What Is Equine-Assisted Therapy?

  • Charlotte Sutherland Master of Science – MSc Translational Neuroscience, Imperial College London

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Overview

Animal-assisted therapy involves interacting with different types of animals as part of the therapeutic process with a therapist to encourage physical and mental well-being. This type of therapy is being used in various settings - including schools, hospitals, and care homes, with positive results. This can vary from having a trained therapy animal, such as a therapy dog, by your side throughout the day, to learning to care for a therapy animal that you can visit.1

Equine-assisted therapy (EAT) involves horses, a trained therapist, and an experienced equine specialist. You might be thinking - why horses? Other animals, like dogs, are more well-known options for animal-assisted therapy. However, involving horses provides a unique therapeutic approach that is becoming increasingly popular for physical and psychological treatments. 

EAT puts people and horses together with a therapist in a safe and comfortable environment, with the innate connection between humans and horses facilitating emotional, psychological, and physical healing to help various mental health conditions and developmental disorders.2

In this article, we will delve into the intricacies of EAT, exploring its underlying principles, benefits, and potential considerations and challenges.

How does equine-assisted therapy work?

EAT incorporates horses into the therapeutic process. As part of EAT, you will engage in various activities with the horse, including grooming, feeding, and leading the horse around an enclosure. 

After participating in these caretaking activities, you will discuss what you have experienced and learnt with a trained therapist. EAT does not normally involve riding horses, but this can be incorporated for certain physical conditions. The goal of this form of therapy is to help you develop skills such as emotional regulation, self-confidence, trust, and responsibility.3

What to expect in an equine-assisted therapy session?

EAT sessions typically involve performing a variety of different activities with a horse. These activities might include basic caretaking activities, such as:

  • Grooming
  • Feeding
  • Leading the horse around an enclosure using a lead rope4

These sessions might involve more complex activities, such as creating an obstacle course and leading the horse around it. This often requires creating thinking and may make you reconsider how you think and act. 

An experienced equine specialist will always supervise you while performing these activities to ensure your and the horse’s safety. However, they will not tell you how to complete the task - the aim of these sessions is for you to explore different methods and learn from your successes and failures.5

After performing these exercises, your therapist will discuss your experience, for example;

  • How it made you feel
  • What you learned
  • What methods were successful or unsuccessful
  • What you might want to target in your next session (e.g., certain behaviours or emotions) 

You should be encouraged to learn more about yourself, and your emotional responses and behaviours.

What are the benefits of equine-assisted therapy?

The goal of EAT is to help people develop skills such as emotional regulation, self-confidence, trust, and responsibility.3,6

Emotional regulation and non-verbal communication

It is thought that horses are especially attuned to respond to human emotions and non-verbal signals, not just verbal commands. While engaging in activities with the horse, you will learn how the horse's behaviours change with your emotional signals. For example, the horse might pull away or not follow what you want if you are anxious or angry.7 

This “mirroring” process is thought to help you identify your current feelings and learn to express a sense of calm, confidence, and openness, all in a non-judgemental environment. This can help you reflect on your behaviour and challenge how you approach situations.8

Self-confidence and anxiety

Horses are large animals and can be intimidating to many people. Therefore, learning to engage and complete activities with them in a safe and supervised environment can help people boost their confidence and self-esteem. Being able to grow trust over time can be very rewarding and can reinforce feelings of empowerment. EAT also encourages people suffering from anxiety to work through their fears in this safe environment. 

Building trust-based relationships

Horses are herd animals, which means they are very social, want to create bonds and enjoy being around others. Over time, many people form bonds with the horses that they work with, fostering empathy and building trust. This is particularly beneficial for people who have experienced some form of trauma and need to learn to trust again.6

Motor skills

Other than the psychological benefits discussed above, EAT can also have physical benefits (although this is often referred to as therapeutic riding or hippotherapy). Riding on a horse involves rhythmic movements on the body which have been shown to improve balance, muscle symmetry, coordination, and posture. Additionally, the warmer heat of a horse’s body can be transmitted to humans during riding, helping to decrease muscle spasticity and improve muscle function.3

Who can benefit from equine-assisted therapy?

