Behavioral Therapeutics

CHAPTER 14 Behavioral Therapeutics




After diagnosing a behavioral problem, the veterinarian must plan a treatment and management program that is both practical and rational from the owner’s perspective. If the program is too complex or time consuming, owners will have difficulty incorporating it into their daily lives and routines. If the program does not make sense to the owner, the owner is likely to disregard the advice. In either case, if the issue is not satisfactorily resolved, the cat may be relinquished or euthanized. It is essential that veterinarians spend time helping owners understand the problem and the reason it has occurred (the underlying causes) and then develop reasonable expectations.


The initial approach is to modify the environment and manage the owner’s expectations so that further problems can be prevented. This may be a short-term remedy, but it may also be the best or only practical long-term solution for some owners and some problems. The owner can then be educated about how cats learn and how their behavior can be effectively modified; this knowledge will help the owner implement the program so that there is some resolution of their concerns.


There is no one-size-fits-all approach in resolving behavioral problems. Therefore every treatment and management program must be tailored to the individual pet and the household where it resides. If there is a safety issue, prevention of further injury is the first concern. Therefore an assessment of the owner, cat, problem, and household is essential not only for determining the prognosis but also for developing an effective treatment and management program.


In general, treatment and management programs for most behavioral problems consist of three key areas, the three M’s: behavior modification, environmental management, and psychotropic medication. Medication is not always necessary, but long-standing, recurrent, or severe cases are unlikely to improve without medication. It should also be noted that delaying the use of medication has serious welfare implications for the cat, so if medication is indicated, then the sooner the medication is started the better.



Behavior Modification


Since first coined by Thorndike in 1911,43 the term behavior modification has been used in many ways. Currently, it mainly refers to techniques for increasing adaptive behavior through reinforcement and decreasing maladaptive behavior through extinction or punishment (with much more emphasis on the former). This is because when aversive punishments are used (or misused), they can lead to more emotional distress and behavioral problems involving fear and anxiety. Most aversive techniques are inappropriate in context, duration, intensity, or time of application. Recent studies have confirmed that punishment-based training and confrontational techniques are more likely to lead to increased aggression and avoidance behaviors.


The aim of any behavior-modification program should always be to reward appropriate behaviors rather than to punish unwanted behaviors. Therefore rather than focusing on how to stop what is undesirable, the owner should first focus on providing a desirable alternative (e.g., where to sleep, where to climb, where to scratch).


Behavior modification in cats generally involves reward-based training, desensitization, counterconditioning, and response substitution. Therefore an understanding of learning theory and the effects of operant and classical conditioning is essential before recommending treatment.


Classical conditioning is the pairing of an unconditioned stimulus with a neutral stimulus that results in a conditioned stimulus and a conditioned response. It does not use rewards, but the cat learns to pair an involuntary behavior with another neutral stimulus.


Classical conditioning can occur in both positive and negative ways. Examples of a positive conditioned emotional response are the pairing of a clicker with favored treats (for clicker training) or any sounds associated with feeding (e.g., filling the food bowl, opening the food cupboard, opening the refrigerator, shaking the package of treats).


Problems arise when a fearfully conditioned emotional response is established toward a previously neutral stimulus (visual, olfactory, auditory, animate, or inanimate) by repeatedly pairing it with a fear-producing stimulus. Once this occurs, the stimulus itself will elicit the fear response. Some examples might be the sound of a doorbell or a car pulling into the driveway that becomes paired with the visit of unfamiliar people (for cats that are fearful of visitors). Another example might be the sight of a grooming brush or nail clipper for a cat that is frightened by those procedures.


Operant conditioning involves the way actions result in consequences. The results either increase or decrease the likelihood of future responses. There are four types of behavior–consequence relationships. Reinforcement increases the likelihood that a behavior will be repeated, and punishment decreases the likelihood that the behavior will be exhibited. There can be both positive and negative reinforcement and punishment techniques. Negative refers to the removal of a stimulus, and positive refers to the application of a stimulus.


