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DePaul University

From the SelectedWorks of Mona Shattell

2008

Healing scents: An overview of clinical


aromatherapy for emotional distress
Andrea Butje
Elizabeth Repede
Mona Shattell, DePaul University

Available at: http://works.bepress.com/mona_shattell/17/


Abstract
Individuals in emotional distress are often treated with psychothera-
peutic agents, but other treatment options exist. One safe and effec-
© 2007 Inspirestock/ iStock International Inc.

tive adjunct for the prevention and treatment of emotional distress is


aromatherapy. This article describes the physiological effects of scent,
reviews the research on aromatherapy, presents practical information
on the use of clinical aromatherapy for emotional distress, and sug-
gests resources for additional training and education.

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ndividuals in emotional dis- Background the spread of airborne infectious
tress are often treated with The medicinal use of aromat- diseases (Robins, 1999). Aroma-
psychotherapeutic agents, ic oils extends back to ancient therapy is often not prescribed by
but other treatment options exist Egyptian and Chinese cultures traditional U.S. medical practi-
(Hogan & Shattell, 2007). One (Lis-Balchin, 2006), but the term tioners; however, its use has in-
safe and effective adjunct for aromatherapy was coined by Rene- creased among CAM and nursing
the prevention and treatment of Maurice Gatteefosse, a French practitioners (d’Angelo, 2002).
emotional distress is aromathera- chemist who experimented with
py (Field et al., 2005; Kuroda et essential oils for wound healing Physiological Effects
al., 2005; Lemon, 2004)—the during World War I (d’Angelo, of Scent
therapeutic use of inhaled es- 2002). However, it was not until The sense of smell is crucial for
sential oils. Aromatherapy is one the 1980s that aromatherapy be- survival in mammals. Human be-
of the fastest growing modalities gan to develop as a serious disci- ings have more than 1,000 differ-
in complementary and alterna- pline (Robins, 1999), when work ent genes that regulate the produc-
tive medicine (CAM) in the on mind-body healing and the tion of specialized receptors in the
United States (d’Angelo, 2002), emerging field of psychoneuroim- nose (Buck, 2004). Each receptor
but research on aromatherapy is munology stimulated interest in cell is specific and able to detect
relatively scant, and few nursing the use of aromatherapy to allevi- only a few molecule odors. The
programs offer courses in aroma- ate emotional and mental distress responses to an odor are neuro-
therapy. This article describes (d’Angelo, 2002). logically transmitted to the olfac-
the physiological effects of scent, Aromatherapy is currently tory bulb in the brain. There the
reviews the research on aroma- taught in French medical schools, information from several olfactory
therapy, presents practical infor- prescribed by European physi- receptors is combined, forming a
mation on the use of clinical aro- cians, reimbursed by many Eu- pattern that is perceived as a dis-
matherapy for emotional distress, ropean health insurers, and used tinct odor in multiple areas in the
and suggests resources for addi- in Japanese factories to enhance cerebral cortex and the limbic sys-
tional training and education. worker productivity and prevent tem (Buck, 2004). Even though

Journal of Psychosocial Nursing • Vol. 46, No. 10, 2008 47


Table 1
Essential Oil Recipes for Emotional Distress
Issue Essential Oils Carrier Application
Anxiety, fear, Sandalwood: 5 drops Inhaler tube a
Inhale several times daily when
panic attacks Lavender: 5 drops the feelings arise
Bergamot: 2 drops
Chronic worry, Sandalwood 10 drops Inhaler tube Inhale several times daily
overthinking Lavender: 5 drops
Lemon: 3 drops
Depression Clary sage: 6 drops 4 oz spray bottle with Spray face (eyes closed), chest,
Geranium: 6 drops water and back of neck in the morning
Lemon: 4 drops and evening
Grief, shock, Rose otto: 6 drops 2 oz unscented lotion or Apply to chest, stomach, and
depression Clary sage: 5 drops jojoba oil lower back several times daily
Lemon: 4 drops
Insomnia Bergamot: 2 drops 2 oz unscented lotion or Apply freely to chest and neck
Lavender: 10 drops jojoba oil prior to bed
Roman Chamomile: 5 drops
Stress, tension Jasmine: 4 drops 2 oz bath salts (sea salts) Use 1 oz in one bath at night;
Bergamot: 2 drops place in tub when water is full
Clary sage: 5 drops
a
An inhaler tube is a small plastic tube that comes with a cotton part onto which the oils are dropped. The oil-soaked cotton is then inserted
into the tube. The oils are inhaled through a small hole in the top of the tube. It also comes with a cover.

