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The Chimo Project - Improving Mental Health Through Animal Assisted Therapy Independent Evaluator’s Final Report

Dr. Bonnie M. Dobbs Associate Director Rehabilitation Research Centre University of Alberta T6G 2G4

This report was prepared for The Chimo Project and for Alberta Health and Wellness.

Acknowledgements This project would not have been possible without the vision and dedication of Dennis Anderson, The Chimo Project Director, the enthusiasm and expertise of Dr. Liana Urichuk, The Chimo Project Coordinator, and the capable abilities of Sylvia Imbeault, Sherryl Husereau, and Anne Nield, Administrative Assistants. Sincere appreciation is extended to members of the Professional Advisory Committee who gave so freely of their time and expertise. Thanks also are extended to the members of the collaborating organizations: Bosco Homes, Canadian Mental Health Association, the Edmonton SPCA, and the Pet Therapy Society of Northern Alberta. Sincere appreciation is given to Blair MacKinnon and co-workers from Alberta Health and Wellness (Health Innovation Fund), and Drs. Peggy and Dale Howard from Howard Research Associates for their guidance and encouragement throughout. A very special thank you is extended to the clients and therapists who participated in the study-their willingness to give of themselves and their time has allowed for the advancement of knowledge of Animal Assisted Therapy. Finally, sincere thanks to Shawn Drefs (BSc), Christine Vandenberghe (MEd), and Natalie Dautovich (BA), Research Assistants, for their assistance with this project.

The Chimo Project Independent Evaluator’s Final Report

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Contents Highlights viii Executive Summary xii Project Overview 1 Approach to Project Implementation 3 Approach to Evaluation 5 Project Description and Context 6

Preliminary Phase 7 Preliminary Phase Objectives 7 Evaluation Overview i. Literature Search, Database, and Review Initiative 7 ii. Recruitment Initiative 7 iii. Orientation Manual Initiative 8 Results

i. Literature Search, Database, and Review Initiative 9 ii. Recruitment Initiative 9 iii. Orientation Manual Initiative 11

Phase One 13

Phase One Objectives 13 Evaluation Overview 13 Results 17

A. Private Practice 17

1. Client Results i. Demographics 17

ii. Therapy Results (AAT vs. Control Clients) 21 iii. Summary of Results Private Practice Clients 40

2. Therapists

i. Demographics 42 ii. Therapy Results (AAT vs. Control Clients) 44

iii. Summary of Results Private Practice Therapists 56

B. Residential Care 58 1. Client Results

i. Demographics 58 ii. Therapy Results (AAT vs. Control Clients) 61

iii. Summary of Results Residential Care Clients 73


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2. Therapist Results i. Demographics 75

ii. Therapy Results (AAT vs. Control Therapists) 76 iii. Summary of Results Residential Care

Therapists 87

C. Unanticipated Findings 88

Learning 91 Contributions to the Health System 93 Implications 95 Appendices 96

A. Overview of Evaluation Plan 97 B. Orientation Manual Questionnaire 103 C1. Canadian Canine Good Citizen (CCGC) Test 106 C2. Aptitude Test for Dogs in Mental Health Settings© 107 D. Client Questionnaires (AAT vs. Control) 110 E. Means and Standard Deviations for Private Practice Clients 121 F. Therapist Questionnaires (AAT vs. Control) 123 G. Means and Standard Deviations for Private Practice Therapists 135 H. Means and Standard Deviations for Residential Care Clients 137 I. Means and Standard Deviations for Residential Care Therapists 139


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Tables Table 1. Recruitment Initiative Survey 10 Table 2. Results (Frequencies) of Ratings From Therapists on the Orientation Manual Entitled Improving Mental Health Through Animal Assisted Therapy 12 Table 3. Demographic Results for Private Practice Clients (AAT and Control) 19 Table 4. Private Practice: Goals developed for AAT and Control Clients for Sessions 1 and 4 (Number of Clients, Percentage) 32 Table 5. Demographic Results for Private Practice Therapists 43 Table 6. Private Practice: Therapist Data (Number and Percentage of Clients For Whom Goals Were Developed) for AAT and Control Clients for Sessions 1 and 4 50 Table 7. Demographic Results of Residential Care Clients (Averages and Standard Deviations) 59 Table 8. Residential Care: Goals Developed for AAT and Control Clients for Sessions 1 and 4 (Number of Clients, Percentage) 68 Table 9. Residential Care: Therapist Data (Number and Percentage of Clients For Whom Goals Were Developed) for AAT and Control Clients for Sessions 1 and 4 81 Appendices Table A1: Overview of Proposed Evaluation Plan for Preliminary Phase and Phase One Objectives 97 Table A2: Overview of Proposed Evaluation Plan for Impact of Animal Assisted Therapy Initiative 99 Table E1: Means and Standard Deviations for Private Practice Clients (Section B) 121 Table E2: Means and Standard Deviations for Private Practice Clients (Section E) 122 Table G1: Means and Standard Deviations for Private Practice Therapists (Section B) 135 Table G2: Means and Standard Deviations for Private Practice Therapists (Section E) 136 Table H1: Means and Standard Deviations for Residential Care Clients (Section B) 137


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Table H2: Means and Standard Deviations for Residential Care Clients (Section E) 138 Table I1: Means and Standard Deviations for Residential Care Therapists (Section B) 139 Table I2: Means and Standard Deviations for Residential Care Therapists (Section E) 140 Figures Figure 1. An overview of the study: sources of recruitment, categories of participants, and type of participant within each category 14 Figure 2. Private Practice: Median number of sessions attended over the course of the study by AAT and Control clients. 20 Figure 3. Private Practice: Mean depression scores at Times 1 (baseline) and 2 for AAT and Control clients 21 Figure 4. Private Practice: Average depression scores for AAT clients as a function of pet ownership at Time 1 (baseline) and Time 2 22 Figure 5. Private Practice: Mean anxiety scores at Time 1 (baseline) and Time 2 for AAT and Control clients 23 Figure 6. Private Practice: Anxiety scores at Time 1 (baseline) and Time 2 for AAT clients as a function of pet ownership 24 Figure 7. Private Practice: AAT client ratings for ‘Therapy in General’ for Sessions 1 and 4 27 Figure 8. Private Practice: Control client ratings for ‘Therapy in General’ for Sessions 1 and 4 28 Figure 9. Private Practice: Mean difference scores (Session 4 – Session 1) for ‘Therapy in General’ for AAT and Control clients 29

Figure 10: Private Practice: Session 1 average ratings on ‘Therapy in General’ for AAT clients who owned pets versus those who did not own pets 30 Figure 11. Private Practice: Session 4 average ratings on ‘Therapy in General’ for AATclients who owned pets versus those who did not own pets 31 Figure 12. Private Practice: AAT and Control clients’ ratings for Sessions 1 and 4 on whether therapy helped them in their home, school, and work performance 34


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Figure 13. Private Practice: Mean ratings for AAT clients for Sessions 1 and 4 on whether therapy helped them at home 35 Figure 14. Private Practice: AAT client ratings on the use of animals in therapy for Sessions 1 and 4 37 Figure 15. Private Practice: Average ratings for AAT clients for Session 1 as a function of pet ownership 38 Figure 16. Private Practice: Average ratings for AAT clients for Session 4 as a function of pet ownership 39 Figure 17. Private Practice: AAT therapists’ ratings for ‘Therapy in General’ for Sessions 1 and 4 46 Figure 18. Private Practice: Control therapists’ ratings for ‘Therapy in General’ for Sessions 1 and 4 47 Figure 19. Private Practice: Mean difference scores (Session 4-Session 1) for ‘Therapy in General’ for AAT and Control therapists 48 Figure 20. Private Practice: AAT and Control therapists’ ratings for Sessions 1 and 4 on whether therapy helped clients in their home, school, and work performance 52 Figure 21. Private Practice: AAT therapists’ ratings on specific information about the animal (positive items) 54 Figure 22. Private Practice: AAT therapists’ ratings on specific information about the animal (negative items) 55 Figure 23. Residential Care: Mean number of sessions attended over the course of the study by AAT and Control clients 60 Figure 24. Residential Care: Mean depression T scores at Times 1, 2, and 3 for AAT and Control clients 61 Figure 25. Residential Care: Anxiety T scores at Times 1, 2, and 3 for AAT and Control clients 62 Figure 26. Residential Care: AAT client ratings for ‘Therapy in General’ for Sessions 1 and 4 65 Figure 27. Residential Care: Control client ratings for ‘Therapy in General’ for Sessions 1 and 4 66 Figure 28. Residential Care: Mean difference scores (Session 4 -1) for AAT and Control clients. 67


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Figure 29. Residential Care: AAT and Control clients’ ratings for Sessions 1 and 4 on whether therapy helped them at home and school, and in Residential Care 70 Figure 30. Residential Care: AAT client ratings on the use of animals in therapy for Sessions 1 and 4 72 Figure 31. Residential Care: Therapist‘s ratings for AAT clients for ‘Therapy in General’ for Sessions 1 and 4 78 Figure 32. Residential Care: Therapist‘s ratings for Control clients for ‘Therapy in General’ for Sessions 1 and 4 79 Figure 33. Residential Care: Mean difference scores (Session 4 – Session 1) for ‘‘Therapy in General’ for AAT and Control clients as per therapist ratings 80 Figure 34. Residential Care: Therapists’ ratings for AAT and Control clients for Sessions 1 and 4 on whether therapy helped clients in their performance at home, school, and in Residential Care 83 Figure 35. Residential Care Therapists’ ratings on for specific information about the animal (positive items) 85 Figure 36. Residential Care: Therapists’ ratings for specific information about the Animal (negative items) 86 Figure 37. Private Practice: Time 1 depression scores as a function of pet ownership 88

Figure 38. Private Practice: Time 4 depression scores as a function of pet ownership 89 Figure 39. Private Practice: Time 1 anxiety scores as a function of pet ownership 90 Figure 40. Private Practice: Time 4 anxiety scores as a function of pet ownership 90


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Highlights The Chimo Project was a 27 month project, representing the collaboration of the Canadian Mental Health Association, the Pet Therapy Society of Northern Alberta, the Edmonton SPCA, and Bosco Homes. Funding was provided by Alberta Health and Wellness (Health Innovation Fund). The primary goal of the project was to assess the effectiveness of Animal Assisted Therapy (AAT) in the Private Practice and Residential Care settings in clients with mental health disorders (depression and anxiety related disorders). AAT is a “goal directed intervention in which an animal that meets specific criteria is an integral part of the treatment process” (The Delta Society, 20001). Clients and mental health therapists participated in the study. There were 26 clients (15 received AAT, 11 received traditional forms of therapy) and eight therapists from the Private Practice setting. Ten youths (seven received AAT and three received traditional forms of therapy) and one therapist participated from the Residential Care setting. A non-randomized, experimental-control repeated measures design was employed. Clients were followed for approximately three months, with data obtained from clients and therapists at each therapy session. Quantitative data were collected from clients and therapists for the following areas: 1) information related to ‘Therapy in General’ (mood, coming to therapy, etc.), 2) individual therapy goals, 3) effects of therapy on school, work, home, and Residential Care performance, and 4) specific information related to AAT (completed by AAT clients and therapists for AAT clients only). Much of the literature directed at assessing the value of animal involvement in therapy consists of qualitative case studies, anecdotal reports, or publications by private organizations. While descriptive or observational studies contribute to our knowledge of clinical phenomena, they are not designed to quantify effect or define causal relationships. Experimental studies overcome those shortcomings. There has been a handful of experimental studies assessing the effects of AAT in the therapeutic setting. However, the majority of those studies suffer from methodological limitations such as small sample size, lack of a control group, instrumentation, study length, etc. Although some of the methodological limitations from previous studies have been addressed with the current study (e.g., use of a control group, study length, instrumentation), a number of methodological limitations remain. Small sample size, particularly in the Residential Care setting, and non-randomization are the primary limitations. Therefore, the results presented must be interpreted with caution. Further research, using a randomized design and a larger sample size, is needed to support or refute the current findings.

1 The Delta Society. (2000). Animal assisted therapy. Retrieved June, 2000 from www.deltasociety.org


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Key Findings: A. From the Private Practice Setting

Client data: • In general, change scores (Session 4 vs. Session 1) between the two groups

(AAT vs. Control) on ‘Therapy in General’ (attitudes toward therapy sessions, interaction with therapist, willingness to disclose during therapy, and effects of therapy) were similar. Although the differences between the two groups were not significant, there was a tendency for Control clients to score higher on almost all measures. Further research, with larger samples, is needed to clarify the present findings.

• AAT appears to be particularly suited for clients in the Private Practice setting with depression and/or anxiety disorders who own pets. Clients who do not own pets may not do as well with AAT as those who do own pets, particularly in the beginning stages of therapy.

Therapist data:

• In general, therapists’ ratings for clients receiving traditional forms of therapy (Control clients) were more positive than ratings for clients receiving AAT. Specifically, therapists with clients receiving traditional forms of therapy thought that the clients’ attitudes toward therapy (e.g., looking forward to coming to therapy) and focusing during therapy improved more across sessions compared to therapists with clients receiving AAT.

• The differences in ratings between AAT therapists and therapists providing

traditional forms of therapy do not appear to be related to pet ownership of the clients.

• AAT therapists and therapists using traditional forms of therapy indicated that

the clients performed better at home as a result of therapy. B. From the Residential Care Setting

Client data: Due to the small sample size (n = 10: 7 AAT clients and 3 Control clients), statistical analyses were not conducted. Thus, the results are descriptive only.

• In general, AAT appears to be an effective adjunct to therapy for youths in a Residential Care setting who have been diagnosed with depression and/or anxiety disorders. Compared to clients receiving traditional forms of therapy, clients receiving AAT were more positive in their attitudes toward coming to therapy, in their ratings on interactions with the therapist, and in their willingness to disclose during therapy. There was, however, no change in their ratings of hopefulness, for improvements in mood, or feelings of anxiousness between Sessions 1 and 4.

• AAT clients thought that therapy helped them to perform at home and at

school, and in Residential Care to a greater extent than clients receiving traditional forms of therapy.


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• Ratings toward the use of animals in therapy were very positive for clients receiving AAT. Overwhelmingly, clients felt that the animal accepted them for who they were. At the beginning of therapy, clients in the Residential Care setting indicated that they had trouble concentrating with the animal in the room. However, over time, this decreased substantially such that by Session 4, clients indicated that they did not have trouble concentrating with the animal in the room.

Therapist data:

• Over time (e.g., between Session 1 and 4), the trend was for greater differences for AAT clients compared to Control clients for ‘Therapy in General’. That is, according to the therapist, AAT controls showed a greater ‘improvement’ on ratings related to comfort level and ability to focus during therapy, willingness to come to therapy, willingness to talk about feelings, etc. compared to clients receiving traditional forms of therapy.

• In terms of performance, the therapist thought that therapy helped both AAT

and Control clients perform better at home and at school, and in Residential Care. The ratings increased between sessions for both sets of clients. However, the therapist thought that therapy helped AAT clients’ performance more so than clients receiving traditional forms of therapy.

• The therapist’s ratings for use of the animal in therapy were, overall, positive.

That is, the animal was deemed to be beneficial in establishing rapport more quickly. Having the animal present seemed to make clients more willing to come to therapy as well.

• The therapist indicated that initially (Session 1), clients paid more attention to

the animal than to the therapist, that clients were more distracted by the animal, and that clients were unable to focus on clinically relevant issues. However, the pattern was such that by Session 4, the therapist thought that clients paid less attention to the animal, were less distracted, and were more focused. The therapist indicated that there were no aggressive behaviors directed at the animal for either Session 1 or 4.

C. Unanticipated Findings An unanticipated finding was that pet ownership appears to moderate the effects of mental illness.

• A comparison of clients’ depression scores at the beginning of the study indicated that AAT clients who owned pets had lower depression scores than AAT clients who did not own pets. The same pattern was found for Control clients. In general, after approximately three to four months of therapy, depression scores were reduced for both AAT and Control clients irrespective of pet ownership. However, the same pattern of lower depression scores for pet ownership clients remained.


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• The anxiety scores for AAT and Control clients were examined for the relationship between pet ownership and level of anxiety at entry to the study and after approximately three to four months. Essentially, the same pattern of results was obtained for the anxiety scores as for the depressions scores.


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Executive Summary This report reflects the results from The Chimo Project, a 27 month project funded by Alberta Health and Wellness. There were two phases to the project: a Preliminary Phase and Phase One. Goals for the Preliminary Phase included compilation of the extant literature on Animal Assisted Therapy (AAT), recruitment and orientation of qualified mental health professionals into the study, development of an Orientation Manual to be used by therapists on an ongoing basis, and the development of criteria and screening procedures for the selection of clients and animals for participation in the study. For Phase One, the goals were as follows: to develop AAT risk management policies and procedures for both human and animal welfare, to screen potential animals for participation in AAT, and to assess the impact of AAT on the mental health outcomes of clients participating in the project. A review of the literature entitled Animal Assisted Therapy: A Review of the Literature (Gardiner & Dobbs, 19912) was completed at the beginning of the project. That report is available on request. Eight therapists were recruited into and received orientation to the project over the course of the study. An orientation manual entitled Improving Mental Health Through Animal Assisted Therapy (Urichuk & Anderson, 20033), was developed and is designed for mental health professionals interested in learning how animals can act as adjuncts to the therapeutic process for individuals with mental health concerns. The manual also is available on request. Finally, during the preliminary phase, enrollment criteria and procedures for screening were developed for clients and animals participating in the study. In Phase One, risk management policies and procedures were developed for therapists, clients, and animals to reduce or alleviate risks associated with the use of AAT. The policies and procedures were approved by the Health Research Ethics Board-Panel B at the University of Alberta. To assess the efficacy of AAT, clients who had been diagnosed with depression and/or anxiety disorders were recruited from the Private Practice and Residential Care settings. The study sample consisted of Experimental clients (clients receiving AAT) and Control clients (clients receiving traditional forms of therapy). At the completion of the project, there were 15 AAT and 11 Control clients from the Private Practice setting, and seven AAT and three Control clients from the Residential Care setting. A total of eight therapists also participated in the project-seven of the therapists were from the Private Practice setting and one was from the Residential Care setting. A non-randomized, experimental-control repeated measures design was employed. Data were collected from clients and therapists using self-administered questionnaires. Questionnaires included the Beck Depression Inventory (or the Beck Depression Inventory-Youth) for clients with depression, the Beck Anxiety Inventory for clients with anxiety disorders (or the Beck Anxiety Inventory-Youth), and questionnaires developed for the study (e.g., information related to therapy in general, attainment of therapy goals, effects of therapy on school, work, home, and Residential Care performance, and specific information related to AAT). Clients and therapists completed the questionnaires at the end of each therapy session.

2 Gardiner, A., & Dobbs, B. (2001). Animal assisted therapy: A review of the experimental literature. Unpublished manuscript. 3 Urichuk, L. & Anderson, D. (2003). Improving mental health through animal assisted therapy. Edmonton.


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The key findings are presented below. The findings from clients and therapists in the Private Practice setting are presented first, followed by client and therapist findings from the Residential Care setting. Private Practice Setting: Client Data: There were no significant differences between AAT and Control clients in terms of age, gender, marital status, physical health, or depression or anxiety scores upon entry to the study. There were, however, significant differences between the two groups for pet ownership, with 64% of AAT clients owning pets compared to 90% for Control clients. The groups were similar in terms of availability of support (e.g., people to count on), as well as number of sessions attended during the study period. Both groups attended five sessions on average. Depression and anxiety scores were examined for change over time. The median time period for assessing change was three months, with a range of one to eight months. Depression scores decreased for both AAT and Control clients over time. The decrease was statistically significant for the Control clients but not significant for the AAT clients. Thus, there was a significant improvement in level of depression for Control clients over the course of therapy sessions but not for AAT clients. Anxiety scores also were examined for change over time. Similar to the depression score results, there was a modest decrease in the AAT clients’ anxiety scores over time but this difference was not significant. There was a significant decrease in anxiety scores for the Control clients however. In the Private Practice setting, there were substantially more Control clients who owned pets than clients receiving AAT. The data were examined to determine if pet ownership had an effect on response to therapy. For clients receiving AAT, the baseline ratings on ‘Therapy in General’ (e.g., look forward to coming to therapy, improved mood, etc.) were higher for clients owning pets than for those not owning pets. Interestingly, the differences in ratings between clients owning pets versus those not owning pets for ‘Therapy in General’ were reduced at Session 4. Thus, it appears that clients receiving AAT who own pets may, at the beginning of therapy, be more receptive to having the animal present than are those who do not own pets but that difference is minimized quite quickly over the course of a few therapy sessions. Ratings on use of animals in therapy also were higher for both Sessions 1 and 4 for AAT clients who owned pets versus those who did not. To examine the effectiveness of AAT compared to traditional forms of therapy, change scores (Session 4 - Session 1) were calculated for each of the groups on ‘Therapy in General’ (attitudes toward therapy sessions, interaction with therapist, willingness to disclose, and effects of therapy). Although the trend was for more positive difference ratings for the Control group, that difference was not statistically significant. The findings suggest that AAT is a useful adjunct to therapy in the Private Practice setting. However, caution in interpreting the results is warranted given the small sample size. In addition to ratings on ‘Therapy in General’, clients also provided ratings on the extent to which therapy helped them at home, school, and work. The trend was for AAT client ratings to decrease or stay the same across sessions, and to increase (i.e., help to a greater extent) for the Control clients.


