Exploring the Perceptions of Individuals with Traumatic Brain Injury Participating in Animal-Assisted Therapy with Domesticated Ducks

Abstract

Background:

Green Care therapies were developed in the late 20th century as nature-based interventions aimed at supporting recovery for individuals with mental and physical health challenges. Animal-assisted therapy with farm animals (AATF), a branch of Green Care, involves engaging individuals with farm animals in natural settings to promote healing. Previous studies have shown the benefits of animal-assisted therapies (AAT) for individuals with traumatic brain injury (TBI), suggesting AATF could offer similar advantages. This study aimed to examine the impact of an AATF program using domesticated ducks as therapeutic companions for individuals with TBI.

Objective:

The primary objective was to explore how individuals with TBI perceive their participation in an AATF-based therapeutic intervention.

Methods:

The study involved a 12-week AATF program, with semi-structured interviews conducted postintervention to capture participants’ experiences. A qualitative descriptive approach with atheoretical thematic analysis was employed to identify key themes from the data.

Results:

Four key themes were developed from the analysis: Emotional Wellbeing, Attachment, Care, and Nature and Environment. These themes reflected participants’ shared experiences and highlighted the perceived benefits of AATF in TBI rehabilitation.

Conclusion:

This study presents AATF, specifically involving domesticated ducks, as an innovative therapeutic intervention for individuals with TBI. The findings suggest that fostering meaningful connections with animals significantly enhances emotional well-being and provides a promising approach to improving rehabilitation outcomes for individuals living with TBI.

Keywords

Green Care animal-assisted therapy (AAT)animal-assisted therapy with farm animals (AATF)traumatic brain injury (TBI)rehabilitation human–animal interaction

Introduction

Patients with traumatic brain injury (TBI) frequently experience psychological challenges, including depression, anxiety, and diminished self-efficacy.^1–4 Studies have shown that animal-assisted therapy (AAT) can improve the emotional well-being of individuals with TBI,^5,6 promoting social behaviors and decreasing depressive symptoms.^7,8 Individuals with TBI are at higher risk for depression compared with the general population, with studies showing a significantly increased incidence rate of depression among patients with TBI.^9,10 While animal-assisted therapy with farm animals (AATF) has been beneficial for various psychiatric conditions,¹¹ there is limited research on its use for TBI. Given the demonstrated efficacy of AAT in this population, it is plausible that AATF-based interventions could yield similar benefits. AAT has been proven to enhance well-being by reducing stress, providing emotional support, and promoting social interaction, suggesting its potential role in TBI rehabilitation.¹² The application of AATF in TBI rehabilitation could offer similar benefits.^13,14 For a more comprehensive overview of AATF, readers are encouraged to consult the narrative review by the authors.¹⁵

To our knowledge, no qualitative study has specifically examined AATF with domesticated ducks. This research could compare AATF with other animals, explore the unique human–duck bond, and assess how AATF may improve well-being and quality of life for survivors of TBI. It may also clarify the mechanisms behind AATF’s therapeutic effects, aiding in the development of more effective interventions.

Purpose of the Study

This study primarily aimed to examine the perspectives of individuals with TBI who participated in a therapeutic intervention incorporating AATF involving domesticated ducks. Upon completing the 12-week AATF program, semi-structured interviews were conducted to gather detailed participant narratives. A qualitative descriptive approach, guided by atheoretical content analysis methodology, was used to explore participants’ experiences.

Although no specific theoretical framework guided the analysis, the research was grounded in a constructivist paradigm, which emphasizes the co-construction of meaning through participant experiences and researcher interpretation. This perspective aligned with the study’s aim to understand how individuals with TBI perceived their participation in AAT with ducks, without imposing external conceptual structures. Details of the quantitative results of this study are discussed elsewhere.¹⁶

Materials and Methods

Ethical considerations

The research protocol, interview questions, and data handling procedures were approved by the institutional review board at the University of Tennessee, Knoxville. All participants provided written consent or assent with conservator consent, prior to the interview. Additionally, the study protocol was reviewed and approved by the Institutional Animal Care and Use Committee at the University of Tennessee, Knoxville.

