Running Head: BENEFITS OF PET THERAPY UTILIZATION

The Use of Pet Companions by Veterans Following a Traumatic Event and how it Influences

their Mental Health

Gina Bellotta, Taylor Hassay, Taylor Tofil and Taylor Minenok

04/10/2019

NURS 3947: Nursing Research

Dr. Valerie O’Dell

EFFECTS OF PET THERAPY UTILIZATION 1

Abstract

The purpose of conducting this research was to explore the effectiveness of veterans with

post-traumatic stress disorder utilizing pet companions as a source of therapy. When considering

the use of pet therapy, the defining characteristics of post-traumatic stress disorder and what

exactly pet therapy is, were both included. Personal stories about both veterans with post-

traumatic stress disorder and veterans with post-traumatic stress disorder who made use of pet

therapy were researched and used as examples. Implementation of pet therapy was researched

and illustrated along with the comparison of the mental health of veterans with post-traumatic

stress disorder before and after the utilization of pet therapy. It was discovered that the use of

pet therapy for veterans with post-traumatic stress disorder provided great satisfaction and put

their minds and bodies at ease. The presentation of personal experiences contributed by these

veterans offered great support towards how beneficial pet therapy is. Overall, the research that

was organized manifested how influential post-traumatic stress disorder can be on a veteran’s

daily life and how the use of pet therapy can drastically improve their quality of life.
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The Use of Pet Companions by Veterans Following a Traumatic Event and How it

Influences their Mental Health

Veterans who return home from prolonged periods of military and combat exposure,

often do not completely leave their experience behind. Post-traumatic stress disorder is

something that many veterans carry with them for months, years, or even the remainder of their

lives following their traumatic event. Sometimes the adverse effects that derive from post-

traumatic stress disorder cannot be single-handedly resolved. The use of pet companions and

service dogs have exhibited a great influence on the mental health of these veterans experiencing

post-traumatic stress disorder. Many studies and statistics have shown how beneficial the use of

pet companions and service dogs can be for a veteran with post-traumatic stress disorder and

how it has improved their quality of life. This use of therapy is not only rewarding for the

victim, but also for the people surrounding them, like their spouse or children, who have seen

how post-traumatic stress disorder has affected their loved one. With that being said, the

following research question has been addressed: In veterans with post-traumatic stress disorder,

how does the use of pet companions or service dogs, compared to not having pet companions or

service dogs influence their mental health in the years to follow a traumatic event?

Literature Review

Introduction

When approaching the research on the use of pet companions and service dogs,

information was acquired from eight different sources that were retrieved from OhioLINK

databases. The information obtained from these resources were carefully analyzed to be used for

the data collection concerning the benefits of veterans utilizing pet companions and service dogs

in comparison to veterans who do not and how it influences their mental health. Several topics
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will be discussed in the following research that has been conducted, including: what post-

traumatic stress disorder is and how many people it has effected, what pet therapy is and the

different pets that have been used for it, personal stories emerging from post-traumatic stress

disorder and the use of pet therapy, comparisons between people who have used pet therapy

versus people who have not, and how pet therapy can be implemented.

Defining Post-Traumatic Stress Disorder

Post-traumatic stress disorder, also known as PTSD, is a trauma induced stress related

disorder that negatively affects the mental health and quality of life of populations that are

exposed to traumatic experiences such as those experience war (active duty members and

veterans), sexual assault, and natural disasters (Bremner, et al., 2017). Most commonly the event

of experiencing violent combat in military deployment is associated with a high risk for

developing PTSD. In a journal from The Lancet Psychiatry exploring the second phase of

MDMA-assisted psychotherapy for military veterans with PTSD clinical trial, Mithoefer, M.C.,

et al stated how PTSD is a major public health problem that affects 8% of the population and

17.1% of those in the military and veterans (Mithoefer, et al., 2018). Veterans and military

personal have a higher rate of overall incidence compared to the general public but other

populations also experience higher rates as such as those mentioned above including survivors of

sexual assault and natural disasters. Comparing genders, however, Yehuda, R. & Hoge, C.W. et.

al stated in the journal article, “Post-traumatic Stress Disorder,” from Nature Reviews Disease

Primers that PTSD is twice as common in women than in men (2015).

Symptoms of PTSD range in severity and triggers. In an article on PTSD from the New

England Journal of Medicine the authors stated, “PTSD is marked by symptoms of “persistent

intense reactions to reminders of a traumatic event, altered mood, a sense of imminent threat,
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disturbed sleep and hypervigilance,” (Shalev, A., M.D. & Liberzon, I., M.D. et al, 2017). This

condition affects a vast amount of differing biological systems in one’s body including their

neurochemistry (brain wiring) and their cellular, endocrine, metabolic, and immune functions.

This causes a severe psychological and emotional burden for those with PTSD and is found to be

correlated with a decrease in quality and satisfaction with their life, increase risk of suicide,

cause occupational and relationship complications, and overall increased medical morbidity

(Mithoefer, M.C., & Mithoefer, A.T., et al (2018). Other symptoms including depression, denial,

avoidance, and helplessness all aid in exacerbating these problems above along with many others

that heavily affect their daily functioning and lives.

