Animal-Facilitated Therapy in Various Patient Populations

Unconventional Animal Species Participation in Animal-Assisted Interventions and Methods for Measuring Their Experienced Stress

The participation of animals during complementary therapy for humans is a developing area. Dogs and horses are the most frequent partner species in animal-assisted services, but several unconventional species have also been involved, although there is a lack of information about the stress they experience caused by AAS. We conducted a comprehensive literature search, analyzing 135 articles with the purpose of investigating the effects of AAS on unconventional species such as guinea pigs, rabbits, farm animals, alpacas, donkeys, reptiles, aquarium fishes, and dolphins. We found that the relevant articles emphasize investigating the impact of animal-assisted interventions on humans, and they generally report positive outcomes. Limited data is available concerning the potential consequences the interventions may have on the animals. Therefore, it is our conclusion that more extensive studies should be conducted to get adequate information on stress experienced by animals during AAS, such as the measurement of biochemical parameters such as cortisol. Hence, meeting animal welfare considerations in addition to human interests could serve as a basis for the recommended methodology for therapies.

Robot therapy aids mental health in patients with hematological malignancy during hematopoietic stem cell transplantation in a protective isolation unit

Patients with hematological malignancy experience physical and psychological pain, such as a sense of isolation and confinement due to intensive chemotherapy in a protective isolation unit (PIU). We examined whether the intervention of a robotic puppy, aibo (manufactured by Sony), could improve patients' mental health as an alternative therapy for pet therapy, which is not feasible in PIU. This study included 21 patients undergoing allogeneic hematopoietic stem cell transplantation (HSCT) (n = 16) or autologous HSCT (n = 5). The patients were randomly divided into the aibo and control groups. Psychological effects were regularly assessed by measuring the levels of salivary stress hormone chromogranin A (CgA), serum oxytocin, and serum cortisol and the quick Inventory of Depressive Symptomatology Self-Report (QIDS-SR) scores. The aibo group demonstrated a significant decrease in CgA level, while the control group showed the opposite trend. In addition, changes in serum oxytocin and cortisol levels indicated that aibo helped reduce stress. There was no significant difference in the QIDS-SR scores between the two groups; however, the psychomotor activity in the aibo group improved significantly. These findings suggest that aibo intervention during a stay in a PIU can improve the mental health of patients with hematological malignancies who have undergone HSCT.

Unleashing compassionate care: canine-assisted intervention as a promising harm reduction approach to prisonization in Canada and its relevance to forensic psychiatry

In recent years, there has been a global advancement in the offering of canine-assisted interventions (CAI) in prisons. However, these programs have focused primarily on the benefits to the dogs involved and not on the impact on the participants. The authors of this perspective study have been running a CAI program with therapy dogs, called PAWSitive Support, in a Canadian federal prison since 2016. Thoughts from the program facilitators and interviews with prison staff indicate that the program, and specifically the therapy dogs, provides a unique and integrated source of comfort, support, and love for participants. These benefits are consistent with those seen in CAI programs outside of prisons. Unique to the prison setting appears to be an improvement in participant-staff relations. The therapy dogs have helped participants to experience comfort and consequently express their emotions. This seems to contribute to their recognition of support within the prison system and specifically developing trust with staff. Additionally, the dogs have helped to create an experience of the feeling of love within the prison, interpreted as the feeling of being cared for, which is rare for this population. The authors suggest that the integration of a therapy dog intervention in prison could be a novel harm reduction strategy to address issues related to prisonization and associated mental health concerns, including substance use. This consideration can offer unique insight into the field of forensic psychiatry about providing compassionate care to patients.

Activity, Activity Personalization, and Well-Being in Nursing Home Residents With and Without Cognitive Impairment: An Integrative Review

OBJECTIVES

Engagement in personally relevant and pleasant activity is a facet of many theories of well-being. This integrated review and narrative synthesis explored the hypothesis that activity participation improves well-being for nursing home residents.

