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Animal therapy groups in East Lyme, CT are part of my highly effective, experiential approach to family therapy. At Wisdom Within Counseling, I use my clinical experience and approach to meet your child or teen exactly where they are, so they feel safe to grow. To read more about the evidence, research, and peer reviewed journal articles in the research paper below. Included are tons of studies backing up the efficacy, self- regulation benefits, and positive coping skills gained through these groups. Treatment goals such as social/emotional learning and reinforced in the animal therapy groups and new peer-to-peer skills are stimulated.

Read more about each experiential component of therapy below.

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Enjoy this informational, evidence-based, extensive and in-depth reading!

The Effect of Animal Assistance on Positive Therapeutic Outcomes

Rebecca Hickey B.S., Mitchell College, 2015

Legal Notes: All rights reserved. This publication is designed to provide accurate, expert, and authoritative information regarding animal assisted therapy and positive outcomes. In regard to the subject matter, it is provided with the understanding that the author and publisher are not engaged in rendering legal, accounting, mental health advice, or other professional services. This is not intended to cure a disease. When professional advice is needed, seek out a competent professional person. Please show respect and do not plagiarize or copy any text illegally.

Abstract

While animal assisted therapy (AAT) has been utilized informally for many years, there is a need for further research to demonstrate its capability for success in augmenting traditional treatments. This review of the literature examined the effect that animal assistance had on psychological and physiological well-being, and focused specifically on research related to the use of animal therapy in promoting the welfare and health of individuals who were affected by a variety of issues, some of which were: autism, psychological disorders, substance dependence, Alzheimer’s and physical disabilities.

Ample empirical research studies supported a positive correlation between animal assistance and favorable therapeutic outcomes across a multitude of areas. It was often demonstrated that the animal worked as a facilitator for the development of a trusting relationship between the client and therapist, as well as the formation of healthy relationships among peers. These findings are valuable to the field of psychology because by presenting the opportunity for others to gain further knowledge about the research on the correlation between animal assistance and positive therapeutic outcomes, it allows for the possibility of AAT to be more widely implemented and accepted as an augmentation to traditional treatment methods.

Additionally, while AAT has the potential to be an invaluable treatment tool, certain precautions must be taken such as proper veterinary maintenance, and temperament evaluation of the animal. The major limitation of this study was the inability to account for confounding variables that may have contributed to the participants’ therapeutic improvement with AAT, such as level of family support/involvement, or a positive past experience with an animal. In conclusion, animal assistance is a multifaceted tool, and because of that, each situation must be carefully evaluated to choose the best possible, and also the most feasible, method for therapeutic incorporation of an animal into the client’s situation.


The Effect of Animal Assistance on Positive Therapeutic Outcomes

The point under investigation is the effect that animal assistance has on therapeutic outcomes when applied in a variety of settings. For example, animal assisted therapy (AAT) is defined as a goal directed intervention, where an animal that meets specific criteria is a vital part of the treatment process (Souter & Miller, 2007). Animal assisted activities (AAA) and animal assisted visitation (AAV) provide opportunities for motivational, educational, recreational, and/or therapeutic benefits to enhance the quality of a person’s life (Souter & Miller, 2007). Souter and Miller (2007) also noted that while by definition AAT and AAA are distinguishable, the two are not clearly differentiated in actual practice and frequently overlap. For the purposes of this literature review, AAA and AAV are classified as AAT unless otherwise noted by the researchers.

The independent variable in this study was the use of a therapeutic animal during the treatment process. This could manifest anywhere from simply the presence of an animal, to physical contact between the client and the animal. It was often seen that the animal worked as a facilitator for the development of a trusting relationship between the client and therapist, as well as the formation of healthy relationships among peers (Coetzee, Beukes, & Lynch, 2013). The dependent variable was the amount of positive progress that was made by the client participating in the AAT program. For the purposes of this literature review, the dependent variable was divided into two measurable categories: psychological, and physiological well-being.

Animal assistance was found to be useful and important because of the diversity of illnesses and age groups for which it was beneficial. Ample empirical research studies supported that there was indeed a positive correlation between animal assistance and favorable therapeutic outcomes in a variety of settings (Moretti et al., 2011; Nimer & Ludenthal, 2011; O’Haire, McKenzie, Beck, & Slaughter, 2013). For example, Moretti and colleagues (2011) conducted a case study on elderly patients in a long-term mental care facility and found a 50% improvement in depressive symptoms through a pet therapy program. Additionally, O’Haire and colleagues (2013) determined that the presence of an animal significantly increased positive social behaviors for children with an autism spectrum disorder. Furthermore, Nimer and Ludenthal (2011) conducted an extensive meta-analysis, which found AAT to be highly beneficial, and supported the continuation of the practice as well as further research.

The purpose of this study was to gather literature and empirical research data to definitively show the correlation between animal assisted therapy and positive outcomes for individuals.

Literature Review

A substantial portion of the available research on animal assistance has focused on its effectiveness and use in the treatment of patients with serious mental illnesses. Chu, Liu, Sun, and Lin (2009) examined the effects of AAA among Taiwanese inpatients with a diagnosis of schizophrenia. After reviewing the literature, the researchers hypothesized that animal assistance would positively impact the self-esteem, self-determination, social support, and psychiatric symptoms of inpatients with schizophrenia (Chu et al., 2009).

The randomly selected treatment group received weekly, 50 minute long AAA sessions over a period of two months (Chu et al., 2009). These sessions were unstructured and informal; however, the patients were encouraged to freely express their feelings and thoughts, as well as to touch, pet, and play with the two therapy dogs (2009). The control group received the routine treatment (2009). The method of measurement was a questionnaire, completed by the patients one week prior to and one week after the study period (2009). The questionnaires were coded and assessed by independent raters to ensure validity (2009).

Results indicated that the hypothesis was partially, but not fully, supported. Statistically significant improvements were present across the areas of self-esteem, self-determination, psychiatric symptoms, and emotional symptoms in the treatment group that were not found in the control group (Chu et al., 2009). However, the scores for social support and negative psychiatric symptoms showed no significant change (2009). The major limitation of this study was the relatively small sample size (n=30; 2009). Another limitation was that fluctuating schizophrenic symptoms may have hindered the patients’ ability to effectively complete the questionnaire (2009). The significance of this study was the finding that animal assisted-activities offered an effective means of improving the well-being of patients living with schizophrenia (2009).

Similarly, Kovács Kis, Rózsa, and Rózsa (2003) determined that animal assistance was helpful in the rehabilitation of patients living with schizophrenia at an inpatient facility. Researchers hypothesized that AAT would provide some degree of benefit to the patients (Kovács et al., 2003). Therapeutic improvement was measured by the Independent Living Skills Survey (ILSS), which assessed the degree of problems pertaining to domestic activities, health, leisure, money management, transportation, eating, and hygiene (2003). The surveys were completed by the nurses living most closely with the patients, seven to ten days prior to the beginning of and seven to ten days after the end of the treatment period (2003). 

