CAMWeek4AromatherapyTherapyCritiqueAssignment9_17_15

Therapy Critique#1: Aromatherapy For Stress Reduction

Therapy Critique Assignment: Aromatherapy for Stress Relief

Therapy Critique #1

Melissa Marshall-900853640

CAM Week 4- 9/17/15

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Part 1: Aromatherapy Introduction

Aromatherapy has been widely used in Europe and integrated into normal medical

practices as opposed the US where there is wide skepticism about aromatherapy’s potential

benefits. Credited with its creation is the French chemist, Maurice-Rene Cattefosse, who coined

the word “aromatherapy”. It is widely told that Cattefosse received a severe burn in his chemistry

lab and out of reflex, stuck his arm in lavender oil (Fontaine, 2015, p 134). He believed the

increased healing he experienced was a result of the lavender oil and delved into researching

“aromatherapy”.

Aromatherapy is the therapy of treating symptoms and disease with botanical essential

oils obtained from different botanical materials from different parts of plants. Some more

commonly used essential oils used in aromatherapy for stress relief include bergamot, lavender,

geranium, rose, and sandalwood (Fontaine, 2015, ch 8). There are a wide variety of blends

created for stress relief including the previously mentioned oils and many more.

Some methods of dispersing the oils are through diffusion into the air, inhalation, topical

application, and there are instances where people take the essential oils orally. The mechanisms

for exactly why aromatherapy can work has not been studied enough to have a supportive body

of evidence for what individual processes are impacted, but there seems to be positive response

to specific oils for specific uses, such as mood enhancement and stress relief. There is a growing

industry using the name aromatherapy, tied to a wide variety of products to disperse the scent;

hydrosols, facial steams, soaps, soaks, and more, that market the use of aromatherapy for stress

relief. As far as aromatherapy’s efficacy, it is a widely debated topic.

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One idea about why aromatherapy is effective for managing mood and stress is what may

occur when the oils are inhaled. The thought is that the scent inhaled, triggers the limbic system

which triggers certain chemicals to be released in response to the specific scent such as those

connected with stimulating or relaxing. In response to inhalation of a stress relieving essential

oil, such as bergamot is thought to be, the volatile oils would be inhaled, and signals initiated

from the stimulus (oils) would trigger memories associated with the scent, along with the

properties the plant’s oils are thought to have. According to the philosophy, the bergamot (when

the person has a positive experience and reacts in a calming manner to the substance) would

experience a decrease in the stress response. The stress levels experienced by the person would

decrease and more of a feeling of wellbeing would persist as a result of the aromatherapy

treatment.

When the oils are inhaled, signals would be sent through the nervous system, but an

exceptionally interesting part of that process is that immune cells are closely linked to nervous

tissue, so as the emotional response to the aromatherapy is calming, the nervous system would

respond in unison by undergoing the changes that occur as the body comes back to homeostasis

from a stress response trigger, including changing functioning of immune cells. When cortisol is

high, the ability for the immune system to respond normally and effectively is decreased, so it

could be inferred that by relieving stress, healthy immune function can resume. (Seaward, 2015,

ch 4). Psychoneuroimmunology suggests that elevated stress levels impact the immune system

negatively, so since “you cannot be physically aroused and relaxed at the same time” (Seaward,

2015, p 51), utilizing aromatherapy for stress relief could buffer the stress response by triggering

relaxation. In theory, then all the negative effects the person faces physiologically due to the

elevated cortisol levels and elevated activity of the sympathetic nervous system, due to acute or

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chronic stress can be lessened using relaxation techniques, including aromatherapy for stress

reduction.

Scent is a mechanism that is deeply personal on levels despite there being archetypal

identification, scent is deeply tied to memories which are tied to specific emotions so one person

may have different memories associated with rose and therefore not have the intended response

to the scent. Creating personalized scent panels for clients seems to be a more effective therapy

than using the generic panel (though could likely work for many). Working with clients to learn

which scents better relax and energize and so on would be more effective than assuming

everyone has the same experience of a scent. Taking the labelling as basic guidelines instead of

restricting use to the labelled or agreed upon use is better.

