Concerned About Unconventional Mental Health Interventions?

Concerned About Unconventional Mental Health Interventions?
Alternative Psychotherapies: Evaluating Unconventional Mental Health Treatments

Wednesday, December 2, 2015

Social Workers Gallop Off in All Directions

I recently came across a document that stated that the National Association of Social Workers has endorsed “equine-assisted therapy” (EAT) for mental health problems. “Wha-a--?”, I said, and began to look up whether there had been such an endorsement. Now, this can be hard to do; I know NASW sometimes passes resolutions at their annual conference, and these can be hard to locate later for those of us who are out of the social work loop (e.g., the resolution against Holding Therapy some years ago). I didn’t find a resolution about EAT, but I did find that NASW had given continuing education credits for a class on this topic (naswct.org/wp-content/uploads/2015/04/NASW-Conference-2015-Brochure.pdf).

Horseback riding has been used therapeutically for many years for children with cerebral palsy and other neurological disorders that contract muscles and distort the structure and function of the limbs. Riding provides a warm and gentle stretch for leg muscles and is so enjoyable that children are distracted  from any discomfort. But, of course, this does not mean that people with other kinds of disabilities--  people who don’t need their muscles stretched—will also benefit from horseback riding. (Similarly, prescription eyeglasses that correct visual disabilities don’t help hearing impairments.)

For some time now, there has been a strong tendency to equate mental illnesses with “brain disorders”. Certainly it’s true that at some level every mental illness has a foundation in brain function and even structure, but this does not mean that it makes sense to force all mental illnesses and all results of brain injury or atypical development unto the same category. I understand the motivation to do this forced combination—everyone knows the results of an injury are not the victim’s fault, and some people still think that the mentally ill could stop being sick if they really tried, so presenting mental illness as equivalent to brain damage supports the important argument that the mentally ill should not be stigmatized.

The two things are not really exactly the same, though, and their treatments cannot be identical. Brain disorders like CP can have powerful effects on the body  and affect children’s behavior and development by damaging physical growth and abilities. Horseback riding helps corrects muscle and bone development and use; it does not cure the brain damage that caused the problems of physical development. It won’t cure any posited brain disorders that may lie behind mental illness, either.

Horseback riding, and learning to handle and care for horses, can be great fun for kids, and shared enjoyable activities are an important key to social skills, sharing, taking turns, and understanding other people. Sharing such activities with a social worker or other helping person can improve interactions and help establish a strong relationship.

But these points are a far cry from evidence that EAT in itself is an effective treatment for autism, ADHD, or other disturbances of children’s mental life. There is very little evidence to that effect.  In a recent review, Kendall et al (2014; Explore, 10(2), 81-87) described EAT as under-researched and largely anecdotal in its support. Even though there are randomized designs used in some studies of EAT, they generally fall down by having a treatment group who have elaborate social, interactive, and riding experiences, but are compared with another group who are given no new experiences at all. This failure to isolate the horseback-riding variable means that no one can know whether apparent benefits came from increased social experience, from interactions with social workers or other helpers, or from riding itself.  

In addition to the lack of empirical evidence supporting EAT as a therapy for children with developmental delays or other mental problems, there has been a strong tendency for advocates of EAT to make exaggerated, even ludicrous, arguments for the treatment. I discussed some of these  several years ago at http://childmyths.blogspot.com/2011/02/clever-hans-rides-again-equestrian.html. I was responding to claims that  horses know when a child is lying (they don’t care for this, it seems), and that a horse’s gait is “downloaded” into a child’s brain, thus apparently doing an end run around all the problems that have been blamed (wrongly) on a lack of crawling experience.  These both summon entertaining images--  a deeply disapproving horse shaking its head at a fibbing child (but why lie to a horse?), and the probable human gait that would be based on a “downloaded” horse pattern. (This last makes me think of playing horses as a little girl and being both horse and rider simultaneously.)

Perhaps NASW feels that interest in EAT by social workers can lead to some serious research about the treatment’s effectiveness, and that is possible, even though much about the treatment is implausible. Nevertheless, it would be wise to limit shows of approval like continuing education credits until better evidence is presented. It would also be a good idea to draw the line clearly between the “downloading” faction and the work of those who are interested in the actual possibilities of this proposed treatment modality.


15 comments:

  1. It's hard to imagine a standardized therapy with horses. From my experience with horses (work and play), they have quite different personalities. Instead of horses "supporting people," it's usually the job of people to understand the individual horse.

    I think this article in a 2014 NASW newsletter about EAT is quite revealing.

    http://www.naswdc.org/pubs/news/2014/10/animal-assisted-therapy.asp

    It may be more fun for the social workers to be outside, too. Unfortunately, they make claims like this: "These animals can mirror what someone is going through internally and the social worker can learn more about their client this way..." and " animals like horses meet people where they are — just like social workers are trained to do."

    I suspect that for all those horse lovers who have to pay through the nose for boarding, renting out their horses for EAT could mean financial survival.

