Animal-Assisted Therapy in Psychiatric Rehabilitation

ABSTRACT

Reviews of animal-assisted therapy (AAT) research suggest the need for better controlled and designed research studies to supplement the many case studies and anecdotal reports. This study reports the results of such an investigation where sixty-nine male and female psychiatric inpatients were randomized to either an AAT psychiatric rehabilitation group or a similarly conducted control group without AAT, to test if AAT can improve prosocial behaviors. The Social Behavior Scale was scored daily by an independent rater and patients were monitored for four weeks. A two-group by weeks repeated measure analysis of variance was conducted for each outcome measure. There were no baseline differences between the two groups on demographics or any of the measures, but by week four, patients in the AAT group were significantly more interactive with other patients, scored higher on measures of smiles and pleasure, were more sociable and helpful with others, and were more active and responsive to surroundings. These data suggest that AAT plays an important role in enhancing the benefits of conventional therapy, and demonstrates the benefit of including a non-AAT group for comparison. The study also demonstrates the importance of using longitudinal, repeated measure designs. Previous studies may have failed to find significant effects because they were restricted to shorter intervals for measuring outcomes.     

Animal-Assisted Therapy in the Treatment of Substance Dependence

ABSTRACT

The purpose of this study was to evaluate the effect of animal-assisted therapy (AAT) on the therapeutic alliance with an adult, residential, substance abuse population in group therapy. We used randomized samples and controlled conditions to establish the effects of chosen variables that influence outcome. A total of 231 people took part in the study (control group [without therapy dog]: n = 96; experimental group [with therapy dog]: n = 135) in which there were 26 group sessions. The results of the study indicate that, overall, the therapeutic alliance is enhanced with the addition of a therapy dog: the AAT group had a more positive opinion of the therapeutic alliance, as measured using the Helping Alliance Questionnaire (HAQ-II), than the control group (ANOVA: F_(1,229) = 25.44, p < 0.001). Clients seeking treatment for a dual diagnosis, clients with state social service involvement, and clients seeking treatment for alcohol addiction had similar opinions of the therapeutic alliance, whether in the experimental group or the control group. Males, females, pet owners, court ordered clients, and clients seeking treatment for polysubstance, cannabis, and methamphetamine dependence all were more positive about the therapeutic alliance if they were in the experimental group than if they were in the control. This study demonstrates that addiction professionals could increase treatment success by adding this complementary, evidence-based practice.     

Animal-Assisted Therapy and Depression in Adult College Students

Abstract

This study investigated the effects of animal-assisted therapy (A-AT) on self-reported depression in a college population. Forty-four participants were selected on the basis of scores on the Beck Depression Inventory (BDI). They then were assigned to one of three groups: A-AT in conjunction with psychotherapy (directive group), A-AT only (nondirective group), and control. Standardized regressed BDI posttest scores were used as dependent variables in one-way analysis of variance with treatment as the independent variable. Results revealed significant differences among groups, F(2,41)=3.69, p<.05. Duncan's Multiple Ranges Test indicated that standardized regressed BDI post-test scores differed significantly between nondirective (M=5.67) and control groups (M=10.18).     

Animal-Assisted Enhancement of Speech Therapy: A Case Study

SUMMARY

This report assesses the impact of Animal-Assisted Therapy (AAT) as it applies to speech/language pathology. It is a case study of a 72-year-old female who had experienced multiple strokes and other related medical complications. Treatment utilizing two canine therapists, Charlie and Josh, increased one-word answers and object identification tasks, as well as verbalization behaviors in the subject.     

