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Lauren VanDalsum
March 19, 2014
Therapy Critique #3
Aromatherapy
1. Holistic aromatherapy utilizes essential oils extracted from plants to provide a
healing effect for both the body and the mind (Tisserand). Essential oils are “plant
compounds that evaporate easily and usually contain the chemicals that make
plants fragrant” and are extracted “by steam distillation or expression” (Nelson,
Buckle). The oils can be “massaged into the skin, absorbed in a bath, or diffused
through the air” (Nelson). Aromatherapy has been used to treat a variety of ailments
and diseases, including depression, stress, menopausal pain, anxiety, tension, cancer
and AIDS (Nelson). The oils are rarely ingested orally, though this technique,
sometimes called “aromatology,” has been used in places like England since 1998
(Buckle).
Aromatherapy is a complementary medical technique that has become
widely accepted not only in the alternative medicine world, but also popular within
a mainstream population as well. During its precedings, aromatherapy as a medical
therapy was directly connected with herbal medicine. Aromatherapy only began to
be separated from herbal medicine recently, with the invention and booming
popularity of pharmaceuticals, especially antibiotics, taking over the Western world
in the early to mid twentieth century (Buckle). Its healing use dates back to
Neanderthal times, as well as back to ancient Chinese, Indian, Tibetan, Australian,
Egyptian, Roman and Middle Eastern sources (Buckle). The term aromatherapy was
coined by the French chemist Gattefosse, “the grandfather of aromatherapy,” in
1937 (Buckle). In the 1950s, an aromatherapy “renaissance” occurred in France,
which later spread throughout Europe, especially to England (Buckle). The therapy
is gaining recognition in the United States, though its international popularity has
been known for some time (Nelson). In places like the United Kingdom,
aromatherapy has been noted as one of the “most commonly used complementary
medicine” over the past thirty years (Nelson).
In the United States, those that incorporate the use of aromatherapy into
their practice include “trained massage therapists, psychologists, social workers,
nurses or chiropractors” (Nelson). Aromatherapy should not be confused with the
use of synthetic fragrances that are meant purely for enjoyment, as these types of
fragrances “have no place in the field” of aromatherapy (Buckle).
2. For many years, the reasoning how aromatherapy works had been debated, its
efficacy questioned by medical practitioners, causing the therapy to be labeled
controversial (Tisserand). Many studies over the years, especially those involving
psychoneuroimmunology, have showed that “the mental and the physical are
intimately linked,” and therefore breathing a soothing scent can directly affect and
enhance a person’s mood (Tisserand). It has been reported that “aromatic molecules
enter the brain’s limbic system through the lining of the nasal cavity. Aromatic
molecules could affect the hypothalamus, autonomic nervous system, and the
endocrine system, and result in promoting peripheral blood circulation, and
regulating respiration, heart rate, and blood pressure” (Chen, et al). Additionally,
studies have shown that the “lipophyllic compounds” in essential oils “can penetrate
the blood-brain barrier. Researchers have reported an increase in cerebral blood
flow in the cortex of healthy human subjects after inhalation of an essential oil”
(Tisserand). As Gattefosse, the grandfather of aromatherapy, indicated, “’Knowledge
of how smells are absorbed is important because, to be effective, they must
penetrate the skin. Gases and thus aromas incorporated in glycerides readily
penetrate the skin where the blood can transport them’” (Tisserand).
Essential oils are typically formulated specifically using low concentrations
of the oil, infused in a carrier oil or liquid. The oils can then be sprayed into the
environment, in which the user will inhale and reap its benefits. Many essential oils
have antibacterial, antifungal, and antiviral properties, which work directly with
strengthening the immune system (Tisserand). Some essential oils, such as
lavender, chamomile, neroli, sandalwood, and geranium have “applications in pain
relief and management” (Tisserand). Commission E, the German research group
leader of studying and reviewing the use of aromatherapy, advise that many plants,
“while safe to use in herbal medicine, are not safe to use as essential oils, or may be
safe only in certain applications,” therefore it is important to work with a specialist,
such as an herbalist, when starting to use aromatherapy as a medical therapy
(Tisserand).
