It wasn’t working for Skylar Thompson, none of it. Not her parents’ relationship, not her friends at elementary school, not Vyvanse, the daily medication her doctor had prescribed for her recently-diagnosed Attention Deficit Hyperactivity Disorder (ADHD).

Over the years, Skylar had grown increasingly impulsive and prone to fits of tears and anger. In school, she could not control what she said to her peers. She’s since blocked out the specifics, but she remembers bringing them to tears. If a friend asked her to keep a secret, she immediately shared it; if she misplaced a pair of scissors, she accused her desk neighbors of theft. “People really didn’t get along with me,” she recalls.

Life at home certainly wasn’t helping. At her house in East Lyme, Connecticut, her mother and father argued without interruption. These episodes made Skylar hyperventilate as though, in her words, a snake were slowly coiling itself around her body and choking the air out of her lungs. During one particularly virulent fight, when Skylar was three, she recalls running in between them, covering her ears, and shouting, “Stop arguing!” Her father left for an apartment in Rhode Island soon after.

The next time she saw her parents in the same room, her doctor gave a name to the behavioral and emotional turbulence that had defined her childhood: ADHD. The diagnosis joined existing diagnoses of anxiety and depression. Though she may have wanted help at the time, Skylar says, her mental state prevented her from asking for it.

Skylar’s case is far from unique. Over 43 million Americans were diagnosed with a mental illness in 2012, but only one third of those afflicted can or do seek professional help, according to the National Alliance on Mental Illness. The rest, due to their location, lack of healthcare access, or insufficient information, are left to cope without the guidance of a qualified therapist or psychiatrist.

Moreover, for many people, especially children like Skylar, traditional talk therapy proves too challenging to help. Yale researchers Alan Kazdin and Stacey Blase, writing in Perspectives on Psychological Science, have suggested that the medical community must pay attention to alternative forms of therapy as a way of reaching more people.

When Skylar was in fourth grade, her swimming instructor suggested an “up-and-coming” form of alternative treatment known as therapeutic horseback riding. The treatment, the swimming instructor claimed, confers many of the same benefits as traditional talk therapy for someone with a mental illness. But, rather than languishing on a therapy couch, patients ride horses. And rather than rehashing life events to a drowsy therapist, they learn character-building skills with a riding instructor.

 

I was first attracted to profiling Skylar because her story echoed my own. Unlike Skylar’s, my anxiety is a newer phenomenon, blossoming unexpectedly at the age of 18 like an unwanted growth. But, like Skylar’s, my anxiety is intense, often without explanation.

In the fall of 2011, I arrived at Yale as the University’s only totally blind undergraduate at the time. College was much more debilitating than I’d anticipated. As my classmates acclimated, I seemed to be the only freshman who didn’t know how to travel to buildings a mere block away from where I lived. I couldn’t serve myself food in the dining hall or search the room for familiar faces to plop down beside. And I couldn’t go out at night without a dedicated set of friends, which I hadn’t yet found.

Each day brought with it the same stressors. I panicked and withdrew further, until I was spending most of my time huddled in a ball on my dorm room bed. Days passed in a fog, and I ended each night with a fistful of pills and much-desired oblivion.

I started seeing a therapist. Slowly, I began to feel better, finding friends, clubs and evening plans. But the anxiety clung to me. Each time I sat to write a challenging paper, or venture somewhere new, my heart thumped, my limbs shook, my teeth chattered and the cycle once more repeated itself.

Even now, though life has otherwise returned to normal, the anxiety hasn’t much subsided. I still cry in most of my therapy sessions. At the conclusion of a particularly tumultuous session earlier this year, I began trembling and sobbing, not to be stopped. My therapist spent several unsuccessful minutes over our time limit trying to calm me, before meekly suggesting that I try calming down in the waiting room. I left, clenching a damp tissue, thinking for the first time that there must be some other way.

That night, I googled “alternatives to talk therapy for anxiety disorders.” The results were largely unhelpful. I could try different types of talk therapies. Perhaps hypnotism or electrocompulsive shock. One wayward commenter prescribed shots of whiskey.

One treatment caught my attention: therapeutic horseback riding. I hadn’t grown up with animals; I thought they were smelly and dirty, and I didn’t fancy going near them. How could riding an animal help when the other therapies I’d tried — talk therapy and anxiety-dampening emergency pills, for starters — had not? Could a horse really calm me down? I didn’t feel convinced. But, for what I told myself would be a purely journalistic exercise, I copied down the contact information of a nearby riding facility.

 

At first, Skylar harbored the same skepticism. But, soon after speaking to her swimming instructor, Skylar and her mother came to High Hopes, a therapeutic horseback riding center in Old Lyme, Connecticut. The center is among a small but growing number of facilities across the country catering to individuals with physical and mental disabilities. It employs a staff of 30 people and offers individual and group lessons for a semesterly fee.

