Paws For Thought: Does A Dog Walk A Day Keep The Doctor Away?

Mark Taylor, MD; FRANZCP, FRCPE, FRCPsych
Introduction

Dog ownership is common in Australia at 39% of all households, similar to the 30% in the UK and 50% seen in America.

The University of Arizona in collaboration with Canine Companions, (an organisation providing guide and service dogs to people with physical disabilities) discovered even young puppies are responsive to human physical and verbal cues, with the ability to reciprocate human social gaze and successfully use information given by a human in a social context from an early age, prior to extensive experience with humans. (Emily Bray, reported in the Times, 3 June 2021).

Physical health is improved through dog ownership via increased cardiovascular health (antihypertensive; lower triglycerides: and in men reduced cholesterol), and more physical activity which in turn can strengthen the immune system.

Dog ownership can improve mental wellbeing through various mechanisms:

  • Via companionship and combatting loneliness
  • Increased opportunities for social interactions
  • The requirement for behavioural activation ie. daily dog walks
  • An external focus for care
  • Providing structure and routine to the day
Mankind’s best friend

In mental health care we have witnessed an increasing uptake of assistance or companion dogs. These are different to the traditional family pet, often being labradors or retrievers trained from puppies for 2 years to undertake various roles including pushing light switches or pedestrian crossing buttons; alerting to possible seizures or low blood sugars; or finding and leading another person to the affected person. In mental healthcare assistance dogs are typically seen with people who have autistic spectrum disorders; post-traumatic stress disorder (PTSD); and dementia.

An NDIS review1 from 2016 concluded that although the evidence was generally weak, with for example only 3 surveys at that time into PTSD, assistance animals were beneficial in mental health for emotional support and companionship with indirect benefits on enhanced work and school attendance.

Potential problems associated with assistance animals included time costs; grief when they pass; and the financial implications. Also, a dog is a personal commitment over many years. Although special arrangements for venues such as medical clinics and hospitals are made for assistance dogs, general accessibility on public transport or in shops and cafes etc can often be compromised by a dog.

The main systematic review2 thus far on the subject of assistance or companion dogs is by Brooks et al, in 2018.  Her group found that the quantitative data on the therapeutic benefits of assistance animals was mixed, mostly due to limitations in the various studies’ designs and power.

Brooks et al found there were significant findings for the benefits of canine companionship for military veterans with PTSD, including effects on reducing feelings of loneliness, depression, worry and irritability, and increased feelings of calmness. There was some evidence for the direct effect of pets on depression and mood through close proximate contact and stroking. However, this finding was not wholly supported by other quantitative studies, which reported neutral or small negative effects of pet ownership.

The importance of pets for emotional regulation was a recurrent theme in the numerous qualitative studies included by Brooks et al, where people reported a profound connection with their pet, sometimes preferring relationships with pets over relationships with other humans and viewing pets as replacement family members. The mechanisms through which pets made the perceived contribution to emotional work seemed to be the provision of a consistent source of comfort and affection.

One caveat to this literature on the effects of pet ownership and mental health is that it has been recognised that those already psychologically vulnerable or lonely can be more likely to seek out a pet.

Who let the dogs out?

Behavioural activation (BA) – essentially a posh jargon phrase for cardiovascular exercise – has been well established as having therapeutic utility in the treatment of many mental disorders, particularly depression3. BA is often the core ingredient of the “B” in CBT, for example.

As noted above, one of the key benefits of an assistance dog is the necessity for the dog to have a walk. Thus, it may be just as or even more beneficial to prescribe a dog rather than BA! Particularly as the evidence for BA seems to suggest that (even mildly) elevating the heart rate, for example via a dog walk, for approximately 50 minutes per day is the ‘recommended dose’ of BA. Combining BA with a dog facilitates motivation, perhaps even through guilt, for the patient or client needs to leave their abode to undertake the BA, and even engage with other dog-walkers. These dog-walker interactions can if needed be brief, due to the dog’s demands, which provides the socially anxious individual justification to ‘move on’ without embarrassment.

Conclusions

Assistance dogs are increasingly seen in day-to-day clinical practice and can be a useful component of a treatment package for isolated, lonely, or avoidant individuals. Specific conditions where there is evidence of a therapeutic role for assistance dogs include epilepsy; depression; and PTSD.  It should be acknowledged however that more good quality evidence of the benefits of assistance dogs is desirable.

The role of assistance dogs in this COVID-19 world has expanded and they can even be trained as quasi-carers for people with dementia, alerting to dangers or pressing buttons or light switches. As noted above however, there are some predictable long-term commitments with dog ownership.

Aside from company and comfort, dogs can be indirectly beneficial by encouraging exercise and social interaction. Assistance dogs are usually easily noticeable due to their obedience, behaviour, and livery. The ‘badge’ these dogs provide arguably also aids in de-stigmatising invisible conditions such as depression, epilepsy, and PTSD by promoting awareness and the perception of commonality for these prevalent disorders. Mankind’s best friend, indeed!

References
  1. La Trobe University Dept of Psychology. Final Report to National Disability Insurance Scheme: Reviewing Assistance Animal Effectiveness. 2016.
  2. Brooks et al. The power of support from companion animals for people living with mental health problems: a systematic review and narrative synthesis of the evidence. BMC Psychiatry (2018) 18:31 DOI 10.1186/s12888-018-1613-2
  3. Uphoff  E, Ekers  D, Robertson  L, Dawson  S, Sanger  E, South  E, Samaan  Z, Richards  D, Meader  N, Churchill  R. Behavioural activation therapy for depression in adults. Cochrane Database of Systematic Reviews 2020, Issue 7. Art. No.: CD013305. DOI: 10.1002/14651858.CD013305