Animals as Icebreakers: A Pilot Animal-Assisted Therapy Group for
Veterans with Serious Mental Illness
Megan M. Pollock, Ph.D., Rebecca E. Williams, Ph.D., & Sonya M. Gomez, M.S., CRCCitation:
Veteran Affairs (VA) San Diego Healthcare System
MM, Williams RE & Gomez SM (2017) Animals as
Icebreakers: A Pilot Animal-Assisted Therapy Group for
Veteranswith Serious Mental Illness International Journal of Psychosocial Rehabilitation. Vol 21 (1) 123-135
Megan M. Pollock, Ph.D., Licensed Clinical Psychologist
E. Williams, Ph.D., Licensed Clinical Psychologist, Associate Clinical
Professor at University of California, San Diego Department of
Psychiatry, Director of the Wellness And Vocational Enrichment Clinic
at the VA San Diego Healthcare System.
Sonya M. Gomez, M.S., CRC, Wellness Coach, San Diego, CA
M. Pollock, Ph.D. was a post-doctoral fellow at VA San Diego Healthcare
System during the time of this project. Sonya M. Gomez, M.S., CRC was a
vocational rehabilitation masters-level fellow at VA San Diego
Healthcare System during the time of this project.
There was no
financial support or financial investment of any of the authors. The
project occurred in context of the primary author’s postdoctoral
research dissemination project in the APA-accredited fellowship at the
VA San Diego Healthcare System.Correspondence
concerning this article should be addressed to Megan Pollock at email@example.com
human-animal connection and healing effects of animals are evident
throughout history from animals’ role in work, companionship, and
medical interventions. Research scientifically supports two forms of
human-animal connections: routine pet ownership and animal-assisted
therapy. The purpose of this program development project was threefold:
(1) to explore the current literature on animal-based interventions for
psychiatric illness, (2) to describe a recently developed Animal
Therapy in the Community group at the VA San Diego Healthcare System,
and (3) to offer recommendations on future directions for including
animals in therapeutic interventions for persons diagnosed with serious
mental illness. The Animal Therapy in the Community group occurred in
the Psychosocial Rehabilitation and Recovery Center, which is an
intensive outpatient program for veterans diagnosed with serious mental
illness with psychosis. A total of eight veterans participated in this
program. Given the small sample size, an emphasis was placed on
qualitative, observational and anecdotal data. Based on the
veterans’ reports to providers, there were improvements in three main
areas: social interaction, keeping busy, and increased self-confidence.
These authors offer ten lessons to inform future providers interested
in implementing an animal-assisted group as part of their treatment
animal-assisted therapy, community integration, serious mental illness,
psychosocial rehabilitation, recovery model, schizophrenia, psychosis
Throughout history, the
human-animal connection endures as a keen interest for work, companionship, and
healing effects. The sense of animals improving human health evolved from early
hunter and gathers belief in a supernatural power of animals and animal spirits;
to more recently, animals as mediators of socialization, and sources of
emotional and social support (Palley, O’Rourke, and Niemi, 2010).
The aim of this paper is threefold:
(1) to explore the current literature on animal-based interventions for
psychiatric illness and enhanced well-being, (2) to describe a recently
developed Animal Therapy in the Community group at the VA San Diego Healthcare
System, and (3) to offer recommendations on future directions for including
animals in therapeutic interventions for persons diagnosed with serious mental
illness. Within the Psychosocial Rehabilitation and Recovery Center (PRRC) at
the Veterans Administration San Diego Healthcare System, a novel Animal Therapy
in the Community group was initiated in which veterans attended several local
animal organizations allowing direct animal interaction on a biweekly basis.
The mission of the San Diego VA PRRC is “to
help veterans with serious mental health conditions live full and productive
lives by instilling the recovery practices of hope, emphasizing strengths, and
teaching skills to achieve their living, learning, working, and socializing goals”.
