BackgroundEvidence synthesis for whole medical systems, defined as complete systems of theory and practice that have evolved independently from biomedicine. is challenging. This paper provides a framework for evidence synthesis of Traditional, Complementary and Integrative Medicine (TCIM) systems incorporating context and complexity. A systematic review program on the effects of homeopathic preparations is used as a practical illustration of the proposed framework.Proposed solutionA systems perspective considers the patient as a complex system of interconnected regulative subsystems embedded in a complex environment, and disease as a dysregulation of the dynamic adaptive state of the organism. Most TCIM systems, including homeopathy, aim to stimulate regulative systems and their functions to regain homeostasis. The consequences of these principles for the approach to evidence synthesis of TCIM systems are explored and explained.Framework componentsA systems perspective takes into account a plurality of evidence sources, including ‘real-world’ clinical data such as case reports, case series and cohort studies. The systematic review program focuses on comparative studies of homeopathy in various clinical indications and includes both non-randomized prospective studies of interventions (NRSIs) and randomized controlled trials (RCTs). For risk-of-bias assessments, use is made of respectively ROBINS-I and ROB2. Evidence certainty is graded transparently and rigorously based on the GRADE framework. An experienced patient advocate is involved in the research program and input from patient advisors who experienced the clinical indication under investigation is incorporated.DiscussionRCT and NRSI evidence on homeopathic preparations for a range of clinical indications will be synthesised. A limitation, from a complex systems perspective, is that the implication of these findings will still need to be contextualized within the broader context of the existing state of knowledge. An ‘evidence eco-system’ that includes complementary sources of information will be required to inform decisions.ConclusionEvidence synthesis of TCIM systems can move beyond conventional approaches by framing evidence within its complexity and context, together with real-world data and patient perspectives. This approach entails methodological challenges and will require gap analyses to guide future research and improve the applicability for public health and individualized patient care.

BackgroundSpirituality has been proposed as a relevant dimension of health, yet its distribution in the general population and its associations with health-related factors remain insufficiently characterized. This study examined how self-reported spirituality and religious affiliation are distributed in Germany and how they are associated with chronic disease burden, health-related quality of life, nutrition-related attitudes, and attitudes toward traditional, complementary, and integrative medicine (TCIM).MethodsWe conducted an anonymous cross-sectional online survey of adults living in Germany aged 18–75 years (N = 4,065). Self-reported spirituality and religious affiliation were assessed alongside sociodemographic variables, Sinus-Milieus®, health status, chronic health conditions, nutrition-related attitudes, TCIM attitudes, and health-related quality of life. Group differences were analyzed using chi-square and Wilcoxon tests. Multivariable regression models examined correlates of healthy nutrition and EQ-5D-5L. In addition, a Bayesian Network was used to explore conditional dependencies among 37 variables (n = 4,013).ResultsOverall, 896 participants (22.0%) self-identified as spiritual, and 2,076 (51.1%) reported a religious affiliation. Women were overrepresented among spiritual participants (60.8%). Spirituality differed significantly by gender, age, Sinus-Milieus®, religious affiliation, overall health status, and health-related quality of life. Cross-classification of spirituality and religious affiliation yielded four groups: religious and spiritual (14.2%), spiritual but not religious (7.9%), religious but not spiritual (36.9%), and neither religious nor spiritual (41.1%). The proportion of participants identifying as spiritual increased with the number of chronic diseases. In multivariable analyses, spirituality, but not religious affiliation, was associated with healthy nutrition. In the multivariable EQ-5D-5L model, only overall health status and chronic disease burden remained significant.ConclusionsIn this large German adult online sample, spirituality showed distinct socio-cultural patterning and was associated with nutrition-related attitudes, TCIM attitudes, and greater chronic disease burden. However, spirituality was not independently associated with health-related quality of life after adjustment for health status and chronic disease burden. Bayesian Network modeling offered an exploratory framework for examining these relationships. Further studies using more differentiated measures of spirituality and religion are needed in order to better understand, classify, and scientifically frame this complex field in a cross-disciplinary manner.