Participants received weekly 50 minute long therapy sessions for a period of nine months (Kovács et al., 2003). Therapists encouraged the patients to talk about their feelings, talk to each other, pet the dog, and participate in care activities such as feeding and brushing (2003). Results from the surveys indicated a significant decrease in the level of problems across the seven areas assessed by the ILSS scale, which supported the researchers’ hypothesis (2003). The two major limitations of this study were the small sample size (n=7), and the absence of a control group (2003).

However, the importance of this study was the finding that all of the participants displayed an increased level of functioning in their living skills after participating in AAT (Kovács et al., 2003). The significance of this was that animal assistance had a positive impact on patients with schizophrenia, which implicated its ability to be used successfully to augment traditional treatment methods for individuals with this disorder (2003).

As well as proving positive outcomes in the treatment of schizophrenia, animal assistance has also been shown to be therapeutically valuable in individuals with mood disorders. Sockalingam and colleagues (2008) explored the effects of AAT on a patient with a mood disorder. In addition to traumatic symptoms stemming from a recent physical assault, this certain patient had a long-standing diagnosis of Bipolar Affective Disorder, Type 1 (2008). At intake to the psychiatric inpatient unit, the patient presented with low mood, hopelessness, persistent tearfulness, rejection sensitivity, reduced speech, poor self-esteem, lack of motivation, psychomotor agitation, irritability, insomnia, and anxiety (2008).

Due to his lack of response to traditional medication, and a self-recalled positive experience with a childhood pet, doctors hypothesized that AAT would be beneficial in his treatment and recovery (Sockalingam et al., 2008). The patient spent several unstructured hours a day with a therapy dog, and was responsible for her needs during that time (2008). There was no formal or empirical assessment of the patient’s progress, which was a limitation of this study (2008). The amount of progress was evaluated by patient self-report, patient satisfaction with the therapy, and evaluation of the patient’s functional status by nursing staff and physicians involved with his care (2008).

After three weeks of daily animal assistance, the patient showed improvement across a multitude of areas (Sockalingam et al., 2008). He had decreased anxiety, irritability, and psychomotor agitation, in addition to improvements in mood, outlook on life, self-esteem, quality of sleep, and ability to concentrate (2008). Especially pertinent to this literature review were the positive results that directly stemmed from the incorporation of AAT into this patient’s treatment.

In addition, Aoki and colleagues (2011) conducted a pilot study, which measured the effect of AAT on cerebral activity in psychiatric patients. Researchers hypothesized that AAT would be useful for promoting the patients’ cerebral activity (2011). There were three participants in this study: a male and female, both with diagnosed mood affective disorders, and a healthy male (2011).

The first activity was AAT, in which a small therapy dog was placed in the lap of the participant (Aoki et al., 2011). The second activity was a verbal fluency task, without the presence of an animal (2011). The FOIRE-3000, a brain imaging system, was used to measure changes in the pre-frontal cortex (PFC) during these activities (2011). The method of data collection fist established a baseline reading, and then another reading during each of the tasks (2011). The results were supportive of the hypothesis, as the signals during the AAT task in the individuals with a mood disorder showed significant blood flow increase in the PFC when compared to the verbal task (2011). The control participant showed no significant difference in the amount of blood flow increase in the PFC during the two activities (2011).

A limitation of this research was the small sample size (n=3), which was dictated by the cost of the experiment and the limited qualified staff to interpret the signals of the FOIRE-3000 (Aoki et al., 2011). Another limitation was the confounding variable of psychiatric medication that the two participants with mood disorders were receiving (2011). The significance of this study was the finding that AAT was useful in inducing activity in the PFC of patients with mood affective disorders who had been diagnosed as having low cerebral activity (2011).

In addition to increasing cerebral activity, AAT was found to be helpful to adults in psychiatric inpatient settings. Nepps, Stewart, and Bruckno (2014) examined the physiological and psychological effects of animal assisted activity (AAA) in a group of inpatients within a mental health unit of a community hospital. The researchers hypothesized that AAA would improve ratings of depression, anxiety, and pain as well as the physiological measures associated with stress and discomfort (Nepps et al., 2014).

The AAA consisted of once weekly, hour long group sessions of primarily unstructured time with a certified therapy dog (Nepps et al., 2014). However, the handlers encouraged the patients to ask questions about the dog and share with the group about their own experiences with animals or pets (2014). The control group participated in once weekly, hour long therapy sessions, which consisted of watching a video based stress management program (2014). Before and after each session, participants completed a questionnaire designed to assess levels of depression, anxiety, and pain (2014). In order to assess the physiological symptoms of stress and discomfort, the participants had their blood pressure and heart rate (HR) measured before and after each session, in addition to having saliva samples collected for cortisol analysis (2014). It was noted that cortisol is a hormone that becomes elevated as part of the human stress response (2014).

Results of the study supported the hypothesis as there was a significant decrease in anxiety, pain, and HR after the AAA program when compared to the traditional stress management program (Nepps et al., 2014). Limitations of the study included a non-randomized sample and confounding variables, such as psychotropic medications (2014). The pertinence of this study was the implication that AAA was more effective than traditional therapies in reducing psychological and physiological symptoms of stress in hospitalized mental health patients (2014).

Additionally, Marr and colleagues (2000) conducted a case study within the psychiatric ward of Terrell State Hospital, which studied the effects of AAT on the improvement of pro-social behaviors. The study consisted of two groups with randomized patient selection (2000). Each group attended daily sessions identical in content; except that the treatment group received unstructured AAT during the sessions (2000). It was hypothesized that the patients in an AAT group would show a greater increase in appropriate social behaviors than would the control group (2000).

The measurement for the study was the Social Behavior Scale, utilized daily by an independent rater (Marr et al., 2000). The patients were monitored for four weeks (2000). It was found that the patients that received AAT socialized more with peers (other patients), and were seen smiling and demonstrating pleasure in their activities more often than the participants of the control group (2000). The significance of this study was that it demonstrated an increase in pro-social behaviors when animal assistance was present, a positive outcome that was not found in the control group.

Similarly, Prothmann, Bienert, and Ettrich (2006) investigated AAT within inpatient psychiatric treatment with children and adolescents. Their hypothesis was that the presence of a therapy dog would have some effect on the state of mind of the participants (Prothmann et al., 2006). The treatment consisted of weekly, 30 minute sessions of unstructured time with a therapy dog, for a duration of five weeks (2006). The control group (n=39) engaged in normal activities such as listening to music, or reading, for the designated 30 minutes (2006). The patients’ state of mind was measured by the Basler Befindlichkeits-Skala (BBS) scale, a method of self-report (2006). Measurements were taken five minutes pre and post session, in both the treatment group and the control group (2006).

The differences in BBS scores between the treatment and control group indicated that the presence of the dog increased the alertness and attention of the child, promoted the perception of healthy and vital factors, caused more openness and social initiation, and enabled the child to become psychologically more well-balanced (Prothmann et al., 2006). A limitation of this study was the non-randomized sample of participants (2006). A significant conclusion was that the integration of animals led to positive outcomes and therapeutic enrichment for the treatment group that may not have otherwise occurred (2006).

