Behavioural Psychotherapy, 1992, 20, 367-372 An Evaluation of Companion Pets with Elderly Psychiatric Patients Elaine Haughie St Augustine's Hospital, Canterbury Derek Milne and Valerie Elliott St George's Hospital, Morpeth, Northumberland The main aim of this study was to evaluate pet therapy in terms of increased interaction with two groups of elderly psychiatric patients. These patients were different in respect of their diagnosis, but their environments were similar in layout, decor and facilities. Each group of patients was observed by an independent observer, and further rated by the ward nurses on a scale which recorded change in their behaviour over the three conditions: baseline, dog intervention and photographic intervention. The total time of observing was four weeks where the baseline (i.e. "normal" amount of interaction) and the two intervening stimuli were introduced, and compared with one another. Time sampling was used throughout the study. The results indicate that the dog intervention was the most effective in increasing interaction when comparisons were made with other conditions. Introduction It has long been asserted that ownership of a pet can have physical, emotional, social and psychological benefits to its owner. Such benefits have promoted some clinical psychologists to look at the possibility of using animals to help reduce anxiety and boredom in some patients who are housed in institutional settings. The first reported case of employing animals in this type of work was documented by Boris Levinson who used his dog Jingles as a co-therapist in individual and family therapy. He found that Jingles was accepted by emotionally disturbed children who would indirectly use the dog as a form of psychotherapy. He noticed that children would often talk indirectly to him through Jingles about their problems and worries. He concluded that dogs were ideally suited for a therapeutic role (cited by Corson, Corson, Gywnne and Arnold, 1977). Subsequently, many studies of the relationship between the presence of a pet and social behaviour in long stay environments have been completed. All the results indicate that the presence of a pet in a nursing home or a hospital increases the residents' verbalization, socialization and orientation. Some researchers believe that the results so far provide enough positive and Reprint requests to Elaine Haughie, Psychology Department, St Augustine's Hospital, Chartham, Canterbury, Kent, UK. 1992 British Association for Behavioural Psychotherapy
368 E. Haughie et al. conclusive evidence for further implementation of pet therapy to all psychiatric hospitals. Other researchers have failed to take this claim seriously, as many of the studies have had weaknesses with their procedural, methodological or statistical techniques. (Mugford and M'Chomisky, 1975; Corson, Corson, Gywnne and Arnold, 1975; Katcher and Beck, 1983; Brickel, 1979, 1982; Hendy, 1984). Many of the studies have lacked scientific rigour. For example, McCulloch (1980) has argued that although strong sentiments and anecdotal information lead us to believe that the relationship with animals can be beneficial in many ways, the actual data are sparse. In order to draw firm evidence from such information, an accurate evaluation of the benefits is required. To illustrate, although generalization is an important concept, no studies have looked at it within the context of pet therapy. Drabman, Hammer and Rosenbaum (1979) have strongly advocated its importance within studies arguing that it should be looked at across time, setting, people and behaviour. In addition, studies have had poor internal validity. The most recent study of pet therapy failed to exclude the effects of novelty on two groups of elderly psychiatric patients (Elliott and Milne, 1991). The main aim of this study is therefore to evaluate the effects of pet therapy using a rigorous analysis, including an assessment of generalization. The following hypotheses will be tested: (a) (b) (c) Prior findings will be supported (i.e. the presence of a pet dog increases verbalization and orientation). Some of the therapeutic effect will, however, be explained by novelty. There will be generalization of the favourable impact of the dog across time, settings, behaviours and people. Method Subjects Two wards within the elderly persons sector of a large NHS psychiatric hospital were used in this study. The wards were very similar in decor and layout, being bungalows in the hospital grounds. Ward 1: Eighteen patients in total, 17 of whom were in-patients. Sixteen were diagnosed as suffering from clinical depression, one was diagnosed as manic depressive, and the final one was diagnosed as schizophrenic. Their age range was 65-86 years; five were male and 13 were female. Ward 2: Nineteen patients in total (all in-patients), 18 were diagnosed as suffering from senile dementia, one was diagnosed as manic depressive (psychotic); age range 70+; all were female. Design The two groups of subjects were assessed within a repeated measures design. The three conditions tested were: (1) Baseline (i.e. "normal" interactions); (2) Dog and