Setting

The study was conducted at a TBI rehabilitation center in the southeastern United States, with strong support from the facility’s board of directors and staff, who recognized the potential benefits of AATF with ducks for reducing depression and anxiety and improving occupational functioning. Detailed discussions on site selection and stakeholder engagement are provided elsewhere.¹⁷ Ducks were chosen for their manageable size and calm temperament, making them ideal for individuals with cognitive and mobility limitations. Twelve adult domestic ducks, including Call, White Crested, Black Swedish, and Rouen breeds, were selected for their gentle nature and visual appeal.

Ducks were chosen to serve as therapy animals based on their temperament, size, and suitability for individuals with cognitive and mobility limitations. While domesticated dogs and horses are the most commonly used species in AAT,¹⁸ ducks represent an underexplored option within the broader framework of AATF. Their calm demeanor, predictable behavior, and responsiveness to human interaction make them well-suited for structured therapeutic activities.

Although formal studies involving ducks in AATF are limited, their use in a therapeutic context was reported anecdotally.^19,20 This study contributes to addressing the gap in empirical research by formally evaluating domesticated ducks as therapeutic companions in a structured AATF intervention. A more detailed overview of the rationale and development of the duck-based intervention is presented in related publications;^16,17 however, key information relevant to the species selection is included here to ensure the article remains self-contained.

Participant recruitment, demographics, and eligibility criteria

Twelve individuals who had previously participated in an AATF intervention with ducks at a TBI rehabilitation center were invited to take part in a semi-structured interview to discuss their experiences. Of these, 10 (2 females and 8 males) agreed to participate, while 2 declined due to a scheduling conflict. The average age of participants in the interview was 51.7 years, ranging from 35 to 64.

Inclusion criteria

Eligible participants were English-proficient adults (18–65) with a history of acquired TBI, in stable physical health, and functional upper extremity motor skills.

Exclusion criteria

Participants with severe motor, cognitive, or language impairments; immunodeficiency; unstable physical health conditions; or ornithophobia were excluded.

Eligibility was verified via chart review by TBI rehabilitation center staff; study personnel refrained from accessing medical records.

Intervention

The AATF intervention included two 1-hour sessions per week for 12 weeks, featuring hands-on duck interactions. It began with an educational session on duck behavior, handling, and feeding. Participants then met the flock and selected a duck, allowing for a more personal connection to the animal. Activities progressed from observing and petting to feeding, watering, and herding. The principal investigator (PI) monitored sessions to ensure the safety and well-being of both ducks and participants. Further details on the intervention’s design are available elsewhere.¹⁷

Data collection

Qualitative data were collected through 10 semi-structured interviews conducted after the intervention concluded. Data were collected from January 17 to January 23, 2024 (inclusive), approximately 4 weeks after the conclusion of the 12-week intervention on December 21, 2023. A semi-structured interview guide was developed collaboratively with input from staff at the TBI center, who had direct clinical experience with the participant population. The guide included open-ended questions designed to explore participants’ experiences with the AATF intervention, including their interactions with the ducks, perceived emotional or physical effects, and any changes in daily routines or perspectives. Although the guide was not formally piloted in a separate study population, it was refined iteratively during this development process. The full list of interview questions is provided in Supplementary Appendix A.

Interviews took place in person during participants’ downtime at the TBI center. Interview recordings were manually transcribed, and the transcripts were stored securely on a password-protected server. The recordings were then destroyed to ensure confidentiality. In the transcripts, participant names were changed to unisex pseudonyms for confidentiality. The transcripts were reviewed for mentions of the TBI facility, and no references were found.

Data analysis

Thematic analysis was used to identify common themes in participant data, following the six-step process outlined by Braun and Clarke.²¹ Ten interview transcripts were reviewed by two authors (A.S. and F.H.), who independently generated initial codes to minimize bias and then clustered them into preliminary themes.

Additionally, to minimize the influence of the researcher’s own beliefs and maintain objectivity during data analysis, the authors utilized Insight7, artificial intelligence (AI)-based software, to identify themes that were not influenced by the authors’ experiences. Essentially, AI was utilized as the third reader for the transcripts.

The authors collaboratively compared the preliminary themes identified by both human and AI analyses against the entire dataset to ensure they accurately captured the depth and richness of the participants’ data. Each team member initially analyzed the transcripts independently. The two human members then compared their identified themes for similarities and differences before reviewing the preliminary themes generated by Insight7. Through refining and integrating these preliminary themes, the authors reached a consensus on the final themes.

To ensure compliance with Standards for Reporting Qualitative Research (SRQR) guidelines for reporting qualitative research, the authors utilized the SRQR checklist²² when drafting and editing this article included in Supplementary Appendix B.

