Clinical Trials

This study carried out in a hospital birthing centre in Sao Paulo, Brazil, included 164 pregnant women who were already in labour and expected to have normal deliveries. With their consent they were randomized to the experimental group (4 drops of diluted Five Flower Formula every 15 minutes for one hour) or the control group (the equivalent dosage of mineral water). Outcome was assessed by statistical analysis of multiple physiological measures. The authors report significant results in the experimental group: increase in systolic blood pressure, increased frequency and intensity of contractions, reduction in time to birth, higher number of vaginal deliveries, and a better pattern of fetal vitality. They conclude “There was evidence of a positive action of the Floral Essence on the potentiating factors of labor, being effective in maternal clinical and obstetrical repercussions, as well as perinatal ones.”

Comment: The strengths of this study are the large sample size, the double-blind randomization, and the use of objective outcome measures. Statistical analyses indicate some beneficial effect of the remedy on the physiology of labour. This is potentially an important finding, however the paper has limitations. The text is difficult to read because it is unduly long and not clearly organised. The detailed Tables are hard for anyone without knowledge of statistics and obstetric variables to understand. Every woman is different, but there was no attempt to evaluate the subjects’ subjective experience, though it would have been so easy to include measures of pain and anxiety on a visual analogue scale. In the quest to seem “scientific”, the value of Simplicity has been lost. Incidentally there is a similar paper by de Lara et al which appears to be based on the same group of subjects: https://www.scielo.br/j/reben/a/tFcR9t677RWC4h69WDtmFJB/?lang=en

Summary: The results of this large double-blind placebo-controlled trial indicate that Five Flower Remedy has a beneficial effect on the physiology of labour, but failed to consider the mothers’ subjective experience or emotional state.

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1.2 de Lara et al. (2021) Effects of floral therapy on labor and birth: a randomized clinical trial

https://www.scielo.br/j/reben/a/tFcR9t677RWC4h69WDtmFJB/?lang=en

Based on use of the Five Flower remedy to alleviate pain and distress symptoms in a randomized controlled triple-blind trial involving 164 Brazilian women during the labour period of giving birth. The context of research relates to aims of the Brazilian Government to move away from Caesarean births and consider more natural childbirth a better option for women. The experimental group were given 4 drops of the Five Flower remedy, diluted in 20ml of water every 15mins for 1 hour (the control group just received the 20ml of water). Findings were assessed by a number of measures, but primarily of statistical analysis of labour time. This showed the experimental group receiving the Five Flower Remedy experienced reduced labour time by 1 hr 30 min (compared to the control group). This was taken as a measure indicating alleviation of pain and distress during the birthing process (as both pain and distress can result in increased labour time).

Comment

Note that this study appeared to draw on the same group of mothers as Magaton et al (2022). Some of its strengths include: the large sample size; randomized allocation and triple-blind design. Although no individualized assessment of emotional reactions was made (so no individual prescription of Bach remedy to suit the individual), use of Rescue Remedy with all participants was a reasonable approach in this context. Statistical analysis indicated a reduction in labour time, which can reasonably be linked to reduced pain and distress during the birthing process. A weakness was some rather confusing and complex discussion of some of the intervention measures (although the significant reduction in labour time was a clear indicator of the overall effectiveness of the intervention). Another limitation was the focus on treating physical symptoms. The Bach Flower remedies were never specifically to be used for physical health symptoms, although the focus on regaining emotional balance as a means of enhancing the Labour experience is quite in keeping with Dr Bach’s holistic approach.

Summary: The results of this large triple-blind placebo-controlled trial provides evidence the Five Flower Remedy relieved distress during labour. Like many similar studies, it didn’t directly assess the mothers’ subjective experience or emotional state.

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1.3 de Albuquerque and Turini (2022): Effect of flower essences on nursing students’ stress symptoms: a randomized clinical trial.

https://www.scielo.br/j/reeusp/a/JXmxC8VNmgn6rk3RVYLcySx/?lang=en

The study consisted of a randomized placebo controlled triple blind clinical trial involving 101 nursing students: mainly female from University of São Paulo. A written test method was used with a perceived stress scale in order to select students with moderate to high stress levels. They were divided into two groups, and one group received a premix bottle to be taken 4 drops, four times per day for sixty days. This treatment bottle consisted of Cerato, Cherry Plum, Elm, Impatience, Larch, Olive and White Chestnut. The other group received the placebo. The results showed that the mix bottle was not more effective than placebo in reducing signs and symptoms of stress; however, the authors believe that doesn’t mean the remedies do not work for stress reduction, but because limitations were found during the study, and also it was run during pandemic and that changed the nature of the collection of data. They would like to repeat the study having addressed these issues.

Comment: The strengths of this paper are: a reasonable number of participants committed in the study. They used the Bacaro test and a Perceived Stress Scale (PSS) measures the level at which individuals perceive stressful situations. However, the statistical results appear confusing. The text is difficult to read because it is unduly long and not clearly organized. Even though the researchers obviously knew and had possibly studied and indeed refer to the Bach system in the paper, they failed to work in the spirit of the remedies by using the same blend for everyone regardless. This is one of the fundamental principles of the Bach system, but has not been followed in this study.

Summary: The results of this large triple blind clinical controlled placebo trial indicate that the mix bottle was not more effective than placebo.

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1.4 Porcar-Castell and Esmel-Esmel (2021) The effect of Bach flower remedies on quality of life and sleep in hospital professionals during the Covid-19 pandemic

https://doi.org/10.53388/TMRIN2021195202

This study from the Hospital Sant Joan de Reus in Tarragona, Spain, aimed “to evaluate the effectiveness of Bach flower therapy for improving the quality of life and sleep of night shift workers in the hospital setting during COVID-19”. 150 of 200 staff members from various disciplines agreed to fill in three screening questionnaires and some were interviewed. 60 subjects who scored highly for sleep disturbance were invited to take part in the study and randomised to either the intervention or control group. 26 people, of whom 23 completed the final assessment, received a mixture of Bach flower remedies containing Red Chestnut, Aspen, Crab Apple, Oak, Olive and Rescue Remedy. 34 people, of whom 18 completed the final assessment, “agreed to be part of the study without taking the flower remedy”. After 15 days the assessments were repeated and various statistical analyses carried out. Significant improvements regarding insomnia, fear, uncertainty, sadness and worry were found in the intervention group, but not in the controls.

Comment: Comparisons between the intervention subjects and the controls are not meaningful, because the controls were not given a placebo mixture, and almost half of them did not complete the final assessment. Those taking Bach flowers did improve, but without a placebo control group it is impossible to say whether this was due to a specific action of the remedies or only to their positive expectations. A further limitation is that everyone was given the same remedies, whereas different ones (for example Mimulus, Elm, White Chestnut) would surely have been more appropriate in some cases. It is not clear whether a trained Bach flower practitioner was involved in planning the study.

Summary: On an observational level, the results suggest that the remedies can help to relieve insomnia and emotional stress in hospital night shift workers. However the value of the study is limited because it lacked a proper control group, and because the choice of remedies was not individualised.

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1.5 Carmo et al. (2023) Evaluation of the adjuvant effect of topic Bach floral in the clinical response to non-surgical periodontal treatment in patients with type 2 diabetes: pilot study

https://rsdjournal.org/index.php/rsd/article/view/40067/32880

This small study looked at the effect of Rock rose gel on periodontal (gum) health after physical therapy in 18 patients with Type II diabetes (a condition which can lead to slower healing with associated adverse effect on diabetic control).

Clinical periodontal parameters were determined before the study using established measures including plaque index, bleeding on probing etc. Diabetic control was measured by considering blood glucose and HbA1c (glycosylated haemoglobin) values.

Periodontal treatment (scaling and root planning) was carried out in two sessions. Each participant’s mouth was treated in 6 sections with each section having either Rock rose gel or the control of saline gel applied. Sections of the mouth were isolated to prevent interference. The study was randomized and triple-blinded and the patients were re-evaluated after 3 months.

