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Review Article

Benefits of Animal Assisted Therapy in Mental Health

Konstantinos Koukourikos, MSc, PhD (c)

Lecturer in Nursing, Nursing Department, International Hellenic University, Thessaloniki, Greece

Athanasia Georgopoulou, RN

International Hellenic University, Thessaloniki, Greece

Lambrini Kourkouta, PhD

Professor, Nursing Department, International Hellenic University, Thessaloniki, Greece

Areti Tsaloglidou, MSc, PhD

Assistant Professor, Nursing Department, International Hellenic University, Thessaloniki, Greece

Abstract

Background: Animal-assisted therapy is defined as the aimed interaction between trained animals and patients,

which is considered complementary to conventional therapies. It is designed and implemented by a team of

experts including the therapist, the animal handler, and some health professionals.

Aim: The aim of this study is to present and highlight the role of animals and their advantages in the treatment

of mental illness

Methodology: Extensive review of the recent literature was conducted in electronic databases (Pubmed, Google

scholar) and scientific journals (Greek and international) using the appropriate key words: animal assisted

therapy, mental illness, aging, animal assisted activity, animal companionship, health, pet ownership and a

combination of them.

Results: Treatment animals are more often dogs, horses, dolphins, birds, and generally animals having gentle

nature. The treatment's benefits to the health of mentally ill are related to reducing the expression of the negative

symptoms of the disease, developing skills in various areas of patients’ personality and moreover improving

their quality of life. A prerequisite for the proper implementation of treatment programs is compliance with

basic terms and principles for the protection of health, security and well-being of the participants.

Conclusion: Prerequisites for the development of this particular therapeutic effort are the definition of treatment

parameters, the proper education of health professionals, the coordinated action of a multidisciplinary team

trained specifically for its design and implementation and the expansion of the research area.

Key words : Animal assisted therapy, mental illness, aging, animal assisted activity, animal companionship,

health, pet ownership

Introduction

From ancient times, human existence is closely

related to the presence of animals. The animals

followed a parallel course with human either

initially as livelihood (food) or later

domestication of some of them as a means of

livelihood (eg plowing fields) and later as

domestic animals for purely personal pleasure

and well-being.

The presence of animals relieves, relaxes and

discharges people from tension and stress of

everyday life. The use of animals for therapeutic

purposes, although has a long history, has been

expanded just in the 20th century. The interest of

many researchers and health professionals had

been developed with regard to the positive

consequences of the interaction of animals with

humans and its potential health benefits (Hughes

et al, 2019).

The studies referring to the above mentioned

interaction have been multiplied and the interest

has mainly focused on the help that animal

contact can provide for the treatment of multiple

diseases, particularly those related to mental

health. The results of these studies have led to

the consolidation of a complementary or

alternative form of treatment for various types of

mental illness, known as "Animal-Assisted

Therapy" (Mandrá et al, 2019).

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The presence of animals as a treatment

The use of interaction with animals specially

trained for this purpose is applied to improve

patient's mental, social, emotional and physical

functions. The treatment sessions can take place

at various facilities and involve activities such as

game, sports and animal care. They are done

individually or in groups, and like any other form

of treatment, they are tailored to suit each

patient's needs (Jackson, 2012).

The animals involved in the treatment are mainly

dogs, cats and dolphins. However, if appropriate

and possible, farm animals such as horses,

rabbits and various birds are also included in the

programs. It is well documented in the literature

that the presence of animals in treatment can

cause feelings of calm and optimism both in

adults and children. At the same time, it helps to

establish trust between the patient and the

therapist, encouraging the achievement of

therapeutic goals. Animal-assisted therapy does

not constitute an individual psychotherapy school

nor is likely to have positive results for all people

with all sorts of disorders (Ogilvie, 2016).

Wide benefits of animal assisted therapy in

mental health

Animal contact has an important place in the

lives of many people, as their presence alone can

contribute to their peace and well-being.

