Effects of therapeutic horseback riding on post-traumatic stress disorder in military veterans
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摘要
Background:Large numbers of post-deployment U.S.veterans are diagnosed with post-traumatic stress disorder(PTSD)and/or traumatic brain injury(TBI),leading to an urgent need for effective interventions to reduce symptoms and increase veterans’coping.PTSD includes anxiety,flashbacks,and emotional numbing.The symptoms increase health care costs for stress-related illnesses and can make veterans’civilian life difficult.Methods:We used a randomized wait-list controlled design with repeated measures of U.S.military veterans to address our specific aim to test the efficacy of a 6-week therapeutic horseback riding(THR)program for decreasing PTSD symptoms and increasing coping self-efficacy,emotion regulation,social and emotional loneliness.Fiftyseven participants were recruited and 29 enrolled in the randomized trial.They were randomly assigned to either the horse riding group(n=15)or a wait-list control group(n=14).The wait-list control group experienced a 6-week waiting period,while the horse riding group began THR.The wait-list control group began riding after 6 weeks of participating in the control group.Demographic and health history information was obtained from all the participants.PTSD symptoms were measured using the standardized PTSD Checklist-Military Version(PCL-M).The PCL-M as well as other instruments including,The Coping Self Efficacy Scale(CSES),The Difficulties in Emotion Regulation Scale(DERS)and The Social and Emotional Loneliness Scale for Adults-short version(SELSA)were used to access different aspects of individual well-being and the PTSD symptoms.Results:Participants had a statistically significant decrease in PTSD scores after 3 weeks of THR(P≤0.01)as well as a statistically and clinically significant decrease after 6 weeks of THR(P≤0.01).Logistic regression showed that participants had a 66.7%likelihood of having lower PTSD scores at 3 weeks and 87.5%likelihood at 6 weeks.Under the generalized linear model(GLM),our ANOVA findings for the coping self-efficacy,emotion regulation,and social and emotional loneliness did not reach statistical significance.The results for coping self-efficacy and emotion regulation trended in the predicted direction.Results for emotional loneliness were opposite the predicted direction.Logistic regression provided validation that outcome effects were caused by riding longer.Conclusion:The findings suggest that THR may be a clinically effective intervention for alleviating PTSD symptoms in military veterans.
Background:Large numbers of post-deployment U.S.veterans are diagnosed with post-traumatic stress disorder(PTSD)and/or traumatic brain injury(TBI),leading to an urgent need for effective interventions to reduce symptoms and increase veterans’coping.PTSD includes anxiety,flashbacks,and emotional numbing.The symptoms increase health care costs for stress-related illnesses and can make veterans’civilian life difficult.Methods:We used a randomized wait-list controlled design with repeated measures of U.S.military veterans to address our specific aim to test the efficacy of a 6-week therapeutic horseback riding(THR)program for decreasing PTSD symptoms and increasing coping self-efficacy,emotion regulation,social and emotional loneliness.Fiftyseven participants were recruited and 29 enrolled in the randomized trial.They were randomly assigned to either the horse riding group(n=15)or a wait-list control group(n=14).The wait-list control group experienced a 6-week waiting period,while the horse riding group began THR.The wait-list control group began riding after 6 weeks of participating in the control group.Demographic and health history information was obtained from all the participants.PTSD symptoms were measured using the standardized PTSD Checklist-Military Version(PCL-M).The PCL-M as well as other instruments including,The Coping Self Efficacy Scale(CSES),The Difficulties in Emotion Regulation Scale(DERS)and The Social and Emotional Loneliness Scale for Adults-short version(SELSA)were used to access different aspects of individual well-being and the PTSD symptoms.Results:Participants had a statistically significant decrease in PTSD scores after 3 weeks of THR(P≤0.01)as well as a statistically and clinically significant decrease after 6 weeks of THR(P≤0.01).Logistic regression showed that participants had a 66.7%likelihood of having lower PTSD scores at 3 weeks and 87.5%likelihood at 6 weeks.Under the generalized linear model(GLM),our ANOVA findings for the coping self-efficacy,emotion regulation,and social and emotional loneliness did not reach statistical significance.The results for coping self-efficacy and emotion regulation trended in the predicted direction.Results for emotional loneliness were opposite the predicted direction.Logistic regression provided validation that outcome effects were caused by riding longer.Conclusion:The findings suggest that THR may be a clinically effective intervention for alleviating PTSD symptoms in military veterans.
