BR ANALYSIS. The burnout syndrome and its toll on professionals’ lives

Newsroom 12/12/2019 | 12:32

According to the World Health Organization, burnout is listed in the 11th Revision of the International Classification of Diseases (ICD-11) as an occupational phenomenon, but it is not classified as a medical condition. It is a syndrome conceptualised as resulting from chronic workplace stress that has not been successfully managed.

By Romanita Oprea

 

The burnout syndrome is characterized by three dimensions: feelings of energy depletion or exhaustion; increased mental distance from one’s job or feelings of negativism or cynicism related to one’s job; reduced professional efficacy. Burnout refers specifically to phenomena in the occupational context and should not be applied to describe experiences in other areas of life.

A UK survey, for instance, found that nearly 30 percent of human resource directors thought burnout was widespread in their organization, while a recent report from Harvard declared physician burnout in the US to be a public health crisis, potentially costing the economy USD 4.6 billion a year.

Within certain people-oriented professions, the norm is to be selfless and work for others, but it isn’t long before the demands of altruism take their toll. Far from being an excuse for laziness, WHO’s own research suggests that burnout occurs when the demands of a job far outweigh the rewards, recognition, and times of relaxation. As a result, workers who are burned out often feel like their ambitions, idealism, and sense of worth are slowly being strangled.

“As one of the most recent phenomena in the global population, burnout pervades the lives of an estimated 5-7 percent of the general population: 210 million people worldwide and 11 million in the US. For those suffering from it, burnout is a slow, terrifying slide into darkness, with pervasive consequences like unemployment, insomnia, diabetes, heart disease, and even death.

Burnout has been studied and diagnosed in a variety of occupations such as medical staff, teachers, social workers, and people working in the financial sector,” said Olga Udrea, Psychotherapist | Coach | Neuroscience Enthusiast.

Olga Udrea | Mind Initiative:

3 types of causes:

  1. causes related to the professional environment: high workload and responsibility, time pressure and extended work schedule, events with negative emotional impact, lack of appreciation, hostile work environment, unsatisfactory relationships with colleagues, lack of respect in working relationships or within the team, low levels of financial satisfaction;
  2. causes related to personality: perfectionism and excessive need for control, waiting for immediate rewards, enthusiasm and exaggerated expectations at the beginning of the career, low emotional stability, poor adaptability and stress resistance, self-confidence, frustrations related to the discrepancy between reality and job expectations;
  3. causes related to lifestyle: insufficient leisure time, insufficient involvement in relaxing activities and social activities, lack of social and family support, failure to observe the need for sleep.

Job factors that contribute to burnout:

  1. Workload – too much or the wrong kind of work;

  2. Control – no authority to do what’s needed to reach work goals;

  3. Reward – inadequate rewards in terms of money, recognition, or job satisfaction;

  4. Community – isolation or frequent conflict with co-workers;

  5. Fairness – pay inequality, cheating, favouritism, or disrespect;

  6. Values – unethical work or conflicting work goals.

 

Moreover, as some studies report, burnout prevalence rates of up to 69 percent in a given population, for example, approximately 30 percent in teachers (Rudow, 1999), 31 percent in medical students (Santen, Holt, Kemp, & Hemphill, 2010), and between 44 percent and 68.6 percent in medical oncologists (Blanchard et al., 2010; Glasberg et al., 2007). Even scientifically more cautious and conservative studies estimate the prevalence of burnout to be above 10 percent; 13.7 percent of the Dutch working population, for example, are said to suffer from the condition (Kant et al., 2003). These findings suggest that burnout is indeed a serious problem in today’s society. Accordingly, burnout has received extensive coverage in the mass media and popular science in recent years, and there is a widespread public interest in the topic.

According to a 2018 Gallup study, 67 percent of US employees suffer from this syndrome, and at the European level, a complex analysis conducted last year at Utrecht University in the Netherlands positions Turkey (25 percent), Slovenia (20.6 percent) and Serbia (19.4 percent) among the countries with the highest levels of burnout. These numbers increase every year. At the same time, 8 percent of the population in Romania is said to be affected by the syndrome.

Moreover, a survey conducted by one of the largest audit companies in the world and published in March 2018 showed that Romanians spend more hours in the office than other Europeans.

