Daniel Cox


Research Classification

Research Interests

Motivations and Emotions
Mental Health and Society

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Graduate Student Supervision

Doctoral Student Supervision

Dissertations completed in 2010 or later are listed below. Please note that there is a 6-12 month delay to add the latest dissertations.

The impact of traditional masculinity ideology on veteran mental health and treatment outcome (2023)

This dissertation examines the intersections between traditional masculinity ideology, mental health, and psychotherapeutic treatment outcome among veteran men. This is an important line of inquiry as endorsement of traditional masculinity ideology is common among veteran men and linked to mental health concerns that can negatively impact the transition from military to civilian life. A better understanding of how, and through which means, traditional masculinity impacts veteran men’s mental health and treatment outcomes may elucidate how negative effects of masculinity on the transition trajectory may be mitigated. To this end, three distinct, but interrelated studies were conducted. The first study aimed to determine the relevance of traditional masculinity ideology to veterans’ transition trajectory by examining the relationship between individual masculinity facets and mental health. Results indicated that restrictive emotionality predicted posttraumatic stress disorder (PTSD), depression, and lack of perceived social support, and avoidance of femininity predicted alcohol-related problems. To build on these findings, we sought to assess whether the relationship between traditional masculinity ideology and veteran mental health extends to psychotherapeutic treatment outcome. We began by assessing whether individual masculinity facets impacted pre-to post-treatment change in PTSD symptomatology. Results indicated that higher endorsement of self-reliance and dominance attenuated positive treatment outcomes. To build on our learnings, we conducted a subsequent treatment-focused study to determine if similar results would be observed when measurement of treatment outcome was expanded beyond a single mental health category. To do so, treatment outcome was assessed according to changes in general psychosocial functioning. Additionally, we conducted three post-treatment follow-ups over 18 months to increase our understanding of how masculinity influences symptom change over a longer trajectory of time. Results indicated that higher endorsement of self-reliance may impede treatment outcome and endorsement of toughness may improve outcomes overtime. Combined, results of the three studies can be used to identify means of interrupting the effects of masculinity on the military to civilian transition trajectory. They may also be useful in potentiating positive treatment outcome by indicating interventions points related to interrupting masculinity facets that may disrupt veteran wellbeing and bolstering those with possible protective effects.

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The effect of cognitive and affective processes on trauma-related distress (2021)

The overall purpose of this dissertation was to examine the effects of cognitive (e.g., maladaptive schemas, cognitive fusion, interpersonal difficulties) and affective (e.g., posttraumatic shame, self-blame, and guilt) processes on trauma-related psychopathology, specifically posttraumatic stress disorder. Implications for this line of research are to further understand the nuances of cognitive and affective processes on people (both civilians and veterans) who have experienced traumatic events. The primary purpose of Study 1 was to understand the impact of interpersonal difficulties on shame- and guilt-proneness following adverse childhood experiences (ACEs) in a community sample. Results indicated that interpersonal difficulties, related to increased cognitive and affective sensitivity, was a strong mediator of both shame and guilt-proneness. The primary purpose of Study 2 aimed to examine effects of posttraumatic negative self-appraisals (shame and self-blame) on the association between maladaptive schemas and PTSD symptom severity in a civilian population. Results indicated that posttraumatic shame mediated the association between maladaptive schemas and PTSD symptom severity, over and above posttraumatic self-blame. Additionally, maladaptive schemas of disconnection & rejection and impaired autonomy & performance were specifically mediated by posttraumatic shame. Based on Studies 1 and 2, we observed that more rigid and chronic maladaptive cognitive and affective processes are more impairing for people following traumatic experiences. Thus, the purpose of Study 3 was to examine (a) the longitudinal change factors impacting PTSD and depression symptom change in a sample of Canadian veterans and (b) the moderating effects of cognitive fusion on PTSD and depression symptom change over the course of treatment. Results indicated that depression symptoms predict changes in PTSD symptoms during treatment; however, cognitive fusion did not. It was additionally found that PTSD and depression symptoms predicted change in cognitive fusion. This may indicate that strong trauma and depression related beliefs may impede cognitive defusion during treatment. Combined, these investigations further our understanding of how cognitive and affective processes are influenced by, impact, and predict trauma-related symptomatology following traumatic experiences across the lifespan.

