Aromatherapy for Stress in Patients
and Hospital Staff
Jane Buckle, PhD, RN
Aromatherapy for Patient Stress
Aromatherapy is a simple, safe, cost-effective method that
can reduce both acute and chronic stress. Inhaling a relaxing
essential oil before a procedure can help a patient with acute
stress. Examples of this are the aromasticks used in a British
hospital for cancer patients prior to radiotherapy,1 the ambient
odor used both in India2 and in Austria3 before dental surgery,
and the inhalation given to U.S. patients prior to colonoscopy.4
The chronic stress of lengthy treatments, such as renal hemodialysis, can be soothed with aromatherapy massage.5 In this
study, as well as reducing stress in 21 patients, aromatherapy
reduced blood pooling and outbreaks of pustules in one patient
with chronic renal asteatotic eczema. The mixture used on the
legs was Helichrysum italicum, Juniperus communis, and Lavandula angustifolia.
Familiar smells associated with happy memories can help
reestablish feelings of happiness. To be happy is to be unstressed. Certain essential oils have their own relaxing properties. Essential oils such as lavender, lavandin, mandarin,
rose, bergamot, and frankincense have all shown their potential
to reduce stress.2,6–10
Each hospital department carries its own particular brand of
stress and fear. One of the most common, but least lifethreatening, stresses in oncology is a woman’s fear of losing
her hair. The simple act of a gentle head massage with a diluted
essential oil such as lavender (Lavandula angustifolia) can do a
tremendous amount to “touch the spot” and help reassure the
patient that her hair will grow back. In a randomized, controlled study, hair loss as a result of alopecia, responded well to
topically applied essential oils.11 It is unfortunate this study has
not been repeated.
Essential oil of lavandin (Lavandula 3 hybrida) reduced the
stress of patients waiting for operations.12 One hundred and
fifty adult patients were randomly allocated to either control
(standard care), experimental (standard care plus essential oil
lavandin), or sham (standard care plus jojoba oil) groups. One
Article reprinted with permission from: Buckle J. Clinical Aromatherapy: Essential Oils in Healthcare, 3rd Edition. St. Louis,
MO: Churchill Livingstone, an imprint of Elsevier Inc., 2014.
210
DOI: 10.1089/act.2015.29016.jbu MARY ANN LIEBERT, INC. VOL. 21 NO. 5
OCTOBER 2015
drop of lavender essential oil was applied to a cotton ball. Each
patient was asked to sniff the cotton ball prior to the nurse
taping the cotton ball to the patient’s hospital gown, near the
chest area. Visual analog scale (VAS) scores were used to
assess anxiety. Muzzarelli et al. used lavender in their study of
118 patients awaiting either colonoscopy or esophagogastroduodenoscopy.4 The “state” part of the State Trait Anxiety
Inventory (STAI) was used to measure patients’ anxiety levels
before and after breathing in lavender. Although the patients
said the smell of lavender was pleasant, it did not reduce their
anxiety. In both these studies on preoperative anxiety, the gas
chromatography/mass spectrometry (GC/MS) charts were not
given. This makes it impossible to know the chemical profile of
the lavender that was used. A selection of published studies on
aromatherapy and stress is provided in Table 1.
This is really important to know. I remember my own randomized, controlled study about 20 years ago, when I compared lavandin (Lavandula 3 intermedia) with lavender
(Lavandula angustifolia).13 It was certainly surprising when
the results showed that lavandin was more effective at reducing
postcardiotomy stress in an intensive care unit (ICU) than
lavender. However, chemical analysis showed that the lavandin used was chemotype (CT) super. This has almost twice
as many esters (shown to be calming and soothing) as the
Lavandula angustifolia used. Therefore, it really is vital to
know the chemistry, particularly for lavender because there are
so many varieties, and some lavenders such as latifolia can be
stimulating.
Lehrner et al. explored the effect of two essential oils: sweet
orange (Citrus sinensis) or lavender (Lavandula angustifolia) on
patients waiting for a dental procedure.14 The study had four
groups: (1) sweet orange; (2) lavender; (3) music; and (4) no
music. Statistical analyses revealed that compared to the control
condition both ambient odors of orange and lavender reduced
anxiety and improved mood in patients waiting for dental treatment. Tukey–Kramer multiple comparisons showed a statistical
difference between the control group and the orange group
(P 5 0.049) and between the control group and the lavender
group (P 5 0.039). There was no statistically significant difference between the control group and the music group (P 5 0.371).
Kritsidima et al. explored the effect of diffused lavender in a
cluster randomized-controlled trial of 340 patients awaiting
ALTERNATIVE AND COMPLEMENTARY THERAPIES
ALTERNATIVE AND COMPLEMENTARY THERAPIES OCTOBER 2015
Table 1. Selection of Published Studies on Aromatherapy and Anxiety
Author
Year
Essential oils
Lavandula angustifolia
Common names Method
Lavender
Bhargava et al.2
Braden et al.12
2009
2009
Citrus sinensis
Sweet orange
Lavandula x intermedia
Lavandin
7
2008
Chang
Inhaled
Inhaled
140
150
Citrus bergamia
Bergamot
Lavandula angustifolia
Lavender
Boswellia carteri
Frankincense
Hand massage
Rosa damascena
Rose
Conrad & Adams10
Holm & Fitzmaurice9
2012
2008
Lavandula angustifolia
Lavender
Citrus aurantium var amara [flos]
Neroli
Hand “M” TechniqueÒ
vs. inhalation
Inhaled
Kasper et al.a
2010
Silexan
Lavender
Oral
15
Number of
participants
58
28
1104
221
Kritsidima et al.
