Animal-assisted therapy

Animal-assisted therapy (AAT) is an alternative or complementary type of therapy that includes the use of animals in a treatment. The goal of this animal-assisted intervention is to improve a patient's social, emotional, or cognitive functioning. Studies have documented some positive effects of the therapy on subjective self-rating scales and on objective physiological measures such as blood pressure and hormone levels.

Dogs are common in animal-assisted therapy.

The specific animal-assisted therapy can be classified by the type of animal, the targeted population, and how the animal is incorporated into the therapeutic plan. Various animals have been utilized for animal-assisted therapy, with the most common types being canine-assisted therapy and equine-assisted therapy.^[1]

Use of these animals in therapies has shown positives results in many cases, such as post-traumatic stress disorder (PTSD), depression, anxiety, sexual abuse victims, dementia, and autism. It can be used in many different facilities, like hospitals, prisons, and nursing homes, to aid in the therapy provided. Some studies have shown that animal-assisted therapy can improve many aspects of a patient's life, such as improving their overall mood or reducing feelings of isolation.^[2][3]

Description

Animal-assisted therapy is an alternative or complementary type of therapy that includes the use of animals in a treatment.^[4][5] It falls under the realm of animal-assisted intervention, which encompasses any intervention in the studio that includes an animal in a therapeutic context such as emotional support animals, service animals trained to assist with daily activities, and animal-assisted activity.^[6][7][8][9]

The goal of animal-assisted therapy is to improve a patient's social, emotional, or cognitive functioning. Literature reviews state that animals can be useful for educational and motivational effectiveness for participants.^[10][11]

Despite overlap, it differs from animal-assisted education, whose focus is teaching and learning with the support of non-human animals.^[12]

History

Research has found that animals can have an overall positive effect on health and improve mood and quality of life.^[13][7][14] Studies have documented some positive effects of the therapy on subjective self-rating scales and on objective physiological measures such as blood pressure and hormone levels.^[15] The positive effect has been linked to the human-animal bond. In a variety of settings, such as prisons, nursing homes, and mental institutions, these animals are used to assist people with different disabilities or disorders.^[16] In modern times animals are seen as "agents of socialization" and as providers of "social support and relaxation".^[17] The earliest reported use of the therapy for the mentally ill took place in the late 18th century at the York Retreat in England, led by William Tuke.^[18] Patients at this facility were allowed to wander the grounds which contained a population of small domestic animals. These were believed to be effective tools for socialization. In 1860, the Bethlem Hospital in England followed the same trend and added animals to the ward, greatly influencing the morale of the patients living there.^[18] Other literature refers to animal-assisted therapy being used as early as 1792 at the Quaker Society of Friends York Retreat in England.^[19] Velde, Cipriani & Fisher also state "Florence Nightingale appreciated the benefits of pets in the treatment of individuals with illness."

Examples of historical uses

The US military promoted the use of dogs as a therapeutic intervention with psychiatric patients in 1919 at St Elizabeth's Hospital in Washington, DC.^[19]

Sigmund Freud kept many dogs and often had his chow Jofi present during his pioneering sessions of psychoanalysis. He noticed that the presence of the dog was helpful because the patient would find that their speech would not shock or disturb the dog and this reassured them and so encouraged them to relax and confide. This was most effective when the patient was a child or adolescent.^[20][21] Increased recognition of the value of human–pet bonding was noted by Dr. Boris M. Levinson in 1961.^[19] Levinson accidentally used animals in therapy with children when he left his dog alone with a nonverbal child, and upon returning, found the child talking to the dog.^[22]

Physiological effects

Edward O. Wilson's (1984) biophilia hypothesis is based on the premise that our attachment to and interest in animals stems from the strong possibility that human survival was partly dependent on signals from animals in the environment indicating safety or threat.^[23] The biophilia hypothesis suggests that if we see animals at rest or in a peaceful state, this may signal to us safety, security and feelings of well-being which in turn may trigger a state where personal change and healing are possible.

Six neurotransmitters that influence mood have been documented to release after a 15-minute or more interaction with animals.^[24] Mirror neuron activity and disease-perception through olfactory (smelling) ability in dogs may also play important roles in helping dogs connect with humans during therapeutic encounters.^[10]

Animal-assisted therapy has also been shown to have a positive impact on brain, neurochemical, and cardiovascular function. Interventions involving canines has been shown to decrease blood pressure, the stress hormones epinephrine and norepinephrine, and increase hormones associated with pleasure, like dopamine and oxytocin.^[10]

Medical uses

Animals can be integrated into settings such as prisons, nursing homes, mental institutions,^[25][13] and in the home.^[16][26] The techniques used depend on the needs and condition of the patient. Assistance dogs can support certain life activities and help people navigate outside the home.^[16][27]

Assessing whether a program is effective as far as its outcomes are concerned is easier when the goals are clear and are able to be specified. There are a range of goals for animal-assisted therapy programs relevant to children and young people, including enhanced capacity to form positive relationships with others. It is understood that pets provide benefits to those with mental health conditions, but further research is required to test the nature and extent of this relationship with an animal as a pet and how it differs between pets, emotional support animals, service animals, and animal-assisted therapy.^[28]

Cognitive rehabilitation treatment

Acquired brain injury survivors with cognitive impairments can benefit from animal-assisted therapy as part of a comprehensive rehabilitation treatment plan.^[29]

Pets may promote kindness in children.