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Possibility in groups: examining group interventions to enhance emerging adults' possible selves (2020)

Emerging adulthood is a period when a person’s sense of who one can become undergoes considerable development. It has been proposed that interventions that focus on enhancing identity can help emerging adults shape and pursue their life goals; however, little is currently known about group interventions that help young people develop a robust sense of identity. Thus, the purpose of this dissertation was to advance understanding of identity-focused group interventions among emerging adults. Three studies were conducted using a staged approach to achieve this goal. Study 1 reviewed identity-focused group interventions that were empirically tested with emerging adults to uncover their defining characteristics and purported mechanisms of change. Interventions were categorized into three groups, including didactic, task-oriented, and experiential. Study 2 compared two possible selves group interventions (interpersonal-experiential and didactic) that aimed to increase participants’ sense of future possibilities. Findings indicated significant improvement in future outlook and personal growth initiative following participation in both types of intervention. While no significant change in vocational possible selves was observed, significant improvement in relational possible selves was found among participants who completed the interpersonal-experiential intervention. Follow-up analyses found that improvement in relational possible selves in the interpersonal-experiential intervention was associated with participants’ ratings of group engagement during the intervention. Study 3 explored participants’ subjective experiences in the aforementioned possible selves group interventions. Three overarching categories emerged from a thematic analysis, including psychosocial changes (four themes), helpful factors (nine themes), and unhelpful factors (five themes). The emergent themes were associated with one or both group interventions. Taken together, these three studies made the following contributions to the advancement of knowledge: consolidating and interpreting the disparate literature; investigating the effectiveness of and participants’ perceptions of change in two identity-focused group interventions; examining group processes in the above interventions, and; exploring participants’ perceived limitations and suggestions for improving the aforementioned interventions. Findings from this dissertation provide support for the need to study psychological interventions that address identity development in emerging adulthood, affording an original and substantive contribution to the identity scholarship domain.

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Is maternal emotion socialization associated with daughters' eating disorder psychopathology and emotion regulation? A mediation study based on mothers' reports. (2019)

There is an ongoing need to improve the models of and treatments for eating disorders (EDs), given the limited recovery rates. Emotion regulation difficulties predict and maintain these disorders but interventions that teach emotion regulation skills to individuals with EDs have not improved the overall treatment efficacy. Research in developmental psychology suggests that parents influence (socialize) emotion regulation of their adolescent children and can be utilized in treatment as emotion coaches. This can be a promising avenue for future interventions for EDs, if research demonstrates that parental emotion socialization is linked to youth’s ED psychopathology through youth’s emotion regulation, as suggested by theory. This study examined if three channels of emotion socialization – practices (emotion coaching, emotion dismissing, and positive beliefs about daughters’ anger), mothers’ emotion regulation, and expressed emotion (critical comments, emotional overinvolvement) – were associated with daughters’ ED psychopathology through daughters’ emotion regulation. Individual differences that might be associated with emotion socialization were also examined. 135 mothers of daughters either with or without an ED diagnosis completed a battery of measures. Daughters’ ages ranged from 12 to 24 years. Results indicated that mothers’ emotion coaching, emotion regulation difficulties, and critical comments were indirectly related to daughters’ ED psychopathology through daughters’ emotion dysregulation. Emotional overinvolvement was only linked to ED psychopathology directly. Mothers’ psychological functioning or daughters’ diagnostic status (presence or absence of an ED diagnosis) were not significantly related to emotion coaching, emotion dismissing, or positive beliefs about anger. This study is a first step towards understanding how emotion socialization, especially emotion coaching, is linked to ED psychopathology and it can inform future research and clinical practice.

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Master's Student Supervision

Theses completed in 2010 or later are listed below. Please note that there is a 6-12 month delay to add the latest theses.

