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Innovative Anti-Stress Study among Physicians at Charité

· 3 min read

The "Anti-Stress Intervention Among Physicians (ASIP)" Study utilizes StudyU to investigate the following intriguing and pertinent research question:

How can the everyday level of perceived stress be reduced in a fast and easy-to-implement manner?

The project will be conducted in cooperation with the Institute for Public Health at Charité – Universitätsmedizin Berlin (Principal Investigator: Dr. med. Valentin Vetter).


Physicians in Germany generally experience a high level of psychosocial stress. This holds true for those working in hospitals, general practitioners, and physicians in outpatient clinics. It is a well-known fact that high levels of stress negatively impact the physical and mental health of individuals. In physicians' case, however, high stress levels have also been identified as a reason for suboptimal quality of medical care. This includes deviations from standard procedures, a decrease in the quality of the doctor-patient relationship, and treatment errors. Potentially substantial structural changes in the organization and management of health care as well as in the way physicians are compensated by health insurers would be required to achieve sustainable improvements for medical personnel. Hence, a more immediate and easy-to-implement solution to reduce perceived stress is needed.

The Intervention

An intervention to improve the stress level of physicians must meet certain criteria to increase the likelihood of being implemented in everyday life and leading to sustainable improvements. First, the intervention needs to be easy to learn and brief, as time is often limited during a busy workday. Second, the intervention should be conducted without additional tools. Third, the intervention needs to be successful in reducing stress. All the criteria listed above are fulfilled by two techniques that have been intensively studied over the past decades: breathwork and mindfulness-based meditation techniques.

Why Use an N-of-1 Design

Perception of stress is highly individual and dependent on a large number of variables, both known and unknown, which are partly hard to measure accurately. The same is potentially true for the effect of an anti-stress intervention on stress levels. Therefore, a randomized study design is needed to account for all known and unknown confounders. While randomized placebo-controlled trials (RCTs) are often used to assess the effects of interventions, this might not be the ideal design for anti-stress interventions. Firstly, RCTs focus on the outcome effect on the group level but neglect intra-individual effects. However, for an anti-stress intervention, it is much more interesting to analyze the effects of the intervention within the individual (which can differ from between-group effects). Additionally, population-level effects can subsequently be estimated from the data collected in the N-of-1 trial as well, thereby ensuring no insights are lost. Secondly, due to the repeated measurements in an N-of-1 trial, temporal changes can be analyzed. Thirdly, owing to advanced applications like StudyU, the interventions can be applied, and the outcomes measured, in the context of daily life. Due to these (and additional) advantages, N-of-1 trials are "regarded [to be] at the top of the evidence hierarchy [...] over and above systematic reviews of RCTs" (Kwasnicka et al., 2019) for individual treatment choices.

Digital Application of Intervention through StudyU

The StudyU platform contributes to the ASIP Study by providing a user-friendly interface that manages and applies the intervention (through audio/video files) and collects the participant-reported outcome measures. The application will ensure good adherence to the study protocol by presenting the current phase of the trial in a structured and clear way, as well as through push notifications.