Aromatherapy in the Control of Stress and Anxiety

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Aromatherapy in the Control of Stress and Anxiety
Dias Paula1, Pedro Luís2, Pereira Olívia R3* and Sousa Maria João1*
1Country Research Center, Higher Agricultural School, Polytechnic Institute of Bragança, Campus of Santa Apolónia, Apartado 1172, 5301-855, Bragança, Portugal
2Center for Environmental and Sea Studies Lisbon, Faculty of Sciences, University of Lisbon, CBV, DBV, 1749-016, Lisboa, Portugal
3Departamento of Diagnostic and Therapeutic Technology, School of Health, Polytechnic Institute of Bragança, Av. D. Afonso V, 5300-121, Bragança, Portugal
*
Corresponding authors:
Sousa Maria João, Country Research Center, Higher Agricultural School, Polytechnic Institute of Bragança, Campus of Santa Apolnia,
Apartado 1172, 5301-855 Bragança, Portugal. Tel: 351 273303200; 351273331570; Fax: 351273325405; E-mail: joaos@ipb.pt
Olívia Rodrigues Pereira, Departamento of Diagnostic and Therapeutic Technology, School of Health, Polytechnic Institute of Bragança, Av. D. Afonso V, 5300-121
Bragança, Portugal, Tel: 351273303200; 351273331570; Fax: 351273325405; E-mail: oliviapereira@ipb.pt
Received date: September 26, 2017; Accepted date: October 06, 2017; Published date: October 13, 2017
Copyright: © 2017 Paula D. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use,
distribution, and reproduction in any medium, provided the original author and source are credited.
Abstract
Background: Currently, complementary and alternative medicine emerge as important therapies in the
prevention and treatment of various health problems. In view of this, the present study aims to evaluate the efficacy
of essential oils in reducing stress and anxiety levels in aromatherapy users, at a clinic of Bragança, Portugal.
Methods: A study was performed with 36 individuals divided in two distinct groups: “aroma group” and “control
group”. Individuals of "aroma group" were treated with a mixture of essential oils of Lavandula angustifolia Mill and
Matricaria recutita L. applied with Effleurage massage while the individuals of "control group" received only
Effleurage massage. Stress and anxiety levels of all individuals participating in the study were evaluated before and
after the treatment. Additionally, the chemical composition of the essential oils was evaluated by GC and GC-MS.
Results: In the aromatherapy assay, the “aroma group” showed a significant decrease of 12% and 30%, in stress
and anxiety levels, respectively, in the “control group” this decrease was lower (3.3% and 2.6% for stress and
anxiety levels, respectively).
Conclusion: In this study, aromatherapy was effective in stress and anxiety levels reduction and linalool, the
major compound of the essential oil mixture, may be positively contributing for these effects.
Keywords: Aromatherapy;
Lavandula angustifolia Mill
;
Matricaria
recutita L.
; Volatil oils; Stress disorders; Anxiety
Introduction
Natural products and particularly those from plants, are used by
humans since ancient times with the purpose to relief and cure
diseases or to maintain health [1]. Gradually the herbs and their
essential oils became part of the prevention and treatment of diseases,
particularly in situations where physicians frequently were not present,
as in the case of rural areas. e use of medicinal plants for the
treatment of various diseases was a common practice among the
populations that resort to spontaneous plants due to easy local access
[2,3]. e World Health Organization (WHO) recognizes several
benets in the use of complementary and alternative medicines (CAM)
playing an important role in the treatment or prevention of chronic
diseases and improving life quality [4,5]. One form of CAM,
aromatherapy, comprises the use of essential oils as treatment,
generally applied by inhalation, on the skin or, less frequently, orally.
