How to Select Veterans for Equine-Assisted PTSD Therapy
How should clinicians determine whether a military veteran with posttraumatic stress disorder is an appropriate candidate for the EAT-PTSD program used in this trial?
Some veterans with posttraumatic stress disorder avoid or do not respond fully to standard PTSD treatments, creating a need for alternative or adjunctive options. This guide applies when clinicians are considering referral to the manualized equine-assisted therapy protocol studied here and need to match patients to the population and safety parameters actually used.
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Screen for likely PTSD by phone
Begin with a phone screen using the PTSD Checklist for DSM-5. In this study, individuals scoring 30 or higher, indicating likely PTSD, were invited for in-person clinical assessment.
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Confirm diagnosis with structured in-person assessment
Arrange an in-person evaluation by a trained independent evaluator. Ascertain primary and comorbid diagnoses with the Structured Clinical Interview for DSM-5, Research Version, and confirm PTSD diagnosis with the Clinician-Administered PTSD Scale for DSM-5.
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Verify core inclusion criteria
Confirm that the patient has a primary diagnosis of PTSD, is 18 to 70 years old, reports military experience, and is fluent in English. These were the required inclusion criteria for participation in the studied protocol.
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Review concurrent treatment stability
Current pharmacotherapy or psychotherapy can be allowed if it has been stable for at least 3 months. In the trial, patients were also asked to keep that regimen stable during the study, and those in psychotherapy were not receiving a strict manualized progressive PTSD protocol such as prolonged exposure or cognitive-behavioral therapy.
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Exclude major psychiatric and substance-related risks
Do not include patients with a history of psychotic disorder or current unstable bipolar disorder on SCID-5-RV assessment. Also exclude patients with severe substance or alcohol use disorder within the past 6 months or moderate use disorder within the past 2 months.
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Assess depression severity and suicide risk
Measure clinician-rated depression severity with the 17-item Hamilton Depression Rating Scale and exclude patients scoring above 25. Exclude patients with elevated suicide risk based on clinical assessment.
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Confirm physical ability to participate safely
Assess for physical limitations that would impede participation in equine-assisted activity. Because the protocol involved direct horse handling and round-pen exercises, patients needed to be physically able to take part.
Clinical Considerations
- This candidate-selection process was studied only in military veterans with DSM-5 PTSD and may not generalize to nonveteran populations.
- Most participants were receiving stable concurrent psychotherapy, pharmacotherapy, or both, so the guide reflects selection for adjunctive or alternative use rather than stand-alone treatment in untreated patients.
- Patients receiving a clearly defined progressive PTSD treatment such as prolonged exposure or cognitive-behavioral therapy were not part of the concurrent psychotherapy profile in this trial.
- Because this was an open trial without a control group, these eligibility criteria identify the studied population but do not prove which patients benefit most.
Bottom Line
Use EAT-PTSD for veterans who meet confirmed DSM-5 PTSD criteria, fit the study's safety and psychiatric exclusions, and can participate physically while keeping other treatments stable.
