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What is Equine Therapy? Exploring Benefits of Human-Horse Relationships

Many people find recreational horseback riding pleasurable and relaxing.  However, many individuals are unaware that there’s a therapeutic form of horseback riding [often integrated with psychotherapy] called “equine assisted therapy.”  In recent years equine therapy has garnered attention as a potential intervention for the treatment of PTSD, troubled youth, and even autism spectrum disorders.

From a historical perspective, equine therapy was found therapeutic in the late 1940s when implemented in Scandinavia to help those with polio.  In Greek literature, the usage of equine therapy dates back to 600 B.C.  In the 1960s, a group called “NARHA” (North American Riding for Handicapped Association) began testing equine therapy in the United States.

Their goal was to help improve quality of life via equine therapy among individuals with disabilities.  NARHA eventually underwent a name change to “PATH” (Professional Association of Therapeutic Horsemanship) to expand therapy to anyone in need of therapy.  Many have found equine therapy to be beneficial for improving prognoses of disabilities, physical conditions, and mental illnesses.

What is Equine Therapy?

Equine therapy is generally more complex than hopping on a horse and going for a ride.  In certain therapy sessions, an individual may not even make physical contact with the horse.  Generally an individual will work with a skilled psychotherapist or instructor that will come up with various therapeutic goals to accomplish for the client.

The goals established between client and therapist may initially be relatively easy.  An example of something easy would be for a client to make peaceful contact with the horse.  A goal of moderate difficulty may be to lead the horse in a specific direction or help guide the horse to a standstill.  This generally involves complex thinking, forming a connection (bonding) with the horse, and trust (between the client and horse).

Over time, the goals in equine therapy may get more advanced and specific to the condition that is being targeted.  For example, someone with PTSD may have radically different therapeutic goals than someone dealing with autism.  Therapy with a client that has PTSD may involve reprocessing and desensitization of the trauma, whereas therapy with a client with autism may involve increasing communication skills.

In many cases there will be communication between an instructor, client, and psychotherapist.  There may be various phases where a client will solely work with an instructor, other phases where they may work solely with a psychotherapist, and other phases where both are involved in the therapy.  There is generally significant communication between a client and the instructor, psychotherapist, and between the client and horse.

Note: Equine therapy is sometimes conducted with a donkey in a form of therapy called “onotherapy.”  While it isn’t quite same as equine-assisted therapy, donkeys may be preferred over horses for certain individuals.

4 Types of Equine Therapy

There are several different types of equine therapy.  For those with mental illnesses, Equine Facilitated Psychotherapy (EFP) is recommended due to the fact that a licensed psychotherapist is involved.  Other forms of equine therapy include: Equine Facilitated Learning (EFL), Hippotherapy, and Therapeutic Riding (TR).

1. Equine Facilitated Psychotherapy (EFP)

This is a form of psychotherapy involving interactions with horses in attempt to improve mental health and functionality.  EFP is often utilized to help individuals with psychological disorders and emotional dysfunction.  It is thought to be helpful for individuals with: PTSD, anxiety disorders, depression, and other mood problems.

It may be therapeutic for those experiencing grief stemming from loss of a loved one or a break-up.  In other cases, it may be used to help cope with emotions associated with major life changes such as an alarming medical diagnosis or even a mid-life crisis.  Equine-facilitated psychotherapy must be done in conjunction with a licensed psychotherapist.

The therapist chosen should be qualified to conduct equine-facilitated psychotherapy.  Since most therapists are not trained in this type of therapy, it could be difficult for you to find a qualified therapist.  It is important to evaluate the credentials of any prospective EFP psychotherapist prior to enrolling in therapy.

2. Equine Facilitated Learning (EFL)

This is a specific type of equine therapy aimed to improve social and emotional learning via interaction with horses.  Individuals conducting EFL may not have a psychotherapy license and don’t generally need one for this type of therapy.  The goal of EFL practitioners is to help individuals improve social interaction skills and emotional regulation with horses.

The idea is that by improving communication skills and balancing emotions while working with horses, the effects will carry-over into everyday functioning.  Many alternative health coaches may recommend EFL.  If you are interested in this type of therapy for yourself or someone you know, it is recommended to review the qualifications of the individual that will be conducting EFL before you enroll.

