Fears, phobias, and anxiety disorders (Proceedings)

Fears and phobias may be due to a pet's genetics, learned from an unpleasant experience or result from inadequate socialization. Dogs and cats that have not been sufficiently socialized to other species and environments during the critical period of socialization may develop fears that are particularly difficult to correct at a later age. When fear-related behavior is successful and removes the pet from the stimulus (e.g. escape, aggression), the behavior may be reinforced. The prognosis for effective correction varies greatly with the cause. Behaviors due to a strong genetic component or social deprivation can be the most difficult to change. Acquired fear disorders generally have a better prognosis.

Fear-related behaviors can be reinforced by the owner's response to the behavior. Owners who try to calm their fearful pets when showing avoidance or aggressive behavior with affection, attention or food may actually reward the response. It is essential, therefore, to consider the owner's response to the fearful pet in order to identify and eliminate any potentiating factors. Punishment can increase the pet's fear and anxiety and is typically contraindicated.

A number of behavior modification techniques including flooding, habituation, systematic desensitization, counterconditioning and positive reinforcement can be used alone or in combination to correct fearful behaviors. The first step is to identify and control every stimulus that might evoke fear until the program is successfully completed. Unfortunately, this may not always be possible (e.g. thunderstorms, traffic, visitors coming to the home). Should a fear-evoking situation arise during the retraining program, it is critical that the pet is well controlled so that injuries do not occur and the problem is not further aggravated. For example, if the pet is in a crate, on a leash or wearing a muzzle or head halter, injuries and escape behavior can usually be prevented. Often, the best owner response is to have the pet perform an acceptable behavior, such as sit-stay. When the pet calms down and exhibits no fear, it can then be rewarded. In some situations, quickly removing the pet from the situation may be the most prudent decision.

Behavior Modification

The primary strategy is to associate something the pet really likes with the stimulus that triggers a fear response. The positive stimulus should be highly motivating to the pet (e.g. meat treats, favorite toy), and should be withheld except for training sessions. For desensitization and counterconditioning, the pet is initially exposed to levels of stimulus that are below the level that will evoke a fear response. Distance, size, volume and human behavior are the variables that are typically controlled during exposure exercises. Rewards are given only if the pet shows no far when exposed to the minimized fear-eliciting stimulus. The pet is then gradually exposed to increasing intensities of the stimulus.1,2 In time, the pet should perform the desired behavior in the presence of the full strength of the stimulus. If the fear threshold is surpassed at any point in the desensitization program, the owner must back up the training to a previous level and proceed in smaller increments.

For owners with good control and a pet with mild problems, flooding techniques (exposure to stimuli above the threshold that elicits fear) may be faster and equally as effective as desensitization at reducing or eliminating fear. For controlled flooding techniques, the stimulus should be presented at a reduced level, sufficient to cause minimal fear or anxiety. A leash and head-halter control can also be used to ensure compliance. The pet should be exposed to the stimulus until it shows nor sign of fear. Once the pet responds shows no fear, rewards should be given and the training session can end. The stimulus can then be gradually increased for each subsequent training session until the pet will accept exposure to the stimulus at full intensity without exhibiting any fear. Flooding may not be the best choice in many cases because it is usually not as practical as using desensitization/counterconditioning and can make the problem worse if not applied correctly.

Since the ultimate goal is to teach the pet to be relaxed in the presence of the fear-eliciting stimulus, techniques that cause pain or discomfort should be avoided. This includes using a pinch collar or using a choke chain to apply a correction. Harsh, uncomfortable corrections are especially problematic for fear-related aggression problems, since they can increase aggressive arousal while at the same time removing warning signals.

Behavior Modification

1. Identify fear-eliciting stimuli

2. Identify thresholds

3. Arrange gradient of stimuli

4. Desensitization and counterconditioning

Fear of People or Animals

Some pets show fear toward a certain type of person/animal (children, babies, men in uniforms, men with beards, small dogs/large dogs, black dogs), or to all humans and/or animals. The fear-related response may include cowering, trembling, freezing, withdrawal, escape or aggression.

Reducing or eliminating fearful behavior requires identification of all stimuli that might cause fear, and avoiding exposure to strong fear-eliciting situations while the pet is being conditioned to be relaxed in the presence of milder ones.

