Emotional Support Animals for Depression

Depression is one of the most common mental health issues concerning individuals in the US and it is the most common cause for student disability amongst college students. It causes negative educational, social, economic outcomes, and even suicide. Depression treatment effectiveness is specific to each individual. Animals have been used throughout history to assist human interaction and wellbeing. Particularly, emotional support animals have shown to aid in reducing the biobehavioral processes associated with depression. It is important to research all treatment options in order to make them available for individuals’ specific condition. This study seeks to support the hypothesis that if individuals with depression have an emotional support animal, then their levels of depression will be reduced.

Depression has become one of the most common mental health concerns. It is now affecting more than 16 million American adults each year. Depression is common predominantly amongst those who have occurrences of social or personal conflicts, health related disabilities, deaths of close family or friends, and social seclusion (Branson, Boss, Cron, & Kang, 2016). It can be caused by several different factors. These may include difficult life events, medication side effects, a family history of depression, imbalance of neurotransmitters, or negative thinking patterns. It may also co-occur along with another condition such as cancer, diabetes, heart disease, or a hormonal disorder. Individuals with depression may exhibit signs of sad or anxious mood, abnormal sleeping patterns, irritability, persistent pain, digestive conditions, trouble with focusing or decisions, lethargy, feelings of guilt or hopelessness, self-harm, and suicidal thoughts or actions. Being such an impairing mental condition, adequate and effective treatment may be difficult to find.

Research shows that depression is considered to be among the most commonly diagnosed and treated of all psychiatric disorders (He, Zhang, et al., 2019). More specifically, in the population of students with disabilities within college campuses, 24 percent reported that they have a mental health condition or depression making this group the largest proportion (Agarwal & Kumar, 2014). Depression during this stage can result in negative educational, social, and economic outcomes. In particular, suicide is reported to be the leading cause of death in college students in the United States (Acharya, Jin, & Collins, 2018). Study results are reflective of the importance of depressive symptoms in relation to suicide ideation among college students and suggest that depressive symptoms must be a key focus of the conceptualization and assessment of risk (Cukrowicz, Schlegel, Smith, Jacobs, Van Orden, Paukert, Pettit, & Joiner, 2011). It may be possible that because depression in college students is more often a first onset disorder it can be treated better as opposed to a recurrent depressive disorder. With college years being such a critical period for individuals with depression, alternate treatment options should be further explored and made available.

There are several options for individuals with this condition. Among the several forms of therapy there is psychotherapy which is a method which involves treating a phycological disorder through communication with a mental health professional. The most common form of psychotherapy for depression is cognitive behavioral therapy. This therapy is considered to be a goal-oriented approach intended to change patterns of thought in order to change the way the individual feels. Various forms of psychotherapy are used in the treatment of depression along with other forms of treatment. Studies show that CBT has enhanced treatment efficacy when used along with antidepressant medication treatment (He, Zhang, et al., 2019). Group therapy was also compared to individual therapy in a study by Cujipers et al. (2016) suggesting that individual treatment is more effectual than group therapy among college students. Psychotherapy has been used in combination with other methods of treatment but considering the diversity of the individuals with depression it is difficult to find effective treatment that fits each individual’s needs.

Medication treatment is also a common recommendation for individuals with depression. Antidepressants have become a recommended alternative or addition to psychotherapy. These medications regulate the balance of neurotransmitters in the brain that directly affect mood and emotions. Their goal is to regulate daily life by increasing positive mood, increase appetite, increase concentration, and regulate sleep patterns. Despite the benefits of taking antidepressant medication, its adherence has been subject for concern. 30-60% of all patients who commence treatment with antidepressant medication discontinue taking the medication within the first 12 weeks causing reduction of treatment effectiveness, risk of relapse and reoccurrence of depression (Buus, Johannessen, & Stage, 2011). This is particularly concerning because the guidelines for antidepressant medications require patients to take their medication for at least 6-9 months to prevent relapse after the remission of a depressive episode (Rheker, Winkler, Doering, & Rief, 2016). Medication therapy for depression encounters several hindrances that reduce its efficacy.

Antidepressant mediations have many side effects that may also cause medications to be managed inappropriately including dose reduction and voluntary secession. Previous research has shown that side effects were regarded a primary cause of non-compliance (Kikuchi, Suzuki, Uchida, Watanabe, & Mimura, 2012). Common side effects of antidepressants are daytime sleepiness, insomnia, dry mouth, loss of interest in sexual activity, nausea, and weight gain (Rheker et al., 2016). These side effects specifically can produce issues with college students because they may cause additional impairments to an already emotionally impaired individual. Additional deficiencies can become hinderances in the lives of college students affecting even further their productivity with coursework. There are other pharmaceutical options added to those the show symptoms of specific side effects. However, there is little information found regarding the adherence of antidepressant medication after receiving additional medication for its side effects.

Another kind of intervention for depression is animal assisted therapy. For centuries animals have been used to assist human beings with physically, mentally, or socially impaired functioning in various ways (Schramm, Hediger, & Lang, 2015). Animal assisted therapy is considered to be an intervention involving an animal to improve cognitive behavioral or social and emotional functioning. Pets are an integral part of the everyday lives of many people in this country and there have been numerous studies on the physical and mental health benefits of animal companionship to people, including stress buffering and facilitation of social interaction (Adams, Sharkin, & Brottnelli, 2017). There is an increasing amount of research indicating positive outcomes regarding human interactions with animals that improve human health and well-being (Schramm, Hediger, & Lang, 2015).

