# Lentis/Robotic Pets for Psychosocial Therapeutics

Robotic animals have been developed as a substitute for animals in animal-assisted therapy (AAT). In AAT, an animal is used as a facilitator to help individuals aid in recovery from, or cope with medical conditions. Animals have a unique ability to break down barriers that may exist between a client and therapist in a relatively short period of time, and thus aids in building trust between client and therapist, to create a more relaxed and comfortable atmosphere. It is highly effective in eliciting communication and interaction from clients who would otherwise prove difficult to engage. Working with live animals has many limitations such as zoonotic disease, allergies, or animal welfare concerns. Robotic pets can bring therapeutic benefits of animal-assisted therapy, while nullifying negative issues associated with living pets such as increased. Robotics technology has been applied in a variety of ways in mental healthcare scenarios. Such applications include interventions for conditions ranging from autism spectrum disorder to cognitive impairments, as well as ways to encourage physical activity and provide companionship to individuals living alone.

## Current State of the Art

Currently, there are dozens of different robotic pets commercially available with a wide variety of features ranging from $100-$6,000. For $100, the Hasbro Joy for All Pets line includes multiple colors of cats and dogs. The cat can blink, purr, meow, wash its face with its paw, and even roll onto its back for belly rubs, and the dog has a realistic heartbeat, can bark in response to voices and move its head around to nuzzle up against the user. At a higher price point of $500, the Tombot Jennie has a moving head and is covered in touch sensors and microphones that allow it to realistically respond to touch and bark in response to voice commands. Aibo, costing $2,900, is able to move around on its own, and has artificial intelligence (AI) powered learning that allows it to develop a unique personality over time. It can pick up a special bone it recognizes, roll over and respond to human interaction through touch or voice, and even sports a fake peeing animation where it lifts a back leg and plays the sound of water being poured on a hard surface through its built-in speakers. Unlike many robotic pets that attempt to mimic it’s real life counterparts, aibo has no fur, instead sporting a metallic dog-like form. For $6,000, PARO, a seal-like pet, holds the Guinness World record for “Greatest reduction in stress levels by a robot”. PARO has been in use in Japan and throughout Europe since 2003. PARO’s cameras allow it to actively seek eye contact with its users, and can even remember faces and associate them with different names for the robot – if the same unit is used for multiple patients, it will recognize each user and respond to the name each has assigned to it.
Therapeutic benefits of a robotic pet mostly parallel those of a living animal. Robotic animals used for AAT have been shown to improve moods and make patients more communicative, improve activity of cortical neurons in patients with dementia, and reduce stress as revealed from urinary tests. In treating loneliness in elderly patients living in long-term care facilities, no statistical difference was shown between treatment groups of a robot, aibo, and living dog, both resulting in similar improvements. Anecdotally, some residents and staff were initially reluctant to interact with aibo; however, with exposure, this resistance largely dissipated. Acceptance of interactive robots suggests their widespread use in geriatric facilities is feasible from a therapeutic standpoint. Research has indicated it is not the mere presence of a robotic animal that produces therapeutic effects, but that it is animated. When the “Haptic Creature”, a furry-animal like device, was breathing compared to inactive, respiration rate, heart rate, and anxiety were lower, and emotional valence was more positive. Additionally, touch has been suggested to promote stress-reducing effects. When participants were touched by a “NAO” robot, compared to absence of touch, arousal reduction was observed through decreased heart rate and respiration rate.

## Ethical Concerns

As robotic technology forays into our daily lives, special consideration must be given to ethical concerns in using robotics for psychosocial therapeutics. Experts in rehabilitative therapy have expressed concerns on privacy and deception. This differs from concerns of users primarily being decreased human contact, followed by deception, dignity, infantilization.

