Manette Monroe, M.D., MEd, an assistant professor of Pathology at University of Central Florida College of Medicine in Orlando, Florida, talks about how horse therapy can improve the lives of war veterans and help them adjust back into civilian life.
Interview conducted by Ivanhoe Broadcast News in November 2017.
With your background in pathology what led you to this area of research?
Dr. Monroe: Our Dean learned about an equine program at Stanford that was using horses to teach interpersonal communication skills to medical students. She knew I had experience with horses and thought I might be interested in exploring the possibility of developing a similar program here at UCF COM. I began looking for an equine facility that might want to partner with the COM. In that process, I met the people at Heavenly Hooves Therapeutic Riding Center and we talked about the possibility of using the facility for the medical students. Thomasa Sanchez, CEO of Heavenly Hooves, discussed wanting to start a veterans program and we talked about how research was needed to prove equine therapy really works. As I began to read the literature, and saw how little there was, I became really interested in all the types of therapy that utilized horses. It just kind of grew from there. I’m a real strong believer that when things come together organically, when you don’t have to force the fit, when the right people meet the right people and everything kind of falls into place, it’s meant to be.
Heavenly Hooves needed to move to a new facility because they had been at the Osceola Heritage Park rodeo facility. It’s a wonderful place and the county was super, super generous to let them use it for so many years. Unfortunately, every time there was a car show, a rodeo, a fair or any other event, we had to shut down operations. It wasn’t really as private as we needed. Osceola county agreed to work together with Heavenly Hooves and UCF COM to build this new place. We now have this fabulous facility and it’s really been a wonderful opportunity.
Talk to me about horses and therapy, we’ve done stories about other animals as therapy animals. The dogs, cats, even ducks. But what is it about a horse that will help someone who is under duress?
Dr. Monroe: What really differs between horses and dogs is that dogs are people pleasers, they’re companion animals, they want us to be a part of their pack. Horses are interested in other horses. They’re not really going to seek out a person for companionship in the same way the dogs do. They’re also a prey animal. They’re hyper-vigilant, always watching for danger, always watching for something to happen around them. When a horse hears a loud noise they react and ask questions later. Well, for a veteran with PTSD, if they hear a loud noise they’re going to have that same reaction. Because the veterans with PTSD are in a state of hyper-vigilance, if they over-react to stimuli it frightens the horse. Because the veterans want that interaction with the horse, they learn to self-sooth, they learn to calm themselves and to keep their own emotions under control. It is really kind of subconscious, because if a horse senses their leader is nervous or upset, they worry that there’s something to be afraid of. But when the person who is working with them is calm and keeps their own emotions in check, then the horse is going to respond calmly.
Talk to me a little bit about how those steps you take to get the veterans involved in the program and what they do and from start to finish what the outcome is.
Dr. Monroe: We got it started really from one veteran. There’s a group called Mission Continues and veteran Lindon Ortiz was working here through them, volunteering with the disabled children. At that time he started talking about working with veterans and horses and we built from there. It is so important to have a veteran vouch for your program with other veterans. Lyndon recruited some of his friends to come and be part of our first group. From there we began going to Wounded Worriers meetings, to the different veterans groups and reaching out to the community, putting up fliers on the UCF campus in order to attract people. We reach out to the entire community and interviews like this help people to learn more about us.
How many veterans are involved right now and what do they physically have to do?
Dr. Monroe: We take up to ten veterans per group that go through a set of ten sessions We do everything from learning how to groom horses and how to handle horses safely, to games on the ground that help build confidence and help them to learn interact to the horses. These non-mounted activities allow the veterans to learn to interact with the horses. They gain confidence and learn how the horses respond to them and learn how the horses respond to each other.
We also do riding activities and that both helps to build confidence and also teaches the veterans to ride. What they really seem to enjoy is riding in the drill team. It reminds them of military maneuvers and the marching that they’ve learned to do. They learn how to ride without us standing there saying here’s how you turn right, here’s how you turn left, here’s how you make the circle. We just tell them, okay you’re going to go down the rail and when you get here we’re going to call a command and you’re going to turn right. And they sort of work together and figure it out themselves and build teamwork too.
One of the problems with veterans coming back and re-assimilating in to civilian society is they often find it difficult to work with civilians. They find it difficult to trust and difficult to participate in teams where they’re not comfortable with everyone. None of the paid employees here have a military background, but the veterans learn that we don’t have an agenda, except that to help them. I hope it helps to build their confidence in civilians again.
What are some of the setbacks and some of the challenges that the veterans might have if they start working with the horses. I know you mentioned the startle, they teach themselves not to startle. Are there some physical things that some have to overcome as well?
- Monroe: The veterans can have all kinds of physical disabilities. We’ve had veterans with one leg completely missing, with two legs completely missing, amputations of arms, all kinds of different things. It teaches them that no matter what the disability is they can still come and do a physical activity that’s challenging. Not everybody knows how to ride a horse anymore. Years ago that was a whole different story, but now we’re participating in an activity that’s of out of most peoples’ comfort level.
