E99 - Should we Prescribe Pets for Mental Health Problems? (with Prof. Nancy Gee)

Nancy Gee, Ph.D is a Professor of Psychiatry in Human Animal Interaction, and the Director of the Centre for Human Animal Interaction at Virginia Commonwealth University (VCU) in Richmond, VA. The Centre is the only one of its kind to be housed in a School of Medicine, and in addition to research and educational activities it also houses the “Dogs On Call” therapy dog program. With over 90 DOC volunteer dog-and-handler teams, this program engages in upwards of 100,000 meaningful interactions with patients, staff, and students in the VCU Health system during a typical year.  Nancy is  also the co-editor of “The Role of Companion Animals in the Treatment of Mental Disorders”.

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Transcript

 Welcome back to the podcast. My name is Alex. I'm a consultant psychiatrist. Today I'm in conversation with Professor Nancy G. Professor G is a human animal interaction specialist and the director of the center for Human Animal Interaction at Virginia Commonwealth University. The center is the only one of its kind to be housed at a medical school, and in addition to research and educational activities, it's also houses the Dog's Uncle Therapy Dog program. With over 90 volunteer dog and handler teams. The program engages with patients, staff, and students at the Virginia Commonwealth University Medical System. Nancy is also the co-editor of a unique book titled The Role of Companion Animals in the Treatment of Mental Disorders, which was released last year by the American Psychiatric Association. Today, we talk about the therapeutic value animals can have in the treatment of both physical and mental health conditions, including neurodivergent conditions like autism and ADHD. We talk about some of the nuances of human dog interactions, the best way to train a dog, some of the common mistakes people make when they're training their dog. We also talk about the therapeutic value of other animals like horses, fish, cats, etc. and we discussed a little bit about the future of the field and the direction things can go in terms of even prescribing animals for particular conditions. This is the Thinking Mind Podcast, a podcast all about psychiatry, psychology, psychotherapy and related topics. Thanks for listening. And now here's today's conversation with Professor Nancy G. Thank you so much for joining me today. Welcome to the podcast. Thank you. It's great to be here. We're going to be talking about a topic we've never covered today, the concept of human animal interaction for the purposes of improving people's mental health and perhaps physical health as well. Very interesting topic. One of those things, I feel like it falls under that category of topics where nowadays we're starting to realize that there's many things we can do to our for our mental health that appear almost like common sense. Like when we think about them, we think, of course that would help, but of course we need to do the research and get all the data to make sure that that that's what the science says. And then we can use that to start implementing that and use it in real life situations with patients, which is what we want. And you're one of those people in this area. So it's a pleasure to be with you. Can you tell us a little bit about how you got into this field, how you got into the field of animal person interactions. Yeah, it's a it's a long story. I've been in this field for a while. Um, it it started, uh, quite some time ago. I had a hobby, a dog training, and I was taking my dogs to competitions and, uh, doing a variety of things that are being very successful. And, um, I met somebody once when I happened to be holding one of my dogs in my arms, and. And she said, you know, your dog would make a great therapy dog. And I said, oh, what's that? And, uh, and so she told me a little bit about what it was and that these are dogs that go and visit with people and, you know, uh, lift their spirits and make them feel better. And we happened to be doing a therapy dog evaluation coming up. Would you like to bring your dogs to the evaluation? I said, oh my goodness, I've not trained them. We couldn't possibly be ready. She said, trust me, your dogs are ready. And so I went to the therapy dog evaluation. And it's basic things like walking on a loose leash, sitting, lying down, um, following your instructions, but also being willing to interact with other people and want other people to touch them. And both of my dogs passed. So now I have registered therapy dogs. What am I going to do with them? When I thought, well, I'm going to start visiting. So I contacted my therapy dog registration organization and I asked them, you know, what's available? And they had some places around where I live that I could visit. And so I tried a bunch of different places I visited with children with behavioral problems. I visited with older adults in nursing homes, just a wide range of experiences. And I saw firsthand what a difference my dogs were making for these folks. It was just really a neat experience for me. And so I ended up visiting a preschool that happened to be in my academic building, and I went there and they said, they said, okay, we want you to be integrated into our curriculum. We want you to come every, every chance you can get because it's wonderful for the kids. They absolutely loved it. So I started going every Tuesday and Thursday because that's what fit my academic teaching schedule and, um, and the kids loved it. The teachers loved it, the parents loved it. I could tell you stories about things that happen, but at the end of the day, I'm a scientist and I was curious, is there anything real to this, or is this just a feel good, fun thing to do? And it was then that I started conducting experience experiments in that building. So, so my laboratory was one floor up in the building. And could you, could you just tell us a little bit, what's your scientific background up until this point in your career? Absolutely. So I'm a I'm a psychologist. Um, my background is cognitive and neuroscience. So my research was studying human memory and aspects of cognition. So I knew really well how to design experiments. And so that's what I did. I started designing these tightly controlled experiments. And I would bring children up to the lab, and they would participate in three different experiments and rotate through the experiments and then go back down. The kids had of all my students who worked with me, loved doing it, and I was collecting data. Uh, and so I started publishing this work, and that's kind of where it all began. Interesting. So he found something that was impactful in the real world. And if you happen to have a scientific background to your thought, why not start testing this stuff out? Yeah, let's see what happens. And my my research was showing I was like, so I had in each of my experiments I had three different conditions. I had a condition where I had a dog and a handler who would interact with the kids, or I had a handler