Treatment of                     Psychological Disorders
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Introduction 5780942

Treatment of Psychological DisordersC:\Users\mburt\Desktop\AP Psych\psych disorders\video\Sheldon the Therapist - The Big Bang Theory.mp4


Introduction

Introduction

  • History of treatment - Maltreatment of the insane throughout the ages was the result of irrational views. Many patients were subjected to strange, debilitating, & downright dangerous treatments. C:\Users\mburt\Desktop\AP Psych\Therapy\239_Early_Treatment_Mental_Disorders.mp4

    • Philippe Pinel: France

    • Dorothea Dix: US/CA

    • founded humane movements to care for the mentally sick.


Therapies

Therapies

Psychotherapy involves an emotionally charged, confiding interaction between a trained therapist and a mental patient.

Biomedical therapyuses drugs or other procedures that act on the patient’s nervous system, treating his or her psychological disorders.

AnEclectic approachuses various forms of healing techniques depending upon the client’s unique problems.


The psychological therapies 4 major therapies

The Psychological Therapies4 Major Therapies


Psychoanalysis

Psychoanalysis

  • PsychoanalysisSigmund Freud’s therapeutic technique. Freud believed the patient’s free associations, resistances, dreams, & transferences – & the therapist’s interpretations of them – released previously repressed feelings, allowing the patient to gain self-insight.

  • When energy devoted to id-ego-superego conflicts is released, the patient’s anxiety lessens.

  • - 4:09 C:\Users\mburt\Desktop\AP Psych\psych disorders\video\Application of Psychoanalytic Therapy.flv

  • Aims of therapy

    • Childhood impulses & conflicts


Psychoanalysis methods

PsychoanalysisMethods

  • Free association

  • Resistancein psychoanalysis, the blocking from consciousness of anxiety-laden material

    • Interpretation in psychoanalysis, analyst’s noting supposed dream meanings, resistances, & other significant behaviors & events in order to promote insight of the meaning

  • Dream analysis

  • Transference


Psychoanalysis methods at work

Psychoanalysis: Methods at work

During free association, the patient edits his thoughts, resisting his or her feelings to express emotions. Such resistance becomes important in the analysis of conflict-driven anxiety.

Eventually the patient opens up & reveals his or her innermost private thoughts, developing positive or negative feelings (transference) towards the therapist. C:\Users\mburt\Desktop\AP Psych\psych disorders\video\Psychoanalysis - explained.mp4


Introduction 5780942

Psychoanalysis C:\Users\mburt\Desktop\AP Psych\Therapy\247_Psychodynamic_Therapies.mp4 Psychodynamic Therapy

  • therapy deriving from the Freud’s psychoanalytic tradition that views individuals as responding to unconscious forces & childhood experiences, & that seeks to enhance self-insight

    • Aims of psychodynamic therapy ….understand symptoms & themes across important relationships in a patient’s life.

    • Similarities & Differences to psychoanalysis

Interpersonal psychotherapy, a variation of psychodynamic therapy, is effective in treating depression. It focuses on symptom relief here & now, not an overall personality change.


Humanistic therapies

Humanistic Therapies

  • Insight therapies a variety of therapies that aim to improve psychological functioning by increasing the client’s awareness of underlying motives & defenses. focus more on:

    • the present rather than the past

    • conscious rather than the unconscious

    • taking immediate responsibility

    • promoting growth instead of curing


Humanistic therapies1

Humanistic Therapies

  • Client-centered therapy(AKA person-centered therapy.) Humanistic therapy, developed by Carl Rogers, the therapist uses techniques such as active listening within a genuine, accepting, empathic environment to facilitate client’s growth.

    • Nondirective therapy

    • Genuineness, acceptance, & empathy

    • Active listeningempathic listening in which the listener echoes, restates, & clarifies.

