Equine-Assisted Therapy for Veterans with PTSD: Manual Development and Preliminary Findings

Abstract

Introduction Equine-assisted therapy (EAT) for post-traumatic stress disorder (PTSD) has attracted great interest despite lacking empirical support, a manual, and a standardized protocol. Our team of experts in EAT and PTSD developed an eight-session group EAT treatment protocol for PTSD (EAT-PTSD) and administered it to two pilot groups of military veterans to assess initial effects. Materials and Methods We describe the development of the treatment manual, which was used with two pilot groups of veterans. Protocol safety, feasibility, and acceptability were assessed by reported adverse events, treatment completion rates, and self-rated patient satisfaction. Preliminary data on PTSD, depressive, and anxiety symptoms and quality of life were collected pretreatment, midpoint, post-treatment, and at 3-month follow up. Results No adverse events were recorded. All patients completed treatment, reporting high satisfaction. Preliminary data showed decreases in clinician-assessed PTSD and depressive symptoms from pre to post-treatment and follow-up (medium to large effect sizes, d = .54–1.8), with similar trends across self-report measures (d = 0.72–1.6). In our pilot sample, treatment response and remission varied; all patients showed some benefit post-treatment, but gains did not persist at follow-up. Conclusions This article presents the first standardized EAT protocol. Highly preliminary results suggest our new manualized group EAT-PTSD appears safe, well-regarded, and well-attended, yielding short-term benefits in symptomatology and quality of life if unclear length of effect. Future research should test this alternative treatment for PTSD more rigorously.

Experiences of Military Veterans in a Therapeutic Horseback Riding Program

“…Other investigators reported that pain significantly lessened in the shoulders, back, and hips of older adults who participated in a 6-week THR program modeled after ours (White-Lewis et al, 2019). Another research team reported no injuries to participants in a THR program (Arnon et al, 2020). Similarly, there were no injuries to our participants.…”

Neural changes following equine‐assisted therapy for posttraumatic stress disorder: A longitudinal multimodal imaging study

“…Each session ended with an opportunity for participants to review and discuss their experiences. The final session included a graduation ceremony celebrating patients' treatment progress and accomplishments (see Arnon et al, 2020;Fisher et al, under review).…”

“…A psychotherapist, assisted by an equine specialist, helps a patient understand and negotiate interactions with a horse, which should help foster regulation, reflection, and verbal and nonverbal communication (Selby & Smith-Osborne, 2013). We have recently developed and manualized EAT for PTSD and tested it in a pilot trial (Arnon et al, 2020) and in a large open trial (Fisher et al, 2021, under review) for military veterans with PTSD. Eight weekly sessions yielded reduction in PTSD and depressive symptoms, high acceptability (very few drop-outs), and tolerability.…”

Equine-Assisted Activities and Therapies for Veterans With Posttraumatic Stress Disorder: Current State, Challenges and Future Directions

“…25,64,65 Among the studies of PTSD, only two of these 55,57 have a control group and only one 57 is a randomized trial. Among the ten investigations only three, 26,55,58 used the same intervention, which was the Equine-assisted growth and learning association (Eagala) model. Most report improvement in PTSD symptoms.…”

“…24 Since the 1990s, the use of EAP has grown rapidly in Europe and the United States 24 and is being increasingly used for active duty military and Veteran populations. 25,26 As one example, the number of equine centers accredited by the Professional Association of Therapeutic Horsemanship International (PATH Intl) providing services to Veterans, grew from 89 to 335 centers between 2009 and 2016. 27…”