in a stuffed dog that looked very much like the real dogs. I actually got stuffed animals that looked very much like the real dogs. And then I had a sort of a just a handler only condition. And what I found consistently was that when the real dog was there, I found things like memory, performance was better and willingness to follow to adhere. Instruction to instructions was better, categorization was better and more accurate. And, you know, I started finding all of these sort of little simple cognitive effects early on when the dog was present compared to the stuffed dog or the no dog condition. And I just started publishing. Those in my work came to the attention of what at the time was the Waltham, um, center for Pet Nutrition. It's now the, um, the Waltham Pet Care Science Institute. It's a subsidiary of bars, and they hired me away to be their, uh, research manager because they were funding human animal interaction research all around the world. And it was a wonderful opportunity for me. I moved to England, uh, lived there for, uh, for a while. I worked for their company for five years and met a lot of people, and we did a lot of research together. And that was just sort of the beginning. Where in England did you live? It was a little village called Waltham on the walls, which is not far from, uh, Leicester, sort of between, uh, Melton and Grantham. Excellent. And what did, what was some of the more interesting results you were getting from your research at this time? So we were doing a lot of different kinds of studies, everything from dog walking amongst older adults. We found in that study, for example, that older adults who own and walk their dogs, they took more steps in a given day. They had fewer sedentary events, which is a big deal. And I'm sitting is the new smoking right? You need to get up and move. And so we were finding that older adults who had pets were doing sort of more healthy behaviors. We used the Avon Longitudinal Study. There's this wonderful longitudinal study that started with women who were pregnant, and it followed them on a number of measures. They had their children. They then followed the children across their life. And those children began having children. And we were able to look at things like the impact of pets in the lives of those individuals. So we're able to look at pet ownership. And in fact, we just published a study on the owls back data recently. But the point is that we're able to get some really interesting things. And we found some information that was confounded, you know, things that tend to go together. So we learned a lot about uh, animal ownership. And, you know, it's very challenging to study pet ownership because from a scientific perspective, people want to choose their own pets, whereas scientists want to assign people to conditions. Right? So they want to assign this group has horses, this group has cats. And, you know, and people don't like that. They want to pick their own pets. And so there's not a lot of research out there in the world where people have been assigned to own a particular kind of. There are about four studies that have done that. So generally speaking, we do correlational research on that. We look at things like across their lifetime. How is this pet impacted them? Um, and you know, I could go I could go on and on. There's lots of different, um, research that we looked at. One study done in Cambridge, looked at children and compared siblings attachment to their siblings and their attachment to their pets. And that's a really great study, showed that there they have fewer conflicts with their pets than they do with their siblings, but they consider themselves to be very close and they confide in their pets. So it's very interesting the family dynamics and where pets fit into that. Yeah, I was going to ask, has it been any research on change in in family dynamics and family systems based on the presence or absence of a pet? Because I often will see families who have pets and see how the family organizes itself around pets in a really interesting ways? And has any research been done on that topic? Funny you should ask. So I worked with Rebecca Fox in England and we did a qualitative study where we looked at over time, do what are the conceptions of care for a pet and how do pets fit into families. And so we've seen that over time, people are doing things now more than they ever used to. So for instance, they're buying clothes for their pets. Um, they're buying accessories for their pets. There's more control over their pets. There is an expectation that people will have their pet on a leash or contained in a fenced in area. Um, and so it's it's really interesting to see the way it used to be that, you know, you get a dog and your dog could run free and open the door and let the dog go out. You know, that's that's not the case anymore. So the way we treat pets has definitely changed over time, and it has affected our attitudes towards pets. We think of them as family members. And there's some there's some research that shows that when they pass away and, you know, we live longer than pets do. And so ultimately we often experience pet laws when they pass away. That can be quite painful. In fact, in some cases, it's more painful than the loss of a human relative because the pet often lives in your home with you. Many people sleep with their pet. Their pet is a constant in their life, whereas a relative who doesn't live with them, it's not quite as impactful. And so pet laws can be a really important factor in considering, you know, whether to get a pet, because the reality is, we know that we're probably going to outlive that animal. And what's that going to be like when the animal passes away? Yeah, I mean, I can imagine it to be absolutely devastating. And I wonder. Of what role pets can serve with people. And and you know something? I work as a psychotherapist, so a lot of the problems I encounter are obviously to do with the sheer complexity of human human relationships. And one of the problems I often see are to do with self esteem and problems with self esteem. Uh, because of either not being able to be of service to someone, but also like a lack of unconditional love, particularly in early childhood. So I wonder, and I'm curious what you would think about this pet serving partly as, as something that, you know, there's a sense of obligation and a person has to take care of the pets, so they have a way of feeling useful. They have a meaningful relationship with the pets, but also particularly with dogs. I imagine there's a sense of, um, conditionality in the relationship. You know, it's a great point. And and when you look at older adults, there's some evidence to indicate that pets give them a resilient right, a reason to live. So they, um, we see that when an older adult loses their spouse, if they own a pet, they're grieving. Process tends to be shorter than if they don't own a pet. There's something about caregiving, about getting out every day. In no way you need to feed the dog. Let the dog out. You know you need to take