After our soldiers come home, they bring the memories from the theater of war that can haunt them for the rest of their lives. Divorce, abuse, violence, and persistent flashbacks or nightmares follow them from overseas and spill into their personal civilian life. Try as they might, many of them continue to struggle even months after moving back.
To find respite from these symptoms, many people look to wholesome treatments as an alternative to pharmaceuticals, which sometime can make them feel like a zombie.
Many people find solace with animals. Simply being around them can make a huge difference in a person’s mood. Because of this reason, and many more, people have utilized animals for decades in recovery efforts for people who suffer from PTSD and other invisible illnesses. With many different programs out there designed to help veterans reintegrate back into normal life, it’s good to do some research about the differences between them.
Equine Therapy: What’s it Like?
When we talk about service animals, dogs usually come to mind. However, horses provide a service to those who struggle with PTSD too. Equine Assisted Psychotherapy is an increasingly popular option.
One of the most obvious and simple impacts that equine therapy has for veterans is the requirement to get outside and into the open. The horse cannot go to the veteran’s house; they must travel to the stable or facility where the horses reside. Agoraphobia is a common symptom of PTSD, and activities outside of the home can bring the veteran one step closer to living a regular civilian life.
Equine Assisted Psychotherapy (hereafter, EAP) works in multi-faceted ways. The mere presence of a horse can be considered ‘therapeutic’ to some clinicians. This is because horses have dynamic personalities of their own, and they also mirror their handler’s emotions. If you are angry, the horse will pull away from you. If you are happy and calm, the horse will be happy and calm. In this way, PTSD veterans learn to see and manage their emotions. Learning to control the horse while simultaneously learning to control your own body helps foster discipline and self-confidence.
In conjunction with the horses, a licensed therapist, and a horse expert, the veteran will be put on their way to recovery by being put out of their comfort zone. Interestingly enough, EAP doesn’t usually involve riding. Rather, you participate in activities with the horse which involves their care and talk through whatever it is you are struggling with at the same time. This method is usually very effective for people who have found traditional therapy lacking.
Horses have some good advantages as far providing therapeutic challenges. Their size requires the participant to show tenacity while handling them. They also are extremely intuitive, expressive, and emotional creatures. They live in a herd dynamic that socializes in a similar way to humans, so they translate well in an atmosphere where they are required to interact closely with another.
We see lots of wonderful testimonies that extoll these programs. But what does the scientific community say?
The Scientific Evidence Supporting Equine Therapy for PTSD in Veterans
There have been many conversations on whether equine therapy works for veterans with PTSD. Even with many individuals vocally claiming equine therapy worked wonders for them, organizations and institutions who provide grants want scientific evidence.
In 2018 the NIH published a study that showed a significant decrease in PTSD symptoms after a six week period of EAP. It was the first study of its kind. It compared a controlled group that was on a six-week waiting list to another group who started the program right away. They took benchmark evaluations at the beginning of the program and collected all the participants previous medical documentation. The study goes into detail about how they measured their success:
“Demographic and health history information was obtained from all the participants. PTSD symptoms were measured using the standardized PTSD Checklist-Military Version (PCL-M).
The PCL-M as well as other instruments including, The Coping Self Efficacy Scale (CSES), The Difficulties in Emotion Regulation Scale (DERS) and The Social and Emotional Loneliness Scale for Adults-short version (SELSA) were used to access different aspects of individual well-being and the PTSD symptoms.”
In response to the VA supported study, accredited equine therapy programs are now eligible for federal funding. The house approved Amendment #47 of H.R. 3219 (the Make America Secure Appropriations Act of 2018), which provides five million dollars to aid these programs, in hopes of expanding them to be available to more veterans.
Service Dogs
Service dogs go beyond helping the blind or physically handicapped. Today, service dogs are being used very successfully to help veterans that struggle with Post-Traumatic Stress Disorder, Military Sexual Trauma, and Traumatic Brain Injury. These dogs are covered by the Americans with Disabilities Act and are allowed anywhere where the public is allowed, save some sterile hospital environments.
