Applied Developmental Science

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Current challenges to research on animal-assisted

interventions

James Serpell, Sandra McCune, Nancy Gee & James A. Griffin

To cite this article: James Serpell, Sandra McCune, Nancy Gee & James A. Griffin (2017): Current
challenges to research on animal-assisted interventions, Applied Developmental Science, DOI:
10.1080/10888691.2016.1262775

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APPLIED DEVELOPMENTAL SCIENCE
http://dx.doi.org/10.1080/10888691.2016.1262775

SPOTLIGHT SERIES: ANIMAL ASSISTED INTERVENTIONS IN SPECIAL POPULATIONS

Current challenges to research on animal-assisted interventions

James Serpella, Sandra McCuneb, Nancy Geeb, and James A. Griffinc
a
University of Pennsylvania; bWALTHAM Centre for Pet Nutrition; cThe National Institutes of Health, Eunice Kennedy Shriver National
Institute of Child Health and Human Development

ABSTRACT
Studies of the effects of animal-assisted interventions (AAIs) face a number of theoretical and
practical challenges. Proposed theoretical processes for the effects of AAIs include those that
address primarily the animal’s ability to facilitate human–human social engagement, those that
emphasize animals’ apparent capacity to trigger social attachments and provide nonhuman social
support, those that categorize certain animals as supernormal stimuli, those that advance a
biophilia hypothesis that living organisms have an innate ability to attract and hold human
attention, and those that promote an integrative biopsychosocial model. Each of these generates
potentially testable hypotheses, and the field would benefit from systematic efforts to address their
validity. Practical challenges to AAI research include issues of study design and methodology,
the heterogeneity of both AAI recipients and the animals participating in these interventions, the
welfare of these animals, and the unusual pressure from the public and media to report and
publish positive findings. Such challenges need to be carefully considered in designing and
implementing future studies in the field.

Introduction
During the last 50 years, a growing body of empirical
research has sought to measure the beneficial influence
of different forms of animal-assisted intervention (AAI)
on psychosocial functioning in client/patient popula-
tions of various ages, genders, diagnoses, and back-
grounds. While many of these studies have reported
benefits, the results of successive critical and systematic
reviews and meta-analyses have been more equivocal
(Anestis, Anestis, Zawilinski, Hopkins, & Lilienfeld,
2014; Beck & Katcher, 1984; Kamioka et al., 2014;
Marino, 2012; Nimer & Lundahl, 2007; O’Haire, Guerin,
& Kirkham, 2015; Souter & Miller, 2007). Several
reviews have noted that weak study designs coupled
with moderate effect sizes makes it difficult to draw
definitive conclusions about efficacy or impact. On a
more positive note, one recent systematic review of arti-
cles published between 2008 and 2012 was able to ident-
ify seven AAI studies that met the criteria for
randomized controlled trials (RCTs), six of which
reported at least some evidence of significant benefits
(Maujean, Pepping, & Kendall, 2015).
In short, the scientific evidence for the effectiveness
of AAIs remains inconclusive. Despite an abundance
of compelling anecdotal reports and a growing number
of positive RCTs, the majority of experimental trials
have been insufficiently rigorous to justify the
conclusion that contact with therapy animals produces
reliable psychological or emotional benefits (Griffin,
McCune, Maholmes, & Hurley, 2011). It should be
emphasized, however, that failure to demonstrate
clear and consistent benefits does not mean that such
interventions are necessarily ineffective, as null results
can result from inadequate sample sizes/statistical
power to detect differences, outcome measures that
are overly broad or otherwise unable to detect
differences in the treatment group over time, and so
forth. It is noteworthy that, since the formation of the
NIH-WALTHAM Partnership more than twenty
human–animal interaction (HAI) studies have passed
rigorous NIH peer-review and received funding
(Esposito, McCune, Griffin, & Maholmes, 2011) and
that a subset of those publishing results to date can be
characterized as utilizing suitable control groups,
adequate sample sizes, and appropriate statistical
methods (see Gabriels et al., 2015; O’Haire, McKenzie,
Beck, & Slaughter, 2013; Schuck, Emmerson, Fine, &
Lakes, 2015).
