By Joseph Nowinski, Ph.D. and Abigail Jeffries
Using Horses to Heal Emotional Wounds
This and a following series of blogs will focus on the subject of equine-assisted therapy, or what is sometimes referred to as therapeutic riding. As a treatment modality it is not intended to replace other treatments, such as psychotherapy or pharmacotherapy, but rather to complement and augment those treatments. The subject of this first blog is Post-Traumatic Stress Disorder. PTSD has had an immense impact of the lives of thousands of returning veterans and their loved ones. It calls for creativity and innovation in how we help them.
Horses for Heroes
Susan March is a licensed physical therapist and the medical director of Bit-By-Bit, Inc., a Professional Association of Therapeutic Horsemanship (PATH) International accredited therapeutic riding center and an American Hippotherapy Association (AHA) registered facility located in Davie Florida (bitbybittherapy.org). March is a centered riding instructor, PATH certified therapeutic riding instructor, and AHA registered therapist. She has been practicing physical therapy for more than 40 years and equine-assisted therapy for since 2000..
One of the programs Susan is most enthusiastic about goes by the name “Horses for Heroes” and, as the name implies, it is aimed at helping veterans cope with their disabilities.
March describes the Horses for Heroes program this way:
“The Horses for Heroes program is a recreational program led by a certified PATH International riding instructor. Prior experience with horses is absolutely NOT required. We meet once a month with as few as two and up to about twelve veterans. The program starts with some friendly social time. We meet at 10:00AM and share coffee and donuts, then we break up into groups. The veterans receive education about horses, they spend time grooming the horses, and then they ride if they choose to do so in a riding lesson type of format.”
Bit-By-Bit collaborates with the Veterans center in Miami as well as the local Disabled American Veterans (DAV) group to help veterans get access to Horses for Heroes. The local VA refers veterans to the program and helps them fill out the required participation forms. A physician also needs to sign off to provide medical clearance for the veteran to take part in the program.
Some veterans return to Horses for Heroes over and over, March says. Others come for a while then move on to other types of activities. Bit-By-Bit covers the cost of Horses for Heroes through grants and an annual fundraising golf tournament; veterans participate free of charge.
March says PATH International helps with the set-up of programs like Horses for Heroes. Once it was established, Bit-By-Bit developed its own curriculum for veterans, which it tailors to each individual based on their needs. Participants work with a therapeutic riding instructor who is trained in disabilities. They work on improving strength, coordination, motor planning, moving on and off the horse and riding the horse. “We were expecting to see veterans who are amputees, and we do work with many who have this disability, but we have been surprised by the high number of PTSD cases we see -- young men and women who have been emotionally disabled as a consequence of their war experiences.”
“I think that the horses are a way for veterans with PTSD not to think about ‘getting help because they are crazy’ but rather about simply spending time with the horses. It enables them to move into the next spot. The horses are not threatening. They end up having a special relationship with a specific horse. It’s amazing to watch. This type of therapy is a calming, nonjudgmental beginning point for healing. The communication is nonverbal, and there are no expectations. There is also a benefit through the social time that’s built in. The veterans don’t have to initiate speaking about what traumatizes them, like the sound of an airplane flying overhead or a loud noise. They can go to the horse and just relax. It gives them a calmness that allows them to move forward.”
Equine-assisted therapy seems to help veterans’ family members, as well. “When a veteran makes progress physically or emotionally, their family members automatically feel the positive effects and enjoy a reduction in the stress that goes along with any disability,” March says. Bit-By-Bit also invites family members to join in the sense of community the center fosters through volunteering around the barn and taking part in grooming the horses.
A Case In Point: Steve
Steve suffers from anterograde amnesia, which prevents him from remembering anything that happened the previous day. His inability to form new memories is believed to be the result of viral encephalitis, which tests suggest may have been caused by West Nile virus. Steve had served in Saudi Arabia during Operation Desert Storm, followed by seven years in the Army National Guard of South Carolina. He re-enlisted in 1998 and was deployed to Kosovo, where he witnessed the aftermath of a brutal attack on civilians in a church. Steve also suffers from PTSD and has problems with balance and depth perception. He has been attending Bit-By-Bit’s Horses for Heroes program for four years.
“The benefits of the riding program are invaluable. You can’t put a price on it,” Steve’s wife Emmy says. (Emmy notes that Steve does not remember his participation in the program due to his amnesia. Each time he goes is like the first time for him.) “It has greatly improved his balance and depth perception. At first, he could not tell how to put his foot in the stirrup, but that has improved a lot. He has great posture when he is on the horse, too, and he does not need to use the cane nearly as much as he did before.” Emmy says that the program has significantly helped to address Steve’s anxiety levers, hyper-vigilance, and nightmares, and says these positive effects last for several days after each session with the horses. Bit-by-Bit’s facility is near a helicopter training area, and the sound of helicopters tends to provoke Steve’s anxiety. “But when he’s on a horse and a helicopter flies overhead, it doesn’t bother him,” Emmy says.
Recently, when a loud noise spooked a horse Steve was grooming, a caregiver who was on the scene and knew Steve, was concerned the incident would trigger Steve’s PTSD. But instead, it was Steve who remained calm and took it upon himself to soothe his startled horse.
One promising pilot study on the effectiveness of equine-assisted therapy to reduce PTSD, anxiety, and depression symptoms was reported in The Journal of Traumatic Stress. [Earles JL, Vernon LL, Yets JP. Equine-assisted therapy for anxiety and posttraumatic stress symptoms. J Trauma Stress. 2015 Apr;28(2):149-52. doi: 10.1002/jts.21990. Epub 2015 Mar 17.]
A team headed by Dr. Julie L. Earles provided a sample of 16 individuals diagnosed with PTSD with 6 weekly 2-hour sessions aimed at developing horse-person, non-verbal communication and experience with such tasks as grooming and tacking horses. In the study, Earles and her team proposed that interaction with horses could increase aspects of mindfulness, such as nonjudgmental acceptance of the present, which could in turn reduce participants’ symptoms. Symptoms were assessed pre and post-treatment. After the program, subjects scored significantly lower on symptoms associated with PTSD including emotional distress, anxiety, depression, and alcohol use. Participants’ mindfulness was also measured and found to have increased following treatment.
Results like the above suggest that further study of equine-assisted therapy would be worthwhile. We will be addressing this in future blogs.
Is there a program like Horses for Heroes near you?
Check the “Find a Center” feature on the PATH International website: http://www.pathintl.org/path-intl-centers/find-center, or inquire through your local VA.
Joseph Nowinski, Ph.D. is a clinical psychologist and author. For further information visit www.josephnowinski,com.