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Equine Facilitated Psychotherapy: A Pilot Study of Effect on Posttraumatic Stress Symptoms in Maltreated Youth
Abstract
Chronic maltreatment of children can provoke a host of neuropsychological and physiological anomalies that manifest as developmental, emotional, behavioral, cognitive, and psychosocial disorders and posttraumatic stress disorder (PTSD). Considering the multidimensional landscape of trauma and PTSD alongside the nonverbal and symbolic language of children, a nondidactic, somatic treatment intervention that engages the body’s own inner communication system seems well suited for young victims of maltreatment. The authors describe the results of a pilot study utilizing equine facilitated psychotherapy (EFP), an experiential, cognitive-behavioral based intervention, for the treatment of PTSD symptoms of maltreated youth. A purposive sample of 11 youth ages 10-18 who presented with PTSD symptomatology participated in eight weekly EFP outpatient sessions 1.5 to 2 hours in length. Pre and post, as well as midpoint, tests were administered. Results suggest the EFP treatment effects are multimodal, working in multiple directions at the same time. Results also suggest that the EFP model may be a viable psychotherapy for traumatized youth suffering PTSD symptomatology.
... There was some repetition of behavioural assessment scales used. Two studies (7%) used both of the same two behavioural assessments, Children's Revised Inventory of Events Scale (CRIES-13) and Human-Animal Bond Scale (HABS) in their methods (44,45,47). Notably, these studies also shared one of the same investigators (McCullogh). ...
... A total of six studies (22%) (eight records; 25%) included in the final analysis targeted youth survivors of trauma or abuse, or related issues, such as PTSD. Three studies (50%; 11% of total) identified a target population of youth with a history of trauma (44,45,47,48), while two studies (33%; 7% of total) focused on trauma in family relations, with one study focused on children of parents with problematic substance use (46) while the other focused on children who have experienced intra-family violence (49). The remaining study specifically targeted youth survivors of sexual abuse (24,61). ...
... All initiatives in this category reported positive outcomes. All seven studies with quantitative methods found significant positive associations between the interventions and outcomes assessed, including a decrease in PTSD symptoms (45,47), an increase in human-animal bonding (44), decreased depression (24,48,61) and anxiety symptoms (24,48), somatosensory complaints and behaviour dysregulation (48), and an increase in global functioning scores (49). Dunlop and Tsantefski reported increased feelings of safety and security and personal and social development as key themes from their analysis (46). ...
Equine-assisted services (EAS) are gaining popularity as ways to promote psychological health and social well-being. EAS may show particular promise as culturally appropriate initiatives for at-risk Indigenous youth, as they are thought to align well with Indigenous ways of knowing which place emphasis on relationships between the land and all living beings. We seek to better understand previous uses of EAS as initiatives for at-risk youth populations, including Indigenous populations, and learn about which outcomes have been addressed in the literature with an EAS initiative by conducting a scoping review. The review focused on initiatives targeting at-risk youth aged 10-18 years of age in Canada, Australia, New Zealand, and the United States. A total of 27 studies were included in the final analysis from all target countries except New Zealand. The target populations were further divided into four subgroups: at-risk youth, youth with mental health disorders and/or learning disabilities, youth survivors of trauma/abuse, and at-risk Indigenous youth. Overall findings of the review suggest EAS are promising approaches for achieving therapeutic and learning goals with the potential to be successful with both Indigenous youth and at-risk youth more broadly.
... The two Australian studies were conducted at the same location, employed the same therapeutic intervention with different populations and four of the six authors were named on both papers (Kemp et al., 2014;Signal et al., 2013). One author was named on two papers from the USA, with different therapeutic interventions and populations (McCullough et al., 2015;Mueller and McCullough, 2017). ...
... There was variability in the studies' research methodology: four studies used a pre-and post-test design with a (quasi)-matched control group (Balluerka et al., 2014(Balluerka et al., , 2015Hamama et al., 2011;Muela et al., 2017); three studies used a repeated measures design with treatment group only (Kemp et al., 2014;McCullough et al., 2015;Signal et al., 2013); two studies used a pre-and post-test design with the treatment group only (Farber and Sabatino, 2007;Tucker et al., 2014); and one study used a repeated measures design with two groups and quasi-random assignment (Mueller and McCullough, 2017). Various mental health outcomes were measured using diverse scales (Table 2). ...
... The psychosocial interventions employed in the studies included four equine-assisted or equine-facilitated (psycho)therapies with young people (Kemp et al., 2014;McCullough et al., 2015;Mueller and McCullough, 2017;Signal et al., 2013). Weekly sessions generally lasted from ninety minutes to two hours, with an eight-to ten-week duration. ...
The natural environment is increasingly used in therapeutic psychosocial interventions for young people who have experienced trauma. However, as the research in this area has yet to be synthesised, very little is known about the types and outcomes of interventions. This prevents the optimisation of social work interventions in outdoor settings. Consequently, a scoping review of peer-reviewed research published from 2008 to 2018 was undertaken to examine how nature is being used in psychosocial interventions with young people aged ten to twenty-four years who have experienced trauma and the impact of these interventions on young people’s mental health. The database search identified 5,425 records; however, only ten papers met the inclusion criteria. These papers suggested that positive changes across a range of mental health outcomes for young people were achieved in psychosocial interventions which were situated in, or made use of the natural environment, although it is unclear whether the environment influenced the outcomes. The scoping review also highlighted the need for conducting further research that examines how environmental factors contribute to clinical change for young people who have experienced trauma.
... In particular, equine-assisted therapy is becoming an increasingly popular therapeutic strategy for treating individuals of all ages with a range of physical and/or emotional conditions, such as cerebral palsy, multiple sclerosis, motor dysfunction, autism spectrum disorders, schizophrenia spectrum disabilities, learning disabilities, and trauma recovery (Freund et al. 2011). Equine-facilitated psychotherapy (EFP) is a specialized form of equine-assisted therapy that is also a method of experiential psychotherapy that addresses mental health challenges by means of a therapist and equine partnering as co-facilitators (Bachi et al. 2012;McCullough et al. 2015). Grounded in the natural affinity existing between horses and humans combined with traditional psychotherapy practices (Bachi et al. 2012), EFP not only offers a more complete psychotherapy experience (Karol 2007) but has also shown to significantly decrease psychological symptoms in individuals having experienced abuse-related trauma (Kemp et al. 2014). ...
... It appears therefore, that EFP may be especially appealing to youth who may be resistant to more traditional therapeutic approaches. In fact, preliminary research exploring EFP as an intervention for youth with PTSD has demonstrated positive effects (McCullough et al. 2015;Wilson et al. 2015). However, additional research with larger sample sizes and the use of control groups is needed to provide evidence for EFP as a viable complementary approach to traditional interventions for this population. ...
... Based on previous work with the CRIES-13 measure, a score of 12 or higher on the CRIES-13 was used as an appropriate eligibility criterion for assessing clinically significant levels of post-traumatic stress symptomology (McCullough et al. 2015;Perrin et al. 2005). The CRIES-13 instrument was administered at baseline (Week 1), midway through the intervention (Week 5), and post-test (Week 10) for both the treatment and control groups. ...
Equine-assisted therapy has become an increasingly popular complementary mental health treatment approach, but there is limited empirical research assessing the effectiveness of this practice. In particular, equine-facilitated psychotherapy has many potential benefits for the treatment of trauma in youth. The purpose of the proposed study was to investigate changes in levels of post-traumatic stress symptomatology and levels of the human-animal bond in children and adolescents ages 10–18 over the course of a 10-week equine-facilitated psychotherapy (EFP) intervention. Youth in the treatment group (n = 36) participated in 10 weekly two hour EFP sessions, and were compared on changes in post-traumatic stress symptoms with a control group of participants (n = 32) who continued to receive the already existing traditional therapeutic services provided by their treatment facility or outpatient therapist. Findings suggested a significant decrease in post-traumatic stress symptoms across the intervention for both the treatment and control group, but the treatment group did not decrease significantly more than the control group. These findings suggest that EFP may be an effective additional treatment modality for post-traumatic stress symptoms, but there was no evidence from this initial study that EFP was significantly more effective than traditional office-based therapy. Further research and discussion of the relative benefits of EFP compared to traditional treatment modalities is warranted.
