Clinical Summary: Equine-Assisted Therapy for Posttraumatic Stress Disorder Among Military Veterans: An Open Trial
Many military veterans with posttraumatic stress disorder do not fully remit with standard care, and dropout and treatment avoidance are common. This study tests whether a manualized equine-assisted therapy program can engage veterans and reduce PTSD and depressive symptoms without the trauma-focused demands that lead some patients to avoid treatment.
Key Findings
- Clinician-rated PTSD improved substantially: mean (SD) CAPS-5 scores decreased from 38.6 (8.1) at baseline to 26.9 (12.4) at termination, with a significant time effect (F3,186 = 30.41, P < .0001, η2p = 0.33) and a significant pre- to posttreatment reduction (P < .0001, d = 1.11) that persisted at 3-month follow-up (P = .88).
- Half the sample achieved clinically significant PTSD change: based on CAPS-5 scores, 32 veterans (50.8%) demonstrated CSC at posttreatment and 34 (54.0%) at 3-month follow-up; 29 participants (46.0%) and 23 participants (36.5%) scored below the cutoff score of 25 at posttreatment and follow-up, respectively.
- Self-reported PTSD also improved: mean (SD) PCL-5 scores decreased from 50.7 (13.8) at baseline to 34.6 (16.7) at termination, with a significant time effect (F3,186 = 30.85, P < .0001, η2p = 0.33), significant pre- to posttreatment reduction (P < .0001, d = 1.05), and additional reduction from mid- to posttreatment (P < .0001, d = 0.34).
- Depressive symptoms improved, though with smaller effects than PTSD: HDRS decreased from 16.3 (5.6) to 12.1 (6.5) (F3,186 = 13.82, P < .0001, η2p = 0.18; pre- to posttreatment P < .0001, d = 0.69), and BDI-II decreased from 27.4 (13.2) to 20.8 (14.0) (F3,186 = 15.92, P < .0001, η2p = 0.20; pre- to posttreatment P = .001, d = 0.49).
- Engagement and safety were favorable: only 5 patients (7.9%) discontinued EAT, including 4 patients (6.3%) before midpoint and 1 patient (1.6%) after; 48 patients (76.2%) provided 3-month follow-up data, the Little MCAR test was nonsignificant (χ214 = 17.53, P = .23), and there were no adverse events or safety concerns reported.
An 8-session manualized equine-assisted therapy program was well tolerated by veterans with posttraumatic stress disorder and was associated with large reductions in PTSD symptoms and more modest reductions in depressive symptoms that were maintained for 3 months. In practice, equine-assisted therapy can be considered as an adjunctive or alternative option for veterans who are reluctant to engage in standard PTSD treatment, while recognizing that efficacy still requires confirmation in randomized controlled trials.
Practice Implications
- Consider equine-assisted therapy as a structured adjunct or alternative for veterans with posttraumatic stress disorder who are avoidant of, demoralized by, or resistant to more formal treatment modalities, especially when engagement is a primary barrier.
- Set expectations that symptom change may begin before the full course is completed: significant PTSD improvement was already evident at midpoint on CAPS-5 (P < .0001, d = 0.96) and PCL-5 (P < .0001, d = 0.70).
- When discussing likely benefits with patients, emphasize that PTSD outcomes were stronger than depression outcomes in this trial, with pre- to posttreatment effect sizes of d = 1.11 for CAPS-5 versus d = 0.69 for HDRS and d = 0.49 for BDI-II.
- If implementing this approach, preserve the studied structure: 8 weekly, manual-guided, 90-minute group sessions for 3 to 5 veterans, co-led by a licensed mental health professional and a qualified equine specialist, with safety support from a horse wrangler.
