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Introduction
Various psychotherapy models and theories are advised to treat various mental health problems and anxiety disorders. This research focuses on using cognitive-behavioural therapy (CBT), a person-centered psychotherapy technique, to aid a patient in alleviating anxiety and depressive symptoms. The study contends, in general, that CBT incorporates distinct concepts from several schools of thought to guide therapeutic practices. The CBT paradigm employs several psychological therapies based on scientific approaches to human cognition, behavior, and emotion.
The primary emphasis of this study will be cognitive-behavioral treatment, especially exposure therapy. Ultimately, this research aims to describe how CBT therapies may be utilized in mental health settings to aid schizophrenic patients in overcoming mental health problems, based on solid empirical data. In addition, the article describes how various subgroups, including gender, class, ethnicity, race, as well as socioeconomic level, react to the mental condition.
Literature Review
CBTs primary premise is that information interpretation of internal and external inputs is skewed in mental illnesses, resulting in systemic distortions of the persons experience synthesis. These distortions comprise cognitive mistakes (biases), dysfunctional ideas, and persistent maladaptive cognitive frameworks (schemas), the last two being stored constructions (representations) of past experiences. Skodlar et al. (2013) describe schemas as stereotyped or recurrent processes in screening, coding, categorizing, and assessing incoming inputs.
Schemas offer the foundation for the formation of certain thought contents, such as attitudes, opinions, and assumptions. According to Becks cognitive psychotherapy, when these three forms of cognitive distortion (dysfunctional beliefs, errors, and schemas) arise, they result in the cognitive characteristics of a particular mental condition (Wills, 2013). CBT aims to modify the cognitive biases, dysfunctional beliefs, and negative schemas (such as self-deficit beliefs and negative expectancies) that cause the symptoms (Skodlar et al., 2013). It is critical to show a patient, as Beck once said, that a specific belief is incorrect or malfunctioning and that another view is more realistic and adaptive (Wills, 2013). Therefore, the signs and symptoms of schizophrenia rely on how the patient interacts with his observations, gives cause to them, generates ideas, and analyzes these thoughts. Such cognitive assessments are generative for a variety of symptoms, feelings and behaviors of the individual (`kodlar et al., 2013). Similarly, the function of direct, instant experiences (like perceptions, feelings, emotions or moods) is either regarded as subordinate or not explored.
From a phenomenological standpoint, efforts to comprehend mental occurrences by transforming them into the interactions between specific (maladaptive) cognitive evaluations fail to grasp and recognize the intricacy of a patients lived experiences. For instance, if a patient on the schizophrenia spectrum reports that she feels significantly different from other individuals, it is difficult to interpret the remark as a belief that creates worry and other effects. This remark typically conveys a widespread and immediate sensation of changed self-presence (e.g., a feeling of not being) and discomfort when interacting with others (Skodlar et al., 2013). These situations can be directly addressed not only by cognitive appraisals. It is agreeable that cognitive evaluations of immediate events play a role in experience construction, but we dispute that this involvement is important or even unique to the emergence of symptoms in schizophrenia.
Rather than conceptualizing such appraisals as merely provoking effects and behaviors, it has been demonstrated that the latter significantly influences the former. Even though ideologies and appraisals are shaped and altered by emotions and mood swings, they are not as coherent and long-lasting as assumed by CBT; therefore, they cannot serve as a primary goal for the therapy of schizophrenia (Skodlar et al., 2013). As a post-cognitive phenomenon, CBT theories tend to theorize emotions caused by appraisals and desires. For instance, Beck states, The affective feedback is determined by how an individual constructs his experience (Wills, 2013). Therefore, if a persons conceptualization of a scenario contains unpleasant information, the person will experience an undesirable affective response.
Although this cognitivist notion of emotions as a type of evaluative verdict is prevalent in the ideology of feelings, it is not unanimously accepted. From a phenomenological standpoint, cognitivism faces many problems when attempting to explain emotions (Skodlar et al., 2013). According to this viewpoint, Moods and Emotions are neither evaluated nor accompanied by subjective phenomena that color the peoples otherwise objective experiences. In contrast, emotions and moods encompass peoples very connected to the world, in the sense that they determine how the world is revealed to us, such as threatening or dull.
