Effects of including a dog on treatment motivation and the therapeutic alliance in child and adolescent psychotherapy: study protocol for a randomized controlled trial.

BACKGROUND: Motivation and a therapeutic alliance are crucial for successful therapy. It is assumed that dogs can increase motivation and help support therapeutic relationships. This is one of the reasons for including dogs in psychotherapy. While the positive effects of psychotherapy with dogs have been documented over the past years, little is known about the underlying mechanisms of animal-assisted psychotherapy. This study therefore aims to investigate whether and how the presence of a dog affects motivation and the therapeutic alliance in child and adolescent psychotherapy. METHODS: The study is a randomized controlled trial assessing motivation and the therapeutic alliance during the first five sessions of psychotherapy attended by children and adolescents with different psychiatric disorders. We will recruit 150 children and adolescents and randomly assign them to one of three conditions: (a) a dog is present but not integrated in the therapeutic narrative, (b) a dog is actively integrated in the therapeutic narrative, and (c) no dog is present. The children's and adolescents' evaluations of the therapeutic alliance and of their motivation will be assessed as the primary outcomes using standardized questionnaires before and after the first five therapy sessions as well as at follow-up. Further outcomes include the therapists' evaluations of the therapeutic alliance and their motivation, treatment adherence of the children and adolescents, and treatment satisfaction of the children and adolescents, their parents, and of the therapists. Interventions are conducted by experienced therapists who regularly work with their dogs. Outcomes will be analyzed using general linear models, with the treatment group as a fixed factor and the baseline values as covariates. DISCUSSION: This study provides information on the possible motivation and alliance-enhancing effects of integrating a dog into child and adolescent psychotherapy. This is relevant for practice, as these two components are strong predictors of therapy outcome. Moreover, the study will contribute to a better understanding of how a dog should be incorporated into psychotherapeutic settings. This can lead to a more purposeful inclusion of dogs in psychotherapy for children and adolescents. TRIAL REGISTRATION: The trial was registered on ClinicalTrials.gov, NCT05384808, on 20 May 2022.

The Promotion and Development of One Health at Swiss TPH and Its Greater Potential.

One Health, an integrated health concept, is now an integral part of health research and development. One Health overlaps with other integrated approaches to health such as EcoHealth or Planetary Health, which not only consider the patient or population groups but include them in the social-ecological context. One Health has gained the widest foothold politically, institutionally, and in operational implementation. Increasingly, One Health is becoming part of reporting under the International Health Legislation (IHR 2005). The Swiss Tropical and Public Health Institute (Swiss TPH) has played a part in these developments with one of the first mentions of One Health in the biomedical literature. Here, we summarise the history of ideas and processes that led to the development of One Health research and development at the Swiss TPH, clarify its theoretical and methodological foundations, and explore its larger societal potential as an integrated approach to thinking. The history of ideas and processes leading to the development of One Health research at the Swiss TPH were inspired by far-sighted and open ideas of the directors and heads of departments, without exerting too much influence. They followed the progressing work and supported it with further ideas. These in turn were taken up and further developed by a growing number of individual scientists. These ideas were related to other strands of knowledge from economics, molecular biology, anthropology, sociology, theology, and linguistics. We endeavour to relate Western biomedical forms of knowledge generation with other forms, such as Mayan medicine. One Health, in its present form, has been influenced by African mobile pastoralists' integrated thinking that have been taken up into Western epistemologies. The intercultural nature of global and regional One Health approaches will inevitably undergo further scrutiny of successful ways fostering inter-epistemic interaction. Now theoretically well grounded, the One Health approach of seeking benefits for all through better and more equitable cooperation can clearly be applied to engagement in solving major societal problems such as social inequality, animal protection and welfare, environmental protection, climate change mitigation, biodiversity conservation, and conflict transformation.

Effects of animal-assisted psychotherapy incorporating mindfulness and self-compassion in neurorehabilitation: a randomized controlled feasibility trial.