These authors aimed to understand the potential psychosocial impact an Animal
Therapy based group has for veterans diagnosed with Schizophrenia-spectrum
disorders. This animal-assisted therapy (AAT) pilot group occurred in the PRRC
in an explorative manner in keeping with the recovery model of care for serious
of the Literature
Animals playing a role in human’s
daily life can be traced back 30,000 years with Native Americans and
domesticated dogs. Animal assisted interventions date back to the 9th
century, when family care providers used animals to assist handicapped persons
in Gheel, Belgium. In the 1700s, the York Asylum used animals instead of
restraints to offer comfort to mentally ill patients (Broodie & Biley,
1999). In the 19th Century, Florence Nightingale suggested that a
bird may be the primary source of pleasure for persons with medical conditions
confined to one room (Nimer & Lundahal, 2007). In the 1960’s, researchers
began to more seriously investigate the health benefits associated with the
human-animal bond. An early pioneer was Boris Levison, who was the first
professionally trained clinician to implement and document the use of companion
animals to enhance psychotherapy. In 1969, Levison wrote a book entitled Pet-Oriented Child Psychotherapy
recounting his experiences and success using animals to help children
struggling with mental health challenges (Broodie & Biley. 1999; Nimer
& Lundahal, 2007).
Research continues to slowly emerge
supporting the healing effects of animals for specific populations. Research of
animal-assisted therapy (AAT) is highly varied in animal species used, patient
populations treated, intervention approaches, and methodology (Nimer &
Lundahal, 2007; Palley, O’Rourke, & Niemi, 2010). Two forms of animal-human
interaction have been scientifically supported. First, routine pet ownership is
associated with lower blood pressure, stronger immunity to illness, and
increased exercise compared to non-pet owners in the general population. Second,
AAT demonstrates favorable results for mental health and medical patients. AAT
is a goal-oriented, planned, structured, and documented therapeutic
intervention directed by health and human services providers as part of their
profession. AAT has been applied for many clinical problems, such as medical
conditions, physical problems, Autism-spectrum disorders, psychiatric
disorders, emotional difficulties, and undesirable negative behaviors. Animals
in AAT have been found to act as social facilitators, social modulators, and
illuminate emotional reactivity (Calvo et al., 2016).
In 2007, Nimer and Lundahal
conducted a meta-analysis on animal–assisted therapy (AAT) and mental and
medical outcomes of patients. Their meta-analysis included 49 studies. AAT is
generally used as a supplemental treatment and is not often considered a
stand-alone treatment. Overall, their findings supported the preexisting belief
that animals can help in the healing of medical and psychiatric disorders.
Consistent moderately strong findings were observed that animals can aid in the
healing process for medical well-being, can improve targeted behaviors, and can
reduce symptoms of Autism. However, a flaw was revealed in that there are few
rigorous scientific studies performed to examine the benefits of AAT. Calvo and
colleagues (2016) explained a reason the scientific evidence is still very
limited in AAT is due to the intrinsic challenges with performing research with
AAT. For example, typical methodological limitations in AAT research are small
sample sizes, difficulties with double blind methods, a lack of an adequate
control group, selection biases as participants who like animals tend to
participate, a lack of physiological evaluation, short program duration, and a
limited number of professionals and animals who currently participate in AAT
(Calvo et al., 2016).
Nimer and Lundahal (2007) examined
the difference between use of animal species such as dogs, horses, or aquatic
animals (dolphins). They found that dogs were used most often and were the most
effective in improving emotional well-being. The animal species played a
significant role, as dogs yielded the highest effect size, and consistently
attained moderately high effect sizes. The targeted presenting problems (e.g.,
medical, mental health, or behavior) did not impact outcomes. When an Animal-assisted therapy group was
initiated in a psychiatric inpatient unit, the group had the highest attendance of all groups (Nimer
& Lundahal, 2007; Calvo et al., 2016).
