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Co
m
m
u
n
ica
ti
o
n
a
p
p
re
h
e
n
sio
n
is
a
m
a
jo
r
c
h
a
ll
e
n
g
e
in
h
ig
h
e
r
e
d
u
c
a
ti
o
n
,
a
ffe
c
ti
n
g
stu
d
e
n
ts
’
c
o
m
m
u
n
ica
ti
o
n
a
b
il
it
y
,
w
h
ich
is
c
ru
c
ial
fo
r
a
c
a
d
e
m
ic
su
c
c
e
ss
a
n
d
fu
tu
re
e
m
p
lo
y
a
b
il
it
y
.
It
m
a
n
ifes
ts
as
p
u
b
l
ic
sp
e
a
k
in
g
a
n
x
iety
,
re
lu
c
tan
c
e
in
g
ro
u
p
d
isc
u
ss
i
o
n
s,
a
n
d
a
v
o
i
d
a
n
c
e
of
c
las
sro
o
m
in
tera
c
ti
o
n
s
,
h
in
d
e
rin
g
so
ft
sk
il
l
d
e
v
e
lo
p
m
e
n
t
a
n
d
a
c
a
d
e
m
ic
p
e
rfo
rm
a
n
c
e
.
Th
is
stu
d
y
a
ims
to
e
v
a
lu
a
te
th
e
e
ffe
c
ti
v
e
n
e
ss
of
c
o
u
n
se
ll
i
n
g
a
p
p
ro
a
c
h
e
s
in
re
d
u
c
in
g
c
o
m
m
u
n
ica
ti
o
n
a
p
p
re
h
e
n
si
o
n
a
m
o
n
g
stu
d
e
n
ts
in
h
ig
h
e
r
e
d
u
c
a
ti
o
n
.
Co
n
se
q
u
e
n
tl
y
,
c
o
u
n
se
ll
i
n
g
i
n
terv
e
n
ti
o
n
m
o
d
u
les
,
i
n
c
lu
d
in
g
th
e
so
lu
ti
o
n
-
f
o
c
u
se
d
b
rief
c
o
g
n
i
ti
v
e
b
e
h
a
v
i
o
r
(
S
F
BCB)
t
h
e
ra
p
y
a
n
d
g
ro
u
p
c
o
u
n
s
e
ll
i
n
g
(G
C)
m
o
d
u
les
,
we
re
d
e
v
e
lo
p
e
d
.
S
ix
t
y
stu
d
e
n
ts
w
h
o
p
a
rti
c
ip
a
ted
in
t
h
is
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d
y
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re
stu
d
y
i
n
g
at
a
p
u
b
li
c
u
n
i
v
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rsity
.
P
re
-
tes
ts,
p
o
st
-
tes
ts,
a
n
d
fo
ll
o
w
-
up
tes
ts
we
re
a
d
m
in
istere
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u
sin
g
th
e
p
e
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a
l
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p
o
rts
o
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c
o
m
m
u
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ica
ti
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n
a
p
p
re
h
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n
sio
n
q
u
e
stio
n
n
a
ire
to
m
e
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su
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c
h
a
n
g
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in
a
p
p
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si
o
n
lev
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ls
a
c
ro
ss
d
iff
e
re
n
t
c
o
m
m
u
n
ica
ti
o
n
c
o
n
tex
ts,
in
c
lu
d
in
g
g
ro
u
p
d
isc
u
ss
io
n
s,
m
e
e
ti
n
g
s,
d
y
a
d
ic
in
tera
c
ti
o
n
s,
a
n
d
p
u
b
li
c
sp
e
a
k
in
g
.
T
h
e
re
su
lt
s
d
e
m
o
n
stra
ted
t
h
a
t
b
o
th
i
n
terv
e
n
ti
o
n
m
o
d
u
les
si
g
n
ifi
c
a
n
tl
y
re
d
u
c
e
d
c
o
m
m
u
n
ica
ti
o
n
a
p
p
re
h
e
n
sio
n
,
with
imp
r
o
v
e
m
e
n
ts
in
p
a
rti
c
ip
a
n
ts
’
c
o
n
fid
e
n
c
e
a
n
d
c
o
m
m
u
n
ica
ti
o
n
a
b
il
it
ies
.
In
c
o
n
c
lu
sio
n
,
th
e
stu
d
y
h
ig
h
li
g
h
ts
th
e
e
ffe
c
ti
v
e
n
e
ss
of
in
teg
ra
ti
n
g
so
lu
ti
o
n
-
f
o
c
u
se
d
a
n
d
c
o
g
n
it
i
v
e
-
b
e
h
a
v
io
ra
l
tec
h
n
iq
u
e
s
in
c
o
u
n
se
ll
i
n
g
i
n
t
e
rv
e
n
ti
o
n
s
to
m
it
ig
a
te
c
o
m
m
u
n
ica
ti
o
n
a
p
p
re
h
e
n
si
o
n
.
Th
e
se
fi
n
d
i
n
g
s
s
u
g
g
e
st
t
h
a
t
su
c
h
a
p
p
ro
a
c
h
e
s
can
be
v
a
lu
a
b
le
to
o
ls
in
h
i
g
h
e
r
e
d
u
c
a
ti
o
n
to
e
n
h
a
n
c
e
stu
d
e
n
ts
’
c
o
m
m
u
n
ica
ti
o
n
sk
il
ls,
u
lt
ima
tely
c
o
n
tri
b
u
ti
n
g
to
th
e
ir
a
c
a
d
e
m
ic
su
c
c
e
ss
a
n
d
p
e
rso
n
a
l
g
ro
wth
.
K
ey
w
o
r
d
s
:
C
o
g
n
itiv
e
b
eh
av
i
o
r
th
er
a
p
y
C
o
m
m
u
n
icatio
n
ap
p
r
eh
e
n
s
io
n
C
o
u
n
s
ellin
g
ap
p
r
o
ac
h
Hig
h
er
ed
u
ca
tio
n
So
lu
tio
n
-
f
o
c
u
s
ed
b
r
ief
th
er
ap
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T
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is
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n
a
c
c
e
ss
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rticle
u
n
d
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th
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CC
BY
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SA
li
c
e
n
se
.
C
o
r
r
e
s
p
o
nd
ing
A
uth
o
r
:
Nik
R
o
s
ila
Nik
Yaa
co
b
Sch
o
o
l
of
E
d
u
ca
tio
n
al
Stu
d
ies,
Un
iv
er
s
iti
Sain
s
Ma
lay
s
ia
Geo
r
g
e
T
o
wn
,
Pen
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1
1
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,
Ma
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ik
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s
m
.
m
y
1.
I
NT
RO
D
UCT
I
O
N
R
esear
ch
co
m
m
u
n
icatio
n
h
as
id
en
tifie
d
co
m
m
u
n
icatio
n
a
p
p
r
eh
e
n
s
io
n
as
a
p
r
o
m
in
en
t
o
b
s
tacle
to
d
ev
elo
p
in
g
co
m
m
u
n
icatio
n
s
k
ills
[
1
]
.
C
o
m
m
u
n
icatio
n
ap
p
r
e
h
en
s
io
n
is
a
ter
m
u
s
ed
to
d
es
cr
ib
e
th
e
d
eg
r
ee
of
an
x
iety
ex
p
er
ie
n
ce
d
by
an
in
d
iv
id
u
al
wh
en
en
g
a
g
in
g
in
co
n
v
er
s
atio
n
s
with
o
th
er
s
,
wh
eth
er
it
be
with
a
s
in
g
le
p
er
s
o
n
or
with
in
a
g
r
o
u
p
s
ettin
g
,
p
a
r
ticu
lar
ly
in
th
e
co
n
tex
t
of
ed
u
ca
ti
o
n
al
en
v
i
r
o
n
m
e
n
ts
s
u
ch
as
u
n
iv
er
s
ity
.
Sev
er
al
f
o
r
m
s
of
co
m
m
u
n
i
ca
tio
n
in
clu
d
e
in
te
r
p
er
s
o
n
al
in
ter
ac
tio
n
s
,
s
m
all
g
r
o
u
p
d
is
cu
s
s
io
n
s
,
an
d
p
r
esen
tatio
n
s
[
2
]
.
C
o
n
s
eq
u
en
t
ly
,
co
m
m
u
n
icatio
n
ap
p
r
e
h
en
s
i
o
n
can
be
d
ef
in
ed
as
a
m
an
if
e
s
tatio
n
of
s
h
y
n
ess
,
r
etice
n
ce
,
or
d
elib
er
ate
a
v
o
i
d
an
ce
of
c
o
m
m
u
n
icatio
n
,
al
o
n
g
s
id
e
s
p
ee
c
h
a
n
x
iety
,
s
tag
e
f
r
i
g
h
t,
an
d
f
ea
r
Evaluation Warning : The document was created with Spire.PDF for Python.
I
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2252
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A
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tio
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o
f c
o
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s
ellin
g
a
p
p
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a
ch
o
n
c
o
mmu
n
ica
tio
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(
N
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r
Hern
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ma
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l Ma
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ass
o
ciate
d
with
p
u
b
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s
p
ea
k
in
g
.
Petr
y
[
3
]
em
p
h
asize
d
two
d
is
tin
ct
ca
teg
o
r
ies
of
co
m
m
u
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:
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ait
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ased
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ased
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T
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s
f
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in
v
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m
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c
o
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d
itio
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or
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tex
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o
m
m
o
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ly
k
n
o
w
n
as
tr
ait
-
b
ased
co
m
m
u
n
icatio
n
ap
p
r
eh
e
n
s
io
n
.
T
h
e
s
itu
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n
al
-
b
ased
n
atu
r
e
of
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n
x
iety
or
d
is
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m
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o
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t
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ch
ar
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ize
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r
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o
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s
ex
p
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ien
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th
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o
tio
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s
ex
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s
iv
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in
a
p
ar
ticu
lar
s
ettin
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or
m
o
m
en
t,
s
u
ch
as
d
u
r
in
g
an
in
ter
v
iew
[
3
]
.
C
o
m
m
u
n
icatio
n
ap
p
r
eh
en
s
io
n
is
co
n
s
id
er
ed
a
s
ig
n
if
ican
t
co
n
ce
r
n
in
s
tu
d
e
n
t
life
b
ec
a
u
s
e
it
can
h
in
d
er
th
e
d
ev
elo
p
m
en
t
of
s
o
f
t
s
k
ills
an
d
n
eg
ativ
ely
af
f
ec
t
a
ca
d
em
ic
p
e
r
f
o
r
m
an
ce
[
4
]
.
Pre
v
io
u
s
r
esear
ch
h
as
h
ig
h
lig
h
ted
th
e
im
p
ac
t
of
c
o
m
m
u
n
icatio
n
ap
p
r
eh
en
s
io
n
on
s
tu
d
en
ts
’
p
u
b
lic
s
p
ea
k
in
g
s
k
ills
an
d
s
u
b
s
eq
u
en
t
im
p
licatio
n
s
f
o
r
th
eir
em
p
lo
y
ab
ilit
y
[
5
]
.
T
h
e
d
ev
el
o
p
m
en
t
of
co
m
p
ete
n
t
p
u
b
lic
s
p
ea
k
in
g
s
k
ills
an
d
ef
f
ec
tiv
e
co
m
m
u
n
icatio
n
ab
ilit
ies
h
as
b
ec
o
m
e
in
c
r
ea
s
in
g
ly
cr
u
cial
in
ed
u
ca
tio
n
al
en
v
ir
o
n
m
e
n
ts
,
as
well
as
in
th
e
co
n
tex
t
of
wo
r
k
an
d
p
r
o
f
ess
io
n
al
g
r
o
wth
[
6
]
.
L
o
u
r
eir
o
et
a
l.
