Manualized equine-assisted therapy shows promise for treating veterans with PTSD

As veterans have high rates of posttraumatic stress disorder (PTSD) and historically poor treatment outcomes and high attrition, alternative treatments have gained much popularity despite lack of rigorous research.

For this study published in The Journal of Clinical Psychiatry, a recently developed and manualized 8-session group Equine-Assisted Therapy for PTSD (EAT-PTSD), was tested in an open trial to assess its preliminary feasibility, acceptability, and outcomes for military veterans.

The research was conducted by Yuval Neria, Ph.D., Co-Director/Principal Investigator, Man O' War Project, Columbia University Irving Medical Center; Professor of Medical Psychology Departments of Psychiatry and Epidemiology, Columbia University Irving Medical Center; Director, PTSD Research Program, Director, New York Presbyterian Military Family Wellness Center at New York State Psychiatric Institute and Prudence W. Fisher, Ph.D., Co-Director/Principal Investigator, Man O' War Project; Columbia University Irving Medical Center; Associate Professor of Clinical Psychiatric Social Work (in Psychiatry) Columbia University, Vagelos College of Physicians and Surgeons; Research Scientist at New York State Psychiatric Institute.

The study found that manualized EAT-PTSD shows promise as a potential new intervention for veterans with PTSD. It appears safe, feasible, and clinically viable. These preliminary results encourage examination of EAT-PTSD in larger, randomized controlled trials.

The study was conducted from July 2016 to July 2019. Sixty-three treatment-seeking veterans with PTSD enrolled. PTSD diagnosis was ascertained using the Structured Clinical Interview for DSM-5, Research Version (SCID-5-RV) and confirmed using the Clinician-Administered PTSD Scale (CAPS-5). Mean age was 50 years, and 23 patients (37%) were women. Clinician and self-report measures of PTSD and depression were assessed at pretreatment, mid-treatment, and post treatment and at a 3-month follow-up. An intent-to-treat analysis and a secondary analysis of those who completed all 4 clinical assessments were utilized.

Thirty-two patients (50.8%) showed clinically significant change (≥30% decrease in CAPS-5 score) at post treatment and 34 (54.0%) at follow-up. Post treatment assessment revealed marked reductions in both clinician-rated and self-reported PTSD and depression symptoms, which persisted at 3-month follow-up. Specifically, mean (SD) CAPS-5 scores fell from 38.6 (8.1) to 26.9 (12.4) at termination. ​ Only 5 patients (8%) withdrew from treatment, 4 before mid-treatment and 1 afterward.

Background

The Man O' War Project at Columbia University Irving Medical Center is the first university-led research study to explore the use of and scientifically evaluate equine-assisted psychotherapy in treating veterans with PTSD, which includes developing a well specified treatment manual – the first of its kind -- which will be made available to the field.

The project began in 2015 with funding from philanthropist Ambassador Earle I. Mack, a veteran himself, and longtime thoroughbred owner/breeder, who was concerned about the mental health crisis facing veterans and his observation of anecdotal stories from various equine-assisted therapy groups, with no hard science to support their claims. Ambassador Mack approached David Shaffer, MD, former director of the Division of Child and Adolescent Psychiatry at the Columbia University/ New York State Psychiatric Institute and soon a team was formed, led by Dr. Prudence Fisher and Dr. Yuval Neria.