Adolescents and Animal Assisted Psychotherapy- A Review of the Evidence

In this blog, I will be summarizing three research studies that support the effectiveness of Animal Assisted Psychotherapy with teens. Each study evaluated the use of AAIs (Animal Assisted Interventions) either with horses or with cats and dogs.  The information from these studies is highly useful, because it shows real and tangible evidence of the effectiveness and benefits of AAT with the adolescent population.  If you are a parent or a consenting teen, you may be curious about whether incorporating animals into therapy is truly helpful for you.  Let's take a look at some of the studies and statistics that can help answer that question. 

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"The Use of Animal-Assisted Therapy in Adolescents that have Acute Mental Illness" by Maria Cristina Stefanini and Franca Tani. 


Population
In this research article, a study was conducted with a sample of 34 adolescents, aged 11-17 at the Child Neurology and Psychiatry Unit of Meyer Pediatric Hospital at the University of Florence. They were selected for having an acute psychiatric diagnosis, being of developmental age, and able to give informed consent.

Research Approach/Methodology

The aim of this study was to compare the effects of Animal-Assisted Therapy (AAT) with a standardized treatment protocol in children and adolescents admitted to the psychiatry hospital for acute mental disorders. The research approach was a randomized controlled trial. The selection criteria involved randomization of patients into treatment or control groups. At the beginning of the AAT intervention, there were no differences in patients' demographical, behavioral and clinical condition in the control and treatment groups. Evaluators and clinicians were blinded about which treatment group a patient was in. Patients participated in weekly sessions for 3 months with four phases: familiarization with the animal and the handler; individual intervention; group activity; discussion of the AAT experience. Three methods of measurement were used: The Children Global Assessment Scale (C GAS), format of hospital care, and ordinary school attendance which was measured by a rating scale.

Results

The findings verified that AAT can have significant positive effects on therapeutic progress and recovery process. Participants also showed a significant increase in their global functioning, a significant reduction of time spent in hospital, and a significant increase of ordinary school attendance compared with the control group patients.

Critique

The strengths of the study were that it used high quality standards of eliminating variables as much as possible, and using 3 assessment measures. The study was conducted in accordance with the guidelines for the ethical treatment of human participants of the American Psychological Association. Protocol research was approved by the hospital ethics committee. It is also the first study to investigate how an AAT program can have an impact on the care process such as length of hospital stay. The study lacked follow up at 6-12 months afterward. The study also had a small selection of participants and did not explore which target populations benefited most from AAT (Anxiety Disorders, Mood Disorders, and Eating Disorders.)

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"Whispering to Horses: Childhood Sexual Abuse, Depression and the Efficacy of Equine Facilitated Therapy" by Tania Signal, Nik Taylor, Helena Botros, Kathryn Prentice, and Kathryn Lazarus.

Population
This study researched three differing age groups; children, adolescents and adults. Participants included 15 children (aged 8-11 years), 15 adolescents (aged 12-17 years) and 14 adults (aged 19-50 years) with 10 of the 44 participants identifying as Indigenous Australians. This study aimed to evaluate and compare the efficacy of an Equine Facilitated Therapy (EFT) program run by Phoenix House (a sexual assault referral center in Queensland, Australia).

Research Approach/ Methodology

This was a quasi-experimental, repeated measures design which was used to evaluate changes in depressive symptoms with all participants, which were measured using the Child Depression Index or Beck Depression Inventory at three points in time. Comparisons of change scores between Time 1 (intake to service) and Time 2 (post in-clinic counseling for 6.6 weeks for child group; 6.4 weeks for adolescent group; 2 weeks-12 months for the adult group.) and Time 2 and Time 3 (post-Equine Facilitated Therapy for 9-10 weeks). A repeated-measures analysis of variance (ANOVA) was used to assess change scores between Time 1, Time 2 and Time 3, and to test the hypothesis that the EFT program was effective in decreasing depression symptoms in participants.

Results

Children- Post-measures indicated that there was no significant change in reported symptoms of depression between data collected at Time 1 and Time 2, while, CDI scores from Time 3 were significantly lower than those at Time 2, indicating a significant decrease in reported depressive symptoms. The children's average score on the CDI scored above the cut off for clinical depression at Times 1 and 2 but falls well below the cutoff at Time 3 following the EFT program.
Adolescents- The study indicates a significant improvement in reported depressive symptoms. The teenagers show a fall from an average rating of ‘moderate’ depression at both Time 1 and Time 2 to ‘mild’ depression at Time 3.
Adults- Although not significant, a consistent trend showed that the older the women in the adult group, the larger the change in scores from Time 2 to Time 3. Average ratings of BDI scores shifted from ‘moderate’ at Time 1 and Time 2 to ‘minimal’ at Time 3.

Critique

The strength of the study is that it shows treatment effectiveness with Equine Facilitated Therapy is not dependent on age, gender or ethnicity. It mentions that previous literature regarding treatment effects for internalizing symptoms (such as depression) following childhood sexual abuse suggests that EFT results were much more significant than seen following TF-CBT, for children and adolescents. Some limitations are that further studies would benefit from measures to assess which type of animal is most effective, and measures for animal welfare and wellbeing. Another limitation is the small numbers of indigenous participants and the lack of other ethnicities in the sample. Greater inclusion of male CSA survivors would also be beneficial due to evidence that women experience depression as a result of Childhood Sexual Abuse.

