C; (Weathers et al., 1993)). The PCL-C is a validated measure consisting of 17 items, rated from 1 (“not at all”) to 5 (“extremely”) on the extent to which the rater has been bothered by PTS symptoms in the past month. The PCL-C has been validated as a community screener for PTSD and used to assess PTS in college populations (Hamdan & Hallaq, 2021; Read et al., 2014; Ruggiero et al., 2003).

2.2.2. Spiritual Well-Being

Spirituality was measured using the Delaney Spirituality Scale (SS; (Delaney, 2005)). The SS is a validated measure of spirituality specifically designed to evaluate spiritual interventions (Delaney, 2005). The measure consists of 23 items rated from 1 (“strongly disagree”) to 6 (“strongly agree”) on the level of agreement with statements regarding spirituality. The SS has been used to measure spirituality in adolescent and young adult populations (Li & Chow, 2015; Shahina & Parveen, 2020; Vinothkumar, 2015).
Spiritual growth and spiritual decline were measured using the two subscales of the Spiritual Transformation Scale (STS; (Cole et al., 2008)). The STS is a validated measure consisting of 11 items measuring spiritual decline and 29 items measuring spiritual growth for a total of 40 items rated from 1 (“it is not true for you at all”) to 7 (“it is true for you a great deal”) on changes in spirituality. The STS has been used to examine spiritual growth and decline in college students (Exline et al., 2017; Hart et al., 2020).
Awakened and achievement awareness were measured using the Awakened Awareness Scale (AA; (Scalora et al., 2022)), a scale designed to assess two distinct forms of ontological perception to hold divergent neural circuits as identified in previous MRI studies (McClintock et al., 2019; Miller et al., 2019). Achievement awareness is an anthropocentric form of perception that hinges on assumptions of radical human control over our lives; its cultivation leads to extrinsic motivations of acquiring, winning, and outward achievement with a narrow focus on accomplishments and goals. Awakened awareness is a form of transcendent awareness that draws us into a union or a dialogue with the sacred ultimate presence in life; its cultivation leads to an enhanced spiritual perspective of oneself, others, and the unfolding of daily life. The AA scale consists of 10 items rated 1 (“not at all”) to 5 (“totally”), with higher scores indicating greater awakened awareness. The literature regarding the scale’s validity has yet to be published; the AA scale has shown high internal consistency in college students (N = 77; α = 0.81; (Scalora et al., 2022)).

2.2.3. Affordances and Constraints

To assess the affordances and constraints of online participation during a global pandemic, the post-intervention survey included the following questions: (1) If you had attended AA-A during a semester not affected by COVID-19, would you have preferred to attend in person or online? (in person, online, no preference)? Why or why not? (2) Did COVID-19 contribute to your reason(s) for signing up for AA-A? How so? The following question was included in post-intervention semi-structured interviews: (3) How do you think the online format of the workshop has either positively or negatively impacted your experience in awakened awareness?

2.3. Data Analysis

2.3.1. Feasibility

Enrollment rates (completed informed consent and baseline assessment), engagement rates (attended ≥ 4 sessions), and retention rates (completed baseline and post-intervention assessments) were calculated to assess the feasibility of online delivery, mirroring the in-person feasibility study. Chi-square analyses were conducted to assess baseline demographic differences between participants who engaged (attended 4+ sessions) and those who did not engage (attended 1–3 sessions) in AA-A. ANOVAs were conducted to identify demographic differences between online and in-person participants.

2.3.2. Acceptability

To assess acceptability, qualitative survey and exit interview data were analyzed for affordances and constraints of delivering AA-A online using thematic analysis (Clarke et al., 2015). Two experienced qualitative researchers trained two additional researchers in thematic analysis, and each of the four researchers independently coded the data using a data-driven inductive approach; themes were derived directly from the data rather than being based on pre-existing theories. Codes were clustered into themes via code mapping (Saldaña, 2021); themes were then reviewed, defined, and named (Clarke et al., 2015). The research team met regularly to discuss interpretations of the data and resolve discrepancies, choosing to come to a consensus on all analyses rather than relying on statistical measures of interrater reliability because of the layers of interpretation required to analyze the meaning of this data (Saldaña, 2021). Methodological rigor was ensured by giving all data equal attention, by checking themes against all data, by considering counterexamples, and by ensuring alignment between data and analysis (Braun & Clarke, 2006; Saldaña, 2021).