Personally, I can remember during labor a friend thinking peppermint was supposed to be

soothing for nausea and it actually triggered emesis for me. The concentration of the oils and

state of mind matters greatly as to how scent may affect someone. In states of extreme duress and

heightened stress response, it is likely better to use much smaller amounts of essential oils to

treat patients. The idea of essential oils is that they are highly concentrated plant molecules that

can be caustic or irritating at full strength (or high strength) and so it is important to

appropriately dilute. It is important for aromatherapists to know the palate of oils they are

utilizing and appropriately blend them and apply to appropriate patients. Children and adults

have different recommendations as do different sexes.

There are many contraindications that could keep a person from utilizing aromatherapy.

As with any new therapy, people should always check with their care provider and medical team.

Some instances that could cause people have negative reactions to aromatherapy include

allergies, asthma, any kind of skin irritation or conditions such as eczema and psoriasis, epilepsy,

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high blood pressure, pregnancy and breastfeeding, certain types of tumors and cancers, deep vein

thrombosis, photosensitivity, and there could be synergistic effects with prescription

medications. (Fontaine, 2015, ch 8) There could be emotional concerns as well, considering

aromatherapy’s activation of the limbic system. The concern could be more pronounced with

behavioral health patients, including people with past trauma and disorders such as PTSD that

involve distressing memories and emotions via the scent trigger. Keeping your physician

informed is an important practice whenever you change therapies or add in new therapies,

especially if you are a higher risk patient with elevated care needs.

There are no governmental certifying bodies in the United States for aromatherapy

practitioners. I am familiar with many CAM therapy providers and do not know anyone in

specific that holds any special aromatherapy certifications. The lack of standardization of

extraction processes, growing and harvesting practices, and blends, can create difficulty figuring

out what products to choose and what dilutions to create. Many companies include specifics

about their products purity and dilution on their packaging or at least company websites. There

are sustainability issues surrounding the harvesting and growth of certain essential oils in certain

conditions and countries. One needs masses of plant material to create small amount of essential

oil and the ideas of monocropping present, along with fair labor and wage issues. These are also

important issues to consider when utilizing essential oils for aromatherapy.

In aromatherapy, there are different functions for different applications of essential oils.

Applied to the skin, the route is more transdermal. Often essential oils associated with

antimicrobial, antifungal, and calming properties are applied topically for skin conditions, but

since one can still experience the inhalation component, in instances such as massage any

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number of blends may be used to relieve stress. As a practitioner, one must be careful of

synergistic effects as well as cancelling effects of using oils with opposing properties

Part 2: Website Assessment- “Quackwatch” and “Science Based Medicine”

First, it appears the websites are heavily biased against CAM therapies. There is an

atmosphere of discrediting anything remotely non reductionist, unfortunately. There are

comments in articles that are very condescending and dismissive of patients’ nonspecific

symptoms and complaints. The unfortunate thing is that these nonspecific complaints can greatly

decrease the quality of life someone is experiencing. The labeling of potentially useful modalities

as scams, really degrades the quality of the websites in my opinion. I am very interested to see

what is supported by scientific evidence and what is not. It is just as repelling to me as the anti-

vaccinator polarity of the western medicine conversation. Anything that seeks only to discredit

and not assess both sides of a subject, with the ability to see the gray areas, misses the point in

my opinion. They close the discussion on both ends and further polarize the topics. The

information loses its ability to bridge populations and belief systems by using closed language

and confrontational and antagonizing language and tone.

Quackwatch’s (www.quackwatch.org) creator and facilitator is Stephen Barrett, M.D.

who has received a lot of attention for his critique of different modalities that appear to lack a

scientific basis. I find it interesting that he is a psychiatrist but focuses more on the

inconsistencies of claims and the people responsible, and doesn’t offer a good body of

knowledge for anyone to understand the science behind why the claim is not true. Barrett

allegedly (many websites stating) has been involved in various litigation with CAM therapists

over the years. There appears to be a lot of “mudslinging” on both ends of the argument.

