INTRODUCTION
Animal-assisted therapy (AAT) is an intervention program that attracts not only general subjects but also those with special problems or needs, patients or their families, therapists, and researchers. It was also used as a preventive approach to non-educational, non-drug, and mediated therapy, as an effective way to intervene in various behavioral and psychological and emotional problems that people are experiencing [1]. Animal-mediated therapeutic effects include the recovery of physical and mental function through the improvement of motor function and self-expression ability and concentration, the promotion of interest and conversation, the improvement of play and recreation ability and self-esteem, the reduction of anxiety and worry and loneliness, the improvement of vocabulary and memory, and the recovery of educational function through the enhancement of visual concept and cognitive ability [2]. Korea, which has a high level of material civilization and a complex society, is in the age of 10 million pets and is a compound word for pets and families, “DINKpet,” which is a family with companion animals instead of children; Human–Animal Bond (HAB) cultural movement is aimed at creating various new words such as, “Viewnimal people,” who enjoy companion animal culture online.
AAT is an intervention program that intervenes at a wide range of levels where animals that meet specific criteria are an important part of the treatment process and is designed to encourage voluntary participation in the treatment to improve human physical, emotional, cognitive, and social functions, among others. Particularly, the importance of treatment is considered to be a very effective treatment method for subjects with various types of diagnoses occurring at each stage of life development, such as depression, dementia, and behavioral disorders [3].
AAT can be considered a complementary and alternative medicine therapy that uses living animals to obtain the healing effect of human subjects. In 1972, it was reported that William Tuke (1732–1822) was the first animal-assisted treatment to raise farm animals to care for mentally ill prisoners in York camps in England. In 1859, Florence Nightingale (1820–1910) recognized that pets could be effective partners in promoting the treatment of chronic illnesses and actively used them in nursing activities. Additionally, Freud (1856–1939) found that his dog was effective in relieving tension in the treatment room. Therefore, he applied an integration of counseling and AAT. However, at the time, animal-mediated treatment was not considered an authorized form of treatment [4].
THE GLOBAL EMERGENCE OF ANIMAL-ASSISTED THERAPY
The official use of AAT began in 1919 when the program was applied to St. Elizabeth in Washington City for treating soldiers suffering from mental illness after World War I, during which its effectiveness was verified. Since then, animals have been officially used as non-drug treatments in the United States to assist with medication. In 1942, the New York City Pauling Air Force Nursing Hospital was the first institution to use dogs. In the 1960s, Boris Levinson, an American psychiatrist, proposed to actively use AAT as an ancillary treatment for traditional independently without treatment. After the terms were first coined by Levinson in 1964, “pet therapy” was defined as an intervention that intentionally involves or incorporates animals as part of a therapeutic or improvement process or environment [5].
ATTEMPTS AT EARLY-STAGE ANIMAL-ASSISTED THERAPY IN KOREA
In Korea, AAT began in 1990 when the Korean Animal Hospital Association applied the program “Animals are my friends,” which was based on the activities of the American Delta Society. In 1992, the Korea Animal Mediation and Welfare Association (formerly Isaac Dog Training Center) began training Service dogs for the disabled; currently, the association trains animal psychologists. The Korea Sapsari Foundation has established a team of dogs in connection with the Department of Social Welfare at local universities. Since then, Samsung Everland has been working with people with mental or physical disabilities with the aim of improving their mood, leisure, and treatment. In 2002, the Samsung Therapeutic Dog Center was officially launched, and a full-scale therapeutic dog program centering on childcare facilities, geriatric hospitals, and mental hospitals. The Animal Mediation Therapy Research Society in 2006, the Korean Animal Mediation Psychotherapy Society in 2008, and the Animal Mediation Therapy Research Institute in 2010 were established to provide animal-assisted psychological counseling, training, and evaluation for therapeutic assistant animals, training animal mediators. It supports various programs. In 2008, Yonggwang Special School and Changpa Animal Mediation Center introduced Asia’s first companion animalmediation support service as part of their curriculum.
