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Trauma —
and PTSD

 

 

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Page Contents: Introduction / The Realm of the Imaginary / The Realm of the Real / The Realm of the Symbolic / Traumatic Events / Trauma / Symptoms / Coping Strategies / Maladaptive Coping Strategies / Treatments for PTSD / Self-help for Trauma / Terrorism and Trauma

 

 

Introduction
 

WHEN natural disasters and other traumatic events occur, survivors, journalists, and relief workers can be overwhelmed with horrendous sights and smells and profound scenes of human suffering. In the midst of profound devastation and helplessness that make immediate relief efforts seem frustratingly inadequate, these persons can do little more than cast weak sympathetic glances at each other.

Then the anger starts to grow. With a show of arrogant bravado, they proclaim, “We’re going to get the ones who caused this!” Or, if it was a natural disaster, they cry out, “Why didn’t the government do more to help? We’re going to get those who are responsible for this!”

In psychological terms, though, in our anger we confuse the psychological realm of the imaginary with the realm of the real—and in so doing, we overlook the healing potential of the realm of the symbolic. For those not familiar with psychology, this needs some explanation, so follow along with me here.

 


 

The
 
Realm
 
Of
 
The
 
Imaginary
 

The Realm of the Imaginary derives from the pre-verbal state of childhood. As children, we need and desire others to take care of our needs, but, without language, we conceive of this caretaking imaginally; that is, as images in our minds. Hence the realm of the imaginary is all in our heads, so to speak; it’s all based in the expectation that our needs should be fulfilled, and it provokes anger when our needs aren’t fulfilled.

  

Now, when a parent takes care of a helpless infant, the caretaking can be an act of pure—rather than imaginary—love in which the parent is concerned only for the infant’s ultimate good.

Once the child becomes capable of language and independent thought, however, caretaking can then fall back into the imaginary realm and degenerate into mere bribery, in which a parent “gives” only to manipulate the child with game playing and guilt into behaviors more suited to the parent’s comfort than the child’s well-being.

Although the realm of the imaginary begins in childhood, it persists even into adulthood. For example, the desire for romantic fulfillment in another person resides in the realm of the imaginary because romantic fulfillment depends on fantasies of someone giving you what makes you feel good. As hard as it is to admit it, and as much as it contradicts popular culture, romantic sentiment is based in self-indulgence, not in real love.

Furthermore, the pursuit of happiness, which characterizes our culture, also belongs to the realm of the imaginary. Whether it be the “happiness” of drugs or alcohol or food or eroticism or athletic triumph or political triumph, it all points back to an infant yearning to be wrapped in unconscious bliss, seemingly protected—at least momentarily—from the reality of its own vulnerability.

  

OK. So there is the realm of the imaginary.

 


 

The
 
Realm
 
Of
 
The
 
Real
 

The world is generally quite stable. We go to bed at night and fully expect our slippers to be there, right where we left them the night before, when we wake up. Without this sense of stability we would be living in an Alice in Wonderland type of craziness. We couldn’t function.

Yet consider just how fragile this sense of daily security really is. Any number of things—from an earthquake to a car crash— could happen suddenly, without warning, and leave us in chaos.

This is reality.

The Realm of the Real is therefore the place of our essential fragmentation, vulnerability, and death. It’s the “place” where every disaster leaves us, wounded and helpless.

To most persons, the Realm of the Real is a terrifying place, and so most persons will do most anything to hide this reality from their own awareness. We try to live secure and peaceful lives in the moment while pushing away the knowledge that in the next moment everything and anything worldly that we rely upon—our possessions and our bodies—can be wiped away.

Psychologically, then, when you encounter the real you experience a shocking disruption of your previously secure—and imaginary—sense of self. Therefore, you will experience a trauma if you encounter the real with nothing but symptoms and defenses from the Imaginary Realm.

  

In fact, the psychological function of a symptom is precisely to hide reality; a symptom hides an intangible and horrifying reality behind tangible mental and physical manifestations such as anxiety, insomnia, lethargy, nightmares, depressed mood, and so on.

  

Furthermore, this encounter can take you right into all the psychological and spiritual dangers of blame.

