Stress Management and Prevention Program Resource Guide
By: Jazell Choi-Andujar Kaplan University Health & Wellness HW410: Stress: Critical Issues in Management and Prevention November 20, 2012 Revised May 13, 2014
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Table of Contents page Unit 1: THE NATURE OF STRESS 5 Information to Remember Resources: Exercises Tools: Journal Writing Unit 2: THE BODY AS BATTLEFIELD 6 Information to Remember Resources: Exercises Tools: Journal Writing Unit 3: FEAST OR FAMINE 7 Information to Remember Resources: Exercises Tools: Journal Writing Unit 4: ONE PLANET UNDER STRESS 8 Information to Remember Resources: Exercises Tools: Journal Writing Unit 5: UNDER STRESS: WHAT NOW? 9 Information to Remember Resources: Exercises Tools: Journal Writing Unit 6: AGELESS WISDOM OF MEDITATION 10 Information to Remember Resources: Exercises Tools: Journal Writing Unit 7: SIGHT, SOUND, AND BODY WORK 11 Information to Remember Resources: Exercises Tools: Journal Writing 4 Unit 8: THE WELLNESS MANDALA 12 Information to Remember Resources: Exercises Tools: Journal Writing Unit 9: APPLYING STRESS: CRITICAL MANAGEMENT AND PREVENTION TO YOUR PROFESSIONAL LIFE 13 Information to Remember Resources: Exercises Tools: Journal Writing Unit 10: APPLYING STRESS: CRITICAL MANAGEMENT AND PREVENTION TO YOUR PROFESSIONAL LIFE 14 Information to Remember Resources: Exercises Tools: Journal Writing ADDITIONAL INFORMATION 15 REFERENCES 16
5 Unit 1: The Nature of Stress Information to Remember: There are three types of stress: Eustress, also known as good stress, neustress are incidents that are not considered good or bad, and distress which is a negative reaction to stress or perceived stressors. Of the three types of stress states, distress is the most destructive one to an individuals health and comes in two forms, acute and chronic.
Stress is recognized as the bodys fight or flight response which produces the hormones epinephrine and norepinephrine to prime the body to either run away from danger or face it head- on. The stress response is meant to be in reaction to acute conditions, and not meant to be activated continuously; as it has been shown to be one of the leading causes of physical and mental diseases.
Stress is an adaptation response produced by the body in an effort to reestablish homeostasis when one experiences a real or perceived stressor. Homeostasis is the physiological state of prime functioning and healthy individuals; it is also the primary goal to achieve for optimal health. A constant internal environment is necessary for the body to stay in homeostasis; stress instigates physiologic fluctuations which threatens homeostasis. Resources: Exercises: Inventory: Are You Stressed?: This simple exercise can be utilized to take inventory of possible stressors being currently experienced in a persons life (Seaward, 2008, p.3). The application ask questions that pertain to an individuals general lifestyle habits and relationships, as those are the matters most people consider to be stressful. What is really helpful about this particular analysis is that not only does it reveal ones current stressor but also takes in account the aspects of their lives that are functioning optimally. Tools: Journal Writing: My Health Philosophy: Since everything in the world around us has the possibility to affect ones health (positively or negatively) it is important to define your core belief system (Seaward, 2008, p.5). An analysis of personal beliefs and philosophies can reveal how one prioritizes their health and what motivates them to stay healthy. This introspective tool is to be used to understand both your present state and your future goals. Unit 1 6 Unit 2: The Body as Battlefield Information to Remember: The stress response affects three dominate physiological systems: the nervous system, the endocrine system and the immune system. The stress response also has three intensities: immediate (sympathetic drive), intermediate (adrenal medulla) and prolonged (neuroendocrine pathways). As the intensity of the stress response increases so does the time associated with each response; from seconds to hours. Due to the systems affected during the activation of the stress response the body inhibits growth, digestion, tissue repair, sex drive, and immunity. The physiology of stress response affects both the body and mind. Stress physiology studies have proven the stress response to be a mind/body occurrence that is activated by a perceived stressor. Stress is subjective to the experiencers perception. Insomnia is a perfect example of a time when the body is undergoing physical rest but the mind continues to invoke the stress response. The study of stress and its mind/body connect is termed Psychophysiology. Studies of the brain have shown that we are designed for the stress response. We are innately hard- wired with neural pathways for the fight or flight response. Research also shows that if someone is chronically stressed it can cause degeneration of the brain, and in particular hippocampus brain tissue. Before stress begins to affect brain tissue, the number one predictor of stress is habitually elevated blood pressure known as hypertension. If one experiences high-blood pressure regularly there