**3. Action mechanism in animal assisted therapies**

Gagnon et. al. defined animal assisted therapy as a clinical intervention method, which has aimed to establish natural and improving bonding between humans and animals, and is applied for both preventive and therapeutic requirements. [46] Animal assisted therapy (AAT) can be applied through different action mechanisms in respect with the disease type and individual characteristics. Five factors directing the mechanism are psychological impulse, emotional, physical and playing mechanisms. [4] Although these mechanisms are defined separately, they cannot be considered independent from each other for functioning and developing of psychosomatic effects. The most important point in the treatment is humananimal interaction. This interaction constitutes a strong emotional background. It has been reported result benefits would depend on the strength of the emotional interactions.

In another words, confident, positive and sedative bonding between a human and an animal can trigger beneficial mechanisms by affecting secretions of adrenaline (epinephrine) and other corticosteroid hormones or stress hormones (like cortisol etc.); decreasing arterial blood pressure, cardiac and respiratory rates. Emotional, psychological impulse, playing and physical mechanisms used in AAT applications cause psychosomatic effects.

Understanding of "play" principle is quite important in animal assisted therapy. Ballarini reported that activities like "entertainment" and especially "laughing" are parts of the bonding between humans and animals. When an ill person plays with a cat or laughs at a dog's behavior, an increase in the healing potential of that illness is initiated. As playing increases mobility, it is a good physical activity source. [4] Haubenhofer and Kirchengast measured cortisol levels in saliva of dogs, which were involved in animal assisted interventions and therapies to investigate their physiological reactions. Cortisol levels, which were monitored during therapy sessions in the earlier time periods of day, were reported to be higher than those measured after the therapy and in the control periods. The study results showed that therapeutic work was physiologically activating for the dogs. [47] At this point, it may be considered that these physiologically changes occurred in dogs can result in positive reactions in humans during animal assisted therapies and activities. But, further research is needed to indicate whether these positive effects related to the animal assisted therapies or not.

Since 1980s, animal assisted therapies, which have been performed by planning and an experienced team, have been shown to improve social functions and to be beneficial especially in elderly people, so studies about this issue have been supported. [35]- [37] Therefore, when it was 1990s, study results of many articles are published from different populations. [28], [29], [38]- [40] Sable explained in the manuscript how, especially dogs and cats, could contribute into well being of family members, with whom they lived all their lives, emotionally and

As mentioned before, the first scientific studies indicating effects of human and animal interactions have been conducted in the second half of 20th century. UK originated Society for Companion Animal Studies (SCAS) is established in 1979, whereas the international organi‐ zation, named International Association of Human-Animal Interaction Organization (IA‐ HAIO) is established in 1990. IAHAIO is an affiliation of the World Health Organization, and it functions as a conductor organ among non-governmental organizations and other affilia‐ tions. The most marked point in the studies belonging to 2000s is that animal assisted therapy has been used against specific diseases, and evaluation of human-animal interaction results.

Current patient healthcare methods, which are developing and containing evidence based interventions, are faced with some problems. Along with conventional treatments, comple‐ mentary and adjuvant treatments are also included in these methods. Animal assisted therapy (AAT) is discussed as a supportive treatment approach with positive effects on life quality and

Gagnon et. al. defined animal assisted therapy as a clinical intervention method, which has aimed to establish natural and improving bonding between humans and animals, and is applied for both preventive and therapeutic requirements. [46] Animal assisted therapy (AAT) can be applied through different action mechanisms in respect with the disease type and individual characteristics. Five factors directing the mechanism are psychological impulse, emotional, physical and playing mechanisms. [4] Although these mechanisms are defined separately, they cannot be considered independent from each other for functioning and developing of psychosomatic effects. The most important point in the treatment is humananimal interaction. This interaction constitutes a strong emotional background. It has been

reported result benefits would depend on the strength of the emotional interactions.

physical mechanisms used in AAT applications cause psychosomatic effects.

