Pilot testing a manualized equine-facilitated cognitive processing therapy (EF-CPT) intervention for PTSD in veterans.

Abstract

Objective:The objective of this study was to test effectiveness and feasibility of equine-facilitated cognitive processing therapy (EF-CPT), a manualized adaptation of the cognitive processing therapy model for veterans with posttraumatic stress disorder (PTSD) championed by the Department of Veterans Affairs, in which equine-facilitated activities are integrated into face-to-face sessions. Method: Twentyseven veterans with a diagnosis of PTSD participated (M age ϭ 51; 78% male) in a pretest-posttest design. Veterans were seen by a single psychologist for 12 sessions of individual EF-CPT. Instruments included: PTSD Checklist (PCL), Trauma Related Guilt Inventory (TRGI), Working Alliance Inventory (WAI), and the Human Animal Bond Scale (HABS). We hypothesized improvement on all measures, low attrition, and good model fidelity. Paired sample t tests were conducted using SPSS. Results: PCL scores improved significantly (M1 ϭ 68.25, M2 ϭ 35.96, p Յ .001), as did TRGI scores (p Յ .001 on all scales). HABS and WAI indicated good working relationship. Two individuals attended one session and did not return (both under the age of 50); there was no other attrition (7% rate). Audio of sessions was reviewed for fidelity; there were variations in temporal order of session plans, which is within the acceptable flexibility of the manual. Conclusions and Implications for Practice: This manualized intervention has promise as an effective and well-tolerated treatment for veterans with PTSD. Impact and ImplicationsThis pilot of an adapted, manualized equine-facilitated cognitive processing therapy model for veterans with posttraumatic stress disorder demonstrated efficacy and low attrition, suggesting a viable alternative treatment option for veterans who have been reluctant to engage with services. This pilot is unique in the use of a novel standardized manual and attention to fidelity to the model.

A Systematic Review of Equine-Assisted Interventions in Military Veterans Diagnosed with PTSD

“…Of the nine studies, one was a randomized controlled trial (Johnson et al, 2018), one used a two-group, sequentially-assigned design with repeated measures (Burton et al, 2019), three were single group, repeated-measures (Craven, 2013;Malinowski et al, 2018;Wharton et al, 2019), three were single group, repeated-measures with mixed methods (Gómez, 2016;Lanning et al, 2017;Nevins et al, 2013), and authors of one study used a qualitative research approach (LaFleur, 2015). Three of these studies were doctoral dissertations (Craven, 2013;Gómez, 2016;LaFleur, 2015).…”

“…Different EAI approaches were used in the studies. Two authors used EAP (Burton et al, 2019;Craven, 2013), three used THR (Johnson et al, 2018;LaFleur, 2015;Lanning et al, 2017), one used equine-assisted therapy (EAT; Gómez, 2016), one used equine-assisted activities therapy (EAAT; Malinowski et al, 2018), one used equine-facilitated cognitive processing therapy (EF-CPT; Wharton et al, 2019), and one used both EAT and natural horsemanship (Nevins et al, 2013).…”

“…A common purpose in the quantitative and mixed methods designs was to examine or explore the efficacy/impact of EAI on PTSD symptoms and/or associated psychosocial/biological variables in military veterans (Burton et al, 2019;Craven, 2013;Gómez, 2016;Johnson et al, 2018;Lanning et al, 2017;Malinowski et al, 2018;Nevins et al, 2013;Wharton et al, 2019). In the qualitative study, authors sought to describe the experience of using THR as part of the PTSD treatment in veterans (LaFleur, 2015).…”

“…Specific military branch was only identified in three studies (Craven 2013;Johnson et al, 2018;Nevins, et al, 2013). The majority of settings varied and included training arenas/centers for horses (Burton et al, 2019;Gómez, 2016;Johnson et al, 2018;LaFleur, 2015;Lanning et al, 2017;Malinowski et al, 2018;Nevins et al, 2013), a farm (Wharton et al, 2019), and a ranch (Craven, 2013).…”

“…Interventions were used in all studies (see Table 1), and time frames ranged from three days (Nevins et al, 2013) to 12 weeks (Wharton et al, 2019). One intervention was held for five days (Malinowski et al, 2018), one was held for four to six weeks (Gómez, 2016), three were held for six weeks (Burton et al, 2019;Craven, 2013;Johnson et al, 2018), and one for eight weeks (Lanning et al, 2017).…”