Aroma seals may alleviate mental stress, breathlessness in mask-wearing: Japanese study

During the COVID-19 pandemic, the use of face masks has become a crucial measure to prevent the airborne transmission of the virus. Governments worldwide have mandated indoor masking even after widespread vaccination efforts. However, this preventive practice has led to an increase in stress among individuals compelled to wear masks.

For some, the stress stems from physical discomfort resulting from muffled voices, foggy glasses and the feeling of warm air hitting them in the face. Some are affected by social interactions having taken a hit, as facial expressions being obscured make communication a bit more challenging than usual

Additionally, the constant reminder of the ongoing pandemic and its potential health risks have contributed to a heightened sense of anxiety. There have also been instances of public confrontations or debates about mask-wearing, leading to a sense of social tension.

The stress from mandatory mask-wearing has been demonstrated through various means, including surveys and studies that have explored the psychological impact of prolonged mask use. People have also shared their experiences on social media, highlighting the emotional and physical toll the pandemic its necessary precautions have taken on them. Overall, while face masks are crucial for public health, they have introduced a unique set of stressors to those wearing them.

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Unmasking ways to deal with mask-related stress​

Based on the abovementioned information, researchers at Hoshi University conducted a study to delve into the stress-relieving potential of aroma seals attached to masks, as well as to highlight cultural and regional differences in mask-wearing behaviours and associated health outcomes.

Conducted as a double-blind, randomised controlled trial (RCT), the study involved 62 university students randomly assigned to two groups. Participants were instructed to apply aroma seals to their masks once daily throughout the study period. These were essentially scented adhesive strips or patches that could be added to face masks for a subtle, pleasant fragrance to make mask-wearing more bearable, especially over long periods.

The primary measure the researchers used was to evaluate the impact of the aroma seals on the study subjects was the Depression, Anxiety and Stress Scale-21 (DASS-21), along with secondary measures such as breathlessness assessment and the World Health Organisation Five Well-Being Index (WHO-5). The intervention group applied seals infused with orange-lime essential oil to harness citrus’ healing effects. In contrast, the non-intervention or placebo group utilised identical seals without any aroma.

The study’s results indicated significant improvements by the second week of the intervention in both total DASS-21 scores and depression scores in the intervention group, compared to their baseline values. Furthermore, the intervention group experienced reduced breathlessness during mask-wearing, compared to the placebo group. Notably, the intervention group displayed significantly higher scores in feeling “calm and relaxed" on the WHO-5 questionnaire, compared to the placebo group.

As such, the study suggested that using aroma seals containing orange–lime essential oil could be a valuable strategy in relieving mental stress and reducing breathlessness during mask-wearing, thereby enhancing overall mental health.

While previous studies have established the effectiveness of masks in reducing the spread of COVID-19, the current research has addressed the pressing issue of stress induced by prolonged mask use. Aroma essential oils, known for their non-invasive and natural properties, may present a potential solution. The study's focus on orange–lime essential oil aimed to showcase the refreshing effects of citrus as a means to alleviate stress.

Biases and benefits​

The researchers acknowledged some limitations of the study, including a gender bias among participants and a reliance on a convenience sample, urging caution in generalising the results across different age groups and demographics. However, the overall significance of the study lied in addressing the real-world challenges faced by individuals globally amid the ongoing pandemic.

They also pointed out “notable disparities” between Asia and Europe in terms of mask-wearing and associated health outcomes, with Poland and China as key examples. They wrote: “Specifically, far fewer Poles (35%) wore masks compared to the Chinese (96.8%), and they reported higher levels of anxiety, depression and physical symptoms by COVID-19. These results underline cultural and regional differences in the health and stress effects of mask use.”

They added that potential benefits of wearing masks with aroma seals may extend to scenarios such as air travel, where the calming and stress-reducing effects of the seals may contribute to passenger comfort and well-being.

In conclusion, the researchers wrote: “This study demonstrated the efficacy of aroma seals containing orange–lime essential oils in relieving mental stress and improving the comfort of breathing while wearing a mask. Therefore, using aroma seals while wearing masks can be expected to improve mental health and alleviate discomfort in breathing, improving the quality of daily life of healthy people worldwide."

Source: ​PLoS One​

“Evaluating the effectiveness of applying aroma seals to masks in reducing stress caused by wearing masks: A randomised controlled trial”​

https://doi.org/10.1371/journal.pone.0294357​

Authors:​ Nobuyuki Wakui, et al​.