Side view of young adult with short hair in athletic clothes half-seated on railing wearing headphones and using phoneIt may be fair to wonder whether technology supports mental health, but there is little doubt some technology has the potential to support treatment efforts. HIPAA-compliant video chat and screen-sharing software enables people to receive mental health services they might otherwise not receive. Several software programs help professionals maintain more efficient and secure notes and billing. Even some apps offer benefit to those working on improving their mental health. A few such apps are reviewed here to give an idea of what is available in the marketplace.

Anxiety Release Based on EMDR

This app costs $4.99. It offers a brain training session, an introduction in which users are encouraged to become aware of their body sensations and familiar with alternating tones in each ear intended to mimic bilateral stimulation used in eye movement desensitization and reprocessing (EMDR). It is best to use headphones with this app. Guided meditative sessions to relieve anxiety follow. Before and after each, users are prompted to identify their level of anxiety on a zero-to-10 scale. The app contains three anxiety-release sessions. The first two are narrated while tones alternate in each ear and correlating light spots alternate left and right on the screen. The third session is not narrated. It also walks users through the “safe place” resource often used in EMDR. If the Logbook feature is enabled, the app will record the user’s anxiety level before and after each session to track progress over time.

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The app is not a substitute for EMDR sessions with a licensed mental health professional who has received adequate training. EMDR is far more complex than the app, which does not include elements critical to EMDR. The alternating lights on the app are not far enough apart to generate the same eye movements as would be used in an EMDR session. However, users may find the app useful for relieving some anxiety symptoms.

Brain Waves – Binaural Beats

This free app is meant to help people with sleep, relaxation, focus, and other brain functions. It is based on the 1839 discovery of binaural beats, whereby two different waveforms are presented in stereophonic earphones to each ear, with the perception of a third “beat” frequency occurring as the difference between the two auditory inputs (Atwater, 1995). Research indicates particular brain states generate particular brain waves, but there is much debate over whether these waves can generate brain states.

Specific brain waves correlate with the following activity levels:

Presets can be selected that generate sine-wave sounds from a mobile phone, or users can set their own frequencies in each ear using “Set L” and “Set R” buttons. The waves are to be played at a moderate volume and generate in real time with no loops. Headphones are required for this app.

Several presets were tried. The “Relax” and “Meditation” frequencies seemed to be particularly true to their names. While the effect may be placebo, it was a pleasant experience.

PTSD Coach

Created by the U.S. Department of Veterans Affairs, this free app is directed toward veterans but may be useful for anyone experiencing posttraumatic stress. It includes information general to posttraumatic stress and an assessment to take as many times as a user wants to track progress of symptom reduction. The assessment can be scheduled so the user remembers to check in.

This app can be a useful resource for people struggling with posttraumatic stress and in need of quick coping resources.

A favorite feature is a list of coping tools to use when feeling triggered. Users can select from a list of symptoms, such as “Angry” or “Disconnected from People,” and be provided with applicable tools. Users can also select from a list of tools for coping with symptoms—and they’re good tools. Users can even create their own tool, such as music paired with pictures of loved ones, pets, or peaceful scenes.

This app can be a useful resource for people struggling with posttraumatic stress and in need of quick coping resources. Of those reviewed, this app was my favorite.

SOAR

The app intends to assist those who fear flying. While the app download is free, the content is not. As of writing, the complete SOAR video course is priced at $480 for 20 days. Add two counseling sessions and the price is $595 for one month. The “Take Me Along” mp3 download, which talks a person through the various stages of a flight, is $29.95 for two days. Other downloads start at $19.95, some including DVDs, and all downloads have time-limited access. The app includes a tool to schedule individual counseling.

Some things are included with the app at no additional cost: a turbulence forecast and weekly group phone counseling. Information to dial in can be found on the app.

Budget-conscious users may start with the group phone counseling and some individual downloads, determine for themselves if helpful, and purchase more if desired.

Conclusion

The apps reviewed here are only a small sample of what is available online. They provide a taste of technology and what may be on the horizon in support of mental health. Since each person’s therapeutic experience is unique, it is encouraging to see mental health apps increase in number and quality, as they add to the variety of tools for therapists and the people they help.

