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| On YOur BesT BehaViOr Today's Veterinary Practice July/August 2014 64 tvpjournal.com Reduction of Stress In some cases, there are limits to how far behavior mod- ification alone can go. Extreme situational stress or fear can interfere with learning and decision making. When dogs are overtly reactive—or, in the language of dog training, over threshold—they are physiologi- cally aroused, which involves both the autonomic (fight or flight instinct) and endocrine (hypothalamic–pitu- itary–adrenal axis up-regulation) systems. In these cases, there is rarely any middle ground—the dog will move rapidly from a lack of reaction to extreme avoidance, ag- gression, or panic. Temperamental or inherited generalized anxiety can also interfere with learning. Generalized anxiety, similar to situational anxiety, is more pervasive and challenging to overcome through training alone. In these patients, the addition of behavioral drug therapy can significantly improve response to treatment. When underlying anxiety is reduced, the dog is more receptive to learning and its behavior can change more reliably in the long-term. As one owner of a fearfully aggressive dog reported after 2 months of fluoxetine ad- ministration, "I feel like it's opened a door to her brain." Sedation, If Needed Although, on a day-to-day basis, sedation is not a desir- able drug effect, it may be necessary to eliminate distress spikes in specific situations, most frequently: • Separation anxiety (administered at point of the owner's departure) • Thunderstorm or fireworks fear (administered just before the event) • Car or airplane travel (administered 30 minutes before travel; then repeated as needed during travel). Rather than administration on a daily or standing basis, sedative medication can be given on an as-needed basis, often in combination with a daily medication. When shOuLD BehaViOraL MeDiCaTiOn Be PresCriBeD? There is some flexibility with regard to prescribing medi- cation relative to the behavior modification plan. • If drug therapy is unequivocally indicated (eg, severe separation anxiety or severe fear, including fear-aggressive behavior), ideally prescribe it during the same appointment as the behavior assessment, which incorporates it into the entire behavior man- agement plan. • If the plan includes significant management changes that do not require medication and/or the pet is not impaired by stress (ie, pet has rea- sonably good quality of life at time of presentation), consider delaying medication implementation until a follow-up visit. In some cases, behavioral drugs may be unnecessary. • If a pet undergoing behavior modification has reached a plateau with little advancement in learned tasks, successful desensitization, and/or counter-conditioning, drug therapy may allow the owner to move further toward treatment goals. hOW shOuLD MeDiCaTiOn Be PresCriBeD? Anxiety is an underlying component of many canine be- havior problems (Table 1). Reducing this anxiety often improves the problem behavior directly or decreases stress, raising the threshold for reactivity, fear respons- es, and other behaviors. Before starting drug therapy in any animal, regardless of age, physical health, or category of drug, a medical history (including current medications) and physical examination are indicated, along with analysis of blood and urine. Duration of Therapy Duration of treatment with behavior medication ranges from: • Relatively short-term (eg, 6 months for patients in which anxiety must be reduced to allow learning to occur) to • Longer-term therapy (eg, years for animals whose behavior is not adequately responsive to behavior modification alone). Other considerations include: • Length of time for medication to take effect: Some medications (eg, antidepressants) require 1 to 2 Case Application: Buttercup in Buttercup's case, the first step—avoid- ing the stimuli that trigger the behavior—might simply mean keeping her in a separate area or gated part of the house while Mrs. Jones en- tertains guests. The second step—learning to behave differ- ently in response to these stimuli—can include: • Feeding Buttercup a high-value food while a guest is seated and in view (counter-conditioning) • asking her to lie down on a previously speci- fied mat while the owner is entertaining (alter- native behavior). TaBLe 1. Canine Behavior Problems associated with underlying anxiety • agression between household dogs • Compulsive disorder • Fear-related aggression • Fears/phobias • inappropriate attention-seeking behavior • Leash reactivity • resource guarding • separation anxiety