One major relationship problem deals heavily with the family. The family environment is

interconnected impacting each and every single family member of a veteran with PTSD; it

doesn’t just affect the person with the diagnosis:

Two major themes emerged on the impact of PTSD on veterans’ family relationships and

how these relationships impact healing from trauma: emotional numbing and anger

negatively impacts familial relationships; and emotional withdrawal from family support

creates a struggle with healing from trauma (Ray, S.L. et al, 2009, pg 838).

Emotional numbing and anger are two of the main symptoms associated in those with PTSD that

often cause problems with personal relationships, especially those of the family. The veteran

needs strong social support from the family to increase positive treatment outcomes. In the

International Journal of Nursing Studies, Ray and Vanstone stated, “There is a strong positive

correlation among social support and positive treatment outcome in those with PTSD, and a lack

of social support is strongly correlated to negative PTSD treatment outcomes,” (Ray, S.L. et al
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2009). However, this strong social support can be difficult when the family processes are

strained, effecting the treatment outcomes on the patient.

There are many challenges beyond symptoms for PTSD that include diagnosing and

treatment methods. Diagnostic criteria for PTSD is challenged with epidemiological,

biological, genetic and treatment studies (Ray, S.L., & Vanstone, M., 2009). Approaches to

treatment involve many combinations of medications (pharmacotherapy) and psycho/behavioral

therapies along with many other complementary therapies. Two medications approved by the US

Food and Drug Administration (FDA) for pharmacotherapy in those with PTSD include

paroxetine and sertraline that work to reduce the severity of the symptoms (Mithoefer, M.C., &

Mithoefer, A.T., et al (2018). In the MDMA-assisted psychotherapy phase 2 clinical trial journal

from the Lancet Psychiatry in 2018, researchers Mithoefer ,M.C. et. al stated that there are also

off-label drugs that are commonly prescribed such as antidepressants, mood-stabilizers,

antipsychotics, and benzodiazepines, however, there is little no actual scientific evidence with a

randomized control trial that supports the risks and benefits to taking those drugs for PTSD.

Along with the different medication therapy options, one of the emerging complementary

therapies used for veterans/military personnel with PTSD is psychiatric service animals/pet

therapy (O’Haire, M.E., & Rodriguez, K.E., 2018).

Defining Pet Therapy

Pet therapy is used as a complementary therapy to other initial primary therapies such as

medications. Different animals are used for this therapy, including dogs. Dogs are most

commonly used for pet therapy and provide different types of psychiatric service including

emotional support, therapy, and companionship by being trained to perform varying commands

that are most significant to the psychiatric needs of the owner/individual (Kruger, Serpell.,
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2010). Kruger and Serpell stated in their journal, “The service dogs are found to aid against the

symptoms of PTSD by instilling a sense of confidence, safety, and independence in the veteran

on a day-to-day basis.” The dogs can help alleviate symptoms of anxiety, hypervigilance,

avoidance, and feelings of isolation/detachment. They are also trained to do specific tasks such

as watching the veterans “back” in public, waking them up from nightmares, and responding to

and distracting them from emotional distress. The assistance the dog provides enables not only

their self confidence but emotional confidence too; they are more eager to leave the confining

walls of their homes and engage in their relationships and in reintegrate into society.

Personal Stories: Veterans PTSD

Krause-Parello et al. (2016), explains how PTSD is a signature wound of Iraq and

Afghanistan wars. Approximateky 7.6% of veterans from Iraq and Afghanistan have received a

diagnosis of PTSD (Krause-Parello, et al., 2016, p. 44). Avariety of vulnerabilities has been

associated with this disease like pre-trauma, peri-trauma, and post-trauma. Verterans diagnosed

with PTSD usually present with experiences of each of these categories. PTSD symptoms

include depression, violence, substance abuse, homelessness, and suicidal ideation. Altschuler

(2018), described a veteran from Afganistan’s personal story. A very powerful video from the

Paws for Veterans organization showed an interview with this veteran. He described his feelings

of depression, nightmares, and suicidal ideation. The veteran stated how he had such severe

migraines and anxiety to the point of beginning to load his service revolver to commit suicide.

This veteran had a service dog who intervened and would not leave the veterans lap. He ended

up changing his mind about his suicide attempt that day, but he stills struggles with little things

like going to the grocery store. (Altschuler, 2018, p. 12).

Personal Stories: Veterans PTSD with Pet Therapy

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After doing research of veterans with PTSD personal stories, the only way to see how

effective pet therapy can be would be to gather PTSD personal stories with pet therapy.

According to Altschuler (2018), the New York Times told a story about a U.S. Marine Veteran,

Bobby Peeker, a combative engineer whose job in Afghanistan was searching for roadside

bombs. During his deployment, Peeker experienced ambushes, and four men in his company

were killed. Upon returning to the U.S., to deal with his PTSD, Bobby started to drink.

