PAP 082:

Strategies to Help Your Anxious Child

with Dawn Huebner, PhD

Many individuals with ADHD struggle with anxiety as well, wether it be an additional condition or the result of the challenges that come with ADHD. Anxiety is often misunderstood by parents and other adults in a child’s life, and can feel like it should be easily rationalized away. But, those with anxiety know no amount of rationalizing can just “turn off” an anxiety attack. In this episode of the Parenting ADHD Podcast, Psychologist, Dr. Dawn Huebner offers both insights for understanding anxiety, as well as strategies to help your child through the difficult challenges of anxiety.

“If a smoke detector detects smoke, it’s gonna set off an alarm. And whether the smoke comes from a house fire, which is really dangerous, or from a piece of toast that’s burning in your toaster, which is not so dangerous, the same alarm gets set off.”

— Dawn Huebner, PhD, Clinical Psychologist

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My Guest

DAWN HUEBNER, PHD
Dr. Dawn Huebner is a Clinical Psychologist and Parent Coach specializing in the treatment of anxiety. Fifteen years ago, Dr. Huebner recognized the need for materials to help children practice the cognitive-behavioral skills they were learning in her office, creating the What to Do Guides for Kids – which have now sold over a million copies. Her more recent book, Outsmarting Worry, maintains Dr. Huebner’s distinctive voice while adding a layer of sophistication and detail appreciated by older children. Dr. Huebner’s books have been translated into 23 languages. She has been featured on the TODAY Show, NHPR, CNN, WebMD and many other news and information outlets. Dr. Huebner’s TEDx talk – Rethinking Anxiety – has been viewed over half a million times. Dr. Huebner has a private practice in NH where she guides young worriers and their parents towards happier lives.

Thanks for joining me!

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Penny Williams (00:00): Welcome back to the parenting ADHD podcast. I am thrilled today to be talking to dr Dawn Huebner about anxiety. We're going to talk all about anxiety in younger children and middle school age children and really cover a lot of strategies to help you to help your anxious child and even to really understand them, understand what their behavior might be signaling in terms of anxiety. Thanks for joining us, dr Huebner, will you start by introducing yourself to the audience? Yes.

Dawn Huebner (00:33): It's a pleasure to be here. Uh, I'm dr Dawn Huebner. I'm a clinical psychologist based in Exeter, New Hampshire. Uh, in therapy I work exclusively with anxious children ages 12 and under and their parents and I also do parent coaching. Um, and then I'm also the author of a number of books for children that teach kids specific strategies to help them better manage a range of feelings, including anxiety.

Penny Williams (01:01): Yeah, you have some great children's books, to read with our kids who are anxious as well. Great work. Let's dive in. I think by talking about what is anxiety, what comes to the level of more than just kind of this daily stress or some typical anxious topics or fears that kids have, what brings us beyond that to actual clinical anxiety?

Dawn Huebner (01:27): Yeah, so it's a good question because we use language kind of loosely. We talk about anxiety and nervousness and fear and worry and those are all normal feelings. So the question about when it rises to the level of needing attention is a really good one. And the answer to that is basically when it's getting in the way. So when a child's uncertainty, discomfort, nervousness, fear rises to the level that it's interfering with things that they used to be able to do or that other kids their age too then it's a problem and needs attention.

Penny Williams (02:07): And what might that look like for parents and caregivers? What are some signals that our kids are really struggling with? Anxiety.

Dawn Huebner (02:17): So anxiety is basically an alert that happens to us internally that is telling us that we might be facing danger. So we get kind of a signal that goes off in our brains around potential danger or potential problems. And the word is an important one and dangers really broadly defined. Anxiety sets off the fight or flight response, which we've all heard about, right? So it's related to fight flight or there's actually a third part freeze. So most commonly we're aware of the flight part and that looks like avoidance. So kids who aren't willing to navigate their house alone, you know, go to different parts of the house by themselves or sleep alone or kids that have trouble separating from parents that go to school or kids who don't want to take part in activities. All that avoidance is the flight part of fight or flight. But we also see the fight with some kids and that is when kids feel afraid and they feel threatened in some way and they come out kind of swinging, you know, they get hurt or angry, you know, I don't like that, I don't want to do that. But that can still be a sign of anxiety. Anxiety's at the base of that often.

