This document is a thesis submitted by Stephanie Davidson to Bergin University in partial fulfillment of a Master of Science degree in Canine Science. The thesis proposes providing psychiatric service dogs to injured workers in British Columbia who suffer from posttraumatic stress disorder. It conducts a literature review on PTSD and the potential benefits of service dogs to address issues faced by injured workers attempting to return to work. The goal is to submit the review to WorkSafeBC to determine if service dogs meet guidelines to provide care for injured workers under the Worker's Compensation Act.

1.
Psychiatric
Service
Dogs
for
Injured
Workers
with
Posttraumatic
Stress
Disorder:
A
Proposal
to
WorksafeBC
By
Stephanie
Rae
Davidson
A
thesis
submitted
in
partial
satisfaction
of
the
requirements
for
the
degree
of
Master
of
Science
(Canine
Science)
Bergin
University
of
Canine
Studies
Committee
in
charge:
Dr.
Kukuh
Noertjojo
Dr.
David
Eveleigh
Dr.
Anne
Deitrich

2.
I,
Stephanie
Davidson,
am
submitting
this
thesis
in
partial
fulfillment
of
the
requirements
of
the
Masters
in
Science,
Bergin
University.
I,
Stephanie
Davidson,
undertake
that
the
work
is
all
my
own
work
and
that
I
have
not
knowingly
used
another’s
ideas
without
attributing
them
nor
engaged
in
plagiarism.
Signed:
Dated:

3.
TABLE
OF
CONTENTS
CHAPTER
1:
INTRODUCTION……………………………………………………………………………..…1
CHAPTER
2:
STATEMENT
OF
INTENTION………………………………………………..……………1
CHAPTER
3:
BACKGROUND…………………………………………………………………………..………2
CHAPTER
4:
METHODOLOGY……………………………………………………………………..…………3
CHAPTER
5:
RESULTS……………………………………………………………………………….………….4
POSTTRAUMATIC
STRESS
DISORDER………………………………...………….4
RESCUE
WORKER
POPULATIONS………………………………………5
RISK
FACTORS…………………………………………………….…………….5
PREVENTION………………………………………………………….…………6
ISSUES
RETURNING
TO
WORK
………………………………….………6
FACTORS
IMPACTING
RETURN-­‐TO-­‐WORK
DECISIONS……….7
CHRONIC
PAIN
ISSUES……………………………………………………………...…..8
RECOVERY
FROM
PTSD……………………………………………..………8
POTENTIAL
BENEFITS
OF
DOGS………………………………………............…...9
SERVICE
DOGS…………………………………………………………………..……...…11
PSYCHIATRIC
SERVICE
DOGS……………………………………………….……...16
MILITARY
SETTINGS………………………………………………...……..17
NON-­‐MILITARY
FOCUSED
STUDIES………………………………….20
CHAPTER
6:
DISCUSSION…………………………………………………………………………….……...21
REFERENCES…………………………………………………………………………...…………………………24
APPENDICES………………………………………………………………………………………………………27

4.
1
INTRODUCTION
Service
dogs
are
used
to
help
people
with
physical
and
psychological
disabilities
navigate
their
home
and
public
environment
(Rintala,
Matamoros
&
Seitz,
2008;
Esnayra
&
Love,
2012).
Bonita
(Bonnie)
Bergin
introduced
the
idea
of
service
dogs
after
visiting
third
world
countries
and
witnessing
people
using
donkeys
as
assistive
devices
for
their
disabilities
(B.
Bergin,
personal
communication,
September
2013).
Once
back
in
the
United
States,
Bergin
began
training
shelter
dogs
to
perform
specialized
tasks
for
people
with
disabilities,
and
later
founded
Canine
Companions
for
Independence
(B.
Bergin,
personal
communication,
September
2013),
the
first
service
dog
training
program
in
the
country.
There
are
now
102
programs
in
North
America
(14
In
Canada)
certified
by
Assistance
Dogs
International,
a
coalition
for
assistance
dog
organizations
(Appendix
I).
Assistance
Dogs
International
functions
as
an
accreditation
system
and
ensures
that
members
are
regularly
assessed
and
meet
the
high
standards
set
out
by
the
organization.
Currently,
WorksafeBC
does
not
cover
the
cost
of
service
dogs
for
injured
workers.
Recently,
there
have
been
requests
for
service
dogs
from
injured
workers,
mostly
from
workers
with
Posttraumatic
Stress
Disorder
(PTSD)
(K.
Hall,
personal
communication,
November
2014).
At
this
time,
the
requests
have
been
denied,
as
there
has
not
been
sufficient
evidence
regarding
the
efficacy
of
service
dogs.
Law
and
policy
guide
WorksafeBC
when
determining
entitlements
to
injured
workers.
Section
21.1
of
the
Worker’s
Compensation
Act
states
that:
In
addition
to
the
other
compensation
provided
by
this
Part,
the
Board
may
furnish
or
provide
for
the
injured
worker
any
medical,
surgical,
hospital,
nursing
and
other
care
or
treatment,
transportation,
medicines,
crutches
and
apparatus,
including
artificial
members,
that
it
may
consider
reasonably
necessary
at
the
time
of
the
injury,
and
thereafter
during
the
disability
to
cure
and
relieve
from
the
effects
of
the
injury
or
alleviate
those
effects,
and
the
Board
may
adopt
rules
and
regulations
with
respect
to
furnishing
health
care
to
injured
workers
entitled
to
it
and
for
the
payment
of
it
(Appendix
II).
STATEMENT
OF
INTENTION
This
paper
aims
to
conduct
a
systematic
review
of
the
current
literature
on
service
dogs,
and
how
service
dogs
could
benefit
the
injured
worker
population.
Of
particular
interest
is
literature
on
workers
with
Posttraumatic
Stress
Disorder.
Research
on
symptoms,
prevention,
risk
factors,
and
remission
rates
will
be
reviewed
for
the
purpose
of
this
paper.
The
review
will
be
submitted
to
WorkSafeBC
in
order
to
determine
if
service
dogs
can
meet
the
guidelines
of
section
21.1.
Current
practice
includes
having
the
Evidence-­‐Based
Practice
Group
at
WorksafeBC
consider
the
evidence
before
deciding
to
entitle
an
expense;
as
such,
this
paper
will
be
submitted
to
the
Evidence-­‐Based
Practice
group
for
examination.

5.
2
BACKGROUND
Service
dogs
are
trained
to
help
people
with
a
multitude
of
disabilities.
Service
dogs
can
include
guide
dogs
for
the
blind,
hearing
dogs
for
the
deaf
and
hard
of
hearing,
mobility
(assistance)
dogs
for
people
with
ambulatory
disorders,
seizure
alert
dogs,
diabetes
alert
dogs,
autism
dogs,
and
psychiatric
service
dogs
for
people
with
PTSD.
Generally,
service
dogs
are
trained
to
perform
tasks
such
as
picking
up
dropped
items,
opening
and
closing
doors,
cupboards
and
fridges,
turning
lights
on
and
off,
pulling
wheelchairs,
and
generally
assisting
around
the
home
and
in
public.
Service
dog
trainers
can
tailor
their
tasks
to
be
more
specific
to
the
individual
needs
of
the
disabled
person;
such
is
the
case
of
alerting
dogs
(diabetic,
seizure,
hearing)
and
autism
dogs
(Camp,
2001).
It’s
been
suggested
that
occupational
therapists
could
play
a
crucial
role
in
bridging
the
gap
between
the
service
dog
organization
and
the
specific
needs
of
the
disabled
person
(Camp,
2001).
WorksafeBC
reports
that
most
of
the
requests
for
service
dogs
come
from
workers
who
are
suffering
from
Posttraumatic
Stress
Disorder
from
work
related
incidents
(K.
Hall,
personal
communication,
November
2014).
Since
2012,
when
Bill
14
(legislation
regarding
mental
health
claims)
came
into
effect,
there
have
been
732
workers
with
a
primary
diagnosis
of
PTSD
who
have
claims
with
WorksafeBC
(Business
Information
and
Analysis
Report,
May
2015,
WorksafeBC).
This
does
not
include
workers
with
a
physical
injury
who
have
developed
PTSD
because
of
the
accident.
It
also
doesn’t
include
any
claims
registered
before
2012.
Injured
workers
with
PTSD
often
report
difficulties
leaving
the
house
and
even
getting
out
of
bed.
Their
struggles
can
be
so
severe
that
WorksafeBC
has
coordinated
with
occupational
therapists
to
take
the
workers
out
in
public
to
movies,
grocery
shopping,
dinner,
etc.
WorksafeBC
has
acknowledged
that
workers
with
PTSD
aren’t
just
struggling
in
terms
of
being
fearful
of
returning
to
the
site
of
the
trauma,
but
have
a
hard
time
being
out
of
their
house
at
all.
This
is
one
area
in
which
people
with
PTSD
tout
the
benefits
of
having
their
service
dogs
(Esnayra,
&
Love
2012).
The
average
health
care
cost
that
WorksafeBC
pays
for
services
for
workers
with
PTSD
is
just
under
$24,000.
The
average
long-­‐term
disability
amount
for
people
who
have
been
deemed
to
be
permanently
disabled
because
of
PTSD
is
an
additional
$18,000
(Business
Information
and
Analysis
Report,
May
2015,
WorksafeBC).
In
the
United
States,
PTSD
results
in
roughly
3.6
missed
days
from
work
each
month,
which
is
similar
to
the
lost
work
days
related
to
depression
(Stergiopoulos,
Cimo,
Cheng,
Bonato
&
Dewa,
2011).
Since
2012,
the
average
amount
of
wage
loss
days
per
claim
for
workers
with
a
primary
diagnosis
of
PTSD
is
266
days
(Business
Information
and
Analysis
Report,
May
2015,
WorksafeBC).
The
average
wage
lost
cost
for
workers
with
a
primary
diagnosis
of
PTSD
is
just
under
$33,000
(Business
Information
and
Analysis
Report,
May
2015,
WorksafeBC).
The
total
cost
of
the
732
PTSD
claims
so
far
is
$57,126,060.14
(Business
Information
and
Analysis
Report,
May
2015,
WorksafeBC).