is a greater chance of the brain becoming negatively affected. Resources: Exercises: Immediate, Intermediate, and Prolonged Stress Effects: This exercise is meant to bring awareness of your bodys physiological response to stress though the three phases from acute to chronic (Seaward, 2008, p.15). The survey asks about the physical bodys reactions to stress ranging from headaches, muscle tension, allergic responses and heart palpation rates. Tools: Journal Writing: Physical Symptoms Questionnaire: This personal analysis focuses is on how often and severe ones stressors affect them (Seaward, 2008, p.17). The assessment concentrates on how often, how severe, and for how long physical symptoms last for by looking at the connections between stress levels and symptoms. Taking the time to truthfully answer this questionnaire will clarify how often your body is being negatively affected due to stress. Unit 2 7 Unit 3: Feast or Famine Information to Remember: Over the year many great thinkers and psychologists have theorized how people cope with stress. Theorist utilized the study of perceptions, cognitive symptoms, emotional reactions, self-awareness or lack thereof, along with many other behavioral factors to explain the psychology of stress. Many theorizers share two mutual interrelated concepts governing the psychology of stress; self- awareness and self-acceptance. Both having and cultivating these innermost perceptions plays a key role in efficiently managing stress. The effects of stress are directly influenced by a persons perception of the stressor. The perception of stress is directly linked to the persons priorities of needs. Theorized by the famous American Psychologist Abraham Maslow, an individuals hierarchy of needs impacts his or her awareness of themselves, also known as self-actualization theory. Self-awareness fosters self-acceptance and self-love, which is what we all inherently striving towards. Those who are self-actualized are capable of having a deeper appreciation for the journey of life which makes them less susceptible to be adversely being effected by the damaging effects of stress. The psychology behind stress has been theorists by neurologist and psychiatrist Viktor Frankl as being related to the search for the deeper meanings of life; this existential analysis is defined as logotherapy. Logotherapy affirms that the journey of life will naturally include stressors, and people are always striving to unfold the meaning of their life. Those who recognize and strive to know the deeper purpose of life will also search for the meaning associated with their stressors in an effort to relieve emotional stress, making them more adapt to handling stress in a more constructive way. Resources: Exercises: The Psychology of Your Stress: This short but powerful exercise was created using several common psychological theories (Seaward, 2008, p.33). It was generated to cultivate ones awareness of their perceptions, mindsets and reactions to stress. Completion of the exercise will help one see their own psychological patterns associated to their behaviors during stressful occurrences. Tools: Journal Writing: Emotional Well-Being: This four question exercise is based on the concept that emotional health is defined as the capacity of feel all ranges of emotions (Seaward, 2008, p.66). This exercise asks the participant to recognize if they may be restraining the expressing of certain emotions. Having the ability to articulate emotions is healthy. However, avoidance of expressing ones feelings can bring about depression and inertia to someones life. Unit 3 8 Unit 4: One Planet Under Stress Information to Remember: The term locus of control (L.O.C) is defined as what one believes has control over their life. Those who believe they solely control their life have an internal L.O.C., and those with the opposite view place responsibility on outside influencers, defining them as having an external L.O.C. Psychologist Julian Rotter coined the term, and theorized that human behavior is generally inclined by both. Hence, ones locus of control is a behavior which can be modified to empower a person to: positively change, have faith, be stress-resistant and conceivably kick addiction. If one were to illustrate the difference between religion and spirituality, religion would be a vessel that holds water and spirituality would be the water itself. Coin by Aldous Huxley, Perennial Philosophy is a term to describe spirituality which is unlike religion. People who have spiritual inner awareness are thought to experience a reality that transcends cultural, religion and internal aspect of their own ego. Stress due to fear and anger can hinder spiritual health; while spiritual well-being can be a powerful tool in undoing the effects of stress. Those who have the tenacity to resolve their stressors gain the opportunity to learn from their lifes experiences. The World Health Organization views spiritual well-being as being a vital asset to the complete expression of genuine health. Resolving stress takes harmony with ones inner self, their relationships, the environment and the universe (higher power). There are four general methods required to intensify ones spirituality: centering, emptying, grounding, and