Abstract Objectives: The objective of this pilot study was to determine the effectiveness of a mixture of essential oils (peppermint, basil, and helichrysum) on mental exhaustion, or moderate burnout (ME/MB) using a personal inhaler. Design: This was a randomized, controlled, double-blind pilot study. Data were collected 3 times a day for 3 weeks (Monday-Friday). The first week was baseline for both groups, the second week was intervention (aromatherapy or placebo), and the third week was washout. Settings/location: Participants used a personal inhaler at home or at work. Subjects: The subjects comprised a convenience sample of 13 women and 1 man who each had self-assessed ME/MB. Interventions: Participants were randomized to receive a personal inhaler containing either a mixture of essential oils or rose water (as used in Indian cooking). Outcome measures: The outcome measures were a 0-10 scale with 10=worst feeling of burnout, 0=no feeling of burnout. There was a qualitative questionnaire rating aroma and a questionnaire listing perceived stressors. Results: While both groups had a reduction in perception of ME/MB, the aromatherapy group had a much greater reduction. Conclusions: The results suggest that inhaling essential oils may reduce the perceived level of mental fatigue/burnout. Further research is warranted.

OBJECTIVE: We evaluated the stress relief effect of lavender aroma by measuring sensitive salivary endocrinological stress markers, cortisol and chromogranin A (CgA). DESIGN: Thirty healthy students performed a serial arithmetic task for 10min and then rested for 10min. During the resting period, 16 students (aroma group) were exposed to airborne organic essential oil of lavender. Saliva samples were collected immediately before and after the arithmetic task, and at 5 and 10min after that. Salivary cortisol and CgA levels were determined by enzyme-linked immunosorbent assay. RESULTS: In the aroma group, levels of CgA that had been elevated at the end of the arithmetic task were statistically significantly lower 10min later. The control group showed no such change. During the protocol, no statistically significant changes in levels of cortisol were detected in either the aroma group or the control group. CONCLUSIONS: These findings suggest that lavender aroma has a stress relief effect.

is a plant of Lamiaceae family, with many therapeutic properties and biological activities, such as anticonvulsant, anxiolytic, antioxidant, anti-inflammatory, and antimicrobial activities. The aim of this study was to evaluate the effect ofMill. essential oil (LEO) on acute inflammatory response. LEO was analyzed using gas chromatography-mass spectrometry (GC-MS) and nuclear magnetic resonance spectroscopy (NMR) methods and showed predominance of 1,8-cineole (39.83%), borneol (22.63%), and camphor (22.12%). LEO at concentrations of 0.5, 1, 3, and 10 g/ml did not presentcytotoxicity. Additionally, LEO did not stimulate the leukocyte chemotaxis. The LEO topical application at concentrations of 0.25, 0.5, and 1 mg/ear reduced edema formation, myeloperoxidase (MPO) activity, and nitric oxide (NO) production in croton oil-induced ear edema model. In carrageenan-induced paw edema model, LEO treatment at doses of 75, 100, and 250 mg/kg reduced edema formation, MPO activity, and NO production. In dextran-induced paw edema model, LEO at doses of 75 and 100 mg/kg reduced paw edema and MPO activity. In conclusion, LEO presented anti-inflammatory activity, and the mechanism proposed of LEO seems to be, at least in part, involving the participation of prostanoids, NO, proinflammatory cytokines, and histamine.

OBJECTIVES:The objective of this study was to evaluate the potential anxiolytic effect of lemongrass (Cymbopogon citratus) aroma in healthy volunteers submitted to an anxiogenic situation.

DESIGN:Forty male volunteers were allocated to four different groups for the inhalation of lemongrass essential oil (test aroma: three or six drops), tea tree essential oil (control aroma: three drops), or distilled water (nonaromatic control: three drops). Immediately after inhalation, each volunteer was submitted to an experimental model of anxiety, the video-monitored version of the Stroop Color-Word Test (SCWT).

