Wednesday, 21 November 2012

Essential oils and Mental Health - what is the evidence - what is the impact?

Coming to our senses

Sensory therapy using essential oils has a useful role to play in maintaining and restoring mental health.  Organoleptic properties are the aspects of food or other substances as experienced by the senses, including taste, sight, smell and touch. Hurdle technology is utilised to preserve food utilising the preservative properties of natural substances such as essential oils.  This has obvious application in wound, skin and mouth care.  Essential oils are also utilised to maintain mental balance by reducing negative states and through experience of essential oils expanding positive states, cognition and awareness.  As emotions directly impact on the skin and other body organs essential oils are used to address directly and indirectly address physical issues.

"Sweet scents, sweet thoughts"

Essential oils are substances which are both experienced by the senses and may have a chemical effect on mind and body in particular both preservative and altering mood.  Essential oils are agreeable and can be experienced as stimulating, balancing and relaxing reflecting their chemistry.  The overall effect is one of establishing the safety and agreeable nature of the environment the mind finds itself in.  This can be useful in the resolution and reduction of the duration and frequency of re-experience or imagination of traumatic episodes.

There is a long tradition of successful horticultural therapy in hospital and prison settings utilising plants which appeal to the visual and mood senses of the mammalian brain.  As such they can have a role in cognitive behaviour therapy establishing and enhancing visual and sensory memories which are agreeable.  

 As ever we must first define terms.  Essential n something of importance.  As a working definition we can define essential oils as the mixture of aromatic chemicals obtained from the steam distillation of aromatic plant matter.  As an exception rose and jasmine absolutes, two of the most powerful antidepressant and mentally restorative oils are obtained by solvent extraction.  Essential oils are also obtained by Co2 extraction.  The essential oils have certain properties which are of use in bodily conditions and mental states.  Their use is termed aromatherapy.  Their use in healthcre environments subject to Good Clinical Practice is termed Clinical Aromatherapy.  There is an extensive aromatherapy literature and an increasingly extensive research literature available on the PubMed database.

Good Clinical Practice is not sceptical in its purest sense.  While it requires issues to be identified and prioritised and compared to evidence it acknowledges the overriding importance of results. Belief in the effectiveness of any treatment requires evidence.  Belief is an important factor in the credibility and effectiveness of treatments.  Just as there is a good evidense base on PubMed for psychological and pharmacological approaches so there is an increasing research base for the properties and uses of Essential Oils.

It is a feature of aromatherapy that it is both effective and harmless provided certain safety precautions are borne in mind by practicioners and patients.   IMPORTANT SAFETY INFORMATION: Directions: Add 5-6 drops to a bath or vaporiser, for massage dilute in 15ml of carrier oil. WARNING Do not use undiluted on the skin. Do not use on broken or irritated skin. If pregnant or suffering from a medical condition seek advice before use. For external use only. Avoid contact with the eyes. Keep out of reach of unattended children, pets and anyone with special needs. Always ensure the integral dropper is in place as this acts as a guard against over consumption should the product fall into the wrong hands. Flammable.  Citrus oils should be kept refrigerated.

Mental heath nursing of course involves not just treatment of mental illness.  Neglect of self care can give rise to many bodily ailments.  Symptoms like Headaches, Constipation and Joint pain can accompany mental distress and the emotional effects of trauma.  Undiagnosed symptoms can be a source of stress.  Research shows depression accompanies undiagnosed symptoms in seventy per cent of cases.

Mental health is unique to the individual.  The chances of two individuals sharing the same psychological landscape run into millions to one.  Evidence for the effectiveness of essential oils is therefore largely anecdotal but has accumulated impressively with the trade organisations in the UK IFPA, IFA and FHT each having over 1000 practicing members, holding events and publishing journals reporting results for over 30 years.

However certain conditions such as agitation are sufficiently common and important to allow the funding of formal double blind studies.

The Companion to Primary Care Mental Health edited by Gabriel Ivbijaro MBE 2012 runs to 715 pages.  On page 595 under the title Aromatherapy the following is noted.  There is accumulating evidence for the benefit of lavender and melissa (lemon balm) oils in the management of agitation (147-149). Melissa oil is formulated into a base cream and applied twice daily and lavender oil is used as an aromastream.  Aromatherapy has a role where there is no immediate high level risk to the patient or others from agitation.