 


 

The
 
Realm
 
Of
 
The
 
Symbolic

The truth is, when “bad” things happen to you, that is reality. But when you set aside blame and anger to face your pain honestly, and surrender to the unconscious, you enter the Realm of the Symbolic. In the symbolic realm, the realm of language, horror can be given containment, thus allowing you to draw wisdom from pain and tragedy.

So let’s see how to do this.

 


 

Traumatic
 
Events

In medical terminology, a trauma is simply a wound or injury that happens suddenly or violently. Analogously, psychological trauma results when “stress” overwhelms a person and causes lasting psychological effects.

A traumatic event, whether a natural disaster such as an earthquake, flood, or fire, or an accident such as a car or airplane crash, can happen to anyone.

Fortunately, most people have a support system that allows for a common sense way of adapting to the trauma: sharing stories and emotional experiences. In fact, talking about the event allows a person to “get a handle on it” and so helps it eventually to slip into place alongside other life experiences.

  

The debilitating effects of trauma derive from its ability to overwhelm a person emotionally while driving out any rational understanding of what is happening psychologically. By consciously creating a narrative structure for the trauma—in psychotherapy, in personal journaling, in prayer—you help to dispel the illusion that the traumatic event has control over you, and you cease to be a helpless victim.

  

Without a way of adapting, however, a person may find that symptoms develop to the point that they become unmanageable.

The information contained in this page will help you understand what is happening to you and will also help you in deciding if you should seek outside assistance for your distress.

 


 

Trauma

The oppressive psychological weight of trauma can result from a surprisingly diverse range of experiences, some of which you might never before have stopped to consider:

Accidents

Childhood physical, sexual, and emotional abuse

Criminal assault

Combat, as it affects military personnel and civilians

Domestic violence and emotional abuse

Hostage-taking situations

Motor vehicle crashes

Surgical medical procedures involving loss (e.g., amputation), death (e.g., abortion), or near death

Natural disasters (earthquakes, tornadoes, hurricanes, tsunamis, floods, fires, blizzards, etc.)

Political and military torture

Rape

Terrorism

Workplace violence

 
A psychologist trained in treating trauma can help you if you feel especially overwhelmed. For a person with no history of previous mental health problems, brief treatment (about 12 sessions) may be all that is needed.

In conjunction with psychotherapy, medications may be advised in helping you to sleep and in temporarily relieving severe anxiety or depression so that psychotherapy can be effective. Following successful psychotherapy, medications should be unnecessary.

If you are not ready to see a psychologist, yet feel that you need some additional support, click on the link for information about trauma support groups.

 


 

Common
 
Responses
 
To
 
Traumatic
 
Events

Common symptoms following exposure to traumatic events include any of the following:

An unusual feeling of being easily startled (e.g., jumpiness”)

Difficulty falling asleep or staying asleep; waking up early

Nightmares and/or flashbacks

Difficulty concentrating or paying attention

Carelessness in performing ordinary tasks

Outbursts of irritability or anger, sometimes without apparent reason

Loss of religious faith and feeling angry at God

Family or work conflicts that were not usually experienced before the trauma

Unusual bodily fatigue

Feelings of emotional numbness (such as being in a daze,or having an “It doesn’t matter” attitude)

Recurrent anxiety over personal safety or the safety of loved ones

Feeling especially alone (e.g., having a “They weren’t there” or “They can’t understand” attitude)

An inability to let go of distressing mental images or thoughts

Feelings of depression, loss, or sadness

Feelings of helplessness, powerlessness, and lack of control

Feelings of guilt for not having suffered as much as others

Unrelenting self-criticism for things done or not done during the event

Anxiety about, and avoidance of, specific reminders of the event

 
Developing symptoms after exposure to a threatening event is expected and normal, and things can often get better without professional help. Yet often clinical problems can occur.

 
Clinical Diagnoses Related to Trauma

If the trauma did not involve an experience so intense as to warrant a diagnosis such as Acute Stress Disorder (see below), and if the symptoms do not represent ordinary bereavement, then an Adjustment Disorder may be diagnosed. The predominant symptoms which characterize an Adjustment Disorder can be depressed mood, anxiety, disturbance of conduct (e.g., fighting, vandalism, reckless driving), or other maladaptive reactions (e.g., physical complaints, work or academic inhibition, social withdrawal). By its definition, an Adjustment Disorder cannot last longer than 6 months, unless the precipitating experience is ongoing or has ongoing consequences.

