Animal-Assisted Psychotherapy for Pediatric Chronic Pain: Case Series of an Open Pilot Study to Test Initial Feasibility and Potential Efficacy

Abstract

Cosima Locher,1,2 Milena Petignat,3 Cora Wagner,3 Karin Hediger,4– 6 Binia Roth,7 Jens Gaab,3 Helen Koechlin8– 10 1Department of Consultation-Liaison Psychiatry and Psychosomatic Medicine, University Hospital Zurich, University of Zurich, Zurich, Switzerland; 2Faculty of Health, University of Plymouth, Plymouth, UK; 3Division of Clinical Psychology and Psychotherapy, Faculty of Psychology, University of Basel, Basel, Switzerland; 4Division of Clinical Psychology and Animal-Assisted Interventions, Faculty of Psychology, University of Basel, Basel, Switzerland; 5Department of Epidemiology and Public Health, Swiss Tropical and Public Health Institute, Allschwil, Switzerland; 6Faculty of Psychology, Open University, Heerlen, the Netherlands; 7Interdisciplinary Pain Consultation, Child and Adolescent Psychiatry of Basel-Landschaft, Binningen, Switzerland; 8Department of Psychosomatics and Psychiatry, University Children’s Hospital Zurich, Zurich, Switzerland; 9Division of Child and Adolescent Health Psychology, Department of Psychology, University of Zurich, Zurich, Switzerland; 10Department of Anesthesiology, Critical Care and Pain Medicine, Boston Children’s Hospital, Harvard Medical School, Boston, MA, USACorrespondence: Helen Koechlin, Email [email protected]: Chronic pain is a common complaint in children and adolescents, placing an enormous burden on individuals, their families, and the healthcare system. New innovative approaches for the treatment of pediatric chronic pain (PCP) are clearly warranted, as drop-out rates in intervention studies are high and it can be difficult to engage patients with PCP in therapy. Here, animal-assisted interventions (AAIs) might be promising, since there is preliminary evidence for the approach in adults with chronic pain, and AAIs are generally known to foster the therapeutic motivation of patients. To date, however, AAIs have not been examined in pediatric chronic pain.Methods: The aim of this open pilot study was to examine the initial feasibility of recruitment and potential efficacy of an animal-assisted group psychotherapy (including horses, rabbits, chickens, goats, and a dog), providing case reports of three children with chronic pain. We applied a mixed-methods approach, including the conductance of semi-structured interviews and assessment of quantitative pre-post data with a focus on pain severity, avoidance behavior, pain acceptance, and ability to defocus from the pain.Results: The three participating girls (age: 9– 12 years) reported chronic pain in the head and abdomen. The process of recruitment turned out to be challenging. All three children reported reduced pain-related disability and pain-related distress, as well as an increased ability to accept pain and to defocus from the pain. The qualitative data revealed that patients and their parents had a positive attitude towards AAIs.Conclusion: Our initial open pilot study is the first to investigate AAIs in the context of pediatric chronic pain. Notably, we had difficulties in the recruitment procedure, mostly due to the Covid-19 situation. Based on three case reports, we found some first indication that AAI approaches might be associated with symptom changes. Future randomized-control studies with larger sample sizes are clearly warranted.Clinicaltrials.gov Identifier: NCT04171336.Keywords: children and adolescents, chronic pain, animal-assisted psychotherapy, group-based

Keywords

• children and adolescents
• chronic pain
• animal-assisted psychotherapy
• group-based