Current approaches to treating storm phobia (Proceedings)
A practical guide to treating storm phobia.
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
