Flower Remedies for Stress Relief
By Georges Ramalanjaona, MD, DSc, FACEP, MBA
Practitioners using flower remedies, also known as flower essences (FE), aim to treat various emotional states. Although the therapeutic use of flowers is not new, modern flower therapy began with work of an English physician, Dr. Edward Bach, in the early 1930s. He theorized that negative emotions predispose to illness, and his FE therapy was aimed at treating underlying psychological and emotional problems associated with disease, rather than treating the illness itself.1,2
In the United States, contemporary practitioners from many different fields—primarily allied health professionals and non-clinician healers—are utilizing flower remedies as part of a holistic approach to treat different ailments such as stress, anxiety, and depression.3
Preparation of Flower Remedies
There are two known methods of preparing FE: the solar and boiling methods. The choice of each method depends upon the specific season in which a particular plant blossoms, and the availability of adequate sunlight.
In the solar method, intact flowers are gathered and protected with grass. The blossoms then are placed in a clear glass bowl full of fresh water and are exposed to sunlight for three hours. At the end of this period, the blossoms are discarded and the remaining water, with a specific flower radiation, is conserved. This flower-infused water is preserved with brandy alcohol, in a one to one ratio, and then is diluted at a 0.2% ratio to form FE stock.1,3
In the boiling method, the flowers and twigs are boiled in water for 30 minutes to create the tincture that constitutes the mother essence. After this step, the water is preserved and diluted.
Mechanism of Action
Because FE are very dilute physically, no conventional or western biomedical mechanism of action can explain their biochemical effect. It is hypothesized, therefore, that FE act by the principle of energetic resonance: A flow of subtle energy field derived from the living plant is imparted to the water through the blossom. This energy field influences its energetic counterpart in the human body when FE are ingested.4
FE are reported to improve health by removing negative stressful states that accompany illness. In this setting, there are two theories that may explain how FE work: the stress theory and the immune therapy.1,4
The stress theory stipulates that a build-up of negative emotions places additional stress upon the human body, resulting in increased heart disease and decreased digestive function. FE transform negative emotions and behavior into positive ones.
The immune theory implicates the effect of excess negative emotions on immune function, which reduces the ability of the human body to heal itself. Clinical studies have shown that a person’s psychological and emotional states influence physiological function of the body by stimulating or suppressing stress hormones and immune cell activities.5 FE are selected according to the personality and emotional states of the users.
With either theory, a patient can use a self-administered questionnaire to analyze and identify his/her emotional imbalances, and thus choose which FE would be suitable for his/her specific conditions.
Anecdotal case reports comprise the majority of published literature on FE. Only a few randomized clinical trials have tested the effectiveness of FE in stress relief (see Table, below).
Clinical trials of flower remedies in stress relief
|Weisglas6||31||Randomized, double-blind, placebo-controlled||Two treatment groups vs. placebo||Statistically significant improvement of self-selected adjective checklist in treatment groups vs. placebo|
|Campanini7||115||Before-and-after||Flower essence program for three months||89% of patients showed short- term improvement in anxiety|
|Cram8||12||Quasi-experimental (time series)||Each patient used a mean of eight flower remedies for three months||Flower therapy produced a 50% decrease in both depression scales|
|Walach et al3||61||Randomized, double-blind, placebo-controlled with partial crossover||Bach flower remedies vs. placebo group||No significant difference between the groups in test anxiety inventory|
The first randomized double-blind placebo-controlled trial demonstrated the effectiveness of FE (level of evidence I on a scale of I-III).6 The author used a total of 39 subjects, ages 19-45 years (mean 27 years), evenly distributed by gender, and randomly assigned to three treatment groups (group 1 received no FE, group 2 received four FE, group 3 received seven FE) for six weeks.
The main hypothesis studied was the FE effect on the subjects, independent of the person’s belief system. Measurements of FE efficacy were done by Adjective Check List (ACL), Luscher Color Test (LCT), and Post-Experimental Questionnaires (PEQ). The ACL is a self-administered test of 300 adjectives that are associated with the number of essences received. The LCT measures the emotional well-being of a subject as defined by the average rank sum of brown, black, and gray colors. Both ACL and LCT were taken at three-week intervals during six weeks.
Results showed that FE significantly improved self-understanding and self-acceptance, increased humor, creativity, and sexuality in groups 2 and 3 when compared to group 1 (P < 0.05). In the ACL test, the adjectives that significantly distinguished group 3 were "self-controlled" and "unemotional" (P < 0.01, P < 0.05) vs. group 1, and "witty" in group 2 vs. group 1. Results in the LCT and PEQ indicated that group 2 increased in well-being and sexuality, but group 3 experienced a significant reduction in well-being (P < 0.05) vs. group 1.
The authors concluded that FE operated independently of the user’s belief system, and in selecting FE for personal growth four or less were recommended, whereas for stress relief four or more were indicated.
