Methods: The study included de-identified clinical progress notes from two programmes (N = 16) that provided integrated therapy of EMDR+EAP. Data were collected over a 14-month period and analysed using an adaptation of the Goal Attainment Scaling (GAS), with scores ranging from −2 to +2, to assess treatment progress from pre- to midtreatment and from pre- to posttreatment. Session characteristics and pretreatment symptom severity were summarised descriptively.

Results: All participants had negative scores at pretreatment. By midtreatment, 56.3% of participants had achieved a score of 0 or higher. At posttreatment, 50% of participants demonstrated outcomes at the expected level or better (GAS scores ≥ 0). Consequently, the proportion of participants with negative scores decreased from 100% at pretreatment to 50% at posttreatment.

Discussion: The findings provide preliminary support for the integration of EMDR+EAP. Several limitations should be noted, including the retrospective design, lack of a comparison group, inconsistent measurement procedures and variability in treatment delivery; further controlled research is warranted to clarify mechanisms and comparative effectiveness.

Highlights – Implications for Practice

1. Maintaining EMDR Fidelity While Integrating EAP
   • Both practitioners noted that fidelity to the two modalities did not diverge; instead, the approaches complemented one another. Adhering to the eight phases and three-pronged approach of EMDR therapy did not interfere with the implementation of EAP. This is important because practitioners often assume that integrating another therapeutic modality requires modifying the standard EMDR protocol. At least in the case of EAP, such modification was not necessary, thereby allowing practitioners to maintain EMDR therapy‘s effectiveness.
   • However, one clear finding is the importance of practitioner competency in both modalities to ensure effective application of the integrated approach. For example, practitioners must know when to use mounted movement, tapping the horse or self-tapping, depending on the client‘s needs and the therapeutic context. This level of clinical judgement underscores the necessity of expertise and specialised training in both EMDR and EAP.
2. Specialised Competency in Both Modalities
   • There is an undertone within these findings that is not explicitly stated. Both practitioners were advanced in their respective fields, holding certification in EMDR and in EAP. This suggests that the positive outcomes may be related, at least in part, to their level of expertise. Therefore, practitioners who are interested in integrating these modalities may require advanced training in both areas to ensure client safety and to implement the therapies effectively. This level of integration necessitates intentional skill development, as practitioners must be able to determine when and how to apply specific interventions (e.g., mounted movement, tapping the horse, self-tapping) based on the client‘s needs and the therapeutic context.
   • Bilateral Stimulation and Client Readiness and Equine Interaction
   • Client readiness is crucial for any therapeutic intervention. In this instance, particularly regarding EMDR‘s bilateral stimulation, it was important to understand what worked best for the client and how to apply EAP simultaneously without compromising the effectiveness of either modality. The flexibility offered by both approaches, as described by one of the practitioners, may explain why the treatment appeared effective rather than counteractive. This flexibility supports individualised treatment planning and enhances client attunement and engagement.