2.3.3. Pre-Post Intervention Changes

Two-tailed, independent sample t-tests were conducted to identify mean baseline differences between online (n = 39) and in-person (n = 77) participants on spiritual well-being and psychopathology measures. One-tailed, paired sample t-tests were conducted to test whether online participants showed significant improvements in spiritual well-being and psychopathology measures from the pretest to post-test. Effect sizes were calculated using Cohen’s d.

2.3.4. SGM Status and Delivery Method

Two-way ANOVAs of change scores with SGM status (SGM or non-SGM) and AA-A delivery method (in-person or online) as independent categorical variables and well-being change scores as dependent variables were conducted using the combined in-person and online delivery samples (N = 116); interactions between SGM status and the AA-A delivery method were analyzed, and follow-up simple main effects analyses with Bonferroni adjustments for multiple comparisons were conducted to establish if there were significant differences in online AA-A outcomes between SGM and non-SGM students.

3. Results

Sample characteristics can be found in Table 1.
Overall, the results showed that AA-A is feasible and acceptable when delivered online, with improvements in spirituality and clinical symptomology.

3.1. Feasibility

Chi-square analyses revealed that those with elevated baseline depression were more likely to engage (attend 4+ sessions) than those without elevated depression, χ2 = 6.0. There were no other significant baseline demographic differences between participants who engaged (attended 4+ sessions) and participants who did not engage (attended 1–3 sessions). Enrollment, retention, and engagement rates can be found in Table 2. Of 67 students who attended the required AA-A orientation session, 90% enrollment rates were comparable to the in-person AA-A study (93%; (Scalora et al., 2022)). Of enrolled participants, 70% retention rates exceeded the in-person study (55%; (Scalora et al., 2022)). Of those who attended at least one AA-A session, 69% engagement rates were comparable to the in-person study (71%; (Scalora et al., 2022)). Retention rates were consistent across the fall 2020 (73%) and spring 2021 (67%) semesters. Due to lower retention and engagement rates in the morning group (42% and 38%, respectively) compared to overall online rates (70% and 69%, respectively), subsequent groups were delivered in the evenings. Online participants attended an average of 6.3 sessions (n = 39), while in-person participants attended 5.8 sessions on average (n = 77; (Scalora et al., 2022)). No significant demographic differences were found between in-person and online participants (Scalora et al., 2022).

3.2. Acceptability

Among participants who initially registered for an in-person university experience disrupted by the pandemic, 87% (34/39) reported that COVID-19 influenced their decision to join AA-A. When asked about their preference for in-person or online attendance in a semester not affected by COVID-19, 59% (23/39) of students preferred to attend in person, 26% (10/39) preferred to attend online, and 15% (6/39) had no preference.
Code mapping can be found in Table 3. Thematic analysis revealed affordances and constraints across three themes: (1) AA-A online delivery impacted interactions with others, (2) accessibility of intrapersonal support offered by online SMB interventions, and (3) effects of technology on participant experience.
Within the first theme, online delivery of AA-A impacted interactions with others; students identified a constraint that peer relationships were restricted without meeting in person. One student shared,
Being in person is important to me and I think it would have been easier to cultivate relationships from it that way…I thought it was so helpful and I got to know people, [but] it doesn’t have that element of showing up early so you chit chat or after you leave people stay behind and chit chat. I think that those tiny elements really do change the way the program works.
Students also identified an affordance within interactions with others: students who felt isolated received access to a community. A student said,
This specific group has allowed me to meet people that go to my school that I really don’t think I would be meeting otherwise. It’s given me an avenue to have social interaction…It’s an hour and a half with this intimate group of people that I feel comfortable with, it’s very nice just having that safe space.
This quote speaks to the close relationships and genuine community found by students online.
Within the second theme, accessibility of intrapersonal support offered by online SMB interventions, students identified multiple affordances. The online delivery increased access to populations for whom attending in person was an obstacle, including people who experience social anxiety, chronic illness, injuries, disabilities, or those with familial obligations or financial constraints. One student shared, “The online format has been helpful because it’s really hard for me to sit up straight for classes because I have a back injury, so…I lay down for all of our meditations”. Another student “felt more comfortable attending” because it was online; another indicated that they “would not have attended as many if it were in person”. Another affordance was the increased accessibility to support spiritual journeys prompted by the COVID-19 pandemic: “I felt somewhat lost spiritually and had never thought too deeply about it until COVID-19 forced me to reconcile my faith and how I move through the world—I wanted to be more intentional”. AA-A provided a timely place to tend to one’s spirituality intentionally. Finally, the online delivery method increased accessibility to mental health support during COVID-19 when mental health services were difficult to access: “The effects that I felt from COVID-19 on my mental health influenced my decision to sign up for AA-A”.
The third theme, the effects of technology on participant experience identified specific constraints and affordances of technology effects. Some students found it “easier to maintain focus in person,” and others were tired of being “in front of screens with blue light” amid the pandemic. Another constraint involved the use of cameras: “When other people don’t have their cameras on, I feel a little awkward keeping mine on. And so, I just felt like…there’s not the same level of trust I guess”. Facilitators noticed it was particularly challenging for some students who did not feel ‘camera ready’ to keep their cameras on. However, cameras also provided an affordance for students to feel less self-conscious during the meditation practices: “For the meditations, I really like that we can turn off our cameras and everyone can be in their own private space”.
Additionally, the video-conferencing platform provided a more comfortable environment for some students to share: “Vulnerability is hard for me; being able to have one layer removed (online vs. in-person) really helped me feel comfortable sharing”. Finally, when students conducted most of their activities online, the technology platform afforded an experience in the group to be cultivated that was unique from the traditional online classroom experience: “The one thing I can say for sure is that it didn’t feel like a class, you know? And so, I didn’t feel Zoom fatigue from it”.
Overall, students identified affordances and constraints across three themes, yet they found the online delivery format to be acceptable and helpful.

