Tag Archives: Cbt

Techniques (Evidence-Based) For Reducing Negative Thoughts.

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We have seen that if we suffered significant, recurring trauma as children, we are put at increased risk of developing depression as adults (see the DEPRESSION AND ANXIETY section of this site which contains many articles about the link between childhood trauma and depression). One of the hallmarks of depression is, of course, NEGATIVE THINKING.

Fortunately, however, much scientific research has been conducted into techniques those suffering from depression can employ in order to reduce their tendency constantly to think in negative ways ; I briefly describe several of the most effective of these techniques below :

1) LEARNED OPTIMISM :

The psychologist, Seligman, has developed a method by which people who are pessimistic and prone to negative thinking can train themselves mentally to respond to adverse events in ways that are less negative and more optimistic by challenging their initial pessimistic responses.

Seligman developed his idea of how optimism may be learned whilst he was studying a phenomenon known as LEARNED HELPLESSNESS (you can read my article Trauma, Depression And Learned Helplessness’  by clicking here); he reasoned that if people, through conditioning, can ‘learn’ to be helpless they may, too, be able to learn a more positive attitude to life and its vicissitudes.

There exists research to support Seligman’s theory. For example, the findings of a scientific study (Buchanan) conducted at the University of Pennsylvania strongly suggested that individuals with a tendency towards pessimism can be made significantly less vulnerable to depression and anxiety by being taught Seligman’s learned optimism techniques.

HOWEVER, there is a balance to be struck here as constantly striving to be positive and ‘upbeat’ at all times is likely to backfire – it is, I think we can all safely agree, axiomatic that one cannot go through life without encountering distress (some of us more than others, of course). Even so, we can make distress less painful to endure by learning techniques in DISTRESS TOLERANCE you can read my article about this by clicking here.

(Interestingly, trying to relax can backfire, too – you can read about why this is in my article : Does Trying To Relax  Paradoxically Increase Your Anxiety?  by clicking here).

 

2) COGNITIVE BEHAVIORAL THERAPY (CBT) :

This can help us challenge our negative thoughts and correct irrational, faulty thinking styles associated with negative thinking (you can read two my articles relevant to this by clicking below):

 Cognitive Behavioral Therapy : Challenging Negative Thoughts

or

Cognitive Behavioral Therapy For Childhood Trauma

 

3) DEFENSIVE PESSIMISM : 

Despite the finding that learned optimism can be helpful in reducing depression it may, too, be paradoxically the case that a tendency towards pessimism, in certain situations, can sometimes be, as it were, strategically exploited.

This can be achieved by considering the worst possible outcome of an event in order to put things in perspective (the caveat being that it is necessary to put an action plan into operation to ensure the worst possible outcome does not come to fruition!).

 

MINDFULNESS :

This involves allowing negative thoughts to pass through the mind whilst NOT emotionally engaging with these thoughts or judging them – a simile that is sometimes used is that one should just observe, in a detached manner, these thoughts running through our heads with the same tranquility we would feel were we to be watching leaves on the surface of a river gently flow past us. You can read more about mindfulness in the HYPNOSIS AND MINDFULNESS section of this site.

 

THE ADVERSITY HYPOTHESIS :

It is important to remember that even very distressing experiences can improve us as a person (e.g. by providing us with a better perspective on life, making us realize what’s important in life, helping us to get our priorities straight, increasing the empathy we feel with others who have suffered in a similar way to ourselves, and toughening us up mentally.

An article of mine you may wish to read relating to this is :

 

RESOURCE :

STOP NEGATIVE THINKING – SELF HYPNOSIS DOWNLOAD

 

David Hosier BSc Hons; MSc; PGDE(FAHE).

 

 

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Socrates and Cognitive Behavioural Therapy (CBT)

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If we have suffered serious childhood trauma the research indicates that we are more likely than those who enjoyed a relatively stable childhood to develop clinical depression during our adulthood (all else being equal).