Still, apps are best looked at as supplemental to in-person therapy, particularly between sessions. Apps are limited in scope and cannot accurately diagnose or assess conditions. For the most effective support and personalized tools, reach out to a licensed therapist in your area.

Reference:

Atwater, F. H. (1995). The hemi-sync process. Retrieved from https://www.monroeinstitute.org/node/954

Two office workers have their heads close together over desk, smiling at each otherWorkplace affairs are on the rise. Research indicates that from 1982 to 1990, 38% of unfaithful wives had affairs starting at work. From 1991 to 2000, 50% of unfaithful wives began an affair at work. Psychologist and marriage and family therapist Shirley Glass, PhD, reports that 46% of unfaithful wives and 62% of unfaithful husbands in her clinical practice had an affair with someone they met through their work (Glass & Staeheli, 2004).

While affairs can begin in a variety of ways, work is one of the most frequently reported settings where infidelity begins. Many people who begin affairs at the office later say, “I didn’t set out to cheat on my partner; it just happened.” Although it may seem as though it “just happened,” there are steps that led up to the infidelity.

Research points to opportunity as a substantial factor in affairs that begin at work. These relationships typically begin with healthy boundaries. When a friendship crosses a line of emotional intimacy, the chances of moving into sexual intimacy increase (Glass & Staeheli, 2004).

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If you think you may have crossed a line with someone at work, ask yourself the following:

If the answer is “yes” to any of these, put a stronger boundary between you and the coworker immediately (Glass & Staeheli, 2004). In the event of an affair, whether begun at work or elsewhere, what next? Partners not involved in the affair often feel hurt and need their hurt acknowledged. The affair might be the most apparent issue, but along with it are issues that left the relationship vulnerable to making poor choices.

Division of labor around the house, sex, and parenting are legitimate relationship issues. If a couple comes to counseling at this stage, the focus can immediately be on these topics. Sometimes one or both partners give an illegitimate response to legitimate issues. Domestic violence, substance abuse, and affairs are examples of illegitimate responses. In these cases, the illegitimate response temporarily negates the legitimate issues because the illegitimate response is so big.

The affair might be the most apparent issue, but along with it are issues that left the relationship vulnerable to making poor choices.

The partner who responded to legitimate concerns with an affair is responsible for owning the fact the focus is going to be on the affair for a period of time before the legitimate issues can be addressed. This takes courage because it is not easy to listen to the betrayed partner explain how the affair hurt them. Likewise, some people who have had an affair may be unwilling to be an open book to their partner for however long it takes to rebuild trust. Yet, these are important steps toward healing.

While some couples dig in and work through an affair and the issues preceding it, others find it easier to leave. In some cases, they leave for the person they had an affair with. But only a small percentage of relationships that begin as an affair last. Unresolved contributions to a failed relationship leave a person prone to make the same mistakes in future relationships.

What to Look for in a Couples Therapist

If you or your partner have engaged in an affair and are considering counseling, or have tried counseling before and felt it went nowhere, look for the following in a therapist as suggested by Glass and Staeheli (2004):

It is harder to take our own inventory than it is to take someone else’s. It is harder still to work on our own issues with honesty and self-compassion. But if each partner focuses on themselves, the chances are greater the couple will rebuild trust and intimacy. If you believe your partnership is vulnerable to infidelity or has already experienced it, contact a licensed couples counselor.

Reference:

Glass, S. P., & Staeheli, J. C. (2004). Not just friends. New York, NY: Atria Books.

Couple standing in open doorway in front of open window at home in the morning.You want a baby soon; your partner does not. You always want to stay out late; your partner just wants to go home and go to bed. You want to spend less and save more; your partner wants to buy a new car or a new wardrobe. According to John Gottman (1999), professor emeritus in psychology at the University of Washington and longtime researcher on the characteristics of successful couples, 69% of marital conflicts are perpetual problems. In other words, they are conflicts that are not going away.

