Animal-Assisted Therapy with Farm Animals for Persons with Psychiatric Disorders: Effects on Anxiety and Depression, a Randomized Controlled Trial

The role of animal-assisted programs in physical health improvement of children and adolescents with special education needs - a systematic review

Programs involving animals in therapeutic programs are becoming increasingly prevalent. These programs can vary greatly in their approach, scope, and objectives, and they can significantly impact the development of healthy children and those with various disorders. In this systematic review, we sought to investigate the psychological ramifications of animal-assisted activities (AAA), therapies (AAT), and interventions (AAI). We searched for relevant studies using the EBSCO Discovery Service search engine across 85 databases, utilising appropriate keywords. Our search generated 262 results, of which 21 were selected for inclusion after title and abstract screening, as well as full-text analysis. Our findings indicate that dogs and horses are animal-assisted programs' most commonly used animals. Additionally, autism, cerebral palsy, and ADHD were found to be overrepresented in these programs. Furthermore, the length of sessions and overall program duration exhibited considerable variation, regardless of patient age or disease type. The principal measures centred on the physiological variables related to the nervous system and motorium-related indicators. The studies were generally of exceptional methodological soundness. Frequently, the studies narrowed their scope to a single segment or just the child or adolescent, but the outcomes lacked contextual interpretation. Expanding the range of studies by comparing psychological and physiological indicators and conducting follow-up analysis with a longitudinal design would be beneficial.

Putting the Ducks in a Row: Development of a Duck-assisted Green Care Intervention for Persons with Traumatic Brain Injury

Green Care therapies are defined as the engagement of a patient with the nature, exposing patients to a nature based therapeutic setting that may facilitate their recovery. Such therapies became popular at the end of the twentieth century. This therapeutic approach may include therapeutic horticulture, nature therapies, care farming, facilitated exercise, and animal-assisted therapies with farm animals (AATF). This paper describes the processes of planning and creating an AATF-based clinical intervention wherein persons with TBI interacted with ducks (in twice weekly, 1-hour groups) for 12 wk at a TBI rehabilitation facility. The discussion includes site identification, stakeholder engagement, intervention design and human and animal safety procedures. The research methods, theoretical framework, ethical consideration, and risk reduction strategies for human participants and ducks are discussed. Also, description of challenges and blueprints of possible solutions for other researchers interested in developing similar initiatives. This program will serve as a study site for examining effects of AATF-based interventions on self-efficacy, depression, and anxiety in persons with TBI. If the study suggests that AATF interventions with ducks may lead to positive changes, the proposed study will be followed with studies that include larger samples at multiple sites. Findings in this paper may contribute to the implementation science body of knowledge. Because of that, the information in this paper may benefit the researchers outside of the healthcare arena. From that perspective methods described in this paper may help to develop studies that focus on policy development, program expansion, or individual project implementation.

Oxytocin levels and self-reported anxiety during interactions between humans and cows

Introduction

Positive social interactions with farm animals may have therapeutic benefits on humans by increasing brain oxytocin secretion, as inferred from circulating oxytocin levels. The aim of this observational study was to investigate acute changes in human plasma oxytocin levels and state anxiety associated with interactions with dairy cows.

Methods

Data were collected from 18 healthy female nursing students who performed stroking and brushing of an unfamiliar cow for 15 min. Blood samples were drawn before entering the cowshed (T1, baseline), and after 5 (T2) and 15 (T3) min of interaction with a cow. At T1 and T3, the students filled out the Norwegian version of the Spielberger State-Trait Anxiety Inventory-State Subscale (STAI-SS).

Results

Across participants, no significant changes in average plasma oxytocin concentration were detected between time points (p>0.05). There was, however, a modest decline in the STAI-SS scores between T1 and T3 (p=0.015) and a positive correlation between the change in individual level of state anxiety between T1 and T3 and the change in OT concentration of the same individual between T2 and T3 (p = 0.045).

Discussion

The results suggest that friendly social interactions with cows are beneficial in lowering state anxiety, but any relationship with release of OT into the circulation was complex and variable across individuals. The acute reduction in state anxiety lends support to the value of interacting with farm animals in the context of Green Care for people with mental health challenges.

Animal-Assisted Green Care Farming for Patients With Mental and Physical Disorders: A Narrative Review

Green care is an umbrella term that includes numerous therapeutic interventions that immerse the patient into nature and natural environments. Animal-assisted therapy (AAT) with farm animals is a component of green care that may benefit patients with mental health disorders. While the majority of research exploring farm AATs originated in Europe, interest in this therapeutic intervention is emerging in the United States. While there are green care farms utilizing animal therapies in the United States, these therapeutic interventions have not been reported in the scientific literature. Further exploration of this topic in the United States may benefit various patient populations and contribute to overall better health care. A literature review found that farm AATs may be beneficial for patients with mental health disorders, but did not identify any studies addressing AAT with farm animals in the context of physical health disorders. This may be a desirable direction for future research.