Researcher characteristics and reflexivity

The study team brought a range of clinical and academic experiences to the project. The PI has a background in nursing and previous experience working with individuals living with TBI. This experience contributed to the development of the intervention and informed the interview approach. Recognizing that prior knowledge and beliefs could influence data interpretation, the PI maintained a reflexive journal throughout the project and regularly discussed analytic decisions with the research team.

A second team member, trained in speech-language pathology, supported data collection and initial coding. Her involvement in the research with individuals with TBI, alongside her clinical expertise in communication disorders, informed her sensitivity to participants’ communication styles and needs.

Two other research team members with extensive backgrounds in mental health nursing, qualitative methodology, and clinical study design contributed to the development of the analytic framework and conceptualization of this study. None of the team members had a therapeutic or supervisory relationship with participants.

The team also reflected on the process of interviewing individuals with TBI. Drawing on clinical experience and input from rehabilitation staff, the interview guide was designed to accommodate potential cognitive and communication challenges. This included using simple, direct language, allowing extended time for responses, and creating a quiet, supportive environment.

Results

Participants viewed the AATF intervention with ducks positively, with one participant specifically describing it as life changing. Four main themes were derived from their experiences: “Emotional Wellbeing,” “Attachment,” “Care,” and “Nature and Environment.”

Theme one: Emotional wellbeing

The main theme of Emotional Wellbeing was derived from the interview transcripts, reflecting the overall mental and emotional state of individuals as they navigated through their AATF experiences. Emotional wellbeing encompasses a broad spectrum of feelings and responses, which are crucial in shaping an individual’s overall quality of life.²³ Within this theme, two key subthemes were developed: Joy and Happiness and Coping.

Joy and happiness

Participants found happiness in caring for ducks, describing the routine of feeding, observing, and interacting with them as a source of comfort and emotional upliftment. The charm and playful nature of the ducks brought great delight. One participant was particularly fond of observing a white duck undergo a unique transformation—growing a single black feather that made it visually distinct. This change not only enhanced the duck’s individuality but also deepened the participant’s connection and admiration, highlighting the special bond formed between them.

The progression from initial uncertainty about working with animals to discovering joy in the experience illustrates the transformative power of forming connections with animals. The overall enjoyment of the experience was a common theme, with many expressing a strong desire to continue working with ducks after 12-week program concluded.

Cameron: I enjoy when they come out to get something to eat. I just enjoy holding them.

Riley: How’d it make me feel? I felt happy the whole time I was in there.

Jordan: It [holding them] made me feel good that we were giving them something that makes them happy, and they want more of it.

Avery: It made me feel good. I enjoyed their company, and they were always active.

Theo: Those ducks are one of the best things that happen.

Coping

Participants shared that engaging with ducks offered a healthy distraction from distressing memories or feelings. The process of feeding, observing, and caring for ducks helped participants immerse themselves in the present moment, which prevented dwelling on negative thoughts about past actions and events.

One participant, in particular, reflected on a violent incident that had left a lasting imprint on their emotional health. They highlighted the importance of seeking emotional support in their journey toward recovery.

Jesse: Well, having them at a time in my life when I need to be calmed down, and they did that.

Engaging with ducks provided a unique coping mechanism, offering a sense of responsibility, routine, and companionship. The calming presence of the ducks, combined with the physical act of caring for them, helped individuals reduce anxiety and maintain emotional balance.

Jesse: Yeah it helped me. I was having real bad nightmares about *Not audible* But after I work with the ducks, it quit. It stopped. And that was good for me because I would wake up and be hitting a wall and everything.

Theme two: Attachment

The main theme of Attachment was derived from the interview transcripts because it was consistently developed as a central element in participants’ experiences, particularly in how they described their emotional connections and relationships with animals. Participants frequently referenced the comfort, security, and companionship that animals provided. Within this theme, two key subthemes were produced: Bond and Interaction with Animals.

Bond

Participants often shared meaningful experiences with their specific duck, describing the bond as providing safety, comfort, and unconditional support—similar to attachment behaviors seen in human relationships. This subtheme was developed because participants felt a deep sense of attachment to the animals, which provided comfort and companionship in ways that closely mirror the attachment behaviors seen in human relationships.

Theo: The best thing I have was getting to know her (their specific duck).