BackgroundMental disorders pose a substantial global health burden. Complementary and Integrative Medicine (CIM) is widely used; however, data on CIM use in mental disorders are limited. The aim was to investigate CIM prevalence, usage patterns, disclosure, and perceived benefits among individuals with mental disorders in Germany.MethodsA cross-sectional study was conducted among adults with psychiatric disorders in Germany between June 2023 and August 2024. Participants were recruited through a nationwide anonymous online survey and on-site surveys in randomly selected outpatient psychiatric, psychosomatic, and psychotherapeutic settings in Berlin and Brandenburg. The 33-item questionnaire assessed lifetime and current CIM use, diagnostic and sociodemographic characteristics, physician disclosure, recommendation sources, and perceived effectiveness. Associations were analysed using logistic regression.ResultsSeven hundred sixty-eight participants (mean age 43.2 years; 77.3% female) completed the questionnaire. Lifetime CIM use was 92.3, and 68.1% reported current use. The most commonly used approaches (lifetime use) were meditation (63.9%), yoga (60.8%), and dietary supplements (59.1%); positive experiences were highest for meditation (76.9%) and yoga (74.6%). Among CIM users, 60.9% informed their physician. Physician awareness was associated with more favourable CIM evaluations (adjusted OR 2.69, 95% CI 1.63–4.49). Recommendations were mainly based on self-directed research (59.9%) and friends’ advice (31.2%).ConclusionCIM use among individuals with mental disorders is highly prevalent and predominantly self-initiated. However, many patients do not disclose their CIM use to clinicians. Physician awareness of patients’ CIM use was associated with more positive patient-reported evaluations, suggesting that proactive enquiry and open communication about CIM use may facilitate safer and more coordinated care. Further clinical research is required to evaluate the effectiveness, safety, and potential interactions of commonly used CIM approaches in psychiatric care.

BackgroundComplementary and integrative medicine (CIM) is widely used among individuals with mental disorders, but evidence on associated out-of-pocket expenditures and socioeconomic differences in spending remains limited.MethodsThis cross-sectional study used data from the PSYKIM cross-sectional study of adults with self-reported psychiatric disorders in Germany. Associations of CIM-related out-of-pocket costs and expenditure categories with sociodemographic and clinical variables, physician awareness, subjective evaluation of CIM approaches, and health insurance status were examined descriptively and using multivariable binary and ordinal logistic regression models where appropriate. A relative financial burden measure, approximated as the ratio of CIM-related out-of-pocket expenses to available monthly income, was analyzed descriptively.ResultsAmong 657 participants with complete cost data, 72% reported out-of-pocket CIM-related costs. Higher disposable income was associated with higher odds of reporting out-of-pocket costs (aOR = 1.19; 95% CI: 1.04–1.37) and higher expenditure categories (aOR = 1.18; 95% CI: 1.06–1.31). Physician awareness of CIM use and more positive evaluations of CIM were also associated with higher expenditures. Men had lower adjusted odds of reporting out-of-pocket costs than women (aOR = 0.44; 95% CI: 0.26–0.76), while participants with university-level qualifications more frequently reported such costs in descriptive analyses. Disease duration, psychiatric diagnosis, and health insurance status were not clearly associated with CIM-related costs. CIM use was not associated with lower use of conventional medication.ConclusionCIM use among individuals with mental disorders in Germany is frequently associated with private out-of-pocket expenditures and appears to be socially patterned. The findings further suggest that CIM is primarily used as an adjunct to, rather than a substitute for, conventional psychiatric treatment. Given the cross-sectional design, these observations should be confirmed in prospective observational studies.

