How I treat about anything: Behavior treatment plan (Proceedings)

This presentation offers general practitioners a quickly reference for the treatment for any patient with behavioral problems. We will discuss the 5 steps needed for a complete behavioral treatment plan employed by specialist for any behavior problem.

Behavior treatment plan

The treatment of any behavioral problem includes a multi-facetted approach consisting of a 5-Step process. You might chose to implement some, or all of the 5 steps involved depending on the case, the circumstances, and your level of skills; however, any veterinarian should be able to recommend steps 1 and 2. An example of a generic discharge or treatment template for any behavior diagnosis could look as follows:

1. Management: Safety and avoidance

In order to set up the patient for success, strict management is needed at the beginning of every plan. Initially, the owner will have to set the stage and manage the pet's environment so as to avoid any situations in which the pet has displayed the unwanted behavior in the past.  Initially, the treatment process can be slow; hence, in the meantime, the owner must prevent those events from reoccurring. Every time a pet displays this behavior, the behavior is further rehearsed and this might be inadvertently reinforcing the behavior problem you try to treat. Therefore, as you are in the process of treating, the patient should not be exposed to the trigger(s) which cause the unwanted or unacceptable behavior(s).  The owner should begin by mentally taking note of all situations where the pet displays the(se) behavior(s). In addition to supporting the overall success of the behavior modification, avoidance may also be a safety recommendation in some cases.

2. Structuring the relationship with the pet and strengthening the human-animal-bond

Aware – affirm – award approach

There are many advantages to using such a program as part of a training program for a pet. First, it is a program that fits all pets and all people, regardless of breed, age, size, gender or personality-type.  It is a non-confrontational technique which is designed to never put the people or pets involved at risk.  It will help to teach pets how to be better prepared to live within human society.  It will help improve behavior and teach the pet to learn to trust people due to the predictable interactions with positive outcomes. The pet will learn to consistently follow commands at home or other low stress situations which makes it easier for him/her to follow commands in potentially challenging situations such as when distracted, anxious or perhaps even while aggressive. Finally, it will help build confidence by providing clear communication and enjoyable outcomes for desired behaviors.  This approach uses only positive, reward-based training methods to teach these valuable lessons. The program consists of 2 principles.

• Predictable interactions with the pet based in Command – Response – Reward (C-R-R)

• Awareness of the good/desired behaviors that will be affirmed (marked) and awarded

3. Tools

This is any equipment that will help with the implementation of the management plan and the reward-based training program. Specific recommendations should be provided to the client. The list is endless, but could include items such as baby gates, kennels, crates, screen doors, window covers, leashes, tethers, head halters, front buckle harness, basket muzzle, clicker, target stick, MannersMinder, treat pouch, treats, relaxation mat, feed dispensing toys and puzzles, interactive toys, Relaxation music (Thru the dogs ear), visual entertainment (DOGTV), litterboxes and litter type, nail caps for cats, scratching posts and many more.

NOTE: My list does NOT include anti-bark devices, shock collars, prong collars, shaker cans, throw chains and other pain and fear eliciting items – tools that help suppress behaviors rather than help teaching new positive behaviors and emotions can lead to increased fear, anxiety and aggression.

http://avsabonline.org/resources/position-statements

https://vet.osu.edu/assets/pdf/hospital/behavior/trainingArticle.pdf

4. Reintroduction: Positive emotional response and incompatible behaviors

First, the animal has to be prepared for the reintroduction to the triggers or situations that have to be avoided initially (see Step 1, 2 and 3). The positive emotional response and behaviors that will be practiced and rewarded should be simple and incompatible with the unwanted behavior.  (Example: sitting quietly is a positive behavior that is incompatible with lunging).  Thus, the pet associates the low level of negative stimulus with the positive reward for a relaxed state and behavior.  The pet will gradually learn to associate good things happening and have a positive response. The Command – Response – Reward (C-R-R) approach helps the dog to perform trained commands reliably in various types of situations and therefore the pet can then be reintroduced to previously challenging situations in a step by step process, where the unwanted behavior is never displayed – this is called desensitizing and counter-conditioning (DS/CC).  It is a technique that all people, regardless of age, size, or personality-type can do.  It is a non-confrontational technique which is designed to never put the people or dogs involved at risk.  Finally, it will help build a dog's confidence by providing clear rules and enjoyable outcomes for good behavior.  Having a pet consistently follow commands at home, in low stress situations, makes it easier for him/her to follow commands when distracted, anxious or perhaps even while aggressive.  The program also acknowledges the animal consistently with a marker and reward when performing any behaviors that are incompatible with the unwanted behavior without a prior cue. 

Give the client Homework and be specific. Ensure that the client understands the exercises, this will enhance owner's compliance and overall success of the treatment plan.

The stimulus that was identified during the appointment as causing the pet's unwanted emotional reaction and subsequent problem behaviors will then be reintroduced in a series of gradual steps/intensities.  The common gradients that are used for DS/CC are altering the intensity and changing the distance to the stimulus.  The intensity can be changed by altering the location, loudness, speed of movement, duration, types of stimuli, or components and response of the stimulus.  DS/CC needs to start at the lowest intensity that results in no signs of anxiety or concern.  The stimulus (at the lowest intensity and/or at the furthest distance) is presented and the pet is rewarded for the new, relaxed attitude and behaviors.  The stimulus is repeated over multiple sessions, while the pet is rewarded for the positive behavior.  Every session should be brief and always end by rewarding the display of positive behavior(s). 

Key points

DS/CC takes time and requires that the process be gradual.  Since progress is often slow, maintaining a journal of the behavior to track the progress is helpful.  Problems usually arise from progressing too quickly and not taking small, incremental steps.  Don't progress faster than what the pet can accept.  It is also vital that every positive behavior be rewarded and that the reward is truly rewarding to your dog.  Each step will need to be planned out and it is important to have all tools needed ready before starting each DS/CC session.  Remember, since the problem behavior took time to develop, to look for small, incremental improvements rather than instant results. 

5. Medications

Medications can be part of the treatment of behavior problems.  Medications should only be used with a concomitant diagnosis and preferably full laboratory testing (CBC, Chem and T4, UA, Urine culture). It can help lower the anxiety level, so that the behavior modification can be more effective. It is not a cure for the problem, nor should medications be used without concurrent behavior modification plan. Most medications are “off label” use and the client needs to be informed about the potential side effects and adverse effects with any other medication(s).