- ICH GCP
- US Clinical Trials Registry
- Clinical Trial NCT04159506
Feasibility and Acceptability Off The Equus Effect
Feasibility and Acceptability of The Equus Effect: A Small Randomized Controlled Pilot Study of an Equine-facilitated Therapy
Study Overview
Status
Conditions
Intervention / Treatment
Detailed 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.
Study Type
Enrollment (Actual)
Phase
- Not Applicable
Contacts and Locations
Study Contact
- Name: Steve Martino, PhD
- Phone Number: 2468 (203) 932-5711
- Email: Steve.Martino@va.gov
Study Contact Backup
- Name: Suzanne Decker, PhD
- Phone Number: 3153 (203) 932-5711
- Email: suzanne.decker@va.gov
Study Locations
-
-
Connecticut
-
West Haven, Connecticut, United States, 06516-2770
- VA Connecticut Healthcare System West Haven Campus, West Haven, CT
-
-
Participation Criteria
Eligibility Criteria
Ages Eligible for Study
Accepts Healthy Volunteers
Description
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 Plan
How is the study designed?
Design Details
- Primary Purpose: Treatment
- Allocation: Randomized
- Interventional Model: Parallel Assignment
- Masking: Single
Arms and Interventions
Participant Group / Arm |
Intervention / Treatment |
---|---|
Experimental: The Equus Effect (TEE)
TEE is a 4-session intervention.
Each session is 4 hours and includes: 1) mindfulness-based activities; 2) didactics about emotion regulation and interpersonal skills; and 3) experiential learning activities with horses that provide opportunities to practice emotion regulation and interpersonal skills.
At the end of each session, Veterans debrief about what they learned and identify how they might apply this knowledge to manage their mental health concerns and function better socially.
|
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.
|
Active Comparator: Attention Control (AC)
AC will exclude equine-related activities or discussions but maintain mindfulness-based activities, emotion regulation and interpersonal skills didactics, and experiential learning activities with between-session application.
Instead of experiential equine activities, AC will rely on team-building activities, which aim to enhance social relations by involving participants in collaborative tasks and providing opportunities for emotion regulation and interpersonal skills practice.
|
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.
|
What is the study measuring?
Primary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
Social Adjustment Scale-Self Report (SAS-SR)
Time Frame: 16-weeks post-randomization
|
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
|
Inventory of Interpersonal Problems-32 (IIP-32)
Time Frame: 16-weeks post-randomization
|
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 Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
Difficulties in Emotion Regulation Scale (DERS)
Time Frame: 16-weeks post-randomization
|
DERS scores range from 36-180, with higher scores indicating more emotion dysregulation.
|
16-weeks post-randomization
|
Collaborators and Investigators
Collaborators
Investigators
- Principal Investigator: Steve Martino, PhD, VA Connecticut Healthcare System West Haven Campus, West Haven, CT
Study record dates
Study Major Dates
Study Start (Actual)
Primary Completion (Actual)
Study Completion (Actual)
Study Registration Dates
First Submitted
First Submitted That Met QC Criteria
First Posted (Actual)
Study Record Updates
Last Update Posted (Estimated)
Last Update Submitted That Met QC Criteria
Last Verified
More Information
Terms related to this study
Other Study ID Numbers
- D3312-P
- 02342-003 (Other Grant/Funding Number: VA Connecticut Healthcare System)
Plan for Individual participant data (IPD)
Plan to Share Individual Participant Data (IPD)?
IPD Plan Description
IPD Sharing Time Frame
IPD Sharing Access Criteria
IPD Sharing Supporting Information Type
- STUDY_PROTOCOL
- SAP
- ICF
Drug and device information, study documents
Studies a U.S. FDA-regulated drug product
Studies a U.S. FDA-regulated device product
product manufactured in and exported from the U.S.
This information was retrieved directly from the website clinicaltrials.gov without any changes. If you have any requests to change, remove or update your study details, please contact register@clinicaltrials.gov. As soon as a change is implemented on clinicaltrials.gov, this will be updated automatically on our website as well.
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