There are approximately 2.13 million veterans living across England, Wales, Scotland, and Northern Ireland (Kirk-Wade, 2022; Northern Ireland Statistics and Research Agency, 2019; Scottish Veterans Commission, 2017), representing roughly 3.1% of the United Kingdom’s (UK) population. Although most veterans transition out of the armed forces well, they can face unique challenges to their well-being. These challenges may relate to complex factors such as occupational trauma, moral injury, pre-service trauma, and difficulties during the transition to civilian life (Fulton et al., 2019). Veterans are at a higher risk than the general population for substance misuse, posttraumatic stress disorder (PTSD), common mental health difficulties (Rhead et al., 2022), as well as loneliness and social isolation (Wilson et al., 2018). Given that a high percentage of the general population experience adverse childhood experiences (Bellis et al., 2014) and recognising that veterans are not exempt from prior trauma, many veterans often present with comorbid difficulties that should be considered together when providing intervention (Murphy et al., 2017). Traumatic events cannot be viewed in isolation when the cumulative effects are well known, particularly in a military population (Agorastos et al., 2014; Herringa et al., 2013; Scoglio et al., 2019), and can often have significant social impacts, such as homelessness (Macia et al., 2020). Indeed, Williamson et al. (2023) found that comorbidity is the norm rather than the exception, leading to a complex presentation that needs to be addressed in interventions.
In the UK, there are three main pillars of support for veterans (Johnstone, 2024). These include statutory services, such as the National Health Service (NHS), charity and third-sector services, and government and legislative support. Specific mental health statutory services have been developed, including Op Courage in England and Wales and Veterans First Point in Scotland. While veteran-specific mental health services have shown promising outcomes in supporting veterans (Finnegan et al., 2023; Fitzpatrick et al., 2018), further evaluation is required.
Despite the provision of support, barriers exist for veterans seeking help. Randles and Finnegan (2022) found a consistent group of factors preventing help-seeking behavior, including stigma, the ability to identify the mental health problem, military culture, an emphasis on stoicism, and access to health services. The authors also identified common facilitators for help-seeking behaviour. Themes included recognising the problem, the severity of difficulty, support from peers, awareness campaigns, and more easily accessible services (reduced waiting times and options for in-person or online help). Therefore, it is important to investigate approaches that show promise in overcoming these barriers, consider the complex comorbidities, and raise awareness to encourage systemic change in veteran perceptions of mental health. This can aid in identifying issues and allow for preventative measures rather than crisis reactions.
Equine-Facilitated Psychotherapy
Based on psychodynamic psychotherapy, which emphasises the importance of working through emotional conflicts by experiencing new and more adaptive feelings within a therapeutic relationship, animal-assisted psychotherapies (AAP) are emerging. AAP focuses on interactions among the service user, therapist, and animals, drawing on theories such as biophilia (the emotional connection to other living beings), adult attachment (the bi-directional connectivity between humans and animals), and social support theory (the feeling of being cared for, loved, and being part of a network of mutual obligations) through the mutual embodied attunement of behavior (Kovács et al., 2020).
Equine-facilitated psychotherapy (EFP) is a specific form of AAP in which mental health professionals incorporate horses to help clients achieve therapeutic goals, build relationships, boost confidence, and develop skills. As herd and prey animals, horses are highly attuned to their environment and the non-verbal cues and body language of humans. They mirror the emotions and behaviours of those around them, providing immediate feedback about individuals’ emotional states and their impact on others. Through the therapeutic triad formed between the service user, therapist, and horse, both intra- and inter-psychological processes can be explored, allowing for the development of corrective emotional experiences.
As the provision of EFP expands, research increasingly aims to bridge the gap between practice and theory. Bachi (2013) identifies attachment theory as a foundational framework to be employed throughout this study. Key concepts, including safe base, affect mirroring, reflective functioning, and non-verbal communication, are applicable to EFP. The unique experiential and physical dimensions of EFP may provide benefits that extend beyond traditional attachment-based psychotherapy. Moreover, engaging with the horse through visual, auditory, tactile, and olfactory modalities is expected to elicit the relaxation response commonly observed in human-animal interaction research (Johnson et al., 2021).
Despite the growing interest in EFP and its potential benefits, significant gaps remain in the research, particularly regarding its application for veterans. Although previous studies have demonstrated the effectiveness of EFP across various populations, the unique experiences of veterans within this therapeutic context have not been thoroughly explored.
Aims
This study aims to address this gap by investigating the personal stories of veterans who have participated in EFP. Considering barriers such as stigma surrounding mental health diagnoses and difficulty accessing therapies in formal clinical settings, this research will focus on veterans’ stories of well-being to illuminate why EFP may provide unique benefits within evidence-based trauma interventions and what the broader implications may be. Exploring these personal stories will highlight how participants engaged with EFP and the impact of the intervention on their well-being. To achieve these aims, the following research questions will be explored: how did veterans experience EFP, and what can their stories reveal about the impact it had on their well-being?
Literature Review
Research has shown EFP to be effective across a range of populations and presentations, including children and adults, neurodevelopmental disorders, social and behavioral issues, mental health diagnoses, and physical health injuries (Kendall et al., 2015; Lee et al., 2016). EFP can significantly reduce trait anxiety, PTSD symptoms, emotional responses to trauma, and symptoms of depression, providing comparable effects to standard PTSD psychotherapy (Earles et al., 2015; Hediger et al., 2021; Holmes et al., 2012). Additionally, EFP can improve self-awareness and self-esteem (Palley et al., 2010) and increase overall well-being (Bivens et al., 2007). It is suggested that the interaction between horse and human can elicit feelings of self-efficacy, receptiveness, communication, patience, emotional comfort, safety, and trust (Yorke, 2003).
Given the growing evidence for EFP across diverse populations, focus is shifting toward its potential use for veterans. Veterans often face complex difficulties related to their health and social circumstances, making EFP a potentially holistic intervention that can address multiple areas of distress. Quantitative studies have explored various aspects, including neural changes (Zhu et al., 2021), psychophysiological changes (Gehrke et al., 2018), and reductions in PTSD symptoms (Fisher et al., 2021; Shelef et al., 2019).
A recent meta-aggregation review of qualitative research concerning veterans and forms of equine-assisted activities and therapies (EAAT) found only 15 qualitative studies, almost all conducted in North America (Campbell, 2024). The review concluded that EAAT may benefit veterans’ compassion, connection, ability to flourish and heal, presence, self-regulation, and sense of transformation, as well as enable trust and safety with both the horses and the instructors. The inclusion of horses may provide unique motivators and serve as a non-judgmental feedback tool. However, the review also indicated challenges associated with EAAT interventions, including the potential for activities to mirror traumatic memories and create frustration if the veteran feels mismatched with their horse partner (Banner, 2016). Overall, the qualitative evidence regarding the application of EAAT for veterans is inconsistent. Furthermore, as there are no qualitative studies based in the UK, caution must be exercised when inferring existing evidence due to differences in population, context, and the varying interventions employed in the research.
