equine facilitated mental health for veterans with posttraumatic stress disorder participant...

Equine Facilitated Mental Equine Facilitated Mental Health Health

for Veterans with for Veterans with Posttraumatic Stress DisorderPosttraumatic Stress Disorder

Participant Hand-OutsParticipant Hand-OutsJennifer Tevlin, MS, LAC, NCC, Director of Special Programs

Jackie West, Head InstructorSunnyside Equestrian Center, Lincroft, NJ

PATH Region 1 ConferenceApril 17-19, 2015

What is Posttraumatic Stress What is Posttraumatic Stress

Disorder?Disorder?

• Posttraumatic Stress Disorder = PTSD

• May occur at any age

• Directly experience, witness or learn of traumatic event

• PTSD must be correctly diagnosed by licensed mental health professional

In general, what are the symptoms of In general, what are the symptoms of

PTSD?PTSD?

• Psychological and Physiological reactions

• Cognitive Effects (often co-occurs w/traumatic brain injury (TBI) in veterans)

• Memories of traumatic event

• Nightmares

• Flashbacks & Re-experiencing

• Avoidance

In general, what are the symptoms of In general, what are the symptoms of

PTSD?PTSD?

• Detachment, hopelessness

• May include anxious and depressed symptoms

• Negative thoughts & feelings, guilt, shame

• Irritability, anger

• Hyperarousal

• Problems with concentration and sleep

What Treatments are Currently used What Treatments are Currently used

to help Veterans with PTSD?to help Veterans with PTSD?

• Eye Movement Desensitization and Reprocessing (EMDR)

• Cognitive Behavioral Therapy (CBT)o Prolonged Exposure (PE) Therapyo Cognitive Processing Therapy (CPT)

• Medications: Anti-anxiety, anti-depressants, Prazosin

What are Equine-Assisted Activities and Therapies? What are Equine-Assisted Activities and Therapies?

• Equine-Assisted Activities and Therapies = EAAT

• EAAT MAY Include:o Therapeutic horseback ridingo Equine-Facilitated Mental Health (EFMH)o Equine-Facilitated Learning (EFL)

• EAAT is Team Approach Involving:o A horse or horses as therapeutic partnerso A participant (may be a client, patient or student)o MAY Include (depending on type of EAAT): Licensed Mental Health

Professional, Educator, Therapeutic Riding Instructor, Certified Equine-Specialist in Mental Health & Learning (ESMHL)

How are Equine-Assisted Activities and How are Equine-Assisted Activities and Therapies Therapies

Different than Currently Accepted Different than Currently Accepted Treatments?Treatments?

• In General, EAAT:o Is Dynamico May be less threateningo Works with horse as partnero May be passive or active depending on type of EAATo Allows participant to experiment with new behaviors and

receive immediate feedback from horse(s)o Allows participant to explore relationships in non-

judgmental setting

What is Equine-Facilitated Mental What is Equine-Facilitated Mental Health?Health?

• Equine-Facilitated Mental Health (EFMH):o Is a team-approach to therapy, involving:

• A horse or horses as therapeutic partners• A Client or group of Clients• A Mental Health Professional• A certified Equine-Specialist in Mental Health & Learning

(ESMHL)o Is Experientialo Uses Metaphorso Is an adjunct to traditional therapies

What are Some Reasons a Veteran What are Some Reasons a Veteran May Seek EFMH for PTSD?May Seek EFMH for PTSD?

• Other types of therapy have not been effective in helping some or all of the veteran’s symptoms

• Veteran may have a love of, or interest in, animals, including horses

• Veteran may relate to horse as respected symbol of power

• EFMH may not “feel” like therapy

• Team approach may be appealing

• Veteran recognizes physical and mental health benefits of interacting with horses, being outdoors, and moving around

What are Some of the Benefits of What are Some of the Benefits of EFMH for a Veteran with PTSD?EFMH for a Veteran with PTSD?

• Oxytocin release as a result of petting and grooming a horse

• Immediate biofeedback

• Safe, unconditionally accepting relationships with horses

• Mindfulness of present moment

• Fun & interesting work learning new skills, learning & understanding horse psychology & behavior

• Grounding techniques involving horses

• Metaphorical and experiential activities, applicable to real-world scenarios

• Awareness of mind-body connection, breathing, energy, body movement, position

What are Some of the Benefits of What are Some of the Benefits of EFMH for a Veteran with PTSD?EFMH for a Veteran with PTSD?