If, however, the precipitating experience involved actual or threatened death or physical injury; the symptoms have elements of dissociation, re-experiencing (i.e., flashbacks), avoidance of reminders of the experience, and anxiety; and the symptoms persist for several days and cause a serious impairment in normal daily functioning, a diagnosis of Acute Stress Disorder (ASD) may be made. If symptoms persist for longer than one month, Posttraumatic Stress Disorder (PTSD) may be diagnosed.

Children subject to repeated, on-going abuse may also develop Dissociative Identity Disorder, commonly known as “multiple personalities.”

All of the above diagnoses, of course, depend on specific symptoms that must be evaluated by a qualified clinician.

 


 

Coping
 
Strategies
 
After
 
Traumatic
 
Events

The best coping strategy, of course, is to talk about the event with family, friends, clergy, or co-workers. Other Positive Coping Strategies after a traumatic event include:

Maintaining a regular routine of eating, sleeping, and working

Avoiding alcohol, tranquilizers, and caffeine because they interfere with deep sleep (i.e., sleep stages 3 and 4)

Getting quiet recreational exercise in nature, such as walking or hiking.

Taking extra time to accomplish ordinary tasks

Acquiring the training, tools, materials, etc. that would have made things easier if you had been able to use them during the event

Mentally rehearsing the positive acts you would perform if there’s a next time

Interpreting physical symptoms (for example, shoulder pain could be telling you that you’re “trying to carry too heavy a burden”)

Asking yourself what emotions you are actually experiencing. Fear and anger are not the only emotions in life.

Getting a therapeutic massage to release pent-up bodily tension

Writing about your experiences (in a journal, diary, or personal letters)

Being careful not to make the event into an obsession by reading about it in newspapers or magazines, or following reports and discussions of it on the radio and TV

Realizing that different people need differing amounts of time to recover from trauma

Learning a relaxation technique such as Progressive Muscle Relaxation or Autogenics

Joining a support group 

Accepting the emotional work of forgiving the person who hurt you [1]

 


 

Maladaptive
 
Coping
 
Strategies

Be careful to watch for the following Maladaptive Coping Strategies:

An increased use—or abuse— of alcohol, coffee, drugs, gambling, tobacco, etc.

A compulsion to work more than usual

A temptation to make hasty major life-decisions (e.g., quitting a job, moving to another location, abandoning your family)

A tendency to completely avoid any feelings or thoughts about the event

 
These are called maladaptive coping strategies because they serve either to push out of awareness any memory of the traumatic event, or to give you a false sense of accomplishment. Unfortunately, such strategies serve no purpose in helping you integrate the trauma into your sense of self. For example, if you use alcohol or marijuana to reduce your anxiety, you might feel better as long as you are using the substance, but, because you are just chemically inducing a state of dissociation, the underlying trauma will not be healed and will stay in the shadows to haunt you.

  

Remember—an event is traumatic because it disrupts your previously secure sense of self. Consider that wild animals live with a sharp awareness of perpetual danger, yet most people live with a naive—and deceptive—sense of safety and security to the point of denying their basic vulnerability and fragmented sense of self. So when something disastrous happens, the psychological damage from the shattering of one’s illusions about life and identity may be more problematic than any physical damage. 

  

Healthy adaptation to the trauma therefore involves reorganizing your attitudes about your being and your purpose in the world. In fact, this explains why some people who experience a trauma come away from it as “changed” persons with a new sense of purpose in life.[2,3,4]

Of course, not everyone is so profoundly changed; most people simply get back to life as usual, feeling perhaps just a bit more practical or realistic about their lives than they felt before the trauma.

 


  

Treatments
 
for
 
PTSD

The clinical treatment for PTSD can take a variety of approaches.[5]
 
Regardless of the treatment approach, the treatment should (a) provide a sense of safety, both as a protection from maladaptive coping strategies and as an acceptance of your thoughts and feelings as non-threatening; (b) resolve the troubling aspects of the memories of the traumatic experience; and (c) integrate positive growth into your lifestyle.

