Anxiety Disorders and Animal Assisted Therapy
Literature Review and Evidence-Based Practice Recommendation
Introduction
The idea that animal-assisted therapy is beneficial for mental health was first conceived in the 17th century, gaining endorsement by healthcare professionals in different types of settings for various populations (Crossman, 2017). Over the past few years, holistic healthcare professionals have recognized that patients have had a tremendous growth in the interest of therapeutic use of companion animals. Companion animals can be an aid for patients with physical, mental, and emotional needs. Dogs have long been known as man’s best friend, but only recently have they been used to help aid in the decrease of anxiety amongst patients. This non-pharmacological intervention to treat anxiety has been beneficial to many people who do not wish to use medication to treat symptoms of anxiety. A concern that people may have about the use of pet therapy to treat anxiety is, how much it can reduce a persons’ level of anxiety and how anxiety can be monitored.
PICO(T) Question
PICOT is a mnemonic that is used by researchers in order to create a good clinical question. P stands for patient or problem, I stands for intervention, C stands for comparison, O stands for outcome, and T stands for time. By utilizing this format, it helps identify and clarify the research question, which in turn makes it easier to find a solution or answer. The PICOT question for this research project is: For patients with an anxiety disorder (P), how does pet therapy twice a week (I) compared to usual care (C) affect anxiety levels (O) after one month of treatment (T)? Don't use plagiarised sources.Get your custom essay just from $11/page
Search Strategy
The key terms used for literature search included: pet therapy anxiety, pet therapy and anxiety, animal assisted therapy, animal assisted therapy anxiety, animal assisted therapy anxiety disorders, pet therapy effects, emotional support animals. The databases utilized for these searches include Google Scholar, EBSCO, ProQuest, CINAHL, PsycINFO, and Clarivate. The search modifiers that were used are peer-reviewed journals, academic journals, published between 2014 and 2019, and published in English. There were a total of 114 resources available that meet all of our search criteria which included academic journals and peer-reviewed journals.
Summary of Findings
According to Crossman (2014), merely being near, petting, interacting, gazing, caring or including an animal in another therapy has been shown to reduce distress. Pet therapy programs can be used to help decrease the human bodys’ stress response, specifically by reducing subjective stress and anxiety levels (Ein et al., 2018).
In a study done by Ambrosi et al. (2019), it was examined how dog assisted therapy helped with depression and distress symptoms in institutionalized elderly patients. The study demonstrated that interactions with the animals helped to reduce the symptoms of distress, as patient focus shifted away from the symptoms to interacting with the animal, resulting in patients experiencing a better mood and feelings of tranquility (Ambrosi et al., 2019). A study conducted by Grajfoner et al. (2017) had similar results with a population of college students, finding that animal assisted therapy resulted in students having an increase in well-being and mood, as well as a decrease in anxiety levels. A study done by Kline et al. (2019) used a population of patients visiting an emergency room. In Kline et al.’s (2019) study, patients were selected based on if the physician believed the patient was experiencing moderate or greater anxiety. The end results of Kline et al.’s (2019) study showed a reduction in anxiety, pain and depression.
Ein et al. (2018) conducted a study that looked at other factors besides self-evaluation, including blood pressure and heartbeat as a physiological measure for anxiety. Ein et al.’s (2018) results demonstrated a significant decrease in heart rate in healthy patients that received pet therapy. Ein et al.’s (2018) study also had subjective data that indicated patients felt that they were experiencing less stress after pet therapy. Another study including subjective data is Lynch et al.’s (2014) study on pregnant woman located in the antepartum unit of a hospital due to high risk pregnancies. Lynch et al.’s (2014) study included 82 women who self-selected to participate in the pet therapy program, granting them about 15 to 20 minutes with a dog in their room. Results demonstrated that participants self-reported a significant decrease in depressive symptoms and anxiety after participating in pet therapy (Lynch et al, 2014). The effects of animal facilitated therapy programs on patients in a surgical-oncology unit was conducted by Ginex et al. (2018). Dog handlers brought their therapeutic dogs to provide therapy that lasts between 10 to 15 minutes at a time. The research study concluded that the quality of life improved, along with depression and anxiety scores (Ginex et al., 2018).