(Barrett, 2015)

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Barrett funds the website himself and with donations, according to the website. The

review process is better than some sites. Barrett’s claim is that the articles may be reviewed by

“many experts” depending on his level of knowledge and the subjects need for review. He claims

on the website that it is written objectively and clearly states his intentions and commitments and

in this way, I find the website to be an honest reflection of the author’s opinions and

understanding of the subjects he is researching. I feel he discloses his position well for the reader

to be able to better understand the lens through which he writes from.

I felt Barrett’s description of aromatherapy also included the mainstream understanding

of aromatherapy (the products and industry created which does not necessarily utilize real

aromatherapy principles) not specifically the definition of the modality as defined by the

textbooks. I was really surprised to learn of how many different websites were connected. There

is a very large body of connected materials that influence media and perceptions that essentially

are linked to one writer or a group of writers (over 20 affiliated websites disclosed on the

website) “debunking” CAM health modalities. This website could be a good place to learn what

to look out for as far as health benefits and claims and what specific businesses and practitioners

that are making claims that may over reach the boundary of our current laws regarding vitamins,

minerals, and nutritional supplements.

I found the website difficult to navigate as far as having a specific heading for a therapy

and being able to search the specific topic. While I can find articles pertaining to the topic

aromatherapy, the search method is less than desirable for me. When I searched internally, the

results stated 84 matches in 38 files. The results were presented with the keyword clearly

highlighted which was helpful, but it was a little disjointed because of that as well. This would

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not be a likely place to find information other than to potentially assess the bias of other websites

against by referring to the list of interconnected websites.

My first impression of Science Based Medicine (www.sciencebasedmedicine.org )

website was the condescending and negative language, specifically the use of “sCAM”, in the

article “Here be dragons: Caring for children in a dangerous sea of sCAM”, and in general,

disrespectful opinion pieces about people and modalities. The search for this website does not

show much that seems directly applicable to aromatherapy. Searching for aromatherapy articles

was not as obvious as I expected; you have to sift through articles and some are about CAM

therapies with seemingly a single mention of aromatherapy in a list of other therapies.

Sometimes there are other recommended articles on the topic listed. I found that helpful.

Some of the articles I found to be more objective and consumer protective such as

“doTERRA: Multilevel Marketing of Essential Oils”, though overall, I found the site to be

mostly opinion. Finding specific information is difficult. I found links back to Quackwatch from

this site, including an aromatherapy link. Due to this alone, I would not trust the information on

the site. The unprofessional tone of the variety of authors is unfortunate, because many appear to

be highly credentialed with PhD and MD’s, though according to the website, they accept any

material from anyone regardless of credentialing if it appears relevant and accurate.

Both websites would not be places I would recommend anyone finding accurate and

unbiased information on therapies. Potential issues of false advertising and marketing scams are

important to know of, and understanding the legality of health claims and labelling is an

important consumer education piece so that the consumer makes the best personal decisions. Yet

as the reading thus far this semester, we know there are a wide variety of ways to measure

impact of modalities on human wellness, with a wide range of measurable positive outcomes.

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The difficulty lies in people and companies overstepping the laws in place to protect the public.

Though people may not agree with the laws, it is important for people making health products

with information on packaging, such as essential oils, to be very careful in their verbiage.

Continuously overstepping the law creates the climate for further resistance from the allopathic

medicine doctors and industry that believes CAM therapies to be “snake oil”.

Part 3: Article Assessment PubMed

“The effects of aromatherapy on stress and stress response in adolescents”

A small sample size was used in the study and it was all female high school students.

There was a placebo group and a group that received the aromatherapy beads. The results

claimed the students receiving the aromatherapy treatment exhibited a significant decrease in

measurable stress than the group which received the placebo. The conclusion stated that

aromatherapy appeared effective and was recommended (Seo, 2014).