3. Not surprisingly, the information found on www.sciencebasedmedicine.org
regarding aromatherapy use was overall negative. Aromatherapy was consistently
blanketed under the scope of complementary and alternative medicine (CAM), along
with therapies like homeopathy, naturopathy, Traditional Chinese Medicine,
chiropractic, herbalism, reflexology and Ayurveda. Many articles, including “The
‘CAM’ Consumer: Misled and Abused,” indicate that these so-called “natural
remedies” are misleading to the public and are not backed by scientific evidence. In
this article, by Jann Bellamy, the founder of the nonprofit organization Campaign for
Science-Based Healthcare, states that within these natural healthcare modalities,
like aromatherapy, state law “generally gives the Boards governing these practices
exclusive authority to regulate their ‘professions,’” which results in natural
healthcare practitioners being allowed to utilize these health remedies without
providing scientific proof that they are effective. Bellamy argues that in general, the
use of CAM by health practitioners is fraudulent, misleading the consumer and
causing more harm than good.
Additional articles go on to discuss aromatherapy as part of the CAM
“umbrella,” some even going as far as calling the entire practice of CAM “quackery”
and “pseudoscience.” In his article, “Quackademic medicine trickles out to
community hospitals,” David Gorski, MD, PhD and surgical oncologist at the Barbara
Ann Karmanos Cancer Institute looks down upon hospitals like Oaklawn Hospital in
Michigan, who recently opened their new Holistic Center. The center offers “holistic
approaches and naturopathic therapies” to treat their patients, including massage,
trigger-point therapy, qigong, and aromatherapy. Gorski describes these modalities
as “quackery” and indicates that there is little scientific evidence to support their
efficacy, claiming most are “nothing more than an elaborate placebo.” Indeed, Steven
Novella, MD, discusses in his article, “Pseudoscience is not Cost Effective,” that while
CAM treatments are “often sold as cost effective because they are less expensive up
front than standard medical care,” there should not be a rush to use them as “cheap
does not mean cost effective.” He indicates treatments like homeopathy and
aromatherapy are often labeled as “natural therapies,” which he feels is misleading
and counterproductive. He, like many other authors on this site, feel that these
therapies are lacking scientific evidence, and this is not something to take lightly.
4. In this critique, I wanted to research multiple areas where aromatherapy was
both used and successful. When searching “aromatherapy” on PubMed, over 800
articles popped up, telling me aromatherapy is indeed a popular and well-studied
area of alternative medicine.
I.) “Aromatherapy for dementia.” (Forrester, et al)
This article was a review on many studies and trials that included aromatherapy as
an “intervention” for dementia care. Specifically, the reviewed information focused
on the fact that patients dealing with dementia were often given FDA-approved
conventional medicine to treat their symptoms, which often lead to negative side
effects. The review was intended to provide information on relief from the “most
distressing features of dementia” – behavioural and psychological symptoms –
rather than focusing on “reducing cognitive dysfunction.”
The review included seven studies with 428 participants. The researchers
were able to utilize published results from two of the studies, and used individual
patient information obtained from the rest. The trials studied aromatherapy’s
effectiveness toward agitation and behavioural symptoms. In all, the review found
that the results from the studies were “equivocal,” meaning they could not indicate
whether aromatherapy was effective or not. It is important to factor in the
methodology in obtaining the results – looking at seven different trials can be
difficult to compare equally, as each trial may have used interventions that were not
comparable to each other. A larger, more controlled study is needed to obtain
clearer results.
