The Impact of Equine Assisted Interventions on Measures of Social and Emotional Wellbeing in Adolescents

Shreyasi Brodhecker
June 2020

Abstract
Although there is anecdotal evidence about the emotional benefits of being with horses and from
qualitative research, there is limited empiric understanding of the emotional and social benefits
of equine assisted interventions. This review addresses the following question: What is the
impact of equine assisted interventions on measures of social and emotional wellbeing in
adolescents? At least eight studies were selected, the majority of which were quantitative
randomized studies including statistical analysis of measures of change resulting from the
particular equine assisted interventions. Conclusions of this review are that there are significant
improvements in measures of social and emotional wellbeing, including perceived social
support, life skills, confidence and various prosocial behaviors, following equine assisted
interventions in adolescents. The findings seem most robust for youth at risk receiving these
interventions.
Background
The rationale for selecting this literature review topic lies in the intention to partner with equines,
in a nature-based setting, to provide life skills and psychoeducation to young adults hailing from
disadvantaged backgrounds or otherwise thought to be “at risk”. “At risk” is variably defined in
studies as encompassing factors such as low academic achievement, poor school attendance, and
the presence of socio-economic barriers like low income and limited access to after-school
activities and programs (Frederick, K.E., Hatz, J.I., & Lanning, B., 2015; Perkins, B.L., 2018). A
large proportion of young adults deemed “at risk” may have been exposed to early childhood
traumatic experiences and be additionally vulnerable to future mental health diagnoses.

Although there is a trove of anecdotal evidence about the emotional benefits of horses
with people, empiric research is limited. There have been recent randomized controlled studies
exploring the effects of equine assisted interventions on various measures of social and
emotional wellbeing in adolescents. There has also been at least one meta-analysis (Wilkie,
Germain, & Theule, 2016) in the last ten years. Equine therapy can be an alternative to
traditional therapies in at-risk youth for various measures of emotional health (Wilkie et al.,
2016). Although there are general limitations such as low sample size, lack of long-term follow
up and limited investigation of the relative contributions of AAI or animal-assisted intervention
components (such as nature setting, horse-human interaction, peer support, etc.), there are
promising findings that equine assisted interventions improve social and emotional wellbeing in
adolescents, particularly in at risk youth. The intention of this review is to determine whether
equine-assisted interventions can enhance social and emotional wellness in adolescents
vulnerable to developing future mental health conditions. As such, the population studied in this
review are largely at risk adolescents who do not have current mental health diagnoses.
Equine assisted interventions (EAI), as defined in this literature review, comprise
“equine-assisted interactions in general” (Latella & Abrams, 2015, Chapter 3, p.115). In this
respect, the term is thought to include both: 1. EFP (Equine Facilitated Psychotherapy),
alternately referred to as EAP (Equine Assisted Psychotherapy), and 2. EFL (Equine Facilitated
Learning), alternately referred to as EAL (Equine Assisted Learning). Latella and Abrams (2015)
define EFP and/or EAP as “an experiential method of psychotherapy that includes equines in the
treatment process… The activities themselves are not the objective; however, they assist the
clinician and client in reaching the psychotherapeutic goals” (p.125). Alternately, EFL and/or
EAL refer to experiential forms of learning that involve interactions with equines. As per these

