View source for Animal-assisted therapy

{{short description|Alternative or complementary type of therapy}}
{{Multiple issues|
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[[File:Therapiehund.jpg|thumb|alt=young child hugging a dog|Dogs are common in animal-assisted therapy.]]
'''Animal-assisted therapy''' ('''AAT''') is an [[alternative medicine|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.

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]].<ref name="Charry-Sánchez 2018 Animal-assisted therapy">{{cite journal |last1=Charry-Sánchez |first1=Jesús David |last2=Pradilla |first2=Iván |last3=Talero-Gutiérrez |first3=Claudia |title=Animal-assisted therapy in adults: A systematic review |journal=Complementary Therapies in Clinical Practice |date=August 2018 |volume=32 |pages=169–180 |doi=10.1016/j.ctcp.2018.06.011 |pmid=30057046 }}</ref>

Use of these animals in therapies has shown positives results in many cases, such as [[post-traumatic stress disorder]] (PTSD), [[Depression (mood)|depression]], [[anxiety]], [[sexual abuse]] victims, [[dementia]], and [[Autism spectrum|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 [[Social isolation|isolation]].<ref name=":6" /><ref name=":2" />

== Description ==
Animal-assisted therapy is an [[alternative medicine|alternative or complementary]] type of [[therapy]] that includes the use of animals in a treatment.<ref>{{cite book |last1=Kruger |first1=Katherine A. |title=Handbook on Animal-Assisted Therapy |last2=Serpell |first2=James A. |year=2010 |isbn=9780123814531 |pages=33–48 |chapter=Animal-assisted interventions in mental health |doi=10.1016/B978-0-12-381453-1.10003-0 |name-list-style=vanc}}</ref><ref>{{cite book |last=Fine |first=Aubrey H. |url=https://books.google.com/books?id=Oa6zC8LVpQIC&dq=%22Animal+assisted+intervention%22&pg=PA264 |title=Handbook on animal-assisted therapy: theoretical foundations and guidelines for practice |publisher=Elsevier/Academic Press |year=2006 |isbn=0-12-369484-1 |location=Amsterdam |page=264}}</ref> 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 animal]]s, [[service animal]]s trained to assist with daily activities, and animal-assisted activity.<ref name="O'Haire Animal-Assisted Intervention for trauma">{{cite journal |vauthors=O'Haire ME, Guérin NA, Kirkham AC |date=2015 |title=Animal-Assisted Intervention for trauma: a systematic literature review |journal=Frontiers in Psychology |volume=6 |pages=1121 |doi=10.3389/fpsyg.2015.01121 |pmc=4528099 |pmid=26300817 |doi-access=free}}</ref><ref name=":7" /><ref name=":10">{{cite journal |vauthors=O'Haire ME, Guérin NA, Kirkham AC, Daigle CL |date=2015 |title=Animal-Assisted Intervention for Trauma, Including Post-Traumatic Stress Disorder |url=https://habricentral.org/resources/52067/download/hc_brief_trauma20150825c.pdf |journal=HABRI Central Briefs}}</ref><ref>{{cite web |last1=Kruger |first1=Katheine A. |last2=Trachtenberg |first2=Symme W. |last3=Serpell |first3=James A. |year=2004 |title=Can animals help humans heal? Animal-assisted interventions in adolescent mental health |url=http://research.vet.upenn.edu/Portals/36/media/CIAS_AAI_white_paper.pdf |archive-url=https://web.archive.org/web/20111203054550/http://research.vet.upenn.edu/Portals/36/media/CIAS_AAI_white_paper.pdf |archive-date=2011-12-03 |pages=1–37 }}</ref>

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.<ref name="Marcus 2013 science behind">{{cite journal |vauthors=Marcus DA |date=April 2013 |title=The science behind animal-assisted therapy |journal=Current Pain and Headache Reports |volume=17 |issue=4 |pages=322 |doi=10.1007/s11916-013-0322-2 |pmid=23430707 }}</ref><ref name="AAT">{{cite web |title=Animal Assisted Therapy |date=28 August 2010 |url=http://www.americanhumane.org/interaction/programs/animal-assisted-therapy/ |publisher=American Humane Association}}</ref>

== History ==
Research has found that animals can have an overall positive effect on health and improve mood and [[Quality of life (healthcare)|quality of life]].<ref name="Netting The Human-Animal Bond"/><ref name=":7" /><ref>{{cite book |doi=10.1016/B978-0-12-381453-1.10004-2 |chapter=Newer and older perspectives on the therapeutic effects of animals and nature |title=Handbook on Animal-Assisted Therapy |date=2010 |last1=Katcher |first1=Aaron H. |last2=Beck |first2=Alan M. |pages=49–58 |isbn=978-0-12-381453-1 }}</ref> 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.<ref>{{cite journal |last1=Teo |first1=Jillian T. |last2=Johnstone |first2=Stuart J. |last3=Römer |first3=Stephanie S. |last4=Thomas |first4=Susan J. |title=Psychophysiological mechanisms underlying the potential health benefits of human-dog interactions: A systematic literature review |journal=International Journal of Psychophysiology |date=October 2022 |volume=180 |pages=27–48 |doi=10.1016/j.ijpsycho.2022.07.007 |pmid=35901904 }}</ref>  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.<ref name="Beck" /> In modern times animals are seen as "agents of socialization" and as providers of "social support and relaxation".<ref>{{cite book |last1=Serpell |first1=James A. |title=Handbook on Animal-Assisted Therapy |year=2010 |isbn=978-0-12-381453-1 |pages=17–32 |chapter=Animal-assisted interventions in historical perspective |doi=10.1016/B978-0-12-381453-1.10002-9 }}</ref> 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]].<ref name="Serpell">{{cite book |doi=10.1016/B978-012369484-3/50003-7 |chapter=Animal Companions and Human Well-Being |title=Handbook on Animal-Assisted Therapy |date=2006 |last1=Serpell |first1=James A. |pages=3–19 |isbn=978-0-12-369484-3 }}</ref> 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.<ref name="Serpell" /> Other literature refers to animal-assisted therapy being used as early as 1792 at the Quaker Society of Friends York Retreat in England.<ref name="Velde, B. P. 2005">{{cite journal |vauthors=Velde BP, Cipriani J, Fisher G |year=2005 |title=Resident and therapist views of animal-assisted therapy: Implications for occupational therapy practice |journal=[[Australian Occupational Therapy Journal]] |volume=52 |issue=1 |pages=43–50 |doi=10.1111/j.1440-1630.2004.00442.x |doi-access=free}}</ref> 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.<ref name="Velde, B. P. 2005"/>

[[Sigmund Freud]] kept many dogs and often had his [[Chow Chow|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.<ref>{{citation |author=Stanley Coren |title=Handbook on Animal-Assisted Therapy |year=2010 |chapter=Foreword |publisher=Academic Press |isbn=978-0-12-381453-1 |author-link=Stanley Coren}}</ref><ref>{{Cite web |last=Ernst |first=Lorraine |date=October 2014 |title=Animal-Assisted Therapy: An Exploration of Its History, Healing Benefits, and How Skilled Nursing Facilities Can Set Up Programs |url=https://www.hmpgloballearningnetwork.com/site/altc/articles/animal-assisted-therapy-exploration-its-history-healing-benefits-and-how-skilled-nursing |access-date=2023-12-28 |website=Annals of Long-Term Care}}</ref> Increased recognition of the value of human–pet bonding was noted by [[Boris M. Levinson|Dr. Boris M. Levinson]] in 1961.<ref name="Velde, B. P. 2005" /> 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.<ref name="Reichert, E. 1998">{{cite journal |vauthors=Reichert E |year=1998 |title=Individual counseling for sexually abused children: A role for animals and storytelling |journal=Child & Adolescent Social Work Journal |volume=15 |issue=3 |pages=177–185 |doi=10.1023/A:1022284418096 }}</ref>