      • Paraphrase

      • Invite clarification

      • Reflect feelings

    • Unconditional positive regard


Introduction 5780942

Behavior Therapies C:\Users\mburt\Desktop\AP Psych\Therapy\244_Cognitive_and_Behavioral_Therapies.mp4

  • Behavior Therapy- therapy that applies learning principles to the elimination of unwanted behaviors. Focus: the ACTION, not the thought patterns associated with the behavior, doesn’t look for the “inner cause”

    • Classical conditioning techniques

      • We learn various behaviors & emotions via classical conditioning

    • Operant conditioning techniques

      • Behavior modification – reinforces desired behaviors & withholding reinforcement for undesired behaviors or punishments


Behavior therapies classical conditioning therapies

Behavior TherapiesClassical Conditioning Therapies

Counterconditioningbehavior therapy procedure that uses classical conditioning to evoke new responses to stimuli that are triggering unwanted behaviors; Includes 242_Drug_Addiction.mp4

  • Exposure therapies behavior therapy procedure that uses classical conditioning to evoke new responses to stimuli that are triggering unwanted behaviors; Includes

    • Systematic desensitization

    • Virtual reality exposure therapy

  • Aversive conditioningassociates unpleasant state (e.g. nausea) with unwanted behavior (e.g. alcohol).


Introduction 5780942

Behavior TherapiesAversion Therapy


Introduction 5780942

Behavior TherapiesAversion Therapy


Introduction 5780942

Behavior TherapiesAversion Therapy

Short term success

(66%)

Long term less successful (33%)

Often used in combo with other treatments


Behavior therapies operant conditioning

Behavior TherapiesOperant Conditioning

  • Behavior modification- reinforce desired behaviors withholding reinforcement for undesired behavior or punishment. Can work b/c a behavior strongly influenced by consequences. (effective with autism, retardation, schizophrenia). Rewards used to modify behavior vary from praise, to attention to more concrete rewards, food.

    • Raises ethical Questions

    • Token economyoperant conditioning procedure. People earn a token of some sort for exhibiting a desired behavior & can later exchange tokens for various privileges/treats. Successful in various settings, cultures, & many mental disorders.


Cognitive therapies

Cognitive Therapies

  • Cognitive therapythat teaches people new, more adaptive ways of thinking & acting; based on the assumption that thoughts intervene btwn events & our emotional reactions

    • Aaron Beck’s therapy for depression

      • Catastrophizing beliefs- recurring negative themes of loss, rejection, abandonment, self-blaming & over generalizing that perpetuate existing feelings of depression

    • Cognitive-behavioral therapypopular integrative therapy that combines cognitive therapy (changing self-defeating thinking) w/ behavior therapy (changing behavior). Seeks to restructure thinking (retrain) people to restructure negative thinking 249_OCD.mp4


Beck s therapy for depression

Beck’s Therapy for Depression

Aaron Beck (1979) suggests that depressed patients believe that they can never be happy (thinking) and thus associate minor failings (e.g. failing a test [event]) in life as major causes for their depression.

Beck believes that cognitions such as “I can never be happy” need to change in order for depressed patients to recover. This change is brought about by gently questioning patients.


Cognitive therapy

Cognitive Therapy

Teaches people adaptive ways of thinking & acting based on the assumption that thoughts intervene between events & our emotional reactions.


Stress inoculation training

Stress Inoculation Training

Meichenbaum trained people to restructure their thinking in stressful situations.

“Relax, the exam may be hard, but it will be hard for everyone else too. I studied harder than most people. Besides, I don’t need a perfect score to get a good grade.”


Group family therapies

Group & Family Therapies

Utilized by all Therapy Types accept Psychoanalysis

Group Therapy

  • saves therapists’ time & client’s money.

  • As is often no less effective than individual therapy

  • Occurs 1 time a week for about 90 minutes

  • Unique benefit: the social context allows people both to discover that others have problems similar to their own & to receive feedback as they try out new ways of behaving

    Family therapy

  • treats the family as a system

  • guides family members toward positive relationships & improved communication.


Introduction 5780942

Group & Family Therapies

  • Methods & Goals & Participation

    • Family therapists work with family groups to heal relationships and to mobilize family resources

    • to help family members discover the role they play within their family’s social system

    • To open up communication within the family or the help family members discover new ways of preventing or resolving conflicts

    • Self-help support groups are widely used & require a high live of involvement for success

      • Great for stigmatized illnesses (AIDS, Alcoholism, Anorexia, etc)


Introduction 5780942

Comparison of Psychotherapies


Introduction 5780942

Comparison of Psychotherapies


Introduction 5780942

Comparison of Psychotherapies


Introduction 5780942

Comparison of Psychotherapies


Introduction 5780942

Comparison of Psychotherapies


Introduction 5780942

Comparison of Psychotherapies


Evaluating psychotherapies

Evaluating Psychotherapies


Evaluating therapies

Evaluating Therapies

Who do people turn to for help with psychological difficulties?


