Health anxiety and illness worry

مِن شَرِّ ٱلۡوَسۡوَاسِ ٱلۡخَنَّاسِ

against the harm of the slinking whisperer––

لَّيۡسَ عَلَى ٱلضُّعَفَآءِ وَلَا عَلَى ٱلۡمَرۡضَىٰ وَلَا عَلَى ٱلَّذِينَ لَا يَجِدُونَ مَا يُنفِقُونَ حَرَجٌ إِذَا نَصَحُواْ لِلَّهِ وَرَسُولِهِۦۚ مَا عَلَى ٱلۡمُحۡسِنِينَ مِن سَبِيلࣲۚ وَٱللَّهُ غَفُورࣱ رَّحِيمࣱ‏

but there is no blame attached to the weak, the sick, and those who have no means to spend, provided they are true to God and His Messenger- there is no reason to reproach those who do good: God is most forgiving and merciful

وَلۡيَسۡتَعۡفِفِ ٱلَّذِينَ لَا يَجِدُونَ نِكَاحًا حَتَّىٰ يُغۡنِيَهُمُ ٱللَّهُ مِن فَضۡلِهِۦۗ وَٱلَّذِينَ يَبۡتَغُونَ ٱلۡكِتَٰبَ مِمَّا مَلَكَتۡ أَيۡمَٰنُكُمۡ فَكَاتِبُوهُمۡ إِنۡ عَلِمۡتُمۡ فِيهِمۡ خَيۡرࣰ اۖ وَءَاتُوهُم مِّن مَّالِ ٱللَّهِ ٱلَّذِيٓ ءَاتَىٰكُمۡۚ وَلَا تُكۡرِهُواْ فَتَيَٰتِكُمۡ عَلَى ٱلۡبِغَآءِ إِنۡ أَرَدۡنَ تَحَصُّنࣰ ا لِّتَبۡتَغُواْ عَرَضَ ٱلۡحَيَوٰةِ ٱلدُّنۡيَاۚ وَمَن يُكۡرِههُّنَّ فَإِنَّ ٱللَّهَ مِنۢ بَعۡدِ إِكۡرَٰهِهِنَّ غَفُورࣱ رَّحِيمࣱ‏

Those who are unable to marry should keep chaste until God gives them enough out of His bounty. If any of your slaves wish to pay for their freedom, make a contract with them accordingly, if you know they have good in them, and give them some of the wealth God has given you. Do not force your slave-girls into prostitution, when they themselves wish to remain honourable, in your quest for the short-term gains of this world, although, if they are forced, God will be forgiving and merciful to them

وَلِكُلࣲّ جَعَلۡنَا مَوَٰلِيَ مِمَّا تَرَكَ ٱلۡوَٰلِدَانِ وَٱلۡأَقۡرَبُونَۚ وَٱلَّذِينَ عَقَدَتۡ أَيۡمَٰنُكُمۡ فَـَٔاتُوهُمۡ نَصِيبَهُمۡۚ إِنَّ ٱللَّهَ كَانَ عَلَىٰ كُلِّ شَيۡءࣲ شَهِيدًا

We have appointed heirs for everything that parents and close relatives leave behind, including those to whom you have pledged your hands [in marriage], so give them their share: God is witness to everything

يَٰٓأَيُّهَا ٱلَّذِينَ ءَامَنُوٓاْ إِذَا جَآءَكُمُ ٱلۡمُؤۡمِنَٰتُ مُهَٰجِرَٰتࣲ فَٱمۡتَحِنُوهُنَّۖ ٱللَّهُ أَعۡلَمُ بِإِيمَٰنِهِنَّۖ فَإِنۡ عَلِمۡتُمُوهُنَّ مُؤۡمِنَٰتࣲ فَلَا تَرۡجِعُوهُنَّ إِلَى ٱلۡكُفَّارِۖ لَا هُنَّ حِلࣱّ لَّهُمۡ وَلَا هُمۡ يَحِلُّونَ لَهُنَّۖ وَءَاتُوهُم مَّآ أَنفَقُواْۚ وَلَا جُنَاحَ عَلَيۡكُمۡ أَن تَنكِحُوهُنَّ إِذَآ ءَاتَيۡتُمُوهُنَّ أُجُورَهُنَّۚ وَلَا تُمۡسِكُواْ بِعِصَمِ ٱلۡكَوَافِرِ وَسۡـَٔلُواْ مَآ أَنفَقۡتُمۡ وَلۡيَسۡـَٔلُواْ مَآ أَنفَقُواْۚ ذَٰلِكُمۡ حُكۡمُ ٱللَّهِ يَحۡكُمُ بَيۡنَكُمۡۖ وَٱللَّهُ عَلِيمٌ حَكِيمࣱ‏

You who believe, test the believing women when they come to you as emigrants- God knows best about their faith- and if you are sure of their belief, do not send them back to the disbelievers: they are not lawful wives for them, nor are the disbelievers their lawful husbands. Give the disbelievers whatever bride-gifts they have paid- if you choose to marry them, there is no blame on you once you have paid their bride-gifts- and do not yourselves hold on to marriage ties with disbelieving women. Ask for repayment of the bride-gifts you have paid, and let the disbelievers do the same. This is God’s judgement: He judges between you, God is all knowing and wise

فَإِذَا جَآءَتۡهُمُ ٱلۡحَسَنَةُ قَالُواْ لَنَا هَٰذِهِۦۖ وَإِن تُصِبۡهُمۡ سَيِّئَةࣱ يَطَّيَّرُواْ بِمُوسَىٰ وَمَن مَّعَهُۥٓۗ أَلَآ إِنَّمَا طَٰٓئِرُهُمۡ عِندَ ٱللَّهِ وَلَٰكِنَّ أَكۡثَرَهُمۡ لَا يَعۡلَمُونَ

then, when something good came their way, they said, ‘This is our due!’. When something bad came, they ascribed it to the evil omen of Moses and those with him, but their ‘evil omen’ was really from God, though most of them did not realize it