BACKGROUND:Digital interventions for promoting relaxation are increasingly popular, yet few combine multiple sensory modalities. This study evaluated the effectiveness of a fully digital relaxation program combining hypnotherapy with aromatherapy and explored whether the scent can induce a conditioned relaxation effect. METHODS:In this four-arm randomized controlled trial (N = 504), participants were assigned to one of four groups for a 4-week intervention: (a) combined (hypnotherapy + aromatherapy), (b) hypnotherapy-only, (c) aromatherapy-only, or (d) control (minimal intervention pause). Sessions were self-guided and delivered online every 2 days. The primary outcome was subjective calmness, assessed via the calmness-restlessness subscale of the Multidimensional Mood Questionnaire. Secondary outcomes included perceived stress (PSS-10) and well-being (WHO-5). A fifth week with aromatherapy-only exposure was conducted in the combined and aromatherapy-only groups to test for conditioning. RESULTS:At post-intervention, both hypnotherapy-involved groups reported significant greater calmness than controls. The combined group showed a mean difference of β = 2.08 (95% CI: 0.50-3.65, p = 0.010, d = 0.38), while the hypnotherapy-only group showed β = 1.80 (95% CI: 0.24-3.37, p = 0.024, d = 0.33). Both effects were consistent across intention-to-treat and per-protocol analyses. Within-group improvements in calmness were also observed across all groups. No significant differences emerged from the conditioning test in week 5. CONCLUSIONS:Digital hypnotherapy improved relaxation, with modest added benefit from aromatherapy. The results support the use of multisensory digital tools to enhance subjective calmness. However, no evidence for conditioned effects of the scent was observed under the current conditions.

Background:Hypnotic suggestibility may moderate treatment outcomes, but evidence in depression is limited and inconsistent. Objective:This analysis examined whether baseline hypnotic suggestibility moderated changes in depressive symptoms over time and whether this effect differed between groups. Methods:This exploratory secondary analysis used data from the HypnoDeep trial, a randomized, controlled, pilot trial. Patients with mild to moderate depressive symptoms were randomized to group hypnosis, progressive muscle relaxation (PMR), or control. Hypnotic suggestibility was assessed with the Harvard Group Scale of Hypnotic Susceptibility, Form 5 (HGSHS-5:G) and the Creative Imagination Scale (CIS) at baseline. Depressive symptoms were measured at baseline and at 6 weeks using the Beck Depression Inventory-II. Linear mixed-effects models examined whether baseline suggestibility moderated depressive symptom changes and whether this association differed between groups, adjusting for age and sex. Separate models were estimated for HGSHS-5:G and CIS. A post hoc power analysis contextualized detectable effect sizes. Results:Ninety-four participants were included (mean age 39.2 years, SD 12.0; women: n = 67 [71.3%], men: n = 25 [26.6%], diverse: n = 2 [2.1%]). Baseline hypnotic suggestibility assessed with the HGSHS-5:G ranged from 0 to 5 (mean 2.9, SD 1.6), and CIS scores ranged from 2 to 35 (mean 17.6, SD 7.7). Baseline hypnotic suggestibility was not associated with differential change in depressive symptoms over time in the control group for either the HGSHS-5:G or the CIS, and there was no indication that this association differed in the hypnosis or PMR group compared with the control group (HGSHS-5:G: hypnosis β = 2.05, 95% CI -2.21 to 6.31, p = 0.350; PMR β = -0.97, 95% CI -5.14 to 3.20, p = 0.651; CIS: hypnosis β = 3.06, 95% CI -1.36 to 7.48, p = 0.179; PMR β = -0.44, 95% CI -4.49 to 3.61, p = 0.833). Post hoc power analysis indicated that complete-case group sizes were insufficient to reliably detect small-to-moderate associations. Conclusion:Exploratory analyses did not indicate that hypnotic suggestibility moderated changes in depressive symptoms across groups. Given limited statistical power, findings are preliminary and hypothesis-generating. Larger studies are needed to clarify treatment-response moderators.