OUTCOME MEASURES:Psychologic parameters (state anxiety, subjective tension, tranquilization, and sedation) and physiologic parameters (heart rate and gastrocnemius electromyogram activity) were evaluated before the inhalation period and before, during, and after the SCWT.

RESULTS:Individuals exposed to the test aroma (three and six drops), unlike the control groups, presented a reduction in state anxiety and subjective tension, immediately after treatment administration. In addition, although they presented an anxious response to the task, they completely recovered from it in 5 min, unlike the control groups. Physiologic alterations along the test were not prevented by any treatment, in the same way as has previously been observed for diazepam.

CONCLUSIONS:Although more investigations are necessary to clarify the clinical relevance of lemongrass essential oil as an anxiety treatment, this work shows that very brief exposure to this aroma has some perceived anxiolytic effects.

OBJECTIVES:The objective of this study was to evaluate the potential anxiolytic effect of sweet orange (Citrus sinensis) aroma in healthy volunteers submitted to an anxiogenic situation.

DESIGN:Forty (40) male volunteers were allocated to five different groups for the inhalation of sweet orange essential oil (test aroma: 2.5, 5, or 10 drops), tea tree essential oil (control aroma: 2.5 drops), or water (nonaromatic control: 2.5 drops). Immediately after inhalation, each volunteer was submitted to a model of anxiety, the video-monitored version of the Stroop Color-Word Test (SCWT).

OUTCOME MEASURES:Psychologic parameters (state-anxiety, subjective tension, tranquilization, and sedation) and physiologic parameters (heart rate and gastrocnemius electromyogram) were evaluated before the inhalation period and before, during, and after the SCWT.

RESULTS:Unlike the control groups, the individuals exposed to the test aroma (2.5 and 10 drops) presented a lack of significant alterations (p>0.05) in state-anxiety, subjective tension and tranquillity levels throughout the anxiogenic situation, revealing an anxiolytic activity of sweet orange essential oil. Physiologic alterations along the test were not prevented in any treatment group, as has previously been observed for diazepam.

CONCLUSIONS:Although more studies are needed to find out the clinical relevance of aromatherapy for anxiety disorders, the present results indicate an acute anxiolytic activity of sweet orange aroma, giving some scientific support to its use as a tranquilizer by aromatherapists.

This study identified the volatile organic compounds in the essential oils that are extracted fromLinné (Linné) and investigated the effects of the inhalation of these compounds. We detected a total of 41 volatile organic compounds, including 32 hydrocarbons, four acids, three alcohols, two ketones, and one aldehyde. In a sniffing test, seven types of volatile organic compounds were identified. Furthermore, the volatile organic compounds inLinné that were identified were found to be derived from 1,8-cineole and camphor. After inhalation of the essential oils, the subjects' systolic blood pressure and heart rate decreased. This indicates that inhalation of the essential oils extracted fromLinné provides mental and physical relaxation. We examined the changes in electroencephalogram findings that are observed afterLinné essential oil inhalation. An increase in theta and alpha waves, which usually appear during relaxation, as well as a decrease in beta and gamma waves, which appear during brain activity such as excessive attention, were noted. These results indicate thatLinné essential oil inhalation helps to reduce blood pressure and may provide mental and physical relaxation.

OBJECTIVES:Geriatric depression is a major public health problem in China. The study compared the intervention and follow-up effects of aromatherapy massage and inhalation on symptoms of depression in community-dwelling older adults after an 8-week intervention.

DESIGN:A prospective, randomized controlled trial was conducted on community-dwelling adults≥60 years old, with symptoms of depression. Participants were randomly assigned, by Latin Square, to aromatherapy massage, inhalation, or control groups (each n = 20).

INTERVENTIONS:The aromatherapy massage group received 30 min of aromatherapy massage with 5 mL oil, twice weekly for 8 weeks. The oil contained 50 μL (one drop) of compound essential oils (lavender [Lavandula angustifolia], sweet orange [Citrus sinensis], and bergamot (Citrus bergamia in a 2:1:1 ratio)], diluted in sweet almond oil to a concentration of 1%. The aromatherapy inhalation group received 30 min of nasal inhalation of 50 μL of the compound essential oils blended in 10 mL of purified water, twice weekly for 8 weeks. The control group received no intervention.

