Therapeutic riding found to be clinically effective for troubled war veterans

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Therapeutic horse riding is clinically effective in easing the symptoms of post-traumatic stress disorder (PTSD) in military veterans, the findings of an American study suggest.

The researchers also found that riding for longer appeared to improve the outcome for the troubled veterans.

Rebecca Johnson and her colleagues say large numbers of US veterans are diagnosed with PTSD and/or traumatic brain injury after deployment, leading to an urgent need for effective ways to reduce symptoms and increase their ability to cope.

Symptoms of PTSD include anxiety, flashbacks, and emotional numbing. These symptoms increase health-care costs for stress-related illnesses and can make their return to civilian life difficult.

The researchers devised a study to test whether a six-week therapeutic horse-riding program would decrease their PTSD symptoms, address their emotional problems, and improve their coping abilities.

They noted that while horses and therapeutic riding had previously been used in treating PTSD, there were no randomized controlled trials studying its effectiveness in reducing levels of the condition.

Twenty-nine mostly older veterans were enrolled in the trial, all of whom had been diagnosed with PTSD or PTSD with traumatic brain injury.

Fifteen were randomly assigned to the horse riding group and 14 went on a wait-list (the control group), which required them to wait six weeks for the riding program while the other group completed it.

Demographic and health history information was collected from all participants, and PTSD symptoms were measured using the standardized military PTSD checklist. The study team also used extra tests to learn more about any changes in the way they coped, the way they regulated emotion, and their feelings of loneliness.

Veterans rode the same horse for the entire study period. They learned basic horsemanship and completed tasks on horseback. Classes consisted of grooming and interacting with the horse before  putting on the gear and riding it. Classes varied as the program progressed, with riding peaking at 30 minutes in a session.

“Participants had a statistically significant decrease in PTSD scores after three weeks of therapeutic horse-riding,” the researchers reported. There was a statistically and clinically significant decrease after six weeks of riding.

Analysis showed that participants had a 66.7% likelihood of having lower PTSD scores at three weeks and a 87.5% likelihood at six weeks.

The results for coping self-efficacy and emotional regulation did not reach statistical or clinical significance, although a trend toward improvement was seen.

Results for emotional loneliness were opposite the predicted direction, worsening slightly, although it was again not statistically significant. “The participants expressed sadness that the therapeutic horse-riding program was ending. It may be that loneliness scores at six weeks were related to the veterans’ anticipation of the completion of the program.”

The evidence showed that riding for longer periods had a stronger influence on outcome than riding for shorter periods.

“The findings suggest that therapeutic horse-riding may be a clinically effective intervention for alleviating PTSD symptoms in military veterans,” they concluded.

However, the study team added that the decline in PTSD symptoms was not uniform for all participants.

Putting their work in clinical context, the researchers said a 10-point PTSD score improvement is the minimum threshold for determining clinically meaningful improvement.

“Our findings show that our participants’ mean improvements in PTSD symptoms were six points at the three-week data point and 13 points at the six-week data point while riding.

“As such, participants’ PTSD symptoms had beneficially responded to therapeutic horse-riding after only three weeks, and by the end of the program, they had definitively achieved a clinically meaningful improvement in PTSD symptoms.

“Our findings suggest that riding is a constructive activity for reducing PTSD symptoms in our participants and that riding for longer periods of time has a stronger influence than riding for shorter periods of time.

“The fact that 13 of our participants had served in the Vietnam war era, and thus had perhaps been living with PTSD for decades, yet derived a clinical meaningful improvement in their PTSD symptoms from a brief six-week therapeutic horse-riding intervention, is promising.”

Their findings, they said, provided evidence that therapeutic riding was effective at improving coping skills and in lessening the veterans’ difficulties with emotional regulation, especially with longer riding interventions.

They said they recognized that outside variables may have influenced their findings, and the question arose: “What components contributed to the change?

“First, we recognize that there is an inherent selection bias in therapeutic horse-riding research because only participants who were willing to ride a horse sought to enroll.

“However, we argue that no intervention toward which a person has a negative predisposition will be of benefit to that person; it is not possible to force people to participate in psychosocial interventions that they are unwilling to experience.

“We do not purport that therapeutic horse-riding is the intervention of choice for all veterans with PTSD, but only for those willing to ride horses.”

They continued: “Veterans expressed interest in participating in the study to try something new or rekindle a childhood experience. Many had ridden horses as children and recalled this fondly.

“Fortunately, veterans who wanted to continue therapeutic horse-riding were able to do so after the study was completed.

“Therapeutic horse-riding is clearly not a replacement for conventional therapies used to treat PTSD, but as a complementary therapy, riding centers may be a readily accessible resource to veterans in rural areas.”

They said horse-riding therapy may be particularly promising for older veterans, such as the majority in the study sample, who may have been diagnosed with PTSD many years ago. “It may be important for health systems to recognize such promise by supporting therapeutic horse-riding as a reimbursable complementary therapy.”

Johnson was joined in the study by David Albright, James Marzolf, Jessica Bibbo, Hayley Yaglom, Sandra Crowder, Gretchen Carlisle, Amy Willard, Cynthia Russell, Karen Grindler, Steven Osterlind, Marita Wassman and Nathan Harms.

Effects of therapeutic horseback riding on post-traumatic stress disorder in military veterans
Rebecca A. Johnson, David L. Albright, James R. Marzolf, Jessica L. Bibbo, Hayley D. Yaglom, Sandra M. Crowder, Gretchen K. Carlisle, Amy Willard, Cynthia L. Russell, Karen Grindler, Steven Osterlind, Marita Wassman and Nathan Harms
Military Medical Research 2018 5:3 https://doi.org/10.1186/s40779-018-0149-6

The study, published under a Creative Commons License, can be read here

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