Too Much Depression, Too Little Sleep: 3 Things You Can Do to Get a Better Night’s Slumber

The worst thing in the world is to try to sleep and not to. – F. Scott Fitzgerald

When first diagnosed with depression, my sleep became fragmented in a way I had never experienced before.

Before this time, I, like most frenzied lawyers, had periods of restless sleep tinged by stress and anxiety. But my sleep would return to normal after a lengthy trial or round of contentious depositions.

But this was different.

Lots of Depression, Little Sleep

I was always tired, but couldn’t sleep through the night. I went to bed early, exhausted from trying to make it through another day with depression. Trouble sleeping is a symptom of major depression.  Kay Redfield Jamison, M.D., a psychiatrist, writes:

The body is bone-weary; there is no will; nothing is that is not an effort, and nothing at all seems worth it. Sleep is fragmented, elusive, or all-consuming. Like an unstable, gas, an irritable exhaustion seeps into every crevice of thought and action.”

Can Creativity Cure Depression? An Interview With Dr. Carrie Barron

creativity cure book

Dr. Carrie Barron, a board-certified psychiatrist/psychoanalyst on the clinical faculty of the Columbia College of Physicians and Surgeons who also has a private practice in New York City.  She has published in peer-reviewed journals, won several academic awards, and presented original works related to creativity and self-expression at national meetings of the American Psychoanalytic Association. Along with her husband, Alton Barron, M.D., a hand and shoulder surgeon, she co-authored the book, The Creativity Cure: How to Build Happiness with Your Own Two Hands.

Dan:

Why is depression such a problem in our culture?

Carrie:

I think the level of stress has gone up enormously because we have so much to do and we’re on twenty-four hours a day. So I think because of technology, which offers us so many great things, but gives us much to do. I think that’s part of it. I also think, especially for children, we’re in a striving, ambitious, be productive all the time mentality – for children and adults. We need to play, we need to hangout, we need to have spontaneous time. I think spontaneous thought does a lot for alleviating depression and anxiety.

Rewire Your Burned-out Brain

Burnout often results from extended periods enduring the emotional stress precipitated by unaccomplished expectations or failure to fulfill unreasonable demands. The symptoms can include intensified emotional exhaustion, physical fatigue, lowered self-worth, changes in eating and exercising habits, social withdrawal, sleep disorders, anxiety, and depression.

If You’re Burned Out, Your Brain Has Rewired to Survival Mode

There are specific and reproducible patterns of changing neural activity and brain connectivity associated with the stress buildup that leads to burnout. In the high-stress state subjects’ neuroimaging scans reveal less activity in the higher, reflective brain (Prefrontal cortex/PFC) and more activity in the lower, reactive brain that controls involuntary behaviors and emotional responses. Prolonged stress correlates with structural increases in the density and speed of the neuron-to-neuron connections in the emotion-driven reactive networks of the lower brain and corresponding decreases connections in prefrontal cortex conscious and reflective control centers.

The explanation of these changes is attributed to the brain’s neuroplasticity defined by the phrase: “neurons that fire together, wire together.” The brain literally rewires to be more efficient in conducting information through the circuits that are most frequently activated.

When stress is frequent, the more frequent activation of the neural pathways to the lower, stress-reactive brain results in their strengthening from enhanced wiring (dendrites, synapses, myelinated axons). These pathways can become so strong that they become your brain’s fast route to its lower, reactive control centers. The stressful, burned out state when the lower, reactive brain is in charge overcomes the calm, reflective, and productive higher neural processing in the (PFC) – the preferred brain locale for control of behavior and emotional self-management.

As your efforts to achieve unreasonable goals are thwarted or increasing demands recur, and the lower brain dominates more frequently, you lose touch with your reflective brain. With less management coming from your reflective PFC, it becomes harder and harder to logically see these challenges in realistic perspective or to solve problems creatively.

Disappointments take on more emotional power and without your higher brain’s perspective, they are interpreted as personal failures. Your self-doubt and stress further activate and strengthen your brain’s involuntary, reactive neural networks. The spiral down to burnout accelerates as these circuits become the automatic go-to networks. Your brain achieves less success in problem-solving and emotional control and ultimately reacts by withholding efforts to escape the burnout state.

Reset Your Brain’s Default Neural Network from Retreat to IGNITE!

