Aromatherapy with ylang ylang for anxiety and self-esteem: A pilot study

Abstract

Objective:
To verify if the use of ylang ylang essential oil by cutaneous application or inhalation alters the anxiety and self-esteem perception and physiological parameters as blood pressure and temperature. Method : A pilot study with 34 professionals from a nursing group randomized in three groups: one received the ylang ylang essential oil by cutaneous application, the second received through inhalation and the third (placebo) received the ylang ylang essence through cutaneous application. The assessment was done by an Anxiety Inventory (IDATE) and the Dela Coleta self-esteem scale, applied on baseline, after 30, 60 and 90 days and after 15 days post-intervention (follow up). Results : In the pre and post-intervention intergroup analysis, there was a significant difference in self-esteem for the three groups (p values: G1=0.014; G2=0.016; G3=0.038). There were no differences in the analysis between groups for anxiety or for physiological parameters. Conclusion : It was found significant alterations only to the intergroup perception of self-esteem for the three groups.

Full text

492
Rev Esc Enferm USP
2014; 48(3):492-9
www.ee.usp.br/reeusp/
Aromatherapy with ylang ylang for anxiety and
self-esteem: a pilot study
Gnatta JR, Piason PP, Lopes CLBC, Rogenski NMB, Silva MJP
RESUMEN
Objevo: Vericar si el uso del aceite
esencial de ylang ylang por medio de la
aplicación cutánea o la inhalación altera
la percepción de la ansiedad y autoesma,
así como de los parámetros siológicos de
presión arterial y temperatura corporal.
Método: Estudio piloto en el cual parci-
paron 34 profesionales de enfermería dis-
tribuidos en tres grupos: el primero recibió
aceite esencial por vía tópica, el segundo
por vía inhalatoria y el tercero (placebo)
esencia de ylang ylang por vía tópica. La
evaluación se realizó aplicando el Inventa-
rio de Ansiedad (IDATE) y la Escala de Au-
toesma de Dela Coleta antes y después
de 30, 60 y 90 días y 15 días después del
período de uso. Resultados: En la evalu-
ación intra grupo, antes y después de la
intervención, hubo diferencias signica-
vas para los tres grupos en la variable au-
toesma (valores p: G1=0,014; G2=0,016;
G3=0,038). No hubo diferencias en los
análisis entre grupos para la ansiedad o
para los parámetros siológicos. Conclusi-
ón: Hubo solamente cambios signicavos
en la percepción de la autoesma intra
grupo para los tres grupos.
DESCRIPTORES
Aromaterapia
Cananga
Ansiedad
Autoimagen
Terapias complementarias
Enfermería
RESUMO
Objevo: Vericar se o uso do óleo essen-
cial de ylang ylang por meio de aplicação
cutânea ou inalatória altera a percepção
da ansiedade e da autoesma e os parâ-
metros siológicos como pressão arterial
e temperatura. Método: Estudo piloto
no qual parciparam 34 prossionais da
equipe de enfermagem randomizados em
três grupos: um recebeu o óleo essencial
de ylang ylang via cutânea, o segundo o
recebeu via inalatória e o terceiro (place-
bo) recebeu essência de ylang ylang via
cutânea. A avaliação foi feita por meio do
Inventário de Ansiedade (IDATE) e da esca-
la de autoesma de Dela Coleta que foram
aplicadas antes, ao nal de 30, 60 e 90 dias
e 15 dias (follow up) após o término do
uso. Resultados: Na avaliação intragrupo,
antes e após a intervenção, houve diferen-
ça signicante para os três grupos na vari-
ável autoesma (valores de p: G1=0,014;
G2=0,016; G3=0,038). Não houve diferen-
ças nas análises entre grupos para a ansie-
dade ou para os parâmetros siológicos.
Conclusão: Houve alterações signicavas
apenas na percepção da ansiedade intra-
grupo para os três grupos.
