1
|
Pahlke ML, Hoopes KH, Black HF, Connelly H, Klinger WR, Joubert K, Nazarenko EE, Marchand WR, Sheppard SR. Examining the Psychological Measures and Feasibility of Recreational Trail Rides in Reducing Cravings for Addictive Substances among Veterans: A Replication Pilot Study. Mil Med 2024:usae352. [PMID: 39002109 DOI: 10.1093/milmed/usae352] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2024] [Revised: 05/30/2024] [Accepted: 07/01/2024] [Indexed: 07/15/2024] Open
Abstract
INTRODUCTION Equine-assisted services have been gaining popularity as complementary therapies for a variety of populations with a diversity of diagnoses. Interventions using equines might benefit the military Veteran population through building therapeutic alliance as well as reducing symptoms. This pilot observational study is primarily aimed to investigate safety, feasibility, and acceptability of equine-assisted services for Veterans with substance abuse disorders. It is the second pilot observational study, the first being completed in 2022. Secondary outcomes included recording the impact of trail riding on psychological measures among Veterans at a large Veterans Administration medical center. METHODS The study included a total of 32 Veterans who participated in trail riding sessions from May 4, 2022 to August 31, 2022. The study utilized the Positive and Negative Affect Scale, Adult Hope Scale, and Craving Experience Questionnaire to assess changes in positive affect, negative affect, hope components, and substance craving. RESULTS The results indicated significant reductions in negative affect and substance craving after the first session, with positive effects observed in subsequent sessions. However, demographic and diagnostic variables did not predict significant changes in psychological instruments. CONCLUSION Overall, the study demonstrated that trail riding was a safe and feasible intervention and may have potential benefits for improving emotional well-being and reducing substance cravings among Veterans. It is recommended that future studies research mechanisms of action, as well as conduct more rigorous investigations, including controlled trials using larger sample sizes and longitudinal research, to best determine lasting effects of these types of complementary therapies.
Collapse
Affiliation(s)
- Makenna L Pahlke
- Department of Animal, Dairy and Veterinary Sciences, Utah State University, Logan, UT 84322, USA
- Cooperative Extension, Utah State University, Logan, UT 84321, USA
| | - Karl H Hoopes
- Department of Animal, Dairy and Veterinary Sciences, Utah State University, Logan, UT 84322, USA
- Cooperative Extension, Utah State University, Logan, UT 84321, USA
| | - Heather F Black
- Mental Health Service, VA Salt Lake City Health Care System, Salt Lake City, UT 84108, USA
| | - Heather Connelly
- Mental Health Service, VA Salt Lake City Health Care System, Salt Lake City, UT 84108, USA
| | - William R Klinger
- Mental Health Service, VA Salt Lake City Health Care System, Salt Lake City, UT 84108, USA
| | - Katryna Joubert
- Mental Health Service, VA Salt Lake City Health Care System, Salt Lake City, UT 84108, USA
| | - Elena E Nazarenko
- VISN 19 Whole Health Flagship site, VA Salt Lake City Health Care System, Salt Lake City, UT 84108, USA
| | - William R Marchand
- Department of Animal, Dairy and Veterinary Sciences, Utah State University, Logan, UT 84322, USA
- VISN 19 Whole Health Flagship site, VA Salt Lake City Health Care System, Salt Lake City, UT 84108, USA
- Department of Psychiatry, University of Utah, Salt Lake City, UT 84108, USA
| | - Stephen R Sheppard
- Mental Health Service, VA Salt Lake City Health Care System, Salt Lake City, UT 84108, USA
| |
Collapse
|
2
|
Rankins EM, Quinn A, McKeever KH, Malinowski K. Ground-based adaptive horsemanship lessons for veterans with post-traumatic stress disorder: a randomized controlled pilot study. Front Psychiatry 2024; 15:1390212. [PMID: 38863605 PMCID: PMC11165701 DOI: 10.3389/fpsyt.2024.1390212] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2024] [Accepted: 05/10/2024] [Indexed: 06/13/2024] Open
Abstract
Introduction Equine-assisted services (EAS) has received attention as a potential treatment strategy for post-traumatic stress disorder (PTSD), as existing literature indicates that symptoms may decrease following EAS. Relatively little is known about the mechanisms at play during lessons and if physiological measures are impacted. The objectives of this pilot study were to 1) explore the effects of adaptive horsemanship (AH) lessons on symptoms of PTSD, hormone concentrations, and social motor synchrony; 2) determine if physiological changes occur as veterans interact with horses; and 3) explore if the interaction between veteran and horse changes over the 8-week session. Methods Veterans with PTSD were randomly assigned to control (CON, n = 3) or AH (n = 6) groups for an 8-week period (clinical trial; NCT04850573; clinicaltrials.gov). Veterans completed the PTSD Checklist (PCL-5) and Brief Symptom Inventory (BSI) at pre-, post-, and 