Just Ask the Expert: Managing storm phobias with difficult patients-and clients

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What is the best way to manage a greyhound with a serious storm phobia? Paroxetine and alprazolam have not calmed the dog enough for behavior modification, and the owner is a bit of a challenge, too.

A. When treating behavior problems, it is especially challenging to get pet owners to comply because you are often asking them to completely change the way they interact with their pets on a daily basis. In addition, they may need to change the way they manage their pets in their environments. And owners usually need to set aside a few minutes every day to practice behavior modification exercises with their pets. Pet owners whose beliefs about pet training and animal behavior are steeped in myths and outdated concepts may have the poorest compliance because you must first convince them to believe in the information you are giving them.

This situation can be sad and frustrating, especially when you are treating problems such as noise phobias for which a properly executed behavior modification program has been shown to be highly effective. There are two primary ways you can approach noise phobias: You can focus on just helping the animal get through the experiences with a modicum of distress, or you can actively work at changing the pet's emotional response to the noise.

Valarie V. Tynes, DVM, DACVB

OPTION 1: JUST GETTIN' BY

If a pet owner wants to just get by during storms, it will be easiest to do if he or she lives in an area where storms are relatively rare and usually predictable. In those circumstances, the pet owner can provide a "safe place" for the pet where it can avoid, to the greatest extent possible, the stimuli associated with the storm.

This safe place can be a dog crate or cage that is placed in a basement, closet, or internal room in the house (anywhere where sounds can be muted and lightning flashes avoided). The crate should be left open at all times and may even be covered with heavy blankets or other material that can help insulate it from sound. The dog is then taught to go to the crate by using special long-lasting chew treats or food-dispensing toys. Once dogs discover that the crate is a safe, quiet place to hide out, most will learn to use it whenever they feel the need to escape aversive stimuli.

Another tool for a storm survival kit is an anxiolytic medication that can be given on an as-needed basis. I cannot overemphasize the fact that acepromazine is not an anxiolytic and should rarely, if ever, be the first choice when treating an anxiety-related condition. The anxiolytics that are usually effective for this purpose are the benzodiazepines.

In order to use benzodiazepines safely in practice, you must be aware of how dose-dependent their effects are. At low doses, benzodiazepines are primarily anxiolytic, while at higher doses they can be quite sedating. You must educate your clients about this feature and help them understand that it will be critical that they test the drug dose before a storm occurs. This way, if they think that the drug has no effect on their dogs at a lower dose, they can, after consulting with you, increase the dose to the next highest level that you suggest and see if it is more effective. In this manner, you can work with clients over a period of a few days, if necessary, to determine what benzodiazepine dose produces mild sedation. That is the dose they will give their pets about 30 minutes to an hour before the next storm is expected. If the dose turns out to be ineffective in the face of a storm, then the dose can be adjusted again for the next storm.

Also emphasize to clients the fact that many animals will experience paradoxical excitement or agitation when given a benzodiazepine. This response is another reason why it is so critical that owners give a test dose before the storm is ever expected. If they determine that the dose given causes an increase in excitement or agitation, then you can recommend that they try a higher dose. In many cases, that dose will be effective. Another option is to switch to another benzodiazepine and see whether the paradoxical reaction still occurs. In some cases, a dog is unable to take any benzodiazepine, and other drugs such as clonidine may need to be considered. Be sure to inform clients that if they wait to give medication until after their pets begin experiencing the anxiety associated with a storm, then the medication is unlikely to be effective.

OPTION 2: MODIFYING THE PET'S RESPONSE

Some owners wish to change their pets' emotional response to thunderstorms by desensitizing and counter-conditioning them to the sounds associated with storms. This behavior modification can usually be done quite effectively by using a recording of thunderstorms. Recordings are readily available on the Internet, often specifically for this purpose.

Desensitization is performed by playing the recording at a level that is so low that it does not appear to cause the dog any fear or anxiety. Over repeated sessions, the volume is slowly increased until the dog no longer responds to the sound even when it is as loud as the sound of a real thunderstorm.

Alone, desensitization can be a lengthy and time-consuming process. But if combined with counter-conditioning, it usually works more quickly. Counter-conditioning is achieved by sitting with the dog while the recording plays and feeding the dog special, highly preferred food treats. This works because the dog eventually learns through classical conditioning to associate good things (eating a special treat) with the sound that previously caused distress (the storm noise).

When pet owners have problems with these procedures, it is usually because they try to turn the volume up too quickly before their pets lose their fear of the noise at that volume. Encourage clients to be patient and let their dogs dictate when the volume gets turned up. Turning the volume up before a dog is ready will only delay success in the long run. Clients must also be taught to be attentive to their dogs' early subtle signs of anxiety such as lip licking, yawning, or avoidance behavior.

A combination of desensitization and counter-conditioning is a proven method of changing an animal's behavior. In the case of treating storm phobias, clients must understand that it will be most effective if they can practice the technique during the season when storms are not common. Trying to do it during thunderstorm season will only make the training more difficult. If an owner is using desensitization and counter-conditioning to change a dog's response to storms, he or she also needs to be aware that the pet should still have a "safe place" during storms and be given an anxiolytic to help the pet deal with the storms until the behavior modification can have an effect.

FINAL THOUGHTS

At this time, no extreme sensitivity to the benzodiazepines or other anxiolytics has been clearly documented in sight hounds, including greyhounds. However, it is always a good idea to err on the side of caution and begin treatment at the low end of the dose range until you can confirm the individual's response to the medication.

Other useful tools for storm survival, especially for clients who are hesitant to give psychotropic drugs to their pets, include pheromone diffusers and collars, anxiety wraps, and natural supplements such as L-theanine (Anxitane—Virbac). More research is needed on these products, but at this time they appear to work often enough in some patients to make them worth mentioning. As with many treatments, not every product works equally in every individual in every circumstance, so help clients to have realistic expectations and to be prepared to try different things until the most effective solution for their pets is identified.

Valarie V. Tynes, DVM, DACVB

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