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BMC psychiatry2024; 24(1); 499; doi: 10.1186/s12888-024-05879-w

Study Protocol: Pegasus: psychotherapy incorporating horses for ‘therapy-resistant’ adolescents with autism spectrum disorders, a study with series of randomised, baseline controlled n-of-1 trials.

Abstract: For people with autism spectrum disorder (ASD), daily life can be highly stressful with many unpredictable events that can evoke emotion dysregulation (ED): a strong difficulty with appropriately negative affect regulation. For some of the patients with ASD, treatment as usual does not prove to be effective for ED. They may be at risk of life-long impairment, development of other disorders and loss of motivation for most regular forms of therapy. A highly promising method that may prove effective for therapy-resistant individuals with ASD is Psychotherapy incorporating horses (PIH). PIH uses the interactions of the horse and the patients on the ground and does not include horseriding. While often met with prejudgment and scepticism, reports from parents and therapists as well as a recent systematic review suggest that PIH may have beneficial effects on youths with ASD. Therefore, we examine clinical outcomes both in the short and in the long terms of PIH offered to adolescents with ASD and severe ED despite regular therapy. Methods: A total of 35 adolescents aged 11-18 years with ASD will receive PIH during 15 sessions once a week with randomization to five different groups differentiating in baseline phase from 2 to 6 weeks. PIH uses horses to promote social awareness and self-awareness as well as relationship management and self-management. The primary outcome is the response to treatment on the Emotion Dysregulation Index (EDI). The secondary outcome measures include ASD symptom severity, quality of life, self-esteem, global and family functioning, and goal attainment. Assessments take place at the baseline (T0), at the end of baseline phase A (T1), after completion of intervention phase B (T2), after the end of post-measurement phase C (T3) and after one year (T4). Qualitative interviews of participants, parents and therapists will be held to reveal facilitators and barriers of PIH and a cost-effectiveness study will be performed. Conclusions: This study aims at contributing to clinical practice for adolescents with ASD and persistent emotion regulation problems despite 1.5 year of treatment by offering Psychotherapy incorporating horses in a study with series of randomised, baseline controlled n-of-1 trials. Background: www. Results: gov NCT05200351, December 10th 2021.
© 2024. The Author(s).
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Publication Date: 2024-07-10 PubMed ID: 38987737PubMed Central: PMC11238395DOI: 10.1186/s12888-024-05879-wGoogle Scholar: Lookup
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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 focuses on the effect of a form of therapy, known as “Psychotherapy incorporating horses” (PIH), on therapy-resistant adolescents with Autism Spectrum Disorder (ASD) who are experiencing severe emotional dysregulation. The study will follow 35 patients over a course of 15 weeks, alongside evaluations of their emotional regulation, Autism symptoms, quality of life, self-esteem, familial relationships, and other areas.

Study Overview

  • The research focuses on the evaluation of Psychotherapy incorporating horses (PIH) as a treatment method for therapy-resistant adolescents diagnosed with Autism Spectrum Disorder (ASD), who have severe emotional dysregulation issues. These young people have not responded to standard therapy practices, necessitating the exploration of alternate methods.
  • The study recognizes that life can be stressful for individuals with ASD due to many unpredictable events which often trigger emotional dysregulation, leading to negative impact on their ability to regulate affect. This can result in life-long impairments, development of other disorders and loss of motivation.

Methods of Study

  • The study involves 35 adolescents aged between 11-18 years, who will undergo a total of 15 weekly sessions of PIH. This therapy uses the interactions between the patient and horses to promote self-awareness, relationship management and social awareness.
  • The research uses randomization, dividing the participants into five different groups with baseline phases ranging from 2 to 6 weeks. Notably, the PIH does not involve horse riding, but rather utilizes the interactions between the patient and the horse on the grounds.
  • The research measures the outcomes on two levels: primary and secondary. The primary outcome focuses on the response to treatment on the Emotion Dysregulation Index (EDI). Secondary outcomes include ASD symptom severity, quality of life, self-esteem, global and family functioning, and goal attainment.
  • Assessments occur at the baseline phase (T0), at the end of baseline phase A (T1), after the intervention phase B (T2), the post-measurement phase C (T3), and after one year (T4). The qualitative interviews of participants, parents and therapists are meant to provide further information to understand the facilitators and barriers of PIH.
  • In addition to the qualitative and quantitative assessments, there will also be a cost-effectiveness study.