Penny Williams (03:42): Right. And I think that that's not typically the first thing that parents think of when they have an arguments to have angry kid think anxiety first. And so I love to make that point because so often it really can be a symptom of that. Yes. And then the freezing is that also,

Dawn Huebner (04:04): so freezing is really what it sounds like. It's, you know, kind of deer in the headlights, um, kids just losing their ability to say what they're thinking or feeling or to move into a situation. Um, in the extreme form of that you might see something like selective mutism where kids literally are not able to speak in positions where they feel unsure of themselves or uncomfortable in some way. And in, in the less extreme form, it's just kids getting kind of paralyzed kids freezing in the face of anxiety and uncertainty. And, and I've brought up uncertainty a couple of times because uncertainty is very much a part of, of anxiety, right? So anxiety often has to do with the fear of things that might happen or could happen. And when kids find themselves feeling not sure about how something is going to go that often sets off this phenomenon, this, this anxiety,

Penny Williams (05:04): right. Do you see a lack of self confidence sometimes as a signal of potential anxiety?

Dawn Huebner (05:12): Yeah, it can be. So, um, confidence is, is very much related to competence. So, you know, when kids feel competent and able to handle challenges, they feel more confident. And one of the things that happens with anxiety is that kids begin to feel that they sort of underestimate their own ability to cope. So they start to think that if a bad thing happens, it's going to completely take over and there's nothing that they're going to be able to do about it. And that's really kind of an underestimation of their own competence, their own abilities. But, but that goes along with anxiety.

Penny Williams (05:54): Yeah. I see that in my college age daughter who some pretty significant anxiety and the attitude of I can't, I can't, I can't, which is kind of a self fulfilling prophecy if that's your attitude about things and when we catch her closing off and just not even trying stuff. And so that's been a battle to help her to push herself through that discomfort and that potential because often it, it doesn't go bad. Often it's just fine. But it's that cognitive distortion. And I think so many of the cognitive distortions come with anxiety.

Dawn Huebner (06:28): Yes, that's true. So, um, there are three very typical cognitive distortions that go along with anxiety. One is misinterpreting, uh, likelihood. So thinking that if a bad thing could happen, it will happen. There is, is misinterpreting or making mistakes about magnitude. So making an assumption that the bad thing is going to be catastrophic. And then the third is underestimating your ability to cope, which we've been talking about. Um, I wanted to say something else about kids who are sure that they're not going to be able to handle something that comes, you know, part of what parents often feel the impulse to do when their kids are lacking confidence is to essentially cheerlead, you know, to tell their kids you can do it. And any parent who has tried to do that knows that it doesn't work. Right. So it feels invalidating to kids to have parents to say, of course you can do that.

Dawn Huebner (07:28): Um, and what we need to do instead is help kids to understand that this is part of anxiety. It's, it's a cognitive distortion which we can get even young kids to understand by calling it something other than a cognitive distortion. We can say it's a thinking mistake or your brain is tricking you or your worry is tricking you. Um, but we want kids to be able to begin to get a little bit of distance from their thoughts so that they can question what they're thinking and what they're feeling and to recognize that some of their thoughts aren't accurate and aren't helpful to them.

Penny Williams (08:06): Yeah, that is such a good point. I think there are mistakes that we make as parents and you know, interestingly enough, I have anxiety myself and I really get it and I still find myself being that cheerleader sometimes for my daughter and my son and anxious moments. And I have to really be mindful and catch myself and say, okay, you know, this isn't helpful. You've been there, you know, let's try to take a different approach. What other mistakes do you see parents making when it comes to anxious kids?

Dawn Huebner (08:40): So the single most common mistake that parents make is to overly accommodate the anxiety. And there's, there was an interesting study that was done recently looking at the parents of anxious children and it found that 97 of parents of anxious children accommodate the anxiety, meaning that they change what they're doing or saying in an attempt to reduce their child's anxiety. Right? And parents do that coming from a place of love, right? You see your child is suffering, you don't want your child to suffer. And so you tried to smooth away or you help them avoid the thing that they're afraid of or you add lots of the extra reassurance or supports. So it actually, it comes from an absolutely well intentioned place, right? And it's one of the most problematic things parents do. And the reason that it's so problematic is that it locks anxiety in place.

