University of Arizona researchers studying the impact service dogs have on veterans with post-traumatic stress disorder say their work may one day lead to more efficient medical intervention for patients.

The Service Dog and Veteran Experiences Study, or UArizona SERVES, is the first national, randomized clinical trial examining the potential medical benefits of a service dog on veterans with PTSD compared to usual care alone. The study is led by Maggie O'Haire, associate dean of research and a professor at the College of Veterinary Medicine, and Evan MacLean, associate professor at the college and the founder and director of the Arizona Canine Cognition Center. Together, they hope to better understand the impact of service dogs on veterans, as well as the factors that may contribute to the success of individual animals.

The supportive roles dogs play in society has greatly expanded over the years, O'Haire said, coming a long way from just seeing-eye and hearing dogs to also include jobs in the military, law enforcement, and psychiatric and medical care. But as those roles expand, there is an urgent call for research to validate different applications of service and working animals.

O'Haire said the lack of evidence supporting the use of service dogs for PTSD patients in particular can create long waitlists for patients to receive a dog, sometimes in the range of five years. Medical providers, insurance companies and lawmakers don't have the evidence to support the use of service animals for veterans suffering from PTSD, which leads to a lack in resources and funding to support the demand for service animals, O'Haire added.

According to the U.S. Department of Veterans Affairs, post-traumatic stress disorder is a mental health problem some people develop "after experiencing or witnessing a life-threatening or traumatic event" and is slightly more common in veterans than in the general population. The number of veterans with PTSD varies by demographic, service era and available data, but The National Library of Medicine concludes that upwards of 23% of veterans experience PTSD during their lifetime.

"We have heard many stories from veterans who have told us things like, 'I would not be alive if I did not have my service dog,' and while those stories may be compelling, when it comes to things like medical insurance coverage, public access policy and clinician recommendations – that all relies on data," O'Haire said.

The five-year SERVES study launches data collection on Sept. 15 and is funded by a $3.2 million grant from the National Institutes of Health's Eunice Kennedy Shriver National Institute of Child Health and Human Development. The study will examine eight groups of veterans, all of whom will have unrestricted access to traditional medical care – though only half will receive additional care in the form of a service dog. Researchers will study one group paired with dogs and one without for 15 months at a time, a year of which is spent with the animals.

Over the course of the study, participants will fill out traditional written surveys on their state of mind, as well as in-the-moment questionnaires through a smartphone app. Humans will wear a device on their wrists that tracks sleep and activity levels, while dogs will have a device on their collars. Researchers will be able to track the proximity of the human and canine subjects to see if spending more time together can help predict the success of treatment. Researchers will also receive regular samples of participant saliva and dog feces to track levels of cortisol – a stress hormone produced and released by the adrenal glands. Participants will also undergo clinical assessments for PTSD symptoms performed by psychiatric professionals.

"We are trying to holistically capture the daily life of each individual, specifically their psychosocial functioning," O'Haire said. "We want to know if they are depressed or anxious, how many panic attacks or flashbacks they are having. We want to assess how they are doing socially. Are they getting out of the house and into society? Are they going to school or work? Is this dog functionally impacting their lives?"

O'Haire hopes the completed study will not only provide evidence for the use of service animals, but also create a starting point from which to improve the practice. Other kinds of medical interventions or medications are developed over time through scientific trials aimed at improving efficacy and lessening side effects. O'Haire said the same needs to occur for partnership with service dogs so organizations can learn how to best raise and prepare the animals, and clinicians can pair humans and dogs for improved outcomes.

Helpful hounds

But why are dogs so well suited for so many different jobs, including those that provide medical benefits? MacLean said the specific answer to that question is at the heart of much of the research conducted by the college's human-animal interaction research group.

MacLean sees the SERVES study as an opportunity to understand what aspects of the service dog partnership are most important for veterans with PTSD.

"It would be great if every dog that every veteran got was the same, but they're not," MacLean said. "We can’t control that, but what we can do is quantify behavioral variation across dogs and assess whether there are particular dog characteristics linked to the greatest therapeutic gains."

MacLean said there is already some preliminary evidence suggesting that dog temperament may be linked to veteran outcomes. For instance, dogs that are less excitable in certain contexts seem to do better with veterans with PTSD.

"That makes sense when you think about what the veterans have the dog for," MacLean said. "If you live in a hypervigilant state and have flashbacks, the last thing you need is a dog who is also hypervigilant and has a hair-trigger alarm. You really need a dog who's your rock, who's mellow and robust in a moment when you're not feeling secure and safe."

Service dogs, by definition, are trained to perform tasks that help mitigate a disability – and can be tailored to the individual. O'Haire said service dogs working with veterans often perform anxiety-relieving actions like nuzzling or leaning against a patient when they sense a heightened state of anxiety, retrieving medication or even alerting a patient to the presence of people behind them.

In addition to O'Haire and MacLean, the SERVES study will include contributions from professor of psychology Daniel Taylor, as well as College of Veterinary Medicine assistant professors Kerri Rodriguez and Emily Bray. The study is also supported by the Mellon Foundation, which granted the team $75,000.