Feb 7, 20209 min read

Animals as Partners in Therapy

The Science of Animal-Assisted Therapy

Pet Therapy Teams, which consist of a human handler and a trained animal, can have a significant positive impact in a variety of contexts. They can open hearts and minds, ease anxiety, help people cope with trauma, injury, illness, and lower stress.

As if that wasn't enough therapy dogs help people find their smiles.

Pet Therapy Teams visit children and adults in schools, hospitals, jails, hospice, courtrooms, libraries, and in many therapeutic environments.

There are several organizations that certify Pet Handler Teams, such as the Alliance of Therapy Dogs, Therapy Dogs International, and Pet Partners, just to name a few. The tests vary by organization, but they are rigorous, requiring very specific obedience and social skills from both the human and the animal. While dogs are the most common to be certified as a visiting therapy teams, horses, miniature horses, cats, rabbits, llamas, dolphins, pigs, goats, birds, monkeys and "pocket animals" are also certified by some organizations.

Therapy animals provide interaction and companionship and may assist in emotional, psychological, and physical interventions in a variety of therapeutic contexts. There are two main categories for Pet Therapy in which certified and registered handler/owners might participate:

1 ) Animal Assisted Therapy (AAT)

2) Animal Assisted Activity (AAA)

Animal Assisted Therapy involves the owner and animal working in tandem with a health professional. The Pet Partners Standards of Practice for Animal-Assisted Therapy defines AAT as follows:

"AAT is a goal-directed intervention in which an animal that meets specific criteria is an integral part of the treatment process. AAT is directed and/or delivered by a health/human service professional with specialized expertise, and within the scope of practice of his/her profession. AAT is designed to promote improvement in human physical, social, emotional, and/or cognitive functioning. AAT is provided in a variety of settings and may be group or individual in nature. This process is documented and evaluated."

AAT has been shown to have multiple benefits for a variety of patients. One randomized control study with patients hospitalized with heart failure was investigated by US Army researchers and reported in the US Army Medical Department Journal. They discovered that those who had just eight minutes of AAT, self-reported less anxiety but also had a "Change from baseline that indicated a significant decrease in systolic pulmonary artery pressure and pulmonary capillary wedge pressure" (US Army Medical Department Journal, Canine Edition USAMDJ).

Canine Assisted Ambulation - patients move more when a dog is part of the process

Another benefit of AAT is that patients who are less willing to comply with treatment or hospital procedures, either because of pain, depression, fatigue, or other reasons, are more likely to be motivated to participate in their treatment if a trained dog is present and involved in their procedures. This has been seen across numerous areas, but one notable example is with Canine Assisted Ambulation (CAA), in which dogs help motivate patients to move more.

Knisely and Barker report that cardiac patients who first refused ambulation with an aide, were then presented with a canine-assisted ambulation. They state that with canine assistance, 18.9% of cardiac patients reversed their position, and voluntarily ambulated with the dog.

"Other patients who that engaged in the CAA walked almost twice as many steps (96% more). This study suggests that CAA may be motivational and an effective adjunct to existing ambulation and patient care routines. Furthermore, as early ambulation has been associated with decreased length of stay and thus reduced patient care costs among cardiac patients, the use of CAA may additionally improve (patient) outcomes." (USAMDJ)

In addition to helping patients, therapy visits can help providers and staff to reduce stress, and lift their spirits. Sweet dogs make almost everyone smile and this can help them reduce the effects of compassion fatigue. So, these visits are not just for patients! Ensminger discusses these multiple benefits and defines the work of a therapy dog as:

"A dog that, with a handler, visits individuals or groups to provide relief from an institution such as a hospital, or condition such as cerebral palsy or Alzheimer's. Therapy dogs may be used one-on-one as part of a treatment program for an individual, which is often called AAT, but mostly therapy dogs in the US today visit facilities to help or at least cheer up the populations of those facilities." (USAMDJ)

Even Short Contact is Beneficial

In a Japanese study on AAT and its effects on the prefrontal cortex, published in The International Journal of Psychiatry and Clinical Practice, by Aoki, et al., it is suggested that:

"AAT possibly causes biological and physiological changes in the prefrontal cortex (PFC), and that AAT is useful for inducing the activity in the PFC. Using NIRS, (near-infrared- spectroscopy), the measurement of cranial nerve activity was measured in real-time, showing numerous positive benefits on the brain from even 20 minutes of contact, including, holding or petting a therapy dog, and many patients look forward to these interactions above all other therapeutic interventions. This increased PFC activity had a positive impact on depression, and other studies have shown positive impacts on issues such as anxiety, fear, blood pressure, heart rate, salivary cortisol, and salivary alpha- amylase."