[
7
]
e
m
p
h
asize
th
at
s
tu
d
en
ts
h
ad
ch
allen
g
es
an
d
e
x
p
r
ess
ed
ap
p
r
eh
en
s
io
n
r
eg
ar
d
i
n
g
co
m
m
u
n
icatio
n
,
s
p
ec
if
ically
in
th
e
co
n
te
x
t
of
o
r
al
co
m
m
u
n
icatio
n
co
m
p
ar
e
d
to
wr
itten
c
o
m
m
u
n
icatio
n
.
T
h
e
f
ea
r
of
how
o
th
e
r
s
m
ay
s
ee
th
em
ca
u
s
es
in
d
iv
id
u
als
to
h
esit
ate
to
p
ar
ticip
ate
in
co
m
m
u
n
i
ca
tio
n
,
r
esu
ltin
g
in
th
eir
av
o
id
a
n
ce
of
ask
in
g
q
u
esti
o
n
s
or
g
iv
in
g
c
o
m
m
en
ts
in
s
u
b
s
eq
u
en
t
class
s
ess
io
n
s
.
C
o
n
s
eq
u
en
tly
,
th
is
b
eh
av
io
r
h
in
d
er
s
th
eir
u
n
d
er
s
tan
d
in
g
of
th
e
s
u
b
ject
[
8
]
.
Fu
r
th
er
m
o
r
e,
s
tu
d
e
n
ts
ten
d
ed
to
av
o
id
ask
in
g
q
u
esti
o
n
s
or
o
f
f
e
r
in
g
co
m
m
en
ts
d
u
r
in
g
class
r
o
o
m
in
ter
ac
tio
n
s
,
wh
ile
a
s
ep
ar
ate
g
r
o
u
p
e
x
p
r
ess
ed
ap
p
r
eh
e
n
s
io
n
ab
o
u
t
d
eliv
er
i
n
g
p
r
esen
tatio
n
s
[
9
]
.
L
eFeb
v
r
e
et
a
l.
[
1
0
]
r
ev
e
aled
t
h
at
s
tu
d
en
ts
wh
o
ten
d
to
r
em
a
in
s
ilen
t
or
d
is
p
lay
r
elu
ctan
ce
to
en
g
a
g
e
in
class
r
o
o
m
d
is
cu
s
s
io
n
s
ex
p
er
ien
ce
h
eig
h
te
n
ed
d
is
co
m
f
o
r
t
in
th
e
p
r
esen
ce
of
s
p
ee
ch
co
m
m
u
n
icatio
n
.
T
h
er
ef
o
r
e,
th
e
ef
f
icac
y
of
a
b
ilit
ies,
s
u
ch
as
ad
o
p
ti
n
g
a
co
g
n
itiv
e,
em
o
tio
n
al,
an
d
s
en
s
o
r
y
s
tan
d
p
o
in
t
a
n
d
en
h
an
cin
g
th
e
willin
g
n
ess
to
e
n
co
u
n
ter
th
em
with
o
u
t
s
ee
k
in
g
to
m
an
ip
u
late
or
e
v
ad
e
th
e
m
.
W
h
en
in
s
tr
u
ctin
g
s
tu
d
en
ts
to
d
ev
elo
p
th
eir
a
b
ilit
y
to
en
d
u
r
e
d
is
co
m
f
o
r
t
d
u
r
in
g
p
u
b
lic
s
p
ea
k
i
n
g
,
it
m
a
y
be
n
ec
ess
ar
y
to
u
n
d
er
s
co
r
e
th
e
im
p
o
r
ta
n
ce
of
s
elf
-
r
eg
u
latio
n
an
d
th
e
p
er
ce
p
tio
n
of
p
r
esen
tatio
n
s
as
a
s
i
g
n
if
ican
t
e
n
d
ea
v
o
r
.
A
l
t
e
r
n
a
ti
v
e
l
y
,
s
u
p
p
o
s
e
t
h
e
o
b
je
c
t
i
v
e
is
to
r
e
d
u
c
e
t
h
e
a
n
x
i
e
t
y
c
o
m
m
o
n
l
y
a
s
s
o
c
i
at
e
d
w
i
t
h
i
n
d
i
v
i
d
u
a
l
s
’
s
u
b
je
c
t
i
v
e
p
e
r
c
e
p
t
i
o
n
of
p
u
b
l
i
c
s
p
e
a
k
i
n
g
.
In
t
h
a
t
c
a
s
e
,
it
m
a
y
be
a
d
v
a
n
t
a
g
e
o
u
s
to
f
o
c
u
s
t
h
e
e
d
u
c
at
i
o
n
of
s
t
u
d
e
n
ts
in
c
u
l
t
i
v
a
ti
n
g
o
p
e
n
n
e
s
s
t
o
w
a
r
d
s
th
e
i
r
o
w
n
e
x
p
e
r
i
e
n
c
e
s
,
e
n
c
o
m
p
a
s
s
i
n
g
t
h
e
i
r
t
h
o
u
g
h
t
s
a
n
d
e
m
o
tio
n
s
[
1
1
]
.
C
o
g
n
itiv
e
b
eh
av
io
r
al
th
e
o
r
y
,
wh
ich
en
co
m
p
ass
es
r
elax
atio
n
s
tr
ateg
ies,
co
g
n
itiv
e
r
estru
ctu
r
in
g
,
an
d
ex
p
o
s
u
r
e,
is
f
r
eq
u
e
n
tly
u
tili
ze
d
in
co
u
n
s
ellin
g
in
ter
v
en
tio
n
s
th
at
r
ed
u
ce
co
m
m
u
n
icatio
n
ap
p
r
eh
e
n
s
io
n
[
1
2
]
.
At
th
e
b
eg
in
n
in
g
of
th
e
r
ap
y
,
it
is
r
ec
o
m
m
en
d
ed
to
em
p
lo
y
c
o
g
n
itiv
e
b
e
h
av
io
r
al
th
e
o
r
y
d
u
e
to
th
e
in
f
lu
en
ce
of
co
m
m
u
n
icatio
n
ap
p
r
e
h
en
s
io
n
on
in
d
iv
id
u
als
’
p
h
y
s
io
lo
g
ic
al,
co
g
n
itiv
e,
an
d
b
eh
av
io
r
a
l
s
y
m
p
to
m
s
[
1
3
]
.
Var
io
u
s
s
tr
ateg
ies,
in
clu
d
in
g
co
g
n
itiv
e
r
estru
ctu
r
in
g
,
e
x
p
er
ien
tial
ex
p
o
s
u
r
e,
ass
er
tiv
en
ess
tr
ain
in
g
,
an
d
p
r
o
b
lem
-
s
o
lv
in
g
,
h
a
v
e
b
ee
n
r
ec
o
g
n
ized
as
h
el
p
f
u
l
ap
p
r
o
ac
h
es
to
e
n
h
an
ci
n
g
s
elf
-
co
n
f
i
d
e
n
ce
an
d
r
esil
ien
ce
in
th
e
f
ac
e
of
an
x
iety
.
R
esear
ch
on
co
m
m
u
n
icatio
n
ap
p
r
eh
e
n
s
io
n
em
p
lo
y
in
g
c
o
g
n
itiv
e
b
eh
av
io
r
al
th
eo
r
y
h
as
r
esu
lted
in
p
o
s
itiv
e
o
u
tco
m
es
[
1
4
]
.
T
h
is
s
tu
d
y
ex
am
i
n
ed
th
e
s
tr
ateg
ies
em
p
lo
y
ed
by
p
o
s
tg
r
a
d
u
ate
i
n
ter
n
atio
n
al
s
tu
d
e
n
ts
to
r
ed
u
ce
an
x
iety
r
elate
d
to
c
o
m
m
u
n
icatio
n
,
s
p
ec
if
ically
in
t
h
e
co
n
te
x
t
of
ac
ad
em
ic
p
r
esen
tatio
n
s
.
Acc
o
r
d
in
g
to
s
tu
d
en
t
f
ee
d
b
ac
k
,
p
o
s
itiv
e
co
g
n
itiv
e
r
estru
ctu
r
in
g
d
u
r
i
n
g
s
elf
-
r
ef
lectio
n
can
co
n
t
r
ib
u
te
to
a
more
o
p
tim
is
tic
o
u
tlo
o
k
a
n
d
in
c
r
ea
s
ed
co
n
f
id
en
ce
in
one
’
s
ab
ilit
ies.
A
d
d
i
t
io
n
a
l
l
y
,
e
m
p
l
o
y
i
n
g
r
e
l
a
x
a
ti
o
n
te
c
h
n
i
q
u
e
s
m
a
y
h
e
l
p
s
t
u
d
e
n
ts
m
a
n
a
g
e
t
h
e
i
r
a
n
x
ie
t
y
,
l
e
a
d
i
n
g
t
h
e
m
to
e
x
h
i
b
it
b
e
h
a
v
io
r
s
s
u
c
h
as
a
v
o
i
d
i
n
g
e
y
e
c
o
n
t
ac
t
a
n
d
u
s
i
n
g
s
m
i
l
i
n
g
as
a
m
e
a
n
s
to
m
a
s
k
t
h
e
i
r
n
er
v
o
u
s
n
e
s
s
.
F
u
r
t
h
e
r
m
o
r
e
,
s
o
m
e
s
t
u
d
e
n
ts
f
i
n
d
t
h
a
t
v
i
s
u
al
i
z
at
io
n
t
e
c
h
n
i
q
u
e
s
a
r
e
b
e
n
e
f
i
c
i
a
l
in
f
ee
l
i
n
g
a
d
e
q
u
a
t
el
y
p
r
e
p
a
r
e
d
f
o
r
p
r
e
s
e
n
t
a
t
i
o
n
s
,
g
o
in
g
b
e
y
o
n
d
m
e
r
e
l
y
c
r
e
a
t
i
n
g
p
r
e
s
e
n
t
a
ti
o
n
s
li
d
e
s
.
Fu
r
th
er
m
o
r
e
,
th
e
u
tili
za
tio
n
of
co
g
n
itiv
e
b
e
h
av
io
r
al
th
e
o
r
y
to
m
itig
ate
co
m
m
u
n
icatio
n
ap
p
r
eh
en
s
io
n
was
co
m
p
lem
en
ted
by
th
e
ef
f
ec
tiv
e
im
p
lem
en
tatio
n
of
s
o
lu
tio
n
-
f
o
c
u
s
ed
b
r
ief
th
er
ap
y
(
SF
B
T
)
,
r
esu
ltin
g
in
a
s
ig
n
if
ican
t
d
ec
r
ea
s
e
in
b
eh
a
v
io
r
al
p
r
o
b
lem
s
r
elate
d
to
an
x
iety
[
1
5
]
.
In
c
o
n
tr
ast
to
tr
a
d
itio
n
al
th
er
a
p
eu
tic
ap
p
r
o
ac
h
es,
SF
B
T
f
o
cu
s
es
on
id
en
tify
in
g
a
n
d
u
tili
zin
g
th
e
cl
ien
t
’
s
s
tr
en
g
th
s
.
C
o
u
n
s
ello
r
s
attem
p
t
to
f
ac
ilit
ate
s
o
lu
tio
n
s
th
at
ex
h
i
b
it
ef
f
icien
c
y
,
ap
p
ea
l,
q
u
ick
n
ess
,
an
d
ef
f
e
ctiv
en
ess
,
m
o
tiv
ated
by
th
eir
s
in
ce
r
e
co
n
ce
r
n
f
o
r
th
e
welf
ar
e
of
th
ei
r
clien
ts
.
SF
B
T
h
as
b
ec
o
m
e
r
ec
o
g
n
ized
as
a
th
er
ap
eu
tic
s
tr
ateg
y
th
at
can
ac
h
iev
e
f
aster
o
u
tco
m
es
wh
ile
m
in
im
izin
g
n
eg
ativ
e
co
n
s
eq
u
en
ce
s
.
Fu
r
th
er
m
o
r
e,
SF
B
T
h
as
b
ee
n
f
o
u
n
d
to
ef
f
ec
tiv
el
y
r
e
d
u
ce
an
x
iety
,
s
o
cial
p
er
f
o
r
m
a
n
ce
,
an
d
d
ep
r
ess
io
n
[
1
6
]
.
