Pilot Study: Is EFP Effective in Treatment of Complex PTSD?
By Leigh Shambo, MSW, and
Heather Vonderfecht, PhD, MSW
As an
EFP practitioner and proponent, I am often asked to present
concrete evidence of EFP’s effectiveness to potential funders.
In this new and very dynamic field, good research studies are
hard to come by. So one of my most rewarding projects for 2006
was a pilot treatment/study called “Taking the Reins: Healing
Trauma with Horses.”
....
Six adult
women participated, all of whom were experiencing a pattern of
complex Post-Traumatic Stress Disorder (PTSD) due to physical
and/or sexual abuse during childhood (at least one woman had
also survived a violent rape in adulthood). The group combined
psychoeducation – an understanding of trauma’s lasting effects
on the brain and nervous system— with cognitive-behavioral group
process and equine-assisted psychotherapy.
Facilitating this amazing group of women over the course of 10
weekly sessions, and seeing with my own eyes the dramatic
positive change showed by each participant, was rewarding in its
own right. The progress for each woman was striking, showing an
impressive amount of positive change. Yet, these stories of
recovery are “anecdotal evidence”, and thus not statistically
valid. Fortunately, our treatment group was also designed as a
research project, funded jointly by Providence St
Peter
Hospital (Olympia,
WA) and Human-Equine
Alliances for Learning (Chehalis,
WA), which allowed us
to examine the results of this treatment with some precision.
The
women who participated were referred from the hospital
outpatient psychiatry unit or from local therapists. All of
them were struggling with an array of mood, anxiety and
dissociative symptoms related to their traumatic history, in
spite of treatment with medication which controlled the worst
symptoms. All of them were quite anxious socially and had
rejected other forms of group treatment, but applied to join
Taking the Reins out of an intriguing sense that the horses
could help them heal.
As the
women arrived for the first group, we were one member short.
After waiting 20 minutes we opened our circle with a gong on a
Tibetan bowl. As we introduced ourselves one woman confessed
that she had spent the morning throwing up from anxiety. It
turns out she was not alone, and several minutes were spent
comparing nausea notes. At that moment the tardy member
arrived, and she confessed that she had been driving on the road
past the farm over and over, finally forcing herself to overcome
anxiety at least to meet us. And at least, see the horses.
The
group curriculum allowed the group to establish immediately a
bond of safety, trust and shared purpose. Each week, in varying
amounts, were educational segments on the neurological effects
of trauma, cognitive behavioral group process to support each
member in identifying and changing dysfunctional core beliefs,
and practice with horses that ranged from quiet reflective
sessions, simple leading and safety, to active round pen
practice and our graduation march, a hike through the woods with
the horses in hand!
I can
honestly say that this group of women, terrified at the outset,
did some of the most profound psychological work that I have
ever been privy to. Each woman experienced herself differently
with the horses, and by feeling this change took guidance from
it to decide on small but profound changes in daily life.
Together these women practiced new, stronger ways of being and
they witnessed each others’ success. As one woman wrote on her
evaluation, “The learning did not stop when the group did,
either. I learned valuable skills for living that I use
everyday. The horses have so much to teach, if we only let
them!”
That is
the anecdotal perspective. What did our research data reveal?
Thanks to Heather Vonderfecht, PhD, MSW, our research director,
we selected reliable, standardized psychological tests to track
the progress of our participants. Self-report questionnaires
were administered to measure depression, anxiety, dissociation
levels and life functioning (using a therapy evaluation tool
called the OQ, or Outcome Questionnaire). Participants were
measured at the beginning (pre-treatment), at mid-treatment, at
the end of treatment (post-treatment) and four months after
treatment in the group concluded (4-month post). Given the
small size of our study group (6 women) it is possible to look
at the effects of this group treatment on the mean scores of the
group and also to track the response of women individually.
Overall, the effects of the EAP in this particular study were
universally positive—demonstrated in both the group means and
individual scores.
On the
whole, our numbers showed an extraordinarily positive response
to this treatment. The mean scores showed significant
improvements for all six women on measures of depression,
dissociation, and life functioning. Unfortunately, we were
unable to obtain a pre-treatment measure on the anxiety scale,
and thus chose to use the mid-treatment score as the beginning
measure; a proper pre-treatment score might have resulted in
more pronounced evidence of change in this symptom area. Even
with this glitch, anxiety scores showed a marked, though not
statistically significant, improvement. The response on all
measures was both robust and enduring; the drop in scores was
extraordinary in many cases and remained consistent or steadily
improving through the follow up period, indicating overall a
very significant positive benefit from treatment.
Most
noteworthy in this study were the highly significant decreases
in depression, showing a response that was dramatic, with scores
virtually plummeting and continuing to drop through the follow
up. The overall reduction in dissociation scores is also
significant, especially in view of the high pre-treatment scores
with which some individuals entered the treatment. This often
overlooked symptom is arguably the most difficult to treat; the
data here show a very pronounced tendency for treatment with EFP
to be highly effective for this symptom.
Therapists always hope that decreasing symptoms results in
greater life satisfaction and improved functioning in a number
of domains- family, social and vocational. The OQ is designed
to gauge treatment effectiveness overall, and it was rewarding
to see significantly positive data on this measure. Mean
scores on this measure show consistent, and significant,
improvement throughout treatment and follow-up.
These
are very promising results, which point to the conclusion that
incorporating EFP into treatment of adult trauma survivors can
be extremely effective. It should be recognized that Taking the
Reins followed a curriculum with a strong theoretical base,
combined a specific model of EFP that was highly effective for
this population, and carefully followed good practice guidelines
for managing interactive group process among participants. A
strong and enduring positive response to therapy is accomplished
not just by the horses, but by the overall skill and
thoughtfulness with which horse experiences are woven into an
already sound intervention. Careful selection of participants,
tailoring the program to target the specific needs of the
population addressed, the skill of facilitators with both human
and horse participants, and a sound research design are all
necessary factors in achieving the remarkable outcomes
demonstrated by this pilot study.
I am
very grateful to all who contributed in such generous ways to
Taking the Reins, most notably to my co-facilitator Susie Seely,
MN, ARNP. The hosting site was Sylvan Meadows, owned by Barb
Hutchinson who served as our equine specialist/educator. As
mentioned previously, the group was made possible with the
generous support of Providence St. Peter Hospital in Olympia, WA
and charitable funds raised by Human-Equine Alliances for
Learning (HEAL) in Chehalis, WA. Certainly not least, Heather
Vonderfecht, PhD, MSW was instrumental in helping with the
measurement and data analysis as our Research Director, as well
as contributing to this article.
Most
of all, I bow in reverence to those who did the most work, the
women themselves, and the horses who were unfailingly honest as
well as compassionate and supportive. This 10-week experience
was amazing and growth-inspiring for us all, leaving us all with
compelling anecdotes and new understandings based on
actual measures of response. Readers who would like more
information on this treatment/study are invited to contact Leigh
Shambo at Human-Equine Alliances for Learning
(
leigh@humanequinealliance.org
).
Author
Leigh Shambo,
MSW is a
clinical therapist and educator whose
first career was horse training and instruction. Leigh
is widely recognized for her articulation of the
horse-human bond and its application in therapeutic and
learning programs. She is the founder and lead
therapist for
Human-Equine Alliances for Learning
(HEAL), a
non-profit charitable organization that supports
equine-assisted services and programs for healing,
personal growth and riding/training.
Leigh is an Advanced
Facilitator
graduate of Linda Kohanov's Epona Center
apprenticeship
program and is EAGALA
certified.
