Evaluating Stress in Dogs Involved in Animal-Assisted Interventions

The role of dog therapy in clinical recovery and improving quality of life: a randomized, controlled trial

BACKGROUND

Any illness places a significant burden on patients, including deterioration in quality of life. Animal assisted therapy may be helpful in the rehabilitation process and in the treatment of patients to alleviate this phenomenon.

METHODS

A randomized, controlled research was conducted in 2019 and 2020 in a rehabilitation center in Budapest. In our study, the control and experimental groups received the same therapy, but the rehabilitation treatment of the intervention group was complemented by dog therapy. Patients were evaluated by means of the short form Beck Depression Inventory, State-Trait Anxiety Inventory, Illness Intrusiveness Ratings Scale, Visual Analog Scale for pain and the WHO-5 Well-being Index. For statistical analysis paired T-test and ANCOVA was performed.

RESULTS

58 participants in both groups took part in the research. Results confirm that both groups showed statistically significant improvement in all outcome measures, except for depression symptoms in dog therapy group. Quality of life of the participants improved significantly, their pain and anxiety levels were significantly reduced, they felt significantly less burdened by the disease in their daily lives. Therapeutic-dog sessions had a large effect on patients' quality of life and anxiety.

CONCLUSIONS

There is a strong case for animal assisted therapy as a complementary therapy in the rehabilitation program, and it is proposed that consideration should be given to the application of this method on a larger scale within health care. The study was retrospectively registered at ISRCTN Registry (registration number: ISRCTN10208787) on 15/03/2022.

How to Measure Human-Dog Interaction in Dog Assisted Interventions? A Scoping Review

Human-dog interaction is the working tool through which the therapeutic, educational and recreational goals of dog-assisted interventions (DAIs) are achieved. A better understanding of the characteristics of this interaction could improve the effectiveness of DAIs. This scoping review addresses the question: how has the human-dog connection been measured in the context of DAIs? After searching the Web of Science and Scopus platforms, only peer-reviewed, primary research studies reporting measures of therapy dog-human interaction, relationship and bond were included. A total of 70 included articles provided information on what was measured (interaction, relationship or bond) and how, as well as the general context (DAIs or experimental situations with therapy dogs). While the majority of the articles identified use behavioural analysis methods to analyse the interaction between the participant/recipient and the therapy dog during DAIs, it was possible to identify some more structured tools that assess the participant/recipient's interaction, relationship or bond with the therapy dog, as well as tools that consider the animal's perspective or focus on the dog-handler dyad, indicating growing areas of research. The tools and methods identified can be used by both practitioners and researchers to further explore aspects of human-dog interaction in the field of DAIs.

Developing and Planning a Protocol for Implementing Health Promoting Animal Assisted Interventions (AAI) in a Tertiary Health Setting

The Ottawa Charter identifies that multiple levels of government, non-government, community, and other organizations should work together to facilitate health promotion, including in acute settings such as hospitals. We outline a method and protocol to achieve this, namely an Action Research (AR) framework for an Animal Assisted Intervention (AAI) in a tertiary health setting. Dogs Offering Support after Stroke (DOgSS) is an AR study at a major tertiary referral hospital. AAI has been reported to improve mood and quality of life for patients in hospitals. Our project objectives included applying for funding, developing a hospital dog visiting Action Research project, and, subsequent to ethics and governance approvals and finance, undertaking and reporting on the Action Research findings. The Action Research project aimed to investigate whether AAI (dog-visiting) makes a difference to the expressed mood of stroke patients and their informal supports (visiting carers/family/friends), and also the impact these visits have on hospital staff and volunteers, as well as the dog handler and dog involved. We provide our protocol for project management and operations, setting out how the project is conducted from conception to assess human and animal wellbeing and assist subsequent decision-making about introducing dog-visiting to the Stroke Unit. The protocol can be used or adapted by other organizations to try to avoid pitfalls and support health promotion in one of the five important action areas of the Ottawa Charter, namely that of reorienting health services.

Animal-assisted Interventions as an Adjunct to ABA Services: Clinician Practices and Perceptions

