Exploring the Benefits of Dog-Assisted Therapy for the Treatment of Complex Trauma in Children: A Systematic Review
Abstract
:1. Introduction
2. Materials and Methods
2.1. Search Strategy
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- The dog is included, with or without other animals, as part of a treatment-based, goal-directed intervention that is focused on treating the symptoms of complex trauma.
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- Participants are children aged under 18 years who have experienced complex trauma exposure.
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- Empirical evidence is provided on quantitative or qualitative outcomes relating to the child’s trauma symptomology.
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- Available in English.
2.2. Data Extraction and Evaluation
3. Results
First Author (Year) | Research Question | Participant(s) | Dog(s) and Handler(s) | Study Design | Program Description and Comparison Group | Measures and Data Collection Time Frames | Results | Quality |
---|---|---|---|---|---|---|---|---|
Allen et al., 2021 [36] | Does integration of AAT into TF-CBT for abused youth (a) impact retention, (b) present challenges to implementation, (c) demonstrate efficacy? | N = 33 (66% female); 6–17 years. 64% Caucasian, 21% African American, 15% multiple ethnicities. At least one incident of physical, sexual abuse or witnessing inter-partner violence | N = 5 labrador retrievers trained as assistance dogs; handlers observed sessions from behind one-way mirror. | RCT: 2 (time) × 2 (group) design | Individual TF-CBT including assistance dog (TF-CBT + AAT): 12 × 90 min sessions with integration of assistance dog (child-led; clinician also offered interaction with dog as a coping skill during sessions). n = 17. Comparison group: Individual TF-CBT: 12 × 90-min sessions. n = 16. |
| TF-CBT + AAT (Measures 1–4: baseline (T1) vs. post-intervention (T4))
TF-CBT (Measures 1–4: T1 vs. T4):
TF-CBT + AAT vs. TF-CBT (Measures 1–4: difference between group change, T1 vs. T4).
| Good |
Balluerka et al., 2015 [37] | Does animal-assisted psychotherapy impact the psychosocial adaptation of adolescents in residential care who have suffered traumatic childhood experiences? | N = 63 (38% female); 12–17 years. Ethnicity not reported (although, 68% of participants were from Basque County, 32% were foreign unaccompanied minors from northern Africa). In residential care; had suffered traumatic childhood experiences (not defined). | N = 1 dog trained as therapy dog. No information on breed or handler identified. | Non-randomised control; 2 (time) × 2 (group) design | Individual psychotherapy (IP) + animal-assisted psychotherapy (AAP): 12-week program (2 days/week, farm-based, separate from and concurrent to individual psychotherapy); 23 group and 11 individual sessions. Five sessions involved integration of therapy dog (including child-led interaction); separate sessions involved horses (number of sessions with horses not specified). n = 43. Comparison group: Individual psychotherapy (IP): dose not specified. n = 24. | 1. Behavior Assessment System for Children (BASC, Spanish version): residential carer, teacher, and self-report. Measures indicators of psychosocial adaptation across 5 composite subscales:
Measure 1 administered at Time 1 (baseline) and Time 2 (Post-intervention). | AAP + IP (Measures 1a–1e: baseline (T1) vs. post-intervention (T2)):
Retention—not reported AAP vs. IP (Measures 1a–1e: AAP change score vs. IP change score).
(Note for hyperactivity subscale, AAP < IP: greater reduction, d = 0.98).
Retention—not reported | Fair |
Dietz et al., 2012 [38] | Is standard group therapy, dog-assisted therapy, or dog-assisted therapy with therapeutic stories more effective in the treatment of trauma symptoms for survivors of child sexual abuse? | N = 153 (93% female); 7–17 years. 37% Caucasian, 43% Hispanic, 17% African American, 3% other (including Native American). Confirmed sexual abuse. | No information on dog(s); external therapy dog organisation with handlers attended sessions for initial 10–15 min. | Non-randomised control; 2 (time) × 3 (group) design. | Group therapy (12 sessions) with two intervention types: - Dogs + no stories (DNS): Visits by therapy dogs and their handlers once per month for an average of four visits. Dogs and handlers available in waiting room for 30 min prior to group sessions; joined group for initial 10–15 min. n = 60. - Dogs + stories (DS): As per dogs + no stories, but with addition of stories written by clinical director and incorporated into group program. n = 61. Comparison group: Group therapy (12 sessions). n = 32. | 1. Trauma Symptom Checklist for Children (TSCC). Measures trauma symptomology across six clinical subscales (all self-report):
| DS (Measures 1a–1f: baseline (T1) vs. post-intervention (T2)).
DNS (Measures 1a–1f: baseline (T1) vs. post-intervention (T2)).
Retention—not reported Group therapy (Measures 1a–1f: baseline (T1) vs. post-intervention (T2)).
Retention—not reported DS c.f. DNS vs. Group therapy (Measures 1a–1f: Dogs with stories change score vs. Dogs no stories change score vs. Group therapy change score).
