Effectiveness of Animal-Assisted Activity on Pain Perception and Anxiety of Children Undergoing Intraoral Local Anesthetic Administration.

Purpose: To investigate the impact of animal-assisted activity (AAA) involving a dog (play therapy) on reducing the pain experienced by children during the administration of local anesthetic (LA). Methods: Children between the ages of eight and 12 years who required LA administration were randomized into an AAA group and a control group. Baseline data for the simplified Modified Child Dental Anxiety Scale-Faces version (MCDAS[f]) was recorded, followed by the implementation of either AAA with standard care or standard care alone. The conventional protocol was followed for the administration of LA. Procedural pain was evaluated using both the Faces Pain Scale-Revised (FPS-R) and the Faces, Legs, Activity, Cry, and Consolability Scale (FLACC). All variations in pulse were also recorded. After the procedure, a simplified MCDAS(f) was recorded once again. The data were tabulated and statistically analyzed. Results: The children in the AAA group reported lower pain scores, as measured by FPS-R, compared to the control group (P =0.009). Pain, as observed in the FLACC scores, was also low in the experimental group (P <0.001). A notable reduction in anxiety scores (P <0.001) was observed among children assigned to the AAA group. Conclusion: AAA involving a dog led to a reduction in the pain experienced by children undergoing LA administration, subsequently decreasing anxiety.

Robotic animal-assisted therapy as a complementary therapy in clinical practice: Exploring animal-assisted intervention professional perspectives.

BACKGROUND: and Purpose: Animal-Assisted Therapy (AAT) is a therapy that incorporates animals to improve the motor, social, behavioral, and/or cognitive functioning of participants. AAT has been shown to be a beneficial intervention for a wide range of populations. Although, researchers have suggested concerns in implementing AAT. The purpose of this study is to gain insight into the perspectives of therapists who incorporate AAT into their programs and to explore benefits and ethical considerations within the field of AAT. This study also aims to seek possible implications for robotic animal-assisted therapy (RAAT). MATERIALS AND METHODS: Professionals from the Association of Animal-Assisted Intervention Professionals (AAAIP) were recruited, along with members from multiple AAT private and public Facebook groups. Participants completed an anonymous online semi-structured survey, exploring their experience with and perspectives on both AAT and RAAT. Fourteen participants' responses were analyzed using Dedoose software to identify common themes in the responses. RESULTS: The results of this study provide various perspectives from professionals in different settings on the benefits of AAT, concerns about AAT, and the implication for the utilization of RAAT. The data indicated that most of the participants have not incorporated RAAT into practice. However, many of the participants believed that RAAT can be an alternative or preparatory intervention when interaction with live animals is not possible. The data collected further contributes to an emerging niche setting.

Characterizing veteran and PTSD service dog teams: Exploring potential mechanisms of symptom change and canine predictors of efficacy.

Psychiatric service dogs are an emerging complementary intervention for posttraumatic stress disorder (PTSD). Initial evidence suggests that partnership with a service dog may be related to less PTSD symptom severity. However, it remains unclear how or why this might occur. To address this gap, we conducted a longitudinal investigation of 82 post-9/11 military members or veterans and their PTSD service dogs to (1) evaluate service dog characteristics as potential predictors of efficacy, (2) assess dog and human characteristics as potential predictors of veteran-dog bond, and (3) explore potential mechanisms for mental health outcomes. Aim 1 results demonstrated that most service dog characteristics did not predict veterans' mental health outcomes, but lower service dog excitability was associated with less PTSD symptom severity at follow-up. Aim 2 results showed that closer dog-veteran relationships were associated with less excitable dog temperament. Aim 3 results indicated that worse mental health at follow-up was associated with greater use of the specifically trained PTSD service dog task to initiate a social greeting ("make a friend"), whereas better mental health was related to less use of dominance-based training methods, lower perceived emotional/logistical costs of service dog partnership, and closer veteran-dog relationships. More frequent use of the trained service dog task to signal when someone approaches from behind (cover/watch back) was associated with greater anxiety, but less PTSD symptom severity. Overall, veterans spent an average of 82% of their time with service dogs (assessed via Bluetooth proximity between dog collar and veteran smartphone), and most frequently asked their service dogs to perform the trained task for calming their anxiety (calm/comfort anxiety). The present study provides subjective and objective metrics of the heterogeneity among veteran-service dog dyads while also suggesting which of the assessed metrics might be potential mechanisms involved in the intervention.