Although the popularity of animal-assisted interventions (AAI) continues to increase, an examination of these practices among clinician populations that may incorporate AAI in their clinical services are largely absent from the literature. This study examined the practices and desirability of incorporating animals into ABA services. A total of 544 ABA clinicians completed a web-based survey. Data revealed respondents not only considered incorporating animals into ABA services (n = 307), but almost 20% (n = 107) also reported engaging in this practice. Dogs were reported as the most frequently incorporated animals and an examination of animal sources and prior training revealed substantial variability. Animal incorporation practices were viewed as desirable, feasible, and a majority of respondents reported being interested in AAI implementation. Implications of these results beget a discussion about potential adverse consequences to clients and clinicians that participate in these practices. This discussion includes physical safety risks, financial threats, and potential Behavior Analysis Certification Board (BACB) code violations. Animal welfare concerns, which are often omitted from discussions about AAI, are also discussed to inform clinicians of the added responsibilities that need to be considered. In total, survey results and the accompanying discussion should urge ABA clinicians to pause when considering the incorporation of animals into their clinical practices. No published articles could be found that examine the use of animal incorporation practices within the area of clinical ABA services. Personal and professional risks and animal welfare concerns associated with the utilization of these practices, as identified in this study, should inform programmatic decision-making by clinical practitioners and supervisors interested in engaging in these practices. Results of this survey highlight the potential need for modifications to professional standards and ethical codes of the BACB and state licensing authorities. As this is a novel area of investigation, this article illustrates the need for further empirical evaluation of animal-assisted interventions as an adjunct to ABA services.

Canine-Assisted Interventions and the Relevance of Welfare Assessments for Human Health, and Transmission of Zoonosis: A Literature Review

CAIs (canine-assisted interventions) include "canine-assisted therapy" in which a therapist sets client-oriented goals, 'canine-assisted activities' with recreational goals for clients, and 'canine-assisted education/learning' in which teachers or coaches create learning goals for students or clients. CAIs vary in nearly every way; their only common trait is the involvement of dogs to respond to human need. However, the benefits of involving dogs are highly dependent on the animal's health and behavior. A dog exhibiting negative behavior or an unwell dog might pose a risk, especially for CAI target groups, specifically individuals with immunosuppression, chronic illness, children, elderly, etc. Therefore, positive animal welfare as preventative medicine to avoid incidents or transmission of zoonosis is an attractive hypothesis, with implications for human and animal, health and well-being. This review aims to summarize the current published knowledge regarding different aspects of welfare in CAIs and to discuss their relevance in the light of health and safety in CAI participants. As method for this study, a literature search was conducted (2001-2022) using the Prisma method, describing issues of dog welfare as defined in the Welfare Quality® approach. This welfare assessment tool includes 4 categories related to behavior, health, management, and environment; it was, therefore, applicable to CAIs. Results indicate that dogs working in CAIs are required to cope with diverse variables that can jeopardize their welfare. In conclusion, we propose regular welfare assessments for dogs in CAIs, which would also protect the quality of the CAI sessions and the clients' safety and well-being.

The Importance of Evaluating Positive Welfare Characteristics and Temperament in Working Therapy Dogs

To date, investigations of the welfare of therapy dogs have focused largely on examining physiological and behavioral measures that could indicate if the animal is experiencing stress or distress. However, this approach does not fully address the definition of welfare which is often described as existing on a continuum from negative (or stressful) to positive. With therapy dogs, it would be worth addressing if they experience positive emotional affect while working since the quality and efficacy of animal-assisted interventions for the human recipient is likely to be influenced by the animal's emotional state during the interaction. The purpose of this review is to articulate how objective measurements of the HPA axis and measurements of behavioral observations and standardized questions can be used to evaluate positive welfare in therapy dogs. A potentially relevant indicator of positive welfare is the peripheral concentration of the neurohormone oxytocin, which has been found to increase in systemic circulation within a variety of species during positive social and affiliative contexts, including during human-dog interaction. Oxytocin is also a negative-feedback regulator of the Hypothalamic-Pituitary-Adrenal (HPA) axis, which culminates with the production of the stress hormone cortisol. Cortisol is widely used as a physiological indicator to assess negative welfare states in animals, including therapy dogs. Observable behavior during interactions with humans that may convey enjoyment could provide indicators of positive welfare in dogs such as engagement in play, or human-directed affiliative behaviors including leaning against, nudging, or licking the patient. However, in assessing positive welfare, it is also critical to consider that all animal behavioral displays and physiological responses are dependent on the dog's individual (and breed) temperament. Temperament directly drives how the animal copes and responds to its current physical and social environment, including during stressful situations such as when therapy dogs interact with unfamiliar humans in novel healthcare settings. Coupled with both positive and negative physiological and behavioral welfare indicators, questionnaire data can provide further context to, and enhance interpretations of, therapy dog welfare assessment results. Overall, to date, no studies have measured all of these factors to assess therapy dog welfare.

Personalized Strategy for Animal-Assisted Therapy for Individuals Based on the Emotions Induced by the Images of Different Animal Species and Breeds

Simple Summary

In this study, we hypothesized that the personalized strategies for the animal-assisted therapy (AAT) could be improved by selecting animal species and breeds for individuals (persons) according to the emotions induced in the persons by different animal species and breeds. To our knowledge, this study is the first in the area in which the FaceReader technique has been applied to improve the methodology of AAT, which could be the first step to avoiding and/or minimizing stressful situations during a person’s contact with an animal. To implement the aim, the images of different animal species (dogs, cats, pigs, sheep, and horses) and various breeds of those species were used. This study showed that the animal species is a significant factor in the intensity of the ‘neutral’ and ‘happy’ emotions as well as valence. In addition, animal breed is a significant factor in the intensity of the emotion ‘happy’ and valence. Finally, in this study, we obtained results that could be used as a personalized strategy for improvement of the AAT and to help the individuals select a pet.

