FREE SHIPPING over $40
OVER 9000 FIVE-STAR REVIEWS
5% OFF ALL SUBSCRIPTIONS
100% HAPPINESS GUARANTEE
Analyze Diet
0
Home / Equine Research Bank / Eat Behav / Animal-assisted therapy in eating disorder treatment: A syst...
Eating behaviors2022; 47; 101673; doi: 10.1016/j.eatbeh.2022.101673

Animal-assisted therapy in eating disorder treatment: A systematic review.

Abstract: Eating disorders (EDs) are deadly illnesses with high relapse rates, highlighting need for better interventions. Animal-assisted therapy (AAT) has been implemented supplementally for EDs, with horses utilized at many residential facilities. AAT shows promise with meta-analyses of randomized control trials (RCTs) showing significant decreases in depression, anxiety, and negative affect; however, no review to date has evaluated efficacy for EDs. Therefore, this study conducted a systematic review of primary literature to investigate the efficacy of AAT for EDs. A systematic review was conducted via PubMed, PsycInfo, and Google Scholar, up to and including September 2021, yielding 10 studies. Therapy animals included horses (n = 8), dogs (n = 1), and dolphins (n = 1). Populations included AAT ED therapists and patients (ages 11 to adult). The PRISMA methodology was used (registration PROSPERO CRD42021256239). Risk of bias assessment used Cochrane method for quantitative studies, Critical Appraisal Skills Programme checklist for qualitative studies, and JBI Critical Appraisal Checklist for Case Reports. Given study type heterogeneity, neither synthesis nor certainty assessments were conducted. Case and qualitative studies reported improvement in cognitive flexibility, ability to relinquish control, and confidence. Quantitative studies demonstrated an inverse relationship between AAT utilization and ED symptoms post-treatment. Effect sizes, when reported, were mostly moderate. All but one study had low, or unclear, risk of bias. Limited randomization and a lack of RCTs measuring ED symptomology directly makes drawing conclusions difficult. While preliminary research indicates possible benefits of AAT as a complement to traditional ED treatment, more research is needed to establish efficacy. Future studies should employ randomized control trials and examine key mechanisms of change.
Published by Elsevier Ltd.
Get Full Text
Publication Date: 2022-09-30 PubMed ID: 36206618PubMed Central: PMC9770014DOI: 10.1016/j.eatbeh.2022.101673Google Scholar: Lookup
The Equine Research Bank provides access to a large database of publicly available scientific literature. Inclusion in the Research Bank does not imply endorsement of study methods or findings by Mad Barn.
LinkedInCopy
  • Systematic Review
  • Journal Article
  • Review
  • Research Support
  • N.I.H.
  • Extramural

Summary

This research summary has been generated with artificial intelligence and may contain errors and omissions. Refer to the original study to confirm details provided. Submit correction.

This research article discusses a systematic review of studies investigating the efficacy of animal-assisted therapy (AAT) for patients with eating disorders (EDs). The review showed promising results, but also highlighted gaps in research and a need for more robust studies.

Methodology

  • The systematic review was carried out by streamlining published studies from PubMed, PsycInfo, and Google Scholar up to September 2021.
  • In total, 10 studies were reviewed which used different therapy animals including horses, dogs, and dolphins.
  • The paper evaluated studies using both adults and children (ages 11 onwards).
  • The PRISMA methodology was used for this systematic review. The risk of bias was assessed using the Cochrane method for quantitative studies, the Critical Appraisal Skills Programme checklist for qualitative studies, and the JBI Critical Appraisal Checklist for Case Reports.
  • Due to the dissimilarities in the types of the studies reviewed, no definitive synthesis or certainty assessments were conducted.

Findings

  • Qualitative and case studies reported improvements in patients’ cognitive flexibility, the ability to give up control and increased confidence.
  • Quantitative studies revealed an inverse relationship between the use of AAT and post-treatment ED symptoms, indicating a possible decrease in ED symptoms after AAT.
  • The effect sizes, when reported, were mostly moderate, suggesting that AAT can have a significant impact on the patient’s condition.
  • Most studies were either of low risk or of unclear risk when assessed for bias.
  • However, due to limited randomization and a lack of randomized control trials, making solid conclusions was challenging.