Authors conclude that periodontal treatment with rock rose gel adjuvant is safe, efficient, and promoted the improvement of clinical periodontal parameters although it does not show superior results to conventional periodontal therapy.

Comments: Authors don’t indicate why they chose to use Rock rose gel and they use the same remedy on all participants. The study also focusses on a physical condition rather than an emotional state. Taken together, these suggest that the study is a poor test of the Bach remedies.

Errors on the evaluation of the gums are large and improvements shown comparable to the errors. By all the measures used, treatment with rock rose gel or saline gel did decrease signs of gum disease. However, this is a condition may improve just with the physical methods used on participants, or even with no intervention.

Due to this study being a ‘split-mouth’ study, no conclusions on diabetic control due to improved gum health could be made in spite of this being the ultimate aim of the work. Also, authors comment that due to relatively good initial control, any expected improvement would be minimal.

Summary: A very small study using Rock rose gel to promote gum health after physical intervention. The main issues are the focus on a physical condition, the choice of Rock rose, the study design which did not allow changes in diabetic control to be included in the outcomes and the relatively small magnitude of the changes observed.

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1.6 Dixit et al. (2020) Comparison of the effectiveness of Bach flower therapy and music therapy on dental anxiety in pediatric patients. A randomized controlled trial

https://journals.lww.com/jped/Fulltext/2020/38010/Comparison_of_the_effectiveness_of_Bach_flower.12.aspx

Dental anxiety is common among children. It can lead to missed appointments and consequent poor oral health, and to disturbed behaviour during treatment. This placebo-controlled (triple blinded) trial from a university dental clinic near Mumbai, India, included 120 children aged 4-6 who were in good health, had no previous experience of dental treatment and were given the painless procedures of oral prophylaxis and fluoride treatment. They were randomised into three groups.

The Bach Flower Group was given four drops of Rescue Remedy diluted in 40 ml of water 15 min before treatment and wore headphones without playing music. The Music Therapy Group was given 40 ml of water before treatment and listened to Indian classical music through headphones. The Control Group was given 40 ml of water and wore headphones without music. Psychological measures were carried out with the Children’s Fear Survey Dental Subscale, a self-administered Facial Image Scale, and the North Carolina Behaviour Rating Scale as rated from videos taken during treatment. Physiological measures included pulse rate, oxygen saturation and blood pressure before, during and after treatment.

All the ratings were made by blinded assessors. Better behaviour, higher oxygen saturation, lower pulse rates and lower blood pressure were found in both treatment groups compared to the control group. As would be expected, anxiety ratings following treatment were reduced in all groups with no significant difference between them.

Comment: This is a well-designed study with a large number of children and a range of physiological and psychological measures of outcomes used. The study indicated that both Rescue Remedy and music therapy can help to improve children’s behaviour during dental treatment and physiological and other measures indicate a reduction in anxiety. However, the children had no previous experience of dental treatment so no history of showing dental anxiety. The assumptions were made that all children would suffer from dental anxiety and that this anxiety indicated that Rescue Remedy was the best treatment for the Bach flower group. There was no way of predicting the level of anxiety (if any) on dental treatment. The possible beneficial effect of sitting in a quiet space and having a glass of water (control group) was not considered.

Summary: This study showed beneficial effects of both Bach flower therapy and music therapy on anxiety and behaviour during dental treatment on children.

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1.7 Rodríguez-Martín et al. (2020) Placebo and food cravings control: results from two randomized controlled trials

https://lcm.amegroups.org/article/view/5638

This paper includes results from two studies looking at the effectiveness of Bach remedies in reducing food cravings in adults from Cuba.

Study One involved a double-blind placebo-controlled trial with 173 participants, assigned to a Bach group, placebo and control group (the control group received no treatment but were given an affirmation to say to help reduce food cravings)

Study Two involved 74 participants with two conditions: a Bach group (37) instructed to sip water with Bach remedies in it whenever they experienced food cravings, and a control group (37) who just sipped water.

Study One:

Food Cravings (FC) were assessed using the Food Craving Questionnaire Trait (validated for Cuban adults). Other baseline measures involved a spirituality measure, social demographics, and BMI.

Measurements of weight and trait FC were taken before the intervention; one month after and three months after.

The Bach remedy was prepared the Homeopathic Pharmacy of Santa Clara. The remedies chosen were those which were assessed as being likely to help with dealing with issues of self-control, more specifically food craving. Five remedies were chosen – Cherry Plum, Walnut, Agrimony, White Chestnut, and Crab Apple.

Participants were recommended to take at least 4 drops every four hours or so during normal waking hours. They were given a questionnaire at the end of the study which asked how many times a day they took the remedy, varying from ‘never’ to ‘as often as recommended’. Participants who said they took the formula less than four times a day were excluded from the main analysis as non-compliant. The control group showed a high drop-out rate.

There were no significant differences between most parameters related to food craving between the placebo and Bach groups, though several parameters were significantly lower for the placebo group (considering only the ‘Per Protocol’ (PP) analysis, which excluded non-compliant participants).

Comments: Study 1 deviates markedly from an authentic Bach treatment protocol, which would involve an individualized assessment for each participant and so the ‘generic’ mixture used here, with an identical one given to each participant, is likely to be much less effective. However, despite this major limitation, the remedies chosen here were at least potentially relevant.

Study Two.

This study was not blinded – participants were informed whether they were in the ‘Bach’ group, or the ‘plain water’ group. Participants were randomly assigned to each group. They were instructed to sip from a glass of water/glass containing Bach remedy whenever they felt food cravings between meals and were instructed that both approaches would help them control food cravings. The Bach group were given the same five remedies as in Study 1. If participants reported they didn’t follow this protocol at least once per day during the 90-day treatment period, they were excluded from the main analysis.

The authors of the study did consider that even the ‘water’ group (although not containing any Bach remedy) could still be potentially effective, in helping participants remind themselves of their goal to reduce food craving.

Findings showed both treatments reduced food cravings and BMI over the 90-day period. However, compared with the water group, the Bach group experienced larger reduction in parameters related to food craving, such as emotional relief and lack of control over eating (effect sizes being from small to medium).

Comments: Authors state that Bach remedies ‘have been historically used by health practitioners to correct emotional imbalances. Thus, drinking sips of BFR diluted into water may be a useful way for individuals to achieve emotional relief beyond eating their desired food’.

The authors do however correctly note that as Study Two wasn’t a blind trial and so ‘the meaning behind BFR treatment, as well as its associated therapeutic ritual, may have contributed to deliver better outcomes for the BFR group’. As a result, some caution should be shown as to the evidence from this study in relation to effectives of Bach remedies.

Summary: The results from Study One showed no effect of using a pre-determined mix of 5 remedies to reduce food cravings and BMI. In Study Two, there are reductions in both BMI and food cravings in the group taking remedies (the same remedies as in Study One), however, the study was not blind and authors correctly state that the therapeutic ritual may have resulted in the observed improvements when using BFRs over placebo.

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1.8 Pinto et al. (2020) Effect of Flower Essence Therapy on Teachers’ Stress: A Randomized Clinical Trial

http://www.revenf.bvs.br/pdf/reme/v24/en_1415-2762-reme-24-e1318.pdf

A prospective double-blind randomised study from Brazil, designed to evaluate the usefulness of Bach flower remedies for reducing stress in schoolteachers, carried out from a nursing perspective.

Teachers who showed medium or high stress levels were selected based on the result of a Perceived Stress Scale (PSS-14) analysis. A total of 43 began the study and these were randomly assigned to the intervention and placebo groups (IG and PG, respectively).

Three measures of stress were used: PSS-14, the List of Stress Signs and Symptoms (LSS) and the subjects had their energy fields measured with a bioelectrographic method similar to Kirlian photography and analysed with the Bio-electrographic Aspects Assessment Form (FAAB).

