Publications

Stress and its Management

Stress

For many just thinking about the word “STRESS” may be enough to set your nerves on edge. Everyone feels stressed at times. Some people perform better when in stressful situations and some may more effectively recover from stressful events than others. It’s important to know your limits when it comes to stress especially, which situation triggers greater stress and how to avoid and recognize these situations/triggers.

The Stress of Change

Stress can be defined as the brain’s response to specific demands. Many things can trigger a stress response, including change.

• Changes can be positive or negative, as well as real or perceived.
• They may be recurring, short-term, or long-term and may include things like commuting to and from school or work every day, traveling for a yearly vacation, or
moving to another home.
• Changes can be mild and relatively harmless, such as winning a race, watching a scary movie, or riding a rollercoaster.
• Some changes are major, such as marriage or divorce, serious illness, or a car accident.
• Other changes are extreme, such as exposure to violence, and can lead to traumatic stress reactions.

Of all the types of stress, changes in health from continued routine stress may be hardest to notice at first. Because the source of stress tends to be more constant than in cases of acute or traumatic stress, the body gets no clear signal to return to normal functioning. Over time, continued strain on your body from routine stress may lead to serious health problems, such as heart disease, high blood pressure, diabetes, depression, anxiety disorder, and other illnesses.

How does stress affect the body?

Not all stress is bad. In the case of dangerous situations, the chemicals and hormones released during such stressful times, prepares us to face a threat or flee to safety. In less threatening situations like exams or job interviews, stress may facilitate one to focus ones attention, cutting out many distractions.

When faced with dangerous situation, your pulse quickens, you breathe faster, your muscles tense, your brain uses more oxygen and increases activity; all functions are geared for survival. In the short term, it can even boost the immune system.

However, with chronic stress, the same chemicals that are life saving in short bursts can suppress functions that aren’t needed for immediate survival. Your immunity is lowered and your digestive, excretory, and reproductive systems stop working normally. Once the threat has passed, other body systems act to restore normal functioning.

Problems occur if the stress response goes on too long, such as when the source of stress is constant, or more commonly if the stress response continues after the danger has subsided.


Tips to Manage Anxiety and Stress

When you’re feeling anxious or stressed, these strategies will help you cope:

Take a time-out. Practice yoga, listen to music, meditate, get a massage, or learn relaxation techniques. Stepping back from the problem helps clear your head.

Eat well-balanced meals. Do not skip any meals. Do keep healthful, energy-boosting snacks on hand.

Limit alcohol and caffeine, which can aggravate anxiety and trigger panic attacks.

Get enough sleep. When stressed, your body needs additional sleep and rest.

Exercise daily to help you feel good and maintain your health.

Take deep breaths. Inhale and exhale slowly.

Count to 10 slowly. Repeat, and count to 20 if necessary.

Do your best. Instead of aiming for perfection, which isn’t possible, be proud of however close you get.

Accept that you cannot control everything. Put your stress in perspective: Is it really as bad as you think?

Welcome humor. A good laugh goes a long way.

Maintain a positive attitude. Make an effort to replace negative thoughts with positive ones.

Get involved. Volunteer or find another way to be active in your community, which creates a support network and gives you a break from everyday stress.

Learn what triggers your anxiety. Is it work, family, school, or something else you can identify? Write in a journal when you’re feeling stressed or anxious, and
look for a pattern.

Talk to someone. Tell friends and family you’re feeling overwhelmed, and let them know how they can help you.

Seek professional help. There are many health professionals that are able to facilitate you through tough times. Talk to a physician or therapist for  professional
help.

Information was sourced from various sources please find below to some links:

NATIONAL INSTITUTE OF MENTAL HEALTH
http://www.nimh.nih.gov/index.shtml

ANXIETY AND DEPRESSION ASSOCIATION OF AMERICA
http://www.adaa.org

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My Approach to Psychotherapy

People turn to psychotherapy for many reasons, but I have come to believe that most life problems centre on difficulties with interpersonal relationships.

This can create feelings of emptiness, despair, anxiety or depression and also addictive behaviour or even suicidal thoughts.

There is a sense of, “not knowing who I really am, and I feel hopeless and out of control of my life”.