II.) “A Comparison of Still Point Induction to Massage Therapy in Reducing Pain and
Increasing Comfort in Chronic Pain.” (Townsend, et al)
This study focused on reviewing the use of complementary and alternative
medicine techniques like aromatherapy, music therapy, massage therapy, and selfinduced cranial still point therapy (CSPT, also referred to as still point induction) to
treat chronic pain – specifically, to reduce pain and to increase comfort in these
patients. On top of their regular pharmacological therapies received, the patients
included in the study were given music therapy and aromatherapy for the entirety
of each session. Afterwards, they were randomly assigned to receive either massage
(group A) or still point induction (group B). Towards the end of the massage or
CSPT, the patients were again subjected to music therapy and aromatherapy. Fortyone sessions were completed on 22 subjects who had chronic pain from
posttransplants, arthritis, back, shoulder, or neck pain, heart disease, and sickle-cell
crisis. Participants were asked to rate their pain on a scale of 0 to 10 before and
after treatments.
Results showed “statistically significant improvement in the participants’
self-reported pain and comfort scores,” regardless of which randomized treatment
they received (either group A with massage or group B with CSPT). Though the
study did not show that specifically aromatherapy was helpful in reducing pain, it
did show that a combination of alternative therapies is a good approach to dealing
with chronic pain. Again, in the future, a large test group will be able to show more
conclusive results about each therapy.
III) “Controlled breathing with or without peppermint aromatherapy for
postoperative nausea and/or vomiting symptom relief: A randomized controlled
trial.” (Sites, et al.)
This study reviewed 330 subjects who were to receive laparoscopic, ENT,
orthopedic, or urological day surgery procedures, undergoing general anesthesia
with intubation. Day Surgery nurses were used to work with the subjects, recording
the patients’ symptoms using a 0 to 10 scale for nausea and vomiting, post
operation. The groups were randomized to receive guidance through either
controlled breathing (inhale to the count of 3, hold for the count of 3, exhale to the
count of 3; control group) or controlled breathing with peppermint essential oil
under the septum (experimental group). 161 subjects were randomized to the
control group and 169 were randomized to the experimental group. Age and sex
were nearly evenly distributed across both groups.
The study was looking to find less invasive methods of dealing with
postoperative nausea and vomiting, rather than using antiemetics. Results from this
study support using controlled, deep breathing as an effective treatment “as a first
line of defense” against postoperative nausea. Those that were given aromatherapy
in addition to deep breathing also agreed the treatment helped. In all, the study
shows that an “inexpensive, readily available alternative to pharmaceutical
medications, with no known side effects, could successfully relieve postoperative
nausea in patients.” While the use of aromatherapy helps, the study notes that
further research is necessary to prove more credible results.
IV) “The anxiolytic effect of aromatherapy on patients awaiting ambulatory surgery:
a randomized controlled trial.” (Ni, et al.)
This study aimed to conclude whether the use of aromatherapy (specifically
used was bergamot essential oil) is effective to treat preoperative anxiety. The trial
studied 109 preoperative patients who were randomized into experimental
(bergamot essential oil) or control (water vapor) groups before their surgeries.
When arriving to the hospital, the patients filled out the State Trait Anxiety
Inventory (STAI – a validated survey to obtain a patient’s anxiety levels) and their
vital signs were recorded. They were then separated into the two groups and either
treated with bergamot essential oil or water vapor diffused into the room. Then, the
patients went on to surgery.
Results showed that those who were exposed to the bergamot oil before
surgery showed significantly decreased levels of anxiety than those who were only
exposed to water vapor. Some limitations to this study were that there were more
patients with surgical experience in the control group than the experimental group.
However, the overall decrease in anxiety within the experimental group shows that
the use of aromatherapy for anxiety may be an effective and simple treatment,
especially for preoperative anxiety.
V) “Complementary therapy provision in a London community clinic for people
living with HIV/AIDS: a case study.” (Lorenc, et al.)