Exposure Therapy is a form of cognitive-behavioral treatment that is really quite a simple concept, and yet it can be very effective in a short time (10 or 12 sessions) for treating discrete traumatic events. Through the process of repeatedly talking (and writing) psychotherapeutically about your traumatic experiences, several things can happen:

  

1. You experience your thoughts and feelings in the safety of psychotherapy, and this helps to reduce the belief that your thoughts and feelings are dangerous.
 
2. You become habituated to your thoughts and feelings. That is, much like a wild animal being tamed, you learn to accept your memories without perceiving them as a threat.
 
3. You prevent yourself from falling into the habit of avoiding your thoughts and feelings as an unhealthy defense against fear.
 
4. You learn to distinguish troubling thoughts and feelings from ordinary thoughts and feelings so that everything does not seem threatening.
 
5. You learn to transform your feelings of helplessness into competence.
 
6. You learn to think of yourself less negatively.

 

  

Imagery Rehearsal Therapy can help to resolve recurring traumatic nightmares.
 

Psychodynamic Psychotherapy helps you explore and understand the unconscious aspects of the trauma and its personal meaning for you. This form of treatment may be necessary for multiple traumatic events experienced over time (e.g., childhood abuse in a dysfunctional family).
 

Hypnosis and Guided Imagery, either alone or in combination with Psychodynamic Psychotherapy, can help you to transform your perceptions of the trauma through imagined visual and sensory experiences.
 

Psychological Debriefing. In years past, it was supposed that a group processing for all persons involved in a critical event within 48 to 72 hours of the event would prevent the development of full-blown PTSD. Experience, however, has shown that talking about the event in a group only increases exposure and can actually make things worse. What people really need, besides basic human contact and comfort, is clear and honest information about what happened.
 

Eye Movement Desensitization and Reprocessing (EMDR). The premise of EMDR is that many traumatic events are not properly “processed” by the memory network of the brain, and that the eye movements of EMDR help a person “reprocess” the traumatic memory through “rapid learning” so that it no longer has negative psychological effects.

  

Is EMDR really all that different from, or more efficient than, other treatments? Does eye movement really aid brain processing of memory? Maybe. Maybe not.[6]
 
Just remember this: after you’ve “reprocessed” your memory network you may still have a fragmented personality, you may still fear love, and you may still have a dark part of you that seeks death and self-destruction. All of these things can be tangled into your life’s overall unconscious misery right along with, on top of, or behind any specific traumatic memory. 

 

  

Pharmacotherapy [7] refers to the use of medications to help alleviate serious symptoms, such as anxiety and insomnia, so that psychotherapy can be effective. It would be a grave psychological mistake to use psychiatric medications without psychotherapy. Following successful psychotherapy, medications should be unnecessary.
 

Group Therapy may be used for social support and to help individuals understand and resolve the social aspects of their symptoms.
 

Marital and Family Therapy can be of help especially when children or adolescents experience a trauma.
 

Inpatient Treatment (that is, hospitalization) for severe cases, may be required especially if the trauma provokes suicidal thoughts.
 

Psycho-social Rehabilitation Techniques may be necessary if the trauma has caused a drastic disintegration of a person’s lifestyle.
 

Creative Arts Therapies are sometimes used in conjunction with other treatment. 

 
Of the above approaches, Debriefing and EMDR are the most controversial. Each of these approaches has been popularized in a similar fashion: one person who discovers the treatment advocates for the use of his or her “discovery” through a reliance on supportive case reports. Both approaches currently lack the unambiguous support of randomized, clinical trials [8] with control groups.[9]

 


 

Self-help
 
for
 
Trauma

If you find that professional treatment for trauma is not available to you or is too expensive, you might try the following self-help writing assignments. These suggestions are not meant to replace professional treatment, but, in some circumstances, anything can be better than nothing.

The assignments are meant to be kept private, for your own use, but in writing them you might be surprised to see things you would not have admitted to yourself in your own thoughts.

Be careful not to try to rush the process—allow two or three days for each assignment.

Write at least one paragraph defining the concept of “victim.” Read it and re-read it over the course of the next couple days.

Write at least one page on what it means to you that you have experienced a trauma. Please consider the effects that the trauma has had on your beliefs about yourself, your beliefs about others, and your beliefs about the world. Also consider the following topics while writing your answer: Safety, Trust, Power, Competence, Esteem, and Intimacy. Read it and re-read it over the course of the next couple days.

