CONCEPTUAL ANALYSIS article

Front. Vet. Sci., 30 March 2021

Sec. Veterinary Humanities and Social Sciences

Volume 8 - 2021 | https://doi.org/10.3389/fvets.2021.630465

This article is part of the Research TopicOur Canine Connection: The History, Benefits and Future of
Human-Dog InteractionsView all 13 articles

Dogs Supporting Human Health and Well-Being: A Biopsychosocial Approach

Nancy R. Gee1* Kerri E. Rodriguez2 Aubrey H. Fine3 Janet P.

4
Trammell
1
 Department of Psychiatry, Center for Human Animal Interaction, School of Medicine, Virginia
Commonwealth University, Richmond, VA, United States
2
 Human-Animal Bond in Colorado, School of Social Work, Colorado State University, Fort Collins,
CO, United States
3
 Department of Education, California State Polytechnic University, Pomona, CA, United States
4
 Division of Social Sciences and Natural Sciences, Seaver College, Pepperdine University, Malibu,
CA, United States

Humans have long realized that dogs can be helpful, in a number of ways, to achieving important goals.
This is evident from our earliest interactions involving the shared goal of avoiding predators and
acquiring food, to our more recent inclusion of dogs in a variety of contexts including therapeutic and
educational settings. This paper utilizes a longstanding theoretical framework- the biopsychosocial
model- to contextualize the existing research on a broad spectrum of settings and populations in which
dogs have been included as an adjunct or complementary therapy to improve some aspect of human
health and well-being. A wide variety of evidence is considered within key topical areas including
cognition, learning disorders, neurotypical and neurodiverse populations, mental and physical health,
and disabilities. A dynamic version of the biopsychosocial model is used to organize and discuss the
findings, to consider how possible mechanisms of action may impact overall human health and well-
being, and to frame and guide future research questions and investigations.

Introduction – A Historical Perspective on Dog-Human Relationships

The modern relationship between humans and dogs is undoubtedly unique. With a shared evolutionary
history spanning tens of thousands of years (1), dogs have filled a unique niche in our lives as man's best
friend. Through the processes of domestication and natural selection, dogs have become adept at
socializing with humans. For example, research suggests dogs are sensitive to our emotional states (2) as
well as our social gestures (3), and they also can communicate with us using complex cues such as gaze
alternation (4). In addition, dogs can form complex attachment relationships with humans that mirror
that of infant-caregiver relationships (5).

In today's society, dog companionship is widely prevalent worldwide. In the United States, 63 million
households have a pet dog, a majority of which consider their dog a member of their family (6). In
addition to living in our homes, dogs have also become increasingly widespread in applications to assist
individuals with disabilities as assistance dogs. During and following World War I, formal training of dogs
as assistance animals began particularly for individuals with visual impairments in Germany and the
United States (7). Following World War II, formal training for other roles, such as mobility and hearing
assistance, started to increase in prevalence. Over the decades, the roles of assistance dogs have
expanded to assist numerous disabilities and conditions including medical conditions such as epilepsy
and diabetes and mental health disorders such as posttraumatic stress disorder (PTSD). At the same
time, society has also seen increasing applications of dogs incorporated into working roles including
detection, hunting, herding, and protection (8, 9).

In addition to these working roles, dogs have also been instrumental in supporting humans in other
therapeutic ways. In the early 1960s, animal-assisted interventions (AAI) began to evolve with the
pioneering work of Boris Levinson, Elizabeth O'Leary Corson, and Samuel Corson. Levinson, a child
psychologist practicing since the 1950s, noticed a child who was nonverbal and withdrawn during
therapy began interacting with his dog, Jingles, in an unplanned interaction. This experience caused
Levinson to begin his pioneering work in creating the foundations for AAI as an adjunct to treatment
(10). In the 1970s, Samuel Corson and Elizabeth O'Leary Corson were some of the first researchers to
empirically study canine-assisted interventions. Like Levinson, they inadvertently discovered that some
of their patients with psychiatric disorders were interested in the dogs and that their patients with
psychiatric disorders communicated more easily with each other and the staff when in the company of
the dogs (11, 12). Over the following decades, therapy dogs have been increasingly found to provide
support for individuals with diverse needs in a wide array of settings (13).