Today, aromatherapy is a form of treatment recognized by the WHO,
commonly used to relieve pain, improve mood and promote a sense of
relaxation and used for anxiety and daily stress problems [6].
e essential oils used in aromatherapy can have dierent origins,
as they can be extracted from spontaneous plants or from cultivars,
and their composition can vary with environmental factors, such as
climatic and soil conditions [7,8]. us, it is very important to know
the composition of the essential oils to compare and understand the
relevance of the major compounds in the eects of aromatherapy. e
essential oil of
Lavandula ssp.
is well known and has been described as
having antibacterial, antifungal, sedative, carminative (smooth muscle
relaxing) properties and antidepressant activity [9], which justies its
use in aromatherapy and as pharmacological agent [10]. Literature
indicates
Matricaria recutita L.
essential oil as antispasmodic and
anxiolytic agent [11] with moderate antioxidant and antimicrobial
activities [12,13] and has been used as natural medicine and in
aromatherapy since a long time. e aim of this study was to evaluate
the eectiveness of essential oils used in aromatherapy in the reduction
of stress and anxiety levels, by applying a mixture of essential oils
(
Matricaria recutita L.
and
Lavandula ssp.
) through Eeurage massage
technique. In addition, and in order to identify the compounds
responsible for the eects, the chemical composition of the essential
oils was determined.
Materials and Methods
Collection of plants
Plants of
Matricaria recutita L.
were collected in the wild at
Montesinho Natural Park, during the owering stage (July-August).
Plants of
Lavandula angustifolia Mill
were collected in the gardens and
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ISSN: 2327-5162
Alternative and Integrative Medicine Paula et al., Altern Integr Med 2017, 6:4
DOI: 10.4172/2327-5162.1000248
Case Report OMICS International
Altern Integr Med, an open access journal
ISSN:2327-5162
Volume 6 • Issue 4 • 1000248

greenhouses of Agrarian School of Bragança, between June and July.
e species were identied and registration vouchers deposited in
Herbarium of the Escola Superior Agrária of Bragança-BRESA. e
extraction of essential oils by hydro distillation was performed using a
Clevenger apparatus, for 3 h, according to the European
Pharmacopoeia [14], with yield determination (v/fresh weight). e
essential oils were stored at -20°C in the dark. From each essential oil, a
small amount was used for the GC and GC-MS analyses and the
remainder was used to prepare the mixtures for further use in the
aromatherapy assays.
Aromatherapy assay
e data were collected using a questionnaire, composed by three
sections. Section 1 was the perceived stress Cohen Perceived Stress
Symptoms scale (1983) with 14 items [15]. Section 2 was composed of
Hamilton Anxiety Rating scale (1959) [16] for measuring the anxiety
levels. In section 3, generic questions were included about the
perception and the use of aromatherapy and also sociodemographic
questions. Section 1 and section 2 were applied to the participants
before and aer the aromatherapy or Eeurage massage treatments
while section 3 was applied just before the treatments.
For the experimental part of the study, an opportunistic sample was
used. Adults aged between 18 and 45 years, users of a clinic in
Bragança, Portugal, with high levels of stress and with medium or
severe anxiety were included in the study. is way, the inclusion
criteria includes a stress level equal or greater than 75% and a
minimum of 20 points on the anxiety scale. For the determination of
the stress values it was used the Cohen Perceived Stress Symptoms
scale (1983) [15] while the Hamilton Anxiety Rating scale (1959) [16]
was used to determine the level of anxiety. Individuals with psychiatric
conditions, pregnant women and individuals under any type of
treatment for stress and anxiety were excluded from the study.
e 36 individuals of both sexes, aged between 18 and 45 years,
included in the study. e participants, mostly of female gender (83%,
n=30) with ages between 18 and 25 (67%, n=24), were divided into two
distinct groups: “aroma group” (n=18) and “control group” (n=18).
“Aroma group” received a treatment with a mixture of the two essential
oils (
Lavandula angustifolia Mill
and
Matricaria recutita L
; 60:40 v/v)
using sweet almond oil as vector and Eeurage massage, while for
“control group” only Eeurage massage with sweet almond oil, an
odorless oil, was applied. e complete treatment of the two groups
consisted of fourteen sessions (once a week) of thirty minutes each.e
levels of stress and anxiety of the participants were assessed before and
aer treatment, in the two groups.