METHODS

Following Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, we searched MEDLINE, PsycINFO, Academic Search Complete, Psychology and Behavioral Sciences Collection, Embase, and CINAHL for research published between 2006 and 2018. We included peer-reviewed, English-language studies of nursing-home residents, with interventions focused on activities and on well-being or affect outcomes.

RESULTS

After screening, the search yielded 45 studies: 15 reviews of specific activities and 30 empirical articles. We found consistent support for tailored activity interventions and less consistent support for specific or generic activity interventions with the possible exception of music therapy. Research focused on specific activity types had methodological limitations and confounds with activity preferences.

CONCLUSIONS

Participation in activities may improve well-being in residents of nursing homes. Tailored activities are likely to be superior to those provided indiscriminately to all residents.

CLINICAL IMPLICATIONS

Improving quality of life in long-term care should include opportunities to engage in activities; those most effective will be tailored to individuals and no single activity will be effective for everyone.

Animal-Assisted Intervention in Speech-Language Pathology: Practical, Clinical, and Theoretical Considerations

Interest in animal-assisted interventions within the field of communication sciences and disorders is growing. As more clinicians become interested in engaging in animal-assisted therapy (AAT) and more researchers begin to study its potential benefits, it will be critical for all stakeholders to demonstrate knowledge of the standards and qualifications for service delivery as well as the challenges that must be met in developing an evidence base for clinical practice. This review highlights some of the foundational information relevant to AAT in the context of speech-language pathology.

The New Status Quo: Enhancing Access to Human-Animal Interactions to Alleviate Social Isolation & Loneliness in the Time of COVID-19

Access to human-animal interactions (HAI) have been influenced by the COVID-19 pandemic. Service animals that were trained and accustomed to daily access to public places had to adjust to staying at home. Therapy animals and their handlers who previously visited with many of the populations most vulnerable to the virus have had to halt their programming. Professionals who utilize animal-assisted interventions (AAI) have had to develop new strategies for providing goal-oriented care. Even the landscape for companion animals has been significantly altered, leading to behavioral changes and new practices for pet owners and veterinarians. While animals and their human companions face new challenges, our recognition of the power of the human-animal bond (HAB) has grown, as it provides a vital need for connection during this time of isolation. In this paper, we will not only focus on describing the new status quo related to various kinds of animals and the public's access to HAI, but will also offer suggestions for sharing the human-animal bond during a time in which physical connections are limited. Organizational insights from the service and therapy animal fields will be explored, and findings related to the auspiciousness of new initiatives, such as animal-related engagement (ARE), will be presented. Recommendations for people who share their lives with any of these kinds of animals will be made to ensure both human and animal welfare. Finally, future research and best practices will be suggested, so we can empirically understand and develop these revised offerings to ultimately bring HAI to a wider audience than ever before.

Assistance, Service, Emotional Support, and Therapy Dogs

This article focuses on the areas where harnessing the canine's trainability, mobility, and sociability enables their use for aiding and augmenting humans. This area, which is rapidly expanding, has provided life-changing solutions for persons affected by various impairments and disabilities (eg, visual, hearing, physical, mental).

Implementation of Assisted Therapy With Dogs in the Therapeutic Approach to People With Autistic Spectrum Disorder

A holistic intervention is needed for individuals who suffer from autism spectrum disorders. Our objective was to work with these individuals in a multidisciplinary manner through the use of animal-assisted therapy, finding improvements in the experimental group as compared with the control group in the different evaluated areas.

A Commentary about Lessons Learned: Transitioning a Therapy Dog Program Online during the COVID-19 Pandemic

Simple Summary

The purpose of this commentary is to highlight the lessons our team learned through transitioning a university campus’ therapy dog program from being delivered in-person to a novel online format during the COVID-19 pandemic. By connecting therapy dog teams virtually with program participants, we aimed for participants to continue to experience feelings of love, comfort and support as occurred in in-person programming, and gain knowledge about the best evidence surrounding mental health care during a pandemic. Through a combined process-outcome evaluation and subsequent needs assessment of the online program, and reflecting on our collective experiences, we learned several lessons regarding program personnel needs, therapy dog handler training and support requirements, and online programming prerequisites. These learning experiences continue to inform our current delivery of the program online and are applicable to other programs considering the same.