Dogs as an Adjunct to Therapy: Effects of Animal-Assisted Therapy on Rehabilitation Following Spinal Cord Injury

ABSTRACT

Approximately 17,000 new cases of spinal cord injury (SCI) are reported annually in the United States. Rehabilitation from SCI involves substantial mental, emotional, and physical challenges. Using a randomized controlled trial design, we assessed the efficacy of animal-assisted therapy (AAT) as an aid in rehabilitation following a SCI. We hypothesized that patients with SCI undergoing rehabilitation occupational therapy with AAT would demonstrate greater positive shifts in mood and outlook, reduced pain, and reduced stress compared with patients exposed to the same rehabilitation therapy but without AAT. Over four sessions of occupational therapy, 31 patients completed standard rehabilitation activities (control group) or rehabilitation activities integrating an animal therapy team (treatment group). Patients completed the Positive and Negative Affect Schedule (PANAS) and Numerical Rating Scale (NRS) at each session, had salivary cortisol sampled at the second session, and completed the Brief Pain Inventory at study baseline and exit. Data were analyzed using repeated measures ANOVAs and t-tests. The results revealed a small but significant effect of animal-assisted therapy on self-reported negative affect. Findings for group differences on positive affect, stress, and pain unpleasantness were null, although non-significant findings were in the hypothesized direction for several variables and yielded small effect sizes. Continued research is needed on the influence of AAT on mood improvement, stress reduction, and ultimately improved physical health outcomes during rehabilitation after SCI.     

Animal-Assisted Therapy Enhances Resident Social Interaction and Initiation in Long-Term Care Facilities

ABSTRACT

Social stimulation is a valuable aspect of therapeutic activities at long-term care facilities, designed to decrease social isolation, maintain or stimulate mental abilities, and increase awareness of the external environment. A study was undertaken at two such facilities to compare the effectiveness of Animal-Assisted Therapy (AAT) with Non-Animal Therapy (NAT) at providing social stimulation, that is, at providing opportunities for patients to engage in social interaction and to initiate social behaviors. While studies have indicated that AAT can improve resident outlook or affect, few have directly studied the social behaviors that might lead to such improvements, or the role the animals themselves might play. We observed 33 patients, both alert and semi- to non-alert, during regular recreational therapy sessions. Most patients were women (29 vs. four men), and geriatric (in their 70's and 80's). Non-Animal Therapies included Arts and Crafts and Snack Bingo, while AAT involved animals from local animal shelters being brought by volunteers to group sessions. Social behaviors naturally divided into Brief Conversations, Long Conversations, and Touch. We determined frequencies and rates of the behaviors, who initiated the behaviors and whether the behaviors were directed at other people or at the animals.

Overall, during AAT residents were involved in as much or more conversation with others, including the animals, as residents in Non-Animal Therapy, and were more likely to initiate and participate in longer conversations. The finding that different kinds of therapies seem to encourage different kinds of conversation might be an important consideration when investigating health benefits. The most dramatic differences between therapy types were found in rates of touch: touching the animals during AAT added significantly to resident engagement in, and initiation of, this behavior. Since touch is considered an important part of social stimulation and therapy, the enhancement of this social behavior by the animals is an important, and perhaps undervalued, effect.     

Post-Operative Benefits of Animal-Assisted Therapy in Pediatric Surgery: A Randomised Study

Background

Interest in animal-assisted therapy has been fuelled by studies supporting the many health benefits. The purpose of this study was to better understand the impact of an animal-assisted therapy program on children response to stress and pain in the immediate post-surgical period.

Patients and Methods

Forty children (3–17 years) were enrolled in the randomised open-label, controlled, pilot study. Patients were randomly assigned to the animal-assisted therapy-group (n = 20, who underwent a 20 min session with an animal-assisted therapy dog, after surgery) or the standard-group (n = 20, standard postoperative care). The study variables were determined in each patient, independently of the assigned group, by a researcher unblinded to the patient’s group. The outcomes of the study were to define the neurological, cardiovascular and endocrinological impact of animal-assisted therapy in response to stress and pain. Electroencephalogram activity, heart rate, blood pressure, oxygen saturation, cerebral prefrontal oxygenation, salivary cortisol levels and the faces pain scale were considered as outcome measures.