There are many great, accredited programs across the US that train and pair dogs with veterans. However, there are some programs that are well-intentioned but not up to par. It’s important to look for an ADI (Assistance Dogs International) accredited program so you know that the dogs are quality service dogs.
These programs house veterans on their campuses or near their campuses, so they can always be close to the dogs. The programs usually last about three weeks and involve training the warrior and the service animal how to function together as a unit. They go out to public places, teach the veteran how to handle the dog, and explain their legal rights to them.
The dog and the veteran are paired together in a way that compliments each personality. Having the veteran and the dog ‘bond’ is of upmost importance in the beginning of their relationship. The dog goes everywhere with the veteran; they sleep with or near them, they eat with them, they shop with them. The dog provides security, comfort, and a sense or responsibility.
Like equine therapy, a service dog requires the participant to care for the animal. They both require that the veteran go outside, exercise, and provide. A sense of duty and responsibility is paramount to getting the veterans out of their own heads and into an activity that requires them to think of others. It’s the required practicality that gives the veteran a sense of purpose. It cannot be understated that these facts play an important role in rehabilitation.
The main difference between equine therapy and service dogs is that a service dog is always present. When a veteran has a nightmare in the middle of the night, the dog is right beside them to provide comfort. When a veteran is shopping in a busy store, the dog is there to help create space and be a focus of security.
Scientific Evidence of Service Dog Efficacy
There have been a few studies that back up the enthusiastic claims behind service dog programs. A 2015-16 study showed that overall PTSD symptoms are much lower among veterans who have service dogs in comparison to those that don’t. The pilot study was co-founded by HABRI (Human Animal Bond Research Institute) and Bayer Animal Health.
Another study, performed by Purdue University in 2018, backed up these claims further with their own research. They show that symptoms of PTSD are reduced in those that received and used service dogs in their daily life.
A third study, and one that elicits the most excitement, shows physiological evidence that service dogs reduce PTSD symptoms. Another Purdue University study, in partnership with K9s for Warriors, shows a reduction in the stress hormone cortisol. Cortisol is a biomarker centrally involved in the stress response system and is measured non-invasively in the veteran’s saliva.
The veterans were able to collect samples for the study at home, in the morning and then 30 minutes after waking up. This allowed them to see how much cortisol was being produced in the mornings. Dr. O’Haire spoke on why this was important:
“We found that military veterans with a service dog in the home produced more cortisol in the mornings than those on the waitlist,” Rodriguez said. “This pattern is closer to the cortisol profile expected in healthy adults without PTSD. Having a service dog was also associated with less anger, less anxiety, and better sleep.”
This study is the pre-cursor for another study, which will be a longitudinal in nature and correlate the stress biomarker cortisol and the reduction of PTSD symptoms. This large-scale study will involve the National Institute of Health, and will study veterans with and without service dogs.
The mounting evidence that is being compiled tells us that service dogs have a huge impact on veterans struggling with PTSD. The fact that there is no federal funding for these programs keeps the waiting list at accredited programs long, which means veterans in need are having to hang by a thread as they wait for effective complimentary treatment.
Both equine therapy and service dog programs are effective in helping veterans. It goes without saying that where one program is funded, the other should be as well. Considering the scientific evidence and the immense effort that has been put into proving that service dogs work, many are calling for VA to take a closer look.
At the moment, the VA is undergoing its own controversial study. It has been delayed due to service dogs biting participant’s children and is now expected to be completed in 2019. Many are against the parameters of this study and they feel that regardless of the outcome, the VA will refuse to provide funds to service dog programs.
There is legislation being pushed now which is backed by a lot of bipartisan support. The ‘PAWS’ bill, as it is called, is ever-changing and morphing due to its supporter’s intentions. These delays keep our veterans from getting the help they need.
K9s for Warriors’ program has a waitlist that stretches for 16 months or more. We must find a way to provide veterans with more service dogs. The waiting list alone illustrates the interest in programs like these.