... This occurred for one study included in this meta-analysis (McCullough, 2011). McCullough, Risley-Curtiss, and Rorke (2015) was a publi- cation from McCullough's (2011) dissertation. Therefore, McCullough (2011) was included as it had more comprehensive information, and McCullough et al. (2015) was excluded. ...
... McCullough, Risley-Curtiss, and Rorke (2015) was a publi- cation from McCullough's (2011) dissertation. Therefore, McCullough (2011) was included as it had more comprehensive information, and McCullough et al. (2015) was excluded. ...
The present meta-analysis examined the efficacy of animal-assisted psychotherapy for individuals who have experienced trauma. Eight studies quantitatively assessed the treatment effects of involvement in animal-assisted psychotherapy. A random effects model was used to aggregate each study into an overall effect size. Eight effect sizes were included in the pre-versus post-comparison analysis. The results indicate a large effect size (Hedge’s g = 0.86, p < 0.001, 95% CI [.53, 1.18]). Two effect sizes were included in the treatment versus control comparison analysis. The results indicated a small to moderate effect size (g = 0.46, p = 0.03, 95% CI [0.04, 0.06]). Limited moderator analyses were able to be conducted due to lack of consistent reporting across studies. Place of study and percentage of female participants in the treatment group were found to statistically moderate the effect of animal-assisted psychotherapy. The results indicate that animal-assisted therapy is an efficacious treatment for trauma.
... Five studies have been identified as examining the effectiveness of EFP for trauma survivors across multiple systematic reviews of EFP literature (Lentini and Knox 2015;O'Haire et al. 2015). One of these is a case study of one adult with Posttraumatic Stress Disorder (PTSD) (Nevins et al. 2013) and the others focus on traumatized youth (Kemp et al. 2014;McCullough et al. 2015;Signal et al. 2013;Yorke et al. 2013). In samples of child sexual abuse survivors, EFP was shown to reduce symptoms of depression (Signal et al. 2013), as well as posttraumatic stress, anxiety, and externalizing behavior problems (Kemp et al. 2014). ...
... Notably, Signal et al. (2013) emphasize that the effect sizes associated with reductions in internalizing symptoms found in their study are larger than those found in TF-CBT research. In addition, studies of youth with a PTSD diagnosis who underwent EFP evidenced reductions in PTSD symptomatology (McCullough et al. 2015) and inconclusive findings related to cortisol levels (Yorke et al. 2013). While all of these studies had small sample sizes (ranging from 4 to 30) and did not involve control groups or randomization, preliminary results suggest that there are many potential benefits associated with EFP for traumatized youth, including those with complex trauma histories (e.g., child sexual abuse). ...
Emerging research suggests that Equine Facilitated Psychotherapy (EFP) may be beneficial for traumatized youth. In addition, complex trauma (i.e., multiple and/or prolonged developmentally adverse traumatic events which are typically interpersonal in nature) treatment research is still growing and there is a need for the development and examination of novel treatments for youth with complex trauma histories. The current article describes a promising EFP model for this population called Equine Facilitated Therapy for Complex Trauma (EFT-CT). EFT-CT embeds EFP practices within Attachment, Regulation and Competency (ARC), an extant evidence-based complex trauma treatment framework for children and adolescents. The authors provide three case studies using both observational data provided by clinicians, as well as longitudinal measures of psychosocial functioning, to illustrate the potential promise of EFT-CT. The article concludes with a discussion about implications for EFP treatment and research.
... A sense of mastery is built through clientdirected touch, balance, and bodily control within the context of a safe, co-regulatory dynamic (Kendall and Maujean, 2015). Several non-randomized, small sample-sized studies reported reductions in depressive and PTSD-associated symptoms after EFP (Nevins et al., 2013;Signal et al., 2013;Yorke et al., 2013;Kemp et al., 2014;McCullough et al., 2015; for a review, see Lentini and Knox, 2015;O'Haire et al., 2015). ...
Although the manifestation of trauma in the body is a phenomenon well-endorsed by clinicians and traumatized individuals, the neurobiological underpinnings of this manifestation remain unclear. The notion of somatic sensory processing, which encompasses vestibular and somatosensory processing and relates to the sensory systems concerned with how the physical body exists in and relates to physical space, is introduced as a major contributor to overall regulatory, social-emotional, and self-referential functioning. From a phylogenetically and ontogenetically informed perspective, trauma-related symptomology is conceptualized to be grounded in brainstem-level somatic sensory processing dysfunction and its cascading influences on physiological arousal modulation, affect regulation, and higher-order capacities. Lastly, we introduce a novel hierarchical model bridging somatic sensory processes with limbic and neocortical mechanisms regulating an individual’s emotional experience and sense of a relational, agentive self. This model provides a working framework for the neurobiologically informed assessment and treatment of trauma-related conditions from a somatic sensory processing perspective.
... Additionally, individuals have been found to focus less on fear and guilt and more on independence and self-support when participating in psychotherapy incorporating equines (Klontz et al.,2007). Participation in psychotherapy incorporating equines has also been found to alleviate some post-traumatic stress disorder symptoms in maltreated youth (McCullough et al., 2015) and veterans (Burton et al., 2019). ...
An annual 2019 survey of directors of college counseling centers reported that 60.7% of students seeking counseling present with the predominant concern of anxiety. Furthermore, counseling centers across the United States have seen a rise in the number of students requesting services in recent years, frequently resulting in wait lists for students to receive counseling. Group psychotherapy sessions may mitigate wait times; however due to student anxiety and negative stigma surrounding mental health treatment it can often be challenging to attract students to participate in groups compared to individual sessions. This pilot study aimed to investigate the efficacy of group psychotherapy incorporating equines for undergraduate women college students presenting with concerns of anxiety. Implementing the Equine Assisted Growth and Learning Association’s model of psychotherapy, six women participants attended one 90-minute group session per week for 7 weeks on the campus of North Dakota State University. Students completed the Self Compassion Scale (SCS) and the Depression Anxiety Stress Scales (DASS) at weeks 0 and 7 as pre and post measures of the intervention. A significant increase was observed in the common humanity subscale of the SCS; however, no other differences were found in the remaining SCS subscales nor in the DASS subscales. Anecdotally, multiple students expressed that they would not have persisted in coming to group without the horses present. Furthermore, there was markedly improved attendance rates in the psychotherapy incorporating equine group compared to other group therapies at the counseling center. We recommend that future research examine whether psychotherapy integrating both horses and the tenets of self-compassion can help woman college students improve their anxiety management skills and become more resilient.
... The change in PTSD symptom severity between baseline and end of treatment of AAI was reported in 20 studies (Burton et al., 2019;Craven, 2013;Dietz et al., 2012;Earles et al., 2015;Faye, 2003;Gómez, 2016;Hamama et al., 2011;Johnson et al., 2017;Kemp et al., 2014;Kloep et al., 2017;Lanning et al., 2017;Malinowski et al., 2018;McCullough, 2011;Mueller & McCullough, 2017;Naste et al., 2018;Romaniuk et al., 2018;Sheade, 2015;Signal et al., 2017;Steele et al., 2018). There is a large variability of effect sizes between different studies ranging from −0.38 to −1.64 (see Table 3). ...
Background: Animal-assisted interventions (AAI) are increasingly applied for people with post-traumatic stress disorder (PTSD) symptoms albeit its effectiveness is unclear.
Objectives: To examine the effectiveness of AAI for treating PTSD symptoms.
Method: We searched 11 major electronic databases for studies reporting quantitative data on effects of AAI for children and adults with PTSD symptoms. Of 22ʹ211 records identified, we included 41 studies with 1111 participants in the systematic review comprising eight controlled studies with 469 participants in the meta-analysis. We conducted random-effects meta-analyses with all controlled studies based on standardized mean differences (SMD), and calculated standardized mean change (SMC) as effect sizes for studies with a pre-post one-group design. Two independent researchers assessed the quality of the included studies using the NIH Study Quality Assessment Tools. The primary outcome was PTSD or depression symptom severity measured via a standardized measurement at pre- and post-intervention assessments.
