PTSD service dogs for military veterans: Current knowledge and future directions

Kerri Rodriguez Author

04/26/2022 Added

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This is a recording of Dr. Kerri Rodriguez's pre-symposium seminar for the Nebraska Symposium on Motivation given on April 20, 2022.

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[00:00:07.810]...is a very salient stressor,
[00:00:09.410]but it could also occur after sexual, child abuse,
[00:00:12.606]after a natural disaster, after a car accident,
[00:00:15.440]lots of different types of traumas.
[00:00:17.620]And PTSD is characterized by four main clusters of symptoms.
[00:00:22.256]So there's intrusion symptoms,
[00:00:23.470]where you often relive the memory of the traumatic event,
[00:00:27.210]either during the day or at night, in nightmares.
[00:00:30.380]There's avoidance symptoms, where you tend to avoid
[00:00:32.381]things that remind you of that traumatic event.
[00:00:36.133]Changes in overall mood and cognition, where you're having
[00:00:39.184]loss of interest in things you used to enjoy,
[00:00:41.820]and overall negative affect.
[00:00:44.600]And then hyperarousal,
[00:00:45.902]which is the feeling of always being alert, being jittery,
[00:00:48.440]always searching for the exits and kind of having
[00:00:51.370]an overall anger and your ability as well.
[00:00:55.760]Unfortunately,
[00:00:56.593]PTSD affects many of our military veterans
[00:00:59.130]of veterans who were deployed after 9/11.
[00:01:01.640]So Iraq and Afghanistan. About one in five or about 20%
[00:01:05.830]of veterans will return with post traumatic stress symptoms,
[00:01:08.720]which is a staggering number of veterans.
[00:01:11.790]They'll often also have comorbid depression and anxiety,
[00:01:14.883]and substance abuse and traumatic brain injuries
[00:01:17.570]that really compound the problem.
[00:01:21.210]Unfortunately, PTSD is difficult to treat,
[00:01:23.450]so there's no one size fit for a cure for PTSD.
[00:01:28.793]And oftentimes those traumatic brain injuries and anxiety,
[00:01:33.430]depression also compound with the treatment problems.
[00:01:36.850]First of all,
[00:01:37.683]it's well known that not all veterans will seek out
[00:01:39.620]treatment due to a bunch of reasons from stigma around
[00:01:42.930]mental health, to poor access to care.
[00:01:46.430]And then of those who do treat, seek out treatment,
[00:01:49.870]dropout and noncompliance can actually be pretty high.
[00:01:54.756]And there's also a ton of reasons for that as well.
[00:01:57.920]But the main column is that the evidence based treatment
[00:02:01.963]that we have of PTSD,
[00:02:03.440]which is largely behavioral therapy and medications,
[00:02:06.770]they treat some, or they don't treat all.
[00:02:09.080]And complimentary interventions have really increased to
[00:02:12.910]help veterans manage their day to day symptoms and that they
[00:02:17.270]compliment their evidence based symptoms, treatments.
[00:02:21.200]So of course you,
[00:02:22.310]these emerging complimentary treatment options,
[00:02:24.780]PTSD service dogs.
[00:02:27.137]And so these are psychiatric service dogs that have been
[00:02:30.540]trained for tasks to mitigate disability. In this case,
[00:02:33.710]it's an invisible disability and it's a self-fractured one
[00:02:36.630]rather than being in a wheelchair or being vision impaired.
[00:02:40.320]So they're different from therapy dogs
[00:02:41.880]or emotional support dogs,
[00:02:43.440]and that they are task trained to help that disability.
[00:02:46.650]So you might be wondering well,
[00:02:48.100]how can you train a dog to help PTSD?
[00:02:50.890]So I have a little visual video
[00:02:52.833]for you guys to be able to get an idea of that.
[00:03:00.340](no audio)
[00:03:29.780](no audio)
[00:03:59.788]Okay, so you saw a couple of things in there and just,
[00:04:02.650]these are kinda just sample tasks.
[00:04:04.940]Every veteran is different and every organization might be
[00:04:07.130]different, but a couple of things that you saw
[00:04:09.290]are the dog providing tactile interactions,
[00:04:12.090]so nudging or licking or pawing when they sense
[00:04:15.070]that the veteran is, is becoming anxious.
[00:04:17.160]They can also be cued to, for example,
[00:04:19.740]jump in the veteran's lap or lay down next to them
[00:04:22.260]to provide kinda that calming.
[00:04:24.800]They also are really useful to veterans in public.
[00:04:27.850]So you saw the dog positioning itself in front the veteran,
[00:04:32.150]we call that a walk around,
[00:04:33.380]where they could help create personal space.
[00:04:35.840]And then there's also one that was in the video
[00:04:38.290]where the veteran can position the dog behind them,
[00:04:41.040]and the dog can help alert the veteran into when someone's
[00:04:44.240]approaching kinda like a watch my back command.
[00:04:47.460]And of course, waking up on nightmares
[00:04:49.660]is part of that alerting and responding to anxiety.
[00:04:52.630]So these are just some of the tasks
[00:04:54.108]that service dogs can be trained for.
[00:04:57.174]So of course, PTSD service dogs are obviously popular.
[00:05:00.910]They've been around for many years,
[00:05:02.440]but they're definitely increasing in the past 10, 15 years,
[00:05:06.290]especially in the United States and Canada.
[00:05:09.080]This is just a graph from 2014 placements,
[00:05:11.530]so it's probably a little bit more now, but as of 2014,
[00:05:15.147]psychiatric service dogs for PTSD
[00:05:17.137]were the 3rd most commonly placed assistance dog
[00:05:19.510]in the United States in Canada.
[00:05:21.460]And of course we have a ton of amazing nonprofits
[00:05:25.330]whose entire mission and is to train and place service dogs
[00:05:29.100]specifically for United States, Canadian,
[00:05:31.756]British, Australian veterans.
[00:05:34.750]So we know that there's something beneficial happening,
[00:05:37.860]right?
[00:05:38.710]These organizations have incredible stories behind them.
[00:05:42.200]The wait list for getting a service dog from a lot of
[00:05:45.410]these organizations that are nonprofits
[00:05:46.740]can be years and years long.
[00:05:50.020]And we have amazing anecdotes of veterans saying,
[00:05:52.817]"This service dog saved my life.
[00:05:53.863]I would not be here today if it wasn't for my dog",
[00:05:57.180]or, you know,
[00:05:58.013]"I've been trying this, this, and this for my anxiety,
[00:06:00.170]and my dog's been one of the most helpful things in my
[00:06:02.150]panic attacks thus far."
[00:06:03.950]So we have a lot of those anecdotes and that's really been
[00:06:06.460]the, the main backing of the field.
[00:06:10.570]However,
[00:06:11.403]the research to back up the efficacy of these dogs
[00:06:14.040]has been lacking.
[00:06:15.460]So the VA, or,
[00:06:17.550]the department of veteran affairs through the United States,
[00:06:20.070]which is kinda the overall governing body of PTSD treatments
[00:06:23.660]has taken a firm stance, which is necessary.
[00:06:26.920]Because treating PTSD requires evidence-based treatments and
[00:06:30.990]they require the and medications that have gone through the
[00:06:33.450]ringer and gone through hospital trials,
[00:06:35.749]what we consider gold standard. So imagine you wouldn't,
[00:06:39.310]you know, just start giving out a medication,
[00:06:41.960]a new drug to veterans with PTSD
[00:06:43.650]if it hadn't gone through a bunch of research first.
[00:06:46.550]And so basically the VA and the current stance on service
[00:06:51.130]dogs is that it's difficult to draw some conclusion
[00:06:53.890]on the studies that have been done.
[00:06:55.800]And there's some preliminary things,
[00:06:57.760]but currently there's just not enough.
[00:07:00.890]So you might be wondering if we already know,
[00:07:04.410]dogs are good for us,
[00:07:06.100]veterans are saying that they're amazing,
[00:07:08.737]and the dog trainers are saying it works.
