Equine Assisted Psychotherapy (EAP) for Addiction | Proposal

Equine Assisted Psychotherapy (EAP): Can EAP help in the treatment of addiction?

If one looks at the statistics for addiction, it is staggering. The annual cost to the NHS for alcohol abuse alone is ?3 billion, with an estimated population of recreational or addicted users of illicit drugs at 50 million (“Breaking the cycle,” 2006). The annual cost to Wales and England from drug abuse is greater than ?18.8 billion (“Breaking the cycle,” 2006).

Goodman (1990) defines addiction to include the addict’s inability or failure to control their own behaviour and the continuation of said behaviour despite the presence of negative behavioural consequences. Addictions address many forms of deviant behaviour ranging from recreational or pharmaceutical drug use to gambling to sex to overeating. While the mechanism of addiction may vary, the profile of the addict is similar. Therefore, treatments to effectively treat addictions are critical.

Although cognitive behavioural therapy (CBT) and/or the use of pharmaceutical agents are often prescribed to treat the addict, both of these methods are costly, can prove invasive and are time consuming than EAP, one of the newer alternative treatments for addicts (“Horse power, 2005).

The origins of EAP began over 200 years ago when German physicians employed horseback riding for the treatment of hysteria related mental illness (Riede, 1988 as cited by Frewin & Gardiner, 2005). While the employment of horseback riding has been shown to help the physical, psychomotor and psychological realms of the patient, EAP does not include horseback riding. Instead it incorporates exercises using the horse as a barometer.

Researchers (Christensen, 2006; Schultz, Remick-Barlow & Robbins, 2007; Frewin and Gardiner, 2005; Vidrine, Owen-Smith & Faulkner, 2002) tell us that horses provide an immediate sense of feedback through their actions to the addict, often called mirroring that allows the addict to immediately realize what it is in their own behaviour that cause the reaction it did in the horse. “The client is encouraged to use interpretation and insight so that they can start developing new ways of being around the horse,” with themselves and in society. This allows the therapist to both see the horse as a therapeutic aid, but also a more important diagnostic tool (Thompson, 2005). Research (Thompson, 2005; “Equine assisted activities, 2006) tells us that when the patient learns how to connect with and automatically control the horse, they have the opportunity to learn how to control and better understand themselves. Mann and Williams (2002 as cited by Frewin & Gardiner, 2005) cite an 82 percent improvement rate in conduct, mood and psychotic manifestations in patients who have tried conventional therapies for many years.

The EAP basis for treatment of addictions believes that if you act on an addiction, you are most likely not connected to your own sense of emotions and self. Connecting with the horse requires that you do (Lavender, 2005 as cited by Thompson, 2005). EAP has been successfully used in the treatment of addiction by many famous dramatic personalities, such as Sophie Anderton, Be Affleck, Christian Slater and Robert Downey Jr. (Thompson, 2005) helping to increase their sense of “self-esteem, personal confidence, interpersonal effectiveness, trust, boundaries and limit setting” all of which are lacking in the addict, creating the weakness and dependency on detrimental substances or behaviour.

Many addicted individuals do not seek treatment; however, for those that do, often the wait is 18 months or longer due to the limited funding for mental health treatment in the UK (“Addition Today,” 2007) whereas EAP is available at The Priory, a north London clinic. As alternatives to standard NHS sponsored CBT and pharmaceutical treatment are sorely needed, this dissertation proposes research into the effectivity of EAP in the treatment of addiction.

Aims

This dissertation asks the following research questions:

Is it possible to prove the therapeutic efficacy of EAP?
Is EAP an effective and quicker therapeutic substitute for the treatment of addictions than cognitive behaviour therapy (CBT)?
Is EAP helpful in the treatment of addictions?

Based on answering these research questions this dissertation seeks to prove the following two hypotheses:

Those suffering from addictions find EAP is a powerful and effective therapeutic technique for the treatment of their addictions.
Those providing treatment find EAP an ethical approach to the treatment of addictions.

Method

Research for this dissertation will consist of a formal literature review and a dual-leg qualitative study.

The literature review will be conducted using a series of academic searches for information through library systems, online academic systems and other subscription based professional research databases, such as Questia or Highbeam. Similarly, professional psychological and medical sites and associations will be reviewed for current literature as well as those professional sites developed for specialized research into alcohol addiction and related topics. Governmental, national and world health associations will also be reviewed for current literature as well as research and development efforts and governmental initiatives. All articles chosen must be written in English, be published in the last 15 years, be published in professional journals and be authored by credible and qualified professionals in their respective fields.