Posttraumatic stress disorder service dogs and the wellbeing of veteran families.

Background: Benefits and challenges associated with service dogs for veterans with posttraumatic stress disorder (PTSD) may extend beyond veterans to their families. Objective: The purpose of the current study is to evaluate the impact of veterans' PTSD service dogs on spouses and families in a parallel-group, longitudinal design with assessments at baseline and three months follow-up. Method: A total of 88 United States military veteran spouses completed a survey composed of multiple standardized measures at baseline and three months later. In the intervention group (n = 48), veterans received service dogs shortly after baseline while the waitlist control group (n = 40) did not. Results: Linear regression analyses demonstrated significantly lower caregiver satisfaction, higher caregiver burden and higher participation in life activities among spouses who had service dogs in their homes compared to those on the waitlist. Though not significant, small effect sizes were present among additional measures. Conclusion: Results suggest that although previous literature demonstrates service dogs may offer significant improvements for veterans, spouses and children may not experience those same benefits. Clinicians should consider how to prepare veteran spouses and families for integrating service dogs into their home. Future studies should explore family-focused approaches for service dog integration, defining an optimal strategy for the benefit of the entire family. HIGHLIGHTS: Though service dogs may improve wellbeing for veterans with posttraumatic disorder, families of veterans may not experience those same benefits. Researchers and clinicians should consider how to best prepare veteran families for integrating service dogs into their homes.Though posttraumatic stress disorder (PTSD) service dogs are trained specifically for veterans, recent studies have demonstrated that their impact may go beyond veterans themselves (McCall, Rodriguez, Wadsworth, Meis, & O'Haire, 2020; Nieforth, Craig, Behmer, MacDermid Wadsworth, & O'Haire, 2021). PTSD service dogs may provide both benefits and challenges for veteran families.

Antecedentes: Los beneficios y desafíos asociados con los perros de asistencia para veteranos con trastorno de estrés postraumático (TEPT) pueden extenderse más allá de los veteranos a sus familias. Objetivo: El propósito del estudio actual es evaluar el impacto de los perros de asistencia en el TEPT de cónyuges y familias de veteranos en un diseño longitudinal de grupos paralelos con evaluaciones al inicio y a los tres meses de seguimiento. Método: Un total de 88 cónyuges de veteranos militares de los Estados Unidos completaron una encuesta compuesta por múltiples medidas estandarizadas al inicio y tres meses después. En el grupo de intervención (n = 48), los veteranos recibieron perros de asistencia poco después del inicio, mientras que el grupo de control en lista de espera (n = 40) no lo hizo. Resultados: Los análisis de regresión lineal demostraron una satisfacción del cuidador significativamente menor, una mayor carga del cuidador y una mayor participación en las actividades de la vida entre los cónyuges que tenían perros de asistencia en sus hogares, comparado con los que estaban en la lista de espera. Aunque no significativos, pequeños tamaños de efecto estuvieron presentes entre las medidas adicionales. Conclusión: Los resultados sugieren que aunque la literatura previa demuestra que los perros de asistencia pueden ofrecer mejorías significativas para los veteranos, es posible que las cónyuges y sus hijos no experimenten los mismos beneficios. Los clínicos deben considerar cómo preparar a las cónyuges y familias de veteranos para integrar perros de asistencia en sus hogares. Los estudios futuros deberían explorar enfoques centrados en las familias para la integración del perro de asistencia, definiendo una estrategia óptima para el beneficio de toda la familia.