The IG received up to six remedies chosen individually by a separate researcher (flower remedy practitioner) blind to the grouping, by active listening but based on the Teachers’ Stress Assessment Form (FAEP). They took four drops, four times a day from the treatment bottle. The PG were given a bottle of mineral water with additives, to mimic the treatment bottle. Follow-up involved two blind assessments over a nine-week period, with the remedy mix being adjusted each time. After some dropouts, 17 in the IG and 12 in the PG completed the study.

All three measures showed a significant reduction in measures of stress for the IG compared with the PG.

Comment: The use of FAAB is of interest but the authors provide no reference showing the validity of this for measuring emotional states (only % yin and yang). Individualising the mixture of remedies, rather than giving the same one to everyone, is a strength of this study though it is not clear how far the choice was based on the FAEP findings rather than personal interviews. Although the number completing the assessments is small, the statistical analysis shows a clear benefit for the intervention group.

Summary: A small double-blinded study using individualised remedies to treat teachers’ stress. The study is clouded by using a supplemental technique alongside personal interviews for remedy selection, but by all measures used, BFRs were shown to promote the reduction of teachers’ stress.

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1.9 Salles et al. (2012), Effect of ﬂower essences in anxious individuals

https://www.scielo.br/j/ape/a/FsVrkRFnv3tDBDwp7Ktnz8r/?format=pdf&lang=en

This randomized, double-blind study looked at the effect of BFRs on anxious people. Anxiety was measured at the beginning and end of study, using the quantitative ‘Diagnostic Inventory of State-Trait Anxiety’ (STAI). Of 34 initial participants 4 dropped out, leaving 15 each in the control (placebo) and experimental groups. They were all employees of Center for Improvement of Health Sciences of the Zerbini Foundation, measured as having at least ‘moderate anxiety’ on the STAI-Trait scale, and having at least five of the following set of characteristics: anxiety, haste, impatience, irritation, impulsiveness, restlessness, difficulty to relax and intolerance of other people’s slower rhythm, nervousness and tension. The same four remedies, impatiens, cherry plum, white chestnut and beech, were used for everyone in the experimental group. Four drops of remedy mix or placebo were taken four times a day for a duration of two months.

Anxiety dropped for all 15 in the experimental group and 10 of the control group. However, the reduction of anxiety in the Bach group was statistically significant compared to that in control group, p < 0.001 (both groups reduced in anxiety score, but the average drop was 3.2 for the control group and 16.2 in the Bach (experimental) group.

Comments:

Over 97% of study participants were women, a limitation of the study.

The authors use of the well-respected STAI-Trait scale to select participants and the STAI-State scale to measure anxiety before and after treatment which is a strength. However, to this they add another selection criterion i.e. the presence of at least 5 characteristics which they state are related to anxiety. However, only nervousness and tension appear to be directly related.

This links to the choice of remedies which are unlikely to be the ones an experienced Bach practitioner would have chosen to make a generic mix for anxiety. Remedies often indicated for anxiety are not included, namely aspen and mimulus.

And the use of a generic mix is also problematic, as it doesn’t follow the Bach protocol of individually assessing which remedies are needed for that particular person. The authors acknowledge this issue.

Summary: In spite of the limitations with this small study, the BFRs did cause a significant decrease in anxiety compared to the control group.

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1.10 Martell et al. (2021) Clinical Evolution and Cost of Treatment in Patients Treated with Bach Flower Essences

http://scielo.sld.cu/scielo.php?pid=S0864-21252021000100005&script=sci_abstract&tlng=en

28 patients with a clinical diagnosis of psoriasis, vitiligo and lichen planus were treated solely with Bach flower essences both orally and, mixed with Vaseline, topically.

The remedies used were Crab Apple, Willow, Vervain, Impatiens, Walnut, Cherry Plum, Sweet Chestnut, Chicory, Clematis, Beech, Star of Bethlehem, White Chestnut and Larch, a total of 13 remedies. It seems likely given the discussion in the paper, that the patients were given all 13 remedies rather than an individualised selection. 17 were described as having anxiety but this wasn’t used to inform remedy choices or followed up after treatment with the remedies.

After 6 months, the patient’s skin condition was assessed and categorized as no skin lesions; an improvement; or no improvement/further deterioration. Results showed no patients deteriorating in this period; 50% (14 patients) were asymptomatic and the remainder showed some improvement. The cost of the Bach flower treatment was calculated as being less than 20% of that of conventional treatment for all three conditions.

Comments: Although these results are positive, conclusions are limited by the design of the study and reporting of the work. There was no control or placebo group. Vaseline itself may have a beneficial effect on skin conditions or conditions may have improved without any treatment. And a comparison with the outcome of conventional treatment, rather than just a comparison of cost, would have been useful.

The number of patients (28) involved was small and the study complicated by patients suffering from one of three different conditions. There is no discussion of the patients’ emotional states and how these link to the remedy selection. Instead, the work of Orozco on transpersonal psychological aspects of the remedies is the basis for remedy selection. This includes the idea that 25% of the remedies selected should be for transpersonal reasons. Some of the remedies were included specifically for this reason, while others were included based on literature reports of favourable results when people had skin conditions. Thus, the selection and use of the remedies is sub-optimal (i.e. the remedies are not selected and used as recommended by Dr Bach and by BFRPs today).

Summary: A small study which showed improvements in 100% of patients with one of three autoimmune skin conditions on using BFRs orally and topically over a period of 6 months. However, lack of control group and issues with remedy selection mean any conclusions from the work should be treated with caution. Given the positive outcomes, perhaps a better-designed study will follow this work.

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1.11 Fedel et al. (2023) Flower therapy effect on the quality of professional life in nursing residents: pilot study

https://revistas.ucr.ac.cr/index.php/enfermeria/article/view/49923/56112

This is a study from a university department of nursing in Sao Paulo, Brazil, carried out during the COVID-19 pandemic. Qualified nurses taking a postgraduate residency course while working in various hospital specialties were invited to take part. Eligibility criteria included scoring highly on the Burnout subscale of the Professional Quality of Life Scale (ProQOL-4). This is also designed to measure Compassion Satisfaction, Compassion Fatigue and Secondary Traumatic Stress. Of the 24 female nurses who volunteered, 19 were eligible to enter the study, and 16 of them completed it. All assessments were carried out by email. Participants were given a three week course of Rescue Remedy with the addition of Walnut. At the end of the treatment, scores on the Secondary Traumatic Stress subscale of the ProQOL-4 were the only ones that had improved (18% reduction) and there was residual improvement of 14% reduction 3 weeks after treatment stopped.

Comment: The paper includes some detailed statistical analyses and graphs, but no conclusions can be drawn from these, due to the limitations of design. There was no placebo control and the number of participants was very small. Participants were in different years of their residencies, working in different specialities and settings and the infection with COVID-19 of someone close was included as a further variable. Due to small numbers in each subset, the analysis has little value. However, the study is described as a pilot, so perhaps a larger, better-designed version will follow. In terms of the use of BFRs, limitations were the lack of interviews in person, due to the ongoing pandemic and all were given the same remedy mix.

Summary: A very small study with multiple variables and no control group. Described as a pilot study, authors report a reduction in Secondary Traumatic Stress in nurses after using a mix of Walnut and Rescue Remedy for 3 weeks, but these results should be treated with caution.

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1.12 Solano Pérez et al. (2021) Effectiveness of Rescue Remedy in patients with persistent mild asthma attacks

MEDISAN,25(1): 81-94; http://scielo.sld.cu/scielo.php?script=sci_arttext&pid=S1029-30192021000100081&lng=es

This study was carried out at a teaching hospital in Cuba. Adult patients presenting with mild, persistent asthma attacks were randomised to receive either Rescue Remedy (4 sublingual drops every 5 minutes for up to 4 doses), or conventional treatment with a salbutamol inhaler for up to 15 minutes.

Sixty patients completed the study, 30 in each group. Of those given Rescue Remedy, 90% improved with respect to symptoms of dyspnoea, wheezing, cough and chest tightness, and none reported any side effects. In the group given salbutamol, only 53% improved, and 96% reported adverse reactions such as tachycardia and tremor.

