It was supper time in the Whittier, California, home of Air Force veteran Danyelle Clark-Gutierrez, and eagerly awaiting a bowl of kibble and canned dog food was Lisa, a 3-year-old yellow Labrador retriever.
Her nails clicking on the kitchen floor as she danced about, Lisa looked more like an exuberant puppy than the highly trained service animal that helps Clark-Gutierrez manage the symptoms of post-traumatic stress disorder.
"Having her now, it's like I can go anywhere," Clark-Gutierrez said. "And, yes, if somebody did come at me, I'd have warning -- I could run."
A growing body of research into PTSD and service animals paved the way for President Joe Biden to sign into law the Puppies Assisting Wounded Servicemembers (PAWS) for Veterans Therapy Act. The legislation, enacted in August, requires the Department of Veterans Affairs to open its service dog referral program to veterans with PTSD and to launch a five-year pilot program in which veterans with PTSD train service dogs for other veterans.
Clark-Gutierrez, 33, is among the 25 percent of female veterans who have reported experiencing military sexual trauma while serving in the U.S. armed services.
Military sexual trauma, combat violence and brain injuries are some of the experiences that increase the risk that service members will develop PTSD. Symptoms include flashbacks to the traumatic event, severe anxiety, nightmares and hypervigilance -- all normal reactions to experiencing or witnessing violence, according to psychologists. Someone receives a PTSD diagnosis when symptoms worsen or remain for months or years.
That's what Clark-Gutierrez said happened to her after ongoing sexual harassment by a fellow airman escalated to a physical attack about a decade ago. A lawyer with three children, she said that to feel safe leaving her home she needed her husband by her side. After diagnosing Clark-Gutierrez with PTSD, doctors at VA hospitals prescribed a cascade of medications for her. At one point, Clark-Gutierrez said, her prescriptions added up to more than a dozen pills a day.
"I had medication, and then I had medication for the two or three side effects for each medication," she said. "And every time they gave me a new med, they had to give me three more. I just couldn't do it anymore. I was just getting so tired. So we started looking at other therapies."
And that's how she got her service dog, Lisa. Clark-Gutierrez's husband, also an Air Force veteran, discovered the nonprofit group K9s for Warriors, which rescues dogs -- many from kill shelters -- and trains them to be service animals for veterans with PTSD. Lisa is one of about 700 dogs the group has paired with veterans dealing with symptoms caused by traumatic experiences.
"Now with Lisa we take bike rides, we go down to the park, we go to Home Depot," said Clark-Gutierrez. "I go grocery shopping -- normal-people things that I get to do that I didn't get to do before Lisa."
That comes as no surprise to Maggie O'Haire, an associate professor of human-animal interaction at Purdue University. Her research suggests that while service dogs aren't necessarily a cure for PTSD, they do ease its symptoms. Among her published studies is one showing that veterans partnered with these dogs experience less anger and anxiety and get better sleep than those without a service dog. Another of her studies suggests that service dogs lower cortisol levels in veterans who have been traumatized.
"We actually saw patterns of that stress hormone that were more similar to healthy adults who don't have post-traumatic stress disorder," O'Haire said.
A congressionally mandated VA study that focuses on service dogs' impact on veterans with PTSD and was published this year suggests that those partnered with the animals experience less suicidal ideation and more improvement to their symptoms than those without them.
Until now, the federal dog referral program -- which relies on nonprofit service dog organizations to pay for the dogs and to provide them to veterans for free -- required that participating veterans have a physical mobility issue, such as a lost limb, paralysis or blindness. Veterans like Clark-Gutierrez who have PTSD but no physical disability were on their own in arranging for a service dog.
The pilot program created by the new federal law will give veterans with PTSD the chance to train mental health service dogs for other veterans. It's modeled on a program at the VA hospital in Palo Alto, California, and will be offered at five VA medical centers nationwide in partnership with accredited service dog training organizations.
"This bill is really about therapeutic, on-the-job training, or 'training the trainer,'" said Adam Webb, a spokesperson for Sen. Thom Tillis (R-N.C.), who introduced the legislation in the Senate. "We don't anticipate VA will start prescribing PTSD service dogs, but the data we generate from this pilot program will likely be useful in making that case in the future."
The Congressional Budget Office estimates the pilot program will cost the VA about $19 million. The law stops short of requiring the VA to pay for the dogs. Instead, the agency will partner with accredited service dog organizations that use private money to cover the cost of adopting, training and pairing the dogs with veterans.
Still, the law represents a welcome about-face in VA policy, said Rory Diamond, CEO of K9s for Warriors.
"For the last 10 years, the VA has essentially told us that they don't recognize service dogs as helping a veteran with post-traumatic stress," Diamond said.
PTSD service dogs are often confused with emotional support dogs, Diamond said. The latter provide companionship and are not trained to support someone with a disability. PTSD service dogs cost about $25,000 to adopt and train, he said.
Diamond explained that the command "cover" means "the dog will sit next to the warrior, look behind them and alert them if someone comes up from behind." The command "block" means the dog will "stand perpendicular and give them some space from whatever's in front of them."
Retired Army Master Sgt. David Crenshaw of Kearny, New Jersey, said his service dog, Doc, has changed his life.
"We teach in the military to have a battle buddy," Crenshaw said. "And these service animals act as a battle buddy."
A few months ago, Crenshaw experienced this firsthand. He had generally avoided large gatherings because persistent hypervigilance is one symptom of his combat-caused PTSD. But this summer, Doc, a pointer and Labrador mix, helped Crenshaw navigate the crowds at Disney World -- a significant first for Crenshaw and his family of five.
"I was not agitated. I was not anxious. I was not upset," said Crenshaw, 39. "It was truly, truly amazing and so much so that I didn't even have to even stop to think about it in the moment. It just happened naturally."
Thanks to Doc, Crenshaw said, he no longer takes PTSD drugs or self-medicates with alcohol. Clark-Gutierrez said Lisa, too, has helped her quit using alcohol and stop taking VA-prescribed medications for panic attacks, nightmares and periods of disassociation.
The dogs actually save the VA money over time, Diamond said. "Our warriors are far less likely to be on expensive prescription drugs, are far less likely to use other VA services and far more likely to go to school or go to work. So it's a win-win-win across the board."
(KHN (Kaiser Health News) is a national newsroom that produces in-depth journalism about health issues. Together with Policy Analysis and Polling, KHN is one of the three major operating programs at KFF (Kaiser Family Foundation). KFF is an endowed nonprofit organization providing information on health issues to the nation.)