Tackling Veterans’ PTSD with Equine-Assisted Therapy
Man O’ War applies therapy with horses to help veterans with post-traumatic stress disorder
By Meghan Murphy-Gill
Photos courtesy of Man O’ War
When participants of the Man O’ War Project step onto a dusty paddock at the Bergen Equestrian Center in Leonia, New Jersey, for the first time, some likely feel similar to the horses they’re about to meet: at the end of their rope.
Misdiagnoses, long waiting lists, and ineffective treatment for the post-traumatic stress disorder (PTSD) that has upended their lives may make them skeptical of the equine-assisted therapy (EAT) they’re about to experience.

Co-Directors of the project, Drs. Prudence Fisher and Yuval Neria, were themselves initially skeptical of EAT because of the relative lack of research around it.

“We both like horses and we thought [EAT] was an interesting idea, but neither of us thought it would work,” Prudence says.

“The entire thing is surprising,” Yuval says.

Both doctors have owned horses and consider themselves to be horse enthusiasts. But neither anticipated the positive outcome they’ve seen using horses therapeutically to treat PTSD. “As we learn more about the field,” Prudence says, “we’ve learned why horses do work.”

Using horses therapeutically to treat PTSD
“Horses are a lot like patients with PTSD,” Yuval says. “They share a number of the same issues,” such as high sensitivity to surroundings, hypervigilance, and hyperreactivity. These traits make sense because horses are prey animals, but like human beings, horses are also social creatures and seek safe, bonding experiences.

“They’re like big mirrors,” Prudence says of horses, which theoretically makes them ideal for treating PTSD. If the veterans demonstrate fear—or ease—the horses reciprocate, giving immediate feedback, which helps the men and women hone their emotional regulation skills.

Drs. Yuval Neria and Prudence Fisher are the co-directors of Man O’ War.
Drs. Yuval Neria and Prudence Fisher are the co-directors of Man O’ War.
/ ALL’S NOT WELL /
Yuval, a military veteran and professor of medical psychology at New York’s Columbia University Irving Medical Center, the institution behind Man O’ War, describes PTSD as “a debilitating mental health disorder accompanied by a host of functional and emotional problems.” The impact of a trauma is a hyperactivation of the fear network across the brain, which makes the person facing the disorder extremely fearful and anxious. These feelings may make patients avoidant and depressed, Yuval says. The key to healing, he adds, is learning how to reverse the impact of the trauma.

During conventional treatments, such as talk therapy, patients process traumatic experiences through talking, with the goal of alleviating strong, negative emotions that are associated with their trauma.

During EAT, interactions with horses lead participants to actively experience fear and nervousness. They need to learn to cope with this sense of threat immediately, and they’re doing it in a safe, controlled environment, without having to revisit the trauma that initially brought on the PTSD.

Overcoming the fear gives participants a sense of confidence and concrete demonstrations of success when facing fear.

Overcoming the fear gives participants a sense of confidence
Overcoming the fear gives participants a sense of confidence and concrete demonstrations of success when facing fear.
/ SOMETHING TO PROVE /
Man O’ War was founded by Earle Mack, also a veteran and former chair of the New York State Racing Commission. He fell in love with horses shortly after graduating from college and is an advocate for finding new homes for and training thoroughbreds after their racing days are over.

“I know from experience that it’s a challenge to win the confidence of a horse. They are hypersensitive animals,” Earle says. “But once you do, it provides a real sense of accomplishment. This [coupled with] how good people often feel around horses—I thought horses could really help veterans with PTSD.”

Before Man O’ War started, the science just wasn’t there. While other projects, such as the Second Chance Re-Entry Project, demonstrated EAT can help reintroduce former inmates to life outside of prison, there is no protocol for using horses in PTSD therapy.

“I thought we needed real scientific research to establish treatment guidelines for veterans with PTSD and to prove that it can work,” Mack says.

He took this idea to Irving Medical Center, where Prudence and Yuval were brought on. The researchers developed a protocol and began testing it to build guidelines for using EAT to treat veterans with PTSD.

Earle Mack
Earle Mack, founder of Man O’ War
The Man O’ War Project
/ EXPERIENCE IS THE BEST TEACHER /
The Man O’ War Project is not a riding program. Instead, over the course of eight weekly 90-minute sessions, participants get to know horses and learn to trust them—and they learn how to earn the horses’ trust in return.

Each group session begins with veterans gathering in a smaller paddock at the Bergen Center for an opening circle. A mental health professional leads the group in a mindfulness relaxation exercise, which sets the tone for the session. This is a time to tune in and observe emotions.

Group leaders, including a mental health professional, a horse expert, and a horse wrangler, go over the day’s tasks.

At the first session, participants receive information about PTSD and the program, then tour the facility, taking in the crisp air, the grassy aroma, and the surrounding rolling verdant hills. Then they’re invited to groom the horses. Getting near these majestic animals requires a sense of ease on the part of the veterans, who, when they’re ready, touch the horses’ velvety noses and experience them for the gentle giants they are.

During each week after that, veterans learn increasingly complex horse-training exercises, culminating in a final accomplishment: leading a horse around the pen without a rope.

Every session ends with a closing circle. Participants are invited to reflect on the day’s experiences. It’s in the closing circle that some veterans reveal the profound changes in their lives thanks to the therapy. Those who once struggled to leave the house are venturing outside. Some say they’re experiencing happiness for the first time in a long while.

“They don’t talk about trauma and there’s no medication. It’s all about the interaction,” Yuval says. “This interaction is tremendously relaxing on the fear system of the brain. The patient feels relaxed.”

Man O’ War dropout rates are very low and the program hasn’t seen any safety issues or side effects.

It’s particularly impressive considering the diversity among participants. They’re men and women who come from a variety of life situations, whose traumatic incidents vary, and for whom PTSD has had unique results. Despite all of the different, complex factors involved, “based on our findings so far, the therapy really seems to help veterans with PTSD,” Prudence says.

Complex horse-training exercises
‘ ‘
[Participants] don’t talk about drama and there’s no medication. It’s all about the interaction. The interaction is tremendously relaxing on the fear system of the brain. –Dr. Yuval Neria
A participant in Man O’ War greets a horse
A participant in Man O’ War greets a horse
/ HIGH HOPES /
Yuval and Prudence will be officially reviewing the data they’ve collected this summer. “The data looks good, promising,” Yuval says. He’s eager to analyze the MRI brain scans patients undergo before and after treatment to learn if the brain experiences a positive change after EAT.

The testimony of participants speaks volumes. “Some veterans wish the program extended beyond eight weeks. Another said the program should be mandatory for all veterans returning from a combat zone,” says Earle. “The Columbia researchers have also found that going through the equine therapy opens up the veterans to other types of treatment as well. One of the best stories I’ve heard is of a veteran who could not leave his home unaccompanied because of his PTSD. After our program, he found that not only could he get out of the house on his own, but that he was able to ride the subway too. It helped him get his life back.”

The results of this research will be invaluable to a community of therapists and doctors tasked with helping veterans manage the symptoms of and recover from PTSD. It could also mean a second career for retired racehorses.

“The most important thing,” Yuval says, “is restoring hope.”
To learn more about EAT and the Man O’ War project, visit MOWProject.org.
About the Writer

Meghan Murphy-Gill is a Midwest-based writer whose childhood was spent traveling the United States. She loves to cook, eat, and run on repeat.

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