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Using music therapy techniques to treat teacher burnout. (Research).

This study was conducted to determine the effectiveness of music therapy techniques as an intervention for teacher burnout. Of the 51 elementary school teachers who participated in the study, 25 were from a school undergoing comprehensive reform, and 26 were from a school employing traditional grade-level classrooms and teaching strategies. Each participant completed pretest and posttest instruments. In addition, there were two treatment groups, either cognitive behavioral/music therapy or cognitive behavioral therapy. Results of the study indicated that teachers who participated in school-based counseling groups, using music therapy techniques in conjunction with cognitive behavioral interventions, reported lower levels of burnout symptoms than teachers in school-based counseling groups using cognitive behavioral interventions only. Implications for mental health counseling are discussed.

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Based on several international studies, approximately 60% to 70% of all teachers repeatedly show symptoms of stress, and a minimum of 30% of all educators show distinct symptoms of burnout (Antoniou, Polychroni, & Walters, 2000; Borg & Falzon, 1989; Capel, 1992; Kyriacou, 1980; Kytaev-Smyk, 1983; Lale, 2001; Rudow, 1999). In fact, Lumsden (1998) found that teacher morale overall was so low that 40% of teachers surveyed would not select teaching again as a career, and 57% were either undecided about leaving teaching, actively planning to leave teaching, or would leave the teaching field if something better came along.

Stress and burnout not only influence teachers' professional lives, but also impact their mental and physical well-being. In a study conducted in the Netherlands, 53% of work-incapacitated teachers left their profession because they suffered from mental health problems (Algemeen burgerlijk pensioenfonds, 1995). Further, recent studies (Lale, 2001; Posen, 1995) found that many individuals who experienced chronic stress often developed physical symptoms including abdominal cramps and nausea, migraine headaches, and heart palpitations.

Additionally, the achievement of educational goals and overall learning is impacted by teacher stress and burnout. As teachers experience more stress and burnout, there are escalating feelings of detachment, alienation, cynicism, and apathy. As these feelings intensify, there is increased absenteeism and, ultimately, many teachers decide to leave the field (Antoniou et al., 2000; Carnegie Forum on Education and the Economy, 1986; Farber, 1991, 1999; Jenkins & Calhoun, 1991; Rudow, 1999; Wiley, 2000).

In choosing a career, individuals usually enter the field of education to motivate and help children grow, to make a difference in their lives, to be challenged, and to gain a sense of accomplishment by working at something worthwhile (Farber, 1999, 2000; Gold & Roth, 1993; Haberman, 2000; McEnany, 1986). To these individuals, teaching is a noble profession, and it is their vision to make a contribution to children, the community, and to society overall (Haberman). Too often, they "encounter reality shock when the stark contrast between expectations and life in the classroom is realized, leading to severe disillusionment, which, in effect, is burnout" (Gold & Roth, p. 13).

Although school reform is intended to revive schools and education, the reform movement has not been successful; the lack of attention to the needs and concerns of the facilitator of the teaching-learning process has not been addressed, much less made a priority (Gold & Roth, 1993; Smylie, 1999). According to Miller (1999), massive school reform means that teachers are not only reinventing their school; they are required to reinvent themselves as well. Due to these immense educational reforms, the culture of the teacher changes and a new professionalism emerges (Hargreaves, 1994). While the reforms are most likely positive, the overall and lasting impact on the teaching population is as yet unknown. It was widely assumed that reform efforts would at least reduce, if not eliminate, teachers' stress-related problems (Farber, 2000). It is becoming increasingly apparent that reform has had little impact (if not actual negative consequences) on the prevalence of teacher stress and burnout (Farber & Ascher, 1991; Miller). Overall, many teachers have felt left out of the reform process and are viewed as successful only if all of their students meet or surpass every index of educational performance. The "inconsequentiality"--the sense that their job efforts are not met with commensurate rewards, satisfactions, or fulfillments--has led teachers to feel undervalued, denigrated, overworked, unappreciated, and ultimately, burned out (Farber).