These examples were representative of some of the research on AAT that has been conducted with participants that suffered from serious psychiatric disorders. The results of these studies indicated that AAT was beneficial to the participants across a multitude of areas. In interpreting and integrating the results from each of these studies, it was concluded that AAT did indeed correlate with positive therapeutic outcomes.

While a substantial portion of the research has focused on more serious psychiatric illnesses, there were studies that explored the effects of animal assistance on disorders such as dementia and Alzheimer’s disease. Moretti and colleagues (2011) examined the effects of pet therapy on a sample of elderly patients in a residential setting. The patients all had a diagnosis of dementia, depression, and/or psychosis (2011). The aspect under investigation was whether cognitive function, mood, and perceived quality of life in the patients would be positively affected by AAT, in comparison to a control group where animal assistance was absent (2011).

A questionnaire that assessed self-perceived quality of life as well as the Mini-Mental State Examination (MMSE) and the Geriatric Depression Scale (GDS) were administered by a physician before and after the program (Moretti et al., 2011). The pet therapy treatment consisted of direct contact between the patients and the dog (holding, petting, brushing, etc.) with no formal structure (2011). The results of this study directly supported the hypothesis, specifically: 50% improvement of GDS symptoms, significant improvement in self-perceived quality of life, and a twice as high probability of improvement in MMSE scores were present in the treatment group when compared to the control (2011). Especially relevant to this literature review was the finding that the presence of an animal had a positive influence on the patients’ overall well-being. However, limitations of the study included a relatively small sample size (n=21), lack of a double-blind procedure, a short-term evaluation, and a non-randomized sample (2011).

When considering animal therapy in an in-patient setting, especially with the elderly, concerns tended to arise over infection or injury, which led many facilities to make the decision to exclude it, despite the research that has shown benefits. To them, it was regarded as a health and safety issue, and the risk just could not be taken. Kramer, Friedmann, and Bernstein (2009) conducted a study at the St. Patrick’s Home for the Aged and Infirm, which utilized a robotic pet, called AIBO. Three scenarios were used: a visitor alone, that same visitor with a real dog, and that same visitor with the robotic dog, AIBO (Kramer et al., 2009). The purpose of this study was to determine whether the use of a robotic pet would provide benefits similar to those provided by a real animal in terms of social stimulation (2009).

Each participant was a female resident of the facility and had a diagnosis of either Alzheimer’s disease or another type of dementia (Kramer et al., 2009). Each patient received a total of three visits, one for each scenario, which were videotaped by a neutral third party (2009). The tapes were later examined and the number of observed social behaviors (conversation, looks, eye contact, and hand gestures) quantitatively examined (2009). The results concluded that both the AIBO dog and the real dog provided more social stimulation than the visitor alone did (2009). This study also found that AIBO actually induced longer looks and more resident-initiated conversation than did the live dog, which could have been due to the uniqueness of the robotic dog (2009).

Some limitations of this research were a lack of gender diversity, the participants only experienced each type of visit once, and the interpreter of the tapes could not be blind to the procedure as it was obvious which visit the patient was experiencing (Kramer et al., 2009). The significance of this study was that it determined that the patients were more responsive in social situations with either a real dog or robotic dog compared to when only a human visitor was present (2009).

Although Alzheimer’s and dementia are considered to be psychiatric disorders, they largely belong to a geriatric population. The results of the studies that explored the use of AAT in individuals with these conditions indicated that animal assistance produced ample benefits. It was concluded that AAT was associated with positive therapeutic outcomes, and improved the participants’ overall quality of life.

In addition to benefitting people with psychological illnesses, animal therapy was also indicated to be helpful to people suffering from substance use disorders. Wesley, Minatrea, and Watson (2009) found AAT to have a positive effect on patients who were receiving treatment for a substance use disorder. The study included 231 participants, all of whom were seeking treatment at a residential facility and had a diagnosis of substance dependence (Wesley et al., 2009). A randomly selected experimental and control group were utilized for this study, which increased its validity (2009). Both groups participated in group therapy that consisted of primarily cognitive behavioral therapy (CBT) skills (2009). Researchers hypothesized that the clients in the animal therapy groups would show higher ratings of the therapeutic alliance, compared to clients in the control groups (2009). The measure utilized was the Helping Alliance Questionnaire Revised (HAQ-II; 2009).

The results of this study indicated a significant difference between the mean HAQ-II ratings of the two groups, as those in the AAT groups reported a more positive opinion of the therapeutic alliance (Wesley et al., 2009). However there were some limitations, such as a demographically homogenous group of participants (2009). The importance of this study was the finding that the utilization of an animal in the treatment of individuals with substance dependence produced a more positive therapeutic outcome when compared to the control group where no animal was present (2009).

Similarly, Cotzee and colleagues (2013) also found animal assistance to be beneficial in the rehabilitation process of people with substance use disorders. The participants for this study were four inpatients attending a substance abuse treatment program (2013). The researchers hypothesized that the use of AAT would promote positive experiences in the patients (2013).  The animal therapy consisted of two hours at a local animal park (2013). During the first hour, participants were encouraged to explore the park freely as well as interact with the animals (2013). The second hour consisted of group therapy, in which a domestic feline was present (2013). Participants were then asked to reflect on their experience of the animal therapy initiative during a focus group discussion (2013). The data collected was thematically analyzed using a six phase method (2013).

The results supported the hypothesis, as participants identified positive experiences with the animals, self-awareness in relation to animals, and social mediation as a result of animal interaction (Cotzee et al., 2013). Limitations of this research included the small sample size (n=4) and the absence of a control group (2013). The significance of this study was the conclusion that animal-assisted therapy had a positive effect on inpatients seeking help for a substance abuse disorder, and made a significant impact on their treatment.

Substance use disorders were noted as particularly difficult to treat due to their multifaceted nature. In these studies, the use of AAT was associated with positive therapeutic outcomes such as the contribution to the formation of relationships and social interaction between peers, as well as the facilitation of relationship building between the client and therapist.

AAT has been found to have a variety of uses and benefits. For example, Marcus and colleagues (2012) conducted an open label study in an outpatient tertiary care clinic in which animal assistance was utilized for pain management. The purpose of the study was to explore and evaluate the effects of therapy dog visits on patients’ pain levels (2012).

 The survey method was used to collect data both prior to and post either animal therapy or control session (Marcus et al., 2012). The questionnaire was a self-report of pain, fatigue, and emotional distress, which utilized an 11-point scale (2012). The participants were provided with either an informal animal therapy session, or waited in the waiting room prior to their appointment (2012). The study period was two months, and the results indicated significant improvement across all numeric scales for patients (2012). An important part of the validity of this study was that the sample size was relatively large and diverse (2012). The finding that 23% of patients reported clinically meaningful pain relief after the visit with the therapy dog was a significant outcome of this study, which exhibited the benefits of animals in health care settings (2012).

Additionally, Engelman (2013) reported similar findings when utilizing AAT in palliative care. The study took place over the course of one year, and had 19 participants. Engelman (2013) hypothesized that the use of a therapy dog would positively affect the participants’ physical aspects of pain, as well as suffering components such as emotional factors, grief, and fear of death. This study did not utilize empirical measures; findings were based on the patients’ self-reports, staff responses, and staff observations (2013). It was found that patients felt physical pain relief, emotional relief, and stress reduction as a result of their interactions with the therapy dog (2013). Some limitations of this study were the absence of a control group and the lack of empirical measurement methods (2013). The importance of these findings was that patients suffering from chronic pain and the personal complications stemming from it were positively affected by AAT.