EAT can help to improve the psychological and physical well-being of people with a wide range of different conditions, including:

Addiction

EAT can help people with addiction and substance use disorders overcome some of the psychological blocks that often prevent recovery. For example, it can help you learn to trust others or learn more about your emotions and how to regulate them.9

Anger

Horses do not respond well to anger. Therefore, to complete activities with the horse, you will have to learn techniques to control your anger and act in a more calm and controlled way. 10

Anxiety

Horses are large animals which can cause feelings of anxiety when you are around them. However, overcoming these feelings and completing tasks with these animals in a safe environment, can help overcome anxiety and improve your self-confidence.11

Autism spectrum disorder (ASD)

Interacting with horses focuses more on non-verbal cues and body language rather than verbal communication. This can help people (especially children) with ASD to understand certain behaviours and learn how to communicate or interact better with others.12

Trauma and post-traumatic stress disorder (PTSD)

EAT can be used for people with PTSD, as the gentle nature of horses can help you to rebuild trust and confidence after experiencing trauma.11

Physical conditions

EAT can also be beneficial for some physical conditions. It can be used to improve the symptoms in conditions such as multiple sclerosis, spinal cord injury, and cerebral palsy. Horse riding and the rhythmic movements associated with this can improve motor skills, balance, and coordination.13,14

What are the limitations and potential considerations of equine-assisted therapy?

There are some potential limitations and challenges with EAT which should be carefully considered before you start this form of therapy.2,15

Suitability

EAT is not suitable for everyone. Your eligibility for this therapy will depend on the following factors:

Mental health condition

Individuals in certain psychological states, such as psychosis, may not be suitable for EAT due to the risk of the patient behaving and acting unexpectedly, potentially leading to safety concerns if the horse reacts negatively.

Timing

Depending on the challenges someone is facing, the timing might not always be appropriate for EAT. For example, those struggling with addiction may need to undergo detoxification and establish a stable treatment programme before integrating EAT into their recovery process.

Fear

For some individuals, EAT can be beneficial for addressing anxiety and fear. However, if you have a strong fear of being around large horses, or have experienced previous trauma related to horses, then you might not be suitable for this therapy. 

Allergies

Some individuals may experience allergic reactions to the horses themselves or their environments (e.g., hay or barn dust), making them unsuitable to be in this environment for EAT sessions.

Cost and accessibility

Despite growing popularity, EAT may not be readily accessible due to a shortage of qualified therapists and equine specialists. Finding a properly trained team and suitable horses for therapy sessions can be challenging. 

Further considerations include that EAT is not typically offered as a standard treatment option by healthcare services, such as the NHS. Therefore, this may pose financial barriers to individuals seeking EAT, as multiple sessions are required to establish a therapeutic bond with the horse.

Summary

Equine-assisted therapy (EAT) offers a unique therapeutic approach that utilises horses as co-therapists to promote emotional, psychological, and physical healing. This form of animal-assisted therapy operates on the principles of non-verbal communication, trust-building, and the unique connection between humans and horses through engaging in a variety of activities with horses under the guidance of trained therapists and equine specialists. EAT has been shown to be an effective therapy modality for a range of conditions. This includes mental health conditions, developmental disorders, and physical conditions. Despite some challenges with suitability, accessibility, and cost, EAT is becoming an increasingly popular therapeutic technique, offering a unique and enriching experience for those seeking psychological and physical healing. 