Leveraging Campus Landscapes for Public Health: A Pilot Study to Understand the Psychological Effects of Urban Sheep Grazing on College Campuses

Since the 1980s, college students in the U.S. have self-reported a decline in their physical and emotional health. With these conditions compounded by the COVID-19 pandemic and its physical distancing restrictions, higher education institutions have an increased responsibility to establish strategic interventions and health-promoting programs for their students. Research collaborations between public health professionals and environmental designers have highlighted the benefits of environmental factors, such as wildlife, street trees, and public parks, on mental health. This pilot project aims to build upon the transdisciplinary dialogue between ecology, design, and public health by examining the social benefits of grazing lawnscape management, which is the practice of using herbivorous livestock to manage turfgrass areas. Through the design of an accessible central campus grazing space for a flock of 25 sheep and use of online questionnaires, a smartphone-based single-item survey, and open-ended feedback given via social media, the UC Davis Sheepmower Project addresses three primary questions: (1) Are there differences in self-reported stress levels and well-being between people who did not watch grazing sheep (no sheepmower group) compared with those who did watch grazing sheep (sheepmower group)? (2) Does holding sheep grazing events create opportunities for education about well-being and engagement with the campus community? (3) Can this type of urban grazing installation ultimately contribute to the overall identity of a college campus? Web-based questionnaire results indicate there is no significant difference in self-reported stress levels between the two groups; however, the moment-in-time smartphone-based single item question suggests that the presence of sheep provides temporary, noticeable relief and enhanced mood for those who observe the animals. Reflections posted on social media suggested that participants found the sheep grazing events fostered feelings of community and placemaking within the campus identity. However, the questionnaire sample indicated the grazing events did not have a significant effect on participants' sense of place or overall campus identity. This transdisciplinary effort breaks down traditionally siloed approaches to human and environmental health and is an example of a whole-systems approach to developing innovative solutions and encouraging applied collective action.

The efficacy of complementary and traditional practice on psychiatric patients with depression symptoms: A meta- analysis study

PURPOSE

This study examined the effect sizes of the complementary and traditional practices on the depressive symptom levels in psychiatric patients DESIGN AND METHODS: The "Health Evidence™ Quality Assessment Tool" and "Comprehensive Meta-Analysis 3" program was used.

FINDINGS

A total of 81 studies with 5934 patients were included. The effect size of the complementary and traditional methods applied to psychiatric patient on depressive symptoms was calculated as d = 0.718 (p = 0.000). According to Cohen, studies have moderate effect size.

PRACTICE IMPLICATIONS

Complementary and traditional practices were found to be significant and effective on depressive symptoms in psychiatric patients.

Exploring Dry-Film FTIR Spectroscopy to Characterize Milk Composition and Subclinical Ketosis throughout a Cow's Lactation

The use of technologies for measurements of health parameters of individual cows may ensure early detection of diseases and maximization of individual cow and herd potential. In the present study, dry-film Fourier transform infrared spectroscopy (FTIR) was evaluated for the purpose of detecting and quantifying milk components during cows’ lactation. This was done in order to investigate if these systematic changes can be used to identify cows experiencing subclinical ketosis. The data included 2329 milk samples from 61 Norwegian Red dairy cows collected during the first 100 days in milk (DIM). The resulting FTIR spectra were used for explorative analyses of the milk composition. Principal component analysis (PCA) was used to search for systematic changes in the milk during the lactation. Partial least squares regression (PLSR) was used to predict the fatty acid (FA) composition of all milk samples and the models obtained were used to evaluate systematic changes in the predicted FA composition during the lactation. The results reveal that systematic changes related to both gross milk composition and fatty acid features can be seen throughout lactation. Differences in the predicted FA composition between cows with subclinical ketosis and normal cows, in particular C14:0 and C18:1cis9, showed that dietary energy deficits may be detected by deviations in distinct fatty acid features.

Nonpharmacological Treatment for Supporting Social Participation of Adults with Depression

BACKGROUND

Social withdrawal is predominantly seen among adults with depression. However, a dearth of reviews exists that explore nonpharmacological treatments, especially occupational therapy (OT) interventions and their effect in promoting social participation. The aim of this research was to review what intervention programs are conducted to support the social participation of adults with depression and their effectiveness.

METHOD

A systematic review was performed wherein relevant articles were searched in PubMed, CINAHL, Wiley Online Library, PsycINFO, and OTseeker databases and AJOT, BJOT, SJOT, and OTMH journals. Only English articles published from January 2010 to December 2018, which tackled intervention for adults aged 20-60 years with depression, were considered. Ten out of 918 studies met the screening criteria.

