Aromatherapy for Self-Care and Wellness

Full text

Amy Cook, M.S., O.T.R./L., C.A., and
Ann Burkhardt, M.A., O.T.R./L., B.C.N., F.A.O.T.A.
O
ccupational therapy (OT) is not just concerned with
rehabilitation; wellness is also discussed in OT litera-
ture. Recent descriptive and research literature has pre-
sented practical and occupation-based perspectives on wellness
and OT practice.
1–5
Much of the interest in wellness can be
attributed to increased human consciousness about the signifi-
cance of maintaining or developing physical, spiritual, and emo-
tional well-being.
Most occupational therapists would agree that they have a role
to play in helping people stay well, and the OT Practice Frame-
work states that health promotion and prevention are important
OT intervention methods.
6
There are many ways in which OT
practitioners can specifically help clients meet wellness and
health-promotion goals. Practitioners can promote a host of occu-
pations and methods for empowering people to strive for health
and well-being.
Aromatherapy is a complementary care tool for wellness that
can assume a meaningful role in OT practice. Because OT is
about doing, it is important that aromatherapy, like most well-
ness approaches, be presented to the client as something that is
done for one’s self. OT practitioners commonly teach clients
health-promoting occupations, such as progressive relaxation,
work simplification, joint protection, visualization, breathing
techniques, time-management skills, meditation, yoga, and t’ai
chi. Aromatherapy can be used much in the same manner, specif-
ically as an occupation of self-care that clients can learn to imple-
ment to promote physiologic, spiritual, or emotional wellness.
This article introduces OT practitioners to aromatherapy and
some of its basic concepts, with the hope that readers will consid-
er studying aromatherapy for the purpose of teaching clients to
adopt it as part of wellness routines and occupations. It should
be noted that OT practitioners are cautioned against teaching
clients about aromatherapy without first obtaining competency
in this area.
Aromatherapy Basics
Aromatherapy is the art and science of using aromatic plant
essential oils for therapeutic purposes. Essential oils are extracted
from plants that contain volatile oils. This extraction process
occurs through steam distillation, cold pressing, or solvent
extraction. Essential oils are used in the perfume and food indus-
tries and for therapy. Therapeutic oils can be purchased from
retail or wholesale suppliers. Some essential oils are costly
because they require a great deal of plant material to produce,
while others are relatively inexpensive.
Essential oils should be purchased from reputable suppliers. It
is important to ensure that the botanical name is indicated on the
bottle label (Table 1 provides names of commonly used essential
oils). There are many suppliers of essential oils and prices vary,
so it is best to shop around for quality.
Aromatherapy in Societal and Health Care Contexts
In the United States, aromatherapy is largely a commercial
enterprise that focuses on marketing and selling “aromatherapy
products,” some of which are hardly therapeutic. One cannot
help but notice the overpowering aroma of the “aromatherapy
candle” aisle at some local retail department stores. But, true aro-
matherapy involves using real, pure, unadulterated essential oils
extracted from aromatic plants.
From a clinical or therapeutic standpoint, massage therapists use
aromatherapy more often than other service providers in the United
States. There are holistic nurses in the United States that also embrace
the use of aromatherapy from a clinical perspective. Buckle
7
wrote
the first U.S. aromatherapy text specifically for nursing practice.
It is important to note that much of the aromatherapy move-
ment within the traditional health care model focuses on the
client being a passive recipient of services, rather than on aro-
matherapy as something one does for oneself, specifically as an
occupation of personal health and well-being. Therefore, OT has
a unique role in promoting aromatherapy as a client-centered
wellness and/or self-care occupation within the medical and
community health models.
In the United States, aromatherapy has been slow to catch on
from a clinical perspective, most likely because of heavy regula-
tion of medical and allied health practices and the cautious and
staunchly empirical approach of the American Medical Associa-
tion toward the acceptance and use of complementary and alter-
native medicines. In England, however, where most
complementary therapies are self-regulated and unlicensed, aro-
matherapy is an established and accepted health care profession.
8
For example, in 1955, Price and Price
8
wrote a noteworthy British
aromatherapy text for health care professionals.
151
Aromatherapy for Self-Care
and Wellness
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In Europe and other parts of the world aromatherapy is con-
sidered a bona-fide complement to the orthodox medical model,
with a good deal of the clinical research on aromatherapy coming
from outside the United States; much of it comes from England,
Australia, and Japan.
