Transcript An Overview of Equine Facilitated Interventions with

An Overview of Equine Facilitated
Interventions with Anxiety Disorders
Presented by:
Joseph P. Callan, M.S., M.S.W., LCSW
Wendy M. Denbo, M.A., IMH
• Joseph P. Callan
– Clinical Director of
TRAVERSE
– Diplomate in Clinical Social
Work
– Diplomate in Clinical
Sexology
– Registered Clinical
Supervisor
– Path Registered Instructor
– Equine Specialist MH&L
– Served on EFMHA and
PATH Boards
• Wendy M. Denbo
– Co-Director of TRAVERSE
– Master’s in Professional
Counseling
– Registered Mental
Health Intern
– PATH member
– Over seventeen years of
equine experience
Definition of Anxiety
• How do you define
Anxiety?
• Anxiety
– Angst or worry
– Normal reaction
to stressor
– Apprehension
without
apparent cause
– “Feels” real
Different types of Anxiety
• Generalized Anxiety Disorder
– Pattern of worry and anxiety over many different
events and/or activities, occurring more days than
not (6 months)
– Symptoms include:
• Restlessness, Fatigue, Irritability, Difficulty
falling asleep and concentrating, etc.
• Significant distress, impairment in functioning
Types of Anxiety
• Panic Anxiety – recurrent panic attacks
– Palpitations, sweating, trembling, shortness of
breath, chest pain, dizziness, derealization,
numbness, tingling, hyperventilation.
• Concern re: the attacks, additional attacks,
consequences, implications, loss of control,
• Impairment in functioning
Types of Anxiety
• Post Traumatic Stress Disorder (PTSD)
– Can occur with exposure to a traumatic event
– Symptoms include:
• Recurrent, intrusive recollections of the event:
– Dreams, flashbacks, etc.
– Intense distress at exposure to cues (triggers)
– Physiological Reactivity on exposure to cues
• Persistent avoidance of stimuli associated with trauma
with numbing of general responsiveness.
• Persistent, increased arousal:
– Difficulty sleeping or concentrating
– Irritability, outbursts of anger
– Hypervigilance, exaggerated startle response
Other Types of Anxiety
•
•
•
•
•
Guilt Anxiety
Performance Anxiety
Separation Anxiety
Social Anxiety
Phobias
Fight/Flight diagram
Stages of Stress/Anxiety
• Stressors
– Financial, family, work, school, etc.
– Internal or External
• Learning Window – A little apprehension
• A-State - heightened anxiety, heart rate increase,
breathing increase & upset, angry, demanding, not
listening - Beginning to Lose Control
• Defensive state -Similar behavior as A-state but much
more intense, more directive and threatening – Has Lost
Control
• Acting out – Fight (physical) or Flight
• Resolution
Interventions
• Staffing
– open, cooperative
mental health
professional
– open, cooperative
equine specialist
Interventions
• Assess, assess, assess !
• Where is the anxiety
coming from?
– Talk to the rider and
listen
– Assess the assessment
you got from others
– A child’s behavior is a
form of communication,
remember to be patient
and assess
Interventions
Interventions
• Getting the client to relax
– Teaching relaxation skills
• Deep breathing
• Plan, practice, rehearse
• Change focus
– Helpful thinking
• Positive self statements
• Clear distorted thinking
– Provide education
– Build a relationship/trust
– “Just be with the
horse…just feel the horse”
Interventions
• Distorted Thinking
–
–
–
–
–
–
–
All or nothing thinking: It’s all good or it’s all bad.
Emotional Reasoning: I am what I feel.
Overgeneralization: Always, everything, never…
Personalization: Your dysfunction is about me…
Catastrophizing: I have a hangnail—I’m going to die.
Perfectionism: If it’s not perfect, it’s not O.K.
Comparing to others: I’m no good because someone
else is better.
Interventions
• Systematic Desensitization (Wolpe, J, 1961)
– Exposure serially to a predetermined list of anxiety
provoking stimuli graded in a hierarchy from least to
most frightening.
– Each of the anxiety provoking stimuli is paired with
the arousal of another affect of an opposite quality
e.g. relaxation, relationship that is strong enough to
suppress the anxiety.
– As they become desensitized to each stimulus in the
scale, the riders move up to the next stimulus until,
ultimately, what previously produced the most anxiety
is no longer capable of eliciting the painful affect
Interventions
• Encourage small successive steps without pushing
(overwhelming) the rider
– Example: Greeting, approaching, haltering, grooming,
leading, mounting, etc.
• If rider becomes overwhelmed
–
–
–
–
Stop
If available, Mental Health Professional may intervene
Provide support
Make a goal for next lesson
• Be prepared for unexpected situations
– Reactions of staff & volunteers and how it transfers
Intervention
• Ensure you engage the rider in a manageable
bit of behavior.
• Describe, demonstrate, engage client in
planning and rehearse
• Engage in activity.
• Monitor closely
• Modulate intensity, duration, etc. so as not to
overwhelm client.
Working with these types of clients
takes time, patience and a special
equine or two.
Contact Information
• Joe Callan
– [email protected]
• Wendy Denbo
– [email protected]