Results

After entrance of the dog faster electroencephalogram diffuse beta-activity (> 14 Hz) was reported in all children of the animal-assisted therapy group; in the standard-group no beta-activity was recorded (100% vs 0%, p<0.001). During observation, some differences in the time profile between groups were observed for heart rate (test for interaction p = 0.018), oxygen saturation (test for interaction p = 0.06) and cerebral oxygenation (test for interaction p = 0.09). Systolic and diastolic blood pressure were influenced by animal-assisted therapy, though a higher variability in diastolic pressure was observed. Salivary cortisol levels did not show different behaviours over time between groups (p=0.70). Lower pain perception was noted in the animal-assisted group in comparison with the standard-group (p = 0.01).

Conclusion

Animal-assisted therapy facilitated rapid recovery in vigilance and activity after anaesthesia, modified pain perception and induced emotional prefrontal responses. An adaptative cardiovascular response was also present.

Trial Registration

ClinicalTrials.gov NCT02284100     

The Effect of Animal-Assisted Therapy on Pain Medication Use After Joint Replacement

Animal-assisted therapy (AAT) has been used in a variety of healthcare settings and studies to evaluate the potential patient benefits are warranted. This retrospective study measured the impact of AAT on the use of oral pain medications by adults after total joint replacement surgery. One group of patients received care in a hospital with an AAT program and the comparison group was in a hospital without an AAT program. Adult patient cohorts were matched on: age, gender, ethnicity, length of stay, and Diagnosis Related Group code for type of total joint replacement. Pain medication doses, converted into morphine equivalent daily doses (MEDD), were compared. Pain medication use was significantly less in the AAT group: 15.32 mg vs. 21.16 (t₍₁₁₉₎ = 2.72, p = 0.007). The effectiveness of AAT in decreasing the need for pain medication and its effect on patient well-being in the post-operative period and in other settings deserves further study.     

A Naturalistic Study of the Acceptability and Effectiveness of Internet-Delivered Cognitive Behavioural Therapy for Psychiatric Disorders in Older Australians

Objectives

The current study investigates the acceptability, effectiveness and uptake of internet-delivered cognitive behavioural therapy (iCBT) amongst older individuals (>60 years) seeking psychiatric treatment in general practice.

Methods

The sample consisted of 2413 (mean age 39.5; range 18–83 years) patients prescribed iCBT through This Way Up clinic by their primary care clinician. The intervention consisted of six fully automated, unassisted online lessons specific to four disorders major depression, generalised anxiety disorder, panic disorder or social phobia. Patients were categorised into five age groups (18–29 years, 30–39 years, 40–49 years, 50–59 years, 60 years and above). 225 (9.3%) patients were aged over 60 years. Analyses were conducted across the four disorders to ensure sufficient sample sizes in the 60 years and older age group. Age differences in adherence to the six lesson courses were assessed to demonstrate acceptability. Age-based reductions in psychological distress (Kessler Psychological Distress Scale; K10) and disability (the World Health Organisation Disability Assessment Schedule; WHODAS-II) were compared to demonstrate effectiveness. To evaluate the uptake of iCBT, the age distribution of those commencing iCBT was compared with the prevalence of these disorders in the 2007 Australian National Survey of Mental Health and Well-Being.

Results

Older adults were more likely to complete all six lessons when compared with their younger counterparts. Marginal model analyses indicated that there were significant reductions in the K10 and WHODAS-II from baseline to post-intervention, regardless of age (p<0.001). The measurement occasion by age interactions were not significant, indicating that individuals showed similar reductions in the K10 and WHODAS-II regardless of age. In general, the age distribution of individuals commencing the iCBT courses matched the age distribution of the four diagnoses in the Australian general population, indicating that iCBT successfully captures older individuals who need treatment.

Conclusion

iCBT is effective and acceptable for use in older populations.     

