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A Systematic Review of Randomized Controlled Trials of Animal-Assisted Therapy on Psychosocial Outcomes
Abstract
The use of animal-assisted interventions (aaIs) to achieve psychological benefits has expanded rapidly over the last few years. However, this is a vastly under-researched area, and the research to date has been largely descriptive, in the form of case studies, or has used only small groups of participants with no control condition. Remarkably few studies have utilized gold standard randomized controlled designs. The aim of the present review was to examine the current state of the literature in regard to only randomized controlled trials (RCts) examining the psychosocial benefits of aaIs, which is a necessary step in order to move the field forward. A search of relevant databases was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and meta-analyses (PRISma) guidelines. A total of 66,180 articles were identified at the outset; this was reduced to eight articles (involving 7 studies), following the removal of duplicates (39,377), unrelated titles (26,525), and those that did not meet inclusion criteria (270). Findings from the present review suggest that aaIs may be of benefit to a wide range of individuals, including children with autism, and adults with psychological disorders, including schizophrenia. However, further research using well-designed RCts is required to more definitively explore what specific types of aaI are beneficial for specific populations. Recommendations for future research are provided.
... However, conducting RCTs in any field, let alone in the field of HAI, is not without challenges. In fact, current reviews of RCTs in the field indicate that the RCTs conducted have been of relatively low quality (Kamioka et al., 2014;Maujean et al., 2015). ...
... While this practice may be widespread in current AAI RCTs, it is not well-reported. A systematic review of AAI RCTs on psychosocial outcomes found that not only were sample sizes relatively small, but only one of eight RCTs in the review reported a statistical power analysis to confirm that the sample size was sufficient to detect an effect on the primary outcome (Maujean et al., 2015). A second sample consideration specific to research on AAIs is the potential for a participation bias such that participants who choose to be in AAI studies disproportionally possess certain traits that make them unrepresentative of the broader population (Elston, 2021). ...
... Previous RCTs in the field have shown that the effects of AAIs and patient health outcomes can be incredibly variable, such that benefits may apply to some participants only under certain conditions (Kamioka et al., 2014;Maujean et al., 2015;Chen et al., 2022). Therefore, moderator analyses are fundamental to the development of the field to answer questions about when, under what conditions, and for whom interventions are effective (MacKinnon and Luecken, 2008). ...
The field of human-animal interaction (HAI) has experienced prolific growth in the scope, breadth, and rigor of research conducted on animal-assisted interventions (AAIs). As knowledge regarding the preliminary efficacy of AAIs on outcomes of human health and wellbeing continues to accumulate, so has information regarding the feasibility, safety, and acceptability of AAIs. This progression, combined with an increase in funding opportunities, institutional resources, and growing recognition of the field from mental and medical health professionals, has led to more widespread implementation of randomized controlled trials (RCTs) in the field. While conducting RCTs in any field of study is an intensive and complex undertaking, researchers conducting RCTs to evaluate the efficacy of AAIs are faced with unique considerations. The goal of this manuscript is to discuss these complexities and considerations surrounding conducting an RCT of an AAI program in regard to study planning, conceptualization, design, implementation, and dissemination. We highlight common confounders in HAI research and provide strategies for minimizing or ameliorating them. Recommendations pertain to such unique issues as ethical considerations, theory, control and comparison groups, sampling, implementation fidelity, and transparent reporting of findings. These considerations and recommendations seek to aid HAI researchers in the design, implementation, and dissemination of future RCTs to continue to advance the rigor of the field.
... Animal-assisted therapy is a goal-oriented health intervention using a trained animal for a wide range of people to achieve specific therapeutic outcomes, such as reducing stress levels [1][2][3]. Any species of animal can possibly be part of the intervention [2,4]. However, the bulk of animal-assisted therapy studies and health benefits demonstrated have focused on dogs because they are easily trainable compared to other species [2,4]. ...
... Furthermore, there were significant improvements noted in the living profile skills and social contact scores of inpatients with schizophrenia in the therapy dog intervention group [2]. However, despite these positive results, existing research is largely descriptionbased, using small samples of participants and rarely including a control group [3]. In studies that did use a control condition, it was often difficult to compare the effectiveness of animal-assisted therapy for specific conditions as different scales were used amongst the studies [5]. ...
