Pawsitivity Service Dogs

HOW SERVICE DOGS HELP WITH PTSD

This page lists the many ways service dogs help with PTSD.

Veterans with PTSD

See also: Veterans with Complications

  
Has it been proven that PTSD service dogs help veterans?

Short answer? Yes.

After 11 years of study, which was ordered by the U.S. Congress, in what is “the most comprehensive and scientifically rigorous examination” of how PTSD service dogs help veterans, the Veterans Administration has proven that PTSD service dogs work much better than emotional support animals or pets. The exact wording of their conclusion states (formatting ours):

“Among secondary outcome measures, participants paired with a service dog experienced:

  • a reduction in the severity of PTSD symptoms (PCL-5) compared to participants paired with an emotional support dog
  • had fewer suicidal behaviors and ideations, particularly at 18 months post-pairing.”

The study started in 2009, and just finished in January 2020.

So how can service dogs help veterans with PTSD?

1. Animal Assisted Therapy (“Alert”)

Short explanation:

  1. Veteran starts feeling anxious. (Generally the veteran with PTSD doesn’t notice early feelings of anxiety, before it spirals into a panic attack.)
  2. Dog alerts the veteran by pawing at them. (The dog lives in the here and now, and they notice the veteran’s behavior as it is happening.)
  3. Having been alerted, the veteran notices how they are feeling. (“Yes, indeed, that awful feeling of anxiety was starting.”)
  4. Veteran pets the dog (and rewards them!).
  5. The veteran should then take the time to notice how they feel now that they are petting the dog.
  6. The veteran should then compare:
    • The rewarding feeling of petting the dog (new result)
    • How this new feeling feels better than what would have happened otherwise (the old result was to be feeling more and more anxious, spiraling into a panic attack).

Long explanation:

  • Dogs live in the now and so they are ideal for helping veterans notice their emotional and physical state. Dogs aren't involved too much in thinking about the past or future, so if they are nicely bonded to the hander, they notice what is happening at the moment it happens, rather than the human's usual state of mind, which is rarely on what is happening at the moment.
  • The service dog model is an interesting one because it focuses on tasks. For veterans with PTSD, the task seems to involve emotions, but in fact, the task is a physical one. A task may be "Watch My Six" (sit behind me so people don't come up from behind unexpectedly, but one of the more powerful tasks is also physical: noticing the dog reacting to the handler when cortisol rises, thus indicating an upcoming panic attack or event. This act is often termed "Animal Assisted Therapy" because the handler is noticing the dog's reaction to the handler's emotional and physical state, thus allowing the handler to short-circuit the rising agitation. If the handler can stop this rising agitation before it spirals out of control, the handler never has to enter the threshold of the red zone of a full-blown panic attack. This service dog model uses therapy to defuse the situation, so it's easy to confuse it with "therapy dog" work, but the therapy is not for others, but instead, used by the veteran to empower themselves.
  • With this model, it's important that the handler be trained on how to read the body language of their service dog. It's not just about training, although that is important (for instance, for being well-behaved in stressful situations and unusual environments). Being able to read the dog means that the veteran is, through animal-assisted therapy, learning to read themselves.
  • One of the many reasons to use positive reinforcement when training is that the dog needs to be encouraged to offer behaviors. If the dog only knows how what has been specifically trained, and punished for anything else, they won't, for instance, place a paw on the handler's foot when the dog notices the handler's blood pressure rising, heartbeat increasing, and rate of breathing increase. This act becomes an alerting behavior, which can be rewarded, thus setting the dog on the path to becoming a medical alert dog.
  • Of course, it's important that the right dog be chosen for this partnership. If the dog is genetically predetermined to focus outwardly, perhaps on prey animals or on protecting one from other people, that dog won't be nearly as helpful for service dog work as a dog who has the genes that encourage focusing on the person. Of course, genes are only one piece of the puzzle because the genes must be activated from the environment (for example, during a puppy's critical socialization period).
  • The veteran is taught several important concepts to help read a dog's body language, including the concept of "arousal."

