The Therapeutic Effects of Equine-Assisted Psychotherapy
Condition: Aggression; Stress; Psychopathy; Empathy
MeSH terms: Aggression
Study type: Interventional

Summary: 
      Equine-assisted interventions (EAI) are an emerging form of alternate psychotherapy that has
      been increasingly found to produce improvements in various treatment outcomes. However, the
      paucity of randomized-controlled trials (RCTs) in the EAI literature prevents any definitive
      conclusions to be made about the general effectiveness of EAI. This study tests whether one
      form of EAI, Equine-Assisted Psychotherapy (EAP), reduces aggression and alters risk factors
      associated with aggression in young adults, and whether emotion regulation mediates any
      effect of EAP on aggression. In a single-blind RCT, undergraduate students will be randomly
      assigned to either an intervention group, an active-control group, or a placebo-control
      group. Participants in the intervention group will undergo a 5-week EAP program consisting of
      structured, interactive activities with horses followed by a clinical processing component.
      Participants in the active control group will undergo a 5-week program that only involves
      interactions with horses without any clinical input (i.e. commonly coined as animal-assisted
      activities). Participants in the placebo-control group will undergo 5 weeks of 1-hour movie
      sessions related to horses. There will be three waves of data collection measuring key
      outcome variables - t1 before the 1st session, t2 after the 3rd session, and t3 after the
      final session. Participants will complete questionnaires assessing the key outcomes of
      aggression, emotional well-being and academic performance. Other risk factors of antisocial
      behaviour such as psychopathy, level of empathy, emotion regulation and executive functioning
      will also be measured. To the author's knowledge, the current study is the first in Singapore
      to investigate if EAP can lower aggression levels and alter psychological risk factors for
      aggression in healthy young adults. In turn, these results could help inform the utility and
      validity of EAP in the forensic populations.
    

Detailed description: 
      The EAP program will span over the duration of 5 weeks, each week having a 1-hour session. 50
      minutes will be allocated to interacting with the horses and the activities while the
      remaining 10 minutes will be allocated to the clinical processing of the behavior, thoughts
      and emotions that are observed during the session. This processing will be guided by trained
      therapists who hold the relevant qualifications (i.e. equine-assisted psychotherapy
      certification). 2 horses (an Oldenburg and a pony, aged 19 and 14 respectively), 2
      therapists, and 2 experienced horse handlers will be present throughout the sessions. Each
      1-hour session will consist a maximum of 8 participants that will be split into two groups of
      4 such that 1 horse, 1 therapist and 1 experienced horse handler are attached to them.

      The design of the experiment will be a single-blind Randomized Controlled Trial. Participants
      will be told that this study aims to investigate the therapeutic effects of two different EAP
      programs (either watching video clips related to horses or actual interactions with horses)
      and that they will be randomly assigned to either one. In actuality, participants are
      randomly assigned to either an intervention group, an active-control group or a
      placebo-control group. 3 time points of data collection are measured throughout the 5-week
      duration - t1 before the 1st session, t2 after the 3rd session, and t3 after the final
      session. All participants will go through the same questionnaire administered at each time
      point during the 5-week duration regardless of their assigned group. Participants in the
      intervention group will go through the 5-week EAP program consisting of the clinical
      processing following some activities found in EAP manuals. Participants in the active-control
      group will undergo a 5-week program that only involves interactions with horses without any
      clinical input (i.e. commonly coined as animal-assisted activities). Participants in the
      placebo-control group will undergo a 5-week movie screening of 1 hour each session that is
      related to horses in the lab.

      Participant recruitment will begin as soon as possible once approval has been given and
      should not take longer than 2 weeks to recruit a total of 120 undergraduate students from
      both NUS and NTU.

      The 5-week intervention program will be briefly structured as such:

      Session 1: Introduction to grooming and horse safety This introductory session is aimed at
      getting participants to be familiar with the safety features when working with these horses
      as well as to be attentive to the warning cues that horses display that is indicative of
      their mood. Once that has been briefed, participants will be taught how to groom the horse as
      part of learning natural horsemanship skills. These includes brushing and cleaning the hooves
      of the horse.