Aoki’s study further suggests that AAT allowed a large region of the PFC to be strongly activated, perhaps due to the combination of the stimulation of the senses of touch, sight, hearing, and even smell, through interactions with animals. This is very important because many patients with depression will exhibit a low level of cerebral activity in the PFC. Aoki’s study, showing the biological and physiological changes induced in the activity of the PFC, gives evidence that AAT can be a useful tool in treating depression.

Animal Assisted Activity

Miniature horses are often used in Pet Therapy

On the other hand, the therapeutic use of AAA (Animal Assisted Activity) is less formal. There are no treatment plans or notes; there is no specific agenda. Interactions are spontaneous, often joyful, and could be as short as two minutes, or could last for an hour. In many cases, the pet-therapy team consists of a human volunteer and their specially trained, certified animal. The focus is on the human-animal bond, uplifting connection, engagement, social interaction, healing the spirits, and even entertainment.

The Pet Partners website defines AAA as follows:

"AAA Provides opportunities for motivational, educational, recreational, and/or therapeutic benefits to enhance the quality of life. AAA are delivered in a variety of environments by specially trained professionals, paraprofessionals, and/or volunteers, in association with animals that meet specific criteria."

Obviously, not all dogs are suitable to become part of a healing team, just as not all humans are adept at such tasks. Each Pet Therapy organization has slightly different methods and objectives. But they will all involve a very specific set of criteria for the dog and their human, and an animal-handler team has to pass a rigorous evaluation and testing process. A candidate should be able to pass such preliminary tests as the CGC, (Canine Good Citizenship) Test, which tests 12 basic obedience skills. But in addition, a therapy dog has to be able to handle the specific stressors that will present themselves on therapy visits.

Therapy Animal Teams Visit Patients in a Variety of Settings

Although Dog and Human handler teams are the most common, a few very special horses, llamas, cats, pigs, and other animals have been certified by various organizations. Here is an amazing therapy horse, Peyo who chooses who to visit and has the ability to detect cancer and tumors.

Animals Help Patients Heal Faster

Orlandi et al., conducted a study and evaluated a one-hour AAA session with oncology patients while they were receiving chemotherapy in a day hospital. Various markers of stress were noticeably reduced in this often-quoted study.

"Self-report measures of anxiety, depression, somatic symptoms, were collected as well as heart rate, arterial oxygen saturation, and blood pressure...Unlike the controls, patients in the AAA group demonstrated a decrease in depression and an increase in arterial oxygen saturation. Significant reductions in anxiety, aggression and blood pressure were also reported..." (USAMDJ)

"Beneficial results for heart patients interacting with animals, for as little as twelve minutes, have been reported by the American Heart Association. This study (November 2005), reported that “Twelve-minute visits with therapy dogs improved heart and lung function, reduced blood pressure, diminished harmful hormones, and decreased anxiety in heart patients.” (USAMDJ)

Some of the Skills a Therapy Animal Must Possess:

Just to mention a few of the skills a therapy dog has to be able to exhibit in the evaluation, are positive interest in strangers and their attention, being able to recover quickly from sudden or loud noises, ability to pass other dogs without distraction, ability to ignore food when commanded, ability to stay still for children who may not know how to pet a dog, tolerate hugging and clumsy petting, be undisturbed by rolling medical equipment, and genuinely want to give and receive affection.

