The influence of pretreatment respiratory sinus arrhythmia dimensions on trauma-focused cognitive behavioral therapy outcomes: Findings from a randomized controlled feasibility trial.

Child maltreatment is associated with respiratory sinus arrhythmia (RSA) dysregulation, a physiological indicator of emotion regulation that predicts elevated posttraumatic stress disorder (PTSD) symptoms and may be a mechanism of action for exposure-based therapies, such as trauma-focused cognitive behavioral therapy (TF-CBT). Animal-assisted therapy (AAT) has been proposed as an adjunct to TF-CBT for improving emotion regulation following maltreatment. The current study reports findings from a randomized controlled feasibility trial (N = 33; Mage = 11.79 years, SD = 3.08; 63.6% White; 66.7% female) that measured youths' resting RSA, RSA reactivity, and RSA recovery in response to a pretreatment laboratory challenge. We tested whether (a) lower pretreatment resting RSA was associated with blunted RSA during the challenge; (b) either of the pretreatment RSA dimensions predicted more severe pretreatment PTSD symptoms; and (c) either of the pretreatment RSA dimensions predicted less severe posttreatment PTSD symptoms and, as an exploratory aim, whether this was moderated by treatment group (i.e., TF-CBT vs. TF-CBT + AAT). Results from multiple linear regression indicated that, after controlling for pretreatment symptom severity, there was a large effect size for higher resting RSA predicting less severe caregiver-reported posttreatment PTSD symptoms, ß = -.52, p = .058, and higher RSA during recovery predicting less severe child-reported posttreatment PTSD symptoms, ß = -.70, p = .056, although these findings were not significant. These preliminary results offer important insights for future studies to investigate how the ability to regulate RSA informs which children need additional support to benefit from psychotherapeutic treatment.

Salivary cortisol concentrations and behavior in a population of healthy dogs hospitalized for elective procedures.

Identification of severe stress in hospitalized veterinary patients may improve treatment outcomes and welfare. To assess stress levels, in Study 1, we collected salivary cortisol samples and behavioral parameters in 28 healthy dogs hospitalized prior to elective procedures. Dogs were categorized into two groups; low cortisol (LC) and high cortisol (HC), based on the distribution of cortisol concentrations (< or ≥ 0.6 µg/dL). We constructed a stress research tool (SRT) based on three behaviors, (head resting, panting and lip licking) that were most strongly related to salivary cortisol concentrations. In Study 2, we collected salivary cortisol samples from 39 additional dogs, evaluated behavior/cortisol relationships, assigned each dog to an LC or HC group, and tested the ability of the SRT to predict salivary cortisol. Median (interquartile range) salivary cortisol concentrations were not different between Study 1 (0.43 µg/dL, 0.33 to 1.00 µg/dL) and Study 2 dogs (0.41 µg/dL, 0.28 to 0.52 µg/dL). The median salivary cortisol concentration was significantly lower (P ≤ 0.001) in LC versus HC dogs in each study; (Study 1 LC: 0.38 µg/dL, (0.19 to 0.44), n = 19, HC: 2.0 µg/dL, (1.0 to 2.8), n = 9, and Study 2 LC: 0.35 µg/dL, (0.25 to 0.48), n = 28, HC: 0.89 µg/dL, (0.66 to 1.4), n = 7). In Study 1, three behaviors were found to be associated with salivary cortisol concentrations. Duration of head resting was negatively associated with salivary cortisol (ρ = -0.60, P = 0.001), panting and lip licking were positively associated with cortisol (ρ = 0.39, P = 0.04, and 0.30, P = 0.05, respectively), Head resting (p = 0.001) and panting (p = 0.003) were also associated with LC/HC group assignment. In Study 2 dogs, the three behaviors correlated (but not significantly) with salivary cortisol concentration; of the three, only head resting was significantly associated with LC/HC group assignment (P = 0.03). The SRT derived from Study 1 was effective at prediction of salivary cortisol concentrations when applied to 20 min but not 2 min of behavioral data from Study 2. Additionally, we note that dexmedetomidine and butorphanol sedation more than 6 h prior to measurement was found to be significantly (P = 0.05) associated with lower salivary cortisol concentrations when compared to unsedated dogs. Our work offers support for eventual construction of a rating tool that utilizes the presence or absence of specific behaviors to identify higher salivary cortisol concentrations in dogs subjected to hospitalization, which may be tied to greater psychogenic stress levels. Future work to investigate the effects of stress on dogs and its mitigation in clinical situations may be approached by studying a combination o f parameters, and should consider the possible beneficial effects of sedatives.

Respiratory Sinus Arrhythmia Change during Trauma-Focused Cognitive-Behavioral Therapy: Results from a Randomized Controlled Feasibility Trial.