Well-Being
Help-seeking veterans often face comorbid difficulties across various life domains (Williamson et al., 2023). Therefore, a move away from a symptom-focused approach is appropriate for capturing the experiences of therapeutic interventions. This is supported by Biscoe and Murphy’s (2024) recent study, which utilised the Warwick-Edinburgh Mental Well-being Scale (WEMWBS). The study found that well-being was significantly associated with lower scores on measures of mental health problems, including anxiety, depression, physical ill health, anger difficulties, PTSD, and complex PTSD (C-PTSD). The authors also discovered that well-being was related to functional outcomes such as sleep quality, loneliness, and alcohol misuse. This suggests that well-being can be a useful transdiagnostic outcome measure for this population, particularly where interventions may involve individuals with different diagnoses and where there is a high rate of complexity and persistence of formal diagnoses.
The present study adopts the well-being framework developed by Ryan and Deci (2001), which has been used to guide the development of the Warwick-Edinburgh Mental Well-being Scale (WEMWBS) (Tennant et al., 2007). This framework proposes that well-being is a multifaceted construct comprising two aspects: subjective well-being and psychological well-being. Subjective well-being pertains to an individual’s overall evaluation of their life satisfaction and the balance of positive and negative emotions experienced over time. This is guided by criteria determined by the individual as meaningful and is regarded as the ‘hedonic’ school of thought on well-being, emphasising pleasure and the avoidance of pain.
Psychological well-being concerns experiences of psychological growth, fulfilment, and personal development. Research suggests six key dimensions contributing to psychological well-being, including self-acceptance, positive relationships, a sense of purpose, autonomy, the ability to manage one’s environment effectively, and growth towards one’s potential (Ryff, 1989; Ryff & Singer, 2008). Psychological well-being originates from the ‘eudaimonic’ school of thought, which encompasses the concept of human flourishing and how that contributes to psychological health.
Dialogical Narrative Analysis
Dialogical narrative analysis (DNA) was chosen over other qualitative methods, such as Interpretative Phenomenological Analysis (IPA) or traditional narrative approaches, due to its unique focus on the dialogical interplay between individual stories and broader sociocultural contexts. Unlike IPA, which centres on the subjective interpretation of personal experiences, DNA allows for an exploration of how veterans’ stories are co-constructed in dialogue with their social environments, including military culture, societal expectations, and the therapeutic setting. Moreover, DNA offers a flexible framework that prioritises the evolving nature of storytelling, making it well-suited to understanding the dynamic relationship between veterans, their identities, and their therapeutic encounters. This contrasts with discourse analysis, which primarily focuses on language use rather than the emotional and identity-based transformations that emerge through narrative. DNA also supports a more holistic understanding of the veterans’ experience by considering not just the content of the stories, but also the relational, cultural, and psychological factors that influence how and why these stories are told.
Rooted in the work of Mikhail Bakhtin (1984) and developed by Frank (2010, 2012), DNA emphasises the role of stories as “artful representations of lives; stories reshape the past and imaginatively project the future” (Frank, 2012, p. 33). Frank (2010) distinguishes between narratives and stories. The former constitutes a broader, overarching framework through which people make sense of their experiences and the world around them. These narratives are shaped by social, cultural, and historical contexts and involve the interaction of multiple voices and perspectives. These wider discourses influence how stories are told and understood.
Stories are the specific, individual accounts that people tell to reflect their experiences. These accounts serve as the building blocks of broader narratives, providing specific content and examples that illustrate and enact overarching frameworks. In DNA, stories are analysed not just for their content but for how they interact with other stories and the broader narratives they are part of. Stories are not a passive representation of someone’s life; they have the capacity to act on, in, and for people in ways that can have implications for well-being.
Veterans are subject to multiple narratives throughout society. These narratives have the power to influence and be influenced by the stories veterans tell. An example is the notion of heroism and military service, which represents a deeply rooted British cultural assumption (Phillips et al., 2022). In contrast, victimising narratives are also prevalent, depicting veterans as “mad, bad or sad” (Parry & Pitchford-Hyde, 2023, p. 441) or “passive, naïve actors” (Phillips et al., 2023, p. 419). This creates a dichotomy through the contradictory positive heroisation and negative victimisation, which can influence how stories are told and experienced.
Given the complex and multifaceted experiences of veterans, DNA allowed the researcher to delve into how veterans construct their identities, make sense of their experiences, and how this intersects with sociocultural narratives on military service, trauma, and therapeutic interventions. It also highlights the dialogic processes through which veterans’ voices interact with those of therapists, peers, and the equine facilitators themselves, revealing the transformative potential of such therapies. DNA provides a nuanced understanding of veterans’ lives and the role of equine therapy in facilitating their healing. This offers insights that can enhance therapeutic practices and support systems for veterans.
Methodology
Primary Researcher Position
I have occupational experience in clinical psychology, as well as a family history shaped by the Armed Forces. DNA promotes immersion within the topic area; therefore, practicing in mental healthcare and having personal experience enables awareness of the narratives that may influence veteran stories.
My interest in dialogical narrative analysis stems from a commitment to amplifying diverse voices and exploring the co-construction of meaning through interaction. I connect with the philosophical underpinnings of DNA as articulated by Bakhtin (1984), especially the notion of individuals as ‘unfinalized’ beings- constantly capable of change and never fully revealed or known to the world. This approach emphasises power dynamics and ensures that participants’ stories are not finalised by research. I also recognise my position as a non-veteran and a practicing healthcare professional, which may influence the dynamics between myself and the participants. To address this, I engaged in reflexive practice, such as journaling and peer debriefing, to continuously examine biases and assumptions. Where possible, rapport was built with participants prior to the interview through attendance at a celebratory event held by the charity for service-users and staff. This helped build safety and security ahead of commencing the research process (Sparkes & Smith, 2013).
Ethics
Ethical approval was obtained from the University of Plymouth (Appendix A). The study’s aims, benefits, risks, confidentiality, anonymity, and withdrawal rights were explained to participants, with detailed information sheets provided (Appendix B). Informed consent was obtained before the interview (Appendix C), and an interview schedule guide was used (Appendix D) for the opening question and further prompts. Local contact details for additional support were provided within a debrief sheet (Appendix E), and the facilitators of the EFP intervention were available to the participants before and after the interview. A follow-up call was arranged five days after the interview to debrief and offer support where needed.
