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This study investigates the effect of an aquarium on pre-treatment anxiety, fear. frustration, and depression in electroconvulsive therapy (ECT) patients. Forty-two patients consecutively referred for ECT were rotated between rooms with and without aquariums. Self report measures of depression, anxiety, fear, and frustration were obtained, along with heart rate and blood pressure measurements. Preliminary mixed-model, repeated measures analysis of variance (ANOVA) revealed no significant differences between the aquarium and control conditions on any of the dependent measures. A trend toward significance was found for self reported anxiety (p=0.08) and further data were collected. Subsequent mixed model, repeated measures ANOVA confirmed the trend toward differences (p=0.08) in anxiety between the aquarium and control conditions. Factoring out demographic factors, the average patient experienced 12% less anxiety in the presence of an aquarium.
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Presence of Aquariums 1
Effect of Aquariums on Electroconvulsive Therapy Patients
Sandra B. Barker, Ph.D.*
Professor of Psychiatry
Director, Center for Human-Animal Interaction
Virginia Commonwealth University
P. O. Box 980710
Richmond, VA 23298-0710
804-828-4570 phone
804-828-4614 fax
Keith G. Rasmussen, M.D.
Assistant Professor of Psychiatry
Mayo Clinic Department of Psychiatry
200 1st Street SW
Rochester, MN 55905
Al M. Best, Ph.D.
Associate Professor of Biostatistics
Virginia Commonwealth University
P. O. Box 980032
Richmond, VA 23298-032
Anthrozoös, (16)3, 229-240
Presence of Aquariums 2
This study investigates the effect of an aquarium on pre-treatment anxiety, fear.
frustration, and depression in electroconvulsive therapy (ECT) patients. Forty-two patients
consecutively referred for ECT were rotated between rooms with and without aquariums. Self
report measures of depression, anxiety, fear, and frustration were obtained along with heart rate
and blood pressure. Preliminary mixed model, repeated measures analysis of variance
(ANOVA) revealed no significant differences between the aquarium and control conditions on
any of the dependent measures. A trend toward significance was found for self reported anxiety
(p =0.08) and further data was collected. Subsequent mixed model, repeated measures ANOVA
confirmed the trend toward differences (p = 0.08) in anxiety between the aquarium and control
condition. Factoring out demographic factors, the average subject experienced 12% less anxiety
in the presence of an aquarium.
Key words:
Animal-assisted therapy
Bonding, human-animal
Electroconvulsive Therapy
Treatment Outcome
Presence of Aquariums 3
Effect of Aquariums on Electroconvulsive Therapy Patients
Electroconvulsive therapy (ECT) is a well-established, effective psychiatric treatment
that is being more widely used, primarily for the treatment of serious mood disorders such as
depression (Harrison and Kaarsemaker 2000). However, one problem that has been recognized
for many years is that patients undergoing ECT often experience fear and anxiety related to
treatment (Gallinek 1956; Freeman and Kendell 1986; Fox 1993). Gomez (1975) reported that
75% of her patients feared ECT, with fears related to memory loss, death, and brain damage.
Between 29% and 40% of patients found ECT to be frightening (Freeman and Kendell 1980;
Benbow 1988). While the effectiveness of ECT has been firmly established, fear and anxiety
have been associated with reduced treatment compliance and treatment refusal (Freeman and
Kendell 1980; Benbow 1988; Fox 1993). Some practitioners have attributed increased fear and
anxiety to lack of information, others attribute these symptoms to unknown aspects of the
treatment itself (Fox 1993; Harrison and Kaarsemaker 2000).
Educational interventions have been primarily developed to address this fear and anxiety;
however conflicting results have been reported regarding their effectiveness. One study focused
on the effect of emotional support, provided by a psychiatric nurse in an educational context, on
the anxiety levels of 32 ECT patients (Cohen 1970). The results revealed no significant
difference in anxiety levels between patients receiving the intervention and those who did not.
Another study involving 37 veteran psychiatric patients reported that while knowledge and
behavioral intent showed positive changes following an educational ECT video, there was no
reduction in fear (Battersby, Ben-Tovim, and Eden 1993). Contrary results were reported using a
continuous quality improvement model in which an educational video and written information
were found to reduce anxiety. These findings are based on followup telephone interviews from
15 patients (Harrison and Kaarsemaker 2000).
The effect of environmental interventions to calm ECT patients has received little
research attention. One environmental intervention, animal-assisted therapy (AAT), has been
found to calm patients in some circumstances. The benefits of interacting with companion
animals are receiving increased attention in the healthcare industry. Studies have documented
reduced cardiovascular risk factors, improved one year survival rates following myocardial
infarction, reduction in minor health problems, and lower physician utilization associated with
pet ownership (Friedman, Katcher, Lynch, and Thomas 1980; Siegel 1990; Serpell 1991;
Anderson, Reid, and Jennings 1992). More recent, randomized controlled studies have shown a
positive effect of pet ownership or the presence of pets in physiological indicators of reactive
stress ( Allen, Blascovitch, Tomaka, and Kelsey 1991; Allen 2000; Allen, Shykoff, and Izzo
2001; Allen, Blascovich, and Mendes 2002;). Interacting with companion animals has also been
associated with reduced anxiety levels for non-psychiatric as well as inpatient psychiatric
populations (Wilson 1991; Barker and Dawson 1998;). A significant reduction in anxiety was
reported in a study involving 241 hospitalized psychiatric patients with a broad range of
diagnoses following 30 minutes of animal-assisted therapy (Barker and Dawson 1998). A more
recent study found a significant reduction in fear following a 15-minute interaction with a
therapy dog and its handler for 35 psychiatric patients waiting for electroconvulsive therapy
Presence of Aquariums 4
(Barker, Pandurangi, and Best 2003). No significant differences were found for anxiety or
A challenge faced by those incorporating therapy dogs into healthcare facilities is
securing volunteers with therapy animals who can provide frequent and consistent services.
Incorporating fish aquariums into healthcare facilities eliminates these challenges. Aquariums
enable more frequent, longer, and consistent exposure to the intervention without involving
volunteers, but requires financial investment in the purchase or lease, and maintenance of the
aquariums. This study was undertaken to determine if aquariums would provide some of the
same benefits for hospitalized psychiatric patients as therapy dogs have been reported to provide.
