1. Methods
The Development of a Cognitive-Behavioral Equine Facilitated Therapy for Children and Adolescents with Anxiety
Authors: Mary Acri, PhD; Meghan Morrissey, LCSW; Emily Hamovitch, MPH, MSW; Kimberly Hoagwood, PhD
Author Background
Process
Equestrian
School Psychology
Social Work
Choose population
Literature review
Regularly scheduled meetings
Seek Best Supported Research
118 Protocols
91 Papers
44 Practice Elements
PracticeWise
“offers innovative tools and services to help clinicians and organizations improve the quality of health care for children and adolescents”
Literature Database of Clinical Trials
Search Criteria:
ages 2-19
symptoms of anxiety
Caregiver Psychoeducation
Relaxation
Client Psychoeducation
In Vivo Exposure
40%
44%
56%
66%
92%
Cognitive Skills
Of the 44 Practice Elements, 5 elements existed in over 40% of protocols, so authors focused on using those 5 elements to develop into session
Department of Child and Adolescent Psychiatry

2. Intervention - Content
Session
Goals (mapped from recommended 5 practice elements)
Exposure, Cognitive, Client Psychoeducation, Relaxation, & Caregiver Psychoeducation
Session 1:
CBT Components
Build rapport
Gather information regarding rider mental status, severity of anxiety, and horsemanship skill
Psychoeducation about identification and connection between thoughts, feelings, and behaviors
Session 2:
CBT Anxiety Focus
Normalize anxiety
Identifying different types of alarms
Gather information about anxiety provoking situations specific to each rider.
Session 3:
Relaxation Techniques
Learn/practice relaxation techniques
Learn about horse communication aids
Session 4:
Review
Review all materials/skills in case of missed sessions
Session 5:
Fear Ladder
Finalize Fear Ladder
Scenarios that are specific to rider anxiety
Scenarios are rated by rider and include 1-10 range of intensity
Session 6:
Thought Changing
Learn/practice thought stopping/changing technique
Session 7:
Cognitive Distortions
Identify fortune-telling thoughts & mind reading thoughts
Practice thought changing with rider specific scenarios
Session 8:
Identify catastrophic thoughts & filtering thoughts
Session 9:
Problem Solving
Learn/practice problem solving steps
Session 10:
Termination Celebration and Maintenance
Review all skills learned
Identify/highlight growth areas
Identify ways to maintain/generalize skills
Flexible to horsemanship skill
Provides modification suggestions
Provides therapeutic stance for scaffolding, priming, and collaboration
Skill building with goals and objectives
Exposure and habituation
Building a fear ladder specific to personal scenarios that evoke anxiety throughout the entire intervention
Fear ladder is useful tool to caregivers as well as traditional therapist
In-Vivo Exposure throughout
8 sessions changed to 10 sessions
To accommodate possible missed session = added review session
To align with study site programming
Adjusted from individual to group format

3. Intervention - Structure
Review previous session/homework
&
Contain any crisis
Review
5 Minutes
Mount
Warm Up
Activity
15 Minutes
Homework
Instruction
Caregiver
Psychoeducation
Cool Down &
Dismount
Unmounted Time
= 15 Minutes
Mounted Time
= 30 Minutes
Start
Horse
Skill
Building
Mental Health Skill Building
Journal with basic review and homework (progressively more)
Depending on how many riders you have, this could take less time
Facilitate riders communicating learned material with caregivers
Important for generalization to community
Models good communication skills
Primes caregivers to coach riders though homework
Physical warm up (both horse and rider) +
Mental warm up (continued review of horsemanship &
mental health skills) 45
Minutes
Total
*can be
adjusted
Activities include both horsemanship skill building and mental health skill building
Scaffold and modify as needed
Cool down horse +
Rider mindfulness or relaxation exercise
Dismount