An adjunctive human-animal interaction intervention for veterans with PTSD: study protocol for a randomized controlled trial

Anouk L Grubaugh, Ursula S Myers, Stephanie M Keller, Bethany C Wangelin, Brian E Lozano, Peter W Tuerk, Anouk L Grubaugh, Ursula S Myers, Stephanie M Keller, Bethany C Wangelin, Brian E Lozano, Peter W Tuerk

Abstract

Background: Posttraumatic stress disorder (PTSD) rarely remits over time, and if left untreated, leads to significant distress, functional impairment, and increased health care costs. Fortunately, effective evidence-based treatments (EBTs) for PTSD, such as Prolonged Exposure (PE), exist. Despite their availability and efficacy, a significant number of individuals with PTSD do not initiate treatment when offered or dropout prematurely. One proposed theory suggests that the emotional-numbing symptoms of PTSD (e.g., blunted affect, apathy) can serve as a barrier to engaging in, and successfully completing, treatment; and the broad human-animal interaction (HAI) literature available suggests that HAI can potentially reduce emotional numbing related to PTSD. Accordingly, this manuscript describes an ongoing, federally funded, randomized controlled trial testing the efficacy of RESCUE, an HAI intervention, as a viable adjunctive treatment component for PE.

Methods/design: The study will include 70 veterans with PTSD treated at a Southeastern Veterans Affairs Medical Center (VAMC). All participants in the trial receive up to 12 sessions of PE. Participants are randomly assigned 1:1 to (1) volunteer at a local animal shelter or (2) volunteer at a community agency of their choice as part of their in-vivo exposure exercises for PE. Outcomes will be examined via standard clinical interviews, self-report questionnaires, and thematic interviews.

Discussion: It is hypothesized that participants in the HAI condition will report greater decreases in emotional-numbing symptoms and increased treatment compliance and completion rates relative to those in the community volunteer condition. If successful, RESCUE, could be easily incorporated into standard PE and broadly disseminated.

Trial registration: ClinicalTrials.gov. ID: NCT03504722. Retrospectively registered on 2 May 2017.

Keywords: Animal-assisted therapy; Human-animal interaction (HAI); Military; Posttraumatic stress disorder (PTSD); Prolonged exposure (PE); Veterans.

Conflict of interest statement

The authors declare they have no competing interests.

Figures

Fig. 1
Fig. 1
Consolidated Standards of Reporting Trials (CONSORT) Diagram
Fig. 2
Fig. 2
Schedule of assessments and procedures

