Dog lovers know assistance dogs can improve mental health. They’ll read the title of this article and immediately think:
“Yes, of course.”
Our default instinct is to agree.
However, we work in a field where evidence speaks louder than instinct. To verify our subjective response, we need verified, peer-reviewed journal articles on the topic, with data and statistics verified through rigorous analysis and review.
As it turns out, we’re in luck. Dog lovers everywhere can congratulate themselves on their wisdom after reading about a recent study on the impact of service dogs on military veterans diagnosed with clinical mental health disorders.
The study – “Effectiveness of Operation K9 Assistance Dogs on Suicidality in Australian Veterans with PTSD: A 12-Month Mixed-Methods Follow-Up Study” – examined the effect of assistance dogs on Australian military veterans diagnosed with post-traumatic stress disorder (PTSD). In the study, researchers collected data from a group of veterans over a 12-month period. To determine baseline levels of symptom severity, researcher screened participants with the Clinician-Administered PTSD Scale for DSM-5 Past Month Version to measure the following:
- PTSD symptoms
- Depression symptoms
- Anxiety symptoms
After collecting data on baseline symptom severity and matching each participant with a service dog, researchers re-assessed participants at three months, six months, and 12-months post baseline and matching. At the three-month assessment, researchers also conducted a qualitative interview with each participant. In this interview, they gathered information on the following topics:
- Positives of having an assistance dog
- Negatives of having an assistance dog
- Changes in mental health after pairing with an assistance dog
- Changes in wellbeing after pairing with an assistance dog
We’re interested in this research because PTSD is a common problem among members of the U.S. Armed Forces as well. Any evidence-based benefit identified in this study can help promote similar programs here to promote wellbeing among our veterans.
Let’s learn more about the study, and why researchers saw the need for conducting research on PTSD in veterans.
PTSD and Military Veterans
The study authors state the problem they seek to address in the introduction of the publication:
“Post-traumatic stress disorder (PTSD) is a pervasive disorder among both current and ex-serving Australian Defence Force (ADF) members. Studies have shown current psychological and pharmacological treatments for PTSD are suboptimal in veterans, with high dropout rates and poor adherence to treatment protocols.”
The mental health and wellbeing of military veterans with PTSD is of critical importance to any society. Their commitment and sacrifice deserve gratitude, of course, but veterans also deserve real help when they face real problems, such as mental health disorders. Evidence shows the consequences of untreated mental illness, including untreated PTSD, can lead to the following negative outcomes:
- Turbulent/rocky interpersonal relationships
- Withdrawal or conflict with family
- Job loss
- Chronic unemployment
- Alcohol and/or substance use
- Risky behavior, e.g. driving, sexual activity
- Legal problems
- Deficits in self-care
- Developing or escalating mental health disorders
- Self-harm/non-suicidal self-injury (NSSI)
- Suicidality: thinking about, talking about, planning, and/or attempting suicide
That’s why this study matters. When veterans develop mental health problems associated with their service, we should pay attention. And when the potential consequences include serious and severe issues – up to and including suicidality – we should do everything we can to help find those veterans the effective, evidence-based treatment that can help them find balance and rebuild their lives.
When Australian veterans with PTSD engage in treatment, the most common modalities include:
- Eye movement desensitization and reprocessing (EMDR)
- Cognitive processing therapy (CPT)
- Prolonged exposure therapy (PE)
However – while these approaches to PTSD do work for millions of people worldwide – evidence from studies in Australia show that among veterans who engage in these modalities, two-thirds meet clinical criteria for PTSD after treatment, and of to half either drop out of treatment or experience no significant symptom relief.
Operation K-9, Assistance Dogs, and Mental Health
The research team that designed this study partnered with an organization called Operation K-9, a non-profit that provides veterans with assistance dogs. One thing many people may not know is that the dogs we generally refer to as “service dogs” or “companion dogs” are not all the same. Companion dogs are exactly what they sound like. They provide comfort and companionship but do not have the same access rights as trained assistance dogs or the guide dogs that help blind people.
The assistance dogs in the Operation K-9 program are trained to:
- Assist people who are vision impaired or blind
- Alert people who are hearing impaired or deaf
- Assist a person having a seizure
- Detect allergens and alert a person to their presence
- Find and retrieve important items, e.g. medication or phones
- Help with balance and stability for people with mobility challenges
- Prevent or interrupt impulsive/destructive behavior in people diagnosed with neurological or psychiatric disorders
- Pull a wheelchair
Assistance dogs are more than friends and companions: they also perform vital functions necessary to the completion of daily tasks and activities. That’s important for people with severe PTSD, because the symptoms of PTSD can impair those activities, which adds to the challenges people with PTSD already face.
Let’s take a look at the results of the study and learn about the impact these assistance dogs had on Australian veterans with PTSD. We’ll examine the quantitative data first.