CBTs method for observing and quantifying mental functions is reification or decreasing mental experiences to object-like things that can be described and comprehended in isolation. In this view, mental experiences are perceived as different things with easily defined features, similar to physical items in the world, such as a chair. Skodlar et al. (2013) describe persecutory delusions as dangerous beliefs that meet basic parameters: the person believes that harm is occurring, or will occur, to them, and the person believes that the persecutor has the motive to inflict harm. At the same time, the beliefs have particular features such as resilience to change, distressing and preoccupying). From a phenomenological standpoint, it is vital to move beyond such restrictive categories and understand the greater subjective environment in which delusions arise and are perceived; otherwise, a key characteristic of consciousness, its symbolic unity, is overlooked. When the characteristics mentioned above of persecutory delusions are considered characteristics or aspects that happen to be connected, for example, there is an inability to acknowledge the intricate interweaving of qualities that occur in interactions of mutual inference. Delusions of Persecution do not arise as individual beliefs amid a continuous stream of events. Rather, they are perceptions of a world that has already been transformed as a result of overpowering sensations of extreme dread and unease.
CBT may be used to treat, for instance, patient X with schizophrenia, who seems to be suffering suicidal ideas that can be related to depression. The patient suffers from anxiety, depression, and cognitive difficulties. The patient has acquired an avoidance behavior that stops him from socializing or leaving the house. Consequently, using exposure treatment as a CBT concept may assist patient X in learning to deal with these frightening stimuli. Furthermore, CBT contains several principles that concentrate on the persons cognitive and behavioral elements, making it a suitable therapy for patient X.
Exposure-based approaches are the most often used kind of cognitive-behavioural therapy to treat various anxiety disorders. From the viewpoint of emotional processing theory, exposure-based therapy is best understood. According to this hypothesis, fear takes the form of connected systems, also referred to as mental fear networks, which store data about the feared stimulus, feared responses like avoidance, and the meaning of the stimuli and responses (e.g., snake represent danger) (Kaczkurkin & Foa 2015). Exposure is believed to modify the compulsive fear network by first activating it and then providing fresh facts that oppose the compulsive, unrealistic linkages within the systems; for example, not every snake is poisonous.
When people meet feared stimuli and incorporate the correct information into their fear memory, they accidentally reduce their anxiety, which becomes a learned pattern. Several exposure methods are imaginal, in vivo, and interoceptive (Kaczkurkin & Foa 2015). In vivo exposure is when a person gradually approaches or faces previously avoided but safe people, places, objects, or circumstances. Imaginal exposure refers to scenarios in which the person is urged to vividly imagine the feared condition/effects without evading the ensuing distress. In interoceptive exposure, the psychotherapist creates the physical sensations that the patient worries about, indicating a panic attack. Overall, these exposure strategies are crucial components of cognitive-behavioral therapy since they allow the person to adapt and attain new behaviours and attitudes that promote the change of the fear network. Exposure treatment often needs fewer sessions than cognitive therapy (Kaczkurkin & Foa, 2015). For example, roughly ten sessions or fewer are required for exposure treatment to be effective.
Patient X needs exposure treatment to overcome his growing avoidance behavior. Avoidance may be an instinctual reaction to a loss and a crucial component of the first severe mourning response. It can be caused by stimuli which act as reflections of the misplaced object, lost person, or animal or by avoiding feelings associated with the loss (Vita & Barlati, 2018). Patient X has acquired a phobia of public settings and intimate relationships. As a therapist, it is essential to destroy these fear systems by helping the client seek social support inappropriate settings (Vita & Barlati, 2018). For instance, patient X should strive to locate someone who can match his demands and move on. Thus, urging him to engage in social interaction activates his compulsive fear mechanism (fear of association) and supplies him with new information that counteracts the systems compulsive, unrealistic linkages.
Patient X may need cognitive-behavioral treatment for insomnia (CBT-i) to address his sleeping disorder. CBT-I aims to assist the client in identifying the thoughts and behaviors that may be contributing to her sleep issues. CBT-I has the benefit over medications, and a patient X current situation (depression) can pinpoint the fundamental reasons for sleep disorders (Trauer et al. 2015). Among the strategies that the therapist may suggest are:
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Avoid lying in bed while awake since this may contribute to poor sleeping habits.
