Visual Abstract for this
project available here!

VA recognizes the need to expand mental health treatment modalities to best serve Veterans with mental health concerns in personalized ways addressing the whole person. One innovative method used at a few VA sites is Equine-Assisted Psychotherapy (EAP),¹ which Mrs. Melissa Herbert, a Martinsburg VA licensed clinical social worker and certified EAP therapist, has piloted over the past two years with support from the MIRECC’s Small Grants for Recovery Program.

The Equine-Assisted Growth and Learning Association (EAGALA) describes EAP as “an experiential approach that utilizes horses to promote emotional growth and learning”,² allowing participants to “learn about themselves and others by participating in activities with horses and then processing thoughts, beliefs, behaviors, and patterns” (EAGALA, 2016; ³). EAGALA sets global standards for EAP with practice guidelines, certification programs for mental health and equine professionals, a code of ethics and ethics committee and continuing education to maintain EAP certification.

The EAGALA model has four parts: the team approach, work on the ground (rather than in the saddle), solution-orientation, and its code of ethics.⁴ The most significant component is the therapeutic relationship between client and horse. Involving horses is uniquely beneficial because, as prey animals, horses are naturally hypervigilant and responsive to subtle shifts in mood and behavior.⁵ Thus, horses provide continuous and sensitive feedback mirroring a client’s emotional and mental state, making visible dissonance that may not be evident in traditional “talk therapy.” Equine therapy specialists can help the client understand their interactions with the horse, the information the animal behaviorally reflects back, and how such insights can be utilized to support the client’s therapy goals.

As a result, EAP has been helpful to Veterans with PTSD by increasing their practice of mindfulness, their confidence, self-esteem, self-understanding, and interpersonal functioning and decreasing detachment from their surroundings.^4,6-8 The EAGALA model of EAP has also benefitted participants regarding anxiety, isolation, communication, and impulse modification.^2,3,5 VA in Montana, California, Wyoming – and now Maryland -- are exploring and utilizing EAP within their recovery model, promoting the VA’s holistic approach to mental health recovery.

VAMHCS’s foray into EAP is quite new, led by Melissa Herbert, LCSW at the VISN 5 Martinsburg VAMC PRRC program and financially supported by a MIRECC Small Seed Grant Award in late 2019. The initial grant proposed to use the EAGALA model of Equine-Assisted Psychotherapy with three cohorts, of 3-6 Veterans each, from the Martinsburg VAMC’s PRRC program. Partnering with Project Horse in Purceville, Virginia, the plan was to hold a 90-minute session each of five weeks for each cohort.

Two face-to-face sessions were completed and well received in early 2020, prior to the onset of the COVID-19 pandemic. Once face-to-face groups were no longer permitted, this project was on hold for several months. In August 2020, after a tremendous amount of creative work, Mrs. Herbert and Project Horse were able to conduct the EAP sessions virtually over VA Webex. For each session, equine specialists at the stables wore a camera and served as the Veteran’s proxy. With the horse in a round pen, through the specialist, the Veteran could touch, groom, pet, move, lead and speak to the horse. Veterans could also instruct the equine specialist to arrange props in the pen, or even build an obstacle course for the horse to navigate. While a little questioning at first, participating Veterans loved the sessions. Pre- and post-surveys incorporating measures of self-efficacy, anxiety, and open-ended feedback were completed with each Veteran, outside the session, by telephone or VVC. While this was not a research study, it was useful to try out these measures in this first pilot project to prepare for a larger project in the future where outcomes can be measured.

As planned, three cohorts of three Veterans each took part, mostly in October and November 2020. With such a small number of participants in this pilot project it is impossible to calculate statistical results. However, Veterans reported feeling they could connect with the horses, even virtually, and shared many insights from the sessions regarding communication, trust, connection, support, overcoming anxiety about tackling new tasks in unfamiliar areas, etc. They were also able to share how they could practically apply those insights in their lives/treatment. Below are some Veteran responses:

“[It was] beneficial in finding more pathways to connecting through touch, smells, serenity in settings with the horses”.
“The horses act just like me at times”.
“I think the exercise we went over helped me throughout my life”.

In the Fall of 2020, Project Horse was awarded a $35,000 Federal Adaptive Sports Grant, which will be used to continue to expand this work with Mrs. Herbert and the Martinsburg VAMC. This achieves the larger goal of Mrs. Herbert’s MIRECC grant, which was to build support for ongoing EAP work within the Martinsburg VAMC. Mrs. Herbert commented, “Thank you and the MIRECC team so much for this opportunity and your support during the interesting adventure it has been in 2020!”

Editor’s Note: Are you interested in learning more about the Small Grants Program for Recovery offered through the VISN 5 MIRECC? Please visit the Small Grants Program for Recovery webpage!

References:

1. Thomas, Melanie l. (July 19, 2019). Veterans ride their way to recovery: horses teach humans new ways to deal with anxiety and stress. Vantage point: official blog of the us Department of Veterans’ Affairs https://blogs.va.gov/VAntage/63128/veterans-ride-their-way-to-recovery/
2. Equine Assisted Growth and Learning Association, Inc. (2013 & 2015). Retrieved from https://www.eagala.org/
3. Thomas, L., Lytle, M., & Dammann, B. (2016). Transforming therapy through horses: Case stories teaching the EAGALA model in action. Scotts Valley, CA: CreateSpace Independent Publishing Platform
4. Boyd, K.,(2013). The language of equus: exploring equine-assisted psychotherapy (EAP) using the Equine-Assisted Growth and Learning Association (EAGALA) model. Theses, Dissertations, and Projects.
   https://scholarworks.smith.edu/cgi/viewcontent.cgi?article=1664&context=theses&httpsredir=1&referer=
5. Masters, N. (2010). Equine-Assisted Psychotherapy for Combat Veterans with PTSD. Washington State University-Vancouver, Masters Thesis. https://research.wsulibs.wsu.edu/xmlui/bitstream/handle/2376/3434/N_Masters_011005659.pdf?sequence=1
6. Earles, J., Vernon, L., Yetz, J. (2015). Equine-Assisted Therapy for Anxiety and Posttraumatic Stress Symptoms. Journal of Traumatic Stress, 28(2), 149-152.
7. Craven, M. B. (2013). Effectiveness of equine assisted psychotherapy in the treatment of veterans with posttraumatic stress disorder (Doctoral dissertation).
   https://oaktrust.library.tamu.edu/bitstream/handle/1969.1/151886/CRAVEN-DISSERTATION-2013.pdf?sequence=1&isAllowed=y
8. Lanning, B. & Krenek, N. (2013). Examining effects of equine-assisted activities to help combat veterans improve quality of life. Journal of rehabilitation research and development, Vol. 50, No. 8, pp. vii-xiii.