In another words, confident, positive and sedative bonding between a human and an animal can trigger beneficial mechanisms by affecting secretions of adrenaline (epinephrine) and other corticosteroid hormones or stress hormones (like cortisol etc.); decreasing arterial blood pressure, cardiac and respiratory rates. Emotional, psychological impulse, playing and

Understanding of "play" principle is quite important in animal assisted therapy. Ballarini reported that activities like "entertainment" and especially "laughing" are parts of the bonding

**3. Action mechanism in animal assisted therapies**

socially. [39]

306 Understanding Alzheimer's Disease

[1], [23], [41]- [44]

health. [45]

We have already mentioned that action mechanism of AAT is based on positive-healing bonding, which has occurred by human-animal interaction, and psychological, emotional, playing and physical mechanisms, which have caused physical and biochemical reactions by activation of this bonding. [4], [46] Key structures activating these mechanisms in patients should be structured according to mainly four theories. These are touching, biophilia hypoth‐ esis, learning and cognitive theories. [48] In animal assisted therapy applications, all types of applications, which are performed according to these four theories, can provide various benefits.

*Touching theory* provides a special and continuous bonding between patient and animal at the first contact. The aim of this bonding is generally due to searching for closeness and tendency to preserve this closeness instinctively. It is normal that such a bonding occurs between an Alzheimer patient and a therapy dog. Because, may be, this is the first time that the patient has met another living organism without any prejudice, without verbal communication and agitated behaviors, and which has accepted him/her as he/she is. In this situation, patient firstly feels comfortable, and a trained dog will allow the patient to direct to itself first by expanding its limits, and allow the patient to touch it. Generally this initial contact in therapies is started with patient directing to the dog and touching it. During therapy period in this comfortablecaring treatment environment, many supportive benefits for clinical treatment compliance (being the leading one), relatives of patients, and healthcare personnel have been achieved.

Another important concept in therapies is *biophilia hypothesis*. As it has been mentioned in this review before, this concept defends that there is an instinctive, strong bonding between humans and all other living organisms, and both sides are in need of his strong bonding in order to survive. According to biophilia concept (short definition may be enthusiasm for life) human beings get in contact with the environment and all living creatures around genetically due to the human nature. This symbiotic relationship was started in the past, and continued in the present by contacting and keeping dogs, cats (the leading animals), other farm animals. As feeling of ownership has affected humans negatively in time, animals have been the mainly damaged side of this relationship. Especially animals, which we are calling currently domesticated, have moved away from their natural environ‐ ments, and instead of living with humans, or accompanying humans, they have got under protection of humans. All other living creatures that human being as not felt close to himself, or could not domesticate or has not get under protection have remained as "Undomesticated-Wild". The reasons why we mention these philosophical approaches is the context of animal assisted therapies especially ethically, are applications, which are performed with animal companionship, and we would very much emphasize to use "living with the company of animals" term rather than "pet ownership" or "keeping an animal". Thus, "living with the company of animals" will be developed. May be this approach will help to develop the awareness of "living with somebody/living creature that is ill" rather than "having an ill relative". Then, experiencing the pure form of animal-human interac‐ tion at the beginning, and providing patient and his/her relatives to share this humane environment may reveal many positive effects, which we have not known or defined yet.

improve their life qualities. After all, we should remembered that the aforementioned para‐ graphs are theoretical concepts which try to comprise biology, sociology, psychology and philosophy to explain some of the effects AAT on humans in general, not only for patients

Animal Assisted Therapy and Activities in Alzheimer´s Disease

http://dx.doi.org/10.5772/54504

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According to medical studies and field screenings, it is evident that AAT has relaxing and supportive effects on humans. Recoveries obtained in some diseases through these positive

