Stress Management Household Stress Using Equine Therapy as Mental Health Treatment What Horses Bring to the Therapeutic Process By Jodi Clarke, MA, LPC/MHSP Jodi Clarke, MA, LPC/MHSP LinkedIn Twitter Jodi Clarke, LPC/MHSP is a Licensed Professional Counselor in private practice. She specializes in relationships, anxiety, trauma and grief. Learn about our editorial process Updated on December 08, 2022 Medically reviewed Verywell Mind articles are reviewed by board-certified physicians and mental healthcare professionals. Medical Reviewers confirm the content is thorough and accurate, reflecting the latest evidence-based research. Content is reviewed before publication and upon substantial updates. Learn more. by Steven Gans, MD Medically reviewed by Steven Gans, MD Steven Gans, MD is board-certified in psychiatry and is an active supervisor, teacher, and mentor at Massachusetts General Hospital. Learn about our Medical Review Board Print Table of Contents View All Table of Contents What Is Equine Therapy? History Who It's For Benefits Conditions Therapists Things to Consider Animals can offer an extraordinary amount of emotional support. Beyond the pet-owner relationship that many of us have lovingly experienced, animals are sometimes used in therapeutic settings to help clients navigate challenging emotional experiences. Verywell / JR Bee What Is Equine Therapy? Equine-assisted psychotherapy incorporates horses into the therapeutic process. People engage in activities such as grooming, feeding, and leading a horse while being supervised by a mental health professional. Goals of this form of therapy including helping people develop skills such as emotional regulation, self-confidence, and responsibility. With mature horses weighing anywhere in the range of 900 to 2,000 pounds or more, it might feel a bit intimidating to have such a large, majestic creature participating in your therapy sessions. However, equine-assisted therapy is growing in popularity due to its experiential approach and some burgeoning evidence of its effectiveness. There are a variety of terms used to describe or reference equine-assisted psychotherapy, including: Equine-assisted mental healthEquine-assisted counselingEquine-facilitated psychotherapyEquine-assisted therapy The last term, equine-assisted therapy, can also often refer to other forms of therapy where horses are used, such as with occupational therapy. History of Equine Therapy Horses have been used for therapeutic purposes since the time of the ancient Greeks. The Greek physician Hippocrates, known as the "Father of Medicine," wrote about the therapeutic potential of horseback riding. Riding became more popular as a therapy tool during the 1950s and 1960s. In 1969, the North American Riding for Handicapped Association was formed, which later became the Professional Association of Therapeutic Horsemanship (PATH) International. Who It's For Equine-assisted psychotherapy (EAP) can be used with a variety of populations and in a variety of therapeutic settings. In fact, horses can be used in counseling with individuals of all ages, even with families and groups. Equine-assisted psychotherapy is often not the sole form of treatment, but rather a complementary therapeutic service to be used in partnership with more traditional treatment. Offering a much different experience than traditional talk therapy, EAP brings people outdoors and offers an opportunity to use all senses while learning and processing through emotional challenges. Children and Teens Equine facilitated psychotherapy may be just as effective with children and teens as it is with adult clients. As with adults, children can experience challenges such as trauma, anxiety, depression, PTSD, and more. Equine therapy offers them a therapeutic environment that can feel less threatening and more inviting than a traditional talk therapy office. The majority of children participating in EAP are between the ages of 6 to 18 years old. Children often find it difficult to open up and process painful emotions and experiences. Equine-assisted psychotherapy allows youth, and people of all ages, to work on issues such as: AssertivenessConfidenceDeveloping and maintaining relationshipsEmotional awarenessEmpathyImpulse controlProblem-solving skillsSocial skillsTrust in othersTrust in self Benefits Although a variety of animals can be used in the psychotherapeutic process, horses offer unique traits that have made them a top choice for animal-assisted therapies. According to anxiety expert Dr. Robin Zasio, horses bring the following unique elements to the therapy process. Non-Judgmental and Unbiased As much as humans, especially therapists, do our best to offer a safe space for clients to explore deep emotional hurts and painful experiences, it can be uncomfortable for clients to openly share their thoughts. Building therapeutic rapport can take time as participants working toward building trust and practicing vulnerability in session. Having the horse present may offer a sense of peace, as they only will react to the client's behavior and emotions with no threat of bias or any judgment of their emotional experience. Feedback and Mirroring Horses are keen observers and are vigilant and sensitive to movement and emotion. They often mirror a client's behavior or emotions, conveying understanding and connection that allows the client to feel safe. This also allows for clients to maintain a sense of self-awareness, using the horse's behavior and interactions for feedback and opportunities to check in and process what is happening in the moment. Managing Vulnerability As clients might find themselves vulnerable when trying to open up about emotional challenges, past experiences, or life transitions, the horse can offer a reference point to use for processing. If something feels too painful to speak of, it can feel a bit easier for clients to process using the horse as an example, or to align their experience with the horse's experiences in the