Projects

The Institute for Complementary and Integrative Medicine aims to crosslink research, patient care and teaching. Based on our methodological expertise, we apply a broad range of research designs and cooperate closely with research partners in Switzerland and abroad.

Current projects

Debriefing in placebo studies: An online survey among researchers (DePPS)

Debriefing in placebo studies: An online survey among researchers (DePPS)

Description
Studies using placebo or nocebo interventions have become an important field of research. In most of the studies, a deception of participants about the study aims and the type of intervention is necessary. However, legal requirements ask for informed consent with explicit explanations of study aims and procedures. As a solution for such studies, a debriefing at the end of study can be used to inform patients about study aims and procedures. In this study, “Debriefing Procedures in Placebo Studies: a web survey among researchers (DePPs)”, we use an anonymous online survey to ask active researchers in the field of placebo and nocebo research questions about how and when they conduct a debriefing within their study.

Principal Investigator
PD Dr. Jürgen Barth

Project coordination
Alexandra Heichel

Researcher
Prof. Dr. med. Claudia Witt, MBA, Institute for Complementary and Integrative Medicine, University Hospital Zurich, Switzerland
Sebastian Lüthi, MSc

Statistics
PD Dr. Jürgen Barth, Institute for Complementary and Integrative Medicine, University Hospital Zurich, Switzerland

Project Partners
Prof. Felicity Bishop, Department of Psychology, University of Southampton, UK
Dr. Zelda di Blasi, School of Psychology, University College Cork, Ireland

Project duration
2018-2020

Project status
Publication (in preparation)

Stakeholder involvement in integrative medicine treatment models (DIMMSI)

Stakeholder involvement in integrative medicine treatment models (DIMMSI)

Description
During the treatment of chronic illnesses, especially in the case of cancer, many patients ask for an integrative medical treatment approach that includes complementary medicine. For stakeholders, the feasibility of such integrative treatments is very important. In this project, numerous integrative treatment models will be developed in cooperation with stakeholders (i.e., for cancer-related fatigue). In addition, an expert committee in which various stakeholders are represented will supervise the research process.

Relevant stakeholders are patients who are directly affected; health professionals, who are involved in the treatment or care for patients suffering from cancer (e.g., physicians, relatives, nurses); and representatives from hospital administration (e.g., clinic managers), professional societies, politics and industry.

The treatment models are developed by a defined process involving stakeholders. This process includes five steps with qualitative and quantitative data collection:

In the first step, a team of medical doctors of the institute drafts a treatment model based on current scientific evidence, clinical studies and practical experience.

In the second step, the draft is reviewed by the stakeholders in qualitative face-to-face interviews and focus group discussions. In addition, stakeholders are asked about their general experiences, needs and opinions on the respective topic.

In the third step, the results of the qualitative analysis are discussed with the expert committee. Based on these results, the relevant questions for the subsequent online survey with a larger group of stakeholders are defined in the fourth step.

In the final fifth step, the expert committee discusses the results of the interviews, focus groups and the online survey. This provides the basis for the further development of the respective treatment models.

Principal Investigator
Prof. Dr. med. Claudia Witt, MBA

Project coordination
lic. phil. Claudia Canella

Statistics
PD Dr. Jürgen Barth

Project duration
2015-2020

Funding
Investigator Initiated Project supported by the Institute for Integrative Health, Baltimore, USA

Project status
Publication (in preparation)

Publications
Witt & Canella (2014). Gemeinsam Forschung und Behandlung verbessern: Stakeholder Involvement. Aktuelle Gesundheitsnachrichten. 15, 30-34;

Witt, Horneber & Rostock (2014). Komplementärmedizin bei der tumor-assoziierten Fatigue. Tumor Diagnose und Therapie. 35, 326-330.