To date, there are several studies
examining the impact of AAT with persons diagnosed with serious mental illness,
such as Schizophrenia and Schizoaffective disorders. For a historical
perspective, the Haverford study conducted by Beck, Seraydarian, and Hunter
(1986) was one of the first controlled studies that occurred in a psychiatric
inpatient unit with an initial hypothesis and preplanned measures of
effectiveness. The researchers hypothesized that patients would feel less
threatened and subsequently attend group therapy more frequently when birds
were present in the room. Patients were randomly assigned to either a bird
group or a non-bird group. Results revealed patients in the bird group attended
sessions at a significantly higher rate than non-bird group members. Additionally,
the number of times individuals in the bird group contributed to conversation
was significantly higher than the non-bird group. Four of the eight bird group
patients were successfully discharged prior to the end of the study, whereas
none of the non-bird participants were discharged (Beck, et al., 1986).
A pilot study was conducted at the
Social Institute for Psychiatric Patients in Budapest, Hungary (Kovacs, Kis,
Rozsa, & Rozsa, 2004) in which researchers examined changes in independent
living skills for patients with Schizophrenia. Seven patients residing at the
institute (duration of living at the institute ranged from 4 to 22 years)
participated in a 9 month AAT group. The group was facilitated by a
psychiatrist, a social worker, a dog and his owner. The group occurred weekly
in the garden, or in bad weather in the occupational room. Results revealed
significant improvement in Domestic Activities and Health on the Independent
Living Skills Survey (ILSS) from pre- to post- group. Qualitatively, the
patients formed a bond with the dog, had regular attendance, and were less
likely to drop-out of the group.
Another pilot study was conducted
by Nathans-Barel, Feldman, Berger, Modai, and Silver (2005) examining changes
in anhedonia for patients diagnosed with Schizophrenia with a group format
resembling Kovacs et al. (2004). Their study included 20 participants. Ten were
assigned to an active AAT group and 10 were assigned to control group treated
without AAT. The AAT group included the presence of a Golden Retriever who was
friendly and well-trained. The group was based on specific goals developed by
the Delta Society (a world class dog therapy training program based in
Australia), which included improving mood, reducing isolation, improving
communication through playing with the animal, developing mutual acceptance and
affection, learning to groom the animal, and teaching the animal new things.
The control group included similar procedures and activities without the dog,
such as discussions about animals, animal care, and walks on hospital grounds.
There were weekly 1-hour sessions. Patients in the AAT group had significantly
reduced anhedonia, improved leisure factor on the Quality of Life Enjoyment and
Satisfaction Questionnaire (QLESQ), and improved motivation factor on the
Subjective Quality of Life Scale (SQLS) compared to the control group; no
differences were found on the other factors of the QLESQ and SQLS.
Qualitatively, the patients reported feeling attached to the dog.
A randomized control study with
blind assessment was conducted to assess the effectiveness of including a
trained therapy dog in an intervention programs for institutionalized patients
diagnosed with chronic Schizophrenia (Villalta-Gil et al., 2009). The sample included 24 patients randomly assigned to a
treatment group with a trained therapy dog or an intervention group without the
dog. The study revealed no significant differences between the group with the
trained therapy dog to the group without the dog. There were other positive
outcomes from introducing a dog into the therapy group; and both treatment
groups yielded significant improvement from pre- and post-measures (Villalta-Gil
et al., 2009).
A recent pilot study was conducted
by Gehrke, Meyers, Evans, and Garman (2016) investigating Heart Rate
Variability at one of the community organizations our group attended at Rolling
Horse Ranch in Ramona, California. This study investigated Heart Rate Variability
and use of self-report measures to assess for changes during equine-assisted
coaching sessions, which included a horse, a coach, and the client. Measuring
the Heart Rate Variability introduces a novel approach in measuring
physiological changes beyond the clients’ self-report from participation in
animal-assisted interventions. Research
has found that balance in the autonomic nervous system can be determined by
measuring Heart Rate Variability; balance leads to more clarity of thinking,
improved attention, increased confidence, improved decision-making, and lower
anxiety and stress (Gehrke et. al, 2016). This study found improved Heart Rate
Variability from the brief one-on-one equine coaching sessions.
