Pub Date : 2018-11-07DOI: 10.1093/oxfordhb/9780190681777.013.22
Nestor L. Lopez-Duran, Valerie J Micol, Andrea Roberts
Neuroendocrine systems play a critical role in modulating biological, cognitive, and affective responses to stress. Not surprisingly, variability in neuroendocrine functioning, and particularly the hypothalamic-pituitary-adrenal axis, has been extensively linked to stress-related mental health disorders. This chapter examines the potential mechanisms that underlie this link and the conceptual challenges that must be addressed in order to advance a more cohesive neuroendocrine model of stress-related psychopathology. To this end, the chapter first explores the various sources of variability in neuroendocrine responses to stress, including individual differences in neural networks and neuroendocrine systems, as well as contextual factors, such as characteristics of the stressors and personality traits. The chapter then examines potential proximal and distal mechanisms that link variability in neuroendocrine functioning to the risk for onset, phenomenology, and course of stress-related disorders, including depression and posttraumatic stress disorder.
{"title":"Neuroendocrinological Models of Stress and Psychopathology","authors":"Nestor L. Lopez-Duran, Valerie J Micol, Andrea Roberts","doi":"10.1093/oxfordhb/9780190681777.013.22","DOIUrl":"https://doi.org/10.1093/oxfordhb/9780190681777.013.22","url":null,"abstract":"Neuroendocrine systems play a critical role in modulating biological, cognitive, and affective responses to stress. Not surprisingly, variability in neuroendocrine functioning, and particularly the hypothalamic-pituitary-adrenal axis, has been extensively linked to stress-related mental health disorders. This chapter examines the potential mechanisms that underlie this link and the conceptual challenges that must be addressed in order to advance a more cohesive neuroendocrine model of stress-related psychopathology. To this end, the chapter first explores the various sources of variability in neuroendocrine responses to stress, including individual differences in neural networks and neuroendocrine systems, as well as contextual factors, such as characteristics of the stressors and personality traits. The chapter then examines potential proximal and distal mechanisms that link variability in neuroendocrine functioning to the risk for onset, phenomenology, and course of stress-related disorders, including depression and posttraumatic stress disorder.","PeriodicalId":375662,"journal":{"name":"The Oxford Handbook of Stress and Mental Health","volume":"85 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2018-11-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"132101701","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2018-09-10DOI: 10.1093/oxfordhb/9780190681777.013.13
S. Goodman, Meeka S. Halperin
This chapter provides a review of research and a description of the central issues regarding the stressor of depression in mothers during pregnancy and the postpartum periods in relation to risk for the development of psychopathology in offspring. Where evidence allows, causal relations are emphasized; otherwise, limitations are noted, especially those regarding being able to draw causal conclusions from the correlational approaches typically taken in this area of study. Evidence for mechanisms in the transmission of risk is also described, given the potential for understanding causal relations. With the developmental psychopathology perspective of depression as a stressor for offspring, the focus is on vulnerabilities to and early signs of disorder as well as mental health outcomes per se. The chapter concludes with suggested critical issues in the field and recommendations for future directions for research.