Acupuncture in patients with chronic back pain (PATE)

Patient expectations and treatment results of acupuncture in patients with chronic back pain (PATE)

Description
Chronic back pain is a common disease and leads to severe limitations in the quality of life of those affected. In addition to pharmacological interventions, complementary treatments such as acupuncture have also proven effective. Observation studies confirm a correlation between the patient's expectations before acupuncture and a positive treatment outcome. In different studies, it has been shown that targeted communication before medical treatment improves expectations, and with this, a more beneficial outcome was achieved. This study examines whether expectations of the results and side effects of acupuncture can be changed by specific communication prior to treatment. More than 150 patients with chronic back pain were included in the study.

This study aims to examine whether verbal communication (briefing) can change treatment expectations before treatment and clinical outcome parameters (i.e., pain and side effects). For this purpose, the content of the briefings is designed in different variants. We compare a regular expectation briefing with a high expectation briefing (factor effectiveness) and a regular side effect briefing with an intensive side effect briefing (factor side effect) in a 2x2 factorial design. In the briefing, evidence-based information is given, but the groups differ in the emphasis on the facts communicated. The treatment consists of 8 sessions of standardized acupuncture over 4 weeks.

Outcome criteria are expectations before the treatment and pain and quality of life immediately after the treatment and after a 6-month follow-up period. In addition, we assessed side effects during the treatment.

Description in Trial Register

Principal Investigator
Prof. Dr. med. Claudia Witt, MBA

Project coordination
Alexandra Heichel
PD Dr. Jürgen Barth

Researcher
Alexandra Kern, MSc
Anja Zieger

Statistics
Prof. Dr. Leonhard Held; Prof. Dr. Burkhardt Seifert, Department of Biostatistics at the Epidemiology, Biostatistics and Prevention Institute at the University of Zurich, Switzerland

Project partners
Prof. Dr. med. Thomas Rosemann, Institute of Primary Care, University of Zurich, Switzerland
Prof. Dr. Ted Kaptchuk, Program in Placebo Studies, Harvard Medical School, USA

Project duration
2015-2020

Funding
Swiss National Science Foundation

Project status
Publication (in preparation)

Publications
Barth, J., Kern, A., Lüthi, S., Witt, C.M. (2019). Assessment of patients' expectations: development and validation of the Expectation for Treatment Scale (ETS). BMJ Open, 9:e026712. Link. Videoabstract

Competence Center for Mental Health

Competence Center for Mental Health: Care for the mentally ill from an integrative perspective

Description
The Competence Center for Mental Health (CCMH) was established at the University of Zurich with the aim of creating a multidisciplinary network of mental health experts equipped to respond to and ultimately reduce the increasing burden of mental health.

The Institute for Complementary and Integrative Medicine is involved in the Competence Center for Mental Health (CCMH) in research projects focusing on the care of patients with mental distress or disorders.

Principal Investigator
Epidemiology, Biostatistics and Prevention Institute, University of Zurich, Switzerland

Project partners
Institute for Complementary and Integrative Medicine, University Hospital Zurich
Children Hospital Zurich
Clinic for Psychiatry and Psychotherapy, Clinic for Psychiatry; Department of Psychology; Psychiatric Hospital (PUK); Department of Child and Adolescent Psychiatry (all University of Zurich)

Project duration
2015-2020

Funding
University of Zurich

Project status
Main phase

Changes in brain activity in EEG and fMRI - Acupuncture vs. control interventions

Changes in brain activity in EEG and fMRI of healthy volunteers - Acupuncture compared to control interventions

Description
Electroencephalography (EEG) and functional magnetic resonance imaging (fMRI) are used to evaluate the changes in brain activity in healthy volunteers upon application of XNKQ acupuncture. XNKQ acupuncture is a technique commonly used in China for stroke patients.

The comparison is based on three control interventions.

Twenty-four study participants were examined over a total of four days. On each of the four days, we measured the brain activity before and after the acupuncture treatment. The treatment consists of five acupuncture needles inserted into the skin.

EEG is used to investigate the general background brain activity (mu-alpha and beta waves). fMRI is used to investigate functional neuronal networks.