Results: There was a small but not statistically significant superiority of AAI over standard PTSD psychotherapy (SMD = −0.26, 95% CI: −0.56 to 0.04) in reducing PTSD symptom severity while AAI was superior to waitlist (SMD = −0.82, 95% CI: −1.56 to 0.08). Getting a service dog was superior to waiting for a service dog (SMD = −0.58, 95% CI: −0.88 to −0.28). AAI led to comparable effects in reducing depression as standard PTSD psychotherapy (SMD = −0.03, CI: −0.88 to 0.83). Pre-post comparisons showed large variation for the reduction in PTSD symptom severity, with SMCs ranging from −0.38 to −1.64, and for depression symptom severity, ranging from 0.01 to −2.76. Getting a service dog lowered PTSD symptoms between −0.43 and −1.10 and depression with medium effect size of −0.74.
Conclusions: The results indicate that AAI are efficacious in reducing PTSD symptomatology and depression. Future studies with robust study designs and large samples are needed for valid conclusions.
... EFP serves those seeking assistance in different areas of their lives including, but not limited to, improving relationships, processing trauma, grieving the loss of a loved one, working through anxiety and depression, identifying and reaching goals, learning effective coping skills, recovering from addictions and maximizing social, emotional, and behavioral abilities. EFP has been found to lower stress across populations including youths (Bachi & Parish-Plass, 2017;Burgon, 2011Burgon, , 2013McCullough, Risley-Curtiss, & Rorke, 2015;Vincent & Farkas, 2017). Bachi and Parish-Plass (2017) and Burgon (2011Burgon ( , 2013, evaluated the risk and resilience of "at-risk" youth working with mental health specialists in EFP. ...
An increased understanding of integrated behavioral healthcare highlights the importance
of mental and physical wellness anchored by person-centered interventions. Evidence is
accumulating in support of non-traditional, empirically supported mental health interventions
such as equine-facilitated psychotherapy (EFP). Historically and currently, insurance companies neglect to cover EFP as a prevention and treatment strategy for children, youth, and families. Without coverage, the cost of participating in EFP is a financial barrier to accessing the intervention. Not covering and not reimbursing costs for this non-traditional intervention represents a crucial misstep by the insurance industry. EFP’s strong history and
professionalization, its comparable cost to talk therapy, a growing research base demonstrating EFP’s benefits for youth, and policy efforts toward increasing person-centered, innovative, integrated healthcare approaches suggest greater access to interventions such as EFP is needed. Because EFP may be more accessible to those who might not traditionally attend or respond positively to talk-therapy sessions, it should not be available only to those with the most privilege. Insurance coverage and reimbursement for EFP is necessary to advance the field, aid service standardization, integrate service tracking systems, and increase the research quality, all of which would ultimately benefit youth mental health. This paper aims to serve as a resource for social work practitioners looking to recommend, engage in, or advocate for EFP.
... Neben erwachsenen Patient_innen untersuchten einige Studien auch die Effekte bei Kindern und Jugendlichen. So konnte gezeigt werden, dass die PTBS-Symptome von Kindern und Jugendlichen mit Missbrauchserfahrungen nach acht pferdegestützten Psychotherapiesitzungen zurückgehen und sich die Mensch-Tier-Beziehung verbessert (McCullough, Risley-Curtiss & Rorke, 2015). Auch zeigten sich bei 36 Kindern und Jugendlichen nach einem zehnwöchigen pferdegestützten Psychotherapieprogramm Verbesserungen bei den PTBS-Symptomen (Mueller & McCullough, 2017). ...
Internationale Studien verweisen auf die großen Potenziale pferdegestützter
Therapie in der Behandlung von Traumata bei Kindern und Jugendlichen. Die Beziehungsqualität zwischen Pferd, Patient_in und Therapeut_in wird als zentrale Basis spezifischer Wirkungsdimensionen wie dem „Antagonismus zwischen Einflussnahme und Getragen-Werden“, dem „Bewegungsdialog“ oder handlungsorientierter Fürsorge identifiziert.
Anschauliche Praxisbeispiele zeigen, wie Modellvorstellungen pferdegestützter Traumatherapie bezüglich Beziehungsaufbau, dem Angebot eines sicheren Ortes sowie durch Erfahrungen der Entspannung, der Affektregulation, der Selbstwirksamkeit etc. zur effektiven Traumabearbeitung beitragen können, wenn unabdingbare Qualifikationsansprüche an Therapeut_innen und klare Tierschutzstandards gewährleistet sind.
... Authors who have applied a theoretical foundation have not been in consensus about which theory to use. Theories that have been extracted from published literature include but are not limited to: 1. psychoanalytic theory with a specific focus on gender roles, aggression, and developmental/executive functioning (Lentini & Knox 2009); 2. Rogerian theory which suggests that "at-risk" youths flourish within an environment of unconditional positive support (Kempt et al., 2014); 3. ecology theory which conceptualizes that if the environment changes, the person changes (Dunlop & Tsantefski 2017); 4. biophilia hypothesis which support the person-in-environment (Fine 206;McCullough, Risley-Curtiss, & Rorke 2015); 5. attention restoration theory, similar to biophilia, suggests that mammals (humans) utilize their innate affinity for the natural world to connect with others and with nature thereby clearing away the chaos of the urban environment at which point the mind is able to calm and focus (Button 2010;Kaplan 1995). In an effort to engage the field of psychology in conversation, Amior and Bastian (2015) conducted a thorough review of the literature to provide an argument for the state of research on human-animal relations. ...
Over the past two decades there has been a growing body of evidence, clinical and anecdotal, that equine-facilitated therapy (EFT) is a powerful tool for social workers and mental health clinicians. Recent research studies have begun to identify, name, and explain the mechanisms of EFT as a treatment tool for individual clients. However, EFT lacks a unified theoretical foundation; many studies lack an explicit theory altogether. Strong empirical support begins with a strong theoretical foundation, the research field lacks a unified voice for the scientific value of EFT. Attachment theory can guide the understanding of how EFT operates and can support more rigorous inquiry to evaluate its effect in mental health treatment. This article reviews the human-horse relationship in the context of attachment theory and concludes with a recommendation for research to strengthen the empirical base of EFT in social work practice.
... Children, for example, have been found to read more fluently when a dog is present (Jalongo, 2005). Horses are often included in animal-assisted activities and therapies, especially miniature breeds, for many of the same reasons (McCullough, Risley-Curtiss, & Rorke, 2015). Full-size horses are included in some psychotherapeutic settings because of their distinction as large prey animals, specifically creating an environment that is not socially buffered. ...
Equine-assisted psychotherapy (EAP) has emerged as a promising, evidence-based intervention for the treatment of trauma and stressor-related disorders. This experiential therapy offers an option for clients whose traumatic experiences render traditional talk therapies ineffective. Initial research on the most robust model of EAP, developed by the Equine Assisted Growth and Learning Association (EAGALA), indicates strong, positive effects for children, adolescents and adults who have experienced trauma. EAGALA was designed to allow for rigorous evaluation of efficacy, a clear theoretical base, standardized implementation, and ongoing training for practitioners. As the primary providers of mental and behavioral health services in the United States, social workers are keenly aware of the need for a portfolio of treatment methods to manage the increasing demand for services. EAP has emerged as an important addition to this portfolio, providing options for some the most vulnerable client populations.
