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Dog Ownership and Training Reduces
Post-Traumatic Stress Symptoms
and Increases Self-Compassion Among Veterans:
Results of a Longitudinal Control Study
Dessa Bergen-Cico, PhD,
1
Yvonne Smith, PhD,
2
Karen Wolford, PhD,
3
Collin Gooley, MSW,
2
Kathleen Hannon, BS,
4
Ryan Woodruff, BS,
4
Melissa Spicer, BS,
4
and Brooks Gump, PhD
1
Abstract
Objectives: The aims of this study were to measure the potential impact of a therapeutic dog ownership and
training program for Veterans with symptoms of post-traumatic stress.
Design: The study used a quasi-experimental design with two cohorts of Veterans—a dog owner-trainer
intervention and a wait list control group. Participants completed baseline and 12-month follow-up assessments.
Setting: Clear Path for Veterans, a nonclinical, open recreation facility whose mission is to support Veterans
and their families in the reintegration process after military service.
Subjects: Participants (n=48) were either enrolled in the veterans therapeutic dog owner-trainer program
(Dogs2Vets) or were placed in the wait list control group.
Intervention: Veterans were enrolled in the Dogs2Vets program, a 12-month structured dog owner-trainer
program that engages veterans in the training and care of a dog that they ultimately adopt. The Dogs2Vets
Program focuses on the healing aspects of the human-animal bond.
Outcome measures: PTSD Checklist, Military Version (PCL-M), perceived stress scale, self-compassion
scale (SCS) composite, and SCS subscales for isolation and self-judgment.
Results: Veterans participating in the Dogs2Vets owner-trainer program experienced significant reductions in
symptoms of post-traumatic stress, perceived stress, isolation, and self-judgment accompanied by significant
increases in self-compassion. In contrast there were no significant improvements in these measures among
veterans in the wait list control group. Qualitative data reinforced the statistical findings with themes of
decreased isolation, unconditional acceptance and companionship, and a renewed sense of safety and purpose
from their relationships with their dogs.
Conclusion: Veterans benefit significantly from dog ownership in combination with a structured dog training
program. Not only do they experience significant decreases in stress and post-traumatic stress symptoms but
also they experience less isolation and self-judgment while also experiencing significant improvements in self-
compassion.
Keywords: post-traumatic stress disorder, self-compassion, veterans, animal assisted interventions, dog therapy, stress
1
Department of Public Health, Syracuse University, Syracuse, NY.
2
School of Social Work, Syracuse University, Syracuse, NY.
3
Department of Psychology, SUNY Oswego, Oswego, NY.
4
Clear Path for Veterans, Chittenango, NY.
THE JOURNAL OF ALTERNATIVE AND COMPLEMENTARY MEDICINE JACM
Volume 00, Number 00, 2018, pp. 1–10
ªMary Ann Liebert, Inc.
DOI: 10.1089/acm.2018.0179
1
Introduction
There are many individual and systematic barriers
to engaging military veterans in traditional clinical treat-
ment for post-traumatic stress disorder (PTSD). Fewer than half
of veterans in need of PTSD treatment will actually receive
clinical services through the Veterans Administration (VA).
1–3
Therefore effective complementary and alternative strategies,
outside of traditional clinical structures, are needed for veterans
with PTSD. Animal assisted interventions (AAIs) are one of the
promising nonclinical strategies for veterans with PTSD. AAIs
have long been used to aid military veterans who experience a
range of trauma-related problems. In fact, the earliest docu-
mented therapeutic use of animals in the United States was a
program developed by the American Red Cross and the U.S.
Army Air Corps Convalescent Center to assist veterans re-
covering from ‘‘battle fatigue’’ following World War II.
4
Service dogs are one form of AAI that is increasingly being
used to improve the quality of life for veterans with physical
limitations and PTSD.
5
AAIs can utilize a variety of animals and encompass a
range of human–animal interactions—from brief thera-
peutic encounters to long-term pet ownership.
5–7
AAIs are
typically used as a complement to traditional medical,
pharmacologic, and psychotherapeutic interventions, al-
though some have suggested that AAIs may be considered
in place of other treatments because there are fewer neg-
ative side effects and AAIs may be more cost effective.