RESULT

Among the ten studies, the effective intervention programs were categorized as either occupation-based intervention (OBI) or cognitive behavioral therapy-based intervention (CBT-BI). These programs sought the following outcomes: behavioral change in social participation (n = 4), reduction of depression or depressive symptoms (n = 13), life satisfaction (n = 4), and quality of life (QoL) (n = 1). Studies showed moderate (n = 3) to strong (n = 7) level of certainty, whereas they also revealed high to unclear (n = 3) and low (n = 7) risk of bias.

CONCLUSION

Both OBI such as animal-assisted therapy and CBT-BI such as behavioral change program and health education have a strong level of certainty and low risk of bias in promoting social participation by supporting positive behavioral change and reducing depressive symptoms. Furthermore, the sport and exercise program of OBI was popular in encouraging participation and engagement with other people. Other programs were suggested for combined interventions to support social participation, life satisfaction, and QoL.

Bringing human-animal interaction to sport: Potential impacts on athletic performance

To gain an edge in performance, athletes, coaches, trainers, and sport psychologists worldwide leverage findings from psychological research to develop training and performance strategies. The field of sport psychology draws upon research on stress, anxiety, mindfulness, and team building to develop these strategies. Here, we introduce human-animal interaction as a potential area of research that may apply to athletic performance. Structured interactions with animals-particularly therapy dogs-can provide physiological benefits associated with stress and the oxytocin system, psychological benefits for anxiety and motivation, and social benefits through social support. Yet these effects have not yet been systematically investigated in athletes. Integration of human-animal interactions into athletics can occur through animal visitation programmes and resident therapy animal programmes. Integrating human-animal interactions into athletics presents some unique challenges and limitations that must be considered before implementing these programmes, and these interactions are not a panacea that will work in every situation. But, given the amount of human-animal interaction research suggesting benefits in medicine, mental health, and education contexts, it is worthwhile exploring potential benefits not just for athletic performance, but also for injury prevention and recovery.HighlightsHuman-animal interaction is a potential area of research that may apply to athletic performance.Structured interactions with animals can provide physiological, psychological, and social benefits to athletes, through it is not a panacea that will work in every situation.Integrating human-animal interactions into athletics presents some unique challenges and limitations that must be considered before implementing these programs.

Animal-assisted therapy on happiness and life quality of chronic psychiatric patients living in psychiatric residential care homes: a randomized controlled study

BACKGROUND

Psychiatric patients who live in psychiatric residential care homes may often feel a loss of autonomy, decision making, and participation in social activities. They usually have few or no visitors and also do not have any purpose for living. Animals may increase the happiness and quality of life of psychiatric patients. This study aimed to evaluate the effects of Animal-Assisted Therapy (AAT) on happiness and quality of life of chronic psychiatric patients living in psychiatric residential care homes in Tehran, Iran.

METHODS

This randomized controlled trial was conducted with 70 males with a chronic psychiatric disorder who were living in psychiatric residential care homes in Tehran, Iran, in 2016. The patients were randomly selected and divided into animal therapy intervention group and control group. Patients in the intervention group received animal-therapy with a bird for eight weeks. Patients in the control group received no intervention. The Oxford Happiness Inventory evaluated all patients pre and post-intervention. To evaluate life quality, the Wisconsin Quality of Life Index was used. Data were statically analyzed using SPSS Ver.19.0. ANCOVA with pretest statistical control. The significance level was set as p < 0.05.

RESULTS

The mean age in both control and intervention groups were 47.12 and 45.82 years, and the mean age of illness onset for both control and intervention groups was 18.94 and 16.83 years, respectively. The result of this study showed that happiness in the intervention group had significantly increased (p < 0.001). The results also showed that the quality of life in four sub-domains increased significantly.

CONCLUSION

To bring happiness to chronic psychiatric patients living in psychiatric residential care homes is essential and may result in returning them to society and healthy life. The results of this study showed that AAT was helpful for chronic psychiatric patients living in psychiatric residential care homes and not only made them happy but also increased their quality of life.

TRIAL REGISTRATION

This was registered in Iranian Registry of Clinical Trials (IRCT) (clinical trial code: IRCT20101013004922N4. Registered 2018-08-19. Retrospectively registered, https://www.irct.ir/trial/32390.

Interaction and Emotional Connection with Pets: A Descriptive Analysis from Puerto Rico

Simple Summary

The coexistence of humans with pets, and the type and quality of interactions that derive from it, is a growing line of research that covers many scientific disciplines: veterinary sciences, education, psychology, biological sciences, sociology, neuroscience, etc. In this article, we analyze both the characteristics of care for pets and the feelings and emotions involved in the human–pet relationship in the population of Puerto Rico. The sample has been of 1436 people. The most representative results of the research show how pets have a positive impact on the mental health of their owners, because of the emotional connection established, which leads them to experience mainly feelings of love, joy and peace.

