1. What data in particular will be shared?
   Response - All of the individual participant data collected during the trial, after de-identification.
   


2. What additional supporting information will be shared?
   Response -  Study Protocol
   Response -  Statistical Analysis Plan
   Response - Informed Consent Form
   Response - Clinical Study Report
   Response -  Analytic Code
   
   
3. Who will be able to view these files?
   Response - Anyone
   


4. For what types of analyses will this data be available?
   Response - To achieve aims in the approved proposal.
   


5. By what mechanism will data be made available?
   Response (Others) -  online access


6. For how long will this data be available start date provided 10-10-2024 and end date provided 03-01-2025?
   Response - Immediately following publication. No end date.
   


7. Any URL or additional information regarding plan/policy for sharing IPD? 
   Additional Information - nil

Anxiety is an emotion characterized by feelings of tension, worries, and negative physiological reactions.(1) In educational settings, Students learning and understandings are assessed through Examination. This situation drives them into psychological disturbance leading to anxiety. (2)Exam or test anxiety is a stress response experienced before, during and sometimes after exams. If it becomes intense, that can impede academic performances. In comparing with other professional courses medical students reported higher prevalence of anxiety and depression. The vast materials of academic and clinical information to memorize, in a short period of time contributes their psychological state affecting the physical conditions, sleep pattern impairing the motivation, concentration, learning, and performance in the tests.(2,3) Although some levels of anxiety are necessary for academic success, tremendous anxiety such as overwhelming emotions, stressful thoughts, and increasing study load was negatively correlated to hinder the ability of students to understand, manage academic load and the ability to prepare for the examinations.(3)The Hamilton Anxiety Rating Scale identifies students with anxiety impairment.(4,5) It is reliable and valid for educational institutes and exam-anxiety evaluations of the students’ performance.

Acupuncture is a Chinese medical treatment involving in insertion of fine metal needles into the skin and underlying tissues at precise points on the body(6). Auriculotherapy is a branch of acupuncture, performing stimulation of specific points on external ear. Auriculotherapy will be conducted based on STRICTA guidelines.(7) Auriculotherapy is a less invasive method of stimulation of auricular branch of vagus nerve and trigeminal nerve (8)(9). Stimulation of specific points on external ear sends signals to central nervous system through the cranial/spinal nerves, inhibiting inappropriate reflexes and modulates the physiological response by increasing the neurotransmitters (norepinephrine and serotonin) release.(10) The vagus nerve regulates anxiety and anxiety perception areas such as thalamus, brainstem, insula, and, amygdala. Vagus nerve has parasympathetic control, visceral function and it involves in emotional expression, social communication, self-soothing behaviours, regulation of mood, anxiety, pain, hormone regulation.(7)

Previous studies observed that various measures like aromatherapy, relaxation, acupressure(11), and acupuncture are effectively used in managing the exam anxiety. This study aimed to measure anxiety levels and manage the student’s anxiety by activating the parasympathetic nervous system and downregulating the adrenergic activities through Shenmen and Zero point of auriculotherapy.