Transdiagnostic psychotherapeutic approaches are increasingly used in neurorehabilitation to address psychological distress. Animal-assistance is thought to increase efficacy. The present study evaluates a psychotherapeutic mindfulness- and self-compassion-based group intervention (MSCBI) with and without animal-assistance for patients with acquired brain injury. Patients (N = 31) were randomly assigned to the 6-week intervention with (n = 14) or without animal-assistance (n = 17). Primary outcome was psychological distress at post- and follow-up treatment, secondary outcomes were changes within-session of patients' emotional states, adherence to treatment and attrition. Psychological distress significantly decreased in both groups from pre- to follow-up treatment with no difference between groups. Patients in the animal-assisted MSCBI group reported significantly higher increases in feeling secure, accepted, comforted, grateful, motivated and at ease during the sessions compared to patients in the MSCBI group without animal-assistance. Adherence to sessions was significantly higher in the animal-assisted MSCBI group. Attrition did not significantly differ between groups. Our results show that both MSCBIs with and without animal-assistance are feasible and effective in reducing psychological distress in patients with acquired brain injury. The significant changes within-sessions mainly in relationship-based emotional states and the higher treatment adherence suggest additional effects of animal-assistance. Animal-assistance might increase acceptability and patients' commitment to psychotherapy.

Animal presence modulates frontal brain activity of patients in a minimally conscious state: A pilot study.

Integrating animals into therapy is applied increasingly in patients in a minimally conscious state (MCS). This pilot study investigates the effect of animal presence on frontal brain activity in MCS patients compared to healthy subjects. O2HB, HHb and tHb of two MCS patients and two healthy adults was measured in frontal cortex using functional near-infrared spectroscopy during three sessions with a live animal and three sessions with a mechanical toy animal present. Each session had five phases: (1) baseline, (2) watching animal, (3) passive contact, (4) active contact, (5) neutral. Data were descriptively analysed. All participants showed the largest hemodynamic response during direct contact with the live or toy animal compared to "baseline" and "watching." During active contact, three of the four participants showed a stronger response when stroking the live compared to the toy animal. All participants showed an inverted signal with higher HHb than O2Hb concentrations while stroking the live or toy animal. Animal contact leads to a neurovascular reaction in both MCS patients and healthy subjects, indicating elevated neural activity in the frontal cortex. We conclude that while a toy animal can elicit attention processes, active contact to a living animal is combined with emotional processes.

Effectiveness of animal-assisted interventions for children and adults with post-traumatic stress disorder symptoms: a systematic review and meta-analysis.

Background: Animal-assisted interventions (AAI) are increasingly applied for people with post-traumatic stress disorder (PTSD) symptoms albeit its effectiveness is unclear.Objectives: To examine the effectiveness of AAI for treating PTSD symptoms.Method: We searched 11 major electronic databases for studies reporting quantitative data on effects of AAI for children and adults with PTSD symptoms. Of 22'211 records identified, we included 41 studies with 1111 participants in the systematic review comprising eight controlled studies with 469 participants in the meta-analysis. We conducted random-effects meta-analyses with all controlled studies based on standardized mean differences (SMD), and calculated standardized mean change (SMC) as effect sizes for studies with a pre-post one-group design. Two independent researchers assessed the quality of the included studies using the NIH Study Quality Assessment Tools. The primary outcome was PTSD or depression symptom severity measured via a standardized measurement at pre- and post-intervention assessments.Results: There was a small but not statistically significant superiority of AAI over standard PTSD psychotherapy (SMD = -0.26, 95% CI: -0.56 to 0.04) in reducing PTSD symptom severity while AAI was superior to waitlist (SMD = -0.82, 95% CI: -1.56 to 0.08). Getting a service dog was superior to waiting for a service dog (SMD = -0.58, 95% CI: -0.88 to -0.28). AAI led to comparable effects in reducing depression as standard PTSD psychotherapy (SMD = -0.03, CI: -0.88 to 0.83). Pre-post comparisons showed large variation for the reduction in PTSD symptom severity, with SMCs ranging from -0.38 to -1.64, and for depression symptom severity, ranging from 0.01 to -2.76. Getting a service dog lowered PTSD symptoms between -0.43 and -1.10 and depression with medium effect size of -0.74.Conclusions: The results indicate that AAI are efficacious in reducing PTSD symptomatology and depression. Future studies with robust study designs and large samples are needed for valid conclusions.