Collaboration in Animal-Assisted Activities and Animal-Assisted Therapy.

Animal Assisted Intervention is a valuable tool in inpatient and outpatient rehabilitation. Conducting goal-directed, therapeutic Animal-Assisted Interventions requires certification, training and collaboration. It is important that Animal Assisted Therapy teams comprised of specially trained dogs and handlers are co-certified to ensure the safety of patients, therapeutic interactions, and beneficial outcomes aligned with rehab goals. Some examples of speech therapy goals and outcomes in AAT are included below. It is preferred to conduct co-treatment sessions with AAT therapists and a second clinician to increase the opportunity for a variety of treatment modalities, to develop collaborative ideas for treatment sessions and to improve socialization opportunities. To collaborate for a successful AAT session, a co-treating therapist must first understand the AAT program and services available specific to the trained animal-handler team. This article outlines the process involved in obtaining and maintaining a skilled facility dog and an Animal Assisted Therapy program in an inpatient rehabilitation hospital. Animal Assisted Therapy has great potential to excite, distract, engage, encourage, and motivate patients. It is a new field, with generalized criteria for practice and limited standard protocols. It is underutilized and often mischaracterized. With more widespread education and advocacy and development of clinical standards and guidelines, AAT could improve the lives of so many people hoping to return to life as they knew it.

Benefícios das Intervenções Assistidas por Animais para estudantes com alteração de linguagem verbal / Benefits of Animal Assisted Intervention for students with verbal language disorders / Los Beneficios de las Intervenciones Asistidas por Animales para estudiantes con trastornos del lenguaje verbal

Introdução: As Intervenções Assistidas por Animais- IAA- com a mediação de cães compreendem atividades com fins terapêuticos e/ou educacionais, nas quais o cachorro é o principal mediador. Objetivo: Apresentar e analisar os resultados parciais das atividades desenvolvidas em um Projeto de Pesquisa e de Extensão, realizado no Colégio de Aplicação da Universidade Federal de Santa Catarina- CA/UFSC, evidenciando os benefícios das IAA com a mediação de cães, no processo de desenvolvimento e aprendizagem, sobretudo da linguagem verbal (fala, leitura e escrita) para os estudantes participantes. Método: Seguiu-se a abordagem qualitativa da pesquisa e realizou-se a Análise de Conteúdo¹ dos registros em diário de campo das atividades desenvolvidas. Resultados: São apresentados os resultados de três ações realizadas no projeto durante o primeiro semestre de 2019. A análise dessas atividades demonstrou que foram favorecidas as habilidades relacionadas à linguagem verbal dos estudantes. Conclusão: Considera-se que no decorrer do projeto, os participantes das IAA com a mediação de cães vêm demonstrando melhora nas aprendizagens, bem como aperfeiçoamento nas habilidades de fala, leitura e escrita.

Introduction: The Animal Assisted Intervention with the mediation of dogs comprises activities for therapeutic and / or educational purposes, in which the dog is the main mediator. Objective: To present and analyze the partial results of the activities developed in a Research and Extension Project, carried out at the Colégio de Aplicação da Universidade Federal de Santa Catarina- CA/UFSC, showing the benefits of Animal Assisted Intervention with the mediation of dogs in the process of development and learning, especially of the verbal language (speaking, reading and writing) for participating students. Method: The qualitative research approach was followed and Content Analysis¹ was carried out on the records in the daily field of the activities developed. Results: The results of three actions carried out in the project during the first semester of 2019 are presented. The analysis of these activities showed that the students' verbal language skills were instigated. Conclusion: It is considered that during the project, the participants of Animal Assisted Intervention with the mediation of dogs have been showing improvement in learning, as well as improvement in speaking, reading and writing skills.

