Animal-assisted therapy in eating disorder treatment: A systematic review

INTRODUCTION

Eating disorders (EDs) are deadly illnesses with high relapse rates, highlighting need for better interventions. Animal-assisted therapy (AAT) has been implemented supplementally for EDs, with horses utilized at many residential facilities. AAT shows promise with meta-analyses of randomized control trials (RCTs) showing significant decreases in depression, anxiety, and negative affect; however, no review to date has evaluated efficacy for EDs. Therefore, this study conducted a systematic review of primary literature to investigate the efficacy of AAT for EDs.

METHOD

A systematic review was conducted via PubMed, PsycInfo, and Google Scholar, up to and including September 2021, yielding 10 studies. Therapy animals included horses (n = 8), dogs (n = 1), and dolphins (n = 1). Populations included AAT ED therapists and patients (ages 11 to adult). The PRISMA methodology was used (registration PROSPERO CRD42021256239). Risk of bias assessment used Cochrane method for quantitative studies, Critical Appraisal Skills Programme checklist for qualitative studies, and JBI Critical Appraisal Checklist for Case Reports. Given study type heterogeneity, neither synthesis nor certainty assessments were conducted.

RESULTS

Case and qualitative studies reported improvement in cognitive flexibility, ability to relinquish control, and confidence. Quantitative studies demonstrated an inverse relationship between AAT utilization and ED symptoms post-treatment. Effect sizes, when reported, were mostly moderate. All but one study had low, or unclear, risk of bias. Limited randomization and a lack of RCTs measuring ED symptomology directly makes drawing conclusions difficult.

CONCLUSION

While preliminary research indicates possible benefits of AAT as a complement to traditional ED treatment, more research is needed to establish efficacy. Future studies should employ randomized control trials and examine key mechanisms of change.

Mental health benefits of mounted equine-assisted therapies: A scoping review

Across mental health professionals, there is growing interest in the field of Equine-Assisted Therapy (EAT). Preliminary evidence suggests EAT is beneficial for a wide spectrum of client populations. EAT programs may be based on groundwork alone, where participants interact with the horses from the ground only, or they may incorporate mounted activities. It remains unclear whether mounted activities add therapeutic benefits to the EAT experience for participants. This scoping review explored whether mounted activities, specifically where the client rides the horse, contribute to distinct therapeutic benefits. Nine databases were searched for studies of EAT programs that included horse riding as a central component of the therapeutic intervention and 36 studies were included in the analysis. The results of these studies suggest that mounted activities positively contribute to a variety of issues experienced by different client groups. However, further quality research is needed to carefully examine riding activities as an independent phenomenon, in order to establish what contribution-mounted activities, over and above groundwork, make to any therapeutic benefit of the EAT experience.