SF
B
T
h
as
d
em
o
n
s
tr
ated
ef
f
icac
y
in
t
r
ea
tin
g
a
d
o
lescen
t
d
is
o
r
d
er
s
an
d
a
r
a
n
g
e
of
p
s
y
c
h
o
lo
g
ical
is
s
u
es,
in
clu
d
in
g
p
o
s
t
-
tr
au
m
atic
s
tr
ess
d
is
o
r
d
er
o
r
p
o
s
ttra
u
m
atic
s
tr
ess
d
is
o
r
d
er
(
PTSD
)
,
d
is
r
u
p
tiv
e
b
eh
av
io
r
,
a
n
d
a
n
x
iety
[
1
7
]
.
T
h
is
th
er
ap
eu
tic
a
p
p
r
o
ac
h
p
r
io
r
itizes
clien
t
g
o
als
an
d
s
tr
en
g
th
s
,
s
teer
in
g
away
f
r
o
m
p
r
o
lo
n
g
ed
an
aly
s
is
of
p
r
o
b
lem
s
.
I
n
s
tead
,
SF
B
T
en
co
u
r
ag
es
clien
ts
to
en
v
is
io
n
s
o
lu
tio
n
s
a
n
d
lev
e
r
a
g
e
ex
is
tin
g
co
p
in
g
s
tr
ateg
ies
[
1
8
]
.
T
h
r
o
u
g
h
tech
n
iq
u
es
s
u
ch
as
s
ettin
g
ex
p
lici
t
clien
t
g
o
als,
em
p
lo
y
in
g
m
ir
ac
le
q
u
esti
o
n
s
,
an
d
id
en
tify
in
g
e
x
ce
p
tio
n
s
to
p
r
o
b
lem
s
,
SF
B
T
f
o
s
ter
s
s
elf
-
estee
m
g
r
o
wth
a
n
d
r
esil
ien
ce
in
teen
ag
er
s
,
eq
u
ip
p
in
g
th
em
with
p
r
ac
tical
to
o
ls
to
n
av
ig
ate
life
’
s
ch
allen
g
es
[
1
8
]
.
SF
B
T
o
p
er
ates
on
th
e
p
r
in
ci
p
le
th
at
lan
g
u
a
g
e
is
cr
ea
tiv
e
an
d
th
at
th
er
a
p
y
s
h
o
u
ld
f
o
cu
s
on
f
in
d
in
g
f
u
t
u
r
e
s
o
l
u
tio
n
s
r
ath
er
th
an
d
wellin
g
on
p
ast
is
s
u
es
[
1
9
]
.
It
is
ch
ar
ac
ter
ized
by
its
b
r
e
v
ity
,
o
f
ten
r
e
q
u
ir
in
g
o
n
ly
a
s
h
o
r
t
d
u
r
atio
n
to
ac
h
ie
v
e
m
ea
n
i
n
g
f
u
l
r
esu
lts
.
Evaluation Warning : The document was created with Spire.PDF for Python.
I
SS
N
:
2252
-
8
8
2
2
I
n
t
J
E
v
al
&
R
es E
d
u
c
,
Vo
l
.
14
,
No
.
3
,
J
u
n
e
20
25
:
1
6
7
4
-
1
6
8
3
1676
By
em
p
h
asizin
g
clien
ts
’
in
h
e
r
en
t
s
tr
en
g
th
s
,
r
eso
u
r
ce
s
,
an
d
p
r
o
b
lem
-
s
o
lv
in
g
s
k
ills
,
SF
B
T
em
p
o
wer
s
in
d
iv
id
u
als
to
tak
e
ch
ar
g
e
of
th
eir
liv
es
an
d
co
n
s
tr
u
ct
p
o
s
itiv
e
p
ath
way
s
f
o
r
war
d
.
T
h
i
s
s
tr
en
g
th
s
-
b
ased
,
s
o
lu
tio
n
-
o
r
ien
te
d
ap
p
r
o
ac
h
is
g
r
o
u
n
d
ed
in
r
esear
ch
a
n
d
o
f
f
e
r
s
a
p
r
ag
m
atic
f
r
am
ew
o
r
k
f
o
r
ad
d
r
ess
in
g
p
s
y
ch
o
lo
g
ical
an
d
b
eh
av
i
o
r
al
co
n
ce
r
n
s
in
ad
o
lescen
ts
an
d
a
d
u
lts
[
2
0
]
.
Sh
u
m
way
[
2
1
]
d
o
c
u
m
en
ted
a
n
o
tab
le
r
ed
u
ctio
n
in
a
n
x
iety
lev
els
with
in
a
s
am
p
le
wh
o
h
a
d
p
r
ev
io
u
s
ly
ex
p
er
ien
ce
d
e
x
ten
d
ed
d
u
r
a
tio
n
s
of
s
tr
ess
an
d
an
x
iety
.
In
a
s
tu
d
y
c
o
n
d
u
cted
by
Am
in
n
asab
et
a
l.
[
2
2
]
,
it
was
o
b
s
er
v
ed
th
at
SF
B
T
led
to
a
r
ed
u
ctio
n
in
f
elt
s
tr
ess
an
d
d
ep
r
ess
io
n
am
o
n
g
a
s
am
p
le
of
s
ix
ty
in
d
i
v
id
u
als
wh
o
h
ad
b
ee
n
d
iag
n
o
s
ed
with
b
r
ea
s
t
ca
n
ce
r
.
B
ased
on
th
e
ex
is
tin
g
b
o
d
y
of
r
esear
ch
,
it
can
be
in
f
e
r
r
ed
th
at
SF
B
T
can
ef
f
ec
tiv
ely
tack
le
v
ar
io
u
s
ch
allen
g
es
ac
r
o
s
s
a
d
iv
er
s
e
ar
r
a
y
of
c
o
n
tex
ts
.
As
a
r
esu
lt,
th
e
co
m
b
in
atio
n
of
co
g
n
itiv
e
b
eh
a
v
io
r
al
th
e
r
ap
y
(
CBT
)
an
d
SF
B
T
co
n
t
r
ib
u
ted
to
d
ev
elo
p
in
g
a
s
o
lu
tio
n
-
f
o
cu
s
e
d
b
r
ief
co
g
n
itiv
e
b
eh
av
i
o
r
(
SF
B
C
B
)
m
o
d
u
le
to
d
ec
r
ea
s
e
co
m
m
u
n
icatio
n
ap
p
r
eh
e
n
s
io
n
am
o
n
g
s
tu
d
e
n
ts
in
h
ig
h
er
e
d
u
ca
tio
n
.
T
h
e
in
teg
r
atio
n
of
SF
B
T
tech
n
iq
u
es,
s
u
ch
as
th
e
im
p
lem
en
tatio
n
of
m
ir
ac
le
q
u
esti
o
n
s
,
s
ca
le
q
u
esti
o
n
s
,
ex
ce
p
tio
n
q
u
esti
o
n
s
,
an
d
g
o
al
s
ettin
g
,
ar
e
co
m
b
in
ed
with
CBT
tech
n
iq
u
es,
in
clu
d
in
g
co
g
n
itiv
e
s
tr
u
ctu
r
in
g
,
s
k
i
lls
tr
ain
in
g
,
r
elax
atio
n
tech
n
i
q
u
es,
im
ag
in
ativ
e
ex
er
cises
,
an
d
p
s
y
ch
o
ed
u
c
atio
n
.
In
th
is
co
n
te
x
t,
th
e
p
u
r
p
o
s
e
of
th
is
s
tu
d
y
is
to
e
x
am
in
e
th
e
im
p
ac
t
of
th
e
co
u
n
s
ellin
g
a
p
p
r
o
ac
h
b
ased
on
SF
B
T
an
d
CBT
on
th
e
lev
el
of
co
m
m
u
n
icatio
n
ap
p
r
eh
en
s
io
n
with
in
th
e
co
n
tex
t
of
h
ig
h
er
e
d
u
ca
tio
n
,
with
a
s
p
ec
if
ic
em
p
h
asis
on
g
r
o
u
p
d
is
cu
s
s
io
n
s
,
m
ee
tin
g
s
,
d
y
ad
co
m
m
u
n
icatio
n
,
an
d
p
u
b
lic
s
p
ea
k
in
g
.
Mo
r
e
s
p
ec
if
ically
,
th
is
ar
ticle
co
m
p
ar
es
two
m
o
d
u
les
b
ased
on
a
c
o
u
n
s
ellin
g
ap
p
r
o
ac
h
th
at
is
more
s
u
itab
le
f
o
r
r
ed
u
cin
g
c
o
m
m
u
n
icatio
n
ap
p
r
eh
en
s
io
n
an
d
f
o
u
r
d
im
e
n
s
io
n
s
of
c
o
m
m
u
n
icatio
n
ap
p
r
eh
e
n
s
io
n
am
o
n
g
s
tu
d
en
t
s
in
h
ig
h
er
ed
u
ca
tio
n
in
Ma
lay
s
ia.
Hen
ce
,
th
is
r
esear
ch
ask
s
th
e
f
o
llo
win
g
g
u
id
in
g
q
u
esti
o
n
s
:
i)
I
s
th
er
e
a
d
if
f
er
e
n
ce
in
co
m
m
u
n
icatio
n
a
p
p
r
eh
e
n
s
io
n
s
co
r
es
am
o
n
g
h
ig
h
er
e
d
u
ca
tio
n
s
tu
d
en
ts
ac
r
o
s
s
tim
e
ef
f
ec
ts
(
p
r
e
-
test
,
p
o
s
t
-
test
,
an
d
f
o
llo
w
-
u
p
)
in
th
e
SF
B
C
B
m
o
d
u
le?
ii)
I
s
th
er
e
a
d
if
f
er
e
n
ce
in
co
m
m
u
n
icatio
n
a
p
p
r
eh
e
n
s
io
n
s
co
r
es
am
o
n
g
h
ig
h
er
e
d
u
ca
tio
n
s
tu
d
en
ts
ac
r
o
s
s
tim
e
ef
f
ec
ts
(
p
r
e
-
test
,
p
o
s
t
-
test
,
an
d
f
o
llo
w
-
u
p
)
in
th
e
g
r
o
u
p
c
o
u
n
s
ellin
g
(
GC
)
m
o
d
u
le?
i
i
i
)
H
ow
do
th
e
SF
B
C
B
an
d
GC
m
o
d
u
les
co
m
p
ar
e
in
r
e
d
u
cin
g
co
m
m
u
n
icatio
n
ap
p
r
eh
e
n
s
io
n
am
o
n
g
h
ig
h
er
ed
u
ca
tio
n
s
tu
d
e
n
ts
ac
r
o
s
s
tim
e
ef
f
ec
ts
(
p
r
e
-
test
,
p
o
s
t
-
test
,
an
d
f
o
llo
w
-
u
p
)
?
2.
M
E
T
H
O
D
2
.
1
.
Resea
rc
h
des
ig
n
T
h
is
s
tu
d
y
em
p
lo
y
ed
a
q
u
asi
-
ex
p
er
im
e
n
tal
d
esig
n
with
two
g
r
o
u
p
s
:
ex
p
er
im
en
t
1,
th
e
tr
ea
tm
en
t
g
r
o
u
p
,
u
s
ed
th
e
SF
B
C
B
,
wh
er
ea
s
ex
p
er
im
en
t
2
,
th
e
co
n
tr
o
l
g
r
o
u
p
,
u
s
ed
th
e
GC
m
o
d
u
le
,
a
s
s
h
o
wn
in
T
ab
le
1.
T
h
is
d
esig
n
allo
ws
r
esear
ch
er
s
to
ev
alu
ate
th
e
im
p
ac
t
of
th
ese
d
is
tin
ct
th
e
r
ap
eu
tic
in
ter
v
en
tio
n
s
on
p
ar
ticip
an
ts
’
co
m
m
u
n
icatio
n
ap
p
r
eh
e
n
s
io
n
by
ass
ess
in
g
ch
an
g
es
o
v
er
tim
e.
