Aromatherapy: Reviewing evidence for its mechanisms of action and CNS effects
Neal Cook, lecturer in nursing and specialist practitioner in critical care and Jacinta Lynch, lecturer in nursing, University of Ulster, School of Nursing, Magee Campus, Northland Road, Londonderry BT48 7JL. Email:


he place of aromatherapy, a branch of herbology, in health care practice has been much debated in recent years, with its use as an adjunct in enhancing health and quality of life alongside conventional medicine increasing (Thomas, 2007; Buckle, 2007). However, the principles that underpin aromatherapy and its application are often not well known, despite aromatherapy being an ancient and well established therapy (Thomas, 2002). This presents a challenge to nurses as nursing care should be based on rationale and an evidence base. This article aims to provide an overview of the principles that underpin aromatherapy and its neurological mechanisms of action so that practitioners can validate and appraise its use contemporary practice.

The nervous system and essential oils
Essential oils are volatile compounds and enter the body in three main ways: absorption through the skin, inhalation

The nervous system

Central nervous system

Peripheral nervous system

Brain and spinal cord

and absorption through the surface of the lungs. Inhalation is thought to stimulate the olfactory nerve and subsequently act on the limbic system (Moss et al, 2003). The limbic system, closely associated with arousal mechanisms, communicates with both branches of the autonomic nervous system, influencing the sympathetic and parasympathetic divisions (Figure 1). This provides the intricate connection between the mind and the body. A problem in one area of the body can affect another as a result of the way in which mental and emotional responses are processed by the central nervous systsem (Keville and Green, 1995). Essential oils are composed of many chemical components or molecules. Once absorbed into the circulation, they stimulate the olfactory bulb, then the cerebral cortex, followed by the thalamus and the limbic system of the brain (Bear, 2006). The limbic system is a complex subcortical region of the brain which is composed of 53 regions and 35 associated tracts (Buckle, 1998). Of these regions, the amygdala and the hippocampus, both part of the limbic system, are of particular importance in the processing of aromas. They govern the emotional response and the formation and retrieval of explicit memories (Buckle, 1998; Bear, 2006). To break this down further, the aromas of essential oils are related to their particular chemical composition. At the molecular level, the vibratory rate of the oils has been reported to complement that of the human energy field or aura. This reportedly enhances and extends this field, in effect energizing it (Boon, 2006). These electrochemical

Autonomic nervous system Somatic nervous sytem

Sympathetic nervous system

Parasympathetic nervous system

Aromatherapy is an ancient and well established discipline, with its roots based in herbology. While aromatherapy has existed in health care practice in many cultures for thousands of years, the mechanisms of its actions, and therefore its place in contemporary health care, are often not widely known. This article explores such mechanisms of action in the nervous system, illustrating the principles of how this health care discipline can potentially provide a successful adjunct to the care of those with neurological disorders.
Key words ■ Aromatherapy ■ Essential oils ■ Massage ■ Olfaction
Accepted for publication following double-blind peer review 27 October 2008.

Blood vessels, glands, internal organs

Skeletal muscles

Figure 1. The nervous system
British Journal of Neuroscience Nursing December 2008 Vol 4 No 12