Most of the empirical research on teacher burnout has involved the theoretical configuration offered by Maslach and Jackson (1986). Using a multidimensional model, they characterized burnout as a syndrome of emotional exhaustion, depersonalization, and reduced accomplishment that may occur among individuals involved in people work. Emotional exhaustion refers to an individual feeling emotionally overextended and depleted of emotional resources. Depersonalization is characterized as a negative, callous, or an excessively detached response to other people, usually the very individuals who should be the recipients of the care or service. Finally, a decline in one's feelings of competence and success, along with reduced productivity, low morale, withdrawal, and an inability to cope, delineates the construct of reduced personal accomplishment.

Interventions and programs for stress reduction are abundant in both the scientific research and lay communities. Suggested interventions for teacher stress and burnout have included stress management seminars (Friedman, 1999; Jenkins & Calhoun, 1991), stress inoculation techniques (Forman, 1982, 1983; Sharp & Forman, 1985), and direct environmental reorganization (Friedman, 2000). Cecil and Forman (1990), investigating the effects of stress inoculation and coworker support groups with 54 regular classroom teachers, found that the stress inoculation group exhibited significant reduction in stress between the pre- and post-tests. Neither the coworker support groups nor the control group showed significant change. In a similar study of 60 teachers (Sharp & Forman), stress inoculation and classroom management techniques were found to improve teachers' affect and behavior. Earlier studies by Forman (1982, 1983) found that teachers who participated in stress inoculation had significant reductions in self-reported stress and anxiety, and in observable motor manifestations of anxiety in the classroom. Follow-up at a 6-week interval indicated that stress and anxiety had decreased.

There is little research on the utilization of music or other expressive therapies with teachers in the area of burnout. Because music often allows people to express feelings that may not be definable by words (Kerr, Walsh, & Marshall, 2001; Yon, 1984), it is an effective ally to the verbal approaches of traditional therapy (Gladding, 1998; Straseske, 1989). In particular, the music therapy investigations of Hanser (1985, 1988, 1990), Hanser and Thompson (1994), and Hendricks, Robinson, Bradley, and Davis (1999) provide a seminal basis for the current research study involving teacher stress and burnout. Hanser's work with music and stress-reduction techniques suggests that music assists in generating a more relaxed mood and reduces stress. Hendricks et al. developed an intervention program using music techniques with adolescents in which the individual members of the treatment group selected music that was relevant to them and their current experiences. These selections were utilized to process the emotions and experiences that the music evoked. Results of the study indicated a significant overall decrease in depressive symptoms for the music therapy group versus the control group. Despite a large number of investigations concerning teacher stress and burnout, there is a lack of empirical research regarding the impact of effective, short-term, school-based interventions particularly in light of school reform movements. Additionally, current research suggests that teachers in schools undergoing comprehensive reformation are more likely to experience symptoms of burnout. In combination with group techniques, music can provide an impetus for further exploration of both verbal and nonverbal processing (Gladding, 1998). Music allows individuals to extend beyond what can be expressed in words alone (Nelson & Weathers, 1998). Utilizing a combination of these techniques with listening activities could provide a positive intervention for teachers experiencing symptoms of burnout and stress. The purpose of the current study was to determine the effectiveness of music therapy techniques as an additive intervention in a cognitive-behavioral approach to reduce teacher burnout. Further, this study sought to determine if the effectiveness of music therapy interacted with the type of school, traditional or reform-based, where the teachers worked.

METHOD

Participants

Participants were recruited from two different elementary campuses within a mid-sized suburban school district in the southwest United States. The first elementary school had been restructured into an academy concept school that employed multi-age groupings, brain-compatible teaching strategies, learning styles, and a "school within a school" in which the approximately 400 students in the school were placed into four vertical teams of kindergarten through fifth grade classrooms. The school employed approximately 30 certified teachers. The second elementary school enrolled approximately 500 students, also ranging from kindergarten through fifth grade. There were 36 certified teachers employed in this school. This elementary school was structured into traditional grade-level classrooms and employed teaching strategies that were more conventional. Participation in this study was voluntary. The mean age of the 48 females and 3 males (n = 51) ranged between 35 to 39 years. All of the participants reported their ethnicity as Caucasian. With regard to years of teaching experience, the mean of all participants was 8.12 years (SD = 6.39). Thirty-nine participants were married, 2 were divorced, and 10 were never married. The annual earnings ranged from $25,000 to $50,000 or more; 54.9% of the participants reported their salaries in the $30,000 to $34,999 span. In terms of health, 19.6% rated their health as excellent, 31.4% rated their health as good, 17.6% rated their health as could be better, and one participant rated poor health. The mean number of days absent per year was 5.55, with the range of absences from 0 to 41 days. Of the total participants, 60.8% stated yes that they would choose to teach, while 39.2% stated no they would not choose to teach. Regarding the two schools, 76% of the participants in the reformed school and 46.2% from the traditional school replied yes.

