An Overview of Equine Facilitated Interventions with Anxiety Disorders

Presented by:Joseph P. Callan, M.S., M.S.W., LCSW

Wendy M. Denbo, M.A., IMH

• Joseph P. Callan– Clinical Director of

TRAVERSE– Diplomate in Clinical Social

Work– Diplomate in Clinical

Sexology– Registered Clinical

Supervisor– Path Registered Instructor– Equine Specialist MH&L– Served on EFMHA and

PATH Boards

• Wendy M. Denbo– Co-Director of TRAVERSE– Master’s in Professional

Counseling– Registered Mental

Health Intern– PATH member– Over seventeen years of

equine experience

Definition of Anxiety

• How do you define Anxiety?

• Anxiety– Angst or worry– Normal reaction

to stressor– Apprehension

without apparent cause

– “Feels” real

Different types of Anxiety

• Generalized Anxiety Disorder– Pattern of worry and anxiety over many different

events and/or activities, occurring more days than not (6 months)

– Symptoms include:• Restlessness, Fatigue, Irritability, Difficulty

falling asleep and concentrating, etc.• Significant distress, impairment in functioning

Types of Anxiety

• Panic Anxiety – recurrent panic attacks– Palpitations, sweating, trembling, shortness of

breath, chest pain, dizziness, derealization, numbness, tingling, hyperventilation.

• Concern re: the attacks, additional attacks, consequences, implications, loss of control,

• Impairment in functioning

Types of Anxiety• Post Traumatic Stress Disorder (PTSD)– Can occur with exposure to a traumatic event– Symptoms include:• Recurrent, intrusive recollections of the event:

– Dreams, flashbacks, etc.– Intense distress at exposure to cues (triggers)– Physiological Reactivity on exposure to cues

• Persistent avoidance of stimuli associated with trauma with numbing of general responsiveness.• Persistent, increased arousal:

– Difficulty sleeping or concentrating– Irritability, outbursts of anger– Hypervigilance, exaggerated startle response

Other Types of Anxiety

• Guilt Anxiety• Performance Anxiety• Separation Anxiety• Social Anxiety• Phobias

Fight/Flight diagram

Stages of Stress/Anxiety• Stressors– Financial, family, work, school, etc.– Internal or External

• Learning Window – A little apprehension• A-State - heightened anxiety, heart rate increase,

breathing increase & upset, angry, demanding, not listening - Beginning to Lose Control• Defensive state -Similar behavior as A-state but much

more intense, more directive and threatening – Has Lost Control

• Acting out – Fight (physical) or Flight• Resolution

Interventions

• Staffing– open, cooperative

mental health professional

– open, cooperative equine specialist

Interventions

• Assess, assess, assess !• Where is the anxiety

coming from?– Talk to the rider and

listen– Assess the assessment

you got from others– A child’s behavior is a

form of communication, remember to be patient and assess

Interventions

Interventions• Getting the client to relax

– Teaching relaxation skills• Deep breathing• Plan, practice, rehearse• Change focus

– Helpful thinking• Positive self statements• Clear distorted thinking

– Provide education– Build a relationship/trust– “Just be with the horse…

just feel the horse”

Interventions

• Distorted Thinking– All or nothingthinking: It’s all good or it’s all bad.– Emotional Reasoning: I am what I feel.– Overgeneralization: Always, everything, never…– Personalization: Your dysfunction is about me…– Catastrophizing: I have a hangnail—I’m going to die.– Perfectionism: If it’s not perfect, it’s not O.K.– Comparing to others: I’m no good because someone

else is better.

Interventions• Systematic Desensitization (Wolpe, J, 1961)– Exposure serially to a predetermined list of anxiety

provoking stimuli graded in a hierarchy from least to most frightening.

– Each of the anxiety provoking stimuli is paired with the arousal of another affect of an opposite quality e.g. relaxation, relationship that is strong enough to suppress the anxiety.

– As they become desensitized to each stimulus in the scale, the riders move up to the next stimulus until, ultimately, what previously produced the most anxiety is no longer capable of eliciting the painful affect

Interventions• Encourage small successive steps without

pushing (overwhelming) the rider– Example: Greeting, approaching, haltering, grooming,

leading, mounting, etc.• If rider becomes overwhelmed– Stop– If available, Mental Health Professional may intervene– Provide support– Make a goal for next lesson

• Be prepared for unexpected situations– Reactions of staff & volunteers and how it transfers

Intervention

• Ensure you engage the rider in a manageable bit of behavior.

• Describe, demonstrate, engage client in planning and rehearse

• Engage in activity.• Monitor closely• Modulate intensity, duration, etc. so as not to

overwhelm client.

Working with these types of clients takes time, patience and a special

equine or two.

Contact Information

• Joe Callan– jcallanlcsw@gmail.com

• Wendy Denbo– wmdenbo@gmail.com