University students experience a high level of stress, which could potentially affect how they manage stressful situations beyond university, such as when entering the workforce. Although universities offer counseling services and various health promotion programs, there is reluctance and negative perceptions about utilizing these from students. Further research is needed to explore the effectiveness of therapy dog interventions in human interactions that is quantifiable and embraces the elements of health promotion. This study aimed to investigate the impact of therapy dog interventions on students’ moods across a multi-campus university during a 2-week final examination period. Two hundred and sixty-five students participated in the study involving a multi-campus university. The intervention group and control group completed a questionnaire involving the positive affect negative affect schedule (PANAS), a 20-item scale that measures a person’s affect at the time. The intervention group (n = 170) had a higher average of total PANAS scores (mean = 77.63, standard deviation = 10.975) compared to the control group (n = 95) (mean = 69.41, standard deviation = 13.442). The results were statistically significant (mean difference = 8.219, 95% CI = 5.213–11.224, p < 0.05) with a t-score of 5.385. Students who engaged with therapy dogs on campus during the examination period were more likely to have a more positive affect. The results suggest that universities should include therapy dog programs within their health promotion programs for students, as these may help improve their mood and reduce the stress associated with university examinations.
... However, horses have been critical as therapeutic animals in recent years. Horse-assisted therapy programs are conducted for a variety of therapeutic reasons [12,13]. These programs have significant benefits such as helping people focus, calmness, mood stabilization, and improving prospects. ...
The relationship between horses and human is unique over the course of the story. The first researchers focused on the horse-human bond as a friendship and believed that it improved the welfare of horses. Today, the role of horses is different from that of history. However, the overall perception is that the horse-human connection requires significant interpretation and explanation. The most important aspect of communicating with the horse is that it is silent. To achieve that, the well-being of horses must develop a good physiological and psychological awareness. To this end, the advancement of sensors and wearable technology creates a facility for measuring and exploring the natural environment. Among the amazing advancements in this area are smartphones, flat screens, high-speed cameras, analog software, GPS tracking, and Bluetooth. You can proceed the way the horse-human link functions, plays, and communicates faster. However, new technologies for horses' well-being can have a positive and negative impact on the sport, their health, and the relationship between horses and humans. In this chapter, we will attempt to explain the emphasis put on the importance of the horse-human bond and interaction for animal beings. Furthermore, we will review the roles of new technologies in the physiological and psychological situations of the horse, and studies of horse-human connection belong to recent research. In this way, we will have put a vision on the side of animals on the horse and the human connection and interaction.
... Within Australia, it is estimated that 40% of households have a dog [1], and dogs may provide humans with a range of physiological, psychological and social benefits [2][3][4][5]. While there is growing scientific evidence of these benefits to humans, the health and welfare impacts on dogs and ethics of engaging dogs in these ways have been less explored [6][7][8]. ...
Dogs may provide humans with a range of physical, mental and social benefits. Whilst there is growing scientific evidence of benefits to humans, there has been less focus on the impact to canine health, welfare and ethical considerations for the dogs. The importance of animal welfare is increasingly acknowledged, indicating that the Ottawa Charter should be extended to include the welfare of non-human animals supporting the promotion of human health. Therapy dog programmes are delivered across a variety of settings including hospitals, aged care facilities and mental health services, highlighting the important role they play in human health outcomes. Research has shown that that there are biomarkers for stress in humans and other animals engaged in human–animal interactions. This review aims to assess the impact of human–animal interactions on therapy dogs engaged in providing support to human health. While challenging, it is paramount to ensure that, within the framework of One Welfare, the welfare of therapy dogs is included, as it is a key factor for future sustainability. We identified a range of concerns due to the lack of guidelines and standards to protect the wellbeing of the dogs engaged in these programmes. Extension of the Ottawa Charter to include the welfare of non-human animals with leveraging through a One Welfare approach would promote animal and human health beyond current boundaries.