During this study, all ethical aspects were guaranteed. Before
starting, all participants were informed about the aim of the study, the
procedures and the voluntary nature of their participation. ey were
informed that a refusal or a termination of their participation would
not have any negative consequence, being able to withdraw from the
study at any time. All participants have signed the informed consent
form and, to ensure condentiality, a code for each participant was
used instead of their names, and the collective disclosure of results was
also guaranteed.
Chemical analysis of essential oils
Gas chromatography (GC): Gas chromatographic analyses were
performed using a Perkin Elmer Autosystem XL (Perkin Elmer,
Shelton, Connecticut, USA) gas chromatograph equipped with two
ame ionization detectors (FIDs), a data handling system and a
vaporizing injector port into which two columns of dierent polarities
were installed: a DB-1 fused-silica column (30 m × 0.25 mm i.d., lm
thickness 0.25 μm) (J&W Scientic Inc., Rancho Cordova, CA, USA)
and a DB-17HT fused-silica column (30 m × 0.25 mm i.d., lm
thickness 0.15 μm) (J&W Scientic Inc.). Oven temperature was
programmed, 45°C to 175°C, at 3°C/min, subsequently at 15°C/min up
to 300°C, and then held isothermal for 10 min; injector and detector
temperatures, 280°C and 300°C, respectively; carrier gas, hydrogen,
adjusted to a linear velocity of 30 cm/s. e samples were injected
using split sampling technique, ratio 1:50. e volume of injection was
0.2 μl of a pentane-oil solution. e percentage composition of the oils
was computed by the normalization method from the GC peak areas,
calculated as mean values of two injections from each essential oil,
without using correction factors.
Gas chromatography-mass spectrometry (GC-MS): e GC-MS
unit consisted of a Perkin. Elmer Autosystem XL (Perkin Elmer,
Shelton, Connecticut, USA) gas chromatograph, equipped with DB-1
fused-silica column (30 m × 0.25 mm i.d., lm thickness 0.25 μm) (J &
W Scientic, Inc.), and interfaced with a Perkin-Elmer Turbomass
mass spectrometer (soware version 4.1, Perkin Elmer, Shelton,
Connecticut, USA). Injector and oven temperatures were as above;
transfer line temperature, 280°C; ion trap temperature, 220°C; carrier
gas, helium, adjusted to a linear velocity of 30 cm/s; split ratio, 1:40;
ionization energy, 70 eV; ionization current, 60 μA; scan range, 40 amu
to 300 amu; scan time, 1 sec. e identity of the components was
assigned by comparison of their retention indices, relative to C9 and
C17 n-alkane indices and GC-MS spectra from a homemade library,
constructed based on the analyses of reference oils, laboratory-
synthesized components and commercial available standards.
Statistical analysis: e results were analyzed using the SPSS
program (version 20) and the descriptive statistics expressed as mean,
standard deviation and percentage. For statistic comparison the
Wilcoxon and Mann-Whitney U tests have been used with a level of
signicance of 5% (p-value<0.05).
Results
Regarding the levels of stress and anxiety in each group, there are
statistically signicant dierences between the initial and nal values
of stress and anxiety of the two groups (Table 1). In the "aroma group"
it was veried that the values distribution of "stress initial" and "stress
nal" are not identical. Similar results have been found for anxiety,
with values of "anxiety initial" and "anxiety nal" not identical.
For the "control group" the distributions of the values of the
variables "stress initial" and "stress nal" are not identical and similar
results have been found for "anxiety initial" and "anxiety nal" values
(Table 1). In the "aroma group” it was evident a decrease in the stress
levels (12%) and anxiety (30%) aer the treatment, from a rating "high"
to "medium", compared to the "control group" while the levels of stress
and anxiety have decreased of 3.3% and 2.6%, respectively. In this way,
in the "aroma group" it was observed that anxiety levels decreased
more intensively than stress levels.
