Dogs in animal-assisted therapy: benefits and implementation

Animal Assisted Therapy

Therapy Animals

When a patient is in a hospital room full of high tech equipment with tubes, wires, bleeping monitors, alarms, and life-support equipment, it can be very depressing. An animal can bring warmth to the atmosphere and relate to the patient as a human being. A nice, calm dog that loves people unconditionally can really cheer a patient up and relieve the sense of dehumanization that comes when nurses and technicians look at the computer read-out instead the patient. But there's more to it than that. Animals are now being used to actively assist therapy. Using dogs in a pet therapy program helps the mental and physical healing of human beings. Using dogs in hospitals began as a recreational activity but has become an important part of patient care today. In this essay we will look at how dogs are used to improve mental and physical well being, how the dogs are trained and maintained, and the rare but possible hazards that could be involved when an animal is brought into a hospital. It will be shown that benefits of therapy animals far outweigh the risks.

Using dogs for police work, watch dogs, Seeing Eye dogs, pets and companions has long been accepted, but only recently have dogs been seen by the healthcare community as able to help the sick, injured, and handicapped (Parshall, 2003). The Delta Society, an organization that studies the bond between humans and animals, defines animal assisted therapy (AAT) as "the use of trained animals in facilitating patients' progress toward therapeutic goals" (Draper cited in Parhsall, 2003). AAT is "a scheduled intervention designed to improve a patient's cognitive or physical function, with specific short- and long-term goals" (Cenner, 2001, p. 44). Therapy dogs are already employed in a variety of settings -- hospitals, classrooms, rehabilitation centers, psychiatric units, prisons, and nursing homes to "lift the spirits" of all who meet them.

Dogs comfort and help dying people to feel "acceptance and decreased isolation" (p. 51). They offer comfort to grieving relatives as well. But before 1990 little scientific research existed on the value of animals for therapy.

History of AAT

The term pet therapy came into use in the 1960s along with keeping records of its use. Documentation started as anecdotal (stories). Then, it grew into scientific research findings. Institutional use of animals grew from using animals occasionally to using them deliberately as part of the therapy. But the use of animals in treatment is not completely new. In 1792, the Society of Friends used animals in a program for mentally ill people. Florence Nightengale said in her Notes on Nursing, "A pet bird in a cage is sometimes the only pleasure of an invalid confined for years to the same room" (cited in Hooker, Freeman, & Steward, 2002).

In 1919 dogs were used to help psychiatric patients at St. Elizabeth's Hospital in Washington, D.C.

In 1942 the Veterans Administration set up a farm with animals as a "diversion for recovering veterans." But no data was collected to document the benefits of these programs. The health care field started to make animals part of established therapies in 1961. Dr. Boris Levinson found that "pets function as transitional objects with which patients can bond. This bonding could eventually expand to include a therapist" (Hooker, et all, 2002). More recently, Dr. William Thomas tried to create more livable, homelike places for humans to get well in. He brought in the natural world -- including animals -- for patients in long-term care.

Dr. Boris Levison was the pioneer of research on therapy dogs. He wrote about using dogs to work with children in psychiatric care. He found that a dog was something positive to begin communicating about, softened the child's defenses, and helped rapport to build. When Dr. Levinson first presented his findings to the American Psychological Association, some of the audience made fun of him ("Does your dog share the fees?").

Since then, nurses have used animals and written about it in their journals. They have found animals promote better patient outcomes. In other words, patients get better faster when an animal is there. Older patients feel needed again and not so useless. Seriously sick patients, families, and personnel report stress levels are lower when an animal is present (Hooker et al., 2002). Cenner (2000) reports the use of dogs in acute care. When a dog is there, patients don't need as much pain medicine. Therapy animals can help comatose patients wake up. The researcher points out that in the past nurses brought animals to the window for a patient to see -- or sneaked them in for a visit. Now, animals are often allowed. They should be allowed in all healthcare facilities.

By the 1990s research on animals in healthcare settings had grown. Nurses wrote about animals in a variety of healthcare settings. One study showed that older patients showed lower blood pressure and heart rates after the nurse brought a dog to visit. Another study used dogs in home visits with children. During painful procedures, the dog was a friend to the child and its parents and made the visit enjoyable.

Animals and Physical Well Being

Animals are being used to help people physically as well as mentally. For example, studies have shown that old and infirm people live longer if they have pets. Pets decrease loneliness and keep people busy caring for them. They like to be touched and pet, are something interesting to watch, make people feel safe, and provide motivation for exercise. Pet ownership has both direct and indirect physical effects on health (Gunter & Furnham, 1999).