... Στη βιβλιογραφία αναφέρονται διαφορετικές θεραπευτικές μέθοδοι που χρησιμοποιούνται σε άτομα με αναπηρία όπως η φυσικοθεραπεία, η θεραπευτική άσκηση, η υδροθεραπεία, εναλλακτικές ενεργειακές μέθοδοι, η μουσικοθεραπεία, οι εικαστικές θεραπευτικές παρεμβάσεις, το ψυχόδραμα, η θεραπεία με την βοήθεια ζώων, κλπ. Ειδικότερα όσον αφορά τη θεραπεία με τη βοήθεια των ζώων, τις τελευταίες δύο δεκαετίες έχει γίνει αποδεκτή η ανάπτυξη προγραμμάτων παρέμβασης που χρησιμοποιούν στην μεθοδολογία τους ως ερέθισμα ζώα όπως κατοικίδια, ζώα φάρμας, άλογα, καθώς και δελφίνια (Maujean, Pepping & Kendall, 2015). Τα προγράμματα αυτά τα συναντούμε με την ονομασία Παρεμβάσεις με τη βοήθεια ζώων -Animal Assisted Interventions (AAIs) και Θεραπεία με τη βοήθεια ζώων -Animal Assisted Therapy (ΑΑΤ) και βασίζονται στην τριγωνική σχέση που αναπτύσσεται μεταξύ του ζώου, του θεραπευτή και του ατόμου με αναπηρία και περιλαμβάνουν αλληλεπίδραση, επικοινωνία ή και άμεση ενεργητική επαφή μαζί τους (Isaat, 2011). ...
Therapeutic programs for individuals with disabilities that use dolphins as a stimulus have emerged during the past decades. Τhe purpose of this study was to present the respective research findings examining the effec-tiveness of interventions using dolphins as a stimulus. In general, the Dolphin Assisted Therapy (DAT) proto-cols for individuals with disabilities vary. Certain interventions used direct or indirect contact between dolphins and the individuals, in the presence of an occupational therapist. In contrast, others presented a more holistic approach enabling parameters as family participation during the process, and an adaptation of the living envi-ronment in which the individuals with disabilities were living during the whole DAT circle. The research find-ings were controversial, as only few studies exhibited positive outcomes in certain variables (attention, moti-vation, emotional behavior, and depression), while they were strongly criticized due to their respective meth-odological limitations. In conclusion, the inconsistent results of DAT may not verify it’s positive effect. At the same time, multiple ethical issues are raised from the use of dolphins under captivity, especially since the DAT is considered a complementary therapy for individuals with disabilities
... This would pose a barrier to the current study as traveling to a farm was not a viable option with the inpatient palliative population. The need for further research such as randomized control trials in animal-assisted therapy was identified, however, the difficulty of determining a causal reaction to horse therapy and attributing it to one lone intervention was noted [25]. ...
With advances in modern medicine, Canadians are living longer with chronic illnesses. While many live at home, those in inpatient units may require comfort measures to complement treatment programs. Anecdotal evidence established that equine (horse) therapy can be beneficial, but there has been limited research about the utilization of horse therapy within the inpatient palliative care population in Canada. The study aimed to understand palliative inpatients’ experiences with equine therapy. Of eight adult palliative care unit inpatients recruited by nursing staff, six (aged 58 – 82) completed the study. A qualitatively driven mixed-methods research design was used to collect qualitative data via individual interviews with participants, and quantitative data through inpatient records and the revised Edmonton Symptom Assessment System (ESASr). The quantitative data, analyzed using a non-parametric sign test, guided the interview questions. Then, narrative analysis of the interview data allowed rich descriptions and exploration of the participants’ real-life experiences. The results of the study identified equine therapy as an effective intervention that allowed participants to "live in the moment." Narrative threads of quality of life, fatigue, distraction, reminiscence, and identification with the therapy horse were examined. This research project outlays an innovative approach for conducting horse therapy within an institutional setting and begins to scientifically address the knowledge gap on the meaning of horse therapy to the adult palliative care inpatient population.
... The above mentioned experiments are designed to independently compare the effect in DAT under different factors such as water, wind or dolphins [49]. To verify the expected outcomes for the experimentation, the raw-results were acquired using IM4pDAT. ...
... Res. Public Health 2022, 19, 14449 3 of 13 disability) [36,37]; others focused on behavioral issues other than core impairments of social and communication stills. Some studies lacked a quality analysis of selected articles (i.e., effect size estimates) or offered a systematic review without meta-analysis [26,38]. ...