Several studies have explored the benefits of fish aquariums in healthcare settings with
equivocal results ( Katcher, Segal, and Beck 1984; Cole and Gawlinski 2000; Edwards and Beck
2002). While Katcher et al. (1984) found that physiological indicators of anxiety, blood pressure
and heart rate, were not significantly lower in patients contemplating an aquarium prior to dental
surgery when compared with a comparison and control group, subjective reports of calming were
significantly different with contemplation of an aquarium associated with more comfort and
relaxation. It is important to note that subjects in this study were told to anticipate a calming
benefit from focusing on the aquarium. Cole and Gawlinski (2000) explored the effect of a salt-
water fish aquarium on levels of stress, anxiety, depression, and hostility in a small (n=10)
sample of patients waiting for orthotopic heart transplantation. While the authors found no
statistically significant reductions on any of the variables assessed, they did note other benefits of
the fish aquarium, including the successful introduction of animal-assisted activities into the
intensive care environment, the provision of cognitive stimulation, and patient subjective reports
of delight and calm associated with the fish aquarium. A more recent study found important
benefits to patients with Alzheimer’s disease (Edwards and Beck 2002). Patients observing
aquariums while dining showed significant increases in nutritional intake and weight over a 16-
week period.
The current study investigated whether the presence of an aquarium is associated with
reduced physiological levels of anxiety and self reported anxiety, fear, depression, and
frustration in psychiatric patients waiting for scheduled electroconvulsive therapy (ECT).
Depression was included as the null hypothesis, as was done in the Barker, Pandurangi, and Best
(2003) study with ECT patients. It was not expected that brief exposure to an aquarium would
impact depression that had not responded to pharmacological treatment and that was of a severity
to warrant ECT.
The study was a within-subject design in which subjects served as their own controls.
Subjects were alternately assigned to the treatment condition (an aquarium present in the ECT
Holding Room) or the control condition (absence of aquarium in the ECT Holding Room) on
subsequent ECT treatment days. Pre and posttest measures of anxiety, depression, fear, and
frustration were collected for both conditions prior to ECT treatment.
Presence of Aquariums 5
Following approval of the study by a university committee for the protection of human
subjects, outpatients consecutively scheduled for electroconvulsive therapy were invited to
participate in the study. These patients were referred for ECT by psychiatrists in the community,
from within the health system in which the study took place, or from other hospitals. These
patients typically have severe depression or bipolar disorder that has not responded to
pharmacological treatment.
The intervention consisted of two ten gallon, fresh water, self contained, fish aquariums,
measuring 20 inches long, 10 inches wide, and 12 inches high. Each aquarium contained
approximately five colorful and hearty (African Cichlid variety) fish, colorful gravel and
decorations, a deep blue background, oxygen pump, light, and self-feeder. They were cleaned
and maintained on a biweekly basis by an aquarium leasing company. Each aquarium was placed
on a 28 inch tall cabinet. An aquarium was placed in two of the four holding rooms used for
patients waiting for ECT. Four private patient rooms located adjacent to the ECT Treatment
Room are designated as holding rooms to provide patients with a private room for changing
clothes and waiting for their ECT treatment as well as recovering following treatment. These
rooms are equipped with furniture, but contain no television, radios, or magazines.
Visual analog scales (VAS) were used to assess depression, anxiety, frustration, and fear.
They were selected for their simplicity and ease of use. The variables were defined globally on
the VAS scales in terms of how much (depression, anxiety, fear, and frustration) the subject felt
at the time. These scales, each 15 cm long and anchored at each end with descriptors of “none”
to “the most severe imaginable” have been used successfully with psychiatric patients with
acceptable levels of reliability and validity (Barker, Pandurangi, and Best 2003). Reported test-
retest (r = 0.45 - 0.78, p = 0.0001) correlations on these scales support their reliability and
significant post intervention correlations (r = 0.65 - 0.68, p = or < 0.01) between patient and
nurse ratings support their validity (Barker, Pandurangi, and Best 2003). Patients simply place a
line on each scale to indicate the intensity of each feeling.
Physiological assessments of anxiety included measurements of heart rate and blood
pressure using an oscillometric, automated device, Dinamap XL Vital Signs Monitor. The
Dinamap Monitor is routinely used in the hospital for assessing blood pressure and heart rate
prior to ECT. Reliability and accuracy of the device has been demonstrated in several studies
(Bruner, Krenis, Kunsman, Sherman 1981; Baker 1986; Mundt, Chambless, Burnham and Heiss
1992; Bald, Kubel, and Rascher 1994; Gardner and Montgomery 1998). It is autocalibrated and
annually tested with a calibrated standard to verify that the transducer is accurate. Blood
pressure was consistently taken in the same position, either sitting or lying, and the cuff was
consistently placed on the same area of the upper arm to insure reliability of the measure.
Demographic information was collected on gender, age, marital status, smoking status,
diagnosis, and previous number of ECT treatments. These variables were assessed since they
Presence of Aquariums 6
could have an effect on the dependent variables, thereby representing intervening variables if not
controlled in the analysis. Marital status was included since it may represent social support that
could affect levels of dysphoria as well as blood pressure. Since some evidence indicates that
fear and anxiety increase in ECT patients as they continue in treatment (Fox 1993), the authors
believed it was important to control for prior treatment. Also, since ECT patients who smoke are
requested to refrain from smoking after midnight the night before ECT, they may experience
increased anxiety related to nicotine withdrawal. Therefore smoking was also controlled in the
data analysis.
Patients were assigned to holding rooms based on a first come basis. ECT nurses were
instructed to alternate assigning patients to holding rooms with and without an aquarium.
Patients were not told about the aquarium or asked to look at it to minimize demand
characteristics. On a subsequent treatment day, patients were assigned to the alternate condition.
The ECT nurse was instructed to take vital signs as soon as patients were taken to their holding
rooms. Nurses were instructed to take vital signs again, after approximately 20 minutes and prior
to the ECT treatment, making sure to take vitals with the patient in the same position (sitting or
lying) as the initial readings. They then asked patients to complete the visual analog feelings
scales presented in random order.