However, it seems that animals offer much more

than just companionship. Their involvement to

the treatment of mental illness is a fact for

several decades, and the benefits obtained are

significant. The multiplicity of terminology

existed until a few years ago on the therapeutic

use of the animals and its implications, caused

confusion to the experts and made it imperative

to define fixed concepts, common and widely

accepted. Undoubtedly, any patient's approach

from an animal to a hospital or clinic is not

included in the treatment if certain basic

conditions are not met (Kruger and Serpell,

2010). The "Delta Society", one of the largest

organizations in the United States, which is

responsible for the organization and provision of

animal assisted programs, has adopted the

following definitions regarding the inclusion of

animals in the therapeutic context (Delta Society,

2008) :

A. Animal - Assisted Therapy:

It is a targeted and structured therapeutic

program that involves animals meeting specific

criteria in the therapeutic process as an integral

and vital part of it, aiming at improving the

cognitive, emotional, social and physical

functions of the patient. It is designed and

implemented by healthcare specialists who have

been further trained for these programs and can

take place in a variety of facilities such as

hospitals, clinics and other rehabilitation areas,

nursing homes, prisons, private homes and

animal farms. In this form of treatment, as well

as in the rest, the progress of its course and the

evaluation of achievement of the initial

objectives for each patient, are recorded. It is

addressed to individual patients or groups of

patients according to the design and objective

criteria that have been set. Animal assisted

therapy does not depend on any particular

psychological theory, but can be incorporated

into various types of them (Delta Society, 2008,

Friedmann and Son, 2009).

B. Animal-assisted activities:

These are opportunities for contacting patients

with specially trained animals, coordinated by

expert professionals or volunteers, in the absence

of treatment program and specific treatment

goals. Visits of animals to patients'

accommodation are spontaneous, without

presupposing the recording and evaluation of

their progress. In the animal assisted activity

context, participants were able to develop interest

in themselves, other residents, and their

environment, due to feelings of ease and the

development of one-on-one relationships with

the AAA animals. (Kawamura, Niiyama,

Niiyama, 2009, Kruger and Serpell, 2010, Crippa

and Feijó, 2014).

C. Animal assisted intervention:

This concept refers to the broader field of

integration of animal assisted therapy into

educational programs aimed at training health

professionals to organize and implement such

treatment programs (Crippa and Feijó, 2014).

Animal assisted programs are being implemented

to support children, adolescents, adults and

elderly patients suffering from mental disorders.

The benefits are achieved through interaction

with the trained animals, whether it is related to

touching and treating them, or simply by

observing the animal and its relationship with its

trainer-carer. These potential benefits stem from

the fact that contact with animals is a potent

supportive source for the patient due to the

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acceptance and positive response of the animals

to him (Yap, Scheinberg, Williams, 2017,

AVMA, 2018).

The benefits of animal assisted therapy extend to

various areas of patient personality, namely

emotional, cognitive, social, and physical

functions (Amerine and Hubbard, 2016):

A. emotional support and stress relief:

It has been observed that interaction with animals

positively affects patients during stressful

situations within the therapeutic process. The

whole environment of the treatment becomes

more friendly and less threatening, and patients

seem to feel more calm and relaxed when an

animal participates even as a mere presence in

treatment sessions. Animals are a tangible source

of pleasure and consolation. Experts suggest that

when contacted with animals, neurotransmitters

such as serotonin and endorphins are released,

causing a feeling of happiness and calm while

reducing the secretion of stress hormones such as

cortisol and adrenaline, a fact that further

contributes to lowering blood pressure and heart

rate. In addition, patients, as they treat animals,

have the potential to develop care and empathic

skills. At the same time, the interaction with

them has a catalytic effect on the patient's

relationship with the therapist, contributing to the

acquisition of trust between them. On the one

hand, therefore, the normalization of aggravating

emotions is achieved and, on the other hand, the

element of laughter and joy is introduced into the

therapeutic process, the value of which should

not be underestimated, as it improves, the

emotional status and quality of life of people in

general (Bachi and Parish-Plass, 2017, Fine,

2018).