BackgroundAcupressure and hypnosis are used by patients with arterial hypertension despite limited evidence supporting their efficacy. The aim of this N-of-1 series was to evaluate feasibility, individual patient responses to both interventions, to inform personalized treatment decisions, and to assess overall effects of interventions.MethodsIn a series of N-of-1 trials, we compared self-administered acupressure plus routine care (RC), hypnosis plus RC, and RC alone in patients with grade 1 or 2 hypertension. After a one-week run-in period with RC only, patients entered a six-week intervention phase consisting of two blocks with periods of acupressure, hypnosis and RC only, each followed by washout periods, administered in randomized order. Outcomes included systolic and diastolic blood pressure and pulse rate, which were measured by patients according to a standardized protocol. Patients recorded cardiovascular parameters, stress levels, vitality, and well-being using visual analogue scales, and documented feasibility and safety data in a study diary. The primary analysis of continuous outcomes was descriptive and conducted at the individual trial level. Secondary analyses included meta-analysis across all N-of-1 trials and outcomes. Overall group effects were analyzed using mixed-effects ANCOVA models.ResultsAltogether 17 patients (59% female, mean age 54.4 [SD 7.6]) were included in this study. Feasibility of interventions was high, as reflected by an adherence rate exceeding 90%. Two patients showed reductions in systolic and diastolic blood pressure with both acupressure and hypnosis, and one patient with acupressure only, compared to RC. In the meta-analysis, no overall effects of acupressure or hypnosis on cardiovascular outcomes were observed. Overall, stress levels were higher during the run-in period (mean 43.6 [SD 18.9]) compared to the subsequent blocks and were similar between treatment periods. All other outcomes remained unchanged. Reported side effects were mild, rare, and occurred mainly during acupressure.ConclusionThis series of N-of-1 RCTs was feasible for self-administered acupressure and hypnosis for hypertension. No relevant changes in outcome parameters, including blood pressure, were observed at the group level, although selected patients showed individual changes. Further studies are needed to identify the treatment as well as individual conditions under which clinical benefits can be expected.Clinical trial registrationDeutsches Register für klinische Studien (DRKS) 00034937, https://drks.de/search/de/trial/DRKS00034937/details.

Introduction A healthy lifestyle is considered to be an important factor for healthy aging. Kneipp therapy (KT) includes a combination of hydrotherapy, herbal medicine, mind-body medicine, physical activities and healthy nutrition. In this study, we investigated the effectiveness of KT care on activities of daily living, health and quality of life in residents of nursing homes. Methods We conducted a prospective, two-armed comparative observational study to compare matched nursing homes with KT (Kneipp group) vs. nursing homes with common preventive interventions (control group) over a 12-month period.. Outcome measures included activities of daily living (Barthel Index), cognition (Mini-Mental State Examination (MMSE)) and quality of life (QUALIDEM; Short-Form 12 (SF-12)). Results We included 7 nursing homes (n=105 residents) for the Kneipp group and 6 nursing homes (n=69) as control. Except for Barthel Index, there were no time point dependent differences between the groups. The Barthel Index showed a smaller difference from baseline in the control group (mean diff. 0.94, 95%CI [-1.94; 3.82]) compared to Kneipp group (- 4.08, 95%CI [-6.46; -1.69]; p=0.009) after 6 months. Pooled over the timepoints the SF-12 mental health sum scale exhibited a smaller difference from baseline in the Kneipp group (-1.3, 95%CI [-3.6; 0.9]) compared to the control group (-3.8, 95%CI [-6.3; -1.4]; p=0.027). Furthermore, the MMSE sumscore, decreased less in the Kneipp group compared to control (-1.1, 95%CI [-2.2, -0.1]; p=0.033) after 12 months. A post hoc comparison of residents from both groups who received at least 30 preventive interventions monthly exhibited better values for QUALIDEM items “social relations”, “social isolation” and “feeling at home”. Conclusion This comparative observational study showed only small differences in outcome measures between the groups. The frequency of treatments may positively influence social components of behavior and well-being in residents. High-quality pragmatic randomized trials are needed for further investigations.

Introduction:Complementary and integrative medical procedures (CIM) are commonly used in Germany, including for the treatment of mental health conditions. The aim of the study was to investigate how CIM is used and perceived in outpatient mental healthcare settings. Methods:This qualitative interview study was conducted as part of the PSYKIM cross-sectional project. Twenty participants (15 women, 5 men; mean age 37.5 years, range 19-64) were recruited from a larger survey sample. Semi-structured telephone interviews were used to explore participants' experiences with CIM therapies in the context of mental healthcare. Interview data was analyzed using qualitative content analysis within a constructivist paradigm. Results:The most frequently used CIM therapies were yoga, acupuncture, meditation, art therapy, and progressive muscle relaxation (PMR). Thematic analysis identified four overarching experiential dimensions across therapies: (1) emotional regulation and inner calm, (2) individual prerequisites and ambivalent effects, (3) creative expression and emotional processing, and (4) the influence of therapeutic setting. CIM therapies were experienced in highly heterogeneous ways. While many interviewed participants reported symptom relief, improved wellbeing, and enhanced self-awareness through CIM therapies, others described frustration, emotional distress, or a lack of effect. Overall, experiences were highly individualized and influenced by factors such as personal readiness, the therapeutic environment, and group dynamics. Conclusion:The highly heterogeneous ways in which patients with mental health conditions experience CIM therapies underscore the need for individualized implementation, professional guidance, and open communication about both benefits and potential risks. Future research should investigate how multimodal interventions that combine CIM with conventional treatments can be individually tailored and contextually adapted to improve mental health outcomes. Trial registration:This study has been registered in the German Clinical Trial Registry with trial ID DRKS00032426 on 08.08.2023.