One investigator scored all of the visual analog scales in millimeters using the same
metric ruler. Scores ranged from 0 – 15, with higher scores indicating higher levels of reported
Basic demographic variables of age, gender, marital status, smoking status, previous ECT
treatments, and primary diagnosis were collected from patient records by one of the
A mixed-model repeated-measures analysis of variance was used to determine the effect
of aquarium presence on anxiety, fear, frustration and depression. In addition to the primary
independent variable of aquarium presence (aquarium or control), the following demographic
factors were included in the ANOVA: gender (male or female), current smoking status (yes or
no), age (continuous), diagnosis (depression or other), marital status (married, divorced, single,
widowed, or separated), and number of prior ECT treatments (continuous). A single analysis was
performed for each dependent variable to test for the effect of aquarium presence or absence
(repeated measure), after the effects of demographic characteristics were covaried out.
Forty-two subjects participated in the study. Most of the subjects were female (74%, n =
31) and ranged in age from 21-82 with a mean age of 48.4 (sd = 16.5). Forty-three percent (n =
Presence of Aquariums 7
18) were married, 19% (n = 8) divorced, 26% (n = 11) single, 7% (n = 3) widowed and 2% (n =
1) separated (one subject’s marital status was not documented). Close to three-fourths (74%, n =
31) of the patients were diagnosed with depressive disorder and had undergone previous ECT
treatments (mean = 3.7) prior to the study. Twenty-four percent (n = 10) of the subjects were
Preliminary mixed model repeated-measures analysis of variance was run after 192
observations had been collected. This included 31 patients, 25 of whom experienced both the
aquarium and control conditions at least once. Results revealed no statistically significant
difference at p = 0.05 between the aquarium and control conditions for heart rate, systolic blood
pressure, diastolic blood pressure, self reported levels of fear, frustration, anxiety, and
depression. There was a marginally significant difference at p = 0.08 for self reported anxiety. A
power analysis suggested that increasing the study size to 282 observations (37 subjects) would
yield 70% power.
Based on the preliminary results and power analysis, data collection continued only for
anxiety for 108 additional, consecutive ECT treatments. This resulted in data collection on a
total of 42 subjects and 300 observations. Table 1 shows the distribution of the number of
observations and subjects under the aquarium and control conditions. Factoring out the
demographic variables, the trend toward differences in anxiety (p = 0.08) was confirmed
between the treatment and control conditions on anxiety (analysis based on 30 subjects receiving
both conditions). Table 2 shows the least squares means, standard errors, and F ratios for all of
the dependent variables. The average subject was found to experiences 12% less anxiety with an
aquarium than without one. Although there was a trend to significance, the power analysis
indicates that the small effect size will not become statistically significant until a study at least
twice as large as this one is performed. A study twice as large would have a power of 77% (at
alpha = 0.05).
Discussion and Conclusions
Preliminary analysis showed no statistically significant difference on any of the
dependent variables between the aquarium and control conditions. A marginally significant
difference at p = 0.08 was found for anxiety level assessed by visual analog scale. Based on a
power analysis, increased numbers of observations were collected for anxiety. The results
confirmed the trend toward differences (p = 0.08) in anxiety between the aquarium and control
conditions. The trend was toward lower anxiety levels in the aquarium condition. It is important
to note that while the total number of observations was increased to 300 (subjects = 42), the
number of observations included in the analyses was limited to 213, the number of observations
for the 30 subjects who received both conditions. Not all subjects received both conditions
because of the limited number of available holding rooms (n = 4), to which patients had to be
assigned as they arrived for treatment. Since this study was conducted in an active clinical
setting, treatment could not be delayed to accommodate the study. Therefore the targeted number
of observations based on the initial power analysis was not reached (213 observations compared
to 282 indicated by the power analysis). Because of the small effect size, the negative findings
Presence of Aquariums 8
of the current study are inconclusive. Power analysis indicates that a study at least twice as large
as the current one is needed for the small effect size to reach statistical significance. In light of
the confirmed trend toward reduced anxiety, further studies with larger subject numbers are
In addition to the study limitation of sample size, subjects were not randomly selected
and caution should therefore be used in generalizing these findings to other psychiatric
populations. Finally, while standard measurements were used to score the visual analog scales,
the researcher performing the measurements was not blind to the conditions. In an attempt to
minimize bias, a random sample of scales was rescored with 100% agreement.
Similar to the results reported by Katcher, Segal, and Beck (1984), blood pressure and
heart rate were not significantly different for the aquarium and control conditions. The presence
of an aquarium was not associated with reduced physiological measures of anxiety in patients
waiting for ECT. However, unlike the earlier Katcher study, patients in this study were not
asked to look at, or in any way attend to, the aquarium, nor was it suggested to them that the
aquarium would have a calming effect. Instead, the purpose of this study was to assess the
impact of the mere presence of a fish aquarium. Further studies are needed in which patients are
instructed to watch the fish.
The lack of significant findings may be in part due to the background role of the
aquarium in this study. Since patients were not seated in front of the aquarium or asked to look
at it, patients were not intentionally exposed to the potentially calming effect of watching the fish
unless they deliberately chose to do so. Most patients tended to lie down while in the holding
rooms. In order to view the fish in this position, they would have to deliberately lie on one side.
It may be necessary for patients to focus on the aquarium to derive benefit; a task that may be
difficult for severely depressed patients. Also, the aquarium may not represent a powerful
enough stimulus to distract patients from thoughts of their upcoming ECT treatment.
While a similar study with ECT patients, involving therapy dogs rather than aquariums,
also found no significant reduction in anxiety or depression, the intervention with the therapy
dog significantly reduced fear (Barker, Pandurangi, and Best 2003). The aquarium intervention
did not significantly impact fear. These inconsistent findings may be due to the difference in
interaction associated with the two species. A self-contained aquarium requires no interaction
with the patient whereas a therapy animal, such as a dog, is more apt to promote interaction in
the form of petting and talking. The entrance of the therapy dog and handler into a patient’s
room almost always results in the patient attending to them, whereas the presence of an aquarium
in the holding room into which the patient is led may not. Also, physical interaction with the fish
is not possible, whereas physical interaction with the dog was readily available. Observing an
aquarium is a more passive experience compared to the active experience of petting or talking to
or about a dog. Perhaps it is more active interaction, such as physically petting the dog that is
needed to impact fear. More research is needed to investigate the components of animal-assisted
activities that contribute to symptom reductions.
