How intolerance of uncertainty makes you anxious

Intolerance of uncertainty

One of the main constructs linked with anxiety is intolerance of uncertainty.

Uncertainty is a peculiar companion of our life, not particularly loved by most of us but surely always present. Daily life situations, economical and political unstable scenarios doubtlessly intertwine to trigger issues related to our threshold of tolerance of uncertainty.

But why is uncertainty such a scary monster for some of us? 

If we look at our daily life through a magnifying glass, we will notice that it is permeated by little daily elements of uncertainty. All things considered, no one has a crystal ball to make well-thought-out decisions and to know for sure what the future will bring. Therefore a dose of uncertainty is normal to experience in life.

We are all different in how we react to uncertainty, but for some of us it can be a cause of intense unease and distress.

If you have trouble dealing with uncertainty, you may find yourself trapped by worry and negative thoughts.

The main feature of worry is that it hinges on a chain of negative possibilities, one followed by another, that brings forth a catastrophic and doomed scenario, in our mind much more likely to happen and scarier than it actually is.

Most of the time habitual worriers believe that thinking and anticipating all the possible negative outcomes helps them feel safer and more prepared if the depicted scenarios become real.

Conversely, relying on worry is usually far from being a constructive strategy, as one may easily get lost among negative scenarios and feel confused and scared.

Among worriers’ preferred coping mechanisms, they also avoid uncertain situations and keep things under control as much as possible. The reason this happens is that we often associate uncertainty with a potential danger and a negative outcome, despite the fact that such outcome might not even occur in the first place.

How to deal with uncertainty? 

Accepting that uncertainty is unavoidable and constitutes an inevitable part of our life is helpful and a good starting point. Focus on what you can actually change and improve (and therefore on what you have control of), such as your reactions to uncertainty: decrease your anxiety level through relaxation techniques, do not avoid situations with potentially unknown outcomes by default and challenge your negative thinking. Talking about it with a therapist may definitely help.

Fear of flying

Fear of flying

Despite being one of the safest means of transport, fear of flying is a common anxiety problem for many of us.

Boeing Corporation found out that 17% of Americans declare to be scared of flying and that this fear is the third most popular reason for avoiding planes (Laker M, 2012). Furthermore, it seems that around 6% of the population suffers from a diagnosed plane phobia, the so-called aviophobia.

This means that if you are afraid of flying, you are most definitely not alone.

Different shades of anxiety

Fear of flying can manifest itself in different ways and its consequences can affect us by impacting several aspects of our life. In less severe cases, it may just generate mild and unpleasant uneasiness when travelling, while for others, it may cause intense anxiety well ahead of time, making our airborne journey a very distressful and negative experience.

Anxiety can be managed using any sort of safety behaviours like choosing a specific seat or side of the plane, or having specific rituals before the flight such as checking the weather forecast, as well as self-medication (homeopathic or non-homeopathic) or a glass of wine aboard to calm the nerves. Again, for others, the idea of flying may be terrifying to the extent that setting foot on a plane is utterly inconceivable.

Triggers of fear of flying

Different factors may trigger this fear, such as being exposed to a traumatic event related to flying (directly or indirectly), or behaviours taught by a “model” of behaviour (the so-called social learning), or suffering from other phobias (i.e. claustrophobia or fear of heights) or other psychological disorders.
Specifically if you suffer from a panic attack disorder and you experience one of them during a flight, it is most probable that you will be very anxious in future flights; instead if you suffer from a generalised anxiety disorder, it is very likely that you will be very distressed when travelling in general.

Cognitive factors

Several psychological factors affect this problem.

Very often, flying phobia stems from the lack of control experienced while on a plane.

Avoiding to fly is a maintaining factor and will worsen fear in the long-term, as fear has to be faced to be overcome. Some cognitive biases can contribute to the fear of flying, like the tendency to catastrophise noises, turbulences and our own bodily reactions and emotional responses (as possible cues of an upcoming disaster), cognitive distortions (by perceiving a low-probability event as a highly possible one) and intolerance of uncertainty.

Fear of flying: treatment

If you feel that your fear of flying is negatively affecting your life, lifestyle, work and relations by limiting your degree of freedom, you should think about asking for help.

