PTSD

PTSD Service Dogs

22 veterans commit suicide each day. Pawsitivity trains PTSD Service Dogs for both veterans and civilians.

PTSD Service Dogs

Pawsitivity trains PTSD Service Dogs for both veterans and non-veterans. Post-Traumatic Stress Disorder involves an underlying state regulation disorder, which is often hypersensitivity to sound. A PTSD Service Dog is especially helpful when combined with cognitive behavioral therapy from a therapist or psychologist, and it is a therapeutic technique that is repeatedly demonstrated to be legitimate and effective. Applying cognitive-behavioral skills to interactions with a Service Dog can produce powerful outcomes. 
A report on PTSD service dogs[1] 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 partnership with a Service Dog.
Another 40% reported that their use of medication decreased.[2]

"There are many clear advantages to using psychiatric service dogs."

"The overwhelming majority of published studies have reported that animals make excellent therapists."

The first long-term, large-study, study on PTSD Service Dogs that uses randomized controls is now underway, but "The overwhelming majority of published studies have reported that animals make excellent therapists.” Source: Psychology Today blog by Dr. Hal Herzog, November 2014, “Does Animal-Assisted Therapy Really Work?”  

Studies show that a Service Dog can:


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

Goals with a PTSD Service Dog


Improving quality of life
Reducing limitations on daily activities
Improvement of PTSD symptoms
Less use of medication
Less depression
Improving sleep quality
Reducing suicide ideation
Increasing in volunteering or job status
Decreasing need of health care

One commonly reported side-effect for people living with anxiety and fear is a tendency to isolate oneself. Many of the symptoms associated with PTSD make going outside difficult and leaving the home daunting due to the potential of triggers. People with PTSD might only feel comfortable going places or running errands with a spouse or close friend. This is one of the main areas in which Service Dogs dramatically improve the quality of life for both those living with the disorder as well as close friends and family; a Service Dog can fulfill the same role as the close friend or family and the dog can be taken with them 24/7. This can lead to feelings of freedom and increase the extent to which the individual is comfortable and confident going to the mall, grocery shopping - everywhere

Tasks and Symptoms


  • Retrieve. Bring pill bottle or dropped items to the handler.
  • Sweep. Go into a room and search for a person in order to reduce anxiety of intruders.
  • Lights. Use nose to turn on a light before the handler enters a room in order to reduce the anxiety of entering a dark area.
Many people with PTSD are not able to get out in public areas, and following can help them do so by controlling anxiety, which can be very useful in fostering the recovery process. Note that this task (and "Behind") are not protection behaviors such as aggressive growling, barking, and biting (which are never appropriate for Service Dog work).
  • Block. Dog sits (or stands) in front of the handler to assist the handler in creating a safe personal space. 
  • Behind. Dog sits (or stands) behind the handler serve as a buffer to calm the handler and reduce feelings of emotional distress in crowded places. This provides panic protection, as the dog braces for possible impact and holds their ground, preventing people from making body contact with their handler

A Service Dog can also help:


Remind the handler to take medication.
Improve organization by reminding the handler to perform her or his daily routines.
Wake the handler to prevent him or her from sleeping too much (hypersomnia).
Provide tactile stimulation.
Reassure the handler, both at home and in public.
Facilitate social interactions and reduce fear associated with meeting new people.
Assist the handler when dealing with mood swings.
Help the handler to calm down when agitated.
Reorient and "ground" the handler to current place and time when struggling with PTSD episodes.

In addition to aiding with clinical symptoms, these Service Dogs can help with more general symptoms, such as sadness and loneliness, by initiating walks outside the home, and showing the handler affection. The dogs can:

Assist the handler when he or she tries to relax (self-soothe) in order to complete uncomfortable tasks.
Provide companionship while in stores and other environments can reduce stress associated with daily activities.
Alert when the handler is starting to experience anxiety problems reminding the handler to take his or her medication.
Encourage the handler to be more social by getting him or her out of the house for walks. Walks also increase the amount of exercise the handler gets and improves his or her ability to self-sooth if they are struggling with insomnia, or having anxiety issues.
Help the handler keep a constant schedule and will be a reason to get out of bed in the morning (walks, relieve themselves).

Leveraging

The PTSD brain generates fear and alertness even when there's no actual danger. Dr. Kelly Skelton, a psychiatrist who is overseeing a Veteran's Affairs service dog study at in Atlanta VA, says that the theory is that that Service Dogs "can serve as a bridge to get them past that initial fear. That way, they can get out more and engage in therapy so they can eventually free themselves of that excessive fear response.

The PTSD brain generates fear and alertness even when there's no actual danger. Dr. Kelly Skelton, a psychiatrist who is overseeing a Veteran's Affairs service dog study at in Atlanta VA, says that the theory is that that Service Dogs "can serve as a bridge to get them past that initial fear. That way, they can get out more and engage in therapy so they can eventually free themselves of that excessive fear response." In addition to accompanying the handler outside the home, there are numerous tasks and therapeutic functions that a Service Dog may be trained to provide. Typically this training focuses on leveraging the dog's natural senses to help the handler interpret the world around them. With PTSD, a person can't always trust their own senses. Relying on a service dog's incredible hearing, smell, and other senses, allows the handler to be reassured that the environment they are currently in is not dangerous.