[00:07:11.900]If we have a lot of buy-in,
[00:07:13.510]why would we need to spend hundred thousand dollars
[00:07:15.940]to do the research?
[00:07:17.340]So there's a lot of reason.
[00:07:18.640]So of course,
[00:07:20.445]Service dogs are in high demand,
[00:07:22.320]wait list can be years and years long
[00:07:24.090]and nonprofits don't have all of the resources to
[00:07:26.885]accommodate. So more research gets more resources.
[00:07:31.420]It also of course, translates to funding.
[00:07:33.790]So service are expensive when you calculate how much it
[00:07:37.475]takes to raise them and train them and care for them.
[00:07:40.700]And so research also helps with that.
[00:07:44.076]Most importantly service dogs
[00:07:45.987]are a very big multi-year long commitment.
[00:07:48.750]It's actually a really big deal to,
[00:07:50.570]to bring a service dog into your home and into your life,
[00:07:53.310]and it has little empirical evidence.
[00:07:56.470]So research is definitely necessary
[00:07:58.150]to give the expectations for veterans
[00:08:01.000]knowing what am I gonna expect from the service dog,
[00:08:03.124]as well as to the clinicians,
[00:08:04.940]the mental health providers who are being asked daily,
[00:08:07.647]"Should I get a service dog for my PTSD?"
[00:08:09.607]And they don't have any answers
[00:08:11.070]'cause there's not enough research to back it up.
[00:08:15.160]Another really crucial reason for research is public policy
[00:08:18.225]and ongoing legislation. So research helps us make bills
[00:08:22.610]that allow people to get service dogs
[00:08:24.159]to be able to fly in airplanes for example.
[00:08:27.800]And then lastly, of course,
[00:08:29.500]research is really good for efficacy and for maximizing
[00:08:32.312]efficacy. So what type of dog is best for this role?
[00:08:36.150]What type of veteran might be most best for this pairing?
[00:08:39.673]What should we treat for?
[00:08:41.450]All of those questions are answered by research.
[00:08:43.820]So hopefully I convinced you, that what I do is,
[00:08:46.150]is very important and that research
[00:08:48.920]is 1,000% necessary for this field
[00:08:51.370]and for a lot of service dog fields.
[00:08:55.340]So our overall goal was to put some science behind this,
[00:08:59.260]quantify the efficacy and role of these dogs.
[00:09:02.260]And we did this in partnership with an organization
[00:09:05.240]called K9s for Warriors.
[00:09:06.750]So everything I wanna talk about is from K9s for Warriors,
[00:09:10.090]we were the researchers,
[00:09:11.150]meaning we just came in objectively quantified.
[00:09:13.560]I did not train or place any service dogs.
[00:09:16.900]That's what the organization did.
[00:09:18.680]So we'll talk a little bit about them in a second.
[00:09:21.420]I'm talking about three studies, really just two.
[00:09:24.790]And then I'll like very briefly go over
[00:09:27.610]what our clinical trial measured at the very end
[00:09:30.470]to give you an idea of what we've done.
[00:09:33.850]Okay. So K9s for Warriors
[00:09:35.406]is one of the largest providers of PTSD service dogs
[00:09:38.545]in the United States. They're located down in Florida,
[00:09:40.790]but they place dogs in all 50 states pretty much.
[00:09:43.330]all over the country. They are a nonprofit.
[00:09:46.350]So the services are all completely free to veterans.
[00:09:50.120]They largely rely on donations like many of these nonprofit
[00:09:53.330]providers and they have a really interesting model.
[00:09:55.830]They, they do get some breeder donations
[00:09:58.230]and they have a pilot puppy program,
[00:10:00.090]but the majority of the dogs come from shelters,
[00:10:02.890]which is a pretty interesting model.
[00:10:04.920]And they've been using that model since the,
[00:10:06.530]the beginning where the model
[00:10:08.600]really save the dog life and save the veteran's life.
[00:10:14.270]And they place specifically service dogs
[00:10:16.070]for veterans with PTSD, traumatic brain injuries,
[00:10:18.910]military, sexual traumas after 9/11.
[00:10:23.220]And this is pretty much the model.
[00:10:25.080]So dogs and rescue shelters,
[00:10:27.370]you can see that they're all kinda lab mixes of some sort.
[00:10:31.050]They do select them to be about hip height
[00:10:32.860]because they feel do some bracing and balance.
[00:10:36.110]So they're all medium dogs and they're rescued pretty early.
[00:10:39.920]And then going through six to eight months of training
[00:10:42.680]and the veterans also apply.
[00:10:44.430]They go through a bunch of screening.
[00:10:46.010]Again, we're not involved with this.
[00:10:47.630]All the people that we recruit for our studies have already
[00:10:50.210]gone through screening, but they get background checks,
[00:10:53.188]no history of animal abuse.
[00:10:57.210]They have to demonstrate that they can care for the dog,
[00:10:59.240]et cetera.
[00:11:00.170]And then they get placed and ongoing training for the
[00:11:03.810]partnership.
[00:11:06.961]Okay. So starting off with our first study.
[00:11:10.289]So this is kinda our like first step with this.
[00:11:11.730]We're like, let's just get some numbers.
[00:11:14.450]And what we're gonna do is a pretty easy design,
[00:11:18.560]especially easy for my first study of my PhD, which is,
[00:11:21.540]we're just gonna compare a group of veterans who already
[00:11:23.987]have a service dog to the group of veterans
[00:11:25.977]who are the wait list to receive a service dog.
[00:11:28.370]So really simple cross-sectional design.
[00:11:31.290]So we had 75 with a service dog, 66 in the wait list.
[00:11:34.930]Again,
[00:11:35.763]everyone had already been approved to be in the program.
[00:11:37.920]We just kinda capture at a single time point.
[00:11:40.090]We didn't follow anyone over time, just compared the groups.
[00:11:43.890]So what was unique about cross-sectional study?
[00:11:47.927]One of limitations is that you could have had your dog for a
[00:11:51.320]year or six years on average,
[00:11:53.940]they had had their dog about 1.6 years.
[00:11:57.290]Again, you could have just gotten on the wait list.
[00:11:59.120]You could have been on the wait list for a little bit.
[00:12:02.040]Individuals had been on the wait list
[00:12:03.140]in average 0.64 years,
[00:12:05.215]but just keep in mind that there is range.
[00:12:06.890]This is just averages.
[00:12:09.520]We had a very military sample,
[00:12:13.150]both the males in the thirties,
[00:12:15.600]mostly married and mostly white.
[00:12:17.720]So you guys, I can understand the limitations around that,
[00:12:20.570]but military sample,
[00:12:21.840]most of them are from the army and almost all of them have
[00:12:25.490]been deployed to Iraq and/or Afghanistan.
[00:12:30.330]Oh, and then of course they all have PTSD diagnosis,
[00:12:32.500]which is clinical screeners of PTSD scores.
[00:12:35.620]OK. So what do we measure?
[00:12:37.300]We measured questionnaires and biological samples.
[00:12:42.120]So questionnaires are really useful because we can ask
[00:12:45.444]veterans how they feel.
[00:12:47.590]So this is really important to get things like depression
[00:12:51.287]and anxiety and social function.
[00:12:54.630]We did 23 standardized instruments,
[00:12:56.680]and we chose instruments that were used in other PTSD
[00:12:59.560]service dog studies or sorry, PTSD treatment studies,
[00:13:03.010]to be able to see if we could compare across things like
[00:13:06.930]psychotherapy and drug trials.
[00:13:09.220]So we used gold standard instruments that were already
[00:13:11.300]validated in the field,
[00:13:12.870]measuring a bunch of different things.
[00:13:16.916]And then we also some biological samples,
[00:13:18.820]which helps us give kinda an objective measure
[00:13:21.400]of how things are going.
[00:13:23.160]So they can't really bias or skew their,
[00:13:26.950]their biological samples.
[00:13:29.196]We tapped into the stress response system,
[00:13:31.020]which I'm sure you all have heard of cortisol.