authors, “the horse and its environment provide opportunities for learning communication and
life skills that can influence how we relate to others in our lives” (Latella & Abrams, 2015,
p.125). The Pro-EFW Canada (Professional Association for Equine Facilitated Wellness,
Canada) website further delineates professionals working in EFP or EAL as being Equine Mental
Health (EMHP) Professionals and Equine Facilitated Learning (EFLP) Professionals respectively
(Professional Association for Equine Facilitated Wellness, 2019).
Indeed, the equine assisted interventions described in this review include elements
derived from White-Lewis’s (2019) concept analysis of horses as healers, namely; 1. A human
participant with an equine physically present to assist the human participant, 2. A treatment or
intervention as a result of the interactions between an equine and a human participant, 3. A
purposeful and regulated interaction and, 4. A positive health outcome goal from this interaction.
Although this concept analysis is intuitively associated with EAP, it can be argued that this broad
definition also encompasses EAL, since EAL educational skills are far-ranging and those life
skills taught within EAL are wellness skills which positively impact social and emotional health.
The life skills, termed as “measures of social and emotional wellness” and intentionally broader-
scope in the literature review’s objective, may include social skills, self-esteem or self-
confidence, sense of self mastery, and responsibility for others. As well, these beneficial skills
can be taught to individuals who do not have mental health diagnoses and for whom there are no
psychotherapeutic treatment goals in the context of the equine assisted intervention. There are
two studies included which specify EAP interventions (Lentini & Knox, 2015; Fo, Zhou, Fung,
and Kua, 2017); however, closer review revealed that these interventions are EAL in terms of
their educational approach, their goals of teaching life skills and prosocial behaviors, and their
compatibility with other educational programs received by the youth involved.

Additional terminology in this review are: 1. “Adolescents”, which refers to teens or
young adults between the ages of thirteen and eighteen and 2. “At risk”, defined earlier in this
review. Some studies did not explicitly assess for mental health diagnoses in at risk youth, which
can be a limitation in interpreting results since such lifestyle factors confer vulnerability to
mental health issues. Nevertheless, the studies are assumed to include teens considered to be
“normotypic”, i.e. those without mental health diagnoses at the time of the interventions (Hauge,
Kvalem, Berget, Enders-Slegers, & Braastad, 2014) but who are “at risk” for future diagnoses.
Regarding study design, the majority of studies in this review are quantitative in nature.
Qualitative data was included from two studies, Maujean, Kendall, and Roquet (2013), and
Coffin (2019). Qualitative data was also included from a literature review (Lentini & Knox,
2015) to further bolster the quantitative findings.
Study Summaries and Analysis
In Frederick et al.’s (2015) study, EAL’s impact on the levels of hope and depression in a
population of at-risk youth was explored by recruiting middle and high school-aged participants
from a Texas school. These children were identified as having one or more risk factors as per the
Texas Educational Association, for example, low academic achievement, grade retention and low
socioeconomic status. Students volunteered to participate in a five week curriculum-based EAL,
which utilized non-riding equine activities, called L.A.S.S.O. (Leading Adolescents in
Successful School Outcomes). Study participants were randomly assigned to the L.A.S.S.O.
group or a waitlist control group (who completed the intervention after the study was
completed). The majority of studies in this literature review followed this general study design,
i.e. random assignment to a treatment/intervention group or waitlist control. In Frederick et al.’s
(2015) study, the L.A.S.S.O. curriculum was provided by a mental health professional and an

equine professional trained in the program, and included discussion topics such as “life’s
obstacles,” “vulnerabilities,” and “achieving goals” (p.811). Observing horses and learning how
to halter and handle them was also taught. Self-report measures were collected from students at
the start and end of L.A.S.S.O.. The sample size was small at 26 (9 males and 17 females) and
the age group was 11yo-17yo. In the results, students attending EAL, relative to control, had
significantly higher levels of hope at the end of the study. Although the treatment group also had
lower ratings of depression, these results were not statistically significant. Hope is thought to be
inversely related to depression and has been associated with optimism, self-esteem and academic
achievement in school-aged children; hope is therefore understood to influence both social and
emotional wellbeing. The strengths of this study were its quantitative study design and inclusion
of a relatively cost effective and replicable form of EAL. Limitations included the limited
generalizability of the results, small sample size, not accounting for volunteerism-related factors,
and data complications affecting statistical analysis.
A similar EAL intervention was attempted in a group of at-risk Australian Aboriginal
youth in Coffin’s (2019) pilot study. The authors sought to trial a culturally secure
psychotherapy for Aboriginal youth, who are typically disenfranchised and experience high rates
of violence, academic underachievement and incarceration compared to their non-Aboriginal
peers. This unique EAL was provided by Aboriginal educators in the context of a culturally
approved program by elders in the local communities. Although there was a large sample size of
270, only 20 fit the age profile (11yo-16yo) of this literature review. Students completed a six to
ten week program in EAL, with weekly 45-60 minute sessions. These sessions included
individual, paired and group activities for non-riding equine interactions, discussion of topics
such as coping skills and self-regulation, and leadership-focused activities. Quantitative data was

