Learn / Groundbreaking or Gimmicky? What Really Happens in Equine-Assisted Therapy

Groundbreaking or Gimmicky? What Really Happens in Equine-Assisted Therapy

Kayla Gill
 July 4th, 2022|   Clinically Reviewed by 
Rajnandini Rathod

Equine therapy (ET), also known as equine-assisted therapy (EAT), is an increasingly popular method of addiction treatment. In this therapy, your interactions with a horse will help you achieve therapeutic goals. Specifically, you might work on social skills, sensory processing, and physical wellness. You may also gain insight into how your behavior affects those around you.

Because ET doesn’t require much conversation, you may feel more at ease working through issues that you don’t feel comfortable addressing in traditional talk therapy. While you may already have an affinity for horses, this therapy can still be beneficial even if you’ve never interacted with these animals before–many people report that horses seem like nonjudgmental creatures that make them feel safe. If this sounds appealing to you, you may choose to explore rehab programs that offer equine therapy.

What is Equine Therapy?

During equine therapy, your therapist will guide you through a series of tasks with the horse. This can include anything from riding to ground activities like grooming or walking, depending on the type of ET your treatment center offers. Session lengths vary, but you can usually expect them to last around 30-90 minutes.

One study determined the following common factors in equine-assisted therapies:1

  • The goal of the interaction is a positive outcome for the participant.
  • Treatment occurs through the interactions between the horse and human, which are purposeful and regulated.
  • A trained facilitator, such as a therapist, is present with the horse, in addition to the human receiving the therapy.

Throughout the session, your therapist will be able to learn about you through your interactions with the horse. This process can help you work through whatever comes up—sometimes it’s not at all what you expect.

Equine-assisted therapies are becoming more popular2 in Europe and the U.S. since their inception in the ‘90s. But what, exactly, takes place during one of these sessions?

What are the Different Types of Equine-Assisted Therapies and Activities (EAAT)?

There are several different kinds of equine-assisted therapies and activities (EAAT) that you may encounter at rehab centers. While there are some discrepancies about the terms used for various types of equine therapy, we’ll look at some of the more popular options below.

Note that offerings vary from rehab to rehab depending on their facilities, staff, and treatment approach. You can contact the admissions team at a center you’re considering for more details about their specific program.

Equine-Assisted Psychotherapy (EAP)

One that you’ll encounter often at many different rehab centers is equine-assisted psychotherapy (EAP). Contrary to popular belief, EAP doesn’t involve riding the horse. During this experiential therapy, the therapist leads the client and horse through a series of activities on the ground. The whole process is slow and gentle, and helps encourage personal growth, responsibility, and healing.

Don Lavender, program director at Camino Recovery in Spain, has worked with horses for over 40 years, and even helped bring the treatment to the U.S. in the early 2000s. According to Don, “It’s become a really effective therapy. It’s therapeutic for the person because they get to learn connection with others.” Don also says that this connection can replace their substance use, and be an integral part of the healing process.

Therapeutic Horseback Riding (THR)

THR includes horseback riding,1 and may include activities like leading the horse around or through obstacles, or simply walking or trotting, depending on the rider’s experience level. This may also include grooming and caring for the horse.

Therapeutic Carriage Driving

In therapeutic carriage driving,1 clients drive the horse while riding in a carriage. This can give the person driving feelings of empowerment and responsibility, especially if other people are present in the carriage. In addition, people who may be unable to ride a horse due to physical difficulties can still experience benefits from THR through this activity.

Interactive Vaulting

Interactive vaulting sessions1 can include gymnastics while riding the horse and group problem solving tasks.

What Happens During an Equine-Assisted Psychotherapy Session?

It may depend on the center, but at Soberman’s Estate, clients are eased into this type of therapy. Equine & Meditation Coach Janice Story doesn’t have the client participate in any particular activities on the first day. Instead, she simply lets the person bond with the horse. “I’ll have them just sit and pet the horse, and see what comes up for them,” she says.

Later, they might go on walks, practice leading the horse, and eventually work their way up to various trust-building and communication practices. During some of these sessions, the client has a blindfold on. Story, or another client, then leads the blindfolded client to the horse and through a series of trust-building tasks, such as picking up their feet. “It teaches clients that they can do something without really knowing how,” she says. “We give them tools and relate it to how they can take it with them when they leave, when they try to navigate their journey back into life.”

At Camino Recovery, Lavender has the client start by grooming the horse, and allows both parties to get to know each other. Eventually, they move towards “lunging.” This involves getting the horse to move around the pen with their personal energy rather than with a rope. To do this requires the client to understand, read and tend to the horse’s emotions.

These are just a few examples of what you might expect during equine-assisted psychotherapy. While it may seem intimidating, Story is confident that the experience will be a positive one. “When our clients first show up, some of them say, ‘I don’t know what this equine therapy is going to do for me,’” she says. “By the end of an hour they’re asking me when we come back.”

