Adaptive Riding Incorporating Cognitive-Behavioral Elements for Youth with Anxiety: An Exploratory Randomized Controlled Study

Between 15% to 20% of youth meet diagnostic criteria for anxiety, yet most do not receive treatment due to workforce shortages, under-detection, or barriers that dissuade families from seeking services in traditional settings. Equine-assisted services (EAS) include several promising approaches to reach populations who do not access traditional therapies. Few studies using rigorous methods have been conducted on EAS for youth. This study examined feasibility and outcomes of a 10-session Cognitive Behavioral Therapy (CBT)-based adaptive riding intervention (hereafter called Reining in Anxiety) delivered by trained equine professionals. Forty-one youth 6-16 years of age were recruited from GallopNYC, an adaptive horseback riding center in the NYC metro area. Youth were randomized to an experimental group (n=22) or services as usual (n=19), a standard adaptive riding group (services as usual or SAU). Severity of anxiety symptoms, anxiety in close relationships, and emotional self-efficacy were assessed at baseline and at the end of treatment. Fidelity to the manual was excellent, ranging from 88.9% to 100%. There was a non-significant trend in the experimental group towards greater improvement with higher number of sessions completed. Youth in the Reining in Anxiety group displayed significant reductions in anxiety (t=4.426, df=38, p=0.042) and improvement in emotional self-efficacy at posttest (t=4.132, df =38, p=0.049) in comparison to the SAU group. No significant differences were found between groups for anxiety in close relationships. This study suggests that a CBT-based adaptive riding intervention delivered by non-mental health equine professionals following a detailed manual can reduce youth anxiety symptoms and be delivered with fidelity by riding instructors. These findings have implications for families seeking non-traditional services.