Therapy Setting
Participants were recruited from a charity providing EFP to veterans. This service offered free, tailored therapeutic interventions to veterans experiencing distress. The EFP charity utilised the LEAP model (LEAP, n.d.), where training is provided by an organisational member of the Professional Body for Accredited Counsellors, Coaches, Psychotherapists, and Hypnotherapists. They follow the British Association for Counselling and Psychotherapy Ethical Guidelines and are regulated by the Office of Qualifications and Examinations Regulation standards.
The intervention was provided either one-to-one or as a group, and was facilitated by a clinical psychologist trained in the LEAP EFP approach. Individual sessions were one hour long, while group sessions lasted two hours and were provided on a weekly basis. Activities involved grooming the horses, building confidence around them, and developing relationships with the horses. Sessions progressed to include therapeutic activities with the horses, such as leading the horse around obstacles, depicting symbolic events in the participants’ lives, and drawing parallels from the horses’ behavior to identify cues for psychoeducation. All participants also received peer support from another team member who is a veteran. This peer support was tailored to the participants’ needs and provided emotional support and/or companionship.
Recruitment
A purposive sampling strategy was used to recruit participants. All attendees were informed about the prospective research study and recruited by the EFP psychologist, whom the participants knew well. Six people expressed initial interest, and five participated. The sixth potential participant did not respond to contact attempts to discuss the research, which was considered a withdrawal of interest.
Inclusion criteria included adult veterans, as defined by the UK Office for Veterans Affairs (2020, p. 2), as someone who has “served for at least one day in His Majesty’s Armed Forces (Regular or Reserve).” Participants must have attended an EFP therapy course in the preceding 2 to 24 months and be able to give informed consent to participate in the study. The only exclusion criterion was if individuals were currently experiencing high levels of distress, which was assessed by the lead clinical psychologist of the EFP service, who was familiar with the participants’ life experiences and mental health presentations. This exclusion criterion was not applicable to any of the prospective participants.
Participants
Participants included two male and three female veterans, aged between 35 and 56 (see Table 1 for participant characteristics). The duration since finishing the EFP ranged between 12 and 24 months. Anonymity was ensured by providing culturally sensitive pseudonyms in recognition of the power dynamics that come from a researcher renaming their participants (Wang et al., 2024). The option to choose a pseudonym was also provided, although no participant opted for this. An introduction to each participant’s context is provided in Appendix F to familiarise readers with the individuals who have kindly provided their time for this study.
Table 1
Participant Characteristics.
| PSEUDONYM | AGE | GENDER | BRANCH OF SERVICE | YEARS OF MILITARY SERVICE | EFP INTERVENTION TYPE | NUMBER OF EFP SESSIONS |
|---|---|---|---|---|---|---|
| Jack | 56 | Male | Army | 12 | One-to-one | 6 |
| Colette | 50 | Female | Army and Navy | 26 | Group and one-to-one | 20 (6 group;14 one-to-one) |
| Freya | 56 | Female | Army | 8 | Group | 6 |
| Ben | 49 | Male | Army | 6 | One-to-one | 9 |
| Abigail | 35 | Female | Navy | 5 | Group | 6 |
Data Collection
Participants were provided with the option to hold the interview at the farm site where they completed the EFP, another location convenient to them, or remotely. Three interviews took place in the therapy space at the farm site, and two interviews took place over the telephone. The data were collected through a narrative interview that began with a broad, open-ended question to enable participants’ stories:
I am interested to hear about your experiences of mental health and well-being difficulties as a veteran, and how you have found accessing support. What was this journey like for you?
Participants were reminded that their involvement was voluntary and that they could choose to take a break or terminate the interview at any time. Prompts were included in the interview schedule (Appendix D), although the aim was to have minimal interruption from the researcher to allow the participants to form lengthy stories about their experiences (Caddick, 2021). Interviews were audio recorded and lasted between 60 to 130 minutes. They were transcribed verbatim by the researcher. Interviews enabled the researcher to gather comprehensive and nuanced stories from the participants regarding their experiences. An iterative approach to data collection and analysis was adopted, whereby these proceeded alongside each other.
Dialogical Narrative Analysis
Interview transcripts were analysed using dialogical narrative (DNA) analysis informed by Frank (2012), Smith (2021), and Caddick’s (2021) heuristic guides. Rather than a prescriptive method, DNA provides a guide to interpretation through which analytical processes can develop fluidly, encouraging theoretical curiosity and “provoking new ways of seeing in the process” (Smith, 2021, p. 241).
Interview transcripts were read through repeatedly to facilitate indwelling, the immersive process of understanding and interpreting stories from within the lived experiences of the storytellers (Smith, 2021). This process emphasises empathy, engagement, and the researcher’s active involvement in the narrative world of the participants to co-construct meaning. As data formulation iteratively grew, identified patterns and structural elements informed later interviews to allow for movement of thought.
The Labovian structure was used to guide the identification of stories (Labov, 1982). This is predicated on the assumption that there is a collectively understood framework regarding the essential components of a story. The Labovian elements are outlined in Appendix G. An average of 18 stories were identified for each participant (ranging from 15 to 21). Stories varied in length and detail. Some participants chose in-depth accounts of their traumatic experiences and recovery, while others opted to tell stories of their wider systemic networks, such as their families or present-day difficulties and interactions with healthcare. All participants spoke of their experiences of EFP.
The primary researcher began with an inclusive approach to identifying stories, cultivating reflexive uncertainty about which may be most useful to the research project (Frank, 2012). Stories were selected based on phronesis (Flyvbjerg, 2001), which refers to the practical wisdom gained through the analytic experience. DNA promotes this as an alternative to the systematic approach of other qualitative methodologies (Frank, 2012). Stories that particularly “spoke to” the research questions were focused on for further analysis. This was based on the researcher’s fieldwork and analytical experience. A dialogical analyst acknowledges stories can be assembled in multiple ways, with different analyses. A strength of this is in the recognition of the unfinalisability of stories and the ethical commitment that DNA does not present itself as the last word (Frank, 2012).
Common threads were identified within and across stories, leading to the identification of narrative themes, as guided by Smith’s (2021) heuristic approach. This was not a process of line-by-line coding, as that could risk fragmenting the stories. Instead, the researcher asked questions of the entire stories, such as: ‘What are the common theme(s) or thread(s) in each story?’ and ‘What occurs repeatedly within the whole story?’ These themes were initially constructed by the primary researcher and later reviewed in collaboration with the EFP facilitator to generate further insights and alternative interpretations.