Instruments

The 51 participants completed a Personal Data Sheet and the Maslach Burnout Inventory-Educators Survey (MBI-ES; Maslach, Jackson, & Schwab, 1996). The MBI-ES was designed to assess three facets of the burnout syndrome: emotional exhaustion, depersonalization, and lack of personal accomplishment. A separate subscale on the inventory represents each facet of burnout. The 22-item Likert-scale instrument is self-administered and takes 10 to 15 minutes to complete. The MBI-ES does not create a composite score. In order to compute the scores for each of the subscales, each respondent's test form is scored with a key and the totals are analyzed as indicating low, average or high by using listed numerical cut-off points. For the Emotional Exhaustion subscale, scores ranging from 27 and higher are considered high indicators of emotional exhaustion. For the Depersonalization subscale, scores from 14 points and higher are indicators of high levels. The Personal Accomplishment subscale is scored in the opposite direction from the other two subscales; a high score would range between 0-30. For the purpose of analysis, each subscale was addressed separately. Sample items of the MBI-ES include: "I feel used up at the end of the workday" (Emotional Exhaustion subscale); "I worry that this job is hardening me emotionally" (Depersonalization subscale); and "I can easily create a relaxed atmosphere with my students" (Personal Accomplishment subscale).

The validity and reliability of the MBI-ES (Maslach et al., 1996) has been corroborated in several studies. Iwanicki and Schwab (1981) reported reliability Cronbach alpha estimates as .90 for Emotional Exhaustion, .76 for Depersonalization, and .76 for Personal Accomplishment. Gold (1984) found reliability estimates of .88 for Emotional Exhaustion, .74 for Depersonalization, and .72 for Personal Accomplishment. These reliability coefficients are closely analogous to other versions of the Maslach Burnout Inventory. In a meta-analysis of studies of the MBI, Schaufeli, Enzmann, and Girault (1993) reported that the internal consistency of the three subscales is satisfactory (Cronbach's [alpha] values ranged from .71 to .90), and indicated that the Emotional Exhaustion subscale appears to be the most stable burnout dimension with Depersonalization being the least stable. Reliability coefficients for the pretest of the MBI-ES yielded an alpha of .77, while the posttest yielded an alpha of .80. Box's Test of Equality indicated that there was equality across all groups (p = .129).

Procedures

The 51 participants were randomly assigned into two groups within each school: (a) a cognitive behavioral combined with music therapy treatment group, and (b) a cognitive behavioral group without music therapy. There were a total of four groups in the study, and no participants were informed about the type of group assignment. From the reformed school, the cognitive/behavioral music therapy treatment group contained 14 participants, and the cognitive behavioral without music therapy group had 11 participants. The cognitive/behavioral music therapy treatment group from the traditional school was comprised of 14 participants, and the cognitive/behavioral group without music therapy contained 12 participants. The participants completed the research packet prior to the initial group meeting and again at the end of the 6-week intervention described below.

The cognitive behavioral/music therapy treatment groups received 6 weeks of cognitive behavioral group therapy based on stress inoculation methods (Meichenbaum, 1985) integrated with music therapy techniques. The cognitive behavioral groups received 6 weeks of cognitive-behavioral group therapy (also based on stress inoculation methods) without music therapy techniques. The researcher served as the group leader for all groups. For this study, each of the groups met for 1 hour and 15 minutes once a week. During the first week, all of the groups were provided with an introduction that included a discussion of informed consent, participant rights, and confidentiality. Using the work of Maslach and Jackson (1986), the groups also discussed the three facets of burnout (Emotional Exhaustion, Depersonalization, and Personal Accomplishment) that are experienced both in and out of the classroom as manifested physically, spiritually, and emotionally.