A Cognitive behavioural psychotherapist can help you manage anxiety by changing the negative beliefs and biases in which your fear is rooted; psychotherapy indeed can help you to start enjoying the pleasure of flying and travelling again.

References
Laker M, “Specific Phobia: flight”; Activitas Nervosa Superior 2012, 54, no 3-4.

Why intimacy stirs up conflictual emotions?

Intimacy

Creating intimacy with a person, either a partner, a friend or even our therapist, is not always a smooth and easy process for everyone. In this instance, the word intimacy means not only a relationship characterised by physical closeness, as we may spend a lot of time with a person without being intimate with them. For an intimate relationship is meant as an emotional relationship connoted by affection, familiarity, mutual support and sharing of our thoughts and emotions. Being intimate with someone entails revealing our deepest secrets, weaknesses and vulnerabilities: this is the reason why it is sometimes hard to get so intimately close to someone.

The role of our past experiences

Our personal way of dealing with intimacy usually reflects a pattern that we have learnt through experience during our life. Our early-years experiences and relationships seem to affect this pattern the most.

This pattern has been discovered by psychiatrist John Bowlby in the 30’s, who named it attachment style. The original theory has been enriched and expanded thanks to the work of many authors and it still remains the benchmark for understanding people and relationships.

Attachment theory suggests that each of us has its own specific attachment pattern based on deep and established expectations rooted in our infancy, but that keep on influencing us during our whole life.
These expectations include specific beliefs about:

  • how much we feel to be love-worthy
  • how much the attachment figure (our parents in our early years/our partner in our adult life) will be availableand loving
  • the outcome of the relationship: positive, rejective or unpredictable.

These patterns are usually well recognisable in our relationship history: in our adult life it is indeed very common to find ourselves in relationships where specific patterns tend to be replicated and as a consequence where specific issues are re-experienced.

In the best-case scenario, people with a secure attachment style will choose a “secure-attachment” partner. They will create long-lasting relationships based on trust and where intimacy and independency are well balanced.

But for around 40% of people, the scenario is more complicated as they carry an insecure attachment from their childhood.

Intimacy and ambivalence

Sometimes, as intimacy implies opening up to the other person and showing our weaknesses, some of us may feel intense and conflictual emotions. Indeed some of us may intensely covet being intimately close to a person but at the same time may experience intense fear of being hurt, used or rejected, or intense anger of being so vulnerable, thus the relationship will be accompanied by an intense anxiety. These emotions, if experienced altogether in a close relationship, can be very confusing but if we refer to attachment theory, these reactions are totally understandable.

Ambivalent attachment adults experienced in their childhood unpredictable caregivers, who in certain instances responded properly to their emotional needs and in others did not respond at all. This unpredictability didn’t allow the kid to form a stable image of the caregiver and of himself as love-worthy. As a consequence these kids intensely suffered separation, as they were not so sure if the caregiver would be back, and they desperately attempted to be as close and dependent as possible to the caregiver. At the same time they did not enjoy the time spent with them, as they were already fearing the future departure. This ambivalent attachment is re-experienced in adult relationships: the person intensely swings between being dependent and very close to the partner and feeling angry, jealous, not wanted or rejected.

Another type of attachment is the avoidant style: people who keep distances in relationships as a protective way for avoiding being hurt or rejected.

Even if attachment plays such an important role in our relationships, the good news is that it is not stable. Attachment style can change during lifespan: as Patricia Crittenden theorises, there are particular moments in our development that represent potential shifting points, where attachment can be reorganised towards a more secure organisation.

Change is possible thanks to its acknowledgment, new experiences, new positive relationships and psychotherapy.

Seven cognitive shortcuts that may worsen your problems

Our mind often plays bad tricks on our discerning and rational abilities, without us being aware of what is happening.

Cognitive biases are a form of cognitive ‘errors’ or shortcuts leading us to evaluate situations, events or people in a distorted and almost irrational way in a very short period of time.

To read my entire article published on Counselling Directory, click here.

The not-so-imaginary invalid: health anxiety

Health anxiety

Health anxiety is very often underestimated. Let’s see what happens in the mind of an hypochondriac.

A little tingling in our cheek, an anomalous heart beat, maybe slightly faster then usual, a pain in our back that doesn’t seem to leave, a particular ache in a muscle… and in a blink of an eye we are immediately alerted, fully focused on our bodily signals scanning any potential change.