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Finally, clients were asked to provide ratings on statements specific to the use of animals in therapy. Areas of interest included attitudes toward coming to therapy, comfort level with the animal, ability to focus during therapy, willingness to disclose/discuss feelings, and feeling accepted by the animal. The ratings were generally positive for all items, with little in the way of change between Sessions 1 and 4. The majority of clients did not have trouble concentrating with the animal in the room. Therapist Data: As noted earlier, seven therapists from the Private Practice setting participated in the study. The therapists provided ratings on statements similar to those rated by the clients (e.g., for ‘Therapy in General’, effects of therapy on home, school, and work performance, use of animals in therapy). In general, the therapists’ ratings for clients receiving traditional forms of therapy were more positive than for clients receiving AAT overall. Specifically, therapists with clients receiving traditional forms of therapy thought that the clients’ attitudes toward therapy (e.g., looking forward to coming to therapy), and focusing during therapy improved more across sessions compared to therapists with clients receiving AAT. In addition, the differences in ratings between AAT therapists and therapists providing traditional forms of therapy do not appear to be related to pet ownership of the clients. Residential Care Setting: Client Data: Due to the small sample size, (n = 10: 7 AAT clients and 3 Control clients), statistical analyses were not conducted on Residential Care clients’ or therapists’ data. Thus, the results presented in this report are descriptive only. In general, AAT appears to be an effective form of therapy for youth in a Residential Care setting who have been diagnosed with depression and/or anxiety disorders. Compared to clients receiving traditional forms of therapy, clients receiving AAT were more positive in their attitudes toward coming to therapy, and in their ratings on interactions with the therapist and willingness to disclose during therapy. There was, however, no change in their ratings of hopefulness, for improvements in mood, or feelings of anxiousness between the two sessions.

• AAT clients thought that therapy helped them to perform at home and at school, and in Residential Care to a greater extent than clients receiving traditional forms of therapy.

• Ratings toward the use of animals in therapy were very positive for clients

receiving AAT. Overwhelmingly, the clients felt that the animal accepted them for who they were. At the beginning of therapy, clients in the Residential Care setting indicated that they had trouble concentrating with the animal in the room. However, over time, this decreased substantially such that by Session 4, none of the clients indicated that he/she had trouble concentrating with the animal in the room.


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Therapist data:

• Over time (e.g., between Sessions 1 and 4), the trend was for greater differences for AAT clients compared to Control clients. That is, according to the therapist, AAT controls showed a greater ‘improvement’ on ratings related to therapy (comfort level, ability to focus, willingness to come to therapy, willingness to talk about feelings, etc.) compared to clients receiving traditional forms of therapy.

• In terms of performance, the therapist thought that therapy helped clients to

perform better at home and at school, and in Residential Care. The ratings increased between sessions and the therapist thought that therapy helped AAT clients’ performance more so than clients receiving traditional forms of therapy.

• The therapist’s ratings for use of the animal in therapy were, overall, positive.

That is, the animal was deemed to be beneficial in establishing rapport more quickly. Having the animal present seemed to make the client more willing to come to therapy, etc.

• The therapist indicated that initially (Session 1), the client paid more attention

to the animal than the therapist, was more distracted by the animal, and was unable to focus on clinically relevant issues. However, the pattern was such that by Session 4, the therapist thought that the client paid less attention to the animal, was less distracted, and was more focused. The therapist indicated that there were no aggressive behaviors directed at the animal for either Session 1 or 4.

Comparison between Private Practice and Residential Care (Therapists’ Ratings)

• It is interesting to note the difference in the pattern of ratings from the

therapist in Residential Care versus therapists in Private Practice. In general, the ratings for the Residential Care setting are more positive than for Private Practice.

• In comparison to the Private Practice setting, the ratings on attention to the

animal, distractibility, and focusing are higher in the Residential Care setting than in Private Practice. This may be the result of the age of the client. In the Residential Care setting, the average age of the clients receiving AAT was 15 years. In the Private Practice setting, the average age was 40 years.


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Project Overview A review of the AAT literature (Gardiner & Dobbs, 2001) indicates a distinct lack of reliable experimental studies examining the effectiveness of AAT with clients in therapy. In general, research to date is comprised of qualitative case studies or anecdotal accounts. The call for scientific research on AAT was first made in the late 1960’s (Levinson, 19694), a call which has been repeatedly echoed (Banks & Banks, 20025; Beck & Katcher, 19846; Fawcett & Guollone, 20017). Despite these calls, there has been little in the way of experimental exploration of the efficacy of AAT. That which is available (Barker & Dawson, 19988; Beck, Seraydarian, & Hunter, 19869; Draper, Gerber & Laying, 199010; Kelly, 200211) has provided little in the way of support for the use of animals in therapy. Small sample sizes, along with other methodological limitations account, in part, for the disappointing findings. Despite the lack of strong empirical evidence, there is widespread belief in the use of AAT. Needed, therefore, is well-designed research examining the use of AAT with individuals with mental health disorders. The current project was designed to meet that need. The Chimo Project was a unique and innovative project, representing initially the collaboration of the Canadian Mental Health Association, the Pet Therapy Society of Northern Alberta, and the Edmonton SPCA. Bosco Homes became an important collaborator following the initiation of the project. The project received funding through the Health Innovation Fund (Alberta Health and Wellness). The initial funding period was for 18 months. An additional 10 months of funding was granted from the Health Innovation Fund. This funding was critical to the success of the project as it enabled the project team to recruit more clients and therapists into the study. The resulting increase in sample size has added to the validity of the study. Amount of funding for the project totaled $331,000.00. The primary goal of The Chimo Project was to enhance and improve the well being of selected consumers of mental health services through animal-assisted therapy (AAT). Individuals diagnosed with either two mental health disorders (depression and anxiety) were included in the project. Individuals were recruited from two settings: Private Practice and a Residential Group Home. The study sample consisted of Experimental clients (clients receiving AAT) and Control clients (clients receiving traditional forms of therapy). At the completion of the project, there were 15 AAT and 11 Control clients from the Private Practice setting, and seven AAT and three Control clients from the

4 Levinson, B. (1969). Pet Oriented Child Psychotherapy. Springfield, Illinois: Charles C. Thomas. 5 Banks, M.R., & Banks, W.A. (2002). The effects of animal-assisted therapy on loneliness in an elderly population in long-term care facilities. Journals of Gerontology Series A-Biological Sciences & Medical Sciences, 57A, 7, MB428-M432. 6 Beck, A.M., & Katcher, A.H. (1984). A new look at pet-facilitated therapy. JAVMA, 184(4), 414-421. 7 Fawcett, N.R., & Gullone, E. (2001). Behavior Change, 18(2), 124-133. 8 Barker, S.B. & Dawson, K.S. (1998). The effects of animal-assisted therapy on anxiety ratings of hospitalized psychiatric patients. Psychiatric Services, 49(6), 797-801. 9 Beck, A.M., Seraydarian, L., & Hunter, G.F. (1986). Use of animals in the rehabilitation of psychiatric inpatients. Psychological Reports, 63-66. 10 Draper, R.J., Gerber, G.J., & Layng, E.M. (1990). Defining the role of pet animals in psychotherapy. Psychiatry Journal of the University of Ottawa, 15(3), 169-172. 11 Kelly, T.A. (2002). Pet facilitated therapy in an outpatient setting. Dissertation Abstracts International: Section B: the Sciences and Engineering, Vol 62(9-B), April 2002, 4222, US: University Microfilm International.


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Residential Care setting. A total of eight therapists participated in the study-seven from the Private Practice setting and one from the Residential Care setting.


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Approach to Project Implementation The Chimo Project represents a unique collaboration among the Project Director (Dennis Anderson), the Project Coordinator (Dr. Liana Urichuk), Chimo Staff (Sylvia Imbeault, Sherryl Husereau, Anne Nield-Administrative Assistants), The Chimo Project Professional Advisory Committee (Dennis Anderson, Paul Arnold-Schutta, Dr. Bonnie Dobbs, Dr. Beverley Edwards-Sawatsky, Ms. Patricia Gay, Nancy Kiss, George Lucki, Stephanie McDonald, Darlene McDonnell, Dr. Earl Mansfield, Dr. Steve Marsden, Wanda Polzin, Peter Pagano, Dr. Liana Urichuk), the Edmonton SPCA, the Pet Therapy Society of Alberta, and the Independent Evaluator (Dr. Bonnie Dobbs). Members of the Professional Advisory Team met regularly during the life of the project.

The initial stages of the project were devoted to developing data collection tools (client and therapist questionnaires), developing recruitment criteria (clients, therapists, and animals), applying for ethics approval (Health Research Ethics Board-Panel B, University of Alberta), and recruitment of therapists.

A non-randomized experimental-control repeated measures design was used in both the Private Practice and Residential Care settings. Although random assignment of subjects to intervention/control groups is the ideal research design, inclusionary/exclusionary criteria restrictions, size of the therapist recruiting population (Private Practice setting), size of client population (institutional setting), and time and cost limitations of the study (27 months) made random assignment of subjects unfeasible.

A number of techniques were used to recruit therapists into the study.

• Use of existing networks-therapists in Alberta were identified and contacted by the Project Coordinator regarding participation in the study.

• Recruitment notices were sent out to mental health therapists using email distributed by the Psychologists' Association of Alberta.

• Posters were posted at Veterinary Clinics in the Edmonton region. • Recruitment aids were posted at Breeding Clubs. • Form letters were forwarded to trainers, veterinarians, and psychiatrists.

The primary source of data collection from therapists and clients was through the use of self-administered questionnaires. Data collection instruments included the Beck Depression Inventory (or the Beck Depression Inventory-Youth) for clients with depression, the Beck Anxiety Inventory for clients with anxiety disorders (Beck Anxiety Inventory-Youth), and questionnaires developed for the study. There is a paucity of empirical investigation into the efficacy of AAT. Thus, instruments assessing its efficacy are unavailable. As a result, questionnaires were developed for the study. Although these questionnaires do not have established psychometric properties, the questionnaires were designed to quantify information available from case studies and anecdotal reports.


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Challenges

The initial recruitment of therapists was more difficult than originally anticipated due to the need for therapy animals that had passed the Canadian Canine Good Citizen (CCGC) Test. Due to recruitment difficulties, a change was made to the protocol that allowed for the use of animals that passed the Aptitude Test for Dogs in Mental Health Settings©. This change, which was approved by the Health Research Ethics Board-Panel B, facilitated recruitment of therapists. A second challenge was the recruitment of clients, particularly Control clients. Enrollment of Control clients was low in the early stages of the study, due in part to restricting recruitment of controls from therapists with AAT clients. In August of 2002, recruitment procedures were changed such that controls were recruited from therapists that did not have Experimental clients enrolled in the study. This change increased the number of Control clients participating in the study. To facilitate recruitment of clients (both AAT and Control), the protocol was expanded to include clients with other mental health disorders (e.g., Post Traumatic Stress Disorder, providing that they had a secondary diagnosis of depression or anxiety). Approval was received from the Health Research Ethics Board-Panel B at the University of Alberta for the expansion of the protocol. This expanded the size of the recruitment population and increased the generalizability of the study.

A third challenge related to data collection. Although the Project Coordinator worked diligently with therapists, a number of questionnaires were returned with data missing. The non-return of questionnaires from clients was particularly problematic (some therapists provided the clients with the questionnaires, and allowed them to complete the questionnaires at home. However, more often than not, the questionnaires were not returned to the therapist). Although therapists were counseled regarding a change in this practice (e.g., to have clients complete the questionnaires in the clinical setting), this did not translate into alterations in practice from some therapists.


4

Approach to Evaluation The Independent Evaluator (Dr. Bonnie Dobbs) worked closely with The Chimo Project team in all phases of the project.

Dobbs, in collaboration with Urichuk and Anderson, designed the client and therapist questionnaires, and selected instruments for the study (e.g., Beck Depression Inventory, Beck Anxiety Inventory). Urichuk was responsible for the recruitment of therapists and for data collection (sending out and collecting questionnaires). Dobbs assumed responsibility for data entry, cleaning of data, data analysis and synthesis, and preparation of the final report (results and final Independent Evaluation report).

Client and therapists questionnaires were designed to answer questions relevant to the evaluation questions.


5

Project Description and Context Project Overview The project consisted of two phases:

Preliminary Phase • A review of the literature related to human-animal bonding and the use of

companion animals in therapeutic settings. • The recruitment and orientation of qualified mental health professionals to the

project.

Phase One • The introduction of AAT into the treatment plans of individuals participating in

the project. Organization of the Report The report is organized by project phases. Thus, information related to the Preliminary Phase is first presented, followed by Phase One information. For the Preliminary Phase, the project objectives are presented, followed by the evaluation objectives. A description of the procedures for recruitment and orientation of qualified mental health professionals also is presented. For Phase One, the project objectives and evaluation objectives are presented. A description of sample characteristics is presented (e.g., age, gender, marital status, ratings of physical health, pet ownership, degree of informal support), followed by the results of AAT for the Private Practice group and the Residential Care group. For each of the practice settings, the demographic results are first presented, followed by the results specific to therapy outcomes and use of animals in a therapeutic setting.


6

Preliminary Phase As noted above, the Preliminary Phase consisted of a review of the literature related to human-animal bonding and the use of companion animals in therapeutic settings. Qualified health professionals were recruited and received orientation to the project during this phase of the project as well.

Preliminary Phase Objectives

The objectives for the Preliminary Phase were to: • develop a ‘database’ of literature related to human-animal bonding and the use of

companion animals in therapeutic settings, • recruit qualified mental health professionals to participate in the project, • orientate recruited mental health professionals in the use of AAT, • prepare an Orientation Manual on The Use of Companion Animals in Therapeutic

Settings for use by other mental health professionals, and • develop criteria and screening procedures for the selection of companion animals

to be used in Phase One of the project. Evaluation Overview An overview of The Chimo Project Evaluation Plan is provided in Appendix A. The Preliminary Phase consisted of three initiatives: i) a Literature Search, Database Development, and Review Initiative, ii) a Recruitment Initiative, and iii) an Orientation Manual Initiative. The evaluation activities related to each of the initiatives are outlined below.

i. Literature Search, Database Development, and Review Initiative-a search of the

extant literature related to human-animal bonding and the use of companion animals in therapeutic settings, the development of a literature database, and a review of the literature. The Literature Search, Database Development, and Review Initiative was not evaluated per se. Rather, the Independent Evaluator conducted a comprehensive literature search and wrote an integrative review of the literature based on studies of the benefits of AAT for persons with depression and/or anxiety disorders (Gardiner & Dobbs, 2001).

ii. Recruitment Initiative-evaluation of criteria used to recruit qualified mental health

professionals to the project.

The goal of the Recruitment Initiative Survey was to determine the congruency between the recruitment criteria for mental health practitioners for The Chimo Project and the qualifications of the mental health practitioners selected for the project. Congruency was determined by an assessment of the ‘fit’ between the recruitment criteria and the résumés of the mental health practitioners participating in the project.


7

iii. Orientation Manual Initiative-evaluation of the Orientation Manual titled The Use of Companion Animals in Therapeutic Settings that was developed for the project.

An important component of the project was the development of an Orientation Manual for AAT. The manual Improving Mental Health Through Animal Assisted Therapy (Urichuk & Anderson, 2003), was “designed to provide mental health professionals and others with currently known information on how animals can act as adjuncts to the therapeutic process for individuals with mental health concerns” (p. xiv). The manual consists of five chapters. The first chapter provides an introduction to AAT, and consists of an overview of The Chimo Project, the history of AAT, anecdotal and case studies of AAT, experimental studies of AAT, and current use of AAT along with relevant references. In Chapter 2, the authors outline approaches to incorporating animals into mental health therapy interventions. Included are goals and strategies of AAT, the roles animals can play in therapy (e.g., assessment tools, projective tools, tools for storytelling, role modeling tools, and teaching tools), and alternative ways to utilize the human-animal bond. In Chapter 3, guidance is given for implementing AAT programs. Topics covered include standards for animal selection, guidelines for training and orientation, issues related to liability, and selected AAT training courses and/or degree programs. Chapter 4 is dedicated to issues related to monitoring and evaluation of AAT programs. Topics addressed include performance indicators, outcome measures, efficacy, testimonials as outcome measures, and safety and ethical issues. The final chapter deals with experimental research studies on AAT including studies on visitation within the home and institutional settings. Appendices include the Canadian Canine Good Citizen (CCGC) Test, the Aptitude Test for Dogs in Mental Health Settings©, Therapist and Client Evaluation Questionnaires (developed specifically for The Chimo Project by Dobbs, Urichuk, & Anderson, 2001), and a summary of the goals and strategies for AAT in mental health settings. The manual is a valuable resource for any mental health therapist interested in implementing AAT in the clinical setting. The evaluation objective for the Orientation Manual was to provide an independent evaluation of the manual Improving Mental Health Through Animal Assisted Therapy (Urichuk & Anderson, 2003). A questionnaire was developed and sent to mental health professionals involved in the project and mental health professionals not involved in the project12. The questionnaire is provided in Appendix B.

12 As per the evaluation plan, data also were to be collected from experts in training mental health professionals and those with expertise in AAT (e.g., Counseling and Clinical MHP educators). However, the manual was released in June, 2003. Thus, time constraints precluded the data collection from this category of experts.


8

Results

i. Literature Search, Database Development, and Review Initiative

As noted above, a comprehensive review of the literature related to human-animal bonding and the use of companion animals in therapeutic settings was conducted by the Independent Evaluator. Databases searched included PsychINFO, Medline, and Current Contents. Further articles were obtained from the reference lists of retrieved articles. A review of that literature, entitled Animal Assisted Therapy: A Review of the Experimental Literature (Gardiner & Dobbs, 2001) is available on request.

ii. Recruitment Initiative

The evaluation results of the Recruitment Initiative Survey are presented in Table 1. As can be seen, in general, the therapists met the 10 inclusionary criteria and the one exclusionary criterion (one therapist - J.M. - counseled Control clients only. As a result, criteria related to AAT were not applicable).


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Table 1 Recruitment Initiative Survey

√ = Met criteria

Criteria Therapists

TW BH DS WP PT JD JM BR

Inclusionary Criteria

1. Licensed in profession. √ √ √ √ √ √ √ √

2. Documentation of current and valid credentials and/or licensure available. √ √ √ √ √ √ √ √

3. Practice within the scope of their profession. √ √ √ √ √ √ √ √ 4. Demonstrated commitment and willingness to participate in

project. √ √ √ √ √ √ √ √

5. a. Attended a seminar on animal and risk management

practices.

√ √ √ √ √ √ √ √

b. Demonstrate knowledge of animal and risk management procedures.

√ √ √ √ √ √ √ √

6. Goals set for AAT on an individual basis (for The Chimo Project clients). √ √ √ √ √ √ √ √

7. Practice includes clientele meeting the inclusionary criteria for clients (DSM-IV criteria for depression/anxiety). √ √ √ √ √ √ √ √

8. a. Willingness to complete study questionnaires at regular

intervals.

√ √ √ √ √ √ √ √

b. Willingness to be interviewed at completion of project. √ √ √ √ √ √ √ √ 9. Demonstrated animal handling skills as per CCGC criteria. √ √ √ √ √ √ N/A √ 10. An animal meeting the CCGC and/or Aptitude Test criteria. √ √ √ √ x √ N/A √

Exclusionary Criteria

1. History of allergies to animals. √ √ √ √ √ √ N/A √ 2. Dislike of animals. √ √ √ √ √ √ N/A √

N/A = Not Applicable


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iii. Orientation Manual Initiative

Questionnaires were sent to 10 therapists, and nine therapists completed and returned the questionnaires (the one therapist was on holidays and received the questionnaire past the return date). Five therapists identified themselves as psychologists, two as clinical psychologists, one as a social worker, and one as a registered psychiatric nurse. The average number of years in practice was 11.44 years (SD = 8.44, Range = 3 to 26 years).

In terms of experience with AAT, 78% of the therapists indicated they had practical experience with AAT. Only 22% of the therapists had taken educational courses, with the Delta Society course identified as the source for educational training. The participating therapists had been using AAT for approximately four and one half years (SD = 2.61 years). At the time of the questionnaire, the vast majority (86%) were currently using AAT in their practices, with 57% using it on a regular basis. Ratings on the relevance, helpfulness, and usefulness of the manual were very positive. As can be seen from Table 2, for all questions, the ratings ranged, for the most part, from relevant to very relevant (question 4), helpful to very helpful (questions 5, 6, 7, 8, and 10), useful to very useful (question 9), and informative to very informative (question 11). More than three quarters (78%) of the respondents rated the quality of the manual as excellent.