During the second session with the music therapy techniques intervention groups, the group leader played music as an introduction to the music therapy techniques and also to facilitate the processing of the group. Group discussions centered on how music could facilitate cognitive processing of upsetting or stress-causing events and how those cognitive processes could be integrated into their daily lives. The individuals were given homework and asked before Session 2 to find a song that was meaningful to them both in terms of their career and in the interaction of the three facets of burnout. The subsequent 5 weeks of the cognitive behavioral music therapy treatment group consisted of listening to individual teachers' music selections and the groups processing of these selections. Throughout the group meetings, the participants discussed their current stressors as well as how the shared musical experiences were assisting their relaxation and cognitive restructuring efforts. The group worked through two to three music selections weekly. Although there were differences in actual group content, the format for each of the cognitive behavioral music therapy groups from each school remained the same.

For the cognitive behavioral groups without music therapy, the five subsequent weeks involved utilizing cognitive-behavioral therapy techniques based on stress inoculation interventions (Meichenbaum, 1985). Initially, in the conceptualization phase, the group members discussed their present stressors and emotions regarding these stressors. Additionally, the group members were instructed to begin monitoring their specific thoughts, feelings, and behaviors both in school and in their private lives. As the group continued, the members discussed and learned various methods of relaxation, including breathing techniques and cognitive restructuring. Group discussions centered on the role that each individual's cognitions and perceptions played in the creation and maintenance of stress in their lives. In the final two sessions of the group, the members discussed the application of the techniques they had learned. There were also some role-plays involving the learned behaviors.

RESULTS

The study was conducted as a 2x2 factorial design. To examine whether the music therapy additive reduced teacher burnout, the three post-test subscale scores of the MBI-ES were submitted to a Multivariate Analysis of Covariance (MANCOVA) as dependent variables, with Type of Group and School as the independent variables and the pre-test scores of the three subscales as covariates. This analysis was selected because a preliminary analysis showed that the three subscale scores were significantly correlated (rs = -.22 to .52).

On the MANCOVA, a significant difference was found between the treatment groups on burnout, (F (3,42) = 6.98;p = .001; Wilks' Lambda = .67). The music therapy treatment accounted for 33 % of the variance in the dependent variable of burnout ([eta.sup.2] = .333). The difference in the perception of burnout between teachers in schools undergoing comprehensive reform and teacher in more traditional schools was not significant (F (3,42) = 1.84; p= .15; Wilks' Lambda = .88). There also was no significant interaction between the Type of Group and Type of School on the perception of burnout (F (3, 42) = .67; p = .57; Wilks' Lambda = .95). Follow-up ANCOVA indicated that participants in the cognitive behavioral/music therapy group reported significantly lower levels of Depersonalization (M = 4.14) than those in the cognitive behavioral condition (M = 5.87; F (1,44) = 15.88,p = .000). See Table. ANCOVA also indicated slight significant differences in Personal Accomplishment (F (1,44) = 4.23, p = .05), although in this case, the cognitive behavioral groups levels increased (M = 40.04) while the cognitive/behavioral groups remained stable (M = 36.25). The treatment variable explained 27% ([eta.sup.2] = .265) of the variance in Depersonalization and 9% ([[eta].sup.2] = .088) of the variance in Personal Accomplishment. Type of group did not significantly influence the factor of Emotional Exhaustion (F (1,44) = .21, p = .69).

DISCUSSION

In this study, teacher burnout was significantly impacted by the cognitive behavioral/music therapy intervention. This finding suggests that by participating in cognitive behavioral/music therapy groups, teachers may have the opportunity to learn more effective strategies for dealing with stress. Earlier research suggested that the addition of music therapy to the groups offered opportunities for the participants to better express their feelings and to establish a relationship with other professionals through social bonding (Bonny, 1987; Rosenblatt, 1991; Yon, 1984), increased coping skills (Hodas, 1994), and the opportunity to express negative emotions through non-verbal behaviors or responses (Nelson & Weathers, 1998).