In a larger but uncontrolled trial, Campanini used a before-and-after design (evidence level II) to evaluate the effect of a FE treatment program on 115 patients with symptoms of anxiety and depression for four months.7 Results displayed a significant symptomatic improvement (P < 0.05) in 89% of patients with anxiety within 3-4 weeks as evaluated by psychological counselors. A separate analysis of patients’ initial trust about FE treatment did not indicate any undue influence on the study outcome.
A recent study by Cram examined the clinical efficacy of FE as an adjunct in the treatment of mild-to-moderate depression.8 He used a time-series design (evidence level II) with 12 patients who were treated with "usual care" (psychotherapy and nutritional support) for one month followed by three months of usual care and FE therapy. During the FE phase, patients were offered an average of eight different FE, a maximum of 5-6 essences were used at any given time per patient. Results showed that FE therapy significantly reduced (P < 0.0001) depressive rating by 50% in both Beck depressive inventory and Hamilton depressive scale at one month and three months.9,10
Current limitations of these clinical trials include small numbers of participants, lack of standardized FE treatment, and short duration of study.
In an ongoing randomized controlled trial of 24 subjects in an induced stress situation, Cram showed that FE (five-flower formula) significantly decreased physiological stress response as measured by paced serial arithmetic task compared to placebo group.11 The Flower Essence Society (www.flowersociety.org) is conducting this trial.
In published clinical trials, FE did not produce any physical or psychological dependency, or known side effects when used alone or combined with any other treatment of traditional medicine.2-4
Contraindications and Precautions
Because FE are preserved in brandy, caution should be exercised by alcoholics, patients who are allergic to alcohol, patients with hepatic damage or liver disease, and those who object to its use on religious/moral grounds. Also, one should be careful about drinking FE on an empty stomach, despite the small quantity.
In one small clinical study, FE did not display any interaction with antidepressant drugs such as selective serotonin-reuptake inhibitors, although this interaction is possible.8
The safety of FE among children and pregnant women has not being studied and is thus unknown.
Dosage and Formulation
FE are taken orally from a dropper bottle, usually four drops four times a day for one to several months. FE can be applied externally either in liquid or cream form when they cannot be ingested.
FE are sold commercially in 5 mL stock bottles. To make a remedy, a patient can fill a one-ounce glass with water and add two drops of FE. A patient can drink up to four glasses a day for optimal effect.
Combinations of FE remedies can be dispensed to maximize effectiveness; however, as a rule of thumb, patients are cautioned not to mix more than 5-6 remedies at once. Mixing more than six may diminish the effect of each.
Based on results of preliminary clinical trials, FE could be used as an adjunct for symptomatic treatment of anxiety and stress. FE appear to be safe and effective for stress relief in preliminary, very small, short studies, but these studies are so imperfect that they cannot tell the whole story.
Due to the limited number of well-designed clinical trials, and the absence of trials against standard treatment, flower essences cannot be recommended for primary symptomatic relief of stress. Recommend further investigation to interested patients v
Dr. Ramalanjaona is Associate Chairman for Academic Affairs, Department of Emergency Medicine, Seton Hall University, School of Graduate Medical Educa- tion, South Orange, NJ; and Director of Research, Division of Emergency Medicine, St. Michael’s Hospital, Newark, NJ.
1. Scheffer M. Mastering Bach: A Guide to Flower Diagnosis and Treatment Therapies. Rochester, NY: Healing Arts Press; 1996.
2. Cucherat M, et al. Evidence of clinical efficacy of homeopathy. A meta-analysis of clinical trials. Homeopathic Medicines Research Advisory Group. Eur J Clin Pharmacol 2000;56:27-33.
3. Walach H, et al. Efficacy of psychological treatment of depression, evidence for the efficacy of psychotherapy alone, and in combination with pharmacotherapy. Arch Gen Psychiatry 1979;36:1261-1269.
4. Linde K, Melchart D. Randomized controlled trials of individualized homeopathy: A state-of-the-art review. J Altern Complement Med 1998;4:371-388.
5. Kaslof LJ. The Bach Remedies: A Self Help Guide. New Canaan,CT: Keats Publishing, Inc.; 1988.
6. Weisglas M. Personal Growth and Conscious Evolution through Bach Flower Essences [dissertation]. San Francisco, CA: California Institute of Asian Studies; 1979.
7. Campanini M. Bach flower therapy: Results of a monitored study of 115 patients. LA Medicina Biologica 1997;15:1-13.
8. Cram JR. Flower essence therapy in the treatment of major depression: Preliminary findings. Int J Healing Caring 2001;1. Available at: www.ijhc.org/Journal/0601articles/Cram-I-1.html.
9. Beck AT, et al. An inventory for measuring depression. Arch Gen Psychiatry 1961;4:561-571.
10. Hamilton M. Development of a rating scale for primary depressive illness. Br J Social Clin Psychol 1968;6:78-96.
11. Cram JR. A psychological and metaphysical study of Dr. Bach’s flower essence stress formula. Subtle Energies [In press].