(And such of your slaves as seek a writing (of emancipation), write it for them�) [24:33]. This verse was revealed about a slave of Huwaytib ibn �Abd al-�Uzza who was called Subayh. The latter asked his master for a writing of emancipation but he refused. When Allah, exalted is He, revealed this verse, Huwaytib agreed to write a letter of emancipation in exchange for a hundred pieces of gold. Out of this sum, he offered him twenty pieces of gold which he paid. But he was killed in war at the Battle of Hunayn. (Force not your slave-girls to whoredom that ye may seek enjoyment of the life of the world, if they would preserve their chastity) [24:33]. Ahmad ibn al-Hasan al-Qadi informed us> the chamberlain of Ahmad al-Tusi> Muhammad ibn Hamdan> Abu Mu�awiyah> al-A�mash> Abu Sufyan> Jabir who said: ��Abd Allah ibn Ubayy used to say to a slave-girl of his: �Go and earn something for us from wh

(And unto each We have appointed heirs and near kindred �) [4:33]. Abu �Abd Allah Muhammad ibn �Abd Allah al-Farisi informed us> Muhammad ibn �Abd Allah ibn Hamawayh al-Harawi> �Ali ibn Muhammad al-Khuza�i> Abu�l-Yaman al-Hakam ibn Nafi�> Shu�ayb ibn Abi Hamzah> al-Zuhri> Sa�id ibn al-Musayyab who said: �The verse (And unto each We have appointed heirs) was revealed about those who used to adopt men who were not their natural sons and then make them inherit from them. Allah, exalted is He, revealed about them that something should be apportioned for them in the bequest while the division of estate He specifically allocated for the heirs who were immediate family relatives or close relatives. He denied a share of the estate to those who were adopted and, instead, allowed them to have a portion of the bequest�.

(O ye who believe! When believing women come unto you as fugitives, examine them. Allah is Best Aware of their faith�) [60:10]. Ibn �Abbas said: �On the year of Hudaybiyyah, the idolaters of Mecca signed a peace treaty with the Messenger of Allah, Allah bless him and give him peace. This treaty stipulated that whoever of the people of Mecca runs away to him from them should be returned to them, and whoever of his Companions runs away to the people of Mecca will not be returned. They wrote the treaty and sealed it. Just after signing the treaty, Subay�ah bint al-Harith al-Aslamiyyah went to the Prophet, Allah bless him and give him peace, while he was still at al-Hudaybiyyah. Her husband, who was an unbeliever came and said: �O Muhammad, return my wife to me, for you had agreed to return to us whoever runs away to you. The ink of the treaty has not dried yet�. Allah, exalted is He, then r

from the evil of the slinking whisperer Satan — he is referred to by the name of the action waswasa on account of his repeated engaging in it — who slinks away and recoils from the heart whenever God is mentioned

As for the weak such as the old and the sick the blind and the chronically ill and those who find nothing to expend for the struggle no blame no sin falls upon them should they stay away from it if they remain true to God and to His Messenger when they stay behind by not spreading false rumours or impeding others from joining the struggle but by adhering to obedience. There is no way of blame no way of reproach against those who are virtuous through such behaviour. And God is Forgiving Merciful to them by granting them such leeway in this matter.

There is no blame on those who are weak or ill or who find no resources to spend, if they are sincere and true (in duty) to Allah and His Messenger. No means (of complaint) can there be against the doers of good. And Allah is Oft-Forgiving, Most Merciful (91)Nor (is there blame) on those who came to you to be provided with mounts, when you said: "I can find no mounts for you," they turned back, with their eyes overflowing with tears of grief that they could not find anything to spend (92)The means (of complaint) is only against those who are rich, and yet ask exemption. They are content to be with (the women) who sit behind (at home) and Allah has sealed up their hearts so that they know not (what they are losing)(93) Legitimate Excuses for staying away from Jihad Allah mentions here the valid excuses that permit one to stay away from fighting. He first mentions the excuses that remain

حَدَّثَنِي عَبْدُ اللَّهِ بْنُ مُحَمَّدٍ، حَدَّثَنَا عَبْدُ الْمَلِكِ بْنُ عَمْرٍو، حَدَّثَنَا زُهَيْرُ بْنُ مُحَمَّدٍ، عَنْ مُحَمَّدِ بْنِ عَمْرِو بْنِ حَلْحَلَةَ، عَنْ عَطَاءِ بْنِ يَسَارٍ، عَنْ أَبِي سَعِيدٍ الْخُدْرِيِّ، وَعَنْ أَبِي هُرَيْرَةَ، عَنِ النَّبِيِّ صلى الله عليه وسلم قَالَ ‏ "‏ مَا يُصِيبُ الْمُسْلِمَ مِنْ نَصَبٍ وَلاَ وَصَبٍ وَلاَ هَمٍّ وَلاَ حُزْنٍ وَلاَ أَذًى وَلاَ غَمٍّ حَتَّى الشَّوْكَةِ يُشَاكُهَا، إِلاَّ كَفَّرَ اللَّهُ بِهَا مِنْ خَطَايَاهُ ‏"‏‏.‏

Narrated Abu Sa`id Al-Khudri and Abu Huraira:The Prophet (ﷺ) said, "No fatigue, nor disease, nor sorrow, nor sadness, nor hurt, nor distress befalls a Muslim, even if it were the prick he receives from a thorn, but that Allah expiates some of his sins for that

حَدَّثَنَا إِبْرَاهِيمُ بْنُ الْمُنْذِرِ، قَالَ حَدَّثَنِي مُحَمَّدُ بْنُ فُلَيْحٍ، قَالَ حَدَّثَنِي أَبِي، عَنْ هِلاَلِ بْنِ عَلِيٍّ، مِنْ بَنِي عَامِرِ بْنِ لُؤَىٍّ عَنْ عَطَاءِ بْنِ يَسَارٍ، عَنْ أَبِي هُرَيْرَةَ ـ رضى الله عنه ـ قَالَ قَالَ رَسُولُ اللَّهِ صلى الله عليه وسلم ‏ "‏ مَثَلُ الْمُؤْمِنِ كَمَثَلِ الْخَامَةِ مِنَ الزَّرْعِ مِنْ حَيْثُ أَتَتْهَا الرِّيحُ كَفَأَتْهَا، فَإِذَا اعْتَدَلَتْ تَكَفَّأُ بِالْبَلاَءِ، وَالْفَاجِرُ كَالأَرْزَةِ صَمَّاءَ مُعْتَدِلَةً حَتَّى يَقْصِمَهَا اللَّهُ إِذَا شَاءَ ‏"‏‏.‏