I have discussed the link between childhood trauma and depression in my book : Childhood Trauma and Its Link to Anxiety and Depression (click here to view) and I have also written several articles available on this site about one of the most effective treatments for depression, namely cognitive behavioural therapy (click here to read one of my articles on this).

In this article, however, I want to look at what CBT has in common with the teachings of Socrates (469-399 BC) who is probably the most famous of the Ancient Greek philosophers. In many ways, Socrates’ beliefs anticipated CBT in the way I describe below.

CBT informs us that our emotional disturbances lie more in the way we interpret events and the meaning we subjectively attribute to those events than the events per se. Indeed, the psychologist, Ellis, developed a model that illustrates this idea, namely the ABC model which I summarise below:

A – the event occurs

B – we attribute our own idiosyncratic meaning to this event

C – the meaning we attribute to the event in stage B, above, determines how we feel about evevt A.

Implications of the ABC model:

From this model, Ellis explains, it follows that we can often alter for the better how we feel about the events in life that we experience by altering how we view and interpret them.

How this fits in with the views of Socrates:

Socrates and the Stoic philosophers took a similar view to that of Ellis, ie. that it is the meaning that we give to events rather than the events themselves that determines how we feel.

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To give an everyday example : some people may feel depressed if they fail an important examination as they interpret their failure as meaning that they must be ‘stupid’.

Another person, however, may fail the same exam and yet NOT be dispirited by the failure as they do NOT interpret the failure as meaning they are stupid or unintelligent as intelligence is made up of many, many diverse factors which are in no way associated with the exam.

Toxic Beliefs :

The individual who interpreted his/her exam failure as meaning s/he ‘must be stupid’ could be said to have been holding a toxic belief and that it was this toxic belief that led to his/her unhappy response to the failed exam.

Implications :

It is, therefore, incumbent upon us to try to change our toxic beliefs by replacing them with more rational, reasonable and less self – destructive ones (according to both Socrates and modern day CBT theorists).

Changing our Toxic Beliefs : The Socratic Method :

In order to change our toxic beliefs, one of the founders of CBT, Beck,  said that it was necessary for us to make use of what he called THE SOCRATIC METHOD : Rather than ‘sleep-walk’ through life, like an automaton, as many do, we need to CRITICALLY EXAMINE what we are doing, how we are acting and behaving, and how we our feeling and coming to the decisions we make (there is a well-known quote, I forget by whom, that ‘ the unexamined life is not worth living’). Gaining more insight into ourselves gives us more choices and increases our general efficacy in life.

images 18 - Socrates and Cognitive Behavioural Therapy (CBT)

In order to decide what, in the lives we find ourselves living, it is in our own best interests to change we need to try to think more independently, rather than merely think (and, consequently , act) according to the beliefs and values that have been inculcated into us by parents, friends, associates, teachers, politicians, the press, television, society and the culture within which we exist.

To help us to achieve this, we need, too, to try to bring our core beliefs, which are likely to reside, for much of the time, below the level of consciousness and have an enormous effect on how we think, feel and behave, into our conscious mind and critically examine and evaluate them. In this way, we give ourselves the chance to discover which of these beliefs are toxic (ie. spoiling our lives and holding us back from achieving fulfilment).

Once we have identified our toxic thoughts we are in a position to be able to replace them with more rational and helpful ones that allow us to change, positively, how we interpret the world around us. If we can achieve this, our emotional and even physical health are likely to improve significantly.

To read one of my articles on CBT, click here.

51GO KIhYmL  AA160  150x1501 - Socrates and Cognitive Behavioural Therapy (CBT)

Above eBook now available from Amazon. Instant download. Other titles available. Click here.

 

David Hosier BSc Hons; MSc; PGDE(FAHE).

 

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Anxiety, CBT and Neuroplasticity

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It is a relatively new discovery within psychology that the brain physically changes throughout our lives (not just during childhood and adolescence as many previously supposed).

