Equine Therapy Helps to Heal PTSD

An innovative research project studying the effectiveness of equine assisted therapy for veterans with post-traumatic stress disorder (PTSD) is underway at Columbia University Irving Medical Center under the leadership of Yuval Neria, PhD, Director of Trauma and PTSD, and Prudence Fisher, PhD, Associate Professor of Clinical Psychiatric Social Work (in Psychiatry) and a research scientist at the New York State Psychiatric Institute. The Man O’ War Project is the first university-led research trial to establish manualized guidelines for the application of equine-assisted therapy for veterans with PTSD and to examine the effectiveness of this promising new treatment.

The project came about through the suggestion and generous support of former U.S. Ambassador Earle I. Mack, a thoroughbred owner/breeder and veteran himself, who was concerned about the mental health crisis facing veterans. “Mr. Mack has long been a proponent of using horses to help treat veterans with PTSD and in 2015, he solicited the help of Columbia’s Department of Psychiatry to design and carry out the study,” says Dr. Neria, who is also Director of the Military Family Wellness Center at NewYork-Presbyterian/Columbia. “Mr. Mack’s belief that horses could be beneficial to human psychopathology was a compelling idea.”

An estimated 30 percent of veterans develop PTSD. “It can involve nightmares and flashbacks and avoidance of situations that remind them of their traumatic experiences,” says Dr. Fisher. Symptoms can range from anger and negative thoughts to debilitating anxiety and hypervigilance. Some veterans may turn to substance abuse and PTSD also can put veterans at an increased risk for suicide. According to the U.S. Department of Veterans Affairs, more than 20 veterans die by suicide each day.

Current treatments, such as cognitive behavioral therapy and exposure therapy, have high dropout rates and limited helpfulness. “Even the most effective therapies and pharmacotherapies for PTSD have success for no more than 50 percent of the patient population for PTSD and even less among veterans,” says Dr. Neria.

“It’s doubly shameful because of the fact that this condition – from the standpoint of how scientifically challenging or difficult it may be to understand – should be solvable,” says Jeffrey A. Lieberman, MD, Psychiatrist-in-Chief, NewYork-Presbyterian/Columbia.

The Man O’ War Project

Equine-assisted therapy in which patients interact with horses to address emotional and behavioral challenges is widely used to treat a variety of mental health problems. However, there is little data supporting its effectiveness and no standardized approach to delivering the therapy. “None of us had ever conducted equine therapy before, and so initially we spent a year and a half traveling throughout the country studying other programs and to learn about the characteristics of horses and how their interactions with the veterans would help regulate their emotions,” says Dr. Fisher. “By their nature, horses are skittish or hypervigilant, and people with PTSD are hypervigilant. This presents an opportunity for veterans to recognize and understand fear responses.”

“We have here a perfect storm where both the human and the animal are preoccupied with the same problem,” says Dr. Neria. “We created a treatment menu to address this very core problem by allowing the two to engage in a structural way in activities that enable them to take care of these ongoing trauma related functional problems.”

“Horses are naturally responsive to verbal and nonverbal cues and thus provide good feedback to the veterans about how they are communicating,” continues Dr. Neria. “Horses are patient and nonjudgmental, allowing opportunities for veterans to make mistakes and learn from them. They are also very forgiving and generous to human beings.”

Unlike dogs, which grant love unconditionally, relationships with horses must be earned, notes the researchers. “One must build trust with a horse for it to welcome you into its world,” says Dr. Fisher. “Veterans relearn how to build trust and how to trust themselves again – valuable tools to help them succeed with family, work, and social relationships.”

To date, more than 70 veterans, both men and women, have participated in the treatment trial, which took place over eight weeks at the Bergen Equestrian Center, just 15 minutes from the Columbia University campus. Treatment began with a full evaluation by Dr. Neria’s research team and included a pre- and post-MRI to determine any changes in the brain. Those data will be detailed in their findings. However, the anecdotal results are encouraging.

“Horses produce a safe relational engagement, more so than any pet or even any person,” says Dr. Lieberman. “And that produces a kind of a transient relaxation in the hypervigilance and the noxious emotionality associated with the traumatic experience that the individual underwent. With repeated administration, the therapy allows the noxious, intensive, emotional component to the memories of their traumatic experience to dissipate.”

“Unlike other treatments for veterans, this program is very desirable for them,” says Dr. Neria. “They are happy to participate, dropouts are minimal, and side effects are basically nonexistent, which is very important. We are only beginning to understand the negative effects that war has on our veterans and how to address them effectively. We have a responsibility to explore all possible avenues of treatment for PTSD, and we are proud to continue this innovative study.”

Dr. Neria and Dr. Fisher will publish the results of their study in the near future and will also distribute a training manual that can be used by horse therapy centers nationwide. “The model, which is tested, can be disseminated and made available to other facilities that want to provide treatment, to veterans organizations that want to simply find a way to have the treatment enacted in conjunction with their mental health care facility, or to equine-assisted therapy programs seeking a proven, effective protocol,” says Dr. Lieberman.