== 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.<ref>{{Cite book |title= Biophilia |url= https://archive.org/details/biophilia00wils |url-access= registration |last=Wilson |first=Edward O. |name-list-style=vanc |date=1984 |publisher=Harvard University Press |isbn=0-674-07441-6 |location=Cambridge, Mass. |oclc=10754298}}</ref> 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 [[neurotransmitter]]s that influence mood have been documented to release after a 15-minute or more interaction with animals.<ref>{{cite journal |vauthors=Odendaal JS |title=Animal-assisted therapy - magic or medicine? |journal=Journal of Psychosomatic Research |volume=49 |issue=4 |pages=275–80 |date=October 2000 |pmid=11119784 |doi=10.1016/S0022-3999(00)00183-5 }}</ref> [[Mirror neuron|Mirror neuron activity]] and disease-perception through [[Olfaction|olfactory]] (smelling) ability in dogs may also play important roles in helping dogs connect with humans during therapeutic encounters.<ref name="Marcus 2013 science behind"/>

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.<ref name="Marcus 2013 science behind"/>  

==Medical uses==
<!-- [[File:Pies asystujacy golden retriever 2009 pl.jpg|thumb |[[Golden Retrievers]] are often trained as assistance dogs.]] This filename has hidden characters (?) in it -->
Animals can be integrated into settings such as prisons, nursing homes, mental institutions,<ref>{{cite journal |vauthors=Barker SB, Dawson KS |title=The effects of animal-assisted therapy on anxiety ratings of hospitalized psychiatric patients |journal=Psychiatric Services |volume=49 |issue=6 |pages=797–801 |date=June 1998 |pmid=9634160 |doi=10.1176/ps.49.6.797 }}</ref><ref name="Netting The Human-Animal Bond">{{cite journal |vauthors=Netting FE, Wilson CC, New JC |date=1987 |title=The Human-Animal Bond: Implications for Practice |journal=Social Work |volume=32 |issue=1 |pages=60–64 |jstor=23713617 |doi=10.1093/sw/32.1.60 }}</ref> and in the home.<ref name="Beck">{{cite book |last=Beck |first=Alan |name-list-style=vanc |title=Between Pets and People: the Importance of Animal Companionship |year=1983 |publisher=Putnam |location=New York |isbn=978-0-399-12775-5}}</ref><ref>{{cite journal |vauthors=[[Froma Walsh|Walsh F]] |title=Human-animal bonds II: the role of pets in family systems and family therapy |journal=Family Process |volume=48 |issue=4 |pages=481–99 |date=December 2009 |pmid=19930434 |doi=10.1111/j.1545-5300.2009.01297.x }}</ref> 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.<ref name="Beck"/><ref>{{cite journal |vauthors=Yamamoto M, Hart LA |title=Professionally- and Self-Trained Service Dogs: Benefits and Challenges for Partners With Disabilities |journal=Frontiers in Veterinary Science |volume=6 |pages=179 |date=2019-06-11 |pmid=31245394 |pmc=6579932 |doi=10.3389/fvets.2019.00179 |doi-access=free }}</ref>

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.<ref>{{cite journal |vauthors=Brooks HL, Rushton K, Lovell K, Bee P, Walker L, Grant L, Rogers A |title=The power of support from companion animals for people living with mental health problems: a systematic review and narrative synthesis of the evidence |journal=BMC Psychiatry |volume=18 |issue=1 |pages=31 |date=February 2018 |pmid=29402247 |pmc=5800290 |doi=10.1186/s12888-018-1613-2 |doi-access=free }}</ref>

=== Cognitive rehabilitation treatment ===

[[Acquired brain injury]] survivors with [[Cognitive impairment|cognitive impairments]] can benefit from animal-assisted therapy as part of a comprehensive rehabilitation treatment plan.<ref>{{cite journal |vauthors=Stapleton M |title=Effectiveness of Animal Assisted Therapy after brain injury: A bridge to improved outcomes in CRT |journal=NeuroRehabilitation |volume=39 |issue=1 |pages=135–40 |date=June 2016 |pmid=27341368 |doi=10.3233/NRE-161345 }}</ref>

[[File:Stella at school..jpg|thumb|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.<ref name="Goddard role and impact of animals">{{cite journal |last1=Goddard |first1=Anna Tielsch |last2=Gilmer |first2=Mary Jo |date=March 2015 |title=The role and impact of animals with pediatric patients |journal=Pediatric Nursing |volume=41 |issue=2 |pages=65–72 |pmid=26292453 |id={{Gale|A414574197}} {{ProQuest|1674729732}}}}</ref> Animals can also help improve children's moods and reinforce positive behaviors while helping to decrease negative ones.<ref name="Goddard role and impact of animals"/>

==== Behavioral health ====
Therapists rely on techniques such as monitoring a child's behavior with the animal, their tone of voice, and indirect interviewing.<ref name="Goddard role and impact of animals"/><ref name=":22">{{cite journal |vauthors=Hoagwood KE, Acri M, Morrissey M, Peth-Pierce R |date=2016-01-25 |title=Animal-Assisted Therapies for Youth with or at risk for Mental Health Problems: A Systematic Review |journal=Applied Developmental Science |volume=21 |issue=1 |pages=1–13 |doi=10.1080/10888691.2015.1134267 |pmc=5546745 |pmid=28798541}}</ref> Animal-assisted therapy can be used in children with mental health problems, as a stand-alone treatment, or along with conventional methods.<ref name=":22" />