recent small randomized control trial was conducted by Calvo and colleagues
(2016) to assess the usefulness of AAT as an adjunctive treatment to
conventional psychosocial rehabilitation for persons diagnosed with
schizophrenia residing at an inpatient facility. The study involved AAT as an
adjunct to a six-month conventional psychosocial rehabilitation program for
persons with schizophrenia. There was a total of 24 participants; eight in the
control group and eight in the two AAT groups. The researchers administered the
following pre-and-post measures Schizophrenia Symptomatology (PANSS) and
Quality of Life (EQ-5D); they also recorded and analyzed adherence to treatment
and salivary cortisol and alpha-amylase for each session. The groups consisted
of one hour sessions twice weekly. AAT sessions aimed to develop emotional
bonds between patients and dogs by guided instruction on allowing each patient
to play and train the dogs. The control group offered choices between art
therapy, group sports, psycho-stimulation, and gymnastics. Findings revealed both
the AAT and control group had significant reduction for positive and general
PANSS scores, however only the AAT group a significant reduction on the
negative symptom subscale. There were no statistically significant differences
found in QOL for the AAT or control groups from pre-to-post measures. The AAT
groups had a much higher attendance rate. Lastly, the salivary cortisol and
alpha-amylase found a significant decrease in cortisol after participation in
an AAT session. Calvo and colleagues’ study notably contributes to the research
base for AAT as it included a randomized design measuring both self-report
symptoms and physiological changes. The study supports that AAT is a worthwhile
adjunct to conventional treatment for persons diagnosed with schizophrenia.
Additionally, the study recommends further investigation of the effects of AAT
on negative symptoms of schizophrenia.
Quality of Life
According to World Health
Organization's Quality of Life (WHOQOL) working group, “quality of life…is an
individual’s perception of their position in life, in the context of the
culture and value systems in which they live and in relation to their goals,
expectations, standards, and concerns…[it includes] in a complex way
individuals physical health, psychological state, level of independence, social
relationships, personal beliefs, and their relationships to salient features of
the environment” (The WHOQOL Group, 1995).
There is a scarcity of literature
available on how animal-assisted therapy (AAT) affects quality of life with
people diagnosed with severe mental illnesses. Some single studies exist revealing
that AAT can decrease agitated behaviors, increase social interaction, and
improve quality of life in relation to dementia (Sellers, 2006). Studies show
that when AAT is used, human–animal bond reduces symptoms and increases social
engagement and communication in dementia care, which is believed to increase
the individual’s overall quality of life. Engagement and participation in
positive and meaningful activities are assumed to correlate with overall QOL
(Nordgren & Engstrom, 2014).
Although there is limited research
available on AAT as it relates to QOL, there is evidence that suggests
community integration is positively related to QOL for persons with serious
mental illness (Townley, Kloos, and Wright, 2009). Prince and Gerber (2005) reveal that both
physical presence in the community and perceptions of sense of community and
belonging can enhance life satisfaction.
A growing need in psychosocial
rehabilitation programs for people with serious mental illness (SMI) is
increased community integration. The Animal Therapy in the Community group in
this project sought out animal-based organizations in the county of San Diego
to fulfill both animal exposure and community integration. The definition of
community integration has been theorized as physical presence in the community
(Aubry & Myner, 1996). Community
integration includes the patients’ ability to perform daily living activities
(physical integration), engagement in typical social interactions with both
disabled and non-disabled groups or individuals (social integration), and
having a sense of community belonging (psychological integration) (Townley et
Historically, individuals with SMI
have received high levels of intervention, usually in specialized settings aimed
to treat psychiatric problems. More recently, a shift has been made to focus on recovery to help individuals
move beyond the patient role towards active engagement in their communities
through employment, connection with family and friends, and participation in
community organizations. Traditionally, a common issue for persons diagnosed
with SMI is isolation with few meaningful relationships and limited activities
to fill their days (Mccormick, Funderburk, Lee, and Hale-Fought, 2005). Over
85% of persons with SMI are unemployed, and studies have revealed a lack of
participation among many members of this population in educational and leisure
activities which leads to feelings of hopelessness (Bond, Salyers, Rollins,
Rapp, & Zipple, 2004; Dewees, Pulice, & McCormick, 1996). Prince and
Gerber (2005) found that both physical presence in the community and
perceptions of sense of community and belonging can enhance life satisfaction
for people with serious mental illness.