How and why these stories were told was explored using dialogical questions adapted from Frank (2012). Categories of dialogical questions include resource, circulation, affiliation, and identity. These are used to deepen the understanding of the stories by exploring the social, cultural, and relational dynamics, and considering what may initially go unnoticed about the story. To inform these questions, the researcher consulted various literary and research resources to elucidate sociocultural and psychological influences. For the purposes of this research, dialogical questions of resource and identity are reported, as the researcher deemed these particularly relevant to the research questions and the veteran population. Acknowledging the narrative resources and identities of the participants helped clarify the reasons behind the stories told. Examples of these questions and notes from the analysis can be found in Appendix H, which represents the story analysis table created for this study. Throughout the analysis, the researcher engaged in a peer-research group to act as ‘critical friends,’ enabling the exploration of alternative viewpoints and reflection.
Findings
Stories sharing common features, providing contrast, and offering insights into the research questions were selected for further analysis. Shared themes from these stories are discussed to explore the veterans’ experiences. Several themes were identified from these stories (see Table 2), which were analysed using dialogical questions related to participant identity and narrative resources; key findings are reported within each theme (see Appendix H for notes from the analysis).
Table 2
Story Themes.
| THEME | OVERVIEW |
|---|---|
| Relating to the horse | Encompasses the process of initial engagement with the intervention, forming bonds with the horses through factors such as self-relating, shared namesakes, and feeling soothed. |
| Self-regulation | Encompasses the practical skills developed through the necessity of soothing oneself to engage more effectively around horses. |
| Insight | Encompasses the insight gained into participants’ lives following parallels and metaphors being drawn through use of the horses’ behaviour. |
| Focus of attention | Encompasses the utility of the horse as a focal point through which participants were enabled to discuss otherwise challenging topics. |
| A safe environment | Encompasses the impact of the open space and farm location, in comparison to clinical spaces, as well as the normalising factors of seeing other veterans receive help. |
| Personal relatedness | Encompasses the facilitator roles and validation participants experienced through warmth, connection, and veteran peer relatedness. |
| Empowerment | Encompasses the self-efficacy developed, and the opportunities that emerged from having engaged in the intervention. |
Relating to the Horse
Most participants voiced initial scepticism about how working with the horses could be beneficial, as Colette describes: “Well, I was a bit dubious at first. I was like, “how the bloody hell is this going to work?’” However, once the sessions began, the scepticism dissipated. The allure of the horses appeared to take over; through self-identification and individualised connection, meaningful relationships were formed. As Jack describes:
She [horse] had my attitude to life. A bit tired, a bit worn, all she wants is a hug and a brush. Yeah, same here! So, it was really comforting. You know you just [exhale] and your worries disappear from then.
Jack related to Cassie on a personal level, identifying aspects of her character within himself. In this story, Jack shares his identity as someone who may be lethargic but yearns for affection, which he was able to express through his connection with the horse.
Freya’s initial connection with a particular horse came from its shared name with someone she supported in her work role. It felt serendipitous to Freya that a horse was named Timmy.
I started grooming Timmy with [facilitator] and Timmy happens to be the name of one of my people that I support. It was lovely. It’s a lovely connection. Sometimes things happen like that, and you shouldn’t have favourites, but he was my favourite one. I just saw a connection there. They started to accept us into their herd, so I looked forward to going on a Monday. It was like a little kid waiting to go to something special.
This was comforting for Freya, as she was in a group of four veterans for EFP, and the others already knew each other. By relating to Timmy and feeling part of the herd, she was able to feel more at ease in a setting that might otherwise have been anxiety-provoking. It also provided Freya with something to look forward to each week.
Dialogical Questioning
Considering how the storyteller’s identity is shaped by the stories they tell, the initial scepticism may represent the possible influence of the known barriers veterans experience in acknowledging and accepting support for their well-being challenges (Randles & Finnegan, 2022). Identity has a clear influence on how initial connections were formed with the horse. The role of biophilia and adult attachment can be considered in encouraging an emotional connection to the horse, as well as a sense of a bi-directional connection between humans and animals (Kovács et al., 2020).
Narrative resources contributing to these stories may include narratives of hopelessness that feed into scepticism, possibly perpetuated by the interaction with stereotypical narratives of veterans being “mad, bad, or sad” (Parry & Pitchford-Hyde, 2023, p. 441).
Cultural narratives of horses have often depicted physical strength and freedom, which may contribute to their allure. This is particularly relevant when considering horses’ involvement in the armed forces and their use in ceremonial events such as Trooping the Colour (Guest & Mattfield, 2019).
Self-Regulation
Self-regulation is the process in which one exerts control over their behavior, through self-monitoring, self-evaluation, and self-reinforcement (American Psychological Association, n.d.). EFP enabled veterans to gain a sense of control over their emotions and trajectory. All participants reported learning how to self-regulate. Jack’s story outlines the skills he developed, the impact this had, and how the horses helped:
They [horses] were like three different attitudes, so there was ‘I don’t care’, ‘I’m a bit sprightly’, and ‘I’m nuts.’ If you can calm all three of them down it was great, and then you were basically calming down yourself. It’s better than having just the one, you know, you could fake it with one horse maybe. We’ve got all three with different characters. That one’s quite sprightly. Right, lets calm that one down. Then you’ve got the one that’s nearly asleep, plodding along. You’re trying to encourage her to do more. and that’s with yourself, you’re trying to encourage yourself to do more. I was just like I’ve got this horse; I’m walking it over these obstacles, and [facilitator] is helping me see that’s my anger or sadness and I’m in control of it. “Yes, I am”, you walk away feeling great, and that’s why I became so different. Because I could control it. Going back to work with everything, you know, I was focused. and now when I get a bit “oh hang on, what am I going to do…” I just think of that paddock and that calms me down, I remember the nice days and get back to it. It’s a tool. Everything that I’ve been shown and taught now, it arms me against everything else. I have ways of calming myself. I’ve ways of giving myself time. I’ve got to take a breath. I can’t just run into it. I think I had to slow down.
The three horses provided Jack with a practice ground, and their varying personalities allowed him to develop different self-regulation methods that he could implement outside of sessions. This was echoed across all participants, with Colette speaking of the self-regulation developed as “a tool; it helped me to compartmentalise things and be able to deal with stuff one thing at a time because I juggle 50 things at once and everything gets done, but it’s chaotic; I’m chaotic.” The therapeutic triad allowed the intra- and inter-psychological processes to be explored, and adaptive emotional strategies to be formed. The participants learned methods of self-regulation relevant to their challenges, an aspect that was acknowledged by all participants, in one-to-one or group settings.
