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Animal-Assisted Therapy: Paging Dr. Dog
As a volunteer at a local hospital with a People-Animal Connection (PAC) program, I’ve witnessed how PAC volunteer teams (typically consisting of well-trained canine and his/her human partner) offer companionship and support through in-patient visits to critically ill children and adults; provide a boost to medical staff; and soothe families that are visiting loved ones at medical centers. Anecdotal observations and clinical studies support how Animal-Assisted Therapy can speed healing and lessen depression and anxiety.
Animal-Assisted Therapy (AAT) is gaining acceptance not only in healthcare clinical settings, but also in private therapy practices, seniors living with dementia and Alzheimer’s, students with literacy challenges, patients in recovery, people with intellectual disabilities and those approaching end of life; and in helping wounded military to mend from physical and emotional damage.
What is Animal-Assisted Interventions (AAI) & Animal-Assisted Therapy (AAT)?
Animal-Assisted Interventions (AAI) is a broad term that includes Animal-Assisted Therapy and other Animal-Assisted Activities.
Animal-Assisted Therapy (AAT) is a growing field that uses specially-trained and certified dogs or other animals, paired with a specially-trained human partner, to focus on a specific goal: to help people recover from or better cope with health problems, such as heart disease, cancer and mental health disorders.
Animal-Assisted Activities have a more general purpose, such as providing comfort and enjoyment for nursing home residents.
The ASPCA points out “therapy animals are not service or assistance animals and are not granted the same legal rights of access.” Unlike service animals, therapy animals don’t help their owners perform tasks and are therefore not protected under the Americans with Disabilities Act. Though there are no national requirements to register therapy animals, most hospitals only allow ones that have been trained, aren’t easily stressed and are covered by an insurance policy.
Animal-Assisted Intervention (AAI) may be provided in a variety of settings, may be individual or group in practice, and can be utilized for persons of any age.
How Does AAI Work?
Dr. Aubrey Fine is an AAI pioneer, author of several books, professor at California State Polytechnic University in Pomona, and licensed psychologist whose practice specializes in treating children with ADHD, learning disabilities, developmental disorders and parent child relations. He also serves on the Board of Directors at Pet Partners, a national nonprofit organization that trains and registers therapy animals.
Three Theories on Why We Connect with Animals
Dr. Fine explained three theories on why we connect to animals. These include:
1) Love. The love we feel with animals makes us feel connected. They bring to us a level of social support. When we come home, animals greet you, making you feel wanted.
2) Attachment. Just like infants are attached to their parents, we turn to animals because we like to be caregivers.
3) Biophilia. Our love for the living environment creates a biological pre-disposition to engage with the environment. This in turn helps us to engage with another species, and that makes the bond incredibly strong
Children & AAT
Animals can act as therapists themselves or can facilitate therapy. According to Dr. Fine, “One of the things that’s always been known is that the animals help a clinician go under the radar of a child’s consciousness, because the child is much more at ease and seems to be much more willing to reveal.”
Dr. Fine’s successful use of therapy animals in treating children is documented in The Handbook on Animal Assisted Therapy (now in production for the fourth edition: Elsevier/Academic Press, 2015).
Dr. Fine describes one of his pediatric cases, 5-year-old Diane, who, though she spoke at home, she was selectively mute and refused to speak to anyone else, including her kindergarten teacher.
A trained therapy dog named Puppy helped the child to break her silence. As Diane was petting Puppy, Dr. Fine gave the dog a signal to walk away. Seeing the girl’s distress, Dr. Fine told her that all she had to do to get the dog to return was to say, “Puppy, come.” Softly, the child said, “Puppy, come, please come, Puppy.” That incident became the breakthrough that Dr. Fine needed to help the child.
“Children are more likely to reveal inner thoughts to the therapist because the animal is right next to them and helps them express themselves,” Dr. Fine explained.
In early work in a social skills program for kids with ADHD, Dr. Fine found that they could be more easily taught how to behave calmly if allowed to handle his pet gerbil. “I realized this approach can have a tremendous impact in teaching because it helps to change how we relate to other beings,” he said.