Background:Large numbers of post-deployment U.S.veterans are diagnosed with post-traumatic stress disorder(PTSD)and/or traumatic brain injury(TBI),leading to an urgent need for effective interventions to reduce symptoms and increase veterans’coping.PTSD includes anxiety,flashbacks,and emotional numbing.The symptoms increase health care costs for stress-related illnesses and can make veterans’civilian life difficult.Methods:We used a randomized wait-list controlled design with repeated measures of U.S.military veterans to address our specific aim to test the efficacy of a 6-week therapeutic horseback riding(THR)program for decreasing PTSD symptoms and increasing coping self-efficacy,emotion regulation,social and emotional loneliness.Fiftyseven participants were recruited and 29 enrolled in the randomized trial.They were randomly assigned to either the horse riding group(n=15)or a wait-list control group(n=14).The wait-list control group experienced a 6-week waiting period,while the horse riding group began THR.The wait-list control group began riding after 6 weeks of participating in the control group.Demographic and health history information was obtained from all the participants.PTSD symptoms were measured using the standardized PTSD Checklist-Military Version(PCL-M).The PCL-M as well as other instruments including,The Coping Self Efficacy Scale(CSES),The Difficulties in Emotion Regulation Scale(DERS)and The Social and Emotional Loneliness Scale for Adults-short version(SELSA)were used to access different aspects of individual well-being and the PTSD symptoms.Results:Participants had a statistically significant decrease in PTSD scores after 3 weeks of THR(P≤0.01)as well as a statistically and clinically significant decrease after 6 weeks of THR(P≤0.01).Logistic regression showed that participants had a 66.7%likelihood of having lower PTSD scores at 3 weeks and 87.5%likelihood at 6 weeks.Under the generalized linear model(GLM),our ANOVA findings for the coping self-efficacy,emotion regulation,and social and emotional loneliness did not reach statistical significance.The results for coping self-efficacy and emotion regulation trended in the predicted direction.Results for emotional loneliness were opposite the predicted direction.Logistic regression provided validation that outcome effects were caused by riding longer.Conclusion:The findings suggest that THR may be a clinically effective intervention for alleviating PTSD symptoms in military veterans.
引文
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2.Silkwood-Sherer D.The difference lies in the perspective.NARHA’s Stride.2003;9:14-6.
3.Bandura A.Social foundations of thought and action:a social cognitive theory.Englewood Cliffs,NJ:Prentice-Hall;1986.
4.U.S.D ept.of Veterans Affairs,National Center for PTSD.PTSD History and Overview.2015.http://www.ptsd.va.gov/professional/PTSD-overview/ptsdoverview.asp.Accessed 18 Oct2017.
5.U.S.Census Bureau.Veterans-the 2012 statistical abstract.2012.https://www.ptsd.va.gov/public/ptsd-overview/basics/howcommon-is-ptsd.asp.Accessed 18 Oct 2017.
6.Koren D,Norman D,Cohen A,Berman J,Klein EM.Increased PTSDrisk with combat-related injury.Am J Psychiatry.2005;162:276-82.https://doi.org/10.1176/appi.ajp.162.2.276.
7.Schell TL,Marshall GN.Survey of individuals previously deployed for OEF/OIF.In:Tanielian T,Jaycox LH,editors.Nvisible wounds of war:psychological and cognitive Injuries,Their consequences,and services to assist recovery.Santa Monica,CA:Rand Corporation;2008.p.93.
8.Seal KH,Matzler TJ,Gima KS,Bertenthal D,Maguen S,Marmar CR.Trends and risk factors for mental health diagnoses among Iraq and Afghanistan veterans using Department of Veterans Affairs health care,2002-2008.Am J Public Health.2011;116:93-101.https://doi.org/10.2105/AJPH.2008.150284.
9.Seal KH,Cohen G,Waldrop A,Cohen BE,Maguen S,Ren L.Substance use disorders in Iraq and Afghanistan veterans in VAhealthcare,2001-2010:implications for screening,diagnosis and treatment.Drug Alcohol Depend.2011;116:93-101.https://doi.org/10.1016/j.drugalcdep.2010.11.027.
10.Kulka RA,Schlenger WE,Fairbank JA,Hough RL,Jordan BK,Marmar CR,et al.Trauma and the Vietnam war generation:report of findings from the National Vietnam Veterans Readjustment Study.New York:Brunner/Mazel;1990.