Abstract

The study of human–animal interactions has become a prominent research field. The presence of pets in our daily lives has meant a change in the perception of our relationship with pets. One of the new lines of research that has opened up in this area analyzes the possible physical, emotional, and psychological benefits of a human–animal bond. In this context, two main objectives were pursued in this study, whose sample (N = 1436) was investigated in Puerto Rico: (PO1) determining the characteristics of the owners and the care of the pets within Puerto Rican society and (PO2) to analyzing the benefits of living with pets for health and personal well-being, especially at the psychological level. We sought to identify the feelings that arose in pet caretakers as a result of human–animal interactions. The methodology used, which was descriptive and not experimental, was based on a questionnaire of 86 questions with a Likert scale. After the descriptive analysis was undertaken through a frequency analysis, a binary logistic regression was carried out to establish whether the feelings and emotions of the subjects toward their companion pets were determined by sociodemographic variables and were related to the type of coexistence with their pets. The two main results from this study are as follows: for most owners, their pets are very important beings, and those who establish an emotional connection with their pets experience love, joy, and peace. Pets are part of human life through very intense relationships and interactions that, in most cases, increase personal welfare by providing improvements to the human–animal biopsychosocial system. In this sense, a relationship with a pet has a positive impact on the mental health of the owner. Pets are a part of our family lives and are regulators of the most elementary feelings and emotions in humans.

Psychological interventions for antisocial personality disorder

BACKGROUND

Antisocial personality disorder (AsPD) is associated with poor mental health, criminality, substance use and relationship difficulties. This review updates Gibbon 2010 (previous version of the review).

OBJECTIVES

To evaluate the potential benefits and adverse effects of psychological interventions for adults with AsPD.

SEARCH METHODS

We searched CENTRAL, MEDLINE, Embase, 13 other databases and two trials registers up to 5 September 2019. We also searched reference lists and contacted study authors to identify studies.

SELECTION CRITERIA

Randomised controlled trials of adults, where participants with an AsPD or dissocial personality disorder diagnosis comprised at least 75% of the sample randomly allocated to receive a psychological intervention, treatment-as-usual (TAU), waiting list or no treatment. The primary outcomes were aggression, reconviction, global state/functioning, social functioning and adverse events.

DATA COLLECTION AND ANALYSIS

We used standard methodological procedures expected by Cochrane.

MAIN RESULTS

This review includes 19 studies (eight new to this update), comparing a psychological intervention against TAU (also called 'standard Maintenance'(SM) in some studies). Eight of the 18 psychological interventions reported data on our primary outcomes. Four studies focussed exclusively on participants with AsPD, and 15 on subgroups of participants with AsPD. Data were available from only 10 studies involving 605 participants. Eight studies were conducted in the UK and North America, and one each in Iran, Denmark and the Netherlands. Study duration ranged from 4 to 156 weeks (median = 26 weeks). Most participants (75%) were male; the mean age was 35.5 years. Eleven studies (58%) were funded by research councils. Risk of bias was high for 13% of criteria, unclear for 54% and low for 33%. Cognitive behaviour therapy (CBT) + TAU versus TAU One study (52 participants) found no evidence of a difference between CBT + TAU and TAU for physical aggression (odds ratio (OR) 0.92, 95% CI 0.28 to 3.07; low-certainty evidence) for outpatients at 12 months post-intervention. One study (39 participants) found no evidence of a difference between CBT + TAU and TAU for social functioning (mean difference (MD) -1.60 points, 95% CI -5.21 to 2.01; very low-certainty evidence), measured by the Social Functioning Questionnaire (SFQ; range = 0-24), for outpatients at 12 months post-intervention. Impulsive lifestyle counselling (ILC) + TAU versus TAU One study (118 participants) found no evidence of a difference between ILC + TAU and TAU for trait aggression (assessed with Buss-Perry Aggression Questionnaire-Short Form) for outpatients at nine months (MD 0.07, CI -0.35 to 0.49; very low-certainty evidence). One study (142 participants) found no evidence of a difference between ILC + TAU and TAU alone for the adverse event of death (OR 0.40, 95% CI 0.04 to 4.54; very low-certainty evidence) or incarceration (OR 0.70, 95% CI 0.27 to 1.86; very low-certainty evidence) for outpatients between three and nine months follow-up. Contingency management (CM) + SM versus SM One study (83 participants) found evidence that, compared to SM alone, CM + SM may improve social functioning measured by family/social scores on the Addiction Severity Index (ASI; range = 0 (no problems) to 1 (severe problems); MD -0.08, 95% CI -0.14 to -0.02; low-certainty evidence) for outpatients at six months. 'Driving whilst intoxicated' programme (DWI) + incarceration versus incarceration One study (52 participants) found no evidence of a difference between DWI + incarceration and incarceration alone on reconviction rates (hazard ratio 0.56, CI -0.19 to 1.31; very low-certainty evidence) for prisoner participants at 24 months. Schema therapy (ST) versus TAU One study (30 participants in a secure psychiatric hospital, 87% had AsPD diagnosis) found no evidence of a difference between ST and TAU for the number of participants who were reconvicted (OR 2.81, 95% CI 0.11 to 74.56, P = 0.54) at three years. The same study found that ST may be more likely to improve social functioning (assessed by the mean number of days until patients gain unsupervised leave (MD -137.33, 95% CI -271.31 to -3.35) compared to TAU, and no evidence of a difference between the groups for overall adverse events, classified as the number of people experiencing a global negative outcome over a three-year period (OR 0.42, 95% CI 0.08 to 2.19). The certainty of the evidence for all outcomes was very low. Social problem-solving (SPS) + psychoeducation (PE) versus TAU One study (17 participants) found no evidence of a difference between SPS + PE and TAU for participants' level of social functioning (MD -1.60 points, 95% CI -5.43 to 2.23; very low-certainty evidence) assessed with the SFQ at six months post-intervention. Dialectical behaviour therapy versus TAU One study (skewed data, 14 participants) provided very low-certainty, narrative evidence that DBT may reduce the number of self-harm days for outpatients at two months post-intervention compared to TAU. Psychosocial risk management (PSRM; 'Resettle') versus TAU One study (skewed data, 35 participants) found no evidence of a difference between PSRM and TAU for a number of officially recorded offences at one year after release from prison. It also found no evidence of difference between the PSRM and TAU for the adverse event of death during the study period (OR 0.89, 95% CI 0.05 to 14.83, P = 0.94, 72 participants (90% had AsPD), 1 study, very low-certainty evidence).