nasal receptors are quite specific, ness, relaxation, attention, perfor- oxidative stress, as well as possible
human beings are able to differen- mance, and healing, and these may anti-inflammatory, anti-aging, and
tiate up to 10,000 odors through a be mediated purposefully with dif- anti-carcinogenic activity (Atsumi
complex sensory-somatic cascade ferent aromas (Field et al., 2005). & Tonosaki, 2007).
that instantaneously activates Lavender, for example, has been These findings on the physi-
the autonomic nervous system, associated with parasympathetic ological effects of scent in human
memory, and emotion through stimulation of the autonomic ner- beings suggest a link to emotions
the amygdala and other limbic vous system, leading to increased and memory, both modulators of
structures (Buck, 2004). beta power and decreased contin- physical and mental health. The
Olfactory stimulation causes gent negative variation on electro- effect is immediate and works
immediate physiological changes encephalogram; these in turn are beyond the level of conscious
in blood pressure, muscle ten- associated with decreased anxiety, awareness (Moss et al., 2003).
sion, pupil size, blink magnitude, improved mood, and increased Thus, certain aromas may be used
skin temperature, skin blood sedation (Moss, Cook, Wesnes, & to affect psychoneuroimmune
flow, electrodermal activity, heart Duckett, 2003). Peppermint and functions to promote healing.
rate, brain wave patterns, and rosemary have been associated
sleep/arousal states (Kuroda et al., with increased arousal, improved Research on
2005). Inhaled odors activate the cognition and memory, and en- Aromatherapy
release of neurotransmitters such hanced performance on cogni- Aromatherapy studies have
as serotonin, endorphins, and tive assessment tests (Moss et al., focused primarily on the physio-
norepinephrine in the hypotha- 2003). The parasympathetic-stim- logical and emotional arousal ef-
lamic pituitary axis and modulate ulating effects of lavender and the fects of essential oils, which can
neuroreceptors in the immune sympathetic-stimulating effects of be inhaled, ingested, or applied
system, altering mood, reduc- rosemary have been shown to sig- topically. Much of the research
ing anxiety, and interrupting the nificantly decrease salivary cortisol has evaluated aromatherapy in
stress response (d’Angelo, 2002). and increase free radical reactive conjunction with other modali-
The sense of smell is related scavenging activity, suggesting a ties such as massage and reflexol-
to daily functions such as alert- protective effect on the body from ogy (Buckle, 2007; Louis & Kow-