Retention—not reported | Fair |
Eggiman 2006 [39] | Will the use of a therapy dog, integrated with CBT, improve PTSD symptomology in a female client with a history of physical and sexual abuse? | N = 1 (female); 10 years. Ethnicity not reported. History of physical and sexual abuse. | N = 1 poodle trained as therapy dog. Therapist is handler. | Single case study | Individual CBT including therapy dog. Initial session involved: explanation of rules, getting to know dog, petting dog and staying relaxed, talking to dog, telling a therapeutic story about dog’s behaviour, and telling him goodbye. No further sessions described; number of sessions not specified. | Behavioural observations only: therapist and carer report. Behaviours:
Informal observations at Time 1 (Baseline) and Time 2 (during or after therapy). | Observations (T1 vs. T2) In session:
At home:
| Poor |
Hamama et al., 2011 [35] | Does AAT: (a) improve psychological distress, and (b) improve self-confidence and wellbeing, among teenage girls who were exposed to traumatic events? | N = 18 (100% female); 14–16 years. Ethnicity not reported. History of physical or sexual abuse (3–4 years before)—intervention group only. Control group had no history of abuse. | No information on dog(s) or handler(s) provided. | Pre- vs. post-test with non-concurrent control | Group intervention with AAT: 12 × 3 h sessions incorporating dog-focused and psychosocial intervention activities. Dog-focused activities included building trust, training, talking to and walking dog. n = 9. Comparison group: Classroom as usual (social games, learning control skills and public speaking). n = 9. |
| AAT (Measures 1–4: baseline (T1) vs. post-intervention (T2)).
Classroom as usual (Measures 1–4: baseline (T1) vs. post-intervention (T2)).
AAT vs. Classroom as usual (Measures 1–4: difference in mean scores at post-intervention (T2)).
| Poor |
Muela et al., 2019 [40] | Is AAT effective in treating behavioural and emotional problems in children who have been exposed to domestic violence? | N = 19 (32% female); 6–15 years. Ethnicity not reported (although, all from Navarre region in north-east Spain). Exposed to domestic violence perpetrated by father or mother’s partner. | N = 4 (3× Labradors; 1 Golden Retriever) trained as therapy dogs. No information on handler(s) provided. | Pre- vs. post-test | ‘Leaving a Mark’ AAT program: 14 × 1 h individual sessions. Program designed using principles of TF-CBT and AAT for childhood trauma. Modules, into which dog and dog-related activities are integrated, focus on establishing a secure base, psychoeducation, arousal regulation and stress management, and emotion expression and regulation. | 1. Child Behaviour Checklist (CBCL): caregiver report. Measures behavioural and emotional problems across two broad syndrome subscales:
And two additional subscales:
Measure administered at Time 1 (baseline) and Time 2 (post-intervention). | Leaving a Mark (Measures 1a–1d: baseline (T1) vs. post-intervention (T2)).
| Fair |
Signal et al., 2017 [23] | Is an AAT program effective in reducing PTSD symptomatology in children who have experienced sexual abuse? | N = 20 (40% female); 5–12 years. 65% Caucasian, 35% Indigenous Australian. Experienced sexual abuse. | N = 1 trained therapy dog. No information on breed provided. Children interacted with dog in presence of dog’s handler/owner. | Multiple-baseline pre- vs. post-test | AAT: 10× sessions—Initial 3 sessions children attended RSPCA shelter and interacted in pairs with therapy dog in presence of handler for approx. 20–30 min—each of these 3 sessions had specific therapeutic objectives and activities designed and delivered by shelter education officer and program staff. Remaining 7 group sessions with assigned program social workers to transfer skills from animal to human interactions. | 1. Trauma Symptom Checklist for Young Children (TSCYC): caregiver report. Measures PTSD-related symptoms. Alongside calculation of:
specific subscales examined for this study included:
| AAT (Measures 1a–1e: intake (T1) vs. program commencement (T2) vs. post-intervention (T3)).
| Good |
3.1. Is the Research of Sufficient Quality, and Is There Consistency in and Comprehensiveness of Descriptions of Dog-Assisted Therapy Program Theory and Components?
3.2. Is Dog-Assisted Therapy an Effective Treatment for Children Presenting with Complex Trauma Exposure, and Does It Have Any Beneficial Impact over and above Standard Therapeutic Treatments?
3.2.1. Internalising Concerns
3.2.2. Externalising Concerns
3.2.3. Post-Traumatic Stress
3.2.4. Depression
3.2.5. Anxiety
3.2.6. Maladjustment and Maladaptive Coping Skills
3.3. Can Dog-Assisted Therapy Decrease Attrition and Increase Therapy Completion Rates?
4. Discussion
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Conflicts of Interest
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Animal assist * | Child * sex * abuse | Maltreatment |
AAT | CSA | Child * abuse |
Canine assist * | Child trauma | Neglect |
CAT | Trauma | Adverse child * experiences |
Dog assist * | Abuse | Maltreat * |
Support dog |
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Chapman, R.L.; Baselmans, C.; Howell, T.J.; Ronken, C.; Butler, D. Exploring the Benefits of Dog-Assisted Therapy for the Treatment of Complex Trauma in Children: A Systematic Review. Children 2024, 11, 1017. https://doi.org/10.3390/children11081017
Chapman RL, Baselmans C, Howell TJ, Ronken C, Butler D. Exploring the Benefits of Dog-Assisted Therapy for the Treatment of Complex Trauma in Children: A Systematic Review. Children. 2024; 11(8):1017. https://doi.org/10.3390/children11081017
Chicago/Turabian StyleChapman, Rebekah L., Caitlin Baselmans, Tiffani J. Howell, Carol Ronken, and David Butler. 2024. "Exploring the Benefits of Dog-Assisted Therapy for the Treatment of Complex Trauma in Children: A Systematic Review" Children 11, no. 8: 1017. https://doi.org/10.3390/children11081017