    For myself, I can only hope that NASW sanctions "Airplane-Assisted Therapy" next year.

    ReplyDelete
  2. I spent some time horseback riding. Horses are strong and shy animals. They feel the weakness and the strength of the rider. Even the calmest horse can feel weakness and mental instability rider. Is it dangerous. The horse can kill .... and it's not the fault of the horse. It is the instinct of self-preservation. Dangerous rider .... a threat to the life of the horse. The horse wants to get rid of this rider. Hyperactive children frighten the horses screaming and sharp movements. You have to understand that this is animal abuse. If there is no evidence that riding is a good treatment for mentally ill children ....... should stop this mockery of horses.

    ReplyDelete
    Replies
    1. I hadn't really thought of it from the horse's perspective! But I think therapists who use this technique must supervise very closely, or as you say it could be dangerous.

      Delete
  3. At least learning to ride horses can't hurt kids with various sorts of mental illness, and might at least help them feel better emotionally. Connecting with responsive animals of any kind plus mastering the skill of riding seems like a positive thing, once you take away the exaggerated claims of miracle cures. Like bringing friendly dogs and cats into hospitals and nursing homes, I think using animals as a kind of therapy can at least cheer people up and make them feel loved and accepted by creatures. Not all things good for people need to be hard science.

    ReplyDelete
    Replies
    1. Of course, as you say, there are lots of things that make people feel better, and it's good to help kids to those things. My objection is to having a specific intervention touted without having evidence that it is effective in itself-- not just because it goes with good times and social interaction.

      Delete
    2. Keep doing your research.

      Delete
  4. Ora-- for some reason your query did not appear here, although it was forwarded on my private e-mail. Would you repeat it?

    Thanks--

    ReplyDelete
    Replies
    1. I wanted to know what you thought of the "holding technique" that was demonstrated in the video I linked to (I don't insert the link here, since this might be reason why the comment did not pass the first time).

      This video proposes: when babies cry, one should hold both their arms (crossed in front of their breasts) in one hand, hold them at a 45 degree angle (head forward) and gently rock them...

      Delete
    2. Thanks for repeating-- I never thought of the link as being a problem, but maybe that's the cause of occasional glitches like this.

      If the method shown is used with quite young babies (maybe 6 weeks or less), I wouldn't call it a therapy. It looks like just a stylized version of a common old-fashioned baby-soothing technique. Tipping the baby off vertical is likely to make him or her less responsive and attentive to environmental events-- think how they brighten up and look around when brought up to the caregiver's shoulder. Holding the arms immobilized is like swaddling, which is a tried and true calmer for the very little ones (assuming that they don't have some real problem, but are just irritable). I think that many current parents don't use the old "receiving blankets" that were so handy for swaddling, because they have sleep sacks instead-- if they don't know about swaddling, they might not look for something to use for that purpose.

      Anyway, I see no harm if this is not done to excess or instead of feeding (e.g.). Of course it should be regarded as a calming method, not something that "treats" an infant psychological problem. Nor would it make sense to do it if a baby was old enough to be infuriated rather than soothed by this technique.

      I think that actual holding therapy was not based on swaddling, but instead on the demonstrable fact that immobilizing older babies makes them furious, which is the point of HT.

      Delete
  5. New on HuffPo -- hyping equine therapy:

    http://www.huffingtonpost.com/tim-hayes/how-horses-heal-our-emoti_b_8710698.html

    ReplyDelete
    Replies
    1. He says it's good, so it must be good. Or do my mirror neurons fail me?

      Delete
  6. Horses are not as "little kittens". They are large "serious" animals. Some kids (especially living in large towns) may like to observe them from distance but may be afraid to approach closely to them (and I understand these feelings well). It is important that these "trainings" would not be made "obligatory",

    ReplyDelete
    Replies
    1. I am sure they introduce child to horse gradually-- but I would be concerned that some of these practitioners might interpret the child's reluctance as meaning that he or she does not want to co-operate or accept help. I am sure that most of them don't think that way, but those who imagine that the horse can tell that a child is lying-- well, I can't imagine how far their fantasy might roam.

      Delete
  7. Probably the therapeutic effect of riding on horseback so as to communicate with cats, dogs or other animals loyal to the man. It's fun and educational for your child. But you can not make this promise Commerce and miraculous healing. Hippotherapy as dolphin therapy is expensive. It's fun for children but not saving miracle. Wonders of the road today: the cost of "miracle", in one of the dolphinariums US is 15 thousand. Euro. One session a commercial swimming with dolphins in Moscow (not recreational diving) costs 2000 rubles, the duration of 10 minutes of swimming.
    To the effect of hippotherapy was, you need a minimum of six sessions - is 50,000 rubles (728.16 US dollars).

    There is no documentary evidence of the therapeutic effect of the treatment does not guarantee. But at stake is the health of the child ... parents are willing to pay any price. It is immoral to use parental love for personal gain. Hike with a child in the woods for mushrooms and feeding squirrels in the park has the same healing effect on the child. But this event is much cheaper.

    ReplyDelete