Relational constructs and suicidal-crisis outcomes : examining trajectories of connectedness, disconnectedness, and burdensomeness (2023)

Objective: Relational constructs such as connectedness, disconnectedness, and burdensomeness have been theoretically emphasized and empirically linked to suicide; however, little is known about how trajectories of these relational constructs are associated with suicide-related outcomes in helping contexts – notably, in interventions with clients in suicidal crisis. Therefore, this study examined the associations between trajectories of (a) connectedness, (b) disconnectedness, and (c) burdensomeness with outcome among suicidal clients who received crisis counseling. Methods: Using multilevel latent-growth modelling, we analyzed single-session text-based crisis intervention sessions with adults in suicidal crisis (N = 242). Results: When modelled separately, trajectories of connectedness, disconnectedness, and burdensomeness were associated with outcome. When modelled simultaneously, (a) decreases in disconnectedness had stronger associations with outcome than increases in connectedness, and (b) burdensomeness was not associated with outcome.Conclusions: While all relational constructs demonstrated associations with outcome when modelled separately, our findings indicate that connectedness and disconnectedness may be the most relevant for clients receiving single-session text-based suicidal crisis intervention. Limitations and future directions are discussed.

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Developing and validating a distress-processing model for clients in suicidal crisis (2022)

While crisis intervention frameworks have indicated the importance of clients in suicidal crisis better understanding their distress to decrease suicidality, it is unclear how clients in suicidal crisis make sense of their distress. We used task analysis to develop and validate a sequential distress-processing model for clients in suicidal crisis based on theory and empirical observation. Online crisis chats (N = 51) with adults in suicidal crisis were coded to develop a distress-processing model for clients in suicidal crisis and corresponding observational measure. We then related clients’ distress processing to psychological outcomes using quantitative methods. We developed a sequential five-stage distress-processing model describing clients moving through (a) distress disengagement, (b) distress awareness, (c) distress clarity, (d) distress insight, and (e) application of distress insight. Our findings supported the sequential nature of our distress-processing model, and that clients with good outcomes were twice as likely as those with bad outcomes of being in a higher overall stage of distress processing. By better understanding how clients in suicidal crisis process their crisis distress, more targeted assessment and intervention can be developed.

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Feeling pressured to talk about trauma: how pressure to disclose alters the association between trauma disclosure and posttraumatic growth (2022)

Talking with others about traumatic experiences (i.e., trauma disclosure) has been associated with increased posttraumatic growth. While this association indicates the value of disclosing, there is evidence that external pressure to disclose can hinder the benefits of trauma disclosure. The aim of the current study was to examine the influence of pressure to disclose on the association between trauma disclosure and posttraumatic growth. People who had experienced a traumatic event and had disclosed their trauma to a close other were recruited from Amazon’s Mechanical Turk (n = 208). Participants completed measures of traumatic experiences, trauma disclosure, pressure to disclose, posttraumatic growth, posttraumatic stress symptoms, and responses to disclosure. Results indicated that the linear association between trauma disclosure and posttraumatic growth was quadratically moderated by pressure to disclose. Pressure to disclose strengthened the positive association between trauma disclosure and growth from low to moderate levels of pressure. However, increasing from moderate to high pressure weakened the association between disclosure and growth. These findings indicate that a moderate amount of pressure to disclose may facilitate the positive impact of disclosure on posttraumatic growth; yet a high amount of pressure may impede disclosure’s positive association with growth. This research furthers our understanding of the nuance of trauma disclosure and how the involvement of close others in trauma disclosures can impact the process of posttraumatic growth for trauma survivors.