### Privacy

Data collected from the multitude of sensors could be leaked or stolen. The Wakamura robot was designed as a companion, but it can also be used for monitoring elderly, delivering messages and reminding them about medicine. A healthcare provider may have access to sensor data for patient safety, consequently making the patient under constant surveillance and losing all right to privacy. The issue becomes more complex if the client’s mental state deteriorates. A person with Alzheimer’s may forget the robot was monitoring them, and could perform acts or say things thinking they are in the privacy of their own home.

### Social Contact

AAT is known to aid in loneliness and encourage social interactions; however, the technology is only intended as a supplement, not a replacement. At present, robots are far from being real companions. They can interact with people, and even show simulated emotions, but their conversational ability is still extremely limited. They cannot form adequate replacements for human love and attention. Nonetheless, some are advertised as such: the Geeko CareBot claims to be “a new kind of companion”. Presence of a robotic animal in a user's presence may justify inattentiveness and a lack of contact; for instance, caregivers in a nursing home may devote more time to residents who do not have the AAT, neglecting those who do. Similarly, family members may use the robotic pet to alleviate guilt for not spending time with an older family member. These effects of robotic pets demonstrate Jevons Paradox: attempting to increase social interaction with the robotic animal can ultimately reduce social contact overall.

### Deception

Deception is another primary concern. Caregivers and family members that market the robot as a real pet to users can be seen as inherently deceitful and as treating users with less dignity. These concerns are exacerbated when the user has cognitive impairments from diseases such as dementia and autism, conditions of which AAT is commonly used for. Morphology is a richly debated topic in the community, with many studies showing people will anthropomorphize and form attachments to nearly anything conveying animacy. Increasingly realistic representations not only convey inaccurate expectations, but may be unethical when treating vulnerable populations. This deception is a form of infantilization by treating older adults as children. It can be seen as disrespectful and can damage their family’s perception of them; thus further decreasing desire to interact and isolating them. Whether users care they are being lied to and treated in such a way vary greatly and a universal consensus of harm cannot be determined. On one hand, “a diagnosis of dementia does not erase the need to be treated with dignity”; however, clients could still enjoy, and benefit, from interacting with a robotic pet without thinking it is actually sentient. Turkle et al. found seniors interacting with robots showed considerable variations in their attitudes and behavior towards them: some wanted to know how they worked in a mechanical sense, whereas others were content to interact with them “as they presented themselves” with no interest in their underlying mechanism. Robotic pets for psychosocial therapy is a tool that still needs more psychological research to provide a clearer picture of beliefs that elderly hold about the robots they encounter and should be used with discretion based on how the patient wants to be treated. A few individual factors have been found to influence acceptance of robots among older adults, such as previous experience with technology. Notably, culture, an increasingly important aspect of healthcare, also plays a role not only in attitudes and behaviors toward robots, but also in preferences in relation to appearance along with verbal and nonverbal communication. Wang et al. found in a cross-cultural study between Chinese and American participants, robots that respect cultural norms are more likely to be accepted. Barua argued the behavior of a robot is a reflection of the creators’ values, which means for robots to be effectively integrated into healthcare, they ought to be created culturally competent and compassionate.