Comment: At face value, these results provide strong support for the use of Rescue Remedy to treat symptoms of mild asthma, but the paper is short on detail. It does not say how many patients, if any, refused to take part in the study or dropped out because their symptoms were getting worse or they wished to switch to conventional therapy. Authors mention that patients resist the continued use of bronchodilators which is relevant both to the comparison of the Rescue Remedy group and the salbutamol group and also to the longer-term outcomes of the study, neither of which are addressed (there is no information about what happened to patients after the very short follow up period of 20 minutes). It also does not consider any improvement in symptoms without intervention.

Symptoms were rated as simply present or absent rather than on a scale of severity. It would have been interesting to include a psychometric measurement, because respiratory symptoms such as shortness of breath and chest tightness can be exacerbated by anxiety and this could account for the success of the Rescue Remedy (and is in contrast to the salbutamol group, for which the treatment may increase anxiety). Finally, the authors’ focus on physical illness is counter to the optimal use of Bach remedies.

Summary: Within the limitations of the study, the results suggest a benefit of using Rescue Remedy for the short-term alleviation of the symptoms of asthma when compared to conventional treatment, when the asthma is classified as causing mild, persistent attacks. However, a larger, more-rigorous study is required to fully validate the suggested benefits.

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1.13 Rivas-Suarez et al. (2017) Exploring the Effectiveness of External Use of Bach Flower Remedies on Carpal Tunnel Syndrome: A Pilot Study

Journal of Evidence-Based Complementary & Alternative Medicine Vol. 22(1) p.18-24

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5871196/

The aim of this study was to test if Bach remedies could help alleviate carpal tunnel syndrome (CTS) symptoms. The participants were forty-three individuals diagnosed with mild to moderate CTS for at least 3 months who had been previously treated without success and were awaiting surgery. They were split into three groups, two of which were single-blinded, i.e. the patients were unaware of which group they were in. The experimental group was treated with a Bach Flower Remedy cream with a base of solid petroleum and containing the Bach remedies Hornbeam, Elm, Star of Bethlehem, Clematis and Vervain. The control group was treated with a placebo involving the same cream base but without the remedies. The third group was non-blinded and was treated with the Bach cream. Creams were used twice a day for 21 days.

Significant improvements with a large effect size were found in symptom severity and pain intensity (self-reported) and also in pain, night pain and tingling (by clinical examination) for both the blinded and non-blinded groups treated with the Bach cream, compared with the placebo group. While both these groups showed large effect sizes compared to the placebo group, the non-blinded group showed even greater effects than the blinded group. The authors attributed this to the combination of a genuine effect from the Bach remedies, combined with an additional impact (context effect) due to the non-blinded group knowing for certain they had received the ‘real’ remedies (compared with the blinded group where patients knew they had a 50% chance of having received a placebo). There was also a reduction in the number of patients requiring surgery in both groups using the Bach cream.

Comments:

The focus of this study is unusual in concentrating on alleviating a specific physical symptom. The authors’ linking of the remedies used directly to physical symptoms (e.g. elm for pain, vervain for inflammation) is counter to the teachings of Dr Bach and the mode of use of BFRs maintained by the Bach Centre and registered practitioners.

However, the Bach system can help treat emotional reactions to any physical symptoms, or possible emotional factors contributing to causing those symptoms, due to the strong links between emotions and bodily well-being. The basis for this experimental trial was anecdotal evidence of the effectiveness in treating CTS with a cream based on the combination of five remedies mentioned above.

The inclusion of the non-blinded group was an interesting addition to the design. The authors stated that in a normal clinical setting, patients will be aware they have received a treatment their doctor considers of value and this additional confidence in the treatment is something that could yield an additional benefit (due, the authors imply, to a strengthened ‘placebo’ effect – on top of the ‘genuine’ effect shown in the blinded trial). This was indeed shown in this study.

A significant limitation to the design was that it involved only single-blinding (in the two groups involving blinding); only the patients were unaware whether they received the Bach cream or the placebo cream, while the doctors were aware who received the Bach cream. This seems an unnecessary weakening of the research design.

Other treatments for CTS like oral steroids or EMLA cream can be effective in the short term but the longer-term efficacy is unclear– it would be interesting to measure the effectiveness of the BFR cream over a longer period than the 3 weeks in this study.

Summary: A small study which shows a significant benefit of using a cream containing five BFRs on symptoms of mild to moderate CTS. As the authors recognise, a larger study with some modifications to the design is required (increasing the number or participants and the duration as well as perhaps adding double-blinding) to ‘firm up’ their conclusions.

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1.14 Fusco et al. (2021) Efficacy of Flower Therapy for Anxiety in Overweight or Obese Adults: A Randomized Placebo-Controlled Clinical Trial

The Journal of Alternative and Complementary Medicine (2021), 27(5), 416-42 https://doi.org/10.1089/acm.2020.0305 (abstract only; thanks to the authors for providing the full paper for review)

This study from a clinical research unit in San Paolo, Brazil, was designed to test the efficacy of Bach flower therapy for the treatment of anxiety in overweight or obese adults with moderate to high anxiety by considering anxiety scores, sleep patterns, binge eating, and change in resting heart rate (RHR). At 9.3% of the population, Brazil has the highest rate of anxiety disorders in the world, often related to obesity.

Subjects were recruited via invitation cards distributed in healthcare and community settings. The 100 people meeting the inclusion criteria were randomised into two groups of 50. One group received a treatment bottle containing Impatiens, White Chestnut, Cherry Plum, Chicory, Crab Apple, and Pine while the other received a placebo liquid. All subjects were instructed to take four drops four times per day for four weeks.

The instruments used for assessment at the beginning and end of the study were the State-Trait Anxiety Inventory (STAI), Pittsburgh Sleep Quality Index (PSQI), Binge Eating Scale (BES), and an electrocardiogram to measure resting heart rate.

Complete follow-up data were obtained for 41 subjects in the treatment group and 40 in the control group. Questionnaire scores indicated that both groups showed improvement in anxiety level, sleep, and eating behaviour, but according to various statistical analyses the improvement was significantly better for the treatment group than the control group. Resting heart rate also reduced for the treatment group.

Comments: This study was well designed and indicates a clear benefit for Bach flower remedies in this population. A standard treatment mix was used for everyone, as opposed to individually selected remedies, however the six chosen remedies were selected after an in-depth study of people who are overweight or obese and do seem appropriate. However, selecting remedies for each individual would be preferable. Due to the particularly high rate of anxiety in Brazil, it would be worth repeating this study elsewhere to compare the results.

The researchers point out some limitations with their study:

Checking adherence to the protocol was carried out by weekly phone calls. Other methods, for example, checking the volume of the bottle or using patient diaries, would be more accurate.

There was variation in the length of time after treatment ended before evaluation was done. The longer-lasting effects of treatment were not considered – authors suggest that with a reduction in anxiety may come a reduction in weight and this needs further study.

Authors are keen to assign individual remedies to individual observed changes and also to look at the effects of dose and concentration of the treatment bottle, in order to help establish the use of BFRs. These may be unnecessary distractions in terms of showing that the remedies have a positive effect (and this work duplicates the studies of Dr Bach when developing the system), however, if it increases acceptance of the system then it may be worthwhile

The results were from a particular research centre and a cohort of mainly middle-class well- educated women. Other groups would need to be considered to validate the effects shown in this study.

Summary: A small study showing a reduction in anxiety, resting heart rate and binge eating and improvement in sleep patterns in overweight or obese Brazilians taking a mixture of BFRs. Extension and fine-tuning of the study as detailed above would allow verification and clarification of the results.

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1.15 Gayatri and Dolas (2023) A Non-Randomized Single Blind Clinical Study To Assess The Efficacy Of Bach Flower Remedies In Management Of Generalised Anxiety Disorder In Age Group Of Above 18 Years

International Neurourology Journal, 27(4), 734-50 (2023); DOI: 10.5123/inj.2023.4.in80

Important statement: The International Neurology Journal (einj.org) states that a journal with the same name is a predatory journal site pretending to be their journal, by using the same title, ISSNs and other features.

