Pilot Testing a Manualized Equine-Facilitated Cognitive Processing Therapy (EF-CPT) Intervention for PTSD in Veterans

• Published in: Psychiatric rehabilitation journal 2019-09, Vol.42 (3), p.268-276
• Main Authors: Wharton, Tracy, Whitworth, James, Macauley, Emily, Malone, Marguerite
• Format: Article
• Language: English
• Subjects: Adult; Aged; Animal Assisted Therapy; Animal Assisted Therapy - methods; Animals; Cognitive Behavioral Therapy - methods; Cognitive Processing Therapy; Cognitive therapy; Effectiveness studies; Feasibility; Feasibility Studies; Female; Horses; Human; Humans; Intervention; Male; Middle Aged; Military Veterans; Pilot Projects; Post traumatic stress disorder; Posttraumatic Stress Disorder; Process Assessment, Health Care; Psychiatric Rehabilitation - methods; Stress Disorders, Post-Traumatic - rehabilitation; Treatment Effectiveness Evaluation; United States; United States Department of Veterans Affairs; Veterans
• ISSN: 1095-158X; 1559-3126
• DOI: 10.1037/prj0000359

Objective: The objective of this study was to test effectiveness and feasibility of equine-facilitated cognitive processing therapy (EF-CPT), a manualized adaptation of the cognitive processing therapy model for veterans with posttraumatic stress disorder (PTSD) championed by the Department of Veterans Affairs, in which equine-facilitated activities are integrated into face-to-face sessions. Method: Twenty-seven veterans with a diagnosis of PTSD participated (Mage = 51; 78% male) in a pretest-posttest design. Veterans were seen by a single psychologist for 12 sessions of individual EF-CPT. Instruments included: PTSD Checklist (PCL), Trauma Related Guilt Inventory (TRGI), Working Alliance Inventory (WAI), and the Human Animal Bond Scale (HABS). We hypothesized improvement on all measures, low attrition, and good model fidelity. Paired sample t tests were conducted using SPSS. Results: PCL scores improved significantly (M1 = 68.25, M2 = 35.96, p ≤ .001), as did TRGI scores (p ≤ .001 on all scales). HABS and WAI indicated good working relationship. Two individuals attended one session and did not return (both under the age of 50); there was no other attrition (7% rate). Audio of sessions was reviewed for fidelity; there were variations in temporal order of session plans, which is within the acceptable flexibility of the manual. Conclusions and Implications for Practice: This manualized intervention has promise as an effective and well-tolerated treatment for veterans with PTSD. Impact and Implications This pilot of an adapted, manualized equine-facilitated cognitive processing therapy model for veterans with posttraumatic stress disorder demonstrated efficacy and low attrition, suggesting a viable alternative treatment option for veterans who have been reluctant to engage with services. This pilot is unique in the use of a novel standardized manual and attention to fidelity to the model.