Measurements for the study will be performed at the Center for Cognitive Neurosciences Berlin (CCNB) at the Freie Universität Berlin.

Description in Trial Register

Principal Investigator
Prof. Dr. med. Claudia Witt, MBA

Project coordination
Dr. Daniel Pach, Institute for Social Medicine, Epidemiology and Health Economics, Charité - Universitätsmedizin Berlin, Germany
Institute for Complementary and Integrative Medicine, University Hospital Zurich, Switzerland

Researcher
Till Nierhaus, Center for Cognitive Neuroscience Berlin (CCNB), Freie Universität Berlin, Deutschland; Max Planck Institute for Human Cognitive and Brain Sciences, Department of Neurology, Leipzig, Germany
Chang Yinghui, First Teaching Hospital of Tianjin University of Traditional Chinese Medicine, Tianjin, China
Liu Bin, First Teaching Hospital of Tianjin University of Traditional Chinese Medicine, Tianjin, China

Data management
Katja Icke, Institute for Social Medicine, Epidemiology and Health Economics, Charité - Universitätsmedizin Berlin, Germany

Project duration
2015-2020

Project status
Data analysis

Publications
Nierhaus, T., Chang, Y., Liu, B., Shi, X., Yi, M., Witt, C.M., & Pach, D. (2019). Somatosensory stimulation with XNG acupuncture modulates functional connectivity or motor areas. Frontiers in Neuroscience, 13(147), Link.

A Mind Body Medicine smartphone app for cancer patients (AIM-C)

A Mind Body Medicine smartphone app for cancer patients (AIM-C)

Description
Cancer can cause high levels of distress in patients. Mind Body Medicine (MBM) interventions have the potential to reduce distress. However, access to these interventions can be difficult. Hence, mobile phone apps are a promising possibility to deliver such interventions in an easy and cost efficient manner. To date, mHealth interventions have been underresearched.

The aims of the project are: 1) to summarize the current state of research regarding app interventions for cancer patients in a systematic review and 2) to conduct a feasibility study for an MBM smartphone app for cancer patients and evaluate the effects on mental well-being of those patients.

Cancer patients are recruited in Canton Zurich and other places in Switzerland. The patients receive a smartphone app with three different MBM exercises. The effects of the app are assessed after 20 weeks by questionnaires and focus groups.

Principal Investigator
PD Dr. Jürgen Barth

Co-Principal Investigator
Prof. Dr. med. Claudia Witt, MBA

Project coordination
Alexandra Heichel

Researcher
Michael Mikolasek, lic. phil.

Project partners
Prof. Dr. Ulrike Ehlert, Clinical Psychology and Psychotherapy, University of Zurich, Switzerland

Project duration
2015-2020

Funding
Swiss Cancer League

Project status
Publication (in preparation)

Publications
Mikolasek, M., Berg, J., Witt, C.M., Barth, J. (2017). Effectiveness of mindfulness- and relaxation-based eHealth interventions for patients with medical conditions: A systematic review and synthesis. International Journal of Behavioral Medicine, 25(1), 1-16. Link

Mikolasek, M. Witt, C.M. & Barth, J. Adherence to a mindfulness and relaxation self-care app for cancer patients. A mixed-methods feasibility study. JMIR mHealth and uHealth, 6(12):e11271. Link Videoabstract

Investigation of analgesic mechanisms of acupuncture on experimental dental pain in the brain (MAC-DENT)

Investigation of analgesic mechanisms of acupuncture on experimental dental pain in the brain (MAC-DENT)

Description
Although the effectiveness of acupuncture in pain relief is well documented, the underlying physiological processes are mostly still unknown. The center of the teeth consists of mainly the pulp, a neurovascular bundle, which is why toothache can be used as a scientific pain model to explain pain modulation through acupuncture. In collaboration with researchers from the Center for Dentistry at the University of Zurich, we apply this pain model to prove the effect of acupuncture. The impact of acupuncture is measured under stable laboratory conditions in healthy volunteers by triggering a moderate pain sensation on the tooth with an electrical impulse. This experimental approach is helpful in characterizing the acupuncture effect in terms of the strength and duration of pain relief.

