Equine-assisted therapies (EATs) have been widely used in the treatment of patients with mental or physical conditions. However, studies on the influence of equine-assisted therapy (EAT) on equine welfare are very recent, and the need for further research is often highlighted. The aim of this study was to investigate whether EAT creates negative or positive emotions in horses, and the influence of patients’ expectations (one group of patients had physical and psychological expectations and one group of patients had only psychological expectations) on horses’ emotional responses. Fifty-eight pairs (patient–horse) were involved in this study. Behaviors and heart rate variability (HRV) data were collected during a resting phase, a preparation phase in which the patients brushed and saddled the horse, and a working phase. Behaviors and HRV were compared between phases and among the groups of patients. Our results suggested that the EAT in this study was neither a negative nor a positive event. EATs with patients who had both physical and psychological expectations were more challenging for horses than those with patients who had only psychological expectations. Further research should focus on providing horses with positive stimulation and reinforcement to understand whether a positive association with EAT can be achieved.
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