Bergamot Essential Oil for Anxiety in Kids with Autism

Anxiety is a normal feeling of extreme stress that creates sensations of fear, alertness, dread, and overall unease. We all feel anxiety at some time or another–when taking a test, making major decisions, or even visiting a medical provider’s office. The stress response kicks in, our hearts beat faster, and we’re not performing at our best as a result. While researchers devote a substantial amount of time and money addressing anxiety disorders, such as generalized anxiety or social anxiety, far less attention is spent focusing on regular, common forms of anxiety. 

This is problematic for all of us but especially for certain groups of people. Children on the autism spectrum, for example, are far more likely to experience this situational form of anxiety, and it can interfere with their overall wellbeing. Because routine anxiety is, well, routine, it’s not something that requires heavy hitting pharmaceuticals or potentially invasive procedures. It needs something simple, noninvasive, and most importantly, effective. Obviously this sounds like a call for aromatherapy! So our team set out to see if simple interventions could help reduce anxiety among children with an autism spectrum disorder who were nervous about regular medical visits. 

Meet the Candidate: Bergamot

Our background research confirmed that we were going to need something simple and likable. Many aromas used for anxiety, such as lavender or coriander, have powerful scents that would further disturb a child who is prone to sensory hypersensitivity (an extreme sensitivity to touch, smells, tastes, sounds, etc). Citrus oils such as orange and lemon were ideal. However, the chemical composition of bergamot is unique in that it reflects both citrus components and those chemicals that are believed to be responsible for lavender’s soothing effects. Lavender benefits packaged in a citrus aroma. Perfect. 

Bergamot was also a no-brainer because existing research showed that it was effective at reducing anxious feelings in similar situations–including medical office stress and anxiety. In this study it was found to reduce anxiety among stressed-out elementary school teachers, and in this study it was found to reduce anxiety in pre-operative patients. 

“But wait!” you wonder, “Why we even need this study? We have two solid trials showing bergamot inhalation reduces anxiety! Why isn’t that enough?” Good question. This involves what scientists refer to as generalizability–applying findings from one group of people to another. You’ll notice that both of these studies are on adults, not children. Children require their own research studies to confirm effectiveness. Their bodies process active ingredients in essential oils differently than adults. Not only are we looking at children, we’re looking specifically at children on the autism spectrum. These kids also require their own studies, because what works on a child who is not on the spectrum may or may not work for one who is on the spectrum. A foundational factor of evidence-based science is knowing when we can generalize findings from one group to another–and when we can’t. 

The Study

The study involved 28 children with a diagnosed autism spectrum disorder who had a regularly scheduled doctor’s appointment during the study period. It’s not ethical to cause children on the autism spectrum distress for a clinical trial, so we take advantage of naturally-occurring stressors like a medical visit to explore ways in which we can help. After we obtained all of the ethical authorizations and informed consent and assent from each participant in the trial, we got started. 

The children were randomly assigned to one of two groups: bergamot aromatherapy or placebo aromatherapy (i.e. no scent). To make sure that neither the medical staff nor the patients could figure out the group, visits were split so that kids in the bergamot group and kids in the placebo group were never seen on the same day. The intervention was simple: provide baseline data, inhale the assigned scent strip for 15 minutes, then provide follow-up data. After that point, the children and providers continued with their office visit. 

We looked at multiple factors: state anxiety (which is the anxiety felt in that specific minute rather than overall anxiety that we feel all the time), heart rate, and blood pressure. This provided multiple avenues to evaluate changes caused by the aromatherapy inhalation. 

What we found about bergamot and childhood anxiety:

So what happened after we provided bergamot scent strips to these kids? It wasn’t great. Some of the kids had dramatically increased levels of anxiety after inhaling the aroma for 15 minutes. Some had anxiety levels that remained about the same. It didn’t do much overall to reduce feelings of anxiety.

When we statistically analyzed the data from the state anxiety scale, there were no differences between the groups, though the placebo group did not have the same extreme scores we saw in the bergamot group. The same was the case for heart rate and blood pressure measures. Overall, the intervention didn’t reduce anxiety and for some kids, it even made things worse. 

Why is this?

Sensory-adapted environments are one of the most effective evidence-based resources for children on the autism spectrum who have medical office anxiety. In a sensory-adapted environment, sensory experiences (sights, sounds, smells) are reduced rather than increased. Our team of research aromatherapists propose that this hypersensitivity to sensory experiences may explain why the addition of a scent, even one known to provide calming effects, produced a different response in this particular group of people. This is particularly noteworthy given that scent memory and the olfactory process are critical factors for aromatherapeutic effects.

So what now? 

Addressing anxious feelings in children with autism is a complex challenge. Just because one approach wasn’t found to be effective doesn’t mean aromatherapy as a whole should be avoided. There are a lot of factors that may account for our findings. Perhaps children need to be primed with scent memory so that the bergamot aroma is not a brand new aroma. Maybe the intervention should start before they enter the medical office. Perhaps the dose is off. Maybe we should use different oils. The amazing thing about clinical research is that negative findings are just as beneficial as positive. Knowing what doesn’t work is just as important as knowing what does. Now we can adjust our approach and we’re one step closer to learning how to help settle anxiety in this anxiety-prone group of kids. 

Our results were published in 2019 in the scientific journal Holistic Nursing Practice, which is published by the Wolters-Kluwer scientific publishing company. The manuscript is entitled: Bergamot Aromatherapy for Medical Office-Induced Anxiety Among Children with an Autism Spectrum Disorder and you can find it on PubMed here