Reducing Anxiety and Stress among Youth in a CBT-Based Equine-Assisted Adaptive Riding Program

Abstract

Reining in Anxiety (RiA) is a therapeutic program for youth with mild to moderate anxiety delivered in a therapeutic riding setting by Certified Therapeutic Riding Instructors. RiA was developed after a review of the evidence base for youth anxiety, is manualized, and includes five core CBT components: in vivo exposure, cognitive restructuring, youth psychoeducation, relaxation, and caregiver psychoeducation about anxiety. This study extended findings from a prior RCT that examined (1) the feasibility of collecting saliva samples from horses and children to measure stress (cortisol) and relaxation (oxytocin); (2) whether changes in stress and relaxation occurred both during each lesson and over the course of the 10-week intervention for horses and youth; (3) whether changes in anxiety symptoms, emotional regulation, and self-efficacy found in the first trial were comparable; and (4) if fidelity to the program was reliable. Youth participants (n = 39) ages 6–17 with caregiver-identified mild-to-moderate anxiety participated in a ten-week therapeutic intervention (RiA), which combined adaptive riding and components of CBT. Physiological data and self-report measures were taken at weeks one, four, seven, and ten for the youth and horses. Saliva assays assessed cortisol as a physiological marker of stress and anxiety, and oxytocin as a measure of relaxation. Fidelity data were recorded per session. Anxiety, as measured by caregiver self-reporting, significantly decreased from pre- to post-test, while emotional regulation scores increased. No significant changes in self-efficacy from pre- to post-test were observed. Saliva samples obtained from participants before and after riding sessions showed a consistent decrease in cortisol and a significant increase in oxytocin at two of the four timepoints (Week 1 and Week 7), but no overall pre- to post-test changes. Horse saliva data were collected using a modified bit; there were no significant changes in oxytocin or cortisol, suggesting that the horses did not have an increase in stress from the intervention. RiA may be a promising approach for reducing anxiety and stress among youth, as measured both by self-reported and by physiological measures. Collection of salivary assays for both youth and horses is feasible, and the intervention does not increase stress in the horses. Importantly, RiA can be delivered by adaptive/therapeutic horseback riding instructors in naturalistic (e.g., non-clinic-based) settings. As youth anxiety is a growing public health problem, novel interventions, such as RiA, that can be delivered naturalistically may have the potential to reach more youth and thus improve their quality of life. Further research is needed to examine the comparative value of RiA with other animal-assisted interventions and to assess its cost-effectiveness.

The potential usefulness of standardized assessments to measure participant outcomes of adaptive/therapeutic horseback riding: a survey study

“…are important to measure in A/TR practice. The outcome constructs identified by respondents are consistent with research findings in the A/TR literature; specifically, research has demonstrated that A/TR can improve mental functions ( 33 ), social functioning ( 34 ), emotional regulation skills ( 35 ), communication skills ( 34 ), physical function ( 36 , 37 ), quality of life ( 38 , 39 ), and community integration ( 40 ). Given these findings, a battery of standardized outcome assessments proposed for use in the A/TR setting should measure a wide variety of outcomes in A/TR participants from a variety of age groups, diagnoses, and life experiences.…”

Volunteer Engagement within Equine Assisted Services

“…Simultaneously, affiliative bonding may also be occurring, which may impact negative stress. The same non-significant trends were echoed in both the horses and riders' experiences [12][13][14] giving additional evidence of the interconnectedness of horse, rider, and volunteer.…”

“…This study extends the current evidence base by triangulating self-reports with an analysis of saliva to measure cortisol and alpha-amylase (stress indicators), and oxytocin (affiliative bonding, defined as "valuing and enjoying interpersonal closeness with others" [13]). Given the current gaps in knowledge and the limitations of current research, this study was undertaken in order to contribute knowledge about the physiological effects and perceived benefits of volunteering to a research study that tested Reining in Anxiety (RiA), a 10-week manualized intervention that combines adaptive riding and core concepts of cognitive behavioral therapy [14][15][16].…”

“…Cortisol is often an indicator of prolonged stress in the body's hypothalamic-pituitary-adrenal axis, while alpha-amylase is a surrogate indicator of acute stress and is experienced in the body's autonomic nervous system. Thus, stress experienced by volunteers may be emotionally negative and/or representative of an increase in physical or mental effort [14]; due to this, both analytes are required to explore this complexity. Stress may be psychological, emotional, or physiological, thus, the indicators aid understanding of nuanced interpretation of stress [15][16][17].…”

Cognitive mechanisms and neurological foundations of companion animals’ role in enhancing human psychological well-being

“… Shearer et al (2016) implemented a four-week intervention involving mindfulness practices and interaction with dogs, noting significant reductions in anxiety levels through both approaches. Hoagwood et al (2022) incorporated Cognitive Behavioral Therapy (CBT) principles and found that equine-assisted adaptive riding programs had a significant impact on reducing anxiety in adolescents.…”