Health & Wellness Benefits
AAT can have health benefits, too. “We’ve done research that looks at blood pressure, regulation and breathing,” Dr. Fine said. “Research has also shown that petting dogs also reduces cortisol, which is the stress hormone. Since 2001, lots of research has come about looking at neurochemistry.”
Tests have shown that having pets around helps their owners to produce serotonin and oxytocin. Serotonin is a neurotransmitter that affects moods, while oxytocin is called the “love hormone,” because it helps create bonds between mothers and their infants. But the benefits go both ways, Dr. Fine explained.
“If an animal wants to engage with you, petting that animal actually reduces its cortisol levels and produces oxytocin,” he says.
Who Can Benefit from Animal-Assisted Therapy?
Animal-Assisted Therapy can significantly reduce pain, anxiety, depression and fatigue in people with a range of health problems:
– Children that are hospitalized
– People receiving cancer treatment
– People in long-term care facilities
– People hospitalized with chronic heart failure
– Veterans with post-traumatic stress
It’s not only the ill person who reaps the benefits. Staff at hospitals/healthcare facilities and family members and friends who sit in on animal visits say they feel better, too.
Animal-assisted therapy is also being used in nonmedical settings, such as prisons, universities and community programs, to help people deal with anxiety and stress.
Animal-Assisted Therapy: Clinical Studies
Hal Herzog, PhD, is a Professor of Psychology at Western Carolina University, an award-winning teacher and researcher, who has been investigating the complex psychology of our interactions with other species for more than two decades.
According to Dr. Herzog, “The idea that interacting with animals can heal our broken minds and bodies is certainly appealing, particularly for those of us who love pets. But is there a mismatch between the media coverage of AAT and the evidence that these therapies actually work?”
Dr. Herzog points out the good news: the overwhelming majority of published studies have reported that animals make excellent therapists. He cites, for instance, Maggie O’Haire of Purdue University, reviewed 14 clinical trials on the effects of AAT on children suffering from autism spectrum disorders.
“Together, these studies measured 30 different variables. The results were impressive. All of the studies found that AAT was effective. Indeed, children with autism who underwent AAT showed, in stat-speak, “statistically significant” improvements on 27 of the 30 outcomes measured.”
Dr. Herzog cautions that while the Animal-Assisted Therapy Research study results sound great, the research has common flaws. In an article he wrote for Psychology Today, these flaws include:
-Lack of a non-treatment control group.
-Insufficient numbers of subjects.
-No controls for effects of novel experiences (e.g., swimming with dolphins).
-No written manual spelling out the treatment procedures (important for standardization and replication).
-No use of “blind observations” to control for unconscious bias on the part of the researchers.
-Reliance on self-reports rather than objective measures.
-Lack of long-term follow-up studies.
-Putting a positive spin on negative results (e.g., “While interacting with the therapy dogs did not actually decrease the patients’ symptoms, the participants reported that they enjoyed interacting with the animals.”).
-Cherry picking (only presenting the results for variables that worked)
Dr. Herzog points to researchers such as Alan Beck, the Director of the Center for the Human-Animal Bond at Purdue University, who is a pioneering researcher who helped establish the field of anthrozoology. In 1984, along with his colleague Aaron Katcher, he published the first review of studies on AAT.
“In that paper, Beck and Katcher warned about the state of research purporting to demonstrate the effectiveness of animals as therapists. They argued that investigators needed to carefully separate the feel-good temporary recreational benefits of interacting with animals from the long-term clinical benefits of AAT. And they were particularly concerned that too many enthusiastic investigators were asking “How can I demonstrate the therapeutic effect of pets?” rather than the more appropriate question, “Do pets have a therapeutic effect?”
According to Dr. Herzog, ”Unfortunately, despite the media hype and 30 years of research on therapy dogs, dolphins and horses, Beck and Katcher’s warning is nearly as true today as it was in 1984. However, things are improving on the research front.”
Dr. Herzog noted that the Waltham Centre for Pet Nutrition [Mars Petcare] and the Eunice Kennedy Shriver National Institute of Child Health and Human Development initiated a grant program in 2008 that has provided over $9 million for research related to human-animal relationships. “Already these funds have begun to pay off in terms of better AAT studies,” he explained.