Antecedentes: Las intervenciones asistidas por animales (AAI por sus siglas en inglés) se aplican cada vez más a personas con síntomas de trastorno de estrés postraumático (TEPT) aunque su eficacia no es clara.Objetivos: Examinar la efectividad de la AAI para el tratamiento del TEPTMétodo: Se realizaron búsqueda en 11 bases de datos electrónicas importantes para estudios que reportaran información cuantitativa sobre los efectos de AAI para niños y adultos con síntomas de TEPT. De los 22.211 registros identificados, se incluyeron 41 estudios con 1111 participantes en la revisión sistemática que comprendían ocho estudios controlados con 469 participantes en el metanálisis. Se realizaron metanálisis de efectos aleatorios con todos los estudios controlados según las diferencias medias estandarizadas (SMD según siglas en ingles), y se calculó el cambio de medias estandarizado SMC (por sus siglas en inglés) como tamaños del efecto para los estudios con diseño de un grupo pre-post. Dos investigadores independientes evaluaron la calidad de los estudios incluidos usando las Herramientas de Evaluación de Calidad del Estudio del NIH. El resultado primario fue la medición de la severidad del TEPT o síntomas depresivos a través de mediciones estandarizadas en evaluaciones pre y post intervención.Resultados: Hubo una pequeña superioridad, pero no estadísticamente significativa, del AAI sobre psicoterapia estándar para TEPT (SMD= −0.26, IC 95%:-0.56 a 0.04) en la reducción de la severidad de los síntomas de TEPT, mientras que la AAI fue superior a la lista de espera (SMD= −0.82, IC 95%:-1.56 a 0.08). Tener un perro de servicio fue superior a esperar por un perro de servicio (SMD= −0.58, IC 95%:-0.88 a −0.28). La AAI produjo efectos comparables en la reducción de depresión como la psicoterapia estándar para TEPT (SMD= −0.03, IC: −0.88 a 0.83). Las comparaciones pre-post mostraron una gran variación en la reducción de la severidad de síntomas de TEPT, con rangos de SMC desde −0.38 a −1.64, y para la severidad de síntomas de depresión, rangos desde 0.01 a −2.76. Tener un perro de servicio bajo los síntomas de TEPT entre −0.43 a −1.10 y la depresión con un tamaño de efecto medio de −0.74.Conclusiones: Los resultados indican que los AAI son eficaces para reducir la sintomatología del TEPT y depresión. Se requieren estudios futuros con diseños de estudio sólidos y muestras grandes para obtener conclusiones válidas.

Influences of Animal-Assisted Therapy on Episodic Memory in Patients with Acquired Brain Injuries.

Animal-assisted therapy (AAT) is shown to be an effective method to foster neurorehabilitation. However, no studies investigate long-term effects of AAT in patients with acquired brain injuries. Therefore, the aim of this pilot study was to investigate if and how AAT affects long-term episodic memory using a mixed-method approach. Eight patients rated pictures of therapy sessions with and without animals that they attended two years ago. Wilcoxon tests calculated differences in patients' memory and experienced emotions between therapy sessions with or without animals. We also analyzed interviews of six of these patients with qualitative content analysis according to Mayring. Patients remembered therapy sessions in the presence of an animal significantly better and rated them as more positive compared to standard therapy sessions without animals (Z = -3.21, p = 0.002, g = 0.70; Z = -2.75, p = 0.006, g = 0.96). Qualitative data analysis resulted in a total of 23 categories. The most frequently addressed categories were "Positive emotions regarding animals" and "Good memory of animals". This pilot study provides first evidence that AAT might enhance episodic memory via positive emotions in patients with acquired brain injury.

