CAM THERAPY CRITIQUE

ROBERT BUSAHSC 300 COMPLEMENTARY HEALTH CAREPROFESSOR JENIFFER HERRMANN

“PAIN IS THE MOST COMMON REASON AMERICANS TURN TO COMPLEMENTARY AND INTEGRATIVE HEALTH PRACTICES. THE NEED FOR NONDRUG TREATMENT OPTIONS IS A SIGNIFICANT AND URGENT HEALTH IMPERATIVE.”

- Josephine P. Briggs, MD, Director of NCCAM (1)

OUTLINEI. PICO QUESTIONII. POST TRAUMATIC STRESS DISORDER A. SYMPTOMS B. VETERANS C. TREATMENT CENTERSIII. PSYCHOTHERAPY A. HISTORY B. DESCRIPTION C. CERTIFICATIONSIV. ANIMAL-ASSISTED THERAPY A. HISTORY B. DESCRIPTION C. CERTIFICATIONV. SCIENTIFIC EVIDENCE VI. CONCLUSIONVII. REFERENCES

Among returning soldiers suffering from Post Traumatic Stress Disorder, PTSD, Does Animal Assisted Therapy, specifically dogs, reduce anxiety, fear, depression, or hopelessness more effectively than Psychotherapy?

POST TRAUMATIC STRESS DISORDER

POST TRAUMATIC STRESS DISORDER IS A MENTAL HEALTH CONDITION TRIGGERED BY A TERRIFYING EVENT (3)

CAN INVOLVE THE ONE THAT WAS HARMED, SOMEONE CLOSE TO YOU THAT WAS HARMED OR WITNESSING SOMEONE BE HARMED (2)

ABOUT 7 % - 8 % OF THE UNITED STATES POPULATION WILL HAVE PTSD IN THEIR LIVES, WHILE ABOUT 5.2 MILLION ADULTS HAVE PTSD IN A GIVEN YEAR (6)

THE INSTITUTE OF MEDICINE AND THE DEPARTMENT OF DEFENSE SPENT NEARLY 3.3 BILLION DOLLARS IN 2012 TO TREAT PATIENTS WITH PTSD (18)

SYMPTOMS OF PTSD (2)1. RE-EXPERIENCING SYMPTOMS FLASHBACKS, BAD DREAMS SITUATIONS, THOUGHTS, WORDS TRIGGER SYMPTOMS2. AVOIDANCE SYMPTOMS STAYING AWAY FROM PLACES, OBJECTS OR EVENTS THAT ARE OF REMINDERS3. HYPERAROUSAL SYMPTOMS EASILY STARTLED, FEELING TENSE, TROUBLE SLEEPING, AND ANGRY OUTBURSTS

Doctors are not completely sure why some people get PTSD but conclude it is a mixture of :

Personality

Childhood life experiences

Inherited health risks

Chemicals and hormones body

releasesTemperament

(3)

A BODIES ATTEMPT TO DEFEND AGAINST DANGER IS KNOWN AS “FLIGHT OR FIGHT”, A HEALTHY REACTION IN RESPONSE TO PROTECTING A PERSON FROM HARM (2)

HOWEVER, PTSD DAMAGES THE FLIGHT OR FIGHT REACTION (2)

A PERSON MIGHT FEEL STRESSED OR FRIGHTENED OUTSIDE OF DANGER (2)

VETERANS AFFECTED BY PTSD

11 – 20 % IRAQI FREEDOM AND OPERATION ENDURING FREEDOM (13)

12 % GULF WAR (DESERT STORM) (13)

15 % VIETNAM VETERANS, YET ESTIMATED THAT 30 % HAVE HAD PTSD IN THEIR LIFETIME (13)

BETWEEN 2000 AND THE FIRST QUARTER OF 2012, 202,281 OF U.S. MILITARY PERSONNEL SUSTAINED A BRAIN INJURY (MOST WERE MILD WHERE CONCUSSIONS WAS THE RESULT) (5)

Motor Vehicle Crashes Falls

Blasts Fragments

Bullets

SOME CAUSES OF TRAUMATIC BRAIN INJURY (TBI) INCLUDE:

UNITED STATES MILITARY PERSONNEL

GENERAL PUBLIC44%

CHRONIC PAIN

26% CHRONIC

PAIN

15.1% OPIOID USE

4% OPIOID USE

-JUNE 2014 (1)

UP TO HALF OF MILITARY VETERANS THAT SUFFER A TRAUMATIC BRAIN INJURY ALSO SUFFER FROM POST TRAUMATIC STRESS DISORDER (10)

