How do service dogs help veterans with PTSD?

1. Animal Assisted Therapy (“Alert”)

Short explanation:

The veteran starts feeling anxious. (Generally the veteran with PTSD doesn’t notice early feelings of anxiety before it spirals into a panic attack.)
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.)
Having been alerted, the veteran notices how they are feeling. (“Yes, indeed, that awful feeling of anxiety was starting.”)
Veteran pets the dog (and rewards them!).
The veteran should then take the time to notice how they feel now that they are petting the dog.
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 moment, so they are good at helping veterans notice their emotional and physical state. Dogs don't think about the past or future as much as humans do, so they can notice things that are happening right now, rather than what the human is thinking about.
Service dogs are trained to do specific tasks. For veterans with PTSD, one of the most important tasks is to alert the veteran when they are starting to feel anxious or stressed. This can help the veteran to take steps to manage their anxiety before it becomes overwhelming.
For example, if a veteran's blood pressure, heart rate, and breathing start to increase, the service dog may place a paw on the veteran's foot. This alerts the veteran to their anxiety and gives them a chance to take a few deep breaths or listen to some calming music.
Petting the dog can also help to reduce anxiety. This is because petting a dog releases oxytocin, which is a hormone that has calming effects.
It is important that the veteran and the service dog be a good match. The dog should be calm and focused on the person, rather than on prey animals or other people. The dog should also be trained to do the specific tasks that the veteran needs help with.
The veteran is taught several important concepts to help read a dog's body language, including the concept of "arousal."

2. Shield

The second biggest benefit most veterans find is that having a service dog helps with is the ability to go to public places.
For many veterans with PTSD, the idea of going to a public place can be terrifying. But with the help of a service dog, they can finally start to live their lives again. Service dogs can help veterans deal with crowds in a number of ways. For example, they can sit behind their handler in line and block people from getting too close in an elevator. This can help the veteran to feel safe and secure in a crowded place.

3. Bridge

In public, we work with the veteran to see show the dog can be a good way to meet people (as well as a way to block 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 the dog?” If these Q&A can become automatic, the hope is that the handler will actually enjoy these encounters. If that result is too much, we can still try to make the meetings pleasant and simple. We really want the veteran to feel excited about going out and about with them in the long run. The service dog can help the veteran by blocking obstacles and also by helping them socialize. We hope that each experience will add up and improve over time, creating a positive cycle instead of a negative one. Even small improvements, one step at a time, can make it easier for them to go out in public.
Before entering a house or public building, the veteran should take a moment to get ready. They should make sure their treat bag and waist-leash are on properly, and that the dog is calm. If the dog is not calm, the veteran can do some "figure eights" to help the dog focus. "Figure eights" are a training exercise where the veteran walks in a figure eight shape, with the dog following them. This helps the dog to focus on the veteran and to stay calm.
When a veteran enters a public building, the first thing they should do is find a quiet place with no people. These "safe zones" are places where the veteran can take a break and calm down if they need to. This will help to keep the veteran and the dog from getting stressed.

4. Excuse

While this isn't a task that the dog is trained to do, the veteran can use the dog as an excuse to leave and take a break. For example, the veteran can say that the dog needs to go to the bathroom. This can be a helpful way to get away from a situation that is making the veteran uncomfortable.

5. Calming Team Member

A service dog can help a veteran calm down in a crowd by sitting on their lap and putting pressure on them. The pressure of the dog's body helps to ground the veteran and make them feel more secure.
The dog can also help calm the veteran down because it gives them something to touch and helps them focus on the dog instead of feeling panicky.

6. Friend, Partner, and Safeguard

A service dog can help a veteran feel safe and comfortable when they feel that they can't talk to people.
Dogs need to be walked, and this exercise can help the veteran feel better.
Talking to a dog is easier than talking to a person.
After building trust with the dog, the veteran can start to 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.

A study in 2002 found that people who got a service dog had a lot of positive things happen[1}. Their self-esteem went up, they felt better about themselves, they felt more independent, and they felt safer. They also felt like they could go out in public more and socialize more. Their family caregivers also benefited because they could do other things and they didn't have to worry about the person with the service dog as much. The people who got the service dogs said that the dogs did everything they expected them to do.

A study in 2010 found that service dogs help people with disabilities in many ways[2]. They can help people with their daily activities, like getting dressed and eating. They can also help people with their physical health, like by helping them walk or stand. And they can help people with their mental health, like by making them feel more confident and less anxious.

Studies show that a service dog can help people with disabilities:

Feel less pain.[3]
Be less likely to get angry or aggressive.[4]
Make friends and do things on their own.[5]
Have lower blood pressure and heart rate..[6]
Feel less lonely.[7]
Feel less anxious or depressed.[8]
Think less about suicide [9]

A report on PTSD service dogs summed up by concluding "there are many clear advantages to using psychiatric service dogs"[10]. A study by the US military in 2009 was more specific: it found that 82% of people with PTSD who had a service dog reported that their symptoms got better. Another 40% said they used less medication after getting a service dog[11].

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] 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.

[11] 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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