moment. Externalizing the content in this way can make things easier to approach and process through. Other Benefits Some other potential benefits of equine therapy include increased: AdaptabilityDistress toleranceEmotional awarenessIndependenceImpulse controlSelf-esteemSocial awarenessSocial relationships Horses also require work. They must be fed, watered, exercised, and groomed. Providing this type of care can often be therapeutic. It helps establish routines and structure, and the act of caring and nurturing something else can help build empathy. Conditions Equine therapy has some evidence supporting its effectiveness in helping to manage several conditions. Anxiety Anxiety disorders affect more than 17 million Americans. Although most people experience some level of anxiety at points in their lives, especially around experiences involving change and uncertainty, there are times when people experience anxiety that meets clinical diagnostic criteria. Anxiety-related conditions include, but aren't limited to: Agoraphobia Generalized anxiety disorder Panic disorder Separation anxiety Selective mutism Social anxiety disorder Specific phobia Many people who struggle with anxiety find themselves stuck in worry about their past and fear about their future. As Dr. Zasio points out, working with a horse during the therapeutic process can create an opportunity for clients to "stay present and focused on the task at hand." Since horses are vigilant and sensitive to behavior and emotions, they can sense danger and respond with a heightened awareness, which typically leads to a change in their behavior and possible attempts to get away. Clients who struggle with anxiety can relate to this ability to sense danger cues and respond in a heightened way. Processing challenges through a horse's behavior can be easier for certain clients than speaking directly about their own personal experiences with anxiety. Another benefit of using equine-assisted psychotherapy in the treatment of anxiety is helping clients practice vulnerability in a safe environment. As clients learn to interact with the horse and try new things, they are being asked to step out of their comfort zone with the help and support of the therapist and the horse. Clients can then process their experience, such as the fears and challenges, as well as any insights, discoveries, or victories in those moments during therapy. PTSD Post-traumatic stress disorder (PTSD), a disordered marked by increased arousal and reactivity, intrusive memories and nightmares, and avoidance symptoms after a traumatic event, can feel debilitating. According to the Anxiety and Depression Association of America (AADA), it is estimated that 7.7 million people aged 18 or older struggle with PTSD. Children, teens, and adults can struggle with PTSD. Although people can experience a variety of traumatic events that could influence the development of PTSD, those who have experienced sexual assault, as well as veterans who have experienced combat, are populations who tend to have higher rates of the development of PTSD. The use of equine-assisted psychotherapy in the treatment of PTSD for veterans is growing. Tess Hassett, a riding instructor at the Northern Virginia Therapeutic Riding Program, has a background in clinical psychology and is working with veterans using EAP. Describing her work with veterans, Hassett noted, "A lot of them have said that after what they've been through with their PTSD and depression, they never thought they'd be able to bond with someone again and feel that personal connection. But with their horse, they're feeling that connection. They're able to take that into the rest of their lives and into their relationships." Addiction Treatment It is known that drug and alcohol addiction continues to rise and be problematic in the United States. The Center for Disease Control and Prevention (CDC) estimates that over 70,000 people died from a drug overdose in 2017. Many of those were a result of the opioid epidemic, with almost 50,000 deaths occurring as a result of opioid use. The need for effective therapies to help treat addiction is at an all-time high. Equine-assisted psychotherapy offers a unique approach to treating addiction and co-occurring conditions. A co-occurring condition, which used to be referred to as a dual diagnosis, describes someone who struggles with addiction in addition to having another mental health condition—a common occurrence. The ultimate goal of addiction treatment is to help clients live sober, healthy, and productive lives. Many times in addiction treatment, clients are also working hard to heal hurts within relationship dynamics, such as within a family or with their partner. Learning to trust, practice vulnerability, and communicate effectively can be a challenge during this treatment process. EAP can help clients learn how to develop a sense of trust through their interactions with the horse as they gain a sense of safety and build a relationship. The experience can encourage clients to be vulnerable as they learn new things and interact with the horse. ADHD Attention-deficit/hyperactivity disorder (ADHD), is an additional area where equine-assisted psychotherapy can be helpful. Some report EAP is appealing to adults and youth with ADHD because it offers them an active, fun, and hands-on experience. During equine-assisted therapy, the client is typically with a trained therapist, an equine specialist, and the horse. Riding isn't necessarily involved with equine-assisted psychotherapy. Rather, the focus is on presence, attention, mindfulness, boundaries, social cues, and more. Kay Trotter, PhD, a licensed professional counselor, author, and founder of Equine Partners in Counseling (EPIC) Enterprises, was one of the first to dedicate research to the effectiveness of equine-assisted psychotherapy. Trotter found that introducing horses to the therapeutic process showed significantly increased positive behaviors while reducing negative behaviors. Her study was