Application of Essential Oils
Aromatherapy is used in several ways: topically (massage, bath,
compress), intensively (orally, rectally, or vaginally), or via olfaction
(diffusion, inhalation). For topical application, essential oils are pri-
marily applied to the body with massage, baths, and hot and cold
compresses. Essential oils must always be diluted in a fatty oil (e.g.,
sweet almond [Prunus amygdalus] oil, olive [Olea europaea] oil) before
placing on the skin to avoid skin irritation. For baths and massages,
oils can be added directly to water and swished around before
applying to the skin (Table 2 outlines methods for topical use).
Aromatherapy in the Literature
There is little to no persuasive evidence indicating that essen-
tial oils are absorbed through the skin. This is a topic that is heat-
edly debated in aromatherapy circles
9
because it is nearly
impossible to pinpoint whether benefits of topical application
occur from absorption of the oils through the skin, through
inhalation, or from the combination of topical application and
inhalation.
It is important to note, however, that topical application of
essential oils (e.g., massage, baths) has shown some promise for
reducing stress and promoting well-being and relaxation in
patients who participated in some studies
10–12
One study on use of aromatherapy in patients with cancer
examined the qualitative aspects of this therapy.
10
Another study
tested topical application of lavender (Lavendula angustifolia)
essential oil with foot baths and detected subtle autonomic ner-
vous system changes in participants.
13
There are also studies on
cancer, palliative, and dementia care that have indicated benefits
of topical aromatherapy application for promoting clients’ well-
being.
14–16
Aromatherapy in OT
In some instances, OT practitioners may want to recommend
that clients use topical application of essential oils for wellness
purposes. For example, an OT practitioner, who has acquired
competence in aromatherapy and massage techniques, can
instruct family members or caregivers on how to perform local-
ized aromatherapy massages on family members or clients.
These applications may be in the form of hand or foot massages.
This intervention is particularly appropriate for dementia or pal-
liative care and empowers a caregiver to engage in an occupation
that helps a loved one who is being cared for.
OT practitioners can also teach clients to use aromatherapy
baths for relaxation and stress reduction, as part of overall well-
ness plans. In this instance aromatherapy is integrated into the
realm of personal self-care occupations.
Occupational therapists who are trained in aromatherapy are
therefore strongly encouraged to take a client-centered, occupa-
tion-based approach by teaching clients and their caregivers about
aromatherapy and how to use it safely for the purpose of individu-
alized self-care or for care of others. We have successfully imple-
mented this type of educational and occupation-based approach
with clients with a variety of physical and psychosocial challenges.
Safety Concerns
It cannot be emphasized enough that topical use of essential
oils requires training and study. All essential oils have the poten-
tial to irritate the skin when applied topically. Irritation can
152 ALTERNATIVE & COMPLEMENTARY THERAPIES—JUNE 2004
Ta b le 1. Some Essential Oils Commonly
Used in Aromatherapy
Latin binomials Common names Uses
Lavendula angustifolia Lavender Sedation
Citrus bergamia Bergamot Stimulation; uplift
Eucalyptus globulus Eucalyptus Address congestion;
coughs
Melaleuca alternifolia Tea tree Antifungal
Rosemarinus officinalis Rosemary Stimulation;
enhance concentration
Boswellia carterii Frankincense Enhance meditation
practice
Ta b le 2. Directions for Topical
Use of Essential Oils
Uses Directions for patients
Massage Essential oils should always be diluted in a quality
fatty carrier oil before they are applied to the skin.
Examples of carrier oils are sweet almond,
a
grape
a
seed, and olive
a
oil. Oils should be diluted to 2%
for adults and 1% for children, older adults, and
frail people. To create a 2% dilution, for every 5
mL
b
of carrier oil add 2 drops of essential oil; to
create a 1% dilution, for every 5 mL of carrier oil,
add 1 drop essential oil.
Baths Fill bathtub with warm water. Add 3 or 4 drops of
essential oil or blend with the water when the tub
is full. The heat of the bath water will evaporate
the essential oils quickly, so add them last. One can
also dilute the essential oils in some fatty milk to
make the skin smooth and soft.
Compresses Using either warm or cold water in a bowl, add 2
or 3 drops of essential oil or blend; swish and soak
washcloth; wring; and apply to affected area.
Replace when temperature of the oil normalizes.
Compresses work well for any situation when pain
management is needed and assist in first aid.
a
Latin binomials are, respectively, Prunus amygdalus, Vitis vinifera, and Olea europaea
b
5 mL = 1 teaspoon.
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occur in the form of blistering, redness, or rashes. Some essential
oils are also phototoxic.