48 JPNonline.com
alski, 2002). However, recent endoscopy in a same-day surgery sential oils showed significantly
studies have sought to isolate center in the United States, no more improvement in scores on
the effects of aromatherapy as a significant difference in anxiety depression, anxiety, and severity
stand-alone therapy. was found before and after laven- of emotional symptoms than did
In a study of 73 healthy col- der inhalation (Muzzarelli, Force, those receiving massage alone.
lege students, different scents & Sebold, 2006). In this acute care Clearly, the research contin-
produced different mood states setting, mean anxiety scores were ues to show mixed findings on
following administration of an extremely high both before and the efficacy of aromatherapy.
anxiety-provoking task (Burnett, after the intervention, suggesting This may be due, in part, to study
Solterbeck, & Strapp, 2004). Stu- that aromatherapy may be better limitations, such as small and
dents receiving inhaled rosemary for moderate anxiety than for se- convenience samples, one-time
scored significantly higher on vere anxiety. Even so, the authors or short-term interventions, and
measures of tension-anxiety and noted that anecdotal reports from methodological issues. However,
confusion-bewilderment than patients who received aromathera- even in those studies in which
did those in lavender and control py suggested continued use of this
groups. Both rosemary and laven- modality (Muzzarelli et al., 2006).
der were significantly associated Louis and Kowalski (2002)
with lower fatigue-inertia rat- examined physiological and
ings. The groups did not differ on emotional parameters in a con-
physiological parameters. These venience sample of 17 terminally
results suggest differences in the ill cancer patients following treat-
effects of aromatic oils on mood, ment with humidified lavender.
independent of physiologically While physiological and psycho-
measurable parameters. logical scores improved in the
Evaluating the effect of aro- predicted direction, the differ- aromatherapy interventions failed
matherapy on crisis management, ences were not statistically signifi- to achieve statistically significant
Fowler (2006) found that 77% of cant, perhaps because of the small improvements, continued use and
a convenience sample of 43 ado- sample. Interestingly, the patients’ study of this modality were en-
lescents in a residential mental caregivers reported increases in couraged by the researchers and
health facility asked for aroma- their own relaxation and sense participants (Louis & Kowalski,
therapy when they felt agitated. of well-being during the lavender 2002; Muzzarelli et al., 2006). Sig-
Fowler used a blend of 3% ylang aromatherapy treatments. nificant improvements were most
ylang, sweet marjoram, and berga- Itai et al. (2000) compared the common in studies in which the
mot in jojoba oil, either inhaled or effects of lavender, hiba oil, and aromatherapy was tailored to the
topically applied using a modified odorless conditions on depression client by an experienced and ho-
hand massage technique. During and anxiety in a group of 14 hemo- listically trained aromatherapist
the 3-month study, the number of dialysis patients. Hiba oil signifi- (Itai et al., 2000; Lemon, 2004).
pharmacological injections for agi- cantly decreased mean scores on Buckle (2007) reported clinically
tation decreased from 43 to 31, the both anxiety and depression, and significant findings even in the
number of oral as needed medica- lavender significantly decreased absence of statistical significance
tions for anxiety or agitation de- mean anxiety scores. The find- in many studies and noted that
creased from 631 to 397, and the ings were significant independent institutional aromatherapy pro-
number of seclusion and restraint of personality traits, psychologi- grams have been implemented for
events decreased from 29 to 20. cal status, and psychotherapeutic relaxation, emotional well-being,
In a convenience sample of 200 medication for anxiety and sleep. and agitation.
adults awaiting dental procedures Lemon (2004) studied the
in Austria, those who received effects of nine essential oils on Use of Clinical
diffused ambient odors of orange anxiety and depression in 32 Aromatherapy
or lavender while waiting had sig- acute care psychiatric patients. Essential Oils to Relieve
nificantly less anxiety and better The study compared levels of de- Emotional Distress
mood than did those exposed to pression and anxiety in a control Essential oils can be applied in
music or controls, even controlling group receiving massage with car- several ways. They can be added
for dental pain (Lehrner, Marwins- rier oil and an experimental group to a carrier, such as a vegetable
ki, Lehr, Johren, & Deecke, 2005). receiving essential oils diluted in oil or unscented lotion, and then
However, among a convenience carrier oil during massage. The applied to the skin, or they can be
sample of 118 patients awaiting group receiving massage with es- added to bath salts, room sprays,