Write a detailed account of your last experience of trauma. Include as many sensory details as possible, as well as your thoughts and feelings about the experience. Be sure to track the development of your anxiety from your description of its first beginnings to its peak and on through its dissipation. If you are unable to complete the account in one sitting, draw a line where you stop. When you are ready to continue, read what you have already written before writing more. If there are parts that you do not remember, draw a line and continue on at the part that you remember next. At least once a day, over the course of the next couple days, read whatever you have written, whether it be complete or in progress.

For this assignment, write three paragraphs.
   First, write a paragraph about how you want your life to change once you have overcome your trauma. Read it and re-read it over the course of the next couple days.
   Second, write a paragraph describing what you will lose (that’s right—lose) by being able to live comfortably without troubling memories or anxiety. Read it and re-read it over the course of the next couple days.
   Third, write a paragraph summarizing the five most important reasons for your being able to overcome the trauma. Read it and re-read it over the course of the next couple days.

Finally, write a statement of what it means to you that you have taken on this self-help work for a trauma. You should, of course, review what you have written in all the writing assignments; you should also consider any anxieties you might still have as well as any insights you may have achieved. (Remember: sometimes knowing where you have been can give you a clue as to where you are headed.)

 


 

A
 
Final
 
Note
 
About
 
Terrorism
 
and
 
Trauma

Imagine sitting in an airplane, happily sipping a glass of wine, talking to your seatmate and feeling quite wonderful about your recent business success. Suddenly there’s a loud noise, the plane pitches nose down, food and baggage fly all over the cabin, everyone is screaming, and you lose consciousness. You wake up covered in blood, surrounded with smoke and fire, and next to you is the mangled body of your seatmate.

Now, although in your daily life you might delight in entertainment that depicts graphic violence and death, when an experience like this suddenly throws itself into your lap—along with your neighbor’s severed arm—it’s no longer fun and games. It’s traumatic, and you’re likely to develop symptoms of posttraumatic stress disorder.

Yet now imagine something even more horrifying. With no sudden warning, people around you start falling ill. Soon, many of the sick begin to die. The government is baffled and helpless. Panic drifts through the air. What do you do? What can you do?

Well, in the case of biological terrorism, you’re confronted not just with actual death but also with the continuing threat of mysterious death on a large, public scale. Such a threat will trigger the deepest, ugliest, and most fearful aspects of your psyche.

And, in the same way, scattered bombings in subways, trains, busses, markets, and hotels pierce deeply into the same fears.

No government is prepared for the mental health consequences of this sort of threat. And no government ever will be.

And that’s because the only treatment for such a trauma is spiritual. Religious mystics have said for ages that you only begin to live when you learn to die to yourself in every moment. So when your life is motivated by pure faith, hope, and love, when you are prepared to die in any moment, and when death is no longer a fearful, ugly mystery, trauma has no place to sink its claws in you.

“Wait a minute,” you say, “the motto of this country is In God We Trust. America is a spiritual country.” 

Well, we can wonder about that. How can the pursuit of “happiness”—with its narcissistic hunger for aggressive political hostility and sniping, angry and hateful protest, violent video games, competitive sports, erotic entertainment, obesity, drugs, gambling, social rudeness, exploitation of the underprivileged, and abuse of the environment—be spiritual? Remember that terrorists are angry with this country because of the happiness that we pursue at the expense of charitable concern for our less fortunate neighbors.[10]

So the trauma of all terrorism is aimed at our deepest vulnerability: the narcissistic emptiness in our own hearts.

 


 

The
 
Book
 

Disasters and Trauma

Shows how to turn the emotional wounds of trauma into psychological growth. Available as a paperback book or as an e-book.

More information

 


 

Gratitude
 

Has this web page been helpful? Then please help support this website in gratitude, as a “down-payment” on the success of your hopes and dreams!

 

No advertising—no sponsor—just the simple truth . . .


 


 

 
Notes:

1. Hamama-Raz, Y., Solomon, Z., Cohen, A., & Laufer, A. (2008). PTSD symptoms, forgiveness, and revenge among Israeli Palestinian and Jewish Adolescents. Journal of Traumatic Stress, 21, 521–529. See p. 527:
    “Thus, when inability to forgive and the need to take vengeance are entrenched within the social texture, their malignant influence over these youths’ mental health may be intensified. Forgiveness, on the other hand, was found to mediate the relationship between PTSD and hostility and to be associated with decreased depression and anxiety.”
 