AUTHORS' CONCLUSIONS

There is very limited evidence available on psychological interventions for adults with AsPD. Few interventions addressed the primary outcomes of this review and, of the eight that did, only three (CM + SM, ST and DBT) showed evidence that the intervention may be more effective than the control condition. No intervention reported compelling evidence of change in antisocial behaviour. Overall, the certainty of the evidence was low or very low, meaning that we have little confidence in the effect estimates reported. The conclusions of this update have not changed from those of the original review, despite the addition of eight new studies. This highlights the ongoing need for further methodologically rigorous studies to yield further data to guide the development and application of psychological interventions for AsPD and may suggest that a new approach is required.

The impact of care farms on quality of life, depression and anxiety among different population groups: A systematic review

Care farming (also called social farming) is the therapeutic use of agricultural and farming practices. Service users and communities supported through care farming include people with learning disabilities, mental and physical health problems, substance misuse, adult offenders, disaffected youth, socially isolated older people and the long term unemployed. Care farming is growing in popularity, especially around Europe. This review aimed to understand the impact of care farming on quality of life, depression and anxiety, on a range of service user groups. It also aimed to explore and explain the way in which care farming might work for different groups. By reviewing interview studies we found that people valued, among other things, being in contact with each other, and feeling a sense of achievement, fulfilment and belonging. Some groups seemed to appreciate different things indicating that different groups may benefit in different ways but, it is unclear if this is due to a difference in the types of activities or the way in which people take different things from the same activity. We found no evidence that care farms improved people's quality of life and some evidence that they might improve depression and anxiety. Larger studies involving single service user groups and fully validated outcome measures are needed to prove more conclusive evidence about the benefits of care farming.

Paws for Thought: A Controlled Study Investigating the Benefits of Interacting with a House-Trained Dog on University Students Mood and Anxiety

Simple Summary

This study investigates whether interacting with a dog would have a positive effect on university students’ mood and anxiety. Students were assigned to either watch videos of a dog or interact directly with a dog. Several measures were collected both before and after their assigned conditions to evaluate their mood and anxiety levels and to assess for possible changes. The results indicated that participants in both conditions experienced a reduction in their anxiety and an improvement in their mood across time, however those who directly interacted with a dog experienced a greater decline in anxiety and improved mood scores.

Abstract

University students have been found to have higher rates of psychological distress than that of the general population, which reportedly rises significantly upon starting university and does not return to pre-university levels throughout their time in university. It is therefore highly important to find ways to improve student health and well-being. One way that may help is by interacting with animals. Therefore, the purpose of this study was to determine whether interacting with a dog would have a positive effect on university students’ mood and anxiety. This study assigned 82 university students to either the experimental condition (dog interaction, n = 41) or to the control condition (dog video, n = 41). The students completed the Positive and Negative Affect Schedule-Expanded Form (PANAS-X), State-Trait Anxiety Inventory (STAI) and the Pet Attitude Scale before their assigned conditions, to evaluate their mood and anxiety levels and attitudes to animals. The participants again completed the STAI and PANAS-X Form after their condition, to assess for possible changes in anxiety and mood. The findings of the study indicated that all participants, regardless of condition, experienced a reduction in their anxiety and an improvement in their mood across time. However, directly interacting with a dog resulted in greater declines in anxiety and improved mood scores, more so than watching a video. Consequently, it appears there are psychological benefits to be gained by students from interacting with dogs and it is hoped this study will help to inform future best practices in designing student dog interventions.

