Equine therapy in the management of teenagers with anorexia nervosa: a qualitative study.
Abstract: Anorexia nervosa is a complex psychiatric pathology with limited therapeutic tools to reduce morbidity and mortality. Equine-assisted therapy could provide additional therapeutic benefits. Objective: We aimed to explore the effects of equine-assisted therapy on the experience of adolescents with anorexia nervosa. Methods: Using a qualitative approach based on Interpretative Phenomenological Analysis, we conducted semi-structured interviews with nine participants who had taken part in equine-assisted therapy sessions. Results: Three superordinate themes were found. Participants initially described an experience of insecurity when meeting the horses which were perceived as a source of fear within a displaced spatiotemporal framework. Equine therapy led to the development of emotional regulation through interactions that allowed for investment without fear of perceived social judgment, a reassuring experience through relational adjustment with the horse, and an experience of support from the humans present. Finally, equine therapy was a transformative learning experience, enabling participants to embody their physicality and care for someone other than themselves. Conclusions: Equine-assisted therapy was found to provide bodily, emotional, and relational therapeutic benefits in anorexia nervosa. The setting, place, and function of the equine therapist, the participants' previous experience with horses, and the interaction with other care areas seem to be essential to ensure therapeutic benefit. Level of Evidence Level III.
© 2025. The Author(s).
Publication Date: 2025-08-16 PubMed ID: 40817957PubMed Central: PMC12357790DOI: 10.1007/s40519-025-01724-5Google Scholar: Lookup
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Summary
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Overview
- This study explored how equine-assisted therapy affects teenagers with anorexia nervosa by using qualitative interviews to understand their personal experiences.
- The research found that interacting with horses helped these adolescents emotionally regulate, feel supported, and engage in a transformative process that improved their relationship with their bodies and others.
Background and Purpose
- Anorexia nervosa is a challenging psychiatric disorder marked by severe body image disturbance, restrictive eating, and high risks of morbidity and mortality.
- Current treatment options for anorexia nervosa are limited, driving interest in complementary therapies that might enhance recovery.
- Equine-assisted therapy, involving guided interactions with horses, has been suggested to support emotional and relational healing.
- The purpose of this study was to qualitatively investigate the subjective experience and perceived benefits of equine therapy in adolescents with anorexia nervosa.
Methodology
- The study used a qualitative research design based on Interpretative Phenomenological Analysis (IPA), which focuses on exploring how individuals make sense of their experiences.
- Nine adolescent participants with anorexia nervosa, who had completed equine-assisted therapy sessions, were recruited.
- Semi-structured interviews were conducted to gather detailed personal accounts of their experiences during the therapy.
- The data from interviews were analyzed to identify key themes representing the participants’ psychological and emotional processes.
Key Findings and Themes
- Initial Insecurity and Fear:
- Participants initially described feelings of insecurity when first encountering the horses.
- The horses were sometimes regarded as intimidating or frightening, experienced within a “displaced spatiotemporal framework,” suggesting that the participants felt disoriented or detached during initial encounters.
- Emotional Regulation and Safe Interaction:
- Engagement with horses helped participants develop emotional regulation skills.
- Interactions allowed them to invest emotionally without fear of social judgment, fostering a sense of safety and acceptance.
- The relationship with the horse itself was described as reassuring, promoting adjustment and calming feelings.
- Support from the human therapists and caregivers present also contributed to a secure environment.
- Transformative Learning Experience:
- Participants reported a deeper embodiment of their physical selves, an important therapeutic milestone given anorexia’s focus on body image and physical perception.
- They also experienced a shift in focus by caring for the horse, moving attention from self-centered symptoms to nurturing another living being.
- This represented a powerful transformation in their perspective and therapeutic progress.
Implications for Therapy
- Equine-assisted therapy offers benefits not just emotionally, but also physically and relationally for adolescents with anorexia nervosa.
- The therapy setting and environment (where sessions occur) are critical to success, as it shapes the sense of safety and engagement.
- The role and approach of the equine therapist play a key part in facilitating therapeutic outcomes.
- Previous experience with horses influenced how participants engaged and benefited, indicating the importance of gradual familiarization.
- Integration with other aspects of care (mental health treatment, medical management) is essential to optimize overall therapeutic benefit.
Conclusion
- Equine-assisted therapy can be a valuable complementary approach in managing anorexia nervosa among teenagers, helping them regulate emotions, rebuild bodily awareness, and experience supportive human and animal relationships.
- Further research and careful implementation are needed to solidify best practices and understand long-term impacts.
- The study is classified as Level III evidence, indicating moderate quality based on qualitative data.
Cite This Article
APA
Lepy C, Letranchant A, Aniorte JL, Bedos J, Hotchkin R, Corcos M, Robin M, Piot MA.
(2025).
Equine therapy in the management of teenagers with anorexia nervosa: a qualitative study.
Eat Weight Disord, 30(1), 66.
https://doi.org/10.1007/s40519-025-01724-5 Publication
Researcher Affiliations
- Institute Mutualiste Montsouris, Paris, France. camille.lepy@gmail.com.
- Institute Mutualiste Montsouris, Paris, France.
- Institute Mutualiste Montsouris, Paris, France.
- Institute Mutualiste Montsouris, Paris, France.
- King's College Hospital NHS Foundation Trust, London, UK.
- Institute Mutualiste Montsouris, Paris, France.
- Institute Mutualiste Montsouris, Paris, France.
- Hôpital Necker-Enfants Malades, Paris, France.
MeSH Terms
- Humans
- Anorexia Nervosa / therapy
- Anorexia Nervosa / psychology
- Equine-Assisted Therapy / methods
- Adolescent
- Female
- Qualitative Research
- Horses
- Animals
- Emotions
Conflict of Interest Statement
Declarations. Ethics approval and consent to participate: This study was approved by the French IRB CERAPHP-Centre ethics committee (Ref 2021-02-04 MS1). The participants and their parents received exhaustive oral and written information on the purpose and modalities of the research. Informed consent was obtained from all individual participants included in this study, and their parents if they were under age. The possibility of opting out at any time and the absence of therapeutic consequences of their participation – or refusal – were emphasized. Competing interests: The authors declare no competing interests.
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