THE JOURNAL OF ALTERNATIVE AND COMPLEMENTARY MEDICINE

Volume 14, Number 6, 2008, pp. 655661

Mary Ann Liebert, Inc.
DOI: 10.1089/acm.2007.0591

Differences Between the Physiologic and Psychologic

Effects of Aromatherapy Body Treatment
Hitomi Takeda, Ph.D.,1 Junzo Tsujita, B.S.,2 Mitsuharu Kaya, Ph.D,3 Masanori Takemura, M.S.,1
and Yoshitaka Oku, M.D.1

Abstract

Background: The wide use of herbal plants and essential oils for the prevention and treatment of diseases dates
back to ancient times. However, the scientific basis for the beneficial effects of such plants and oils has not been
precisely clarified.
Objective: The purpose of this study was to evaluate the effects of aromatherapy body treatment on healthy
subjects.
Design: We compared the physiologic and psychologic effects of aromatherapy body treatment (E), massage
treatment with carrier oil alone (C), and rest in healthy adults.
Subjects: Seven (7) female and 6 male volunteers participated as subjects.
Interventions: Each subject underwent 3 trials, in which the Advanced Trail Making Test (ATMT) was given
as a stress-inducing task before and after 1 of 3 treatments.
Outcome measures: The State Anxiety Inventory (SAI), the Visual Analog Scale, and the Face Scale were used
to assess anxiety, feelings, and mood, respectively.
Results: After the treatments, the SAI score and the feelings of fatigue were decreased, the positive and comfortable feelings were increased, and mood improved significantly in C and E. Furthermore, significant declines
in the feelings of mental and total fatigue were maintained even after the second ATMT in E. On the other
hand, the cortisol concentration in the saliva did not show significant changes in any of the trials. Secretory immunoglobulin A levels in the saliva increased significantly after all treatments.
Conclusions: We conclude that massage treatments, irrespective of the presence of essential oils, are more advantageous than rest in terms of psychologic or subjective evaluations but not in terms of physiologic or objective evaluations. Furthermore, as compared to massage alone, the aromatherapy body treatment provides a
stronger and continuous relief from fatigue, especially fatigue of mental origin.

Introduction

tress-related and fatigue-related diseases have increased

recently. The development of effective methods to prevent such diseases is urgently needed. Aromatherapy is a
kind of phytotherapy, which uses essential oils extracted
from plants. The bacteriocidal and the antiseptic action of
herbal plants and essential oils has been used for the prevention and cure of miscellaneous diseases since the age before modern medicine developed.1 Therefore, aromatherapy
has tended to be viewed as a nonscientific folk remedy. However, the effects of odor compounds contained in the essen-

tial oils have been clarified scientifically,2,3 and aromatherapy has come to be used as a complementary and alternative medicine for mental and physical diseases. For example,
aromatherapy effectively ameliorates anxiety, pain, and depressive mood in the elderly4 and in patients.48
Most previous scientific surveys have used inhalation
methods to evaluate the effects of essential oils.2,3,9,10 However, inhalation methods are not suitable for evaluating the
total effect of aromatherapy body treatment. Aromatherapy
has been generally used in combination of inhalation and
massage. The physical and psychologic effects of massage
may be important factors in aromatherapy treatment. Dunn

1Department

of Physiology, Hyogo College of Medicine, Hyogo, Japan.

of Health and Sport Sciences, Hyogo College of Medicine, Hyogo, Japan.
3Liberal Arts Center, Hyogo University of Health Sciences, Hyogo, Japan.
2Department

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656
et al.11 compared the effects of aromatherapy using lavender (Lavandula angustifolia), massage therapy, and rest in intensive care patients. Dunn et al. found some psychologic effects but did not find any physiologic effectiveness of
aromatherapy. However, the effects of aromatherapy massage on healthy subjects have been scarcely tested. Therefore, in the present study, our aim was to evaluate the effects of aromatherapy body treatment on healthy subjects
and to clarify the association between physiologic and psychologic responses to the therapy.
Methods
Subjects
Seven (7) female and 6 male volunteers (age: 30.9  7.8
years) who gave their informed consent participated as subjects. The present study was performed in accordance with
the guidelines for the Declaration of Helsinki: Ethical Principles for Medical Research Involving Human Subjects
(World Medical Association).
Experimental protocols
Each subject participated in 3 trials, in which a stress-inducing task was given before and after 1 of 3 treatments (Fig.
1). Treatments included massage treatment with essential
oils diluted in carrier oil (trial E), massage treatment with
carrier oil alone (trial C), and rest (trial N). The 3 trials were
performed on separate days in random order. Each treatment was carried out on a massage table specially designed
for aromatherapy. The massage treatment was done by one
of the authors (H.T., female), who is qualified as an aromatherapist by the Aroma Environment Association of
Japan, in the following sequence: the posterior part of legs
and back in a prone position, then shoulder, neck, arms, and

