PTSD is an anxiety disorder that occurs after exposure to a life-threatening event or injury. PTSD is marked by four symptom domains: re-experiencing (i.e., flashbacks), avoidance, changes in beliefs and feelings, and hyperarousal. Estimations of the percentage of the more than 23 million veterans who experience clinically significant PTSD symptoms per year vary by service era and are estimated to be in the range of 11%–20% from Operation Enduring Freedom/Operation Iraqi Freedom/Operation New Dawn, 12% from the Gulf War, and 15% from the Vietnam war (30% in their lifetime). While these numbers are significant, PTSD is likely to be under-reported due to stigma, making these percentages lower than might be accurate among those who have served.

            PTSD has been associated with poor quality of life and increased use of health care services, and a variety of co-morbid physical and psychological conditions; most notably depression and substance misuse and addiction to drugs and alcohol. Emotional withdrawal and numbing is common among men, while higher arousal, lack of control, and self-persecution occurs among women. Greater combat exposure has been associated with more PTSD symptoms and poorer readjustment.

            Research suggests that a common coping response to PTSD among veterans is excessive alcohol use. Furthermore, veterans’ attempts to cope with PTSD symptoms through alcohol use may further magnify the challenges of reintegrating into post-deployment life. PTSD, depression, and substance use disorders are associated with a variety of family problems, including marital distress, domestic violence, poor parenting, and a variety of behavioral health problems for children. These consequences place spouses and children at increased risk for their own behavioral health concerns.

            Clinically, Therapeutic Horse Riding (THR) is a standardized horse riding program for people with disabilities in which the primary goal is their rehabilitation. THR psychological and social benefits may be important factors to facilitate veterans’ coping with PTSD symptoms. Preliminary evidence suggests that PTSD and other anxiety/depression related mental health symptoms may also decrease with Physical Activity (PA). PA occurring during THR may be a potential positive coping strategy for veterans with PTSD. In THR, the rider experiences the horse’s stride, using core strength to remain erect, making horseback riding not merely a passive experience, but also a PA. THR in a class setting may foster social support and enhance the veterans’ willingness to do other PA.

            Veterans who participated in an equine assisted learning program (i.e., horses used to promote cognitive reframing and mindfulness) reported that the program had very positive benefits on their PTSD symptoms and coping skills. Veterans who took part in a THR program reported greater communication skills and self-awareness and self-esteem. THR participants have characterized horses as accepting and nonjudgmental.

            THR may be a beneficial activity to reduce PTSD symptoms in veterans and also increase PA, reduce stress, enhance coping self-efficacy, and provide social support.