Riley: The whole time I was in the … The whole time I just wanted to go in there. I’m like “When is the time for the ducks?” I would always ask the staff here: “Can I go do this for the ducks?”, you know “Is it my turn?”

Addison: What did I like about it? I liked that I was more in tune with them, you know, and trying to get the duck language going.

The process of bonding involved trust building through consistent, positive interactions such as petting, playing, feeding, or simply observing the ducks. On the contrary, the bond the ducks formed with humans was reflected in duck behaviors such as seeking proximity, displaying excitement when held, and trusting humans to hand-feed them, all of which underscored the reciprocal nature of the relationship.

Addison: I just put my hands down, and they come down to me. … I think it was more important for me to get to know them, you know. … and they like it when we go out there and talk to them. I think it’s good for us and also good for them.

Many participants consistently rated their love for the ducks highly and often reflected on the joy and fulfillment they derived from the experience. Deep bonds were established through holding and nurturing the birds.

Jesse: Probably, for me, the best part was holding and petting and getting to know each other.

Interaction with animals

This subtheme highlighted how participants’ interactions with the animals, through touch, communication, or care activities, strengthened their emotional connection. Participants expressed a strong appreciation for the hands-on experience of feeding and petting the ducks. This tactile interaction allowed them to feel a deeper connection, as the physical act of feeding or petting created a sense of closeness and involvement. These interactions brought happiness, reinforced their bond with the ducks, and offered a fulfilling, rewarding experience that went beyond mere observation.

Drew: They are soft.

Theo: And you know, they all listen to me. … They listen very good because they will listen to you.

Theme three: Care

The main theme of Care was derived from the interview transcripts because it repeatedly appeared as a key element in the participants’ experiences and reflections. Across various responses, participants frequently described the act of caring for the ducks not only as a responsibility but also as an emotionally fulfilling and transformative experience. Within the Care theme, two key subthemes were developed: Learning and Growth and Meaningful Work.

Learning and growth

The subtheme of Learning and Growth was developed from the way participants spoke about the personal development they experienced through their caregiving roles. Many participants noted that caring for the ducks provided them with opportunities to learn, whether about animal behavior, communication, or responsibility. This process was not just about gaining knowledge, but also about personal growth. Participants reflected on how their work with the ducks helped them become more patient and attentive.

Several participants highlighted the enriching learning experience they gained from working with ducks. They spoke of how observing the ducks’ actions, vocalizations, and responses provided valuable insights into the birds’ needs and personalities.

Avery: Yeah, I would say I was holding them correctly.

Addison: My favorite is feeding them. … More hands on so I can feed them more like that.

Particular attention was given to the care of call ducks, with several participants noting that their smaller size and gentle nature made the experience especially rewarding. Compared with standard-sized ducks, which could be more challenging to manage due to their larger build, call ducks were easier to handle and fostered a more pronounced connection. The calm demeanor of the call ducks, combined with their ease of handling, deepened participants’ appreciation for them, making participants feel more engaged with the birds and more attuned to their needs.

Jordan: The bigger ones would knock the smaller ones out of the way [to get feed]. Well, I just kind of waited until the bigger those mean ducks moved away, and those smaller [call] ducks could move closer [and feed them].

Meaningful work

The subtheme of Meaningful Work was developed because many participants expressed that their caregiving tasks were deeply meaningful, not merely tasks to be checked off but actions that brought them purpose and fulfillment. For these individuals, the act of caring for the ducks went beyond the routine; it was a source of joy and a sense of purpose. The emotional satisfaction derived from this meaningful work played a crucial role in how participants valued their caregiving experiences, reinforcing the idea that their work was not only necessary but also highly rewarding.

Riley: I thought it was a lot of fun. Even though it was work, it was fun work. I’m glad I did it, though.

PI: Tell me more … I know you helped with building the shed [duck shelter].

Theo: Yeah.

PI: What was that experience like?

Theo: Oh that was very hard but *Not audible*.

PI: Yeah you helped to cut the door and does it make you what?

Theo: More appropriate.

PI: More appropriate?

Theo: More happy.

PI: So what makes you more happy? The thing that you can build the stuff?

Theo: The helping.

Several participants particularly enjoyed when the ducks were eating directly from their hands. They appreciated the opportunity to engage more directly with the birds, fostering a sense of connection. The act of handfeeding not only allowed for closer interaction but also provided a sense of fulfillment, making the experience especially meaningful and enjoyable.