Implications and Future Directions

  • The review shows preliminary evidence hinting towards potential benefits of using AAT as an auxiliary to conventional treatment for ED.
  • However, there is a need for more extensive, conclusive research in this field for establishing the efficacy of AAT in treating ED.
  • Future studies should involve randomized control trials and should focus on understanding the key mechanisms that bring about change through AAT.

Cite This Article

APA
Fennig MW, Weber E, Santos B, Fitzsimmons-Craft EE, Wilfley DE. (2022). Animal-assisted therapy in eating disorder treatment: A systematic review. Eat Behav, 47, 101673. https://doi.org/10.1016/j.eatbeh.2022.101673

Publication

Eating behaviors
ISSN: 1873-7358
NlmUniqueID: 101090048
Country: United States
Language: English
Volume: 47
Pages: 101673
PII: S1471-0153(22)00079-4

Researcher Affiliations

Fennig, Molly W
  • Department of Psychiatry and Behavioral Sciences, University of Minnesota, MN, USA; Department of Psychological and Brain Sciences, Washington University in St. Louis, MO, USA. Electronic address: fennig.m@wustl.edu.
Weber, Elise
  • Department of Psychiatry and Behavioral Sciences, University of Minnesota, MN, USA.
Santos, Bolade
  • Department of Psychiatry and Behavioral Sciences, University of Minnesota, MN, USA.
Fitzsimmons-Craft, Ellen E
  • Department of Psychiatry, Washington University School of Medicine, St. Louis, MO, USA.
Wilfley, Denise E
  • Department of Psychiatry, Washington University School of Medicine, St. Louis, MO, USA.

MeSH Terms

  • Humans
  • Dogs
  • Horses
  • Animals
  • Anxiety Disorders
  • Feeding and Eating Disorders / therapy
  • Chronic Disease

Grant Funding

  • R01 DK116616 / NIDDK NIH HHS
  • K08 MH120341 / NIMH NIH HHS
  • T32 HL130357 / NHLBI NIH HHS
  • R21 MH119417 / NIMH NIH HHS
  • P30 DK056341 / NIDDK NIH HHS

Conflict of Interest Statement

Declaration of competing interest The authors have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.