Although progress has been made in increasing the
methodological rigor of HAI AAI studies, considerable
theoretical and practical challenges continue to confront
researchers investigating AAIs which may impede or

CONTACT Sandra McCune sandra.x.mccune@effem.com Human-Animal Interaction Research Programme, WALTHAM Centre for Pet Nutrition,
Freeby Lane, Waltham-On-The-Wolds, Melton Mowbray, Leicestershire LE14 4RT, UK.
© 2017 Mars Petcare
2 J. SERPELL ET AL.
confound efforts to demonstrate or replicate positive
findings. The purpose of this article is to provide an
overview of where some of the most important
challenges lie and some possible directions for future
AAI research.
Challenges
Theoretical challenges
A coherent body of theory that seeks to explain or
predict outcomes is an important element of good
clinical research, as it helps to determine both the initial
research question(s) and the resulting design of the
study protocol (Hulley & Cummings, 1988). Unfortu-
nately, the field of AAI research currently lacks strong
explanatory theories, particularly with regard to the
fundamental question of what it is about AAIs that dis-
tinguishes them from other sorts of psychotherapeutic
intervention (Marino, 2012). The implicit assumption
behind all of this work is that there is something
unusual, specific, or even unique about animals, or
human interaction with animals, that contributes to
positive outcomes. But if this is the case, then one or
more plausible theories are needed to account for the
supposed greater efficacy of AAIs compared with other,
more conventional therapeutic modalities. Several such
theories have been proposed.
Social catalysts and social capital
Social relationships with animals may benefit people
indirectly by stimulating positive social interactions
and relationships with other humans, including
therapists and hospital staff. Numerous experimental
studies have demonstrated that people of all ages,
including those with physical disabilities, enjoy more
frequent and more positive interactions with strangers
when accompanied in public by a dog than when
unaccompanied (Guéguen & Ciccotti, 2008; Mader,
Hart, & Bergin, 1989; McNicholas & Collis, 2000; Wells,
2004). Community-based surveys have further estab-
lished that pet ownership is positively associated with
social interaction among neighbors and with perceptions
of neighborhood friendliness. After adjusting for demo-
graphic factors, pet owners also tend to score higher on
measures of social capital and civic engagement than
non-owners (Wood, Giles-Corti, & Bulsara, 2005).
This type of social catalyst effect of animals is widely
reported in the AAI literature. As early as the 1960s,
the child psychotherapist, Boris Levinson (Levinson,
1969), proposed the use of animals as “co-therapists” to
help break the ice with particularly withdrawn and
uncommunicative patients. Similarly, one early clinical
evaluation referred to therapy dogs as “nonverbal com-
munication mediators” that offered patients, “a form of
non-threatening, non-judgmental, reassuring nonverbal
communication and tactile comfort and thus helped to
break the vicious cycle of loneliness, helplessness and
social withdrawal” (Corson & O’Leary Corson, 1980).
Again, the specific ways in which animals are able to
achieve this ice-breaker effect are unknown, although
the concept of animals as “optimally discrepant social
others” (Myers, 1998) may be helpful. According to this
idea, because animals are sufficiently similar to humans
to elicit prosocial behavior and positive affect, and
sufficiently dissimilar to avoid posing a threat, they
may possess an unusual capacity to mediate interactions
in otherwise anxiety-provoking therapeutic contexts
(Serpell, 1996). Further research on these apparent social
catalytic effects of animals in AAIs would be desirable.
Attachment, bonding, and social support
The AAI literature is replete with anecdotes concerning
the loving bonds that develop between people and ani-
mals; the implication being that such human-animal
attachments are an important part of what helps clients
to achieve therapeutic gains (Kruger & Serpell, 2010).