the dog, um, to the vet. You need to take the dog for a while. You have responsibilities to that animal, and that provides some meaning in your life. And we see that particularly true for older adults. But I also want to point out that, um. Pets fulfill the the four major roles of an attachment figure, right? We find them enjoyable. They're comforting, they're missed when absent, and they're sought in times of distress. And another thing that's really interesting about pets is that they tend to display similar attachment styles that humans do. And we did. We did some neat research on attachment to pets, and we used the strange situation test and discovered that their styles are very similar to humans. If you think about kind of the history we have with dogs particular, I mean, it goes back, you know, what, 30,000 years this, this process of domestication and selection that we've we've sort of brought them through. Right? Maybe if you think back early days, you know, we began, uh, hunting with hunting together because it was in, in both of our best interests. And then we began keeping them as pets. But through this process, we are breeding dogs that are likely to be more social with us. And as a result, the dogs that we have today, they're very adept at socializing with humans. They tend to be very sensitive to our emotional states and our gestures. Um, they communicate using complex cues Schemes. And what's interesting is that they do form complex attachment relationships with humans. Dogs will also form complex attachment relationships with other animals. So for instance, a dog that protects sheep will often become very attached to sheep. Um, but when they when they live with us, they become very attached to us. They really kind of cue in to, um, to our moods. And if you've ever if you have a dog and you've ever raised your voice in anger, right, the dog will react. You can see basically watching their behaviors. The dogs react, some come to you, want to calm you down, and other dogs are uh oh, and they run out of the room. But the point is that they're reacting to your emotional state. And very often when a human is sad and crying, a dog will come over. Hey, what's going on? You know, and they will. They're curious. And the human, um, takes that kind of as caring and support and unconditional love. And from the dog's perspective, it's probably this is no different. Is this okay? I need to investigate. I need to check this out. And dogs are, um, they definitely want to calm us down. So when they see us getting more and more emotional, they send lots of calming signals to us and try to help us to sort of moderate our emotions. That's really interesting. So when you say when you use the term complex. Q what do you mean by that? In terms of conflicts because so complex could we think of a of giving dogs instructions. Right. We say to them, you know, come sit, you know, but the reality is we're giving dogs very complex cues every day. One example is people who feed their dog canned dog food. You know, you're that can opener opening. The dog is running. You know they that's they've definitely queued internet dogs know somehow they know the days that you go to work and the days they don't go to work because they've been watching your behaviors. So they had seen that in the days that you go to work, the alarm goes off, you get in the shower. So they're watching for pretty complicated cues. They're also really good at having an idea about when you're coming home. And some of that is that they have amazing senses. So they could hear your car coming. They could smell you coming in, uh, their variety of ways that dogs can kind of ping to those things, but also they kind of get the cue right. They understand about this idea that this is about the time of day when Mom or dad comes home and they they clue themselves into that. I think it's like, I'm not I'm not making the argument that they can tell time, but they can certainly smell the time of day to some degree. You know, it gets warmer in the middle of the day and, you know, and the smells change and the dog can sense those kind of temperature variations. They have senses that are much stronger in a than ours. And they can sense things that we might not notice. And so that's telling them the time is passing. And it is about this time of day that mom or dad comes home. And it is about this time of day that I get fed. And it is about this time of day that we go to bed and they start, you know, behaving in concert with those cues that are around them. Wow. And when you say complex attachment relationships, do you mean relationships where. The dog would serve more than one role. For example, protecting sheep but also caring for sheep. Is that what you mean by this? Yeah. It can. It can be taken in a number of different ways, but that's a really good example. Also, within a human household there are multiple people, and they may form different attachments to different people and have different expectations about what each of those people will do. You know this person, they're the treat machine. I can always count on them to give me treats. Whereas this person, you know, they're really good at opening the door to let me go outside, you know, so they can they get, uh, they can get some complicated information from us and they can attach differentially. They can really want to snuggle with one person and, and play in sort of a raucous way when the child, for instance. So there's a lot of complexity in terms of their relationships with, with a variety of human beings. But also as you mentioned, with animals as well. If a person were to get a new puppy. How important is training and if it is important? What are common mistakes people make when they're training and you don't? I know nothing about this topic, so just talk to me like I'm five now. Training a dog is so important, and it's part of what helps you to bond with the animal. They really enjoy training. So first of all, I advocate 100% positive reinforcement in the training. And that could be challenging for people because puppies can do annoying things. Puppies have sharp little needle teeth. Then they learn about the world by putting their mouth on it and it can be painful. And so how do you teach a copy, for instance, in a positive way that this is what you can put your teeth on and these are things you shouldn't put your teeth on. And so it involves some thought and oftentimes getting into a puppy class or a basic obedience class, um, a family companion class where the dog learns basic things like how to go into a crate and to enjoy. We play great games, or we make it fun to go into the crate so that the dog really likes being in a crate. Here in the United States, when we get these massive leather pads, you've heard about probably the recent hurricanes, and it's important to create train your dog so that if you have to evacuate, you can pop your dog in a crate, Put them in your vehicle. Evacuate, and then wherever you evacuate to the dogs, happy to stay in their crate. Of course, you take them in and out, but you're