connecting. Stress reducing techniques and coping mechanisms tend to share these same qualities. Cultivating spiritual strength has been shown to reduce stress, and fortify a greater sense of peace. Resources: Exercises: Your Personal Value System: The exercise contains an illustration of a large circle, where one would write their core values, surrounded by twelve small circles for the supporting values (Seaward, 2008, p.95). Ones values are a measure of their personal belief system which guides their aspirations. Upon completion, the participant is left with a clear picture of whether or not their core values are actually being sustained or blocked by their supporting ideals. Tools: Journal Writing: Stress-Resistant Personality Survey: This questionnaire will demonstrate if the partaker has a stress-resistant personality, since people with hardy personality traits are known to be better at resisting stress (Seaward, 2008, p.72). After reading each phrase, the partaker then rates how often he/she can relate to the statement. A score of more than thirty points indicates that the candidate probably has a stress resistant personality. Unit 4 9 Unit 5: Under Stress: What Now? Information to Remember: Beneficial coping strategies are developed by honestly evaluation of ones perception of their stressors, the viewpoints of their issues, and manifesting a peaceful resolution that is seen to closure. If the closure is not achieved in the final step, then the specific stress coping mechanism is not an effective one. Having successful coping skills can be quantified the following way: Effective coping strategies = Increased awareness + Information processing + Modified behavior + Peaceful resolution (Seaward, 2004). Reframing is a concept that allows the perceiver to look at a stressful situation in a different light. Under stress, the mind has the propensity to engage in negative self-talk which can distort ones cognition. Cognitive contemplation fosters sensible thinking, and coping techniques when undergoing stressors. Reframing the minds thought pattern allows for flexible optimism instead of pessimism. Valuable techniques to help reframe the mind and boost self-confidence are: self- praise, affirmations, humor and having a creative outlet. Time is meant to be used to manifest moments that are personally satisfying, yet people find themselves stressed out by how little time they think they have. The increasing pace of our society tends to be an overwhelming stress factor. Although our culture has various technologies to help us simplify our lives, these same tools can hinder our healthy boundaries, instigating more complications. Being able to organize and prioritize how one utilizes their time is a proven coping mechanism. By utilizing time management techniques one can meet their lifes goals by making better use of the time. Resources: Exercises: One Thousand Things Went Right Today!: This exercise is used as method to develop ones optimistic thinking. The partaker is guided to recount the positive things that happened throughout their day and the mind frame they were in when they experienced those occurrences (Seaward, 2008, p.123). The second portion asks if there were any lessons erudite from their days activities. Chronicling the daily events that went well trains the mind to focus on the positive attributes of their day, instead of the negative ones. Tools: Journal Writing: The Time-Crunch Questionnaire: This questionnaire provides twenty-three diverse quotes that help the partaker to contemplate exactly where they are focusing their time and energy (Seaward, 2008, p.179). The thought provoking quotes range from asking directly if the participant would define themselves as a procrastinator, or do they believe that there are not enough hours in the day; furthermore, whether one allows basic health needs like eating be effected by their lack of time management skills. Unit 5 10 Unit 6: Ageless Wisdom of Meditation Information to Remember: Unlike prayer which is considering an appeal to an external force, meditation is the act of creating an intentional quiet space in which no requests are made but instead deep listening is instigated. The meditative process itself allows the mind to shift from left- to right-brain thinking which results in experiences of: time distortion, ineffability, present-centeredness, perception distortion, enhanced receptivity and self-transcendence. As a tool, meditation is used to clear the mind of burdens in an effort to increase self-awareness, which forester insights that guide the meditator to a viable solution to ones problems. The physiological and psychological effects of meditation stimulate dramatic health altering benefits. The scientific study of mediation has proven its physiological changes which include a decrease of: oxygen consumption, blood lactate levels, heart rate, blood pressure and muscle tension. Meditation has also been shown to increase the brains alpha waves, and physical skin resistance. Clinical studies have linked therapeutic practices such as yoga, biofeedback and autogenic training to the same characteristics produced by meditation. Journaling is a convenient, generally advisable, and user friendly meditation tool used to clear the mind and