Design and challenges for a randomized, multi-site clinical trial comparing the use of service dogs and emotional support dogs in Veterans with post-traumatic stress disorder (PTSD)

Saunders, Gabrielle H.; Biswas, Kousick; Serpi, Tracey; McGovern, Stephanie; Groer, Shirley; Stock, Eileen M.; Magruder, Kathryn M.; Storzbach, Daniel; Skelton, Kelly; Abrams, Thad E.; McCranie, Mark; Richerson, Joan T.; Dorn, Patricia A.; Huang, Grant D.; Fallon, Michael T.

doi:10.1016/j.cct.2017.08.017

Cited by 14 publications

(8 citation statements)

References 18 publications

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“…In both arms of the VA study it is a prerequisite that eligible individuals desire a dog. There are practical reasons why this critical inclusion criterion is important: Not every veteran desires or is suitable for a service animal (Saunders et al, 2017). On this point, we have previously reported that service dog ownership comes with challenges, including emotionally and physically demanding training sessions, potentially unwanted public attention, burdens and costs of owning a dog, and delayed benefits while veterans become accustomed to their service dogs and learn to optimize their use (Yarborough, Stumbo, Yarborough, Owen-Smith, & Green, 2018).…”

Section: Potential Self-selection Biasmentioning

confidence: 99%

“…In this commentary, we discuss remaining challenges and important next steps to more definitively determine the efficacy of service dogs for managing PTSD symptoms and improving quality of life. Some challenges-the lack of availability of trained animals, the lack of standardized dog-training procedures, and the cost of training service animals-have been reported elsewhere (Krause-Parello, Sarni, & Padden, 2016;Saunders et al, 2017). However, some additional unique challenges, briefly described in O' Haire and Rodriguez (2018), deserve further enumeration.…”

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confidence: 99%

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Preliminary evidence is promising, but challenges remain in providing service dogs to veterans: Commentary on preliminary efficacy of service dogs as a complementary treatment for posttraumatic stress disorder in military members and veterans (O’Haire & Rodriguez, 2018).

Stumbo

Yarborough

2019

Journal of Consulting and Clinical Psychology

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Objective: Veterans with posttraumatic stress disorder (PTSD) are interested in service dogs to manage or reduce symptoms. Until recently, evidence was anecdotal with few research studies documenting the feasibility or benefits of service dogs for veterans. In the past year, new studies have presented preliminary evidence on the benefits of service dogs. Method: Comment on O' Haire and Rodriguez (2018). Results: Positive findings presented in O' Haire andRodriguez (2018) andYarborough et al. (2017) included reduced self-reported PTSD symptoms, decreased depression symptoms, improvements in relationships, and increased activity levels. In addition to the benefits, Yarborough, Stumbo, Yarborough, Owen-Smith, and Green (2018) described challenges that veterans had not expected, including the demands of long, intensive training sessions required to receive a service animal, and an increase in unwanted public attention. In light of this preliminary evidence, a critical appraisal and identification of next steps for future research are in order. In this commentary we argue that rigorous randomized controlled trials comparing veterans who receive service dogs with those who do not are due. Such trials should account for self-selection bias and some veterans' overly optimistic expectations for service dogs, both of which have not previously been controlled for in non-randomized studies to date and may present a challenge to trial validity. We also argue that future research needs an adequate long-term follow-up evaluation period and should investigate the specific mechanisms of action at work (i.e. how do service dogs improve PTSD symptoms and quality of life). Conclusions: Additional trials are needed to establish the efficacy of service dogs for veterans with PTSD. What is the public health significance of this article?Evidence from nonrandomized observational studies suggest that service dogs may be helpful in alleviating veterans' posttraumatic stress disorder (PTSD) symptoms and improving quality of life. Randomized trials are needed to determine the initial and enduring effectiveness of service dogs as an intervention to manage PTSD.

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Section: Potential Self-selection Biasmentioning

confidence: 99%

mentioning

confidence: 99%

Preliminary evidence is promising, but challenges remain in providing service dogs to veterans: Commentary on preliminary efficacy of service dogs as a complementary treatment for posttraumatic stress disorder in military members and veterans (O’Haire & Rodriguez, 2018).