11

Table 2 Results (Frequencies) of Ratings From Therapists on the Orientation Manual Entitled Improving Mental Health Through Animal Assisted Therapy

Item Ratings 4. How would you rate the relevance of the information in the

manual? Relevant = 22% Very Relevant = 78%

5. How helpful did you find the specific examples of goals and strategies for animal-assisted therapy (Chapter 2)?

Helpful = 22% Very Helpful = 78%

6. How helpful did you think the information on goals and strategies would be for enhancing the knowledge of the following groups of people:

a) students in a mental health discipline? Helpful = 33% Very Helpful = 67%

b) students in another health discipline? Helpful = 88% Very Helpful = 12%

c) education students? Helpful = 63% Very Helpful = 25%

d) professionals in a mental health field? Helpful = 11% Very Helpful = 89%

e) professionals in another health field? Helpful = 63% Very Helpful = 37%

f) professional educators? Helpful = 44% Very Helpful = 56%

g) volunteer animal handlers? Helpful = 50% Very Helpful = 37.5%

h) program directors/managers? Helpful = 56% Very Helpful = 33%

7. How would you rate the usefulness of the information on implementing an animal-assisted therapy program (Chapter 3)?

Useful = 44% Very Useful = 56%

8. How helpful do you think the information on implementing an animal-assisted therapy program would be for individuals/organizations who are not familiar with (or are not currently using) animal-assisted therapy?


9. How would you rate the information on monitoring and evaluating animal-assisted therapy programs (Chapter 4)?

Useful = 56% Very Useful = 44%

10. How helpful do you think the information on monitoring and evaluating animal-assisted therapy would be for individuals/organizations who are implementing a new animal-assisted therapy program?


11. How informative did you find the review of experimental literature on animal-assisted therapy (Chapter 5)?

Informative = 44% Very Informative = 56%

12. Overall, how would you rate the quality of the manual’s contents?

Good = 22% Excellent = 78%


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Phase One

Phase One of the project consisted of the introduction of AAT into the treatment plans of individuals participating in the project.

Phase One Objectives • develop policies and procedures to address risk management pertaining

to human and animal welfare issues relevant to the use of companion animals in therapeutic settings (Risk Management Initiative).

• screen companion animals for participation in the therapeutic phase of the project (Companion Animal Screening Initiative).

• assess the impact of AAT on individuals participating in Phase One of the project (Impact of AAT Initiative).

Evaluation Overview

Of the objectives listed above, the objective that was included in the evaluation plan for Phase One of the project was to:

• assess the impact of AAT on individuals participating in Phase One of the project (Impact of AAT Initiative).

The remaining two objectives (Risk Management Initiative and Companion Animal Screening Initiative) did not require evaluation per se. Rather, the Independent Evaluator provided assistance to The Chimo Project personnel in developing risk management policies and procedures relevant to the use of companion animals, and the criteria and screening procedures for the selection of companion animals.

As noted in the Project Overview, the primary objective of The Chimo Project was to enhance and improve the well being of selected consumers of mental health services through AAT. Given its primacy, this objective formed the major component of the evaluation plan.


13

Overview of the Study

There were two sources of recruitment: the Private Practice setting and a Residential Care (Group Home) setting. There also were two categories of participants in the study. The first category consisted of individuals diagnosed with depression and/or anxiety disorders (Client). The second category consisted of therapists (Therapist). Finally. the study sample consisted of Experimental clients (clients receiving AAT) and Control clients (clients receiving traditional forms of therapy). A graphic overview of the study is provided in Figure 1.

AAT Control

Client

AAT Control

Therapist

Private Practice

AAT Control

Client

AAT Control

Therapist

Residential Care

Figure 1. An overview of the study: Sources of recruitment, categories of participants, and type of participant within each category. Clients and therapists were recruited for the study based on the following inclusionary/exclusionary criteria:

Clients

Inclusionary Criteria 1. Clients must currently meet the DSM-IV criteria for

depression (Major Depressive Episode) or for Anxiety Disorders.

Exclusionary Criteria 1. History of allergies to animals. 2. Fear or dislike of animals. 3. A history of abuse of dogs13. 4. Immune suppression.

13 The past history of each client was reviewed by their therapist and a judgment as to their suitability to participate was made.


14

Therapists

Inclusionary Criteria 1. Therapists must have valid credentials and be licensed in

their profession as specified within that profession’s jurisdiction (e.g., if a psychologist, must be chartered and licensed with the College of Alberta Psychologists).

2. Documentation of current and valid credentials and/or licensure must be available upon request.

3. Therapists will practice within the scope of their profession.

4. Therapist will demonstrate commitment and willingness to participate in the project.

5. Therapists will attend a seminar on animal and risk management practices, and demonstrate knowledge of animal and risk management practices.

6. Therapists will set goals for AAT on an individual client basis.

7. The therapists’ practices include clientele meeting the inclusionary criteria for clients listed above.

8. Therapists will be willing to complete study questionnaires at regular intervals and be interviewed at project completion with regard to the use of AAT.

Exclusionary Criteria 1. History of allergies to animals. 2. Dislike of animals.


15

Animals used in the AAT sessions were required to meet the following inclusionary/exclusionary criteria:

Inclusionary Criteria 1. Successful completion of the Canadian Canine Good

Citizen (CCGC) Test or a modification thereof (See Appendix C for a copy of the CCGC Test)14.

2. Documentation must be available of annual vaccinations and other screening tests that are advised by the facilities risk management policies.

3. Animals will be groomed appropriately (e.g., nails short and smooth, paws and coat clean, teeth clean, breath not offensive, etc.)

4. The animal handler will demonstrate that the animal has appropriate reactions to different social situations and incidents that may directly or indirectly affect public health and/or safety.

5. The animal will demonstrate its obedience during assessment, and the handler will demonstrate the animal can be engaged and disengaged from activities or interactions easily.

6. The animal will demonstrate acceptable behavior during task-appropriate simulations of AAT situations.

Exclusionary Criteria 1. 12 months of age or younger

The project received approval from the Health Research Ethics Board-Panel B at the University of Alberta.

14 This criterion was changed approximately half way through the study to a requirement that the animal pass the Aptitude Test for Dogs in Mental Health Settings© (see Appendix C). Over the course of the study, it was found that the CCGC Test was a major barrier to recruiting therapists. That is, there were therapists who wanted to participate in the study but were unable to do so because their animals did not pass the CCGC Test. A contributing factor to these failures is the environment in which the test is administered (i.e., a large open space that is set up similar to an obedience ring). The majority of therapists and animals screened for the project were not familiar with this setting and, as a result, became quite nervous and failed one or more of the obedience skills tested. Unfortunately, the CCGC Test cannot be administered in an office environment because of space requirements. After the inception of the project, The Pet Therapy Society of Alberta developed an Aptitude Test for Dogs in Mental Health Settings© to help screen animals for The Chimo Project (see Appendix C). This test is easily administered in an office setting where the animal and therapist are more comfortable. All of the therapy dogs (i.e., dogs that are currently used by therapists during client sessions) screened for the project passed the Aptitude Test for Dogs in Mental Health Settings©.


16

The results of the project are presented as follows:

A. Private Practice

1. Client Results i. Demographics ii. Therapy Results (AAT vs. Control Clients)

2. Therapist Results

i. Demographics ii. Therapy Results (AAT vs. Control Clients)

B. Residential Care

1. Client Results




Results Data were analyzed using SPSS 11.5. Multivariate analysis of variance (MANOVA’s), and independent and paired t-tests were used to analyze continuous data (e.g., age, ratings of therapy in general, ratings on the use of animals in therapy, etc.) and chi-square analyses were used to analyze categorical data (gender, marital status, pet ownership, etc.). Over the course of the study, there were no untoward incidences involving use of the animals for AAT. A. Private Practice Results Forty-five clients with mental health problems and eight therapists participated in the study. Nine clients were deleted from the sample: seven clients because they attended two or fewer sessions and two clients because they failed to complete the questionnaires. Thus, data from 36 clients were available for analyses.

1. Client Results

i. Demographics

Clients completed a comprehensive client questionnaire upon enrollment into the study and after each therapy session. Copies of the client questionnaires (AAT and Control) are provided in Appendix D.


17

Of the 36 clients participating in the study, 26 clients were from Private Practice. Of those, 15 received AAT in conjunction with traditional therapy (e.g., cognitive behavioral therapy, psychotherapy), and 11 received traditional therapy. The majority of the Control clients were members of the same anxiety group conducted by one therapist. The age, gender, marital status, and ratings of physical health for the Private Practice clients are provided in Table 3. Importantly, there were no significant differences between the two groups for age, gender, marital status, physical health, or level of depression or anxiety (p > .05).

Age As can be seen, the average age for AAT clients was 34 years. The average age for Control clients was 40 years. Gender There were 11 females and 4 males in the AAT group, and 10 females and 1 male in the Control group. Marital Status The marital status for each of the groups was as follows: for the AAT group, 7 were single, 5 were married, and 3 were classified as other (e.g., separated). In the Control group, 1 was single, 8 were married, and 1 was classified as other. Physical Health The majority of individuals in both groups rated their health as good or very good. Eighty percent (80%) of AAT clients rated their health as good or very good, 70% of Control clients rated their health as good or very good. Depression and Anxiety Diagnoses and Scores Seven of the AAT clients were diagnosed with a depression, five with an anxiety disorder, and three with both depression and anxiety disorders. Five of the Control clients were diagnosed with depression, five with an anxiety disorder, and one with Post Traumatic Stress Disorder (PTSD). Diagnoses were made using DSM-IV criteria for depression, anxiety disorder, and PTSD (American Psychiatric Association, 199415). Thirty-three percent (33%) of the AAT clients had a co-morbid disorder (e.g., Attention Deficit Hyperactivity Disorder, agoraphobia, obsessive-compulsive personality disorder, avoidant personality disorder, etc.). For Control clients, co-morbidity was known for only eight. Of those eight, 25% had a co-morbid diagnosis.


18

15 American Psychiatric Association. (1994). Diagnostic and statistical manual of mental disorders – Fourth Edition. Washington, DC: American Psychiatric Association.

The average depression score (as per the Beck Depression Inventory) for the AAT group was 31 (severely depressed) and the average for the Control group was 25 (moderately depressed). This difference was not statistically significant (p > .05). The average anxiety score (as per the Beck Anxiety Inventory) for the AAT group was 29 (severely anxious) and the average for the Control group was 22 (moderately anxious). The difference between the two groups was not significant (p > .05).

Table 3 Demographic Results for Private Practice Clients (AAT and Control)

AAT Control p

Private Practice Age 34.40

(15.89) 40.20 (9.81)

>.05 (NS)

Gender M=4 F=11

M=1 F=10

>.05 (NS)

Marital Status

S=7 M=5

Other=3

S=1 M=8

Other=1

>.05 (NS)

Physical Health

2.79 (.89)

3.10 (.74)

>.05 (NS)

BDI–II* (baseline)

31.40 (17.86)

25.44 (10.10)

>.05 (NS)

BAI+ (baseline)

28.71 (19.52)

22.44 (14.81)

> .05 (NS)

* = Beck Depression Inventory-II + = Beck Anxiety Inventory NS = Not significant

In addition to demographic information, clients were asked to provide information on pet ownership and the degree of informal support available to them. The results are provided below.

Pet Ownership Sixty-four percent (64%) of the AAT clients and 90% of the Control clients owned pets. The length of pet ownership was 3.6 years for the AAT group and 8.4 years for the Control group. The difference for length of pet ownership was statistically significant (p < .04).


19

Clients also were asked to provide information on availability of support. People That They Can Count on to Listen On average, both AAT and Control clients indicated that they had two or more people that they could count on to listen when they needed to talk to someone. People That Are There to Help Them Feel Better Both AAT and Control clients also had two or more people that were there that help them feel better when they were generally feeling ‘down in the dumps’.

Data also were collected on the number of therapy sessions attended by each of the clients. Not surprisingly, the number of therapy sessions attended differed among clients. The number of therapy sessions for AAT clients ranged from three to thirteen. The range for the Control clients was three to eight. The median number of sessions attended was four for the AAT group and six for the Control group (see Figure 2).

0

2

4

6

8

10

AAT Control

Med

ian

Figure 2. Private Practice: Median number of sessions attended over the course of the study by AAT and Control clients.

As noted above, the range for sessions attended was larger for the AAT group than for the Control group. Three clients in the AAT group attended 10, 11, and 13 sessions respectively. These can be considered as outliers in the sample given that the average number of sessions attended for the AAT group was 6.3 (compared to a mean of 5.2 for the Control group). Once these outliers were removed, the average number of sessions attended by the AAT group was 5.0. A comparison of sessions attended revealed no significant differences between the AAT and Control groups, with and without the outliers (p > .05).


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ii. Therapy Results (AAT vs. Control Clients) Depression Scores at Time 1 and 2

Clients’ scores on the Beck Depression Inventory-II (BDI-II) were examined for change over time (the median time period was three months, with a range of one to eight months). The BDI-II scale is such that a higher score indicates a greater severity of depression. As can be seen in Figure 3, the level of depression decreased for the AAT clients. However, that decrease was not significant (p > .25). The Control client’s level of depression also decreased between Time 1 (baseline) and Time 2. That decrease was significant (p = .01). Thus, there was a significant improvement in level of depression for Control clients over the course of therapy sessions but not for the AAT clients.

0

10

20

30

40

50

60

BDI Baseline BDI Time 2

Mea

n AATControl

Figure 3. Private Practice: Mean depression scores at Times 1 (baseline) and 2 for AAT and Control clients.


21

As noted above, there was a significant difference in pet ownership between AAT and Control clients. Therefore, the data were examined to see if there were differences in average depression scores for AAT clients who owned animals and those who did not. The results indicated that the Time 1 depression scores were substantially higher for AAT clients who did not own pets compared to those did (see Figure 4 below). Interestingly, the depression scores for the two groups (AAT clients who owned pets vs. those who did not) at Time 2 were approximately the same. Statistical comparisons were not carried out due to the small sample size (n = 9: 7 owed pets, 2 did not). Caution is advised in interpreting the data because of the small sample size.

0

10

20

30

40

50

60

BDI Baseline BDI Time 2

Mea

n

AAT Clients: DoNot Own PetAAT Clients: OwnPet

Figure 4. Private Practice: Average depression scores for AAT clients as a function of pet ownership at Time 1 (Baseline) and Time 2.

A similar examination of the data for the Control clients was not conducted because of the small sample size overall (n = 10), and because of the size of the sample for the non-pet ownership category (n = 1).


22

Anxiety Scores at Time 1 and 2 Clients’ scores on the Beck Anxiety Inventory (BAI) also were examined for change over time (approximately three to four months). Scoring on the BAI is such that a higher score indicates a greater severity of anxiety. As shown in Figure 5, there was a modest decrease in AAT clients’ anxiety scores over time. This difference was not significant. There was, however, a significant decrease in the anxiety scores for Control clients over time (p = .003).

0

10

20

30

40

50

60

BAI Baseline BAI Time 2

Mea

n AATControl

Figure 5. Private Practice: Mean anxiety scores at Time 1 (Baseline) and Time 2 for AAT and Control clients.


23

As with the depression scores, the anxiety scores were examined to see if there were differences in anxiety scores for AAT clients who owned animals and clients who did not. The results indicated that the Time 1 anxiety scores were substantially higher for AAT clients who did not own pets compared to those clients who did (see Figure 6 below). Unlike the depression scores, the differences in scores at Time 2 for the two groups (those AAT clients who owned pets vs. those who did not) remained. Statistical comparisons were not carried out due to the small sample size (n = 7: 4 owned pets, 3 did not). Again, due to the small sample size, caution is advised in interpreting the data.

0

10

20

30

40

50

60

BAI Baseline BAI Time 2

Mea

n AAT Clients: DoNot Own PetAAT Clients: OwnPet

Figure 6. Private Practice: Anxiety scores at Time 1 (baseline) and Time 2 for AAT clients as a function of pet ownership.

A similar examination of the data for the Control clients was not conducted because of the small sample size overall (n = 10) and because of the size of the sample for the non-pet ownership category (n = 1).


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Effectiveness of AAT vs. Traditional Therapy

To determine the effectiveness of AAT, Session 1 ratings were compared to Session 4 ratings for both AAT and Control clients. Session 4 was used as the comparison unit of analyses for two reasons: 1) The median number of sessions attended by the AAT group was four, and 2) Session 4 had the least amount of missing data for both AAT and Control clients.

Client ratings were compared between Sessions 1 and 4 for the three categories of interest (‘Therapy in General’, the Degree to Which Goals Were Met, and Overall Assessment). The results are presented as follows:

1. Ratings for ‘Therapy in General’ − AAT clients’ Ratings for Sessions 1 and 4. − Control Clients’ Ratings for Sessions 1 and 4. − Difference Scores (Session 4 - Session 1) for Both AAT

and Control Clients. 2. The Degree to Which Goals Were Met 3. Overall Assessment


25

Ratings for ‘Therapy in General’

Clients completed questionnaires upon entry to the study and after each therapy session. Copies of the questionnaires (AAT and Control) are provided in Appendix D. All clients (those receiving AAT and Controls) were asked to provide ratings on items related to ‘Therapy in General’ using a visual analogue scale (10 mm in length). An example of the scale is provided below.

____________________________________________________ Not at all To a great extent

Responses ranged from 0 to 10. The nine items were as follows:

1. I feel comfortable talking with the therapist. 2. I find it easy to focus on important problems when I talk with the

therapist. 3. I look forward to coming to therapy. 4. I would like therapy sessions to last longer. 5. I am willing to discuss what is happening to important people in

my life. 6. I am willing to talk about my feelings during therapy sessions. 7. As a result of this therapy session, I am more hopeful about my

life. 8. I feel like my mood has improved because of this therapy session. 9. I feel less anxious because of this therapy session.

Baseline ratings (means and standard deviations) for both AAT and Control clients are provided in Appendix E (Table E1). Importantly, there were no differences in baseline responses between the two groups (AAT vs. Controls) (overall MANOVA, p > .07). Means and standard deviations for both AAT and Control clients for Session 4 also are provided in Appendix E (Table E1).


26

AAT Clients Ratings for Sessions 1 and 4 The ratings for Sessions 1 and 4 from AAT clients on items related to ‘Therapy in General’ are shown in Figure 7. The ratings at baseline (Session 1) were generally positive (a rating of six or higher). Interestingly, the ratings for Session 4 are, in general, lower. However, those differences are not significant (p > .05 on paired sample t-tests).

02468

10

Feel Comfortable

Easy to Focus

Look Forward to Coming

Last Longer

Willing to Discuss

Willing to Talk

More Hopeful

Mood Improved

Less Anxious

Mea

n Session 1Session 4

Figure 7. Private Practice: AAT client ratings for ‘Therapy in General’ for Sessions 1 and 4.


27

Control Clients Ratings for Sessions 1 and 4 The ratings for Sessions 1 and 4 for the Control clients on items related to ‘Therapy in General’ are shown in Figure 8. Unlike the AAT clients, the ratings for the Control clients tended to be more positive at baseline (Session 1) and increased at Session 4.

02468

10

Feel Comfortable

Easy to Focus

Looks Forward to Coming

Last Longer

Willing to Discuss

Willing to Talk

More Hopeful

Mood Improved

Less Anxious

Mea


Figure 8. Private Practice: Control client ratings for ‘Therapy in General’ for Sessions 1 and 4.

Paired t-tests indicate that the differences in Control client ratings between Sessions 1 and 4 were significant for two of the items: Question 7 “The therapy has made me more hopeful about my life”, (p = .005), and Question 8 “I feel like my mood has improved as a result of this therapy session”, (p=.02). The differences were such that the clients were more hopeful and felt that their mood had improved more so at Session 4 than Session 1. Caution is warranted, however, in interpreting the results given the size of the sample (n=10).


28

Differences Scores (Session 4 - Session 1) for Both AAT and Control Clients

Differences were calculated between Sessions 1 and 4 ratings for each group by subtracting Session 1 ratings from Session 4 ratings. Thus, a positive difference score indicates that clients rated the item as higher for Session 4 than for Session 1 (i.e., an improvement in ratings across sessions). The average difference score for each item for both the AAT and the Control groups is shown in Figure 9.

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10

Feel Comfortable

Easy to Focus


Last Longer

Willing to Discuss

Willing to Talk

More Hopeful

Mood Improved

Less AnxiousMea

n D

iffer

ence

AATControl

Figure 9. Private Practice: Mean difference scores (Session 4 – Session 1) for ‘Therapy in General’ for AAT and Control clients. As can be seen in Figure 9, the trend was for negative difference ratings for the AAT clients and for positive difference ratings for the Control clients. Importantly, the overall MANOVA was not significant (p > .13), indicating that the differences between the two groups were not significant. In general, the difference scores ranged from -2 to +2.


29

Pet Ownership As indicated earlier, there were substantially more Control clients who owned pets compared to AAT clients (5 = did not own pets, 9 = owned pets). The data were examined to determine if pet ownership had an effect on response to therapy. As shown in Figure 10, the pattern of ratings for ‘Therapy in General’ for AAT clients who owned pets was different compared to those who did not own pets. In general, Session 1 (baseline) ratings for clients who owned pets were higher than the ratings for those who did not own pets (Note: the lower rating for Question 4 “I would like therapy to last longer” is driven by two very low ratings [0 and .4] ). There were greater differences between the two groups on two of the items: Question 2 “I find it easy to focus on important problems when I talk with the therapist”, and Question 5 “I am willing to discuss what is happening to important people in my life”. The pattern is such that AAT clients who did not own pets found it more difficult to focus on important problems during the therapy session and were less willing to discuss what was happening to important people in their lives. However, due to small sample sizes, statistical analyses were not carried out. Caution is again advised in interpreting the data.