2010
Lavandula angustifolia
Lavender
Inhaled
340
Lee et al.b
2011
Various
Various
Various
16 (review and RCT)
Lavandula angustifolia
Lavender
2005
Citrus sinensis
Sweet orange
Inhaled
200
Lavandula angustifolia
Lavender
Rosmarinus officinalis
Rosemary
Lavandula angustifolia
Lavender
Inhaled
Inhaled
40
118
3
Lehrner et al.
McCaffrey et al.c
Muzzarelli et al.4
2009
2006
a
Kasper S, Gastpar M, Muller W, et al. Silexan, an orally administered lavandula oil preparation, is effective in the treatment of subsyndromal anxiety disorder: A randomized,
double-blind, placebo controlled trial. Int Clin Psychopharmacol 2010;15:277–287; bLee Y, Wu Y, Tsang H, et al. A systematic review on the anxiolytic effects of aromatherapy
in people with anxiety symptoms. J Altern Complement Med 2011;17:101–108; cMcCaffrey R, Thomas D, Kinzelman A. The effects of lavender and rosemary essential oils
on test-taking anxiety among graduate nursing students. Holist Nurs Pract 2009;13:88–93.
RCT, randomized, controlled trial.
dental surgery.15 Analyses of variance showed that although
both groups had similar levels of generalized dental anxiety,
the lavender group reported significantly lower current anxiety
(P < 0.001) than the control group. Doshi, an RJBA (R.J.
Buckle Associates) student, explored the effect of aromatherapy (bergamot and frankincense) on 24 women who were
about to undergo breast needle biopsy at a hospital in New
Jersey.16 The women were randomly allocated to one of four
groups: (1) inhaling essential oils (on a patch on the hospital
gown); (2) receiving the hand “M” TechniqueÒ (a registered
method of gentle, structured touch suitable for the very fragile,
actively dying, or stressed individual, which is also useful for
practitioners who would like to soothe someone with gentle
touch, but are not trained in massage); (3) receiving the hand
“M” Technique plus aromatherapy; and (4) the control group.
The group who received both the hand “M” Technique plus
aromatherapy had the greatest reduction in stress. The intervention was only given for 10 minutes.
Graham et al. found that essential oils of lavender, bergamot,
and cedarwood reduced the stress of patients during radiotherapy.17 Lavender and Japanese cedarwood (Hiba oil, botanical name Thujopsis dolabrata) both reduced anxiety in 14
female patients who were receiving regular hemodialysis.18
The outcome measure was the Hamilton rating scale for anxiety. Markish, an RJBA student and dialysis nurse, conducted a
study on 16 patients undergoing hemodialysis 3 times a week for
4 hours in a busy teaching hospital in Texas.19 She used a
combination of angelica root (Angelica archangelica), bergamot (Citrus bergamia), and lavender (Lavandula angustifolia)
on a cotton ball placed in the patient’s pillowcase close to the
nose. The outcome measure was the VAS. Patients were receiving pro re nata (prn) morphine, valium, and Benadryl.Ò The
essential oil mix showed a positive difference—reduction in
anxiety in the patients and reduction in prn medicines needed.
Aromatherapy for Hospital Staff
Health professionals experience many emotional and disturbing scenes. Often there is no way of ameliorating emotions
until the next break and frequently there are no breaks. The
pressure can be eased if aromatherapy is used. Mandarin (Citrus reticulata), lavender (Lavandula angustifolia), or chamomile (Chamaemelum nobile) inhaled in an aromasticks can
have a calming effect very quickly. Peppermint (Mentha piperita), black pepper (Piper nigrum), or rosemary (Rosmarinus
officinalis) can revive and stimulate these health professionals,
making night shifts more tolerable.
