**2. Benefits of animal companionship for therapy from past to present**

Close relationships between humans and animals are way back to the prehistoric ages. By using DNA techniques, it has been demonstrated that dogs might have been domesticated 100,000 years ago. [30] Animals have been used to improve emotional and functional condi‐ tions of humans since ancient Greeks. Ancient Greeks have used dog drawings in their therapeutic temples, and they have provided melancholic people to ride on horses so as to get rid of their diseased souls. These applications have been used later also by Romans. [31] A dog showing the way to a blind man is drawn on armor in Pompeii historical ruins. [32]

The first studies, which have shown animal assistance in therapy, were performed to recover behaviors of mentally ill people in 1792 in York Retreat in United Kingdom by using farm animals. [3] Florence Nightingale defined the significance of assisting animals for therapy as: "Especially during treatment of a patient with a chronic illness, a small pet is a perfect friend for the patient". [32]

Dogs were used in rehabilitation after the World War I, in the first half of the 20th century. To improve moods of American army officers, who experienced depression related to the war, dogs were given to them to keep in company. [33] In the same period, thousands of dogs were trained under a program to support blinded soldiers in Germany. In 1931, "Guiding Dogs Society" was established for blind people. Currently, dogs are being trained in order to support people with hearing problems; to alert people with seizures before the symptoms are started; and to support people with severe physical problems.

Similar applications have been widely spread all over the world, so they have helped thou‐ sands of people with disabilities to live freely. Lane et. al. have reported that this ability of dogs was very amazing, and this social support that they have provided for people they have accompanied was very significant. [34]

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 socially. [39]

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

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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

*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

these positive effects related to the animal assisted therapies or not.

benefits.

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

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 health. [45]
