Service Dogs & PTSD

At the OHAIRE lab we conduct research to better understand the psychosocial outcomes of having a service dog.

Learn more about the OHAIRE lab's current research on this topic.

What is PTSD?

Post Traumatic Stress Disorder (PTSD) is a trauma and stress-related disorder that affects about 1 in 12 adults at some point in their lives. PTSD can develop from exposure to a variety of psychologically traumatic events such as experiencing sexual abuse or assault, a life threatening event or natural disaster, or unexpected death or harm to a loved one [1-3].

PTSD and Military Personnel

Military personnel who are exposed to combat violence are strongly at risk for developing PTSD. In fact, the recognition of the disorder by modern psychiatry in 1980 was largely brought about as result of the mental health experiences of veterans returning from the Korean and Vietnam Wars [4]. Today, it is estimated that 6-14% of veterans deployed to Iraq and Afghanistan are impacted by PTSD [5, 6].

PTSD is a particularly difficult disorder to treat in military personnel. While empirically supported treatments work for many people, some can have dropout and nonresponse rates of up to 50% [7]. Additionally, few treatments incorporate the family members and/or spouses, who often suffer from their own psychological distress, secondary trauma, and caregiver burden. Therefore, it is imperative to discover and, most importantly, to evaluate complementary and integrative treatments for PTSD that encourage retention and have family-wide effects.  

What can service dogs do for PTSD?

Specially trained PTSD service dogs are one emerging complementary treatment option for PTSD that may address the needs of the family unit and encourage treatment retention. PTSD service dogs are specifically trained to instill a sense of confidence, safety, and independence on a day-to-day basis for the veteran. For example, a PTSD service dog may be trained to assist the veteran by "watching" their back in public, serving as a physical barrier between the veteran and approaching strangers, waking them up from nightmares, and serving as a physical brace for balance. However, not all dogs are trained to use the same cues, and specific cues may vary on an individual basis. Service dogs for PTSD are mostly Labrador Retrievers, Golden Retrievers, or German Shepherds but can be a variety of different breeds, including mixed breeds and rescue animals from shelters.

What is the difference between a service dog and an emotional support dog for PTSD?

To gain the public access rights and title of a service animal, PTSD service dogs and their handler must go through specialized training and pass a Public Access Test that certifies them to be deemed safe for public access. The Public Access Test evaluates the service dog's behavior and obedience in public as well as the handler's skills in a variety of situations. Once certified, a service dog and its handler are allowed access into most public spaces including restaurants and airplanes under the Americans with Disabilities Act (ADA).

Emotional support, therapy, comfort, or companion dogs are not considered service animals under the ADA and thus do not have the same public access rights. Although an emotional support dog may be well behaved and provide comfort and support to a veteran, they differ from service dogs by not being required to have any specific training. A well-behaved pet dog can be an emotional support dog if a professional mental health provider states in a letter that the individual's health condition, disorder, or disability is mitigated by the emotional support of the dog. These letters can grant special access for the dog (for instance inside airplanes or in housing that normally does not allow pets). Additionally, some state or local governments have laws that allow emotional support animals into public places. Emotional support dogs may still wear vests or tags in public indicating that they are an emotional support animal for the handler, and should be treated with the same respect that service dogs are given.

How should I interact with someone with a PTSD service dog or emotional support dog?

Because PTSD is an invisible disorder like diabetes or hearing loss, seeing an individual with a service or emotional support dog who seems perfectly healthy on the outside might be confusing in public. For military veterans suffering from PTSD, it is often very hurtful and personal to be asked what the dog "does" for them. In order to respect the privacy of the handler, it is poor etiquette to ask personal questions about their disability.

If you see a service dog or emotional support dog working in public, be respectful and do not approach or pet the dog without permission. Many veterans with a service dog are willing to answer respectful questions about their dogs, but you should not assume that this is always the case. Those with a service or emotional support dog out in public are just going about their business like anyone else, and might be too busy or unwilling to engage with everyone who approaches. 

For service dogs only, the ADA states that employees of public areas may ask only two specific questions to a service dog handler:

  • "Is the dog a service animal required because of a disability?"
  • "What work or task has the dog been trained to perform?"

Staff are not allowed to ask for any documentation, ask for the service dog to demonstrate any tasks that they are trained to do, or ask about the handler's specific disability.