Abstract

The aim of this study was to apply the FaceReader technique to select the animal species and breed for a personalized AAT based on the emotions (‘neutral’, ‘happy’, ‘sad’, ‘angry’, ‘surprised’, ‘scared’, ‘disgusted’, and ‘contempt’) induced in the persons (18–64 years old) by the images of different animal species and breeds. To implement the aim, the images of different animal species (Canis familiaris, Felis silvestriscatus, Sus scrofa domesticus, Ovis aries, and Equus caballus) and their breeds (dogs: Australian shepherd, pug, Labrador retriever, Doberman, miniature schnauzer, beagle, three mixed-breed types, Yorkshire terrier, Cane Corso, Samoyed, and Chihuahua; cats: British shorthair, Himalayan cat, three mixed breed types, Siamese cat, Sphynx, and Bengal cat; horses: Norwegian Fjord, Exmoor pony, Andalusian, and Friesian; pigs: Vietnamese pot-bellied and Kunekune; sheep: Herdwick sheep and Suffolk sheep) were used. This study showed that the animal species is a significant factor in the intensity of the emotions ‘neutral’ and ‘happy’ as well as valence, and the animal breed is a significant factor for the emotion ‘happy’ intensity and valence. The obtained results could be used as a personalized strategy for improving AAT and helping the individuals to select a pet.

Handlers' Representations on Therapy Dogs' Welfare

While research on the benefits of animal-assisted interventions is beginning to build a significant body of work, studies on the well-being of therapy dogs are still in their infancy. Since handlers are the people responsible for their therapy dog's welfare, we interviewed 111 French handlers through an online questionnaire. Our results underlined that (i) therapy dogs' welfare is multidimensional when physical and psychological welfare, a balance between work and dog life and the settings and interactions of sessions are all taken into consideration. (ii) The response of our handlers emphasized that considering therapy dog welfare is important for the quality and safety of AAI. (iii) Three categories of risks factors were highlighted: the spatio-temporal framework (planning and environment), the interactions with beneficiaries and the handler themselves. It is particularly important that handlers talk about the negative impact of interactions with beneficiaries since they are at the heart of AAI, however there are few studies focusing on interactions as a stressor for dogs in this practice. Moreover, since there is a potential for positive bias in the handlers' representations, it is important that they be trained to identify and manage the stress in their dogs. Future research is particularly needed on the impact of interactions during sessions on therapy dog welfare.

Recognizing and Mitigating Canine Stress during Animal Assisted Interventions

Animal-assisted Interventions (AAI) proliferated rapidly since clinicians and researchers first noted the positive effects animals have on people struggling with physical and mental health concerns. The intersection of AAI with the field of animal welfare evolved from considering animals’ basic needs, such as freedom from pain, to recognition that animals experience nuanced emotions. Current conceptualizations of the various roles of companion animals as an adjunct to treatments for humans emphasize not only the animals’ physical comfort and autonomy, but also their mental well-being and enjoyment of AAI activities. However, numerous challenges to effective monitoring of animals involved in AAI exist. This article focuses specifically on dogs, highlighting factors that may lead handlers and therapists to miss or ignore canine stress signals during human-animal interactions and offers strategies to recognize and ameliorate dogs’ distress more consistently. The primary goals of this discussion are to summarize the current thinking on canine well-being and to highlight practical applications of animal welfare principles in real-world AAI settings. The paper highlights contextual factors (e.g., physical setting, patient demand), human influences (e.g., desire to help), and intervention characteristics (e.g., presence or absence of a dog-specific advocate) that may promote or inhibit humans’ ability to advocate for therapy dogs during AAI activities. Deidentified examples of each of these factors are discussed, and recommendations are provided to mitigate factors that interfere with timely recognition and amelioration of canine distress.

