ANXIOLYTIC EFFECTS OF AROMATHERAPY 107 memories by particular smells associated with some essen- 15.Sjosten N,Kivel S.The effects of physical exercise on de- tial oils.The unclear biologic mechanisms explaining how pressive symptoms among the aged:A systematic review aromatherapy reduces anxiety symptoms leave room for Int J Geriatr Psychiatry 2006;21:410-418. further research. 16.Kyle G.Evaluating the effectiveness of aromatherapy in reducing levels of anxiety in palliative care patients:Results of a pilot study.Complement Ther Clin Pract 2006:12: Conclusions 148-155. As generally all of the 16 reviewed studies showed a 17.Soden K,Vincent K,Craske S,et al.A randomized con- positive result of aromatherapy on anxiety,it is re- trolled trial of aromatherapy massage in a hospice setting. commended that aromatherapy could be applied as a com- Palliat Med2004;18:87-92. plementary therapy for people with anxiety symptoms. 18.Wilkinson S,Aldridge J,Salmon I,et al.An evaluation of Although there is no conclusive evidence to show lasting aromatherapy massage in palliative care.Palliat Med 1999:13:409-417. effects of aromatherapy for treating anxiety,it may best be 19.Burnett KM,Solterbeck LA,Strapp CM.Scent and mood considered as a safe and pleasant intervention for those who can afford it and are prepared to pay for it. state following an anxiety-provoking task.Psychol Rep 200495:702-722 20.Kennedy DO,Little W,Haskell CF.Anxiolytic effects of a Disclosure Statement combination of Melissa officinalis and Valeriana officinalis No competing financial interests exist. during laboratory induced stress.Phytother Res 2006;20: 96-102 References 21.Kutlu AK,Yilmaz E,Cecen D.Effects of aroma inhalation on examination anxiety.Teach Learn Nurs 2008;3:125-130. 1.Seligman MEP,Walker EF,Rosenhan DL.Abnormal Psy- 22.Fujii M,Hatakeyama R,Fukuoka Y,et al.Lavender aroma chology.New York:W.W.Norton Company,2001. therapy for behavioral and psychological symptoms in de- 2.Smith M.Anxiety Attacks and Disorders:Guide to the Signs, mentia patients.Geriatr Gerontol Int 2008;8:136-138. Symptoms,and Treatment Options.Help Guide website. 23.Muzzarelli M,Force M,Sebold M.Aromatherapy and re- June 2008.Online document at:www.helpguide.org/ ducing preprocedural anxiety:A controlled prospective mental/anxiety_types_symptoms_treatment.htm Accessed study.Gastroenterol Nurs 2006;29:466-471. March 3,2009. 24.Lehrner J,Marwinski G,Lehr S,et al.Ambient odors of 3.Treating depression and anxiety in primary care.Prim Care orange and lavender reduce anxiety and improve mood in a Companion J Clin Psychiatry 2008;10:145-152. dental office.Physiol Behav 2005;86:92-95. 4.National Mental Health Association.Online document at: 25.Graham PH,Browne L,Graham J.Inhalation aromather- www.capefearhealthyminds.org/April 27,2009. apy during radiotherapy:Results of a placebo-controlled 5.Schmidt NB,Keough ME,Hunter LR,Funk AP.Physical double-blind randomized trial.I Clin Oncol 2003;21:2372- illness and treatment of anxiety disorders:A review.In: 2376. Zvolensky MJ,Smits J,eds.Series in Anxiety and Related 26.Wilkinson SM,Love SB,Westcombe AM,et al.Effective- Disorders:Anxiety in Health Behaviors and Physical Illness. ness of aromatherapy massage in the management of New York:Springer,2008:341-366. anxiety and depression in patients with cancer:A multi- 6.Lippa A,Czobor P,Beer B,et al.Selective anxiolysis pro- plecentre randomized controlled trial.I Clin Oncol 2007; duced by ocinaplon,a GABAA receptor modulator.Proc 25:532-538. Natl Acad Sci2005,102:7380-7385. 27.Imura M,Misao H,Ushijima H.The psychological effects of 7.Tyrer P.Anxiety:A Multidisciplinary Review.London:Im- aromatherapy-massage in healthy postpartum mothers. perial College Press,1999. I Midwifery Womens Health 2006;51:21-26. 