Before you think about replacing your partner over perpetual problems, think again. For instance, your partner agrees to spend only Thanksgiving or Christmas with your family. You want more holidays with your family. However, another partner might refuse to spend any holidays with your family. Yet another partner may agree but instigates an argument with your family at every opportunity. A third partner may agree, but only if your family comes to your house. After they leave, this partner obsessively cleans for hours and complains about them not taking their shoes off at the door. Knowing the options, would you have worked harder to compromise with the partner you picked?

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In Gottman’s book The Seven Principles for Making Marriage Work, he advises couples to accept the fact all couples have ongoing differences. The key is to keep working on them from a win-win position so you both feel you matter to each other. Successful couples find ways to manage ongoing disagreements with humor and affection. Couples who fail to accommodate perpetual differences can find themselves in a gridlock (Gottman, 1999).

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Differences between partners may stem from a variety of sources. Some differences are rooted in beliefs or values taught by the family while growing up. For example, you may prefer a tidy home because you found comfort growing up in one. But your partner does not find it important to put dirty socks in a laundry hamper because that is how they grew up. Other differences may be styles like being a night owl or a morning person. How you got there matters less than how you come together to handle your perpetual problems.

Couples who accept each other’s styles with empathy tend to fare better than couples who do not. They know the difficulty is like an irritating allergy. It won’t go away, but they do not allow it to become so important it becomes a gridlock. According to Gottman (1999), the following are characteristics of gridlock:

Busting a gridlock begins with understanding each other’s dreams. A dream not shared is often at the core of unresolved conflict. Dreams are hopes or wishes that give meaning and purpose to your life. What are your partner’s dreams behind the issue? When is the last time you told your partner any of your aspirations behind an issue important to you (Gottman, 1999)?

Voice your dreams behind the issue, what they symbolize to you, and why they are important to you. Invite your partner to do the same. Many people believe they are not entitled to their dreams. Yet, the longing does not go away and may resurface in some form (Gottman, 1999).

Gridlocks do not have to signify the end of a relationship. Be flexible and open to compromises that don’t involve changing or fixing your partner.

In response to your partner sharing their dreams behind the perpetual problem, acknowledge them. You don’t necessarily have to be a part of them but respect them. Consider ways to compromise in ways that keep the door open to further conversation. The issue may never completely go away. Rather than try to solve it, focus on diffusing the amount of pain felt around it (Gottman, 1999).

Diffuse the hurt by separating the issue into nonnegotiable and flexible areas. Nonnegotiable are aspects you cannot conciliate on without violating your core values or needs. Flexible areas are those you can consider temporary or creative concessions for. Try to put as many aspects in the flexible area as possible. After you negotiate, say “thank you.” End the conversation on a positive note with loving words for each other (Gottman, 1999).

Gridlocks do not have to signify the end of a relationship. Be flexible and open to compromises that don’t involve changing or fixing your partner. Because perpetual problems have a lot of longevity, you may need to match your issue with patience. Remind yourself that your partner and you are on the same side and the problem is on the other. The problem is no match for the two of you.

Reference:

Gottman, J. (1999). The Seven Principles for Making Marriage Work. New York, NY: Harmony Books.

Rear view of person in casual blouse with hair in ponytail looking out over city at sunset in a blue sky with a few cloudsDo you have a grievance you think about more than the positive things in your life? If so, do you think the same, repetitive thoughts about it? Do you seek out people who will listen to you tell the same painful story many times? Does this story have a villain?

If you recognize these patterns in yourself, maybe it is time to forgive.

Why Forgive?

When we hold on to hurt, we remain locked in an unhealthy bond that keeps the people in our lives from having all of who we are. Hurt also robs us of our personal strength. Left unresolved long enough, it can even develop into a victim story that becomes part of our identity.

Some research suggests forgiveness correlates with fewer health problems and less stress (Luskin, 2002).

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What Is Forgiveness?

Some question what forgiveness is and is not. According to Dr. Frederic Luskin, author of the 2002 book Forgive for Good: A Proven Prescription for Health and Happiness, forgiveness is:

Per Luskin, forgiveness is not:

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Focus on the personal aspect of a hurt often comes from our beliefs and expectations that were not met. Luskin (2002) shares some common beliefs and expectations he refers to as “unenforceable rules”:

Challenge Unenforceable Rules

Forgiveness centers on giving back peace of mind. It prevents a past hurt from determining a negative future. Luskin (2002) offers the following steps to address unenforceable rules:

A big part of forgiveness is giving up the hope that the past could be anything other than what it was.

