Frequently Asked Questions

Yes. In this open trial of 63 military veterans with posttraumatic stress disorder, clinician-rated PTSD symptoms on the CAPS-5 decreased from a mean (SD) of 38.6 (8.1) at baseline to 26.9 (12.4) at posttreatment, with a significant pre- to posttreatment change of d = 1.11 (P < .0001). Self-reported PTSD symptoms on the PCL-5 also decreased from 50.7 (13.8) to 34.6 (16.7), with a significant pre- to posttreatment change of d = 1.05 (P < .0001).

Yes. The study found that the pre- to posttreatment reductions in PTSD symptoms were maintained at 3-month follow-up on both clinician-rated and self-report measures. For CAPS-5, the posttreatment improvement persisted at follow-up (P = .88), and for PCL-5, improvement was also maintained (P = .39).

Based on the study's prespecified definition of clinically significant change as at least a 30% reduction in CAPS-5 score, 32 veterans (50.8%) met that threshold at posttreatment and 34 (54.0%) did so at 3-month follow-up. In addition, 29 participants (46.0%) scored below the CAPS-5 cutoff score of 25 at posttreatment and 23 (36.5%) were below that cutoff at follow-up.

Yes, depressive symptoms improved, although the effects were smaller than for PTSD symptoms. Mean (SD) HDRS scores decreased from 16.3 (5.6) at baseline to 12.1 (6.5) at posttreatment, with a significant pre- to posttreatment change of d = 0.69 (P < .0001), and BDI-II scores decreased from 27.4 (13.2) to 20.8 (14.0), with a significant change of d = 0.49 (P = .001). These reductions were maintained at 3-month follow-up.

The intervention was a manualized group treatment called EAT-PTSD consisting of 8 weekly 90-minute sessions. Groups included 3 to 5 veterans and were co-led by a licensed mental health professional and a qualified equine specialist, with an additional horse wrangler present for safety; each group worked with the same two horses throughout treatment.

The therapy was experiential rather than trauma-focused. According to the manual, it did not ask participants to recount or process PTSD-related trauma, but instead aimed to increase affective awareness, improve communication, help regulate emotional responses, improve problem solving, and increase self-confidence and self-efficacy through structured interactions with horses.

In this study, equine-assisted therapy appeared safe and well tolerated. Only 5 of 63 participants (7.9%) discontinued treatment, including 4 (6.3%) before midpoint and 1 (1.6%) after, and the authors reported no adverse events or safety concerns from participants or staff.

Improvement was already evident by the midpoint assessment. For clinician-rated PTSD, the pre- to midpoint CAPS-5 reduction was significant (P < .0001, d = 0.96), and for self-reported PTSD, the pre- to midpoint PCL-5 reduction was also significant (P < .0001, d = 0.70).

Depressive symptoms also showed midpoint improvement. HDRS improvement from baseline to midpoint was significant (P = .003, d = 0.50), and BDI-II improvement was significant as well (P = .005, d = 0.28).

No. This was an open trial without a control group, so it cannot establish clinical efficacy relative to usual care, placebo, or no active treatment. The authors specifically note that the lack of a control condition is a major limitation and that randomized controlled trials are needed to test efficacy more formally.

Interpretation is also limited because many participants were receiving stable concurrent treatment: 47 enrolled veterans were in psychotherapy, pharmacotherapy, or both during the study.

• No control arm, which prevents a formal efficacy test and leaves open the possibility that some symptom change reflected time or nonspecific factors.
• Independent evaluators could not be blinded to treatment because of the open-trial design.
• Many participants were receiving stable concurrent psychotherapy and/or medication, which may have influenced outcomes.
• The study could not control additional treatment received between posttreatment and 3-month follow-up.
• The intervention may be less accessible in areas without horse facilities, and the study did not assess cost relative to benefit.
• Results may partly reflect selection factors or nonspecific features such as participants' affinity for horses, the outdoor bucolic setting, transportation support, and assessment payments.

No. In this manualized EAT-PTSD protocol, treatment did not elicit, focus on, or discuss PTSD-associated trauma. Instead, it used grounding exercises, horse-handling tasks, and group reflection to work on affective awareness, communication, emotional regulation, problem solving, and self-efficacy.