3.3. Pre-Post Intervention Changes

Online participants in AA-A demonstrated reduced clinical symptoms and increased spirituality. Pre- and post-intervention scores, alongside paired sample t-test results for depression, anxiety, PTS symptoms, and four spiritual well-being scales, can be seen in Table 4.
As in the previous in-person sample (Scalora et al., 2022), mean scores significantly improved on anxiety symptoms, PTS symptoms, and three spiritual well-being scales: awakened awareness, personal spirituality, and spiritual decline. Effect sizes were large for spiritual decline and small for all other variables in the online sample. Although the mean change in depression symptom scores was comparable between online (M = −1.33, SD = 5.57) and in-person participants (M = −1.22, SD = 4.8), the improvement in depression symptoms was not significant in the smaller online sample as it was in the in-person sample (Scalora et al., 2022). As with the in-person sample, mean spiritual growth scores did not significantly change (Scalora et al., 2022). No significant differences were found between in-person and online participants’ baseline scores on outcome measures (Scalora et al., 2022).

3.4. SGM Status and Delivery Method

Two-way between subjects’ ANOVAs were conducted to analyze the interaction effects of SGM status and delivery method on improvements in psychopathology and spiritual well-being (see Table 5).
There were statistically significant interactions between the effects of SGM status and delivery method on changes in depression symptoms, anxiety symptoms, and spiritual growth. There were no significant interaction effects of SGM status and delivery method on change in post-traumatic stress, spiritual decline, personal spirituality, or awakened awareness.
Follow-up simple main effects analyses with Bonferroni adjustment for multiple comparisons showed that SGM students improved significantly more on depression symptoms than non-SGM students by 4.95 points on the PHQ-9 (95% CI = 1.83 to 8.07) when they participated in the online delivery model [F(1,112) = 9.88, p = 0.002], but there were no differences between SGM and non-SGM students when they participated in the in-person delivery model [F(1,112) = 0.05, p = 0.833]. See Figure 1.
SGM students improved significantly more on anxiety symptoms than non-SGM students by 4.33 points on the GAD-7 (95% CI = 0.92 to 7.73) when they participated in the online delivery model [F(1,112) = 6.35, p = 0.013], but there were no differences between SGM and non-SGM students when they participated in the in-person delivery model [F(1,112) = 2.02, p = 0.158]. See Figure 2.
SGM students demonstrated significantly greater spiritual growth than non-SGM students, showing an additional 31.12-point increase on the Spiritual Transformation Scale (95% CI = 4.41 to 57.83) when participating in the online delivery model [F(1,112) = 5.33, p = 0.023]. However, no significant differences were observed between SGM and non-SGM students in the in-person delivery model [F(1,112) = 0.59, p = 0.443]. See Figure 3.