My approach to therapy is to enable clients to gain a deeper understanding of who they are, and how early interaction patterns with significant people are often unconsciously repeated in the present.

Once a client is able to understand how past relationships unconsciously affect the way they view themselves and others, there is growth and change and their lives are enriched as they live more fully and effectively.

My scope of practice includes play therapy and therapy with adolescents, adults, couples and families.

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Depression

Depression

Most people feel anxious or depressed at times. Losing a loved one, getting fired from a job, going through a divorce, and various other difficult situations can lead a person to feeling sad, lonely, scared, nervous, or anxious. These feelings are normal reactions to life’s stressors. But some people experience these feelings daily or nearly daily for no apparent reason, making it difficult to carry on with normal, everyday functioning.

Clinical depression is more than just the “blues”, “being down in the dumps,” or experiencing temporary feelings of sadness. It is a serious condition that affects a person’s mind and body. It may impact many aspects of everyday life including eating, sleeping, working, relationships, and how a person thinks about himself/herself. People who are clinically depressed cannot simply will themselves to feel better or just “snap out of it.” If they do not receive appropriate treatment their symptoms can continue for weeks, months, or ultimately culminate in complete debilitation.

People who are depressed find daily tasks to be a significant struggle. They tire easily, yet cannot get a good night’s sleep. They have no motivation and lose interest in activities that were once enjoyable. Depression places a dark, gloomy cloud over how we see the world, our future, and ourselves. This cloud cannot be willed away, nor can we ignore it and have it magically disappear.

Depression does not discriminate.

Men and women of every age, educational level, and social and economic background suffer from depression. There is no area of life that does not suffer when depression is present. Marriage, parenting, friendships, careers, finances; every aspect of daily living is compromised by this disease. Once an episode of depression occurs, it is also quite likely that it may reappear. And the impact of depression can be even more severe when it occurs in combination with other medical illnesses such as diabetes, stroke, cardiovascular disease, or with related disorders such as anxiety or substance abuse.

The problems caused by depression are made worse by the fact that most people suffering from the disease are never diagnosed, let alone treated. The good news is that when depression is promptly identified and treated, its symptoms are manageable and there are many effective strategies for living with the disease. Depression and bipolar disorder are both treated most effectively in their earliest stages when symptoms are less severe.

HOW IS DEPRESSION TREATED?

There are several strategies for treating depression. Depending upon each individual’s unique characteristics and symptoms, healthcare professionals may employ one or more psychotherapy approaches based upon interpersonal treatment. In addition, clinicians may incorporate lifestyle changes, including improvements in sleeping and eating habits, physical activity and stress reduction, as they have proven very helpful in managing symptoms.

WHAT ARE THE SYMPTOMS OF DEPRESSION?

Depression commonly affects your thoughts, emotions, behaviors and overall physical health. Here are some of the most common symptoms that point to the presence of depression. An occurrence of any one of these symptoms on its own does not constitute depression.

Feelings:

• Sadness
• Hopelessness
• Guilt
• Moodiness
• Angry outbursts
• Loss of interest in friends, family and favorite activities, including sex

Thoughts:

• Trouble concentrating
• Trouble making decisions
• Trouble remembering
• Thoughts of harming yourself
• Delusions and/or hallucinations can also occur in cases of severe depression

Behaviors:

• Withdrawing from people
• Substance abuse
• Missing work, school or other commitments
• Attempts to harm yourself

Physical problems:

• Tiredness or lack of energy
• Unexplained aches and pains
• Changes in appetite
• Weight loss
• Weight gain
• Changes in sleep – sleeping too little or too much
• Sexual problems

Of course, all of us can expect to experience one or more of these symptoms on occasion. An occurrence of any one of these symptoms on its own does not constitute depression.

Sources:

http://www.depressiontoolkit.org/aboutyourdiagnosis/depression.asp

http://www.allaboutdepression.com

http://www.nimh.nih.gov

http://www.adaa.org

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Forensic and medico-legal assessments

It is a sad truth that not all divorces end amicably and it often happens that bitter fights rage over who gets custody of the children.

The word custody no longer applies in legal terms, instead one or the other parent gets so-called primary residence of the minor children (under 18 years of age) and the other parent gets contact rights.