The composition of this sample needs to be considered in interpreting the results of the intervention. With regard to marital status, the majority of the participants (76.5%) in this study indicated that they were married. De Heus and Diekstra (1999) reported that married individuals demonstrated fewer symptoms of burnout. Thus marital status may have had an impact on the results of this study in that the spousal relationships could have served as a source of support for the teachers outside of the school-based groups. In terms of the participants' response regarding whether if given the choice, they would again choose teaching as a career, 39.2% of the participants reported that if given the choice, they would not choose to return to teaching, which supported previous research findings (Carnegie Foundation for the Advancement of Teaching, 1990; Lumsden, 1998). Despite the congruence of this study with other studies, there are differences between the responses of the participants in this study. Almost 54% of the teachers at the traditional school stated that they would not return to teaching, whereas only 24% of the teachers at the reformed school stated that they would not return to teaching. This result was surprising in that one would surmise that the teachers implementing massive reform would be less inclined to remain in the teaching field. Yet, the majority of the teachers at the traditional school, not the reformed school, indicated that they would not choose teaching as career, if given the choice. Perhaps teachers in school settings involving change and reform are actually more invested in the teaching process. In the traditional school, teachers are being required to implement school reform standards and teaching methodologies without the benefits of the increased collaboration and communication of teachers in more innovative schools (see Van den Berg and Sleegers, 1996). However, differences in years of experience could be pertinent to this point. Graham (1999) suggested that teachers with more teaching experience tend to show greater signs of burnout than their less experienced colleagues. In this study, teachers from the traditional school had more experience (9.80 years) than their reformed school counterparts (6.68 years).

IMPLICATIONS FOR MENTAL HEALTH COUNSELORS

The results of the study, which add to the increasing body of research regarding teacher stress and burnout, suggest several avenues for future research and practice. For one, future research in stress and burnout interventions, as suggested by Maslach and Leiter (1999), should include collaborative efforts between mental health counselors, educators, and researchers. Additionally, the findings of this study converge with earlier research on music as an effective component of therapeutic interventions (Crabbs, Crabbs, & Wayman, 1986; Davis & Thaut, 1989; Gladding, 1998; Hanser, 1985, 1988, 1990; Hanser & Thompson, 1994; Hendricks et al., 1999; Jellison, 1975; Kerr et al., 2001; Robb, 2000; Rohner & Miller, 1980; Staum & Brotons, 2000; Strauser, 1997). It could, therefore, be helpful for mental health counseling interventions to include music components. Music can be used effectively and simply because it is easily integrated and implemented into a variety of stress-producing situations. Mental health counselors can utilize music with both individual and group interventions without any type of musical knowledge or experience. Musically based techniques may also be prescribed for clients who may be at a therapeutic plateau or who are experiencing other difficulties that are thwarting their progress. By utilizing musical selections, clients may be more open to disclosure and processing of problems that they cannot express verbally. Mental health counselors may also select musical pieces that address specific issues or emotions that can facilitate further therapeutic processing.

Second, the results of this study have implications for the creation of more effective schools. Prevention of burnout is "more effective and less expensive than treatment" (Friedman, 1999, p. 174), and ultimately benefits the children served by the system through increased teacher enthusiasm, creativity, innovation, and commitment (Firestone & Pennell, 1993). Mental health counselors could consider implementing music-therapy based groups in schools or community settings, which could reduce symptoms of burnout among teachers, thus improving the overall environment of the school.

One of the most significant contributions of this study was the stimulation of questions and ideas concerning future research. Further mental health counseling research is needed to explore the relationship between the many demographic variables discussed previously and their influence on teachers' stress and burnout. A study of these characteristics could provide a vital link to early stress and burnout prevention efforts. Future longitudinal studies extending more than 6 months (preferably 18 to 24 months) are needed to continue investigating the impact of school reform on students and staff as well as the role of mental health counselors in the emerging school reform environment.

Limitations of the Study

As with any research, this study has limitations. The limitations occurred in two general areas: participants and instrumentation. Participants for the study were limited to teachers in an elementary school setting. The experiences and needs of teachers in secondary schools or other school environments may not be accurately reflected in this study. Additionally, because the sample size was small, the results may not have been representative of all teachers in the two schools. Because all of the participants were volunteers, the study did not reflect the experience of teachers who did not choose to participate in the study. Likewise, since expectations and requirements vary between local school districts and states, the results of this study may not accurately reflect the experience of teachers in schools in other areas of the United States, including those employed in private schools. In addition, the participants were primarily Caucasian, married women. Although this reflects the demographics of the geographical area, it is not indicative of the total population of school teachers in the United States.