Animal-assisted therapy for schizophrenia and related disorders: A systematic review

Animal-assisted therapy (AAT) is increasingly researched as a potential treatment for physical and mental illness, including schizophrenia. The aim of the current paper is to systematically review randomised controlled trials (RCTs) to assess the effectiveness of AAT for schizophrenia and related disorders. We searched PubMed, PsycINFO, CINAHL, EMBASE, The Cochrane Library, CAB Abstracts, and Web of Science for RCTs of AAT for schizophrenia and related disorders. Primary outcomes were mental state and behaviour, clinical global response, and quality of life and wellbeing. Studies were eligible if they were RCTs that had compared AAT, or other animal-assisted intervention, to any control group using any participants with a clinical diagnosis of schizophrenia (or related disorder), regardless of age, gender, setting, or severity and duration of illness. Seven studies were identified for the review. Meta-analysis was not possible due to heterogeneity of studies, including marked differences in outcome measures and interventions. Five out of seven studies included symptoms as an outcome measure, with one reporting improvements in negative symptoms and one study reporting improvements in positive and emotional symptoms. The remaining studies reported no significant effects of AAT. Three studies included quality of life as an outcome measure but did not find any significant effects. Two studies did, however, report improvements in various measures of self-view. The use of AAT for schizophrenia remains inconclusive and there is currently not enough evidence to draw any firm conclusions due to heterogeneity of studies, risk of bias, and small samples. Rigorous, large-scale RCTs are needed to assess the true impact of AAT on schizophrenia.

A Randomized Controlled Trial of Animal-Assisted Therapy as an Adjunct to Intensive Family Preservation Services

METHOD

Families referred by Child Protective Services ( M _{child age} = 6 years ± 4; M _{parent age} = 32 years ± 8.26) were individually randomized to experimental ( n = 14) or control ( n = 14) intervention. Family functioning outcomes were measured using the North Carolina Family Assessment Scale for Reunification.

RESULTS

All four targeted family functioning outcomes were significantly increased for participants who received animal-assisted therapy as an adjunct to intensive family preservation services ( n = 14) with medium to large effect sizes. These improvements were sustained in two of the subscales through discharge. No significant differences were measured for the distal clinical outcome of disposition of children at discharge.

CONCLUSIONS

Findings suggest that adding animal-assisted therapy as an adjunct can improve evidence-based clinical interventions aimed at enhancing the caregiving contexts of children.

Animal‐assisted therapy, including animal‐assisted activities and resident animals, for improving quality of life in people with stroke

This is a protocol for a Cochrane Review (Intervention). The objectives are as follows:

To assess the effects of animal‐assisted therapy for improving quality of life for people with stroke. A secondary objective is to assess outcomes relating to the feasibility and potential barriers of providing animal‐assisted therapy for stroke patients, including recruitment, cost, adherence, and attrition.

Impact and cost-effectiveness of care farms on health and well-being of offenders on probation: a pilot study

Background

Care farms (CFs), in which all or part of the farm is used for therapeutic purposes, show potential for improving well-being for disadvantaged groups. We assessed the feasibility of determining the cost-effectiveness of CFs in improving quality of life compared with comparator sites among probationers undertaking community orders (COs).

Objectives

(1) To conduct a systematic review of CF impacts and mechanisms in improving health and logic model development; (2) to inform future studies by estimating differences in quality of life and other outcomes, identifying factors driving CO allocation and ways to maximise recruitment and follow-up; and (3) to assess feasibility of cost-effectiveness analysis.

Review methods

A mixed-methods synthesis following Campbell Collaboration guidelines. Pilot study: three probation service regions in England, each with a CF and a comparator CO site. Participants were adult offenders (aged ≥ 18 years) serving COs. The primary outcome was quality of life [as measured via the Clinical Outcome in Routine Evaluation–Outcome Measure (CORE-OM)]. Other outcomes were health behaviours, mental well-being, connectedness to nature and reconvictions.

Data sources

In November 2014, we searched 22 health, education, environmental, criminal justice and social science electronic databases, databases of grey literature and care farming websites across Europe. There were no language restrictions. A full list of databases searched is given in Appendix 1; some examples include Web of Science, Cumulative Index to Nursing and Allied Health Literature (via EBSCOhost), The Campbell Library, Criminal Justice Abstracts (via EBSCOhost), MEDLINE (via Ovid) and Scopus (Elsevier B.V., Amsterdam, the Netherlands).