It helpful to have verbal control of the pet. Reinforcing command responses such as sit-stay or down-stay for tasty food rewards can be taught before beginning the conditioning exercises. Once the pet has been effectively trained to respond to obedience commands, the owner can begin to expose the pet to controlled levels of the fearful stimuli beginning below the threshold that elicits a fear response. If the pet shows no fear and responds to the commands, food rewards should be given and the owner can proceed to a slightly stronger level of stimulus with each successive training session. By withholding rewards except for training sessions, the pet should learn to associate positive experiences with the formerly fear-eliciting stimuli. A leash attached to a head-halter system may be helpful for some owners that have difficulty gaining control and getting the pet to respond to commands.

a) Fear of People (men, children, babies, etc.)

Conditioning should begin at a distance from the stimulus where the pet recognizes the stimulus but exhibits no sign of anxiety. As the pet improves, the distance is very gradually reduced. If the pet is fearful of specific types of people, training should begin with a person of slightly different characteristics. For example, pets that are fearful of young children should first be desensitized to the presence of older children. Additionally, the pet can be desensitized to tape recordings of children playing before actual exposure to the children. Pets that are afraid of men with beards, hats or uniforms can first be desensitized to approach and handling from men without beards, hats or uniforms, or to members of the family "dressed up" with beards, hats, or uniforms. Pets that are anxious in the presence of babies might first be desensitized to tape recordings of the baby's sounds, or to the owner carrying dolls wrapped in baby blankets. During exposure techniques, the pet must be well controlled. For aggressive pets or pets that might attempt to escape, a leash, halter or crate may be useful.

For the pet that becomes fearful when visitors arrive, you may first want to desensitize it to arrival cues. Changing the door bell tone may help reduce fear arousal in some dogs. Begin by desensitizing the pet to sounds at the door by having family members ring the bell or knock at the door. The bell should be rung repeatedly at short intervals until the pet habituates and all undesirable fear-related responses cease. Each time the bell rings or the person knocks and the pet shows no undesirable response, it should be given a very tasty food reward or favorite toy. Next, invite people to visit that are familiar to the pet and around whom it feels the most comfortable. Have the pet on a leash at a safe distance away from the door. When the visitor enters, he should ignore the dog and avoid making eye contact. If the pet shows no signs of fear, it can be asked to sit for a tasty food reward. Once indoors, the visitors should ignore the pet and provide attention only if it approaches in a friendly, non-fearful manner. Treats may be casually tossed near the pet to facilitate approach behavior. The distance between the visitor and the pet should gradually be decreased. Next, proceed to other people that the pet has previously met and finally to strangers. If the pet is most afraid of adult men, then this set of exercises should first involve unfamiliar women followed by exercises with unfamiliar young adult men, and, finally adult men. Ensure that rewards that are most valuable to the pet are saved for training sessions, so that the pet learns to look forward to the presence of visitors or strangers because their presence predicts that the pet will receive special food treats.

b) Fear of Other Animals

Desensitization to other animals should begin in a neutral environment with a well behaved, well trained and well controlled animal as the stimulus. There should be sufficient distance between the animals to ensure successful desensitization. The starting distance should be an interval at which the pet can recognize the other animal, but not close enough to it that any fearful response is elicited. The fearful pet should receive something it values for exhibiting no fear in the presence of the fear-eliciting stimulus. In time, the distance between the pets is gradually reduced. Head-halters can be very helpful for control.

Noise Phobias (thunder, gunshots, fireworks)

a) Identify all stimuli causing the phobic behavior and attempt to isolate the pet from exposure to these stimuli during training. Keeping the pet indoors, sound-proofing an area of the home or temporarily relocating the pet when problem situations are expected may be helpful.

b) Find a method of controlling or modifying the stimulus for desensitization and counterconditioning. For dogs with gunshot phobias, a starter pistol can be placed in a sound-controlled chamber or muffled with towels. As conditioning progresses, the sound insulation is gradually removed. Increasing the distance from the stimulus to the subject can also be used to provide low levels of exposure. Tape recordings or videotapes of thunderstorms may be useful provided the recordings are also capable of evoking fear. The pet should be exposed to increasing levels of the stimulus. Some modification of the stimulus may also be helpful.

c) To begin desensitization and counterconditioning, select an appropriate location for training, preferably where the pet feels most comfortable and secure. Expose the pet to a low level of the fearful stimulus. For desensitization, the level should be just below the threshold that will evoke fear. While the pet is exposed to the stimulus, it should receive something of value (food, play, social contact). For well trained dogs, requesting command responses for food may help keep the pet more focused on the conditioning and lessen the likelihood of an anxious response. As conditioning progresses, gradually increase the intensity of the stimulus until the pet is exposed to it at full strength. Once the pet learns to be relaxed in the presence of the strongest stimulus, the conditioning should move to a variety of environments and the tonality/presentation of the stimulus can be varied.