Counterconditioning occurs when a stimulus that evokes an unpleasant response is consistently and repeatedly paired with something that is highly positive until a positive association is made. To be successful, counterconditioning should be coupled with desensitization, wherein the intensity of the stimulus is minimized to a level that does not incite the fear response, such as by reducing volume, increasing distance, changing the environment, or modifying the stimulus to something less threatening.


Desensitization and counterconditioning are extremely time consuming. The exercises must be constantly repeated so that the response is altered to one that is positive. Clients often want both a quick fix and less work. However, moving too quickly provokes anxiety and sabotages any behavior-modification program.


Response substitution involves replacing an undesirable response with a desirable one. The process would be to use high-value rewards to teach desirable behaviors that have been selected as an acceptable and practical alternative to the undesirable behavior. However, if the behavior is part of the cat’s natural repertoire (e.g., scratching), it can be particularly difficult to train the cat to perform alternative behaviors.


Training should always begin in the environment where success can be most readily achieved. The target behavior is for the cat to be quiet and calm. Therefore the owner must learn to read the look in the cat’s eyes, its body posture, its facial expressions, and its breathing to be able to gradually shape the desired behavior. Training could then move to environments with increasing distractions and places where the problem is most likely to arise.


To replace the undesirable behavior with a desirable behavior, response substitution should be coupled with desensitization, by setting up exposure to low levels of the stimulus and practicing the target behaviors and relaxation exercises while reinforcing with the highest-valued rewards. If the cat is fearful or anxious, the focus should also be on classical counterconditioning so that each exposure to the stimulus is associated with only highly positive outcomes and no negative outcomes.



Environmental Management


Environmental management is usually necessary to prevent exposure to the stimulus, prevent access to locations where problems might arise, or provide outlets for expression of the behavior. For example, cats may need to be confined to avoid exposure or access to other cats, so cat enclosures made of metal or mesh can be attached to a door or window to allow the cat access to outdoors and some or all of the yard (Figure 14-1). Another option might be to fence off the garden to keep the cat enclosed.



Management may also include physical and mental stimulation in the form of enrichment, which may reduce stress as well as help the cat cope with potential stressors in day-to-day living. There are many types of environmental enrichments that allow the cat to express normal behaviors in an acceptable way.


Any environmental enrichment program should be designed to provide sufficient outlets and opportunities for species-specific normal behavioral patterns, while offering the individual cat sufficient control and choices to be able to cope with challenges in a normal way. Therefore motivation, novelty, and complexity are important considerations when developing enrichment strategies.


The goal is an environment that the cat can use in a positive way, while reducing or eliminating abnormal behaviors. The enrichment program suggested must be individually tailored to the cat, its personality, and its behavioral problem so that the behavior is not inadvertently exacerbated. It should also be noted that too much enrichment (i.e., too many choices) can lead to increased stress in already anxious cats.


Studies have investigated disease rates among animals in enriched environments versus those in standard housing. Enriched environments were found to decrease the incidence of gastric ulcers in rats35 and urinary tract disorders in cats4 and to improve the immune functioning of animals.39 Conversely, stress may alter immune function and has been shown to be a contributing or aggravating factor in gastrointestinal diseases, dermatologic conditions, respiratory and cardiac conditions, behavioral disorders, and a shortened life span.12,31,44


Enrichment might also delay the onset or lessen the effects of feline cognitive dysfunction. Studies in dogs and humans have shown that continued learning; physical exercise; and a change to a diet rich in antioxidants, essential fatty acids, and mitochondrial cofactors can have a positive effect on well-being,26,29 and the same may be true for cats.16


Appropriate enrichment may prevent some behaviors that are of concern to owners33,46 and lower stress, which may in turn lessen the chances of stress-related diseases such as interstitial cystitis.35