Conclusions

  • This study aims to contribute to clinical practice for adolescents with ASD experiencing persistent emotional regulation problems despite traditional therapy methods. It seeks to explore the effectiveness of incorporating horses into the therapy routine.
  • Providing new treatment strategies like PIH may help these young people cope better with their daily lives, by improving emotional regulation among other outcomes.

Cite This Article

APA
den Boer JC, Klip H, Blonk A, Lenselink M, Kaijdoe SPT, Tielkes M, van Zandbeek A, Bres G, Herinx M, Staal WG, Rommelse N. (2024). Study Protocol: Pegasus: psychotherapy incorporating horses for ‘therapy-resistant’ adolescents with autism spectrum disorders, a study with series of randomised, baseline controlled n-of-1 trials. BMC Psychiatry, 24(1), 499. https://doi.org/10.1186/s12888-024-05879-w

Publication

BMC psychiatry
ISSN: 1471-244X
NlmUniqueID: 100968559
Country: England
Language: English
Volume: 24
Issue: 1
Pages: 499
PII: 499

Researcher Affiliations

den Boer, Jenny C
  • Karakter, Child and Adolescent Psychiatry, Ede, the Netherlands. J.denboer@karakter.com.
  • Department of Psychiatry, Radboud University Medical Centre, Nijmegen, the Netherlands. J.denboer@karakter.com.
Klip, Helen
  • Karakter, Child and Adolescent Psychiatry, Nijmegen, the Netherlands.
Blonk, Anita
  • Gagelhoeve, Mill, the Netherlands.
Lenselink, Monique
  • Paardenblik, Wageningen, the Netherlands.
Kaijdoe, Shireen P T
  • Karakter, Child and Adolescent Psychiatry, Nijmegen, the Netherlands.
Tielkes, Melanie
  • Karakter, Child and Adolescent Psychiatry, Nijmegen, the Netherlands.
van Zandbeek, Amber
  • Gagelhoeve, Mill, the Netherlands.
Bres, Gerdine
  • Horses en Co, Heerjansdam, the Netherlands.
Herinx, Mandy
  • Horses en Co, Heerjansdam, the Netherlands.
Staal, Wouter G
  • Karakter, Child and Adolescent Psychiatry, Nijmegen, the Netherlands.
  • Department of Psychiatry, Radboud University Medical Centre, Nijmegen, the Netherlands.
  • Institute for Brain and Cognition, Leiden, the Netherlands.
Rommelse, Nanda
  • Department of Developmental Psychology, Utrecht University, Utrecht, the Netherlands.

MeSH Terms

  • Autism Spectrum Disorder / therapy
  • Autism Spectrum Disorder / psychology
  • Adolescent
  • Humans
  • Child
  • Animals
  • Equine-Assisted Therapy / methods
  • Horses
  • Male
  • Female
  • Randomized Controlled Trials as Topic
  • Emotional Regulation
  • Psychotherapy / methods

Grant Funding

  • project 636310020 / ZonMw
  • project 636310020 / ZonMw
  • project 636310020 / ZonMw
  • project 636310020 / ZonMw
  • project 636310020 / ZonMw
  • project 636310020 / ZonMw
  • project 636310020 / ZonMw
  • project 636310020 / ZonMw
  • project 636310020 / ZonMw
  • project 636310020 / ZonMw
  • project 636310020 / ZonMw

Conflict of Interest Statement

The authors declare no competing interests.