Assistance Dogs: Effect on Mental Health Symptoms
(Numbers reflect average scores on clinical diagnostic metrics across all participants in the study group. Higher scores reflect higher symptom severity. Suicidality is expressed in terms of percentage of the study group who reported suicidal ideation)
- PTSD symptoms:
- Baseline: 67.69
- 3 months: 60.19
- 6 months: 54.44
- 12 months: 51.56
- Depression symptoms
- Baseline: 21.25
- 3 months: 16.88
- 6 months: 14.13
- 12 months: 15.75
- Anxiety symptoms
- Baseline: 20
- 3 months: 12.50
- 6 months: 12.25
- 12 months: 10.50
- Baseline: 56%
- 3 months: 37%
- 6 months: 37%
- 12 months: 44%
With regards to PTSD, depression, and anxiety, these results are overwhelmingly positive. Average scores on PTSD symptoms decreased by an average of 16 points over 12 months, average scores in depression symptoms decreased by six (6) points over 12 months, and symptoms of anxiety decreased by and average of 10 points over 12 months.
With regards to suicidality, the results appear promising. However, although the proportion of veterans reporting suicidality decreased – which is promising – the was no statistically significant reduction in likelihood of reporting suicidality between each time point.
Now let’s look at the results of the qualitative interview researchers conducted at the three-month interview.
Qualitative Analysis: Did Assistance Dogs Improve Subjective Experience Among Veterans?
At the three-month interview, researchers asked study participants a series of questions to gauge the positives and negatives of having an assistance dog and any changes in mental health or wellbeing after paring with an assistance dog.
Three themes emerged during these semi-structured, qualitative interviews. Veterans report that assistance dogs were life-changers, constant companions, and improved their levels of social engagement.
We’ll explore the details on these subjective experiences now.
A majority of the veterans reported that having an assistance dog significantly improved their quality of life and helped reduce their mental health symptoms. Here’s what one veteran said about the presence of an assistance dog in his life:
“I didn’t even think it was possible for me to ever, ever improve. I thought this was going to be my lifestyle for the rest of my life, but you know this has just absolutely proven me wrong, it’s turned me right around 180 degrees.”
Three veterans reported the positive impact of their assistance dogs on suicidality and thoughts of suicide. One veteran said:
“This has alleviated all of the [suicidal ideation], I don’t even think about it anymore.”
While another said:
“You just sort of look at (dog) and you think, well, you know, at least she’s worth living for and she’s there …it sort of reminds you constantly, you know, when you’re all by yourself, there’s always someone there.”
“[My assistance dog] gives me a reason and purpose now, so I’ve got to stay well and fit enough now to look after him, so he’s now my family.”
Finally, one veteran said his assistance dog “…just makes me feel good all the time.” Those are the kind of results you want from an intervention with people diagnosed with PTSD: for them to feel good all the time, experience symptom reduction, and report a decrease in suicidal ideation.
Across the board, the veterans in this study valued the continuous physical presence of their assistance dog and the emotions associated with having a new four-legged friend. Veteran reported the dogs helped them manage stress and reduce anxiety and previously stressful of difficult situations.
One veteran said his dog was like a “security blanket,” while another appreciated the “constant sort of watching on her part and constant support.” Yet another described the experience of having an assistance dog this way:
“[My assistance dog] …gave me more reassurance and confidence, and the ability to rest easier at night…it has all been absolutely amazingly positive.”
Again, that’s exactly the kind of thing treatment professionals seek: positive experiences for people with mental illness, especially patients who would say the experience of mental illness is anything but “absolutely amazingly positive.”
One negative consequence of untreated PTSD, or PTSD that does not respond to treatment, is social isolation, a decrease in contact with friends and family, and an overall decrease in contact with other people in the community. Most veterans reported their assistance dog increased their positive interactions with others and improved their baseline level of feeling safe and comfortable in social situations.
Here’s what one veteran said:
“I was a recluse and didn’t leave my home for many, many years and now every day is an adventure … and gives me something to look forward to.”
“I’ve just felt a lot more comfortable going out in public … kind of broken that barrier where I used to … try and avoid the public at all costs.”
The sentiment expressed in these subjective interviews was overwhelmingly positive. Assistance dogs helped veterans feel safe and cared for when at home, alone. They also helped veterans feel safe and secure when out in public, among people. These are primary objectives for PTSD treatment, which makes this study important for veterans worldwide: when traditional therapies are ineffective, a trained assistance dog may – as some veterans put it – be a life-changer.
Assistance Dogs, PTSD, and Hope for the Future
The results of this study indicate that assistance dogs can become an important part of any treatment program for people with PTSD, and especially military veterans. As promising these results are, they need confirmation through more thoroughly designed experiments. For instance, a random-controlled trial with a control group (PTSD and no assistance dog) compared to an experimental group (PTSD + assistance dog) will allow researchers to verify and report results with more confidence. In addition, studies with a larger sample size – i.e. more participants – will allow statisticians to make more accurate generalizations based on the data they collect.
Also, this study is limited to veterans. We’re interested in a repeat study conducted for people with complex, treatment-resistant PTSD who are not veterans. PTSD can make life challenging on all levels, and people who don’t respond to treatment often lose hope.
It appears that assistance dogs can change that, and restore not only hope, but a sense of purpose for people with severe PTSD symptoms and other mental health challenges. Here’s how the researchers describe these results:
“This study provides clear evidence that assistance dogs can play a key role in a veteran’s recovery from post-traumatic stress and other mental health conditions, supporting existing treatments.”
If the results are consistent across populations and demographic groups, and are not limited to veterans, then we’ll have one more reason – among the almost infinite reasons we can list already – that dogs are truly among our best and most trusted friends.