HEARING


  • If you listen carefully to an old-school TV that has a picture tube, you can hear a high-pitched whine at the very upper end of your high-frequency hearing, which is about 16,000 Hz. Dogs hear up to 50,000 Hz. We would have to add 48 extra notes on the high end of a piano to hear that high. This measure of a dog's incredible hearing help explain why some dogs hate some vacuum cleaners and power tools - these types of equipment may have rapidly rotating shafts that can produce intensely loud shrieks - but the noise is so high that we can't even hear it.
  • dog's hearing is also considerably more sensitive to quiet noises than our hearing is. We can hear down to 0 decibels, but a dog can hear down to an amazing -10 decibels...that's minus ten decibels.[10]

SMELL


  • A dog's sense of smell is incredible, too. When James Earl Ray, the assassin of Martin Luther King, Jr., escaped from the maximum security Missouri State Penitentiary while serving another crime, a trained dog named Buttercup tracked him from his scent trail, finding him his hiding place seven miles away.
  • Service Dogs have also been used to find where pipelines have been leaking. In the first time service dogs were used for this purpose, at the request of gas company, trainer Glen Johnson inspected the first 20 miles of a natural gas pipeline in the Province of Ontario in Quebec - and found leaks, later confirmed, at a distance of 40 feet underground.[11]
Because of a dog's increased range of hearing and smell, in conjunction with the relationship between the Service Dog and its handler, Service Dogs provide an excellent source of real-time information about potential threats in the environment. For instance, if the handler suddenly goes on high-alert because of a noise at night or upon entering a dark room, they can double-check their responses against that of their Service Dog. Unless the dog's hackles (neck hair) are up, or the dog is wild-eyed and alerting to danger, the handler can relax and remain calm in an unthreatening situation. Moreover, as mentioned previously, with PTSD, it's easy to feel alone because of the trauma one has experienced in the past. But with a service dog, the handler is not alone - they can go out in public with their service dog (many children have their dogs with them 90% of the time they are not in school). Having a constant companion provides positive feedback in situations that might otherwise be stressful for those suffering from PTSD. These dogs also reduce the stigma of PTSD; it provides the handler an opportunity to interact with the public in a positive and supportive way.

Triggers

There are two kinds of PTSD triggers: trauma-specific and environmental.

1. Trauma-Specific

A PTSD Service Dog does not prevent trauma-specific triggers.

An example would be a veteran who is triggered by the sound of helicopters (and the dog would not prevent helicopters from coming around).

2. Environmental

A Service Dog for PTSD can help prevent environmental triggers.

The Service Dog can help the handler get more personal space in public, and do so without attracting attention that the handler doesn't want. The dog can be used as a buffer and keeps other people from unexpectedly getting right next to the handler. Thus, the intensity of being out in public can be reduced to a nice lower level...and the handler can feel much better about going out in public again.
  • Stress alerting. In a stressful situation, it can be easier to see how a dog is reacting (panting, licking, looking away constantly, and other stress-reduction techniques specific to dogs) and thus the handler can realize that both the dog and handler need a break. Also, once the dog is fully bonded to the handler, often the dog will pick up on the handler's stress levels and alert the handler that they are becoming stressed (even before the handler would notice the symptoms in themselves), and in this way, the dog becomes a biofeedback tool. (Also, the dog can be used as an excuse for the handler to remove themselves from the stressful situation.) 
  • Medication reminders. The dog can be trained for the task of reminding the handler to take their medication, thus keeping all the effects that happen when the handler doesn't take their medication regularly.

SECONDARY INTERVENTIONS


After a symptom occurs, then a Service Dog can help, too. 

  • After the handler starts to react to either a trauma-specific trigger (such as the sound of a helicopter) or environmental trigger (such as people getting too close to the handler), the dog can be a calming presence, thus reducing the effect of the triggering.
  • The handler can be trained to focus on the dog during these attacks--instead of focusing on oneself, the dog helps the handler get out of their head and into the moment.
  • The Service Dog can be physically placed directly between the handler and the triggering event.
  • The dog can be used as a source of emotional stability and comfort.
Residual Effects
With continued use of a PTSD Service Dog, the handler can find that their overall stress is reduced. In this new, less-stressed state, the handler is less sensitive to their triggers (both primary and secondary triggers). Also, the handler can get better sleep, which reduces overall stress and leads to a better ability to handle future stress. These reductions in overall stress can lead to:
  • Less hypersensitivity (to sounds and other triggers)
  • Fewer flashbacks
  • Better concentration
  • Less insomnia
Other Benefits
Residual effects also help with inappropriate emotional responses often associated with PTSD:
  • Depression: The handler can no longer be tempted to stay in bed all morning (or worse, commit suicide), because the dog must be walked and fed and taken care of.
  • Anger: The temptation to lose one's temper is inhibited when the handler realizes their not alone any more, and their actions will directly affect their Service Dog. For instance, if the handler feels like they are so angry that they might be arrested for their behavior, the fact that their dog would be impounded keeps the handler from giving in to their outbursts.
  • Dissociation: It's easy to "check out" for long periods of time, but when the dog is fully bonded to the handler, the dog will often need, want, and request attention, thus bringing the handler back to the here and now.
[1] Effectiveness of Psychiatric Service Dogs in the Treatment of Post-Traumatic Stress Disorder among Veterans, by Dr. James Gillett, PhD, Mcmaster University and Rachel Weldrick, BA, McMaster University.
[2] 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.  
[4] 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.
[5] Western Journal of Nursing Research, McCabe, B. W., Baun, M. M., Speich, D., & Agrawal, S. (2002). 24(6), 684-696.
[6] International Psychogeriatrics/IPA. Filan, S. L., & Llewellyn-Jones, R. H. (2006). 18(4), 597-611.
[7] Psychosomatic Medicine, Allen, K., Blascovich, J., & Mendes, W. B. (2002). 64(5), 727-739.
[8] The Journals of Gerontology, Series A, Biological Sciences and Medical Sciences. Banks, M. R., & Banks, W. A. (2002). 57(7), M428-M432.
[9] 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.
[10 and 11] "How Dogs Think", Stanley Coren, Simon and Shuster, 2004.

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