Narrated Abu Huraira:Allah's Messenger (ﷺ) said, "The example of a believer is that of a fresh tender plant; from whatever direction the wind comes, it bends it, but when the wind becomes quiet, it becomes straight again. Similarly, a believer is afflicted with calamities (but he remains patient till Allah removes his difficulties.) And an impious wicked person is like a pine tree which keeps hard and straight till Allah cuts (breaks) it down when He wishes." (See Hadith No. 558, Vol)

حَدَّثَنَا مُحَمَّدُ بْنُ يَحْيَى، قال حَدَّثَنَا إِسْحَاقُ بْنُ مُحَمَّدٍ الْفَرْوِيُّ، قال حَدَّثَنَا إِسْمَاعِيلُ بْنُ جَعْفَرٍ، عَنْ عُمَارَةَ بْنِ غَزِيَّةَ، عَنْ عَاصِمِ بْنِ عُمَرَ بْنِ قَتَادَةَ، عَنْ مَحْمُودِ بْنِ لَبِيدٍ، عَنْ قَتَادَةَ بْنِ النُّعْمَانِ، أَنَّ رَسُولَ اللَّهِ صلى الله عليه وسلم قَالَ ‏ "‏ إِذَا أَحَبَّ اللَّهُ عَبْدًا حَمَاهُ الدُّنْيَا كَمَا يَظَلُّ أَحَدُكُمْ يَحْمِي سَقِيمَهُ الْمَاءَ ‏"‏ ‏.‏ قَالَ أَبُو عِيسَى وَفِي الْبَابِ عَنْ صُهَيْبٍ وَأُمِّ الْمُنْذِرِ ‏.‏ وَهَذَا حَدِيثٌ حَسَنٌ غَرِيبٌ ‏.‏ وَقَدْ رُوِيَ هَذَا الْحَدِيثُ عَنْ مَحْمُودِ بْنِ لَبِيدٍ عَنِ النَّبِيِّ صلى الله عليه وسلم مُرْسَلاً ‏.‏ حَدَّثَنَا عَلِيُّ بْنُ حُجْرٍ، قال أَخْبَرَنَا إِسْمَاعِيلُ بْنُ جَعْفَرٍ، عَنْ عَمْرِو بْنِ أَبِي عَمْرٍو، عَنْ عَاصِمِ بْنِ عُمَرَ بْنِ قَتَادَةَ، عَنْ مَحْمُودِ بْنِ لَبِيدٍ، عَنِ النَّبِيِّ صلى الله عليه وسلم نَحْوَهُ وَلَمْ يَذْكُرْ فِيهِ عَنْ قَتَادَةَ بْنِ النُّعْمَانِ ‏.‏ قَالَ أَبُو عِيسَى وَقَتَادَةُ بْنُ النُّعْمَانِ الظَّفَرِيُّ هُوَ أَخُو أَبِي سَعِيدٍ الْخُدْرِيِّ لأُمِّهِ وَمَحْمُودُ بْنُ لَبِيدٍ قَدْ أَدْرَكَ النَّبِيَّ صلى الله عليه وسلم وَرَآهُ وَهُوَ غُلاَمٌ صَغِيرٌ ‏.‏

Qatadah bin An-Nu'man narrated that the Messenger of Allah (s.a.w) said:"When Allah loves a slave, He prevents him from the world, just as one of you prevents his sick from water." Another chain reports a similar narration

حَدَّثَنَا عَبَّاسُ بْنُ مُحَمَّدٍ الدُّورِيُّ، قال حَدَّثَنَا يُونُسُ بْنُ مُحَمَّدٍ، قال حَدَّثَنَا فُلَيْحُ بْنُ سُلَيْمَانَ، عَنْ عُثْمَانَ بْنِ عَبْدِ الرَّحْمَنِ التَّيْمِيِّ، عَنْ يَعْقُوبَ بْنِ أَبِي يَعْقُوبَ، عَنْ أُمِّ الْمُنْذِرِ، قَالَتْ دَخَلَ عَلَىَّ رَسُولُ اللَّهِ صلى الله عليه وسلم وَمَعَهُ عَلِيٌّ وَلَنَا دَوَالٍ مُعَلَّقَةٌ قَالَتْ فَجَعَلَ رَسُولُ اللَّهِ صلى الله عليه وسلم يَأْكُلُ وَعَلِيٌّ مَعَهُ يَأْكُلُ ‏.‏ فَقَالَ رَسُولُ اللَّهِ صلى الله عليه وسلم لِعَلِيٍّ ‏"‏ مَهْ مَهْ يَا عَلِيُّ فَإِنَّكَ نَاقِهٌ ‏"‏ ‏.‏ قَالَ فَجَلَسَ عَلِيٌّ وَالنَّبِيُّ صلى الله عليه وسلم يَأْكُلُ ‏.‏ قَالَتْ فَجَعَلْتُ لَهُمْ سِلْقًا وَشَعِيرًا فَقَالَ النَّبِيُّ صلى الله عليه وسلم ‏"‏ يَا عَلِيُّ مِنْ هَذَا فَأَصِبْ فَإِنَّهُ أَوْفَقُ لَكَ ‏"‏ ‏.‏ قَالَ أَبُو عِيسَى هَذَا حَدِيثٌ حَسَنٌ غَرِيبٌ لاَ نَعْرِفُهُ إِلاَّ مِنْ حَدِيثِ فُلَيْحٍ ‏.‏ وَيُرْوَى عَنْ فُلَيْحٍ عَنْ أَيُّوبَ بْنِ عَبْدِ الرَّحْمَنِ ‏.‏ حَدَّثَنَا مُحَمَّدُ بْنُ بَشَّارٍ، قال حَدَّثَنَا أَبُو عَامِرٍ، وَأَبُو دَاوُدَ قَالاَ حَدَّثَنَا فُلَيْحُ بْنُ سُلَيْمَانَ، عَنْ أَيُّوبَ بْنِ عَبْدِ الرَّحْمَنِ، عَنْ يَعْقُوبَ، عَنْ أُمِّ الْمُنْذِرِ الأَنْصَارِيَّةِ، فِي حَدِيثِهِ قَالَتْ دَخَلَ عَلَيْنَا رَسُولُ اللَّهِ صلى الله عليه وسلم فَذَكَرَ نَحْوَ حَدِيثِ يُونُسَ بْنِ مُحَمَّدٍ إِلاَّ أَنَّهُ قَالَ ‏"‏ أَنْفَعُ لَكَ ‏"‏ ‏.‏ وَقَالَ مُحَمَّدُ بْنُ بَشَّارٍ وَحَدَّثَنِيهِ أَيُّوبُ بْنُ عَبْدِ الرَّحْمَنِ ‏.‏ هَذَا حَدِيثٌ جَيِّدٌ غَرِيبٌ ‏.‏