Cost-of-Illness in Psoriasis: Comparing Inpatient and Outpatient Therapy

Treatment modalities of chronic plaque psoriasis have dramatically changed over the past ten years with a still continuing shift from inpatient to outpatient treatment. This development is mainly caused by outpatient availability of highly efficient and relatively well-tolerated systemic treatments, in particular BioLogicals. In addition, inpatient treatment is time- and cost-intense, conflicting with the actual burst of health expenses and with patient preferences. Nevertheless, inpatient treatment with dithranol and UV light still is a major mainstay of psoriasis treatment in Germany. The current study aims at comparing the total costs of inpatient treatment and outpatient follow-up to mere outpatient therapy with different modalities (topical treatment, phototherapy, classic systemic therapy or BioLogicals) over a period of 12 months. To this end, a retrospective cost-of-illness study was conducted on 120 patients treated at the University Medical Centre Mannheim between 2005 and 2006. Inpatient therapy caused significantly higher direct medical, indirect and total annual costs than outpatient treatment (13,042 € versus 2,984 €). Its strong influence on cost levels was confirmed by regression analysis, with total costs rising by 104.3% in case of inpatient treatment. Patients receiving BioLogicals produced the overall highest costs, whereas outpatient treatment with classic systemic antipsoriatic medications was less cost-intense than other alternatives.     

The Effect of an Animal-Assisted Intervention on Anxiety and Pain in Hospitalized Children

ABSTRACT

Forty children between the ages of 8 and 18 years, who were admitted to a hospital pediatric unit, were randomly assigned to an animal-assisted intervention (AAI) or an active control condition (working on an age-appropriate jigsaw puzzle). Ratings of pain and anxiety were taken both pre- and post-condition. The attachment Questionnaire and Family Life Space Diagram (FLSD) also were administered, and information on medications taken was recorded. A significant post-condition difference was found between groups for anxiety, with the aaI group having lower anxiety scores. However, no significant within- or between-group pre-post changes in either pain or anxiety were detected. Nearly two-thirds of the children (64%) reporting pain at baseline were receiving some type of analgesic, which may have influenced outcomes. Findings demonstrate some support that attachment may be a moderating variable: children with a secure attachment style reported lower pain and anxiety at baseline, with large effect sizes for differences in both anxiety (g = 1.34) and pain (g = 1.23). Although the aaI did not significantly reduce anxiety and pain in these hospitalized children, further investigation of the influence of analgesic use and the moderating effect of attachment style is indicated.     

Spiritist Psychiatric Hospitals in Brazil: Integration of Conventional Psychiatric Treatment and Spiritual Complementary Therapy

In Brazil, during the XX century, dozens of Spiritist psychiatric hospitals emerged seeking to integrate conventional medical treatment with complementary spiritual therapy. This combined inpatient treatment is largely found in Brazil, where many psychiatric hospitals stem from the Spiritist movement. The present report describes the use of these spiritual practices, their operating structure, health professionals involved, modalities of care, and institutional difficulties in integrating spiritual practices with conventional treatment in six leading Brazilian Spiritist psychiatric hospitals. These hospitals combine conventional psychiatric treatment with voluntary-based spiritual approaches such as laying on of hands (“fluidotherapy”), lectures regarding spiritual and ethical issues, intercessory prayer, spirit release therapy (“disobsession”) and “fraternal dialogue”. The non-indoctrination and optional nature of these spiritual complementary therapies seem to increase acceptance among patients and their family members. In conclusion, the Spiritist psychiatric hospitals in Brazil have, for more than half a century, provided an integrative approach in the treatment of psychiatric disorders, associating conventional and spiritual treatments, more specifically Spiritist therapy. The lack of standardized treatment protocols and scientific studies remain a barrier to assessing the impact of this integrative approach on patients’ mental health, quality of life, adherence, and perceived quality of treatment.     

Psychiatric Emergencies in an Urban Borough

An analysis is presented of all emergency calls made in one year, “out of hours,” to local authority mental health social workers as part of a comprehensive psychiatric service in an urban community. Of 212 calls received, more related to men than women, and in both sexes the peak age group was 40 to 49 years; 72% of referrals were in the psychosis or personality disorder diagnostic groups. A minority of cases referred had symptoms of only recent onset, and 70% of all calls related to patients previously known to the local services.     

