Managing Separation Anxiety: An Evidence-Based Approach By Jacqui Neilson, DVM, DACVB AAHA gratefully acknowledges the following for their sponsorship of this Webcast. MANAGING SEPARATION ANXIETY: AN EVIDENCE BASED APPROACH Jacqueline C. Neilson, DVM, DACVB 1
Separation Anxiety (SA) Signs of severe distress (anxiety) when an individual is separated from other group members Overview Incidence/Impact Diagnosis Treatment Behavioral Modification Drug Therapy Pheromone Therapy Incidence/Impact 2
Separation Anxiety Incidence 14% -17% dogs suffer 63 million owned dogs in US 8-11 million suffer 1 in 6 Impact of Separation Anxiety Substantial & Serious 3
Impact of Separation Anxiety Dog suffers Compromised welfare Extreme emotional distress Physical injury Impact of Separation Anxiety Owner suffers Concern for their dog Property destruction Eviction Impact of SA Relinquishment to shelters 3/10 most commonly reported problems are consistent with separation anxiety* 4/10 most commonly reported problems are consistent with separation anxiety** Euthanasia 50-70% of all dog/cat euth is due to behavioral problems*** *Miller et al JAVMA 1996 **Kogan J App An Wel Sci 2000 *** Spencer JAVMA 1993 4
Raider Sadie 5
Diagnosis Diagnosis Anxiety when separated from attachment figure(s) Vocalization Elimination Destruction Pacing Panting Etc. 6
Is Separation Anxiety (SA) Normal? Fear can be an adaptive behavior Dogs are social animals Attachment behaviors beneficial-serve to maintain social cohesion Separation = distress response NORMAL Habituation to separation NORMAL Separation = excessive distress response SEPARATION ANXIETY Puppy Behaviors when left home alone 18 puppies 9 pups < 3 months of age 9 pups > 3 months of age Videotaped for first 90 min of owner departure Results 75% of time puppies displayed passive behaviors Younger pups showed more lip licking, yawning, scratching & vocalized more No differences bwt. crated vs. free pups Normal puppies don t display excessive distress responses if a client complains of excessive distress response very well may be abnormal 7
Diagnosis Verbal history from owner Physical examination Diagnostic testing to rule out primary medical problems Bloodwork UA/Fecal Video during owner absences Clinical Signs of Separation Anxiety Obvious signs Destruction Elimination/House-soiling Vocalization Pacing Panting Salivation Withdrawal Anorexia Subtle signs Diagnosis Clinical signs of separation anxiety are non-specific clinical signs Must rule out other conditions that could cause those clinical signs and verify that the trigger for the signs is separation 8
Rule-outs for Clinical Signs Vocalization Reaction to external stimuli Socially facilitated Play Fear induced Separation Anxiety Destruction Play Exploration Reaction to external stimuli Separation Anxiety House-soiling Lack or break in house-training LUTD PU/PD Urine marking Excitement urination Separation Anxiety Challenging Case: Buster Owner returned home to find destruction 9
Buster had a noise phobia 40% dogs with noise phobia also had SA 8-50% of dogs with SA have noise phobia 10
Comparison of behaviors when left alone in Control vs. SA dogs 80 70 60 50 40 30 20 10 0 destruction elimination vocalization Flannigan G and Dodman N; JAVMA 219(4) 2001 control SA Comparison dog attributes in Control vs. SA dogs 90 80 70 60 50 40 30 20 10 0 follow owner excess greeting angst keys angst coat shoe Control SA 11
Challenging Cases: Multiple Pets Culprit?? Guilty Look Guilty Party Treatment Treatment Separation Anxiety Owner Education Behavioral modification Pheromone treatment Drug treatment 12
Owner Education Owner Education Behavior is anxiety driven, not spite or disobedience Dogs are social creatures Normal to have distress response when separated from companions Excessive distress response = separation anxiety Results in Increased tolerance Better treatment compliance Behavior Modification Basic Advanced 13
Basic Interventions Be Positive Only Reward Calm Behavior No more drama when you come and go Develop your dog s independence Basic Verify that dog is getting enough exercise/enrichment Advanced Desensitization & counterconditioning to pre-departure routine and departures Gradual introduction of anxiety provoking stimuli and pair the stimuli with something very positive to establish a new, calm emotional state To do properly must avoid over-threshold experiences (e.g. cannot leave dog for a period of time that triggers anxiety) 14