Umm Al-Mundhir said:"The Messenger of Allah (ﷺ) entered upon me, while `Ali was with him, and we had a cluster of unripe dates hanging." She said: "The Messenger of Allah (ﷺ) began eating, and `Ali ate with him. The Messenger of Allah (ﷺ) said to `Ali: 'Stop, stop, for you are still recovering.' So `Ali sat and the Prophet (ﷺ) ate." She said: "I made some chard and barley for them, so the Prophet (ﷺ) said: 'O `Ali eat from this, for indeed it will be more suitable for you." Another chain reports a similar narration

أما ما ذكرتم من أن النبي كان يعجبه الفأل الحسن فلا ريب في ثبوت ذلك عنه وقد قرن ذلك بإبطال الطيرة كما في الصحيحين من حديث الزهري عن عبيد بن عبدالله عن أبى هريرة رضى الله عنه قال قال رسول الله صلى عليه وسلم لاطيرة وخيرها الفأل قالوا وما الفأل يا رسول الله قال الكلمة الصالحة يسمعها أحدكم فابتدأهم النبي بإزالة الشبهة وأبطال الطيرة لئلا يتوهموها عليه في إعجابه بالفأل الصالح وليس في الإعجاب بالفأل ومحبته شىء من الشرك بل ذلك إبانة عن مقتضى الطبيعة وموجب الفطرة الإنسانية التي تميل إلى مايلائمها ويوافقها مما ينفعها كما أخبرهم أنه حبب إليه من الدنيا النساء والطيب 00

وقد قال رسول الله إذا كان بالبلد الذي أنتم فيه فلا تخرجوا منه وقال إن كان ببلد فلا تدخلوه يريد بقوله لا تخرجوا من البلد أذا كان فيه كأنكم تظنون أن الفرار من قدر الله ينجيكم من الله ويريد إن كان ببلد فلا تدخلوه فإن مقامكم في الموضع الذي لا طاعون فيه أسكن لأنفسكم وأطيب لمعيشتكم ومن ذلك المرأة تعرف بالشؤم والدار فينال الرجل مكروه أو جائحة فيقول أعدتني بشؤمها فهذا هو العدوى الذي قال فيه رسول الله لا عدوى فأما الحديث الذي رواه أبو هريرة رضى الله عنه أنه قال الشؤم في المرأة والدار والدابة فإن هذا الحديث يتوهم فيه الغلط على أبى هريرة وأنه سمع فيه شيئا من رسول الله فلم يعه حدثني محمد بن القطعي حدثنا عبد الأعلى عن سعيد عن قتادة عن أبى حسان الأعرج أن رجلين دخلا على عائشة فقالا إن أبا هريرة رضى الله عنه يحدث عن رسول الله أنه قال إنما الطيرة في المرأة والدار والدابة فطارت شفقا ثم قالت كذب والذي أنزل الفرقان على أبى القاسم من حدث بهذا عن رسول الله إنما قال رسول الله كان أهل الجاهلية يقولون إن الطيرة

وقالت طائفة أخرى معنى الحديث إخباره عن الأسباب المثيرة للطيرة الكامنة في الغرائز يعنى أن المثير للطيرة في غرائز الناس هي هذه الثلاثة فأخبرنا بهذا لنأخذ الحذر منها فقال الشؤم في الدار والمرأة والفرس أي أن الحوادث التي تكثر مع هذه الأشياء والمصائب التي تتوالى عندها تدعو الناس إلى التشاؤم بها فقال الشؤم فيها أي أن الله قد يقدره فيها على قوم دون قوم فخاطبهم بذلك لما استقر عندهم منه من إبطال الطيرة وإنكار العدوى ولذلك لم يستفهموا في ذلك عن معنى ما أراده كما تقدم لهم في قوله لا يورد الممرض على المصح فقالوا عنده وما ذاك يا رسول الله فأخبرهم أنه خاف في ذلك الأذى الذي يدخله الممرض على المصح لا العدوى لأنه أمر بالتوادد وإدخال السرور بين المؤمنين وحسن التجاوز ونهى عن التقاطع والتباغض والأذى فمن اعتقد أن رسول الله نسب الطيرة والشؤم إلى شيء من الأشياء على سبيل إنه مؤثر بذلك دون الله فقد أعظم الفرية على الله وعلى رسوله وضل ضلالا بعيدا والنبي ابتداهم بنفي الطيرة والعدوى ثم قال الشؤم في ثلاث قطعا لتوهم

واقد بن عبد الله الحضري والحضرمي حضرت الحرب فكذب عليه وإنما قال ذلك أعداؤه من اليهود فتطيروا بذلك وتفاءلوا به فكانت الطيرة عليهم و وقدت الحرب عليهم

| الفصل الثامن والخمسون في الفأل والطيرة

فإن قلت : فلم نهى عن الخروج من البلد الذي فيه الوباء وسبب الوباء في الطب الهواء وأظهر طرق التداوي الفرار من المضر والهواء هو المضر وترك التوكل في أمثال هذا مباح وهذا لا يدل على المقصود ولكن الذي ينقدح فيه والعلم عند الله تعالى أن الهواء لا يضر من حيث إنه يلاقى ظاهر البدن بل من حيث دوام الاستنشاق له فانه اذا كان فيه عفونة ووصل إلى الرئة والقلب وباطن الأحشاء أثر فيها بطول الاستنشاق فلا يظهر الوباء على الظاهر إلا بعد طول التأثير في الباطن فالخروج من البلد لا يخلص غالبا من الأثر الذي استحكم من قبل ولكن يتوهم الخلاص فيصير هذا من جنس الموهومات كالرقي والطيرة وغيرهما ولو تجرد هذا المعنى لكان مناقضا للتوكل ولم يكن منهيا عنه ولكن صار منهيا عنه لانه انضاف اليه أمر آخر وهو أنه لو رخص للأصحاء في الخروج لما بقي في البلد إلا المرضى الذين أقعدهم الطاعون فانكسرت قلوبهم وفقدوا المتعهدين ولم يبق في البلد من يسقيهم الماء ويطعمهم الطعام وهم يعجزون عن مباشرتهما بأنفسهم فيكون ذلك سعيا في اهلاكهم تحقيقا وخلاصه