[00:13:34.030]One of the end of the HPA axis of our stress system.
[00:13:40.240]And you might be thinking of cortisol
[00:13:41.820]as kind of what we think of a short term cortisol.
[00:13:44.550]So I'm up here in front of people.
[00:13:46.640]My cortisol might increase. Increasing is bad.
[00:13:50.030]It means more stress, right?
[00:13:52.260]But we actually tapped into a different aspect of cortisol,
[00:13:56.390]which is called the E cortisol awakening response.
[00:13:59.370]And if you're not familiar, every morning, when you wake up,
[00:14:02.520]you experience a rise in cortisol.
[00:14:04.460]It's not because you're super,
[00:14:05.840]super stressed when you wake up.
[00:14:07.460]It's because it's part of your security rhythm.
[00:14:09.890]So every morning, the average healthy adult experiences,
[00:14:13.405]a 50 to 70% rise in their cortisol
[00:14:16.810]and in psychology research,
[00:14:18.110]we can actually look at the magnitude of that rise as a
[00:14:20.910]biomarker. So here you can see a normal,
[00:14:24.445]healthy awakening response looks like,
[00:14:27.130]it's that good increase.
[00:14:29.354]And what we see in the individual's PTSD and other types of
[00:14:33.190]stressor disorders is this really flat,
[00:14:36.760]what we call a dampened or low cortisol response.
[00:14:40.470]So the hypothesis is that they've just been fired cortisol,
[00:14:43.030]cortisol, cortisol for years and years and years.
[00:14:45.150]And it basically disregulates cortisol system and they don't
[00:14:49.240]have this increase in the morning, which is a bad thing.
[00:14:51.901]You want the increase in the morning.
[00:14:53.591]So I just wanted to orient you to like higher cortisol
[00:14:56.162]could be better sometimes,
[00:14:57.730]especially in when we're measuring things like this.
[00:15:01.906]So we looked at the cortisol awakening response,
[00:15:04.540]we asked about everyone to spit into tubes for us,
[00:15:06.730]right when they wake up, and 30 minutes later,
[00:15:09.517]across a couple of days.
[00:15:11.550]We're really lucky that cortisol can get from spit these
[00:15:14.550]days, back in the day,
[00:15:15.630]it was either blood or urine and we weren't ever with
[00:15:18.730]veterans, they were all across the country.
[00:15:20.470]So very useful to be able to give us some spit in the
[00:15:24.110]morning and then ship it off to us at the university.
[00:15:28.840]So this is what the instructions looked like.
[00:15:31.400]There's me and my fingers demonstrating.
[00:15:35.570]And if you're really wanting a one minute amazing
[00:15:38.930]video, salivavid.com,
[00:15:40.240]we bought the website show how to get saliva.
[00:15:44.920]And then this is one of our veteran models showing what
[00:15:49.223]collection looks like, look how happy he is,
[00:15:52.170]to have collected his saliva. He loves it.
[00:15:57.500]So, before I kind of go into what we found,
[00:16:00.423]I just wanted for anyone wondering
[00:16:02.470]on the statistician side of things,
[00:16:04.630]that we controlled for the demographics,
[00:16:07.080]we also controlled for whether or not they had a pet dog
[00:16:09.170]in the home, and we controlled for things
[00:16:12.190]like marital status and other things like that.
[00:16:14.240]So we're not looking at the effect that those have,
[00:16:17.390]we're basically them constant to isolate
[00:16:19.727]the effect that the service dog has.
[00:16:22.720]So things like gender identity, age, are controlled.
[00:16:26.910]Okay.
[00:16:28.920]So let's start off questionnaires.
[00:16:32.620]So, first thing we found, of course, our big outcome,
[00:16:35.170]was PTSD symptoms, right?
[00:16:37.160]So, oh, sorry.
[00:16:39.080]We're doing treatment first.
[00:16:40.560]So first we wanted to just look at, what kinds of treatments
[00:16:43.167]are they getting other than a service dog?
[00:16:46.090]So they probably are taking medications.
[00:16:48.100]Hopefully they're seeing a, a therapist.
[00:16:50.390]Maybe they're seeing a psychiatrist.
[00:16:52.630]We wanted to first document that.
[00:16:54.430]So we found was that there was really no group difference.
[00:16:57.250]And the percent of veterans that said they were receiving
[00:16:59.770]a PTSD treatment, independent from the service dog.
[00:17:02.990]And there was really no difference,
[00:17:04.640]significant difference in the number of sessions they were
[00:17:07.310]getting per year. So both were about 40,
[00:17:09.780]which is like three sessions a week, which is pretty normal.
[00:17:14.170]So this was really good data to kind of validate that
[00:17:17.500]service dogs are complimentary treatment option.
[00:17:19.900]They're not replacing other treatments.
[00:17:22.280]And it seems that after getting a service dog,
[00:17:23.633]they're still engaging other treatments at the same rates,
[00:17:27.170]so that was kind of the first step.
[00:17:30.474]So then we moved on to PTSD symptoms.
[00:17:33.091]So we found that compared to the wait list,
[00:17:34.720]those with the service dog did report lower PTSD symptom
[00:17:37.560]severity on the PTSD checklist where higher is worse PTSD.
[00:17:44.330]Those with the service dog in blue had lower PTSD scores.
[00:17:49.140]However,
[00:17:50.240]a cutoff for this measure for a likely PTSD diagnosis is 50.
[00:17:54.290]So as you can see,
[00:17:55.480]those are the service dog were still above the threshold.
[00:17:58.350]And this matches a lot of our PTSD treatment,
[00:18:01.891]randomized control trials,
[00:18:03.660]where you see that there's a reduction in symptom quality,
[00:18:06.610]but you don't necessarily cure the PTSD.
[00:18:09.180]So this suggests also that service dogs
[00:18:12.020]are not cure for PTSD.
[00:18:13.540]They're not associated with loss of diagnosis,
[00:18:16.000]but they are associated with lower symptoms.
[00:18:21.620]Great. Okay.
[00:18:22.824]So the second thing we found was that those with
[00:18:24.360]the service dogs also reported better mental health.
[00:18:27.540]They're reported less depression symptoms,
[00:18:29.641]less anger and less anxiety.
[00:18:33.490]However, also similar 50 is not the cutoff for anything.
[00:18:38.100]It's actually the population norm on these scales.
[00:18:41.330]So the average healthy adult is a 50 on most of these.
[00:18:44.420]So you can still see that those of service dogs are still
[00:18:47.330]depressed a little bit still angry
[00:18:49.720]and they still have anxiety,
[00:18:51.110]but they're significantly lower than those in the wait list.
[00:18:53.530]So again, not curing depression, helping depression.
[00:18:58.857]We also looked at the positive things.
[00:19:00.780]So I think too often in psychology research,
[00:19:02.605]we just do all those like negative things.
[00:19:04.827]But we put in some positive things in there.
[00:19:07.450]We measured positive mood.
[00:19:08.780]We found that those with the service dog had better moods.
[00:19:11.920]There are more satisfied with their lives and they reported
[00:19:15.410]more resilience to stress.
[00:19:19.010]We also looked at social health and again,
[00:19:21.990]found findings here.
[00:19:23.070]We found that those are the service dog reported being less
[00:19:26.180]socially isolated. You know,
[00:19:27.550]we're going out to see people more often
[00:19:30.220]and they're participating in more social activities.
[00:19:33.080]This includes things like going the movies
[00:19:34.760]and going out to eat and things like that.
[00:19:37.470]And this is really important.
[00:19:39.104]This is a picture that was provided by one of the veterans
[00:19:42.334]to the organization,
[00:19:44.136]this was him going to the grocery store for the first time
[00:19:46.803]without having a panic attack.
[00:19:48.470]And this is huge for him and really the service dog in that
[00:19:52.880]way is helping them go out into society and helping them
[00:19:55.925]affiliate back into the society,
[00:19:58.186]which over time would help their social isolation.
[00:20:01.380]So definitely a big aspect of the intervention.
