Horses Are Helping Vets with PTSD

By Keri Blakinger 12/29/17

“Both the horses and the vets kind of exhibit or even suffer from the same fear circuit-based behavior."

older man and his horse

In his old age, Chuck decided to take up a side job - walking in circles.

To be fair, he doesn’t only work in circles. The retiree also lets people pet him, groom him, pick up his feet and talk sweet to him. Sometimes he even accepts sugar cube treats. That’s because Chuck is a horse—one who’s part of the Man O’War program’s equine therapy study.

Branded as the first university-led formal study of its kind, the Columbia University research seeks to measure the efficacy of the seldom-studied use of equine therapy for veterans suffering post-traumatic stress disorder.

Horse-assisted treatment is not new; it’s been used for autism, eating disorders, addiction and more. But it’s not well studied, and that’s what Columbia researchers Prudence Fisher and Yuval Neria are hoping to change.

“A lot of people are doing it, but there’s not a lot of research on it,” Fisher told The Fix. “There’s a lot of very good anecdotal reports—but we’re really carefully assessing people.”

Given the dearth of research in the field, there wasn’t a lot to go by in terms of figuring out how the study should be structured.

“Basically, what we had to do is come up with what we’re testing,” Fisher said. That meant conferring with expert consultants and people who’d done equine therapy in the past. In the end, the researchers settled on a program regime of eight 90-minute sessions.

They’ll continue running eight-week sessions throughout the study period, which started in late 2016 and could last through mid-2018. Held at the Bergen Equestrian Center in northern New Jersey, the sessions combine two horses—Chuck and Gordon—with veterans who have a PTSD diagnosis. They can be involved in other treatment, but it needs to stay consistent throughout the course of the study. And they can’t be actively suicidal.

“You’d still want a more intensive treatment for that,” Fisher said.

Unfortunately, geographic and funding restrictions mean that it’s not a randomized trial, but researchers hope it’ll be enough to develop a manual for future trials and therapy efforts.

The eight sessions follow a progression, but none of them involve riding the animals.

“We didn’t want to create an interaction where the human is dominating the horse by riding it,” Fisher told the Washington Post. “It’s about joining up with them, it’s really about an even type of interaction that gives both players an even role.”

The classes also do not rely on reliving and analyzing past trauma.

“This is not a therapy that you talk about what happened to you,” Fisher told The Fix. “A lot of PTSD treatments really focus on the trauma, so you’re talking about the trauma all the time and the idea is that you’re sort of processing it.”

But the point of the Man O’War program is to help veterans sharpen emotional skills that may help them interact with others in day-to-day life.

“The things that we’re doing in this program are things that people with PTSD have difficulty with—regulating their emotions, recognizing their emotions, recognizing that they’re quick to react, things like that,” Fisher said. “You’re not dealing with the trauma at all—just things in daily life.”

And in some ways, horses are the perfect animals for that. Naturally, they have predators. So they’re always on watch, particularly keyed into people.

“The veterans feel that the horses are mirroring what they feel,” Neria, a medical psychology professor, told the Post. “Both the horses and the vets kind of exhibit or even suffer from the same fear circuit-based behavior. They are both fearful initially, they are both apprehensive initially, they avoid being together initially, and over time they develop the ability together.”

The sessions kick off with some basic “mindfulness” training and progress to activities like grooming and walking the horse on a lead. The veterans learn about communication, body language, and tone as they strive to work together to complete specific horse training tasks.

“There’s a lot about trust, about being clear with your intentions,” Fisher told the Washington paper.

Eventually, they are able to perform harder tasks, like doing a “sendaway,” where the horse moves a certain distance away.

“It has to do with your body language and how the horses are walking around, and then when you want the horse to come back in you have to change your stance,” Fisher said. “It gets you very aware of what you’re feeling and how you’re expressing it non-verbally. It’s all about being conscious of how your feelings are expressed.”

And the small group settings can help build teamwork skills between the veterans as well, as they learn to become attuned to one another’s body language.

Ultimately, the goal of such treatment is to help veterans resume normal aspects of life. But changes are also measured using established tests.

“The clinician completes a standard measure of PTSD and they do the Hamilton depression scale for the patient and they fill out a number of standard measures,” Fisher said. “And then afterward they’re re-evaluated. We look at symptom improvement—quality of life things. Like maybe people who weren’t working, got jobs. Or maybe people who had more restrictive lives are now doing things.”

They’ve already seen some successes.

"One veteran, for example, had been afraid to take the subway before the sessions; afterward, that fear had lifted," Fisher told the Post. “Another participant wouldn’t go outside, now he goes outside.” 

The Columbia researchers started looking into the project almost three years ago, at the urging of veteran and horse-lover Earle Mack.

Mack, who’s also the former ambassador to Finland, set up the Man O’War as a nonprofit and approached Columbia about a partnership.

Eventually they got together a pilot group in mid-2016 and launched their study.

If the first run of testing groups seems successful in the end, Fisher and her fellow researchers could look to expand the program and conduct another trial.

But research projects require a lot of staffing, time and infrastructure that makes them a pricy proposition. So even if more studies aren’t feasible, Fisher at least hopes to come out with a plan for future researchers and practitioners.

“I think the goal of the MOW project is to have us come up with a manual that can be disseminated and taught to other people,” she said. “Certainly our therapists, who don’t really work for us, I’m sure they will continue using our manual.”

The program has already raised more than $1 million to fund its work, but they hope to go after federal grants from the DOD, the VA and NIH. The study hasn’t released initial results with the work still underway, but noted that so far there’s been a lower dropout rate than plagues some studies, and some participants have even started riding lessons on the side.

“One of the things we’re optimistic about is how much the veterans like the treatment,” Fisher said.

And it all benefits the horses too.

“When they retire they have nothing really to offer and they are sometimes slaughtered or live in very difficult conditions,” Neria said.

“Not all horses receive fair and appropriate treatment. Some are traumatized. So it’s a very fascinating opportunity to bring together traumatized horses and traumatized vets to interact and to overcome what they both suffer from.”

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Keri Blakinger is a former drug user and current reporter living in Texas. She covers breaking news for the Houston Chronicle and previously worked for the New York Daily News and the Ithaca Times. She has written about drugs and criminal justice for the Washington Post, Salon, Quartz and more. She loves dogs and is not impressed by rodeo food. Find Keri on LinkedIn and Twitter.