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I love dogs and have always loved them. As a child, I wasn’t allowed to have one, so when I became an adult, the first thing I did was get a dog of my own. Over the years, I have felt the truest, purest love, unconditionally given by my dogs. One of my greatest teachers was Woollie, a stray Cairn mix, who I rescued and later adopted. She was with me through a very difficult time in my life. When I lost her, I realised that probably no one on earth had ever loved me as deeply as Woollie. Currently, I have two Cairn terriers, Jock and Skye, both of whom have worked as therapy pets at various venues in Bermuda and the UK.

Animals have provided a specifically therapeutic purpose since the time of the Ancient Greeks, who documented the ameliorative process of horse assisted therapy.¹ The Greeks considered horseback riding not only as a means of transport, but also as a means of improving health and wellbeing. Hippocrates spoke of the benefits of horses for rehabilitation purposes, describing ‘hippotherapy’ as ‘…treatment with the help of a horse’.²

The use of animals in therapy has expanded quite dramatically in the last century, as we have learned more about the ways in which animal contact can provide treatment for many illnesses, especially those related to mental health.³ Therapy pets are frequently seen in a variety of locations such as care homes, a wide range of educational organisations, mental health institutions and within correctional facilities.

Why does petting a dog enhance mood and increase a sense of wellbeing? Dogs are one of the few species that does not generally exhibit xenophobia – fear of strangers. According to Hare and Woods,⁴ most dogs are actually xenophilic: they love strangers.

In April 2018, Emma Jane Mather, then wellbeing co-ordinator for the University of Derby Online (UDOL), organised a variety of lunchtime activities for staff, including meditation, walking a midday mile and an informal pet therapy session. During one lunch hour, Jock and Skye, suited and booted, visited the University’s Enterprise Centre and played with various staff members. Emma Jane and I conducted a follow-up survey and found that a 55% mood elevation was reported among the attendees, after their interaction with the dogs. The experience was also described as healing, calming, soul-soothing and blissful.

Increasingly, the healing potential of animals as a form of therapy is becoming apparent. In 2018, therapy dogs were flown in to comfort the survivors and families when 58 people were killed at a shooting at an outdoor music festival in Florida. Last year, 19 comfort dogs attended a vigil for the victims of the school shooting in Florida. Dogs are social creatures who respond to us quite sensitively, and they seem to respond to our emotions.⁵ Pet programmes are becoming fixtures in many human service organisations across the UK, including the NHS.

As the use of animals in therapy grows, it is helpful to differentiate between less formal activities and professionally directed therapies. Animal assisted therapy (AAT) is an umbrella term, referring to a structured and targeted therapeutic programme that involves the use of specially trained animals. The animals must meet stringent criteria, specified by Animal Assisted Intervention International.⁶ In addition, the programme is implemented by healthcare specialists, who have also undergone specialised training.⁷

Animals play an integral role in a process that is aimed at improving cognitive, social, emotional and physical functions, which can take place in a range of facilities, such as schools, hospitals, prisons and farms. AAT does not align with any specific theoretical modality and has been successfully used with a variety of different therapeutic approaches.⁸

Animal assisted psychotherapy (AAP) and animal assisted play therapy (AAPT) are interventions that include interactions between a targeted population, in combination with a recognised form of therapy. The interaction with the animal is incorporated into the patient’s treatment plan. Canine assisted therapy (CAT), for example, is an AAP intervention supported by the intentional and meaningful inclusion of dogs, and has proven beneficial for autistic children and adults with Alzheimer’s disease.⁹

Animal assisted activities (AAA) are less formal than AATs and provide the opportunity for service users to interact with specially trained animals who are handled either by professionals or volunteers, in the absence of specialised treatment programmes. The AAA category covers my work with Jock and Skye. Although they are trained and certified therapy dogs, they are not included in formal treatment programmes. Our visits to hospices and various residential facilities take place on a voluntary basis, with no set therapeutic agenda other than to offer their calming and nurturing presence.

Finally, the term animal assisted interventions (AAI) refers to the integration of animal assisted therapy in educational programmes, used for the purpose of training health professionals to become facilitators.¹⁰

Which animals?

Dogs, cats and dolphins are most commonly used in treatment.¹¹ Dolphin assisted therapy (DAT) has gained in popularity in recent years. DAT involves a patient swimming with dolphins while engaging in tasks, such as verbal response targets and hand-eye co-ordination.¹² Farm animals, such as horses, llamas and rabbits, can be used, as well as certain fish, birds, ferrets and even boa constrictors.

The screening criteria for therapy animals varies, but basically require that the animal is of a certain age, has attained a required level of training (with certification), can comply with defined obedience commands and has appropriate vaccination status. For example, therapy puppies might be taken to hospital grounds several times to familiarise them with ambulance sounds, wheelchairs and the general hustle and bustle. Another important component of the training is the ‘leave’ command, so that the therapy dog does not eat stray pills on the ground or the unfinished meal on a patient’s bedside table.

There are three basic stages of AAT. During the first stage, the therapist forms an assessment of the client’s needs, without the presence of the therapy animal. The assessment is followed by a session when the client meets the animal and their interaction begins. The second stage involves the development of a bond between animal and client, including activities such as feeding and grooming the animal. The therapist monitors the interaction and, in the final stage, the client becomes more independent and makes choices for their AAT partner.

How do animals help?