Results

Our systematic review identified 1659 articles: 14 qualitative, 12 quantitative and one mixed-methods study. Small sample sizes and poor design meant that all were rated as being at a high risk of bias. Components of CFs that potentially improve health are being in a group, the role of the farmer and meaningful work, and interaction with animals. There was a lack of quantitative evidence indicating that CFs improve quality of life and there was weak evidence of improved mental health, self-efficacy, self-esteem, affect and mood. In the pilot study we recruited 134 respondents, and only 21 declined; 37% were allocated to three CFs and the remainder to comparators. This was below our recruitment target of 300. Recruitment proved challenging as a result of the changes in probation (probation trusts were disbanded in 2014) and closure of one CF. We found significant differences between CFs and comparator users: those at CFs were more likely to be male, smokers, substance users, at higher risk of reoffending (a confounder) and have more missing CORE-OM questions. Despite these differences, the use of propensity analysis facilitated comparison. Participants consented to our team accessing, and we were able to link, probation and police reconviction data for 90% of respondents. We gained follow-up questionnaire data from 52% of respondents, including health and social care use cost data. We transformed CORE-OM into CORE-6D, allowing derivation of quality-adjusted life-years. As a pilot, our study was not powered to identify significant differences in outcomes. Qualitatively, we observed that within COs, CFs can be formally recognised as rehabilitative but in practice can be seen as punitive.

Limitations

Changes in probation presented many challenges that limited recruitment and collection of cost data.

Conclusions

Recruitment is likely to be feasible in a more stable probation environment. Retention among probationers is challenging but assessing reconvictions from existing data is feasible. We found worse health and risk of reoffending among offenders at CFs, reflecting the use of CFs by probation to manage challenging offenders.

Future work

A sufficiently powered natural experiment is feasible and of value. Using reconvictions (from police data) as a primary outcome is one solution to challenges with retention. Propensity analysis provides a viable method for comparison despite differences in participants at CFs and comparator sites. However, future work is dependent on stability and support for CFs within probation services.

Study registration

This study is registered as PROSPERO CRD42014013892 and SW2013–04 (the Campbell Collaboration).

Funding details

The National Institute for Health Research Public Health Research programme.

The Efficacy of Dog Assisted Therapy in Detained Drug Users: A Pilot Study in an Italian Attenuated Custody Institute

Drug addiction is a major care and safety challenge in prison context. Nowadays, rehabilitation and specific therapeutic programs are suggested to improve health and well-being of inmates during their detention time and to reduce substance abuse relapse after release from prison. Among these programs, several studies reported the benefits for inmates coming from animal assisted interventions. In this pilot controlled study, we investigated the efficacy of a dog assisted therapy program addressed to 22 drug addicted male inmates housed in an attenuated custody institute in Italy. The study lasted six months, the treated group (12 inmates) was involved once a week for one hour in 20 dog assisted therapy sessions, whereas the control group (10 inmates) followed the standard rehabilitation program. One week before the beginning and one week after the end of the sessions, all inmates involved were submitted to symptom checklist-90-revised and Kennedy axis V. Inmates involved in the dog assisted therapy sessions significantly improved their social skills, reducing craving, anxiety and depression symptoms compared to the control group. Despite the limitation due to the small number of inmates enrolled and to the absence of follow up, we found these results encouraging to the use of dog assisted therapy as co-therapy in drug addicted inmates rehabilitation programs, and we claim the need of more extensive study on this subject.

Exploring the Role of Farm Animals in Providing Care at Care Farms

We explore the role of farm animals in providing care to different types of participants at care farms (e.g., youngsters with behavioural problems, people with severe mental problems and people with dementia). Care farms provide alternative and promising settings where people can interact with animals compared to a therapeutic healthcare setting. We performed a literature review, conducted focus group meetings and carried out secondary data-analysis of qualitative studies involving care farmers and different types of participants. We found that farm animals are important to many participants and have a large number of potential benefits. They can (i) provide meaningful day occupation; (ii) generate valued relationships; (iii) help people master tasks; (iv) provide opportunities for reciprocity; (v) can distract people from them problems; (vi) provide relaxation; (vii) facilitate customized care; (viii) facilitate relationships with other people; (ix) stimulate healthy behavior; (x) contribute to a welcoming environment; (xi) make it possible to experience basic elements of life; and (xii) provide opportunities for reflection and feedback. This shows the multi-facetted importance of interacting with animals on care farms. In this study the types of activities with animals and their value to different types of participants varied. Farm animals are an important element of the care farm environment that can address the care needs of different types of participants.

Mental health rehabilitation in a care farm context: A descriptive review of Norwegian intervention studies

BACKGROUND

C are farming is a service developed at farms for promoting mental and physical health and is increasingly used in mental health rehabilitation in Norway.