Abstract

In 2015, the University of Saskatchewan PAWS Your Stress Therapy Dog program partnered with St. John Ambulance for therapy dog teams to visit our campus and offer attendees love, comfort and support. We recognized at the start of the COVID-19 pandemic that students, staff and faculty may require mental health support, particularly with the challenges of isolation and loneliness. In response, our team transitioned from an in-person to a novel online format at the start of the COVID-19 pandemic. We designed online content for participants to (1) connect with therapy dogs and experience feelings of love, comfort and support as occurred in in-person programming, and (2) learn about pandemic-specific, evidence-informed mental health knowledge. Our unique approach highlighted what dogs can teach humans about health through their own care and daily activities. From April to June 2020, we developed a website, created 28 Facebook livestreams and 60 pre-recorded videos which featured therapy dogs and handlers, and cross-promoted on various social media platforms. Over three months, first a combined process-outcome evaluation helped us determine whether our activities contributed to the program’s goals. A subsequent needs assessment allowed us to elicit participant preferences for the program moving forward. This commentary reflects on these findings and our teams’ collective experiences to share our key lessons learned related to program personnel needs, therapy dog handler training and support requirements, and online programming prerequisites. This combined understanding is informing our current activities with the virtual program and should be of interest to other therapy dog programs transitioning online.

The effects of assistance dogs on psychosocial health and wellbeing: A systematic literature review

Beyond the functional tasks that assistance dogs are trained for, there is growing literature describing their benefits on the psychosocial health and wellbeing of their handlers. However, this research is not only widely disparate but, despite its growth, has not been reviewed since 2012. Our objective was to identify, summarize, and methodologically evaluate studies quantifying the psychosocial effects of assistance dogs for individuals with physical disabilities. Following PRISMA guidelines, a systematic review was conducted across seven electronic databases. Records were independently screened by two authors. Studies were eligible for inclusion if they assessed outcomes from guide, hearing, medical, or mobility service dogs, if they collected original data on handlers' psychosocial functioning, and if the outcome was measured quantitatively with a validated, standardized measure. Studies on psychiatric service dogs, emotional support dogs, and pet dogs were excluded. Of 1,830 records screened, 24 articles were identified (12 publications, 12 theses) containing 27 studies (15 cross-sectional, 12 longitudinal). Studies assessed the effects of mobility (18), hearing (7), guide (4), and medical (2) assistance dog partnerships with an average sample size of N = 83. An analysis of 147 statistical comparisons across the domains of psychological health, quality of life, social health, and vitality found that 68% of comparisons were null, 30% were positive in the hypothesized direction, and 2% were negative. Positive outcomes included significant effects of having an assistance dog on psychological wellbeing, emotional functioning, self-esteem, and vitality. However, it is of note that several methodological weaknesses of the studies make it difficult to draw any definitive conclusions, including inadequate reporting and a failure to account for moderating or confounding variables. Future research will benefit from stronger methodological rigor and reporting to account for heterogeneity in both humans and assistance dogs as well as continued high-quality replication.

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.

The Best Medicine: Personal Pets and Therapy Animals in the Hospital Setting

Companion animals can have a positive impact on people's health and well-being. Personal pet visitation and animal-assisted interventions (AAIs) can benefit patients' pain, blood pressure, stress, depression, and anxiety, as well as increasing mobility and socialization with staff and families. Implementing personal pet visitation and/or AAI programs requires the involvement of stakeholders from multiple disciplines. AAI is generally well received by staff. Animal presence in the intensive care unit carries few risks for humans and animals but is not risk free. Programs should be designed to minimize these risks. Effective planning can create programs that support patient-centered and family-centered care.