8.Brown TA,Barlow DH.Long-term outcome in cognitive 28.Stringer J,Swindell R,Dennis M.Massage in patients un- behavioral treatment of panic disorder:Clinical predictors dergoing intensive chemotherapy reduces serum cortisol and alternative strategies for assessment.J Consult Clin and prolactin.Psycho-Oncology 2008;17:1024-1031. Psychol199563:754-765. 29.Burns EE,Blamey C,Ersser SJ.An investigation into the use 9.Kite SM,Maher EJ,Anderson K,et al.Development of an of aromatherapy on intrapartum midwifery practice.I Al- aromatherapy service at a cancer centre.Palliat Med tern Complement Med 2000;6:141-147. 1998:12:171-180. 30.Wiebe EE.A randomized trail of aromatherapy to reduce 10.Perry N,Perry E.Aromatherapy in the management of anxiety before abortion.Eff Clin Pract 2000;3:166-169. psychiatric disorders.CNS Drugs 2006;20:257-280. 31.Woelk H,Schlafke S.A multi-center,double-blind,rando- 11.Yim WC,Ng KZ,Tsang HWH,Leung AY.A review on the mised study of the lavender oil preparation silexan in effects of aromatherapy for patients with depressive symp- comparison to lorazepam for generalized anxiety disorder. toms.I Altern Complement Med 2009;15:187-195. Phytomedicine 2010:17:94-99. 12.Glasziou P,Irwig L,Bain CJ,Colditz G.Systematic Reviews 32.Hadfield N.The role of aromatherapy massage in reducing in Health Care:A Practical Guide.UK:Cambridge Uni- anxiety in patients with malignant brain tumors.Int I Palliat versity Press,2001. Nus2001;7:279-285. 13.Hollis S,Campbell F.What is meant by intention to treat 33.Fountoulakis KN.Reliability and psychometric properties analysis?Survey of published randomised controlled trials. of the Greek translation of the state-trait anxiety inven- BM01999319:670-674. tory form Y:Preliminary data.Ann Gen Psychiatry 2006; 14.Spatz C,Kardas EP.Research Methods in Psychology: 52. Ideas,Techniques,and Reports.New York:McGraw-Hill, 34.Vizi ES.Handbook of Neurochemistry and Molecular Neu- 2008. robiology.New York:Springer,2008.memories by particular smells associated with some essen￾tial oils. The unclear biologic mechanisms explaining how aromatherapy reduces anxiety symptoms leave room for further research. Conclusions As generally all of the 16 reviewed studies showed a positive result of aromatherapy on anxiety, it is re￾commended that aromatherapy could be applied as a com￾plementary therapy for people with anxiety symptoms. Although there is no conclusive evidence to show lasting effects of aromatherapy for treating anxiety, it may best be considered as a safe and pleasant intervention for those who can afford it and are prepared to pay for it. Disclosure Statement No competing financial interests exist. References 1. Seligman MEP, Walker EF, Rosenhan DL. Abnormal Psy￾chology. New York: W.W. Norton & Company, 2001. 2. Smith M. Anxiety Attacks and Disorders: Guide to the Signs, Symptoms, and Treatment Options. Help Guide website. June 2008. Online document at: www.helpguide.org/ mental/anxiety_types_symptoms_treatment.htm Accessed March 3, 2009. 3. Treating depression and anxiety in primary care. Prim Care Companion J Clin Psychiatry 2008;10:145–152. 4. National Mental Health Association. Online document at: www.capefearhealthyminds.org/ April 27, 2009. 5. Schmidt NB, Keough ME, Hunter LR, Funk AP. Physical illness and treatment of anxiety disorders: A review. In: Zvolensky MJ, Smits J, eds. Series in Anxiety and Related Disorders: Anxiety in Health Behaviors and Physical Illness. New York: Springer, 2008:341–366. 6. Lippa A, Czobor P, Beer B, et al. Selective anxiolysis pro￾duced by ocinaplon, a GABAA receptor modulator. Proc Natl Acad Sci 2005;102:7380–7385. 7. Tyrer P. Anxiety: A Multidisciplinary Review. London: Im￾perial College Press, 1999. 8. Brown TA, Barlow DH. Long-term outcome in cognitive behavioral treatment of panic disorder: Clinical predictors and alternative strategies for assessment. J Consult Clin Psychol 1995;63:754–765. 9. Kite SM, Maher EJ, Anderson K, et al. Development of an aromatherapy service at a cancer centre. Palliat Med 1998;12:171–180. 