Any Dog Breed Could Become a Great Therapy Dog

Any breed of dog can become a therapy dog if he or she has the right temperament and has an excellent response to their handler’s commands. This author has worked with excellent therapy dogs that were German Shepherds, Pit Bulls, Boxers, Chihuahuas, Shih Tzus – in addition to the more common Golden Retrievers and labrador mixes. Shelter and rescue dogs, even those that have survived difficult circumstances, if they have the right temperament, can become excellent therapy dogs.

Here is a short film I made when I was on The Human-Animal Bond Program at Tripler Army Medical Center in Honolulu, Hawaii, called Dogs Are Healers.

Here is a shorter version of this video if you prefer.

Oscar - My First Therapy Dog

Oscar, rescue dogs make great therapy dogs

Oscar was a boxer-pitbull mix, who I had adopted from a shelter. He had escaped from an unfortunate situation where the dogs were forced to be pig hunters, and were often underfed in order to increase aggression, had scars all over his body. When he escaped with a very expensive GPS collar, his abusive owners wouldn't risk claiming him. He had been at the shelter for a long time when I met him.

With minimal training and a lot of healing touch, Oscar became one of the best therapy animals I have ever encountered.

Oscar would enter a room full of tough soldiers with PTSD. He would greet each one – knowing to avoid those with fear of dogs – without being told. Then he would “select” the one who needed the most attention at that moment. He would settle down with this soldier, who would invariably drop down to his belly to pet this large, gentle dog. Their hearts would open instantly. Perhaps they identified with the slower movements, missing teeth, and visible scars. Therapy dogs with missing limbs are often revered by the service members. Many soldiers with PTSD have had to shut their hearts down to survive, and the dog, without requiring any talk, helps them to open their hearts again. This begins a process of healing. In the words of Pope John Paul II, “The worst prison would be a closed heart.”

Here is a story about Oscar that I wrote that appeared in the Honolulu Advertiser:

“Saving one dog will not change the world, but for that one dog, the world will change forever.” Oscar was that one dog. When I adopted him he had been at the shelter a long time. He had that slow, sad, sweetness I just found irresistible. I didn’t care that he was missing teeth, that he had scars all over his brown body, or that he was mostly bit pull. I was told he had been forced to be a pig hunter and had escaped with his expensive GPS collar and was never claimed by his cruel owners. When I first brought him home, all you had to do was raise your arm to reach for something and watch him cower to imagine what Oscar had endured. But Oscar was pure love. Oscar taught me that we do not need to be ruled by our past. We are who we choose to be in each new moment. Oscar and I learned to become a therapy dog team, and we made regular visits to Tripler Army Medical Center. One day Oscar stopped outside the door of a room of a wounded young man. We went inside and sat next to Hector, whose head was covered in bandages. Oscar didn’t care. He nuzzled his bandaged hand. Hector gave a crooked smile and a croaky laugh as Oscar settled his old bones ever so gently next to Hector. Oscar looked him in the eye as Hector whispered a long story in Oscar’s scarred ear. I didn’t try to listen; I knew the story wasn’t for me. At the end of the visit, Hector sighed peacefully, and Oscar made a breathy noise kind of like a laugh, too. When we finally left the room, the nurse had a stunned expression on her face. “Hector never talks,” she said. “We thought he had lost his voice.”

And I was reminded that one dog, one visit, one whisper at a time may not change the world, but it can make the world a place I want to live in. *

Oscar always knew who needed attention most in that moment.

Therapy dogs have a furry key that works like magic. When engaging with children, without being told, Oscar would instantly detect which child had the greatest emotional need and would attend to that child first. As an abused, and then long-term resident at a shelter, without specific training or instruction, this dog seemed to have a deep wisdom about the needs of wounded humans.

One of the most important qualities in a great dog/handler team is excellent communication between dog and human, a desire to please, and a very calm nature. The human-animal bond must be very strong so that each is reading the other’s non-verbal cues instantly. Since dogs can pick up and take on human pain, it is extremely important that a handler be attentive to when the dog has had enough. This is especially critical for dogs working in disaster response, as will be discussed later in this section. It is important to make sure the dog has a way to release any unwanted energy he or she may have absorbed through interacting with those humans in physical and emotional pain.