The Meadows Blog

As Humans, we are intensely social creatures. Close relationships with other people are often the source of our greatest joy in life, but they can also be associated with tremendous pain and suffering. Early relationships with caregivers, siblings, and extended family are not merely a static backdrop to a mechanistic unfolding of human development - these relational experiences have profound effects on biological and psychological processes, for better or for worse. We now know that children come into the world with sophisticated neurobiological systems that are keenly attuned to the social environment and in turn these systems are shaped by the social milieu. This means that the narrative of the early social experience is written into the biology of the developing child, or in other words, nurture actually becomes nature.

Unfortunately, overt forms of childhood abuse and neglect are all too common and can result in serious long-term physical and psychological consequences. In fact, large research studies have shown that adverse childhood experiences can lead to serious health risks, including many forms of chronic illness and even shortened length of life. However, it is increasingly recognized that covert forms of relational trauma and emotional abuse can also lead to deleterious outcomes, particularly in the area of social-emotional development.

While the term "relational trauma" often connotes overt forms of maltreatment such as physical and sexual abuse, it can also be used to describe covert forms of maltreatment such as abandonment, enmeshment, parent-child role reversal, verbal abuse, love-withdrawal, and many other forms of emotional abuse. Relational trauma can be difficult for children, caregivers and outside observers to recognize, which means it can persist throughout much of childhood and even into adulthood. For this reason, relational trauma can have insidious effects on development through persistent, maladaptive interaction patterns. These social interaction patterns occur while the brain is developing and can therefore shape the way that individuals think and feel about themselves, others, and the world around them.

Attachment theory is a very useful framework for understanding how differences in the quality of close interpersonal relationships, particularly parent-child bonds and adult romantic bonds, influence health and well-being throughout the lifespan. In the mid-nineteen hundreds, John Bowlby proposed that an attachment behavioral system evolved in humans (and other animals) because it improved the chances of offspring survival and successful reproduction by fostering proximity to caregivers, protection and safety, and sense of security for the developing child. Bowlby argued that a secure attachment relationship between a parent and child doesn't lead to dependency, which was the contention of his psychoanalytic colleagues at the time, but instead creates a secure base for the child. In fact, he postulated that attachment security, and specifically a secure base, actually facilitates exploration and learning in childhood and ultimately leads to greater autonomy and social competence later in life.

According to attachment theory, when a child experiences conditions such as pain, sickness, loneliness, or fear, the attachment system is activated and there is a natural, even biological, drive to seek comfort and safety from an attachment partner. In a secure attachment relationship, the attachment figure is sensitive and responsive to the child's desire for closeness and safety. Moreover, a secure attachment relationship provides a safe haven where intense emotional states are co-regulated and the child is able to return to engaging openly with the environment. This cycle of attachment system activation, proximity and support seeking behavior, interpersonal interaction (with the possibility of co-regulation of affect), and a return to environmental exploration occurs repeatedly in the day-to-day exchanges between attachment partners. It is in the context of this repeated "dyadic dance" that patterns of attachment behavior take shape. In turn, these attachment-related patterns contribute to the organization of biological pathways in the brain and body that underlie emotion regulation capacities and mental representations of the self and others (i.e., internal working models).

Due to the attachment system's critical role in human development, it remains active even in adverse conditions, such as relational trauma, emotional abuse, neglect, and maltreatment. As suggested by Pia Mellody in her model of development, children are born "valuable, vulnerable, imperfect, dependent, and spontaneous". This precarious natural state of the child necessitates that he or she seek comfort and support from an attachment figure, even if that caregiver is ill-equipped to consistently provide a safe haven or a secure base. The child can't simply choose to not to attach - like the physiological drive to drink when thirsty, children are compelled to seek closeness and security when feeling threatened in some way. Thus, in the context of relational trauma, the child experiences an instinctive drive to find support and safety in an attachment figure who, often without malicious intent, may also be a source of fear, anger, shame, and pain.

This "double-bind" situation is emotionally and mentally confusing - the child is torn between the attachment-related drive to seek security and love, and the self-protective impulse to avoid pain and fear. It is no wonder that relational trauma often leads to an insecure attachment pattern where the child unwittingly adopts various mental and emotional strategies aimed at obtaining or maintaining a sense of relationship security, while also protecting against loss, pain, and fear. In this light, insecure attachment patterns represent the child's best efforts to negotiate incredibly complex relational circumstances and, at least in the short-term, can be seen as a successful adaptation to environmental adversity. However, in the long-run, the distorted mental representations and emotional processes that are often associated with insecure attachment relationships can have significant effects on core areas of development.

