Analyze Diet
Frontiers in psychiatry2023; 14; 1277338; doi: 10.3389/fpsyt.2023.1277338

Equine-assisted interventions for veterans with posttraumatic stress disorder: a systematic review.

Abstract: Equine-assisted intervention therapy has a nearly 60-year history and has been shown to have a significant positive impact on various types of psychotherapy patients. Due to an increase in research on EAT, the number of existing methods of equine-assisted intervention therapy has gradually increased. Based on existing literature on the application of equine-assisted intervention therapy on veterans with post-traumatic stress disorder (PTSD), this study examines the characteristics of several types of equine interventions and includes a systematic review of peer-reviewed literature on equine-assisted interventions for veterans with PTSD published over the past 5 years, from 2018 to the present. Ten articles met the review criteria and served as the primary data for analysis. Several types of equine-assisted interventions were shown to have a beneficial psychological impact on veterans. However, some limitations were also found in the studies, such as that the majority of experiments were constrained by small sample sizes. Equine-assisted intervention therapy has been shown to be effective, but further research is merited, in order to focus on the specific details and theories involved in equine-assisted interventions, and on the welfare of the horses involved in the therapy.
Publication Date: 2023-11-03 PubMed ID: 38025432PubMed Central: PMC10654975DOI: 10.3389/fpsyt.2023.1277338Google 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.
  • Systematic Review

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.

The research article presents a review of studies examining the benefits of equine-assisted interventions for veterans dealing with post-traumatic stress disorder (PTSD). While these therapeutic approaches have shown promising results, more research is needed to establish the details and theories behind these treatments, and care for the horses involved.

Overview of Equine-Assisted Interventions (EAT)

  • The research discusses equine-assisted intervention therapy, a therapeutic approach that has been around for approximately 60 years. Such therapy has been documented to have a positive influence on numerous types of psychotherapy patients.
  • As more research on EAT has been conducted, there’s been a rise in the number of methods associated with this type of therapy.

The Scope and Methodology of the Review

  • The study delves into the existing literature with a focus on the application of equine-assisted intervention therapy specifically for veterans with PTSD.
  • The review systematically targets peer-reviewed literature on this topic published in the past five years, resulting in ten articles which fit the study’s criteria and were used as the primary data for analysis.
  • The goal of this examination was to discover the traits of several types of equine interventions and to highlight their effectiveness.

Findings of the Study

  • The review found that various types of equine-assisted interventions have been shown to bring about a beneficial psychological impact on veterans.
  • However, several limitations were identified in the studies, such as most of them being constrained by small sample sizes, thus potentially limiting the statistical significance of their results.

Conclusions and Future Recommendations

  • Overall, the review concludes that equine-assisted intervention therapy showed effectiveness in treating PTSD in veterans, but more work is warranted on this subject.
  • Future research should focus on the specific details and theories entailed in equine-assisted interventions, paying special attention to the welfare of the horses used in the therapy.

Cite This Article

APA
Li J, Sánchez-García R. (2023). Equine-assisted interventions for veterans with posttraumatic stress disorder: a systematic review. Front Psychiatry, 14, 1277338. https://doi.org/10.3389/fpsyt.2023.1277338

Publication

ISSN: 1664-0640
NlmUniqueID: 101545006
Country: Switzerland
Language: English
Volume: 14
Pages: 1277338
PII: 1277338

Researcher Affiliations

Li, Jiaxin
  • Facultad de Ciencias de la Actividad Física y del Deporte (INEF), Universidad Politécnica de Madrid, Madrid, Spain.
Sánchez-García, Raúl
  • Facultad de Ciencias de la Actividad Física y del Deporte (INEF), Universidad Politécnica de Madrid, Madrid, Spain.

