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Aromatherapy for Self-Care and Wellness

Article in Alternative and Complementary Therapies · June 2004

DOI: 10.1089/1076280041138252

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toc_119-181 5/25/04 10:42 AM Page 151
Aromatherapy for Self-Care
and Wellness
Amy Cook, M.S., O.T.R./L., C.A., and
Ann Burkhardt, M.A., O.T.R./L., B.C.N., F.A.O.T.A.
ccupational therapy (OT) is not just concerned with
O rehabilitation; wellness is also discussed in OT litera-
ture. Recent descriptive and research literature has pre-
sented practical and occupation-based perspectives on wellness
and OT practice. 1–5 Much of the interest in wellness can be
attributed to increased human consciousness about the signifi-
cance of maintaining or developing physical, spiritual, and emo-
tional well-being.
Most occupational therapists would agree that they have a role
to play in helping people stay well, and the OT Practice Frame-
work states that health promotion and prevention are important
OT intervention methods.6 There are many ways in which OT
practitioners can specifically help clients meet wellness and
health-promotion goals. Practitioners can promote a host of occu-
pations and methods for empowering people to strive for health
and well-being.
Aromatherapy is a complementary care tool for wellness that
can assume a meaningful role in OT practice. Because OT is
about doing, it is important that aromatherapy, like most well-
ness approaches, be presented to the client as something that is
done for one’s self. OT practitioners commonly teach clients
health-promoting occupations, such as progressive relaxation,
work simplification, joint protection, visualization, breathing
techniques, time-management skills, meditation, yoga, and t’ai
chi. Aromatherapy can be used much in the same manner, specif-
ically as an occupation of self-care that clients can learn to imple-
ment to promote physiologic, spiritual, or emotional wellness.
This article introduces OT practitioners to aromatherapy and
some of its basic concepts, with the hope that readers will consid-
er studying aromatherapy for the purpose of teaching clients to
adopt it as part of wellness routines and occupations. It should
be noted that OT practitioners are cautioned against teaching
clients about aromatherapy without first obtaining competency
in this area.
Aromatherapy Basics
Aromatherapy is the art and science of using aromatic plant
essential oils for therapeutic purposes. Essential oils are extracted
from plants that contain volatile oils. This extraction process
occurs through steam distillation, cold pressing, or solvent
extraction. Essential oils are used in the perfume and food indus-
tries and for therapy. Therapeutic oils can be purchased from
retail or wholesale suppliers. Some essential oils are costly
because they require a great deal of plant material to produce,
while others are relatively inexpensive.
Essential oils should be purchased from reputable suppliers. It
is important to ensure that the botanical name is indicated on the
bottle label (Table 1 provides names of commonly used essential
oils). There are many suppliers of essential oils and prices vary,
so it is best to shop around for quality.
Aromatherapy in Societal and Health Care Contexts
In the United States, aromatherapy is largely a commercial
enterprise that focuses on marketing and selling “aromatherapy
products,” some of which are hardly therapeutic. One cannot
help but notice the overpowering aroma of the “aromatherapy
candle” aisle at some local retail department stores. But, true aro-
matherapy involves using real, pure, unadulterated essential oils
extracted from aromatic plants.
From a clinical or therapeutic standpoint, massage therapists use
aromatherapy more often than other service providers in the United
States. There are holistic nurses in the United States that also embrace
the use of aromatherapy from a clinical perspective. Buckle7 wrote
the first U.S. aromatherapy text specifically for nursing practice.
It is important to note that much of the aromatherapy move-
ment within the traditional health care model focuses on the
client being a passive recipient of services, rather than on aro-
matherapy as something one does for oneself, specifically as an
occupation of personal health and well-being. Therefore, OT has
a unique role in promoting aromatherapy as a client-centered
wellness and/or self-care occupation within the medical and
community health models.
In the United States, aromatherapy has been slow to catch on
from a clinical perspective, most likely because of heavy regula-
tion of medical and allied health practices and the cautious and
staunchly empirical approach of the American Medical Associa-
tion toward the acceptance and use of complementary and alter-
native medicines. In England, however, where most
complementary therapies are self-regulated and unlicensed, aro-
matherapy is an established and accepted health care profession.8
For example, in 1955, Price and Price8 wrote a noteworthy British
aromatherapy text for health care professionals.
151
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152 ALTERNATIVE & COMPLEMENTARY THERAPIES—JUNE 2004