TAKEDA ET AL.
hands in a supine position. Simple Swedish technique was
used for the massage. The total treatment time was about 45
minutes.
Macadamia nut (Macadamia integrifolia) oil was used as the
carrier oil. We blended 3 essential oils, instead of a single essential oil, in an attempt to make the fragrance pleasant for
all subjects. Essential oils included orange sweet (Citrus
sinensis), true lavender, and marjoram sweet (Origanum majorana). The oils were all mixed into the carrier oil with the
ratio of 2:1:1 as one 1% solution. All oils were purchased
from Laboratoire Sanoflore (Gigors-et-Lozeron, France).
We confirmed that the fragrance of these essential oils did
not give the subjects an unpleasant sensation and that none
of the oils caused any allergic reaction to the subjects by the
open test.
The Advanced Trail Making Test (ATMT12) was performed as a stress-inducing task before and after each treatment. The ATMT is a computerized version of the Trail Making Test13 in which each subject performs a visual search
task. In the test, circles numbered from 1 to 25 spread out
randomly on the initial screen of a touch screen monitor. The
subjects task is to touch these numbered circles sequentially.
When the subject touches the circle numbered as 1, it disappears and the circle numbered as 26 appears on the screen,
and positions of the numbered circles change randomly. A
search from the number 1 to 25 was repeated 5 times before
and after treatments (ATMT1 and ATMT2, respectively).
Two (2) parameters, the number of errors (ATMT-Errors)
and the time to finish (ATMT-Time), were used to assess the
level of mental fatigue. In addition, the following variables
were measured at 4 measurement points: at the beginning
of each trial (M1), after the first ATMT (M2), after each treatment (M3), and after the second ATMT (M4).
State-Trait Anxiety
Anxiety was assessed by the State-Trait Anxiety Inventory
Form.14.15 The Trait Anxiety Inventory was assessed before
the first ATMT (M1). The State Anxiety Inventory (SAI) was
assessed before and after each ATMT.
Subjective feelings
Subjective feelings of fatigue (physical, mental, and total),
relaxation, refreshment, and satisfaction were measured by
the visual analog scale.
Change of mood
Changes of mood were evaluated by the 20-step Face
Scale.16 In the test, face pictures (cartoons), numbered from
1 to 20, are presented to each subject. As the number increases, the appearance of the face changes from a happy
look to a sad look. Subjects choose a face picture that most
represents their feeling at that time. Therefore, a decrease in
number shows improvement of their feeling, and an increase
shows deterioration.

FIG. 1. Experimental protocol. Each subject participated in

3 trials, in which the Advanced Trail Making Test was given
before and after 1 of 3 interventions. N: rest only, C: massage treatment with carrier oil alone, E: massage treatment
with essential oils diluted in carrier oil. Variables were measured at 4 measurement points (M1, M2, M3, M4).

Cortisol and secretory immunoglobulin A concentrations

in the saliva
Saliva samples were collected using saliva collection test
tubes, Sallivett (Bhlmann Laboratories AG, Schnenbuch,
Switzerland), and stored at 80C for later analyses. Corti-

EFFECTS OF AROMATHERAPY TREATMENT

657

sol and secretory immunoglobulin A (s-IgA) in the saliva

were measured by radioimmunoassay (RIA) and turbidimetricimmunoassay (TIA), respectively. There is diurnal
variation with cortisol. The cortisol concentration in the
saliva is the highest in immediately after awakening, gradually decreases, and keeps a stable level after noon.17 Therefore, all experiments were performed between 2:00 PM and
6:00 PM to minimize the influences of the diurnal variation
of the cortisol secretion.
Statistical analysis
Differences of parameter values between trials or measurement points were analyzed depending on whether the
parameters were parametric or nonparametric. Parametric
data were analyzed by one-way analysis of variance and posthoc test of Fishers Projected Least Significant Difference
(PLSD). Nonparametric data were analyzed by Friedmans
test and Wilcoxon signed rank test. p-values less than 0.05
were considered as significant. Values were presented as
mean  standard deviation.