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2. Stimulus control treatment to assist the patient in removing the stimuli that cause the mind to oppose sleep. Ideally, the therapist should encourage patient X to establish a consistent sleep and waking schedule.
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Sleep hygiene- altering behaviors that may have an effect on sleep, such as smoking and consuming alcohol.
The therapist must emphasize to patient X the need to obtain the proper social support. He can only do this by not speeding the process and refraining from self-judgment and comparison. The psychotherapist should make him aware that everyone experiences tragedy and handles it differently. For instance, if he had friends who overcame their sadness more rapidly than he did, this does not distinguish him from them. Therefore, he should not evaluate himself. By adopting a positive outlook, patient X will learn to progressively eliminate the negative ideas that cause him to feel nervous and unhappy. The CBT paradigm will only help treat the patient if the psychotherapist includes the different cognitive and behavioral therapy components.
One of the primary goals of pharmacological treatments and psychiatric care in specific is to enhance the clients quality of life. Several studies have investigated the standard of living of Schizophrenic individuals who have undergone CBT. Tripathi et al. (2018) undertook one of the biggest trials, in which 315 Schizophrenic patients received CBT in addition to routine care and supportive counseling. The CBT subject was associated with a considerably more rapid treatment response than the control condition. Tripathi et al. (2018) discovered that CBT aided Schizophrenic participants in achieving remission more rapidly, which related to improved living standards. This perspective insinuates that wellness is defined by eliminating the illnesss manifestations. Nonetheless, the studys outcomes have been challenged since the CBT group showed substantial enhancement only in terms of reduced psychotic symptoms and not based on delusions, positive symptoms, or the overall Symptom Scores.
Improvements in a clinical condition will invariably correlate with their social functioning and job prospects. Devoe et al. (2019) focused on CBT and social functioning utilization. Over the course of four years, 40 patients got CBT and interpersonal capacity building. The therapy focused on treating auditory hallucinations and strengthening social competence. According to the findings, the prevalence of delusions and their impact on the patient decreased significantly. In addition, 18% of patients claimed that their psychotic symptoms completely disappeared. 60% demonstrated significant developments in anxiousness, disinhibition, and mental disturbance. Finally, 67% of the research respondents demonstrated significant gains in social competence (Devoe et al., 2019). Despite this, several significant flaws in the technique adopted for this study make it challenging to accept the results with certainty. There was no control condition, the evaluators were not neutral, and retrospective background measurements were taken. In addition, it was observed that abilities needed to be reinforced and honed in particular social contexts through refresher courses.
To adequately judge the effectiveness of CBT for the management of schizophrenia, it is necessary to explore additional studies in this field. In addition, Harmanci and Budak (2021) experimented with integrating standard care with motivational interviewing, CBT, and family therapy. A subsequent study found that this technique had significantly enhanced the patients overall functioning and abstinence from alcohol and substance usage. Harmanci and Budak (2021) argued that the co-morbidity of symptoms and those associated with schizophrenia could make it exceedingly difficult for the patient to find suitable employment. Consequently, this comprehensive therapy method has been proven to enhance social functioning, which should theoretically increase patients prospects of advancing their vocational standing.
The above hypothesis necessitates additional empirical research to determine the magnitude of this link. According to research by (Pozza & Dèttore, 2019), the cognitive-behavioral paradigm lowered schizophrenia symptoms more rapidly in the first 12 weeks after hospitalization. According to Jansen et al. (2020), admitted participants had fewer positive signals than patients who received the same level of assistance and treatment at home. Depressive outcomes did not diminish much during the first 12 weeks. Nonetheless, after a nine-month follow-up, subjects who were treated with cognitive-behavioral treatment showed a reduction in positive feelings but no improvement in negative symptoms compared to the control participants. Jansen et al. (2020) discovered that improved insight, decreased dysregulation, and low-level psychotic thought consistently increased therapeutic outcomes. Antipsychotic medicines in the United States have demonstrated the capacity to reduce a substantial proportion of positive symptoms.