4. Discussion

Thirty-nine college students participated in AA-A delivered in a live online format during the COVID-19 pandemic, with results compared to 77 students who participated in AA-A groups delivered in person (Scalora et al., 2022).
AA-A delivered online was shown to be feasible, acceptable, and helpful in developing personal spirituality and reducing anxiety and traumatic stress symptoms. The online delivery format demonstrated high levels of feasibility, acceptability, and helpfulness, consistent with in-person delivery.
One aim of the current study was to assess whether AA-A can be feasibly and acceptably delivered online. Comparable enrollment, engagement, and retention rates between the online and in-person samples suggest that the online platform maintained the integrity of the curriculum and program facilitation. Thematic analysis of students’ qualitative data further indicated the high acceptability of the online delivery method.
A secondary aim of the study was to assess the viability of supported spiritual development during a time of crisis for college students. The same pattern of pre-post improvements associated with AA-A in-person (prior to the COVID-19 pandemic) was found when AA-A was delivered online during the pandemic. Specifically, spiritual decline decreased and awakened awareness and personal spirituality increased, suggesting that AA-A delivered online was spiritually supportive during the age-related developmental task of spiritual individuation and identity development. Additionally, clinical symptoms of anxiety and PTS decreased, indicating that AA-A online also supported students’ mental health.
Notably, students with clinically elevated depression symptoms demonstrated higher engagement with AA-A. Some may have lacked access to or desire for other mental health services and used AA-A for support. Other students found AA-A a helpful adjunct to individual therapy, addressing aspects of spiritual wellness that may not have been addressed elsewhere. As spirituality is a robust protective factor against depression in emerging adults (Bonelli et al., 2012; Miller, 2013), AA-A may have supported depressed students via supporting spiritual individuation.
Higher retention rates observed in the online sample likely reflect increased accessibility afforded by an online delivery platform. Barriers such as illness, injury, disability, mood symptoms, social anxiety, family obligations, and the financial and time costs associated with commuting were mitigated, facilitating greater attendance. Students identified the lack of in-person interaction as a constraint of the online platform, noting it as a challenge to building relationships with other student participants that extended beyond the completion of the program. At the same time, students also identified the live, online format of the program to be an affordance as it provided access to the community when in-person gatherings were not accessible. AA-A’s online platform offers a real-time, community-based wellness intervention at a lower cost than in-person interventions and expands accessibility for underserved student populations.
These findings have broader implications for the field of education. Prior literature from the field of educational technology has found that tools and approaches that foster interconnection and decrease loneliness are important when students are learning virtually (Greenhow & Chapman, 2020; Greenhow & Galvin, 2020). Given the affordances of online learning identified above, the viability of online AA-A extends the literature by illustrating the effectiveness of SMB programming for remote students.
It is important to consider potential reasons SGM students improved more than non-SGM on depression and anxiety symptoms and spiritual growth when AA-A was delivered online compared to in person. It may be that SGM students experienced lower barriers to deep engagement in the online delivery format and derived greater help from the online format around spiritual growth and stress reduction. Indeed, online AA-A students cited a sense of anonymity when sharing and a sense of privacy while meditating as benefits of the online format. Not only did online delivery increase access to wellness support, but it may have created an equal playing field for SGM and non-SGM students to feel equally safe to engage in AA-A. It may also be that self-selecting SGM emerging adults are particularly primed for AA-A, making the online delivery format a particularly safe and supportive environment for them to engage in an intervention that they were already prepared to benefit from. Future campus-based wellness approaches might utilize intentional marketing and programmatic decisions toward the inclusion of SGM students in generalized student wellness groups, including delivering group wellness resources in a live online format to decrease barriers to services and increase safety for SGM students.
Exploratory findings within the online delivery format are also notably confounded with the cultural climate and presence of the pandemic. Additionally, SGM status serves as a confounding factor, as experiences of marginalization and resilience may have influenced both engagement with the intervention and its outcomes. Some SGM students who voluntarily enrolled in AA-A made a conscious decision to seek support while living with unsupportive family members. SGM individuals were disproportionately negatively affected by the pandemic but were also resilient in several ways, including preparedness through their marginalized backgrounds, adopting a stance of radical acceptance, and building community (Gonzales et al., 2020). SGM participants may have been more attuned to life’s difficulties and better prepared for resilience in a global crisis. They likely utilized AA-A to build community and embrace radical acceptance, concepts encouraged by awakened awareness.
Findings indicate that SGM students in AA-A were not only resilient to their circumstances but also better able to utilize the support offered through the program compared to their non-SGM peers. Amid unprecedented circumstances when emerging-adult mental health was generally worsening, SGM students in AA-A not only maintained their levels of well-being, but they also resiliently grew while supported in the AA-A spiritual community. Leaders in a resilient response to COVID-19, SGM students utilized online spiritual community and spiritual wellness support toward spiritual growth, renewal, and the alleviation of psychological distress during a pandemic.
The present study has several limitations. The online sample is smaller and has fewer male participants than the previous in-person open trial study, leading to less statistical power; this may explain why depression symptom scores did not significantly improve in the online sample as they did in the larger in-person sample. The self-report nature of the data is a potential limitation, whereas the in-person study benefited from the additional collection of heart rate variability (Anderson et al., 2023). The present online study lacks longitudinal data, limiting its ability to make inferences about the sustainability of intervention effects over time. Additionally, student attitudes may be more or less favorable toward online wellness programming outside of a crisis; it is possible that during the challenges of the pandemic, any social space would have yielded similar results. Additionally, students in online degree programs may be more favorable toward online wellness programming than in the present sample.
Another limitation is the lack of a control group, which poses a risk of potential bias and influence of confounding variables in study findings, particularly during the unprecedented time of COVID-19. The decision to forgo a control group was based on ethical concerns about withholding spiritual support from adolescents. Since standard campus well-being care often lacks this support, a normative control group would have been largely deprived of it. To prevent confounding of online and in-person support, data collected during the initial onset of the pandemic, amid a mid-intervention shift from in-person to online delivery of AA-A, were removed from the current dataset and examined separately (Mistur et al., 2022). The present study uses the data from in-person cohorts who participated in AA-A before the pandemic (2018–2019) as a reference to compare with the online cohort who participated in AA-A after the initial onset of the pandemic (2020–2021), during semesters when university learning and the AA-A program were fully remote due to the continued presence of COVID-19. Therefore, while the most disrupted cohort was removed from the current sample, there remains in this study the inability to disentangle the effects of the online format from the broader impact of the pandemic, including SGM students’ altered living situations, social isolation, and health concerns. While university learning was fully remote, students experienced varied living arrangements. Due to the lack of available data on students’ specific living environments, it was not possible to examine their potential influence on the findings. Additionally, without a control group, effects of maturation, statistical regression, selection, or demand characteristics cannot be accounted for when examining clinical and spiritual well-being improvements observed in the AA-A program and, thus, cannot be attributed to the AA-A program. Replicating this study outside the COVID-19 pandemic and in a sample of online degree-earning undergraduate students would enable assessment of the degree to which the present findings are generalizable across time and settings for online learners. That said, it may be that online wellness programming is particularly feasible and acceptable within fully online undergraduate student communities, who often have limited access to community-based wellness resources.
Future studies might also utilize a multi-arm trial with fellow forms of spiritual support (such as campus-based ministry) to assess the specific effects of awakened awareness (rather than using an empty “standard of care” style control group that may deprive students of spiritual support), as well as follow-up assessments to evaluate whether students’ self-reported changes are sustained over time.