02468

10Feel Comfortable

Easy to FocusLooks Forward to Coming

Last LongerW

illing to Discuss

Willing to Talk

More HopefulMood Improved

Less AnxiousM

ean Do Not Own Pet

Own Pet

Figure 10. Private Practice: Session 1 average ratings on ‘Therapy in General’ for AAT clients who owned pets versus those who did not own pets.


30

Average ratings for Session 4 are presented in Figure 11. Interestingly, the pattern is such that, overall, the differences in ratings between the AAT clients who owned pets versus those who did not own pets are somewhat reduced from those seen in Session 1.

02468

10

Feel Comfortable

Easy to FocusLooks Forward to Coming

Last LongerWilling to Discuss

Willing to TalkMore HopefulMood Improved

Less AnxiousM

ean Do Not Own Pet

Own Pet

Figure 11. Private Practice: Session 4 average ratings on ‘Therapy in General’ for AAT clients who owned pets versus those who did not own pets. For the Control clients in Private Practice, nine owned a pet and one did not. The small sample size overall, and the ‘n’ of one for the non-pet owner category made statistical comparisons impossible. Out of interest, the data were examined to see if the same pattern existed for the Control clients as it did for the AAT clients in terms of pet ownership. In general, for Session 1, the ratings were very similar for five of the nine items (easy to focus, look forward to coming to therapy, want therapy to last longer, willing to discuss, and willing to talk). The Control client who did not own a pet felt more comfortable talking with the therapist that did Control clients who owned pets. The reverse was true for the last three items (more hopeful, mood improved, and less anxious). That is, the ratings for Control clients who owned pets were higher for the three items compared to the Control client who did not own a pet. For Session 4, the Control client who did not own a pet had higher ratings on all items. However, given that there was only one Control client who did not own a pet, the results should be interpreted with extreme caution. The data also were examined to see if there were similarities or differences for AAT clients who owned pets and Control clients who owned pets. For Session 1, the ratings were similar for the two groups. For Session 4, the ratings were higher for the Control clients who owned pets compared to AAT clients who owned pets. Thus, the differences between Control clients and AAT clients cannot be attributed to higher pet ownership in the Control group.


31

Degree to Which Therapy Goals Were Met At the beginning of the therapy session, the client and the therapist were to develop a list of goals for the therapy session. At the end of the session, clients were asked to indicate the degree to which they felt each of the goals was met using the following scale:

-2 -1 0 +1 + 2

Much less than

expected

Somewhat less than expected

Expected level

Somewhat better than expected

Much better than

expected

Examination of the data indicates however, that, with the exception of Session 1, few goals were developed for either AAT or Control clients. Table 4 indicates the number of clients for which goals were developed (number of clients and percentage of sample). As can be seen, at least one goal was developed rather consistently for Session 1 for both AAT and Control clients. There were few goals developed in Session 4 for either group. Table 4 Private Practice: Goals Developed for AAT and Control Clients for Sessions 1 and 4 (Number of Clients, Percentage) AAT Control Session 1 Goal 1 9 (60%) 8 (80%) Goal 2 7 (47%) 0 (0%) Goal 3 2 (13%) 1 (10%) Session 4 Goal 1 6 (13%) 5 (50%) Goal 2 4 (13%) 1 (10%) Goal 3 0 (13%) 0 (0%)

For Session 1, the average rating for goal number one for the AAT clients was .67. The average rating was .14 for the Control clients. Thus, clients in each group indicated that their goal expectations for therapy were met.


32

Specific breakdowns for each category for goal number one are as follows:

AAT clients 33% thought that the degree to which the goal was met was somewhat less than expected, 11% expected, 11% somewhat better than expected, and 44% much better than expected. Control clients 14% thought that the degree to which the goal was met was somewhat less than expected, 57% expected, and 29% somewhat better than expected.


33

Overall Assessment Clients provided ratings indicating the extent that therapy helped them at home, school, and work. Clients were asked to provide ratings using a visual analogue scale (10 mm in length) as shown below.

____________________________________________________

Not at all To a great extent

Responses ranged from 0 to 10. Ten (67%) of the AAT clients attended school, none of the Control clients did. Three (20%) of the AAT clients and three (33%) of the Control clients worked outside the home. The ratings for each of the areas (home, school, and work) for Sessions 1 and 4 are provided in Figure 12. As can be seen, the trend was for the ratings for the AAT clients to decrease or stay the same across sessions, and to increase for the Control clients. Because of small sample sizes, only the difference in home ratings was tested for statistical significance. The difference was significant (p = .04). In essence, the Control clients showed a greater degree of improvement in ratings of how therapy helped them in performing better at home compared to the AAT clients.

0

2

4

6

8

10

AATSession 1

AATSession 4

ControlSession 1

ControlSession 4

Mea

n HomeWorkSchool

Figure 12. Private Practice: AAT and Control clients’ ratings for Sessions 1 and 4 on whether therapy helped them in their home, school, and work performance.


34

To determine if the difference in home ratings was due to animal ownership, the ratings for AAT clients who owned pets were compared to AAT clients who did not. The average ratings for Sessions 1 and 4 are shown in Figure 13. The ratings were somewhat higher for the AAT clients who owned pets than for those who did not for both Sessions 1 and 4 but more so for Session 1. Examination of the results suggests that the difference in home ratings between the AAT group and the Control group cannot be explained by animal ownership, particularly for Session 4.

0

2

4

6

8

10

Home Session 1(Baseline)

Home Session 4

Mea

n

AAT Clients: DoNot Own PetAAT Clients: OwnPet

Figure 13. Private Practice: Mean ratings for AAT clients for Sessions 1 and 4 on whether therapy helped them at home.


35

Information Specific to the Use of Animals in Therapy

Information also was collected from AAT clients regarding the use of animals in therapy. AAT clients were asked to provide ratings on their comfort with the animal, if the animal had an impact on coming to therapy, etc. The 10 items are provided below:

1. The animal helps me feel more comfortable with the therapist. 2. The animal helps me focus on important problems. 3. The animal was of comfort to me during the therapy session. 4. The animal makes me look forward to coming to therapy. 5. Having the animal in the room makes me want to stay in the

therapy session longer. 6. I am more willing to discuss what is happening to important people

in my life with the animal present. 7. I am more willing to talk about my feelings with the animal present. 8. The animal accepts me for who I am. 9. I feel like taking better care of myself because of the animal. 10. I have trouble concentrating with the animal in the room.

Baseline ratings (means and standard deviations) are provided in Appendix E (Table E2).

AAT client ratings on the 10 items for Sessions 1 and 4 are provided in Figure 14.


36

As shown in Figure 14, ratings were generally positive for all items across both sessions, with little in the way of change. It is important to note that for the last item in Figure 14 (I have trouble concentrating with the animal in the room), a low rating is positive. In general, clients indicated that the animal helped them to feel more comfortable with the therapist and to talk about their feelings. They also indicated that the animal made them look forward to coming to therapy and to stay in therapy sessions longer. It is important to note that clients felt that the animal accepted them for who they were. Clients indicated that the animal did not affect their concentration during therapy.

0

2

4

6

8

10

A. Helps to Feel Comfrt.

A. Helps to Focus

A. of Comfort

A. Coming to Therapy

Stay in Therapy Longer

Willing to Discuss

Talk About Feelings

A. Accepts Me

Take Better Care

Trouble Concentrating

Mea


Figure 14. Private Practice: AAT client ratings on the use of animals in therapy for Sessions 1 and 4.


37

Pet Ownership To determine if pet ownership made a difference in how the clients felt toward the use of animals in therapy, the responses to the items were examined as a function of pet ownership. The average ratings for Session 1 for AAT clients who owned a pet and for those who did not are shown in Figure 15. As can be seen, the trend was for lower ratings for clients who did not own a pet.

02468

10


A. Helps to Focus

A. of Comfort



Willing to Discuss

Talk About Feelings

A. Accepts Me

Take Better Care


Mea

n

AAT Clients: Do NotOwn PetAAT Clients: OwnPet

Figure 15. Private Practice: Average ratings for AAT clients for Session 1 as a function of pet ownership.


38

The average ratings for Session 4 for AAT clients who owned a pet and for those who did not are shown in Figure 16. The patterns for the two groups of clients are more dissimilar than for Session 1 ratings. The trends are however consistent in that the ratings are lower for clients who did not own a pet.

02468

10


A. Helps to Focus

A. of Comfort



Willing to Discuss

Talk About Feelings

A. Accepts Me

Take Better Care


Mea

n AAT Clients: Do NotOwn PetAAT Clients: OwnPet

Figure 16. Private Practice: Average ratings for AAT clients for Session 4 as a function of pet ownership.


39

iii. Summary of Results Private Practice Clients Demographics

• Private Practice clients were diagnosed with depression, an anxiety disorder, and/or Post Traumatic Stress Disorder. A number of clients (33% of the AAT clients and 25% of Control clients) also had a co-morbid disorder (e.g., obsessive-compulsive personality disorder, avoidant personality disorder, ADHD, etc.).

• There were no differences in demographics (age, gender, marital

status, physical health, depression scores, anxiety, etc.) for the clients receiving AAT versus clients receiving traditional forms of therapy at baseline. There were differences in pet ownership: more Control clients owned pets than did AAT clients (90% vs. 67%). The potential effect of this difference is addressed below.

‘Therapy in General’/Functioning at Home

• Results of client ratings on items related to ‘Therapy in General’

indicated that although there were no differences statistically between clients receiving AAT and clients receiving traditional forms of therapy, the overall pattern was for the ratings for clients receiving traditional forms of therapy to be slightly higher. In addition, depression and anxiety scores improved for clients receiving traditional forms of therapy over time (between Sessions 1 and 4). No such improvement was seen across sessions for the clients receiving AAT. Finally, Control clients showed a greater degree of improvement in ratings of how therapy helped them in performing better at home compared to the AAT clients.

• The results from Private Practice clients may be related to pet

ownership. That is, the ratings for Private Practice clients who own pets are very similar to clients receiving traditional forms of therapy. The ratings for clients receiving AAT who do not own pets were lower at the start of therapy. Interestingly, the ratings for later sessions (Session 4) for AAT clients who did not own pets were similar to the ratings of AAT clients who owned pets.

• One reason for the differences in depression and anxiety scores over time also may be related to pet ownership. AAT clients who did not own pets were more depressed and more anxious at the start of the study than AAT clients who owned pets. After four sessions, there were no differences in depression scores between those who owned pets and those who did not. However, at Session 4, clients who did not own pets were still more anxious than clients who did own pets.


40

• The ratings at Session 1 for how therapy helped clients perform at home were somewhat higher for AAT clients who owned pets versus those who did not. However, by Session 4, the ratings were very similar. Given the similarity in ratings at Session 4 for both groups, it is unlikely that pet ownership had an influence on these ratings.

Information Specific to the Use of Animals in Therapy • Clients receiving AAT were asked to rate items related to the use of

animals in therapy. The ratings were generally positive for all items across both sessions, with little in the way of change. Thus, in general clients indicated that:

o the animal helped them to feel more comfortable with the therapist,

o the animal helped them to focus on important problems, o the animal helped them to discuss their feelings and what was

happening to important people in their lives, o the animal made them look forward to coming to therapy, o the animal made them stay in therapy sessions longer, o the animal accepted them for who they were, o they felt like taking better care of themselves because of the

animal, and o the animal did not affect their concentration during therapy.

Interestingly, the pattern of ratings was, in general, similar for AAT clients who owned pets versus those who did not on the items related to the use of animals in therapy. However, the trend was for higher ratings for those who owned pets.

Broad Conclusions from Study on the use of AAT in Private Practice (Client data):

• In general, AAT is a useful adjunct to therapy for individuals

diagnosed with depression and/or anxiety disorders in the Private Practice setting.

• AAT appears to be particularly suited for clients with depression and/or anxiety disorders in the Private Practice setting who own pets. Clients who do not own pets may not do as well with AAT as those who do, particularly in the beginning stages of therapy.


41

2. Therapist Results i. Demographics

Therapists completed a comprehensive questionnaire upon enrolment into the study, and after each therapy session. Copies of the questionnaires (for AAT and Control clients) are provided in Appendix F.

Of the eight therapists participating in the study, seven were from the Private Practice setting. Two of the Private Practice therapists counseled AAT clients only and two counseled Control clients only. The remaining therapists (3) counseled both AAT and Control clients. The demographics for the Private Practice therapists are shown in Table 5.

Age The average age for AAT therapists was 50 years and the average age for Control therapists was 43 years. Gender All therapists were female. Professional Affiliation Sixty-two percent (62%) of the AAT therapists were clinical psychologists, 19% were social workers, and 19% classified themselves as other. Of the Control therapists, 10% were clinical psychologists, 20% were counseling psychologists and 70% were social workers.

Years in Practice The AAT therapists had been in practice significantly longer (16 years on average) than Control therapists (4 years on average). The effect of this difference on study results is not known.


42

Table 5 Demographic Results for Private Practice Therapists AAT Control p Private Practice Age 49.88

(10.93) 43.45 (6.87)

>.05 (NS)

Gender 6 (F) 1 (M)

1(F) >.05 (NS)

Professional Affiliation <.005 (Sign) Clinical Psychologist

10 (63%) 1 (10%)

Counseling Psychologist

-- 2 (20%)

Social Worker 3 (19%) 7 (70%) Other 3 (19%) --

Years in Practice 15.87 (8.87)

3.73 (2.15)

< .001 (Sign)

NS = Not significant Sign = Significant


43

ii. Therapy Results (AAT vs. Control Therapists)

As noted above, therapists completed questionnaires for each client at the beginning of the study and after each therapy session. All therapists (those in Private Practice and those in a residential care setting) provided ratings on items related to:

1. ‘Therapy in General’ 2. The degree to which individual therapy session goals were met,

and 3. Whether therapy helped the clients to perform better at home,

school, and work.

AAT vs. Traditional Therapy

To determine if there were differences in ratings between AAT and traditional therapy, Session 1 ratings were compared to Session 4 ratings for both AAT and Control therapists. For consistency in data analyses between therapist and client data, Session 4 was used as the comparison unit of analyses. Therapists’ ratings were compared between Sessions 1 and 4 for the three categories of interest (‘Therapy in General’, The Degree to Which Goals Were Met, and Overall Assessment). The results are presented as follows:

1. Ratings for ‘Therapy in General’ − AAT Therapists’ Ratings for Sessions 1 and 4 − Control Therapists’ Ratings for Sessions 1 and 4 − Difference Scores (Session 4 - Session 1) for AAT and

Control Therapists 2. The Degree to Which Goals Were Met 3. Overall Assessment


44


Therapists completed questionnaires upon entry to the study and after each therapy session. Copies of the questionnaires (for AAT and Control clients) are provided in Appendix F. All therapists were asked to provide ratings on items related to ‘Therapy in General’ using a visual analogue scale (10 mm in length). An example of the scale is provided below.



1. The client is comfortable talking with me. 2. The client is able to focus on important problems when talking with

me. 3. The client looks forward to coming to therapy. 4. The client would like therapy sessions to last longer. 5. The client is willing to discuss what is happening to important

people in his/her life. 6. The client is willing to talk about his/her feelings during therapy

sessions. 7. As a result of this therapy session, the client is more hopeful about

his/her life. 8. The client’s mood has improved because of this therapy session. 9. The client is less anxious because of this therapy session.

Baseline ratings (means and standard deviations) for both AAT and Control therapists are provided in Appendix G (Table G1). Importantly, there were no differences in baseline responses between the two groups (AAT vs. Controls) (overall MANOVA, p > .07). Means and standard deviations for both AAT and Control clients for Session 4 also are provided in Appendix G (Table G1).


45

AAT Therapists’ Ratings for Session 1 and 4 The ratings for Sessions 1 and 4 from AAT therapists on the nine items related to ‘Therapy in General’ are shown in Figure 17. As shown, the ratings at baseline were primarily positive and those ratings remained approximately the same for Session 4.

0

2

4

6

8

10

Feel Comfortable

Easy to Focus


Last Longer

Willing to Discuss

Willing to Talk

More Hopeful

Mood Improved

Less Anxious

Mea

n

Session 1Session 4

Figure 17. Private Practice: AAT therapists’ ratings for ‘Therapy in General’ for Sessions 1 and 4.


46

Control Therapists’ Ratings for Sessions 1 and 4 The ratings for Sessions 1 and 4 for the Control therapists on the items related to ‘Therapy in General’ are shown in Figure 18. Similar to the AAT therapists, the ratings were moderately positive at baseline. However, unlike the AAT therapists, the ratings improved at Session 4, with ratings very positive for all items.

0

2

4

6

8

10

Feel Comfortable

Easy to Focus


Last Longer

Willing to Discuss

Willing to Talk

More Hopeful

Mood Improved

Less Anxious

Mea


Figure 18. Private Practice: Control therapists’ ratings for ‘Therapy in General’ for Sessions 1 and 4.

Differences Scores (Session 4 - Session 1) for AAT and Control Therapists

Differences were calculated between Sessions 1 and 4 ratings for each group by subtracting Session 1 ratings from Session 4 ratings. Thus, a positive difference score indicates that therapists rated the item as higher for Session 4 than for Session 1 (i.e., an improvement in ratings across sessions). The average difference scores for each item for both the AAT and the Control group are shown in Figure 19.


47

Overall, the differences in ratings between Sessions 1 and 4 were greater for the Control therapists. Those differences were statistically significant for two items: Item 2 “The client is able to focus on important problems when talking with me” (p < .04), and Item 4 “The client would like the therapy sessions to last longer” (p < .02). Item 1 “The client is comfortable in talking with me” approached statistical significance (p < .06). Thus, therapists with clients receiving traditional forms of therapy thought that their clients improved more across sessions in terms of focusing on important problems. They also thought that the clients looked forward to coming to therapy more so at Session 1 than Session 4 than did therapists with clients receiving AAT. For all other items, therapists using traditional forms of therapy (Control therapists) and those using AAT thought that clients improved between sessions in terms of their willingness to discuss what was happening to important people in their lives and to talk about their feelings during therapy sessions. They also thought that there were improvements in mood and that the clients were more hopeful about their lives. They also thought that the clients’ level of anxiety had decreased between sessions such that the clients were less anxious as a result of therapy. Finally, both sets of therapists indicated that the clients looked forward to coming to therapy more so at Session 4 than at Session 1.

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10

Feel Comfortable

Able to Focus


Last Longer

Willing to Discuss

Willing to Talk

More Hopeful

Mood Improved

Less Anxious

Mea

n AAT TherapistsControl Therapists

Figure 19. Private Practice: Mean difference scores (Session 4 – Session 1) for ‘Therapy in General’ for AAT and Control therapists.


48

Pet Ownership Recall that with the client data, pet ownership had a significant effect on clients’ ratings of ‘Therapy in General’. In essence, the responses of clients with pets were more positive for Session 1 than were the responses of those who did not own pets. To determine if the clients’ responses affected therapists’ responses for clients’ ability to focus and looking forward to coming to therapy, the average ratings of therapists for clients receiving AAT were examined in terms of pet ownership. There were no significant differences in therapists’ ratings on the two items in terms of whether the clients owned a pet or not (p > .50 for item 1, and p > .44 for item 2). Thus, the difference in AAT and Control therapists ratings for clients’ comfort level and ability to focus do not appear to be related to pet ownership in the AAT group.


49

Degree to which Therapy Goals Were Met At the beginning of the therapy session, the client and the therapist were to develop a list of goals for the therapy session. At the end of the session, both therapists and clients were asked to indicate the degree to which they felt each of the goals was met using the following scale:

-2 -1 0 +1 + 2

Much less than

expected


Expected level


Much better than

expected

The ratings from the therapists are shown in Table 6. The data are presented as the number and percentage of clients for whom goals were developed. Table 6 Private Practice: Therapist Data (Number and Percentage of Clients for Whom Goals Were Developed) for AAT and Control Clients for Sessions 1 and 4 AAT Control Session 1 Goal 1 15 (100%) 11 (100%) Goal 2 14 (93%) 4 (36%) Goal 3 5 (33%) 0 (--) Session 4 Goal 1 10 (67%) 9 (82%) Goal 2 7 (47%) 2 (18%) Goal 3 0 (--) 0 (--)

For Session 1, the average rating for goal number one for the AAT therapists was .47. The average was .18 for the Control therapists. Thus, therapists in each group indicated that the degree to which the goal expectations for the therapy were met was at the expected level. The pattern of ratings was similar for the remaining goals generated for Sessions 1 and 4.


AAT therapists 53% thought that the degree to which the goal was met was as expected and 47% somewhat better than expected.


50

Control clients 4% thought that the degree to which the goal was met was somewhat less than expected, 61% as expected, 31% better than expected, and 4% much better than expected.


51

Overall Assessment Therapists provided ratings indicating the extent that therapy helped the clients at home, school, and work. Therapists were asked to provide ratings using a visual analogue scale (10 mm in length) as shown below.