Equine-Assisted Intervention to Improve Perceived Value of Everyday Occupations and Quality of Life in People with Lifelong Neurological Disorders: A Prospective Controlled Study

People with neurological disorders suffer from poor mobility, poor balance, fatigue, isolation and monotonous everyday activities. Studies show that equine-assisted interventions can improve their mobility and balance, but could these kinds of interventions also increase participants’ activity repertoire and self-assessed health, and reduce their fatigue? The study was conducted as a prospective, controlled study with three cohorts followed for one year: intervention group (n = 14), control group Passive (n = 29), and control group Active (n = 147). Participants in the study were affected by neurological disease or injury that limited their opportunities for an active everyday life. The intervention group lacked regular activities outside the home before the intervention, which consisted of riding once a week, led by a certified therapist. Control group Passive lacked regular activities outside the home, while control group Active had several activities outside the home per week. Primary outcome measures were activity repertoire measured with Occupational Value Assessment questionnaire. Secondary outcome measures were global self-assessed health measured with EuroQol-VAS and fatigue measured with Shirom-Melamed Burnout Questionnaire. The intervention group’s activity repertoire and self-assessed health increased significantly compared to both baseline and the control groups. Equine-assisted interventions could help to improve the perceived value of everyday occupations and quality of life, as well as break isolation and increase the activity repertoire of people with neurological disorders.

Parroting patriots: interspecies trauma and becoming-well-together

At a Veterans Affairs (VA) Medical Center in West Los Angeles, traumatised parrots and former soldiers participate in an experimental therapy programme aimed at overcoming the wounds of war and abandonment. Drawing on the work of Giorgio Agamben and Peter Sloterdijk, this article uses the VA parrot therapy programme to develop an interspecies account of trauma in and beyond language that emphasises the dangers of isolation and denaturalisation. Looking after parrots, veterans reacclimate themselves to an alternative mode of existence centred around care for the other. This article reflects on the possibilities for therapeutic encounter-value in processes such as this, where humans and non-humans are 'becoming-well-together'. At stake in these multispecies encounters is a form of care critical for a world filled with too many traumatised beings.

Dog-Assisted Therapy and Dental Anxiety: A Pilot Study

Simple Summary

The participation of animals, specifically dogs, in therapeutic activities has been demonstrated to improve individuals’ physical and mental health. However, few investigations have been carried out in the area of dentistry. This study was conducted to evaluate the effect of dog-assisted therapy for individuals with a history of anxiety related to dental visits. During preventative dental procedures (cleaning), a therapy dog accompanied the participant. After this intervention, people reported lower perceived discomfort at dental visits. The participation of therapy dogs in this area of health could help improve people’s experiences in dental offices.

Abstract

Animal-assisted therapy aimed at improving individuals’ mental or physical health has been widely reported. However, the data on how a therapy dog could help control anxiety during dental procedures is scarce. The objective of this work was to evaluate the effect of dog-assisted therapy on people with a history of dental anxiety while receiving preventive dental treatment. Twelve adults participated (women: n = 11 (91.7%) and men: n = 1 (8.3%), mean age = 31.25 years, D.E. = 5.78). The Corah Dental Anxiety Scale was applied, the patient’s mood was assessed with a Likert scale before and after receiving the dental treatment, and their blood pressure was recorded for each of the three stages of treatment. A therapy dog accompanied the participants during the dental procedure. The main results indicated that a decrease in discomfort was perceived during the intervention, and there was also an improvement in the patient’s evaluation of the experience. The results are based on the decrease in patients’ blood pressure when taken in the middle of the dental treatment.

Pediatric Oncology and Animal-Assisted Interventions: A Systematic Review

Animal-assisted interventions are part of the therapeutic plan in pediatric oncology. This is the first systematic review to summarize the literature and provide insights for new clinical approaches, policy, best practices, and standards. The results underline the potentially beneficial role for pediatric patients, parents, caregivers, and medical staff.