Certainly, relationships and attachments are critically
important to health and survival in humans and other
social species. Large numbers of longitudinal and meta-
analytical studies have confirmed that people with few
and/or poor quality social relationships are at greatly
increased risk of morbidity and mortality compared
with those who enjoy high levels of social support
(Holt-Lunstad, Smith, & Layton, 2010; Steptoe, Shankar,
Demakakos, & Wardle, 2013; Yang, Boen, Gerken,
Schorpp, & Harris, 2016). The mechanism for these
effects seems to be the capacity of positive social
relationships to protect or buffer people from the del-
eterious health consequences of chronic psychosocial
stress (Kikusui, Wilson, & Mori, 2006). This in turn
has prompted several authors to argue that the reported
health benefits associated with human-animal inter-
actions are consistent with the idea of animals serving
as nonhuman social support providers (Collis &
McNicholas, 1998; Garrity & Stallones, 1998; Serpell,
1996; Virués-Ortega & Buela-Casal, 2006).
In evolutionary terms, the association between social
relationships and health probably originates in the
attachment bonds between parents and their offspring,
which are essential to the biological fitness of the former
and the survival of the latter (Bowlby, 1969; Collis &
McNicholas, 1998). In highly social mammals, including
humans, this same attachment system appears to have
been co-opted as a way of reinforcing cooperative,
mutually beneficial social bonds among other, often

unrelated individuals. Both processes seem to be
mediated by the neuropeptide hormone, oxytocin
(OT). For example, the particular social cues exchanged
between mothers and infants, such as suckling, vocaliza-
tion, tactile stimulation, and mutual gaze (eye contact),
are known to stimulate the release of OT from the hypo-
thalamus which then appears to activate the dopamine
reward system, leading to behavioral reinforcement
and long-term social preferences. Natural OT release,
as well as its artificial administration, has powerful
anxiolytic effects by inhibiting the stress response of
the Hypothalamo-Pituitary-Adrenal (HPA) axis (Julius,
Beetz, Kotrschal, Turner, & Uvnäs-Moberg, 2013;
Strathearn, 2011). Similarly, the salutary effects of
socially supportive relationships in general are believed
to be due to these same inhibitory effects of OT release
on the psychosocial stress-induced activity of the
HPA axis (Heinrichs, Baumgartner, Kirschbaum, &
Ehlert, 2003).
Comparable effects have also been observed in
interactions between people and animals. Several studies
have demonstrated increases in peripheral OT levels
when humans interact with their own (but not other
people’s) dogs (Handlin et al., 2011; Miller et al., 2009;
Odendaal, 2000; Odendaal & Meintjes, 2003), and
another found that both owners’ and dogs’ OT levels
were positively correlated and associated with the
owners’ subjective assessments of the quality of their
relationships with the dogs (Handlin, Hydbring-
Sandberg, Nilsson, Ejdebäck, & Uvnäs-Moberg, 2012;
Nagasawa et al., 2015). A further study detected signifi-
cantly elevated levels of OT metabolites in the urine of
dog owners who received greater amounts of visual
attention (gaze) from their dogs in an experimental trial.
When questioned, these owners also professed stronger
attachments for their more attentive dogs (Nagasawa,
Kikusui, Onaka, & Ohta, 2009). A great deal of research
is currently ongoing on this topic, including the devel-
opment of multiple measures to assess the interaction
between stress response systems and OT release
underpinning the apparent benefits of human-animal
interaction (Borgi & Cirulli, 2016; Buttner, 2016;
Coleman et al., 2016; Marsa-Sambola et al., 2016; Payne,
DeAraugo, Bennett, & McGreevy, 2016).
Although superficially compelling as an explanation
for the health benefits of pet ownership, it is somewhat
unclear how well this social support/social buffering
hypothesis applies to AAIs, since the theory implies
the existence of long-term social relationships with
particular animals (Esposito et al., 2011), whereas the
animal contacts associated with AAIs tend to be rela-
tively transient and anonymous. One way around this
obstacle might be to argue that animals—or at least
APPLIED DEVELOPMENTAL SCIENCE 3
some animals—are simply more effective at stimulating
these beneficial oxytocinergic effects than (most)
humans are.
Animals as supernormal stimuli
The term “supernormal stimulus” was first coined by
the Danish ethologist and Nobel laureate, Niko
Tinbergen, to describe the tendency of animals
(including humans) to display open-ended preferences
for biologically relevant stimuli that are more extreme
or exaggerated than would occur in nature (Tinbergen,
1951). For example, he observed that, when offered the
choice between a normal egg and an artificial, supersized
one, nesting oystercatchers (Haematopus ostralegus) will
preferentially attempt to incubate the unnaturally large
egg. This concept subsequently led various authors to
conclude that the unusually “cute” features of things
like teddy bears, Disney cartoon characters, and even
pets, possess supernormal stimulus properties that are
“designed” to trigger innate human parenting or
nurturing behavior (Archer, 1997; Frank & Frank,
1982; Gould, 1979; Lorenz, 1943; Serpell, 1996).