A lot of the veterans say, until these sessions I had no reason to leave my house. I stay at home and I don’t even want to go to the grocery store. Now at least once a week I have an exciting thing I want to come out and do. Then once they start coming to do this they start doing all kinds of things. We had one gentleman who began painting again after years and years. We had another gentleman who actually started going into the Ocala National Forest and finding homeless veterans who were living there and bringing them back. The first veteran participant, Lyndon Ortiz just earned his master’s degree in social work. He graduated this past spring. He went back to college and now he’s thinking about applying to medical school to be a psychiatrist for the VA. It’s really done so much to open up all the possibilities that veterans can do.
Can you talk to me some of the research you have done, are you seeing that this has actually not just antidotal evidence but do you have some numbers to support it?
Dr. Monroe: We have just submitted a journal article for review and possible publication. The results we’ve seen actually even go beyond what medication normally does. Now, I never say stop your treatment; we want the veterans to remain on the prescribed treatment they’re already receiving from their physicians. This is the extra tool that can make all the difference. It can make everything else, all the pieces and parts and the therapy they’re going through and the medications they’re taking, kind of come together. Horses can give them that extra little boost they need to overcome the last barriers to really feel more confident about working out in civilian society.
What are you finding?
Dr. Monroe: We have measured depression scores and they have gone from severe depression to normal for several veterans. We also use a test called the PCL-M which tests post-traumatic stress syndrome for military personnel. It’s a short survey that the VA uses it every time a veteran with PTSD comes in for a visit. We’ve seen remarkable improvements in their PCL-M scores. They’ve all had extreme improvements in the Adult Attachment Inventory where we look at how they’re relating to other people in their community and their household. Even their quality of life index is improved. We’re seeing every single measure that we’re looking at going in the positive direction. The results are so good that I am afraid reviewers for scientific journals won’t believe us!
Can you tell me how many veterans and was it a response survey?
Dr. Monroe: We’ve had sixty-eight veterans come through the program so far. I’ve actually gotten a statistically significant cohort to evaluate. When we have our first session, the veterans complete a series of surveys and after the ten sessions are completed, we repeat the same surveys again. We also interview them and ask them some questions about their experiences here and how they felt about participating and about ways to improve the program as well.
Ten week sessions because it runs with the school?
Dr. Monroe: No, ten week sessions because that seems to be the optimum number. We started out with twelve weeks, but that was too long. It was hard keeping that much of a commitment. Eight was not quite enough for the treatment effect. What we’re trying to do is standardize a protocol for equine therapy with veterans. One of the problems is that people everywhere are doing this work, but they’re not following any set curriculum. We’re trying to develop a cohesive curriculum that other people can follow for proven results.
Is there any doubt in your mind that you’re making a difference in the lives of the people that come through here?
Dr. Monroe: No, there’s no doubt and you can hear it from the veterans. It’s all about them. You really need to hear what they think and what they have to say. So far, every single person that has gone through the program that has spoken to me, has had an extremely positive experience.
Is there anything I didn’t ask you that you want to make sure that people know about the therapy, about the men and women who are coming through?
Dr. Monroe: Equine therapy is not for everyone. We do have a self-selected group of people who want to participate with the horses. Some people just find it too intimidating and that’s okay because there is therapy with cats and dogs and even ducks. The biggest thing is to find something that’s going to help you, as a veteran, to re-assimilate into society. Something that’s going to help you be comfortable in civilian life; whatever that is. The message is that treatment doesn’t stop with traditional therapy and medication. There may be other things, in addition to traditional treatments, that are going to help to bring you back into civilian life, to help you feel better and be more comfortable. The important thing, you have to find ways to reach out.
The need for therapies like this is not going to end. I’m assuming it’s only going to grow.
Dr. Monroe: PTSD is not something that ever entirely goes away. You learn to manage it and you learn to control it. It can becomes less and less over time. There is going to be continually a need for this type of therapy; even if we were so lucky as to never have another war. We’ve done one study with autistic children in conjunction with the physical therapy department at UCF. We want to continue to work with people who have had a stroke and with veterans who have different types of traumatic brain injury. We’re working on some projects that will allow us to do that. There’s actually already been some work with multiple sclerosis and cerebral palsy showing the benefit of therapeutic riding for both of those conditions.
I know that your background is not in mental health. Is there a mental health component such as other professionals who come in?
Dr. Monroe: We have a licensed mental health worker who is always a part of our team. You can’t really do this kind of work without having that person there. Joanne Turner, LMHC is our mental health care provider and that’s super important. A lot of people who do this work don’t necessarily have a mental health background or have someone who’s licensed for mental health care or therapy. You never know when you’re going to evoke a memory or some sort of situation is going to occur where you might have someone who needs that professional.
Unless there’s anything that I’ve forgotten or you would to add?
Dr. Monroe: Horses cure almost everything. They’re so good for you. You notice on our volunteer’s shirts there is a quote from Winston Churchill that says, “There is something about the outside of a horse that is good for the inside of a man.” That’s so true – when I’m having a rough day and I go ride my horse, it makes all the difference.
END OF INTERVIEW
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