Animal-Assisted Therapy in Adolescents With Eating Disorders

Study Overview
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Brief Summary
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This study aims to improve eating disorders symptomatology, mental, psychosocial and physical health, quality of life, strength and body composition of adolescents with eating disorders by the development of a dog-assisted therapy program. The current research will involve thirty-two patients distributed equally in a control and an experimental group. The intervention group will participate once a week in a dog-assisted therapy of seven weeks. Moreover, all the included patients will participate in an assessment session before and after the intervention to compare the effects of the dog-assisted therapy within and between groups in anxiety, depression, character, behavior, eating disorder evolution, health-related quality of life, treatment satisfaction, strength and body composition. Based on previous studies on different populations, it is expected that, compared to the control group, the experimental group may experience a potential reduction in anxiety, depression and symptoms, while improving quality of life, strength, body composition and behavior.

Detailed Description
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Animal-Assisted Therapies (AAT) have proved to increase self-esteem, social capacity and impulse control while reducing anxiety and depression. Thus, AAT could be an innovative and effective therapy to improve the mental, social and physical health of adolescents with eating disorders. Based on previous studies on different populations, it is expected that, compared to the control group, the experimental group may experience a potential reduction in anxiety, depression and symptoms, while improving quality of life, strength, body composition and behavior. Thirty-two adolescents, younger than 18 years and diagnosed with eating disorders from the University Hospital Niño Jesus will participate in this study. The informed consent must be signed to be included in the study. The intervention will consist of 7 weeks conducted once a week (50 minutes each session). It will include three parts: 1) a welcome part aimed to get in touch with the dog, 2) a main part, where participants will be taught basic notions about dog training and then try to train the dogs. In this part, the patients will perform different activities and exercises with the dog. 3) A closing part to say goodbye to the dogs.

Official Title
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Effects of Dog-assisted Therapy in Adolescents With Eating Disorders: a Controlled Trial.

Conditions
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Eating Disorders in Adolescence, Eating Disorders, Anorexia Nervosa/Bulimia

Intervention / Treatment
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* Behavioral: Dog-Assisted Therapy


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Adolescents in the Psychiatry and Psychology Service of the Niño Jesús University Hospital Patients diagnosed with eating disorders Adolescents with the willingness to participate and availability to assist Having read and signed the written informed consent. Exclusion Criteria: Patients with dog-allergy or dog phobia Adolescents with a history of impulsive animal aggression

Ages Eligible for Study
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Maximum Age: 18 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Supportive Care
Allocation: Non-Randomized
Intervention Model: Parallel Assignment
Interventional Model Description: Two groups: one control and one experimental group
Masking: Single


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| No Intervention: Control group<br>Participants in this group will simply continue with their daily living and therapies. Assessments will be conducted before and after the 7wk program but patients in this group will not take part in it | |
| Experimental: Experimental group<br>Participants in this group will take part in 7 dog-assisted therapy sessions (1 per week). This therapy will be added to their usual daily living and therapies. Assessments will be conducted before and after the 7-week program. | Behavioral: Dog-Assisted Therapy<br>* During seven weeks patients will assist one time per week (1 hour). The therapy will be conducted by an expert psychologist. The intervention will consist of 7 weeks conducted once a week (50 minutes each session). It will include three parts: 1) a welcome part aimed to get in touch with the dog, 2) a main part, where participants will be taught basic notions about dog training and then try to train the dogs. In this part, the patients will perform different activities and exercises with the dog. 3) A closing part to say goodbye to the dogs.<br>* Other names: animal-assisted intervention;|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Changes in Eating disorder symptoms | Measured by the EDI-2 questionnaire to evaluate the evolution of anorexia nervosa and bulimia nervosa normal symptoms. The EDI 2 is a 91 item scale with 8 subscales - (Drive for thinness, Bulimia, body dissatisfaction, ineffectiveness, perfection, interpersonal distrust, interoceptive awareness and maturity fears.). Respondents rate each item from 5 (usually), to 0 (never). Higher scores mean more severe symptoms. | At baseline and inmediately after the intervention (within 7 days after the last session) | 
| Changes in Health-related quality of life | Measured by the Kidscreen-10, which consists of 10 items scored on a 5-point Likert scale. Scores range between 10 and 50, and a higher score means better health-related quality of life. | At baseline and inmediately after the intervention (within 7 days after the last session) | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Changes in Anxiety | Measured by the STAI-C questionnaire. It includes two different scales, one to asses state anxiety (20 items) and the other one to evaluate trait anxiety (20 items) in Spanish adolescents. Each item is rated from 1 to 3 thus, scores in each sub-scales can range from a minimum of 20 to a maximum score of 60. Higher scores mean higher anxiety. | At baseline and inmediately after the intervention (within 7 days after the last session) | 
| Changes in Depression | Measured by the Children Depression Inventory with the included 27 items, each one with 3 options, from 0 (absence of symptoms) to 2 (severe symptoms). The total score ranges from 0-54. Higher scores mean higher depression. | At baseline and inmediately after the intervention (within 7 days after the last session) | 
| Changes in Adolescent character | Measured by the Temperament and Character Inventory-Revised. It consists of 240 items and 5 options for each one. It measures 4 temperaments, Novelty Seeking (NS), Harm Avoidance (HA), Reward Dependence (RD), and Persistence (PS), and three characters, Self-directedness (SD), Cooperativeness (CO), and Self-transcendence (ST). Each item is scored from 1 to 5 with higher scores meaning higher levels in each dimension. | At baseline and inmediately after the intervention (within 7 days after the last session) | 
| Changes in Behavior | Measured by the Child Behavior Checklist inside the Achenbach System of Empirically Based Assessment to assess adolescents' psychopathology. It consists of 113 items and the parents must complete it to evaluate emotional and behavioural problems in children and adolescents. It is scored from 0=not true to 2=true. Raw scores range from 0 to 226. Higher scores mean a worse outcome. | At baseline and inmediately after the intervention (within 7 days after the last session) | 
| Changes in Strength | Measured by a handgrip dynamometer (Takei) to evaluate the maximum strength applied with the hand. | At baseline and inmediately after the intervention (within 7 days after the last session) | 
| Changes in Body mass | Assessed using a weighing device | At baseline and inmediately after the intervention (within 7 days after the last session) | 
| Treatment satisfaction | Measured by the treatment satisfaction scale (CRES-4) by Feixas i Viaplana et al., 2012, which consists of 3 dimensions. The score in each one ranges from 0 to 100 and the global score is the sum of the dimensions (from 0 to 300). Higher scores mean higher satisfaction. | Inmediately after the intervention (within 7 days after the last session) | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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Strength, Dog-assisted intervention, Eating Disorder Symptom, Depression, Adolescent behavior and character, Health-related quality of life, Body composition, Treatment satisfaction, Anxiety