Research on Military Veterans & Service Dogs

Qualitative interviews and reports from veterans placed with PTSD service dogs suggest that service dogs can help with daily anxious arousal, hypervigilance (always being on alert), nightmares, flashbacks, and many of the struggles that those with PTSD face on a day to day basis [8-10]. In addition, veterans with a PTSD service dog report feeling more safe and secure in public allowing them to do things like go to the movies with their family or to the grocery store. These reports are anecdotal, which means that they do not apply to all veterans and include only a select number of cases.

Additionally, most of what we know regarding the relationship with and benefits received from owning a PTSD service dog or emotional support dog are from studies that are relatively weak with no control comparison (such as comparing to a waitlist group or a similar population of individuals who don't own a dog). Our research group at the Center for the Human Animal Bond has conducted a systematic review of the literature and found a lack of peer-reviewed, empirical studies of service dogs as a complementary treatment option for military veterans with PTSD [11].

There is a strong need for more research in this area to determine exactly what therapeutic effect dogs may have on the mental health and wellbeing of those with PTSD, particularly in the military population. The Veteran's Administration (VA) does not currently provide any resources or funding for PTSD service dogs because of the lack of empirical evidence supporting their efficacy as a complementary treatment for PTSD.

The OHAIRE Lab's Research with Military Veterans & Service Dogs

The goal of our research at the OHAIRE lab is to empirically evaluate the effects of service dogs on the mental health and wellness of military members diagnosed with PTSD and their families. In particular, we are interested in determining if military members with PTSD who have been placed with a service dog will show changes in PTSD symptom severity, physiological arousal, and social competency compared to those receiving usual treatment services while on the waitlist to receive a PTSD service dog.

We are also interested in the spouse's perspective from the service dog placement. Do spouses of military veterans experience any effects from the service dog being inside the home? To answer this question, we are also measuring spousal stress, caregiver burden, relationship satisfaction, and overall family functioning from the spouse's point of view. Future research will plan to incorporate children and other family members. 

Our research is conducted in collaboration with K9s for Warriors, an Assistance Dogs International (ADI) accredited organization providing service dogs for veterans with PTSD, traumatic brain injury (TBI), military sexual trauma (MST), and mobility issues.

Read More

Written by Kerri E. Rodriguez and the OHAIRE Group

References

  1. Helzer, J.E., L.N. Robins, and L. McEvoy, Post-traumatic stress disorder in the general population. New England Journal of Medicine, 1987. 317(26): p. 1630-1634.
  2. Kessler, R.C., et al., Posttraumatic stress disorder in the National Comorbidity Survey. Archives of general psychiatry, 1995. 52(12): p. 1048-1060.
  3. Breslau, N., The epidemiology of posttraumatic stress disorder: what is the extent of the problem? Journal of Clinical Psychiatry, 2001.
  4. Trimble, M.R., Post-traumatic stress disorder: History of a concept. Trauma and its wake, 1985. 1: p. 5-14.
  5. Hoge, C.W., et al., Combat duty in Iraq and Afghanistan, mental health problems, and barriers to care. New England Journal of Medicine, 2004. 351(1): p. 13-22.
  6. Tanielian, T. and L.H. Jaycox, Invisible wounds of war. Santa Monica, CA: Rand Center. Retrieved on July, 2008. 11: p. 2008.
  7. Schottenbauer, M.A., et al., Nonresponse and dropout rates in outcome studies on PTSD: review and methodological considerations. Psychiatry, 2008. 71(2): p. 134-168.
  8. Yount, R.A., et al., The role of service dog training in the treatment of combat-related PTSD. Psychiatric Annals, 2013. 43(6): p. 292-295.
  9. Yeager, A.F. and J. Irwin, Rehabilitative canine interactions at the Walter Reed National Military Medical Center. US Army Medical Department Journal, 2012: p. 57-61.
  10. Taylor, M.F., M.E. Edwards, and J.A. Pooley, "Nudging them back to reality": Toward a growing public acceptance of the role dogs fulfill in ameliorating contemporary veterans' PTSD symptoms. Anthrozoos, 2013. 26(4): p. 593-611.
  11. O'Haire, M.E., N.A. Guérin, and A.C. Kirkham, Animal-assisted intervention for trauma: A systematic literature review. Frontiers in Psychology, 2015. 6.

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