So many worries come to our mind: what is this? Am I having a heart attack? Is this cancer? Or maybe an aneurysm? All raised by a tremendous amount of anxiety.

If it happened to you, how would you behave?

It would be quite normal to gather information from books or the Internet about signs and symptoms of the disease you think you may have and very probably you will urgently book an appointment with your GP asking him/her to run several medical tests.

But what happens to some of us is that books and the Internet will provide much information and many negative scenarios that will scare us even more, and very likely we may focus only on the information that confirm our worries. Moreover, even if test results will show that nothing is wrong with our body, we will feel reassured only for a short period of time, until the next strange body signal appears, which will prompt us to request other specialist exams. And so on…

What is happening?

What was once a normal and understandable way to react to possible abnormal symptoms has become a pervasive and exaggerated way of dealing with our body, which creates intense distress in the person experiencing it and hence several negative consequences and limitations to their everyday life.

This is the so-called hypochondria or health anxiety, a distressful condition where a person’s beliefs and worries are often considered by others as imaginary or fake, making the person feel even more misunderstood and lonely.

On the contrary, health anxiety is a real problem, the person’s symptoms are real and the worries are extremely distressful.

Health anxiety treatment

The good news is that health anxiety can be treated and cognitive behavioural psychotherapy is the most recommended form of therapy in these instances. CBT can indeed help you in acknowledging and changing the cognitive misinterpretations that maintain the problem and in finding new coping mechanisms to better deal with anxiety.

Understanding the symptoms of anxiety

Anxiety

We all agree that being anxious and suffering from anxiety is something that we would rather avoid in the first place.

Anxiety is an annoying condition and if its intensity raises, its symptoms may scare the person and bring forth the sensation of not being in control of our body reactions. Experiencing very intense anxiety symptoms in our body may be so terrifying that for many people it may become itself an experience to be very scared of.

In these instances we are talking about what is so called “fear of fear” itself. Fear of fear can bring more intense consequences than anxiety itself, leading the person to avoid any possible situation where they may feel the unwanted anxiety symptoms.

Fear of fear is a very powerful and delicate mechanism that in most cases maintains and/or worsens the initial situation.

The first step to overcome fear of fear is getting to know the enemy.

Let’s try to understand together what is happening to our body when we are so anxious and why.

Understanding the symptoms of anxiety

The first thing that is important to know is that anxiety is an emotion that in our evolutionary history derives from the most primitive emotion of fear, but it has appeared in the history of the human being only after the development of our superior cortical functions. Anxiety is indeed linked to the complex ability of our brain to make long-term plans and assumptions about what could possibly happen in the future; on the contrary fear is a more primitive and archaic instinctive that implies an immediate reaction to a threat in the “here-and-now”.

Secondly, anxiety, like fear, is related to the perception of a threat, and it activates the same brain pathways that are activated by its fellow emotion of fear. In both situations, the automatic reaction that is induced in our body is the fight-or-flight response: our body prepares itself to fight the threat or to run away to ensure survival.

Each symptom that is experienced when we are anxious can indeed be explained and understood in the fight-or-flight perspective.

Let’s see the most commons symptoms that we experience when we are anxious and their physiological explanations:

  • Muscle tension: usually we feel our muscles contracted and rigid; if the anxious condition becomes prolonged in time, we may even feel some sort of pain. This happens because our body is preparing itself to fight the threat or to run away; as a consequence our muscles are in tension and ready to react immediately if it is necessary.
  • Tachycardia or heart palpitations: our heart rate tends to increase so that our heart may pump more blood to our muscles and send more oxygen. This helps our muscles to be better prepared to react to the danger.
  • Tingling or torpidity in our body’s extremities: we may feel tingling in our hands or feet. This happens because the majority of our blood flow becomes concentrated in our main muscles (for the reasons explained above) and not in the extremities. As a consequence this may be experienced as tingles, torpidity or cold hands and feet.
  • Difficulty breathing: we may experience the sensation of having trouble breathing. This happens because the contraction of our muscles may counteract the expansion of our lungs.
  • Air hunger: we may have the feeling of needing air. Very often during anxiety we experience hyperventilation; this means that we increase the number of breaths per minute but the quality our breathing worsens, as we tend to breath using only the higher parts of our lungs (thoracic breathing) and not our diaphragm. Hyperventilation introduces too much oxygen in our body, and the consequence is a worsening of the intensity of anxiety symptoms.
  • Goose bumps: muscle contraction involves as well the skin, causing goose bumps.
  • Stomach ache: very often we may experience stomach ache, as if someone punched us in our stomach, nausea or gastrointestinal problems. This happens because when the fight-or-flight response is activated, all the energy of our body is suddenly concentrated in facing the danger and digestion is interrupted, as it consumes a lot of energy that needs to be used to deal with the threat.
  • Blurred vision: we may have the feeling that our vision is blurred during intense anxiety episodes. What happens is that pupils dilate in order to let more light come in the eye and have a better sight of the danger. Our eyes focus better on details and peripheral vision worsens, giving us the feeling of blurred vision.
  • Dizziness and giddiness: we may experience those symptoms as a consequence of hyperventilation. As written above, hyperventilation brings more oxygen in our body. The consequence is the vaso constrictions of some brain blood vessels, so even if more oxygen is introduced in our body, our brain receives less of it and the consequence may be dizziness.