      Session 2: Review of grooming, learning to put on halter and leading the horse The second
      session is built upon the previous session in that reviews of grooming and horse safety will
      continually be surfaced throughout the program as such lessons is always an ongoing process.
      On top of that, participants will be taught how to put on a halter on the horse and to lead
      the horse. The session ends with a modified activity called Catch and Release which allows
      participants to have personal interaction with the horse.

      Session 3: Review of grooming and Give-and-Take The third session is more focused on the
      importance of proper communication as this helps convey the investigators intentions across
      with greater accuracy while still remaining respectful and mindful of the other party on the
      receiving end. After the grooming segment, participants will engage in an activity called
      Give-and-Take which work improving communication in a non-verbal manner only through the
      string they are provided with to guide the horse.

      Session 4: Review on grooming and Life's Little Obstacles This session is aimed at utilizing
      participants' critical thinking skills to achieve the objective of the activity. This is
      meant to push participants' out of their comfort zones which could bring about feelings of
      frustration and worry that can be processed after the activity is over. The activity that is
      meant to create such a roadblock is the Life's Little Obstacles whereby participants are told
      to make the horse jump over a low obstacle with multiple restrictions.

      Session 5: Review on grooming, Equine Billiards, and closing This final session is aimed at
      utilizing participants' problem-solving skills through the use of non-verbal communication.
      This is done using the Equine Billiards activity whereby the lessons learnt from previous
      sessions would culminate in this one task. Following the processing of the activity after it
      ends, the therapy team and participants would gather in a circle for the program closure to
      integrate whatever they have learnt from the past 5-weeks.

      GPower 3.1 was used to calculate an appropriate sample size for a medium effect size of 0.15,
      power at 0.95 and alpha error probability at 0.05. For a multiple linear regression analysis
      with 2 tested predictors and total number of 4 predictors, the calculation yielded a total
      sample size of 119. This number was rounded up to 120.

      All data will be analyzed using SPSS version 22. Some potential analyses include multiple
      linear regression, ANCOVAs and their respective post-hoc t-tests, paired-sample t-tests to
      demonstrate significant changes between pre and post intervention groups, and PROCESS Macro
      for the mediator analysis.
    

Intervention name(s): Equine-Assisted Psychotherapy; Equine-Assisted Activities; Placebo-control group
Intervention type(s): Behavioral; Behavioral; Other
Intervention description(s): Equine-Assisted Psychotherapy (EAP) involves working on the psychological goals set between the client and the mental health professional. This is done through the experiential interactions between the clients and the horse. This experiential aspect is vital as it allows clients to process the emotions, thoughts and behaviors that were expressed during sessions with the horse.; Simple interactions with the horses that does not necessarily involve any goals being set between the client and the personnel handling the session. These can involve activities such as grooming or petting of the horse.; This group will only be watching movies related to horses and they are told that this is another form of EAP even though this is not the case. This type of intervention has not been known to provide any therapeutic effect relevant to the study and thus is used as the placebo-control.
Other intervention name(s): Equine-Facilitated Psychotherapy
Allocation: Randomized
Intervention model: Parallel Assignment
Intervention model description: The design of the experiment will be a single-blind Randomized Controlled Trial. Participants are randomly assigned to either an intervention group, an active-control group or a placebo-control group. Participants in the intervention group will go through the 5-week EAP program consisting of the clinical processing following some activities found in EAP manuals. Participants in the active-control group will undergo a 5-week program that only involves interactions with horses without any clinical input (i.e. commonly coined as animal-assisted activities). Participants in the placebo-control group will undergo a 5-week movie screening of 1 hour each session that is related to horses in the lab.
Masking: Single (Participant)
Primary purpose: Other
Keywords: Equine-Assisted Psychotherapy; Emotion Regulation; Aggression; Outcomes; Randomized-Controlled Trials