Publications of Interest

Animal Assisted Therapy for Trauma

Lynn Hazard, LCSW, Coordinator, POI

Lynn Hazard, POI Editor

This quarter we are taking a look at the recent information regarding animal-assisted therapy. You may have read Michelle M. Yarberry’s article in ISSTD News’s Kid’s Korner July 2018: Squeaks, nuzzles, tail wags, woofs, and whinnies: An experiential glimpse into animal/equine-assisted psychotherapy/play therapy.

Our trauma and dissociative clients have many unique challenges that often include difficulty with self-regulation, grounding, social interaction, bonding, and self-confidence. Animals are increasingly recognized as a valuable support system for social and emotional growth and healing for these clients. As such, this quarter we choose to highlight a few recent articles on this topic.

Emmy A. E. van Houtert, Nienke Endenburg, Joris J. Wijnker, Bas Rodenburg & Eric Vermetten (2018) The study of service dogs for veterans with Post-Traumatic Stress Disorder: a scoping literature review, European Journal of Psychotraumatology, 9:sup3,

DOI: 10.1080/20008198.2018.1518199
To link to this article: https://doi.org/10.1080/20008198.2018.1518199

Abstract:
The therapeutic application of human–animal interaction has gained interest recently. One form this interest takes is the use of service dogs as complementary treatment for veterans with Post Traumatic Stress Disorder (PTSD). Many reports on the positive effect of PTSD Service Dogs (PSDs) on veterans exist, though most are indirect, anecdotal, or based on self-perceived welfare by veterans. They therefore only give a partial insight into PSD effect. To gain a more complete understanding of whether PSDs can be considered an effective complementary treatment for PTSD, a scoping literature review was performed on available studies of PSDs. The key search words were ‘dog’, ’canine’, ‘veteran’, and ‘PTSD’. This yielded 126 articles, of which 19 matched the inclusion criteria (six empirical studies). Recurrent themes in included articles were identified for discussion of methodology and/or results. It was found that results from most included studies were either applicable to human–animal interaction in general or other types of service animals. They therefore did not represent PSDs specifically. Studies which did discuss PSDs specifically only studied welfare experience in veterans, but used different methodologies. This lead us to conclude there is currently no undisputed empirical evidence that PSDs are an effective complementary treatment for veterans with PTSD other than reports on positive welfare experience. Additionally, the lack of development standardization and knowledge regarding welfare of PSDs creates risks for both human and animal welfare. It is therefore recommended that a study on the effect of PSDs be expanded to include evaluation methods besides self-perceived welfare of assisted humans. Future studies could include evaluations regarding human stress response and functioning, ideally conducted according to validated scientific methodologies using objective measurement techniques to identify the added value and mechanisms of using PSDs to assist treatment of PTSD in humans.

Lass-Hennemann, J., Schäfer, S.K., Römer, S., et. al. (2018). Therapy dogs as a crisis intervention after traumatic events? – An experimental study. Frontiers in Psychology (August 2018).
DOI: 10.3389/fpsyg.2018.01627

Abstract:
Animal-assisted therapy has been proposed as a treatment adjunct for traumatized patients. In animal-assisted crisis response, dogs are used directly after a traumatic event to reduce stress and anxiety. However, to date there as few controlled studies investigating the effects of therapy dogs on PTSD symptoms and to our knowledge there is no study investigating the effects of a therapy dog intervention directly after a traumatic event. In this study, 60 healthy female participants were randomly assigned to one of three groups. After exposure to a “traumatic” film clip (trauma-film paradigm), one group of participants interacted with a friendly dog for 15 minutes, another group of participants watch a film clip showing a person interacting with a friendly dog, and the last group was instructed to relax. Participants who had interacted with the dog after the film reported lower anxiety levels, less negative affect, and more positive affect after the intervention as compared to the other two groups. However, participants who interacted with the dog showed less decrease in physiological arousal after the traumatic film clip compared to both other groups. There were no differences in intrusion symptoms between the three groups. Our results show that dogs are able to lessen subjectively experienced stress and anxiety after a “traumatic” stress situation.