Is psychotherapy effective

Is Psychotherapy Effective?

It is difficult to gauge the effectiveness of psychotherapy because there are different levels upon which its effectiveness can be measured.

  • Does the patient sense improvement?

  • Does the therapist feel the patient has improved?

  • How do friends and family feel about the patient’s improvement?


Client s perceptions

Client’s Perceptions

If you ask clients about their experiences of getting into therapy, they often overestimate its effectiveness. Critics however remain skeptical.

  • Clients enter therapy in crisis, but crisis may subside over the natural course of time (regression to normalcy).

  • Clients may need to believe the therapy was worth the effort.

  • Clients generally speak kindly of their therapists.


Clinician s perceptions

Clinician’s Perceptions

Like clients, clinicians believe in therapy’s success. They believe the client is better off after therapy than if the client had not taken part in therapy.

  • Clinicians are aware of failures, but they believe failures are the problem of other therapists.

  • If a client seeks another clinician, the former therapist is more likely to argue that the client has developed another psychological problem.

  • Clinicians are likely to testify to the efficacy of their therapy regardless of the outcome of treatment.


Outcome research

Outcome Research

How can we objectively measure the effectiveness of psychotherapy?


Is psychotherapy effective1

Is Psychotherapy Effective?

Client & Clinician perceptions of therapy’s effectiveness are vulnerably to inflation from 2 Phenomena

  • Placebo effect & Regression toward the Mean the tendency for extreme or unusual scores to fall back (regress) toward their average. Pg 702

    Client’s perceptions- justify & overly positive (placebo effect or belief in a treatment = Placebo Treatment or expectation of relief analogous with a reward)

    Clinician’s perceptions- seem to mainly recognize only other clinician’s failures 251_Therapeutic_Effectiveness.mp4

  • Outcome research

    • Meta-analysisa procedure for statistically combining the results of many different research studies.


Outcome research1

Outcome Research

Meta-analysis of a # of studies suggests that 1000s of patients benefit more from therapy than those who did not go to therapy.

Research shows that treated patients were 80% better than untreated ones.


The relative effectiveness of different therapies

The Relative Effectiveness of Different Therapies

Which psychotherapy would be most effective for treating a particular & specific problem?


Evaluating alternative therapies

Evaluating Alternative Therapies

Eye movement desensitization & reprocessing (EMDR) therapist attempts to unlock & reprocess previous frozen traumatic memories by waving a finger in front of the eyes of the client.

  • EMDR has not held up under scientific testing.

  • Light exposure therapy

    • Seasonal affective disorder (SAD) a form of depression, has been effectively treated by light exposure therapy.

    • This form of therapy has been scientifically validated.


  • Commonalities among psychotherapies

    Commonalities Among Psychotherapies

    Three commonalities shared by all forms of psychotherapies are the following:

    • Hope for demoralized people

    • A fresh perspective

    • An empathic, trusting, caring relationship


    Culture values in psychotherapy

    Culture & Values in Psychotherapy

    Psychotherapists may differ from each other & from clients in their personal beliefs, values, & cultural backgrounds.

    A therapist search should include visiting two or more therapists to judge which one makes the client feel more comfortable.


    Therapists their training

    Therapists & Their Training

    Clinical psychologists: They have PhDs mostly. They are experts in research, assessment, and therapy, all of which is verified through a supervised internship.

    Clinical or Psychiatric Social Worker (LCSW):They have a Masters of Social Work. Postgraduate supervision prepares some social workers to offer psychotherapy, mostly to people with everyday personal and family problems.


    Therapists their training1

    Therapists & Their Training

    Counselors:Pastoral counselors or abuse counselors work with problems arising from family relations, spouse and child abusers & their victims, & substance abusers.

    Psychiatrists:They are physicians who specialize in the treatment of psychological disorders. Not all psychiatrists have extensive training in psychotherapy, but as MDs they can prescribe medications.


    The biomedical therapies

    The Biomedical Therapies


    Introduction1

    Introduction

    • Biomedical therapy - prescribed medications or medical procedures that act directly on the patient’s nervous system.

