VA study of dogs for PTSD has critics

In this Thursday, April 14, 2016 photo, military veteran Cole Lyle, who suffers with PTSD, walks with his dog Kaya in the hallways of Rayburn House Office building on Capitol Hill in Washington, prior to testifying before the House National Security subcommittee hearing on "Connecting Veterans with PTSD with Service Dogs."
In this Thursday, April 14, 2016 photo, military veteran Cole Lyle, who suffers with PTSD, walks with his dog Kaya in the hallways of Rayburn House Office building on Capitol Hill in Washington, prior to testifying before the House National Security subcommittee hearing on "Connecting Veterans with PTSD with Service Dogs."

FAYETTEVILLE, N.C. -- Army veteran Joe Aguirre opens a restaurant door, then steps aside to let his golden retriever take point. "Clear," Aguirre commands, and 3-year-old Munger pivots right, left, then right again, sweeping the room for potential threats.

"He's basically looking for ... anything that would be out of the ordinary. A bag. A particular weapon. People acting erratic," says Aguirre, who suffers from post-traumatic stress disorder after three tours of duty in Iraq and one in Afghanistan. At the cash register, Aguirre says, "Block," and the dog places himself perpendicular to his master, creating a buffer to anyone who might approach.

Before Munger, a simple outing like this would have been terrifying if not impossible.

"He's put faith back into my way of looking at society," Aguirre says.

Since 2002, the U.S. Department of Veterans Affairs has paid veterinary bills to veterans with guide or service dogs for physical disabilities. Now the agency is in the midst of a $12 million study to gauge the efficacy and costs of using dogs to help those who suffer from post-traumatic stress.

Four years in, that research has been plagued by problems. Only about 50 dogs have been placed with veterans, and critics question whether the protocol itself is flawed -- with the dogs being trained to do things that could reinforce fears. Others worry the animals could become a substitute for the hard but efficient work that comes with therapy.

"You will have the veterans go to more places with the dogs and do more things than they would otherwise do. But they are reliant on the dog, not on their knowledge of ... whether really they are afraid of a ghost," said Dr. Edna Foa, director of the Center for the Treatment and Study of Anxiety at the University of Pennsylvania's Perelman School of Medicine.

More than 350,000 veterans of the Iraq and Afghanistan wars have sought help from the VA for PTSD. Yet the agency is authorized to pay only for "evidence-based" therapies such as cognitive processing and prolonged exposure, which involve having veterans confront and analyze traumatic events.

In 2010, Congress permitted the VA to study alternative treatments for PTSD, including the therapeutic use of animals. The study began in late 2011 in Tampa, Fla., with three nonprofit groups contracted to provide up to 200 service dogs for veterans, who would be compared against a control group that did not receive dogs.

The effort soon ran into trouble. The VA cut off two of the three dog vendors after biting incidents involving participants' children. The final contract was terminated in August 2012 amid allegations of lax veterinary care and placement of dogs "with known aggressive behavior," according to VA records. By then, only 17 dogs had been placed.

During the next year and a half, the study protocol was revamped to exclude veterans with children under age 10. It also dropped the no-dog control group in favor of a group that would receive less-specialized "emotional support dogs" whose "sole function is to provide comfort."

Critics of the study object most strongly to the tasks the VA is requiring of the dogs -- sweeping the perimeter of a room before a veteran enters, for example, or protecting the veteran by "blocking."

"Isn't that saying that al-Qaida could be behind the shower curtain? That's supporting paranoid, pathological thinking," said Meg Daley Olmert, author of a book on how contact with a dog can create a sense of well-being.

Olmert is chief research adviser for Warrior Canine Connection, a Maryland-based nonprofit that uses veterans to train service dogs for their fellows. The group's leaders say dogs should be trained to pick up on cues from PTSD sufferers and then provide the appropriate support, such as learning to wake someone up during a nightmare or detecting when a veteran is anxious, and interacting in a way that helps calm him.

The VA's training protocol "reinforces the cognitive distortions that accompany PTSD," said Robert Koffman, a retired Navy psychiatrist and chief medical officer for Warrior Canine Connection.

Rick Yount, executive director of the nonprofit, questioned whether the study had perhaps even been set up to fail so that the VA wouldn't have to pick up the tab for veterinary bills for psychiatric service dogs. Already the VA is on the hook for upward of $1.4 million per year to cover bills for service dogs for physical disabilities.

Michael Fallon, the VA's chief veterinary medical officer, said the insinuation that money is the researchers' chief concern is "ludicrous." As for the training guidelines, he said the list of commands was developed during more than a year of consultation with mental-health experts, service dog providers and veterans. They help get veterans "out into the community and integrated more into the public life," he said.

One dog trainer agreed, in part. David Cantara heads North Carolina-based Patriot Rovers, which trained Aguirre's dog and is not connected to the VA's study. While Cantara is opposed to using dogs to sweep rooms, he said the blocking command is one of the most vital to his veterans.

"They startle very quickly. And knowing that they have that dog there, guarding ... they're not in this constant hypervigilant state," he said.

A Section on 04/22/2016

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