References

This article includes 56 references
  1. Fombonne E. The rising prevalence of autism.. J Child Psychol Psychiatry Allied Discip 2018;59(7):717–20.
    doi: 10.1111/jcpp.12941pubmed: 29924395google scholar: lookup
  2. Aldao A, Nolen-Hoeksema S, Schweizer S. Emotion-regulation strategies across psychopathology: a meta-analytic review.. Clin Psychol Rev 2010;30(2):217–37.
    doi: 10.1016/j.cpr.2009.11.004pubmed: 20015584google scholar: lookup
  3. Samson AC, Wells WM, Phillips JM, Hardan AY, Gross JJ. Emotion regulation in autism spectrum disorder: evidence from parent interviews and children’s daily diaries.. J Child Psychol Psychiatry Allied Discip 2015;56(8):903–13.
    doi: 10.1111/jcpp.12370pubmed: 25442191google scholar: lookup
  4. Nader-Grosbois N, Mazzone S. Emotion regulation, personality and Social Adjustment in Children with Autism Spectrum disorders.. Psychology 2014;5:1750–67.
    doi: 10.4236/psych.2014.515182google scholar: lookup
  5. Swain D, Scarpa A, White S, Laugeson E. Emotion dysregulation and anxiety in adults with ASD: does Social Motivation play a role?. J Autism Dev Disord 2015;45(12):3971–7.
    doi: 10.1007/s10803-015-2567-6pubmed: 26319254google scholar: lookup
  6. Mazefsky CA, Borue X, Day TN, Minshew NJ. Emotion regulation patterns in adolescents with high-functioning autism spectrum disorder: comparison to typically developing adolescents and association with psychiatric symptoms.. Autism Research: Official J Int Soc Autism Res 2014;7(3):344–54.
    doi: 10.1002/aur.1366pmc: PMC4136477pubmed: 24610869google scholar: lookup
  7. Mazefsky CA. Emotion regulation and emotional distress in Autism Spectrum Disorder: foundations and considerations for Future Research.. J Autism Dev Disord 2015;45(11):3405–8.
    doi: 10.1007/s10803-015-2602-7pmc: PMC4609632pubmed: 26391886google scholar: lookup
  8. Mogensen L, Mason J. The meaning of a label for teenagers negotiating identity: experiences with autism spectrum disorder.. Sociol Health Illn 2015;37(2):255–69.
    doi: 10.1111/1467-9566.12208pubmed: 25677601google scholar: lookup
  9. Gillespie-Lynch K, Kapp SK, Brooks PJ, Pickens J, Schwartzman B. Whose expertise is it? Evidence for autistic adults as critical autism experts.. Front Psychol 2017;8(438).
    pmc: PMC5368186pubmed: 28400742
  10. Fuller EA, Kaiser AP. The effects of Early Intervention on Social Communication Outcomes for Children with Autism Spectrum disorder: a Meta-analysis.. J Autism Dev Disord 2020;50(5):1683–700.
    doi: 10.1007/s10803-019-03927-zpmc: PMC7350882pubmed: 30805766google scholar: lookup
  11. Reichow B. Overview of meta-analyses on early intensive behavioral intervention for young children with autism spectrum disorders.. J Autism Dev Disord 2012;42(4):512–20.
    doi: 10.1007/s10803-011-1218-9pubmed: 21404083google scholar: lookup
  12. Peters-Scheffer N, Didden R, Korzilius H, Sturmey P. A meta-analytic study on the effectiveness of comprehensive ABA-based early intervention programs for children with Autism Spectrum disorders.. Res Autism Spectr Disorders 2011;5:60–9.
    doi: 10.1016/j.rasd.2010.03.011google scholar: lookup