This supportive therapy with various services is being provided to more than 35000 patients in more than 100 healthcare service units in San Francisco. Subjects mainly benefited from these services are as follows: *Children treated in pediatric clinic; AIDS patients; patients, who require acute care and physical rehabilitation services; children with conduct disorder and physical problems; subjects staying at hospitals (patients, their relatives and hospital personnel), patients with mental diseases.* Public health organizations currently provide various services with dogs suitable for therapies. Samples for some application fields of AAT are given in Table 2 regarding human

As Ballarini has mentioned, AAT is no longer a mysterious application, but currently it has become a treatment option, which is applied for supportive aims, and has resulted in positive outcomes in many diseases. In recent years, AAT has gained more attention all over the world, and it is being preferred as a complimentary and supportive method to improve life quality and health in some therapies, during which various problems have arisen. [45], [53], [54] Therefore, many studies have been performed to establish its scientific background, and different AAT models are being developed. Dolphin assisted therapy is one of these, and it is employed as an adjunctive method in various diseases (Table 3). [55], [56] During therapies, it has been observed that dolphins have tried to communicate with ill subjects by increasing

with Alzheimer´s disease.

Decreased anxiety and depression

Increased impulse for communication

Increase in required motivation for recovery

Increased self-esteem

Decreased blood pressure

their sound levels. [57]

**4. Fields of Animal Assisted Therapies (AAT)**

interactions are listed in Table 1. [49], [34]- [39], [50] , [51]

Decrease in analgesic requirement in some patients, who have had previous operations

Improvement in communication with other patients or hospital personnel

**Table 1.** Main improvements observed in AAT applied subjects

health improvement and development. [4], [52]

*Learning theory*, which is a model in psychology, defends that human beings give various responses to his/her surroundings by the learning principle. In AAT, the learning principle of the patient is triggered in a more human way; so a patient with Alzheimer´s disease can show some behaviors that he or she has started to forget, without the degree of forgetting, in the same way again, or can show some behaviors for longer times without forgetting. For example, while feeding fish in the aquarium, their eating desire may be increased or they remember eating behavior and eat some food; while feeding a dog, they may start to use hand skills, so that these will help them to improve slightly their daily life activities etc. *This interaction with animals may be perceived as a more human approach than verbal reminding of healthcare personnel and/or patient's relatives or verbal commands of caregivers what to do. While healthcare personnel and/ or patient caregivers can be under intensive stress and may unintentionally pronounce these commands at higher and sharp voice tones, and they may even say/behave in agitated ways for patients.* Therefore, animal assisted therapies and activities can be a good supportive way in long term therapy and care for individuals with chronic diseases like Alzheimer´s disease. *Cognitive theory*, which is another model in psychology, tries to explain human behaviors by investigating how human beings gain, process, and store the knowledge. Main headings in cognitive approach, which investigates perception of knowledge, processing of knowledge, and switching into behaviors, are perception language, attention, memory, problem solving, decision making-judging and intelligence.

As animals do not have any expectations and demands from humans at their first contacts, patients feel self-confidence, and they may feel that everything is under their controls. [48] Therefore, animals do not react like us when they meet a healthy or ill person. We, humans, tend to perceive, remember, shape up, judge with the previously learned concepts, and even show verbal-physical behaviors, when we first meet a healthy or ill person or any living being. This situation is quickly sensed and perceived by the opposite side. When a dog meets a blind, limb or amnestic person in the street, it will behave as if it has met a healthy individual. However, when we meet people with health problems in the street, we define them as "he has got no arm!", "he is blind!", "Is he a lunatic?", "ill person", and we imply our thoughts sometimes with words or sometimes with our behaviors. Due to these reasons, animal assisted therapies naturally eradicate negative conditions like these, and they provide a more humane surrounding for therapies of subjects with chronic diseases; they support them; they increase adaptation potentials of patients and their relatives to difficult therapy periods, and they improve their life qualities. After all, we should remembered that the aforementioned para‐ graphs are theoretical concepts which try to comprise biology, sociology, psychology and philosophy to explain some of the effects AAT on humans in general, not only for patients with Alzheimer´s disease.
