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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.
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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
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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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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.
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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
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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.
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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.
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Schroeder K, Stroud D, Sherwood DM, Udell MAR. Therapeutic Factors in Equine-Facilitated Group Psychotherapy for Women Survivors of Interpersonal Violence. JOURNAL FOR SPECIALISTS IN GROUP WORK 2018. [DOI: 10.1080/01933922.2018.1516707] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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Abstract
Nearly half of all combat veterans suffer from serious psychological disorders and reintegration issues. Veterans shy away from typical talk therapy and are seeking alternative treatments. Equine-facilitated mental health therapy has shown promise in treating veterans with depressive and anxiety disorders and reintegration issues. This article reports on an institutional review board-approved pilot program designed to address the mental health needs of veterans. Furthermore, this article discusses future directions for evolving development of equine treatment programming.
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Schroeder K, Stroud D. Equine-Facilitated Group Work for Women Survivors of Interpersonal Violence. JOURNAL FOR SPECIALISTS IN GROUP WORK 2015. [DOI: 10.1080/01933922.2015.1082684] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Dezutti JE. Eating disorders and equine therapy: a nurse's perspective on connecting through the recovery process. J Psychosoc Nurs Ment Health Serv 2013; 51:24-31. [PMID: 23786240 DOI: 10.3928/02793695-20130612-01] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2012] [Accepted: 04/30/2013] [Indexed: 11/20/2022]
Abstract
Patients with eating disorders may have the most complex interdisciplinary treatment plans of any mental illness. Nurses need innovative evidence-based treatment interventions to assist their patients with eating disorders on their road to recovery. Although much has been written about equine-assisted psychotherapy (EAP) and equine-facilitated psychotherapy, the literature has not described a detailed session that can help nurses understand how this experiential treatment works and the impact it can have on the patient. A review of the literature on eating disorders and on the use of equine therapy in its treatment is presented in this article. In addition, the role of the nurse during equine therapy will be highlighted, and an individual example will provide a detailed review of an EAP session.
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Application of Attachment Theory to Equine-Facilitated Psychotherapy. JOURNAL OF CONTEMPORARY PSYCHOTHERAPY 2013. [DOI: 10.1007/s10879-013-9232-1] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Abstract
PURPOSE The purpose of this study was for nurses to experience equine-assisted learning and for them to describe their being in the moment with their horse. The aims of the study were to assist clinicians in recognizing their ability and skill at being present--that is, calm and centered--as they engage with horses and to determine if interaction with horses is a valid representation in recognizing presence in the participants. DESIGN Descriptive phenomenology was used to explore this lived experience. FINDINGS Five themes emerged: The Experienced Novice, Present in the Moment, Discovery of Self, Team Building, and Leadership. CONCLUSIONS Equine-assisted learning can be a meaningful venue for nurses to self-discover their ability to be present.
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Stepleman L, Rutter MC, Hibbard J, Johns L, Wright D, Hughes M. Validation of the patient activation measure in a multiple sclerosis clinic sample and implications for care. Disabil Rehabil 2010; 32:1558-67. [DOI: 10.3109/09638280903567885] [Citation(s) in RCA: 73] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Affiliation(s)
- Lara Stepleman
- Department of Psychiatry and Health Behavior, Medical College of Georgia, Augusta, GA, USA
| | - Marie-Christine Rutter
- Department of Psychiatry and Health Behavior, Medical College of Georgia, Augusta, GA, USA
| | - Judith Hibbard
- Department of Planning, Public Policy and Management, University of Oregon, Portland, OR, USA
| | - Lisa Johns
- School of Medicine, Medical College of Georgia, Augusta, GA, USA
| | - Dustin Wright
- Charlie Norwood Veterans Affairs Medical Center, Augusta, GA, USA
| | - Mary Hughes
- Neuroscience Associates Greenville Hospital System, Greenville, SC
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Affiliation(s)
- Dulce M. Garcia
- Department of Transformative Studies, California Institute of Integral Studies, San Francisco, California
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