scorecardWhat is equine-assisted therapy? What horses can do for your mental and physical well-being
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What is equine-assisted therapy? What horses can do for your mental and physical well-being

Shaena Montanari,Andrea Stukey Colella   

What is equine-assisted therapy? What horses can do for your mental and physical well-being
LifeScience6 min read
Research on the effectiveness of equine-assisted therapy is mixed.    Klaus Vedfelt/Getty Images
  • Equine-assisted therapy is provided by licensed professionals who incorporate horses into their treatment plans.
  • People of all ages with diverse abilities can gain benefits from equine-assisted therapy.
  • A variety of equine-assisted therapies are used to treat conditions ranging from autism to PTSD.

Pets and the use of assistance or therapy animals - including horses - can be helpful and healing for people with a variety of conditions, from cancer to depression.

People of all ages with diverse abilities can gain vast benefits from equine-assisted therapy. This treatment program emerged in the late 1960s, has gained public interest since the early 2000s, and involves working therapeutically with horses. These services fall into three categories:

  1. Therapy
  2. Equine-assisted learning
  3. Horsemanship, which includes therapeutic and adaptive riding, or recreational riding for those with special needs.

Medical term: Physical, occupational, or speech/language pathology therapy administered in the presence of horses is known as "hippotherapy."

Recreation and working with horses, including adaptive riding, have numerous beneficial therapeutic opportunities, says Caitlin Peters, PhD, an occupational therapist and postdoctoral fellow at Colorado State University's Temple Grandin Equine Center administers occupational therapy in an equine environment.

Learn more about the process and benefits of equine-assisted therapy, and how to find credentialed providers in your area.

What is equine-assisted therapy?

Equine-assisted therapy comes in many varieties and can range from occupational and physical therapy to psychological counseling. These services are provided by licensed professionals who incorporate horses into their treatment plans. Therapists can use the natural movement of horses as physical therapy tools for people.

In addition to the benefits of learning to ride a horse, unmounted horsemanship-related activities such as grooming, tacking, feeding and watering, cleaning the barn, and bedding or care of saddles may all contribute as mental health treatment tools.

"There's been a big push to put the therapy first, and then include that horses are a part of it," Peters says. The process varies significantly depending on the needs of the patient and what type of therapy it is.

In her occupational therapy research that focuses on youth with autism, Peters uses "sequencing" activities with multiple steps, such as learning how to put a saddle on a horse. "Or if I'm working on fine motor skills, then helping with the buckles on the saddle is a great activity," she says.

In speech and language therapy in an equine environment, riding horses can help patients practice breath control. In physical therapy, patients with cerebral palsy, for example, can ride the horses to improve their balance and posture.

Most of the places where equine-assisted therapy takes place are nonprofit facilities that have contracts with licensed therapists, Peters says, and there is someone in charge of taking care of the horses that are used during these sessions.

The horses are typically retired from other careers and have a trial for up to six months to make sure they would be good for therapy programs. The Professional Association of Therapeutic Horsemanship International (PATH INTL) sets standards for the horses (and centers) to ensure they are treated ethically at licensed facilities. Although licensure is not required by PATH INTL, it offers accreditation for centers. Instructor certification, however, is mandated by PATH INTL and there are several levels and designations.

Important: Not all states require licensure to conduct equine-assisted activities/therapy (EAAT) or modalities where horses are involved. The Equine-Assisted Growth and Learning Association (EAGALA) offers equine-assisted psychotherapy and personal development with a team approach. There is an EAGALA certified mental health professional and an EAGALA certified equine specialist present at all sessions, which are private.

As for who equine-assisted therapy works best for and who it doesn't, Peters says there isn't much research on that topic yet. "I will say, in my experience, there have been several of my clients who are initially very wary of horses," she says, but often "kids will really learn to love it."

What conditions can be treated with equine therapy?

Equine-assisted therapy is complementary to other more traditional forms of therapy. Numerous conditions have been studied by researchers and therapists using equine interventions. These include:

  • Cerebral palsy. In a 2020 meta-analysis, researchers found physical therapy with horses helped children with cerebral palsy recover gross motor function, which are whole-body movements such as sitting or standing.
  • Multiple sclerosis (MS). A small 2020 study of 33 people with MS showed that this type of therapy intervention improved patients' ability to walk.
  • Autism. "A lot of youth with autism have sensory processing differences," Peters says, so the equine environment is good for dealings with tactile, auditory, and olfactory (smell) sensations, as well as for the vestibular (balance) and proprioceptive (body position) systems. Her research has found occupational therapy for youth with autism that incorporates horses lead to improved communication and decreased hyperactivity.
  • Post-traumatic stress disorder (PTSD). A small 2017 study of youth with PTSD found equine-facilitated psychotherapy was effective, but no more so than traditional office-based psychotherapy. A small 2020 clinical trial shows this type of therapy for veterans with PTSD may show promise for short-term symptom relief.
  • ADHD. One small 2018 study of youth with ADHD found improvement of quality of life and attention with equine-assisted therapy, similar to the study group that used pharmacological intervention.

For all of these conditions, much more research is needed in the equine environment.

"The research on equine-assisted therapy has been mixed and largely depends on what outcomes you are looking at," says Megan Mueller, PhD, the co-director for Tufts Institute for Human-Animal Interaction. Mueller points out there are reviews that show a minimal effect from equine-assisted therapies, but high-quality work done more recently is promising.

This is why Peters is preparing her studies for randomized clinical trials in her occupational therapy work.

"Most of the studies are really promising and show promising effects, but they're just not using rigorous design," she says. Also, the research studies are small because it is often difficult to conduct a large study where there are enough participants.

What the research says: Though most of the studies on equine-assisted therapy are small, a comprehensive 2020 review found physical therapy with horses was helpful for children with cerebral palsy, who recovered significant gross motor functioning.

How do you find equine-assisted therapy?

If you are looking for a place to find equine-assisted services, some associations maintain databases. Peters recommends finding a facility with certification from The Professional Association of Therapeutic Horsemanship International or the American Hippotherapy Association to make sure they are following safety recommendations and other guidelines.

Therapists can obtain credentials from the American Hippotherapy Association or Eagala to show they have experience in the equine environment. These associations all maintain searchable lists of providers.

Important: Insurance may cover equine-assisted therapy in some states, but not in others. Sessions are hundred of dollars out of pocket, although many facilities apply for grants to offset costs for patients.

Insider's takeaway

There are a variety of equine-assisted therapies people use to treat conditions ranging from autism to PTSD. There is promising evidence that equine-assisted therapy, which is performed by occupational therapists, physical therapists, speech and language pathologists, or psychotherapists, is beneficial for many conditions. More rigorous research is needed to discern the benefits of these therapies.

Anecdotally, therapy in an equine environment does work for patients according to providers.

"It's really beneficial for some people, whether it's because the horse is extremely motivating, so it gets clients who would otherwise not participate in therapy to really engage, or because it offers this really unique [physical activity], which provides both movements as well as sensory stimulation that's really difficult to mimic in a traditional clinic," says Peters.