Dawn Huebner (09:37): So a parent accommodates anxiety and I'm just going to give them more specific examples so it's clear what we're talking about. So let's say there's a child who, um, has become really nervous about pickup at the end of the school day and they have the fear that maybe the parent isn't going to be there, um, or isn't going to be there at time on time. And so the child checks with their parents every day before school. Are you going to be there? When are you going to be there? Where are you going to be beforehand? So then sure that you're going to be there, right? And accommodation is answering all those questions. And the reason that's a problem is that when you answered the questions, you provide that reassurance. It helps the child feel better. Right? In the moment. It reduces the anxiety, but it makes the child utterly dependent on having you answer that question again.

Dawn Huebner (10:33): Every time they're anxious, thoughts occurs to them again. So it keeps the child really locked into continuing to get that reassurance. Wow, I hadn't thought about that. Yeah. So it's, it's um, you know, it provides relief in the moment and it makes the problem worse in the long run and what we need to do instead, it begins with externalizing anxiety, which is helping children to conceptualize their worry. Like it's a little creature, you know, like a little beast of some sort that is separate from them. And that little worry creature comes along and it pulls the danger alarm in their brain and it tries to trick them or it tries to scare them about things that are not actually dangerous to them. And every time the child jumps in response to that worry and obeys it, that externalized worry, it's like it's feeding the worry, it's strengthening the worry. And so what kids need to do instead is to learn how to question this little worry creature, challenge it, disobey it. And that's something that parents can help their children do. That's such an interesting thing. And so in example of

Penny Williams (11:54): the child who's worried that you're not going to pick them up or pick them up on time, how would you more appropriately handle that in the moment?

Dawn Huebner (12:02): So assuming that you have already talked to your child about imagining their worry like this, it's this little creature, this little past that comes along and tries to scare them or tries to trick them, you might say to them, it sounds like worries pulling your alarm, or it sounds like that's, you know, mr worry, who's trying to scare you. And then a parent can either say, let's talk back to that worry. I'm helping a child to say something like to themselves like, um, you know, worry, you always scare me, but my mom has been there every single day after school or worry, I know you're trying to scare me, but I'm not listening to you or you're not the boss of me. And it's much more effective for kids to do this kind of talking back or pushing back against their worry rather than having a parent just provide the reassurance again. Because ultimately we want kids to internalize the ability to not necessarily believe what their worry is telling them to, you know, kind of question or push back against it.

Penny Williams (13:08): Yeah. To be able to navigate and cope on their own.

Dawn Huebner (13:11): Right, right. And this one's a strategy that's not just meant for little kids. Right. So it, you know, it might sound like it's a little kid strategy to kind of talk back to mr worry. Um, but it's a strategy that's effective even for adults to personify worry. You don't have to call it mr worry. Like, you know, you can come up with your own name for it. Um, but to talk back to it or to recognize, you know, this is, this is a little worry part of my brain that's trying to protect me, but it's actually going overboard and I, I don't need to buy what it's saying or I don't need to listen to it.

Penny Williams (13:46): Yeah. And what that's really doing, I think is separating irrational fear from rational fear, which is a concept really above understanding for the kids of the age that we're talking about. But I'm in what I know of anxiety and navigating myself and for my teen and young adult, that's kind of what you're doing in a way that younger kids can really grab ahold of it and understand it. And therapists that treat adults, do you? Absolutely. Um, tell them to personify their anxiety as well, which is amazing. But also I've heard, you know, don't try to make it go away. Understand that it's part of you or it's

Dawn Huebner (14:30): there. That's right. So, um, in, in the first book that I wrote, I had recommended that kids talk back to their worry in kind of a yelling at it way, you know, go away, worry. I no longer recommend that. Um, because of what you said that if a child kind of yells at their imaginary worry says go away, worry. It's not as if they suddenly feel better. Right. It's not as if worry complies with that. So it was turning out that when kids were yelling at their worry, they would come back and say, dr Huebner, that totally didn't work. Right. And so instead I'm teaching kids to say to their worry something like, you're not the boss of me or I'm not listening to you or I know you're trying to scare me, but you're hardly ever right. So I've kind of modified the way that I've taught kids to talk back.

