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Creature comfort

04 October 2019

Our pets make us smile and laugh – but they might also help improve the health of the nation. Should CPs be making greater use of animal-assisted therapy?

Students at the University of Surrey are benefiting from a special kind of stress-busting technique during exam season – being able to stroke or cuddle a dog. It may sound quirky but it’s a form of therapy that’s gaining traction.

Dogs being used as ‘canine teaching assistants’ have been introduced at Middlesex University to improve student and staff wellbeing, while ‘pet therapy’ sessions with collies and golden retrievers are also offered at Edinburgh Napier University. Such programmes reinforce the link between an animal’s presence and their positive effect on human health – an association that was established decades ago (Amiot et al, 2016) and continues to be supported by an increasing amount of empirical evidence.

It’s raised the question of whether animal-assisted therapy – where animals such as dogs, horses, cats and rabbits are used as a form of treatment – has a wider role to play in patient care and could be made more use of by community practitioners (CPs).
 

What do we know?

Pets can be of benefit to those with mental health conditions, (Brooks et al, 2018) not only because of the bond they feel with their animal but also because they provide emotional support during times of crisis. Dog ownership is also associated with a lower risk of cardiovascular disease (Mubanga et al, 2017).  

But the positive effects of animals are not limited to those looking after a pet full-time.

Residents of a nursing home had lower blood pressure and heart rate after receiving visits from a therapy dog (Handlin et al, 2018). Another study carried out among students highlighted that petting a dog even during a single session has an immediate boost on happiness levels while also cutting stress levels (Ward-Griffin et al, 2018). The effects were felt for as long as 10 hours after the session.

Other research explains the physiological response and thus the benefits humans feel. An owner merely gazing back at their dog triggers an increase in oxytocin, a hormone which can relieve stress (Nagasawa et al, 2015). Contact such as gentle stroking or scratching a dog can also raise dopamine and endorphin levels in both humans and dogs (Amiot et al, 2016). Meanwhile, a randomised trial involving 246 students by Washington State University (WSU) in July found that those who had interacted with dogs and cats for just 10 minutes had a significant reduction in cortisol, a major stress hormone (Pendry et al, 2019).

‘The reduction of stress hormones may, over time, have significant benefits for physical and mental health,’ says author Patricia Pendry, an associate professor in WSU’s department of human development.  

‘Canine therapy improves wellbeing in care homes, can help with rehabilitation in prisons and can support people with autism’

More than a best friend?

What does this all mean? Dr Liz Spruin, senior lecturer in psychology at Canterbury Christ Church University (CCSU) says her research has found that dogs can offer an alternative and effective way to cope with stress.

Her own study, due to be published soon, suggests that interaction with a canine can be just as beneficial as a mindfulness programme.

‘In fact, research shows that canine therapy provides a range of support for humans,’ she says. ‘It offers comfort and improves wellbeing at care homes, can help with rehabilitation in prisons, enhances wellbeing and confidence in schools and universities, helps those with ADHD manage their symptoms better, and can support people with autism.’

Canine Concern Scotland Trust has run its Therapet service since 1988, which organises volunteer pet owners of dogs – and some cats – to provide regular visits to care homes, hospices, universities, prisons, and schools. It has service-level agreements in place with health boards across Scotland, including Greater Glasgow and Clyde and Grampian, to visit stroke, dementia and orthopaedic rehab units, general medicine wards and even oncology departments in hospitals. All kind of breeds of dogs are used, from Chihuahuas to Newfoundlands, but they are all assessed to ensure they have the right temperament and are suitable for this kind of work.

Mel Hughes, support and development officer at the charity, explains that its ‘therapets’ work in schools, helping encourage children who are reluctant readers or have learning difficulties as part of a Reading with Dogs programme. And Therapet also has involvement with CAMHS.

‘There’s the potential to work more with counsellors supporting individuals suffering mental health issues, trauma, abuse or bereavement. Animal therapy can really help,’ she adds.

‘One person I visited with my dog was struggling with depression and had been off work as a result. She would walk the dog and look after him. After six months she was back at work. I do think that can be partly attributed to her involvement with animals. The benefits of animal-assisted therapy are becoming more well known, so currently we are struggling to meet demand.’

In fact, canine therapy is also used for ex-servicemen to help with PTSD, with various studies seeking to show this empirically (LaFollette et al, 2019; Altschuler, 2017) and a number of charities providing dogs to veterans (for example, Bravehound and Veterans with Dogs).