Current evidence certainly suggests that the charac-
teristic physical features of human infants—termed
“baby-schema”—do influence adult, and especially adult
female, perceptions of cuteness, as well as eliciting care-
giving motivations (Glocker et al., 2009; Sprengelmeyer
et al., 2009). Brain imaging studies further suggest that
this type of response may be hard-wired in the sense
that it can be localized to a specific region of the
brain—the medial orbitofrontal cortex (Kringelbach
et al., 2008). Similar responses are elicited by
pedomorphic (child-like) images of animals (Archer &
Monton, 2011; Golle, Lisibach, Mast, & Lobmaier,
2013; Hecht & Horowitz, 2015; Lehmann, Huis i’nt
Veld, & Vingerhoets, 2013; Little, 2012; Waller et al.,
2013), although the perceived cuteness of pets such as
dogs appears also to be related to the quality of their
relationships with their owners (Thorn, Howell, Brown,
& Bennett, 2015). The existence of this cute-response/
care-giving predisposition toward certain animals
would help to account for the widespread occurrence
of cross-species adoption (or pet keeping) in human
cultures throughout the world (Serpell, 1987, 1989,
1996; Serpell & Paul, 2011), as well as the choice of
which species to adopt and eventually domesticate. It
also helps to explain the apparent ongoing selection
for pedomorphic traits—small body size, short limbs
relative to body size, soft skin/fur, large eyes relative
to head size, domed foreheads, flattened muzzles,
drooping ears, attachment related behaviors, and so
on—in species and breeds of animals used predomi-
nantly for companionship (Serpell, 2003).
4 J. SERPELL ET AL.
Possible evidence for this process was brought
to light in a recent Japanese study that examined the
interactions between peripheral OT levels and aspects
of social interaction among dog and wolf owners and
their pets (Nagasawa et al., 2015). The experimenters
collected urine samples from dogs and hand-raised
wolves and their owners before and immediately after
a 30-minute interaction, and then assayed these samples
for OT. They also measured the duration of dog/
wolf-to-owner gaze throughout these 30-min periods,
and on this basis divided the dog owners into long-gaze
and short-gaze groups (hand-raised wolves rarely gazed
at their owners). After the 30-min interaction, only the
owners in the long-gaze group showed significant
increases in peripheral OT, and the actual duration of
gaze correlated with the amount of talking and petting
the owners directed toward their animals. Furthermore,
the dogs that gazed at their owners most also showed
the highest increases in their own urinary OT. To
confirm that it was the duration of dog-to-owner gaze
that regulated these effects, the researchers conducted
a second experiment in which they administered OT
intranasally to a second group of dogs. In this case,
OT-treated female dogs (but not males) gazed more at
their owners than those who received saline, and their
owners responded to this extra attention with an
increase in their own OT levels. The authors speculate
that, in the process of domesticating dogs from wolves,
humans selected for those animals that displayed exag-
gerated affiliative behaviors, such as mutual gaze, that
are classically associated with mother-infant interac-
tions. If this interpretation is correct, it could both sup-
port theories focusing on attachment behavior as an
important component of AAIs, and gives some direc-
tion to investigations of potential mechanisms. How-
ever, further research is needed to test whether and
how short-term attachments may be mediating effective
AAIs.
