Assessing the Impact of Integrative Medicine on Anxiety and Wellbeing of Hospital Workers Exposed Directly or Indirectly to Terror, Trauma or War
Phase: NA
Conditions: Anxiety
Sponsor: Bnai Zion Medical Center

Official title: 
Assessing the impact of integrative medicine on anxiety and 
wellbeing of hospital workers exposed directly or indirectly to terror, 
trauma or war 
 
NCT number: not yet available 
 
Document date: December 20th, 2023 
 
 
 
 

Background: 
In Israel, one of the world's leading treatment concepts has been developed on the subject of 
mental treatment for trauma as a result of terrorism and war, based on experience in Israel and 
the world, including in disaster-stricken areas [1]. The incidence and intensity of the trauma 
that patients and staff members experience depends on many variables, and can involve both 
those who were directly exposed to the trauma and those who were indirectly exposed (for 
example: treatment of patients who were exposed to trauma or emotional distress in the general 
public as a result of a national trauma) [2]. Typical ASD symptoms include hyperarousal; 
Avoidance (convergence in), dissociation (detachment) and intrusion ("flashbacks") [3]. In 
these situations, conversational therapy, psychotherapy and other approaches are accepted 
which are limited in terms of effectiveness in reducing the symptoms and preventing the risk 
of developing PTSD. Hence the need for additional treatment approaches, such as a 
combination of treatment with complementary/integrated (integrative) medicine focused on 
responding to physical distress and reducing arousal more [4]. 
During the "Iron Swords" war, the residents of the Gaza Strip and the surrounding area, along 
with the soldiers of the security service, were exposed to a very high intensity of trauma. Added 
to this is an extensive cycle of trauma for those who were directly and indirectly exposed to 
loss and terror throughout the country. Medical teams in the hospitals and in the community 
were exposed with the highest intensity to these traumatic aspects which were amplified by the 
collapse of many of the resilience and mental health centers in the south. 
An integrative medicine treatment clinic was established at the Bnei Zion Medical Center for 
the purpose of providing a response to all hospital employees who are exposed and will be 
exposed (directly or indirectly) to the wounded and patients expressing trauma, including 
symptoms of acute stress disorder, as a result of war and terrorism. Hospital employees are 
invited to register for complementary medicine treatments on the hospital's website according 
to indications that include anxiety, emotional distress and/or typical Acute Stress Disorder 
(ASD) symptoms, including physical distress (such as pain, breathing disorder, digestive 
system symptoms, exhaustion, etc.). The employees are treated by a team from the system for 
integrated (integrative) medicine, including practitioners of acupuncture (acupuncture); 
touch/movement techniques (for example, qigong, reflexology, shiatsu) or mind-body 
medicine (for example, relaxation and breathing exercises) and may include one or more of the 
above 3 treatment areas. 

In the proposed study, we plan to examine the effect of these treatments on various symptoms 
experienced by hospital employees during this period. 
 
Aim: 
The purpose of the study is to characterize the hardships of the employees of the Bnei Zion 
Medical Center in order to evaluate the effect of integrative medicine treatments that can be 
alleviated on the main hardships, including in the spectrum of acute stress disorder, expressed 
by the employees whether as a result of direct or indirect exposure to war/terror events and/or 
as a result of the treatment of casualties. 
 
Methods: 
This is a questionnaire study examining the effect of integrative medicine treatments that are 
routinely given in a clinic established for all employees of the Bnei Zion Medical Center. The 
research focuses on the plight of all Bnei Zion Hospital employees, including staff members in 
the emergency medicine departments, operating room, hospitalization and clinics who are 
exposed to war/terrorist events and/or as a result of the treatment of casualties. 
Evaluation of the research results will be based on the MYCAW - Measure Yourself Concerns 
and Wellbeing questionnaire. This questionnaire assesses before the start of the integrative 
intervention the two main distresses that the study participant expects to improve following the 
integrative treatment, and assesses their severity on a VAS (Visual Analogue Score) scale 
ranging from 0 to 6. Another question measuring the hospital employee's performance at work 
on the VAS scale was added to the original MYCAW questionnaire. Another assessment of 
the MYCAW questionnaire will be carried out 24 hours after the integrative treatment of phone 
call findings. In addition, a valid questionnaire will be sent that assesses anxiety and mental 
distress ASD (Acute Stress Disorder) before the start of the treatment and approximately 4-8 
weeks later. 
The study will be conducted within the Bnai Zion Medical Center during the current 
emergency. The state of the study will include up to 500 participants and repeat treatments will 
be possible for the entire hospital staff. 
 

Inclusion criteria: All hospital employees expressing anxiety, emotional distress and/or typical 
ASD symptoms, including physical distress resulting directly or indirectly from exposure to 
the trauma of terrorism or war, who receive integrated medical treatments as part of the staff 
clinic established in Bnei Zion. 
Exclusion criteria: none 
Conditions for stopping the medical experiment: Staff members who express a desire to stop 
their participation in the study. 
 
Data analysis: 
The data analysis will be conducted using a research methodology that combines quantitative 
and qualitative aspects. The results of the study and demographic characteristics will be coded 
in an EXCEL sheet and then into the SPSS software. Descriptive data of the various variables 
will be produced. The findings will be analyzed with the help of t-test for unpaired tests for 
prevalence percentages. If necessary, non-parametric tests will be used to compare 
subpopulations. 
 
Ethical issues of the experiment: 
The extraction of the demographic information and its analysis will be done by the researchers. 
Research data will be coded in an electronic file in a way that will not allow identification of 
the participants. The study has been approved by the Ethical Committee of Bnai Zion Medical 
Center (ID: 0105-23-BNZ). 
 
References: 
1. Lahad M, Leykin D. Ongoing exposure versus intense periodic exposure to military conflict 
and terror attacks in Israel. J Trauma Stress. 2010 Dec;23(6):691-8. 
2. Koren D, Caspi Y, Leiba R, Bloch D, Vexler B, Klein E. Acute stress reactions among 
medical and non-medical personnel in a general hospital under missile attacks. Depression 
Anxiety. 2009;26(2):123-8. 

3. Lawyer SR, Resnick HS, Galea S, Ahern J, Kilpatrick DG, Vlahov D. Predictors of 
peritraumatic reactions and PTSD following the September 11th terrorist attacks. Psychiatry. 
2006 Summer;69(2):130-41. 
4. Tan L, Strudwick J, Deady M, Bryant R, Harvey SB. Mind-body exercise interventions for 
prevention of post-traumatic stress disorder in trauma-exposed populations: a systematic 
review and meta-analysis. BMJ Open. 2023 Jul 12;13(7):e064758.