Presence of Aquariums 9
Since neither study resulted in a significant reduction in anxiety, it may be that the
anxiety related to the ECT procedure is not amenable to the calming effects of animal-assisted
activities. Or the global nature of the visual analog scales used in both studies may not be
sensitive to anxiety changes resulting from animal-assisted activities.
Positive benefits of the aquariums were noted in positive patient comments about them.
Some patients named the fish and staff frequently commented positively on the presence of the
aquariums and expressed the desire to keep them on the unit. They reported soothing and
calming effects related to the visual and auditory aspects of the aquariums. The cost of
acquisition, set-up, lease and full maintenance of both ten gallon fish aquariums used in this
study totaled $965 a year. Whether the potential benefits justify the cost of incorporating fish
aquarium into psychiatric settings remains to be seen. While our preliminary study documented
a trend towards less anxiety with the presence of an aquarium, it remains for a larger or more
controlled study to confirm this finding.
Presence of Aquariums 10
Allen, K. M. 2000, October. Presence of pets predicts reactivity to psychological and physical
stress among hypertensive caregiving spouses of individuals with traumatic brain injury:
A randomized controlled trial. Paper presented at the 40th Annual Meeting of the Society
for Psychophysiological Research, San Diego, CA.
Allen, K., Blascovich, J., and Mendes, W.B. 2002. Cardiovascular reactivity and the presence of
pets, friends, and spouses: The truth about cats and dogs. Psychosomatic Medicine
64(5): 727-739.
Allen, K. M., Blascovitch, J., Tomaka, J., and Kelsey, R. M. 1991. Presence of human friends
and pet dogs as moderators of autonomic responses to stress in women. Journal of
Personality and Social Psychology 61(4): 582-589.
Allen, K., Shykoff, B. E., and Izzo, J. L., Jr. 2001. Pet ownership, but not ace inhibitor therapy,
blunts home blood pressure responses to mental stress. Hypertension 38(4): 815-820.
Anderson, W. P., Reid, C. M., and Jennings, G. L. 1992. Pet ownership and risk factors for
cardiovascular disease. The Medical Journal of Australia 157: 298-301.
Baker, L. K. 1986. DINAMAP monitor versus direct blood pressure measurements. Dimensions
in Critical Care Nursing 5: 228-235.
Bald, M., Kubel, S., and Rascher, W. 1994. Validity and reliability of 24 hour blood pressure
monitoring in children and adolescents using a portable oscillometric devide. Journal of
Hum Hypertension 8: 363-366.
Barker, S. B., and Dawson, K. S. 1998. The effects of animal-assisted therapy on anxiety ratings
of hospitalized psychiatric patients. Psychiatric Services 49(6): 797-801.
Barker, S. B., Pandurangi, A. K., and Best, A. M. 2003. The effects of animal-assisted therapy
on patients' anxiety, fear, and depression prior to ECT. Journal of ECT 19(1): 38-44.
Battersby, M., Ben-Tovim, D., and Eden, J. 1993. Electroconvulsive therapy: a study of attitudes
and attitude change after seeing an educational video. Australia New Zealand Journal of
Psychiatry 27(4): 613-619.
Benbow, S. M. 1988. Patients' views on electroconvulsive therapy on completion of a course of
treatment. Convulsive Therapy 4: 146-152.
Bruner, J. M., Krenis, L. J., Kunsman, J. M., Sherman, A. P. 1981. Comparison of direct and
indirect methods of measuring arterial blood pressure. Biomedical Instrument
Technology 15: 11-21, 97-101, 182-188.
Cohen, R. 1970. The effect of specific emotional support on anxiety levels prior to
electroconvulsive therapy. Nursing Research 19(2): 163-165.
Cole, K. M., and Gawlinski, A. 2000. Animal-assisted therapy: the human-animal bond. AACN
Clinical Issues 11(1): 139-149.
Edwards, N. E. and Beck, A. 2002. Animal-assisted therapy and nutrition in Alzheimer's
Disease. Western Journal of Nursing Research 24(5): 697-712.
Fox, H. A. 1993. Patients' fear of and objection to electroconvulsive therapy. Hospital and
Community Psychiatry 44(4): 357-360.
Freeman, C. P., and Kendell, R. E. 1980. ECT: I. Patients' experiences and attitudes. British
Journal of Psychiatry 137: 8-16.
Freeman, C. P., and Kendell, R. E. 1986. Patients' experiences of and attitudes to
Presence of Aquariums 11
electroconvulsive therapy. Annals of the New York Academy of Sciences 462: 341-352.
Friedman, E., Katcher, A. H., Lynch, J. J., and Thomas, S. A. (1980). Animal companions and
one-year survival of patients after discharge from a coronary care unit. Public Health
Reports 95: 307-312.
Gallinek, A. 1956. Fear and anxiety in the course of electroshock therapy. American Journal of
Psychiatry 113: 428-434.
Gardner, A.W., Montgomery, P. S. 1998. Comparison of 3 blood pressure methods used for
determining ankle/brachial index in patients with intermittent claudication. Angiology 49:
Gomez, J. 1975. Subjective side effects of ECT. British Journal of Psychiatry 127: 609-611.
Harrison, B., and Kaarsemaker, B. 2000. Continuous quality improvement to an
electroconvulsive therapy delivery system. Journal of Psychosocial Nursing Mental
Health Services 38(3): 27-35.
Katcher, A. H., Segal, H., and Beck, A. 1984. Contemplation of an aquarium for the reduction of
anxiety. In The Pet Connection, 171-178, eds. R. K. Anderson, B. Hart, and L. Bart .
Minneapolis: University of Minnesota Press.
Mundt, K., Chambless, L. E. Burnham, C. B., and Heiss, G. 1992. Measuring ankle systjolic
blood pressure: Validation of the Dinamap 1836 SX. Angiology 43: 555-566.
Serpell, J. 1991. Beneficial effects of pet ownership on some aspects of human health and
behavior. Journal of the Royal Society of Medicine 84: 717-720.
Siegel, J. M. 1990. Stressful life events and use of physician services among the elderly: The
moderating role of pet ownership. Journal of Personality and Social Psychology 58:
Wilson, C. C. 1991. The pet as an anxiolytic intervention. The Journal of Nervous and Mental
Disease 179: 482-489.