Exposure-based cognitive-behavioural therapy via the internet and as bibliotherapy for somatic symptom disorder and illness anxiety disorder: randomised controlled trial.: Background: In DSM-5 two new diagnoses, somatic symptom disorder (SSD) and illness anxiety disorder (IAD), have replaced DSM-IV hypochondriasis. There are no previous treatment studies for these disorders. Cognitive-behavioural therapy (CBT) delivered as therapist-guided or unguided internet treatment or as unguided bibliotherapy could be used to increase treatment accessibility. Aims: To investigate the effect of CBT delivered as guided internet treatment (ICBT), unguided internet treatment (U-

Interoceptive accuracy and bias in somatic symptom disorder, illness anxiety disorder, and functional syndromes: A systematic review and meta-analysis.: Somatic symptom disorder, illness anxiety disorder, and functional syndromes are characterized by burdensome preoccupation with somatic symptoms. Etiological models propose either increased interoceptive accuracy through hypervigilance to the body, or decreased and biased interoception through top-down predictions about sensory events. This systematic review and meta-analysis summarizes findings of 68 studies examining interoceptive accuracy and 8 studies examining response biases in clinical or

A randomized trial of treatments for high-utilizing somatizing patients.: Background: Somatization and hypochondriacal health anxiety are common sources of distress, impairment, and costly medical utilization in primary care practice. A range of interventions is needed to improve the care of these patients. Objective: To determine the effectiveness of two cognitive behavioral interventions for high-utilizing, somatizing patients, using the resources found in a routine care setting. Design: Patients were randomly assigned to a two-step cognitive behavioral treatment pr

Cognitive and perceptual variables in hypochondriasis and health anxiety: a systematic review.: This review examined (a) whether hypochondriacal/health-anxious individuals hold distinct assumptions about health and illness, (b) if triggering these assumptions leads to increased hypochondriacal concerns, and (c) whether these individuals perceive their bodily sensations differently from others (i.e., experience greater somatosensory amplification). There was clear evidence that health anxiety is related dysfunctional health-related beliefs. Few studies have examined how hypochondriacal conc

Medically unexplained symptoms, somatisation disorder and hypochondriasis: course and prognosis. A systematic review.: Objective: To study the course of medically unexplained symptoms (MUS), somatisation disorder, and hypochondriasis, and related prognostic factors. Knowledge of prognostic factors in patients presenting persistent MUS might improve our understanding of the naturalistic course and the identification of patients with a high risk of a chronic course. Methods: A comprehensive search of Medline, PsycInfo, CINAHL, and EMBASE was performed to select studies focusing on patients with MUS, somatisation d

Mechanistic studies in pathological health anxiety: A systematic review and emerging conceptual framework.: Background: Pathological health anxiety (PHA) (e.g., hypochondriasis and illness anxiety disorder) is common in medical settings and associated with increased healthcare costs. However, the psychological and neurobiological mechanisms contributing to the development and maintenance of PHA are incompletely understood. Methods: We performed a systematic review to characterize the mechanistic understanding of PHA. PubMed, PsycINFO, and Embase databases were searched to find articles published betwe

Treatment course and its predictors in patients with somatoform disorders: A routine outcome monitoring study in secondary psychiatric care.

Aim: Somatoform disorders are common and often chronic. It would be helpful to distinguish those patients who are likely to have a positive treatment course from those who are likely to follow a negative course. Such studies of different somatoform disorders are scarce, especially in secondary psychiatric care. This study examined the 6-month treatment course of psychological, physical symptoms, and functioning, and its predictors in a naturalistic sample of secondary psychiatric care outpatients with somatoform disorders. Method: The present study used routine outcome monitoring data of patients with somatoform disorders regarding their 6-month treatment course of psychological and physical symptoms as well as functioning. The following patient groups were included: total group of somatoform disorders (N = 435), and undifferentiated somatoform disorder (N = 242), pain disorder (N = 102)…

matched on Hypochondriasis (keyword), Somatoform Disorders (mesh)

Childhood trauma and somatic symptoms among psychiatric outpatients: Investigating the role of shame and guilt.

Previous research suggests a link between experiences of childhood maltreatment and adult somatic symptom distress. Contributing mechanisms, however, are not yet well understood. It is possible that shame and guilt may function as mediators in the relationship between childhood trauma and adult somatic distress. The present study was developed to investigate the relationship between childhood maltreatment and adult somatic distress, including the potential mediating role of shame and guilt, among psychiatric outpatients. Using data from a sample of 99 Canadian psychiatric outpatients, mediation models with shame and guilt as parallel mediators were evaluated for relationships between childhood emotional abuse, sexual abuse, emotional neglect, and somatic symptoms. Controlling for current depressive symptoms, a significant indirect effect was found for the relationship between emotional a…

matched on Medically Unexplained Symptoms (mesh), somatic symptom (text)

The Somatic Symptom Disorder - B Criteria Scale (SSD-12): Factorial structure, validity and population-based norms.

Purpose: The Somatic Symptom Disorder - B Criteria Scale (SSD-12) assesses the psychological features of DSM-5 Somatic Symptom Disorder (SSD). The present study investigates the dimensionality and psychometric properties in a general population sample and provides norm values. Method: Test dimensionality was evaluated via confirmatory factor analysis and nonparametric item response theory. Correlational analyses and logistic regression models based on related measures (SSS 8, PHQ-2, GAD-2, Health Care Utilization) were used to derive predictive validity. Age and gender specific norms were derived via quantile regression. Results: The SSD-12 has good item characteristics and excellent reliability (Cronbach's α=0.95). Confirmatory factor analyses revealed a high correlation between the three proposed psychological subscales interpreted as cognitive, affective and behavioral aspects, indica…

matched on Medically Unexplained Symptoms (mesh), somatic symptom (text)

Intragenerational social mobility and functional somatic symptoms in a northern Swedish context: analyses of diagonal reference models.

Background: Research indicate that social class mobility could be potentially important for health, but whether this is due to the movement itself or a result of people having been integrated in different class contexts is, to date, difficult to infer. In addition, although several theories suggest that transitions between classes in the social hierarchy can be stressful experiences, few studies have empirically examined whether such movements may have health effects, over and above the implications of "being" in these classes. In an attempt to investigate whether intragenerational social mobility is associated with functional somatic symptoms in mid-adulthood, the current study tests three partially contrasting theories. Method: The dissociative theory suggests that mobility in general and upward mobility in particular may be linked to psychological distress, while the falling from grac…

matched on Medically Unexplained Symptoms (mesh), somatic symptom (text)

The overlap of somatic, anxious and depressive syndromes: A population-based analysis.