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Linguistic synchrony: indicator or facilitator of therapeutic bond (2022)

Interpersonal synchrony is an adaptive and pro-social process that has been associated with social bonding, cohesion, and cooperation. Existing research in a therapeutic context has primarily conceptualized linguistic synchrony as an indication of the therapeutic relationship. However, in non-therapeutic contexts, synchrony has been conceptualized as a process that facilities relationship formation and maintenance. The aim of the present study was to examine if an indication model or facilitation model provided a better explanation for the association between linguistic synchrony and the therapeutic bond. Online text-based crisis sessions (N = 350) with clients in suicidal crisis were coded for linguistic synchrony (i.e., similarity of function words) and therapeutic bond. To examine the indication and facilitation models, we used Random Intercept Cross-Lagged Panel Models (RI-CLPM; Hamaker et al., 2015) and compared the model fit of the competing models. The association between linguistic synchrony and therapeutic bond was better explained by the facilitation model (i.e., linguistic synchrony predicting the therapeutic bond) than the indication model (i.e., linguistic synchrony and therapeutic bond occurring simultaneously). However, a combined model that included (a) linguistic synchrony predicting therapeutic bond and (b) the cross-sectional association between therapeutic bond and linguistic synchrony was the best fit to our data. This study contributes theoretical understanding of the association between linguistic synchrony and therapeutic bond. Clinical implications for counsellor practice are discussed.

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Social role dysfunction and coping in borderline personality disorder (2020)

Individuals with borderline personality disorder (BPD) often experience deficits in social role performance, which encompasses the ability to adhere to socially defined rules and norms of behaviour. Additionally, research suggests that coping styles influence the way individuals with BPD manage stress, and that overall symptom severity and functioning in individuals with BPD varies across genders. This study sought to explore these variables via moderated mediation, investigating the mediating influence of coping styles on the relationship between BPD symptoms and social role dysfunction, and if these association were further moderated by gender. Participants (N = 233) were outpatients attending an intensive group treatment program who completed self-report measures on personality dysfunction, coping styles, and social role functioning. A moderated mediation model shows that for women with high BPD symptoms, usage of emotion-oriented coping was associated with increased social role dysfunction. Interestingly, also for women with high BPD symptoms, decreased use of social diversion-oriented coping was associated with increased social role dysfunction. No significant associations were found between coping and social role dysfunction among men. Findings suggest that social support seeking and a healthy social network may play an important part in the ongoing social development of women with BPD. From this, potential early therapeutic interventions targeting safe social engagement in times of stress may decrease the pervasive and persistent nature of social dysfunction in BPD.

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Interpersonal problems and social dysfunction in patients with avoidant and borderline symptoms (2019)

Interpersonal problems are one of the most persistent difficulties facing those withpersonality disorders (PDs) and are linked with dysfunction across numerous social domains.Researchers have explored the associations between PDs, interpersonal problems, and socialdysfunction; however, there is limited understanding of which interpersonal problems mediatethe link between PDs and social dysfunction. Using an interpersonal model of PDs, we examinedwhich interpersonal problems mediated the association between PD symptoms and socialdysfunction in adults with avoidant personality disorder (AvPD) and borderline personalitydisorder (BPD) symptoms. Participants were 226 adults experiencing personality dysfunctionwho were taking part in the Day Treatment Program at the University of Alberta Hospital inEdmonton, Canada. Using cross-sectional data from self-reported measures, we found that cold(b = .10, 95% CI [.038, .176]) and overly nurturant (b = .04, 95% CI [.001, .090]) interpersonalproblems mediated the link between AvPD symptoms and social dysfunction. The onlysignificant mediator in the link between BPD symptoms and social dysfunction was overlynurturant (b = .05, 95% CI [.001, .120]). The results from our study may aid in the developmentof more individualized treatments for those struggling with AvPD and BPD so as to improvesocial functioning as well as other clinical outcomes.

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Exploring crisis counsellor helping styles in online crisis counselling (2018)