OUTCOME MEASURES:The Geriatric Depression Scale Short Form (GDS-SF) and Patient Health Questionnaire-9 (PHQ-9) were used for assessment at pretest, posttest, and 6- and 10-week follow-ups in all groups. 5-Hydroxytryptamine (5-HT) concentration was assessed pretest and posttest.

RESULTS:Postintervention, the aromatherapy massage and inhalation groups demonstrated significantly lower GDS-SF and PHQ-9 scores than control participants. Compared with the pretest, the GDS-SF and PHQ-9 scores for depressive symptoms in both experimental groups remained lower at posttest (8 weeks), 6-week (14 weeks), and 10-week (18 weeks) follow-ups. However, the GDS-SF and PHQ-9 scores did not differ among the four time points in the control group. The posttest 5-HT concentrations in the aromatherapy massage and inhalation groups were increased over pretest values.

CONCLUSIONS:Both aromatherapy massage and aromatherapy inhalation may have important implications for intervening depression in older adults.

This randomized, controlled, blinded study examined the effectiveness of an aromatherapy intervention on the reduction of children's distress in a perianesthesia setting. The sample included children with and without developmental disabilities (n = 94). Subjects in the intervention group received an aromatherapy intervention of lavender and ginger essential oils. The control group received a placebo intervention of jojoba oil. Distress was measured at two times: before induction and in the PACU, using the Faces, Legs, Arms, Cry and Consolability (FLACC) scale. The mean distress level was lower for the children in the essential oil group, but the effect was not statistically significant (P = .055). Parents' responses to survey questions about satisfaction with aromatherapy did not differ between groups, although open-ended comments indicated a more positive opinion of the benefits of the intervention in the aromatherapy group.

AIM:To investigate the effects of aromatherapy massage on pain, functional state and life quality of elderly individuals with knee osteoarthritis.

METHODS:This controlled and experimental study was conducted in two nursing homes. In this study, 90 elderly individuals with knee osteoarthritis were randomized as aromatherapy, massage and control groups. Data were collected in weeks 0, 4, and 8 using Patient Information Form, Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) Knee Osteoarthritis Evaluation Scale, OsteoArthritis Knee and Hip Quality of Life Scale (OAKHQoL). Aromatherapy and massage groups received a total of 15-20 min total classic leg massage twice weekly for 3 weeks. In the aromatherapy group, two essential oils (ginger and rosemary) were added to the black seed oil.

RESULTS:In the aromatherapy group, WOMAC (pain and functional state) scores were lower and quality of life scores were higher than the massage and control groups in week 4, and these differences were statistically significant (p < .001). These significant differences were present in the massage group when compared with the control (p < .001). These significant differences in the aromatherapy group were also sustained decreasingly in week 8 (p < .001), while the means were not different from baseline in the massage group (p > .05).

CONCLUSIONS:Aromatherapy massage performed in elderly patients with knee osteoarthritis reduced pain and improved functional status and quality of life. The week 8 findings showed that aromatherapy has more favorable and longer sustained effects than the massage.

PURPOSE:To investigate the effectiveness of aromatherapy on blood pressure, heart rate variability, aortic pulse wave velocity and the aortic augmentation index of essential hypertensive patients.

METHODS:Using a coin toss, 22 participants were assigned to the experimental group and 20 to the control. The experimental group was given a blend of oils of lemon (Citrus limonum), lavender (Lavandula angustifolia), and ylang ylang (Cananga odorata) which were prepared in the ratio of 2:2:1, respectively. The control group was given an artificial lemon fragrance of Limonene (35 cc) and Citral (15 cc) mixture. The experiment, inhalation, was conducted for 3 weeks (2 min per inhalation, 2 times per day) to both groups.