you're kind of doing some disaster preparedness. But there's some basic things that you can do with a puppy to really help them prepare for a life in your home, and also to prepare them for places that you might take them. If you want to walk your dog, for instance, in the neighborhood, you need to train them to walk on a leash. Dogs don't automatically know how to do it. They want to pull. They're excited. They want to go somewhere. And so you have to teach them well. It's very rewarding if you walk next to me. It's not rewarding if you're walking over there. And so, um, you have to find ways to be rewarding to your dog and also to make your dog feel a sense of safety around you, that you're the one who's there to protect them and to help them through the world. So you're not the one who's going to be angry with them or come at them with a newspaper, for instance. It's a really bad training technique. We definitely don't want newspapers don't work. You know, in the olden days when a when a dog would pee in the house, right, a person would rub their nose in it and swat them with the newspaper. Well, all that's really teaching the dog is, oh, I got caught. So I know I'll go behind the couch and do that because they won't see me do it and I can get away with it. And it's not. And it's damaging to the relationship as it would with a human. With parents. We want to be positive with our children and teach them positive ways. It's the same sort of thing. So common mistakes would be to not take the dog to training class. That's a big mistake, and to expect to have an expectation that the dog understands English because they don't they don't understand English. There are some words that they learn to understand over time. So they learn things like, you know, fetch and want to go for a walk and so or a squirrel, you know, they learn some of those words, but generally speaking, we need to show them through behaviors, the kinds of things that we want from them and then reward them through those behaviors. So I suppose when the dog does an undesired behavior, you're going to use an absence of positive reward rather than a negative reinforcement. And then when they do something desired, then you do some sort of positive reward. And what what are like really common positive reinforcement. It's a great question. And we do more than just the absence of rewards. So first of all, you're right. Uh, when a dog, for instance, one of the hardest things is that dogs want to jump up on people, right. So when the dog is jumping up, you just ignore them, turn away, you kind of ignore them. Um, and when they're not jumping, you want to ask them for a desired behavior. So how can you sit? And when the dog says you treat, treat it treat. And so instead of, um, just nothing, you want to ask them for something that they can do. And so something very simple. So one of the first things you want to teach a dog is to sit, give them lots of reward for the word sit. And then that's a very simple one because they can't be sitting and jumping up at the same time. So you can eliminate the jumping off by rewarding the sit. Yes, that makes sense. So you're giving them a clear pathway to what's desired, which you can't do the desire than the undesired at the same time. So you could see how that would work. Well, that's really interesting. And I suppose going back to your point that dogs don't speak English yet. And I suppose you want to be really leveraging non-verbal cues like vocal tonality. Body language, is that right? Things of that nature. You know, it's funny, I used to teach a human animal interaction class to undergraduates, and I would I would bring a dog in and do some example things. We would do clicker training, which is positive reinforcement. We do a variety of those things. Um, but one of the things that I would do is I would talk to my class about how dogs do respond to the tone of your voice, and a question always goes up at the end. And so you can get your dog's attention just by raising your voice at the end. And so I would say to my dogs, I would say, hey, do you want to go do some matrix algebra? And then on there, you know, they're wagging their tail and they're super excited, but definitely want to go to their matrix house. But they don't know what matrix algebra is. But the point is that the tone goes up and the dogs get excited by that. And so absolutely tone of voice. Um, it's important for, for us to think about our own sort of body postures around the dogs looming over them. Leaning over a dog can be seen as threatening to the dog. So you want to kneel down when you're interacting with the puppy to help them feel safer. But one of the biggest things is that humans are notoriously bad at reading dog signs. So they give us lots of signals, and we tend to not be great at reading those signals. Everybody assumes that a wagging tail is a happy dog, but a dog can be wagging their tail and bite. The dog will send the signals through their body. So a very stiff body posture is a very tense dog. That's the first thing that a dog does when well, it's not the first thing. Correction. It is one of the first things that you notice right before the bite is that there body defense up so that that that freeze when the dog freezes, when their mouth closes, when they're, um, when they do this thing called side eye, they're not really looking at you. They're kind of looking out of the side of their eye. Uh, we can really read the tension in the dog when a dog is tired, but they yawn. That's a stress sign when the dog is just standing there. But it's a paw. Just one more. That's often a stress sign. You want to check and make sure they haven't stood, you know, stepped on something. But assuming that they get stuck on a sticker or something, lifting a positive sign of stress. So we want to be able to read when they're stressed so that we can then move them to a state of non stress, right, of being happy. And so when a dog is relaxed, their body is loose, their mouth is slightly open off and their tongue is kind of falling out to the side. Their tail may or may not be wagging, but their tail is kind of in a mid set. Um, the tail that's really high may be a dog that's being super aggressive with another dog. Or it may be that that's a breed of dog that has a high tail set. So that's partly why it's hard for us to read dogs. And some dogs are all black, and when they're all black, it's hard to see their their facial muscles moving. And so it's a little bit harder to read their expressions. Dogs that have lighter colors, it's easier for humans to see those facial expressions and to read them a little bit better. Mhm. Somewhere from the culture of absorbed this idea that dogs are pack animals and in taking care of a dog, you need to be the quote unquote alpha of the pack and therefore display a high amount of certainty and, and decisiveness. And you need to be in charge. How how true is that? Does that is that true, or is it kind of an oversimplification in your view? Yeah, it's it's just a dated and outmoded idea. Um, research has shown that that