Journal of Psychosocial Nursing • Vol. 46, No. 10, 2008 49


Table 2
Aromatherapy and Essential Oils Resources
Resource Type Organization Web Site
Organizations National Association for Holistic Aromatherapy http://www.naha.org
Publications Aromascents Journal (Canada) http://www.aromascentsjournal.ca
Aromatherapy Journal (United States) http://www.naha.org/journal.htm
Aromatherapy Thymes (United States) http://www.aromatherapythymes.com
Aromatherapy Today (Australia) http://aromatherapytoday.com
International Journal of Clinical Aromatherapy http://www.ijca.net
(France)
International Journal of Essential Oil Therapeutics http://www.ijeot.com
(France)
Aromatherapy education The Aromahead Institute, School of Essential http://www.aromahead.com
and certification programs Oil Studies
The College of Botanical Healing Arts http://www.cobha.org
The Institute of Integrative Aromatherapy http://www.aroma-rn.com
R.J. Buckle Associates LLC http://www.rjbuckle.com
Essential oil distributors Aromatics International http://www.aromaticsinternational.com
Florihana® Distillery http://www.florihana.com

or diffusers for inhalation. How- including uses, side effects, precau- chemical components in individ-
ever, the most effective applica- tions, chemical and botanical in- ual oils is important because some
tion route for decreasing anxiety formation, and potential interac- of the therapeutic benefits of oils
and slowing an overactive mind tions can be found in Lis-Balchin’s are determined by their chemi-
is inhalation. Using a small blank (2006) aromatherapy text. cal makeup. Reports of chemical
inhaler tube, essential oils are components should be available
added to a piece of cotton that is Buying and Storing to the buyer on request.
inserted into the tube. The oil is Essential Oils Factors that cause oxidation
then available to smell. Adulterated oils or oils that of essential oils include exposure
Oils used by aromatherapists to are synthetic and called fragrance to oxygen, heat, and light. Stor-
reduce anxiety, improve mood, and or perfume oils will not offer the age affects the shelf life of essen-
reduce stress include (d’Angelo, same therapeutic effects as pure tial oils. When stored properly,
2002; Lis-Balchin, 2006): plant-extracted oils, and they their oxidation rate slows signifi-
l Bergamot (citrus bergamia). may actually cause allergies, cantly. The potential for allergic
l Lemon (citrus limon). headaches, and chemical sen- reactions and skin irritation from
l Clary sage (salvia sclarea). sitivities. Gas chromatography essential oils increases when es-
l Lavender (lavandula (GC) and mass spectrometry sential oils oxidize. Ideally, oils
angustifolia). (MS) are methods of separating should be stored in a dark, cool
l Roman chamomile compounds in essential oils into room. Bottles should be dark-
(chamaemelum nobile). individual components and iden- colored glass. Shelf life can range
l Geranium (pelargonium tifying major components in the from 1 to 8 years, depending on
graveolens). oil. These processes are used to the chemical makeup of the oil
l Rose otto (rosa damascene). identify any adulteration of an and the storage conditions. Han-
l Sandalwood (santalum essential oil, which means the oil dling of oils and possible problems
album). has had chemicals or other sub- in storage conditions are reduced
l Jasmine (jasminum stances added or removed. GC/ when there is only one company
officinalis). MS testing is also used to identify between distiller and customer, so
The effects and dosing of these the exact chemical profile of an it is best to purchase essential oils
nine essential oils are shown in oil and assess its potential thera- from a company that buys directly
Table 1. Data on each of these oils, peutic uses. The breakdown of from a distiller.

