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Equine Assisted Therapy

Updated: Jul 13, 2022

Humans and horses share a special bond that has been harnessed throughout most of recorded history. Archaeological evidence has shown that horses had been domesticated over 6000 thousand years ago and used for functions such as transportation, food, industry, and warfare (Goodwin, 2007). More recently, the role of horses in modern-day society has been relegated to sport, farming and companionship but despite this, they are still held in extremely high esteem and are deeply interconnected with humans on many levels. Accordingly, the use of horses is becoming increasingly recognized and applied within animal-assisted therapy (AAT). Essentially, AAT is a form of treatment that actively involves a therapeutic animal within the therapeutic process. Oftentimes, AAT will be implemented in goal-directed modalities of therapy such as trauma work, or recovery from addictions (MacLean, 2011; Portaro et al., 2020). Within this framework, horse-assisted therapy (HAT), has begun to show promising evidence for increasing psychological facets such as emotional awareness, confidence, empathy, problem-solving and interpersonal functioning (Lee et al., 2016). Moreover, experimental forms of HAT have been demonstrated to affect all demographics from adolescents to the elderly (Koukourikos et al., 2019). As such, it is crucial to wholly analyze the potential that HAT may bring to both the clinical and general population as well as ascertain the science behind the observed benefits through a psychological lens. Throughout this article, we will impart to you the underlying mechanisms of HAT that drive psychological health. We believe that understanding the science behind the observed effects is an essential component of gaining awareness of how and when to integrate this form of treatment within your life. Second, we will outline the various appliances for HAT and demonstrate how they can be used to enhance therapeutic outcomes for different disorders.

How do Horses help facilitate in the healing process?

As HAT is a recent phenomenon that has pierced mainstream research only recently, it is difficult to ascribe any neural underpinnings to its effects on the individual. However, various studies investigating the effects of HAT have distinguished various processes that are unique to horses which bring about significant impacts on clinical disorders (Aranda-Garcia et al., 2015; Lewis et al., 2017). Similar to humans, horses are social animals with herd dynamics that mirror the typical family system that most humans share. As such, they are emotionally expressive and provide the groundwork for humans to establish an emotional connection between the horse and themselves (Tobin, 2020). This feature is highly utilized in treating disorders that possess a component of social dysfunction within them, such as autism spectrum disorders (ASD) (Srinivasan et al., 2018). In addition, studies assessing the effects of HAT on mental illness have shown that horses mirror the patient and provide immediate, honest nonverbal feedback that is not followed by the usual human constraints (Tobin, 2020). This feature is a strong promoter of trust and is utilized in treating vulnerable clients, namely those whose conditions stem from trauma and addiction disorders (Shambo et al., 2013; Buzel, 2016). Lastly, caring for a horse demands a range of responsibilities that may be emotionally laden which include concentration, selflessness, and partnership. These responsibilities can bring forth elements that are key to treating attention and affective disorders as they provide a sense of accomplishment and improve self-esteem, emotional awareness, confidence and empathy (White et al., 2020).

How can Horse Assisted Therapy be Used?

HAT possesses observable and robust therapeutic effects when used in conjunction with mainline psychotherapies. Most studies attribute these effects to the nature of the horse itself as it promotes many critical processes that are necessary for effective therapy (Tobin, 2020). Research demonstrates that poor treatment engagement may lead to worse clinical outcomes if the patient refuses to actively participate in the therapeutic process (Dixon, Holoschitz & Nossel, 2016). Another common threat to adequate treatment is a poor therapeutic alliance between the patient and therapist. Oftentimes, these problems arise from particularly vulnerable patient demographics who express strong treatment resistance and a lack of overall trust towards the therapist and the therapeutic process. Research has shown that HAT is extremely efficient at mitigating these factors by facilitating the therapeutic process and maximizing the overall impact that is derived from the respective treatment (Kemp et al., 2014; Fostrom, 2019). In a prominent 2013 study, researchers Selby and Smith-Osborne demonstrated that horses are engaged as change agents to facilitate the process of enhanced biopsychosocial development, growth, and education (Selby & Smith-Osborne, 2013). As such, studies investigating the integrative effects of HAT in therapy have found that HAT significantly reduces levels of depression and anxiety (e.g., Koukourikos et al., 2019), improves therapeutic alliance (Kemp et al., 2014), and increases treatment engagement and retention (Marchand, 2021). Broadly, it is an efficient treatment modality for enhancing the respective therapeutic goals for treating a wide range of mental health difficulties such as affective disorders (e.g., depression and anxiety), trauma-related disorders and issues surrounding social dysfunction among others.