Attention, distraction, and “Biophilia”
Distracting images, sounds, and activities, such as video
games or even hospital clowns, have been found to
ameliorate anxiety, negative mood, pain and other
unpleasant mental states in human experimental trials
(Koller & Goldman, 2012; Patel et al., 2006; Primack
et al., 2012). A handful of studies suggest that animals
may also be particularly effective at attracting and
holding human attention in similar ways (e.g., Barker,
Panduragi, & Best, 2003; Buttelmann & Römpke,
2014; Havey, Vlasses, Vlasses, Ludwig-Beymer, &
Hackbarth, 2014). This “special” effect of animals may
have a neurological basis. Neurons in the right
amygdala of the brain appear to react selectively to
images of animals rather than to those of people,
familiar objects, or landmarks, suggesting that this
region may have evolved the capacity to process infor-
mation specifically about animals, as opposed to other
categories of “things” (Mormann et al., 2011). It has also
been found that human infants (4–12 months) show a
significant preference for looking at films and pictures
of animals rather than those of objects, motor vehicles,
or toys (DeLoache, Pickard, & LoBue, 2011). Such
findings fit with the so-called “biophilia hypothesis,”
according to which humans possess an innate predis-
position to attend to living organisms, purportedly as
an evolved adaptation to living as hunter-gatherers
(Kellert, 1993; Wilson, 1984), though critics of the
hypothesis point to the lack of robust empirical evi-
dence supporting an innate or genetic basis for the tend-
ency (Kahn, 1999; Levy, 2003). Either way, it is plausible
to suggest that AAIs might also serve a therapeutic role
as distractors (Barker, Knisely, Schubert, Green, &
Ameringer, 2015; Brickel, 1984), though whether
animals are more or less effective at diverting us from
aversive mental states than other, perhaps less costly,
sources of cognitive distraction remains to be established.
Biopsychosocial model
The biopsychosocial model (Chapa et al., 2014)
represents a broad perspective that attributes health
and disease outcomes to an intricate interaction among
three contributing factors: biological (e.g., biochemical,
genetic, disease severity), psychological (e.g., per-
sonality, depression, distress), and social (e.g., culture,
family, loneliness). Challenges, insults, or positive
changes impacting any one of these three factors leads
to consequences for each of the other two, and all three
factors collectively combine to determine health and
disease outcomes. For example, companion animals
have been shown to moderate physiological responses
to stress (e.g., Friedman, Son, & Saleem, 2015) in a
variety of situations. Stress is a perceived challenge or
threat that causes the activation of the autonomic ner-
vous system which has a cascading effect resulting in
increased respiratory rate, heart rate, blood pressure,
and decreased heart rate variability and body surface
temperature. AAI has been shown to buffer this physio-
logical reaction to stressors, particularly to social
stressors. A biopsychosocial model explanation for this
stress buffering effect in the biological system is likely
to indirectly impact or alter the other two contributing
factors during the course of the AAI (Engel, 1981;
Esposito et al., 2011).
The biopsychosocial model allows for the integration
of some or all of the constructs covered by the other
theories previously described, allowing for a more

comprehensive conceptual model of the mechanisms
underlying the effects if AAIs on a range of biological,
psychological, and social outcomes. Researchers might
be best served by employing multi-level models that
incorporate the relevant theories previously outlined
when constructing their own theory of change model
that best captures the hypothesized outcomes for their
AAI and the measures they are using to assess those
changes over the course of treatment (Mueller, 2014).
Practical challenges
Study design and methodology
Many investigators have described serious methodologi-
cal flaws in research on AAIs (e.g., Chur-Hansen, Stern,
& Winefield, 2010; Herzog, 2014; Kazdin, 2011). Those
flaws include poorly defined research questions, small
sample sizes, non-random assignment to conditions,
inappropriate or absent control conditions, lack of
standardized measures or intervention procedures,
researcher expectancy effects, and lack of long-term
follow up. One methodological challenge inherent in
AAI studies is the inability to blind participants and
those carrying out the research—it is evident to all if
an animal is involved in the intervention or not (Griffin
et al., 2011). Blind scoring is often possible and the use
of suitable control or alternative treatment conditions
that utilize robotic, stuffed or other animal surrogates
would help to control for the novelty effect of having
an animal included in the therapeutic process, and, in
the case of a robotic dog, may provide an alternative
treatment modality to a live dog (Marino, 2012).
The starting point for any good study is the research
question. This question must be clearly defined and the
hypotheses generated must be directly testable via the
resulting study design. As part of this process, research-
ers should apply appropriate statistical powering to
determine the size of the sample needed to adequately
test the experimental hypotheses.
