Equine-Assisted Psychotherapy and Continuous Traumatic Stress: What the Research Says

TL;DR

Equine-Assisted Psychotherapy (EAP) shows promising outcomes for reducing symptoms of PTSD, anxiety, and depression in populations exposed to Continuous Traumatic Stress (CTS). Across randomized trials, pilot programs, and meta-analyses, EAP consistently demonstrates short-term psychological benefits, often outperforming waitlist controls and equaling or exceeding traditional therapy outcomes.

Key Takeaways

• EAP leads to significant symptom reduction in PTSD, anxiety, and depression in trauma-exposed populations.

• Some randomized controlled trials report sustained improvements at 2–6 months post-treatment.

• Meta-analyses show large effect sizes for PTSD relief (d = 1.156 post-treatment; d = 0.994 at follow-up).

• EAP is delivered in various formats, yet most studies show positive post-treatment gains regardless of protocol differences.

• Larger trials and standardized methods are still needed to strengthen long-term and comparative claims.

  
  

Introduction

For individuals living under continuous traumatic stress—such as military veterans, first responders, or those in conflict zones—traditional therapies may feel limited. Enter Equine-Assisted Psychotherapy (EAP), a trauma-informed intervention integrating human-horse interaction with evidence-based mental health care. Recent research asks: How effective is EAP compared to traditional therapies or waitlist controls in addressing PTSD, anxiety, and depression in these populations?

Study Scope and Review Methods

A comprehensive review analyzed over 500 academic papers sourced from Semantic Scholar, narrowing down to 25+ studies that:

• Focused on adults (13+) with clinical diagnoses of PTSD, anxiety, or depression

• Involved professionally delivered EAP interventions

• Used standardized mental health assessment tools

• Employed randomized controlled, quasi-experimental, or observational designs

  
  

PTSD Outcomes: What the Numbers Show

• Rankins et al. (2024): EAP group showed a mean PCL-5 score reduction of 11.5 points, while the waitlist group worsened (+5.3). Benefits were maintained at 2- and 6-month follow-ups.

• Cornelius-White et al. (2024): Meta-analysis of 18 studies found large effect sizes for PTSD symptom reduction (d = 1.156 post-treatment; d = 0.994 follow-up).

• Fisher et al. (2021): 54% of veterans had a ≥30% decrease in PTSD symptoms after 8 EAP sessions.

• Wharton et al. (2019): A 12-session Equine-Facilitated CPT intervention halved PTSD checklist scores.

• Across studies, PTSD symptom reductions were consistent—even in varied populations like veterans, trauma-exposed civilians, and adolescents.

  
  

Anxiety and Depression Outcomes

• Tobin (2024): Participants in an 8-week EAP group reported lower anxiety (β = .170) and depression (β = .081) compared to traditional therapy.

• Matonti et al. (2021): Significant improvement in anxiety and loneliness after equine therapy retreats (p < .05).

• Earles et al. (2015): Large effect sizes observed (d = 1.01 for anxiety; d = 0.54 for depression).

• Marchand et al. (2022) and Bergeron Boudreault (2020) also documented significant post-treatment improvements, some of which persisted up to 6 months.

  
  

What Kind of EAP Works?

Delivery formats varied—from ground-based horsemanship and therapeutic riding to manualized trauma protocols. Sessions ranged from:

• 4 to 25+ total sessions

• 30 minutes to 2 hours in length

• 5 days to 12 months in duration

• Conducted individually or in groups

Programs using certified models (PATH Intl., EAGALA) and manualized frameworks generally had higher fidelity and replicability.

Adherence, Feasibility, and Limitations

• Retention rates were often high—some studies reached 100%

• Dropout rates were minimal when tracked

• Challenges included small sample sizes, lack of long-term follow-up, and varied protocols

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Discussion: How EAP Helps—and What We Still Need to Learn

EAP appears to be a potent intervention for trauma-exposed individuals, offering:

• Emotional safety through animal-human interaction

• Regulation via movement, rhythm, and relational presence

• Nonverbal, embodied access to trauma healing

Yet, this field needs:

• Larger, multi-site RCTs

• Standardized intervention protocols

• Inclusion of more diverse populations beyond veterans

• Clear cost-benefit analysis for implementation

  
  

Conclusion

Equine-Assisted Psychotherapy is more than a feel-good add-on—it’s a trauma-informed, evidence-aligned approach that supports psychological healing for populations under chronic stress. While more rigorous studies are needed to confirm its physiological and long-term benefits, the data already points to its strong therapeutic potential.

References

Bergeron Boudreault, M. (2020). Effets de l’équitation thérapeutique sur les symptômes du trouble d’anxiété généralisée chez l’adulte : utilisation d’un schème expérimental à cas unique.

Cornelius-White, J. H. D., Joyce, S. E., & Taylor, M. (2024). Equine-assisted services for veterans with PTSD: A meta-analysis. Society & Animals.

Earles, J., Vernon, L. L., & Yetz, J. P. (2015). Equine-assisted therapy for anxiety and posttraumatic stress symptoms. Journal of Traumatic Stress, 28(2), 149–152.

Fisher, P., Lazarov, A., Lowell, A., Arnon, S., Turner, J., Bergman, M., & Ryba, M. (2021). Equine-assisted therapy for posttraumatic stress disorder among military veterans: An open trial. Journal of Clinical Psychiatry.

Matonti, T., Gitto, P., & McGrann, K. (2021). The effects of equine therapy on military veterans with PTSD. Journal of Student-Scientists' Research.

Rankins, E., Quinn, A., McKeever, K. H., & Malinowski, K. (2024). Ground-based adaptive horsemanship lessons for veterans with PTSD: A randomized controlled pilot study. Frontiers in Psychiatry, 15.

Tobin, K. (2024). The relationship between equine-assisted psychotherapy and client-therapist attachment on symptom reduction. International Journal of Psychology.

Wharton, T., Whitworth, J. D., Macauley, E., & Malone, M. G. (2019). Pilot testing a manualized equine-facilitated cognitive processing therapy (EF-CPT) intervention for PTSD in veterans. Psychiatric Rehabilitation Journal, 42(3), 251–259.