How Horses Help With Mental Health Issues

When combined with traditional psychotherapy, activities involving horses can help people suffering from a range of mental conditions, including depression and ADHD.

Humans and horses have maintained a healthy relationship for millennia — research suggests people first domesticated the large ungulates 6,000 years ago in the western region of the Eurasian Steppe. But far from being the simple beasts of burden or transportation tools they were in the past, horses today have become key players in the mental rehabilitation of many people around the world.

Equine-assisted therapy is an umbrella term encompassing several therapeutic activities involving horses. Hippotherapy, for example, utilizes the movement of horses for physical, occupational, or speech therapy, and has been used to treat motor and sensory issues associated with cerebral palsy, multiple sclerosis, and stroke, among other things. Though horses have been used for physical therapy since at least the fifth century B.C., the formal discipline of hippotherapy wasn't established until the 1960s

On the other hand, equine-assisted psychotherapy (EAP) — a type of experiential psychotherapy that uses horses to help in the treatment of psychological and behavioral issues — is a much newer activity that isn't widely practiced yet, says Hallie Sheade, a licensed professional counselor who runs Equine Connection Counseling, an EAP practice based in Texas. "It is a very exciting and rapidly growing field," she says.

How Horses Help

While scientists understand how the rhythmic movement of horses can assist with motor and sensory problems, how horses help with mental or behavioral issues hasn't been completely worked out.

"The mechanism of action hasn't been well established for equine-assisted therapies with relation to non-physiological, non-mobility activities," says Alexa Smith-Osborne, an associate professor of social work at the University of Texas at Arlington, who studied equine-assisted therapy. "Nevertheless, on a practical basis, there are some theoretical perspectives."

For one thing, horses are prey animals, she says. Because of this, horses are more highly attuned to environmental activity and sensitive to people's emotional states than dogs and other animals typically used in assisted therapies.

"They're capable of reading or becoming aware of how [a patient's] feeling before I'm aware of it or the even the client is," Sheade says. "The horse will then give feedback to the client, such as by moving towards the client or away."

Additionally, horses are large and powerful and have the potential of allowing people to overcome fear and develop confidence that can be translated into real-life situations. They can also help put people at ease because they're unbiased and non-judgmental, responding only to people's intent and behavior. What's more, they're social animals with their own personalities, and are most willing to interact when people are engaged and work to build a relationship with them.

Uses and Benefits of EAP

EAP has been used in the treatment of a wide range of conditions, including: 

Depression

Post-traumatic stress disorder

Attention deficit hyperactive disorder

Anxiety

Behavioral issues, including aggressive behavior

Substance abuse

Eating disorders, including anorexia and bulimia

Relationship problems

Communication issues

Equine-assisted therapy sessions, which involve a therapist and horse handler, vary depending on the condition being treated and the person(s) involved. In general, traditional experiential psychotherapy techniques, such as role-playing, role-reversal, and mirroring, are combined with equine-based activities, including choosing, grooming, and walking a horse. After the activity, patients then process or discuss their feelings and behaviors associated with the session.

Though qualitative case studies have demonstrated benefits to equine-assisted psychotherapy, well-controlled, quantitative studies are lacking. But in a study published in the journal Health Psychology, Smith-Osborne and her colleague Alison Shelby reviewed previous research on EAP, and found that the practice is a promising adjunct to traditional therapy.

"It's really only possible to say with any confidence that there's empirical evidence that equine-assisted activities appear to be helpful as a complementary treatment for a range of disorders," Smith-Osborne says. "And for people who have not responded well to first-line treatments, it does show promise."

Anecdotally, the horse-based therapy can provide numerous benefits, which can arise in as little as two to three sessions, Sheade says. Benefits include improved: 

Self-esteem

Communication skills

Self-awareness

Relaxation

Empowerment

Interpersonal relationships

Self-control

Focus and concentration

Happiness

Studies have also suggested EAP can decrease anger, depression, dissociation, and aggression.

Adverse effects from EAP are rare, but decreased self-esteem and increased aggression in children and adolescents have been reported. Researchers think these negative effects may be due to attachment and subsequent loss of the horse companion after the therapy ends.

Seeking Horse Therapy

Given that EAP isn't widely available yet, it may be difficult to find an establishment offering this service in your area. However, PATH International and EAGALA — reputable equine-assisted therapy associations — have listings of accredited centers by location.

When you visit a center, a therapist will discuss with you your background and goals, and come up with a treatment plan. Keep in mind that your insurance may not cover some or all of the therapy costs.

"But there have been cases where individuals have gone to court with insurance companies and won," Smith-Osborne says..