{"title":"Perinatal Depression as an Early Stress","authors":"S. Goodman, Meeka S. Halperin","doi":"10.1093/oxfordhb/9780190681777.013.13","DOIUrl":"https://doi.org/10.1093/oxfordhb/9780190681777.013.13","url":null,"abstract":"This chapter provides a review of research and a description of the central issues regarding the stressor of depression in mothers during pregnancy and the postpartum periods in relation to risk for the development of psychopathology in offspring. Where evidence allows, causal relations are emphasized; otherwise, limitations are noted, especially those regarding being able to draw causal conclusions from the correlational approaches typically taken in this area of study. Evidence for mechanisms in the transmission of risk is also described, given the potential for understanding causal relations. With the developmental psychopathology perspective of depression as a stressor for offspring, the focus is on vulnerabilities to and early signs of disorder as well as mental health outcomes per se. The chapter concludes with suggested critical issues in the field and recommendations for future directions for research.","PeriodicalId":375662,"journal":{"name":"The Oxford Handbook of Stress and Mental Health","volume":"36 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2018-09-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"127550997","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2018-07-10DOI: 10.1093/oxfordhb/9780190681777.013.17
T. Schweizer, B. Hankin
This chapter focuses on how several prominent cognitive risk processes (attention bias, overgeneral autobiographical memory, executive functioning difficulties) and products (negative inferential style, dysfunctional attitudes, depressive rumination) may translate stress into different forms of prevalent psychopathologies, including internalizing (e.g., depression, anxiety) and externalizing disorders (e.g., conduct disorder). First, prominent conceptual models are presented that explain how cognitive risks relate to psychopathology and the interplay between stress and cognition in contributing to psychopathology. Second, the chapter describes how cognitive risks have typically been conceptualized and measured, and it reviews evidence on associations between each cognitive risk and different psychopathologies. Third, three conceptual models are presented that can be used to organize and understand the relations among stress, cognition, and psychopathology—(1) vulnerability-stress, (2) mechanism, and (3) transactional/bidirectional. Last, key future research directions are highlighted, including integrating cognitive risks across multiple units of analysis and establishing a taxonomy of cognitive risk.
{"title":"Cognitive Risks","authors":"T. Schweizer, B. Hankin","doi":"10.1093/oxfordhb/9780190681777.013.17","DOIUrl":"https://doi.org/10.1093/oxfordhb/9780190681777.013.17","url":null,"abstract":"This chapter focuses on how several prominent cognitive risk processes (attention bias, overgeneral autobiographical memory, executive functioning difficulties) and products (negative inferential style, dysfunctional attitudes, depressive rumination) may translate stress into different forms of prevalent psychopathologies, including internalizing (e.g., depression, anxiety) and externalizing disorders (e.g., conduct disorder). First, prominent conceptual models are presented that explain how cognitive risks relate to psychopathology and the interplay between stress and cognition in contributing to psychopathology. Second, the chapter describes how cognitive risks have typically been conceptualized and measured, and it reviews evidence on associations between each cognitive risk and different psychopathologies. Third, three conceptual models are presented that can be used to organize and understand the relations among stress, cognition, and psychopathology—(1) vulnerability-stress, (2) mechanism, and (3) transactional/bidirectional. Last, key future research directions are highlighted, including integrating cognitive risks across multiple units of analysis and establishing a taxonomy of cognitive risk.","PeriodicalId":375662,"journal":{"name":"The Oxford Handbook of Stress and Mental Health","volume":"18 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2018-07-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"116562694","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2018-06-07DOI: 10.1093/oxfordhb/9780190681777.013.1
S. Monroe, George M. Slavich
The purpose of the present chapter is to provide an overview of key issues involving the definition and assessment of major life events for researchers interested in the effects of life stress on a wide range of disorders. General conceptual and definitional issues are addressed initially, and a conceptual heuristic is proposed for guiding inquiry on major life stress and human disorder. This heuristic is drawn upon to develop principled practices for assessing, operationalizing, and finally quantifying major life events. Throughout the chapter, contemporary approaches for research on major life events are evaluated, their relative merits and shortcomings discussed, and their psychometric credentials formally compared. In closing, we consider future directions for research on major life events and their implications for health and disease.