It was difficult for me to understand the process that was undertaken and the methods

used. The tables were difficult for me to interpret. Many other versions of the study were not in

English. It made me wonder about what could be lost in translation. Also, I thought about the

cultural implications that a “stress score” could be subject to. These could be issues such as

religious or spiritual practice, daily stress load, and socioeconomic status and the ways in which

these issues could confound the study. I noticed between the two groups, over 90% were

considered above middle class by the standards set by the study. Something that I found

intriguing was that 66% of the group reported less than satisfied with their peer relationships

(Seo, 2014). Reflecting on this factor, I wondered if the type of stress experienced (social

pressure, self-esteem issues, etc.) would affect the type of result one would receive, for example

would having a group of students of lower socioeconomic status but more satisfied with their

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peer relationships (How would different levels of stress factors change the perceived efficacy of

aromatherapy?) .

Since the study was part of a student’s dissertation, and published in the Journal of

Korean Academy of Nursing, I would expect is to be peer reviewed and critiqued well. I found it

interesting to see the amount of times the article had been cited in other publications, yet I found

it difficult to ascertain specifics and it indeed had a small sample size. While I do not specifically

doubt its accuracy, using such a small and focused sample size makes it less applicable and

needs to be retested with a larger sample size including a diverse pool of adolescents.

“The Physical Effects of Aromatherapy in Alleviating Work-Related Stress on

Elementary School Teachers in Taiwan”

The purpose of the study was to assess work related stress and the effects of bergamot

essential oil. There was no placebo group for comparison, synthetic bergamot oil was used for

the alternative to the naturally derived bergamot essential oil. Physiological changes were

measured after receiving the aromatherapy. This study had a very small sample size. The

majority of participants were female (26:3) (Liu et al, 2013).

Something really interesting found was in the results section, the normal BMI group

showed response to the aromatherapy, but the abnormal BMI participants did not show marked

changes. This brings up ponderances on the efficacy of aromatherapy on people with abnormal

body composition and function. The increased BMI, could be exacerbated by chronic stress,

considering elevated cortisol levels and their influence on amount and area of fat storage on the

body. In a situation of abnormal functioning the body could be further out of balance than the

people with normal BMI. The abstract culminates stating “the aromatherapy treatment had a

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weak effect on young teachers who had a heavy workload. Moreover, the aromatherapy

treatment exhibited no effect on teachers who belong to the abnormal body mass index subgroup

having a heavy workload” (Liu et al, 2013). This supports my thoughts on the further from

balance one is, the less effective aromatherapy may be. Their conclusion also supports this

stating “the results also suggest that age and BMI factors affect aromatherapy performance when

teachers have a heavy workload” (Liu et al, 2013).

Their reported results showed more of a decrease in stress response (according to the

chosen tests and definition for the study) for the naturally derived bergamot oil group in

comparison with the synthetic bergamot oil group. Thinking about the utilization of the synthetic

bergamot, catalyzed my thoughts on what difficulties may arise concerning placebo and

aromatherapy. Where there is any administered scent, it could alter the results, but without a

scent it could be obviously a placebo. I think it could be really difficult creating placebos for

widely known therapies.

The study was supported by the National Science Council of Taiwan and was published

by Evidence-Based Complementary and Alternative Medicine. The publishing company,

Hindawi, according to their company website, www.hindawi.com, charges processing fees for

articles but there is a waiver based system as well, based on lower financial ability guidelines,

and there is only a charge once the article has been accepted. Also, members of their institution

do not pay the fee. The journal is open access and peer reviewed. I would also expect this article

to be a trusted source of information, as the last article. I would likely trust this more as it is not

part of an individual’s dissertation, but a wider study with more researchers.

“Aromatherapy: Does It Help to Relieve Pain, Depression, Anxiety, and Stress in

Community-Dwelling Older Persons?”

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Utilizing aromatherapy to reduce the psychological and physiological suffering of older

people. Though this was talking about pain throughout, in the introduction the pain was a

measurement of physiological and psychological pain, which considered stress. A larger sample

size was used. All participants were chronic pain patients. Lavender and bergamot were used.

This study spanned 4 weeks, the longest of the sample studies. Again, the numbers were skewed

as far as females being overrepresented (67:15). No placebo was used in the study.

An increase in the understanding that “non-pharmacological” therapies can be utilized to

reduce suffering was a result of the study. “Decreased scores for depression, anxiety, and stress”

(Tang & Tse, 2014) were recorded for the group that received aromatherapy. The conclusion

states this as a finding. The article also stated that “Aromatherapy was able to relieve negative

emotional symptoms” (Tang & Tse, 2014).