Care note.  In practice in agitation it is better to drop melissa oil onto the patients pjama collar or issue them with an inhaler containing melissa oil which they can use when they start to feel agitated or at particular times of the day.

In practice nurses conduct their own evidence based research albeit that the numbers involved in each trial are small.  For example on a ward of 8 n=8.  It is possible to diffuse geranium oil in an aromastream and observe whether the number of 'sundown' incidents falls.This evidence can then be incorporated in the sensory therapy protocol.

Mental health issues are obviously not confined to Mental Health Hospitals.  Mental health issues besides resulting from trauma result from the birthing, ageing and end of life process so clinical aromatherapy finds applications in maternity units, cancer care, hospices and nursing homes.

Besides mental health issues protocols have been developed for the use of essential oils in Maternity units and general nursing for Wound Care, Skin Care and Mouth Care.  These protocols principally incorpoate a relaxing oil - Lavender, a stimulating oil - Tea Tree, and an anti-inflammatory oil Chamomile.  These oils are used as ingredients in bases which are themselves of therapeutic value such as calendula or aloe vera in an oil, lotion of ointment or simply diffused in an aromastream or aromastick.

There is also an extensive aromatherapy literature.

LinkedIn contains groups dedicated to the use of essential oils

Shirley Price Aromatherapy

Shirley Price Aromatherapy has since 1974 gathered evidence of the uses and effectiveness of essential oils.  With licensees in 40 countries worldwide our drive for wellbeing is universal.
Our training connects aromatherapists and users with bodily and emotional
wellbeing.  With over 6000 alumni our College events and workshops include
world class thought leaders.  Our content is based on international bestselling
books and online resources.  We aim to get everyone to radically change their
approach to wellbeing and enjoy good health - naturally.
In May 2012 Shirley Price Aromatherapy hosted the Robert Tisserand weekend seminar on essential oil science at Imperial College London.  In 2013 Robert Tisserand releases a new edition of his book on the safety and uses of essential oils with more than 4000 Research references on both the analysis, safety and uses of essential oils.  A particular oil and aspect of research can be searched for on the Pubmed database.

We recognise 5 kinds of wellbeing
What do we mean by the five elements of wellbeing? 
The first element is about how you occupy your time or simply liking what you do every day: your Career Wellbeing.
The second element is about having strong relationships and love in your life: your Social Wellbeing.
The third element is about effectively managing your economic life: your Financial Wellbeing.
The fourth element is about having good health and enough energy to get things done on a daily basis: your Physical Wellbeing.
The fifth element is about the sense of engagement you have with the area where you live: your Community Wellbeing.
Mental heath illness challenges all five elements of wellbeing in patients.

Essential oils in a word
Basil is the oil for the good fight. A nerve tonic.
Bergamot is the oil of awakening. The first top note of a blend 
Black pepper is the oil of appetite. Stimulating appetite.
Fennel is an oil of abstinence. Curbing appetite and gluttony.
Frankincense the oil of integrity. Life is sweet.
Jasmine an oil of childbirth 
Lavender the oil of relaxation. Natural beauty.
Melissa the oil of calm. Gentling agitation.
Neroli the oil of softness
Rose is the oil of peace. 
Rosemary the oil of remembrance. Improving cognition.

Essential oils have been found to be effective in the treatment of emotional states such as stress and depression.

All essential oils are to some extent sedative or stimulating.  Essential oils have been found to have the following properties:  analgesic, anti-bacterial, anti-fungal, anti-inflammatory, anti-spasmodic, anti-viral, aphrodisiac, anaphrodisiac, astringent, decongestive, deodorant, diuretic, expectorant, fungicidal, immunstimulant, insect repellant, neurotonic, sedative and stimulant.

Essential oils have been found to be of use in the treatment of the following conditions:  arthritis, asthma, athletes foot, backache, bronchitis, bruises, candida, catarrh, cellulite, circulation, cold sores, coughs, cystitis, dandruff, dermatitis, diarrhoea, eczema, fatigue, hayfever, headache, headlice, hives, indigestion, inflammation, influenza, insect bites, itching, jetlag, menopause, migraine, mouthcare, muscular aches, nausea, neuralgia, oedema, period pains, PMS, psoriasis, rheumatism, sciatica, shingles, sinusitis, sore throat, spots, sprains, sunburn, toothache, travel sickness, varicose veins, warts, wound care.