References

This article includes 36 references
  1. American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, Text Revision. 2022.
  2. Chesney E, Goodwin GM, Fazel S. Risks of all-cause and suicide mortality in mental disorders: a meta-review.. World Psychiatry 2014 Jun;13(2):153-60.
    doi: 10.1002/WPS.20128pmc: PMC4102288pubmed: 24890068google scholar: lookup
  3. Atwood ME, Friedman A. A systematic review of enhanced cognitive behavioral therapy (CBT-E) for eating disorders.. Int J Eat Disord 2020 Mar;53(3):311-330.
    pubmed: 31840285doi: 10.1002/eat.23206google scholar: lookup
  4. Griffin C, Fenner P, Landorf KB, Cotchett M. Effectiveness of art therapy for people with eating disorders: A mixed methods systematic review. Arts Psychother 2021;76:101859.
  5. Kruger KA, Serpell JA. Animal-assisted interventions in mental health: Definitions and theoretical foundations. Handbook on Animal-Assisted Therapy 2010:33–48.
  6. Driscoll CJ. Animal-assisted interventions for health and human service professionals. Published online 2020.
  7. Souter MA, Miller MD. Do animal-assisted activities effectively treat depression? A meta-analysis. Anthrozoös 2007;20(2):167–180.
  8. Huber A, Klug SJ, Abraham A, Westenberg E, Schmidt V, Winkler AS. Animal-Assisted Interventions Improve Mental, But Not Cognitive or Physiological Health Outcomes of Higher Education Students: a Systematic Review and Meta-analysis.. Int J Ment Health Addict 2022 Nov 15;:1-32.
    pmc: PMC9666958pubmed: 36406903doi: 10.1007/s11469-022-00945-4google scholar: lookup
  9. Maujean A, Pepping CA, Kendall E. A systematic review of randomized controlled trials of animal-assisted therapy on psychosocial outcomes. Anthrozoös 2015;28(1):23–36.
  10. Holder TRN, Gruen ME, Roberts DL, Somers T, Bozkurt A. A Systematic Literature Review of Animal-Assisted Interventions in Oncology (Part II): Theoretical Mechanisms and Frameworks.. Integr Cancer Ther 2020 Jan-Dec;19:1534735420943269.
    pmc: PMC7378713pubmed: 32698731doi: 10.1177/1534735420943269google scholar: lookup
  11. Notgrass CG, Pettinelli JD. Equine assisted psychotherapy: The equine assisted growth and learning association’s model overview of equine-based modalities. J Exp Educ 2015;38(2):162–174.
  12. Whittlesey-Jerome WK. Adding equine-assisted psychotherapy to conventional treatments: A pilot study exploring ways to increase adult female self-efficacy among victims of interpersonal violence. Pract Sch J Couns Prof Psychol 2014;3(1):82–101.
  13. Helm K. The Effects of Equine Assisted Psychotherapy on Women with Eating Disorders: A Multiple Case Study. PhD Thesis. The University of the Rockies; 2009.
  14. Cumella E, Lutter CB, Smith-Osborne A, Kally Z. Equine therapy in the treatment of female eating disorder. Published online 2014.
  15. Kingston O. Equine assisted psychotherapy in the treatment of eating disorders from the therapist’s perspective. Published online 2008.
  16. Petitte S. Review of Literature: Potential Benefits of Equine-Facilitated Therapy for Individuals with Eating Disorders. Recreat Parks Tour Public Health 2018;2:77–90.
  17. Zilcha-Mano S, Mikulincer M, Shaver PR. Pet in the therapy room: an attachment perspective on Animal-Assisted Therapy.. Attach Hum Dev 2011 Nov;13(6):541-61.
    pubmed: 22011099doi: 10.1080/14616734.2011.608987google scholar: lookup
  18. Fassino S, Pierò A, Tomba E, Abbate-Daga G. Factors associated with dropout from treatment for eating disorders: a comprehensive literature review.. BMC Psychiatry 2009 Oct 9;9:67.
    pmc: PMC2765944pubmed: 19818137doi: 10.1186/1471-244x-9-67google scholar: lookup
  19. Sharf J. Psychotherapy Dropout: A Meta-Analytic Review of Premature Termination. PhD Thesis. ProQuest Information & Learning; 2008.
  20. Faber A, Dubé L, Knäuper B. Attachment and eating: A meta-analytic review of the relevance of attachment for unhealthy and healthy eating behaviors in the general population.. Appetite 2018 Apr 1;123:410-438.
    pubmed: 29183700doi: 10.1016/j.appet.2017.10.043google scholar: lookup
  21. Tasca GA. Attachment and eating disorders: a research update.. Curr Opin Psychol 2019 Feb;25:59-64.
    pubmed: 29579723doi: 10.1016/j.copsyc.2018.03.003google scholar: lookup
  22. Hoagwood KE, Acri M, Morrissey M, Peth-Pierce R. Animal-Assisted Therapies for Youth with or at risk for Mental Health Problems: A Systematic Review.. Appl Dev Sci 2017;21(1):1-13.
    pmc: PMC5546745pubmed: 28798541doi: 10.1080/10888691.2015.1134267google scholar: lookup
  23. McIntosh VVW, Jordan J, Carter JD, Frampton CMA, McKenzie JM, Latner JD, Joyce PR. Psychotherapy for transdiagnostic binge eating: A randomized controlled trial of cognitive-behavioural therapy, appetite-focused cognitive-behavioural therapy, and schema therapy.. Psychiatry Res 2016 Jun 30;240:412-420.
    pubmed: 27149410doi: 10.1016/j.psychres.2016.04.080google scholar: lookup
  24. Hunt MG, Chizkov RR. Are therapy dogs like Xanax? Does animal-assisted therapy impact processes relevant to cognitive behavioral psychotherapy?. Anthrozoös 2014;27(3):457–469.
  25. Biddle SJH, Ciaccioni S, Thomas G, Vergeer I. Physical activity and mental health in children and adolescents: An updated review of reviews and an analysis of causality. Psychol Sport Exerc 2019;42:146–155.
    doi: 10.1016/J.PSYCHSPORT.2018.08.011google scholar: lookup
  26. Page MJ, McKenzie JE, Bossuyt PM, Boutron I, Hoffmann TC, Mulrow CD, Shamseer L, Tetzlaff JM, Moher D. Updating guidance for reporting systematic reviews: development of the PRISMA 2020 statement.. J Clin Epidemiol 2021 Jun;134:103-112.
    doi: 10.1016/j.jclinepi.2021.02.003pubmed: 33577987google scholar: lookup
  27. Lutter CB. Equine Assisted Therapy and Exercise with Eating Disorders: A Retrospective Chart Review and Mixed Method Analysis. The University of Texas at Arlington; 2008.
  28. Lutter C, Smith-Osborne A. Exercise in the Treatment of Eating Disorders. Best Pract Ment Health 2011;7(2):42–59.
  29. Stefanini MC, Martino A, Bacci B, Tani F. The effect of animal-assisted therapy on emotional and behavioral symptoms in children and adolescents hospitalized for acute mental disorders. Eur J Integr Med 2016;8(2):81–88.
  30. Stefanini MC, Martino A, Allori P, Galeotti F, Tani F. The use of Animal-Assisted Therapy in adolescents with acute mental disorders: A randomized controlled study.. Complement Ther Clin Pract 2015 Feb;21(1):42-6.
    pubmed: 25701449doi: 10.1016/j.ctcp.2015.01.001google scholar: lookup
  31. Træen B, Moan KA, Rosenvinge JH. Terapeuters opplevelse av hestebasert behandling for pasienter med spiseforstyrrelser. Tidskr Nor Psykologforening 2012;49:348–355.
  32. Schenk R, Schandry R, Schenk S. Animal-assisted therapy with dolphins in eating disorders. Published online 2009.
  33. Sharpe H. Equine-facilitated counselling and women with eating disorders: Articulating bodily experience. Published online 2013.
  34. Lac V. Amy’s story: An existential-integrative equine-facilitated psychotherapy approach to anorexia nervosa. J Humanist Psychol 2017;57(3):301–312.
  35. Dezutti JE. Eating disorders and equine therapy: a nurse's perspective on connecting through the recovery process.. J Psychosoc Nurs Ment Health Serv 2013 Sep;51(9):24-31.
    pubmed: 23786240doi: 10.3928/02793695-20130612-01google scholar: lookup
  36. Hermeneutics Kakkori L. and Phenomenology Problems When Applying Hermeneutic Phenomenological Method in Educational Qualitative Research. Philos Inq Educ 2009;18(2):19–27.

