Some Patients Petting Their Way To Improved Mental Health

A patient in a locked psychiatric ward is petting a rabbit. A dog offers his paw to a patient during a psychotherapy session. Another canine accompanies an individual experiencing panic attacks onto an airplane. Such scenarios are not as unusual as they once were, and a small but growing number of experts suggest that people with mental illness can make significant improvements by interacting with animals, according to Aaron Katcher, M.D., and Patricia Gonser, Ph.D.

Katcher, a psychiatrist, has examined the interaction between animals and people in dozens of scientific papers and book chapters. He is an emeritus professor of psychiatry at the University of Pennsylvania and a partner in Biophilia-In-Action, a consulting group providing animal-assisted therapy and other activities.

Gonser is a nurse practitioner and a community mental health care clinician. She also is an assistant professor of community mental health and nursing at the University of Southern Alabama.

In addition, she is executive director of the not-for-profit Pets and People: Companions in Therapy and Service Inc., which offers training programs on animal-assisted therapy and animal-assisted activity.

According to Katcher, people with psychiatric disorders can reap the benefits of interacting with animals in four ways.

First, many people with mental disorders enjoy the social and emotional benefits of having a pet. In fact, Katcher said, “psychiatrists should explore whether patients have pets and how they relate to them. And for those who don’t have a pet, psychiatrists should evaluate if the patient—especially one who is socially withdrawn—would be amenable to obtaining one.”

Second, in animal-assisted activities (AAA), trained volunteers and their pets visit with individuals or groups at prisons, nursing homes, psychiatric hospitals, and other locales. While the patients pet dogs, rabbits, pigs, or other pets, they discuss their experiences with animals, said Gonser.

Third, in animal-assisted therapy (AAT), therapists and trained volunteers who work under the direction of therapists use a variety of pets in therapy sessions to help patients meet specific treatment goals such as increased social interaction and decreased aggression.

“This is usually accomplished by using the animal as a Skinnerian reinforcer to motivate patients to reach specified goals or by taking advantage of the way animals favorably change the social dynamics between therapist and patient,” said Katcher.

Patients with poor communication skills are most likely to benefit from participating in these three modalities, since they find it easier to communicate with others in the presence of animals, he noted.

The last modality involves psychiatric service dogs, which are usually identified with a cape, tag, or harness. These dogs perform specific tasks that mitigate the negative effects of the person’s mental illness. For example, a psychiatric service dog might bring patients their medication or lead them to a safe place when they are having a panic attack, explained Gonser

Evidence of Benefits

According to Katcher, a few controlled clinical trials researching human-animal relationships have been published. Most of this research is on AAT, and it provides evidence for the following outcomes:

• Depressed patients had increased socialization and decreased depression.

• Children with severe ADHD and conduct disorder had decreased aggressive behavior and improved attention.

• Patients with autism or developmental disabilities had increased socialization and improved attention.

• Patients with Alzheimer’s disease had improved attention and decreased aggression and anger.

Besides these controlled studies, Katcher said, “clinical and anecdotal evidence suggests that many patients with dissociative disorders and agoraphobia who have companion animals have decreased anxiety and increased social competence.”

These patients improved, he suggested, “Because [humans] evolved solving problems about animals; animals have the power to entrain our attention. And when we are around animals, we become more joyous, communicative, expressive, and calm.”

Not surprisingly, because of these outcomes and because of word-of-mouth referrals, these four modalities are becoming more widely used, with AAA being the most popular, said Gonser and Katcher.

Currently, there are three journals and several national and international conferences on animal-human relationships. The professionals most interested in this field are social workers and psychologists. In fact, Katcher thinks he is the only psychiatrist attending these conferences and contributing journal articles.

When asked why, he replied, “Psychiatry has become biologically based, less attuned to social environment. This is unfortunate because there is so much evidence that social support is a critical variable in the recovery from many serious biological disorders including psychiatric illnesses.”

Hospital’s Program

Last September, Benedictine Hospital in Kingston, N.Y., began offering AAA and AAT on its locked 21-bed and 18-bed progressive mental health units.

The program’s 10 volunteers completed a six-week program that trained them to work with inpatients having a wide variety of illness including psychiatric disorders, explained Carolyn Siewers, an occupational therapy assistant who manages the program, oversees the volunteers’ sessions, and conducts some of the AAA and AAT sessions.

In AAA and AAT, the patients pet, cuddle, and hold the dogs while they talk about pets. Also, the patient usually has the dog perform a trick and rewards the dog for it.

In AAT, Siewers directs the conversation and patient’s behavior to meet specific goals. Thus, with the incorporation of these animals into therapy, most patients can learn and feel relaxed enough to meet and make small talk with a stranger, take directions, have appropriate eye contact, and develop other skills, said Siewers. “I know I’m doing animal-assisted therapy, and I am using the dog to work toward therapeutic goals,” she added, “but what seems to be important to the patients is that they get to pet and cuddle with a dog and [that] it feels so good.”

John Mitchell, M.D., the psychiatrist who works on the treatment team with Siewers, is very pleased with the program: “One of the biggest challenges [patients] face is relating to people to get their needs met. Many have difficulty communicating on all levels. . . . The dogs are a bridge to developing communication skills and confidence. . . . And they help reach patients who would otherwise be resistant to therapy.

“The fundamental change that results from this therapy is that patients are better able to communicate with and relate to others. Specifically, I found patients to be more animated, more expressive, more spontaneous, and less hindered by internal noise,” said Mitchell. He added that three patients who had not shown any improvement before attending AAT sessions made “memorable and significant progress” during these sessions.

Information about using pets and animals in therapy with psychiatric patients is available on the Web at www.biophiliainaction.com and www.petsandpeople.org. ▪