animal intervention research

4th January 2020. Animal-Assisted Interventions Research Review:
An Analysis of Contemporary Research in the Field of Animal-Assisted Approaches and Recovery Models.

1.1 Abstract

This research considers the potential benefits of Animal-Assisted Interventions (AAI) and Animal-Assisted Therapies (AAT), and how they may apply to residential settings. This is a literature review that aims to establish the health benefits that can be gained from regular contact with animals and how they affect recovery outcomes. Current research suggests AAI’s can positively impact on both the physical and mental health of individuals, and the incorporation of regular, structured interaction with animals can have a measurable outcomes for a variety of service users. This research analysis assesses the validity of the current research and if aspects of these studies can be extrapolated and applied to the work undertaken in residential settings.

1.2 Introduction:

This piece of research is a literature review of contemporary studies in Animal-Assisted Interventions (AAI’s) and the benefits of applying these approaches in residential settings. This research has been commissioned by Great Glens Facility.

Great Glens Facility utilises current evidence-based practices and applies contemporary theory in all aspects of work undertaken with service users.

As such this secondary study of relevant research relating to possible outcomes associated with AAI’s serves to demonstrates the theoretical base from which work is undertaken at Great Glens Facility. In this study I will critically evaluate research in this field and apply my findings to the experience I have applying AAI’s, and the feedback presented by residents who actively engage with these approaches at our facility.

It is pertinent at this point to differentiate between Animal Assisted Interventions (AAI) and Animal Assisted Therapy (AAT), as these are two separate approaches that have differing aims with regards to resident outcomes. AAI’s refers to an unstructured approach whereby animals are used to provide a psychological or emotional benefit. This can include goal setting, but it is generally a more unstructured approach to including animals within a therapeutic setting. AAT’s are approaches that deliberately involve animals in a therapeutic treatment plan, with measurable goals. The inclusion of the animal is ‘’designed to accomplish outcomes believed to be difficult to achieve without the animal’’ (Nimer and Lundahi, 2007, pg. 225). This approach involves having specified goals that the clinician aims to achieve by specifically designed therapeutic interactions with the animal. It is also relevant to differentiate at this stage the difference between Visitation animals and Resident animals, as the therapeutic value of both are used in the research I will analyse, and both approaches are utilised at Great Glens Facility. Visitation programmes are most commonly used in AAI’s, and this refers to animals that are brought into clinical or residential settings for both structured and unstructured interaction. Residential programmes involve an animal as a permanent resident in a particular clinical setting. Both approaches have their benefits. Pet visitation approaches are most commonly used, especially among the long-term care facilities, and are especially beneficial in populations where social isolation can be a significant concern, (Johnson et al, 2002).

Great Glens Facility has always advocated for the positive impact that animal interaction can have on an individual’s mental and physical health. The facility has both visitation and residential animals, and applies primarily AAI’s. However it also incorporates structured work with the visitation animal, which is goal focused and incorporated into individual care plans with specified outcomes. The resident animal is a house cat that the home community is encouraged to take ownership of and responsibility for. Residents feed and pet the cat, and it’s welfare is monitored by the residents of the home. The visitation is provided by the inclusion of a dog visiting the facility two to three times a week, which residents can pet, walk and feed.

These interventions are provided in two forms; one is informal contact, whereby residents will interact with the animals intermittently and in an unstructured, ad hoc way. Secondly formal contact with the animals is be structured into residents’ care plans and is an on-going feature of their recovery approaches. This study provides an opportunity to examine if these interventions can have measurable therapeutic outcomes and if some forms of AAI’s are more effective than others. It will look at why this approach can prove beneficial and the importance of these approaches on residents’ perceived quality of life.

1.3 History of Animal-Assisted Interventions:

AAI’s have been used to treating mental and physical conditions from as far back as the 9th century, when animals were used as treatment for disabled individuals, and ‘’rabbits and chickens were used in therapies with mentally ill patients’’ (Morrison, 2007, pg.51). During the 1830’s mental health facilities were recommended to have animals on the premises to provide emotional support and focus for individuals.