Dawn Huebner (15:26): I want to go back. Um, you touched on a moment ago about, um, whether kids can understand the concept about a realistic versus an unrealistic worry. So I actually do a huge amount of teaching about the concepts that make the techniques work because I feel like if a child can understand conceptually why they need to talk back to their worry or why it's okay to disobey the worry, it helps them to then use some of those strategies. So when I'm talking to kids about the concept of realistic versus unrealistic fears, I use the example of something like a smoke detector in your cage and right. So if a smoke detector detects smoke, it's going to set off an alarm. And whether the smoke comes from a house fire, which is really dangerous or a piece of toast to that's burning in your toaster, which is not so dangerous, the seam alarm gets set off.

Dawn Huebner (16:24): I love that that happens in our brains as well. We have the same alarm, meaning the same feeling of imminent danger and the same feeling of fear related to a real danger versus something that's not actually dangerous. And so, you know, I think for kids to understand something about that helps them because the internal experience is I feel scared and when I feel scared, I think that there must be something dangerous to make me feel this way. And so we want kids to understand that they can feel that fear even in the face of no actual danger because that's the way that our brains work.

Penny Williams (17:05): That's such a great example for kids too. And kids of all ages. I mean even an adult eye as you described that I sat and I thought, wow, that would be a really great way when I get super anxious to remind myself that it's that alarm and what to take a minute to say what does this mean and is it realistic? Right. So good. I want to talk a second then about kids who really physically feel their anxiety, their heart races, their chest tightens and they might feel Tingley. They might feel like they can't breathe. They feel like it's at a medical emergency. What do we do to help them? Because it's, it's almost more tangible to them and I feel like harder to push against.

Dawn Huebner (17:55): Great. So the first thing that's really important for parents and caregivers is to know that these are, these are legitimate actual physical sensations. So when it says my stomach's hurting, they're not making that up. Right. And often when a child says, my stomach hurts and a parent says, you're just worried that doesn't fly, right? Because the child's experience is, wait a minute, my stomach actually hurts and they're right. It does actually hurt. Or if a child says, I can't breathe or you know, my heart is racing or whatever, those things are actually happening. And so there, there are two things that are helpful. One is to, um, apart from the time that it's happening, help kids to understand why our bodies do those things. So that's part of the fight or flight response when when an alarm goes off in our brains, our body Springs into action, preparing us to protect ourselves.

Dawn Huebner (18:53): And it does that by increasing our heart rate, sending more blood to our arms and legs in case we have to run away or in case we have to fight off a Dean judger. Um, and when those changes happen, our heart rate goes up, our stomach starts to feel kind of flippy because, um, we're not digesting anymore. Instead, our muscles are getting fueled. So all of those physical sensations, kids feel happen because a danger alarm has gotten triggered. Right? They're not dangerous in and of themselves, even though they feel scary and uncomfortable. It's also important for parents and kids to develop an understanding that when that fight or flight responses has gotten triggered and those kinds of physiological changes start to happen, the logical thinking part of the brain goes offline. So it becomes really difficult to think in clear ways to use a skill set that you've been taught to think logically.

Dawn Huebner (19:58): It becomes nearly impossible to do that because the thinking part of our brain shuts down in response to the fight or flight response. Yeah. That's where something like breathing or mindfulness exercises come in because that helps to kind of quiet that process down and get the thinking brain back on. So breathing isn't an end unto itself. It's something that we can coach our children to do, to try to quiet the internal alarm, to get them to the point that they can be more responsive to the coaching that we as adults are trying to do with kids when they're in anxious moments.

Penny Williams (20:40): Yes. I remember when I learned about amygdala hijack and the fact that it kind of blocks the thinking brain, the frontal lobe and how amazing that information, it was just life changing for me as a parent with a kid who has anxiety, who also, you know, has ADHD and autism is a meltdowns. And me being type a and always wanting to rationalize out of these situations and it never worked and I couldn't understand it until I realized that physiologically our kids can not rationalize after they're flooded with emotion or fear. And that's so, so valuable for parents to understand that all of that talking in the world that you want to do. And, and again from that, please have a good intention of wanting to help, but it's not effective in those moments. Right,

Dawn Huebner (21:40): right. Because you're essentially talking to a part of a child's brain that's not available. Right, right. As parents do that, that gets more frustrating to both parent and child. Right? Yes. You know, just like kids have a danger alarm in their brain, parents have one in their brain as well. And when a child gets triggered that often triggers a parent. So both are operating suboptimally and then as parents try to kind of quiet the alarm or put out the fire or use logic or maybe sometimes start to threaten their children to get them to do something, um, neither is really operating out of their frontal cortex at that point out of the thinking part of their brain. And everybody needs to do a calm down activity so that the thinking part of the brain comes back online. One of the most effective ways to help kids be GYN begin to reaccess their thinking brain is to empathize.