Pediatric care

Animals can be used as a distraction method when it comes to various situations or pain, and animals can also help bring happiness, pleasure, and entertainment to the pediatric population.^[30] Animals can also help improve children's moods and reinforce positive behaviors while helping to decrease negative ones.^[30]

Behavioral health

Therapists rely on techniques such as monitoring a child's behavior with the animal, their tone of voice, and indirect interviewing.^[30][31] Animal-assisted therapy can be used in children with mental health problems, as a stand-alone treatment, or along with conventional methods.^[31]

Hospital setting

Animal-assisted therapy (AAT) is used in hospital settings with children to try to improve their overall well-being and mood during their stay.^[32][33] Most commonly reported research results are decreased anxiety and pain within the pediatric population.^[30][34][32] One area of pediatric hospital care in which the use of AAT has been studied is magnetic resonance imaging procedures which can trigger negative emotions in children, causing them to move and require procedural sedation.^[35] After AAT intervention, the anxiety levels of the subjects decreased significantly when compared to controls.^[35] Dogs have been shown to increase comfort and decrease pain in pediatric palliative care.^[36] Specific tactics have not been researched, but collective reviews of varied techniques displayed similar results of increased comfort reports by children and guardians.^[36] Though meta-analysis has determined that children receiving AAT have seen a reduction in pain when compared to control groups, further quantitative research is needed to confirm this conclusion.^[37]

Potential risks

Though AAT has existed and been in practice for decades, the lack of standardization creates potential risks for both the animals and humans involved.^[38] As the use among pediatric populations continues to climb, another concern that has been raised about the use of animals in a hospital setting is the spread of germs.^[39] Many children in hospital settings have weakened immune systems and are already at risk of contracting hospital-borne infections. It has been found that both the patients and dogs participating in therapy experienced changes to their biome after their sessions.^[39] Whether these changes pose a long-term benefit or risk has yet to be proven, and more in-depth studies are needed to make this determination.^[39] Additionally researchers are working to find an accurate way to determine the effects of AAT on both the service animal and the human participating in therapy.^[40]

Prisons

Animal-assistance programs, such as cell dog programs, may be useful in prisons to relieve stress of the inmates and workers, or to provide other benefits, but further study is needed to confirm the effectiveness of such programs in these settings.^[41] Internal file data reviews, anecdotal stories, and surveys of inmate and staff perceptions have been used to gauge the effectiveness of animal-assisted therapy in prisons, but these methods are limited and have resulted in an inadequate assessment.^[42][43]

Researchers have, however, begun to find methods of gauging the effectiveness of prison animal programs (PAPs) by using Propensity Score Watching. One study using this method found that PAPs positively impact reductions in severe or violent infractions. A reduction in offenses statistically may reduce recidivism rates and increase former inmate job marketability and societal reintegration.^[44]

Training and being responsible for an animal can foster empathy, emotional intelligence, communication, and self-control in inmates; however, the results of studies done so far must be taken with caution as the methodological quality of existing studies is limited.^[45] PAPs also benefit the animals involved as many come from situations where they faced abuse, neglect or potential euthanasia.^[46]

Nursing homes

The findings offer proof of the concept that canine-assisted therapies are feasible and can elicit positive quality-of-life experiences in institutionalized people with dementia.^[47] Researchers and practitioners need to elucidate the theoretical foundations of animal-assisted therapies. The Lived Environment Life Quality Model may serve as a guide for client-centered, occupation-focused, and ecologically valid approaches to animal-assisted occupational therapy beyond people with dementia.^[47]

When elderly people are transferred to nursing homes or long-term care facilities, they often become passive, agitated, withdrawn, depressed, and inactive because of the lack of regular visitors or the loss of loved ones.^[48] Supporters of animal-assisted therapy say that animals can be helpful in motivating the patients to be active mentally and physically, keeping their minds sharp and bodies healthy.^[11] A significant difference has been seen among verbal interactions among nursing home residents with a dog present.^[3] Therapists or visitors who bring animals into their sessions at the nursing home are often viewed as less threatening, which increases the relationship between the therapist or visitor and patient.^[49]

Occupational therapy

Occupational therapists can use animal-assisted therapies to work on the child's motivation.^[50] Some occupational therapy goals using animal-assisted therapies include improving attention skills, social skills, participation in play, self-esteem, and reducing anxiety, loneliness, and isolation.^[50]

Types

Various animal species are used in animal-assisted therapy. Individual animals are evaluated with strict criteria before being used. The criteria include appropriate size, age, aptitude, typical behaviors and the correct level of training. The most commonly used species are dogs and horses. Research has been published on dolphin therapy.^[50]