Furthermore, Havey, Vlasses, Vlasses, Ludwig-Beymer, and Hackbarth (2014) examined the effect of AAT on pain medication use after joint replacement surgery. Hospital A had a standardized AAT program in which certified canine-human teams would provide visits to patients upon request (Havey et al., 2014). Hospital B had no AAT program (2014). It was hypothesized that there would be a measurable difference in the amount of pain medication used post-surgery between the patients in hospital A who received AAT and the patients in hospital B (2014).

The participants in this study were patients in a non-academic hospital (A or B) who had received either a hip or knee replacement (Havey et al., 2014). The study utilized a file review system of electronic patient records in order to analyze the levels of pain medication used by each patient, starting on the second day post operation (2014). The amount of pain medication was measured in milligrams by the Mean Morphine Equivalent Daily Dose, or MEDD (2014). A limitation of this study was that it did not account for confounding variables, such as co-morbities, type of anesthesia used, or length of surgical procedure (2014). However, results indicated that the patients who received AAT visits (hospital A) used lower amounts of pain medication than the patients who did not receive AAT (hospital B; 2014). These significant findings displayed a negative correlation between AAT and use of pain medication, meaning that the animal visits were associated with the decreased use of pain medicine.

These studies exhibited the versatility of AAT, as animal assistance was indicated as beneficial for people with physiological ailments such as pain. The presence of AAT was associated with a negative correlation in pain levels and the use of pain medication, as well as other aspects of palliative care such as fear of death and grief.

While the most commonly used animal for therapy was a canine, O’Haire and colleagues (2013) utilized guinea pigs. The researchers’ hypothesis was that children with an autism spectrum disorder (ASD) would demonstrate increased social behaviors and positive emotional displays, as well as decreased problem and self-focused behaviors in sessions with an animal, compared to sessions with toys (2013). Each AAT session included a program facilitator, one child with an ASD, two peers who were noted as typically developing (not having an ASD), and two guinea pigs (2013). Each toy session (control) consisted of the same group of children, facilitator, and a selection of toys (2013).

The level of functioning was measured by two independent observers, who were unaware of the existence of the study or its purpose (O’Haire et al., 2013). The Observation of Human Animal Interaction for Research (OHAIRE) coding system was utilized, which consisted of the identification of the presence or absence of each behavior during ten second intervals (2013). The coding system was found to be valid and reliable (2013).

Results indicated that the participants with an ASD talked more, looked more at human faces, and made more physical contact with people in the presence of animals compared to toys (O’Haire et al., 2013). There were no significant differences in the amount of specific problem behaviors between the toy and animal sessions (2013). Limitations of this study included confounding variables, such as a lack of information about participant cognitive functioning, or IQ (2013). Especially relevant to this literature review was the finding that the presence of animals (guinea pigs), had a positive therapeutic effect on the level of functioning of children with an ASD.

Similarly, Ghorban, Sedigheh, Marzieh, and Yaghoob (2013) found animal-assisted therapy to be beneficial for children with ASDs. The researchers hypothesized that participants in a four week therapeutic horseback riding intervention would demonstrate significant improvement in social skills (Ghorban et al., 2013). The method of measure was the Social Skills Rating Form, a subscale of Triad Social Skills Assessment, which was completed by the parents (2013).

The therapeutic equine program included horseback riding, learning familiarity of the horse and its anatomy, as well as basic care and safety skills (Ghorban et al., 2013). Participants received twice weekly 45-minute sessions over a course of four weeks (2013). It was found that participants significantly improved on subscales of affective understanding/perspective taking, initiating interactions, and maintaining appropriate interactions (2013). Two limitations of this research were the absence of a control group, as well as a small sample size (n=6; 2013). The importance of this study was that it exhibited that the incorporation of animals had a significant positive effect on social skills improvement in children with ASDs (2013).

Conclusions from these studies indicated that AAT was a valuable tool for the treatment of children with an ASD. Animal assistance was associated with an increase in social behaviors and positive displays of emotion, both of which were indicated as problem areas for children with ASDs.

In addition to aiding in the treatment of ASDs, animal assistance was found to be helpful for children with language disorders. Boyer and Mundschenk (2014) explored the use of feline animal-assisted therapy with children who had speech impairments. It was hypothesized that there would be some degree of change in the quality of social communications between a child with a speech impairment and a typically developing peer in response to the animal-assisted therapy (2014). The participants were three females between the ages of four and eight years of age (2014).

The study was 12 weeks long and consisted of 15-minute sessions conducted three times a week with a language impaired child and a typically developing peer (Boyer & Mundschenk, 2014). The sessions were identical in structure and had three manipulated variables, which were alternated across days and sessions (2014). The variables were a toy cat, a real cat, and a favorite toy (2014). In order to assess the validity of the target behaviors outside the therapy room, the children’s teachers used a five point scale to rate the child’s use of response behaviors and verbal interaction opportunities in the classroom (2014). The rating scale was used four times: before the start of the study, at the midpoint of the study, at the conclusion of the study, and one month after the study (2014).The videotaped recordings of each session were also examined by a data coder for social interaction (2014).

Results indicated that two out of the three participants had statistically significant improvements in verbal interactions (Boyer & Mundschenk, 2014). The third participant showed no significant improvement (2014). However, it was noted that the third participant’s data may not have been as accurate due to more than five absences (2014). Limitations of this study included a small sample size (n=3), and a lack of gender diversity (2014). Particularly notable was the finding that children with language impairments responded more successful to speech therapy when an animal was present.

Similarly, Macauley (2006) conducted a pilot study on the use of AAT in speech therapy for patients with aphasia. The participants were three men with aphasia from left-hemisphere stroke who were enrolled in a speech therapy program (2006). The purpose of this study was to examine the effects of speech-language AAT for people with aphasia, and then to compare its effectiveness to the traditional speech therapy (2006).

The formal method of measurement was Western Aphasia Battery, or WAB (Macauley, 2006). The informal method was a client-satisfaction questionnaire, designed to measure each participant’s motivation and attitude towards the therapy sessions (2006). Results from the study indicated that the WAB scores of the patients did not change substantially after the AAT program. However, the questionnaire portion indicated that all of the participants believed that they had progressed more during the AAT sessions (2006). Furthermore, it was noted that during the AAT sessions, the participants initiated speech more often than in the traditional sessions, with most of these informal initiations directed at the dog (2006). Limitations of this study included the small sample size (n=3), and the length of time that had passed since the stroke (a mean of six years; 2006). The study also implicated that further research conducted within the first six months after brain injury would likely reveal more significant differences (2006).

Especially pertinent to this literature review was the finding that participants were more likely to direct their communicative abilities towards the dog than the speech therapist (Macauley, 2006). The importance of this was that it documented that the presence of the dog raised the level of motivation in the patients, and acted as a catalyst for communication (2006). It also suggested that the dog provided an atmosphere of acceptance, as many patients with aphasia tended to be embarrassed about their disordered speech (2006).