DEVELOPMENT OF KOREA ANIMAL-ASSISTED THERAPY
In Korea, Kim et al. [6] initiated the validation of the effectiveness of an animal-medication program. This program, introduced by Kim et al. [6], was applied to adolescents who had experienced interpersonal problems due to school violence. Subsequent studies applying the animal-medication program to various subjects and confirming its efficacy have been consistently published. AAT research has emerged as a valuable approach, emphasizing treatment methods to enhance the lives of patients with diverse conditions and clients with special needs. Additionally, it has shown potential for improving interpersonal relationships across various academic disciplines, including veterinary medicine, health supplementation, social sciences, pedagogy, nursing, humanities, sociology, special education rehabilitation, and psychology. By analyzing the trends of these animal-medication studies, effective program directions can be presented. From the 1960s, the contribution of the journals and researchers was analyzed by providing specific years, classification by editors, and comparison means to further comprehensively analyze contents. Since then, researchers have been incorporating details such as the publication year, information source, content, methodology, and settings. More recently, they have also adopted a systematic method to analyze papers and their content for specific research objectives [7]. Therefore, it is necessary to identify the research trends of AAT, which has been proven to be effective in increasing the desire for program intervention and in the holistic aspect of the client group as well as the general public and seek concrete developmental directions.
RESEARCH TRENDS OF ANIMAL-ASSISTED THERAPY IN KOREA
To date, there have been limited studies on animal-mediation research trends in Korea, and it has only recently begun being conducted. Kang and Jang [8] comprehensively analyze the trends of animal-assisted intervention (AAI) research using 32 therapeutic helper animals published in domestic journals from 2017 to May 2021. Kim et al. [9] conducted a study where they selected a total of five domestic academic journals and theses published between 2011 and 2021. Their research focused on examining trends in AAT studies related to social communication for children with autism spectrum disorders. They analyzed these studies based on the intervention techniques and effects employed in AAT. Jang [10] finally selected six books from 2011 to 2020, analyzed the domestic research trend of AAI for the subjects with autism spectrum disorder, and further analyzed the number of publications, age of the subjects, program sessions, and dependent variables. Ryu et al. [11] conducted an analysis based on publication year, program type, age of research subjects, type of research subjects, and intervention effects. Their aim was to comprehend research trends using a dataset of 69 domestic and 123 foreign journal articles and theses published between 2011 and 2021. This analysis sought to provide insights into the evolving landscape of animal-mediated research targeting children and adolescents. In a similar vein, Lee [12] aimed to understand research trends in animal-assisted activities (AAAs) and treatment for students with disabilities. The study involved analyzing 29 papers from domestic journals spanning 2010 to 2020. The analysis took into account the year of presentation, research subjects, research methods, AAAs, and treatment programs.
NECESSITY OF TREND ANALYSIS OF ANIMAL-ASSISTED THERAPY IN KOREA
While the number of studies verifying the effectiveness of AAT is increasing, systematic and integrated trend research is not being conducted appropriately. Therefore, trend analysis research is necessary. It will be an opportunity to identify the trends of research that can complement the existing limitations, ascertain the deficiencies, suggest directions for future research, and provide systematic and quality treatment programs. Additionally, it is necessary to systematically analyze research trends based on previous studies applying animal brokerage programs in Korea because practical experimental studies beyond the theory are insufficient, and the causal relationship between theory and practice is not clarified.
Accordingly, this study aims to analyze the overall trend of papers published in academic journals from the late 1990s to 2022, when animal-medication programs began in various domestic environments, and to suggest directions for academic and practical development regarding the application of convergence. The research questions to achieve this study’s objectives are as follows. First, what is the source and yearly research trend of animal-mediation research in Korea? Second, what is the research trend of animal-mediation research in Korea? Third, what are the research trends of each method of animal-mediation research in Korea? Fourth, what are the research trends of each content of animal-mediation research in Korea?