  1. Acknowledge your feelings: confusion, anger, indignation, etc. Ask yourself if you are experiencing feelings in the present over events in the past.
  2. Concede that you feel bad because your expectations were not met.
  3. Give yourself the grace to challenge the unenforceable rule underlying your hurt.
  4. Identify the unenforceable rule. What is the experience in your life that you demanded to be different?
  5. Change the unenforceable rule you demanded into something you hoped to get. Express it in positive terms. “I wanted a partner who did not cheat on me” is different from “I wanted a monogamous partnership.” The latter is a positive expression.
  6. Notice what changes for yourself when your demands change to hopes. Do you feel more peaceful?

HEAL

Luskin (2002) further offers a HEAL (hope, educate, affirm, long-term) method to help forgive:

A big part of forgiveness is giving up the hope that the past could be anything other than what it was. It is important to acknowledge the feelings that come with an injustice, but also to not remain locked in them. If you have tried to forgive and not been successful, a therapist can help you process a grievance.

Something happened that we did not want to happen, or something did not happen that we wanted to happen. Forgiveness is the power we receive as we assert that we have a well of resilience to draw upon. It gives us the chance to rewrite a story about a victim into a story about a hero (Luskin, 2002).

Reference:

Luskin, F. (2002). Forgive for Good. New York, NY: HarperCollins.

Grayscale photo of person in hoodie looking out toward cityMany people struggle to understand how our culture defines domestic violence. Some believe that to constitute domestic violence, a person must be beaten or violently struck in some way. However, domestic violence behaviors do not necessarily include physical assault. While it may include sexual, emotional, and/or physical abuse, the most consistent component of a domestic violence relationship is an ongoing effort to maintain power and control over one’s partner.

The National Coalition Against Domestic Violence (2016) lists several abusive behaviors that are earmarks of domestic violence:

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Abusive individuals often want the people they abuse to believe they are at fault: “If you would only ____, I would not get angry. You provoked me. You are crazy.” To be clear, there is nothing any person can say or do that provokes or deserves abuse. While a person may behave in ways that could benefit from modification, those are relationship issues. Domestic violence is not a relationship issue; it is in many cases a criminal act.

Abuse loves when we don’t talk about it; it thrives in silence. By giving a voice to those who feel they have none and talking about their pain, we give abuse nowhere to hide.

In many states, a domestic violence charge does not necessarily need to include touching a partner. Destroying property, stalking, and harassing—including menacing texts and phone calls—can constitute domestic violence. Domestic violence may be addressed in three different types of court: criminal, civil, and family (American Bar Association, 2001). Abusive people will sometimes attempt to pressure or manipulate a partner into dropping charges or to lie to help minimize the consequences of the abusive person’s behavior.

Often, a domestic violence relationship may seem like any happy relationship in the beginning, but becomes more controlling and abusive over time (National Coalition Against Domestic Violence, 2016). Because of this, people who have been abused sometimes report feeling shame for not recognizing the signs of abuse sooner. It is not unusual for someone leaving a domestic violence relationship to state they realized they were in a domestic violence relationship only after they felt it was too late to leave, and that they wanted to leave sooner but did not believe they could materially survive alone. However, many resources are available to assist with safety plans, housing, legal advocacy, and other resources.

Getting Help for Domestic Violence

If you or someone you care about is in a domestic violence relationship, you are not alone. To speak confidentially with a trained advocate, call the National Domestic Violence Hotline at 1-800-799-7233. Live, private chat is also available at http://www.thehotline.org/. Information and thousands of resources, including counseling, across the United States are available to people in an abusive relationship and to friends and family of a person they believe to be in an abusive relationship. Contact a trained therapist if you need further guidance or support.

Abuse loves when we don’t talk about it. It thrives in silence. By giving a voice to those who feel they have none and creating spaces for them to talk about their pain—and offering support as they do so—we give abuse nowhere to hide.