These studies explored the use of AAT in occupational therapy for speech disorders in both children and adults. In the children, AAT was associated with an genuine improvement in verbal communications. While the adults’ speech did not actually improve with AAT, their perception of their own progress increased positively. The adult participants, who had experienced left-hemisphere stroke, also initiated verbal interaction more often in AAT sessions, which indicated that they felt more relaxed with an animal present, and less embarrassed about their speech abilities, or lack thereof.

            In addition to aiding occupational therapy, animal assistance was also found to be helpful in psychotherapy for children and adolescents. Lubbe and Scholtz (2013) conducted a case study that pertained to the use of AAT in child psychotherapy. The method of data collection was a document analysis of the case file of a 14-year-old boy (2013). The background noted that his mother had surrendered the child to a safe care facility, and his father was incarcerated (2013). The child also had a history of difficulty in cooperating with previous therapists (2013).  It was noted that the child, Brandon (a pseudonym), did not answer any questions or initiate any conversation in sessions. Furthermore, he pulled his sweatshirt hood over his head to cover as much of his face as possible (2013). However, when the counselor brought her therapy dog, Moxie, to the fourth session, she noted that his demeanor immediately changed, and he smiled (2013).  This was the beginning of his positive therapeutic progression. Moxie assisted Brandon in dealing with some very painful emotional issues by serving as a safe medium between him and the therapist.

Five themes were identified through the course of his treatment: “facilitating relationship building, enabling communication, experiencing physical affection through the therapy dog, socialization skills, and enhanced self-esteem” (Lubbe & Scholtz, 2013, p. 120). It was concluded that Moxie stimulated his progression in each of these themes. A meaningful implication for the field of child psychology was the indication that Brandon felt more at ease with an animal present, and allowed Moxie to act as a catalyst for the formation of a personal and caring relationship with his therapist (2013).

Additionally, Lange, Cox, Bernert, and Jenkins (2007) explored the use of AAT in a 12 week anger management group for adolescents, in which a four-year-old Golden Retriever was utilized. The researchers hypothesized that the presence of the dog would assist in the overall success and therapeutic value of the group (Lange et al., 2007). The participants consisted of five adolescents between the ages of 13 and 16 – three males and two females (2007). One of the methods used for collecting data was observational, in which the lead facilitator of the group recorded progress and notable behavior in the clients (2007). The other method was an interview with three of the group members at the conclusion of the 12-week period (two clients were unavailable for the interview; 2007). The recorded interview was conducted to explore the clients’ experience of having a dog in their counseling group (2007).

The researchers cross compared their clinical observations with the information from the interviews and found that the results were consistent with their predictions (Lange et al., 2007). Beneficial effects of having the dog in the sessions included: a calming effect on the adolescents, humor relief during sessions, increased feelings of safety within the group, higher levels of empathy, and motivation to continue attending the group (2007). Additionally, the researchers took steps to protect against observer bias by having the transcript of the interview analyzed by an independent party. The major limitation of this study was that it was not quantitative and had no control group, meaning that there was no way to show concrete numerical correlations. The other limitation was that the sample size was very small (n=5) so it could not be viewed as fully representative. The significance of this study was that it found AAT to have a positive effect on adolescents in an anger management group.

Additionally, Kemp, Signal, Botros, Taylor, and Prentice (2014) explored the benefits of animal therapy in helping adolescents who had been sexually abused. All of the participants were assessed three times: upon intake, before any counseling [Time 1], after in-clinic counseling but prior to beginning equine assisted therapy (EFT) [Time 2], and at completion of the EFT program (Time 3; Kemp et al., 2014). The researchers’ hypothesis was that compared to the data collected at Time 1 and 2,  psychometric data collected at the completion of EFT [Time 3] would show significantly fewer symptoms of trauma, internal and externalized behaviors, as well as lower scores on measures of depression and anxiety (2014). The researchers also hypothesized that participants’ change in scores from Time 2 to Time 3 would reveal more significant improvements when compared to the change in scores between Time 1 and 2 (2014).

The children’s improvement was measured using the self-report Children’s Depression Inventory (CDI) and the caregiver reported Child Behavior Checklist (CBC; Kemp et al., 2014). The adolescents’ improvement was assessed using the Trauma Symptom Checklist, the Beck Depression Inventory, and the Beck Anxiety Inventory, all of which were self-report questionnaires (2014). The in-clinic counseling consisted of weekly individual sessions for an average of 6.5 weeks (2013). The EFT was a group program that took place for 90 minutes, once a week, for nine to ten weeks (2014). The EFT consisted of dynamic exercises with horses designed to address issues such as: trust, communication, boundaries, observation, body language, attitude and self-perception (2014).

It was found that both the children and adolescents displayed significant improvement in reduction of trauma symptoms, and internal and externalized behaviors, as well as lowered levels of depression and anxiety (Kemp et al., 2014). The major limitations of this research were confounding variables related to the children and adolescents’ positive change in daily life such as: appropriate living arrangements, absence of abuse, and adequate nutrition (2014). The significance of this study was the finding that animal assistance was more effective than traditional therapy in aiding the treatment of children and adolescents who had been sexually abused (2014).

In addition to aiding victims of sexual abuse, equine therapy was also found to help at-risk youth. Burgon (2011) recounted the positive experiences of seven at-risk youths in an equine therapy program. The hypothesis was that the youths involved would benefit from the equine therapy (2011). The results of this study suggested that the relationships and experiences the participants had with the horses correlated directly to them gaining social competence, empathy, sense of purpose and future, mastery, self-efficacy, self-confidence, and self-esteem (2011). The primary limitation was that the sample was so small (n=7) that it alone could not be indicative of the perceived psychosocial benefits of equine therapy (2011). The significance of this study was the finding that equine therapy had a profoundly positive effect on the seven at-risk youths.

Similarly, Trotter, Chandler, Goodwin-Bond, and Casey (2008) also explored the positive effects of AAT on high-risk youth. Their hypothesis was that there would be measurable differences in the therapeutic progress of at risk-youth when comparing equine assisted counseling (EAC) to traditional classroom based counseling (RD; Trotter et al., 2008). Therapeutic progress was measured by the Behavioral Assessment System for Children (BASC), a self-rating scale (SRS), and a parent rating scale (PRS) administered pre and post treatment (2008). The EAC group met for two hours each week, for a duration of 12 weeks (2008). The RD group met for one hour each week, also for 12 weeks (2008). The EAC course of treatment took place at a local ranch, and consisted of group interactions with horses in order to facilitate the prevention and resolution of emotional and behavioral problems (2008). The RD course of treatment was provided at Kid’s Connection, an indoor school-based group counseling program (2008).

There were significant differences in the amount of therapeutic progress made by the participants in the EAC group when compared to the RD group. The BASC, SRS and PRS results depicted statistically significant improvements in 17 behavior areas in the EAC group, while the RD group showed statistically significant improvement in only five areas (Trotter et al., 2008). A limitation of this study was the difference in hours of counseling received; the EAC group received two hours weekly while the RD group received one (2008). The importance of this study was that the data clearly exhibited the superiority of animal assistance in counseling when compared to traditional classroom based counseling techniques (2008).

