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Analysis of Equine-Assisted Therapy (EAT)
Equine assisted therapy is a burgeoning medical field that is aiding in the care for children and in the recovery of a stagnant equine industry. Animal-Assisted Therapy (AAT), which includes Equine-Assisted Therapy (EAT), has shown ample advantages over solely using ordinary forms of medical therapy which do not include animals. These advantages range from an increase in an overall sense of wellness to quantifiable increases in the production of the following hormones; serotonin, dopamine, prolactin, and oxytocin (M. Bass, 2009). For the purpose of this paper EAT will be used as an umbrella term encompassing the following various types of horse related therapy; psychotherapy, occupational therapy, physical therapy, and speech-language therapy. The utilization of EAT improves the quality of life for human patients and provides a new facet to the equine industry that has yet been tapped.
The history of EAT is deep routed in the companionship between horse and human. This 5,000 plus year history of companionship has developed a foundation for impressive non-verbal communication skills and improved the horse’s innate allelomimetic behavior. In the 1980’s German Physicians started testing the positive effects of riding a horse; during experiments, horse riding therapy diminished the rates of mental illness in patients who suffered from hypochondria and hysteria. After recognizing there was benefit in Hippotherapy (another term for EAT) European physicians standardized therapeutic riding. This standardization helped patients improve psychological wellness, physical ailments, and was used to rehabilitate patients with decreased motor skills (K. Frewin et al, 2005). In 2012, another step to solidify EAT as a vital addition to the equine industry was taken via the formation of the Federation of Horses in Education and Therapy International (HETI). The formation of HETI has led to the collaboration of members in 49 different countries. This group along with others further standardized EAT for treatment of patients with physical, social, and psychiatric disabilities (Fry, 2013).
Equine Assisted Therapy is commonly utilized to improve cognitive and physiological ability in children with Autism Spectrum Disorder (ASD). Patients diagnosed with ASD are usually categorized into two broad groups, high functioning and low functioning individuals. The effects of EAT have been shown to improve ASD patients with all different levels of functioning. This is because EAT addresses the ‘triad of impairment’ that is typically associated with autism: deficits in communication, social interactions, and repetitive patterns of behavior (Malcolm et al, 2018).
According to “‘It just opens up their world’: autism, empathy, and the therapeutic effects of equine interactions” ASD is commonly described as a disorder of sociality. Autism is characterized by a limited ability to have intersubjective relations due to uncivilized, uncultured, and uncommunicative behavior. The study performed provides examples of typical equine-assisted therapy sessions and their results in regards to a subsample of United Kingdom patients diagnosed with ASD. These children were led through exercises which ranged from trail riding to communicating with the horses via touch and sound. The EAT Center which performed the therapy and recorded their research describe many “breakthrough” moments. These were significant moments when the patients exhibited improved ability to understand and communicate with the therapists and assistants after completing EAT. The therapists and parents believe the improved social abilities stem largely from the utilization of verbal communication and empathic awareness which is stimulated via an equine-human relationship. The three core improvements which provide evidence for the efficacy of EAT were noted and are as follows: sensorial, the embodied experience of riding a horse; the specific movements and rhythms of a horse; and the interaction with horse personalities (Malcolm et al, 2018).
The previously provided study is only one of many which support the use of EAT to treat ASD. In the “Effect of Equine-Assisted Activities on Social and Sensory Functioning of Children with Autism” a 12-week equine assisted intervention is detailed which focused specifically on social and sensory functioning. Significant improvement was witnessed when comparing the control group and a group who underwent the equine assisted intervention. This study uses the Social Responsiveness Scale (SRS) to evaluate how the patients with ASD improve. In the provided figure denotes improvement in all sub categories with the exception of Autistic Mannerisms (Coman et la, 2018).
Children diagnosed with ASD are not the only party affected by its symptoms. Parents are commonly taken into consideration when it comes to evaluating the success of any therapy related to a child with ASD. Parent perception is a good indicator of the applied affects after a child has completed EAT or an equine assisted intervention. Parents are key in understanding the long-term benefits of successful EAT and how these benefits are appreciated when a patient with ASD is in “real world” circumstances. “Parents Perceptions of Psychosocial Outcomes of Equine-Assisted Interventions for Children with Autism Spectrum Disorder” followed families with children attending an EAI (Equine Assisted Intervention) for ASD. This research identifies four super-ordinate themes with which the parents describe positive developments; improved self-concept and emotional well-being, improved self-regulatory ability, social benefits for child, and unexpected outcomes. The article lists many more themes which are beneficial, however these four showed the most promise in regards to the efficacy of treating ASD with EAT (Xue-Ling Tan et la, 2017).
