VISN 19 Whole Health Flagship Site, VA Salt Lake City Health Care System, Salt Lake City, UT 84108, USA.
Department of Psychiatry, University of Utah, Salt Lake City, UT 84108, USA.
Mil Med. 2024 Jan 23;189(1-2):e220-e226. doi: 10.1093/milmed/usad274.
Veterans have high rates of substance use disorders and other mental health conditions including post-traumatic stress disorder. Effective treatments for these conditions exist; however, high attrition rates and residual symptoms after completing treatment are common. Complementary treatment approaches could enhance treatment engagement and/or response among this population. We previously reported a study of one such intervention, an equine-assisted learning, and psychotherapy incorporating horses intervention provided to veterans admitted to a Veterans Health Care Administration residential substance abuse treatment program. The first aim of this study was to replicate the previous study assessing the safety, feasibility, and preliminary outcomes of this intervention. The second aim was to examine the effect of participants attending multiple intervention sessions.
Participants were 94 veterans who participated in one to six sessions of a 3-4-hour program consisting of both equine-assisted learning and psychotherapy incorporating horses. Pre- and post-session administration of the Positive and Negative Affect Scale, State-Trait Anxiety Inventory, and Craving Experience Questionnaire was utilized to assess changes in affect, anxiety, and craving. Wilcoxon signed-rank or paired two-tailed t-tests were utilized for pre- to post-session comparisons of the outcome measures for sessions 1-4. Generalized linear mixed-effects (GLME) models were constructed to determine the impact of dosage. GLME models were constructed to determine the impact of dosage.
As with our previous study, the intervention was safe and feasible to utilize for this population. There were statistically significant pre- to post-session improvements, with medium-to-large effect sizes, for sessions 1-3 for negative affect and sessions 1 and 2 for positive affect, anxiety, and craving. The GLME models revealed no statistical significance for any of the predictors.
Taken together, this study and our previous investigation of this equine-assisted services intervention suggest that it is safe and feasible to utilize for veterans admitted to a residential substance abuse treatment program and we have now found short-term benefits in two separate studies. Thus, a randomized controlled trial of this intervention is warranted to demonstrate cause and effect and determine whether longer-term benefits are associated with the intervention. The finding that there was no additional benefit from attendance at more than two intervention sessions suggests that dose-response relationship studies of equine-assisted services interventions for veterans are needed.
退伍军人有很高的物质使用障碍和其他心理健康问题，包括创伤后应激障碍。这些疾病存在有效的治疗方法；然而，在完成治疗后，高退出率和残留症状是很常见的。补充治疗方法可以提高退伍军人在接受退伍军人事务部住院药物滥用治疗项目时的治疗参与度和/或反应。我们之前报道了一项关于这种干预措施的研究，即马辅助学习和心理治疗，该研究纳入了退伍军人心理健康管理局住院药物滥用治疗项目的退伍军人。这项研究的第一个目标是复制之前的研究，评估这种干预措施的安全性、可行性和初步结果。第二个目标是研究参与者参加多次干预会议的效果。
参与者是 94 名退伍军人，他们参加了一个由 3-4 小时的课程组成的计划，该课程包括马辅助学习和心理治疗，共参加了 1-6 次课程。在课程开始前和结束后，使用正性和负性情绪量表、状态特质焦虑量表和渴望体验问卷来评估情绪、焦虑和渴望的变化。使用 Wilcoxon 符号秩或配对双尾 t 检验比较 1-4 次课程的结果测量值的前后变化。构建广义线性混合效应（GLME）模型来确定剂量的影响。构建 GLME 模型来确定剂量的影响。
与我们之前的研究一样，该干预措施对这一人群是安全和可行的。在 1-3 次课程中，负性情绪有统计学意义上的前后改善，具有中等至大的效应量；在 1 次和 2 次课程中，正性情绪、焦虑和渴望也有统计学意义上的前后改善。GLME 模型对任何预测因子都没有统计学意义。
综上所述，这项研究和我们之前对这种马辅助服务干预的调查表明，它对住院药物滥用治疗项目的退伍军人是安全和可行的，我们在两项独立的研究中已经发现了短期益处。因此，有必要对这种干预措施进行随机对照试验，以证明因果关系，并确定是否与干预相关的长期益处。从两次以上的干预会议中没有获得额外益处的发现表明，需要对退伍军人的马辅助服务干预进行剂量反应关系研究。