==== 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.<ref name=":33">{{cite journal |last1=Calcaterra |first1=Valeria |last2=Veggiotti |first2=Pierangelo |last3=Palestrini |first3=Clara |last4=De Giorgis |first4=Valentina |last5=Raschetti |first5=Roberto |last6=Tumminelli |first6=Massimiliano |last7=Mencherini |first7=Simonetta |last8=Papotti |first8=Francesca |last9=Klersy |first9=Catherine |last10=Albertini |first10=Riccardo |last11=Ostuni |first11=Selene |last12=Pelizzo |first12=Gloria |title=Post-Operative Benefits of Animal-Assisted Therapy in Pediatric Surgery: A Randomised Study |journal=PLOS ONE |date=3 June 2015 |volume=10 |issue=6 |pages=e0125813 |doi=10.1371/journal.pone.0125813 |pmc=4454536 |pmid=26039494 |bibcode=2015PLoSO..1025813C |doi-access=free }}</ref><ref>{{Cite journal |last1=Lindström Nilsson |first1=Maria |last2=Funkquist |first2=Eva-Lotta |last3=Edner |first3=Ann |last4=Engvall |first4=Gunn |date=May 2020 |title=Children report positive experiences of animal-assisted therapy in paediatric hospital care |journal=Acta Paediatrica |volume=109 |issue=5 |pages=1049–1056 |doi=10.1111/apa.15047 |pmid=31597211 |doi-access=free }}</ref> Most commonly reported research results are decreased anxiety and pain within the pediatric population.<ref name="Goddard role and impact of animals"/><ref>{{cite journal |vauthors=Braun C, Stangler T, Narveson J, Pettingell S |date=May 2009 |title=Animal-assisted therapy as a pain relief intervention for children |journal=Complementary Therapies in Clinical Practice |volume=15 |issue=2 |pages=105–9 |doi=10.1016/j.ctcp.2009.02.008 |pmid=19341990}}</ref><ref name=":33" /> 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.<ref name=":02">{{cite journal |last1=Perez |first1=Manuela |last2=Cuscaden |first2=Claire |last3=Somers |first3=Joanne F. |last4=Simms |first4=Nicole |last5=Shaheed |first5=Sabia |last6=Kehoe |first6=Leah A. |last7=Holowka |first7=Stephanie A. |last8=Aziza |first8=Albert A. |last9=Shroff |first9=Manohar M. |last10=Greer |first10=Mary-Louise C. |title=Easing anxiety in preparation for pediatric magnetic resonance imaging: a pilot study using animal-assisted therapy |journal=Pediatric Radiology |date=July 2019 |volume=49 |issue=8 |pages=1000–1009 |doi=10.1007/s00247-019-04407-3 |pmid=31030334 }}</ref>  After AAT intervention, the anxiety levels of the subjects decreased significantly when compared to controls.<ref name=":02" /> Dogs have been shown to increase comfort and decrease pain in pediatric [[palliative care]].<ref name=":16">{{cite journal |vauthors=Gilmer MJ, Baudino MN, Tielsch Goddard A, Vickers DC, Akard TF |date=September 2016 |title=Animal-Assisted Therapy in Pediatric Palliative Care |journal=The Nursing Clinics of North America |volume=51 |issue=3 |pages=381–95 |doi=10.1016/j.cnur.2016.05.007 |pmid=27497015}}</ref> Specific tactics have not been researched, but collective reviews of varied techniques displayed similar results of increased comfort reports by children and guardians.<ref name=":16" />  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.<ref>{{cite journal |last1=Zhang |first1=Yuanyuan |last2=Yan |first2=Fanghong |last3=Li |first3=Sijun |last4=Wang |first4=Yutan |last5=Ma |first5=Yuxia |title=Effectiveness of animal-assisted therapy on pain in children: A systematic review and meta-analysis |journal=International Journal of Nursing Sciences |date=January 2021 |volume=8 |issue=1 |pages=30–37 |doi=10.1016/j.ijnss.2020.12.009 |pmid=33575442 |pmc=7859554 }}</ref>

==== 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.<ref name=":43"/> 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.<ref name=":17">{{cite journal |last1=Dalton |first1=Kathryn R. |last2=Ruble |first2=Kathy |last3=Redding |first3=Laurel E. |last4=Morris |first4=Daniel O. |last5=Mueller |first5=Noel T. |last6=Thorpe |first6=Roland J. |last7=Agnew |first7=Jacqueline |last8=Carroll |first8=Karen C. |last9=Planet |first9=Paul J. |last10=Rubenstein |first10=Ronald C. |last11=Chen |first11=Allen R. |last12=Grice |first12=Elizabeth A. |last13=Davis |first13=Meghan F. |title=Microbial Sharing between Pediatric Patients and Therapy Dogs during Hospital Animal-Assisted Intervention Programs |journal=Microorganisms |date=13 May 2021 |volume=9 |issue=5 |pages=1054 |doi=10.3390/microorganisms9051054 |doi-access=free |pmid=34068292 |pmc=8153335 }}</ref> Many children in hospital settings have weakened immune systems and are already at risk of contracting [[Hospital-acquired infection|hospital-borne infections]]. It has been found that both the patients and dogs participating in therapy experienced changes to their biome after their sessions.<ref name=":17" /> 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.<ref name=":17" /> 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.<ref>{{cite book |doi=10.1109/EMBC.2018.8513384 |chapter=A System for Assessment of Canine-Human Interaction during Animal-Assisted Therapies |title=2018 40th Annual International Conference of the IEEE Engineering in Medicine and Biology Society (EMBC) |date=2018 |last1=Foster |first1=Marc |last2=Beppler |first2=Eric |last3=Holder |first3=Timothy |last4=Dieffenderfer |first4=James |last5=Erb |first5=Patrick |last6=Everette |first6=Kristy |last7=Gruen |first7=Margaret |last8=Somers |first8=Tamara |last9=Evans |first9=Tom |last10=Daniele |first10=Michael |last11=Roberts |first11=David L. |last12=Bozkurt |first12=Alper |pages=4347–4350 |pmid=30441316 |isbn=978-1-5386-3646-6 }}</ref>

===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.<ref>{{cite journal |vauthors=Allison M, Ramaswamy M |title=Adapting Animal-Assisted Therapy Trials to Prison-Based Animal Programs |journal=Public Health Nursing |volume=33 |issue=5 |pages=472–80 |date=September 2016 |pmid=27302852 |doi=10.1111/phn.12276 }}</ref> 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.<ref>{{cite journal |last1=Furst |first1=Gennifer |title=Prison-Based Animal Programs: A National Survey |journal=The Prison Journal |date=December 2006 |volume=86 |issue=4 |pages=407–430 |doi=10.1177/0032885506293242 }}</ref><ref>{{cite journal |last1=Bachi |first1=Keren |title=Equine-Facilitated Prison-Based Programs Within the Context of Prison-Based Animal Programs: State of the Science Review |journal=Journal of Offender Rehabilitation |date=January 2013 |volume=52 |issue=1 |pages=46–74 |doi=10.1080/10509674.2012.734371 }}</ref>

Researchers have, however, begun to find methods of gauging the effectiveness of prison animal programs (PAPs) by using [[Propensity score matching|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.<ref>{{cite journal |vauthors=Van Wormer J, Kigerl A, Hamilton Z |title=Digging deeper: Exploring the value of prison-based dog handler programs. |journal=The Prison Journal |date=September 2017 |volume=97 |issue=4 |pages=520–38 |doi=10.1177/0032885517712481 }}</ref>

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.<ref>{{cite journal |last1=Villafaina-Domínguez |first1=Beatriz |last2=Collado-Mateo |first2=Daniel |last3=Merellano-Navarro |first3=Eugenio |last4=Villafaina |first4=Santos |title=Effects of Dog-Based Animal-Assisted Interventions in Prison Population: A Systematic Review |journal=Animals |date=November 2020 |volume=10 |issue=11 |pages=2129 |doi=10.3390/ani10112129 |pmid=33207818 |pmc=7697666 |doi-access=free }}</ref> PAPs also benefit the animals involved as many come from situations where they faced abuse, neglect or potential euthanasia.<ref>{{Cite web |url=https://abcnews.go.com/US/prison-animal-programs-benefitting-inmates-hard-adopt-dogs/story?id=60600864 |title=Prison animal programs are benefitting both inmates and hard-to-adopt dogs: Experts |website=ABC News |access-date=2019-10-05}}</ref>