6.
3
Using
service
dogs
for
people
suffering
from
PTSD
is
a
fairly
new
concept
(within
the
last
7-­‐
10
years),
hence
the
limited
research
on
this
topic.
Most
reports
are
anecdotal,
but
the
reported
effectiveness
is
sufficiently
high
that
both
the
American
and
Canadian
Veterans
Affairs
agencies
have
been
looking
into
reports
that
service
dogs
are
beneficial
for
Veterans
with
PTSD
(“Dogs
and
PTSD”,
n.d.;
“Service
Dogs”,
2015).
Veterans
Affairs
Canada
commissioned
the
Canadian
Institute
for
Military
and
Veteran
Health
Research
to
examine
the
existing
research;
however,
they
determined
that
more
research
is
needed
(“Service
Dogs”,
2015).
Subsequently,
Veterans
Affairs
Canada
announced
a
two
and
a
half
year
pilot
study
looking
at
Veterans
and
PTSD
Service
dogs,
with
$500,000
allotted
to
the
research
(“Service
Dogs”,
2015).
Veterans
Affairs
in
the
United
States
has
started
a
research
study
to
‘determine
if
there
are
things
a
dog
can
do
for
a
Veteran
with
PTSD
that
would
qualify
the
animal
as
a
Service
Dog
for
PTSD’
(“Dogs
and
PTSD”,
n.d);
however,
it
will
take
several
years
before
the
study
is
complete.
Currently,
Veterans
Affairs
in
America
does
not
provide
service
dogs
for
any
condition,
although
they
do
cover
the
cost
of
veterinary
care
for
veterans
with
physical
disabilities
who
privately
obtain
service
dogs.
METHODS
This
paper
is
a
literature
review
that
aims
to
summarize
up
to
date
information
on
Posttraumatic
Stress
Disorder,
injured
workers,
benefits
of
pets
on
human
health,
and
service
dogs.
I
searched
for
articles
using
the
following
databases:
Ebscohost,
Academic
Search
Premier,
PsycINFO,
Cinahl,
Medline,
Embase,
and
OTseeker,
with
no
date
range
limitations.
I
used
keywords
service
dog,
assistance
dog,
psychiatric
dog,
PTSD
dog,
Posttraumatic
stress
disorder
dog,
posttraumatic
stress
disorder
injured
worker,
PTSD
injured
worker,
posttraumatic
stress
disorder
work
related,
PTSD
work
related
and
mental
health
dog.
I
limited
my
search
to
peer
reviewed
journal
articles,
and
only
articles
in
English.
Several
articles
were
discarded
upon
reading
the
title
of
abstract,
which
deemed
the
articles
irrelevant
(e.g.
war
dogs
coming
back
from
combat
with
PTSD,
people
experiencing
PTSD
from
dog
bites).
I
also
scanned
the
reference
section
of
all
the
pertinent
papers
and
found
other
studies
of
interest.
Fifty
one
papers
were
read
and
considered
relevant
to
the
topic.
Ten
papers
are
original
research
or
systematic
reviews
of
research
on
service
dogs
for
people
with
physical
disabilities.
Eight
are
studies
on
service
dogs
or
therapy
dogs
for
people
with
mental
health
issues,
including
PTSD.
Most
of
these
studies
utilize
a
survey
design.
Fifteen
papers
are
on
posttraumatic
stress
disorder.
Finally,
seventeen
papers
are
on
general
health
effects
of
animals
on
humans.
In
the
following
sections,
I
will
summarize
the
literature
on
PTSD
and
workplace
injury,
followed
by
potential
benefits
of
companion
animals
and
service
dogs
for
psychologically
injured
workers.
I
will
then
review
WorksafeBC’s
current
policies
on
accepting
new
treatment
modalities,
and
relate
this
to
psychiatric
service
dogs.

7.
4
RESULTS
POSTTRAUMATIC
STRESS
DISORDER
AND
WORKPLACE
INJURY
Posttraumatic
stress
disorder
has
had
many
names
over
the
last
century
before
being
formally
called
posttraumatic
stress
disorder
in
1980.
Dr.
Jacob
Mendez
Da
Costa
first
described
it
as
‘soldier’s
heart
syndrome’
in
1871,
which
was
later
changed
to
‘Da
Costa
syndrome’
in
his
honour.
In
World
War
I,
the
condition
was
referred
to
as
‘shell
shock’,
and
in
World
War
II
it
was
coined
‘combat
neurosis’
or
‘operational
fatigue’.
It
has
also
been
referred
to
as
‘traumatic
neurosis’
(Javidi
&
Yadollahie,
2012).
Originally,
it
was
thought
of
as
a
combat
related
disorder,
but
since
has
been
changed
to
encompass
several
types
of
traumatic
events
outside
of
the
military.
This
includes,
but
is
not
limited
to,
occupational
type
trauma
that
workers
can
experience
at
their
workplace.
There
are
four
clusters
of
symptoms
in
the
diagnostic
criteria
for
PTSD
(DSM-­‐5,
American
Psychiatric
Association,
2013):
firstly,
re-­‐experiencing
of
the
traumatic
event,
which
could
include
flashbacks
or
dreams
or
intrusive
thoughts
of
the
event;
secondly,
avoidance
of
the
trauma
or
related
objects
in
the
environment;
thirdly,
negative
cognitions
and
emotions
such
as
emotional
numbing,
estrangement,
diminished
interest,
and
blame;
and
lastly,
arousal,
which
can
include
reckless
behaviour,
hypervigilance,
and
exaggerated
startle
reactions
(for
full
diagnostic
criteria,
see
Appendix
III).
Roughly
eighty-­‐four
percent
of
PTSD
sufferers
experience
issues
with
alcohol
or
drug
abuse,
shame,
despair,
hopelessness,
employment
problems,
divorce,
physical
symptoms
or
violence
(Javidi
&
Yadollahie,
2012).
PTSD
can
often
be
co-­‐morbid
with
depression,
anxiety
disorders,
substance
abuse
disorders,
and
conduct
disorder
(Javidi
&
Yadollahie,
2012).
PTSD
can
be
acute
(symptoms
persist
for
less
than
3
months)
or
chronic
(symptoms
persist
for
greater
than
3
months)
(DSM-­‐5,
American
Psychiatric
Association,
2013).
It
should
also
be
noted
that
PTSD
can
be
diagnosed
as
‘delayed
expression’,
where
the
full
diagnosis
of
PTSD
is
not
made
until
6
or
more
months
after
the
trauma,
even
if
some
symptoms
occur
immediately
(DSM-­‐5,
American
Psychiatric
Association,
2013).
Some
professions
are
potentially
exposed
to
more
traumatic
experiences
than
others,
such
as
police
officers,
firefighters,
paramedics,
journalists,
emergency
service
workers,
employees
of
retail
that
are
at
risk
of
burglary,
and
employees
of
health
and
social
services
(Javidi
&
Yadollahie,
2012;
Skogstad,
Skorstad,
Lie,
Conradi,
Heir
&
Weisaeth,
2013).
Additionally,
PTSD
is
highly
co-­‐morbid
with
other
mental
disorders
(Chapman
et
al.,
2012).
Rescue
Worker
Populations
A
systematic
review
and
meta-­‐regression
analysis
of
PTSD
in
rescue
worker
populations
found
that
the
pooled
current
worldwide
prevalence
of
PTSD
in
rescue
workers
is
10%
(Berger,
Coutinho,
Figueira,
Marques-­‐Portella,
Luz,
Neylan,
Marmar
&
Mendlowicz,
2012).
These
results
are
consistent
with
previous
reports
of
police
officers
having
the
lowest
incidence
of
PTSD,
and