Description and Methodology
The Animal Therapy in the Community
group was developed as the primary author’s postdoctoral research dissemination
project at the VA San Diego’s Psychosocial Rehabilitation and Recovery Center
(PRRC). The first and third authors were
the designated group facilitators and the second author was assigned as the
clinical supervisor. The group was developed
in an explorative manner, in which the specific community partners were created
concurrently while the group was running. Creating community partnerships was
the most crucial and time-consuming step in developing the animal therapy in
the community group. Each group meeting involved visiting one community
animal-based organization. There was a winter and spring group cycle each
consisted of six animal community outings. Four veterans participated in the
winter cycle and six in the spring cycle; two veterans participated in both
The veterans met the two
facilitators at the VA Medical Center for transportation to the community
locations. Table 1 Animal Therapy in the
Community lists the group’s winter and spring scheduled outing locations
with each organization’s animal species present, mileage, minutes from the
hospital, and associated fees. The main goals for the community partnerships
included (1) animal interaction (if animal interaction is not feasible for
safety then close-up animal observation), and (2) education about the
animal(s). The facilitators employed these tenets with the additional goal for
veterans to experience novel situations. For example, when visiting the
California Wolf Center, most group members shared it was their first time
observing a wolf close-up. The facilitators gathered veterans’ feedback on each
community partner visited to determine if the organization should be retained
on the group schedule for future group meetings. Getting real-time feedback
from group participants enhanced interaction skills. A primary aim of this
pilot program development project was to implement an Animal-Assisted Therapy
group based in the Community to assess if there were benefits to veterans and
if the program was feasible for staff.
Table 1. Animal
Therapy in the Community
Fees for Visit
Pegasus Rising Project
Woodward Animal Center
Santa Fe, CA
reptiles, rodents, birds, horses, dogs
Diego Humane Society
and marine mammals
education & observation
Vista Nature Center
shark & ray, shore birds, eagle observation
authors were interested in the phenomenon of how direct exposure to animals in
a novel situation impacted persons diagnosed with a Schizophrenia-spectrum
disorder. Data was collected through self-report measures, interview questions,
and observation. The authors were particularly interested in the role of
quality of life and self-efficacy in the participants’ experiences. The
exploratory project was a mixed methodology as closed-ended self-report
measures were used and analyzed; yet the aim was to ascertain trends given the
small sample size (n = 8).
measures were administered to gather information about trends in relation to
quality of life and self-efficacy. At the first cycle, all veterans completed
the Quality of Life Enjoyment and
Satisfaction Questionnaire-Short Form (Q-LES-Q-SF, Endicott, Nee, Harrison,
Blumenthal, 1993) before and after the cycle. At the second cycle, the General Self-Efficacy Scale (GSE, Schwarzer,
& Jerusalem, 1995) was added; and the Q-LES-Q-SF and GSE were administered
pre-mid-and-post-cycle. Throughout both group cycles, veterans were asked how
the group meetings helped them reach their recovery goals.
Quality of life.
the breadth in quality of life, which includes physical health, psychological
health, level of independence, social relationships, and personal beliefs, a
quality of life measure was used to determine if there was an impact in QOL
during the participants’ experiences. The Q-LES-Q-SF is a 16-item self-report
measure with good validity and reliability. The internal consistency has a
reliability of 0.90. It has test-retest reliability of 0.93 on items one
through 14; a test-retest reliability of 0.75 on item 15 and 0.80 on item 16
(Stevanovic, 2011). Of note, research has demonstrated that finding changes in
self-report quality of life appears to be particularly challenging in pre- and
post- interventions (Vauth, Kleim, Wirtz, & Corrigan, 2007). Additionally,
research has demonstrated patients with Schizophrenia who are undergoing
treatment can experience a progressive decline in QOL in response to increased
insight into their symptoms. Future research should focus on specific domains
of QOL where AAT appears to have a direct effect, such as depression and
anxiety (Calvo et al., 2016).