Following the literature review, this researcher will conduct a dual leg qualitative study composed of both interpersonal interviews and a survey instrument. Addicts who have participated in both standard treatment and EAP will be utilized for interviews and will be recruited through notices posted at EAP treatment centres, 12 step recovery meeting. After signing appropriate waivers for both taping the interviews and potentially using quotations as appropriate from interviews, interviewees will be asked a series of questions designed to elicit open-ended responses. All care will be taken to prevent researcher bias by asking each participant the same questions in the same manner and order. Survey participants will be comprised of therapists specialising in addiction and will be recruited through direct mailings to therapists and therapy centres specialising in addiction with questions on the instrument focusing on treatment for addiction, efficacy of CBT, efficacy of pharmaceutical agents, efficacy of EAP and the ethical considerations of each treatment modality.

Although a phenomenological approach has limitations due to potential researcher bias in theme identification and in participants self-reporting what they believe the research wants to hear, Gorgio (2002, p. 136) believes effective researchers can identify and obtain “a clarification of the conditions from human subjects… the descriptive phenomenological method implements this strategy. Indeed, it is an extension of the very spirit of science.” Ashworth (2003, p. 145) tells us that phenomenological psychology in the UK focuses on the interrogation of real world experiences, such that both participant and researcher can focusing on the problems or situation and apply meaning based on context and content.

Analysis

Consistent with a phenomenological approach, the analysis will be performed through the use of theme identification when reviewing group interview transcripts from which to prove or disprove the dissertation hypothesis. Questionnaires will be statistically analysed using frequency distributions based on the Likert-scale responses.

Workplan

Initiate Literature Review

Two and a half months, (9/1 – 11/15)

Recruit Subjects (both addict and therapist groups)

One month (11/1 – 11/30)

Develop questionnaire/survey for therapists, test for validity, clarity and ethical considerations,

Mass mail survey instruments.

One week (11/15 – 11/22)

Develop salient set of questions for interviews based on subject knowledge and research questions

One week (11/15 – 11/22)

Conduct interviews

Three weeks (11/23 – 12/15)*

Analyze group transcripts

Analyze returned surveys

One month (12/15 – 1/15)

Prepare written dissertation

One month (1/15 – 2/15)

*May vary slightly due to holiday schedules

References

The Addiction Recovery Foundation. (2007). Addiction Today. Retrieved 14 August 2007, from The Addiction Recovery Foundation website: http://www.addictiontoday.org

Ashworth, P. (2003). An approach to phenomenological psychology: The contingencies of lifeworld. Journal of Phenomenological Psychology, 34(2), 145 – 156.

Breaking the Cycle of Addiction. (2006). The Living Room. Retrieved 14 August 2007, from The Living Room website: http://thelivingroom.me.uk/stats.htm

Christensen, M. (2006, 25 April). The healing power of horses: Equine therapy helps emotionally distressed. Times-News (Twin Falls, Idaho). Retrieved 14 August 2007, from the Highbeam professional database website: http

Equine assisted activities. (2006). Palaestra, 22(3), 48.

Frewin, K. & Gardiner, B. (2005). New age or old sage? A review of equine assisted psychotherapy. Australian Journal of Counselling and Psychology, 6, 13 – 17.

Goodman, A. (1990). Addiction: Definition and implications. British Journal of Addiction, 85(11), 1403 – 1408.

Gorgio, A. (2002). The question of validity in qualitative research. Journal of Phenomenological Psychology, 33(4), 135-147.

Horse power; Olivia Stewart-Liberty was at the end of her tether until she tried a new therapy that’s already a hit in Hollywood. Meet the four-legged therapist who got her back in the saddle. (2005, 18 November). The Evening Standard (London, England). Retrieved 14 August 2007, from the Highbeam professional database website: http://www.highbeam.com/doc/1P2-2581505.html

Schultz, P. N., Remick-Barlow, G. A. & Robbins, L. (2007). Equine assisted psychotherapy: A mental health promotion/intervention modality for children who have experienced intra-family violence. Health and Social Care in the Community 15(3), 265 – 271.

Thompson, J. (2005, 23 October). The Priory enlists horses to treat the anxious, the angry and the …” The Independent on Sunday. Retrieved 14 August 2007, from The Findarticles database website: http://findarticles.com/p/articles/mi_qn4159/is_20051023/ai_n15720133

Vidrine, M. I., Owen-Smith, P. & Faulkner, P. (2002). Equine-facilitated group psychotherapy: Applications for therapeutic vaulting. Issues in Mental Health Nursing, 23(6), 587 – 603.