This study was unique because it introduced complementary therapies to
those living with HIV/AIDS in a deprived area, where not many of the people were
aware of alternative medical treatments. It observed the patients over a two year
period, utilizing volunteer feedback to gather results – “feedback from 9 clients and
9 staff was collected through one to one, fact to face meetings with clients who had
used the complementary therapies.” Those surveyed said their most common
ailments when dealing with HIV/AIDS were pain, stress and insomnia. “Over 26
months, 1416 complementary therapies were prescribed: 875 aromatherapy and
471 shiatsu.” 189 clients received the therapies, and all were dealing with HIV or
AIDS.
The overall effect for the complementary therapies given to the clients was
positive: 54% felt significant improvements following the treatments, and 56%
reported positive individual wellbeing scores. Most clients reported that they were
unaware of complementary therapies before the study, as most claimed to not be
able to afford additional healthcare. Quotes from the clients after the study ended
included positive remarks, saying they wouldn’t have known what to do if they
hadn’t received the therapies, and that they greatly benefitted from them. Overall,
this study is a great reflection of how alternative treatments like aromatherapy and
shiatsu massage can significantly complement conventional medical practices.
VI) “The effects of aromatherapy in relieving symptoms related to job stress among
nurses.” (Chen, et al.)
Workplace stress is a common issue most people face at some point in their
lives. This study set out to address this issue, specifically nurses dealing with
workplace stress. 110 nurses were randomized between a control group (57
nurses) and an experimental group (53 nurses). The nurses were selected according
to similar amounts of stress they dealt with, along with similar job duties. The 53
nurses in the experimental group “wore small bottles containing lavender essential
oil at 3% concentration; whereas the control group wore small bottles without oil.”
The nurses wore the bottles for seven days.
At the end of the study, the nurses wearing the lavender essential oil
reportedly experienced a decrease in the number of stress symptoms, as a group
reporting a decrease from a stress level of 5.6 to 2.8. The control group’s stress
levels increased slightly over the course of the study, from 5.6 to 5.8. Though the
control group’s increase is hardly large enough to draw conclusions, the
experimental group’s considerable decrease in stress levels is significant. It should
be noted that the efficacy of the lavender oil was most useful when used for 3 or
more days, and that it was not as effective used for 2 days or less. This study shows
that with some patience, aromatherapy can be an effective and noninvasive form of
relief for workplace stress.
5. The first additional website I found when I searched, “aromatherapy” on Google
was a website called aromatherapy.com. The entire website is devoted to
information on the history and use of essential oils. Most of the information aligns
with the information I have found in my research, which tells me that the website
overall is generally supplying useful and factual information. The website discusses
the extraction process to obtain essential oils, the fact that essential oils are not the
same as perfumes or fragrances, and that essential oils should not be applied
directly to the skin – one should use a carrier oil to dilute its strength. It discusses in
detail the most popular essential oils, like bergamot, marjoram, patchouli,
cedarwood, chamomile, peppermint, rose, eucalyptus, and lavender. The website
even has a helpful “Frequently Asked Questions” section, in which it advises the
“do’s and don’ts” of aromatherapy application and use.
While the information contained on the website does line up with my own
knowledge and research on aromatherapy, unfortunately there is no author to
credit the information to on the site. This is problematic because its decreases the
validity of the website. Another way the credibility of the site is damaged is because
it has an entire section with links to buy essential oils off another website, even
including a 15% off coupon code. To the uninformed reader or to the skeptic, this
site would not be a credible website, and should not be considered a scholarly
source of information.
The next additional site I found when searching “aromatherapy” on Google
was an article entitled “Top five essential oils for stress relief and how to properly
use them,” written by Angela Doss and posted on naturalnews.com. The article
discusses the top five popular essential oils – lavender, frankincense, rose,
chamomile, and vanilla – and their medicinal properties. It also informs the reader
to use them with a carrier oil, and to avoid direct contact with the skin. The last
paragraph encourages the reader to do his or her “homework” on finding out more
about essential oils, as their use can have adverse reactions with “sun exposure,
certain medications, medical conditions, or pregnancy.”
