If you live with an anxiety disorder, you have several options to consider when it comes to treatment. Not all of these approaches take place inside a therapist’s office, either.

One out-of-the-office approach to treating anxiety is equine-assisted therapy, which involves caring for and spending time with horses under the guidance of a mental health professional.

This approach doesn’t require any previous experience with a horse, and you won’t need to do any riding. Instead, you might spend your sessions doing things like stroking, grooming, feeding, or leading horses — or even simply observing them.

A 2015 report suggests any of these activities may help:

Wondering how, exactly, horses can help improve anxiety symptoms? Interested in equine-assisted therapy as a potential treatment for yourself or a loved one?

Get the details on equine-assisted therapy for anxiety below, including what to expect from a session, key research findings, and how to find a therapist who offers equine therapy.

Each therapy session will generally include some of the following activities, depending on the type of program:

  • spending time observing horses and their behavior
  • grooming and brushing a horse
  • offering food or treats
  • leading a horse on a walk inside an enclosed area
  • guiding a horse through an obstacle course or along a trail

Why these activities? There are a few reasons:

  • Basic, repetitive acts of grooming can help soothe you and promote feelings of calm.
  • Walking can improve your mood, so simply leading the horse may help ease anxiety.
  • Feeding and caring for the horse can help you form a bond.

At all times, your therapist will stay with you and offer guidance as you interact with the horse. They may ask questions about your observations and offer support with exploring any uncomfortable feelings — or helpful insights — that surface during the experience.

Equine-assisted therapy can take a very different shape from person to person, based on the model used.

“Some of the people I work with simply appreciate being outdoors and having the horses there to make a more comfortable talk therapy setting,” explains Kelsey Devoille, a licensed marriage and family therapist in Redmond, WA. Devoille specializes in equine and talk therapy for teens and adults with anxiety, depression, and eating disorders.

“Others use the horses very intentionally, building a connection and relationship with the horse to address issues of trust, trauma, or anxiety,” she says.

Safety first

If your therapist notices you seem distracted or lost in your own thoughts, they might offer some gentle redirection to help you stay in the present.

This doesn’t just help you get more out of the therapy experience, it’s also essential for your own safety when working with a large and powerful animal.

You might already know some of the therapeutic benefits animals — from beloved pets to emotional support animals — can provide.

Horses are no exception.

These intelligent, highly social animals use sounds and body language to interact with the rest of their herd, and they can communicate with humans in similar ways. In fact, it’s their ability to recognize and respond to human emotions that gives them a unique role in the therapy process.

Interaction with horses can foster insight and behavioral changes through the development of emotional bonds, according to Prudence Fisher, co-director of the Man O’ War Project at Columbia University Irving Medical Center. This project aims to explore and evaluate the effectiveness of equine-assisted therapy for post-traumatic stress disorder (PTSD) and other mental health conditions.

“We suspect people with anxiety might equally benefit as they share many of the same symptoms as people with PTSD: hypervigilance, feeling keyed up or on edge, avoidance of people or things, insomnia or restlessness, irritability, and changes in mood and thinking, among others,” Fisher says.

Working with horses can help address anxiety symptoms in a number of ways.

They can foster emotion regulation

One key aspect about horses that makes them unique for therapy, according to Devoille, is the fact that they are prey animals.

“Because of this, they’re very attuned to their environment and able to pick up on the emotional states of others. They can give clients feedback on how their emotions affect others and help teach them to regulate and communicate more effectively,” Devoille says.

Example

You enter the therapy session with the worry, tension, and anxious jitters you carry most days. The horse you’re working with picks up on those emotions and pulls back, moving away from you skittishly instead of letting you approach.

In response, you try a calming exercise, like deep breathing, that helps ground you and to ease your distress. As you release the tension in your body, you notice the horse seems less nervous toward you.

Anxiety can leave you overwhelmed to the point where you find it difficult to manage emotions or express them clearly, both to yourself and others.

Equine-assisted therapy teaches you to communicate with horses effectively. When you use these skills, the horse will likely engage with you. This can reinforce your faith in your communication skills, bolstering your confidence in your ability to relate to humans.