Essential oils have been found to be supportive of the following mental states
Anger, anxiety, breavement, claustrophobia, depression, exhaustion, fear, frustration, grief, guilt, hysteria, impatience, indecision, insecurity, insomnia, irritability, jealousy, loneliness, mood swings, poor memory, negativity, panic, regret, restlessness, sadness, self confidence, shock, stress, tantrum, worry.

Chemistry download


For example for Anger
Chamomile roman, Orange sweet, Frankincense, Helichrysum, Ylang, Grapefruit, Geranium, Neroli
For Anxiety
Marjoram sweet, Juniperberry, Sandalwood, Clary sage, Palmarose, Bergamot, Lavender, Rose
For Depression
Chamomile roman, Orange sweet, Geranium, Bergamot, Rosemary, Melissa, Neroli
For Mood swings
Cedarwood, Clary sage, Rosemary,
For Poor memory
Peppermint, Grapefruit, Rosemary

Many essential oils are derived from one plant family the lamiaceae whose flowers are intended to appeal to the mammalian brain both visually and aromatically.

The research throws up some suprises. Orange oil being citrus one would imagine to be stimulating, 85% monoterpenes but this calms autonomic system activity (1) Hongratanaworakit T and Buchbauer, G. Autonomic and emotional responses after transdermal absorption of sweet orange oil in humans: placebo controlled trial. International Journal of Essential Oil Therapeutics (2007) 1,29-34. So the oil is of use both in the treatment of stress and depression. Not least because it makes us feel cheerful.

The concept of mental balance

Love, Truth, Right, Non violence (safety), Peace are fruits they are not feelings.  They are as a result of actively doing.

Badness.  Hatred of human values - We avoid...... materialism/ego push, petulance/out of control, love of entertainment/joker/derision, hardheartedness/mercilessness, cowardice/resignation/poor me, anger/criminality/fury, inapproprate mirth/mockery, gluttony/overindulgence, bitterness of heart/sourness, wickedness/indifferent to the welfare of self and others, lying/poor intention, war/violance/stress/contention, unhappiness/sorrow/gloom, immoderation/anarchy/unreason, lost soul/misery, arrogance/ego push/conceited, envy/jealousy/aversion, desire for glory/celebrity worship, disobedience/defiance/ego push, disbelief/distrust/disloyalty, despair/pessimism/depression, obscenity/sex without love, injustice/dishonesty/disrespect, lethargy/apathy, oblivion/forgetfulness/insignificance, unreliability/lack of character, false security/greed, obstinency/uncaring, craving/addiction, discord/quarreling/disagreement, vulgarity/rudeness, aimless/purposeless, dark material obsessions, avarice/tyranny, melancholy.

Past experiences
If a child lives with criticism, he learns to condemn
If a child lives with hostility, he learns to fight
If a child lives with ridicule, he learns to be shy
If a child lives with shame, he learns to be guilty
If a child lives with tolerance, he learns to be patient
If a child lives with encouragement, he learns confidence
If a child lives with praise he learns to appreciate
If a child lives with security, he learns to have faith
If a child lives with approval, he learns to like himself
If a child lives with acceptance and friendship, he learns to find love in the world

We seek their opposite.  Inevitably this involves some belief.  We do not hold that one system of beliefs or customs holds any better path than another.

Goodness.  Their opposite and antidote is love of human for the immaterial, discipline/under control/ordered, simplicity/politeness/courtesy, compassion/sympathy, bravery/the good fight, tranquility/patience/composure, goodhumour/cheerfulness, abstinence/moderation/eating to satisfy appetite, generosity/goodwill, devotion to the good, truth/honesty/good intention, peace/tranquility/non violence, cheerfulness/pleasure, moderation/reason, rescue/well being/healing, humility/modesty/simplicity, charity/kindness/oneness, reverence/belief, obedience/compliance/coperation/friendship, faith/trust/loyalty, hope/cheerfulness/optimism, restaint/purity/sex with love, justice/integrity/honesty, fortitude/bravery/determination, remebrance/importance/stewardship, stability/self control, seeking the immaterial/carefree, remorse/ready for a new start, letting go/liberation, harmony/agreement, esteem/mutual respect, stability/seeking balance/goals, dedication to the immaterial, satisfaction/gratitude, joy in the night sky (celebration - a birthday card).

