Running Head: THE USE OF PET THERAPY 1

The Use of Pet Therapy Related to the Therapeutic Response in Mental Illness

Perla Diaz, Rachael Huey, Brooke Hunkus, Kali Kerpelis, Christopher Leymarie, Starla Nguyen

Youngstown State University

NURS 3749: Nursing Research

Dr. Kim Ballone

04/08/2020
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Abstract

Complementary therapies are commonly used along with conventional medical treatment in

those with mental health disorders. The purpose of this research was to examine the relationship

between pet therapy and its therapeutic benefits in various mental health disorders. Disorders in

focus in this research include Anxiety, Depression, Autism, Dementia, and Post-traumatic stress

disorder (PTSD). It was found that implementation of pet therapy, or animal therapy, can be

beneficial. Pet therapy helped increase socialization and reduce or control symptoms of mental

illnesses and disorders

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The Use of Pet Therapy Related to the Therapeutic Response in Mental Illness

Did you know that owning a pet has been studied and proven to be beneficial to one’s

mental health? According to the American Pet Products Association (2020), 67 percent of

American households, which amounts to nearly 85 million families, own a pet. In return, these

pets are supporting the mental health of millions. As a nurse, it must be recognized that many

people not only struggle with mental health disorders, but also possibly have an option to use

alternative therapies, such as pet therapy, rather than medication alone. Pet therapy, or otherwise

known as animal-assisted therapy, has been studied to show how the interaction between animals

and humans is beneficial to one’s mental, social, emotional, and physical functions. When

studied in more depth, pet therapy can have a therapeutic response with various mental illnesses.

In mental illnesses, what is the effect of pet therapy on therapeutic response and comfort? This

research examines the relationship between pet therapy and its therapeutic benefits in various

mental health disorders.

Overview on Pet Therapy

Konstantios et. al (2019) describes animal-assisted therapy as “A targeted and structured

therapeutic program that involves animals meeting a specific criteria in the therapeutic process as

an integral and vital part of it, aiming at improving the cognitive, emotional, social and physical

functions of the patient” (1898). The group of doctors and a registered nurse in Greece studied

an animal’s presence as a form of treatment along with the benefits in which they present to

those who have mental illnesses. It is noted that throughout the study, pet therapy is found to be

beneficial and supportive of all age groups. Initially in the study, the group noticed that animals

naturally relieve and relax people from daily stressors. In fact, the patients describe the

environment to be “more friendly and less threatening” with an animal presence which, in turn,
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would create a more relaxed atmosphere. Additionally, the group noticed that the benefits of pet

therapy was directly related to the physical contact, whether it is petting or touching, between the

patient and the pet. Aside from physical touch, the group noticed that when the patients were

around animals, they would release endorphins and serotonin. The release of these chemicals

create both feelings of happiness and calmness. The group studied that animals provided the

patients with the opportunity to participate in physical activities, which released endorphins and

created an increased mood. Simultaneously, stress hormones, such as cortisol and adrenaline,

were reduced. Those with mental illness tend to feel powerless and may rely on others to care for

them. Through the study, the group noticed that even just the presence of an animal encourages

one to care more for themselves and do more daily tasks. With the accomplishment of self-care

and daily tasks, the patient begins to build self-confidence and a sense of self. It is also noted that

mental illness can cause one to be socially withdrawn. The study revealed that animals can make

good companions and proved to help one with improving social skills. In the end, the group

concluded the pet therapy benefits those with mental illnesses with positive changes in mental,

social, emotional, and physical health.

A second study was conducted by Brooks et. al (2016) in Manchester and had focused on

taking a deeper look on the effects of pet related support networks toward mental health

recovery. The group in this study focused more on the importance of a good social network and

how that relates to a positive effect on mental health. The group emphasized the importance of a

social network by stating, “having a support network in place provides options for the

management of living everyday life with a mental health problem”(409). In this case, the study

focused on a group of adults, 18 and older, who were under the care of community-based mental

health services and received a diagnosis from a health professional of having a severe mental
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illness. As opposed to the first study, this study is quantitative and focused on percentages of

how patients ranked their pets in their social network. The group interviewed the participants and

asked them to create a network, using a series of circles, based on what was most important to

them. The central circle was designated for what was most important for the participant, the

second circle was for what was important but not as important as the first circle, and the third

circle was important but not as important as the first two circles. After collecting all the data, the

group determined that 60 percent of the participants recognized their pet as being central and

most important in their life. Meanwhile, 20 percent placed their pet in the second circle, 12

percent in the third circle, and the remaining 8 percent did not place their pet in any of the three.

The group determined that usually, one is able to rely on friends and family for daily support.