Dialogical Questioning
Reflections on a sense of accomplishment were included in Jack’s story of developing self-regulation, and a focus on a sense of control enabled Jack to feel more confident in his identity. Colette describes herself as chaotic yet functional. Through the development of self-regulation, this identity and story project hope for a containing approach to her initial assertion of a chaotic identity.
The stories included an emphasis on control as a marker of success. Self-discipline is often highlighted as a key component of success across multiple domains, including philosophical schools of thought, such as stoicism, prevalent self-help books, and longitudinal studies (Poulton et al., 2015). Leadership narratives are also evident in Jack’s description of leading the horses and adapting their behaviour. This may echo past experiences from Jack’s occupation, where the necessity to take charge in stressful situations was paramount. This permitted Jack to regain a sense of mastery that may have diminished since transitioning into civilian life.
Insight
EFP provided insights into triggers and processes the participants were not previously aware of. Through the horses’ attunement to the environment, the facilitator drew comparisons between how the horse was acting and what that might reflect for the participants. Abigail described a task where she had to represent her life story alongside one of the horses. On the final step, when she took a ‘leap of faith’ over a small jump, the horse didn’t go with her. The facilitator explained that the horse sensed that she wasn’t ready. Abigail then described practicing self-regulation and self-reflection to encourage herself to take this final step:
I’d given myself that breathing, telling myself that when you take this leap of faith you are going to get to where you need to go. I told myself, and I really felt it and then she went over with me so yeah, that was very empowering.
I feel like being with the horses and being around other veterans, it’s kind of unconditioned you in the way that you were conditioned to be in the forces. I used to just get on with the job without thinking about what came next.
By interacting with the horse and responding to its cues, Abigail practiced self-regulation and gained insight into how her past conditioning to simply “get on with the job” was no longer helping her make effective life choices. She also touches on the presence of her peers in the group and the validating process of collective unconditioning.
Ben also experienced a pivotal moment in self-realisation, enabled by the behaviour of the horse and the guidance of the facilitator:
We did a walk up the lane with a horse but it’s a bit weird because [facilitator] would draw parallels with the way things happen. She’d say, “do you think it’s symbolic of something?” Because she said that in all the time, she’d never had horses escape, and that happened twice with me. Yeah, they barged against the fence and were gone. and she said that it’s never happened before, and it happened two weeks running. She said, “maybe that’s a bit like you, you want to get away?” But just the fact that I would never think about anything. Maybe I do need to change and… yeah…get away.
EFP provided parallels between the horses’ behavior and the processes occurring for each participant that they may not have been previously aware of. Through the facilitator’s guidance, these metaphors became reflective moments that encouraged growth.
Dialogical Questioning
A sense of hope and optimism for the participants’ identities can be found through these stories. By building self-awareness through the horses’ feedback, Abigail and Ben were able to confront the aspects of their identities that prevented them from consciously recognising their needs and figuring out how to achieve them.
Contributing narratives may relate to those of recovery, incorporating the hope and optimism portrayed when someone realises that change is possible. Abigail’s story begins to reject the narratives and her experiences of conditioning. She reclaims her trajectory through narratives of discovery and growth. Principles of positive psychology have explored the role of hope and optimism and how these may influence health. Research indicates that with greater optimism and hope, people often seek to engage in healthier behaviours, even when contending with chronic health difficulties (Schiavon et al., 2017).
Focus of Attention
The two male participants both reported that the horses provided something to focus on. The tactile and practical presence of the horses facilitated conversations that might have otherwise felt uncomfortable, as Jack describes:
It’s more the tactile side of things, of touching something. You can feel the heat of the animal, you can feel the fur and all the rest of it, the hair. I’d say with the horses, it is more of a physical thing. You’re calming while you’re brushing them, they know you’re calm because you’re brushing them. and that’s relaxing them anyway.
A reciprocal relationship had formed between Jack and the horse, where they were both calming each other and establishing trust and safety. Ben explained another benefit of the horses’ presence: the practical distraction it provided, which enabled him to share with the facilitator:
I don’t know if it’s a man thing or just me, but it’s quite hard sat talking to someone. and that’s when I found out about this place because you’re not sat in an office face-to-face. If you’re walking the horses around or whatever, you can talk without being too focused. It’s just nice to have that distraction, isn’t it? But having someone like [facilitator] to lead the conversation. I think just having it as a distraction, you feel less conscious about stuff. Less Under the spotlight, yeah.
By shifting the focus onto the horse and alleviating the ‘spotlight’ on Ben, he was able to feel less vulnerable. The horse facilitated Ben’s discussions about his emotional difficulties.
Dialogical Questioning
The identities of traditional masculinity can be instilled through implicit and explicit messages in the military that normalise and reinforce socially constructed gender ideologies, including emotional stoicism (Neilson et al., 2020). This can impact a male’s ability to discuss his emotional difficulties. The horses appear to break down barriers, enabling male participants to feel less vulnerable and more able to engage with the intervention.
Contributing narratives may consider the parallels of reciprocity that Jack highlighted, reflecting sociocultural themes of cooperation, exchange, and social bonding. This aligns with social support theory (the sense of being cared for, loved, and being part of a network of mutual obligations), which is proposed as underpinning the EFP intervention (Kovács et al., 2020). Through mutual embodied attunement, Jack was able to draw on sociocultural expectations of helping one another.
Ben’s reflections illustrate how narratives of traditional masculinity may interact with storytelling. Masculinity narratives promote emotional suppression, strength, and resilience as protective traits (Neilson et al., 2020). This becomes particularly powerful when combined with narratives about veterans needing to be stoic and heroic. Through an effective therapeutic triad, the inclusion of the horse enabled participants to reconstruct masculinity narratives, fostering emotional openness and providing resources for overcoming mental health difficulties (Caddick et al., 2015).
A Safe Environment
All participants reflected on the environment of the farm and the profound effect it had on their ability to engage with EFP. This was in direct contrast to the clinical settings they had previously experienced. Colette found solace in being outdoors and no longer having to rely on her coping mechanism of knowing her exits:
It was a lot easier for me to speak to somebody out in the open than it was to speak to somebody sat in a room because for people like me who don’t like to be sat in enclosed spaces, it’s vital that we can get out.
Jack echoed Colette’s sentiment, noting that the sense of relaxation he gained from the farm facilitated discussions and reflections on his previous help-seeking experiences. He shared, “After going through all the treatment, you just think, yeah, that’s wrong [clinical spaces]. You need a place where you can relax, talk about it, and actually let it out.”