Introducción: Las intervenciones asistidas por animales con la mediación de perros comprende actividades con fines terapéuticos y / o educativos, en las que el perro es el principal mediador. Objetivo: Presentar y analizar los resultados parciales de las actividades desarrolladas en un Proyecto de Investigación y Extensión, realizado en el Colégio de Aplicação da Universidade Federal de Santa Catarina- CA/UFSC, mostrando los beneficios de las intervenciones asistidas por animales con la mediación de perros en el proceso de desarrollo y aprendizaje, especialmente del lenguaje verbal (hablar, leer y escribir) para los estudiantes participantes. Método: Se siguió el enfoque de investigación cualitativa y se realizó el Análisis de Contenido Content de los registros en el campo diario de las actividades desarrolladas. Resultados: Se presentan los resultados de tres acciones llevadas a cabo en el proyecto durante el primer semestre de 2019. El análisis de estas actividades mostró que las habilidades del lenguaje verbal de los estudiantes fueron instigadas. Conclusión: Se considera que durante el proyecto, los participantes de las intervenciones asistidas por animales con la mediación de perros han ido mostrando una mejora en el aprendizaje, así como una mejora en las habilidades de expresión oral, lectura y escritura.

Tracking positive and negative affect in PTSD inpatients during a service dog intervention.

Though popular across many audiences, engagement with a service dog has undergone limited empirical evaluation as a complementary or alternative treatment for posttraumatic stress disorder (PTSD). The present study took advantage of a service dog training intervention underway in a Department of Veterans Affairs residential PTSD treatment program to perform a within-subjects comparison of a range of phenotypic markers. The present report considers negative and positive affect, assessed throughout the day, contrasting weeks when participants were or were not accompanied by their service dog. Fifty-four veterans were studied for 2-6 weeks. Negative and positive affect were sampled five times per day using items from the Positive and Negative Affect Schedule. Participants also wore a single-patch ECG/activity recorder and slept on beds recording sleep actigraphically. Linear mixed effects regression was employed to estimate the effect of the presence of service dog on momentary affect in the context of other presumable influences. Missing data were managed using methods applicable to random and nonrandom missingness. In this sample, the presence of a service dog was associated with reduced negative and increased positive affect, with both effects diminishing over time. Only negative affect was associated with time in residential treatment, and only positive affect was associated with concurrent heart rate, activity, and the interaction of activity and prior-night actigraphic sleep efficiency. These results concur with prior reports of reduced PTSD symptomology in association with the presence of a service dog, and with the distinct neurocircuitries underlying defensive and appetitive emotion and motivation. Limitations derive from the artificial environment and brief duration of study. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

Animal-Assisted Therapy as an Intervention for Older Adults: A Systematic Review and Meta-Analysis to Guide Evidence-Based Practice.

BACKGROUND: Animal-assisted therapy (AAT) can ameliorate diverse health problems in older adults. However, applications of AAT have been limited because of the lack of intervention guidelines for older adults. AIMS: This study aimed to explore applications of AAT to older adults, analyze its health effects, and provide evidence for future interventions. METHODS: A systematic review and meta-analysis were conducted based on the Preferred Reporting Items for Systematic Reviews and Meta-Analyses checklist. Data were analyzed based on both a narrative synthesis and a meta-analysis specifically for depression. RESULTS: A total of 47 studies were selected for analysis. About 45% focused on older adults with diseases such as dementia, and 57.4% selected dog(s) as an intervention animal. About 34.0% delivered interventions once a week, and the behavioral outcome domain was the most frequently investigated. The meta-analysis showed that the effect sizes of the AAT group were -1.310 (95% CI [-1.900, -.721]). LINKING EVIDENCE TO ACTION: This review provides evidence for AAT as an intervention in the physiological, psychosocial, cognitive, and behavioral domains of older adults. When planning interventions for older adults, nurses should consider intended health outcomes, appropriate therapeutic animals, and the consequent intervention contents.

Animal-Assisted Support: Actionable Intervention for Burnout.