Protecting human and animal welfare

The use of animals has some obvious difficulties, particularly in a healthcare setting: not everyone likes animals; others have phobias, fears or allergies.

Mel Hughes of Canine Concern Scotland Trust explains that infection control is also a key concern. A professional guide, Working with dogs in health care settings, has helped address some of the issues (RCN, 2018). It sets out a protocol for animal-assisted work, covering infection prevention control and health and safety. ‘We are thorough in what our expectations are from volunteer dogs,’ says Mel.

Animal welfare is also important, and therapist Sarah Urwin warns that animals should not be overworked or mishandled.

‘We need to have the welfare of our animals uppermost in our minds as traumatising them through this work is not ethical practice,’ she says. ‘This means practitioners need to have a good understanding of animal behaviour.’


Horses for courses

Working with horses – equine-assisted therapy – is another intervention becoming more popular to help with a range of mental health and related problems, says Sarah Urwin, a BACP-accredited counsellor and therapist. The therapy can incorporate horse riding but more often simply involves ground-based activities such as feeding, grooming and learning how to ‘be with’ horses.  

Research has found, for example, that it can benefit children living with parents who are misusing alcohol and drugs, with programmes offering a safe environment for youngsters to improve their interpersonal behaviours (Dunlop and Tsantefski, 2017). It can also be an effective form of therapy for children with autism (Trzmiel et al, 2019), helping to improve social functioning.

Sarah uses equine- and animal-assisted therapy for clients who have suffered trauma, who have emotional and behavioural difficulties, autistic spectrum disorders and learning disabilities. She helps with depression, anxiety, low self-confidence, eating disorders, self-harming behaviours and other mental health issues.

Living in the moment

Working with animals can be very therapeutic, especially for vulnerable people, she says, because animals are non-critical and non-judgmental. ‘In counselling terms, this is akin to unconditional positive regard, one of the central tenets of person-centred counselling. Animals offer this quite naturally, as well as authenticity and the ability to live in the present moment.’

Sarah adds that animals also encourage ‘a more external focus, helping clients to empathise with others and widen their perspective. Being involved with activities such as feeding or grooming helps clients learn new skills, in turn improving self-confidence and self-esteem.’  

As for people who have experienced trauma, Sarah says that ‘healing may be about learning how to relate to others. Working with an animal can help us learn to communicate better, both verbally and non-verbally, and form relationships, skills which can then be used with people.’

‘Being involved with activities such as feeding or grooming helps clients improve self-confidence and self-esteem’

Animal practice

A range of animals can be used for therapy, explains Sarah. ‘Different people respond to different animals. I have worked with guinea pigs, rabbits, chickens, pigs and cats, although some cats don’t enjoy this work. With farm animals there may be welfare and other statutory responsibilities to consider. Also, animals such as pigs can grow big and heavy. Smaller animals can work better for some clients.’

However, she admits that dogs and horses are the animals she works most with now because she believes they are better suited to – and often very good at – this type of work. ‘Dogs and horses are usually well socialised and there’s a big selection of “personalities” to choose from.’

All of the experts here agree there is potential for animal-assisted therapy to take on a bigger role in healthcare and become a service that CPs either signpost to or make use of directly.

‘Health visitors, community nursery nurses and school nurses could make more use of the service for their clients where they think it can help, through signposting,’ says Mel. ‘They would need to look into what’s available locally and increase their awareness of its benefits.’

She also suggests a practical application. ‘Alternatively, if they were holding certain clinics and thought interaction with an animal could benefit clients to reduce anxiety levels, a dog could be present for a limited time in a separate room so individuals could choose to have a session with them if they liked. It means those who are not so keen on dogs don’t have to come into contact with them.’

Sarah trains therapists in animal- and equine-assisted therapy. ‘Counsellors, psychotherapists, physiotherapists and other clinicians are using animal-assisted interventions more often to help their clients. There is an increasing evidence base, and these interventions could benefit more people if they were on CPs’ radar.’

Liz Spruin at CCSU highlights that for animal-assisted therapy to take the next step, more empirical evidence is needed: ‘It’s a field that’s getting established.’ But she’s confident of one thing: ‘Animals have an important part in increasing the wellbeing of our society.’      