When one has weak human relationships, they are able to turn to their pet as an outlet for

companionship, love, and support. They came to this conclusion because those who did not have

close friends or family tended to have an intimate relationship with their pet and placed them as

more important in the social network. Additionally, those who did have strong human

relationships, in turn, either placed their pet on a less important circle or not on the network at

all. With this being said, pets can provide a trusting and supportive relationship for those

suffering with a mental illness that needs support that cannot be given through human

interaction.

Anxiety and Pet Therapy

Anxiety is defined as a feeling of worry, nervousness, or unease, typically about an

imminent event or something with an uncertain outcome. It is the most common of all mental

disorders, and currently affects about one in thirteen people, which equates to 7.3 percent. Pet

therapy is a non pharmacological method that can be utilized in hospitals and outpatient settings
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to help patients to deal with anxiety. It is often used for patients with or at risk for mental health

problems, so it is a perfect method to help alleviate anxieties any patient may have. It is a form

of distraction for the patients and can often ease their anxieties about their diagnoses, any

upcoming surgeries or procedures, or general anxiety (Anxiety and Depression Association of

America, n.d.).

An article written by Hinic et al. (2019), discusses a study they performed to evaluate the

effects of pet therapy visits on anxiety in children who are hospitalized. The sample included

children and adolescents hospitalized at the study site, spoke English, and were between the ages

of six and seventeen years old with no cognitive impairments. Study data collected was through

the STAIC S-Anxiety Scale as well as a researcher generated background and coping

questionnaire. The pets utilized for this study were therapy dogs that regularly visit pediatric

units. The study found that a brief pet therapy visit with the dog was more effective in reducing

state anxiety than a comparative activity such as doing a puzzle. Pet therapy is a distraction

method, and parents of the children hospitalized identify distraction as a strategy that is most

effective for their children to help cope with any stress the hospitalization and procedures give

them. Pet therapy is a technique that gives active, pleasant engagement on the part of the child

and the study also found that parents and families of the children who had the pet therapy visit

had increased satisfaction with their overall hospital experience. This study and its findings show

the significance pet therapy can play on the effects of anxiety on those in the hospital who are

struggling to cope with their diagnoses and upcoming procedures and surgeries.

In another article, Hudson (2016), discusses a study done on pet therapy on alleviating

anxieties in geriatric patients in resident facilities. Geriatric residents often have increased

anxiety and behavior disturbances, and treatments for these are more often than not
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pharmacological. The study sample included geriatric patients from ages 55 to 85 who were

diagnosed with anxiety or behavior symptoms and also live in a facility. Dogs were the pet of

choice for the therapy. The study found that there were improvements in multiple areas,

including anxious moods, tension, fears, insomnia, intellectual function, and depressed mood.

The study found that participants who were previously withdrawn, lacked initiative and had flat

affect, showed to have an increase in interactions with the therapy dog and even with other

participants in the study. Participants ended up being able to initiate feeding and petting the dog,

and even attempting to teach the therapy dog simple tricks. They were often found smiling and

talking about previous experiences with other pets and animals. A lot of participants were sad

when the study was over. This study and its results shows the importance of pet therapy on

anxiety and even on behavioral aspects. It also highlights the importance of non pharmacological

treatment options as opposed to pharmacological treatment options.

Pet therapy is found to be a very significant and important non pharmacological treatment

option to alleviate anxieties in patients in the hospital. This method of treatment is found to help

patients of many ages, ranging from children and adolescents in pediatric facilities to adult and

geriatric patients in resident facilities.

Depression and Pet Therapy

According to the American Psychiatric Association (2017), depression is defined as a

common and serious mental illness that negatively affects how one feels, thinks, and acts.

Depression causes feelings of sadness and/or a loss of interest in activities once enjoyed. It can

lead to a variety of emotional and physical problems and can decrease a person’s ability to

function at work and at home. Symptoms of depression occur for more than two weeks and
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include sadness, disinterest, changes in appetite and sleeping habits, loss of energy, difficulty

thinking or making decisions, and thoughts of suicide.

The relationship between pet therapy and depression has long been considered and

researched. Pet therapy is an alternative method that has been considered and implemented by

those seeking to treat symptoms of depression. Overall, the results of animal assisted therapy

indicates improved mood and reduction in symptoms of depression. When animal assisted

therapy is used with hospitalized patients, studies have also indicated an improvement in the

acceptance of invasive procedures, improvement of the sense of well-being during

hospitalization, reduction of depressive symptoms, and better adaptation to proposed therapies

(Osorio & Silva, 2018). In a study conducted with pediatric oncology patients, a positive impact

on depressive symptoms of patients was observed. After spending only 30 minutes participating

in pet assisted therapy, patients saw significant improvement in pain levels, stress, irritation, and

symptoms of depression (Osorio & Silva, 2018). It was also discovered in this study that

caregivers of pediatric oncology patients experienced a decrease in rates of depression as a result

of pet assisted therapy.