Non-pharmacological interventions for restless legs syndrome (RLS) are frequently used, although scientific evidence remains limited. The study aimed to investigate the feasibility and effects of self-applied hydrotherapy and self-applied acupressure in patients with RLS. In a three-armed randomized single-center open exploratory pilot study, adults with moderate to severe RLS were randomly allocated to 6 weeks of daily hydrotherapy plus routine care (HT group), acupressure plus routine care (AP group), or routine care alone (RC group). Outcome measures included RLS symptom severity (IRLS), disease-specific quality of life (RLSQoL), the impression of change (PGI-C), health-related quality of life (SF-12), psychological outcomes (SGW-B, HADS, and GSE), and adherence and adverse events (AEs) after 6 and 12 weeks. Fifty-four adults (mean age 57.5 ± 11.4 years, 63% women) were included. The study showed good feasibility with an 83% retention rate. After 6 weeks, baseline-adjusted mean IRLS scores were 19.8 (95% [16.4, 23.2]) for HT, 22.9 (19.2, 26.6) for AP, and 24.0 (20.8, 27.2) for RC. RLSQoL adjusted means were 65.3 (59.7, 70.9) for HT, 68.3 (62.3, 74.3) for AP, and 56.2 (50.9, 61.5) for RC, after 6 weeks. Both interventions were safe, with high adherence rates. Self-applied hydrotherapy and acupressure appear to be feasible and safe interventions for patients with RLS. This exploratory pilot study suggests potential benefits, though larger, well-designed confirmatory studies are needed to validate these findings. This study was registered in the German Clinical Trials Register (number DRKS00029960) on August 09, 2022. https://drks.de/search/de/trial/DRKS00029960.

Background: In Germany, the nutritional situation of adults and children living in households at risk of poverty has been insufficiently studied so far. Aim: The aim of the mixed-methods study MEGA_kids is to gain a deeper understanding of the nutritional situation including socioeconomic, behavioral, and attitudinal factors and health characteristics among persons living in families at risk of poverty. Method: MEGA_kids is a mixed-methods cross-sectional study consisting of four modules combining quantitative and qualitative methods. The first module (A) applies self-administered questionnaires to assess the individual's diet, household food insecurity, and several other factors among adults and children of 500 households. Cash receipts are used to assess household's food expenses. For the second module (B), a semistructured interview guide is used to identify factors influencing food security and nutritional quality from the perspective of a subsample of module A (n = 20). The third module (C) applies the participatory World Café technique to explore experiences and generate ideas for tailored support measures for a healthy diet from the perspective of 40 parents participating in module A. Finally, the fourth module (D) investigates the knowledge and usage of existing nutrition-related preventive measures among 200 parents at risk of poverty by using an online questionnaire. Conclusion: By providing a comprehensive picture of nutritional aspects of families living at risk of poverty, MEGA_kids will guide officials to target and prioritize public health nutrition measures, inform policy makers to implement and improve healthy policies and, finally, identify research gaps to be prioritized.

BACKGROUND:Considering the analogies between the disruption in ecological systems and in individuals, the concept of integrative medicine is extended to the One Health concept and integrative medicine is introduced as an innovative model for guidance/correction in patients' therapy as well as in ecological realignment. SUMMARY:The specific elements of integrative medicine that can be applied to human health as well as to environmental health are described (e.g. self-regulation, salutogenic healing processes, transdisciplinary multimodal approaches, methodological pluralism). The need for sustainable use of limited resources in medicine and pharmacy is pointed out. As examples for urgent action, the need of taking into account the whole life cycle of pharmaceutical products as well as the impact of diet for human and planetary health are mentioned. KEY MESSAGE:Self-regulation plays a crucial role in human and environmental health; sustainable promotion of self-regulation enables people to become co-creators of their own health. Such a fundamental change requires transformation of one's inner relationship to nature and to oneself. The aim of the mini-review was to concretize individual fields of action and to investigate the question of whether the concepts of integrative medicine can be transferred from humans to the environment and thus to planetary health and whether this makes sense.

