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Animal-Assisted Therapy May Help Patients with Brain Injury

Animal-assisted therapy may boost social behaviors after brain injury.

Yesterday, the New York Times published a heart-wrenching profile of three-time world champion and Olympic cyclist Kelly Catlin, who had a bike crash last January, which may have resulted in a concussion and traumatic brain injury (TBI). At the time, Catlin complained that she felt her mind was slipping. As the article describes, “The concussion that her family said changed everything happened on Jan. 5 when Catlin crashed while riding with her professional road cycling team, Rally UHC Cycling.”

According to the article, writen by Juliet Macur, Catlin told her sister, “What is it like to no longer have a mind? It is unimaginable,” she wrote. “Terrifying.” Catlin also sent an email to loved ones soon after the incident saying that her thoughts were “never-ending spinning, spinning, spinning” and that she was “never at rest, never at peace.” Tragically, Catlin was found dead at her Stanford apartment on March 8 after committing suicide.

The recent Times article about the life and death of Kelly Catlin is disturbing and eye-opening on many levels. If you are having suicidal thoughts or ideations, please call the National Suicide Prevention Lifeline at 800-273-8255 (TALK) or visit SpeakingOfSuicide.com/resources for additional resources.

As a former elite-level endurance athlete, I strongly identified with some of the details about Catlin’s relentless drive and the pursuit of excellence in sports and other areas of life. My over-the-top passion for pushing myself to the limit as an endurance athlete was a double-edged sword. (For more see: "The Dark Side of Mythic Quests and the Spirit of Adventure" and "Motivation to Run (or Not to Run) Is Linked to Cannabinoids")

As the father of an 11-year-old aspiring athlete, this Times article also struck a deep emotional chord. My daughter pours her heart and soul into mastering her tennis strokes, swimming as fast as she can, and loves horseback riding. Generally, she strives to be "the best" in every sports competition. This Times article served to remind me of the importance of doing whatever I can as a parent to help my daughter navigate the thin line between the rewards of working hard to become really good at something without ever thinking that her "worthiness of love and belonging" is in any way based on winning blue ribbons or gold medals.

In this article, Kelly Catlin’s father blamed overtraining, stress, and his daughter’s “success-at-all-costs personality” as contributing factors to her suicide. Moments before her sister’s coffin was closed at the graveside, Catlin’s sister, Christine, placed a handwritten note inside that read: “Kelly, if I could trade my life for yours, I would. I love you without all your accomplishments.”

Chiemsee/Pixabay
Source: Chiemsee/Pixabay

One paragraph of this article that jumped out at me described how Kelly Catlin grew up loving horses. From reading this profile, it didn’t seem that Catlin actually owned a horse, but the article says “She studied the 512-page book, The Ultimate Book of the Horse and Rider, so much that she had to tape the binding because the book was so worn. She maintained a collection of dozens of model horses that she did not allow anyone to touch because they were arranged in a certain order.”

In a recent post, “3 Things That Helped Me Learn to Love Solitude” I shared stories about how bonding with my childhood horse, Commander, when I was in middle school played a pivotal role in maintaining my mental health during a psychologically traumatic period of "not self-determined solitude" (NSDS).

In many ways, the Times’ profile paints a portrait of Catlin as someone who was stoic and kept her emotions bottled up inside. Macur writes, “For years, Catlin, 23, was someone who took pride in holding back tears. Catlin told her sister, Christine, that seeking therapy meant she was weak and that she would rather suffer.”

Coincidentally, this morning, I read about a new study that reminded me of Kelly Catlin in terms of the role that animal-assisted therapy (AAT) can play in helping patients who have suffered brain injuries increase their emotional involvement during therapy.

(Disclaimer: By drawing a narrative link in this post between the new study on animal-assisted therapy helping people with acquired brain injuries during neurorehabilitation and Catlin’s recent story in the Times, I am not suggesting—or making a diagnosis—that AAT would have been an appropriate therapy for Kelly Catlin. For example, the extent of Catlin’s brain injuries is unclear. Her parents donated her brain to science and have requested a post-mortem assessment of her potential brain injuries. That said, the new research on the benefits of animal-assisted therapy suggests that AAT may be helpful for some patients with TBI.)