Stumbo

Yarborough

2019

Journal of Consulting and Clinical Psychology

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“…Various forms of animal-assisted intervention or therapy represent another extreme form of HCAP with the aim to provide specific physical and mental assistance for children and adult humans in need (e.g. Martin and Farnum 2002;Moretti et al 2011;O'Haire 2013;Saunders et al 2017). This kind of interaction also relies in evoking components of the caring behaviour in humans supported by the high level of social competence displayed by the involved individual animals.…”

Section: Partnership As a Continuummentioning

confidence: 99%

Searching where the treasure is: on the emergence of human companion animal partnership (HCAP)

2021

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In our view, the discipline, often referred to as human–animal interaction (HAI), lacks a well-defined conceptual framework. It is too narrow both with respect to the animal species investigated and the nature of human–animal interactions studied. So instead, we introduce the term human–companion animal partnership (HCAP) that is not only a better descriptor for most research efforts within HAI but also helps to direct research efforts on an ethological basis. In our approach, ‘companion’ is a function and not a feature of some species. This means that many species had and could have a potential to form mixed social groups with humans if they evolve some capacity of social competence. This view may initiate new comparative research involving a range of species to find out how complex social engagement could be maintained in such hetero-specific social groups based on evolutionary heritage, recent selection and individual experience (socialisation). Our approach emphasises the role of human caring behaviour and social competence in the emergence of a partnership with several species, and thus could also help in setting expectations for welfare and aid in designing artificial companions for specific purposes.

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“…A major challenge facing research in this area is the fact that the standard “intervention” in this domain involves long-term companionship promoting the development of a human–animal bond. Such an intervention is difficult to study using conventional controls such as random assignment (Saunders et al, 2017) with the result that this literature, while showing positive impacts of varied service-dog-assisted interventions on PTSD (O’Haire et al, 2015; O’Haire & Rodriguez, 2018; Whitworth et al, 2019; Yarborough et al, 2017), has relied largely on uncontrolled observational studies (van Houtert et al, 2018). Reinforcing the need for stronger controls is the finding in 35,000 Swedish twin pairs that dog ownership is heritable (Fall et al, 2019) to a degree comparable to personality traits such as neuroticism (Jang et al, 1996).…”

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confidence: 99%

Tracking positive and negative affect in PTSD inpatients during a service dog intervention.

Woodward

Jamison

Gala

et al. 2021

Journal of Consulting and Clinical Psychology

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Though popular across many audiences, engagement with a service dog has undergone limited empirical evaluation as a complementary or alternative treatment for posttraumatic stress disorder (PTSD). The present study took advantage of a service dog training intervention underway in a Department of Veterans Affairs residential PTSD treatment program to perform a within-subjects comparison of a range of phenotypic markers. The present report considers negative and positive affect, assessed throughout the day, contrasting weeks when participants were or were not accompanied by their service dog. Fifty-four veterans were studied for 2-6 weeks. Negative and positive affect were sampled five times per day using items from the Positive and Negative Affect Schedule. Participants also wore a single-patch ECG/activity recorder and slept on beds recording sleep actigraphically. Linear mixed effects regression was employed to estimate the effect of the presence of service dog on momentary affect in the context of other presumable influences. Missing data were managed using methods applicable to random and nonrandom missingness. In this sample, the presence of a service dog was associated with reduced negative and increased positive affect, with both effects diminishing over time. Only negative affect was associated with time in residential treatment, and only positive affect was associated with concurrent heart rate, activity, and the interaction of activity and prior-night actigraphic sleep efficiency. These results concur with prior reports of reduced PTSD symptomology in association with the presence of a service dog, and with the distinct neurocircuitries underlying defensive and appetitive emotion and motivation. Limitations derive from the artificial environment and brief duration of study.What is the public health significance of this article? Veterans undergoing inpatient treatment for PTSD reported reduced negative affect and increased positive affect when in the company of a familiar service-dog-in-training. These effects were consistent with modest augmentation of treatment, at least in the short term.

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Design and challenges for a randomized, multi-site clinical trial comparing the use of service dogs and emotional support dogs in Veterans with post-traumatic stress disorder (PTSD)

Cited by 14 publications

References 18 publications

Preliminary evidence is promising, but challenges remain in providing service dogs to veterans: Commentary on preliminary efficacy of service dogs as a complementary treatment for posttraumatic stress disorder in military members and veterans (O’Haire & Rodriguez, 2018).

Preliminary evidence is promising, but challenges remain in providing service dogs to veterans: Commentary on preliminary efficacy of service dogs as a complementary treatment for posttraumatic stress disorder in military members and veterans (O’Haire & Rodriguez, 2018).

Searching where the treasure is: on the emergence of human companion animal partnership (HCAP)

Tracking positive and negative affect in PTSD inpatients during a service dog intervention.

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