Self-Efficacy. Self-efficacy has been
described as global confidence in one’s ability across a range of demanding or
novel situations. Persons with high self-efficacy choose to engage in more
difficult tasks. Self-efficacy has also been found to be indirectly related to
self-stigma in persons diagnosed with Schizophrenia (Vauth, Kleim, Wirtz, &
The General Self-Efficacy Scale
(GSE) is a 10-item questionnaire that measures perceived self-efficacy. In
samples from 23 nations, the GSE’s Cronbach’s alphas ranged from .76 to .90,
with the majority in the high .80s (Schwarzer & Jerusalem, 2016). Research
has demonstrated favorable outcomes for improved self-efficacy in
Animal-Assisted Therapy (Bente, Ekeberg, & Brasstad, 2008).
Goals. All veterans enrolled in the PRRC
develop an individualized Recovery Plan collaboratively with their primary
mental health provider. The recovery plans focus on the veteran achieving goals
in the domains of their living situation, learning environments, working,
dependent t-test was conducted to examine differences between pre- and post-
QOL scores for the winter group (cycle 1). Two separate one-way ANOVAs were
conducted to examine differences between pre-, mid- and post- QOL and GSE
scores for the spring group (cycle 2). There was no statistical significance
found in QOL or GSE in the winter or spring group. Given the small sample size
(n = 8), the facilitators emphasized qualitatively reviewing the data for
individual and group trends.
trend observed for the winter
cycle revealed most of the participants (three of four) QOL scores
average of 5.33%), and the fourth participant’s scored stayed the same.
was found of increased QOL and Self-Efficacy specifically at the
point in the spring cycle. In the spring group, three of the six
an increased QOL score, one veteran’s score remained the same, two
scores declined. In the GSE measure, four of the six veterans had
scores from pre- to post- group measures, and two veterans had a slight
decrease. Interestingly, mid-group measures were the highest for three
with only one veteran having a one point lower score than
The group facilitators routinely
inquired after each outing how the experience related to and helped veterans
work toward their recovery goals. The facilitators coded responses for common
themes. Table 2 highlights the main themes of the veterans’ responses.
Table 2. Common Themes: Animal Therapy Outings Relate to Veterans’ Recovery
me socialization with other people
interacting with the animals
about reading emotions
me a good distraction
me participate in healthy behaviors
me stay out of trouble
me out of the house
me keep busy
new parts of the communities
me overcome fear of animals
in something new
me focus on the present and increased mindfulness
There was no statistical
significance found in the analyses for the QOL and GSE measures. There was a
very small sample size of four veterans for the winter measures and six
veterans for the spring measures; two veterans participated in both the winter
and spring cycles. A few other noteworthy factors include the infrequency in
which measures were administered: pre-and-post in the winter cycle and
pre-mid-post winter cycle. A recommendation is the measures should be
administered at the beginning and end of each group meeting to derive a
real-time assessment from the given activity. Moreover, an increase in data points
could be helpful in better deriving a trend as the spring cycle mid-treatment
measures yielded the highest group averages of all administration points.
Lastly, given the limited research yielding statistically significant finding
in quality of life measurements for animal-therapy interventions (Vauth, Kleim,
Wirtz, & Corrigan, 2007), these authors suggest using a specific recovery
measure or targeting specific domains of QOL versus a general QOL measure. In
our analyses, there was a trend of improvement in self-efficacy; whereas QOL
demonstrated an increased trend in the winter cycle and remained fairly
consistent in the spring cycle for most veterans.
on findings from inquiries regarding recovery goals, the most common reply was
that outings helped veterans engage in social activities. This finding is
consistent with the established hypothesis that the presence of an animal can
act as a social facilitator and reduce anxiety, which facilitates communication
among people (Calvo et al, 2016; Beck, et al.,1986).
