Animal-Assisted Therapy for Post-traumatic Stress Disorder: Lessons from “Case Reports” in Media Stories

Abstract

Post-traumatic stress disorder (PTSD) can follow war trauma, sexual abuse, other traumas, and even be experienced by commanders for the PTSD of their subordinates. Medications and counseling are sometimes not effective, so new treatments are needed. Some years ago, I suggested that animal-assisted therapy (AAT) (pet therapy) might be beneficial for PTSD. A large randomized controlled trial is underway of canine-assisted therapy for PTSD. Randomized controlled trials are most useful in assessing the efficacy of a medical intervention as these trials control for known and unknown biases. However, due to their very nature and rigorous requirements, knowledge gained from randomized controlled trials may need to be supplemented from other kinds of studies. Here, I note that media reports of AAT for PTSD may effectively function as case reports and suggest further studies: For PTSD, these demonstrate that (1) AAT can be dramatically effective in improving PTSD symptoms; (2) there is the potential for benefit from AAT by multiple different animals besides canines for PTSD; and (3) AAT may have a role in preventing suicide in patients with PTSD.

Post-traumatic stress disorder (PTSD) can follow war trauma, sexual abuse, or other traumas.¹ PTSD symptoms can also be experienced by caregivers of individuals with PTSD,² or even commanders for the PTSD of their subordinates.³ Medications and counseling are sometimes not effective,¹ so new treatments are needed.

Some years ago, I suggested⁴ that animal-assisted therapy (AAT) (pet therapy) might be beneficial for PTSD. After a promising preclinical study⁵ and proposal of treatment strategy,⁶ AAT is now being commonly used for PTSD with anecdotally reported significant benefits.⁷ However, there has not been much formal study,⁸ although a large randomized controlled trial (RCT) is underway.⁹

RCTs are most useful and uniquely powerful for assessing the efficacy of a medical intervention while controlling for known and unknown biases. Due to the very nature of the rigorous requirements for a well done RCT, information learned from an RCT in terms of interventions, patient groups and outcome measures can be supplemented by other studies. In the RCT for PTSD, canine-assisted therapy is being studied. Also, out of appropriate concern for the risk of suicide in untreated or “placebo-treated” PTSD, the control arm of the trial is an emotional support dog vs. a service dog as the treatment arm. Benefit thus might not be found of treatment vs. control. However, this would still be a most useful result given the much lower cost of an emotional support dog compared with a service dog. Indeed, in my original proposal⁴ of AAT for PTSD, the patient described therein benefited from “merely” a “regular” pet dog.

Information gained from RCTs can be supplemented and complemented by case reports or case series. However, doing a case series of even two patients requires institutional review board approval, and the burden of time, paper work, and cost can be so great as to limit doing these studies.

It turns out, fortuitously, for AAT for PTSD in combat veterans, we can right now find a tremendous number of cases by simply examining media reports of such. Furthermore, the media reports typically have more detailed information than would ever be allowed to be published in typical medical case reports.

The New York Post recently ran a story¹⁰ about a U.S. Marine veteran, Bobby Peeker, a combat engineer whose job in Afghanistan was searching for roadside bombs. While deployed, according to the article, the veteran experienced ambushes, and four men in his company were killed.

To try to deal with the PTSD, Peeker started drinking. According to the article, after therapy and medication, he was able to stop drinking but the PTSD remained. Indeed, the story quotes Peeker as being “in a dark place, a funk.” “I was always depressed, constantly thinking about when I was deployed.” Then Peeker was able to obtain a service dog. The dog, Sapper, was extremely helpful in terms of PTSD symptoms and signs. “He’s gotten me out of the house,” said Peeker. “He’s pulled me out of a dark place.” And 4 mo after receiving Sapper, Peeker was beginning to be weaned off his medications.

Peeker was even able to go back to work in a job repairing roads. But this job would not let him bring Sapper with him. Without Sapper, Peeker had panic attacks so severe it took “lengthy phone calls with his therapist to calm him down,” and so Peeker had to leave this job.

Peeker then interviewed for a job with a security company working with a dog to sniff out explosives. This employer agreed to allow Sapper to be trained as a bomb sniffing dog. The president of the security company described Peeker’s and Sapper’s job performance thus, “They are excelling – one of the best teams we have.”

This article describes the case of an individual with a classic risk factor for developing PTSD – personal experience of the trauma of war – who developed severe PTSD with severe social and vocational dysfunction and anxiety not relieved by medications or counseling. AAT greatly alleviated PTSD symptoms, improved social functioning, and the patient was able to go back to work full time! This case is also a demonstration that a PTSD service animal can also be trained to function simultaneously at a high level for other tasks.