  13. Malter Cohen M, Tottenham N, Casey BJ. Translational developmental studies of stress on brain and behavior: implications for adolescent mental health and illness?. Neuroscience 2013;249:53–62.
    doi: 10.1016/j.neuroscience.2013.01.023pmc: PMC3696429pubmed: 23340244google scholar: lookup
  14. Mengler L, Khmelinskii A, Diedenhofen M, Po C, Staring M, Lelieveldt BP. Brain maturation of the adolescent rat cortex and striatum: changes in volume and myelination.. NeuroImage 2014;84:35–44.
    doi: 10.1016/j.neuroimage.2013.08.034pubmed: 23994458google scholar: lookup
  15. Burnett Heyes S, Jih YR, Block P, Hiu CF, Holmes EA, Lau JY. Relationship reciprocation modulates Resource Allocation in Adolescent Social networks: Developmental effects.. Child Dev 2015;86(5):1489–506.
    doi: 10.1111/cdev.12396pmc: PMC4855684pubmed: 26235042google scholar: lookup
  16. Sussman D, Leung RC, Vogan VM, Lee W, Trelle S, Lin S. The autism puzzle: diffuse but not pervasive neuroanatomical abnormalities in children with ASD.. NeuroImage Clin 2015;8:170–9.
    doi: 10.1016/j.nicl.2015.04.008pmc: PMC4473820pubmed: 26106541google scholar: lookup
  17. Fein D, Barton M, Eigsti IM, Kelley E, Naigles L, Schultz RT. Optimal outcome in individuals with a history of autism.. J Child Psychol Psychiatry Allied Discip 2013;54(2):195–205.
    doi: 10.1111/jcpp.12037pmc: PMC3547539pubmed: 23320807google scholar: lookup
  18. McDaniel Peters BC, Wood W. Autism and equine-assisted interventions: a systematic mapping review.. J Autism Dev Disord 2017;47(10):3220–42.
    doi: 10.1007/s10803-017-3219-9pubmed: 28733851google scholar: lookup
  19. Trzmiel T, Purandare B, Michalak M, Zasadzka E, Pawlaczyk M. Equine assisted activities and therapies in children with autism spectrum disorder: a systematic review and a meta-analysis.. Complement Ther Med 2019;42:104–13.
    doi: 10.1016/j.ctim.2018.11.004pubmed: 30670226google scholar: lookup
  20. Nieforth LO, Schwichtenberg AJ, O’Haire ME. Animal-assisted interventions for Autism Spectrum disorder: a systematic review of the literature from 2016 to 2020.. Rev J Autism Dev Disorders 2023;10(2):255–80.
    doi: 10.1007/s40489-021-00291-6pmc: PMC10259834pubmed: 37313251google scholar: lookup
  21. 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 (New York NY) 2021;27(1):88–95.
    doi: 10.1089/acm.2020.0415pubmed: 33252244google scholar: lookup
  22. Goodman G, Calderon A, Midgley N. Expert clinicians’ prototypes of an adolescent treatment: common and unique factors among four treatment models.. Psychother Res 2022;32(6):792–804.
    doi: 10.1080/10503307.2021.2001603pubmed: 34806540google scholar: lookup
  23. Midgley N, Ensink K, Lindqvist K, Malberg N, Muller N. Mentalization-based treatment for children: a time-limited approach.. American Psychological Association. 2017.
  24. Weijers JG, ten Kate C, Debbané M, Bateman AW, de Jong S, Selten JPCJ. Mentalization and psychosis: a rationale for the Use of Mentalization Theory to understand and treat non-affective psychotic disorder.. J Contemp Psychother 2020;50(3):223–32.
    doi: 10.1007/s10879-019-09449-0google scholar: lookup
  25. Goepfert E, Mulé C, von Hahn E, Visco Z, Siegel M. Family System interventions for families of children with Autism Spectrum Disorder.. Child Adolesc Psychiatr Clin N Am 2015;24(3):571–83.