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"Equine-Assisted Psychotherapy for adolescents experiencing depression and/or anxiety: A therapist’s perspective" by Kaitlyn Wilson, Melissa Buultjens, Melissa Monfries and Leila Karimi.

Population

The study was conducted in Victoria and New South Wales, Australia, among therapists currently registered with the EAGALA and offering EAP to adolescents diagnosed with depression and/or anxiety. Participants were obtained through a Google search for EAP programs in Australia. Three of the eight therapists interviewed were registered psychologists, three participants held undergraduate and postgraduate degrees in psychology, and the final two participants were horse specialists on EAP teams, who also held qualifications in psychology, enabling them to provide a deeper insight on the horse's behaviors in therapy sessions.

Research Approach/Methodology
The study uses a phenomenology framework which seeks to create knowledge and an understanding of the lived experience of individuals in regard to a particular phenomenon. The method of obtaining data was through interviews. A semi-structured interview schedule that included open-ended questions was developed for the study. The interviews typically lasted between 30 and 45 minutes, asking such questions as:
What motivated you to start working as an EAP therapist? What are the features of EAP that distinguishing it from other therapy methods? What are the key factors that facilitate change, specifically within the adolescents?
Data analysis was conducted using thematic analysis which allows for the recognition and analysis of common ideas or themes within the therapist transcripts. Data analysis yielded three master themes including: The nature of EAP, clinical implications of EAP, and the practice and limitations of EAP.


Results
The interviewed therapists commented that the experiential characteristic of EAP allows an adolescent to become an active participant within the session, to be able to experiment and ‘do’ rather than be a passive client sitting in a chair. It eliminates feelings of pressure to talk in a therapeutic setting. Therapists believed that the experiential nature of the therapy gives the adolescent the opportunity to experiment within safe boundaries, try new behaviors and to judge if these behaviors are more effective the ones they used previously. The therapists highlighted the ability to create a relationship with the horse during therapy. This is particularly beneficial for those adolescents who have difficulties forming relationships, especially those who have been previously ‘let down’ or ‘failed’ by adults. Therapists in the study also stated that the adolescents always progressed during each session, even if the changes were only small. The therapists believed that the marketing and advertising of EAP was overlooked and ignored due to the low prominence assigned to it by the medical community. They reported that EAP requires more research so that it can be considered a viable evidence-based practice.


Critique
One strength of this study was only interviewing therapists who were conducting EAP under the EAGALA model, ensuring a level of standardization. One limitation of this study is that it relies on the therapist's self-reported experience with their use of EAP. EAP in Australia has been identified as particularly successful for the adolescent population experiencing depression/anxiety, however more empirical evidence that is culturally convergent is missing and required to assess the validity of EFP when treating children and adolescents of various populations.

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Conclusion

The second study I summarized was particularly useful as a therapist which specializes with teens and trauma. It explored the adolescent population with a history of childhood sexual abuse. This being a traumatic experience which may conversely, but not as effectively, be treated with Trauma Focused CBT. The first and third article examine adolescents with depression and anxiety which are common manifestations of difficult life experiences. 

I hope to have provided a practical reference to some of the studies which correlate with AAP's effectiveness with adolescents, even though the field still lacks substantial research. Finally, some questions remain unanswered about this population in order to gain adequate knowledge of the application of AAP: How does AAT differ from AAP with this population? How do felines measure up when working with adolescents who have experienced trauma? Are there any research studies with felines in AAP? Are there any animal welfare research studies when working with traumatized adolescents? Are there any qualitative studies with adolescents using AAP, so that therapists can gain self-reported feedback about experiences, feelings, and the meaning of AAP for adolescents?

 

References

 
1. Stephanini, M.C. et.al. (2015) The use of Animal-Assisted Therapy in adolescents with acute mental disorders: A randomized controlled study. [Online]. Available: in Complementary Therapies in Clinical Practice. https://www.researchgate.net/publication/272624422_The_use_of_Animal-Assisted_Therapy_in_adolescents_with_acute_mental_disorders_A_randomized_controlled_study [May 25th, 2018].

2. Signal, T. et.al. (2013) Whispering to Horses: Childhood Sexual Abuse, Depression and the Efficacy of Equine Facilitated Therapy [Online]. Available: Sexual Abuse in Australia and New Zealand, 5(1): 24-32. https://www.researchgate.net/publication/237145214_Whispering_to_horses_Childhood_sexual_abuse_depression_and_the_efficacy_of_Equine_Facilitated_Therapy [May 25th, 2018].

3. Wilson, K. et.al. (2013) Equine-Assisted Psychotherapy for adolescents experiencing depression and/or anxiety: A therapist’s perspective. [Online]. Available: Clinical Child Psychology and Psychiatry 2017, Vol. 22(1) 16 –33. http://journals.sagepub.com/doi/pdf/10.1177/1359104515572379

 

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