Skylar was placed atop a horse named Dolly, who began walking with Skylar fearfully astride. Never had she felt so disconnected from the ground and vulnerable to falling. But she let herself ride, and she did not falter. Six years later, she continues to take lessons at High Hopes twice a week. “It’s like they give you a best friend,” she tells me.

Proponents of this form of treatment say that horses have human-like social and responsive behaviors, making it easy for humans to bond with them. They posit that building a healthy relationship with a horse helps people navigate other social interactions as well.

But the passion surrounding therapeutic riding is not presently echoed by empirical research. A group of researchers at Southern Mississippi University and Emory stated in a 2014 paper that the few empirical studies conducted have yielded inconclusive results.

“Investing in therapeutic horseback riding is premature at this point,” said Molly Crossman, a psychology graduate student at Yale University working with Alan Kazdin, one of the few researchers across the country applying rigorous experimental methods to animal-assisted therapeutic treatments.

Crossman said there is preliminary evidence that other animals, such as dogs, may help alleviate anxiety. But, in the meantime, treatment seekers charging ahead with therapeutic horseback riding risk exposing themselves to unknown harm, and, without insurance companies’ backing, are spending excessively on a treatment with dubious benefits.

“We want people to use treatments that are empirically supported,” Crossman said. Right now, therapeutic horseback riding is not one of those treatments.

 

With equal parts curiosity and bemusement, I find myself one misty November morning on a train headed for Old Lyme. High Hopes’ program director Liz Adams, a willowy woman with long brown hair and full lips, ushers me into her office off the cozy waiting room.

I’ve come to ask about Skylar, whose family has given me consent to observe and interview her. But Liz declines to discuss the specifics of Skylar’s condition. Though all students must submit medical forms with proof of a disability, she says, the specific diagnoses are irrelevant so long as riders can interact with horses safely. Liz emphasizes that her instructors are not licensed therapists: they can discuss riders’ behavior relative to that of their horses, but they are not qualified to delve into why particular emotions or behaviors may be surfacing.

A new rider starts on the ground, stroking the horse’s neck, petting its shoulders — even allowing it to sniff her. I shudder at this, and Liz takes notice. The key is to act calmly around the horse, she says, not to charge toward it or hold yourself back.

Once the rider feels comfortable, Liz transitions to mounted work. Participants at High Hopes are always accompanied by an instructor and a “side-walker,” a volunteer who steers the horse and ensures the rider knows she will not fall. Gaining riders’ trust and confidence is itself a feat. But more important is being able to teach riders that they can control the horses through calm communication. “A panic attack is a feeling of being out of control,” Liz says. “So finding a way to gain control over your emotions to help align with another is a good coping mechanism.”

I still feel skeptical. If therapeutic horseback riding really works, then why isn’t it a recognized treatment for mental illness? Liz cites a lack of research. “The research that we have is small and not necessarily reliable,” she concedes. “There’s been a lot more evidence-based research that’s been done with people with physical disabilities. But it’s a lot easier to measure someone’s range of motion or balance reactions than it is to measure someone’s emotional well-being.”

Still, the therapy’s profile is on the rise. This past August, the Professional Association of Therapeutic Horsemanship International, the group shaping the treatment’s standards, was invited for the first time to exhibit at the annual American Psychological Association conference in Washington D.C. High Hopes is also partnering with therapists and school districts, which have referred a portion of their students to the program.

“As more and more research happens, and as there’s more and more publicity for what we do, there’s less and less skepticism,” Liz says. “I mean,” she adds, “obviously it’s still out there, or else insurance companies would be paying for [the therapy] regularly.”

 

The next afternoon, I meet Skylar just before she enters the barn for grooming. She is wearing jeans, riding boots and a forest green High Hopes hoodie, faded from what appears to be too many washings. I take note of her punk-looking hair, dyed bright orange-red with a purple streak. Suddenly, I become conscious of my inappropriate attire: suede ballet flats and a gray knit sweater. As she leads me into the barn, I silently pray that the smell of manure doesn’t cling to me after I leave.

She leads me toward her regular riding partner, Gracie, a ladylike black bay horse with white splotches. “She’s very stubborn and nosy,” she says with a laugh. “She’s just like me, actually, now that I think about it.” The two even share a birthday: May 30, 1999. Skylar briefly grooms her horse, using an array of different-sized brushes, before mounting her.

In the facility’s indoor arena, a large rectangular room with a vaulted ceiling, Skylar and four other girls mount their horses and trot the perimeter under their instructor Lauren’s watch. A horse passing in front of me neighs loudly, and I spring backward; luckily, no one notices.

“We have to be proactive riders, not reactive riders,” Lauren tells the girls. “What does it mean to be ‘proactive’?” Skylar meekly offers “getting someone to do something.” Lauren latches on. “That’s right! When you act reactively, you are a passenger. You should not be a passenger when you are riding,” she says. “We need to be active riders. You need to be thinking three to four steps ahead of where your horse is going.”