===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.<ref name="Wood et al 2017">{{cite journal |vauthors=Wood W, Fields B, Rose M, McLure M |title=Animal-Assisted Therapies and Dementia: A Systematic Mapping Review Using the Lived Environment Life Quality (LELQ) Model |journal=The American Journal of Occupational Therapy |volume=71 |issue=5 |pages=7105190030p1–7105190030p10 |date=September–October 2017 |pmid=28809656 |doi=10.5014/ajot.2017.027219 }}</ref> 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.<ref name="Wood et al 2017" />

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.<ref name="Sutton">{{cite conference |last1=Sutton |first1=Diana M. |title=Use of Pets in Therapy with Elderly Nursing Home Residents |date=August 1984 |id={{ERIC|ED252762}} |oclc=425259708 }}</ref> 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.<ref name="AAT" /> A significant difference has been seen among verbal interactions among nursing home residents with a dog present.<ref name=":2">{{cite journal |last1=Fick |first1=Katharine M. |title=The Influence of an Animal on Social Interactions of Nursing Home Residents in a Group Setting |journal=The American Journal of Occupational Therapy |date=1 June 1993 |volume=47 |issue=6 |pages=529–534 |doi=10.5014/ajot.47.6.529 |pmid=8506934 |doi-access= }}</ref> 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.<ref name="Marx">{{cite journal |last1=Veilleux |first1=Ashley |title=Benefits and challenges of animal-assisted therapy in older adults: a literature review |journal=Nursing Standard |date=13 January 2021 |volume=36 |issue=1 |pages=28–33 |doi=10.7748/ns.2020.e11625 |pmid=33345484 }}</ref>

=== Occupational therapy ===
Occupational therapists can use animal-assisted therapies to work on the child's motivation.<ref name="Andreasen Stella 2017 Animal-assisted therapy">{{cite journal |last1=Andreasen |first1=Gena |last2=Stella |first2=Tiffany |last3=Wilkison |first3=Megan |last4=Szczech Moser |first4=Christy |last5=Hoelzel |first5=Allison |last6=Hendricks |first6=Laura |date=2 January 2017 |title=Animal-assisted therapy and occupational therapy |journal=Journal of Occupational Therapy, Schools, & Early Intervention |volume=10 |issue=1 |pages=1–17 |doi=10.1080/19411243.2017.1287519 }}</ref> 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.<ref name="Andreasen Stella 2017 Animal-assisted therapy"/>

== 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.<ref name="Andreasen Stella 2017 Animal-assisted therapy"/>

=== Canine-assisted therapy ===
{{main|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.<ref name=":4">{{Cite journal |last=Fung |first=Suk-chun |name-list-style=vanc |date=2017 |title=Canine-assisted reading programs for children with special educational needs: rationale and recommendations for the use of dogs in assisting learning |journal=Educational Review |volume=69 |issue=4 |pages=435–450 |doi=10.1080/00131911.2016.1228611 }}</ref><ref name=":0">{{cite journal |vauthors=Krause-Parello CA, Sarni S, Padden E |title=Military veterans and canine assistance for post-traumatic stress disorder: A narrative review of the literature |journal=Nurse Education Today |volume=47 |pages=43–50 |date=December 2016 |pmid=27179660 |doi=10.1016/j.nedt.2016.04.020 }}</ref><ref name=":3">{{cite journal |vauthors=Lundqvist M, Carlsson P, Sjödahl R, Theodorsson E, Levin LÅ |title=Patient benefit of dog-assisted interventions in health care: a systematic review |journal=BMC Complementary and Alternative Medicine |volume=17 |issue=1 |pages=358 |date=July 2017 |pmid=28693538 |pmc=5504801 |doi=10.1186/s12906-017-1844-7 |doi-access=free }}</ref> Well-trained therapy dogs exhibit the behavior that human patients construe as friendly and welcoming.<ref name=":3" /> They comfort patients via body contact.<ref name=":0" /> 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.<ref name=":0" /> They promote patients engaging in interactions which can help patient improve motor skills and establish trusting relationship with others.<ref>{{Cite journal |last1=Decina |first1=Elizabeth |last2=Evangelista |first2=Bernadette |last3=Harantschuk |first3=Alicia |date=January 2022 |title=Collaboration in Animal-Assisted Activities and Animal-Assisted Therapy |journal=Seminars in Speech and Language |volume=43 |issue=1 |pages=54–62 |doi=10.1055/s-0041-1742264 |pmid=35135022 }}</ref> The interaction between patients and therapy dogs also aids reducing stressful and anxious feelings patients have.<ref name=":0" /> 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.<ref name=":4" /><ref name=":3" /><ref name=":0" />

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.<ref name=":4" /> 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.<ref name=":4" />

=== Dolphin therapy ===
{{Main|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,<ref name="MariLili">{{cite journal |last=Nathanson |first=David E. |name-list-style=vanc |year=1998 |title=Long-Term Effectiveness of Dolphin-Assisted Therapy for Children with Severe Disabilities |journal=Anthrozoös|volume=11 |issue=1 |pages=22–32 |doi=10.2752/089279398787000896 }}</ref> and being based on flawed observations.<ref name="ReferenceA">{{cite journal |last1=Marino |first1=Lori |last2=Lilienfeld |first2=Scott O. |name-list-style=vanc |year=2007 |title=Dolphin-Assisted Therapy: More Flawed Data and More Flawed Conclusions |journal=Anthrozoös|volume=20 |issue=3 |pages=239–249 |doi=10.2752/089279307X224782 }}</ref> 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.<ref name="Science Daily">{{cite press release |title=Dolphin 'Therapy' A Dangerous Fad, Researchers Warn |url=https://www.sciencedaily.com/releases/2007/12/071218101131.htm |work=ScienceDaily |publisher=Emory University |date=24 December 2007 }}</ref> The child has a one-on-one session with a therapist in a marine park.<ref name="Humphries 2003" /> 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.<ref name="Humphries 2003">{{cite journal |last1=Humphries |first1=Tracy |name-list-style=vanc |title=Effectiveness of dolphin-assisted therapy as a behavioral intervention for young children with disabilities |journal=Bridges |date=May 2003 |volume=1 |issue=6 }}</ref>

===Equine-related therapy===
{{Main |Equine-assisted therapy}}
[[File:Therapeutic horseback riding 2.JPG|thumb |upright=1.25 |[[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.<ref>{{cite web
| title      = Mosby's Dictionary of Complementary and Alternative Medicine. S.v. "therapeutic riding."
| url        = http://medical-dictionary.thefreedictionary.com/therapeutic+riding
| author     = Jonas
| website    = TheFreeDictionary.com
| publisher  = Elsevier, Inc.
| year       = 2005
| access-date = 15 January 2016
}}</ref> 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.<ref name=anestis>{{cite journal|vauthors = Anestis MD, Anestis JC, Zawilinski LL, Hopkins TA, Lilienfeld SO |title=Equine-related treatments for mental disorders lack empirical support: a systematic review of empirical investigations| journal=The Journal of Clinical Psychology| volume=70|issue=12|year=2014|pages=1115–1132 |pmid=24953870|doi=10.1002/jclp.22113 | type=Systematic review}}</ref>