Animal-assisted therapy has become a fast-growing and effective approach for remediating core impairments of children with ASD; however, recent systematic review studies on the effects of AAT in children with ASD have some limitations, including referral to a variety of animal-assisted interventions rather than to horseback-riding therapy alone and the absence of any meta-analysis in systematic reviews. A complete systematic review of the studies that describe the use of THR as an intervention is needed to specifically target the core impairments of children with ASD. The purpose of this study was to employ the systematic review method to synthesize research findings regarding the effects of THR programs on the social interaction and communication skills of children with ASD. We conducted a structured search in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. We searched for potentially relevant studies in five databases (Web of Science, PubMed, CINAHL, Scopus, and SPORTDiscus) from inception until February 2022. In addition, we manually searched the bibliographies of the included studies to find articles that might otherwise have been missed. We considered articles eligible or ineligible if they satisfied specific inclusion or exclusion criteria. Our results showed that the THR program is an effective direct and alternative therapeutic program that can considerably improve the social behaviors and communication skills of children with ASD and can effectively impact autistic impairments in areas such as social awareness, social cognition, social motivation, and social communication. These findings are in line with those of previous studies; however, we did not find statistical evidence of any effect of THR on the autistic behaviors of irritability, stereotypy, and inappropriate speech. In conclusion, the findings produced by this meta-analysis study provide evidence that THR programs can considerably improve the social behaviors and communication skills of children with ASD.
Unlabelled:
Due to the high burden of mental health issues among students at higher education institutions world-wide, animal-assisted interventions (AAIs) are being used to relieve student stress. The objective of this study was to systematically review of the effects of AAIs on the mental, physiological, and cognitive outcomes of higher education students. Randomized controlled trials using any unfamiliar animal as the sole intervention tool were included in this review. Study quality was assessed using the Cochrane Risk-of-Bias tool. Where possible, effect sizes (Hedges' g) were pooled for individual outcomes using random-effects meta-analyses. Albatross plots were used to supplement the data synthesis. Of 2.494 identified studies, 35 were included. Almost all studies used dogs as the intervention animal. The quality of most included studies was rated as moderate. Studies showed an overall reduction of acute anxiety and stress. For other mental outcomes, studies showed smaller, but nonetheless beneficial effects. Studies showed no clear effect on physiological or cognitive outcomes. Strong methodological heterogeneity between studies limited the ability to draw clear conclusions.
Supplementary information:
The online version contains supplementary material available at 10.1007/s11469-022-00945-4.
Animal-assisted therapy (AAT) has become increasingly popular as an adjunct to treatment across a variety of populations and disciplines. However, minimal empirical documentation for AAT exists in the literature. The purpose of this project was to assess the efficacy of animal-assisted occupational therapy (AAOT) on attention in preschoolers. We hypothesized that the presence of a specially trained canine in the treatment room would increase attention to therapist-directed activities during a table-based occupational therapy activity. A total of 12 preschool-aged children participated in this study during regularly-scheduled occupational therapy sessions. Data were collected based on the percentage of time the student was off-task during the activity. Results demonstrated statistical significance, with the children significantly less off-task on average when a dog was present during instruction than when a dog was not present (t (11) = 2.89, p = .015). This study provides additional research to support the efficacy of AAT with a focus on the preschool population, which is an area that is underrepresented in published literature.
Systematic reviews and meta-analyses are essential to summarize evidence relating to efficacy and safety of health care interventions accurately and reliably. The clarity and transparency of these reports, however, is not optimal. Poor reporting of systematic reviews diminishes their value to clinicians, policy makers, and other users.
Since the development of the QUOROM (QUality Of Reporting Of Meta-analysis) Statement—a reporting guideline published in 1999—there have been several conceptual, methodological, and practical advances regarding the conduct and reporting of systematic reviews and meta-analyses. Also, reviews of published systematic reviews have found that key information about these studies is often poorly reported. Realizing these issues, an international group that included experienced authors and methodologists developed PRISMA (Preferred Reporting Items for Systematic reviews and Meta-Analyses) as an evolution of the original QUOROM guideline for systematic reviews and meta-analyses of evaluations of health care interventions.
