The healing touch of animal therapy

SINGAPORE – Dealing with major depressive disorder and anger issues from past trauma, Charles turned to drinking and overeating as coping mechanisms – habits that took him years to break.

When the 24-year-old tried out equine-assisted learning in June 2024, which had him grooming and feeding the animals, he found a new way of connecting with and managing his emotions.

“Having to focus on the horses pulls you away from your problems, say with work, personal or relationships,” said Charles, who did not give his full name. “It’s like meditating.”

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Charles was among 821 people, up from 722 the year before, who benefited from charity Equal’s animal-assisted programs in the last financial year ending June 2024. They included youth, seniors and people with special needs.

This could be part of a growing trend, with some therapy providers here saying they are seeing more people seeking such novel forms of therapy.

What is animal-assisted therapy?

Charles looked forward to his weekly sessions at the stable in Jalan Mashhor, under Equal’s Horse-ibilities program.

He said being with horses took away the pressure he felt during talk therapy to face up to his emotions, as avoidance was his “survival mechanism” when he was younger. “When we wanted to work on my emotions, my behavior, my actions, I had a very hard time.

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“When I went for horse therapy, it almost felt like the horses were more aligned with their emotions than I was… They are very sensitive to emotions.”

This helped Charles, who works in the real estate industry, become more attuned to his emotions.

His favorites were miniature horse Ginger, which he described as goofy and adorable, with messy hair, and Valentina, the “incredibly gentle” giant. “The horses are very loving. I could connect with them.”

Associate Professor Mythily Subramaniam, assistant chairman of the medical board at the Institute of Mental Health, said animal-assisted therapy refers to structured interventions designed by a qualified healthcare professional that integrate animals.

It is different from pet interaction in animal cafes, or even in animal-assisted activities. Such activities are unstructured and informal, involving animals that provide comfort and enjoyment and boost general well-being without specific therapeutic goals, she said.

In a therapy setting, the therapist, animal handler and patient, with the help of the animal, work to achieve specific therapeutic goals.

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Ms Adele Lau, founder of animal-assisted interaction and intervention provider The Dogtors, said a common misconception about animal-assisted therapy is that the animal is the therapist.

“While the presence of an animal can be incredibly comforting and create a non-judgmental space, the therapeutic benefits of animal-assisted therapy come from the structured interventions designed by a qualified professional.

“The animal helps to facilitate the process, not the primary provider of therapy.”

Dr Lim Boon Heng, a psychiatrist at Gleneagles Hospital, said interaction with therapy animals has been associated with increased dopamine, serotonin and endorphins, which are neurotransmitters linked to pleasure, mood regulation and pain relief. At the same time, it promotes relaxation by lowering levels of a stress hormone – cortisol.

“Pet ownership requires long-term commitment and can be stressful for some individuals, while animal-assisted therapy provides controlled exposure without the responsibility of pet care,” said Dr Lim.

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He added that being around animals can shift the autonomic nervous system from a fight-or-flight state to a rest-and-digest state, which reduces the heart rate and blood pressure, and regulates emotions.

Dr Lim said various animals have been used in different therapeutic settings, with dogs most commonly used for emotional support, post-traumatic stress disorder (PTSD), anxiety, depression and autism spectrum disorder (ASD), because of their strong bond with humans.

Horse therapy also seems to be effective in cases of depression, trauma, attention-deficit hyperactivity disorder and ASD, he added.

Ms Cathy Livingston, a certified equine-assisted psychotherapist and founder of Livingston Counselling & Psychotherapy, said horses, as prey animals, have a more acute perception of danger and sense of change in their environment.

“Horses are constantly watching and sensing everything and are extremely intuitive about the intentions of the human. They communicate through body language, with a highly built-up brain stem, because their DNA is flight or fight – usually flight,” she said.

She added: “Our brains develop with predictable, rhythmic, patterned input. Trauma is arrhythmic and unpredictable. A horse offers rhythm, through their walking, grazing and breathing.

“Also, the resting heart rate of a horse is about 32 beats per minute. This offers co-regulation for someone who is anxious.”

A 2018 paper by Colombia’s Universidad del Rosario reviewed 23 published studies on the impact of animal interaction on psychological and motor outcomes, and found that animal-assisted therapy was generally positive for patients with depression, PTSD and dementia.

Preliminary evidence supports the efficacy of animal-assisted therapy in managing behavioural symptoms of dementia in institutionalised patients, the paper said. For instance, one study found a decrease in agitation symptoms among dementia patients right after the intervention, and an increase several months after the intervention.

But Dr Lim cautioned that animal therapy should not be viewed as a substitute for evidence-based treatments such as medication or structured psychotherapy, which remain the “cornerstone” of managing mental health conditions.

Growing interest

Ms Ann Hui Peng, head of programs and services at Equal, said interest has grown in the charity’s equine-assisted learning programs, which are facilitated by instructors. Through these programs, participants develop social-emotional and relationship skills in a safe environment.

It now uses equine-assisted interactions to help young people facing mental health challenges and seniors, and it even takes miniature horses to visit nursing home residents who are unable to leave their beds.

She said Equal has increased its network of community partners by more than 25 per cent in the last two years, collaborating with more schools and social service agencies, and “doubling” its reach to active ageing centres and nursing homes.

Equal worked with more than 20 partnering institutions in the financial year ending June 2023.

Who cares for the therapy animals?

In therapeutic settings, the welfare of the animal is also taken into consideration, with an animal handler usually involved.

Ms Lau said dogs are most comfortable when their owners are present, as owners tend to understand their dogs’ preferences, behaviour, and stress signals best.

This makes them the “best advocates” for their dogs’ well-being, ensuring they can intervene and remove the dogs from stressful situations before they escalate, she said.

“Stressed or unhappy dogs are not going to benefit the beneficiary. And people can tell. When we work with youth at risk, who are very withdrawn, and they see that you are rough towards the animals, they’re not going to trust you.”

The Dogtors’ dog handlers undergo a theory course and a 10-hour mentorship programme on how to recognize signs of stress in their dogs and to be sensitive around the needs of beneficiaries.

Ms Lau said the dogs are screened to ensure they possess the appropriate traits and temperament for specific needs by patients across various settings.

The dogs are evaluated for their energy levels, playfulness, curiosity and sociability, as well as how well they respond to their handlers and participants, and adapt to their environment. They are also assessed on how they react around people with involuntary movements, or who use mobility aids.

The Dogtors then works with doctors, occupational therapists, physiotherapists and clinicians to develop a therapy plan for the beneficiary, and decide which dog is most suitable for them.

Whether with horses or dogs, animal-assisted therapy is helping more people.

Shi Min, 20, stayed home for months after she dropped out of ITE, overwhelmed with personal issues.

“I was always feeling very down or numb. I couldn’t really recognize my own emotions. So when other people asked me how I feel, it was always ‘I don’t know’.”

Shi Min, who receives support from Fei Yue Community Services, took a leap of faith to join Horse-ibilities in October 2024. She now volunteers with the organization.

The horses brought her comfort and helped her learn about herself, she said.

“I learnt I can be more confident than I am,” said Shi Min, who has found work as a freelance pet sitter.

To youth struggling with their mental health, she said: “It might not be easy to even get out of bed, (what) more to come here, and socialize with people and the horses.

“I hope you are able to take the first step to come down to give it a shot, especially if you have tried other therapies and it’s not working.”