one of the first published on the effectiveness of EAP, published in the Journal for Creativity in Mental Health. It has been shown that clients can experience a variety of benefit from equine-assisted psychotherapy, such as: Increased in self-esteemIncreased in self-respectImproved adjustment to routines and guidelinesImproved focusLess stressful friendshipsReduced aggression For clients struggling with ADHD, the sense of accomplishment in an equine-assisted psychotherapy session can be of great benefit. As a licensed clinical social worker, Kit Muellner says that "clients feel that they've achieved something on their own, rather than being told to do something by a parent or teacher. A 1,500-pound animal responds the way you want him to because you were able to focus. So you've accomplished something you wanted to do, versus something that somebody else wanted you to do." This sense of accomplishment can feel significant for anyone, especially someone who struggles with ADHD. In those moments, they are getting instant feedback from their horse and learning how to develop trust, communicate effectively, and how to work toward meeting a personal goal or milestone. Equine Assisted Therapists The Equine Assisted Growth and Learning Association (EAGALA) is a non-profit organization dedicated to setting the standard for professionals working with horses in a therapeutic setting. They offer training and have established a specialized certification process for those wishing to become a recognized, trained equine-assisted therapy professional. In addition to EAGALA, there are other programs dedicated to proper training and maintenance of standards for those working with clients in the field of EAP. To conduct therapy, regardless of whether you are providing equine-assisted therapy or not, you will need to contact your state regulatory board to learn about the educational and clinical requirements needed to become a licensed professional counselor or therapist in your state. Equine-assisted therapy is a particular style and specialization within the field of psychotherapy, with clinicians seeking and earning special training and certification related to the practice of EAP. Things to Consider There are some factors to consider when deciding to explore equine-assisted therapy for yourself or a loved one. Always take physical ability and overall health into consideration. If you have scoliosis, spina bifida, or another back-related health issue, talk to your doctor before trying equine therapy. Timing Depending on the challenges the client is facing, the timing may or may not be appropriate for EAP. For example, when someone is faced with addiction, they will need proper time to detox and establish compliance with an appropriate treatment program before possibly incorporating equine-assisted therapy services. Fear Although equine-assisted therapy has been shown to be helpful in the treatment of anxiety, a client may fear being around a large horse and not feel motivated to attend this type of treatment. There may also be a traumatic memory involving animals that would prevent someone from being willing to participate. It is important to speak with a trained mental health provider to determine if you or your loved one are a good fit for equine-assisted therapy. Most programs will have an assessment process to determine if EAP is right for you before beginning any treatment. Cost Because equine-assisted psychotherapy is only more recently growing in popularity and gaining traction as an effective treatment for mental health and substance abuse, keep in mind that this service may not be covered by insurance benefits. The fees for EAP services will vary by location and can range in price. It is recommended that you contact your insurance company and your local equine therapy facility to discuss those details in advance. Using Therapy Dogs to Improve Mental and Physical Health 10 Sources Verywell Mind uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy. Hemingway A, Carter S, Callaway A, Kavanagh E, Ellis S. An exploration of the mechanism of action of an equine-assisted intervention. Animals (Basel). 2019;(9)6. doi:10.3390/ani9060303 US National Library of Medicine. General anxiety disorder. Anxiety and Depression Association of America. Facts & statistics. 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(9-10):394-399. doi:10.1093/milmed/usz036 Centers for Disease Control and Prevention. Drug overdose deaths. Jang B, Song J, Kim J, et al. Equine-assisted activities and therapy for treating children with attention-deficit/hyperactivity disorder. J Altern Complement Med. 2015;21(9):546-53. doi:10.1089/acm.2015.0067 Trotter KS, Chandler CK. A comparative study of the efficacy of group equine assisted counseling with at-risk children and adolescents. Journal of Creativity in Mental Health. 2008;(3)3:254-284. doi:10.1080/15401380802356880 Hauge H, Kvalem IL, Berget B, Enders-slegers MJ, Braastad BO. Equine-assisted activities and the impact on perceived social support, self-esteem and self-efficacy among adolescents - an intervention study. Int J Adolesc Youth. 2014;19(1):1-21. doi:10.1080/02673843.2013.779587 Naste TM, Price M, Karol J, et al. Equine facilitated therapy for complex trauma (EFT-CT). J Child Adolesc Trauma. 2018;11(3):289-303. doi:10.1007/s40653-017-0187-3 Kern-Godal A, Brenna IH, Arnevik EA, Ravndal E. More than just a break from treatment: How substance use disorder patients experience the stable environment in horse-assisted therapy. Subst Abuse. 2016;10:99-108. doi:10.4137/SART.S40475 Additional Reading National Institute on Drug Abuse. Overdose Death Rates. By Jodi Clarke, MA, LPC/MHSP Jodi Clarke, LPC/MHSP is a Licensed Professional Counselor in private practice. She specializes in relationships, anxiety, trauma and grief. See Our Editorial Process Meet Our Review Board Share Feedback Was this page helpful? Thanks for your feedback! What is your feedback? 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