Building Solutions in Youth: Evaluation of the Human–Animal Resilience Therapy Intervention

Three studies were ranked as 'fair' for methodological quality, indicating the possibility of bias.

“Three of the studies [56, 73, 74] were ranked as ‘fair’ for methodological quality, indicating the possibility of bias.”

In Hartwig [73], pre-intervention data was not reported, making comparison between groups difficult, and only self-report outcome measures were used.

“Pre-intervention data was not reported, making comparison between groups difficult, and only self-report outcome measures were used.”

Hartwig [73] reported randomisation, however the process was not described.

“Hartwig [73] reported randomisation, however, the process was not described.”

One intervention was reportedly standardised; the HART model developed by Hartwig [73].

“One intervention was reportedly standardised; the HART model developed by Hartwig [73].”

The number of canines employed in the interventions was not reported by Hamama et al. [74] or Hartwig [73].

“The number of canines employed in the interventions was not reported by Hamama, Hamama-Raz [74] or Hartwig [73].”

In the HART study, the control group engaged in the standard HART curriculum, whilst the intervention group engaged in a HART plus AAT curriculum, where session activities were modified to incorporate a canine.

“The control group engaged in the standard HART curriculum, whilst the intervention group engaged in a HART plus AAT curriculum, where session activities were modified to incorporate a canine.”

Facilitators were reported to be qualified or student counsellors, social workers, psychologists, or psychiatric hospital staff.

“Facilitators were reported to be qualified or student counsellors [73, 75, 76], social workers [74], psychologists [72], or psychiatric hospital staff [71].”

The HART model was a 10-week (8.3 total hours) intervention based on the concepts of solution focused and play therapies, and utilising creative and expressive techniques delivered during individual counselling sessions.

“This was a 10-week (8.3 total hours) intervention based on the concepts of solution focused and play therapies, and utilising creative and expressive techniques delivered during individual counselling sessions.”

None of the studies reported details about the canine's breed/type or size, although Hartwig [73] did indicate that the canine's temperament or behaviour may impact outcomes.

“None reported details about the canine’s breed/type or size, although Hartwig [73] did indicate that the canine’s temperament or behaviour may impact outcomes.”

Participants presented with a range of difficulties, including females with a history of physical or sexual abuse, low achievement in school and interpersonal difficulties; males and females requiring an anger management intervention; adolescents referred to counselling for emotional issues; or adolescents admitted to hospital with severe psychiatric illness.

“Participants presented with a range of difficulties, including: females with a history of physical or sexual abuse, low achievement in school & interpersonal difficulties [74]; males and females requiring an anger management intervention [75, 76]; adolescents referred to counselling for emotional issues [56, 73]; or adolescents admitted to hospital with severe psychiatric illness [71, 72].”

Four of the studies included information about the selection, assessment or certification status of the canines employed.

“Four of the studies included information about the selection, assessment or certification status of the canines employed [71–73, 75].”

Hartwig [73] found a significant reduction in both depression and anxiety from pre- to post-test for both the intervention group (HART curriculum + AAT) and the comparison group (HART curriculum without AAT) (p's < .05).

“Paired comparisons indicated a significant reduction in both depression and anxiety from pre- to post-test for both the intervention group (HART curriculum + AAT), and the comparison group (HART curriculum without AAT) (p’s < .05).”

Hartwig [73] found that all children showed significant reductions in disruptive behaviour, but the difference between the HART+AAT and HART only groups in rate of change was not significant.

“Although all children showed significant reductions in disruptive behaviour, the difference between the two groups in rate of change was not significant.”

Both individual counselling interventions [56, 73] were delivered indoors, in typical counselling rooms.

“Both individual counselling interventions [56, 73] were delivered indoors, in typical counselling rooms.”

There was no difference between the intervention group (AAT) and the comparison group on either depression or anxiety measure in Hartwig [73].

“There was no difference between the intervention group (i.e., AAT) and the comparison group on either measure.”

Hartwig [73] found no significant differences in anger over time or between groups.

“In terms of anger, no significant differences were seen over time and between groups.”