Very often a Parenting Plan is drawn up and agreed upon by the parents, and this is usually mediated by a psychologist or social worker and forms part of the divorce order.

Primary residence disputes tend to be more complicated and it is often wrongly assumed that children are allowed to make the decision about the parent they want to live with.

Psychologists are usually called upon to conduct a thorough investigation into all the parties involved and to make a recommendation to court regarding the children’s best interests.

During this process the children’s wishes are considered and form part of the final recommendation.

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The progression of relationships (from cradle to grave)

Relationships are as complex as they are unpredictable – they are at times messy, they will make you sad, they will make you laugh, leaving you confused, perplexed and ultimately in awe of how great sharing and receiving love can be.
Moreover relationships are not static, they evolve and mature and as you develop so too will your relationships.

Take a moment to think of how your friendship circles have changed as you have grown and matured.

The mythical mate

Bader and Pearson in their book “In Quest of the Mythical Mate” highlighted that  relationships are a living, breathing ‘thing’ that require daily observation if they are to survive and thrive.

The process goes through a number of stages:

Symbiosis

Here individuals believe that they are ‘madly in love’, their lives merge and there is an intense bonding between the couple. Similarities are magnified and many differences are overlooked.

The purpose of this stage is to form an attachment, with a great deal of passion and mutual giving and receiving.

As each partner receives nurturance from the other, an agreement is made to form a couple – “a we” is set in motion and sees the beginning of the creation of a solid foundation for the relationship.

This is commonly referred to as the “honeymoon period”. This may sound like paradise, and for a while it is, but the relationship must evolve or it will decay into two different forms of dysfunctional symbiotic union

◾Enmeshed symbiosis: characterized by merger, the avoidance of conflict and a minimizing of differences.
This may sound like an ideal existence; however the continual denial of one’s true feelings will become toxic and eventually lead to chronic frustration and fatigue.
◾Hostile-dependent symbiosis: dominated by anger and conflict.
As both individuals “find” themselves too terrified to terminate the relationship, nor mature enough to end the frantic battles, a gridlocked cycle of endless mutually inflicted pain ensues.

Differentiation

Should individuals navigate the ‘honeymoon phase’ of their relationships they move into the Differentiation stage where differences begin to manifest and each partner is taken down from their proverbial pedestal.

Each partner is now viewed with greater objectivity.

It must be noted that this stage is never easy, as it goes hand in hand with heart wrenching disillusionment.

Here individuals emerge from their symbiotic slumber as each seeks to re-establish their own boundaries.

Some individuals find the shattering of the symbiotic illusion devastating and the relationship ends suddenly and dramatically.

However, some couples gradually awake from the symbiosis and tolerate the differences that are being recognised.

These couples may find the differences a source of continued challenging conversation and enjoy getting to know the other on a much deeper more intimate level.

There may be a new appreciation of the other as an individual and also learning to tolerate the other’s unique and often challenging views of the world.

Practicing

If partners have managed to survive the disillusionment, a new journey of discovery begins.

Couples enter into a normal period of practicing (discovery), seeking to re-engage in activities away from the other.

Individuals may be seem to become self-centered, as they are no longer empathically attuned to their partner, and also begin “rediscovering” themselves as unique entities.

It suddenly dawns upon one that “the you/I/me” the other fell in love with needs to re-surface.

It is not uncommon for friends and family to have been temporarily lost in the humdrum of falling in love as the couple enters the all-consuming honeymoon phase.

However, this new phase may lead to misunderstandings and conflicts intensify.  Healthy conflict resolution processes are needed, if the couple wishes to maintain an emotional connection.

Rapprochement

Following the practicing stage is the so-called rapprochement stage or “reunion stage” where individuals develop a well-defined, competent identity and it once again becomes safe to look to the relationship for intimacy and demonstrative sustenance.

Here vulnerabilities re-emerge as partners now seek to find previously held security and support from each other. This period is marked by increased intimacy and efforts to re-establish independence.

It is here that the balance between the “I” and the newly created “we” becomes firmly established.

Mutual interdependence

With the “we” now established couples now enter into a “life-liaison” or mutual interdependence.

Couples are now two well-integrated individuals who have found satisfaction in their own existence and have created a bond with their partner that is secure and mutually satisfying.