• Additional support through team approach

• Opportunity for powerful emotional release

• Share feelings while actively petting, grooming, walking w/horse

• Sense of normalcy (especially if veteran has positive childhood, or other past experiences with animals)

• Awakening of happy feelings through laughter, smiling at horse behavior/interactions

• May provide a purpose: Ability to help horse through rehabilitation or training

Some Things to Consider When Working Some Things to Consider When Working with Veterans who have PTSD in an EFMH with Veterans who have PTSD in an EFMH

SettingSetting

• Military branches have individual and shared aspects of culture

• Educate yourself about military culture

• Use your judgment to understand unfamiliar military terms “in the moment” or research after session

• May be difficult for veteran to ask for and accept help

• PTSD does not have same visible wounds as many physical injuries, making it difficult for veteran to understand that they deserve help

• Stigma associated with mental health in the military


SettingSetting

• Respect veteran’s right to privacy and confidentiality as you would with any client

• During intake assessment, provide tour of facility: Point out safe, private, quiet places where veteran can go if they need to take a break

• Hold EFMH sessions during low volume, off-peak, quiet times

• Ask veteran to identify potential triggers: Always be aware when there may be planes, gun shots or other sights, sounds or smells that could trigger a flashback or create a stressful situation for the veteran, and have a plan to manage any symptoms that may arise

• Struggling to find new identity, especially when no longer able to work in military or another former career due to PTSD


SettingSetting

• Veterans often relate well to horse’s position as prey animal in nature

• Psychology of horse as a prey animal is similar to psychology of veteran in dangerous situation: Both have heightened awareness, use peripheral vision to constantly scan environment for threats, and rely on quick assessments of situations to determine danger

• Consider structuring program so veteran has opportunity to volunteer at farm

What are Some EFMH Techniques for What are Some EFMH Techniques for a Veteran with PTSD?a Veteran with PTSD?

• Herd Observation

• Choose equine partner from herd and process decision

• Groom, pet, lead equine partner: Focus on mindfulness including energy, breathing, body position and movement, as well as horse’s reaction when adjustments are made

• Design an obstacle course representing most significant challenges or future goals and walk through it with equine partner


• Grounding techniques using concrete objects or images such as piece of horse mane or tail, or picture of horse

• Doubling exercise with horse as supportive figure

• Chalk exercises with horses: Feelings, Characteristics, Qualities, Goals

• Identify events or feelings and physically move them by leading horse to new destination


• Metaphors around significant life elements involving feed buckets and horses to represent positive and negative influences

• Concrete activities using obstacle courses to focus on real life problems like time management, prioritizing tasks, daily, short term and long term goals and relationships

• Teach horse to back or lounge

• Teach horse to accept tack or equipment


• Create areas of the arena to represent current struggles or achievements, and observe where veteran stands and where horse or horses stand and process significance

• Teach horse behavior and psychology during session and continually process equine responses to veteran’s speech, tone, pace, volume, body language, body position, and movement


• Use a horse with a visible physical injury such as a missing eye, an injury that you cannot see but which restricts the horse’s ability to perform his job, such as laminitis, or a horse who has himself, experienced some type of past trauma, which causes him to be even more cautious, vigilant and apprehensive

• Consider sharing some of this information with the veteran, or allow the veteran to tell you what he or she believes happened to the horse, as well as what the horse is thinking and feeling, and what the horse needs to progress and heal

• Consider asking the veteran if he or she sees any parallels between the horse’s journey and their own journey

During an EFMH Session with a During an EFMH Session with a

Veteran Remember to…Veteran Remember to…

• Help veteran identify, express and process emotions including anger, guilt, shame, sadness and fear

• Provide support and reflect back feelings

• Normalize PTSD as the result of heroic military service

• Validate decision to get help

• Incorporate future-focused goals

• Assign relevant homework to aid healing in between sessions

Thank you!Thank you!

equine facilitated mental health for veterans with posttraumatic stress disorder participant...

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