A study conducted by Crossman (2014), explains it is unclear what elicits a positive response, but indicated some reasons could be by providing opportunity for reward and reinforcement, emotional contagion, coping support, distress tolerance, interpersonal emotion regulation, tactile stimulation or expectations of improvement.
The evidence-based practice model that was utilized for this research project was the Johns Hopkins Nursing Evidence-Based Practice Rating Scale (JHNEBP). This evidence rating scale was used in order to identify the strength of the evidence in each of the research studies reviewed. This model is known to aid in problem-solving and decision-making for clinical nursing research (Vera, 2019). JHNEBP has a three step process called PET, which stands for practice question, evidence, and translation, with the goal of ensuring that the best practices and current research findings are correctly incorporated into patient care in a timely manner (Vera, 2019).
With the use of the Johns Hopkins Nursing Evidence-Based Practice Rating Scale (JHNEBP), the levels of evidence from each research study was determined. The level of evidence in the study, “Randomized controlled study on the effectiveness of animal‐assisted therapy on depression, anxiety, and illness perception in institutionalized elderly” was determined to be level I, as it was conducted as a randomized controlled trial. In the, “Effects of Interactions With Animals On Human Psychological Distress” study, researchers used a systematic review which classifies this study as a level IV. “The effects of pet therapy on the physiological and subjective stress response” research was conducted as a meta-analysis, which falls into the level I category of JHNEBP. “The Effect of Dog-Assisted Intervention on Student Well-Being, Mood, and Anxiety,” is considered a level III, since it was a controlled trial with no randomization. The level of evidence of the, “Controlled clinical trial of canine therapy versus usual care to reduce patient anxiety in the emergency department” is a level I, since the research was created with a controlled study group. The research, “A bite out of anxiety: Evaluation of animal-assisted activity on anxiety in children attending a pediatric dental outpatient unit” was determined to be a level I, as it was conducted in a well controlled environment without any outside factors interfering with the study. The “Pet therapy program for antepartum high-risk pregnancies: a pilot study” is considered to be a level III when using the JHNEBP because patients self-reported their findings, using a qualitative study approach. A research study conducted on, “Animal-Facilitated Therapy Program: Outcomes from Caring Canines, a program for patients and staff on an inpatient surgical oncology unit” has an EBP level of II, since the research was conducted as a quasi-experimental research study design.
Recommendation for Practice Change
Some recommendations of animal assisted therapy to treat anxiety is to use a reliable tool to measure the level of patients’ anxiety before, during, and after therapy. One study conducted by Grajfoner, D., Harte, E., Potter, L. M., & McGuigan, N. (2017) had every participant complete multiple surveys and scales such as the Warwick–Edinburgh Mental Well-Being Scale (WEMBS), the State Trait Anxiety Scale (STAI), and the UWIST Mood Adjective Checklist (UMACL). These were all used both before, and after, the animal assisted therapy intervention was completed. A tool that can incorporate all important data should be created by the research team or found from previous studies that have proven to be useful also have the ability to yield reliable results even when administered over a period of time. This is important in order to track how the patients’ anxiety levels have changed over time. Another recommendation of animal assisted therapy to treat anxiety would be to use a variety of animals (Nammalwar, R. B., & Rangeeth, P., 2018). Not all individuals will have a strong connection to dogs, so it would be interesting to see the possible effects a horse, cat, or other animal can have on an individuals’ level of anxiety. A majority of research conducted on pet therapy for individuals with anxiety has been done with the use of therapy dogs. By using other animals, the researcher would be able to test if other animals can have the same effect of decreasing anxiety on patients as dogs do. It could also help determine if individuals have a greater decrease in anxiety if animal-assisted treatment is conducted with a specific species that the individual personally is drawn and connected to.
Conclusion and Recommendation for Further Research
After reviewing the compiled research, it demonstrates that pet therapy can diminish physical pain, lower blood pressure, and relieve anxiety. Although there have been numerous studies conducted on the association of animal assisted therapy and the decrease in anxiety levels, it is not definitive that it can produce long-term benefits (Ginex et al., 2018). The results show that patients would have to continue to use animal-assisted therapy in order to minimize their perceived stress (Ein et al., 2018).