“More alarming is that even if the employees of corporations work over 30 percent more than the European average, a Eurostat report shows that productivity in Romania is six times lower than the EU average. And we have a big problem here. It is a matter of productivity, education and personal beliefs: our parents taught us to work hard, not necessarily to be efficient, but to be seen and accepted. Spending long hours at work over a long period of time inevitably leads to chronic stress. And when the first symptoms of burnout start to set in, the yield drops even more. According to another study conducted in 2018, Romania is at an average level of burnout compared to other European countries, but the rate is expected to increase in the coming years,” said Alecsandra Ionita, wellbeing specialist at Smart Experience.

For a mainstream employee, there are about 15 free days a year + 21 days for holidays + weekends. How does that cover the natural need for disconnection, for taking the time to be with themselves, to care and be there for the loved ones?

Statistics on happiness show that a stressful working environment is only surpassed by an 8-day vacation when usually people come back to work right after these 8 days? Usually, the working week is of 40 hours, yet many of us work more than 50. Not to mention that many employees take home their working cells, laptops and more often than not, they keep working and answering emails from home, even during the weekends.

“The continuous connection to the working state of mind heavily increases the level of stress. It is already proved that it is not the increased number of working hours that make greater products, but rather the most efficient ones. And to be efficient, disconnection from work is mandatory, unless we want to provoke errors, toxic human interactions, and inappropriate emotional reactions,” said Raluca Mihaila, Marketing strategist | Writer | Photographer & Owner Utopic Brain.

 

Pieces of advice not to arrive in this situation from Raluca Mihaila:

“Take 5 minutes a day to ask yourselves 3 things:

  1. Is my physical and mental well-being top priority on my to-do list?
    • do I sleep enough
    • do I hydrate enough
    • do I laugh enough
    • do I eat the right things
    • do I daily engage in activities my soul vibrates to? (music, nature, games, sports, quality talks etc)
    • do I live online or offline?
  2. Am I working on projects and with people who make me a better person? (emotionally, personally, professionally, relationship wise)?
  3. How many times do I genuinely smile a day? And then double the figure J for the following days. Smiling makes you feel better, on the long run boosts your immune system, hence helps you live longer. You know what they say: we are what we repeatedly do. Plus: “smiling stimulates our brain’s reward mechanisms in a way that even chocolate, a well-regarded pleasure-inducer, cannot match.”

Also, I would like to share with you my own learnings and findings after my own burnout periods. I often revisit them to give me perspective.

  1. You need to know when, to whom and how to say NO and allow closing the doors that lead to nowhere.
  2. It is ok to make compromises, but don’t compromise yourself.
  3. Stop putting pressure on you. From one moment on, even the best circuits burn.
  4. Stop wanting everything, all at once. Life comes in chunks.
  5. Own your ideas, but don’t force them where people don’t get them. Stop barking at the wrong trees.
  6. So what if you can’t control everything?
  7. Stop trying to please everybody. It’s impossible and it’s ok. Because we all want different things. What matters is what you want.
  8. Have patience. No acorn can become oak the next day.
  9. If you’re in a context where you expect the others to say you’re good, move. You have to believe it first.
  10. Enjoy life. These years will not come back.
  11. People who drag you down are already below you”

 

In the USA, Society for Human Resource Management shows that about 43% of the American companies plan to introduce the 4-day working week, a tendency developing in many countries already. But would that be a real solution, provided that the same 40-50 hours a week need spending, or is it the time to make even deeper adjustments within the process?

The countries with the highest burnout levels are predominantly found in Eastern and South-Eastern Europe, whereas countries with the lowest burnout scores are those in North-Western and Northern Europe. In countries with poorer economic performance in terms of GDP, higher levels of burnout can be observed. Taken together, the analyses show that burnout at the country level is associated in a meaningful way with various economic, governance, and cultural indicators.

 

The predisposition to 

“I’ve met both entrepreneurs and corporate people who had been diagnosed with burnout. It all depends on each person’s workload and the satisfaction that their job brings. I have also seen people who work very hard and are very happy because their work brings them the satisfaction they need for a perfect state of wellbeing. I’m not saying one must work until they hit the burnout button, but that it is good to know your limits and to know when to stop to avoid stress and depression,” said Ionita.

First coined in the 1970s by Dr. Herbert Freudenberger and Dr. Christina Maslach, it was noticed among human services workers (doctors, nurses, social workers), which are professions with a high level of self-sacrifice.