Understand that this type of equine therapy is not technically “psychotherapy.”  It may be therapeutic in that it increases self-esteem and quality of life, but you will not be working with a licensed psychotherapist.  As a result of now working with a licensed psychotherapist, you may not attain as many benefits as you otherwise would.  This is recommended for those who are “at risk” or “troubled” rather than individuals with a mental illness.

3. Hippotherapy

Another type of equine therapy is commonly referenced as “hippotherapy.”  This is focused mostly on using horse movements as a form of occupational, physical, or speech therapy.  In other words, a therapist will use the fine-tuned movements of a horse to provide specific motor and/or sensory input for the client.

The goal is to establish neurological connection between the horse’s movements and sensory processing.  The idea is that hippotherapy has significant carry-over to other aspects of functioning.  Most people note improvements in motor skills, balance, coordination, attention, and other sensory processing abilities.

Depending on the subtype of hippotherapy you plan on pursuing, you will need to find a licensed practitioner.  Any therapist conducting hippotherapy should have a “Hippotherapy Clinical Specialty” (HPCS) certification.  This type of therapy can provide significant functional benefits for individuals (particularly children) with disabilities.

4. Therapeutic Riding (TR)

Another form of equine therapy is referenced as “therapeutic riding.”  This involves horseback riding by a client to improve various aspects of physical and/or psychological functioning.  Therapeutic riding is often provided by individuals with specialized training in horseback riding and/or under the supervision of a professional licensed in hippotherapy.

The goal of therapeutic riding is to improve cognitive, emotional, physical, and social functioning of the rider.  This is considered a beneficial therapy for those with disabilities, but it is not limited to solely the disabled – many individuals find “therapeutic riding” beneficial for their mental health.  It is thought that therapeutic riding may be particularly ideal for those with autism, language development disorders, trauma survivors, and those with sensory integration disorders.

Therapeutic riding is thought to help improve motor skills, confidence, and boost well-being among all individuals – especially those with disabilities.  It also may help people connect with nature and is considered an enjoyable recreational activity.

Potential Therapeutic Uses of Equine Therapy

Equine-assisted therapy is thought to provide a wide range of psychological and physical benefits to individuals with a variety of conditions.  It may help improve sensory processing and motor skills among those with disabilities and may improve physical strength and flexibility among those undergoing pain rehabilitation.  Below are some potential therapeutic uses for equine-assisted therapy.

ADHD: Some evidence suggests that equine-assisted therapy may be beneficial for those with attention-deficit/hyperactivity disorder.  Working with a horse requires a significant amount of attention and patience (the opposite of impulsivity).  In a small-scale study of 5 children enrolled in therapeutic horseback riding (twice per week, one hour per session), improvements were noted in: social behavior, quality of life, and motor skills.

  • Source: http://www.ncbi.nlm.nih.gov/pubmed/22010778

Aggression: Equine therapy is thought to be helpful for those with aggressive personalities and/or troubled youth.  It is speculated to reduce aggression via bonding that takes place between the human and horse.  This bonding results in reduction of stress and increased activation of the oxytocin system.  As oxytocin levels increase, individuals feel more connected to others and experience reductions in aggression.

  • Source: http://www.ncbi.nlm.nih.gov/pubmed/25269512

Autism: In a 20-participant study, therapeutic horseback riding was found to be a helpful treatment for those diagnosed with autism spectrum disorders.  After 3 months of riding, there were significant improvements in parent-child interactions and also improvements in “mood and tone” were noted.  All outcomes associated with therapeutic riding among those with autism were rated as “good” or “very good.”

  • Source: http://www.ncbi.nlm.nih.gov/pubmed/22164808

Behavioral problems: Those with behavioral problems may benefit from partaking in equine therapy.  Equine therapy demands attention, empathy, and compassionate interaction.  Teens or “at-risk” youth with poor behavior may experience improvements with equine-assisted psychotherapy.  It teaches them cooperation and may result in increased empathy as a result of oxytocin increases.

