FREE SHIPPING over $40
OVER 10000 FIVE-STAR REVIEWS
5% OFF ALL SUBSCRIPTIONS
100% HAPPINESS GUARANTEE
Analyze Diet
0
BMC psychiatry2024; 24(1); 544; doi: 10.1186/s12888-024-05984-w

Are equine-assisted services beneficial for military veterans with post-traumatic stress disorder? A systematic review and meta-analysis.

Abstract: Equine-assisted services (EAS) involves the use of horses within therapy, learning or horsemanship sessions and has been used with military veterans suffering from post-traumatic stress disorder (PTSD). This study systematically reviewed existing research on the use of EAS in the treatment of PTSD in military veterans and evaluated its effectiveness. A systematic review was performed, in May 2023, with searches and data extraction carried out from three separate databases (PubMed, JSTOR and Science Direct) related to testing the effect of EAS on PTSD outcomes in veterans. A risk of bias assessment of included studies was conducted and meta-analysis of outcomes performed when two or more studies reported the same outcomes. Other effects of EAS on veterans' health were also discussed. A total of 13 studies were identified based on our inclusion and exclusion criteria with 11 originating from the US and the remaining two from Australia and Israel. There were 344 participants amongst all of the studies with a mean age of 47 years and a male:female ratio of 19:6. Eight out of the 13 studies reported PTSD scores, as measured by either PTSD Checklist for DSM-5 (PCL-5) or PCL-Veteran/-Military versions (PCL-V/-M), and results suggested a reduction in PTSD score after EAS treatment of 22.6%. A meta-analysis confirmed that EAS favored a significantly lower PTSD score after treatment, with a mean difference of 12.46, 95% CI [9.03,15.88], p < 0.00001. However, only one study had low risk of bias whilst all the rest of the studies had some concerns to high risk of bias. EAS appeared to have a positive influence on PTSD symptoms in military veterans, significantly reducing PTSD severity scores. Other benefits of EAS may be peer support, social integration, learning new skills and bonding. However, the results of this systematic review must be interpreted with caution as almost all of the studies were of low quality. Therefore, further rigorous research is required with larger participants to be able to draw conclusions about the benefits of EAS on PTSD severity.
© 2024. The Author(s).
Get Full Text
Publication Date: 2024-08-01 PubMed ID: 39085783PubMed Central: PMC11293092DOI: 10.1186/s12888-024-05984-wGoogle 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
  • Journal Article
  • Systematic Review
  • Meta-Analysis

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.

Overview

  • This research article systematically reviews and analyzes studies on the use of equine-assisted services (EAS) as a treatment for post-traumatic stress disorder (PTSD) in military veterans.
  • The meta-analysis suggests that EAS can significantly reduce PTSD severity scores, but the quality of existing studies is generally low, indicating the need for more rigorous research.

Introduction to Equine-Assisted Services (EAS) and PTSD in Veterans

  • EAS involves therapeutic activities, learning, or horsemanship sessions incorporating horses.
  • Military veterans with PTSD are a target population for EAS due to challenges with traditional PTSD therapies.
  • This study aims to evaluate the effectiveness of EAS for reducing PTSD symptoms in veterans through systematic review and meta-analysis of existing literature.

Methods

  • A comprehensive literature search was conducted in May 2023 using three academic databases: PubMed, JSTOR, and Science Direct.
  • Inclusion criteria focused on studies assessing the impact of EAS on PTSD outcomes specifically in military veterans.
  • Data extraction was performed from selected studies, followed by an assessment of the risk of bias to evaluate study quality.
  • A meta-analysis was carried out when at least two studies reported on the same PTSD outcome measures.

Study Characteristics

  • A total of 13 studies met the inclusion criteria.
  • Geographical distribution included mainly the United States (11 studies), with two from Australia and Israel.
  • The combined sample size across studies was 344 veterans, average age approximately 47 years.
  • Gender ratio was heavily skewed male (19 males for every 6 females), reflecting typical veteran demographics.

Outcome Measures and Results

  • Eight studies measured PTSD severity using standardized tools like the PTSD Checklist for DSM-5 (PCL-5) and military-specific versions (PCL-Veteran/Military).
  • Collectively, these studies showed an average PTSD score reduction of approximately 22.6% following EAS treatment.
  • Meta-analysis revealed a significant reduction with a mean difference of 12.46 points on PTSD scales, 95% confidence interval between 9.03 and 15.88, and very strong statistical significance (p < 0.00001).
  • This suggests that EAS is associated with clinically meaningful improvements in PTSD symptoms among veterans.