5. Conclusions

Results suggest that AA-A is feasible and acceptable in an online format and can support remote college students’ spiritual individuation and mental health comparably to its in-person format. Delivering AA-A in a live online format for some students may decrease barriers to access, may increase perceptions of safety within the group setting, and may allow SGM students to experience even greater benefits from AA-A. Larger longitudinal studies of the online delivery of SMB are needed. Online platforms may be considered in primary and emergency education settings to provide SMB programs for undergraduates, a crucial response to address the present mental health crisis in emerging adult college students.

Author Contributions

Conceptualization, E.J.M., A.A.C. and L.M.; methodology, E.J.M., A.A.C., S.C.S., A.L.C. and L.M.; formal analysis, E.J.M., A.A.C. and A.L.C.; investigation, E.J.M., A.A.C., S.C.S., A.L.C., M.R.A. and L.M.; resources, E.J.M., A.A.C., A.L.C., S.C.S. and L.M.; data curation, E.J.M.; writing—original draft preparation, E.J.M.; writing—review and editing, E.J.M., A.A.C., S.C.S., M.R.A., A.L.C. and L.M.; visualization, E.J.M.; supervision, L.M.; project administration, E.J.M., A.A.C., S.C.S. and M.R.A.; funding acquisition, S.C.S. and L.M. All authors have read and agreed to the published version of the manuscript.

Funding

This research was funded by gifts from the Living Peace Foundation and the John Templeton Foundation.

Institutional Review Board Statement

The study was conducted in accordance with the Declaration of Helsinki and approved by the Institutional Review Board of Teachers College, Columbia University (protocol code 19-031, approved 8 October 2018).