The impact of long shifts, the puzzling illnesses and manifestations of COVID-19, its personal and family impacts, and the sustained grief of many losses in the past 6 months requires consideration of interventions to lift caregivers' spirits. Burnout has long been a challenge for nurses working in intense acute environments. Today, the risk and effects are even greater. Animal-assisted support is one intervention that shows some promise in supporting employee well-being. [J Contin Educ Nurs. 2020;51(11):496-497].

Youth and Pet Survivors: Exploring the Experiences of Pediatric Oncology and Bone Marrow Transplant Patients in a Virtual Animal-Assisted Therapy Pen Pal Program.

Introduction: YAPS™ (Youth and Pet Survivors™) is a form of virtual animal-assisted therapy (AAT), a pen pal program designed for children and adolescents with cancer and/or having a bone marrow transplant (BMT) to engage in virtual visits with a dog or a cat (who has also been treated for cancer or serious medical illness) through letter writing and pictures. The purpose of this qualitative descriptive study was to explore the experiences of YAPS participants over time and to explore how virtual AAT may be an additional or alternative intervention to the traditional form of AAT, which involves live visits with animals, primarily dogs. Method: Open-ended, face-to-face interviews were conducted throughout the participants' involvement with their animal pen pal. Interviews were digitally recorded. Data were analyzed using a content analysis method. Results: Fifteen children and adolescents, aged 7 to 16 years, participated. Three main themes and five subthemes were found, including connection, shared experience, and friendship. Themes suggested that a virtual AAT letter writing program can provide a source of fun and a way to process the cancer experience with a dog or cat pen pal who has also faced cancer or serious medical treatment. Discussion: Interventions that promote well-being for pediatric oncology and BMT patients are needed, and virtual AAT seems to be one such intervention suited for those who have an affinity for animals and enjoy letter writing. The findings of this study also presented an exciting and intriguing gap for further research in virtual AAT.

The Impact of a 20-Minute Animal-Assisted Activity Session on the Physiological and Emotional States in Patients With Fibromyalgia.

OBJECTIVE: To study the direct physiological and emotional impact of an animal-assisted activity (AAA) session (a form of complementary and integrative medicine) in patients with fibromyalgia (FM). PATIENTS AND METHODS: The study population consisted of 221 participants with FM who were attending Mayo Clinic's Fibromyalgia Treatment Program between August 5, 2017, and September 1, 2018. This was a randomized controlled trial. Participants were randomly assigned to either the treatment group (a 20-minute session with a certified therapy dog and handler) or the control group (a 20-minute session with a handler only). To gain a better understanding of the direct physiological and emotional effects of AAA in patients with FM, we used multiple noninvasive physiologic-emotional biomarkers, including salivary cortisol and oxytocin concentrations, tympanic membrane temperatures, and various cardiac parameters, in addition to standardized pain and mood-based questionnaires. RESULTS: Results show a decrease in heart rate, an increase in heart rate variability, an increase in well-being survey scores, an increase in salivary oxytocin, and subsequent tympanic membrane temperature changes, suggesting that participants in the treatment group were in a more positive emotional-physiologic state as a result of the AAA session compared with the control group. CONCLUSION: Our results suggest that a 20-minute therapy dog visit in an outpatient setting can significantly and positively impact the physical and mental health of patients with FM.

"The connection just happens": Therapists' perspectives of canine-assisted occupational therapy for children on the autism spectrum.