I find something really important noted in the conclusion while discussing findings. That

with uncontrolled pain management there was an increase in psychological distress. It could be

inferred that enabling some level of self-efficacy to the patient, giving more of a perception of

control utilizing a non-pharmacological treatment by their own administration could very likely

enhance their quality of life alone. The activation of different parts of the brain with the

inhalation of the scent changes the brain pattern for the moment, breaking a cycle in its own way.

This could help rumination by changing something (even if minor) physiologically, changing the

pattern of neurons firing in the brain which would have a greater effect to be studied.

The research article was published in BioMed Research International with a declaration

of no conflicts of interest. BioMed Research International is a peer reviewed, open access,

journal. The findings are as trusted as possible given the parameters and peer review process.

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“Effects of Bergamot (Citrus bergamia (Risso) Wright & Arn.) Essential Oil

Aromatherapy on Mood States, Parasympathetic Nervous System Activity, and Salivary

Cortisol Levels in 41 Healthy Females”

The study was to use bergamot to study the processes involved in aromatherapy and

mood because of past findings associating bergamot with antianxiety and antidepressant activity

in lab settings. Aerial diffusion of bergamot essential oil was used. Physiological and

psychological elements were measured. Out of all the studies, this seemed the most controlled as

far as measurements and environment. All the subjects were female students. No placebo was

used.

The results the researcher expressed were that there was a marked physiological and

psychological response to the aromatherapy, specifically decreased cortisol levels were measured

and “negative mood of the study participants has decreased” (Watanabe, et al, 2015).

The article was published by Karger Publishing Company in the publication Forschende

Komplementarmedizin (Research in Complementary Medicine). I like how the journal explains

that both allopathic and CAM practitioners participate together to peer review the journal. The

conflicts of interests clause states it is the author’s responsibility to disclose where their funding

came from as well as any conflicts of interests. There are not specific charges incurred by the

authors (as far as I could understand through my research). This is the first of the articles coming

from source where payment is accepted as part of the publishing process, though exceeding a

certain length limits payments appear to be charged. My feeling is that there may be less

conflicts of interest in this way. I feel like this publication may be one of the more trustworthy

publications (only by my surficial understanding of the publications).

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PubMed Articles Reflection:

I found it interesting that my search on Pubmed, for the free full text articles, with the

generally random method of choosing studies, they were all studies from Asia (Korea, Hong

Kong, Japan, and Taiwan). None of the studies had a placebo group. Also, there were mostly

female participants. The studies where I found that the lack of placebos used and lack of

diversity somewhat disconcerting from a scientific perspective. Generally, my understanding of

effective studies necessitates at least a larger sample size and a diverse cross section of the

population.

Open access journals are most likely where the general public and student researchers

will retrieve their information from given the free access. There is always the possibility of

publication bias, but hopefully the peer review process maintains high standards as well as the

authors publishing the study. I was surprised at the wide variety of articles available on Pubmed

and their varying levels of standards utilizing all kinds of resources for information. There are so

many people claiming to be experts on topics and it is very difficult to discern who is a trusted

source. Personal bias will lead readers to any variety of information, some more informative and

some more opinion based. Fortunately, it seems there is promising information for the utilization

of aromatherapy for stress relief.

Part 4: 3 More Sources

University of Maryland Medical Center’s website

(www.umm.edu/health/medical/altmed/treatment/aromatherapy) corroborated information found

elsewhere. It provided the history and a brief overview as well as recommendations and

contraindications for aromatherapy. Something I found valuable was the warning to not take

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essential oils by mouth. Though mentioned earlier in the information that specially trained

people administer the oils by mouth, further down the caution is stressed to not administer the

essential oils by mouth. I find it important because I know of people who do take essential oils

this way who are not trained in any specialized way in science and healthcare, to administer oils

orally.