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Precautions
Like all medicinal products, es- K E Y P OINTS
sential oils can be toxic or incom-
patible with other compounds or 1. The medicinal use of aromatic oils extends back to ancient Egyptian and
treatments, or they can produce Chinese cultures.
side effects or cause allergic reac- 2. The sense of smell is related to daily functions such as alertness, relaxation,
tions (Lis-Balchin, 2006). When attention, performance, and healing, and these may be mediated purposefully
recommending a therapeutic regi- with different aromas.
men of essential oils for a client, 3. Essential oils used to reduce anxiety, improve mood, and reduce stress include
the appropriate dosing, the route bergamot, lemon, clary sage, lavender, Roman chamomile, geranium, rose
of administration, and the client’s otto, sandalwood, and jasmine.
size, health status, and individual
preferences should be taken into 4. Effective use of aromatherapy requires adequate knowledge and skills and the
ability to safely tailor interventions to the unique needs of each client.
account (d’Angelo, 2002). Side
effects can include exacerbation
of asthma or respiratory disorders
Do you agree with this article? Disagree? Have a comment or questions?
due to allergen load, and with Send an e-mail to Karen Stanwood, Executive Editor, at kstanwood@slackinc.com.
topical application, contact der- We’re waiting to hear from you!
matitis or irritation. Also, particu-
lar odors may be unpleasant or ir- sociation for Holistic Aroma- of particular oils and combina-
ritating to clients. therapy (NAHA). A list of these tions of oils on mood, memory,
Some oils, such as bergamot programs is provided in Table 2. and sense of well-being; replica-
or lemon, may cause photosen- Courses to obtain certification in tion studies using rigorous study
sitivity. This can be avoided aromatherapy are also available. designs and appropriate sample
by limiting sun and ultraviolet The NAHA (2005) has is- sizes; studies on the use of aro-
light exposure for 12 hours af- sued national educational stan- matherapy in various populations
ter use (d’Angelo, 2002). Just dards for aromatherapy certifica- (i.e., children, older adults, ethnic
as with allopathic medications, tion. To be certified through the or cultural groups); and studies
certain oils are contraindicated NAHA, an aromatherapist must that combine aromatherapy with
in certain health conditions, have 200 hours of training from guided imagery, meditation, or
including epilepsy (lavender, an approved school, which in- hypnosis to augment the manage-
rosemary), hypertension (rose- cludes courses in the chemistry, ment of emotional distress.
mary), asthma (rosemary), and botany, and anatomy and physi- The accessibility, low cost,
pregnancy (lemon balm). Prac- ology of aromatherapy; the use of and low side effect profile make
titioners must practice in an essential oils; extraction meth- aromatherapy attractive for man-
ethical and safe manner based ods; oil quality and absorption; aging emotional distress. In ad-
on professional aromatherapy carrier oils; blending techniques; dition, its wide adaptability and
and nursing guidelines (Buckle, methods of application; clinical ease of use make it easy to tailor
2003; d’Angelo, 2002). therapeutics; and ethics. Aroma- to diverse inpatient and outpa-
therapy texts (Buckle, 2003; Lis- tient settings. Effective use re-
Aromatherapy Balchin, 2006) and a variety of quires adequate knowledge and
Education Internet resources available from skills and the ability to safely tai-
Safe use of essential oils re- AHNA and NAHA may also be lor interventions to the unique
quires an understanding of bota- helpful to nurses interested in us- needs of each client. The art of
ny, biochemistry, physiology, and ing aromatherapy. nursing requires a balanced and
essential oil therapeutics, includ- integrative approach to healing.
ing dosing, administration, toxic- Conclusion Aromatherapy is a healing prac-
ity, interactions, and side effects Clinical aromatherapy shows tice that blends the “essence” of
(Buckle, 2003). Essential oils can promise as a safe alternative or science with the holism inherent
be used by nurses, but advanced complement to traditional health in the art of nursing.
training should be obtained be- care interventions to relieve
fore clinical use. Continuing edu- stress, reduce anxiety, and im- References
cation programs in aromatherapy prove mood; however, more re- Atsumi, T., & Tonosaki, K. (2007). Smell-
ing lavender and rosemary increases
can be found through the Ameri- search is needed. Suggestions for
free radical scavenging activity and de-
can Holistic Nurses Association future research include interven- creases cortisol level in saliva. Psychiatry
(AHNA) and the National As- tion studies that isolate the effects