CHRONIC PAIN IS ONE OF THE MOST COMMON COMPLAINTS AMONG U.S. VETERANS THAT SERVED IN OPERATION IRAQI FREEDOM, OPERATION ENDURING FREEDOM (AFGHANISTAN), AND OPERATION NEW DAWN (10)

TREATMENT CENTERS (13)DEPARTMENT OF VETERAN AFFAIRS OFFERS NEARLY 200 SITES, WITH SPECIALISTS TREATING FOR PTSD IN VETERANS

MENTAL HEALTH PROFESSIONALS PROVIDES TREATMENT

SERVICES INCLUDE ONE-ON-ONE HEALTH ASSESSMENT AND TESTING AS WELL

ONE ON ONE PSYCHOTHERAPY AND FAMILY THERAPY

GROUP THERAPY, COVERS STRESS, ANGER, WAR EXPERIENCE SUPPORT

GROUPS FOR SPECIFIC CONFLICTS OR SPECIFIC TRAUMAS IF NEEDED

PSYCHOTHERAPY DEVELOPED BY PSYCHOTHERAPIST AARON BECK, M.D., IN THE 1960’S (4)

“TALK THERAPY”, FOCUSES ON ASSISTING THE PATIENT UNDERSTAND THEIR ILLNESS, AND TO FUNCTION BETTER THROUGH VERBAL COMMUNICATION (4)

DOES NOT USE MEDICATION, BUT CAN BE USED COMPLEMENTARY WITH MEDICATION (4)

IS USUALLY DONE WITH A THERAPIST, AND CAN BE ADMINISTERED ONE ON ONE SESSIONS OR IN GROUPS (4)

FOCUSES ON EDUCATING PEOPLE BY GIVING THEM STRATEGIES TO COPE WITH STRESS AND NEGATIVE AND UNHEALTHY THOUGHTS AND BEHAVIORS (4)

Cognitive Therapy

• Focuses on thoughts and beliefs, which has an impact on moods, and aims for more positive thoughts (4)

Behavioral Therapy

• Focuses on actions to try and change into positive, healthy behavior patterns (4)

COGNITIVE BEHAVIORAL THERAPY (CBT) (4)

DEPRESSION

ANXIETY

SCHIZOPHRENIA

EATING DISORDER

BIPOLAR

MENTAL DISORDERS THAT CAN BE TREATED WITH PSYCHOTHERAPY (4)

LICENSED TO PROVIDE PSYCHOTHERAPYLICENSED CLINICAL

PSYCHOLOGISTS

LICENSED SOCIAL

WORKER

MASTER’S LEVEL

CLINICIAN

LICENESED CLINICAL PSYCHOLOGISTS HAVE A DOCTORAL DEGREE, 4 OR MORE YEARS OF GRADUATE TRAINING IN COUNSELING OR CLINICAL PSYCHOLOGY, MUST ALSO HAVE 1 TO 2 YEARS OF SUPERVISED CLINICAL EXPERIENCE (13)MOST LICENSED SOCIAL WORKERS HAVE A MASTERS DEGREE, EITHER 2 YEARS OF GRADUATE TRAINING OR A DOCTORAL DEGREE IN SOCIAL WORK (13)MASTER LEVEL CLINICIANS HAVE THEIR MASTERS IN COUNSELING, MARRIAGE AND FAMILY THERAPY, OR PSYCHOLOGY (13)

LICENSED TO PRESCRIBE MEDICATION (13)

PRIMARY CARE PHYSICIANS

PSYCHIATRISTS

NURSE PRACTIONERS

PSYCHIATRIC NURSES

PHYSICIAN’S ASSISTANTS

ANIMAL ASSISTED THERAPY

IN THE 9TH CENTURY, GHEEL, BELGIUM WAS THE FIRST RECORDED THERAPEUTIC FARM ANIMAL PROGRAM FOR PATIENTS (9)

FOUNDED IN 1792, THE YORK RETREAT, IN ENGLAND FOR PEOPLE WITH MENTAL ILLNESSES, USED SMALL FARM ANIMALS IN THEIR TREATMENT (9)

IN 1867, IN BETHEL, GERMANY AN EPILEPSY TREATMENT CENTER USED FARM ANIMALS FOR THERAPY (9)

RETURNING SOLDIERS FROM WORLD WAR II WERE ENCOURAGED TO WORK WITH FARM ANIMALS SUCH AS HOGS, CATTLE AND HORSES AT THE ARMY AIR CORPS CONVALESCENT HOSPITAL, PAWLING, NEW YORK (9)

HISTORY:

ANIMAL ASSISTED THERAPYSPECIFICALLY SELECTED ANIMALS TREATMENT IN HEALTH AND HUMAN SETTINGS (9)