Presence of Aquariums 12
Table 1
Distribution of Observations and Subjects Receiving
Aquarium and Control Conditions
Number of Number of subjects
Observations Aquarium Control
0 9 3
1 6 10
2 9 5
3 5 8
4 5 2
5 3 6
6 1 1
7 1
8 1 2
10 1
12 1 1
15 1 1
Presence of Aquariums 13
16 1
18 1
total 42 42
Presence of Aquariums 14
Table 2
Least Squares (LS) Means and Standard Errors (SE) for Depression, Anxiety, Frustration, Fear,
Heart Rate, and Blood Pressure for Patients in Rooms with and without a Fish Aquarium Prior to
Electroconvulsive Therapy
Condition LS 95% Confidence
N* Mean SE Interval DF F p-value
Depression (n = 20 subjects)
aquarium 62 3.26 1.81 0.05 7.19
control 98 4.34 1.78 0.82 7.86 1,139 1.6 0.2101
Anxiety (n = 30 subjects)
Aquarium 119 5.53 0.95 3.66 7.40
Control 145 6.26 0.95 4.40 8.13 1,233 3.0 0.0848
Frustration (n = 20 subjects)
Aquarium 62 2.13 1.76 -1.35 5.61
Control 98 1.99 1.73 -1.43 5.41 1,139 0.0 0.8266
Fear (n = 20 subjects)
Aquarium 62 2.84 2.53 -2.16 7.83
Control 99 2.50 2.51 -2.46 7.47 1,140 0.5 0.4939
Heart Rate at Baseline (n = 30 subjects)
Aquarium 121 80.28 2.96 74.47 86.09
Control 148 79.21 2.95 73.42 85.00 1,400 0.9 0.3561
Heart Rate Post Condition (n=30 subjects)
Aquarium 64 76.66 3.09 70.59 82.73
Control 100 76.87 3.02 70.93 82.81 1,400 0.02 0.8889
Systolic Blood Pressure at Baseline (n = 30 subjects)
Aquarium 122 130.28 3.99 122.44 138.12
Control 149 130.48 3.97 122.67 138.28 1,400 0.01 0.9141
Systolic Blood Pressure Post Condition (n = 30 subjects)
Aquarium 122 129.61 4.24 121.28 137.94
Control 149 130.13 4.11 122.05 138.21 1,400 0.05 0.8259
Diastolic Blood Pressure at Baseline (n = 30 subjects)
Aquarium 122 74.21 2.12 70.04 78.38
Control 149 73.38 2.11 69.23 77.53 1,400 0.58 0.4470
Diastolic Blood Pressure Post Condition (n = 30 subjects)
Aquarium 122 72.32 2.28 67.83 76.81
Control 149 72.10 2.20 67.77 76.43 1,400 0.02 0.8778
*N = number of observations
... The study investigator (AL) was present to clarify any doubts, concerning the questionnaires, which may have risen during completion by the participants. After completion of the questionnaires, that were filled out during the 20 minutes of waiting in the waiting area, the blood pressures and heart rates were measured again, three times [19]. The patients then proceeded to their respective planned dental treatments. ...
... However, the current trial did not provide evidence for this. Our study findings have been observed in previous experiments where there were no effects of interaction with fish on the physiological and subjective anxiety measurements [11,19,22]. We believe that our results may have been influenced by several factors including lack of randomization, exposure time, concentration/focus, and age of the participants. ...
... However, with an ageadvanced cohort with dementia, the effects were again relevant [8,9,28]. Our study had a mixed aged cohort and the mean age was 65.07 years; perhaps this could have been a factor in not demonstrating completely positive findings as seen in previous studies [19,26,27]. Another factor which may have influenced our results could have been the sample size. ...
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Background: Interaction with fish is known to reduce stress and anxiety in humans. Objective: This trial evaluated the effect of an aquarium present in a geriatric dental clinic waiting-area (WA) on blood pressure (BP), heart-rate (HR), anxiety, and mood of waiting patients. Methods: Participants were recruited into three groups: control (CG): WA without aquarium; partially-stocked aquarium (PSA): aquarium without fish; fully-stocked aquarium (FSA): aquarium with fish. BP and HR of the participants were recorded upon arrival and after 20-minutes of waiting, along with anxiety [State trait anxiety inventory (STAI-6)] and mood [Feeling scale (FS), Felt arousal scale (FAS)] scores. A purpose-built questionnaire evaluated the subjective assessment of the participants’ experience in the WA. ANOVA with repeated measures and nonparametric tests were used for statistical analysis (p<0.05). Results: 392 patients (mean age: 65.07±16.9y) completed this trial. There was an effect of time on the BP [systolic: F(1, 120)=44.82, p<0.001; diastolic: F(1, 120)=25.10, p<0.001] and HR [F(1, 120)=40.94, p<0.001]. No effect of groups on BP [systolic: F(1, 120)=1.01, p=0.32; diastolic: F(1, 120)=0.01, p=0.92] was revealed, but a decrease of HR [F(1, 120)=21.59, p<0.001]. No effect of time*group on BP [systolic: F(1, 120)=0.89, p=0.35; diastolic: F(1, 120)=0.31, p=0.58], or HR [F(1, 120)=1.04, p-0.31]. WA groups had no effects on the participants’ anxiety [H(2)=2.76, p=0.25], or mood [FS: H(2)=2.28, p=0.32; FAS: H(2)=1.54, p=0.46]. Patients rated FSA higher than others [H(2)=20.98, p<0.001). Conclusions: There was no influence of the presence of an aquarium on the patients’ blood pressure, heart rate , anxiety, or mood. Keywords: Aquarium, Stress, STAI-6, Blood pressure, Anxiety, Geriatric dentistry
... There is evidence that the interaction between humans and their pets arouses oxytocin-a hormone responsible for well-being and love [36], making the individual feel happier and, as such, improving task performance. Barker et al. [55] showed that pets influence their owners through basic interactions such as observing and caring, which helps them to deal effectively with their daily tasks. Gee et al. [56], in an experimental study showed that performance on a memory task was better in the presence of a dog (compared to the absence, or the presence of a person). ...