INTRODUCTION: The inclusion of a therapy dog has been suggested as a means of facilitating therapy engagement for children on the autism spectrum within occupational therapy sessions. The aim of this study was to seek an understanding of possible benefits and challenges of this practice from the perspectives of occupational therapists, trained in canine-assisted therapy. METHOD: This study adopted an interpretive descriptive design. Six therapists participated in a semi-structured, telephone interview to describe their experience of working as canine-assisted occupational therapists with children on the autism spectrum. An inductive thematic analysis was used to analyse the data. RESULTS: Two overarching themes emerged. The first captured how therapists incorporated their therapy dog into sessions to accelerate children's initial motivation to engage within the therapy process. Specifically, therapists discussed how involving their therapy dog facilitated the development of a secure relationship, supported autonomous task involvement and increased children's sense of confidence. Second, they identified challenges inherent in their practice, such as the therapist's ability to maintain a goal-directed focus when including a therapy dog. Beyond the challenges within their own practice sessions, therapists reflected on issues thought to impact the occupational therapy profession since starting practice as a canine-assisted occupational therapist. CONCLUSION: Findings from this study contribute to the current understanding of how occupational therapists incorporate therapy dogs into their practice with children on the autism spectrum. The specific challenges noted by the therapists highlighted the importance of canine-assisted occupational therapy being viewed as an advanced scope of practice within Australia and, therefore, the need for training and practice guidelines to be established.

Risks associated with animal-assisted intervention programs: A literature review.

The benefits of animal-assisted interventions (AAI), to utilize companion animals as an adjunctive treatment modality, is well-established and a burgeoning research field. However, few studies have evaluated the potential hazards of these programs, such as the potential for therapy animals to transfer hospital-associated pathogens between individuals and the hospital environment. Here we review the current literature on the possible risks of hospital-based AAI programs, including zoonotic pathogen transmission. We identified twenty-nine articles encompassing reviews of infection control guidelines and epidemiological studies on zoonotic pathogen prevalence in AAI. We observed substantial heterogeneity in infection control practices among hospital AAI programs. Few data confirmed pathogen transmission between therapy animals and patients. Given AAI's known benefits, we recommend that future research utilize a One Health framework to evaluate microbial dynamics among therapy animals, patients, and hospital environments. This framework may best promote safe practices to ensure the sustainability of these valuable AAI programs.

Equine-assisted therapeutic activities and their influence on the heart rate variability: A systematic review.

OBJECTIVE: To examine the effect of equine-assisted therapeutic interventions on users' heart rate variability, using this said variability as an objective biological variable related to stress levels. METHOD: A systematic review has been carried out using the methodology suggested in the PRISMA declaration following systematic searches in academic databases. RESULTS: 432 registers were initially identified; however, in the screening and suitability process, nine papers were included in the review. With one exception, all of them reported that equine-assisted therapeutic activities had a favourable effect on users' heart rate variability as such activities favour a state of relaxation by activating the Parasympathetic Nervous System. The analysis of the quality of the evidence and the confirmation of the bias in the works indicate that these results must be considered with caution. DISCUSSION: Although these preliminary results are promising, more rigorous clinical trials are necessary to overcome the methodological limitations of the works.

Animal-Assisted Activity in Critically Ill Older Adults: A Randomized Pilot and Feasibility Trial.

BACKGROUND: Limited evidence suggests the efficacy of animal-assisted activities (AAA) in improving biobehavioral stress responses in older patients in intensive care units (ICUs). OBJECTIVES: To assess the feasibility of an AAA (dog) intervention for improving biobehavioral stress response, measured by self-reported stress and anxiety and salivary cortisol, C-reactive protein, and interleukin-1ß in older ICU patients, we examined enrollment, attrition, completion, data collection, and biobehavioral stress responses. METHODS: ICU patients ≥60 years old were randomly assigned to a 10-min AAA intervention or control/usual ICU care. Attitudes toward pets were assessed before the intervention. Self-reported stress and anxiety and salivary stress biomarkers were collected before and after the intervention and the usual care condition. RESULTS: The majority of patients were ineligible due to lack of decisional capacity, younger age, inability to provide saliva specimens, or critical illness. Though 15 participants were randomly allocated (AAA = 9; control = 6), only 10 completed the study. All participants completed the questionnaires; however, saliva specimens were significantly limited by volume. AAA was associated with decreases in stress and anxiety. Biomarker results were variable and revealed no specific trends associated with stress responses. Conclusions: Barriers to recruitment included an insufficient number of patients eligible for AAA based on hospital policy, difficulty finding patients who met study eligibility criteria, and illness-related factors. Recommendations for future studies include larger samples, a stronger control intervention such as a visitor without a dog, greater control over the AAA intervention, and use of blood from indwelling catheters for biomarkers.