THE CONCEPT IS TO BRING AN OVERALL BONDING EXPERIENCE WITH THE PATIENT (9)

DEPENDING ON ANIMAL AND SIZE, COULD BE FOUND IN ANY SOCIAL SETTING SUCH AS HOSPITALS, SCHOOLS, TRAIN STATIONS AND PRISONS AS WELL

DESCRIPTION:

ANIMAL-ASSISTED THERAPY CERTIFICATON

CLASSROOM

SETTING OR

ONLINE CLASS

SCREENING OF HEALTH

OF ANIMA

L

CHECKS SKILLS AND

ABILITIES OF

ANIMAL

SUBMISSION OF

APPLICATION

MUST APPLY THROUGH PET PARTNERS (FORMERLY DELTA SOCIETY) (12)4 STEP PROCESS:

1. THE OWNER OR HANDLER IS TRAINED TO GUIDE THE ANIMAL (12)2. LOOKING FOR ANY DISEASES OR ISSUES THAT MAY RESTRAIN ANIMAL FROM

BECOMING A THERAPY ANIMAL. HERE THE ANIMAL MUST BE CHECKED BY A VETENARIAN TO PROCEED TO THE NEXT STEP (12)

3. TEST THAT CHECKS THE HANDLERS AND ANIMALS SKILLS, ABILITIES, AND REACTIONS IN THERAPY SESSIONS (12)

4. THE FINAL STEP IS THE PAPERWORK (12)

DSM -5 IS THE DIAGNOSTIC AND STATISTICAL MANUAL OF MENTAL DISORDERS AND IS THE CRITERIA FOR THE DIAGNOSIS AND CLASSIFICATION OF MENTAL DISORDERS (7)

RELEASED IN MAY 2013 AT THE ANNUAL AMERICAN PSYCHIATRISTS ASSOCIATION’S MEETING (7)

THE AMERICAN PSYCHIATRISTS ASSOCIATION (APA), IS THE WORLDS LARGEST PSYCHIATRISTS ORGANIZATION, DATING BACK TO 1844 (8)

THE APA ENSURES HUMANE CARE AND EFFECTIVE TREATMENT FOR PEOPLE LIVING WITH MENTAL DISORDERS, SUBSTANCE USE, AS WELL AS INTELLECTUAL DISABILITIES. (8) THE APA IS THE “BASELINE” FOR PSYCHIATRY

Creating a Therapeutic and Healing Environment with a Pet Therapy Program (11)CANCER, ASTHMA, HEART FAILURE, DIABETES, CORONARY ARTERY DISEASE, GASTROINTESTINAL BLEEDING

AMPUTATION, HYSTERECTOMY, ANEURYSM REPAIR, VENOUS BYPASS SURGERY, GI SURGERY, CAROTID ENDARTERECTOMY

59 PATIENTS PARTICIPATED , MEDIAN AGE 61TRAINING HOSPITAL, NORTHEASTERN UNITED STATESUSES VOLUNTEER HANDLERS AND THEIR OWN DOGS12 INPATIENT TWO AFTERNOONS EACH WEEK, AVEARAGE 10 MINUTES1 OUTPATIENT TWO AFTERNOONS EACH WEEKAFTER VISITSSMALL YET SIGNIFICANT DECREASES IN RESPIRATION RATES AND PAIN WERE REPORTEDNO SIGNIFICANT CHANGES IN BLOOD PRESSURE OR PULSETHE FIRST 50 PATIENTS THAT WERE VISITED BY THE THERAPY DOGS WERE ASKED TO RATE THEIR EXPERIENCE VIA A SEMANTIC DIFFERENTIAL SCALETOTAL MOOD DISTURBANCE (TMD) DECREASED, SATISTICALLY SIGNIFICANT IMPROVEMENTS WERE REPORTED/OBSERVED FOR TENSION, ANXIETY, ANGER, FATIGUE AND DEPRESSIONALL OF THE PARTICIPANTS RECOMMENDED THE PROGRAM CONTINUE, WHILE ALL THE PARTICIPANTS RATED THEIR OWN EXPERIENCE AS VERY FAVORABLECONCLUSION: WAS THE LENGTH OF VISITS WERE TEN MINUTES AVERAGE, SOME WERE BEING DISCHARGED, YET THE SCORES WERE POSITIVE HOWEVER MORE RESEARCH IS NEEDED

PERCEPTIONS OF COMPANION DOG BENEFITS ON WELL BEING OF U.S. MILITARY VETERANS WITH HIV/AIDS (16)