Risk of Bias and Study Quality

  • Only one study was assessed to have a low risk of bias.
  • The remaining 12 studies exhibited moderate to high risks of bias, raising concerns about the reliability of findings.
  • Potential biases could stem from factors like small sample sizes, lack of proper controls, non-randomized designs, or inadequate blinding.
  • These limitations emphasize caution in interpreting the results and underline the need for future high-quality trials.

Additional Benefits of EAS

  • Beyond reducing PTSD symptoms, EAS may promote peer support among veterans participating in group sessions.
  • Social integration is another positive effect, as veterans interact within a supportive community setting.
  • Veterans have opportunities to learn new skills related to horsemanship, which can foster a sense of accomplishment and purpose.
  • Bonding with horses may provide emotional benefits and improve overall well-being.

Conclusions and Future Directions

  • This systematic review and meta-analysis provide preliminary evidence supporting the positive effects of EAS on PTSD severity in military veterans.
  • The significant PTSD symptom reductions indicate potential for EAS as a complementary treatment approach.
  • However, the predominance of low-quality studies mandates cautious interpretation of the current evidence base.
  • The authors call for larger, rigorously designed trials to better establish the efficacy and mechanisms of EAS in managing PTSD among veterans.

Cite This Article

APA
Provan M, Ahmed Z, Stevens AR, Sardeli AV. (2024). Are equine-assisted services beneficial for military veterans with post-traumatic stress disorder? A systematic review and meta-analysis. BMC Psychiatry, 24(1), 544. https://doi.org/10.1186/s12888-024-05984-w

Publication

BMC psychiatry
ISSN: 1471-244X
NlmUniqueID: 100968559
Country: England
Language: English
Volume: 24
Issue: 1
Pages: 544
PII: 544

Researcher Affiliations

Provan, Maisy
  • Institute for Inflammation and Ageing, College of Medical and Dental Sciences, University of Birmingham, Edgbaston, Birmingham, B15 2TT, UK.
Ahmed, Zubair
  • Institute for Inflammation and Ageing, College of Medical and Dental Sciences, University of Birmingham, Edgbaston, Birmingham, B15 2TT, UK. z.ahmed.1@bham.ac.uk.
  • Centre for Trauma Sciences Research, University of Birmingham, Edgbaston, Birmingham, B15 2TT, UK. z.ahmed.1@bham.ac.uk.
Stevens, Andrew R
  • Institute for Inflammation and Ageing, College of Medical and Dental Sciences, University of Birmingham, Edgbaston, Birmingham, B15 2TT, UK.
Sardeli, Amanda V
  • Institute for Inflammation and Ageing, College of Medical and Dental Sciences, University of Birmingham, Edgbaston, Birmingham, B15 2TT, UK. a.veigasardeli@bham.ac.uk.

MeSH Terms

  • Animals
  • Female
  • Humans
  • Male
  • Equine-Assisted Therapy / methods
  • Horses
  • Stress Disorders, Post-Traumatic / therapy
  • Stress Disorders, Post-Traumatic / psychology
  • Veterans / psychology
  • Middle Aged

Conflict of Interest Statement

The authors declare no competing interests.