is, um, that is not the best way to approach a relationship with the dog. Much like with children, um, dominating children and ordering them from point A to point B, not giving them choices, that doesn't build a good relationship. What does build a good relationship is having positive regard, paying attention to their needs, and meeting their needs. And and to the extent that we think they're giving us unconditional love, we want to return that so they feel safe with us so we aren't dominating them. Now, does that mean the dog can walk all over us? It doesn't. And it doesn't mean that with children either. As long as you're very clear with the dog about what it's positive reinforcement and what is going to be ignored, they start to figure out and they really want that positive reinforcement. I can tell you I have dogs where I feed them their kibble, and so I will put their kibble bowl down right next to me on the floor. And I will sit there. And they would much rather interact with me for treats, then go eat out of their kibble bowl. And. And that tells you something that the dog. They tell you what they want. Um, we can do consent testing with dogs as well. It's really simple. You, you, you know, you're sitting there petting the dog. They seem to be enjoying it. If you stop, is the dog moves forward. They're saying more and more, please. If they move back, they're saying they've had enough. And so we want to do those little measures of consent along the way. I run a dog some call program here at the hospital. And in this program we have right now 66 dogs in the program. And they have a handler. And then they go and visit patients in the hospital. The dogs are the partners in the process. They determine everything. So if a dog is saying I'm stressed or I don't feel like visiting today, it's the handler's responsibility to respond to the dog's needs because oftentimes there's something going on. If a dog doesn't want to visit because they've been so positively reinforced, they love that these dogs are excited to come into the hospital. If they don't want to know that something's going on. I saw a handler with his dog leave, and the dog walked outside and the dog was sick. And and you know, he kept saying, my dog doesn't look right at something's going on. I'm going to I'm going to leave. He walked outside. The dog was sick. And so the dog is sending these messages, and it's our responsibility to trust the dog, to trust that they know I really shouldn't be visiting because I'm going to be sick. Right? They do know, and it's our responsibility to respond to the cues that they're sending us. Yeah. I mean, so, so way more I guess this relationship is way more three dimensional than perhaps an outsider can appreciate it. It really is. And I think when you when you spend time with the dog and you really kind of get to know them, you realize just how clever they are, just how smart they are, how much they really do understand, and how nuanced the relationship with the dog can be. And, you know, it's it's up to us as the handlers we call it to you are your animal's best advocate. And that's that is what our handlers are trained and they need to advocate for their dogs. But the dogs absolutely love is patients and staff and, you know, visitors, students, they love it. And they can tell when the handler puts on. We have a polo shirt that the handler wears and the dog wears events, and they can tell when they're going to the hospital. And, you know, they get very excited. They pull all the way into the hospital. They get very excited to to come in and to visit with patients and healthcare workers and, uh, students, family. Um, and it's kind of neat walking around the hospital with them because it's a little bit like you're walking with a member of the Beatles. You know, people come to the woodwork to pet these dogs. They love the dogs program. And we've done some neat research on it, too, that shows that a visit from a dog therapy dog reduces depression. Um, we've got it. It reduces anxiety, loneliness. We see in healthcare workers, they have a decrease in cortisol. Uh, so there are some measurable effects of the presence of the dogs visiting in the hospital. And it's interesting. You know, we did a simple quality assurance study where we followed our dogs on all teams around the hospital, and we said, who's actually touching the dogs? You know, we think we're there to serve the patients, but who's actually touching the dogs? 77% of the people who touch the dogs are healthcare workers. And so that really says something about the need from the health care workers just to have a momentary pause where they can connect with an animal, let their cortisol drop and then get back to work. You know, and we've not done the study. It'll be interesting to see what kind of effects it has on burnout. You know, compassion fatigue. Those are very real things. And from what we're seeing, the evidence seems to show that it's likely that visits from dogs on call does reduce that. And in this program, uh, dogs visiting mental health, uh, inpatient facilities at all. Also just physical health facilities. It's our entire hospital system. So we do have two, um, inpatient mental health, uh, wards. So two, two floors of psychiatry wards. And we do visit in there as well. And I can tell you I've visited there, I have my own therapy dog and I have visited there. And the patients love it. They absolutely love it. It's really cute. In fact, um, it was just a month ago, I, I went and I visited in one of our psychiatric units, and there was a patient there who was saying, I love the dogs on call. I'm so excited. And he calls and puts in his own requests for dogs on call to come and visit. And he showed me he drew really just lovely artwork of each dog that had visited him. And I'm like, I recognize that dog. I know that dog. That was just very sweet. You could tell how impactful it was for him. I mean, it's it's really interesting. I used to work in a lot of acute mental health wards in south London, and this is a bit of a dark story. But on wards like that, one common problem is that people can smuggling drugs sometimes. So even dogs coming in to look for drugs would be like a really positive therapeutic experience. And everyone would be really excited. And the dog isn't even there for an explicitly therapeutic reason. And even then it's just like intensely positive for most people. You know, it is interesting just and there's something to be said for just seeing a dog in a hospital because it's to some degree, a little bit unexpected. I mean, here it's not as unexpected because we have, um, you can actually you can call our line to get a visit. You can send us an email or we have a pager. So unit staff pay you dogs on call. And we, we go and visit all the we try to meet every single request that we get. And that's a lot. It's a good problem to have. We have a lot of requests to meet. And it's it's really rewarding to see how, um, how much this hospital. So the VCU Virginia Commonwealth University Health System has Integrated. Our dogs are called