As our understanding of mental health conditions improved more advanced, peer-reviewed research into the benefits of AAI’s was expanded to ascertain if and how animal interventions result in therapeutic outcomes. This enabled researchers to analyse if there was a possible positive impact of interacting with animals and how this affected the physical and mental health of individuals. In 1944 the first scientific journal relating to AAI’s was published. This was titled ‘’The Mental Hygiene of Owning a Dog’’ and was published by sociologist James Bossad. The paper discussed the beneficial relationship between pets and their owners and how this improved the quality of life of mentally ill patients. However it was Boris Levinson (1962) who actively promoted the use of therapy animals in clinical settings. Levinson was a child psychologist who incorporated the use of dogs in therapy sessions and used them as ‘co-therapists’. He reported that the interactions between the child patients and the dog served to provide the children with a ‘’sense of security in the therapy setting and quickened the therapy process’’ as the dog represented a ‘’communication link’’ that enable the patients to engage more readily with the intervention, (Barker, 1999, pg. 2). These findings have been supported by numerous research studies since, such as Mason and Hagan (1999), Emmens (2007), Bachi and Parish-Plass, (2016).

Levinson’s findings propelled more studies and researchers began investigating the physical health benefits of animal interaction. The methodology of these studies was more scientific in approach and were initiated primarily in the 1970’s. In 1977 research headed by Dr. Katcher looked at the effects of animal interaction on blood pressure, and concluded contact with animals reduced participants’ blood pressure and anxiety levels. His findings were revolutionary in how clinicians viewed the impact of animal interactions and physical health. The significant findings relating to the reduction of physiological symptoms inspired an acceleration in research studies on the subject, and expanding the scope to the possible impact animals can have on psychological and mental health conditions.

As our understanding of how individuals respond to animal contact, and how effective specific animal-assisted therapies and interventions can be regarding improving physical and mental health conditions, has improved significantly due to the research findings. The studies conducted in the 1970’s, and continuing through to modern scientific approaches, has developed our understanding of how AAI’s can improve an individuals’ quality of life. As a consequence the inclusion of these approaches in residential and clinical settings has expanded rapidly. However the validity of this research needs to be examined to clarify how relevant and effective such approaches can be, and also how these approaches can be applied to achieve the most effective therapeutic outcomes.

1.4 Literature Review:

The positive the impact that animals have on all aspects of well-being has been researched and documented extensively in recent years. Studies indicate that regular contact with animals can improve both physical and mental health, and have the potential to positively impact recovery outcomes. AAI’s entail using animals to provide therapeutic contact, which includes providing comfort, relaxation and easing pain and physical discomfort. The incorporation of AAI’s is a contemporary therapeutic intervention that is increasingly being used in hospitals, residential units and in community settings.

Research in this field has drawn on many different disciplines, such as biology, genetics, developmental psychology, psychoanalytic theory and behaviourism, to name a few. Many studies have demonstrated that some interactions with animals can reduce blood pressure and enable patients in hospital settings to feel more relaxed, (Moretti et al, 2010, Wisdom et al, 2009). This contact promotes the release of endorphins (such as serotonine) and hormones, (such as Phenylethylamine). Combined this results in individuals feeling more positive, relaxed and less anxious, (Doherty, 2018). Although direct contact with animals appears to have health advantages it seems ‘’the mere presence of a companion animal can also offer short-term health benefits, helping to lower autonomic responses to conditions of moderate stress’’ (Wells, 2009). Research continues to show transient reductions in heart rate and/or blood pressure in patients exposed to a wide array of stressors while in the presence of an animal, (Beck 1986, Wells 2009), and can take effect is as little as five minutes after human-animal contact, (Barker and Wolen, 2008). Studies indicate that petting a dog with which the patient had a bond with, resulted in a decrease in blood pressure (Baun et al, 1984, Cole et al, 2007). These results have been found to be related to each individual’s perception of animals, and the closer the bond with the animal the more significant the physiological response. This suggests a physiological and psychological interface. The indication being that therapeutic interactions can be achieved without the use of specified goals or therapy based interactions, (Wells et al , 1997). Paradigm changing research undertaken in the 1980’s highlighted how the central nervous system (CNS) was traditionally viewed as an isolated, physiological construct, and emotional and psychological aspects of human experience separate. However Blalock and Smith (1981) and Livnat et al (1985) demonstrated that endorphins are produced by the immune system, as well as by the CNS, and that lymphocytes (white blood cells) contain receptors for neurotransmitters. The conclusion being that anatomical and biochemical connections create a physiological expression. Odendaal (1999) further expanded this research and was able to demonstrate that both humans and dogs experienced beneficial neurochemical changes in beta endorphins, dopamine and oxytocin (amongst others), after as little as fifteen minutes interaction. This indicates that physiological experiences promote psychological reactions when individuals interact with animals.

