An Overview of Equine Facilitated Interventions with Anxiety Disorders

1. 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

2. 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

3. Wendy M. Denbo • Co-Director of TRAVERSE • Master’s in Professional Counseling • Registered Mental Health Intern • PATH member • Over seventeen years of equine experience

4. Definition of Anxiety • How do you define Anxiety? • Anxiety • Angst or worry • Normal reaction to stressor • Apprehension without apparent cause • “Feels” real

5. 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

6. 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

7. 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

8. Other Types of Anxiety • Guilt Anxiety • Performance Anxiety • Separation Anxiety • Social Anxiety • Phobias

9. Fight/Flight diagram

10. 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

11. Interventions • Staffing • open, cooperative mental health professional • open, cooperative equine specialist

12. 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

13. Interventions • CREATE A SAFE PLACE • Open communication • Staff working as a team • Normalize • Recruit volunteers for support and comfort • Selection of appropriate horses (safe &relates to client)

14. 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”

15. 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.

16. 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

17. 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

18. 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.

19. Working with these types of clients takes time, patience and a special equine or two.

20. Contact Information • Joe Callan • jcallanlcsw@gmail.com • Wendy Denbo • wmdenbo@gmail.com