DESCRITORES
Aromaterapia
Cananga
Ansiedade
Autoimagem
Terapias complementares;
Enfermagem
ABSTRACT
Objecve: To verify if the use of ylang
ylang essenal oil by cutaneous applica-
on or inhalaon alters the anxiety and
self-esteem percepon and physiological
parameters as blood pressure and tem-
perature. Method: A pilot study with 34
professionals from a nursing group ran-
domized in three groups: one received
the ylang ylang essenal oil by cutaneous
applicaon, the second received through
inhalaon and the third (placebo) recei-
ved the ylang ylang essence through cuta-
neous applicaon. The assessment was
done by an Anxiety Inventory (IDATE) and
the Dela Coleta self-esteem scale, applied
on baseline, aer 30, 60 and 90 days and
aer 15 days post-intervenon (follow up).
Results: In the pre and post-intervenon
intergroup analysis, there was a signicant
dierence in self-esteem for the three
groups (p values: G1=0.014; G2=0.016;
G3=0.038). There were no dierences in
the analysis between groups for anxiety or
for physiological parameters. Conclusion:
It was found signicant alteraons only to
the intergroup percepon of self-esteem
for the three groups.
DESCRIPTORS
Aromatherapy
Cananga
Anxiety
Self concept
Complementary therapies
Nursing
Aromatherapy with ylang ylang for
anxiety and self-esteem: a pilot study
Original article
Juliana Rizzo Gnatta1, Patricia Petrone Piason2, Cristiane de Lion Botero Couto Lopes3, Noemi
Marisa Brunet Rogenski4, Maria Júlia Paes da Silva5
AROMATERAPIA COM YLANG YLANG PARA ANSIEDADE E AUTOESTIMA: ESTUDO PILOTO
AROMATERAPIA CON YLANG-YLANG PARA LA ANSIEDAD Y AUTOESTIMA: UN ESTUDIO PILOTO
1 PhD student in Health Sciences, Nursing School, Universidade de São Paulo, São Paulo, SP, Brazil. juliana.gnatta@gmail.com 2 Bachelor student in
Nursing, Nursing School, Universidade de São Paulo, São Paulo, SP, Brazil. 3 Chief Nurse in the Central of Materials and Sterilization, Hospital Universitário,
Universidade de São Paulo, São Paulo, SP, Brazil. 4 Director of Surgical Nursing Division, Hospital Universitário, Universidade de São Paulo, São Paulo, SP,
Brazil. 5 Head Professor, Department of Medical-Surgical Nursing, Nursing School, Universidade de São Paulo, São Paulo, SP, Brazil.
Received: 11/22/2013
Approved: 03/27/2014
DOI: 10.1590/S0080-623420140000300015
Português / Inglês
www.scielo.br/reeusp

493
Aromatherapy with ylang ylang for anxiety and
self-esteem: a pilot study
Gnatta JR, Piason PP, Lopes CLBC, Rogenski NMB, Silva MJP
Rev Esc Enferm USP
2014; 48(3):492-9
www.ee.usp.br/reeusp/
INTRODUCTION
Aromatherapy is a therapeuc technique based in the
use of essenal oils (EO). Aroma means pleasant odor and
therapy means treatment that aims cure of a physical,
emoonal or mental indisposion. This pracce uses vola-
le concentrates extracted from plants – essenal oils –
and its objecve is to modify a behavior or humor. The EO
is a condensate obtained from vegetable disllated ma-
terials, as roots, stems, leaves, owers, fruits, seeds and
resins(1). They are composed by high complexity chemical
molecules that can be applied directly to the skin or to be
inhaled. When the contact is cutaneous, the EO crosses
the skin barrier due to its small and low weight molecules,
they are absorbed and falls into the blood stream which
transports it to the ssues and organs(2). When the OE
is inhaled, its molecules are absorbed by the nostrils and
it contacts the olfactory nerves that are directly connect-
ed to the Central Nervous System and take the smulus
to the Limbic System that is responsible for the feelings,
memory, impulses and emoons(2).
