Across the United States, 5.8 million children and adolescents between 3 and 17 years of age have a diagnosable anxiety disorder, which, if left unaddressed, can recur or become more detrimental to the child’s overall mental health. Cognitive-behavioral therapy (CBT) is considered the gold standard of treatment for youth with mild and moderate anxiety; however, half of all youth who would benefit from mental health services do not access any care, and the large majority of youth do not receive evidence-based practices (EBP). Reining in Anxiety (RiA) is a 10-session, manualized adaptive horseback riding program that incorporates evidence-based cognitive-behavioral elements for children and adolescents with anxiety. RiA is delivered in horse stables by certified therapeutic riding instructors, who are credentialed professionals through the Professional Association of Therapeutic Horsemanship International (PATH Intl.). Delivering mental health services in naturalistic settings using alternative providers addresses logistical and perceptual barriers to help seeking as well as expands the workforce to meet the need for services. Accordingly, the purpose of this chapter is to provide an overview of Reining in Anxiety, including its development and evidence base, gaps in research for both RiA and animal-assisted services (AAS) more broadly, and future directions.