Table 1. Some Essential Oils Commonly Table 2. Directions for Topical

Used in Aromatherapy
Latin binomials Common names Uses
Lavendula angustifolia Lavender Sedation
Citrus bergamia Bergamot Stimulation; uplift
Eucalyptus globulus Eucalyptus Address congestion;
coughs
Melaleuca alternifolia Tea tree Antifungal
Rosemarinus officinalis Rosemary Stimulation;
enhance concentration
Boswellia carterii Frankincense Enhance meditation
practice
In Europe and other parts of the world aromatherapy is con-
sidered a bona-fide complement to the orthodox medical model,
with a good deal of the clinical research on aromatherapy coming
from outside the United States; much of it comes from England,
Australia, and Japan.
Application of Essential Oils
Aromatherapy is used in several ways: topically (massage, bath,
compress), intensively (orally, rectally, or vaginally), or via olfaction
(diffusion, inhalation). For topical application, essential oils are pri-
marily applied to the body with massage, baths, and hot and cold
compresses. Essential oils must always be diluted in a fatty oil (e.g.,
sweet almond [Prunus amygdalus] oil, olive [Olea europaea] oil) before
placing on the skin to avoid skin irritation. For baths and massages,
oils can be added directly to water and swished around before
applying to the skin (Table 2 outlines methods for topical use).
Aromatherapy in the Literature
There is little to no persuasive evidence indicating that essen-
tial oils are absorbed through the skin. This is a topic that is heat-
edly debated in aromatherapy circles 9 because it is nearly
impossible to pinpoint whether benefits of topical application
occur from absorption of the oils through the skin, through
inhalation, or from the combination of topical application and
inhalation.
It is important to note, however, that topical application of
essential oils (e.g., massage, baths) has shown some promise for
reducing stress and promoting well-being and relaxation in
patients who participated in some studies10–12
One study on use of aromatherapy in patients with cancer
examined the qualitative aspects of this therapy.10 Another study
tested topical application of lavender (Lavendula angustifolia)
essential oil with foot baths and detected subtle autonomic ner-
vous system changes in participants.13 There are also studies on
cancer, palliative, and dementia care that have indicated benefits
of topical aromatherapy application for promoting clients’ well-
being.14–16
Use of Essential Oils
Uses Directions for patients
Massage Essential oils should always be diluted in a quality
fatty carrier oil before they are applied to the skin.
Examples of carrier oils are sweet almond,a grapea
seed, and olivea oil. Oils should be diluted to 2%
for adults and 1% for children, older adults, and
frail people. To create a 2% dilution, for every 5
mLb of carrier oil add 2 drops of essential oil; to
create a 1% dilution, for every 5 mL of carrier oil,
add 1 drop essential oil.
Baths Fill bathtub with warm water. Add 3 or 4 drops of
essential oil or blend with the water when the tub
is full. The heat of the bath water will evaporate
the essential oils quickly, so add them last. One can
also dilute the essential oils in some fatty milk to
make the skin smooth and soft.
Compresses Using either warm or cold water in a bowl, add 2
or 3 drops of essential oil or blend; swish and soak
washcloth; wring; and apply to affected area.
Replace when temperature of the oil normalizes.
Compresses work well for any situation when pain
management is needed and assist in first aid.
aLatin binomials are, respectively, Prunus amygdalus, Vitis vinifera, and Olea europaea
b5 mL = 1 teaspoon.
Aromatherapy in OT
In some instances, OT practitioners may want to recommend
that clients use topical application of essential oils for wellness
purposes. For example, an OT practitioner, who has acquired
competence in aromatherapy and massage techniques, can
instruct family members or caregivers on how to perform local-
ized aromatherapy massages on family members or clients.
These applications may be in the form of hand or foot massages.
This intervention is particularly appropriate for dementia or pal-
liative care and empowers a caregiver to engage in an occupation
that helps a loved one who is being cared for.
OT practitioners can also teach clients to use aromatherapy
baths for relaxation and stress reduction, as part of overall well-
ness plans. In this instance aromatherapy is integrated into the
realm of personal self-care occupations.
Occupational therapists who are trained in aromatherapy are
therefore strongly encouraged to take a client-centered, occupa-
tion-based approach by teaching clients and their caregivers about
aromatherapy and how to use it safely for the purpose of individu-
alized self-care or for care of others. We have successfully imple-
mented this type of educational and occupation-based approach
with clients with a variety of physical and psychosocial challenges.
Safety Concerns
It cannot be emphasized enough that topical use of essential
oils requires training and study. All essential oils have the poten-
tial to irritate the skin when applied topically. Irritation can
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ALTERNATIVE & COMPLEMENTARY THERAPIES—JUNE 2004 153

