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.
Clinical Anxiety
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 (GAD)
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
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.).
Stress Response
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.
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.
Drug claims
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.
Research
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 anxiolytic 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 10 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 majorana) by –2.73 points. These results were statistically significant and supports the use of aromatherapy as evidence-based medicine.
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 contraindications with medical conditions (i.e. pregnancy, seizure disorders, 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.
Expert Aromatherapist Recommendations
The 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 (Chrysopogon zizanioides).
Summary
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/or panic attacks.
References
American Psychiatric Association (APA). (2013). Diagnostic and Statistical Manual of Mental Disorders (5th ed.). American Psychiatric Association.
Battaglia, S. (2003). The complete guide to aromatherapy (2nd ed.). The International Centre of Holistic Aromatherapy.
Buckle, J. (2015). Clinical aromatherapy: Essential oils in healthcare. Elsevier.
Bowles, J.E. (2003). The chemistry of aromatherapeutic oils (3rd ed.). Allen & Unwin.
Caddy, R. (2015). The essential blending guide: Creating a collection of pure medicinal blends for common ailments (4th ed.). Amberwood Publishing Ltd.
Chen, Y-J., Cheng, F., Shih, Y., Chang, T-M., Wang, M-F., Lan, S-S., (2008). Inhalation of Neroli essential oil and its anxiolytic effects. Journal of Complementary and Integrative medicine, 5(1). https://doi.org/10.2202/1553-3840.1143
European Medicines Agency, Committee on Herbal Medicinal Products. (2012). Assessment report on Citrus bergamia Risso et Poiteau, aetheroleum [PDF]. Retrieved from: http://www.ema.europa.eu/docs/en_GB/document_library/Herbal_-_HMPC_assessment_report/2012/08/WC500131463.pdf
Fukumoto, S. Morishita, A., Furutachi, K., Terashima, T., Nakayama, T., & Yokogoshi, H.(2008). Effective flavor components in lemon essential oil on physical or psychological stress. Stress and Health, 24, 3–12. https://doi.org/10.1002/smi.1158
Graeff, F. (2007). Anxiety, panic and the hypothalamic-pituitary-adrenal axis. Rev Bras Psiquiatr, 29. http://dx.doi.org/10.1590/S1516-44462007000500002
Harvard Medical School, Harvard Women’s Health Watch. (2008, July). Anxiety and Physical Illness. Retrieved 3/20/17 from: http://www.health.harvard.edu/staying-healthy/anxiety_and_physical_illness
Hongratanaworakit, T., Buchbauer, G. (2004). Evaluation of the harmonizing effect of Ylang-Ylang oil on humans after inhalation. Plant Medica, 70(7), 632–636.
Johnson, J. Rivard, R., Griffin, K., Kolste, A., Joswiak, D., Kinney, M., Dusek, J. (2016). The effectiveness of nurse-delivered aromatherapy in an acute care setting. Complementary Therapies in Medicine, 55, 164-169.
Lawless, J. (1994). Aromatherapy and the Mind (Kindle Locations 1623-1625). Retrieved from Amazon.com.
Lima, N., De Sousa, D., Pimenta, F., Alves, M., De Souza, F., Macedo, R., Cardoso, R., Almeida, R. (2013). Anxiolytic-like activity and GC–MS analysis of (R)–(+)–limonene fragrance, a natural compound found in foods and plants. Pharmacology, Biochemistry and Behavior, 103, 450–454.
Karadag, E. Samancioflu, S., Ozden, D., Bakir, E. (2015). Effects of aromatherapy on sleep quality and anxiety patients. British Association of Critical Care Nurses, 22(2), 105 – 112.
National Institute of Mental Health. (n.d.). Any Anxiety Disorder Among Adults [Statistics file]. Retrieved 3/20/17 from: https://www.nimh.nih.gov/health/statistics/prevalence/any-anxiety-disorder-among-adults.shtml
National Institute of Mental Health. (n.d.). Any Anxiety Disorder Among Children [Statistics file]. Retrieved 3/20/17 from: https://www.nimh.nih.gov/health/statistics/prevalence/any-anxiety-disorder-among-children.shtml
National Institute of Mental Health. (n.d.). Generalized Anxiety Disorder Among Adults [Statistics file]. Retrieved 3/24/17 from: https://www.nimh.nih.gov/health/statistics/prevalence/generalized-anxiety-disorder-among-adults.shtml
National Institute of Mental Health. (n.d.). Panic Disorder Among Adults [Statistics file]. Retrieved 3/24/17 from: https://www.nimh.nih.gov/health/statistics/prevalence/panic-disorder-among-adults.shtml
Price, S., Price, L. (Eds). (2012). Aromatherapy for health professionals (4th ed.). Elsevier.
Purchon, N., Cantele, L. (2014). The complete aromatherapy and essential oils handbook for everyday wellness. Robert Rose Inc.
Rhind, J.P. (2014). Fragrance and wellbeing: Plant aromatics and their influence on the psyche. Singing Dragon.
Schnaubelt, K. (1998). Advanced aromatherapy: The science of essential oil therapy. Healing Arts Press.
Schnaubelt, K. (1999). Medical aromatherapy: Healing with essential oils. Frog Books.
Seyyed-Rasooli, A., Salehi, F., Mohammadpoorasl, A., Goljaryan, S., Seyyedi, Z., Thomson, B.(2016). Comparing the effects of aromatherapy massage and inhalation aromatherapy on anxiety and pain in burn patients: A single-blind randomized clinical trial. Burns, 42(8), 1774-1780.
Shutes, J., Easley, T. (n.d.). Herbs and essential oils for anxiety [PDF for video]. Retrieved 3/20/17 from: https://aromaticstudies.com/herbs-essential-oils-anxiety/
Tisserand, R., Young, R. (2015). Essential oil safety (2nd ed.). Elsevier.
Tsang, H., Lo, S., Chan, C., Ho, T., Fung, K., Chan, A., Au, D. (2012). Neurophysiological and behavioural effects of lavender oil in rats with experimentally induced anxiety. Flavour and Fragrance Journal, 28, 168–173. https://doi.org/10.1002/ffj.3148