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Seeger L, Kübler A, Hilger K. Drop-out rates in animal-assisted psychotherapy - Results of a quantitative meta-analysis. BRITISH JOURNAL OF CLINICAL PSYCHOLOGY 2024. [PMID: 39101511 DOI: 10.1111/bjc.12492] [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: 03/02/2024] [Accepted: 06/27/2024] [Indexed: 08/06/2024]
Abstract
INTRODUCTION Animal-assisted psychotherapy is an emerging field with great potential and growing popularity. However, empirical research on its effectiveness is insufficient, and consistent evidence about patients' commitment is missing. The present meta-analysis addresses this gap by systematically comparing drop-out rates in animal-assisted psychotherapy and by relating the resulting across study drop-out rate to across study drop-out rates reported in meta-analyses on conventional psychotherapy. METHOD Fifty-seven studies published until August 2022 were identified as eligible for meta-analytic comparison, that is, they conducted animal-assisted psychotherapy on at least one group of psychiatric patients and reported drop-out rates. Potential moderating influences of the type of animal and patients' disorder were considered, as well as multiple other demographic and study design variables. RESULTS The across study drop-out rate in animal-assisted psychotherapy was 11.2%. This was significantly lower than the across meta-analyses drop-out rate of conventional psychotherapy (d = -.45, p = .0005). Although effects of moderator variables could not be evaluated statistically due to too small and heterogeneous data sets, descriptive results suggest influences of the type of animal and patient disorder. However, study quality ratings identified serious shortcomings regarding proper research design, most critically concerning the report of effect size measures, the use of standardized intervention plans and Open Science practices. CONCLUSION Drop-out constitutes a major problem of psychotherapeutic research and practice. By proposing that the inclusion of an animal in the psychotherapeutic setting can enhance patients' commitment and by outlining challenges and opportunity of animal-assisted psychotherapy, this meta-analysis offers a starting point for future research in this evolving field.
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Affiliation(s)
- Linnea Seeger
- Department of Psychology I, Würzburg University, Würzburg, Germany
| | - Andrea Kübler
- Department of Psychology I, Würzburg University, Würzburg, Germany
| | - Kirsten Hilger
- Department of Psychology I, Würzburg University, Würzburg, Germany
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Palomar-Ciria N, Bello HJ. Equine-Assisted Therapy in Post-Traumatic-Stress Disorder: A Systematic Review and Meta-Analysis. J Equine Vet Sci 2023; 128:104871. [PMID: 37355148 DOI: 10.1016/j.jevs.2023.104871] [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: 01/24/2023] [Revised: 06/13/2023] [Accepted: 06/19/2023] [Indexed: 06/26/2023]
Abstract
Alternative treatments for Post-traumatic-Stress Disorder (PTSD) have attracted attention, especially Equine-Assisted Services (EAS) including psychotherapy and occupational therapy involving horses. In this work, we measured the effectiveness of EAS in PTSD through a meta-analysis. An intensive bibliography search focusing in EAS and PTSD was conducted following the PRISMA recommendations. The search was not restricted by date. For the quantitative analyses, 5 works were selected. They were chosen based on the instrument utilized for the assessment of PTSD symptoms: the PTSD Checklist for DSM-5 (PCL-5). A random effects model was carried out, showing significant results in the reduction of PTSD symptoms. In the qualitative synthesis, 10 studies were included which showed interesting results in the improvement of PTSD symptoms and other variables. In conclusion, EAS are beneficial for post-traumatic symptoms in the short term follow-up period. However, EAS require further research and major standardization.
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Affiliation(s)
- Nora Palomar-Ciria
- Psychiatry Service, Complejo Asistencial Universitario de Soria, Soria, Spain.
| | - Hugo J Bello
- Department of Applied Mathematics, University of Valladolid (Campus Duques de Soria), Soria, Spain
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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.
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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
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Mazzeo G, Bendixen R. Community-Based Interventions for Childhood Trauma: A Scoping Review. OTJR-OCCUPATION PARTICIPATION AND HEALTH 2023; 43:14-23. [PMID: 35485320 DOI: 10.1177/15394492221091718] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
Experiencing trauma has long-lasting effects on a child's well-being, which may affect their occupational performance. This scoping review synthesized research on community-based interventions for children who have experienced trauma to highlight occupational therapists' role in trauma-informed care. We searched PubMed and PTSDPubs, including community-based interventional trials that addressed childhood trauma and excluding studies specific to refugees, sex-trafficking, significant comorbid diagnoses, and reviews. Eleven articles met criteria. Psychotherapy-based interventions (e.g., trauma-informed cognitive behavioral therapy), play and art therapy, yoga, and equine-facilitated interventions reduced posttraumatic stress symptoms. One article measured the impact of these symptoms on a child's function. Occupational therapists working in community settings appear to be underutilized in the treatment of children who have experienced trauma. Future studies should examine occupational therapists' potential to work alongside mental health providers in the community to optimize functional outcomes for children who have experienced trauma.