Table 3. Skin-Patch Testing: Advice and

Directions to Give Patients
• Any time an essential oil is to be used on the skin, one should
conduct a skin patch test to determine if one is allergic to the oil.
• Apply 1 drop of the essential oil on the anterior surface of the
forearm and cover with a Band Aid.
• Check the area in 24 hours
• If there is redness, itching, or a blister, this indicates a topical
allergy to that oil and, thus, it should not be used topically.

occur in the form of blistering, redness, or rashes. Some essential

oils are also phototoxic.17 Some oils should also not be used dur-
ing pregnancy or with children.8 A great deal of data on the topi-
cal safety of essential oils can be accessed from the perfume
industry or through in vitro studies.18–20
Any OT practitioner trained in aromatherapy should consult
resources on essential oil safety and should be well-versed in the
potential toxicity of every essential oil used. When teaching
clients to use aromatherapy, it is important to use clinical judg-
ment when considering whether a client is capable of using
essential oils safely. Because of the potential for misuse of essen-
tial oils, coupled with the skin-irritation factor, we generally limit
client instruction of topical use to safe oils, and only after doing a
skin patch test for safety (Table 3).
With regard to use for inhalation, it has also been posited that
some essential oils should not be inhaled by individuals with
medical conditions, such as seizure disorders and asthma.8 Cer-
tainly, in any event, essential oils should always be used in a
well-ventilated room.
Intensive use (oral, rectal, vaginal application) of essential oils
is not widely practiced in the United States. In France, some med-
Rosemary (Rosemarinus officinalis).
ical doctors prescribe essential oils intensively in capsules or sup-
positories. However, essential oils can be highly toxic when
consumed orally or when directly applied to mucous mem-
branes. three nasal conchae. There are supporting cells in between the
Some essential oils are lethal even in the smallest amounts. olfactory receptor cells that secrete mucus. The mucus traps the
These methods of use are beyond the scope of most individuals chemicals (“odors”). These cells are broken down and replaced
that use aromatherapy and are never appropriate for use in OT by basal stem cells (via cellular mitosis) every month.
practice. They warrant mentioning here only because of the The facial nerve (cranial nerve VII) innervates the olfactory
importance of knowing the potential danger of such uses. epithelium and its glands to produce mucous secretion. The
odor/chemicals bond to transmembrane receptors in the den-
drites (first-order neurons), opening the sodium channel, gener-
How Essential Oils Work ating a potential and a nerve impulse. There is rapid adaptation
of the nerve fibers and the fibers adjust to the odor within a few
The most common method of use of essential oils is through seconds to a few minutes.
the sense of smell. There is some evidence that essential oils are Unmyelinated neurons extend through the foramina in the
absorbed in the body through olfaction and that inhalation of oils crista galli of ethmoid bone and synapse with the second order
can alter emotional states and stimulate memories. neurons in the olfactory bulb. The impulse is transmitted along
the olfactory tract (cranial nerve I) to the lateral olfactory area of
Physiology the temporal lobe to produce awareness of the smell. Neural con-
The olfactory system is linked directly to the midbrain, and it nections transmit the signal to the thalamus and the frontal lobe
is there that emotional state(s) and memories are regulated. to identify the smell. Further connections to the hypothalamus
Olfaction is stimulated when odors activate receptors in the and limbic system evoke an emotional response and generate
epithelium that covers the cribriform plate and upper half of the odor-related memories.21
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154 ALTERNATIVE & COMPLEMENTARY THERAPIES—JUNE 2004