This relationship is further strengthened as the relationship is based on growth rather than that of need.

The couple achieves consistency in which the idea of perfect is transformed by  the experience of being real people having real interactions, which signifies the start of  mutual interdependence or mature relating.

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Trauma, the brain and consequences and PTSD

Trauma, the brain and consequences and PTSD
Have you ever found yourself telling someone after a traumatic experience to “…just get over it” or “it was not that bad” or perhaps you’ve been on the receiving end of such commentary.

Often these comments are born out of frustration or the lack of anything else to say. However, not being able to “just get over it” may be out of your conscious control.

Some people may have grown up being told to not feel, cowboys don’t cry or showing emotion is weakness. Statements like this are fundamentally flawed and ultimately harmful to psychological well-being.

Following a traumatic experience some people may even begin to admonish themselves or tell themselves they are weak or pathetic as they struggle to regain normal functioning following, their traumatic encounter.

The truth however is not so simple. In fact people are usually helpless in the face of trauma and its frightening aftermath.

So how does our brain process information?

Basically our brain has two information-processing systems one hot (amygdala) and one cool (hippocampus).

The cool one is cognitive (thinking); the hot one is emotional (feeling).

◾The cool system records information in a controlled, unemotional and neutral manner, elaborates on autobiographical (first-person) events, complete with spatial-temporal context (stores events in time sequence e.g. it was around 5pm when she called or I was at John’s birthday party when I heard about 9/11).
◾The hot system is closely linked to low-level fear responses; it is highly emotional, acts without much thought, inflexible, keyed to instinct and less easy to control (following a car accident people will often not be able to recall “what exactly happened, I recall being scared/frightened next thing I knew the car had flipped and it was upside down”).

Everybody has a hot and cool system: the cool system stores the context (circumstances) of the events and the hot system contributes the emotional experience of events (specifically the ones associated with fear).

In moments of fright/fear/panic the logical (cool) mind will switch off and the more instinct driven (hot) mind will take over.

As one begins to calm down following the incident the logical (cool) mind takes over again and begins to make sense of what just happened.

Trauma

Trauma breaks this normal processing pattern. It forces the cool system to switch off and the hot system takes over.

Moreover, trauma often forces the brain to corrupt its memory formation and storage process (as the hot system remains on).

It can force one to believe that one is reacting to the present, where as in fact, one is superimposing past experiences onto the present.

This becomes rather problematic as the hot system (remaining on) continually corrupts the cool systems information and memory processing sequences.

Our every experience is something we create inside of our heads. Reality is not experienced directly because the brain filters all sensory input.

It is continually deleting, distorting and generalizing our perception of reality.

Moreover, as we seek to alleviate or escape disturbing thoughts or forget painful experiences, the brain will create more acceptable thoughts/memories, often convoluted and contrived, in order to facilitate day-to-day survival.

This often causes people to re-experience situations as if they where happening “now” even when “now” is a memory fragment from the past. This diminishes the ability to separate “now and safe” from “now and danger.”

The cool system puts memories in time order (So you don’t confuse today with five years ago). However, the cool system is very weakly enabled during trauma.

Thus the brain fails to put the right time stamp on the trauma experienced. Consequently, a stimulus can evoke a hot memory, causing us to relive the original low-level response. (e.g. following being high-jacked at a traffic light, you may become anxious every time you again have to stop at one; the emotions keep flooding back forcing one to re-experience the event. Some people begin to take routes that have no traffic lights or even refuse to drive again).

This re-experiencing is not a conscious choice and often the more one tries to ignore the intrusive thoughts the more invasive they tend to become.

The longer one continues to “live the past as if it is the present” the greater chance there is of permanent damage.

This heightened state of awareness and anxiety may eventually push the brain to extremes, damaging it and culminate in PTSD (Post-Traumatic Stress Disorder).

Conclusion

Trauma is not always one big event and it  may often be a culmination of many small incidents or exposures e.g. police officers confront traumatic incidents/events daily.

Trauma is real, painful and potentially disabling if minimized, ignored or bottled-up. It is not a sign of weakness if one begins to suffer from anxiety, compulsive/intrusive thoughts or sleep disturbances following a traumatic event/experience.