2. Linley, P. A., Joseph, S. (2004). Positive change following trauma and adversity: A review. Journal of Traumatic Stress, 17, 11–21.
 
3. Waysman, M., Schwarzwald, J., & Solomon, Z. (2001). Hardiness: An examination of its relationship with positive and negative long term changes following trauma. Journal of Traumatic Stress, 14, 531–547.
 
4. Tedeschi, R. G., Calhoun, L. G. (1996). The Posttraumatic Growth Inventory: Measuring the positive legacy of trauma. Journal of Traumatic Stress, 9, 455–471.
 
5. Foa, E. B., Keane, T. M., & Friedman, M. J. (Eds.). (2000). Effective Treatments for PTSD: Practice Guidelines from the International Society for Traumatic Stress Studies. New York: Guilford Publications.
 
6. McNally, R. J. (1999). Research on Eye Movement Desensitization and Reprocessing (EMDR) as a treatment for PTSD. PTSD Research Quarterly, 10, 1.
 
7. Friedman, M. J. (2000). A guide to the literature on pharmacotherapy for PTSD. PTSD Research Quarterly, 11, 1.
 
8. Avery, A., King, S., Bretherton, R., & Ørner, R. (1999). Deconstructing psychological debriefing and the emergence of calls for evidence-based practice. Traumatic Stress Points, 13, 2.
 
9. Schnurr, P. P. (1999). Control groups in psychotherapy research. PTSD Research Quarterly, 10, 1.
 
10. Those who commit acts of terrorism also defile spirituality. This just goes to show that there are no gray areas in regard to a genuine spiritual life: either your life is grounded in true love, or it isn’t. Period. Those who advocate terror and violence cut themselves off from any hope of healing the anger that fuels their bitterness.
 

 
Additional Resources
 
Anxiety Disorders:
Anxiety Disorders  from THE MERCK MANUAL, Sec. 15, Ch. 187.
 
Community Services:
Knowledge Exchange Network (KEN)  from the Center for Mental Health Services.
 
Crisis Counseling:
Crisis Counseling - Non-Profit Information, Guidance and Referral Assistance
Crisis Counseling  from the Center for Mental Health Services.
 
Emergency Services:
Emergency Services  from the Center for Mental Health Services.
 
Trauma & Child/Sexual Abuse Survivors:
Adult Survivors of Child Abuse (ACSA)  is an innovative psychologically based support group recovery program that offers workshops, peer-guided and professional-guided support groups, and a guidebook.
The National Organization on Male Sexual Victimization (NOMSV)  “is dedicated to the prevention, treatment, and elimination of male sexual victimization.”
 
Trauma & Children:
Helping Children After a Disaster  from the American Academy of Child and Adolescent Psychiatry.
 
Trauma & Law Enforcement:
Law Enforcement Traumatic Stress: Clinical Syndromes and Intervention Strategies  from The American Academy of Experts in Traumatic Stress.
 
Trauma/PTSD – General:
The International Society for Traumatic Stress Studies (ISTSS)  provides a forum for the sharing of research, clinical strategies, public policy concerns, and theoretical formulations on trauma in the United States and around the world through its education and training programs and its various publications.
Mental Health Net: Self-help Trauma, PTSD, and Stress Resources  is a comprehensive listing of trauma, PTSD, and stress information and self-help resources online.
The National Center for PTSD  provides information about PTSD research and a PILOTS data base linked to the world’s largest collection of traumatic stress literature.
Suicide and Posttraumatic Stress Disorder (PTSD)  provides information about suicidal thinking and PTSD.
Trauma Information Pages  provides a comprehensive listing of trauma support info, disaster info, and related mental health issues on the Internet.
 
Related pages within A Guide to Psychology and its Practice:
Anger
Autogenics Training
Death—and the Seduction of Despair
Forgiveness
Hypnosis and “Negative” Hypnosis
Identity
Personality
Progressive Muscle Relaxation
Questions and Answers about Psychotherapy
Spiritual Healing
Stress
Systematic Desensitization
Terrorism and Psychology
Trauma Support Groups
The Unconscious
 
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