RESULTS:There was a noticeable difference in systolic blood pressure between the groups (p=.001), however the difference in diastolic blood pressure between the two groups was not significant. There was a notable difference in sympathetic nerve system activity of heart rate variability (p=.047). However, the differences in aortic pulse wave velocity or the aortic augmentation index were not significant.

CONCLUSION:Aromatherapy is effective in lowering systolic blood pressure and sympathetic nerve system activity.

BACKGROUND:In intensive care units (ICUs), patients cannot sleep well. Aromatherapy is used for depression, anxiety, relaxation and disorders related with sleep and stress.

AIM:This study aimed to investigate the effect of lavender essential oil on the sleep quality and anxiety level of patients in coronary ICU.

PARTICIPANTS:A total of 60 patients in coronary ICU participated in this study.

DESIGN:A randomized controlled study was conducted with 60 patients in a province located in the southeast of Turkey.

METHODS:After informing the patients in both groups about the study, they were administered a questionnaire, Pittsburgh Sleep Quality Index (PSQI) and the Beck Anxiety Inventory (BAI) scale. The patients in the intervention group were given 2% lavender essential oil via inhalation for 15 days after which they were administered the same scales again to evaluate the sleep quality and anxiety. As for the control group, they were administered the same scales again after 15 days without the inhalation of lavender essential oil.

RESULTS:Comparison of the PSQI and BAI scores of the patients in the control and intervention groups before and after the intervention showed statistically significant differences in the change in favour of the intervention group (p<0·05).

CONCLUSION:Lavender essential oil increased quality of sleep and reduced level of anxiety in patients with coronary artery disease.

RELEVANCE TO CLINICAL PRACTICE:As a non-invasive, cheap, easily applicable, cost-effective, independent nursing intervention and appropriate for cardiac patients, lavender essential oil could be applied in ICUs.

One of the problems of cancer patients is sleep disorder. Given the absence of studies on comparing the effect of inhalation aromatherapy with lavender and peppermint on the sleep quality of the cancer patients, this study was performed to compare the effect of inhalation aromatherapy with lavender and peppermint essential oils on the sleep quality of cancer patients. For this purpose, 120 patients were randomly allocated to three groups of lavender, peppermint, and control. The intervention groups received three drops of the essential oil for 7 days. In the control group, aromatic distilled water was used instead. Pittsburgh Sleep Quality Inventory (PSQI) was used. Before the intervention, no significant difference was observed between the mean PSQI scores of three groups, while the difference was statistically significant after the intervention. The mean PSQI scores were lower in lavender and peppermint groups than in the control group. Aromatherapy can improve the sleep quality of cancer patients. To confirm the findings, more studies should be done.

BACKGROUND:Reducing labor pain and anxiety is one of the most important goals of maternity care.

OBJECTIVE:This study aimed to assess the effects of aromatherapy with Rosa damascena on pain and anxiety in the first stage of labor among nulliparous women.

DESIGN, SETTING, PARTICIPANTS AND INTERVENTIONS:This was a randomized clinical trial of 110 nulliparous women. The eligible participants were randomly assigned to two groups of aromatherapy and control in an Iranian maternity hospital. The participants received 0.08 mL of Rosa damascena essence in the aromatherapy group and 0.08 mL of normal saline in the control group, every 30 min. Pain was measured 3 times, once each at three stages of cervical dilation (4-5, 6-7, and 8-10 cm). Anxiety was measured twice, once each at two stages of cervical dilation(4-7 and 8-10 cm). The tools for data collection were the Spielberger anxiety questionnaire, numerical pain rating scale, demographic and obstetric questionnaire, and an observational checklist. Data analyses included the t-test, Mann-Whitney U test and Chi-square test.

MAIN OUTCOME MEASURES:Severity of labor pain and severity of anxiety were used as primary outcome measures. Labor and delivery characteristics (including number of contractions, duration of contractions in second stage, Bishop score, augmentation by oxytocin, Apgar score, and mode of delivery), demographic characteristics, and fertility information were used as secondary outcome measures.