It is the body/mind’s way of highlighting that a disturbance (traumatic experience/event) has created disharmony in the system.

Research has highlighted how even brief psychological intervention following traumatic experiences can alleviate many negative symptoms experienced or help to “just make sense of it all”.

So think twice before telling someone to “just get over it” or “it was not that bad”.

For them it really may have been “that bad”, it could have forced them to confront a traumatic experience/event they had forgotten as children or just something they have suppressed and denied.

Each individual person experiences the world in vastly different ways. Getting help is not a sign of weakness; it is a sign of maturity and respect for your self and those that love you.

Criteria of PTSD:

◾The person goes through or sees something that involves actual or threatened death or serious injury. The person responds to this with intense fear, helplessness or horror.
◾The person then relives this traumatic event through dreams, or recollections. He or she can behave as if the trauma is actually happening right then, and can react strongly to events that even resemble the original trauma.
◾The person tries desperately to avoid this, and to avoid anything associated with the trauma, in fact, may not even remember the trauma yet still react strongly to certain stimuli.
◾The person often has difficulty sleeping and concentrating. He or she may be hyper-vigilant.
◾All this lasts longer than a month
◾Causes significant distress in daily life.

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Finding Help and Coping with Stress

For many just thinking about the word “STRESS” may be enough to set your nerves on edge. Everyone feels stressed at times.

Some people perform better when in stressful situations and some may more effectively recover from stressful events than others.

It’s important to know your limits when it comes to stress especially, which situation triggers greater stress and how to avoid and recognize these situations/triggers.

The Stress of Change

Stress can be defined as the brain’s response to specific demands. Many things can trigger a stress response, including change.

◾Changes can be positive or negative, as well as real or perceived.
◾They may be recurring, short-term, or long-term and may include things like commuting to and from school or work every day, traveling for a yearly vacation, or moving to another home.
◾Changes can be mild and relatively harmless, such as winning a race, watching a scary movie, or riding a rollercoaster.
◾Some changes are major, such as marriage or divorce, serious illness, or a car accident.
◾Other changes are extreme, such as exposure to violence, and can lead to traumatic stress reactions.

Of all the types of stress, changes in health from routine stress may be hardest to notice at first.

Because the source of stress tends to be more constant than in cases of acute or traumatic stress, the body gets no clear signal to return to normal functioning.

Over time, continued strain on your body from routine stress may lead to serious health problems, such as heart disease, high blood pressure, diabetes, depression, anxiety disorder, and other illnesses.

How does stress affect the body?

Not all stress is bad. In the case of dangerous situations, the chemicals and hormones released during such stressful times, prepares us to face a threat or flee to safety.

In less threatening situations like exams or job interviews, stress may facilitate one to focus ones attention cutting out many distractions.

When faced with dangerous situation, your pulse quickens, you breathe faster, your muscles tense, your brain uses more oxygen and increases activity; all functions are geared for survival. In the short term, it can even boost the immune system.

However, with chronic stress, the same nerve chemicals that are life saving in short bursts can suppress functions that aren’t needed for immediate survival.

Your immunity is lowered and your digestive, excretory, and reproductive systems stop working normally.

Once the threat has passed, other body systems act to restore normal functioning.

Problems occur if the stress response goes on too long, such as when the source of stress is constant, or more commonly if the stress response continues after the danger has subsided.

Tips to Manage Anxiety and Stress

When you’re feeling anxious or stressed, these strategies will help you cope:

◾Take a time-out.

Practice yoga, listen to music, meditate, get a massage, or learn relaxation techniques. Stepping back from the problem helps clear your head.

◾Eat well-balanced meals. Do not skip any meals. Do keep healthful, energy-boosting snacks on hand.
◾Limit alcohol and caffeine, which can aggravate anxiety and trigger panic attacks.
◾Get enough sleep. When stressed, your body needs additional sleep and rest.
◾Exercise daily to help you feel good and maintain your health.
◾Take deep breaths. Inhale and exhale slowly.
◾Count to 10 slowly. Repeat, and count to 20 if necessary.
◾Do your best. Instead of aiming for perfection, which isn’t possible, be proud of however close you get.
◾Accept that you cannot control everything. Put your stress in perspective: Is it really as bad as you think?
◾Welcome humour. A good laugh goes a long way.
◾Maintain a positive attitude. Make an effort to replace negative thoughts with positive ones.
◾Get involved. Volunteer or find another way to be active in your community, which creates a support network and gives you a break from everyday stress.
◾Learn what triggers your anxiety.

