Compiled and Presented by Jezey Wolf    


Recently, there has been a rise in novel and alternative therapeutic approaches to supporting Trauma clients. This review will look to understand the research around a few of these. Specifically this review will look at Equine-assisted therapy (also known as Equine facilitated and Equine guided) (EAP), other animal assisted therapies (AAT), trauma-informed/focused Yoga (TIY) and psychedelic therapy (PT).These approaches typically encourage clients to move off the therapist’s couch and engage their bodies and minds and novel ways, encouraging them to connect more deeply with themselves, be it through grooming a horse, building a projection to lead a horse through, the somatic experiences of Yoga or experiencing altered states and perspectives.

These activities, experiences and movement patterns are things an individual would likely not find themselves typically doing day-to-day; this undoubtedly forms part of clients’ attraction to these novel approaches. Although new, these bottom-up and novel approaches have been shown to have solid neurophysiologic underpinnings (Grabbe, 2018), which no doubt has also supported their rise in popularity.

Recent research into trauma survivors has shown promise with the use of non-traditional forms of therapy (Naste, 2018). For example, in recent research into emerging trends and interventions for treating trauma-related conditions such as Post Traumatic Stress Disorder (PTSD), Equine therapy was nominated as a popular novel and/or emerging intervention (Metcalf O, 2016). Looking laterally, recent research has shown evidence supporting the effectiveness of mind-body and behavioural techniques such as mindfulness, sensory integration, and biofeedback-based approaches in the treatment of trauma. These elements all typically form part of the approaches that underpin these novel interventions. (Naste, 2018).

Historical approaches to treating trauma and its subsequent conditions, such as Post Traumatic Stress Disorder, include things such as Cognitive Behavioural Therapy and Prolonged Exposure Therapy. These often involve the client being asked to revisit past traumas (Motta, 2020). This approach has repeatedly been shown to increase anxiety in clients, leading to attrition for treatment (Motta, 2020), and those who remained have often shown limited long-term improvements (Van der Kolk, 2015).

The author has selected this topic due to their personal experience as an Equine assisted practitioner and one who often leverages other typically novel approaches in the therapeutic experience for trauma clients. This, combined with these areas of specialty rapidly growing in popularity and availability, it is determined that understanding the literature around the approaches is a key step in supporting these methods in gaining wider social acceptance as valid therapeutic ways to support clients,  along with identifying areas needing further research into efficacy.  


Research FindingsEquine and Animal Assisted Therapies

There is a growing body of research into animal-assisted therapy (AAT), Equine-assisted psychotherapy (EAP) and their role in supporting trauma clients. Multiple components are at play when considering why or how these modalities support positive outcomes. The first to consider is the therapeutic approach; research into Equine-assisted therapy has suggested that while Equine-assisted therapies can be delivered within the practitioner’s preferred theoretical background, it typically have four main underpinnings. These are brief therapy, Gestalt therapy, reality therapy, and Adlerian therapy (Trotter K. , 2012).

There however, does not seem to be evidence of a general direction underpinning the therapeutic approach to AAT. Next is the novel element – the horse or the animal, etc. The research around how animal-assisted therapies typically integrate a therapeutic approach is varied. The animal is sometimes simply employed adjunct to traditional therapy, offering the client things such as warmth, weight on the legs or co-regulation, through to entirely holistic animal-human approaches where the animal works as an agent of change. 

However, there seems to be no clear consensus as to what the standard format of an animal-assisted therapy approach is. Equine Assisted Therapy, unlike AAT, does tend to have some greater alignment on the approaches. Typically, the horses will be an equal part of the session with the therapist, and activities would vary from herd observations and leading or grooming tasks to obstacle courses. There is also a combination of approaches from the ground or mounted on the horses. The horse will be a crucial function in the session, acting as a key agent of change and co-regulator (Motta, 2020) rather than just an add-on as is often seen in AAT. It has been suggested that animals being invited into the therapeutic journey for clients supports them in many ways.

A recent study indicated animals reportedly support reduced anxiety and hyperarousal, given that their presence is related to the secretion of oxytocin (Beetz, 2012). Research has also suggested experiences with animals are associated with reduced isolation due to increased social interactions and decreased sensations of loneliness (Banks MR, 2002). As well as these, there is research indicating documented facilitation of mindful present-focused experiences when animals are involved in the therapeutic journey (O’Haire ME, 2015) (N, 2008). In recent research into emerging trends and interventions for treating trauma-related conditions such as posttraumatic stress disorder (PTSD), EAP was nominated as a popular, novel and/or emerging intervention (Metcalf O, 2016).

Along with the benefits described above, EAP specifically, is also suggested to help support a stronger relationship between the therapist, support adaptation skills, promote resiliency, and positive attachment (Kendall, 2015). For trauma clients, this modality is especially helpful in supporting improved mind-body connections, supporting empathy development (M, 2010), building safety via the absence of interpersonal triggers, and the enhanced self-regulation found via the co-regulation offered by the horse-human interactions. One study into the use of EAP for complex trauma clients highlighted in depth the mind-body dysregulation prevalent in trauma cases.A 2018 study published in the Journal of Child & Adolescent Trauma introduces the notion of Equine Facilitated Therapy for Complex Trauma (EFT-CT).

