Horse Therapy Shows Real Promise in Psychiatry, but the Evidence Remains Shaky

Horses have long occupied a peculiar place in the human imagination, but in recent decades they have also quietly entered the clinic. Equine-assisted services, or EAS, now appear in psychosocial rehabilitation programs around the world as a complement to pharmacological treatment for psychiatric patients. A new systematic review published in BMC Complementary Medicine and Therapies has taken the most comprehensive look yet at what this animal-based therapy actually delivers, and the results are both encouraging and cautionary in almost equal measure.

The review, conducted by Laura Desmet, Nelly Ledoux, and Anne Héron of the Centre Hospitalier Victor Jousselin in Dreux, France, and Université Paris Cité, followed the PRISMA guidelines for systematic evidence synthesis. The team searched four major databases, Embase, EBSCOhost, PubMed, and Web of Science, for records published up to February 10, 2026. Their inclusion criteria were strict: only primary research articles written in English or French, targeting populations with diagnosed psychiatric conditions, involving live horses, and reporting qualitative or quantitative biopsychosocial outcomes made the cut. Reviews and meta-analyses were excluded to keep the analysis anchored in original data.

The scale of the resulting evidence base is striking. Out of 888 records initially identified, 107 articles were included, covering a combined 3,097 participants, roughly 65 percent of whom were male. The literature was dominated by American research teams, who produced 49 percent of the studies, followed by European teams at 35 percent. In terms of study design, 40 percent were longitudinal quantitative studies, 17 percent were randomized controlled trials, and 12 percent were non-randomized trials, while 22 percent were purely qualitative and 9 percent used mixed methods. The populations studied skewed young: children and adolescents accounted for 55 percent of participants, adults for 24 percent, and veterans for 21 percent.

The diagnostic landscape of the included studies is equally revealing. Neurodevelopmental disorders were the most common target, appearing in 43 percent of the interventions, with trauma-related disorders close behind at 25 percent. This distribution reflects a broader trend in complementary and animal-assisted therapies, which have found their most enthusiastic adoption in populations where conventional treatments often leave functional gaps. Most programs, 78 percent of them, combined mounted riding with unmounted activities such as grooming, leading, and ground-based exercises, reflecting the idea that the therapeutic relationship with the horse matters as much as the physical act of riding.

What did the evidence show? On the surface, remarkably positive results. Qualitative studies, which capture participants’ lived experiences through interviews and observational data, reported positive outcomes in 99 percent of cases. Quantitative studies, which rely on standardized measurements and statistical testing, were positive in 69 percent of cases. Across both types of evidence, EAS demonstrated substantial benefits for clinical symptoms, quality of life, and biopsychosocial skills. The largest improvements were observed in symptom severity, social skills, and motor skills among people with neurodevelopmental disorders, suggesting that the structured, embodied, and emotionally engaging nature of horse-human interaction may be particularly well suited to these populations.

The mechanisms behind these effects are likely multifactorial. Horses are social, highly attentive, and emotionally sensitive animals, capable of responding to subtle human cues in posture, voice, and affect. For patients with psychiatric conditions, this creates a uniquely demanding but nonjudgmental social partner. Caring for and riding a horse requires attention, emotional regulation, communication, and trust, all of which are core therapeutic targets across a wide range of diagnoses. The physical dimension adds further layers: the rhythmic movement of riding engages motor coordination and balance, while the outdoor, activity-based setting contrasts sharply with the passive experience of many conventional treatments.

Yet the review’s authors are careful not to let enthusiasm outrun the data. Overall methodological quality across the 107 studies was rated as low when assessed with the Mixed Methods Appraisal Tool. The field is plagued by widespread biases, small sample sizes, and a frequent lack of control groups or statistical testing. Many studies relied on before-and-after designs without comparison conditions, making it impossible to separate the specific effects of equine interaction from placebo effects, novelty, physical activity, or simply spending structured time with attentive adults. The 30-point gap between positive qualitative and positive quantitative results hints at this problem: subjective experiences are almost uniformly glowing, but objective measurements are more tempered.

Another significant weakness the review exposes is the absence of standardization. Programs varied widely in terminology, content, and duration, making it difficult to compare results across studies or to identify which specific components of EAS drive which outcomes. The umbrella term equine-assisted services covers everything from therapeutic horseback riding taught by certified instructors to ground-based psychotherapy sessions conducted alongside a horse, and these are not interchangeable interventions. Until the field agrees on common definitions, protocols, and dosage parameters, attempts to replicate findings or to translate them into clinical guidelines will remain frustratingly imprecise.

The authors’ conclusion is measured but clear: EAS represents a promising and innovative complementary therapy in psychiatry, one that deserves a place in the broader conversation about psychosocial rehabilitation. But promise is not proof. The review explicitly calls for standardized programs and more rigorous research, particularly randomized controlled trials with high levels of evidence, to scientifically validate the effectiveness of EAS on clinical symptoms and psychosocial skills. The study was registered prospectively on PROSPERO under registration number CRD42021246614, and the authors declared no competing interests, adding credibility to their assessment.

For now, the image of a troubled child finding calm in the presence of a horse, or a veteran rebuilding trust through the demands of horsemanship, remains supported more by lived experience than by gold-standard trials. This review does not diminish that experience; it simply insists that the next chapter of equine-assisted therapy be written with the same scientific rigor applied to any other psychiatric intervention. With more than 3,000 participants already studied and nearly seven in ten quantitative results pointing in the right direction, the field has earned its chance to prove itself properly.

Subject of Research: Effects of equine-assisted services on biopsychosocial outcomes in psychiatric disorders

Article Title: Effects of equine-assisted services in psychiatric disorders: a systematic review

Article References: Desmet, L., Ledoux, N., & Héron, A. (2026). Effects of equine-assisted services in psychiatric disorders: a systematic review. BMC Complementary Medicine and Therapies. https://doi.org/10.1186/s12906-026-05545-6

Image Credits: AI Generated

DOI: 10.1186/s12906-026-05545-6

Keywords: equine-assisted services, psychiatry, systematic review, biopsychosocial outcomes, neurodevelopmental disorders, trauma-related disorders, complementary therapy, randomized controlled trials, psychosocial rehabilitation, animal-assisted therapy, clinical symptoms, methodological quality