Likewise, Klontz, Bivens, Leinart, and Klontz (2007) conducted a longitudinal clinical trial of equine assisted experiential therapy (EAET) and had comparable findings. Their hypothesis was that the severity of general symptoms in youth in residential treatment would decrease following equine intervention (Klontz et al., 2007). The program consisted of 28 hours of EAET with the goal of working through unresolved issues, reliving psychological stress, living more fully in the present, and changing destructive patterns of behavior (2007). The symptoms were examined by two self-reporting measures, the Brief Symptom Inventory (BSI) and the Personal Orientation Inventory (POI; 2007). The questionnaires were completed before treatment, on the final day of treatment, and six months after the treatment (2007).

Participants exhibited significant and stable reductions in overall psychological distress as well as improvements in psychological well-being, from pre-test to post-test and through the follow-up period (Klontz et al., 2007). The participants also reported fewer psychological symptoms, in addition to improvement in the areas that the therapy targeted (2007). Limitations included a lack of control group, and a non-random sample (2007). The significance of this study was that it exhibited the production of lasting positive therapeutic outcomes through the utilization of AAT.

Numerous studies indicated the benefits of AAT in psychotherapy, in particular for those who were deemed to be “at risk”. Most significant was the finding that the presence of an animal acted as a catalyst for the formation of a trusting relationship with the therapist, which largely contributed to the clients’ positive progress in therapy.

In addition to helping at-risk youth, animal therapy was found to be beneficial in aiding hospitalized children. Tsai, Friedman, and Thomas (2010) explored the effects of animal assisted therapy on a sample of hospitalized youth (n=15). Researchers hypothesized that animal assisted therapy would produce positive effects on cardiovascular responses, anxiety, and medical fear in the children (Tsai et al., 2010). Self-reported fear was measured by the Child Medical Fear Scale (CMFS), while self-reported anxiety was measured by the State-Anxiety scale from the State-Trait Anxiety Inventory for Children (STAI-C; 2010). The child either received six to ten minutes of AAT, or a human visitor who brought a puzzle to complete (2010). The questionnaires were completed after each type of visit (2010). Blood pressure and heart rate were recorded every two minutes starting six minutes before the visit and ending six minutes after the conclusion of the visit (2010).

Physiological outcomes in the AAT visits were superior to the control intervention, as there was a measured decrease in systolic blood pressure that continued after the visit was over (Tsai et al., 2010). However, there were no significant differences in fear or anxiety levels between the two groups (2010). A limitation of this study was the confounding variable of whether or not the children had been hospitalized previously or routinely, which may have either added to or decreased their level of psychological distress (2010). The importance of this study was the finding that AAT visits decreased physiological symptoms of stress in hospitalized children (2010).

A popular tactic used in psychotherapy has been identified as cognitive behavioral therapy, or CBT. Hunt and Chizkov (2014) examined the effects of having a dog present on process variables related to CBT, such as emotional stimulation, and cognitive change. The participants consisted of 107 undergraduates at the University of Pennsylvania and were divided into an experiment and a control group for each of the two expressive writing activities (2014). Over the course of three daily sessions, one group was instructed to write about a negative or traumatic event, while the other group was instructed to describe the furnishings of different rooms (2014). AAT consisted of the presence of a dog in the room where the writing assignment was being completed (2014). The researchers hypothesized that there would be some difference in the process variables in relation to the presence of a dog (2014).

Before the first writing session, participants completed self-report measures to assess baseline levels of depressive symptoms, dimensions of personality, pet attachment, anxiety, and affect (Hunt & Chizkov, 2014). Immediately after writing, the students completed the Spielberger State Anxiety Inventory (STAI) and the Positive and Negative Affect Scale (PANAS; 2014). Two weeks after their first session, participants completed these questionnaires again, in addition to the Beck Depression Inventory (BDI; 2014). Examination of the results indicated that participants who wrote trauma essays with the dog present had significantly lower levels of anxiety and emotional distress than those who wrote trauma essays without a dog present (2014). In addition, the difference in scores of the baseline and two week follow-up questionnaires indicated that the participants who had the dog present while completing the trauma writing task showed an overall decrease in depressive symptoms across time in comparison to the control group (2014).

A limitation of this study was that the participants were self-selected, and students may have been more likely to sign up if they liked dogs, which therefore decreased the generalizability of the results (Hunt & Chizkov, 2014). However, the findings indicated that the presence of a dog was related to emotional wellness and decreased negative symptoms in students writing about traumatic or unpleasant events (2014). Especially relevant to the field of psychology was the suggestion that animals have the potential to be beneficial to the therapeutic recovery of trauma victims, as well as promote their emotional well-being across time by increasing the effectiveness of CBT (2014).

Likewise, Gonsález-Ramírez, Ortiz-Jiménez, and Landero-Hernández (2013) explored the use of AAT in CBT groups for stress management. The researchers hypothesized that there would be a measureable difference in the stress levels between the AAT group and the traditional CBT group (Gonsález-Ramírez et al., 2013). Stress levels were measured by the Visual Analog Scale (VAS), the Perceived Stress Scale (PSS), and the Patient Health Questionnaire (PHQ) both pre and post intervention (2013). The two groups were identical in structure and based on CBT for stress management (2013). However, the treatment group utilized certified therapy dogs to assist in the achievement of therapeutic objectives (2013).

The results indicated that while participants in both groups experienced reduction of stress and stress symptoms, those in the animal therapy group experienced only slightly greater reductions than did the control group (Gonsález-Ramírez et al., 2013). However, the major limitation of this study was that there was a significant difference between the control group and the treatment group in terms of the number of participants that were assessed at the final session (2013). When the researchers explored this limitation further, it was found that the primary reason that participants named for maintaining attendance in the AAT group was the presence of the dogs (2013). This finding was especially significant because it indicated that AAT increased the motivation for attendance at the CBT group, which correlated positively with the likelihood of a favorable therapeutic outcome (2013).

Additionally, Campo and Uchino (2013) examined the cardiovascular benefits of AAT in comparison to visitation with a close friend. The researchers hypothesized that cardiovascular responses would be at least equivalent when comparing the participants who had their companion animal present to those who had their close friend present (2013). The participants (n=159) were randomly assigned to either have a same-sex friend present, their pet present, or be alone during the stress activities (one passive coping task and one active coping task; 2013). Physiological symptoms of stress such as systolic blood pressure (SBP), diastolic blood pressure (DBP), and heart rate (HR) were measured continuously during the baseline, the stressor, and the recovery period (eight minutes post activity; 2013).

Results indicated that the participants with their dog present had lower DBP and HR than the participants who had a close friend present during the stress task (Campo & Uchino, 2013). Additionally, the dog participants had lower SBP and HR during the eight minute recovery period when compared to the participants with a friend present (2013). It was noted that a limitation of this study was that the participants were relatively young and healthy, and did not have cardiovascular problems (2013). The relevance of this study was that it was demonstrated that companion animals provided cardiovascular benefits for their owners during and after stress that were superior to the benefits provided by a close human friend (2013).

