These disabilities are usually complicated by PTSD.
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Even though we work with veterans who have multiple disabilities, why do we place so much focus on PTSD?
- Most veterans with multiple disabilities also have PTSD, and PTSD complicates everything.
- Post-Traumatic Stress Disorder (PTSD) and/or Traumatic Brain Injury (TBI) are the "signature injuries" of the Iraq and Afghanistan wars [1]. These injuries occur so often in part because more soldiers are surviving blast injuries due to improved torso protection, surviving only to live with the percussive head wounds (and resulting PTSD).
Post-Traumatic Stress Disorder involves an underlying state regulation disorder, which is often hypersensitivity to sound. Other clients we have worked with have had hypersensitivity to crowds or to specific sounds such as helicopters. A service dog can significantly help with some of the major symptoms and improve one's overall quality of life.
Goals with a service dog
- Improving one's 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 hours volunteering or working
- Decreasing the need for healthcare
Symptoms and tasks[4]
Note: This list is from a study. Please also see our page on how service dogs help with PTSD.
- Reclusiveness: The dog accompanies the handler outside the home.
- Startle Reaction: Dog-defined personal space perimeter.
- Neurochemical Imbalance: Team walks to stimulate endorphin production.
- Dissociative Flashback: Tactile stimulation mediates sensory reintegration and orientation to time/place.
- Startle Response: Alert to the presence of others (i.e., 'pop a corner' or 'watch my back’) work--leveraging a dog's natural senses.
- Emotional Regulation: The dog can be used as a therapeutic distraction.
- Sensory Overload: The dog can be used as an alternate focus.
- Social Withdrawal: Dog-facilitated interpersonal interaction (social bridge), which helps with community integration.
- Lack of Insight: An alert to emotional escalation, by leveraging a dog's natural senses.
- Hyper-vigilance: Dog provides an environmental threat assessment when the handler learns to leverage a dog's natural senses.
- Hallucinations: Dog-facilitated reality testing by leveraging a dog's natural senses.
A 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.
TRIGGERS
There are two kinds of triggers: trauma-specific and environmental.
A service dog does not prevent trauma-specific triggers.
An example would be a veteran who is triggered by the sound of helicopters (the dog would not prevent helicopters from coming around).
What a service dog does do:
A service dog 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). Thus, the handler can realize that both the dog and the 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 an 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 the continued use of a 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, fed, and taken care of.
- Anger: The temptation to lose one's temper is inhibited when the handler realizes their not alone anymore, and their actions will directly affect their Service Dog. For instance, if the handler feels that 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.
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 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."
Reduce Isolation
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 when going to the mall, grocery shopping - everywhere.
Other Functions
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, the handler is reassured that the environment they are currently in is not dangerous.
Leveraging 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 a sentence for another crime, a service dog named Buttercup tracked him from his scent trail, finding him in 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 the 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]
Leveraging 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.
- A 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.[11]
Because of the 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 an unexpected 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.
A PTSD service dog from Pawsitivity can help:
- Remind the handler to take medication.
- Remind the handler to perform her or his daily routines.
- Wake the handler to prevent him or her from sleeping too much.
- Assist handler in creating a safe personal space in public, serving as a physical buffer to calm handler and reduce feelings of emotional distress in crowded places.
- Reorient and "ground" the handler to the current place and time when struggling with PTSD episodes.
- During a panic attack, a psychiatric service dog can assist the handler by providing tactile stimulation.
- Assist the handler when he or she tries to relax (self-soothe) in order to complete uncomfortable tasks.
- Accompany while in stores and other environments to reduce the stress associated with daily activities, as well as facilitate social interactions and reduce the fear associated with meeting new people.
- Alert when the handler is starting to experience anxiety problems reminding the handler to take his or her medication.
- Remind the handler to take walks, which encourages the handler to be more social and increases the amount of exercise the handler gets. This also helps the handler keep a constant schedule and will be a reason to get out of bed in the morning.
[1] Case Reports, Journal of Psychosocial Nursing and Mental Health Services, 2010 Feb;48(2):22-8. doi: 10.3928/02793695-20100107-01.
[11] "How Dogs Think", Stanley Coren, Simon and Shuster, 2004.