{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,21]],"date-time":"2026-09-21T15:02:37Z","timestamp":1790002957434,"version":"4.0.1"},"reference-count":31,"publisher":"SAGE Publications","license":[{"start":{"date-parts":[[2026,9,18]],"date-time":"2026-09-18T00:00:00Z","timestamp":1789689600000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["Journal of Integrative and Complementary Medicine"],"abstract":"<jats:sec>\n                    <jats:title>Background:<\/jats:title>\n                    <jats:p>Examinations are highly stressful for students and can impair their academic performance and mental well-being. While aromatherapy is used to relieve stress, its effectiveness during acute stress periods, such as pre-exam situations, remains underexplored.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Objective:<\/jats:title>\n                    <jats:p>To evaluate the effectiveness of aromatherapy with bergamot essential oil using aroma stones in reducing pre-exam anxiety among university students.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods:<\/jats:title>\n                    <jats:p>A randomized, parallel-group, open-label trial was performed with 57 Hoshi University undergraduates. Participants were assigned to either an intervention group (aroma stones infused with bergamot essential oil) or a control group (stones with water) for 3 days. The primary outcome was the change from baseline in the State Anxiety Inventory (SAI) scores at 180 min on each of the 3 days immediately preceding the regular examinations; secondary outcomes included the Short-form Measure of Relaxation Effects (S-MARE), Stanford Sleepiness Scale (SSS), Depression Anxiety Stress Scale (DASS-21), and Subjective Happiness Scale (SHS).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results:<\/jats:title>\n                    <jats:p>\n                      The intervention group showed significantly lower SAI scores at 180 min on all 3 days compared with the control group (all\n                      <jats:italic toggle=\"yes\">p<\/jats:italic>\n                      &lt; 0.0167, the Bonferroni-adjusted significance threshold; Cohen\u2019s\n                      <jats:italic toggle=\"yes\">d<\/jats:italic>\n                      &gt; 0.8). Improvements were observed in the total and subscale scores of the S-MARE. The SSS scores indicated lower sleepiness only on Day 2. The SHS scores were significantly higher on the day before the exam. No significant between-group differences in DASS-21 scores were observed. Moreover, no intervention-related adverse events were reported.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion:<\/jats:title>\n                    <jats:p>Aromatherapy with bergamot essential oil using aroma stones may reduce pre-exam anxiety and promote relaxation and well-being. This simple, noninvasive method may have potential as a practical psychological support tool in pre-examination educational settings, although the findings should be interpreted cautiously given the single-center design and relatively small sample size.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1177\/27683605261488658","type":"journal-article","created":{"date-parts":[[2026,9,18]],"date-time":"2026-09-18T07:35:43Z","timestamp":1789716943000},"update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":0,"title":["Evaluation of the Anxiety-Reducing Effects of Aroma Stones with Bergamot Essential Oil before Examinations: A Randomized Controlled Trial"],"prefix":"10.1177","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-9738-0438","authenticated-orcid":false,"given":"Nobuyuki","family":"Wakui","sequence":"first","affiliation":[{"name":"Division of Applied Pharmaceutical Education and Research, Faculty of Pharmaceutical Sciences, Hoshi University, Tokyo, Japan."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hinako","family":"Kagi","sequence":"additional","affiliation":[{"name":"Division of Applied Pharmaceutical Education and Research, Faculty of Pharmaceutical Sciences, Hoshi University, Tokyo, Japan."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yuna","family":"Hirota","sequence":"additional","affiliation":[{"name":"Division of Applied Pharmaceutical Education and Research, Faculty of Pharmaceutical Sciences, Hoshi University, Tokyo, Japan."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yuna","family":"Koakutsu","sequence":"additional","affiliation":[{"name":"Division of Applied Pharmaceutical Education and Research, Faculty of Pharmaceutical Sciences, Hoshi University, Tokyo, Japan."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Aika","family":"Okami","sequence":"additional","affiliation":[{"name":"Division of Applied Pharmaceutical Education and Research, Faculty of Pharmaceutical Sciences, Hoshi University, Tokyo, Japan."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shoko","family":"Kawakubo","sequence":"additional","affiliation":[{"name":"Division of Applied Pharmaceutical Education and Research, Faculty of Pharmaceutical Sciences, Hoshi University, Tokyo, Japan."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shunsuke","family":"Shirozu","sequence":"additional","affiliation":[{"name":"Division of Applied Pharmaceutical Education and Research, Faculty of Pharmaceutical Sciences, Hoshi University, Tokyo, Japan."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yoshiaki","family":"Machida","sequence":"additional","affiliation":[{"name":"Division of Applied Pharmaceutical Education and Research, Faculty of Pharmaceutical Sciences, Hoshi University, Tokyo, Japan."}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"179","published-online":{"date-parts":[[2026,9,18]]},"reference":[{"key":"e_1_3_5_2_1","doi-asserted-by":"publisher","DOI":"10.1007\/s40670-024-01999-w"},{"key":"e_1_3_5_3_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jsp.2023.02.003"},{"key":"e_1_3_5_4_1","doi-asserted-by":"publisher","DOI":"10.1080\/00207144.2023.2246512"},{"key":"e_1_3_5_5_1","doi-asserted-by":"publisher","DOI":"10.1186\/s40359-022-00896-4"},{"key":"e_1_3_5_6_1","doi-asserted-by":"publisher","DOI":"10.1038\/s41598-024-59739-4"},{"key":"e_1_3_5_7_1","doi-asserted-by":"publisher","DOI":"10.1006\/ceps.2001.1094"},{"key":"e_1_3_5_8_1","doi-asserted-by":"publisher","DOI":"10.1007\/BF02090068"},{"key":"e_1_3_5_9_1","doi-asserted-by":"publisher","DOI":"10.1155\/2020\/8833804"},{"key":"e_1_3_5_10_1","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0084911"},{"key":"e_1_3_5_11_1","doi-asserted-by":"publisher","DOI":"10.1017\/ipm.2017.54"},{"key":"e_1_3_5_12_1","doi-asserted-by":"publisher","DOI":"10.1038\/npjscilearn.2016.11"},{"key":"e_1_3_5_13_1","doi-asserted-by":"publisher","DOI":"10.1097\/HNP.0b013e3181a110aa"},{"issue":"455","key":"e_1_3_5_14_1","first-page":"493","article-title":"Aromatherapy: A systematic review","volume":"50","author":"Cooke B","year":"2000","unstructured":"13.Cooke B, , Ernst E. 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