The Bottom Line

HAT expresses promising therapeutic outcomes for many clinical demographics. Not only can it be used in conjunction with psychotherapy to treat disorders such as ASD, PTSD, Addiction and ADHD, but it is also a potential vector for enhancing overall psychological wellbeing (Koukourikos et al., 2019; Tobin, 2020). Research has begun to investigate the science behind the potential impacts of HAT to find that the horse itself expresses many features that human psychology is very receptive to (Buzel, 2016). A horse conveys emotions and reacts to a human’s emotions in a comprehensive way (Tobin, 2020). Through this exchange, they impart honest and raw nonverbal feedback that is the source of many positive outcomes such as increased emotional connection, stress reduction and trust. Moreover, when used in parallel with psychotherapy, HAT serves to increase levels of therapeutic alliance, as well as improve treatment engagement for vulnerable patients (Kemp et al., 2014; Fostrom, 2019) Taken outside of this context, consistent interaction with animals such as horses lay the groundwork for enhancing general wellbeing and emotional maturity. Research concerning these effects is still being undertaken, yet the recent findings demonstrate a proven effect on many health-related factors and recommend HAT within all treatment modalities.

Esther Adams-Aharony is a World, National, and Regional Champion Equestrian as well as a certified EAGALA Equine Psychotherapy practitioner and certified Equilateral Equine Assisted EMDR practitioner. She brings over 20 years of equine experience in addition to her therapeutic experience. For more information about equine therapy click here.


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Buzel, A. H. (2016). Beyond words: The healing power of horses: bridging the worlds of equine assisted therapy and psychotherapy. AuthorHouse.

Dixon, L. B., Holoshitz, Y., & Nossel, I. (2016). Treatment engagement of individuals experiencing mental illness: review and update. World Psychiatry, 15(1), 13-20.

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Koukourikos, K., Georgopoulou, A., Kourkouta, L., & Tsaloglidou, A. (2019). Benefits of animal assisted therapy in mental health. International journal of caring sciences, 12(3), 1898-1905.

Lee, P. T., Dakin, E., & McLure, M. (2016). Narrative synthesis of equine‐assisted psychotherapy literature: Current knowledge and future research directions. Health & Social Care in the Community, 24(3), 225-246.

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Portaro, S., Maresca, G., Naro, A., Calabrò, R. S., Gemelli, G., & Aliberti, B. (2020). Role of horse-assisted therapy in the rehabilitation field: Past, present, and future perspectives. Innovations in Clinical Neuroscience, 17(1-3), 8.

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Srinivasan, S. M., Cavagnino, D. T., & Bhat, A. N. (2018). Effects of equine therapy on individuals with autism spectrum disorder: A systematic review. Review journal of autism and developmental disorders, 5(2), 156-175.

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White-Lewis, S., Russell, C., Johnson, R., Cheng, A. L., & McClain, N. (2017). Equine-assisted therapy intervention studies targeting physical symptoms in adults: A systematic review. Applied nursing research: ANR, 38, 9-21.

White, E., Zippel, J., & Kumar, S. (2020). The effect of equine-assisted therapies on behavioural, psychological and physical symptoms for children with attention deficit/hyperactivity disorder: A systematic review. Complementary therapies in clinical practice, 39, 101101.

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