The use of animals in care and in schools is becoming increasingly common. The acceptance in society of the positive effect of animals is increasing and visiting a therapy dog at school is now not uncommon. For example, having the opportunity to pat a dog as comfort when everything feels difficult is beneficial. In schools in particular, the relationship between children and animals is often regarded as simpler than that between children and adults.
Animals are also becoming more common in the care of the elderly. It may be animals visiting a nursing home from the farm, such as a rabbit, a chicken or even a horse. Some nursing homes now have a resident dog or cat. The interesting factor here is that acceptance has increased despite the fact that there are not very many concrete scientific results.
Acceptance is not yet as prevalent in terms of animals as a resource in schools, care and rehabilitation.
Positive outcomes from animal-assisted treatment have been identified in psychotherapy and in situations where people experience a lot of stress. Studies have been carried out on many different target groups, such as students, children in hospitals, people with PTSD, children with autism, the elderly and dementia patients. The vast majority of research studies are relatively small and lack significant results (e.g., Parbery-Clark et al 2021). Some of the studies are randomised (known as RCT studies), but still not very large. Factors that have been investigated include the effects of animals on stress level, anxiety, worry, blood pressure, pulse rate, heart variability, and biomarkers such as cortisol. One study showed that university students who were at risk of failing their exams and who got to interact with therapy dogs, reduced their anxiety and worry and changed their study strategy to succeed in their academic studies (Pendry et al 2020). For students with already well-functioning study strategies, therapy dog treatment had no effect. The study is one of the few major randomised studies with significant results.
Residents of a Swedish nursing home who got to spend time with a dog had lower heart rate and blood pressure (Handlin et al 2018) and higher fingertip temperature. The elevated fingertip temperature is probably due to a decrease in the activity of the sympathetic nervous system and therefore indicates a decrease in stress level (Nilsson et al 2020).
In order for animal-assisted interventions to really become a natural part of healthcare, politicians, other decision-makers and health-care professionals need more scientific results in the form of larger randomised studies (Fine & Andersen 2021). It is therefore unfortunate that the scientific studies are increasingly concerned with summaries of other research, where author after author states that more randomised studies are needed. Part of the explanation for producing summaries and not RCT studies is that providing summaries is simple and relatively inexpensive. Carrying out an RCT study requires a large amount of data to be collected from several different activities which carry out their program in a similar way. This is not simple, and it takes time, resources and, ultimately, a lot of money to instigate an RCT study, which sits poorly with research funding today. Priority is given to fast-track projects that produce quick results and cost less money.
This is why we end up with small research projects and lots of summaries.
That being said: It is interesting to note that, despite a lack of evidence, animals are still considered to be a good complement to care providing increased comfort and facilitating the care.
Horses are frequently used for both physical and mental treatment. The idea that this works for physical development and improvement has been quite well refuted. However, there is less research into horse-assisted interventions for better mental capability and social development (Kendall et al 2015). Many of the studies are small and unable to identify any significant results. Most of the research has been devoted to horse-assisted treatment in children with autism and there is one randomised study that shows that social motivation increases, and that inattention and distraction decreases in children who interact with horses compared to children without contact with horses (Bass et al 2009). Other studies, often small ones, show that horse-assisted interventions have a positive effect on ADHD, schizophrenia, intellectual impairment, cerebral palsy and are effective in helping young people who are 'at-risk' (Kendall et al 2015). Horse-assisted interventions have also proved to assist with post-traumatic stress, and American veterans experience less stress and anxiety when participating in horse-assisted therapy (for example, Romaniuk et al 2018, Johnson et al 2021). Horse-assisted interventions also increase quality of life, prevent isolation and increase the activity levels of people with neurological disorders (Palsdottir et al 2020).
Green Care is a concept in which agriculture and the associated animals and activities, which are used primarily in day-to-day activities, are also used in care, therapy and rehabilitation. In this case, it is also important to note that there are a lot of review studies summarising this field from different perspectives, in fact almost as many surveys as there are completed projects. One of these is a summary of studies in the Nordic countries showing that people in Green Care (people with mental and/or drug problems, or people not in work or education, who need some form of daily activity) become better at managing different situations, have better mental health, are more physically active, have a better structure to their everyday life, and experience more meaningfulness, when animals and nature are included as a assistive element of their activity (Steigen et al 2016). Contact with animals, the natural surroundings, the role of the group leader, the social acceptance and cohesion of other participants and the meaningful and customised activities that participants engage in, are all important factors in the enterprise. This therefore produces a very positive result. Another of the survey studies concludes that the greatest benefit from Green Care is that the participants appreciate meeting up, that they feel they are doing something worthwhile and that they feel satisfaction and belonging (Murrey et al 2019). The authors believe, however, that the evidence that Green Care reduces depression and anxiety, is questionable and that there is no evidence of an improved quality of life. This is therefore a much more modest result than that found in other studies. As usual, larger, randomised studies are demanded.
The quality of nature visits increased when children with disabilities and their carers participated in a course on nature and animals (Sahlin et al 2019), the well-being of both users and carers increased, and their relationship was positively affected. The authors argue that nature- and animal-based education should be provided more often for groups with different disabilities.
/Text: Ann Dolling
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