Theoretical Framework for Dog Interaction Benefits

For over 40 years, the biopsychosocial model (14) has been widely used to conceptualize how biological,
psychological, and social influences combine to determine human health and well-being. Biological
influences refer to physiological changes such as blood pressure, cortisol, and heart rate, among others;
psychological influences include personality, mood, and emotions, among others; and social influences
refer to cultural, socio-economic, social relationships with others, family dynamics, and related
matters. Figure 1 presents a graphical illustration of the relationship among these three influences in
determining overall health and well-being. Although the model has dominated research and theory in
health psychology for decades, more recently, it was re-envisioned as a more dynamic system (15) that
construes human health as the result of the reciprocal influences of biological, psychological and social
factors that unfold over personal and historical time. For example, if a person breaks his/her arm, there
will be a biological impact in that immune and muscle systems respond and compensate. Social, or
interpersonal, changes may occur when support or assistance is offered by others. Psychological
changes will occur as a result of adjusting to and coping with the injury. Thus, the injury represents a
dynamic influence initiated at one point in time and extending forward in time with diminishing impact
as healing occurs.

FIGURE 1
Figure 1. A biopsychosocial perspective of how biological, psychological, and social influences may
impact one another (solid lined arrows) and influence human health and well-being (represented here
by the large thick circular shape).

This dynamic biopsychosocial approach to understanding health and well-being is appealing to the field
of human-animal interaction (HAI) because of the dynamic nature of the relationship between humans
and animals. For example, a person may acquire many dogs over his/her lifetime, perhaps from
childhood to old age, and each of those dogs may sequentially develop from puppyhood to old age in
that time. Behaviorally, the way the human and the dog interact is likely to be different across the
lifespans of both species. From a biopsychosocial model perspective, the dynamic nature of the human-
canine relationship may differentially interact with each of the three influencers (biological,
psychological, and social) of human health and well-being over the trajectories of both beings. Notably,
these influencers are not fixed, but rather have an interactional effect with each other over time.

While a person's biological, psychological, and social health may affect the relationship between that
person and dogs with whom interactions occur, the focus of this manuscript is on the reverse: how
owning or interacting with a dog may impact each of the psychological, biological, and social influencers
of human health. We will also present relevant research and discuss potential mechanisms by which
dogs may, or may not, contribute to human health and well-being according to the biopsychosocial
model. Finally, we will emphasize how the biopsychosocial theory can be easily utilized to provide firmer
theoretical foundations for future HAI research and applications to therapeutic practice and daily life.

Psychological Influences

Much research has been conducted on the impact of dog ownership and dog interactions on human
psychological health and functioning. Frequent interactions with a dog, either through ownership or
through long-term interventions, have been associated with positive psychological outcomes across the
lifespan [for a systematic review of this evidence see (16)]. One psychological aspect of interest to many
HAI researchers is depression, especially among older adults. However, the relationship of pet dog
ownership and depression over the lifespan continues to have inconsistent and inconclusive findings
(16). Nevertheless, there are examples in the literature highlighting the beneficial role of dog ownership
in reducing depression. As is frequently the case in HAI, the evidence from intervention studies is
stronger than that of pet ownership studies (16), with the preponderance of this evidence linking
animal-assisted interventions to a decrease in depression, as measured by self-report indices. Among
the mechanisms for this reduction in depression are biological and social influences. For example, one
such study found that an attachment relationship with a pet dog may serve as a coping resource for
older women by buffering the relationship between loneliness (also measured by self-report indices)
and depression, such that the presence of the pet dog appears to ameliorate the potential for loneliness
to exacerbate depression (17). A causal relationship between dog ownership and mental health is
difficult to determine. Not only may owning a pet dog increase stress, but those who are already
suffering from loneliness or depression may be more inclined to have a pet dog than those who do not.