The aromatherapy can be used with massage and it is
absorbed by the skin or olfactory system. Studies found that
the olfactory smulus produces changes in parameters as
blood pressure and in skin temperature(3), it reduces anxiety
by massage and aromatherapy in breast cancer paents(4),
reduces anxiety in nurses of emergency team during the win-
ter and summer with massage and aromatherapy(5) and has
posive eects in anxiety and self-esteem in elderly woman
through massage, aromatherapy and music(6).
A research was conducted recently in a teaching hos-
pital about the use of aromatherapy with ylang ylang and
rose EO to enhance self-esteem in workers from the Cen-
tral of Material and Sterilizaon and Hygiene Service(7).
The results pointed that more studies are needed with an
inial sample with low self-esteem and that invesgates
the best way to deliver the EO (cutaneous or inhalaon),
as well as its frequency of use. Proposals like this, which
cares for nursing professionals, has represented a new
path to quality assistance. The excellence in the Nursing
care also depends on the professional’s psycho emoon-
al condion, therefore the focus of caring for the team
member helps to build a healthier work environment and
to perform a more structured, planned and solid care(8).
Thus, a tool, which can be implemented to the Nursing
care, is the aromatherapy, considered one of the Natural
Therapies/Tradional and Complementary/Not Convenon-
al in accordance with the Municipal Law of São Paulo 13.717,
implemented in 2004(9). The World Health Organizaon(10)
has smulated the use of Complementary Therapies (CT)
and the development of scienc studies to obtain beer
knowledge of ecacy, safety and quality of those pracces.
In the case of Nursing, the use of CT can be promoted by its
professionals once the specic law from the regulatory sec-
tor of their profession to pracce it(11) protects them.
The ylang ylang (Cananga odorata) EO was chosen for
this research due to its aroma’s therapeuc properes as
described in the literature. It is found that the ylang ylang
oil is andepressant and it is indicated for anxiety, frus-
traons, nervous tension, fear and depression(1-2,12), and it
was used for a self-esteem study with a Nursing team(7).
Low self-esteem and anxiety can be related to many or
few of those emoonal condions. This OE is chemically
derived from the mevalonic acid, which comes from the
Acetyl coenzyme A. Hydrocarbons and hydroxyl groups
constute it, which gives it a pleasant odor and generates
a revitalizing sensaon(12).
Anxiety is an emoonal state that encloses psychologi-
cal and physiological components and it has feelings as
fear, insecurity, apprehension and alert state alteraon.
Anxiety becomes pathologic when it is not proporonal to
the situaon which started it, or when there is no specic
object directed(13).
Self-esteem incorporates two components: sense
of personal competence and sense of personal value. If
those two are unbalanced, there is negave self-esteem,
which manifests inadequacy, insecurity, doubts, guilt and
fear. When balanced, the posive self-esteem generates
condence towards life, competence and merit feelings.
Self-esteem does not show as negave or posive, but
when in low levels, every human being is capable of devel-
oping and enhancing it(14).
The present study used aromatherapy with ylang
ylang EO as care tool for the nursing group, quesoning if
this pracce produces posive eects for anxiety and low
self-esteem enhancement for nursing professionals. The
study objecves were to verify if the ylang ylang EO alters
anxiety and self-esteem percepon, to compare if the ap-
plicaon of ylang ylang EO by cutaneous or inhaling paths
alters the physiological parameters measured through
mean blood pressure and temperature.
METHOD
An experimental controlled eld pilot study with
quantave approach, conducted at the University Hos-
pital from Universidade de São Paulo (HU-USP). The study
aended the Resoluon 196/1996, from the Naonal
Health Council, involving human beings in the research
and it was iniated aer the Hospital Research and Eth-
ics Commiee approval, under n° 1153/11 SISNEP CAAE
0038.0.198.000-11. Besides that, for ethical maers, it
was assured to the parcipants from the control group
the opportunity to use the gel or freshener with the ylang
ylang EO aer the intervenon, for the same period as the
study lasted, as a free choice.