{"title":"Major Life Events","authors":"S. Monroe, George M. Slavich","doi":"10.1093/oxfordhb/9780190681777.013.1","DOIUrl":"https://doi.org/10.1093/oxfordhb/9780190681777.013.1","url":null,"abstract":"The purpose of the present chapter is to provide an overview of key issues involving the definition and assessment of major life events for researchers interested in the effects of life stress on a wide range of disorders. General conceptual and definitional issues are addressed initially, and a conceptual heuristic is proposed for guiding inquiry on major life stress and human disorder. This heuristic is drawn upon to develop principled practices for assessing, operationalizing, and finally quantifying major life events. Throughout the chapter, contemporary approaches for research on major life events are evaluated, their relative merits and shortcomings discussed, and their psychometric credentials formally compared. In closing, we consider future directions for research on major life events and their implications for health and disease.","PeriodicalId":375662,"journal":{"name":"The Oxford Handbook of Stress and Mental Health","volume":"13 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2018-06-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"115059052","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2018-06-07DOI: 10.1093/OXFORDHB/9780190681777.013.14
Kelsey D Vig, R. El‐Gabalawy, G. Asmundson
This chapter discusses the complex relationship between stress and physical health, with a focus on comorbid posttraumatic stress disorder (PTSD) and physical health conditions. There is a great deal of evidence that stress and mental health conditions, such as PTSD, often co-occur with physical health conditions. This chapter reviews this evidence, describes potential mechanisms underlying the comorbidity, and outlines theoretical frameworks for understanding the relationship between stress and physical health. It considers the ways in which stress leads to poor physical health, how physical health conditions can lead to stress, and how other factors may both increase stress and worsen physical health. Clinical implications of comorbid mental and physical health conditions and suggestions for future research in the area are also discussed.
{"title":"Stress and Comorbidity of Physical and Mental Health","authors":"Kelsey D Vig, R. El‐Gabalawy, G. Asmundson","doi":"10.1093/OXFORDHB/9780190681777.013.14","DOIUrl":"https://doi.org/10.1093/OXFORDHB/9780190681777.013.14","url":null,"abstract":"This chapter discusses the complex relationship between stress and physical health, with a focus on comorbid posttraumatic stress disorder (PTSD) and physical health conditions. There is a great deal of evidence that stress and mental health conditions, such as PTSD, often co-occur with physical health conditions. This chapter reviews this evidence, describes potential mechanisms underlying the comorbidity, and outlines theoretical frameworks for understanding the relationship between stress and physical health. It considers the ways in which stress leads to poor physical health, how physical health conditions can lead to stress, and how other factors may both increase stress and worsen physical health. Clinical implications of comorbid mental and physical health conditions and suggestions for future research in the area are also discussed.","PeriodicalId":375662,"journal":{"name":"The Oxford Handbook of Stress and Mental Health","volume":"222 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2018-06-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"122480474","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2018-06-07DOI: 10.1093/OXFORDHB/9780190681777.013.10
Alexandra F. Corning, Isabella Viducich
Stress has long been implicated in the development and maintenance of both eating disorders and obesity. In this chapter, evidence for the most commonly implicated putative stressors, as culled from cross-sectional and longitudinal studies, is reviewed within the framework of the diathesis-stress model. These stressors include childhood maltreatment and sexual violation; military combat and military sexual violation; traumatic stress, injury, and illness; occupational stress; sociocultural pressure to be thin; and negative appearance-related feedback. Constructs that may mediate or moderate pathways from stressors to problematic eating are identified within the framework of the maladaptive coping model, wherein stress initiates a cascade of events potentially leading to disordered eating. Methodological challenges are identified and new directions based on recent analytic advances are proposed.