Informed Consent Statement

Informed consent was obtained from all subjects involved in the study.

Data Availability Statement

The datasets presented in this article are not readily available because the data are part of an ongoing study. Requests to access the datasets should be directed to ejm292@cornell.edu.

Acknowledgments

The authors wish to thank the Living Peace Foundation and the John Templeton Foundation for their generous support, the dedicated masters-level research assistants who transcribed interviews and supported the study administratively, and to Joey Kopriva, Rob Peñaherrera, and Helen Herman for their vital support on this project.

Conflicts of Interest

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

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Figure 1. The interaction of SGM status and the delivery method on change in depression symptoms.
Figure 1. The interaction of SGM status and the delivery method on change in depression symptoms.
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Figure 2. The interaction of SGM status and the delivery method on change in anxiety symptoms.
Figure 2. The interaction of SGM status and the delivery method on change in anxiety symptoms.
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Figure 3. The interaction of SGM status and the delivery method on change in spiritual growth.
Figure 3. The interaction of SGM status and the delivery method on change in spiritual growth.
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Table 1. Baseline sample characteristics.
Table 1. Baseline sample characteristics.
Participated OnlineParticipated in Person
Characteristicn (%)/nn (%)/n
Gender
Male3 (8%)3912 (15.6%)77
Female32 (82%)3962 (80.5%)77
Transgender and non-binary4 (10.3%)393 (3.9%)77
Sexual orientation
Heterosexual18 (46%)3948 (62.3%)77
Gay/Lesbian6 (15%)396 (7.8%)77
Bisexual9 (23%)3916 (20.8%)77
Questioning5 (13%)392 (2.6%)77
Queer/Pansexual0 (0%)393 (3.9%)77
Prefer not to specify1 (3%)392 (2.6%)77
Race/Ethnicity
African American/Black6 (15%)3914 (18.2%)77
Asian10 (26%)3913 (16.9%)77
Latino/a3 (8%)396 (7.8%)77
White/Caucasian13 (33%)3932 (41.6%)77
American Indian0 (0%)391 (1.3%)77
Polynesian1 (3%)390 (0%)77
Multiracial5 (13%)3910 (13%)77
Middle Eastern 0 (0%)391 (1.3%)77
Black Caribbean1 (3%)390 (0%)77
Employment
Yes16 (41%)3932 (41.6%)77
No23 (59%)3945 (58.4%)77
Household income
Above 200,000 USD6 (15%)3915 (19.5%)77
100,000–200,000 USD8 (21%)3911 (14.3%)77
75,000–100,000 USD9 (23%)3914 (18.2%)77
50,000–75,000 USD5 (13%)399 (11.7%)77
30,000–50,000 USD5 (13%)3913 (16.9%)77
15,000–30,000 USD5 (13%)398 (10.4%)77
other/not applicable1 (3%)394 (5.2%)77
International status
Yes5 (13%)3917 (22.1%)77
No34 (87%)3960 (77.9%)77
Clinical Characteristics
Elevated depression a17 (44%)3927 (35.1%)77
Elevated anxiety b18 (46%)3929 (37.7%)77
Elevated post-traumatic stress c29 (74%)3957 (74%)77
Spiritual Characteristics
Religious affiliation
Buddhist0 (0%)391 (1.3%)77
Hindu2 (5%)391 (1.3%)77
Eastern Orthodox0 (0%)392 (2.6%)77
Jewish6 (15%)394 (5.2%)77
Muslim2 (5%)392 (2.6%)77
Protestant Christian5 (13%)399 (11.7%)77
Roman Catholic3 (8%)399 (11.7%)77
Other4 (10%)3910 (13%)77
None17 (44%)3939 (50.6%)77
Importance of religion or spirituality
Highly Important11 (28%)3913 (16.9%)77
Moderately Important14 (36%)3924 (31.2%)77
Slightly Important12 (31%)3922 (28.6%)77
Not Important at All2 (5%)3918 (23.4%)77
Importance of religion
Highly Important6 (15%)393 (11.1%)27
Moderately Important5 (13%)396 (22.2%)27
Slightly Important14 (36%)394 (14.8%)27
Not Important at All14 (36%)3914 (51.9%)27
Importance of spirituality
Highly Important10 (26%)398 (29.6%)27
Moderately Important15 (39%)399 (33.3%)27
Slightly Important14 (36%)395 (18.5%)27
Not Important at All0 (0%)395 (18.5%)27
M (SD)/nM (SD)/n
Age20.4 (1.52)3919.5 (1.5)77
a. PHQ-9 score ≥ 10. b. GAD-7 score ≥ 10. c. PCL-C score ≥ 30.
Table 2. Participation rates.
Table 2. Participation rates.
nRate (%)
Attended required pre-group orientation session67--
Enrolled a6090%
Completed pretest and post-test measures (retention) b4270%
Attended ≥ 1 session54--
Attended ≥ 4 sessions (engagement) c3769%
Attended ≥ 1 session and completed post-test measures (AA-A group) d39--
a. Enrollment was defined as the rate of participants who enrolled (signed consent forms and completed the pretest assessment battery) of those who attended the orientation session. b. Retention was defined as the rate of enrolled participants who completed the pretest and post-test assessment battery. c. Engagement was defined as the rate of attending participants who attended four or more sessions. d. The AA-A group included those who completed the pretest and post-test batteries and attended at least one session. The overall attendance rate for the AA-A group was 79%.
Table 3. Code mapping for acceptability of online delivery of AA-A intervention.
Table 3. Code mapping for acceptability of online delivery of AA-A intervention.
Third Iteration: Affordances and Constraints Across Themes
  • AA-A online delivery impacted interactions with others
  • Accessibility of intrapersonal support offered by online SMB interventions
  • Effects of technology on experience
Second Iteration: Pattern Variables