B. learning cognitive self-care skills and

improving self-image:

Patients suffering from mental illness often feel

powerless, vulnerable and dependent on other

people. With the presence of animals, they

become potential caregivers of another entity -

the animal - for which they often feel responsible

by undertaking activities related to its survival.

This contributes to strengthening self-confidence

and trust. Moreover, many benefits appear for the

elderly patients in whom a progressive decline of

cognitive skills is observed, such as those

associated with memory, self-care, hygiene and

cleanliness. Undertaking practices related to

animal care by elderly patients, raises motivation

and stimulates memory, while the discussion on

self-care issues takes place with less discomfort

during the treatment sessions under the presence

of an animal. (Bachi and Parish-Plass, 2017,

Bachi, Terkel, Teichman, 2012).

C. cultivating social skills:

Mental illness largely cuts the patient out of his

social environment not only because of his

stigma but also because of the reduction of skills

necessary for the social interaction of humans

and the establishment of normal social relations.

Moreover, if the disease leads to the patient

entering a clinic, he automatically cuts off his

social environment and his quality of life is

degraded. The inclusion of animals in the

treatment of these patients contributes to the

partial extension of a normal lifestyle - animals

are an excellent companion for many people -

and the cultivation of lost social skills. Even by

simple observation of the therapist's relationship

with the animal and their interaction, the patient

gains information about accepted and non-social

behaviors. As a result, patient learns how his

actions affect those who receive them and he also

practices self-control and self-restraint. Another

key point is that animals respond in a direct way

to the movements and attitudes of people towards

them. This positive or negative response helps

the patient to adopt appropriate behaviors

(Chitic, Rusu, Szamoskozi, 2012, Bachi and

Parish-Plass, 2017).

D. Providing opportunities for activity and

training:

Animal assisted therapy provides incentives and

opportunities for participation in physical

exercise activities that physically enhance the

patient and offer fun and enjoyment at the same

time. Walking and jogging, gymnastics and

animal play contribute to the production of

endorphins and improved mood. They also

contribute to the practice of coarse and fine

mobility, which is significantly affected in some

patients with mental disorders (Velde, Cipriani,

Fisher, 2005).

Benefits of incorporating animals into modern

methods of treating mental illness for

children, adults and elderly patients

Study results on patients suffering from mental

disorders have confirmed that participation in

animal assisted treatment programs, coupled with

other more traditional therapeutic interventions,

results in reducing anxiety and depression

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symptoms, reducing behaviors associated the

disease and improving their social interactions.

Experts argue that each patient has undoubtedly

his own independent course with regard to the

process of rehabilitation, in which traditional

treatments have steadily for years positive

results. However, searching for new methods and

techniques for those who do not respond to basic

intervention patterns or who are positively

involved in new forms of treatment becomes

vital. It is well documented in the literature that

animal assisted therapy is a feasible and dynamic

alternative for children, adolescents, adults and

elderly patients with various forms of mental

disorders (Mangalavite, 2014).

Depression

Studies have shown that interaction with animals

causes biochemical changes in the patient's brain

and release neurotransmitters that improve mood

and cause relaxation and suppression of anxiety.