The following URL is the link to the fake journal site: https://einj.net.

The current article can be found in the ‘predatory journal’. The authors are likely to have published the paper there in good faith although it does seem strange to publish a paper on GAD in a journal on urinary conditions. It is included in the database as it is easily accessible and will be found in any searches for papers on BFRs. We do not endorse the publication of such journals and readers are warned to treat the results therein with caution.

This study was carried out in a homoeopathic medical college in India, for a postgraduate research project. Subjects were adults who presented with symptoms of generalized anxiety disorder (GAD) and scored more than 8 on the GAD-7 assessment scale. They were interviewed in depth and given an individually prescribed mixture of Bach flower remedies to be taken as 4 drops 4 times per day. The interviewer had completed Level 1 training from the Bach Centre. The most-frequently indicated remedy was Impatiens, followed by Rescue Remedy, Larch, Mimulus, Rock Rose, Red Chestnut and Hornbeam.

The first follow-up interviews were carried out after 15 days, then at weekly or fortnightly intervals presumably depending on clinical progress. Of 34 patients who entered the study, 30 completed it. The mean GAD-7 score before treatment was 14.83 (SD 3.77) and after treatment 9.27 (SD 3.75), a highly significant reduction according to the statistical analysis. It is not clear what the time scale, of the experiment is and whether the “after treatment” score refers to the 15-day follow-up for everyone, or to longer periods in some cases. In one place, the authors state that the study lasted 18 months but this seems unlikely.

Comments: Many of the issues with this paper may be related to the integrity of the journal – it may not have undergone peer review and certainly does not appear to have been edited to any extent. It is a long paper containing a lot of detail about the Bach flower remedies which could have been better referred to rather than spelled out as well as dubious explanations of the remedies’ mode of action and choices made in the study design. However, although there are references mentioned, none appear at the end of the paper.

The study is purely observational – although it is described as single-blind this aspect is not described (or may not have been fully understood by the authors). All participants received a mix of BFRs as determined by discussion with someone who had completed some training in BFRs (Level 1). This training does elevate the paper in comparison with many as it allows the individualised nature of the remedies to be reflected. It would have been interesting to see how the remedy choices would compare with those of a fully-trained practitioner as this extra training would allow similar remedies to be better distinguished. BFRs are treated as an adjunct of homoeopathy rather than a distinct and complete system of healing – perhaps not surprising as the study is carried out at a homoeopathic university. The treatment bottle for each patient is made up using sterile water – it is unclear what the authors mean here. It is recommended to use mineral water in treatment bottles.

Summary: The results of this study suggest that Bach flower remedies are very effective in cases of generalized anxiety disorder before and after use of BFRs based on mean GAD-7 scores compared using the paired t-test. However, please note the above statement regarding the journal.

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1.16 Halberstein et al. (2007) Healing With Bach Flower Essences: Testing a Complementary Therapy

Complement. Health Pract. Rev., 12(1), 3–14 https://journals.sagepub.com/doi/10.1177/1533210107300705

The authors of this paper from Miami include an anthropologist, academic nurses and a Bach practitioner. The subjects were nursing students, mainly female. 111 students, from a total population of 186, volunteered to take part in the study, which was repeated under identical conditions during four separate classes.

Subjects were randomised to take either Rescue Remedy (n=53) or an identical-tasting grape alcohol placebo supplied by Nelsons (n=58) in five doses spread over a three-hour period. To induce anxiety the researchers used a deception, telling the students that they would have a test at the end of the class because their previous performance had been poor. They were assessed with the State-Anxiety (S-Anxiety) subscale of the Spielberger State-Trait Anxiety Inventory (STAI) at the beginning and end their class, and afterwards were told that there would be no test after all. There was a trend for anxiety scores to decrease in all subjects, but a statistically significant benefit of Rescue Remedy over the placebo was found only in the subgroup of subjects whose initial anxiety scores had been high.

Comment: As the study was devised, the benefits of using Rescue Remedy over placebo are not statistically significant. However, the authors then sub-group the participants into high-, medium- and low anxiety. They then report statistically significant improvements for the Rescue group in students with high anxiety only. This group numbers 39 of the 111 participants in the study, with 17 receiving Rescue and 22 the control. Sub-grouping reduces the quality of the study by reducing the group size considered and could bring possible accusations of manipulation in order to produce a certain result.

That it is high anxiety group that shows biggest effect is exactly what would be expected – both from the intended use of Rescue Remedy in crisis situations and from the effect of ‘regression to the mean’, where the most extreme (highest) initial scores on the S-anxiety subscale change most as they are furthest from the mean anxiety level.

The use of the deception seems dubious from an ethical point of view and would perhaps not have been allowed if the study had been done more recently. It also compromises the idea of ‘intention’ when giving BFRs – was the intention to help the participants taking the Rescue Remedy or to produce a research paper?

Summary: This study shows a statistically significant benefit of using Rescue Remedy only for the ‘high anxiety’ sub-group of participants. As devised initially, for participants with all levels of anxiety, the improvement is not statistically significant.

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1.17 S. Yang, Y. Wang (2012) P02.177: Effects of Bach Rescue remedy on cardiac autonomic balance in healthy women

BMC Complement Altern Med, 12(Suppl 1), p233 doi: 10.1186/1472-6882-12-S1-P233

This conference poster reports a cross-over study with a one-month ‘wash-out’ period between the two treatments, carried out on 7 healthy young women and comparing treatment with Rescue Remedy and a placebo. It was double-blinded and looked at any effects on the autonomic function of the heart.

Reported results were mean percentage changes of LnLF (natural logarithm-transformed LF) and LF/HF ratio. LF is the low frequency power domain index and HF is the high frequency power domain index. The mean percentage change of LnLF in the Rescue remedy group was -15.9+/-7.4% compared with 18.3+/-21.6% in the placebo group. The mean percentage change of LF/HF was -27.8+/-13.0% in the Rescue remedy group compared with 53.2+/-89.1% in the placebo group.

Authors indicate that Rescue Remedy has a marked effect in increasing parasympathetic activity, so promoting relaxation.

Comment: Participants in the study were not identified as stressed or anxious and so did not really need Rescue Remedy. However, the increased parasympathetic (‘rest and digest’) and decreased sympathetic (‘fight or flight’) response after taking Rescue Remedy is interesting.

Looking at the reported results for the placebo group, the quoted changes are smaller than the error in these numbers and so can’t be reliably compared with the Rescue Remedy group. Although the effects with Rescue are larger than the errors, the result should be viewed with caution because the study was very small (only seven participants) and the write-up is short on detail.

The design would have been strengthened by inclusion of a psychometric questionnaire as well as the physiological measurements. Unfortunately, this work was not expanded into a full paper.

Summary: A very small study with minimal details provided which suggested that Rescue Remedy may increase activity of the parasympathetic and decrease activity of the sympathetic nervous systems, providing a possible method of stress reduction.

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1.18 C. Bayraktar, S. Akkoç (2024); Evaluation of The Role of Music and Bach Flower Remedies in The Management of Anxious Pediatric Dental Patients: A Randomised Clinical Trial

Clin Exp Health Sci; 14(4), 176-182; doi: 10.33808/clinexphealthsci.1485687

The aim of this randomised, controlled clinical study was to test the effectiveness of Bach remedies and distraction with music in reducing dental fear and anxiety (DFA) in children aged 6–8 years. There were twelve participants (identified as prone to dental anxiety using the anxiety scale CFSS-DS), randomly allocated to three groups (four per group). Group 1 were given ‘traditional behavioural guidance – tell-show-do’ (control); Group 2 took a single dose of Bach Rescue Remedy 15 minutes before treatment; Group 3 were passively distracted using music (the same piece of classical music played over headphones throughout the treatment). Anxiety level was measured before and after treatment, using a combination of physiological measures (diastolic and systolic blood pressure, heart rate, oxygen saturation) and two self-report scales (Facial Image Scale and Venham’s Picture Test).