6,7
Across a range of populations, AAIs have been found to
result in biopsychosocial benefits, such as decreased neg-
ative effect, increased adaptive functioning, decreased
perceived pain, and decreased healthcare utilization.
8–12
AAIs have also been shown to improve psychosocial
functioning in several areas, including loneliness,
13
social
support,
14
stress reduction,
15
and anxiety.
16
Researchers have theorized that the benefits of human–
animal interaction are related to three main mechanisms as
follows: the reduction of anxiety and arousal, the facilitation
of human to human social interaction, and by directly meet-
ing people’s fundamental social need for attachment.
17
These
three mechanisms involve interrelated neurobiologic and
psychologic processes that also impact social interactions.
Research is needed to better understand the mechanisms of
change associated with AAIs and pet ownership.
18
Although
AAIs for returning veterans have found that such interven-
tions are generally beneficial for PTSD symptoms and related
mental health outcomes, the effect sizes vary and studies are
plagued by methodological shortcomings, and there are in-
consistencies in the outcomes for veterans.
4,5,19,2 0
There is substantive research on the physical health
benefits of both AAIs and animal companionship/pet
ownership programs. AAIs involve planned, time-limited
one-time or recurrent interactionswithananimalorani-
mals designed to meet specified mental health or other
biopsychosocial goals.
21
Pet ownership programs, while
they may also be planned and goal-directed and involve
time-limited sessions with providers (such as animal trainers
or clinical professionals), involve sustained animal com-
panionship, with the animal or animals living in the dwell-
ing of the program participant. Even brief visits with dogs
have shown significant decreases in state anxiety, systolic
pulmonary artery and capillary wedge pressure, epinephrine
levels, and norepinephrine levels during and after dog vis-
itation.
14
Some have theorized that the benefits of human-
dog interactions result from neurobiologic changes, such as
the release of oxytocin during calm interactions with ca-
nines, that facilitate reductions in anxiety and hyperarousal.
22
Another often-reported physical benefit of dog ownership
(as opposed to time-limited AAIs) is increased daily physical
activity and cardiovascular benefits, which researchers suggest
may be the result of participants walking their dog daily.
23
Research on AAIs has been limited by small sample sizes
and lack of control groups, thus empirical studies with larger
sample sizes are needed.
24
Although high-quality outcome
studies of the effects of pet ownership on psychosocial func-
tioning are few, there is some evidence that pet ownership also
contributes to psychosocial well-being.
25–27
Consistent anec-
dotal reports suggest that AAIs and pet ownership interven-
tions may be especially well suited to people who are socially
withdrawn and isolated, which are symptoms of post-traumatic
stress among veterans; however, these assumptions are not
necessarily based on empirical evidence.
26
Some researchers
posit that the companionship of an alert dog may ameliorate
hypervigilance and reduce depression
28
and anxiety.
29
Pets
may be beneficial in alleviating stress, depression, and alien-
ation, by providing a sense of comfort and motivation to live.
23
It is important to bear in mind that the psychologic benefits of
pet ownership are not guaranteed and that pet ownership also
introduces new stressors that may aggravate existing condi-
tions; therefore, stress should also be measured in pet owner-
ship intervention research.
Increasingly, researchers are emphasizing the importance
of examining self-compassion as an outcome for interven-
tions that aim to address chronic PTSD among military vet-
erans.
30,31
The cultivation of self-compassion is associated
with decreased PTSD related symptoms of self-judgment,
self-criticism, and rumination specifically among Iraq and
Afghanistan War veterans.
30–32
Researchers note that the
compassionate and nonjudgmental demeanor of dogs makes
them well suited for veterans with PTSD who often experi-
ence hypervigilance, isolation, and reintegration challenges
while also feeling the need to project a strong persona.
28
Thus
the constructs of self-compassion and judgment are particu-
larly salient for service dog programs and are important
outcomes for the present study. To the best of their knowl-
edge, research has not been conducted that has examined the
effect of a service dog ownership program for veterans on
self-compassion and PTSD. Thus, one purpose of this study
was to explore the effect of a veterans’ dog ownership and
training program on facets of self-compassion among veter-
ans with symptoms of post-traumatic stress.
