This is my golden retriever. His name is Levi, and yes, he is a good boy (Figure 1). Dogs are great companions to come home to; their presence diminishes stress, irradiates energy and eases our anxieties. Colleges and universities, Columbia (CUIMC) included, are aware of the positive effects of puppy play times. Collaborating with organizations such as the Good Dog Foundation, Columbia allows students to enjoy the company of a furry friend by bringing in volunteer dogs and their handlers to spend time with students several times each month (“Pet Therapy”). Not only do students benefit from the decease in stress, but medical institutions such as CUIMC have pet programs that allow patients to enjoy a furry companion while receiving care. (“Volunteering for the Dog Therapy Program at New York-Presbyterian”).
The exposure of patients to dogs and other animals is collectively known as “animal-assisted interventions” (AAI). The International Association of Human-Animal Interaction Organizations (IAHAIO) defines AAIs as goal-oriented and structured interventions that incorporate animals in health, education, and human services for the individual’s therapeutic gain (IAHAIO Guidelines). This is actually an umbrella term that can include three separate types of interventions: 1) Animal-Assisted Activities (AAA); 2) Animal-Assisted Therapy (AAT); and 3) Animal-Assisted Education (AAE) (Pet Partners). AAA includes visiting programs in hospitals, memory care facilities, hospice care, stress reduction and at-risk youth sessions. AAT includes the use of animals for assisting therapies such as occupational therapy (OT) and counseling activities, while AAE involves the animal’s contribution to human education and literacy programs. AAI interaction focus on enhancing the physical, cognitive, behavioral, and/or social-emotional functions of the client, which in a hospital setting could be geared towards patients and/or hospital staff. A 2019 study showed that the inclusion of therapy dogs for as little as five minutes of play time per day significantly decreased cognitive stress and anxiety in hospital staff working in emergency medicine (Kline et al., 2020). This study also reported a reduced concentration of cortisol, a known stress hormone, at the end of their shift compared to a short coloring session as an alternate intervention, or no intervention at all.
The inducible benefits of AAI methodologies have been well-studied and in a variety of contexts. The principle of pet-mediated therapeutic benefits was first popularized following a study conducted over 40 years ago (Freidmann et al., 1980). It concluded that, among 92 outpatients receiving cardiac care, individuals who owned pets showed longer survival compared to their non-animal-owner counterparts. Pre-approved therapy dogs alleviate psychophysical conditions such as pain, irregular blood pressure, stress, depression, and anxiety (Barchas et al., 2020). Dog-lovers such as myself can easily comprehend how the feelings of well-being, self-esteem, self-efficacy, and social interactions can increase in patients receiving AAIs. As someone who has been admitted to a hospital and who currently works in the medical field, I recognize issues that many patients, especially long-term patients, struggle with. Indeed, one-third of hospitalized patients experience depression (IsHak et al., 2017), which can worsen patient outcomes and lead to increases in healthcare costs, the length of stay, and the likelihood to be re-admitted. However, one-hour sessions with therapy dogs significantly decrease patient depression and anxiety in one controlled study (Nepps et al., 2019), which was reproduced in sessions as short at 10 minutes (Coakley et al., 2009). Even long-term patients with schizophrenia reported significant increases in self-esteem, self-determination, and positive psychiatric symptoms following 50-minute weekly play sessions with a therapy dog, highlighting the use of AAI as a therapeutic strategy for individuals with chronic mental health illness (Chu et al., 2009).
Emotional and psychological improvements are followed by physical benefits. An occupational therapy (OT) study, for example, showed that 100% of patients reported less pain compared to cohorts that did not receive AAI (Bolden et al., 2017). Similarly, patients with chronic heart failure (CHF) were more compliant and mobile following AAI compared to the historical baseline (Abate et al., 2011). In another study, patients had significant decreases in blood pressure and changes in neurohormones within 5-24 minutes of AAI (Odendaal, 2000). These hormones included beta-endorphins, oxytocin, prolactin, dopamine, phenylacetic acid, all of which are associated with positive interpersonal experiences. Similarly, postoperative children ages 3-17 presented with increased beta waves on electroencephalogram recordings following AAI, which are associated with wakefulness and attention and can potentially decrease recovery time after anesthesia (Calcaterra et al., 2015).
Obviously, there are potential downsides to having animals in hospital settings. Pets can pose sanitary issues which is problematic in a mandatoriy sterile setting. Other risks with AAI fall into five categories: phobias, allergies, fomites (objects contaminated by infectious agents), zoonosis (contracting animal diseases), and traumatic injuries (Barchas et al., 2020). Controlling these potential issues can be relatively easy, however. Screening for phobias and allergies before giving patients access to AAI could be sufficient to avoid negative outcomes. In addition, the ability for dogs to transmit human pathogens from humans to dogs and back to humans, can be is relatively limited to specific diseases requiring isolation. Using physical barriers when appropriate, avoiding licking/kisses to and from the animal, and washing/sterilizing hands before and after each interaction are helpful risk mitigation techniques. To avoid transmitting animal diseases to humans, animals participating in AAI should be healthy, groomed, and bathed before visits. Lastly, to avoid direct injury, animals should be selected for good temperament and be accompanied with a handler (Barchas et al., 2020). These precautionary steps may be worth the compelling benefits to hospital staff and patients, which vastly outweigh the costs to implement said precautions. This seems to be realized in the hospitals as well, as one study found that 100% of staff and patients at a children’s hospital reported zero concerns about safety or sanitation with the therapy dogs (Uglow, 2019).
All of the above studies, and the most common AAI programs, use dogs from volunteer-based organizations. While visits from family pets can similarly improve patient mood and increase motivation to get well (Yamasaki, 2017; Sehr et al., 2013 ), these animals do not necessarily undergo proper therapy training or temperament screenings prior to potential visitations. Future studies should consider the addition of family pets as a separate cohort to measure family versus therapy pet benefits. Dog owners like me, if ever in the hospital, would certainly appreciate getting a visit from their own puppy!
Edited by Andreacarola Urso
References
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