Animal-facilitated therapy has been documented to produce health changes that are both objective and subjective for patients (Ginex et al., 2018). A recommendation to further research on this topic would be to incorporate analyzing subjective data such as blood pressure and heart rate over the period of time a patient is receiving animal-assisted therapy. This would help identify just how much this animal therapy is able to reduce anxiety through the use of tangible data. It is also critical to acknowledge that hormones related to emotions play a big role in anxiety. Studying how hormones changed through the use of pet therapy would also be a useful research study to help fill in the gap in how animal assisted therapy aids patients with anxiety and other health disorders.
Evidence Table
| Authors & Date | Evidence Type (real, demonstrative, documentary, or testimonial) | Sample and setting (patient, person, population) | Key Findings | Limitations | Level of Evidence and EBP model
John Hopkins Nursing EBP Model |
| Ambrosi, C., Zaiontz, C., Peragine, G., Sarchi, S., & Bona, F. (2019) | Real evidence, as patients were present during this study. | Elderly population with a 5 on a depression scale rating | Dog assisted therapy results in positive emotional responses and mood, reduced symptoms of depression, and feelings of serenity. | Wide sociodemographic and clinical population resulting in findings that are broad in relevancy, subjects with comorbidities of severe cognitive deterioration and depression were excluded. | Level I, since it is listed as a randomized controlled trial. |
| Crossman, M.K. (2017) | Demonstrative, as they are second thoughts in this study and they are going by what was happening at the given time. | Population was people whom have anxiety disorders. | Animal assisted therapy produces small-to-medium distress reduction, and it is unclear what exactly results in distress reduction. | Extratherapeutic factors, social facilitation, insufficient statistical power, generalization across animals, publication bias, questionable research practices. | Level IV, since it is a systematic review. |
| Ein, N., Li, L., & Vickers, K. (2018) | Documentary, as this was a meta-analysis study that utilized other articles and independent samples. | 1,310 participants ranging from children to older adults who have self-reported anxiety | There was a significant difference in heart rate, self-reported anxiety, and self-reported stress after pet therapy. | Small sample size, limited amount of self-reported stress, lack of validated stress measures. | Level I, as it is a meta-analysis. |
| Ginex et al. (2018) | Documentary, as patients responded to open-ended questions to describe their emotions and pain levels after pet therapy. | 100 patients enrolled with 50 in the control group and 50 in the therapy group, the average age in the control group was 58 years old and 55 in the study group, all patients were on a surgical oncology unit | Anxiety scores improved significantly, patients level of energy increased, and their level of happiness, hopefulness, level of stress, fatigue, pain, and overall well being improved but were not significant. | Setting was in an adult surgical oncology unit, the average age of participants was between 55 and 58 years. Patients were experiencing physical pain along with anxiety as they are recovering from surgery | Level II, since it has a quasi-experimental research study design. |
| Grajfoner, D., Harte, E., Potter, L. M., & McGuigan, N. (2017) | Demonstrative, as it was done in a college. | College population for those who face anxiety. | 20 minute interactions with dogs resulted in improved well-being of the students, an increase in mood, and a decrease in anxiety. | Control that required interactions with the handler only, some individuals were more likely to participate resulting in gender imbalance. | Level III, since it was controlled trial with no randomlization, as they had to qualify. |