The primary aim of the present study was to investigate
the effect of a veteran dog owner-trainer program (Dogs2-
Vets) on symptoms of post-traumatic stress among veterans;
secondary outcomes include perceived stress, self-compassion,
self-judgment, and isolation. The authors hypothesized that the
dog owner-trainer program would decrease self-judgment
and isolation while increasing self-compassion. The authors
further hypothesized that participation in the Dogs2Vets
program would significantly reduce symptoms of post-
traumatic stress and perceived stress. In contrast, the au-
thors hypothesized that veterans in the wait list control
group would not experience significant improvements in
any of these constructs.
2 BERGEN-CICO ET AL.
Materials and Methods
This study was approved by the Syracuse University
Human Subjects Institutional Review Board. The population
recruited for this study included veterans enrolled in the
Dogs2Vets program at Clear Path for Veterans, a nonclinical,
open recreation facility whose mission is to support veterans
and their families in the reintegration process after military
service. Participants were military veterans who had symp-
toms of PTSD. Veterans may self-refer to the Dogs2Vets
program or be referred by their psychotherapists at the re-
gional VA Medical Center or Vet Center. Dogs2Vets is re-
commended as an additional tool in managing symptoms of
post-traumatic stress and not as an alternative to clinical
therapies.
Recruitment and sample
Potential participants were provided with verbal and
written information about what the study entailed, and in-
terested veterans were then engaged in the informed consent
process. The recruitment pool included all veterans who
enrolled in the Dogs2Vets program from 2014 to 2017
(n=64); 94% (n=60) of Dogs2Vets participants agreed to
enroll in the study. Of the 60 who enrolled in the study,
n=12 were omitted from the final analysis because they had
only completed baseline data collection. In total, n=48
provided complete baseline and follow-up data, n=14 were
wait list control participants, and n=34 were enrolled in the
dog owner-trainer program. The wait list control group en-
gaged with social programs through the agency while
waiting to begin the Dogs2Vets program; these included
volunteering and the Wingman (peer support) program. The
average amount of time wait list control participants waited
to be enrolled in the program was 12 months.
Military service related data were collected during enroll-
ment in the Dogs2Vets program, including branch of military
service, combat exposure, time since separation from military,
and era of service in addition to age, race, and sex.
Description of Dogs2Vets program
The Dogs2Vets program is a structured dog training pro-
gram that engages veterans in the training and care of a dog
that they ultimately adopt. In many cases, both the veteran
and the dog come to Clear Path somewhat displaced having
experienced significant traumas and disruptions to impor-
tant relationships. The Dogs2Vets Program at Clear Path for
Veterans focuses on the healing aspects of the human-animal
bond. Unlike many other organizations that provide trained
service dogs to veterans, Dogs2Vets follows the owner-trainer
model of training; each veteran selects a dog, and the
veteran/dog team train with their dog under the guidance of
a Dogs2Vets professional trainer. During training, partici-
pants learn to care for their dogs and learn dog behavioral
management and training skills. Veteran/dog teams engage in
90-minute weekly dog training sessions for 12–18 months.
Each team undergoes the American Kennel Club (AKC)
testing for both Canine Good Citizen (CGC) and Community
Canine. Upon passing the CGC evaluations, veteran/dog
teams begin public access training and attend weekly sessions
working in new environments where they practice in real
world settings (e.g., stores and public events). Throughout this
process, veterans are encouraged to conduct several outings to
enhance their dog’s training and promote social engagement.
Measures
Post-traumatic stress symptoms were measured with the
PTSD Checklist-Military Version (PCL-M). The PCL-M is
a 17-item questionnaire in which respondents rate the degree
to which they have been bothered by military related post-
traumatic stress symptoms in the past month using a 5-point
Likert scale from 1 (not at all) to 5 (extremely).
33,34
Possible
scores on the PCL-M range from 17 to 85. Internal consis-
tency was high with a Cronbach’s alpha of 0.83 at baseline.