Aim:This systematic review of clinical trial evidence aims to determine whether homeopathy can effectively relieve symptoms and reduce antibiotic use in patients diagnosed with otitis media (OM). Methods:Seven databases and four trial registries were searched. Eligible studies included randomised- and non-randomised-controlled-trials in patients diagnosed with OM. Studies on Individualised- and non-Individualised-Homeopathy (IH, non-IH) were included, and controls were inactive and/or active treatment. Primary outcomes were clinical-improvement and antibiotic-use. Data extraction, Risk of Bias and certainty of evidence (GRADE) were performed using established methodology. Results:Nine studies (IH = 4, non-IH = 5) comprising seven Randomised Clinical Trials (RCTs) and two non-RCTs (nRCTS) compared homeopathy with placebo (n = 2) or standard care (n = 7). 4/7 included RCTs reported statistically significant individual outcomes at relevant time points (symptom score, MEE, and antibiotic use) favouring homeopathy. However, heterogeneity of study designs, homeopathic interventions and outcome measures hindered the pooling of data for most outcomes, except for antibiotic use (non-IH). Add-on non-IH reduced filled antibiotic prescriptions by 46 % (RR = 0.54 [95%CI: 0.28, 1.06], P = 0.07, I2 = 12 %), but this did not reach statistical significance. Most studies demonstrated that the homeopathy group had less adverse events than the control group. Conclusions:The evidence base for the effectiveness of homeopathy and OM treatment is modest in study number, size, and risk of bias assessment. Individual RCTs report positive effects on clinical improvement and/or antibiotic use at relevant time points with homeopathy with no safety issues. Due to heterogeneity, the current evidence is insufficient to satisfactorily answer whether homeopathy is effective for clinical improvement and reducing antibiotic use in patients with OM. A Core Outcome Set for OM for future research is warranted to improve the potential for meta-analyses and strengthen the evidence base.

Background: The hypothesis of this presentation is that the narratives on the evidence of homeopathy and the plausibility of research data are based to a relevant degree on belief systems of the respective actors.

Background: Effective and safe non-antibiotic treatment may contribute to reducing antibiotic use and antimicrobial resistance (AMR), and meeting doctors’ and patients’ desire for symptom relief in (acute) Otitis Media (OM). This systematic review aims to assess whether homeopathy can effectively reduce OM symptoms and the use of antibiotics.

Background The Modified Naranjo Criteria for Homeopathy (MONARCH) inventory is a novel and useful tool for assessing the likelihood of a causal relationship between the homeopathic intervention and the ultimate clinical outcome. Objectives To explain and elaborate on the use of the MONARCH inventory to improve its consistency of use and thereby elevate the overall quality and evidentiary value of homeopathy case reports. Explanation and Elaboration Each of the 10 MONARCH inventory domains is explained and elaborated with the aid of references from published literature and hypothetical clinical situations. The MONARCH total score can range from -6 to +13; within that range, an arithmetic total of +6 is available from the scores of four critical domains, which should be given prominence in the overall consideration of causality. In reporting a clinical case, great importance should be placed on the narrative of the MONARCH evaluation process, domain by domain. Conclusion The application of MONARCH allows us to evaluate the likelihood of a causal relationship between the intervention and the observed clinical outcomes in successfully treated cases, thereby augmenting their evidentiary value.

