ANNOTATED BIBLIOGRAPHY 1
Annotated Bibliography Assignment
Jessica Baccus
Department of Counselor Education and Family Studies, Liberty University
COUC 515: Research Methods and Program Evaluation
Dr. Melanie Roudkovski
Author Note
Jessica Baccus
Department of Counselor Education and Family Studies, Liberty University
I have no known conflict of interest to disclose.
Correspondence concerning this article should be addressed to Jessica Baccus
Email: jbaccus1@liberty.edu
ANNOTATED BIBLIOGRAPHY 2
Abstract
This annotated bibliography will review five sources from peer-reviewed journals that have
studied potential factors of equine-assisted therapy and the benefits to the symptoms of PTSD as
compared to traditional treatment in the past five years. For many years the use of horses has
been used for different therapy needs, but more and more studies are coming forth with the use
of horses for psychology disorders such as PTSD. Here we look at studies of different age groups
and demographics to find a correlation with a decrease in PTSD symptomatology when equine-
assisted therapy is used either alone or with traditional PTSD treatments. Many different
assessments were used in the studies to gain a better variety of how the positive outcomes were
measured.
Keywords: PTSD, equine-assisted therapy, youth, veterans, equine-facilitated
psychotherapy
ANNOTATED BIBLIOGRAPHY 3
References
Arnon, S., Fisher, P. W., Pickover, A., Lowell, A., Turner, J. B., Hilburn, A., Jacob-McVey, J.,
Malajian, B. E., Farber, D. G., Hamilton, J. F., Hamilton, A., Markowitz, J. C., & Neria,
Y. (2020). Equine-Assisted Therapy for Veterans with PTSD: Manual Development and
Preliminary Findings. Military Medicine, 185(5-6), e557–e564.
https://doi.org/10.1093/milmed/usz444
Arnon et al. developed a manual to use for equine-assisted therapy (EAT)
treatments and tested it with 2 sets of 4 Veterans who were experiencing PTSD symptoms
by way of referrals, print, and online advertisements. The participants were evaluated
using the DSM-5 diagnostic criteria for PTSD and had to score over 50 on the Clinical-
Administered PTSD Scale (CAPS). Participants had to be between the age of 18 and 65,
be fluent in English, and had military experience.
This research indicated that EAT helped to decrease the CAPS-5 score and
depressive symptoms. All the participants showed signs of benefiting from the treatment
post-treatment, but these benefits did not continue at follow-up. This helps make a case
that equine-assisted therapy can help people with PTSD symptoms.
Shay Arnon is a research assistant at The National Suicide Prevention Program for
the Israeli Ministry of Health. She holds a master's in clinical psychology. She has been a
research coordinator for 3 years.
The CAPS is known for its great reliability, convergent and discriminant validity,
and sensitivity to clinical change. CAPS was used and had good internal consistency with
a = .83. The test is considered the go-to test for PTSD symptoms. Internal consistency for
this study ranged from a = .76 - 0.86.
ANNOTATED BIBLIOGRAPHY 4
Arnon et al. indicated that EAT did help with veterans' symptoms of PTSD, but the long-
term effects were not persistent. Arnon et al. (2020) mentioned the lack of processing of
traumatic events during the EAT. My research question is could EAT have longer-lasting effects
on PTSD symptoms if a cognitive procession attribute was added into the therapy.
Burton, L. E., Qeadan, F., & Burge, M. R. (2019). Efficacy of equine-assisted psychotherapy in
veterans with posttraumatic stress disorder. Journal of Integrative Medicine, 17(1), 14–
19. https://doi.org/10.1016/j.joim.2018.11.001
Burton et al. conducted a group trial with 10 veteran participants with PTSD diagnosis
receiving equine-assisted psychotherapy (EAP) along with already established PTSD treatment
and another 10 participants only receiving the already established PTSD treatment. They thought
that the participants who received the EAP would have better resilience and reduced symptoms
as compared to the group that did not. The PTSD Check List – Military Version (PCL-M) was
used to assess PTSD symptoms at week 0 and week 6.
This research shows that EAP may work just as well as standard therapy methods for
treating PTSD symptoms. It helps to make a case that EAP could be just as effective as
traditional PTSD therapy.
L. Elisabeth Burton is a registered nurse who got her degree from The University of New
Mexico where she also works in the trauma unit. She has written 3 publications on the topic of
PTSD.
The PCL-M was used specifically for traumatic military experiences. It evaluates 17
symptoms associated with PTSD straight from the DSM-5. It has been well validated. It
demonstrated temporal stability, internal consistency, and test-retest reliability.
ANNOTATED BIBLIOGRAPHY 5
Burton et al. found that the severity of symptoms is reduced with both traditional and
EAP treatment for PTSD. There was no evidence that one is better than the other. This does show
that EAP could be a good alternative treatment for PTSD symptom reduction.