A study conducted with residents of long term care facilities explored the effects of a

companion dog on depression levels of residents in a long term care facility. Eight men and eight

women were randomly selected and assigned to either a control group or an Animal Assisted

Activity group (AAA). The study showed that the residents in the AAA group had a difference in

depression levels (Fenstermaker et al., 2016).

Lastly, a study involving antepartum hospitalized women with high-risk pregnancies

found that pet therapy significantly reduced depression (Journal of Perinatology, 2014). The

psychological effects for these women may be profound due to hospitalization and pregnancy
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complications, all of which has been observed to increase depression (Journal of Perinatology,

2014).

As suggested by the aforementioned studies, there is a positive relationship between pet

therapy and depression. Pet facilitated therapy has been shown to reduce depression. In residents

of long term care facilities, pet therapy reduced depression, stress, and agitation, while increasing

activity, socialization, and providing a sense of touch and warmth. In pediatric oncology patients

and their caregivers, pet therapy was found to have many positive impacts, including a decrease

in pain, cortisol levels and depression (Osorio & Silva, 2018, p. 8). In hospitalized women with

high-risk pregnancies, facing potential complications, pet therapy was shown to decrease

depression, as well. Many studies have indicated that the use of pet therapy reduces symptoms of

depression. This is a positive finding that will have an impact on the alternative therapies used to

treat depression and its symptoms.

Autism and Pet Therapy

The Journal of Autism & Developmental Disorders (2019) describes Autism Spectrum

Disorder as representing a heterogeneous group of neurodevelopmental disorders characterized

by persistent deficits in social communication and social interaction, and by restricted, repetitive

patterns of behavior, interests, or activities It is a spectrum so it is not one condition but each

individual has their own strengths and weaknesses, with their own challenges. Pet Therapy has

been a relatively new intervention for this condition and the results have been positive towards

improving social and verbal communication. And studies have been done with various animals

such as dogs and horses.

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Pet therapy is a modality that has been used for various disorders, and various animals

have been used for each. One example of such is the use of equestrian therapy with Autism

Spectrum Disorder. It has been seen that there have been many benefits to horseback riding in

those with neurodevelopmental disabilities and those without. It has proven to improve balance,

posture, mental well-being, increase self esteem and muscle symmetry (Germone, et al., 2019).

A journal in the Journal of Autism and Developmental Disorders (2019) discussed a study done

with horses and children with autism over a period of six months. The sample of the study

included a total of twenty-eight males between the ages of six to twelve. Each child had a

diagnosis of autism spectrum disorder and were verbal, with an IQ above seventy. The data was

collected using the Vineland Adaptive behavior scale, which measures in four areas:

Communication, Daily Living Skills, Socialization and Motor Skills. These boys were exposed

to horses and did activities with them like grooming, petting and riding them for approximately

an hour a week for six months. The study showed that the children increased in social interaction

with those around them, motor skills and adaptive and executive functioning (Germone, et al.,

2019, pp. 1740-1751). Horses have a positive impact on the social skills and motor functioning

of children with autism.

As earlier mentioned, pet therapy encompasses a variety of animals such as dogs as

mentioned throughout. An article done by the Journal of Autism and Developmental Disorders

(2015) discussed a study done on pediatric patients in a hospitalized psychiatric setting

diagnosed with Autism Spectrum Disorder. There were a total of seventy-five children between

the ages of four and seventeen, group one had forty-eight participants who completed both the

experimental and control conditions. Group two with twenty-two participants on the other hand

completed the experimental conditions only and lastly group three with eight children received
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the control condition only. They were exposed to two-ten-minute conditions: one with an

experimental dog and its adult handler. The other 10-minute control condition with just hospital

supplied toys. This was done to examine if those in these experimental conditions demonstrated

more positive social-communication behaviors when engaged with Animal Assisted Activities

then those with hospital provided toys. The study demonstrated that Animal Assisted Activities

improved the social and communication behaviors in Autism Spectrum Disorder pediatric

patients. They used more verbal and nonverbal gestures. Such as positive facial expressions

(Borgi, et al., 2015). The outcome of this study shows how pet therapy specifically with dogs has

a positive impact on children with autism. These two studies demonstrate the importance of

incorporating animals in treatments of pediatric patients with autism. Bringing a new light to the

use of holistic therapies to treat such a disorder.

