Systematic review on animal-assisted therapy for children affected by sexual abuse

Abstract

Child sexual abuse (CSA) is a pervasive public health issue with profound psychological consequences. Traditional talk-based therapies often face limitations due to the mistrust, shame, and avoidance common among survivors. Therefore, this creates a need for complementary interventions. This qualitative narrative systematic review aims to explore the effectiveness and therapeutic mechanisms of Animal-Assisted Therapy (AAT) in addressing the psychological impact of CSA. It furthermore looks at the factors that might influence the success or limitation of AAT interventions in CSA treatment. Guided by the seven-step systematic review framework proposed by Petticrew and Roberts (2006), the review employed an interpretative thematic analysis (Braun & Clarke, 2006) to synthesise findings from fourteen studies published between 1994 and 2024 that were primarily conducted in the United States, Australia, and Israel. These studies provided both quantitative and qualitative evidence on AAT’s role in trauma recovery among CSA survivors aged 4 to 17 years. Three overarching themes emerged: First, key therapeutic mechanisms were identified: the therapy animal provides psychological and physiological safety, which serves as a social bridge to facilitate communication and enables indirect emotional expression. Second, implementation factors, notably the structured integration of the animal into the therapeutic model and therapist competency, were evaluated to be determinants of success. Third, consistent clinical outcomes included significant reductions in PTSD, anxiety, and behavioural symptoms, coupled with exceptionally high treatment engagement and near-zero dropout rates. The review concludes that AAT is an effective complementary intervention for CSA survivors. Its efficacy is rooted in the animal's unique ability to establish a foundation of safety that bypasses verbal barriers and fosters therapeutic engagement.