The PRISMA Statement consists of a 27-item checklist and a four-phase flow diagram. The checklist includes items deemed essential for transparent reporting of a systematic review. In this Explanation and Elaboration document, we explain the meaning and rationale for each checklist item. For each item, we include an example of good reporting and, where possible, references to relevant empirical studies and methodological literature. The PRISMA Statement, this document, and the associated Web site (http://www.prisma-statement.org/) should be helpful resources to improve reporting of systematic reviews and meta-analyses.
Animal-assisted therapy and animal-assisted activities involve a nonhuman animal as a key therapeutic agent in some kind of intervention that may range from highly specified, as in AAT, to more casual, as in AAA. In this review I address the question: How important is the animal
in animal therapy? In other words, does the recent literature strongly support the notion that a live animal, as opposed to another novel stimulating component, is specifically necessary for therapeutic success. Two meta-analyses and 28 single empirical studies were reviewed in order to address
this issue. I conclude that the effects of AAT and AAA are likely to be moderate and broad at best and that, although improving, the literature has not yet reached an experimentally rigorous enough level to provide a definitive robust conclusion about the effectiveness of these approaches,
particularly with regard to the question of whether a live animal is necessary for a therapeutic effect.
There is a significant body of research into the benefits of animal-assisted therapy (AAT) but less into the fields known as equine-assisted learning and therapy (EAL/EAT) where horses are incorporated in therapeutic and learning interventions. This paper explores the experiences of seven 'at-risk' young people who participated in a therapeutic horsemanship (TH) programme. The study followed a practice-near approach seeking to capture the young people's experiences within a participative ethnography. Themes related to the risk and resilience literature such as self-confidence, self-esteem, self-efficacy and a sense of mastery, empathy and the opening of positive opportunities are explored in this paper.
The concept of Green care includes a diversity of interventions at farms, where the common basis of the interventions is use of nature and the natural environment to improve or promote health and well-being. Farm animals are a natural part of this service and farm animal-assisted interventions
may act as a complementary intervention within mental health care. The main aim of this study was to examine the effect of a 12-week farm animal-assisted intervention on levels of depression (BDI-IA), state anxiety (STAI-SS), and self-efficacy (GSE) in people with clinical depression. Twenty-nine
people (23 women and 6 men, mean age 37.8 years, range 23–58) were randomly assigned to the intervention (n = 16) or a wait-list control group (n = 13). In the intervention group, the participants worked twice a week with the farmer in the cowshed. They interacted on their
own choice with dairy cattle via work tasks and physical contact. A significant decline in depression (t
(15) = –3.53, p = 0.003) and a significant increase in self-efficacy (t
(15) = 2.18, p = 0.045) were seen in the intervention group
between recruitment and end of intervention. In the control group, no significant changes were found. No significant differences were found when comparing change in mental health measures in the intervention and control groups. However, more subjects in the intervention group (6) than in the
control group (1) had clinically significant change, indicating that animal- assisted intervention in Green care could be beneficial for subgroups of clients and act as a useful supplement within mental health care.
From its unpretentious beginnings in pastoral England to the current interest in scientific research and trials of its use, pet therapy is clearly drawing attention to its benefits. Throughout the 40-year history of pet therapy, nursing and nursing research has been at the very heart. The growing body of research in pet therapy reflects nursing's own evolutionary process. This article reviews the history of pet therapy and discusses the growing body of research illustrating the healing power of animal use.
Substantial sums of money are invested annually in preventative medicine and therapeutic treatment for people with a wide range of physical and psychological health problems, sometimes to no avail. There is now mounting evidence to suggest that companion animals, such as dogs and cats, can enhance the health of their human owners and may thus contribute significantly to the health expenditure of our country. This paper explores the evidence that pets can contribute to human health and well-being. The article initially concentrates on the value of animals for short- and long-term physical health, before exploring the relationship between animals and psychological health, focusing on the ability of dogs, cats, and other species to aid the disabled and serve as a “therapist” to those in institutional settings. The paper also discusses the evidence for the ability of dogs to facilitate the diagnosis and treatment of specific chronic diseases, notably cancer, epilepsy, and diabetes. Mechanisms underlying the ability of animals to promote human health are discussed within a theoretical framework. Whereas the evidence for a direct causal association between human well-being and companion animals is not conclusive, the literature reviewed is largely supportive of the widely held, and long-standing, belief that “pets are good for us.”
