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Reducing Anxiety and Stress among Youth in a CBT-Based Equine-Assisted Adaptive Riding Program

Hoagwood, Kimberly; Vincent, Aviva; Acri, Mary; Morrissey, Meghan; Seibel, Lauren; Guo, Fei; Flores, Chelsea; Seag, Dana; Peth Pierce, Robin; Horwitz, Sarah
Reining in Anxiety (RiA) is a therapeutic program for youth with mild to moderate anxiety delivered in a therapeutic riding setting by Certified Therapeutic Riding Instructors. RiA was developed after a review of the evidence base for youth anxiety, is manualized, and includes five core CBT components: in vivo exposure, cognitive restructuring, youth psychoeducation, relaxation, and caregiver psychoeducation about anxiety. This study extended findings from a prior RCT that examined (1) the feasibility of collecting saliva samples from horses and children to measure stress (cortisol) and relaxation (oxytocin); (2) whether changes in stress and relaxation occurred both during each lesson and over the course of the 10-week intervention for horses and youth; (3) whether changes in anxiety symptoms, emotional regulation, and self-efficacy found in the first trial were comparable; and (4) if fidelity to the program was reliable. Youth participants (n = 39) ages 6"“17 with caregiver-identified mild-to-moderate anxiety participated in a ten-week therapeutic intervention (RiA), which combined adaptive riding and components of CBT. Physiological data and self-report measures were taken at weeks one, four, seven, and ten for the youth and horses. Saliva assays assessed cortisol as a physiological marker of stress and anxiety, and oxytocin as a measure of relaxation. Fidelity data were recorded per session. Anxiety, as measured by caregiver self-reporting, significantly decreased from pre- to post-test, while emotional regulation scores increased. No significant changes in self-efficacy from pre- to post-test were observed. Saliva samples obtained from participants before and after riding sessions showed a consistent decrease in cortisol and a significant increase in oxytocin at two of the four timepoints (Week 1 and Week 7), but no overall pre- to post-test changes. Horse saliva data were collected using a modified bit; there were no significant changes in oxytocin or cortisol, suggesting that the horses did not have an increase in stress from the intervention. RiA may be a promising approach for reducing anxiety and stress among youth, as measured both by self-reported and by physiological measures. Collection of salivary assays for both youth and horses is feasible, and the intervention does not increase stress in the horses. Importantly, RiA can be delivered by adaptive/therapeutic horseback riding instructors in naturalistic (e.g., non-clinic-based) settings. As youth anxiety is a growing public health problem, novel interventions, such as RiA, that can be delivered naturalistically may have the potential to reach more youth and thus improve their quality of life. Further research is needed to examine the comparative value of RiA with other animal-assisted interventions and to assess its cost-effectiveness.
ISSN: 2076-2615
CID: 5350082

Evaluation of a Modified Bit Device to Obtain Saliva Samples from Horses

Vincent, Aviva; Peth-Pierce, Robin Marie; Morrissey, Meghan A; Acri, Mary C; Guo, Fei; Seibel, Lauren; Hoagwood, Kimberly E
(1) Background: Accounting for the well-being of equine partners is a responsibility of those engaged in Equine-Assisted Services (EAS). Researchers took heed of this call to action by developing an innovative way to collect data to assess the physiological indicators of stress in equine participants. The collection of saliva is considered to be a minimally invasive method of data collection and is typically performed using a cotton swab; however, in equines, the introduction of a foreign object may induce stress; (2) Methods: Researchers used a modified bit to collect pooled saliva in an effort to further reduce stress during the saliva collection process. Additionally, the collection of pooled saliva, via the bit, increases the opportunity to consider additional analyses, such as oxytocin, which is more reliable in pooled saliva than site-specific saliva captured with a swab; (3) Results: A data analysis demonstrated that ample saliva was captured using the modified bit. Observational data supported that the horses demonstrated fewer physical stress signals to the bit than to the swab. Thus, the modified bit is a feasible and valid method for equine salivary sample collection; (4) Conclusions: The results suggest that the modified bit provides a viable method to collect equine saliva and supports national calls to prioritize animal welfare analysis, specifically for horses used within EAS. Future research should enhance methodological rigor, including in the process and timing, thereby contributing to the bit's validation.
PMID: 34679064
ISSN: 2306-7381
CID: 5045922

An Equine-Assisted Therapy for Youth with Mild to Moderate Anxiety: Manual Development and Fidelity

Acri, Mary; Morrissey, Meghan; Peth-Pierce, Robin; Seibel, Lauren; Seag, Dana; Hamovitch, Emily K.; Guo, Fei; Horwitz, Sarah; Hoagwood, Kimberly E.
Childhood anxiety is common, yet approximately half of youth do not receive treatment due to stigma, mistrust of the mental health service system, extensive wait lists for services and provider shortages. Alternative models and modes of treatment are needed. This paper describes the development of an alternative treatment that incorporates cognitive behavioral components for anxiety into an adaptive/therapeutic riding program delivered by certified riding instructors in a horse stable that offers horseback riding and therapeutic horsemanship programs. Using PracticeWise®, a well-established database of evidence-based mental health practices for youth, we identified five therapeutic elements that are the most commonly examined in rigorous research for childhood anxiety, and integrated them into a manualized program of adaptive riding sessions. Excellent fidelity to the intervention (98.7% mean score) and high inter-rater reliability (k = 0.92) were achieved. This approach has implications for expanding access to and engagement in adaptive/therapeutic riding interventions.
ISSN: 1062-1024
CID: 4962732

