Horses are sensitive creatures. They pay attention to their surroundings, including humans. However, their behavior will differ depending on whether the stimulus is sudden or gentle. This characteristic of horses is at the heart of equine-assisted therapy, which has started to be introduced in certain clinical settings. However, “equine-assisted therapy” has become something of a sales pitch; some practitioners claim that it is the cure for everything, while others believe that it is nothing else but an expensive trip to the countryside. Many studies have been conducted on equine-assisted psychotherapy, the findings are examined below.
What is Equine-Assisted Psychotherapy?
In most models, a session is run by two people: a licensed mental health professional and an equine specialist who handles the horses. The client works with one or more horses, usually on the ground, grooming them or leading them through a simple course. Riding isn’t always part of the therapy, and many programs have no riding element.
This is usually followed by the analysis stage. In a guided exercise, a horse might stop or wander off if the patient is hurrying it along, and the therapist can use that moment to ask what the client noticed about themselves. The horse isn’t assessing anyone, and its behavior could have any number of causes. The reflection afterward is where the therapy occurs.
Equine-Assisted Psychotherapy vs. Hippotherapy and Therapeutic Riding
The terminology isn’t fully standardized. A 2023 systematic review in Frontiers in Psychiatry split horse-based treatments into five separate categories, and the authors noted that the definitions tend to overlap. The main ones you’ll run into:
- Equine-assisted psychotherapy (EAP): a mental health professional and a horse specialist working toward psychological goals, mostly through groundwork.
- Hippotherapy: physical, occupational, or speech therapists using the horse to improve a patient’s physical function.
- Therapeutic horseback riding: adapted riding with therapeutic aims, studied heavily in children with autism.
- Equine-assisted activities and therapies (EAAT): a broader umbrella that has historically centered on riding and physical rehabilitation.
So if a program says “equine therapy,” ask which one they mean. A hippotherapy session and an EAP session can look alike, but they’re built for different problems.
Why Horses?
Horses are prey animals. They watch their surroundings constantly and react fast to signs of threat, and the review authors describe them as sensitive to the behavior of the people near them. Advocates of horse therapy argue that it allows the therapist to have an objective subject to work with, though a horse’s behavior cannot be considered a definitive measure of someone’s inner state.
There’s a trauma angle too. People with PTSD often feel like they are always on alert for potential dangers, similar to a horse’s behavior. Building trust with an animal that has to decide whether you’re safe can mirror the work of rebuilding trust with people.
That’s the theory, anyway. It’s a reasonable one, but it’s still a theory.
Equine Therapy for PTSD: Where the Data Is Strongest
Much of the research so far involves veterans. Researchers at Columbia University Irving Medical Center ran an open trial with 63 veterans who had PTSD, meeting in small groups for eight weekly 90-minute sessions co-led by a mental health professional and an equine specialist. According to Columbia’s summary of the veteran PTSD trial, published in the Journal of Clinical Psychiatry, more than half the participants showed a marked drop in PTSD and depression symptoms after treatment and at the three-month follow-up.
The researchers also suggested the format might engage avoidant patients who resist more structured therapy. That’s a hypothesis from an uncontrolled trial, though, not evidence that EAP outperforms established PTSD treatments.
And the trial had no control group. Its authors noted that open trials can inflate results, and that some improvement could reflect time passing, especially since many participants were already on stable medication or talk therapy.
Equine Therapy in Addiction Treatment
PTSD and substance use have been known to coexist. In the Frontiers review, substance abuse is mentioned as one of the long-term effects of PTSD. In veteran PTSD cases, both PTSD and substance abuse are often found to occur simultaneously. However, the studies related to the efficacy of EAP for substance abuse are not numerous. In most cases where the use of horses is present in addiction treatment, other methods of treatment such as detox, medications, and therapy are used in conjunction with the horse therapy.
For families comparing options, a program’s own description is mostly useful for understanding the format. A residential center may describe its equine-assisted psychotherapy program in terms of groundwork, such as grooming and leading, co-led by a licensed therapist and a horse professional. That tells you how sessions run and who leads them, not whether the approach works for addiction, so it’s worth asking the treatment team how the sessions fit into the wider plan.
Where the Evidence Falls Short
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As much attention should be paid to the limitations as to the results. The 2023 review only included the equine-assisted interventions for veterans suffering from PTSD, which consisted of ten studies, divided into four types of intervention by the authors, i.e., equine-assisted therapy (five studies out of ten, one of which being a therapeutic riding program), equine-assisted services (two studies), equine-assisted activities and therapies (two studies) and EAP (one study). It should also be noted that the same issues recurred in these studies:
- Small samples, flagged directly in four of the ten studies
- Few control groups, which makes cause and effect hard to pin down
- Short or missing follow-up, with two studies seeing symptoms creep back by three months
- Vague session descriptions, so it’s often unclear what the horses were doing
Horse welfare came up too. Only a handful of the reviewed studies described how horses were matched to participants or how the animals handled the work.
Because of that scope, the review’s findings don’t automatically carry over to addiction treatment, depression in the general population, or EAP as a distinct model. The evidence suggests potential benefits for veterans with PTSD, but methodological limitations make the size and reliability of those benefits uncertain. Evidence for other uses remains limited.
Who May Be a Good Fit, and Who May Not
Equine-assisted work tends to appeal to people who’ve stalled in a traditional office setting, who struggle to put things into words, or who do better when their hands are busy. For some, being outside and moving lowers the pressure that comes with sitting across from a therapist
It may not suit everyone, though. A few situations call for an individual clinical assessment before starting:
- A strong fear of horses, or allergies to them
- Physical limitations, which matter more for riding-based programs than for groundwork
- Active psychosis, which some of the reviewed studies used as an exclusion criterion
- Cost and travel, since programs need land, horses, and trained staff
Whether any of these rules someone out depends on the person, the type of program, and the judgment of the treating team.
Where a Psychiatrist Fits In
Most of the research treats equine-assisted interventions, EAP included, as an add-on rather than a replacement. In several of the PTSD studies, participants stayed on their existing medication or psychotherapy throughout the horse sessions.
For anyone living with PTSD, depression, or a substance use disorder, there is still a necessity to address the psychiatric part of therapy. A thorough psychiatric evaluation can help confirm the diagnosis, flag anything that might make barn work risky, and keep medication on track while a person tries something new. It is always better to inform the psychiatrist in order to ensure that both treatments work toward the same goal.
Some Psychiatry practices such as GABA Telepsychiatry offer flexible treatment, managing the medication for the patient and collaborating with other treatment providers. This can be a good fit for patients looking to try out different therapy types.
What is clear from the research is that being around horses won’t fix everything. However, it has been shown to reduce anxiety and PTSD symptoms for many patients, similar to the relief emotional support animals have been shown to provide and can work well in combination with traditional treatment methods for mental health.