2. Shield

  • The biggest benefit most handlers find is that having a service dog helps with is the ability to go to public places.
  • A service dog can help the handler deal with crowded places. For crowds, the most important tasks are usually sitting behind them in line (if needed), and blocking others who would otherwise intrude on their space. An elevator is a good example of one of the many places where these tasks are helpful.

3. Bridge

  • It can be nice when visiting places other than the hotel where the handler stays (Mall of America, IKEA), to see how the dog could be a positive bridge (as well as a blocker of crowds). To do this, we practice interactions, starting with me playing the stranger (asking questions), and practice common replies for the common questions. Such as: “Are you the trainer? Is that a service dog? What breed is she?” If these Q&A can become rote or automatic, the hope is that the handler will actually enjoy these encounters. If that hope is too optimistic, we can, at least, help make the encounters nice and easy (we’re really hoping that in the long term, the handler will be looking forward to getting out and about with their service dog...between the blocking for the handler and then also serving as a social bridge, our hope is that the experiences will slowly build and accumulate, creating a “virtuous circle” (as opposed to a vicious circle), where, 1% improvement by 1% improvement, their ease at going into public gets better and better.
  • Regroup Before Entering. Before going into a house or public building, the handler should regroup and get all set. They should make sure their treat-bag and waist-leash are set up correctly, and ensure that the dog is calm. Do “figure eights” if necessary (a “figure eight” is a strict heel, walking in double-loops that make a figure eight–this exercise is great at getting the dog to focus on the handler).
  • Find “Safe Zones”. When the handler enters a public building, the first thing the handler should do is find any areas that are quiet and free from people. These “safe zones” will be spots where the handler can pause and regroup if needed, which will help to keep stress levels down for both the handler and the dog.

4. Excuse

  • While this isn’t a task, the handler can use the dog as an excuse to leave and take a break (as if the dog needs to potty). 

5. Calming Team Member

While in crowds, the handler can calm themselves in public with their service dog.

  • Having the dog do “Lap” can bring calming relief because of the weight and pressure of the dog.
  • The tactile stimulation a dog can bring, combined with focusing outwardly on the dog (instead of inwardly at one’s panic) can soothe the handler back down to a state in which they can handle the situation better.

6. Friend, Partner, and Safeguard

  • When people are too anxious, shut down, or dysregulated to find comfort in people, then a deep (but less complicated) relationship with a service dog can be very effective in their healing.
  • If exercise was a pill, it would be the best-selling pill ever. Dogs cannot be happy without exercise, and when the handler who loves their dog goes out for walks, the handler benefits, too.
  • Engaging with the dog is much safer than connecting with other people, and once a person feels safe, then they can eventually build relationships with other people.

Benefits:

Psychiatric service dogs can help not just with PTSD, but also with severe depression, anxiety, phobias, and panic attacks, whether or not these conditions are associated with Obsessive Compulsive Disorder, Tourette's Syndrome, Dementia, Schizophrenia, or other conditions.

A 2002 study of the effects of a person getting a service dog[1] found that:

  • Self-esteem was enhanced significantly, as measured by the Rosenberg Self-Esteem Scale.
  • Participants reported that their service dogs had a positive effect on going out in public, feeling needed, feeling independent, feeling safe, and socializing, including more people who approached them when in public.
  • Family caregivers benefited, too, by being able to pursue other activities, and having more peace of mind.
  • Note: Participants reported that their actual experience with the service dogs met the participant's expectations, which is good to know.

A 2010 study[2] concluded that service dogs:

  • Alleviate the mental burden of daily activities.
  • Improve the physical functioning of their handlers.
  • Have positive functional and mental effects on their disabled handlers.