Does Animal-Assisted Therapy Have Risks?
The biggest concern, particularly in hospitals, is safety and sanitation. Hospitals and other facilities that use AAT have stringent rules to ensure that the animals are clean, vaccinated, well-trained and screened for appropriate behavior. Hospitals also have strict admission processes for volunteers. There are often background checks, volunteer orientations, volunteer training, and health screenings a handler must pass before they are permitted to volunteer.
The pathway to becoming a therapy animal is no jog in the park — for the dogs or the human handlers. Every animal that enters the hospital has gone through a rigorous certification process. Before receiving their therapy assistance status, the dogs receive expert training and are put through a series of drills to test their patience and demeanor. Regular evaluations, veterinary checkups and special baths are just part of a therapy dog’s routine. The dogs have to be social, get along with each other and accept loud noises. They have to be comfortable around medical equipment. They have to be obedience-trained. To that end, dogs that bark or growl at each other are generally disqualified.
Common guidelines at a hospital/healthcare facility include:
– Safety First. Safety is always a consideration when working with animals. Volunteer handlers will have undergone the necessary preparation, training and registration or certification to have the animal properly screened and trained. The animal should be up-to-date on all necessary vaccinations and in good health. Organizations providing AAT should be able to validate this information.
– Fear Factor. Some patients are afraid of animals, particularly large ones. Volunteer handlers are trained to assess the willingness of the patient to participate in AAT.
Allergies are another aspect to consider, and volunteer handlers ensure that a patient isn’t allergic to a particular animal before engaging in AAT
– Behavioral Health.Those with behavioral health issues can benefit from AAT, and are monitored to ensure the safety of both animal and client.
– Reduced Immunity. Patients with reduced immunity – individuals with cancer, HIV/AIDS, patients receiving chemotherapy or radiation, those on high-dose steroids and other immune-suppressive medications – need clearance from their physician before participating in AAT.
The most common AAT animals in a hospital setting are dogs. Depending on the facility, some allow cats and rabbits. Check with your healthcare facility on their specific regulations and policies. Guidelines released in 2015 from the Society for Healthcare Epidemiology of America (SHEA) recognizes that while hospital policies on animal visits vary widely among institutions, SHEA doesn’t recommend that cats serve as AAT at hospitals [see article: http://www.livescience.com/50011-pet-therapy-hospitals-dogs-cats.html].
Animal-Assisted Therapy In Action
Animals are being used more frequently in clinical settings. For instance, South Nassau Communities Hospital in Oceanside NY started an AAT Program about two years ago, which now features six dogs and their animal handlers. The AAT Volunteers will walk the floors, and visit patients in pediatrics, oncology, behavioral health, and the transitional care unit—anywhere except the ICU and the CCU.
Anne Fernandez, Director of Volunteer Services at South Nassau Communities Hospital, explained that “the dogs are kept in pristine condition: exceptionally well-groomed and de-shedded. It’s a treat for patients to see the dogs. Being in a hospital can be scary and lonely. Some patients have pictures of their dogs on windowsills, and having a visit with the pet handler and dog gives them the comfort of being at home. It’s a stress-relief for the patients.”
According to Fernandez, “Not only do our volunteers and their dogs cheer up patients in the units they visit–the therapy dogs are a big hit with the staff, too.” The dogs also help break the stress and tension of family members in the waiting room, and are a welcome diversion.
South Nassau Communities Hospital AAT Volunteer Jodi Ekberg, who shares her home with four Siberian Huskies, went through the AAT certification process with her dog, Frankie. Frankie was first certified as an American Kennel Club (AKC) Canine Good Citizen; and then received AAT training by a nonprofit, Love on a Leash.
Jodi, a cancer survivor, credits her dog with being a key part of her healing process. “I truly believe that I am only here because of my dogs. I want them to do for others what the have done for me.”
Jodi (who works full-time) and Frankie serve as weekly Saturday visitors at South Nassau Communities Hospital, and will typically spend 3-4 hours visiting patients. As Jodi makes rounds with Frankie, “he brings a smile to the faces of everyone he meets.” Jodi describes how patients, even those who seem withdrawn, come to life when interacting with Frankie.