OBJECTIVE

This article aims to present a descriptive review of Norwegian intervention research on care farms that provide rehabilitation for people with mental health disorders.

METHODS

This literature review applied a non-systematic search strategy: all articles in the field known to the authors were selected for inclusion. The selected studies were intervention studies that were conducted on farms in Norway, that used adult participants with mental health problems/disorders, and that reported outcome measures related to mental health. The studies and articles presented quantitative and/or qualitative data.

RESULTS

The findings from the published articles report improvements to mental health problems, such as depression, anxiety, perceived stress, positive affect, rumination, and self-efficacy. Qualitative data describe a variety of positive experiences, such as improved coping ability, increased social support, and appreciation of the care farm activity.

CONCLUSION

Participating in interventions on care farms positively influences mental health. Care farming may therefore be used as a supplementary approach in mental health rehabilitation, as it offers meaningful and engaging occupations and social inclusion.

An integrative review of social and occupational factors influencing health and wellbeing

Therapeutic approaches to health and wellbeing have traditionally assumed that meaningful activity or occupation contributes to health and quality of life. Within social psychology, everyday activities and practices that fill our lives are believed to be shaped by structural and systemic factors and in turn these practices can form the basis of social identities. In occupational therapy these everyday activities are called occupations. Occupations can be understood as a contextually bound synthesis of meaningful doing, being, belonging and becoming that influence health and wellbeing. We contend that an integrative review of occupational therapy and social psychology literature will enhance our ability to understand the relationship between social structures, identity and dimensions of occupation by elucidating how they inform one another, and how taken together they augment our understanding of health and wellbeing This review incorporates theoretical and empirical works purposively sampled from databases within EBSCO including CINAHL, psychINFO, psychArticles, and Web of Science. Search terms included: occupation, therapy, social psychology, occupational science, health, wellbeing, identity, structures and combinations of these terms. In presenting this review, we argue that doing, being and belonging may act as an important link to widely acknowledged relationships between social factors and health and wellbeing, and that interventions targeting individual change may be problematic.

From Animal Behavior to Human Health

Abstract. Animal-assisted therapy (AAT) has been shown to be effective in recent meta-analyses with an improvement of mental health, quality of life, and a decrease in the sense of isolation. Reduction of depressive symptoms in human beings is one of the most beneficial outcomes of AAT. For relapse prevention in depression, conventional mindfulness programs such as mindfulness-based Cognitive Therapy(MBCT) proved to be useful, but are often difficult to learn and produce high dropout rates in high risk patients. For this patient group, the teaching of mindfulness skills was facilitated by using sheep in an open pilot study. Six partially or unstable remitted patients with early trauma participated in eight group sessions of a nature and animal-assisted mindfulness training. The approach was feasible and highly accepted by participants with no dropouts. The results show a decrease of depressive symptoms and rumination, an improvement of overall mindfulness skills, but not of acceptance skills. Further studies using randomized controlled designs are warranted.

Farm-based interventions for people with mental disorders: a systematic review of literature

PURPOSE

Farms are increasingly used in mental healthcare. This study aimed to systematically review the evidence on the effectiveness of farm-based interventions for patients with mental disorders.

METHODS

Controlled and uncontrolled studies of farm-based interventions were included. Within- and between group effect sizes were calculated. Qualitative data were summarized using thematic synthesis. The review followed the PRISMA, Cochrane and COREQ standards.

RESULTS

The eleven articles included reported results of five studies, three of which were randomized control trials (RCTs). Overall, 223 patients with depressive disorders, schizophrenia or heterogeneous mental disorders attended three types of farms-based interventions. Favourable effects on clinical status variables were found in one study in patients with depressive disorders that did not respond to medication and/or psychotherapy, and in one RCT in patients with schizophrenia. Assessment of rehabilitative effects (functioning and quality of life) was limited and yielded conflicting results. Patients' experiences revealed that social and occupational components of interventions were perceived as beneficial, and provided insights into how farm-based interventions may facilitate recovery.

CONCLUSIONS

Our results suggest that the farm environment should be considered, especially for patients with mental disorders who do not achieve an adequate response with other treatment options. Further research is needed to clarify potential social and occupational benefits.

Farm animal-assisted intervention: relationship between work and contact with farm animals and change in depression, anxiety, and self-efficacy among persons with clinical depression

Fourteen adults with clinical depression participated twice a week in a 12-week farm animal-assisted intervention consisting of work and contact with dairy cattle. Each participant was video-recorded twice during the intervention, and the recordings were categorized with respect to various work tasks and animal and human contact. Levels of anxiety and depression decreased and self-efficacy increased during the intervention. Interaction with farm animals via work tasks showed a greater potential for improved mental health than via sole animal contact, but only when progress in working skills was achieved, indicating the role of coping experiences for a successful intervention.