AN ANALYSIS OF ANIMAL-ASSISTED THERAPY IN KOREA
Thesis selection criteria and data collection
This study uses the following criteria and search methods to select papers that meet the purpose of the study. First, the papers included in the analysis were published in domestic journals published from late 2000 to October 2022, when AAT began in earnest. Although AAT in Korea has been increasing in various environments since the 2000s, it has been difficult to analyze research trends. Based on Kil [13], this study aims to identify research trends and present empirical verification effects by analyzing intervention effects such as research time, segmented areas, and specific topics of animal-mediation therapy. Second, only the articles published in academic journals in Korea were included in the analysis to secure the qualitative level of the analytical papers, including only the academic papers subject to rigorous examination. Further, previous studies show that these are excluded from the analysis because there is a difference in level between degrees. Third, only the thesis that verified the effectiveness of intervention with the intervention program using the dog, which is the most effective treatment assistant animal for animal-assisted treatment, was applied to the scope of analysis. Additionally, based on Kil [13], the possibility of the multiple intervention approach was confirmed by including the areas of individual and integrated treatment approaches in the analysis study. Lastly, although the term “AAT” was not used, the thesis that used interventions that included animal-mediated factors was selected as the analysis target. Fourth, to secure the data included in the analysis of research trends, a list of related papers was secured using keyword search techniques in Research Information Sharing Service (RISS), Koreastudies Information Service System (KISS), Korea Education and Research Information Servic (KERIS), DataBase Periodical Information Academic (DBpia), E-article, KyoboScholar, Korean Social Science Data Center (KSDC DB), NewPaper, Korean Science (Korea Institute of Science and Technology Information [KISTI]), National Discovery for Science Library (NDSL), National Assembly Library, and Google Scholar, among others (as of October 30, 2022). Additionally, related research was searched by linking animal mediation, animal mediation activity, animal mediation program, companion animal mediation therapy, companion animal mediation activity, pet mediation activity, pet mediation therapy, pet mediation activity, animal mediation, animal mediation activity, animal mediation activity, mediation dog use, animal sympathizing activity, animal mediation education (AAE), animal mediation healing, and animal auxiliary therapy, among others. Lastly, the references of the provisional papers were reviewed through the procedure method to confirm whether the papers with the possibility of selection were excluded (Fig. 1).
Fig. 1. Analytical literature extraction process.
Methods of analysis
A total of 72 papers were selected for the analysis of research trends. The analysis framework was further categorized based on previous studies analyzing research trends. The frequency and percentage were obtained using the Microsoft Excel Program, and codes were added to classify related elements, or examples of individual classification were modified based on an integrated approach. Additionally, to improve the accuracy of the analysis, each category of the whole thesis, the contents of the code, and the examples of classification were analyzed several times, and the Coding Sheet was further produced.
Thesis analysis: Frame of reference
To collect papers that meet the purpose of the study, a research analysis framework was set up based on the criteria used in research trend analysis in Korea and presented in Table 1. First, for the analysis by source and year, the research trends and trends were grasped after sorting the number by classifying the year when the animal-mediation thesis was published. Based on the criteria suggested by Kil [13], Kang and Jang [8], this study analyzes the process of continuous development since the late 2000s when animal-mediated therapy began in earnest and the period and increasing trend when systematic and diverse approaches began to take place. Second, the analysis of each research subject was classified into the characteristics of the research subject and the selection of the research subject (simple request, related inspection). This classification was established using the analytical framework presented by Lee and Lim [14] and based on the specific analysis of pregnant women [15]. The analysis of research subjects was conducted with consideration for the fact that animal-mediated therapy, a non-drug treatment approach, is categorized and applied to both individuals in the general population and those with medical diagnoses. Third, the analysis of each research method was classified into intervention type (AAT, AAE, AAA, AAI, or others), research design (pre-post-single group, comparison before and after control group, case study, pre-post parallelism, etc.), and intervention object (infant, child adolescent, woman, adult, elderly, disabled, etc.). This classification was conducted according to the analysis framework for each research method presented by Kil [13], as well as Kang and Jang [8]. Fourth, the analysis for each research content was classified into the research topic and the intervention session. This study aims to provide important basic data for developing therapeutic programs and using research keywords to verify the effectiveness of therapeutic programs by examining the most frequently used variables and intervention sessions. The study is based on the study of Roh and Jeon [16], which emphasizes the importance of intervention sessions in verifying the effectiveness of the program. Fifth, the analysis by treatment approach method was classified into the individual and integrated treatment approaches. Based on this, Kil [15] suggested that the intervention method that integrates two or more individual activities in AAT can have a more positive effect. Shin et al. [17]. Based on the study, we have identified whether there is an ethical consideration statement or whether the Institutional Review Board (IRB) approves the ethical aspect of the study.
Table 1. Characteristics of included studies
ANALYSIS RESULTS OF THE KOREAN ANIMAL-ASSISTED THERAPY ARTICLES
Research trends by source and year of research
Regarding the source and yearly distribution of animal-mediation related research in Korea, the research trend has been steadily increasing since the mid-2000s. Table 2 presents the analysis results. As a result of analyzing trends by source, it was found that most papers were included in 34 animal-related societies (50%), followed by 11 educational associations (16%), 8 therapeutic research associations (12%), 7 social science associations (10%), 4 disability associations (6%) and 4 others (6%).The research trends by year included one from 2000 to 2005, one from 2006 to 2010 (1.5%), 20 from 2011 to 2015 (29%), 34 from 2016 to 2020 (50%), and 12 from 2021 to October 2022 (18%).