Upon some “digging” through the website, I found that naturalnews.com is an
advocate of alternative and complementary medicine, and its key mission is to
“empower consumers with factual information about the synthetic chemicals, heavy
metals, hormone disruptors, and other chemicals found in foods, medicines,
personal care products, children’s toys and other items.” The site comes across as
quite biased against traditional medicine, which thus negatively affects is credibility.
Another issue I found with this site is that the process to become a writer for the site
is fairly straightforward, and does not require any type of educational background
or certified training. This is problematic, because anyone can write anything they
would like about a topic, without credible sources to back up their claims. This
writer in particular did cite a few sources at then end of her article, but I did not find
the websites scholarly or credible (most also seemed biased toward alternative
medicine, as well). Therefore, overall I found this article to be more detrimental
than helpful towards the topic of aromatherapy as a viable medical source, as it
lacked the proper credibility to be considered factual.
The third additional website I found when searching “aromatherapy” on
Google directed me to Bath and Bodyworks, a popular fragrant soap store, whose
mission, according to their website, is to “make fragrance fun.” The website has an
entire section of “aromatherapy,” selling different items claiming to contain
essential oils which provide relief for a number of different ailments, such as stress
and tension. After learning about aromatherapy through class and my own research,
this site is problematic because it is claiming “aromatherapy” to sell their products.
While it may be possible that the manufacturers do use essential oils to create these
lotions and sprays, more often than not the oils are combined with synthetic
fragrances and other chemicals, completing defeating the original medicinal
contents of the essential oil. When sites like Bath and Bodyworks use the word
“aromatherapy” to sell their products, it creates a puzzling dichotomy for the
uninformed consumer, and propagates the confusion of aromatherapy as a
legitimate medicinal therapy.
6. I) The first reason I would be hesitant to use aromatherapy is because
aromatherapy is often labeled in items like lotions and perfume sprays, which may
not be able to provide effective relief for the ailment I am dealing with.
II) The next reason I would be hesitant to use aromatherapy is because it is an
additional cost. Some essential oils are particularly expensive, for quite a small
bottle.
III) The next reason I would be hesitant to use aromatherapy is because its efficacy
for stress relief may take a few days, according to the study on nurses’ workplace
stress, which showed lavender essential oil is more effective after a few days’ use
(Chen, et al.). If I needed an immediate stress reducer, I may be more apt to do yoga
or go for a run.
IV) Another reason I would be hesitant to use aromatherapy is because it may
interfere with or have adverse reactions with other medications I am taking,
medical conditions I am dealing with, sun exposure, or pregnancy.
V) A final reason I would be hesitant to use aromatherapy is because, as evidenced
through most of the research I did, its effectiveness is usually enhanced when used
with other complementary therapies, like massage or reflexology (Lorenc, et al.).
This means there is more research I need to do on additional complementary
therapies. These therapies may also not be included in my health insurance
coverage, which means additional expenses for me.
7. I) The first reason I would be willing to use aromatherapy is because studies have
shown that the essential oils work directly with the brain, to provide positive relief
from ailments such as stress, tension, and anxiety.
II) Another reason I would be willing to use aromatherapy is because it has been
shown to be an effective complementary therapy, when used in conjunction with
conventional medicine, as well as with other alterative therapies, like massage.
III) The next reason I would be willing to use aromatherapy is because it is a
noninvasive way to treat symptoms like stress and anxiety. Rather than taking a
harsh drug or pill, I can use lavender essential oil to soothe my tension.
IV) Another reason I would be willing to use aromatherapy is because it can be used
as a preventative measure, to avoid poor health conditions in the future. For
example, by using lavender essential oil daily to reduce workplace stressors, it may
prevent me from getting high blood pressure or reduce the risk of a heart attack in
the future.
V) The final reason I would be willing to use aromatherapy is because of cost. The
cost of a few bottles of essential oil, which could last upwards of a year or longer,
may be less than constantly buying pills to help with pain, and perhaps the medical
bills that could result from the prolonged effect of taking a pill to mask my pain,
rather than treating the cause of the pain in the first place.
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