____________________________________________________


Responses ranged from 0 to 10. There were therapists’ ratings for 60% of AAT clients for school performance, 27% for work performance, and 93% for performance at home. For Control clients, therapists provided ratings for 45% of the Control clients for work performance and 100% for home. None of the Control clients attended school. The ratings for each of the areas (home, school, and work) for Sessions 1 and 4 are provided in Figure 20. As shown in Figure 20, the trend was for the therapists’ ratings to increase for home and school performance for the AAT clients, and for home and work performance for Control clients. Because of small sample sizes, only the difference between AAT and Control therapists’ ratings for home performance was tested for statistical significance. The difference was not significant (p > .29). Thus, according to the therapists, there were no differences between AAT and Control clients in terms of performance at home.

0

2

4

6

8

10

AATSession 1

AATSession 4

ControlSession 1

ControlSession 4

Mea

n HomeWorkSchool

Figure 20. Private Practice: AAT and Control therapists’ ratings for Sessions 1 and 4 on whether therapy helped clients in their home, school, and work performance.


52


Information also was collected from AAT therapists regarding the use of animals in therapy. Therapists were asked to provide ratings on clients receiving AAT in terms of the whether the animal assisted in establishing rapport, if the animal had an impact on the client coming to therapy, etc. The 15 questions are provided below:

1. The animal assisted in establishing rapport with the client more quickly than in sessions where the animal was absent.

2. Having the animal present seemed to make the client more willing to come to therapy.

3. The animal served as a source of comfort for the client. 4. The animal provided impetus to discuss love and bonding with the

therapist. 5. Having the animal present helped the client stay longer in the

session. 6. The client was more open as a result of the animal’s presence. 7. Having the animal present helped the client to discuss positive

feelings. 8. The client paid more attention to the animal than to the therapist. 9. The client was distracted by the animal. 10. In the presence of the animal, the client was more communicative. 11. The client exhibited aggressive behaviors directed at the animal. 12. The client touched the animal. 13. The client talked directly to the animal. 14. The client was more willing to share as a result of the animal’s

presence. 15. The client was unable to focus on clinically relevant issues.

AAT therapists’ ratings (for positive and negative items) for Sessions 1 and 4 are provided in Figures 21 and 22.


53

Private Practice AAT therapists’ ratings for specific information about the Animal (positive items) are shown in Figure 21. As indicated, the pattern of ratings was similar between the two sessions such that ratings were positive for five of the items (the animal assisted in establishing rapport more quickly than in sessions where the animal was absent, having the animal present seemed to make the client more willing to come to therapy, the animal served as a source of comfort for the client, the client touched the animal, and the client talked directly to the animal).

On the other hand, therapists did not think that the animal provided the impetus to discuss love and bonding with the client. They also did not think that having the animal present helped the client to stay longer in the session, that the client was more open as a result of the animal’s presence, or that having the animal present helped the client to discuss positive feelings. Therapists also indicated that having the animal present did not make the client more communicative or more willing to share.

0

2

4

6

8

10

Establishing Rapport

More Willing to Come

Animal of Comfort

Love and Bonding

Stay Longer

More Open

Positive Feelings

More Communicative

Touched the Animal

Talked Directly to Animal

More Willing to Share

Mea


Figure 21. Private Practice: AAT therapists’ ratings on specific information about the animal (positive items).


54

Private Practice therapists’ ratings on specific information about the animal (negative items) are shown in Figure 22. Importantly, therapists did not think that the client paid more attention to the animal than to the therapist, that the client was distracted by the animal, or that the client was unable to focus on clinically relevant issues. The therapists indicated that there were no aggressive behaviors directed at the animal.

0

2

4

6

8

10

Paid More Attention

Distracted by Animal

Aggressive Behaviors

Unable to Focus

Mea


Figure 22. Private Practice: AAT therapists’ ratings on specific information about the animal (negative items)


55

iii. Summary of Results for Private Practice Therapists AAT therapists

• The ratings from AAT therapists and therapists using traditional forms of

therapy were similar at baseline (Session 1) on the nine items related to ‘Therapy in General’. For both groups, the ratings at baseline were primarily positive

• For AAT therapists, the ratings remained approximately the same for Session 4. However, unlike the AAT therapists, the ratings from therapists using traditional forms of therapy improved at Session 4, with ratings very positive for all items.

• There were differences in ratings between AAT therapists and therapists

using traditional forms of therapy: Those differences were statistically significant for two items: Item 2 “The client is able to focus on important problems when talking with me” (p < .04), and Item 4 “The client would like the therapy sessions to last longer” (p < .02). Item 1 “The client is comfortable in talking with me” approached statistical significance (p < .06). Thus, therapists with clients receiving traditional forms of therapy thought that their clients improved more across sessions in terms of focusing on important problems, and thought that the clients looked forward to coming to therapy more so at Session 1 than Session 4, compared to therapists with clients receiving AAT. For all other items, therapists using traditional forms of therapy (Control group) and those using AAT thought that clients improved between sessions in terms of their willingness to discuss what was happening to important people in their lives and to talk about their feelings during therapy sessions. Both groups of therapists also thought that there were improvements in mood and that the clients were more hopeful about their lives. They also thought that the clients’ level of anxiety had decreased between sessions such that the clients were less anxious as a result of therapy. Finally, both sets of therapists indicated that the clients looked forward to coming to therapy more so at Session 4 than at Session 1.

• The differences between AAT therapists and therapists providing traditional

forms of therapy do not appear to be related to client pet ownership. There were no significant differences in therapists’ ratings on the two items in terms of whether the clients owned a pet or not (p > .50 for item 1, and p > .44 for item 2). Thus, the differences in comfort level and ability to focus between AAT and Control therapists do not appear to be related to pet ownership in the AAT group.


56

• Did therapy help the clients perform better at home? In essence, AAT therapists and therapists using traditional forms of therapy indicated that the clients performed better at home as a result of therapy.


57

B. Residential Care

1. Client Results

i. Demographics

Of the 36 clients participating in the study, 10 clients were from a Residential Care setting. Of those, seven received AAT in conjunction with traditional therapy (e.g., cognitive behavioral therapy, psychotherapy) and three received traditional therapy.

The age, gender, marital status, and ratings of physical health for the Residential Care clients are provided in Table 7. Due to the small sample size, statistical analyses were not conducted. The results are such that the groups were similar for age and physical health, and were identical for gender and marital status. The trend was for the AAT clients to score higher (more depressed) on the Beck Depression Inventory-Youth than clients receiving traditional forms of therapy (Control clients).

Age As can be seen in Table 7, the average age for AAT clients was 13 years. The average age for Control clients was 15 years. Gender There were seven females in the AAT group and three females in the Control group. The nature of the Residential Care system is the reason that only females participated in the study. In this system, female and male clients reside in separate group houses, with therapists assigned to one group house. The therapist participating in the study had responsibilities for a female group house. Marital Status All clients (AAT and Control) were single. Physical Health All of the AAT clients rated their health as good or very good, with an average rating of 2.40 (good) for the AAT clients and 2.0 (good) for Control clients. Specifically, all AAT clients rated their health as very good or very good. Two of the three (67%) Control clients rated their health as good or very good; the remaining client rated her health as excellent.


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Depression and Anxiety Diagnoses and Scores Six the AAT clients were diagnosed with depression and one with an anxiety disorder. One of the Control clients was diagnosed with depression and two with anxiety disorders. Diagnoses were made using DSM-IV criteria for depression and anxiety disorders (American Psychiatric Association, 1994). The average depression T score (as per the Beck Depression Inventory-Youth [BDI-Youth]) for the AAT group at Time 1 was 71 (extremely elevated), the average for the Control group was 56 (mildly elevated). Thus, the trend was for the AAT clients to be more depressed, as per BDI-Youth ratings, compared to Control clients. The anxiety T score (as per the Beck Anxiety Inventory-Youth [BAI-Youth]) at Time 1 for the AAT client was 56 (mildly elevated). The average for the Control client was 68 (moderately elevated). Thus, the Control client had a higher anxiety score at Time 1 (baseline) compared to AAT clients.

Table 7 Demographic Results of Residential Care Clients (Average and Standard Deviation)

AAT Control Age 13.00

(1.63) 15.00 (1.00)

Gender F=7 F=3 Marital Status

S=7

S=3

Physical Health

2.40 (.53)

2.00 (1.0)

BDI-Youth* (baseline)

71.33 (12.92)

56.00 (8.48)

BAI-Youth+ (baseline)

56 (--)

68 (--)

* = Beck Depression Inventory-Youth (T scores) + = Beck Anxiety Inventory-Youth (T scores)


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In addition to demographic information, Residential Care clients also were asked to provide information on pet ownership and the degree of informal support available to them. The results are shown below.

Pet Ownership Fifty-seven percent (57%) of the AAT clients and 67% of the Control clients owned a pet. People That They Can Count on to Listen On average, both AAT and Control clients indicated that they had two or more people that they could count on to listen when they needed to talk to someone. People That Are There to Help Them Feel Better Both AAT and Control clients also had two or more people that helped them feel better when they were generally feeling ‘down in the dumps’.

Data were collected on the number of therapy sessions attended. Consistent with the results from Private Practice clients, the number of therapy sessions attended differed among clients in Residential Care. The number of therapy sessions for AAT clients in Residential Care ranged from 4 to 12. The range for the Control clients was 5 to 12. The mean number of sessions attended was 7.7 for the AAT group and 8.7 for the Control group (see Figure 23).

0

2

4

6

8

10

AAT Control

Mea

n

Figure 23. Residential Care: Mean number of sessions attended over the course of the study by AAT and Control clients.


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ii. Therapy Results (AAT vs. Control Clients)

Depression Scores at Times 1, 2 and 3

Client’s scores on the Beck Depression Inventory-Youth (BDI-Youth) were examined for change over time (a median of four months for both groups). The scoring on the (BDI-Youth) is such that higher scores score indicate a greater degree of depression. As can be seen in Figure 24, there were improvements over the course of the study for both groups, but particularly for the AAT group. The slight improvement by the Control group over time may be the result of low depression scores (mildly elevated) to begin with.

0

10

20

30

40

50

60

70

80

BDI Baseline BDI Time 2 BDI Time 3

Mea

n AATControl

Figure 24. Residential Care: Mean depression T scores at Times 1, 2, and 3 for AAT and Control clients.


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Anxiety Scores at Times 1, 2, and 3 Beck Anxiety Inventories were completed for only one AAT client and two Control clients during the course of the study (data were available for two Control clients at Time 1, and one Control client at Times 2 and 3). The scoring of the BAI-Youth is such that higher scores indicate a greater degree of anxiety. The ratings across time (Time 1 [Baseline], and Times 2 and 3) improved slightly for both groups as shown in Figure 25.

01020304050607080

BAI Baseline BAI Time 2 BAI Time 3

Mea

n AATControl

Figure 25. Residential Care: Anxiety T scores at Times 1, 2, and 3 for AAT and Control clients.


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Effectiveness of AAT vs. Traditional Therapy

To determine the effectiveness of AAT, Session 1 ratings were compared to Session 4 ratings for both AAT and Control clients in the Residential Care setting. Session 4 was used as the session of comparison despite the fact that the mean number of sessions was approximately 7 for both the AAT and Control groups. The reasons for using Session 4 as the comparator are as follows: 1) after Session 5, there was a large amount of missing data for both sets of clients and 2) there were more complete data on Sessions 4 and 5 (n = 7). However, an examination of the pattern of means for Sessions 4, 5, and 6 indicated that the Session 4 means more adequately reflected the overall ratings. Thus, Session 4 data were used for both AAT and Control clients.

Client ratings were compared between Sessions 1 and 4 for the three categories of interest (‘Therapy in General’, The Degree to Which Goals Were Met, and Overall Assessment). The results are presented as follows:

1. Ratings for ‘Therapy in General’ (Sessions 1 and 4) and Changes

in Ratings Between the Two Sessions -AAT clients’ ratings for Sessions 1 and 4. -Control clients’ ratings for Sessions 1 and 4. -Difference scores (Session 4 - Session 1) for both AAT and Control clients.

2. The Degree to Which Goals Were Met 3. Overall Assessment


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Ratings for ‘Therapy in General’ Residential Care clients (AAT and Control) completed questionnaires upon entry to the study and after each therapy session. The questionnaires used in the Residential Care setting were identical to those used in the Private Practice setting (see Appendix D). All clients (AAT and Controls) were asked to provide ratings on items related to ‘Therapy in General’ using a visual analogue scale (10 mm in length). An example of the scale is provided below.


Responses ranged from 0 to 10.

The nine items were as follows:

1. I feel comfortable talking with the therapist. 2. I find it easy to focus on important problems when I talk with the

therapist. 3. I look forward to coming to therapy. 4. I would like therapy sessions to last longer. 5. I am willing to discuss what is happening to important people in

my life. 6. I am willing to talk about my feelings during therapy sessions. 7. As a result of this therapy session, I am more hopeful about my

life. 8. I feel like my mood has improved because of this therapy session. 9. I feel less anxious because of this therapy session.

Baseline ratings (means and standard deviations) for both AAT and Control clients are provided in Appendix H (Table H1). Importantly, the baseline responses (Session 1) were similar between the two groups. Means and standard deviations for both AAT and Control clients for Session 4 also are provided in Appendix H (H1).


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AAT Clients’ Ratings for Sessions 1 and 4 The average ratings on the nine items related to ‘Therapy in General’ for the AAT clients for Sessions 1 and 4 are shown in Figure 26. As can be seen, the ratings, overall, improved over time, such that the AAT clients felt more comfortable in talking with the therapist and found it easier to focus on important problems when talking with the therapist at Session 4 compared to Session 1. They also looked forward to coming to therapy to a greater degree and indicated that they wanted sessions to last longer at Session 4. They were more willing, at Session 4, to discuss what was happening to important people in their lives and were more willing to talk about their feelings during therapy sessions. There was no change in their ratings of hopefulness, improvements in mood, or feelings of anxiousness between the two sessions. Noteworthy are the high ratings (nine or higher) for the first six items for Session 4. Thus, the responses from Residential Care AAT clients on items related to ‘Therapy in General’ were generally very positive and those ratings increased over the course of therapy.

0

2

4

6

8

10

Feel Comfortable

Easy to Focus


Last Longer

Willing to Discuss

Willing to Talk

More Hopeful

Mood Improved

Less Anxious

Mea

n

Session 1Session 4

Figure 26. Residential Care: AAT client ratings for ‘Therapy in General’ for Sessions 1 and 4.


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Control clients’ ratings for Sessions 1 and 4 The average ratings on the nine items related to ‘Therapy in General’ for the Control clients in Residential Care for Sessions 1 and 4 are shown in Figure 27. As can be seen, there was, for the most part, a slight improvement in the ratings over time. In essence, the AAT clients felt more comfortable in talking with the therapist and found it easier to focus on important problems when talking with the therapist at Session 4 compared to Session 1. There was little in the way of change in terms of looking forward to coming to therapy. The ratings for ‘wanting the sessions to last longer’ were higher at Session 4. Clients were willing to discuss what was happening to important people in their lives, were willing to talk about their feelings during therapy sessions, and were more hopeful as a result of therapy sessions. There was little in the way of change in the ratings for improvements in mood or feelings of anxiousness between Sessions 1 and 4.

0

2

4

6

8

10

Feel Comfortable

Easy to Focus


Last Longer

Willing to Discuss

Willing to Talk

More Hopeful

Mood Improved

Less Anxious

Mea


Figure 27. Residential Care: Control client ratings for ‘Therapy in General’ for Sessions 1 and 4.


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Difference scores (Session 4-Session 1) for both AAT and Control Clients To determine the effectiveness of AAT versus traditional therapy, difference scores were calculated between Session 4 and Session 1 ratings for each group (Session 4 – Session 1 ratings). A positive difference score indicates that clients rated the item higher for Session 4 than for Session 1 (i.e., an improvement in ratings across sessions). The average difference scores for each item for both the AAT and the Control group is shown in Figure 28 below. The average difference scores were greater for the AAT clients than for the Control clients. Thus, the change in ratings for therapy between sessions in general was greater (more positive) for the AAT clients.

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10

Feel Comfortable

Easy to Focus


Last Longer

Willing to Discuss

Willing to Talk

More Hopeful

Mood Improved

Less Anxious

Mea

n D

iffer

ence

Sco

re

AAT ClientsControl Clients

Figure 28. Residential Care: Mean difference scores (Session 4-1) for AAT and Control clients.


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Degree to which Therapy Goals Were Met At the beginning of the therapy session, the client and the therapist were to develop a list of goals for the therapy session. At the end of the session, clients were asked to indicate the degree to which they felt each of the goals was met using the following scale:

-2

Much less than

expected

-1 Somewhat less than expected

0 Expected

level

+1 Somewhat better than expected

+ 2 Much better than

expected

Examination of the data indicates that at least one goal was developed for all the AAT and Control clients at Session 1. For Session 4, goals were developed for fewer of the AAT or Control clients. Table 8 indicates the number of clients for which goals were developed (number of clients and percentage of sample). Table 8 Residential Care: Goals Developed for AAT and Control Clients for Sessions 1 and 4 (Number of Clients, Percentage) AAT Control Session 1 Goal 1 7 (100%) 3 (100%) Goal 2 3 (43%) 2 (67%) Goal 3 1 (14%) 0 (--) Session 4 Goal 1 4 (57%) 2 (67%) Goal 2 3 (43%) 1 (33%) Goal 3 0 (--) 0 (--)

For Session 1, the average rating for goal number one for the AAT clients was 1.30. The average rating was .67 for the Control clients. Thus, clients in each group indicated that their goal expectations for therapy were met. The pattern was similar for the other goals.


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AAT clients 14% thought that the degree to which the goal was met was ‘as expected’, 43% ‘somewhat better than expected’, and 43% ‘much better than expected’. Control clients 67% thought that the degree to which the goal was met was ‘as expected’ and 33% ‘much better than expected’.


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Overall Assessment Clients provided ratings indicating the extent that therapy helped them perform at home, school, and in Residential Care. Clients were asked to provide ratings using a visual analogue scale (10 mm in length) as shown below.

____________________________________________________


Responses ranged from 0 to 10. All of the AAT and Control clients attended school. None of the AAT or Control clients was employed. The ratings for each of the areas (at home and at school, and in Residential Care) for Sessions 1 and 4 are provided in Figure 29. As can be seen, AAT clients thought that therapy helped them perform at home and at school, and in Residential Care (ratings of six or higher at Session 1). The ratings increased between Sessions 1 and 4. The ratings are particularly high for both home and Residential Care. Control clients were less convinced that therapy helped them perform better at home and at school, or in Residential Care at Session 1. They did, however, think that therapy helped at school and in Residential Care at Session 4. There was little change between Sessions 1 and 4 for the home setting ratings for Control clients. Although there were increases between sessions for the Control clients, the overall ratings were not as high compared to AAT client ratings.

0

2

4

6

8

10

AATSession 1

AATSession 4

ControlSession 1

ControlSession 4

Mea

n R

atin

g

HomeSchoolResidential Care

Figure 29. Residential Care: AAT and Control clients’ ratings for Sessions 1 and 4 on whether therapy helped them at home and school, and in Residential Care.


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Information also was collected from the Residential Care AAT clients regarding the use of animals in therapy. AAT clients were asked to provide ratings on their comfort with the animal, if the animal had an impact on coming to therapy, etc. The 10 items are provided below:

1. The animal helps me feel more comfortable with the therapist. 2. The animal helps me focus on important problems. 3. The animal was of comfort to me during the therapy session. 4. The animal makes me look forward to coming to therapy. 5. Having the animal in the room makes me want to stay in the

therapy session longer. 6. I am more willing to discuss what is happening to important people

in my life with the animal present. 7. I am more willing to talk about my feelings with the animal present. 8. The animal accepts me for who I am. 9. I feel like taking better care of myself because of the animal. 10. I have trouble concentrating with the animal in the room.

AAT client ratings on the 10 items for Sessions 1 and 4 are provided in Figure 30.


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As shown in Figure 30, ratings for Sessions 1 and 4 are similar, and indicate that the AAT clients thought that the animal helped them to feel more comfortable with the therapist and to focus on important problems. They also found the animal to be of comfort to them during the therapy session. AAT clients also thought that the animal made them look forward to coming to therapy and to stay in therapy sessions longer. They indicated that they were more willing to discuss what was happening to important people in their lives, and were more willing to talk about their feelings with the animal present. They also indicated that they felt like taking better care of themselves because of the animal. The clients overwhelmingly felt that the animal accepted them for who they were. Interestingly, at Session 1, AAT clients indicated that they had trouble concentrating with the animals in the room. However, by Session 4, the ratings dropped dramatically such that the clients indicated that they did not have trouble concentrating with the animal in the room.

0

2

4

6

8

10


A. Help to Focus

A. of Comfort



Willing to Discuss

Talk About Feelings

A. Accepts Me

Take Better Care


Mea

n

Session 1Session 4

Figure 30. Residential Care: AAT client ratings on the use of animals in therapy for Sessions 1 and 4.


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iii. Summary of Results for Residential Care Clients

Of the 36 clients participating in the study, 10 clients were from a Residential Care setting. Of those, seven received AAT in conjunction with traditional therapy (e.g., cognitive behavioral therapy, psychotherapy) and three received traditional therapy.

Due to the small sample size, statistical analyses were not conducted. Thus, the results are descriptive only.

