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October 15, 2021

New law provides for service dogs for veterans with PTSD

Veterinary research established evidence of service dogs’ effectiveness for this use
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Researchers have been studying in recent years whether trained service dogs can help war veterans with post-traumatic stress disorder. Some results indicate that these working dogs can help lessen symptoms. Others have found that service dogs at least did not worsen or interfere with PTSD recovery in their owners. This growing body of evidence, along with ongoing advocacy efforts, has helped pave the way for recently passed legislation that creates a pilot program in which veterans struggling with PTSD will train and later keep service dogs.

President Joe Biden on Aug. 25 signed into law the Puppies Assisting Wounded Servicemembers for Veterans Therapy Act (HR 1448/S 613) that requires the secretary of veterans affairs to establish a five-year program to provide service dogs to veterans with PTSD. The AVMA supported the legislation.

“We know service dogs are a proven life-changing and life-saving form of therapy for our veterans suffering from post-traumatic stress,” said U.S. Rep. Mikie Sherrill of New Jersey in a statement.

“With this new law, we are addressing the high-cost barrier that prevents many from accessing these incredible dogs,” added Sherrill, a Navy veteran.

Investigating the human-animal bond

PTSD is a leading cause of impaired quality of life and functioning among veterans. From 11-20% of veterans from the Iraq and Afghanistan conflicts have PTSD in a given year, according to the Department of Veterans Affairs.

Currently, the VA covers the veterinary costs of service dogs that support veterans with physical disabilities, including blindness and mobility issues. The dog and veteran have to successfully complete a training program offered by an organization accredited by Assistance Dogs International or the International Guide Dog Federation. The VA has not previously provided service dogs for veterans with PTSD, saying research supporting their effectiveness was limited.

Critiques of past research on potential benefits of service dogs for veterans with PTSD found that prior studies failed to describe the type or amount of service dog training, duration of pairing, or effectiveness of the human-dog bond; had limited PTSD outcome measures; and lacked control groups as well as randomization or other controls for bias.

Maggie O’Haire and canine friend
Maggie O’Haire, associate professor of human-animal interaction at Purdue University College of Veterinary Medicine, is leading research into how service dogs can benefit veterans experiencing post-traumatic stress disorder. (Photos courtesy of HABRI)

Results were released in 2018 from a first-of-its-kind pilot study investigating the efficacy of service dogs as a complementary, therapeutic intervention for veterans with PTSD. Funded by the Human Animal Bond Research Institute and conducted by Maggie O’Haire, PhD, assistant professor of human-animal interaction at Purdue University College of Veterinary Medicine, and her team, the study found that veterans with a service dog exhibited significantly lower overall PTSD symptom severity, including increased overall psychological well-being; a better ability to cope with flashbacks and anxiety attacks; a lower frequency of nightmares and less overall sleep disturbance; lower overall anxiety, depression, and anger; higher levels of companionship and social reintegration; and lower levels of social isolation. Participants in this study were recruited from a database of individuals provided by K9s For Warriors, a nonprofit organization that provides veterans with service dogs.

Dr. O’Haire and her team are currently conducting a National Institutes of Health–funded clinical trial to collect more extensive evidence.

Veterans Affairs study

Before Dr. O’Haire’s study, Congress had directed the secretary of veterans affairs in 2010 to begin a three-year study to assess “the benefits, feasibility, and advisability of using service dogs for the treatment or rehabilitation of veterans with physical or mental injuries or disabilities, including post-traumatic stress disorder.” During the first phase of the study, however, investigators ran into issues, including service dog groups using rescue dogs with uncertain behavioral and health histories or those that were poorly trained. Some of these groups also discouraged participants from reporting problems to the VA and inflated expectations, thus biasing study outcomes.

That’s according to “A Randomized Trial of Differential Effectiveness of Service Dog Pairing Versus Emotional Support Dog Pairing to Improve Quality of Life for Veterans with PTSD,” released in January 2020 by the Veterans Health Administration’s Office of Research and Development. The report details the results of the second phase of the study, taking place from December 2017 to June 2019 and led by Dr. Joan T. Richerson, assistant chief veterinary medical officer in the Office of Research and Development, and a team of fellow VA researchers.

The study (PDF) occurred at three VA medical centers—Atlanta VA Medical Center; Iowa City Veterans Affairs Health Care System in Iowa City, Iowa; and VA Portland Health Care System in Portland, Oregon—among 227 veteran participants, of whom 181 were paired with a study dog. Ninety-seven got a service dog, and 84 got an emotional support dog.

The primary aim was to determine whether overall disability and quality of life of participants with PTSD was improved by service dogs relative to emotional support dogs. The special tasks that the service dogs were trained to perform were expected to benefit participants with PTSD and thereby provide more improvement than the emotional support dogs, which provided comfort and companionship only.

The secondary aim was to compare the impact of service dogs versus emotional support dogs on mental health outcomes. Participants who received trained service dogs were expected to have reduced PTSD symptoms; decreased suicidality, depression, and anger; as well as improved sleep outcomes in comparison with participants who received emotional support dogs.

According to the VA study, both groups appeared to have experienced some benefit to their mental health, including a decrease in symptoms such as anger and disrupted sleep, but the service dogs were able to decrease the severity of symptoms better than emotional support dogs.

“Participants paired with a service dog experienced a reduction in the severity of PTSD symptoms (PCL-5) compared to participants paired with an emotional support dog, and had fewer suicidal behaviors and ideations, particularly at 18 months postpairing,” according to the study.

The study results were reviewed by a committee that had been appointed by the National Academies of Sciences, Engineering, and Medicine at the request of the VA.

The committee noted that the authors clarified “that the study does not provide evidence that service dog placement improves overall disability or quality of life among Veterans with posttraumatic stress disorder (PTSD).”

The committee added that the methods and analysis of this study could be instrumental in informing the design of future research on this topic.

A second paper reporting on health economics and cost effectiveness was expected to be released to the public in September. At press time, the paper was under National Academies review.

Witnesses are sworn in
Witnesses are sworn in at a hearing before the U.S. House of Representatives Subcommittee on National Security regarding the Puppies Assisting Wounded Servicemembers Act of 2016. President Biden signed the most recent version of the act into law in August.

New program

In the meantime, the VA will partner with nonprofit organizations for the newly authorized pilot program, which provides for veterans diagnosed with PTSD to assist in training a service dog. At the end, the veteran may adopt the dog.

The VA will document and track the progress of participating veterans regarding health benefits and improvements. The bill also authorizes the VA to provide service dogs to veterans with mental illnesses, regardless of whether they have a mobility impairment.

“We commend the White House for supporting this bill as a critical step in combatting veteran suicide, and we’re confident in the path ahead for service dogs ultimately becoming a covered VA benefit to veterans with PTSD,” said Rory Diamond, CEO of K9s For Warriors, in a press release from the Human Animal Bond Research Institute.