More specifically, emotional support animals have been becoming more frequently used by individuals with mental health conditions especially. Emotional support animals are considered to be a service animal by the criteria that it has been shown to have the innate ability to assist a person with a disability requiring only obedience training (Ensimger & Thomas, 2013). An emotional support animal may be a dog, cat, rabbit, or any species allowed under local law which is not trained to do specific tasks but who’s mere presence assists in providing relief from symptoms associated with a disability (Kogan, Schaefer, Erdman, & Schoenfeld-Tacher, 2016). During the past 10 years, college campuses have been seeing a rising number of appeals from students to bring pets to campus in order to help them manage with emotional symptoms associated with diagnosable conditions such as anxiety, depression, and post-traumatic stress (Adams, Sharkin, & Brottnelli, 2017).

Particularly, Branson et al. (2016) found that companion animals reduce the negative biobehavioral processes associated with depression. Despite the popularity of emotional support animals in college campuses there is a lack of information regarding researching its effectiveness. Depression has various treatment options, and each should be researched in detail in order to make them easily available to individuals for whom it might benefit. This study seeks to support the hypothesis that if individuals with depression have an emotional support animal, then their levels of depression will be reduced.

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The participants in this study included 232 Florida International University students. Participants included 110 males and 122 females. All participants were between the ages of 18-22. All participants were recruited on a volunteer basis through the recommendation of the Florida International University Counseling and Psychological Services department. All of the participants were previously diagnosed with depression within 6 months prior to the study by the university’s psychological services department. All of the participants were open to adopting an emotional support animal and were non pet owners prior to the study. Participants were randomly assigned to one of the two conditions.

A demographic questionnaire was issued to all referred participants with using pen and paper in the Counseling and Psychological Services Department (see Appendix A). The demographic questionnaire consisted of 30, both multiple choice and open-ended anchor questions. The demographic questionnaire included questions regarding whether the participants had been diagnosed with depression, how long ago their diagnosis was, if they are currently under any kind of treatment, and if they were willing to adopt an emotional support animal. Those participants who qualified for the study were given a consent form regarding the procedures, benefits, and risks of participation.

Emotional support dogs were provided to participants who were assigned to the corresponding condition. These emotional support animals were dogs adopted through the Miami Dade County Animal Shelter. The breed of dog chosen for this study were Labrador retrievers. The dogs were all within the ages of 1-3. These animals all were provided with basic obedience training with a dog trainer who was certified with the Certification Council for Professional dog trainers and the Association of Pet dog trainers in the animal shelter prior to adoption. Each of these dogs were provided to the participants along with the materials necessary for caring for the animal. These materials included a leash, collar, name tag, bowls, and food. The emotional support animal certification was obtained with the licensed mental health provider who the participants were referred by in the form of an ESA letter in order for participants to be allowed access to public locations with their dogs.

Cognitive behavioral therapy sessions were conducted in the Counseling and Psychological services department of Florida International University in an office setting for each individual participant by a licensed mental health provider.

The Beck Depression Inventory was used after 6 months of cognitive behavioral therapy and having the emotional support animal to evaluate depression levels of participants. The Beck Depression inventory contains 21 questions with each answer scored on a scale from 0 to 3. The score for each question is added up and the higher the total score is the more severe the depressive symptoms are. The total scores are put into four categories; 0 to 13 meaning minimal depression, 14-19 meaning mild depression, 20-28 meaning moderate depression, and 29-63 meaning severe depression (Beck et al., 1961). Participants answered these questions in a computer form in the office of Counseling and Psychological services. The data collected from the Beck Depression Inventory was analyzed using SPSS.

This study was a simple between subjects research design. The independent variable had two levels. One level was receiving an emotional support animal along with receiving cognitive behavioral therapy and the second condition was only receiving cognitive behavioral therapy. The dependent variable was the severity of depression of the participant and it was measured using the Beck Depression Inventory (Beck et al., 1961).

Participants were screened using a demographic questionnaire (see Appendix A) using pen and paper in the Counseling and Psychological Services Department. The participants that qualified for the study received a consent form describing the procedures, benefits, and risks of participation. At this time the participants were provided the contact information of the researchers in case necessary throughout the course of the study. Participants were then randomly assigned to either the emotional support animal condition or the cognitive behavioral therapy condition. All participants attended three, weekly, one-hour sessions of individual cognitive behavioral therapy with a licensed mental health professional in an office setting within Florida International University Counseling and Psychological Services department for a period of 6 months. In addition, the participants in the experimental group were provided with an emotional support dog to take home for a period of 6 months.

After the six months all participants were provided with the Beck Depression Inventory in the same office setting within Florida International University Counseling and Psychological Services department where they had received cognitive behavioral therapy. Participants were afterwards debriefed that the purpose of the study was to study the effectiveness of emotional support animals in treating depression and which condition they were in. Participants were thanked for their contribution in the study and asked if they had any questions regarding their involvement. Participants who received an emotional support animal were given the option to officially adopt and become the owners of their emotional support dog after the study. The emotional support dogs that were not adopted were later rehomed by the researchers.

The data acquired during this study was analyzed using SPSS. Analysis was performed on the dependent variable comparing both independent variable conditions using an independent samples t-test. The Levene’s test was used to test for homogeneity of variance.