EQUINE-ASSISTED PSYCHOTHERAPY

Transcription

1 EQUINE-ASSISTED PSYCHOTHERAPY Impact of EAP on Resilience and Self-Efficacy in Two Diverse Samples Dr. Wanda Whittlesey-Jerome, New Mexico State University - courtesy of EAGALA (2013)

2 Opening Comment from EAP Study Participant s Journal I like being in the arena with the horses. This is so different from my regular life. I wonder what they think. Do they like when people come and pet them? Are some in a bad mood and don t want us to walk by them? What do we look like to them? Are we sort of color-coded by our anxiety or whatever emotion we have? Seems they aren t complicated in their minds like me.

3 Equine-Assisted Psychotherapy Equine-assisted activities and treatments (EAAT) have been in use therapeutically since the late 1990 s. EAAT is used internationally, and can include psychotherapy, which is known as equine-assisted psychotherapy (EAP), equine-facilitated psychotherapy (EFP), or equine-facilitated counseling (EFC). EAP is a human-animal intervention showing promise with behavioral and social issues across the human lifespan with under-served (in treatment) and under-represented (in the literature) populations. EAP has been studied with children, adolescents, adults, older adults, and the military. The evidence-base for EAP s effectiveness is growing. EAP was developed by the Equine Assisted Growth and Learning Association (EAGALA). The EAGALA model is a 98% on-the-ground with horses problem-solving and relationship-building team approach facilitated by a clinical/behavioral therapist working in a professional dyad with an equine specialist. Two mixed-methods exploratory studies examined EAP s impact on psychological indicators of adjustment and well-being: resilience in at-risk youth and self-efficacy in adult female victims of interpersonal violence (IPV).

4 CHARACTERISTICS OF TWO SAMPLES At-Risk Adolescents Adult Female Victims of Interpersonal Violence

5 Characteristics of the Two Samples Study #1 Study #2 EAP Group CHARACTERISTICS PED Group EAP Group CHARACTERISTICS COM Group 5 TOTAL IN GROUP 7 7 TOTAL IN GROUP AGE (mean) 16.9 GENDER 3 (60%) Male 2 (29%) 2 (40%) Female 5 (71%) ETHNICITY 4 (80%) Hispanic 4 (57%) 1 (20%) Non-Hispanic 3 (43%) GRADE IN SCHOOL 47.0 years AGE (mean) 40.5 years GENDER 7 (100%) Female 6 (100%) ETHNICITY 3 (43%) Hispanic 3 (50%) 4 (57%) Non-Hispanic 3 (50%) 2 (40%) 9 th Grade 0 (00%) 1 (20%) 10 th Grade 4 (57%) 2 (40%) 11 th Grade 1 (14%) 0 (00%) 12 th Grade 2 (29%) TIME IN SERVICES 34.4 weeks Weeks (mean) 14.4 weeks

6 METHODS AND RESULTS At-Risk Adolescents and Resilience (Mastery, Relatedness, Emotional Reactivity, Vulnerability) Adult Female Victims of Interpersonal Violence (Self-Efficacy, Depression, Anxiety, Global Assessment of Functioning)

7 Measures for Data Collection Study #1 RESILIENCE SCALES FOR CHILDREN AND ADOLESCENTS (Prince-Embury, 2007) Measures resilience via a Resilience Index (Sense of Mastery, Sense of Relatedness, and Emotional Reactivity) and a Vulnerability Index Observer Data Participant Journals Study #2 BECK DEPRESSION INVENTORY (Beck, 1996) Measures hopelessness, irritability, guilt, and physical symptoms BURNS ANXIETY SCALE (Burns, 1989) Measures anxious feelings, anxious thoughts, and physical symptoms GENERAL SELF-EFFICACY SCALE (Schwarzer & Jerusalem, 1995) Measures optimism in beliefs, persistence in the face of adversity, and resilience GLOBAL ASSESSMENT OF FUNCTIONING (Hall, 1995) Measures the social, occupational, and psychological functioning of adults Observer Data Participant Journals