8.
5
paramedics
having
the
highest
(Berger
et
al.,
2012).
One
interesting
finding
of
the
study
was
an
absence
of
gender
differences
in
the
prevalence
of
PTSD.
This
is
surprising
because
being
female
is
often
listed
as
a
risk
factor
for
PTSD
(DSM-­‐5,
American
Psychiatric
Association,
2013).
Similar
to
the
study
by
Berger
et
al.,
studies
involving
military
and
police
officers
failed
to
find
an
increased
level
of
PTSD
in
the
female
population
(Lilly,
Pole,
Best,
Metzler
&
Marmar,
2009).
This
may
be
due
to
different
peritraumatic
emotional
reactions
in
female
police
officers
compared
to
the
female
civilian
population
(Lilly
et
al.,
2009).
Peritrauma
refers
to
the
time
that
occurs
during
and
shortly
after
the
traumatic
incident.
Emotions
such
as
helplessness
and
overwhelming
fear
during
the
peritraumatic
period
have
been
noted
as
key
predictors
in
the
development
of
PTSD
later
on
(Lilly
et
al.,
2009).
Expectedly,
female
military
members
and
police
officers
would
be
screened
through
psychological
testing
and
would
be
less
likely
to
have
the
emotional
reactions
that
may
be
more
common
with
civilian
females.
It
has
also
been
found
that
people
who
are
able
to
maintain
their
sense
of
control
in
traumatic
situations
are
less
likely
to
develop
PTSD,
whereas
people
who
dissociate
(emotionally
detach
from
their
surroundings)
show
a
higher
likelihood
of
developing
PTSD
(Javidi
&
Yadollahie,
2012).
After
conducting
their
review,
Berger
et
al.
(2012)
suggest
improving
pre-­‐employment
strategies
to
ensure
selection
of
the
most
resilient
rescue
workers,
along
with
educational
campaigns
about
PTSD
in
order
to
reduce
the
stigma
and
improve
awareness.
Some
studies
show
a
higher
prevalence
rate
than
in
the
systematic
review
that
was
previously
discussed.
For
instance,
in
one
study,
police
officers
had
a
roughly
10%
prevalence
rate
of
PTSD,
however,
firefighters
scored
around
20%,
as
did
ambulance
personnel
(Skogstad,
Skorstad,
Lie,
Conradi,
Heir
&
Weisaeth,
2013).
Several
studies
have
found
that
lack
of
social
support
and
poor
organizational
conditions
at
work
are
associated
with
PTSD
symptoms
in
ambulance
personnel
(Skogstad,
et
al.,
2013).
Journalists,
particularly
war
correspondents,
show
a
lifetime
prevalence
of
close
to
30%
for
PTSD.
The
lifetime
prevalence
of
PTSD
in
the
USA
for
the
general
populations
is
approximately
10%
for
women,
and
5%
for
men
(Skogstad,
et
al.,
2013).
Similarly,
the
DSM-­‐5
reports
the
projected
lifetime
risk
for
PTSD
is
8.7%
(American
Psychiatric
Association,
2013).
Risk
Factors
Potential
risk
factors
for
the
development
of
work-­‐related
PTSD
include,
but
are
not
limited
to,
female
gender,
previous
psychiatric
issues,
lack
of
social
support
and
type
and
intensity
of
the
exposure
to
the
traumatic
incident
(Javidi
&
Yadollahie,
2012).
The
best
predictors
of
the
severity
of
the
symptoms
include
intensity
of
trauma,
temperament
traits
(specifically
neuroticism)
and
other
pre-­‐trauma
demographic
variables
(Javidi
&
Yadollahie,
2012).
According
to
the
DSM-­‐5,
risk
factors
include
lower
socioeconomic
status,
lower
education,
prior
trauma,
prior
mental
disorders,
lower
intelligence,
being
female,
being
younger
at
the
time
of
the
trauma,
and
being
of
a
minority
racial
status
(American
Psychiatric
Association,
2013).
Similarly,
the
severity
of
the
trauma,
perceived

9.
6
threat
to
life,
and
dissociation
are
related
to
an
increased
risk
of
PTSD
(DSM-­‐5,
American
Psychiatric
Association,
2013).
Prevention
Workplaces
can
implement
some
preventative
measures
to
decrease
the
likelihood
of
PTSD
after
traumatic
incidents.
The
three
main
preventative
strategies
are
pre-­‐employment
selection,
training
in
stress
management
and
early
intervention
(Skogstad,
Skorstad,
Lie,
Conradi,
Heir
&
Weisaeth,
2013).
It
has
been
hypothesized
that
self
selection
of
employees
in
high
risk
careers,
such
as
police
officers,
may
be
the
reason
for
the
lower
than
expected
rates
of
PTSD
in
this
profession
(Berger,
Coutinho,
&
Figueira,
2012).
Firefighters
who
have
been
trained
in
stress
management
show
better
coping
mechanisms
and
lower
levels
of
PTSD
than
non-­‐professional
or
volunteer
firefighters
(Skogstad
et
al.,
2013).
This
highlights
the
importance
of
on
the
job
training
in
stress
management
programs
and
learning
to
handle
their
own
stress
reactions
(Skogstad
et
al.,
2013).
Early
intervention,
such
as
‘psychological
first
aid’
has
been
used
extensively
in
military
settings
(Skogstad
et
al.,
2013).
Using
this
model,
soldiers
are
treated
as
quickly
as
possible,
while
still
near
the
battlefield,
and
then
brought
back
to
duty
after
a
brief
rest
period.
It
has
been
suggested
by
some
that
this
method
is
more
effective
than
pulling
them
permanently
out
of
service.
This
could
be
similar
to
the
benefits
seen
by
workers
doing
an
early
and
safe
return
to
work.
It
has
been
found
that
attachment
to
the
workplace,
an
early
return
to
work,
support
from
co-­‐workers
and
providing
evidence-­‐based
treatment
following
a
traumatic
incident
is
highly
beneficial
for
workers
(McFarlane
&
Bryant,
2007).
Psychological
first
aid
has
been
accepted
by
some
researchers
as
an
appropriate
intervention
to
a
traumatic
incident,
and
is
often
used
in
natural
disaster
aftermath
(Pfefferbaum
&
Shaw,
2013).
However,
a
review
done
in
2002
found
that
in
many
cases,
compulsory
debriefing
was
actually
correlated
with
a
higher
risk
of
PTSD
in
victims
of
traumatic
events
(Rose,
Bisson,
Churchill
&
Wessely,
2002).
Drayer,
Cameron
and
Woodward
first
coined
the
term
psychological
first
aid
in
1954.
It
has
since
been
modified
and
updated
over
the
years.
There
is
a
now
a
manual
called
the
Psychological
First
Aid
Field
Operations
Guide,
which
outlines
8
main
components
of
psychological
first
aid:
(1)
contact
and
engagement,
(2)
safety
and
comfort,
(3)
stabilization,
(4)
information
gathering:
current
needs
and
concerns,
(5)
practical
assistance,
(6)
connection
with
social
supports,
(7)
information
on
coping,
and
(8)
linkage
with
collaborative
services
(Psychological
First
Aid:
Field
Operations
Guide,
2005).
In
2011,
Forbes
et
al.
developed
a
framework
for
implementing
psychological
first
aid
in
occupational
settings.
Issues
returning
to
work
One
of
the
main
barriers
of
returning
to
work
for
people
with
PTSD
is
avoidance.
A
key
symptom
of
PTSD
is
avoidance
of
environments
linked
to
the
traumatic
event,
which
then
makes