Objective: The comorbidity of somatic, anxious and depressive syndromes occurs in half of all primary care cases. As research on this overlap of syndromes in the general population is scarce, the present study investigated the prevalence of the overlapping syndromes and their association with health care use. Method: A national general population survey was conducted between June and July 2012. Trained interviewers contacted participants face-to-face, during which, individuals reported their health care use in the previous 12months. Somatic, anxious and depressive syndromes were assessed using the Somatic Symptom Scale-8 (SSS-8), Generalized Anxiety Disorder-2 (GAD-2) and Patient Health Questionnaire-2 (PHQ-2) respectively. Results: Out of 2510 participants, 236 (9.4%) reported somatic (5.9%), anxious (3.4%) or depressive (4.7%) syndromes, which were comorbid in 86 (3.4%) cases. The incr…

matched on Medically Unexplained Symptoms (mesh), somatic symptom (text)

Psychosocial mechanisms for the transmission of somatic symptoms from parents to children.

Aim: To examine familial aggregation of irritable bowel syndrome (IBS) via parental reinforcement/modeling of symptoms, coping, psychological distress, and exposure to stress. Methods: Mothers of children between the ages of 8 and 15 years with and without IBS were identified through the Group Health Cooperative of Puget Sound. Mothers completed questionnaires, including the Child Behavior Checklist (child psychological distress), the Family Inventory of Life Events (family exposure to stress), SCL-90R (mother psychological distress), and the Pain Response Inventory (beliefs about pain). Children were interviewed separately from their parents and completed the Pain Beliefs Questionnaire (beliefs about pain), Pain Response Inventory (coping) and Child Symptom Checklist [gastrointestinal (GI) symptoms]. In addition, health care utilization data was obtained from the automated database of G…

matched on Illness Behavior (mesh), somatic symptom (text)

Identifying the key characteristics of clinical fear of cancer recurrence: An international Delphi study.

Objective: Without an agreed-upon set of characteristics that differentiate clinical from nonclinical levels of fear of cancer recurrence (FCR), it is difficult to ensure that FCR severity is appropriately measured, and that those in need of intervention are identified. The objective of this study was to establish expert consensus on the defining features of clinical FCR. Method: A three-round Delphi was used to reach consensus on the defining features of clinical FCR. Sixty-five experts in FCR (researchers, psychologists, physicians, nurses, and allied health professionals) were recruited to suggest and rate potential features of clinical FCR. Participants who indicated they could communicate diagnoses within their clinical role were also asked to consider the application of established DSM-5 and proposed ICD-11 diagnostic criteria (Health Anxiety, Illness Anxiety Disorder, Somatic Symp…

matched on health anxiety (text), illness anxiety (text), somatic symptom (text)

A Comparative Study on Hypochondriasis Among Medical and Dental Students in Post-COVID-19 Pandemic: A Cross-Sectional Study.

Background and aims: Health anxiety can be common for health professions students and was elevated during the COVID-19 pandemic. Differences in clinical exposures between dental and medical students can influence post-pandemic hypochondriasis. This study aimed to compare the levels of hypochondriasis among medical and dental students in the post-COVID-19 era. Methods: This cross-sectional study was conducted among medical (MBBS) and dental (BDS) students at different colleges in Karachi, Pakistan. A questionnaire (S1) was constructed and distributed among students. Hypochondriasis of the participants was evaluated using the Short Health Anxiety Inventory-18 (SHAI-18) scale. Independent t-tests were used to compare the SHAI-18 scores. A p-value of ≤ 0.05 was considered statistically significant. Results: A sample of 350 participants was recruited, with 220 (62.9%) MBBS students and 130 (3…

matched on Hypochondriasis (keyword), health anxiety (text)

Effectiveness and prediction of treatment adherence to guided internet-based cognitive behavioral therapy for health anxiety: A cohort study in routine psychiatric care.

Objective: Health anxiety, also known as hypochondriasis, is a common psychiatric disorder which leads to considerable distress and is associated with high societal costs. Internet-based cognitive behavioural therapy (ICBT) for health anxiety has demonstrated efficacy in randomized controlled trials (RCTs), but there is limited knowledge regarding its effectiveness in real-world settings. This study aimed to evaluate the clinical effectiveness of guided ICBT for health anxiety in routine psychiatric care, including symptom change, treatment adherence, and potential negative effects. Additionally, we explored predictors of treatment adherence. Method: A longitudinal cohort study of 447 patients enrolled in 12 weeks of ICBT for health anxiety between 2018 and 2020 in an outpatient psychiatric clinic specializing in ICBT. Primary outcome measure was the 14-item Short Health Anxiety Inventor…

matched on Hypochondriasis (keyword), health anxiety (text)

Do patients with pathological health anxiety fear COVID-19? A time-course analysis of 12 single cases during the "first wave" of the COVID-19 pandemic in Germany.

Objective: Pre-existing health anxiety is associated with an intensified affective response to the novel COVID-19 pandemic in the general population. Still, results on the reaction of people with a diagnosis of pathological health anxiety (i.e., hypochondriasis) are scarce. Methods: In the present study, we investigated the course of (health) anxiety related to SARS-CoV-2/COVID-19 in comparison to (health) anxiety related to other severe diseases (e.g., cancer) in a sample of 12 patients with the diagnosis of pathological health anxiety during the "first wave" of the COVID-19 pandemic in Germany. Both SARS-CoV-2 related anxiety and anxiety related to other severe diseases were assessed weekly over 16 measurement points (30.03.-19.07.2020) and primarily analyzed with fixed effects regression analyses. Results: Unexpectedly, SARS-CoV-2 related anxiety was on average significantly lower tha…

matched on Hypochondriasis (keyword), health anxiety (text)

Health anxiety among medical students: A comparison between preclinical and clinical years of training.