Is it work, family, school, or something else you can identify? Write in a journal when you’re feeling stressed or anxious, and look for a pattern.

◾Talk to someone. Tell friends and family you’re feeling overwhelmed, and let them know how they can help you.
◾Seek professional help.

There are many health professionals that are able to facilitate you through tough times. Talk to a physician or therapist for professional help.

Contact Us

Information was sourced from various sources please find below to some links:

National Institute of Mental Health
http://www.nimh.nih.gov/index.shtml

Anxiety and Depression Association of America
http://www.adaa.org

Read more...

How Stress Becomes Burnout

Don’t confuse Stress and Burnout

All to often stress and burnout are considered to be the same thing. However, they are vastly different entities.

For starters ‘almost everybody’ suffers from occasional stress at some point during his or her life or career.

Burnout on the other hand is due to prolonged exposure to continued stress and stressors. One can say that burnout is “born out of stress”.

When does stress become burnout?

It is tricky to distinguish between were normal stress stops and burnout begins, however, often stress is the beginning of burnout.

Stress=> more stress=> a lot of stress=> too much stress=> BURNOUT

Burnout does not develop without stress but one may suffer from stress without ending up suffering from burnout. Stress is not a disorder in itself, while burnout is.

Any person living a normal life will experiences occasional stress and/or stressors; sometime or another.

Burnout however is a disorder; it may disrupt normal everyday life to such an extent, that you are no longer the person you want to be or used to be.

Stress and the body

When a person experiences a stressful situation, the whole nervous system reacts and specific hormones (adrenaline and cortisol) are released into your blood system.

These hormones speed up your heart rate, breathing, blood pressure and metabolism. This kind of response is an evolutionary adaptation and highly useful when confronted with life threatening situations.

BUT, you are not in the jungle or Serengeti fighting off wild animals; you are probably in doors, sitting down and not partaking in physical exertion as often as you should.

In the long-term, the extra pressure put on your body can have many very negative impacts on both your physical and emotional wellbeing.

This culminates in the body becoming “stressed-out” and potentially burnout occurs. This is a state of complete mental, physical and emotional exhaustion.

Stress
Burnout
Little or no input
Your emotions are experiences as the same
Causes a helpless feeling
Less motivation and hope in future
Leads to depression
Many emotional consequences
You put to much effort into everything
You experience emotions more strongly
It causes hyperactivity
You have lees energy
It can lead to anxiety
Many physical consequences

What to do about it?

Prevention is better than cure. Yes a cliché but relevant, moreover, there are some relatively simple things that can facilitate one in maintaining balance and bring down ones stress.

It must be highlighted that discipline and the desire to bring about change is needed if one truly wants to sustain long-term health and restore balance.
◾Taking time out for yourself
◾Learn to unwind and relax
◾Set aside time each day to switch off and from technology
◾Develop healthy problem solving skills to better handle stressful situations
◾Set boundaries to limit oneself being over worked
◾Keep open lines of communication with family, friends, colleagues and health professionals

Importantly if you have reached or are reaching the point of burn out, you MUST take it seriously. Added to this there are ways to look after YOU.

Three simple things that may facilitate great change in your overall well-being are:
◾Slow down and force yourself to take a break (the world will not end if you step back and take some time out for you. Sometimes one must be honest about how functional you are when completely exhausted)
◾Reach out for support from family, friends or health professionals (there is no reason to carry the weight of the world on your shoulders, nor is there any shame in getting a little help from someone. Think about the people you have helped, do you perceive them as weak? As the Beetles said “we get by with a little help from our friends”)
◾Re-evaluate your goals and priorities, so that you tip the balance back to including activities that provide you with happiness and good health.

(What do you really want from your life and how are you going about taking care of yourself. If you’re no longer able to take care of you or your family who will have to? Be aware of your current state of being and balance in your life).

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