2- and 6-month follow-up time points. They also completed a social motor synchrony test (pendulum swinging) and blood draw at pre- and post-time points. In weeks 1, 4, and 8, blood samples were drawn at 0 min, 3 min, 5 min, 25 min, and 30 min during the 30-min AH lessons. Veterans completed the Human-Animal Interaction Scale (HAIS) after each lesson. Blood samples were assayed for plasma cortisol, epinephrine, norepinephrine, and oxytocin. Data were analyzed with repeated measure ANOVAs. Changes in PTSD symptoms from pre- to post-time point were analyzed with paired t-tests. Results Changes in PCL-5 scores tended to differ (p = 0.0989), and global BSI scores differed (p = 0.0266) between AH (-11.5 ± 5.5, mean ± SE; -0.5 ± 0.2) and CON (5.3 ± 5.4; 0.4 ± 0.2) groups. Social motor synchrony and hormone concentrations did not differ between groups or time points (p > 0.05). Cortisol, norepinephrine, and oxytocin concentrations did not differ across sessions (p > 0.05). Epinephrine concentrations tended (p = 0.0744) to decrease from week 1 to 4 of sessions. HAIS scores increased (p ≥ 0.0437) in week 3 and remained elevated as compared to week 1. Discussion Participant recruitment was the greatest challenge. These preliminary results agree with the literature suggesting that EAS can reduce symptoms of PTSD.
Collapse
Affiliation(s)
- Ellen M. Rankins
- Equine Science Center, Department of Animal Sciences, Rutgers University, New Brunswick, NJ, United States
| | - Andrea Quinn
- Center for Psychological Services, Rutgers University, New Brunswick, NJ, United States
| | - Kenneth H. McKeever
- Equine Science Center, Department of Animal Sciences, Rutgers University, New Brunswick, NJ, United States
| | - Karyn Malinowski
- Equine Science Center, Department of Animal Sciences, Rutgers University, New Brunswick, NJ, United States
| |
Collapse
|
3
|
Marchand WR, Smith J, Nazarenko E, Joubert K, Black H, Osborne M, Andersen S, Bell K, Baldwin S, Klinger W, Connelly H, Sheppard S, Hoopes K. A Pilot Replication Study of Implementing an Equine-Assisted Services Program Within a VA Residential Substance Use Disorder Treatment Program. Mil Med 2024; 189:e220-e226. [PMID: 37522743 DOI: 10.1093/milmed/usad274] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2023] [Revised: 06/27/2023] [Accepted: 07/10/2023] [Indexed: 08/01/2023] Open
Abstract
INTRODUCTION Veterans have high rates of substance use disorders and other mental health conditions including post-traumatic stress disorder. Effective treatments for these conditions exist; however, high attrition rates and residual symptoms after completing treatment are common. Complementary treatment approaches could enhance treatment engagement and/or response among this population. We previously reported a study of one such intervention, an equine-assisted learning, and psychotherapy incorporating horses intervention provided to veterans admitted to a Veterans Health Care Administration residential substance abuse treatment program. The first aim of this study was to replicate the previous study assessing the safety, feasibility, and preliminary outcomes of this intervention. The second aim was to examine the effect of participants attending multiple intervention sessions. MATERIALS AND METHODS Participants were 94 veterans who participated in one to six sessions of a 3-4-hour program consisting of both equine-assisted learning and psychotherapy incorporating horses. Pre- and post-session administration of the Positive and Negative Affect Scale, State-Trait Anxiety Inventory, and Craving Experience Questionnaire was utilized to assess changes in affect, anxiety, and craving. Wilcoxon signed-rank or paired two-tailed t-tests were utilized for pre- to post-session comparisons of the outcome measures for sessions 1-4. Generalized linear mixed-effects (GLME) models were constructed to determine the impact of dosage. GLME models were constructed to determine the impact of dosage. RESULTS As with our previous study, the intervention was safe and feasible to utilize for this population. There were statistically significant pre- to post-session improvements, with medium-to-large effect sizes, for sessions 1-3 for negative affect and sessions 1 and 2 for positive affect, anxiety, and craving. The GLME models revealed no statistical significance for any of the predictors. CONCLUSIONS Taken together, this study and our previous investigation of this equine-assisted services intervention suggest that it is safe and feasible to utilize for veterans admitted to a residential substance abuse treatment program and we have now found short-term benefits in two separate studies. Thus, a randomized controlled trial of this intervention is warranted to demonstrate cause and effect and determine whether longer-term benefits are associated with the intervention. The finding that there was no additional benefit from attendance at more than two intervention sessions suggests that dose-response relationship studies of equine-assisted services interventions for veterans are needed.