Just as the brain’s physical development can be harmed (eg certain types of severe childhood trauma can interfere with the development of the amygdala, which, in turn, is related to the development of borderline personality disorder (BPD)click here to read my article on this), so, too, can its structure and functionality be repaired and enhanced by therapeutic interventions; the harnessing of the power of such  beneficial interventions has come to be known as  SELF-DIRECTED NEURO-PLASTICITY.

Self-directed neuro-plasticity essentially involves us teaching ourselves to think and act in new ways that can positively shape and control the functioning of our physical brain, altering its structure to our advantage and ‘re-wiring’ it in helpful ways (click here to read my article about how the brain can ‘re-wire’ itself).

 

images 7 - Anxiety, CBT and Neuroplasticity

 

HOW THIS RELATES TO THE TREATMENT OF ANXIETY

A recent research study, conducted by the psychologist Schwartz, involved patients suffering from an anxiety disorder being treated with a cognitive behavioural therapy (CBT) technique (called ‘mindfulness‘). CBT, to explain it in very basic terms, is a form of therapy based on the premise that by changing how we think, we can change how we act and feel, and, furthermore, that many psychological disorders have at their heart a faulty thinking style that causes distress. CBT seeks to correct this faulty thinking style.

But back to Schwartz’s study. He found that those treated with CBT improved to about the same degree as would be expected had they been treated with medication. This having been established, Schwartz then arranged for these improved patients to be given a brain scan (specifically, for those interested, a PET scan, or positron emission tomography scan).

This revealed that certain NEURAL PATHWAYS in the brains of the patients had undergone significant change. Specifically, there was seen to be, after the CBT therapy had been completed, significantly greater activity in the patients’ ORBITAL FRONTAL CORTEX.

FUTURE IMPLICATIONS

As research into neuroplasticity continues and more experiments, such as the one outlined above, are conducted, it is likely that more and more psychological disorders will be amenable to interventions that exploit the phenomenon of neuroplasticity, providing us all, even those with conditions  thought to be deeply entrenched, a good deal of hope that we can get very significantly better.

David Hosier BSc Hons; MSc; PGDE(FAHE).

 

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Childhood Trauma and Obsessive-Compulsive Disorder (OCD) Treatment

 

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STOP OBSESSIVE THOUGHTS – CLICK IMAGE ABOVE

In the last 2 posts on this condition I explained what OCD is. In this post, Part 3, I want to consider how it may be treated.

WHAT TREATMENTS ARE NORMALLY GIVEN?

Experts in the field of the treatment of OCD generally recommend cognitive-behavioural therapy (CBT) which is made even more effective if it is combined with medication – usually the medication will be an anti-depressant, although sometimes a benzodiazepam may be used.

Generally speaking, the anti-depressant is a long-term treatment, eg given for perhaps a minimum of a year, and up to a whole life-time, even if symptoms significantly improve (this is done in order to minimize the chances of a relapse occurring).

On the other hand, if the individual with OCD is prescribed a benzodiazepam, this will generally only be taken over a short period of time (eg a period when the symptoms are very acute) in order to minimize the risk of the individual with OCD becoming physically and/or psychologically dependent upon them (as they are addictive).

HOW EFFECTIVE IS TREATMENT?

If studies on the effectiveness of anti-depressants for the treatment of OCD are looked at as a whole, on average individuals with OCD who undergo such treatment significantly improve around about 45% of the time. Whilst any improvement is obviously extremely desirable, in general the improvements individuals make by taking anti-depressant medication are not great enough to eliminate the need for other treatments being given alongside.

As has already been referred to, cognitive-behavioural therapy (CBT) is usually the type of therapy to be used alongside medication – in fact, it is a specific type of CBT which is known as EXPOSURE WITH RESPONSE PREVENTION (which I’ll henceforth refer to as EWRP). As has also been mentioned, if symptoms are extremely severe then benzodiazepam may be prescribed over the short term before the EWRP can take place.

WHAT DOES EWRP ACTUALLY ENTAIL?

