Can Horses and Dolphins Help You Kick the Habit?

By Jeanene Swanson 01/19/15

Animal-assisted therapy may not be the first thing you think of when it comes to recovery. It works, but how effectively?

Group of wild animals

When you think of rehab, do you think of horses? What about dolphins? Wolves? While many addiction treatment facilities have turned to so-called holistic therapies like meditation and acupuncture to augment more traditional treatments, they have also begun to add animal-assisted therapies to their stable (no pun intended). However, while these therapies might show loads of anecdotal evidence of patients “feeling better” when they pet a dog or ride a horse, are these therapies effective? And, are they worth the cost if they only offer short-term improvement?

Animal-assisted therapy

Animal-assisted therapy, loosely speaking, has been around for a long time; in fact, it dates back to at least the 18th century. A PubMed or Google Scholar search will turn up hundreds of studies showing animal-assisted activities (AAA) or animal-assisted therapies (AAT) as having varying degrees of effectiveness for a wide range of diseases and conditions. Studies have shown that it reduces aggression and depression, anxiety, and pain in psychiatric patients; assists in the neurorehabilitation of patients with cerebral palsy, developmental disorders, multiple sclerosis, spinal cord injury, stroke, and mental disorders; and decreases agitation while increasing socialability in patients with dementia. A recent article in The Lancet summed up the many one-off studies: AAA and AAT have shown some degree of improvement on mood in Alzheimer’s disease and dementia, anhedonia in schizophrenia, and gait and balance in multiple sclerosis; as well as helping some people with mood disorders and addiction problems, and children with physical disabilities like autism, epilepsy, Angelman’s syndrome, dyslexia, or Tourette’s syndrome.

The science behind it

Patients who take part in AAT typically report feeling calmer and happier—and objectively, their stress measurements go down. One study showed that dog visits can reduce pain and pain-related symptoms in patients by decreasing catecholamines and increasing endorphins. 

A study led by the University of Rostock’s Dr. Andrea Beetz reviewed evidence from 69 studies on human-animal interactions and proposed that these interactions up levels of oxytocin. Sometimes called the “bonding hormone,” oxytocin promotes a sense of intimacy, increases trust, and decreases fear. When we interact with animals, frequently domesticated dogs and cats, many people with social disorders—social anxiety, for instance, or autism—are able to relax and therefore, “open” up.

Many hospitals, nursing homes, and rehabilitation centers now use dog-assisted therapy, “probably more do than don’t,” says Dr. Margaret Nepps, a clinical psychologist at Lancaster General Hospital in Pennsylvania. In these sessions, patients are encouraged to pet the dog, make it sit or fetch, and in general, express their feelings. “To some degree [dogs play a role of] social lubricant,” Nepps says. They can get people talking—if not to others, then to the dog itself—when otherwise they wouldn’t. “[Dogs] help people to feel that they are a little more normal, to make them feel good because the dog is responding to them, to get them to open up with their own emotions.”

In a recent study, Nepps showed that interacting with a volunteer Border Collie during group therapy sessions worked as well as the hospital’s traditional stress management program among patients with a variety of psychiatric diagnoses. 

Equine-assisted psychotherapy

Dogs aren’t the only animals used in AAT. Riding horses as a form of physical or psychological therapy dates back hundreds, if not thousands of years. However, it’s only been in the past several decades that it has gained traction for treating mental health and substance use disorders. In fact, if you search for rehabs that offer equine therapy, you might be surprised to find that many do—including leading addiction treatment centers like Hazelden, Promises, and others. According to the Equine Assisted Growth and Learning Association (EAGALA), there are over 600 programs in 49 countries that use “equine therapy (horse therapy) to address mental health and human development needs.”

Equine-assisted psychotherapy (EAP) works not by teaching patients how to ride a horse, but by “setting up ground activities involving the horses, which will require the client or group to apply certain skills,” including “non-verbal communication, assertiveness, creative thinking and problem-solving, leadership, work, taking responsibility, teamwork and relationships, confidence, and attitude.” According to EAGALA, EAP can be used to address “behavioral issues, attention deficit disorder, PTSD, substance abuse, eating disorders, depression, anxiety, relationship problems and communication needs.”

Dede Beasley, an equine-assisted psychotherapist at The Recovery Ranch just outside of Nashville, uses an open-ended approach to horse-human interaction. “I think all animals are therapeutic if you’re enjoying the animal.” Beasley says. In her practice, she looks for what she calls “roadblocks” to recovery; these are often reflected in the patient’s interaction with the horse. “Working from a somatic point of view, there’s a lot going on that tells us where people are and where they want to go.”

Beasley instructs both individuals and groups in ground and mounted work, including leading horses and obstacle courses—“sometimes I just make stuff up.” She says that EAP especially helps with specific disorders. “Attachment disorders are really obvious with equine-assisted therapy,” she says. With PTSD—“feeling hopeless and helpless”—being with such large creatures taps into “all the situations they’ve been in where things are bigger than [they are].”

Horses tend to mirror human relationships, and Beasley believes that working with these animals can help patients improve their relationship skills. “You learn the difference between being empowered and being abusive, how to have needs, and acceptance of your limitations or others’,” she says.