... The non-pet owner group was smaller than the other group; hence, the interpretation of the means comparison results should be regarded with some caution. Second, we used self-reported measures, which might account for common method variance [49][50][51][52][53][54][55][56][57][58][59][60][61][62], however, as referred before, we took some strategies to minimize it. Second, there are studies demonstrating that individual differences (e.g., personality traits) may influence how individuals perceive themselves, for instance regarding performance [63]. ...
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Although there is evidence that pets may help individuals facing significant daily stressors, and that they may enhance the well-being of their owners, little is known about the benefits of pets for job performance. Since the COVID-19 pandemic crisis, teleworking was a strategy implemented in many countries to reduce the virus widespread and to assure organizational productivity. Those who work from home and who own pets may work close to them. Based on the conservation of resources theory, this study aimed to analyze whether positive affect mediated the relationship between telecommuting and self-reported job performance and if psychological and physical closeness to the pet would moderate this relationship in such a way that it would be stronger for those who worked closer to their pet, and who were more emotionally attached to them. For this study, we collected data from 81 teleworkers who did not own pets, and from 320 teleworkers who owned pets. Both answered an online questionnaire. Findings: Results from the study showed the existence of significant differences between those who owned and who did not own pets regarding positive affect and performance, in which those who owned pets reported higher levels of positive affect and self-reported performance and perceived telework more positively. Moreover, positive affect mediated the relationship between telework and self-reported job performance. Furthermore, emotional and physical closeness moderated the mediating effect. This study contributes to a better understanding of the human-animal interaction and how pets can be a personal resource able to change their owners’ affective experiences and job performance while they are working from home. The findings demonstrate that telework may be a suitable organizational strategy for pet-owners.
... There have been several forms of exposure to water in indoor environments of healthcare settings as well. Indirect exposure such as window views to water in various parts, water projection, water paintings on walls, grounds, and even ceilings, and aquariums are the existing design strategies (Annerstedt et al., 2013;Barker, Rasmussen, & Best, 2003;Edwards & Beck, 2002). ...
... Due to their magnificent swimming behaviors, people enjoy spending their leisure time with fish, inspiring them to carry out inventions, the most obvious being related to transportation and the most recent being robotic fish [3]. Considering the therapeutic inclinations of fish, medical institutions have installed fish tanks to calm stressed patients and as a pretreatment for anxiety, fear, frustration, and depression [4][5][6]. ...
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Numerous studies have been conducted to prove the calming and stress-reducing effects on humans of visiting aquatic environments. As a result, many institutions have utilized fish to provide entertainment and treat patients. The most common issue in this approach is controlling the movement of fish to facilitate human interaction. This study proposed an interactive robot, a robotic fish, to alter fish swarm behaviors by performing an effective, unobstructed, yet necessary, defined set of actions to enhance human interaction. The approach incorporated a minimalistic but futuristic physical design of the robotic fish with cameras and infrared (IR) sensors, and developed a fish-detecting and swarm pattern-recognizing algorithm. The fish-detecting algorithm was implemented using background subtraction and moving average algorithms with an accuracy of 78%, while the swarm pattern detection implemented with a Convolutional Neural Network (CNN) resulted in a 77.32% accuracy rate. By effectively controlling the behavior and swimming patterns of fish through the smooth movements of the robotic fish, we evaluated the success through repeated trials. Feedback from a randomly selected unbiased group of subjects revealed that the robotic fish improved human interaction with fish by using the proposed set of maneuvers and behavior.
... Fifth, future studies should explore the role of different pet species, e.g., dogs, or cats, because there are studies that demonstrated that different species had different effects. A study developed in a dentist's office showed that an aquarium full of fish provided a relaxing climate and made the space calmer [66]. A study at Ferrari revealed that a cat interacting with customers and workers provided little distraction, and at the same time lowered stress levels [67]. ...
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Although there is evidence that pets may help individuals who are facing significant daily stressors, little is known about the benefits of pet-friendly practices for their owners’ well-being. Based on the social exchange theory and on the Rusbult investment model, we argue that organizational pet-friendly practices will be viewed as a source of support from an organization that increases workers’ organizational identification, which in turn will lead to higher levels of psychological well-being and life satisfaction. For this study, 208 working adults answered an online questionnaire. Results from the study showed that the more pet-friendly practices the higher the workers’ organizational identification, which led to higher indices of psychological well-being and life satisfaction. This study contributes to a better understanding of the human–animal interaction and how pets can function as a resource for individuals’ well-being at work.
... Kweon et al., 2008;White et al., 2010). Particularly popular historically have been aquariums, which can help people recover from stress (Cracknell et al., 2017), as well as help people manage subsequently stressful situations (Wells, 2005), such as electroconvulsive therapy (ECT) (Barker et al., 2003) more effectively. They have also been used in dementia care, where they have been found to help calm older adults, as well as encourage healthy levels of eating and the promotion of social interactions (Edwards and Beck, 2002). ...
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In this chapter, Mathew P. White, Lewis R. Elliott, Mireia Gascon, Bethany Roberts and Lora E. Fleming present an overarching review of the evidence from the current research literature and from the findings of the research carried out in the BlueHealth project in order to provide the best evidence planners and designers can use to support their policies, plans and projects. It is essentially an overview of the current knowledge, extensively but not exhaustively referenced and presented in a way which is accessible to professional and student readers. It integrates the benefits and risks by showing that the one often comes with the other. © 2022 selection and editorial matter, Simon Bell, Lora E. Fleming, James Grellier, Friedrich Kuhlmann, Mark J. Nieuwenhuijsen, and Mathew P. White.
The study aimed to investigate the psychological effect of the emotional insect-assisted healing program on the stress experienced by 43 children in a community child center. Silkworm (Bombyx mori [Linnaeus]) was used in the healing programs, and the stress was measured using salivary alpha-amylase levels. Saliva samples and a survey on insect preference were collected before and after the healing programs, respectively. After the program, the satisfaction score for participation was evaluated. Results indicate that the emotional insect-assisted healing programs led to statistically significant lowering of salivary alpha-amylase levels and increased the preference for insects. The children's satisfaction in the healing program activities using silkworms was 4.23 points out of 5. This is an Open-Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License ( which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.