For some reason we call the balance between badness and goodness sanity!

love is patient, love is kind
it does not envy, it does not boast, it is not proud
it is not rude it is not self seeking, it is not easily angered it keeps no record of wrongs
love does not delight in evil but rejoices in the truth
it always protects, always trusts, always hopes, has faith, and always perseveres, love never fails
and now these three remain, faith, hope and love
but the greatest of these is love

If someone is stuck in badness and hatred of human values no amount of cognitive behaviour therapy in front of a computor is going to help that much.  The visual nature of computor images can provide some agreeable memories.  However there needs to be real remorse and a desire to embrace human values and leave taking pleasure in badness behind.  The best way is perhaps by example - something a computor cant give.

Fundamental to the concept of SP's training is the self care concept of mental balance.  How can you address mental imbalance if you do not study what is commonly recognised as constituting mental balance and the human values involved?

  As important as the study of physical anatomy is, equally important is the study of mental anatomy.

 Fundamental is the concept of integrity - honesty, justice, stewardship, mutual respect.  Energy also requires wellbeing and Intelligence - IQ, EQ and awareness.

Regarding integrity we can draw from the world of the workplace - what constitutes integrity in the workplace

1. Justice
The first principle is justice which can be defined as just conduct, fairness, exercise of authority in maintenance of human right.
2. Mutual Respect (Love)
The second principle-mutual respect or love and consideration for others -is also
inherent in the moral teachings of religion. What Scripture expresses as love is here rendered as mutual respect or reciprocal regard that exists between two individuals. The application of this has come to mean that self interest only has a place in the community in as much as it takes into account the interests of others. Of paramount importance in this respect is the employee.
3. Stewardship
A third principle is that of stewardship (trusteeship). While this may be readily understood by an owner of a small business or an inheritor of an agricultural holding, the principle is applicable to anyone who is entrusted with the responsibility of managing scarce resources. It applies equally to individual wealth, the long-term viability of a business. Ownership is not seen, therefore, to be absolute. As such, businesses have an obligation to use resources for the benefit of the people in society at large as well as for its stockholders.  The New Testament stresses the accountability of Christians for the way they have used resources. Jesus summed this up by stating: “From everyone to whom much is given, much will be required” (Luke 12:48).  This principle provides a longer term perspective for business decisions than is likely to be found where the concept of absolute ownership predominates. It also provides the basis for a proper concern for the natural environment on which business activity  makes considerable demands. It implies a caring management not a selfish exploitation and is concerned with both present and future.
4. Honesty
The fourth principle is honesty. It incorporates the concepts of truthfulness and reliability and covers all aspects of relationships in human life-thought, word and action. It is more than just accuracy, it is an attitude which is well summed up in the word “integrity.”  Muslims place considerable emphasis on truthfulness in business. For instance, in a Hadith it is stated: “The merchant whose words and transactions are righteous and who is a trusty man will be (resurrected) amongst the martyrs in the day of judgement” (Ibn Mace, Sunan, II/724, no. 2139 [Ticaveti]).  Jews too constantly stress honesty as the basis for human relationships. The book of Leviticus is explicit concerning honesty in business: “You shall have true scales, true weights, true measures” (Lev. 19: 36), and “All who act dishonestly are an abomination to the Lord” (Dt. 26: 16), and regarding truthfulness, the Decalogue states: “You should not bear false witness” (Ex. 20: 16).

  Cognitive behavior Therapy

Treatment for psychological and emotional trauma

In order to heal from psychological and emotional trauma, you must face and resolve the unbearable feelings and memories you’ve long avoided. Otherwise they will return again and again, unbidden and uncontrollable.
Trauma treatment and healing involves:
  • Processing trauma-related memories and feelings
  • Discharging pent-up “fight-or-flight” energy
  • Learning how to regulate strong emotions
  • Building or rebuilding the ability to trust other people