Severe thunderstorm phobias present quite a challenge and can be extremely difficult to treat solely using conventional behavior modification. Multiple stimuli are involved in this problem and it is difficult to find artificial stimuli for use in desensitization and counterconditioning to which most pets will respond. It is also difficult to protect the pet from storm exposure between training sessions. For pets that are at a very high risk for severe injuries related to the phobia or who may cause extensive damage in the home, extended pharmacological treatment for days or weeks at a time during storm season may be necessary.

Despite the best of intentions, the pet may inadvertently be exposed to a strong stimulus before conditioning is complete. Should the pet show any fear or anxiety, the owner should ignore the pet. If the pet calms down or can be sufficiently distracted to the point that the fear ceases, a reward maybe given.

Pharmacology

Phenothiazine tranquilizers (acepromazine) may be helpful for mild cases but are sedatives, not anxiolytics. High doses for advanced problems may cause so much sedation that the pet is not be functional. Benzodiazepines are very potent anxiolytics that can be very helpful for severe cases. In most cases, medication should be given one to three hours prior to exposure to the fear-evoking stimuli for optimum effect.

SSRIs, TCAs and buspirone may also be beneficial, but cannot be given "as needed" since they typically take two to four weeks to produce a behavioral response.

Benzodiazepines

Mode of Action:

-Acts on limbic system and reticular formation

-Potentiates GABA, an inhibitory neurotransmitter

-Part of effect may be do to sedation

Uses: a. Anxiety disorders

b. Fears and phobias

c. Feline urine marking

c. Anxiety related inappropriate elimination

Comments:

-Long term use may produce habituation

-May be withdrawal signs which can be severe. Always must be carefully tapered off.

-May cause hyperphagia, ataxia, depression, and sometimes a paradoxical increase in activity/agitation (which may subside after a few days)

-May release inhibitions in fear aggression and disinhibit attack behavior.

-May interfere with learning.

-Contraindicated: Impaired liver function

Alprazolam: DOGS: 0.25-2.0 mg po bid-tid

CATS: 0.125-0.25 mg/cat po bid

Clorazepate: (longer acting, more expensive)

DOGS: 0.55-2.2 mg/kg PO daily sid-bid

CATS: 0.55-2.2 mg/kg PO as needed or .5-1.0 mg/kg sid-bid

Diazepam: DOGS: 0.55 to 2.2 mg/kg PO as needed

CATS: 1-3 mg/cat sid-bid (**Acute, fatal hepatopathy has been documented in a small number of cats**)

Lorazepam: CATS: 0.125-0.25 mg/cat bid

Tricyclic Antidepressants

Mode of action:

-Block serotonin reuptake at receptor sites; serotonergic

-Other effects

-Peripheral and central anticholinergic action

-Variable degree of antihistaminic activity

-Mildly sedating

Uses: a. Antianxiety disorders (separation anxiety)

b. Phobias (storms, noise)

c. Compulsive disorders (acral lick, spinning, fly snapping, feather picking, woolsucking in cats)

d. Housesoiling (marking, anxiety-related)

e. Aggression

Caution:

-Side effects: (anticholinergic) dry mouth, inappetence, constipation, disorientation, depression, ataxia urine retention,

-May reduce seizure threshold

-May interfere with thyroid replacement medications

-Must have normal hepatic and renal function

-May alter liver enzymes

-Cardiotoxic: Possible arrhythmias in cats and dogs. May cause tachycardia, syncope.