Reviews of animal-assisted therapy (AAT) research suggest the need for better controlled and designed research studies to supplement the many case studies and anecdotal reports. This study reports the results of such an investigation where sixty-nine male and female psychiatric inpatients were randomized to either an AAT psychiatric rehabilitation group or a similarly conducted control group without AAT, to test if AAT can improve prosocial behaviors. The Social Behavior Scale was scored daily by an independent rater and patients were monitored for four weeks. A two-group by weeks repeated measure analysis of variance was conducted for each outcome measure. There were no baseline differences between the two groups on demographics or any of the measures, but by week four, patients in the AAT group were significantly more interactive with other patients, scored higher on measures of smiles and pleasure, were more sociable and helpful with others, and were more active and responsive to surroundings. These data suggest that AAT plays an important role in enhancing the benefits of conventional therapy, and demonstrates the benefit of including a non-AAT group for comparison. The study also demonstrates the importance of using longitudinal, repeated measure designs. Previous studies may have failed to find significant effects because they were restricted to shorter intervals for measuring outcomes.
Animal-assisted therapy (AAT) has been practiced for many years and there is now increasing interest in demonstrating its efficacy through research. To date, no known quantitative review of AAT studies has been published; our study sought to fill this gap. We conducted a comprehensive search of articles reporting on AAT in which we reviewed 250 studies, 49 of which met our inclusion criteria and were submitted to meta-analytic procedures. Overall, AAT was associated with moderate effect sizes in improving outcomes in four areas: Autism-spectrum symptoms, medical difficulties, behavioral problems, and emotional well-being. Contrary to expectations, characteristics of participants and studies did not produce differential outcomes. AAT shows promise as an additive to established interventions and future research should investigate the conditions under which AAT can be most helpful.
Patients with a diagnosis of schizophrenia living in long-term care units show high levels of disability. The present study aimed to assess the effectiveness of including a trained therapy dog in an intervention program applied to institutionalized patients with chronic schizophrenia. A randomized, controlled study with blind assessment was conducted. Twenty-four persons with chronic schizophrenia were randomly selected from a register that included all inpatients at Saint John of God's psychiatric hospital in Spain. Patients who agreed to participate (n = 21) were randomly assigned to one of the two treatment groups: one group received an intervention assisted by a therapy dog (IG+D) (12 patients), while the other received the same intervention but without a therapy dog (IG) (9 patients). The assessment items included the Positive and Negative Symptoms Scale (PANSS), the Living Skills Profile (LSP), the Brief World Health Organization Quality of Life Assessment (WHOQOL-BREF), and the Satisfaction with Treatment Questionnaire (STQ). Mann Whitney U tests and Wilcoxon signed-rank tests were conducted. Patients in the IG+D group showed significant improvements in the LSP social contact score (p = 0.041), in the positive (p = 0.005) and negative symptom dimensions (p = 0.005) and total score of the PANSS (p = 0.014), and in quality of life related with social relationships (p = 0.024). Patients in the IG group showed significant positive changes in positive (p = 0.027) and general symptoms (p = 0.046) and total PANSS score (p = 0.027). No differences were found between the two groups before and after the application of the intervention. Introducing a dog into the psychosocial intervention for patients with schizophrenia produced some positive outcomes. However, the results of the study are not conclusive and must be interpreted cautiously.
Proper diagnostic assessment in an inpatient psychiatric setting requires observation of patients under various conditions. Group activities such as animal-assisted therapy (A-AT) can provide an excellent opportunity for assessment—but only if the patient chooses to attend. Retrospective analysis of attendance at a major metropolitan inpatient psychiatric unit indicates that over the course of two years (N= 23 months) the A-AT group attracted the highest percentage of inpatients voluntarily choosing to attend an occupational therapy group. It was found that A-AT was the most effective of all groups offered in attracting isolated individuals regardless of diagnosis. The authors conclude that A-AT is an effective tool for diagnostic observation and assessment.