Additionally, Beck and colleagues (2012) examined the effects of AAT on veterans who had been injured in combat. The researchers sought to determine what effect, if any, AAT had on the levels of stress, resilience, and fatigue, as well as daily function and mood state of wounded veterans who were participating in an occupational therapy (OT) Life Skills Program (2012). The participants (n=24) were stationed at an Army Warrior Transition Unit (WTU) for treatment (2012). The dependent variables were measured three times (baseline, four weeks post baseline, and eight weeks post baseline) by the following self-assessment questionnaires: Profile of Mood States (POMS), Perceived Stress Scale (PSS), Connor-Davidson Resilience Scale (CD-RISC), Fatigue Scale, Functional Statues Questionnaire (FSQ), and The Occupational Self-Assessment (OSA; 2012)

Participants of both groups attended OT Life Skills classes identical in structure and content (Beck, et al., 2012). However, the participants of the AAT group received 30 minutes of one on one time with a dog following each Life Skills class (2012). Results indicated that there were no significant differences between the control and treatment groups across the variables that were measured (2012). However, it was noted that several participants reported feeling more calm and at ease after the AAT sessions (2012). Furthermore, the therapy dogs were often a topic of conversation between service members, their families, and the staff (2012). The significance of this was that the AAT served as a catalyst for the formation and sustentation of healthy social relationships, an aspect that has been known to increase the likelihood of positive therapeutic outcomes among combat veterans (2012).

Numerous and diverse studies have examined the effect of AAT on stress and anxiety, both psychological and physiological. While a portion of the research has focused on the negative correlation between AAT and symptoms of stress in veterans, animal assistance has also been associated with a positive effect on the stress levels of regular civilians, including children.

Additionally, Mullett (2008) discussed the benefits of animals in healthcare settings and described the different forms of therapeutic intervention with animals. Naturalistic observations from registered nurses were also included in this article. In addition, the risks involved with AAT were discussed, such as allergies to the animal, or transmission of disease (2008). The latter point was addressed by emphasizing the importance of animal vaccination upkeep, proper hand washing for humans, and regular visits to the veterinarian (2008). The pertinence of this article was that it pointed out the positive experiences patients had with therapy animals in hospital settings, as observed by hospital staff and family members.

O’Callaghan and Chandler (2011) examined the use of animal assisted interventions by mental health professionals. The purpose of this study was to determine which AAT techniques were utilized by mental health professionals, how frequently they used these techniques, and what their intention was in using them (2011). The survey method was used to collect data, and was constructed based on information obtained in an extensive literature review; which identified 18 techniques, and 10 intentions (2011). Their hypothesis was that there would be some techniques that were used more often than others, the study sought to explore this (2011). The participants were licensed mental health professionals in the United States that practiced AAT (n=31; 2011). The results of the survey indicated that the most common techniques used in AAT were:

Counselor reflects/comments on client’s relationship with therapy animal

Counselor encourages client to interact with therapy animal by touching or petting

Counselor comments or reflects on spontaneous client-animal interactions

Counselor has therapy animal present without any directive interventions

Counselor allows therapy animal to engage with client in spontaneous moments that facilitate therapeutic discussion. (O’Callaghan & Chandler, 2011, p. 93)

Additionally, O’Callaghan and Chandler found that the technique of “counselor reflects/comments on client’s relationship with therapy animal” (p.93) was the most frequently used among mental health professionals, as 90.3% of participants reported that they used this technique often or always (2011). The most commonly stated purpose for the use of AAT was to “build a rapport in the therapeutic relationship” (2011, p. 93).

A limitation of this study was the inability to identify the target population, which stemmed from a lack of databases and resources that cataloged therapists who practiced AAT (O’Callaghan & Chandler, 2011). The importance of this specific study was that it described how mental health professionals successfully incorporated therapy animals into their practice, and their reasons behind that incorporation.

In order to examine the history and evolution of AAT, Behling and colleagues (2011) compared the use of animal therapy in 1990 to the use in 2010. The purpose of this study was to explore how the practice and use of AAT had evolved over a period of 20 years (2011). The process of collecting data was the survey method, in the form of a self-administered questionnaire completed by the different facilities (2011). Results indicated that there was approximately the same amount of animal contact, whether it be AAA, AAV, and/or AAT in 2010 as there was in 1990 (2011). However, there was a significant increase in the number of requests from staff for animal programs, as the programs were continually perceived as having benefits for the residents, both psychological and physiological (2011). There was also a statistically significant increase in the number of facilities that had formal procedures and policies surrounding animal programs (2011). However, it was mentioned that between 1990 and 2010, the further development of organizations whose specific purpose was the delivery of animal visitation or AAT had aided in the accessibility of these programs (2011).

A limitation of this study was the unequal sample size of facilities that participated in the original 1990 survey and the more recent one. In 1990, the number of facilities that completed the questionnaire was 233; in 2010, only 61 facilities completed it (2011). This decreased the amount of information researchers had to draw conclusions on, which therefore decreased the reliability of results. Especially significant to this literature review was the finding that animal programs were being more fully recognized as having an important function within long-term care facilities (2011). Although the quantitative use of animal programs in long-term facilities was about the same as twenty years prior, the significant increase in requests by staff and family members suggested that the benefits of animal assistance had been clearly identified by those closest to the residents (2011).

Additionally, Rabbitt, Kazdin, and Hong (2014) examined the acceptability and attitudes toward animal-assisted therapy for the treatment of behavioral problems in children. The researchers had three hypotheses before beginning this study: that AAT would be a highly acceptable form of treatment, that AAT would be equally as acceptable as psychotherapy, and that AAT would be more acceptable than medication and also than no formal treatment (Rabbitt et al., 2014). The sample (n=189) consisted of parents who had a child under the age of 18-years-old (2014). The participants were presented with one of two vignettes each which depicted a child with disruptive behavioral problems (2014). Following each vignette, a brief description of the four treatment options (animal-assisted therapy, medication, psychotherapy, or no treatment) was provided (2014).

The participants rated the acceptability of each treatment using the Treatment Evaluation Inventory (TEI), which measured the degree to which the participants viewed the different treatments as fair, humane, and appropriate for the identified problem (Rabbitt et al., 2014). Results indicated that AAT was seen as highly acceptable and also more acceptable than medication and no formal treatment. However, AAT was viewed as less adequate than the more traditional method of psychotherapy (2014). When considering the number of children who have been placed on medication for behavioral problems such as ADHD, the finding that AAT was seen as more acceptable than medication was a notably significant outcome.

While a substantial portion of this literature review has focused on relatively brief periods of AAT, there were situations in which AAT was more frequent and longitudinal. Foreman and Crosson (2012) detailed some of the training procedures for service dogs, as well as the implementation of these dogs for wounded veterans. The National Education for Assistance Dog Services (NEADS)/Dogs for Deaf and Disabled Americans was noted as an organization dedicated to training service dogs and placing them with a person in need (2012). The dogs in this program entered the program at eight to ten weeks of age, and spent another eight weeks at the Laura J. Niles Early Learning Center, located in Princeton, Mass. (2012). The foundation that was established at the Learning Center was then built upon for a year, either through a foster home or the Prison PUP Program (2012).