Studies show that a service dog can:

  • Lessen perception of physical pain.[3]
  • Decrease agitation and aggression.[4]
  • Increase social interaction and the ability to manage daily living.[5]
  • Lower blood pressure and heart rate.[6]
  • Decrease loneliness.[7]
  • Ease anxiety or depression.[8]

Other studies have shown that a service dog can:

  • Lessen perception of physical pain.[9]
  • Decrease agitation and aggression.[10]
  • Increase social interaction and the ability to manage daily living.[11]
  • Lower blood pressure and heart rate.[12]
  • Decrease loneliness.[13]
  • Ease anxiety or depression.[14]

A report on PTSD service dogs[15] states "there are many clear advantages to using psychiatric service dogs", and findings from a 2009 survey distributed by the US military reported:

  • 82% of those with a PTSD diagnosis reported symptom reduction after a partnership with a service dog.
  • Another 40% reported that their use of medication decreased.[16]

Sources:

[1] Human-Animal Bond Resource Center research abstract on the effects of service dogs, Rintala, Diana H; Sachs-Ericsson, Natalie; hart, Karen A. SCI; Psychosocial Process, 15(2): 2002 Summer; 69-72.

[2] The Effect of Service Dogs on the Improvement of Health-related Quality of Life, Shintani M, Senda M, Takayanagi T, Katayama Y, Furusawa K, Okutani T, Kataoka M, Ozaki T. Department of Orthopaedic Surgery, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama.

[3] Complementary Therapies in Clinical Practice, Braun, C., Stangler, T., Narveson, J., & Pettingell, S. (2009). 15(2), 105-109. Also, Journal of Holistic Nursing: Official Journal of the American Holistic Nurses' Association Sobo, E. J., Eng, B., & Kassity-Krich, N. (2006). 24(1), 51-57.

[4] Western Journal of Nursing Research, McCabe, B. W., Baun, M. M., Speich, D., & Agrawal, S. (2002). 24(6), 684-696. 

[5] International Psychogeriatrics/IPA. Filan, S. L., & Llewellyn-Jones, R. H. (2006). 18(4), 597-611.

[6] Psychosomatic Medicine, Allen, K., Blascovich, J., & Mendes, W. B. (2002). 64(5), 727-739.

[7] The Journals of Gerontology, Series A, Biological Sciences and Medical Sciences. Banks, M. R., & Banks, W. A. (2002). 57(7), M428-M432.

[8] American Journal of Critical Care: An Official Publication, American Association of Critical-Care Nurses. Cole, K. M., Gawlinski, A., Steers, N., & Kotlerman, J. (2007).  16(6), 575-585; quiz 586; discussion 587-588.

[9] Western Journal of Nursing Research, McCabe, B. W., Baun, M. M., Speich, D., & Agrawal, S. (2002). 24(6), 684-696.

[10] International Psychogeriatrics/IPA. Filan, S. L., & Llewellyn-Jones, R. H. (2006). 18(4), 597-611.

[11] Psychosomatic Medicine, Allen, K., Blascovich, J., & Mendes, W. B. (2002). 64(5), 727-739.

[12] The Journals of Gerontology, Series A, Biological Sciences and Medical Sciences. Banks, M. R., & Banks, W. A. (2002). 57(7), M428-M432.

[13] American Journal of Critical Care: An Official Publication, American Association of Critical-Care Nurses. Cole, K. M., Gawlinski, A., Steers, N., & Kotlerman, J. (2007). 16(6), 575-585; quiz 586; discussion 587-588.

[14] "How Dogs Think", Stanley Coren, Simon and Shuster, 2004.

[15] Effectiveness of Psychiatric Service Dogs in the Treatment of Post-Traumatic Stress Disorder among Veterans, by Dr. James Gillett, Ph.D., Mcmaster University and Rachel Weldrick, BA, McMaster University.

[16] The Use of Psychiatric Service Dogs in the Treatment of Veterans with PTSD. Craig Love Ph.D., US Army Medical Research and Materiel Command, Fort Detrick, MD, 2009.

 

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