Objective: It is common among medical students to falsely attribute bodily sensations/symptoms and holds a belief of having a medical illness with varying level of conviction. We studied and compared this condition known as "medical student syndrome", a type of hypochondriasis, between preclinical and clinical years students. Methodology: This research was a descriptive study where a total of 100 students were approached and were asked to complete a short form of health anxiety inventory (SHAI) which has Cronbach's alpha 0.855. No personal identifiers were included in the study questionnaires. All statistical analyses were performed using the SPSS statistical software package (IBM SPSS Statistics Version 23, SPSS Inc., Chicago, IL, USA). Results: The response rate among participants was 88% (42 from preclinical and 48 from clinical years of training). Health-related anxiety (SHAI main se…

matched on Hypochondriasis (keyword), health anxiety (text)

Somatosensory amplification, health anxiety, and alexithymia in generalized anxiety disorder.

Aim: The aim of this study was to study somatosensory amplification, health anxiety (hypochondriasis), and alexithymia among patients with generalized anxiety disorder (GAD) and to evaluate the association of these variables with the severity of GAD. Materials and methods: Cross-sectional design was employed, and patients were recruited from the outpatient clinic of the psychiatry department of a multispecialty tertiary care medical institute in North India. The patients who were clinically diagnosed to have GAD by the two independent qualified psychiatrists were screened with Mini International Neuropsychiatry Interview to confirm the diagnosis. Forty patients with GAD meeting the inclusion criteria were assessed with GAD-7 scale, somatosensory amplification scale (SSAS), the Whiteley Index (WI) and Toronto alexithymia scale - 20 Hindi version (TAS-H-20). Results: The mean scores of pat…

matched on Hypochondriasis (keyword), health anxiety (text)

A Preliminary Investigation into Worry about Mental Health: Development of the Mental Health Anxiety Inventory.

Background: Worry about physical health is broadly referred to as health anxiety and can range from mild concern to severe or persistent anxiety such as that found in DSM-IV hypochondriasis. While much is known about anxiety regarding physical health, little is known about anxiety regarding mental health. However, recent conceptualizations of health anxiety propose that individuals can experience severe and problematic worry about mental health in similar ways to how people experience extreme worry about physical health. Aims: Given the paucity of research in this area, the aim of the current study was to explore anxiety regarding mental health through validation of the Mental Health Anxiety Inventory (MHAI), a modified version of the Short Health Anxiety Inventory. Method: The MHAI, and measures of state anxiety (Depression, Anxiety and Stress Scales-21), trait worry (Penn State Worry Q…

matched on Hypochondriasis (keyword), health anxiety (text)

Mindfulness-Based Cognitive Therapy (MBCT) for Health Anxiety (Hypochondriasis): Rationale, Implementation and Case Illustration.

Recent research has shown that mindfulness-based cognitive therapy (MBCT) could be a useful alternative approach to the treatment of health anxiety and deserves further investigation. In this paper, we outline the rationale for using MBCT in the treatment of this condition, namely its hypothesised impact on the underlying mechanisms which maintain health anxiety, such as rumination and avoidance, hypervigilance to body sensations and misinterpretation of such sensations. We also describe some of the adaptations which were made to the MBCT protocol for recurrent depression in this trial and discuss the rationale for these adaptations. We use a case example from the trial to illustrate how MBCT was implemented and outline the experience of one of the participants who took part in an 8-week MBCT course. Finally, we detail some of the more general experiences of participants and discuss the …

matched on Hypochondriasis (keyword), health anxiety (text)

Health anxiety and the non-medical use of prescription drugs in young adults: A cross-sectional study.

Introduction: Studies have demonstrated a relation between health anxiety (hypochondriasis) and substance use, but this minimal body of literature has focused on alcohol or illicit drugs. The use of medications without a physician's prescription (i.e., non-medical use of prescription drugs, NMUPD) is increasingly prevalent among young adults. Health anxiety, a tendency to worry excessively about health, is a factor that could contribute to NMUPD, but this has not been examined. The purpose of the current study was to examine the relations among health anxiety, NMUPD, and other psychological variables related to substance use. Methods: In the present study, young adult college students (N = 758), ages 18-25, completed an anonymous online survey assessing demographics, health anxiety, NMUPD, and other psychological characteristics, including depression and general anxiety. Results: Partici…

matched on Hypochondriasis (keyword), health anxiety (text)

Medical student syndrome: fact or fiction? A cross-sectional study.

Objectives: It is often reported by medical practitioners that medical students develop hypochondriacal concerns and symptoms relating to diseases they are studying, a phenomenon labelled 'medical student syndrome'. However, the evidence that this syndrome exists and particularly that it contributes to an increased number of consultations (as typical hypochondriasis does) is weak. The present study investigates this phenomenon in terms of differences between medical and non-medical students in help-seeking behaviour. Design: Cross-sectional survey. Setting: Three universities in London. Participants: Medical students (n = 103), non-medical science student controls (n = 107) and law student controls (n = 78), all third-year undergraduates, were recruited from within their universities. Main outcome measures: Help-seeking behaviour was measured using the 'Health Anxiety Questionnaire' reas…

matched on Hypochondriasis (keyword), health anxiety (text)

Health anxiety and healthcare costs in Japanese individuals: an Internet survey.

Aim: Health anxiety, also known as hypochondriasis, is classifiable as an anxiety disorder. The aim of this study was to examine the relationship between health anxiety and healthcare costs. Method: Participants - 100 Japanese individuals from the general population with chronic health problems and 100 without chronic health problems - were recruited via the Internet. They completed self-report scales measuring health anxiety, state anxiety, depression, obsessionality, and a scale specifically developed for this study that measured the use of healthcare services and the personal costs of respondents' healthcare. Results: Health anxiety was associated with more incidents of inpatient care and greater healthcare expenditure. These associations remained significant even after controlling for state anxiety, depression, obsessionality, and the presence of chronic health problems. Conclusion: …

matched on Hypochondriasis (keyword), health anxiety (text)

The Short Health Anxiety Inventory: Psychometric Properties and Construct Validity in a Non-clinical Sample.

Contemporary conceptualizations of hypochondriasis (HC) as severe health anxiety have led to the development of cognitive-behavioral approaches to understanding, assessing, and treating this problem. The Short Health Anxiety Inventory (SHAI) is a new instrument that measures cognitive factors associated with HC. In the present study, we examined the psychometric properties and factor structure of the SHAI in a large sample of medically healthy university students. We also examined the scale's convergent, divergent, and predictive validity. Results indicated that the SHAI has good psychometric properties and contains three factors that assess the perceived likelihood and perceived severity of becoming ill, and body vigilance. Facets of health anxiety uniquely predicted increased safety-seeking behavior and medical utilization, behaviors that are commonly observed in HC. Results are discus…

matched on Hypochondriasis (keyword), health anxiety (text)

Illness Anxiety Disorder and Its Relationship with Social Health in the Elderly, Isfahan, Iran.