BackgroundThere is evidence that patients’ positive outcome expectations prior to study interventions are associated with better treatment outcomes. Nevertheless, to date, only few studies have investigated whether individual outcome expectations affect treatment outcomes in hypnosis.ObjectiveTo examine whether outcome expectations to hypnosis prior to starting treatment were able to predict perceived stress, as measured on a visual analog scale (VAS), after 5 weeks.MethodsWe performed a secondary data analysis of a multicenter randomized controlled trial of intervention group participants only. Study participants with stress symptoms were randomized to 5 weekly sessions of a group hypnosis program for stress reduction and improved stress coping, plus 5 hypnosis audio recordings for further individual practice at home, as well as an educational booklet on coping with stress. Perceived stress for the following week was measured at baseline and after 5 weeks using a visual analog scale (0–100 mm; VAS). Hypnosis outcome expectations were assessed at baseline only with the Expectations for Treatment Scale (ETS). Unadjusted and adjusted linear regressions were performed to examine the association between baseline expectations and perceived stress at 5 weeks.ResultsData from 47 participants (M = 45.02, SD = 13.40 years; 85.1% female) were analyzed. Unadjusted (B = 0.326, t = 0.239, p = 0.812, R2 = 0.001) and adjusted (B = 0.639, t = 0.470, p = 0.641, R2 = 0.168) linear regressions found that outcome expectations to hypnosis were not associated with a change in perceived stress between baseline and after 5 weeks in the intervention group.ConclusionOur findings suggest that the beneficial effect of group hypnosis in distressed participants were not associated with outcome expectations. Other mechanisms of action may be more important for the effect of hypnosis, which should be explored in future research.Clinical trial registration: ClinicalTrials.gov, identifier NCT03525093.

Rosary prayer is a popular Catholic meditative prayer practice and has been used since the thirteenth century. The aim of this study is to describe characteristics, prayer practice, religiosity and piety of those practicing the prayer and to investigate whether and how religion/spirituality (R/S) and well-being are related in this specific population. An online cross-sectional survey was performed between June and September 2022 which included items on sociodemographic data, prayer practice, well-being, religiosity and spirituality, transpersonal trust and spiritual meaning. Results were described descriptively, and a possible relationship between R/S and well-being was examined using correlational and moderator analyses. In total, 164 participants who pray the Rosary completed the online questionnaire. A total of 92% of the participants belonged to the Roman Catholic Church, and 61% of the sample were women. A majority of participants reported to be very religious/spiritual (36%) or quite religious/spiritual (47%). Most participants experienced the prayer as a calming and relaxing practice, which slows down the breathing and the awareness in the prayer being focused on the prayer beads. Most of the participants expressed a high-to-very high transpersonal trust. All R/S measures used in this study are highly intercorrelated (r between 0.64 and 0.91) and show similar small-size associations (r between 0.10 and 0.20) with well-being. Moderator analysis shows that the connection between R/S and well-being was stronger among those with more positive prayer experiences. Subjectively perceived positive prayer experiences may act as an amplifier or emotional affirmation of the "rightness" or "effectiveness" of one's faith and this very amplification may have a strengthening effect on the relationship between R/S and well-being. The interaction of R/S and well-being in Rosary praying and other meditative techniques should be a major topic of future research.

Objective Hydrotherapy is a traditional prevention and treatment strategy. This study’s aim is to systematically review all available randomised controlled trials (RCTs) investigating clinical effects of hydrotherapy according to Kneipp which is characterised by cold water applications. Methods RCTs on disease therapy and prevention with Kneipp hydrotherapy were included. Study participants were patients and healthy volunteers of all age groups. MEDLINE (via PubMed), Scopus, Central, CAMbase, and opengrey.eu were systematically searched through April 2021 without language restrictions and updated by searching PubMed until April 6th 2023. Risk of bias was assessed using the Cochrane tool version 1. Results Twenty RCTs (N=4247) were included. Due to high heterogeneity of the RCTs, no meta-analysis was performed. Risk of bias was rated as unclear in most of the domains. Of 132 comparisons, 46 showed significant positive effects in favour of hydrotherapy on chronic venous insufficiency, menopausal symptoms, fever, cognition, emotional function and sickness absenteeism. However, 81 comparisons showed no differences between groups and 5 were in favour of the respective control group. Only half of the studies reported safety issues. Conclusion Although RCTs on Kneipp hydrotherapy seem to show positive effects in some conditions and outcomes, it remains difficult to ascertain treatment effects due to the high risk of bias and heterogeneity of most of the considered studies. Further high-quality RCTs on Kneipp hydrotherapy are urgently warranted. PROSPERO registration number CRD42021237611.