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Kearney BE, Lanius RA. The brain-body disconnect: A somatic sensory basis for trauma-related disorders. Front Neurosci 2022; 16:1015749. [PMID: 36478879 PMCID: PMC9720153 DOI: 10.3389/fnins.2022.1015749] [Citation(s) in RCA: 24] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2022] [Accepted: 10/14/2022] [Indexed: 08/16/2023] Open
Abstract
Although the manifestation of trauma in the body is a phenomenon well-endorsed by clinicians and traumatized individuals, the neurobiological underpinnings of this manifestation remain unclear. The notion of somatic sensory processing, which encompasses vestibular and somatosensory processing and relates to the sensory systems concerned with how the physical body exists in and relates to physical space, is introduced as a major contributor to overall regulatory, social-emotional, and self-referential functioning. From a phylogenetically and ontogenetically informed perspective, trauma-related symptomology is conceptualized to be grounded in brainstem-level somatic sensory processing dysfunction and its cascading influences on physiological arousal modulation, affect regulation, and higher-order capacities. Lastly, we introduce a novel hierarchical model bridging somatic sensory processes with limbic and neocortical mechanisms regulating an individual's emotional experience and sense of a relational, agentive self. This model provides a working framework for the neurobiologically informed assessment and treatment of trauma-related conditions from a somatic sensory processing perspective.
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Affiliation(s)
- Breanne E. Kearney
- Department of Neuroscience, Schulich School of Medicine and Dentistry, Western University, London, ON, Canada
| | - Ruth A. Lanius
- Department of Neuroscience, Schulich School of Medicine and Dentistry, Western University, London, ON, Canada
- Department of Psychiatry, Schulich School of Medicine and Dentistry, Western University, London, ON, Canada
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Haig L, Skinner K. Use of Equine-Assisted Services to Improve Outcomes Among At-Risk and Indigenous Youth: A Scoping Review. Front Public Health 2022; 10:730644. [PMID: 35419329 PMCID: PMC8996079 DOI: 10.3389/fpubh.2022.730644] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2021] [Accepted: 02/25/2022] [Indexed: 11/13/2022] Open
Abstract
Equine-assisted services (EAS) are gaining popularity as ways to promote psychological health and social well-being. EAS may show particular promise as culturally appropriate initiatives for at-risk Indigenous youth, as they are thought to align well with Indigenous ways of knowing which place emphasis on relationships between the land and all living beings. We seek to better understand previous uses of EAS as initiatives for at-risk youth populations, including Indigenous populations, and learn about which outcomes have been addressed in the literature with an EAS initiative by conducting a scoping review. The review focused on initiatives targeting at-risk youth aged 10-18 years of age in Canada, Australia, New Zealand, and the United States. A total of 27 studies were included in the final analysis from all target countries except New Zealand. The target populations were further divided into four subgroups: at-risk youth, youth with mental health disorders and/or learning disabilities, youth survivors of trauma/abuse, and at-risk Indigenous youth. Overall findings of the review suggest EAS are promising approaches for achieving therapeutic and learning goals with the potential to be successful with both Indigenous youth and at-risk youth more broadly.
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Affiliation(s)
- Laurie Haig
- School of Public Health Sciences, University of Waterloo, Waterloo, ON, Canada
| | - Kelly Skinner
- School of Public Health Sciences, University of Waterloo, Waterloo, ON, Canada
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Hediger K, Wagner J, Künzi P, Haefeli A, Theis F, Grob C, Pauli E, Gerger H. Effectiveness of animal-assisted interventions for children and adults with post-traumatic stress disorder symptoms: a systematic review and meta-analysis. Eur J Psychotraumatol 2021; 12:1879713. [PMID: 34377357 PMCID: PMC8330800 DOI: 10.1080/20008198.2021.1879713] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
Background: Animal-assisted interventions (AAI) are increasingly applied for people with post-traumatic stress disorder (PTSD) symptoms albeit its effectiveness is unclear.Objectives: To examine the effectiveness of AAI for treating PTSD symptoms.Method: We searched 11 major electronic databases for studies reporting quantitative data on effects of AAI for children and adults with PTSD symptoms. Of 22'211 records identified, we included 41 studies with 1111 participants in the systematic review comprising eight controlled studies with 469 participants in the meta-analysis. We conducted random-effects meta-analyses with all controlled studies based on standardized mean differences (SMD), and calculated standardized mean change (SMC) as effect sizes for studies with a pre-post one-group design. Two independent researchers assessed the quality of the included studies using the NIH Study Quality Assessment Tools. The primary outcome was PTSD or depression symptom severity measured via a standardized measurement at pre- and post-intervention assessments.Results: There was a small but not statistically significant superiority of AAI over standard PTSD psychotherapy (SMD = -0.26, 95% CI: -0.56 to 0.04) in reducing PTSD symptom severity while AAI was superior to waitlist (SMD = -0.82, 95% CI: -1.56 to 0.08). Getting a service dog was superior to waiting for a service dog (SMD = -0.58, 95% CI: -0.88 to -0.28). AAI led to comparable effects in reducing depression as standard PTSD psychotherapy (SMD = -0.03, CI: -0.88 to 0.83). Pre-post comparisons showed large variation for the reduction in PTSD symptom severity, with SMCs ranging from -0.38 to -1.64, and for depression symptom severity, ranging from 0.01 to -2.76. Getting a service dog lowered PTSD symptoms between -0.43 and -1.10 and depression with medium effect size of -0.74.Conclusions: The results indicate that AAI are efficacious in reducing PTSD symptomatology and depression. Future studies with robust study designs and large samples are needed for valid conclusions.