Description in Trial Register

Principal Investigator
Prof. Dr. med. Claudia Witt, MBA

Project coordination
Nuno Prates de Matos, MSc.

Project partners
PD Dr. Dr. Dominik Ettlin, Center of Dental Medicine, University of Zurich, Switzerland
Dr. Michael Bruegger, Center of Dental Medicine, University of Zurich, Switzerland
Dr. Daniel Pach Institute for Social Medicine, Epidemiology and Health Economics, Charité - Universitätsmedizin Berlin, Germany

Project duration
2015-2020

Funding
Investigator Initiated Project

Project status
Publication (in preparation)

Publications
de Matos, N.M.P., Pach, D., Xing, J.J., Barth, J., Beyer, L.E., Shi, X., Kern, A., Lukic, N., Ettlin, D.A., Brügger, M., Witt, C.M. (2019). Evaluating the Effects of Acupuncture Using a Dental Pain Model in Healthy Subjects - A Randomized, Cross-Over Trial. The Journal of Pain, in press. Link. Videoabstract

Qualitative research: Intake of Passiflora incarnata and Angelica archangelica

Qualitative research in the context of the intake of ethanolic herbal extracts of Passiflora incarnata and Angelica archangelica

Description
The aim of these two explorative, observational studies is twofold. First, we want to answer the questions of whether qualitative research methods can be applied to a setting of the intake of ethanolic herbal extracts and whether such an approach leads to meaningful results. Second, we want to explore patients' experiences and the values, views and interpretive processes that form their perceptions of using two specific herbal ethanolic extracts, those of Passiflora incarnata and Angelica archangelica, produced by Ceres Heilmittel AG.

In the studies, we adopt a phenomenological approach. We perform different qualitative methods of data collection, such as participant observation, diary writing and conducting semistructured face-to-face interviews.

The participating patients fill in short questionnaires about their medical history and write diaries about their intake and their experiences with the herbal extracts. In a concluding qualitative interview, the patients are asked about their overall experiences with the herbal extracts.

In addition, pharmacists and medical doctors specialized in phytotherapy are interviewed about their experiences with Passiflora incarnata and Angelica archangelica. Furthermore, a participant observation is conducted of the production of the two herbal extracts.

For data analysis, descriptive statistics, qualitative content analysis, narrative inquiry and documentary methods are applied. The analyses are supported by the use of the Software MAXQDA.

Principal Investigator
Prof. Dr. med. Claudia Witt, MBA

Project coordination
lic. phil. Claudia Canella

Project duration
2015-2020

Funding
Investigator Initiated Project with CERES Heilmittel AG

Project status
Publication (in preparation)

Publications       
Canella, C., Bachmann, C., Wolfensberger B. & Witt, C.M. (2019). Patients' experiences attributes to the use of Passiflora incarnata: A qualitative, phenomenological study. Journal of Ethnopharmacology, 231, 295-301. Link.

Effectiveness of hypnosis in third molar extraction (HypMol)

Effectiveness of hypnosis with the Dave Elman technique in third molar extraction (HypMol)

Description
Extraction of a third molar is painful for patients. This clinical condition can be used to evaluate the analgesic effects of pain treatments. For reduction of pain during third molar extraction, hypnosis can be beneficial. Patients who underwent hypnosis showed less pain during third molar extraction and at the time of follow-up, rather than patients who did not undergo hypnosis. Furthermore, postoperative analgesic use was lower in patients with additional hypnosis during third molar extraction. The aim of this monocentric randomized controlled study is to test the effectiveness of hypnosis in patients with third molar extraction, considering patient expectations, treatment preference and hypnotic depth. A total of 33 patients with molar extractions on both sides receive two types of pain-reducing interventions to investigate the effect of hypnosis. During one extraction, the patient receives hypnosis as an add-on intervention (Dave Elman technique) and reduced medication during third molar extraction. In the other molar extraction, patients receive regular medication. The order of interventions and the side of third molar extraction are randomized. The primary outcome of the intervention is the area under the curve of pain intensity after the extraction (measured after extraction, 3 hours after extraction, in the evening, and at the first and second day after extraction). Secondary outcomes are pain medication and the preferred treatment after two appointments.