10.
7
returning
to
the
workplace
very
challenging
(Stergiopoulos,
Cimo,
Cheng,
Bonato
&
Dewa,
2011).
That
being
said,
workers
who
are
unable
to
return
to
work
experience
more
persistent
PTSD
symptoms
(Stergiopoulos
et
al.,
2011).
It
has
been
well
established
that
an
early
and
safe
return
to
work
is
highly
beneficial
to
the
physically
injured
worker
populations.
However,
it
could
be
the
case
that
the
correlation
is
reversed
in
the
study
by
Stergiopoulos
et
al.,
and
the
workers
that
are
unable
to
return
to
work
had
more
severe
PTSD
in
the
first
place.
One
thing
to
consider
is
the
difference
in
possible
return-­‐to-­‐work
interventions
between
workers
who
experienced
one
highly
traumatic
incident
(e.g.,
robbery)
versus
workers
who
experience
multiple
incidents
(e.g.,
paramedics
who
have
developed
PTSD
from
years
of
working
traumatic
scenes).
The
worker
who
was
robbed
might
show
a
high
level
of
avoidance
to
the
place
of
the
robbery,
whereas
the
paramedic
may
show
a
stronger
fight
or
flight
response
from
years
of
being
‘at
the
ready’
for
a
stressful
call.
A
recent
study
by
Karam
et
al.
(2014)
found
that
people
who
had
experienced
four
or
more
traumatic
events
ended
up
with
more
complex
PTSD
with
substantially
higher
functional
impairments.
People
who
had
experienced
four
or
more
traumatic
events
were
also
found
to
be
at
an
increased
risk
of
comorbidity
with
other
mood
and
anxiety
disorders
(e.g.
depression),
and
are
more
likely
to
be
of
the
dissociative
subtype
of
PTSD
(Karam
et
al.,
2014).
This
could
partially
explain
the
severity
of
the
PTSD
seen
in
paramedics
and
other
rescue
worker
populations.
Factors
Impacting
Return-­‐to-­‐Work
Decisions
If
employers
are
aiming
for
an
early
return
to
work,
but
workers
are
still
experiencing
symptoms
such
as
distractibility
or
recklessness
due
to
PTSD,
the
risk
for
re-­‐injury
is
high
(Buodo,
Ghisi,
Novara,
Scozzari,
Natale,
Sanavio
&
Palomba,
2011).
If
workers
are
distracted
or
acting
recklessly,
this
could
lead
to
further
accidents,
which
could
exacerbate
the
PTSD
symptoms.
Employers
and
return
to
work
specialists
with
WorksafeBC
should
be
cognizant
of
this
when
developing
return
to
work
plans
they
set
up
for
workers
who
are
still
suffering
from
PTSD
symptoms.
Psychiatric
service
dogs
could
help
the
worker
maintain
calm,
which
may
prevent
accidents
resulting
from
distraction
and
recklessness.
Several
studies
have
found
that
people
with
PTSD
show
decreased
attention,
impaired
executive
functioning
and
learning
deficits
(Buodo
et
al.,
2011).
An
information-­‐processing
model
of
PTSD
postulates
that
trauma-­‐related
stimuli
activate
a
network
of
fear-­‐related
responses,
and
this
fear
structure
increases
attentional
states
to
the
stimulus,
thereby
reducing
attentional
resources
to
non-­‐trauma
related
activities,
such
as
the
task
at
hand
(Foa,
Steketee
&
Bothbaum,
1989).
This
level
of
distraction
could
lead
to
further
accidents
and
injury.

11.
8
Chronic
Pain
Issues
Several
studies
have
found
a
link
between
chronic
pain
and
PTSD
(Asmundson,
Norton,
Allerdings,
Norton
&
Larsen,
1998).
Along
with
PTSD
symptoms,
it
has
been
reported
that
accidental
injury
survivors
report
fear
and
anxiety,
insomnia,
shame
about
physical
scars,
and
depression
(Asmundson
et
al.,
1998).
Asmundson
et
al.
conducted
a
study
with
139
injured
workers
who
were
part
of
a
tertiary-­‐care
rehabilitation
program.
Participants
were
given
a
series
of
self-­‐report
questionnaires
including
the
Modified
PTSD
Symptom
Scale
(MPSS),
Anxiety
Sensitivity
Index
(ASI),
Beck
Depression
Inventory
(BDI),
Symptom
Checklist-­‐90
Somatization
Subscale,
and
Fear
Questionnaire
(FQ).
The
authors
report
all
of
these
questionnaires
as
having
good
reliability
and
validity
(internal
and
external).
Eighty-­‐seven
percent
of
the
participants
reported
current
and
chronic
(greater
than
3
months)
pain,
and
all
participants
were
receiving
workers
compensation
benefits
for
their
injuries.
When
reviewing
the
results
from
the
questionnaires,
it
was
concluded
that
fourty-­‐two
(34.7%)
of
the
injured
workers
met
criteria
for
PTSD,
twenty-­‐two
(18.2%)
met
criteria
for
partial
PTSD,
and
fifty-­‐seven
(47.1%)
did
not
meet
criteria
for
PTSD
(Asmundson
et
al.,
1998).
The
diagnostic
criteria
for
PTSD
were
based
on
DSM-­‐IV
criteria,
which
are
somewhat
different
from
current
DSM
5
criteria
(Asmundon
et
al.,
1998).
The
link
between
accidental
injury,
chronic
pain,
and
PTSD
is
worth
investigating
further,
as
the
literature
suggests
a
substantial
overlap
between
chronic
pain
and
PTSD
in
the
injured
worker
population.
Recovery
from
PTSD
A
longitudinal
study
by
Venke
et
al.
in
2013
looked
at
stability
of
PTSD
over
8
years
in
physical
assault
victims.
The
authors
found
that
the
probability
of
recovery
from
PTSD
in
an
8-­‐year
period
was
fifty-­‐two
percent.
A
study
of
8841
Australian
participants
looked
at
remission
from
PTSD
and
found
that
projected
lifetime
remission
rate
was
ninety-­‐two
percent
(Chapman
et
al.,
2012).
The
median
time
to
remission
was
14
years.
Childhood
trauma,
interpersonal
violence,
severity
of
symptoms
and
a
secondary
anxiety
or
affective
disorder
were
listed
as
factors
in
longer
remission
times
(Chapman
et
al.,
2012).
A
5-­‐year
study
of
199
patients
with
PTSD
found
that
remission
rates
were
around
thirty-­‐eight
percent
by
year
5,
but
of
those
thirty-­‐eight
percent
in
remission,
twenty-­‐
nine
percent
had
at
least
one
episode
of
recurrence
(Pérez
Benítez,
Zlotnick,
Stout,
Lou,
Dyck,
Weisberg
&
Keller,
2012).
The
study
also
found
a
link
between
psychosocial
impairment
and
likelihood
of
recovery,
such
that
when
psychosocial
functioning
related
to
work,
household
duties,
relationships,
recreation
and
life
satisfaction
improved,
so
did
the
chance
of
recovery
from
PTSD
(Pérez
Benítez
et
al.,
2012).
This
is
important
to
note,
as
it
relates
to
psychiatric
service
dogs
and
their
ability
to
increase
social
interactions
in
the
disabled
population.
A
meta-­‐analysis
of
long
term
outcome
studies
involving
PTSD
found
that
overall
remission
rates
were
between
51.7%
and
36.9%,

12.
9
depending
on
whether
the
baseline
was
before
or
after
5
months,
respectively
(Morina
et
al.,
2014).
These
findings
highlights
that
early
diagnosis
may
play
a
key
role
in
potential
recovery.
It
should
be
noted
that
this
meta-­‐analysis
only
looked
at
PTSD
with
spontaneous
recovery
(no
specific
treatment).
It
is
curious
that
remission
rates
in
this
study
were
linked
to
early
diagnosis,
considering
that
the
authors
looked
specifically
at
PTSD
without
specific
treatment.
It
could
be
that
once
people
are
diagnosed,
they
are
able
to
put
a
name
and
a
reason
to
their
symptoms,
which
could
‘normalize’
their
struggles.
They
found
that
participants
with
PTSD
associated
with
a
physical
injury
had
the
lowest
rate
of
remission
(31.4%)
(Morina
et
al.,
2014).
That
should
be
of
particular
importance
to
WorksafeBC
regarding
injured
workers
with
a
secondary
diagnosis
of
PTSD.
Overall,
almost
half
of
patients
remit
from
PTSD
after
a
mean
of
more
than
three
years
(Morin
et
al.,
2014);
however,
it
was
found
that,
surprisingly,
recovery
from
PTSD
does
not
generally
increase
with
longer
periods.
The
authors
write
that
their
conclusions
do
not
support
the
old
saying
that
“time
heals
all
wounds”
(Morina
et
al.,
2014).
The
research
seems
to
indicate
that
although
some
people
can
fully
recover
from
PTSD,
the
timeframe
for
full
recovery
can
be
long,
and
the
chance
of
reoccurrence
can
be
high.
POTENTIAL
BENEFITS
OF
DOGS
Recently,
a
lot
of
attention
has
been
given
to
the
health
benefits
of
pet
ownership.
Several
studies
have
found
that
owning
a
pet
(generally
a
dog)
can
be
beneficial
to
both
physical
and
mental
health
(Wells,
2009a).
However,
researchers
have
been
unable
to
replicate
the
results
from
some
of
these
studies,
specifically
a
study
that
found
that
pet
owners
are
more
likely
to
be
alive
1
year
after
a
heart
attack
(Friedmann,
Katcher,
Lynch,
&
Thomas,
1980).
Conversely,
other
studies
have
found
no
benefits
or
even
negative
implications
of
pet
ownership,
as
described
below.
In
2003,
Parlsow
and
Jorm
conducted
a
study
and
found
no
relationship
between
pet
ownership
and
decreases
in
heart
disease.
However,
studies
by
Sigel,
Anderson
and
Friedman
found
that
pet
ownership
(particularly
dogs)
increased
survival
rates
and
reduced
doctor’s
visits
with
those
suffering
from
cardiovascular
disease.
Also
found
were
reduced
levels
of
plasma
trigyclerides
and
lowered
systolic
blood
pressure
for
pet
owners.
Several
researchers
have
found
that
the
action
of
petting
an
animal
can
lower
blood
pressure
and/or
heart
rate
(Katcher,
1981;
Katcher,
Friedmann,
Beck
&
Lynch,
1983;
Shiloh,
Sorek
&
Terkel,
2003).
This
effect
has
been
shown
to
be
replicable
by
many
researchers,
and
it’s
noted
that
the
effects
are
stronger
when
interacting
with
a
familiar
animal
as
opposed
to
an
unfamiliar
animal
(Schuelke,
Trask,
Wallace,
Baun,
Bergstrom,
&
McCabe,
1991).
It
should
be
taken
into
account
that
these
effects
disappear
almost
instantly
after
the
exposure
to
the
animal
has
ended.
Conversely,
a
study
of
425
heart-­‐attack
patients
found
that
pet
owners
have
a
higher
chance
of
dying
or
readmission
compared
to
non-­‐pet
owners
(twenty-­‐two
percent
compared
to
fourteen
percent),
although
this
applied
more
to
cat
owners
than
dog
owners
(Parker
,
Gayed,
Owen,
Hyett,
Hilton,
&
Heruc,
2010).