The Perceived Stress Scale (PSS) is a psychometrically
validated measure of the degree to which situations in one’s
life are appraised as stressful. The PSS is a 10-item scale
designed to tap how unpredictable, uncontrollable, and
overloaded respondents find their lives to be in the past
month.
35
The PSS was used to measure life stressors over
time and to assess potential additional stressors of dog
ownership. Internal consistency of the PSS was high with a
baseline Cronbach’s alpha of 0.87.
Self-compassion was measured using the Self-Compassion
Scale Short Form (SCS-SF), a 12-item scale in which re-
spondents’ rate how they typically act toward themselves
ranging from 1 =almost never to 5 =almost always.
36
The
SCS-SF yields a total composite score and can be used to
compute subscale scores for isolation, self-judgment, over-
identification, self-kindness, common humanity, and mind-
fulness. SCS-SF subscales are computed by calculating the
mean for the subscale item responses. The SCS composite
score is computed by reverse scoring the negative subscale
items for self-judgment, isolation, and over-identification (i.e.,
1=5, 2 =4, 3 =3, 4 =2, 5 =1) and computing a total mean.
37
The baseline Cronbach’s alpha for the composite SCS-SF was
0.89; the alphas for the SCS-SF subscale measures for isola-
tion and self-judgment were both 0.90.
Statistical approach
The first step in the analysis entailed calculating means and
standard deviations for each of the outcome variables and
paired-sample ttests to measure within group differences from
baseline to 12-month follow-up. Due to the small sample size,
the authors used bootstrapping with 1,000 samples for the
within group analyses. Between group effect size (d
ppc2
)was
calculated according to Morris’s recommendations for differ-
ent sample sizes and potential differences in baseline/pretest
values. Morris recommends using the pooled baseline/pretest
standard deviation for weighting the differences of the pre-post
means.
38,39
The final step in their analysis was simple linear
regression, to examine changes in outcome scores by group
(Dogs2Vets =1; wait list control =0) through linear regression
models where group was the selection variable, baseline scores
the independent variables, and the dependent variables were
PTSD, perceived stress, isolation, self-judgment, and self-
compassion. Relevant assumptions were evaluated and deter-
mined to be within acceptable parameters; these included
normality, linearity, independence, and homoscedasticity.
Qualitative feedback was also collected from participants
in the Dogs2Vets program at 12-month follow-up through
written responses to an open-ended question placed at the
end of the survey e-mailed directly to participants. The
VETERANS’ DOG PROGRAM REDUCES TRAUMATIC STRESS SYMPTOMS 3
question asked participants to write a response in a text box
to the question ‘‘How did the Dogs2Vets program benefit
you?’’ The aim of this inquiry was to explore the relationship
between the veterans and the dogs and to better understand
the veteran’s experience with the program. In step one,
participants’ responses were reviewed independently by two
researchers who clustered responses into themes; the re-
searchers then triangulated their findings to establish con-
sensus and confirmation of thematic classifications. Open-
ended responses were ultimately clustered into five themes
and are presented at the conclusion of the results section.
Results
Baseline characteristics
The majority (84%) of the veterans identified as Cauca-
sian/white, 8% identified as African American, and 8%
identified as Hispanic. Fifty percent of the veterans had
served in the U.S. Army, 30% served in the Marines, 7%
had been in the Air Force, 7% had been in the Navy, 3% had
served in the Army National Guard, and 3% in the Marine
National Guard. There was substantial variation in the
number of years the veterans had been separated from
service with a mean of 12.9 years (SD 12.3) ranging from 1
to 32 years. The variation in years of service is also re-
flected in the diversity of the era of their military service;
20% had served in the Vietnam War, whereas the remaining
80% were post-9/11 military veterans.
The mean age at the time of baseline survey data col-
lection for the Dogs2Vets participants was 41 (SD 12) and
43 (SD 11) for the wait list control group. There were no
statistically significant differences ( p‡0.05) in age or out-
come measures at baseline between veterans who completed
the baseline and follow-up surveys (n=48) and those who
completed only baseline surveys (n=12) (age p=0.63;
PTSD p=0.93; perceived stress p=0.24; self-compassion
p=0.16; judgment p=0.50; or isolation p=0.43).
