Current approaches to treating storm phobia (Proceedings)

Phobia

Fear reactions that

are persistent over time

are consistent in terms of what causes the fear

are learned, irrational, not adaptive

May be, but is not necessarily intense (hysteria, catatonia, panic)

"Normal" Fear vs. Phobia

Experiencing fear every time a hungry lion charges at you is normal (run, hide, defend)

Experiencing fear when lightning hits a nearby tree is normal (run, hide)

Experiencing fear every time there is a dark cloud in the sky is a phobia

Interaction of Stimulus X Fear

Possible Causes

Genetic Factors

Traumatic/Aversive Events

Restricted Early Experiences

Unintentional Reinforcement

Management Steps

Under NO circumstances should punishment be used

Management Steps

Relaxation...

Keeping the pet calm and relaxed in general is an very important part of treatment

Sit/Stay/Relax exercises

Treatment may be simple:

Bring the dog indoors during the storm

Provide television or radio "noise"

Dog may be ok as long as owner is present

Provide "safe hiding place"

Bathtub

Laundry basket

Closet

May be serious and not respond to simple treatment

Serious injury

Significant damage

Upset owners

Owner-pet bond

Re-homing

Euthanasia

Composite fear

thunder, lightning

change in barometric pressure, ionization, illumination

Simple techniques not always effective

Set Realistic Goals

I don't care that there's a tornado hitting the house.

I don't care that there's a severe thunderstorm overhead.

I don't care that there's a moderate thunderstorm overhead

I don't care that it's raining.

I don't care that there are dark clouds in the sky.

Anxiolytic medication

Maintenance drug: gets daily

Fast-acting drug: gets as needed

Behavior modification

Maintenance Drug

At least for length of storm season

Relief from chronic, mild to moderate anxiety

Some anxiolytic effect if owners miss storm-specific dose

Fast-acting Drug

To get dog through the storm NOW

Maintenance drug may not be sufficient when severe storm immediately overhead

Fast-acting, strong anxiolytic effect

Some notable for anti-panic effects, especially alprazolam

Behavior Modification

Desensitization and Counter-Conditioning

Maintenance Drugs

Tricyclic antidepressant

Clomipramine

Selective Serotonin Reuptake Inhibitor Fluoxetine

Paroxetine

Fast Acting Drug

Diazepam

Alprazolam

Desensitization

The animal is exposed to a stimulus that elicits a given response, but at such a low level that the response is not elicited. Over time and successive repetitions, then intensity of the stimulus is gradually increased, ideally without eliciting the response.

Counter-conditioning

A response is elicited which is behaviorally and physiologically incompatible with another response.

DS&CC

Expose pet to a very low level of stimulus

Counter-condition with food when relaxed or playful

Very gradually increase the intensity of the stimulus until it approximates actual levels

If at any time the pet experiences anxiety or fear, move back to lower stimulus level

Time-consuming

May be useful if dog shows clinical signs during "mock" storm (i.e. CD recording)

May work for the noise component of the fear

Need to narrow down part of storm dog is fearful of

Don't start with thunder if dog is afraid of rain

Start with least threatening stimulus

Light Rain < Heavy Rain < Soft Thunder, etc.

May be best to DS&CC off storm season

Goal is for animal never (ideally) to experience fear

Make sure that dog is never anxious

Reward calm and relaxed behavior

Open Clinical Trial

Combination Treatment

Clomipramine

Alprazolam

Behavior modification

Sponsored by Novartis Animal Health

Extra-label use of Clomicalm™

Treatment

Clomipramine

2 mg/kg b.i.d. for 90 days

then 1 mg/kg b.i.d. for 14 days

then 0.5 mg/kg b.i.d. for 14+ days

until actual exit visit

If no improvement at 30-60 days, increase dose to 3 mg/kg b.i.d.

If unacceptable side-effects not severe enough to require exit, decrease dose to 1 mg/kg b.i.d.

Treatment

Alprazolam

0.02 mg/kg given prior to storms

Can repeat dose every 4 hours up to 4 times/24 hours

Post hoc: Increase alprazolam dose up to 0.1 mg/kg in conjunction with clomipramine if lower dose is

insufficient

Do in a stepwise fashion

Likert Scale

Checklist of behaviors seen during storms

at Baseline, 30, 60, 90, 120 Days

Destructiveness 1-5 Elimination 1-5

Excess salivation 1-5

Excess vocalization 1-5

Hiding 1-5

Pacing 1-5

Panting 1-5

Remains near owner 1-5

Self-trauma 1-5

Trembling 1-5

Score of 0 if doesn't occur

Total possible score: 0-50

Owner Report at 30 Days (N=38)

Worse           1

Unchanged           12

Somewhat better           18

Substantially better, not resolved           7

66% of dogs have shown some improvement at 30 days

Owner Assessment of Overall Improvement at 120 Days (N=32)

Worse           0

Unchanged           2

Somewhat better           16

Substantially better, not resolved           12

Resolved           2

94% show some improvement by 120 days

No patients got worse

Predictability of 30 Day Response?

Significant correlation of total Likert score between improvement at 30 days and total improvement at

D.A.P.?

Open trial suggests may be beneficial to some patients.

Ongoing double-blind placebo-controlled study