Several studies have shown the positive effects of the presence of animals on humans at work, especially pets. It is increasingly common to find workplaces all over the world that provide this benefit, allowing employees to work with their pet beside them. These workplaces are called “pet friendly.” These practices, in addition to the direct effects on employees, affect the company’s image, showing positive effects in reducing absenteeism and increasing productivity. It is also expected that they impact the company’s perception of social responsibility, and that this influences the attitudes of its employees. In view of this growing reality and its possible impact with regard to organizational behavior, this study aims to observe the effect that the presence of pets in the workplace has on the perception of the social responsibility of organizations and on the organizational commitment (OC) of employees. To this end, 177 participants were randomly assigned to one of two conditions according to a unifactorial design. All participants received a descriptive scenario of practices adopted by an organization to improve employee performance and business success. The scenario varied according to the inclusion of animals versus noninclusion. The results show the positive effect of the presence of animals both in the perception of social responsibility and in employees’ OC. This study leads us to conclude that animals are important in people’s lives and as such have a positive impact on organizational life.
Background and aims: Electroconvulsive therapy (ECT) is considered a safe, effective, and significant treatment in patients suffering from a major depressive disorder. Anxiety caused by this invasive treatment may impose several side effects on patients. The purpose of this study was to evaluate the effectiveness of aromatherapy with inhaled lavender essential oil and breathing exercises on ECT-related anxiety in depressed patients. Methods: In this randomized controlled clinical trial, 90 depressed patients were selected and divided into three groups: aromatherapy, breathing exercise, and routine care using a random allocation method. Before undergoing ECT, the aromatherapy group was exposed to the inhaled lavender essential oil (n = 30), the breathing exercise group performed the breathing exercises (n = 30), and the routine care group received routine care (n = 30). Before (20 min) and after the intervention (30 min later), patients' anxiety was assessed using Beck Anxiety Inventory. Results: After the intervention, the results revealed that anxiety score changes were statistically significant among the three groups (p < 0.001). In addition, it was found that the patients’ mean anxiety scores significantly decreased in the aromatherapy and breathing exercise groups compared to with the pre-intervention scores (p < 0.001). Conclusion: Aromatherapy with inhaled lavender essential oil and breathing exercises can be considered by clinical nurses as simple, applicable, and effective interventions to reduce ECT-related anxiety in depressed patients.
Background Pet therapy, or animal-assisted interventions (AAI), have demonstrated positive effects for patients, families and health care providers (HCP) in inpatient settings. However, the evidence supporting AAI in emergency or ambulatory care settings is unclear. We conducted a systematic review to evaluate the effectiveness of AAI on patient, family, and HCP experience in these settings. Methods We searched (from inception to May 2020) Medline, Embase, Cochrane CENTRAL, PsycINFO, and CINAHL, plus grey literature, for studies assessing AAI in emergency and ambulatory care settings on: 1) patient and family anxiety/distress or pain; and 2) HCP stress. Screening, data extraction and quality assessment were done in duplicate with conflicts adjudicated by a third party. Random-effects meta-analyses are reported as mean differences (MD) or standardized mean differences (SMDs) and 95% confidence intervals (CIs), as appropriate. Results We included 9 randomized controlled trials (RCTs; 341 patients, 146 HCP, 122 child caregivers), 4 before-after (before-after; 83 patients), and 1 mixed-method study (124 patients). There was no effect across three RCTs measuring patient-reported anxiety/distress (n=380; SMD: -0.36, 95% CI: -0.95 to 0.23; I²=81%), while two before-after studies suggested a benefit (n=80; SMD: -1.95, 95% CI: -2.99 to -0.91; I²=72%). Four RCTs found no difference in measures of observed anxiety/distress (n=166; SMD: -0.44; 95% CI: -1.01 to 0.13; I²=73%) while one before-after study reported a significant benefit (n=60; SMD: -1.64, 95% CI: -2.23 to -1.05). Three RCTs found no difference in patient-reported pain (n=202; MD: -0.90; 95% CI: -2.01 to 0.22; I²=68%). Two RCTs reported positive but non-significant effects on HCP stress. Conclusions Limited evidence is available on the effectiveness of AAI in emergency and ambulatory care settings. Rigorous studies using global experience-oriented (or patient-identified) outcome measures are required.
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A 10-month prospective study was carried out which examined changes in behaviour and health status in 71 adult subjects following the acquisition of a new pet (either dogs or cats). A group of 26 subjects without pets served as a comparison over the same period. Both pet-owning groups reported a highly significant reduction in minor health problems during the first month following pet acquisition, and this effect was sustained in dog owners through to 10 months. The pet-acquiring groups also showed improvements in their scores on the 30-item General Health Questionnaire over the first 6 months and, in dog owners, this improvement was maintained until 10 months. In addition, dog owners took considerably more physical exercise while walking their dogs than the other two groups, and this effect continued throughout the period of study. The group without pets exhibited no statistically significant changes in health or behaviour, apart from a small increase in recreational walking. The results provide evidence that pet acquisition may have positive effects on human health and behaviour, and that in some cases these effects are relatively long term.
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A 10-month prospective study was carried out which examined changes in behaviour and health status in 71 adult subjects following the acquisition of a new pet (either dogs or cats). A group of 26 subjects without pets served as a comparison over the same period. Both pet-owning groups reported a highly significant reduction in minor health problems during the first month following pet acquisition, and this effect was sustained in dog owners through to 10 months. The pet-acquiring groups also showed improvements in their scores on the 30-item General Health Questionnaire over the first 6 months and, in dog owners, this improvement was maintained until 10 months. In addition, dog owners took considerably more physical exercise while walking their dogs than the other two groups, and this effect continued throughout the period of study. The group without pets exhibited no statistically significant changes in health or behaviour, apart from a small increase in recreational walking. The results provide evidence that pet acquisition may have positive effects on human health and behaviour, and that in some cases these effects are relatively long term.
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Autonomic responses were measured while 45 adult women performed a standard experimental stress task in the laboratory with only the experimenter present and 2 weeks later at home in the presence of a female friend, pet dog, or neither. Results demonstrated that autonomic reactivity was moderated by the presence of a companion, the nature of whom was critical to the size and direction of the effect. Ss in the friend condition exhibited higher physiological reactivity and poorer performance than subjects in the control and pet conditions. Ss in the pet condition showed less physiological reactivity during stressful tasks than Ss in the other conditions. The results are interpreted in terms of the degree to which friends and pets are perceived as evaluative during stressful task performance. Physiological reactivity was consistent across the laboratory and field settings.