Is Animal-Assisted Therapy for Minimally Conscious State Beneficial? A Case Study.

OBJECTIVE: The goal of this single case study was to qualitatively investigate the effects of animal-assisted therapy in a patient in a minimally conscious state. METHOD: We present a 28-year-old female patient in a minimally conscious state following polytrauma after a sports accident leading to cerebral fat embolism causing multiple CNS ischemic lesions. She received eight animal-assisted therapy sessions and eight paralleled control therapy sessions over 4 weeks. We investigated the reactions of the patient during these sessions via qualitative behavior analysis. RESULTS: The patient showed a broader variability and higher quality of behavior during animal-assisted therapy compared to control therapy sessions. CONCLUSION: The observed behavioral changes showed higher arousal and increased awareness in the presence of an animal. The presented case supports the assumption that animal-assisted therapy can be a beneficial treatment approach for patients in a minimally conscious state.

Dog-Assisted Therapy in Neurorehabilitation of Children with Severe Neurological Impairment: An Explorative Study.

BACKGROUND: Dog-assisted therapy (DAT) is increasingly applied in neurorehabilitation of patients with severe neurological impairments. To date, there are only anecdotal reports investigating its effects. OBJECTIVES: This study was aimed to evaluate the potential of DAT in pediatric inpatient neurorehabilitation for severely neurologically impaired children and adolescents, to identify characteristics of patients receiving this therapy, characteristics of the therapy sessions, and to evaluate feasibility and extent of goal achievement. METHODS: We retrospectively analyzed 850 DAT sessions performed between 2010 and 2017 at an inpatient neurorehabilitation center. The dataset included 196 children and adolescents (Md = 5.50, 0.58-20.33 years) suffering from severe neurological impairments (disorders of consciousness in 37 patients) of various etiologies. We extracted information regarding patient and session characteristics, analyzed the predefined goals with content analysis, and examined to what extent the goals were met during DAT. Data were analyzed using descriptive statistics. RESULTS: Patients received an average of 4.34 therapy sessions. A total of 247 of 392 predefined goals (63%) were reached during DAT. The most frequently achieved goal was "enhancing fun" (83%), followed by "establishing contact and communication" (81%), and "relaxation" (71%). Only one critical incident regarding the dogs' safety occurred. CONCLUSION: DAT is a feasible approach and appears to facilitate emotional, social, and psychological goals in children and adolescents with severe neurological impairment.

Animal-assisted therapy for patients in a minimally conscious state: A randomized two treatment multi-period crossover trial.

OBJECTIVE: To investigate if animal-assisted therapy (AAT) leads to higher consciousness in patients in a minimally conscious state during a therapy session, measured via behavioral reactions, heart rate and heart rate variability. METHODS: In a randomized two treatment multi-period crossover trial, 10 patients in a minimally conscious state participated in eight AAT sessions and eight paralleled conventional therapy sessions, leading to 78 AAT and 73 analyzed control sessions. Patients' responses during sessions were assessed via behavioral video coding and the Basler Vegetative State Assessment (BAVESTA), heart rate and heart rate variability (SDNN, RMSSD, HF and LF). Data were analyzed with generalized linear mixed models. RESULTS: Patients showed more eye movements (IRR = 1.31, 95% CI: 1.23 to 1.40, p < 0.001) and active movements per tactile input during AAT compared to control sessions (IRR = 1.13, 95% CI: 1.02 to 1.25, p = 0.018). No difference was found for positive emotions. With BAVESTA, patients' overall behavioral reactions were rated higher during AAT (b = 0.11, 95% CI: 0.01 to 0.22, p = 0.038). AAT led to significantly higher LF (b = 5.82, 95% CI: 0.55 to 11.08, p = 0.031) and lower HF (b = -5.80, 95% CI: -11.06 to -0.57, p = 0.030), while heart rate, SDNN, RMSSD did not differ. CONCLUSIONS: Patients in a minimally conscious state showed more behavioral reactions and increased physiological arousal during AAT compared to control sessions. This might indicate increased consciousness during therapeutic sessions in the presence of an animal. TRIAL REGISTRATION: ClinicalTrials.gov NCT02629302.

