Canine-Assisted Therapy Improves Well-Being in Nurses

Dog companionship and cortisol levels in youth. A systematic review and meta-analysis

OBJECTIVE

Traditional and non-traditional strategies have been employed to improve youth health. Dog-assisted interventions have been proposed as a novel strategy to regulate stress and its consequences across all age groups. This systematic review and multilevel meta-analysis assessed the influence of dog-assisted interventions on cortisol levels in youth and explored potential moderators.

SOURCES

We conducted a comprehensive systematic search across multiple databases, including PubMed, Scopus, Web of Science, Cochrane Library, and ScienceDirect, up to June 17, 2024, to evaluate the impact of dog-assisted interventions on youth cortisol levels. Two reviewers independently extracted and verified data from eligible randomized clinical trials, with a third reviewer ensuring accuracy. Cochrane's RoB 2.0 tool was used to assess the risk of bias. Heterogeneity was analyzed using Q and I2 statistics. A random-effects model was employed to calculate effect sizes (ES) using R software.

SUMMARY OF THE FINDINGS

Significant cortisol reductions were found for interventions lasting >15 min (ES: 0.65; p = .038), with a non-significant trend towards reduced cortisol in non-medical settings (ES: 0.46; p = .070). No significant effects were observed for shorter interventions, different control groups, or age-specific analyses. Meta-regression analysis revealed significant differences, showing better outcomes with longer intervention times and fewer female participants.

CONCLUSION

Dog-assisted interventions lasting >15 min seem to be a promising and non-traditional strategy for regulating cortisol levels in children and adolescents in stressful situations. This study outlines gaps in the research and future directions.

Rudolph, the kids' ward reindeer: a scoping review of the effects of support animals on the well-being of healthcare staff

BACKGROUND

Many systematic reviews identify support animals or animal assisted activity as a beneficial and standard practice in several medical disciplines for patients (children, adolescents, and adults) and residents in care homes. A variety of animals are used such as dogs, cats, ponies, horses, alpacas, reindeer, penguins, rabbits, and tarantulas. Our objective was to explore the evidence regarding effects of animal assisted activity on a further population of interest; namely, healthcare staff.

METHODS

We asked the question "how do support animals in healthcare settings affect the well-being of healthcare staff?" As an addendum, we were also interested in what - possibly more unique - animals have visited healthcare settings at Christmas time in particular. We conducted a scoping literature review using PubMed and Web of Science (search as of 26 April 2023).  RESULTS: Twenty studies (in the USA, Australia, Europe; dogs: n = 19; cats: n = 1) since 2002 included: studies with biological measures (n = 3), longitudinal survey studies with analyses (n = 5), cross-sectional survey studies with analyses (n = 2), and cross-sectional survey studies with descriptive statistics (n = 10). Overall, animal assisted activities appear to be well-received by staff and there do not seem to be negative impacts on staff well-being.

CONCLUSIONS

Relevant positive effects and avenues of research are identified. Our review suggests that, but not exactly how, animal assisted activity benefits staff. Study evidence is limited with most studies being cross-sectional, descriptive, having low participant numbers, and mostly only involving dogs. Nonetheless, the evidence is mostly positive. The potential of animal assisted activities impacting positively on staff well-being warrants systematic research. Gaps in hard-fact-evidence should not deter us - especially at the festive season - to encourage work with, and systematic research regarding, support animals that provide warmth, empathy, comfort, and more in healthcare settings.

Potential Mechanisms of Action and Outcomes of Equine-Assisted Services for Veterans with a History of Trauma: A Narrative Review of the Literature

Equine-assisted services (EASs) are being increasingly used as complementary interventions for military veterans who have experienced trauma. However, there is limited evidence of benefit for this population and almost no literature describing the desired potential outcomes and possible mechanisms of action. The aim of this article is to address these gaps by reviewing the extant literature of animal-assisted interventions in general, and equine-assisted services in particular, with the goal of providing guidance for future investigations in the field. Currently, the field is in the early stage of scientific development, but published results are promising. Interventions that enhance treatment compliance and/or outcomes could benefit this population. Preliminary results, reviewed herein, indicate that EAS interventions might benefit the military veteran population by enhancing treatment engagement and therapeutic alliance, as well as by contributing to symptom reduction and resulting in various transdiagnostic benefits. It is recommended that future studies include exploration of potential beneficial outcomes discussed herein, as well as investigate suggested mechanisms of action.