Collapse
Affiliation(s)
- William R Marchand
- VISN 19 Whole Health Flagship Site, VA Salt Lake City Health Care System, Salt Lake City, UT 84108, USA
- Department of Psychiatry, University of Utah, Salt Lake City, UT 84108, USA
- Department of Animal, Dairy and Veterinary Sciences, Utah State University, Logan, UT 84322, USA
| | - Judy Smith
- Department of Animal, Dairy and Veterinary Sciences, Utah State University, Logan, UT 84322, USA
| | - Elena Nazarenko
- VISN 19 Whole Health Flagship Site, VA Salt Lake City Health Care System, Salt Lake City, UT 84108, USA
| | - Katryna Joubert
- Mental Health Service, VA Salt Lake City Health Care System, Salt Lake City, UT 84108, USA
| | - Heather Black
- Mental Health Service, VA Salt Lake City Health Care System, Salt Lake City, UT 84108, USA
| | - Makenna Osborne
- Department of Animal, Dairy and Veterinary Sciences, Utah State University, Logan, UT 84322, USA
| | - Sarah Andersen
- Department of Animal, Dairy and Veterinary Sciences, Utah State University, Logan, UT 84322, USA
| | - Kylie Bell
- Department of Animal, Dairy and Veterinary Sciences, Utah State University, Logan, UT 84322, USA
| | - Shannon Baldwin
- Mental Health Service, VA Salt Lake City Health Care System, Salt Lake City, UT 84108, USA
| | - William Klinger
- Mental Health Service, VA Salt Lake City Health Care System, Salt Lake City, UT 84108, USA
| | - Heather Connelly
- Mental Health Service, VA Salt Lake City Health Care System, Salt Lake City, UT 84108, USA
| | - Stephen Sheppard
- Mental Health Service, VA Salt Lake City Health Care System, Salt Lake City, UT 84108, USA
| | - Karl Hoopes
- Department of Animal, Dairy and Veterinary Sciences, Utah State University, Logan, UT 84322, USA
| |
Collapse
|
4
|
Marchand WR, Sullivan-Sakaeda L, Lackner R, Taplin D, Nazarenko E. A replication study of a psychotherapy incorporating horses resiliency intervention for healthcare workers. Complement Ther Med 2023; 76:102965. [PMID: 37473927 DOI: 10.1016/j.ctim.2023.102965] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2023] [Revised: 06/16/2023] [Accepted: 07/17/2023] [Indexed: 07/22/2023] Open
Abstract
OBJECTIVES The first aim of this pilot observational study was to replicate a previous study of a resiliency psychotherapy incorporating horses (PIH) intervention for healthcare workers. The second aim was to address some gaps in the literature regarding equine-assisted services more broadly. DESIGN Prospective open trial. SETTING A large healthcare system and a community equine facility INTERVENTION: A single-session four-hour intervention that focused on participants resilience. MAIN OUTCOME MEASURES Safety, feasibility, and utilization were assessed, and psychological instruments were administered. Instruments utilized were the Positive and Negative Affect Scale the Acceptance and Action Questionnaire II, and the Conner-Davidson Resiliency Scale. RESULTS Thirty-eight subjects participated in the study, the majority of which were female (71.1 %). The age group with the most representation included those ranging from age 25-34. The intervention was safe but underutilized. Participation was associated with improved psychological flexibility (PF), and positive affect, as well as reduction in negative affect pre- to post-intervention. There was no change in resiliency and there were no associations between improvements in affect and PF. CONCLUSIONS Resiliency PIH interventions for healthcare workers can be utilized safely and likely result in short-term psychological benefits for participants. Future randomized controlled investigations are warranted, and these studies should implement methods to maximize utilization. Additionally, this study and the literature suggest that enhanced affect and PF are likely important EAS outcomes across a variety of interventions. These constructs should be investigated with more rigorous studies including comparisons of interventions with and without a psychotherapy component.
