**2. Background to equine assisted interventions (EAI's)**

In the broader equine intervention related literature there have been studies showing positive impacts on wellbeing through equine assisted therapy with individuals suffering with disabilities, [2–10] chronic illness physical or mental [11–14], or individuals with eating disorders [15–17]. The potential benefits of equine assisted psychotherapy or experiential therapy have also been studied although outcomes have been mixed in terms of the efficacy of interventions with some studies showing positive results and some no effect [18–25].

Research by Dell's [26] (equine assisted education) captured the improved communication skills and pride the young participants gained while interacting with horses. Hemingway et al., [27] also described the positive impact of an EAI with young prisoners in a young offender's institution who said they felt calmer, and importantly more positive about learning with the prison guards reporting some improvements in behaviour whilst incarcerated. A qualitative study on an intervention in Guatemala which teaches natural horsemanship to reduce violence produced positive changes particularly in relation to increased calmness [28].

Pendry and Roeter [29] published a randomised controlled trial evaluating the effectiveness of an EAI which uses natural horsemanship to improve child social competence. The findings showed improvements with a moderate effect size for 5th to 8th grade children. In 2014 Hauge et al. [30], reported on a waiting list cross over design research study undertaken with young people aged 12–15. Those in the intervention group reported an increase in perceived social support compared with the control group which was statistically significant. In 2015 Boshoff et al., [31] shared the results from an experimental study, which measured subjective well-being, problem focused coping, and emotion focused coping. The findings from the study showed some positive changes for young men living in a custodial school.

Nimer & Lundahl [32] published a meta-analysis of animal assisted therapy for young people which showed a moderate positive affect for young people with autism, medical, behaviour and emotional issues. Two recent systematic reviews suggest a need for future studies to include when publishing detailed insights into the intervention and in addition to consider using both validated measures and a qualitative exploration [33, 34].

Two systematic reviews have been published [35, 36] considering the impact of equine assisted therapy on physical issues for adults living with disabilities and schizophrenia respectively. These reviews both found that studies lacked any randomisation within the sample and an adequate sample size. The reviews did show however that studies that have been published so far do report some positive outcomes in relation to a range of physical, behavioural and social issues.

A small study has considered equine assisted therapies impact on depression, anxiety, mindfulness and sleep quality. All areas showed statistically significant improvement, but the sample was small, and the intervention used within the study not well described [37].

EAIs have also been studied by occupational therapists. A pilot study [38] aimed to test an occupational therapy intervention offered in an equine environment and assess preliminary effects on occupational performance goals, behaviour, and social functioning of youth with autism. The findings showed there may be improvements in occupational, behavioural, and social outcomes for this group. Next steps in research terms included refining feasibility measures and implementing a randomised controlled efficacy study.

As the world is currently suffering in the grip of the COVID-19 pandemic it is important to note that the intervention under study here plus other equine assisted *The Embodied Nature of Horse Human Communication: A Feasibility Study of an Equine… DOI: http://dx.doi.org/10.5772/intechopen.98848*

interventions internationally have reported increased demand to support young people particularly during the pandemic. As alternative learning or therapy providers equine assisted interventions offer non-pharmacological support for those for whom talk based therapies are not working. Particularly during lockdown and prolonged periods of isolation equine assisted support has been particularly in demand for supporting young people; albeit with strict safety measures in place and some changes made to how sessions are delivered [39].

It is also vital to consider the welfare of equines involved in this activity. Horses are highly susceptible to work stressors related to physical constraints and/or to the need to control emotions while interacting with humans. A narrative review of research [40] found that to date few studies have investigated horses' stress responses during EAIs, and further studies are recommended, with the final aim to derive a reliable multidimensional method for assessing a horse's reaction during therapeutic programs, ultimately helping professionals to better develop interventions by taking into consideration the animal's perspective. However, it is clear that the use of interventions which enable humans to consider the world from the horse's perspective as a prey animal are likely to improve the world for horses as they increase understanding of and empathy for these wonderful animals.
