Post-traumatic stress disorder (PTSD) is a complex psychological condition. It most often occurs following exposure to a traumatic event. Indeed, hypervigilance, flashbacks and emotional distress are among the most prominent symptoms. As such, PTSD can profoundly affect the quality of life of those affected.
Conventional therapies, such as cognitive and behavioural approaches, remain the cornerstone of treatment. However, these treatments are not always sufficient to meet the needs of every patient. This is why animal-assisted therapy, and in particular equine-assisted therapy, is emerging as a promising complementary approach. In practice, it does not replace standard treatments, but rather complements them.PTSD (Post-Traumatic Stress Disorder).
By drawing on the human–animal relationship, this form of therapy aims to strengthen emotional regulation, self-confidence and overall well-being. The horse, a social and sensitive animal, is highly attuned to human emotional states and responds to them non-verbally. As such, it plays a key role in this type of support.
What is PTSD?
Post-traumatic stress disorder (PTSD), also known as PTSD (Post-Traumatic Stress Disorder), develops following direct or indirect exposure to a traumatic event. In practical terms, this may involve a threat to life, sexual or physical violence, a serious accident or an assault.
According to current classifications, symptoms include:
- intrusive re-experiencing (memories, nightmares, flashbacks);
- avoidance behaviours;
- cognitive and emotional changes;
- arousal and reactivity disorders (irritability, startle response, hypervigilance).
Historically, symptoms similar to PTSD have been described since ancient times, particularly amongst soldiers returning from war. Later, in the 19th century, doctors such as Oppenheim referred to ‘traumatic neurosis’. Subsequently, the major wars of the 20th century led to a better understanding of these disorders among combatants.
Today, the diagnosis is based, on the one hand, on duration (symptoms present for more than one month) and, on the other, on functional impact. For a diagnosis of PTSD to be made, the condition must significantly disrupt the person’s social, family or professional life. Furthermore, several factors increase the risk: early-life trauma, a history of mental health problems, and poor social support.
Conversely, early intervention – for example, through CUMPs – and certain specific therapies such as EMDR or exposure therapies can significantly improve the prognosis. Specialist care therefore remains the foundation of treatment, and equine-assisted therapy is used to complement this, never to replace it.
What does animal-assisted therapy involve?
Animal-assisted therapy, also known as animal-assisted intervention, encompasses therapeutic, educational or social practices that utilise the presence of animals. The principle is simple: the relationship with the animal facilitates engagement in care, learning or social rehabilitation.
In practice, animals are selected and trained for this role. The sessions are structured, with specific objectives. They always involve a trio: the participant, the animal and a trained professional. Thus, animal-assisted therapy is not simply a matter of ‘petting an animal’, but is based on a clear framework.
Historically, animals were used in healthcare settings from very early on. For example, there are reports of birds being used with patients to support their mental recovery. Later, in the 19th century, animals were introduced into certain psychiatric institutions. After the First World War, they were sometimes used to support traumatised soldiers.
In the 1950s, Boris Levinson formalised ‘animal-assisted therapy’. He described patients who had previously been resistant to conventional approaches but who opened up in the presence of a dog. Since then, animal-assisted intervention has become more structured. It now takes the form of therapy, education, recreational activities or animal-assisted coaching.
The objectives may be cognitive (attention, memory), emotional (anxiety, self-esteem) or social (communication, interpersonal relationships). Interventions aim, for example, to reduce anxiety, improve communication, build confidence or boost motivation – leading to improvements in cognitive, emotional and social areas.
In this context, the horse plays a special role. From being a working animal, it has become a therapeutic partner in equine-assisted therapy. Its sensitivity to its environment and to human bodily cues makes it a valuable ‘mirror’. It thus enables the observation and promotion of behavioural changes, particularly in PTSD.
How can hippotherapy and equine-assisted therapy be used in the treatment of PTSD?
The horse, through its emotional sensitivity, plays a unique role in animal-assisted therapies. In practice, two main forms of equine-assisted intervention are used in PTSD: hippotherapy and equine-assisted therapy.
In hippotherapy, the horse acts primarily as a ‘co-therapist’ on a physical level. Its gentle, rhythmic, three-dimensional movement stimulates postural control, coordination and balance. This can also alleviate certain chronic pains, often linked to trauma or prolonged stress. Thus, these stimuli enhance body awareness, which helps to reduce anxiety and restore a sense of security.
Equine-assisted therapy, on the other hand, focuses more on the psychological sphere. The horse acts as an emotional mirror. It reacts to the tensions, hesitations or calmness of the person it is accompanying. This enables participants to address emotional regulation, self-assertion and interpersonal relationships in a practical way.
The exercises offered (grooming, walking the horse by hand, free-range handling, and riding in some cases) require focus, self-awareness and active engagement. As such, they can foster self-esteem, confidence in one’s abilities and resilience in the face of trauma.
Furthermore, the natural setting of the sessions (indoor arena, outdoor arena, or the open countryside) provides rich sensory stimulation. Smells, touch, the sounds of nature and the horse’s movement all help to promote relaxation. Thus, the time spent in the company of the horse becomes a moment of grounding and respite.
Finally, the patient–therapist–horse triad creates a unique therapeutic alliance. The horse acts as a mediator. It helps to engage people who may be wary of the conventional medical setting. Moreover, it enables difficult emotions to be addressed without relying solely on words.
The wellbeing and needs of therapy horses
The wellbeing of the mediating horse is a central consideration. This is not only an ethical requirement but also a prerequisite for ensuring that sessions remain effective and safe. The horse remains a large, social, active and sensitive herbivore. Consequently, its specific needs must be respected.
Basic needs include:
- regular contact with other horses;
- sufficient freedom of movement (paddock, pasture, daily exercise);
- access to high-quality forage, amounting to around 1.5 to 2 per cent of live weight in dry matter per day;
- clean water, available ad libitum.
A suitable diet, rich in fibre, allows for prolonged chewing. This helps to prevent stereotypy, gastric ulcers and other digestive disorders.
Housing must provide a safe resting area, allow for easy movement and facilitate social interaction. Regular time spent out in the open, if possible in a group, reduces the risk of stress or chronic hypervigilance in horses.
Training and working methods should, preferably, be based on the principles of learning. The use of positive reinforcement helps to maintain motivation and cooperation. Conversely, coercive techniques should be avoided. Habituation to equipment, varied environments and different beneficiaries must take place gradually. This ensures that sessions are safe and appropriate.
Finally, regular monitoring of the horse’s physical and emotional state remains essential. Tools such as welfare assessment grids or protocols such as ‘Cheval Bien-Être’ help to observe the horse’s behaviour both during and outside sessions. They also enable the workload to be adjusted where necessary.
Adhering to these principles ensures a well-balanced horse. It also provides fairer, safer and more effective interactions for people suffering from PTSD. Ultimately, the quality of equine-assisted therapy depends as much on the therapeutic framework as it does on respect for the therapy horse.
