To complete the literature review, the authors conducted an electronic search using CINAHL, ProQuest, PsycINFO, MEDLINE, EBSCO, BIOSIS, PLoS, and ScienceDirect using the keyword combinations pet therapy and psychiatric patients, and animal-assisted therapy and psychiatric patients.
Animal-Assisted Therapy and Increased Socialization
A plethora of literature supports that, in general, patients involved in AAT have a notable improvement in their ability to communicate, interact with others, and socialize (Barak, Savorai, Mavashev, & Beni, 2001; Bernstein, Friedman, & Malaspina, 2000; Corson, Corson, Gwynne, & Arnold, 1977; Kovács, Bulucz, Kis, & Simon, 2006; Kovács, Kis, Rózsa, & Rózsa, 2004; Levinson, 1969, 1970; Martin & Farnum, 2002; Prothmann, Bienert, & Ettrich, 2006; Richeson, 2003; Walsh, Mertin, Verlander, & Pollard, 1995). These improvements were documented in children, adolescent, adult, and geriatric psychiatric patient populations.
Levinson (1969), a pioneer in the field of pet therapy, identified the benefits of animal-human interaction in psychotherapy and described the benefits that his pet dog, Jingles, brought to his counseling sessions with children. Levinson provided numerous examples of ways in which animals enhanced therapy and noted that animals serve as a communication link during therapy sessions. Levinson made significant progress with a disturbed child when Jingles attended therapy sessions. Children who were withdrawn and uncommunicative would interact positively with the dog. The animal served as a transitional object to aid in facilitating a relationship between the patient and the human therapist.
Benefits to the physical, psychological, and social status of patients were reported (Levinson, 1969). Examples of animals’ physical benefits would be patients experiencing a decrease in blood pressure, heart rate, and anxiety level just through interaction with a dog (Barker & Dawson, 1998). Animals can affect the psychological level by serving as a link between the patient and therapist, in a way to build rapport. When a child is experiencing tension in revealing his or her feelings, it may be easier for the child to talk to a dog than to a therapist. A withdrawn child may interact quicker with a dog than a human being. Dogs can also be a catalyst for emotion. Therapeutic interaction with a dog can lighten the mood and promote smiling and laughter. Finally, examples of social status benefits would be that dogs are “social lubricants.” Patients who are normally withdrawn are known to increase communication and interaction with unfamiliar people when a dog is present. Levinson (1970) encouraged mental health centers to employ what he called “seeing heart” dogs—dogs trained as psychotherapeutic aids.
Seminal work by Corson et al. (1977) identified pet dogs as nonverbal communication links for adult and adolescent patients on psychiatric units. The pet-facilitated psychotherapy resulted in “extensive positive social interactions, not only on the part of the patient being treated, but also on the part of other patients” (Corson et al., 1977, p. 61). In addition, results included improved staff-patient interaction, as identified on videotape recordings, and development of a humanizing atmosphere in the psychiatric milieu. Pets were identified as having positive influences on the patients, and the staff responded warmly to the pet and the idea of pet therapy. Corson et al. (1977) reported that “a widening circle of warmth and approval was observed, over and above the interaction between the specific patient, the pet, and the therapists” (p. 65).
More recent studies have also highlighted the effects of AAT with children. Results of a study by Martin and Farnum (2002) indicated that children with pervasive developmental disorders exhibited a more playful mood, were more focused, and were more aware of their social environments when in the presence of a therapy dog. German researchers Prothmann et al. (2006) documented that incorporating a dog in psychiatric treatment could catalyze psychotherapeutic work in this age group.
Kovács et al. (2006) reported that AAT can improve certain aspects of nonverbal communication in severely disabled adult patients with chronic schizophrenia. Three of 5 patients in the study improved related to “an expansion in the space used by the patients in their communication” (Kovács et al., 2006, p. 361). Partial improvement was noted in other domains of non-verbal communication (as measured by the Budapest Gesture Rating Scale), specifically, the anatomy of movements, dynamics of gestures, and regulatory gestures. These findings, as well as those of Kovács et al. (2004), which showed an increase in the level of independent living skills after 9 months of AAT, strongly suggest that animals can be incorporated into the treatment of those affected with serious mental illness.
Older adult patients with schizophrenia have also been reported to benefit from AAT during hospitalization. Barak et al. (2001) reported that “animal-assisted therapy proved to be a successful tool for enhancing socialization, activities of daily living, and general well being” (p. 439). These are important improvements in the lives of individuals with chronic illness. Patients with dementia on a psychiatric ward were observed to experience significant changes in their heart rate during a pets-as-therapy program (Walsh et al., 1995). Interactions among patients and between patients and staff on the unit increased, and the overall noise level decreased. Bernstein et al. (2000) and Richeson (2003) studied the effects of AAT on social interactions of older adults (some with Alzheimer’s disease). Results showed significant increase in patients’ social interactions when participating in AAT.
Psychological Benefits of Animal-Assisted Therapy
The effect of AAT on a variety of mood and depressive symptoms was clear from this literature search. Many psychological benefits have been consistently linked to AAT (Barker & Dawson, 1998; Barker, Pandurangi, & Best, 2003; Hanselman, 2001; Sockalingam et al., 2008; Souter & Miller, 2007). Psychiatric patients exposed to pet-assisted therapy were better able to control anger, experienced decreased depressive symptoms and feelings of distress, and exhibited reduced anxiety (Barker et al., 2003).
Hanselman (2001) presented a cognitive-behavioral approach in group work with adolescents. Pet therapy was used as an adjunct for treatment of anger management. Results obtained through observations and Mood Thermometer analysis indicated that pet therapy reduced apprehension and was an important adjunct to anger management when working with children and adolescents.
In a meta-analysis of five research studies, Souter and Miller (2007) concluded that AAT had positive effects on depressive symptoms in human beings. Sockalingam et al. (2008) presented a case study demonstrating the effectiveness of AAT in the psychiatric rehabilitation of a male assault victim with a concurrent mood disorder. The authors encouraged mental health nurses to be aware of the importance of AAT in patient care and rehabilitation.
Often, a reduction in patients’ anxiety has been noted by researchers as a result of AAT. Barker et al. (2003) reported that AAT decreased fear and anxiety prior to electroconvulsive therapy sessions with adult patients. Barker and Dawson (1998) noted a decrease in anxiety scores when adult patients with psychotic and mood disorders were involved in AAT sessions.
There is a dearth of literature related to the influence of pet therapy on health care staff. Rossetti, DeFabiis, and Belpedio’s (2008) qualitative study reported on the impact of AAT on staff in one behavioral health hospital. An increase in self-awareness and staff morale were significant findings. The authors concluded that the use of AAT can have a significant effect on the entire therapeutic process: “Increased staff morale and increased self-awareness in the therapeutic milieu were significant effects of this therapy, and the effectiveness of the therapy dogs’ nonverbal communication and the impact of the human-animal bond were emphasized” (Rossetti et al., 2008, p. 33). The authors also investigated whether AAT affected staff retention. Responses were mixed, with some staff reporting the AAT program was significant in their retention and others viewing AAT as a “bonus,” rather than as a direct contributor to retention.