Dawn Huebner (22:42): Yes. And that's something that we sometimes kind of jump past or we do in sort of a cursory way and then we are quick to be logical after it. Really helpful to say to a child who's panicking, I know you're scared, or I know this feels hard. And to really kind of stay with that empathy without prematurely jumping ahead too, but you can do this or, but this isn't dangerous or, but we already talked about, or you know, whatever. You want to really stay with the empathy because that's part of what helps a child calm down enough to hear the rest of what you, you might want to say [inaudible]

Penny Williams (23:26): validating how they're feeling. I think a lot of times when we try to help, but we try to rationalize, we're really sending the message that how they say they're feeling or how they're acting like they're feeling isn't valid. It isn't true or it's not appropriate. And in that moment, sending that message is only unhelpful, not helpful.

Dawn Huebner (23:50): Yeah. And you know, there's a difference between being afraid and being in danger. So we want to validate the fear, but we're not agreeing that they're in danger, danger. And so parents want to keep clear in their own mind. You know, we're not saying this is scary or dangerous, we're saying, I can see how scared you are or I know you're scared. Right? And it's, it's, you know, it's maybe semantics, it's a subtle distinction, but it's actually an important one that we're, we're empathizing and acknowledging and validating the reality of what our child is feeling to help them feel connected to us, to help them to feel like I see you and I care about you. And that's part of what helps to calm my brain down, to be able to then cope in some other way.

Penny Williams (24:46): Yes. I think anxiety is really wholly misunderstood for the most part, you know, from parents, from maybe teachers, other adults and a child's life because it can look like so many other things as we talked about early on, the avoidance or being angry or argumentative or, um, and then also really feeling very out of scale for the reality of the situation. We often end up acting from that place instead of kind of taking a step back, taking a pause ourselves and recognizing that this is how our child feels. So often when they are conveying something that isn't totally the truth or maybe as exaggerated, they're really expressing how something feels to them and instead of dismissing that they are, are somehow not acting age appropriate or something like that. Just validating the feeling is immensely helpful in a wide range of applications, not just for anxiety, but you know, that's one of the BS for parenting is to really say, I see you, I see what's happening for you and I want to help you. Yes. Right. Oh, so important. So let's talk a minute about externalizing anxiety and why that's really important. I think this ties them into our conversation about giving the little creature name. Um, was there anything else really to talk about as far as externalizing anxiety?

Dawn Huebner (26:24): Yeah, it's, it's mainly that it helps a child to get a little bit of distance from what they're thinking and feeling. And it also allows a parent to be on the same side as their child. So when you haven't externalized it often feels to children like their parents or adversaries, their parents are trying to make them do things that they don't want to do cause they're scared. And when you externalize you can talk about, you know, let's not let worry be the boss of this or I know you can be brave. It sort of helps a parent to be on the scene side is their child instead of against their child. And then the externalization makes possible the other strategies. So one strategy that we touched on was talking back to worry, not yelling at it, but you know, sort of engaging with it a little bit, saying something like I'm not listening to you or I don't fall for that or you're not the boss of me. And then the other strategy we haven't talked about yet that is a hugely important one is to challenge what this externalized worry is telling you to, to not obey it. And that technically is called exposure. When you're learning to move towards a feared situation instead of away from it. And exposure is a, is a really important part in the more effective management of anxiety or treatment of anxiety.

Penny Williams (27:56): Yeah. And that could be, you know, someone who is afraid to leave the house. If they go somewhere, something bad might happen. It's getting them out of the house showing they're showing their brain that yes, I can do this, I can leave the house. And it doesn't mean that every time something's scary you might happen. Or I might panic. Just an easy example.