References

    1. Institute of Medicine . Treatment for Posttraumatic Stress Disorder in Military and Veteran Populations: Initial Assessment. 2012.
    1. VA-DOD. VA/DOD Clinical Practice Guideline for the Management of Posttraumatic Stress Disorder and Acute Stress Disorder. 2017. Retrieved from . Accessed 9 July 2018.
    1. Bradley R, Greene J, Russ E, Dutra L, Westen D. A multidimensional meta-analysis of psychotherapy for PTSD. Am J Psychiatr. 2005;162:214–227. doi: 10.1176/appi.ajp.162.2.214.
    1. Goetter EM, Bui E, Ojserkis RA, Zakarian RJ, Weintraub BR, Simon NM. A systematic review of dropout for psuchotherapy posttraumatic stress disorder among Iraq and Afghanistan combat veterans. J Trauma Stress. 2015;28:401–409. doi: 10.1002/jts.22038.
    1. Hoge CW, Grossman SH, Auchterlonie JL, Riviere LA, Milliken CS, et al. PTSD treatment for soldiers after combat deployment: low utilization of mental health care and reasons for dropout. Psychiatr Serv. 2014;65:997–1004. doi: 10.1176/appi.ps.201300307.
    1. Hundt NE, Helm A, Smith TL, Lamkin J, Cully JA, Stanley MA. Failure to engage: a qualitative study of veterans who decline evidence-based psychotherapies for PTSD. Psychol Serv. 2017; e-pub ahead of print.
    1. Steenkamp MM, Litz BT, Hoge MD. Psychotherapy for military-related PTSD: a review of randomized clinical trials. JAMA. 2015;315:489–500. doi: 10.1001/jama.2015.8370.
    1. Frewen PA, Lanius RA. Toward a psychobiology of posttraumatic self-dysregulation: reexperiencing, hyperarousal, dissociation, and emotional numbing. Ann N Y Acad Sci. 2006;1071:110–124. doi: 10.1196/annals.1364.010.
    1. Ramirez SM, Glover H, Ohlde C, Mercer R, Hamlin C, Goodnick P, et al. Relationship of numbing to alexithymia, apathy, and depression. Psychol Rep. 2001;88:189–200. doi: 10.2466/pr0.2001.88.1.189.
    1. Litz BT. Emotional numbing in combat-related post-traumatic stress disorder: a critical review and reformulation. Clin Psychol Rev. 1992;12:417–432. doi: 10.1016/0272-7358(92)90125-R.
    1. Taylor S, Thordarson DS, Maxfield L, Fedoroff IC, Lovell K, Ogrodniczuk J. Comparative efficacy, speed, and adverse effects of three PTSD treatments: exposure therapy, EMDR, and relaxation training. J Consult Clin Psychol. 2003;71:330. doi: 10.1037/0022-006X.71.2.330.
    1. Wangelin BC, Tuerk PW. Taking the pulse of prolonged exposure therapy: physiological reactivity to trauma imagery as an objective measure of treatment response. Depress Anxiety. 2015;32:927–934. doi: 10.1002/da.22449.
    1. Lefkowitz C, Prout M, Bleiberg J, Paharia I, Debiak D. Animal-assisted prolonged exposure: a treatment for survivors of sexual assault suffering posttraumatic stress disorder. Soc Anim. 2005;3:275–296.
    1. Litz BT, Schlenger WE, Weathers FW, Caddell JM, Fairbank JA, LaVange LM. Predictors of emotional numbing in posttraumatic stress disorder. J Trauma Stress. 1997;10:607–618.
    1. Sachs-Ericsson N, Hansen NK, Fitzgerald S. Benefits of assistance dogs: a review. Rehabil Psychol. 2002;47:251. doi: 10.1037/0090-5550.47.3.251.
    1. Crossman MK. Effects of interactions with animals on human psychological distress. J Clin Psychol. 2017;73:761–784. doi: 10.1002/jclp.22410.
    1. Ein N, Li L, Vickers K. The effect of pet therapy on the physiological and subjective stress response: a meta-analyis. Stress and Health. 2018; e-pub ahead of print.
    1. Friedman E, Gee NR. Critical review of research methods used to consider the impact of human-animal interaction on older adults health. Gerontologist. 2018; epub ahead of priint.
    1. O'Haire ME, Geurin NA, Kirkham AC. Animal-assisted intervention for trauma: a systematic literature review. Front Psychol. 2015. 10.3389/fpsyg.2015.01121.
    1. Rumayor CB, Thrasher AM. Reflections on recent research into animal-assisted interventions in the military and beyond. Curr Psychiatry Rep. 2017;19:110. doi: 10.1007/s11920-017-08861-z.
    1. Foa E, Hembree E, Rothbaum BO. Prolonged exposure therapy for PTSD: emotional processing of traumatic experiences therapist guide. New York: Oxford University Press; 2007.
    1. Blake DD, Weathers FW, Nagy LM, Kaloupek DG, Gusman FD, Charney DS, et al. The development of a clinician-administered PTSD scale. J Trauma Stress. 1995;8:75–90. doi: 10.1002/jts.2490080106.
    1. American Psychiatric Association . Diagnostic and statistical manual of mental disorders, DSM 5. Arlington: American Psychiatric Publishing; 2013.
    1. First M, Williams J, Karg R, Spitzer R. Structured Clinical Interview for DSM-5 Disorders–Research Version (SCID-5-RV) Arlington: American Psychiatric Assocation; 2014.
    1. Spearing MK, Post RM, Leverich GS, Brandt D, Nolen W. Modification of the Clinical Global Impressions (CGI) Scale for use in bipolar illness (BP): The CGI-BP. Psychiatry Res. 1997;73:159–171. doi: 10.1016/S0165-1781(97)00123-6.
    1. Wechsler D. Wechsler Adult Intelligence Scale–Fourth Edition (WAIS–IV) San Antonio: The Psychological Corporation; 2008.
    1. Weathers FW, Litz BT, Keane TM, Palmieri PA, Marx BP, Schnurr PP. The PTSD Checklist for DSM-5 (pcl-5). Scale available from the National Center for PTSD at ; 2013. Accessed 9 July 2018.
    1. Steer RA, Beck AT. Beck Anxiety Inventory. 1997.
    1. Kroenke K, Spitzer RL. The PHQ-9: a new depression diagnostic and severity measure. Psychiatr Ann. 2002;32:509–515. doi: 10.3928/0048-5713-20020901-06.
    1. Ferrans C, Powers MJ. Quality of Life Index: development and psychometric properties. Adv Nurs Sci. 1985;8:15–24. doi: 10.1097/00012272-198510000-00005.
    1. Üstün TB, Kostanjsek N, Chatterji S, Rehm J. Measuring health and disability: manual for WHO disability assessment schedule WHODAS 2.0: World Health Organization. 2010.
    1. Orsillo SM, Theodore-Oklota C, Luterek JA, Plumb J. The development and psychometric evaluation of the emotional reactivity and numbing scale. J Nerv Ment Dis. 2007;195:830–836. doi: 10.1097/NMD.0b013e318156816f.
    1. King LA, King DW, Vogt DS, Knight J, Samper RE. Deployment risk and resilience inventory: a collection of measures for studying deployment-related experiences of military personnel and veterans. Mil Psychol. 2006;18:89–120. doi: 10.1207/s15327876mp1802_1.
    1. Attkisson CC, Zwick R. The Client Satisfaction Questionnaire: psychometric properties and correlations with service utilization and psychotherapy outcome. Eval Prog Plann. 1982;5:233–237. doi: 10.1016/0149-7189(82)90074-X.
    1. Snijders T, Bosker R. Modeling variance in two-level models. Sociol Methods Res. 1994;22:342–363. doi: 10.1177/0049124194022003004.
    1. Hembree EA, Cahill SP. Handbook of exposure therapies. 2007. Obstacles to successful implementation of exposure therapy; pp. 389–408.
    1. Schottenbauer MA, Glass CR, Arnkoff DB, Tendick V, Gray SH. Nonresponse and dropout rates in outcome studies on PTSD: review and methodological considerations. Psychiatry. 2008;71:134–168. doi: 10.1521/psyc.2008.71.2.134.
    1. Litz BT, Schlenger WE. PTSD in service members and new veterans of the Iraq and Afghanistan Wars: a bibliography and critique. PTSD Res Quaterly. 2009;20:1050–1835.

Source: PubMed

スポンサーと協力者

医学的状態

薬物療法

3
購読する