REVIEW OF: Leighton SC et al, JAMA Network Open 2024;7(6):e2414686

STUDY TYPE: Nonrandomized controlled trial

Veterans with PTSD may seek companion animals, but there is little evidence they help. A 2023 study compared service dogs trained to perform five tasks specific to supporting PTSD with emotional support dogs that were socialized but not taught PTSD-specific tasks. Overall, the benefits were small in both groups, and it remains unanswered how having a companion animal may stack up against not having one.

Leighton and colleagues enrolled 156 veterans diagnosed with PTSD who received a service dog and support for its care through K9s for Warriors, a nonprofit service dog organization. Participants’ average age was approximately 38 years, and 75% were male. They continued to receive mental health care as usual throughout the study. After special training to work with service dogs, 81 participants were moved from a waitlist to the intervention group and compared with 75 waitlisted controls. The service dogs received at least 60 hours of training, which included skills specific to PTSD such as blocking (creating space), covering (watching), and displaying affection. 

The primary outcomes were PTSD severity, depression, and anxiety after three months. Self-reported scores from the PTSD Checklist for DSM-5 (PCL-5) and blinded clinician-assessed scores from the Clinician-Administered PTSD Scale for DSM-5 (CAPS-5) were used to measure PTSD severity. The secondary outcomes examined social health and quality of life. 

Veterans with service dogs showed significant improvements compared to controls. In the treatment group, CAPS-5 scores decreased by 7 points and PCL-5 scores by 11.5 points, respectively (out of 80 points each). Both depression and anxiety symptoms improved. Veterans with service dogs reported less social isolation, more companionship, and improved quality of life.

Retention is a challenge with PTSD, but in this trial, patients with service dogs had a lower dropout rate than that typically observed with other treatments. Eight veterans (approximately 10%) in the treatment group returned the service dog, 92% of all participants completed the follow-up PCL-5, and 87% completed the follow-up CAPS-5.

Paradoxically, one potential downside is that service dogs decreased social activity in this study. The researchers hypothesized that this could have been due to the accessibility or stigma associated with service dogs.

CARLAT TAKE

While service animals aren’t right for everyone, they may be helpful for veterans living with PTSD. It remains unclear if an emotional support dog would have offered the same benefits. K9s for Warriors, America’s VetDogs, and Warrior Canine Connection are good places to start training. Most provide financial support but require stable housing and sobriety from drugs and alcohol.