The Effect of Animal-Assisted Therapy on Physiological Stress and Anxiety in Hospitalized Children

Tsai, C.C.1; Friedmann, E.2; and Thomas, S.A.2

1 Yuanpei University School of Nursing, Taiwan and 2 University of Maryland, Baltimore, MD, USA

Introduction Procedure (cont.) Results (cont.)

Hospitalization experiences are stressful to children when they are AAT

There was a significant 3 way ANOVA interaction with the effects of
hospitalized.
visit type, activity, and order on SBP[F(2,26) = 3.56, p= .043] .
Hospitalized children experience a high level of stress, anxiety, and fear
that can be affected by sources of hospital stress. The dogs used in this study were dogs and their
handlers from pet therapy program. The dog was
The stress associated with hospitalization of children may lead to positioned on the bed next to the child or stayed
physiological and psychological sequelae resulting from adverse stress the bedside with the child. The child was
allowed to pet, touch, and brush the dog.
Interventions that have effectively promoted coping and decreased
children’s stress are distraction or social support with animals.

Animal-assisted therapy (AAT) is a intervention, referred to as a coping

strategy, directed by a health or human-services provider, designed to
promote improvement in human physical and emotional functioning. Person

Animal-assisted therapy (AAT) has been used to alleviate the stress of

hospitalization/health care experience across a variety of settings.
An age appropriate puzzle was used with each
Previous studies indicate that AAT may decreases stress-related response, child.
A research assistant participated in a quiet puzzle
such as anxiety, elevated blood pressure and heart rate. Figure 2. Average systolic blood pressure (SBP) pre-(activ=1), during (activ=2), and post-
activity with the child.
(activ=3) visits (AAT visit=1; person visit=2) for of hospitalized children (N=15) with the
AAT frequently is used with hospitalized adults and children, but little AAT visit first (First=1).
scientific evidence evaluates the use of AAT in hospitalized children

Data Analysis

Purpose

•Demographic data were analyzed using descriptive statistics.

•Differences between children assigned to each group were analyzed with t-
To examine the effects of AAT on cardiovascular responses (blood tests.
pressure and heart rate) and state anxiety in hospitalized children. •Separate analyses were conducted for each of the dependent variables.
•Analyses of variance with repeated measures were used to test the effects of
visit type, activity, and order on SBP, DBP, and HR.
•The interactions between visit type (AAT visit, person visit), activity (pre-,
during, and post-visit), and order (AAT visit first, person visit first) was used
Methods to evaluate whether the effect of AAT alleviate the physiological stress
Figure 3. Average systolic blood pressure (SBP) pre-(activ=1), during (activ=2), and post-
response. (activ=3) visits (AAT visit=1; person visit=2) for of hospitalized children (N=15) with the
person visit first (First=2).
•Paired-sample t-test and Holm’s sequential Bonferroni procedure
•Recruited from general pediatric medical or surgical wards or inpatient chronic adjustments for pairwise comparison were used if interactions were
illness units statistically significant.
•Participant Inclusion Criteria: •An analysis of variance with repeated measures was used to test the effects
Results
–Children aged 7-17 years of visit type and order on state anxiety after visits.
–Had a minimum of a one night stay There was a tendency for a significant 2 way ANOVA interaction with
–Children and their parents were willing to have a dog visit the effects of visit type and activity on DBP [F(2, 26) = 2.54, p= .098] .
–Had ability to speak and read English
•A total of 15 hospitalized children aged 7-17 years (M =10.97, standard
deviation = 3.01) were recruited to participate in the study; eight were previously
•Participant Exclusion Criteria:
hospitalized, and 8 had pets at home. (See Table 1).
–Hospitalized in an intensive care unit
–Allergic to or afraid of dogs
•There were no significant differences in average pre-visit SBP, DBP, or HR
–Had physical disabilities that preclude participation, or have psychiatric diagnoses, chronic between the AAT first (n = 9) and the person visit (n = 6) groups. (see Figure 1).
mental symptoms or cognitive impairment.
–were on strict contact, or respiratory isolation restrictions Cardiovascular responses---
–Currently had severe pain, fever, are dehydrated, or are restricted to NPO. –SBP (SBP responses depended on visit order)
•In the person visit first group, SBP decreased from pre- to post-AAT (p<.05), and did not
–Roommates and/or their family were afraid of or allergic to dogs change from pre- to post-person visit. (see Figure 3)
•SBP did not change in the AAT first group. (see Figure 2)
–DBP
•Changes in DBP were not parallel for AAT and person visits
•DBP did not change from pre- to post-AAT and increased from pre- to post-person visits
(p<.05). (see Figure 4)
–HR
•Visit type did not affect HR. Figure 4. Average systolic blood pressure (DBP) pre-(activ=1), during (activ=2), and post-
(activ=3) AAT (visittypet=1) and person visits (visittype=2) for of hospitalized children
(N=15).
Procedure •State anxiety
–No evidence was supported in children’s state anxiety after visits.