Adaptive riding incorporating cognitive behavioral elements for youth with anxiety: Fidelity outcomes

Seibel, Lauren; Seag, Dana E. M; Guo, Fei; Morrissey, Meghan; Peth-Pierce, Robin; Acri, Mary; Hamovitch, Emily K; Horwitz, Sarah; Hoagwood, Kimberly E
Equine-assisted services include novel approaches for treating children's mental health disorders, one of which is anxiety (Latella & Abrams, 2019). Reining in Anxiety is a manualized approach to adaptive riding drawing on evidence-based cognitive behavioral therapy elements for youth with anxiety. This intervention was delivered by PATH Certified Therapeutic Riding Instructors (CTRIs) in a randomized pilot study. Fidelity checklists, developed to match the core components of the manualized intervention, were collected by independent observers. Fidelity scores addressed an average of 98.7% of components, well beyond the threshold for high fidelity (e.g. >80%) established in the literature (Garbancz et al., 2014). These findings show that the PATH CTRIs trained in the Reining in Anxiety intervention for this study, with supervision and implementation supports, delivered this intervention with high fidelity. This has important implications for expanding access to evidence-based community mental health services beyond traditional clinic settings and providers, and for addressing the gap between the need for and use of evidence-based youth mental health services. (PsycInfo Database Record (c) 2022 APA, all rights reserved)
ISSN: 2333-522x
CID: 5212402

Adaptive riding incorporating cognitive-behavioral elements for youth with anxiety: An exploratory randomized controlled study

Hoagwood, Kimberly E; Acri, Mary; Morrissey, Meghan; Peth-Pierce, Robin; Seibel, Lauren; Seag, Dana E. M; Vincent, Aviva; Guo, Fei; Hamovitch, Emily K; Horwitz, Sarah
Between 15% to 20% of youth meet diagnostic criteria for anxiety, yet most do not receive treatment due to workforce shortages, under-detection, or barriers that dissuade families from seeking services in traditional settings. Equine-assisted services (EAS) include several promising approaches to reach populations who do not access traditional therapies. Few studies using rigorous methods have been conducted on EAS for youth. This study examined feasibility and outcomes of a 10-session Cognitive Behavioral Therapy (CBT)-based adaptive riding intervention (hereafter called Reining in Anxiety) delivered by trained equine professionals. Forty-one youth 6- 16 years of age were recruited from GallopNYC, an adaptive horseback riding center in the NYC metro area. Youth were randomized to an experimental group (n=22) or services as usual (n=19), a standard adaptive riding group (services as usual or SAU). Severity of anxiety symptoms, anxiety in close relationships, and emotional self-efficacy were assessed at baseline and at the end of treatment. Fidelity to the manual was excellent, ranging from 88.9% to 100%. There was a non-significant trend in the experimental group towards greater improvement with higher number of sessions completed. Youth in the Reining in Anxiety group displayed significant reductions in anxiety (t=4.426, df=38, p=0.042) and improvement in emotional self-efficacy at posttest (t=4.132, df=38, p=0.049) in comparison to the SAU group. No significant differences were found between groups for anxiety in close relationships. This study suggests that a CBT-based adaptive riding intervention delivered by non-mental health equine professionals following a detailed manual can reduce youth anxiety symptoms and be delivered with fidelity by riding instructors. These findings have implications for families seeking non-traditional services. (PsycInfo Database Record (c) 2022 APA, all rights reserved)
ISSN: 2333-522x
CID: 5212412

Animal-Assisted Therapies for Youth with or at risk for Mental Health Problems: A Systematic Review

Hoagwood, Kimberly Eaton; Acri, Mary; Morrissey, Meghan; Peth-Pierce, Robin
To systematically review experimental evidence about animal-assisted therapies (AAT) for children or adolescents with or at risk for mental health conditions, we reviewed all experimental AAT studies published between 2000-2015, and compared studies by animal type, intervention, and outcomes. METHODS: Studies were included if used therapeutically for children and adolescents (
PMID: 28798541
ISSN: 1088-8691
CID: 2664182

Equine-assisted activities and therapies: Enhancing the social worker's armamentarium

Acri, Mary; Hoagwood, Kimberly; Morrissey, Meghan; Zhang, Shirley
Introduction: Equine-assisted activities and therapies (EAAT) have gained prominence as a viable therapeutic approach for a range of mental health and developmental problems, yet is not widely known and not conventionally provided within the social work educational curriculum. Thus, the purpose of this study is to provide a review of various certification bodies available to social workers in order to bring EAATs into their therapeutic work. Methods: A multi-stage process, including consultation with experts in the field and an online search was undertaken to locate certification programs for mental health professionals. Results: Seven certification organizations were identified; programs varied with respect to mental health pre-requisites, type of certification, training components, and cost. Discussion: There has been substantial growth in EAAT for children with mental health and developmental problems, and there are a range of certification types to select from. Factors to consider when choosing which type of certification to pursue, and barriers to certification are discussed.
ISSN: 0261-5479
CID: 2580212

CBT for Children and Adolescents With High-Functioning Autism Spectrum Disorders. [Book Review]

Morrissey, Meghan
ISSN: 1527-5418
CID: 1812632