We have already looked at  how sufferers of OCD have obsessive thoughts which cause them distress. What EWRP is designed to do is to help the individual TOLERATE SUCH DISTRESS. For, example, one common way in which OCD manifest itself is by making the sufferer inordinately and irrationally fearful of germs. Therefore, s/he may constantly be acutely anxious that his/her hands are ‘dirty’ and that this is potentially ‘highly dangerous’ – this, in turn. leads to constant compulsions to wash their hands in order to relieve their distressing and acute anxiety. However, the sense of relief is extremely ephemeral and the compulsion returns, perhaps leading the afflicted individual to wash his/her hands 100 times a day.

In the above example, the approach EWRP takes is to help the person tolerate the distress that his/her perception of having ‘dirty’ hands causes him/her by encouraging him/her not to wash them for a given period of time. As the person becomes better and more used to the anxiety caused by not washing them, the period of time can be gradually increased. The idea is that the person will become desensitized to the anxiety associated with unwashed hands.

On top of this, CBT can be used to help the individual challenge irrational thoughts which are connected to his/her OCD. For example, in the case described above, the individual could be helped to challenge thoughts such as ‘having any dirt on my hands is highly dangerous’ and to understand that the thought is an enormous exaggeration of any objective danger.

clinical hypnotherapy 468 604 - Childhood Trauma and Obsessive-Compulsive Disorder (OCD) Treatment

STOP OBSESSIVE THOUGHTS – CLICK IMAGE ABOVE

David Hosier BSc Hons; MSc; PGDE(FAHE).

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Addressing The Effects Of Childhood Trauma With Dialectical Behavior Therapy. Part 2

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In part 1, I introduced the new and promising therapy called dialectical behavior therapy (DBT); as I said, there is growing evidence that it is a very effective treatment for conditions which may arise as a consequence of an individual having suffered childhood trauma (especially those who have developed borderline personality disorder -BPD).

As a quick reminder, five key skills which DBT endeavours to teach those who choose to undergo the therapy are:

1) CORE MINDFULNESS
2) TAKING THE ‘MIDDLE PATH’
3) DISTRESS TOLERANCE
4) EMOTIONAL REGULATION
5) INTERPERSONAL EFFECTIVENESS

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In part one I covered 1 and 2 above. It seems quite logical then (!) that I should, in this post, move on to look at number 3 – DISTRESS TOLERANCE:

3) DISTRESS TOLERANCE

Practitioners of DBT try to instil the view in their clients that sometimes it is easier, and psychologically healthier, to stop struggling against reality, and,(they tell us) we need to accept that we, nor anybody else, for that matter, can prevent painful events from occurring in life (sometimes extremely painful ones, if we’re going to be up-front about it), nor can the painful emotions they bring with them. It is hardly a new idea, but practitioners of DBT also remind us that some painful things in life cannot be changed and that the only viable option we really have, therefore, is to accept the fact. This, of course, is difficult and requires considerable inner strength. By accepting the things which cannot be changed, though, it is reasoned, we free up energy which could have been wasted (by, say, being angry and bitter about the existence of these unchangeable facts) to deal with what CAN BE CHANGED.

DBT therapists tell us that there are certain skills we may wish to develop which will INCREASE OUR ABILITY TO TOLERATE DISTRESS; these are:

a) distraction/improving the moment
b) self-soothing
c) considering pros and cons of the situation
d) radical acceptance

Let’s briefly look at each of these in turn:

a) distraction/improving the moment – eg distracting ourselves with activities we enjoy, keeping our minds busy ; reminding ourselves of the good things in life ; reminding ourselves that it is better to think clearly and in a focused way about our problems ‘after the storm has passed’ (rather than try to make decisions when in the middle of an intense crisis which may be over-determined by our emotions) ; remind ourselves that difficult periods will pass

b) self-soothing – eg we can use postive self-talk (see my posts on cognitive behavior therapy for more on this – to access the posts just type ‘CBT’ into this site’s search facility) ; meditation/relaxation activities/breathing exercises ; using our imaginations to recall a soothing and comforting memory or place (if recalling a place it can be helpful to imagine, for a while, actually being there) ; thinking of things in life which are meaningful to us and give us the motivation to get through the difficult period.