[00:20:07.510]We looked at employment just for fun and,
[00:20:10.130]and found really no difference here that those in the wait
[00:20:12.780]list were just as like we to be employed as those with the
[00:20:14.800]service dog, it was a little bit higher,
[00:20:17.010]but it's not significant.
[00:20:18.830]And then we also broke down employment impairment and we
[00:20:22.810]found a couple of things.
[00:20:24.230]We found that compared to the wait list in gray,
[00:20:26.730]those are the service dog who were employed,
[00:20:28.920]had less absenteeism to the L. So they missed more,
[00:20:33.020]less days and hours.
[00:20:34.740]And they all reported less overall impairment
[00:20:38.570]at their work as well.
[00:20:40.730]So just some,
[00:20:41.660]a couple of interesting findings on that as well.
[00:20:47.110]Then we measured sleep,
[00:20:48.730]which was one of the really interesting areas.
[00:20:51.250]I don't know if any of you guys follow
[00:20:52.930]kind of like dog media things,
[00:20:55.187]but there was a couple of things that were like dogs
[00:20:57.800]actually make us sleep worse.
[00:20:59.800]And so that was like one of the big headlines,
[00:21:01.770]which makes sense. They're really hot.
[00:21:03.540]They make, they took up a lot of space in the bed.
[00:21:05.480]So we were kind of like, oh,
[00:21:06.650]service dogs are gonna help or hurt.
[00:21:08.970]We didn't really know.
[00:21:10.330]So what we found is that on a group level,
[00:21:12.708]when we looked at sleep on one of these sleep measures,
[00:21:15.730]we found no difference in the service dog and the wait list,
[00:21:18.330]sleep quality. So as a whole,
[00:21:20.732]but then we also broke it down by subscales and you can see
[00:21:24.610]that there were two areas in which
[00:21:26.420]the service dog was performing better. One,
[00:21:28.880]those of the service dogs felt better when they woke up,
[00:21:31.630]they had better subjective sleep quality.
[00:21:34.300]And two, they reported less daytime dysfunction.
[00:21:37.150]This is basically asking how tired you are
[00:21:39.041]throughout the day.
[00:21:39.874]So they had more energy throughout the day and they felt
[00:21:41.950]better. However,
[00:21:43.090]no differences in the rest and keep in mind,
[00:21:45.840]this is self-report, which lead us into the next steps.
[00:21:50.550]So this is kind of our first step here.
[00:21:52.490]So some interesting findings,
[00:21:54.820]but there's no evidence that service dogs are miraculously
[00:21:57.821]curing the sleep problems.
[00:22:01.580]Okay. And then another area we found no difference.
[00:22:03.740]So as we looked at family function,
[00:22:06.542]we found family functioning was the same in groups.
[00:22:10.800]And among those who were married
[00:22:12.590]or living with significant other,
[00:22:14.088]they weren't more or less satisfied with their relationship.
[00:22:17.430]So another area here where service dogs,
[00:22:19.970]aren't magically coming in and fixing everything.
[00:22:22.330]There's still a lot of stress in military families.
[00:22:24.930]And there's still a lot that goes into these things.
[00:22:30.230]And then just really quickly on biological samples.
[00:22:32.800]I'm not gonna bore you too much if you are into cortisol,
[00:22:37.207]I I'll talk to you later about it,
[00:22:40.350]but we did find a significant difference
[00:22:42.668]in that those with the service dog had
[00:22:45.170]higher awakening responses,
[00:22:47.210]which is a good thing in this context.
[00:22:49.970]It also correlated with things like lower depression,
[00:22:52.450]anxiety, and lower PTSD.
[00:22:54.330]So more evidence that it it's a healthier,
[00:22:57.130]awakening response, again,
[00:22:58.860]this was a single time point though.
[00:23:00.270]So didn't measure it over time.
[00:23:01.980]And this is the paper. If you wanna get nitty gritty,
[00:23:04.410]into cortisol.
[00:23:06.550]So overall we found that service dogs are complimentary
[00:23:11.320]intervention, but not replacing evidence based treatment.
[00:23:13.950]They're associated with symptom reduction overall,
[00:23:17.130]but not a loss of diagnosis.
[00:23:19.620]They're pretty good at some mental health quality of life
[00:23:24.100]and wellbeing outcomes.
[00:23:27.230]They may or may not be impacting the stress response system.
[00:23:32.020]Preliminary evidence suggests that they don't, they do,
[00:23:35.090]however they're not becoming a magical cure for everything.
[00:23:38.880]We found that they weren't really affecting sleep.
[00:23:41.320]They weren't really affecting family relationship
[00:23:43.510]functioning either.
[00:23:45.820]So obviously single time point, we didn't randomize.
[00:23:48.810]We didn't follow them over time.
[00:23:51.270]We needed to do a bunch of research, which was great.
[00:23:53.360]Next step. You know, we asked one question
[00:23:55.460]and then now we can just go from there.
[00:23:58.800]So lucky for me, I had four and a half years left my PhD.
[00:24:02.990]So I was like, yeah, let's keep going.
[00:24:04.990]So we went into the next study,
[00:24:06.670]which we knew we wanted to do a clinical trial,
[00:24:08.980]but we also weren't exactly sure what we were measuring
[00:24:11.700]in a clinical trial. So it's a little bit different.
[00:24:14.940]If we did like a drug trial,
[00:24:16.668]we would give 50 milligrams of a pill to everyone.
[00:24:20.260]We give a placebo to the others and we would know exactly
[00:24:23.170]what's in the 50 milligram pill, right.
[00:24:25.100]Have the chemical makeup for it.
[00:24:26.590]You know exactly what everyone's getting.
[00:24:28.970]When we give a service dog,
[00:24:30.150]we have no idea what they're getting.
[00:24:32.220]So every veteran service dog pair is gonna be different.
[00:24:35.540]We don't really have any great data on what the average use
[00:24:39.901]of, of trained tasks.
[00:24:42.340]We really weren't able to put, you know,
[00:24:45.610]what is the service dog intervention?
[00:24:48.010]So we decided to do stem on it.
[00:24:49.610]Let's put some numbers behind what this intervention is,
[00:24:53.070]so that we can actually study it in a randomized design.
[00:24:57.029]So we basically wanted just to define the intervention,
[00:25:00.058]we wanted to know, you know, how often are tasks being used,
[00:25:03.727]but what tasks are most important,
[00:25:06.450]what's happening over time?
[00:25:08.497]How is everything relating to PTSD and the bond?
[00:25:11.720]And what about the things
[00:25:12.553]that the service dog did not train for?
[00:25:14.440]Like how important are those things
[00:25:16.520]that any dog can provide?
[00:25:19.520]So we had 136, again, all with the service dog,
[00:25:22.790]but for different amounts of time,
[00:25:24.260]they had their dogs for 1.8 years on average,
[00:25:28.410]same similar sample. A couple of them were in study one,
[00:25:30.840]but mostly this was kind of a new sample.
[00:25:34.300]And we looked at a bunch of different tasks and a couple of
[00:25:38.230]them you already know of, but kind of orient you.
[00:25:42.020]So we looked at a task of like interrupting someone's
[00:25:46.540]anxiety as well as to calm the anxiety.
[00:25:49.640]So we did split these up as, as different things.
[00:25:53.080]We also looked at the tasks that happened in public.
[00:25:56.090]The cover one was the watching our back command
[00:25:58.950]and the block was getting personal space to be in front.
[00:26:02.170]So those are the other two we looked at.
[00:26:04.150]And then we also looked at the waking up from a nightmare
[00:26:06.450]as a separate task.
[00:26:07.840]So these are the main five tasks
[00:26:09.660]that K9s for Warriors trains for.
[00:26:11.080]So we looked in depth at these. Other organizations train
[00:26:14.810]other things, but this was what we looked at in our study.
[00:26:19.830]Again, I,
[00:26:20.980]I just wanna point out that this is controlling for age,
[00:26:23.383]gender identity, marital status.