How EAT Can Improve Mental Health

Equine-assisted therapy can improve mental health1 in several ways. Research shows that it can increase self-esteem. It can also inspire feelings of freedom, independence, and competency.

Our own beliefs about these creatures play a role in this process. According to researchers, interacting with horses creates “visual imagery of power and beauty,” which can empower recipients of this therapy. What’s more, horses have been human companions for thousands of years.3 We’re used to seeing them as pets, working animals, transportation, and entertainment. This familiarity can help clients establish trust.

Horses Provide Connection and Comfort

Equine therapy can also facilitate connection.2 According to one study, “many people find that human-horse bonding results in a comforting and affectionate relationship.”

Horses are pack animals, and they need a connection with their herd. And that doesn’t just mean connecting with other animals—they can also bond with people. Experts believe horses may actually “perceive humans as herd members.” This allows them to form close bonds with ET clients during treatment.

In another study, scientists observed that equine therapy was an effective treatment for combat veterans.4 “When you’re with a horse they give you kindness and compassion and love and they don’t expect anything,” one participant explained. “They don’t want to give you advice and they don’t want to make things seem less than they are. They’re just there for you.”

These relationships can be extremely grounding for people in addiction recovery. Many people report that it feels comforting to connect with such a large, powerful animal. By slowly building a rewarding bond based on mutual trust and respect, as ET clients gain the horse’s trust, they learn to trust themselves.

Sharing Your Emotions Becomes Easier

Equine-assisted therapy provides a nonjudgmental place2 for people to express themselves. By interacting with a non-verbal animal, you may feel safe to share thoughts you normally wouldn’t mention to another person.

After over 30 years of working with horses, Janice Story understands the animals, and how much they can truly help her clients, very well. “The horses are really amazing at creating a safe space for our clients. When clients first come in, oftentimes they haven’t felt any emotions for a long time. Horses will bring that up for them.”

EAT Can Boost Your Confidence

Equine-assisted activities can improve your self-esteem.2 Horses are large animals, and some people may find this intimidating, especially if they haven’t interacted with them before. But when they overcome these challenges successfully, they feel empowered, which boosts their sense of self-confidence.

Because horses are pack animals, they naturally look for a leader. If the person doesn’t become the leader, the horse will. Therefore, the person must establish themself as the leader, and work on becoming assertive and confident in order to gain the horse’s respect. This process can teach you valuable leadership skills.

Building Self-Awareness

Horses have evolved to be on the lookout for predators. Because of this, they’re highly attuned to their environment. And in equine therapy, that awareness includes empathy.

Horses easily understand and react to human emotions.2 And they’re not afraid to give you feedback. If you make a horse feel uncomfortable, you can trust it to let you know. This dynamic is intended to help you improve your self-awareness. Instead of acting on impulse, you’ll learn to control your emotional reactions to help the horse stay calm.

According to Story, horses act as mirrors, reflecting the client’s emotions back to them. “If the client needs to work on holding some boundaries, they might not know it, but the horse will show that to them,” she says. “And then at the same time, they’ll help them work through it. So it actually teaches them how to hold their boundaries.”

In that way, equine therapy differs from talk therapy. Janice points out that, in traditional therapy, “the issues might arise but sometimes the solution is not instant. Where with the horses, they’ll teach them at the same time.” This real-time feedback can help the client work through the issues that they’re dealing with right then and there.

Equine Therapy for Specific Mental Health Concerns

Equine therapy is used to treat various mental health concerns such as anxiety, depression, and post-traumatic stress disorder (PTSD). Many of these conditions occur alongside substance use disorders. And thus, equine therapy can be helpful in treating mental health concerns that arise because of, or separately from, drug misuse.

Post-Traumatic Stress Disorder (PTSD)

One study found that equine-assisted therapy can help alleviate PTSD symptoms.5 After just 6 weekly, 2-hour EAP sessions, participants reported feeling significantly less intense responses to trauma, and minimized PTSD symptoms. Additionally, they experienced less anxiety and reduced depressive symptoms.

Equine therapy may work especially well for symptoms of PTSD6 in part because horses are prey animals. This makes them hypervigilant, and unlike dogs, humans need to gain their trust over time. People with PTSD often experience the same hypervigilance, which can help them relate better to the horse. And because horses communicate primarily through body language, people can work to improve other PTSD symptoms, such as emotional numbness and bodily dissociation.


Numerous studies show that equine therapy helps reduce anxiety. A participant in one study said that therapeutic horseback riding helped her minimize her anxiety7 through the “teamwork” experienced between her and the horse. In this process, clients move “in sync with the horse’s body,” and the horse intuitively responds to the rider.


