Journal of Psychosocial Nursing and Mental Health Services

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CNE Article 

Use of Animal-Assisted Therapy with Psychiatric Patients: A Literature Review

Jeanette Rossetti, EdD, RN; Camille King, MS, RN, PMHCNS-BC

Abstract

The use of animal-assisted therapy (AAT) as an adjunct treatment approach in psychiatric settings has received much attention in the literature. This article explores the use of AAT with psychiatric patients. The authors performed a literature review and found that AAT can have a significant effect on the improvement of psychiatric patients’ socialization and provides a variety of psychological benefits. Nurses can benefit from learning about the potential benefits of AAT for psychiatric patients.

Abstract

The use of animal-assisted therapy (AAT) as an adjunct treatment approach in psychiatric settings has received much attention in the literature. This article explores the use of AAT with psychiatric patients. The authors performed a literature review and found that AAT can have a significant effect on the improvement of psychiatric patients’ socialization and provides a variety of psychological benefits. Nurses can benefit from learning about the potential benefits of AAT for psychiatric patients.

Dr. Rossetti is Associate Professor, Northern Illinois University School of Nursing and Health Studies, DeKalb, and Ms. King is Coordinator of Education and Research, Linden Oaks at Edward, Naperville, Illinois.

The authors disclose that they have no significant financial interests in any product or class of products discussed directly or indirectly in this activity, including research support.

Address correspondence to Jeanette Rossetti, EdD, RN, Associate Professor, Northern Illinois University School of Nursing and Health Studies, 1240 Normal Road, DeKalb, IL 60115; e-mail: rossetti@niu.edu.

Received: April 20, 2010
Accepted: June 15, 2010
Posted Online: September 22, 2010

Practitioners in psychiatric settings often encounter patients with a multitude of psychiatric and or medical issues. A multidisciplinary approach with a variety of treatment strategies is beneficial to a therapeutic milieu. Animal-assisted therapy (AAT) is an adjunct treatment approach that has great potential for care and healing and is becoming an increasingly common therapeutic intervention. This article will explore the use of AAT with psychiatric patients.

Background

Terms and Definition

A wide range of terminologies and definitions are used to describe AAT. The terms pet and animal are used interchangeably in the literature to describe programs involving animals in psychiatric therapy. It is important to note the use of the term therapy in pet-assisted or animal-assisted therapy. This literature review is confined to therapy method and does not include pet or animal visitation.

The American Veterinary Medical Association (2007) defines AAT as:

a goal directed intervention in which an animal meeting specific criteria is an integral part of the treatment process. Animal assisted therapy is delivered and/or directed by health or human service providers working within the scope of their profession. Animal assisted therapy is designed to promote improvement in human physical, social, emotional, or cognitive function. Animal assisted therapy is provided in a variety of settings, and may be group or individual in nature. The process is documented and evaluated.

Requirements and Training

It is important to address who is qualified to conduct AAT in the hospital setting. All handlers and therapy dogs must meet rigorous requirements through organizations such as Therapy Dogs Inc., Delta Society®, and Therapy Dogs International. For the dogs, this includes an initial temperament test, obedience class training to learn basic commands, and AAT training in which the dog learns to behave appropriately in the facility. This training may include learning to be sensitive to loud noises (e.g., machine alarms), ride on elevators, and be comfortable around patients who use wheelchairs or walkers. In addition, a good veterinary health record, current vaccinations, and biannual fecal specimens are needed to assure the dog’s health. For example, Therapy Dogs Inc. issues a card to the handler to designate the dog as a therapy dog; this card needs to be renewed annually.

Settings

A variety of health care settings use AAT, including medical-surgical areas and psychiatric, long-term care, and residential facilities. Prison systems have used AAT for rehabilitation, and school systems use AAT to assist with children with behavioral disorders (e.g., attention-deficit/hyperactivity disorder, autism spectrum disorders) and to promote self-esteem, responsibility, and socialization in healthy children.

In the hospital setting, RNs, clinical therapists, behavioral health associates, psychologists, and social workers have been known to participate in AAT. Dogs, horses, and even dolphins have been identified for use in AAT. The animals can be in residence or brought in from the outside by the handlers. On an inpatient unit, most dogs come from the dog handler’s home, spend AAT session time with the patients, and leave for the day. Some programs will have a resident dog that lives in the home with the residents. When horses are used, the patients will often go to a horse farm to work with the animals and have their AAT sessions off site from the hospital.

The decision to use AAT is usually made by hospital managers and program staff. Policies and procedures are developed to ensure the AAT program would benefit the patients and cause no harm; therefore, individual orders and assessments are often made for patients to participate in AAT. Patients who are allergic to or fearful of dogs often do not participate in AAT. Group and/or individual AAT session times can be built into the programming schedule.

Literature Review

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.

Contraindications

It is important to note there may be some contraindications to AAT. Notably, patients may be uninterested in dogs, fearful of them, or allergic to the animal. In addition, they may have medical conditions, such as asthma, that could be aggravated by the presence of an animal (Morrison, 2007). In Rossetti et al.’s (2008) study, staff viewed AAT as a challenge due to the extensive amount of time involved in preparing the dogs for the program and the time-intensive commitment needed when working with the dogs. In addition, some staff had phobias of dogs, which resulted in personal difficulty when animals were present on the unit (Rossetti et al., 2008).

Conclusion

This review of the literature revealed many studies reporting benefits of AAT in the treatment of patients in a variety of psychiatric settings. The literature also revealed preliminary evidence for benefits of AAT to psychiatric nursing staff. It is imperative that psychiatric nurses recognize AAT’s potential for positive effects on psychiatric patients’ socialization and other outcomes.

