Aromatherapy
Aromatherapy has been one of the most popular CAM therapies used to help reduce anxiety86,102,116. Aromatherapy, defined as using essential oils for therapeutic purposes, is administered through the epidermis (skin) or by inhalation117. For MRI anxiety, aromatherapy has been administered via inhalation as the olfactory system is believed to be the primary healing point for emotions118.
An advantage of using aromatherapy is the immediate physiological and psychological effects it has when compared to other currently used interventions in MRI anxiety such as sedation or hypnosis119,120. Inhaled aromatherapy’s immediate effect is due to the scent molecules’ ability to bypass the blood–brain barrier and go directly to the olfactory portions of the limbic system, which regulates emotions via the autonomic nervous system (ANS)53,116,119,121. When a scent molecule enters the nasal cavity, it attaches to the olfactory epithelial receptors. These receptors take this scent information along the olfactory nerves and signals the limbic system via the hippocampus within the amygdala122. Once this information reaches the hippocampus, the ANS is activated and neurotransmitters are secreted. The type of neurotransmitter secreted depends on which branch of the ANS is activated. If the odor is pleasant and/or attached to positive memories, then the parasympathetic nervous system (PNS) is activated and neurotransmitters such as GABA and serotonin are secreted, producing a relaxation effect53,122,123. In the case of an unpleasant scent and/or negative emotions attached to it, the sympathetic nervous system (SNS) is activated and neurotransmitters such as norepinephrine and epinephrine are secreted, creating anxious feelings53,122,123. This action takes place in less than a second (approximately 300–400 milliseconds). The reaction time may be dependent on gender with women having faster emotional reactions than men119,121,124. In short, aromatherapy is the result of the scent molecule interacting with the limbic system and, hence, is dependent on the respiratory system121,122.
Aromatherapy has been used to help reduce anxiety not only in the MRI environment but in a variety of other medical settings as well. There have been several studies evaluating its use in reducing anxiety in dental patients, post-surgical nervousness and pain, and postpartum anxiety, all with positive results102,125,126.
The use of scent to help reduce anxiety has been evaluated in the MRI environment with respect to the number of canceled exams with varying results127. Aromatherapy was reported to help treat anxiety, including cognitive- and stress-related disorders119,128. This directly correlates with MRI claustrophobia, which is a stress-related disorder in which cognition greatly contributes to anxiety during the exam5,20,25,109.
Fragrance has been successful in reducing MRI anxiety, including the study I conducted, there have been three studies dealing specifically with the use of aromatherapy in the MRI environment 20,127. The earliest study showed a reduction in overall MRI anxiety by 63% in patients using a vanilla scent administered through a nasal cannula127. This study went one step further and evaluated the experimental group participants who considered the scent pleasing and found their level of anxiety was reduced127. This finding is supported by the physiological idea of “pleasantness” of a fragrance is related to anxiety reduction and supports the study hypothesis that fragrance had a cognitive effect on patients, enabling them to remain calm during their examination. This was in alignment with a study that concluded scents can affect a person’s mood and, consequently, their cognition20,119,127. In essence, scents appear to block anxious feelings and replace them with more positive ones127. Likewise, a pleasant scent causes people to slow their breathing and deepen their inhalations, triggering a relaxation response129. Lastly, the study I conducted during graduate school combined both aromatherapy and breathing techniques, which resulted in a 77% reduction in MRI patient anxiety20.
In conclusion, aromatherapy has been shown to be effective in reducing anxiety in the MRI environment. Scent has helped patients with anxiety in a variety of medical procedures and treatments, including MRI, with varying results20,118,122,127,129,130. The effectiveness of using scent is dependent on whether or not the patient finds the scent pleasant and/or has a positive association with it. Likewise, women tend to be affected by scent more quickly than men.
Hint: If you use aromatherapy, then let the patient choose their scent because if they don’t like it, then more anxiety may result.