Trauma-Focused Cognitive-Behavioral Therapy (TF-CBT) is a well-established treatment for pediatric posttraumatic stress disorder (PTSD). Animal-assisted therapy (AAT) has been proposed as an adjunct to TF-CBT that may improve treatment effects through enhanced targeting of affect regulation, as indexed by specific changes in the respiratory sinus arrhythmia (RSA). The current study reports results from a randomized controlled feasibility trial (N = 33; Mage = 11.79 [SD = 3.08]; 64% White; 67% female) that measured RSA during Sessions 1, 4, 8, and 12 of a twelve-session TF-CBT protocol and tested whether: 1) TF-CBT + AAT achieved higher average RSA amplitudes relative to TF-CBT alone, and 2) RSA regulation, defined as less variability around person-specific RSA slopes during treatment, explained variation in post-treatment PTSD symptoms. Multilevel modeling failed to support an effect for TF-CBT + AAT on RSA amplitudes (δ001 = 0.08, p = 0.844). However, regardless of treatment condition, greater RSA withdrawal was observed within Sessions 4 (γ11 = -.01, p < .001) and 12 (γ13 = -.01, p = .015) relative to the Session 1 baseline. The average level of RSA amplitude in Session 8 was also significantly lower compared to Session 1 (γ02 = -0.70, p = .046). Intraindividual regression models demonstrated that greater RSA regulation predicted improved PTSD symptoms at post-treatment after adjusting for pre-treatment levels (b3 = 20.00, p = .012). These preliminary results offer support for future confirmatory trials testing whether affect regulation, as indexed by changes in RSA, is a mechanism of action for TF-CBT in the treatment of pediatric PTSD.

The Importance of Evaluating Positive Welfare Characteristics and Temperament in Working Therapy Dogs.

To date, investigations of the welfare of therapy dogs have focused largely on examining physiological and behavioral measures that could indicate if the animal is experiencing stress or distress. However, this approach does not fully address the definition of welfare which is often described as existing on a continuum from negative (or stressful) to positive. With therapy dogs, it would be worth addressing if they experience positive emotional affect while working since the quality and efficacy of animal-assisted interventions for the human recipient is likely to be influenced by the animal's emotional state during the interaction. The purpose of this review is to articulate how objective measurements of the HPA axis and measurements of behavioral observations and standardized questions can be used to evaluate positive welfare in therapy dogs. A potentially relevant indicator of positive welfare is the peripheral concentration of the neurohormone oxytocin, which has been found to increase in systemic circulation within a variety of species during positive social and affiliative contexts, including during human-dog interaction. Oxytocin is also a negative-feedback regulator of the Hypothalamic-Pituitary-Adrenal (HPA) axis, which culminates with the production of the stress hormone cortisol. Cortisol is widely used as a physiological indicator to assess negative welfare states in animals, including therapy dogs. Observable behavior during interactions with humans that may convey enjoyment could provide indicators of positive welfare in dogs such as engagement in play, or human-directed affiliative behaviors including leaning against, nudging, or licking the patient. However, in assessing positive welfare, it is also critical to consider that all animal behavioral displays and physiological responses are dependent on the dog's individual (and breed) temperament. Temperament directly drives how the animal copes and responds to its current physical and social environment, including during stressful situations such as when therapy dogs interact with unfamiliar humans in novel healthcare settings. Coupled with both positive and negative physiological and behavioral welfare indicators, questionnaire data can provide further context to, and enhance interpretations of, therapy dog welfare assessment results. Overall, to date, no studies have measured all of these factors to assess therapy dog welfare.

Methods of collection for salivary cortisol measurement in dogs.

Salivary cortisol has been increasingly used as a measure of stress response in studies of welfare, reaction to stress and human-animal interactions in dogs and other species. While it can be a very useful measure, there are a number of saliva collection issues made evident through studies in the human and animal fields which have not been investigated in the canine species. Collection materials and the volume of saliva that is collected; the use of salivary stimulants; and the effect of food contamination can all dramatically impact cortisol measurement, leading to spurious results. In order to further examine the limitations of the collection method and the effects of collection material and salivary stimulant on salivary cortisol levels, a series of clinical, in vitro and in vivo studies were performed. It was found that there is a large amount of inter- and intra-individual variation in salivary cortisol measurement. Beef flavoring of collection materials leads to unpredictable variability in salivary cortisol concentration. Using salivary stimulants such as citric acid also has the potential to affect cortisol concentration measurement in saliva. Hydrocellulose appears to be a useful collection material for salivary cortisol determination. Recommendations for collection materials and use of salivary stimulants are presented.

Maternal behavior changes after immune challenge of neonates with developmental effects on adult social behavior.

To examine whether maternal responsiveness during interactions with endotoxin-treated pups contributes to long-term effects on social development, neonatal mice were fostered on postnatal day 1 to dams from three selectively bred lines that differ in social behaviors. On day 5, neonates were administered saline or 0.5 mg/kg endotoxin (lipopolysaccharide, i.p.). Observations of undisturbed dams and litters on days 2, 4, 6, and 8 showed modest line differences in maternal behaviors. At the peak intensity of the transient illness induced by endotoxin (3 hr postinjection on day 5), dams increased licking and decreased time off-nest for endotoxin, but not saline-treated pups. As adults, fostered-reared males were observed in brief social interactions. Males exposed to endotoxin early in life showed changes in adult social behaviors that depended on foster dam line as well as individual differences in maternal responsiveness. Maternal responsiveness to stressed neonates can ameliorate the social-developmental effects of early illness.