“However, anyone with high work demands and limited resources can experience burnout. Today we know it affects social workers, educators, law enforcement officers, and military personnel. It also shows up in fields like sales, IT, and management. Bankers, tech workers, lawyers, consultants, and hedge fund managers are affected as well. Unfortunately, we can’t be sure how burnout breaks down by profession. Certainly, burnout among medical staff, business executives and corporate field employees seems to be getting worse,” said Olga Udrea, Psychotherapist | Coach | Neuroscience Enthusiast.

Last year, the Bucharest College of Physicians conducted a study revealing that 55 percent of Bucharest doctors suffered from personal burnout, 52 percent from professional burnout, 36 percent from burnout related to patient interaction, and 24 percent suffered from all three types. In Romania, stress is mainly generated by systemic factors: bureaucracy, legislation, pressure from colleagues, high social pressures, material shortages. Another conclusion of the study was that women were more affected than men.

“Lately we have particularly studied the behaviour of Millennials at work because most of the companies we work with mainly have employees belonging to this generation. Using international studies and our local surveys, we discovered that nearly three in ten Millennials are very often or always burned out at work and about 70 percent of them experience at least some burnout. Compared to 5 years ago, burnout syndrome has advanced significantly, with more and more companies looking to implement programs in order to target and combat this problem among their employees,” explained Alecsandra Ionita.

It’s really important to know that burnout is characterised by disengagement, blunted emotions, helplessness and hopelessness, loss of motivation, ideals, and hope, and that its primary damage is emotional. Burnout and chronic fatigue syndrome (CFS) share similar symptoms as fatigue plays a central role and they are both triggered by stress, while the main difference is illness attribution: psychological for burnout, and physical for CFS. Furthermore, they are also conceptualised differently: burnout is seen as a work-related condition and prolonged fatigue is perceived as a general condition.

What generates it? According to Madalina Uceanu, some of the causes are related to our emerging economy context: someone who is now in their mid-40s started working before the year 2000 when working during the weekends or overtime was the norm and not the exception if you wanted to keep your well-paying job in a multinational.

“Moreover, I think that we were lacking the proper education in how to manage our emotional relationship with our job. Romanians tended to be perceived even by expats as more emotional about their jobs, bosses and work environment, while also taking a lot of personal confirmation and satisfaction from work results. That worked rather well for the organisations, as having employees who were so fully dedicated to the business was working miracles. However, more and more people started to adjust to a healthier emotional “relationship” with their jobs, searching for self-confirmation outside of job as well and not linking that much of their self image to their business cards,” explained Madalina Uceanu managing partner CareerAdvisor.

Moreover, according to Raluca Mihaila, we don’t have the exercise of failure and that is the starting point of burnout: you think you have it, you are taught to never give up, people still don’t appreciate you enough, so you keep on doing until you break.

“This vicious cycle can make us blind to the alternative: collaboration, open talks, trusting one another, value-based teams, honest work and trustworthy environments. And these would be the premises for what we all search for: the virtuous cycle. None of the upper elements of our beings help us express ourselves, fail and learn from it, collaborate with others, understand trial and error and what it is like to be imperfect,” said Utopic Brain’s representative.

Therefore, we learn by doing, and usually by falling very far behind the false expectations, we pulled together over decades. Working too much and not really caring about our mental and physical health, ignoring the sounds of our soul and passions and maintaining the phrase “work-life balance” when work should be 100 percent about living, not separated from it, will not help us move forward as individuals and will not help them, as international companies, understand that they wrong us just because they can and because we don’t know how to say no.

“There are high hopes of sustainable change for the better with the young Z and X generations. Millennials, unfortunately, are already doomed. Anne Helen Petersen’s massively popular Buzzfeed article ‘How Millennials Became The Burnout Generation’ argued that many in her generation have internalised the idea that they should be working all the time,” added Mihaila.

But whom are the people more likely to suffer from burnout? From Madalina Uceanu’s point of view, burnout chances are rather equal for all of us, irrespective of the job we are doing. I think that it is rather related to the level of personal accountability and the tendency towards perfectionism that easily drives people towards burnout. And Olga Udrea, Psychotherapist | Coach | Neuroscience Enthuziast at Mind Initiative, thinks the same, saying that no one is immune from burnout. It can hit the overworked and undervalued employees in diverse industries, the high-achieving executives, nurses or doctors who care give around the clock or the everyday employee trying to get to the top.