This study documented in detail the use of EAP in supporting youth with complex trauma. The outcomes of this study demonstrated considerable favourable results for participants, including decreased symptoms associated with trauma, improved interpersonal skills, communication strategies, and overall social functioning. Improved internal regulation and organisation, higher-order cognitive functioning (e.g., accessing language, decision making) and the development of positive coping skills, increased capacity to recognise and respect boundaries and improved somatic experiencing (Naste T. P., 2018). Notwithstanding the encouraging outcomes observed in research concerning the effectiveness of EAP and AAT for trauma survivors, the current literature exhibits a notable lack of detailed information pertaining to specific modalities.

Consequently, the replicability of existing studies is impeded, and the standardisation of existing treatments remains unaddressed. Moreover, there is a lack of uniformity across the diverse array of available approaches, and several fail to offer a cohesive set of generalisable techniques, thereby constraining the dissemination of effective treatments. There is also a current lack of standardisation of therapeutic framework integration – thus making measuring in a standardised way the effectiveness of the interventions challenging.

Trauma-Informed/Focused Yoga

A growing body of people who have experienced trauma are either intentionally or unintentionally tuning to Yoga for relief of their distress and symptoms (Jackson, 2014). No single definition of Yoga exists, but it is believed to have been practised for some 5000 years, with some 20 different types being practised in the United States alone. However, Yoga for trauma is quite different to traditional Yoga. Traditional Yoga involves a series of poses or holds guided by an instructor who often moves about the class, supporting participants to move their bodies into place. TIY, however, uses more suggestions of movement and leverages invitational language to support participants in feeling in control and safe in choosing how deeply they participate in each movement; there is little to no touch, and the focus is on the participant having authority in each moment (Motta, 2020).

Recently, a program called iRest has gained momentum with the US Department of Veterans Affairs; this program is considered a modern adaption of Yoga Nidra (Miller, 2015). It is a well-researched approach with ten underpinning themes guiding the participant’s experience. The exact reasons why TIY is so effective are not entirely clear. However, there are many compelling theories. One of the most supported is that what we refer to as the mind and the body are inextricably linked. This concept is supported by a great deal of research (Pert, 2020). As such, if the body can be moved in a way that releases stress and tension, then there is a good chance this will impact the mind in similar calming or soothing ways. Beyond this, the critical elements of Yoga, such as self-regulation and self and bodily awareness, would not doubt helpful also. Many of the better-known names in trauma research and literature, such as Bessel Van der Kolk, also call out the value of Pilates and Yoga in supporting trauma (Van der Kolk, 2015).

Psychedelic Therapy

The use of psychedelics, namely Psilocybin and MDMA – 3,4-methylenedioxy-methamphetamine (MDMA), in the therapeutic environment for the treatment of mental health conditions has been part of the mental health landscape for many years, Its use was more common prior to the 1970’s/19080’s when it was up scheduled and criminalised, however despite this, organisation like the Multidisciplinary Association for Psychedelic Studies has continued to advocate and lobby for its use and continued extensive research into its effectiveness. In many countries around the world, these products are still heavily controlled or criminalised.

However, Australia has this year (June 2023) down-scheduled both MDMA and Psilocybin for use in treating PTSD and treatment-resistant depression (Lu, 2023). Research into the use of MDMA argues that MDMA-assisted therapy is more effective than psychotherapy alone in treating patients with severe PTSD (Mitchell, 2021). It is also suggested that with the influence of MDMA, clients became able to view or access previously avoided or repressed memories without the anxiety and avoidance that typically occurs (Motta, 2020). Psilocybin has been shown to support reductions in anxiety, depression, hopelessness, demoralisation, and death anxiety sustained at the first and second follow-ups in distressed life threatened cancer patients (Agin- Liebes, 2020).Despite the recent progress in the legalisation of these options and the extensive promising research, they are still heavily burdened by a negative social stigma, limited practitioner access and face the risk of being abused as party drugs in the wrong hands. These compounding factors will inevitably slow their social uptake and limit their wider use by clients.


The universal sentiment in the research observed is that these approaches have favourable impacts in supporting trauma clients. However, the studies are small, and the lack of standardisation of approaches. This makes drawing conclusive parallels and observations of efficacy challenging (Naste, 2018) (Lentini, 2015). This review has explored several novel and alternative therapeutic approaches to support trauma clients. The rise in popularity and availability of these innovative interventions, reflects a shift towards more experiential and body-centred methods of addressing trauma-related conditions. Incorporating animals, particularly horses, as agents of change within therapeutic contexts has gained attention for its potential to create unique and transformative client experiences.

