Canine-Assisted Therapy in Reducing Stress and Anxiety Levels of University Students: Systematic Review and Meta-analysis of Randomized Controlled Trials

Background Due to the high prevalence of mental health issues among university students worldwide, canine-assisted therapy (CAT) has emerged as a potential intervention to reduce student stress and anxiety. This study systematically reviews and meta-analyzes the effects of CAT on reducing stress and anxiety levels among university students. Methods A systematic search was conducted across multiple databases for randomized controlled trials (RCTs) published in English and Chinese including Google Scholar, Duke Libraries, APA PsychNet, PubMed, CNKI, and Wanfang, focusing on RCTs. Only studies utilizing professionally trained dogs and handlers in therapy sessions were included. Data were extracted independently by two reviewers (SS and ZL), and the risk of bias was assessed using the Cochrane Risk-of-Bias tool. Effect sizes (Hedges’ g) were pooled for individual outcomes using random-effects meta-analysis. Statistical analyses, including subgroup analyses examining the impact of intervention duration, were conducted to determine the overall effect size and explore potential moderators. Results Thirteen RCTs met the inclusion criteria, involving interventions with varying durations and control conditions. The meta-analysis revealed a statistically significant overall effect size of d = -0.703 (p < 0.001), indicating a moderate reduction in stress and anxiety levels among university students. However, high heterogeneity was observed across studies ( I ²  = 71.77, p < 0.001), suggesting variability in intervention effectiveness. Conclusion CAT demonstrates promise in alleviating stress and anxiety among university students. Despite methodological variations and potential publication bias, the findings suggest that CAT may offer a feasible and accessible approach to enhancing mental well-being within university environments. Further studies are necessary to examine factors influencing methodological diversity and refine the integration of CAT within university settings.