RESULTS:Pain severity in the group receiving aromatherapy with R. damascena was significantly lower than in the control group after treatment at each pain assessment (cervical dilation of 4-5, 6-7, and 8-10 cm; P < 0.05). Anxiety levels were also significantly lower in the treatment group than in the control group after treatment at each time of measurement (cervical dilation of 4-7 and 8-10 cm; P < 0.05).

CONCLUSION:Aromatherapy with R. damascena reduced the severity of pain and anxiety in the first stage of labor. Aromatherapy with R. damascena is a convenient and effective method for pain and anxiety reduction during the first stage of labor.

TRIAL REGISTRATION:Iranian Registry of Clinical Trial: IRCT201306258801N3.

We investigated the effects of fragrance inhalation on sympathetic activity in normal adult subjects using both power spectral analysis of blood pressure fluctuations and measurement of plasma catecholamine levels. Fragrance inhalation of essential oils, such as pepper oil, estragon oil, fennel oil or grapefruit oil, resulted in 1.5- to 2.5-fold increase in relative sympathetic activity, representing low frequency amplitude of systolic blood pressure (SBP-LF amplitude), compared with inhalation of an odorless solvent, triethyl citrate (P<0.05, each). In contrast, fragrance inhalation of rose oil or patchouli oil caused a 40% decrease in relative sympathetic activity (P<0.01, each). Fragrance inhalation of pepper oil induced a 1.7-fold increase in plasma adrenaline concentration compared with the resting state (P = 0.06), while fragrance inhalation of rose oil caused a 30% decrease in adrenaline concentration (P<0.01). Our results indicate that fragrance inhalation of essential oils may modulate sympathetic activity in normal adults.

OBJECTIVE:The is study examined the effects of geranium aroma on anxiety among patients with AMI.

METHODS:This randomized, triple-blind, placebo-controlled clinical trial recruited 80 patients with AMI through convenience sampling. The patients were allocated to geranium and placebo groups (n = 40 each) using stratified block randomization. On the second day of admission three drops of geranium essential oil and placebo were poured on absorbing patches attached inside the oxygen masks of the geranium and placebo groups, respectively. The patients were asked to inhale the aroma for 20 min a day on two consecutive days.

RESULTS:all stages of the intervention, the two groups had a significant difference in anxiety scores, i.e. geranium aroma caused significantly greater reductions in the anxiety scores (P < 0.001).

CONCLUSION:Inhalation aromatherapy with geranium essential oil is recommended as an easy-to-use, intervention to reduce anxiety among patients with AMI.

OBJECTIVE:To assess the efficacy of inhaled ginger aromatherapy on nausea, vomiting and health-related quality of life (HRQoL) in chemotherapy breast cancer patients.

DESIGN:Single-blind, controlled, randomized cross-over study. Patients received 5-day aromatherapy treatment using either ginger essential oil or fragrance-matched artificial placebo (ginger fragrance oil) which was instilled in a necklace in an order dictated by the treatment group sequence.

SETTING:Two oncology clinics in the East Coast of Peninsular Malaysia.

MAIN OUTCOME MEASURES:VAS nausea score, frequency of vomiting and HRQoL profile (EORTC QLQ-C30 scores).

RESULTS:Sixty female patients completed the study (age=47.3±9.26 years; Malay=98.3%; on highly emetogenic chemotherapy=86.7%). The VAS nausea score was significantly lower after ginger essential oil inhalation compared to placebo during acute phase (P=0.040) but not sustained for overall treatment effect (treatment effect: F=1.82, P=0.183; time effect: F=43.98, P<0.001; treatment×time effect: F=2.04; P=0.102). Similarly, there was no significant effect of aromatherapy on vomiting [F(1, 58)=0.29, P=0.594]. However, a statistically significant change from baseline for global health status (P<0.001) was detected after ginger essential oil inhalation. A clinically relevant 10 points improvement on role functioning (P=0.002) and appetite loss (P<0.001) were also documented while patients were on ginger essential oil.