13.
10
In
terms
of
psychological
benefits,
some
research
indicates
that
pets
can
help
during
times
of
distress
(divorce,
deaths,
etc.)
and
can
lower
reported
levels
of
anxiety,
loneliness
and
depression
(Folse,
Minder,
Aycock
&
Santana,
1994).
Several
studies
have
looked
specifically
at
feelings
of
loneliness
and
isolation
and
have
found
that
pet
owners
experience
these
feelings
less
than
non-­‐pet
owners
(Jessen,
Cardioello
&
Baun,
1996;
Zasloff
&
Kidd,
1994).
Feelings
of
isolation
and
exclusion
can
be
prevalent
in
the
disability
community,
and
many
service
dog
owners
report
their
dogs
act
as
‘social
lubricants’
for
them
(Hart,
Hart
&
Bergin,
1987).
There
is
a
large
body
of
research
that
indicates
that
feeling
excluded
can
result
in
emotional
distress,
depressed
mood,
and
increased
levels
of
loneliness
(Blackhart,
Nelson,
Knowles,
&
Baumeister,
2010).
A
study
of
40,000
people
in
Sweden
recently
found
that
pet
owners
were
more
physically
healthy
than
non
pet
owners,
but
suffered
from
more
psychological
conditions
(anxiety,
insomnia,
fatigue,
and
depression
(Müllersdorf,
Granström,
Sahlqvist
&
Tillgren,
2010).
Although
several
studies
have
found
both
positive
and
negative
psychological
effects
of
pet
ownership,
some
simply
find
no
results.
A
study
by
Miller
and
Lago
(1990)
found
no
relationship
between
pet
attachment
and
depression,
and
owning
a
pet
had
very
little
to
do
with
physical
or
mental
well-­‐being.
A
review
done
in
1997
on
the
physical
and
mental
benefits
of
pet
ownership
found
that
in
many
studies,
owning
a
pet
was
found
to
decrease
sympathetic
arousal,
increase
exercise,
boost
self-­‐
esteem,
reduce
stress
and
increase
feelings
of
social
support
(Jennings,
1997).
In
1991,
James
Serpell
found
that
dog
owners
reported
decreased
levels
of
headaches,
colds,
hay
fever,
and
dizziness
for
up
to
10
months
after
acquiring
their
dog.
In
a
completely
different
set
of
findings,
a
Finnish
study
of
21,000
people
discovered
that
pet
owners
had
an
increased
risk
of
migraine
headaches,
depression,
panic
attacks,
gastric
ulcers,
hypertension
and
high
cholesterol
(Koivusilta
&
Ojanlatva,
2006).
This
is
partially
explained
by
the
fact
that
older
people
(generally
with
more
health
problems
related
to
age)
are
more
likely
to
have
pets,
as
they
likely
have
more
time
and
resources
available
to
look
after
an
animal
(Koivusilta
&
Ojanlatva,
2006).
Parslow
and
Colleauges
also
found
that
in
people
aged
60-­‐64,
depressive
symptoms
were
higher,
use
of
pain
medication
was
higher
and
general
health
reports
were
lower
in
pet
owners
(Parslow,
Jorm,
Christensen,
Rodgers
&
Jacombs,
2005).
This
could
possibly
be
explained
if
depressed
people
were
obtaining
pets
in
the
hope
that
they
would
decrease
depressive
symptoms.
Somewhat
expectedly,
pet
ownership
resulted
in
a
significantly
higher
number
of
falls
and
fractures
in
elderly
people
(Pluijm
et
al.,
2006).
A
review
by
Wells
(2009a)
argues
that
although
there
is
no
conclusive
evidence
for
or
against
the
health
benefits
of
pet
ownership,
the
literature
supports
the
idea
that
pets
are
indeed
good
for
human
health.
In
her
own
primary
research,
Wells
looked
at
pet
owners
who
suffered
from
chronic
fatigue
syndrome.
While
the
respondents
touted
several
physical
and
psychological
benefits,
their
scores
on
standardized
testing
measuring
depression,
worry,
and
stress
were
the
same
as
non-­‐pet
owners
(2009b).
A
study
in
2012
looking
at
dogs’
ability
to
buffer
feelings
of
mental
distress
after
social
exclusion
found
that
those
participants
who
experienced
exclusion
while
in
the
presence
of
a
dog
reported
higher
levels
of
life

14.
11
satisfaction,
self-­‐esteem,
perceived
meaning
in
life,
and
general
feelings
of
social
acceptance
than
the
control
group
(Nilüfer,
Krueger,
Fischer,
Hahn,
Kastenmüller,
Frey
&
Fischer,
2012).
Research
seems
to
suggest
that
owning
a
dog
is
generally
good
for
human
health,
although
factors
such
as
zoonotic
diseases
and
increased
risk
of
trips
and
falls
in
elderly
people
is
increased
in
pet
owners.
Studies
with
large
samples
of
participants
have
shown
that
pet
owners
are
generally
older,
therefor
age
could
be
a
potential
confound
in
pet
ownership
studies.
SERVICE
DOGS
Research
on
service
dogs
became
popular
in
the
late
1990s.
There
are
a
handful
of
original
studies
on
the
benefits
of
service
dogs,
and
over
the
years,
several
reviews
of
the
original
studies
have
been
done.
In
2002,
Sachs-­‐Ericsson,
Hansen
&
Fitzgerald
reviewed
the
current
literature
on
service
dogs,
and
participants
reported
that
most
of
the
original
studies
were
methodologically
weak,
therefore
limiting
any
clear
conclusions
that
could
come
from
the
results.
Individual
results
from
the
reviewed
studies
are
discussed
in
the
following
paragraphs.
A
review
of
service
dog
literature
by
Modlin
in
2000
also
found
some
issues
with
the
methodology
in
the
research.
A
main
concern
for
Modlin
was
the
lack
of
detail
in
which
most
researchers
described
(or
didn’t
describe)
the
type
of
dogs
used.
This
makes
replication
difficult
for
future
research,
and
creates
potential
confounds
(e.g.
the
researchers
may
have
used
a
breed
of
dog
that
is
not
suitable
for
service
dog
work).
She
was
also
concerned
with
the
lack
of
discussion
surrounding
the
non-­‐significant
findings
(Modlin,
2000).
In
the
review
by
Sachs-­‐Ericsson
(2002),
the
authors
looked
at
three
longitudinal
studies,
however
two
of
the
three
studies
had
a
fairly
short
time
frame,
small
sample
sizes,
and
one
of
the
studies
didn’t
have
a
comparison
group.
The
third
longitudinal
study
was
done
by
Allen
and
Blascovitch
in
1996
and
was
conducted
over
2
years,
and
was
the
only
study
to
use
random
assignment
(albeit
it
wasn’t
shown
how
the
participants
were
randomized).
Allen
and
Blascovitch
(1996)
found
that
participants
matched
with
service
dogs
fared
better
in
terms
of
well-­‐being,
self-­‐esteem,
school
attendance
and
part
time
employment.
They
also
report
a
significant
decrease
in
paid
assistance
hours
(Allen
&
Blascovitch,
1996).
It
has
been
generally
accepted
that
service
dogs
help
disabled
individuals
by
performing
up
to
100
tasks
such
as
opening
and
closing
doors
(in
the
home
and
in
public),
picking
up
dropped
items
off
the
floor,
helping
clients
pay
for
things
while
shopping,
and
providing
stability
while
moving
from
sitting
to
standing
by
‘bracing’.
Most
service
dog
organizations
have
lengthy
waitlists,
which
speaks
to
the
volumes
of
disabled
individuals
who
are
willing
and
anxious
to
obtain
service
dogs.
They
are
no
longer
a
trend;
service
dogs
have
been
helping
people
since
the
1970’s.
A
review
by
Winkle,
Crowe
and
Hendrixin
in
2011
found
that
most
research
done
so
far
on
service
dogs
is
methodologically
weak.
Specifically,
of
the
12
studies
they
reviewed,
there
was
one
small
(under
100
participants)
randomized,
controlled
trial,
six
cohort
studies
or
systematic
reviews
of
case
control

