Expert Commentary

From best friend to therapist: Research on emotional support animals

emotional support animals
(Chloe Reichel)

It turns out pigs can fly. And turtles and dogs, but maybe not peacocks or hamsters. As some household (and exotic) pets receive promotions to more clinical roles as emotional support animals (ESAs), companions that run the gamut from furry to scaly are popping up increasingly in unexpected places.

The U.S. Department of Justice writes that emotional support animals “provide comfort just by being with a person,” distinguishing them from service animals, which are “trained to perform a specific job or task” and have special protections under the Americans with Disabilities Act of 1990 (ADA).

ESAs, however, do enjoy some accommodations. The federal Air Carrier Access Act has provisions for emotional support animals, which may fly with their owners provided there is adequate documentation (e.g., a note from a licensed health care professional) and/or sufficient notice. There are some restrictions, primarily size-related, on which animals are allowed to fly.

Disabled people with emotional support animals are protected in the realm of housing under the Fair Housing Act and Section 504 of the Rehabilitation Act of 1973, according to the U.S. Department of Housing and Urban Development.

These accommodations have met controversy in some places. At the University of Nebraska at Kearney, the question of whether college campuses must comply with the Fair Housing Act’s accommodation for ESAs ended up in court in 2013, where it was decided that the Act applies to student housing.

Some critics suggest that the designation is misused by people who might not have a genuine emotional need for an animal companion. Websites promise “hassle free emotional support animal registration” (for a fee). Vests and accessories emblazoned with “Emotional Support Animal” are readily available for purchase online.

This research roundup highlights scholarship on perceptions and conceptions of emotional support animals. It also delves into another controversial aspect of ESAs — whether or not the animals provide benefits to their owners — by looking at research on the effects of ESAs on health. Two law review articles, which advocate specific positions on legislation around ESAs, are included at the end of this roundup.


Controversial conceptions and perceptions of ESAs

Public Perceptions of Service Dogs, Emotional Support Dogs, and Therapy Dogs
Schoenfeld-Tacher, Regina M.; et al. International Journal of Environmental Research and Public Health, 2017. DOI: 10.3390/ijerph14060642.

Abstract:  “As service dogs, emotional support dogs, and therapy dogs have become more prevalent in the U.S.A., so too has the controversy surrounding their legitimacy. Yet, there is a lack of objective data regarding the public’s understanding of the role played by each of these types of animals, as well as their perceptions regarding the legitimacy of their integration. An anonymous, online survey was distributed to examine the perceptions of U.S. adults who do not own any type of assistance animal. A total of 505 individuals responded to the online survey, yielding 284 usable responses. Results suggest widespread misconceptions about definitions, rules, regulations, and rights associated with each type of assistance dog. In general, service dogs are more likely to be perceived as helping with a legitimate need, and their access to public spaces is viewed favorably. While there are some concerns about the legitimacy and necessary access rights for emotional support dogs, members of the public correctly identified the roles and rights of therapy dogs. Despite the media’s focus on abuses and false representation of these dogs, most participants reported feeling the majority of people are not taking advantage of the system.”

Professional Veterinary Programs’ Perceptions and Experiences Pertaining to Emotional Support Animals and Service Animals, and Recommendations for Policy Development
Schoenfeld-Tacher, Regina M.; Kogan, Lori R. Journal of Veterinary Medical Education, 2017. DOI: 10.3138/jvme.0116-003R.

Abstract: “Given the unique nature of programs in professional veterinary medicine (PVM), the increasing numbers of students requesting accommodations for emotional support animals (ESAs) in higher education settings is of growing interest to student affairs and administrative staff in PVM settings. Since the legislation pertaining to this type of support animal differs from the laws governing disability service animals, colleges and universities now need to develop new policies and guidelines. Representatives from a sample of 28 PVM programs completed a survey about the prevalence of student requests for ESAs and service animals. PVM associate deans for academic affairs also reported their perceptions of this issue and the challenges these requests might pose within veterinary teaching laboratories and patient treatment areas. Responses indicated that approximately one third of PVM programs have received requests for ESAs (32.1%) in the last 2 years, 17.9% have had requests for psychiatric service animals, and 17.9% for other types of service animals. Despite this, most associate deans reported not having or not being aware of university or college policies pertaining to these issues. Most associate deans are interested in learning more about this topic. This paper provides general recommendations for establishing university or PVM program policies.”

