For years Raymond Galmiche, 64, had nightmares about his two deployments to Vietnam as a tanker in the Army. He would awake with the mattress soaked in sweat and spend hours playing solitaire until he could fall asleep again.
The haunting memories also came in the form of daytime flashbacks in which he might spend 20 minutes lost in another time and place.
Galmiche, who retired from the Army in 1986 after 20 years of service, was diagnosed with post-traumatic stress disorder in 2002. Though he attended counseling sessions and took medication during the following years, he says he did not find profound relief from his symptoms until being matched with a PTSD service dog last September.
Galmiche received Dazzle, a German Shepherd, through a research study at the James A. Haley Veterans' Hospital in Tampa, Fla. The study is evaluating whether or not symptoms improve when a veteran is paired with a PTSD service dog.
During their first night together, Galmiche began to have a nightmare and Dazzle licked his face then tapped a paw on his chest, a task the dog was trained to perform. When Galmiche awoke, Dazzle nuzzled against him and the two quickly fell asleep.
"It blew me away," Galmiche told NBC News. "I can talk with just about any social worker, counselor, my closest friend, a psychologist, and as much as they can get it ... the dog looks in my eyes and seems to understand what my real basic need is. It’s that self-worth that makes me feel a private pride, something that I thought I’d lost a long time ago."
Galmiche prays that others like him will have the same experience, but many challenges remain to providing PTSD service dogs to veterans on wide-scale basis.
Though stories like Galmiche's are becoming more common, few of the service dogs trained annually are specifically for PTSD patients. There have been no double-blind, randomized controlled trials — the gold standard for studying medical interventions — on the benefits of a service dog for PTSD patients. There are also no widely accepted standards or best practices for training dogs to alleviate PTSD symptoms, a point of concern for many traditional service dog organizations, some of which have been in the industry for decades.
At the veterans' hospital in Tampa, a team of epidemiologists, mental health providers, veterinarians and other experts are conducting a study that will address some of these questions. Seventeen participants enrolled in the program over the past year, though Congress -- which recommended the study -- permitted the Department of Veterans Affairs to match as many as 200 with service dogs.
While many are eager for the three-year study to deliver scientific research that will demonstrate benefits and help create a framework for training PTSD service dogs, there have been some challenges. The study was temporarily suspended from January to June after a young girl was bitten by a dog. VA declined to be interviewed about the study, but told NBC News that the project resumed after it increased monitoring through phone calls and home visits by the researchers and service dog providers.
The study is the first of its kind at VA; the agency only just began providing benefits for service dogs to veterans with physical disabilities in 2001 and had previously done a handful of small studies looking at whether veterans benefits from mobility and hearing service dogs. The research hinted that some veterans with service dogs might have improved affect but the results were limited.
Before the most recent study even began, it sparked a debate among experts in the field. Federal law requires that service animals perform specific tasks to assist with a disability, and organizations that train service dogs have spent years identifying and refining appropriate tasks and training techniques. The idea that a dog can assist with a so-called invisible disability, however, has many in the field skeptical.
"There is a view I guess from some people that PTSD dogs are therapy dogs because there is no manifestation of physical disability that you can see," said Michael Sapp Sr., CEO of Paws With A Cause in Wayland, Mich. The distinction is important as a therapy dog is not considered a service animal under the American Disabilities Act, and is not granted the same access to public and private buildings.
Sapp said that Paws With A Cause learned of the VA study in Tampa last year and was reluctant to participate because the organization lacked in-depth knowledge of PTSD and how symptoms might be ameliorated by a service dog. Paws With A Cause had previously explored providing service dogs to children with autism and spent a year-and-a-half interviewing families, visiting schools for autistic children and conducting surveys before it felt comfortable training dogs for that purpose.
Sapp is also concerned about the proliferation of upstart organizations that are trying to meet the growing demand for PTSD service dogs, but don't have years of experience in the field and aren't accredited by Assistance Dogs International, one of the industry's only standard-setting groups. Matching a service dog to the right owner takes time, Sapp said, and should be followed up regularly with evaluations for both the animal and the client. That requires resources and infrastructure that many newer organizations lack, Sapp said.