Dementia and Pet Therapy

According to the World Health Organization (2019), dementia is a syndrome in which

there is deterioration in cognitive function beyond what might be expected from normal aging. It

affects memory, thinking, orientation, comprehension, learning capacity, language, and

judgement. Alzheimer disease is the most common form of dementia. One aspect of treatment of

dementia involves non-pharmacological treatments and therapies.

Pet therapy, or animal therapy, has been found beneficial. In a study by Wesenberg et al.

(2019), 19 patients with moderate to moderately severe dementia residing in a nursing home

were treated with animal- assisted intervention (AAI) and a control intervention. The study found

the positive effects on pleasure were significantly larger during AAI than during the control

intervention. Longer and more frequent periods of positive emotions and social interactions were
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found with the use of AAI, and the dog appeared to provide a highly compelling stimulus

(Wesenberg et al., 2019).

Animal therapy may help reduce symptoms of dementia. Kårefjärd and Nordgren (2019)

found a decrease in sadness and discomfort, which can be recognized as signs of agitation, in

patients with dementia with the use of dog-assisted interventions (DAI): “If agitation is reduced,

the person with dementia will become more satisfied and relaxed. Often this means they are

calmer, more communicative, and more positive ” (p. 438). Similarly, a study by Olsen et. al’s

(2016), found improvement in symptoms of depression in patients with dementia using animal

assisted activity, compared to their control group, whose symptoms gradually worsened during

the study period.

The use of animal, or dog, assisted interventions can have positive effects on quality of

life in people with dementia (Kårefjärd & Nordgren, 2019; Olsen et al., 2016). AAI improved the

psychological well-being of people with dementia to a larger degree than a control intervention

(Wesenberg et al., 2019). In a qualitative study focusing on Alzheimer’s disease patients and dog

therapy by Swall et. al (2017), behaviors such as empathy and affection were shown through

expressions of feelings of joy and tenderness. The moments people with dementia spent with a

therapy dog possibly gave them momentary empowerment despite the symptoms of the disease,

and may have given them a sense of being important, needed, and meaningful to the dog. These

studies demonstrate that pet therapy can be a beneficial complementary therapy to those with

dementia, especially those who enjoy animals.

PTSD and Pet Therapy

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According to Dr. Eric Altschuler (2018), post-traumatic stress disorder (PTSD) can

happen to an individual following war experiences, different types of trauma, and various forms

of abuse. Symptoms of PTSD can include feelings of isolation, nightmares, anxiety, and

depression. Altschuler has said that sometimes medications and counseling are sometimes not

enough to properly treat an individual’s PTSD, and that new therapy options are often needed.

Most PTSD related studies focus on veterans.

As stated above, additional means of treating those impacted by PTSD have long been

sought. There is no universal cure-all for managing mental health, and PTSD certainly is no

exception to that rule. Pet therapy has recently been used as a means of treating the symptoms of

PTSD and to increase an individual’s overall wellbeing. A study from 2018 showed that an

individual with heavy alcoholism and severe PTSD symptoms greatly benefited from a service

dog (Altschuler, 2018). This individual felt significantly better within four months after receiving

his service dog and felt that he had better control of managing his symptoms (Altschuler, 2018).

Another individual with PTSD found relief after working with parrots who were abused

(Altschuler, 2018).

Another study focused on the impacts of dog training and ownership in veterans with

PTSD. In this study, forty-eight veterans participated in the Dogs2Vets program, which focuses

on providing service animals to veterans (Bergen-Cico et al., 2018). According to the study,

veterans that participated in a structured dog training program experienced substantially less

PTSD-related symptoms and felt less isolated than when they began the program (Bergen-Cico

et al., 2018). This study verified the findings of other trials involving veterans and pet therapy.
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As discussed, it is obvious of the benefits of pet therapy in regards to PTSD. Pet therapy

has been proven to reduce or resolve all together the symptoms of PTSD. Based on the studies

and examples listed, it is promising to use pet therapy as an alternative means of treating PTSD

and other mental illnesses.

Conclusion

When working as a nurse and assisting patients with mental health disorders, it is

important to remember the benefits of pet therapy. Studies have proven that pet therapy is

important because it benefits one’s mental, social, emotional, and physical functions. The

assistance of a pet greatly impacts one’s mood with the release of endorphins and serotonin. It is

noted that the presence of an animal can assist with feeling calm and relaxed. When a patient

feels happier and relaxed, this allows them to be able to improve their social functions. It is also

vital to realize that pets assist with physical functions such as getting up and moving. Lastly, pet

therapy could help manage symptoms of mental health disorders. All of the benefits pet therapy

offers directly relates to assisting in treatment for a range of mental health disorders. In the end,

nurses should remember the benefits of pet therapy and implement the treatment into a patient’s

care instructions.
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