15.
12
studies,
four
case
control
studies
or
case
series
cohort
studies
with
concurrent
control
group,
and
one
expert
opinion.
From
this,
the
authors
of
the
review
advised
readers
to
be
cautious
of
the
conclusions
drawn
from
the
individual
studies.
That
being
said,
they
found
that
service
dogs
seem
to
have
a
positive
effect
on
socialization
and
community
inclusion
on
disabled
patients
in
several
environments
(Winkle
et
al.,
2011).
It
was
also
mentioned
that
service
dogs
seem
to
act
as
a
catalyst
for
conversation
and
greetings
from
strangers
(Hart
et
al.,
1987),
and
in
one
study,
one-­‐hundred
percent
of
the
respondents
(n=202)
reported
that
they
were
approached
more
in
public
when
their
service
dog
was
with
them
(Fairman
&
Huebner,
2000).
That
same
study
by
Fairman
and
Huebner
(2011)
found
that
dogs
act
as
emotional
supporters
and
made
participants
feel
more
secure
at
home
and
in
public.
Looking
at
more
measurable
terms,
two
studies
tracked
paid
assistance
time
by
caregivers
and
compared
those
changes
to
service
dog
ownership
(Allen
&
Blascovich,
1996;
Fairman
&
Huebner,
2000).
Allen
and
Blascovich
(1996)
found
that
participants
with
a
service
dog
decreased
their
need
for
a
paid
assistant
by
an
average
of
60
hours
in
2
weeks,
which
amounted
to
a
saving
of
$60,000
over
8
years
(average
span
of
a
working
dog’s
career).
Fairman
and
Huebner
(2000)
had
much
lower
numbers,
at
a
decrease
of
paid
assistance
by
2
hours
per
week,
resulting
in
a
$600
saving
annually.
Rinalta,
Matamoros
and
Sietz
(2008)
reported
no
significant
difference
in
paid
assistance
time
between
participants
with
and
without
service
dogs.
However,
it
was
reported
in
their
study
that
33%
of
participants
were
able
to
stop
using
at
least
one
assistive
device
(reacher,
walker,
etc)
since
obtaining
their
service
dog
(Rinalta
et
al.,
2008).
The
biggest
issues
reported
with
a
service
dog
partnership
was
the
cost
of
food
and
vet
bills,
grooming,
difficulties
with
poorly
trained
dogs
or
required
tasks
that
the
dog
avoided,
being
denied
access
by
store
owners
or
public
facilities,
strangers
stopping
to
pet
the
dog,
and
challenges
finding
housing
(Lane
et
al.,
1998;
Fairman
&
Huebner,
2000;
Rinalta
et
al.,
2008).
Another
study
found
that
the
distress
caused
from
ending
a
guide
dog
relationship
due
to
death
of
the
dog
or
the
dog
being
placed
with
a
new
handler
was
a
significant
stressor
for
the
disabled
person
(Nicholson,
Kemp-­‐Wheeler
&
Griffiths,
1995).
Allen
and
Blascovitch
(1996)
have
carried
out
the
only
randomized
controlled
trial
to
date.
The
study
was
conducted
with
48
participants
with
severe
and
chronic
ambulatory
disabilities
who
required
the
use
of
a
wheelchair.
Participants
were
matched
for
age,
sex,
marital
status,
race
and
the
nature
of
the
disability.
From
this,
24
pairs
were
created.
One
person
from
each
pair
was
put
in
the
experimental
group,
and
the
other
in
the
control
group.
Participants
in
the
experimental
group
were
paired
with
a
service
dog
one
month
after
the
study
began,
and
participants
in
the
control
group
got
service
dogs
13
months
after
the
study
began.
The
dependent
variables
listed
were:
self-­‐reported
assessments
of
psychological
well-­‐being,
internal
locus
of
control,
community
integration,
school
attendance,
part-­‐time
work
status,
self-­‐esteem,
marital
status,
living
arrangements
and
number
of
paid
and
unpaid
assistance
hours.
Data
collection
ran
every
6
months
for
a
2
year
period,
with
all
participants
completing
questionnaires
such
as
the
Spheres
of
Control
Scale,
the
Rosenberg
Self
esteem
Scale,
the
Affect
Balance
Scale,
and
the
Community
Integration
Questionnaire.
In
addition,
a

16.
13
custom
questionnaire
was
developed
to
include
questions
about
marital
status,
educational
achievements,
work
status,
living
arrangements
and
paid
and
unpaid
assistance
hours.
It
appears
that
this
study
utilized
private
trainers,
instead
of
working
with
a
service
dog
organization,
and
the
dogs
were
trained
for
6-­‐12
months
(significantly
lower
than
the
usual
24
month
training
that
most
service
dog
organizations
employ).
The
study
found
that
psychologically
(self
esteem,
internal
locus
of
control,
well-­‐being),
socially
(community
integration),
and
demographically
(school
attendance
and
part-­‐time
employment),
participants
in
the
experimental
group
fared
better
than
those
in
the
control
group
(Allen
&
Blascovich,
1996).
The
authors
report
that
the
only
effects
that
were
not
significant
were
living
arrangements
and
marital
status.
The
study
also
touts
the
importance
of
reducing
unpaid
assistance
hours,
as
the
burden
on
caregivers
(often
family
and
friends)
can
be
substantial.
A
common
report
from
disabled
individuals
with
service
dogs
is
that
their
dogs
act
as
social
facilitators.
Lane,
McNicholas,
and
Collins
(1998)
report
that
social
exclusion
can
be
a
prominent
issue
in
the
disabled
population,
especially
those
with
severely
limiting
mobility
issues
or
visual
impairments.
It
has
been
suggested
that
loneliness
can
increase
vulnerability
to
a
range
of
health
problems
(Lane
et
al.,
1998),
so
measures
to
mitigate
feelings
of
loneliness
and
social
exclusion
are
paramount
in
the
disabled
population.
Research
has
shown
that
being
accompanied
by
a
dog
increases
social
exchanges
with
strangers
in
the
able
bodied
population,
and
even
more
so
in
the
disabled
population
(Lane
et
al.,
1998).
It
has
often
been
reported
by
pet
owners
that
they
value
their
pets
immensely
and
feel
as
though
the
pets
are
part
of
the
family
(Lane
et
al.,
1998).
This
is
often
seen
in
the
mental
health
reports
of
injured
workers
on
claims
at
WorksafeBC,
where
the
workers
often
report
that
their
support
system
includes
their
pets.
In
fact,
it
is
part
of
the
mental
health
action
report
template
which
reads:
social
support
(family/marriage/friends/children/pets).
It’s
also
noted
by
a
senior
psychology
advisor
at
WorksafeBC
that
it
is
not
uncommon
for
workers
with
mental
health
claims
to
have
setbacks
in
their
progress
when
their
pet
dies
(as
shows
up
in
the
psychology
reports
by
the
attending
psychologist)
(Dr.
D.
Eveleigh,
personal
communication,
February
2015).
Lane
et
al.
(1998)
designed
a
study
to
test
for
the
following
theories:
dogs
acting
as
social
facilitator
by
encouraging
contact
with
strangers
and
enhancing
social
integration,
dogs
as
an
affectionate
relationship
above
and
beyond
the
working
relationship,
dogs
as
a
support
system
offering
emotional
support
and
esteem,
and
dogs
as
an
influence
on
self-­‐perceived
physical
health.
They
designed
their
questionnaire
to
assess
these
four
dimensions,
and
they
attempted
to
avoid
response
bias
by
adding
both
positively
and
negatively
phrased
questions.
They
obtained
fifty-­‐seven
completed
surveys
back,
and
they
were
surprised
to
find
that
thirty
percent
of
respondents
indicated
that
they
were
prompted
by
others
(vets,
family,
doctors,
and
friends)
to
obtain
their
service
dog
(Lane
et
al.,
1998).
Participants
indicated
that
the
most
important
tasks
performed
by
their
service
dog
was
retrieving
and
carrying
items
(84%),
opening
doors,
(40%),
companionship
(35%),
and
barking
on
command
(35%).
Their
main
motivations
for
obtaining
the
dog
was
hope
for