=== Pig therapy ===
Pigs have been used in various types of animal-assisted therapy to perform duties in facilities including airports,<ref>{{Cite news |last=Ross|first=Jane|date=2019-11-11|title=World's first airport therapy pig hogs the limelight at San Francisco airport |work=Reuters |url=https://www.reuters.com/article/us-california-therapy-pig-idUSKBN1XL1M7|access-date=2021-01-30}}</ref><ref>{{Cite web |last=Baskas |first=Harriet |title=San Francisco airport introduces first 'therapy pig'|url=https://www.usatoday.com/story/travel/flights/todayinthesky/2016/12/05/san-francisco-airport-introduces-first-therapy-pig/94983676/|access-date=2021-01-30|website=USA Today }}</ref> hospitals,<ref name=Thunderbolt>{{Cite web|title=Therapy Pigs Thunder and Bolt Are Happy to Trade Belly Scratches and Hugs for Smiles|url=https://people.com/pets/therapy-pigs-thunder-and-bolt-tampa-hospital/|access-date=2021-01-30|website=PEOPLE.com }}</ref> nursing homes,<ref>{{Cite web |last=McKnight |first=Pat |title=Mini pig trains to work as therapy animal |url=https://www.leadertelegram.com/country-today/country-updates/mini-pig-trains-to-work-as-therapy-animal/article_424480d3-bc33-575e-b11b-c833d21656b1.html |access-date=2021-01-30 |website=Leader-Telegram |date=3 February 2020 }}</ref> and special-needs schools, or as emotional support animals for individuals with conditions such as autism or anxiety<ref>{{Cite web|date=2020-01-29|title=Therapy pigs are here to help humans|url=https://www.kidsnews.com.au/animals/therapy-pigs-are-here-to-help-humans/news-story/f7a3136711d0a0f2be3fa06d65719d0a|access-date=2021-01-30|website=KidsNews }}</ref> and veterans with PTSD.<ref>{{Cite web|last=WEAR|first=KATHRYN DANIEL|date=2018-02-19|title=Therapy pigs in Northwest Florida trained to help veterans suffering from PTSD|url=https://weartv.com/news/local/therapy-pigs-in-northwest-florida-trained-to-help-veterans-suffering-from-ptsd|access-date=2021-01-30|website=WEAR}}</ref> Two well-known [[miniature pig]]s 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.<ref name=Thunderbolt />

===Therapy with other animals===
{{see also|Therapy cat}}

Llamas are also used in therapy.<ref name="Ettinger2020"/>

For patients that have allergies to animals that have fur, snakes have been used to provide emotional support.<ref name="Ettinger2020">{{Cite web |last=Ettinger |first=Zoë |title=16 surprising therapy and emotional support animals |url=https://www.insider.com/surprising-therapy-and-emotional-support-animals-2020-4 |access-date=2023-02-21 |website=Insider |language=en-US}}</ref>

== 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.<ref name=":0" /><ref name="Andreasen Stella 2017 Animal-assisted therapy"/> 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.<ref name=":22" /><ref name=":3" /><ref name=":0" /><ref name="Andreasen Stella 2017 Animal-assisted therapy"/>

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.<ref name=":4" /> 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,<ref name=":0" /> 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.<ref>{{cite journal |vauthors=Kamioka H, Okada S, Tsutani K, Park H, Okuizumi H, Handa S, Oshio T, Park SJ, Kitayuguchi J, Abe T, Honda T, Mutoh Y |display-authors=6 |title=Effectiveness of animal-assisted therapy: A systematic review of randomized controlled trials |journal=Complementary Therapies in Medicine |volume=22 |issue=2 |pages=371–90 |date=April 2014 |pmid=24731910 |doi=10.1016/j.ctim.2013.12.016 }}</ref><ref name="O'Haire Animal-Assisted Intervention for trauma"/><ref name="Charry-Sánchez 2018 Animal-assisted therapy"/>

=== Attention deficit hyperactivity disorder ===
Children with [[attention deficit hyperactivity disorder]] (ADHD) may decrease behavioral issues and improve socialization skills with the intervention of animal-assisted therapy. Compared to children who received only cognitive-behavioral therapy, children who received both canine-assisted therapy and cognitive-behavioral therapy had reduced severity of ADHD symptoms.<ref name=":22"/><ref name=":3" /><ref name=":0" /><ref name="Andreasen Stella 2017 Animal-assisted therapy"/> However, the dog-assisted therapy did not relieve symptoms in long-term treatment.<ref name=":3" />

=== Post-traumatic stress disorder ===
[[Post-traumatic stress disorder]] (PTSD) is a psychological disorder affects people's mental health and has varying severity and forms.<ref name=":0"/><ref name=":6">{{Cite book |title=Effectiveness of psychiatric service dogs in the treatment of post-traumatic stress disorder among veterans. |vauthors=Gillett J, Weldrick R |publisher=McMaster University |year=2014 |location=Hamilton, ON }}</ref>{{page needed|date=November 2020}} It is often difficult to treat due to high drop-out rates and low responses to traditional psycho-therapeutic approaches and interventions.<ref name=":7">{{cite journal |vauthors=Glintborg C, Hansen TG |title=How Are Service Dogs for Adults with Post Traumatic Stress Disorder Integrated with Rehabilitation in Denmark? A Case Study |journal=Animals |volume=7 |issue=5 |pages=33 |date=April 2017 |pmid=28441333 |pmc=5447915 |doi=10.3390/ani7050033 |doi-access=free }}</ref>

Animals have both direct and indirect effects on a mental health spectrum including biological, psychological, and social responses,<ref name=":6" /> further targeting marked symptoms of post-traumatic stress disorder (i.e., re-experiencing, avoidance, changes in beliefs/feelings, and hyperarousal). Direct effects of animals include a decrease in anxiety and blood pressure while indirect effects result in increased social interactions and overall participation in everyday activities.<ref name=":6" />

Biologically, specific chemicals are released when observing human and animal interactions.<ref name=":6" /> Similarly, dog assistance can potentially mediate [[oxytocin]] which effects social and physical well-being and decrease blood pressure.<ref name="Goddard role and impact of animals"/>{{clarify|reason=is that a reference? why not use the standard style?|date=November 2020}} The psychological benefits of animals focus mainly on dog and human interactions, the reduction of anxiety and depressive symptoms, and increased resilience.<ref name=":6" /> Animals in this capacity can further provide emotional and psychological assistance and support, addressing several of the disorder's symptoms.<ref name=":6" /><ref name="O'Haire Animal-Assisted Intervention for trauma"/> The presence of an animal can alleviate intrusion symptoms by providing a reminder that there is no danger present.<ref name="O'Haire Animal-Assisted Intervention for trauma"/> Animals can further elicit positive emotions, targeting emotional numbing experiences.<ref name="O'Haire Animal-Assisted Intervention for trauma"/> Animal interactions also provide social benefits, providing companionship and alleviate feelings of loneliness and isolation through everyday routines and increased social interactions in public.<ref name=":6" /><ref name="O'Haire Animal-Assisted Intervention for trauma"/>

The incorporation and involvement of animals dates back to the earliest forms of organized combat.<ref name=":6" /> Dogs, in particular, were utilized in different capacities.<ref name=":6" /> Ancient armies employed dogs as soldiers and companions which extended to modern combat including dogs as a crucial asset in communication, detection, and intimidation.<ref name=":6" /> While a range of animals can be utilized, dogs and horses have been the principal species studied in practice.<ref name=":6" /> Dog-assisted therapy and therapeutic horseback riding are non-invasive methods for treating post-traumatic stress disorder in veterans.<ref name="Goddard role and impact of animals"/>