Enrichment can alleviate boredom and may play a role in preventing obesity and associated medical problems such as diabetes mellitus, hepatic lipidosis, and osteoarthritis.33 Stress has a negative role in the development of skin conditions such as infections and pruritus, feline lower urinary tract disease (FLUTD), and conditions such as irritable bowel syndrome.31,44 Addressing the environment of affected cats may help in reducing the number and severity of outbreaks of chronic diseases such as FLUTD.21


Any enrichment that is added to a cat’s environment must take into account the species-specific behavior of cats and the preferences of the individual cat. An elderly cat that has lived most of its life without feline company will have different needs than a young cat living in a multicat household. As discussed in previous chapters, cats are small, solitary, ambush hunters that have a crepuscular activity pattern. They have complex and highly variable social systems, depending on the spread and amount of resources such as food and shelter.9,11 Cats are territorial, with male territories overlapping several female territories.10 Enrichment devices and activities must address the biological needs of cats as well as the individual preferences to have a positive effect on feline welfare.



Hunting and Foraging Behavior


Wild and feral cats spend a significant amount of their waking hours foraging and hunting for food. It is therefore unsurprising that pet cats investigate new objects in their environments and engage in play with small, prey-size objects.17 Cats should not be allowed to play with human hands or feet because of the potential for injury resulting from their claws and teeth. However, toys that encourage the behaviors of the hunting sequence, such as stalking, rushing, pouncing, and biting, are popular with cats and their caregivers and provide opportunities for cats to engage in these normal behaviors. There are many types of toys that foster this type of play, including fishing rod–style toys and laser pointers. However, because the cat can never catch the light, some cats find laser toys frustrating. It can also be an issue for cats with the potential of developing an obsessive-compulsive disorder. Providing treats periodically during the game or afterwards may reduce frustration.


Cats hunt in short bursts, so play sessions should mimic this natural behavior. The owner should provide toys of a size and texture that motivate the cat. Cats may quickly become habituated to and lose interest in a particular toy; studies have shown that play intensity may be heightened in the short term if play is repeated with three or four different toys that have slightly different characteristics. Owners should try to maintain the cat’s role as the predator with the toy as prey by using sudden changes of speed and direction when manipulating the toy. Toys on strings should be used for supervised play only as when alone the cat may ingest the string, leading to severe intestinal damage and possible death. After play sessions the cat’s interest in further play may remain heightened for 15 minutes or more, so it might be advisable to give the cat some food or treats to keep it occupied and perhaps simulate the feeding that might logically follow predatory activity in the wild.


Cats that hunt for food will chase, capture, and eat several small meals a day. Therefore some cats may benefit from more play sessions and multiple smaller, prey-size meals. This might be accomplished by using timed feeding dishes or making meal feeding more complex by placing canned food in ice cube trays, small containers, or toys that require manipulation with paws or teeth to extract the food. A number of commercial toys are now available that require varying degrees of batting and rolling, dexterity, and mental activity to release the food.


Wild and feral cats frequently eat grass.1 Cat grass offers a safe grazing choice for cats kept indoors (Figure 14-2). If the owner periodically moves the cat grass throughout the home, the cat will have to seek out the forage and therefore replicate natural behavior.




Resting Places


Cats spend an average of 2.8 hours resting and 7.8 hours sleeping during the day.1 Comfortable, protected areas should be provided for cats to sleep and rest. Many cats like high positions and will gravitate to beds in high places, such as in cupboards or on shelves. In multicat homes cats are less likely to compete over prime space when there are several choices, such as window ledges, cat climbing frames, and furniture to which cats are allowed access. Every room that cats visit frequently should offer them appropriate hiding and perching places, which can reduce stress (Figure 14-3).23 Cats are both predator and prey and may feel more secure in a place where they can watch activities without being watched themselves.


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Aug 26, 2016 | Posted by in INTERNAL MEDICINE | Comments Off on Behavioral Therapeutics

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