29 VETERANS

28 OF 29 REPORTED HAVING A PET WAS A POSITIVE EXPERIENCE

LEXINGTON ATTACHMENT TO PETS SCALE 83.2

CONCLUSION: THEIR POSITIVE EXPERIENCE IMPROVED THE VETERANS WELL BEING BY HAVING MORE PHYSICAL ACTIVITY, COMPANIONSHIP, RESPONSIBILTY AND STRESS REDUCTION

DOGS HELP WOUNDED WARRIORS HEAL AT WALTER REED (17)3 YEAR OLD CHOCOLATE LABADOR RETRIEVER

WAS THE FIRST THERAPY DOG ASSINGED TO A MILITARY HOSPITAL IN THE UNITED STATES

HE PARTICIPATES BY GOING ON WALKS WITH PATIENTS MISSING LEGS, HELPS WITH IMPROVING PROSTHETICS BY PLAYING “FETCH”, LETS PATIENTS BALANCE ON HIM DURING THERAPY

POSITIVE REACTIONS WERE REPORTED SECONDARY TO TALKING WITH DOG AS WELL

ROBOT ASSISTED THERAPY FOR IMPROVING SOCIAL INTERACTIONS AND ACTIVITY PARTICIPATIONAMONG INSTITUTIONALIZED OLDER ADULTS. A PILOT STUDY (15)16 PARTICIPANTS

30 MINUTES TWICE A WEEK FOR FOUR WEEKS

USED A SEAL LIKE ROBOT PET FOR COMMUNICATION AND INTERACTION SKILLS

CONCLUSION: COMMUNICATION, INTERACTION SKILLS, AND ACTIVITY PARTICIPATION ALL HAVE THE POTENTIAL TO BE IMPROVED USING ROBOT ASSISTED THERAPY

WHY NOT ACCEPTED SOME PLACES

BARKING IN CERTAIN SITUATIONS

CONCERNS OVER ZOONOSES, ANIMAL TO HUMAN DISEASE

BITES

NON-CREDIBLE WEBSITE

WIKIPEDIAI CHOSE WIKIPEDIA AS A NON-CREDIBLE WEBSITE FOR IT HAS INFORMATION FROM MANY DIFFERENT SOURCES AND DIFFERNET CITATIONS

CREDIBLE WEBSITE

WWW.NIMH.NIH.GOV

NATIONAL INSTITUTE OF MENTAL HEALTH (NIMH) IS A COMPONENT OF THE U.S. DEPT OF HEALTH AND HUMAN SERVICES

IT EDUCATES ON UNDERSTANDING AND TREATMENT OF MENTAL ILLNESSES

CONCLUSION

DOG THERAPY IS AN ALTERNATIVE MEDICINE. IT HAS BEEN PROVEN FOR THE WELL BEING AND HEALTH OF ONES MIND, BODY, AND SOUL REGUARDLESS OF THE DISEASEMUCH MORE RESEARCH IS NEEDED AS IT IS IN ITS EARLY STAGESIT IS LOW COST

REFERENCES1. www.nccih.nih.gov/research/blog/opiod/military, July 14,20142. www.nimh.nih.gov/health/topics/post-traumatic-stress-disorde

r-ptsd/index.shtml3. www.mayoclinic.org4. www.nimh.nih.gov/health/topics/psychotherapies/index.shtml5. https://nccih.nihgov/grants/concepts/consider/military6. https://nccih.gov/health/ptsd7. www.dsm5.org/pages/default.aspx8. http:www.psychiatry.org9. Fontaine, Karen Lee (2014). Complementary and Alternative

Therapies for nursing practice (4th Edition) Pearson10. http://projectreporter.nih.gov//project_info_description.cfm?a

id=8753690&icde=23107476&ddparan11. Coakley, Amanda; Mahoney,

EllenComplementTherClinPract.2009, August;15(3):141-146.doi:10.1016/j.ctcp.2009.05.004

REFERENCES12. www.Wikipedia.com“How to become registered therapy animal team”, Pet partners, retrieved 29 October, 201313. www.ptsd.va.gov/public.treatment/therapy-med/types_of_therapies15. Sung HC, Chang SM, Chin MY, Lee WL; Asia Pac Psychiatry.2014 Apr 1.doi:10.1111/appy.121.3116. Kruger KS, Stern SL, Anstead G, Finley EP; South med J, 2014 Mar, i07(3):188-193.doi:10.1097/smj17. Lorge, Elizabeth; June 27,2008, www.army.mil/article/10451/dogs_help_wounded_warriors_heal_at_walter_reed18. www.cbsnews.com/news/only-half-the-vets-with-ptsd-are-getting-treatment-report