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Affiliation(s)
- Karin Hediger
- Faculty of Psychology, Division of Clinical Psychology and Psychotherapy, University of Basel, Basel, Switzerland.,REHAB Basel, Clinic for Neurorehabilitation and Paraplegiology, Basel, Switzerland.,Department of Epidemiology and Public Health, Human and Animal Health Unit, Swiss Tropical and Public Health Institute, Basel, Switzerland.,Institute for Interdisciplinary Research on the Human-Animal Relationship Switzerland, c/o Swiss TPH, Basel, Switzerland
| | - Julia Wagner
- Faculty of Psychology, Division of Clinical Psychology and Psychotherapy, University of Basel, Basel, Switzerland
| | - Pascale Künzi
- REHAB Basel, Clinic for Neurorehabilitation and Paraplegiology, Basel, Switzerland
| | - Anna Haefeli
- Faculty of Psychology, Division of Clinical Psychology and Psychotherapy, University of Basel, Basel, Switzerland
| | - Felicitas Theis
- Faculty of Psychology, Division of Clinical Psychology and Psychotherapy, University of Basel, Basel, Switzerland
| | - Carmina Grob
- Faculty of Psychology, Division of Clinical Psychology and Psychotherapy, University of Basel, Basel, Switzerland
| | - Elena Pauli
- Faculty of Psychology, Division of Clinical Psychology and Psychotherapy, University of Basel, Basel, Switzerland
| | - Heike Gerger
- Faculty of Psychology, Division of Clinical Psychology and Psychotherapy, University of Basel, Basel, Switzerland.,Department of General Practice, Erasmus MC University Medical Center, Rotterdam, The Netherlands
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Naste TM, Price M, Karol J, Martin L, Murphy K, Miguel J, Spinazzola J. Equine Facilitated Therapy for Complex Trauma (EFT-CT). JOURNAL OF CHILD & ADOLESCENT TRAUMA 2017; 11:289-303. [PMID: 30220956 PMCID: PMC6132374 DOI: 10.1007/s40653-017-0187-3] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/23/2023]
Abstract
Emerging research suggests that Equine Facilitated Psychotherapy (EFP) may be beneficial for traumatized youth. In addition, complex trauma (i.e., multiple and/or prolonged developmentally adverse traumatic events which are typically interpersonal in nature) treatment research is still growing and there is a need for the development and examination of novel treatments for youth with complex trauma histories. The current article describes a promising EFP model for this population called Equine Facilitated Therapy for Complex Trauma (EFT-CT). EFT-CT embeds EFP practices within Attachment, Regulation and Competency (ARC), an extant evidence-based complex trauma treatment framework for children and adolescents. The authors provide three case studies using both observational data provided by clinicians, as well as longitudinal measures of psychosocial functioning, to illustrate the potential promise of EFT-CT. The article concludes with a discussion about implications for EFP treatment and research.
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Affiliation(s)
| | - Maggi Price
- Boston College, Department of Counseling, Developmental, and Educational Psychology, Boston, MA USA
| | | | - Lia Martin
- Justice Resource Institute, Needham, MA USA
| | | | | | - Joseph Spinazzola
- Department of Psychology, Suffolk University, Boston, MA USA
- The Trauma Center at Justice Resource Institute, 1269 Beacon St, Brookline, MA 02446 USA
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Gibbons JL, Cunningham CA, Paiz L, Poelker KE, Chajón A. ‘Now, he will be the leader of the house’: An equine intervention with at-risk Guatemalan youth. INTERNATIONAL JOURNAL OF ADOLESCENCE AND YOUTH 2016. [DOI: 10.1080/02673843.2016.1202844] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
Affiliation(s)
- Judith L. Gibbons
- Department of Psychology, Saint Louis University, St. Louis, MO, USA
| | | | - Leslie Paiz
- Lead-Up International, Jocotenango, Guatemala
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