The first theme identified, a child’s improved self-concept and emotional well-being, was present in all patient cases studied. The positive impacts of EAT on the children was often described by parents as an increase in general happiness throughout the days which EAT was performed. Before EAT was started parents described their children’s reluctance to attempt extracurricular activities (whether they be medically indicated or for leisure) and hesitation to accept challenges. This reluctance made it difficult to involve their children in hobbies or sports. When interviewing parents after EAT, they frequently described their child’s new-found sense of empowerment, pride, and a greater openness to challenges. The parent’s believed EAT, although therapy, was ultimately an opportunity for an unintentional “hobby” which helped their children find a sense of place and responsibility (Xue-Ling Tan et la, 2017).
A child’s improved self-regulatory ability was noted as the second theme of improvement which parents realized after their children started the equine-assisted intervention. In the majority of reports by parents participating in the Centre’s program there was a noted increase in alertness, calmness, ability to take instruction, and a decrease in reactive behaviors. Parents believed that during riding therapy their children had enhanced neural integration. Parents stated this integration of motion and verbal commands contributed to the capacity to regulate internal processes making day-to-day tasks easier. The self-regulatory benefits go hand in hand with the social benefits that patients exhibited. Parents witnessed their children forming relationships with the horses, therapists, and assistants during private sessions. This bond between child and horse helped the child understand social cues and express emotions in a safe, non-judgmental environment. In addition, patients who attended EAT with groups of other patients would bond with horses and other children during the sessions especially when challenged in group activities. EAT is a premier tool for ASD therapy due to a horse’s perceived non-judgmental character and acknowledgment that helps provide an environment which communication is possible both verbally and physically (Xue-Ling Tan et la, 2017).
There were further unexpected outcomes which were noted after the patients finished EAT. These unexpected outcomes are often characterized as trickle down effects. Parents would often see improved generalized skills learned in therapy positively effecting everyday life. This led to an overall improvement in quality of life for the entire family and not only the patient whom directly underwent EAT. Research of ASD has proven the importance of parental empowerment which EAT facilitates via parental pride, family bonding, and an improved parental sense of well-being. An accompanying unexpected outcome relates to the benefits of ecopsychology. During the parental interviews there were no questions asked relating to the environment. However, in all interviews the parents attributed the natural environment to the promotion of therapeutic psychological and affective experiences. This unintended outcome is directly related to the outdoor environment which EAT is performed (Xue-Ling Tan et la, 2017).
Although the bulk of research related to EAT has focused on the treatment of ASD there are many other issues EAT can help medically manage. Recently, new evidence is supporting the utilization of EAT for a vast range of medical ailments including Cerebral Palsy. According to the Center for Disease Control (CDC) Cerebral Palsy is the most common motor and movement disability in children. This disease affects an individual’s ability to move and maintain balance/posture. “Improvement in Muscle Symmetry in Children with Cerebral Palsy After Equine-Assisted Therapy (Hippotherapy)” is a study which has provided sufficient evidence EAT improved the symmetry in muscle activity of children. While half of the subjects were undergoing hippotherapy the other half were on a control experiment which used a covered 55-gallon barrel raised to the height of an average horse. The average percentage improvement of children who underwent hippotherapy was 64.6% while the control groups suffered a 12.8 average increase in asymmetry (Brenda et la, 2003).
