As veterans have high rates of posttraumatic stress disorder (PTSD) and historically poor treatment outcomes and high attrition, alternative treatments have gained much popularity despite lack of rigorous research. For this study published in The Journal of Clinical Psychiatry on August 31, 2021, a recently developed and manualized 8-session group Equine-Assisted Therapy for PTSD (EAT-PTSD) was tested in an open trial to assess its preliminary feasibility, acceptability and outcomes for military veterans.
Editor’s note: The Journal of Clinical Psychiatry published this open-access (free to anyone) article titled “Equine-Assisted Therapy for Posttraumatic Stress Disorder Among Military Veterans: An Open Trial.”
The research was conducted by Yuval Neria, PhD, Co-Director/Principal Investigator, Man O’ War Project, Columbia University Irving Medical Center; Professor of Medical Psychology Departments of Psychiatry and Epidemiology, Columbia University Irving Medical Center; Director, PTSD Research Program, Director, New York Presbyterian Military Family Wellness Center at New York State Psychiatric Institute and Prudence W. Fisher, Ph.D., Co-Director/Principal Investigator, Man O’ War Project; Columbia University Irving Medical Center; Associate Professor of Clinical Psychiatric Social Work (in Psychiatry) Columbia University, Vagelos College of Physicians and Surgeons; Research Scientist at New York State Psychiatric Institute.
The study found that manualized EAT-PTSD shows promise as a potential new intervention for veterans with PTSD. It appears safe, feasible and clinically viable. These preliminary results encourage examination of EAT-PTSD in larger, randomized controlled trials.
“Our findings that both PTSD and depressive symptoms significantly improved are very exciting because we demonstrated that our treatment is a viable alternative or supplemental treatment for those who suffer from PTSD,” said Dr. Fisher. “Importantly, the veterans liked the treatment and completed the protocol, which is not the case for many other PTSD treatments where dropout rates are high. Finally, because we created a manual for the protocol, the first well-specified treatment manual for any EAT treatment, it can be taught to others in the field.”
The study was conducted from July 2016 to July 2019. Sixty-three treatment-seeking veterans with PTSD enrolled. PTSD diagnosis was ascertained using the Structured Clinical Interview for DSM-5, Research Version (SCID-5-RV) and confirmed using the Clinician-Administered PTSD Scale (CAPS-5). Mean age was 50 years, and 23 patients (37%) were women. Clinician and self-report measures of PTSD and depression were assessed at pretreatment, mid-treatment, post-treatment and at a 3-month follow-up. An intent-to-treat analysis and a secondary analysis of those who completed all 4 clinical assessments were utilized.
Thirty-two patients (50.8%) showed clinically significant change (≥30% decrease in CAPS-5 score) at post treatment and 34 (54.0%) at follow-up. Post treatment assessment revealed marked reductions in both clinician-rated and self-reported PTSD and depression symptoms, which persisted at 3-month follow-up. Specifically, mean (SD) CAPS-5 scores fell from 38.6 (8.1) to 26.9 (12.4) at termination. Only 5 patients (8%) withdrew from treatment, 4 before mid-treatment and 1 afterward.
The Man O’ War Project at Columbia University Irving Medical Center is the first university-led research study to explore the use of and scientifically evaluate equine-assisted psychotherapy in treating veterans with PTSD, which includes developing a well specified treatment manual—the first of its kind—which will be made available to the field. The project began in 2015 with funding from philanthropist Ambassador Earle I. Mack, a veteran himself and a longtime thoroughbred owner/breeder, who was concerned about the mental health crisis facing veterans and his observation of anecdotal stories from various equine-assisted therapy groups, with no hard science to support their claims. Ambassador Mack approached David Shaffer, MD, former director of the Division of Child and Adolescent Psychiatry at the Columbia University/ New York State Psychiatric Institute and soon a team was formed, led by Dr. Prudence Fisher and Dr. Yuval Neria.
“We are so thrilled to see the results of this scientifically validated EAT study, which gives new hope to our brave veterans so deserving of our support. In addition, we have every reason to believe this protocol will be adaptable to other groups suffering from trauma, anxiety or PTSD,” said Ambassador Mack. “So many people have been impacted by recent events and the pandemic has made things even more difficult for all age groups. This study shows great promise that we can help not only our veterans but others facing anxiety issues and mental health challenges.”
The Man O’ War project has been supported by the Earle I. Mack Foundation, The Jockey Club, the David and Julia Koch Foundation, the Nicholson Family Charity Fund, the Mary & Daniel Loughran Foundation, the Viola Foundation, Gulfstream Park Racing Association, Gerald Parsky, Peter M. Brant, the Ganek Family Foundation, the Live Oak Foundation, the Reid Family Charitable Fund, Meta Aerospace Capital, LTD, and Tactical Air Support.