derived from measurements on a modified Strength and Difficulties Questionnaire at the start
and end of EAL. This study extended data collection beyond the quantitative findings of
Frederick et al.’s (2015) work to include qualitative data. Qualitative findings were observations
made by the primary investigator/EAL provider, parents, school teachers and occasionally
psychologists on participant body language, behaviours, and relationships with horses, at home
and at school. Findings of this study also showed EAL’s benefits – namely, that youth attending
the EAL showed improved social and emotional wellbeing, self-regulation, socialization and
self-awareness ratings and behaviors. Although this study integrated qualitative and quantitative
data in a disenfranchised population, shortcomings were the potential for bias in observations
being made by the principal investigator and the lack of control group, thereby limiting statistical
significance of the results.
There have been a number of studies highlighting the benefits of EAL on healthy social
functioning in teens. For example, Hauge et al. (2014) investigated the impact of an EAL on
levels of perceived social support among Norwegian teens aged 12 to15 years old without
diagnosed mental health conditions. This was a waitlist-list cross-over design study, similar to
Frederick et al. (2015) above. Specifically, participants were randomized to the intervention
group or to a waitlist control group (the control group completed the EAL after the initial
treatment group). These authors termed their study intervention EAA (equine-assisted activities),
although the format was in keeping with EAL. Specifically, students from ten local schools
voluntarily participated in a four month intervention at select local farms, where they attended
two-hour weekly sessions with a peer who was new to them at the study start, worked with the
same horses and instructor over the weeks of intervention, and had the opportunity to learn and
perform groundwork, riding, communication with the horses and general farm skills. Self-report

measures of self-esteem, self-efficacy and perceived social support were collected at the start and
end of the intervention, and a questionnaire was provided to assess the degree to which
participants thought they had mastered task-based and relationship skills with the horses as a
result of EAL. There were groups of 49 and 41 used in the pre-/post-comparison and correlation
data analysis respectively. There was significant improvement in the level of perceived social
support at the end of EAL compared to the start, although there were no changes seen in either
self-esteem or self-efficacy ratings. As well, those teens with lower levels of perceived social
support at the study start showed the strongest correlation with experienced mastery of horse
skills. In other words, although the participant demographic had similar psychological variable
scores at the start of the study, those with slightly lower levels of social support showed the most
improvement in mastery of skills with horses. Possible social support factors at play include the
horse-human relationship, peer relationships and teen-instructor relationships. Specific self-
efficacy scales and long-term data may have enriched the study findings, since these youth are an
interesting comparator to those with mental health diagnoses often studied in this field.
Social competence, related to social wellbeing, is also impacted by EAL/EFL (Pendry,
Carr, Smith, & Roeter, 2014). The effects of an 11-week EFL program on the social competence
and behaviors of Grade 5 to 8 children was explored by random assignment of 131 children to an
EFL group (53 youth) or to waitlist control (60 youth). The EFL group provided participants
with weekly 90-minute sessions of individual and group activities. Study measures included
parent-rated social competence scores pre- and post-EFL, and checklist scores from three
independent raters at each EFL session to gauge the frequency of positive and negative behaviors
demonstrated. Results of this study were that EFL participation (vs. waitlist) had a moderate
treatment effect on social competence regardless of pre-test ratings, age or gender. As may be