Sample inclusion criteria: to be a nursing employee
at the HU-USP and not during experience period; to ac-
cept parcipaon in the research, to ll and sign the Free

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Rev Esc Enferm USP
2014; 48(3):492-9
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Aromatherapy with ylang ylang for anxiety and
self-esteem: a pilot study
Gnatta JR, Piason PP, Lopes CLBC, Rogenski NMB, Silva MJP
Informed Consent Term (TCLE); to accept the gel or fresh-
ener use with the EO or ylang ylang essence; to answer the
Anxiety Inventory(15) (IDATE), the Dela Coleta self-esteem
scale(16) and the informaon about socio demographic data;
to present moderate, high or really high anxiety at IDATE(15),
medium or low self-esteem at the Dela Coleta scale(16); to
accept not wearing perfume during the study period; to ac-
cept olfacvely the ylang ylang aroma. Sample exclusion
criteria: to take vacaons or any kind of me out that would
aect the oil or essence use during this period, to not ad-
here to the protocol during baseline tesng or, hypotension
self-reported.
Aer the research approval, there was a two-week
adversement by intranet, posters inside elevators, in the
unit kitchens and in the HU-USP employees’ community
center. Those who accepted to parcipate aer learning
about the study objecve and method, signed the TCLE
and aer, each volunteer answered the IDATE(15) and the
Dela Coleta self-esteem scale(16). As explicated, the sub-
jects with high or really high scores in the IDATE(15) and me-
dium or low self-esteem by the Dela Coleta scale(16) were
selected. It was opted to blind the Dela Coleta scale(16) by
hiding the word self-esteem in the instrument, as there is
a possibility that people have a hard me to assume hav-
ing a low self-esteem.
Two tests were conducted aer the potenal sub-
jects were selected and before the randomizaon. The
rst one was to verify the EO olfactory acceptance by
the possible subject. For that, the ylang ylang EO was
oered in a bole. The person would inhale it and tell if
that odor was pleasant. The second test had the inten-
on to maximize the follow-up and the protocol adher-
ence. During one-week period, all parcipants that were
candidates to parcipate in the study used a gel (carbo-
gel) with only the ylang ylang essence (placebo) with
a 2% concentraon. The parcipants were instructed
to use the gel three mes a day as follows: when living
their homes to go to work at the Instuon where the
research was conducted, when leaving their shis and
before sleeping. The choice of moments for its applica-
on was due to the lack of literature consensus for dose,
frequency and ways to apply the oil essences. The indi-
cated points were the two wrists and the sternum area.
The gel was applied and massaged in place with circular
movements for 30 seconds, unl its absorpon in each
region. Aer this period, only those who adhered to the
gel-placebo as indicated were randomized. In the data
collecon, it was not informed to them that they were
using the placebo product.
The subjects that passed in the two entrance tests were
part of the study sample and each one of them were sort-
ed to parcipate in one of the three groups: Group 1: re-
ceived the gel with 2% ylang ylang EO (G1); Group 2: pla-
cebo received gel with 2% ylang ylang essence (G2);
Group 3: received a personal freshener with pure ylang
ylang EO (G3). It was determined that the placebo group
would use the enriched gel with ylang ylang essence for
two reasons. First, in accordance with the literature, the
EO is composed by a number of chemical substances
proper from the plant, which give it the aroma therapeu-
c property and, for this reason, could not be substuted
by a synthec substance. While the synthec products,
known as essences, acts in only one way (relave to the
acve chemical compound), the EO acts in a broader way
in the body(17). The second reason for opng for only one
type of intervenon, the essence enriched gel and not the
freshener with essence, was because it was considered
harder to a subject to adhere to an intervenon protocol
that demands more me and it is done by himself/herself.