als who want or need to address such areas of occupational

Resources performance.
Essential oils are commonly diffused or dispersed in the air
Essential Oil Suppliers
and are inhaled by individuals. There are a myriad of devices for
SunRose Aromatics, LLC diffusing essential oils, including fan-operated diffusers, ultra-
P.O. Box 98 sonic atomizers, electric devices with essential-oil soaked pads,
Bronx, NY 10465 light bulb rings, and clay pots with tea light candles or light
Phone: (718) 794-0391 bulbs. Essential oils are best dispersed with a gentle, safe heat
e-mail: support@sunrosearomatics.com
Web site: www.sunrosearomatics.com source and as noted above used in well-ventilated areas of the
environment.
Aura Cacia When teaching clients to use essential oils in diffusion, it is
Frontier Natural Products Co-Op important that the OT practitioners be well-versed in how each
P.O. Box 299 oil can potentially affect an individual emotionally, physically,
3021 78th Street
Norway, IA 52318 and/or cognitively. Essential oils also work well when blended
Phone: (800) 437-3301 together. There is an art to blending essential oils, and most indi-
Fax: (800) 717-4372 viduals learn to blend through study and practice.
Web site: www.auracacia.com Clients can be taught to diffuse or disperse essential oils as part
of general wellness routines, such as in the morning while
Programs for Study
preparing for work, when meditating or practicing relaxation
Australasian College of Health Sciences techniques, or when helping a restless child fall asleep.
5940 SW Hood Avenue Clients with specific medical conditions can also be assisted to
Portland, OR 97239 use problem solving to integrate aromatherapy into daily rou-
Phone: (800) 487-8839 tines. For example, a client with multiple sclerosis might choose
Web site: www.achs.edu
The aromatherapy department’s courses include Introduction to set a personal goal for diffusing aromatherapy oils during an
Aromatherapy, Certificate in Aromatherapy, Aromatherapy Blending afternoon relaxation and rest session, as part of an overall energy
and Repertoire, Establishing an Aromatherapy Consultancy, conservation program. A parent with a child who has attention-
Aromatherapy Chemistry. There is also an Aromatherapy Summer deficit hyperactivity disorder might be taught to place a drop of
School in Provence, France, and a Diploma in Aromatherapy lavender essential oil on the child’s pillow at bedtime to induce
Distance Education program. For more information on locations or
distance-learning options, visit the College’s Web site. All courses relaxation. Staff members at a nursing home can be taught to dif-
are trademarked by the College. fuse essential oils in residents’ rooms or public areas to promote
a pleasant, relaxing environment. Essential oils can also be used
R.J. Buckle Associates, LLC as part of a sensory stimulation program for older adults with
Contact is completely electronically based dementia.
e-mail: info@rjbuckle.com
Web site: www.rjbuckle.com
Courses include Aromatherapy for Health Professionals, Conclusions
Foundations in Clinical Aromatherapy, The “M” Technique® (a
registered method of touch including stroking movements for use This article has provided OT practitioners with a framework
with fragile patients), and customized course for specialized areas for using aromatherapy as an occupation-based tool for wellness
such as chronic pain, women’s health, AIDS/HIV, pediatrics, and
long-term care. in OT. Practitioners must seek training and acquire competency
before teaching clients to use aromatherapy, as is expected with
The authors have no vested interest in the products and educational programs metioned any treatment technique, principle, or modality. It is recommend-
in this article. This information is only provided as a resource for the reader. The reader
is encouraged to research all products and aromatherapy training programs carefully
ed that OT practitioners who are interested in studying aro-
before purchasing. matherapy research available courses and programs carefully.
There are quality programs offered through distance learning
and there are also some that are classroom-based. With good
Effects training, it is easy to use and teach aromatherapy safely and
Several controlled studies have indicated that inhalation of effectively.
certain aromas can bring about specific emotional and memo- Aromatherapy is nurturing to the body, mind, and spirit. Any
ry changes, including mental status changes in people with therapist who learns about aromatherapy will personally experi-
dementia,22,23 relaxation in healthy adults, and stimulation of ence the benefits of this dynamic and creative area of wellness
memory in healthy adults. 24 Another study showed that and will ultimately be able to teach a valuable wellness-based
inhalation of lavender and rosemary (Rosemarinus officinalis) occupation to interested clients and their caregivers. ■
essential oils improved alertness and mathematical computa-
tion skills in a sample of adults.25 Thus, current research indi- References
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Amy Cook, M.S., O.T.R./L., C.A., is a certified aromatherapist and regis-
tered ocupational therapist with more than 13 years of experience work-
ing with children, adults, and older adults in a variety of clinical settings.
Ann Burkhardt, M.A., O.T.R./L., B.C.N., F.A.O.T.A., is the director of
occupational therapy at New York Presbyterian Hospital-Columbia Pres-
byterian, in New York City.
To order reprints of this article, write to or call: Karen Ballen, ALTERNA-
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