Avery: Well, there’s just a lot feeding them and having them eat out of your hand. It’s nice.

Theme four: Nature and environment

The main theme of Nature and Environment was developed from the interview transcripts, as participants highlighted the significance and impact of nature and the environment when working with ducks. Furthermore, the comparison of domesticated ducks to other animals enriches the theme by illustrating how different environments influence various species, even within domesticated settings. This comparison underscores that the behavior of domesticated ducks, as part of the natural world, reflects broader patterns in how humans perceive and interact with animals in their environments.

Seasonal changes posed challenges in caring for farm animals, especially in cold weather, which may affect water access, food availability, and bring exposure to harsh elements. Participants showed growing responsibility for the ducks, recognizing the need for shelter and the impact of freezing temperatures on water sources, which are essential for both hydration and hygiene. This demonstrated a deeper understanding of animal care and environmental factors affecting the ducks’ wellbeing.

Jordan: I feel sorry for them sometimes being out in the cold. [but] They got a house.

Theo: The water, you know, it freezes, the water in the pool freezes.

PI: Yeah, so what do you do if the water in the pool freezes?

Theo: I use my foot to go out and break the ice.

When comparing their experiences with ducks to those with other animals, participants highlighted differences in behavior and care. One participant reflected on past experiences with fighting roosters, emphasizing the stark contrast in care, attachment, and emotional connection between the two. The participant noted that ducks were more affectionate and engaging, while roosters required more cautious handling due to their aggressive nature. Others, drawing from their prior experiences with dogs, cats, and horses, recognized and appreciated the distinct personalities each animal species possesses. They noted that, like dogs, cats, and horses, ducks also exhibit unique behaviors and preferences, highlighting the importance of understanding the behavioral distinctions between different species.

Casey: In other words, you can lead horses, but you cannot lead ducks. It’s completely different between those two.

Additionally, some participants noticed the “wild side” of the ducks, distinguishing them from other domesticated farm animals. Participants observed that occasionally ducks could be cautious or reserved, sometimes needing space or seeking shelter when feeling threatened. The contrast between the wild instincts of ducks, such as their tendency to congregate in flocks, and the more domesticated nature of other farm animals created an environment that felt dynamic and sometimes unpredictable.

Jordan: Because I feel they [ducks] are more on the wild side, and they kind of like to stick together.

Discussion

This study explored the perceptions of individuals with TBI participating in a nature-based AATF intervention. For clinicians, examining such innovative approaches provides valuable insights into patient recovery. Developing novel interventions like AATF with ducks is essential for promoting recovery and improving health outcomes in persons with TBI, who require ongoing therapies to progress in physical and cognitive functions.

While both joy and happiness are positive emotional states, they exhibit distinct characteristics. Joy is often spontaneous, transient, and arises in moments of connection, heightened awareness, and a sense of freedom. In contrast, happiness is a more long-term and stable mental state, typically achieved through intentional pursuit, and is closely associated with virtue, self-regulation, and the exercise of self-control.²⁴ Both joy and happiness may be viewed as an emotional reaction to the process of accomplishment.²⁵ Participants’ experiences with ducks in our study reflected a strong sense of achievement and fulfillment, as they frequently described moments of progress, mastery, and personal growth, which inevitably translated into feelings of joy and happiness.

There are inherent challenges in quantifying these abstract concepts, and the qualitative research could provide deeper insights into the role of joy and happiness in the process of healing.²⁶ Notably, evidence suggests that the experiences of joy and happiness associated with AAT can facilitate recovery.²⁷ This aligns with our findings, which demonstrate that individuals with TBI highly value the joy and happiness they experience through interactions and engagement with ducks during AATF activities. Participants also expressed profound affection for the ducks, showing deep care and attention to their well-being. Their love for the birds was evident not only in their actions, such as feeding, petting, and ensuring the ducks’ comfort, but also in the genuine emotional bond they formed with the birds.

Resilience is a cornerstone of effective coping, enabling individuals to navigate adversity with strength and adaptability. It reflects an inner capacity to recover from setbacks, adapt to challenging situations, and grow through difficulty.²⁸ Key aspects of resilience include maintaining a positive outlook, fostering emotional regulation, and relying on support networks.²⁹ Interaction with animals provided comfort, companionship, and emotional support, which is particularly beneficial for individuals experiencing trauma, chronic stress, or mental health disorders.³⁰ Indeed, participants reported that immersion in AATF activities enhanced their ability to cope with past negative experiences.