Equine-assisted therapy has demonstrated effectiveness in facilitating mind-body connections, promoting empathy development, building safety through non-triggering interactions, and enhancing self-regulation through co-regulation mechanisms. Notably, Equine Facilitated Therapy for Complex Trauma (EFT-CT) has shown promising outcomes, indicating reduced trauma symptoms, improved interpersonal skills, enhanced cognitive functioning, and the development of positive coping strategies.Trauma-informed/Focused Yoga (TIY) offers an alternative avenue for individuals seeking relief from trauma-related distress. TIY acknowledges the interconnectedness of the mind and body in the healing process by emphasising movement, self-regulation, and somatic awareness. The gentle and invitational approach of TIY allows participants to control their level of engagement, fostering a sense of safety and empowerment. While historically marginalised due to legal and social constraints, psychedelic therapy has recently regained attention as a potentially transformative approach.

Substances like MDMA and Psilocybin have shown promise in assisting clients in revisiting and processing traumatic memories with reduced anxiety, leading to significant improvements in conditions like PTSD and treatment-resistant depression. Despite the promising research and recent legal advancements, the stigma and potential for misuse still pose challenges to the widespread adoption of psychedelic therapy. Overall, these novel therapeutic approaches challenge traditional trauma treatment methods by focusing on embodied experiences, sensory integration, and unique avenues for healing. The research discussed in this review highlights the potential of these interventions to provide profound and lasting benefits to trauma survivors.

However, it is evident that further research is needed to establish standardised protocols, assess long-term effectiveness, and address the potential barriers to wider acceptance and implementation. As the field of trauma therapy continues to evolve, these innovative approaches hold the promise of expanding the therapeutic landscape and enhancing the well-being of trauma clients.     


Agin- Liebes, G. M. (2020). Long-term follow-up of psilocybin-assisted psychotherapy for psychiatric and existential distress in patients with life-threatening cancer. Journal of Psychopharmacology.

Banks MR, B. W. (2002). The effects of animal-assisted therapy on loneliness in an elderly population in long-term care facilities. The Journals of Gerontology. Series A, Biological Sciences and Medical Sciences.

Beetz, A. U.-M. (2012). Psychosocial and psychophysiological effects of human-animal interactions: The possible role of oxytocin. Frontiers in Psychology.

Grabbe, L. &.-K. (2018). The trauma resiliency model: a “bottom-up” intervention for trauma psychotherapy. Journal of the American Psychiatric Nurses Association, 24(, 6–84.

Jackson, K. (2014). Treatments for veterans with PTSD- Outside the traditional toolbox. Social Work Today.

Kendall, E. M. (2015). A systematic review of the efficacy of equine-assisted interventions on psychological outcomes. European Journal of Psychotherapy & Counselling, 1-23.

Lentini, J. K. (2015). Equine-Facilitated Psychotherapy With Children and Adolescents: An Update and Literature Review. Journal of Creativity in Mental Health.

Lu, D. (2023, June 1). Australian psychiatrists can now prescribe MDMA and psilocybin: who can access them, and how do they work? Retrieved from The Guardian:

M, K. (2010). Gestalt equine psychotherapy. Gestalt Journal of Australia and New Zealand.

Metcalf O, V. T. (2016). Efficacy of fifteen emerging interventions for the treatment of posttraumatic stress disorder: A systematic review. Journal of Traumatic Stress.

Miller, R. C. (2015). The iRest program for healing PTSD – A proven effective approach to using yoga nidra meditation and deep relaxation techniques to overcome trauma. Oakland CA: New Harbinger.

Mitchell, J. B. (2021). MDMA-assisted therapy for severe PTSD: a randomised, double-blind, placebo-controlled phase 3 study. Natural Medicine.

Motta, R. W. (2020). Alternative Therapies for PTSD: The Science of Mind-Body Treatments,. American Psychological Association.

N, P.-P. (2008). Animal-assisted therapy with children suffering from insecure attachment due to abuse and neglect: A method to lower the risk of intergenerational transmission of abuse?,. Clinical Child Psychology and Psychiatry,.

Naste, T. P. (2018). Equine Facilitated Therapy for Complex Trauma (EFT-CT). Journal of Child & Adolescent Trauma., 289-303.Naste, T. P. (2018). Equine Facilitated Therapy for Complex Trauma (EFT-CT). Journal of Child & Adolescent Trauma.

O’Haire ME, G. N. (2015). Animal-assisted intervention for trauma: A systematic literature review. Frontiers in Psychology,.Pert, C. B. (2020). Alternative Therapies for PTSD: The Science of Mind-Body Treatments. American Psychological Association.

Trotter, K. (2012). Harnessing the power of equine-assisted counselling: Adding animal-assisted therapy to your practice. New York: Routledge.

Trotter, K. C. (2008). A Comparative Study of the Efficacy of Group Equine Assisted Counseling With At-Risk Children and Adolescents. Journal of Creativity in Mental Health.

Van der Kolk, B. A. (2015). The body keeps the score: brain, mind, and body in the healing of trauma. Penguin Books.