•Each child participated in two study sessions, once with AAT visit and once
Discussion
with person visit, administered at the same time of day on two consecutive Results (cont.)
days

Table 1. Demographic Characteristics of Children (N=15) during Hospitalization •In both AAT and the person visit first groups, SBP decreased in a linear
Day 1 Day 2
–Group 1: AAT visit (6-10mins) person visit (6-10mins) manner from pre to during to post AAT visits.
–Group 2: person visit AAT visit Variable n (%) Mean (SD)
Gender •Results suggest that the effect of AAT on SBP may continue fro at least a
Boy 7 (46.7) few minutes after the end of the session.
Girl 8 (53.3)
Age (y) 10.97 (3.01) •The increases in DBP from pre to post the person visit provides evidence for
Before study on 1st day--- Grade level (y) 5.93 (3.39) that any interaction may elevate arousal in a low stress situation.
•Children were assigned to 2 groups Race
White 6 (40.0) •Data demonstrate that AAT can alleviate SBP and DBP for hospitalized
Black (African American) 7 (46.7) children when comparing with the person visit.
Day of Pet Asian 1 (6.7)
Group
visitation
Ethnicity
• The effects of the AAT and the person visits did not differ in HR that may
AAT First AAT visit Person visit Hispanic or Latino 1 (6.7) be due to both visits let to similar small increase in HR.
Hospitalization History
•Use of the post visit only design for psychological measurements limits the
Person First Person visit AAT visit Previously hospitalized 8 (53.3) that say YES
Previous overnight 6 (40.0) that say YES differences in medical fear and state anxiety after AAT and person visits.
hospitalization
Surgery 2 (13.3) that say YES
•Obtained informed consent from parent and assent form from child Previous hospital pet visit 4 (26.7) that say YES
•Limitations:
•Parents completed child form of demographic data sheets Pets at home 8 (53.3) that say YES
•Measured the child’s arm circumference Dog 3 (20.0) – The major limitations of the current study are the small sample size and lack of random
Cat 3 (20.0) assignment.
Both 1 (6.7) – The study was also limited by the complexity of the nature setting, inconsistent interventions
Pre visit--- and study environments, and instrument issues.
•Measure BP & HR every 2 minutes for 6 minutes with Dinamap Pro 400 oscullometric BP
monitor

Conclusion
During visit--- Differences in average pre-visit SBP, DBP, and HR between 2 groups.
•Measure BP & HR every 2 minutes for 6-10 minutes
•The results of this study indicates that AAT can decrease physiological
arousal for hospitalized children compared with other in hospital play activities.
Post-visit---
105.78 106.94
•Measure BP & HR every 2 minutes for 6 minutes 120 103.22

•Complete State Anxiety Scale of STAIC 100

92.96
•This study suggests that AAT may be useful in health care settings to play a
80 63.59
58.56
part in decreasing hospitalized children’s physiological stress.
60
Next day---
40
• Start alternative intervention session (AAT or person) First=1
20
First=2
0 Acknowledgement
SBP DBP HR

Figure 1. Average pre-visit SBP, DBP, and HR for hospitalized children in the AAT visit first Thanks to Shady Grove Adventist Hospital and Mt. Washington Pediatric
group (First=1) and person visit first group (First=2). Hospital and University of Maryland Medical Center, the participating
hospitals, and to child life and dog visitation teams for assistance with data
collection.