Evaluation of an equine-assisted therapy program for veterans who identify as 'wounded, injured or ill' and their partners

The aim of this study was to evaluate outcomes of an equine-assisted therapy program for Defence Force veterans and their partners across the psychological domains of depression, anxiety, stress, posttraumatic stress, happiness, and quality of life, as well as compare the outcomes of an Individual and Couples program. A non-controlled, within-subjects longitudinal design was utilized with assessment at three time points (pre-intervention, post-intervention, and three months follow-up). Between-subjects analysis with two groups was also conducted to compare the outcomes of the Individual and Couples programs. Participants were recruited from ten programs in 2016 with a total of 47 veterans and partners from both an Individual program (n = 25; veterans only) and a Couples program (n = 22). Outcome measures included the Depression Anxiety Stress Scale-21, Posttraumatic Stress Disorder Checklist for DSM-5, Oxford Happiness Questionnaire, and Quality-of-Life Enjoyment and Satisfaction Questionnaire-Short Form. Paired samples t-tests revealed that within both the Individual and Couples programs, there were significantly fewer psychological symptoms and significantly greater levels of happiness and quality of life at post-intervention compared to pre-intervention. Reduced psychological symptoms were maintained at the three months follow-up for participants of the Couples program only. Independent samples t-tests revealed participants in the Couples program reported significantly less symptoms of depression, stress, and posttraumatic stress disorder (PTSD) at follow-up compared to participants in the Individual program. These results indicate there may only be meaningful benefits for equine-assisted therapy in the reduction of depression, stress, and PTSD symptoms for veterans, if partners are integrated into the intervention.

Animal-Facilitated Therapy Program: Outcomes from Caring Canines, a Program for Patients and Staff on an Inpatient Surgical Oncology Unit

BACKGROUND

Animal-facilitated therapy (AFT) is a complementary medicine intervention. To the authors' knowledge, no study has investigated the benefits of an AFT program in an adult surgical oncology setting.

OBJECTIVES

The purpose of this study is to assess the effects of an AFT program on patients and staff on a surgical oncology unit.

METHODS

A quasiexperimental design was used for the patient group, and a pre-/post-test design was used for the staff group. The intervention involved the AFT program being fully integrated on a surgical inpatient unit. Outcomes included patient-reported symptoms and quality-of-life (QOL) outcomes for patients, as well as professional QOL for staff.

FINDINGS

QOL indicators improved for all patients, and the level of energy at follow-up was significantly higher in the AFT group after adjusting for baseline. For staff, compassion satisfaction was high and burnout was low.

We're Not Just Horsing Around: Creating Innovative Community Clinical Experiences Utilizing Diverse Opportunities

Community nursing clinical experiences are essential to the education of BSN prelicensure students. Because of limited traditional community clinical sites, faculty must identify innovative, nontraditional community sites that provide quality experiences. Faculty at Ohio University identified a unique opportunity to provide a multidisciplinary collaborative community clinical rotation in conjunction with the Center for Therapeutic Riding Center located at the Ohio Horse Park. Nineteen senior BSN students participated in a six-week community clinical experience caring for a variety of vulnerable populations participating in the therapeutic riding program. Faculty and students responded positively to the experience.

Effects of Interactions With Animals On Human Psychological Distress

CONTEXT

Human-animal interaction (HAI) is widely used as a method of reducing psychological distress. However, research findings in support of HAI have not kept pace with the widespread prevalence in practice.

OBJECTIVE

I review and synthesize the quantitative evidence for the influence of HAI on psychological distress and outline future directions for research.

RESULTS

The evidence suggests that HAI has a small-to-medium effect on distress but does not clarify whether animals account for the treatment effects. Research also has not determined whether positive effects observed in circumscribed HAI programs extend to companion animal ownership.

CONCLUSION

HAI research needs to address methodological limitations and expand the focus beyond treatment outcome studies. By increasing our understanding of the processes through which HAI reduces distress, the circumstances under which it is most effective at doing so, and the influence HAI has on the animals, we can enhance the impact of HAI.