    doi: 10.1016/j.chc.2015.02.009pubmed: 26092740google scholar: lookup
  26. Meijer MaW R. Geen woorden maar paarden, equine assisted coaching & therapie. 2023. 246 p..
  27. Srinivasan SM, Cavagnino DT, Bhat AN. Effects of Equine Therapy on individuals with Autism Spectrum disorder: a systematic review.. Rev J Autism Dev Disord 2018;5(2):156–75.
    doi: 10.1007/s40489-018-0130-zpmc: PMC6178825pubmed: 30319932google scholar: lookup
  28. 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 Veterinary Sci 2018;64:17–26.
    doi: 10.1016/j.jevs.2018.01.011pubmed: 30973147google scholar: lookup
  29. Dobson D DK. Evidence-based practice of cognitive-behavioral therapy. 2018.
  30. Dobson D, Dobson KS. Evidence-based practice of cognitive-behavioral therapy, 2nd ed.. New York, NY, US: Guilford Press; 2017. xiii, 354-xiii, p..
  31. American Psychiatric Association. Diagnostic and statistical manual of mental disorders: DSM-5.. 5. Washington, D.C: American Psychiatric Association; 2013.
  32. Wechsler D, Hendriks MPH, Ruiter S, Schittekatte M, Bos A. WISC-V-NL: Wechsler Intelligence Scale for children :Nederlandstalige bewerking.. Tweede druk ed. Amsterdam: Pearson; 2018.
  33. Wechsler D. Wechsler adult intelligence scale-fourth edition-nederlandstalige bewerking.. Tweede druk. ed. Amsterdam: Pearson; 2018.
  34. Mazefsky CA, Yu L, Pilkonis PA. Psychometric properties of the emotion dysregulation inventory in a nationally Representative Sample of Youth.. J Clin Child Adolesc Psychol 2020:1–13.
    pmc: PMC7781089pubmed: 31910035
  35. Mazefsky CA, Day TN, Siegel M, White SW, Yu L, Pilkonis PA. Development of the emotion dysregulation inventory: a PROMIS(R)ing method for creating sensitive and unbiased questionnaires for Autism Spectrum Disorder.. J Autism Dev Disord 2018;48(11):3736–46.
    doi: 10.1007/s10803-016-2907-1pmc: PMC5378674pubmed: 27699685google scholar: lookup
  36. Kiresuk TJ, Sherman RE. Goal attainment scaling: a general method for evaluating comprehensive community mental health programs.. Commun Ment Health J 1968;4(6):443–53.
    doi: 10.1007/BF01530764pubmed: 24185570google scholar: lookup
  37. The KIDSCREEN Group Europe. The KIDSCREEN questionnaires - quality of life questionnaires for children and adolescents. Handbook.. Lengerich: Pabst Science; 2006.
  38. Verhulst FC, Van der Ende J. Handleiding ASEBA-Vragenlijsten voor leeftijden 6 t/m 18 jaar: CBCL/6–18, YSR en TRF.. Rotterdam: ASEBA Nederland; 2013.
  39. Achenbach TM, McConaughy SH, Ivanova MY, Rescorla LA. Manual for the ASEBA brief Problem Monitor™ (BPM). Burlington: ASEBA; 2011.
  40. Franck E, De Raedt R, Barbez C, Rosseel Y. Psychometric properties of the Dutch Rosenberg Self-Esteem Scale.. Physiol Belgica 2008;48(1):25–35.
  41. Constantino JN, Davis SA, Todd RD, Schindler MK, Gross MM, Brophy SL. Validation of a brief quantitative measure of autistic traits: comparison of the social responsiveness scale with the autism diagnostic interview-revised.. J Autism Dev Disord 2003;33(4):427–33.
    doi: 10.1023/A:1025014929212pubmed: 12959421google scholar: lookup
