By Dr. Katie Cagle-Holtcamp
His heart races as Jason (name changed for anonymity) puts his foot in the stirrup and swings his leg over the saddle. He’s never ridden a horse before, but that’s not the issue. Extreme anxiety has become a normal part of everyday life ever since he returned from deployment. He’s constantly on edge, can’t sleep and his mind races. The only thing that seems to help is alcohol, but that’s become habitual and unsustainable.
Today, he’s looking for a fresh start. As part of his addiction treatment, Jason is participating in a special program that combines therapist-led psychotherapy with horseback riding to help veterans like him break through the emotional trauma fueling his substance use disorder.
This new treatment approach, clinically known as psychotherapy incorporating equine (PIE), has already demonstrated dramatic results, helping veterans unlock repressed thoughts and feelings that have, to this point, hindered their recovery.
PIE vs. Equine Therapy
Traditional equine assisted therapy involves individuals working with horses—typically grooming, feeding or simply being in the presence of these gentle giants—as a way to calm anxiety or soothe depression. There’s even scientific evidence to support these therapies: a horse’s heart beats much slower than a human’s and when we’re in proximity, our heart rates synchronize—a phenomenon known as heart coupling.
As a result, we feel calmer, and our mind slows down. But in most cases, there’s no actual therapy or mental health professional involved. It’s a feel-good moment, but it ends once the interaction is over.
Horse-Rider Connection is Key to PIE
In a PIE session, veterans actually ride the horse as it’s led by a handler (no previous riding experience is needed), while a licensed mental health therapist walks alongside. The therapist guides the patient through a psychotherapy session in which they directly address trauma and emotional issues and examine the patient’s assumptions and beliefs about themselves, their history and their addiction.
While the therapist listens, they’re also watching the horse for clues that provide unmistakable insight into the patient’s state of mind and stress level, regardless of whether they actually verbalize it—and even if they deny it. The horse can sense and will react to their emotional state.
For example, when someone feels vulnerable recounting a traumatic situation, they will instinctively move toward a fetal position and lean forward to cover and protect their vital organs. On the horse, this forward lean signals the horse to walk faster, which the PIE therapist can observe as a trauma response. Similarly, if the therapist touches on a difficult subject, the person might stiffen their legs, causing them to sit back in the saddle, which signals the horse to stop.
Sometimes sessions involve moments of tension, resistance or even anger, and the horse also tenses up. But once the individual relaxes, the horse snorts, releasing the pent-up pressure of the interaction. As a patient moves toward acceptance, the horse will begin to lick its lips and chew on nothing—the same way it would signal acceptance when learning a new task or training tactic. If an individual feels emotionally off balance or is struggling to make sense of a situation during therapy, they might lean to one side, causing the horse to bring its hips around to counteract the weight shift and may even walk in a circle.
A Window into Reality
Veterans often repress their feelings. They’re conditioned that emotions are a sign of weakness, and certainly a liability on the battlefield.
But on the horse, there’s no hiding it, which is why PIE is so helpful for veterans. As the therapist asks pointed questions, they get authentic feedback from the horse and can nudge the patient to become more honest and willing to open up. Veterans in the program become more introspective, self-aware and gain a much clearer perspective of their mental health. One gentleman who claimed to have a “wonderful” childhood opened up and began describing how it wasn’t so wonderful after all. Despite insisting things were great growing up, he clearly displayed a trauma response when talking about his upbringing, and finally admitted he’d never told anyone about his childhood experiences. The breakthrough was pivotal in his recovery.
Another veteran had an inflated sense of his own well-being, and often said, “I’m good,” when asked how he was doing, claiming that he was getting better every day. But his behavior on the horse told a different story and, through PIE, he was able to realign his view of himself and recognize he still had work to do. That kept him from leaving treatment too early and risking a relapse.
PIE therapy offers veterans a way to break through the trauma and emotional blockades that have kept them mired in PTSD and addiction and prevented them from fully enjoying life after deployment. It facilitates healing, even for those who have felt broken beyond repair, allowing them to move forward with a sober and satisfying civilian life.
Dr. Katie Holtcamp has cultivated a diverse and intentional knowledge base for psychotherapy incorporating equine through academic and professional achievement within the horse and human components equally. Currently, Dr. Holtcamp maintains a robust research program between American Addiction Centers and Mississippi State University’s Animal and Dairy Science Department, evaluating physiological interactions between horse and human in the therapeutic environment.
Read more articles for the veteran community here.
