Clinical Trials Logo

Clinical Trial Details — Status: Completed

Administrative data

NCT number NCT04159506
Other study ID # D3312-P
Secondary ID 02342-003
Status Completed
Phase N/A
First received
Last updated
Start date June 20, 2022
Est. completion date July 30, 2023

Study information

Verified date October 2023
Source VA Office of Research and Development
Contact n/a
Is FDA regulated No
Health authority
Study type Interventional

Clinical Trial Summary

The VA Office of Patient Centered Care and Cultural Transformation's Whole Health initiative promotes the use of complementary and integrative health (CIH) approaches with traditional medical care to help Veterans achieve meaningful life goals and improved functioning. Equine-facilitated therapy (EFT), an animal-assisted form of CIH, is increasingly available to Veterans within the VA. Horses have extreme sensitivity to the emotional states, behaviors, and intentions of their herds and other animals, including humans, and mirror body language and respond to subtle nonverbal cues. As such, horses have the capacity to provide immediate feedback about a people's emotional and behavioral states. This capacity affords people opportunities to become more emotionally self-aware and, with guidance from EFT facilitators, learn how to regulate emotions and become calmer and more patient, attentive, and confident to gain the horses' cooperation. Participants in EFT are encouraged to apply what they have learned from their equine experiences to their relationships with people. Since high quality social functioning depends on effective regulation of one's emotions, EFT offers a novel way in which to improve the social functioning of Veterans with mental health concerns. VAs are increasingly embracing EFT as a CIH. However, carefully conducted, scientifically valid research about EFT has not been conducted. Existing peer-reviewed research about EFT for mental health is very limited, of poor methodological quality, and not focused on adults. None of it targets social functioning as a main outcome. This small randomized controlled pilot study proposes to examine an innovative EFT called The Equus Effect (TEE) as a complement to Veterans' existing VA mental health services to improve social functioning. TEE aims to improve Veterans' social functioning by developing their emotion regulation and interpersonal skills through therapeutic interactions with horses. This study will evaluate 1) the feasibility of study procedures, assessments, and outcomes, 2) the fidelity of experimental and control interventions, and 3) the acceptability of the interventions to Veterans and their mental health clinicians using mixed quantitative-qualitative methods. The study has the potential to lend initial credibility to the therapeutic claims of this increasingly popular CIH.


Description:

**Please note that as a consequence of the COVID-19 pandemic, and after consultation with the appropriate research oversight, regulatory and monitoring entities, screening and enrollment was placed on temporary administrative hold from 04/30/2020 - 3/31/2022. Experimental and comparator conditions had to occur in person, in groups, and with van transportation to and from the intervention site. The study resumed preparations for the pilot trial 4/1/2022 and began participant screening and recruitment 6/15/2022.** The VA Office of Patient Centered Care and Cultural Transformation launched the Whole Health initiative to transform the Veterans Health Administration into a healthcare system in which providers and Veterans develop holistic, personalized, proactive, patient-driven healthcare plans that center on realizing meaningful life goals and improved functioning. Whole Health promotes the use of complementary and integrative health (CIH) approaches with traditional medical care to achieve these aims - consistent with psychosocial rehabilitation's emphasis on recovery-oriented, community-based functional outcomes. Equine-facilitated therapy (EFT), an animal-assisted form of CIH, is increasingly available to Veterans within the VA. Horses are prey animals with extreme sensitivity to the emotional states, behaviors, and intentions of their herds and other animals, including humans, and mirror body language and respond to subtle nonverbal cues. As such, horses have the capacity to provide immediate feedback about a person's emotional and behavioral states (e.g., pinning ears back when someone is angry or relaxing them forward when a person is calm). As a person interacts with horses, this capacity affords him or her an opportunity to become more emotionally self-aware and, with guidance from EFT facilitators, learn how to regulate emotions and become calmer and more patient, attentive, and confident to gain the horses' cooperation. With EFT, emotion regulation is the key mechanism for social interaction with horses, and participants in EFT are encouraged to apply what they have learned from their equine experiences to their relationships with people. Since high quality social functioning depends on effective regulation of one's emotions, EFT offers a novel way in which to improve the social functioning of Veterans with mental health concerns. In fact, in the VA, EFT has been used to address a variety of diagnostic issues commonly experience by Veterans, including PTSD, depression, anxiety, substance use and eating disorders. However, peer-reviewed published quantitative and qualitative research on EFT as a CIH for mental health is very limited, of poor methodological quality, and focused on school-age children and adolescents, not adults. None of it targets social functioning as a main outcome. Given VAs increasing embrace of EFT as a CIH, carefully conducted research that aims to systematically develop and study EFT for Veterans is sorely needed to ensure that EFT is feasible to study, acceptable to Veterans and clinicians, and clinically promising. The investigators propose to pilot test an innovative EFT called The Equus Effect (TEE) as a complement to Veterans' existing VA mental health services to improve social functioning. TEE aims to improve Veterans' social functioning by developing their emotion regulation and interpersonal skills through therapeutic interactions with horses. In line with recommendations for pilot investigations, the investigators will conduct a randomized pilot study to 1) evaluate the feasibility of study procedures, assessments, and outcomes, 2) demonstrate experimental and control interventions can be delivered with fidelity, and 3) examine the acceptability of the interventions. To accomplish these goals, the investigators will enroll a transdiagnostic cohort of 40 Veterans involved in VA mental health services with social dysfunction and emotion dysregulation. Participants will be randomized to receive either 1) TEE or 2) attention control (AC), both group interventions. Each week, the 4-session TEE will include 1) mindfulness activities, 2) emotion regulation and interpersonal skills education, 3) experiential activities with horses incorporating opportunities to develop emotion regulation and interpersonal skills, and 4) between-session application of lessons learned from the equine activities. AC will have similar elements without equine features. Intervention outcomes will be measured at 4- and 16-weeks post randomization. Specifically, using mixed quantitative-qualitative methods, the investigators aim to: Aim 1: Determine the feasibility of recruitment, randomization, retention, assessment procedures, and implementation of TEE and AC. Hypothesis: Rates of recruitment will be at least 8 participants per month, and Veterans randomized to TEE will attend intervention sessions, remain in the study, and experience clinically significant changes in social functioning and emotion dysregulation at rates equal to or superior to AC. Aim 2: Demonstrate TEE and AC can be delivered with fidelity. Hypothesis: Facilitators will deliver each intervention consistently and as intended across sessions. Aim 3: Establish acceptability of TEE and AC by assessing intervention credibility and satisfaction and the usefulness of TEE as a complementary mental health intervention using mixed quantitative-qualitative methods. Hypothesis: Veterans will find TEE and AC credible and satisfying and Veterans and their mental health clinicians will qualitatively report the therapeutic benefits of TEE as a CIH for mental health treatment.


Recruitment information / eligibility

Status Completed
Enrollment 31
Est. completion date July 30, 2023
Est. primary completion date July 30, 2023
Accepts healthy volunteers No
Gender All
Age group 18 Years and older
Eligibility Inclusion Criteria: - seeing a VA Connecticut mental health clinician at least 3 times in the past 3 months with intent to remain in treatment during study enrollment; - age 18 and over; - social dysfunction (score > 2.5 on the Social Adjustment Scale-Self Report (SAS-SR) and > 1.5 on Inventory of Interpersonal Problems-32 (IIP-32); - emotion dysregulation (score > 95 on the Difficulties in Emotion Regulation Scale (DERS); - sufficient mobility to participate in study procedures, as determined by PI; - consent to all study procedures, including audio recording of TEE and AC sessions. Exclusion Criteria: - psychotic disorder per self-report and verified in medical record or as determined by the Mini-International Neuropsychiatric Interview (MINI); - acute suicidality; - inability to read English or communicate in spoken English; - anticipated unavailability to the study during the next 20 weeks; - participation in any equine-facilitated therapy in the past 24 weeks; - unavailability of a landline or cellular telephone.