Pediatric critical care nurses are in a position to manipulate the critical care environment in an attempt to reduce fears experienced by the young child. One way to accomplish this is through minimizing the number of invasive procedures to which a young child is subjected. An accurate method for the noninvasive measurement of blood pressure would decrease the demand for invasive pressure measurement and would eliminate the complications resulting from the insertion of an arterial catheter. In this study, the author compares DINAMAP* Monitor with direct arterial blood pressure measurements.
The incidence of side-effects present 24 hours after electroconvulsive therapy was studied in 96 patients who between them received 500 treatments in a consecutive series. None of the side-effects occurred frequently: headache was experienced after 2-6 per cent and subjective memory impairment after 3 per cent of treatments. None of the unwanted effects held any serious physical threat. The aspect of ECT most disliked by the patients in this study, and mentioned by 16 per cent of them, was the fear of permanent memory upset.
To compare risk factors for cardiovascular disease in pet owners and non-owners. Accepted risk factors for cardiovascular disease were measured in 5741 participants attending a free, screening clinic at the Baker Medical Research Institute in Melbourne. Blood pressure, plasma cholesterol and triglyceride values were compared in pet owners (n = 784) and non-owners (n = 4957). Pet owners had significantly lower systolic blood pressure and plasma triglycerides than non-owners. In men, pet owners had significantly lower systolic but not diastolic blood pressure than non-owners, and significantly lower plasma triglyceride levels, and plasma cholesterol levels. In women over 40 years old, systolic but not diastolic pressure was significantly lower in pet owners and plasma triglycerides also tended to be lower. There were no differences in body mass index and self-reported smoking habits were similar, but pet owners reported that they took significantly more exercise than non-owners, and ate more meat and "take-away" foods. The socioeconomic profile of the pet owners and non-owners appeared to be comparable. Pet owners in our clinic population had lower levels of accepted risk factors for cardiovascular disease, and this was not explicable on the basis of cigarette smoking, diet, body mass index or socioeconomic profile. The possibility that pet ownership reduces cardiovascular risk factors should therefore be investigated.
Clinical and epidemiologic situations requiring repeated measurements of blood pressure in the lower extremity are increasingly incorporating automated measurement devices; however, no device has been validated adequately for ankle blood pressure. This study evaluates the Dinamap 1846 SX against Dop pler ultrasound in determining ankle systolic blood pressure (SBP) and com pares a parallel with contour wrapping technique for applying the blood pres sure cuff. Ankle SBP was measured on 71 adult volunteers by both devices simultaneously, for each cuff wrap. Averages of three readings were compared to evaluate Dinamap versus Doppler SBP estimates and to assess any cuff wrap effect. Multiple linear regression was used to assess potential effect modifiers. Instrument differences (Dinamap minus Doppler) for the parallel wrap (95% confidence intervals in parenthesis) were —1.5 mmHg (-3.1, 0.0) and — 3.9 mmHg (-5.6, -2.2) for the contour wrap. Wrap effect differences (contour minus parallel) for the Doppler were -4.9 mmHg (-6.3, -3.5) and -7.2 mmHg ( — 8.7, — 5.8) for the Dinamap. Degree of ankle taper was a strong modi fier of cuff effect for the Dinamap but not for the Doppler: adjusted cuff effect with the Dinamap ranged from — 3 to —10 mmHg. Measurement precision (within-person reproducibility, measured by within-person standard deviation [σ ² ] and reliability coefficient [R]) was higher for the Dinamap than the Doppler technique, lowest for the parallel wrap and Doppler configuration (σ ² = 5.4 mmHg, R = 0.88) and greatest for the contour wrap and Dinamap (σ ² = 4.0 mmHg, R = 0.94). In conclusion, cuff-wrapping technique can generate SBP differences of greater magnitude than instrument differences. Conditional on the use of the contour wrap, and by virtue of its high repeatability and ease of operation, the Dinamap is a useful tool for epidemiologic study and the clinical assessment of peripheral arterial disease.
The effect of a pet on psychological consequences of stress (i.e., state and trait anxiety levels) of college students was examined under three test conditions (i.e., reading aloud, reading quietly, and interacting with a friendly but unknown dog). A repeated-measures analysis of variance with three covariates was used to examine the effect of the treatment on each dependent variable (state and trait anxiety). Reading aloud differed from baseline measure under all treatment conditions (p less than .001). Reading quietly and interacting with the dog were slightly below baseline for variables, with more effect seen by reading quietly than by interacting with the dog. Examination of interactions among variables showed no significant differences. Effects upon state anxiety were significant, while trait anxiety levels remained fairly constant throughout the treatments. Baseline differences in trait anxiety scores indicate a potentially greater benefit for pet owners than nonowners. Selected social network and relationship data related to the role of the pet during anxiety-producing times were also analyzed. While interaction with the pet produced a decrease in anxiety level, pet owners did not report the use of their own pet as a social support (i.e., as confidant) significantly more than did previous owners. Results indicated that interacting with a pet for some individuals does affect both physiological and psychological responses by lowering response levels. However, a parallel effect was also seen by reading quietly. Given the effect of pet interaction upon selected social support indicators of health in well college students, these data suggest the importance of examining this treatment with an "at-risk" group in which it is possible to control for ownership characteristics.
The physician utilization behavior of 938 Medicare enrollees in a health maintenance organization was prospectively followed for 1 year. With demographic characteristics and health status at baseline controlled for, respondents who owned pets reported fewer doctor contacts over the 1-year period than respondents who did not own pets. Furthermore, pets seemed to help their owners in times of stress. The accumulation of prebaseline stressful life events was associated with increased doctor contacts during the study year for respondents without pets. This relationship did not emerge for pet owners. Owners of dogs, in particular, were buffered from the impact of stressful life events on physician utilization. Additional analyses showed that dog owners in comparison to owners of other pets spent more time with their pets and felt that their pets were more important to them. Thus, dogs more than other pets provided their owners with companionship and an object of attachment.