Cerebral palsy: A review of evidence published in 2012 suggested that equine therapy may benefit individuals with cerebral palsy.  Specifically, it has been suggested to improve gross motor function, especially in children.  Both hippotherapy and therapeutic horseback riding for at least 45 minutes, once weekly, for at least 8-10 weeks has potential to improve various aspects of motor function.

  • Source: http://www.ncbi.nlm.nih.gov/pubmed/22122355

Depression: Equine therapy is thought to increase well-being and promote a balanced, positive mood.  One study assigned participants to receive either 5 weeks of equine-assisted learning (EAL) or standard treatments (control group).  Results from the study suggested that individuals that had gone through the equine-assisted learning (EAL) were significantly less depressed and had greater hope for the future compared to the control group.

  • Source: http://www.ncbi.nlm.nih.gov/pubmed/25698076

Down syndrome: Hippotherapy has been thought to improve functionality among individuals with Down syndrome.  In an 11-week hippotherapy intervention among 2 children diagnosed with Down syndrome, it was found to improve gross motor functions.  The children were thought to improve in gaining postural control of the head/trunk region.  Adding horse-therapy as an intervention for those with this condition is thought to yield additional benefits to standard therapy.

  • Source: http://www.ncbi.nlm.nih.gov/pubmed/17474591
  • Source: http://www.ncbi.nlm.nih.gov/pubmed/20673078

Drug abuse or addiction: It has been suggested that equine therapy may benefit individuals prone to drug abuse and/or addiction.  Not only does the therapy serve as an extracurricular, enjoyable recreational activity, but it helps individuals address mood disturbances and increases their confidence.  This may be of significant benefit to those attempting to overcome an addiction or abstain from drugs.

Emotional dysfunction: Individuals with mental illness or trauma-induced emotional dysfunction may benefit from human-horse interactions.  It is thought that equine-assisted psychotherapy (EAP) could reduce dysfunctional emotions, particularly those stemming from a trauma.  Equine-assisted psychotherapy is known to reduce depressive symptoms and improve mood.

Low self-esteem: It has been reported that equine therapy is likely to increase self-esteem.  This is likely due to an array of complex individual factors.  The responsibility associated with horseback riding, the feeling of connectedness with the horse, and well-being derived from this type of therapy may significantly boost self-esteem.

Major life changes: Individuals dealing with major life changes such as: medical diagnoses, mid-life crises, grief, a divorce, or other loss may benefit from equine therapy.  Interacting with a horse can increase oxytocin levels via human-animal bonding.  In addition, this type of therapy is thought to reduce: anxiety, stress, trauma, and depression – all of which may help you cope with significant changes.

Pain / joint rehabilitation: Those undergoing pain or joint rehabilitation may benefit from equine therapy.  Horseback riding is thought to lightly stimulate muscle groups, joints, and increase flexibility.  Additionally, it may help change a person’s mood and shift focus off of muscle or joint pain.  Rehabilitation agents may focus on particular areas of the body and utilize ice, heat, electricity, and compression to aid in the process.

  • Source: http://www.ncbi.nlm.nih.gov/pubmed/16297723
  • Source: http://www.ncbi.nlm.nih.gov/pubmed/23212951

PTSD: Those that have post-traumatic stress disorder may benefit from equine-assisted therapy.  One study with 16 volunteers that had experienced traumatic events were assigned to engage in tasks with horses for six weekly 2 hour sessions.  Symptoms of PTSD were significantly reduced following the sessions.  Participants noted reduced severity of emotional responses related to trauma, less anxiety, and less depression.  This may be an effective adjunct for anyone attempting to overcome PTSD.

  • Source: http://www.ncbi.nlm.nih.gov/pubmed/25782709

Traumatic brain injuries: Many individuals with traumatic brain injuries experience problems with balance and gait function.  It is thought that hippotherapy may improve specific rehabilitation efforts among those that have endured traumatic brain injuries.  One study found that after 8 weeks of hippotherapy, individuals with TBIs significantly improved in balance and gait function; these effects were maintained approximately 2 months post-therapy.

