title: Animal-assisted therapy with chronic psychiatric inpatients: equine-assisted psychotherapy and aggressive behavior.
abstract: OBJECTIVE
  Animal-assisted therapy (AAT), most frequently used with dogs, is being used increasingly as an adjunctive alternative treatment for psychiatric patients. AAT with larger animals, such as horses, may have unique benefits. In this randomized controlled study, equine and canine forms of AAT were compared with standard treatments for hospitalized psychiatric patients to determine AAT effects on violent behavior and related measures.
  
  
  METHODS
  The study included 90 patients with recent in-hospital violent behavior or highly regressed behavior. Hospitalization at the 500-bed state psychiatric hospital was two months or longer (mean 5.4 years). Participants were randomly selected to receive ten weekly group therapy sessions of standardized equine-assisted psychotherapy (EAP), canine-assisted psychotherapy (CAP), enhanced social skills psychotherapy, or regular hospital care. Participants' mean age was 44, 37% were female, 76% had diagnoses of schizophrenia or schizoaffective disorder, and 56% had been committed involuntarily for civil or forensic reasons. Violence-related incident reports filed by staff in the three months after study intake were compared with reports two months preintake.
  
  
  RESULTS
  Interventions were well tolerated. Analyses revealed an intervention group effect (F=3.00, df=3 and 86, p=.035); post hoc tests showed specific benefits of EAP (p<.05). Similar AAT effects were found for the incidence of 1:1 clinical observation (F=2.70, df=3 and 86, p=.051); post hoc tests suggested benefits of CAP (p=.058) as well as EAP (p=.082). Covariance analyses indicated that staff can predict which patients are likely to benefit from EAP (p=.01).
  
  
  CONCLUSIONS
  AAT, and perhaps EAP uniquely, may be an effective therapeutic modality for long-term psychiatric patients at risk of violence.
authors.affiliation: At the time of the study, Dr. Nurenberg, Dr. Schleifer, Dr. Desai, Dr. Amin, Mr. Bouchard, and Dr. Montalvo were with the Department of Psychiatry, Greystone Park Psychiatric Hospital, Morris Plains, New Jersey ( jeffry.nurenberg@dhs.state.nj.us ). Dr. Nurenberg remains affiliated with Greystone and is also with the Department of Psychiatry, Rutgers New Jersey Medical School, Newark, where Dr. Schleifer was primarily affiliated at the time of the study and remains. Dr. Desai is now with the Department of Psychiatry, St. Elizabeths Hospital, Washington, D.C. Dr. Amin is now with the Department of Surgery, East Carolina University, Greenville, North Carolina. Mr. Bouchard is now with the Department of Psychology, University of Nebraska, Lincoln. Dr. Montalvo is now with the Department of Psychiatry, Boston University School of Medicine, Boston. Mr. Shaffer was and remains with the Department of Training and Ms. Yellin was and remains with the Department of Occupational Therapy at Greystone Park Psychiatric Hospital. Portions of this work were presented at the European Congress of Psychiatry, Vienna, Austria, March 12-15, 2011; the annual meeting of the American Psychiatric Association, Honolulu, Hawaii, May 14-18, 2011; and the European Congress of Psychiatry, Nice, France, April 6-9, 2013.
authors.forename: Jeffry R
authors.initials: JR
authors.lastname: Nurenberg
authors.forename: Steven J
authors.initials: SJ
authors.lastname: Schleifer
authors.forename: Thomas M
authors.initials: TM
authors.lastname: Shaffer
authors.forename: Mary
authors.initials: M
authors.lastname: Yellin
authors.forename: Prital J
authors.initials: PJ
authors.lastname: Desai
authors.forename: Ruchi
authors.initials: R
authors.lastname: Amin
authors.forename: Axel
authors.initials: A
authors.lastname: Bouchard
authors.forename: Cristina
authors.initials: C
authors.lastname: Montalvo
mesh_terms: D000328:Adult; D000374:Aggression / Q000523:psychology*; D056447:Animal Assisted Therapy / Q000379:methods*; D000818:Animals; D003134:Commitment of Persons with Psychiatric Disorders; D004285:Dogs; D056147:Equine-Assisted Therapy / Q000379:methods; D005260:Female; D006736:Horses; D006801:Humans; D007297:Inpatients; D008297:Male; D008875:Middle Aged; D011615:Psychotherapy, Group / Q000379:methods*; D011618:Psychotic Disorders / Q000628:therapy*; D012559:Schizophrenia / Q000628:therapy*; D066107:Social Skills; D016896:Treatment Outcome; D014754:Violence / Q000517:prevention & control*