8 Methods and Results Study #1 Methods 12 males & females 15 to 19 years old Results PED was higher on positive aspects of resilience and lower on negative at start of study Study #2 Methods 14 adult women 28 to 64 years old Results EAP group higher on all measures except for anxiety at post-test Assigned to EAP or psycho-educational group (PED) EAP was higher on positive aspects of resilience and lower on negative at end of study Assigned to EAP or comparison group (COM) Between groups pre-post on self-efficacy came close to significance Pre-Post on Resilience Scales, Observer Notes, and Personal Journaling 8, 2-hour EAP sessions over 2 months Resilience and relatedness difscores came close to significance Qualitative data added insight into the mechanisms underlying the benefits conveyed from the addition of EAP to conventional treatments Pre-Post on Self-Efficacy Scales, Depression, Anxiety, and Global Assessment of Functioning, Observer Notes and Personal Journaling 8, 2-hour EAP sessions over 2 months No significance was found in difscores overall Qualitative data added insight into the mechanisms underlying the benefits conveyed from the addition of EAP to conventional treatments

9 Scores from Measurement Instruments Study #1 PED EAP

10 Scores from Measurement Instruments Study #

11 Quantitative Results Study #1: General Linear Model Study #2: Mixed Factorial Analysis Study #2: ANOVA and General Linear Model Study #1 Study #2 Study #2 1 st Study Resilience 2 nd Study Self-Efficacy 2 nd Study Self-Efficacy General Linear Model ANOVA General Linear Model (MAS Difscore) F = 1.129; p =.313 (EMO Difscore) F = 2.033; p =.184 (VUL Difscore) F =.035; p =.856 (RES Difscore) F = 3.83; p =.079 (REL Difscore) F = 3.054; p =.11 (Between Groups on Pretest of Self-Efficacy) F = 3.359; p =.094 (Between Groups on Post-test of Self-Efficacy) F = 2.926; p =.115 (BDI Difscore) F =.018; p =.896 (BAS Difscore) F =.1415; p =.259 (GAF Difscore) F = 1.229; p =.291 (GSES Difscore) F =.075; p =.789

12 Qualitative Data Results The Richness of the Qualitative Data MESSAGES RECEIVED BY EAP PARTICIPANTS DURING SESSIONS: I matter. I have value. I am not alone. I am strong. I can do this. I can change. - courtesy of EAGALA (2013)

13 Qualitative Data from Study #1 An excerpt from an EAP participant s debriefing after the second session: I didn t figure putting the halter on Sam was going to be hard. I was just going to go up to him and slip it over his head. Well, I got it on after dropping it in the dirt three times. But I just laid it on his ears and tucked it under his chin. And it fell off. Sam was standing on the lead rope and wouldn t move his foot. I got frustrated and threw the thing on the ground. Sam just stood there and looked at me like, You jerk you can t even put a halter on a horse! The other kids were watching me and laughing and I got really mad. The therapist said, Try it again, but this time, try a different approach. So, I found the latch and unlatched the halter to open it up. I put it around Sam s nose and attached the lead rope to the snap thing. Then, I latched the halter behind his ears. It was funny and it was weird looking, but he let me lead him around the arena. And I was really proud. - Courtesy of EAGALA (2013)

14 Qualitative Date from Study #2 Excerpt from EAP participant s journal after the fourth session: Today I felt all alone in the arena with my horse. Like I was stuck in a nightmare where you are screaming for help but nothing comes out. But I knew I had to go in. Then, I got angry at myself. Where have I gone? What happened to my courage? My self-esteem? How did I let someone take my selfworth, my voice, my value away? Another woman, at the end of particularly grueling session, wrote, Yea she s moving again, okay just keep swimming. Just keep swimming yeah that works. For the moment. Great. Well, we made it to the fence. Yeah good job girl you did it. One hurdle down, one million to go, but she made it. Wow that was definitely hard work. Okay I get to actually cry on my way home. I finished the test barely but I got through it. - courtesy of EAGALA (2013)