expected, higher levels of program attendance predicted more observed positive behaviors in the
children. Despite the risk of bias from parent-derived scores, the study’s strengths were utilizing
randomization and a large sample size with control, and inclusion of various validated scales.
Other studies exploring the impact of EFL on prosocial behaviors in children included
those by Perkins (2018), Maujean et al. (2013), and Fo et al. (2017). EAL’s association with
significant improvement in prosocial behaviors related to social and emotional wellbeing, such
as communication, confidence, and impulse control, in at risk youth was demonstrated. Perkins
(2018) described a quantitative pilot study of 6 adolescent females from the foster care system,
who attended an eight week psychoeducational/EAL program called Cowboy Trails, or eight
weeks of group therapy (group therapy served as the control in this study). Weekly EAL sessions
included a 15-minute discussion of a life skill taught that week, 45 minutes to complete a task
with a horse, and then final group debrief. Questionnaires on prosocial behaviors were completed
by the participants at the start and end of the intervention. Questionnaires were also collected
from members of the EAL team (mental health professional and equine professional) and a ranch
worker not involved with the program through the study. On the participant’s pre- and post-
intervention questionnaires, measures of emotional regulation increased significantly at the end
of the Cowboy Trails intervention. Further, on the team reports’ pre- and post-test comparisons,
other prosocial skills such as communication, confidence and respect also showed improvement.
Although this study was limited by the small sample size and generalizability of the results, it
showed that EFL may be a worthwhile avenue to improve prosocial behaviors in at risk youth. It
was unclear whether this group already had mental health diagnoses, as this was not addressed in
the study.

Similar findings of improved emotional and social wellbeing in teens were found by
Maujean et al. (2013), who conducted a qualitative pilot study of 16 disenfranchised youth in
Queensland, Australia, to assess the impact of an equine-assisted intervention on measures of
self-esteem, self-efficacy, engagement and prosocial behaviors. Participants completed a ten
week hourly intervention called Horse Play, which incorporated Parelli natural horsemanship,
life skills teaching and applying character traits such as kindness outside of sessions. Qualitative
themes from interviews of the participants and case managers were: 1. Enjoyment (of the
program), 2. Social and Psychological Benefits (including improved social skills and self-
esteem), 3. Engagement (improved school attendance and participation in non-horse activities),
and 4. Transferable Skills (e.g. improved motivation and self-awareness).
These prosocial behavior findings are in alignment with those from Fo et al. (2017), who
tested an equine assisted intervention’s impact on the Habits of Mind program, a prosocial skills-
based curriculum in the at risk youth’s school. Known as EQUAL (Equine Assisted Learning),
the intervention included EAP, EAL, therapeutic riding, and hippotherapy provided for weekly
three-hour sessions over a total of 16 weeks. There were two cohorts, in 2013 and 2014, of
students between the ages of 11 and 15 years of age (who entered this school after failing their
elementary school exams). There were 75 students in the EQUAL group and 82 students in a
waitlist control in 2013, and 58 students in the EQUAL group and 59 students in the waitlist
control in 2014. Scores on a rating scale for dimensions of the Habits of Mind curriculum,
including Persistence, Thinking Flexibly, Taking Responsible Risks, Managing Impulsivity and
Understanding/Empathy were measured at the start and end of EQUAL in treatment and control
groups, similar to other studies mentioned in this review. There were significant improvements
in the Habits of Mind factors in the EQUAL group versus control; this finding was seen in the