      • Drug therapy

      • Brain Stimulation (Electroconvulsive therapy), Magnetic impulses

      • Psychosurgery

      • Psychiatrist


    Drug therapies

    Drug Therapies

    • Psychopharmacologythe study of the effects of drugs on mind & behavior

      Factors to consider with drug therapy

      • Normal recovery rate of untreated patients

      • Recovery due to Placebo effect

        • Double blind procedure

    To test the effectiveness of a drug, patients are tested with the drug & a placebo. 2 groups of patients & medical health professionals are unaware of who is taking the drug & who is taking the placebo.

    In such studies several drugs have proven useful in treating Psych Disorders`


    Introduction 5780942

    Drug Therapies

    Psychopharmacology is the study of drug effects on mind & behavior.


    Introduction 5780942

    Drug Therapies


    Introduction 5780942

    Drug Therapies


    Introduction 5780942

    Drug Therapies


    Drug therapies1

    Drug Therapies

    However, many patients are left homeless on the streets due to their ill-preparedness to cope independently outside in society.

    Les Snider/ The Image Works


    Drug therapies2

    Drug Therapies

    • Antipsychotic drugsdrugs used to treat schizophrenia & other forms of severe thought disorder

      • Psychoses

      • Chlorpromazine (Thorazine)classical antipsychotic : remove a number of positive symptoms associated with schizophrenia, such as agitation, delusions, & hallucinations (dampens the responsiveness to irrelevant stimuli)

      • Patients with negative symptoms, (withdrawal or apathy) often do not respond well to these drugs


    Drug therapies3

    Drug Therapies

    Antipsychotic drugs

    • Dopamine–Block this neurotransmitter. Molecules are small enough to occupy the dopamine receptor sites, blocking its activity. This reinforces the belief that overactive dopamine system contributes to schizophrenia.

    • Side Effects : tremors, sluggishness, twitches, & Tardivedyskinesia involuntary movements of the facial muscles/tongue/limbs; possible neurotoxic side effect of long-term use of drugs that target certain dopamine receptors. (D2 receptors)

      NEW GENERATION of Anti psychotic drugs- target D1 receptors & have fewer side effect. BUT these drugs (clorazipine, Risperdal, Zyprxa) not more effective & increase risk of obesity & diabetes & require extreme monitoring to manage the proper dosage


    Atypical antipsychotic

    Atypical Antipsychotic

    Clozapine (Clozaril) blocks receptors for dopamine & serotonin to remove the negative symptoms of schizophrenia. Eg. apathy, jumbled thoughts, concentration difficulties, & difficulties in interacting with others

    Also helps those with positive symptoms that did not respond to other drugs.

    Side Effect:

    May cause toxic effect on white blood cells


    Drug therapies antianxiety drugs

    Drug TherapiesAntianxiety Drugs

    • Antianxiety drugsdrugs used to control anxiety & agitation

      • Xanax, Ativan, D-cycloserine

      • Physiological dependence


    Antianxiety drugs

    Antianxiety Drugs

    Antianxiety drugs (Xanax & Ativan) depress the central nervous system & reduce anxiety & tension by elevating the levels of the Gamma-aminobutyric acid (GABA) neurotransmitter.


    Drug therapies antidepressant drugs

    Drug TherapiesAntidepressant Drugs

    • Antidepressant drugsdrugs used to treat depression; also increasingly prescribed for anxiety. Different types work by altering the availability of various neurotransmitters.

      • Use with mood & anxiety disorders

      • Fluoxetine (Prozac), Paxil

        • Selective-serotonin-reuptake inhibitors (SSRI)

        • Neurogenesis

      • Side effects of anti- depressants


    Introduction 5780942

    Drug TherapiesAntidepressant Drugs

    Antidepressant drugs like Prozac, Zoloft, & Paxil are Selective Serotonin Reuptake Inhibitors (SSRIs) that improve the mood by elevating levels of serotonin by inhibiting reuptake.


    Drug therapies mood stabilizing medications

    Drug TherapiesMood-Stabilizing Medications

    • Mood-stabilizing medications

      • Lithium

      • Depakote

    Lithium Carbonate, a common salt, has been used to stabilize manic episodes in bipolar disorders.

    It moderates the levels of norepinephrine & glutamate neurotransmitters.