Usi
n
g
p
r
e
-
t
ests
,
p
o
s
t
-
test
s
,
an
d
f
o
llo
w
-
up
test
s
,
th
e
s
tu
d
y
ca
n
s
y
s
tem
atica
lly
m
ea
s
u
r
e
th
e
p
r
o
g
r
ess
io
n
of
o
u
tco
m
es
a
n
d
d
eter
m
i
n
e
ea
c
h
m
o
d
u
le
’
s
ef
f
icac
y
,
h
i
g
h
lig
h
ti
n
g
th
e
im
p
o
r
tan
ce
of
f
o
llo
w
-
up
ass
ess
m
en
ts
in
u
n
d
er
s
tan
d
in
g
th
e
lo
n
g
-
ter
m
im
p
ac
ts
of
p
s
y
ch
o
lo
g
ical
p
r
o
g
r
am
s
[
2
3
]
.
T
h
is
s
tu
d
y
em
p
lo
y
s
p
u
r
p
o
s
iv
e
s
am
p
lin
g
,
s
elec
tin
g
s
tu
d
en
ts
b
ased
on
s
p
ec
if
ic
cr
iter
ia.
Par
ticip
an
ts
a
r
e
f
r
esh
m
e
n
e
n
r
o
lled
in
a
s
cie
n
ce
co
u
r
s
e
an
d
do
not
r
ec
eiv
e
an
y
th
er
a
p
y
.
T
h
e
y
also
h
av
e
a
p
er
s
o
n
al
r
ep
o
r
t
c
o
m
m
u
n
icatio
n
a
p
p
r
eh
e
n
s
io
n
(
PR
C
A
-
24
)
s
co
r
e
o
v
er
72,
in
d
icatin
g
m
o
d
er
ate
to
h
ig
h
co
m
m
u
n
icatio
n
ap
p
r
eh
e
n
s
io
n
.
T
h
er
e
ar
e
30
in
d
i
v
id
u
a
ls
in
each
ex
p
er
im
e
n
t
g
r
o
u
p
.
T
h
is
s
am
p
le
s
ize
is
s
u
f
f
icien
t
an
d
m
ee
ts
th
e
m
in
im
u
m
r
eq
u
ir
e
m
en
t
f
o
r
q
u
asi
-
e
x
p
er
im
en
tal
s
tu
d
ies.
It
en
s
u
r
e
s
s
ati
s
f
ac
to
r
y
an
d
r
eliab
le
f
in
d
in
g
s
[
2
4
]
.
T
ab
le
1.
T
h
e
r
esear
ch
d
esig
n
of
q
u
asi
-
ex
p
e
r
im
en
tal
G
r
o
u
p
Te
st
Ex
p
e
r
i
m
e
n
t
a
l
1
(
N
=
3
0
)
O1
X
O2
O3
Ex
p
e
r
i
m
e
n
t
a
l
2
(
N
=
3
0
)
O1
X
O2
O3
N
o
t
e
:
O
1
:
p
r
e
-
t
e
s
t
,
O
2
:
p
o
st
-
t
e
s
t
,
O
3
:
f
o
l
l
o
w
-
u
p
t
e
s
t
,
X
:
6
-
w
e
e
k
c
o
u
n
se
l
l
i
n
g
sessi
o
n
2
.
2
.
I
nte
rv
ent
io
n
co
un
s
ellin
g
T
h
e
s
tu
d
y
em
p
lo
y
ed
a
co
m
b
in
ed
ap
p
r
o
ac
h
of
SF
B
C
B
in
ex
p
er
im
e
n
t
1.
T
h
is
ap
p
r
o
ac
h
in
v
o
lv
ed
in
ter
ac
tiv
e
d
is
cu
s
s
io
n
s
f
o
cu
s
ed
on
p
r
o
b
lem
-
s
o
lv
i
n
g
,
g
o
al
-
s
ettin
g
,
an
d
ap
p
ly
in
g
v
ar
io
u
s
s
tr
ateg
ies
s
u
ch
as
p
s
y
ch
o
ed
u
ca
tio
n
,
c
o
g
n
itiv
e
s
tr
u
ctu
r
in
g
,
r
elax
atio
n
,
s
k
ill
tr
ain
in
g
,
m
o
d
els,
m
ir
ac
le
q
u
esti
o
n
s
,
ex
ce
p
tio
n
q
u
esti
o
n
s
,
s
ca
le
q
u
esti
o
n
s
,
an
d
p
r
aise.
A
GC
m
o
d
u
le
was
u
tili
ze
d
in
ex
p
er
im
en
t
2.
T
h
is
less
o
n
is
ce
n
ter
ed
ar
o
u
n
d
th
e
p
r
ev
alen
t
p
r
ac
tice
of
g
r
o
u
p
th
er
ap
y
,
wh
ich
is
co
m
m
o
n
ly
e
m
p
lo
y
e
d
by
co
u
n
s
ello
r
s
to
p
r
o
v
id
e
GC
.
Activ
ities
in
v
o
lv
e
d
is
cu
s
s
i
o
n
s
on
ch
allen
g
es,
p
er
s
o
n
al
ex
p
er
ien
ce
s
,
an
d
s
tr
a
teg
ies,
in
clu
d
in
g
Evaluation Warning : The document was created with Spire.PDF for Python.
I
n
t
J
E
v
al
&
R
es E
d
u
c
I
SS
N:
2252
-
8
8
2
2
A
n
ev
a
lu
a
tio
n
o
f c
o
u
n
s
ellin
g
a
p
p
r
o
a
ch
o
n
c
o
mmu
n
ica
tio
n
…
(
N
o
r
Hern
a
ma
w
a
r
n
i A
b
d
u
l Ma
jid
)
1677
p
s
y
ch
o
ed
u
ca
tio
n
al
tech
n
i
q
u
e
s
,
co
g
n
itiv
e
s
tr
u
ctu
r
in
g
,
an
d
r
elax
atio
n
m
et
h
o
d
s
.
GC
’
s
p
r
im
ar
y
f
o
cu
s
is
f
ac
ilit
atin
g
d
is
cu
s
s
io
n
s
an
d
e
x
p
lo
r
in
g
th
e
c
o
g
n
itiv
e
p
r
o
ce
s
s
es
ass
o
ciate
d
with
co
m
m
u
n
i
ca
tio
n
ap
p
r
eh
en
s
io
n
r
ath
er
th
an
em
p
h
asizin
g
b
eh
av
io
r
al
asp
ec
ts
.
T
h
e
co
u
n
s
ellin
g
i
n
ter
v
en
tio
n
o
cc
u
r
r
e
d
f
r
o
m
week
f
o
u
r
to
week
14
of
th
e
ac
ad
e
m
ic
s
ess
io
n
.
E
ac
h
ex
p
er
im
en
tal
g
r
o
u
p
is
r
eq
u
ir
ed
to
atten
d
s
ix
co
u
n
s
ellin
g
s
ess
io
n
s
.
E
ac
h
s
es
s
io
n
tak
es
one
hour
a
n
d
30
m
in
u
tes.
T
h
e
r
esear
ch
er
s
ap
p
o
in
ted
s
ix
ex
p
er
ts
in
p
s
y
c
h
o
lo
g
y
,
p
s
y
c
h
o
m
etr
ics,
a
n
d
g
u
id
a
n
ce
an
d
co
u
n
s
ellin
g
f
o
r
th
e
co
n
te
n
t
v
alid
ity
of
th
e
SF
B
C
B
an
d
GC
m
o
d
u
les.
In
(
1
)
p
r
esen
ts
th
e
f
o
r
m
u
la
f
o
r
m
u
lated
to
ca
lcu
late
th
e
co
n
ten
t v
alid
ity
ac
h
iev
em
e
n
t f
r
o
m
ea
ch
ex
p
e
r
t (
x
)
[
2
5
]
.
T
h
e
o
u
tco
m
e
is
ex
p
r
ess
ed
as a
p
er
ce
n
tag
e
(
z%
)
.
I
f
th
e
p
er
ce
n
tag
e
o
f
co
n
ten
t v
ali
d
ity
attain
m
en
t e
x
ce
ed
s
7
0
%,
th
en
th
e
m
o
d
u
le
is
co
n
s
id
er
ed
to
h
av
e
a
h
ig
h
lev
el
o
f
co
n
ten
t
v
alid
ity
.
C
o
n
v
e
r
s
ely
,
if
th
e
p
er
ce
n
tag
e
is
b
elo
w
7
0
%,
th
e
m
o
d
u
le
is
d
ee
m
ed
to
h
av
e
a
lo
w
lev
el
o
f
v
alid
ity
[
2
5
]
.
T
h
e
m
ea
n
co
n
t
en
t
v
alid
ity
SF
B
C
B
was
8
0
%
o
r
0
.
8
0
0
,
s
u
g
g
esti
n
g
a
h
i
g
h
lev
el
o
f
co
n
ten
t
v
alid
ity
.
T
h
e
GC
co
n
ten
t
v
alid
ity
is
7
9
%
(
0
.
7
9
0
)
.
Hen
ce
,
th
e
m
o
d
u
le
is
c
o
n
s
id
er
e
d
ef
f
icac
io
u
s
an
d
ap
p
r
o
p
r
iate
f
o
r
u
s
e.
(
x
/
100
)
×
100
=
z%
(
1
)
2
.
3
.
Study
ins
t
rum
ent
T
h
e
s
tu
d
y
em
p
lo
y
ed
a
PR
C
A
-
24
q
u
esti
o
n
n
air
e
[
2
6
]
to
m
ea
s
u
r
e
p
r
e
-
test
,
p
o
s
t
-
test
,
an
d
f
o
llo
w
-
up
co
n
s
is
tin
g
of
24
item
s
.
T
h
is
s
u
r
v
ey
e
v
alu
ates
co
m
m
u
n
icati
o
n
ap
p
r
eh
en
s
io
n
in
g
r
o
u
p
d
is
cu
s
s
io
n
s
,
m
ee
tin
g
s
,
d
y
ad
co
m
m
u
n
icatio
n
,
an
d
p
u
b
lic
s
p
ea
k
in
g
,
with
s
co
r
es
r
a
n
g
in
g
f
r
o
m
24
to
120.
Sco
r
e
s
of
85
or
h
ig
h
er
in
d
icate
h
ig
h
ap
p
r
eh
e
n
s
io
n
,
60
or
h
ig
h
er
s
ig
n
if
y
m
o
d
er
a
te
ap
p
r
eh
en
s
io
n
,
an
d
59
or
lo
wer
d
en
o
te
lo
w
ap
p
r
eh
e
n
s
io
n
.
To
e
n
s
u
r
e
ac
c
u
r
ac
y
,
th
e
PR
C
A
-
24
q
u
esti
o
n
n
air
e
u
n
d
er
we
n
t
b
ac
k
tr
a
n
s
latio
n
an
d
ex
p
er
t
r
ef
er
en
ce
.
T
h
e
a
d
m
in
is
tr
atio
n
in
v
o
lv
ed
eig
h
t
p
r
o
f
ess
io
n
als,
in
clu
d
in
g
s
ix
in
co
u
n
s
ellin
g
an
d
p
s
y
ch
o
lo
g
y
an
d
two
lan
g
u
a
g
e
s
p
ec
ialis
ts
.
T
h
e
in
ter
n
al
co
n
s
is
ten
cy
of
th
e
s
ca
le
was
m
ea
s
u
r
ed
u
s
in
g
C
r
o
n
b
ac
h
’
s
alp
h
a,
wh
ich
y
ield
ed
a
v
alu
e
of
c
o
m
m
u
n
icatio
n
ap
p
r
e
h
en
s
io
n
(
0
.
9
2
3
)
,
g
r
o
u
p
d
is
cu
s
s
io
n
(
0
.
7
8
9
)
,
m
ee
tin
g
s
(
0
.
8
0
5
)
,
d
y
ad
co
m
m
u
n
icatio
n
(
0
.