Hayden-Evans, M., Milbourn, B., & Netto, J. (2018). Pets provide meaning and purpose: A qualitative study of pet ownership from the perspective of people diagnosed with borderline personality disorder. Advances in Mental Health, Volume 16, Issue 2.
DOI: 10.1080/18387357.2018.1485508

Abstract:
Objective: This qualitative study aimed to explore the experiences of pet ownership for adults with borderline personality disorder (BPD) and understand the impacts of pets on their attachments, social connections, and activity participation.
Method: Semi-structured interviews were conducted with eight individuals with BPD and analyzed using interpretive phenomenological analysis.
Results: Five dominant themes emerged: Pets (1) provide meaning and purpose; (2) influence positive emotional attachments; (3) influence positive social connections; (4) promote participation and engagement in meaningful activities; and (5) have therapeutic value. Discussion: Pets provided opportunities for community engagement, social interaction, and participation in meaningful activities, and may aid development of coping skills and secure attachments, inviting further research to confirm the role of pets personally and therapeutically for this population.

Burgon, H., Gammage, D., & Hebden, J. (2018). Hoofbeats and heartbeats: equine-assisted therapy and learning with young people with psychosocial issues – theory and practice. Journal of Social Work Practice, Volume 32, Issue 1.
DOI: 10.1080/02650533.2017.1300878

Abstract:
The practice of equine-assisted therapy and learning (EAT/L) to deliver psychosocial interventions to young people is a rapidly growing field. However, recent reviews have cited a need for further documentation of a theoretical foundation and evidence of outcomes of these programmes. This paper is a theoretical discussion on psychotherapeutic theories and models that the authors understood and being relevant and giving substance to the application of EAT/L at a Therapeutic Horsemanship centre in the UK. It also describes and defines the practice of EAT/L at the centre. Philosophical and psychological theories/models of Non-Violent Communication, Object Relations, Play and Dramatherapy, Mindfulness practice, and Attachment theory, all set within a person-centered and relationship-based approach employed at the centre were examined and illustrated in the form of client case material. The authors report the central role relationship plays between client-horse-therapist and horse-handler in the building of trust and resolution of the impact of trauma. The paper highlights a need to carry out well-designed empirical studies with different client groups in the field of EAT/L in order to gain more insight into this growing field.

Germain, S.M., Wilkie, K.D., Milbourne, V.M.K, & Theule, J. (2018). Animal-assisted psychotherapy and trauma: A meta-analysis. Anthrozoös, Vol. 31, Issue 2.
DOI: 10.1080/08927936.2018.1434044

Abstract:
The present meta-analysis examined the efficacy of animal-assisted psychotherapy for individuals who have experienced trauma. Eight studies quantitatively assessed the treatment effects of involvement in animal-assisted psychotherapy. A random effects model was used to aggregate each study into an overall effect size. Eight effect sizes were included in the pre-versus post-comparison analysis. The results indicate a large effect size (Hedge’s g = 0.86, p < 0.001, 95% CI [.53, 1.18]. Two effect sizes were included in the treatment versus control comparison analysis. The results indicated a small to moderate effect size (g = 0.46, p = 0.03, 95% CI [0.04, 0.06]. Limited moderator analyses were able to be conducted due to lack of consistent reporting across studies. Place of study and percentage of female participants in the treatment group were found to statistically moderate the effect of animal-assisted psychotherapy. The results indicate that animal-assisted therapy is an efficacious treatment for trauma.

Krause-Parello, C.A., Thames, M., Ray, C.M., & Kolassa, J. (2018). Examining the effects of a service-trained facility dog on stress in children undergoing forensic interview for allegations of child sexual abuse. Journal of Child Sexual Abuse, Volume 27, Issue 3.
DOI: 10.1080/10538712.2018.1443303

Abstract:
Disclosure of child sexual abuse can be a stressful experience for the child. Gaining a better understanding of how best to serve the child, while preserving the quality of their disclosure, is an ever-evolving process. The data to answer this question come from 51 children aged 4-16 (M = 9.1, SD = 3.5), who were referred to a child advocacy center in Virginia for a forensic interview (FI) following allegations of sexual abuse. A repeated measures design was conducted to examine how the presence of a service trained facility dog (e.g. animal-assisted intervention (AAI) may serve as a mode of lowering stress levels in children during their FIs. Children were randomized to one of the two FI conditions: experimental condition (service-trained facility dog present-AAI) or control condition (service-trained facility dog not present – standard forensic interview). Stress biomarkers salivary cortisol, alpha-amylase, immunoglobulin A (IgA), heart rate, and blood pressure, and immunoglobulin A were collected before and after the FI. Self-report data were also collected. Results supported a significant decrease in heart rate for those in the experimental condition (p = .0086) vs the control condition (p = .4986). Regression models revealed a significant decrease in systolic and diastolic respectively. Statistically significant changes in alpha-amylase and IgA were also found in relation to disclosure and type of offense. The results of this study support the stress reducing effects of a service-trained facility dog for children undergoing FI for allegations of a child sexual abuse.