[00:26:25.370]The pet dogs in the home and,
[00:26:26.911]and someone else we control for PTSD symptoms as well.
[00:26:32.080]Okay. So what's the most important we asked veterans,
[00:26:35.421]how important has each one of these tasks been
[00:26:38.440]for your PTSD symptoms?
[00:26:40.999]What we found was on a scale from not at all
[00:26:43.920]to extremely important for my PTSD,
[00:26:46.623]they were all pretty important.
[00:26:48.831]So that is not shocking, right?
[00:26:51.760]Of course they're important in some way,
[00:26:53.350]if they're being trained, however,
[00:26:56.010]the calm and comfort to anxiety was the most important.
[00:27:01.470]And we asked for untrained behaviors,
[00:27:04.400]things that any dog can do.
[00:27:07.120]How important are these for your PTSD?
[00:27:09.429]So the dog's ability to be provide companionship,
[00:27:12.950]to be calming without overdoing anything,
[00:27:14.850]just to be in the room, to be nonjudgmental,
[00:27:17.015]to provide independence, source of love,
[00:27:20.520]getting me out of the house,
[00:27:21.450]like going on walks, overall happiness.
[00:27:24.610]And again, we found that all of these things were important.
[00:27:28.250]So on average, quite a bit to extremely important for PTSD.
[00:27:33.480]So when we looked at overall trained versus untrained
[00:27:37.060]telling the average untrained behaviors actually rated more
[00:27:39.840]important on average for PTSD than the train,
[00:27:42.940]just by a little, which was an interesting finding.
[00:27:46.120]So essentially what we knew,
[00:27:48.417]we like had a gut feeling, but now is,
[00:27:51.070]is proved in numbers,
[00:27:52.103]is that the service dogs trained task are
[00:27:54.130]pretty important in the intervention,
[00:27:55.687]but you're also giving a dog and there's a lot of aspects
[00:27:58.910]that are in that intervention.
[00:28:00.980]So you're getting this routine,
[00:28:02.280]you're getting this companionship. So we,
[00:28:03.797]you had to really understand that the intervention was
[00:28:06.446]combination of both.
[00:28:10.193]So these were the most important.
[00:28:13.830]We looked at how often things are being used.
[00:28:16.320]And this is what we found about overall,
[00:28:18.930]an average of three times a day and lots of variability,
[00:28:23.480]of course,
[00:28:24.950]but that overall the common comfort anxiety was used the
[00:28:27.580]most often about five times a day, which is interesting
[00:28:30.970]because it was also rated as most important.
[00:28:35.300]And then we wanted to look at a couple of,
[00:28:37.680]of things that we thought were moderating this.
[00:28:39.740]So the first thing, obviously, as I told you,
[00:28:43.150]you could have had your dog for six months or seven years.
[00:28:45.770]So that was actually a really good x-axis for us to be
[00:28:48.023]able to see how that changed over time.
[00:28:51.275]So we looked at our outcomes in time and we found that with
[00:28:55.480]a service dog or how many years you've been
[00:28:57.020]with your service dog did not relate
[00:28:59.160]to how important you view the dog,
[00:29:01.425]but it did relate to the how often you're using the tasks,
[00:29:04.970]such that the more longer you hire your service dog,
[00:29:07.697]some of the less frequently you're using task per day.
[00:29:09.950]So that indicates that there's less reliance over time and
[00:29:13.190]that they might be like
[00:29:14.023]weaning off the service dogs' commands.
[00:29:17.260]Then we wanted to look PTSD severity.
[00:29:19.750]So it's very much not as much of a spectrum as autism,
[00:29:23.160]but there's,
[00:29:23.993]there's a lot of flexibility around how severe your
[00:29:26.660]symptoms might be. And so we quantified that severity and,
[00:29:30.420]and looked at that.
[00:29:31.290]And what we found was nothing. So if you had moderate PTSD,
[00:29:36.390]if you had very severe PTSD,
[00:29:38.230]it did not matter in terms of how important you view your
[00:29:41.442]service dog for your own symptoms,
[00:29:44.003]more often using the tasks. So that was really interesting.
[00:29:46.740]We thought that the more severe your PTSD was the more tasks
[00:29:49.840]you're using, but it seems to not be effect.
[00:29:54.710]And then we looked at the bond,
[00:29:57.070]the relationship between the service dog and the veteran,
[00:30:00.090]and we quantified it.
[00:30:01.060]Interestingly through this scale,
[00:30:03.950]it's a really easy seven point scale.
[00:30:05.377]It's just a bunch of circles and you rate
[00:30:08.402]and how closely your circles overlap.
[00:30:12.200]So we asked between you and your service dog pick this set
[00:30:16.040]of circles that fits to those for your relationship.
[00:30:19.710]And we found that the bond related to everything which is
[00:30:22.910]surprising, but also not surprising.
[00:30:25.860]So the closer the relationship, the, the higher the bond,
[00:30:29.460]the more veterans are reporting that importance of the,
[00:30:33.510]the trained and untrained tasks.
[00:30:35.560]And the more often are using tasks on a daily basis.
[00:30:38.990]However, remember we didn't measure this contained,
[00:30:41.660]there's no causality. So it's like chicken and the egg,
[00:30:44.170]like, did the bond come first?
[00:30:45.840]And then they view their dog as more important or were they
[00:30:48.930]really important to using the tasks a lot?
[00:30:50.590]And then the bond came.
[00:30:51.520]So that is one thing that we don't have data for likely a
[00:30:55.250]little bit of both. Right.
[00:30:58.890]And then on that bond,
[00:31:00.130]just in case any of you guys are researchers
[00:31:02.690]and are interested in using
[00:31:03.950]a new measure for your, your studies,
[00:31:06.580]we found really good variability here.
[00:31:08.850]There's a lot of people that said, yeah,
[00:31:11.200]we're completely overlapping, but 40% in all majority,
[00:31:15.960]and then down from there.
[00:31:18.040]And what we looked at was kind of that obviously just
[00:31:21.270]quantifying how many people were in each circle,
[00:31:24.010]but we also just wanted to kind of look at that over time.
[00:31:27.477]And we did find a, a pretty good correlation here,
[00:31:30.510]largely driven by these individuals on the left,
[00:31:35.400]such that the more time with your dog,
[00:31:37.334]the stronger this bond over time.
[00:31:41.550]Okay. So basically we quantify the intervention.
[00:31:44.997]We looked at everyday experience,
[00:31:47.040]we looked at average use and overall,
[00:31:49.530]we just wanna document how and why this intervention was
[00:31:52.230]working and, and ultimately
[00:31:53.850]set us up for a more gold standard clerical design.
[00:31:59.740]So, oh, and then if you're interested, we studied a lot more
[00:32:03.410]things if you wanted to get into the nitty gritty.
[00:32:06.250]This is the paper.
[00:32:08.970]So yeah, we studied a lot more.
[00:32:10.730]We did some qualitative open ended interviews about how
[00:32:13.247]veterans viewed their service dogs.
[00:32:15.500]We looked at the benefits and the drawbacks,
[00:32:17.340]the service dogs. We interviewed the spouses.
[00:32:20.390]We looked at how it was an impacting families.
[00:32:22.680]We looked at training methods.
[00:32:24.140]We did a lot research from 2015, 2017,
[00:32:27.410]really documenting everything we could,
[00:32:29.607]then we were ready for the clinical trial.
[00:32:31.640]So COVID did a little hiccup, but it's done now.
[00:32:35.840]And I'm sorry, I'm not sharing any results yet,
[00:32:38.180]but I wanted to just give you an idea of what was studied.
[00:32:42.290]So this study took a big team and we needed more people
[00:32:48.540]helping us. So we recruited a bunch more people
[00:32:51.220]to be a part of this study on the dog side and
[00:32:53.900]the human side.
[00:32:55.110]So we integrated the military Family Resource Institute at
[00:32:57.660]Purdue to help have a more clinical expertise on the PTSD
[00:33:01.980]side. And then on the dog side,
[00:33:03.960]we integrated individuals from
[00:33:05.830]the Arizona Canine Cognition Center to get us more data
[00:33:11.100]on the dog side.
