Citrus aurantium and cognitive function -
RESUMO O óleo essencial de laranja OEL e seus constituintes obtidos da Citrus aurantium L. MATERIAL AND METHODS Animals Were used months old male Wistar rats weighing g. Chemicals The OEO was supplied from International Flavors and Fragrance IFF Ltda. Analysis of the essential oil The OEO was analyzed by gas chromatography.
Treatment Groups with 12 rats each were used. Open-field behavioral test The open-field test was originally proposed as a measure of emotionality, with the animals being exposed to excessive light or noise. Social interaction test This procedure is based on the observation that animals tend to reduce or even suppress their interaction with other animals under conditions of new environments or excessive light.
Elevated plus-maze test The maze consists of two open arms and two closed arms by 30 cm high walls. Statistical analysis Student's t test was used to analyze the behavioral parameters observed in the open-field, as well as the one-way ANOVA, followed by the Tukey's and the Duncan's tests, to analyze the data we obtained in the TSI and the EPM, respectively.
RESULTS Identification of constituents of OEO The chromatographic analysis of the OEO showed a phytochemical profile that confirms the presence of the main classes of components characteristic of the species Citrus aurantium L.
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J Affect Disord : Herbal medicines have been used widely since old days in ancient civilizations [ 17 ]. Aromatherapy is one of the treatments that have grown increasingly in recent years compared to complementary medicine treatments [ 18 ].
According to a recent systematic review, various essential oils, such as lavender, bergamot, and chamomile, have improved sleep quality and reduced stress, pain, anxiety, depression, and fatigue [ 19 ].
These oils help individuals to relax their bodies and minds, leading to better sleep quality. Also, some aromas may increase slow-wave sleep SWS and subjective sleep quality [ 20 ].
One of the essential oils used in aromatherapy is Citrus aurantium. This essential oil is an amber-colored liquid that turns red in the presence of light. Its smell is strong, very fragrant and its taste is bitter [ 21 ]. Citrus aurantium has central nervous system stimulating and mood-enhancing effects, as well as sedative, antispasmodic, anti-inflammatory, anti-flatulence, digestive, antihypertensive and diuretic effects [ 22 ].
Based on the literature review, limited studies have been found about the effect of Citrus aurantium on sleep quality, anxiety, and quality of life of pregnant women. In a recent study, this essential oil was effective in reducing the anxiety of women at risk of preterm labor [ 24 ]; it was also effective in reducing anxiety during labor in another study [ 25 ].
No study has been conducted with the integration of CBT and aromatherapy. Considering that poor sleep quality has detrimental effects on mood, psychological function and overall well-being [ 26 ] and given the various studies have reported the sedative and anxiolytic effects of Citrus aurantium [ 22 ], and also CBT helps the patient to recognize and change distorted thought patterns and dysfunctional behaviors [ 14 ].
Thus, the present study aimed to evaluate the effect of cognitive—behavioral counseling with and without Citrus aurantium on sleep quality primary outcome , anxiety and quality of life secondary outcomes in pregnant women.
This randomized controlled trial was conducted on 75 pregnant women referring to health centers in Tabriz, Iran from July to February The inclusion criteria included pregnant women with a gestational age of 20—24 weeks, women with poor sleep quality based on the Pittsburgh Sleep Quality Index PSQI score above 5 , having a minimum degree of secondary school, living in Tabriz, having a medical record in the health center integrated health system , lack of olfactory problems and allergy to herbal medicines by examination by the researcher, obtaining a depression score of 12 and lower according to the Edinburgh Pregnancy Depression Scale EPDS.
The exclusion criteria included pregnant women with mental illness and a history of hospitalization in a psychiatric hospital or the use of any psychiatric medication, addiction to drugs and smoking, high-risk pregnancies including diabetes, hypertension, chronic diseases, such as cardiovascular, lung, etc.
The sample size in this study was calculated using G-Power software. According to the results of the study conducted by Effati et al.
Sampling began after obtaining the code of ethics from the ethics committee of Tabriz University of Medical Sciences code: IR. Sampling was performed in 6 health centers of Tabriz, Iran. The researcher referred to health centers in Tabriz, and then briefly explained the goals and methods of the research to women with 20—24 gestational ages.