One study found that equine-assisted psychotherapy can also treat aggression.8 This may be due to the horse’s larger size, which can make them seem more intimidating. People may realize that, if they can’t control their anger impulses, there is a possibility that the horse can cause them harm. This helps them to learn to react calmly and carefully. And because the horse gives instant feedback, patients can learn quickly exactly which behaviors are hurtful and work to correct them.

Autism Spectrum Disorder (ASD)

Another study looked at children with autism spectrum disorder (ASD) who did 10 weeks of therapeutic horseback riding.9 Children with ASD are sometimes rough with pets, but participants in this study were reportedly more caring towards them after the study ended. The control group, which learned about horses but did not interact with them, did not show as much of a change in their behavior.

A similar study discovered that adolescents with ASD showed significant improvements in social behaviors and communication.7 The researchers theorized that the reason for these positive changes was due to the “shared attention experience” that came from working with the horse. Horses mirror and respond to humans’ body language, which can help those with ASD better understand social cues and behaviors. The children also showed decreased irritability and hyperactivity, which may be due to the relaxing effect of horse riding.

A Program for Veterans

The Professional Association of Therapeutic Horsemanship (PATH) International Equine Services for Heroes® program is an equine-assisted therapy program that specifically works with veterans.4 Because veterans are more likely to experience PTSD after returning home from service, PATH developed this unique program just for them. Each veteran receives a horse intended to help them heal both physically and mentally. In this particular study, 13 veterans completed 24 weeks of both riding and ground activities (grooming and walking).

Afterwards, the veterans involved in the study reported feeling more confident, less isolated, and more trusting of others. Their depressive symptoms decreased over the course of treatment. “You’re forced to bring [problems] up and deal with them to the horse,” said one participant. “It’s pretty interesting. It’s amazing.”

Another participant stated that “I learned that even though I have issues in my life, I can come here to this program and get past my issues by working with the horse.”

Reconnect With Yourself Through Equine Therapy

Horses can teach you communication, confidence, and even interpersonal skills. Don Lavender may summarize it best: “Equine therapy is about connection, learning to connect to self by first learning to connect to another.”

Through your connection with a horse, you can learn how to reconnect with yourself.

To learn more about this powerful approach and see photos, reviews, insurance information, and more, visit our searchable directory of equine therapy rehab centers.

Reviewed by Rajnandini Rathod

  1. White‐Lewis, S. (2019). Equine‐assisted therapies using horses as healers: A concept analysis. Nursing Open7(1), 58–67. https://doi.org/10.1002/nop2.377 [] [] [] [] []
  2. Marchand, W. R., Andersen, S. J., Smith, J. E., Hoopes, K. H., & Carlson, J. K. (2021). Equine-assisted activities and therapies for veterans with posttraumatic stress disorder: Current state, challenges and future directions. Chronic Stress5, 2470547021991556. https://doi.org/10.1177/2470547021991556 [] [] [] [] []
  3. Domesticating Horses. (n.d.). American Museum of National History ; American Museum of National History. https://www.amnh.org/exhibitions/horse/domesticating-horses []
  4. Lanning, B. A., & Krenek, N. (2013). Guest Editorial: Examining effects of equine-assisted activities to help combat veterans improve quality of life. Journal of Rehabilitation Research and Development, 50(8), vii–xiii. https://www.rehab.research.va.gov/jour/2013/508/pdf/JRRD-2013-07-0159.pdf [] []
  5. Earles, J. L., Vernon, L. L., & Yetz, J. P. (2015). Equine-assisted therapy for anxiety and posttraumatic stress symptoms. Journal of Traumatic Stress28(2), 149–152. https://doi.org/10.1002/jts.21990 []
  6. MacLean, B. (2011). Guest editorial: Equine-assisted therapy. Journal of Rehabilitation Research and Development, 48(7), ix–xii. https://www.rehab.research.va.gov/jour/11/487/pdf/pageix.pdf []
  7. Gabriels, R. L., Pan, Z., Dechant, B., Agnew, J. A., Brim, N., & Mesibov, G. (2015). Randomized controlled trial of therapeutic horseback riding in children and adolescents with autism spectrum disorder. Journal of the American Academy of Child and Adolescent Psychiatry54(7), 541–549. https://doi.org/10.1016/j.jaac.2015.04.007 [] []
  8. Animal-assisted therapy with chronic psychiatric inpatients: Equine-assisted psychotherapy and aggressive behavior. (n.d.). https://doi.org/10.1176/appi.ps.201300524 []
  9. Petty, J. D., Pan, Z., Dechant, B., & Gabriels, R. L. (2017). Therapeutic horseback riding crossover effects of attachment behaviors with family pets in a sample of children with autism spectrum disorder. International Journal of Environmental Research and Public Health14(3), 256. https://doi.org/10.3390/ijerph14030256 []

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