Canines can easily integrate into a multitude of environments, are highly responsive to humans, and are very intelligent.<ref>{{cite book |doi=10.1007/978-94-007-6585-6_9 |chapter=Animal-Assisted Therapy: Benefits and Challenges |title=Biotherapy - History, Principles and Practice |date=2013 |last1=Cole |first1=Mary |last2=Howard |first2=Maureen |pages=233–253 |isbn=978-94-007-6584-9 }}</ref> For those reasons, dogs are the species most commonly used in interventions.<ref name=":10" /> Dogs are typically categorized according to the level of training received and the specific needs of the individual.<ref name=":10" /> A service dog provides relief through specialized support related to a physical, mental, or psychological disability.<ref name=":11">{{cite journal |vauthors=Schoenfeld-Tacher R, Hellyer P, Cheung L, Kogan L |title=Public Perceptions of Service Dogs, Emotional Support Dogs, and Therapy Dogs |journal=International Journal of Environmental Research and Public Health |volume=14 |issue=6 |pages=642 |date=June 2017 |pmid=28617350 |pmc=5486328 |doi=10.3390/ijerph14060642 |doi-access=free }}</ref> Emotional support animals solely provide psychological relief and do not require specialized training.<ref name=":11" /> Therapy animals often provide additional support in a therapeutic environment by supporting counselors or therapists in their therapeutic duties.<ref name=":11" /> While service dogs, emotional support animals, and therapy dogs can support the diverse symptoms that veterans, specifically bred and selected post-traumatic stress disorder service dogs, are trained and assigned to veterans with the disorder to support with daily life activities <ref name="van Houtert 1518199">{{cite journal |vauthors=van Houtert EA, Endenburg N, Wijnker JJ, Rodenburg B, Vermetten E |title=Erratum: The study of service dogs for veterans with Post-Traumatic Stress Disorder: a scoping literature review |journal=European Journal of Psychotraumatology |volume=9 |issue=Suppl 3 |pages=1518199 |date=2018-09-11 |pmid=30221635 |pmc=6136358 |doi=10.1080/20008198.2018.1518199 }}</ref> as well as with emotional and mental health needs.<ref name=":6" />

Dogs provide subjective positive effects to veterans and serve as a compassionate reminder to veterans with post-traumatic stress disorder that danger is not present, creating a safe space for the veteran.<ref name=":7" /> They are often sensitive to humans and have the ability to adapt their behavior accordingly by doing tasks such as preventing panic, waking a veteran from a nightmare, and nudging to help the veteran "stay in the present".<ref name=":12">{{cite journal |vauthors=Yarborough BJ, Owen-Smith AA, Stumbo SP, Yarborough MT, Perrin NA, Green CA |title=An Observational Study of Service Dogs for Veterans With Posttraumatic Stress Disorder |journal=Psychiatric Services |volume=68 |issue=7 |pages=730–734 |date=July 2017 |pmid=28292227 |doi=10.1176/appi.ps.201500383 |doi-access=free }}</ref> Dogs provide veterans with a nonjudgmental and safe environment that can help a veteran express feelings and process thoughts without interruption, criticism or advice.<ref name=":13">{{Cite journal |last1=Stern |first1=Stephen L. |last2=Donahue |first2=D. Allen |last3=Allison |first3=Sybil |last4=Hatch |first4=John P. |last5=Lancaster |first5=Cynthia L. |last6=Benson |first6=Trisha A. |last7=Johnson |first7=Allegro L. |last8=Jeffreys |first8=Matthew D. |last9=Pride |first9=Denise |name-list-style=vanc |date=2013-01-01 |title=Potential Benefits of Canine Companionship for Military Veterans with Posttraumatic Stress Disorder (PTSD) |journal=Society & Animals |volume=21 |issue=6 |pages=568–581 |doi=10.1163/15685306-12341286 }}</ref> Interactions, such as petting, playing and walking, with the dog can increase physical activity, reduce anxiety, and provide encouragement to stay in the present moment.<ref name=":13" /> The interaction between dog and veterans supports social interactions for isolated veterans, reduces symptoms associated with the disorder such as depression and anxiety, and increases veterans' calmness.<ref name="Goddard role and impact of animals"/>{{clarify|reason=is that a reference? why not use the standard style?|date=November 2020}}

Similar to dogs, horses have been included in the treatment of veterans with post-traumatic stress disorder<ref name=":10" /> by providing an accepting and nonjudgmental environment,<ref name=":8">{{cite journal |vauthors=Johnson RA, Albright DL, Marzolf JR, Bibbo JL, Yaglom HD, Crowder SM, Carlisle GK, Willard A, Russell CL, Grindler K, Osterlind S, Wassman M, Harms N |title=Effects of therapeutic horseback riding on post-traumatic stress disorder in military veterans |journal=Military Medical Research |volume=5 |issue=1 |pages=3 |date=January 2018 |pmid=29502529 |pmc=5774121 |doi=10.1186/s40779-018-0149-6 |doi-access=free }}</ref> which further facilitates a veterans' ability to cope with symptoms.<ref name=":8" /> Because horses are social animals, they are capable of creating and responding to relationships based on the veteran's energy, providing an opportunity for veterans to regain the ability to form trusting relationships.<ref>{{cite journal |vauthors=Voelpel P, Escallier L, Fullerton J, Abitbol L |title=Interaction Between Veterans and Horses: Perceptions of Benefits |journal=Journal of Psychosocial Nursing and Mental Health Services |volume=56 |issue=5 |pages=7–10 |date=May 2018 |doi=10.3928/02793695-20180305-05 |doi-access=free }}</ref> Therapeutic work with horses varies from ground-based activities, mounted activities, or a combination of both.<ref name=":10" /> In the therapeutic context, horses can promote cognitive reframing as well as an increase in the use of mindfulness practice.<ref name=":8" /> While there is limited research and standardized instruments to measure the effects, veterans who have participated in pilot programs have better communication skills, self-awareness, and self-esteem,<ref name=":8" /> promoting safety and support during the transition into civilian life.<ref name=":14">{{cite journal |vauthors=Lanning BA, Krenek N |title=Guest Editorial: Examining effects of equine-assisted activities to help combat veterans improve quality of life |journal=Journal of Rehabilitation Research and Development |volume=50 |issue=8 |pages=vii–xiii |date=2013 |pmid=24458903 |doi=10.1682/jrrd.2013.07.0159 |doi-access=free }}</ref> Long-term effects of equine-based interventions with veterans include increased happiness, social support, and better sleep hygiene<ref name=":10" /> because they are able to process information regarding their emotions and behaviors in a nonjudgmental space.<ref name=":14" />