A unique aspect of the environment was the presence of others receiving therapeutic support. As Ben explained, “It was nice seeing other people here. I didn’t have anything to do with them, but it helped to remind you it’s not just you.” This was particularly powerful for Ben, who described himself as an introvert and was the only participant who wasn’t part of a veterans’ social club or organisation. He did not have access to these normalising experiences beforehand.
Dialogical Questioning
Identity development shared in these stories indicates the role of the environment for veterans. Colette’s stories depict a life shaped by her necessary coping mechanisms, such as knowing where the exits are. The story of the farm environment allows the listener to understand the impact of enclosed spaces and the unique contributions provided by the EFP site. Ben’s sense of identity was shaped by witnessing others receiving support, creating a normalising process that reminded him he wasn’t alone.
Narratives highlighting the healing role of the environment contribute to these stories, drawing on the sense of relaxation and restoration that can effectively take place. This is supported by the growing utilisation of therapeutic models such as ecotherapy, which promotes the natural environment for its tranquillity, serenity, and stress-reducing influence (Arisoy, 2023). Bachi (2013) similarly notes the benefits of the natural environment within EFP as a relaxing, non-threatening setting that promotes openness and relationship building.
Personal Relatedness
An integral part of the participants’ stories was their appreciation for the EFP facilitator, and the peer support provided. Having felt disappointed in previous help-seeking experiences, they found it validating to be met with warmth, safety, understanding, and gentle guidance. Colette’s initial reluctance stemmed from her past interactions with healthcare:
The first thing I remember saying to [facilitator] was, I don’t like psychologists. and it was a bit touch and go with her for a while and I have to say she was really good; I did tackle quite a lot. I do have to say, if it wasn’t for [facilitator] and the help she gave me, I wouldn’t be here now. It had come to a point where the only way out of everything was to commit suicide. and luckily enough, touch wood, I don’t feel like that.
Colette goes on to describe how the peer support further enabled her trust and safety in the facilitator:
It wasn’t until you kind of realised that she [facilitator] knows what she’s doing with us because of [peer facilitator]. He knows what goes on and what went on and that way it’s good because you can kind of broach the subject with him first and say ‘I can really do with getting a lot more about it off my chest. Do you think it would be alright to talk to her [facilitator] about it?’ Nine times out of ten he’d say yes, she’ll get it, and if she doesn’t get it, you can always come back to me. They are a perfect duo.
All participants expressed gratitude toward the facilitator and the peer support offered, with many attributing their successes to the assistance provided. This was particularly powerful given that most had previously felt there was no way out of their distress. Despair was transformed into hope, offering an alternative future that became part of the participants’ stories.
Dialogical Questioning
Identity was developed through validation from the EFP facilitator, which helped participants overcome experiences of power imbalances, adapt to vulnerability, and process difficulties. From an attachment framework, this reflects the provision of a secure base. Reciprocally, Colette’s confidence in the therapist and peer support enabled her to explore her emotional difficulties and develop an embodied sense that feelings can be tolerated (Wallin, 2007). Peer support within the service also modelled how the veteran identity could be adapted, providing hope for participants’ own sense of self.
Narratives of community and belonging characterised stories of personal relatedness, reflecting a widely accepted fundamental human need that most people seek to fulfil (Allen et al., 2021). Confidence was bolstered by the EFP, peer support, and the shared narratives the service provided. This may mirror narratives around being part of the armed forces, where the ‘band of brothers’ and camaraderie are emphasised to foster trust and safety (McCormick et al., 2019).
Empowerment
The insights gained led participants to take action. Some participants struggled with assertiveness, and EFP allowed the facilitator to identify this through the participants’ interactions with the horses, which were typically hesitant and worried. The program provided a training ground for practicing these skills, enabling participants to enact them outside of sessions. As Jack describes, this led to a shift in how they navigated their social relationships:
I was a yes man. “Yeah, I’ll help you with that, oh, I’ll do that for you.” Always trying to be Mr. Nice Guy. I’ve figured out a nice level now and can be thoughtful about my limits at work as well. I try and make time for myself, so yeah, I’m not trying to be helpful with everybody all the time. I took nearly took 3 or 4 months off and got help here and then went back to work a completely different person.
Freya described how her pattern of seeking validation was transformed through the confidence she gained by participating in EFP. “I was always asking for validation. ‘Am I doing this right? Am I doing that right?’ By the end of the course, I wasn’t even asking those questions; I was just doing.” Freya went on to explain how her identity had changed through this sense of empowerment: “I don’t define myself by what’s wrong with me, any more than I define myself by how many A-levels I’ve got.” The opportunity for recovery, self-learning, and eschewing the medical narrative was evident in Freya’s story as she spoke of using her EFP experience to “throw down the challenge” to her movement disorder consultant and take control of her Parkinson’s disease care plan.
EFP provided a sense of empowerment that led to regained confidence, positive emotions, and a reason to live, as Abigail echoes:
I finally felt that I had that self-worth. I finally felt like there was a little thing that ignited in me again. It felt like that was the thing that was missing for a while. It was nice to have a bit of a spring back in my step, it made me feel like I could live again. I haven’t seen light at the end of the tunnel for a long time but since working with the horses you can see that the hole gets bigger now even on the bad days, there’s still light. It just makes you want to carry on, really.
There was a common theme of EFP opening doors to a future that had not been considered possible. Self-efficacy developed as EFP validated Ben’s decision not to continue with a job that had left him feeling stuck for many years:
I did have to change my life. Which is happening. It’s never something I’ve contemplated before; I thought I was going to work until retirement and that would be it. It’s kind of knowing that, yeah, it doesn’t have to be like this, does it?
There is a striking difference between these future-oriented stories and those depicted in Appendix F prior to the EFP intervention. While the earlier stories were characterised by despair and a sense of hopelessness, EFP appears to have enabled a shift in perspective shaped by optimism and hope.
Dialogical Questioning
Identity was developed through individualised means relevant to each participant. Personal growth was encouraged through the holding environment and the affect mirroring provided by the horse (Bachi, 2013). This resulted in a sense of empowerment and motivation to move forward.
Through EFP instilling empowerment, narratives moved from those of inevitable despair to narratives of an alternative future. Recovery-focus and future-mindedness were characteristic of the participants resulting empowerment, with narrative contributions of recovery feeling more ‘in-reach’ for the participants (Rennick-Egglestone et al., 2019).