If women were willing to participate in the study, they were examined in terms of inclusion and exclusion criteria and eligible individuals were selected. Then, the PSQI and the EPDS were completed through interview with participants by the researcher and participants who scored sleep quality score higher than 5 and a depression score 12 and less, and met other inclusion criteria were included in the study after obtaining informed written consent and then the socio-demographic characteristics questionnaire, Pregnancy-Specific Anxiety Scale PSAS and Pregnancy-Specific Quality of life Questionnaire QOL-GRAV were completed through interview with participants by the researcher.
Participants were randomly allocated to three groups including the first intervention group receiving cognitive—behavioral counseling with aromatherapy with Citrus aurantium essential oil , the second intervention group receiving cognitive—behavioral counseling and placebo , and control group using the block randomization method with the block sizes of 6 and 9 and an allocation ratio of The type of intervention was written on paper and placed in opaque and sealed envelopes that numbered sequentially to conceal the allocation sequence.
The envelopes were opened in the order in which the participants entered the study and the type of group of individuals was determined.
Envelopes were prepared by a person not involved in sampling, data collection and analysis. Similar glasses of Citrus aurantium essential oil or placebo were prepared and coded with letters of A and B.
The Citrus aurantium essential oil and placebo had exactly the same appearance smell, color, and shape. The intervention groups received a glass of drug or placebo in addition to counseling. The researcher and participants of intervention groups were blinded to the type of drug received.
The first and second intervention groups received 8 sessions of cognitive—behavioral counseling held in the health center in groups of 5—7 people.
The mean duration of counseling sessions was 60—90 min. Cognitive—behavioral counseling sessions were by the first author Master of Counseling in Midwifery under the supervision of the project clinical psychologist in health centers held as 2 sessions per week and lasted for 4 weeks.
The content of the counseling included explaining the goals of training and acquaintance with the members, conducting a pre-test, explaining the importance of treatment, assessing the insomnia, perception of sleep and insomnia, evaluating thoughts, training relaxation, sleep health and new sleep schedules, restriction of sleep, prevention of daily naps, problem-solving skills, summarizing thoughts, reality of sleep, introducing the cycle of thought and feeling and behavior, and training thought blocking.
Due to COVID disease, the last two sessions were held online in the Zoom program due to unwillingness of pregnant women to attend the health center.
The content of the counseling sessions was as follows:. Session 1: Explaining the goals of training and acquaintance with members, conducting a pre-test, teaching how to monitor the baseline of sleep with a sleep report table, reminding the importance of treatment tasks, a complete assessment of the nature of insomnia.
Session 2: Presenting the principles and logic of treatment, teaching the mechanism of sleep and its stages, sleep—wake cycles and underlying factors, maintenance and continuation of insomnia, relaxation training.
Session 3: Reviewing the previous session of treatment, reviewing the findings of the sleep report form, sleep hygiene training, and review the relaxation and new sleep schedule. Session 4: Restricting sleep, preventing daily naps, evaluating thoughts and teaching how to record thoughts related to insomnia and reviewing the assignments of previous sessions sleep report form and homework schedule.
Session 5: Summarizing thoughts, problem-solving skills, reviewing the sleep report form and homework and troubleshooting. Session 6: Introducing the cycle of thinking, feeling and behavior, reviewing relaxation and training not to try fall asleep and apply all the instructions of the previous sessions and reviewing the homework of the previous sessions sleep report form and homework table.
Session 7: Training thought blocking, mental imaging, troubleshooting cognitive-behavioral therapy plan, reviewing patient homework. Session 8: Reviewing and troubleshooting the cognitive—behavioral treatment plan, noting the progress of treatment according to the sleep calendar to the patients.
The participants in the first intervention group, in addition to cognitive—behavioral counseling sessions, received aromatherapy with Citrus aurantium essential oil, so that they placed 2 drops of Citrus aurantium aromatic distillate on a tissue and inhaled it through normal breathing for 15—20 min before bedtime.
The Citrus aurantium essential oil required for the study was purchased from Bu Ali Sina Medical Company of Iran and after determining the concentration by gravimetric method was used by the Faculty of Pharmacy of Tabriz University of Medical Sciences.
The safe dosage was 8 mg of Citrus aurantium essential oil in ml of distilled water. Based on the evaluations made by the pharmacist, the minimum number of drops was considered for pregnant women.
The second intervention group received a placebo with the same prescription. The content of the placebo were distilled water. A kind of aroma was used to make the placebo smell similar to Citrus aurantium essential oil when opening the lid of container; however, it didn't have the potential to stimulate the nervous system.