References:

  1. American Bar Association. (2001). Know your rights: Domestic violence. Retrieved from http://www.americanbar.org/content/dam/aba/migrated/publiced/domviol.authcheckdam.pdf
  2. National Coalition Against Domestic Violence. (2016). What is domestic violence? Retrieved from http://ncadv.org/learn-more/what-is-domestic-violence
  3. National Domestic Violence Hotline. (2016). Is this abuse? Retrieved from http://www.thehotline.org/is-this-abuse/

Couple smiles at each other with faces close together under duvet coverWhen you come home at the end of a workday, do you notice a difference in how the evening goes depending on how you and your partner greet each other? Similarly, do you notice any patterns in the outcome of an argument with your partner based on how the issue is presented? Those first few minutes can have a terrific impact on how the rest of that exchange, and the next several hours, may go, and may ultimately set up your relationship for success or failure.

The First 4 Minutes Together

Imagine walking in the door to your partner handing you a stack of bills and then turning to a household chore while they tell you the oil light in the car is on again, the dentist says one of the children needs braces, and an extended family member you do not look forward to seeing is visiting next week. Or worse, your partner greets you by telling you all the ways you disappoint them.

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Now imagine walking in the door, seeking out your partner wherever they are, and—before discussing the latest family news or obligations—taking a few minutes to sit close while you both talk about how good it is to see each other and how you are glad to be sharing life together. Or better, add a few kisses and hugs to the greeting.

Begin each day with some kind words to each other. In the evening, whoever gets home last is to find the other person. Focus total, positive attention on each other for at least 4 minutes. At the end of the experiment, consider how you feel about each other and yourselves.

Zunin and Zunin (1972) believe the first 4 minutes when a couple awaken together, and the first 4 minutes after returning to each other at the end the workday, are critical to the success or failure of the partnership. If, for example, a couple begins each day with complaining, listing the trivial tasks to accomplish that day, or insisting one partner cannot talk to the other until after the third cup of coffee, this sets a negative tone for the day that over time erodes the warm, loving feelings between the couple. If, on the other hand, the morning’s opening minutes are spent on something mutually pleasurable, such as caressing or rubbing a partner’s back or neck while gently saying, “Good morning,” it reinforces the foundation of the partnership.

Zunin and Zunin (1972) also believe the 4 minutes when many couples meet at the end of a workday are an opportunity to renew the most gratifying feelings they have for each other. As an experiment, try this with your partner by talking about what would help you each feel more connected. Begin each day with some kind words to each other. In the evening, whoever gets home last is to find the other person. Focus total, positive attention on each other for at least 4 minutes. At the end of the experiment, consider how you feel about each other and yourselves.

Couples who have less aligned work schedules may need to be more creative. Those who work vastly different schedules, such as one works days and the other nights, may schedule a few minutes when they pass each other at home. Similarly, couples including a partner who travels a majority of the time may want to select an appointed time to talk for a few minutes, and stick to a plan to spend the first few minutes renewing positive feelings for each other.

The First 3 Minutes of Conflict

How important are the first few minutes of a conflict with your partner? In one of the many studies on couples performed by The Gottman Institute, Carrére and Gottman (1999) observed 124 newlywed couples, married for the first time for less than six months, to learn if it was possible to predict divorce or marital stability based on how a couple interacted in a conflict. The couples were video recorded while participating in a marital interaction session in which they were asked to discuss a marital issue that was ongoing along with two recall sessions in which the couple viewed their initial session. The couples completed questionnaires and were followed up with annually for between four and six years.

The results were fascinating. Using quantitative data of the couples’ affect, it was possible to predict whether the couples would divorce or remain married by observing just the first 3 minutes of interaction in conflict. If, for example, issues were introduced as complaints about a specific behavior, the receiving partner was less likely to respond defensively or negatively, and the couple was more likely to report marital stability years later. If, on the other hand, issues were presented with criticism of the partner that suggested the partner is bad or wrong in some way, the couple was more likely to divorce.

What This All Means

While the entire interaction with a partner matters, the first few minutes can be crucial. By allocating a few minutes at critical times in your day to let your partner know you are on their side, and by being more thoughtful about how you present concerns, it is possible to create a more loving, lasting bond.