The Group 1 and Group 2 subjects respecvely re-
ceived, one bole of aromac gel (carbogel) enriched
with 2% concentraon of ylang ylang EO or essence, in
accordance to its group. Because it was found studies in
the literature that indicated massage with 20 minutes of
mean me with EO, three mes per week(3,6), it was deter-
mined that the gel contact with the skin would also be of
30 minutes/week, Thus, it was oriented that each parci-
pant should use the product as described in the start test,
during the 90 days.
The Group 3 subjects were responsible for pung one
drop of ylang ylang EO on the coon inside the personal
freshener before their work shis, and it should be used
during the whole shi, during a 90 days period. The gel
and fresheners were under subjects’ responsibility and
the researchers gave them.
The data was collected in ve moments by the IDATE(15)
and the Dela Coleta scale(16), both internaonally rec-
ognized and validated in Brazil and used in studies that
assessed the aroma therapy eect for anxiety(18-19) and
self-esteem(7), respecvely. The inventory and scale were
applied before the start of intervenon, aer one month
using the gel enriched with ylang ylang EO or the personal
freshener, aer sixty days and aer ninety days of use.
The data from the h moment were obtained at a 15 day
aer intervenon follow-up. Blood pressure and tempera-
ture were veried in the ve moments.
The data was typed into a Microso Excel spreadsheet
and processed in the SPSS (Stascal Package for the So-
cial Sciences) version 18.0 and analyzed quantavely. Be-
fore and aer tests were conducted for the dierence of
means for each month of EO use. The study was a before
and aer design and the subject was its own control. To
guarantee reliability in the obtained data, the Cronbach
Alpha (α) was applied to the results of IDATE prole and
the inial state obtained by those instruments at the rst
assessment. To assess the self-esteem, anxiety, mean
blood pressure and body temperature variables, a paired
T-test intragroup before and aer the intervenon and a
Variance Analysis (ANOVA) within groups. It was used the
Kolmogorov-Smirnov to verify the data normality and the
Levene test for the variances homogeneity.

495
Aromatherapy with ylang ylang for anxiety and
self-esteem: a pilot study
Gnatta JR, Piason PP, Lopes CLBC, Rogenski NMB, Silva MJP
Rev Esc Enferm USP
2014; 48(3):492-9
www.ee.usp.br/reeusp/
RESULTS
One hundred and twenty-one nursing professional
volunteered to ll the instruments(15-16) to check if they
met the indicated points for inclusion. From those, 46
volunteers met the recommended points and did the
two inial tests. Aer one week using the carbogel plus
ylang ylang essence, 45 parcipants started the study
and they were randomized in three groups, including 15
in G1, 15 in G2 and 15 in G3. Before nishing the rst
month of intervenon, there were 11 dropouts because
the parcipants did not adhere to the aroma use during
the study as proposed by the protocol. Therefore, stayed
in the groups: G1 – 10; G2 – 11; G3 – 13 volunteers. Thir-
ty four subjects nished the study.
The average age for the groups were 43.8 years (medi-
an = 45; standard deviaon = 8.46). Thirty-three parcipants
were female and only one male parcipant in the G1. Three
parcipants from G1 and two from G2 and G3 were using
an-depressant medicaon. Two subjects from G1 and two
from G3 were using an-hypertensive medicaon.
As menoned, the two instruments anxiety and self-
esteem data collecon, the IDATE and the Dela Coleta,
were applied in ve moments: 1) before start using ylang
ylang EO or essence (accordingly to the group where the
subject were), 2) aer 30 days using the aroma, 3) aer
60 days, 4) aer 90 days and 5) at a 15 day follow-up aer
using the aroma.
A paired T-test was made for an intergroup analysis
comparing the subjects before and aer the intervenon,
therefore, using the moments 1 and 4. The results are
described in Table 1. There were signicant dierences
observed only for the self-esteem variable for the three
groups, measured by the Dela Coleta instrument.
