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Introduction   

Canine-assisted therapy is a therapeutic intervention that involves trained dogs to enhance the treatment and well-being of various patients of all ages and diagnoses. Dogs are commonly preferred for therapy because of their deep bond with humans and their sensitivity to emotional states. They can easily be brought into various healthcare and residential facilities with their handlers to work collaboratively with the therapists. Canine-assisted therapy is also a relatively inexpensive addition to a facility since the dogs are owned and trained by an individual who is independent of the facility. 

History of Canine-Assisted Therapy 

Throughout history, back to the earliest interactions, dogs have assisted humans in achieving goals, including fending off predators and finding food. The inclusion of dogs and their ability to improve human health and well-being is known in a variety of therapeutic settings as an adjunct or complementary therapy and is not a recent or uncommon practice. The earliest documented instance dates to the 18th century when animals were introduced into mental institutions to enhance social interactions among their patients. (1) 

Florence Nightingale most popularly documented the therapeutic effect of animals on patients in the late 1800s. Nightingale, considered the founder of modern nursing, noted how patients in a psychiatric facility positively responded to small animals. (2)  

In the early 1960s, animal-assisted interventions began to evolve with the pioneering work of Boris Levinson, Elizabeth O’Leary Corson, and Samuel Corson. Levinson, a child psychologist practicing since the 1950s, noticed a child who was nonverbal and withdrawn during therapy began interacting with his dog, Jingles, in an unplanned interaction. This experience caused Levinson to begin his pioneering work in creating the foundations for animal-assisted therapy as an adjunct to treatment. (3) 

In the 1970s, Samuel Corson and Elizabeth O’Leary Corson were some of the first researchers to empirically study canine-assisted interventions. Like Levinson, they inadvertently discovered that some of their patients with psychiatric disorders were interested in the dogs and that their patients with psychiatric disorders communicated with each other and the staff when in the company of the dogs. Over the following decades, therapy dogs have been increasingly found to provide support for individuals with diverse needs in a wide array of settings. (3) 

Canine-assisted therapy has come a long way since it was first documented over 150 years ago and has profoundly impacted the mental and physical health of patients with many chronic and acute conditions. Even patients with common disorders, such as anxiety and depression, are excellent candidates, and this kind of therapy has improved the quality of life for many people and, in some cases, even slowed their symptoms. (2) 

Benefits 

One theory as to the effectiveness of animal therapy is that we, as humans, evolved to be highly aware of our natural environment, including the animals around us. The sight of a calm animal reassures us that the environment is safe, thus reducing anxiety and increasing our feelings of calm. (4) 

It is well known that spending time petting a dog can cause an immediate emotional boost through the release of hormones such as serotonin, prolactin, and oxytocin, which are all hormones that play a part in elevating moods. Dogs make your nervous system release endorphins, the brain chemicals that make you feel good. They bind to and activate opioid receptors in the nervous system, acting like painkillers and producing euphoria. Patients not only experience an increase in endorphin release but also a decrease in secretions of stress hormones, like cortisol, norepinephrine, and epinephrine. This all contributes to the overall improvement that has been observed in patients exposed to animal-assisted therapy. (5) 

When a patient interacts with a therapy dog, they temporarily forget their painful or difficult situation. The dogs act like a bridge between therapists and patients. Dogs give unconditional, nonjudgemental love, unlike many fellow human beings. This is essential for those who feel vulnerable because of their physical, mental, or emotional conditions. Dogs do not notice the little things that may make humans feel uncomfortable or reject others so for this reason, people feel safe with dogs. 

Research has shown that therapy dogs cause an automatic relaxation response, including reducing feelings of anxiety and loneliness and a reduction of blood pressure that improves cardiovascular health, which can therefore reduce the intake of medications and lower the risk for cardiovascular disease. (6)  

Use in Physical Therapy and Psychotherapy 

Canine-assisted therapy aims to fill the physical, psychological, cognitive, and social needs of patients. Dealing with a serious medical or mental health condition causes a great deal of stress for patients. Stress can hinder healing, but spending time with animals can make the healing process faster and easier by providing a needed distraction and stress reduction.  

The type of therapy and goals depends on the type of aid the patient needs and the addition of canine therapy can increase motivation toward improving movement or motor skills, boost their mood, and reduce signs of pain. The canines support the therapeutic process rather than lead it but can either take an active role, such as when the therapy patient walks with it or grooms it, or they can be there simply to offer comfort.  

With physical therapy that requires exercise that is sometimes uncomfortable, patients find themselves more motivated to participate in therapy after interacting with a pet. The increased pain threshold that comes with the oxytocin release can also motivate people to push harder in their therapy programs and the number of minutes of therapeutic ambulation is higher with the dog (17 min) compared to the control group (15 min) (7). 

Neurodevelopmental disorders are a group of conditions characterized by impairments in personal, social, academic, or occupational functioning. The most common are autism and attention deficit/hyperactive disorder. For these patients, the ability to build an attachment and trust between themselves, their therapist, and the dog is one of the important and core benefits of the use of canine-assisted therapy.  