The good news is you can apply what we’ve learned from neuroscience about your brain’s survival mode to take actions to retrieve voluntary control of your choices and emotional wellbeing.

You can activate the same neuroplasticity, that gave dominance to the lower brain networks in the burnout state, to construct a new, stronger positive default response. With increasing successful experiences in achieving goals, you can reset the circuits to redirect your brain to access its highest cognitive resources. You can build up newly improved circuitry switching your responses from retreat to IGNITE for mindful awareness and creative problem-solving!

Since an effort-failure pattern sets up the brain’s survival response to withhold effort, you’ll need to strengthen your brain’s recognition that effort toward your goals can result in success. Your weapon of mass reconstruction can come from your brain’s very powerful drive for its own intrinsic neurochemical reward— dopamine and the deeply satisfying and motivating pleasure it brings. When the brain releases dopamine in rewarding bursts, you experience a deep intrinsic satisfaction along with increased motivation, curiosity, perseverance, and memory. Dopamine is particularly released when your brain recognizes that you’ve achieved a challenge (from the “I get it” of figuring out a joke to the satisfaction of completing a marathon).

To get the dopamine-pleasure response from challenges achieved, you’ll need to plan for your brain to experience frequent recognition (feedback awareness) of incremental progress. The choices of what you set as a goal should be guided by their desirability and the goal’s suitability to be broken down into clear segments. You want to set goals, the progress of which, you can chart or easily recognize with each stepwise challenge and success. The pleasure burst of dopamine’s intrinsic motivation accompanying your brain’s recognition of each progressive increment achieved in the goal pathway will keep you motivated to persevere.

Goal Buy-In for Your Brain’s Neural REWIRING

Buy-in and relevance are important in choosing your rewiring goal. Since your goal is to rewire your brain’s expectations that your goal efforts do yield progress, despite increasing challenge, you need to really want the goal. This is not the time to challenge yourself with something you feel you should do, but won’t really look forward to, such as dieting, climbing stadium stairs, or flossing after every meal.

The idea of planning and achieving goals as a burnout intervention is probably not new to you. These are likely to be activities you’ve considered but didn’t do for the obvious reason. They take time. when it comes to adding another activity to your schedule, past experiences have left you with the expectation that there is not enough time.

These first goals that can provide ongoing awareness of your progress are often tangible (visible, such as planting a garden or making pottery on a wheel, or auditory such as playing an instrument, or physical such as learning tai chi), but your goal can also be spending more time at something you already do, but want to do more frequently or successfully, such as journaling, practicing yoga, or sketching.

You’ll Find Your Own Goal for Buy-In, but Here are Some Examples of Planning 

Physical goals: Notice I didn’t say exercise. That’s not as motivating as “training” for a physical goal you want to achieve, even though they often overlap. If you want to run a 10K, and you enjoy running, the goal for an achievable challenge could first be building up to the distance starting with your baseline distance you comfortably run now. Then, plot out the increments that you’ll consider progressive successes, such as adding 100M each day or a week (with increments based on what you consider both challenging and achievable). Once you reach 10K goal, speed can become the next goal again plotted out in segments of incremental progress before you start.

Hobbies: From woodworking to shooting wooden arrows, hobbies really are opportunities for brain rewiring. Again, plan your stepwise achievable challenge increments. If you select darts, start with a home dartboard—low initial investment and throw from a close, but challenging distance at first. As you get better in accuracy move back further. Record your results with the notations of the distance of each improvement you set as an achievable challenge. If you get so good that you are no longer challenged by the dartboard, try that archery!

Mindfulness and meditation are certainly positive interventions for burnout and will be topics of a subsequent blog.

Your Rewired Brain’s Default Changes from Defeat to Ignite

With your understanding of what happened in your brain to create the hopeless frustration of burnout, you’ll hopefully have more positive expectations to help you put in the effort to try (or retry) suggested interventions. Your own natural dopamine-reward system will then be at work deconstructing the resistance network built by your burnout as you reset your circuits of motivation.

The repeated experiences of dopamine-reward you’ll experience as you monitor your goal progress will literally change your brain’s circuitry. Repeated effort-reward experiences promote the neuroplasticity creating neural networks that expect positive outcomes in your new default network. This is because your brain will build stronger connections into the memory pattern. The expectation in achieving this challenge will bring pleasure. As with other less used networks, the previous lower brain stress-activated go-to response network you developed in burn-out, that caused you to react negatively to stressors, will be pruned away from disuse.