It was in 1990 that a significant piece of research undertaken by Friedmann measured and documented blood pressure reduction and one-year survival rates, which he found positively correlated to animal ownership among patients discharged from a coronary care unit. This finding was subsequently replicated on a much larger scale by Friedmann and Thomas in 1995. These profound findings ignited a substantial increase in research as the connection between physical health and emotional well-being continued to be seemingly reinforced by positive animal contact. The reduction in stress experienced by animal owners was also observed. The findings of Herrald et al’s 2002 study also found that cardiac patients were significantly more likely to complete rehabilitation if they owned an animal than those that did not. Pets, in particular dogs, appear to buffer individuals from the impact of stressful life events, (Siegel, 1990). This is considered to be in part due to the physiological impact of animal interactions on health and the increased social interaction animal ownership offers. Dog ownership is especially good at creating opportunities for social interaction. ‘’Dogs serve as social catalysts, presenting opportunities to meet others while out walking’’ and can ‘’reduce feelings of loneliness’’, (knight and Edwards, 2008 pg. 438). In many elderly and psychiatric settings social isolation, and associated feelings of loneliness, are common.

Research undertaken in 1986 by Garrity et al. found the bond with animals was related to a decrease in depression among older adults. This finding has been repeatedly replicated with Morretti at al (2010) observing that AAI’s improve depressive symptoms in residents in long-term care facilities. Improvements in other physiological expressions of mental health conditions have also been recorded. Barker and Dawson (1998) used a controlled design to compare patients’ anxiety levels following AAT activities and general Therapeutic Recreation (TR) activities. The results showed a significant decrease in anxiety levels following AAT for individuals with mood and psychotic disorders. In fact the reduction in anxiety observed following AAT was twice as great as recorded following TR. This may be because AAT’s are considered less threatening than traditional group activities, as well as having a direct impact on physiological responses to stress. Further research suggests the use of AAI’s in psychiatric settings reduce fear and anxiety (Barker et al. 2003), increase attendance to occupational therapies (Holcomb and Meacham 1989) and result in more positive social behaviours (Marr et al. 2000). Francis et al. (1985) found improvements in social interaction, life satisfaction, mental function, depression and psychological well-being in patients residing in a home receiving six weekly puppy visits. Increased positive socialisation was also recorded in Alzheimer’s populations when a dog was used in for AAI’s, (Batson at al. 1995).

Research into the effects of animal interaction on people with severe mental illness is more limited and tends to be hospital based. However there was a detailed and robust study conducted by Stern et al (2013), which addressed the impact that animal ownership can have on the well-being of individuals with the diagnosis of Post-Traumatic Stress Disorder (PTSD). This study looked at the possible benefits of canine interaction on psychological well-being. This research was comprehensive and included the participants documenting the effect of animals on ‘’reducing feelings of loneliness, depression, worry and irritability, and increased feelings of calmness’’ (Brooks et al, 2018). Participants rated their experience of how animals responded and reported feeling that animals respond in an intuitive way, especially in times of crisis or periods of increased symptoms. These findings were replicated in similar, although less comprehensive studies, (White, 2014, Wells 2009, Ford 2012). Stern et al’s (2013) qualitative research specifically addressed how individuals with PTSD responded to animal companionship. This study demonstrated that participants with PTSD did not report feeling less affected by their flashbacks, but indicated that the companionship of an animal lessened the negative impact of these experiences. Although there is no indication that AAI’s can improve any manifestation of psychotic symptomology the findings indicate that the reduction in stress and anxiety related to symptoms experiences can improve an individual’s overall quality of life. Participants reported that canines try to cheer them up, especially when they were experiencing more symptoms. The sentiment of not feeling judged by the animal, and the canine encouraging owners to stay in the present and detract them from ruminations about past incidents were reported by participants.