17.
14
independence
(70%),
companionship
(35%),
and
hope
for
increased
socialization
(23%).
Regarding
social
inclusion,
ninety-­‐two
percent
of
participants
indicated
that
people
often
stopped
to
talk
with
them
when
they
were
with
their
dog,
seventy-­‐five
percent
stated
that
they
had
made
new
friends
since
obtaining
their
service
dog,
and
thirty-­‐three
percent
reported
that
they
had
an
overall
better
social
life.
Participants
noted
that
they
found
the
casual
contact
with
strangers
the
most
valuable
change,
as
many
of
them
felt
excluded
previous
to
getting
paired
with
the
dog
(Lane
et
al.,
1998).
Many
participants
indicated
that
their
service
dogs
were
valued
family
members
(92%),
were
one
of
their
most
important
relationships
(72%),
and
felt
that
their
dog
was
more
important
as
a
friend
than
as
a
working
dog
(70%).
Many
participants
noted
that
they
wished
to
keep
the
service
dog
after
it
was
retired
(generally,
organizations
‘lease’
the
dog
to
the
client,
with
the
legal
ownership
staying
with
the
organization
in
case
the
dog
needs
to
be
removed
from
the
client
for
reasons
of
abuse
or
neglect).
Seventy
percent
of
participants
reported
turning
to
their
dog
in
times
of
sadness,
and
fifty-­‐
nine
percent
confided
in
their
dog
with
their
problems.
The
strongest
findings
came
from
the
perceived
health
scales,
in
which
ninety-­‐seven
percent
of
participants
reported
feeling
more
relaxed
since
having
their
dog,
fifty-­‐one
percent
reported
worrying
less
about
their
health,
and
forty-­‐seven
percent
believed
that
their
health
had
improved
since
obtaining
their
dog.
Of
the
participants
who
reported
that
other
people
had
suggested
they
get
a
service
dog,
many
of
them
reported
that
they
wished
the
dog
was
more
reliable
in
its
work,
and
they
often
reported
that
the
dog
did
not
have
as
big
of
an
impact
on
their
lives
as
they
hoped.
They
were
more
likely
to
indicate
that
the
dog
was
more
trouble
than
they’re
worth,
and
they
gave
lower
ratings
on
the
scales
related
to
close
relationships
with
the
dog
and
perceived
improvement
on
health
(Lane
et
al.,
1998).
This
is
not
surprising,
since
working
with
a
service
dog
does
require
a
substantial
amount
of
extra
work,
such
as
feeding,
toileting,
grooming,
and
vet
care.
If
someone
was
pushed
into
acquiring
a
service
dog
that
they
didn’t
particularly
want,
it
may
follow
that
they
feel
resentment
towards
the
dog
and
the
extra
work
that
the
dog
requires.
Fairman
and
Huebner
(2000)
designed
a
study
to
look
at
the
physical,
emotional
social
and
economic
functions
of
service
dogs,
along
with
training
methods,
and
problems
encountered
with
the
service
dogs.
They
developed
a
31-­‐question
survey
and
had
202
participants
respond.
Participants
were
recruited
through
Canine
Companions
for
Independence:
a
large
service
dog
organization
based
out
of
Santa
Rosa,
California.
The
authors
report
that
from
an
occupational
therapy
perspective,
service
dogs
fall
into
the
category
of
‘rehabilitation’,
in
which
the
goal
is
functional
independence
(Fairman
&
Huebner,
2000).
It
is
of
the
opinion
of
the
authors
that
occupational
therapists
should
be
involved
with
the
service
dog
industry.
They
don’t
believe
that
medical
practitioners
have
enough
information
about
service
dogs,
so
they
are
not
suggested
to
patients
even
though
they
may
benefit
immensely
from
them.
Similarly,
service
dog
organizations
aren’t
experts
in
physical
disability,
and
therefore
would
benefit
from
having
an
occupational
therapist
involved
whom
could
help
explain
the
functional
needs
of
the
disabled
person.
From
that,
the
training
of
the

18.
15
dog
could
be
tailored
more
specifically
for
the
disabled
person.
The
questionnaire
(Fairman
&
Huebner,
2000)
was
designed
from
an
occupational
therapy
setting
and
included
the
following
5
areas
of
investigation:
1. Based
on
Occupational
Therapy’s
Uniform
Terminology,
what
functional
assistance
do
service
dogs
provide?
2. Do
service
dog
owners
receive
emotional,
social,
and/or
economic
assistance
from
their
service
dogs?
3. What
training
on
service
dog
utilization
is
received
by
consumers?
4. What
problems
do
owners
experience
with
their
service
dogs?
5. Are
service
dog
owners
satisfied
with
their
service
dogs?
Participants
responded
to
questions
on
a
5
point
scale,
with
1
being
definitely
false
and
5
being
definitely
true.
Respondents
indicated
4
or
5’s
in
response
to
“I
feel
safer”
(91%),
“my
independence
has
increased”
(88.4%),
and
“I
feel
more
in
control
of
my
life”
(83.1%).
One-­‐hundred
percent
of
participants
indicated
that
they
were
approached
more
in
public
when
they
were
accompanied
by
their
dog.
Seventy-­‐seven
percent
of
participants
stated
that
it
is
easier
for
them
to
leave
their
homes
with
their
service
dog.
Financially,
seventy-­‐five
percent
reported
that
they
spend
a
maximum
of
$1000
per
year
on
food
and
vet
bills.
Additionally,
thirty-­‐two
percent
reported
getting
financial
aid
for
these
costs
from
either
vet
donations
or
government
dog-­‐allowance
funds.
Participants
reported
a
decrease
in
paid
assistance
by
2
hours
a
week,
and
unpaid
assistance
by
6
hours
a
week.
In
regards
to
a
partnership
with
an
occupational
therapist,
eighty-­‐two
percent
believed
that
this
would
be
beneficial
in
the
initial
client
training
and
partnership
stage
with
the
dog.
The
largest
problem
reported
by
the
respondents
was
physical
maintenance
of
the
dog
(grooming,
bathing,
nail
clipping).
Less
problematic,
but
still
mentioned
was
difficulties
controlling
the
dog,
especially
in
public
and
when
off
leash,
strangers
petting
the
dog
while
it
is
working,
and
access
issues
(being
denied
entry
with
the
dog
to
restaurants,
stores,
etc).
Problems
aside,
eighty-­‐two
percent
of
participants
reported
being
extremely
satisfied
with
their
service
dogs.
A
study
published
in
the
American
Journal
of
Occupational
Therapy
looked
at
the
potential
benefits
of
service
dogs
as
‘assistive
aids’
for
people
with
disabilities
(Camp,
2001).
The
authors
note
that
up
to
seventy-­‐five
percent
of
recommended
assistive
devices
are
abandoned
by
clients,
highlighting
the
importance
of
effective
forms
of
assistive
technology
(Camp,
2001).
When
used
properly,
assistive
devices
have
been
shown
to
increase
control
and
independence
in
all
occupational
performance
areas
(Camp,
2001).
In
Japan,
under
the
Basic
Act
for
Disabled
Persons,
service
dogs
are
considered
welfare
equipment,
and
are
considered
a
medical
intervention
if
they
were
recommended
and
received
by
medical
rehabilitation
experts
(Shintani,
Senda,
Takayanagi,
Katayama,
Furusawa,

19.
16
Okutani,
Kataoka
&
Ozaki,
2010).
Camp
ran
a
qualitative
study,
interviewing
five
service
dog
paired
clients,
asking
them
the
five
following
open-­‐ended
questions:
1. Tell
me
about
owning
a
service
dog
2. How
is
the
service
dog
used
as
an
adaptive
strategy
to
increase
independence
in
occupational
performance?
3. What
perceived
benefits
does
the
service
dog
provide
for
the
owner?
4. What
perceived
drawbacks
does
the
service
dog
have
for
the
owner?
5. What
is
the
meaning
of
the
interaction
between
person
and
service
dog
for
the
owner?
Participants
reported
that
their
service
dogs
were
used
as
an
adaptive
strategy
by
compensating
for
physical
defects
such
as
strength,
motor
control,
range
of
motion
and
endurance
(Camp,
2001).
The
dogs
helped
with
bracing,
opening
doors,
turning
lights
on
and
off,
and
retrieving
items.
Respondents
also
stated
that
their
dogs
allowed
for
increased
participation
in
the
community
and
with
hobbies
they’d
previously
given
up
(wheelchair
sports
for
one
client).
It
was
also
reported
that
they
gained
independence,
self-­‐esteem,
security,
social
contact,
fun
and
new
skills.
In
terms
of
drawbacks,
participants
reported
grooming,
toileting,
feeding
and
vetting
as
the
largest
drawbacks,
which
is
consistent
with
responses
in
other
studies.
Participants
mentioned
increased
independence
as
one
of
the
largest
benefits,
stating
that
not
having
to
rely
on
caregivers
for
as
much
help
was
a
huge
relief
for
them.
Their
improved
sense
of
autonomy
since
obtaining
the
service
dog
was
mentioned
as
an
important
factor
in
the
‘meaning
of
the
interaction
between
person
and
service
dog’.
Having
the
dog
watch
over
them
and
look
out
for
them
was
something
that
the
author
noted
that
wasn’t
in
the
previous
literature
on
service
dogs.
PSYCHIATRIC
SERVICE
DOGS
According
to
the
Americans
with
Disabilities
Act
(ADA),
for
someone
to
use
a
psychiatric
service
dog,
that
person
must
have
a
psychiatric
impairment
that
substantially
limits
him/her
from
one
or
more
major
life
activities.
Psychiatric
service
dogs
have
been
increasing
in
popularity
over
the
last
15
years,
with
PTSD
dogs
and
Autism
dogs
receiving
a
lot
of
media
attention.
In
the
last
several
years,
researchers
have
begun
investigating
the
potential
benefits
of
service
dogs
for
psychiatric
injuries.
Of
particular
interest
are
military
veterans
with
posttraumatic
stress
disorder.
There
have
been
a
handful
of
studies
on
this
subject,
with
most
studies
consisting
of
surveys
which
have
been
criticized
for
lacking
scientific
rigor.
It
has
been
stated
that
dogs
benefit
people
with
PTSD
by
increasing
feelings
of
safety
and
security,
providing
non-­‐judgmental
support,
decreasing
loneliness
and
depression,
and
helping
reintegrate
into
society
(Taylor
et
al.,
2013;
Stern
et
al.,
2014;
Yount
et
al.,
2012).
It
is
suggested
that
the
benefits
are
due
to
increased
levels
of
Oxytocin
that
can
be
released

