In the October 10, 2014 episode of the “Academic Minute,” an influential podcast developed by Inside Higher Ed, Dr. Erika Berg of North Dakota State University discussed an ongoing pilot study examining the efficacy of equine assisted psychotherapy (EAP) in the treatment of adolescents with conduct problems (https://www.insidehighered.com/audio/2014/10/10/equine-therapy). Although we commend Dr. Berg and her colleagues for investigating EAP and fully support the pursuit of new and more effective treatments for mental illness, we wish to voice several serious concerns with the content of her discussion.
During the podcast, Dr. Berg noted that her study will compare “traditional talk therapy” with EAP and that preliminary results indicate favorable outcomes for those in EAP but not the comparison condition. The meaning of “traditional talk therapy,” however, was unclear. Many treatments with varying levels of scientific support could be referred to as “talk therapy” and the degree to which they are considered “traditional” probably depends upon who is being asked. In this sense, EAP is being compared with an unknown entity and the degree to which evidence exists supporting these (or other) approaches in the treatment of adolescents with conduct problems went unmentioned. The importance of these points is highlighted by a recent review article that noted that no controlled studies demonstrate EAP is effective and/or efficacious in the treatment of any mental illness (http://onlinelibrary.wiley.com/doi/10.1002/jclp.22113/abstract). Nevertheless, the lack of research support for EAP was not acknowledged, let alone discussed, in the podcast. Furthermore, studies that examine the efficacy of EAP and related approaches are plagued by a variety of design flaws (e.g., lack of comparison group, lack of diagnostic information, lack of long-term follow-up) that render their results impossible to interpret. These studies fall far below the threshold of scientific integrity necessary for a treatment to be considered evidence-based. That threshold has been clearly outlined with respect to adults (http://www.div12.org/PsychologicalTreatments/index.html), as well as children and adolescents (http://www.effectivechildtherapy.com/).
As Dr. Berg correctly noted in the podcast, costs associated with the upkeep and administration of EAP can be high and need to be justified. We would take this point a step further by noting the importance of opportunity costs. When individuals with mental illnesses are directed away from treatments with strong empirical evidence and towards untested treatments that are associated with sweeping claims, these individuals are vulnerable to a longer duration of symptoms and to the financial costs of additional required treatment. These individuals are also less likely to seek out treatment after a failed course of ineffective intervention, further compounding the opportunity cost. Although Dr. Berg noted the importance of establishing an evidence base to support coverage of EAP by insurance companies, compelling research support is needed to justify the presence of EAP in the treatment marketplace in the first place. Treatment centers offering EAP should therefore be required to note the lack of evidence supporting their approach, as well as the overwhelming research support for other treatment modalities for specific mental illnesses. Future research may demonstrate that EAP is markedly effective in treating specific conditions in specific populations. Until then, it is vital that advocates of EAP test their assumptions, and provide explicit disclaimers to clients regarding the experimental nature of the treatment and the current lack of scientific support for its use.
The authors, including lead author Dr. Michael Anestis, are members of the Public Education and Media Committee, which is part of the Society for a Science of Clinical Psychology (SSCP). SSCP is Section III of Division 12 of the American Psychological Association (APA), and an organizational affiliate of the Association of Psychological Science (APS), but we are writing on behalf of SSCP, not APA or APS.