A different person

Sarah Urwin, a BACP-accredited counsellor, explains that one of her clients who had suffered a traumatic childhood chose to work with horses. This was the case even though the client had no knowledge of horses.

Sarah says: ‘She learned over time what works with horses and what doesn’t in terms of building a relationship with them. When we started sessions she would become angry, defensive, or give up. But a couple of years on, that doesn’t happen any more. She is a different person in terms of her self-esteem, confidence and ability to self-regulate.’


Resources

Find out more about animal-assisted therapy…  

  • NICE provides an evidence search of animal-assisted therapy at evidence.nhs.uk  
  • The Society for Companion Animal Studies raises the awareness of the importance of pets in society scas.org.uk  
  • The International Association of Human-Animal Interaction Organizations promotes research and practice development iahaio.org  

Charities and organisations offering animal-assisted therapy services include:


References

Altschuler EL. (2017) Animal-Assisted Therapy for Post-traumatic Stress Disorder: Lessons from “Case Reports” in Media Stories, Military Medicine. See: https://academic.oup.com/milmed/advance-article/doi/10.1093/milmed/usx073/4781646  (access 17 September 2019).

Amiot C, Bastian B, Martens P. (2016) People and Companion Animals: It Takes Two to Tango. See:  https://academic.oup.com/bioscience/article/66/7/552/2463231 (accessed 24 September 2019).

Brooks H L, Rushton K, Lovell K, Bee P, Walker L, Grant L, Rogers A. (2018) The power of support from companion animals for people living with mental health problems: a systematic review and narrative synthesis of the evidence. See: https://bmcpsychiatry.biomedcentral.com/articles/10.1186/s12888-018-1613-2 (accessed 24 September 2019).

Dunlop K, Tsantefski M. Child and Family Social Work. (2017) A space of safety: Children's experience of equineassisted group therapy. See: https://onlinelibrary.wiley.com/doi/abs/10.1111/cfs.12378 (accessed 24 September 2019).

Handlin L, Nilsson A, Lidfors L, Petersson M, Uvnäs-Moberg K. (2018) The Effects of a Therapy Dog on the Blood Pressure and Heart Rate of Older Residents in a Nursing Home. See: https://www.tandfonline.com/doi/abs/10.1080/08927936.2018.1505268 (accessed 24 September 2019). LaFollette MR, Rodriguez KE, Ogata N, O'Haire ME. (2019)

Military Veterans and Their PTSD Service Dogs: Associations Between Training Methods, PTSD Severity, Dog Behavior, and the Human-Animal Bond. See: https://www.frontiersin.org/articles/10.3389/fvets.2019.00023/full (accessed 24 September 2019). 

Mubanga M, Byberg L, Nowak C, Egenvall A, Magnusson P K, Ingelsson E, Fall T. (2017) Dog ownership and the risk of cardiovascular disease and death – a nationwide cohort study. See: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5693989/ (accessed 24 September 2019). Nagasawa M, Mitsui S, En S, Ohtani N, Ohta M, Sakuma Y, Onaka T, Mogi K, Kikusui T,

Science. (2015) Social evolution. Oxytocin-gaze positive loop and the coevolution of human-dog bonds. See: https://www.ncbi.nlm.nih.gov/pubmed/25883356 (accessed 24 September 2019).

Pendry P, Vandagriff J L, AERA Open. (2019) Animal Visitation Program (AVP) Reduces Cortisol Levels of University Students: A Randomized Controlled Trial. See: https://journals.sagepub.com/doi/10.1177/2332858419852592 (accessed 24 September 2019).

RCN. Working with Dogs in Health Care Settings. See: (2018) https://www.rcn.org.uk/professional-development/publications/pdf-006909 (accessed 23 September 2019).

Trzmiel T, Purandare B,Michalak M, Zasadzka E, Pawlaczyk M. (2019) Equine assisted activities and therapies in children with autism spectrum disorder: A systematic review and a meta-analysis. See: https://www.sciencedirect.com/science/article/pii/S0965229918308331?via%3Dihub (accessed 24 September 2019).

Ward-Griffin E, Klaiber P, Collins H K, Owens R L, Coren S, Chen F S. (2018) Stress and Health. Petting away pre-exam stress: The effect of therapy dog sessions on student well-being. See: https://onlinelibrary.wiley.com/doi/abs/10.1002/smi.2804 (accessed 24 September 2019).

 

 

Image credit | Getty images

 

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