FIG. 3. Change of mood evaluated by Face Scale. Changes

of mood were evaluated by the 20-step Face Scale. Face scale
scores at M3 were significantly lower than those at M1 in trials C and E. However, the effect disappeared after the second Advanced Trail Making Test. Asterisks indicate significant differences as compared to M1. *p  0.05, **p  0.01.

Results

Change of mood

State-Trait Anxiety

Face scale scores at M3 (immediately after treatments)

were lower than those at M2 (immediately before treatments)
in all trials (Fig. 3). However, in comparison with the initial
values, Face Scale scores at M3 were significantly lower in
trial C (M1: 8.2  3.2 versus M3: 5.2  2.6, p  0.01) and trial
E (M1: 5.9  2.9 versus M3: 8.0  3.2, p  0.01) but unchanged in trial N (M1: 7.2  2.7 versus M3: 6.5  2.6, not
significant).

Statistical differences in SAI scores between measurement

points were found in trial C [F (3, 11)  20.6, p  0.0001] and
trial E [F (3, 11)  16.6, p  0.0001]. SAI scores after treatments decreased significantly as compared to the initial values in trial C (M1: 38.7  7.3 versus M3: 31.7  6.4, p  0.001)
and trial E (M1: 39.1  7.9 versus M3: 30.1  6.6, p  0.001),
but not in trial N (M1: 37.9  9.3 versus M3: 33.5  7.4, not
significant; Fig. 2). Although SAI scores increased after the
second ATMT in all trials, significant differences from the
initial values were maintained in trials C and E. SAI score at
M4 was lowest in trial E (E: 33.2  7.5, C: 35.7  8.2, N:
36.6  7.0).

FIG. 2. Changes in State Anxiety Inventory (SAI) score. SAI

was assessed before and after each Advanced Trail Making
Test (ATMT). Note that even after the second ATMT, significant differences from the initial values were maintained in
trials C and E. Asterisks indicate significant differences as
compared to M1. *p  0.05, **p  0.01, ***p  0.001.

Subjective feelings
Changes in subjective feelings of fatigue in each trial are
shown in Figure 4A. Differences in total fatigue [N: F (3,
12)  7.28, p  0.0006; C: F (3, 12)  5.36, p  0.0041; E: F (3,
12)  5.74, p  0.0026] and physical fatigue [N: F (3, 12) 
5.03, p  0.0052; C: F (3, 11)  6.33, p  0.0016; E: F (3, 12) 
6.05, p  0.0019] were detected between measurement points
in all trials. Although the feelings of total fatigue and physical fatigue at M3 were significantly lower than those at M1
in all trials, the decrease in the feeling of mental fatigue at
M3 was significant only in trial C (M1: 3.5  2.2 versus M3:
2.2  1.6, p  0.01) and trial E (M1: 3.7  2.5 versus M3: 2.0 
1.6, p  0.001). These 3 kinds of feelings of fatigue increased
after the second ATMT. However, the feelings remained at
lower levels as compared to the initial values only in trial E.
Changes in subjective feelings of relaxation, refreshment,
and satisfaction in each trial are shown in Figure 4B. These
3 kinds of positive and comfortable feelings increased significantly in trial C [relax: F (3, 11)  7.62, p  0.0005; refreshment: F (3, 11)  1.35, p  0.0001; satisfaction: F (3, 11) 
12.8, p  0.0001] and trial E [relax: F (3, 12)  11.7, p  0.0001;
refreshment: F (3, 12)  14.6, p  0.0001; satisfaction: F (3,
12)  7.32, p  0.0006] but were unchanged in trial N.
ATMT-Errors and ATMT-Times
Changes in ATMT-Errors and ATMT-Time in each trial
are shown in Figure 5. There were no significant differences
between ATMT1-Time and ATMT2-Time in all treatments
(N: 343.3  32.6 seconds versus 331.6  31.3 seconds, C:

658

TAKEDA ET AL.

FIG. 4. Changes in subjective feelings evaluated by visual analog scale. A. Changes in subjective feelings of fatigue. Upper, middle, and lower traces show the subjective feelings of total fatigue, physical fatigue, and mental fatigue, respectively.
These fatigue-associated feelings at M3 were significantly lower than those at M1 in trials C and E. However, significant
differences were maintained only in trial E after the second Advanced Trail Making Test. B. Upper, middle, and lower
traces show the subjective feelings of relax, refreshment, and satisfaction, respectively. These 3 kinds of positive and comfortable feelings increased significantly in trials C and E but were unchanged in trial N. Asterisks indicate significant differences as compared to M1. *p  0.05, **p  0.01, ***p  0.001.