17
Some oils should also not be used dur-
ing pregnancy or with children.
8
A great deal of data on the topi-
cal safety of essential oils can be accessed from the perfume
industry or through in vitro studies.
18–20
Any OT practitioner trained in aromatherapy should consult
resources on essential oil safety and should be well-versed in the
potential toxicity of every essential oil used. When teaching
clients to use aromatherapy, it is important to use clinical judg-
ment when considering whether a client is capable of using
essential oils safely. Because of the potential for misuse of essen-
tial oils, coupled with the skin-irritation factor, we generally limit
client instruction of topical use to safe oils, and only after doing a
skin patch test for safety (Table 3).
With regard to use for inhalation, it has also been posited that
some essential oils should not be inhaled by individuals with
medical conditions, such as seizure disorders and asthma.
8
Cer-
tainly, in any event, essential oils should always be used in a
well-ventilated room.
Intensive use (oral, rectal, vaginal application) of essential oils
is not widely practiced in the United States. In France, some med-
ical doctors prescribe essential oils intensively in capsules or sup-
positories. However, essential oils can be highly toxic when
consumed orally or when directly applied to mucous mem-
branes.
Some essential oils are lethal even in the smallest amounts.
These methods of use are beyond the scope of most individuals
that use aromatherapy and are never appropriate for use in OT
practice. They warrant mentioning here only because of the
importance of knowing the potential danger of such uses.
How Essential Oils Work
The most common method of use of essential oils is through
the sense of smell. There is some evidence that essential oils are
absorbed in the body through olfaction and that inhalation of oils
can alter emotional states and stimulate memories.
Physiology
The olfactory system is linked directly to the midbrain, and it
is there that emotional state(s) and memories are regulated.
Olfaction is stimulated when odors activate receptors in the
epithelium that covers the cribriform plate and upper half of the
three nasal conchae. There are supporting cells in between the
olfactory receptor cells that secrete mucus. The mucus traps the
chemicals (“odors”). These cells are broken down and replaced
by basal stem cells (via cellular mitosis) every month.
The facial nerve (cranial nerve VII) innervates the olfactory
epithelium and its glands to produce mucous secretion. The
odor/chemicals bond to transmembrane receptors in the den-
drites (first-order neurons), opening the sodium channel, gener-
ating a potential and a nerve impulse. There is rapid adaptation
of the nerve fibers and the fibers adjust to the odor within a few
seconds to a few minutes.
Unmyelinated neurons extend through the foramina in the
crista galli of ethmoid bone and synapse with the second order
neurons in the olfactory bulb. The impulse is transmitted along
the olfactory tract (cranial nerve I) to the lateral olfactory area of
the temporal lobe to produce awareness of the smell. Neural con-
nections transmit the signal to the thalamus and the frontal lobe
to identify the smell. Further connections to the hypothalamus
and limbic system evoke an emotional response and generate
odor-related memories.
21
ALTERNATIVE & COMPLEMENTARY THERAPIES—JUNE 2004 153
Ta b le 3. Skin-Patch Testing: Advice and
Directions to Give Patients
• Any time an essential oil is to be used on the skin, one should
conduct a skin patch test to determine if one is allergic to the oil.
• Apply 1 drop of the essential oil on the anterior surface of the
forearm and cover with a Band Aid.
• Check the area in 24 hours
• If there is redness, itching, or a blister, this indicates a topical
allergy to that oil and, thus, it should not be used topically.
Rosemary (Rosemarinus officinalis).
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Effects
Several controlled studies have indicated that inhalation of
certain aromas can bring about specific emotional and memo-
ry changes, including mental status changes in people with
dementia,
22,23
relaxation in healthy adults, and stimulation of
memory in healthy adults.
24
Another study showed that
inhalation of lavender and rosemary (Rosemarinus officinalis)
essential oils improved alertness and mathematical computa-
tion skills in a sample of adults.
25
Thus, current research indi-
cates that aroma has the power to induce relaxation,
concentration, or memory skills and is of benefit to individu-
als who want or need to address such areas of occupational
performance.
Essential oils are commonly diffused or dispersed in the air
and are inhaled by individuals. There are a myriad of devices for
diffusing essential oils, including fan-operated diffusers, ultra-
sonic atomizers, electric devices with essential-oil soaked pads,
light bulb rings, and clay pots with tea light candles or light
bulbs. Essential oils are best dispersed with a gentle, safe heat
source and as noted above used in well-ventilated areas of the
environment.