7
5
7
)
,
an
d
p
u
b
lic
s
p
ea
k
in
g
(
0
.
8
2
4
)
.
2.
4
.
Da
t
a
a
na
ly
s
is
T
h
e
s
tu
d
y
u
tili
ze
d
th
e
g
en
e
r
al
lin
ea
r
m
o
d
el
(
GL
M)
p
r
o
ce
d
u
r
e,
em
p
lo
y
in
g
r
ep
ea
ted
m
ea
s
u
r
es
an
aly
s
is
o
f
v
ar
ian
ce
o
r
AN
OVA
f
o
r
with
in
-
s
u
b
ject
a
n
d
b
etwe
en
-
s
u
b
ject
ef
f
ec
ts
a
n
a
ly
s
es.
E
f
f
ec
t
s
ize,
m
ea
s
u
r
ed
by
p
ar
tial
eta
s
q
u
a
r
ed
[
2
7
]
,
was
ca
teg
o
r
ized
in
t
o
s
m
all
(
0
.
2
0
)
,
m
ed
iu
m
(
0
.
5
0
)
,
a
n
d
lar
g
e
(
0
.
8
0
)
lev
els.
T
h
e
p
r
im
ar
y
f
o
c
u
s
was
on
ass
ess
in
g
th
e
im
p
ac
t
of
ti
m
e
in
ter
ac
tio
n
(
p
r
e
-
test
,
p
o
s
t
-
t
est,
an
d
f
o
llo
w
-
u
p
)
on
c
o
m
m
u
n
icatio
n
ap
p
r
e
h
en
s
i
o
n
v
ar
iab
les,
in
cl
u
d
in
g
g
r
o
u
p
d
is
cu
s
s
io
n
,
m
ee
tin
g
s
,
d
y
ad
c
o
m
m
u
n
icatio
n
,
a
n
d
p
u
b
lic
s
p
ea
k
in
g
d
im
en
s
io
n
s
.
3.
RE
SU
L
T
S
AND
D
I
SCU
SS
I
O
N
L
ev
en
e
test
,
wh
ich
was
co
n
d
u
cted
to
en
s
u
r
e
th
at
th
e
ass
u
m
p
tio
n
of
eq
u
ality
of
v
a
r
ian
ce
was
s
atis
f
ied
,
is
a
cr
u
cial
p
r
er
eq
u
is
ite
f
o
r
th
e
s
u
b
s
eq
u
en
t
s
tatis
tical
an
aly
s
es
to
be
v
alid
an
d
r
eliab
le.
T
ab
le
2
d
is
p
lay
s
th
e
r
esu
lts
o
f
L
ev
e
n
e’
s
test
ass
ess
in
g
th
e
h
o
m
o
g
en
eity
o
f
v
ar
ian
ce
s
.
Pre
-
test
SF
B
C
B
g
r
o
u
p
(
p
=
0
.
8
8
5
)
,
p
r
e
-
test
GC
g
r
o
u
p
(
p
=
0
.
1
4
3
)
,
p
o
s
t
-
test
SF
B
C
B
g
r
o
u
p
(
p
=
0
.
1
7
8
)
,
p
o
s
t
-
test
GC
g
r
o
u
p
(
p
=
0
.
2
9
2
)
,
SF
B
C
B
g
r
o
u
p
f
o
llo
w
-
u
p
test
(
p
=
0
.
3
1
8
)
,
an
d
GC
g
r
o
u
p
f
o
ll
o
w
-
u
p
test
(
p
=
0
.
2
4
5
)
all
y
iel
d
ed
n
o
n
-
s
ig
n
i
f
ican
t
co
m
m
u
n
icatio
n
ap
p
r
e
h
en
s
io
n
r
esu
lts
(
p
>
0
.
0
5
)
.
T
h
is
s
u
g
g
ests
th
at
th
e
ass
u
m
p
tio
n
o
f
h
o
m
o
g
en
eity
o
f
v
a
r
ian
ce
f
o
r
co
m
m
u
n
icatio
n
ap
p
r
eh
en
s
i
o
n
ac
r
o
s
s
g
r
o
u
p
s
is
m
et,
in
d
ic
atin
g
eq
u
ality
o
f
v
a
r
ian
ce
in
th
e
d
ata.
T
ab
le
2.
L
e
v
en
e
’
s
test
o
f
eq
u
a
lity
o
f
er
r
o
r
v
a
r
ian
ce
s
D
e
p
e
n
d
e
n
t
v
a
r
i
a
b
l
e
Te
st
G
r
o
u
p
F
d
f
1
d
f
2
S
i
g
.
C
o
mm
u
n
i
c
a
t
i
o
n
a
p
p
r
e
h
e
n
s
i
o
n
Pre
P
o
st
F
o
l
l
o
w
-
up
S
F
B
C
B
GC
S
F
B
C
B
GC
S
F
B
C
B
GC
.
0
2
1
2
.
2
7
3
1
.
9
1
1
1
.
1
5
3
1
.
0
3
6
1
.
4
1
2
1
1
1
1
1
1
28
28
28
28
28
28
0
.
8
8
5
0
.
1
4
3
0
.
1
7
8
0
.
2
9
2
0
.
3
1
8
0
.
2
4
5
3
.
1
.
Ana
ly
s
is
of
t
he
t
i
m
e
ef
f
e
ct
in
t
he
SFBCB
g
ro
up
a
n
d
g
ro
up
co
un
s
elling
g
ro
up
A
r
ep
ea
ted
m
ea
s
u
r
es
ANOVA
test
an
aly
ze
d
t
h
e
s
ig
n
if
ican
ce
of
d
if
f
er
e
n
ce
s
in
p
r
e
-
test
,
p
o
s
t
-
test
,
an
d
f
o
llo
w
-
up
test
s
co
r
es
in
th
e
SF
B
C
B
an
d
GC
ex
p
er
im
en
t
g
r
o
u
p
s
,
f
o
cu
s
in
g
on
m
itig
ati
n
g
co
m
m
u
n
icatio
n
ap
p
r
eh
e
n
s
io
n
in
g
r
o
u
p
d
is
cu
s
s
io
n
s
,
m
ee
tin
g
s
,
d
y
ad
co
m
m
u
n
icatio
n
,
a
n
d
p
u
b
lic
s
p
ea
k
in
g
.
Data
f
r
o
m
th
e
an
aly
s
is
r
esu
lts
is
p
r
o
v
id
ed
in
T
ab
le
3.
I
n
T
ab
le
3
,
th
e
r
esu
lts
s
h
o
w
th
at
th
e
S
FB
C
B
ex
p
er
im
en
t
g
r
o
u
p
Evaluation Warning : The document was created with Spire.PDF for Python.
I
SS
N
:
2252
-
8
8
2
2
I
n
t
J
E
v
al
&
R
es E
d
u
c
,
Vo
l
.
14
,
No
.
3
,
J
u
n
e
20
25
:
1
6
7
4
-
1
6
8
3
1678
in
d
icate
s
a
s
ig
n
if
ican
t
g
r
o
u
p
b
y
tim
e
e
f
f
ec
t
o
n
co
m
m
u
n
i
ca
tio
n
ap
p
r
eh
e
n
s
io
n
(
F[2
,
5
8
]
=5
4
.
3
8
0
;
P=0
.
0
0
0
;
ηp
2
=0
.
5
9
6
)
,
g
r
o
u
p
d
is
cu
s
s
io
n
(
F[2
,
5
8
]
=
2
6
.
1
1
2
;
P=0
.
0
0
0
;
η
p
2
=0
.
4
7
4
)
,
m
ee
tin
g
s
(
F[2
,
5
8
]
=3
0
.
2
3
8
;
P=0
.
0
0
0
;
ηp
2
=0
.
4
9
5
)
,
d
y
ad
c
o
m
m
u
n
icatio
n
(
F
[
2
,
5
8
]
=2
4
.
2
7
6
;
P=0
.
0
0
0
;
η
p
2
=0
.
4
5
6
)
,
a
n
d
p
u
b
lic
s
p
ea
k
in
g
(
F[2
,
5
8
]
=3
6
.
2
2
4
;
P=0
.
0
0
0
;
η
p
2
=0
.
5
5
5
)
.
T
h
e
r
esu
lts
in
d
icate
th
at
th
e
SF
B
C
B
m
o
d
u
le
s
ig
n
if
ican
tly
r
ed
u
ce
d
co
m
m
u
n
icatio
n
ap
p
r
eh
en
s
io
n
am
o
n
g
h
i
g
h
er
e
d
u
ca
tio
n
s
tu
d
en
ts
.
T
h
e
a
n
aly
s
is
r
ev
ea
led
s
ig
n
if
ican
t
g
r
o
u
p
-
by
-
tim
e
ef
f
ec
ts
ac
r
o
s
s
all
d
im
en
s
io
n
s
o
f
co
m
m
u
n
ic
atio
n
ap
p
r
eh
en
s
io
n
,
in
clu
d
in
g
g
r
o
u
p
d
is
cu
s
s
io
n
,
m
ee
tin
g
s
,
d
y
ad
co
m
m
u
n
icatio
n
,
an
d
p
u
b
lic
s
p
ea
k
in
g
.
T
ab
le
3.
An
aly
s
is
of
t
h
e
tim
e
ef
f
ec
t in
th
e
SF
B
C
B
g
r
o
u
p
an
d
GC
g
r
o
u
p
V
a
r
i
a
b
l
e
s
G
r
o
u
p
SS
df
MS
F
P
v
a
l
u
e
P
a
r
t
i
a
l
Et
a
s
q
u
a
r
e
d
(
ηp
2
)
C
o
mm
u
n
i
c
a
t
i
o
n
a
p
p
r
e
h
e
n
s
i
o
n
S
F
B
C
B
9
8
7
2
.
9
5
6
1
.
4
6
3
6
7
4
6
.
6
8
2
5
4
.
3
8
0
0
.
0
0
0
0
.
5
9
6
5
2
6
5
.
0
4
4
4
2
.
4
3
8
1
2
4
.
0
6
4
GC
4
9
4
6
.
2
8
9
1
.
5
4
0
3
3
4
4
.
4
8
9
3
3
.
4
9
7
0
.
0
0
0
0
.
5
3
6
4
0
8
8
.
3
7
8
4
4
.
6
5
6
9
9
.
8
4
5
G
r
o
u
p
d
i
s
c
u
ss
i
o
n
s
S
F
B
C
B
4
7
6
.
9
5
6
2
2
3
8
.
4
7
8
2
6
.
1
1
2
0
.
0
0
0
0
.
4
7
4
5
2
9
.
7
1
1
58
9
.
1
3
3
GC
5
4
2
.
4
6
7
2
2
7
1
.
2
3
3
2
5
.
2
3
0
0
.
0
0
0
0
.
4
6
5
6
2
3
.
5
3
3
58
1
0
.
7
5
1
M
e
e
t
i
n
g
s
S
F
B
C
B
5
3
0
.
8
6
7
2
2
6
5
.
4
3
3
3
0
.
2
3
8
0
.
0
0
0
0
.
4
9
5
5
0
9
.
1
3
3
58
8
.
7
7
8
GC
1
3
0
.
0
2
2
1
.
4
3
9
0
.
9
4
9
7
.
3
6
5
0
.
0
0
5
0
.
2
0
3
5
1
1
.
9
7
8
4
1
.
4
5
9
1
2
.
3
4
9
D
y
a
d
c
o
mm
u
n
i
c
a
t
i
o
n
S
F
B
C
B
5
1
3
.
6
8
9
1
.
4
9
7
3
4
3
.
0
9
3
2
4
.
2
7
6
0
.
0
0
0
0
.
4
5
6
6
1
3
.
6
4
4
4
3
.
4
2
0
1
4
.
1
3
3
GC
4
6
0
.
0
2
2
2
2
3
0
.
0
1
1
2
8
.
7
1
2
0
.
0
0
0
0
.
4
9
8
4
6
4
.
6
4
4
58
8
.