Canine-assisted therapy

Main article: Therapy dog

In canine-assisted therapy, therapy dogs interact with patients in animal assisted interventions, to enhance therapeutic activities and well-being including the physical, cognitive, behavioral and socio-emotional functioning of clients.^[51][52][53] Well-trained therapy dogs exhibit the behavior that human patients construe as friendly and welcoming.^[53] They comfort patients via body contact.^[52] Therapy dogs are also required to possess a calm temperament for accommodating the contact with unfamiliar clients while they serve as a source of comfort.^[52] They promote patients engaging in interactions which can help patient improve motor skills and establish trusting relationship with others.^[54] The interaction between patients and therapy dogs also aids reducing stressful and anxious feelings patients have.^[52] Due to those benefits, canine-assisted therapy is used as a complement to other therapies to treat diagnosis such as post-traumatic stress disorder, attention deficit hyperactivity disorder, autism spectrum disorder, and dementia.^[51][53][52]

Canine assistance can also be used in classroom for promoting the development of creative writing and living skills and the participation of children in group activities.^[51] There are programs called canine-assisted reading programs which facilitate children with special educational needs. These programs utilize the calm, non-judgmental, happy characteristics of canines to let the process of reading become more meaningful and enjoyable for children. With these benefits, researchers suggest incorporating dogs into assisting learning and educational programs.^[51]

Dolphin therapy

Main article: Swimming with dolphins

Dolphin-assisted therapy refers to the controversial alternative medicine practice of swimming with dolphins. This form of therapy has been strongly criticized as having no long-term benefit,^[55] and being based on flawed observations.^[56] Psychologists have cautioned that dolphin-assisted therapy is not known to be effective for any condition and that it presents considerable risks to both human patients and the captive dolphins.^[57] The child has a one-on-one session with a therapist in a marine park.^[58] An ethical issue with data on dolphin-assisted therapy and the effectiveness of it is that most of the research is done by people who operate the dolphin-assisted therapy programs.^[58]

Equine-related therapy

Main article: Equine-assisted therapy

Hippotherapy is promoted as a treatment for people with physical or mental challenges.

Equine-assisted therapy encompasses a range of treatments that involve activities with horses and other equines to promote human physical and mental health.

Therapeutic riding is used by disabled individuals who ride horses to relax, and to develop muscle tone, coordination, confidence, and well-being.^[59] Equine-assisted psychotherapy (EAP) or Equine Facilitated Psychotherapy (EFP) is the use of equines to treat human psychological problems in and around an equestrian facility. The existing body of evidence does not justify the promotion and use of equine-related treatments for mental disorders.^[60]

Pig therapy

Pigs have been used in various types of animal-assisted therapy to perform duties in facilities including airports,^[61][62] hospitals,^[63] nursing homes,^[64] and special-needs schools, or as emotional support animals for individuals with conditions such as autism or anxiety^[65] and veterans with PTSD.^[66] Two well-known miniature pigs named Thunder and Bolt trained by children to certified animal therapy status have been put to work in a number of nursing homes, schools and a hospital.^[63]

Therapy with other animals

See also: Therapy cat

Llamas are also used in therapy.^[67]

For patients that have allergies to animals that have fur, snakes have been used to provide emotional support.^[67]

Effectiveness

Based on current research, there are many conditions that can benefit from animal-assisted therapy in diverse settings around the world. Those conditions include psychological disorder, developmental disorder, dementia, chronic pain, advanced heart failure, etc.^[52][50] Animal-assisted therapy is commonly used for psychological disorders. Attention deficit hyperactivity disorder, autism spectrum disorder, post-traumatic stress disorder, and major depressive disorder are among the psychological disorders that can benefit from animal-assisted therapy.^{[31][53][52][50]}

In recent decades, an increased amount of research indicates the social, psychological, and physiological benefits of animal-assisted therapy in the fields of health and education.^[51] Although the effectiveness of animal-assisted therapy is still unclear due to the lack of clarity regarding the degree to which the animal itself contributes in the recovery process,^[52] there is a growing awareness that the therapy may be effective in treating attention deficit hyperactivity disorder, post-traumatic stress disorder, autism spectrum disorder, and dementia.^[68][6][1]

In addition to its typical application in clinical disorders, recent research has focused on studying animal-assisted therapy in broader populations. A 2025 meta-analysis of randomized controlled trials determined that interactions with therapy dogs were associated with notable reductions in anxiety and stress levels among college students.^[69] The most significant improvements were reported by students who began with higher stress levels, indicating that these interventions could be specifically useful for individuals experiencing elevated psychological strain.^[70] Similar results have been observed in other contexts, including among otherwise healthy healthcare workers participating in animal-assisted programs.^[71] While additional research is necessary, current outcomes suggest that animal-assisted therapy could provide a viable option for reducing anxiety and stress and supporting the emotional health of young adult populations.