The elegant theoretical model used at The Meadows treatment centers, which is based on extensive clinical work by Pia Mellody and her colleagues, indicates that relational trauma leads to developmental immaturity by causing an individual to become polarized along five core dimensions of development: 1) self esteem (less than versus better than), 2) boundaries (too vulnerable versus invulnerable), 3) reality issues (bad/rebellious versus good/perfect), 4) dependency (too dependent versus needless/wantless), and 5) moderation (too little versus too much self-control). The model goes on to predict that relational trauma and the subsequent distortions of the core issues result in higher rates of addiction, mental health disturbances, and spiritual disconnection. Finally, the model describes how these cascading variables almost invariably lead to problems with intimacy and romantic relationships in adulthood.

While relational trauma can have direct effects on these core dimensions of development, it may be helpful to also consider the indirect effects that are mediated by the attachment relationship. For example, when a child experiences abandonment and neglect, it may be adaptive for the child to amplify or "hyperactivate" the attachment system to get proximity and support from an elusive caregiver. Under these conditions, the child may engage in energetic and insistent attempts to remain close to the caregiver out of a fear that separation will bring abandonment, loneliness, and insecurity.

As a way of making sense of a caregiver's repeated failures to be emotionally and physically present, the child often develops a deep sense of personal unworthiness - a belief that "something is wrong with me" - thereby assuming a "one-down" position. Additionally, the child may resort to mental rumination, perseveration, and fantasy about the attachment relationship as a way of keeping it alive and filling the internal void associated with its absence. These individuals often experience their own self-worth as being highly dependent on the actions of others. So, naturally they are hypervigilant and hypersensitive to possible relationship threats and can experience intense negative emotions when threatened with loss or separation. This "anxious" or "preoccupied" behavioral pattern represents one dimension of attachment insecurity and accurately describes some of the socioemotional challenges for individuals who have been exposed to relational trauma.

Another form of relational trauma is enmeshment or parent-child role-reversal, which paradoxically involves abandonment. Often, the enmeshed caregiver isn't able to meet the attachment needs of the child because he or she is getting their own needs met through the child. In contrast to attachment-related anxiety, under conditions of enmeshment, the child may find it most adaptive to suppress or "deactivate" their own attachment system so that he or she can effectively meet the caregiver's needs and thereby maintain closeness and support. In fact, over time, the child may tacitly learn that his or her own bids for proximity and security elicit disapproval, frustration, and anger from the caregiver, and actually threaten the attachment relationship.

Therefore, when the attachment relationship is marked by enmeshment, the child dutifully meets the caregiver's interpersonal demands by suppressing, avoiding, and down-playing their own attachment-related desires. This role-reversal can create a sense of false empowerment for the child and a "one-up" position. However, it can also foster an undercurrent of resentment and rebellion as the child yearns to be free of the expectations and roles given to him or her by the caregiver. Often these individuals feel unable to depend or rely on others to meet their attachment needs, so they avoid interdependence and instead resort to rugged self-reliance and a commitment to deal with adversity alone. This "avoidant" behavioral pattern represents the other main dimension of attachment insecurity. Like its counterpart, it is often associated with relational trauma and is thought to have long-term consequences for socioemotional functioning.

It should be noted that abandonment and neglect are not always associated with attachment-related anxiety, and enmeshment is not always associated with attachment-related avoidance. Certainly the reverse can be true for both types of relational trauma, and in some cases, individuals who have experienced relational trauma can show elements of both attachment-related anxiety and avoidance. Also, even though these two dimensions of attachment behavior are considered insecure, they are nevertheless organized patterns of mental and emotional strategies aimed at maintaining intra- and inter-personal equilibrium within the context of a suboptimal attachment relationship.

However, in recent decades it has been discovered that some children who are exposed to relational trauma exhibit disorganized attachment patterns involving contradictory approach-avoidance behaviors toward the caregiver. Disorganized attachment can involve various un-integrated elements of the anxious and avoidant dimensions, as well as more ominous signs such as "freezing" or trance-like expressions and coercive or controlling interpersonal behaviors. Of importance to clinicians, disorganized attachment in early childhood has been linked to later deficits in mentalization (i.e., understanding one's own and other's mental and emotional states), dissociation, and mental health disturbances.