... The purpose of this review was to focus on the use of EFT for PTSD and trauma. Four studies included youth (Goodkind et al., 2012;Kemp et al., 2014;McCullough et al., 2015;Yorke et al., 2013) . Children who had experienced sexual abuse or maltreatment showed improvement in PTSD after EFT, as well as in depression, anxiety, and internalizing/externalizing behaviors. ...
p>Equine-facilitated therapy (EFT) is a relatively new treatment for trauma and PTSD. EFT as well as animal assisted interventions in general have been introduced and implemented in mental health treatment for children and adults, though the research in support of these interventions has not kept up with practice. The purpose of this review is to examine the use of EFT for clients suffering from trauma/PTSD. Studies were included if PTSD/trauma was assessed and/or was measured as an outcome. A search of relevant databases resulted in nine peer-reviewed studies that met criteria. Studies are summarized and implications for future research are discussed. In general, findings suggest that EFT is a promising intervention for trauma/PTSD. Recommendations include a call for more research that includes veterans as well as for research that explicates the mechanisms by which EFT may be effective.
Key words: trauma, PTSD, equine, equine therapy</p
La Psicoterapia Asistida con Equinos en jóvenes expuestos a experiencias adversas en la infancia o trauma: una revisión sistemática Resumen En la última década, los estudios que incluyen animales en el tratamiento de salud mental para personas con antecedentes de trauma aumentaron en gran medida. Las actividades y la interacción con los equinos parecen ser particularmente ef icientes en jóvenes expuestos a experiencias adversas. La psicoterapia Asistida con Equinos (PAE), sigue siendo un enf oque innovador que utiliza caballos en el proceso terapéutico. A través de terapia asistida con equinos, varios estudios argumentan la mejora de comportamental, ansiedad, depresión, o adaptación interpersonal. Sin embargo, la diversidad de métodos, muestras y tipos de publicaciones representadas en la literatura hacen dif ícil para los prof esionales de Salud Mental sintetizar la investigación existente en guías útiles y recomendaciones de tratamiento. Además, muchos de los diseños de investigación tienen metodologías def ectuosas. Por lo tanto, la presente revisión pretende separar los artículos por su calidad, de los trabajos donde la investigación de intervención se haya centrado en resultados psicosociales (de f uncionamiento emocional, social o conductual). Se realizó una investigación sistemática-utilizando la metodología sugerida en la declaración de Prisma, de artículos de texto completo, escritos en inglés y publicados entre enero de 2000 y diciembre de 2021-abordando el uso de Terapias con Equinos para jóvenes sin discapacidades y que hayan experimentado violencia o trauma. La búsqueda inicial produjo un total de 394 artículos; se extrajeron 26 que cumplían con los criterios de inclusión. Los textos completos de las 26 obras seleccionadas f ueron examinados en detalle y 18 f ueron excluidos por contener metodologías def icientes o f alta de datos. Las 8 obras restantes f ueron analizadas. La investigación colectada muestra que el enf oque experiencial adaptado a l a PAE suele ser particularmente benef icioso para jóvenes expuesto a trauma en la inf ancia. Palabras Clave: tratamiento de salud mental; terapia con caballos; beneficios psicológicos; jóvenes en riesgo; experiencias adversas en la infancia, Interacciones con animales. 1. Introducción El trauma en la inf ancia puede ser particularmente devastador (Kemp et al., 2013; Hemingway y Sullivan, 2022; Craig, 2020). Los eventos traumáticos tienen un gran impacto y a largo plazo en la salud de los niños. Las causas son diversas y pueden incluir abusos-sean f ísicos, emocionales o sexuales-así como el abandono. Los entornos adversos durante la inf ancia están relacionados con un mayor riesgo a suf rir abuso de sustancias, apegos inseguros y problemas relacionados con el estrés, depresión, ansiedad o trastorno de estrés postraumático que tienen ef ectos negativos y duraderos si no se tratan (Dell et al., 2011; Mueller y McCullough, 2017). El trauma inf antil es un problema generalizado que af ecta a millones de niños. Sin embargo, involucrar ef ectivamente a los niños en el tratamiento tras el trauma es un desaf ío. En la última década, los estudios que incluyen animales en el tratamiento de salud mental para niños con antecedentes de trauma aumentaron en gran medida. Los animales utilizados para f acilitar la
Ce projet de thèse vise à étudier la pertinence d’utiliser la médiation équine en thérapie, auprès de personnes ayant des troubles addictifs. Dans un premier temps, il s’agira d’étudier l’influence du style d’attachement des patients sur leur niveau d’autonomie ; en s’appuyant sur des modèles théoriques tels que la théorie de l’attachement (Bowlby, 1969-82 ; Hazan, 1987) et la théorie de la motivation autonome (Decy et Ryan, 2000). Dans un deuxième temps, l’objectif sera d’explorer, de décrire et d’évaluer les processus à l’œuvre durant l’intervention à visée thérapeutique avec le cheval. Cette recherche s’inscrit dans le cadre de la compréhension et de l’évaluation des interventions complexes, axe fort de recherche du laboratoire APEMAC. Le questionnement principal de ce projet de thèse est d'interroger la place de la théorie de l’attachement dans les interventions en psychologie de la santé, notamment dans les programmes de prévention de la reconsommation et de la rechute. Quels liens la motivation et l’attachement entretiennent-ils ? En quoi les troubles de l’attachement peuvent-ils entraver le processus de guérison et la tenue de l’abstinence chez ces patients ? L’utilisation du cheval en thérapie peut-elle permettre d’augmenter le sentiment de sécurité interne des personnes et favoriser le développement de leurs compétences d’auto-régulation et de la motivation autonome ? En somme, peut-on augmenter l’autonomie des patients en leur proposant une intervention qui cible les troubles de l’attachement ? Le recueil des données sera réalisé au Centre de Soins de Suite et de Réadaptation en Addictologie « la Fontenelle ». Tout au long de cette recherche, nous prévoyons d’effectuer différentes évaluations quantitatives à l’aide d’outils psychométriques. Nous utiliserons également des méthodes qualitatives en réalisant des entretiens cliniques.
Experiencing trauma has long-lasting effects on a child's well-being, which may affect their occupational performance. This scoping review synthesized research on community-based interventions for children who have experienced trauma to highlight occupational therapists' role in trauma-informed care. We searched PubMed and PTSDPubs, including community-based interventional trials that addressed childhood trauma and excluding studies specific to refugees, sex-trafficking, significant comorbid diagnoses, and reviews. Eleven articles met criteria. Psychotherapy-based interventions (e.g., trauma-informed cognitive behavioral therapy), play and art therapy, yoga, and equine-facilitated interventions reduced posttraumatic stress symptoms. One article measured the impact of these symptoms on a child's function. Occupational therapists working in community settings appear to be underutilized in the treatment of children who have experienced trauma. Future studies should examine occupational therapists' potential to work alongside mental health providers in the community to optimize functional outcomes for children who have experienced trauma.
This thesis explores the role of interactions between people and horses in Equine-Assisted Therapy and Learning interventions (EAT/L) for disadvantaged young people (YP). Part one is a conceptual review of the theories, methods, and techniques currently used in EAT/L research and practice for disadvantaged YP. Part two is an empirical research paper that explores the role of interactions between people and horses in interventions at a charity offering EAT/L for disadvantaged YP. It aimed to develop a theory of the role of horse-human interactions in EAT/L from the views and experiences of people facilitating and participating in it. It is a qualitative study using semi-structured interviews with 13 young people and 6 staff, and observations of EAT/L sessions that they participated in. Part three is a critical appraisal of the research process. It focuses on the ways in which the researcher’s worldview, experiences, preconceptions and intentions influenced the research process, and how the process of the research influenced the researcher’s personal development and clinical and research practice.
The Clinical Practice of Equine-Assisted Therapy bridges theory, research, and practical methods to fill a rapidly developing gap for physical, occupational, speech, and mental health professionals interested in incorporating horses in therapy. Extensively researched and citing over 300 peer-reviewed journal articles, it examines core issues such as terminology, scope of practice, competency recommendations, horse care ethics, and clinical practice considerations. This book is an essential resource for professionals who wish to use a best-practices approach to equine-assisted therapy.