One study showed that pet owners go to the doctor less frequently and have fewer health problems (Gunter & Furnham, 1999). Odendaal (2000) found that when people interacted with their dogs, their blood pressure and chemical plasma levels improved. In 1980 Barker & Dawson did a study of 92 cardiac outpatients. They found that pet owners lived longer than those who were not. The same researchers did a study of 5,741 people to find the effects of animals on heart health. Results showed that pet owners had "lower blood pressure and triglyceride levels than did non-pet owners" (cited in Parshall, 2003 and Gunter & Furnham, 1999, p. 69). Petting a dog lowered blood pressure and respiratory rate -- even if the dog was somebody else's. Pet owners that have heart surgery recover faster and stand a better chance of full recovery. Touching a warm furry animal gives them relief.

Moreover, pet ownership is a predictor of survival after hospitalization for any serious illness (Gunter & Furnham, 1999).

Demello (1999) found that the "mere presence of an animal" could lower blood pressure and that the effect persisted even after the animal was gone. Visual contact with an animal, although it helped, was not as good as touching. Heart rates decreased significantly in a three-minute period of physical contact with the animal (Demello, 1999).

A story in Time magazine (2001) tells how a brain-injured man needed help to get back his sense of balance. Ginger, an Australian shepherd, liked to fetch, so physical therapy for this man was to reach down, pet the dog with his weak arm, and then throw a ball for her to bring back. He said, "I can't turn my neck, and my eyesight isn't good. The dog gives me courage" (cited in Time, 2001, p. 53). The benefits are both physical and spiritual. The primary force that helps a patient to get well is motivation, and animals in critical care units remind patients there is a life to live away from the hospital and a reason to get well (Cenner, 2001).

Dog Certification

Dogs who do therapy must be trained. Most dogs that practice in hospitals are certified by Therapy Dogs International in New Jersey or by the Delta Society. Animals are insured for liability by these organizations (Cenner, 2001). The Delta Society screens dogs for personality and obedience. Certification reassures personnel that the dog will behave. Leaser (2005) points out, "While many dogs have a sweet nature and calm disposition, and offer love and companionship at home, not all dogs are appropriate or have the proper temperament suitable for a therapy dog..." (p. 978). Dogs also have to know hospital protocols. They must remain calm in the face of careening wheelchairs, screaming and weeping strangers, hospital emergencies, and scary equipment. Animals with aggressive behavior are screened out.

A dog must be a year old to get a license. It must be in good health, accept strangers, be well-groomed and attractive; be able to walk through crowded, noisy areas; obey voice commands; react calmly to other dogs, and remain calm no matter what. Parshall (2003) states, "A license represents a minimum standard that is observable to a hiring agency and clients and that provides liability insurance for the therapy animal" (p. 54).

The Risks of AAT

In the unlikely event of something negative happening and a law suit, the hospital or therapist is covered by insurance. In the past animals were banned from hospitals mainly because those who made the rules believed it wasn't safe. They worried about infection and the possibility that an animal could injure a patient by biting the person or knocking the person over. However, researchers have found the danger is very low for an animal that is certified, and the benefits outweigh the risks (Brodie, Biley & Shewring, 2001). Patients who have weak immune systems (AIDS, for example) may be prone to infections from bacteria that animals carry, but the use of a certified dog minimizes all these risks because the dog has been examined and is healthy. Oddly enough, the risk to the dog may be greater. Barlow, for instance, a therapy dog that lived at a hospice facility became "overly fatigued and overfed" and had to be removed from the facility for the sake of his health. Lucky, a dog that lived at a nursing home, died prematurely from congestive heart failure brought on by weighing 113 pounds -- the residents continually overfed him.

There really isn't any danger. Parshall (2003), who conducted a thorough review of the literature on animal assisted therapy, found no incidents of aggressive behavior in therapy dogs. The hazards are minimal and can be minimized even further by "careful selection of animals, thorough planning and allocation of responsibility, rigorous health care of the animal, and informed practices by all involved" (Brodie, et al., 2002, p. 456). Ethical barriers to using animals for therapy do not exist either. The public health department may bar a dog from the kitchen, laundry, and dining hall, but this does not really pose a problem because therapy dogs quickly learn where they can go and where they aren't allowed.

Animals can be used very effectively to help sick people get better. Obviously, a nurse or therapist can't entirely turn a case over to an animal, but when an animal is carefully chosen and assigned, the physical and mental benefits for the patient are real. Animals that are trained for this work can be trusted. They seem to understand what they are there for -- to comfort and be a friend to somebody that is sick, disabled, or dying. They give unconditional love and don't care what the person looks like, how old they are, how sick or disturbed they may be. It makes sense to use animals for healing. Maybe someday when we see an animal in the hospital, it won't seem like a novelty. The animal will be like one of the staff.