Human-Animal Interaction in Animal-Assisted Interventions (AAI)s: Zoonosis Risks, Benefits, and Future Directions-A One Health Approach

Animal-assisted interventions (AAI)s represent the expression of integrated medicine, according to the One Health approach. Actually, animal-assisted therapies and animal-assisted activities are implemented in hospitals, rehabilitation centers, etc. The efficacy of AAIs is based on interspecific interactions and would be impacted by different factors, such as the characters of both the animal and the handler, a suitable selection of animal species, an appropriate animal educational protocol, the relationship between the handler and the animal, and mutual relationship among the animal, the patients, and members of the working team. AAIs produce many advantages for the patients but could expose them to zoonotic-pathogens transmission. Therefore, positive animal welfare, as preventative medicine to avoid incidents or transmission of zoonosis, is a relevant aspect with implications for human and animal health and wellbeing. This review aims to summarize the current published knowledge regarding the occurrence of pathogens in AAIs and to discuss their relevance in light of health and safety in AAIs participants. In addition, this review will contribute to defining the state of the art of AAIs through a careful benefits/challenges analysis and offers discussion points on the possible future developments according to the One Health approach.

High prevalence of insomnia among physiatrists in the Czech Republic: A web-based questionnaire survey

BACKGROUND

Physicians who suffer from poor sleep quality are at an increased risk of mistakes and poor decision-making. We deemed it noteworthy to assess sleep quality in practicing physiatrists, previously reported to be at higher risk of physician burnout, which was documented associated with sleep deprivation.

OBJECTIVE

The aim was to estimate the prevalence of sleep disturbance among practicing physiatrists and evaluate the association of sleep quality with their sleep hygiene habits and depression.

METHODS

Of the 101 study participants (77 females) who met the inclusion criteria, the majority was between the age of 25 and 40 years (70.3% ); 62 (61.4% ) were specialists and 39 (38.6% ) were in training. In this cross-sectional study, practicing physiatrists were invited to complete an anonymous and voluntary web-based survey. The survey consisted of questions covering demographic information, nicotine and caffeine consumption, exercise habits, and three questionnaires: the Pittsburgh Sleep Quality Index (PSQI), the Beck Depression Inventory-II (BDI-II), and the Sleep Hygiene Index (SHI).

RESULTS

Sixty-five (64.4% ) respondents showed poor sleep quality (PSQI >  5), and 23 (22.8% ) showed at least mild symptoms of depression (BDI-II>13). The mean PSQI, SHI, BDI-II scores were 6.85±3.09, 18.18±5.35, and 8.36±7.52, respectively. Poor sleep quality was significantly positively correlated with symptoms of depression and sleep hygiene misbehavior.

CONCLUSION

We found that 64.4% of practicing physiatrists suffered from poor sleep quality, and 22.8% showed at least mild symptoms of depression. Considerable efforts should be directed toward sleep hygiene behavior and mental health improvement.

A Correlational Study Exploring Nurse Work Anxiety and Animal-Assisted Therapy

OBJECTIVE

The aim of this study was to perform a correlational study to explore nurse work anxiety.

BACKGROUND

Nurses experience work anxiety with chronic stressful situations, high-acuity assignments, and rigorous patient care standards. The purpose of this study was to determine whether animal-assisted therapy during active worked hours would reduce nurse work-related anxiety.

METHODS

Animal-assisted therapy interventions were performed for both day and night shifts. Beck's Anxiety Inventory (BAI) tool was used pre and post intervention. Each nurse interacted with the therapy dog for at least 10 minutes.

RESULTS

Pet-assisted therapy as an intervention for nurses during work reduced work-related anxiety (t = 5.878, P < 0.05). A Pearson's correlational study displayed a strong positive correlation between the animal-assisted therapy and reduction in BAI scores (r = 0.7717, R2 = 0.5955).

CONCLUSION

This prospective study has shown that nurse work anxiety significantly decreased during worked hours of active bedside care when the nurses actively engaged with a therapy dog.

Psychophysiological mechanisms underlying the potential health benefits of human-dog interactions: A systematic literature review