Further, with regard to dierences between the initial and nal
values of stress and anxiety levels, aer individual and group analysis, a
signicant decrease of 6.7% and 7.2 points it was observed for stress
and anxiety levels, respectively (Table 2). Moreover, it is important to
note that the dierences between initial and nal values were greater in
the "aroma group”.
Citation: Paula D, Luís P, Olívia RP, João SM (2017) Aromatherapy in the Control of Stress and Anxiety. Altern Integr Med 6: 248. doi:
10.4172/2327-5162.1000248
Page 2 of 5
Altern Integr Med, an open access journal
ISSN:2327-5162
Volume 6 • Issue 4 • 1000248

Aroma Group (n=18) Control Group (n=18)
Variables Initial Final Test Values p-value Initial Final Test Values p-value
Stress
(%) 77.4 ± 3.5 68.3 ± 7.2 -3.731 <0.001 72.7 ± 2.8 70.28 ± 2.7 -3.52 <0.001
Anxiety (points) 25.3 ± 7.6 17.7 ± 7.9 -3.29 <0.001 17.17 ± 2.0 16.72 ± 2.0 -2.53 0.011
The levels of stress e anxiety initial and final are expressed as average ± standard deviation; Values of the test and p-value of Wilcoxon test.
Table 1: Initial and nal levels of stress and anxiety.
Variables
Aroma Control ≠ Groups
p-value
Group (n=18) Group (n=18) average
Stress (%) 9.2 ± 6.9 2.4±1.6 6.7 <0.001
Anxiety(points) 7.7 ± 8.1 0.4±0.6 7.2 <0.001
Differences of stress e anxiety levels in each group are expressed as average ± standard deviation; p-value of Mann-Whitney U test.
Table 2: Initial and nal values of stress and anxiety levels.
Concerning aromatherapy treatment, the majority of participants
were satised (67%) and 22% were totally satised. In agreement with
this, when questioned about the benets of aromatherapy, most
participants agreed that aromatherapy has health benets, namely, it is
useful (83%), promotes health (86%), is eective in preventing disease
(86%), promotes well-being and quality of life (69%) and promotes a
good relationship between the therapist and the client (83%).
Accordingly, 70% of the participants agreed with the inclusion of
aromatherapy in the National Health Service, due to the following
reasons (with percentages of response between 94% to 100%): lack of
condence in conventional medicine, less adverse eects by using
natural products, ecient prevention of disease and low cost
treatment.
Is important to highlight that is a study with some limitations
mainly due the sample size and non-probability sampling used. e
small sample size and their non-random selection limit the
extrapolation of the results to the population. In accordance to that,
the degree to the aromatherapy eect of the individuals of the sample
diers from the population is unknown.
Additionally, there may have been subjects who might be le out
during the selection process and individuals who are over-represented
in the sample. In conclusion, the results obtained in the aromatherapy
assays indicate positive eects in the control of stress and anxiety for
the sample studied, however it must be conrmed in further studies.
e essential oils of
Lavandula angustifolia
and
Matricaria recutita
,
were obtained with a yield of 3.5% and 0.41% (v/fresh weight),
respectively. e composition of the essential oils of Lavender, of
Chamomile and of the mixture used in the aromatherapy assay is
shown in Table 3, considering only the major compounds (≥2%).
For Lavender essential oil, with a percentage of identication near
99%, the more abundant compounds were linalool, camphor, 1,8-
cineole, terpinen-4-ol, borneol and cis-β-ocimene. Although with a
lower percentage of identication (approximately 50%) for
Chamomile, the main compounds were 1,8-cineole, pinocarvone,
trans-pinocarveol, hexyl angelate, α-pinene and isobutyl isobutyrate.
It is noteworthy the dierent prole of the two essential oils with
some compounds present in the essential oil of only one of the plant
species while others are common to both plant species essential oils,
but frequently with clearly quantitative dierences (e.g. linalool and
terpinen-4-ol).