Collapse
Affiliation(s)
- William R Marchand
- VISN 19 Whole Health Flagship site, VA Salt Lake City Health Care System, 500 Foothill Drive, Salt Lake City, UT 84148, USA; Department of Psychiatry, University of Utah, 501 Chipeta Way, Salt Lake City, UT 84108, USA; Department of Animal, Dairy and Veterinary Sciences, Utah State University, 4815 Old Main Hill, Logan, UT 84322, USA.
| | | | - Ryan Lackner
- VISN 19 Whole Health Flagship site, VA Salt Lake City Health Care System, 500 Foothill Drive, Salt Lake City, UT 84148, USA
| | - Dylan Taplin
- VISN 19 Whole Health Flagship site, VA Salt Lake City Health Care System, 500 Foothill Drive, Salt Lake City, UT 84148, USA
| | - Elena Nazarenko
- VISN 19 Whole Health Flagship site, VA Salt Lake City Health Care System, 500 Foothill Drive, Salt Lake City, UT 84148, USA
| |
Collapse
|
5
|
Marchand WR. Potential Mechanisms of Action and Outcomes of Equine-Assisted Services for Veterans with a History of Trauma: A Narrative Review of the Literature. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:6377. [PMID: 37510609 PMCID: PMC10379349 DOI: 10.3390/ijerph20146377] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/05/2023] [Revised: 07/08/2023] [Accepted: 07/14/2023] [Indexed: 07/30/2023]
Abstract
Equine-assisted services (EASs) are being increasingly used as complementary interventions for military veterans who have experienced trauma. However, there is limited evidence of benefit for this population and almost no literature describing the desired potential outcomes and possible mechanisms of action. The aim of this article is to address these gaps by reviewing the extant literature of animal-assisted interventions in general, and equine-assisted services in particular, with the goal of providing guidance for future investigations in the field. Currently, the field is in the early stage of scientific development, but published results are promising. Interventions that enhance treatment compliance and/or outcomes could benefit this population. Preliminary results, reviewed herein, indicate that EAS interventions might benefit the military veteran population by enhancing treatment engagement and therapeutic alliance, as well as by contributing to symptom reduction and resulting in various transdiagnostic benefits. It is recommended that future studies include exploration of potential beneficial outcomes discussed herein, as well as investigate suggested mechanisms of action.