scents are known to evoke deeply buried memories. 1992. Such cortical mapping suggests that such information has an association with social and sexual behaviour (Kolb and Whitshaw. by retrieving the memory of a past experience or creating a new memory response. since the chemical components take only seconds to reach the brain (Buckle. producing either a calming. A Cochrane review (Fellowes et al. feelings and moods. 2002). this research was conducted on elderly patients where the integrity of the olfactory division may not be intact. An example of this is the inhalation of ylang ylang. Therefore. 2006) (Figure 3). it is possible that the inhaled essential oils might influence the central nervous system. It concluded that massage and aromatherapy confer shortterm benefits on psychological wellbeing. Indeed. There was no conclusive evidence that aromatherapy enhances the effects of massage. it would appear logical that the parasympathetic division will be stimulated by aroma and therapeutic touch. olfaction is the strongest sense most strongly linked to memory (Salvo. 2006) (Figure 2). Reception Thalamus Olfactory cortex Touch and smell Aromatherapy is thought to stimulate the parasympathetic response through the effect of touch and smell. which has also been described for sandalwood and lavender essential oils (Hongratanaworakit and Figure impulses stimulate the limbic system and may evoke powerful memories. the person’s ability to respond to the environment is maintained alongside his/her cognitive readiness to respond. Bear (2006) supports this. but massage-induced relaxation can often allow these unconscious systems to be modified. change human perception. and alter human behaviour as well as activate cognitive responses (Serby and Chobor. balancing or stimulating response. identifying that each aroma is interpreted by groups of receptor cells. This suggests a concept of ‘harmonization’. Olfactory bulb 3. and that in turn each aroma activates specific areas of the brain. In addition. they have the fastest effect. 2004). and transcending life can have an effect on the autonomic nervous system (ANS). i. resulting in the reduction of the autonomic responses to painful stimuli. and increased abdominal/ digestive sounds. Bear. If lying in a quiet room. massage is thought to stimulate endorphin release (Maddock-Jennings and Wilksinson.e. encouraging relaxation at a deeper level. In addition. there lies an opportunity to enhance wellness through the stimulation of the release of encephalines and endorphins. Relaxation has been shown to alter perceptions of pain (Buckle. 2008) examined the evidence for aromatherapy and/or massage in view of the effect on psychological morbidity. a sensory map.e. Perception Neocortex 1. by methods that conscious thought may not achieve. which increases arousal but does not cause deactivation at the behavioural level. 1988). 1990). and the impact of polypharmacy needs to be considered. Pituitary Hypothalamus Limbic system Olfactory bulb 2. closing one’s eyes. Massage Aromatherapy massage stimulates the parasympathetic nervous system through afferent nerve fibres (Howarth. This can have an analgesic effect and create a sense of wellbeing (Kyle. It is through these processes that the brain not only interprets the stimulus of the oil. 2006). symptom distress and quality of life in patients with a diagnosis of cancer. but also mediates conscious perception of the aroma (Bear. 2006). Further evidence for this is a reduction in respiratory rate and heart rate. slowing heart rate and increasing peristalsis (Harrington and Haskvitz. Many of the endocrine and ANS functions are not easily altered through conscious intent. 1982) has asserted that scent molecules generate a specific vibration frequency which affects the receptors through changing specific chemical bonds. 1999a). Wright (1977. Some evidence suggests no impact on either parasympathetic or sympathetic divisions of the nervous system (Reed and Held. i. requiring further studies are required to clarify this. 1999b). including the emotions pertaining to the remembered events (Boon. Stimulation of the olfactory nerve also triggers the hypothalamus which controls the subjective response from memories. including the vagus nerve. 2003). primarily in terms of anxiety. Olfactory system 596 British Journal of Neuroscience Nursing December 2008 Vol 4 No 12 .Transmission To cerebral cortex Bone Olfactory nerve fibre Olfactory cell Olfactory hair (receptors) Harmonization Through the mediation of stress. When essential oils are inhaled. 2006). However.

the involvement of the hypothalamus in the actions of aromatherapy is the integrator between mind and body (Thibodeau and Patton. Therefore. Examples of this are the actions of clary-sage and camomile. which are thought to have direct analgesic properties (Burns et Parasympathetic Inhibits pupil dilation Sympathetic Dilates pupil Stimulates flow of saliva Ganglion Medulla oblongata Inhibits flow of saliva Slows heartbeat Vagus nerve Constricts bronchi Solar plexus Stimulates peristalsis and secretion Accelerates heartbeat Dilates bronchi Inhibits peristalsis and secretion Conversion of glycogen to glucose Secretion of adrenaline and noradrenaline Stimulates release of bile Chain of sympathetic ganglia Contracts bladder Inhibits bladder contraction Figure 3. Bakkali et al (2008) cite 23 studies that demonstrate the pro-oxidant activity of these oils. Parasympathetic and sympathetic nervous system divisions Buchbauer. which also demonstrate a contribution to homeostasis. lavender or roman camomile. 1990). This pro-oxidant activity is reported to be efficient in reducing local tumour volume or tumour cell proliferation by apoptotic and/or necrotic effects. 2004). or some of their constituents. 2004). Further studies have determined that essential oils may not elicit a direct analgesic effect on the body. Evidence exists to support the notion that relaxation reduces the body’s response to norepinephrine (Soloman et al. 1996). particularly within the nervous system. This shows the complexity of the relationship between essential oils and the nervous system. e. 2000). Howarth (2002) indicates that essential oils containing esters and a high terpene level have analgesic properties. directly reducing pain and also through moderating conscious intent. This makes these oils beneficial in both health and altered homeostasis. but alter the affective appraisal of experience and consequently the retrospective evaluation of treatment-related pain (Gedney et al.g. British Journal of Neuroscience Nursing December 2008 Vol 4 No 12 597 .

