Written by: Savanna Payne
Edited by: Jonathan Cina
Many treatment options have been consistent in their effects and applications for decades. Cognitive-behavioral therapy (CBT), a popular treatment approach commonly used for a plethora of mental health issues such as depression or anxiety, has been actively used since its development in the 1960s. CBT treatment frequently involves intensive weekly treatment sessions that address an individual's distorted thinking and the development of new coping strategies to improve regulation of their behavior and emotions (“What is Cognitive Behavioral Therapy?”, 2023). While traditional treatment pathways such as CBT may be effective for many individuals, there are many reasons why these common treatments may not be a person’s first choice. Traditional treatment may be too expensive, not easily accessible, or simply ineffective. For example, over 30% of people diagnosed with major depressive disorder will have “treatment-resistant” depression, a diagnosis where common treatment methods such as antidepressants or CBT are ineffective. (“Treatment-Resistant Depression”, 2023). Any of these reasons for not using traditional treatments can cause significant frustration and additional distress to a person. In hopes of reducing these difficult outcomes, research in alternative treatment methods has been growing. One method, with a unique inclusion of horses, has shown promising results.
Equine-assisted therapy (EAT) or equine-assisted activities and therapy (EAAT) is a treatment program that allows a person to participate in both beginner riding, and non-riding activities, including feeding, grooming, and leading, as well as participating in ground exercises. Although EAT does not have standardized guidelines on treatment criteria, these programs typically focus on fostering a more habitual pattern of mindfulness in the client. Mindfulness emphasizes the importance of identifying an individual’s “present” feelings and thoughts while in their surroundings. Through EAT, this method may include a client being instructed to perform a task with their horse, follow the direction to the best of their ability, and reflect on their thought process. Like humans, horses are highly responsive and observant creatures toward others’ actions. When engaging in an activity, such as leading the horse through an obstacle course, participants will need to be more attentive to their current emotions to better encourage or soothe the horse through the activities; a process also known as “mirroring” (Marchand et al., 2021). The unique relationship of trust that builds between the client, their horse, and the equine specialist can create a safe and comfortable environment that promotes the discussion of a participant’s challenges with their mental health.
While the activities involved may appear deceptively simple, many participants have shown significantly positive results. One study followed 9/11 veterans with post-traumatic stress disorder (PTSD), a population that shows continuously high rates of resistance to treatment and medication noncompliance. People with PTSD can experience symptoms such as vivid nightmares or flashbacks, strong feelings of anger and fear, and physiological symptoms of anxiety or panic that can lead to a strong tendency to avoid stressful environments. Over the course of just eight weeks with only one 90-minute session per week, the veterans in the study reported “high satisfaction” with an overall reduction of their symptoms, with some participants even continuing the EAT program after the study was over, showing just how impactful this treatment had on their lives (Arnon et al., 2020).
Another study on EAT focused on children with autism spectrum disorder (ASD), a neurodevelopmental condition that can affect a person’s ability to communicate, interact, and perceive the world. Similarly to PTSD and many other mental health conditions, ASD can symptomatically be expressed differently and lead to a wide range of neurodevelopmental distinctions that may not be able to be treated with the same approach effectively. Due to the diverse ways ASD can be expressed, a multitude of treatments, such as speech and behavioral therapy, are often used, with each approach varying in effectiveness. With this in mind, researchers employed a 12-week program of EAT and recorded the effects on more than ten domains, including aspects like academic progress and emotional functioning. After only six weeks, both researchers and parents reported an increase in social functioning, including reduced disruptive behaviors and higher self-esteem compared to children who participated in a non-equine program (Lanning et al., 2014). These results surpassed the researchers’ expectations, with results not only showing significant improvements toward the children’s daily quality of life, but also allowing them to feel more confident in themselves and the new skills they learned.
But what makes EAT so effective? EAT allows participants to experience a greater sense of control and autonomy. Just as in traditional therapy approaches, trust is a critical component in the relationship-building process. However, unlike traditional therapist-client relationships, human-horse relationships can require the participant to take a more leadership-like role. As participants begin progressing in their skills with the horses, the affectionate bond that forms between a person and their horse can lead to both a strong sense of accomplishment and independence. EAT also allows a safe and judgment-free environment that may feel more comfortable for some individuals than a typical psychotherapy office (Marchand et al., 2021). Above all, EAT can provide an optimal, unique space for a person to thrive in.
With continued research in alternative treatments like equine-assisted therapy, these treatment options can become more accessible and more credible in their effectiveness. Some may argue against the functionality of alternative treatments due to high expenses, with some EAT lessons ranging anywhere between $50-300. However, with the increase in its research and development, programs like EAT can become more readily available with more possible cost alternatives (such as group EAT programs) and better insurance coverage. As EAT becomes more popular, with positive results beginning to be seen in preliminary research of other physical and mental health conditions, the more possible support in standardizing the treatment process. The Equine Assisted Growth and Learning Association (EAGALA) is one of the few non-profit organizations that has established standardized training programs and certification for EAT. Their goal is not only to educate mental health professionals in this therapeutic practice, but to also systemize and uphold the highest level of ethical care possible (“Eagala - A Global”). With EAGALA and others’ growing support, EAT, and other alternative treatments like it, can better aid people and their walk with mental health.
References:
American Psychological Association. (2017). What is Cognitive Behavioral Therapy? (n.d). American Psychological Association. Retrieved February 27, 2024, from https://www.apa.org/ptsd-guideline/patients-and-families/cognitive-behavioral
Eagala - A Global Standard in Equine-Assisted Psychotherapy and Personal Development. (n.d). Www.eagala.org. Retrieved February 29, 2024, from https://www.eagala.org/org
Lanning, B. A., Baier, M. E. M., Ivey-Hatz, J., Krenek, N., & Tubbs, J. D. (2014). Effects of Equine Assisted Activities on Autism Spectrum Disorder. Journal of Autism and Developmental Disorders, 44(8), 1897–1907. https://doi.org/10.1007/s10803-014-2062-5
Marchand, W. R., Andersen, S. J., Smith, J. E., Hoopes, K. H., & Carlson, J. K. (2021). Equine-Assisted Activities and Therapies for Veterans With Posttraumatic Stress Disorder: Current State, Challenges and Future Directions. Chronic Stress, 5, 247054702199155. https://doi.org/10.1177/2470547021991556
Shay Arnon, Prudence W Fisher, Alison Pickover, Ari Lowell, J Blake Turner, Anne Hilburn, Jody Jacob-McVey, Bonnie E Malajian, Debra G Farber, Jane F Hamilton, Allan Hamilton, John C Markowitz, Yuval Neria, (2020) Equine-Assisted Therapy for Veterans with PTSD: Manual Development and Preliminary Findings, Military Medicine, 185 (5-6), 557–564. https://doi.org/10.1093/milmed/usz444
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