Nurses, physicians, physical therapists, and others represent
a large reservoir of professionals who touch other people
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ALTERNATIVE AND COMPLEMENTARY THERAPIES OCTOBER 2015
Table 2. RJBA Student Studies on Nurse Stress
Name
Tiller
a
Yusui
23
Pemberton
20
Year
State
Essential oils
Participants
Method
Number
2006
AZ
Lavender
Child abuse hotline
Inhaled
12
2006
NY
Peppermint, bergamot
Night nurses
Aromastick
10
2007
TX
Lavender, clary sage
ICU nurses
Topical
14
Meyerb
2007
NE
Mandarin, geranium
Nurses
Hand “M” TechniqueÒ
18
Lucierc
2010
MA
Lavender, bergamot,
ylang ylang
Behavioral health nurses
Aromastick
30
Schellerd
2010
MN
Lavender, clary sage
Community hospital nurses
Hand “M” Technique
14
Doshi16
2012
NJ
Bergamot, frankincense
Patients pre–breast biopsy
Inhaled & “M”
Technique
24
Finnerone
2011
MA
Lavender, clary sage
Clinical nurse managers
Roller ball
9
19
2011
TX
Lavender, bergamot, angelica
Hemodialysis patients
Cotton ball
16
2012
MA
Lavender/Roman chamomile
Surgical pediatric transplant staff
Roller ball
10
Markish
Moonan22
Palmer
f
2010
MA
Lavender, bergamot
Outpatient clinic staff
Aromastick
10
Pritchardg
2012
TX
Bergamot
Relatives & patients
“M” Technique
30
Romanelloh
2012
CT
Lavender, geranium, bergamot,
black pepper
Operating room staff
Aromastick
14
St. Micheli
2011
MN
Lavandin
Nurse leadership
Rollerball
13
a
b
Tiller L. Effect of lavender on the stress of a Child Abuse Hotline in AZ. Unpublished RJBA dissertation, 2006; Meyer P. Effects of Citrus reticulata (mandarin) and Pelargonium
graveolens (geranium) on the stress levels of nurses and nursing assistants working on an adult oncology unit. Unpublished RJBA dissertation, 2007; cLucier J. The effect of
essential oils on work-related stress in behavioral health nurses. Unpublished RJBA dissertation, 2010; dScheller M. Effects of Salvia sclarea (clary sage) and Lavandula angustifolia
(lavender) on stress levels of nurses and nursing assistants in a rural community hospital in Minnesota. Unpublished RJBA dissertation, 2010; eFinneron K. The effect of essential
oils on work-related stress for nurse clinical risk managers. Unpublished RJBA dissertation, 2011; fPalmer D. Does inhaling essential oils reduce the perceived stress levels of
employees in an outpatient multispecialty physician office? Unpublished RJBA dissertation, 2010; gPritchard C. Aromatherapy intervention to reduce the anxiety and depression
levels of family members and friends of patients with traumatic injury. Unpublished RJBA dissertation, 2012; hRomanello V. Aromatherapy on the work-related stress of operating
room staff. Unpublished RJBA dissertation, 2012; iSt. Michel J. Effect of lavandin on nurse manager stress. Unpublished RJBA dissertation, 2011.
RJBA, R.J. Buckle Associates; ICU, intensive care unit.
throughout life—from pediatrics to the care of the elderly. This
is procedural touch: necessary for the medical or nursing intervention and not intended to relax or calm the patient.
However, a 5-minute hand “M” Technique with bergamot
(Citrus bergamot) can provide rapid, therapeutic help for a
colleague following a traumatic experience. If this is not possible, just inhaling angelica or rose can be useful. Touch and
smell may be as old as antiquity, but they can be deeply
comforting. RJBA students have carried out numerous studies
on stress in hospital staff. A selection of these studies is provided in Table 2.
Pemberton conducted a study on 14 ICU nurses to test if a
5% mixture of lavender and clary sage (self-applied to the
inner aspect of the arms) reduced work-induced stress more
than a placebo (carrier oil only).20 The study lasted 2
weeks. Each nurse was asked to evaluate his or her own
stress using a VAS (0–10) 3 hours into a 12-hour shift. Then
they applied Application 1 oil for the first three shifts and
Application 2 oil for the next three shifts. The results
showed that the nurses’ stress decreased 50% more for
Application 2 oil. Application 2 was the aromatherapy mixture. The study was published a few years later in Holistic
Nursing Practice.21
212
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Moonan, another RJBA student, explored the effects of
lavender and Roman chamomile on the stress levels of the
leadership and administrative group for surgical programs and
the pediatric transplant center at a large pediatric hospital in
Massachusetts.22 Participants were randomly allocated to one
of two groups. Intervention was 5 drops each of chamomile
(Chamaemelum nobile) and lavender (Lavandula angustifolia)
in 20 mL of jojoba oil to be applied by a roller ball when the
participant felt stressed. The control group received a roller
ball with rose water only. The study took 3 weeks: baseline;
intervention; and washout. The perceived stress score (PSS)
was measured for each week and compared (n 5 10). Participants had greater reduction with the essential oil roller ball than
with just rose water.
Yusui, another RJBA student, explored the effect of inhaling
peppermint and bergamot in aromasticks on oncology night
nurses.23 Stress at the beginning, the midpoint, and at the end
of the nurses’ 12-hour shift was measured using the PSS and
the VAS. The control group received an inhaler with jojoba
vegetable oil that has a slight smell but no essential oils. Both
groups had some stress reduction, possibly as a result of
breathing deeply. However, stress reduction in the aromatherapy group was 34% and in the control group only 12%. n
ALTERNATIVE AND COMPLEMENTARY THERAPIES OCTOBER 2015
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Jane Buckle, PhD, RN, is Director of RJ Buckle Associates LLC, in Hazlet,
New Jersey, and London, United Kingdom.
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