Background: The present study investigated the prevalence of illness anxiety disorder and its relationship with social health in the elderly population. Materials and methods: This cross-sectional study was conducted on 400 elderly people in Isfahan referred to the educational health service in 2020. In addition to demographic characteristics, they answered the 36-item Evans hypochondriasis questionnaire and the 28-item social health questionnaire. Results: Four hundred elderly participants with a mean age of 68.1 ± 6.6 (range: 60-89) were included in the study. One hundred and ninety-nine (49.8%) were female and 201 (50.3%) were male. Only 24.3% of the geriatrics were in the healthy group and 21.2% in the borderline category. Seventy-two of the geriatric population (18%) had poor social health and 299 of this population (74.8%) had moderate social health, and the social health status of…

matched on Hypochondriasis (keyword), illness anxiety (text)

Collaborative stepped care for somatoform disorders: A pre-post-intervention study in primary care.

Objective: The successful management of somatoform disorders in primary care is often limited due to low diagnostic accuracy, delayed referral to psychotherapy, and unstructured overuse of health care. This study aimed to investigate the feasibility of establishing a collaborative stepped health care network for somatoform disorders, and its impact on the diagnostic process and treatment recommendations in primary care. Method: The Network for Somatoform and Functional Disorders (Sofu-Net) was established to connect 41 primary care physicians (PCP), 35 psychotherapists, and 8 mental health clinics. To evaluate Sofu-Net, primary care patients at high risk of having a somatoform disorder were identified using the Patient Health Questionnaire, and were assessed in detail at the patient and PCP level. Discussion of psychosocial distress in the consultations, diagnostic detection rates and tr…

matched on Somatoform Disorders (mesh), Medically Unexplained Symptoms (keyword)

Psychological resilience, depression, anxiety, and somatization symptoms in response to COVID-19: A study of the general population in China at the peak of its epidemic.

Rationale: Psychological resilience is characterized as the ability to respond to extreme stress or trauma or adverse experience successfully. While the relation between public emergencies and psychological distress is well known, research on therelationship between psychological resilience and mental health is very limited during the outbreak of public health emergencies. Objective: This research investigated the relationship between psychological resilience and mental health (depression, anxiety, somatization symptoms) among the general population in China. Method: Psychological resilience, depression, anxiety, and somatization symptoms of 1770 Chinese citizens were investigated during the epidemic peak of coronavirus disease 2019 (COVID-19) (23rd February 2020 to 2nd March 2020). The analyses were done through the Connor-Davidson Resilience Scale (CD-RISC), the Patient Health Question…

matched on Somatoform Disorders (mesh), somatic symptom (text)

"Thoughts Can Kill You": Characterization of Mental Health Symptoms by Ugandan Grandparent-Caregivers in the HIV/AIDS Era.

Studies of caregiving provided to HIV/AIDS orphans by sub-Saharan African grandparents have found that it has physical, financial, and emotional consequences. Our study extended this research by identifying and characterizing the symptoms experienced by Ugandan grandparent- caregivers, particularly as related to the caregiving role, loss and grief. Grounded theory methodology was used to conduct and analyze audio-recorded, semi-structured interviews with 32 grandparents. Findings revealed a cluster of biopsychosocial distress symptoms, especially anguish (driven by traumatic anxiety and disbelief), depression, and somatic symptoms that were linked primarily to psychological distress. The impact of cultural practices and beliefs on these symptoms was also identified. Results have implications for public health, research, and policy changes needed to alleviate symptoms of biopsychosocial d…

matched on Somatoform Disorders (mesh), somatic symptom (text)

Is there a relationship between psychological factors and TMD?

Introduction: Medical students are in a very demanding environment and are affected by high degree of stress. High levels of anxiety can affect a student's academic performance and also increase the risk of other health-related problems. This study aims to evaluate, thanks to the intensity of stress manifestations (4DSQ) together with the sense of coherence (SOC), the prevalence of TMD and oral parafunctions in students enrolled in the University of Medical Sciences. Moreover, it aims to evaluate the relationship between the psychosocial manifestations of stress and sense of coherence in relation to gender. Materials and methods: A total of 324 students of Poznań University of Medical Sciences participated in this study. Students were assessed using a three-part questionnaire: one was to assess symptoms of TMD, the second part was 4DSQ, and the third was a SOC Questionnaire. Results: Abo…

matched on Somatoform Disorders (mesh), somatic symptom (text)

The network structure of major depressive disorder, generalized anxiety disorder and somatic symptomatology.

Background: Major depressive disorder (MDD) and generalized anxiety disorder (GAD) often co-occur with somatic symptomatology. Little is known about the contributions of individual symptoms to this association and more insight into their relationships could help to identify symptoms that are central in the processes behind the co-occurrence. This study explores associations between individual MDD/GAD symptoms and somatic symptoms by using the network approach. Method: MDD/GAD symptoms were assessed in 2704 participants (mean age 41.7 years, 66.1% female) from the Netherlands Study of Depression and Anxiety using the Inventory of Depressive Symptomatology. Somatic symptoms were assessed with the somatization scale of the Four-Dimensional Symptom Questionnaire. The technique eLasso was used to estimate the network of MDD/GAD and somatic symptoms. Results: The network structure showed numer…

matched on Somatoform Disorders (mesh), somatic symptom (text)

Motivation for Psychotherapy and Illness Beliefs in Turkish Immigrant Inpatients in Germany: Results of a Cultural Comparison Study.

Objective: Some immigrant populations, for instance, Turkish immigrants, suffer from worse mental health than the general population. Moreover, psychotherapeutic treatment does not work well in this group. This might be explained by lower motivation for psychotherapy and particular illness beliefs as important early predictors of treatment outcome. We investigate differences in these predictors between Turkish immigrant inpatients and inpatients without a migration background and evaluate whether particular illness beliefs have a negative impact on motivation for psychotherapy. Method: Turkish immigrant inpatients and inpatients without a migration background (N = 100), suffering from depressive disorder, somatoform disorder, and/or adjustment disorder, completed questionnaires assessing motivation for psychotherapy, depressive and somatic symptoms, illness perception, illness-related lo…

matched on Somatoform Disorders (mesh), somatic symptom (text)