Equine-facilitated interventions have shown promise for facilitating emotional and behavioural changes in diverse groups. The current study evaluated the effectiveness of an equine workshop for vulnerable Guatemalan youth using a mixed-method approach. The 37 participants (Mage = 18.22, SD = 2.25, 14 girls) came from difficult circumstances including poverty and other risks. Using a wait-list control group design with random assignment, the effects of a 2-day equine-based workshop were evaluated. Participants completed quantitative measures of leadership, emotion regulation, aggression, and interpersonal response to threat. Mentors completed reports of aggression and prosocial behaviour. Self-reported leadership increased significantly in the group receiving the intervention; mentor reports of aggression revealed significant decreases. Focus groups with participants and family members reported multiple benefits, including improved emotion regulation. Equine-based interventions may provide at-risk Guatemalan youth with tools of leadership, reduced violence and aggression, and better emotion regulation. © 2016 The Author(s). Published by Informa UK Limited, trading as Taylor & Francis Group
This study examined the effectiveness of hippotherapy versus traditional therapy for children with language-learning disabilities. Three boys, ages 9, 10, and 12 years, and their parents independently completed a satisfaction questionnaire at the end of traditional therapy (T1) and again at the end of hippotherapy (T2). A comparison of the responses from T1 and T2 indicated that both the parents and the children reported improvement in speech and language abilities after both therapies. Overall, responses were noticeably higher following hippotherapy, with additional benefits of improved motivation and attention also reported.
The purpose of this study was to examine the effects of body-oriented therapy, as an adjunct to psychotherapy, for women in recovery from childhood sexual abuse. A two-group randomized design was employed. Eight women were recruited from a community sample and randomly assigned to an experimental group or wait-list control group. The experimental condition involved eight 1-h weekly sessions of body-oriented therapy, a combination of bodywork and the emotional processing of psychotherapy. The study examined changes in somatic and psychological symptoms, and the subjective experience of the intervention using a mixed method approach. Methods included interview, written questionnaire, and self-report outcome measures of psychological symptoms, dissociation, post-traumatic stress, and physical symptoms. Pre–post comparison of the two groups revealed remarkable decreases on SCL-90 global score, PTSD, number and severity of physical symptoms, and a trend toward decreased dissociation for the experimental compared to the control group. Qualitative results revealed the positive impact of body-oriented therapy on sense of inner security and psychotherapeutic progress.
Human-animal contact can influence psychological and physiological parameters important to health and welfare; nevertheless, there has been relatively little research on the variables that influence or mediate those health consequences. In addition, little attention has been paid on how to create or alter the animal interactions for the betterment of people and their animals. The investigation can be guided by two theoretical perspectives, which make powerful but different and testable predictions: the biophilia hypothesis and social support theory. Along with this theoretically driven research, there is a need for replication of salient research findings to resolve important discrepancies in the literature. Last, animal-assisted therapy (AAT) has to be placed in the context of alternative therapies now available to define its specificity, risks, and overall benefits.
T he developing child is a miracle of complexity. Billions of dynamic processes, internal (e.g., release of neurotransmitter at the synapse) and ex ternal to the child (e.g., interactions with caregiv ers and family), work together to influence, shape, and create the individual. Each person becomes unique, with his or her collection of strengths and vulnerabilities. In some cases the vulnerabilities can be profound, interfering with the capacity to engage others, participate in, contribute to, and ap preciate the fullness of life. For centuries scholars have known to some degree that the capacity to ex press full human potential is related to the balance of developmental opportunities and challenges. In extreme cases of developmental challenge such as maltreatment-threat, neglect, humiliation, degra dation, deprivation, chaos, and violence-children express a range of serious emotional, behavioral,
This study evaluates and compares the effectiveness of three group interventions on trauma symptoms for children who have been sexually abused. All of the groups followed the same treatment protocol, with two of them incorporating variations of animal-assisted therapy. A total of 153 children ages 7 to 17 who were in group therapy at a Child Advocacy Center participated in the study. Results indicate that children in the groups that included therapy dogs showed significant decreases in trauma symptoms including anxiety, depression, anger, post-traumatic stress disorder, dissociation, and sexual concerns. In addition, results show that children who participated in the group with therapeutic stories showed significantly more change than the other groups. Implications and suggestions for further research are discussed.
Although most human-animal bond research has focused on relationships between humans and pets, animals have been used for therapeutic purposes in a variety of settings. Therapeutic riding programs have demonstrated a positive impact on quality of life for people with disabilities. Equine-facilitated psychotherapy is a promising approach to address self-esteem, depression, and other emotional or psychological problems. Restoration of the trauma victim's capacity for recovery hinges on provision of safety and development of trust, self-esteem, and self-efficacy. Thus, recovery from trauma represents an ideal context for exploring the therapeutic impact of equine-human relationships. The six participants in this study recognized that their pre-existing relationships with horses were therapeutic during recovering from trauma, defined as sufficient to have caused significant change in the participant's life. Semi-structured interviews and video-tapes of horse-rider interaction were used to describe the nature of the equine-human bond and its contribution to recovery from trauma. The equine-human bonds described by participants have parallels both with important elements of therapeutic alliances between professionals and clients and with the positive impact of relationship factors on client outcome.
The Children's Revised Impact of Event Scale (CRIES) is a brief child-friendly measure designed to screen children at risk for Posttraumatic Stress Disorder (PTSD). It has good face and construct validity, a stable factor structure, correlates well with other indices of distress, and has been used to screen very large samples of at-risk-children following a wide range of traumatic events. However, few studies have examined the scale's validity against a structured diagnostic interview based on the DSM-IV criteria for PTSD. In the present study, the CRIES and the PTSD section of the Anxiety Disorders Interview Schedule-Child and Parent Version (ADIS-CP) were administered to a sample of children and adolescents (n=63) recruited from hospital accident and emergency rooms and the validity of the CRIES as a screening tool evaluated. Cutoff scores were chosen from this sample with a low base-rate of PTSD (11.1%) to maximize sensitivity and minimize the likelihood that children with a diagnosis of PTSD would fail to be identified. Cutoff scores were then cross-validated in a sample of 52 clinically referred children who had a high base-rate of PTSD (67.3%). A cutoff score of 30 on the CRIES-13 and a cutoff score of 17 on the CRIES-8 maximized sensitivity and specificity, minimized the rate of false negatives, and correctly classified 75–83% of the children in the two samples. The CRIES-8 (which lacks any arousal items) worked as efficiently as the CRIES-13 (which includes arousal items) in correctly classifying children with and without PTSD. Results are discussed in light of the current literature and of the need for further development of effective screens for children at-risk of developing PTSD.
In this day of high-tech, managed-care service delivery with an emphasis on medication and brief treatment, it is important for nurses to be aware of nontraditional treatment options that may be uniquely beneficial for some clients. Although it may still be considered a novelty, including animals in the healing milieu is not a new idea. Florence Nightingale herself suggested that "a small pet animal is often an excellent companion for the sick, for long chronic cases especially" (Nightingale, 1969, p. 102). Healing, according to one recent nursing article, can be seen as "a gradual awakening to a deeper sense of the self (and of the self in relation to others) in a way that effects profound change" (Dorsey & Dorsey, 1998, p. 36). Equine-facilitated psychotherapy, while not a new idea, is a little-known experiential intervention that offers the opportunity to achieve this type of awakening. In this article, the reader is introduced to equine-facilitated psychotherapy's theoretical underpinnings, techniques, and outcomes as illustrated by actual clinical vignettes and research findings.
Children and adults exposed to chronic interpersonal trauma consistently demonstrate psychological disturbances that are not captured in the posttraumatic stress disorder (PTSD) diagnosis. The DSM-IV (American Psychiatric Association, 1994) Field Trial studied 400 treatment-seeking traumatized individuals and 128 community residents and found that victims of prolonged interpersonal trauma, particularly trauma early in the life cycle, had a high incidence of problems with (a) regulation of affect and impulses, (b) memory and attention, (c) self-perception, (d) interpersonal relations, (e) somatization, and (f) systems of meaning. This raises important issues about the categorical versus the dimensional nature of posttraumatic stress, as well as the issue of comorbidity in PTSD. These data invite further exploration of what constitutes effective treatment of the full spectrum of posttraumatic psychopathology.