Discussion
The present study was the first to explore UK veterans’ experiences of EFP. The findings suggest that EFP may be beneficial to UK veterans’ experience of psychological therapies. Key findings included themes of relating to the horse, self-regulation, insight, focus of attention, the environment, personal relatedness, and empowerment.
Dialogical questioning of identity and narrative resources enabled an exploration of the broader influences on participants’ stories. Recognising the sociocultural narratives related to veterans helps us understand the barriers and facilitators to help-seeking and how interventions can effectively address these issues. This involves offering alternative narratives and developing self-actualisation to support improvement.
In relation to the facilitators of help-seeking identified by Randles and Finnegan (2022), this study found that most participants were enabled through peer support, as well as experiencing an increasing severity of difficulty which encouraged them to seek help. The charity provided an accessible service with no lengthy wait time or referral process. The farm site offered a calming environment where even the most doubtful participants felt they could be receptive to support. Altogether, this highlights an important consideration for how services can be better shaped to encourage engagement.
Attachment theory and the principles of psychodynamic therapy were considered. Participants were enabled through a secure base and an effective therapeutic triad. This allowed for emotional vulnerability, exploration of inter- and intra-psychological processes, and corrective emotional experiences within the therapeutic relationship (Kovács et al., 2020). The presence of the horse fostered a sense of connection to other living beings, provided non-verbal feedback to guide the sessions, and enabled an experiential, sensory intervention through which participants developed an understanding of themselves and coping mechanisms for emotion regulation.
Well-Being
The stories told allow for the exploration of the second research question: how EFP may influence well-being. Ryan and Deci’s (2001) construct of well-being consist of two components: subjective well-being and psychological well-being. In terms of the former, an increase in positive affect and experiences can be observed through the content of the stories. Positive experiences stemmed from connection and activities that participants looked forward to. Most participants described a renewed perspective, with hopeful optimism reported, which may indicate a subjective evaluation of their developing well-being.
In terms of the second component, psychological well-being, the six dimensions outlined earlier were considered. Self-acceptance was demonstrated through themes of self-regulation, insight, and empowerment. Participants shared stories of learning how to live with their distress, coming to terms with the fact that it may never go away fully but can be ameliorated through the tools provided by EFP. By developing insight, presence, and processing factors contributing to their distress, participants were able to cultivate self-awareness and self-compassion. This appeared to have an impact on the participants’ identities moving forward, encouraging confidence in their abilities and hope for their futures.
Positive relationships were developed among participants, the horses, the facilitator, and peer supporters. Connection with the horses appeared to be central to the therapeutic process and served as a source of positive affect in itself. These connections were facilitated by participants identifying aspects of their own personalities in the horses. Through developing these connections and with feedback from the horses and the facilitator’s guidance, participants became aware of interpersonal barriers they had not previously recognised. This awareness led to further benefits, as participants developed healthy boundaries and assertiveness, encouraging meaningful and positive relationships outside of the EFP sessions.
Previous research supports the unique attributes of the horses, and the connections formed through EAAT as unique factors and intrinsic motivators (Campbell, 2024). The presence of identified facilitators—such as warmth, trust, and safety—along with peer support similarly encouraged connection and enabled participants to alter their narrative resources and shape their identities.
A sense of purpose and autonomy could be identified for all participants following EFP. Participant stories were shaped by redefined hope and optimism, as well as reduced maladaptive coping mechanisms such as avoidance. Participants began to embrace opportunities and make life choices, such as leaving a job that caused distress and was no longer fulfilling.
Self-regulation is related to the psychological well-being dimension of being able to manage one’s environment. Participants left with a “toolkit” to manage their emotions and behaviours, which they could continue to draw on when adversity occurred. Self-regulation is implicated across multiple domains of psychological well-being, highlighting its protective function and its role in maintaining resilience in the future.
Finally, growth was reported by all participants. Through gained insight, renewed self-worth, and tools to improve their mood, participants were enabled to progress toward their potential. A shift in the participants’ identities and the narratives that informed the stories they chose was evident. This was particularly apparent when contrasting their stories with the descriptions provided in Appendix F, which characterised the participants’ lives before engaging with EFP.
Overall, the findings of this study strongly suggest that EFP was associated with significant improvement in well-being for these participants, all of whom had experienced impactful difficulties such as PTSD and suicidal thoughts. This also supports the findings of Campbell’s (2024) meta-aggregative review, which identified key aspects of the therapeutic process, including compassion, connection, the ability to heal, self-regulation, and the establishment of trust and safety with the horses and facilitators. This is promising for the emerging qualitative literature base on EFP, particularly with veterans, as a consistency in results can inform future innovations.
Strengths
Strengths of the study include the efforts taken to be guided by the participants and to iteratively incorporate findings. The presence of the researcher at the service celebration day, as well as before the formal research process began, helped to build trust and safety. When this was not possible (if participants didn’t attend the event), the researcher ensured that telephone calls were made ahead of the interviews so the participants could have a sense of who the researcher was.
Representation in this study included three female veterans and two male veterans. Prior to 2016, females were excluded from close combat roles; as an overlooked population of veterans, there is a need for robust and rigorous research to ensure that the unique challenges faced by female veterans are explored. All participants, regardless of gender, described the stated benefits.
An issue with EFP research is the varied approaches and models used. This possibly reflects the emerging nature of the field, and the flexible, person-centred methods employed. However, to promote an intervention through the evidence base and to enable funding for such services, consistency is required. The EFP provider used in this research utilised the LEAP model, where training is regulated by the Office of Qualifications and Examinations Regulation standards, and ethical guidelines of professional UK membership organisations are adhered to.
The researcher ensured that steps were taken to address the potential for bias through reflexive measures, such as consulting with a research peer group, reflective journalling, and research supervision. The emphasis of DNA in exploring the sociocultural influences of stories has allowed for rich analysis and systemic considerations not often included in the research of interventions. As a population subject to numerous narratives, it is promising to see the changing narrative resources utilised in the storytelling of EFP, as well as the evolving identities of the participants, which point to an intervention that entails positive experiences. The flexible approach allowed for movement of thought, enabling the researcher to incorporate a wide range of existing evidence and the perspectives of each participant, while also evidencing the commonalities between them. While further research is required, this is promising for EFP provision for veterans in the UK.
Limitations
It is recommended in DNA to corroborate and collaborate on the analysis with the participants. Unfortunately, this was not possible due to the timeframe in which the study had to be conducted. While the iterative approach enabled corroboration across the course of interviews and analysis, it would have been more robust to ask the participants back for a second interview to discuss how their interview experience had been, whether the analysis felt accurate, and if there had been any further reflections the participants wished to add.