While animal-assisted interventions may be effective, it is not yet verified due to limited research.<ref name=":7" /> Animal-assisted interventions can be challenging to study. Because of lack of effective resources, most studies are limited to small sample sizes which prevents genralizing results over a larger population. <ref name=":8" /> Furthermore, there is often a lack of randomization and a lack of information about sample representativeness that prevents widespread application. <ref name=":12" /> Hospital-based animal-assisted therapy programs may present a slight risk of pathogen transmission, but further research is needed.<ref>{{Cite journal |last1=Dalton |first1=Kathryn R. |last2=Waite |first2=Kaitlin B. |last3=Ruble |first3=Kathy |last4=Carroll |first4=Karen C. |last5=DeLone |first5=Alexandra |last6=Frankenfield |first6=Pam |last7=Serpell |first7=James A. |last8=Thorpe |first8=Roland J. |last9=Morris |first9=Daniel O. |last10=Agnew |first10=Jacqueline |last11=Rubenstein |first11=Ronald C. |last12=Davis |first12=Meghan F. |date=May 2020 |title=Risks associated with animal-assisted intervention programs: A literature review |journal=Complementary Therapies in Clinical Practice |language=en |volume=39 |pages=101145 |doi=10.1016/j.ctcp.2020.101145 |pmc=7673300 |pmid=32379677}}</ref>

'''Post-traumatic stress disorder in''' '''sexual assault survivors'''

{{see|Rape trauma syndrome}}

The disorder can develop when a person experiences a sexual assault or rape.<ref>{{cite book |last1=Hoffman |first1=Barbara L |title=Williams gynecology |publisher=McGraw-Hill Education |year=2016 |isbn=978-0-07-184908-1 |edition=3rd |pages=307 |language=en |oclc=921240473}}</ref><ref>{{Cite journal |last1=Surís |first1=Alina |last2=Lind |first2=Lisa |last3=Kashner |first3=T. Michael |last4=Borman |first4=Patricia D. |last5=Petty |first5=Frederick |date=September 2004 |title=Sexual Assault in Women Veterans: An Examination of PTSD Risk, Health Care Utilization, and Cost of Care |journal=Psychosomatic Medicine |volume=66 |issue=5 |pages=749–756 |doi=10.1097/01.psy.0000138117.58559.7b |pmid=15385701 }}</ref> Sexual assault is the leading cause of post-traumatic stress disorder in women; an estimated 50% of women who were sexually assaulted develop the condition.<ref>{{Cite journal |last=Chivers-Wilson |first=Kaitlin A. |date=July 2006 |title=Sexual assault and posttraumatic stress disorder: A review of the biological, psychological and sociological factors and treatments |journal=McGill Journal of Medicine |volume=9 |issue=2 |pages=111–118 |pmc=2323517 |pmid=18523613 }}</ref> Animal-assisted therapy can be an effective in treating the trauma for survivors of sexual assault.<ref>{{cite book |doi=10.1016/b978-0-323-98815-5.00003-3 |chapter=Animal-assisted therapy for posttraumatic stress disorder in sexual trauma survivors |title=Animal Assisted Therapy Use Application by Condition |date=2023 |last1=Emmons |first1=Simone Swartzentuber |pages=97–118 |isbn=978-0-323-98815-5 }}</ref> The presence of dogs have been shown to improve communication between the survivor and the therapist and to decrease survivors' anxiety and fear-responses.<ref>{{Cite journal |last1=Bleiberg |first1=James |last2=Prout |first2=Maurice |last3=Debiak |first3=Dennis |last4=Lefkowitz |first4=Carin |last5=Paharia |first5=Indira |date=2005-01-01 |title=Animal-Assisted Prolonged Exposure: A Treatment for Survivors of Sexual Assault Suffering Posttraumatic Stress Disorder |journal=Society & Animals |volume=13 |issue=4 |pages=275–296 |doi=10.1163/156853005774653654 }}</ref> Animal-assisted therapy increases social interaction for those with the disorder.<ref name="O'Haire Animal-Assisted Intervention for trauma"/> Studies show that animal-assisted therapy leads to an overall reduction of symptoms including anger, depression, and dissociation in survivors of sexual assault.<ref>{{Cite journal |last1=Dietz |first1=Tracy J. |last2=Davis |first2=Diana |last3=Pennings |first3=Jacquelyn |date=November 2012 |title=Evaluating Animal-Assisted Therapy in Group Treatment for Child Sexual Abuse |journal=Journal of Child Sexual Abuse |volume=21 |issue=6 |pages=665–683 |doi=10.1080/10538712.2012.726700 |pmid=23194140 }}</ref> Animal-assisted therapy has also been shown to reduce problem behavior and improves overall behavioral functioning for children survivors of sexual assault.<ref name="O'Haire Animal-Assisted Intervention for trauma"/>

Further research is needed to show the effectiveness of animal-assisted interventions in treating post-traumatic stress disorder for sexual assault survivors across varying demographics. Limitations in current research include small sample sizes and reliance on anecdotal evidence.

=== Autism spectrum disorder ===

Animal-assisted therapy may reduce the symptoms of [[Autism spectrum|autism spectrum disorder]] such as aggressiveness, irritability, difficulty concentrating, and hyperactivity.<ref name=":22"/> In one review,<ref name=":22"/> five out of nine studies reviewed showed positive effects of therapeutic horseback riding on children with autism spectrum disorder. Canine-assisted intervention provides a calmer environment by reducing the stress, irritation, and anxiety that children with autism spectrum disorder experience.<ref name="Andreasen Stella 2017 Animal-assisted therapy"/><ref name=":5">{{Cite book |title=Handbook on Animal-Assisted Therapy : Foundations and Guidelines for Animal-Assisted Interventions |last=Fine |first=Aubrey |name-list-style=vanc |publisher=Elsevier Science & Technology |year=2015 |isbn=9780128014363 |pages=226–229}}</ref> Playing with dogs increases positive mood in children with autism spectrum disorder.<ref name=":5" /> Animals also can serve as a social catalyst. In the presence of animals, children with autism spectrum disorder are more likely to engage in social interactions with humans.<ref name=":5" /> However, the impact of animal-assisted therapy upon parent–child interaction is not clear.<ref name=":22"/>

=== Dementia ===
Animal-assisted therapy encourages expressions of emotions and cognitive stimulation through discussions and reminiscing of memories while the patient bonds with the animal. Studies have found that animal-assisted therapies (particularly using dogs) resulted in measurable quality of life improvements for patients with [[dementia]].<ref name="Wood et al 2017"/> Patients with dementia were also found to improve their social interactions and their scores on the Cohen-Mansfield Agitation Inventory.<ref>{{cite journal |vauthors=Cherniack EP, Cherniack AR |title=The benefit of pets and animal-assisted therapy to the health of older individuals |journal=Current Gerontology and Geriatrics Research |volume=2014 |pages=623203 |date=2014 |pmid=25477957 |pmc=4248608 |doi=10.1155/2014/623203 |doi-access=free }}</ref> Animal-assisted therapy has been shown to slightly reduce depressive symptoms in people with dementia in a 2019 [[systematic review]].<ref>{{cite journal |vauthors=Lai NM, Chang SM, Ng SS, Tan SL, Chaiyakunapruk N, Stanaway F |title=Animal-assisted therapy for dementia |journal=The Cochrane Database of Systematic Reviews |volume=2019 |issue=11 |date=November 2019 |pmid=31763689 |pmc=6953240 |doi=10.1002/14651858.CD013243.pub2 }}</ref>