Emotional Support Animals, Service Animals, and Pets on Campus
Von Bergen, C.W. Administrative Issues Journal, 2015. DOI: 10.5929/2015.5.1.3.

Abstract: “For decades, universities have been accommodating physically disabled students who require guide dogs and other types of service animals. Within the past several years, however, mentally disabled students have increasingly petitioned colleges with no-pet policies to permit them to bring their animals on campus because they need a companion or emotional support animal to make college life easier and to reduce their stress, loneliness, depression, and/or anxiety. Institutions that unlawfully reject such requests are finding themselves in court and charged with disability discrimination. Schools are understandably confused about their obligation, if any, to waive their no-pet rules under these circumstances. This article discusses pets on campus and provides administrators guidance with respect to this increasingly contentious issue and to keep their organizations ‘out of the legal dog house.’”

University Counseling Centers’ Perceptions and Experiences Pertaining to Emotional Support Animals
Kogan, Lori R.; et al. Journal of College Student Psychotherapy, 2016. DOI: 10.1080/87568225.2016.1219612.

Abstract: “Increasing numbers of students are requesting accommodations for emotional support animals (ESAs) in higher education settings. Since the legislation pertaining to this type of service animal differs from the laws governing disability service animals, colleges and universities are faced with developing new policies and guidelines. A sample of 248 University Counseling Centers (UCCs) completed a survey about student requests for ESA letters of support from their counselor. The UCCs were also asked if they issue official disability diagnoses for clients. Responses showed that UCCs are not yet being asked to write many letters of support for ESAs — 56.9 percent almost never do it, and 31.05 percent do it only several times per year. And, only 47.18 percent of UCCs write official diagnosis letters in support of disability accommodations. Yet, most UCCs are aware of the need for official policies in this arena. This article provides general recommendations for establishing university policies.”

The Role of Pets in the Lives of College Students: Implications for College Counselors
Adams, Aimee S.; Sharkin, Bruce S.; Bottinelli, Jennifer J. Journal of College Student Psychotherapy, 2017. DOI: 10.1080/87568225.2017.1299601.

Abstract: “The roles that pets play in the lives of college students have received little attention in the college counseling literature. This article will review four topics related to college students and pets that have implications for counselors: (a) the separation anxiety that students experience from not having their pets at college, (b) the devastating impact of losing a pet, (c) requests from students for emotional support animals, and (d) the use of animal-assisted interventions on campuses.”

A Revised Taxonomy of Assistance Animals
Parenti, Lindsay; et al. Journal of Rehabilitation Research & Development, 2013. DOI: 10.1682/JRRD.2012.11.0216.

Abstract: “The use of animals in various assistive, therapeutic, and emotional support roles has contributed to the uncoordinated expansion of labels used to distinguish these animals. To address the inconsistent vocabulary and confusion, this article proposes a concise taxonomy for classifying assistance animals. Several factors were identified to differentiate categories, including (1) whether the animal performs work or tasks related to an individual’s disability; (2) the typical level of skill required by the animal performing the work or task; (3) whether the animal is used by public service, military, or healthcare professionals; (4) whether training certifications or standards are available; and (5) the existence of legal public access protections for the animal and handler. Acknowledging that some category labels have already been widely accepted or codified, six functional categories were identified: (1) service animal; (2) public service animal; (3) therapy animal; (4) visitation animal; (5) sporting, recreational, or agricultural animal; and (6) support animal. This taxonomy provides a clear vocabulary for use by consumers, professionals working in the field, researchers, policy makers, and regulatory agencies.”


Effects of Emotional Support Animals

The Power of Support from Companion Animals for People Living with Mental Health Problems: A Systematic Review and Narrative Synthesis of the Evidence
Brooks, Helen; et al. BMC Psychiatry, 2018. DOI 10.1186/s12888-018-1613-2.