They can teach vulnerability and trust

As you’ve probably noticed, horses are pretty darn enormous. A fully grown horse can weigh about 1,000 pounds, if not more — a fact that can bring up a certain level of fear and vulnerability, Devoille says.

“The size of the horse can bring up issues of trust and anxiety that can be hard to simulate in a talk therapy setting,” she explains.

To safely interact with a horse, you need to respect them and recognize they may behave in unpredictable ways.

It’s only natural to feel a little vulnerable around such a large animal, but keep in mind that horses are social and receptive to humans. When you respect their boundaries and respond to their behavioral cues with your own gestures and body language, you can build a trusting, cooperative relationship.

Knowing you can successfully engage with such a massive animal may boost your self-confidence and eventually help you feel more at ease when it comes to navigating everyday situations that inspire fear and worry.

They provide a change of place

Equine-assisted therapy happens outdoors, often in a scenic natural environment.

Increasing evidence suggests time in nature can help improve your mood and reduce feelings of anxiety, anger, and stress. So, you might find the natural setting alone helps soothe some of your ever-present tension and worry, especially if you enjoy spending time outside.

Fisher notes that the new, pleasant setting can be extra beneficial if you haven’t gotten much out of talk therapy and other traditional approaches.

Maybe describing your anxiety in words proves challenging, or you have a hard time naming its source and specific triggers. A change in setting could jump-start this process — particularly when it involves a third party (a horse) who can reflect your mood and emotions.

If your therapist notices you seem unusually tense, frustrated, or on edge, they might point out how the horse responds to you. This could make it easier for you to acknowledge those feelings and eventually prompt a discussion about the issues on your mind.

They can help you learn mindfulness skills

Interacting with a horse requires attention and focus.

For one, you’ll need to watch what the horse does and pay attention to your own actions to make sure you don’t startle or upset them.

But throughout your session, you’ll also monitor the feedback you get from the horse. Do they seem calm and willing for you to approach and touch them? What do their body language and vocalizations convey? (As part of the therapy process, your therapist will give you more guidance on interpreting horse language.)

All of this requires you to remain in the present moment, without letting thoughts of past events or future ones sweep you off course.

This state of mindfulness, or judgment-free awareness of your emotions and thoughts, physical sensations, and surrounding environment, can promote acceptance, openness, and curiosity. These changes may even last beyond your session, especially as you get in the habit of cultivating mindfulness.

“Equine-assisted therapy may help you reflect on your feelings, behaviors, and interactions with other beings, in large part through your becoming attuned to the reactions of the horse, as horses provide clear and steady feedback that reflects the mood and messages you project,” Fisher says.

Increased mindfulness can also help interrupt unhelpful patterns or behaviors, including anxiety responses like rumination. This might have particular benefits as you cope with the source of your anxiety.

Take trauma, for instance. Evidence suggests childhood trauma, which might include abandonment or neglect, may contribute to anxiety later in life.

If you’ve experienced trauma, your interactions with horses could bring up the old brain pathways formed when the trauma happened, Devoille explains, giving the example of a horse walking away as you attempt to connect with it. The horse’s response might feel painfully similar to a loved one abandoning you in childhood.

“It’s in those moments we can notice our reactions to those experiences, change our interaction with the horse, and allow for a different experience to occur,” Devoille says.

To date, few studies have explored the benefits of equine-assisted therapy for anxiety specifically, and those that do include fairly small sample sizes. Most research on the benefits of equine-assisted therapy for mental health concerns focuses on PTSD treatment.

Yet, as Fisher noted above, PTSD and anxiety do share some symptoms. Previous editions of the “Diagnostic and Statistical Manual of Mental Disorders” (DSM) even included PTSD in the category of anxiety disorders. The most recent edition (DSM-5) lists PTSD as a distinct condition, but experts still acknowledge some overlap in symptoms.