Crisis counselling via suicide prevention hotlines has demonstrated reduced distress and suicidality in individuals seeking support. Text-based online crisis counselling services (i.e., chats) are becoming an increasingly common way to support suicidal individuals in crisis. Existing research has not yet established a clear understanding of the crisis counselling process and how it relates to outcomes like reduced distress and suicidality. The purpose of this study was to build on current research by examining patterns of different crisis counsellor helping styles and exploring their associations with chatter outcomes, with the goal to develop a theoretical stage model of online crisis counselling. This study also explored whether crisis counsellor behaviours considered to be unhelpful were associated with a lack of chatter improvement. Past chat transcripts (N = 100) from a local crisis intervention centre were collected and coded for different crisis counsellor helping styles (i.e., active listening, collaborative problem-solving, and unhelpful) and chatter outcomes (i.e., affect, suicide risk, and suicide ideation). Analyses of variance were performed. Results indicated that active listening and collaborative problem-solving styles fluctuated over the course of chat, and some patterns of different crisis counsellor behaviours were associated with chatter outcome. Unhelpful crisis counsellor behaviours were associated with lack of chatter improvement. These findings contribute to the growing body of literature on online crisis counselling by generating a theoretical model of what the online crisis counselling process could look like, and how it may support suicidal individuals. Theoretical and practical implications are discussed.

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Is motivation enough? Confidence as a predictor of outcome in inpatient treatment for eating disorders (2018)

While motivation has been shown to be a robust predictor of eating disorder treatment outcome, little attention has been paid to the role of confidence. This study sought to better understand the role of confidence and the possible interaction it may have with motivation in promoting eating disorder symptom change. Participants were adult women (N = 159) in inpatient treatment for eating disorders. They completed measures of readiness and motivation for change, which assessed precontemplation, action, confidence and internality (changing for oneself vs. for others) and eating disorder symptom severity at pre- and post-treatment. Medical variables (e.g. height and weight) were also recorded. Precontemplation and confidence had significant effects on pre-and post-treatment symptom severity, while action only had a significant effect on pre-treatment symptoms. Confidence was also shown to moderate relations between both measures of readiness (i.e., precontemplation and action) and change in symptoms. Follow up analyses indicated that high precontemplation (low readiness) was associated with poor outcome, irrespective of confidence, however, low precontemplation (high readiness) was associated with better outcome at high levels of confidence. The interaction between confidence and action was significant only at very high levels of confidence. Among individuals who had high action at baseline, those with lower confidence had significantly poorer outcomes relative to those with high levels of confidence. Findings indicate that readiness and confidence are important prognostic factors and suggest that early behaviour change in the absence of confidence does not guarantee best outcomes in inpatient eating disorder treatment.

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Partner trust and childhood emotional maltreatment: considering the roles of maladaptive schemas and psychological flexibility (2018)

Victims of childhood emotional maltreatment (CEM) often experience lasting interpersonal impacts. CEM is commonly experienced as a betrayal of trust and can lead victims to generalize this mistrust to relationships in adulthood, including their romantic partners. The aim of the present study was to better understand the association between CEM and partner trust by examining the relative strength of three potential mediators – psychological flexibility, maladaptive self schemas, and maladaptive other schemas. The study also investigated whether psychological flexibility buffers the association between maladaptive schemas and partner trust. Adults (N = 231) in committed romantic relationships completed measures of CEM, romantic partner trust, maladaptive schemas, and psychological flexibility. Simple and multiple mediation analyses were performed. I found that maladaptive self schemas were a stronger mediator than maladaptive other schemas; however, psychological flexibility was a more potent mediator than either schema type. Contrary to my hypothesis, psychological flexibility did not significantly moderate the effect of maladaptive schemas on partner trust. The findings highlight the importance of attending to and increasing psychological flexibility with victims of CEM to facilitate romantic partner trust. Practical and clinical implications are discussed.

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Self-compassion: an adaptive way to reduce recurrent depression symptoms through emotion regulation (2017)