Abstract: “A total of 17 studies were included in the review. Quantitative evidence relating to the benefits of pet ownership was mixed with included studies demonstrating positive, negative and neutral impacts of pet ownership. Qualitative studies illuminated the intensiveness of connectivity people with companion animals reported, and the multi-faceted ways in which pets contributed to the work associated with managing a mental health condition, particularly in times of crisis. The negative aspects of pet ownership were also highlighted, including the practical and emotional burden of pet ownership and the psychological impact that losing a pet has. … This review suggests that pets provide benefits to those with mental health conditions. Further research is required to test the nature and extent of this relationship, incorporating outcomes that cover the range of roles and types of support pets confer in relation to mental health and the means by which these can be incorporated into the mainstay of support for people experiencing a mental health problem.”

Patient Benefit of Dog-Assisted Interventions in Health Care: A Systematic Review
Lundqvist, Martina; et al. BMC Complementary and Alternative Medicine, 2017. DOI 10.1186/s12906-017-1844-7.

Findings: “Eighteen studies that fulfilled the inclusion criteria, and were judged to be of at least moderate quality, were included in the analysis. Three of them showed no effect. Fifteen showed at least one significant positive effect but in most studied outcome measures there was no significant treatment effect. Dog-assisted therapy had the greatest potential in treatment of psychiatric disorders among both young and adult patients. Dog-assisted activities had some positive effects on health, wellbeing, depression and quality of life for patients with severe cognitive disorders. Dog-assisted support had positive effects on stress and mood. … The overall assessment of the included studies indicates minor to moderate effects of dog-assisted therapy in psychiatric conditions, as well as for dog-assisted activities in cognitive disorders and for dog-assisted support in different types of medical interventions. However, the majority of studied outcome measures showed no significant effect.”

Animal-Assisted Intervention for Autism Spectrum Disorder: A Systematic Literature Review
O’Haire, Marguerite E. Journal Autism and Developmental Disorders, 2013. DOI: 10.1007/s10803-012-1707-5.

Abstract: The inclusion of animals in therapeutic activities, known as animal-assisted intervention (AAI), has been suggested as a treatment practice for autism spectrum disorder (ASD). This paper presents a systematic review of the empirical research on AAI for ASD. Fourteen studies published in peer-reviewed journals qualified for inclusion. The presentation of AAI was highly variable across the studies. Reported outcomes included improvements for multiple areas of functioning known to be impaired in ASD, namely increased social interaction and communication as well as decreased problem behaviors, autistic severity and stress. Yet despite unanimously positive outcomes, most studies were limited by many methodological weaknesses. This review demonstrates that there is preliminary ‘‘proof of concept’’ of AAI for ASD and highlights the need for further, more rigorous research.

Cat and Dog Companionship and Well-being: A Systematic Review
Islam, Azharul; Towell, Tony. International Journal of Applied Psychology, 2013. DOI: 10.5923/j.ijap.20130306.01.

Abstract: “Existing literature on pet-human relationships reports mixed evidence indicating both positive and negative impacts of pet possession. Based on specific inclusion criteria, including only considering pet ownership in terms of cats and dogs, this paper reviewed 11 empirical studies published in eight journal articles to explore whether pet possession has any impact on owner’s health and well-being. Results of this review failed to demonstrate a clear relationship between pet possession and owner’s well-being. Few studies report that having a cat or dog promotes physical activity and overall fitness of the owners. Additionally, few studies claim pet-owner companionship impacts positively on the owner’s psychological well-being in terms of decreased depression, anxiety and loneliness. No other areas within the general health of the owner were noted to benefit from cat or dog ownership. However, these findings need to be considered very cautiously because of the methodological flaws in pet-human well-being studies. Robust scientific enquiry is needed to claim the health benefits of pet possession.”

Ontological Security and Connectivity Provided by Pets: A Study in the Self-Management of the Everyday Lives of People Diagnosed with a Long-Term Mental Health Condition
Brooks, Helen; et al. BMC Psychiatry, 2016. DOI: 10.1186/s12888-016-1111-3.

Conclusions: “Drawing on a conceptual framework built on Corbin and Strauss’s notion of illness ‘work’ and notions of a personal workforce of support undertaken within whole networks of individuals, this study contributes to our understanding of the role of pets in the daily management of long-term mental health problems. Pets should be considered a main rather than a marginal source of support in the management of long-term mental health problems, and this has implications for the planning and delivery of mental health services.”