1999a Saeki and Shiohara. indicating a decrease in autonomic nervous system arousal • Reduces systolic blood pressure. Therapeutic effects of essential oils Essential Oil Bergamot Effect • Stimulates or sedates according to individual need. and other phenylpropane ethers • Well-documented antispasmodic. 2003). 2001 Henry et al. stress and emotional trauma are common elements in people who attend aromatherapists for treatment. impairs speed of memory. 1995 Davis. 1999 Tisserand. 2001 Lawless. and increased feeling of contentedness • Psychologically strengthening (uplifting) • Stabilizing and antispasmodic effect on an overactive sympathetic nervous system as a result of estragole (methyl chavicol). 2001 Lis-Balchin and Hart. Pain. Buckle. demonstrating a decrease of sympathetic tone and physiological arousal • Increases alertness and attention. 2003 Saeki and Shiohara. Davis. As previously mentioned. 1995 Kirk-Smith. producing a sedative effect similar to that of diazepam and results in pain relief • Increases parasympathetic activity while depressing sympathetic nervous activity • In people with dementia promotes longer and better structured night-time sleep • Mood balancing effect to help with depression —users self-report more positive emotions • Significant reduction in performance of working memory. 2001 Moss. impaired reaction times for both memory and attention-based tasks. 2005 Hongratanaworakit and Buchbauer. Davis. 1994. 1994 Kaddu et al. lower β brainwave activity. 1995 Schnaubelt. 1994. was shown to decrease blood flow and increase systolic blood pressure immediately after inhalation. demonstrating an increase of arousal in terms of self-evaluation Evidence Lawless. 2004 Sandalwood Sweet marjoram Ylang ylang 598 British Journal of Neuroscience Nursing December 2008 Vol 4 No 12 . 2003 Maddocks-Jennings and Wilkinson. thus helpful in dealing with muscular stress and tension • Calming • Reduces stress through higher α brainwave activity. 1994 Clinical application Common essential oils have a variety of therapeutic effects (Table 1). linalool. relieving anxiety and calming fears • Enhances mood through neuro-limbic pathways • Balances and reduces tension • Deeply relaxing effect. lower electrodermal activity level and higher skin temperature • Significant impact on autonomic activity which induces relaxation • Key component. has antispasmodic effects • Stimulates the amygdala. 2003 Moss et al. All of these responses are associated with changes in hypothalamic activity (Tortora and Grabowski. 2003 Liu et al. 1988. 2003 Rossi et al. increases alertness and feeling of contentedness • May increase or decrease seizure activity • Characterized by the concept of ‘harmonization’ rather than relaxation/sedation • Analgesic and antispasmodic • Inhalation is shown to decrease pulse rate. and sedative properties • Refreshing effect. 1988 Saeki and Shiohara. as a result of nervous stimulation • Significantly enhances performance for overall quality of memory and secondary memory factors. calming. 2004 Hongratanaworakit et al. the hypothalamus controls the ANS and can therefore regulate defensive reactions such as fear Table 1. 1994 Liu et al. 2004 Kim et al. 2003 Buckle. 2003 Clary sage Lavender (Lavandula angustifolia) Lemon Aniseed (Pimpinella anisum) Roman camomile Rosemary Lawless.

