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An Equine-Assisted Therapy for Youth with Mild to Moderate Anxiety: Manual Development and Fidelity


Childhood anxiety is common, yet approximately half of youth do not receive treatment due to stigma, mistrust of the mental health service system, extensive wait lists for services and provider shortages. Alternative models and modes of treatment are needed. This paper describes the development of an alternative treatment that incorporates cognitive behavioral components for anxiety into an adaptive/therapeutic riding program delivered by certified riding instructors in a horse stable that offers horseback riding and therapeutic horsemanship programs. Using PracticeWise®, a well-established database of evidence-based mental health practices for youth, we identified five therapeutic elements that are the most commonly examined in rigorous research for childhood anxiety, and integrated them into a manualized program of adaptive riding sessions. Excellent fidelity to the intervention (98.7% mean score) and high inter-rater reliability (k = 0.92) were achieved. This approach has implications for expanding access to and engagement in adaptive/therapeutic riding interventions.


  • Almost half of children with a treatable mental health disorder such as anxiety do not receive mental health services due in part to stigma, mistrust, workforce shortages and wait lists for services.

  • Adaptive/therapeutic riding delivered by an alternative workforce such as equine instructors can reduce barriers to services.

  • Using PracticeWise®, a well-established database of evidence-based mental health practices for youth, the authors identified five therapeutic elements that are the most commonly examined in rigorous research for childhood anxiety, and integrated them into a manualized program of adaptive riding sessions.

  • The program, called Reining in Anxiety, consists of 10 sessions that follow a similar format: (1) weekly review, (2) groom and connect, (3) warm up (4) session activity, (5) cool down, (6) parent/caregiver psychoeducation, and (7) homework instruction.

  • There was high fidelity to the program as examined by session and instructor.

  • Reining in Anxiety has much promise for delivery by a non-mental health workforce; future to examine the effectiveness of adaptive/therapeutic riding for childhood anxiety is underway, including enhancing access to and reducing barriers to services.

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Correspondence to Mary Acri.

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Acri, M., Morrissey, M., Peth-Pierce, R. et al. An Equine-Assisted Therapy for Youth with Mild to Moderate Anxiety: Manual Development and Fidelity. J Child Fam Stud 30, 2461–2467 (2021).

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  • Adaptive/therapeutic riding
  • equine assisted activities and therapies
  • child
  • adolescent anxiety
  • cognitive behavior therapy
  • treatment engagement