Dogs2Vets and wait list control participants completed
follow-up assessments 12 months after baseline assessments.
Paired sample ttests were conducted to measure within group
baseline to follow-up differences, and significant improve-
ments were found for each of the outcome measures among
Dogs2Vets participants ( p£0.05); however, there were no
significant changes among the wait list control group. The
means, standard deviations, within group paired sample ttests,
and between group effect sizes are presented in Table 1. The
authors also conducted simple linear regression for their final
step of the analysis; these results are presented in Table 2.
There were significant improvements ( p£0.05) across all
measures when the Dogs2Vets participants were compared to
the wait list control group, with the exception of the measure
for isolation.
Changes in post-traumatic stress symptoms
At baseline all participants scored above 36, which is the
low end of the cut point score on the PCL-M for post-
traumatic stress symptoms when PTSD is assessed in spe-
cialized medical clinics or VA primary care. The mean
baseline PCL-M score was 64 (SD 9.6) with a range of 39–
85 for the entire group. There were no significant between
group (intervention vs. control) differences in baseline PCL-
M scores. Among Dogs2Vets participants there was a sig-
nificant decline ( p=0.03) in PCL-M scores with a mean
decline of 4.2 (SD 8.5) points. However, there were no
significant changes at follow-up among the control group; in
fact, there was even a moderate increase of 0.5 (SD 8.1)
points. The effect size for between group differences in the
Dogs2Vets and control group for PCL-M score was mod-
erate at -0.28. Changes in PCL-M scores for each group are
presented in Figure 1 and Table 1. The authors also con-
ducted linear regression to examine the main effect of the
Dogs2Vets intervention on PCL-M scores at 12 months. The
results indicate that participation in the Dogs2Vets program
significantly predicted reductions in PCL-M scores at
follow-up ( p=0.01). There were no significant changes in
the regression model for the control group. Linear regression
results for PCL-M scores are presented in Table 2.
Perceived stress
There were significant reductions in perceived stress
among the Dogs2Vets group ( p=0.02) at follow-up; how-
ever, there were no significant differences in the wait list
Table 1. Within Group tTests and Between Group Effect Sizes for Intervention and Control Groups
Measure
Dogs to Vets (n=31) Control (n=14) Between group
Baseline Follow-up pBaseline Follow-up pEffect size dppc2
PCL-M 63.9 (9.2) 60 (8.8) 0.03 64.5 (10.8) 63.4 (12.6) 0.82 -0.28
PCL-M score change -4.2 (8.5) 0.5 (8.1)
Perceived stress 20.9 (6) 18 (6.2) 0.02 21.8 (5) 22.4 (7.3) 0.87 -0.6
Self-compassion 4.7 (1.4) 5.2 (1) 0.02 4.3 (1.7) 4.3 (1.5) 0.91 0.37
Self-judgment 3.8 (0.9) 3.3 (1) 0.01 3.4 (1.2) 3.8 (1.1) 0.55 -0.9
Isolation 4.1 (0.8) 3.6 (1) 0.02 3.9 (1.2) 4.0 (1.1) 0.18 -0.64
Bootstrap results based on 1,000 bootstrap samples.
PCL-M, PTSD Checklist, Military Version.
Table 2. Linear Regression Dogs2Vets Outcomes
BSEBbtpDR
2
PCL-M 0.54 0.20 0.49 2.8 0.01 0.24
Perceived stress 0.66 0.13 0.72 5.2 £0.001 0.52
Self-compassion 0.57 0.10 0.76 5.9 £0.001 0.58
Self-judgment 0.65 0.19 0.55 3.4 0.002 0.30
Isolation 0.31 0.22 0.26 1.4 0.17 0.07
PCL-M, PTSD Checklist, Military Version.
4 BERGEN-CICO ET AL.
control group. The effect size between the Dogs2Vets and
control group for perceived stress was moderate at -0.60.