program and the center for Human Animal Interaction that I run. The center was started in oh one. So we are in our our 23rd year now. And and we do research, we do teaching, we do service. And it's really neat to just see here how well integrated and how well accept that it is to have dogs visiting these various places we visit on the university campus. We visit throughout the health system, and the health system is quite large. We're in an urban environment. Um, the state capital is right across the street. Um, and so we have lots and lots of patients here, but we also have dogs on call that extends to our, um, our other units that are farther away. We've got a hospital that's two hours away in South Hill. We've got another one that's an hour and a half away. And all of these locations, they see dogs on call and they will start their own dogs on all program. It's just really rewarding to to to be involved, not only participating in the program, but I'm also running the program. And it's really neat to be, you know, this is my work. This is what I get to do. I get to do research on how animals impact humans. But then I also get to provide a service where animals are on a daily basis, making a difference in the lives of patients. At the beginning, you mentioned how the presence of dogs can even show cognitive benefits in children, and that's immediately got me thinking about neurodivergent. So I work a lot with ADHD and autism and things like that. Has that been looked at at all like human animal interactions for improvements in symptoms of autism, ADHD or related phenomena? Absolutely. Um, in fact, you should take a look at our book and there's a whole chapter on that. Uh, and to be completely open the proceeds of the book, I have been we've donated those to support the dogs I call program. So by the book support the dogs and call program, the money's not going in my pocket. Um, but the but the book is all about how animals may, um, may be involved in the treatment of mental disorders. And it was published by the American Psychiatric Association. It was actually an invited book. And there is a whole chapter in there about how animals have been involved in the treatment of ADHD and autism and a number of, uh, a number of those, uh, neurodivergent, uh, disorders. What's interesting is that I get a lot of calls from, for instance, a parent will say, I've got a child on the spectrum, and I think I want to get a dog for him or her. Would you recommend it? That's really hard to make a recommendation, because it is so dependent on that child and their affinity for dogs and their desire to connect with a dog. Um, there's been some research using guinea pigs, the research on involving dogs. But at the end of the day, for the children who really do connect, it can be incredibly beneficial. But also there's the other side where there are children who are very upset by a dog and who really don't want to have the dog around them. So you. So I can't advise parents go get a dog because it may or may not be effective for your child. You really have to have your child get some experience with some dogs to see if they have the affinity for for a dog, if they want to interact with desire to interact. To some degree, if you think about all the research we have and we've got quite a, um, an accumulation of research at this point, but if you think about all of that research, it's on people who like dogs or who like animals. Seldom would somebody agree to be in a study if they're allergic or fearful. So the research base is really about people who have an affinity towards animals. And so we can say, have we found all these great results for children on the spectrum or for children with ADHD? But it's for those children who do like dogs and or have an affinity to dogs or whatever species of animal your your you want it to involve. Yeah. So that's an important caveat. But, uh, and with that caveat being said, uh, a lot of people worry that, for example, if their child doesn't have a sibling, they won't learn as well how to socialize, how to get along with others. Would it be fair to say, you know, if it's appropriate and a child develops a relationship with a pet, that they can learn a lot of the the importance and a lot of the nuances of a reciprocal, reciprocal, um, relationship in that manner by having a relationship with a pet. So assuming they have an affinity and they enjoy interacting with an animal. Absolutely. There are a number of benefits, not least of which is that the dog can help them connect to other children because children want to hear about the dog and what's your dog's name. And it starts communications and it can help them connect in that way. It can help them to become more, more social. You're right. It can help them to understand that when you're nice to the dog, the dog wants to be around you. But when you're not nice to the dog, the dog will move away from you. And so there are a lot of there are a lot of ways in which jobs may be beneficial in those situations. But you're right. It needs we need the right mix. We need to make sure that this is a child who really does want to be around us, because the reality is that there are children on the spectrum who are very fearful of dogs and are very overwhelmed by dogs. And so we have to be fair to the child and to the dog in pairing them together. We can't assume you just get a dog, put the dog in the room with the child and everything's going to be okay. That's not the case. It requires some work, and it requires a parent or an adult to be present to supervise the the interactions, because it can go south and with a parent there making sure that the interaction is going well, that's in the in the best interest of the child and the Da. Yeah, that makes sense. We've talked a lot about dogs so far and you know, for good reason. But what are the the other animals that deserve a special mention in terms of their therapeutic value to, to people. There are a number of other animals, and it's neat that we talked about dogs because you're right, most of the research involves dogs, but there's lots of work done with horses. So equine therapy, um, it has been used in a variety of settings. Uh, for instance, uh, with women who faced, uh, partner abuse, um, interacting with, with horses has been extraordinarily beneficial. Horses are prey animals and they behave differently than dogs, which are predators. And so your interaction with a horse has to be very different from the way you would interact with a dog, for instance. And so it brings different things to the therapeutic setting. Um, cats have also been involved in this research, though less so, and usually as a in a pet ownership kind of setting, so that typically people interacting with their own, their own cat guinea pigs have been involved. The most common pet in the United States are Finnish fish outnumber all other pets by by some distance, and largely because you can have one tank and lots of fish in the tank, right? Um, but but fish also help our our blood pressure decrease, help our stress decrease. There's some a