  • Source: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3546176/

Troubled teens: Teens that are considered troubled or “at risk” may significantly benefit from equine therapy.  Interaction with horses is thought to build empathy, compassion, and teach teens responsibility.  There is evidence that therapeutic horseback riding has a mood-elevating effect and increases hope for a positive future.

  • Source: http://www.ncbi.nlm.nih.gov/pubmed/25698076

What Equine-Assisted Therapy Teaches

Many people prefer equine therapy over standard therapy simply because interacting with a horse makes it feel less like a person is “in therapy.”  For some people, sitting on a couch talking about life is not an effective therapy.  Getting an animal involved, particularly for individuals that don’t interact well with humans could make a huge difference.

  • Acceptance: Some individuals are better able to accept their own condition when interacting with a horse.  Horses unconditionally accept us for who we are, making it easier for us to accept whatever diversity we are facing.
  • Attention: Equine therapy demands attention and focus from a client for safety of both themselves and the horse.  Consistent equine therapy is thought to help an individual cultivate an increased attention span.
  • Empathy: In order to work with horses, it is important to be in tune with their moods.  The horse will sense the mood of the human, and the human needs to sense the mood of the horse.  Equine therapy can increase empathy or the ability to recognize and share feelings with another entity.
  • Emotional bonding: The client and horse must form a connection in order for the therapy to be successful.  This connection is established over time by grooming the horse, riding the horse, and via nonverbal communication.  This bonding may increase levels of the connected hormone “oxytocin.”
  • Fine motor skills: Some evidence suggests that therapeutic horseback riding may help individuals with various disorders improve their fine motor skills.  It takes balance, flexibility, and hand-eye-coordination to ride a horse.
  • Mutual trust: To have an effective therapy session, clients must learn to work with an instructor as well as a horse.  It is the complex dynamic of trusting an instructor as well as an animal that helps people rebuild their ability to trust others.  Following trauma, many people are unable to trust others, which impairs their functioning.
  • Nonverbal communication skills: A significant portion of all communication is nonverbal.  Working with horses in equine therapy may be of major benefit to individuals struggling with poor or deficiencies in nonverbal communication skills.
  • Patience: Individuals that are hyperactive and/or impulsive may lack patience.  Working with horses requires patience.  In fact, many patients do not get to ride the horse until they demonstrate patience.  They may not even touch the horse initially, then groom the horse, and eventually work their way up to riding it.
  • Respect: Working with a horse can teach others how to respect animals as well as instructors.  Without first having respect for the animal and all parties involved in the therapy, an individual will not advance towards horseback riding or grooming.  All activities incorporated within the therapy have potential to help build both self-respect and respect for the animal.
  • Self-awareness: Clients working with the horses in therapy often gain a profound sense of self-awareness.  They come to realize how their actions affect their interaction with the horse and vice versa.  This newfound self-awareness may improve functional outcomes in other real-world scenarios.
  • Self-control: The ability to control oneself may influence the therapy session with the horse.  It is important to avoid impulsivity, hyperactivity, and acting out frustrations.  By having self-control, a person is able to have a kind, successful interaction with the horse.
  • Self-esteem: Initially a person may be fearful of interacting with a horse.  As they learn new nonverbal communication skills and how to treat the horse, they often realize that there was nothing to fear in the first place.  Increased competence in regards to interacting with the horse generally improves a person’s self-esteem.
  • Speech-language skills: For some individuals, equine therapy may enhance their communication skills.  Horses are smart enough to recognize many nonverbal cues as well as many speech instructions.  By communicating both verbally and nonverbally with the horse, a person’s communicative repertoire is strengthened.
  • Well-being: Many people simply enjoy interacting and connecting with another animal.  Going for a horseback ride can be a pleasurable experience and often exposes people to nature.  Frequent exposure to nature and being outdoors is known to increase a person’s sense of well-being.

Have you used equine-assisted therapy?

If you’ve experienced equine-assisted therapy, be sure to mention whether you’ve found it beneficial in the comments section below.  To help others better understand your situation, you may want to discuss: the specific type of equine therapy utilized, the condition you were attempting to treat, and the number of sessions completed.  Discuss what you liked most about equine therapy and whether you’d recommend it to others.

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