This is one of the great misdeeds of practitioners. While there may be some oils that are

safe in this way, there are always people who sell essential oils (personally, I know doTERRA

representatives) who pronounce that the oral ingestion is safe. The website for Atlantic Institute

of Aromatherapy (www.atlanticinstitute.com) began an injury list and posted their first one this

year for 2014. While it was a small sample, one could easily discern patterns for the people in the

area who were reporting the essential oil injuries. It could be skewed as such a small sample, yet

patterns emerge from their data. Injuries were predominantly adults that had used undiluted, or

water diluted, doTERRA essential oils orally. The biggest issues posed seemed to be the

improper dilution and improper application orally or topically of the products. Dilution would be

very important both topically and orally. Knowledge of specific oils and their potential benefits

as well as potential dangers is important education for consumers. While the information is self-

reported, it regardless highlights and important issue to consider.

A great reminder in all this research is the misconception that because a product is

natural, it is innocuous or safe. The practices used by health professionals should stand true for

aromatherapy as well. The “rights” of medication and drug administration are right patient, right

drug (oil), right dosage (dilution), right time, and right route (method of dispersion), along with

documentation. These seem that they could be beneficial practices for aromatherapists.

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What this information tells me is that there is much more access to essential oils and in

that region at least, there are many people utilizing doTERRA. The predominant product line

seems to not be ensuring the safe use of their products by ensuring appropriate customer support

and education.

Essential Oil University (http://essentialoil.university/) is a chemist’s website, Dr.

Pappas, who tests the chemical composition of essential oils. He apparently has been testing oils

and creating standards for decades. His mission is to create better standards for “therapeutic oils”

and to catalogue the chemical composition of the variety of essential oils available. He offers a

distance organic chemistry of essential oils class and has a YouTube channel with informative

lectures, (https://www.youtube.com/playlist?list=PLW8zVD5h7caIGtY-EPIpm_cHKCcTrtuKz).

On the main website, Dr. Pappas directs you to his Facebook page which has an informative

“notes” section. I particularly enjoyed the “essential oils myths “where Dr. Pappas explains why

commonly stated phrases about essential oils are actually misconceptions and why it is so. He

explains things like the concept of how different essential oils from different plants have

different freezing points (dispelling the myth that “better grade” essential oils do not freeze). I

find this resource to be the best resource besides the scientific studies.

Part 5: 5 Concluding Reasons to Recommend or Contraindicate Aromatherapy

Five reasons I would recommend aromatherapy for stress relief:

1. There are many reasons one could find aromatherapy to be a positive addition or

alternative to other stress relief therapies. Used properly, aromatherapy for stress relief

has very little side effects, if any. For some people this would enable them to have relief

that appears to be quick acting. Often times, this is what people are looking for in stress

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relief. In my experience working in a medical office, many front line medications can

treat the behavioral patterns and chemistry brought on by chronic stress (more in relation

to the potentially resulting depression and anxiety), and anything short acting is not

generally what a practitioner prefers to prescribe (often due to ability to abuse

medications). For something fast acting with a low impact side effect profile,

aromatherapy could be a good choice.

2. Another reason for utilizing aromatherapy may be that other options such as exercise or

dietary changes are slower to implement or not possible for certain factors such as

decreased mood states and increased pain which are often symptoms people with high

stress or chronic stress levels suffer from. The aromatherapy could be both a mood

enhancer and stress reliever that could help motivate implementing the lifestyle changes

that relieve stress.

3. Also, aromatherapy could be a good option for people with limited mobility if they

cannot move their body in certain ways, or at all to receive the benefits of stress relief

from exercise. In conjunction with meditative and visualization type practices,

aromatherapy could be of benefit.

4. Aromatherapy could be good for increasing feelings of self-efficacy in stress relief. Many

people feel out of control when experiencing the symptoms of elevated stress response.

Empowering someone with a relatively low impact way to manage their own stress relief

with a medication-like substance can relieve the stress as well as alleviate the further

frustration associated with feelings of helplessness in face of their individual healthcare

needs.

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5. Certain essential oils can be far cheaper than other medications to be used for stress

related symptoms and a patient does not need to go to an appointment to refill a

prescription, which can be costly and difficult to schedule.