The control group received only routine prenatal care. Data collection tools included the socio-demographic and obstetric characteristics questionnaire, PSAS, PSQI, and QOL-GRAV, which were completed before and after the intervention through interview with participants.
The PSQI is a self-report tool scored from 0 to 21 and developed by Buysse et al. This questionnaire has seven components that include subjective sleep quality, sleep latency, sleep duration, habitual sleep efficiency, and sleep disturbances, the use of sleeping medication, and daytime dysfunction.
A score above 5 indicates insomnia and poor sleep quality [ 29 ]. In a study conducted on pregnant women in Tabriz, Iran, the reliability of this tool was reported 0.
A modified PSAS was used to measure pregnancy anxiety. Its short version contains 11 questions. The answer to each question varies from not at all score 1 to very relevant score 5. Higher scores indicate a higher level of anxiety and there is no cut-off point.
In a study conducted in Tabriz, Iran, Cronbach's alpha coefficient was obtained at 0. The QOL-GRAV has 9 questions to assess the level of personal experiences of quality of life during pregnancy. Each item is scored based on the Likert scale ranging from not at all score zero and completely score five.
In this questionnaire, the first six questions are scored in reverse. Persian version of QOL-GRAV has good validity and reliability, so this tool can be used to assess the quality of life of pregnant women [ 31 ].
Data were analyzed by SPSS software. The Kolmogorov—Smirnov test was used to assess the normality of quantitative data and all variables had normal distribution. Chi-square, Chi-square for trend, and Fisher's exact and independent t tests were used to evaluate the homogeneity of groups in terms of sociodemographic and obstetric characteristics.
One-way analysis of variance was used to compare the mean scores of quality of life and anxiety among the intervention groups before the intervention and ANCOVA test was used after the intervention by adjusting the baseline score and the age variable. Figure 1 shows the study flow diagram.
The socio-demographic and obstetric characteristics of the participants are presented in Table 1. There was no statistically significant difference among the groups in terms of all socio-demographic characteristics except age variable, the effect of which was controlled by ANCOVA test. After the intervention, the quality of life score in the intervention group 1 AMD: 2.
The results of this study showed that cognitive—behavioral counseling reduced anxiety and improved quality of life but had no effect on sleep quality.
The results of studies conducted by Edinger and Sampson [ 32 ] on patients at Durham Medical Center showed that cognitive—behavioral therapies improve sleep quality.
Also, the results of a study conducted by Reybarczyk [ 33 ] on older adults show that CBT is effective in reducing sleep onset time and improving sleep quality. In another study by Querstret et al. Thus, the results are controversial. Cognitive—behavioral counseling with or without Citrus aurantium essential oil did not have an effect on quality sleep, which is probably due to differences in participants, the virtual holding of some sessions due to COVID disease, as well as the lack of regular and correct exercise at home.
Along with primary insomnia and physical conditions, pregnancy-specific sleep problems may impede treatment. It seems that CBT may not be sufficient for women with high PSQI scores. Also, observing sleep restrictions and scheduling might be difficult during pregnancy.
There is a need to perform high-quality trials for sleep-related interventions during pregnancy and implement effective programs in standard prenatal care [ 35 ].
Citrus aurantium essential oil did not have an effect on sleep quality in our study. Based on the literature review, the effect of Citrus aurantium on sleep quality has been less studied than other essential oils, such as lavender, bergamot, and chamomile [ 36 ].
In comparison with the previous studies, the results may be due to the pregnancy-specific conditions and socio-demographic differences of the participants [ 37 , 38 ]. It is recommended that future studies focus more on the above-mentioned items.
The results showed that cognitive—behavioral counseling had a positive effect on pregnancy anxiety. Many studies confirm the role of psychological therapies as a way to reduce anxiety and choose natural childbirth in pregnant women.
For example, the results of a study showed that CBT methods reduce anxiety in nulliparous women [ 39 ]. Firouzbakht et al. Another study revealed that psychological education in nulliparous women with severe fear of childbirth reduces the choice of cesarean section and increases satisfaction with the experience of childbirth [ 42 ].
Cognitive reconstruction, also known as rational empiricism, helps people identify the flow of anxious thoughts using logical reasoning for practical testing the content of their anxious thoughts against the reality of their life experiences.