A comprehensive study of the impact of AAT on loneliness in three long-term care facilities carried out by Banks and Banks (2002) looked at the impact of dog visitation on isolation in socially-limited residents. This was a controlled study that compared findings from several care units with differing levels of resident social interaction, and evaluated the data. There was a significant improvement in loneliness scores for dog visitation to control groups in all three settings. However there was no significant improvement between the groups of residents having more frequent visits from the dog. This is a finding that has been replicated by other studies and suggests ‘’one weekly visit from the animal was satisfactory for improved loneliness scores’’ (Morrison, 2007). This finding highlights both the lasting benefits of animal interaction on sustaining people’s improved sense of inclusion, and the need to understand how AAI’s are effective. The conclusion being if the Human-animal interaction is positive the decrease in reported levels of loneliness will be sustained for longer, but further investigation into how we can ensure AAI’s are as effective as possible needs to take place.

In relation to pet ownership in particular the improvement in social development documented in these studies seems to enable pet owners to more successfully integrate into society. Moreover social integration is linked to individuals feeling connected to their community and their citizenship (Zimolag and Krupa, 2009). In addition to this pet owners also reported benefitting from the physical health aspect associated with pet-orientated activities, most notably dog walking. Exercise increases the production of endorphins and impacts immeasurably on all facets of health. Dog walking results in ‘’social rewards in terms of meeting other dog walkers, making friends and providing a conversation point’’ (Knight and Edwards, 2008), as well as fulfilling a sense of purpose and being a motivating factor in individuals exercising. In a qualitative Study conducted by Bradley and Bennett (2015), participants’ feedback indicates that this sense of purpose pet care provides gave more meaning to their lives, which was considered by the participates to have diminished following their diagnosis with a mental health condition. Participant feedback emphasised that the responsibility of pet ownership had helped them overcome this. This sense of purpose was viewed as contributing to a sense of control over their lives and feelings of empowerment, and was considered particularly therapeutic when individuals felt ‘’consumed by their illness or when self-management felt out of control’’ (Brooks et al. 2018). Participants reported that having animals around enabled them to be motivated to undertake activities, such as walking, which they otherwise would not feel compelled to do, (Zimolag and Krupa, 2010).

A study by Hunt and Stein (2007) discovered that participants found their animals directly contributed to maintaining a consistent sense of self and identity. Furthermore animals offer a form of validation through pride associated with successfully caring for a pet, (Pehle, 2010) and sustaining pre-illness identities (White, 2014). Incorporated in these findings is the cultural connotations of taking care of an animal and how people with mental health conditions were perceived by others. Animal care is ‘’considered a culturally sanctioned meaningful occupational and social role’’ (Brooks et al. 2018), and this finding was supported by other studies, (Zimolag and Krupa 2010, Stern et al, 2013). These studies highlight the impact animals have in counter-balancing a loss of social status as a result of being diagnosed with a mental health condition. Animals impacted on the management of negative perceptions and experiences related to have a mental illness (Pehle 2010, White 2014, Wells, 2009), and the non-judgmental acceptance offered by animals made owners feel valued (Zimolag and Krupa 2009) and encouraged owners to feel good about themselves (Stern et al. 2013).