Components RI Lavender Chamomile Mixture
α-Pinene 930 0.6 3.8 1.9
Isobutyl isobutyrate 999 - 2.6 0.3
1,8-Cineole 1005 7.5 13.9 12.2
Limonene 1009 1.3 - 2
cis-β-Ocimene 1017 5 - 4.1
Linalool 1074 45.1 0.5 43.4
Camphor 1102 8.6 0.3 8.2
trans-Pinocarveol 1106 - 4.7 -
Pinocarvone 1121 - 7.8 1.3
Borneol 1134 5.5 - 4.8
Terpinen-4-ol 1148 7 0.6 6.3
Linalyl acetate 1245 2.9 - 2.3
Hexyl angelate 1273 - 3.9 -
*RI: Retention Index relative to C9 and C17 n-alkanes on the DB-1 column
Table 3: Major compounds (≥ 2%) in the essential oils of Lavender,
Chamomile and their mixture.
Citation: Paula D, Luís P, Olívia RP, João SM (2017) Aromatherapy in the Control of Stress and Anxiety. Altern Integr Med 6: 248. doi:
10.4172/2327-5162.1000248
Page 3 of 5
Altern Integr Med, an open access journal
ISSN:2327-5162
Volume 6 • Issue 4 • 1000248

Discussion
e results indicated that aromatherapy is an eective treatment in
the reduction of stress and anxiety levels. Specically, the “aroma
group” showed a signicant decrease of 12% and 30%, with respect to
stress and anxiety compared to the control group in which a minor
decline in these levels (3% in stress and 2.6% in anxiety) was observed.
e dierences in stress and anxiety levels between aroma and control
groups before and aer treatment were also signicant.
e essential oils analyses allow to found compounds such as
linalool, 1,8 cineole in
Lavandula
. As described in the literature, the
essential oil of this plant is mostly composed by oxygen-containing
monoterpenes compounds [17]. Although the composition of the
essential oil of
Lavandula angustifolia
shows a remarkable variability,
depending on the source, the season or the method of isolation
[18-22], the main constituents are predominantly linalool, 1,8-cineole
or linalyl acetate, and oxygenated monoterpenes constitute, largely, the
major group. A recent publication showed that the essential oil of
Lavender and its main constituent, linalool, have a potential inhibitory
eect on neuronal spontaneous electrical activity, using rat neuronal
networks [20]. Similar studies have demonstrated the benet of
aromatherapy in stress control in primary school teachers [23] and
nurses [24]. Additionally, various studies have shown that
aromatherapy reduces anxiety in surgical patients [25,26].
To clarify the aromatherapy regarding the eectiveness, it is
important the increase of research in this area [27,28]. In addition, the
monitoring and reporting of possible side eects should be done to
ensure the safety of this technique [29,30].
A comprehensive view of the actual position of these participants in
relation to aromatherapy has been collected, which recommended the
inclusion of this therapy in National Health Service. e European
Information Centre for Complementary & Alternative Medicine
highlight the remarkable growth of these practices in the last ten years,
meeting the recommendation that patients may have more choice
outside the scope of conventional medicine [27,31,32].
Conclusion
Although the study showed the importance of aromatherapy in the
reduction of stress and anxiety levels, more research is needed to
understand which compounds are involved and the mechanism of
action related to each essential oil used.
Acknowledgements
e authors gratefully acknowledge the nancial support provided
by Fundação para a Ciência e a Tecnologia (FCT) under UID/AMB/
50017/2013, FEDER PT2020-Compete 2020. Authors are also grateful
to Gabinete Terapêutico Telmo Teles, Unipessoal, Lda, Bragança, for
the availability to perform the aromatherapy assay.
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Citation: Paula D, Luís P, Olívia RP, João SM (2017) Aromatherapy in the Control of Stress and Anxiety. Altern Integr Med 6: 248. doi:
10.4172/2327-5162.1000248
Page 5 of 5
Altern Integr Med, an open access journal
ISSN:2327-5162
Volume 6 • Issue 4 • 1000248