While the symbiotic nature of human-dog relationships and perceived benefits to human health have attracted much scientific interest, the mechanisms through which human-dog interactions may confer health benefits to humans are still poorly understood. The aim of this systematic literature review was to synthesize evidence of physiological changes associated with human-dog interactions with relevance to human health. Electronic databases were systematically searched (PubMed, MEDLINE with full text, Scopus, PsycINFO, CINAHL Plus with Full Text, and Web of Science Core Collection) for relevant studies. Of the 13,072 studies identified, 129 met the inclusion criteria, with approximately half being randomized trials (Level 2) based on the Oxford Centre for Evidence Based Medicine level system. Measures employed to study human physiological changes associated with human-dog interactions most commonly involved cardiac parameters and hormones, with negligible research of brain activity. The main positive findings were increases in heart rate variability and oxytocin, and decreases in cortisol with human-dog interactions. These physiological indicators are consistent with activation of the parasympathetic nervous system (PNS) and oxytocinergic system (OTS), and down-regulation of hypothalamic-pituitary-adrenal (HPA) axis activity. These results provide evidence of specific pathways through which human-dog contact may confer health benefits, likely through relaxation, bonding, and stress reduction. However, these findings should be interpreted contextually due to limitations and methodological differences. Previous research using other biological variables was limited in quantity and quality, thus impeding firm conclusions on other possible mechanisms. Further research is needed in some psychophysiological domains, particularly electroencephalography, to better understand central nervous system (CNS) effects. The findings of this review have implications for human-dog interactions to positively affect several stress-sensitive physiological pathways and thus confer health benefits. This supports their incorporation in various clinical, non-clinical, and research settings to develop evidence-based interventions and practices for cost-effective and efficacious ways to improve human health.

Working like a Dog: Exploring the Role of a Therapy Dog in Clinical Exercise Physiology Practice

Therapy animals in clinical settings are purported to reduce patients’ anxiety, decrease agitated behaviour, serve as social mediators, enhance the social atmosphere, and increase patients’ openness towards practitioners. A therapy dog worked alongside her exercise physiologist handler for approximately 1 day/week in a university clinic. The canine and handler functioned as a team, while the handler simultaneously undertook supervision of students. The clinic was open 24 h/week, and no other therapeutic animal was present for any part of the week. We explored, via surveys and interviews, human responses to the dog. The survey comprised 15 statement items regarding the canine’s role, behaviour, and acceptability in the clinic, ranked from strongly disagree (−2) to strongly agree (2), followed by an open item inviting participants to follow up interviews. Eleven (11) clinical clients and seven (7) students completed the survey. One client had not encountered the canine; these data were excluded. Four (4) participants from the client sample provided subsequent telephone interviews. All participants identified the canine as well-behaved; no participants considered that she detracted from their exercise sessions. Most participants were equivocal to statements regarding social lubrication and openness to practitioners; only three clients and two students identified that they felt more willing to share health information; three students identified that they felt they could confide more in the canine than in the practitioner. Interviewees’ reports were similarly favourable, reinforcing the information obtained from the surveys. Interview transcripts were subject to thematic analysis, which focussed around four key themes: (1) the canine’s good behaviour, (2) clients giving permission, and the canine as both (3) a pleasant distraction from the effort of exercise, and (4) nice to have. A therapy dog may enhance some aspects of exercise physiology service delivery.

Molecular Biomarkers of Adult Human and Dog Stress during Canine-Assisted Interventions: A Systematic Scoping Review

Positive relationships, including those between humans and other animals, particularly dogs, may be a way to reduce stress in humans. However, research into this area is relatively new, and a comprehensive review of the impacts of these interactions on humans and dogs has not been conducted. A scoping review of the scientific literature was conducted to explore what is known about the impacts of canine-assisted interventions on molecular biomarkers (e.g., cortisol and oxytocin) and associated measures (e.g., heart rate and blood pressure) of human and canine stress. As reported across 27 identified studies, canine-assisted interventions have consistently been demonstrated to elicit positive changes in human stress markers, and typically do not cause negative impacts on the studied canine stress markers. However, results were inconsistent across measures of stress. For example, in humans, it was common for a study to show improvements to cortisol levels but no change to self-reported stress, or vice versa. Many of the reviewed studies also had significant methodological issues, such as not aligning the timing of sample collections to when the analyzed stress biomarkers could be expected to peak. More rigorous research should be conducted on the impacts of canine-assisted interventions on a wider range of stress biomarkers.

Animal-Assisted Intervention and Health Care Workers’ Psychological Health: A Systematic Review of the Literature

Healthcare settings have recently increased the use of companion animals in the workplace to provide emotional support to people with disabilities, but there is limited empirical research on the effects of these programs on healthcare workers. However, it is reasonable to speculate that Animal-Assisted Interventions (AAIs) may have positive effects on health care workers (HCWs) by buffering the negative effects of work-related stress and other occupational psychosocial risk factors. The aim of this review was to examine the beneficial effects of AAIs on the psychological well-being of HCWs. A systematic review was conducted in December 2021 to gain insight into the positive effects of pets on HCWs in the workplace. Searches were conducted in the following databases: Scopus, PubMed/Medline, Web of Science, and Google Scholar, including studies between 2001 and December 2021, and 12 articles were included in the review. The results indicate that implementing the AAI program in a busy clinic is feasible and that the program is accepted by medical professionals because of the immense psychological benefits it provides. However, the healthcare professionals disliked the experimental design that forced them to leave their workplaces at a certain time.