My first experience of the therapeutic power of animals occurred when I took Winston, a small Yorkie cross, with me to work one day at a drug and alcohol treatment facility. One particular service user was reluctant to be in treatment and had shown resistance and non-compliance since the first day. However, when they saw and began to interact with Winston, their defences started to break down and their level of engagement in the treatment programme increased dramatically.

Many of us are aware that interaction with animals can provide emotional support and stress relief, but what can we learn from research? In a recent, small-scale, factorial, mixed-measures study conducted by one of our undergraduate students at the University of Derby, a significant interaction effect was found between dog presence and perceived stress prior to taking a quiz, as compared with a control group with no dogs present.¹³ The therapeutic environment becomes less threatening and friendlier when an animal is involved.⁷

Individuals with mental health disorders are often dependent on others for care. In the presence of therapy animals, service users have the opportunity to become caregivers. By caring for the animal, increased levels of self-care and improved self-image begin to emerge.¹⁴ Mental illness can result in a lack of social skills and in social isolation.¹⁵ Animals in treatment contribute to the cultivation of social skills and the development of a relatively normal lifestyle, in addition to providing opportunities for physical activity and training. Animals have the ability to increase self-soothing and feelings of attachment, which is supported by the oxytocin hypothesis.Ìý

The hypothesis suggests that, in the presence of an animal, humans produce the anxiolytic hormone oxytocin, leading to bonding and increased prosocial behaviour.¹⁶

Who do animals help?

People of all ages, from young children and adolescents to seniors and the elderly, can benefit from animal assisted interventions, especially those individuals with mental health disorders. Children bond naturally with animals, and individuals in palliative or hospice care are gently comforted by them. There are many disorders that can be partnered with animal therapy, a few of which are described briefly below.

How does pet therapy work in counselling?

Counselling involves the facilitation of healing, primarily through alliance, or relationship. Individuals suffering from mental health conditions are often mistrustful of human contact, whereas they might associate pets with companionship and nurture. During lapses in human relationships, pets can provide the emotional support that is often vital for survival. Animals can significantly enhance the counselling process by increasing the client’s sense of safety and providing opportunities for insight, growth and healing.

Addiction

AAT has shown positive results in the treatment of various pathologies, including substance abuse disorder and related mental health disorders. In a recent study,17 dual diagnosed patients who participated in AAT showed an improvement in daily skills and decreased impulsiveness, enabling the participants to regain self-control. Incorporating AAT into adolescent substance treatment has been shown to improve treatment access, engagement, retention, and outcomes.¹⁸ Since there are gaps in treatment services for adolescents with substance use problems,^19,20 AAT could provide a helpful way forward. Many recovering addicts and alcoholics attribute their success to maintaining a relationship with an animal. Success is associated with an improved therapeutic alliance when pets are involved, and a reduction in patient anxiety about the treatment process in general, leading to increased adherence to the recommended treatment plan and increased retention for the duration of treatment.

Autism

Although autism spectrum disorder is a highly individualised disorder, difficulty in socialising is an underlying core condition, alongside difficulty in forming and maintaining close relationships.²¹ The presence of animals has been linked to increased social interaction.²² Animals can also act as social facilitators to connect individuals with autism to the people around them. Serum markers, such as oxytocin, cortisol and dopamine, associated with social bonding, are improved by positive interactions with therapy animals.²³ The effects are particularly marked in children, as animals can elicit social interactions more successfully than counselling props such as toys.²⁴ Animals provide a focal point of concentration for children when they are trying to cope with multiple stimuli, helping them to become calm and more relaxed.²⁵

Dementia

Dementia is a progressive disorder, often associated with decreasing movement and activity. The presence of a therapy animal can provide a communication bridge between reality and the service user. AAT is associated with the reduction of the negative symptoms, such as confusion, aggression and irritability.²⁶ For individuals suffering with dementia, a treatment animal provides security and friendship, increasing levels of nutritional and self-care skills.

Depression

The idea that the presence of animals leads to increased levels of wellness is well documented. Research studies indicate that interaction with animals can lead to neurological changes and the release of neurotransmitters that suppress anxiety and improve mood.²⁷ These changes lead to a decrease in depression and increased verbal interaction, and are particularly effective in institutionalised seniors.²⁸ Other related health benefits include the lowering of blood pressure, increased activity and mobility, as well as a reduction in feelings of isolation and loneliness.

Concerns and limitations

Of course, not everyone likes or is comfortable around animals; people with allergies must avoid exposure as much as possible. Proponents of AAT also do not ignore the potential impact of their work on the animals, although research studies tend to focus on human health outcomes. Incidents of animal cruelty and abuse have been reported, including injuries from rough handling or from other animals, lack of veterinary care, exercise and enjoyment. However, in a recent multisite study across five different hospitals in the US, Amy McCullough, national director of research and therapy at American Humane, analysed levels of cortisol in the saliva of therapy animals and found no difference in the cortisol levels at home and during therapy times. She concluded that therapy dogs in paediatric cancer wards are not stressed by their work, and in fact seem to enjoy it in most cases.²⁹

Walker and Tumilty³⁰ suggest that a code of ethics for AAT should include the following:

• the animal’s welfare must be prioritised
• the therapy animal must never be forced if he or she is reluctant to engage
• animals must be provided with quiet time before sessions and be protected from disease.

Animals can provide great comfort by making people feel calm and loved, which is important for all of us, but especially for those who are unwell, either physically, mentally or both. In a clinical context, animals are an untapped potential, but as more research supports the efficacy of this mode of treatment, the value of animals will hopefully become more widely recognised.