As those of us who have the privilege of riding and spending time with horses know, horses are great therapy. Working around these large animals provide those of us with or without underlying mental health issues with an escape from daily stress, a non-judgmental partner, a positive and peaceful (often outdoors) environment, to name a few of the coping mechanisms time at the barn gives us. During the current pandemic, where the mental health of 50% of Canadians is under strain according to a Angus Reid study, our animal partners have become even more vital.
But it’s not only life-long horse lovers who benefit. Equine Assisted Psychotherapy (EAP) programs around the globe for military veterans, prison inmates, troubled youth and others, prove that even those who didn’t ride previously can still gain benefits and healing through exposure to, and experiences with, horses.
Groundbreaking Study
This year, a group of Canadian researchers based in British Columbia are studying the impact EAP has with young people who are battling eating disorders. The first study of its kind in Canada, the end goal is to create a permanent program devoted to EAP and eating disorders. The study will work out of the Pacific Riding for Developing Abilities (PRDA) in Langley, BC.
The idea originated with Dr. Joan Fujiwara, a family doctor who has been involved with youth health in Surrey, BC for almost 30 years and who helped establish an eating disorder program in the province. She also became aware of a program that used horses as an adjunctive therapy for eating disorders in the United States and knew that Equine Assisted Psychotherapy was used to help in a number of mental health conditions including PTSD, anxiety, depression, trauma – conditions that those with eating disorders also experience.
According to Dr. Fujiwara, eating disorders evolve as a coping mechanism that young people need to help them deal with many different issues in their lives including attachment, relational problems with both families and peers, and emotional dysregulation, to name a few. She adds these youths are also dealing with the negative physical symptoms and effects of eating disorders which affect their ability to function.
Alex, one of the horses in the eating disorder study.
Where do the horses fit into this picture? “Traditional talk therapy does not work for all youth, especially if they are extremely low weight and have difficulty connecting with those who are trying to help,” explains Dr. Fujiwara. “I have found that many of the youth I see love animals and a number of them love horses and have been involved in riding. Many have expressed an interest in the possibility of this type of therapy and I think they are open to any form of non-traditional therapy.”
As many people reading this article can attest, being around horses is a form of mental therapy no matter if you are using horses as such; it is a natural by-product. One reason is that horses are extremely sensitive to our emotions, physical stance, voice, actions, you name it. According to Dr. Fujiwara, “Often the horses [in EAP] are not ridden and may not even be in physical contact with the patients but are able to respond to emotions and physical ways of being that the humans demonstrate, both purposefully or unintentionally.”
How It Works
An example of how EAP would work in such a program is that patients may be asked to try to achieve a certain task (such as getting a horse to move around a line of cones) without leading or touching the horse. If there is a group working on this, how each person interacts with the others in trying to achieve the goal, as well as how the horse reacts, can be indicative of how people act with each other.
“The horse’s responses can be used to show the patient how he/she might act in specific situations which may relate to how they act in their own life (for example, frustration when not being able to get the horse to do what the person wants) and this can then be discussed afterwards with the therapist who can refer to specific events which occurred during the patient-horse interactions,” explains Dr. Fujiwara. “These may reflect how the patient reacts in specific incidences in their own life or in relationships with family or friends which are “played out” in the interaction with the horse(s) and are a concrete example to the youth, demonstrating how their own behaviours affect others.”
The study is in the planning stages so far and the researchers, including two patient partners, one high school student and an undergraduate student, both former patients of the Fraser South Eating Disorders program, have received four grants towards the project. They plan to develop a 6-8 week pilot program with current youth in treatment and to work with former and current patients, along with their team and allied professionals to evaluate and refine the program idea.