Dawn Huebner (28:21): Right? And for children it might be examples like, you know, going upstairs alone when everyone else is downstairs or doing a new activity for the first time, going to a friend's house you've never been to before answering a question at school. Right? So there are lots of child's size examples and one of the really nice things about exposure is that it's not an all or none kind of thing. So when I'm talking to families about this, I use the analogy of getting used to the water in a pool, right? So exposure is a decent physician kind of activity, meaning that we're trying to get used to something that seems scary or, or too hard for us. And just like when we are getting used to the cold water in a pool or we can do that by either jumping in and getting used to the water all at once or we can take steps and get used to it a little bit at a time.

Dawn Huebner (29:16): Right? So when there's a situation that feels scary and overwhelming to a child, they can have the choice between doing a jump in method, like, you know, kind of throw themselves into the situation all at once or taking steps, which is approaching a situation a little bit at a time. And both of those are perfectly valid ways to accomplish exposure. Um, and both will move a child towards being able to manage situations to kind of move outside their comfort zone and ultimately get on top of whatever it is that they're afraid of. Yeah. And I like that you give them the option you can or you can take these tiny little stops because I think what works is different for each kid. And if it's their choice, that's always helpful. Lowering for kids if they're taking steps is to make the steps progressive. Right? So not just to take one step into stay there forever.

Dawn Huebner (30:14): Um, but I talk to kids a lot about, we're trying to do medium-sized challenges, right? So not things that are super easy. They don't evoke any fear at all, but we also don't want things that make you feel terrified. So we want that kind of medium range. And even young kids are pretty good at, at, you know, being able to distinguish between something that's so easy that it's not scary at all. And we don't want kids to do it at that level cause they're not benefiting. Like there's no, there's no gain, there's no progress if we're only doing medium things. Yeah. Such good points because we do have to find how much to push in order to challenge for growth or progress. But not so much that we break them. You know that we really are starting to do more harm than good. Right? And, and again, empowering kids like giving them some choice or helping them to see that they can be brave and they can take on challenges is a really important part of this.

Dawn Huebner (31:16): So, you know, let's say there's a child that is afraid to sign up for some new activity cause a parent isn't going to stay. It's not really a success if the parent just forces the child to go and the child is, you know, angry and feeling uncared about and they go because they have to go, there's nothing that's really accomplished by that. If instead I'm a parent, maybe works out with their child, okay, the first time you go I'll stay. And then, you know, the next step might be I'll stay, but I'm going to be out of view. And the next step might be, I'll stay, but I'm going to be in the parking lot. So you know, you're sort of progressive Lee, and it's important for kids to know that they're challenging their anxiety. You know, too. This is something that we're sort of doing together.

Dawn Huebner (32:05): It's not something that a parent is doing to their child. Right. Yeah. And there's a big distinction there. That's true. And empowering kids is always the best way. I feel like that's touching me. Our goal as parents is empowering our kids. Yes. Before we close, are there any other strategies for parents of anxious kids? Things that can realistically be beneficial? Yeah, so, um, I often have kids tell me that when they feel anxious they just try to ignore it or they try to, you know, get themselves busy. Um, and that's a strategy with limited utility because what often happens is then at night when things get quiet, it all comes flooding back to them, right? So what I do instead is I talk to kids about how their brain is essentially like a television set and they can decide that they're going to change the channel.

Dawn Huebner (33:01): So like if you know, the worry channel is playing, they can decide that they, they're going to change the channel, but before they change the channel, it's important to label what's going on. So to say something like, that's my worry talking to me. I don't need to listen to that and then to shift over to something else. So it's kind of like you're recognizing, okay, worry is here trying to bother me right now and you're kind of affirming for yourself. I'm not going to have this be my focus or I'm not going to let this sweep me away. And then you turn your attention, which is different from just pretending that you don't hear the worry. Right? It's different than distraction. It's like intentional distraction or intention changing of the channel.

Penny Williams (33:48): That's great. That's a great idea and you have so many amazing analogies that really help us to visualize what's happening and to help our kids through it in a way that works for them. I love that. For everybody listening, you can go to the show notes and get links to dr Huebner, her books, anything that we've discussed here in this episode. You can access that at parenting, ADHD and autism.com/zero eight two for episode 82 and I thank you so much dr Haner. First sharing a little bit of your time and your wisdom to help parents who are trying to help their anxious kids. Thank you for inviting me and with that. Well, in this episode, I will see everyone next time.

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