Description in Trial Register

Principal Investigator
PD Dr. Jürgen Barth

Co-Principal Investigator
Prof. Dr. med. Claudia Witt, MBA

Project coordination
Alexandra Heichel

Project partners
Dr. med. dent. Patrick Meyenberger, Zahnarztpraxis Dr. Meyenberger, Will (SG), Switzerland
Med. dent. Mathias Egli, Zahnarztpraxis Dr. Meyenberger, Will (SG), Switzerland
Institute for Complementary and Integrative Medicine, University Hospital Zurich, Switzerland

Statistics
PD Dr. Jürgen Barth

Project duration
2017-2020

Project status
Publication (in preparation)

Publications
Barth, J., Egli, M., Maier, S., Meyenberger, P., & Witt, C.M. (2019). Effectiveness of hypnosis with the Dave Elman technique in third molar extraction: study protocol for a randomized controlled trial (HypMol). European Journal of Integrative Medicine, 26, 18-23. Link

E-learning program on complementary and integrative medicine

Development and evaluation of an e-learning program on complementary and integrative medicine for oncology physicians and medical students

Description
It is increasingly important for oncologists as well as for medical students to be familiar with complementary medicine procedures.

Since the field of complementary medicine is so complex and there is no systematic information available, it is important to have a reliable evidence-informed offer.

E-learning is a tool that can be very well integrated into everyday life, so you can acquire knowledge in a flexible way. The aim of the study is to develop and evaluate an e-learning training concept on complementary and integrative medicine for doctors and medical students in the field of oncology.

For this purpose, content is developed with the help of renowned experts and implemented in an appealing and innovative way on a modern learning platform. Stakeholder groups will test and evaluate the training concept in detail.

The evaluation takes place using online or paper-pencil surveys plus multiple-choice questions. The questionnaires are evaluated using descriptive statistics.

For this study, there is a cooperation with the Competence Network Complementary Medicine in Oncology KOKON in Germany.

Principal Investigator
Prof. Dr. med. Claudia Witt, MBA

Project coordination
Dr. sc. ETH Anita Thomae

Project duration
2017-2020

Funding
Gemeinnützige Dachstiftung Empiris, Günther und Regine Kelm Stiftung, Zurich

Project status
Data analysis

Publications
Helmer, S.M., Rogge, A.A., Fischer, F., Pach, D., Horneber, M., Roll, S., Witt, C.M. (2019). A prospective, multi-center, cluster-randomized trial evaluation a blended learning training concept to train oncology physicians to advise their patients about complementary and integrative medicine: The KOKON-KTO study protocol. Trials, 20(1):90. Link.

Effectiveness of a mindfulness and relaxation self-care app on cancer patients' distress

Effectiveness of a mindfulness and relaxation self-care app on cancer patients' distress: a randomized controlled multicenter study (CANRELAX RCT)

Description
In our previous feasibility study, we were able to show that an app intervention based on mindfulness and relaxation was well accepted by cancer patients (A Mind Body Medicine smartphone app for cancer patients).

The patients showed a decrease in distress, depression and anxiety over time. This study aims to evaluate the effectiveness of a relaxation- and mindfulness-based mobile app on distress (CAN Relax 2.0) for cancer patients with elevated levels of distress compared to a waitlist control group. Furthermore, the impact of this intervention on health status and quality of life and the dose response effects will be investigated.

This study is a randomized controlled multicenter trial with cancer patients from the Zurich and Lausanne area.