As suggested above the majority of studies into the effects of animal interaction has centred around pet ownership and how the connection to pets, and the responsibility of ownership, impacts on health. As cited earlier there are many studies that have explored the impact of pet ownership on loneliness and isolation (Barker and Wolen, 2008), but others have expanded this research field to explore a more holistically how owning pets can impact on an individual’s health. Due to the nature of pet ownership, especially that of dogs, there is a social element that impacts on physical and psychological well-being. ‘’Pets have the capacity to influence social networks with people with mental illness’’ who tend to have ‘’social networks that are considered to be smaller…and less complex than those of the general population’’ (Zimolag and Krupa, 2009). Pet ownership, therefore, has the potential to expand the social network considerably for people with mental health conditions. In addition to this a study by De Souza (2000) observed people with mental illness living in the community and collected qualitative reports of their experience living with mental health conditions. The feedback highlighted increased levels of loneliness and separation from the wider community that people with mental illness often experience. Participants reported feeling isolated and rejected by society. De Souza found these participants drew on the social and emotional support their pets provide, which significantly improved their perception of their quality of life. Pets offer the opportunity to ‘’care for ‘someone’ without the complexities of human relationship dynamics’’ (De Souza, 2000). The study concluded that the emotional benefits of feeling needed and having a purpose were motivational for people with mental illness. Pets enabled individuals to ‘’exercise control, feel that they mattered and could make a difference to another living thing’’ and consequently these feelings of responsibility and agency ‘’strengthened feelings of self-esteem and self-efficiency’’ (Wisdom et al. 2009). This study was qualitative in design and relied on participants self-reporting their experience of pet ownership. This subjective approach has its limitations, but the findings of this study were significant. Furthermore interaction with pets has been statistically proven to contribute to a sense of self, and the development of empathy and morality (Ascione 2005, Melson 2001). Qualitative data also suggests that the sense of purpose pets provide contribute to a sense of empowerment (White 2014) and gives individuals hope for the future (Wells 2009, Wisdom et al. 2009).

Developing these findings further it has been theorised that due to the ‘’unique, intrinsic attributes of animals’’, specifically that they are non-judgmental (Wells 2009) can ‘’affect positive changes in patients self-concept and behaviour through patient’s acquisition of various skills and acceptance of personal agency and responsibility’’ (Kruger and Serpell, 2010). The development of social skills may result from the ability animals have to help learn about appropriate interactions, and the cause and effect of an individual’s behaviour. Animals are ‘’uniquely helpful in providing feedback on social behaviour due to their unambiguous, ‘honest’ and immediate responses’’ (Kruger and Serpell, 2010). Moreover studies of animal visitation approaches have also recorded significant, measureable improvements in interactions between patients, improved self-esteem and that they create an effective distraction from symptoms and mental distress (Bardill, 1997), and this resulted in improvements in perceived quality of life, (Salmon and Salmon, 1982).

Beck et al. (1986) carried out a study involving psychiatric patients, which assessed the impact of having caged birds present. This was a controlled study, and the findings noted a significant improvement in how relaxed and comfortable patients were in the room with birds, and these individuals participated more in therapeutic activities offered. This may be due to decreased anxiety levels resulting in an increase in willingness to engage with tasks on the ward. Analysis indicates patients in psychiatric communities ‘’become less withdrawn’’, and become ‘’more engaged’’ with psychological interventions when animals are present. In a later study Beck (2000) replicated these findings and noted that the most significant increase in participation of therapeutic interactions took place when the AAI was canine assisted. The improvement in social interaction may be related to the move away form the need for complex language as a primary form of communication towards ‘’non-linguistic social behaviour’’, which is able to more clearly ‘’structure social actions’’ (Soloman, 2010). Soloman therefore suggests that sociality is ‘’not a quality of an individual but a capacity realised through certain kinds of social interaction’’ (2010), and his findings suggest that canine facilitated interactions may open the possibility of fulfilling this capacity for people who struggle with more traditional forms of communication.

A broad summary of this research analysis suggests that owning pets and/or having regular contact with companionable animals has a generally positive impact on the perceived quality of life for people with mental health conditions. As the above analysis indicates the factors that contribute to this are multifactorial and are inextricably linked. The physical and psychological, as well as the social benefits associated with human-animal interactions are many and symbiotic. The results recorded in these studies demonstrate how animal interactions improve physical health, with the mere presence of animals of animals improving physiological responses (Wells, 2009) as well as psychological well-being (Beck 2006). This improved well-being stems from a myriad of interconnecting psychological, social, emotional and cognitive interfaces that are ‘’all influenced by and affect each other and are self-perpetuating’’, and Knight and Edwards provide the following example; an example; ‘’walking enhances physical fitness and that in turn can increase a persons’ self-respect and self-esteem’’ (2010) and this in turn releases endorphins and improving mood.

