They are each wary and slow to trust others. They each scan their surroundings constantly. And each stays constantly alert for danger.
But while horses depend on those characteristics for survival, veterans with post-traumatic stress disorder can find them debilitating — traits that interfere with family and work life and can result in disturbed sleep, depression and substance abuse.
Now, researchers are hoping that when man and beast find common ground, through a series of guided interactions such as grooming the horse and leading it around a ring, it will help treat PTSD.
Columbia University is conducting one of the first such university-led studies of horse-assisted therapy with veterans who have PTSD at the Bergen Equestrian Center in Leonia.
The study is funded by the Man O’ War Project, named after a famous racehorse and founded by Earle I. Mack, a U.S. Army veteran, lifelong horseman and founding director of the Mack-Cali real estate firm.
Horses have long been used therapeutically with a variety of patients, including those with autism, addictions, behavioral problems and developmental disabilities. And horseback riding has supplemented physical therapy for conditions such as polio and cerebral palsy. But few studies have measured the impact of this type of treatment and compared the results with other treatments.
That’s what Yuval Neria, director of Columbia’s PTSD research program, and Prudence Fisher, a research scientist at Columbia and the New York State Psychiatric Institute, are trying to do. The initial study, at the Leonia stables, will involve 60 to 70 veterans. Participants are still being recruited.
“It’s a great confidence builder, to interact with something that is bigger and more powerful than you are,” said Donald J. Parker, chief executive officer of the Carrier Clinic, another New Jersey facility where equine-assisted therapy is used with child and adult patients. “They have to work with the horses in a calm and confident manner to do the tasks we’ve assigned them.”
A dialogue between horse and patient
There is a “dialogue,” Neria said, as the horse mirrors the patient’s mood or emotional state, leading the patient to greater self-awareness and self-control.
One recent morning at the Leonia barn, Jack, a 12-year-old dun-colored Mexican horse with a white blaze, was led into the pen, looking nervous.
A horse’s natural instinct “is to get away from you, in order to protect themselves,” said Neria. “See how his ears are moving, like he’s listening to things going on?”
Finally, Jack stopped in the center of the ring and lowered his head. “Now he’s settling in,” Neria said. “He’s relaxed and OK, once he figures out who we are and that we are not going to attack him.”
Neria, a psychology professor at Columbia, was a tank commander in the Israeli Army who received his nation’s highest military honor in the Yom Kippur War.
The horse’s behavior is “very parallel to the PTSD patient experience,” he said. “The patient is thinking about how to regain safety, how to guarantee safety.”
The horse drew closer to Neria as he spoke, gently checking his back pockets and finally thrusting his nuzzle over Neria’s shoulder. “The way he licks now — the way he uses his tongue — suggests he is not stressed out,” Neria said. “He is completely relaxed. He trusts us.”
A horse weighs more than 1,000 pounds and stands at least 15 hands (5 feet) high. The profound connection a veteran feels when such a beast trusts him is key to the therapy.
PTSD is the signature disorder of returning war-zone veterans, afflicting an estimated 14 percent of Iraq and Afghanistan veterans, according to the Department of Veterans Affairs, as well as 10 to 12 percent of Gulf War veterans and 30 percent of Vietnam War veterans.
Symptoms include flashbacks, nightmares, social withdrawal, depression and hyper-arousal, which can cause aggression and sleeplessness. Patients may avoid places or activities that trigger bad memories, such as crowds or driving. Trash beside a highway might remind them of a hidden explosive device.
“Talk therapy” and medication are the main forms of treatment. But they don’t work for everyone, and some veterans don’t stick with them, prompting research into other types of treatment. New Jersey recently allowed medical marijuana to be prescribed to treat anxiety in such patients.
Veterans tend to find therapy with horses enjoyable, the researchers said. Transportation is provided, and they come to the Equestrian Center in Overpeck Park once a week for eight weeks. The sessions, in small groups with two horses, last 90 minutes.
Unlike psychotherapy that requires repeated discussion, visualization or thinking about the frightening event, “We don’t talk about the trauma at all,” said Fisher, who observes the sessions.
Nor do the veterans ride the horses. Over the sessions, they learn to groom them, to pick up their feet, to lead them around the pen and call them back from untethered freedom. A therapist leads the sessions, and a horse wrangler helps out.
“This doesn’t feel like therapy,” said Matthew Ryba, a U.S. Marine Corps veteran who served in Iraq and Afghanistan. He has observed the study sessions as administrator of a suicide-prevention program at Columbia. “You’re not laying on a couch talking to a psychiatrist.”
Some veterans don’t seek help because of the stigma associated with a mental-health diagnosis, said Ryba. But this research project is independent of the Departments of Defense or Veterans Affairs, so the veterans’ participation is kept confidential. (As a result, no participants in the study were made available for interviews.)
The study is not complete, but some of the changes seen so far “are very dramatic,” Neria said. “You see people suddenly getting employed, or having a better relationship with family. They sleep better and have fewer angry outbursts. They’re happier, and easier to be around.
Veterans are expected not only to gain confidence from mastering a once-frightening situation but also to become more aware of the effects their mood and behavior have on the horse. If a veteran can learn to be centered and relaxed around a horse, the thinking goes, the same skills can be applied to human relationships.
The effectiveness of equine therapy must be studied before it can be marketed or expanded as a treatment for PTSD, said a researcher who reviewed the published literature on equine-related therapy in a 2014 study in the Journal of Clinical Psychology.
“As of now, there’s not a single study showing that equine-assisted therapy in its many different forms is an effective treatment for any mental illness, yet it’s being disseminated all over the place,” cautioned Michael Anestis, an associate professor of psychology at the University of Southern Mississippi who co-wrote the article.
Using horses in therapy is expensive, he said in an interview, and the results should show significantly greater improvement in PTSD symptoms than conventional therapy to justify the expense.
“It’s great for people to study it, as long as it’s a well-designed trial and they don’t oversell it,” he said. Accumulating the data that would qualify this as evidence-based therapy “takes a lot of time, money and effort,” he added.
This initial study will be expanded if it shows promising results, Columbia’s researchers said. As an important first step, Fisher said, they have created a manual for treatment, with guidance for each session, so it can be repeated in future trials.
If things go well, there may be an additional dividend, said Neria.
Many racehorses are forced to retire early, if they don’t win, and consigned to lives of “joblessness and neglect,” he said. Serving in therapy for veterans with PTSD may provide the horses a second, noble career.