Citations

This article has been cited 3 times.
  1. Simón M, Fernández-Jiménez E, García-Sánchez P, Rubik J, Canalejo-Gonzalez D, Lacaille F, Bergamo C, Hugo-Martin V, Benetti E, Bermúdez A, Gonzalez-Vicent M, Costa T, Sevilla P, Simó-Nebot S, Bueno D, Ramos-Boluda E, Vigezzi S, Pérez-Martinez A, Méndez-Echevarría A. Pet ownership and parent-reported mental health in pediatric transplantation. A cross-sectional study from the European reference network Transplantchild. The pink study. One Health 2026 Jun;22:101337.
    doi: 10.1016/j.onehlt.2026.101337pubmed: 41630839google scholar: lookup
  2. Núñez BM, Sánchez JF, Pérez AML, Rincón LL, García MF, García IG, Berna MG, Mateo DC. Effects of Dog-assisted Therapy in Anxiety Symptoms of Female Adolescents With Eating Disorders: A Controlled Trial. Actas Esp Psiquiatr 2025 Dec;53(6):1265-1273.
    doi: 10.62641/aep.v53i6.1919pubmed: 41437761google scholar: lookup
  3. Lepy C, Letranchant A, Aniorte JL, Bedos J, Hotchkin R, Corcos M, Robin M, Piot MA. Equine therapy in the management of teenagers with anorexia nervosa: a qualitative study. Eat Weight Disord 2025 Aug 16;30(1):66.
    doi: 10.1007/s40519-025-01724-5pubmed: 40817957google scholar: lookup
Subscribe to our newsletter
Join 99,357 horse owners like you who receive our email updates on horse health and nutrition.