These were found to be effective in reducing postoperative nausea by 48%. Of those who received aromatherapy massage with a blend of essential oils known to be analgesic. can induce relaxation and reduce sympathetic activity. Pain is a subjective experience that typically accompanies nociception. using peppermint oil. pain is likely to be less intrusive and disruptive to the individual. the authors noticed that aroma may not have produced the effect but rather that a conscious effort to control breathing. 88% improved sense of wellbeing. the amelioration of pain responses is firmly anchored within the remit of essential oils. and therefore cutaneous application is often necessary for therapeutic effect (Snow et al. and therefore includes an emotional response Spinal nucleus of nerve V V VII IX X Medial lemniscus Neotrigeminothalamic tract Periaqueductal grey matter V VII IX Mesencephalon Reticular formation Medulla Spinoreticular tract Spinomesencephalic tract Paleospinothalamic tract Dorsal column Multisynaptic afferent systems Neotrigeminothalamic tract Figure 4. Stress Stress may disrupt human emotional and somatic homeostasis causing negative physiological and psychological responses (Hubbard and Workman. psychosocial approach is taken. This is particularly important in the case of those with neurological impairment. 55% had improved sleep. the oils used were not specified and other variables that may have influenced results were not taken into account. 64% improved mobility. all of which essential oils can help treat if a holistic. sleep and other physical abilities (Diamond et al. Postoperative care Anderson and Gross (2004) also trialled the use of aromatherapy in postoperative care. P=0. 2003). 2004). 78% continued using essential oils. and the known method of action that essential oils have on both emotional and nervous impulse transmission. 2006). 2003). and its application. Pain transmission Pain transmission can also be moderated by essential oils (Figure 4). The study also had a small sample size. Olfactory abilities are essential in inhalation to achieve the effect of essential oils. but was statistically significant in that there was randomisation used in the type of aromatherapy administered and that regression analysis revealed a modest significant correlation between a reduction in reported nausea five minutes after initial aromatherapy and the patients’ overall satisfaction (ρ2= 0. Multiple sclerosis Others have contributed to the knowledge of the role of aromatherapy in practice. mood. Therefore if an essential oil’s use. However. isopropyl alcohol and saline. or placebo effect. The recipient’s expectations also play a significant role in determining the effect of oils that are mood enhancing (Campenni et al. Pain pathways in the nervous system British Journal of Neuroscience Nursing December 2008 Vol 4 No 12 599 . 1998). With both these elements involved. 2004). may have produced these results. frustration. and 7% a reduction in medication consumption. exasperation. fatigue. Howarth (2002) conducted an audit on a pain service for patients with multiple sclerosis (MS).review and rage (Tortora and Grabowski.17. tension. such as dementia. but can also arise without a stimulus. (Mollet and Harrison.028). This is supported by Pemberton and Turpin (2008) who determined that Lavandula angustifolia (lavender) and Salvia sclaria (sage) essential oils decreased the perception of work-related stress. Olfactory stimulation can enhance cognitive performance and mood (Moss et al. 91% improved ability to relax. Essential oils may ameliorate disturbances in cognition. Stressed people experience anxiety. 2003). While these were notable effects. behavioural changes and illnesses as well as low cognitive performance. distraction.

(n =50) Howarth. 2002: 64% improvement in mobility. Gross JB (2004) Aromatherapy with peppermint. Food Chem Toxicol 48: 446–75 Ballard CG. J Perianesth Nurs 19(1): 29–35 Bakkali Conclusions Complementary therapies are often viewed with scepticism. Perry EK (2002) Aromatherapy as a safe and effective treatment for the management of agitation in severe dementia: The results of a double-blind. the evidence that does exist should be acknowledge and appraised. rose geranium. (n =50) Ballard et al. 2007: aromatherapy acupressure significantly reduces shoulder pain and improves mobility Eron. 2002: 55% improvement in sleep. grapefruit. The evidence reviewed here indicates some of the mechanisms of actions of aromatherapy. J Clin Psychiatry 63(7): 553–8 Bear MF. highlighting that there is a role for its use as an adjunct in treating neurological disorders alongside conventional medicine. 2002: 91% improvement in ability to relax. and roman camomile 5% concentration blend of lemon. sweet basil. 2005: lavender hand massage program effective on emotions and reducing aggressive behaviour Alzheimer’s type dementia Shin and Lee. Reichelt K. and peppermint Blend not specified Blend not specified Blend not specified Blend not specified Melissa Evidence Shirreffs. O’Brien JT. Paradiso M (2006) Neuroscience—Exploring The Brain (3rd Edition). therefore aromatherapy has the potential to help achieve holistic. lavender. and peppermint Epilepsy Seizures Jasmine Ylang ylang. Williams and Wilkins. rosemary. BJNN Conflict of interest: None declared Anderson LA. placebo-controlled trial with Melissa. 600 British Journal of Neuroscience Nursing December 2008 Vol 4 No 12 . 2003: over one third of patients who used aromatherapy and aromatherapy with hypnosis were seizure free after one year Dementia Agitation/psychosis Cognitive dysfunction and agitation Lavender Hemiplegia Shoulder pain Lavender. (n =50) Howarth. 2001 (case study) Fatigue Shirreffs. Lippincott. person-centred care (Table 2). and while the evidence base that underpins many such therapies continues to require development. 2002: 88% improvement in well-being. 1957: jasmine can act as a countermeasure to seizures in epilepsy as it stimulates activity in the same cortical region where epileptic potentials originate Betts. or placebo is equally effective in relieving postoperative nausea. rosemary. black pepper. 2001 (case study) Disturbed sleep Impaired mobility Diminished well-being Anxiety Howarth. Neurological conditions for which aromatherapy has been shown to be useful Disorder Guillian Barre syndrome Guillian Barre syndrome Multiple sclerosis Symptom Pain Essential oils 5% concentration blend of geranium. 2002: safe and effective treatment for clinically significant agitation in people with severe dementia Lee. Averbeck D. Averbeck S. camomile. (n =50) Howarth. Idaomar M (2008) Biological effects of essential oils—A review. isopropyl alcohol. lavender. Connors B. Philadelphia Table 2.

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