Trauma therapy treatment approaches

Trauma disrupts the body’s natural equilibrium, freezing you in a state of hyperarousal and fear. In essence, your nervous system gets stuck in overdrive. Successful trauma treatment must address this imbalance and reestablish your physical sense of safety. The following therapies are commonly used in the treatment of emotional and psychological trauma:
  • Somatic experiencing takes advantage of the body’s unique ability to heal itself. The focus of therapy is on bodily sensations, rather than thoughts and memories about the traumatic event. By concentrating on what’s happening in your body, you gradually get in touch with trauma-related energy and tension. From there, your natural survival instincts take over, safely releasing this pent-up energy through shaking, crying, and other forms of physical release.
in the area of somatic psychology and psychotherapy so using the senses to deal with trauma

Aromatherapy blending note
The listed physical symptoms eg headaches(H), constipation(C), aching joints(A)
accompanying the emotional trauma reflect in the oil choice

eg frustration Roman Chamomile (HA), Cypress, Frankincense (A) Juniperberry (A) Lemon (H,A), Mandarin (C), Bitter Orange (C) Thyme Sweet (A)
irritability Lavender (HA)

so blend of Roman chamomile, Lemon, Lavender, Bitter Orange/Mandarin)

Therapeutic Applications

 I should say at once that memories of the experience of trauma is a serious business.  Researchers investigate this and theorise and experiment to improve wellbeing.  Anyone who has experienced trauma of any kind knows how upsetting that is and disturbing the emotions experienced.  Triggers which can bring back memories of the trauma and associated helplessness, anger, anxiety and fear must be respected carefully.  Often a sensory trigger can be quite innocent such as the smell of a beefburger left at the scene of a traumatic crime scene.