Collapse
Affiliation(s)
- William R Marchand
- VISN 19 Whole Health Flagship Site, VA Salt Lake City Health Care System, 500 Foothill, Salt Lake City, UT 84148, USA
- Department of Psychiatry, School of Medicine, University of Utah, 501 Chipeta Way, Salt Lake City, UT 84108, USA
- Animal, Dairy and Veterinary Sciences, Utah State University, 4815 Old Main Hill, Logan, UT 84322, USA
| |
Collapse
|
6
|
Evaluation of a mindfulness and self-compassion-based psychotherapy incorporating horses for Veterans who have experienced trauma. Complement Ther Med 2023; 72:102914. [PMID: 36610554 DOI: 10.1016/j.ctim.2023.102914] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2022] [Revised: 12/20/2022] [Accepted: 01/03/2023] [Indexed: 01/06/2023] Open
Abstract
OBJECTIVES The primary aim of this pilot study was to assess the safety, feasibility, acceptability, as well as preliminary outcomes of a mindfulness and self-compassion-based psychotherapy incorporating horses (PIH) intervention, Whispers with Horses, for Veterans who had experienced trauma. Whispers with Horses was developed as a structured intervention that could be easily replicated for additional studies. If shown to be effective by future rigorous research, the aim is to disseminate a manualized version of the intervention to the field. DESIGN Prospective open trial. SETTING A large Veterans Administration healthcare system and local equine facilities. INTERVENTION A six-session PIH intervention that focused on participants developing or enhancing mindfulness and self-compassion skills in the context of an emerging horse-human relationship. MAIN OUTCOME MEASURES Safety, feasibility and acceptability were assessed, and psychological instruments were administered. Instruments utilized were the PTSD Checklist for DSM 5 (PCL-V), the Patient Health Questionnaire 9 (PHQ-9), the Positive and Negative Affect Scale (PANAS), the Acceptance and Action Questionnaire II (AAQ-II), and the Physical Activity Enjoyment Scale (PACES). RESULTS Subjects were 33 Veterans who were 52% male with a mean age of 46 years-old. There were no adverse outcomes to participants indicating the intervention was safe. Participants completed an average of 3.8 sessions with 24% completing all sessions indicating the intervention is feasible to use, and acceptable to, the population studied. The mean PACES score for all sessions together was 110.4, indicating subjects generally enjoyed participation. Preliminary outcome assessments revealed pre- to post-session significant improvements in affect and psychological flexibility for some sessions (p ranging from.001 -0.015). Pre- to post-intervention outcomes indicated significant improvements in depression (p = .003) and psychological flexibility (p = .005). CONCLUSIONS The Whispers with Horses intervention shows promise as a PIH for Veterans who have experienced trauma. More rigorous studies of this intervention are warranted. Also, additional investigations aimed at better understanding mechanisms underlying changes in psychological flexibility are justified.
Collapse
|
7
|
Marchand WR, Smith J, Hoopes KH, Osborne M, Andersen SJ, Bell K, Nazarenko E, Macneill R, Joubert K. A pilot observational study of horsemanship skills training for veterans with posttraumatic stress disorder. Complement Ther Med 2023; 72:102910. [PMID: 36535458 DOI: 10.1016/j.ctim.2022.102910] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2022] [Revised: 12/12/2022] [Accepted: 12/14/2022] [Indexed: 12/23/2022] Open
Abstract
OBJECTIVES Pilot assessment of an equine-assisted services intervention for Veterans with posttraumatic stress disorder. DESIGN Prospective cohort. SETTING A large Veterans Administration healthcare system. INTERVENTION Two sessions of instruction in horsemanship skills and two sessions of trail rides. MAIN OUTCOME MEASURES Safety and feasibility of recruitment, retention, providing the intervention, and measuring outcomes, as well as acceptability of the intervention to the population studied were the main outcome measures. RESULTS There were no injuries among the 18 participants, 6 staff, or 11 equines over the 3 months of the study. Eleven of 12 (92 %) planned intervention sessions were provided, with one being canceled due to weather. Out of approximately 1800 potential subjects, 21 were enrolled within three months and three dropped out before the first session. The mean number of sessions attended was 3 % and 52 % of participants completed all sessions. The mean PACES score for all sessions together was 109 (SD = 12), with a range of 50-126. Pre- to one-month post-intervention exploratory results indicated increased psychological flexibility (p = 0.008) and positive affect (p = 0.008) as measured by the Acceptance and Action Questionnaire II and the Positive and Negative Affect Scale, respectively as well as decreased PTSD (p = 0.001) and depressive symptoms (p = 0.017) as measured by the PTSD Checklist for DSM 5 and the Beck Depression Inventory, respectively. CONCLUSIONS Results suggest the intervention can be conducted with minimal risk. Further, it was feasible to recruit participants as well as provide the intervention and measure exploratory outcomes. Session attendance and PACES scores indicate acceptability to the Veteran population. The exploratory results will provide sample size estimates for future randomized controlled studies of this intervention Future studies should plan for missed sessions due to weather and consider compensating subjects to enhance retention. Finally, this work provides preliminary evidence that this intervention, without a mental health treatment component, might benefit the mental health of Veterans with PTSD.