True experimental designs require random assign-
ment to conditions, but in many clinical settings this is
not possible. For example, a participant cannot be
assigned to have a particular psychological or physical
disorder, any more than they can be assigned to have a
particular gender or be a certain age. When participants
are placed into conditions based on such pre-existing
characteristics the experiment becomes a quasi-
experiment. Such designs are subject to threats to
internal validity primarily because the treatment and
control groups are fundamentally different to begin with.
If the two groups are not equivalent at the start of the
study, drawing causal inferences is not possible, and
the researcher may not have enough information in
APPLIED DEVELOPMENTAL SCIENCE 5
advance of the study to determine all the important
variables. In order to establish causal links related to
AAIs, random assignment to treatment versus control
groups is a requirement.
In many applied clinical settings there is resistance to
the use of control groups because of the ethical concern
related to denying an individual a potentially effective
intervention. Kazdin (2015) makes the argument for
strong control (or comparison) groups that involve
treatment as usual or an alternate viable treatment in
place of no-treatment or waitlist control conditions, as
a way of overcoming this concern and maintaining high
methodological rigor in the study.
Treatments must also be well delineated and include
manuals that codify procedures and practices (Kazdin,
2015). This practice not only clarifies and operationa-
lizes the study protocol but also allows for future train-
ing in the application of the intervention and replication
of the study and results. Standardized assessment
measures should be used which will allow for direct
comparisons across different populations and inter-
ventions. Furthermore, the fidelity and integrity of
treatment and control conditions must be monitored
as the study progresses. The use of multiple outcome
and assessment measures, along with monitoring of
attrition rates, is recommended.
Currently, a minimal amount is known about either
the dosage required with most AAIs in order to achieve
therapeutic efficacy or the long-term effects of these
interventions. Researchers need to evaluate the clinical
significance of change in relation to duration and inten-
sity of animal exposure, and follow-up weeks, months,
or even years after the treatment to determine the
long-term effects of AAIs (Kazdin, 2015).
Heterogeneity of AAI recipients
In much of the earlier AAI literature, there is an unspo-
ken assumption that the beneficial effects of human-
animal interactions are universal rather than dependent
on the individual characteristics of the human recipi-
ents. Studies have commonly grouped together indivi-
duals with widely varying clinical diagnoses (Kruger &
Serpell, 2010), although it is known that people with
particular disabilities, such as ASD, may react more
positively to AAIs than behaviorally normal controls
(O’Haire et al., 2015). Studies have also tended to ignore
the fact that people vary greatly in both their attitudes to
animals, and in the quantity and quality of their
previous interactions with animals (Serpell, 2004), all
of which are likely to influence their receptiveness to
AAIs. In one experimental trial, for example, current
dog owners were found to display positive cardiovascular
6 J. SERPELL ET AL.
responses in the presence of an unfamiliar dog, whereas
current nonowners showed more positive responses
when the dog was absent (Kingwell, Lomdahl, &
Anderson, 2001). Experienced dog owners also appear
to be more attuned to dogs’ emotions than inexperienced
ones (Wan, Bolger, & Champagne, 2011), and people of
different personality types both interact with dogs
differently (Kis, Turcsán, Miklósi, & Gácsi, 2012) and
show differing cardiovascular responses to these interac-
tions (Tateishi, Ohtani, & Ohta, 2014). These differential
responses to animal contact may be established in child-
hood. Previous studies have reported greater likelihood
of pet ownership among adults exposed to relationships
with pets in childhood, as well as demonstrating that
singleton children and children with no younger siblings
form stronger attachments for their pets (Melson,
Schwarz, & Beck, 1997; Paul & Serpell, 1992; Serpell &
Paul, 1994; Westgarth et al., 2013). It is not known
whether such early experiences with animals influence
people’s adult responses to AAIs but it seems intuitively
likely that they would. Recent evidence further suggests
that children with different attachment styles—for
example, disorganized versus insecure-avoidant—
interact differently with unfamiliar therapy dogs in
stressful situations (Wedl, Kotrschal, Julius, & Beetz,
2015). Age, gender, and culture/ethnicity have also been
shown to influence people’s attachments to companion
animals (Brown, 2003; Miura, Bradshaw, & Tanida,
2000; Siegel, 1995), and hence may also impact their
receptiveness to animal-based interventions. Interest-
ingly, gender, culture, and early environment have also
been found to modulate human OT responses to
interpersonal social interactions (Feldman, Monakhov,
Pratt, & Ebstein, 2016).