Spattini, L., Mattei, G., Raisi, F., et. al. (2018). Efficacy of animal assisted therapy on people with mental disorders: an update on the evidence. Minerva Psichiatrica, 59(1), 54-66.
DOI: 10.23736/S0391-1772.17.01958-6

Abstract:
Introduction: Animal assisted therapy (AAT) is a structured form of animal assisted intervention (AAI), which specifically adopts animals in healthcare services and education facilities, to achieve therapeutic goals. Although such interventions are widely used nowadays, evidence supporting them is still largely lacking. A previously published review of the literature highlighted some promising effects of AAT on people presenting with psychiatric disorders, though quality of the studies included was generally low. In order to provide an update of recent evidence, the aim of this study was to systematically review randomized control trials (RCTs) published since 2000, involving people affected by mental disorders and receiving AAT.
Evidence Acquisition: The following databases were searched: CINHAI, EBSCO Psychology and Behavioral Science Collection, PubMed and Web of Science. 115 papers were obtained and screened. 28 were from CINHAI, Psyc-INFO and Psychology and Behavioral Science Collection together. 15 from PubMed and 72 from Web of Science. In addition to this, grey literature and references of already published reviews and meta-analyses on the topic were searched, resulting in the addition of 6 further articles. After screening, 10 RCTs were included in this review.
Evidence synthesis: Studies involving outpatients were more frequent than those involving inpatients, sample size was generally low. The majority of studies adopted scales routinely used in clinical trials, with a good level of validity and reliability. Five out of ten studies reported significant differences in the main outcomes favoring AAT. Most of the studies did not include any follow-up, yet where prospective data were available, the benefits of AAT appeared long lasting. Dropout rates were higher in studies involving outpatients. However, the only trial which enrolled both inpatients and outpatients showed a higher drop-out rate among the inpatients group, possibly due to their more severe psychopathology.
Conclusions: Though a paucity of available studies partly limits our findings, AAT seems to improve empathy, socialization and communication, and to favor therapeutic alliance among patients who have difficulties with therapeutic programs adherence. AAT appears to be a feasible and well-received intervention, potentially with few or no side effects reported. However, there is a need for further studies with larger sample sizes and high-quality research standards.

Jones, M.G., Rice, S.M., & Cotton, S.M. (2018). Who let the dogs out? Therapy dogs in clinical practice. Australasian Psychiatry, February 2018.
DOI: 10.1177/1039856217749056

Abstract:
Objectives: Animal-assisted therapy (AAT) is a growing field in Australia, and therapy dogs are becoming increasingly common in clinical settings. This paper aims to highlight the current issues facing AAT in Australia and to make recommendations on how to progress the field. We acknowledge that there are several ways that therapy dogs may enhance treatment outcomes for clients, such as reductions in stress and acute anxious arousal, and improvements in engagement and rapport. These psychological and physiological advantages, however, may not be sustained once interaction with the dog ceases. Clinicians require adequate training and support to develop and implement interventions that are based on sound theoretical foundations, and take advantage of the adjunctive benefits of animal presence.
Conclusions: A series of recommendations are made for the professionalism of AAT, including the development of consensus definitions, clinical governance, accreditation, research and evaluation.

The Future of Publications of Interest

This is the last Publications of Interest which will be coordinated by Lynn as she moves into retirement. I cannot thank Lynn enough for her work on this feature. She has been a pleasure to work with: full of ideas for future columns and always interested in suggestions and comment from others. Thank you, Lynn, for the time and effort you have put into each POI. We will miss you, but we know that you are off to enjoy more time with family.

Publications of Interest is a quarterly feature which highlights key articles within a theme that may be of interest to members. We are seeking a new Coordinator. For this role you only need a love of reading and collating research. No literature reviews, analysis or comment are required. It would help if you had access to a research publications database (eg through a university), but this is not essential as I can help access articles.

Publications of Interest is a low-demand way, but an important way, to contribute to ISSTD. If interested contact Kate on katemcmaughpsychology@gmail.com

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