Conflict of Interest Statement

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

References

This article includes 69 references
  1. Berg EL, Causey A. The life-changing power of the horse: equine-assisted activities and therapies in the U.S.. Anim Front (2014) 4:72–5.
    doi: 10.2527/af.2014-0025google scholar: lookup
  2. Masini A. Equine-assisted psychotherapy in clinical practice.. J Psychosoc Nurs Ment Health Serv (2010) 48:30–4.
    doi: 10.3928/02793695-20100831-08pubmed: 20873699google scholar: lookup
  3. . Eagala - a global standard in equine-assisted psychotherapy and personal development. .
  4. Lee PT, Dakin E, McLure M. Narrative synthesis of equine-assisted psychotherapy literature: current knowledge and future research directions.. Health Soc Care Commun (2016) 24:225–46.
    doi: 10.1111/hsc.12201pubmed: 25727575google scholar: lookup
  5. Zinzow HM, Grubaugh AL, Frueh BC, Magruder KM. Sexual assault, mental health, and service use among male and female veterans seen in veterans affairs primary care clinics: a multi-site study.. Psychiatry Res (2008) 159:226–36.
  6. Murdoch M, Polusny MA, Hodges J, O’Brien N. Prevalence of in-service and post-service sexual assault among combat and noncombat veterans applying for Department of Veterans Affairs posttraumatic stress disorder disability benefits.. Mil Med (2004) 169:392–5.
    doi: 10.7205/MILMED.169.5.392pubmed: 15186007google scholar: lookup
  7. Hoge CW, Castro CA, Messer SC, McGurk D, Cotting DI, Koffman RL. Combat duty in Iraq and Afghanistan, mental health problems, and barriers to care.. N Engl J Med (2004) 351:13–22.
    doi: 10.1056/NEJMoa040603pubmed: 15229303google scholar: lookup
  8. Palomar-Ciria N, Bello HJ. Equine-assisted therapy in post-traumatic-stress disorder: a systematic review and Meta-analysis.. J Equine Vet (2023) 128:104871.
    doi: 10.1016/j.jevs.2023.104871pubmed: 37355148google scholar: lookup
  9. Marchand WR. Potential mechanisms of action and outcomes of equine-assisted Services for Veterans with a history of trauma: a narrative review of the literature.. IJERPH (2023) 20:6377.
    doi: 10.3390/ijerph20146377pmc: PMC10379349pubmed: 37510609google scholar: lookup
  10. American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders. Fifth Edition. American Psychiatric Association. 2013.
  11. Sareen J, Cox BJ, Afifi TO, Stein MB, Belik SL, Meadows G. Combat and peacekeeping operations in relation to prevalence of mental disorders and perceived need for mental health care: findings from a large representative sample of military personnel.. Arch Gen Psychiatry (2007) 64:843–52.
    doi: 10.1001/archpsyc.64.7.843pubmed: 17606818google scholar: lookup
  12. Spitzer C, Barnow S, Völzke H, John U, Freyberger HJ, Grabe HJ. Trauma, posttraumatic stress disorder, and physical illness: findings from the general population.. Psychosom Med (2009) 71:1012–7.
    doi: 10.1097/PSY.0b013e3181bc76b5pubmed: 19834051google scholar: lookup
  13. Seng JS, Graham-Bermann SA, Clark MK, McCarthy AM, Ronis DL. Posttraumatic stress disorder and physical comorbidity among female children and adolescents: results from service-use data.. Pediatrics (2005) 116:e767–76.
    doi: 10.1542/peds.2005-0608pubmed: 16322133google scholar: lookup
  14. American Psychiatric Association, American Psychiatric Association. Diagnostic and statistical manual of mental disorders: DSM-5.. 5th ed. Washington, D.C: American Psychiatric Association; (2013). 947 p..
  15. Hourani LL, Council CL, Hubal RC, Strange LB. Approaches to the primary prevention of posttraumatic stress disorder in the military: a review of the stress control literature.. Mil Med (2011) 176:721–30.
    doi: 10.7205/MILMED-D-09-00227pubmed: 22128712google scholar: lookup
  16. Gillies D, Taylor F, Gray C, O’Brien L, D’Abrew N. Psychological therapies for the treatment of post-traumatic stress disorder in children and adolescents (review).. Evid Based Child Health (2013) 8:1004–116.
    doi: 10.1002/ebch.1916pubmed: 23877914google scholar: lookup
  17. Bradley R, Greene J, Russ E, Dutra L, Westen D. A multidimensional meta-analysis of psychotherapy for PTSD.. Am J Psychiatry (2005) 162:214–27.