EFFECTS OF AROMATHERAPY TREATMENT

FIG. 5. Changes in Advanced Trail Making Test (ATMT)Time and ATMT-Errors. ATMT was performed before and
after each intervention and evaluated by ATMT-Time and
ATMT-Errors. There were no significant differences between
ATMT-1 and ATMT-2, or between the 3 trials.
326.1  35.8 seconds versus 335.2  35.4 seconds, E: 332.9 
37.7 seconds versus 339.0  39.6 seconds). The comparison
between the 3 trials did not show significant differences.
Analyses of ATMT-Errors yielded similar results (i.e., there
were no significant differences between ATMT-1 and ATMT2, and between the 3 trials).
s-IgA and cortisol concentrations in the saliva
Changes in s-IgA concentration in the saliva in each trial are
shown in Figure 6. Analysis of variance detected statistical differences between measurement points in all trials [N: F (3,
11)  14.8, p  0.0001; C: F (3, 11)  15.5, p  0.0001; E: F (3,
12)  9.17, p  0.0001]. The post-hoc test revealed that the s-IgA
concentration in the saliva increased significantly as compared
to the initial values after all treatments (N: 394.5  223.5
g/mL versus 744.0  360.6 g/mL, C: 328.3  157.8 g/mL
versus 613.8  272.2 g/mL, E: 337.1  142.9 g/mL versus
626.1  332.9 g/mL). However, there were no significant differences between the 3 trials.

659
relieving effects independent of massage treatment, which
would be beneficial for workers under stressful environments. Similar results have been reported for patients in hospice care facilities.7 Amelioration of anxiety and improvement of immunity by massage and touching have been
reported at palliative care18 and elderly care19 facilities. Both
the psychologic effects of touching and the physical effects
such as the relaxation of muscle tension offer these beneficial effects. However, there are a number of factors that must
be taken into account when interpreting the present results.
First, the concentration of essential oils might be insufficient to elicit significant effects. Dilution concentrations being used in the reports where significant differences were
found between massage alone and massage with essential
oils were 1.3% for patients with cancer6 and 4% for students
with dysmenorrhea.20 On the other hand, dilution concentrations used in the reports where significant differences
were not found were 1% for patients in intensive care units,11
1% for patients with cancer,7 and 2%3% for healthy adults.21
Furthermore, the same fragrance gives both pleasant and unpleasant sensations depending on the dilution concentration.22,23 The 1% concentration of essential oils used in the
present study was at the lower end of the range of recommended dilution concentrations for safety reasons.
Second, essential oils chosen for the present study might
not exactly suit subjects preferences, although we confirmed
that the fragrance of these essential oils did not give the subjects an unpleasant sensation. Physiologic and psychologic
responses to the fragrance vary by the subjects individual
fragrance preference.2427 The difference in individual fragrance preference may explain why the cortisol concentration in the saliva did not show a significant change. Consistent with this thought, previous studies using the inhalation
of essential oils report inconsistent results; cortisol increased
immediately after inhalation and subsequently decreased in
female subjects with rose (Rosa damascena),28 decreased with
rose29 and with lavender and rosemary (Rosmarinus offici-

Concentrations of cortisol in the saliva

Changes in cortisol concentration in the saliva in each trial
are shown in Figure 7. Although downward trends from the
initial values were seen after treatments, there were no significant changes in any of the trials (N: 1.0  0.6 versus 0.8 
0.4 g/dL, C: 0.8  0.8 versus 0.6  0.3 g/dL, E: 0.7  0.4
versus 0.6  0.4 g/dL).
Significant difference in their outcomes was not found between men and women.
Discussion
We compared the physiologic and psychologic effects of
aromatherapy treatment, massage treatment with carrier oil
alone, and rest in healthy adults. Massage treatments decreased anxiety and feelings of fatigue and increased positive and comfortable feelings, irrespective of the use of essential oils. The results indicate that most beneficial effects
of the aromatherapy body treatment are the result of massage rather than essential oils. Aromatherapy had no adverse
effect. Furthermore, aromatherapy had long-lasting, fatigue-

FIG. 6. Changes in secretory immunoglobulin A (s-IgA)

concentration in the saliva. The s-IgA concentration in the
saliva increased significantly as compared to the initial values after all interventions. However, there were no significant differences between the 3 trials. Asterisks indicate significant differences from M1. ***p  0.001.