CONCLUSION:At present time, the evidence derived from this study is not sufficiently convincing that inhaled ginger aromatherapy is an effective complementary therapy for CINV. The findings for HRQoL were however encouraging with significant improvement in several domains.

PURPOSE: The purpose of this study was to explore the effects of the lavender fragrance on sleep and depression in women college students. METHOD: Forty-two women college students who complained of insomnia were studied during a four-week protocol(control treatment week, 60% lavender fragrance treatment week, washout week, 100% lavender fragrance treatment week). All subjects were in the department of nursing in "K" college and the study was a single blind repeated measurements experiment. For the duration of the study, weekly evaluations of sleep, patterns of sleep disturbance, severity of insomnia scale, self satisfaction with sleep, and severity of depression were performed. RESULT: Among sleep variables, length of time taken to fall asleep, severity of insomnia, and self satisfaction with sleep were improved for the 60%(p=.000, p=.000, p=.000) and 100%(p=.000, p=.000, p=.000) week while the severity of depression was improved only for the 100%(p=.002) week. CONCLUSION: According to the study results, it can be concluded that the lavender fragrance had a beneficial effect on insomnia and depression in women college students. Repeated studies are needed to confirm effective proportions of lavender oil and carrier oil for insomnia and depression.

OBJECTIVE: The purpose of the present study was to investigate the effect of listening to soft music or inhaling Citrus bergamia aroma on autonomic nervous system activity in young healthy individuals. STUDY DESIGN, LOCATION, AND SUBJECTS: This single-institution study was an open-label randomized controlled trial carried out on 114 healthy undergraduate students at a university located in south Taiwan. INTERVENTION: Participants were randomly allocated to one of four study groups including (1) a music group, (2) an aroma group, (3) a combined music and aroma group, and (4) a control group. Participants in the music group were asked to listen to preselected soft music for 15 minutes, and those in the aroma group were asked to inhale Citrus bergamia essential oil vapor generated from an ultrasonic atomizer for 15 minutes. OUTCOME MEASURE: The outcome measure involved heart rate variability (HRV) indices measured before and after the intervention. The low frequency (LF) and high frequency (HF) components of the HRV were used to quantify modulation of the sympathetic and parasympathetic branches of the autonomic nervous system. RESULTS: The percentage changes of normalized LF (p = 0.003), normalized HF (p = 0.001), and the ratio of LF to HF (p < 0.001) were significantly different among the four groups. Tukey's post hoc analysis revealed that the percentage change of normalized LF and HF were significantly different between the control group and the music group. For the percentage change of the ratio of LF to HF, the negative change in the music group, the aroma group, and the combined group was significantly different from that of the increase in the control group. In addition, no significant differences were found in the percentage changes in systolic blood pressure, diastolic blood pressure, and mean heart rate in the four groups. CONCLUSIONS: Listening to soft music and inhaling Citrus bergamia essential oil was found to be an effective method of relaxation, as indicated by a shift of the autonomic balance toward parasympathetic activity in young healthy individuals.

Anxiety disorders are some of the most common psychiatric disorders, with potentially debilitating consequences on individual function. Existing pharmacotherapies for anxiety disorders are limited by delay to therapeutic effect, dependence, tolerance, withdrawal, and abuse potential. Therefore, safe and evidence-based complementary or alternative therapies may be important allies in the care of patients with anxiety disorders. Essential oils are lipophilic and concentrated botanical extracts that exhibit many properties of drugs, although they are not Food and Drug Administration approved and have limitations characteristic of herbal preparations. Lavender essential oil has an extensive anecdotal history of anxiolytic benefit that has recently been supported by clinical efficacy studies. The 2 primary terpenoid constituents of lavender essential oil, linalool and linalyl acetate, may produce an anxiolytic effect in combination via inhibition of voltage-gated calcium channels, reduction of 5HT1receptor activity, and increased parasympathetic tone. The objectives of this article are to provide a brief overview of lavender oil in aromatherapy, explore variability in the constituents of lavender oil, summarize its pharmacology and safety profile, as well as describe its body of research that has been conducted for anxiety.