References

  • American Veterinary Medical Association. (2007). Guidelines for animal assisted activity, animal-assisted therapy, and resident animal programs. Retrieved from http://www.avma.org/issues/policy/animal_assisted_guidelines.asp
  • Barak, Y., Savorai, O., Mavashev, S. & Beni, A. (2001). Animal-assisted therapy for elderly schizophrenic patients: A one-year controlled trial. American Journal of Geriatric Psychiatry, 9, 439–442.
  • Barker, S.B. & Dawson, K.S. (1998). The effects of animal-assisted therapy on anxiety ratings of hospitalized psychiatric patients. Psychiatric Services, 49, 797–801.
  • Barker, S.B., Pandurangi, A.K. & Best, A.M. (2003). Effects of animal-assisted therapy on patients’ anxiety, fear, and depression before ECT. The Journal of ECT, 19, 38–44. doi:10.1097/00124509-200303000-00008 [CrossRef]
  • Bernstein, P.L., Friedman, E. & Malaspina, A. (2000). Animal-assisted therapy enhances resident social interaction and initiation in long-term care facilities. Anthrozoös, 13, 213–224.
  • Corson, S.A., Corson, E.’L., Gwynne, P.H. & Arnold, E. (1977). Pet dogs as non-verbal communication links in hospital psychiatry. Comprehensive Psychiatry, 18, 61–72. doi:10.1016/S0010-440X(77)80008-4 [CrossRef]
  • Hanselman, J.L. (2001). Coping skills interventions with adolescents in anger management using animals in therapy. Journal of Child and Adolescent Group Therapy, 11(4), 159–195. doi:10.1023/A:1014802324267 [CrossRef]
  • Kovács, Z., Bulucz, J., Kis, R. & Simon, L. (2006). An exploratory study of the effect of animal-assisted therapy on nonverbal communication in three schizophrenic patients. Anthrozoös, 19, 353–364.
  • Kovács, Z., Kis, R., Rózsa, S. & Rózsa, L. (2004). Animal-assisted therapy for middle-aged schizophrenic patients living in a social institution. A pilot study. Clinical Rehabilitation, 18, 483–486. doi:10.1191/0269215504cr765oa [CrossRef]
  • Levinson, B.M. (1969). Pet-oriented child psychotherapy. Springfield, IL: Charles C. Thomas.
  • Levinson, B.M. (1970). Pets, child development, and mental illness. Journal of the American Veterinary Medical Association, 157, 1759–1766.
  • Martin, F. & Farnum, J. (2002). Animal-assisted therapy for children with pervasive developmental disorders. Western Journal of Nursing Research, 24, 657–670. doi:10.1177/019394502320555403 [CrossRef]
  • Morrison, M.L. (2007). Health benefits of animal-assisted interventions. Complementary Health Practice Review, 12, 51–62. doi:10.1177/1533210107302397 [CrossRef]
  • Prothmann, A., Bienert, M. & Ettrich, C. (2006). Dogs in child psychotherapy: Effects on state of mind. Anthrozoös, 19, 265–277.
  • Richeson, N.E. (2003). Effects of animal-assisted therapy on agitated behaviors and social interactions of older adults with dementia. American Journal of Alzheimer’s Disease and Other Dementias, 18, 353–358. doi:10.1177/153331750301800610 [CrossRef]
  • Rossetti, J., DeFabiis, S. & Belpedio, C. (2008). Behavioral health staff’s perceptions of pet-assisted therapy: An exploratory study. Journal of Psychosocial Nursing and Mental Health Services, 46(9), 28–33. doi:10.3928/02793695-20080901-13 [CrossRef]
  • Sockalingam, S., Li, M., Krishnadev, U., Hanson, K., Balaban, K. & Pacione, L.R. et al. (2008). Use of animal-assisted therapy in the rehabilitation of an assault victim with a concurrent mood disorder. Issues in Mental Health Nursing, 29, 73–84. doi:10.1080/01612840701748847 [CrossRef]
  • Souter, M.A. & Miller, M.D. (2007). Do animal-assisted activities effectively treat depression? A meta-analysis. Anthrozoös, 20, 167–180.
  • Walsh, P.G., Mertin, P.G., Verlander, D.F. & Pollard, C.F. (1995). The effects of a ‘pets as therapy’ dog on persons with dementia in a psychiatric ward. Australian Occupational Therapy Journal, 42, 161–166. doi:10.1111/j.1440-1630.1995.tb01331.x [CrossRef]

CENSHARE: Center to Study Human Animal Relationships and Environments

http://www.censhare.umn.edu

Center for the Human-Animal Bond

http://www.vet.purdue.edu/chab

Delta Society

http://www.deltasociety.org

Latham Foundation for the Promotion of Humane Education

http://www.latham.org

  1. The use of animal-assisted therapy (AAT) as an adjunct treatment approach in psychiatric settings has received much attention in the literature.

  2. The literature indicates that AAT can have a significant effect on the improvement of psychiatric patients’ socialization, as well as a variety of psychological benefits.

  3. Nurses can benefit from learning about the potential benefits of AAT for psychiatric patients.

Key Points

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Authors

Dr. Rossetti is Associate Professor, Northern Illinois University School of Nursing and Health Studies, DeKalb, and Ms. King is Coordinator of Education and Research, Linden Oaks at Edward, Naperville, Illinois.

The authors disclose that they have no significant financial interests in any product or class of products discussed directly or indirectly in this activity, including research support.

Address correspondence to Jeanette Rossetti, EdD, RN, Associate Professor, Northern Illinois University School of Nursing and Health Studies, 1240 Normal Road, DeKalb, IL 60115; e-mail: .rossetti@niu.edu

10.3928/02793695-20100831-05

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