1A. Access to the community during COVID-19
1B. Access to community for people otherwise isolated (outside COVID)
1C. Peer relationships restricted without face-to-face interaction
2A. Increased access for commuters, people with disabilities, people who are socially anxious
2B. Support to spiritual journeys prompted by COVID-19
2C. Access to mental health resources during COVID-19 stress
2D. Decreased loneliness during COVID-19 isolation
3A. Harder to focus online
3B. Internet issues
3C. Bluelight/screen time
3D. Zoom platform did not get in the way of AA-A feeling distinct from a class
3E. Zoom breakout rooms
3F. Camera on/off
First Iteration: Initial Codes
1A. Affordance: access to community during COVID-19
1C. Constraint: relationships restricted without face-to-face interaction
2A. Affordance: increased access for those with pain or disability
2A. Affordance: reduces feelings of social anxiety
2A. Affordance: population for whom AA online might be suited
2A. Affordance: more comfort/access
2B. Affordance: support to spiritual journey during COVID-19
2C. Affordance: access to meditation during COVID-19 isolation
2C. Affordance: access to mental health resources during COVID-19 stress
2D. Affordance: decreased loneliness
3A. Constraint: home environment associated with work
3A. Constraint: harder to focus online
3A. Affordance: easier to focus during meditation online with the camera off
3B. Constraint: internet issues
3C. Constraint: blue light/screen time
3D. Affordance: felt distinct from a class although on the same online platform (Zoom)
3E. Affordance: increased vulnerability
3E. Affordance: Zoom breakout rooms
3E. Constraint: Zoom breakout rooms can be awkward
3F. Affordance: privacy during meditation
3F. Affordance: camera on/off
3F. Constraint: camera on/off
Table 4. Paired samples T-tests of student well-being from pre-intervention (T1) to post-intervention (T2).
Table 4. Paired samples T-tests of student well-being from pre-intervention (T1) to post-intervention (T2).
T1T2Paired Difference (T2 − T1)
Clinical well-beingM (SD)M (SD)M (SD)95% CIt (df)p (one-tailed)Cohen’s d
Depression symptoms a8.87 (5.62)7.54 (5.21)−1.33 (5.57)−3.14, 0.47−1.49 (38)0.072−0.24
Anxiety symptoms b9.46 (6.14)7.41 (5.69)−2.05 (5.96)−3.98, −0.12−2.15 (38)0.019 **−0.34
Post-traumatic stress c41.79 (13.57)37.51 (11.93)−4.28 (10.44)−7.67, −0.90−2.56 (38)0.007 **−0.41
Spiritual well-being
Awakened awareness d32.74 (6.55)34.79 (7.37)2.05 (5.51)0.26, 3.842.32 (38)0.013 **0.37
Spirituality e100.51 (16.46)104.79 (18.56)4.28 (12.26)0.31, 8.262.18 (38)0.018 **0.35
Spiritual growth f114.13 (39.56)118.38 (45.23)4.26 (36.01)−7.42, 15.930.74 (38)0.2330.12
Spiritual decline f35.59 (12.74)24.49 (11.15)−11.1 (12.1)−15.03, −7.18−5.73 (38)<0.001 **−0.92
** p < 0.01. a Depression symptoms measured by the Patient Health Questionnaire PHQ-9. b Anxiety symptoms measured by the General Anxiety Disorder Scale GAD-7. c Post-traumatic stress measured by the post-traumatic checklist-civilian scale PCL-C. d Awakened awareness measured by the Awakened Awareness Scale. e Spirituality measured by Delaney’s Spirituality Scale. f Spiritual growth and spiritual decline measured by the Spiritual Transformation Scale.
Table 5. Two-way analyses of variance in well-being change scores.
Table 5. Two-way analyses of variance in well-being change scores.
Dependent VariablePredictordfMean SquareFη2 p
Depression symptoms a(Intercept)1137.445.710.0490.019 *
SGM status1139.905.810.0490.018 *
Delivery method10.580.0040.0000.961
SGM status × delivery method1170.347.080.0590.009 **
Error11224.06
Anxiety symptoms b(Intercept)1285.8710.000.0820.002 **
SGM status140.601.420.0130.236
Delivery method14.130.140.0010.705
SGM status × delivery method1235.878.250.0690.005 **
Error11228.58
Post-traumatic stress c(Intercept)12373.5922.710.169<0.001 **
SGM status158.100.560.0050.457
Delivery method149.760.480.0040.492
SGM status × delivery method1100.810.970.0090.328
Error112104.50
Awakened Awareness d(Intercept)1768.7126.120.239<0.001 **
SGM status1183.006.220.0700.015 *
Delivery method1116.893.970.0460.050 *
SGM status × delivery method199.573.380.0390.069
Error8329.44
Spirituality e(Intercept)14655.8621.440.161<0.001 **
SGM status1487.452.250.0200.137
Delivery method1834.123.840.0330.052
SGM status × delivery method1657.793.030.0260.085
Error112217.13
Spiritual Growth f(Intercept)13405.361.930.0170.167
SGM status13491.411.990.0170.162
Delivery method1762.580.430.0040.512
SGM status × delivery method19456.835.370.0460.022 *
Error1121761.59
Spiritual Decline f(Intercept)110,433.4550.980.313<0.001 **
SGM status1145.580.710.0060.401
Delivery method157.470.280.0030.597
SGM status × delivery method1136.830.670.0060.415
Error112204.65
* p < 0.05. ** p < 0.01. a Depression symptoms measured by the Patient Health Questionnaire PHQ-9. b Anxiety symptoms measured by the General Anxiety Disorder Scale GAD-7. c Post-traumatic stress symptoms measured by the post-traumatic checklist-civilian scale PCL-C. d Awakened awareness measured by the Awakened Awareness Scale. e Spirituality measured by Delaney’s Spirituality Scale. f Spiritual growth and spiritual decline measured by the Spiritual Transformation Scale.
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MDPI and ACS Style