Collapse
Affiliation(s)
- William R Marchand
- VISN 19 Whole Health Flagship Site, VA Salt Lake City Health Care System, 500 Foothill Drive, Salt Lake City, UT 84148, USA; Department of Psychiatry, University of Utah, 501 Chipeta Way, Salt Lake City, UT 84108, USA; Department of Animal, Dairy and Veterinary Sciences, Utah State University, 4815 Old Main Hill, Logan, UT 84322, USA.
| | - Judy Smith
- Department of Animal, Dairy and Veterinary Sciences, Utah State University, 4815 Old Main Hill, Logan, UT 84322, USA
| | - Karl H Hoopes
- Department of Animal, Dairy and Veterinary Sciences, Utah State University, 4815 Old Main Hill, Logan, UT 84322, USA
| | - Makenna Osborne
- Department of Animal, Dairy and Veterinary Sciences, Utah State University, 4815 Old Main Hill, Logan, UT 84322, USA
| | - Sarah J Andersen
- Department of Animal, Dairy and Veterinary Sciences, Utah State University, 4815 Old Main Hill, Logan, UT 84322, USA
| | - Kylie Bell
- Department of Animal, Dairy and Veterinary Sciences, Utah State University, 4815 Old Main Hill, Logan, UT 84322, USA
| | - Elena Nazarenko
- VISN 19 Whole Health Flagship Site, VA Salt Lake City Health Care System, 500 Foothill Drive, Salt Lake City, UT 84148, USA
| | - Rachel Macneill
- Mental Health Service, VA Salt Lake City Health Care System, 500 Foothill Drive, Salt Lake City, UT 84148, USA
| | - Katryna Joubert
- Mental Health Service, VA Salt Lake City Health Care System, 500 Foothill Drive, Salt Lake City, UT 84148, USA
| |
Collapse
|
8
|
Marchand WR, Zhang C, Hamilton C, Presson AP, Nelson R, Yoo M, Garland EL, Nazarenko E, Herrmann T. Utilization and outcomes of a Whole Health model of care by Veterans with psychiatric illness. Complement Ther Med 2022; 71:102884. [PMID: 36096414 DOI: 10.1016/j.ctim.2022.102884] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2022] [Revised: 08/16/2022] [Accepted: 09/08/2022] [Indexed: 02/06/2023] Open
Abstract
OBJECTIVES The Veterans Health Administration (VHA) is implementing a model of healthcare known as Whole Health (WH). The goal of WH is to shift from a disease-oriented system to one that emphasizes health promotion and disease prevention as well as promotes the use of Complementary and Integrative Health. The aim of this project was to investigate utilization and outcomes of WH programming among Veterans with psychiatric disorders. DESIGN This was a retrospective study. Subjects were 7138 Veterans who had a mental health diagnosis. Descriptive data, as well as within- and between-subjects analyses were conducted to investigate utilization and outcomes. SETTING The study was conducted at a large VHA medical center. INTERVENTIONS Whole health interventions considered in this study were mindfulness training, health education, wellbeing, and nutrition classes as well as health coaching. Other whole health interventions, such as acupuncture and message were not evaluated. MAIN OUTCOME MEASURES Utilization of mental health treatment services, medication prescriptions, pain scores and suicide-related behaviors were the primary outcome measures. RESULTS There were 305 Veterans with at least one WH appointment. The existence of several specific psychiatric disorders was associated with WH utilization. The mean number of appointments completed per individual was 6.9 for all WH programming. Finally, WH participation was associated with decreased risk of suicide as well as reduced use of mental health services. There were no significant changes to other outcome variables. CONCLUSIONS WH programming shows promise to reduce suicide risk and the need for mental health services among this population. Additionally, WH services were underutilized and there was a lack of treatment engagement.
