New Directions in the Treatment of PTSD and Traumatic Brain Injury (TBI)
Pets and Human Good Health
Introduction
It has been known for some time that the human-animal bond is a mutually beneficial and dynamic relationship that positively influences the health and well-being of both. Lately, as the field of animal intelligence rapidly grows in practice and public awareness, the body of scientific research supporting ownership of pets and, particularly, therapy animals has also become increasingly robust.
The Health Benefits of Pet Ownership
Before we discuss the use of specially trained dogs in the treatment of people suffering of post-traumatic stress disorder (PTSD) or traumatic brain injury (TBI) I think it will be instructive to review the general health benefits of pet ownership.
When our ancestors settled into farming, dogs became domesticated. As a result, dogs became not only master communicators but also able to read human faces and pick up on stress signals. These abilities make them great companions for humans
A 12-year study of 3.4 million Swedish adults, ages 40 to 80 found that dog owners had a reduced risk of cardiovascular death and all-cause death. Research from the University of Vienna as well as University of Skövde, Sweden, indicate that oxytocin increases in both dogs and humans during positive interactions while cortisol drops, indicating a lowering of stress levels in both participants. Oxytocin helps promote social relations and sleep. Its latter effect is important since many people afflicted with a variety of emotional problems suffer of insomnia.
Studies have shown dog ownership may help increase fitness levels, lower blood pressure, cholesterol, and body mass index, lead to fewer doctor visits, and boost overall happiness and well-being. Pets also provide social support, the sense that you have a friend. The feeling that you are not alone. You are not coming home to an empty place.
Pets function as great icebreakers. On your walks or in the park you can meet your fellow dog owners and strike up a conversation. Pets require grooming services, visits to the vet, the pet supply store, etc. This socialising is all for the good because we have learned during the COVID epidemic that social isolation is highly detrimental to body and soul.
Trauma and PTSD
Trauma is the Greek word for "wound" originally used only for physical injuries. Today it is more commonly expressed in the context of the emotional. But as words gain useful new meanings over time, they can also lose precision in the public domain.
In scientific circles, trauma is generally defined as an event that induces severe fear, helplessness, or horror. Post-traumatic stress disorder (PTSD) is a particular type of trauma that occurs when a person feels overwhelmed and helpless in a life-threatening situation. It usually occurs after an extremely stressful event, such as armed conflict, persecution, imprisonment, torture, starvation, a natural disaster, or sexual, emotional or physical abuse.
PTSD has long-lasting and often debilitating effects. Individuals afflicted by PTSD exhibit enduring and pervasive symptoms of depression, survivor guilt, anger, intense fear, self-destructive behavior including substance abuse, hypervigilance, dissociation, low self-esteem, flashbacks, recurring nightmares, involuntary and intrusive memories of the traumatic event, memory loss for other parts of that event, lack of ability to concentrate, impairment of social functioning, and feelings of detachment or estrangement from others.
Traditional Approaches to Healing PTSD
Health professionals such as osteopaths, chiropractors, craniosacral therapists, massage therapists, and others working with their clients’ bodies generally subscribe to the belief that traumas, whether physical or psychological have created localized, a compressed area or areas of foreign, disorganized energy in the body, walled off from consciousness. Working on these areas will often liberate traumatic memories and, hopefully, free the person of chronic pain and deprive the memory of its distressing effect.
Personal counseling or therapy, or group therapy may provide a cathartic release of painful emotions. It initiates grief resolution, including a more positive identity and a commitment to individual and community healing. This has resulted in less shame, guilt, stigma, anger, sadness, and an increase in joy, a sense of personal power, self-esteem, and respect for one’s familial origins.
Recent Developments in the Treatment of PTSD and TBI
Several current research papers have focused on the role animals, in particular, dogs, play in helping veterans deal with PTSD and/or TBI. Of course, these findings apply equally to non-veterans with PTSD and/orTBI.
At the Steven A. Cohen Military Family Clinic at the University of Pennsylvania animal-assisted therapy is prescribed as complementary, woven into the care approach taken with patients.