    Brain stimulation electroconvulsive therapy

    Brain StimulationElectroconvulsive Therapy

    • Electroconvulsive therapy (ECT) used for severely depressed patients who do not respond to drugs.

      • Procedure- The patient is anesthetized &given a muscle relaxant. Patients usually get a 100 volt shock that relieves them of depression.

      • Severe depression

      • Problems/side effects


    Brain stimulation electroconvulsive therapy1

    Brain StimulationElectroconvulsive Therapy


    Brain stimulation alternative neurostimulation therapies

    Brain StimulationAlternative Neurostimulation Therapies

    • Magnetic Stimulation

      • Repetitive transcranial magnetic stimulations (rTMS)- the application of repeated pulses of magnetic energy to the prefrontal regions brain; used to stimulate or suppress brain activity

    • Deep-Brain Stimulation


    Introduction 5780942

    Brain StimulationAlternative Neurostimulation Therapies


    Psychosurgery

    Psychosurgery

    Psychosurgery was popular even in Neolithic times.

    Although used sparingly today, about 200 such

    operations do take place in the US alone.

    http://www.epub.org.br


    Psychosurgery1

    Psychosurgery

    Psychosurgery is used as a last resort in alleviating psychological disturbances.

    Psychosurgery is irreversible. Removal of brain tissue changes the mind.


    Psychosurgery2

    Psychosurgery

    • Psychosurgerysurgery that removes or destroys brain tissue in an effort to change behavior

      • Lobotomya now-rare psychosurgical procedure once used to calm uncontrollably emotional or violent patients. The procedure cut the nerves connecting the frontal lobes to the emotion-controlling centers of the inner brain

        • History

        • Procedure

        • Side effects

        • Use today


    Preventing psychological disorders

    Preventing Psychological Disorders

    “It is better to prevent than cure.”

    Peruvian Folk Wisdom

    Preventing psychological disorders means removing the factors that affect society.

    Those factors may be poverty, meaningless work, constant criticism, unemployment, racism, & sexism.


    Preventing psychological disorders1

    Preventing Psychological Disorders


    Therapeutic life style change

    Therapeutic Life-Style Change

    • Integrated biopsychosocial system

    • Therapeutic life-style change

      • Aerobic exercise

      • Adequate sleep

      • Light exposure

      • Social connection

      • Anti-rumination

      • Nutritional supplements


    Preventing psychological disorders2

    Preventing Psychological Disorders

    • Resiliencethe personal strength that helps most people cope with stress and recover from adversity and even trauma.

    • Preventing psychological disorders


    Psychological disorders are biopsychosocial in nature

    Psychological Disorders are Biopsychosocial in Nature


    The end

    The End


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    Definition Slides


    Eclectic approach

    Eclectic Approach

    = an approach to psychotherapy that, depending on the client’s problems, uses techniques from various forms of therapy.


    Psychotherapy

    Psychotherapy

    = treatment involving psychological techniques; consists of interactions between a trained therapist and someone seeking to overcome psychological difficulties or achieve personal growth.


    Psychoanalysis1

    Psychoanalysis

    = Sigmund Freud’s therapeutic technique. Freud believed the patient’s free associations, resistances, dreams, and transferences – and the therapist’s interpretations of them – released previously repressed feelings, allowing the patient to gain self-insight.


    Resistance

    Resistance

    = in psychoanalysis, the blocking from consciousness of anxiety-laden material.


    Interpretation

    Interpretation

    = in psychoanalysis, the analyst’s noting supposed dream meanings, resistances, and other significant behaviors and events in order to promote insight.


    Transference

    Transference

    = in psychoanalysis, the patient’s transfer to the analyst of emotions linked with other relationships (such as love or hatred for a parent).


    Psychodynamic therapy

    Psychodynamic Therapy

    = therapy deriving from the psychoanalytic tradition that views individuals as responding to unconscious forces and childhood experiences, and that seeks to enhance self-insight.


    Insight therapies

    Insight Therapies

    = a variety of therapies that aim to improve psychological functioning by increasing the client’s awareness of underlying motives and defenses.


    Client centered therapy

    Client-centered Therapy

    = a humanistic therapy, developed by Carl Rogers, in which the therapist uses techniques such as active listening within a genuine, accepting, empathic environment to facilitate client’s growth. (Also called person-centered therapy.)