According to the New York Times Article, “after therapy and medication, he was able to stop

drinking but the PTSD remained” (Altschuler, 2018, p. 11). Peeker used adjectives like dark,

funk, and gloomy to describe himself. Eventually, someone had suggested to Peeker to get a

service dog, and after just four short months of receving the dog, Sapper, Peeker was able to

begin wenning off his medications. With time, Peeker was able to go back to work in a job

reparing roads. His job did not allow him to bring Sapper. Without the dog, Peeker was having

panic attacks so severe he had to leave the workplace. Eventually the reoccurance of the panic

attacks made him have to leave his job. Peeker then interviewed for a new job with a security

company working with a dog to sniff out explosives. The company agreed to train Sapper so that

Peeker can be with him throughout his days. Peeker found great success at his job with the

security company and Sapper by his side. “This personal experience of PTSD from trauma in the

war created severe social and vocational dysfunction and anxiety not relieved by medications or

counseling. Pet Therapy greatly alleviated PTSD symptoms, improved social functioning, and

the patient was able to go back to work full time” (Altschuler, 2018, p. 12). Another example

Altschuler, (2018) gives as a personal story of a veteran with Post Traumatic Stress Disorder

with a pet companionship is a veteran with a history for forty years of PTSD. This veteran’s
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symptoms were not alleviated by many years of counseling or medications. The veteran felt that

equine therapy (horse therapy), saved his life. The patient commented on equine therapy stating,

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 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 cant show them

fear or anything (Altschuler, 2018, p. 12).

Altschuler, 2018, explains two more personal stories showing that not only mammals are used in

pet therapies. One of which the veteran’s PTSD symptoms were alleviated with working with

parrots. The last story involved canine therapy.

Implementing Pet Therapy

Seeing a service animal in a public setting is not an uncommon finding. Some of the

people using pet therapy are veterans that suffer from PTSD and there are many different ways

those veterans acquired their service animals. There are specific qualifications and processes to

go through before veterans are able to use AAI. First, veterans often try many different

medications and various amounts of counseling, but these treatments aren’t always effective.

When these treatments aren’t effective that opens a new door and this is the first step for veterans

to be able to have a pet companion (Altschuler, 2018). A veteran from the Vietnam war did

counseling for many years and still suffered from PTSD on and off before he was able to be put

in a trial for AAT and his type of therapy was equine. Once he started his therapy the veteran

was quickly able to find “peace” (Altschuler, 2018). A lot of evidence shows that although AAT
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seems to work quicker and better for a lot of veterans suffering from PTSD they often must try

medications and counseling first.

Before and After Pet Therapy

Veterans suffering from PTSD is a commonly talked about issue in the world. However,

exploring the options of how veterans deal with PTSD is not a commonly heard about topic.

While there are many therapy options for veterans to use, Animal Assisted Therapy (AAT) is

commonly used and there are many facts that show improvement in veterans while they are

using AAT. There are many reasons veteran’s mental health improves following their post-

traumatic event if they are using AAT. Most forms of AAT give veterans the option to always

have a companion with them because AAT is allowed in public places. Veterans with PTSD

often have problems in crowded places and having service dogs allow them comfort in crowded

places by “putting space between veterans and strangers” (Yarborough et al, 2017, p.733). There

is also other evidence that shows the different ways pet therapy serves veterans in many special

ways. Having an animal with them at all times is a constant reminder that they are no longer

surrounded with danger (Yount et al., 2013). Another safety concern in veterans with PTSD is

when they are startled and service dogs help with this because they can “alert the veteran if a

stranger is in the house” they alert the veteran by barking, licking or nudging (Yarborough et al.,

2017, p. 733). Yarborough et al also states that service dogs are helpful throughout the night by

“waking the veteran from a nightmare” (2017, p.733). Before the veterans with PTSD received

their service, dogs or used AAI, they often had problems going in public, being at ease at home

and sleeping through the night. There is a lot of evidence showing that since they have started

using pet therapy (AAI) they are now able to do those everyday things like going into public,

being at ease at home and not being worried to go to bed at night.

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Conclusion

After researching and addressing the question “in veterans with post-traumatic stress

disorder, how does the use of pet companions or service dogs, compared to not having pet

companions or service dogs influence their mental health in the years to follow a traumatic

event,” studies showed that the use of pet therapy provided great contentment and improvement

in quality of life for these veterans. Studies showed that with the use of a therapy pet, veterans

displayed less symptoms of PTSD like depression anxiety and panic, and could feel safe again.

It was also shown that some of these veterans who had begun to cope with their PTSD with

drinking and medications, were able to replace and discard these mechanisms with the use of a

therapy pet. There was evidence that that the implementation of pet therapy exhibited great

improvement in veterans’ social and work skills. The use of pet therapy for veterans with post-

traumatic stress disorder continues to expand and the benefits continue to grow.