Collapse
Affiliation(s)
- W R Marchand
- VISN 19 Whole Health Flagship Site Located at VA Salt Lake City Health Care System, 500 Foothill, Salt Lake City, UT 84148, the United States of America; University of Utah School of Medicine Department of Psychiatry, 501 Chipeta Way, Salt Lake City, UT 84108, the United States of America; Animal, Dairy and Veterinary Sciences, Utah State University, 4815 Old Main Hill, Logan, UT 84322, the United States of America.
| | - Chong Zhang
- University of Utah Study Design and Biostatistics Center, 27 S Mario Capecchi Dr, Salt Lake City, Utah 84133, the United States of America
| | - Clayton Hamilton
- VISN 19 Whole Health Flagship Site Located at VA Salt Lake City Health Care System, 500 Foothill, Salt Lake City, UT 84148, the United States of America
| | - Angela P Presson
- University of Utah Study Design and Biostatistics Center, 27 S Mario Capecchi Dr, Salt Lake City, Utah 84133, the United States of America
| | - Richard Nelson
- University of Utah Study Design and Biostatistics Center, 27 S Mario Capecchi Dr, Salt Lake City, Utah 84133, the United States of America
| | - Minkyoung Yoo
- University of Utah Study Design and Biostatistics Center, 27 S Mario Capecchi Dr, Salt Lake City, Utah 84133, the United States of America
| | - Eric L Garland
- VISN 19 Whole Health Flagship Site Located at VA Salt Lake City Health Care System, 500 Foothill, Salt Lake City, UT 84148, the United States of America; University of Utah, College of Social Work, 395 S 1500 E, Salt Lake City, UT 84112, the United States of America; University of Utah Center on Mindfulness and Integrative Health Intervention Development, 395 S 1500 E, Salt Lake City, UT 84112, the United States of America
| | - Elena Nazarenko
- VISN 19 Whole Health Flagship Site Located at VA Salt Lake City Health Care System, 500 Foothill, Salt Lake City, UT 84148, the United States of America
| | - Tracy Herrmann
- VISN 19 Whole Health Flagship Site Located at VA Salt Lake City Health Care System, 500 Foothill, Salt Lake City, UT 84148, the United States of America; University of Utah, Health Sciences Center, Department of Nutrition and Integrative Physiology, Salt Lake City, UT 84108, the United States of America
| |
Collapse
|
9
|
Marchand WR, Sullivan-Sakaeda L. A pilot observational study of a psychotherapy incorporating equines resiliency intervention for staff at a large medical center. Complement Ther Clin Pract 2022; 49:101660. [PMID: 35988323 DOI: 10.1016/j.ctcp.2022.101660] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2021] [Revised: 06/12/2022] [Accepted: 08/10/2022] [Indexed: 11/03/2022]
Abstract
BACKGROUND and purpose: Stress and burnout among healthcare workers are significant public health concerns. The primary aim of this pilot study was to conduct preliminary assessments of safety, feasibility, and participant satisfaction with a psychotherapy incorporating equines (PIE)-based resiliency intervention for healthcare workers. The overarching goal was to lay the groundwork for future, more rigorous investigations. Lastly, a very preliminary assessment of using the Acceptance and Action Questionnaire II (AAQII) to assess for changes in psychological flexibility (PF) associated with PIE was conducted. MATERIALS AND METHODS Thirty-seven staff members from a medical center participated in a 4-h PIE-based resiliency retreat. Pre- and post-intervention instruments were utilized to assess participants' self-perception of physical and psychological health (PROMIS Global Short Form) and enjoyment of (Physical Activity Enjoyment Scale) and satisfaction with (Client Satisfaction Questionnaire) the intervention, as well as changes in PF (AAQII). RESULTS There were no adverse effects on participants, staff, or equines. Preliminary results suggested that the intervention was perceived as enjoyable by participants. However, the intervention was not fully utilized. Finally, there was a significant (p = 0.02) pre-to post-intervention change in AAQII scores. CONCLUSION This study provides a foundation for future rigorous studies of PIE-based resiliency interventions for medical staff. Given the limitations of this pilot work, firm conclusions cannot be drawn regarding safety and feasibility. However, the preliminary results suggest that future studies of this intervention are warranted and that the AAQII may be a useful instrument to assess for possible changes in PF.
Collapse
Affiliation(s)
- William R Marchand
- VISN 19 Whole Health Flagship Site, Located at VA Salt Lake City Health Care System, 500 Foothill Drive, Salt Lake City, UT, 84148, USA; Department of Psychiatry, University of Utah, 501 Chipeta Way, Salt Lake City, UT, 84108, USA; Department of Animal, Dairy and Veterinary Sciences, Utah State University, 0500 Old Main Hill, Logan, UT, 84322, USA.
| | | |
Collapse
|