Surprisingly, the influence of most of these traits on
people’s responses to AAIs has not been investigated.
Future studies should attempt to either control for, or
include measures of, these various traits and charac-
teristics so that their intervening or confounding effects
on health-related outcomes can be accounted for.
Heterogeneity of therapy/assistance animals
Just as individual variation among AAI recipients is
often ignored by researchers, so too are the individual
characteristics of the animals that participate in these
interventions. While species differences are generally
acknowledged—for example, equine-assisted therapy,
farm animal-assisted therapy, dolphin-assisted
therapy—variation within species is frequently
overlooked. Such omissions tend to result from viewing
the animal primarily as a passive instrument or tool
rather than as an active agent in the therapeutic process
(Kruger & Serpell, 2010).
Animals such as dogs not only display a bewildering
array of different shapes, sizes, and fur types, but also
show corresponding variations in temperament and
social behavior (McGreevy et al., 2013; Serpell & Duffy,
2014). Some of these phenotypic traits may be more
appealing and efficacious in therapeutic contexts than
others. For example, the recent finding that dog owners’
OT levels reflect the amount of gaze or eye contact they
receive from their dogs suggests that high levels of
attachment behavior and visual attentiveness may be
particularly desirable traits in therapy dogs (Nagasawa
et al., 2015). Since different breeds of dog tend to dis-
play these kinds of behavior to different degrees (Serpell
& Duffy, 2014), it also suggests that some breeds may be
better at performing this function than others. Although
methodologically challenging, efforts to quantify
variations in behavioral style among potential therapy
animals would improve the selection of animals for this
role, as well as contributing to our understanding of the
mechanisms responsible for their therapeutic effects.
It should also be emphasized that not every dog—or
guinea pig, for that matter—is likely to be temperamen-
tally suited to the role of therapy animal. By repeatedly
obliging such animals to engage in uninvited social
interactions with unfamiliar humans, some of whom
may be very young or old, or abnormal in their behavior
or demeanor, AAIs certainly have the potential to be
highly stressful for the animal participants (Butler,
2004; Serpell, Coppinger, Fine, & Peralta, 2010). Inter-
ventions that cause the animal undue stress or anxiety
are clearly going to be detrimental to its health and wel-
fare and are unacceptable. By modifying the animal’s
social behavior, stress and anxiety are also likely to
detract from its therapeutic value. There is growing
recognition of the needs of the therapy animal in AAIs,
and many of the professional organizations have now
developed standards and guidelines as to how animals
should be incorporated in interventions and their
welfare protected (IAHAIO, 2014). It is essential that
the welfare of animals involved in AAI should be
constantly reviewed throughout and following any
intervention in which they are included (Gee, Hurley,
& Rawlings, 2016). For example, Ng and colleagues
(Ng, Albright, Fine, & Peralta, 2015) provide a tool
for the behavioral assessment of dog well-being before,
during, and after therapy sessions.
The possibility of interaction effects between client/
recipient and animal individuality should also be
considered. For example, in a study of how dog beha-
vior influences owner-dog attachment, Hoffman,
Chen, Serpell, and Jacobson (2013) found that levels
of attachment/attention-seeking behavior by dogs had
a positive effect on adult attachments but no effect on

children’s attachments, while levels of canine excitability
had a negative impact on attachment among Caucasian
owners but not among non-Caucasians. The reasons for
such differences are unknown, but they nevertheless
underline the need to recognize that no two individuals,
especially if they have disparate backgrounds and
experiences, will necessarily respond to the same animal
characteristics in the same way. Equally, it would be
naïve to imagine that all dogs are equivalent from a
therapeutic perspective, given the likely variation in
their interactions with unfamiliar humans of different
ages, genders, backgrounds, personalities, neuroendo-
crine profiles, and so on.