Operation Kindness is the largest no-kill animal shelter in North Texas; and is a partner to nonprofit organization Pets for Vets. Pets for Vets is dedicated to supporting veterans and providing a second chance for shelter dogs by rescuing, training and pairing them with veterans who could benefit from a companion animal. As the official Pets for Vets North Texas Chapter, Operation Kindness will train, socialize and match companion dogs with veterans in North Texas at no cost to the veteran.
“Many veterans returning home suffer with emotional and physical injuries that make the transition into civilian life difficult,” says Jim Hanophy, Operation Kindness CEO. “It is our goal to help ease this process by providing deserving veterans in North Texas with a companion animal. We believe trained companion animals will provide a source of friendship and comfort that many of our service men and women need.”
Here’s how it works: A professional trainer from Operation Kindness will meet with North Texas veterans to discuss what type of companion dog each wants. The trainer will identify one that’s appropriate for the veteran’s needs, lifestyle and personality. For example, if the veteran is less mobile, the trainer looks for dogs that require less physical exercise. The trainer then works with Operation Kindness and its network of rescue and shelter partners to thoroughly evaluate each dog’s temperament, breed, age, socialization skills and overall well being to find the right match for the veteran. Once a dog is selected, the trainer takes it home to socialize and train it before introducing the companion animal to the veteran.
Can Any Animal Be Involved in AAT?
While a wide variety of animals can be wonderful companions or pets, not every animal is suited to therapy work. According to Pet Partners, therapy pets can include “dogs, cats, rabbits, birds, guinea pigs, rats, miniature pigs, llamas, alpacas, horses, donkeys and mini-horses,” as long as they’re at least a year old and have lived with their owner for six months, according to Pet Partners. Though the organization registers “birds,” it does not register ducks, and does not allow exotic or wild animals.
“We know many people have wonderful experiences with these animals as pets, but without research documenting their behavior over time, we cannot evaluate their predictability and reaction to stress,” according to the Pet Partners website.
The best way to get involved in AAT is to join a group that can help evaluate your dog, provide some structure, and offer financial protection in the form of insurance. While a hospital, convalescent home, or other care facility is more likely to allow visits by organized groups than individuals, check with your local healthcare facility, since policies vary.
If you think that you and your animal companion could be a perfect AAT pair, check out the registration and/or certification process. As a first step, it’s critical to determine your animal’s suitability. For dogs, obedience skills and a calm temperament are essentials. Your dog can’t bark at people, jump on them, or pull on the leash. Your dog must be relaxed when a stranger pets him and unfazed by noises and smells.
– Ask yourself: Am I willing to interact with people in need? Can I deal with people in discomfort?
– Also ask: Can I follow a facility’s rules? If you can answer yes to each question, you’re on your way.
Training. Some organizations train both dogs and owners; others train owners only. Look for an accredited organization with standards and procedures to protect you and your dog. This includes liability insurance, visit-length rules so your pet isn’t overworked, infection control, and regular health screenings for your pet.
Training length varies. Some organizers offer online courses that can be completed in a certain amount of hours; others require teams to train together for weeks. Registration should require in-person team testing.
Therapy animals: certified or registered? Different organizations offer different pathways. For instance, Pet Partners therapy animal teams are registered, not certified. Certification implies that Pet Partners has participated in the handler’s and the animal’s training. Whereas registration requires training and screening, Pet Partners does not certify that the team is trained to a certain level. Instead, the team is registered as having met minimum requirements.
Will you need volunteer insurance? Check with the facility where you and your animal companion will be volunteering, to ensure that you are covered by their insurance. For instance, when acting as a volunteer for Pet Partners within the scope of a volunteer’s duties as a Therapy Animal volunteer, you and your pet are insured by Pet Partners commercial general liability insurance. That means that if either member of a team causes a loss at a location where the team is visiting, and that loss results in a claim for which Pet Partners is liable, Pet Partners’ commercial general liability insurance will defend and pay expenses of the claim. Likewise, as a Pet Partners Therapy Animal Team, you will be covered on the Pet Partners insurance policy when you are doing volunteer work as a team. In cases where professionals are using animals in the context of their jobs, Pet Partners insurance does not provide coverage. It is important that you understand your coverage in case of an incident.