Study Design


Related Conditions & MeSH terms


Intervention

Behavioral:
mindfulness, emotion didactics, interpersonal skills, experiential learning
mindfulness interventions involve body scanning, deep breathing, and muscle relaxation. Emotion didactics focus on emotion recognition and regulation. Interpersonal skill development looks at how to use emotion regulation to improve social functioning. Experiential learning means learning either through interactions with horses or via team-building activities.

Locations

Country Name City State
United States VA Connecticut Healthcare System West Haven Campus, West Haven, CT West Haven Connecticut

Sponsors (2)

Lead Sponsor Collaborator
VA Office of Research and Development VA Connecticut Healthcare System

Country where clinical trial is conducted

United States, 

Outcome

Type Measure Description Time frame Safety issue
Primary Social Adjustment Scale-Self Report (SAS-SR) SAS-SR details social functioning in a range of role areas (e.g., work, social and leisure, family); the overall SAS-SR score is 1 (no impairment), to 5 (highest impairment). 16-weeks post-randomization
Primary Inventory of Interpersonal Problems-32 (IIP-32) IIP-32 taps people's interpersonal difficulties across role areas; the IIP-32 total score is 0 (no difficulties), to 4 (extreme difficulties). 16-weeks post-randomization
Secondary Difficulties in Emotion Regulation Scale (DERS) DERS scores range from 36-180, with higher scores indicating more emotion dysregulation. 16-weeks post-randomization
See also
  Status Clinical Trial Phase
Completed NCT03824353 - Social Intelligence Training in Midlife Phase 2
Not yet recruiting NCT04037579 - Protocol for a Non-randomized Survey in Down Syndrome People Who Practice Sports. Self and Observers´ Perception.
Completed NCT00886171 - Effects of Social Skills and Physical Activity Training on Recreational Activities in Youth N/A
Completed NCT03488927 - Development and Pilot Trial of an Intervention to Reduce Disclosure Recipients Negative Social Reactions and Victims Psychological Distress and Problem Drinking N/A
Completed NCT04478240 - Automating Peer Learning to Reduce Alcohol Use and Related Deviant Behavior in Secondary School N/A
Completed NCT05162729 - Working Memory and Social-emotional Training for Preschoolers at Risk of ADHD N/A
Active, not recruiting NCT04656990 - SKIPping With PAX: An Integrated Gross Motor and Social-Emotional Skill Intervention N/A
Recruiting NCT06101225 - Effects of a Relaxation and Guided Imagery Intervention in School Context N/A
Recruiting NCT04005794 - Virtual Reality Training for Social Skills in Schizophrenia - Comparison With Cognitive Training N/A
Completed NCT06031701 - Neuro-psychosocial Teleassistance for Neuromuscular Diseases N/A
Enrolling by invitation NCT06440460 - Intergenerational Study of War-Affected Youth
Recruiting NCT03873831 - Effects of Therapy Dogs on Social Behavior in Group Social Skills Instruction With Children With Autism N/A
Recruiting NCT05718427 - Effect of ASI on Sensory, Motor, Cognitive, Behavioral Skills and Social Participation in Children With ADHD N/A
Recruiting NCT05791825 - Evaluation of the CHIME Intervention for Improving Early Head Start/Head Start Educator Well-being N/A
Recruiting NCT06270160 - Livelihoods Intervention With Urban Refugee Youth in Kampala, Uganda N/A
Completed NCT03622138 - The Impact Integrated Data System for Quality and Outcomes Tracking of Prevention Programs N/A
Terminated NCT03968081 - Exploration of Theory of Mind in a Situation of Social Rejection in Borderline Personality Disorder N/A
Completed NCT03336190 - Blue Star Cares: Innovative Approaches to Helping Military-Connected Caregivers N/A
Completed NCT03625297 - Shelter Cat Adoption in Families of Children With Autism (Feline Friends) N/A
Recruiting NCT05077371 - Peer Support Program in Cancer Patients Elkar Laguntza N/A