The presentation of a conventional cognitive system is a crucial component of CBT for Schizophrenia. The framework consists of cognitive distortions, the formulation, and assessment of alternative beliefs, a discussion of the activation mechanisms, and behavioral outcomes (Jansen et al., 2020). Counselors have used this technique to address depressed and nervous symptoms before addressing psychotic symptoms to lessen the discomfort that could sustain illusions and boost the psychotherapy interaction between the physician and patient. Once a pooled connection has been created and the client is acquainted with the psychological approach, a therapist must construct a method for addressing psychotic symptoms.
Initial comprehensive endeavors to employ CBT to manage schizophrenia concentrated on the rehabilitation of inpatients somatic symptoms. The analysis by Laws et al. (2018) offered a theoretical foundation for applying cognitive behavioral therapy to schizophrenia. They explain psychomotor retardation and neurocognitive deficit that makes the person susceptible to adverse reactions, such as academic failure. Thus, this results in dysfunctional beliefs, such as I am incompetent, negative cognitive evaluations, and functional impairment, such as disconnectedness (Law et al., 2018). As a result, these result in increased uncomfortable experiences, which exacerbate psychophysiological distress.
They emphasized that vulnerable individuals with schizophrenia exhibit deficits in neurocognitive functioning, concentration, working memory, and executive function, which they classify as mental insufficiency. This deficiency might result in subpar performance, which increases stress levels. Laws et al. (2018) propose that an overload in stress and corticosteroids facilitates the development of psychotic episodes. They hypothesize that depletion of integrative processes hinders other processes, such as self-reflection, self-monitoring, and misconstruction rectification, resulting in erroneous beliefs, decreased perception, and cognitive restructuring. Laws et al. (2018) discuss specific psychotic symptoms and how a mental exam can be utilized to alleviate these symptoms. For example, they remark that delusions can be distinguished by externalizing, comprehending and rationalizing fallacies, categorical reasoning, emotion-based and somatic-based arguments, and faulty executive function, such as making assumptions.
Individuals with a self-centered perspective, an exterior point of causation, and a predisposition to attach extraneous occurrences reach incorrect judgments. Law et al. (2018) explained how impairments and delusions might be comprehended and addressed in a cognitive paradigm in the research. Negative symptoms are produced and maintained by premorbid dispositions regarding social attachment along with low expectations for enjoyment, achievement, acceptability, and the feeling of limited finances (Law et al., 2018). Patients with schizophrenia frequently have long-established patterns of hunting for perceived injustices, assuming that people do not like them, and nervousness about managing disagreements with relatives and friends, which can exacerbate psychotic manifestations (Laws et al., 2018). Even simple activities, such as combining duties with roommates, limiting sexual companions access to shared living places, and consenting to standards for reasonable conduct in these shared areas, may require coaching for people with schizophrenia.
People with schizophrenia may interpret casual remarks from housemates, such as discussing intentions to reconnect with others, as proof that the companions do not care about them or want them to leave the flat. Laws et al. (2018) illustrated using quintessential CBT methodologies for intervention, such as constructing loyalty and cooperation and coordinating activities to understand the definition of symptomatology. Moreover, comprehending the patients understanding of past and present activities, particularly those that the client believes are connected to their existing challenges growth and consistency, formed part of their CBT techniques (Law et al., 2018). Their CBT approach highlighted contextualizing these perspectives and informing patients about the stress-vulnerability paradigm and socialization.
Clarifying the behavioral and emotional repercussions of a delusions activation contributes to an initial examination of the evidence-based on more distant assumptions. Laws et al. (2018) proposed treating negative symptoms such as dysthymia, amotivation, social disengagement, and anergia with behavioral self-monitoring, activity scheduling, proficiency and enjoyment assessments, appraised work schedules, and stress management. Furthermore, for individuals whose lives may have been strictly curtailed for many years, it may be necessary to implement these treatment approaches slower than the therapist is accustomed to when taking care of persons with moderate impairments.
Finally, concentration switching, focus restriction, heightened exercise habits, socialization and withdrawal, alteration of self-statements, and internal conversation are specific neurobehavioral approaches advocated. Lodha and Sousa (2020) underlined that the formation of a counseling relationship, which is similar to all effective therapies but created in a coordinated approach stressing the patients viewpoint, is a defining characteristic of CBT. Nonetheless, they note that schizophrenia patients may be less receptive to the psychiatrists efforts to understand their issues as having a scientific basis. For instance, the client can characterize their difficulty as depressive episodes, anxiety, a disagreement with close relatives, or even a strange sensory perception in their head. It is preferable to use these as entry points into how the practitioner can help the patient mitigate these clinical signs instead of insisting that the individual endorse a diagnosis of Schizophrenia (Lodha & Sousa, 2020). They note that it is not required for the patient and physician to agree on the cause of the clinical condition to team together to alleviate the symptoms effect on the individual.
