How to Deliver Group Equine-Assisted Therapy for PTSD
How was the manualized group equine-assisted therapy protocol for posttraumatic stress disorder delivered to military veterans in this trial?
Clinicians interested in equine-assisted therapy need a defined structure rather than a loosely described activity. This guide applies to the specific EAT-PTSD model tested in veterans with posttraumatic stress disorder and outlines the treatment components that were standardized in the trial.
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Set up the treatment structure
Deliver treatment as 8 weekly, manual-guided, 90-minute group sessions at an equestrian center. Organize groups of 3 to 5 veterans, and provide roundtrip transportation if replicating the study conditions.
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Staff each group with the required team
Co-lead sessions with a licensed mental health professional and a qualified equine specialist. Include an additional horse wrangler to enhance safety during sessions.
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Keep horses consistent within each group
Use the same two horses throughout all sessions for a given group. In the study, this consistency was part of the manualized treatment format.
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Frame the therapy as experiential rather than trauma-focused
Do not elicit, focus on, or discuss PTSD-associated trauma during treatment. Instead, use horse-human interaction to target affective awareness of self and others, communication, emotional regulation, critical thinking and problem solving, and self-confidence or self-efficacy.
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Conduct the orientation session
Use session 1 to orient patients to the treatment rationale, description, and possible benefits. Include psychoeducation such as common reactions to trauma and the development and maintenance of PTSD, followed by a barn tour and meeting the horses in a private round pen.
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Use a standard session sequence in later meetings
In subsequent sessions, work in the round pen and begin with review of previous content. Include a grounding exercise focused on current physical sensations, then introduce horse encounters and interactions of increasing complexity, and end with a closing circle to review and discuss the session experience.
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Build early-phase horse handling skills
In sessions 2 and 3, focus on helping participants become acquainted with the horses. Use grooming exercises and teach leading, in which patients direct the horses with a rope or a wand.
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Advance to middle-phase mastery and teamwork exercises
In sessions 4 through 7, increase mastery and comfort with the horses through individual and teamwork exercises. Examples from the manual include using a wand to distance the horse and create personal space, and collaboratively maneuvering a horse onto a tarpaulin to foster teamwork and cooperation.
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Close with a graduation session
Use the final session to include a graduation ceremony celebrating treatment progress and accomplishments. This was the concluding element of the manualized protocol.
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Monitor fidelity and supervision
Videotape treatment sessions and review them to ensure adherent delivery of the intervention. Hold weekly supervision calls with treatment teams to discuss each session and provide feedback.
Clinical Considerations
- The study found the protocol appeared safe and well tolerated, but some injury risk may still exist because participants work in close proximity to horses.
- The favorable engagement and low attrition observed may have been influenced by nonspecific factors such as the outdoor setting, transportation support, and assessment payments.
- This manualized protocol was tested in an open trial, so the structure can be replicated but efficacy still requires confirmation in randomized controlled trials.
- Geographic access to horse facilities may limit feasibility, and the study did not assess costs relative to benefits.
Bottom Line
If offering EAT-PTSD, preserve the studied format: 8 weekly 90-minute manual-guided group sessions, co-led by a mental health professional and equine specialist, with structured non-trauma-focused horse interactions and explicit safety oversight.
