The Benefits of Equine-Assisted Therapy
Research was conducted in Australia to determine whether veterans and their partners could benefit from equine-assisted therapy. There are 600 equine-assisted therapy worldwide used for a wide variety of physical and psychological conditions. Participants from these studies report less anxiety and depression after finishing the study. Stigma is a major cause of veterans not seeking mental health providers to treat depression, anxiety and PTSD is theorized equine therapy has less stigma attached to it than typical interventions.
The outcome measures used to determine effectiveness of treatement included: Disorder checklist for Depression Anxiety Stree Scale-21, Post-traumatic Stress Disorder Checklist for DSM-V, Oxford Happiness Questionnaire and Quality of life enjoyment questionnaire- Short Form. These tests were used to identify veterans. Participants were given this testing at three points during the study: pre-intervention, post-intervention and follow up.
Participants were also placed into the intervention by themselves or as part of a couple. Twenty-five veterans were recruited into the individual arm of the study, while twenty-two participated with their life partner. The therapeutic activities were the same in both arms, but the Couples cohort also received couples counseling. The lead facilitator and the program developer were the same for all these groups.
There were no significant differences between both groups during the pre-test. There was a decrease of PTSD, anxiety and depression among both groups during the post-test which indicates equine therapy was beneficial when used as a treatment for PTSD, anxiety and depression. At three months follow up, the individual group had lost the improvement they had gained during the study. Interestingly the couples group retained their successes at follow up. Overall the study indicates that having the veteran’s partner involved in the trial is more beneficial to the veteran than completing the course on their own. This is definitely something to take into consideration in the future with equine therapy so that participants will continue to benefit from the therapy.
The Warrior Wellness Study: A Randomized Controlled Exercise Trial for Older Veterans with PTSD
The Warrior Wellness study is a pilot study to determine if a 12 week exercise program would benefit veterans who have PTSD. The research in the attached link discusses the development, design and implementation of that study. Up to 30% of veterans are affected by PTSD, and there are known negative health outcomes reported in those with PTSD. The study authors theorized veterans may be more likely to engage in an exercise program than seek mental health treatment. This study enrolled veterans who are 60 years old and older who have a diagnosis of PTSD. They were also screened by a 6 minute walk test to assess overall health. The 6 Minute Walk Test is a quick and effective means to determine a potential health problem that would screen out that veteran. After pre-testing, the chosen participants were placed in two groups: 1) those who received the exercise prescription and 2) those who received their usual care. Study participants were randomized into one of the groups. The study enrolled twice as many veterans in the exercise arm. For those in the exercise arm, an exercise physiologist set up exercise prescriptions and monitored the veterans to ensure they were doing the exercises correctly and tolerating them well. The exercise physiologist also adjusted their routines as they became stronger and better able to handle the exercise. The goal was that participants attend 36 sessions over the 12 week period. However, it was emphasized to the veterans that if they need to miss a session, they should go back as soon as possible and not get discouraged. The main purpose of this study was to see whether regular exercise improves PTSD in older veterans. The link above has the full paper for those who want the full details of the planning and implementation of this study. The results from the Warrior Wellness pilot are found in another study that will be added to this site in a couple of weeks.
The follow up article to the Wellness Warrior article shows that Veterans with PTSD who were enrolled in a trial of exercise showed improvements in their PTSD symptoms and PTSD related conditions such as depression. The follow up article to the Wellness Warrior article posted earlier this month follows 54 Veterans who were placed into either the experimental group or a “Wait List” group that delays the beginning of the exercise program until the initial experimental group has completed the study. The main experimental group enrolled 36 participants and 18 were placed on the “Wait List”, or control, group. The main outcomes the study looked at were recruitment, attendance, satisfaction and retention. The attrition rate for this study is low at 14% and the adherence to the exercise program was high at 82% . The secondary outcomes observed are: changes in PTSD symptoms, depression, quality of life related to health and sleep quality. Questions regarding these outcomes were asked at baseline and then again after the 12 weeks of the intervention.
This study focuses on older Veterans. Older Veterans tend to not be interested in conventional therapies due to stigma around both the therapy and PTSD. As a matter of fact, some Veterans would only agree to participate after they were told traditional therapy would not be required. Veterans recruited for the study were registered for care through the Durham North Carolina VA, live within 50 miles of the VA and were independently mobile with assistive devices if needed. Participants were identified through the electronic medical record at the Durham VA. Potential study recruits were excluded for several reasons, including existing psychosis, illness that would make them unable to exercise and current enrollment in trauma focused psychotherapy. All participants were given a personalized exercise prescription based off their exercise history, exercise capacity, personal preferences and health status.
Exercise sessions were held 3 days a week from 60-90 minutes each based on the individual’s prescription. The average age of the participants was 67.4 and the majority (90.7%) were male. Most of the study’s participants were African American. Only 6 enrolled participants dropped out of the study. This study showed that PTSD symptoms decreased for those in the exercise treatment. The study also showed a decrease in depression symptoms and an increase in sleep for the exercisers. The results of this study give empirical support to an exercise program being beneficial to older Veterans who may have age related health issues. Veterans in the exercise arm of the study showed a decrease in PTSD symptoms and in symptoms related to PTSD such as depression. These improvements are consistent with previous exercise studies in younger Veterans. This study opens up a new potential treatment for older adults who suffer from long term PTSD and could also help with the overall health in this population.