Changes in perceived stress for each group are presented in
Table 1 and Figure 2. Linear regression was conducted to
examine the main effects of the Dogs2Vets intervention on 12-
month follow-up for perceived stress scores and to measure
potential increases in stress due to dog ownership responsi-
bilities. Participation in the Dogs2Vets program significantly
predicted reductions in perceived stress ( p£0.001). Thus, dog
ownership did not have a negative effect on perceived stress.
There were no significant changes in the regression model for
the control group. Results of the linear regression for perceived
stress are presented in Table 2.
Self-compassion
Analysis revealed significant within group increases from
baseline to follow-up for self-compassion ( p=0.02) among
Dogs2Vets participants while there were no significant
changes within the control group. There was a moderate
effect size of 0.37 between the groups for changes in self-
compassion. The results of within group differences in self-
compassion are presented in Table 1 and Figure 3. Linear
regression was conducted to examine the main effects of the
Dogs2Vets intervention for self-compassion using the
composite SCS scores, and the results are presented in Ta-
ble 2. Participation in the Dogs2Vets program significantly
FIG. 1. Longitudinal changes in
PCL-M scores for Dogs2Vets
intervention and control groups.
PCL-M, PTSD Checklist, Military
Version.
FIG. 2. Longitudinal changes in
perceived stress for Dogs2Vets in-
tervention and control groups.
VETERANS’ DOG PROGRAM REDUCES TRAUMATIC STRESS SYMPTOMS 5
predicted improvements in self-compassion at 12 months
(p£0.001). However, there were no significant changes in
the regression model for the control group.
Self-judgment
Paired sample ttests revealed significant improvements in
self-judgment within the Dogs2Vets participants ( p=0.01),
while there were no significant within group differences for
the control group. The effect size between the Dogs2Vets
and control group for self-judgment was large, -0.90. The
within group changes in self-judgment are presented in
Table 1 and Figure 4. Linear regression to examine the main
effects of the Dogs2Vets intervention on self-judgment
produced results similar to their results for self-compassion.
The results indicate that participation in the Dogs2Vets
program significantly predicted decreased self-judgment
(p=0.002), whereas there were no significant changes in the
regression model for the control group. Results of the linear
regression are presented in Table 2.
Isolation
Paired sample ttests revealed significant within group
declines for the measure of isolation among Dogs2Vets
participants ( p=0.02), but no significant change for the
control group. The effect size between the Dogs2Vets and
control group was moderate for isolation at -0.64. The
FIG. 3. Longitudinal changes in
self-compassion for Dogs2Vets
intervention and control groups.
FIG. 4. Longitudinal changes in
self-judgment for Dogs2Vets
intervention and control groups.
6 BERGEN-CICO ET AL.
within group changes in isolation are presented in Table 1
and Figure 5. Linear regression did not reveal a significant
main effect of the Dogs2Vets program on isolation; results
are presented in Table 2.
Veterans perceptions of the impact
of the Dogs2Vets program
Qualitative analysis of the veterans’ open-ended com-
ments regarding their experience with the Dogs2Vets pro-
gram was analyzed for themes. One hundred percent (n=34)
of the Dogs2Vets participants provided written responses to
the question on the follow-up survey that asked them to
describe in their own words how the Dogs2Vets program
has benefitted them. The analysis revealed five thematic
types of benefits; in rank order of prevalence from highest to
lowest they are as follows: (1) decreased isolation (47%,
n=16); (2) improved mental health and emotional well-
being (44%, n=14); (3) renewed sense of purpose, including
the opportunity to apply service skills (35%, n=12); (4)
PTSD symptom management (12%, n=4); and (5) increased
physical activity (6%, n=2).