According to Utopic Brain’s representative, the burnout “clientele” is formed from people who can’t put healthy boundaries between their lucrative efforts and their me-time, due, of course, to various reasons.

“Burnout can hit absolutely anywhere, although the most prevalent domains are the heavily competitive ones. In terms of working types, again, work overdose can appear both in predictable environments like the corporate sector and in unpredictable ones like entrepreneurship and freelancing. In the end, it’s all about right balancing emotions, tasks, free time and quality personal relationships. As we know, strong emotions are, from a chemical standpoint, signs of a hormonal imbalance[1] within the body, so when we entertain and encourage negative emotions within a stressful background, it is only natural to expect we welcome disaster in our lives,” said Raluca Mihaila.

Unfortunately, the burnout syndrome is quite often seen in the advertising industry.

“Whether people are working physically too much or they cannot handle stress, the effect is quite visible and spread out. I am very fortunate to like what I do so from this perspective things are looking pretty well. Over the years, I have been exposed to numerous trainings which emphasized the importance of the “work-life balance” concept and I took them seriously. Also, getting older and having a family were crucial factors in focusing on what mattered most. Having periods of relaxation after high-stress periods, especially if you are in a management position, is a duty not only for yourself and for your family but also for the people in your team. Only with a crystal-clear mind does a leader have the power to be effective and emphatic and make the best decisions in business and life,” said Dana Bulat, general manager & owner United Media Services.

As a specialist who has been working for more than 20 years in the marcomm industry, one of the most dynamic and demanding fields, Bulat knows and understands the high importance of trying to maintain a lifestyle that is as balanced as possible, and she is very interested in the well-being of her team. Therefore, at United Media Services, they limit the hours spent at the office, offer extra days off based on defined criteria, she and the managerial team talk to their colleagues on a regular basis and also send key members of the team to personal growth programs.

“Besides the working hours and the trainings, we also focus on the workspace itself: providing fresh fruit every day, green plants, healthy lighting and really comfortable chairs. We encourage people to be active, to come to work by bicycle or electric scooters. We even have some exercising machines in the office. Another empowering experience is helping people get involved in social activities. I am constantly impressed by my colleagues’ desire to do good around them and I contribute as much as possible allowing hours and sometimes days off from work or by making donations when needed,” added Dana Bulat.

Moreover, as Raluca Mihaila points out, trying to be different in an industry where clients want to be different, yet don’t dare to, is a nightmare for any agency trying to do their job. Stress, frustration, tensions come along.

“The marcomm industry also has another trait: you need to prove yourself endlessly. You’re never good enough and you’re always as good as your last best project. Being in the paradigm of always trying to overcome challenges and outdo yourself sets the stage for work overdoses.”

In this context, one might wonder, how can well-being experiences help people in corporations avoid the syndrome? According to Alecsandra Ionita, there are dedicated programs for combating burnout syndrome, through which employees become familiar with the term, find out about the causes and especially about ways to avoid falling into this trap. Furthermore, the classic well-being programs help the employee discover new passions and hobbies, and bring more balance to their life.

“There are also programs that teach employees how to eat healthy, how to be more active, how to lead a balanced and healthy life in general. These programs take care of the employee’s health, both physically and mentally. Thus, any type of depression or other mental disorder will be much more difficult to set in. Any initiative by companies to help the employees in this regard is welcome, and people’s level of well-being increases considerably after just a few activities, according to the studies that we carry out periodically with the employees we work with,” explained Ionita.

In looking for a more balanced life, people should also look towards taking better care of their bodies, as well as their minds. Playing sports, going to the gym, taking up dance classes, reading more and going to spas are some of the best solutions for taking care of oneself.

“Even though they sometimes find it hard to take time for themselves and benefit from a little bit of time off and pampering in a spa or any other well-being area, the feeling of guilt disappears once the client starts enjoying that service. The secret lies in prioritising yourself and realising you deserve to give yourself more attention and time because you are worth it. The burnout syndrome is more visible among people working in a corporate environment where deadlines are very tight and targets are high and hard to reach,” said Angela Coman, co-founder Belle Maison Spa.

