Green Care: Effects of Animal-Assisted Therapy on Persons with Psychiatric Disorders

Liv Lønne Dille

Although Animal-Assisted Therapy (AAT) for humans with mental disorders has been well documented with pets, there is almost a complete lack of controlled studies of farm animals as therapeutic agents for psychiatric patients. The main aim of this doctoral project was to examine effects on self-efficacy, coping ability, quality of life, anxiety and depression of a three-month intervention with farm animals among adult psychiatric patients. The results indicate that animal-assisted therapy had beneficial effects when used as a supplement to ordinary therapeutical treatment, especially for patients with affective disorders.

During the past decade, an increasing number of persons with mental disorders have worked on a farm with farm animals as part of their therapy, both as rehabilitation and work training measures. This is called Green Care, a concept which is not restricted to the use of animals, but also includes the use of plants, gardens, forests and the landscape.

In 2006, Bente Berget completed her doctoral thesis titled "Animal-assisted therapy: effects on persons with psychiatric disorders working with farm animals". The project was conducted as a three-month, randomized, controlled study and follow-up registrations six months after the completed intervention. The patients worked with the animals, primarily cattle and sheep, twice a week for three hours. The work consisted mainly of feeding, milking and brushing the animals. The various parameters were recorded prior to, immediately upon conclusion and six months after conclusion of the intervention. The health outcome measures were based on validated, standardized tests (Spielberger State Anxiety Inventory, Beck Depression Inventory, Generalized Self-Efficacy Scale, Coping Strategies Scale and Quality of Life Scale). By measuring the same parameters of mental health six months after the end of the intervention, we sought to examine if the effects were permanent for a longer period for the treatment group (AAT group, n=60) compared to the control group (n=30).

The main diagnoses were affective disorders, anxiety disorders, personality disorders, and schizophrenia. In addition to animal-assisted therapy, the patients also received traditional treatment throughout the entire project period. This enabled us to document whether an intervention with farm animals had an effect in addition to traditional psychiatric therapy. Using video recordings, we examined if the individual patients changed behaviour and their attitude towards the animals in the course of the intervention period, and if these changes could be detected as improved mental health. Among the 90 included patients, 41 completed the intervention (68 %) and 28 completed in the control group (93 %).

The patients showed greater intensity and exactness of the work with the animals by the end of the intervention than during the first part of the period. Although we could not detect effects of the actual intervention on the various health parameters, we found that anxiety was lower at the follow-up registrations six months after the end of the intervention compared to base line observations (F(1,61)=4.36, p=0.04), and at follow-up compared to the end of the intervention (F(1,61)=5.17, p=0.03). Accordingly, observed self-efficacy was higher at follow-up than at the start (F(1,55)=4.20, p=0.05) and higher at follow-up than at the end of the intervention (F(1,55)=5.60, p=0.02), with improved effects in the treatment group. Among diagnostic groups, the clearest effect was that patients with affective disorders showed significant increase in self-efficacy and quality of life during the follow-up registration. The patients with the largest reduction in depression during intervention also reported the largest increase in coping ability, mood and self-esteem.

Even if the health outcome effects were rather moderate, positive effects were nevertheless observed regarding improved self-efficacy and reduced anxiety among the patient group at the 6-month follow-up. This could indicate that the patients did not notice the changes until some time had passed after the conclusion of the intervention. Most of the patients had had their symptoms for many years, which makes it more unlikely to achieve rapid and significant improvements. The strengths of the project were the use of validated assessments, its practicability and the moderate drop out rate. Limitations were especially the rather unspecific intervention and the lacking capacity to provide another form of intervention to the control group, which would have given more reliable results when comparing groups.

The results suggest that AAT with farm animals was a useful supplement to traditional psychiatric treatment, particularly for patients with affective disorders. Furthermore, it seems as if the project has contributed to increased cooperation between health institutions, therapists and farmers, and has thus contributed to greater acceptance for AAT with farm animals among health professionals.

As a continuation of the research in this field, a controlled intervention study on the use of farm animals with depressive persons has recently been initiated. The study aims to document the effects on symptoms, functionality, quality of life and interpersonal relations. The research is funded by the Arealprogramm, and will last until mid-2010.

For further information, please contact project coordinator Bente Berget (bente.berget@umb.no).

Updated: 14.05.09
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