20.
17
when
having
a
positive
interaction
with
a
dog
(Yount
et
al.,
2013).
The
biggest
tasks
that
psychiatric
service
dogs
seem
to
assist
people
with
is
support,
whether
it’s
emotional
support,
social
facilitation
or
increasing
feelings
of
safety.
These
are
commons
themes
that
reoccur
in
the
literature
and
are
often
stated
as
highly
beneficial
to
participants.
Military
Settings
In
2009,
American
Military
officials
met
with
animal-­‐assistance
organizations
at
the
animal-­‐
assisted
therapy
summit
in
Virginia
to
discuss
implementing
animal-­‐assisted
therapy
in
the
military
(Rubenstein,
2012).
In
military
settings,
dogs
are
used
in
three
main
ways:
service
dogs
for
injured
soldiers
and
veterans,
therapy
dogs
who
are
sent
into
combat
zones
to
help
with
combat
and
operation
stress
control,
and
therapy
dogs
to
help
veterans
with
PTSD
and
other
mental
health
issues
(Ritchie
&
Amaker,
2012).
Combat
and
operational
stress
control
(COSC)
teams
have
been
used
in
the
American
military
since
1992,
but
in
2007,
the
Office
of
The
Army
Surgeon
General
looked
at
adding
two
dogs
to
the
COSC
teams.
Two
black
Labrador
retrievers,
Boe
and
Budge,
travelled
to
Iraq
as
the
first
canine
members
of
the
COSC
team.
Because
a
veterinarian
is
deployed
with
other
canine
teams
(explosive
dogs,
military
police
dogs),
the
health
of
the
COSC
would
be
looked
after
by
the
vet
already
on
site.
Boe
and
Budge
worked
a
total
of
24
months
in
Iraq.
The
dogs
were
primarily
used
as
an
icebreaker
between
soldiers
and
health
care
providers,
to
encourage
open
communication
and
reduce
the
stigma
of
‘getting
help’.
When
they
returned,
Boe
seemed
to
be
suffering
from
some
trauma
of
her
own,
so
received
6
weeks
of
treatment
and
is
now
working
with
Soldiers
with
mild
traumatic
brain
injuries.
The
next
set
of
dogs
was
sent
to
Afghanistan
in
2010,
and
were
still
there
when
the
paper
was
published
in
2012.
Ritchie
and
Amaker
(2012)
report
that
at
the
Walter
Reed
Army
Medical
Centre,
many
occupational
therapists
bring
in
their
own
personal
dogs
to
interact
with
the
soldiers.
They
state
that
the
soldiers
who
were
tired
of
the
constant
human
attention
responded
well
to
the
interactions
with
the
dogs.
Walter
Reed
is
known
for
having
several
animal-­‐assisted
therapy
programs
already
in
place,
such
as
Specialized
Therapy
K-­‐9
program,
the
Warrior
Transition
Brigade
occupational
therapy
work
and
education
program,
and
the
Washington,
DC
Humane
Society
Warrior
in
Transition
Behavior
and
Grooming
Training
program
(Watkins,
2012).
Ritchie
and
Amaker
(2012)
visited
Vet
Dogs
and
National
Education
for
Assistance
Dog
Services
to
talk
with
soldiers
suffering
from
PTSD
who
had
acquired
service
dogs,
and
the
soldiers
reported
benefits
such
as
reduction
in
medications,
less
social
phobia
and
agoraphobic
behaviours,
aiding
with
stress
relief
following
nightmares,
and
increased
family
bonding.
In
2008,
social
worker
and
service
dog
trainer,
Rick
Yount,
created
a
program
in
which
veterans
with
PTSD
train
service
dogs
for
other
veterans
in
need
(Yount
et
al.,
2012).
This
program,
Paws
for
Purple
Hearts,
has
had
over
200
military
members
participate
in
the
service
dog-­‐training
program.
Five
service
dogs
have
graduated

21.
18
from
the
program
and
have
been
placed
with
veterans,
and
two
military
members
have
become
service
dog
trainers
and
are
pursuing
jobs
in
the
field.
Two
years
later,
Yount
was
invited
to
the
National
Intrepid
Center
of
Excellence
at
the
Walter
Reed
National
Military
Medical
Center
to
create
a
service
dog-­‐training
program.
The
program,
Warrior
Canine
Connection,
has
had
eighty-­‐five
military
members
involved
by
2012.
Yount
spoke
at
the
2009
Veterans
Administration
National
Mental
Health
Conference
and
reported
the
following
benefits
of
service
dogs
for
veterans:
increased
patience,
impulse
control,
emotional
regulation,
ability
to
display
affection,
assertiveness
skills,
decreased
depression,
startle
response,
pain
medication
and
stress
levels
(Yount
et
al.,
2012).
These
findings
were
anecdotal
reports
by
clinicians,
program
instructors
of
animal
assisted
interventions,
and
veterans.
In
April
of
2011,
the
Office
of
The
Surgeon
General
Rehabilitation
and
Reintegration
Division
released
OTSG/MEDCOM
Policy
Memorandum
11-­‐030
(Watkins,
2012),
which
recognized
the
role
that
dogs
play
in
assisting
healthcare
professionals
in
many
rehabilitation
settings,
including
combat
and
operational
stress
control.
The
memo
outlines
the
role
of
animal-­‐assisted
therapy
and
animal-­‐
assisted
activity
dogs
in
combat
and
operational
stress
control
units,
and
throughout
the
battle
space,
and
designates
the
Army
occupational
therapists
at
the
handlers
for
these
dogs.
Due
to
the
growing
interest
in
service
dogs
and
animal-­‐assisted
therapy
and
animal-­‐assisted
activity
dogs
for
Soldiers
and
Veterans,
the
Deputy
Assistant
Secretary
of
Defense
for
Wounded
Warrior
Care
and
Transition
Policy
held
a
Department
of
Defense
service
dog
development
meeting
in
March
of
2011.
The
purpose
of
the
meeting
was
to
have
clear
guidelines
for
Wounded
Warriors,
healthcare
providers,
and
military
staff
regarding
service
dogs,
as
the
military
is
not
required
to
abide
by
ADA
laws
(Watkins,
2012).
It
should
be
noted
that
Canada
does
not
have
a
federal
disabilities
act.
It
seems
that
the
military
is
recognizing
and
responding
to
the
overwhelming
reports
by
veterans
that
dogs
are
helpful
in
their
recovery
from
physical
and
psychological
injuries.
One
study
involving
twenty-­‐four
wounded
soldiers
with
various
illnesses
and
disabilities
who
were
attending
an
Occupational
Therapy
Life
Skills
program
found
that
anecdotally,
participants
were
eager
to
work
with
the
therapy
dogs,
stated
they
were
pleased
with
the
experience,
and
were
sad
to
see
it
end
(Beck,
Gonzales,
Sells,
Jones,
Reer,
Wasilewski
&
Zhu,
2012).
That
being
said,
no
significant
differences
were
found
(pretest,
posttest,
non
randomized
study).
Participants
were
assigned
to
one
of
two
groups:
the
OT
life
skills
program,
or
the
OT
life
skills
program
plus
animal
assisted
therapy.
Participants
were
tested
three
times:
baseline,
post
intervention
(four
weeks
after
baseline)
and
follow-­‐up
(eight
weeks
after
baseline).
The
measurement
tools
included:
Profile
of
Mood
States,
Perceived
Stress
Scale,
Connor-­‐Davidson
Resilience
Scale,
Fatigue
Scale,
Functional
Status
Questionnaire,
and
The
Occupational
self
Assessment.
The
participants
assigned
to
the
test
group
spent
thirty
minutes
after
each
OT
session
with
a
therapy
dog
team
(dog
and
handler)
on
a
one
on
one
basis.
The
animal
assisted
therapy
included
asking
the
dog
to
complete
five
commands,
and
then
spending
the
remaining
time
doing
what
the
participant
wished
with
the
dog
(going
for
a
walk,