    Active listening

    Active Listening

    = empathic listening in which the listener echoes, restates, and clarifies. A feature of Roger’s client-centered therapy.


    Unconditional positive regard

    Unconditional Positive Regard

    = a caring, accepting, nonjudgmental attitude, which Carl Rogers believed would help clients to develop self-awareness and self-acceptance.


    Behavior therapy

    Behavior Therapy

    = therapy that applies learning principles to the elimination of unwanted behaviors.


    Counterconditioning

    Counterconditioning

    = a behavior therapy procedure that used classical conditioning to evoke new responses to stimuli that are triggering unwanted behaviors; includes exposure therapies and aversive conditioning.


    Exposure therapies

    Exposure Therapies

    = behavioral techniques, such as systematic desensitization, that treat anxieties by exposing people (in imagination or actuality) to the things they fear and avoid.


    Systematic desensitization

    Systematic Desensitization

    = a type of exposure therapy that associates a pleasant relaxed state with gradually increasing anxiety-triggering stimuli. Commonly used to treat phobias.


    Virtual reality exposure therapy

    Virtual Reality Exposure Therapy

    = an anxiety treatment that progressively exposes people to simulations of their greatest fears, such as airplane flying, spiders, or public speaking.


    Aversive conditioning

    Aversive Conditioning

    = a type of counterconditioning that associates an unpleasant state (such as nausea) with an unwanted behavior (such as drinking alcohol).


    Token economy

    Token Economy

    = an operant conditioning procedure in which people earn a token of some sort for exhibiting a desired behavior and can later exchange the tokens for various privileges or treats.


    Cognitive therapy1

    Cognitive Therapy

    = therapy that teaches people new, more adaptive ways of thinking and acting; based on the assumption that thoughts intervene between events and our emotional reactions.


    Cognitive behavioral therapy

    Cognitive-behavioral Therapy

    = a popular integrative therapy that combines cognitive therapy (changing self-defeating thinking) with behavior therapy (changing behavior).


    Family therapy

    Family Therapy

    = therapy that treats the family as a system. Views an individual’s unwanted behaviors as influenced by, or directed at, other family members.


    Regression toward the mean

    Regression Toward the Mean

    = the tendency for extreme or unusual scores to fall back (regress) toward their average.


    Meta analysis

    Meta-analysis

    = a procedure for statistically combining the results of many different research studies.


    Evidence based practice

    Evidence-based Practice

    = clinical decision-making that integrates the best available research with clinical expertise and patient characteristics and preferences.


    Biomedical therapy

    Biomedical Therapy

    = prescribed medications or medical procedures that act directly on the patient’s nervous system.


    Psychopharmacology

    Psychopharmacology

    = the study of the effects of drugs on mind and behavior.


    Antipsychotic drugs

    Antipsychotic Drugs

    = drugs used to treat schizophrenia and other forms of severe thought disorder.


    Tardive dyskinesia

    Tardive Dyskinesia

    = involuntary movements of the facial muscles, tongue, and limbs; a possible neurotoxic side effect of long-term use of antipsychotic drugs that target certain dopamine receptors.


    Antianxiety drugs1

    Antianxiety Drugs

    = drugs used to control anxiety and agitation.


    Antidepressant drugs

    Antidepressant Drugs

    = drugs used to treat depression; also increasingly prescribed for anxiety. Different types work by altering the availability of various neurotransmitters.


    Electroconvulsive therapy ect

    Electroconvulsive Therapy (ECT)

    = a biomedical therapy for severely depressed patients in which a brief electric current is sent through the brain of an anesthetized patient.


    Repetitive transcranial magnetic stimulation rtms

    Repetitive Transcranial Magnetic Stimulation (rTMS)

    = the application of repeated pulses of magnetic energy to the brain; used to stimulate or suppress brain activity.


    Psychosurgery3

    Psychosurgery

    = surgery that removes or destroys brain tissue in an effort to change behavior.


    Lobotomy

    Lobotomy

    = a now-rare psychosurgical procedure once used to calm uncontrollably emotional or violent patients. The procedure cut the nerves connecting the frontal lobes to the emotion-controlling centers of the inner brain.


    Resilience

    Resilience

    = the personal strength that helps most people cope with stress and recover from adversity and even trauma.


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