10. Perry N, Perry E. Aromatherapy in the management of psychiatric disorders. CNS Drugs 2006;20:257–280. 11. Yim WC, Ng KZ, Tsang HWH, Leung AY. A review on the effects of aromatherapy for patients with depressive symp￾toms. J Altern Complement Med 2009;15:187–195. 12. Glasziou P, Irwig L, Bain CJ, Colditz G. Systematic Reviews in Health Care: A Practical Guide. UK: Cambridge Uni￾versity Press, 2001. 13. Hollis S, Campbell F. What is meant by intention to treat analysis? Survey of published randomised controlled trials. BMJ 1999;319:670–674. 14. Spatz C, Kardas EP. Research Methods in Psychology: Ideas, Techniques, and Reports. New York: McGraw-Hill, 2008. 15. Sjosten N, Kivel S. The effects of physical exercise on de￾pressive symptoms among the aged: A systematic review. Int J Geriatr Psychiatry 2006;21:410–418. 16. Kyle G. Evaluating the effectiveness of aromatherapy in reducing levels of anxiety in palliative care patients: Results of a pilot study. Complement Ther Clin Pract 2006;12: 148–155. 17. Soden K, Vincent K, Craske S, et al. A randomized con￾trolled trial of aromatherapy massage in a hospice setting. Palliat Med 2004;18:87–92. 18. Wilkinson S, Aldridge J, Salmon I, et al. An evaluation of aromatherapy massage in palliative care. Palliat Med 1999;13:409–417. 19. Burnett KM, Solterbeck LA, Strapp CM. Scent and mood state following an anxiety-provoking task. Psychol Rep 2004;95:702–722. 20. Kennedy DO, Little W, Haskell CF. Anxiolytic effects of a combination of Melissa officinalis and Valeriana officinalis during laboratory induced stress. Phytother Res 2006;20: 96–102. 21. Kutlu AK, Yilmaz E, Cecen D. Effects of aroma inhalation on examination anxiety. Teach Learn Nurs 2008;3:125–130. 22. Fujii M, Hatakeyama R, Fukuoka Y, et al. Lavender aroma therapy for behavioral and psychological symptoms in de￾mentia patients. Geriatr Gerontol Int 2008;8:136–138. 23. Muzzarelli M, Force M, Sebold M. Aromatherapy and re￾ducing preprocedural anxiety: A controlled prospective study. Gastroenterol Nurs 2006;29:466–471. 24. Lehrner J, Marwinski G, Lehr S, et al. Ambient odors of orange and lavender reduce anxiety and improve mood in a dental office. Physiol Behav 2005;86:92–95. 25. Graham PH, Browne L, Graham J. Inhalation aromather￾apy during radiotherapy: Results of a placebo-controlled double-blind randomized trial. J Clin Oncol 2003;21:2372– 2376. 26. Wilkinson SM, Love SB, Westcombe AM, et al. Effective￾ness of aromatherapy massage in the management of anxiety and depression in patients with cancer: A multi￾plecentre randomized controlled trial. J Clin Oncol 2007; 25:532–538. 27. Imura M, Misao H, Ushijima H. The psychological effects of aromatherapy-massage in healthy postpartum mothers. J Midwifery Womens Health 2006;51:21–26. 28. Stringer J, Swindell R, Dennis M. Massage in patients un￾dergoing intensive chemotherapy reduces serum cortisol and prolactin. Psycho-Oncology 2008;17:1024–1031. 29. Burns EE, Blamey C, Ersser SJ. An investigation into the use of aromatherapy on intrapartum midwifery practice. J Al￾tern Complement Med 2000;6:141–147. 30. Wiebe EE. A randomized trail of aromatherapy to reduce anxiety before abortion. Eff Clin Pract 2000;3:166–169. 31. Woelk H, Schla¨fke S. A multi-center, double-blind, rando￾mised study of the lavender oil preparation silexan in comparison to lorazepam for generalized anxiety disorder. Phytomedicine 2010;17:94–99. 32. Hadfield N. The role of aromatherapy massage in reducing anxiety in patients with malignant brain tumors. Int J Palliat Nurs 2001;7:279–285. 33. Fountoulakis KN. Reliability and psychometric properties of the Greek translation of the state-trait anxiety inven￾tory form Y: Preliminary data. Ann Gen Psychiatry 2006; 5:2. 34. Vizi ES. Handbook of Neurochemistry and Molecular Neu￾robiology. NewYork: Springer, 2008. ANXIOLYTIC EFFECTS OF AROMATHERAPY 107