Therapy Dogs and Service Dogs
There is a distinct difference between a therapy and a service dog, although both benefit their owner.
Therapy or Emotional Support dogs engage with their human handlers to provide therapy, comfort and emotional support.
Service dogs are individually trained to do work or perform tasks for people with disabilities. This includes seeing eye dogs, medical alert dogs, or mobility dogs. Service dogs for PTSD receive additional training in a variety of tasks specific to assisting individuals with PTSD, for example, turning on lights in a dark room, enter rooms and sweep the perimeter and providing space between the individual and an approaching person.
Presently, the use of SDs continues to increase as an emerging treatment modality for veterans with a history of PTSD and/or TBI. Veterans who are prone to panic attacks are instructed to focus on petting their SD and thus re‐centering and ideally, preventing and/or mitigating the panic attack.
Veterans with mental health concerns have reported that specially‐trained SDs are able to intervene with the manifestations of symptoms, thereby preventing suicidal and aggressive behavior. A study from Stanford University aimed to assess the therapeutic and economic benefits of service dogs versus emotional support dogs for veterans with PTSD. Both groups of veterans appeared to benefit from having a service or emotional support dog respectively. No significant differences in improved functioning or quality of life were observed between the groups. However, those in the service dog group had a greater reduction in PTSD symptoms and better antidepressant adherence, improvements that should be explored further.
KEY POINTS
• Traumatized people react to reminders of the trauma with emergency responses that were relevant at the time of the original threat.
• The effects of the trauma persist because the traumatic event is locked into the cellular structure of the body.
• There is a ton of research to show the health benefits of owning a pet.
• Dogs have the power to make people feel safe, and they build relationships faster than any human can.
• Most patients with PTSD or TBI apear to benefit from having a service or emotional support dog.
• Almost all people with PTSD have nightmares or underlying sleep problems, which, if alleviated, can help in the treatment of other symptoms.
References
Curl, A. L., Bibbo, J., & Johnson, R. A. (2017). Dog walking, the human–animal bond and older adults’ physical health. The Gerontologist, 57(5), 930-939.
Handlin, L., Nilsson, A., Ejdebäck, M., Hydbring-Sandberg, E., & Uvnäs-Moberg, K. (2012). Associations between the psychological characteristics of the human–dog relationship and oxytocin and cortisol levels. Anthrozoös, 25(2), 215-228.
Heim C, Nemeroff CB. (2001). The role of childhood trauma in the neurobiology of mood and anxiety disorders: preclinical and clinical studies. Biological Psychiatry. 49:1023–1039;
Levine, G. N., Allen, K.,... & Lange, R. A. (2013). Pet ownership and cardiovascular risk: a scientific statement from the American Heart Association. Circulation, 127(23), 2353-2363.
Marshall-Pescini, S., Schaebs, F. S., Gaugg, A., Meinert, A., Deschner, T., & Range, F. (2019). The role of oxytocin in the dog–owner relationship. Animals, 9(10), 792.
Mubanga, M., Byberg, L., . . . & Fall, T. (2017). Dog ownership and the risk of cardiovascular disease and death–a nationwide cohort study. Scientific reports, 7(1), 1-9.
Richerson, J. T., Wagner, T. H.,... & Stock, E. M. (2023). Therapeutic and Economic Benefits of Service Dogs Versus Emotional Support Dogs for Veterans With PTSD. Psychiatric Services, appi-ps.
Shiroff, J. J., Gray, K., & Fulford, J. O. R. (2022). A Qualitative Exploration of the Use of Service Dogs in Veterans with Post Traumatic Stress Disorder and Traumatic Brain Injury. Psychiatric Research and Clinical Practice.
van der Kolk, B. A. (1994). The body keeps the score: Memory and the evolving psychobiology of posttraumatic stress. Harvard review of psychiatry, 1(5), 253-265.
van der Kolk B. A. (1987). Psychological Trauma. Washington, DC: American Psychiatric Press.