Amitriptyline: (moderate sedation, potent anticholinergic )

DOGS: 2.2-4.4 mg/kg PO sid-bid OR DOGS: 1-2 mg/kg PO q12 hr PO

CATS: 5.0-10.0 mg/cat/q24 hrs OR CATS: 0.5-1.0 mg/kg PO q12-24 hr

Clomipramine: DOGS: 2-4 mg/kg PO per day SID or split BID

CATS: 0.5 mg/kg PO q 24 hr

Selective Serotonin Reuptake Inhibitors (SSRI)

Mode of action:

-Block serotonin reuptake at presynaptic receptor sites

-Potent serotonergic agents

-may take two weeks to see behavior effects

Uses: a. Anxiety disorders, phobias

b. Compulsive disorders

c. Aggression

d. Urine marking, anxiety-related housesoiling

Comments:

-May cause anorexia, nausea, sedation, constipation, paradoxical agitations

Fluoxetine:DOGS: 1 mg/kg PO q 24 hr3

CATS: 0.5 mg/kg PO q 24 hr3

Paroxetine:

DOGS: 1 mg/kg PO q 24 hr

CATS: 1 mg/kg PO q 24 hr4

2.5-5.0 mg/cat q 24-48 hours for urine spraying5

Sertraline:DOGS: 1-3 mg/kg q 24 hrs4

Azapirones

Buspirone: (non-sedative anxiolytic)

Mode of action:

-Serotonin agonist

-Nonspecific anxiolytic agent

-May take two weeks to see behavior effects

Uses: a. Anxiety disorders, mild phobias

b. Urine marking

c. Aggression

DOGS: 1.0 – 2.0 mg/kg PO q sid-tid

CATS: 5.0-7.5 mg/cat bid

Comments:

-Wide margin of safety, little sedation, minimal effect on cognition, no withdrawal problems

Mao Inhibitors

Mode of action:

-MAOB inhibitor

-Blocks oxidative deamination of brain amines

-Increases dopamine, norepinephrine, epinephrine

Uses: a. Canine cognitive dysfunction and associated behavior problems (sleep disorders, housesoiling, barking, disorientation, confusion, decreased social interaction)

b. Separation anxiety

Selegiline (Anipryl®)

DOGS: 0.5 mg/kg q 24 hrs

CATS: 0.5 mg/kg q 24 hrs

Beta Blockers

Mode of action:

-B1- B2-adrenergic receptor blocker

- Decreases somatic components of anxiety

Uses:

-Mild anxieties, noise phobias

-Separation anxiety

Propranolol:

DOGS: 0.5-2 mg/kg PO bid-tid

CATS: 0.2-1.0 mg/kg PO bid-tid

Pheromones

Dog Appeasing Pheromone (D.A.P.)

Pheromones are chemicals emitted by an individual that have a biological effect on the recipient. D.A.P. is a synthetic copy of a dog's naturally occurring appeasing pheromones from the intermammary groove of the lactating female which appears in the first three days post whelping. It mimics the properties of the natural pheromones of the lactating female. By replicating a signal of comfort, D.A.P. helps alleviate fear and stress related signs in puppies and adult dogs. D.A.P. is available as a plug-in diffuser, spray and collar. D.A.P has virtually no odor and has no side effects.

Indications:

• Separation anxiety
• Settling a pup/dog into a new environment
• Travel anxiety
• Global anxiety disorders
• Social and environmental deprivation problems
• Fear of people
• Noise phobias

Feliway (US distributor - Veterinary Products Laboratories vpl.com)

Available as an environmental spray and a diffuser. Contains synthetic analogues of naturally occurring facial pheromones. Feliway replicates pheromones cats use for marking when they rub their cheeks against objects.

Indications:

• Urine spraying

• Anxiety-related housesoiling

• Scratching

• Hospitalized cats

o Anxiety

o Aggression

o Anorexia

• Settling into a new environment

• Travel

• Interfeline aggression

References

Hart B, Hart L. Canine and Feline Behavioral Therapy. Lee & Febiger, 1985.

Voith VL, Borchelt PL. Fears and Phobias in Companion Animals, Comp Cont Educ, Vol. 7, No. 3, March 1985

Shanley, Overall K. Rational Selection of Antidepressants for Behavioral Conditions. Vet Forum, Nov 1995, p30-34

Landsberg GL, Hunthausen WL, Ackerman L. 2003. Handbook of Canine and Feline Behavior, 2nd Edition, Saunders

Dr. Jacqui Neilson – Personal communication

Additional reading

Casey R, Fear and stress, Manual of Canine and Feline Behavioural Medicine (eds: Horwitz, D Mills & Sarah Heath),BSAVA pub., Gloucester, Eng, 144-153, 2002