15 Observer s Notes from Study #1 I ve seen it, felt it, saw a kid changed for life in just five minutes. It was mind-blowing so fast, so immediate, so profound the learning I mean. Here he is this kid with an attitude and pants hanging down to his ankles and the horse could care less about his purple hair and tattoos and so this kid gets the halter on the horse but he puts it on upside down and backward! Funny, the horse is cool with it, you know. She is kind of curious about the kid lets him lead her around. Looks to me like she is kind of warming up to him and the kid is so proud. And so he starts talking more and more and he really made a breakthrough. I want to understand, really understand, how it works and why. Why horses? What is it about horses, and why do they have such an impact in treatment?

16 Observer Notes from Study #2 Ultimately, two main factors were observed to influence the EAP group s outcomes: being with the horses, and being with each other. The horses provided a safe place where the women could project their own stories, their fears, their feelings, their dreams and their questions. In fact, their journals are proof of how much they perceived the horses to be listening to them. Secondly, because they had felt isolated prior to EAP group, their weekly conversations with each other indicated they felt part of a larger community one where other people experienced similar situations. The EAP group was motivated to change in a relatively short period of time eight weeks. The EAGALA facilitators did not interfere in the change process, as the women gleaned more from their interpretation of their own experience than a classic meaning-making process often seen in traditional talk therapy. These two combined elements accounted for the successful outcomes of the EAP group. This, then, was the ultimate message the women participants in the EAP group were able to hear You are not alone. You are strong. You can change. Why horses? What is it about horses, and why do they have such an impact in treatment?

17 STRENGTHS, LIMITATIONS, AND IMPLICATIONS What Worked, What Didn t, and What the Future Holds

18 Some Identified Benefits for Use of Horses in Treatment (Or, why not just use dogs?) The Very Nature of Horses Themselves May Influence the Outcomes in EAP Whereas dogs are predators, horses are prey. Whereas dogs are smaller than humans, horses are larger. Whereas dogs and horses behaviors reflect high levels of curiosity, dogs behaviors reflect more of a Can I eat that? focus whereas horses behaviors reflect more of a Can that eat me? focus. Horses are masterful at observing the body language of other horses and predators, including us. Their hyper-vigilance is a means whereby they constantly perceive and respond, and they are keenly aware of the environment as a result. This is why so much of the EAP literature describes horses as mirrors that reflect back to us our thoughts and feelings in many cases before we realize what it is we are thinking or feeling (EAGALA, 2013).

19 Lessons Learned Strengths of the Studies Mixed-methods design offers qualitative richness and depth to support quantitative significance Comparison-group design Use of EAGALA-certified professionals and EAGALA Model Both groups continued to receive agency services during study Provided transportation or gas coupons for participants Suggestions for Further Research Increase sample size and number of sessions Employ random selection and assignment strategies where feasible Include a control group from waitlist of clients who receive EAP next Include debriefing/journaling time at end of EAP session Find ways of decreasing costs (increase size of group, number of groups for fixed cost, etc.) Include follow-up at 30, 60, 90 days

20 Major References Visit for much more! Equine Assisted Growth and Learning Association, Inc. (2012). Fundamentals of EAGALA model practice training manual: Equine assisted psychotherapy and learning certification program (7 th ed.). Santaquin, UT: Author. Ewing, C. A., MacDonald, P. M., Taylor, M. & Bowers, M. (2007) Equine-facilitated learning for youths with severe emotional disorders: A quantitative and qualitative study. Topeka, KS: Springer Science ± Business Media, USA. Fine, A.H. (2006). Handbook on animal assisted therapy: Theoretical foundations and guidelines for practice (2 nd ed). San Diego, CA: Academic Press. Froeschle, J. (2009, April). Empowering abused women through equine assisted career therapy. Journal of Creativity in Mental Health, 4 (2), Horses and Humans Research Foundation. (2013). Research. Retrieved from: horsesandhumans.org/research_awardedprojects.html