Equine-assisted therapy has a longer history in mental health than many people realise. Programmes have grown rapidly over the past two decades, and equine work is now offered for trauma, mood disorders, addictions, autism, and — more recently — schizophrenia and psychosis. The evidence in schizophrenia specifically is small but emerging.
Equine-assisted therapy in schizophrenia is a structured therapeutic intervention involving ground-based work with horses, delivered by a licensed mental health professional alongside an equine specialist, supporting emotional regulation, social engagement, and recovery.
What equine-assisted therapy is
The terminology has evolved over the years. The most current umbrella terms include equine-assisted services (EAS), equine-assisted psychotherapy (EAP), and equine-assisted learning. Two of the most established models in mental health are:
- EAGALA (Equine Assisted Growth and Learning Association) — a model that always pairs a licensed mental health professional with a credentialed equine specialist, conducted entirely on the ground (no riding), with the horses as active partners in the process.
- PATH International — a broader credentialing body covering equine-assisted services and therapeutic riding for a range of conditions.
Most equine-assisted psychotherapy work in schizophrenia is ground-based, not riding-based. Sessions take place in a paddock or arena. Activities might include observing horses, leading them, grooming, building obstacle courses, or simply being present with them. The horse's responses become material for reflection and conversation with the therapist.
Why horses?
Horses are large, prey-animal mammals with acute sensitivity to body language and emotional state. They tend to respond to people in ways that mirror what is happening internally — a person who is hiding distress, performing calm, or genuinely grounded will get visibly different responses from a horse. This makes the horse a kind of biofeedback partner, gently surfacing what is present without judgment or interpretation.
For people with schizophrenia, several aspects fit the recovery process:
- Working outdoors, with animals, in a non-clinical setting reduces the institutional feel of treatment.
- The pace is slower than verbal therapy and matches the rhythms of negative-symptom recovery.
- The horse provides immediate, non-verbal feedback — useful for people who find direct social interaction effortful.
- Caring for and connecting with a large animal can rebuild a sense of agency and competence.
What the evidence shows
The evidence base for equine-assisted therapy in schizophrenia is small. A few pilot studies and case series have reported improvements in negative symptoms, social functioning, and self-esteem in people with schizophrenia. A 2014 small randomised trial by Corring and colleagues in Canada showed signal for psychosocial improvement in adults with serious mental illness using an equine programme. Reviews like those from the Horses and Humans Research Foundation note positive but methodologically limited findings, with calls for larger and more rigorous trials.
Major guidelines like NICE do not specifically recommend equine-assisted therapy for schizophrenia. The intervention is best understood as an adjunct, with promising but not definitive evidence.
What a session looks like
A typical EAGALA-model session involves the participant, a licensed mental health professional, an equine specialist, and one or more horses, in a paddock or arena. The therapist may set up an activity — for example, a "lead the horse through a course" task, or a "build a structure that represents your week" task with props. The participant works with the horses, who respond. The therapist observes and reflects back what was noticed, opening conversation about what came up.
No riding is involved in standard EAP. There is no requirement for horse experience or skill. Many participants are wary at first; pacing is gentle.
Reputable programmes screen for safety carefully — no large-animal work in active acute psychosis where unpredictability could be dangerous. Helmets, boundaries, and trained equine specialists are standard. Tell programme staff about fears, allergies, or relevant trauma.
Therapeutic riding vs equine-assisted psychotherapy
Therapeutic riding programmes — where participants learn to ride and interact with horses — are common and have benefits for general wellbeing, physical fitness, and confidence. They are different from equine-assisted psychotherapy, which is a goal-directed mental health intervention delivered by a licensed clinician. For schizophrenia care, EAP is the more relevant model.
Who tends to do well
- People with prominent negative symptoms who appreciate non-verbal, embodied work
- People who like animals and outdoor settings
- People in stable recovery looking for something distinct from clinical group therapy
- People with co-occurring trauma where safe embodied work is part of treatment
Who may find it less useful
- People in active acute psychosis
- People with significant fear of large animals
- People with severe allergies
- People with mobility or balance issues that make outdoor settings unsafe (though programmes adapt where possible)
Cost and access
Equine-assisted therapy is most often offered through specialised programmes outside mainstream mental health services. Programmes vary in cost and funding model. Some are insurance-billable through the licensed mental health clinician on the team; some are grant-funded or sliding-scale; many are out-of-pocket. EAGALA's "find a programme" directory and PATH International's centre directory can help identify programmes.
Veteran-focused programmes are particularly numerous and well-funded — see our piece on veterans and schizophrenia for context.
How equine work fits with the rest of treatment
Equine-assisted therapy does not replace medication or primary psychological therapy like CBTp. It sits alongside them. For some people it becomes a significant part of recovery; for others it is a one-time experience that opens something. The point is fit: it is not the right intervention for everyone, and good programmes will say so honestly.
The bigger picture
Equine-assisted therapy is part of a broader move toward embodied, nature-based, non-clinical mental health care. The evidence in schizophrenia is preliminary, but the patient experience is often deeply positive — particularly for people who feel boxed in by years of clinical settings. As the evidence base grows, the place of equine work in schizophrenia care will likely become clearer.
This article is for educational purposes only and is not medical advice, diagnosis, or treatment. Always consult a qualified mental health professional. If you or someone you know is in crisis, call or text 988 in the US, or your local emergency number.