Researchers find therapeutic benefits in the “social and emotional geography of the stable”

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Young adults with substance-use problems have told researchers of their ability to construct a “positive self” when working around stables.

The study participants talked of a self image around the stable environment in which they were accepted and could cope with challenges. It was, they said, a positive move away from being the “patient” receiving treatment for a problem or disease.

The study team in Norway, Ann Kern-Godal, Ida Halvorsen Brenna, Espen Ajo Arnevik, and Edle Ravndal, noted that the inclusion of horse-assisted therapy in substance-use disorder treatment was rarely reported.

Their previous research had shown improved treatment retention and the importance of the patient–horse relationship.

The researchers interviewed four men and four women receiving treatment for substance use problems about their experiences of the stable environment during their involvement in a horse-assisted therapy program.

Writing in the journal Substance Abuse: Research and Treatment, the researchers reported that patients described the horse therapy as a “break from usual treatment”.

They raised four interrelated aspects around their experience – a change of focus, activity, identity, and motivation.

This, according to the study team, suggested that the horse-based therapy was more than just a break from their usual treatment.

“The stable environment is portrayed as a context where participants could construct a positive self: one which is useful, responsible, and accepted; more fundamentally, a different self from the ‘patient/self’ receiving treatment for a problem,” Kern-Godal and her colleagues reported.

“The implications extend well beyond animal-assisted or other adjunct therapies. Their relevance to broader substance-use disorder policy and treatment practices warrants further study.”

They said getting patients to remain in substance use disorder treatment and complete the program was associated with improved prognosis. Preventing dropout, which often exceeded 50%, was a constant challenge to those working in the field.

“There is increasing popularity for alternative or complementary health treatment methods, such as yoga, art, music, gardening, or animal-assisted therapy, for substance use disorders,” they noted.

“An increasing volume of horse-assisted therapy literature claims benefits to health based on explanations more or less founded in psychological theories such as attachment and psychoanalysis.

“Other explanations focus on the characteristics of the horse.

“The outdoor, active, and less verbal therapeutic environment of the stable (as compared to the
verbal and enclosed atmosphere of the therapy room) is also regarded as more beneficial for some clients.”

In 2011, the Department of Addiction Treatment (Youth) at Oslo University Hospital embarked on a multifaceted study of horse therapy as an integral part of its substance-use disorder treatment program.

The researchers found that those who participated in the horse program remained in treatment significantly longer and were more likely to complete their agreed treatment program.

A later study which focused specifically on the patient–horse relationship found that participants perceived the horse to be an important facilitator of a positive self-construct and an emotional support during treatment.

“In another study of the reasons for dropping out of treatment from the same institution, participants spontaneously cited horse-assisted therapy as a rare, positive aspect of their substance use disorder treatment.

“While not mentioning horses specifically, they emphasized the activity and exercise aspects of time spent in the stable.

“The horse obviously has a pivotal role in horse-assisted therapy. However, there appear to be important physical, social, and emotional contextual aspects of the stable environment that deserve further study.”

With this background, the study team wanted to obtain a better understanding of how patients experienced the stable environment and other contextual aspects of horse therapy as part of their treatment.

The four men and four women interviewed for the study were aged 20 to 30, with an average age of 24.8 years. They were recruited from patients undergoing treatment at the Department of Addiction Treatment (Youth), who had agreed to participate in research.

All participants highlighted horse-assisted therapy as a pleasant variation from their usual treatment and as something they could look forward to.

Activity, as well as the opportunity to do something productive, was highlighted by most participants as an important part of the horse therapy “break”.

“[It was] best illustrated in the words of one participant who said ‘first and foremost I like to work”. Participants also readily communicated through these expressions of ‘doing something useful’.

“Simple, pragmatic aspects of horse-assisted therapy work, like feeding the horses or helping to stack the hay, were seen as both different and important because they were seen as necessary.”

The positive effect from the horse therapy staff’s appreciation of participants’ work in the stable did
not go unnoticed, the study team noted.

“Most participants highlighted their relationship with the horse-assisted therapy team as different from their relationship with other therapists and staff. The horse-assisted therapy team was generally described as more friendly than traditional therapists.”

The stable environment was considered more relaxed than the main treatment base, with horse therapy staff generally working alongside patients doing stable duties.

“Participants implied that the horse-assisted therapy team acted toward them in a way that gave them a sense of being normal people. It was implied that the experience of being included in the stable working environment also gave participants a sense of belonging, and direction.”

While most participants described having a positive view of being involved with horses, two initially had a very indifferent or downright negative attitude to horses. They described thinking of horses as “big, and ugly and spooky” before experiencing the therapy.

stable-bedding“Both described how they gradually had become more open to the possibility of participating in horse-assisted therapy, and how their attitude to the horses had changed when they had spent some time in the stable.”

Discussing their findings, the study team said: “Participants generally presented their time spent in the stable as a consistently positive and different experience, which they looked forward to.

“Having something pleasant and active to look forward to gave a sense of structure and endurance to their experience, which they seemed to contrast to an otherwise negatively connoted mere ‘existence’ in treatment.”

They continued: “Throughout participants’ accounts, the stable is constructed as a context where they experience different versions of themselves: where, in addition to enjoyment, they felt responsible and necessary, and achieved and contributed to something.

“By perceiving themselves as someone who could contribute to, or achieve, something useful in the stable context, they were able to draw a positive contrast between themselves ‘as I am’ with their concept of themselves as a ‘patient’ or ‘drug addict’ – a problem.

“In this, there is an implicit acknowledgment of the social and emotional geography of the stable.”

The study team said their work had obvious implications for those interested in horse-based therapy.

“Participants’ self-perception of being a ‘person’ in the stable, in contrast to being a ‘patient’ in their usual treatment location, is, we believe, the most significant finding from this study – one previously unreported in the scientific literature as far as we are aware.

“The possible relationship of this finding to aspects of recognition theory is noted with the suggestion that it should be explored further.

“Similarly, this finding calls for exploration in other settings of how the physical, social, and emotional geography of the therapeutic landscape may facilitate patients’ identification with the treatment program and encourage a positive self-concept, thereby enabling them to be, and to be seen as, a person in treatment rather than as a patient.

“As most addiction treatment programs struggle to find means of combating high dropout rates, it is important to test factors that patients themselves identify as making treatment more endurable and/or facilitating retention.”

Kern-Godal et al. More Than Just a Break from Treatment: How Substance Use Disorder Patients Experience the Stable Environment in Horse-Assisted Therapy.
Substance Abuse: Research and Treatment 2016:10 99–108 doi: 10.4137/SART.S40475.

A link to the study, published under a Creative Commons License, can be found here

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