Systematic Review of Equine Facilitated Therapy and Trauma: Current Knowledge, Future Needs

BACKGROUND:

Equine-facilitated therapy (EFT) is a relatively new treatment for trauma and PTSD.  EFT has been introduced and implemented in mental health treatment for children and adults, though the research in support of these interventions has not kept up with practice. In this poster we review studies of EFT with individuals who have PTSD/trauma symptoms.

METHODS: 

We searched relevant databases: Social Work Abstracts, Scopus, CINAHL, ERIC, Web of Science, PsychArticles, PsychInfo, and Google Scholar.  Due to the newness of this field, we did not restrict the search based on years nor type of study design. Inclusion criteria were: 1) the study was published in a peer-reviewed journal; 2) horses were used as the primary treatment or as an adjunct to traditional treatment; and 3) the study sample was assessed for PTSD/trauma, and/or PTSD/trauma was measured as an outcome. The search followed the PRISMA paradigm. Each author read each abstract, then met to discuss articles to include. If a decision could not be made based on the abstract, we read the full article to make a final decision.

RESULTS:  

Nine studies -- involving 97 participants, five adult and four youth studies, and all published since 2008 – met search criteria. Two adult studies addressed combat-related trauma, two focused on interpersonal violence and one focused generally on traumatic events.  There was one qualitative design, one case study and three intervention studies. Of the studies with youth, one was a correlational single system study and three were intervention studies. Two studies focused on children who had experienced maltreatment or sexual abuse, one addressed historical trauma with American Indian children, and the other did not specify the trauma though all met the criteria for PTSD based on a standardized scale. Findings showed EFT resulted in significant improvements in trauma symptoms and PTSD as well as other areas of well-being (e.g., anxiety, social support, alcohol use, and mindfulness in adults; internalizing and externalizing behavior, self-perception, self-esteem, social adjustment and anxiety in youth).

CONCLUSIONS and IMPLICATIONS:

Despite the limitations of our review (we did not search for gray material) and of the studies themselves (small sample sizes, lack of a control group), to our knowledge this is the first review of EFT that focused on trauma/PTSD. A primary strength was including only studies where trauma symptoms were objectively measured as an outcome. Findings suggest that EFT is a promising intervention for trauma/PTSD. Broadly, more studies of increased rigor are recommended as well as qualitative studies to address the acceptability of EFT to clients and providers, and issues of implementation. Specifically, future research should further explore EFT for veterans, reflecting the current national response to their mental health needs. Research is also needed to examine the mechanisms by which EFT leads to improved outcomes, investigate possible contraindications of equine therapy, as well as termination issues. In summary, EFT is a relatively new modality that offers promise for treating trauma/PTSD symptoms and the studies in this review provide a base upon which to build.