Because the instruments used in this study were self-report measures, the accuracy of the study could be influenced by inaccurate self-reports or inaccurate perceptions of the situation. Moreover, the length of the intervention or the number of participants may limit this study. A larger group of participants might have been beneficial to this study in that the increased number of participants would have amplified the statistical power of the study while simultaneously supplementing the overall information gleaned from the study. Results of this study should be interpreted in light of these limitations, and generalizations to the other populations of school teachers should be made with caution.

Another limitation is that the researcher acted as the group leader. However, efforts were made to control for factors that could bias the results of this study. Members were randomly assigned into their group, and the procedures for each weekly group were kept standardized to best extent possible. Despite the efforts of the researcher, the study could be biased. Furthermore, the results could have been impacted by other threats to validity including the sensitizing effects of the pre- and post-tests, results based on perceived experimenter demand, a thank-you effect, or a Pygmalion effect created by the participants' response to the researcher as the group leader.

In summary, this study provided information regarding the effectiveness of music therapy techniques as an intervention for teacher burnout. Mental health counselors may provide an important link in helping teachers combat stress and burnout by providing proactive and preventive music-based stress reduction techniques. By serving as a professional and knowledgeable source for collaboration, consultation, and referral, mental health counselors have the potential to positively impact teachers, their students, and schools overall.
MBI-ES--Means and Standard Deviations

 Type of Group

Dependent Variables Cog/Beh. W/Music Cog/Behavioral

 Reformed School
Emotional Exhaustion Pretest 22.14 (9.24) 22.82 (12.45)
 Posttest 19.86 (10.35) 20.00 (12.55)
Depersonalization Pretest 5.93 (4.81) 2.36 (2.73)
 Posttest 3.29 (4.23) 2.82 (2.56)
Personal Accomplishment Pretest 38.86 (5.60) 40.36 (5.03)
 Posttest 39.86 (4.80) 41.64 (4.08)

 Traditional School

Emotional Exhaustion Pretest 32.93 (10.72) 30.00 (10.69)
 Posttest 30.21 (11.71) 25.50 (14.12)
Depersonalization Pretest 8.36 (4.16) 7.75 (7.68)
 Posttest 5.00 (4.13) 8.67 (7.61)
Personal Accomplishment Pretest 33.93 (6.96) 37.50 (5.57)
 Posttest 32.64 (7.71) 38.58 (4.68)

 Totals for Both Schools

Emotional Exhaustion Pretest 27.54 (11.25) 26.57 (11.87)
 Posttest 25.04 (12.06) 22.87 (13.39)
Depersonalization Pretest 7.14 (4.58) 5.17 (6.36)
 Posttest 4.14 (4.20) 5.87 (6.39)
Personal Accomplishment Pretest 36.39 (6.69) 38.87 (5.40)
 Posttest 36.25 (7.30) 40.04 (4.58)

 Type of Group

Dependent Variables Both Groups

 Reformed School
Emotional Exhaustion Pretest 22.44 (10.53)
 Posttest 19.92 (11.12)
Depersonalization Pretest 4.36 (4.35)
 Posttest 3.08 (3.53)
Personal Accomplishment Pretest 39.52 (5.30)
 Posttest 40.64 (4.50)

 Traditional School

Emotional Exhaustion Pretest 31.58 (10.59)
 Posttest 28.04 (12.84)
Depersonalization Pretest 8.08 (5.92)
 Posttest 6.69 (6.15)
Personal Accomplishment Pretest 35.58 (6.49)
 Posttest 35.38 (7.05)

 Totals for Both Schools

Emotional Exhaustion Pretest 27.10 (11.43)
 Posttest 24.06 (12.59)
Depersonalization Pretest 6.25 (5.49)
 Posttest 4.92 (5.31)
Personal Accomplishment Pretest 37.51 (6.20)
 Posttest 37.96 (6.45)

Note. Standard deviations are delineated by parenthesis.


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James R. Cheek, Ed.D., is an assistant professor, Department of Human Services and Counseling, St. John's University, Jamaica, NY. E-mail: jameycheek@hotmail.com. Loretta J. Bradley, Ph.D., is a professor; Gerald Parr, Ph.D., is a professor; and William Lan. Ph.D., is an associate professor; all are with Departmen of Educational Psychology, Texas Tech University, Lubbock.
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