Analysis showed that there were no statistically significant reductions in anxiety for groups 1 and 3 (control and music groups) across the range of measures. For group 2, there was a statistically significant (p < .05) reduction in heart rate, although no significant benefits were seen by any of the other measures.

Comments:

In this study, the use of the Bach ‘Rescue Remedy’ seemed an appropriate choice and the range of measures to assess anxiety was comprehensive. Although no statistically significant difference between the three groups was found, the significant reduction in heart rate found only in the Bach group is a clear indication of stress reduction and could be investigated further in a larger trial.

Anxiety was measured only before and after treatment (so as not to disrupt any beneficial interaction with the dentist) so the effect during the treatment is unknown. Participants were effectively rating anxiety only in the last few minutes of the treatment. Perhaps continuous monitoring using the physiological measures would give a more accurate reflection of the effects of the interventions. Rescue Remedy was given only once, 15 minutes before treatment so the potential cumulative effects on DFA of multiple doses prior to and possibly during treatment was not considered.

Authors acknowledge the limitations of the study due to the small number of participants. They chose the small number due to concerns about the limited studies of Bach flower remedies for paediatric patients. The rationale for choosing Rescue Remedy as opposed to other combinations was that – ‘it has become the preferred choice as it is recommended as a multi-purpose emergency agent in cases of acute anxiety.’ As a result, parents easily accepted it being given to their children.

Summary: A very small-scale study looking at the effect of Rescue Remedy and music in reducing DFA in children. It showed a statistically significant reduction of heart rate in the Bach group as the only measurable effect.

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1.19 Gava et al (2024) Flower therapy and perceived stress in primary health care nursing professionals

F.G.S. Gava and N.R.T. Turrini. Rev Gaúcha Enferm. 2024;45:e20230132

https://doi.org/10.1590/1983-1447.2024.20230132.en

This double-blinded, placebo-controlled trial was carried out in Brazil during 2021-2 and all contact with the subjects was done electronically through WhatsApp. Nurses and technicians working in primary health care (PHC) settings were invited to participate if they considered themselves to be stressed. They were assessed with the PSS-14 (Perceived Stress Scale) and included in the study even if they did not score highly.

87 of the volunteers were considered eligible, and were randomised to intervention (n=43) or placebo (n=44) groups. Everyone in the intervention group received the same remedy mixture: Cherry Plum, Elm, Hornbeam, Olive, Star of Bethlehem, Walnut and White Chestnut. Subjects were contacted once a week during the four-week duration of the study. There were a few dropouts in both groups, and only 44% of subjects reported taking the drops on 5-7 days of the week (there is no information if these people took the correct dosage on these days).

At the end, PSS-14 scores had reduced in both groups and although the intervention group showed a slightly greater improvement than the placebo one, this difference was not statistically significant. Self-reported improvement was greater in the intervention group.

Comments: Authors report difficulty in recruiting the required number of participants among staff at ‘Basic Health Units’, requiring them to extend to include participants from a University School of Public Health. It is unclear if participants from here could be described as PHC professionals.

The premise of the study is that PHC staff, working in a highly stressful environment, would all require the same 7 Bach flower remedies. However, stress is highly individual and only from knowledge of participants emotional reactions can the best remedy mix be assessed – this would provide a better test of the efficacy of the system.

Considering the mix of remedies given in this trial, some could be relevant to multiple participants (e.g. elm for feeling overwhelmed) but others (e.g. hornbeam for difficulty in getting started) are unlikely to be widely required.

An improvement to this study would involve both groups (placebo and experimental) being assessed by a Bach practitioner to decide on the remedy mix appropriate for their emotional reactions to their stress, with only the intervention group actually receiving that remedy mix. This would help control for any ‘therapeutic’ impact of the assessment itself, which involves being heard by a sympathetic listener, as this, in itself, may have a beneficial impact in reducing stress. Authors suggest they will use an individualised mix in future trials.

Most of the subjects did not take the remedies regularly. The remedies would not be expected to work properly in such subtherapeutic doses. Authors note that participants who received the remedies had a higher perception of change occurring than the placebo group – perhaps the remedies are improving their emotional health in ways not measured by the PSS-14. However, the difference between groups was not statistically significant.

It became clear at the end of the study most participants believed they were in the intervention group because all bottles in both groups were labelled ‘treatment bottle’ and this could have created a bias. Authors also acknowledged that as positive results were discussed by participants, this could have contributed to the placebo group positive results.

No robust conclusions about the efficacy of the remedies can be drawn from this study, but perhaps it does confirm the power of the placebo effect and illustrates the benefits of giving care and attention.

Summary: A pre-determined mix of 7 Bach remedies was no more effective than placebo in treating self-determined stress in a group on PHC professionals in Brazil. However, the study has numerous issues which limit the application of these conclusions to the optimal use of the Bach system.

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1.20 de Resende et al. (2025), Effect of floral therapy in mothers of premature newborns: A randomized controlled trial

Acta Psychologica, 252, 104642

https://doi.org/10.1016/j.actpsy.2024.104642

This study, carried out in a maternity hospital in Brazil, was intended to assess the efficacy of Dr Bach’s Five Flower remedy in reducing postpartum stress in the mothers of premature babies admitted to intensive care between June 2019 and May 2021. Of 328 eligible women, 117 entered the study and were randomised (triple blind) to receive either the Five Flower Remedy (four drops four times per day for two weeks) or placebo, both during hospitalisation and when back at home.

They were assessed with the Parental Stress Scale: Neonatal Intensive Care Unit (PSS:NICU), and measurements of salivary cortisol, on four occasions. The PSS:NICU scale measures stress using 26 items in 3 domains (sounds and noises; appearance and behaviour of the newborn; and changes in the parental role), with each item given a score of 1 to 5 based on how stressful mothers found each, and the scores added together. 68 subjects, 34 in each group, completed the study. Multiple statistical analyses were carried out and the only significant finding was a greater reduction in the parental role subscale of the PSS:NICU for the intervention group compared to the control.

Comment: The study was carried out during the COVID-19 pandemic which may have led to heightened stress levels but also to interruptions in data collection. This may partially account for the high drop-out rate. The authors’ statement that “The use of the Five-Flower essence … is effective in reducing the stress and cortisol levels in mothers of premature newborns admitted to neonatal and semi-intensive care units”, cannot be justified by the results. The statistical analysis shows minimal difference between the intervention and control groups, particularly as regards the level of salivary cortisol which gives an objective indication of psychological stress. Unsurprisingly, stress levels decreased with time for both the intervention group and the control group, perhaps reflecting the mothers adapting to the situation and the items considered in the PSS:NICU scale (e.g. ‘not being able to hold their baby’, presence of equipment, abnormal color and breathing etc.). In addition, babies were not always in hospital for the duration of the intervention so the situation was fluid. As the Five Flower mix is designed for use during a crisis it would only be recommended for use for a short period and may not have been indicated for the duration of the intervention for each participant.

Summary: This study showed no significant difference in the presence of the stress marker cortisol in mothers with babies in ICU between the control group and those taking Five Flower remedy. There was a slight benefit on the subjective measure of stress provided by the PSS:NICU scale.

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1.21 de Carvalho et al. (2020), Efficacy of Fibromyalgia Treatment Using Bach Flower Therapy: Preliminary Results

Altern. Integ. Med. 9: 292; doi:10.37421/aim.2020.9.292

This is an open study from a university department of health sciences in Brazil. Six women with a diagnosis of fibromyalgia (FM) were treated with the Rescue Remedy, 2 drops every 3 hours, during waking hours only, for 60 days. They were assessed before and after treatment with the Beck scales for anxiety and depression, a visual analogue scale for pain, measurement of tender points on the body, a dysbiosis questionnaire (assessing changes in digestive symptoms) and the Pittsburgh sleep assessment scale. Six healthy women, acting as controls, were also given Rescue Remedy and completed the same assessments.

