Anxiety disorders are one of the most prevalent mental health disorders within the United States today, affecting just over 18% of adults, and 25% of children ages 13-18 years old (National Institute of Mental Health, n.d.). Anxiety has been linked to the development of multiple health problems from heart disease (Harvard Medical School, 2008) to gastrointestinal disorders. They can cause significant distress, and have detrimental effects on the overall health and well-being of the individual as well as those around them.
Traditional approaches for anxiety
Psychotherapy and medication have been the routine methods of treatment for anxiety. For some people, this may not be enough. There is a risk of addiction with some of the medications typically prescribed for anxiety (particularly benzodiazepines). Some people may prefer to begin utilizing alternative and holistic therapies for integration into their care. These therapies fall under the Complementary and Alternative Medicine (CAM) umbrella and include things like: acupuncture, yoga, tai chi, nutritional intervention, herbal remedies, and aromatherapy.
The FDA (U.S. Food and Drug Administration) says that we cannot make drug claims when it comes to essential oils. For instance, it is against regulations to use language like “Bergamot can be used to treat anxiety”. What we can say is that “Bergamot supports overall emotional wellness”. This article focuses on the research that has been done and is using language taken from those studies and other educational materials in the field of aromatherapy.
There are various animal and human studies that may show support for the effectiveness of aromatherapy in reducing feelings of anxiousness and calming the nervous system. Some studies have been focused on various chemical constituents, while others have been focused on the essential oils themselves.
Several studies have shown anxiolytic effects of various essential oils in health care, from patients on an intensive care unit (Karadag, Samancioflu, Ozden, & Bakir, 2015), burn patients (Seyyed-Rasooli et al. 2016), and in hospice.
Ylang ylang (Conanga odorata) was found to have harmonizing effects and was shown to decrease pulse rate and blood pressure. This is an indication that there is a decrease in autonomic nervous system arousal (Hongratanaworakit & Burchbauer, 2004).
Fukumoto et al. (2008) studied the effects of lemon essential oil in an animal study and results showed that some of the chemical constituents in the lemon essential oil (limonene, citral, and γ-terpinene) decreased physical and psychological stress. In 2013, Lima et al. found that (+)-limonene exhibited anxiolytic effects and was comparable to the control of Diazepam in a study with mice.
In 2008, Chen et al. found that neroli (Citrus aurantium var. amara) essential oil was comparable to that of the benzodiazepine Xanax in an animal study. In another animal study, inhalation of lavender (Lavandula angustifolia) essential oil was shown to have anxiolytic effects comparable to chlordiazepoxide, also a benzodiazepine (Tsang et al., 2012)
The European Medicines Agency (2012) reviewed several studies on bergamot essential oil. They indicate that bergamot essential oil “possesses anxiolitic and neuroprotective activity and attenuates HPA axis activity by reducing the corticosterone response to stress.” (p. 16).
Johnson et al. (2016) of Allina Health in Minneapolis, Minnesota, published a study of aggregate data from 10,262 hospital admissions. Qualified and trained nurses offered aromatherapy interventions to patients (inhalation, massage, or both). Patients rated their symptoms on an 11 point scale, “0” being reflective of no symptoms and “10” being the most. Lavender (Lavandula angustifolia) had an average decrease in anxiety symptoms by –2.73 points, mandarin (Citrus reticulata) by –2.44 points, and sweet marjoram (Origanum marjorana) by –2.73 points. These results were statistically significant and supports the use of aromatherapy as evidence-based medicine.
The American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders 5th edition (DSM-5) describes anxiety disorders as differing “from one another in the types of objects or situations that include fear, anxiety, or avoidance behavior, and the associated cognitive ideation.” (2013, p. 189).
Generalized Anxiety Disorder
The diagnostic criteria for GAD include excessive anxiety and worry that is difficult to control. There must also be other symptoms present such as sleep disturbance, muscle tension, irritability, difficulty concentrating, being easily fatigued, and restlessness (APA, 2013, p. 222). The worries associated with GAD are not routine everyday life worries. This worry is excessive and interferes with significant impairment in various areas of life functioning. Around 3.1% of the U.S. adult population carries this diagnosis (NIMH, n.d.).