[00:33:12.140]So looking at cognition and temperament and behavior
[00:33:14.780]and how that placement outcomes.
[00:33:17.067]This is also a National Institute of Health
[00:33:19.970]funded clinical trial.
[00:33:21.320]So we had to kind of do all the things that come with NIH
[00:33:24.470]funding like preregister our clinical trial on a database,
[00:33:28.530]and set a data safety monitoring board and all those
[00:33:33.547]things. So it was a much, much bigger endeavor.
[00:33:36.540]So just really quickly what we went over, what we studied,
[00:33:41.110]the first thing obviously,
[00:33:42.260]was that we had changes over time now.
[00:33:44.630]So this is our design.
[00:33:46.720]In the beginning, we recruit veterans again,
[00:33:49.250]all from K9s for Warriors,
[00:33:51.020]they've already been accepted into the program.
[00:33:53.350]They just don't have a dog yet at recruitment.
[00:33:57.005]So they've just been accepted into the program.
[00:33:59.450]We give them a baseline, which is in the,
[00:34:02.380]the first study period.
[00:34:04.310]And the assessments are all two weeks long.
[00:34:06.410]So we basically are in their lives, following them,
[00:34:09.510]calling them daily,
[00:34:10.800]asking them to do a bunch of things for two whole weeks.
[00:34:13.670]Then there's a three month period of,
[00:34:16.747]of a break where half the veterans are receiving
[00:34:19.990]a service dog at the beginning of that,
[00:34:21.517]and the other half are being on the wait list.
[00:34:23.950]So it's not truly randomized.
[00:34:25.810]It would be pretty unethical for us to say,
[00:34:27.930]you're not getting a service dog, but you are.
[00:34:30.290]Everyone's getting a service dog,
[00:34:31.560]it's just whether it happens now or after the three months.
[00:34:34.860]So it's kind of a pseudo-randomized design.
[00:34:37.386]And then we follow up with everyone three months later.
[00:34:39.920]Half of them have a dog at that time.
[00:34:42.430]Half of them are about to receive a dog,
[00:34:44.260]but they're still on the wait list.
[00:34:46.370]So about 50 in each group, so a hundred veterans over time.
[00:34:50.630]And we also integrated their spouses.
[00:34:52.300]So a hundred veterans, a hundred spouses in this research.
[00:34:54.700]And a hundred dogs.
[00:34:57.530]So we have a lot more measures, a lot of things
[00:34:59.770]that you might have been like, "What about this?
[00:35:00.833]What about this?"
[00:35:02.060]We pretty much integrated them all.
[00:35:04.450]We're looking at, sort of brain injury,
[00:35:06.900]and sexual trauma comorbidities,
[00:35:08.743]looking at how much combat you were in,
[00:35:11.375]your really detailed deployment information,
[00:35:13.796]your disability ratings,
[00:35:17.020]we're documenting exactly what treatments
[00:35:19.137]the veterans are engaging in, and any dropout.
[00:35:24.150]We're looking at current and past treatments.
[00:35:28.070]We also have many more outcomes. We're looking at suicide,
[00:35:31.590]suicidal thoughts as an outcome now,
[00:35:33.810]to look at how service dogs are impacting that.
[00:35:36.785]We're looking at medication use and dosages.
[00:35:38.920]So after you get a service dog,
[00:35:40.570]do you have less use of anxiety meds
[00:35:42.544]or any other medications?
[00:35:45.620]So lots, lots more things.
[00:35:49.110]The other thing we're doing is rather than asking,
[00:35:52.290]well, we're still asking veterans to self report,
[00:35:54.230]but we're not relying on the self report.
[00:35:56.440]We're in integrating clinician assessments
[00:35:58.920]to diagnose the PTSD, to assess severity.
[00:36:03.300]And these clinicians do it over the phone.
[00:36:05.350]Again, we're never with veterans in person.
[00:36:07.000]So this is all over the country, and they're masked
[00:36:09.970]or blinded to whether or not the veteran has a dog or not.
[00:36:12.874]And what time point it is, so it adds
[00:36:14.397]a little bit more objectivity to that PTSD severity.
[00:36:19.690]We're getting lots more saliva over more days
[00:36:22.410]to look at that awakening response.
[00:36:25.380]We're measuring sleep effectively. Now with wristbands,
[00:36:28.820]similar to like your Apple watch or your Fitbit,
[00:36:31.200]that measure on how well you're sleeping at night,
[00:36:34.370]how much you're moving, how much you're getting up.
[00:36:38.250]We are doing a lot more data collection about
[00:36:41.921]kind of overall mood and what you're doing every day.
[00:36:45.490]So we're integrating these daily check-ins to basically
[00:36:50.720]randomly page veterans on their smartphones,
[00:36:54.193]and ask them how they're feeling in the moment.
[00:36:56.310]So this is a really good way to kind of get at
[00:36:59.750]what veterans are doing every day, who they're with,
[00:37:02.025]they're getting outta the house, how they're feeling.
[00:37:04.380]And we ask them every day for two weeks.
[00:37:06.900]So we get kind of a more day to day variability
[00:37:09.580]rather than the surveys asked in the past month.
[00:37:12.430]How often have you felt X, Y, and Z.
[00:37:14.580]We're asking them every day. So lots more data.
[00:37:18.770]And then like I mentioned,
[00:37:19.780]we have some more dog stuff in here.
[00:37:22.930]So including the dogs this time,
[00:37:25.750]we put an activity monitor on the dogs too.
[00:37:29.343]So all the dogs also wore a little Fitbit on their collar
[00:37:32.480]to monitor their sleep and their activity.
[00:37:34.720]This is what that looks like. It's called a whistle.
[00:37:38.510]And then we're also integrating
[00:37:40.070]the dogs' personality and temperament.
[00:37:42.840]So just another reminder here
[00:37:45.120]that these dogs are all different.
[00:37:47.220]They all have incredibly different personalities,
[00:37:49.164]they're all shelter dogs,
[00:37:50.990]they all differ in how sociable they are,
[00:37:52.920]how food motivated and how driven they are.
[00:37:55.850]They, they might have different rearing histories.
[00:38:00.690]And that's one of the things we're looking at,
[00:38:02.840]is what kind of behavioral personality traits
[00:38:05.520]are you able to pick out here
[00:38:06.940]and see how that's related to outcomes?
[00:38:09.300]So that's in the works as well.
[00:38:12.425]And I just wanted to end with really happy news.
[00:38:15.420]It's amazing when your research means something
[00:38:18.000]and like help the world.
[00:38:19.930]And as part of the research that we did at Purdue,
[00:38:22.890]and then also many other research groups
[00:38:25.243]and research that the VA did themselves,
[00:38:27.710]all of this research culminated into this new act,
[00:38:31.450]which was signed in August and started in January,
[00:38:34.710]which is called the PAWS Act.
[00:38:36.590]So you might have seen it in the news
[00:38:38.720]where it's a pilot program and,
[00:38:40.920]and really the first time in American history that
[00:38:43.570]the VA has, has put funding towards service dogs or PTSD.
[00:38:48.225]So that is just starting and it's really cool.
[00:38:52.710]The, translational impact of the research
[00:38:55.389]to be able to do this pilot program
[00:38:58.610]where the VA is partnering with some nonprofits,
[00:39:01.540]including K9s for Warriors, to be able to provide funds
[00:39:04.500]for the service dogs to be placed.
[00:39:06.650]And then they'll be documenting outcomes over several years.
[00:39:10.970]So that is in the works as well.
[00:39:14.350]And just a really happy outcome.
[00:39:18.390]So I'm all done.
[00:39:19.740]I just wanted to thank my humongous team of collaborators.
[00:39:23.740]It takes a village to do this research.
[00:39:25.600]We have to have dog people and veteran people,
[00:39:27.640]and mailing people, and obviously funding to do it.