Given burnout is a concern
throughout the mental health field (Wicks, 2008; Wicks & Maynard, 2014), it
is extremely vital to not only practice self-care outside of work, but also
during work. According to Mayo Clinic (2010), some causes of burnout include:
1) a lack of control in the workplace, or the inability to make decisions that
directly affects one’s job, 2) feeling as if one’s job does not fit individual
interests and/or skills, 3) a lack of social support or social isolation within
the workplace, and 4) unclear job expectations. On many levels, the Animal
Therapy in the Community group addressed some of these causes of burnout for
the clinicians involved.
The Animal Therapy in the Community project
afforded clinicians the ability to develop and implement a pilot group giving
the clinicians a sense of responsibility and control in their work. With the
increased autonomy, there were certain logistical dilemmas that arose during
the course of the group that necessitated the facilitators work together to
problem solve unique challenges. Contacting various locations throughout San
Diego, advocating for free or discounted tours of the locations, and organizing
transportation were all aspects of the program development that revealed to be
more time consuming for the clinicians than expected.
Being able to work with veterans
outside of a clinical setting allowed clinicians to have a break from their
typical office work and enjoy work time in more casual locations learnings
about different animals and their natural habitats. Since both clinicians
involved have a love for animals, and one clinician in particular having her
bachelor’s degree in Animal Science, being able to spend time with animals
during the work day allowed clinicians to create a group that fit personal
interests and skills.
Rapport building between the
clinicians was a positive outcome that stemmed from co-facilitation. The
rapport between the two facilitators grew stronger as they spent more time
together in the community. Colleagues of the group facilitators have also noted
that facilitators brought an optimistic attitude back to their clinical team
upon return to the workplace from an animal therapy outing. With the clinicians
being able to spend time together in the community with animals, and with
colleagues noticing a change in demeanor within the clinicians, there was a
sense of social support.
The autonomy the clinicians were
afforded allowed them to develop their own expectations and experiences within
the group dynamics. For example, not only did the Animal Therapy in the
Community group build the rapport between clinicians, it also benefitted the
rapport building between the veterans and clinicians, and veterans with one
another. Having the presence of animals themselves was an effective ice breaker
to initiate conversation. Clinicians found that conversations about how the
veterans were feelings could be addressed more easily and with less discomfort
in the animals’ presence. The animal interaction catalyzed conversation skills
between veterans, between veterans and facilitators, and between veterans with
employees at the animal facilities. Observationally, this enhanced veterans’
casual conversational skills.
There were two key limitations of this
study. First, the development and implementation of the group occurred
concurrently given the time-constraint for the primary author to complete this
pilot project in the one-year fellowship program at the San Diego VA Medical
Center while sustaining clinical duties. A developmental phase of this project
would have allowed for more in-depth literature review of measures to use and
would have allowed for the implementation of a semi-structured interview. The
second limitation was the small sample size of four veterans in the winter
group and six veterans in the spring group (two participated in both cycles).
Nonetheless, due to safety of patient-to-staff ratio having a large sample size
in an AAT group is intrinsically difficult (Calvo, et al., 2016). A common
limitation of many AAT is a limited rigorous study design. Future AAT research
may help to establish a stronger research base for the use of animals in
therapeutic settings by developing a more rigorous study design prior to the
implementation of the intervention(s).
Animal-assisted therapy in the community had a significant
social and psychological impact on the veterans with serious mental illness who
actively participated in the activity. After
each animal-assisted activity, veterans were asked to share how the outing
affected their recovery from mental illness, in keeping with the recovery model
of care. Veteran shared improvements in
three main areas. The first area of
improvement reported was social
interaction. Veterans reported enjoyment and feeling at ease in social
interactions with other participants, with the providers, and with the diverse
experience with the animals. Animal
interactions can mediate symptoms of anhedonia, social isolation and anxiety in
The second area of improvement
reported by the veterans was keeping busy.
Veterans reported a decrease in troubling behaviors (for example, “I don’t feel
like gambling”) when attending the animal therapy experiences. The impact of staying busy and active as one
recovers from a serious mental health condition increases engagement in
meaningful activities. The third area of improvement reported by the veterans
was increased self-confidence. Veterans reported feeling better about
themselves when interacting with the animals, they experienced a sense of
mastery and control over themselves and their environment. There was a noticeable increase in positive
behaviors such as smiling, feeling calmer and mindful of the experience,
feeling accomplished, and experiencing less anxiety. Many of the veterans reported wanting to
visit with animals on their own after the series of outings was over. Several veterans were interested in
volunteering with animals based on their successful interactions. Improving
social interactions, keeping busy, and building self-confidence were the top
three benefits reported by the veteran participants, and these benefits can
have a far-reaching influence on the course of mental health treatment and
recovery from serious mental illness.