These are the most common symptoms that we may experience when we are anxious. As you can read, each of them has a specific physiological explanation related to the physiological reactions caused by the perception of a threat.

Taking care of your emotional states is a very important way of taking care of yourself.

Anxiety treatment

If you suffer from a serious anxiety condition, gathering information about what is going on is the first step but it doesn’t substitute specialist help. Psychotherapy and counselling can help you in better handling anxiety symptoms, dealing with hyperventilation and facing the perceived threats that foster your anxiety.

Irritable bowel syndrome: can psychotherapy help?

Irritable Bowel Syndrome

Irritable Bowel Syndrome (IBS) is a functional gastrointestinal disorder, affecting around 11% of the general population, that tends to be chronic and is certainly bothersome. Even if usually no inflammation or tissues alteration is present, IBS may be a very disturbing and distressing condition, that significantly worsens a person’s quality.

Irritable Bowel Symptoms

People suffering from IBS may experience a great variety of symptoms:

  • abdominal pain: its intensity is usually mild and not severe, it may follow food ingestion and stop after evacuation
  • cramping and/or bloating
  • constipation or diarrhea
  • gas and/or mucus.

The risk factors of IBS are: being woman, being under 45, having a familiar history of IBS and having a mental health problem.

The causes of IBS are still unknown, but it is very likely that several concomitant factors may play a role.

Furthermore, stress seems to have an impact in worsening the syndrome. In particular, the stress condition caused by suffering from IBS may itself create a vicious cycle, fostering IBS symptoms and consequently creating more anxiety. Moreover, it seems that up to 70-90% of people suffering from IBS may experience psychological difficulties, more likely mood or anxiety disorders.

What is neuroscience telling us?

The tight relationship between our brain and our bowel is not a novelty, but in the last decade neuroscience has given us amazingly interesting new information about it.

It seems that our brain and our guts are in constant communication, both influencing each other through top-down and bottom-up processes. But we are not talking only about digestion-related information: our guts have been defined by scientist M. Gershon like a real “second brain”.

Our “second brain” contains indeed around 100 millions of neurons that are responsible for digestion but also for making us experience the so called “gut feelings”, such as “butterflies” in the stomach. Furthermore, it seems that those feelings can have an influence on our mental states even if no conscious thought or decision-making can be undertaken by our second brain. In particular it seems that some specific macrobiota in our guts may impact the functions of our central nervous system; in mice, an impact on anxiety and stress-related behaviours has been found.

Can psychotherapy help?

If you suffer from IBS and you believe you are suffering from anxiety and stress, you may consider taking care of this to avoid a worsening of your IBS.

Research has showed high comorbidities of anxiety and mood disorders in IBS patients, the problematic vicious cycle that anxiety may create and the consequent risk of perceiving a poor quality of life.

Psychotherapy may help you with the aforementioned psychological issues, as our mind and our bowel are so deeply interconnected.

Furthermore, research has showed promising results on the efficacy of psychotherapy, in particular cognitive behavioural therapy and therapies involving relaxation techniques, in improving IBS symptoms, anxiety and the patient’s quality of life.

