In this study, we included a convenience sample of all patients who underwent hippotherapy. It consisted of 16 patients (three women and 13 men) with paranoid schizophrenia, and 9 patients (4 women and 5 men) with acute and transient psychotic disorders. Participating patients were in the age range from 20 to 57 years with no previous experience with horses. At the time of participation Hippotherapy, the patients were hospitalized in a psychiatric hospital and therapeutic classes were indicated by their physician after the acute phase of their mental illness. In the acute phase of mental illness, hippotherapy is contraindicated and practically impossible, because it is associated with a high risk of unpredictable behavior of the patient (
Patients attended hippotherapy on a regular basis two days a week for a period of three weeks. The therapeutic unit lasted 90 minutes and took the form of group therapy. Each therapeutic unit was led by health care professionals and had always been very well prepared in advance (depending on the patient’s individual plans and set targets). The study was approved by the ethical commission, hospital of Havlíckuv Brod, Czech Republic.
Hippotherapy in psychiatry is not concerned only about the patient sitting on a horse and the horseback movement influencing the physical condition of the patient, his functional and postural disorders. We are concerned with positive effects on the mental state of a patient and use mainly contact with the horse, work with the horse from the ground and to a lesser extent, riding on horseback in a saddle or with handles. We put emphasis on enjoyment and processing, social communication and focus on the development of cognitive and executive functions. Therapeutic units are organized as a group therapy with each group having 6 patients. Each unit is started by a group session and ended by reflection of the whole group in a therapy room. During the therapeutic activity, the patients work with a horse in two groups of three and have the same horse throughout the whole hippotherapy treatment.
During those six therapeutic units, patients initially get familiar with the environment of stables with horses and make first contact with a health care worker. In the next lesson, we use therapeutic technique for cleaning horses and general care of the horses. Among the key therapeutic activities is work with the horse from the ground and work with nonverbal communication. This may produce a large amount of valuable therapeutic material, which under the supervision of experienced medical staff may be worked out, consciously adopted and used in the personal life of the patient. During the interaction of the patient with the horse, we can monitor: activity vs. passivity, submissiveness vs. dominance, certainty vs. uncertainty, aggression vs. affiliation, working with space, time and boundaries, stance and posture, work with pressure and relaxation.
In the work with horse from the ground we start from the observed social behavior of horses in the herd. We are talking about interspecies communication between horse and man, where man learns horse’s body language, especially with non-verbal communication. There is an effort to create a natural partnership between the horse and the man, this can only be achieved with mutual trust. It requires mindfulness training and good knowledge of hippology by humans (
Other therapeutic activity in hippotherapy includes horse riding. We include this activity only after the patient knows his horse well, thus increasing the therapeutic effect and minimizing patient’s and horse’s discomfort. Some patients are from the beginning scared of the horse and others do not respect the horse, without required empathy. Opportunity to learn his horse and establish a relationship with him results in needed self-confidence, respect, and relaxation for the patient.
We defined well-being as a state that has five characteristics - excellent mood, the feeling of total relaxation, no sense of fear, a willingness to establish contacts, and inclination to communicate. Patients assessed their current well-being by completing a form where each of these five characteristics had a value from zero to ten. The best well-being was present with the score 10 for mood, contact and communication, and with the score 0 for tension and fear. For the analysis of the scores, tension and fear were reversed scored so that the total scores could range from 0 to 50. This scale had very good reliability with Cochran alpha from 0.73 to 0.83 for different treatments. Patients were asked to fill out a form before starting treatment and after its completion.
3.2. Statistical Analysis
For this study, we analyzed the state of well-being before and after six hippotherapy treatments. The overall effect was analyzed by general linear modeling (GLM) with repeated values. We Also compared the scores for each application by ANOVA and the changes of individual characteristics by the paired t-test. To control for multiple comparisons, we considered significant difference only for P < 0.01. For these analyses we divided patients into two groups: 1, patients with diagnosis of paranoid and undifferentiated schizophrenia and; 2, patients with other diagnoses including acute polymorphic psychotic disorder with symptoms of schizophrenia, acute psychotic disorder with a prevalence of schizoaffective disorder and delusions.