Animal Assisted Therapy for Children and Adolescents with Autism Spectrum Disorder: Parent perspectives.

Animal-Assisted Therapy (AAT) is an intervention for children with Autism Spectrum Disorder (ASD). This study explores parent perspectives of the impact of five AAT sessions involving trained dogs with their children with ASD. A phenomenological qualitative approach was used to explore first-hand perspectives of parents. In-depth, semi-structured interviews were conducted. Data were analyzed using thematic analysis. Seventeen parents reported that the presence of the dogs facilitated their children's engagement, enjoyment, and motivation. Parents also reported that this contributed to gains in the child's communication with others and the dog (n = 11, 64.7%), behavioral regulation (n = 12, 70.6%), and community participation (n = 14, 82.3%). These findings indicate that parents supported the use of AAT and that dogs facilitated therapeutic gains.

Canine Assisted Occupational Therapy for Children on the Autism Spectrum: A Pilot Randomised Control Trial.

Children on the autism spectrum frequently display difficulties engaging with people and with functional tasks. A pilot, randomised control trial was completed to explore the impact of canine assisted occupational therapy on the on-task behaviours and goal attainment of autistic children when compared to occupational therapy sessions as usual. Twenty-two children between the ages of 4, and 6 years and 11 months, were randomly placed in either the treatment group (n-11) or waitlist control group (n = 11). Results showed that although there was a positive trend for on-task behaviour and goal attainment within the treatment group, results were not statistically significant. These results support the need for further research in the area of canine assisted occupational therapy for autistic children.

Randomized Trial of Therapy Dogs Versus Deliberative Coloring (Art Therapy) to Reduce Stress in Emergency Medicine Providers.

OBJECTIVE: Cognitive stress during shift work contributes to burnout in emergency department (ED) workers. We hypothesize that if physicians and nurses interact with a therapy dog for 5 minutes while on ED shift, both their perceived and their manifested stress levels will decrease. METHODS: In this single-center, prospective, randomized controlled clinical trial (NCT03628820), we tested the effectiveness of therapy dogs versus coloring a mandala and versus no intervention (control) on provider stress. Consenting emergency medicine physicians and nurses provided three self-reported assessments of stress and saliva samples at the start (T1), at the middle (T2), and near the end (T3) of shift. Thirty minutes prior to T2, participants were randomized to either interacting with a therapy dog or coloring for 5 minutes; controls had neither. Stress was assessed on visual analog scale (VAS, 0-100 mm) and with salivary cortisol (Salimetrics) and the modified Perceived Stress Scale (mPSS-10). To assess potential change in participant behavior, patients of providers in either group were asked to complete an internally derived survey of empathic behaviors displayed by providers at T1 and T3. RESULTS: We enrolled 122 providers (n = 39 control, n = 40 coloring, n = 43 dog); 48% were residents, and 60% enrolled on an evening shift. At T1, mean (±SD) VAS score was not different between groups (18.2 [±17.8] mm). At T3, VAS tended to increase with coloring (24.5 mm), remain unchanged in controls (20 mm), and decreased slightly with dogs (13.6 mm, p = 0.018 vs. coloring, Tukey's post hoc). Salivary cortisol levels were consistently highest at the beginning of each providers' shift and were significantly decreased versus control in both the dog and the coloring groups (p < 0.05, Tukey's). We observed no difference between groups for the mPSS-10 nor in patient reported survey of empathic behaviors. CONCLUSION: This randomized controlled clinical trial demonstrates preliminary evidence that a 5-minute therapy dog interaction while on shift can reduce provider stress in ED physicians and nurses.