De-stigmatizing psychotic manifestations such as delusions and hallucinations are somewhat at odds with the biological approach. To lessen the influence of positive symptomatology, contextual questioning, a procedure in which the individual is questioned about the particulars of their delusional thoughts to determine how they came to their judgments, may be utilized (Lodha & Sousa, 2020). Thus, this is then coupled with a scaled reality assessment to introduce uncertainty and propose alternative explanations. For example, if patient X believes they have innovated a piece of equipment that will remedy several global challenges, ask how and when the idea came to them (Lodha & Sousa, 2020). The client could be asked what the early stages of configuration constituted, if he has taken any measures to register for intellectual property and if others have assisted in the undertakings. The goal is to identify any cracks in the patients deluded framework that may offer the counselor opportunities to weaken the patients confidence in their beliefs. In inference chaining, the individualized interpretation of a systematized illusion is investigated to alleviate the distress caused by the delusion.
Schizophrenia as a Function of Gender
The frequency, treatment responses, and symptoms of various mental diseases, such as schizophrenia, vary between men and women. Although the frequency of schizophrenia is consistent across men and women, most research indicates that the start of symptoms in females is generally 35 years later than in men (Gogos et al., 2019). Particular research assessed gender as a variable in collaborative treatment for depression and anxiety in patients with schizophrenia (Grubbs et al., 2015). Women had less opportunity for socioeconomic resources like poor income and suffered from more chronic health issues than males, yet they benefited from the intervention. To explore the relative variations in the reaction between men and women receiving collaborative treatment, gender disparities were examined in mental health attitudes among patients receiving collaborative care while adjusting for gender disparities in baseline variables (Grubbs et al., 2015). Women expressed more dedication to treatment and a stronger conviction in its efficacy than males. These factors have been shown to predict more favorable clinical results in CBT and are hypothesized to influence motivation and effort throughout therapy partly.
The sex disparities in schizophrenia are associated with gonadal hormones, like estrogen, which may perform neuroprotective effects against schizophrenia pathogenesis in women. The estrogen theory is validated by the second incidence peak and the late age of onset around menopause age in females. In menopause, estrogen insufficiency is strongly associated with the severity of psychiatric manifestations in women (Gogos et al., 2019). For instance, female schizophrenia clients frequently experience more severe symptoms during the part of their menstrual period when estrogen levels are lowest. Studies indicate that decreased testosterone levels tend to be connected with more acute symptoms (Halverson et al., 2019). However, the findings are less reliable than for estrogens. Studies have shown, for example, that schizophrenia individuals with decreased testosterone levels frequently have an excess of negative symptoms.
Schizophrenia as a Function of Class
It has been shown repeatedly that psychiatric problems are more prevalent in lower social classes. According to reports, social class is linked to an increased incidence of psychosis. Even though some results are encouraging, several contradictory research demonstrates no relationship between schizophrenia and low social class at birth or even a relationship between schizophrenia and high social class. Schizophrenia is also linked to indicators of the disadvantaged groups, both singularly and cumulatively. Patients with first-episode schizophrenia are more inclined to live in solitary, single, or jobless and reside in overcrowded rental housing. In addition, they have a below-poverty income at the time of their initial encounter with psychiatric services and up to five years before the start of psychosis, with a twofold greater likelihood of developing psychosis (Stilo et al., 2019). The World Health Organization (WHO) studies indicate that greater chronic impairment and dependence rates in schizophrenia are seen in high-income nations than in low-income countries, indicating that a crucial component of the social fabric is lacking (Stilo et al., 2019). The research implies that the influence of social class is magnified among the impoverished with negative symptoms.