Table 2. Research trends by source and year
Research trends by subject
As shown in Table 3, 45 (66%) of the subjects were general subjects, while 23 (34%) were medically diagnosed. Mental disorders such as autistic developmental disorder, autism spectrum, intellectual disability, attention deficit hyperactivity disorder (ADHD), mild cognitive impairment, dementia, schizophrenia, etc., have been medically diagnosed, and research on animal-mediated treatment has been actively conducted for the past 10 years. Regarding the method of selecting the subjects, 60 studies (88%) were conducted through evaluation, and 8 (12%) were conducted by referral, and more studies were conducted by related evaluation than those conducted by referral for the last 10 years.
Table 3. Research trends according to research subjects
Research trends by method
As presented in Table 4, the most common types of interventions were AAT 26 (38%), AAI 14 (21%), AAA 13 (19%), and AAE 6 (9%). Regarding the trend of research experimental design, 27 (40%) of the pretest-control group pretest was the most, followed by 22 (32) of the single pretest, and 18 (26%) of the case study and pretest. The subjects of intervention were 40 (59) children and adolescents, 15 (22%) disabled, and 7 (10%) elderly. Additionally, infants, women, adults, correctional subjects, and college students were included as subjects. Regarding the research trend, according to follow-up examination, 3 papers (4%) were followed up, while 65 (96%) were not.
Table 4. Research trend according to research method
Research trends by contents
The frequency of keywords dealt with in the subject of analysis was classified by year, and the research trend according to the research topic was further analyzed; this is presented in Table 5. A total of 25 studies examined the effects of intervention with depression as a variable, including 6 from 2011 to 2015, 7 from 2016 to 2020, and 2 from 2021 to October 2022, followed by 11 from sociality, and 10 from self-esteem. Additionally, personality (6), social skills (5), and respect for life (4) were in order. Regarding research trends according to treatment intervention sessions, as shown in Table 6, 53 (78%) were less than 12 sessions, 13 (19%) were 13–20 sessions, and 2 (3%) were more than 21 sessions.
Table 5. Research keywords
Table 6. Intervention session
Statement of research trends and ethical considerations by treatment approach method
Regarding research trends according to treatment approach, as shown in Table 7, demonstrate 58 (85%) of individual animal-mediated treatment approaches and 10 (15%) of studies integrated animal-mediated play therapy, healing agriculture program, bibliotherapy, art therapy, creative experiential activities, praise therapy, and personality education. Consequently, although individual treatment approaches still occupied the majority, it was found that complex intervention studies incorporating two or more individual treatment approaches, including animal-mediated treatment, are gradually increasing. Regarding research trends according to ethical consideration statements, as shown in Table 8, 23 (34%) studies had ethical consideration statements or were approved by the IRB considering the ethical aspects of the study. Forty five (66%) studies did not state ethical considerations. There has been an increasing trend of papers stating ethical considerations from 2011 to date.
Table 7. Research trends according to treatment approach
Table 8. Research trends according to the statement of ethical considerations
DISCUSSION
Since the early 2000s, many studies on animal medication have been conducted. However, systematic and integrated research on the thesis trends that applied animal medication to various subjects and verified its effectiveness is still lacking. Based on the research trends of AAT as described above, the following limitations are to be overcome. First, dogs, which are therapy animals with strong ties to humans, play a role in healing and treatment as assistants for subjects suffering from psychological and emotional difficulties. The most commonly used animal as a therapeutic helper is a single animal, which meets the four conditions of selection, training, hygiene, and animal welfare most easily. These preconditions enable excellent mutual communication with humans and optimal utilization. Additionally, the dog, which is a therapeutic assistant animal, has characteristics such as mutual contact, emotional communication, human mobility, and animal pleasure, consequently acting as a mediator represented by living animals. Moreover, it can induce active participation and a rapid therapeutic effect due to the possibility of quick interaction. The analysis of research trends has encompassed various animals used in animal mediation, such as dogs, cats, horses, fish, reptiles, rabbits, and insects. However, a significant research focus and trend have been observed in animal mediation research specifically involving dogs, which has been actively studied since 2000. Secondly, due to the limited availability of analytical papers, most of the existing research trends, comprising both master’s and doctoral theses as well as journal articles, were included in the analysis. However, the scale that can evaluate the current status and development of each discipline is best reflected in the journals. Therefore, only the papers published in journals were selected and analyzed to improve the quality of future research by excluding duplicated or plagiarized research contents. Thirdly, because the fragmentation of the analytical framework that can contribute to practical studies is insufficient, I attempted to construct a systematic analytical framework and derive meaningful results by referring to previous papers that conducted research trends in various disciplines that attempted treatment approaches to various subjects. Fourth, to supplement the limitation that the intervention effect for the change of the subjects was not grasped in the existing research trend, the research topic was classified and analyzed by year to grasp the variables that were most used in animal medication and effective for change. Fifth, in several studies that verified the effectiveness of the AAT program through intervention, Kil et al [1]. Reflecting the results of previous studies, new approaches were attempted by classifying them into individual treatment approaches (animal-mediated individual treatment approaches) and integrated treatment approaches (integrated treatment approaches including animal-mediated approaches). Additionally, all human clinical studies must comply with ethical considerations so that the general audience and patients have the right to privacy. Therefore, the authors must state that they have obtained prior consent to what is posted in the paper. The authors, who used animals for human treatment, analyzed whether evidence that they had received ethical or legal approval before conducting the study.