References 

  1. Geist TS. Conceptual framework for animal assisted therapy. Child Adolesc Soc Work J [Internet]. 2011 Jun 1 [cited 2024 Feb 8];28(3):243–56. Available from: https://doi.org/10.1007/s10560-011-0231-3
  2. Fry NE. Equine-assisted therapy: an overview. In: Grassberger M, Sherman RA, Gileva OS, Kim CMH, Mumcuoglu KY, editors. Biotherapy - History, Principles and Practice: A Practical Guide to the Diagnosis and Treatment of Disease using Living Organisms [Internet]. Dordrecht: Springer Netherlands; 2013 [cited 2024 Feb 8]. p. 255–84. Available from: https://doi.org/10.1007/978-94-007-6585-6_10
  3. White‐Lewis S. Equine‐assisted therapies using horses as healers: A concept analysis. Nurs Open [Internet]. 2019 Sep 27 [cited 2024 Feb 8];7(1):58–67. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6917924/
  4. MacLean B. Equine-assisted therapy. Journal of Rehabilitation Research & Development [Internet]. 2011 Jul 1 [cited 2024 Feb 8];48(7):ix–ix. Available from: https://go.gale.com/ps/i.do?p=HRCA&sw=w&issn=07487711&v=2.1&it=r&id=GALE%7CA267610582&sid=googleScholar&linkaccess=abs
  5. Symington A. Grief and horses: putting the pieces together. Journal of Creativity in Mental Health [Internet]. 2012 Apr [cited 2024 Feb 8];7(2):165–74. Available from: http://www.tandfonline.com/doi/abs/10.1080/15401383.2012.685017
  6. Bachi K. Application of attachment theory to equine-facilitated psychotherapy. J Contemp Psychother [Internet]. 2013 Sep 1 [cited 2024 Feb 8];43(3):187–96. Available from: https://doi.org/10.1007/s10879-013-9232-1
  7. Scopa C, Contalbrigo L, Greco A, Lanatà A, Scilingo EP, Baragli P. Emotional transfer in human-horse interaction: new perspectives on equine assisted interventions. Animals (Basel). 2019 Nov 26;9(12):1030.
  8. Gehrke EK. A mixed-method analysis of an equine complementary therapy program to heal combat veterans. JCMAH [Internet]. 2018 Nov 2 [cited 2024 Feb 8];8(3). Available from: https://juniperpublishers.com/jcmah/JCMAH.MS.ID.555739.php
  9. Diaz L, Gormley MA, Coleman A, Sepanski A, Corley H, Perez A, et al. Equine-assisted services for individuals with substance use disorders: a scoping review. Substance Abuse Treatment, Prevention, and Policy [Internet]. 2022 Dec 14 [cited 2024 Feb 8];17(1):81. Available from: https://doi.org/10.1186/s13011-022-00506-x
  10. Nurenberg JR, Schleifer SJ, Shaffer TM, Yellin M, Desai PJ, Amin R, et al. Animal-assisted therapy with chronic psychiatric inpatients: equine-assisted psychotherapy and aggressive behavior. PS [Internet]. 2015 Jan [cited 2024 Feb 8];66(1):80–6. Available from: https://ps.psychiatryonline.org/doi/full/10.1176/appi.ps.201300524
  11. Earles JL, Vernon LL, Yetz JP. Equine‐assisted therapy for anxiety and posttraumatic stress symptoms. Journal of Traumatic Stress [Internet]. 2015 Apr [cited 2024 Feb 8];28(2):149–52. Available from: https://onlinelibrary.wiley.com/doi/10.1002/jts.21990
  12. Borgi M, Loliva D, Cerino S, Chiarotti F, Venerosi A, Bramini M, et al. Effectiveness of a standardized equine-assisted therapy program for children with autism spectrum disorder. J Autism Dev Disord [Internet]. 2016 Jan 1 [cited 2024 Feb 8];46(1):1–9. Available from: https://doi.org/10.1007/s10803-015-2530-6
  13. White-Lewis S, Russell C, Johnson R, Cheng AL, McClain N. Equine-assisted therapy intervention studies targeting physical symptoms in adults: A systematic review. Applied Nursing Research [Internet]. 2017 Dec 1 [cited 2024 Feb 8];38:9–21. Available from: https://www.sciencedirect.com/science/article/pii/S0897189717302471
  14. Zadnikar M, Kastrin A. Effects of hippotherapy and therapeutic horseback riding on postural control or balance in children with cerebral palsy: a meta-analysis: Review. Developmental Medicine & Child Neurology [Internet]. 2011 Aug [cited 2024 May 21];53(8):684–91. Available from: https://onlinelibrary.wiley.com/doi/10.1111/j.1469-8749.2011.03951.x 
  15. 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 [Internet]. 2021 Jan [cited 2024 Feb 8];5:247054702199155. Available from: http://journals.sagepub.com/doi/10.1177/2470547021991556

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Charlotte Sutherland

Master of Science – MSc Translational Neuroscience, Imperial College London

Charlotte is a recent MSc Translational Neuroscience graduate from Imperial College London where she undertook research investigating antidepressants and Alzheimer’s disease. She has a strong interest in translational research and is aiming to pursue a PhD in the field of neurodegenerative diseases.

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Klarity is a citizen-centric health data management platform that enables citizens to securely access, control and share their own health data. Klarity Health Library aims to provide clear and evidence-based health and wellness related informative articles. 
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