little bit of mood elevation. So having a fish tank, for instance, in a dentist's office can help calm people down before they get their teeth drilled. But it can it can be beneficial in other settings, too. For instance, in nursing homes, older adults who have cognitive impairment may forget to eat. Their taste buds aren't as effective, so eating isn't as desirable to them as it used to be, and so getting them to get enough calories can be challenging if you just put a fish tank in the dining room. Older adults will eat more. So there's been research showing you can increase calorie intake just by having a fish tank in their own. And what about specific benefits for dementia? Perhaps that was covered in your book. It is. There's a there's definitely a chapter on dementia. There are a number of benefits. Uh, some are very simple. So there are dogs that are trained to to essentially take people for a walk. So they are trained. But the dog on a leash, an older person who's physically capable, uh, can can walk the dog and the dog will return back to the facility. So that's one kind of neat way to get an otherwise physically capable person out for a nice stroll. Um, but dogs also do things like, um, they help people to orient to the time of day because. Or the day of the week. So, for instance, when therapy dogs come and visit, um, memory care units, for some reason, they tend to remember when the dogs are going to come and they're excited to go down to the to the Roman, you know, meet with the dogs and so it can help them to orient that. Um, do you think that's like an emotional landmark, like the emotion land marking time better than something more rational, let's say? Yes. I think it gives them more cues to the memory and and it helps them to access that memory because there is an emotional element, there's a tactile element. There may be a smell element. There's all kinds of things that can help them to remember that there could be a sound, you know, they could the jingling of the the dogs tags. There's a variety of cues for when the dogs are going to come. And you're absolutely right. The emotional component, the joy. And as I said, I've interacted with older adults in nursing homes and they all want to tell stories about their own dogs. And it's just really neat to sit there and listen to them tell you a story about their about their own dog. Um, but yeah, absolutely. Uh, older adults with dementia also benefit in other ways. They're they're more willing to they're they tend to score a little bit higher on activities of daily living when I'm with a dog than when not with the dog. Um, they socialize more. They're more willing to talk. They're they they can be less combative. There have been a number of measures that when the dog is present, we see improvements on a number of these different measures with individuals with Alzheimer's and other forms of dementia. I'm really interested in that. The first point you mentioned about horses and how, because they're prey animals, uh, you have to interact with them in a very different way to dogs, and that can be helpful for abuse victims. Can you dive more into that? How should a person interact with a horse that's different? And and how does that confer benefits on the on the individual? Well, to be honest, I'm not a horse person. So it's it's a little bit outside my, my direct experience. I've got of horses. I've got a lot of dog, uh, experience. With that said, from what I understand, the way that you would want a dog to come to you, you bend down, you open your arms, you call their name, and they they, you know, they start wagging and they come running, right? This is not how you would want an a horse to approach you. You don't want to face them directly. There's, you know, your body language. Just be much more subtle and contained with a horse so that the horse will feel safe and coming to you. If you do that, spread your arms and get excited and, and, um, make a lot of verbalization or so back up. So it's almost like what you do to draw a dog in is the opposite of what you would want to do to draw a horse in. And so I guess, is there some, some value in learning to create a sense of psychological safety? That and I'm speculating that perhaps then the person can apply to themselves as well. Is that how the theory goes? Yes. That is that is how the theory goes. And then there are also a number of other things that can be done. Some of the work is called groundwork, where the person is standing on the ground and trying to move a horse from point A to point B, and how you physically move the horse and trying to draw the horse in. And some of it is done on astride, so some of it is done on horseback. Um, but a lot of this work is done by a ground war with a trained professional. They're sort of working them through the process and making it as beneficial to their unique and individuals for themselves as possible. Right. You've you've obviously carried out and supervised a lot of research in this field. And I'm curious, out of all of these years of research, what are some of the findings, perhaps, which have shocked you the most or surprised you? You know, I have to tell you, early on when I saw that memory was better and the presence of the dog for preschool kids, I that's not possible. That's not true. And I discounted it. So I, um, I wrote it off to them being the preschool children, being able to focus and focus on the demands of the task. And so I wrote it off to their engagement motivation. Then years later, I was involved in two other research projects, one at the University of Lincoln in England and the other one at Washington State University. And in both cases, we looked at executive functioning. So this is a which is big in ADHD, of course. Yeah. So executive functioning is very important for our ability to plan, problem solve. Remember things. And it's highly correlated with success in life. So we looked at executive functioning in two different groups. In England it was eight year old children. In the US it was university students. And these university students were were struggling with um, with essentially making the grade right. They were they were stressed. And and what we found in both populations is that when either the children or the university students interacted with their dog, with the with the therapy dog, we saw improvements in the measures of executive functioning that we were using. And I, I was absolutely surprised by that. Why would executive functioning be better? Well, I don't think it's just about focus or motivation or mood. So I do think those things factor in. I also think what's going on is that interacting with the dog helps you to relax. We see a number of stress reduction things happening. We see decreases in heart rate, blood pressure, cortisol. So we know that interacting with the dog can help you to relax. When you relax, your executive functioning tends to get better. The other thing that happens is it helps us to avoid off task thoughts. So when you're interacting with the dog, you're focused on just interacting with the dog