Dr. Elspeth Cameron Ritchie, a retired colonel who served in the Office of the U.S. Army Surgeon General until 2010, told NBC News that using service dogs for PTSD may require a new way of looking at training. It might be that a classically-trained service dog or a shelter animal could be taught PTSD-related tasks. The fear in the field and what's behind the "active dispute" among experts, Ritchie said, is that "you have to be very careful, because if you’ve got an untrained or poorly trained dog, then you’re skewing it for other dogs."
The VA study had partnered with three service dog organizations, two of which were ADI accredited and have since left the project. Guardian Angels Medical Service Dogs, Inc., in Williston, Fla., has been the only one of the three original providers to continue with the VA study, and matched Galmiche with Dazzle.
Carol Borden, the organization's executive director, said her staff provides 500 to 1,500 hours of rigorous training for the animals over a six to 24-month period. They have trained PTSD service dogs for the past three years, teaching them to help ground a client during an anxiety episode, awaken a client from a nightmare and remind a client to take medication, among other tasks.
Borden has witnessed dramatic turnarounds in many veterans' lives once matched with a dog.
"The results are very immediate, they’re very quick," Borden told NBC News. "It’s not a cure, but they are able to manage their challenges much better than they have in years."
Borden said the demand for PTSD service dogs is far more than her organization can handle; most people on her four-year waiting list have requested a dog for that purpose.
An estimated 13 to 20 percent of the more than 2.6 million service members who served in Iraq or Afghanistan since 2001 have or may develop PTSD, creating a pool of possible patients as large as 520,000 people. Even if a fraction of those veterans could benefit from a PTSD service dog, there is no pipeline to provide them in a consistent, safe manner.
The anecdotal success stories are compelling, but researchers are still trying to understand how the relationship works.
Rick Yount, founder of Warrior Canine Connection, believes his service dog training program may help provide insight into how treatment could work.
Patients with PTSD don't receive a service dog in WCC, but instead train them to assist another veteran with physical disabilities. After participating in a 2008 training program at a VA residential PTSD treatment center, many veterans reported better emotional and impulse control, decreased depression, lowered stress levels, improved sleep and more "in the moment" thinking.
Yount attributes the improvements partly to the opportunity for veterans to participate in a "mission" for other wounded warriors. The sense of purpose helps, but there may also be neurobiological effects of interacting with an animal; research has shown that when focus is on petting and playing with a dog, it can increase oxytocin, a brain chemical that boosts trust and quiets the brain's fear response.
"It may not be as fantastic-looking as having a dog pulling a wheelchair," Yount said, "but the results are pretty fantastic when you talk to a vet who can live a normal lifestyle because he has a dog."
Yount argues that it might even be more effective to allow PTSD patients to train a dog before receiving one.
"They have to convince the dog the world is a safe place, rather than letting the dog prove to them that the world is a safe place," Yount said. For some, that difference could lead to a greater sense of independence and perhaps such a marked improvement in their symptoms that they wouldn't require a service dog.
Yount and his research partner, Meg Daley Olmert, are designing a study to test the benefits of training service dogs. In the meantime, they are working with the National Intrepid Center of Excellence, located on the campus of the Walter Reed National Military Medical Center, to help establish a set of guidelines for how service dogs can be used to help veterans. They hope that eventually the Department of Defense will create a training corps staffed by PTSD patients that could offer both therapy as well as a solution to the shortage of service dogs.
Both agree that research into this field warrants federal support and must go beyond the efforts of small nonprofits to meet the demand. It will also require people to change the way they've traditionally thought of service dogs to encompass the invisible wounds of war or service.
For Galmiche, participating in the VA study has been life-changing. With Dazzle at his side to alert Galmiche to potential threats or people who approach too quickly, he now feels comfortable going out in public. Galmiche has also strengthened his relationship with his children after ending a painful period of isolation in which he had little communication with them for more than two years.
"He’s there for me constantly, everywhere I go, everything I do," Galmiche said. "It’s like the brotherhood I had in Vietnam where we counted on each other for everything. This dog gives me the same sense."
Rebecca Ruiz is a reporter at NBC News and a 2011-2012 Rosalynn Carter Mental Health Journalism Fellow. Follow her on Twitter here.
Update: This article originally misstated that all three of the organizations participating in the VA study were not accredited by ADI.
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