660

FIG. 7. Changes in cortisol concentration in the saliva. Although downward trends from the initial values were seen
after interventions, there were no significant changes in any
trials.

nalis),23 and was unchanged with lavender and rosemary.30

In the actual clinical treatment situation, essential oils that
meet the symptoms and the fragrance preference of each individual subject are chosen at the pretreatment consultation.
Such personalized treatment has been proven to be effective
in several studies.6,31
We observed an increase in salivary s-IgA in all trials. Salivary s-IgA increases after pleasant and relaxing experiences,
such as relaxation training,32 massage therapy,19 touch therapy,33 watching rakugo (Japanese comic storytelling),27 and
contact with pet robots.34 On the other hand, chronic psychologic stresses decrease salivary s-IgA levels.35 Therefore,
judging from the changes in salivary s-IgA, simple rest has
an equivalent effect in improving immunity as compared to
massage alone or massage with essential oils. It is interesting that physiologic or objective parameters such as cortisol,
s-IgA, ATMT-Errors, and ATMT-Time were not distinguished between trials, whereas the subjective parameters
revealed advantages of massage treatments over rest. We
should bear this difference in mind when we evaluate the
effects of aromatherapy. Regarding the cortisol level, the kinetics of cortisol might be slower relative to the study time
period. However, significant changes in cortisol level were
shown after inhalation of odor for 5 minutes23 and after the
aromatherapy treatment, which includes 5-minute footbath
and 30-minute massage.21 Therefore, we think that the cortisol level could be changed within the study time period.
The effects of essential oils in the aromatherapy body treatment are the result of pharmacologic actions of odor compounds sensed via the olfactory system, inhaled to the lung,
or absorbed directly through the skin.36 Although there are
many studies about the effects of essential oils, most studies
have used inhalation methods to evaluate the effects of essential oils and have used undiluted solutions of essential oils;
such studies have included the sedative action of lavender2,3,9,37; the antianxiety action of lavender,10 orange sweet,10
geranium (Pelargonium roseum)38; and the awakening action of
rosemary37,39 and peppermint (Mentha piperita).40 The stimulus of fragrance in these inhalation experiments should be

TAKEDA ET AL.
stronger than in the case in which essential oils diluted in carrier oil are applied to the skin during body treatment. Therefore, in these experiments, the stimulation to the central nervous system from the olfactory system would be the most
important pathway for alleviating anxiety and stress. Olfactory
stimulus evokes pleasant or unpleasant emotions41,42 and
causes changes in the autonomic nervous system and endocrine system outputs by central commands.26,27 On the other
hand, since essential oils diluted in carrier oil were applied to
the skin in the present study, there might be some effects induced by components absorbed through the skin. The quantity of essential oils absorbed through the skin has been reported to be 4%25% of applied quantity.36 The amount of
essential oils absorbed by the lung is unknown.
It has been suggested that the effects of essential oils cannot exceed the effects of massage and touching unless essential oils are chosen carefully to meet with individual fragrance preference.1 This is consistent with the current results
that the majority of beneficial effects are brought about by
massage treatment. If we added a trial using aromatherapy
inhalation alone and compared the results with results by
massage, more differences could have been observed.
However, our results have also shown that essential oils
prolong fatigue-relieving effects. Therefore, essential oils
may have long-term effects to enhance stress-coping ability.
The effects are useful for workers to perform their tasks with
less fatigue and a better mood and to maintain their physical and mental health. We do not know whether the prolonged effect is caused by the delayed actions of odor compounds permeated through the skin or by the fragrance of
the essential oils left on the skin surface.
Conclusions
Massage treatments are superior to rest in terms of psychologic or subjective evaluations but are equivalent to rest
in terms of physiologic or objective evaluations. Beneficial
effects of aromatherapy body treatment with a 1% concentration for healthy subjects largely depend on the effects of
massage treatment rather than the effects of the essential oils.
In addition, aromatherapy has long-lasting, fatigue-relieving
effects independent of massage treatment. Although we did
not find significant differences in the outcomes between men
and women, the sample size of the present study might be
too small to detect the differences of outcomes by the differences of gender or age. Further study is needed with larger
sample sizes.
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Yoshitaka Oku, M.D.
Department of Physiology
Hyogo College of Medicine
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E-mail: yoku@hyo-med.ac.jp