EAT is not only vitally important to the human patients, it will also have a positive effect on the equine industry as a whole. Before the great recession in the United States there were 4 million households with at least one horse, since 2004 the U.S has lost approximately 1 million households which previously owned horses. However, recent research done by the U.S. Equine Markey, 3rd Edition, shows this dip stabilizing. There are multiple factors which have helped in stabilizing the equine industry, one of these factors is EAT (Granderson, 2017). Three organizations are responsible for over 800 individuals and programs which provide EAT to their communities. These three organizations are as follow; the North American Riding for Handicapped Association (NARHA), Equine Facilitated Mental Health Association (EFMHA), and Equine Assisted Growth and Learning Activities (EAGALA) (McConnel, 2010). These organizations are committed to the therapeutic benefits of horses to mitigate the effects of both physical and mental illness. The room for growth within EAT is exponential and will bring new patrons to the equine industry. As research continues, EAT is being found to help with an increasingly diverse gamut of medical and psychological issues and will provide an altogether new facet for the equine industry to inhabit.
The effects of EAT on the horses used for EAT is sparse. According to preliminary research from a pilot study of 28 horses involved in four EAT programs there is a positive correlation to a horse cortisol levels while a horse is being used for therapy. Blood samples were collected from all horses before and after therapy. These blood samples were tested for concentrations of cortisol (a hormone released in the presence of stress). The study discovered 82% of the horses had a decrease in the levels of cortisol after therapy sessions. The variables which have to be controlled are complex and include but are not limited to the following; horse mentation, patient’s disability, environment, and form of therapy. This type of experiment is the first step to determining the long-term and short-term effects on horses used for therapy (O’ Rourke, 2004).
Equine Assisted Therapy has shown benefit to humans in a variety of modalities and across many disabilities including physiological, psychological dysfunctions, and developmental challenges (Corman, 2018). These improvements in human health were either unattainable or difficult to obtain prior to the use of EAT. The proliferation of EAT programs and the positive feedback from patients and patient families is a good indicator of an industry which will achieve continued success. This success will also be shared by the equine industry and hopefully the horses which provide this necessary therapy.
The accumulation of benefits and the success of current research will continue to spur on the development of Equine-Assisted Therapy and AAT.
- F. Del Rizzo (2017) “Equine Assisted Constructivist Psychotherapy: Theory and Practice”, Personal Construct Theory and Practice 14, Institute of Constructive Psychology, Padua, Italy
- Bass, M.M., Duchowny, C.A. & Llabre, M.M. J Autism Dev Disord (2009) 39: 1261. https://doi.org/10.1007/s10803-009-0734-3
- Frewin, K . & Gardiner, B. (2005). New age or old sage? A review of equine assisted psychotherapy. In The Australian Journal of Counselling Psychology, 6, pp13-17.
- Fry N.E. (2013) Equine-Assisted Therapy: An Overview. In: Grassberger M., Sherman R., Gileva O., Kim C., Mumcuoglu K. (eds) Biotherapy – History, Principles and Practice. Springer, Dordrecht
- Malcolm R., Ecks S. & Pickersgill M. (2018) ‘It just opens up their world’: autism, empathy, and the therapeutic effects of equine interactions, Anthropology & Medicine, 25:2,220-234, DOI: 10.1080/13648470.2017.1291115
- Coman, D. C., Bass, M. P., Alessandri, M., Ghilain, C. S., & Llabre, M. M. (2018). Effect of Equine-Assisted Activities on Social and Sensory Functioning of Children with Autism, Society & Animals, 26(6), 551-575. doi: https://doi.org/10.1163/15685306-12341479
- Tan, V.XL. & Simmonds, J.G. J Autism Dev Disord (2018) 48: 759. https://doi.org/10.1007/s10803-017-3399-3
- William Brenda, M.D., Nancy H. McGibbon, M.S., P.T., H.P.C.S., and Kathryn L. Grant, Pharm.D. (2003) Improvements in Muscle Symmetry in Children with Cerebral Palsy After Equine-Assisted Therapy (Hippotherapy), The Journal of Alternative and Complimentary Medicine
- Patricia J. McConnel (2010) National Survey on equine assisted therapy: An exploratory study of current practitioners and programs, Walden Dissertations and Doctoral Studies Collection
- Kate O’Rourke (2004) Horse-assisted therapy: Good for humans, but how about horses?, Convention Coverage of JAVMA (AVMA)
- Daniel Granderson (2017) 5 reasons U.S. Horse and Equine Market Will Finish Strong in 2017, PR Newswire, Cision doi: https://www.prnewswire.com/news-releases/5-reasons-us-horse–equine-market-will-finish-strong-in-2017-300429758.html
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