Panic Disorder is characterized by having recurrent panic attacks that are unexpected. There also must be a persistent concern or worry about having additional panic attacks, or there has been a maladaptive change in behavior because of the panic attacks. A panic attack occurs with an abrupt surge of intense fear that usually peaks within minutes and symptoms may include: heart palpitations, sweating, trembling, shortness of breath, chest pain, nausea, dizziness, paresthesia, etc. (APA, 2013, p. 208-217). There are 2.7% of adults in the U.S. that live with Panic Disorder (NIMH, n.d.).
The DSM-5 refers to fear as the “emotional response to real or perceived imminent threat”, and anxiety is the “anticipation of future threat”. Both of these mental states trigger the body’s stress response (APA, 2013, p. 189).
The stress response involves the autonomic nervous system, which consists of the sympathetic and parasympathetic. The sympathetic nervous system is like a gas pedal that launches the body into fight, flight, or freeze response. It prepares the body for action to engage and defend against stress. The parasympathetic is like the brake pedal of the car. It promotes the rest and digest response by helping the body return to homeostasis.
Essential Oil Chemistry
Essential oils can be chosen by looking at the chemical constituents, as well as the individual’s medical history (for contra-indications) and aromatic preferences.
Monoterpenes Several monoterpenes have been stated to have therapeutic actions that are anxiolytic, sedative, and calming/relaxing to the nervous system. Examples would be limonene, α-pinene, and terpinolene.
Sesquiterpenes Sesquiterpenes, such as β–caryophyllene, generally have a calming effect and are soothing to the nervous system.
Monoterpene alcohols Monoterpene alcohols tend to be sedative and soothing to the nervous system. Anxiolytic properties can be found in citronellol, linalool, and terpinen-4-ol.
Sesquiterpene alcohols Sesquiterpene alcohols like cedrol and santalol (α and β), are known to be soothing to the endocrine and nervous systems as well on an emotional level.
Esters Esters are relaxing and balancing to the central nervous system and known for releasing and easing muscle tension. Relaxant properties can be found with Bornyl acetate. Linalyl acetate is known for anxiolytic action.
Aldehydes Anxiolytic and sedative properties are found in aldehydes such as citral.
Ketones Ketones such as carvone and pulegone have sedative qualities. Carvone has also been studied to show that it has anxiolytic properties.
Choosing the essential oils
The choice of oils will depend on several factors including not only the chemical constituents, but also aroma preferences of the individual receiving the aromatic intervention. Care also needs to be taken into account for potential contra-indications with medical conditions (i.e. pregnancy, epilepsy, heart conditions, allergies) and medications. Following safety guidelines is recommended for ethical and best practices.
Symptoms of GAD include excessive anxiety and worry, restlessness, muscle tension, fatigue, sleep disturbance, irritability, and difficulty concentrating. Panic attack symptoms are related to the arousal of the autonomic nervous system and peak within a few minutes. Essential oils that would be supportive for would be aimed at helping the body’s natural ability to return to homeostasis. Also, essential oils that help in calming the central nervous system, promoting restful sleep, interrupting ruminative thinking, and clearing the mind would be supportive for use on a daily basis.
The expert recommendations are vast and wide, and each essential oil has multiple indications for use. However, there is a theme among the experts. The most common examples of essential oils recommended for use with feelings of anxiousness remain to be: bergamot (Citrus bergamia), sweet orange (Citrus sinensis), lavender (Lavandula angustifolia), sweet marjoram (Origanum majorana), neroli (Citrus aurantium var. amara), petitgrain (citrus aurantium), Cedarwood, Atlas (Cedrus atlantica), Ylang ylang (Conanga odorata), and Vetiver (Vetiveria zizanoides).
While exploring aromatherapy as a wellness tool for people with anxiety, it is important to review the chemistry of the essential oils to learn more about their properties. It is also important to follow safety guidelines. Essential oil therapy is a subjective experience for the end user. While essential oils can be effective as a stand-alone modality, pairing them with another mind-body technique, as well as psychotherapy, may enhance the overall effect. This would add even greater support for the overall health and well-being of those who live with GAD and panic attacks.
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