These changes has proved to be effective in

reducing symptoms of depression in

institutionalized elderly and increasing verbal

interaction, act as a facilitator of social

interaction and eliciting positive emotional

responses (Moretti et al. 2011, Ambrosi et al,

2019). At the same time, other benefits to the

patient's body functions such as lowering blood

pressure and pulse and increasing activity and

mobility are achieved, contributing to better and

faster recovery of patient health. Potential

psychological benefits are emotional support,

reduction in feelings of isolation and loneliness,

cultivation of empathic skills, rehabilitation of

self-image and self-confidence and improvement

of orientation towards reality in general (Souter

and Miller, 2007). Dealing with animals may

also contribute to the mental deprivation of the

illness and its symptoms and improve patient’ s

quality of life. The undertaken activities in

connection with the treatment animals urge

patient to be active and also to perform regular

self-care actions. A tight link between the patient

and the animals is often created, and it is a source

of support and motivation for commitment to the

therapeutic procedure. At the same time, contact

with animals improves the social skills of

patients with depression, breaking the limits of

his potential marginalization and providing

opportunities for interaction with other people,

which is essential for the course of treatment

(Horowitz, 2010, Cheung and Kam, 2017). In

conclusion, the treatment of depression with

animal assistance may present positive and

encouraging results as data from various surveys

and studies show. The need for further study in

this field becomes imperative for the general

acceptance and establishment of the method.

Autism

Animal assisted therapy could have positive

effects on children with autism. Animals have

features that are not available to humans, which

work positively to the symptoms of autism.

Opposite to low sensory response induced by

autism, animals provide powerful multi-sensory

stimuli - strong and clear repetitive sounds,

vibrant visual images, distinct and special smell

and pleasant touch. This contributes to the ability

of animals to have a particular non-verbal

communication with them. The involvement of

an animal in autistic children's treatment

positively affects their reactions and their

behavior in general. The children seem more

cheerful and concentrated, while their fixed

motifs of kinesiology and their tendency to

isolate, as well as other characteristics of autistic

behavior are diminished. The release of

hormones due to contact with animals also leads

to the improvement and increase of social

interactions of children, even those who develop

intense withdrawal from the environment and the

people around them ( Hanson et al, 2007,

Foden and Anderson, 2011, Siewertsen, French,

Teramoto, 2015, Borgi et al, 2016).

In animal assisted therapy, many different

symptoms of autism are set as treatment targets.

The most important benefits of the treatment

include improving child communication and

social skills as well as controlling and limiting

stereotypical behaviors. Animals not only are the

same efficient companion, but also provide

opportunities – motivating them - to further

social interaction and communication. At the

same time they help the child to work within the

social environment and reduce his anxiety. They

are also a focal point of concentration for the

child when he has to cope with over-stimulating

sensory states and stimuli, helping him remain

more calm and relaxed (Siewertsen, French,

Teramoto, 2015). Furthermore, through the care

and treatment of the animal, the child acquires

daily self-care skills and promotes self-image

and confidence. Dealing with animals can also

increase the strength of the child and improve the

areas of fine and coarse mobility. Animals are

not only an incentive to engage in important

activities for children, but also a model for their

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own learning. Through the observation of their

personal interaction with them, but also of other

people with animals, children are taught social

behaviors, develop ideas, patterns, internal

expectations and standards related to normal

behaviors and human relationships (Wang, 2013,

Anderson and Meints, 2016).

The therapeutic involvement of dogs, horses and

dolphins, animals, has been found to be the most

effective in the field of developmental disorders

of children and adults. Therapeutic riding also

presents - due to horse physiology and

kinesiology - additional benefits in terms of

improving the motor functions of autistic patients

(Bass, Duchowny, Llabre, 2009, Wang, 2013,).

Dementia

Animals, and especially dogs, have been

participating for many years in visiting programs

in elderly patients with dementia, offering the

opportunity to create bonds of affection and fun.

However, experts on the disease claim that the

benefits for patients can be much more by

implementing targeted therapeutic interventions

with the assistance of animals. People with

dementia may experience various symptoms and

behaviors during the course of the disease

progression. As the disease progresses, the

patient usually cuts off links and contact with the

environment and social environment, is isolated

and greatly restricts his movement and activities.

The presence of a treatment animal has been

observed to be the only remaining functional

patient communication bridge with the reality

around him. Research results show that animal

assisted treatment can improve the social and

communication behaviors and skills of patients

with dementia. Many times patients can

communicate more effectively with animals than

with people of their environment. This contact

with the animals provides the trigger and the

motivating power of their disengagement from

the margin and loneliness that has been caused

by the disease (Baun and Mccabe, 2003, Cevizci

et al,. 2013).