Therapy Dog Welfare Revisited: A Review of the Literature

During the past decade, the field of human-animal interaction(s) research has been characterized by a significant increase in scientific findings. These data have contributed to our current understanding of how humans may benefit from contact with animals. However, the animal experience of these interactions is still an under-researched area. This paper addresses the welfare of dogs who participate in animal-assisted interventions (AAIs) to improve health in human recipients. This paper builds on previous work by Glenk (2017) and provides an updated review of the literature on therapy dog welfare published from 2017-2021. New advances in scientific methodology, such as the determination of salivary oxytocin, breath rate and tympanic membrane temperature, are analyzed regarding their value and limitations for research in AAIs. Moreover, welfare-related social and environmental factors (e.g., freedom of choice, exploration of novel environments, inequity aversion, individual development, working experience, relationship with handler and handler skills) that profoundly influence dog perception and well-being are reviewed and discussed. Accounting for the globally increasing interest and the number of dogs utilized in AAIs, safeguarding therapy dog well-being, and identifying situations, circumstances and protocols that may challenge animal welfare remains an emerging and crucial area of scientific effort.

How Different Personalities Affect the Reaction to Adoption of Dogs Adopted from a Shelter

Dog shelters provide a valuable service by housing homeless dogs and seeking subsequent adoption for these dogs. Few studies have aimed to monitor the behavior of adopted dogs when adoption is successful. The aim of this study was to detect what behavioral modifications, based on their personality, occurred in dogs after their adoption. The personality of 34 healthy dogs was evaluated in the pre-adoption phase by means of a Principal Component Analysis (PCA) of their behavioral patterns. In the post-adoption phase, we analyzed the behavior of the same dogs, completing a questionnaire with their owners. Pre- and post-adoption data were standardized and a PCA was run on the differences between these variables. A k-means cluster analysis was run on the six components, obtaining three groups of dogs: for groups one and two, changes in behavior after adoption seemed to be influenced by dog personality: bolder dogs (1st group) became more active, excitable and playful, showed increased aggressive behavior towards humans, and decreased anxious and submissive behavior towards dogs and humans; shyer dogs (2nd group) went in the opposite direction, displaying increased aggressive behavior. For the 3rd group, personality was not predictive of behavior changes. All the dog adoptions in this study were successful.

The Impacts of the Presence of an Unfamiliar Dog on Emerging Adults' Physiological and Behavioral Responses Following Social Exclusion

Research indicates that non-human attachment figures may mitigate the negative consequences of social exclusion. In the current experiment, we examined how the presence of an unfamiliar companion dog in the laboratory effects physiological and behavioral reactions in female emerging adults after social exclusion compared to inclusion. Results revealed the beneficial effects of the dog: Socially excluded participants in the company of a dog showed less aggressive behavior in response to the hot sauce paradigm compared to excluded participants in the control condition. Furthermore, cardiac responses indicated mitigated perception of threat in a subsequent insult episode when a dog was present. The presence of a dog did not impact the most instantaneous, "reflexive" response to the social exclusion as revealed by characteristic cardiac changes. Together, the findings indicate that the presence of a companion dog takes effect in a later, reflective period following a social exclusion experience, which implicates relevant social elaboration and appraisal processes.

Evaluating the Effectiveness and Cost-Effectiveness of Seizure Dogs in Persons With Medically Refractory Epilepsy in the Netherlands: Study Protocol for a Stepped Wedge Randomized Controlled Trial (EPISODE)

Background: Epilepsy is associated with a high disease burden, impacting the lives of people with epilepsy and their caregivers and family. Persons with medically refractory epilepsy experience the greatest burden, suffering from profound physical, psychological, and social consequences. Anecdotal evidence suggests these persons may benefit from a seizure dog. As the training of a seizure dog is a substantial investment, their accessibility is limited in the absence of collective reimbursement as is seen in the Netherlands. Despite sustained interest in seizure dogs, scientific knowledge on their benefits and costs remains scarce. To substantiate reimbursement decisions stronger evidence is required. The EPISODE study aims to provide this evidence by evaluating the effectiveness and cost-effectiveness of seizure dogs in adults with medically refractory epilepsy.

Methods: The study is designed as a stepped wedge randomized controlled trial that compares the use of seizure dogs in addition to usual care, with usual care alone. The study includes adults with epilepsy for whom current treatment options failed to achieve seizure freedom. Seizure frequency of participants should be at least two seizures per week, and the seizures should be associated with a high risk of injury or dysfunction. During the 3 year follow-up period, participants receive a seizure dog in a randomized order. Outcome measures are taken at multiple time points both before and after receiving the seizure dog. Seizure frequency is the primary outcome of the study and will be recorded continuously using a seizure diary. Questionnaires measuring seizure severity, quality of life, well-being, resource use, productivity, social participation, and caregiver burden will be completed at baseline and every 3 months thereafter. The study is designed to include a minimum of 25 participants.

Discussion: This protocol describes the first randomized controlled trial on seizure dogs. The study will provide comprehensive data on the effectiveness and cost-effectiveness of seizure dogs in adults with medically refractory epilepsy. Broader benefits of seizure dogs for persons with epilepsy and their caregivers are taken into account, as well as the welfare of the dogs. The findings of the study can be used to inform decision-makers on the reimbursement of seizure dogs.