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BMC complementary medicine and therapies2026; 26(1); 124; doi: 10.1186/s12906-026-05315-4

Effect of Equine-assisted Biographical Work (EABW) in older adults with subclinical depression: a randomized controlled trial.

Abstract: Preventive approaches for depression in adults aged 50 years and older have received little attention, despite increasing needs arising from demographic changes. In particular, subclinical depression is often underdiagnosed and associated with anxiety, a poorer quality of life, and greater need for assistance from the healthcare system. This multicentre, randomised, controlled phase III trial investigated if Equine-Assisted Biographical Work (EABW) is effective to improve subclinical depression. Qualified sites in Germany enrolled 52 participants ≥ 50 years (Full Analysis Set (FAS),  = 50). The intervention received weekly sessions of EABW for 8 weeks. The control group was not treated. Follow-up was after 3 months. Participants in both groups had similar demographic and baseline characteristics. The primary endpoint was change in Beck Depression Inventory-II (BDI-II). Secondary target parameters included questionnaires, e.g., dealing with anxiety, behavioural avoidance, and state of health. The pre-test BDI-II score averaged 20.92 (SD 5.99) in the intervention group and 22.36 (SD 6.80) in the control group with a highly significantly greater improvement after treatment (F = 15.21,  < 0.001, Cohen’s d = 1.80) for intervention group. This difference was maintained until the follow-up period (F = 15.23,  < 0.001, d = 1.43). This outcome was supported by an improvement of secondary endpoints at week 8: Beck Anxiety Inventory (F = 8.38,  < 0.001, d = 0.93), Ego-Integrity Questionnaire (F = 19.60,  < 0.001, d = 1.32), Questionnaire for Positive and Negative Spontaneous Thoughts (F = 9.95,  < 0.001, d = 1.07), Gratitude Questionnaire (F = 12.71,  < 0.001, d = 1.09), Cognitive Behavioural Avoidance Scale (F = 18.26,  < 0.001, d = 1.50), Reminiscence Functions Scale (identity, F = 7.93,  < 0.001, d = 0.93; problem-solving, F = 5.88,  = 0.004, d = 0.85), Short Form Health Survey (36) (mental, F = 8.41,  < 0.001, d = 1.11), General Self-Efficacy Scale (F = 9.44,  < 0.001, d = 0.89), Multidimensional Mood State Questionnaire. For the Short Form Health Survey (36) (physical, F = 0.17,  = 0.84, d = 0.11) and other subgroups of the Reminiscence Functions Scale (death preparation, bitterness revival, boredom reduction, intimacy, conversation, and teach) no differences were observed. EABW was able to achieve a significant and lasting treatment success. This approach may represent an innovative concept to prevent worsening of depressive symptoms, improve anxiety and quality of life. The gentle use of the horse as a medium turned out to be very effective in achieving therapeutic results and acted as a kind of gateway for therapeutic processes. German Clinical Trials Register DRKS00017010. Registered on 01 April 2019. The online version contains supplementary material available at 10.1186/s12906-026-05315-4.
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Publication Date: 2026-02-28 PubMed ID: 41761195PubMed Central: PMC13059425DOI: 10.1186/s12906-026-05315-4Google Scholar: Lookup
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  • Journal Article

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 study examined whether Equine-Assisted Biographical Work (EABW), a therapy involving horses and guided personal reflection, effectively reduces symptoms of subclinical depression in adults aged 50 and older.
  • The randomized controlled trial showed that participants who received eight weekly EABW sessions had significant and lasting improvements in depression, anxiety, and quality of life compared to those who did not receive treatment.

Background and Purpose

  • Depression prevention in adults over 50 has not been extensively researched despite demographic trends leading to increased need.
  • Subclinical depression, often underdiagnosed, can negatively affect anxiety levels, quality of life, and increase healthcare needs.
  • The study aimed to test whether EABW could improve symptoms in this population by combining horses’ therapeutic effects with structured personal biography work.

Study Design

  • Multicenter, randomized, controlled, phase III clinical trial conducted in Germany.
  • 52 participants aged 50 years or older enrolled; 50 were included in the analysis.
  • Intervention group received weekly sessions of EABW over 8 weeks; control group received no treatment.
  • Follow-up assessment conducted 3 months after intervention completion.
  • Baseline demographic and clinical characteristics were similar between groups.