[00:39:31.500]So thank you to all of our funders for each of our studies,
[00:39:35.050]and the collaborators. And please get in touch
[00:39:37.960]if you wanna talk about all things service dogs.
[00:39:42.522]I'm happy to answer some questions now as well.
[00:39:44.772]So, thank you.
[00:39:55.599]So we have mics here
[00:39:56.910]if someone would like to come up
[00:39:57.743]and ask questions at the microphones.
[00:40:00.507]And we can also check in on Q&A and chat.
[00:40:04.428]Come on up and ask your questions.
[00:40:18.305][Audience Member 1] So when you're talking about
[00:40:19.940]the first study, you mentioned that you used batteries
[00:40:21.738]that have been used as sort of gold standard.
[00:40:25.680]Wondering if you could speak to the sort of size and the
[00:40:28.347]effect of therapy dogs versus some of those
[00:40:32.590]gold standard treatments like CBT or something like that.
[00:40:35.360]Yep. Our affects size
[00:40:37.060]are pretty similar for PTSD, depression, and anxiety,
[00:40:40.910]which were the main comparisons.
[00:40:43.330]So about a medium affect size and also replicated,
[00:40:46.840]what I want to mention is that there was a loss
[00:40:49.238]or symptom reduction without a loss of diagnosis.
[00:40:52.810]So yeah, pretty much very similar.
[00:40:55.670]The one thing to keep in mind is that as I mentioned,
[00:40:59.349]everyone was receiving usual care.
[00:41:01.200]So they're also receiving other treatments.
[00:41:03.500]So we're really unable to parse out exactly
[00:41:05.650]how many of the symptoms would be the dog
[00:41:07.509]and how many, you know, other things.
[00:41:10.070]So that's why in the clinical trial, we're,
[00:41:11.760]we're exactly asking, "What are you doing right now?
[00:41:14.457]And what are you doing in three months?"
[00:41:15.840]and trying to isolate that service dog component, so.
[00:41:19.490]That's just a caveat.
[00:41:25.060]Read a question from Simpkins,
[00:41:28.097]"The $2,000 average for a service dog,
[00:41:31.610]would you be able to provide more information-
[00:41:34.380]would you be able to provide more information
[00:41:35.800]on where that money goes?
[00:41:37.690]If the dogs are coming from a shelter, is it expensive
[00:41:39.890]'cause the cost is of the trainer. So why,
[00:41:42.080]why does it cost $20,000 to train a service dog?"
[00:41:45.970]Yeah. So that is more of just an average
[00:41:47.960]across the whole industry. It's just an average.
[00:41:50.900]I don't know, that's been like kinda the dollar it's,
[00:41:54.910]it's different for everyone, but yeah,
[00:41:56.510]it's a lot of personnel time.
[00:41:58.630]I mean the dog trainer's salary for the,
[00:42:01.600]the breeding programs,
[00:42:03.010]of course those are much more expensive.
[00:42:05.200]And then you have to care for the dog for its entire life.
[00:42:07.760]So veterinary cost and then food and you know,
[00:42:10.820]all those things. So yeah,
[00:42:12.320]if you calculate much you're spending on your pet dog
[00:42:14.330]for a month or for a year you'll understand
[00:42:16.028]how expensive they are. But yeah,
[00:42:18.070]that is one of the reasons why is really that time,
[00:42:20.458]that person time, as well as the overhead of training.
[00:42:33.355][Audience Member 2] I was wondering if there was
[00:42:34.880]any screening for the safety of the dogs,
[00:42:37.370]such as being placed with a veteran
[00:42:39.190]that has violent night terrors or blackouts.
[00:42:41.710]Yeah. Like I said,
[00:42:42.897]K9s for Warriors does all of that screening,
[00:42:44.640]they're very protective of their dogs.
[00:42:46.740]They go through a lot of interview process and
[00:42:49.180]recommendation letters and, and, and things.
[00:42:52.070]So we don't screen them for that.
[00:42:53.820]They're already screened.
[00:42:54.653]So anyone that has any sort of violence
[00:42:56.437]would not be eligible to get a service dog,
[00:42:59.010]they have to really demonstrate that they are gonna keep the
[00:43:02.818]dog safe and that they're gonna be able to care for the dog.
[00:43:05.970]So that is one of the screeners for sure.
[00:43:10.793][Audience Member 3] Okay.
[00:43:11.626]I just wondered if you had looked at
[00:43:14.080]the number of hospitalizations with the veterans,
[00:43:17.210]I didn't see that on there, but you know,
[00:43:19.580]hospitalizations are very expensive. So, you know,
[00:43:22.050]to look at the 20,000 it takes to pay for it
[00:43:25.430]as opposed to the hospitalization.
[00:43:26.950]So I just wondered about that.
[00:43:28.970]Yeah. I, we are not collecting that.
[00:43:31.180]I believe we will be collecting that in their pilot study.
[00:43:34.430]So that'll be really important to get
[00:43:36.475]kind of that dollar amount estimate.
[00:43:40.000]So yeah,
[00:43:40.833]I believe that is really interesting forthcoming data.
[00:43:43.430]As well as overall like, the animal utilization,
[00:43:45.993]I think is an important outcome to look at.
[00:43:48.700]If that's influencing things.
[00:43:52.325][Audience Member 4] Hi. This is gonna be
[00:43:54.130]a bit of an intense question. (laughs)
[00:43:57.675]Cause I was wondering, thinking about like what PTS-
[00:44:01.630]what these dogs are helping with versus
[00:44:03.710]what they, like, don't really have a true effect on.
[00:44:06.240]So like making sure you're not planting anything,
[00:44:08.440]that's not there.
[00:44:09.273]Another thing I was wondering is I think the,
[00:44:12.040]sometimes when this is like, colloquially,
[00:44:15.240]someone is like, oh, I need a service dog 'cause, X-Y-Z
[00:44:18.755]And so the, like,
[00:44:22.330]an ultimate, like, good
[00:44:24.920]rather than just the mildly helped symptoms,
[00:44:27.240]is this idea that there are some veterans who
[00:44:30.140]aren't committing suicide
[00:44:31.310]because they have their dog in their life.
[00:44:32.684]Yeah.
[00:44:33.551][Audience Member 4] Is there any way you could,
[00:44:35.090]like, quantify that like over a time scale,
[00:44:37.500]how many in this swarm of PTSD
[00:44:40.267]versus PTSD with service animal, like, commit suicide?
[00:44:44.729]Is that anything you looked at or a possibility?
[00:44:47.419]Not necessarily commit suicide.
[00:44:50.630]We are integrating that suicidal behavior and thoughts,
[00:44:54.660]which is actually very complex to study ethically
[00:44:58.460]and it requires a diff- just a lot more.
[00:45:02.330]So we did integrate that.
[00:45:04.590]I think that's a really interesting future direction,
[00:45:08.440]it's just very hard to quantify.
[00:45:09.720]I think we need, we need a lot of,
[00:45:11.500]of years of, of placement.
[00:45:13.230]So as the field continues to grow and as we're getting
[00:45:15.670]more researchers in this field and more funding, I,
[00:45:18.150]I think that's definitely the direction we'll be heading
[00:45:20.110]is kinda these more longitudinal studies.
[00:45:23.360]The other question that we don't have data on by think needs
[00:45:26.590]a lot more data is what happens
[00:45:27.770]when the service dog dies. So again,
[00:45:30.220]we need to kind have, you know, many data points
[00:45:33.300]in many years to be able to understand that,
[00:45:35.380]we don't necessarily have great data on that right now.
[00:45:38.203]So future direction, for sure.
[00:45:43.333]Another question that says,
[00:45:45.842]"I know you kind of shared the results of the third project
[00:45:47.567]but what keeps you up at night regarding
[00:45:49.675]the PTSD service dogs? What kinds of things-
[00:45:52.040](indistinct)
[00:45:53.298]Yeah.
[00:45:54.310]Yeah. What's,
[00:45:55.143]what's messing up your cortisol in the morning?