Demographics • The clients were similar for age and physical health, and were

identical for gender and marital status. The trend was that the AAT clients scored higher (more depressed) on the Beck Depression Inventory-Youth than clients receiving traditional forms of therapy. Conversely, the scores were higher for clients receiving traditional forms of therapy on the Beck Anxiety Inventory-Youth compared to AAT clients.

• Unlike clients in the Private Practice setting, pet ownership was

similar for AAT clients and clients receiving traditional forms of therapy in the Residential Care setting. Fifty-seven percent (57%) of the AAT clients and 67% of clients receiving traditional forms of therapy owned a pet.

• Both AAT and clients receiving traditional forms of therapy indicated

that they had people they could count on for support. • Depression scores for both groups improved over the course of the

study, but particularly for clients receiving AAT group.

Therapy in General/Functioning at Home • There were no differences between the two groups on their ratings for

‘Therapy in General’ at the start of the study. That is, the groups were equal at baseline.

• The ratings for the AAT clients, overall, improved over time such that

the AAT clients felt more comfortable in talking with the therapist and found it easier to focus on important problems when talking with the therapist at Session 4 than Session 1, and this was more so than the ratings for Control clients. They also looked forward to coming to therapy to a greater degree, and indicated that they wanted sessions to last longer at Session 4. They were more willing, at Session 4, to discuss what was happening to important people in their lives and were more willing to talk about their feelings during therapy sessions.


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There was no change in their ratings of hopefulness, for improvements in mood, or feelings of anxiousness between the two sessions. Noteworthy are the high ratings (9 or higher) for the first six items for Session 4. Thus, the responses from Residential Care AAT clients on items related to ‘Therapy in General’ were generally very positive and those ratings increased over the course of therapy.

• When the ratings for both sessions for ‘Therapy in General’ for the

AAT clients were compared to the clients receiving traditional forms of therapy, the average difference scores were larger for the AAT clients. Thus, the change in ratings for therapy between sessions in general was greater for the AAT clients.

• Clients were asked whether therapy helped them to perform better at

home and at school, and in Residential Care. Although the ratings were positive for both AAT clients and clients receiving traditional forms of therapy, the ratings were higher overall for the AAT clients.

• The ratings for the use of animals in therapy were very positive for

clients receiving AAT. Thus, clients receiving AAT thought that the animal helped to increase their comfort level with the therapist and helped them in talking with the therapist (both about important people in their lives and about their feelings). Clients thought that the animal made them look forward to coming to therapy and to stay in therapy sessions longer. Overwhelmingly, the clients felt that the animal accepted them for who they were. At the beginning of therapy, clients in the Residential Care setting indicated that they had trouble concentrating with the animal in the room. However, by Session two, this had decreased substantially. By Session 4, the clients indicated that they did not have trouble concentrating with the animal in the room.


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i. Demographics One of the eight therapists participating in the study was from a Residential Care setting. The therapist counseled both AAT and Control clients.

Age The therapist was 31 years of age. Gender The therapist was female. Professional Affiliation

The therapist was a counseling psychologist. Years in Practice

The AAT therapist had been in practice for approximately four years.


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ii. Therapy Results (AAT vs. Control Therapist’s Ratings)

The therapist completed questionnaires for each client at the beginning of the study and after each therapy session. The therapist provided ratings on items related to:

1. ‘Therapy in General’ 2. The degree to which individual therapy session goals were met,

and 3. Whether therapy helped the clients to perform better at home and

at school, and in Residential Care.

AAT vs. Traditional Therapy

To determine if there were differences in ratings between AAT and traditional therapy, Session 1 ratings were compared to Session 4 ratings for both AAT and Control therapy sessions. For consistency in data analyses between therapist and client data, Session 4 was used as the comparison unit of analyses.

The therapist’s ratings were compared between Sessions 1 and 4 for the three categories of interest (‘Therapy in General’, The Degree to Which Goals Were Met, and Overall Assessment). The results are presented as follows:

1. Ratings for ‘Therapy in General’ − AAT Therapists’ Ratings for Sessions 1 and 4. − Control Therapists’ Ratings for Sessions 1 and 4. − Difference Scores (Session 4 - Session 1) for AAT and

Control Therapists 2. The Degree to Which Goals Were Met 3. Overall Assessment


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The therapist completed questionnaires for each client upon the client’s entry to the study and after each therapy session. The therapist was asked to provide ratings on items related to ‘Therapy in General’ using a visual analogue scale (10 mm in length). An example of the scale is provided below.



1. The client is comfortable talking with me. 2. The client is able to focus on important problems when talking with

me. 3. The client looks forward to coming to therapy. 4. The client would like therapy sessions to last longer. 5. The client is willing to discuss what is happening to important

people in his/her life. 6. The client is willing to talk about his/her feelings during therapy

sessions. 7. As a result of this therapy session, the client is more hopeful about

his/her life. 8. The client’s mood has improved because of this therapy session. 9. The client is less anxious because of this therapy session.

The therapist’s baseline ratings (means and standard deviations) for both AAT and Control clients are provided in Appendix I (Table I1). Means and standard deviations for therapist’s ratings both AAT and Control clients for Session 4 also are provided in Appendix I (Table I1).


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Therapist’s Ratings for AAT Clients for Sessions 1 and 4 The ratings from the therapist for AAT clients on the nine items related to ‘Therapy in General’ are shown in Figure 31. As shown, the ratings at baseline were neutral or slightly positive at Session 1. The ratings at Session 4 increased and were more positive. Thus, the therapist thought that clients were more comfortable in talking with her, were able to focus on important problems, looked forward to coming to therapy, and wanted the therapy session to last longer more so at Session 4 than at Session 1. In addition, the therapist indicated that clients were more willing to discuss what was happening to important people in their lives, were more willing to talk about their feelings, were more hopeful, had a more improved mood, and were less anxious because of the therapy session at Session 4 compared to Session 1.

0

2

4

6

8

10

Feel Comfortable

Easy to Focus


Last Longer

Willing to Discuss

Willing to Talk

More Hopeful

Mood Improved

Less Anxious

Mea


Figure 31. Residential Care: Therapist‘s ratings for AAT clients for ‘Therapy in General’ for Sessions 1 and 4.


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Therapist’s Ratings for Control Clients for Sessions 1 and 4 The ratings on the nine items related to ‘Therapy in General’ from the therapist for clients receiving traditional forms of therapy are shown in Figure 32. Similar to client’s receiving AAT, the ratings for clients receiving traditional forms of therapy at baseline were neutral or slightly positive at Session 1. The ratings at Session 4 increased and were more positive. Thus, the therapist thought that clients were more comfortable in talking with her, were able to focus on important problems, looked forward to coming to therapy, and wanted the therapy sessions to last longer, more so at Session 4 than at Session 1. In addition, the therapist indicated that clients were more willing to discuss what was happening to important people in their lives, more willing to talk about their feelings, were more hopeful, had a more improved mood, and were less anxious because of the therapy session at Session 4.

0

2

4

6

8

10

Feel Comfortable

Easy to Focus


Last Longer

Willing to Discuss

Willing to Talk

More Hopeful

Mood Improved

Less Anxious

Mea


Figure 32. Residential Care: Therapist‘s ratings for Control clients for ‘Therapy in General’ for Sessions 1 and 4.


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Difference Scores (Session 4 - Session 1) for AAT and Control Clients

Differences were calculated between ratings for Sessions 1 and 4 from the therapist for each group by subtracting Session 1 ratings from Session 4 ratings. Thus, a positive difference score indicates that the therapist rated the item as higher for Session 4 than for Session 1 (i.e., an improvement in ratings across sessions). The average difference score for each item for both the AAT and the Control group is shown in Figure 33.

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10

Feel Comfortable

Easy to Focus


Last Longer

Willing to Discuss

Willing to Talk

More Hopeful

Mood Improved

Less Anxious

Mea

n

AATControl

Figure 33. Residential Care: Mean difference scores (Session 4 – Session 1) for ‘Therapy in General’ for AAT and Control clients as per therapist ratings.

As can be seen in Figure 33, the trend was for greater differences for AAT clients compared to Control clients. That is, according to the therapist, AAT controls showed a greater ‘improvement’ on ratings related to therapy (comfort level, ability to focus, willingness to come to therapy, willingness to talk about feelings, etc.) compared to clients receiving traditional forms of therapy.


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Degree to Which Therapy Goals Were Met At the beginning of the therapy session, the client and the therapist were to develop a list of goals for the therapy session. At the end of the session, both therapists and clients were asked to indicate the degree to which they felt each of the goals was met, using the following scale:

-2 -1 0 +1 + 2

Much less than

expected


Expected level


Much better than

expected

The ratings from the therapists are shown in Table 9. The data are presented as the number and percentage of clients for whom goals were developed. As can be seen, at least one goal was developed for all clients for Sessions 1 and 4. Table 9 Residential Care: Therapist Data (Number and Percentage of Clients For Whom Goals Were Developed) for AAT and Control Clients for Sessions 1 and 4 AAT Control Session 1 Goal 1 7 (100%) 3 (100%) Goal 2 4 (57%) 2 (67%) Goal 3 1 (14%) 0 (0%) Session 4 Goal 1 7 (100%) 3 (100%) Goal 2 4 (57%) 2 (67%) Goal 3 0 (0%) 0 (0%)

For Session 1, the average rating for goal number one for the AAT clients was .14. The average was .67 for the Control clients. Thus, the therapist indicated that that the goal expectations for therapy for each client were met. Specific breakdowns for each category for goal number one are as follows:

Therapist’s Ratings for AAT clients The therapist thought that goal number one was met ‘somewhat less than expected’ 14% of the time, ‘as expected’ 57% of the time, and ‘somewhat better than expected’ 29% of the time for AAT clients.


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Therapist’s Ratings for Control clients The therapist thought that goal number one was met ‘as expected’ 33% of the time, and ‘somewhat better than expected’ 67% of the time for AAT clients.


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Overall Assessment The therapist provided ratings indicating the extent that therapy helped the clients at home and at school, and in Residential Care. The therapist was asked to provide ratings using a visual analogue scale (10 mm in length) as shown below.

____________________________________________________


Responses ranged from 0 to 10. The therapist provided ratings for all clients (AAT and Control) for school and home performance, and for performance in Residential Care. The ratings for each of the areas (home, school, and Residential Care setting) for Sessions 1 and 4 are provided in Figure 34. As shown in Figure 34, the trend was for the therapist’s ratings to increase for both AAT clients and clients receiving traditional forms of therapy (Control clients) in all three settings. The trend was for the therapist’s ratings to increase more in all three areas between Sessions 1 and 4 for the AAT clients compared to the ratings for the Control clients. Thus, the therapist thought that therapy helped the clients overall to perform better at home and at school, and in Residential Care, and that the benefit increased between sessions. She also thought that therapy helped AAT clients’ performance more so than Control clients’ performance.

0

2

4

6

8

10

AATSession

1

AATSession

4

ControlSession

1

ControlSession

4

Mea

n HomeSchoolResidential Care

Figure 34. Residential Care: Therapists’ ratings for AAT and Control clients for Sessions 1 and 4 on whether therapy helped clients in their performance at home, school, and in Residential Care.


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Information also was collected from the therapist regarding the use of animals in therapy. The therapist was asked to provide ratings on clients receiving AAT in terms of the whether the animal assisted in establishing rapport, if the animal had an impact on the client coming to therapy, etc. The 15 questions are provided below:



3. The animal served as a source of comfort for the client. 4. The animal provided impetus to discuss love and bonding with the

therapist. 5. Having the animal present helped the client stay longer in the

session. 6. The client was more open as a result of the animal’s presence. 7. Having the animal present helped the client to discuss positive

feelings. 8. The client paid more attention to the animal than to the therapist. 9. The client was distracted by the animal. 10. In the presence of the animal, the client was more communicative. 11. The clients exhibited aggressive behaviors directed at the animal. 12. The client touched the animal. 13. The client talked directly to the animal. 14. The client was more willing to share as a result of the animal’s

presence. 15. The client was unable to focus on clinically relevant issues.

The therapist’s ratings (for positive and negative items) for AAT clients for Sessions 1 and 4 are provided in Figure 35 and 36 below.


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As shown in Figure 35, the therapist’s ratings for Sessions 1 and 4 were primarily positive. The trend was for the ratings to increase at Session 4. Thus, the therapist thought that at Session 1, the animal assisted in establishing rapport more quickly compared to sessions where the animal was absent, having the animal present seemed to make the clients more willing to come to therapy, and the animal served as a source of comfort for the clients. The therapist also thought that having the animal present helped clients to stay longer in the session, that clients were more open as a result of the animal’s presence, having the animal present helped clients to discuss positive feelings, and that having the animal present made clients more communicative and more willing to share. Finally, the therapist indicated that clients touched the animal and talked directly to the animal. The therapist thought that for all items (with the exception of item one and two), that clients showed positive gains for Session 4 on the items listed above.

0

2

4

6

8

10

Establishing Rapport

More Willing to Come

Animal of Comfort

Love and Bonding

Stay Longer

More Open

Positive Feelings

More Communicative

Touched the Animal

Talked Directly to Animal

More Willing to Share

Mea

n

Session 1Session 4

Figure 35. Residential Care: Therapist’s’ ratings on specific information about the animal (positive items).

It is interesting to note the difference in the pattern of ratings from the therapist in Residential Care versus therapists in Private Practice (see Figure 21). In general, the ratings for the Residential Care setting are more positive than for those in Private Practice.


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The ratings from the therapist on specific information about the animal (negative items) are shown in Figure 36. The therapist indicated that initially (Session 1), clients paid more attention to the animal than the therapist, were more distracted by the animal, and were unable to focus on clinically relevant issues. However, the pattern was such that by Session 4, the therapist thought that clients paid less attention to the animal, were less distracted, and were more focused. The therapist indicated that there were no aggressive behaviors directed at the animal for either Session 1 or 4.

0

2

4

6

8

10

Paid More Attention

Distracted by Animal

Aggressive Behaviors

Unable to Focus

Mea

n

Session 1Session 4

Figure 36. Residential Care: Therapists’ ratings for specific information about the animal (negative items).

In comparison to the Private Practice setting (see Figure 22), the ratings on attention to the animal, distractibility, and difficulty focusing are higher in the Residential Care setting than in Private Practice. This may be the result of the age of the clients. In the Residential Care setting, the average age of the clients receiving AAT was 15 years. In the Private Practice setting, the average age was 40 years.


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iii. Summary of Results Private Practice Therapists AAT therapists • The ratings from the therapist for AAT and Control clients were similar

at baseline (Session 1) on the nine items related to ‘Therapy in General’. Interestingly, for both groups, the ratings at baseline were primarily neutral (e.g., a rating of ~ 5).

• Over time (e.g., between Sessions 1 and 4), the trend was for greater

differences for AAT clients compared to Control clients. That is, according to the therapist, AAT controls showed a greater ‘improvement’ on ratings related to therapy (comfort level, ability to focus, willingness to come to therapy, willingness to talk about feelings, etc.) compared to clients receiving traditional forms of therapy.

• In terms of performance, the therapist thought that therapy helped

clients to perform better at home and at school, and in Residential Care. The ratings increased between sessions and the therapist thought that therapy helped AAT clients’ performance more so than clients receiving traditional forms of therapy.

• The therapist’s ratings for use of the animal in therapy were, overall,

positive. That is, the therapist thought the animal was beneficial in establishing rapport more quickly. In addition, the therapist also thought having the animal present seemed to make the client more willing to come to therapy, etc.

• The therapist indicated that initially (Session 1), the client paid more

attention to the animal than to the therapist, that the client was more distracted by the animal, and that the client was unable to focus on clinically relevant issues. However, the pattern was such that by Session 4, the therapist thought that clients paid less attention to the animal, were less distracted, and were more focused. The therapist indicated that there were no aggressive behaviors directed at the animal for either Session 1 or 4.


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C. Unanticipated Results As noted earlier, there were differences on ratings from clients receiving AAT as a function of pet ownership. AAT Clients who owned pets rated items on ‘Therapy in General’ and use of animals in therapy higher than AAT clients who did not own pets. Based on these results, the data were further examined to determine if pet ownership was related to degree of depression or anxiety.

Relationship between Pet Ownership and Depression Scores (Private Practice Setting)

Depression scores upon entry to the study for clients in the Private Practice setting were examined in terms of pet ownership. Because of the small sample size, a similar analysis was not carried out for Residential Care clients. As can be seen in Figure 37, depressions scores were higher for both AAT and Control clients who did not own pets compared to those who did own pets. Based on established cut-offs, clients (AAT and Control) who did not own pets were severely depressed, whereas clients (AAT and Control) who did own pets were moderately depressed.

0

10

20

30

40

50

60

Own Pet Do Not Own Pet

Mea

n

AATControl

Figure 37. Private Practice: Time 1 depression scores as a function of pet ownership.


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Depression scores also were examined after approximately three to four months of therapy for the Private Practice clients. The results are shown in Figure 38. As can be seen, the pattern of results is similar to that found upon entry to the study. That is, the depression scores continue to be lower for those who owned pets versus those who did not own pets, irrespective of type of therapy received. Importantly, the depression scores were lower for all groups at Time 4 versus Time 1.

0

10

20

30

40

50

60


Mea

n

AATControl

Figure 38. Private Practice: Time 4 depression scores as a function of pet ownership.


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Relationship between Pet Ownership and Anxiety Scores (Private Practice Setting)

Client scores on the Beck Anxiety Inventory also were examined to see if there were differences in terms of pet ownership. Time 1 and Time 4 scores for Private Practice clients (AAT and Control) are shown in Figure 39 and 40, respectively. The pattern at both time periods is similar to that found for the depression scores. That is, anxiety scores were lower for those clients who owned pets versus those that did not (Note: there were no control clients diagnosed with an anxiety disorder who owned a pet).

0

10

20

30

40

50

60


Mea

n

AATControl

Figure 39. Private Practice: Time 1 anxiety scores as a function of pet ownership.

0

10

20

30

40

50

60


Mea

n

AATControl

Figure 40. Private Practice: Time 4 anxiety scores as a function of pet ownership for clients. The results of the depression and anxiety scores suggest that pet ownership may ‘moderate’ the effects of mental illness. However, more research is necessary to more fully understand the direction of the relationship.


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Learning There were a number of challenges to the project. Those challenges were primarily methodological in nature, and related to recruitment and data collection procedures. The most obvious implication of these challenges was in terms of small sample sizes, particularly in the Residential Care setting.

1. Recruitment of Clients and Therapists

The initial recruitment of therapists was more difficult than originally anticipated due to the need for therapy animals that had passed the CCGC (Canadian Canine Good Citizen) Test. In response to the difficulties associated with recruitment, the protocol requiring that all animals pass the CCGC Test was changed. The revised protocol allowed for the use of animals that had passed the Aptitude Test for Dogs in Mental Health Settings© (see Appendix C). This facilitated recruitment of therapists and increased the number of therapists participating in the study from five to eight. In the Residential Care setting, only one therapist had an animal that met the criteria for study participation. In the Residential Care Home associated with the study, therapists are assigned to a Residential Care group house. Each group house has a maximum number of clients (10 to 12 depending on the age of the clients). Thus, client recruitment was restricted by both therapists with animals and client assignment per group house. Recruitment of clients also was more difficult that originally anticipated. Enrollment of Control clients was low in the early stages of the study, due in part to restricting recruitment of Control clients from therapists with Experimental clients. From August 2002, Control clients were recruited from therapists that did not have Experimental clients enrolled in the study. Although this increased the number of Control clients participating in the study, problems with the data collection procedures (as outlined below) continued to be of concern. The end result was that fewer Control clients participated in the study than originally anticipated. A greater number of Control clients would have increased the internal validity of the study. Therapists also had difficulty recruiting new clients with a primary diagnosis of depression or anxiety into the study. To address this difficulty, the protocol was expanded to include clients with other mental health disorders (e.g., Post Traumatic Stress Disorder, provided that they had a secondary diagnosis of depression or anxiety). This change expanded the size of the recruitment population and increased the generalizability of the study.


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2. Data collection procedures There were difficulties with therapists completing the questionnaires and instructing the clients in questionnaire completion. One therapist in particular had difficulties with the forms and this therapist had the majority of clients enrolled in the study. Although the Project Coordinator worked diligently with therapists, a number of questionnaires continued to be returned with data missing over the course of the study. Particularly problematic was the non-return of questionnaires from clients (some therapists provided the clients with the questionnaires and allowed them to complete the questionnaires at home. However, more often than not, the questionnaires were not returned to the therapists). The Project Coordinator counseled the therapists regarding the need for a change in this practice but this did not translate into alterations in practice by some therapists.

To address the concern regarding small sample sizes, the study was extended an additional eight months (to June, 2003). Extension of the study allowed for a longer period of time for data collection from existing clients and for enrollment of new clients. The longer data collection period and the enrollment of more clients (both Experimental and Control) were critical for statistical analyses and for study validity.


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Contributions to the Health System Despite the methodological limitations, there are a number of contributions from the project relevant to the health system. The contributions are outlined in terms of project level inquiry and provincial/system level inquiry. Project Level Inquiry 1. Does AAT offer a new approach to the delivery of health services in the treatment of

individuals diagnosed with mental health disorders?

Results of this research indicate that AAT appears to be an effective adjunct to traditional forms of therapy in the Private Practice setting. AAT appears to be particularly effective for youths in a Residential Care setting (performance at school and at home, and in Residential Care). However, small sample sizes dictate that the results be considered preliminary. Further research is needed involving a greater number of participants.