Five reasons I would not recommend aromatherapy for stress relief:

1. There are some important factors that may make aromatherapy not a good choice for

someone in response to the need for stress relief. One of those factors would be if

someone has chemical sensitivity or is very scent sensitive. Some people do not react

well to concentrated scents and aromatherapy could trigger migraines, nausea, and other

unpleasant symptoms.

2. Using aromatherapy for someone who has a lot of allergies, including unexplained

contact dermatitis and hives would be risky. When someone is having a heightened

response to external stimuli, it may not be a benefit to introduce aromatherapy

considering it is a concentrated substance and could exacerbate an inflammatory

response.

3. When there are potential synergistic effects with prescription medications, aromatherapy

would not be recommended for that individual. Especially with people taking many

medications which already may have some level of synergism, adding in another therapy

could be detrimental (for example, using bergamot and lavender to de-stress an individual

who has very low blood pressure, utilizing multiple medications to increase the blood

pressure).

4. Since there are recommendations against pregnant and breastfeeding women using

certain essential oils, I would likely not recommend using aromatherapy in that instance.

There may be safe oils, but checking with a physician first, as in all situations is the best

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idea. It was stated in many places that oils are excreted and as they are oils, being fat

soluble would result in more oil secretion in breast milk increasing infant exposure.

5. I would be very cautious and not necessarily administer aromatherapy for patients with

unresolved trauma or PTSD. It is likely that aromatherapy could trigger memories and

emotions that could be counterproductive to their healing and wellbeing if not treated

carefully. Aromatherapy could be fine with higher functioning individuals, but with

lower functioning individuals with multiple behavioral health diagnosis, it could be an

unhealthy or unsafe situation.

References:

Barrett, S. (2015) Quackwatch, www.quackwatch.com

Erlich, S. (2011) “Aromatherapy”, University of Maryland Medical Center, Retrieved from https://umm.edu/health/medical/altmed/treatment/aromatherapy

Fontaine, K. (2015) “Complementary and Alternative Therapies for Nursing Practice, 4th edition, Pearson Education, Inc

Liu, S., Lin, T., & Chang, K. (2013) The Physical Effects of Aromatherapy in Alleviating Work-Related Stress on Elementary School Teachers in Taiwan, Evidence Based Complementary and Alternative Medicine, Retrieved from: http://www.hindawi.com/journals/ecam/2013/853809/

National Association for Holistic Aromatherapy (NAHA) (2015) “Exploring Aromatherapy”, retrieved from https://www.naha.org/education/approved-schools/

Novella, S., (Exec. Ed.) (2015) Science-based Medicine, www.sciencebasedmedicine.org

Pappas, R. (2015) Essential Oil University, Retrieved from: http://essentialoil.university/

Seaward, B. (2014) Managing stress: Principles and strategies for health and wellbeing, eighth edition, Jones and Bartlett Publishing

Sheppard-Hanger, S. (2014) Injury Report, Atlantic Institute of Aromatherapy, Retrieved from http://www.atlanticinstitute.com/injury-report-2014

Seo, J. (2009) The Effects of Aromatherapy on Stress and Stress Responses in AdolescentsJournal of Korean Academy of Nursing 39.3.357-365. Retrieved online from:

http://synapse.koreamed.org/DOIx.php?id=10.4040/jkan.2009.39.3.357

Tang, S., & Tse, M., (2014) Aromatherapy: does it help to relieve pain, depression, anxiety, and stress in community-dwelling older persons? BioMedical Research International, Retrieved from: http://www.hindawi.com/journals/bmri/2014/430195/

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University of Maryland Medical Center (2015) “Aromatherapy”, Retrieved from: www.umm.edu/health/medical/altmed/treatment/aromatherapy

Watanabe, E., Kuchta, K., Kimura, M., Rauwald, H., Kamei, T., & Imanishi, J. (2015) Effects of bergamot ( Citrus bergamia (Risso) Wright & Arn.) essential oil aromatherapy on mood states, parasympathetic nervous system activity, and salivary cortisol levels in 41 healthy females, Forsch Komplementmed, 22.1.43-49, Retrieved from: http://www.karger.com/Article/FullText/380989

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CAMWeek4AromatherapyTherapyCritiqueAssignment9_17_15

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