## Conclusion

With increased use of robots as service machines in the medical context, human-robot interactions are more and more frequent in healthcare. Robots interacting with humans in a way that supports mental and physical well-being have potential for directly supporting individuals at risk and also the healthcare system in general. As technology advances and robot morphology becomes increasingly closer to their real-life counterparts, their potential technological dangers and ethical social issues must be considered in future developments.
* ↑ Fine, Aubrey H. (2010). Handbook on Animal-Assisted Therapy: Theoretical Foundations and Guidelines for Practice. Saint Louis, UNITED STATES: Elsevier Science & Technology. ISBN 978-0-12-381454-8. Retrieved 2021-12-07.
* ↑ Mason, Margaret S.; Hagan, Christine B. (1999-06-01). "Pet-Assisted Psychotherapy". Psychological Reports. 84 (3_suppl): 1235–1245. doi:10.2466/pr0.1999.84.3c.1235. ISSN 0033-2941. Retrieved 2021-12-08.
* ↑ Katcher, A; Wilkins, G. G (1997). "Animal-assisted therapy in the treatment of disruptive behavior disorders in children. In "The Environment and Mental Health: A Guide for Clinicians"(A. Lundberg, ed.)". The Environment and Mental Health: A Guide for Clinicians (A. Lundberg, ed.).
* ↑ "Lifelike Robotic Pets for Seniors - Joy for All". Ageless Innovation LLC. 2018. Retrieved 2021-12-08.
* ↑ "Tombot | Robotic Emotional Support Animals". Tombot, Inc. 2021. Retrieved 2021-12-08.
* ↑ "aibo". aibo. 2021. Retrieved 2021-12-08.
* ↑ "aibo - Communication". aibo. 2021. Retrieved 2021-12-08.
* ↑ "aibo - Communication". aibo. 2021. Retrieved 2021-12-08.
* ↑ Guinness World Records (2021). "Greatest reduction in stress levels by a robot". Guinness World Records Limited 2021. Retrieved 2021-12-08.
* ↑ "PARO Therapeutic Robot". Retrieved 2021-12-08.
* ↑ Banks, Marian R.; Willoughby, Lisa M.; Banks, William A. (2008-03). "Animal-assisted therapy and loneliness in nursing homes: use of robotic versus living dogs". Journal of the American Medical Directors Association. 9 (3): 173–177. doi:10.1016/j.jamda.2007.11.007. ISSN 1538-9375. PMID 18294600. {{cite journal}}: Check date values in: |date= (help)
* ↑ Yu, Ruby; Hui, Elsie; Lee, Jenny; Poon, Dawn; Ng, Ashley; Sit, Kitty; Ip, Kenny; Yeung, Fannie; Wong, Martin; Shibata, Takanori; Woo, Jean (2015-05-01). "Use of a Therapeutic, Socially Assistive Pet Robot (PARO) in Improving Mood and Stimulating Social Interaction and Communication for People With Dementia: Study Protocol for a Randomized Controlled Trial". JMIR Research Protocols. 4 (2): –45. doi:10.2196/resprot.4189. ISSN 1929-0748. PMC 4433493. PMID 25934173. Retrieved 2021-12-08.{{cite journal}}: CS1 maint: PMC format (link)
* ↑ Wada, Kazuyoshi; Shibata, Takanori (2007-10). "Living With Seal Robots—Its Sociopsychological and Physiological Influences on the Elderly at a Care House". IEEE Transactions on Robotics. 23 (5): 972–980. doi:10.1109/TRO.2007.906261. ISSN 1941-0468. {{cite journal}}: Check date values in: |date= (help)
* ↑ Banks, Marian R.; Willoughby, Lisa M.; Banks, William A. (2008-03). "Animal-assisted therapy and loneliness in nursing homes: use of robotic versus living dogs". Journal of the American Medical Directors Association. 9 (3): 173–177. doi:10.1016/j.jamda.2007.11.007. ISSN 1538-9375. PMID 18294600. {{cite journal}}: Check date values in: |date= (help)