2. Does AAT influence the quality of the therapeutic counseling received?

Results from clients and therapists in Private Practice and the Residential Care setting indicated that AAT was well received (e.g., clients wanting to come to therapy, stay longer in therapy, etc.).

3. Does AAT have positive effects on health outcomes?

The most positive effects were demonstrated with youths in the Residential Care setting. Unanticipated findings suggest that pet ownership may moderate the effects of mental illness.

4. Does AAT result in improved efficiencies in the treatment of depression and anxiety/panic disorders? Cost effective analysis was beyond the scope of the evaluation. However, data indicate improvement in functioning particularly for youths in Residential Care.

5. Does AAT facilitate collaboration /integration with other parts of health system? The manual Improving Mental Health Through Animal Assisted Therapy and the results from the project can be used to facilitate discussions with decision makers in educational and health care settings.


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Provincial /System Level Inquiry 1. Does AAT improve access to appropriate services?

Improved access to appropriate services was not directly measured in the current study. However, the data indicate increased willingness by clients to come to therapy and to stay in therapy longer. Further research examining access to therapy is warranted based on the preliminary findings from this project.

2. Is AAT effective in the treatment of mental health disorders?

and 3. Is AAT appropriate as a treatment strategy for improving/maintaining health?

Results suggest that AAT is an effective adjunct to traditional forms of therapy in Private Practice and Residential Care settings. The trend was for youths in Residential Care to show greater improvement than youths receiving traditional forms of therapy. However, because of the small sample sizes, caution is advised in interpreting the data.

4. Are there incentives to clinicians to use AAT?

Positive results from both therapists and clients (use of animals in therapy, ratings of clients’ performance at home, school, work, and in Residential Care) do suggest that there are incentives to clinicians to use AAT. The findings that clients looked forward to coming to therapy and wanted to stay in therapy longer may be additional incentives.

5. If positive, will the results encourage mental health professionals to incorporate AAT into their treatment regimes?

Results from a survey from therapists at the end of the project indicate that the vast majority (86%) were currently using AAT in their practices, with 57% using it on a regular basis.


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Implications Results from the current study on the benefits of AAT are preliminary. Further research, involving larger sample sizes, is needed before statements relevant to decision-makers and policy-makers can be made.


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Appendices

Appendix A: Overview of Evaluation Plan Appendix B: Orientation Manual Questionnaire Appendix C1: Canadian Canine Good Citizen (CCGC) Test Appendix C2: Aptitude Test for Dogs in Mental Health Settings© Appendix D: Client Questionnaires (Experimental and Control) Appendix E: Means and Standard Deviations of Results for Private Practice Clients Appendix F: Therapist Questionnaires (Experimental and Control) Appendix G: Means and Standard Deviations of Results for Private Practice Therapists Appendix H: Means and Standard Deviations of Results for Residential Care Clients Appendix I: Means and Standard Deviations of Results for Residential Care Therapists


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Appendix A–Overview of Evaluation Plan

Table A1 Overview of Proposed Evaluation Plan for Preliminary Phase and Phase One Objectives

Initiative Evaluation Objectives

Indicators Data Methods and Sources

Timelines

Preliminary Phase • Literature

Initiative

• To develop a ‘database’ of research literature on the use of AAT for individuals with mental health disorders. *

• PsychINFO, Medline, Current Contents and other relevant databases

• July 15, 2001

• Recruitment Initiative

• To determine success of recruitment process

• Demonstrated congruence between recruitment criteria and mental health professionals (MHPs) recruited for the project

• Comparative analysis of recruitment criteria and resumes of MHPs recruited

• Satisfaction ratings of MHPs recruited

• September, 2001

• February, 2002

• Orientation Manual Initiative

• To determine the effectiveness of the AAT Orientation Manual developed for use by other MHPs for animal assisted therapy

• Expert reviews of training materials.

• Systematic

review and evaluation by MHPs participating in project

• Evaluative review by experts in training MHPs and those with expertise in AAT (e.g., Counseling and Clinical MHP educators)

1. Evaluation of first draft of manual

2. Evaluation of final draft of manual

• MHPs recruited for

the project 1. Evaluation of

first draft of manual

2. Evaluation of final draft of manual

• September,

2001 • August, 2002 • September,

2001 • August, 2002


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• Systematic review and evaluation by MHPs not participating in project (e.g., provide independent feedback)

• MHPs not participating in project 1. Evaluation of

final draft only

• July, 2002

(Note: this is not an objective that will be evaluated per se. Rather, the evaluators will be responsible for searching, acquiring, and preparing a brief literature review)

Phase One Initiative Evaluation

Objectives Indicators Data Methods and

Sources Timelines

• Impact of AAT Initiative

• To determine the effectiveness of AAT in improving the mental health of selected mental health clients (e.g., those diagnosed with Depression and Anxiety/Panic Disorder)

• This component of the project is the primary objective of The Chimo Project. As such, this component will comprise the major portion of the evaluation plan and will be evaluated according to the Health Innovation Fund’s terms of reference. The evaluation plan for this objective of the project is provided in the table below.

• See table below • See table below


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Table A2 Overview of Proposed Evaluation Plan for Impact of Animal Assisted Therapy Objective

A. Project Level Evaluation HIF Area of

Inquiry How do project

activities:

Chimo Project Area of Inquiry

Indicators Data Source Proposed Timelines

• Offer a new approach to delivery of health services

• Does AAT offer a new approach to the delivery of health services in the treatment of individuals diagnosed with mental health disorders?

Improved mental health of clients participating in project as measured by pre- and post- intervention measures of depression (for depression group) and anxiety/panic (for anxiety/panic group). Measures will be selected based on information obtained from literature searches and consultation with MHPs specializing in depression and anxiety/ panic disorders

• Clients participating in project who receive AAT and MHPs participating in the project

• Pilot testing: September, 2001

• Program testing: October, 2001 through June 30, 2002

• Influence the quality of health services

• Does AAT influence the quality of therapeutic counseling received by clients diagnosed with depression and anxiety/panic disorders?

• Satisfaction ratings on the benefits of AAT as a component of therapeutic counseling

• Other indicators as noted above

• Clients participating in project who receive AAT therapy and MHPs participating in the project

• October, 2001 through June 30, 2002

• Influence health outcomes

• Does AAT have a positive influence on health outcomes?

• Indicators of improvements in mental health (pre- and post-intervention measures)




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HIF Area of Inquiry

How do project activities:

Chimo Project Area of Inquiry


• Contribute to cost effective service*

• Does AAT result in improved efficiencies in the treatment of depression and anxiety/panic disorders?

• Comparative measures of treatment duration (e.g., comparison of treatment duration between clients enrolled in AAT program with ‘control’ clients)

• Cost

effectiveness also can be measured in terms of client functioning. Measures of improved functioning as measured by ability to return to work / school, participation in social activities will be the major indicator

• Client records from client’s therapist and grouped data from clients of therapists participating in the project with similar profiles

• Client

records from client’s therapist

• Client self-reports


• October, 2001

through June 30, 2002

* Note: A comprehensive cost-effective analysis is beyond the scope of this project. However, data will be gathered to determine cost-effectiveness of service at a less detailed level) • Facilitate

collaboration / integration with other parts of the health system

• Does AAT facilitate collaboration/integration with other parts of the health system?

• Integration of AAT in University curriculum / Mental Health Programs for training mental health practitioners (a long term goal that may not be realized during the life of this project. However, the project outcomes can be used to facilitate discussions with the decision makers regarding the inclusion of AAT in the curriculum).

• University and Mental Health educators

• July, 2002


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B. Provincial/System Level Evaluation HIF Area of Inquiry: How do project activities contribute to achieving an integrated system for health in terms of:

Project Area of Inquiry


• Primary Health • Does AAT improve access to appropriate services?

• Is AAT effective in

the treatment of mental health disorders?

• Increased compliance in keeping treatment appointments

• Improved mental

health of clients participating in project as measured by pre- and post- intervention measures of depression (for depression group) and anxiety/panic (for anxiety/panic group). Measures will be selected based on information obtained from literature searches and consultation with MHPs specializing in depression and anxiety/panic disorders

• Client records

• Self-reports by client

• Clients

participating in project who receive AAT and MHPs participating in the project


• October, 2001

through June 30, 2002

• Primary Health (cont’d)

• Is AAT appropriate as a treatment strategy for improving / maintaining the health status of this population?

• Client and Therapist ratings of appropriateness of treatment regime

• Improved mental health functioning of clients

• Medication usage (e.g., reduction in dose)




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• Incentives • Are there incentives to clinicians (i.e., improved treatment outcomes) to using AAT in the treatment of mental health disorders?

• Measures of improved treatment outcomes

• Measures of improved compliance with treatment schedule

• Satisfaction ratings by clients of AAT



• Information • If positive, will the results on the use of AAT in the treatment of mental health disorders encourage mental health practitioners to incorporate AAT into their treatment regimes?

• Measures of willingness / intent to incorporate the use of AAT in treatment strategies following the completion of the project

• Few, if any, barriers identified to the use of AAT for the treatment of mental health disorders

• MHPs participating in the project

• MHPs and

clients participating in the project

• July, 2002

• Sustaining an Affordable Health System

• Is AAT a cost effective strategy for the treatment of mental health disorders?

• Shortened treatment duration (see Project Level objective: Contribute to Cost Effective Service)

• If possible, a

gross comparison between estimated costs of counseling only, counseling and drug therapy, counseling and AAT

• Records of treatment duration from MHPs participating in the project

• MHPs

participating in the project (information will be used to develop an algorithm to estimate average treatment costs)


• July, 2002


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Appendix B-Orientation Manual Questionnaire

ORIENTATION MANUAL QUESTIONNAIRE The purpose of this questionnaire is to get feedback on The Chimo Project manual entitled Improving Mental Health Through Animal-Assisted Therapy. The information you provide will be used as part of The Chimo Project’s external evaluation.

• Your participation is voluntary and you are not required to complete the questionnaire. However, it is most helpful if everyone responds in order to provide a more objective interpretation of how therapists perceive the manual.

• Responses are anonymous. Please do not put your name on the questionnaire. When you have finished answering the questions, please return it to The Chimo Project or to the Rehabilitation Research Centre with attention to Dr. Bonnie Dobbs, by one of the following means:

The Chimo Project The Rehabilitation Research Centre Fax: 780-452-1610 Email: [email protected] Mail: The Chimo Project Suite 200A, 10140-117 Street Edmonton, AB T5K 1X3

Fax: 780-492-1626 Email: [email protected] Mail: The Rehabilitation Research Centre 3-62 Corbett Hall, University of Alberta Edmonton, AB T6G 2G4

(Note: fax or email is preferred due to the possible postal strike)

Please return by July 28, 2003.


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mailto:[email protected]

mailto:[email protected]

Please read the following statements carefully, and Mark the box that best reflects your opinion. If you would like to provide specific comments, please do so in the space provided under the appropriate question, or on a separate page. 1. What is your professional discipline? 2. How long have you been practicing? 3. What kind of experience do you have with animal-assisted therapy? educational What programs/courses?

practical How long ago did you start using it? Are you currently using it? yes, on a regular basis yes, on an irregular basis no little to none 4. How would you rate the relevance of the information in the manual?

Very relevant Relevant Neutral Irrelevant

5. How helpful did you find the specific examples of goals and strategies for animal-assisted therapy (Chapter 2)?

Very helpful Helpful Neutral Not at all helpful

6. How helpful do you think the information on goals and strategies would be for enhancing the knowledge of the following groups of people:

Very helpful Helpful Neutral Not at all

Helpful a) students in a mental health discipline? b) students in another health discipline? c) education students? d) professionals in a mental health field? e) professionals in another health field? f) professional educators? g) volunteer animal handlers? h) program directors/managers?


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7. How would you rate the usefulness of the information on implementing an animal-assisted therapy program (Chapter 3)?

Very useful Useful Neutral Not at all useful

8. How helpful do you think the information on implementing an animal-assisted therapy program would be for individuals/organizations who are not familiar with (or are not currently using) animal-assisted therapy?


9. How would you rate the usefulness of the information on monitoring and evaluating animal-assisted therapy programs (Chapter 4)?

Very useful Useful Neutral Not at all useful

10. How helpful do you think the information on monitoring and evaluating animal-assisted therapy would be for individuals/organizations who are implementing a new animal-assisted therapy program?


11. How informative did you find the review of experimental literature on animal-assisted therapy (Chapter 5)?

Very informative Informative Neutral Not very

informative 12. Overall, how would you rate the quality of the manual’s contents?

Excellent Good Fair Poor

Thank you for your participation!


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Appendix C1-Canadian Canine Good Citizen (CCGC) Test

Developed by the Human-Animal Bond Association of Canada, 1999

The purpose of Canine Good Citizen training is to ensure that our favorite companion, the dog, can be a respected member of the community because it is trained and conditioned to act in a mannerly way in the home, in public places, and in the presence of other dogs.

Ten Steps to Demonstrate Confidence and Control

1. Accepting a friendly stranger • Demonstrates that the dog will allow a friendly stranger to approach it and

speak to the handler in natural everyday situation • Stranger will shake hands with the handler • Dog should show no resentment, shyness, or aggression

2. Sitting politely for petting • Demonstrates that the dog will allow a friendly stranger to touch it while it

is with its handler • Dog should show no shyness, resentment, or aggression

3. Appearance and grooming • Shows that the dog will welcome being groomed and examined, and will

permit a stranger to do so 4. Out for a walk (walking on a loose leash)

• Should include a left and right turn with at least one stop in between 5. Walking politely through a crowd

• Shows that the dog can move about politely in pedestrian traffic and is under control in public places

6. Sit and flat on command/staying in place • Shows that the dog will respond to handler’s command to sit and flat.

7. Come when called • Shows that dog will come when called by the handler

8. Reaction to another dog • Dog can behave politely around other dogs

9. Reaction to distractions • Dog is confident in distracting situations • Dog is not frightened and does not exhibit aggressive behavior

10. Supervised separation • Dog will behave when left with a person other than the owner


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Appendix C2-Aptitude Test for Dogs in Mental Health Settings©

PET THERAPY SOCIETY OF NORTHERN ALBERTA

APTITUDE TEST FOR DOGS IN MENTAL HEALTH SETTINGS© Handler name: __________________________________________ Dog Name: __________________________________________ Breed: _______ Age: _______ male ___ female ___ altered ___ intact ___ Date of Test: ________________ Evaluator(s): Important Notes Dogs must be at least one year old. Dogs must have earned a Canine Good Citizen Certificate prior to being evaluated. All tests are performed on leash or off leash at the discretion of the evaluator with the owner/handler in the

testing area. Dogs are evaluated on the basis of acceptable and unacceptable responses to each of the tests. A dog

whose response is acceptable but exhibits stress or discomfort will be considered borderline. Should a dog exhibit borderline responses in more than three (3) tests, the dog will be considered unsuitable for animal-assisted therapy in a mental health setting.

Any dog that growls, barks, snaps, bites, or lunges at a person will be considered unsuitable for animal-assisted therapy in a mental health setting.

Any dog that touches anyone with his teeth or feet will be considered unsuitable for animal-assisted therapy in a mental health setting.

Any dog that eliminates during the testing will be considered unsuitable for animal-assisted therapy in a mental health setting.


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A = Acceptable, U = Unacceptable, B = Borderline

Description A U B Comments 1. Handled by Stranger

The animal is handled and manipulated by a stranger. The evaluator will look in ears, hold tail, put fingers in mouth, and handle feet.

2. Exuberant/Clumsy Petting The evaluator will repeat the petting manipulation using stronger, more aggressive pressure. Evaluator becomes exuberant, speaking in a high-pitched voice, squealing, jiggling the animal and handling feet. Evaluator will pet the animal using an inanimate object.

3. Test for Hand-Shy The evaluator will, unexpectedly, move their hand directly at the animal’s head in a quick motion.

4. Restraining Hug The evaluator will, unexpectedly, give the animal a full body hug that restricts the animal’s movement.

5. Pain Response The evaluator will pet the dog and then, unexpectedly, pinch the dog between the toes or on the flank.

6. Direct Stare The evaluator will stare directly at the animal until the animal breaks the stare and averts his eyes.

7. Bumped From Behind While the animal is distracted, the evaluator will bump into the animal’s body from behind. If the dog is very small, a hard stomp or loud slap will be made behind the animal.

8. Loud, Angry Vocalization (indirect) The evaluator will begin to shout and wave arms approximately two meters from the animal without making eye contact with the animal.

9. Loud, Angry Vocalization (direct) The evaluator will shout and wave arms approximately two meters from the animal making direct eye contact with the animal.

10. Sitting with Stranger (touching) The evaluator will sit in a chair and the dog will be asked by its handler to “go see”. The evaluator will pet and talk to the animal (duration of three minutes).

11. Sitting with Stranger (not touching) The evaluator will sit in a chair and the dog will be asked by its handler to “go see”. The evaluator will not pet or talk to the animal (duration of three minutes).

12. Reaction to Movement The evaluator will sit in a chair and swing an extremity in the proximity of the animal.


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Description A U B Comments 13. Taking a Treat

The evaluator will offer the dog a treat by finger pinch and by open hand.

Cautionary A = Acceptable, U = Unacceptable, B = Borderline

Description A U B Comments 14. Blow In Face

The evaluator will, unexpectedly, blow into the animal’s face.

15. Feet Stomping The evaluator and at least one other person will walk around the animal in a wide circle (at least two meters from the animal) stomping their feet loudly.

16. Reaction to Running/Being Chased The evaluator will run past the animal; if the animal begins to run, the evaluator will chase the animal.

17. Play/Settle The evaluator will excite the dog with enthusiastic play for up to one minute and then terminate the interaction.

18. Crowded Petting The evaluator and two other persons will gather closely around the animal and begin to touch it. All people will talk at once and will try to gain the animal’s attention.

19. Come When Called (other than handler) The evaluator and two other persons will stand at least three meters from the animal and call the animal to come one at a time.

Summary:


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Appendix D-Client Questionnaires (Experimental and Control)

The Chimo Project

Client Questionnaire-Control (Non-AAT) Clients The Chimo Project is a unique project that is being tested in Alberta. The goal of the Chimo Project is to make people with mental health concerns feel better. The project is looking at different types of therapy used for people who have mental health concerns. The project will study the benefits of different types of therapy. Some forms of therapy may involve the use of animals. The purpose of this questionnaire is to collect information that will help us to determine the effectiveness of different methods of therapy offered to individuals with mental health concerns. Would you please take a few minutes to complete this survey? Your participation is voluntary and the responses you provide in the completion of this survey will be kept strictly confidential. The responses to this survey will be kept in a secure area for at least five years from the time the survey is completed. The information will be accessible only to members of the research team. Upon completion of the survey, please place it in the envelope provided, seal and return the envelope to the therapist. The therapist will forward the envelope unopened to the researcher. If there are questions in the survey that you wish not to answer, you have every right to do so. If you do not wish to complete the survey, we ask that you place it in the envelope provided, seal and return the envelope to the therapist. The therapist will forward the envelope unopened to the researcher. Not completing the survey will not affect your treatment in any way. Thank you for your participation. If you have any concerns about this survey, please call:

Ron La Jeunesse Executive Director of the Canadian Mental Health Association, Alberta Division

780-482-6576


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The Chimo Project Client Questionnaire Control (Non-AAT) Clients

Note: This section (A: General Information) is to be completed at the beginning of the study only. The information from this section will be detached from the initial questionnaire and will be kept on file. You will be asked to complete the other sections of the Client Questionnaire (Sections B to E) at each of your therapy sessions over the course of the study. An ID number, which will be assigned at the beginning of the study, will identify these sections of the client questionnaire. This is done to protect your privacy and the confidentiality of your answers over the course of the study. A. General Information 1. Today’s Date: _________/____________/________ (Day) (Month) (Year) 2. Name: __________________________________ 3. Address: __________________________________ __________________________________ 4. Postal Code: ____________ 5. What is your age? __________ Sex? __________ 6. Marital Status: Married_______ Single_______ Other (please specify) __________ 7. Do you own a pet? Yes No

a. If yes, what type of pet do you own? dog cat other (please specify)_________

b. How long have you owned this pet? _______________ (for example, 2 years) 8. How would you rate your physical health? Excellent Very good Good Poor Very poor 9. How many people are there that you can count on to listen when you need to talk to someone? (Check only one box)

No one 1 person 2 people 3 people 4 people more than 4 people 10. How many people are there that help you feel better when you are generally feeling down in

the dumps? (Check only one box) No one 1 person 2 people 3 people 4 people more than 4 people


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B. Specific Information For each of the questions below, place a mark on the line at a point that best represents your level of agreement with the statement. For example, if your level of agreement to a statement was mid-range, you would mark the line at the mid point as shown below.