    doi: 10.1176/appi.ajp.162.2.214pubmed: 15677582google scholar: lookup
  18. Schneier FR, Neria Y, Pavlicova M, Hembree E, Suh EJ, Amsel L. Combined prolonged exposure therapy and paroxetine for PTSD related to the world trade center attack: a randomized controlled trial.. Am J Psychiatry (2012) 169:80–8.
  19. Engelman SR. Palliative care and use of animal-assisted therapy.. Omega (2013) 67:63–7.
    doi: 10.2190/OM.67.1-2.gpubmed: 23977780google scholar: lookup
  20. Beck AM. The use of animals to benefit humans.. In: Handbook on animal-assisted therapy. (2006). 21–40.
  21. Jorgenson J. Therapeutic use of companion animals in health care.. Image J Nurs Sch (1997) 29:249–54.
  22. Farmer SM. Integrating animal-assisted interventions in United States veterans with self-reported posttraumatic stress disorder.. J Nurse Pract (2021) 17:619–22.
  23. Kinney AR, Eakman AM, Lassell R, Wood W. Equine-assisted interventions for veterans with service-related health conditions: a systematic mapping review.. Mil Med Res (2019) 6:28.
    doi: 10.1186/s40779-019-0217-6pmc: PMC6714435pubmed: 31462305google scholar: lookup
  24. McCardle P, McCune S, Griffin JA, Maholmes V. How animals affect us: examining the influences of human–animal interaction on child development and human health. vol. xvi. Washington, DC, US: American Psychological Association; (2011). 228 p..
  25. Nurenberg JR, Schleifer SJ, Shaffer TM, Yellin M, Desai PJ, Amin R. Animal-assisted therapy with chronic psychiatric inpatients: equine-assisted psychotherapy and aggressive behavior.. Psychiatr Serv (2015) 66:80–6.
    doi: 10.1176/appi.ps.201300524pubmed: 25269512google scholar: lookup
  26. Ahn B, Joung YS, Kwon JY, Lee DI, Oh S, Kim BU. Effects of equine-assisted activities on attention and quality of life in children with cerebral palsy in a randomized trial: examining the comorbidity with attention-deficit/hyperactivity disorder.. BMC Pediatr (2021) 21:135.
    doi: 10.1186/s12887-021-02597-0pmc: PMC7976699pubmed: 33740922google scholar: lookup
  27. Alfonso SV, Alfonso LA, Llabre MM, Fernandez MI. Project stride: an equine-assisted intervention to reduce symptoms of social anxiety in young women.. Explore (2015) 11:461–7.
    doi: 10.1016/j.explore.2015.08.003pubmed: 26386749google scholar: lookup
  28. Bass MM, Duchowny CA, Llabre MM. The effect of therapeutic horseback riding on social functioning in children with autism.. J Autism Dev Disord (2009) 39:1261–7.
    doi: 10.1007/s10803-009-0734-3pubmed: 19350376google scholar: lookup
  29. Chinniah H, Natarajan M, Ramanathan R, Ambrose JWF. Effects of horse riding simulator on sitting motor function in children with spastic cerebral palsy.. Physiother Res Int (2020) 25:e1870.
    doi: 10.1002/pri.1870pubmed: 32808394google scholar: lookup
  30. Matusiak-Wieczorek E, Dziankowska-Zaborszczyk E, Synder M, Borowski A. The influence of Hippotherapy on the body posture in a sitting position among children with cerebral palsy.. Int J Environ Res Public Health (2020) 17:6846.
    doi: 10.3390/ijerph17186846pmc: PMC7558765pubmed: 32961681google scholar: lookup
  31. Park S, Park S, Yoo J, Jee YS. Effects of equine riding on static and dynamic mechanical contraction of the thighs and trunk muscles in inactive women.. J Back Musculoskelet Rehabil (2021) 34:521–35.
    doi: 10.3233/BMR-200008pubmed: 33523037google scholar: lookup
  32. Bachi K, Terkel J, Teichman M. Equine-facilitated psychotherapy for at-risk adolescents: the influence on self-image, self-control and trust.. Clin Child Psychol Psychiatry (2012) 17:298–312.
    doi: 10.1177/1359104511404177pubmed: 21757481google scholar: lookup
  33. 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 (2021) 5:2470547021991556.
    doi: 10.1177/2470547021991556pmc: PMC7890715pubmed: 33644617google scholar: lookup
  34. Burton LE, Qeadan F, Burge MR. Efficacy of equine-assisted psychotherapy in veterans with posttraumatic stress disorder.. J Integrat Med (2019) 17:14–9.
    doi: 10.1016/j.joim.2018.11.001pubmed: 30497951google scholar: lookup
  35. Ferruolo DM. Psychosocial equine program for veterans.. Soc Work (2016) 61:53–60.