Another psychological outcome related to dog interaction that receives considerable research attention
is anxiety. Studies have found that short-term, unstructured interactions with a therapy dog can
significantly reduce self-reported anxiety and distress levels [e.g., (18)]. For example, children with their
pet dog or a therapy dog present during a stressful task exhibit lower perceived stress and more positive
affect compared to when alone (19), when a parent was present (20), or when a stuffed dog was present
(21). In addition to psychological mechanisms, there are social and biological mechanisms at play as
well. In these short-term stressful contexts, a dog may serve as both a comforting, nonjudgmental
presence as well as a positive tactile and sensory distraction. Dog interaction might also reduce anxiety
and distress by influencing emotion regulation while coping with a stressor (22). During animal-assisted
therapy, having a dog present during psychotherapy such as cognitive behavioral therapy can aid in
decreasing self-reported anxious arousal and distress for patients who have experienced trauma,
making the therapeutic treatment process more effective (23).

In addition to the negative aspects of psychological functioning, HAI research has also aimed to quantify
the effects of dog interaction and ownership on positive psychological experiences such as happiness
and well-being. Some studies have found that dog ownership is associated with higher life satisfaction
and greater well-being (24), while other studies show that this is the case only when the dog provided
social support (25) or satisfied the owner's needs (26). However, other large-scale surveys have found
no significant differences in self-reported happiness between dog owners, cat owners, and non-pet
owners (27), contributing to mixed findings. Recent discussions argue that too much focus has been
placed on the relationship between mental health and the simple variable of dog ownership, when the
specific activities that owners engage in with their dogs (e.g., walking, tactile interaction, and shared
activities,) may be more important in explaining positive well-being (28). Further, many other factors
may be driving these inconsistent findings in depression, anxiety, and well-being, including the owner's
personality (24), gender and marital status (29), and attachment to the dog (30).

Dogs may also provide a source of motivation; for example, people with dogs are more likely to comply
with the rigors of their daily life (31). The relationship with a pet dog may provide motivation to do
things that may be less desirable. For example, for older adults who own pets, it is not uncommon for
them to be more involved in daily life activities because of the need to take care of their animals (32).
Likewise, children also complete less desired activities due to their relationship with the dog [for a
discussion of this topic see (33)].

An accumulation of research also suggests that dog interaction may have specific psychological benefits
for individuals with physical disabilities and chronic conditions. Cohabitating with a specially trained
assistance dog, including guide, hearing, and service dogs, can be associated with increased
psychological and emotional functioning among individuals with disabilities (34). For individuals with
mental disorders such as posttraumatic stress disorder (PTSD), recent research has also found that
having a psychiatric service dog is associated with fewer PTSD symptoms, less depression and anxiety,
and better quality of life [For a review see (35)]. These benefits appear to be due to a combination of the
service dog's specific trained tasks and aspects inherent to cohabitating with a pet dog, including having
a source of love, nonjudgmental social support, and companionship (36).

Similar research has also highlighted the value of dogs for children with disorders of executive
functioning and self-regulation, especially autism spectrum disorder (ASD) and
attention-deficit/hyperactivity disorder (ADHD). For some children with ASD, dogs may provide a
calming and positive presence (37) and may both reduce anxiety (38) and improve problematic
behaviors (39). Parents report that both pet dogs and service dogs can provide certain benefits for
children with ASD, including benefits to children's moods, sleep, and behavior (40, 41). Therapy dogs
have also been found to be impactful in supporting children with ADHD in their emotional regulation
(42) and aspects of character development (43). Nevertheless, the outcome of dog interactions may not
be positive for all individuals with ASD and ADHD; despite evidence of psychological benefits of dog
interaction for some children, others may be fearful or become over-stimulated by dogs (44).

In addition to impacts on psychological health, dog interaction can also impact psychological
functioning, cognition, and learning. Among children, emerging research suggests short-term
interactions with a therapy dog may lead to improvements in specific aspects of learning and cognition.
A recent systematic review of research on therapy dog reading programs indicated that reading to a dog
has a number of beneficial effects including improved reading performance (45). Studies suggest that
interacting with a therapy dog may also improve speed and accuracy on cognitive (e.g., memory,
categorization, adherence to instructions) and motor skills tasks among preschool-aged children
compared to interacting with a stuffed dog or human (46). Similarly, a recent study showed that 10–14-
year-old children had greater frontal lobe activity in the presence of a real dog as compared to a robotic
dog, indicating a higher level of neuropsychological attention (47).