Costs. There are fees for the handler course, evaluation and registration and/or certification. Additionally you will need your vet to complete a health screening, which may have an associated charge. Typically, training and registration costs vary widely – costs can range from $100 – $300; to as high as $2,000. Once you’ve graduated, your training organization may help you find facilities to visit, but be prepared to do your own research and coordinate with staff for visitation. Finally, be prepared to commit to a schedule of regular visits.
Find training here:
- Pet Partners, petpartners.org
- Canine Link, http://cltherapydogs.org
- Therapy Dogs Inc., https://therapydogs.com
- Good Dog Foundation, http://thegooddogfoundation.org
- Therapy Dogs International, http://tdi-dog.org
In appreciation for sharing their expertise & advice:
- Aubrey Fine’s website contains more information, including his books and other helpful resources: www.aubreyhfine.com/
- Pet Partners is the national’s largest national nonprofit registering handlers of multiple species as volunteer teams providing animal-assisted interactions https://www.petpartners.org
- Hal Herzog https://www.psychologytoday.com/…/hal–herzog-phd His article in Psychology Today: Animal Assisted Therapy: Does It Really Work, is a balanced overview of the good news/bad news about AAT clinical studies; and suggest further readings: https://www.psychologytoday.com/blog/animals-and-us/201411/does-animal-assisted-therapy-really-work
- Jim Hanophy, CEO of Operation Kindness, operationkindness.org/ — Operation Kindness is the largest no-kill shelter in North Texas; and has saved more than 80,000 cats and dogs over almost 40 years.
- South Nassau Communities Hospital, located in Oceanside, NY, started its AAT Program approximately 2 years ago, and now has teams of 6 human-certified dogs who visit patients of all ages southnassau.org/
- Jodi Ekberg is an AAT Volunteer at South Nassau Communities Hospital – for more information you can visit her website at http://www.thehuskybrothers.com/Book_s.html and/or view her and Frankie in action at: https://www.youtube.com/watch?v=16W6cn-hUrM. She and Frankie were trained by Love on a Leash, loveonaleash.org/
- American Kennel Club (AKC) Canine Good Citizen, visit their website to learn more, at: http://www.akc.org/dog-owners/training/canine-good-citizen/
ABOUT THE BOOK’S AUTHOR, DR. AUBREY FINE:
Dr. Fine received his graduate degree from University of Cincinnati in 1982 and has been on the faculty at California State Polytechnic University since 1981. His leadership among faculty and teaching excellence earned him the prestigious Wang Award in 2001, given to a distinguished professor within the California State University system (23 Universities), in this instance for exceptional commitment, dedication, and exemplary contributions within the areas of education and applied sciences. Dr. Fine is also a licensed psychologist who opened his practice in Southern California in 1987. His practice specializes in treating children with ADHD, learning disabilities, developmental disorders and parent child relations.
Foundations and Guidelines for Animal-Assisted Interventions
In the 15 years since the first edition of the Handbook published, the field has changed considerably. The fourth edition of the Handbook highlights advances in the field, with 11 new chapters and over 40% new material. In reading this book, therapists will discover the benefits of incorporating animal-assisted therapy (AAT) into their practices, best practices in animal-assisted intervention, how to design and implement animal-assisted interventions, and the efficacy of AAT with different disorders and patient populations. Coverage includes the use of AAT with children, the elderly, those receiving palliative care, as well as people with chronic disorders, AIDS, trauma, and autistic spectrum disorders. Additional chapters cover techniques for working with families, in juvenile and criminal justice systems, and in colleges and universities.
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Researchers and clinicians in psychology work across a vast array of sub-disciplines, including applied psychology, addictions, cognitive psychology, developmental and educational psychology, experimental physiological psychology, forensic psychology, neuropsychology, and behavioral and cognitive therapy. For these professionals, and students as well, cross-disciplinary study is a given. For more than 75 years, Elsevier has cultivated portfolios of psychology books, eBooks, and journals covering current and critical issues in all of these areas. This vital content provides a sound basis of understanding for all those involved in this multi-faceted field.