Childhood maltreatment has been linked to a variety of changes in brain structure and function and stress-responsive neurobiological systems. Epidemiological studies have documented the impact of childhood maltreatment on health and emotional well-being.
After a brief review of the neurobiology of childhood trauma, we use the Adverse Childhood Experiences (ACE) Study as an epidemiological "case example" of the convergence between epidemiologic and neurobiological evidence of the effects of childhood trauma. The ACE Study included 17,337 adult HMO members and assessed 8 adverse childhood experiences (ACEs) including abuse, witnessing domestic violence, and serious household dysfunction. We used the number of ACEs (ACE score) as a measure of cumulative childhood stress and hypothesized a "dose-response" relationship of the ACE score to 18 selected outcomes and to the total number of these outcomes (comorbidity).
Based upon logistic regression analysis, the risk of every outcome in the affective, somatic, substance abuse, memory, sexual,and aggression-related domains increased in a graded fashion as the ACE score increased (P <0.001). The mean number of comorbid outcomes tripled across the range of the ACE score.
The graded relationship of the ACE score to 18 different outcomes in multiple domains theoretically parallels the cumulative exposure of the developing brain to the stress response with resulting impairment in multiple brain structures and functions.
The number of American children living in partner-violent households was estimated from a nationally representative sample of 1,615 dual-parent households. Approximately 15.5 million American children were estimated to live in families in which partner violence had occurred at least once in the previous year, with 7 million estimated to live in families in which severe partner violence had occurred. The prevalence of partner violence was higher among couples with children than among couples without children.
In the 10 years since the first edition of Handbook on Animal-Assisted Therapy published, the field has changed considerably. The third edition of the Handbook highlights advances in the field, with 10 new chapters and over 50% new material. In reading this book, therapists will discover the benefits of incorporating animal assisted therapy into their practice, how to design and implement animal assisted interventions, and the efficacy of animal assisted therapy with different disorders and patient populations. Coverage includes the use of AAT with children, families, and the elderly, in counseling and psychotherapy settings, and for treating a variety of specific disorders.* Includes coverage of the use of cats, dogs, birds, and horses* Discusses the "why" to use animals in therapy as well as the "how"* Covers the use of animal-assisted therapy with different special populations and to treat different disorders.
This clearly written textbook clarifies the concepts underpinning descriptive and inferential statistics in organizational research. Acting as much more than a theoretical reference tool, step-by-step it guides readers through the various key stages of successful data analysis. Covering everything from introductory descriptive statistics to advanced inferential techniques such as ANOVA, multiple and logistic regression and factor analysis, this is one of the most comprehensive textbooks available. Using examples directly relevant to organizational research it includes practical advice on such topics as the size of samples required in research studies, using and interpreting SPSS, and writing up results. In helping readers to develop a sound understanding of statistical methods, rather than focusing on complex formulas and computations, this outstanding textbook is as appropriate for those who wish to refresh their knowledge as those new to the subject area.
At the center of therapeutic work with terrified children is helping them realize that they are repeating their early experiences and helping them find new ways of coping by developing new connections between their experiences, emotions and physical reactions. Unfortunately, all too often, medications take the place of helping children acquire the skills necessary to deal with and master their uncomfortable physical sensations. To "process" their traumatic experiences, these children first need to develop a safe space where they can "look at" their traumas without repeating them and making them real once again.15.
Since the early 1980s many articles and chapters have been published to educate and encourage small animal practitioners in their dealings with clients who are considering euthanasia for their pets or clients whose pets have died. The human/horse bond, however, should be understood and appreciated in a different way than the human/small animal bond. From a practice management perspective, the interaction between client and veterinarian can directly affect client continuation, referrals, and client loss. Possibly 68% of client loss can be traced to insensitive handling of the euthanasia process. In order to maintain a successful and productive practice, it is essential that veterinarians become skilled in client interaction during this emotional time. Part 1 of this series covered the definition and identification of the human/horse bond. Part 2 covered equine client bereavement. This installment explores equine euthanasia, the veterinarian's grief, stress, and burnout.
Animal-assisted interaction programs place animal/handler teams into close relationship with people and into settings never imagined by the crafters of standards and selection procedures developed over 15 years ago. One of the primary changes in the practice of animal-assisted interactions is the mounting recognition of the value of animal contact by providers in the fields of human health, development, and education. This chapter provides a brief overview of the development of selection procedures for animal/handler teams engaged in animal-assisted interactions. Additionally, the extent to which current procedures truly assess the specific behavioral repertoire and skills required of the animals and whether these practices provide an accurate picture of the animal's "fit" with participant specific applications is examined. This chapter compares and contrasts the selection and training practices of animals engaged in animal-assisted interactions with the selection and training practices of other animal functions such as police work and competition. Finally, this chapter recommends the development of selection procedures that accurately reflect the role of the animal in moving adults and children across the lifespan toward increased functional capacity. The prime focus is on the selection of dogs and horses as these two species are most commonly encountered in animal-assisted interactions; however, it should be noted that the selection of other animals most often follows either similar procedures to dogs and horses or are included but lack specific procedures.
This introductory chapter provides readers not only with a basic foundation to
appreciate and understand this unique kinship with all living creatures but also to
discover the roots to the overwhelming growing interest in animal-assisted intervention
(AAI). The chapter should also help solidify and clarify how the benefits
witnessed within this unique bond have prompted numerous professionals to become
more curious about the advantages of animal-assisted interventions.
It is apparent that dogs have been bred to coexist with their human counterparts
and have filled many roles including herding, guarding, hunting, fishing and being our
best friend (Clutton-Brock, 1995). Dogs have also been widely used as service
animals, supporting the quality of life of people in need. There have been increasing
insights into science’s current understanding of dog behavior and cognition. Perhaps
one of the strongest insights that she discusses pertains to dogs’ ability to understand
our behaviors (Hare, 2007; Hare et al., 2002). Horowitz (2009) explains that dogs’
This paper reviews the evidence for the existence of a complex form of post-traumatic disorder in survivors of prolonged, repeated trauma. This syndrome is currently under consideration for inclusion in DSM-IV under the name of DESNOS (Disorders of Extreme Stress Not Otherwise Specified). The current diagnostic formulation of PTSD derives primarily from observations of survivors of relatively circumscribed traumatic events. This formulation fails to capture the protean sequelae of prolonged, repeated trauma. In contrast to a single traumatic event, prolonged, repeated trauma can occur only where the victim is in a state of captivity, under the control of the perpetrator. The psychological impact of subordination to coercive control has many common features, whether it occurs within the public sphere of politics or within the private sphere of sexual and domestic relations.
This study presents the development and validation of an index of empathy for use with children and adolescents. 56 first graders, 115 fourth graders, and 87 seventh graders were studied. Item means, item-total correlations, test-retest reliabilities, correlations testing the relationship of empathy to aggressiveness and acceptance of individual differences, correlations testing the relationship of this adapted index of empathy to other existing measures of empathy as well as to social desirability response set and reading achievement formed the basis of internal, discriminant, convergent, and general construct validation. The measure demonstrated satisfactory reliability and preliminary construct validity. The study of a subset of items controlling for same-sex versus cross-sex stimulus figures provided the basis for investigating developmental aspects of empathic arousal toward peers of different sexes. Overall, the availability of comparable forms of a measure of empathy for use with children, adolescents, and adults will be useful for exploring the developmental antecedents and conditions surrounding the expression of emotional empathy.
Equine facilitated psychotherapy is a developing form of animal assisted therapy, which primarily incorporates human interaction with horses as guides. The behavior of a sensitive horse, provides a vehicle by which the therapist can use to teach the patient coping skills. This theoretical study is present to reader our opinion, about the main considerations of equine facilitated psychotherapy for children. In this scenario, the horse could be included as a cotherapist in a team composed of psychologist, occupational therapists, veterinary doctors and horsemen. Horses, by their large, gentle presence, put children therapeutically in touch with their own vitality. Children who ordinarily shun physical and emotional closeness often can accept from a horse. Beneficial results of a child-horse relationship include care translation, socialization and conversation, self-esteem promotion, companionship and affection stimulation. We conclude that equine facilitated psychotherapy provides well being and improvement in quality of children with mental health problems.