Mistur, E.J.; Crete, A.A.; Scalora, S.C.; Anderson, M.R.; Chapman, A.L.; Miller, L. Awakened Awareness Online: Results from an Open Trial of a Spiritual–Mind–Body Wellness Intervention for Remote Undergraduate Students. Psychol. Int. 2025, 7, 32. https://doi.org/10.3390/psycholint7020032

AMA Style

Mistur EJ, Crete AA, Scalora SC, Anderson MR, Chapman AL, Miller L. Awakened Awareness Online: Results from an Open Trial of a Spiritual–Mind–Body Wellness Intervention for Remote Undergraduate Students. Psychology International. 2025; 7(2):32. https://doi.org/10.3390/psycholint7020032

Chicago/Turabian Style

Mistur, Elisabeth J., Abigail A. Crete, Suza C. Scalora, Micheline R. Anderson, Amy L. Chapman, and Lisa Miller. 2025. "Awakened Awareness Online: Results from an Open Trial of a Spiritual–Mind–Body Wellness Intervention for Remote Undergraduate Students" Psychology International 7, no. 2: 32. https://doi.org/10.3390/psycholint7020032

APA Style

Mistur, E. J., Crete, A. A., Scalora, S. C., Anderson, M. R., Chapman, A. L., & Miller, L. (2025). Awakened Awareness Online: Results from an Open Trial of a Spiritual–Mind–Body Wellness Intervention for Remote Undergraduate Students. Psychology International, 7(2), 32. https://doi.org/10.3390/psycholint7020032

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