0
1
1
P
u
b
l
i
c
s
p
e
a
k
i
n
g
S
F
B
C
B
6
8
4
.
6
0
0
1
.
5
2
1
4
5
0
.
0
7
3
3
6
.
2
2
4
0
.
0
0
0
0
.
5
5
5
5
4
8
.
0
6
7
4
4
.
1
1
2
1
2
.
4
2
5
GC
2
6
2
.
4
8
9
2
1
3
1
.
2
4
4
1
2
.
7
9
7
0
.
0
0
0
0
.
3
0
6
5
9
4
.
8
4
4
58
1
0
.
2
6
As
s
ee
n
in
T
a
b
l
e
3,
r
e
s
u
l
t
s
f
o
r
t
h
e
GC
e
x
p
e
r
i
m
e
n
t
g
r
o
u
p
r
e
v
e
a
l
a
s
i
g
n
i
f
i
ca
n
t
g
r
o
u
p
by
t
i
m
e
e
f
f
e
c
t
on
c
o
m
m
u
n
i
c
a
t
i
o
n
a
p
p
r
e
h
e
n
s
i
o
n
(
F
[
2
,
5
8
]
=
3
3
.
4
9
7
;
P
=
0
.
0
0
0
;
ηp
2
=
0
.
5
3
6
)
,
g
r
o
u
p
d
i
s
c
u
s
s
i
o
n
(
F
[
2
,
5
8
]
=
2
5
.
2
3
0
;
P
=
0
.
0
0
0
;
ηp
2
=
0
.
4
6
5
)
,
m
e
e
t
i
n
g
s
(
F
[
2
,
5
8
]
=
7
.
3
6
5
;
P=
0
.
0
0
0
;
ηp
2
=
0
.
2
0
3
)
,
d
y
a
d
c
o
m
m
u
n
i
c
a
t
i
o
n
(
F
[
2
,
5
8
]
=
2
8
.
7
1
2
;
P
=
0
.
0
0
0
;
ηp
2
=
0
.
4
9
8
)
,
a
n
d
p
u
b
l
i
c
s
p
e
a
k
i
n
g
(
F
[
2
,
5
8
]
=
1
2
.
7
9
7
;
P
=
0
.
0
0
0
;
ηp
2
=
0
.
3
0
6
)
.
T
h
e
an
aly
s
is
r
ev
ea
led
s
ig
n
if
ican
t
g
r
o
u
p
-
by
-
tim
e
ef
f
ec
ts
ac
r
o
s
s
a
ll
d
im
en
s
io
n
s
of
co
m
m
u
n
icatio
n
ap
p
r
eh
e
n
s
io
n
,
in
clu
d
in
g
g
r
o
u
p
d
is
cu
s
s
io
n
,
m
ee
tin
g
s
,
d
y
ad
co
m
m
u
n
icatio
n
,
an
d
p
u
b
lic
s
p
ea
k
in
g
.
3
.
2
.
Ana
ly
s
is
of
t
he
t
i
m
e
ef
f
e
ct
bet
wee
n
SFBC
B
g
ro
up
a
nd
g
ro
up
co
un
s
elli
ng
g
ro
up
T
ab
le
4
d
is
p
lay
s
th
e
m
ea
n
co
m
m
u
n
icatio
n
a
p
p
r
eh
e
n
s
io
n
s
co
r
es
o
v
er
a
p
e
r
io
d
of
tim
e
f
o
r
th
e
SF
B
C
B
an
d
GC
g
r
o
u
p
s
.
T
a
b
le
5
s
h
o
ws
th
e
ef
f
ec
ts
of
th
e
tim
e
(
p
r
e
-
test
,
p
o
s
t
-
test
,
an
d
f
o
llo
w
-
up
test
)
in
ter
ac
tio
n
b
etwe
en
th
e
SF
B
C
B
an
d
GC
g
r
o
u
p
s
u
s
in
g
r
ep
ea
ted
tw
o
-
way
ANOVA
an
aly
s
is
.
T
h
e
f
in
d
in
g
s
h
o
wn
in
T
ab
le
5
is
a
s
ig
n
if
ican
t
in
ter
ac
tio
n
tim
e
ef
f
ec
t
b
etwe
en
g
r
o
u
p
s
,
s
p
ec
if
ically
f
o
r
th
e
d
im
e
n
s
io
n
o
f
m
ee
tin
g
s
(
F
[
1
.
7
7
3
,
9
9
.
2
7
3
]
=4
.
0
6
5
,
p
=0
.
0
2
4
,
η
p
²=
0
.
0
6
8
)
s
u
g
g
ests
th
at
th
e
two
m
o
d
u
les
h
ad
d
if
f
er
in
g
ef
f
ec
ts
o
v
er
tim
e
o
n
s
tu
d
en
ts
’
co
m
m
u
n
icatio
n
ap
p
r
eh
e
n
s
io
n
in
m
ee
tin
g
s
.
T
h
e
m
o
d
er
ate
ef
f
ec
t
s
ize
(
η
p
²=
0
.
0
6
8
)
i
n
d
icate
s
th
at
th
is
d
if
f
er
en
ce
is
m
ea
n
in
g
f
u
l
,
with
th
e
SF
B
C
B
m
o
d
u
le
s
h
o
win
g
a
m
o
r
e
s
ig
n
if
ican
t
i
n
itial
ap
p
r
eh
en
s
io
n
r
ed
u
ctio
n
th
an
th
e
GC
m
o
d
u
le.
Ho
wev
er
,
t
h
e
s
lig
h
t
d
ec
r
ea
s
e
in
m
ea
n
s
co
r
es
b
etwe
e
n
th
e
p
o
s
t
-
test
an
d
f
o
llo
w
-
u
p
s
u
g
g
ests
th
at
th
e
ef
f
ec
t
m
ay
ta
p
er
o
f
f
o
v
er
tim
e
f
o
r
th
e
SF
B
C
B
g
r
o
u
p
,
wh
ile
th
e
GC
g
r
o
u
p
s
h
o
we
d
litt
le
ch
an
g
e.
T
h
e
r
esu
lt
s
h
o
wed
n
o
n
-
s
ig
n
if
ican
t
in
ter
ac
tio
n
ef
f
ec
ts
f
o
r
o
v
er
all
co
m
m
u
n
ic
atio
n
ap
p
r
e
h
en
s
io
n
(
F
[
1
.
7
4
1
,
9
7
.
5
2
0
]
=1
.
8
5
1
,
p
=
0
.
1
6
7
,
η
p
²=
0
.
0
3
2
)
,
g
r
o
u
p
d
is
cu
s
s
io
n
(
F[2
,
1
1
2
]
=
0
.
0
6
3
,
p
=
0
.
9
2
7
,
η
p
²=
0
.
0
0
1
)
,
d
y
ad
ic
co
m
m
u
n
icatio
n
(
F
[
2
,
1
1
2
]
=
1
.
3
4
2
,
p
=
0
.
2
6
5
,
η
p
²=
0
.
0
2
3
)
,
an
d
p
u
b
lic
s
p
ea
k
in
g
(
F
[
1
.
8
7
0
,
1
0
4
.
7
4
8
]
=
2
.
9
1
5
,
p
=
0
.
0
6
2
,
η
p
²=
0
.
0
4
9
)
in
d
icate
s
th
at
th
e
m
o
d
u
les
d
id
n
o
t
p
r
o
d
u
ce
s
i
g
n
if
ican
tly
d
if
f
er
en
t
ef
f
ec
ts
o
v
er
tim
e.
I
n
T
ab
le
4
,
th
e
m
ea
n
co
m
m
u
n
icatio
n
ap
p
r
e
h
en
s
io
n
s
co
r
es
d
r
o
p
p
ed
i
n
b
o
t
h
SF
B
C
B
(
2
0
.
6
6
7
)
an
d
GC
(
1
7
.
0
0
3
)
g
r
o
u
p
s
f
r
o
m
p
r
e
-
to
p
o
s
t
-
test
.
SF
B
C
B
g
r
o
u
p
s
h
o
we
d
a
0
.
5
3
3
d
ec
r
ea
s
e,
wh
ile
th
e
GC
g
r
o
u
p
in
c
r
ea
s
ed
b
y
2
.
2
0
0
f
r
o
m
p
o
s
t
-
test
to
f
o
llo
w
-
u
p
.
Gr
o
u
p
d
is
cu
s
s
io
n
s
r
ev
ea
led
a
d
ec
lin
e
i
n
SF
B
C
B
an
d
GC
g
r
o
u
p
s
b
y
4
.
6
3
3
an
d
5
.
0
3
3
,
r
esp
ec
tiv
ely
,
f
r
o
m
t
h
e
p
r
e
-
test
to
th
e
p
o
s
t
-
test
.
T
h
e
p
o
s
t
-
test
to
f
o
llo
w
-
u
p
s
co
r
e
d
if
f
er
en
ce
s
wer
e
0
.
4
6
7
(
SF
B
C
B
)
an
d
0
.
3
3
3
(
GC
)
.
Fo
r
m
ee
tin
g
s
,
th
e
p
r
e
-
test
an
d
p
o
s
t
-
test
S
FC
B
C
g
r
o
u
p
(
m
ea
n
=5
.
1
6
7
)
m
o
r
e
t
h
an
th
e
GC
g
r
o
u
p
(
m
ea
n
=2
.
7
0
0
)
,
wh
ile
a
d
ec
r
ea
s
e
in
th
e
m
ea
n
b
etwe
en
th
e
p
o
s
t
-
test
an
d
f
o
llo
w
-
u
p
f
o
r
th
e
SF
C
B
C
g
r
o
u
p
an
d
th
e
g
r
o
u
p
GC
d
id
n
o
t
s
h
o
w
a
s
ig
n
if
ican
t
d
if
f
er
en
ce
wh
ic
h
was
r
esp
ec
tiv
ely
m
ea
n
=
-
0
.
1
6
7
an
d
m
ea
n
=
-
0
.
3
3
3
.
Fo
r
d
y
ad
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by
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s
all
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with
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h
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in
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s
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im
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e
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T
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is
s
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g
g
ests
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at
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m
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e
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tech
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ly
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m
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t
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m
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m
ilar
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e
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g
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ated
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m
m
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s
all
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s
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o
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e
im
p
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e
n
ts
in
g
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p
d
is
cu
s
s
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n
s
,
d
y
ad
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co
m
m
u
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a
n
d
p
u
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s
p
e
ak
in
g
.
T
h
e
GC
m
o
d
u
l
e
’
s
e
m
p
h
a
s
i
s
on
c
o
g
n
it
i
v
e
r
e
s
t
r
u
c
t
u
r
i
n
g
,
r
e
la
x
a
t
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n
t
e
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h
n
iq
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e
s
,
a
n
d
p
s
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c
h
o
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g
i
c
a
l
e
d
u
c
ati
o
n
l
i
k
e
l
y
c
o
n
t
r
i
b
u
t
e
d
to
t
h
e
s
e
p
o
s
i
t
i
v
e
o
u
t
c
o
m
es
.
B
o
th
th
e
SF
B
C
B
an
d
GC
m
o
d
u
les
lev
e
r
ag
e
c
o
r
e
p
r
in
c
ip
les
o
f
CBT
to
tac
k
le
co
m
m
u
n
icatio
n
an
x
iety
,
em
p
h
asizin
g
th
e
m
o
d
if
icatio
n
of
m
ala
d
ap
tiv
e
th
o
u
g
h
ts
an
d
th
e
p
r
o
m
o
tio
n
of
r
el
ax
atio
n
tech
n
i
q
u
es.
T
h
is
ap
p
r
o
ac
h
alig
n
s
with
e
x
is
tin
g
r
esear
ch
,
s
u
ch
as
th
e
s
tu
d
y
by
Kak
am
ad
[
2
8
]
,
w
h
ich
h
i
g
h
lig
h
ted
th
e
ef
f
ec
tiv
en
ess
of
a
12
-
week
CBT
in
ter
v
en
tio
n
in
r
ed
u
ci
n
g
s
y
m
p
to
m
s
of
s
tu
tter
in
g
an
d
s
o
cial
an
x
iety
a
m
o
n
g
ad
u
lt
s
tu
d
en
ts
.