You’ll be rewired with optimism and renew positive expectations about your self-efficacy. With your higher, reflective brain back in control, as you access your perseverance, innovation, and creative problem-solving when you need them.

Just be sure to take the time to break down big challenges into opportunities to recognize incremental progress as you achieve each small step en route to your goals. With that positive recharge, your well-deserved dopamine reward will sustain your brain’s motivated perseverance on to the next step of the path to your goals.

Dr. Judy Willis is a board-certified neurologist and middle school teacher, specializing in brain research regarding learning and the brain. With a unique background as both a neurologist and classroom teacher, she writes extensively for professional educational and parenting journals and has written six books about applying the mind, brain, and education research to classroom teaching and parenting strategies. The Association of Educational Publishers honored Dr. Willis as a finalist for the Distinguished Achievement Award for her educational writing. Check out her website.

 

 

The Creativity Cure for Depression: An Interview with Dr. Carrie Barron

Today’s guest is Dr. Carrie Barron, a board-certified psychiatrist/psychoanalyst on the clinical faculty of the Columbia College of Physicians and Surgeons who also has a private practice in New York City.  She has published in peer-reviewed journals, won several academic awards, and presented original works related to creativity and self-expression at national meetings of the American Psychoanalytic Association. Along with her husband, Alton Barron, M.D., a hand and shoulder surgeon, she co-authored the book, The Creativity Cure: How to Build Happiness with Your Own Two Hands.

Dan:

Why is depression such a problem in our culture?

Carrie:

I think the level of stress has gone up enormously because we have so much to do and we’re on twenty-four hours a day. So I think because of technology, which offers us so many great things, but gives us much to do. I think that’s part of it. I also think, especially for children, we’re in a striving, ambitious, be productive all the time mentality – for children and adults. We need to play, we need to hangout, we need to have spontaneous time. I think spontaneous thought does a lot for alleviating depression and anxiety.

Dan:

We have so many different words in our culture for unpleasant experiences. We might say things like, “I’m sad,” “I’m burnt-out,” “I’m stressed-out,” or “I’m depressed.”  But what is the difference in your mind, as a clinician, between sadness, say, and depression?

depressed-83006_960_720

Carrie:

Sadness is a normal emotion. We don’t have to treat everything and be afraid of sadness. We don’t have to pathologize everything. There is a range. I mean, life can be very hard and it’s appropriate not only to have it, but let yourself have it. Sometimes it is actually moving towards the authentic feeling, rather than running away from it, that actually makes it go away. You first have to experience it, and then when you understand it, and you’re in it, it runs its course. Now, this is separate from a true major depression where you can’t get up in the morning. That’s another story. But sadness is a normal part of life.

Dan:

In your clinical practice, how often would you say depression has played a role in why people have come to see you?

Carrie:

I think it plays a role often. The categories that we have in the DSM-5, I think they’re useful so that clinicians can communicate with others. But nobody is fully described by a category or diagnosis. There’s a lot of overlap. When people are depressed, they’re also often anxious and also stressed, and sometimes it’s more one than the other. But depression does come up a lot for people and it’s very painful. I think not being able to get up in the morning, not feeling like doing anything, not being able to enjoy the sunny day or the view of the water, or whatever else people are getting into, it makes you feel very separate and alone when you are depressed and other people around you are not.  So it has, kind of, a trickle-down effect, too.

Dan:

Why did you write the book, The Creativity Cure? I found it such an interesting book, a fascinating read. You wrote it with your husband who is a surgeon. Can you tell our audience why you wrote it?

creativity cure book

Carrie:

There are two things.  I talk about this now, I didn’t talk about this in the book, when I was a kid, I had some problems. I was depressed. I was anxious. We weren’t taking meds at that time. There was some chaos in my world.  I really had to find a way to survive. When I look back on it now, all those things that I recommend in my book are things I was doing, or trying to do, like using my hands. I would cook a lot. I would take long walks.  Then, later in my practice, maybe ten years ago, patients were saying, “You know, I went home and I fixed my sink and I became euphoric! I felt great!” I started to realize that meaningful hand use has a lot to do with happiness. And yet, because so much of what we do now is accomplished with a click on a device, we’re deprived of the process. And process, being deeply immersed in making, or making music, brings with it the possibility for euphoria, and satisfaction, and feeling good about living. So creativity is really about a way to have an optimal life. How you define creativity is another matter.