Interacting with animals to develop attachment involves building trust, mutual responsiveness, and emotional connection. Participants in our study engaged in positive activities such as feeding, grooming, and petting, which helped the animals feel secure. These interactions established a foundation of reliability and affection, reflecting the key elements of secure attachment—trust, safety, and confidence in relationships, fostering reciprocal connections.³¹

Learning and growth were key to providing adaptable care for the ducks, ensuring the relationship was both nurturing and responsive to their changing needs. By understanding duck behavior, preferences, and health, participants developed empathy, patience, and a deeper connection. As they refined their skills, caregivers built trust with the animals and enhanced their sense of responsibility and purpose. This commitment to learning created an environment where both caregivers and ducks could thrive.

Meaningful work fosters self-realization and a sense of purpose, offering autonomy, authenticity, and impact. It not only fulfills personal aspirations but also strengthens one’s connection to a broader societal influence.³² It fosters engagement, motivation, and personal growth, instilling a deep sense of purpose and fulfillment.³³ The sense of purpose derived from meaningful work deepened participants’ connection to their roles, illustrating that care was not merely a task, but a rewarding and personally significant endeavor. Caring for ducks brought profound meaning to the work, as it involved nurturing living beings who relied on human compassion and care. This work also holds broader significance, supporting animal welfare and contributing to the conservation of rare breeds like call ducks,³⁴ and facilitating personal recovery and rehabilitation through therapy animals. Each act of care reinforced the intrinsic value of life and the caregivers’ profound impact, making their work purposeful and fulfilling. Participants found caring for ducks unique due to their playful, social nature, and despite seasonal challenges, admired their resilience. In extreme conditions, such as deep freezes, caregivers demonstrated commitment by breaking ice to ensure the ducks had access to water.

Limitations

This study has several limitations. The small sample size, drawn from a single TBI rehabilitation center, limits the generalizability of the findings to a broader population. Additionally, the qualitative nature of the study makes it difficult to determine the specific impact of AATF experiences in isolation. Participants engaged in various other activities at the center, such as occupational and physical therapy, watching movies, playing games, and attending creative sessions like painting classes. These additional experiences likely influenced their reflections, making it challenging to attribute their reported benefits solely to AATF. Instead, their responses may reflect the combined effects of multiple rehabilitation activities, highlighting the complex and multifaceted nature of their recovery process. Further limitations include the potential for subject bias, which may have influenced participants’ responses. Subject bias is considered in this study, as participants, especially in therapeutic or rehabilitative settings, may feel inclined to report positive experiences due to social desirability or a perceived expectation to show progress.^35,36 This could have impacted the accuracy of the reported experiences and perceptions, making it difficult to distinguish genuine responses from those influenced by what participants perceived as desirable. Lastly, the interview guide was not formally piloted with a separate sample, which may have limited opportunities to identify issues with question clarity or structure in advance. These factors should be considered when interpreting the findings and in designing future research to strengthen the study’s credibility and applicability.

Conclusions

Many individuals with TBI continue to face significant challenges in coping with the long-term consequences of their condition. This study introduces AATF, specifically involving domesticated ducks, as a novel strategy to help individuals address these challenges. Insights derived from participant interviews and informal interactions with staff at the TBI center during the study reveal enthusiasm and overwhelming support for the AATF program. The findings suggest that fostering meaningful human–animal bonds not only supports the development of effective coping strategies but also significantly enhances the overall well-being of this population, which contends with the considerable burden of illness.

Authors’ Contributions

A.S.: Conceptualization (lead), project administration (lead), investigation (lead), formal analysis (equal), methodology (lead), writing—original draft (lead), and writing—review and editing (equal). F.H.: Project administration (supporting), resources (lead), formal analysis (equal), and writing—review and editing (equal). L.H.B.: Conceptualization (supporting), formal analysis, methodology, writing—original draft (supporting), and writing—review and editing (equal). S.T.: Methodology (supporting) and conceptualization (supporting).

Footnotes

Author Disclosure Statement

The authors have no conflicts of interest to disclose.

Funding Information

The authors have no funding information to declare.