1.5 Future Research:

Analysis of the current research in this field has been increasingly nuanced and has developed our understanding of how human-animal relationships can be mutually beneficial. However this is a relatively new area of research and more work still needs to be done in specific aspects of AAI. For instance there is a lack of studies comparing the use of different animals, and also analysis into how attitudes towards the animals used impacts on the findings. It has been noted that the stronger the connection to the animal the more significant the outcome (Baun et al, 2984), but the extent of this affect has yet to be fully explored. In addition to this the majority of studies focus on the use of canine interventions, as the positive relationship with humans and dogs has been historical and well documented (Soloman, 2010). A wider animal base for studies would be useful, and analysis how species that interact differently with people may impact on other aspects of health and well-being needs to be explored. Most studies have focused on short-term visitation to mental health or elderly facilities, but there is little research on the long-term use of visitation animals, and how this consistency impacts on the bonds developed by individuals with a specific animal.

Research indicates a strong and clear connection between positive human-animal interaction and the therapeutic benefits achieved. Following on from this observation further exploration into the degree to which companion animals are part of a social network for people with mental health conditions needs to be expanded, as this seems to be central to long-term recovery approaches, (Zimolag and Krupa, 2009). In relation to visitation animals more research into the quality of the interactions with animals needs to be undertaken. Currently studies have assumed all interactions are of equal merit, and further consideration into how animals are integrated into long-term rehabilitation programs needs to be evaluated. More research into animal temperament is also required, as current research does not examine what the most beneficial characteristics of animals used are and how this affects the outcomes of AAI’s. It seems reasonable to postulate that the inherent nature of an animal will have an impact on the outcomes recorded. There seems to be an assumption, with canines in particular, that they all present similarly and most research does not take into account the nature of the animal. It seems fair to hypothesize that animals that are companionable, intuitive to the participants’ moods and responses and affectionate would be more suited to visitation and have more significant outcomes. Again this needs further exploration and this concept has not been central to any of the research analysed, and is only occasionally considered briefly without any further analysis or reflection on the research results.

The studies available also seem not to take into account ‘’the potential influence of the differences in demographic characteristics of human subjects (e.g. differences in education, ethnicity)’’ (Cherniack and Cherniack, 2014). It is reasonable to suggest that such factors can potentially have a large impact on the beneficial outcomes of AAI’s. In addition to this observation O’Haire (2010) noted the need for research to include analysis of what populations benefit most from different types of interventions. As dogs are culturally popular in Britain, and are seen as ‘mans best friend’, most research has focused on human-canine interventions. AAI’s for other cultures may require different species to be incorporated into the studies to achieve the same results.

More research on visitation animals is also required, as most AAI and AAT studies focus on pet ownership. In addition to this the pets owned are almost always dogs. The therapeutic value of ownership of other animals would be helpful. Further studies into the effects of sustained animal visitation, with the consistent use of one animal over a prolonged period of time, is also a necessity as there are no current studies that assess the outcomes of this approach.

2.1 Applications are Great Glens Facility:

Great Glens Facility applies AAI’s in the form of both animal visitation and pet ownership. Residents are encouraged to take responsibility for the house cat and take ownership for caring for the animal. A visitation dog also comes to the facility several times a week and provides both informal AAI’s and more structured AAT’s.

As discussed in the literature review research focused on pet ownership that goes beyond studying canine companions is limited. However findings relating to individuals having a sense of purpose (Zimolag and Krupa, 2009) and having a distraction from symptoms (Stern et al. 2013, White 2014, Ford 2012), as well as develop a stronger sense of agency and improved self-esteem (Soloman 2010, Wisdon et al. 2010) still apply. Residents that take responsibility for the house cat report liking the opportunity for responsibility that it affords them, and the enjoyment of petting the animal. As contact with animals can have an almost immediate physiological impact (Beck 1984) and longer-term psychological benefits (Kruger and Serpell, 2010, Johnson et al. 2002) the house cat serves a purpose of improving residents’ quality of life.