Dogs are the most commonly used animals for AAT for PTSD – indeed, an Internet search shows numerous organizations devoted to providing service canines for individuals with PTSD – but certainly are not the only animals. Horses too now are being used to treat PTSD – equine-assisted therapy. A recent news report describes the cases of two combat veterans whose PTSD symptoms were significantly alleviated by equine-assisted therapy.¹¹

The first individual was a Vietnam War combat veteran who had a 40-yr history of PTSD not alleviated by many years of counseling. He felt that equine therapy “saved my life.” The patient’s wife similarly felt that equine therapy was effective after years of other methods of therapy were not. The patient commented about equine therapy, “When I first came here, I didn’t know what to expect. But what I found was inner peace. Peace, peace, peace, everybody talks about peace. But you really don’t know it if you’ve never had it. And this is peaceful.” “It felt good. Real, real good. It’s really hard to explain. Very quiet. Knowing I was safe. You interact with the horses, you don’t spook or jump them, you just kind of walk up to them and they walk up to you, and you just start up a relationship. But you gotta be totally open with them, and honest. You can’t show any fear or anything.”

Another Vietnam combat veteran discussed in the story commented on equine therapy, “It’s very soothing. It’s like if you had a horrible story on your mind and all of a sudden that mind trauma just faded.” “I can’t explain it, it’s just being with that horse, it’s super peaceful.” “The first time I went [for equine therapy] was to pick a horse out, and he actually came up to me. I nicknamed him Blue.” “The second time I went over, I was really upset, and by the time I left, I felt great. It’s a feeling I can’t really explain, but every time I go by there, I say “hi Blue.”” “The last time I was down there I was brushing the horse. And he just stood there. Have you ever seen a cat when you just rub him and his eyes just kind of squint? Well, that’s what the horse did, and it just made me feel so good that he could understand me.”

“It’s my highlight of the week to go see that horse. For the last couple of weeks, I’ve been a lot more mellow. When I drive, I’m not as tense. When I’m with my wife, we are much closer together. I’m looking forward to more of that.” The veteran’s wife also feels equine therapy has been extremely beneficial. “[My husband] is a lot more cheerful. The horse that [he’s] working with seems to be very sensitive and gentle, and I think some of that has transferred to my husband.” “[He] has always had so much trouble living in the past with all of his PTSD memories. I think that he is learning the value of learning to live in the present. It’s a plus for both of us.”

Animals useful in treating PTSD symptoms are not just mammals. A TV news report describes the case of a combat veteran with PTSD whose symptoms were significantly alleviated by working with parrots.¹² (Interestingly, these parrots are at a bird sanctuary after they themselves were rescued after they were traumatized.) The veteran in the news story describes how after returning home after his duty tour he was too anxious to go outside if he thought he was going to be in a crowd, and he could not drive because cars that might cut into his lane reminded him of explosive-laden cars that had cut into combat convoys. He found working with the parrots alleviated his anxiety and allowed him to do activities he could not previous to working with the birds, and that also his nightmares occurred less often.

For a final case, we return to canine therapy. An extremely powerful video¹³ from the Paws for Veterans organization¹⁴ shows an interview with a U.S. Marine combat veteran with PTSD. The veteran describes how he had severe migraines and anxiety to the point of beginning to load his service revolver to commit suicide. At this point, his dog jumped onto his lap. The veteran pushed the dog away, but the dog would not be deterred. The veteran changed his mind about a suicide attempt. The veteran said that the dog would wake him up in the middle of the night when he was having a nightmare and that he would, initially, only leave the house to go for training with his dog. The veteran’s PTSD symptoms have continued to improve, and he credits his dog fully for this.

These media stories are often as detailed – sometimes even more detailed – than medical case reports. Further, as these are public and often freely and widely distributed, these receive “post-publication” review. These stories suggest a number of hypotheses about AAT for PTSD that are worthy of future formal study: (1) AAT can be dramatically effective in improving PTSD symptoms; (2) there is the potential for benefit from AAT by multiple different animals for PTSD; (3) AAT may have a role in preventing suicide in patients with PTSD. Media case reports certainly have the potential problem of selection bias – pet therapy not working out does not sell newspapers or TV ads. But there is a similar bias in published medical case reports – the file drawer effect of ineffective cases not being submitted for publication. Information from media “case reports” provides valuable information on AAT for PTSD and suggests ideas for future RCTs and other formal studies.