The effects of relational trauma on the attachment system and on subsequent developmental trajectories are moderated by a number of contextual factors. For example, evidence suggests that genetic and temperamental factors play a role in how susceptible a person is to traumatic experiences. Children with the DRD4 variant of the dopamine receptor gene are more negatively affected by relational trauma than those children without the genetic susceptibility. Also, in light of the growing awareness of critical or sensitive periods in development, it stands to reason that the timing and type of relational trauma are important variables. In some cases, the negative consequences associated with an insecure attachment to a particular caregiver can be buffered to some degree by a warm and loving relationship with a different caregiver. The family system as a whole, with its intricate dynamics and various roles, is an important, but frequently overlooked moderating variable. Finally, it is important to remember that the child is an active agent in their own development, so how he or she perceives and formulates the experience of relational trauma will have considerable bearing on its developmental consequences.

There is mounting evidence that the effects of early relational trauma and attachment insecurity can reverberate across generations. Bowlby hypothesized that the attachment behavioral system remains active throughout the lifespan and that attachment-related patterns of thinking and feeling influence adult romantic relationships and parent-child relationships. It should be noted that attachment insecurity in childhood doesn't guarantee that an individual will experience significant problems in being able to bond with romantic partners or children in adulthood. However, consistent with the clinical model used at The Meadows treatment center, longitudinal research has shown that relational trauma and attachment insecurity in childhood are associated with disturbances in core developmental areas, which are in-turn related to higher rates of mental and emotional problems, addiction to mood altering substances and behaviors, and challenges in negotiating adult relationships. For practitioners who recognize and routinely encounter the intergenerational effects of relational trauma in their clinical practice, attachment theory provides an elegant framework that connects childhood attachment experiences to adult pair-bonding and parenting.

Adult attachment orientations, whether assessed by a semi-structured interview or a self-report questionnaire, generally fall on the previously noted dimensions of attachment-related anxiety and avoidance. In a series of research studies, my colleagues and I showed that adults with a history of childhood maltreatment, particularly emotional abuse, were more likely to have problems with emotion dysregulation (especially when facing fear), addictions, depression, and adult attachment-related anxiety and avoidance. Importantly, these two attachment dimensions are remarkably similar to the constructs of Love Addiction and Love Avoidance, which are an integral part of Pia Mellody's model and the clinical work at The Meadows. While more research is needed to understand how these two perspectives interface with each other, they are both extremely useful frameworks for understanding how early relational experiences influence cognitions, emotions, and behavior in adult relationships. Adult attachment will be discussed in greater detail in future articles.

Fortunately, individuals who have experienced relational trauma and attachment insecurity can receive treatment that leads to a path of true and lasting recovery. Certainly, early intervention with at-risk parents and children is ideal, but there is also much hope for adults who have experienced trauma in childhood or adult relationships. Indeed, recent findings indicate that the brain is more "plastic" or malleable than we once thought. In fact, research has shown that social experience, including therapeutic experiences, can have meaningful effects on gene expression, physiological processes, and brain function. This means that the neurobiological pathways that were sub-optimally organized in the context of relational trauma and attachment insecurity can be re-organized by the application of appropriate treatment techniques. Similar to a secure attachment relationship, effective treatment generally involves the creation of a secure therapeutic environment where raw, painful thoughts and emotions associated with past trauma can be safely explored and metabolized so that personal and interpersonal well-being can be restored. The Meadows has been offering this kind of treatment for decades and remains a world-leader in the treatment of trauma and addiction.

Jon G. Caldwell, D.O., is a board certified psychiatrist who specializes in the treatment of adults with relational trauma histories and addictive behaviors. He currently works full-time as a psychiatrist at The Meadows treatment center in Wickenburg Arizona. For a number of years he has been teaching students, interns, residents, and professionals in medicine and mental health about how childhood adversity influences health and wellbeing. His theoretical perspective is heavily influenced by his PhD graduate work at the University of California at Davis where he has been researching how early childhood maltreatment and insecure attachment relationships affect cognitive, emotional, and social functioning later in life. His clinical approach has become increasingly flavored by the timeless teachings of the contemplative traditions and the practice of mindfulness meditation.