{"title":"Stress in Eating Disorders and Obesity","authors":"Alexandra F. Corning, Isabella Viducich","doi":"10.1093/OXFORDHB/9780190681777.013.10","DOIUrl":"https://doi.org/10.1093/OXFORDHB/9780190681777.013.10","url":null,"abstract":"Stress has long been implicated in the development and maintenance of both eating disorders and obesity. In this chapter, evidence for the most commonly implicated putative stressors, as culled from cross-sectional and longitudinal studies, is reviewed within the framework of the diathesis-stress model. These stressors include childhood maltreatment and sexual violation; military combat and military sexual violation; traumatic stress, injury, and illness; occupational stress; sociocultural pressure to be thin; and negative appearance-related feedback. Constructs that may mediate or moderate pathways from stressors to problematic eating are identified within the framework of the maladaptive coping model, wherein stress initiates a cascade of events potentially leading to disordered eating. Methodological challenges are identified and new directions based on recent analytic advances are proposed.","PeriodicalId":375662,"journal":{"name":"The Oxford Handbook of Stress and Mental Health","volume":"1 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2018-06-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"130143544","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2018-06-07DOI: 10.1093/OXFORDHB/9780190681777.013.8
C. N. White, C. Conway, T. Oltmanns
This chapter reviews literature investigating the complex relationships between stress and personality disorders. Various forms of early life adversity, particularly experiences of abuse and neglect, portend the development of personality disorders and maladaptive personality traits later in life. Much of this association appears to be causal (i.e., independent of genetic risk). A comparatively much smaller literature suggests that acute stressful events later in development show complex interrelations with personality disorders. These connections appear to be bidirectional, such that not only does stress influence the development of personality, but personality also influences stress exposure. Additionally, personality traits influence the way in which individuals respond to stressors, both psychologically and physiologically. Our review concludes by underlining enduring methodological problems and conceptual issues that await resolution in future empirical work.
{"title":"Stress and Personality Disorders","authors":"C. N. White, C. Conway, T. Oltmanns","doi":"10.1093/OXFORDHB/9780190681777.013.8","DOIUrl":"https://doi.org/10.1093/OXFORDHB/9780190681777.013.8","url":null,"abstract":"This chapter reviews literature investigating the complex relationships between stress and personality disorders. Various forms of early life adversity, particularly experiences of abuse and neglect, portend the development of personality disorders and maladaptive personality traits later in life. Much of this association appears to be causal (i.e., independent of genetic risk). A comparatively much smaller literature suggests that acute stressful events later in development show complex interrelations with personality disorders. These connections appear to be bidirectional, such that not only does stress influence the development of personality, but personality also influences stress exposure. Additionally, personality traits influence the way in which individuals respond to stressors, both psychologically and physiologically. Our review concludes by underlining enduring methodological problems and conceptual issues that await resolution in future empirical work.","PeriodicalId":375662,"journal":{"name":"The Oxford Handbook of Stress and Mental Health","volume":"34 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2018-06-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"124384215","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2018-06-07DOI: 10.1093/OXFORDHB/9780190681777.013.11
A. M. Greca, BreAnne A. Danzi, Ashley N. Marchante-Hoffman, Naomi Tarlow
This chapter reviews the literature on the association between traumatic stress exposure and rates of both posttraumatic stress disorder (PTSD) and acute stress disorder (ASD) among children and adults. It begins by reviewing current definitions of PTSD and ASD, which vary substantially across diagnostic systems. The chapter highlights research linking large-scale events, such as natural disasters and acts of terrorism, with the emergence of PTSD and ASD, as well as the literature on the impact of individual traumatic events, such as sexual assault, child sexual abuse, and medical trauma. The chapter concludes by noting several important directions for future research in the area of trauma exposure and traumatic stress.