One small 2015 study involved 16 volunteers who experienced symptoms of PTSD, anxiety, depression, and other emotional distress after trauma. After participating in 2-hour sessions of equine-assisted therapy for 6 weeks, they reported:

  • reduced symptoms of PTSD
  • decreased anxiety and depression
  • improved emotional response to the trauma
  • improved mindfulness skills
  • less alcohol use

A 2018 study evaluated the benefits of equine-assisted therapy for addressing symptoms of anxiety, post-traumatic stress, and other mental health concerns among veterans and their partners. The study, which included 25 veterans and 22 veterans and their partners, took place at a residential therapy course over 5 days.

At the end of the study, individual veteran participants reported short-term improvements in anxiety, PTSD, stress, and depression, along with happiness and quality of life. And 3 months later, their symptoms had mostly returned to pre-program levels — with the exception of anxiety, which remained slightly lower than at the start of the program.

The couples who participated reported a gradual improvement in anxiety symptoms that continued until the 3-month follow-up.

According to Fisher, participating in equine-assisted therapy may also help you feel more open to other types of therapy. She explains that some participants in the Man O’War Project had avoided therapy in the past, or had negative experiences in therapy.

“After receiving equine-assisted therapy, many felt ready to talk with a mental health professional and attend more traditional treatment modalities,” Fisher says.

To sum up, existing evidence suggests equine-assisted therapy may have promise as a treatment for anxiety. Still, experts need to conduct randomized controlled trials with larger numbers of participants before they can come to any conclusions about its benefits.

Therapy with horses can be a good option for adolescents and adults, especially those who have had negative therapy experiences, dislike talk therapy, or find it difficult to put feelings into words.

“I love equine therapy for kids and teens who find talk therapy in an office intimidating and uncomfortable. Sometimes just the act of brushing the horse while talking changes the whole experience for them,” Devoille says.

She also recommends the approach for anyone hoping to address relationship issues, social skills, or family dynamics, since equine-assisted therapy helps you practice building a relationship, which can transfer to relationships outside of therapy.

Though it might go without saying, therapy with horses may not be the best option if you have allergies or an intense fear of horses. (Though, if you’d like to overcome a fear or phobia of horses, gradual exposure to horses can make a big difference. Just know exposure therapy involves a completely different approach.)

A session of equine-assisted therapy does typically cost more than a traditional talk therapy session.

Devoille, for example, charges $225 for a session of equine-assisted therapy and $160 for a talk therapy session, though she says she often has interns who offer lower rates.

The price you’ll pay will probably depend on several factors, like:

  • your location
  • the therapist’s experience
  • program length (longer workshops and multi-week programs will cost more than a single weekly session)

It never hurts to check whether your insurance covers this approach, but many providers won’t cover equine-assisted therapy for mental health purposes.

The therapist you’re considering can answer any questions you have about their rates and whether they offer low cost options or financial assistance.

Since equine-assisted therapy is still a newer approach, you may have a harder time finding therapists who offer this treatment.

You can start by checking a therapist directory, or simply doing an internet search for “equine-assisted therapist for anxiety near me.”

Combining therapy approaches?

If you plan to try equine-assisted therapy along with talk therapy from another therapist, make sure to let both therapists know so they can collaborate on your treatment, Devoille recommends.

Before choosing a therapist, always feel free to take advantage of their initial consultation and ask them any questions you have about their experience and what each session might involve.

You can also check whether they have any specific certifications, such as those offered by:

Evidence doesn’t yet suggest that therapy with horses can replace evidence-backed treatments for anxiety, like cognitive behavioral therapy or exposure therapy.

All the same, many people find caring for horses helps relieve anxiety symptoms while teaching communication and emotion regulation skills that lead to improved everyday interactions.

So, if your progress in talk therapy has stalled, equine-assisted therapy could help you learn to acknowledge and address your anxiety in a new way, with support from a nonjudgmental animal companion.

Crystal Raypole writes for Healthline and Psych Central. Her fields of interest include Japanese translation, cooking, natural sciences, sex positivity, and mental health, along with books, books, and more books. In particular, she’s committed to helping decrease stigma around mental health issues. She lives in Washington with her son and a lovably recalcitrant cat.