By Anne D. W. Poulson

U.S. Army veteran Aroch Bolanos considered himself lucky. He returned home after enduring two tours of duty at the height of the Iraq War and had been spared from the physical injuries suffered by thousands of his fellow soldiers. Despite his seemingly healthy appearance, Bolanos realized that something was wrong. His behavior had become erratic. He was angry. Impatient. Relationships were crumbling around him. Bolanos had become a completely different person and he had no idea why.

Bolanos sought help and, like many other veterans, was diagnosed with Post-Traumatic Stress Disorder (PTSD), a mental health diagnosis that impacts nearly 30 percent of soldiers who return from combat. Tragically, many veterans never receive help, and of those that do, approximately one-third drop out, likely due to the stigma attached to PTSD or the demanding requirements associated with exposure treatment.

The result? Veterans in the U.S. are in crisis. There is an average of 20 veteran suicides every day and many who suffer from PTSD are not finding current treatments effective. Bolanos experienced this firsthand; he was undergoing traditional therapy programs, but nothing seemed to be working for him.

Then he heard about an experimental equine assisted therapy research trial for veterans with PTSD called the Man O’ War Project at Columbia University Irving Medical Center. Initiated by Ambassador Earle I. Mack, himself a former Lieutenant in the U.S. Army and an avid racehorse owner and equine advocate, the Man O’War Project’s unique method of equine assisted therapy was able to get Bolanos back on track.

While anecdotal evidence suggests horses can have a positive impact on humans, there is a lack of scientific research on why or how equine assisted therapy can be used to treat any mental health condition. The interdisciplinary team at Columbia, led by principal investigators Drs. Prudence Fisher and Yuval Neria, is working to change that and in their work have established standardized guidelines for providing equine therapy for veterans suffering from PTSD. Jeffrey Lieberman, Chairman of Columbia University’s Department of Psychiatry explains, “What is needed is a ‘Manhattan Project’ to elucidate the pathophysiology, develop effective treatments, and ultimately find a cure for PTSD. This research represents an important part of the equation.”

Why horses? Horses and veterans have much in common. Horses are hyper-vigilant prey animals, much like veterans who have PTSD. They also share a “mission mentality.” As veterans re-enter civilian life, they can feel a lack of purpose and seek out a new mission. Retired racehorses, similarly, need new tasks and purpose after their first “careers” come to an end.  

The key to ground-based equine assisted therapy lies in a horse’s natural sensitivity to human emotion and behavior. Horses react to people and send cues that humans can recognize to help them better understand their own behavior and apply the lessons they learn to their everyday lives.

“When we use equine-assisted therapy in our program, we don’t address the trauma directly,” explains Yuval Neria, Ph.D., co-principal investigator of the Man O’ War Project, director of Columbia’s PTSD research program, and professor of medical psychology at Columbia University Irving Medical Center. Rather, the veterans progress through a series of interactions with horses under the guidance of licensed mental health professionals and equine specialists. By understanding the reactions of the horse and the interactions with others in the group, veterans re-acquire skills to better communicate and regulate their own emotions and behaviors.

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One unique component of this study is its use of advanced brain imaging methods (multimodal MRI) before and after treatment in order to capture changes in patients’ brains. MRIs provide a valuable objective measure to validate and strengthen the clinical data of the research. “We hypothesize that this therapy may enable patients to re-wire their brains, helping them to better distinguish between threatening and safe conditions, and we are trying to capture the neural signature of these changes,” says Neria.

The initial step in Columbia’s Man O’ War Project was to define the treatment. After one year of research, the team produced a 100-page, first-of-its-kind standardized manual for the application of group equine-assisted therapy, based on a year’s worth of research by the Columbia team.

“Before you can investigate whether a treatment works, you have to define what the treatment is, and what it is not, so you are sure about what you are testing,” explained Prudence Fisher, Ph.D., co-principal investigator of the Man O’ War Project and associate professor of clinical psychiatric social work at Columbia. “You also have to specify what the treatment is for – in our case it was designed specifically for PTSD.  We manualized the treatment and we are now testing our protocol to see if it proves clinically effective.”

Entry into the Man O’ War Project starts with a full evaluation of each veteran to confirm a diagnosis of PTSD. Veterans participate in groups with two horses over an eight-week treatment period, which includes comprehensive four- and eight-week evaluations, as well as a three-month follow-up.

“When treating veterans, it is vitally important to do a thorough assessment before starting any equine therapy program, and to work hand in hand with licensed mental health counselors,” said Fisher. “Treating veterans without understanding their underlying disorder can be extremely dangerous.”

At first, Bolanos was somewhat intimidated by the horses. He began the treatment with simple tasks like grooming and guiding the horse, with each week bringing a different level of interaction designed to increase trust and communication. By the end of the treatment, Bolanos was guiding the horse unbridled, by himself, in the training ring.

While preliminary results are promising, the research team is hopeful that they will continue to find the treatment affective in treating PTSD.  So far, they have tested approximately half of the veterans needed to go through the research phase of the program.

If the Man O’ War Project treatment protocol proves successful, it could help open equine therapy to mainstream clinical acceptance. It could erase the stigma associated with PTSD. It could ensure that veterans get the help they deserve. It could help end the epidemic of PTSD. It could save countless lives. 

“This program definitely helped me,” says Bolanos. “It brought me to another level.” This progressive approach helped him understand his own behavior and engage with those around him. It helped him land a new, satisfying career, and brought him closer to his family once again.

Anne D. W. Poulson is strategic advisor to the Man O’ War Project at Columbia University Irving Medical Center. She is a lifelong horsewoman, who practiced law in Washington, D.C., and is a former president of the Virginia Thoroughbred Association and former chairman of the Virginia Racing Commission. She has served on numerous non-profit boards and currently serves on several equestrian industry boards, including the NTRA Horse PAC, the Washington International Horse Show, and Equestricon.