References:

  1. Carrére, S. and Gottman, J. M. (1999). Predicting divorce among newlyweds from the first three minutes of a marital conflict discussion. Family Process, 38(3). Retrieved from http://www.johngottman.net/wp-content/uploads/2011/05/Predicting-Divorce-among-Newlyweds-from-the-First-Three-Minutes-of-a-Marital-Conflict-Discussion.pdf
  2. Zunin, L. & Zunin, N. (1972). Contact: The first four minutes. New York, NY: Ballantine Books.

Person with long curly dark hair sits in grassy field with eyes closed, meditating peacefullyLife can be stressful for anyone, but for people dealing with the negative effects of trauma on top of everyday life, elevated stress levels can be much more common. One course of treatment for experiencing a more positive and peaceful life after trauma is eye movement desensitization and reprocessing (EMDR), a methodology originated by Francine Shapiro. It pairs specific protocols with bilateral stimulation—back-and-forth eye movements, alternating tones delivered through headphones, and/or alternating tactile stimulation such as vibrations delivered through hand-held pulsers. Part of the eight-phase EMDR protocol includes teaching the person in therapy a relaxation technique to recall when needed.

One of the most common relaxation techniques for EMDR is known as “safe place,” also referred to as “calm place.” This technique is part of the second phase of EMDR known as “preparation.” Prior to this phase, the person’s history is taken, assessments are performed to determine if EMDR is appropriate, and a treatment plan is prepared. This matters because before a counselor proceeds with EMDR, a person must be assessed for physical health, support system, and any tendency to dissociate. Therefore, it is imperative that all portions of EMDR protocols are performed only by a trained, qualified EMDR clinician.

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“Safe place” may be thought of as an emotional sanctuary where a person can internally go to recover stability when feeling stressed. Once the person has successfully learned to perform “safe place,” it is used in the reprocessing phase or to close a session. It is also useful in one’s everyday life between sessions when a person feels stress or a disturbance rising to a point they need to take out and use a coping tool from their internal toolbox.

‘Safe Place’ Protocol in EMDR

When “safe place” is taught to a person preparing for EMDR, the counselor will guide the person through the following steps shared by Shapiro (2001):

“Safe place” may be thought of as an emotional sanctuary where a person can internally go to recover stability when feeling stressed.

  1. The person is asked to picture an image of a place that generates feelings of calm and safety.
  2. The person is asked to focus on the physical sensations and emotions that are conjured while imagining the “safe place.”
  3. The counselor encourages a sense of security and may add soothing tones, such as ocean waves, to enhance the effect.
  4. While the person concentrates on the image, sensations, and emotions, sets of eye movements or other bilateral stimulation may be included to “install,” or strengthen, the “safe place.”
  5. The person is asked to think of a word to associate with the “safe place” and add this to the calm, safe image and sensations. Sets of bilateral stimulation are added.
  6. The person is asked to self-cue the image and feelings.
  7. The person is asked to think of a minor annoyance and its accompanying emotions. The counselor then guides the person through the exercise until the undesired emotions melt away.
  8. The person is asked to think of another disturbance and follow the exercise without the counselor’s assistance to ensure the person can perform the exercise unassisted.

The person should be instructed to practice “safe place” daily by retrieving the positive image, emotions, and sensations via the cue word. People can then use “safe place” to relax and reduce stress any time needed. Shapiro believes people preparing to be treated with EMDR can benefit not only the “safe place” visualization but also from listening to guided visualizations such as those included in Letting Go of Stress (Miller, 2014), as these may increase the the effectiveness of “safe place” as a means of self-control.

While “safe place” for EMDR should be taught by a qualified clinician, anyone can access guided meditation/visualization CDs and podcasts to help to manage stress, fall asleep at bedtime, and promote a positive self-image. These materials may be found for little or no cost through public libraries, iTunes, and online resources. Comments below sharing your favorite guided visualization/meditation resources are welcome.

References:

  1. Miller, E. (2014). Letting go of stress. San Anselmo, CA: Halpern Inner Peace Music.
  2. Shapiro, F. (2001). Eye movement desensitization and reprocessing: Basic principles, protocols, and procedures (2nd). New York, NY: The Guilford Press.
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