Lessons In TR

Today’s post is about working with and instructing Veterans in the setting of Therapeutic Riding / Equine Assisted Activities and Therapies (EAAT). This is a compilation of notes I have taken the past few years. This is NOT comprehensive, just helpful, hopefully!

Veterans’ Experiences

To work with veterans, you need to know where they are coming from.

This means learning about veterans and hearing their stories. There are some links on the Veterans Program Resources posts to help with this. Recent movies have done a great job portraying the realities of the current wars.

Returning from Combat

• They have wounds (see below)
• There are no programs for transition
• They are expected to adapt within a few days
• What’s adaptive during combat must change at home – ex: at war they must be suspicious of anything that looks like a roadside bomb, back home they experience the same suspicion, often turns into anxiety

Veterans’ Wounds

Wounds can be visible physical disabilities, or the “Invisible Wounds of War.” For a detailed explanation of each one, see the following links. My notes are from the presentations, focused on manifestations you may see during EAAT and how to adapt activities.

• Applying Therapeutic Principles to Equine-Assisted Therapy in Military Veterans With PTSD by Jim Spira, PhD, MPH Director, National Center for PTSD Department of Veterans Affairs
• Boots in the Arena by Eva J. Usadi, MA, BCD
• Presentation by Fred Nolan, PHD at Ivy Tech on Combat Trauma and Treatment. Check out his book Combat Trauma (PTSD)

Invisible Wounds of War

Everyone experiences invisible wounds, although not enough to be diagnosed that something’s going on.

• PTSD
• stress
• depression
• substance addiction and abuse
• emotional, behavioral difficulties
• isolation

PTSD

• Lasts for 1 month+
• Less than 1/3 experience remission within 1 yr
• Brain is not fully formed until 26 years old
• Can’t be treated the same as a civilian their age, have gone through more
• Flashback episodes – during daily life may experience like they are back in the field, ex) they tackle you – they may be trying to protect you not attack
• Avoidance – reason why it’s hard to get veterans to come to centers
• Inability to remember, jumbled memories – it’s all in there but they can’t make sense of it, may remember something different or differently the next day = they’re not lying, what they are saying is true, be patience, don’t judge
• Diminished interest in participating
• Lost trust, detach – they came back different so everyone else appears different
• Seek adrenaline = find activities that keep them engaged
• Exaggerated startle response = don’t come up behind and tap them, always announced yourself

Concussion

• EVERYONE experiences concussions – ex: their heads are constantly hit while riding in Humvees, they experience constant blasts
• 3+ concussions cause permanent white matter damage

TBI

• Same symptoms as PTSD but with headaches and nausea
• Lose impulse control
• Short term memory (so can’t convert into long term)
• Critical thinking is impaired

Pain

• Makes everything harder/worse, including co-wounds & recovery
• Do what you can, then move on to refocus on something else

Other Invisible Wounds of War

• Depression
• Military Sexual Trauma

Visible/Physical Wounds

• amputation
• injuries incurred on duty
• paralysis
• spinal cord injury
• TBI
• speech difficulties
• visual and auditory impairment

Treatment for PTSD/TBI/Concussion/Pain

There are many different therapies:

• Most common:
  • Cognitive Therapies – CPT (cog processing), SIT (stress inoculation, put in stressful situations), CBT
  • Exposure Therapies – PE, EMDR (eye movement), VR (virtual reality put in war environment)
• Alternative/Less effective therapies:
  • less effective OR less researched, so less used but EQUALLY important
  • Medication
  • Supportive Therapies – support groups
  • Stress Reduction – meditation, yoga, etc.

Therapy issues:

• Many veterans don’t seek help
• Many veterans therefore go undiagnosed
• Half drop out of therapies
• Stigma/ego about therapy = instead focus on their mission
• Not all symptoms addressed in therapies – it is assumed that addressing PTSD etc will fix the rest (anger, sleep, numbing, etc.)

We need additional approaches/support

• Experiential based approaches such as EAAT

The Wars

Which war the veterans were in will affect which symptoms and triggers they have.

• Civil War
• Ww1
• Korea
• Ww2
• Vietnam
• OEF/OIF – Operation Enduring Freedom (OEF) / Iraq: Operation Iraqi Freedom (OIF)

About OIF/OEF

• More deployments and days fired at than others wars = more stress
• More wounded survive
• Drone operators – see it happen to others, even if not in person
• Massive killing potential of weapons (vs other wars)
• War in cities (vs Vietnam in fields)
• Driving slow means something bad is happening, fast is defensive
• Hypervigilant about trash and dead animals on the road, seen during daily city sweeps, potential bombs
• (= back in the US, anxiety can be caused by slow traffic, and piles of trash on the roadside)

Additional war specific issues (not listed in DSM5)

• Agent orange exposure
• Gulf war syndrome (“chronic multisymptom illness” and “undiagnosed illnesses”)
• Fake discharges on “personality disorder”
• Intentional misdiagnosis to avoid paying compensation
• = mistrust doctors and government

Triggers

A “trauma trigger” causes someone to recall a previous traumatic memory, related to PTSD, causing the recurrence of emotional or physical symptoms that cannot be controlled.