Free Lecture Series - Houston, Texas, August 2, 2011

RELATIONSHIP REBUILDING - WHEN TRAUMA IS UNMASKED by JEANNA GOMEZ, LCSW, LADAC, CPC

The Council on Alcohol and Drugs Houston
303 Jackson Hill
Houston, Texas 77007
For information on The Meadows or its Houston-based activities,
please contact Melanie Shelnutt, Houston Community Relations Representative, at 877-733-7930 (713-702-7784 local) or email mshelnutt@themeadows.com.

Adrianna Irvine will be speaking at The Meadows Free Lecture on March 29, 2011 at 7:00 pm at The Cadogan Hotel, Knightsbridge in London. Ms. Irvine will discuss A Cross Cultural View on Cross Addiction. The presentation will cover the difference between substance addictions and process addictions, including the more recent findings of the likelihood of cross addiction between both categories. It will also briefly cover dual diagnosis with an in-depth look at some the different fellowships within the 12 step programs. Contact Jenna Pastore at 001 815 6412185 or jpastore@themeadows.com for more information. No registration required. We look forward to seeing you.

Bellevue, Washington, Wednesday, March 2, 2011
Portland, Oregon, Thursday, March 3, 2011
Lust, Anger, Love: Understanding Sexual Compulsivity and the Road to Healthy Intimacy
This lecture will offer a theoretical structure for the treatment of compulsive sexual behaviors. It will explore the roles of sexualized shame and anger as they relate to the cycle of addiction. The ideology of behavioral patterns, including the development of trauma templates, will be discussed, as will the ways this wounding relates to specific sexual behavioral patterns. The lecture also will explore the integration of theoretical approaches, behaviors and specific treatment techniques.

About the Presenter:

Maureen Canning, MA, LMFT, Clinical Consultant for Sexual Disorders at The Meadows and Dakota, has extensive experience working with sexual disorders. She is a past board member of the Society for the Advancement of Sexual Health, as well as past president of the Arizona Council on Sexual Addiction. She facilitated inpatient sexual disorders treatment at The Meadows for a number of years before opening a private practice in Phoenix. Maureen is the author of Lust, Anger, Love: Understanding Sexual Addiction and the Road to Healthy Intimacy.

Learning Objectives
Participants will be able to:

  • Describe the diagnostic criteria for sexual addiction
  • Explore the roles of sexualized anger and shame in the addiction cycle
  • Recognize and discuss trauma templates

Location - Washington
Hilton Bellevue Hotel
300 112th Avenue SE
Bellevue, Washington 98004
425-455-1300
Location - Oregon
Holiday Inn® Portland Airport
8439 NE Columbia Blvd.
Portland, Oregon 97220
503-256-5000
Schedule
Wednesday, March 2, 2011
Registration 8:30 a.m. - 9 a.m.
Lecture 9 a.m. - 12 p.m.
Lunch 12 p.m. - 1 p.m. (boxed lunch provided)
Lecture 1 p.m. - 4 p.m.
Cost
$95 per person / $85 online registration
(includes lecture, lunch, materials, hotel parking and 6 continuing education credits)
Earn 6 Continuing Education Credits

March 29, 2011

Adrianna Irvine will be speaking at The Meadows Free Lecture on March 29, 2011 at 7pm at The Cadogan Hotel, Knightsbridge in London. Ms. Irvine will discuss A Cross Cultural View on Cross Addiction. The presentation will cover the difference between substance addictions and process addictions, including the more recent findings of the likelihood of cross addiction between both categories. It will also briefly cover dual diagnosis with an in-depth look at some the different fellowships within the 12 step programs. Contact Jenna Pastore at 001 815 6412185 for more information. No registration required. We look forward to seeing you.

Thursday, 17 February 2011 19:00

Frequently Asked Questions about Sex Addiction

I receive many questions about sex addiction. I thought I would share some common questions...

Does all sex addiction come from abuse? I don't think I was abused as a kid.