gain inner wisdom. The act of writing thoughts down to empty the mind bring a release and clarity that allows for a deep understanding of oneself, consciously and unconsciously. There are distinct psychological benefits to journaling, as it is evidence of ones internal confrontation; the act of writing allows the person to take ownership of their feelings. Journaling is a meditative tool that can be used as a coping mechanism that allows one to release their mental clutter while channeling self-expression. Resources: Exercises: Focus!: Focusing is the primary step to any meditative practice (Seaward, 2008, p.213). Focusing ones attention is not an effortless task; in order to do so several factors must come together as focusing does not come naturally. To encourage inner awareness, this exercise asks the doer to reveal ten behaviors which contribute to poor attention span, and a reduced mental focus. Tools: Journal Writing: Unwritten Letters: This journaling method provides the writer a way to communicate with others, and even themselves, without actualizing the words they want to say (Seaward, 2008, p.141). The exercise instructs the writer to inscribe several letters: one to someone who has passed on, another to oneself with the premise that they only have one month to live, and lastly, to ones unborn child. This meditative act is spiritually liberating as it has the effect of provoking creativity, revealing resolutions and allowing passive closure. Unit 6 11 Unit 7: Sight, Sound and Body Work Information to Remember: The vision and hearing are the primary senses utilized to understand and interpret the world around us. Since these two senses are highly labored, relaxation systems tend to focus on neutralizing their functions through mental imagery and music therapy. The purpose of these sensory relaxation techniques is to decrease the overwhelming bombardment of information by replacing them with enjoyable stimuli. The therapeutic affect induced by visualization, and music tends to clear and clam the mind while bring ones thoughts to the present moment.
Music is the most popular relaxation technique engaged in worldwide. Music therapy is a methodical system used to induce emotional changes, reduce pain and inspire dance or movement. The therapeutic effect is the key reason massage therapists play background music during their restorative sessions. Clinicians theorize that music induces relaxation biochemically by hearing, and processing the sound vibrations which are interpreted by either the sympathetic or the parasympathetic nervous system. Effective music therapy is implemented with the use of music without lyrics, and environmental sounds like the ocean or falling rain.
There is a direct correlation between stress, the immune system and ones relationship with food. An unhealthy diet can have a detrimental effect on how the body processes stress. People have a tendency to use eating as a coping mechanism because food is strongly connected to emotions. If this coping method is exploited, stress will affect the necessary nutrients needed in the production of energy for sympathetic system; subsequently, depleted nutrients cannot be regenerated. Although the body will attempt to compensate itself from the loss of vital nutrients, ultimately ones health will be negatively affected. Resources: Exercises: Music and Visualization: This exercise incorporates imagery and music as meditative tool (Seaward, 2008, p.229). The participant is guided to set the mood for the relaxation method by diming the lights, laying down, closing ones eyes and simply listening. This practice is meant to allow space for the music to create a picture in the minds eye without any effort. Tools: Journal Writing: Stress-Related Eating Behaviors: This analysis is intended to divulge if the persons eating behaviors maybe having an unhealthy effect on their immune system (Seaward, 2008, p.251). The survey gives instructions to rank the twenty statements provided between the numbers zero through four, zero being considered not applicable and four meaning constantly. The statements focus on nutritional patterns such as: how often one eats, times of the day, healthy cooking and cravings and vices. Unit 7 12 Unit 8: The Wellness Mandala Information to Remember: The management of stress incorporates the mind and body connection. Just as healthy mental and spiritual patterns reduce stress so does a regular fitness regimen. Rhythmic exercises like swimming, cycling, walking and running, permits the analytical left brain to gradually slow down, and incites the creative left brain. The benefits gains from physical exercise are improved self- esteem, self-efficacy and mental alertness which is reflected in a decrease of stress, anxiety and depression. These enhanced traits allows for exercise to be used as a recognized stress coping method. A habitual exercise regimen rewards one with both physiological and psychological homeostasis. Exercising promotes ones ability to handle stress, as the act itself is a form of stress because it elicits the fight or flight response. There are two general types of exercise: anaerobic defined as short yet intense activity is thought to stimulate the flight response, and aerobic which incites the fight