Animal-assisted psychotherapy shows promise in patients with borderline personality disorder, according to new research published in the Journal of Psychiatric Research.
Borderline personality disorder is a common psychiatric disorder characterized by self-image and emotion regulation instability, impulsivity, self-harming behavior, fear of abandonment, chronic emptiness, and dissociative symptoms. Individuals with BPD often struggle with maintaining trusting relationships due to experiences of childhood neglect or abuse.
Four evidence-based psychotherapeutic approaches have shown success in treating BPD: dialectical behavior therapy (DBT), mentalization-based therapy (MBT), schema therapy (ST), and transference-focused psychotherapy (TFP). However, building and maintaining trusting therapeutic relationships can be challenging due to deep-seated mistrust stemming from adverse experiences.
Previous studies have shown that interactions with animals, especially pet animals like dogs, can improve therapeutic alliance and interaction in both children and adults with various mental health conditions. Animal-assisted therapeutic approaches have been found to reduce stress, improve mood, decrease fear and anxiety, and enhance overall mental and physical health. These effects may be mediated by the release of oxytocin, a hormone associated with positive social interactions and anxiolytic effects, as well as the regulation of cortisol, a stress hormone.
In the new study, the researchers aimed to investigate the effects of human-guided and animal-assisted skills training on salivary cortisol and oxytocin levels in patients with BPD.
“As a clinical psychiatrist, I work with young people with borderline personality disorder,” said study author Martin Brüne, a professor of psychiatry at Ruhr University Bochum. “Many have experienced severe trauma, mainly in childhood, with primary caregivers often being the source of threat. In line with attachment theory, this has caused ‘mistrustful inner working models’, i.e. the perception that the (social) world is dangerous and unreliable.”
“Animals, in contrast to humans, don’t hurt intentionally. So, for many people with BPD, it is easier to affiliate with an animal; in addition, this can also be a door-opener for human therapeutic interaction.”
The study included 40 BPD patients, with 20 of them serving as controls. The patients were recruited from an in-patient ward of a hospital and were divided into two groups: an animal-assisted group and a human-guided skills training group. The animal-assisted group received therapy sessions involving interactions with animals, while the human-guided skills training group engaged in therapy sessions led by human therapists. The interventions were conducted over a six-week in-patient treatment period.
The participants completed self-rating questionnaires to assess borderline symptoms, impulsivity, alexithymia (difficulty identifying and describing feelings), and fear of compassion. Saliva samples were collected to measure cortisol and oxytocin levels. Salivary cortisol and oxytocin levels were measured as indicators of stress and social bonding, respectively. Saliva samples were collected from the participants at multiple timepoints throughout the study.
The researchers found that both therapeutic interventions led to a significant reduction in cortisol levels. Self-reported symptom severity, impulsivity, fear of compassion, and alexithymia also decreased, regardless of whether patients participated in the animal-assisted group sessions or the human-guided interventions. Oxytocin levels increased for both groups, but this effect was not statistically significant.
“Animal-assisted psychotherapy seems to work well in emotionally unstable young people and reduces stress symptoms,” Brüne told PsyPost. “However, a good human-guided psychotherapy seems to have similar effects.”
The researchers had hypothesized that animal-assisted therapy would be more effective than human-guided skills training, based on the assumption that past experiences of early adversity would make patients more receptive to animal-assisted approaches. Surprisingly, the animal-assisted intervention was no superior to the human-guided skills training.
“I expected more profound hormonal changes in the animal-assisted group compared to the human-guided group,” Brüne explained. “There are several possible explanations for that. One is, our human therapists are simply good at addressing the needs of our patients!”
Like all research, the study had some limitations. The sample size was relatively small, and potential effects of the menstrual cycle or oral contraceptives were not controlled for in female participants. The timing of the interventions also varied between groups, which could have influenced cortisol levels due to the natural diurnal cortisol rhythm.
“Our findings should be replicated in larger samples to disentangle who benefits from animal-assisted therapy and who doesn’t,” Brüne said. “The current sample was too small to address this properly. The study yields some very interesting and promising results; I believe, animal-assistance should receive greater attention in psychotherapy.”
The study, “Effects of human and animal-assisted skills training on oxytocin and cortisol levels in patients with borderline personality disorder“, was authored by Olivia Plett, Vera Flasbeck, and Martin Brüne.