Theraplay, modeled on the natural, playful patterns of healthy interaction between parent and child, produces remarkable change in a short time for troubled families. It achieves its success by aggressively addressing four serious problems that prevent the development of the secure attachment relationship essential to healthy development: (1) inadequate structure in daily experience; (2) too little personal engagement; (3) insufficient empathic, nurturing touch; and (4) failure to provide the right kinds of challenge. Part 1 provides an overview of the method through the following components: (1) "Learning the Basics of the Theraplay Method"; and (2) "Understanding Why Theraplay Is Effective." Part 2 considers strategies: (3) "Structuring Theraplay Treatment"; and (4) "Working with the Child"; and (5) "Working with Parents or Other Caretakers." Part 3 deals with Theraplay applications: (6) "Problems in Regulation"; (7) "Autism and Pervasive Developmental Disorders"; (8) "Physical Disabilities"; (9) "Children Who Have Been Abused and Traumatized"; (10) "Children Who are Adopted or in Foster Care" (S. Lindaman); (11) "Adolescents"; and (12) "Group Theraplay" (P. Rubin). Appendixes include: (A) "Procedures for Obtaining Certification as a Theraplay Therapist"; (B) "Marschak Interactive Method"; and (C) "Theraplay Activities by Dimension." Recent research on attachment, autism, stress and trauma, and new thinking on child development is integrated in this revised edition. (EMK)
This article describes an equine-assisted experiential therapy approach and presents treatment outcomes in 31 participants in an equine-assisted, experiential therapy program. Participants completed psychological measures prior to treatment, immediately following treatment, and 6 months after treatment. Reported reductions in psychological distress and enhancements in psychological well being were significant immediately following treatment and were stable at 6-month follow-up. The article discusses the clinical implications and limitations of the present study and directions for further research.
In "The Facilitating Partnership," Jeffrey Applegate and Jennifer Bonovitz show how D. W. Winnicott's therapeutic ideas and technique are particularly relevant to [a social service] agency-based psychodynamic treatment of clients whose histories of deprivation and trauma have made them unlikely—and reluctant—candidates for in-depth clinical services. . . . Through extensive case vignettes, Applegate and Bonovitz demonstrate that interventions emerging from Winnicott's key concepts—the good-enough mother, the holding environment—can bolster clients' ego strengths and coping capacities while promoting their psychosocial development in ways that help them profoundly alter maladaptive life patterns. (PsycINFO Database Record (c) 2012 APA, all rights reserved)
Discusses the clinical indications of supportive psychotherapy (SP)—making a holding environment in which succor is a central factor. SP fosters and maintains positive transference, enhances the patient's functioning and self-esteem, and provides a therapeutic structure. Diagnosis appraises the patient's intrapsychic and interpersonal functioning—ego defenses and function, object relations, core conflicts, and coping styles. Clinical indications for SP are primitive impulses, impaired object relations, inadequate modulation of affect, and overwhelming anxiety over separation/individuation issues. The clinical components of treatment are an active giving of self by the psychotherapist, sympathy and concern, reality enhancement, and enhancement of the patient's ego strengths through identification with and internalization of the benign, accepting, nonjudgmental therapist qualities. (PsycINFO Database Record (c) 2012 APA, all rights reserved)
This paper presents a comprehensive review of the literature on Equine Facilitated Psychotherapy (EFP) with children and adolescents. Methods used in EFP, including traditional mounted, vaulting, husbandry, and unmounted ac-tivities are described. The theory and background of EFP is summarized with references to various psychotherapeutic per-spectives, such as Freudian, Jungian, cognitive, behaviorist, and psychodynamic models. The status of the research is dis-cussed, and available empirical studies and reports on this topic are summarized. Possible applications to patients with eating disorders, anxiety, trauma history, attention-deficit hyperactivity disorder, oppositional defiant disorder, and delin-quency are described. Recommendations are made regarding the direction of future research on EFP.
The present study quantitatively and qualitatively evaluated the effects of an alternative therapeutic learning method on
youths with severe emotional disorders (SED). The youths participated in a nine-week equine-facilitated learning program.
Very little research exists investigating the effectiveness of utilizing horses in the therapeutic learning process. The present
study encompasses three years of research on a unique program hypothesized to enhance traditional therapy and facilitate the
learning process for youths with special needs.
This paper describes the factor structure of the newly developed 13-item version of the Impact of Event Scale (CRIES), which was administered along with the Children’s Post-Traumatic Stress Reaction Index (CPTS-RI) to 2037 children and adolescents, aged 9–17 years, from the Municipality of Peristeri, as a part of a survey concerning children’s stress reactions after the 1999 Athens earthquake. Results showed that the total scores on both instruments were highly correlated (r = 0.79), confirming the convergent validity of the scale. Furthermore, the internal consistency of the scale was excellent with acceptable values for the three subscales. Confirmatory factor analysis revealed that the three CRIES subscales formed separate but inter-correlated factors (i.e. PTSD symptom domains), irrespective of age and gender, basically replicating the factor structure found in previous studies with different child populations. These factors loaded on a general PTSD factor. These findings imply that post-traumatic stress reactions are not culture-bound, and that the CRIES factor structure is stable across age, gender, and different types of trauma.
In his foundational work The Restoration of the Self, noted psychoanalyst Heinz Kohut boldly challenges what he called âthe limits of classical analytic theoryâ and the Freudian orthodoxy. Here Kohut proposes a âpsychology of the selfâ as a theory in its own rightâone that can stand beside the teachings of Freud and Jung. Using clinical data, Kohut explores issues such as the role of narcissism in personality, when a patient can be considered cured, and the oversimplifications and social biases that unduly influenced Freudian thought. This volume puts forth some of Kohutâs most influential ideas on achieving emotional health through a balanced, creative, and joyful sense of self. "Kohut speaks clearly from his identity as a psychoanalyst-healer, showing that he is more of a psychoanalyst than most, and yet calling for major theoretical revisions including a redefinition of the essence of psychoanalysis.ââAmerican Journal of Psychotherapy
This qualitative study examined the stories of 5 women who experienced abuse and participated in equine-facilitated psychotherapy (EFP) as part of their recovery. Anecdotal accounts support the effectiveness of EFP with women who have experienced abuse, but there is a lack of supporting research. This study was designed to examine the effectiveness of EFP in the treatment of women who have experienced abuse. Selection criteria included age, experience of abuse, participation in EFP, and ability to understand English. Data analysis identified four patterns in the participants' stories: I Can Have Power; Doing It Hands On, Horses as Co-Therapists, and Turned My Life Around. Overall, the participants' stories show that EFP can be an effective intervention for women who have experienced abuse.
The role and function of the therapeutic alliance in psychotherapy has increasingly been the focus of clinicians' and researchers' interests over the last decade. Alliance concepts have, however, been criticized for lack of conceptual clarity. The paper presents a generic model as a heuristic means for clarifying the conceptual meaning of the therapeutic alliance. The model distinguishes between the personal relationship aspect, and the collaborative, task-related aspect of the alliance, with therapist, patient, and common contributions to each of these aspects. The model is compared to other alliance conceptualizations, and its implications for alliance theory and research are discussed. A content analysis of four widely used alliance scales in relation to the model shows the scales to represent conceptually different, yet overlapping constructs. It is argued that the componential nature of the therapeutic alliance will render difficult any interpretation of findings regarding the relationship between alliance and outcome in traditional process-outcome research. More complex research strategies guided by theory are called for, if the therapeutic alliance should remain a vital field of research.