When teaching clients to use essential oils in diffusion, it is
important that the OT practitioners be well-versed in how each
oil can potentially affect an individual emotionally, physically,
and/or cognitively. Essential oils also work well when blended
together. There is an art to blending essential oils, and most indi-
viduals learn to blend through study and practice.
Clients can be taught to diffuse or disperse essential oils as part
of general wellness routines, such as in the morning while
preparing for work, when meditating or practicing relaxation
techniques, or when helping a restless child fall asleep.
Clients with specific medical conditions can also be assisted to
use problem solving to integrate aromatherapy into daily rou-
tines. For example, a client with multiple sclerosis might choose
to set a personal goal for diffusing aromatherapy oils during an
afternoon relaxation and rest session, as part of an overall energy
conservation program. A parent with a child who has attention-
deficit hyperactivity disorder might be taught to place a drop of
lavender essential oil on the child’s pillow at bedtime to induce
relaxation. Staff members at a nursing home can be taught to dif-
fuse essential oils in residents’ rooms or public areas to promote
a pleasant, relaxing environment. Essential oils can also be used
as part of a sensory stimulation program for older adults with
dementia.
Conclusions
This article has provided OT practitioners with a framework
for using aromatherapy as an occupation-based tool for wellness
in OT. Practitioners must seek training and acquire competency
before teaching clients to use aromatherapy, as is expected with
any treatment technique, principle, or modality. It is recommend-
ed that OT practitioners who are interested in studying aro-
matherapy research available courses and programs carefully.
There are quality programs offered through distance learning
and there are also some that are classroom-based. With good
training, it is easy to use and teach aromatherapy safely and
effectively.
Aromatherapy is nurturing to the body, mind, and spirit. Any
therapist who learns about aromatherapy will personally experi-
ence the benefits of this dynamic and creative area of wellness
and will ultimately be able to teach a valuable wellness-based
occupation to interested clients and their caregivers. ■
References
1. Burkhardt A. Occupational therapy and wellness. OT Pract
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154 ALTERNATIVE & COMPLEMENTARY THERAPIES—JUNE 2004
Resources
Essential Oil Suppliers
SunRose Aromatics, LLC
P.O. Box 98
Bronx, NY 10465
Phone: (718) 794-0391
e-mail: support@sunrosearomatics.com
Web site: www.sunrosearomatics.com
Aura Cacia
Frontier Natural Products Co-Op
P.O. Box 299
3021 78th Street
Norway, IA 52318
Phone: (800) 437-3301
Fax: (800) 717-4372
Web site: www.auracacia.com
Programs for Study
Australasian College of Health Sciences
5940 SW Hood Avenue
Portland, OR 97239
Phone: (800) 487-8839
Web site: www.achs.edu
The aromatherapy department’s courses include Introduction
Aromatherapy, Certificate in Aromatherapy, Aromatherapy Blending
and Repertoire, Establishing an Aromatherapy Consultancy,
Aromatherapy Chemistry. There is also an Aromatherapy Summer
School in Provence, France, and a Diploma in Aromatherapy
Distance Education program. For more information on locations or
distance-learning options, visit the College’s Web site. All courses
are trademarked by the College.
R.J. Buckle Associates, LLC
Contact is completely electronically based
e-mail: info@rjbuckle.com
Web site: www.rjbuckle.com
Courses include Aromatherapy for Health Professionals,
Foundations in Clinical Aromatherapy, The “M” Technique
®
(a
registered method of touch including stroking movements for use
with fragile patients), and customized course for specialized areas
such as chronic pain, women’s health, AIDS/HIV, pediatrics, and
long-term care.
The authors have no vested interest in the products and educational programs metioned
in this article. This information is only provided as a resource for the reader. The reader
is encouraged to research all products and aromatherapy training programs carefully
before purchasing.
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Amy Cook, M.S., O.T.R./L., C.A., is a certified aromatherapist and regis-
tered ocupational therapist with more than 13 years of experience work-
ing with children, adults, and older adults in a variety of clinical settings.
Ann Burkhardt, M.A., O.T.R./L., B.C.N., F.A.O.T.A., is the director of
occupational therapy at New York Presbyterian Hospital-Columbia Pres-
byterian, in New York City.
To order reprints of this article, write to or call: Karen Ballen, ALTERNA-
TIVE & COMPLEMENTARY THERAPIES, Mary Ann Liebert, Inc., 2
Madison Avenue, Larchmont, NY 10538-1961, (914) 834-3100.
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