Welcome to my blog, a place to explore and learn about the experience of running a psychiatric practice. I post about things that I find useful to know or think about. So, enjoy, and let me know what you think.

Saturday, November 16, 2013

The Comfort of Dogs

I'm coming up on a year with my first dog. How did that happen? Long story. Is she a royal pain? Yes. Am I crazy about her? Of course. Do I take her with me everywhere I go? No.

An article in the NYTimes, Emotional Support, With Fur, Draws Complaints on Planes, describes the practice of bringing Emotional Support Animals (ESA's, mostly dogs), onto airplanes, where they sit on their handlers' laps, rather than under the seat in a cage, where regular pets have to ride. They also fly free.

I hadn't heard of ESA's. When I worked in a hospital setting, there were therapy dogs that visited with patients. It was actually quite amazing to see their effect. There was a beautiful golden retriever who was universally loved. He would come onto the unit, and even non-verbal, nearly catatonic patients would smile and pet him.

So I got curious about what an emotional support dog is. According to the US Dog Registry,

"An emotional support dog is a dog that provides comfort and support in forms of affection and companionship for an individual suffering from various mental and emotional conditions. An emotional support dog is not required to perform any specific tasks for disability like service dogs are. There are meant solely for emotional stability and unconditional love."

The "mental and emotional conditions" include most psychiatric diagnoses and cognitive conditions. The National Service Animal Registry notes exclusions as follows:

Neither deviant behavior (e.g., political, religious, or sexual) nor conflicts that are primarily between the individual and society are mental disorders unless the deviance or conflict is a symptom of a dysfunction in the individual. According to Title II of the American with Disabilities Act of 1990, current or future interpretation of psychological disabilities excludes common personality traits such as poor judgment or a quick temper.

Unlike service dogs, who undergo rigorous training to assist people with limited mobility, hearing and visual impairment, some psychiatric conditions, and certain medical problems, emotional support dogs have no specific training. The only requirement for an emotional support dog is a letter from a doctor indicating that you have a condition for which an emotional support dog is warranted. Once you have that, you can take your dog anywhere, including restaurants and airplanes, and you can even live in places that don't allow dogs. There are services that provide such letters. One template for the letter looks like this:


To Whom It May Concern:
[Full Name of Patient] is my patient and has been under my care since [date]. I am intimately familiar with his/her history and with the functional limitations imposed by his/her emotional/mental health-related issue.

Due to this emotional disability, [patient first name] has certain limitations coping with what would otherwise be considered normal, but significant day to day situations. To help alleviate these challenges and to enhance his/her day to day functionality, I have prescribed [patient first name] to obtain an emotional support animal. The presence of this animal is necessary for the emotional/mental health of [patient name] because its presence will mitigate the symptoms he/she is currently experiencing.


(Physician’s name and title)

You can officially register your emotional support dog, for a fee, and get a kit that includes a certificate, ID card, dog tag, and for an additional fee, a service dog vest.

A reasonable question, I think, is how useful, psychologically speaking, are emotional support dogs? And for that matter, how useful are dogs, in general, for "emotional" problems?

There are three official roles that dogs play in emotional conditions. There's the emotional support dog, which is used by an individual for emotional support, which can obviously be defined very broadly. There are therapy dogs, who are trained to bring comfort to strangers, or groups of strangers, in a hospital or assisted living facility, for example. According to the American Kennel Club, "It is unethical to attempt to pass off a therapy dog as a service dog for purposes such as flying on a plane or being admitted to a restaurant."

And there are service dogs for psychiatric conditions. For example, Autism Assistance Dogs are trained to help their handlers fall asleep when they have insomnia, and provide deep pressure during panic attacks (source). And Psychiatric Assistance Dogs can assess the safety of a situation in the case of paranoia or hallucinations, can remind their handlers to take their meds, and can interrupt self-harming behaviors (same source). Think of the training involved in all that.

An article entitled, Do animal-assisted activities effectively treat depression: a meta-analysis, "found some empirical support for the therapeutic effectiveness of dog-assisted activities/therapy for treating depression." But it noted that the studies were limited in number and quality.

What was really interesting was where I found the reference to this article. It was here, in The United States Army Medical Department Journal: Canine-Assisted Therapy in Military Medicine, April to June 2012, edition. This is a huge document that I'm quite interested in reading, in my copious free time, of course. I did peruse the section entitled, Research on Benefits of Canine-Assisted Therapy for Adults in Nonmilitary Settings; Knisely, et al, Pp. 30 and following. This section cited the Virginia Commonwealth University Center for Human-Animal Interaction (CHAI), which has done some interesting research on the topic of animal assisted therapy.

I don't really have an opinion about taking emotional support dogs onto airplanes, or into restaurants. I can see both sides. Apparently there have been a lot of complaints, but dogs and humans go way back. We're clearly wired to respond to each other. One theory I read somewhere when I was researching getting a dog states that humans were able to evolve into non-olfactory focused beings who walk upright because we had dogs to do the sniffing for us, and this was supposedly advantageous for our survival.

I have a colleague (psychiatrist) who brings her dog to work. My dog is too skittish for that, but it's interesting to consider incorporating animals into psychiatric outpatient treatment. I'd like to see more studies on the topic.


  1. Do you have feelings about emotional support ducks?

    1. Ducks are complicated. They're used as ESA's only about 2% of the time-less than ferrets, at 5%,but more than aardvarks, at 0.6%- while dogs are much more prevalent. And if there's a duck and a herding dog together on a flight, the dog may chase the duck. Also, dogs with a strong prey drive might be inclined to attack the duck.
      And if a dog, a duck, and a Rabbi get on a flight together, you have problems.

  2. Thanks for the laugh! I do have pts who might have emotional support ducks!

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