[00:45:58.283]Oh, oh.
[00:46:04.918]Um.
[00:46:06.660]I don't know. I think you guys don't realize how much
[00:46:09.242](laughs) data there is.
[00:46:12.020]We had to link everything up.
[00:46:14.160]So veterans, you know, wore the wristbands.
[00:46:16.600]We had that for two weeks. Then they also like, you know,
[00:46:19.700]did, like, surveys four times a day on their smartphones.
[00:46:22.610]We have that four times a day for two weeks,
[00:46:24.890]we have to link up that data.
[00:46:26.160]Then they have their survey they completed and then
[00:46:29.070]they have their cortisol. We have the essay,
[00:46:32.610]we took all that data. And then we also had the spouses.
[00:46:35.711]So we have to link up the spouses of the veterans
[00:46:37.830]on all these data streams. It's incredibly complex.
[00:46:41.200]I did not even realize what I was signing,
[00:46:43.050]or like what we were signing up for
[00:46:44.323]when we built this study. It is insane.
[00:46:47.430]So that maybe that's what is the hurdle, but it's coming,
[00:46:51.690]we worked with the statistician at Purdue
[00:46:53.210]that's doing all the analyses
[00:46:54.610]and all the complex multi-level models.
[00:46:58.410]I'm actually not working on it.
[00:46:59.782]They're working on it very hard.
[00:47:03.821][Audience Member 5] So thank you Kerri,
[00:47:04.660]for a lovely talk. That was very interesting.
[00:47:07.810]As someone who studies cortisol, momentary reactivity,
[00:47:13.430]real life data, I was really disappointed
[00:47:15.450]that you just brushed over the cortisol.
[00:47:17.080]Can you talk about that for us?
[00:47:19.010]I usually put people
[00:47:19.901]the most amount of time.
[00:47:20.734][Audience Member 5] I have to know- (indistinct)
[00:47:26.330]But I do want to know when you were talking about
[00:47:30.020]sort of this notion of finding that over time,
[00:47:34.190]the longer the service dog was with the veteran,
[00:47:38.210]you noticed a decrease in the amount of time that the dog
[00:47:43.230]was used for specific trained behaviors.
[00:47:46.510]Yeah.
[00:47:47.343][Audience Member 5] Yet the untrained behaviors,
[00:47:49.200]if I remember correctly,
[00:47:51.090]you know, seemed to be going up and I'm just,
[00:47:54.620]I thought that was a really interesting finding
[00:47:56.970]and I want to know, one, did you
[00:47:59.090]potentially explore that qualitatively in some of this
[00:48:02.420]other work, and also is it possible that
[00:48:06.000]there may be some adaptation
[00:48:09.600]that occurs that is sort of an initial reduction of PTSD
[00:48:15.000]where the dog eventually becomes more pet-like.
[00:48:18.660]Yeah.
[00:48:19.579][Audience Member 5] I'm just, can you talk more about it?
[00:48:21.013]That is one big hypothesis in the field
[00:48:23.457]as, as the,
[00:48:24.750]as the reliance on the service dog's trained task,
[00:48:27.880]and especially going into public with the service dog
[00:48:29.960]might be decreasing, that they're integrating more.
[00:48:33.170]Yeah. As, as a pet or as emotional support.
[00:48:36.090]And we haven't been able to really quantify that.
[00:48:38.447]What's gonna be interesting is we have,
[00:48:40.227]in the clinical trial, only three months time point.
[00:48:43.240]So we're gonna be really interested to see
[00:48:45.140]if we're finding these effects in three months,
[00:48:47.490]or what actually might take six months or a year
[00:48:49.810]for these things to happen. We don't necessarily know yet.
[00:48:53.020]Qualitatively, we haven't studied this,
[00:48:55.940]but other groups have in looking at this,
[00:49:00.040]these kinda parsing out the effects.
[00:49:02.780]And then I think what the really interesting data that will
[00:49:05.870]help answer that question is the VA study,
[00:49:09.080]which I don't know if you're familiar with,
[00:49:10.840]they compare the emotional support dogs to the service dogs.
[00:49:14.710]So they kind of parsed out that public access component and
[00:49:18.350]that training task component to see how much that's
[00:49:22.450]influencing PTSD and how much the dog is.
[00:49:26.020][Audience Member 5] Well, and I also wondered if,
[00:49:27.170]if we're making the argument that this is useful
[00:49:30.340]especially under this new act,
[00:49:31.860]I worried that maybe your findings
[00:49:34.370]will lead people to think, well,
[00:49:35.750]then, only have the service dog for the first year and then
[00:49:39.710]maybe a, a regular untrained pet
[00:49:42.362]or an emotional support animal might do.
[00:49:45.690]I don't know. I mean, that's-
[00:49:46.523]be a really interesting...
[00:49:47.438][Audience Member 5] There's something about findings
[00:49:49.081]that do weird things.
[00:49:51.000]No, that very well might be the case.
[00:49:52.300]We don't have great data. So like a guide dog, when your,
[00:49:55.318]or your guide dog or service dog retires,
[00:49:57.530]you get a new one, right.
[00:49:59.020]We don't have great data on if getting another service dog
[00:50:01.860]after seven years of working life
[00:50:03.640]is the correct thing to do, we have none of that data.
[00:50:06.640]So that is still very much in the air that I don't think
[00:50:09.580]any clinician or service dog trainer or researcher
[00:50:12.470]is able to say, "This is definitely beneficial."
[00:50:15.600]So yeah, I think that's a big, big question
[00:50:18.297]in the field for sure.
[00:50:22.777][Audience Member 6] That was a very excellent talk.
[00:50:23.838]I wondered if you could speak to whether,
[00:50:27.890]especially with the results of your study,
[00:50:31.150]the reduction in the symptoms overall,
[00:50:33.977]in the PTSD populations, it's quite striking,
[00:50:36.758]but then I thought, well, should I get a dog
[00:50:39.148]to decrease my- (indistinct)
[00:50:40.322](laughs) Yeah.
[00:50:44.816][Audience Member 6] Is it, localized?
[00:50:46.864]Is that improvement localized to that clinical population?
[00:50:50.971]Or is it more generalized in owning a companion like a dog?
[00:50:56.847]Yeah.
[00:50:57.772][Audience Member 6] Or just, you know, (indistinct)
[00:50:59.381]regardless of our own diagnosis symptoms?
[00:51:01.618]Or decrease depression?
[00:51:05.030]That's a great question, and, um,
[00:51:06.740]unfortunately it is very difficult to research,
[00:51:09.140]because we would need to take all you guys, you know,
[00:51:11.567]nobody have a dog,
[00:51:12.820]randomized to who gets a dog or not and follow
[00:51:15.441]your depression over time. It's impossible to do.
[00:51:18.060]We haven't had definitive studies to say causally
[00:51:22.860]that dogs decrease depression.
[00:51:25.150]Our PTSD studies do that with the three months,
[00:51:27.681]but not like a general population.
[00:51:31.050]So there's some correlational research that might suggest
[00:51:34.160]that having a dog is less depression.
[00:51:36.060]There's also correlational research that suggests that
[00:51:38.300]having a dog meets with more depression,
[00:51:41.970]so very complex field with a lot of mixed findings.
[00:51:46.570]And in general, no,
[00:51:48.240]I do not think you need to get a dog for your depression.
[00:51:51.820]And it, it's a lot more complex than that.
[00:51:55.540]So it's definitely a growing field,
[00:51:57.490]but it's not one that's very conclusive as far as,
[00:52:00.040]like, that causal, if you get a dog, then you will get this.
[00:52:04.115][Audience Member 6] Thank you.
[00:52:04.948]Mhm.
[00:52:09.340]Thank you so much, Dr. Rodriguez for this talk
[00:52:11.760]It was a wonderful talk.
[00:52:12.721]Thank you!
[00:52:15.460]Join me in thanking her.
[00:52:17.466](clapping)

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PTSD service dogs for military veterans: Current knowledge and future directions

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