Table 1 – Distribution of means and p values after the paired T-test for intragroup analysis, before and after intervention, for the self-
esteem variables (Dela Coleta), Anxiety (Idate State), temperature and blood pressure – São Paulo, 2014
Analysis N
Dela Coleta Idate State Temperature MBP*
Mean p Mean p Mean p Mean p
G1 before
x G1 after
10 6.10
8.30 0.014 51.80
45.00 0.096 36.00
36.07 0.835 91.73
89.86 0.861
G2 before
x G2 after
11 8.18
11.18 0.016 46.27
41.54 0.091 36.06
36.06 1.000 91.33
92.09 0.892
G3 before
x G3 after
13 7.17
9.46 0.038 45.61
42.76 0.276 36.03
36.10 0.598 97.53
95.43 0.578
*MBP = mean blood pressure
Figure 1 – Distribution of mean score for subject’s anxiety
according to groups at the ve moments of the IDATE-state
instrument application – São Paulo, 2014.
To assure the reliability of the collected data for the
IDATE instrument(15), it was applied the Cronbach Alpha
(α). At the rst data collecon moment for the IDADE-
trace and inial state, it was found 0.808 for the IDADE-
trace and 0.931 for the IDATE-inial state.
An ANOVA was performed for the between groups
analysis for obtained scores in each moment, as described
previously. The sphericity assumpon was met (Mauchys
test, p = 0.331) and there was no dierence between the
three groups for the variable anxiety (p = 0.109). The Fig-
ure 1 demonstrates the scores mean distribuon in the
ve moments of assessment for anxiety, by the IDATE-
state instrument. It is observed that the gel plus ylang
ylang EO group (G1) shows a tendency to reduce the
anxiety scores, kept even aer the end of the aroma use
(follow-up), while the G2 and G3 showed a tendency to
increase the IDATE-state score.
An ANOVA was applied only at the rst moment
for the Dela Coleta instrument(16), normality was veri-
ed by the Kolmogorov-Smirnov test (p = 0.245) and
Levene test, indicang homogeneity in the means be-

496
Rev Esc Enferm USP
2014; 48(3):492-9
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Aromatherapy with ylang ylang for anxiety and
self-esteem: a pilot study
Gnatta JR, Piason PP, Lopes CLBC, Rogenski NMB, Silva MJP
fore the treatment for self-esteem in the three groups
(p = 0.226). The ANOVA applied for the obtained scores
at the ve moments previously described did not meet
the sphericity assumpon (Mauchlys test p = 0.000),
therefore, for the hypothesis test it was used the Green-
house-Geisser correcon, that indicated no dierence
between groups along the treatment (p = 0.437). Fig-
ure 2 demonstrates the distribuon of groups mean
scores in ve assessment moments for self-esteem
through the Dela Coleta instrument(16). It was observed
a self-esteem score reducon in the three groups at
the beginning of the intervenon and aer started to
increase and this tendency was sustained for the G1
and G3 groups. It is important to note that the G1 curve
keeps increasing, while the G3 has a tendency to stabi-
lize. The G2 curve indicates a possible decay behavior.
Figure 2 demonstrates the G2 (placebo) with a dier-
ent behavior from the other two groups at the second
moment of assessment, for this reason, it was applied a
second ANOVA which indicated no dierence between
the three groups (p = 0.141). It was noted no dierence
for the three groups at the end of treatment (p = 0.705).
a Greenhouse-Geisser correcon was applied for the hy-
pothesis test indicang no dierence between groups
along treatment (p = 0.875). Figure 4 shows the axillary
temperature mean distribuon in the ve groups for all
assessment moments.
Figure 2 – Mean distribution of self-esteem scores in accordance
with groups at the ve moments of Dela Coleta instrument
application – São Paulo, 2014.