response thru prolonged cardiovascular motions. The stress hormones induced by physical exercise are utilized for its intended purposes of strengthening and detoxifying the body. Nutritional research has proven that some foods actually induce a state of stress. Hence if someone eats unhealthy, they will be unhealthy. Foods rich in sugar, sodium, caffeine and fats should be reduced or avoided while one is undergoing stress as these ingredients are known to weaken the immune system and decrease resistance to stress. Also, addictive substances like alcohol and cigarettes should be eliminated altogether as these substances are not only stress inducers but can cause mortality. Resources: Exercises: Mandala for Personal Health: Your Holistic Stress Management Strategy: This exercise involves filling in a pre- labeled circle with methods currently being utilized, or techniques one wants to incorporate into their lifestyle regimen in order to achieve balance between the mind, body, spirit and emotions (Seaward, 2008, p.274). Once completed, it is advised to place the mandala in a decidedly visible area to serve as a reminder. Tools: Journal Writing: Your Circadian Rhythms: People who are both healthy and successful have been shown to keep a consistent schedule of daily habits (Seaward, 2008, p.271). This journaling activity asks the participant to monitor their lifestyle behaviors according to the hours in the day. Questions asked are time directed as in when do you wake, sleep, eat, have sex, use the bathroom and exercise. Unit 8 13 Unit 9: Applying Stress: Critical Management to your Professional Life Information to Remember: The holistic wellness field is influencing medical science to interpret stress as more than just a physical respond associated with the fight-or-flight system. Scientific studies of stress delve into the subjects of sociology, psychology, theology, physics, anthropology, clinical medicine and health. However, ironically enough, lasting solutions to stress can be found beyond the medical field and into the non-scientifically proven complimentary or alternative modalities. The wellness field benefits both the medical community and its supporters by bringing light to these obscure, ancient and unquantifiable systems of healing which have shown to work. The healthcare industry is steadily undergoing a paradigm shift. Significantly, even the World Health Organization defines health as a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity.
During times of stress, resentment, fear and anger can toxically increase in an individual. To manage those powerful feelings one can utilize countless types of coping techniques; many of them have already been discussed. Two additional and intrinsically known methods include information seeking and the act of forgiveness. Information seeking is to act of reducing ones stress by expanding their awareness of the facts associated with situation; while the act of forgiveness is related to releasing negative feeling in order to find closure. These two particular techniques also reflect ones values and principals.
Designing a stress management program takes time, self-awareness, creativity and determination. There are six key concepts to planning ones own plan: set time for daily self-exploration using time management skills, practice recognizing your emotional state, cultivate self-esteem by focusing on your positive qualities, nurture your creative side as they help strengthen problem solving skills, learn to balance all dimensions of your health and relearn what it is like to be a child full of inquisitiveness, imagination and creativeness. Resources: Exercises: Creative Problem Solving: This exercise was created to help solve problems creativity (Seaward, 2008, p.172). The task requires the problem to be defined and assigned practical solutions. Next choose the top solution from the prior list to expand upon all the while explain how the plan will be put into action. Finally, evaluate the effectiveness of the problem solving solution plan. Tools: Journal Writing: Sweet Forgiveness: This writing task directs the writer to jot down a list of people who have dehumanized them (Seaward, 2008, p.205). After the names are written, beside them write: how the person/s hurt you, how long have you felt this way, which emotions manifest when this person is seen and lastly, explore a way to find closure. Resentments cause roadblocks to optimal health while forgiveness is the best tool to creating a path of forgiveness. Unit 9 14 Unit 10: Applying Stress: Critical Management to your Personal Life Information to Remember: To develop an effective holistic stress management plan requires wisdom of how the body reacts to stress and its connection to the mind, body, emotions and spirit. Also, knowledge of valuable coping methods and relaxation techniques are needed to create the proactive portion of the program. Conclusively, to measure the effectiveness of the program, periodic evaluation and necessary revisions to the plan must be maintained. Usually, muscle tension is a clear sign of stress. The body produces muscle tension in order to prepare itself to undergo physical survival. Interestingly, most muscle stiffness is isometric in nature and barely noticeable. Over