Dan:

What’s going on in the body, in particular, the brain when someone is struggling with depression? And how does creative action interact with that?

Carrie:

I think a lot of studies have been done, and serotonin and neurotransmitters, there’s a depleted state, and that we need to boost it up with medication or activities that do the same. Vigorous exercise can create the same biological state that antidepressants can. I want to qualify this and say that one must see their physician and make an informed decision, but certainly exercise can help a lot. Also, meaningful hand use has been shown to boost mood. Dr. Kelly Lambert wrote a book, Lifting Depression: A Neuroscientist’s Hands-On Approach to Activating Your Brain’s Healing Power, and she was the one who talked a lot about how purposeful hand use can affect brain chemistry and make people feel happier.

Dan:

What would be some examples of using your hands? When we think of creativity, many people might think of painting, for example. They might say to themselves, “Well, I’m not a good painter,” or “I don’t play an instrument.” But creativity isn’t really limited to that. Can you expand on that?

red knitting

Carrie:

Sure. I am so glad you asked that. I think this is the crucial question. And I think you hit the nail on the head. A lot of people say, “I’m not creative.” Well, first of all, I think we’re all born creative. It’s a matter of finding what you can do. It can be applied to business. You can be amazing. You could be a genius at figuring out what the team needs to be. That’s very creative. You could be an amazing cook. You could have a tremendous talent for decorating. Gardening, the design of a garden. It doesn’t have to be on a professional level. It’s really a matter of figuring out what you can get into. You may find that if you put some time into mastering a skill that you find a certain pleasure and freedom with it. That could be something like painting, but it doesn’t have to be. Knitting, crafting, it could even be fixing things. All of that involves meaningful hand use.

There are many definitions of creativity.  My definition of it is allowing most natural self to emerge to make a positive contribution. It’s allowing you a freedom, a spontaneity in the way that you live, a feeling of safety that allows you to do that so you’ll throw out an idea, you’ll say something funny in conversation, so that you are just yourself and it works. That’s really optimal living.

Dan:

You talked earlier about when you were younger and growing up having some difficult childhood experiences and learning some creative coping skills.  Myself, when I think about this, I had a very difficult childhood as well with an alcoholic, abusive father. Over time, I didn’t have what I would now think of as depression as a young adult. It developed more at midlife when I turned forty.  It seems that there’s a lot of research that suggests that when people in their childhoods have difficult experiences, either emotional abuse, or physical abuse, or deprivation, there’s some kind of linkup with adult-onset depression. Have you found you found that in your experience?

Carrie:

Yea, I think so. I think because in certain ways when you’re in your twenties and your thirties and you’re striving, and you’re distracted and you have a strong goal, that, in and of itself, that kind of commitment to a goal or emotion can stave off certain aspects of your memory or your inner life and it might get triggered in your forties.  Maybe when you have a little bit more time to contemplate or think back. I will say that there are certainly ways, I just like to not be falsely optimistic, but be really optimistic and really encourage people to understand that there are ways to look into your particular history, your particular form of depression, and work with it to get to a much better place at any age.

Dan:

In your book, you talk specifically about not only being creatively engaged, but the use of one’s hands, a physical activity, and how that somehow connects to creativity, no matter your history, or the causes of your depression. This seems to work for just about anybody with depression or unhappiness. Would you say that’s the case?

Carrie:

I do. I think it’s mild or moderate depression. I think if you have a very severe depression, you might need some medical intervention or an intense therapy. But what I like to say is that if you develop a creative habit, it’s very useful to fall back on it when you are depressed. You may not be able to master a new habit when you’re severely depressed, but if you’re mild to moderate, and you work on your knitting, or you work on your painting, or you go into the kitchen and you are inventive about your cooking, it really can shift mood, but not if you’re in a very crippled state. In a crippled state, you need to get to, sort of, a better place, and then use the creativity after that.

Dan:

You’re living in New York City, but you’re soon to be on the move. Tell us a little bit about that.

