Recently, I discovered a report listed in the database of the US National Institute of Health; it claimed that the flower remedies failed to demonstrate any effects beyond a placebo response. I am shocked by the result and I wondered if there are any factors that caused the result to be biased against flower remedies?


In a recent written research proposal, Dr. Paul J. Mills addressed the aforementioned report in the following manner:

Brief Background and Critique of the Literature

Despite decades of use in clinical practice and anecdotal reports of clinical effectiveness (1, 2), there have been relatively few placebo-controlled double-blinded studies of flower essence therapy for the treatment of stress and anxiety.  A review of the medical literature yields only three original studies, including one reporting a positive outcome (3) and two reporting negative outcomes (4, 5). Each of the three studies tested the effectiveness of essence formulas on test taking anxiety in college students. 

Both of the negative studies relied on inappropriate study designs and inappropriate applications of the flower essence formulas. The Armstrong & Ernst study (4), for example, suffered from an inappropriate use of what is called the Five-Flower Formula (a.k.a. Rescue Remedy, which contains Star of Bethlehem, Cherry Plum, Impatiens, Rock Rose & Clematis). This formula is typically used as an acute remedy for more immediate, short-term situations of anxiety and stress. The formula's effects are typically short-term. This study examined the effects of the formula over a period of one week with 1 to 4 dosages/day. In addition, the study participants – college students preparing for their pending examinations – had only low to moderate levels of trait anxiety prior to randomization into the study (mean baseline Trait Spielberger Inventory scores of 41 to 51). The Five-Flower Formula is not intended for such a population but for individuals with higher levels of anxiety and/or stress. The study’s 50% dropout rate is also problematic.

As in the therapeutic setting, in the research setting it is crucial that any study of flower essences ensure that the subjects actually need the essence or formula being given and that the setting matches the indications of the essence. This is the approach that was taken by the study that reported a positive outcome (3). This study also used the Five-Flower Formula but in an acute test anxiety setting of 3 hours duration (with treatment applications every 20 minutes). This double bind placebo controlled study had no dropouts and had a sample size approximately double of the two negative studies (approximately 55 students/ treatment group). The findings showed that the students treated with the Five-Flower Formula who had high Spielberger state anxiety scores (mean baseline scores of 2.93 to 3.02) at pre-randomization had a significant drop in anxiety levels as compared to those high state anxiety students treated with placebo formula. Students with low to medium levels of state anxiety showed no benefit of the formula, thus supporting the notion that the effectiveness of this formula is to be found in its originally intended application, namely in individuals with the greatest need, i.e., high levels of anxiety and/or stress.


1. Long L, Huntley A, Ernst E. Which complementary and alternative therapies benefit which conditions? A survey of the opinions of 223 professional organizations. Complement Ther Med 9:178-85, 2001.

2. LaTorre MA. Integrative perspectives. Integrating Bach flower remedies into a therapeutic practice. Perspect Psychiatr Care 42(2):140-3, 2006.

3. Halberstein R, DeSantis L, Sirkin A, et al. Healing with Bach Flower Essences: Testing a Complementary Therapy. Complementary Health Practice 12:3-14, 2007.

4. Armstrong & Ernst. A randomized, double-blind, placebo-controlled trial of a Bach flower remedy. Complementary Therapies in Nursing and Midwifery 7:215-221, 2001.

5. Walach H, Rilling C, Engelke U. Efficacy of Bach flower remedies in test anxiety: a double-blind, placebo-controlled, randomized trial with partial crossover. J Anxiety Disord. 15:359-66, 2001. 


Richard Katz

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