Not ___________________________________________________To a great at all extent ↑

(This mark indicates your level of agreement)

1. I feel comfortable talking with the therapist.

___________________________________________________ Not at all To a great extent

2. I find it easy to focus on important problems when I talk with the therapist.


3. I look forward to coming to therapy.


4. I would like therapy sessions to last longer.


5. I am willing to discuss what is happening to important people in my life.


6. I am willing to talk about my feelings during therapy sessions.


7. As a result of this therapy session, I am more hopeful about my life.


8. I feel like my mood has improved because of this therapy session.


9. I feel less anxious because of this therapy session.


* Scale reduced for presentation purposes


112

C. Individual Goals At the beginning of this therapy session, you and your therapist made a list of goals for this therapy session. Please write down each of those goals. Then, indicate the degree to which you feel each of the goals were met by checking the box to the right of the goal. Goals Degree to which goal met

-2 Much less

than expected


0 Expected

level



expected

Goal #1: ___________________________________________________________________________

Goal #2: ___________________________________________________________________________

Goal #3: ___________________________________________________________________________

Goal #4: ________________________________________________________________________


113

D: Overall Assessment For each of the questions below, place a mark on the line at a point that best represents your level of agreement with the statement. For example, if your level of agreement to a statement was mid-range, you would mark the line at the mid point on the line.

1. I feel that therapy helps me to perform better at school.


2. I feel that therapy helps me to perform better at home.


Complete this question only if you are working.

3. I feel that therapy has helped me to perform better at work.


* Scale reduced for presentation purposes E. Comments _________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________


114

The Chimo Project Client Questionnaire-Experimental (AAT) Clients

The Chimo Project is a unique project that is being tested in Alberta. The goal of the Chimo Project is to make people with mental health concerns feel better. The project is looking at different types of therapy used for people who have mental health concerns. The project will study the benefits of different types of therapy. Some forms of therapy may involve the use of animals. The purpose of this questionnaire is to collect information that will help us to determine the effectiveness of different methods of therapy offered to individuals with mental health concerns. Would you please take a few minutes to complete this survey? Your participation is voluntary and the responses you provide in the completion of this survey will be kept strictly confidential. The responses to this survey will be kept in a secure area for at least five years from the time the survey is completed. The information will be accessible only to members of the research team. Upon completion of the survey, please place it in the envelope provided, seal and return the envelope to the therapist. The therapist will forward the envelope unopened to the researcher. If there are questions in the survey that you wish not to answer, then you do not have to answer them. If you do not wish to complete the survey, then we ask that you place it in the envelope provided, seal and return the envelope to the therapist. The therapist will forward the envelope unopened to the researcher. Not completing the survey will not affect your treatment in any way. Thank you for your participation. If you have any concerns about this survey, please call:

Ron LaJeunesse Executive Director of the Canadian Mental health Association, Alberta Division

780-482-6576


115

The Chimo Project Client Questionnaire-Experimental (AAT) Clients

Note: This section (A: General Information) is to be completed at the beginning of the study only. The information from this section will be detached from the initial questionnaire and will be kept on file. You will be asked to complete the other sections of the Client Questionnaire (Sections B to F) at each of your therapy sessions over the course of the study. An ID number, which will be assigned at the beginning of the study, will identify these sections of the client questionnaire. This is done to protect your privacy and the confidentiality of your answers over the course of the study. A. General Information 1. Today’s Date: _________/____________/________ (Day) (Month) (Year) 2. Name: __________________________________ 3. Address: __________________________________ __________________________________ 4. Postal Code: ____________ 5. What is your age? __________ Sex? __________ 6. Marital Status: Married_______ Single_______ Other (please specify) __________ 7. Do you own a pet? Yes No

c. If yes, what type of pet do you own? dog cat other (please specify)_________

d. How long have you owned this pet? _______________ (for example, 2 years) 8. How would you rate your physical health? Excellent Very good Good Poor Very poor 9. How many people are there that you can count on to listen when you need to talk to someone? (Check only one box)

No one 1 person 2 people 3 people 4 people more than 4 people 10. How many people are there that help you feel better when you are generally feeling down in

the dumps? (Check only one box) No one 1 person 2 people 3 people 4 people more than 4 people


116
























117

C. Individual Goals At the beginning of this therapy session, you and your therapist made a list of goals for this therapy session. Please write down each of those goals. Then, indicate the degree to which you feel each of the goals were met by checking the box to the right of the goal. Goals Degree to which goal met

-2 Much less

than expected


0 Expected

level



expected

Goal #1: ___________________________________________________________________________

Goal #2: ___________________________________________________________________________

Goal #3: ___________________________________________________________________________

Goal #4: ___________________________________________________________________________


118

D: Overall Assessment For each of the questions below, place a mark on the line at a point that best represents your level of agreement with the statement. For example, if your level of agreement to a statement was mid-range, you would mark the line at the mid point on the line.

1. I feel that therapy helps me to perform better at school.


2. I feel that therapy helps me to perform better at home.


Complete the next question only if you are working.

3. I feel that therapy has helped me to perform better at work.




119

E. Specific Information For each of the questions below, place a mark on the line at a point that best represents your level of agreement with the statement. For example, if your level of agreement to a statement was mid-range, you would mark the line at the mid point on the line.

1. The animal helps me feel more comfortable with the therapist.


2. The animal helps me focus on important problems.


3. The animal was of comfort to me during the therapy session.


4. The animal makes me look forward to coming to therapy.


5. Having the animal in the room makes me want to stay in the therapy session longer.


6. I am more willing to discuss what is happening to important people in my life with the animal present.


7. I am more willing to talk about my feelings with the animal present.


8. The animal accepts me for who I am.


9. I feel like taking better care of myself because of the animal.


10. I have trouble concentrating with the animal in the room.


* Scale reduced for presentation purposes F: Comments __________________________________________________________________________________________________________________________________________________________________________________________________


120

Appendix E-Means and Standard Deviations for Private Practice Clients Table E1 Specific Information on Therapy in General - Means and Standard Deviations for Private Practice Clients (Section B)

AAT Control Session 1 Session 4 Session 1 Session 4


7.67 (2.44)

6.61 (2.46)

8.10 (1.57)

8.63 (1.35)


6.34 (2.30)

6.23 (2.47)

6.63 (2.71)

8.50 (1.23)


7.76 (1.90)

6.53 (2.56)

7.52 (1.86)

8.73 (1.18)


5.14 (2.76)

4.94 (2.65)

6.91 (2.05)

7.78 (1.90)


6.55 (3.31)

6.00 (2.32)

7.94 (1.86)

8.73 (1.23)


7.52 (3.04)

6.31 (2.44)

8.14 (2.01)

8.66 (1.32)


6.52 (2.35)

6.53 (2.01)

6.59 (1.58)

8.62 (1.12)


5.87 (2.52)

6.38 (2.11)

6.59 (2.37)

8.42 (1.57)


5.43 (2.63)

5.39 (3.16)

6.78 (2.28)

8.31 (1.60)


121

Table E2 Specific Information on the Use of the Animal in Therapy - Means and Standard Deviations for Private Practice Clients (Section E) Session 1 Session 4 1. The animal helps me feel more comfortable

with the therapist. 6.69

(3.17) 7.17

(2.70) 2. The animal helps me focus on important

problems. 5.15

(3.09) 5.97

(3.30) 3. The animal was of comfort to me during the

therapy session. 7.71

(2.29) 7.60

(1.99) 4. The animal makes me look forward to

coming to therapy. 7.73

(2.42) 8.10

(1.63) 5. Having the animal in the room makes me

wanted to stay in the therapy session longer.

6.31 (2.69)

6.26 (2.96)


4.54 (3.45)

5.63 (3.54)

7. I am more willing to talk about my feelings with the animals present.

5.91 (3.04)

5.96 (3.79)

8. The animal accepts me for who I am. 8.15 (2.05)

7.61 (2.12)


4.52 (2.78)

5.56 (3.20)


2.59 (3.06)

3.30 (3.73)


122

Appendix F-Therapist Questionnaires (Experimental and Control)

The Chimo Project Therapist Questionnaire for Control (Non-AAT) Clients

The Chimo Project is a unique project that is being tested in Alberta. The project is looking at different methods of therapy offered to individuals with mental health concerns. The goal of The Chimo Project is to improve the well being of persons with mental health concerns. The purpose of this questionnaire is to collect information that will help us to determine the effectiveness of different methods of therapy offered to individuals with mental health concerns.

Would you please take a few minutes to complete this survey? Your participation is voluntary and the responses you provide in the completion of this survey will be kept strictly confidential. The responses to this survey will be kept in a secure area for at least five years from the time the survey is completed. The information will be accessible only to members of the research team. Upon completion of the questionnaire, please place it in the envelope provided, seal and return the envelope to the research team. If there are questions in the survey that you wish not to answer, then you do not have to answer them. If you do not wish to complete the survey, we ask that you place it in the envelope provided, seal and return the envelope to the research team. Thank you for your participation. If you have any concerns about this survey, please call:

Ron LaJeunesse Executive Director of the Canadian Mental Health Association, Alberta Division

780-482-6576


123

The Chimo Project Therapist Questionnaire for Control (Non-AAT) Clients

Note: This section (A: General Information) is to be completed at the beginning of the study only. The information from this section will be detached from the initial questionnaire and will be kept on file. You will be asked to complete the other sections of the Therapist Questionnaire (Sections B to E) at each of the therapy sessions over the course of the study. An ID number, which will be assigned at the beginning of the study, will identify these sections of the therapist questionnaire. This is done to protect your privacy and the confidentiality of your answers over the course of the study. A. General Information 1. Today’s Date: _________/____________/________ (Day) (Month) (Year) 2. Name: ______________________________ 3. Address: _____________________________________ _____________________________________ 4. Postal Code: ____________ 5. What is your age? __________ Sex? __________ 6. What is your professional affiliation?

Clinical Psychologist Social Worker Counselling Psychologist Other ______________ (please specify)

7. How many years have you been in practice? _____________


124




1. The client is comfortable talking with me.


2. The client is able to focus on important problems when talking with me.


3. The client looks forward to coming to therapy.


4. The client would like therapy sessions to last longer.


5. The client is willing to discuss what is happening to important people in his/her life.


6. The client is willing to talk about his/her feelings during therapy sessions.


7. As a result of this therapy session, the client is more hopeful about his/her life.


8. The client’s mood has improved because of this therapy session.


9. The client is less anxious because of this therapy session.




125

C. Individual Goals At the beginning of this therapy session, you and the client made a list of goals for this therapy session. Please write down each of those goals. Then, indicate the degree to which you feel each of the goals were met by checking the appropriate box to the right of the goal.

Goals

Degree to which goal met

-2 Much less

than expected


0 Expected

level



expected

Goal #1: ___________________________________________________________________________

Goal #2: ___________________________________________________________________________

Goal #3: ___________________________________________________________________________

Goal #4 ___________________________________________________________________________



126

D. Overall Assessment For each of the questions below, place a mark on the line at a point that best represents your level of agreement with the statement. For example, if your level of agreement to a statement is mid range, you would mark the line at the mid point on the line.

1. I feel that therapy helps the client to perform better at work or school.


2. I feel that therapy helps the client to perform better at home.



E. Comments ____________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________


127

The Chimo Project Therapist Questionnaire-Experimental (AAT) Clients

The Chimo Project is a unique project that is being tested in Alberta. The project is looking at different methods of therapy offered to individuals with mental health concerns. The goal of the Chimo Project is to improve the well being of persons with mental health concerns. The purpose of this questionnaire is to collect information that will help us to determine the effectiveness of different methods of therapy offered to individuals with mental health concerns. Would you please take a few minutes to complete this survey? Your participation is voluntary and the responses you provide in the completion of this survey will be kept strictly confidential. The responses to this survey will be kept in a secure area for at least five years from the time the survey is completed. The information will be accessible only to members of the research team. Upon completion of the questionnaire, please place it in the envelope provided, seal and return the envelope to the research team. If there are questions in the survey that you wish not to answer, then you do not have to answer them. If you do not wish to complete the survey, we ask that you place it in the envelope provided, seal and return the envelope to the research team. Thank you for your participation. If you have any concerns about this survey, please call:

Ron LaJeunesse Executive Director of the Canadian Mental Health Association, Alberta Division

780-482-6576


128

The Chimo Project Therapist Questionnaire-Experimental (AAT) Clients

Note: This section (A: General Information) is to be completed at the beginning of the study only. The information from this section will be detached from the initial questionnaire and will be kept on file. You will be asked to complete the other sections of the Therapist Questionnaire (Sections B to F) at each of the therapy sessions over the course of the study. An ID number, which will be assigned at the beginning of the study, will identify these sections of the therapist questionnaire. This is done to protect your privacy and the confidentiality of your answers over the course of the study. A. General Information 1. Today’s Date: _________/____________/________ (Day) (Month) (Year) 2. Name: ______________________________ 3. Address: _____________________________________ _____________________________________ 4. Postal Code: ____________ 5. What is your age? __________ Sex? __________ 6. What is your professional affiliation?

Clinical Psychologist Social Worker Counseling Psychologist Other ______________ (please specify)

7. How many years have you been in practice? _____________


129


Not ___________________________________________________To a great

at all extent ↑
















8. The client’s mood has improved because of this therapy session.






130

C. Individual Goals At the beginning of this therapy session, you and the client made a list of goals for this therapy session. Please write down each of those goals. Then, indicate the degree to which you feel each of the goals were met by checking the appropriate box to the right of the goal.

Goals Degree to which goal met

-2 Much less

than expected


0 Expected

level



expected

Goal #1: ___________________________________________________________________________

Goal #2: ___________________________________________________________________________

Goal #3: ___________________________________________________________________________

Goal #4: ___________________________________________________________________________



131

D. Overall Assessment For each of the questions below, place a mark on the line at a point that best represents your level of agreement with the statement. For example, if your level of agreement to a statement is mid range, you would mark the line at the mid point on the line.


1. I feel that therapy helps the client to perform better at work or school.


2. I feel that therapy helps the client to perform better at home.



132

E. Specific Information About the Animal For each of the questions below, place a mark on the line at a point that best represents your level of agreement with the statement. For example, if your level of agreement to a statement is mid range, you would mark the line at the mid point on the line.





3. The animal served as a source of comfort for the client.


4. The animal provided impetus to discuss love and bonding with the client.


5. Having the animal present helped the client stay longer in the session.


6. The client was more open as a result of the animal’s presence.


7. Having the animal present helped the client to discuss positive feelings.


8. The client paid more attention to the animal than to the therapist.


9. The client was distracted by the animal.


10. In the presence of the animal, the client is more communicative.


11. The client exhibited aggressive behaviours directed at the animal.


12. The client touched the animal.


13. The client talked directly to the animal.



133

14. The client was more willing to share as a result of the animal’s presence.


15. The client was unable to focus on clinically relevant issues.


* Scale reduced for presentation purposes F. Comments ____________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________


134

Appendix G-Means and Standard Deviations for Private Practice Therapists Table G1 Specific Information on Therapy in General–Means and Standard Deviations for Private Practice Therapists (Section B)



6.54 (1.37)

6.64 (2.24)

6.66 (2.45)

8.57 (1.17)


6.50 (1.74)

6.03 (2.02)

6.60 (2.34)

8.51 (1.01)


6.02 (1.17)

7.06 (2.14)

6.53 (2.46)

8.29 (1.45)


4.41 (1.72)

4.66 (2.16)

5.46 (2.15)

7.91 (1.71)


4.97 (2.10)

5.33 (2.21)

6.81 (1.62)

8.17 (1.51)


5.55 (2.51)

6.59 (2.04)

6.69 (2.33)

8.33 (1.15)


6.05 (1.93)

6.43 (1.91)

6.40 (1.68)

7.97 (1.50)

8. The client’s mood has improved because of the session.

5.75 (2.27)

5.68 (2.30)

6.78 (1.74)

7.91 (1.52)


5.54 (1.85)

5.69 (2.07)

6.22 (2.09)

7.39 (2.11)


135

Table G2 Specific Information on the Use of Animals in Therapy-Means and Standard Deviations for Private Practice Therapists (Section E) Session 1 Session 4 1. The animal assisted in establishing rapport

with the client more quickly than in sessions where the animal was absent.

7.00 (1.96)

8.26 (1.75)


5.74 (3.20)

7.20 (3.18)


6.41 (3.15)

7.60 (2.76)

4. The animal provided impetus to discuss love and bonding with the client.

3.90 (3.54)

4.76 (3.47)


9.14 (3.14)

4.22 (4.47)


10.00 (4.73)

5.74 (3.14)

7. Having the animal present helped the client to discuss positive feelings.

7.00 (4.09)

5.09 (3.42)

8. The client paid more attention to the animal than to the therapist.

094 (1.55)

1.47 (1.93)

9. The client was distracted by the animal. 0.81 (0.97)

.936 (1.14)


4.89 (2.90)

5.30 (3.58)

11. The client exhibited aggressive behaviours directed at the animal.

0.12 (0.13)

0.04 (0.07)

12. The client touched the animal. 6.06 (3.30)

7.64 (2.25)

13. The client talked directly to the animal. 7.00 (2.40)

7.78 (1.95)


4.71 (3.19)

5.99 (2.57)


1.39 (2.06)

1.16 (2.94)


136

Appendix H-Means and Standard Deviations for Residential Care Clients

Table H1 Specific Information on Therapy in General-Means and Standard Deviations for Residential Care Clients (Section B)



6.77 (2.74)

9.30 (0.67)

6.77 (2.97)

8.83 (0.15)


6.33 (2.36)

9.23 (0.90)

6.70 (2.92)

7.57 (0.83)


6.20 (2.35)

9.65 (0.38)

6.60 (2.82)

6.90 (0.20)


6.19 (2.72)

9.75 (0.30)

5.73 (1.80)

7.47 (0.55)


5.91 (2.72)

9.48 (0.64)

5.03 (0.96)

7.37 (0.97)


7.00 (1.50)

9.65 (0.17)

6.93 (2.60)

7.93 (0.50)


7.54 (1.72)

7.05 (4.30)

6.97 (2.45)

8.00 (1.51)


7.84 (1.88)

8.43 (2.36)

8.17 (1.72)

7.70 (1.21)


8.00 (1.82)

8.00 (2.13)

7.13 (2.60)

7.27 (1.26)


137

Table H2 Specific Information on the Use of Animals in Therapy-Means and Standard Deviations for Residential Care Clients (Section E) Session 1 Session 4 1. The animal helps me feel more

comfortable with the therapist. 8.29

(1.18) 7.18

(1.72) 2. The animal helps me focus on important

problems. 7.54

(1.07) 7.15

(1.80) 3. The animal was of comfort to me during

the therapy session. 9.09

(0.79) 9.98

(0.05) 4. The animal makes me look forward to

coming to therapy. 8.81

(0.76) 8.80

(2.00) 5. Having the animal in the room makes me

wanted to stay in the therapy session longer.

8.06 (0.90)

8.08 (1.89)


7.59 (1.03)

8.08 (2.00)

7. I am more willing to talk about my feelings with the animals present.

7.79 (0.95)

7.98 (2.00)

8. The animal accepts me for who I am. 9.44 (0.59)

9.90 (0.14)


7.31 (1.29)

8.13 (1.83)


7.36 (1.62)

0.55 (0.40)


138

Appendix I-Means and Standard Deviations for Residential Care Therapists Table I1 Specific Information on Therapy in General-Means and Standard Deviations for Residential Care Therapists (Section B)



5.96 (3.00)

9.07 (1.11)

7.17 (2.51)

8.67 (1.27)


4.31 (2.81)

8.59 (1.50)

5.00 (1.77)

7.67 (2.66)


5.87 (2.44)

9.03 (1.16)

5.83 (2.14)

7.93 (1.58)


5.80 (2.59)

8.43 (1.60)

5.70 (1.83)

7.70 (1.47)


4.16 (2.52)

8.10 (1.19)

5.37 (1.59)

8.33 (0.91)


4.16 (2.28)

8.74 (0.92)

5.27 (2.21)

7.70 (0.66)


3.90 (2.25)

7.40 (1.94)

4.60 (2.61)

6.13 (0.75)

8. The client’s mood has improved because of the session.

5.79 (2.07)

8.77 (2.05)

5.83 (1.88)

6.37 (1.14)


5.30 (2.63)

8.00 (2.02)

5.63 (1.62)

6.63 (0.59)


139


140

Table I2 Specific Information on the Use of Animals in Therapy in General-Means and Standard Deviations for Residential Care Clients (Section E) Session 1 Session 4 1. The animal assisted in establishing rapport

with the client more quickly than in sessions where the animal was absent.

8.21 (1.19)

7.81 (2.52)


7.31 (1.88)

6.80 (2.15)


8.14 (2.47)

9.59 (0.51)

4. The animal provided the impetus to discuss love and bonding with the client.

8.99 (0.92)

9.60 (0.55)


7.20 (2.21)

8.13 (2.09)


6.13 (2.17)

8.46 (1.67)

7. Having the animal present helped the client to discuss positive feelings/

8.27 1.84

9.66 (0.30)

8. The client paid more attention to the animal than the therapist.

7.07 (2.70)

5.03 (2.22)

9. The client was distracted by the animal. 6.76 (2.88)

3.41 (2.25)


6.41 (0.99)

7.20 (1.74)

11. The client exhibited aggressive behaviors directed at the animal.

0.63 (1.07)

0.87 (1.91)

12. The client touched the animal. 6.86 (2.08)

7.37 (2.12)

13. The client talked directly to the animal. 6.29 (1.09)

6.81 (3.06)


5.70 (0.93)

6.30 (2.01)


4.94 (3.01)

3.54 (2.77)

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