The primary goal of psychotherapists is to provide these patients with non-judgmental support and a sense of safety and comfort to make them feel more comfortable during treatment. Using a therapy dog can increase the strength of the therapeutic alliance early in treatment and reduce premature treatment termination, which is vital for people who have difficulty establishing and maintaining emotional connections with others. The animal can act as an attachment figure, especially during the initial stages of therapy. (8) 

When with the therapy dog, they can feel understood and valued without the fear of rejection or criticism due to the animal’s empathy and non-verbal communication which increases the strength of the therapeutic relationship and helps promote the patients’ emotional, cognitive, and social development. It has been shown to be a self-esteem enhancer, a catalyst for mood improvement, and a facilitator of social interactions. (9) 

As patients continue to interact with the therapy animal, they may begin to project their feelings and experiences onto the animal, thus creating opportunities for the therapist to explore and address these emotions. The therapist can “listen in” to the communication the patient may be having with the dog, who is often seen as a friend to whom they can tell their problems or talk about difficult issues, which is much easier than revealing these thoughts to the therapist.  

The therapist can also use relaxation and bonding methods involving the dog where the patient pets the dog as it is lying or resting next to the patient. As the patient pets the dog, they practice their breathing in sync with the dog while listening to relaxing music, creating a calm state of mind.  

Canine-assisted therapy is a promising intervention that benefits children with mental health disorders, their families, and mental health professionals.  

In general, canine-assisted psychotherapy supports the therapeutic process by: 

• Non-judgmental support –Therapy canines provide unconditional love and acceptance when feeling safe and relaxed. Their warm presence may encourage patients to express themselves without fear of judgment or criticism. 

• Subjective sense of safety – Ensuring the patient and the therapy animal feel safe during sessions is vital for building trust and promoting a positive therapeutic experience. 

• Empathy and connection – Dogs can innately sense and respond to human emotions, which may help individuals feel understood, validated, and connected during therapy. 

• Responsibility and accountability – Caring for, interacting with, and leading a therapy animal can help patients deepen their emotional connections, which can help them establish healthy human relationships 

• Growth and change – Building trust with therapy animals can provide personal growth, self-reflection, and opportunities for change. This process can help break the cycle of unstable interpersonal connections and emotional instability that is characteristic of them to establish healthy human relationships. 

(9) 

Supporting Evidence 

In the acute care setting, studies have shown that patients randomly assigned to canine-assisted therapy before procedures, such as a cystoscopy, had lower anxiety and stress levels than a treatment-as-usual control group (11). In the ER, patients with moderate or great anxiety had lower anxiety following canine-assisted therapy than those in a control group (13). A study of 200 emergency department patients who were waiting to be treated or admitted had half of the participants spending 10 minutes with a therapy dog and its handler, while the other half received standard care without a dog visit.  

Those patients visited by a therapy dog reported a decrease in pain (43%) with similar improvements in anxiety (48%), depression (46%), and overall well-being (41%). Since pain is the most common reason that someone visits an emergency department, the finding that therapy dogs can decrease pain levels is notable – particularly because most of the patients in the study with the therapy dog (77%) did not receive any pain medication. (12) 

In the intensive care unit, the effects of a critical illness, as well as the treatment interventions, can be difficult for patients and families, who may experience stress, anxiety, and/or depression during this time. There is a recognized need for the implementation of non-pharmacological interventions to support ICU patients, their families, and clinicians to enhance well-being, improve resilience, and minimize adverse psychological outcomes. (13)  

Their presence in the ICU is new for many hospitals, even though their positive effects are well documented for patients in other hospitals and clinical settings.  

Nursing Considerations 

Nurses can assist in identifying those patients who would benefit from this therapy, be part of the care planning for the needs that the therapy dog could assist with, support the addition of a therapy dog in their facility, and ensure that the boundaries and policies related to having a dog in the facility are adhered to.  

As nurses work closely with their patients and families, seeing the effects of pain, depression, and anxiety during acute or chronic diseases and the treatments for them, it gives them the best perspective to suggest and support this as an adjunct therapy that may not have been proposed or thought of before and represents a creative, non-pharmaceutical option.  

Issues that many healthcare facilities deal with, and that nursing personnel are well aware of, is the financial stability of its operations. Cost-effectiveness is a key consideration when addressing the addition of any new program. One supportive argument in favor of canine-assisted therapy is that the therapy dogs reside with their owners in the community. Owners assume the costs including veterinary care, food, training, therapy dog certification, etc. They function as volunteers, incurring only a modest cost to the facility for orientation and training of the handler.  The cost of program management would be minimal for the facility and potentially add significant improvements to their patient and employee satisfaction results.  

Conclusion

As the research supporting the benefits of canine-assisted therapy in acute care, clinical settings, and senior housing facilities continues to grow, the promising outcomes and low cost of implementation make this a positive complementary intervention to traditional medicine. Some may argue there are risks any time animals and humans interact, but these risks are minimized when only trained, tested, and certified therapy dogs work with their handlers to improve the lives of others by providing comfort, affection, motivation, and acceptance.  

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