Supplemental Material

References

Belanger

, Vanderploeg

, Curtiss

, et al. Self-efficacy predicts response to cognitive rehabilitation in military service members with post-concussive symptoms. Neuropsychol Rehabil, 2020; 30(6):1190–1203; doi: 10.1080/09602011.2019.1575245

Plourde

, Daya

, Low

, et al. Evaluating anxiety and depression symptoms in children and adolescents with prior mild traumatic brain injury: Agreement between methods and respondents. Child Neuropsychol, 2019; 25(1):44–59; doi: 10.1080/09297049.2018.1432585

Zelencich

, Kazantzis

, Wong

, et al. Predictors of working alliance in cognitive behaviour therapy adapted for traumatic brain injury. Neuropsychol Rehabil, 2020; 30(9):1682–1700; doi: 10.1080/09602011.2019.1600554

Howlett

, Nelson

, Stein

. Mental health consequences of traumatic brain injury. Biol Psychiatry, 2022; 91(5):413–420; doi: 10.1016/j.biopsych.2021.09.024

Hediger

, Thommen

, Wagner

, et al. Effects of animal-assisted therapy on social behaviour in patients with acquired brain injury: A randomised controlled trial. Sci Rep, 2019; 9(1):5831; doi: 10.1038/s41598-019-42280-0

Theis

, Luck

, Hund-Georgiadis

, et al. Influences of animal-assisted therapy on episodic memory in patients with acquired brain injuries. Int J Environ Res Public Health, 2020; 17(22):8466; doi: 10.3390/ijerph17228466

Maalouf

, Clark

, Tavitian

, et al. Bias to negative emotions: A depression state-dependent marker in adolescent major depressive disorder. Psychiatry Res, 2012; 198(1):28–33; doi: 10.1016/j.psychres.2012.01.030

Hediger

, Petignat

, Marti

, et al. Animal-assisted therapy for patients in a minimally conscious state: A randomized two treatment multi-period crossover trial. PLoS One, 2019; 14(10):e0222846; doi: 10.1371/journal.pone.0222846

Choi

, Kim

, Sun

, et al. Incidence of depression after traumatic brain injury: A nationwide longitudinal study of 2.2 million adults. J Neurotrauma, 2022; 39(5–6):390–397; doi: 10.1089/neu.2021.0111

10.

Hellewell

, Beaton

, Welton

, et al. Characterizing the risk of depression following mild traumatic brain injury: A meta-analysis of the literature comparing chronic mTBI to Non-mTBI populations. Front Neurol, 2020; 11:350; doi: 10.3389/fneur.2020.00350

11.

Berget

, Ekeberg

, Pedersen

, et al. Animal-assisted therapy with farm animals for persons with psychiatric disorders: Effects on anxiety and depression, a randomized controlled trial. Occupational Therapy in Mental Health, 2011; 27(1):50–64; doi: 10.1080/0164212X.2011.543641

12.

Pandey

Himanshu

Gunjan

et al. The role of animal-assisted therapy in enhancing patients’ well-being: Systematic study of the qualitative and quantitative evidence. JMIRx Med, 2024; 5:e51787; doi: 10.2196/51787

13.

Berget

, Ekeberg

, Braastad

. Animal-assisted therapy with farm animals for persons with psychiatric disorders: Effects on self-efficacy, coping ability and quality of life, a randomized controlled trial. Clin Pract Epidemiol Ment Health, 2008; 4(1):9; doi: 10.1186/1745-0179-4-9

14.

Pedersen

, Martinsen

, Berget

, et al. Farm animal-assisted intervention for people with clinical depression: A randomized controlled trial. Anthrozoös, 2012; 25(2):149–160; doi: 10.2752/175303712X13316289505260

15.

Sargsyan

, Beebe

. Animal-assisted green care farming for patients with mental and physical disorders: A narrative review. Creat Nurs, 2023; 29(2):192–196; doi: 10.1177/10784535231195433

16.

Sargsyan

, Beebe

, Ng

, et al. “Quacking for Noggin”: Farm animal–assisted therapy for traumatic brain injury survivors. People and Animals: The International Journal of Research and Practice, 2024; 7(1).

17.

Sargsyan

, Beebe

. Putting the ducks in a row: Development of a duck-assisted green care intervention for persons with traumatic brain injury. Issues Ment Health Nurs, 2024; 45(3):274–282; doi: 10.1080/01612840.2023.2281026

18.

Suba-Bokodi

, Nagy

, Molnár

. Unconventional animal species participation in animal-assisted interventions and methods for measuring their experienced stress. Animals (Basel), 2024; 14(20):2935; doi: 10.3390/ani14202935

19.