    doi: 10.1093/sw/swv054pubmed: 26897999google scholar: lookup
  36. Malinowski K, Yee C, Tevlin JM, Birks EK, Durando MM, Pournajafi-Nazarloo H. 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 (2018) 64:17–26.
    doi: 10.1016/j.jevs.2018.01.011pubmed: 30973147google scholar: lookup
  37. Yoo JH, Kim SE, Lee MG, Jin JJ, Hong J, Choi YT. The effect of horse simulator riding on visual analogue scale, body composition and trunk strength in the patients with chronic low back pain.. Int J Clin Pract (2014) 68:941–9.
    doi: 10.1111/ijcp.12414pubmed: 25039929google scholar: lookup
  38. Aranda-García S, Iricibar A, Planas A, Prat-Subiran JA, Angulo-Barroso RM. Comparative effects of horse exercise versus traditional exercise programs on gait, muscle strength, and body balance in healthy older adults.. J Aging Phys Act (2015) 23:78–89.
    doi: 10.1123/JAPA.2012-0326pubmed: 24425454google scholar: lookup
  39. Bunketorp-Käll L, Lundgren-Nilsson Å, Samuelsson H, Pekny T, Blomvé K, Pekna M. Long-term improvements after multimodal rehabilitation in late phase after stroke: a randomized controlled trial.. Stroke (2017) 48:1916–24.
    doi: 10.1161/STROKEAHA.116.016433pubmed: 28619985google scholar: lookup
  40. Žalienė L, Mockevičienė D, Kreivinienė B, Razbadauskas A, Kleiva Ž, Kirkutis A. Short-term and long-term effects of riding for children with cerebral palsy gross motor functions.. Biomed Res Int (2018) 2018:1–6.
    doi: 10.1155/2018/4190249pmc: PMC6057413pubmed: 30069468google scholar: lookup
  41. Hemachithra C, Meena N, Ramanathan R, Felix AJW. Immediate effect of horse riding simulator on adductor spasticity in children with cerebral palsy: a randomized controlled trial.. Physiother Res Int (2020) 25:e1809.
    doi: 10.1002/pri.1809pubmed: 31502387google scholar: lookup
  42. Uchiyama H, Ohtani N, Ohta M. Three-dimensional analysis of horse and human gaits in therapeutic riding.. Appl Anim Behav Sci (2011) 135:271–6.
  43. Silkwood-Sherer D. The difference lies in the perspective.. NARHA’s Stride (2003) 9:14–6.
  44. Yorke J. The therapeutic value of the equine-human relationship in recovery from trauma: A qualitative analysis.. Theses and dissertations (comprehensive) [internet]. (2003).
  45. Wood W, Alm K, Benjamin J, Thomas L, Anderson D, Pohl L. Optimal terminology for Services in the United States that Incorporate Horses to benefit people: a consensus document.. J Altern Complement Med (2021) 27:88–95.
    doi: 10.1089/acm.2020.0415pubmed: 33252244google scholar: lookup
  46. Marchand WR, Lackner R, Hartquist A, Finnell L, Nazarenko E. 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
  47. Shelef A, Brafman D, Rosing T, Weizman A, Stryjer R, Barak Y. Equine assisted therapy for patients with post traumatic stress disorder: a case series study.. Mil Med (2019) 184:394–9.
    doi: 10.1093/milmed/usz036pubmed: 30839068google scholar: lookup
  48. Sylvia L, West E, Blackburn AM, Gupta C, Bui E, Mahoney T. Acceptability of an adjunct equine-assisted activities and therapies program for veterans with posttraumatic stress disorder and/or traumatic brain injury.. J Integrat Med (2020) 18:169–73.
    doi: 10.1016/j.joim.2020.01.005pubmed: 31996299google scholar: lookup
  49. Marchand WR, Smith J, Hoopes KH, Osborne M, Andersen SJ, Bell K. A pilot observational study of horsemanship skills training for veterans with posttraumatic stress disorder.. Complement Ther Med (2023) 72:102910.
    doi: 10.1016/j.ctim.2022.102910pubmed: 36535458google scholar: lookup
  50. Romaniuk M, Evans J, Kidd C. Evaluation of an equine-assisted therapy program for veterans who identify as ‘wounded, injured or ill’ and their partners.. PLoS One (2018) 13:e0203943.
  51. Arnon S, Fisher PW, Pickover A, Lowell A, Turner JB, Hilburn A. Equine-assisted therapy for veterans with PTSD: manual development and preliminary findings.. Mil Med (2020) 185:e557–64.
    doi: 10.1093/milmed/usz444pmc: PMC7282489pubmed: 32034416google scholar: lookup
  52. Fisher PW, Lazarov A, Lowell A, Arnon S, Turner JB, Bergman M. Equine-assisted therapy for posttraumatic stress disorder among military veterans: an open trial.. J Clin Psychiatry (2021) 82:21m14005.