Major depressive disorder (MDD) is often a recurring disorder, with multiple major depressive episodes (MDEs) experienced over a lifetime. A key challenge for those who struggle with depression is the prevention of recurrence, given that the risk of recurrence increases significantly with each episode. Difficulty with emotion regulation has consistently been found to predict both depression symptoms and MDD, and is proposed to be an important factor in both the development and chronicity of this disorder (Atherton, Nevels, & Moore, 2015; Aldao, Nolen-Hoeksema, & Schweizer, 2010). Recently, self-compassion has been presented as a robust protective factor in depression (Diedrich, Grant, Hofmann, Hiller, & Berking, 2014; Ehret, Joormann, & Berking, 2015; Krieger, Berger, & Hotlforth, 2016). Furthermore, it has been suggested that low levels of self-compassion may be an enduring risk factor for depression recurrence (Ehret et al., 2015). This study examined how self-compassion may be protective in the recurrence of depression symptoms through specific emotion regulation strategies associated with depression: rumination, experiential avoidance, acceptance, and cognitive reappraisal. Surprisingly little research has examined the pathways through which self-compassion and depression symptoms are linked. A sample of 105 participants with a history of recurrent depression were recruited using Amazon’s Mechanical Turk (MTurk). Simple and multiple mediation analyses (Preacher & Hayes, 2008) were conducted. Results from the simple mediation models indicated that higher levels of self-compassion were associated with lower depression symptoms through rumination, experiential avoidance, and acceptance. Surprisingly, cognitive reappraisal did not mediate the relation between self-compassion and recurrent depression symptoms. The multiple mediation model revealed that rumination was the only significant mediator, when controlling for other emotion regulation strategy variables. Theoretical and clinical implications are discussed.

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Attachment, Alexithymia, Gender, and Emotional Disclosure: An Interactional Investigation (2016)

Emotional disclosure—verbal communication of emotional experiences—reduces emotional distress and positively impacts interpersonal relationships. Consequently, concealing emotions has been shown to negatively impact physical and psychological health. Previous research has shown that people with attachment avoidance orientation, and people with alexithymia, limit their use of emotional disclosure as a means of affect regulation. Little research however, has been conducted to determine if alexithymia mediates the negative relation between attachment avoidance and emotional disclosure. Additionally, there is little research evaluating the moderating effect of gender on the relation between attachment avoidance and alexithymia. Presently, we investigated if alexithymia mediated the negative relation between attachment avoidance and emotional disclosure. Secondarily, we evaluated whether gender moderated the positive relation between attachment avoidance and alexithymia. Participants were Mechanical Turk workers (N = 178) who completed measures of attachment orientation, alexithymia, and generalized emotional disclosure tendencies. Our primary hypothesis was supported: alexithymia partially mediated the relation between attachment avoidance and emotional disclosure. Our secondary hypothesis was also supported: gender moderated the relation between attachment avoidance and alexithymia in that the relation was stronger for male participants compared to female participants. Implications for theory and counselling psychology practice will be discussed.

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Multicultural Counselling Self-Efficacy Among School Counsellors in British Columbia (2015)

Across Canada, schools are serving an increasingly multicultural student population, one with diverse and sometimes unfamiliar experiences and worldviews. Despite this fact, very little research has been conducted on school counsellor multicultural self-efficacy in Canada. To address this gap, a survey research design was used to assess the level of multicultural self-efficacy among a sample of school counsellors (N = 226) in British Columbia. This study also sought to identify the demographic and workplace variables that contribute to higher levels of multicultural counselling self-efficacy among school counsellors in British Columbia. In addition, the study examined the relative contribution of years of experience versus caseload diversity, and the impact of high levels of multicultural training on the relationship between self-efficacy and years of experience. The School Counselor Multicultural Self-Efficacy Scale (SCMES; Holcomb-McCoy, Harris, Hines, & Johnston, 2008) measured self-efficacy across six factors. Results suggest that BC school counsellors have moderate to high levels of multicultural counselling self-efficacy across all six factors of the SCMES. Hierarchical regression analyses were used to identify the unique contributions of specific predictor variables to specific SCMES factors. Three distinct patterns emerged. In Pattern #1, graduate-level multicultural training courses, and frequency of cross-cultural sessions were the most influential predictors. In Pattern #2, multicultural training alone exerted the greatest influence. However, in Pattern #3, teaching experience and community setting combined with graduate-level multicultural training as significant contributors to a single factor: Factor 3 (Developing Cross-Cultural Relationships). Factor 3 plays an important and unique role in subsequent analyses. The implications of these findings for counsellor training and practice, and suggestions for further research are discussed.

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