Dr. Maya Gislason, assistant professor, health sciences, Simon Fraser University, is one of the researchers on the project. She explains that based on the patient partners working with them, they have come to understand the importance of “creating opportunities for youth in treatment to step outside of the clinical experience and to re-engage, within a supportive environment, with other aspects of everyday life that need to be reclaimed, such as going outside, doing chores, socializing, contributing to their communities.” The result is funding to develop a non-clinical aspect of the project to run alongside (and to be integrated with) the clinical pilot study. “This may include helping to care for the horses in the barn, including learning how to feed and groom them, taking the horses in the adjacent Campbell Valley Equine Park area and spending time in a park settings and possibly also doing some park volunteer activity.”
Dr. Gislason also explained that the program and study will be asset-based, meaning it begins with the needs of the patients by listening to them and appreciating what they know through their own lived experiences. The researchers feel this is empowering and contrasts with approaches where the experts impose ideas and solutions and do so in ways that may not be relevant to what patients need, want, or can actually do.
Easing Social Alienation
Strengthening social connections is another vital component and comes from observing the myriad ways children (up to the age of 18) can lose social connections, become alienated, isolated or disempowered. “I am a sociologist by training and view social alienation and struggle as important drivers of suffering,” explains Gislason. “Helping people re-engage socially in a supported and positive way is a very important step to healing, particularly for children and adolescents.”
To that end, what the study is calling “community integration and time in nature” refers to the importance of reintegrating into the social world after having withdrawn and become disengaged for myriad reasons. “In our project, we will work as a group on non-clinical tasks by doing barn chores, feeding and caring for horses, going outside, walking and talking in a natural park setting,” says Gislason. “All of these activities mimic other daily activities that are part of everyday social life, such as doing chores, getting tasks done, walking and talking with peers, being outside, taking one’s mind off of the eating disorder.”
The pilot study will also use indirect learning via working with horses and eating disorder patients. Dr. Fujiwara gives an example of an exercise in the U.S. she heard about and would like to try where three bales of hay are placed in the arena and labelled as ‘relationship with my family,’ ‘education,’ and ‘my friends and social life.’ “These are things the patient and therapist have come up with together before the session, the things that the eating disorder has affected,” she explains.
The patient is then asked to stand on one of the bales and the horse, labelled as “my eating disorder,” is allowed to be loose with a halter on in the arena. Also in the arena is the equine specialist with a lead rope who stands at the side. The patient is not allowed to get off the bale of hay and is not to touch the horse. She needs to keep the horse (eating disorder) from eating away at the hay bales (family, education, friends and social life).
The horse, after running around first, will likely go to one of labelled hay bales and start to eat. The goal is for the patient to realize that she needs to “ask for help” from the equine specialist to manage the horse (her eating disorder). “This is not exactly indirect, but more of a concrete example of what the patient does not really understand unless it can be shown,” explains Dr. Fujiwara. “I see this as a jumping-off point for a discussion in therapy.”
Dr. Maya Gislason’s daughter, who benefited from equine therapy to ease grieving. (Photo: www.davideklof.com)
Of course, it’s fitting that both Dr. Fujiwara and Dr. Gislason also love horses and have their own personal experiences with them. “I used to ride and have always loved horses and have three now (two retired) that my daughter rides,” says Dr. Fujiwara. “My daughter is an eventer and has grown up with horses and I have travelled with her to many events in the United States to watch her ride. I am also on the Board of the Campbell Valley Equestrian Society in Langley (we manage the horse part of the Park) and I am one of the organizers of the Campbell Valley Horse Trials.”
Dr. Gislason admits to being horse obsessed as a child and owned her own horse, adding that riding to the end of her teens had a profound impact on her life. She has recently taken up the sport again. However, her involvement with horses as therapy came from a personal tragedy. “I became interested in EAP work after my husband died from cancer and my then seven-year-old daughter was bereft and grieving deeply. No talk therapy helped her, but she had started riding at four years old. I realized that when she was with the horses she was happy and I sought out a woman who did equine healing with horses, with special training in children and bereavement,” explains Gislason. “These experiences transformed my daughter and so I am a great believer in the healing power of authentic and respectful human-horse relationships.”