    doi: 10.4088/JCP.21m14005pubmed: 34464523google scholar: lookup
  53. Johnson RA, Albright DL, Marzolf JR, Bibbo JL, Yaglom HD, Crowder SM. Experiences of military veterans in a therapeutic horseback riding program.. Clin Nurs Res (2021) 30:38–45.
    doi: 10.1177/10547738211003580pubmed: 33855883google scholar: lookup
  54. Gonzales F, Jr S, Haertlein C, Jones C, Reer T. The effects of animal-assisted therapy on wounded warriors in an occupational therapy life skills program.. US Army Med Dep J (2012):1524–0426.
    pubmed: 22388679
  55. Beetz A, Uvnäs-Moberg K, Julius H, Kotrschal K. Psychosocial and psychophysiological effects of human-animal interactions: the possible role of oxytocin.. Front Psychol (2023) 3:234.
    doi: 10.3389/fpsyg.2012.00234pmc: PMC3408111pubmed: 22866043google scholar: lookup
  56. Vormbrock JK, Grossberg JM. Cardiovascular effects of human-pet dog interactions.. J Behav Med (1988) 11:509–17.
    doi: 10.1007/BF00844843pubmed: 3236382google scholar: lookup
  57. Maercker A, Brewin CR, Bryant RA, Cloitre M, Reed GM, van Ommeren M. Proposals for mental disorders specifically associated with stress in the international classification of diseases-11.. Lancet (2013) 381:1683–5.
    doi: 10.1016/S0140-6736(12)62191-6pubmed: 23583019google scholar: lookup
  58. Kovács G. Experiential equine-assisted focal psychodynamic psychotherapy: addressing personality and attachment in clients with chronic childhood trauma.. In: Equine-assisted mental health for healing trauma. Ed. Trotter KS. New York: Routledge; (2018). 107–22.
  59. Anestis MD, Anestis JC, Zawilinski LL, Hopkins TA, Lilienfeld SO. Equine-related treatments for mental disorders lack empirical support: a systematic review of empirical investigations.. J Clin Psychol (2014) 70:1115–32.
    doi: 10.1002/jclp.22113pubmed: 24953870google scholar: lookup
  60. Selby A, Smith-Osborne A. A systematic review of effectiveness of complementary and adjunct therapies and interventions involving equines.. Health Psychol (2013) 32:418–32.
    doi: 10.1037/a0029188pubmed: 22888815google scholar: lookup
  61. Porges SW. The polyvagal theory: phylogenetic substrates of a social nervous system.. Int J Psychophysiol (2001) 42:123–46.
    doi: 10.1016/S0167-8760(01)00162-3pubmed: 11587772google scholar: lookup
  62. Van der Kolk B. The body keeps the score: brain, mind, and body in the healing of trauma.. New York. 3. (2014).
  63. Perry BD. Applying principles of neurodevelopment to clinical work with maltreated and traumatized children: The neurosequential model of therapeutics.. (2006).
  64. Moberg GP. Biological response to stress: implications for animal welfare. In: Moberg GP, Mench JA, editors. The biology of animal stress: Basic principles and implications for animal welfare [internet]. 1st ed. UK: CABI Publishing; (2000). 1–21.
  65. Covalesky ME, Russoniello CR, Malinowski K. Effects of show-jumping performance stress on plasma cortisol and lactate concentrations and heart rate and behavior in horses.. J Equine Vet (1992) 12:244–51.
  66. Lanning BA, Krenek N. Guest editorial: examining effects of equine-assisted activities to help combat veterans improve quality of life.. J Rehabil Res Dev (2013) 50:vii–xiii.
    doi: 10.1682/JRRD.2013.07.0159pubmed: 24458903google scholar: lookup
  67. Wharton T, Whitworth J, Macauley E, Malone M. Pilot testing a manualized equine-facilitated cognitive processing therapy (EF-CPT) intervention for PTSD in veterans.. Psychiatr Rehabil J (2019) 42:268–76.
    doi: 10.1037/prj0000359pubmed: 30907609google scholar: lookup
  68. Goodson J, Helstrom A, Halpern JM, Ferenschak MP, Gillihan SJ, Powers MB. Treatment of posttraumatic stress disorder in U.S. combat veterans: a meta-analytic review.. Psychol Rep (2011) 109:573–99.
  69. Steele E, Wood DS, Usadi J E, Applegarth DM. TRR’s warrior camp: an intensive treatment program for combat trauma in active military and veterans of all eras.. Mil Med (2018) 183:403–407.
    doi: 10.1093/milmed/usx153pubmed: 29635563google scholar: lookup

Citations

This article has been cited 0 times.