* ↑ Sefidgar, Yasaman S.; MacLean, Karon E.; Yohanan, Steve; Van der Loos, H.F. Machiel; Croft, Elizabeth A.; Garland, E. Jane (2016-04). "Design and Evaluation of a Touch-Centered Calming Interaction with a Social Robot". IEEE Transactions on Affective Computing. 7 (2): 108–121. doi:10.1109/TAFFC.2015.2457893. ISSN 1949-3045. {{cite journal}}: Check date values in: |date= (help)
* ↑ Willemse, Christian J. A. M.; van Erp, Jan B. F. (2019-04-01). "Social Touch in Human–Robot Interaction: Robot-Initiated Touches can Induce Positive Responses without Extensive Prior Bonding". International Journal of Social Robotics. 11 (2): 285–304. doi:10.1007/s12369-018-0500-9. ISSN 1875-4805. Retrieved 2021-12-09.
* ↑ Bradwell, Hannah L.; Winnington, Rhona; Thill, Serge; Jones, Ray B. (2020-07-14). "Ethical perceptions towards real-world use of companion robots with older people and people with dementia: survey opinions among younger adults". BMC Geriatrics. 20 (1): 244. doi:10.1186/s12877-020-01641-5. ISSN 1471-2318. Retrieved 2021-11-04.
* ↑ Bradwell, Hannah L.; Winnington, Rhona; Thill, Serge; Jones, Ray B. (2020-07-14). "Ethical perceptions towards real-world use of companion robots with older people and people with dementia: survey opinions among younger adults". BMC Geriatrics. 20 (1): 244. doi:10.1186/s12877-020-01641-5. ISSN 1471-2318. Retrieved 2021-11-04.
* ↑ Shiotani, Shigetoshi; Tomonaka, Tetsuya; Kemmotsu, Keiichi; Asano, Shin; Oonishi, Ken; Hiura, Ryouta (2006-01). "World's first full-fledged communication robot" Wakamaru" capable of living with family and supporting persons". Mitsubishi Juko Giho. 43 (1): 44–45. {{cite journal}}: Check date values in: |date= (help)
* ↑ GeckoSystems (2021). "CareBot™ - Benefits for the Elderly and the Entire Family". Mobile Robot Solutions for Safety, Security and Service. Retrieved 2021-12-09.
* ↑ Epley, Nicholas; Waytz, Adam; Cacioppo, John T. (2007). "On seeing human: A three-factor theory of anthropomorphism". Psychological Review. 114 (4): 864–886. doi:10.1037/0033-295X.114.4.864. ISSN 1939-1471.
* ↑ Duffy, Brian R. (2003-03-31). "Anthropomorphism and the social robot". Robotics and Autonomous Systems. Socially Interactive Robots. 42 (3): 177–190. doi:10.1016/S0921-8890(02)00374-3. ISSN 0921-8890. Retrieved 2021-12-08.
* ↑ Nass, Clifford; Moon, Youngme (2000). "Machines and Mindlessness: Social Responses to Computers". Journal of Social Issues. 56 (1): 81–103. doi:10.1111/0022-4537.00153. ISSN 1540-4560. Retrieved 2021-12-08.
* ↑ Heerema, Esther (2018-01-10). "Pros and Cons of Doll Therapy in Dementia". HOPE Dementia Support. Retrieved 2021-12-09.
* ↑ Turkle, Sherry; Taggart, Will; Kidd, Cory D.; Dasté, Olivia (2006-12-01). "Relational artifacts with children and elders: the complexities of cybercompanionship". Connection Science. 18 (4): 347–361. doi:10.1080/09540090600868912. ISSN 0954-0091. Retrieved 2021-12-09.
* ↑ Sharkey, Amanda; Sharkey, Noel (2012-03-01). "Granny and the robots: ethical issues in robot care for the elderly". Ethics and Information Technology. 14 (1): 27–40. doi:10.1007/s10676-010-9234-6. ISSN 1572-8439. Retrieved 2021-12-09.
* ↑ "The Influence of Culture on Attitudes Towards Humanoid and Animal‐like Robots: An Integrative Review - Papadopoulos - 2018 - Journal of Nursing Scholarship - Wiley Online Library". Retrieved 2021-12-07.
* ↑ Wang, L.; Rau, P.; Evers, V.; Robinson, B.; Hinds, P. (2010). "When in Rome: the role of culture & context in adherence to robot recommendations". HRI 2010. doi:10.1109/HRI.2010.5453165.
* ↑ Barua, Resheque; Sramon, Shimo; Heerink, Marcel (2015). "Barua, Resheque, Shimo Sramon, and Marcel Heerink. "Empathy, compassion and social robots: An approach from Buddhist philosophy." philosophy 3.4 (2015)". philosophy. 3: 4.