At the same time, Madalina Uceanu isn’t sure there is a foolproof method not to get there, but she believes there are less chances one keeps asking himself/herself, in any role, „what’s in it for me” and always try to find his/hers personal answers, this way one will know all the time why does what he/she does for a living.

“Moreover, constant and repetitive self-evaluations of where I am, what I dreamt of becoming, what I want to achieve, what brings me happiness, help us keep things in check and avoid decisions driven mostly by vanity or social conventions. Becoming friends with ourselves and setting the right limits is always a healthy way of both working and living,” added Uceanu.

According to Olga Udrea, T. David talks about 4 potential predictors that can lead to poor work-life balance and eventual burnout. These are personality – with an emphasis on passion, high tendency to comparison, local and broader culture. So, people who are very passionate about what they do, ambitious, focused, enthusiastic, that struggle to set aside enough time not to do work – simply put they live to work.

“Social comparison is something we learn very early in childhood, during school years and further. Phares such as “Maria had a higher mark, why didn’t you?”, “What mark did the other colleges take?”, “Alexandra finished his exams earlier” and so on. Think about a company or an organisation or a work environment where people are amazing at what you are supposed to be amazing at and top performers are all gathered together; only one person can be the top performer. That might lead to a culture where everyone works harder and harder to gain a sense of mastery, self-esteem, and respect,” explained the Mind Initiative representative.

A family or organization culture that expects you to be a star, to fit certain criteria, to look and act in a certain way; so overworking is a way to become what you know you should be. Moreover, on a more macro level, living in a city, region, or country with an inspiring and invigorating culture, where extra-hard work is an element of pride (e.g. startup culture) reinforces the idea that success requires working incredibly long hours.

 

Steps to be made

Taking those aspects into account, the first piece of advice she would give is for each of us to try to reach a mindfulness state.

“It makes us more aware of the context we are in and offers us different perspectives on things. It gives us energy instead of using it up. In this manner, we start doing things in the right order and become more efficient. One must realise that not all the things we deal with at work have the same importance and, in some cases, some are not even necessary. I strongly believe in the ‘mens sana in corpore sano’ concept, therefore any type of pampering helps not only the body but also the mind, as they are very connected and influence each other. A relaxing massage can be the ideal treatment ahead of a very complicated and hard week, as well as at the end of it,” added Angela Coman.

“I would advise people to try any form of therapy or self-development method that targets a healthy emotional management, as it will be productive for both the professional and the personal life. Jobs tend to affect the emotional rapport in personal relationships as well: pressure can be built at work but it reflects on all aspects of one’s life. Having a constant habit of introspection, being used to looking at things from a wider perspective and not taking oneself too seriously are all good habits that can help us avoid serious burnout. I think that burnout chances are rather equal for all of us, regardless of the job we are doing. I think that it is rather related to the level of personal accountability and the tendency towards perfectionism that easily drive people towards burnout,” explained Madalina Uceanu.

In her turn, Alecsandra Ionita believes that the answer is to simply take a break.

“Think about what’s important in your life and how you want to live from now on. Then call a specialist who can guide you to avoid burnout. Analyse whether it is your fault or the employer’s and take the measures you think are appropriate. It is often easier than you think, just ask for help,” said the well-being specialist.

On the other hand, Raluca Mihaila believes that one should allow themselves to be listened to, heard and helped by their close ones. In this order: listened (they have to talk about it), heard (so they need to choose wisely whom they talk to) and helped (by those willing and able to do so).

“Being vulnerable is the most courageous gesture one can make, although it’s not that easy to do it in a competitive and shame-prone culture. In more practical terms, I would recommend setting clear priorities aligned with personal desires, endeavors, and skills. And also allowing flexibility and setting the scene for work and relaxing together, in a common understanding and ‘negotiation’ with the loved ones,” said the Utopic Brain representative. At the same time, she would advise them to get over the feelings of shame or guilt. “Breaking the pattern is the hardest, yet the most useful for a healthy and enriching life. The first step is the most difficult one, but also the most important. Everything starts with a first step,” commented Mihaila.

 

Taking action

How is burnout treated? First of all, the reason behind it has to be identified, as well as finding out the roles an individual has in their life, how much time they spend in those roles and what changes can be made in the matter.