Among young adults, similar effects on cognition and learning have been found. Numerous colleges and
universities now offer interactions with therapy dogs, typically during high stress times (such as before
exams). In this sense, a biological mechanism through which dog interaction may positively impact
cognition and learning is via stress reduction and improvement in positive affect. Even such short and
infrequent interactions with therapy dogs may decrease perceived stress and increase perceived
happiness in college students [e.g., (48, 49)]. Further, some institutions have permanent resident
therapy dogs and/or long-term intervention programs; one such program showed that students who
interacted with therapy dogs for 8 weeks reported significantly less homesickness and greater
satisfaction with life than wait-listed controls (50). These effects may translate to additional effects on
students' academic success, learning, and cognition. For instance, a recent randomized controlled trial
(51) paired a standard academic stress management program with therapy dog interaction; the pairing
produced significantly higher levels of self-reported enjoyment, usefulness, self-regulation, and behavior
change than the stress management program or dog interaction alone. However, when therapy dog
interaction is closely paired with more specific learning experiences, beneficial effects on stress remain,
but benefits to academic performance may not manifest. For example, a recent study showed that
interacting with a therapy dog resulted in significant improvements in students' perceived stress and
mood, but not in actual exam scores (52). Similarly, interacting with a therapy dog during the learning
and recall phase of a memory test did not improve memory compared to a control group (53). Taken
together, dog interaction may improve stress and affect among college-aged adults as well as
dimensions important for academic success and learning, but these results may or may not translate to
cognitive performance benefits.

Biological Influences

The psychological and biological effects of HAI are often closely interwoven, as seen in the Psychological
Influences section above and as demonstrated by the frequency with which psychological effects are
evaluated using biological assessments of stress, anxiety, and arousal (54). For example, a plethora of
studies have examined how short-term interactions with dogs can influence stress by measuring
physiological biomarkers. Studies have found that dog interaction can influence parameters such as
blood pressure, heart rate, and electrodermal activity (55) as well as neurochemical indicators of
affiliative behavior [e.g., beta-endorphins, prolactin, and dopamine; (56)].

However, one of the most popular physiological measures in HAI research is the stress hormone cortisol
(57). Studies have found that short-term interactions with a dog can decrease both subjective stress and
circulating cortisol concentrations [e.g., (58)]. Cohabitating with a dog has also been found to impact
circulating cortisol after waking among children with ASD (39) and military veterans with PTSD (59).
Experimental studies have also examined how having a dog present may modulate the stress response
and cortisol secretion among individuals undergoing a stressful situation. Among adults, studies have
found that having a dog present during a socially stressful paradigm can attenuate cortisol compared to
when alone or with a human friend (60). A recent randomized controlled trial similarly found that
interacting with a therapy dog, for 20 min, two times per week, over a 4-week period resulted in
reduced cortisol (basal and diurnal measurement) among typically developing and special needs school
children compared to the same duration and length of delivery for a yoga relaxation or a classroom as
usual control group (61). However, it is of note that many methodologically rigorous studies have not
found significant effects of interacting with a dog on physiological parameters, including salivary cortisol
(21, 62, 63). A recent review of salivary bioscience research in human-animal interaction concluded that
significant variation exists with regards to sampling paradigms, storage and assaying methods, and
analytic strategies, contributing to variation in findings across the field (57).

As research quantifying the physiological outcomes from dog interaction continues to increase, so does
research attempting to understand the underlying mechanisms of action leading to stress reduction.
One theoretical rationale for dogs' stress-reducing benefits consists of the dog's ability to provide non-
judgmental social support (60), improve positive affect (64), and provide a calming presence (22). Dogs
may also contribute to a feeling of perceived safety and provide a tactile and grounding comfort (65).
For these reasons, dogs are often incorporated into treatment and recovery for individuals who have
experienced a traumatic event (66). Another mechanism contributing to these stress reducing benefits
may be tactile stimulation and distraction derived from petting or stroking a dog. For example, Beetz et
al. (67) found that the more time a child spent stroking the dog before a stressful task, the larger the
magnitude of cortisol decrease. In fact, calming tactile interactions such as stroking, touching, and
petting may be a key mechanism explaining animal-specific benefits to stress physiology, as touch is
more socially appropriate in interactions with animals than as with other people (