Service dogs

A service dog comforting her owner (Photo credit: Mark Riley)

Whenever I have a patient with PTSD who has a dog, I always make a point to ask how the dog is going, which helps me gauge progress.

I’ve been involved with the charity Whiskey’s Wish for a few years now. They provide service dog training for veterans, first responders, and corrections officers who have PTSD. They’ve done some tremendous good in this world, but sadly they’ll be closing their doors later this year.

Around the time that I started working with Whiskey’s Wish, some colleagues and I scoured the scientific literature on the benefits of using canines to compliment treatment for PTSD. I’ve discussed how medication can be used in the treatment of PTSD as well as theatre. All of this is to enhance engagement in psychotherapy, which is the core of treating PTSD.

In this blog post, I would like to bring you along for a dogwalk to discuss how canines can help treat PTSD.

Service Dogs

Firstly, I’d like to start with a little terminology.

Service dogs differ from companion dogs in that they are working dogs that are trained to respond to a particular condition and are legally permitted to enter public spaces. They may be trained to work with PTSD or epilepsy or blindness.

Companion dogs on the other hand are not working dogs

This is a service dog:

Roxy the service dog. (Photo credit: Jessica Hinchliffe)

Note the jacket. They know when they’re working and there are rules around how to interact with them, such as not patting them while they’re working.

Whereas this is a companion dog:

(Photo credit: Sharleen Chao)

However, companion dogs can be trained to become service dogs.

Benefits of companion animals

Regardless of whether the dog is a service dog or a companion dog,

Animal companions - not just dogs - can reduce the effects of anxiety, depression, and loneliness, as well as improving physical health. Animal companionship helps to provide a sense of normalcy, improve behavioural activation and self-esteem, and provide a sense of belonging and companionship, as well as a sense of calm and distraction.

Studies show that both humans and dogs experience increases in beta-endorphin, oxytocin, prolactin, beta-phenylethylamine, and dopamine. Oxytocin levels appear to be positively correlated with the strength of the human-dog bond perceived within the gaze, which may reflect a closer attachment.

Humans experience a decrease in cortisol as well as a decrease in blood pressure, and heart rate and variability. This is important as heart rate variability is a sign that the sympathetic nervous system (fight/flight) and parasympathetic nervous system (rest/digest or freeze/dissociate) are out of balance.

Impact on PTSD

In our systematic review of the literature, we really struggled to find a consistent message. Unfortunately there wasn’t much despite the general wisdom that dogs are good for your health. There was also no evidence outside the veteran population, which makes it difficult to generalise the results to first responders, corrections officers, and the rest of the population with scientific confidence.

Having said that, the few papers that we did find generally reported that dogs help to improve PTSD symptoms. But I should add - as did the papers in our review - that service dogs cannot replace conventional therapy.

Some of the benefits of having a service dog include reduced PTSD and depression symptoms and increased social participation and functionality at home. Veterans felt as they had regained a sense of purpose by caring for the dogs, a benefit that I don’t believe any medication could give.

I highlighted the difference between service dogs and companion dogs before. But the relationship formed between a service dog and its owner is more important than the training level of the dog.

However, having a service dog is not for everyone and gaining access to training or a trained dog can be difficult. And some studies raised concerns about the welfare of the dog when the owner has persistent and severe PTSD symptoms.

My own experience working with veterans with service dogs for their PTSD is that they have been life-changing. The dogs know when they’re working and when they can just be a dog.

The overall picture

Dogs have been our loyal companions for about 20,000 years. Service dogs play a valuable role within a multidisciplinary and multimodal approach to treating PTSD, though they may not be for everyone. But they can alter hormones and neurotransmitters in ways that medication cannot. They can create a sense of connection and belonging in ways that psychotherapy and social interventions cannot.

And from time to time, they remind us of the simple pleasure of having fun and rolling in the grass.