Figure 3 – Mean distribution of MBP in accordance with groups
at the ve moments of assessment – São Paulo, 2014.
Figura 4 – Mean distribution of axillary temperature in accordance
with groups at the ve moments of assessment – São Paulo, 2014.
For the variable mean blood pressure (MBP) assessed
at ve moments with the described instruments as men-
oned before, an ANOVA was applied and the sphericity
assumpon was not met (Mauchlys test p = 0.000), and
a Greenhouse-Geisser correcon was applied for hypoth-
esis test indicang no dierence between groups along
the treatment (p = 0.398). Figure 3 demonstrates the MBP
means distribuon in the groups along treatment.
Lastly, for the axillary temperature measured at the
ve moments, an ANOVA was applied and the sphericity
assumpon was not met (Mauchlys test p = 0.030), and
DISCUSSION
Nowadays, nursing professionals are unsased with
their work and it shows how much it aects their acv-
ity results. In this profession, it is needed more than the
technical knowledge; there is the ability to recognize oth-
ers needs and to deal with human relaonships. Consider-

497
Aromatherapy with ylang ylang for anxiety and
self-esteem: a pilot study
Gnatta JR, Piason PP, Lopes CLBC, Rogenski NMB, Silva MJP
Rev Esc Enferm USP
2014; 48(3):492-9
www.ee.usp.br/reeusp/
ing those condions, it becomes a necessity to care about
Nursing because the physical and emoonal state of those
professionals interfere in reaching opmal performance or
frustraon(8). Aromatherapy as other CTs tries to enhance
ones physical, mental and emoonal well-being(7). The
ylang ylang EO was chosen for this study due to its indi-
caon for anxiety, frustraon, nervous tension, fears and
depression(1-2,12), and assistance to reduce blood pressure(3).
From the 45 parcipants who began the protocol,
only 34 concluded the research. The sample loss rate
was around 24% although it was sll inferior to the 1/3
of the expected loses for studies that uses the subjects´
adherence to the treatment as intervenon(20). This is
the reality not only faced by the CT but also by allopac
treatments, once the intervenon proposal depends on
the subject, similar to a prescribed treatment. There-
fore, the no adherence to the treatment was an exist-
ing possibility as a result in this research because there
was no therapist to do the procedure, which contributed
to eliminate the possibility of a therapeuc bond inter-
fering in the results, which is an adopted technique in
studies similar to aromatherapy for anxiety(18). Thus, the
minimizaon of bias through the entrance tests was a
strategy, excluding the subjects that did not adhere to
intervenon at the rst week of placebo use or that did
not accepted the ylang ylang odor. It was observed only
one dropout in this period and all other dropouts (11)
were during the rst month of intervenon. This situa-
on was a study limitaon suggesng a longer period
for entrance tests in future trials avoiding loses in the
sample, or a next clinical trial with a shorter period of
me using, for example, an experimental model that
induces anxiety, to avoid self-intervenon and the de-
pendence of the study to be carried out by parcipants.
Besides that, subming subjects to an anxiety will allow
measurements in a well delimited state before and aer
intervenon, in similarity to other studies that inves-
gated aromatherapy for anxiety(19, 21), and one of them
also applied the Anxiety Inventory as instrument(19).
For the IDATE instrument internal consistency evalu-
aon by the stascal indicator Cronbach Alpha (α) the
values were 0.808 for the IDATE- trace, 0.931 for the
IDATE- inial state, arming that the instrument was
considered valid and reliable with α >0.700 values.
Those ndings corroborate with the instruments assess-
ment of a similar study(18).
The pre and post intragroup analysis demonstrated sig-
nicant dierence only to self-esteem in three groups, and
applied the intergroup analysis; the dierences were not sig-
nicant as the three intervenons enhanced self-esteem in
similar levels. The study contributes to raise the importance
of a negave control inclusion for aromatherapy. It is pro-
posed the inhalaon or to use products that uses disllated
water instead of EO in its composion. That would facilitate
the intergroup comparison, in cases where the EO or essence
use has signicant results, as the present study results.