Similar
ly
,
r
esear
ch
b
y
L
estar
i
et
a
l.
[
2
9
]
d
em
o
n
s
tr
ated
t
h
at
in
teg
r
atin
g
CBT
with
p
u
b
lic
s
p
ea
k
in
g
in
s
tr
u
ctio
n
led
to
s
ig
n
if
ican
t
r
ed
u
ctio
n
s
in
an
x
iety
,
r
ein
f
o
r
cin
g
th
e
th
er
ap
e
u
tic
v
alu
e
of
CBT
in
co
m
m
u
n
icatio
n
co
n
tex
ts
.
Ad
d
itio
n
ally
,
th
e
f
in
d
in
g
s
f
r
o
m
p
r
ev
io
u
s
s
tu
d
ies
[
3
0
]
,
[
3
1
]
u
n
d
e
r
s
co
r
e
th
e
b
r
o
ad
e
r
ef
f
icac
y
of
CBT
in
m
an
ag
in
g
an
x
iety
,
p
ar
tic
u
lar
ly
in
ad
o
le
s
ce
n
ts
.
T
h
ese
s
tu
d
ies
not
o
n
l
y
co
n
f
ir
m
ed
CBT
’
s
im
p
ac
t
on
r
ed
u
cin
g
ex
am
an
x
iety
an
d
ir
r
atio
n
al
b
elief
s
b
u
t
also
em
p
h
asized
it
i
s
r
o
le
in
e
n
h
an
cin
g
p
r
o
b
lem
-
s
o
lv
in
g
ab
ilit
ies
an
d
d
ec
r
ea
s
in
g
av
o
id
a
n
t
co
p
in
g
m
ec
h
an
i
s
m
s
.
T
h
e
lo
n
g
-
ter
m
b
en
e
f
its
o
b
s
er
v
ed
in
th
ese
s
tu
d
ies
s
u
g
g
est
th
at
CBT
’
s
in
f
lu
en
ce
e
x
ten
d
s
b
ey
o
n
d
im
m
ed
iate
s
y
m
p
to
m
r
elief
,
f
o
s
ter
in
g
last
in
g
im
p
r
o
v
em
e
n
ts
in
b
o
th
co
g
n
itiv
e
an
d
b
eh
a
v
io
r
al
r
esp
o
n
s
es
to
an
x
iety
.
T
h
er
e
f
o
r
e,
in
c
o
r
p
o
r
atin
g
CBT
elem
en
ts
with
in
th
e
SF
B
C
B
an
d
GC
m
o
d
u
les
is
th
eo
r
etica
lly
s
o
u
n
d
an
d
s
u
p
p
o
r
ted
by
em
p
ir
ical
ev
id
en
ce
d
em
o
n
s
tr
atin
g
its
ef
f
ec
tiv
e
n
ess
in
d
iv
er
s
e
an
x
iety
-
r
elate
d
co
n
tex
ts
.
T
h
e
s
tu
d
y
co
m
p
ar
es
th
e
e
f
f
ec
tiv
en
ess
of
th
e
SF
B
C
B
an
d
GC
m
o
d
u
les
in
r
ed
u
ci
n
g
c
o
m
m
u
n
icatio
n
ap
p
r
eh
e
n
s
io
n
.
B
o
th
m
o
d
u
les
wer
e
p
r
ac
tical,
with
SF
B
C
B
s
h
o
win
g
b
etter
im
m
ed
iate
r
esu
lts
,
p
ar
ticu
lar
ly
in
m
ee
tin
g
s
an
d
p
u
b
lic
s
p
ea
k
in
g
,
wh
ile
GC
h
ad
m
o
r
e
s
u
s
tain
ed
ef
f
ec
ts
in
d
y
ad
ic
c
o
m
m
u
n
icatio
n
.
C
o
n
s
is
ten
t
with
th
e
in
f
o
r
m
atio
n
p
r
o
v
id
ed
by
th
e
s
u
b
ject,
b
ef
o
r
e
en
g
ag
i
n
g
in
th
e
co
u
n
s
ellin
g
s
ess
io
n
,
th
e
s
u
b
ject
g
r
ap
p
led
with
co
n
ce
r
n
s
r
e
g
ar
d
in
g
g
o
al
-
s
ettin
g
an
d
ap
p
r
eh
en
s
io
n
.
Ho
wev
er
,
f
o
llo
win
g
SF
B
T
tech
n
iq
u
es,
th
e
s
u
b
ject
’
s
cir
cu
m
s
tan
ce
s
im
p
r
o
v
e
d
.
Fo
ll
o
win
g
tr
ea
tm
en
t,
t
h
e
s
u
b
jects
f
elt
more
ass
u
r
ed
,
at
ea
s
e,
a
n
d
co
n
f
i
d
en
t
as
th
ey
Evaluation Warning : The document was created with Spire.PDF for Python.
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c
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ess
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t
ial
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f
a
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t
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ex
p
l
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ti
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il
ities
a
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d
d
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r
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cti
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g
th
ei
r
at
te
n
ti
o
n
s
o
le
ly
t
o
w
ar
d
f
in
d
i
n
g
s
o
lu
ti
o
n
s
.
H
e
n
ce
,
t
h
e
f
u
n
d
a
m
e
n
t
al
id
ea
s
e
m
p
lo
y
ed
in
t
h
is
t
h
e
r
a
p
y
h
a
v
e
d
e
m
o
n
s
tr
ate
d
t
h
e
ef
f
e
cti
v
e
n
ess
of
SF
B
T
t
h
e
r
a
p
y
in
a
lle
v
i
ati
n
g
c
o
m
m
u
n
ic
ati
o
n
a
p
p
r
eh
e
n
s
i
o
n
,
p
a
r
ti
c
u
la
r
l
y
in
ca
s
es
r
eq
u
i
r
i
n
g
in
t
r
i
ca
t
e
a
n
x
i
et
y
.
T
h
e
f
i
n
d
i
n
g
s
f
r
o
m
m
u
lti
p
l
e
s
t
u
d
ies
s
u
p
p
o
r
t
t
h
e
e
f
f
ic
ac
y
of
SF
B
T
in
r
e
d
u
ci
n
g
a
n
x
i
et
y
a
n
d
en
h
a
n
ci
n
g
s
o
ci
al
s
k
ills
a
m
o
n
g
v
a
r
i
o
u
s
p
o
p
u
l
ati
o
n
s
.
F
o
r
i
n
s
t
an
ce
,
J
av
a
d
ia
n
a
n
d
E
q
li
d
i
[
3
2
]
d
em
o
n
s
t
r
at
ed
t
h
a
t
SF
B
T
e
f
f
ec
t
iv
el
y
a
lle
v
i
ates
a
n
x
iet
y
an
d
f
o
s
te
r
s
s
o
ci
al
s
k
il
l
d
e
v
el
o
p
m
e
n
t
in
h
ig
h
s
ch
o
o
l
s
tu
d
e
n
ts
.
T
h
is
is
co
n
s
is
t
e
n
t
wi
th
Ar
c
h
u
let
a
e
t
a
l
.
[
3
3
]
f
in
d
i
n
g
s
t
h
a
t
SF
B
T
r
e
d
u
ce
s
s
t
r
ess
a
n
d
a
n
x
iet
y
s
y
m
p
t
o
m
s
w
h
il
e
p
r
o
m
o
t
i
n
g
g
o
al
-
s
e
tti
n
g
b
e
h
a
v
i
o
r
s
a
n
d
h
o
p
ef
u
l
n
ess
.
A
d
d
it
io
n
a
ll
y
,
t
h
e
t
ec
h
n
i
q
u
e
h
as
b
e
e
n
n
o
te
d
to
eli
cit
p
o
s
iti
v
e
e
m
o
ti
o
n
al
an
d
c
o
g
n
i
ti
v
e
c
h
a
n
g
es
,
p
ar
t
ic
u
lar
ly
in
g
o
a
l
-
s
ett
in
g
b
e
h
a
v
i
o
r
s
an
d
h
o
p
e
f
u
l
n
ess
.
Mo
r
e
o
v
e
r
,
r
es
ea
r
c
h
b
y
C
h
e
n
e
t
a
l
.
[
3
4
]
h
i
g
h
li
g
h
te
d
t
h
e
e
f
f
ec
t
iv
e
n
ess
of
SF
B
T
in
m
iti
g
a
ti
n
g
s
tr
ess
a
n
d
an
x
i
et
y
a
m
o
n
g
a
d
o
lesc
e
n
ts
,
m
ain
ly
t
h
r
o
u
g
h
t
h
e
u
s
e
of
th
e
“
m
i
r
ac
le
q
u
es
ti
o
n
”
m
et
h
o
d
.
T
h
is
te
ch
n
i
q
u
e
,
w
h
i
c
h
en
co
u
r
a
g
es
cl
ie
n
ts
to
e
n
v
is
i
o
n
t
h
e
ir
li
v
es
wit
h
o
u
t
t
h
ei
r
c
u
r
r
e
n
t
p
r
o
b
l
em
s
,
f
a
cili
tat
es
a
f
o
c
u
s
on
a
c
h
ie
v
i
n
g
m
ea
n
i
n
g
f
u
l
g
o
als
,
s
u
c
h
as
m
a
n
a
g
i
n
g
p
e
r
f
o
r
m
a
n
c
e
a
n
x
i
et
y
.
T
h
e
m
et
h
o
d
r
e
p
o
r
te
d
l
y
en
h
an
ce
s
s
el
f
-
p
e
r
ce
p
ti
o
n
an
d
f
o
s
te
r
s
a
p
o
s
i
ti
v
e
m
i
n
d
s
et,
s
u
g
g
est
in
g
a
m
o
r
e
s
u
b
s
tan
tia
l
i
m
p
ac
t
on
co
g
n
it
iv
e
f
u
n
cti
o
n
i
n
g
t
h
a
n
on
em
o
ti
o
n
a
l
or
s
o
cia
l
as
p
e
cts,
as
n
o
te
d
by
D
ak
i
an
d
Sav
ag
e
[
3
5
]
.
Si
m
il
ar
f
i
n
d
in
g
s
we
r
e
r
e
p
o
r
te
d
by
Sah
r
a
h
et
a
l
.
[
3
6
]
w
h
o
o
b
s
e
r
v
e
d
t
h
a
t
b
r
ie
f
g
r
o
u
p
t
h
e
r
a
p
y
ce
n
te
r
e
d
on
s
o
l
u
ti
o
n
s
s
i
g
n
if
ic
an
t
ly
im
p
r
o
v
e
d
t
h
e
s
p
i
r
it
u
a
l
wel
l
-
b
e
in
g
of
p
o
s
t
g
r
a
d
u
at
e
s
tu
d
en
ts
e
x
p
er
ie
n
c
in
g
a
q
u
a
r
te
r
-
li
f
e
c
r
is
is
.
W
a
n
g
et
a
l
.
[
3
7
]
e
x
te
n
d
e
d
t
h
es
e
o
b
s
e
r
v
ati
o
n
s
to
o
l
d
e
r
a
d
u
lts
in
r
u
r
al
C
h
i
n
a
,
d
e
m
o
n
s
t
r
ati
n
g
th
a
t
c
u
l
tu
r
all
y
t
ail
o
r
e
d
SF
B
T
r
e
d
u
ce
d
d
ep
r
ess
iv
e
s
y
m
p
t
o
m
s
an
d
p
r
ese
r
v
e
d
co
g
n
i
tiv
e
f
u
n
cti
o
n
s
,
w
it
h
p
a
r
ti
ci
p
a
n
t
s
r
ep
o
r
ti
n
g
f
ewe
r
s
y
m
p
to
m
s
p
o
s
t
-
t
h
e
r
a
p
y
[
17
].
