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People receiving help for substance misuse found horse-assisted therapy to be a welcome break from more traditional treatments, but researchers say the evidence suggests it offers far more than that.
Ann Kern-Godal and her colleagues said patients also talked about a welcome change of focus, being involved in an activity, positive thoughts around their identity, and the motivation factor.
The University of Oslo researchers have explored the use of horse-assisted therapy for people with substance-use disorder from several angles.
They reported in a previous study that people receiving help through a Norwegian hospital for substance-use problems were far more likely to complete their treatment if they opted to take part in added horse-assisted therapy.
Preventing treatment dropout, which often exceeds 50%, is a constant challenge to those engaged in such work.
Patients have described horse-assisted therapy as a rare, positive aspect of their treatment. While not mentioning horses specifically, they emphasized the activity and exercise aspects of time spent in the stables.
Their research has also highlighted the importance of the patient-horse relationship to those seeking treatment.
The study team, based at the University of Oslo and its hospital, set out to learn more about feelings toward the stable environment where they received the therapy, questioning eight patients.
The patients portrayed the stables as somewhere where they could build a positive self, one which is useful, responsible, and accepted. More fundamentally, it was a different self from the one receiving treatment for a problem.
The implications of this extended well beyond animal-assisted or other add-on therapies, they reported in the journal Substance Abuse: Research and Treatment.
“Their relevance to broader substance-use disorder policy and treatment practices warrants further study.”
The authors had noted the increasing popularity of alternative or complementary health treatment methods, such as yoga, art, music, gardening, or animal-assisted therapy, for substance-use problems.
They said that while the horse obviously had a pivotal role in horse-assisted therapy, there appeared to be important physical, social, and emotional aspects from tasks in the stable that deserved further study.
The patients enlisted in the study were in a program generally reserved to 16 to 26-year-olds following detoxification. Patients in residence spent their time, according to their treatment plan, in individual or group therapy. All treatment units were in an area near the stables, where the horses were visible.
The stables housed five horses, of different breeds, appearance, and temperament. Each horse was carefully selected, trained, and exclusively used in therapeutic work with substance-use disorder patients.
Experienced therapists, who were also qualified riding instructors, were responsible for horse-assisted therapy. They provided a structured 12-session therapy program.
The four men and four women in the study were aged 20 to 30. They were at different stages of their treatment program when interviewed at various times over a ten-week period. Five were residents at the inpatient unit, two were residents in the assessment/intermediate unit, and one attended for day treatment.
All were undertaking therapy at the hospital voluntarily.
In their interviews, all participants highlighted the horse therapy as a pleasant variation from their usual treatment and as something to look forward to.
For others, being in the stable was associated with specific and positive effect: “I’m always really happy when I’m going down to the stable … it is very positive for me”
“For most, however, relationship issues, with self and/or others, were alluded to as the most important part of the changed focus associated with horse-assisted therapy.
“For some, being in the stable provided an opportunity to focus on ‘the here and now’, to turn their attention away from their own, often troublesome, issues and ‘forget everything’.”
The patients also talked about “doing something useful”, best illustrated in the words of one participant who said, “first and foremost I like to work”.
Their recognition of the sense of purpose and wellbeing associated with doing productive activity was noted by the researchers. “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 interviews also cast light on identity. “During the interviews, participants seemed to share an idea about the ‘real me’.
“They felt that both the horses and the horse-assisted therapy team appeared to recognize them as persons and implied a contrast with their experience of ‘usual’ treatment at ‘the house’.”
The researchers found that horse-assisted therapy was an obvious inducement for some (young women in particular) to come to the treatment unit in the first place and then to remain there.
“From the patients’ genuine and detailed accounts, we found that the stable provided a context where they were able to construct a positive self.” As such, horse therapy appeared to be more than just a break from treatment as usual.
“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.”
The patients’ accounts portrayed the stable as a place where they experienced different versions of themselves, where, in addition to enjoyment, they felt responsible and necessary, and achieved and contributed to something.”
More than Just a Break from Treatment: How Substance Use Disorder Patients Experience the Stable Environment in Horse-Assisted Therapy
Ann Kern-Godal, Ida Halvorsen Brenna, Espen Ajo Arnevik, Edle Ravndal