References

This article includes 35 references
  1. Latella D, Abrams B. Chapter 10 - The Role of the Equine in Animal-Assisted Interactions. Handbook on Animal-Assisted Therapy (Fourth Edition) 2015; pp. 115–137.
  2. Wright EC. Clinical and administrative insights from delivering massed trauma-focused therapy to service members and veterans. Cogn Behav Pract 2022.
  3. Schottenbauer MA, Glass CR, Arnkoff DB, Tendick V, Gray SH. Nonresponse and dropout rates in outcome studies on PTSD: review and methodological considerations. Psychiatry 2008;71:134–68.
    doi: 10.1521/psyc.2008.71.2.134pubmed: 18573035google scholar: lookup
  4. Blanchard EB. Prediction of response to psychological treatment among motor vehicle accident survivors with PTSD. Behav Ther 2003;34(351):353.
  5. Strawbridge R, Carter B, Marwood L. mentation therapies for treatment-resistant depression: systematic review and meta-analysis. Br J Psychiatry 2019;214:42–51.
    doi: 10.1192/bjp.2018.233pubmed: 30457075google scholar: lookup
  6. Earles JL, Vernon LL, Yetz JP. Equine-assisted therapy for anxiety and posttraumatic stress symptoms. J Trauma Stress 2015;28:149–52.
    doi: 10.1002/jts.21990pubmed: 25782709google scholar: lookup
  7. Beinotti F, Christofoletti G, Correia N, Borges G. Effects of horseback riding therapy on quality of life in patients post stroke. Top Stroke Rehabil 2013;20:226–32.
    doi: 10.1310/tsr2003-226pubmed: 23841970google scholar: lookup
  8. Marchand WR, Andersen SJ, Smith JE, Hoopes KH, Carlson JK. Equine-assisted activities and therapies for veterans with posttraumatic stress disorder: current state, challenges and future directions. Chronic Stress (Thousand Oaks) 2021;5:2470547021991556.
    doi: 10.1177/2470547021991556pmc: PMC7890715pubmed: 33644617google scholar: lookup
  9. Professional Association of Therapeutic Horsemanship International (https://pathintl.org/) guidelines. https://pathintl.org/wp-content/uploads/2023/07/PATH-Intl-Definitions-Guide-for-Researchers.pdf. Last accessed 4 Apr 2024.
  10. Alfonso SV. Project stride: an equine-assisted intervention to reduce symptoms of social anxiety in young women. Explore 2015;11(6):461–7.
    doi: 10.1016/j.explore.2015.08.003pubmed: 26386749google scholar: lookup
  11. Kendal E. Hypotheses about the psychological benefits of horses. Explore 2014;10(2):81–7.
    doi: 10.1016/j.explore.2013.12.001pubmed: 24607074google scholar: lookup
  12. Ducan et al. Can Praxis: A Model of Equine Assisted Learning (EAL) for PTSD. Can Med Assoc J 2014;14(2).
  13. Palley, et al. Mainstreaming animal-assisted therapy. ILJR J 2010;51(3).
    pubmed: 21131720
  14. Page, et al. The PRISMA 2020 statement: an updated guideline for reporting systematic reviews. BMJ 2021.
    pmc: PMC8005924pubmed: 33782057
  15. Weathers FW. The PTSD Checklist for DSM-5 (PCL-5). PTSD: The National Center for PTSD.US Department of Veteran Affairs 2013.
  16. Higgins JPT. The cochrane collaboration’s tool for assessing risk of bias in randomised trials. BMJ 2011;343:d5928.
    doi: 10.1136/bmj.d5928pmc: PMC3196245pubmed: 22008217google scholar: lookup
  17. Sterne JAC. ROBINS-I: a tool for assessing risk of bias in non-randomised studies of interventions. BMJ 2016;355.
    pmc: PMC5062054pubmed: 27733354
  18. ROBINS-E Development Group, Higgins J. Risk of Bias in Non-randomised Studies- of Exposure (ROBINS-E). Risk of bias tools 2023.
  19. Johnson RA. Effects of therapeutic horseback riding on post-traumatic stress disorder in military veterans. Mil Med Res 2018;5(3).
    pmc: PMC5774121pubmed: 29502529
  20. Fisher PW. Equine-Assisted Therapy for Posttraumatic Stress Disorder Among Military Veterans: An Open Trial. J Clin Psychiatry 2021;82(5).
    pubmed: 34464523
  21. Arnon S. Equine-assisted therapy for veterans with PTSD: manual development and preliminary findings. Mil Med 2020;185(5–6):557–64.
    doi: 10.1093/milmed/usz444pmc: PMC7282489pubmed: 32034416google scholar: lookup
  22. Zhu X. Neural changes following equine-assisted therapy for posttraumatic stress disorder: A longitudinal multimodal imaging study. Hum Brain Mapp 2020;42(6):1930–9.
    doi: 10.1002/hbm.25360pmc: PMC7978114pubmed: 33547694google scholar: lookup
  23. Romaniuk M. Evaluation of an equine-assisted therapy program for veterans who identify as ‘wounded, injured or ill’ and their partners. PLoS One 2018;13(9).
    pmc: PMC6160012pubmed: 30260975
  24. Burton LE. Efficacy of equine-assisted psychotherapy in veterans with posttraumatic stress disorder. J Integr Med 2018;17(1):14–9.
    doi: 10.1016/j.joim.2018.11.001pubmed: 30497951google scholar: lookup
  25. Rosing T. A qualitative study of equine‐assisted therapy for Israeli military and police veterans with PTSD—impact on self‐regulation, bonding and hope. Health Soc Care Community 2022;30(6):5074–82.
    doi: 10.1111/hsc.13922pubmed: 35852225google scholar: lookup
  26. Sylvia L. Acceptability of an adjunct equine-assisted activities and therapies program for veterans with posttraumatic stress disorder and/or traumatic brain injury. J Integr Med 2020;18(2):169–73.
    doi: 10.1016/j.joim.2020.01.005pubmed: 31996299google scholar: lookup
  27. Johnson RA. Experiences of military veterans in a therapeutic horseback riding program. Clin Nurs Res 2021;30(7):923–33.
    doi: 10.1177/10547738211003580pubmed: 33855883google scholar: lookup
  28. Ferruolo DM. Psychosocial equine program for veterans. Soc Work 2016;61(1):53–60.
    doi: 10.1093/sw/swv054pubmed: 26897999google scholar: lookup
  29. Malinowski K. The effects of equine assisted therapy on plasma cortisol and oxytocin concentrations and heart rate variability in horses and measures of symptoms of post-traumatic stress disorder in veterans. J Equine Vet Sci 2018;64:17–26.
    doi: 10.1016/j.jevs.2018.01.011pubmed: 30973147google scholar: lookup
  30. Marchand WR. A pilot observational study of horsemanship skills training for veterans with posttraumatic stress disorder. Complement Ther Med 2023;72.
    pubmed: 36535458
  31. Marchand WR. Evaluation of a mindfulness and self-compassion-based psychotherapy incorporating horses for Veterans who have experienced trauma. Complement Ther Med 2023;72:102914.
    doi: 10.1016/j.ctim.2023.102914pubmed: 36610554google scholar: lookup
  32. Memishevikj H, Hodzhikj S. The effects of equine-assisted therapy in improving the psychosocial functioning of children with autism. ИCКУCTBA И HOBИHИ OД CBETOT 2010.
  33. Asselin G. Therapeutic horse back riding of a spinal cord injured veteran: a case study. Rehabil Nurs 2012.
    doi: 10.1002/rnj.27pubmed: 23212951google scholar: lookup
  34. Raab PA. Impact of comorbid depression on quality of life in male combat Veterans with posttraumatic stress disorder. JRRD 52(5):563–576.
    pubmed: 26466310
  35. Sharp M-L. Stigma as a barrier to seeking health care amongst military personnel with mental health problems. Epidemiol Rev 2015;37:144–62.
    doi: 10.1093/epirev/mxu012pubmed: 25595168google scholar: lookup