There were several lessons learned
following the development and implementation of the animal-assisted therapy in
the community for veterans with serious mental illness. Here are the top ten lessons:
1. It would be advisable to assess and modify measures based on the available
research. For instance, it is
recommended to document in-vivo social interactions, measure self-efficacy, and
review other measures that tap into the experiences of individuals with severe
mental illness. Using a structured
interview with ten targeted questions would allow for qualitative collection
and coding of responses, which might uncover themes not accessible in
2. It is
recommended that sufficient time be
set aside for preparation and planning of this type of community group. This would include calling animal-assisted
agencies, visiting agencies prior to taking the group members if time permits,
securing safe and secure transportation, notifying other providers well in
advance of the group, recruiting and retaining group members, and developing a
targeted structured interview.
3. In addition to calling animal-assisted agencies
and requesting visiting privileges, it is recommended that the group leaders cultivate a relationship with these
organizations to secure future visits and determine if there are volunteer or
job opportunities available for the veterans who are interested in continued
interactions with animals.
4. It is recommended that providers be comfortable in social situations out in
the community. This type of activity
would benefit providers-in-training looking to improve their comfort level in
community integration. The inclusion of
casual social conversation (for instance “what did you have for breakfast?” or
“what do you think about the weather today?”) between provider and veteran
models this social skill which could be built upon in subsequent community
5. Having an interest
in animals, animal therapy and a predisposition to liking animals and
liking community experiences is important for the providers of this type of
group. Providers who bring their own
curiosity about animals to the experience of animal-assisted therapy would be a
good match for this type of therapy experience and would model this type of
curiosity to the participants
in driving persons diagnosed with serious mental illness would be helpful,
along with knowledge of how to handle emergent situations while in the
community. Practicing a role play of an
emergent event prior to the start of the community outing would be useful for
the providers. The providers would also
benefit in having all emergency contact numbers and equipment in the vehicles
at the onset of the outings.
7. With respect to safety, it is recommended that
providers practice driving. For example, during the same time of day,
managing traffic, driving a larger unfamiliar vehicle, utilizing navigation
equipment to decrease likelihood of getting lost in the community would better
prepare providers for the upcoming events.
8. Having two providers attend each event is
preferable due to management of the participants, event coordination, note
writing, and shared driving on long trips.
It is recommended that participants minimize communicating with the
driver during long trips and focus on interactions with the non-driving
9. The question of a group with diagnostic cohesiveness is worth discussing between the group
leaders and clinical supervisor.
Determining if the group would include participants with and without
serious mental illness would be useful. In addition, prior to the beginning of
the group experience, group leaders would be well served to discuss how to
manage personality conflicts within the group or other interpersonal group
challenges or mental health or medical emergencies. Having a structured clinical team to consult
with if a mental health or medical emergency occurs would be asset to the
10. The authors also recommend developing a manual as part of the process of implementation of
animal-assisted therapy in a group format.
Having a structure is extremely beneficial not only for the providers of
the current group, but for future provider-in-training who would like to
continue animal-assisted therapy in the community. Part of the manual may include providers
de-briefing with a clinical supervisor after each event and using the
de-briefing experience to inform the next community outing and target recovery
goals of the veterans.
animal-assisted therapy for veterans with serious mental illness is an
exceptionally worthwhile experience. AAT
is a true ice-breaker which helps participants improve social interactions,
improve their ability to stay active, and increase their self-confidence. AAT
can positively impact targeted mental health recovery goals in veterans who
actively participate. Providers would be
well-served to review the ten lessons learned from this pilot project prior to
implementing an animal-assisted group or to enhance AAT groups already in
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