The Prison PUP program involved two inmates (a primary and a designated backup) who were responsible for the daily care of the dog, as well as training (Foreman & Crosson, 2012). The inmates were provided with a weekly, two hour session in which training objectives were explained, and ‘homework’ assigned (2012). It was then the inmates’ responsibility to work on the identified tactics throughout the week (2012). It was noted that some of the best-trained dogs came out of the Prison PUP Program as opposed to foster homes, which was presumed to be due to the inmates’ lack of alternative activities (2012). In addition, the dogs in the PUP program provided informal AAT to the inmates by bringing a sense of calm and unconditional love (2012).

While the PUP program has been in existence for 14 years, NEADS was more recently recruited by the Walter Reed Army Medical Center to provide assistance for injured combat veterans (Foreman & Crosson, 2012). There were a few tasks that were commonly identified as difficult for the injured veterans, such as retrieval of dropped objects, and physical support and balance for those with prosthetics (2012). The dogs were noted as invaluable in these situations not only on the physical level, but psychological as well, in sparing the veterans the social embarrassment of possibly falling in public due to loss of balance (2012).

Additionally, anecdotal evidence illustrated that having a service animal reduced the symptoms of PTSD in the veterans (2012). Foreman and Crosson (2012) also pointed out the extensive application and interview process involved with matching a dog with an applicant. Especially pertinent was the overview of how NEADS service dogs were trained and implemented to effectively enhance positive therapeutic outcomes in diverse situations, one of which was injured combat veterans (2012).

These studies constituted a brief overview of AAT as a practice and explored factors that contributed to either the inclusion or exclusion of animal assistance. The findings described the training process for some of the service dogs, as well as the growing recognition of the benefits of AAT and the acceptance of the practice as a valuable treatment tool.

Discussion

The results of this study indicated that the use of animal therapy is beneficial across numerous and diverse settings, and does indeed correlate positively with favorable therapeutic outcomes, both psychological and physiological. One of the most valuable aspects of AAT as indicated by this research is the versatility of the practice, or the ability for it to be applied effectively to treat or improve a multitude of situations. Animal assistance is a multifaceted tool, and because of that, each situation must be carefully evaluated to choose the best possible, and also the most feasible method for therapeutic incorporation of an animal into the client’s specific situation.

Within psychological contexts, one of the settings in which AAT was found to be beneficial was with patients suffering from serious psychiatric disorders, one of which was schizophrenia. Schizophrenia is notoriously difficult to treat due to its multifaceted nature and the chronic severity of the symptoms. Although Schizophrenia is only present in about 1.1% of the population, between 32.5 and 65 billion dollars is spent each year for the treatment of, and other related costs due to the illness (SARDAA, 2014). Considering this, Chu and colleagues’ (2009) finding that inpatients diagnosed with schizophrenia significantly improved on subscales of self-esteem, self-determination, psychiatric symptoms, and emotional symptoms after two months of AAA carries notable significance. Additionally, Aoki and colleagues (2011) used a brain imaging system to determine that AAT was useful in inducing activity in the PFC of patients with mood affective disorders who had been diagnosed as having low cerebral activity. Numerous other studies also found a connection between AAT and improved well-being in psychiatric patients, both adult and adolescent.

Furthermore, it is estimated that the ramifications of illicit drug use costs the United States roughly 193 billion dollars each year (Zobeck, 2014). With this in mind, the finding that animal assistance was beneficial in the treatment and rehabilitation of individuals with substance use disorders is a poignant example of the value of AAT, not only for the individual but for society as whole (Cotzee, et al., 2013; Wesley et al., 2009).

Moreover, AAT was found to have a substantially positive effect on children with an ASD. This is especially significant because autism is considered the fastest growing developmental disability and costs the United States roughly 250 billion dollars each year (Autism Society, 2011). Perhaps most significant across the psychological measure was the nearly unanimous finding that the presence of an animal consistently served as a catalyst for the formation of a healthy relationship between client and therapist, which therefore provided for therapeutic growth and positive outcomes that would not otherwise have occurred.

In addition to psychological outcomes, AAT is beneficial on physiological measures as well. When used in an outpatient pain management clinic, AAT was found to improve the symptoms and stress associated with chronic pain (Marcus et al., 2012). Furthermore, patients who were recovering from a joint replacement surgery that received therapy dog visits used less morphine than those who received no AAT (Havey et al., 2014). As well as pain management, research has also revealed cardiovascular benefits, among others. Campo and Uchino (2013) concluded that having a pet present provided cardiovascular benefits during and after stress activities that were superior to those produced when a close human friend was present.

To summarize, there was not a single study that I reviewed in which the presence of animals did not produce or enhance the degree to which the desired therapy was beneficial or effective. These findings are significant because they implicate AAT as an effective and versatile treatment tool. As of yet, there is no other resource in existence that has the ability to be applied so effectively to such varied, and even contrasting environments and situations. When taking into consideration the substantial amount of time and money that is spent each year on afflictions such as autism, substance use, schizophrenia, etc., the relatively simple incorporation of AAT into traditional treatments is only logical.

However, a weakness of this research is that a number of the studies focused on a relatively small sample of people, which decreased the reliability of the results. Also, the studies in which the measures were observed by independent raters were somewhat biased, as it was obvious which type of therapy or visit the participant was receiving by the visual presence or absence of an animal. Additionally, the confounding variables such as level of family support and a possible predisposed affection for animals were not accounted for. For example, a history of having a positive past experience with a beloved pet could have enhanced the degree to which the participant responded to the goals and directions of the given treatment, which therefore is a threat to the internal validity of this study.

Nonetheless, the fairly large number of studies that I was able to synthesize with similar positive results carries notable significance and speaks to the external validity of my study. When taking into consideration the prominent and consistent results of these studies, it can be concluded that there is indeed a positive correlation between the use of AAT and favorable therapeutic outcomes across a multitude of settings. Due to the overwhelmingly consistent nature of my findings, these results are fairly generalizable and could easily be duplicated in numerous other settings with similar positive results. This is significant because these outcomes exhibit and promote the use of AAT as an effective means of successfully augmenting traditional treatment methods for a variety of diverse issues.

As this literature review was relatively general in its direction of study, further directions could focus on research into specific target areas of interest in using AAT. For example, a longitudinal study (taking place over the span of a year or more) in a specific area, such as pain management, could provide insight and quantitative research data documenting the benefits of AAT. This particular area could further be studied by conducting a file review of electronic patient records, derived from several hospitals, and containing information from numerous and diverse participants. Such information could consist of: whether or not the patient received an AAT visit that day, amount of pain medication administered, and the patient’s self-report of his/her pain level.

Additionally, those findings could further form a foundation for the promotion of AAT as a valuable treatment tool, and consequently be seen as a medical necessity to be covered by major insurances. This in turn would broaden the implementation of such programs in medical, psychological, educational, and veteran institutions and organizations and henceforth improve the effectiveness of treatments and quality of life for those seeking assistance.

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