In other words, they test the probability of occurring that something that will happen in reality [ 43 ]. Thus, cognitive assessment of events affects the response to those events and will pave the way for changing cognitive activity [ 44 ]. The results of this study showed that cognitive—behavioral counseling has a positive effect on quality of life.
In explaining these results, it can be stated that pregnancy is associated with stress, which can affect the quality of life of pregnant women. Thus, cognitive—behavioral counseling helps pregnant women manage stress, identify stressful situations, and then teach strategies to cope with these situations.
CBT equips participants with a variety of integrated techniques that they can use to reduce stress and improve quality of life [ 45 ]. Through training muscle relaxation and diaphragmatic breathing, people are taught to control their daily stress, and through negative thinking and thinking power, people are taught to recognize and control their negative cognitive symptoms [ 46 ].
The effect of cognitive—behavioral counseling with aromatherapy on sleep quality in pregnant women was examined for the first time. In this regard, standard and valid questionnaires were used to assess the consequences and the native language of pregnant women was used during counseling sessions to communicate more with women and these cases can be considered as the study strengths.
All women participating in this study were literate, so this can affect the generalizability of results in illiterate women. Also, we only included pregnant women with a gestational age of 20—24 weeks. The future studies should be conducted on women in the first and third trimesters of pregnancy.
It is recommended to hold several sessions of cognitive—behavioral counseling for those who support these women husbands and other family members. Also, the effect of CBT-I should be also assessed in future studies.
It is also recommended to investigate the effect of cognitive—behavioral counseling on other populations such as women of childbearing age. Based on the findings of the study, it is concluded that cognitive—behavioral counseling with or without aromatherapy with Citrus aurantium essential oil can reduce anxiety and improve quality of life during pregnancy, but had no effect on the quality of sleep of pregnant women and its subdomains.
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The data sets used during the current study are available from the corresponding author upon reasonable request. Department of Exercise Science and Sport Management, Kennesaw State University, Kennesaw, GA, USA. You can also search for this author in PubMed Google Scholar.
BK contributed to study design, data collection HRV and Biomarker , data analysis, major contribution to the writing of the manuscript.
EB contributed to data collection, performed HRV analysis and interpretation, blood assay analysis, conducted literature review, and major contribution to the writing of the manuscript. CW contributed with data collection, assisted with data analysis Biomarker , and moderate contributions to the editing of the manuscript.
PB contributed to study design, data collection, moderate editing of the manuscript. WH significant contribution to data collection, moderate editing of the manuscript. JM contributed to study design, data statistical analysis, and moderate editing of manuscript.
CM contributed to the study design, data collection, moderate editing of manuscript, and procurement of funds. All authors read and approved the final manuscript. Correspondence to Brian Kliszczewicz. The Institutional Review Board approved all testing procedures and protocols prior to beginning data collection 17— Participants read and sign an informed consent prior too participating in this study.
These authors declare that they have no competing interest and have no relation too the supplement or associated companies.
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations. Open Access This article is distributed under the terms of the Creative Commons Attribution 4. Reprints and permissions.
For more information Caloric needs for sedentary lifestyle PLOS Subject Areas, click here. Caloric needs for sedentary lifestyle the current study, Athletic endurance support investigated the funvtion effects of dry extracts ad from Citrus aurantium Cognnitive. fruit juice Functio de auratnium the regulation of 3T3-L1 cells adipocyte differentiation and function in vitro. CA de improves insulin-induced glucose uptake of 3T3-L1 adipocytes, as well. These findings provide evidence that the exposure to CA de enhances in vitro fat cell differentiation of pre-adipocytes and functional capacity of mature adipocytes, and pave the way to the development of products derived from Citrus aurantium L. Epilepsy is a serious coghitive condition and pharmacotherapy is not effective for all patients and causes serious adverse effects and pharmacokinetic Citrys pharmacodynamic interactions. Natural Post-workout recovery for athletes and ethnobotanical resources can help aurantiu, new therapeutic options Cogitive conditions like aurntium. In Puerto Citrus aurantium and cognitive function, ethnobotanical resources highlight the anxiolytic properties of a tea like preparation made from the leaves of the Citrus aurantium tree or bitter orange. Studies performed with essential oils from the peel of the fruit have shown to increase seizure latency to pentylenetetrazole PTZ and maximal electroshock seizure in mice. We characterized the extract composition, and used a model of PTZ induces seizures in the zebrafish and a receptor-ligand binding assay to determine if this preparation has anticonvulsant properties and its mechanism of action.
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