== Limitations ==
There is limited scientific research on the use of the therapy among adults who have been sexually assaulted. While animals do tend to comfort survivors, animal therapy may not be the catalyst that provides positive success in therapy sessions. As mentioned above, adults tend not to focus as much on having an animal companion, and therefore, animal therapy cannot be attributed as the reason for success in those types of therapy sessions.{{fact|date=March 2025}} There are some ethical concerns that arise when applying animal therapy to younger survivors of sexual assault. For example, if a child is introduced to an animal that is not their pet, the application of animal therapy can cause some concerns. First of all, some children may not be comfortable with animals or may be frightened which could be avoided by asking permission to use animals in therapy. Second, a special bond is created between animal and child during animal therapy. Therefore, if the animal in question does not belong to the child, there may be some negative side effects when the child discontinues therapy. The child will have become attached to the animal, which does raise some ethical issues as far as subjecting a child to the disappointment and possible relapse that can occur after therapy discontinues.{{fact|date=March 2025}}

It is unclear to what degree the animal itself contributes in the recovery process.<ref name=":0" />

There are some concerns specific to dolphin-assisted therapy: First, it is potentially hazardous to the human patients, and it is harmful to the dolphins themselves; by taking dolphins out of their natural environment and putting them in captivity for therapy can be hazardous to their well-being.<ref name="Science Daily"/> Second, dolphin-assisted therapy has been strongly criticized as having no long-term benefit,<ref name=MariLili/> and being based on flawed observations.<ref name="ReferenceA"/> Third, psychologists have cautioned that dolphin-assisted therapy is not effective for any known condition.<ref name="Science Daily"/>

There are concerns that people may become dependent on the animal and could interfere with the recovery process for PTSD.<ref>{{Cite web |title=Dogs and PTSD - PTSD: National Center for PTSD |url=https://www.ptsd.va.gov/gethelp/dogs_ptsd.asp |access-date=2020-11-09 |website=www.ptsd.va.gov }}</ref> People may feel as though they cannot do things on their own without the presence of the animal.

== Ethical concerns ==
Though AAT has existed and been in practice for decades, the lack of standardization creates potential risks for both the animals and humans involved.<ref name=":43">{{cite journal |last1=Evans |first1=N. |last2=Gray |first2=C. |title=The Practice and Ethics of Animal-Assisted Therapy with Children and Young People: Is It Enough that We Don't Eat Our Co-Workers? |journal=British Journal of Social Work |date=June 2012 |volume=42 |issue=4 |pages=600–617 |doi=10.1093/bjsw/bcr091 }}</ref> Due to the unclear structural guidelines on the use of animals in therapeutic settings, possible impacts to the animal include stress, injury, and health complications.<ref name=":43" /><ref name=":422">{{cite journal |last1=Glenk |first1=Lisa Maria |date=February 2017 |title=Current Perspectives on Therapy Dog Welfare in Animal-Assisted Interventions |journal=Animals |volume=7 |issue=2 |pages=7 |doi=10.3390/ani7020007 |pmc=5332928 |pmid=28157145 |doi-access=free}}</ref> Research has shown that despite quality guidelines in place to ensure the health of the therapy animal, there are reports of negative interactions between human participant and therapy dogs.<ref name=":422" /><ref name=":632">{{cite journal |last1=De Santis |first1=Marta |last2=Contalbrigo |first2=Laura |last3=Borgi |first3=Marta |last4=Cirulli |first4=Francesca |last5=Luzi |first5=Fabio |last6=Redaelli |first6=Veronica |last7=Stefani |first7=Annalisa |last8=Toson |first8=Marica |last9=Odore |first9=Rosangela |last10=Vercelli |first10=Cristina |last11=Valle |first11=Emanuela |date=September 2017 |title=Equine Assisted Interventions (EAIs): Methodological Considerations for Stress Assessment in Horses |journal=Veterinary Sciences |volume=4 |issue=3 |pages=44 |doi=10.3390/vetsci4030044 |pmc=5644660 |pmid=29056702 |doi-access=free |last12=Farina |first12=Luca}}</ref> These reports include mistreating and teasing the dogs by patients and staff at locations in which therapy is hosted.<ref name=":422" /> In studies conducted, people with certain disabilities had to be excluded from the experiment due to increase in the stress of the therapy dog, and ultimately decline in overall well-being.<ref name=":422" /> There is a question as to whether bringing animals into AAT settings where the client has a history of violence is ethical, or if the benefit outweighs the risk.<ref name=":43" />

Equine-assisted therapy showed a need for more studies of equine behavior to obtain an understanding of stress signals from horses.<ref name=":632"/> Through understanding the stress signals shown by horses, a safe and healthy experience during the therapy session can be held, by allowing handlers to minimize stress.<ref name=":632"/> For therapy animals limited time for rest, multiple sessions, and long duration of sessions were linked to higher stress.<ref name=":422"/><ref name=":632"/><ref name=":32">{{cite journal |last1=Grandgeorge |first1=Marine |last2=Dubois |first2=Elodie |last3=Alavi |first3=Zarrin |last4=Bourreau |first4=Yannig |last5=Hausberger |first5=Martine |title=Do Animals Perceive Human Developmental Disabilities? Guinea Pigs' Behaviour with Children with Autism Spectrum Disorders and Children with Typical Development. A Pilot Study |journal=Animals |date=August 2019 |volume=9 |issue=8 |pages=522 |doi=10.3390/ani9080522 |pmid=31382429 |pmc=6719160 |doi-access=free }}</ref><ref name=":52">{{cite journal |last1=Wirth |first1=S |last2=Gebhardt-Henrich |first2=SG |last3=Riemer |first3=S |last4=Hattendorf |first4=J |last5=Zinsstag |first5=J |last6=Hediger |first6=K |title=The influence of human interaction on guinea pigs: Behavioral and thermographic changes during animal-assisted therapy |journal=Physiology & Behavior |date=15 October 2020 |volume=225 |pages=113076 |doi=10.1016/j.physbeh.2020.113076 |pmid=32673619 |doi-access=free }}</ref> Assessing animals for signs of fatigue and stress can prevent negative experience for both humans and animals involved.<ref name=":422"/><ref name=":32" /><ref name=":632"/><ref name=":52" /> Animals used should be limited to a specific duration and number of sessions, as well as given access to proper environmental conditions, food, water, and rest.<ref name=":422"/><ref name=":632"/>

== See also ==
{{Columns-list |colwidth=22em |
* [[Animal cognition]]
* [[Animal consciousness]]
* [[Care farming]]
* [[Classroom pet]]
* [[Emotional support animal]]
* [[Human-canine bond]]
* [[Service animal]]
* [[Service dog]]
* [[Therapy cat]]
* [[Therapy dog]]
* [[School dog]]
}}

== References ==
{{Reflist |30em}}

== External links ==
* {{Commons category-inline}}
* [https://www.animallaw.info/topic/table-state-assistance-animal-laws Assistance Animal State Laws] - Michigan State University
* [https://www.tsa.gov/travel/special-procedures Disabilities and Medical Conditions] - TSA (Transport Security Administration)
* Skloot, Rebecca (December 31, 2008) [https://www.nytimes.com/2009/01/04/magazine/04Creatures-t.html "Creature Comforts"], ''[[The New York Times]]''
* [https://medicinehorse.org Medicine Horse]

{{Mammals in culture}}
{{Authority control}}

[[Category:Animal-assisted therapy|*]]
[[Category:Environmental psychology]]
[[Category:Outdoor education]]
[[Category:Treatment of dementia]]