There are two ways abuse can manifest; the first is overt abuse. Overt abuse is usually aggressive behavior that is measurable, such as bruises, a raised voice, a verbal attack, or an insult. The second is covert abuse. Covert abuse is passive, often unconscious, and not seen as abusive (such as withholding love, giving a stern or threatening look, failing to protect a child, or minimizing his or her realities). One can be abused covertly and/or overtly and, no matter how the abuse is perpetrated, it always leaves victims feeling shame and pain on some level.

Individuals often normalize abusive behavior or, even worse, blame themselves for the abuse. "If I hadn't been drunk, I wouldn't have been raped." "Putting each other down is just what my family does." When it is pointed out that these are examples of abuse, often the reaction is denial, defensiveness, or confusion.

Because of these common reactions, it is important to grasp the scope of abuse and to become aware of how abuse may have affected or influenced one's life.

Once an individual begins to understand the scope of abuse they can see how it set them up to feel disemboweled as a child because of the continual fear, guilt, and shaming one received. The wreckage of such abuse leaves all sex addicts with a sense of betrayal so severe that they lose the ability to trust. They are convinced that if they are seen or really known, they will be despised.

Too afraid to tell anyone, the addict learned what was perhaps his most powerful coping skill. He learned to live a double life- a life of secrets and lies, where shame festers, multiplies, and spreads like a deadly cancer. But when one can establish a bond of trust, they can have a respectful attachment- a place at which the healing can begin.

What does abuse look like?

Below is an outline of the types of abuse, with examples of specific behaviors in each category.

I. Physical Abuse (any forced or violent physical action)

  • Hitting
  • Punching
  • Scratching
  • Spitting
  • Pushing
  • Burning
  • Burning
  • Choking
  • Poking
  • Unsolicited touching or tickling
  • Restraining
  • Pulling hair
  • Slapping

II. Emotional or Verbal Abuse (putting down, threatening, and saying cruel or untrue things about another person)

  • Cursing, swearing, screaming
  • Harassing or interrogating
  • Insulting, name-calling, shaming, ridiculing
  • Threatening to harm; beat up; sabotage; hurt; maim or kill pets, children, or
  • family members
  • Controlling others (e.g., through money or power)
  • Criticizing
  • Forcing others to engage in degrading acts
  • Making accusations
  • Blaming
  • Intimidating
  • Punching, throwing, destroying property
  • Going through others' property or possessions
  • Stealing
  • Threatening to kill oneself as a form of manipulation
  • Sexualizing others
  • Driving recklessly
  • Stalking
  • Not letting others sleep or eat
  • Making facial expressions or physical gestures that indicate judgment, rejection, ridicule (e.g., smirking, covering the ears as if unwilling to listen, walking out of the room while someone is sharing, rolling the eyes, shaking the head, moving the hands in a manner indicating that the other is wrong or inadequate)

III. Sexual Abuse (any nonconsensual sexual act, behavior, gesture)

  • Not respecting "no"
  • Making sexual remarks, jokes, innuendos, suggestions, insults
  • Taking advantage of situations and exploiting others' intoxication or incapacitation
  • Demanding or manipulating unwanted sexual acts (e.g., anal penetration, physical restriction, choking, golden showers, oral sex, sadomasochistic acts, role-playing)
  • Having unprotected sex while knowingly having a sexually transmittable disease
  • Giving sexual criticism
  • Engaging in inappropriate touching (e.g., touching in public, grabbing, pinching the breast or groin)
  • Blackmailing or manipulating the vulnerable (i.e., the much younger and/or sexually inexperienced, the disabled, the mentally or emotionally challenged)
  • Taking advantage of a power differential (e.g., the case of a boss, clergy member, lawyer, judge, law enforcement officer, landlord, teacher, coach)

IV. Neglect (failing to provide the essential necessities for a child, including the following)

  • Nurturance
  • Clothing
  • Medical care
  • Dental care
  • Security
  • Protection
  • Hygiene
  • Education
  • Supervision
  • Shelter
  • Attention to physical, emotional, and intellectual needs

This outline does not include every possible abusive behavior, but it does provide an overview of abuse.

If you would like to read more about this, please visit www.sexaddictionfaq.com

Tuesday, 15 February 2011 19:00

Free Lecture Series MONDAY in Phoenix

Feel Confident.
Promote Your Life Work.
Thrive.

Monday, February 21, 2011
7 p.m. to 8:30 p.m.