A concious experience of smells is in epilepsy.  Epileptic sufferers report experiencing digusting smells, visions  and being spoken to by the observing mind which they experience as a voice speaking. Emotional disorders are often characterised by fear and anxiety.  Such mental diseases are disabling and devastating for patients and caretakers and represent a huge economic burden to health care systems.  Therapeutic approaches to such diseases often involve the inhibition of fear through cognitive behaviour therapy encouraging habituation.  Patients can suffer and display extreme traumatic stress to the extent that normal psychological defense mechanisms fail.  Reestablishing a sense of safety is the object of therapy.  Essential oils for which there is clear evidence of use including Rosemary and Melissa offer a potential benefit in enhancing Cortex activity and control.  Symptoms may involve persistent reexperience of the traumatic event, impairment of social interaction and aversive behaviours such as self injury.
 How essential oils can help in fear and anxietyThe use of essential oils for fear and anxiety includes a mix of the pharmacoligical, hardwired responses to smell and the psychological.  Clearly when an agitated patient responds positively to Melissa oil that is not a learned response.  When improved cognition results from Rosemary oil and particularly improvement in memory recall and quality that is not a learned response.  These would appear to be enhance cortical function and control which is expecially valuable in trauma and self harm or learning disability.  The mere fact that smells can be pleasant can be valuable in associating smell with disgust or alarm and unsafety.The positive nature of the mood states induced by fragrant oils may have a part to play in extinguishing or reducing learned fear responses.  Specific therapeutic approaches an nursing protocols can be developed utilising oils which are of well evidenced therapeutic effect for example melissa oil and rosemary.  The possibility of actively coping with fear opens up the possibility of therapeutic benefit and improved ward order and safety.  This process is referred to in the literature as 'escape from fear'.  In escape from fear learning an organism learns to perform active behaviours that eliminate a fearful stimulus and thus reduce fear. (1,2).  A circuit switch occurs in the circuitry of the amygdala.To survive in an environment an organism of any kind needs to learn about places and things which may threaten its survival.  The normal 'flight. fight. freeze' response are conserved processes that enhance survival.  It is an important insight that the 'freeze' response is just as important as the 'fight or flight' responses.  Predatory eyes are particularly sensitive to movement so a freeze response can enhance survival allowing the danger to pass.  Unfortunately among those who experience real trauma the fear response system can become hyperactive in identifying fearful stimuli and activating fear response circuitry.  The memory of the response and the memory of the trauma can be relived in an intrusive way.  Studies show the hippocampus, the prefrontal cortex and the amygdala are involved in emotional memory formation.  The amygdala is a key structure involved in fear and anxiety.  The prefrontal cortex exerts a top down control of the amygdala but this control can break down where cognition is impaired. This indicated a valuable role for Rosemary oil in improving general congnition and memory. Because this invoves our limbic brain studies in animals can be helpful in advancing science.  A mild electric shock is the adversive stimulus and this is linked to a neutral stimulus for example an auditory tone.  A learned adversion to the auditory tone results.AMYGDALA Identifying adverse stimuli.  Anxiety, Fear, Aggression. Storing fearful responses.   HIPPOCAMPUS Declarative and spatial memory  PREFRONTAL CORTEX Executive function, fear extinction.  The effects of repeated stress on the Hippocampus and Prefrontal Cortex are measurable in animal studies so can be assumed to be real in human.  Research 1.  Amorpanth. P., LeDoux, J.E., and Nader, K.  (2000) Pubmed 2. Cain C.K., LeDoux, J.E. (2007) Escape from fear   Sleep disturbance.  Sleep and Wakefulness is regulated by the hypothalamus.  Sleep is necessary for bodily repair and to conserve energy.  Brain activity in sleep can even exceed wakefulness.  Essential oils which are relaxing and promote a sense of safety and routine can have an effect on sleep.  There is clear evidence of the sedative effect of Sweet Marjoram and Lavender oils.  This may work by temporary suppression of arousal neurons which stop the sleep neurons in the event of alarm (rising Co2 in sleep apnea or baby crying).  These are certainly not learned behaviours but a consequence of oil chemistry.  As much as we may know about the chemistry of sleep behaviour clearly plays an important part in getting good sleep.  Clearly a tired mind will have poor cognition and an inability to learn.  Certain oils are known to brighten dreams such as Helichrysum and Fragonia which have an emotional effect.  Pleasurable smell can perhaps improve appreciation of context and so assert cortex control over uncontrolled emotions.  This goes beyond placebo but can perhaps be considered placebo in nature in that the effect is not to attempt a direct pharocological impact on the brain.  Stress can have a negative and long lasting impact on health not least by resulting in brain changes however stressors are encountered in daly life without producing permannet changes.  Stress related conditioning has a role to play in anxiety disorders and disturbed sleep.  Stressful experiences during wakefulness can disturb sleep.    The anxiety is normally extinguished when the stressor is removed.  it may be possible to learn to extinguish the fear.  Stress hormones such as cortisol mobilise energy to the body's vital organs.  Persistent high levels of stress hormones are known to have a negative impact on health. Trauma can appear associated with lower levels of cortisol.  Cognitive difficulties include - cognitive appraisal/impaired reappraisal of emotions (the cortex 'observes' and appraises the emotional state), self related processing/exaggerated self relatedness(healthy self relatedness is important to social function), retention of fear extinction/persistent fear responses, overexpression of negative mood states/depressive states, emotional processing-(amygdala) heightened responsivity to threat, memory (hippocampus memoryabnormalitiesLong term antipsychotics have the ability to produce adverse effects including substantial weight gain, elevated blood glucose and metabolic syndrome.  Guided imagery techniques encompass verbal instructions for creating mental representations.  These mind-body techniques combine aspects of skills training, visualisation and meditation to achieve relaxation, improved mood and enhanced concentration.  Guided imagery for trauma (GIFT).  Goal setting and follow up."I still listen to guided imagery, it keeps me going", "I am no longer the victim in my dreams", I have not had an anxiety attack since using guided imagery" "I feel this is a positive way to heal the effects of trauma". Reference Guided imagery as a therapeutic tool in post traumatic stress disorder jennifer L Strauss, Patrick S. Calhoun, Christine E Marx Learning and Memory It is hard to learn with impaired memory whether through emotional trauma or physical change in the brain.  .Memory in fear and anxiety can become distorted and subject to error.  Autobiographical memory is part of the larger self memory system that maintains a representation of the sense of self.  Periods or safety or unsafety can have a disproportionate weight in this memory.  Record of ongoing experience and goals are affected by this sense of self and observation.  Negative perception of self can result in negative memory and where trauma is involved momory of the trauma is suppressed to avoid distress impeding recollection.  This can affect present and future thought.  Learning impairment could therefore be expected.  Are trauma memories likely to differ from general memory because of their emotional connections.   From this recital we can see that it is not exactly easy to say what memory is or where it is located as for example one can say what computor memory is and where that is located.  The fact that Rosemary oil can improve memory and cognition is interesting.     

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