Companion pets 369 visitor; (3) Photographs of the dog plus visitor. They were assessed within an A B A C reversal design. Measures (a) Patient Interaction Oberservation Scale. An observation scale was modified from an existing one (i.e. Elliott and Milne, 1991) to record all interactions under the three conditions being tested. All interactions were split between verbal and nonverbal. Each individual was observed for exactly one minute, timed by a stop-watch. Records were made of the number of patients present on the ward at the beginning and end of the observation period. The time period for each observation session lasted for twenty minutes. Patients were observed in a left to right sequence on both wards. In order to keep the method of observation uniform, the visitor was instructed to move around the patients in exactly the same sequence. To enable as many patients as possible to be observed, the visitor was instructed to stay with each patient for approximately one minute. All observations over the three conditions were carried out on the same days at the same time each week. Each rater was equipped with a procedural manual detailing the coding of behaviour. Examples of these included: frowns, gestures, positive intonation in utterances, sharing a joke, smiling etc. (A copy of the observation manual is available on request to the first author.) (b) Nurses Rating Scale. A nurses rating scale was used to gain an independent judgement of any possible changes in interaction across experimental conditions. The rating was on a bipolar, 5 point scale. The rated items were: amount of speech; appropriateness of speech; mobility; dependency; mood; morale; orientation; interaction with staff; interaction with other patients; and amount of patients who responded favourably to the visit. The nurses on both wards were instructed to complete the form approximately two hours after the visits, twice weekly for a total of four weeks. They were asked to rate the patients who had responded favourably to the visits as a group and not individually. This scale was adapted from an existing scale used by Elliott and Milne (1991). The outlay of the scale was clearly explained to the staff who had agreed to participate. (A copy of the Nurses Rating Scale is available on request to the first author.) Results Reactivity to observation The reactivity check was carried out by comparing data from the first and eighth observation sessions of each experimental phase (i.e. baseline, dog intervention and photographic intervention). The use of the Mann Whitney U tests indicated no significant differences for any of the six comparisons. This suggested that there was no reactivity to observation.
370 E. Haughie et al. > C j -, LJ 3 a V =; 20 19 18 17 16 15 14 13 12 11 10 9 8 7 6 5 4 3 2 1 0 A /\ K / \ 1 / \ / \ / N/ W baseline dog photographs Experimental Phases FIGURE 1. Collapsed data across phases, settings and time for the three conditions Reliability of observations On Ward 1 there was a 73% agreement between two independent raters on the amount and type of interactions perceived. On Ward 2 there was an 80% agreement. Hypothesis One: The Observational data were collapsed over time, wards and experimental phases to construct a graphical representation of all three experimental conditions. Figure 1 shows that the baseline data were lower than the dog intervention and photographic intervention conditions. In turn, the dog intervention data were higher than the other two conditions. The use of independent t tests revealed that there was a significant difference between (i) the baseline and the dog intervention (t = 9.56, d.f. = 304.0, p <.05, 2-tailed) and (ii) the baseline data and the photographs intervention, (t = -6.46, d.f. = 284.0,/? < 0.05, 1-tailed). These data were also used to test the second hypothesis. The nurses rating scale data supported the observational findings: in particular, nurses perceived a greater increase in mobility and dependency of the patients. Hypothesis Two: Statistical analysis was also carried out between the second and third experimental phases (i.e. dog intervention and the photographic intervention). The use of the independent t tests revealed that there was a significant difference in the level of interaction (t = 2.50, d.f. = 182.0, p < 0.05, 1-tailed). In summary,
Companion pets 371 these results indicate that there was a significant novelty effect (phase two - photographs), but that the effect of the clog's presence was significantly greater still. Hypothesis Three: (a) Generalization across time. A one way ANOVA was carried out on the three (i.e. A B and C) collapsed sets of observations (i.e. no distinction was made between the settings or the days of observation). Statistical comparisons between the alternating baseline and intervention conditions indicated that there was a significant difference. This suggests that the impact of the two interventions did not generalize over a period of two days. (b) Generalization across settings. Independent t tests were carried out on the pooled observational data, which had been collapsed across time. This revealed a significant difference between the two wards at the baseline stage (t = 1.83, p < 0.05, d.f. = 202, 2-tailed) suggesting that there was less interaction on Ward 1. No such differences between the wards were obtained for either of the two subsequent experimental phases (for the dog's visit t = 0.26, p < 0.05, d.f. = 100; for the photographs t = 0.06, p < 0.05, d.f. = 80). This finding indicates that the patients responded with similar amounts of interaction in both settings, despite clear differences in terms of their characteristics. It suggests that the interventions had equivalent impact across settings and subjects. (c) Generalization across behaviour. The behaviours rated by the nurses indicated that there was some improvement in all nine behaviours and that all behaviours were affected and not just the targetted ones (i.e. amount of aptness of speech and orientation). The greatest improvements were reported for "mobility" and "dependency". The findings suggest that there were generalization across the assessed behaviours. (d) Generalization across people. This analysis examined whether persons who were not in direct contact with the dog/photographs responded alongside those who were. This can only be discussed anecdotally from notes regarded on the observation sheets and from the nurses rating scale. The data suggest that an extra eight patients interacted with the dog on Ward 1 in comparison with no extra interactions on Ward 2. Therefore, it is reasonable to conclude that the dog promoted social interaction among some of the uninvolved patients, indicating that there was some generalization across people. Discussion The research design and particularly the three conditions tested represent the most rigorous evaluation of pet therapy to date. The results support other less well designed studies (e.g. Brickel, 1979) in indicating that there is a significant improvement in the level of social interaction when the dog was introduced to both groups of patients. This shows that in comparison to the introduction of the photographic stimulus, the presence of the companion pet can increase social interaction among the patients themselves and the patients and the staff. The generalization data indicate mixed success, with no maintenance but some extension of the impact of the pet intervention across settings, people and behaviours.
372 E. Haughie et al. These findings are important in terms of supporting an increase in pet therapy within hospitals and nursing homes. They are also in line with thefindingsof Hendy (1984), who suggested that the presence of a companion pet made the hospital ward seem a more enjoyable and less sterile type of environment. Pet therapy may also be justified in that it brings a sense of "normalization" to the psychiatric ward. In terms of "community care", the dog actually helps the volunteer to visit (i.e. acting as a "social bridge") and so promotes involvement by community members in the hospital. Another notable advantage of pet therapy is that it is a "free good", representing a voluntary contribution by the pet owner who devotes their time and pet resource to assisting staff in stimulating patients. In conclusion, this relatively rigorous study suggests that earlier claims of a therapeutic effect due to companion pets are well founded, but probably exaggerated due to the confounding variable of novelty. When this is controlled for, the effect of the pet is still large and positive. In relation to the emphasis on community care, such pets seem to represent a double bonus to hospitals and should perhaps be reconsidered in the light of this new evidence in their favour. References BRICKEL, C. M. (1979). The therapeutic roles of cat mascots with hospital based geriatric population: a staff survey. Gerontologist 17, 368-372. BRICKEL, C. M. (1982). Pet facilitated psychotherapy: theoretical explanation via attention shift. Psychological Reports 50, 71-74. CORSON, S., CORSON, E. O., GYWNNE, P. H. and ARNOLD, L. E. (1975). Pet facilitated psychotherapy in a hospital setting. In J. Masserman (Ed). Current Psychiatric Therapies If. New York: Grune and Stratton, pp. 277-286. CORSON, S. A., CORSON, E. O., GVWNNE, P. H. and ARNOLD, L. E. (1977). Pet dogs as nonverbal communication links in hospital psychiatry. Comprehensive Psychiatry 18, 61-72. DRABMAN, R. S., HAMMER, D. and ROSENBAUM, M. A. (1979). Assessing generalisation with children: a generalisation map. Behavioural Assessment 6, 203-219. ELLIOTT V. and MILNE, D. (1991). Patients' best friend. Nursing Times 87, 6. HENDY, H. M. (1984). Effects of pets on the sociability and health activities of nursing home residents. In R. K. Anderson and B. L. Han (Eds). The Pet Connection. University of Minnesota Press. KATCHER, A. H. and BECK, A. M. (1983). New Perspective on Our Life with Companion Animals. University of Pennsylvania Press. MCCULLOCH, M. J. (1980). Animal facilitated therapy: overview and future direction. In A. H. Katcher and A. M. Beck (Eds). New Perspective on Our Life with Companion Animals. University of Pennsylvania Press. MUGFORD, R. A. and M'CHOMISKY (1975). Therapeutic value of caged birds with old people. In R. S. Anderson (Ed). Pet Animals and Society. London: Bailliere Tindall.