Carrie:

I’m very excited because I am going to be moving to Austin, Texas soon.  I’m going to be involved in, and working with the great people to try to develop a creativity/wellness program together. I’m not sure exactly, I haven’t submitted a proposal to them about human flourishing and aspects of human flourishing, but from my research, I outline 10 principles that are based on scientific research, but also on ancient philosophies that really help people with optimal living. Most of those are, actually, linked to creativity and linked to better health. So I’m really excited to get to work with people there.

Dan:

You actually have a website. Where can our podcast listeners and readers find you?

Carrie:

At carriebarronmd.com and we have a pretty active Facebook page has a wide following. People make lots of comments and have lots of pretty interesting things to say on that.  So that might be a place to look. And I do have an active Psychology Today blog. I try to keep it lighter for Facebook, kind of short for my website. On Psychology Today, I try to deal with deeper, more complicated issues, but try to be useful.

Dan:

Carrie, it’s been a real pleasure speaking with you today on this very important topic of depression and what we can do about it with creativity.  And we look forward to following your future work.  I hope everybody follows Carrie on her website and reads her blogs. This is Dan Lukasik from Lawyers with Depression. Join us next week for another interesting interview.

Other People’s Judgements About Our Depression

We all dish out opinions and advice whether asked for or not.

Much of it harmless; some, necessary and kind.

Then there’s those we dole out without knowing what the hell we’re talking about. Where we should tread carefully, we lumbar.

For better or worse, there’s tremendous power in words we use to express our opinions.  When vulnerable – as we are during depression – the critical or misguided words of others take on the ring of gospel truth. Some may blame us for our depression.

In one poll, 54% of Americans said they thought of depression as a “personal or emotional weakness”.  This explains much of stigma surrounding not only depression but all mental illness.

In a recent survey, what do 43.8 percent of women state as the Number 1 reason for not telling someone they were depressed?

“Others would think I am weak or think less of me.

What do 57 percent state as their Number 1 reason?

“I believe I will get over it by myself”, followed by the same reason as women, the fear of being seen as weak, at 32 percent.

In the book, Unholy Ghosts: Writers on Depression, author Susanna Kaysen writes:

“The Failure of Will theory is popular with people who are not depressed. Get out and take your mind off yourself, they say. You’re too self-absorbed. This is just about the stupidest thing you can say to a depressed person, and it is said every day to depressed people all over this country. And if it isn’t that, it’s, shut up and take your Wellbutrin. These attitudes are contradictory. Conquer Your Depression and Everything Can Be Fixed by the Miracle of Science presuppose opposite explanations of the problem. One blames character, the other neurotransmitters. They are often thrown at the sufferer in sequence: Get out and do something, and if that doesn’t work, take pills. Sometimes they’re used simultaneously: You won’t take those pills because you don’t WANT to do anything about your depression, i.e. Failure of Will.”

Some just don’t think of it as the illness it is, but an excuse not to work hard.

Years ago, when I first told my three law partners that I was diagnosed with major depression and would need to take time off from work.  They sat there stunned. After a moment of awkward silence, one partner said, “What in the world do you have to be depressed about? You’ve got a great job, wife, family and friends. Take a vacation!”

His anger humiliated me.  “What’s wrong with me?” I thought.

I later learned that his reaction was, sadly, all too common. His judgment was that a lack of gratefulness was at the root of my distress. If only I jetted to Florida and sat under a palm counting my blessings, I would be depression-free.

For some time, these types of comments hurt me.  They made me feel less-than. But after a while, they often made me angry. I thought, “What the hell do I have to do to be worthy of their mercy?” In retrospect, it wasn’t a question of my worthiness, but their ignorance. They didn’t have an emotional reference point for depression. They thought of it as stress, or, at worst, a bit of burnout.  I recall a surgeon friend of mine (you would think that he, as a medically trained person, would know better!) telling me I was just in a “funk.” And then he said, “You want to see people who really have a right to be depressed?  You should see the poor people with little money take two bus rides just to get to my office!”

Another painful innuendo.  I had no right to be depressed, he must have thought.  I was an upper-middle class professional, after all.

Some people (friends, family and business associates) will never be able to overcome the inertia of their own ignorance. They’re not bad people. It’s just the way life is. And we have to learn to be okay with that.

One of my best friends who has struggled with depression the past five years is frustrated by his wife’s lack of interest in talking to him about his depression.  “Why doesn’t she love me, Dan?”  “It’s not that she doesn’t love you,” I replied.  “It might just be that she’s not capable of understanding in the way you want her to.”