a period of time these muscles tend to show signs of shortening which produces decreases mobility and eventually making one susceptible to disease. A valuable muscle relieving technique appropriately entitled progressive muscular relaxation is used to release the ones physical tensions while promoting body awareness relaxation. Medical doctor Paul Rosch pointed out that stress is not just an acute issue as it also affects the business for which that employ our countrys stressed out masses. He defined occupational stress as having a massive amount of duties with little to no decision making power. His findings fostered some of the first work place wellness programs. Regrettably, he quickly discovered that programs that were too short term or too restrictive did not have an influential change in the employees lifestyle. However, wellness programs that exhibited positive results were able to be measured according to decreased absenteeism, reduced illness and increase morale. Resources: Exercises: Progressive muscular relaxation: Created by Dr. Edmund Jacobson, this audio guided session is geared to progressively relax all of the bodys muscle groups (Seaward, 2008, p.243). The exercise begins by requesting to undo any tight clothing, locate a restful position in which they can focus on abdominal breathing. The next step asks to create 100% tension in specific muscle groups begging at the top of the head, and ending at the feet. The second phase asks to do the same but only at 50% intensity and lastly, only at 5% contraction. The purpose of P.M.R. is to guide the listener to experience three phases of tension in specific muscle groups in order to allow for complete relaxation. Tools: Journal Writing: Relaxation Survival Kit: To begin creating the kit, write a list of tangible items that currently assist you in relaxing (Seaward, 2008, p.280). Examples of objects that can induce feeling of relaxation are a candle, sweet treat or a piece of music. The list can be divided into separate categories, representing the five senses. The kit can also include any other tools or objects that have been proven to incite feelings of calmness, peace and stillness. Unit 10 15 Additional Information Articles Holistic Approaches to Heart Health: Stress Management by Nicole L. Hatcher This article focuses stress management methods that can keep ones heart health and lifestyle on a positive track. healthandwellness.kaplan.edu/articles/stress/Holistic%20Approaches%20to%20Heart%20Health.html.
Workplace Wellness - Managing Stress at Work by Jennifer Koslo, PhD, RD, CSSD, CPT Most people suffer from acute stress at work, and are hindered to release the tension due to the professional environment of the work place. healthandwellness.kaplan.edu/articles/stress/Workplace%20Wellness%20- %20Managing%20Stress%20at%20Work.html#cont
Audios Progressive Muscle Relaxation This is an audio version of Dr. Edmund Jacobsons muscle relaxation technique recorded with background music. A link to an audio/video session of Dr. Jacobsons PMR technique www.youtube.com/watch?v=HFwCKKa--18
3-Minute Guided Meditation A short meditation that leads one through body awareness, the breath and inner silence. http://swamij.com/Sounds/3MinuteMeditation24.mp
Books The Art of Peace and Relaxation Workbook by Brian L. Seaward This is the companion book to Managing Stress: Principles and Strategies for Health and Well-Being. The workbook contains more than 130 stress management exercises. The exercises are meant to foster awareness of stressors, teach coping skills and provide proven relaxation techniques. Managing stress: principles and strategies for health and well-being by Brian L. Seaward For the layman and practitioner alike, these two books are considered the authority on stress from A through Z. These books stand out from your standard health literature as they emphasizing how stress is linked to the mind-body-spirit connection.
PowerPoint Physical Exercise and Activity By Andrea Shenkman Physical Exercise and Activity is a visually inspiring PowerPoint that clearly communicates why regular exercise is a necessary component to stress management.
Video Healing Through Diet Filmed for Ted.com, Dean Ornish a prominent figure in the field of preventative medicine gives a seventeen minute discourse on simple ways to heal the body, primarily through diet. The video clip can be found on the Ted.com website or this link www.ted.com/talks/dean_ornish_on_healing.html.
Websites Kaplan University: Center for Health & Wellness - http://healthandwellness.kaplan.edu/ National Center for Complementary and Alternative Health - http://nccam.nih.gov/ Both websites are an excellent source for all information in the wellness and holistic fields. The NCCA site is a federal resource whose focus is on the scientific investigation of the safety of non-western medicine systems. 16 References: Sapolsky, R. M.. (2004). Why Zebras Don't Get Ulcers (3rd ed.) NY: St. Martin's Press
Seaward, B.L.. (2006). Managing stress: principles and strategies for health and well-being. Sudbury, MA: Jones and Bartlett Publishers
Seaward, B.L.. (2008). The Art of Peace and Relaxation Workbook. Sudbury, MA:Jones and Bartlett Publishers
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