There was overlap between these thematic areas such that
improvements in mental well-being and PTSD symptoms
were often related to decreased isolation and renewed sense
of purpose. Examples of veteran’s responses that reflect the
interconnectedness between these facets include: ‘‘My dog
has made me more comfortable in public places and around
people I don’t know. Having my dog with me reduces some
of my hypervigilance.’’; ‘‘My dog has helped decrease my
isolation by fostering my socialization and reducing my
PTSD symptoms–particularly my hypervigilance.’’; ‘‘It has
kept me sane’’; ‘‘I believe the relationship with my dog has
been positive for my mental state and happiness’’; ‘‘My dog
has helped greatly with my major depression’’; ‘‘On my bad
days my dog works to make me happy’’; ‘‘When I feel upset
my dog helps me feel better.’’; ‘‘My dog is able to help calm
me down a lot more than I could do on my own and she
allows my anxiety to be less of an issue so that I can go to
stores and be less awkward in social situations.’’; ‘‘The
relationship I am developing with my dog is growing and
making me feel better inside.’’; ‘‘Working with my dog has
given me hope for the future because I don’t feel so alone.’’;
and ‘‘It is forcing me to be more social. I must ensure my
dog gets to the park and other places I am very uncom-
fortable being.’’
One third of veterans reported that their dog provides a
renewed sense of purpose: ‘‘Quantifying a feeling is difficult
at best, but I feel like the tasks we complete in training
together give me a sense of accomplishment and purpose.
Much like I felt and had in the military. The teamwork and
camaraderie have been great for my self-esteem.’’ Within
this theme several indicated that the training components of
the program provided them with opportunities to apply
military service skills again—‘‘One of the greater satisfac-
tions I had while in the military was teaching and training
soldiers. I get some of those same feeling through the
training with my dog.’’; ‘‘I feel like we are a team and my
dog is my partner’’; and ‘‘The biggest benefit thus far has
been having another life that I am responsible for.’’ The
final thematic area that emerged was that of increased
physical activity through interactions with their dogs—
‘‘Physically, I have become more active and enjoy being
outdoors again.’’ and ‘‘I have developed a strong bond with
my dog and have been more active.’’
Discussion
Each of their hypotheses was confirmed. Veterans par-
ticipating in the Dogs2Vets program experienced reductions
in post-traumatic stress symptoms, perceived stress, isola-
tion, and self-judgment and an overall increase in self-
compassion. Although there was a significant decline in
symptoms of PTSD, the mean decline was just below the
FIG. 5. Longitudinal changes in
isolation for Dogs2Vets interven-
tion and control groups.
VETERANS’ DOG PROGRAM REDUCES TRAUMATIC STRESS SYMPTOMS 7
5-point change in PCL-M score that is considered to be the
threshold for clinically determining whether an individual
has responded to PTSD treatment.
40,41
It is also notable that
in contrast post-traumatic stress symptoms for the wait list
control cohort increased moderately.
Dog ownership did not have a negative effect on perceived
stress among Dogs2Vets participants, indicating that the ad-
ditional stressors of pet ownership (such as the cost of supplies
and veterinary care and time spent exercising, feeding, and
caring for the dog) do not appear to add substantial stressors
that would outweigh the benefits of the program. Although
perceived stress declined among Dogs2Vets participants, it
should be noted that the authors did not collect specific data or
information about challenges or potential negative aspects of
dog ownership.
The areas that demonstrated the strongest and most consis-
tent statistical changes were the measures of self-compassion
and self-judgment. These changes may be associated with the
general orientation of empathy, nonjudgment, and acceptance
that is associated with human–animal interactions.
42,43
Re-
searchers have observed that dogs provide a nonjudgmental
entity for emotional attachment and support which may reduce
self-judgment
44
; their findings support this theory. The unique
attachment and relationship with one’s dog may facilitate in-
creases in self-compassion, which is constructive because self-
compassion is a protective factor against PTSD among military
veterans.
45,46
Increased self-compassion is important be-
cause higher levels of self-compassion are characterized by
objective less distorted observation while also being associated
with well-being, resilience, and lower rates of depression.
36,37,46
Moreover, self-compassion entails being discerning and
gentle toward oneself while recognizing that suffering, fail-
ure, and perceived inadequacies are part of the human con-
dition and that everyone, including oneself, is worthy of
compassion.
37,45,46
Thus, the cognitive changes in self-
compassion and self-judgment, brought about through ser-
vice dog training and ownership, may prove to be important
healing processes for returning veterans.