The role of cortisol in the association of canine-companionship with blood pressure, glucose, and lipids: a systematic review

INTRODUCTION

The dog is known as man's best friend and canine-companionship is associated with positive effects on cardiovascular health.

AIM

We aim to review the role of cortisol in the association of canine-companionship with human blood pressure, glucose and lipid profile.

METHODS

Electronic databases, and reference lists of the selected articles were searched for original articles in English which evaluate the role of cortisol in the association of canine-companionship with human blood pressure, glucose and lipid profile. Appropriate tools from the National Institute of Health were used for the quality assessment.

RESULTS

Of the 2108 articles included for screening, 6 studies fulfilled the selection criteria. The USA had produced the highest number of studies (50%, 3/6). Pre-post studies (83%, 5/6) were the predominant type, and the overall quality of the selected studies was acceptable. The majority of studies showed a significant reduction of cortisol with dog companionship or therapy (67%, 4/6) along with a significant reduction of heart rate (2/4), systolic blood pressure (1/4), mean arterial blood pressure (1/4), or total cholesterol level (1/4). The role of cortisol in the association of canine-companionship with human blood pressure, glucose and lipid profile was scarcely studied with no studies from lower-middle-income countries, where the disease burden is on the rise.

CONCLUSION

A significant reduction of few cardiovascular risk factors was found along with a significant reduction of cortisol in canine companionship in few studies. Future comparative or higher-level studies are essential on the association between canine companionship, cortisol and cardiovascular risk factors, especially in lower-middle-income countries.

Acceptability of AAI from the Perspective of Elderly Clients, Family Members, and Staff-A Pilot Study

Although animal-assisted interventions (AAIs) are increasingly part of comprehensive rehabilitation and many of its effects are already well described, the methodology for performing AAI depends on the specific patient, animal, and treatment objective. Acceptability of AAI from all involved members is a little explored area. Thus, 214 respondents (32 AAI clients, 146 family members, and 36 healthcare and social care workers; 98 males, 116 females; mean age 46.3 years (±16.5 SD)) completed a list of statements focused on AAI with a dog. This list was distributed directly in nursing homes, retirement homes, and in households with home hospice care. All statements were rated on a Likert scale of 0-3. The results show that AAI is generally very well received, with over 90% of respondents considering AAI to be beneficial. The perception of AAI and trusting the handler with their dog was evaluated very positively, as well as possible concerns about hygiene. The results were in many cases affected by demographic factors of the respondents (age, gender, role in AAI, education, and size of settlement). It seems appropriate in future studies to focus on the attitude of individual groups, and thus advance the methodology of implementing AAI.

Developing an animal-assisted support program for healthcare employees

Background

Employee burnout and its associated consequences is a significant problem in the healthcare workforce. Workplace animal therapy programs offer a potential strategy for improving employee well-being; however, research on animal therapy programs for healthcare workers is lacking. This study aimed to evaluate the feasibility, acceptability and preliminary impact of an animal-assisted support program to improve healthcare employee well-being.

Methods

In this mixed-methods pilot intervention study, we implemented an animal-assisted support program in a multidisciplinary healthcare clinic at a large VA hospital. The program included 20 sessions over 3 months, each approximately 1-h long. Real-time mood data were collected from participants immediately before and after each session. Participation rates were tracked in real time and self-reported at follow-up. Data on burnout and employee perceptions of the program were collected upon completion via a survey and semi-structured interviews. Differences in mood and burnout pre/post program participation were assessed with t-tests.

Results

Participation was high; about 51% of clinic employees (n = 39) participated in any given session, averaging participation in 9/20 sessions. Mood (on a scale of 1 = worst to 5 = best mood) significantly improved from immediately before employees interacted with therapy dogs (M = 2.9) to immediately after (M = 4.5) (p = 0.000). Employees reported significantly lower levels of patient-related burnout (e.g., how much exhaustion at work relates to interaction with patients) after (M = 18.0 vs. before, M = 40.0) participating (p = 0.002). Qualitative findings suggested that employees were highly satisfied with the program, noticed an improved clinic atmosphere, and experienced a reduction in stress and boost in mood.

Conclusions

Establishing an animal-assisted support program for employees in a busy healthcare clinic is feasible and acceptable. Our pilot data suggest that animal-assisted programs could be a means to boost mood and decrease facets of burnout among healthcare employees.

The Psycho-Social Impact of Human-Animal Interactions

When I was asked by the Journal to guest edit a special issue on the psychosocial impact of human-animal interactions, I was honored to accept the invitation [...].