{"title":"Trauma Exposure in Posttraumatic Stress and Acute Stress Disorders","authors":"A. M. Greca, BreAnne A. Danzi, Ashley N. Marchante-Hoffman, Naomi Tarlow","doi":"10.1093/OXFORDHB/9780190681777.013.11","DOIUrl":"https://doi.org/10.1093/OXFORDHB/9780190681777.013.11","url":null,"abstract":"This chapter reviews the literature on the association between traumatic stress exposure and rates of both posttraumatic stress disorder (PTSD) and acute stress disorder (ASD) among children and adults. It begins by reviewing current definitions of PTSD and ASD, which vary substantially across diagnostic systems. The chapter highlights research linking large-scale events, such as natural disasters and acts of terrorism, with the emergence of PTSD and ASD, as well as the literature on the impact of individual traumatic events, such as sexual assault, child sexual abuse, and medical trauma. The chapter concludes by noting several important directions for future research in the area of trauma exposure and traumatic stress.","PeriodicalId":375662,"journal":{"name":"The Oxford Handbook of Stress and Mental Health","volume":"15 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2018-06-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"115372776","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2018-06-07DOI: 10.1093/oxfordhb/9780190681777.013.32
J. Beck, Alison M. Pickover, Alexandra J. Lipiniski, Han N. Tran, Thomas S. Dodson
In this chapter, we review the current literature on cognitive-behavioral treatments for posttraumatic stress disorder (PTSD) and acute stress disorder (ASD). Particular attention is paid to treatments for PTSD that have strong empirical support, specifically cognitive processing therapy, prolonged exposure, and eye movement desensitization and reprocessing therapy. Cognitive-behavioral treatments for ASD have evolved differently, with greater emphasis on treatment packages; notably, this literature is less well developed and deserving of considerable more study, relative to the PTSD literature. Throughout the chapter, we have addressed areas for future study, as well issues that are currently salient in the treatment of these two conditions.
{"title":"Cognitive-Behavioral Interventions for Disorders of Extreme Stress","authors":"J. Beck, Alison M. Pickover, Alexandra J. Lipiniski, Han N. Tran, Thomas S. Dodson","doi":"10.1093/oxfordhb/9780190681777.013.32","DOIUrl":"https://doi.org/10.1093/oxfordhb/9780190681777.013.32","url":null,"abstract":"In this chapter, we review the current literature on cognitive-behavioral treatments for posttraumatic stress disorder (PTSD) and acute stress disorder (ASD). Particular attention is paid to treatments for PTSD that have strong empirical support, specifically cognitive processing therapy, prolonged exposure, and eye movement desensitization and reprocessing therapy. Cognitive-behavioral treatments for ASD have evolved differently, with greater emphasis on treatment packages; notably, this literature is less well developed and deserving of considerable more study, relative to the PTSD literature. Throughout the chapter, we have addressed areas for future study, as well issues that are currently salient in the treatment of these two conditions.","PeriodicalId":375662,"journal":{"name":"The Oxford Handbook of Stress and Mental Health","volume":"31 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2018-06-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"116223370","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2018-06-07DOI: 10.1093/oxfordhb/9780190681777.013.20
M. Deanna, D. Pagliaccio
This chapter reviews associations between early life stress and brain structure and function as assessed by structural and functional magnetic resonance imaging. Particularly, this chapter focuses on structural associations in children and adults and the regional overlap with neural alterations observed in major depressive disorder, though we also more briefly cover diffusion imaging, task-based imaging, and resting-state functional connectivity. Major depressive disorder is highlighted given that early life stress is a critical risk factor for depression and the neural alterations observed with stress and depression may serve as key mediating factors of this association. A brief methodological overview is provided for each neuroimaging domain as well as a discussion of limitations and future directions for this field.
{"title":"Stress and the Brain","authors":"M. Deanna, D. Pagliaccio","doi":"10.1093/oxfordhb/9780190681777.013.20","DOIUrl":"https://doi.org/10.1093/oxfordhb/9780190681777.013.20","url":null,"abstract":"This chapter reviews associations between early life stress and brain structure and function as assessed by structural and functional magnetic resonance imaging. Particularly, this chapter focuses on structural associations in children and adults and the regional overlap with neural alterations observed in major depressive disorder, though we also more briefly cover diffusion imaging, task-based imaging, and resting-state functional connectivity. Major depressive disorder is highlighted given that early life stress is a critical risk factor for depression and the neural alterations observed with stress and depression may serve as key mediating factors of this association. A brief methodological overview is provided for each neuroimaging domain as well as a discussion of limitations and future directions for this field.","PeriodicalId":375662,"journal":{"name":"The Oxford Handbook of Stress and Mental Health","volume":"1 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2018-06-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"130363450","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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