Equine-assisted interventions for veterans with servicerelated health conditions: a systematic mapping review

Background:Evidence-based treatments for service-related health conditions such as posttraumatic stress disorder(PTSD),depression,and traumatic brain injury(TBI)are not effective for all veterans.Equine-assisted interventions are emerging as an additional treatment modality,but little is known regarding the safe and effective delivery of these interventions.This study aimed to describe the following features of the body of literature concerning equineassisted interventions among veterans:1)veterans who have participated in equine-assisted interventions;2)specific characteristics of equine-assisted interventions in veterans;and 3)the specific characteristics of research on equineassisted interventions in veterans.Methods:We conducted a systematic mapping review of peer-reviewed literature reporting on equine-assisted interventions among veterans between 1980 and 2017.Searches of nine databases yielded 3336 unique records,six of which met the inclusion criteria and were reviewed.Data relevant to the study aims were extracted and analyzed.Results:Equine-assisted interventions among veterans disproportionately targeted psychosocial outcomes and yielded promising results.The detailed methods of EAI varied in the reported studies,ranging from communicating with the horse to mounted exercises.There was also great diversity in outcome measurement.The state of theoretical development regarding the mechanisms by which equine-assisted interventions benefit the veteran population is currently underdeveloped.Studies provided insufficient detail with respect to the description of the intervention,reasons for attrition,and the dose-response relationship.Conclusions:Scientific development of equine-assisted interventions targeting psychosocial outcomes among veterans is warranted to establish their efficacy.Targeted outcomes should be expanded,including outcomes more closely aligned with the nature of polytraumatic injuries.Future research must also emphasize the theoretical development of equine-assisted interventions for veterans and thoroughly describe the participants,components of the intervention,factors contributing to attrition,and optimal dose-response relationships.

Acceptability of an adjunct equine-assisted activities and therapies program for veterans with posttraumatic stress disorder and/or traumatic brain injury

Objective: Equine-assisted activities and therapies(EAATs) have been a growing adjunctive integrative health modality, as they allow participants to practice mindfulness, emotional regulation, and self-mastery or self-esteem building skills. Preliminary evidence suggests that these programs may be helpful in reducing posttraumatic stress disorder(PTSD), anxiety, and depressive symptoms. The current study examines the acceptability of integrating an EAAT program as part of a two-week, intensive clinical program for veterans with PTSD and/or traumatic brain injury(TBI).Methods: A family member or support person could accompany veterans and participate in the program.One hundred and six participants(veteran n = 62, family n = 44) left the urban environment in an intensive outpatient program(IOP) to attend a two-day, weekend EAAT in rural New Hampshire. Satisfaction surveys were conducted on the last day of the program and examined using thematic analysis.Results: The following themes were reported in the surveys: ability of horses to catalyze emotional rehabilitation, effectiveness of immersion in equine-assisted activities, program’s ability to foster interpersonal relationships and necessity of education about PTSD for staff. Participants also reported enjoying the program as highlighted by qualitative feedback, a mean score of 9.76(standard deviation[SD] = 0.61) as reported by veterans and a mean score of 9.91(SD = 0.29) as reported by family members on a 10-point visual analog scale with higher scores indicating a greater overall experience.Conclusion: These data offer preliminary evidence that an adjunct EAAT program is acceptable for veterans with PTSD and/or TBI participating in an IOP.

Efficacy of equine-assisted psychotherapy in veterans with posttraumatic stress disorder

Background: Posttraumatic stress disorder(PTSD) is a common and debilitating disorder among war veterans. Although complementary and alternative therapies are gaining acceptance in the treatment of PTSD, the efficacy of animal-based therapies in this disorder is unknown. The goal of equine-assisted psychotherapy(EAP) is to improve the social, emotional, and/or cognitive functions of individuals with PTSD.Objective: This study aims to explore the effects of EAP on PTSD symptoms. We hypothesized that veterans with PTSD who participate in a standardized EAP program for 1 h per week for 6 weeks would experience decreased PTSD symptoms and would demonstrate increased resilience as compared with individuals who do not receive EAP intervention.Design, setting, participants and interventions: We conducted a sequentially assigned, two-arm parallel group trial comparing 6 weeks of EAP with standard, previously established, ongoing PTSD therapy.Therapy was conducted at a community EAP facility in conjunction with an academic University Hospital. Twenty adult veterans with symptomatic PTSD completed the study. Ten adult veterans with previously diagnosed PTSD were assigned to EAP and received directed interaction with trained horses for one hour a week in groups of 3 or 4 individuals, while also continuing their previously established therapies. A certified therapist supervised the sessions, and a professional horse handler was also present.Results were compared with those from 10 adult veterans who only received their standard previously established PTSD care as prescribed by their provider.Main outcome measures: Changes in salivary cortisol, scores for the PTSD Check List-Military Version(PCL-M) and the Connor-Davidson Resilience Scale(CD-RISC) after 6 weeks of study were measured.Results: Of the 20 enrolled patients, 10 served in Afghanistan, 5 served in Iraq, and 3 served in Vietnam. Subjects were(47 ± 14) years old, were predominantly male, and had a body mass index of(29 ± 7) kg/m2. They had(9.2 ± 6.1) years of military service and carried 66% ± 37% service-connected disability. PCL-M scores declined significantly in both groups and CD-RISC scores increased significantly in the EAP group. There was no difference between the groups with respect to the magnitude of change.Conclusion: As compared to the control group, a 6-week EAP program did not produce a statistically significant difference with respect to PCL-M and CD-RISC scores, or salivary cortisol. However, our results suggest that EAP may work as well as standard therapy with respect to these parameters. This study supports further inquiry into EAP as a potentially efficacious alternative for veterans suffering from PTSD.Trial registration: ClinicalTrials.gov NCT #03039361.

The Effects of Therapeutic Horseback Riding Program on Motor Skills inChildren with Autism Spectrum Disorder

Therapeutic horseback riding(THR)as an animal-assisted intervention is one of the innovative approaches emer-ging in the treatment for children with autism spectrum disorder(ASD).The current study was designed to inves-tigate the effects of a 12-week,twice a week THR program on motor skills in sixty-eight children with ASD aged 5–10 years old.All participants selected met the DSM-V criteria for ASD,and a total offifty-three participants completed the study.A randomized controlled trial design was utilized for the study.Data was collected via a pre-THR test,interim-THR test,and post-THR test to investigate the possible changes in motor skills throughout the 12-week THR program.Results showed that the THR program significantly improved overall motor skills across time points(p<0.05)and sub-skills of run,gallop and two-hand catch(as compared to the control group,p<0.05).In conclusion,the THR program may be an effective option for improving motor skills in children with ASD and further investigation with a longer period of intervention is warranted.