It all sounds a bit like an overwrought metaphor. But as I leave the arena, I realize that the message she is attempting to deliver to her girls is one that they must work harder than most to absorb. And it’s easier to do so mounted on a horse, where they feel at ease.

 

Skylar and I slip into Liz’s office, now vacant, to continue chatting. I ask her how therapeutic horseback riding has helped her cope. She says that when she first began, her depression actually worsened. Her mom remarried, and Skylar fell in with friends she describes as “fake.” Petty fights with her mother and stepfather grew frequent. (Her mother Deborah declined to be interviewed herself.)

Skylar began cutting herself. First her wrists, then her thighs. She started seeing a psychotherapist. But riding still seemed to help more than anything else. “Being here,” she says, “would always end up being the one place where I would really start smiling.”

In eighth grade, she realized “if people get through anxiety and depression without doing that to themselves, I can do it too. I just have to find the proper way.” She chose to continue with therapeutic horseback riding. “It’s like a dirty, smelly spa,” she says.

Around that time, she found friends in the “queer, emo crowd,” which inspired her conversion to paganism and interest in drawing comics. In ninth grade, a girl named Olivia in her art class caught Skylar’s eye. “We’ve been dating for six months,” she tells me excitedly.

Megan, her regular riding instructor, said that Skylar’s social skills have undeniably improved. “I would say in the last few years, she’s been getting into her teenage years, she’s come out of her shell a lot,” Megan told me. “She’s actually quite social now. Which is nice to see. I can see it pull her focus away from horseback riding a bit, but it’s great to see her developing relationships and really getting a lot of joy out of that.”

 

When I return after observing Skylar’s riding lesson, I give Molly Crossman, the Yale researcher, another call. Skylar seemed convinced of the effectiveness of horseback riding as a therapy; even I, despite my repulsion to horses, feel like I am beginning to understand. Why, then, has research on the treatment lagged so far behind?

“In the general population of people, there isn’t really a lot of skepticism about animal-assisted therapies, more than they almost believe in other kinds of therapies,” Molly says. “Maybe it historically has not been subjected to that kind of scrutiny because it has that sort of intuitive appeal.”

We hang up, and I realize that I will not be able to decide for myself unless I personally give therapeutic horseback riding a try.

I arrive again at High Hopes, shivering at the thought of climbing on a horse. The memory of the horse’s smell fills my nostrils, and I begin feeling nauseous.

Then my instructor, Megan, arrives. She must notice I’m nervous, because she puts her hand on my arm as she begins to speak. She fits a helmet onto my head before I can adjust my hair. I try to move on — I am a horseback rider now, after all.

As we walk towards the arena, Megan tells me a story. Several years ago, she says, one of her students, a woman who was prone to anxiety, became worried that she would lose control of her horse. When the woman panicked, so did the horse, jumping higher and increasing its gait. Megan, fearing for the woman’s safety, advised her to dismount, but the horse remained antsy. Finally, Megan asked the woman to shut her eyes and visualize herself walking calmly through the field. The moment she did, Megan says, the horse neighed and came to a standstill. “It was really a fascinating situation where the horse was so in tune with the human’s energy,” she says, “that when she was able to consciously lower her anxiety, the horse’s anxiety immediately lowered as well.”

At the arena, my horse Vixen stands in front of me, waiting to be mounted. I swing one leg over her back — Megan catches my arm so I don’t fall — and arrive mostly centered on Vixen’s saddle. When the horse begins walking, I feel myself teetering to the left and reflexively grab Vixen’s hair to steady myself. I wonder if I’ve hurt her. I wonder how many more times I will nearly fall.

Megan steps beside me and instructs me to hold Vixen’s rein.  “Horseback riding is dangerous, you know? It is scary, it involves the need to balance on this narrow, moving creature that has its own mind and can be unpredictable, and there’s nothing strapping you down or holding you on. But I do think there is a sense of dignity in taking on a risk like that.”

Vixen and I fall into a rhythm, and I begin to relax. Megan asks me if I want to try a trot, one speed faster than walking, and I say sure. She tells me that when I want to slow down, I can clench my abdominal muscles to signal the horse. The pace quickens and I begin bouncing up and down, enjoying myself. I forget to signal until Megan, behind me, shouts at me to clench. When I do, the horse comes to a quick halt.

“I can’t believe it was that easy to signal her,” I tell Megan in disbelief. She laughs, moving Vixen and me back into a trot.

Soon, my surroundings begin to disappear — first the echoing noises in the arena, then Megan’s voice, and even the footfalls of Vixen below me. I feel melded to my horse, peaceful as she moves forward. She slows as if to express her calm, but I am ready for her to go. With one gentle squeeze of my legs, she’s off, and any anxiety I had carried into the arena falls further and further away as the horse trots on.