  42. Frazier TW, Youngstrom EA, Speer L, Embacher R, Law P, Constantino J. Validation of proposed DSM-5 criteria for autism spectrum disorder.. J Am Acad Child Adolesc Psychiatry 2012;51(1):28–e403.
    doi: 10.1016/j.jaac.2011.09.021pmc: PMC3244681pubmed: 22176937google scholar: lookup
  43. Roeyers HTM, Druart C, De Schryver M, Schittekate M. SRS Screeningslijst voor autismespectrumstoornissen. Handleiding.. Amsterdam: Hogrefe; 2011.
  44. Veerman JW, Kroes G, De Meyer R, Janssen J, Nguyen L, Vermulst A. Handleiding VGFO. Vragenlijst Gezinsfunctioneren volgens Ouders.. Nijmegen: Praktikon; 2016.
  45. Veerman JW, Kroes G, De Meyer R, Janssen J, Janssen J, Nguyen L, Vermulst A. Manual VGFO. Questionnaire on Family Functioning according to parents.. Nijmegen: Praktikon; 2016.
  46. Miller SD, Duncan BL. The outcome and session rating scale. Administration and scoring manual.. Chicago, IL: Institute for the Study of Therapeutic Change; 2004.
  47. Melissa G, Murphy SRRMH. The Psychometric properties of the Session Rating Scale: a narrative review.. J Evid Based Soc Work 17:3279–99.
    pubmed: 32420833
  48. Hafkenscheid ADB, Miller SD. The outcome and session rating scales: a cross-cultural examination of the psychometric properties of the Dutch translation.. J Br Ther (7):1–12.
  49. Janse P, Boezen-Hilberdink L, van Dijk MK, Verbraak MJPM, Hutschemaekers GJM. Measuring feedback from clients.. Eur J Psychol Assess 2014;30(2):86–92.
    doi: 10.1027/1015-5759/a000172google scholar: lookup
  50. Duncan BLSJ, Miller SD et al. Giving youth a voice: a preliminary study of the reliability and validity of a brief outcome measure for children, adolescents, and caretakers.. J Br Ther 5:71–87.
  51. Straten LR, Tiemens A, Donker B. Manual Trimbos/iMTA Questionnaire for Costs Associated with Psychiatric Illness (TIC-P) (in Dutch).. 2002;2.
  52. Benjamini Y, Yekutieli D. False Discovery rate–adjusted multiple confidence intervals for selected parameters.. J Am Stat Assoc 2005;100(469):71–81.
    doi: 10.1198/016214504000001907google scholar: lookup
  53. Heyvaert M, Moeyaert M, Verkempynck P, Van den Noortgate W, Vervloet M, Ugille M. Testing the intervention effect in single-case experiments: a Monte Carlo Simulation Study.. J Exp Educ 2017;85(2):175–96.
    doi: 10.1080/00220973.2015.1123667google scholar: lookup
  54. Manly BFJ. Randomization Tests, 4th Edition by, Edgington ES. Patrick Onghena.. Int Stat Rev 2007;75(2):269-.
  55. Kvale S, Brinkmann S. Interviews: learning the craft of qualitative research interviewing.. Thousand Oaks, California, USA: Sage; 2009.
  56. Baarda BB, E ea. Basisboek Kwalitatief onderzoek, Handleiding voor het opzetten en uitvoeren van kwalitatief onderzoek.. 4e druk ed2018. 336 p..

Citations

This article has been cited 1 times.
  1. Marano G, Kotzalidis GD, Anesini MB, Barbonetti S, Rossi S, Milintenda M, Restaino A, Acanfora M, Traversi G, Veneziani G, Picilli M, Callovini T, Lai C, Mercuri EM, Sani G, Mazza M. Exploring the Autistic Brain: A Systematic Review of Diffusion Tensor Imaging Studies on Neural Connectivity in Autism Spectrum Disorder. Brain Sci 2025 Jul 31;15(8).
    doi: 10.3390/brainsci15080824pubmed: 40867159google scholar: lookup
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