Potential Benefits of Canine Companionship for Military Veterans with Posttraumatic Stress Disorder (PTSD)
Stern, Stephen L.; et al. Society and Animals, 2013. DOI: 10.1163/15685306-12341286.

Abstract: “Investigators surveyed 30 U.S. military veterans with PTSD who reported having benefited from living with a dog. The subject population included men and women aged 34 to 67, with a mean of 56.9 years (SD = 8.1), who were being treated at two Department of Veterans Affairs (VA) outpatient clinics. Participants received a questionnaire packet designed to assess aspects of their mental and physical health and relationship with a canine companion, which they completed at home and returned either in person or by mail. The packet consisted of the PTSD Checklist- Military Version (PCL-M); Beck Depression Inventory, Second Edition (BDI-II); Veterans Short Form Health Survey and Health Behaviors Questionnaire (SF-36); Dog Information Sheet; Dog Relationship Questionnaire; and Lexington Attachment to Pets Scale. Respondents indicated that since adopting their dog they had experienced improvement in several areas, including feeling calmer, less lonely, less depressed, and less worried about their and their family’s safety. These results suggest that living with a companion dog may help relieve some of the psychological distress associated with PTSD in some veterans.”

Design and Challenges for a Randomized, Multi-Site Clinical Trial Comparing the Use of Service Dogs and Emotional Support Dogs in Veterans with Posttraumatic Stress Disorder (PTSD)
Saunders, Gabrielle H.; et al. Contemporary Clinical Trials, 2017. DOI: 10.1016/j.cct.2017.08.017.

Summary: “Posttraumatic stress disorder (PTSD) is a leading cause of impairments in quality of life and functioning among veterans. Service dogs have been promoted as an effective adjunctive intervention for PTSD, however, published research is limited and design and implementation flaws in published studies limit validated conclusions. This paper describes the rationale for the study design, a detailed methodological description, and implementation challenges of a multi-site randomized clinical trial examining the impact of service dogs on the on the functioning and quality of life of veterans with PTSD. Trial design considerations prioritized participant and intervention (dog) safety, selection of an intervention comparison group that would optimize enrollment in all treatment arms, pragmatic methods to ensure healthy well-trained dogs, and the selection of outcomes for achieving scientific and clinical validity in a veteran PTSD population. Since there is no blueprint for conducting a randomized clinical trial examining the impact of dogs on PTSD of this size and scope, it is our primary intent that the successful completion of this trial will set a benchmark for future trial design and scientific rigor, as well as guiding researchers aiming to better understand the role that dogs can have in the management of veterans experiencing mental health conditions such as PTSD.”


Legal scholarship

Criminalizing Fake Service Dogs: Helping or Hurting Legitimate Handlers?
Lee, Tiffany. Animal Law, 2017.

Abstract: “An increasing number of states are passing laws criminalizing the use of fraudulent service animals. This Article explores the potential impact of these laws on people with disabilities and the effectiveness of these laws for places of business who want to exclude fraudulent service animals. The Article considers the nature of fraudulent service animal use and the reasons people may use them, the difficulties in enforcing these state laws in light of the Americans with Disabilities Act, and the potential detrimental effects on the civil rights of people with disabilities using legitimate service animals. Based on this analysis, the Article proposes alternative approaches to address the problem of fraudulent service animal use, recommending an increase in legislative clarity and improved public education.”

Supporting the Adoption of Legislation Criminalizing ‘Fake’ Service and Emotional Support Animals
Campbell, Kayla. Journal of Animal and Environmental Law, 2016.

Excerpt: “Although many sources report that the ADA makes it a federal crime to misrepresent your pet as a service animal, this claim is untrue. The ADA is a civil statute and no other federal legislation mentions the issue of service animal misrepresentation or fraud. It is essential that local legislators, lobbyists, and citizens advocate for Kentucky to pass legislation to prevent people from fraudulently claiming their pet is a service animal or ESA. The abundance of this fraud is causing problems for people who truly need the assistance of appropriately trained animals. It is important that we address this issue in order to help those who benefit daily from the use of assistance animals, including both service animals and emotional support animals.”

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