SPEAKER:
Sarah Jenkins, LPC

LOCATION:
Chaparral Christian Church
6451 East Shea Blvd.
Scottsdale, Arizona 85254
Please No Smoking on Church Property
MAP

Earn 1.5 Continuing Education Credits
No registration required.

For information on The Meadows or The Meadows' Arizona-based activities, please contact Meagan Foxx, Arizona Community Relations Representative, at 866-922-0951, 602-531-5320 (local) or email mfoxx@themeadows.com.

Tuesday, 15 February 2011 19:00

Free Lecture Series TONIGHT in Seattle

Video Game and Internet Addiction:
What You Need to Know

Wednesday, February 16, 2011
7 p.m. to 9 p.m.

SPEAKER:
Hilarie Cash, PhD, LMHC

LOCATION:
Double Tree Hotel
16500 Southcenter Parkway
Seattle, Washington 98188
206-575-8220
Free Parking
MAP

SAVE THIS DATE:
Wednesday, May 18, 2011
Getting It: Eight Realizations of Those Who Work at Recover
George Duwors, MSW, LCSW

Earn 2 continuing education hours for the following:
NAADAC Approved Provider, Provider # 000217. The Meadows is recognized by the National Board for Certified Counselors to offer continuing education. Provider # 5687.
No registration required.

For information on The Meadows or its Seattle-based activities, please contact I.J. Williams, Washington/Oregon/Idaho Community Relations Representative, at 866-922-0945 (360-980-0376 local) or email ijwilliams@themeadows.com.

Tuesday, 15 February 2011 19:00

Free Lecture Series TONIGHT in Tucson

Sex, Love and Longing:
Understanding the Addicted Self

Wednesday, February 16, 2011
6:30 p.m. to 8 p.m.

SPEAKER:
Debra L. Kaplan, MA, LAC, LISAC, CSAT-III

LOCATION:
Jewish Heritage Center
3800 East River Road
Tucson, Arizona 85718
MAP

Earn 1.5 Continuing Education Credits
No registration required.

For information on The Meadows or The Meadows' Arizona-based activities, please contact Meagan Foxx, Arizona Community Relations Representative, at 866-922-0951, 602-531-5320 (local) or email mfoxx@themeadows.com.

For immediate release:
Feb. 14, 2011
Wickenburg, Arizona

THE MEADOWS NAMES JERRY BORISKIN, PhD AS SENIOR FELLOW

The Meadows is pleased to announce the naming of Jerry Boriskin, PhD, CAS, as Senior Fellow.

Dr. Boriskin is an author, lecturer, and clinician widely known for his ground breaking work in the fields of trauma, PTSD, and addictive disorders. He was a pioneer in extending the continuum of care and developed two extended residential treatment programs for co-occurring disorders. A passionate advocate for integrated treatment, he possessed a vision that predated the ongoing movement toward specialized and integrated treatment for co-occurring disorders, particularly those involving trauma.

In addition to his groundbreaking work with The Meadows, Dr. Boriskin is the author of “PTSD and Addiction: A Practical Guide for Clinicians and Counselors.” and co-authored, “At Wit’s End: What Families Need to Know When A Loved One is Diagnosed with Addiction and Mental Illness.”

Jim Dredge, CEO of The Meadows, said, "we are fortunate indeed to have Dr. Boriskin as a member of The Meadows' team. Thanks to his hard work and dedication, The Meadows is at the forefront of the treatment of co-occurring disorders and trauma."

The Meadows, with rehab treatment centers in Arizona and Texas, has been a leader in the treatment of addiction, trauma and recovery since 1976.

Contact: Nancy Koplow, Director Of Marketing, The Meadows. nkoplow@themeadows.org  Phone: 800-632-3697

Dr. Boriskin is an author, lecturer, and clinician with expertise in trauma, PTSD, and addictive disorders. He began his career in 1979 when PTSD emerged as a diagnosis. He transitioned to the private sector in the mid-1980s, working with sexual abuse survivors and addicts. He is a licensed psychologist and addiction specialist who recently resumed working with warriors at the V.A. of Northern California. He has authored PTSD and Addiction: A Practical Guide for Clinicians and Counselors and co-authored At Wit's End: What Families Need to Know When A Loved One is Diagnosed with Addiction and Mental Illness.

Contact The Meadows

Intensive Family Program • Innovative Experiential Therapy • Neurobehavioral Therapy

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