Public and media perceptions
The mass media and the public seem to have an
inexhaustible appetite for stories of animals helping
people with their illnesses and disabilities. Unfortu-
nately, satisfying this appetite often results in superficial
and inaccurate media accounts of scientific findings,
and a bias towards reporting positive outcomes. This
phenomenon represents a double-edged sword for
researchers and the field as a whole. While, on the
one hand, it promotes awareness of AAIs and their
potential benefits, and helps to generate support for
AAI programs and research, it also tends to inflate
expectations among the general public, policy makers,
funding agencies, and the medical profession; expecta-
tions that the field sometimes struggles to meet. With
such an unusually high level of enthusiasm for any
“treatment,” there is always a danger of a negative back-
lash when the results of research fail to demonstrate
unequivocally positive benefits. This in turn may lead
researchers to suppress (not publish) negative results
or put an unjustifiably positive spin on inconclusive
findings (Herzog, 2014). While this problem is certainly
not unique to AAI research, it does appear to be parti-
cularly prevalent, perhaps—and somewhat ironically—
due to the inherent popularity and salience of all things
animal.
Future directions
The clinical evaluation of AAIs is often described as a
nascent field, despite the fact that such studies have
been conducted over a period of more than 40 years.
Moving the field out of its prolonged infancy and
toward maturity will involve confronting a variety of
significant challenges.
The various theories that purport to explain why
animal-based interventions are equally or more effective
than existing or established therapies need to be tested
systematically to confirm or refute their explanatory
APPLIED DEVELOPMENTAL SCIENCE 7
value. For example, observational studies incorporating
non-invasive physiological biomarkers could be used to
test the ability of animals—compared with appropriate
control stimuli—to reduce anxiety by simply attracting
and holding human attention. Similarly, the theory that
certain dogs are exceptionally good at activating the OT
system due to their tendency to gaze at people could be
tested by comparing the OT levels of human subjects
before and after exposure to interactions with otherwise
similar dogs that display this type of behavior to differ-
ent degrees. Likewise, the concept of animals serving as
supernormal social stimuli could be investigated by
observing clients’/patients’ differential responses to ani-
mals independently assessed as being “cute” versus “less
cute.” Solid theories that survive such tests of validity
will not only help to refine AAI treatment modalities
but also focus future research in the most productive
directions.
Future researchers in the field must also strive for the
highest degree of methodological rigor. This means not
only following prescribed procedures for high quality
RCTs, but also accounting for heterogeneity by carefully
defining the phenotypes of both the AAI recipients and
the animals that participate in these interventions. In
other words, in addition to reporting human subjects’
ages, genders, ethnicities, and diagnoses, or simply
describing the animal as a guinea pig or a certified ther-
apy dog, future studies should also note AAI recipients’
personalities, attitudes to animals, and previous animal-
owning experience, as well as the animal’s age, sex,
breed, and, ideally, its behavioral style or temperament.
In addition, future studies need to address the question
of appropriate dosage of animal exposures, as well as
focusing not just on immediate and direct effects of
AAIs but also on long-term benefits and possible
indirect effects on outcomes such as attendance and
compliance with therapy.
Finally, it is important that negative results, assuming
they derive from high quality RCTs, are also published.
Individuals and diagnoses that fail to respond to AAIs
may be as informative from a scientific perspective as
the ones that do, and the entire field potentially suffers
when these sorts of contrary or ambiguous findings get
buried or ignored.
In summary, the proliferation of AAIs across a broad
range of treatment populations and modalities, coupled
with a parallel increase in discipline-specific research
studies that rarely reference studies published outside
of their discipline-specific journals, has impeded pro-
gress in the accumulation of knowledge regarding the
successful implementation and efficacy of AAIs (Griffin
et al., 2011). Developmental science has the potential to
break down disciplinary barriers while at the same time
8 J. SERPELL ET AL.
enhancing both the conceptualization and implemen-
tation of AAI studies. It is hoped that this series of
articles will make a meaningful contribution toward
the achievement of that goal.
Acknowledgments
The views expressed in this article are those of the authors and
do not necessarily represent those of the National Institutes of
Health, Eunice Kennedy Shriver National Institute of Child
Health and Human Development, or the U.S. Department
of Health and Human Services
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