Two decades later, animal-assisted therapy has its day

May 5, 2018

In the 1998, Hertz Fellow Eric Altschuler – then a medical student at UC San Diego, met a patient who would change how he thought about treating complex diseases. Altschuler was assisting at a general medical clinic for veterans. One of the patients, clearly uncomfortable to be at the clinic, refused to wait at the pharmacy in the clinic to pick up medicines for his diabetes and hypertension.

The reason the man wanted to spend as little time as possible in the clinic was that the strict no-pets policy meant the man had to leave his dog at home, and he became extremely anxious whenever he had to be separated from his dog. As a physician-in-training, Altschuler quickly realized that, for this patient at least, the benefits of caring for a pet might be doing more to ameliorate the psychological issues of posttraumatic stress disorder (PTSD) than the multiple medications and individual and group therapy sessions then prescribed for PTSD.But as a scientist, Altschuler realized he might be glimpsing a new paradigm in PTSD treatment.

“It’s easy to blow off as an anomaly, but that’s a classic mistake,” says Altschuler. Instead, he wrote up his proposal – that animal-assisted therapy might be a valuable tool in the fight against debilitating PTSD – and submitted it to the Annals of Clinical Psychiatry. The paper received relatively little attention for years, in part, Altschuler believes, because it didn’t fit into established research programs or funding organs. "It's a wholly different way of treating people,” he said. “We have drugs, we have surgeries, we have behavioral therapy, but this is a totally different modality."

In recent years, Dr. Altschuler's proposal has received renewed scientific interest, says Dr. Maggie O'Haire, an assistant professor of human-animal interaction at Purdue University's College of Veterinary Medicine. O'Haire, who is leading a long-term study on the effects of service dogs, says funding increases driven by partnerships between the National Institutes for Health and big players in the pet industry, including MARS Waltham, have made formal studies into the effects of animal-assisted intervention more prevalent in general, and PTSD is no exception.

"Dr. Altschuler had some excellent ideas that needed funding to be effectively studied, "O'Haire said.

Two decades after Altschuler’s paper was published, non-profits around the country pair traumatized veterans with dogs, or traumatized children with horses, and success stories are a staple of inspirational media. “There are hundreds if not thousands of organizations dedicated to that now,” says Altschuler.

Though the precise reasons animal interventions may work so well for PTSD in particular are unconfirmed, both Altschuler and O'Haire float hypotheses that will be intuitive to anyone who has cared for a pet. The physical and emotional work of caring for an animal may force patients to think about present needs and actions, rather than fixating on the past. Or perhaps the animals provide a sorely needed social connection to patients with deep anxiety about interacting with humans. Whatever the cause, the benefit of animals is clear in the popular mind.

And of course, the possible advantages of animal-assisted intervention -- when service animals not only provide a non-judgmental anchor to the present, but also assist humans in particular tasks -- are even greater.

But Altschuler and O'Haire both agree more formal research will give more information on how strong and widespread those benefits actually are. More importantly, randomized controlled studies -- the gold standard for clinical research – will point to what sorts of therapy work for a given population, and shed light on exactly why. "The research hasn't yet caught up with practice, or with hypotheses," says O'Haire.

But the many possible benefits for animal-assisted therapy are ripe enough that Altschuler is eager to explore other aspects of the relationship between animal-assisted therapy and trauma. “The randomized trial is the standard,” says Altschuler, “so we’re waiting for that. But we do have information outside of randomized trials.”

This January, Altschuler published a paper in Military Medicine exploring the potential for the many news stories about the success of animal-assisted therapy to serve the same purpose as case reports in guiding the questions that medical researchers ask. “By definition, a randomized controlled trial has to be very controlled. You can only use dogs – you can’t use horses,” he says. “You may not find the outliers,” with large effects that point to wholly new research directions.

“The media reports also have so much more details than you could ever publish in a case study,” says Altschuler. As other examples of the new directions that media reports could guide scientists, Altschuler points to the possibility of particularly deep emotional connection between patient and animal when the dog or bird has also been rescued from past adversities, or the testimony of patients who say their companions have been, in multiple instances, the only thing between them and suicide. “Some units have more deaths from suicide than they do from enemy fire, so this is a significant issue,” he says.

Like Altschuler, O'Haire is carefully optimistic that the news reports point to a larger trend towards effective treatment along many axes. "We need to take it with a grain of salt, but it's very useful that Dr. Altschuler has compiled these reports."

Altschuler sees a direct connection between his open-minded inquiry in this field and the creative innovation the Hertz Foundation seeks in its fellows. “This is really applied science. I think this is exactly the kind of thinking that Mr. Hertz intended when he decided to give people the freedom of their investigation.”