Hartwig [73] states that there were some difficulties adapting the HART curriculum to include the canines.

“Hartwig [73] further states that there were some difficulties adapting the HART curriculum to include the canines.”

No drop-outs are evident or reported for four of the studies [56, 73, 74, 76].

“With regard to acceptability (i.e., attendance and attrition), no drop-outs are evident or reported for four of the studies [56, 73, 74, 76].”

Lange, Cox [75], Lubbe and Scholtz [56] and Hartwig [73] reported on limitations to feasibility, stating that access to appropriately trained animals and handlers must be considered in addition to facilitator training and supervision.

“Lange, Cox [75], Lubbe and Scholtz [56] and Hartwig [73] reported on limitations to feasibility, stating that access to appropriately trained animals and handlers must be considered in addition to facilitator training and supervision.”

Hartwig [73] found no significant differences in self-concept pre to post-test for either the intervention group (HART + AAT) or the comparison group (HART).

“There were no significant differences pre to post-test for either the intervention group (HART + AAT) or the comparison group (HART).”

Only two studies included information about existing psychological theories or techniques that informed the nature of the intervention, such as play therapy, attachment theory, solution-focused therapy and CBT [73, 76].

“Only two studies included information about existing psychological theories or techniques that informed the nature of the intervention, such as play therapy, attachment theory, solution-focused therapy and CBT [73, 76].”

Only one intervention was reported to be standardised [73].

“Although some authors included brief program outlines, only one intervention was reported to be standardised [73].”

Dosages spanned 8.3 total hours [73] to 36 total hours of treatment [74].

“Dosages spanned 8.3 total hours [73] to 36 total hours of treatment [74].”

Studies conducted with lower levels of methodological rigour reported mixed findings, indicating that CAP may have been helpful in reducing some symptoms over and above treatment as usual, namely PTSD symptoms [74], but not others, including depression, anxiety and disruptive behaviour over the standard treatment without the canines [73, 74].

“Studies conducted with lower levels of methodological rigour reported mixed findings, indicating that CAP may have been helpful in reducing some symptoms over and above treatment as usual, namely PTSD symptoms [74], but not others, including depression, anxiety and disruptive behaviour over the standard treatment without the canines [73, 74].”

Hartwig [73] discussed the difficulties of adapting existing curriculum to include canines, reflecting that active and experiential activities may have been more therapeutic.

“Hartwig [73] discussed the difficulties of adapting existing curriculum to include canines, reflecting that active and experiential activities may have been more therapeutic.”

There is insufficient evidence from this review to conclude that CAP will improve factors associated with participant wellbeing; such as self-concept, self-esteem, coping or subjective wellbeing [73, 74], with only one case study finding self-reported improvements to self-esteem [56].

“There is insufficient evidence from this review to conclude that CAP will improve factors associated with participant wellbeing; such as self-concept, self-esteem, coping or subjective wellbeing [73, 74], with only one case study finding self-reported improvements to self-esteem [56].”

Hartwig [73] reports no improvements to anger; however, anger was not a treatment goal for any of the study participants.

“For example, Hartwig [73] reports no improvements to anger; however, anger was not a treatment goal for any of the study participants.”

Facilitator training and/or supervision is required [73, 75], even when employing external canine and handler teams [71, 72].

“Facilitator training and/or supervision is required [73, 75], even when employing external canine and handler teams [71, 72].”

Screening, training or assessment of the canines is also required [71-73, 75].

“Screening, training or assessment of the canines is also required [71–73, 75].”

Access to large rooms and outdoor spaces may be of benefit [71-74].

“For example, access to large rooms and outdoor spaces, may be of benefit [71–74].”

Previous literature indicates that simple canine-presence is sufficient to impact treatment outcomes [34], whereas other authors have indicated that active engagement [73] or matching of canines to participants [71, 72, 74] may also be important.

“Previous literature indicates that simple canine-presence is sufficient to impact treatment outcomes [34], whereas other authors have indicated that active engagement [73] or matching of canines to participants [71, 72, 74] may also be important.”