OBJECTIVE--The purpose of this study was to compare the relative effects of various forms of maltreatment on the development of posttraumatic stress disorder (PTSD) in children. DESIGN--Children were randomly selected from a population of court-involved maltreated children. The children were then assigned to a PTSD group and a non-PTSD group on the basis of their responses to a structured interview. SETTING--A juvenile/family court in a large urban area. PARTICIPANTS--This study examined 101 children who were before a juvenile/family court because of severe child maltreatment. All children had been removed from parental custody as a result of the maltreatment. INTERVENTIONS--None. MEASUREMENTS AND RESULTS--Structured clinical psychiatric interviews were administered to each child and each parent, and all court records were reviewed. The major analyses assessed the extent to which the presence and duration of the most common types of severe maltreatment were associated with a diagnosis of PTSD. Thirty-nine children met criteria for PTSD. Those who were sexually maltreated and those who witnessed family violence had a much greater likelihood of developing PTSD than did those whose histories of maltreatment did not include these types of events. The duration of emotional abuse (psychological terror) also proved to be a significant factor in discriminating children diagnosed as having PTSD from other severely maltreated children. CONCLUSIONS--These findings delineate factors implicated in the cause of PTSD. Moreover, they provide information that will enable the protective service community to screen more effectively for PTSD among maltreated children.
This review integrates recent advances in attachment theory, affective neuroscience, developmental stress research, and infant psychiatry in order to delineate the developmental precursors of posttraumatic stress disorder.
Existing attachment, stress physiology, trauma, and neuroscience literatures were collected using Index Medicus/Medline and Psychological Abstracts. This converging interdisciplinary data was used as a theoretical base for modelling the effects of early relational trauma on the developing central and autonomic nervous system activities that drive attachment functions.
Current trends that integrate neuropsychiatry, infant psychiatry, and clinical psychiatry are generating more powerful models of the early genesis of a predisposition to psychiatric disorders, including PTSD. Data are presented which suggest that traumatic attachments, expressed in episodes of hyperarousal and dissociation, are imprinted into the developing limbic and autonomic nervous systems of the early maturing right brain. These enduring structural changes lead to the inefficient stress coping mechanisms that lie at the core of infant, child, and adult posttraumatic stress disorders.
Disorganised-disoriented insecure attachment, a pattern common in infants abused in the first 2 years of life, is psychologically manifest as an inability to generate a coherent strategy for coping with relational stress. Early abuse negatively impacts the developmental trajectory of the right brain, dominant for attachment, affect regulation, and stress modulation, thereby setting a template for the coping deficits of both mind and body that characterise PTSD symptomatology. These data suggest that early intervention programs can significantly alter the intergenerational transmission of posttraumatic stress disorders.
Baccalaureate nursing students who participated in equine-facilitated psychotherapy (EFP) clinical observation found that they could benefit as much from the program as the child clients. By identifying beneficial educational outcomes of this nontraditional learning assignment, the authors hope readers will explore similar possibilities for nurses at various stages of their professional development. The baccalaureate nursing program at a small liberal arts university in the southeast contains several strands of content woven throughout the curriculum, including psychiatric/mental health nursing (PMHN). The students are introduced to such wellness concepts as anxiety and stress management, communication, spirituality, client education and methods to support behavior change, and family dynamics during the first of 4 semesters. Psychiatric illness and treatment content are combined with courses that cover traditional medical-surgical, pediatric, and maternity nursing. Medical-surgical faculty often assign clients who have a comorbidity of addiction, bipolar disorder, schizophrenia, or other psychiatric diagnoses in the acute care setting. Students also care for clients, including those with mental health issues, in community settings. Thus, students have many opportunities to experience the care of all clients holistically. In their third semester, when students study pediatrics, they have classes on parenting and the most common childhood mental health/behavioral disorders. In addition to caring for children in acute care settings, they have community-based observations in agencies that deal with several aspects of child mental health, including a child welfare agency, schools, a juvenile detention facility, and an equine-facilitated psychotherapy (EFP) program for children with mental health and/or behavioral issues.
This study examines the unique contribution of five types of maltreatment (sexual abuse, physical abuse, emotional abuse, physical neglect, emotional neglect) to adult health behaviors as well as the additive impact of exposure to different types of childhood maltreatment.
Two hundred and twenty-one women recruited from a VA primary care clinic completed questionnaires assessing exposure to childhood trauma and adult health behaviors. Regression models were used to test the relationship between childhood maltreatment and adult health behaviors.
Sexual and physical abuse appear to predict a number of adverse outcomes; when other types of maltreatment are controlled, however, sexual abuse and physical abuse do not predict as many poor outcomes. In addition, sexual, physical, and emotional abuse and emotional neglect in childhood were all related to different adult health behaviors. The more types of childhood maltreatment participants were exposed to the more likely they were to have problems with substance use and risky sexual behaviors in adulthood.
The results indicate that it is important to assess a broad maltreatment history rather than trying to relate specific types of abuse to particular adverse health behaviors or health outcomes.
The authors present a multidimensional meta-analysis of studies published between 1980 and 2003 on psychotherapy for PTSD.
Data on variables not previously meta-analyzed such as inclusion and exclusion criteria and rates, recovery and improvement rates, and follow-up data were examined.
Results suggest that psychotherapy for PTSD leads to a large initial improvement from baseline. More than half of patients who complete treatment with various forms of cognitive behavior therapy or eye movement desensitization and reprocessing improve. Reporting of metrics other than effect size provides a somewhat more nuanced account of outcome and generalizability.
The majority of patients treated with psychotherapy for PTSD in randomized trials recover or improve, rendering these approaches some of the most effective psychosocial treatments devised to date. Several caveats, however, are important in applying these findings to patients treated in the community. Exclusion criteria and failure to address polysymptomatic presentations render generalizability to the population of PTSD patients indeterminate. The majority of patients posttreatment continue to have substantial residual symptoms, and follow-up data beyond very brief intervals have been largely absent. Future research intended to generalize to patients in practice should avoid exclusion criteria other than those a sensible clinician would impose in practice (e.g., schizophrenia), should avoid wait-list and other relatively inert control conditions, and should follow patients through at least 2 years.
Magnetic resonance imaging (MRI) studies have especially reported smaller hippocampal volume in patients with post-traumatic stress disorder (PTSD), most of them war or sexual abuse victims. The present study compares the hippocampal volumes of out-patients with PTSD who had low co-morbidity rates to those of trauma-exposed control subjects without PTSD, and measures hippocampal volume changes in these patients after brief eclectic psychotherapy. We hypothesized that smaller hippocampal volumes are specific to PTSD and that hippocampal volume changes after effective psychotherapy would be measurable.
Eighteen patients with PTSD and 14 traumatized control subjects were examined with MRI. In a randomized clinical trial, the PTSD patients were assigned to treatment (n = 9) or waiting-list group (n = 9). After the former received psychotherapy for 4 months, the MRI was repeated on both PTSD groups. Three temporal lobe structures were manually segmented: hippocampus, amygdala, and parahippocampal gyrus. Volumetric analysis was used to measure grey matter, white matter, and cerebrospinal fluid.
PTSD patients had significantly smaller hippocampal volumes at baseline (total 13.8%, right 13.5%, left 14.1%) compared to the control subjects. After effective psychotherapy, however, no volume changes were found in the smaller hippocampi.
We confirmed previous findings of smaller hippocampal volume in PTSD in a new population made up of out-patients who experienced different types of traumas, reducing co-morbidity to a minimum. Smaller hippocampal volumes did not change after effective psychotherapy, even while symptoms resolved.
To determine the effects of a therapeutic riding program on psychosocial measurements among children considered at risk for poor performance or failure in school or life and among children in special education programs.
Observational study.
17 at-risk children (6 boys and 11 girls) and 14 special education children (7 boys and 7 girls).
For the at-risk children, anger, anxiety, perceived self-competence, and physical coordination were assessed. For the special education children, anger and cheerfulness were measured, and the children's and their mothers' perceptions of the children's behavior were assessed. Measurements were made before and after an 8-session therapeutic riding program.
For boys enrolled in the special education program, anger was significantly decreased after completion of the riding program. The boys' mothers also perceived significant improvements in their children's behavior after completion of the program.
Results suggest that an 8-session therapeutic riding program can significantly decrease anger in adolescent boys in a special education program and positively affect their mothers' perception of the boys' behavior.