ANIMAL-ASSISTED INTERVENTIONS IN MENTAL HEALTH

Preface

The term "pet therapy" was coined in 1964 after the child psychiatrist Boris M. Levinson observed positive effects while using his dog, Jingles, in sessions with severely withdrawn children. He noticed that the dog served as an ice-breaker and provided a focus for communication. Animal assisted interventions (AAI) is the term that has substituted "pet therapy" which better describes the heterogeneous range of potential human-animal interactions. Notwithstanding their long history and the attention they typically receive from the media, AAI are often described as a category of promising complementary practices that need to demonstrate their efficacy and validity.

There is nowadays sufficient agreement that therapy with animals is distinct from other types of animalcentric activities and has to be characterized by the involvement of health/human services professionals and by the need for formalized treatment plans and goals. The papers collected here testify the effort which is currently being put into place by different professionals, ranging from ethologists to veterinarians and to health care professionals to standardize terminology and methodology involved in AAI. A consensus appears to have been reached that if this field has to gain greater attention from the medical community, data from efficacy studies have to be collected and clinical trials performed.

At the institutional level, we are faced with two main problems: ensure safety of practices for the public and promote animal welfare. In the absence of a specific legislation, the Istituto Superiore di Sanità, the Italian National Institute of Health, has being taking an ever increasing role in promoting a discussion forum for methodological standards and sponsoring pilot studies on the topic (see Cirulli et al., in this issue). A major effort towards establishing ethical standards for AAI has been put forward by the National Committee for Bioethics (see Santori, in this issue) while specific guidelines are currently being elaborated to deal with this issue.

The field of AAI currently lacks a unified, widely accepted or empirically supported theoretical framework that might indicate why human-animal relationships are potentially good or even therapeutic. The dog can be seen as a prototype of companion animals, because of the long period and the wide distribution of human-dog bond, which has been widely investigated for different theoretical reasons. Dogs have been reported to be very skilful in comprehending a variety of human communicative signals in many independent studies and the paper by G. Lakatos provides a very interesting overview of the possible explanations behind the dogs' exceptional communicational abilities towards humans from an evolutionary perspective. The building of a common communication system has allowed these two species to share emotional feelings and a growing body of research is now clarifying the characteristics of human-animal interactions allowing to optimize the relationship and manage behavioural problems, when these occur (see Bompadre and Cinotti, in this issue). The disclosure of the physiological mechanisms underlying human-animal interactions seems only to confirm the well-know dearousing effect of animals and their ability to provide companionship and social support, mostly on an emotional basis. Since mental health reflects to a large extent emotional balance, the role of animals as an adjunct to more traditional forms of therapy shouldn't be underestimated. Animals may in fact represent a valid help in therapeutic contexts thanks to their ability to catalyze social interactions and to create a more relaxed environment conducive to self-disclosure, a requirement necessary for the therapeutic process. There is however a lack of clear scientific data that would help defining the most appropriate procedures to target different health-related problems.

The delivery of interventions involving animals in therapeutic context can vary also according to the type of animal involved. Due to their catalyzing effect on socialization and communication, dogs are very often employed in mental health directed interventions aimed to reduce symptoms linked to anxiety, depression and loneliness. By contrast, the most important elements of horseback riding therapy – astride position and rhythmic movements – have made the horse a valuable therapeutic tool for the treatment of individuals with neuromuscular disorders, while donkeys appear best suited for children or people with severe psychiatric disorders or dementia (see De Rose et al.). Grandegeorge and Hausberger's paper, in this issue, provides an exhaustive review of different interventional approaches, including studies aimed at exploiting the peculiar behavioral pattern of different species and analyzing the human-animal relationship "from the double point of view". Berget and Braastad enlarge this perspective to analyze AAIs with farm animals in the context of Green care practice suggesting that human animal interactions in a rich outdoor environment may positively affect human physical/physiological health by stimulating exercise and physical condition, also resulting in reduced stress and enhanced mental well-being.

We hope that this monographic issue will be of use for all those working in this field or wishing to approach it. Overall, while recognizing that further scientific data are needed to establish more clearly the benefits of human-animal companionships, the search for the mechanisms underlying our continuous seeking for pet companions might shed new light on the processes underlying emotional regulation for the promotion of mental health.

Francesca Cirulli
Dipartimento di Biologia Cellulare e Neuroscienze, Istituto Superiore di Sanità, Rome, Italy