Although the alteraons in scores were not signicant
between groups, did the subjects noce dierence in its
state of anxiety and self-esteem? This queson could be
answered if a validated instrument that assesses emo-
onal alteraons by sensaons and self-perceived behav-
ioral changes, aiming to capture the subjects´ percepons
during the intervenon. Does the EO cutaneous contact
produces beer aromatherapeuc eects for anxiety and
self-esteem than inhalaon only? In this case, only studies
comparing two groups of intervenon as this could help
in this observaon. As there is no standards about the
essenal oils adequate dosages for aromatherapy in the
literature, maybe higher concentraons of EO responds
faster in comparison with an emoonal nuance.
As described in the literature that the ylang-ylang EO
can cause a hypotension eect or temperature alteraon(3),
blood pressure and temperature was veried to detect pos-
sible alteraons for the data collecon instruments fulll-
ment. Regarding the MBP assessment along the study, it was
observed that the freshener group (G3) presented an inial
MBP superior to the recommended (above 95 mmHg(22))
and aer three months of intervenon there was a reduc-
on tendency that was kept during the follow up, and the G1
and G2 did not present the same behavior. Maybe the high-
er levels of EO concentraon or the pure use in the fresh-
ener presents a faster answer in comparison to physiologi-
cal parameters, for example, when used a 20% ylang ylang
concentraon during a massage, resulng in lower blood
pressure aer 20 minutes of intervenon(3). Regarding the
temperature, there was not any signicant changes observed
with OE or essence, in similarity with other study(3).
This pilot study contributes to help professionals to
elaborate a more robust study design to verify if an aro-
matherapy done with ylang ylang oil or other EO alters the
percepon of anxiety and self-esteem. This study will be
developed in a second phase and will use the present sam-
ple for an adequate sample size calculaon. It will include a
potenal anxiogenic situaon that will allow verifying the
EO aromatherapeuc eect before and aer intervenon.
Besides the IDATE(15) and the Dela Coleta Scale(16) used in the
present and previous studies(7,18-19), the associaon of an-
other validated scale as the Visual Analog Humor Scale(23),
will allow assessment of possible emoonal alteraons by
sensaons and self-perceived behavioral changes(19).
Besides the previously cited limitaons, a bias in the
study was also considered: the EO dosage denion, the ad-
equate way to apply the oil and the exposion frequency to
it(7,18). Although it is not possible to arm the beer way to
use aromatherapy, more studies are needed and its method-
ological designs should include at least two ways to apply EO
with the aim to compare its ecacy. It is raised that the ylang
ylang dosage, applicaon and frequency could be insu-
cient, contribung to its lack of success. Thus, it is relevant
that all variables in aromatherapy studies to be explicit, be-
cause only then it will be possible to build a robust scienc
literature for a correct and safe use of EO.

498
Rev Esc Enferm USP
2014; 48(3):492-9
www.ee.usp.br/reeusp/
Aromatherapy with ylang ylang for anxiety and
self-esteem: a pilot study
Gnatta JR, Piason PP, Lopes CLBC, Rogenski NMB, Silva MJP
CONCLUSION
It was veried that the ylang ylang essenal oil sig-
nicantly altered the self-esteem percepon only for the
three groups and the physiological parameters measured
by mean blood pressure and temperature did not suered
signicant changes.
This pilot study contributes to new aromatherapy inves-
gaons with the ylang ylang oil and other essenal oils
in the anxiety and self-esteem percepon that can use as
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Aromatherapy with ylang ylang for anxiety and
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Correspondence addressed to: Juliana Rizzo Gnatta
Av. Prof. Lineu Prestes, 2565 – Cidade Universitária
CEP 05508-000 – São Paulo, SP, Brazil