Dolphin-assisted psychotherapy

Dolphins have been used only relatively recently as therapy assists, and the practice is controversial. Originally intended for physical therapy, it has been adopted by the mental health field—in spite of charges that it is ineffective and moreso, puts both dolphins and people at risk of physical injury. As the only substance abuse treatment program in the world where clients swim in the open ocean with wild dolphins, according to Eliza Wille, Hawaii Island Recovery uses dolphin-assisted psychotherapy to get clients to address uncomfortable feelings. “As a therapist, more is revealed to me after an hour in the water with a client than I may learn in a month of seeing them in a controlled office setting,” says Wille, who is the program director and animal-assisted psychotherapy specialist. “Things get real very quickly in the ocean and it becomes quickly apparent what tools our clients have or don’t have for managing their feelings.”

In general, her clients, who have substance abuse and mental health disorders, learn “increased self-awareness, develop self-soothing techniques, and improve their distress tolerance.” The unique experience of not only being with dolphins, but being with them in a wild, unpredictable setting, is seemingly what underlies a memorable—and life-changing—experience. “These experiences have been transformative for many clients,” Wille says. “Feelings that clients have shared relative to their experience include joy, acceptance, forgiveness, peace, and belonging. For many people who have been mired in addiction, these feelings are deeply life-affirming and poignant reminders of why they are seeking recovery.”

But, does it work?

Not everyone is convinced that AAT is anything but a short-term intervention that hasn’t been proven effective. “The efficacy is still largely unestablished,” says clinical psychologist, professor, and author Dr. Scott Lilienfeld of Emory University. In fact, there have been no randomized, controlled trials for substance use disorders using AAT, to his knowledge. 

In a recent study, Lilienfeld and colleagues found that while equine therapies for mental disorders are becoming more popular, they haven’t been investigated empirically. Of the 14 peer-reviewed studies he looked at, all had validity concerns, which called into question the significance of the findings. He concluded that “Equine-related treatments for mental disorders should not be offered to the public unless and until well-designed studies provide evidence that justify different conclusions.”

He’s even more dubious about dolphin-assisted therapy, which has been popularized as a method for treating children with disabilities. In multiple studies, he and his colleagues have called into question the legitimacy of dolphin-assisted therapy —even still, at least two organizations (Island Dolphin Care, associated with Lucida Treatment Center, part of the Elements Behavioral Health network of treatments facilities; and Hawaii Island Recovery) use it to treat substance use disorders. There are probably more, considering that there are at least 100 organizations that offer dolphin-assisted therapy.

The problem with the dolphin studies, like most of the studies on AAT, is that they are methodologically flawed, invalidating the results. In general, “not a lot [of AAT studies] use randomized, controlled trials, which are the best way of ascertaining efficacy,” Lilienfeld says. These types of studies are better at ruling out alternative explanations—maybe the kid liked being in the water and it had nothing to do with the dolphin. A study lacking this design “makes it very difficult to interpret.”

Secondly, in poorly constructed studies, it’s hard to tell if these treatments affect disease symptoms or are “merely palliative,” he says. “If you have a serious condition like autism or substance abuse, you want to go beyond making people feel better.” Importantly, he adds, you want the effect to last. “Animals can produce short-term improvements in mood, but does it stick months, years after? I’m not aware of any study that shows long-term effects for the core symptoms for any psychological disorder.”

That’s not to say that these treatments can’t be helpful for some people, and for some conditions. Depression might be most helped in the long-term, Lilienfeld says, but not conditions like eating disorders or addiction.

If it appears to work, what’s the harm?

One might wonder, well, if it’s helping people, what’s the problem? For dolphins, the problem is, using captive—and some might argue, wild—sea mammals is unethical. For patients, the problem is, it costs money to go to rehab—especially for iffy therapies that have not been proven to work.

For Lilienfeld, the problem is, methodologically-flawed studies can catch up with psychologists. Treatments that appear effective might actually be the opposite. “We know that some people may like a treatment, but it could still be ineffective and/or harmful,” he says. “We have to be wary of short-term improvements—people’s subjective impression of how well these treatments work could be misleading.” 

Beasley acknowledges that horse therapy isn’t for everyone, and that it’s meant to be used as a complement to traditional therapy. “I’ve had people not like it, some people don’t see horses as anything other than something they can ride,” she says. “It’s not a cure-all: we can enjoy it and use it, but it’s not guaranteed to speak to everybody.”

Lilienfeld wouldn’t tell someone not to get horse therapy, but he would tell them to lower their expectations—recovery is going to take cognitive-behavioral work in order to acquire long-term coping skills. “The most that they can expect [from animal therapy] is that they might enjoy the experience, feeling happier and more relaxed. But I’m not sure that they can reasonably expect more than that, given what we know.”

Jeanene Swanson is a regular contributor to The Fix. She last wrote about how to take care of your liver and the stigma of addiction.

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Jeanene Swanson is a science journalist who specializes in mental health and addiction. As a science writer with a background in biotechnology, she enjoys turning complex subjects into stories that everyone can understand—and apply to their lives. You can find Jeanene on Linkedin.