“The need for professional and personal life. There are many people that drown themselves in their professional lives, therefore running away from the personal ones. Unfortunately, there can be deep traumas hiding behind a so-called successful professional path. I have to remind you of the difficulties of creating emotional connections with others, of getting involved at a social level in inter-human relationships. They are all based on countless fears,” said psychologist Andreea Neagu.

Therefore, she suggests that one should get involved in pleasant activities that bring positive emotions and grow the frequency of those actions. Knowing oneself, an action that leads to identifying some personal purposes, a sense of life for each person, setting priorities, focusing on resources and activities that bring accomplishments are key to fighting burnout.

“Another important aspect is paying attention to your health. Quality sleep, good food, proper hydrating, physical relaxing exercises (meditation, yoga, dance, jogging), bring multiple benefits and balance the general state of being. Moreover, someone who believes they are close to burnout should seek the help of a good psychologist, a specialist that will help them find the source of the problem. It is also recommended that HR specialists contribute to reducing the syndrome’s effects, as the entire attitude should be focused on prevention. Employees should tell their superiors when they see the aspects presented above that can worsen the situation and lead to burnout,” added Andreea Neagu.

Her view is supported by Olga Udrea, who believes the intervention may occur at the level of the individual, workgroup, and/or organisation. In general, the primary emphasis and the focus in psychotherapy and/or counseling has been on individual strategies, though there is an urgency for social or organisational interventions due to the research evidence about the primary role of situational factors. The most common recovery interventions include: changing work patterns (e.g., working less, taking more breaks, avoiding overtime work, balancing work with the rest of one’s life); developing coping skills (e.g., cognitive restructuring, conflict resolution, time management); obtaining social support (from both colleagues and family); using relaxation strategies; promoting good health and fitness; developing a better self‐understanding (via various self‐analytical techniques, counseling, or talk therapy).

“The severity of the syndrome guides the approaches to treating burnout. In the case of early detected symptoms, we recommend methods for changing life habits and optimising work-life balance, focusing on three main factors: relief from stressors; recovery through relaxation and physical activity; abandoning external ideas of perfection (Hillert and Marwitz). I would emphasize the value of the social component of burnout and prevention measures such as health promotion in the workplace, the introduction of working time models, and the implementation of supervision sessions that would require companies, organisations, and employees to rethink and restructure their relationship with work,” added Udrea.

Not dealing with the situation properly and not treating the cause and the syndrome can lead to difficult situations and negative socio-economic consequences, physiological manifestations (the worsening of an illness or even developing one).

“Those individuals suffer from a high level of vulnerability, exhaustion, irritation, and instability. From a professional standpoint, some may even quit their jobs from one day to another,” concluded Neagu.

People who are experiencing burnout can have a negative impact on their colleagues, both by causing greater personal conflict and by disrupting job tasks. Thus, burnout can be “contagious” and perpetuate itself through social interactions on the job.

“Burnout progress slowly, your health, relationships, and well-being start to collapse, but you may not know why, and miss it entirely. Eventually, your body simply shuts down to prevent you from working. Burnout is not laziness, burnout is not mediocrity, it is not the price we must pay for glory and success, is not recovering after one good night’s sleep or a holiday. It’s nothing to be ashamed of if you find yourself in this condition. Burnout is serious,” explained Udrea.

In her turn, Madalina Uceanu explains that her main concern related to burnout is that this could be a term that can be subject to “positive discrimination” from people who fear facing themselves and working more on increasing their self- confidence and results.

“Assuming this is not the case, burnout definitely can be a precursor of depression, so I would not suggest taking it easy, but rather paying attention to self-harmonisation and to establishing healthy limits as much as possible.”

It’s high time for organisations to take responsibility and find ways to reduce workplace stressors that may contribute to burnout by considering the implementation of a psychological health and safety management system.

“Frontline management has significant influence over the factors that impact burnout, so managers or support positions should become aware of the signs and symptoms of burnout, as well as what they can do to prevent or respond to burnout. Because the majority of employees experiencing burnout will remain at work, employees need training and guidance to become aware of changes in attitudes and energy to help with early identification. In general, recovery takes anywhere from 6 weeks to 2 years, with an average of 6 to 9 months. Most people described recovery as a life-long journey, and many benefit from talk therapy and make significant life changes around the way they take care of and think about themselves, how they do their work, and how they engage in relationships,” added Udrea.

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