Intervention: Equine-Assisted Biographical Work (EABW)

  • EABW involves interaction with horses combined with guided biographical reflection and counseling techniques.
  • The horse acts as a therapeutic medium facilitating emotional openness and processing of personal experiences.
  • Sessions focus on therapeutic goals such as reducing depression and anxiety, improving mood, self-efficacy, and quality of life.

Primary and Secondary Outcomes

  • Primary endpoint: Change in Beck Depression Inventory-II (BDI-II) scores measuring depression severity.
  • Secondary endpoints: Questionnaires assessing anxiety (Beck Anxiety Inventory), ego integrity, thought patterns, gratitude, behavioral avoidance, reminiscence functions, health status (Short Form Health Survey), self-efficacy, and mood states.
  • Some Reminiscence Functions Scale subcategories and physical health measured by SF-36 did not show significant changes.

Results

  • Baseline average BDI-II scores: 20.92 (intervention) vs. 22.36 (control) indicating similar initial depression levels.
  • Post-treatment, intervention group showed highly significant and large reductions in depression scores (F=15.21, p<0.001, Cohen’s d=1.80), maintained at 3-month follow-up (F=15.23, p<0.001, d=1.43).
  • Secondary outcomes also improved substantially at week 8, with large effect sizes, including:
    • Anxiety reduction (Beck Anxiety Inventory)
    • Higher ego integrity
    • More positive spontaneous thoughts and gratitude
    • Reduced cognitive behavioral avoidance
    • Improved reminiscence functions related to identity and problem-solving
    • Better mental health scores on the SF-36 survey
    • Increased self-efficacy and improved mood states
  • Physical health measures and some reminiscence subscales showed no significant changes.

Conclusions and Implications

  • EABW demonstrated a significant, lasting beneficial effect on subclinical depression symptoms in older adults.
  • It also improved associated anxiety symptoms and several aspects of psychological well-being and quality of life.
  • The horse as a gentle therapeutic medium appeared to facilitate access to therapeutic processes, serving as a unique gateway for treatment.
  • This suggests EABW could be a promising, innovative prevention strategy for worsening depression and associated symptoms in aging populations.

Trial Registration and Additional Information

  • Registered in the German Clinical Trials Register (DRKS00017010) on April 1, 2019.
  • The online publication includes supplementary material for further details.

Cite This Article

APA
Schmidt J, Wartenberg-Demand A, Forstmeier S. (2026). Effect of Equine-assisted Biographical Work (EABW) in older adults with subclinical depression: a randomized controlled trial. BMC Complement Med Ther, 26(1), 124. https://doi.org/10.1186/s12906-026-05315-4

Publication

BMC complementary medicine and therapies
ISSN: 2662-7671
NlmUniqueID: 101761232
Country: England
Language: English
Volume: 26
Issue: 1
PII: 124

Researcher Affiliations

Schmidt, Julia
  • Psychology and Clinical Psychology of the Lifespan, Department of Psychology, University of Siegen, Adolf-Reichwein-Str. 2a, Siegen, 57068, Germany.
  • Reittherapie Wittgenstein, Bad Berleburg, Germany.
Wartenberg-Demand, Andrea
  • Pferdegestützte Interventionen, Nidda, Germany.
Forstmeier, Simon
  • Psychology and Clinical Psychology of the Lifespan, Department of Psychology, University of Siegen, Adolf-Reichwein-Str. 2a, Siegen, 57068, Germany. simon.forstmeier@uni-siegen.de.

Conflict of Interest Statement

Declarations. Ethics approval and consent to participate: The study is registered in the German Clinical Trial Register under DRKS00017010 and was conducted in accordance with principles enunciated in the current Declaration of Helsinki (DoH) and the guidelines of Good Clinical Practice (GCP) issued by the International Conference on Harmonisation (ICH). Ethics approval has been obtained for the study, and any amendment was submitted for approval. Approved protocol amendments were forwarded to the therapists, and they were trained accordingly when it came to conducting the study. The trial registry and the Ethics Committee were informed accordingly. Participation in the study was voluntary, and the participants were informed of the study conditions in detail and an opportunity was given to discuss and clarify specific questions. An informed written consent was obtained from each participant. The study participants were informed that their disease- and personal data will be stored in pseudonymized form and used for scientific evaluation. (Ethics Approval 1 & 2). Consent for publication: Not applicable. Competing interests: The authors declare no competing interests.

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