Journal of Psychosocial Nursing • Vol. 46, No. 10, 2008 51


Research, 150(1), 89-96. Lemon, K. (2004). An assessment of
Buck, L.B. (2004). Unraveling the sense treating depression and anxiety
of smell. Retrieved May 16, 2007, with aromatherapy. International
from the Nobel Prize Web site: Journal of Aromatherapy, 14(2),
http://www.nobelprize.org/nobel_ 63-69.
prizes/medicine/laureates/2004/ Lis-Balchin, M. (2006). Aromather-
buck-lecture.html apy science: A guide for healthcare
Buckle, J. (2003). Clinical aroma- professionals. London, United
therapy: Essential oils in practice Kingdom: Pharmaceutical Press.
(2nd ed.). New York: Churchill Louis, M., & Kowalski, S.D. (2002).
Livingstone. Use of aromatherapy with hos-
Buckle, J. (2007). Literature review: pice patients to decrease pain,
Should nursing take aromather- anxiety, and depression and to
apy more seriously? British Journal promote an increased sense of
of Nursing, 16, 116-120. well-being. American Journal of
Burnett, K.M., Solterbeck, L.A., & Hospice & Palliative Care, 19,
Strapp, C.M. (2004). Scent and 381-386.
mood following an anxiety-pro- Moss, M., Cook, J., Wesnes, K., &
voking task. Psychological Reports, Duckett, P. (2003). Aromas of
95, 707-722. rosemary and lavender essential
d’Angelo, R. (2002). Aroma- oils differentially affect cogni-
therapy. In S. Shannon (Ed.), tion and mood in healthy adults.
Handbook of complementary and International Journal of Neurosci-
alternative therapies in mental ence, 113, 15-38.
health (pp. 71-92). San Diego, Muzzarelli, L., Force, M., & Sebold,
CA: Academic Press. M. (2006). Aromatherapy and
Field, T., Diego, M., Hernandez-Reif, reducing preprocedural anxiety:
M., Cisneros, W., Feijo, L., Vera, A controlled prospective study.
Y., et al. (2005). Lavender fra- Gastroenterology Nursing, 29,
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of Neuroscience, 115, 207-222. Aromatherapy. (2005). Standards
Fowler, N.A. (2006). Aromatherapy, of training. Retrieved September
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sis management by adolescents org/standards.htm
in a residential treatment center. Robins, J.L. (1999). The science and
Journal of Child and Adolescent art of aromatherapy. Journal of
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Hogan, B.K., & Shattell, M.M.
(2007). Fallout from the bio- Ms. Butje is Clinical Aroma-
logical model: Implications for therapist; Aromatherapy Educator;
psychiatric mental health nurses. Essential Oil Importer; Owner, Aro-
Issues in Mental Health Nursing, mahead Institute (NAHA-approved
28, 435-436. Aromatherapy Institute); and
Itai, T., Amayasu, H., Kuribayashi, Owner, Aromatics International
M., Kawamura, N., Okada, (International Internet store for
M., Momose, A., et al. (2000). essential oils), Sarasota, Florida.
Psychological effects of aroma- Ms. Repede is a doctoral student,
therapy on chronic hemodialysis and Dr. Shattell is Assistant Profes-
patients. Psychiatry and Clinical sor, University of North Carolina
Neurosciences, 54, 393-397. at Greensboro, School of Nursing,
Kuroda, K., Inoue, N., Ito, Y., Ku- Greensboro, North Carolina.
bato, K., Sugimoo, A., Kakuda, The authors disclose that
T., et al. (2005). Sedative ef- they have no significant financial
fects of the jasmine tea odor and interests in any product or class
(R)-(-)-linalool, one of its major of products discussed directly or
odor components, on autonomic indirectly in this activity, including
nerve activity and mood status. research support.
European Journal of Applied Physi- Address correspondence to
ology, 95, 107-114. Mona M. Shattell, PhD, RN,
Lehrner, J., Marwinski, G., Lehr, S., Assistant Professor, University of
Johren, P., & Deecke, L. (2005). North Carolina at Greensboro,
Ambient odors of orange and School of Nursing, PO Box 26170,
lavender reduce anxiety and Moore Building 320, Greensboro,
improve mood in a dental office. NC 27402; e-mail: mona.shattell@
Physiology & Behavior, 86, 92-95. gmail.com.

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