Dogs2Vets participants had a statistically significant decline
in isolation over time, yet this decline was not significant when
analyzed between groups using linear regression. However,
participants’ written responses strongly demonstrated ways in
which the companionship of the dogs decreased their isola-
tion. Moreover, veterans’ written narratives illustrated ways in
which the trained and certified service dogs enabled them to go
out in public and interact socially. Those who were once iso-
lated and unwilling to set foot outside the door are now fre-
quently going into public places and working with their dog in
socially stressful environments. The veterans’ narratives also
suggest that their dog may provide a bridge to social interac-
tion, thus decreasing the barriers to being in public that PTSD
symptoms can often present. The veterans’ narratives also il-
lustrated ways in which their active participation in the training
of their dog provided a bridge from their military training roles
to civilian life and engendered a renewed sense of purpose and
responsibility for the life of another.
Limitations
The generalizability of the findings may be limited by the
sample characteristics. Notably, all participants were mili-
tary veterans, and they were predominantly white and male.
In addition, the sample size was small, which limited their
statistical power. Despite these sampling limitations, the
authors did find significant improvements among partici-
pants in the Dogs2Vets program. There were moderate ef-
fect sizes for post-traumatic stress symptoms, perceived
stress, and isolation. However, moderate effect sizes based on
small sample groups may be meaningful when implemented
in larger groups. Another limitation of the present study may
be the omission of measurements that reflect the changes as-
sociated with the training component of the Dogs2Vets pro-
gram and the absence of questions to solicit information about
potential challenges associated with dog ownership. Some
participants indicted that training their dog enabled them to
apply military service skills again, and this area would benefit
from further exploration. Another limitation of the current
study is the self-report measure of post-traumatic stress
symptoms using the PCL-M rather than a clinically adminis-
tered diagnostic evaluation of PTSD; future studies would
benefit from including a clinician-administered diagnostic
measure of PTSD. Additional studies are needed to more
thoroughly understand the specific ways in which dog own-
ership and dog training programs reduce symptoms of trauma,
stress, and isolation among veterans who participate in such
programs.
Conclusion
The findings from the present study contribute to the field
of research on complementary therapies for veterans with
symptoms of post-traumatic stress by providing insight into
the positive impact dog ownership and training has on self-
compassion and self-judgment, which are understood to be
beneficial for treating chronic PTSD symptoms.
29
Partici-
pation in this structured dog ownership and training program
for veterans demonstrated reductions in perceived stress, as
well as reductions in traumatic stress symptoms. Reductions
in isolation experienced by veterans in the Dogs2Vets pro-
gram may be attributed to the companionship of the dog,
increased social engagement through their dog, decreased
PTSD symptoms, or any combination of these factors. The
qualitative findings reinforce the statistical findings that
demonstrate decreased isolation, unconditional acceptance,
and a renewed sense of safety and purpose that comes from
the veterans’ relationships with their dogs. Taken together
the findings indicate that the veteran dog owner trainer
model appears to operate by decreasing isolation through
facilitation of human social interaction; increasing self-
compassion while decreasing self-judgment; and reducing
perceived stress and PTSD symptoms. As such, pet own-
ership and training programs, like this one, may facilitate
further engagement with other forms of treatment, like
psychotherapy or self-help groups, that require intense so-
cial interaction and may be experienced as exposing oneself
to judgment.
Future research can build upon the findings of the present
study with more advanced methods to examine the mecha-
nisms of transformation and temporal order of changes in
symptoms of post-traumatic stress, self-compassion, and its
subscale facets of self-judgment and isolation. More re-
search is also needed to replicate these findings and to fa-
cilitate better understanding of the ways in which this
type of dog ownership and training program may impact
8 BERGEN-CICO ET AL.
veterans’ need for medications and use of clinical services
over time.
Acknowledgment
This study was supported, in part, through funding from the
National Science Foundation’s Research Education for Un-
dergraduates (NSF REU) awards No. 1063014, No. 1359358,
and No. 1559793.
Author Disclosure Statement
No competing financial interests exist.
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Address correspondence to:
Dessa Bergen-Cico, PhD
Department of Public Health
Syracuse University
Suite 444 White Hall
Syracuse, NY 13244
E-mail: dkbergen@syr.edu
10 BERGEN-CICO ET AL.