But then there are others. These precious souls – and there don’t have to be lots of them – who have our back. They truly want to understand and help. Mother Teresa was once asked by a hard-boiled reporter what God expects of humanity. I think the reporter expected some stock answer. Mother Teresa, in all her gracious dignity, said that all God really wants from us to be is a “loving presence” to one another. There are those in our lives who want to be that presence to us.

Give them the chance to be that light.

 

Biology of the Binge: The Biochemical Link Between Depression and Food

Many of us have experienced the instantaneous connection between food and mood. We may find ourselves crunching nervously through bags of potato chips when under pressure for example, or slurping down containers of cool and silky chocolate ice cream in distracted attempts to soothe our sadnesses. However, while an occasional hankering for sweet or starchy “comfort foods” is both normal and expected, for some, the link between negative feelings and out of control eating is far more profound. Recent studies suggest that the suspicious overlap in symptoms of major depression and food addiction may be due to deep biochemical connections that have gone largely ignored in treatment programs until now.

cake

The coexistence of psychiatric diagnoses and problems with appetite is shocking common. One research study concluded that approximately 80 percent of patients with binge eating disorder (BED) and 95 percent of patients with bulimia met the criteria for at least one other diagnosis outlined in the Diagnostic and Statistical Manual of Mental Disorders. Overweight men and women are 25 percent more likely to suffer from mood disorders than the rest of the population. Between 15 percent and 40 percent of patients with eating disorders also struggle with substance abuse.

Strikingly, 75 percent of patients with eating disorders also suffer from depression. For those individuals with binge eating disorder who are overweight, one study found that rates of depression are even higher than for individuals who are overweight but do not have binge eating disorder. In this particular study, researchers found that symptoms of depression led to binge eating episodes. Other studies have found that depressive symptoms, including low self-esteem, predicted increases in binge eating, demonstrating further evidence of the relationship between depression and binge eating. These results suggest that for some binge eating is a way to regulate emotion, however they also reveal that there is something more to the association between food addiction and depression than previously thoughtsomething disruptive, persistent, and physiological.

A look into the intricate neurochemical underpinnings of depression and binge eating disorder provides a clearer understanding of the biological nature of their troubling comorbidity. Interestingly, depression and food addiction both involve alterations in neurotransmitters, the substances that relay messages from one brain cell to another and then to the rest of the body. We know that imbalances in any of the neurotransmitters can wreak havoc with brain circuitry and predispose individuals to mental and physical distress. Normal levels of serotonin, the neurotransmitter linked most closely to satisfaction, lead both to emotional satisfaction and a sense of fullness after a meal. Low levels, on the other hand, can lead to depression and a tendency to binge on sweet and starchy foods. In fact, one study looking at how depression and a gene associated with lower levels of serotonin related to binge eating found that depressed children and older females who carried this gene were more likely to engage in binge eating behaviors.

In the context of a biochemical perspective on binge eating, this correlation makes sense. For some binge eating foods begins as a way to find a moment of much needed relief from depressive tendencies, and to fill the emotional void left by a lack of serotonin. However, what begins as a seemingly innocent attempt to self-soothe, quickly gives way to a complex cycle of addiction in the body. The flood of endorphins from eating large amounts of food only temporarily alters the neurochemistry of the brain, providing brief periods of solace from emotional distress; but these are not lasting. Ultimately, the demand for food intake to achieve such pacifying effects only increases over time and the coping mechanism completely fails, exacerbating instabilities with mood.

More research is needed to examine the precise mechanisms by which a serotonin deficiency can affect food, appetite, weight gain, and mood, and the causal nature of this overlap. However it is evident from the current body of scientific literature, that a holistic approach to investigating the interplay between an individual’s relationship to food and co-existing mood disorders is essential in order for successful recovery opportunities to exist. Treating one problem in isolation is not enough. It is only by comprehensively assessing the neurochemical commonalities underlying such complex psychological conditions that sustainable treatment solutions become possible.

By Stephen B. Jones, M.D., psychiatrist.

Post-Prozac Nation

From The New York Times, an important new article which addresses what we now know about depression, antidepressants and serotonin.  Important read for anyone who takes medication.  Read the Story.

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