Date Published: January 17, 2019
Publisher: Public Library of Science
Author(s): Melanie G. Jones, Simon M. Rice, Susan M. Cotton, Roxanna Morote Rios.
As interest in Animal-Assisted Interventions (AAI) grows, there is increasing need to differentiate informal activities from formal and professionally directed therapies, including mental health focussed Canine-Assisted Psychotherapy (CAP). There have been no reviews focusing exclusively on CAP and the distinct developmental period of adolescence. The aims of this study were to identify the characteristics of CAP interventions, their impacts and their acceptability, tolerability and feasibility for adolescents with mental health disorders.
A systematic review identified studies incorporating canines into mental health treatments for adolescents aged 10–19 years. Studies reporting qualitative or quantitative psychological or psychosocial outcomes were included.
Seven studies were scrutinised. Intervention characteristics varied, including a range of formats, settings, locations, doses, and facilitators. Information on the role of the canines in sessions was sparse. CAP had a positive impact on primary diagnoses and symptomatology, conferring additional benefits to standard treatments for internalising disorders, post-traumatic stress disorder, and equivalent effects for anxiety, anger and externalising disorders. CAP was associated with positive impacts on secondary factors including increased engagement and socialisation behaviours, and reductions in disruptive behaviours within treatment sessions. Global functioning also improved. There was insufficient evidence that CAP improved factors associated with self-esteem, subjective wellbeing, or coping. Good attendance and retention rates indicated high levels of acceptability. Moderate to high tolerability was also indicated. Feasibility may be limited by additional training and logistical requirements.
We recommend the development of theoretically informed, standardised (manualised) intervention protocols that may subsequently form the basis of efficacy and effectiveness testing. Such protocols should clearly describe canine-participant-facilitator interactions via a formalised nomenclature; spontaneous (animal-led), adjunctive (facilitator-led), and experiential (participant-led).
There is emerging evidence to suggest that CAP improves the efficacy of mental health treatments in self-selected adolescent populations via reductions in primary symptomatology, and via secondary factors that improve therapeutic processes and quality, such as engagement and retention.
A total of 3985 studies were identified for initial screening via database searching. After exclusions (see Fig 1), 88 studies were selected for full-text screening, including 3 studies identified via hand searching of reference lists. Seven studies met the inclusion criteria and were included in the final analysis. These seven studies examine a range of presenting issues, including mood, anxiety, trauma, anger and disruptive behaviour, self-concept, adaptive functioning and global functioning, and clinical severity of serious psychiatric illness. A range of assessment tools were used by the authors, including therapist report, youth self-report, observation and qualitative thematic analyses. Given the heterogeneity of the methodologies, assessment tools and presenting issues, meta-analysis was not feasible.
This review was the first attempt to synthesise the CAP literature, using clear definitions to delineate goal-focussed mental health treatments from informal activities that did not contain any psychotherapeutic theories or techniques. This review was also the first systematic review of AAT for participants in the distinct developmental period of adolescence. The characteristics of CAP interventions were explored, including the nature of interactions between participants, facilitators and canines in an attempt to determine the specific components of importance. The impact of CAP on primary mental health symptomatology was reviewed and distinguished from secondary factors associated with improved therapeutic processes and participant wellbeing. This resulted in a more comprehensive exploration than previous reviews on AAIs. Acceptability, tolerability and feasibility were also examined. These factors have not successfully been explored previously in the CAP literature.
There is evidence to suggest that CAP may improve the efficacy of mental health treatments in self-selected adolescent populations via reductions in primary symptomatology including PTSD and internalising symptoms, and the severity of serious psychiatric disorders. CAP may also confer additional benefits via secondary factors that improve therapeutic processes and quality, such as attendance and retention, positive socialisation, and feelings of connection.