The visitation dog is brought to the facility several times a week and some residents interact in an informal way, initiating stroking and petting the dog, and feeding her ‘treats’. This less structured interaction is useful for individuals who’s symptoms can fluctuate and where increased levels of responsibility would not be appropriate. It has been documented that individuals with a diagnosis of schizophrenia, which is linked to ‘’greater impairment of social and occupational functioning’’ (Zimolag and Krupa, 2009) can gain more benefits from these less structured AAI’s, (Samson et al. 1998). There are numerous factors that prevent pet ownership for many people with serious mental illness and for such individuals AAI’s in the form of regular visitation is a more suitable approach to achieving the positive outcomes associated with animal interaction, (Corrigan and Watson, 2002).
AAI’s are usually considered to be relatively unstructured, the benefit being achieved from the contact with the animal and the companionship they offer. Salmon and Salmon (1982) found the presence of a dog in a residential setting resulted in ‘’happier, more alert and more responsive residents’’. In the respect of AAT’s a more structured approach can benefit residents by motivating them to be more active and more engaged in support programs. At Great Glens Facility activities with the visitation dog is incorporated into some of the residents’ care programs, as there are specific therapeutic outcomes these interactions aim to achieve. The use of AAT’s is only suitable to some residents due to their mental health condition and the ability to engage in regular, structured activities.

Studies indicate that people coming into the care setting who are accompanied by animals have a positive impact on residents’ perception of their friendliness and approachability. Residents perceive visitors, professionals and resident’s relatives, with animals as ‘’facilitating a sense of domesticity’’ (Savishinsky, 1992), which resulted in reduced tension, confusion, depression and fatigue, (Crowley et al. 1996). The visitation dog used at Great Glens Facility is handled by the clinical lead professional for the unit, and interactions with residents are planned so the residents involved understand how and when the AAT will take place each week. Research suggests the most effective AAT’s, which are more goal directed, should be delivered by a ‘’service professional with specialised expertise, and within the scope of his/her profession’’ to achieve the most effective outcomes, (Kruger and Serspell, 2010). This is so the professional can apply their knowledge to provide as many ‘’opportunities for motivational, educational, recreational and/or therapeutic benefits to enhance quality of life’’, (Kruger and Serpell, 2010).

The use of pet ownership, informal AAI’s and more structured AAT’s at Great Glens Facility has had positive outcomes for residents. Residents that are involved in these various forms of AAI’s were asked for feedback on how these interventions impacted on their quality of life and how they felt about the contact they have with the animals. It was explained to the residents what this piece of research entailed and where it would be made available for others to read. The residents were informed that their feedback would be anonymous and confidential, to enable them to speak freely about their experiences with the animals.

The residents taking ownership of the house cat were asked for their feedback on this experience. Research suggests that resident animals enable a sense of focus and responsibility for individuals, and a sense of homeliness sometimes lacking in residential settings. The following are comments from residents that take a key role in taking responsibility of the cat and that have the most contact with the animal:

‘’I talk to her about my problems…when I’m stroking her I feel better’

‘’I like feeding her and giving her treats, I like the purpose in life…it keeps me going’’

‘’She makes me feel a bit better, especially first thing in the morning…she cheers me up’’

‘’Keeping her well makes me feel better’’

The residents that take a lead role in the caring of the house cat reported having a sense of purpose and a distraction from their ruminations and symptoms, as well as benefitting from the responsibility for maintaining the cat’s health. In addition one service user also mentioned the therapeutic value of petting the cat and being able to openly talk to the animal when experiencing symptoms of their mental illness. The feedback received from service users reflects that found in the qualitative studies reviewed, and reinforces the findings of current empirical research.

Residents that participate in AAI’s in the form of regular, but unstructured contact with the visitation dog reported the impact that having a companion that they have developed a bond with over the past eight years has had and how these interactions influence their experience living at Great Glens Facility:

‘’I feel happy when I see her’’

‘’Whenever I stoke her it makes me feel well again’’

Furthermore, as reflected in the research analysis, having this contact with the visitation dog reminded residents of positive aspects of their pre-morbid lives:

‘’She reminds me of my old dog…she lifts my spirits’’

This feedback highlights both the physical and psychological benefits that having regular contact with the dog has on their perceived quality of life. There was also reference to the development of relationships with the animal, and how this has changed over time and the bond between the resident and animal had grown over the years. Initially one individual was nervous around the animal, but now states he feels safer when the dog is nearby. As noted in the research findings the temperament of the animal, and how individuals view the animal, will impact on the outcomes achieved. However this feedback indicates that regular, sustained contact with an animal can change a persons’ initial perception of animals and have a positive impact in their lives. This development of a therapeutic bond over time is an aspect of AAI’s usually associated with per ownership, but the longevity of our approach and sustained interaction with one animal seems to have impacted on the outcomes achieved:

‘’Before I was a little scared of dogs, but now I am not scared…She is lovely with her nature with people’’

‘’If she didn’t come in she’d be missed…I look forward to her visiting’’

Other residents have more structured contact with the visitation dog and activities, such as walking her, are incorporated into their care programs. These activities create a sense of familiarity and structure that people with mental illness often find difficult to establish without support. Residents who walk and interact with the dog in this way, as part of their recovery approach, stated:

‘’I look forward to going out with her…I like throwing things for her to chase’’

‘’It’s a treat to see her and get out with her. She has a placid temperament’’

‘’Watching her run in the park makes me feel good. She’s therapeutic’’

‘’I get a lot of satisfaction out of seeing her, she’s part of the team’’

The overall feedback from the residents who interact with the visitation dog was positive. It is the role of the handler and professional to be aware of which service users will benefit from these interactions and which approaches to utilise with individuals for the most effective outcomes. Those that have more structured interaction with the dog viewed her as having a therapeutic impact on their lives and considered her to be central to how their support is provided. She was viewed by one resident as an extension of the team that supports him at Great Glens Facility. This feedback reflects the research findings in relation to the effectiveness of structured therapy activities, and how this encourages residents to engage in activity outside the facility.

As new residents commence placements at the facility they are given the opportunity to engage with these approaches and assessments to their suitability are made by the clinical lead.

2.2 Conclusion

After reviewing the current data and assessing the validity of the research methodology, the studies available indicate a significant therapeutic value of animal intervention, both for improving physical and psychological health conditions. The research strongly indicates that individuals with mental health conditions benefit from contact with animals, that is suited to their level of functioning and experience of their environment. Most studies focused on pet ownership, although this is used less frequently in residential settings, and the pets used were almost exclusively canines. However the findings indicate that the benefits of regular contact with animals are multifactorial and the physical and psychological improvements are inextricably linked. Therefore it is difficult to assess the impact that AAI’s have on one aspect of health alone, as the positive affects documented reflects an interconnection between physical and mental well-being that is difficult to unpick. However the results of the research reviewed in this secondary study, and the feedback from residents that engage in these interventions at Great Glens Facility, seem to support each other. The direct physical affects of using pet ownership, AAI’s and AAT’s at the facility are difficult to assess, and was not relevant to this study. As Great Glens Facility is a mental health unit and the aim of this research was to further understand the positive impact these approaches have had for our residents by confirming the validity of our experience as reflected in other aspects of health care and research.

Although there is much still to learn about exactly how AAI’s inform the positive results achieved, the sense that these approaches have a significant impact on residents’ perceived quality of life has been reaffirming. The validity of the differing approaches (Pet ownership, AAI’s and AAT’s) and when each one is deemed most appropriate still requires further consideration to fully understand how animal interaction specifically benefits individuals. Research to address the imbalance in animals used in these studies, and develop a greater understanding of the psychological benefits is also required. The research indicates AAI’s positively impact on mental and physical health, but focuses on pet ownership. More research needs to be undertaken to assess how these benefits also apply to people that have frequent contact with animals, even if they are not the animal’s owner. Some of the findings from pet ownership studies can be extrapolated to reflect AAI’s generally based on the methodology of these studies, but specific research needs to be initiated to better our understanding of the complex interfaces that occur with animal interaction.

Great Glens Facility is proud to utilise all three approaches to varying degrees with measurable success. Resident feedback is useful and indicates that these approaches have a positive impact on their perception of their quality of life at the home. Great Glens Facility will continue to apply evidenced-based approaches in all aspects of the service we provide to residents.

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About the author

Research has been conducted by Nesta Chambers BSc Social Worker and Registered Manager for Great Glens. Nesta works closely alongside Service Users and Staff and is always looking to implement evidence-based practice. To this end she has undertaken two pieces of research - one focusing on the impact of animals in care. the second piece looks at how getting staff to work reflectively improves the lives of the people they are caring for.