2013 and 2014 cohorts. As well, measures of change correlated positively with student grade
point average at the end of semester.
Directions for Future Research
Following review of these studies, the following directions for future research are
suggested: 1. Recruiting larger sample sizes in ongoing randomized controlled studies, 2. Using
standardized scales to assess self-esteem, specific self-efficacy, perceived social support and
prosocial traits and behaviors, and 3. Including follow-up data in six months or later after the
study to gauge the longevity of the benefits. Additionally, statistical analysis for the effects of
EALs on at risk youth with and without mental health diagnoses is helpful; along with
comparisons of EAL with EFP and other control group psychotherapies, and comparing riding
EALs with non-riding EALs.
Conclusions and Applicability to Future AAI Practice
This literature review facilitated the following considerations for future practice. Firstly,
various forms of EAL can be helpful for improving measures of social and emotional wellbeing
in at risk youth. On average, EAL interventions consisted of at least eight weekly sessions, each
session being at least one hour in duration. The studies’ EALs included riding-related and non-
riding related equine activities, implying that both are beneficial modalities. Secondly, although
one study (Hauge et al. 2014) cited equine assisted interventions being applied in normotypic
teens, the majority of studies showed benefit for at-risk youth of both genders. Finally, factors
hypothesized to positively contribute to study results and that can be integrated into future
practice include: 1. A program blend of structured equine activities and group discussion about
life skills and themes from the sessions, 2. Consistent and intentional pairing of horse and

participant where possible, 3. A nature-based setting and, 4. A non-judgmental and supportive
learning environment.
In conclusion, this literature review indicated that there is significant improvement in
measures of social and emotional wellbeing, such as perceived social support, enjoyment,
mastery of skills, improved engagement at school and improved ratings on prosocial behavior
scales, associated with administering equine assisted interventions in adolescents.

Bibliography
1. Coffin, J. (2019). The Nguudu Barndimanmanha project- Improving social and emotional
wellbeing in Aboriginal youth through equine assisted learning. Frontiers in Public
Health, 7, 278, 1-11.
2. Fo, N.F., Zhou, J., Fung, D.S.S., & Kua, P.H.J. (2017). Equine-assisted learning in youths
at-risk for school or social failure. Cogent Education, 4, 1334430.
3. Frederick, K.E., Hatz, J.I., & Lanning, B. (2015). Not just horsing around: The impact of
equine-assisted learning on levels of hope and depression in at-risk adolescents.
Community Mental Health Journal, 51, 809-817.
4. Hauge, H., Kvalem, I.L., Berget, B., Enders-Slegers, M-J., & Braastad, B.O. (2014).
Equine-assisted activities and the impact on perceived social support, self-esteem and
self-efficacy among adolescents – an intervention study. International Journal of
Adolescence and Youth, 19(1), 1-21.
5. Latella, D., & Abrams, B. (2015). The role of the equine in animal-assisted interactions.
In A. Fine (Ed.), Handbook on animal-assisted therapy: foundations and guidelines for

animal-assisted interventions (pp.115-140). Fourth Edition. San Diego, CA: Academic
Press Publications.
6. Lentini, J.A., & Knox, M.S. (2015). Equine-facilitated psychotherapy with children and
adolescents: an update and literature review. Journal of Creativity in Mental Health, 10,
278-305.
7. Maujean, A., Kendall, E., & Roquet, L. (2013). Connecting for health: playing with
horses as a therapeutic tool. Journal of Community Psychology, 41(4), 515-522.
8. Pendry, P., Carr, A.M., Smith, A.N., & Roeter, S.M. (2014). Improving adolescent social
competence and behavior: a randomized trial of an 11-week equine facilitated learning
prevention program. Journal of Primary Prevention, 35, 281-293.
9. Perkins, B.L. (2018). A pilot study assessing the effectiveness of equine-assisted learning
with adolescents. Journal of Creativity in Mental Health, 13(3), 298-305.
10. Professional Association for Equine Facilitated Wellness. (2019). Certification overview.
Pro-EFW Professional Designations.
http://www.equinefacilitatedwellness.org/certification
11. White-Lewis, S. (2020). Equine-assisted therapies using horses as healers: A concept
analysis. Nursing Open, 7, 58-67.
12. Wilkie, K.D., Germain, S., & Theule, J. (2016). Evaluating the efficacy of equine therapy
among at-risk youth; a meta-analysis. Anthrozoos, 29(3), 377-393.