Tan

. Airplane passengers fall in love with emotional support duck accompanying owner with PTSD. 2016. Available from: https://abcnews.go.com/Lifestyle/airplane-passengers-fall-love-emotional-support-duck-accompanying/story?id=42878860

20.

Piatt

. Veteran brings therapy ducks to senior living facilities. 2022. Available from: https://www.youtube.com/watch?v=3pX5BBcvj5w

21.

Braun

, Clarke

. Using thematic analysis in psychology. Qualitative Research in Psychology, 2006; 3(2):77–101; doi: 10.1191/1478088706qp063oa

22.

O’Brien

, Harris

, Beckman

, et al. SRQR checklist: Standards for reporting qualitative research: A synthesis of recommendations. EQUATOR Network, 2014.

23.

Zhang

, Balloo

, Hosein

, et al. A scoping review of well-being measures: Conceptualisation and scales for overall well-being. BMC Psychol, 2024; 12(1):585; doi: 10.1186/s40359-024-02074-0

24.

Cottrell

. Joy and happiness: A simultaneous and evolutionary concept analysis. J Adv Nurs, 2016; 72(7):1506–1517; doi: 10.1111/jan.12980

25.

Summa

. Joy and happiness. In: The Routledge Handbook of Phenomenology of Emotion. Routledge: 2020; pp. 416–426.

26.

Tulip

, Fisher

, Bankhead

, et al. Building wellbeing in people with chronic conditions: A qualitative evaluation of an 8-week positive psychotherapy intervention for people living with an acquired brain injury. Front Psychol, 2020; 11:66.

27.

Brown

, Snelders

, Godbold

, et al. Effects of animal-assisted activity on mood states and feelings in a psychiatric setting. J Am Psychiatr Nurses Assoc, 2020; 26(6):555–567; doi: 10.1177/1078390319853617

28.

Semanision

, Williams

, Moran

, et al. Psychosocial determinants conferring resilience after TBI: Current Understanding. Curr Phys Med Rehabil Rep, 2024; 12(3):359–367; doi: 10.1007/s40141-024-00461-7

29.

de la Fuente

, Santos

, Garzón-Umerenkova

, et al. Cross-sectional study of resilience, positivity and coping strategies as predictors of engagement-burnout in undergraduate students: Implications for prevention and treatment in mental well-being. Front Psychiatry, 2021; 12:596453.

30.

Brooks

, Rushton

, Lovell

, et al. The power of support from companion animals for people living with mental health problems: A systematic review and narrative synthesis of the evidence. BMC Psychiatry, 2018; 18(1):31; doi: 10.1186/s12888-018-1613-2

31.

Ainsworth

. Attachments beyond infancy. Am Psychol, 1989; 44(4):709–716; doi: 10.1037//0003-066x.44.4.709

32.

Martela

, Pessi

. Significant work is about self-realization and broader purpose: Defining the key dimensions of meaningful work. Front Psychol, 2018; 9:363; doi: 10.3389/fpsyg.2018.00363

33.

Bailey

, Yeoman

, Madden

, et al. A review of the empirical literature on meaningful work: Progress and research agenda. Human Resource Development Review, 2019; 18(1):83–113; doi: 10.1177/1534484318804653

34.

Stichting Zeldzame H. Hollandse kwaker. 2017. Available from: http://szh.nl/eenden/hollandse-kwaker/ [Last accessed: February 20, 2025].

35.

Perinelli

, Gremigni

. Use of social desirability scales in clinical psychology: A systematic review. J Clin Psychol, 2016; 72(6):534–551; doi: 10.1002/jclp.22284

36.

Ruslin

, Mashuri

, Sarib

, et al. Semi-structured interview: A methodological reflection on the development of a qualitative research instrument in educational studies Ruslin. IOSR-JRME, 2022; 12:22–29; doi: 10.9790/7388-1201052229

Supplementary Material

Please find the following supplemental material available below.

For Open Access articles published under a Creative Commons License, all supplemental material carries the same license as the article it is associated with.

For non-Open Access articles published, all supplemental material carries a non-exclusive license, and permission requests for re-use of supplemental material or any part of supplemental material shall be sent directly to the copyright owner as specified in the copyright notice associated with the article.

0.00 MB

0.02 MB

0.03 MB