Citations

This article has been cited 3 times.
  1. Jankowski SE, Bennett R, Tao B, Neria Y, Dixon LB, Wainberg M, Sweetland A, Patel SR. Trauma-Focused Treatment in Early and Lifetime Psychosis: A Scoping Review. Schizophr Bull 2025 Nov 23;.
    doi: 10.1093/schbul/sbaf202pubmed: 41275365google scholar: lookup
  2. Lanning BA, Smith CM, Ugale C, Nazarenko E, Marchand WR. Using Functional Near-Infrared Spectroscopy to Elucidate Neurophysiological Mechanism of Action of Equine-Assisted Services: Proof-of-Concept Study. Int J Environ Res Public Health 2025 Aug 19;22(8).
    doi: 10.3390/ijerph22081294pubmed: 40869879google scholar: lookup
  3. Rankins EM, Faremi BE, Hartmann K, Quinn A, Posada-Quintero HF, McKeever KH, Malinowski K. Heart rate variability responses of horses and veterans with post-traumatic stress disorder to ground-based adaptive horsemanship lessons: a pilot study. Transl Anim Sci 2025;9:txaf019.
    doi: 10.1093/tas/txaf019pubmed: 40124971google scholar: lookup
Subscribe to our newsletter
Join 99,928 horse owners like you who receive our email updates on horse health and nutrition.