It is shown in the literature that animal assisted

treatment can act preventively and

therapeutically on the effects of dementia and on

the emotional health of patients, significantly

reducing its negative symptoms, such as

aggression and psychotic behavior, confusion,

irritability and depressive tendencies. These are

common benchmarks among dementia patients

(Nordgren and Engström, 2012, Bono et al,

2015). Contact and interaction with animals may

also reduce the symptoms of another common

disorder in patients with dementia, known as the

"West syndrome", in which patients have intense

signs of anxiety, confusion and aggression during

the early evening hours. The presence of

treatment animal has a complacent action in the

mental state of patient, providing security and

companionship (Perkins et al, 2009).

AAT had a positive effect in dementia patients

for several neuropsychiatric symptoms like

delusion, depression, disinhibition, euphoria, and

aberrant motor activity. Moreover, the ratings of

the various behaviors during each session

suggest that the beneficial effects of AAT appear

during the first few sessions (Tournier, Vives,

Postal, 2017).

In addition, activities with treatment animals,

such as grooming, gymnastics, walking and

playing, give patients a pleasant incentive to get

out of their stillness and improve their physical

condition and body functions. This reduces the

sense of muscle pain, increases motor skills and

muscle strength, limits patients' falls and

enhances their nutritional and self-care skills

(Richeson, 2003, Moretti et al, 2011).

Schizophrenia

The interaction of schizophrenic patients with

treatment animals leads to positive effects on the

symptom of anhedonia, a disease-induced

symptom associated with a lack of capacity for

experiencing pleasure with situations and

activities that normally cause it. It has been

observed that the implementation of animal

treatment programs in patients with

schizophrenia living in psychiatric institutions

has gained the preference of patients compared to

other treatment models, as participation in them

showed a decrease in the sense of apathy and the

manifestation of adverse symptoms of the

disease. In addition, patients' cortisol levels seem

to be reduced at the end of the reported

programs, indicating the reduction of anxiety and

stress in people with schizophrenia (Chu et al,

2009, Rossetti and King, 2010).

The therapeutic use of interaction with animals

provides patients with the incentive and

opportunity for the general improvement of their

quality of life. Research has shown not only the

reduction of the negative symptoms of the

disease but also the onset of positive behaviors

related to everyday activities and care of patients.

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Patients showed significant improvements in the

Living skills profile (withdrawal, anti-social

behavior and compliance) and in quality of life

related with social relationships. Through regular

contact with animals and the performance of

activities such as self-care, patients improve their

self-esteem and become more active and

responsible in their personal lives (ViIIaIta-Gil et

al, 2009, Davidson, 2014). Another study

reporting improvements in emotional symptoms

and in various measures of self-view and self-

image (Virués-Ortega et al, 2012).

The most important element is that it can

produce practical benefits, especially in areas

where traditional treatments seem inadequate,

such as the symptom of patient anhedonia, which

greatly affects the quality of their everyday lives

(Davidson, 2014).

Conclusions

Animal assisted therapy, as a complementary

approach to traditional therapies, leads to several

important benefits for patients suffering from

mental illnesses. Its implementation in patients

with diagnoses such as depression, autism,

dementia, schizophrenia can achieve changes in

their personality, behavior and physical health.

These changes mainly affect the social

interactions of patients, as well as the cognitive,

psychological and emotional field, which seems

to improve the abilities and skills that have been

limited due to the underlying disease. New skills

are also being cultivated. This improves patients’

self-image and their overall quality of life. The

positive benefits of animal involvement in the

treatment process lead to the reduction of the

onset of negative symptoms caused by mental

disorders and the emergence of positive

behaviors, mainly concerning the responsibilities

and activities of everyday life on behalf of

patients.

However, research into the involvement of

animals in the treatment of mental illness needs

to be broadened and enriched but also to

overcome obvious weaknesses and constraints.

In this way its potential strengths can be taken

into account and the therapy itself can be

established as appropriate and important method

of intervention.

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