The sample within this study totalled only five participants from one EFP charity, which was facilitated by one staff member. While not an aim of the study, it’s important to note that generalisations about EFP cannot be made. The aim of this study was to explore the stories of veterans who had participated in EFP; however, this focus meant that participants had actively sought EFP, and only those who had completed a course were included. Studies aimed at evaluating EFP would need to ensure the participation of a representative sample of veterans and include those who did not complete a full course.
It was also not possible to capture the experiences of people who may have begun EFP and been unable to continue. There is benefit in capturing these experiences to further understand who EFP may be well-suited to, as well as how EFP may be tailored to enable engagement.
Future Research
The present study indicates similarities arising from the qualitative evidence of EFP with veterans from North America. Considering the use of DNA and identifying aspects such as narratives and the role of identity, recreating this study in other countries would be useful to explore the differing sociocultural resources that veterans may draw upon in their storytelling and whether this may influence the provision and/or outcomes of EFP.
Inconsistent quality and results across qualitative and quantitative evidence (Boss et al., 2019; Campbell, 2024) point to areas for further research. Randomised controlled trial (RCT) research is required to examine the effects of EFP on the veteran population. RCTs should be conducted with a UK-based veteran sample to establish the efficacy of EFP in reducing mental health-related symptoms and its wider impact on aspects such as well-being and quality of life. The aims of these studies should focus on reproducibility and the creation of a protocol for the provision of EFP to ensure consistency. Comparisons between EFP, a control group, and established therapeutic modalities such as Eye Movement Desensitisation and Reprocessing (EMDR) and Cognitive Behavioral Therapy (CBT) can be made to explore potential similarities and differences. Outcome measures to consider could include the Warwick-Edinburgh Mental Well-being Scale (WEMWBS), as mentioned previously, for its transdiagnostic usefulness (Biscoe & Murphy, 2024), as well as established measures for mental health symptom reduction.
The current research also indicates the role of the environment, as it was incorporated into all participants’ stories. Further exploration of the influence of the environment in EFP is required to ascertain the underlying mechanisms attributable to EFP and/or its setting. This could also highlight additional implications regarding the provision of other therapeutic modalities and the exploration of environmental influences, as well as whether these modalities may be adapted to incorporate the natural environment.
Clinical Implications
Clinical implications from the results of this research must be approached with caution, given the specific sample and setting used. However, some apparent themes consistently arose across the findings that can tentatively inform clinical practice. The presence of peer support at the farm site was a prominent factor reflected in all participants’ stories. Peer support can encourage engagement and serve as a bridge to civilian professionals, helping to overcome barriers such as feeling misunderstood as a veteran. Given the negative experiences expressed by all participants with statutory services, embedding peer support may help address these challenges and indicates a benefit for the co-production of services, which can help shift unhelpful narratives and enable positive outcomes.
Participants expressed disdain for the clinical settings in which they were seen when accessing statutory services and reported the negative consequences this had on them. Given the positive evaluation of the farm site as an enabling factor in EFP, consideration must be given to how statutory services can incorporate the natural environment into their service provision. While there are understandable difficulties in balancing adherence to principles such as confidentiality and the use of non-clinical spaces, it is not unfeasible to consider the incorporation of the natural environment. Service users could be presented with the choice to enable person-centred practice and improve engagement.
It is promising for sociocultural change that EFP as an intervention may have contributed to a shift in the narratives influencing the stories told by these participants. Given the power of narratives such as “mad, bad or sad” (Parry & Pitchford-Hyde, 2023, p. 441), it is hopeful that, with an increase in promising outcomes for veterans seeking help, sociocultural narratives may begin to normalise challenges to well-being and actively encourage help-seeking. This could potentially lead to a “snowball effect,” whereby veterans experience increased positive healing support and advocacy through well-established peer networks, further encouraging others who are struggling to reach out for help.
The broader application of EFP, its availability, and utilisation should be considered. EFP presents an experiential and unique therapeutic intervention that may offer benefits beyond traditional psychotherapy. As the evidence base grows, it may provide a promising avenue for service users across populations and a range of presentations, especially for those who may not have experienced positive outcomes from traditional interventions offered within statutory and third-sector services. Services and service users may experience better outcomes if EFP, or more generally animal-assisted psychotherapies, were commissioned into service provision.
Conclusion
The present study provides valuable insights into veterans’ experiences of EFP and the factors contributing to the extremely positive outcomes they reported. It further supports the potential for EFP to become a viable option for UK-based veterans, albeit with additional research needed. The participants in this study benefited from relating to the horses, developed self-regulation coping mechanisms to manage daily struggles, gained insight into their personal circumstances that contributed to their distress, were enabled by the focal point of the horses, found safety in the natural environment, experienced personal relatedness with peers, facilitators, and the horses themselves, and ultimately gained a sense of empowerment to enhance their self-worth, self-efficacy, and inform life choices.
Multiple research and clinical implications have been documented for further consideration. Supporting these recommendations, this study provided insight into why and how EFP might be effective in improving well-being in veterans. Specific factors unique to EFP were identified, offering insight into potential processes through which EFP may produce benefits for well-being.
Additional File
The additional file for this article can be found as follows:
Ethics and Consent
This study was approved by the University of Plymouth, Faculty of Health Ethics Committee.
Primary Researcher’s Acknowledgements
I would like to give special thanks to the amazing veterans who took part in this study. Their authenticity, willingness to share, and dedication to healing and overcoming challenges truly inspires me. I would like to express my heartfelt gratitude to everyone who contributed to this research project. A special thank you to Dr Alex Button and Darren Button for welcoming me into your wonderful team. I also extend my appreciation to Dr Stephen Minton for connecting me with the equine therapy service and providing invaluable guidance throughout the research process. Lastly, I am immensely grateful to Professor David Murphy for stepping in as my Director of Studies and for his unwavering support along the way. I dedicate this research to my family, who have supported my growth and learning, enabling me to become the person I am today. In particular, my grandparents taught me to appreciate the power of stories and to revel in the interests of others. To my granny, Flora Campbell, thank you for your endless stories that spark my imagination and create lasting memories. Your ability to find joy in everyday moments always brings a smile to those around you. I truly appreciate your steady support and practical wisdom, which continue to guide me in life. To my grandfather, ‘Dadda’ (David Robson Smith), who sadly passed away during my training, I am profoundly grateful for your lasting influence on my life. You were not just a remarkable wordsmith and storyteller; you were a truly fantastic person whose wisdom and warmth inspired everyone around you. Thank you.
Funding Information
This research received no specific grant from any funding agency in the public, commercial, or not-for-profit sectors.
Competing Interests
The authors have no competing interests to declare.