Schizophrenia as a Function of Ethnicity and Race
More cases of schizophrenia are seen in persons of African descent than in those of white descent. There are racial disparities in the care approaches and treatments schizophrenia patients get. People of Black African heritage are more likely to access mental health programs via forensic routes and undergo mandatory detention; receive medications by depot; and be liable to community rehabilitation orders in the United Kingdom (Morris et al., 2020). Black individuals with the treatment-resistant schizophrenic disorder are less likely to get medication therapies following national recommendations, while Asian British individuals with a diagnosis of schizophrenia are less likely to obtain records of their care plans. Other nations have also revealed ethnic-based disparities in treatment (Morris et al., 2020). In the United States, persons of African origin are less likely to obtain medications with minimal side effects and receive less funding for their healthcare via state-funded programs (Morris et al., 2020). Cognitivebehavioral therapy (CBT) is suggested to prevent and treat schizophrenia (CBTs) since CBTs have shown strong evidence of its effectiveness regarding service-user outcomes.
Moderation studies revealed that neurocognitive, daily living skills, and social skills all influence functional outcomes in an equally effective manner in White and black Americans. These results show how critical it is to comprehend the reasons behind the dismal performance of African-Americans on tests administered in neurocognitive assessments (Nagendra et al., 2018). Interestingly, the results of the current study contradict those of a meta-analysis which found that the magnitude of the connection between neurocognitive and functional results was reduced for ethnic and racial minority categories (Halverson et al., 2019). On the other hand, in the study conducted by Halverson et al. (2019), the researchers differentiated race as either Caucasian or Non-Caucasian and used worldwide samples. As a result, it is possible that the two pieces of research cannot be compared.
Schizophrenia as a Function of Socioeconomic Status
Previous studies on the connection between risk for schizophrenia and socioeconomic status (SES) have produced contradictory findings. Research that looked at individuals socioeconomic status concluded that a poor socioeconomic status was related to a greater risk for poor treatment outcomes. Nine out of the 17 studies in one particular study project looked at employees job status (Finegan et al., 2018). Jobless individuals had poor treatment results, according to six of these trials. Post-treatment, unemployed individuals reported elevated rates of depression and stress. Regardless of the work situation, Delgadillo et al. (2016) observed that group psychoeducational CBT had identical effects in terms of anxiety assessment (Finegan et al., 2018). Overall, the data shows a connection between treatment outcome and work position, notwithstanding a few exceptions. According to some studies, growing up in surroundings with a low socioeconomic status is linked with a greater incidence of Schizophrenia (Olbert et al., 2018). However, other research has found that this effect does not exist, and still other analyses have confirmed that being raised in an environment with a high socioeconomic status may be connected to a higher risk of schizophrenia.
Conclusion
In conclusion, schizophrenia is a severe mental disorder defined by an aberrant perception of reality. People with schizophrenia may appear to have lost touch with reality, which can be distressing for them and their loved ones. The illnesses may make it difficult to engage in daily activities, but therapeutic options are available. CBT is one of the most popular and extensively studied forms of psychotherapy. Cognitive-behavioral therapy is a combination of psychological and behavioral psychotherapies.
CBT is the most frequent evidence-based psychotherapy for schizophrenia and often involves setting goals, educating the individual on how to reduce symptoms, forming a positive therapeutic partnership, and gaining situational awareness. This method has always been used to reduce the behavioral and emotional impacts of psychotic episodes resistant to the medicine. These events include hallucinations, catatonic behavior, unpleasant symptoms, disorganized speech, and delusions. A fundamental objective of pharmacological therapies and psychiatric care, in particular, is to improve the clients quality of life.
References
Devoe, D. J., Farris, M. S., Townes, P., & Addington, J. (2019). Interventions and social functioning in youth at risk of psychosis: A systematic review and metaanalysis. Early Intervention in Psychiatry, 13(2), 169-180. Web.
Finegan, M., Firth, N., Wojnarowski, C., & Delgadillo, J. (2018). Associations between socioeconomic status and psychological therapy outcomes: A systematic review and metaanalysis. Depression and Anxiety, 35(6), 560-573. Web.
Friedman-Yakoobian, M., West, M. L., Woodberry, K. A., ODonovan, K. E., Zimmet, S., Gnong-Granato, A., Giuliano, A. J., Guyer, M. E., Rodenhiser-Hill, J., Keshavan, M. S. & Seidman, L. J. (2018). Do you need this or any other assignment done for you from scratch?
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