you are not thinking about, oh my gosh, I've got a test tomorrow or oh my gosh, what am I going to make for dinner? Or I have a doctor's appointment. What are the results going to be? Those off task thoughts drive performance down. If you can get any individual to stay on task, they're going to do better than if they're having these irrelevant thoughts. And so increasing executive functioning helps you to inhibit irrelevant thoughts. And it helps us to focus. So to answer your question, to me, the most surprising finding has been that to some degree, interacting with a dog makes us smarter. I mean, these measures are showing that it's making us smarter. I'm proud that I was like, you know, all those years ago. No, that's not what's happening. That is not the case. It's all these other things. But the reality is, if you look at the biopsychosocial model with biological effects, psychological effects, social effects all coming together to help us perform better, and so does the dog. Make us smarter? I don't know, but the point is that all of these things are converging together because the dog is there. Yeah. And that it makes me think of a couple of things. First, the obviously, as a as a psychologist, I would understand your skepticism because we tend to think of notions of intelligence and IQ as quite relatively fixed, although of course success and performance is not purely based on intelligence, of course, but it's intelligence but also executive function, which is not intelligence, but actually executive function is the ability to think, plan, organize, resist impulses and delay gratification. And it also makes me think about something I've been thinking in terms of ADHD more recently, which is. I wonder. And there's no research. I don't think confirming this, but I wanted to what extent is ADHD a condition resulting from chronic life stress, chronic early life stress resulting in executive dysfunction and restlessness, and so on. Again, those are purely speculations on my part, but the idea that you can have something that relaxes you and that improves your executive function, I suppose, doesn't necessarily surprise me. And a lot of the things I recommend for ADHD, like exercise in person, socializing, using the sauna, cold exposure, they of course they're a little bit stressful sometimes in the moment, but then in the long the medium term you get quite relaxed and those can improve ADHD symptoms. So all of those things on my mind, yeah, it is interesting I think I think there's something to that. There's been there's been some, uh, extensive work done on ADHD with dogs. There was a, a program at the University of California. Trying to remember if it was Santa Barbara or not. Anyways, at the University of California, one of the one of the UC schools, and it was Sabrina Schook and I knew did their research, and they developed a program where they had therapy dogs coming to work with children who had ADHD, and they saw a number of improvements related to having the dogs there, not least of which, and this is interesting, the the children often were not motivated to go to school on the days that the dogs were there. There were reports of the children going and waking up. Mom and dad, I don't want to be late for school. Let's get going and encouraging their parents to get them to school on time. That says something that says something about putting a dog in that situation can make a real difference for individuals in those populations. Yeah, that makes sense. We're pretty much out of time. But if I could ask you one more question, uh, Nancy, it would be where, where do you see the future of this field going, and what are some of the big questions you'd still have to answer? Yeah, it's it's a good question. I've recently given a couple of state of the science, uh, presentations. And, you know, we are we are really at the, at a precipice, I think in the field right now, we've got a lot of information that says there is something unique and special about the contribution of an animal in a variety of settings. What we need to do now is we need to get more information. We need to know who benefits, when, where, how, why? We need to answer a lot of questions. The field is really right. There is a lot of work that we can do. So we're seeing effects, but we need to get more information. We're at the point where the possibility of prescribing pets is on the horizon. Now, we have to be very careful with that, because we want to make sure that it is an appropriate situation. So we have to take into account the type of animal, the particular situation. But this is a possibility right now. We with the whole program, we a doctor could actually put an order in for a dog's on call visitation. The problem is we're volunteer based program. We can't guarantee that we could get a dog there. So they're not putting orders in. They just put in a request. But that could be next. We could start having these programs in hospital settings where it's very clear that in this circumstance, the presence of the dog is going to be beneficial. Why? Because we got the evidence to show it. Okay. Now that we know that, let's put the dog in the situation. But before we do that, and I and I, I always want to end with a note about animal welfare. It is so important to consider the animal side. We want the animals to be our partners. They are not objects for us to use to our benefit. Even in the book that we wrote, we never talked about using dogs to achieve things. We talk about partnering with the dogs because we want the dog to have agency. We want the dog to say, I don't want to do this and to be able to remove themselves from the situation. The interactions always go better when the dog wants to be there. When the dog doesn't want to be there, that's when interactions cannot go well. And it is so important to make sure that these creatures are respected for what they do bring to the situation, and that we are very careful about what expectations we apply. Because, as I said, they don't speak English. We can't expect them to understand, you know, these complete sentences. We have to watch their behaviors and follow when their body is saying follow their stress signs and their happy signs, if you will. Yeah. And I think the part the paradigm of partnership makes total sense. And on a note on prescribing, you know, as a clinician, one of the things that's quite disheartening is when you're with a patient or a client and you feel like you're running out of options. So the idea of having more options on the table, and also the kinds of options which are much less likely to have side effects and then fall into that sort of almost common sense framework. It would always be great to have more options like that. So on that note, thank you so much for your work, Professor Nancy, and thank you for spending some time with me today. We'd love to help you promote your book, The Role of Companion Animals in the Treatment of Mental Disorders. We'll put a link to that in the description. Thank you so much. Yeah, thank you very much for having me. And lovely.