On follow-up, the FM patients reported improvement by all measures, statistically significant except for sleep. In the control group there was a trend for worsening of symptoms though the changes were not statistically significant. It is unclear if follow-up was carried out after 30 days or 60, as both are mentioned in the text.

Comments: As the authors acknowledge, this is a very small study and further work would need to be carried out before any meaningful conclusions could be drawn.

There are significant differences between the control group and FM group both in age and ethnicity. In addition, the use of a ‘healthy’ group as control seems strange – it would be of more relevance to use a group of FM patients who were given a placebo rather than Rescue Remedy. The dosing of the Bach remedy was also sub-optimal – 2 drops every 3 hours during waking hours may not amount to the minimum daily amount recommended (4 drops, 4 times a day) for everyone, and the variation of dose depending on number of hours awake per day seems an unnecessary complication.

Summary: This small study suggests that a course of Rescue Remedy may benefit patients with fibromyalgia both mentally and physically.

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1.22 S. Toyota (2006), The Study of Bach Flower Remedies as Premedication

Intl. Soc. Life Info. Sci., 24(2), 455 – 60, doi: https://doi.org/10.18936/islis.24.2_455

This double-blind, placebo-controlled study comes from the department of anaesthesiology of a hospital in Japan. It was designed to investigate the value of Rescue Remedy for reducing anxiety before operations. Forty patients, scheduled for either general or orthopaedic surgery under either general or local anaesthetic, were selected to take part. They were randomised to two groups of 20, a treatment group given Rescue Remedy and a control group given mineral water, with each instructed to take as many doses as they felt necessary on the day before their operation. One person’s procedure was cancelled, and three people saw no need to take any treatment so they were excluded leaving 18 subjects in each group. Blood pressure and heart rate were measured when they entered the operating room. Anxiety was self-assessed by a visual analog (A-VAS) scale both on the day before surgery and on entering the operating room.

Analysis of the results showed that the Rescue Remedy group had lower blood pressure, lower heart rate, and less self-reported anxiety than the controls, although these differences did not reach statistical significance. The one significant finding was that the Rescue Remedy group had taken few doses from their bottle than had the control group.

The author concluded that this showed that Rescue Remedy does reduce pre-operative anxiety on the basis that participants took less doses because their anxiety was alleviated. Hence, Rescue Remedy does have potential use as a premedication.

Comments: These results provide evidence that Rescue Remedy is effective in reducing preoperative anxiety and tension. The system of taking the remedy doses only as required is consistent with the recommended use of this combination remedy (as opposed to single remedies).

Confirmation of these preliminary findings would require a larger study, preferably on a more homogeneous group of patients all having the same type of surgery and anaesthetic.

Summary: This small study shows a significant reduction in the patient-assessed need to take a remedy for stress and anxiety in pre-operative patients, suggesting potential use as a premedication.

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1.23 Mahia et al. (2014), Using Personalized Bach Flower Therapy for Diabetic Patients with Dyslipidemia

https://www.flowersociety.org/mahia and links therein

NB: This article is available on the website of the Flower Essence Society, translated from the original Spanish, but does not appear to have been published in a peer reviewed journal so the study should be viewed with caution.

It describes a prospective randomized placebo-controlled trial to evaluate the effectiveness of personalized Bach flower therapy on glycaemic control and lipid levels for patients with type 2 diabetes mellitus. The study was based at INACV, a Cuban research and clinical care facility and involved 200 patients aged between 60 and 80.

Half of them received a mixture of up to six Bach flower essences, individually prescribed according to their responses to a personality test. The other half received a placebo of alcohol in water. They were instructed to take 4 drops 4 times daily for 8 weeks, alongside their usual medical treatment (glyburide). Levels of fasting blood glucose, total cholesterol and triglycerides were measured at the beginning and end of the study. Significantly more patients in the Bach flower group had a “favourable response” as judged by changes in their laboratory measurements. The State Trait Depression Inventory and the State Trait Anxiety Inventory were used to assess changes in their emotional well-being. Significant positive changes were observed on both scales for the Rescue Remedy group. The authors conclude that Bach flower therapy promotes the health of diabetic patients by balancing their emotional energy.

Comments: The strengths of this study are the large number of patients included, and the prescription of remedies by individual assessment. However, the personality test used to select the remedies involves asking specific questions related to each remedy – this does follow ‘best practice’ for remedy selection.

Treatment response was considered favourable when pathological levels of blood glucose and lipid reached a normal value and was considered unfavourable when the levels of glucose and lipids remained pathological. It would have been clearer to have the laboratory results presented as actual values in mmol/litre after treatment as well as before, rather than in terms of “favourable response” and “percentage reduction”.

It is likely that some patients would have dropped out, or failed to take the drops regularly, but this is not mentioned.

Despite these reservations, the findings indicate that Bach flower therapy can have a valuable role in the medical, not only the psychological, management of diabetic patients. As type 2 diabetes requires self-management and adherence to diet and exercise regimes to maintain the best possible control, the improvement observed with improved emotional balance is understandable.

The reported benefit is remarkably large and it would be interesting to see whether this can be replicated in studies by other investigators, particularly if these were peer-reviewed.

Summary: Significant improvement was observed in emotional state and physical measures of diabetes and lipid control (reduction of blood glucose, total cholesterol and triglycerides) in patients with type 2 diabetes taking individualised remedy mixes.

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1.24 Balgobin (2015), The impact of the Bach flower remedies on stress among emergency and health care workers

https://bachcentre.com/wp-content/uploads/2020/12/2015-08-stress-and-emergency-service-workers.pdf

NB: This article is available on the website of the Bach Centre but has not been published in a peer reviewed journal so the study should be viewed with caution.

This multi-centre pilot study was designed to examine the impact of Bach flower remedies on British emergency workers (police, fire, ambulance) suffering from stress. Due to the reluctance of employers to be involved, subjects were sought by inviting self-referral through advertising. Participants were randomised to receive either an individualized mixture, or Rescue Remedy^®. They were assessed with the CORE-OM (Clinical Outcomes in Routine Evaluation-Outcome Measure) before and after the six-month duration of the study, and offered monthly consultations with one of seven BFR practitioners, who knew which type of remedy they were giving.

Only 12 people volunteered, and 11 completed the study. The two treatment groups were not well matched on demographics or CORE scores. The CORE scores were not particularly high, despite the subjective complaints of anxiety and stress. Scores decreased in 9 of the 11 subjects over the study period and the improvement in mean scores was statistically significant in the group receiving individualized mixtures, which had scored higher to start with. Of the 2 participants showing an increased score, one reported a significant deterioration in their work situation during the study. All 11 subjects reported subjective benefits from the treatment.

Comments: An ambitious study which was carefully designed and clearly written up but unfortunately is too small to permit any definite conclusions. The results suggest that individualized treatment is superior to Rescue Remedy^®, but this could just be a chance finding considering the very small number of subjects, the heterogeneity of the two treatment groups, and the lack of blinding of the practitioners.

Some of the practitioners were unhappy about having to prescribe only Rescue Remedy^®. There is a possibility that the seven practitioners involved offered differing pastoral care (while still conducting the consultation correctly), particularly if they felt uncomfortable about ‘only’ giving Rescue Remedy^®. Double-blinding would help to address this.

The difficulty of recruiting subjects is interesting. Maybe front-line workers do not have such high levels of stress as might be expected or, if they do, they are reluctant to admit it.

It should be noted that the study was sponsored by the Bach Centre and the Twelve Healers Trust

Summary: A small-scale pilot study suggesting a larger reduction in stress and anxiety on use of individualized treatment with remedies rather than Rescue Remedy^® in emergency service personnel.

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1.25 Romão et al (2025) Psycho-emotional effects of flower therapy in nursing professionals: prototypical analysis; Cogitare Enferm. [Internet],30, https://doi.org/10.1590/ce.v30i0.98619en

A parallel, two-arm, double-blind, placebo-controlled randomized clinical trial based in Brazil, comprising of 75 mostly female nursing professionals.