c) considering the pros and cons of the situation : eg we may wish to consider how getting through a very difficult period may benefit us – for example, we may learn from it, it may strengthen us, it may make us more compassionate and sensitive towards others, we may be able to pass on the benefit of our experience to help others, it may even open up completely unexpected avenues in life which may not otherwise have been available to us (bad events do sometimes lead to positive outcomes, however indirectly – it is often worth keeping that in mind).

d) radical acceptance : this might involve trying to view what is happening, however undesirable, from as objective and detached a perspective as possible – a bit like watching the events unfold around somebody else in a movie ; another, perhaps surprising, technique suggested by DBT therapists is to try to, literally, half-smile. This sounds strange and even rather silly, but research shows that just as the mind can affect the body (eg thinking about something embarrassing and going red in the face) so too can the body effect the mind – in this case, the idea is that the half-smile ‘fools’ the brain into ‘believing’ things aren’t as bad as all that. It is obvious, however, that in certain situations this technique would be highly inappropriate (I need hardly list examples).

4) EMOTIONAL REGULATION :

The fourth skill that DBT teaches is how to cope with intense and overwhelming emotions – this skill is referred to by practitioners of DBT as emotional regulation.

This skill is made up of three sub-skills : a) increasing one’s understanding of one’s emotions; b) decreasing one’s emotional vulnerability; c) lessening the degree of distress caused by one’s negative emotions.

5) INTERPERSONAL EFFECTIVENESS

The final skill of interpersonal effectiveness helps the person undertaking DBT to communicate with others effectively when interacting with others in a way that helps to improve his/her relationships.

In order to achieve this, s/he is helped to communicate with others in a more controlled manner and to be less prone to speaking impulsively and without forethought due stress or overwhelming emotions (such as anger).

RESOURCE :
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DBT TRAINING MANUAL :

 

David Hosier BSc Hons; MSc; PGDE(FAHE).

 

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‘Fighting’ Anxiety can Worsen It: Why Acceptance Works Better.

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childhood trauma and anxiety

Trying to fight anxiety, research suggests (and, certainly, my own experience of anxiety would tend to confirm this) can actually AGGRAVATE the problem and lead to greater feelings of distress. Stating the shatteringly obvious, none of us wants to experience the feelings an anxiety condition brings; however, difficult as it may sound at first, DEVELOPING AN ATTITUDE OF ACCEPTANCE TOWARDS IT, rather than entering an exhausting mental battle with it, has been reported by many to be a superior strategy for coping with anxiety.

The psychologist Beck, to whom I have made several references already in this blog (he was one of the founders of the very helpful therapy called Cognitive Behaviour Therapy, or CBT, for people suffering from conditions such as depression and anxiety – see my posts on CBT) devised the acronym A.W.A.R.E for ease of remembering the key strategies for coping. Let’s take a look at what the acronym A.W.A.R.E stands for:

A Accept the anxiety (it sounds hard, I know, but so is constantly struggling to fight it):

The benefits of adopting this approach are that it may help to reduce the PHYSIOLOGICAL symptoms commonly associated with anxiety (eg accelerated heart rate, increased muscle tension, hyperventilation, sweating -or ‘cold sweats’- trembling, dry mouth etc). It may, too, help with PSYCHOLOGICAL symptoms (people report that an attitude of acceptance towards their anxiety makes them feel less distressed). A kind of motto which has come to attach itself to the acceptance approach to anxiety is: ‘if you are not WILLING to have it, you WILL’ (see what they’ve done there!)

W Watch your anxiety:

It is suggested that rather than get too ‘caught up’ in anxiety, together with all the distressing negative thoughts and fears it produces, to, instead, just observe it in a DETACHED and NON-JUDGMENTAL manner; this involves trying to adopt a kind of NEUTRAL MENTAL ATTITUDE towards it – in other words, neither liking it nor seeing the experience of anxiety as a terrible, unsolvable catastrophy (again, I realize, of course, that intense anxiety is very painful, so this, too, may sound difficult at first). People report that when they adopt this DETACHED, NEUTRAL view of their feelings of anxiety they starts to lose their, hitherto, tenacious grip on their lives.