Triggers depend on the war:

• People of nationalities (if in Vietnam War may be Asians, if in OEF/OIF may be Muslims)
• Auditory (helicopters of certain kind/era)
• Smells (burning plastic, BBQ may smell like burning skin)
• Touch
• Taste
• Anniversaries – set off by calendar day/time, floating holidays (they may not even realize why they feel depressed until someone points out it’s the anniversary of their injury)

If they don’t know/understand their triggers, they will blame the here and now

Application to EAAT

The point is healing, not just to be in riding lessons forever.

• Focus on how they are doing in the moment. Discuss past events if it informs the present (don’t have to stay in past).
• Challenge beliefs that stem from trauma and interfere with living fully
• Help them develop realistic and positive beliefs
• Note you should not discuss more than you are qualified to
• Consider creating a list of local therapists to reccommend if issues come up that you are not qualified to deal with.

TBI

• Activities with multiple steps

Pain

• Help learn to refocus
• The absorption of attention is healing – facilitate their absorption into the horse activity
• Have chairs available everywhere for resting – some veterans may not be able to participate the whole time but need a sit down break
• Tell volunteers when they may need to subtly help – ex: a veteran cannot lift past vertical so the volunteer helps him groom and tack
• Plan for plenty of breaks if needed – ex: our group had chronic pain issues so we started with the classroom chatting, did groundwork with chairs available, took a break, groomed and tacked with chairs available, then rode, and ended in the classroom again

Military Culture Applications

• Respond well to skill based approaches
• Use concrete straight forward explanations (step 1, 2, 3 vs. figure it out)
• Connect with personal motivation (their family, etc)

Instructing tips

• the underlying goal is always adapting – how to improve and not hurt others
• teach fundamental skills and principles that can be learned and applied to a variety of situations
• solicit feedback about use in real world
• teach at the threshold – challenge them to the point they are able to overcome
• Establish personal motivation
• Establish problems and goals
• debrief – how did that work for you, how can you use that
• be aware that so many rules at TR barns may block the healing process (don’t feed with hands, don’t go into the field, etc.) – treat them as adults, not as disabled kids – consider changing the boundaries – ex: let them go out in the field and groom, it’s healing for both horses and veterans
• focus on why they are doing things, not just the fix – ex: their heels are up, don’t just tell them heels down, but ask them to do a body scan and identify any tension and discover why their heels are up – could be nervous or tense

Non-riding activities

• Become a member of the herd
• Interact with single horse
• Directing, following directions
• Working together nonverbally for various missions

Riding (individual & group) activities

• Appropriate interactions with horse
• Balance, focus
• Working with others in groups
• Discussion before and after
• Before – clearly state mission
• During – challenge at the threshold they can manage, toward success
• After – debrief, give homework

Volunteers

• Veterans volunteering can be equally therapeutic!

Equine Terminology that originated in the military

These can be fun to reference when instructing veterans. Rewritten from Windrush Farms veterans program resource handout

Eventing – was originally called “Militaire” by the French. It was created to better prepared horse and rider for the battlefield. It has 3 phases: 1) Dressage – tests their team work and discipline, 2) Cross Country – natural obstacles test courage, team work, endurance, leadership, 3) Stadium Jumping – tests endurance, obedience, team work. Eventing is used to create partnership between horse and rider just as in the military drills and obstacles are used for the platoon and their leader. The platoon and horse are responsible for knowing their job and completing the task, and there is one leader.

Pass left shoulder to left shoulder – while riding, same as how officers salute each other (if with sabers this avoids crossing them)

Salute – we drop our hand to our thigh, as a cavalry officer would have saluted with saber in hand — correction by reader: “The military salute actually started in the middle ages with knights in armor lifting their visor to pay respects to the king. This motion is what has become the military salute we know today.”

Flank – part of the horse, a drill movement referring to same area – turning right or left flank

Hope that helps!

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Note: This is not professional advice, this is a blog. I am not liable for what you do with or how you use this information. The activities explained in this blog may not be fit for every rider, riding instructor, or riding center depending on their current condition and resources. Use your best personal judgment!