| Kline, J. A., Fisher, M. A., Pettit, K. L., Linville, C. T., & Beck, A. M. (2019) | Real evidence, as this was witnessed in an ER. | In an ER, if the patient was stable and physician thought that they had anxiety. | The patients with moderate or severe anxiety that received animal assisted therapy experienced lower anxiety, pain and depression scores. | The design of the study does not provide a mechanism that explains why patients experience less anxiety, pain and depression; it is probable that patients had limited or no interaction with humans during the period without a dog, it is unmeasured the degree to which the control group could have experienced disappointment at not seeing a dog, possibility of gender specific issues such as women being seen as more anxious. | Level I, since the article states it was a controlled study. |
| Lynch, C. E., Magann, E. F., Barringer, S. N., Ounpraseuth, S. T., Eastham, D. G., Lewis, S. D., & Stowe, Z. N. (2014) | Demonstrative, because subjective data was used. | 82 women in a hospital setting in antepartum with high risk pregnancies. | Both depressive symptoms and anxiety symptom scores significantly decreased from pre-pet therapy to post-pet therapy. | There was no control group, and volunteer bias occurred through self-selection to participate in pet therapy. | Level III, because patients self-reported. |
| Nammalwar, R. B., & Rangeeth, P. (2018) | Demonstrative, as the pediatric patients demonstrated the results within 15 minutes. | 20 children (9 Malemales, 11 Females males), aged 4-–11 years, attending a private dental care facility in Chennai | Implementing pet therapy at the dental practice was effective, as a reduction in anxiety was seen. | Only included children without disabilities, those having their first dental visit or those who did not have an exclusive dental facility. | Level I, since it was a well controlled environment. |
References
Ambrosi, C., Zaiontz, C., Peragine, G., Sarchi, S., & Bona, F. (2019). Randomized controlled study on the effectiveness of animal‐assisted therapy on depression, anxiety, and illness perception in institutionalized elderly. Psychogeriatrics, 19(1), 55-64. doi-org.concordia.idm.oclc.org/10.1111/psyg.12367
Crossman, M. K. (2017). Effects of Interactions With Animals On Human Psychological Distress. Journal of Clinical Psychology, 73(7), 761–784. https://doi-org.concordia.idm.oclc.org/10.1002/jclp.22410
Ein, N., Li, L., & Vickers, K. (2018). The effects of pet therapy on the physiological and subjective stress response: A meta‐analysis. Stress & Health: Journal of the International Society for the Investigation of Stress, 34(4), 477–489. Retrieved from http://search.ebscohost.com.concordia.idm.oclc.org/login.aspx?direct=true&db=s3h&AN=132394675&site=eds-live
Ginex, P., Montefusco, M., Zecco, G., Trocchia Mattessich, N., Burns, J., Hedal-Siegel, J., … Tan, K. S. (2018). Animal-Facilitated Therapy Program: Outcomes from Caring Canines, a program for patients and staff on an inpatient surgical oncology unit. Clinical Journal of Oncology Nursing, 22(2), 193–198. https://doi-org.concordia.idm.oclc.org/10.1188/18.CJON.193-198
Grajfoner, D., Harte, E., Potter, L. M., & McGuigan, N. (2017). The Effect of Dog-Assisted Intervention on Student Well-Being, Mood, and Anxiety. International Journal Of Environmental Research And Public Health, 14(5). https://doi-org.concordia.idm.oclc.org/10.3390/ijerph14050483
Kline, J. A., Fisher, M. A., Pettit, K. L., Linville, C. T., & Beck, A. M. (2019). Controlled clinical trial of canine therapy versus usual care to reduce patient anxiety in the emergency department. Plos One, 14(1), e0209232. https://doi-org.concordia.idm.oclc.org/10.1371/journal.pone.0209232
Lynch, C. E., Magann, E. F., Barringer, S. N., Ounpraseuth, S. T., Eastham, D. G., Lewis, S. D., & Stowe, Z. N. (2014). Pet therapy program for antepartum high-risk pregnancies: a pilot study. Journal of Perinatology, 34(11), 816–818. https://doi-org.concordia.idm.oclc.org/10.1038/jp.2014.120
Nammalwar, R. B., & Rangeeth, P. (2018). A bite out of anxiety: Evaluation of animal-assisted activity on anxiety in children attending a pediatric dental outpatient unit. Journal of the Indian Society of Pedodontics & Preventive Dentistry, 36(2), 181–184. https://doi-org.concordia.idm.oclc.org/10.4103/JISPPD.JISPPD_54_18
Vera, D. (2019, May 7). 2017 EBP Models and Tools. Retrieved from https://www.hopkinsmedicine.org/evidence-based-practice/ijhn_2017_ebp.html.