Suggested links

Irritable Bowel Syndrom Network UK

Bibliography

Al-Asmakh, M; Anuar; Zadjali, F; Rafter, J;  Pettersson, S. “Gut microbial communities modulating brain development and function”. Gut Microbes 2012 Jul-Aug;3(4):366-73. Epub 2012 Jun 29.
Blanchard, E; Lackner, JM; Sanders, K; Krasner, S; Keefer, L; Payne, A; Gudleski, GD; Katz, L; Rowell, D; Sykes, M; Kuhn, E;  Gusmano, R; Carosella, AM; Firth, R;  Dulgar-Tulloch, L. “A controlled evaluation of group cognitive therapy in the treatment of irritable bowel syndrome”. Behavioural Research and Therapy, April 2007, vol 45(4):663-648.
Garakani, A; Win, T; Virk, S; Gupta, S; Kaplan, D; Masand, PS. “Comorbidity of Irritable Bowel Syndrome in Psychiatric Patients: A Review”. Am J Ther. 2003 Jan-Feb;10(1):61-7.
Kuo, B; Bhasin, M; Jacquart, J; Scult, MA; Slipp, L; Riklin, El, Lepoutre, V; Comosa, N; Norton, BA; Dassatti, A; Rosenblum, J; Thurler, AH; Surjanhata, BC; Hasheminejad, NN; Kagan, L; Slawsby, E; Rao, SR; Mackin, EA; Fricchione, GL; Benson, H, Libermann, TA; Korzenik, J; Denninger, JW. “Genomic and Clinical Effects Associated with a Relaxation Response Mind-Body Intervention in Patients with Irritable Bowel Syndrome and Inflammatory Bowel Disease” PLoS One. 2015 Apr 30;10(4):e0123861. doi: 10.1371/journal.pone.0123861. eCollection 2015.

Working mothers: when guilt becomes too much

Working mothers

Being working mothers of toddlers is a fulfilling and challenging experience that no one really prepares us to face. Everything is on the move: every day the child grows up a little bit more, discovers new things, new behaviours and its personality is being shaped. This usually makes us want to spend as much time as we can watching them growing up, playing with them, discovering the world with them and enjoying everyday moments.

But after our maternity leave, work calls us back to real life and this can become tricky. Often young families live far from their relatives and taking up a part-time position is not always possible. Very often the only solutions are kindergartens or qualified nannies, and for new mums it can be quite hard to leave their toddlers with strangers for a whole day. As a matter of fact, this may set off a feeling of intense guilt, possibly making the moment of separation very distressful for both the mum and as a consequence the child. In fact, if our child realises the mother’s distress during the moment of separation, he may think that there is something wrong and probably something to be worried about.

What is guilt?

Guilt is a complex social emotion, that implies different cognitive evaluations. To experience guilt indeed it is necessary that at least two people are represented in one’s own mind. In particular, the person who feels guilty believes he may have potentially damaged or harmed another person (voluntarily or not) or have transgressed a moral or a social principle. As a consequence of guilt, the “guilty” person usually tries to restore a sort of balance with the “harmed” one, helping out the person or finding a way to expiate this unpleasant emotion.

Why would mums feel guilty?

As written above, very often it occurs that new mums experience maternity far away from their country of origin and without the support of the original and the extended family. In addition, the most common scenario is mums that work full-time, while simultaneously take care of housework, their partner and their baby. In summary, multitasking is not a choice but a duty! We have to cover so many roles in our daily life and we try to do it in a good way: we want to work well for ourselves/our boss/colleagues or clients, we want to be good partners and for sure we want to be the best mothers for our children. But while in the best case scenario we may be confident about our work and our relationship with our partner, being a new mum is for many a totally new experience that may lead to many doubts and thoughts.

Usually the most common thoughts of new mothers are: am I doing the right thing? Am I interpreting the signals that my baby is sending me in the right way? Is he/she OK in the kindergarten? Is it normal if he/she cries at separation? Am I a bad mother if I leave him/her there all day long? Will there be consequences if I don’t spend enough time with my baby?

The direct consequence of those questions is obviously a strong sense of guilt. You may feel guilty at work because you left your kid at the kindergarten or you may even feel guilty towards your job if you spend a day at home with child because maybe he/she is sick…

Anyway, experiencing a bit of guilt is normal as we have so many roles and responsibilities, we try to do our best to multitask and doing everything in a perfect way is really difficult. Making mistakes is normal as well! When motherhood is a brand new experience, the only way to go forward is to put ourselves on the line and just try, make mistakes and learn from them.

