Equine-assisted therapies involve working with horses to treat physical and mental illness. But can horses really help us heal?

hand petting horse as part of  equine therapy to help with anxietyShare on Pinterest

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Can horses help with anxiety? It did with mine. As a child, I was one of those horse-enthusiast kids, lucky enough to have parents who paid for and drove me to weekly $5 horseback riding lessons at a stable just outside the city.

Although I was shy at school, I had friends at the barn. I was horrible at volleyball and kickball, but not bad at riding. I had intense anxiety and depression, but at the barn, I faced my fears and felt happy for a few hours.

I was lonely, but Smokey was my best friend. I loved the barn: Horses, fresh air, hard work, sport, knowledge — even the smell of horses.

Horses can be therapeutic. Therapies involving horses (and animals in general) have developed as the benefits of human-animal interaction have been increasingly researched.

Horses have been our partners in life and healing for a long time. The ancient Greeks gave horseback rides to people with incurable illnesses. Seventeenth-century literature suggests riding was used as a treatment for:

  • gout
  • neurological ailments
  • low morale

Horses are still helping us heal in therapy. Horses provide a multifaceted experience that can help people with a variety of physical, emotional, and mental health issues. The number of equine-assisted therapies is growing worldwide.

Who leads equine therapy?

Depending on the type of therapy, the team may include a licensed physical, occupational, or mental health therapist, who is either trained to work with horses, or partnered with an equine specialist. There may also be volunteer or staff “spotters,” to assist clients on horseback.

Anxiety — whichever way you describe the mounting emotions and subsequent behaviors — boils down to uncertainty and apprehension about future events.

Everything from cognitive distortions to retreating from situations or other people may be based on past experiences or prior episodes — but they affect the near future.

Equine therapy can interrupt this cycle by bringing folks back to the present moment. Activities with horses can only be engaged, at that moment. Horses don’t care about what hasn’t happened yet and don’t know your backstory. Horses feed off our emotions in real-time.

When you’re calm-assertive, they perceive and respond to interaction. If you’re angry or distant, they likely will be, too.

A small 2015 study of 12 women under 30 found that equine-assisted activities coupled with cognitive behavioral therapy (CBT) strategies significantly reduced social anxiety symptoms.

Symptoms of anxiety can be paralyzing and zap folks of self-confidence and esteem. In a 2015 Australian study of horse-assisted psychotherapy, study authors found adolescent participants improved in:

  • assertiveness
  • self-esteem
  • confidence

Equine-Assisted Psychotherapy (EAP)

EAP, developed by the Equine Assisted Growth and Learning Association (EAGALA), has been growing in popularity, and programs now exist all over the world.

Horses, being prey animals, are uniquely suited to therapy because they react quickly to subtle changes in the environment, people, and animals around them.

The horse acts as a mirror, reflecting the client’s energy. Horses are also herd animals, and there is safety in that uniformity.

This means horses are not only sensitive to their environment but also highly attuned to other members of the herd. This quality is what makes it possible for a human-horse bond to form.

In contrast to the therapeutic riding programs, equine-assisted learning and EAP are unmounted therapies — meaning there is no riding involved.

As the EAGALA explains on their website, “horses are equal partners on the team and are left unencumbered to allow them to interact freely with the client.”

Since horses are highly sensitive, participants can workshop life challenges by “interacting with the horses without feeling judgment or interpretation by another person,” it says.

Equine-Assisted Learning (EAL)

Generally, therapies that emphasize learning, like equine-assisted or equine-facilitated-learning (EAL or EFL), are focused on building skills, such as problem-solving and team building.

In contrast, equine-assisted and equine-facilitated psychotherapies (EAP or EFL) focus on treatment goals, such as managing depression symptoms or processing trauma.


Hippotherapy (from the Greek word “hippos”, meaning horse) is a form of physical and occupational therapy that has been used to treat disabilities, including:

  • autism
  • cerebral palsy
  • arthritis
  • multiple sclerosis
  • head injury
  • stroke
  • spinal cord injury
  • behavioral disorders
  • other mental health conditions

Therapeutic horseback riding

Therapeutic riding expands on hippotherapy to include not only riding, but horse and barn management. This helps people with special needs develop cognitive, physical, emotional, and social skills.

In therapeutic riding, the client’s relationship with a certified therapeutic riding instructor is paramount.

Hippotherapy and therapeutic riding have led to the evolution of newer therapies using horses in mental health treatment.

A note on safety

Equine-assisted therapies are all about safety. The equine specialist and mental health practitioner are dedicated to the physical, emotional, and psychological safety of both the client and the horse.

Horses are large, unpredictable animals and even in unmounted activities, there is always risk when working with them. As the client learns to respect the horse’s boundaries, a therapeutic relationship with the horse develops, based on mutual trust and affection.

Benefits of equine therapy

  • A 2018 study found a decrease in PTSD symptoms in military veterans after therapeutic riding treatment.
  • A 2015 study found that after horse-assisted therapy, young people reported significantly stronger motivation to stay in substance abuse treatment.
  • Several studies found significant increases in resilience in veterans and in young people in residential care that involved equine therapy.
  • A 2016 study showed significant increases in emotional intelligence among professional caregivers with compassion fatigue.

Disadvantages of equine therapy

  • It’s not yet agreed upon what the best practice equine-assisted therapy methods are, and for which conditions. As stated before, there aren’t enough studies. But this is changing, as research continues.
  • Horses are expensive — therefore, therapies using horses are expensive. While the Veterans Administration has been funding EAP through EAGALA since 2019, health insurance may not cover equine-assisted therapies.
  • Horses can be difficult to access. Horses tend to be kept in rural areas, while many folks tend to live in or near cities. However, horses are not always out of reach.
Was this helpful?

Equine-assisted therapies for the treatment of mental health conditions including anxiety are growing in popularity, but more scientific studies are needed.

Spending time participating in activities grooming and socializing with a horse could offer you practice in emotional regulation and present moment awareness. For more information, you can reach out to your local therapist about opportunities in your region or search this equine therapy directory.