Vital Signs Directed Therapy: Improving Care in an Intensive Care Unit in a Low-Income Country

Background

Global Critical Care is attracting increasing attention. At several million deaths per year, the worldwide burden of critical illness is greater than generally appreciated. Low income countries (LICs) have a disproportionally greater share of critical illness, and yet critical care facilities are scarce in such settings. Routines utilizing abnormal vital signs to identify critical illness and trigger medical interventions have become common in high-income countries but have not been investigated in LICs. The aim of the study was to assess whether the introduction of a vital signs directed therapy protocol improved acute care and reduced mortality in an Intensive Care Unit (ICU) in Tanzania.

Methods and Findings

Prospective, before-and-after interventional study in the ICU of a university hospital in Tanzania. A context-appropriate protocol that defined danger levels of severely abnormal vital signs and stipulated acute treatment responses was implemented in a four week period using sensitisation, training, job aids, supervision and feedback. Acute treatment of danger signs at admission and during care in the ICU and in-hospital mortality were compared pre and post-implementation using regression models. Danger signs from 447 patients were included: 269 pre-implementation and 178 post-implementation. Acute treatment of danger signs was higher post-implementation (at admission: 72.9% vs 23.1%, p<0.001; in ICU: 16.6% vs 2.9%, p<0.001). A danger sign was five times more likely to be treated post-implementation (Prevalence Ratio (PR) 4.9 (2.9–8.3)). Intravenous fluids were given in response to 35.0% of hypotensive episodes post-implementation, as compared to 4.1% pre-implementation (PR 6.4 (2.5–16.2)). In patients admitted with hypotension, mortality was lower post-implementation (69.2% vs 92.3% p = 0.02) giving a numbers-needed-to-treat of 4.3. Overall in-hospital mortality rates were unchanged (49.4% vs 49.8%, p = 0.94).

Conclusion

The introduction of a vital signs directed therapy protocol improved the acute treatment of abnormal vital signs in an ICU in a low-income country. Mortality rates were reduced for patients with hypotension at admission but not for all patients.     

Inpatient Hypoglycemic Events in a Comparative Effectiveness Trial for Glycemic Control in a High-Risk Population

Objective: Inpatient hypoglycemia (glucose ≤70 mg/dL) is a limitation of intensive control with insulin. Causes of hypoglycemia were evaluated in a randomized controlled trial examining intensive glycemic control (IG, target 140 mg/dL) versus moderate glycemic control (MG, target 180 mg/dL) on post–liver transplant outcomes.Methods: Hypoglycemic episodes were reviewed by a multidisciplinary team to calculate and identify contributing pathophysiologic and operational factors. A subsequent subgroup case control (1:1) analysis (with/without) hypoglycemia was completed to further delineate factors. A total of 164 participants were enrolled, and 155 patients were examined in depth.Results: Overall, insulin-related hypoglycemia was experienced in 24 of 82 patients in IG (episodes: 20 drip, 36 subcutaneous [SQ]) and 4 of 82 in MG (episodes: 2 drip, 2 SQ). Most episodes occurred at night (41 of 60), with high insulin amounts (44 of 60), and during a protocol deviation (51 of 60). Compared to those without hypoglycemia (n = 127 vs. n = 28), hypoglycemic patients had significantly longer hospital stays (13.6 ± 12.6 days vs. 7.4 ± 6.1 days; P = .002), higher peak insulin drip rates (17.4 ± 10.3 U/h vs. 13.1 ± 9.9 U/h; P = .044), and higher peak insulin glargine doses (36.8 ± 21.4 U vs. 26.2 ± 24.3 U; P = .035). In the case-matched analysis (24 cases, 24 controls), those with insulin-related hypoglycemia had higher median peak insulin drip rates (17 U/h vs. 11 U/h; P = .04) and protocol deviations (92% vs. 50%; P = .004).Conclusion: Peak insulin requirements and protocol deviations were correlated with hypoglycemia.Abbreviations:DM = diabetes mellitusICU = intensive care unitIG = intensive glycemic controlMELD = Model for End-stage Liver DiseaseMG = moderate glycemic controlSQ = subcutaneous