The main results of the study are as follows. First, as a result of analyzing research trends by source and year, it was confirmed that the interest and awareness of research related to AAT is expanding to various areas, and the number of research articles is steadily increasing. However, it is necessary to expand the research related to animal-mediated treatment, which mainly examines animalrelated fields, to various fields such as social welfare, education, nursing, psychology, and counseling. Secondly, as a result of analyzing research trends by subject, 45 papers covered general topics, while 23 papers focused on specific medical diagnoses, including autistic developmental disorder, autism spectrum disorder, intellectual disability, ADHD, mild cognitive impairment, dementia, and asthma. Over the last 10 years, more studies have been conducted through related evaluations than through referrals. This analysis of research trends by subject has highlighted a growing interest in nondrug treatments, particularly emphasizing animal-mediated therapies. This research has targeted both patients with these medical diagnoses and preventive approaches. Furthermore, it is crucial to carefully select subjects through pre-evaluation during program planning. Thirdly, this analysis of research trends by method reveals that intervention types were the most commonly used. To assess the effectiveness of intervention applications and ensure their adaptability to the rapidly changing social landscape, it is crucial to align the intervention type with the intervention target and select a scientifically rigorous experimental design method for research experiments. Furthermore, it’s worth noting that most studies related to animal-mediated therapy in Korea have not conducted follow-up tests. As pointed out by Kil [13], addressing these issues is necessary to verify the effectiveness of animal-mediated therapy in post-assessment and to determine how long its desired effects last. These findings will allow for a clearer presentation of the effects of animal-mediated research. Fourthly, in this analysis of research trends by content, we found that the most frequently used term in animal-mediated research was ‘depression.’ Depression is a prevalent emotional disorder experienced by many individuals. To maximize the potential benefits of animal-mediated interventions and prevent depressive mood states from progressing into pathological conditions, it is advisable to integrate a depression improvement program with an AAT program. This integrated approach can help prevent or alleviate depression, a common negative emotion experienced in daily life, and address the life problems and conflicts associated with chronic depression. Fifthly, in this analysis of research trends and ethical consideration statements using the treatment-approach method, we observed that individual treatment approaches still dominate. However, it’s worth noting that there is a gradual increase in complex intervention studies that incorporate two or more individual treatment approaches, including animal-mediated treatment. Additionally, there has been a growing trend of papers including ethical considerations from 2011 onwards. Based on the findings of Kil [2], who suggests that multiple interventions are more effective due to the steady rise of integrated treatment approaches, we anticipate that this approach will play an active role in shaping integrated treatment programs, including animal-mediated treatment, across various fields in future studies. Furthermore, these analysis expect ongoing development and research efforts to provide experts and programs that can be applied to complex interventions in the long term. In the context of ethical consideration statements, it’s worth noting that most domestic and international journals in the field of medicine and health require the inclusion of an ethics approval statement for experiments involving human subjects. Such statements must receive approval from the Ethics Committee or the IRB before research commences. The IRB’s primary aim is to ensure the protection of human participants as experimental subjects. Ethical consideration statements should continue to be a crucial aspect of future studies related to animal-mediated treatment.
CONCLUSION
This study holds significance in its analysis of recent research trends in animal-mediation related studies that have intervened across various subject areas. It offers both academic insights and practical implications for the expansion of multidisciplinary practices. However, it’s important to note that this study has limitations. Notably, it does not incorporate the editor’s classification, the researcher’s contributions, the provision of means for comparison, or an assessment of bias risks.
SUPPLEMENTARY MATERIALS
Supplementary materials are only available online from: https://doi.org/10.5187/jast.2023.e112.
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