Effects of animal-assisted therapy on social behaviour in patients with acquired brain injury: a randomised controlled trial.

Animal-assisted therapy (AAT) is increasingly used to address impaired social competence in patients with acquired brain injury. However, the efficacy of AAT has not been tested in these patients. We used a randomised, controlled within subject trial to determine the effects of AAT on social competence in patients undergoing stationary neurorehabilitation. Participants received both AAT sessions and paralleled conventional therapy sessions. The patients' social behaviour was systematically coded on the basis of video recordings of therapy sessions. Moreover, mood, treatment motivation and satisfaction was measured during each therapy session. We analysed 222 AAT and 219 control sessions of 19 patients with linear mixed models. Patients showed a significantly higher amount of social behaviour during AAT. Furthermore, patients' positive emotions, verbal and non-verbal communication, mood, treatment motivation and satisfaction were increased in the presence of an animal. Neutral emotions were reduced but no effect was found regarding negative emotions. Our results show that AAT increases aspects of social competence and leads to higher emotional involvement of patients with acquired brain injury, reflected in higher social engagement, motivation and satisfaction during a therapeutic session.

A One Health Research Framework for Animal-Assisted Interventions.

BACKGROUND: The integration of animals into healthcare, referred to as animal-assisted intervention, is a rapidly growing research field and was previously related to One Health. However, the assessment of synergistic effects of animal-assisted interventions (AAI) has been poorly addressed to date. METHOD: We discuss experiences in integrated human and animal assessments in AAI and provide a methodical framework for One Health approaches in AAI research. We propose theoretical consideration of an integrated human and animal health assessment, as well as the use of such an integrated approach in research. Based on the existing research, we argue that, for a deeper understanding of AAI mechanisms, parallel research designs are needed. RESULTS AND CONCLUSION: Our paper shows that a One Health study design is necessary to ensure that a tradeoff in health of animals is prevented and that an added value, or synergistic benefit, can be achieved on both sides during animal-assisted interventions.

Effects of animal-assisted therapy on concentration and attention span in patients with acquired brain injury: A randomized controlled trial.

OBJECTIVE: Previous studies have reported that brain-injured patients frequently suffer from cognitive impairments such as attention and concentration deficits. Numerous rehabilitation clinics offer animal-assisted therapy (AAT) to address these difficulties. The authors' aim was to investigate the immediate effects of AAT on the concentration and attention span of brain-injured patients. METHOD: Nineteen patients with acquired brain injury were included in a randomized, controlled, within-subject trial. The patients alternately received 12 standard therapy sessions (speech therapy, physiotherapy, occupational therapy) and 12 paralleled AAT sessions with comparable content. A total of 429 therapy sessions was analyzed consisting of 214 AAT and 215 control sessions. Attention span and instances of distraction were assessed via video coding in Noldus Observer. The Mehrdimensionaler Befindlichkeitsbogen ([Multidimensional Affect Rating Scale] MDBF questionnaire; Steyer, Schwenkmezger, Notz, & Eid, 1997) was used to measure the patient's self-rated alertness. Concentration was assessed through Visual Analogue Scale (VAS) via self-assessment and therapist's ratings. RESULTS: The patients' attention span did not differ whether an animal was present or not. However, patients displayed more instances of distraction during AAT. Moreover, patients rated themselves more concentrated and alert during AAT sessions. Further, therapists' evaluation of patients' concentration indicated that patients were more concentrated in AAT compared with the control condition. CONCLUSIONS: Although the patients displayed more instances of distraction while in the presence of an animal, it did not have a negative impact on their attention span. In addition, patients reported to be more alert and concentrated when an animal was present. Future studies should examine other attentional processes such as divided attention and include neurobiological correlates of attention. (PsycINFO Database Record