The object of the study was to evaluate the perceived effect of Bach flower remedies on the psycho-emotional state of the participants, and particularly how primary health care nurses see the effects of Bach flower therapy on their psycho-emotional states.

The intervention group received a mix of flower remedies – cherry plum, elm, hornbeam, olive, star of Bethlehem, walnut and white chestnut. The placebo group had an inert treatment bottle. Both groups took 4 drops, 4 times a day, every day for 4 weeks.

They were assessed before the trial began and after 4 weeks by free word evocation (FWE). This technique originated in clinical psychology, enabling spontaneous, quick, and objective mental projections to be captured. They were asked to provide the first 5 words they thought of when asked ‘how are you feeling right now?’ and rank them in order of importance.

Different words from the FWE were collated and prototypical analysis, which organizes them into central and peripheral ideas, was used to determine the results. This analysis indicated that there was no difference in the psycho-emotional states of the participants between the study groups, regardless of the formula received.

However, the researchers state that the categories mentioned by the intervention group (IG) were more concise and organised compared to the placebo group and conclude that this perception of improvement in psycho-emotional state of the IG can be attributed to the use of the flower remedies.

Comments: The authors note that using the same mix of remedies for all the IG is a limitation of the study.

Tiredness and anxiety were identified as the most significant central core elements before the treatment and, as such, would be expected to take some time to change. Continuing the study for only 4 weeks may affect any beneficial effects observed.

Repeating this study with a larger group. Over a longer period and considering simplification of the data analysis may improve the validity of the conclusions.

Summary: A small study showing some difference in the perception of psycho-emotional states of a group of nurses taking a mixture of remedies compared with the placebo group.

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1.26 Fringes et al. (2009) Double blind, randomized placebo controlled mono centre clinical study on the influence of Rescue® Bach flower remedy on erythrocyte rouleaux formation

Journal of Alternative Medicine Research, 1(2), 211 (entire issue available at https://www.livskvalitet.org/pdf/JAMR-2009_Volume_1_Issue_2_FP_Version.pdf)

A double-blind, randomised, placebo controlled clinical study was performed at a centre in Austria involving 32 healthy volunteers in a relaxed state. They were given one dose of either Rescue Remedy or a placebo alcohol solution.

Blood samples taken before and after administration were viewed under a dark-field microscope and the formation of erythrocyte rouleaux assessed. This measure was chosen because formation is associated with capillary vasodilation and when the body is under stress, vasoconstriction occurs in response (so formation could be associated with a reduction in stress).

There was no significant difference between the two groups before treatment but there was a significant difference after treatment with all 16 of the intervention group showing increased formation of erythrocyte rouleaux. Authors conclude that this could suggest that the Rescue Remedy is regulating stress.

Comments: This study attempts to use an objective physiological measure of the effect of the remedies on stress. However, increased rouleaux formation is not a widely accepted indicator of the body’s ability to counteract the stress response and is often regarded as a sign of inflammation and therefore undesirable.

Authors are measured in their conclusions, stating that the physiological effect may not be strong enough to cause a subjectively detectable improvement compared to the placebo group (so participants may not feel any difference) but further work using a larger sample would certainly be justified by the results.

Subjects in this study were stated to be in a relaxed state and this might not be optimal when looking at stress responses.

Details of how they study was carried out are a bit sparse: it is not stated how the volunteers were selected, what doses they were given, or how long afterwards the second measurement was made.

Summary: A small study in which an increase in erythrocyte rouleaux formation was found for participants taking Rescue Remedy. This may be linked to a reduction in stress response.

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1.27 Balakrishnan et al.(2025), Exploring Novel Behavior Modification Techniques-Comparing the Effectiveness of Bach Flower Therapy and Bubble Breath Play Therapy on Dental Anxiety in Pediatric Patients: A Randomized Clinical Trial

Int J Clin Pediatr Dent. 2025 Jun;18(6):677-682. doi: 10.5005/jp-journals-10005-3149, PMID: 41041011

This study from a dental clinic in India aimed to compare three interventions for reducing dental anxiety in children. Subjects were 45 children aged between 4 and 10 years old, who were attending for either oral prophylaxis or restorative treatments, and who scored highly on the Children’s Fear Survey Schedule – Dental Subscale. They were randomly divided into three groups: BFT (a single dose of Rescue Remedy 20 minutes before treatment), BBPT (blowing bubbles to promote distraction and controlled breathing), or TSD (tell, show, demonstrate to explain the procedure). Pulse rate and blood pressure were measured at baseline, following the intervention, and after treatment. Postoperatively, the children were assessed with Venham’s anxiety and behaviour rating scale. To summarise the results, the children who received Rescue Remedy showed the greatest reduction in pulse rate however there was an increase in systolic blood pressure after taking the remedy and post-operatively. As regards clinical signs and symptoms the greatest improvement was observed in the TSD group with the Rescue Remedy group having the least signs of improvement.

Comments: Finding ways to reduce dental anxiety in children is important, because such anxiety can lead to ongoing avoidance of dental care with consequent poor oral health in later life. This study was clearly designed and written up.

As the authors state, it would not have been possible to use a double-blind or placebo-controlled approach. The results do not lead to any definite conclusions about which of the three interventions works best. They are probably all helpful in different ways, and are not mutually exclusive alternatives. In fact it would seem good clinical practice for all patients to have the treatment explained to them (TSD) as well as, not instead of, an extra therapy to reduce anxiety. Therefore perhaps a future study could include only two groups: TSD + BFT, or TSD+BBPT?

Only a single dose of Rescue Remedy was given and authors suggest that using it in the few days prior to treatment might benefit children with extreme anxiety. Additionally, a second dose at the point of treatment, when expected anxiety would be highest, may also be beneficial, as Rescue is used to alleviate extreme anxiety.

Summary: A single dose of Rescue Remedy given to children prior to dental treatment reduced their pulse rate but had no other significant beneficial effects.

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1.28 K. Paiva et al. (2026), Effectiveness of flower therapy in reducing anxiety in older adults

Revista Cuidarte; 17(1):e4887, https://doi.org/10.15649/cuidarte.4887

A prospective, quasi-experimental, double-blind study from Brazil involving adults aged over 60 who were receiving treatment in primary health care. 194 subjects were both eligible for the study and willing to take part. Eligibility criteria included self-identifying at least three of the following traits: anxiety, haste, impatience, irritability, impulsiveness, restlessness, difficulty relaxing, intolerance toward others’ slower pace, nervousness, tension, fear and loneliness.

The basis for the study is the Betty Neumann model which states that precursors appear as early signs of an anxiety disorder, such as cold hands, impatience, fear, tachycardia, sweating, and anger. These physical and emotional signs can be explained as responses to internal and external stressors.

Participants were assessed using symptom checklists and with the STAI scale which measures state and trait anxiety before the study began. They were randomised to an intervention group given a remedy mixture of Impatiens, Cherry plum, Clematis, Rock rose and Star of Bethlehem (this is equivalent to Dr. Bach’s crisis mix), and a control group given a brandy mixture. Four drops were taken four times a day. A follow-up was completed after 15 days and final assessment after 30 days.

Of the initial number of 97 subjects in each group, only 28 in the control group and 31 in the intervention group completed the study. In the intervention group, but not in the control group, there were significant reductions in STAI scores and in symptoms of impatience, fear, irritability, restlessness, sadness and anxiety.

Comments: The findings of this study suggest that Bach flower remedies can be effective in reducing anxiety in older people. However, the statistics should be interpreted with caution because so many eligible subjects either declined to take part or dropped out before the end. The reasons for this are not discussed. The initial STAI scores were higher in the intervention than the control group, which makes direct comparison difficult and results are complicated by the potential of ‘regression to the mean’ where abnormal initial results may correct without intervention.

The quasi-experimental nature of the study means researchers could alter certain variables decreasing the validity of any conclusions drawn from the results. Researchers’ interaction with participants may have its own therapeutic value which is not easily quantified.

Summary: A small study which shows positive effects of Dr Bach’s crisis mix on anxiety and its precursors in older adults.

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