Annals of Clinical Psychiatry, Vol. 11, No. 1,1999

Communication

Pet-Facilitated Therapy for Posttraumatic Stress Disorder

Eric Lewin Altschuler, Ph.D.1

It is suggested that pet-facilitated therapy might be a useful adjuvant on treatment of posttrau-matic stress disorder. Some motivation and rationale for this idea is given, and a discussionof method of testing it.

Posttraumatic stress disorder (PTSD) is beingdiagnosed increasingly often, and no longer only inveterans of war, but, for example, in women whohave been raped or in children who have witnessedviolence. In many cases PTSD can prove notoriouslyresistant to treatment by either medications or ther-apy (1). A patient with PTSD recently told me thathis anxiety was much increased at times when hehad to be separated from his pet. Reflection on thepatient's comment has caused me to consider the ideathat pet facilitated therapy (PFT) might be a usefuladjuvant for treatment of PTSD.

With little doubt, pets have interacted with hu-mans in health and disease for many thousands ofyears. One of the first written reports of PFT as anadjuvant for medical therapy came from the YorkRetreat in York, England, in 1792, where pets wereused for positive reinforcement for patients to carefor themselves (see Ref. 2 and references therein).The modern use of PFT was galvanized in part bychild psychiatrist B. Levinson's classic paper (3). PFThas been used for many diseases including depres-sion, anxiety disorders, and a variety of childhoodpsychiatric and emotional problems, for elderlypatients, and on hospital medical and surgical wards(2).

PFT might be helpful in alleviating some of the

1School of Medicine, University of California at San Diego, 0606,and Brain and Perception Laboratory, 0109, 9500 Gilman Drive,La Jolla, California 92093-0606.

fear and anxiety of PTSD patients. As well, PTSDpatients, who are often refractory to therapy, andindeed may tend to separate themselves from (hu-man) society, may benefit from interacting withtheir animals.

PFT for PTSD can initially be tested, for exam-ple, as follows. In a prospective and randomized, butunblinded trial, PTSD patients willing to obtain a petcan then be randomized to pet or no pet (with bothgroups concurrently continuing all standard care bymedicines and single or group therapy). Using out-come measures such as the Clinician-AdministeredPTSD Scale (4) and the Civilian Mississippi Scale(5), given at the outset of the trial, at intervals duringthe trial, and at the conclusion of the trial, numberand length of hospital admissions, and change in med-ication doses, it can be tested whether PFT is benefi-cial for PTSD. [If PFT is successful in the trial (pet)group, those in the no-pet group could be crossedover to pet.] To reduce, somewhat, the heterogeneityamong PTSD patients, an initial trial could be re-stricted to war veterans.

If PFT is efficacious for PTSD, it will be a wel-come addition to the treatment armamentarium.

REFERENCES

1. Shalev AY: Treatment failure in acute PTSD. Lessons learnedabout the complexity of the disorder. Ann NY Acad Sci1997; 821:372-387.

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1040-1237/99/0300-0021$16.00/1 C 1999 American Academy of Clinical Psychiatrists

KEY WORDS: pet-facilitated therapy; posttraumatic stress disorder.

2. Cusack O: Pets and Mental Health. New York: HaworthPress; 1988

3. Levinson BM: The dog as co-therapist. Ment Hygiene 1962;46:59-65

4. Blake DD, Weathers F, Nagy LM, Kaloupek DG, Klauminzer

G, Charney DC, Keane TM: The development of a clinician-administered PTSD scale. J Trauma Stress 1995; 8:75-90.

5. Keane TM, Caddell JM, Taylor KL: Mississippi Scale for Com-bat-Related Posttraumatic Stress Disorder: three studies in re-liability and validity. J Consult Clin Psychol 1988, 56:85-90

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