A Systematic Review of Animal-Assisted Therapy on Psychosocial Outcomes in People with Intellectual Disability

The aim of the study was to review the literature on animal assisted therapy (AAT) in people with intellectual disabilities (ID) measuring psychosocial outcomes (behavioural, social, cognitive and emotional). Quantitative studies were found through a systematic search that identified studies using AAT in people with ID and measuring psychosocial outcomes (behavioural, cognitive, emotional and social). The quality of studies was assessed using a standardised tool and rated as strong, moderate or weak. Only published articles from peer-reviewed journals were included. No language or age restrictions were applied. Over half of the included studies were identified outside standard database searches (e.g. hand searching reference lists from included articles, references from AAT websites and using Google Scholar and a Grey Literature Database). Ten studies were included in the final review; two were rated as moderate quality and eight were rated as weak quality. Overall there was a positive improvement reported from studies for all psychosocial outcomes (with some cognitive, behavioural, social, emotional components reaching statistical significance p ≤ 0.01). Despite having no age restrictions, the included studies had participants that were mainly children and adolescents, in particular favouring male participants, which may limit generalisation. More rigorous methodology is required to improve the quality of future studies including in the main multicentre randomised designs and improved reporting according to CONSORT criteria. Further research should expand to include adults with ID and specific disorders such as challenging behaviour or mental illness.

Animal-assisted therapy at Mayo Clinic: The time is now

The animal-human bond refers to an emotional, almost existential, relationship between animals and people. From the time of antiquity, domestic animals were an important source of economic vitality, but with the changing cultural landscape, the companion animal has become a faithful friend. Overwhelming anecdotal evidence supports the healing power of this relationship. We summarize the emerging literature on the neurobiochemical and cardiovascular benefits of companion pet ownership. We address the peer-reviewed data from myriad journal articles assessing the impact of the companion animal on the quality and often the length of life of select patients.

Can presence of a dog reduce pain and distress in children during venipuncture?

The aim of this study was to investigate the effectiveness of animal-assisted intervention as distraction for reducing children's pain and distress before, during, and after standard blood collection procedure. Fifty children (ages 4-11 years) undergoing venipuncture were randomly assigned to the experimental group (EG; n = 25) or to the control group (CG; n = 25). The blood collection procedure was carried on the children in the EG arm in the presence of a dog, whereas no dog was present when venipuncture was conducted on children in CG. In both cases, parents accompanied the child in the procedure room. Distress experienced by the child was measured with the Amended Observation Scale of Behavioral Distress, while perceived pain was measured with a visual analog scale or the Wong Baker Scale (Faces Scale); levels of cortisol in blood also were analyzed. Parental anxiety during the procedure was measured with State Trait Anxiety Inventory. Children assigned to the EG group reacted with less distress than children in the CG arm. Furthermore, cortisol levels were lower in the EG group compared with the CG group. There were no significant differences in pain ratings and in the level of parental anxiety. It appears that the presence of dogs during blood draw procedures reduces distress in children.

Setting the One Health agenda and the human-companion animal bond

“One Health”, also called “One Medicine”, began as an initiative advocating greater integration of human and animal medicine, in the 1800s. This concept has recently come to prominence, driven by the recognition that 75% of the newly emerging infectious diseases will arise from animal reservoirs, and that successful control and prevention will require a coordinated human medical and veterinary approach. Consequently, many One Health discussions have centered on the surveillance of animals in order to anticipate the potential emergence of new zoonotic diseases. An area that has been given only cursory mention, are the many ways that small companion animals benefit individual, community and possibly world health. The goal of this paper is to briefly review some of the evidenced-based data concerning the benefits of having companion animals in our lives, focusing on four major areas; cancer, heart disease, autism spectrum disorder (ASD), and the potential positive economic effects of the human-companion animal bond on One Health. Heart disease and cancer are the two leading causes of morbidity and mortality in the world, while ASD is a growing concern, not only for its individual effects, but also for its effect on family units, educational institutions, and its social implications for the community. In addition, these diseases can greatly affect the national and global cost of healthcare, as well as the economic output of a nation. It is therefore important to include and build on the concept of the Human-Animal Bond (HAB) as it relates to healthcare in these areas.