11.Taft CT,Schumm JA,Panuzio J,Proctor SP.An examination of family adjustment among operation desert storm veterans.JConsult Clin Psychol.2008;76:648-56.https://doi.org/10.1037/a0012576.
12.Gewitz AH,Polusny MA,De Garmo DS,Khaylis A,Erbes CR.Posttraumatic stress symptoms among National Guard soldiers deployed to Iraq:associations with parenting behaviors and couple adjustment.J Consult Clin Psychol.2010;78:599-610.https://doi.org/10.1037/a0020571.
13.Hoge CW,Auchterlonie JL,Milliken CS.Mental health problems,use of mental health services,and attrition from military service after returning from deployment to Iraq or Afghanistan.JAMA.2006;295:1023-32.https://doi.org/10.1001/jama.295.9.1023.
14.Jacobson IG,Ryan MAK,Hooper TL,Smith TC,Amoroso PJ,Boyko EJ,et al.Alcohol use and alcohol related problems before and after military combat deployment.JAMA.2008;300:663-75.
15.Milliken CS,Auchterlonie JL,Hoge CW.Longitudinal assessment of mental health problems among active and reserve component soldiers returning from the Iraq war.JAMA.2007;298:2141-8.
16.Galovski T,Lyons JA.Psychological sequelae of combat violence:a review of the impact of PTSD on the veteran’s family and possible interventions.Aggress Violent Behav.2004;9:477-501.https://doi.org/10.1016/S1359-1789(03)00045-4.
17.Chandra A,Lara-Cinisomo S,Jaycox LH,Tanielian T,Burns RM,Ruder T,et al.Children on the homefront:the experiences of children from military families.Peds.2010;125:16-25.https://doi.org/10.1542/peds.2009-1180.
18.Lester P,Peterson K,Reeves J,Knauss L,Glover D,Mogil C,et al.The long war and parental combat deployment:effects on military children and athome spouses.J Am Acad Child Adolesc Psychiatry.2010;49:310-20.
19.Otis JD,Keane TM,Kerns RD.An examination of the relationship between chronic pain and post-traumaticstress disorder.JRehabil Res Dev.2003;40:397-406.
20.Zatzick DF,Marmar CR,Weiss DS,Browner WS,Metzler TJ,Golding JM,et al.Post-traumatic stress disorder and functioning and quality of life outcomes in a nationally representative sample of male Vietnam veterans.Am J Psychiatry.1997;154:1690-5.
21.Nazarian D,Kimerling R,Frayne SM.Post-traumatic stress disorder,substance use disorders,and medical comorbidity among returning U.S.veterans.J Trauma Stress.2012;25:220-5.https://doi.org/10.1002/jts.21690.
22.Foa EB,Meadows A.Psychosocial treatments for post-traumatic stress disorder:a critical review.Annu Rev Psychol.1997;48:449-80.https://doi.org/10.1146/annurev.psych.48.1.449.
23.Department of Veterans Affairs and Department of Defense.VA/DOD clinical practice guidelines for the management of posttraumatic stress.The Office of Quality and Safety,VA,Washington DC and Quality Management Division,United States Army MEDCOM.2010.
24.Ehlers A,Clark DM.A cognitive model of post-traumatic stress disorder.Behav Res Ther.2000;38:319-45.https://doi.org/10.1016/S0005-7967(99)00123-0.
25.Cohen S,Wills T.Stress,social suppor t and the buffering hypothesis.Psychol Bull.1985;98:310-57.
26.House J,Kepkowski J,Kinney A,Mero R,Kessler R,Herzog A.The social stratification of aging and health.J Health Soc Behav.1994;35:213-34.
27.Mc Leod J,Kessler R.Socioeconomic status differences in vulnerability to undesirable life events.J Health Soc Behav.1990;31:162-72.
28.Brewin CR,Andrews B,Valentine JD.Meta-analysis of risk factors for posttraumatic stress disorder in trauma-exposed adults.J Consult Clin Psychol.2000;68:74866.https://doi.org/10.1037//0022-006X.68.5.748.
29.Ozer EJ,Best SR,Lipsey TL,Weiss DS.Predictors of post-traumatic stress disorder and symptoms in adults:a meta-analysis.Psychol Bull.2003;129(1):52-73.
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