Common Problems Enthusiastic owners overwhelm dogs Owners don t temper their behavior to AVOID anxiety Need to keep beneath threshold for anxiety Common problems Can t avoid anxiety ridden departures Can t take to work Can t afford doggie daycare Dog isn t allowed in doggie daycare, etc. Guinness Can t take to work Single owner Tried crating escaped from crate/injuries sustained Used to live with other dogs was fine Friend drops off dog to stay with Guinness he is fine Not long term solution Owner doesn t want another dog 15
If you can implement behavioral modification Does It Work? Success of Behavioral Modification 50 dogs with SA Behavior modification (34) Adequate exercise Owner initiated interactions Treats provided at departure No punishment Pre-departure cues altered Departure desensitization No Treatment-Control (16) Blackwell E Vet Record 158, April 2006 Results Based upon Video footage Owner evaluations 75% dogs with behavior modification showed improvement (often significant) @ 12 weeks 31% of control dogs had improvement (often mild) @ 12 weeks YES, Behavioral Modification can work with TIME & EFFORT 16
Compliance with Behavior Modification for > 1 month No punishment (79%) Increase in exercise (78%) Special toy at departure (69%) Desensitization to departures (43%) Uncoupling pre-departure cues (35%) Takeuchi Y JAVMA 217 (3) 2000 Drug Therapy Drugs Daily medications Event drugs 17
Drugs Daily Medication Two drugs approved by the FDA to treat canine separation anxiety when used in combination with a basic behavioral modification program fluoxetine clomipramine Clomipramine Tricyclic anti-depressant Dosing 2-4 mg/kg/day Clomipramine Study 159 dogs with SA Basic Behavioral Modification Clomipramine 4 mg/kg/day 56 days Placebo 56 days 18
Results 70 60 % of dogs 50 considered improved 40 30 20 10 0 week 1 week 3 week 5 week 8 clomipram ine Placebo Fluoxetine Selective serotonin reuptake inhibitor Dosing 1-2 mg/kg/day Fluoxetine Study 242 dogs with SA Basic Behavioral Modification Fluoxetine 1-2 mg/kg/day 56 days Placebo 56 days 19
% of dogs improved in overall separation anxiety score Results % of dogs considered improved 80 70 60 50 40 30 20 10 0 42% * 18% * * * * * 72% 1 2 3 4 5 6 7 8 * Week of Trial 51% Fluoxetine Placebo * p<0.05 Fluoxetine w/out Behavioral Mod 208 dogs with Sep Anxiety 14 days baseline 1-2 mg/kg fluoxetine /day placebo 6 weeks tx Results 70 60 50 40 30 20 10 0 1 2 3 4 5 6 Week of Study * * p< 0.05 Fluoxetine Placebo 20
Most common Side Effects with fluoxetine: lethargy (32%) and decreased appetite (27%) Drugs: Event Drugs Quick acting anxiolytics Given ~ 60 minutes before onset of departure anxiety Lasts a few hours Sedation possible Alprazolam Benzodiazepine PRN in addition to serotonin medication Dose 0.05-0.1 mg/kg PRN ~60 min prior to onset of anxiety 10% dogs get hyperexcitable/agitated 21
Trazodone Atypical anti-psychotic Mixed serotonergic agonist/antagonist PRN in addition to serotonin medication Dose 2-5 mg/kg as PRN bolus ~60 min prior to onset of anxiety Long term drug use Unknown ramifications Examination/bloodwork every 6-12 months Pheromone Therapy 22
DAP: Dog Appeasing Pheromone Clinical study (Gaultier, Pageat) 57 dogs with Separation Anxiety destruction soiling, vocalization 30 dogs DAP placebo pill beh. mod 27 dogs placebo pulg-in clomipramine (2.2-4 mg/kg BID) beh. mod Results % of Dogs Improved or Resolved 100 90 80 70 60 50 40 30 20 10 0 Clom DAP 23
In Summary Verify diagnosis Behavior Modification Consider client/pet limitations Drug therapy Treat early and adequately Pheromone therapy Questions 1. To complete the evaluation, please go to the following website: http://www.keysurvey.com/survey/278508/1427/ 2. After completing the evaluation, you will automatically be linked to the Continuing Education Certificate. The CE certificate can only be accessed after the evaluation is completed. 3. Download the CE Certificate (in pdf format) to your computer and print enough copies for those persons viewing the web conference with you. Your input is very important! We take feedback seriously in order to provide you with the highest quality experience possible. If you have any questions about completing the evaluation or accessing your CE certificate, please email us atwebconference@aahanet.org or call 800/252-2242. 24
Questions to the Speaker Please email your questions to webconference@aahanet.org by Sunday, December 27, 2009. Dr. Neilson will provide written responses to all of the questions and they will be posted on AAHA s website by Friday, January 8, 2010. AAHA gratefully acknowledges the following for their sponsorship of this Webcast. 25