C Randy Duncan, Steve Critchley, & Jim Marland. (2017). Equine Assisted Therapy to Help
Couples with PTSD: The Evidence for Improved Personal Relationships. Canadian
Military Journal, 17(2).
Duncan et al., conducted a follow-up study after a 3-day equine-assisted therapy program
for 46 veterans and 42 spouses to assess positive change in couples relationships and PTSD
symptoms. The HOLSTER scale was used as a self-report questionnaire to measure the change.
This research adds the spouse’s perspective of the treatment for PTSD symptoms of the
veteran after a follow-up period of at least 3 months. This helps to understand the short-term
effects of the equine assisted therapy.
Dr. Duncan is an adjunct professor with the Department of Sociology at the University of
Saskatchewan. He is an independent researcher who works with the co-founder of Can Praxis
which is the program used in this study.
The HOLSTER scale stands for Horses Operational Stress Through Experiential
Relationships. It is a semi-structured self-report questionnaire that has 20 items. It has a high
internal reliability coefficient of 0.80.
This study shows the relational aspect that equine-assisted therapy can have. The
experience can help add to the therapy process of emotion regulation and find a sense of calm.
The interactions the veterans have with the horses can positively cross over into the relationships
they have with others.
ANNOTATED BIBLIOGRAPHY 6
Shelef, A., Brafman, D., Rosing, T., Weizman, A., Stryjer, R., & Barak, Y. (2019).
Equine Assisted Therapy for Patients with Post Traumatic Stress Disorder: A Case
Series Study. Military Medicine, 184(9–10), 394–399.
https://doi-org.ezproxy.liberty.edu/10.1093/milmed/usz036
Shelef et al. conducted a study on equine-assisted therapy on patients with PTSD to
assess symptoms and functioning at work and in relationships. This study used the SPRINT test
on 13 participants who had been diagnosed with PTSD for at least 1 year. Weekly sessions were
given in two 6 months intervals.
This study had a longer-term duration than some other studies. It lasted 24 weeks and
only had participants who had been diagnosed with PTSD and no other known disorders. This
therapy also included therapeutic riding within the sessions. The participants were given the
Sprint scale 6 months after treatment.
Amir Shelef is a Ph.D. student at Tel Aviv University in Israel. He works at Abarbanel
Mental Health Center which is the best-known psychiatric hospital in Israel.
The SPRINT scale is short for Short Post Traumatic Stress Disorder Rating Interview. It
consists of 8 self-report items. Symptoms are rated on a five-point scale. It also has 2 items to
track improvements in symptoms. SPRINT scale has shown good test-retest reliability and high
internal consistency of a =.88. It has good divergent validity against the Davidson Trauma Scale.
This study showed positive outcomes for overall functioning and symptoms. It is noted
that the structured outdoor activities could have played a role in the positive outcomes. The
sample size was small so more research still needs to be done the better understand the positive
outcomes. The dropout rate for this therapy was similar to traditional PTSD treatments which
may also need to be researched further to reduce dropout.
ANNOTATED BIBLIOGRAPHY 7
Mueller, M. K., & McCullough, L. (2017). Effects of Equine-Facilitated Psychotherapy on Post-
Traumatic Stress Symptoms in Youth. Journal of Child and Family Studies, 26(4), 1164–
1172. https://doi.org/10.1007/s10826-016-0648-6
Mueller and McCullough investigated the benefits of equine-facilitated psychotherapy
(EFP) on 36 youth ages 10 to 18. The children received 2 hours of EFP weekly for 10 weeks and
the control group received traditional treatment for PTSD. This study used the self-report
CRIES-13 scale. And had a control group of 32 youth.
Trauma can affect anyone at any age. I wanted to be sure that different types of trauma
and different ages were represented in the research of the benefits of EFP on PTSD symptoms.
Just like in adults the benefits are positive, but there is no evidence that one is better than the
other.
Dr. Megan Mueller is an Assistant professor and Co-director at Tufts Institute for Human-
Animal Interaction. She has multiple publications with many focusing on human and animal
interactions.
CRIES-13 is a self-report 13-item Likert-type scale that measures symptoms of PTSD.
Children scoring 12 or higher were used for this study. It was administered at weeks 1, 5, and 10
to both groups. The CRIES-13 showed adequate internal reliability. Cronbach’s a = 0.72 (week
1) a = 0.88 (week 5) and a = 0.84 (week 10).
This study showed significant benefit to EFP but did not conclude that it is any better
when compared to traditional treatment for PTSD. This study did not measure adults but utilized
youth. This helps to see that adults who have experienced trauma are not the only demographic
that can benefit from EFP.
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