But if you have the feeling that guilt is becoming overwhelming, it is generating too much anxiety, it is difficult to handle or it is affecting in a bad way the relationship with your child, then take a step back and try to think about what is happening.

Many times beyond a sense of intense guilt there is a strong sense of responsibility, an excessive perfectionism or fear of committing mistakes. Furthermore, often our own personal experiences as children may play a role as well, triggering old emotions and relational memories that may influence our attitude towards our child. And this influence may not be always positive.

If this happens, considering seeking the help of a psychotherapist may be a good choice, as it could help you deal with this sense of guilt and the aforementioned dynamics, as well better handling that special and unique relationship with your child.

Sleep Paralysis: an unsettling sensory experience

Sleep Paralysis

Sleep Paralysis is a very frightening experience that can sometimes happen during sleep.

Here it goes.

You are lying in bed in that special transitional state between sleep and wakefulness. You may be about to fall asleep, or you might have woken up in the middle of the night and are then trying to fall asleep again, or you may be just about to fully wake up in the morning.

In either case, what actually happens is that your mind is fully aware of being awake but your body is unable to move. It doesn’t matter how hard you try but no muscle will eventually respond to your orders. Obviously you might feel frightened and you will most likely have several thoughts crossing your mind, such as: What’s happening to me? Am I paralysed? I want to call for help but I’m not even able to open my mouth and utter a single word!

This temporary paralysis can last from a few seconds up to even 10-15 minutes. After a while you will eventually regain control of your own body but this represents quite a shocking experience that won’t easily be forgotten.

Another disquieting feature of sleep paralysis is the fact that most of the times it is accompanied by hallucinatory phenomena, adding to the experienced sense of fear.

The most common kind of hallucinatory phenomenon reported, is the perception of a threatening presence in the room, as if there were an intruder. Sometimes this presence is more intensively perceived through the senses than just merely detected: it could even be seen, heard or smelled. Those who have gone through this kind of unsettling experience can also report they were being touched or even attacked by this ‘alleged’ presence as though a weight was pressing them down on the chest, leaving them unable to move or preventing them from sitting up.

It is indeed quite a disturbing experience.

Another particular but less common hallucinatory phenomenon that can accompany Sleep Paralysis, is an Out-of-Body experience (OBE).

The person is paralysed in bed but has the feeling that their own soul is leaving the body, flying and floating in the room or even outside of the house, watching the body from an external perspective. Contrary to the intruder hallucination, this kind of experience is usually associated to very positive feelings.

Causes 

Sleep paralysis seems to be caused by a REM-sleep intrusion into wakefulness. REM-sleep is a stage of sleep where our muscles are almost totally atonic.

It is rare yet it can occur if the transition between REM-sleep and wakefulness is quick and sudden; as a matter of fact, the brain maintains the body in an atonic state ‘by mistake’.

Some authors suggest that the reason why hallucinations tend to accompany sleep paralysis lies in the activation of the so called ‘vigilance system’. The potential threat of the sleep paralysis experience activates this system, whose aim is to scan and monitor the environment in search of potential dangers. In this singular and ambiguous situation, the brain may very easily misinterpret environmental signals (Cheyne, 2002; Cheyne, 2007).

Experiencing Sleep Paralysis once in a while shouldn’t worry you excessively.

Sleep deprivation, having an irregular sleep-wake rhythm or going through a stressful period can well trigger this phenomenon.

Furthermore, sleep paralysis is a frequent symptom of narcolepsy.

If this phenomenon is recurrent then consulting a sleep specialist is warmly recommended.

The first panic attack is hard to forget

Symptoms of a panic attack

Suddenly your heart beats fast, like a drum; it’s difficult to breath and you have air hunger. Your stomach hurts, like if someone punched it. Your head is spinning, the world around you or your body seem suddenly unreal, weird.

You feel an intense fear or anxiety, that is increasingly worsening moment by moment. You are worried about going crazy, losing control or that something really bad could happen, maybe you are even afraid that you could die and you feel the sudden impulse to go out, breath new air.

After about ten minutes, everything goes back to normal. But worries about what has just happened still remain: did I have a heart attack? Am I getting crazy? Will this happen again?

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