 Courtesy of REHAB Basel
Animal-assisted therapy may boost social behaviors after acquired brain injury.
Source: Courtesy of REHAB Basel

This paper, “Effects of Animal-Assisted Therapy on Social Behaviour in Patients with Acquired Brain Injury: A Randomised Controlled Trial,” was published April 9 in the journal Scientific Reports. According to the authors, after experiencing severe TBI, many patients exhibit social behavior problems such as reduced emotional empathy and impaired social expression, which often lead to problems communicating their emotions during social interactions.

Having animals, such as rabbits, guinea pigs, or sheep, present during rehabilitation therapy appears to increase patients' motivation and improves deficits in their social engagement. For this randomized controlled trial, psychologists at the University of Basel conducted the first-ever systematic review of animal-assisted therapy on a cohort of 19 adult in-patients with acquired traumatic brain injury and compared the AAT sessions with conventional therapy sessions.

Throughout a total of 200 AAT and conventional neurorehabilitation therapy sessions, the researchers recorded patients’ social interactions and documented overall mood and motivation. The researchers used the multidimensional mood questionnaire (MDBF) to gauge a patient’s mood during therapy sessions and a combination of self-reports and a visual analogue scale (VAS) to measure degrees of motivation.

The researchers found that patients exhibited more active social engagement when they were close to, or caring for, animals during a therapy session than during conventional “animal-free” sessions.

During AAT sessions, patients expressed nearly twice as many positive emotions than during conventional therapy. Overall, they also engaged in more frequent verbal and non-verbal communication. Notably, one potential shortcoming of these findings is that animal-assisted therapy did not appear to have an effect on negative emotions such as anger and rage.

The key to these animal-assisted therapy sessions seemed to be taking care of the animals. As the authors explain:

"In the animal-assisted therapy sessions, the procedure always followed a scheme: First, the patient and the therapist greeted the animal and then the therapist explained the therapeutic activity that had to be related with the presence of the animal. Examples for therapeutic activities were as reported in a previous paper (31): Cutting vegetables and feeding it to the present guinea pigs (AAT session) versus cutting vegetables to make a salad (conventional occupational therapy/physiotherapy/speech therapy); building a course and walking through it with, for example, a minipig (AAT), versus building a course and walking through managing a ball (conventional occupational therapy/physiotherapy); cleaning the rabbit’s cage in the presence of the animal (AAT) versus cleaning furniture (conventional occupational therapy/physiotherapy/speech therapy); walking with a sheep and the therapist (AAT) versus walking with the therapist (conventional physiotherapy); reading questions about the involved, present animal and filling in the answers (AAT) versus reading questions about an animal in general and filling in the answers (conventional speech therapy). In the previous paper, we also presented the number of sessions held with the different species involved in the study.”

"The results suggest that animal-assisted therapy can have a positive effect on the social behavior of patients with brain injuries," the study's principal investigator, Karin Hediger of the University of Basel in Switzerland, concluded in a statement. "Animals can be relevant therapeutic partners because they motivate patients to care for the animal. Secondly, animals provide a stimulus for patients to actively engage in the therapeutic activities. Animal-assisted therapy may be a promising supplement to conventional neurorehabilitation.”

References

Karin Hediger, Stefan Thommen, Cora Wagner, Jens Gaab, and Margret Hund-Georgiadis. "Effects of Animal-Assisted Therapy on Social Behaviour in Patients with Acquired Brain Injury: A Randomised Controlled Trial." Scientific Reports (First published: April 9, 2019) DOI: 10.1038/s41598-019-42280-0

Vanya Gocheva, Margret Hund-Georgiadis, Karin Hediger. "Effects of Animal-Assisted Therapy on Concentration and Attention Span in Patients with Acquired Brain Injury: A Randomized Controlled Trial." Neuropsychology (First published online: October 16, 2017) DOI: 10.1037/neu0000398

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