A Act with your anxiety:

Severe anxiety can leave us feeling as if we are incapable of functioning on even a basic level. It is important to remember, however, as I have repeated at, no doubt, tedious length througout this blog, that just because we believe something it does not logically follow that the belief must be true. Indeed, when my anxiety was at its worst, I did not feel able, or even believe I could,shave or brush my teeth etc…etc… Many people report, however, that if they take the first (often, extremely challenging) step to try to carry on with normal activities, despite the feeling of anxiety which may accompany this, they can, after all, accomplish that which they originally believed they couldn’t. Success then tends to build upon success: completion of the first activity increases the self-belief and the confidence to go on to the second activity, the completion of which provides further self-belief and confidence…and so on…and so on…

In order to make this easier, it may be necessary to slow down the pace at which, in different circumstances, we would otherwise carry out the particular tasks that we set ourselves.

R Repeat the steps:

This just means that by repeating the ACCEPTING ANXIETY, WATCHING OUR ANXIETY (in a detached and neutral manner) and ACTING (despite the feelings of anxiety which may accompany such action) CYCLE, the anxiety may be slowly eroded away.

E Expect the best (even if it does not come naturally)

When we are depressed and anxious we, almost invariably, expect the worst. This is overwhelmingly likely to perpetuate the condition. However, just as expecting the worst can become a self-fulfilling prophecy, so, too, can expecting the best. If, like me, you are not a natural optimist, the concept of expecting the best may go against the grain. However, research shows that optimistic people are more likely to achieve their goals than those of us who do not appear to have been blessed with quite such a sunny disposition. It is worth adapting the strategy on, at least, an experimental basis. It is also useful to keep in mind that even if the best does not occur, we will still have the inner-strength necessary to cope.

workbook cover - 'Fighting' Anxiety can Worsen It: Why Acceptance Works Better.

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Best wishes,
David Hosier BSc Hons; MSc; PGDE(FAHE).

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Combining Hypnosis with Cognitive-Behaviour Therapy.

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Cognitive-Behaviour Therapy, or CBT, is, essentially, a therapy which seeks to alter the way we think and behave in order to improve how we feel. CBT can be COMBINED with hypnotherapy in order to make it more effective. it is thought to make it more effective as it causes the individual being treated to become more receptive to the therapist’s suggestions, and, also, it enhances his/her ability to utilize imagery. Hypnosis can also help the individual being treated become more insightful into the causes of his/her psychological symptoms.

Below, I provide some examples of areas of CBT in which hypnosis can help it become more effective in treating the patient:

1) THE USE OF POST HYPNOTIC SUGGESTION: For example, the individual being treated may be given the post-hypnotic suggestion (this is a suggestion made by the therapist to the effect that the individual will behave in a particular way once the hypnosis is over. An example of a post-hypnotic suggestion is: ‘whenever you have a negative thought you will challenge it and try to replace it with a more positive one.’

Another area where it can be useful to combine hypnotherapy with CBT is by improving the ability of the individual being treated develop the skill of REFRAMING. Reframing refers to the skill, taught in CBT, of looking at a negative experience or situation and to try, with conscious effort, to interpret it in a more positive way.

Furthermore, it can help the individual under treatment identify INTRUSIVE THOUGHTS and more effectively control their emotional responses to such thoughts.

These are just some of the ways that hypnosis can be combined with CBT to both accelerate and augment its effectiveness. It is thought to do this by helping the individual under treatment FOCUS on the experience of therapy. It may, too, improve the therapeutic relationship between the therapist and the individual being treated, because, for example, the hypnotic experience tends to be comforting, and, also,to promote trust between the therapist and patient. Additionally, it can give the individual being treated a greater sense of security which often leads to greater compliance with the therapist’s suggestions

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Best Wishes, David Hosier BSc Hons; MSc; PGDE(FAHE).

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