Principal Investigator
PD Dr. Jürgen Barth

Co-Principal Investigator
Prof. Dr. med. Claudia Witt, MBA

Project coordination
Alexandra Heichel

Researcher
Sonja Schläpfer, MSc

Project partners
Prof. Dr. rer. med. Manuela Eicher, Institut universitaire de formation et de recherché en soins University of Lausanne, Switzerland
Prof. Dr. Tobias Kowatsch, ITEM-HSG, University of St. Gallen, Switzerland

Statistics
PD Dr. Jürgen Barth

Project duration
2019-2022

Funding
Swiss Cancer League

Project status
In preparation

Impact of treatment expectations on health in patients receiving integrative medicine

Impact of treatment expectations on health in patients receiving integrative medicine (TExH)

Description
Expectations for treatments have been proven to be a predictor for success in therapy. The aim of this project is to record individual expectations and the possible changes of these expectations after treatment, in the context of a change in the state of health.

In addition to expectations, the working alliance between the therapist and patient may also contribute to the success of the treatment.

The association between an experienced quality of the relationship and a changed state of health is a topic that is also covered by this project. All patients who received a medical prescription for either osteopathy, Traditional Chinese Medicine (TCM), acupuncture, nutritional counseling, psychotherapy or hypnosis, are included. An anonymous longitudinal monthly survey via a web interface is used for electronic questionnaires where patients can document the treatment process and their current state of health.

This project is part of the quality management process in cooperation with the Institute for Complementary and Integrative Medicine and the SIHLMED Center for Integrative Medicine in Zurich.

Principal Investigator
PD Dr. Jürgen Barth

Co-Principal Investigator
Prof. Dr. med. Claudia Witt, MBA

Project coordination
Alexandra Heichel

Project partners
SIHLMED Center for Integrative Medicine, Zurich, Switzerland

Statistics
PD Dr. Jürgen Barth

Project duration
2018-2020

Project status
Recruiting

Systematic reviews and meta-analyses

Systematic reviews and meta-analyses

We conduct systematic reviews and meta-analyses with a focus on non-pharmacological interventions. The institute is a satellite of the Cochrane CAM Field.

Mindfulness and relaxation eHealth interventions (Link)
Jonas Berg (Ph.D. student)
Michael Mikolasek, Claudia Witt, Jürgen Barth

App interventions for medical ill patients (Link)
Karma Emchi (Ph.D. student)
Jiani Wang, Daniel Pach, Claudia Witt, Jürgen Barth

Comparison of eHealth and face to face studies in depression (Link)
Vera Aemisegger (Ph.D. student)
Claudia Witt, Jürgen Barth

Acupuncture for depression (Link)
Ruyu Xia (Ph.D. student)
Jürgen Barth and many others

Allegiance and spin of research
Pim Cuijpers (University of Amsterdam), Klaus Lieb (University of Mainz), Jürgen Barth

Publications
Witt, C.M., Vertosick, E.A., Foster, N.E., Lewith, G., Linde, K., MacPherson, H., Sherman, K.J., Vickers, A.J. on behalf of the Acupuncture Trialists'. (2019). The effect of patient characteristics on acupuncture treatment outcomes: An individual patient data meta-analysis of 20,827 chronic pain patients in randomized controlled trials.
The Clinical Journal of Pain, 35(5):428-434, Link. Videoabstract

Anheyer, D., Haller, H., Barth, J., Lauche, R., Dobos, G. & Cramer, H. (2017). Mindfulness-based stress reduction for treating low back pain: A systematic review and meta-analysis. Annals of Internal Medicine, 166(11), 799-807. Link.

Vetter, D., Barth, J., Uyulmaz, S., Vonlanthen, R., Belli, G., Montorsi, M., Bismuth, H., Witt, C.M. & Clavien, P.A. (2015). Effects of art on surgical patients: a systematic review and meta-analysis. Annals of Surgery, 262(5), 704-713. Link.


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