T
h
e
ap
p
licatio
n
of
SF
B
T
,
m
ai
n
ly
th
r
o
u
g
h
tech
n
iq
u
es
lik
e
th
e
m
ir
ac
le
q
u
esti
o
n
an
d
s
ca
lin
g
q
u
esti
o
n
s
,
is
f
u
r
th
er
s
u
p
p
o
r
te
d
by
r
esear
ch
s
h
o
win
g
its
p
o
ten
tial
to
d
e
cr
ea
s
e
an
x
iety
ac
r
o
s
s
v
ar
io
u
s
co
n
tex
ts
,
in
clu
d
i
n
g
lab
o
r
p
ain
[3
8
],
d
ep
r
ess
io
n
[
39
],
an
d
a
n
x
iety
d
is
o
r
d
er
s
am
o
n
g
teen
ag
e
g
i
r
ls
[
40
].
T
h
e
s
tr
en
g
th
s
-
f
o
c
u
s
ed
b
r
ief
tr
ea
tm
en
t
(
SF
B
C
B
)
m
o
d
u
le,
wh
ich
in
clu
d
es
ex
p
o
s
u
r
e
ac
ti
v
ities
s
u
ch
as
p
r
esen
tatio
n
s
,
s
elf
-
r
ef
lectio
n
,
an
d
f
ee
d
b
ac
k
,
alig
n
s
with
I
r
elan
d
’
s
wo
r
k
[
41
],
d
em
o
n
s
tr
atin
g
ef
f
icac
y
in
r
ed
u
ci
n
g
p
u
b
li
c
s
p
ea
k
in
g
an
x
iety
th
r
o
u
g
h
s
im
ilar
m
eth
o
d
s
.
T
h
e
s
tr
en
g
th
s
-
f
o
c
u
s
ed
b
r
ief
t
r
ea
tm
en
t
also
em
p
h
asizes
th
e
clien
t
’
s
p
o
s
itiv
e
attr
ib
u
tes
an
d
p
r
e
v
io
u
s
an
d
f
u
t
u
r
e
ac
h
iev
em
e
n
ts
[
42
].
4.
CO
NCLU
SI
O
N
T
h
is
s
tu
d
y
d
em
o
n
s
tr
ates
th
e
ef
f
ec
tiv
en
ess
o
f
th
e
SF
B
C
B
an
d
GC
m
o
d
u
les
ef
f
ec
tiv
ely
r
ed
u
ce
co
m
m
u
n
icatio
n
ap
p
r
eh
en
s
io
n
am
o
n
g
h
ig
h
er
ed
u
ca
tio
n
s
tu
d
en
ts
,
with
th
e
SF
B
C
B
m
o
d
u
le
p
r
o
v
i
d
in
g
lo
n
g
er
-
last
in
g
r
esu
lts
.
B
y
in
co
r
p
o
r
a
tin
g
C
B
T
p
r
in
cip
les,
th
ese
m
o
d
u
les
o
f
f
er
p
r
ac
tical
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tr
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r
m
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x
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s
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o
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in
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d
C
B
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ca
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last
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wo
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s
m
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m
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wh
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ay
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it
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lar
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m
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ltu
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ac
k
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r
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n
d
s
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ld
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h
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ce
u
n
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er
s
tan
d
in
g
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f
th
e
m
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d
u
les
'
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tiv
en
ess
ac
r
o
s
s
d
if
f
er
en
t
p
o
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u
latio
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s
.
Ad
d
itio
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ally
,
t
h
e
s
tu
d
y
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s
s
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r
t
f
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llo
w
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p
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estricts
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o
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lo
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ter
m
s
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s
tain
ab
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y
.
W
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ile
th
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SF
B
C
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m
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Fu
tu
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ld
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ap
p
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ap
eu
tic
co
m
b
in
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ACK
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DG
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F
UNDING
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My
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Min
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Hig
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Evaluation Warning : The document was created with Spire.PDF for Python.
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C
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C
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M
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DATA AV
AI
L
AB
I
L
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Y
T
h
e
au
th
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e
av
ailab
le
in
t
h
e
ar
ticle
.
RE
F
E
R
E
NC
E
S
[
1
]
T.
H
a
ssal
l
,
J.
L.
A
r
q
u
e
r
o
,
J.
J
o
y
c
e
,
a
n
d
J.
M
.
G
o
n
z
a
l
e
z
,
“
C
o
mm
u
n
i
c
a
t
i
o
n
a
p
p
r
e
h
e
n
si
o
n
a
n
d
c
o
mm
u
n
i
c
a
t
i
o
n
se
l
f
‐
e
f
f
i
c
a
c
y
i
n
a
c
c
o
u
n
t
i
n
g
st
u
d
e
n
t
s
,
”
Asi
a
n
R
e
v
i
e
w
o
f
Ac
c
o
u
n
t
i
n
g
,
v
o
l
.
2
1
,
n
o
.
2
,
p
p
.
1
6
0
–
1
7
5
,
J
u
l
.
2
0
1
3
,
d
o
i
:
1
0
.
1
1
0
8
/
A
R
A
-
03
-
2
0
1
3
-
0
0
1
7
.
[
2
]
X
.
S
h
i
,
T.
M
.
B
r
i
n
t
h
a
u
p
t
,
a
n
d
M
.
M
c
C
r
e
e
,
“
T
h
e
r
e
l
a
t
i
o
n
sh
i
p
o
f
se
l
f
-
t
a
l
k
f
r
e
q
u
e
n
c
y
t
o
c
o
mm
u
n
i
c
a
t
i
o
n
a
p
p
r
e
h
e
n
si
o
n
a
n
d
p
u
b
l
i
c
sp
e
a
k
i
n
g
a
n
x
i
e
t
y
,
”
P
e
rs
o
n
a
l
i
t
y
a
n
d
I
n
d
i
v
i
d
u
a
l
D
i
f
f
e
re
n
c
e
s
,
v
o
l
.
7
5
,
p
p
.
1
2
5
–
1
2
9
,
M
a
r
.
2
0
1
5
,
d
o
i
:
1
0
.
1
0
1
6
/
j
.
p
a
i
d
.
2
0
1
4
.
1
1
.
0
2
3
.
[
3
]
A
.
P
e
t
r
y
,
“
C
o
mm
u
n
i
c
a
t
i
o
n
a
p
p
r
e
h
e
n
s
i
o
n
a
f
f
e
c
t
s
p
e
r
f
o
r
ma
n
c
e
,
”
M
.
S
.
t
h
e
si
s
,
Jo
h
n
C
a
r
r
o
l
l
U
n
i
v
e
r
si
t
y
,
U
S
A
,
2
0
1
6
.
[
4
]
T.
M
.
D
a
v
i
s
,
“
A
n
a
n
a
l
y
si
s
o
f
c
o
mm
u
n
i
c
a
t
i
o
n
a
n
x
i
e
t
y
a
n
d
r
e
a
d
i
n
g
c
o
m
p
r
e
h
e
n
s
i
o
n
i
n
si
x
t
h
,
s
e
v
e
n
t
h
a
n
d
e
i
g
h
t
h
g
r
a
d
e
s
t
u
d
e
n
t
s,”
P
h
.
D
.
d
i
ssert
a
t
i
o
n
,
U
n
i
v
e
r
si
t
y
o
f
C
e
n
t
r
a
l
F
l
o
r
i
d
a
,
U
S
A
,
2
0
1
2
.
[
5
]
T.
L
.
C
l
o
k
i
e
a
n
d
E
.
F
o
u
r
i
e
,
“
G
r
a
d
u
a
t
e
e
mp
l
o
y
a
b
i
l
i
t
y
a
n
d
c
o
mm
u
n
i
c
a
t
i
o
n
c
o
m
p
e
t
e
n
c
e
,
”
Bu
si
n
e
ss
a
n
d
Pr
o
f
e
ssi
o
n
a
l
C
o
m
m
u
n
i
c
a
t
i
o
n
Q
u
a
rt
e
rl
y
,
v
o
l
.
7
9
,
n
o
.
4
,
p
p
.
4
4
2
–
4
6
3
,
D
e
c
.
2
0
1
6
,
d
o
i
:
1
0
.
1
1
7
7
/
2
3
2
9
4
9
0
6
1
6
6
5
7
6
3
5
.
[
6
]
H
.
S
c
h
r
o
t
h
,
“
A
r
e
y
o
u
r
e
a
d
y
f
o
r
G
e
n
Z
i
n
t
h
e
w
o
r
k
p
l
a
c
e
?
”
C
a
l
i
f
o
r
n
i
a
M
a
n
a
g
e
m
e
n
t
Re
v
i
e
w
,
v
o
l
.
6
1
,
n
o
.
3
,
p
p
.
5
–
1
8
,
M
a
y
2
0
1
9
,
d
o
i
:
1
0
.
1
1
7
7
/
0
0
0
8
1
2
5
6
1
9
8
4
1
0
0
6
.
[
7
]
M
.
L
o
u
r
e
i
r
o
,
N
.
L
o
u
r
e
i
r
o
,
a
n
d
R
.
S
i
l
v
a
,
“
D
i
f
f
e
r
e
n
c
e
s
o
f
g
e
n
d
e
r
i
n
o
r
a
l
a
n
d
w
r
i
t
t
e
n
c
o
mm
u
n
i
c
a
t
i
o
n
a
p
p
r
e
h
e
n
s
i
o
n
o
f
u
n
i
v
e
r
s
i
t
y
st
u
d
e
n
t
s
,
”
Ed
u
c
a
t
i
o
n
S
c
i
e
n
c
e
s
,
v
o
l
.
1
0
,
n
o
.
1
2
,
p
.
3
7
9
,
D
e
c
.
2
0
2
0
,
d
o
i
:
1
0
.
3
3
9
0
/
e
d
u
c
sc
i
1
0
1
2
0
3
7
9
.
[
8
]
M
.
Z
.
M
.
H
u
s
i
n
,
“
E
n
g
l
i
sh
a
t
w
o
r
k
p
l
a
c
e
:
a
q
u
a
n
t
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t
a
t
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4
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[2
6
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9
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[
30
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.
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31
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[
32
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[
33
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L.
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[
34
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.
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.
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[
35
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J.
D
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.
S
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[
36
]
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6
.
[
37
]
C
.
W
a
n
g
e
t
a
l
.
,
“
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f
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d
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5
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[
38
]
M
.
M
o
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t
i
,
S
.
S
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l
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n
,
A
.
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o
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d
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ma
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i
,
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:
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d
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l
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v
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B
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.
2
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2
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6
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6
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6
.
2
6
0
3
.
[
39
]
D
.
A
y
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d
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.
S
a
b
a
n
c
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o
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u
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Arc
h
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f
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rsi
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4
.
[
40
]
H
.
K
.
A
f
s
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r
,
R
.
S
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f
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r
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f
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r
d
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n
d
G
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N
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v
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i
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t
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o
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,
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1
,
p
p
.
8
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–
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1
,
2
0
2
2
.
[
41
]
C
.
J
.
I
r
e
l
a
n
d
,
“
R
e
d
u
c
i
n
g
p
u
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k
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s:
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.
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ssert
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,
E
n
g
l
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n
d
,
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K
,
2
0
1
8
.
[
42
]
R
.
L
e
st
a
r
i
a
n
d
B
.
A
s
t
u
t
i
,
“
Th
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t
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u
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l
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m
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1
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1
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4
.
Evaluation Warning : The document was created with Spire.PDF for Python.
I
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J
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&
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B
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AUTH
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Abd
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ro
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r
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n
.
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h
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c
a
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c
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ted
a
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k
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u
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tern
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l
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a
m
ic
Un
iv
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rsity
(Un
i
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S
).
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in
terv
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of
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d
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o
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o
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v
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of
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ts.
S
h
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c
a
n
b
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c
o
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tac
ted
a
t
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m
a
il
:
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u
r
h
i
k
m
a
h
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n
ish
a
m
s.e
d
u
.
m
y
.
Evaluation Warning : The document was created with Spire.PDF for Python.