The treatment of behavior problems is best managed using a standardized approach. As every behavior is determined by genetic predisposition, learning from previous experiences, and the environment, all three areas must be addressed. The approach to treating behavior problems can be called the 3 M plus 1 approach: managing the environment, behavior modification, medication (when indicated), plus ongoing monitoring. After diagnosing a behavior problem, the veterinarian must plan a treatment 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 help the owner develop reasonable expectations.

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, the sooner the medication is started the better. The following sections will discuss each part of the approach to treatment; more information is found in Box 17.1.

Since first coined by Thorndike in 1911, the term behavior modification has been used in many ways.1 It refers to techniques for increasing adaptive behavior through reinforcement and decreasing maladaptive behavior through extinction or punishment. In modern behavior modification techniques, punishment is not used as it can lead to more emotional distress and behavior problems involving fear and anxiety. Most aversive techniques are inappropriate in context, duration, intensity, or time of application. 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). This means redirecting the behavior that the owner finds unacceptable.

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

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 sound such as a clicker or a sound associated with feeding (e.g., filling the food bowl, opening the food cupboard, opening the refrigerator, shaking the package of treats) with favorite 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. Examples include 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 behaviors (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. Positive refers to the application of a stimulus while negative refers to the removal of a stimulus and does not imply good and bad.

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 (change in emotional state) is made. To be successful, counterconditioning is best 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 and consistently repeated until 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 a behavior modification program.

Response substitution involves replacing an undesirable response with a desirable one. The process involves using high-value rewards to teach desirable behaviors that have been selected as an acceptable and practical alternative to the undesirable behavior. However, if the undesirable 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 cat’s body language, its facial expressions, and its respiration rate 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 one, 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-value 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. The aim is always to change the cat’s emotional response from negative to positive (or at least neutral).

The cat should always be rewarded for calm, relaxed behaviors. Using quiet praise (whispering), gentle massage (if the cat likes being touched), and tiny, tasty treats are also helpful in changing the cat’s emotional state to a more positive one.

Environmental management is usually necessary to prevent exposure to the stimulus (if possible), prevent access to locations where problems might arise, or provide appropriate outlets for expression of the behavior. For example, cats may need to be confined to avoid exposure or access to other cats, so safe 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 (Fig. 17.1). Another option might be to fence off the garden to keep the cat enclosed.

Management may also include physical and mental stimulation to provide for the cat’s behavioral needs, which may reduce stress as well as help the cat cope with potential stressors in day-to-day living. There are many ways to provide for a cat’s behavioral needs that allow the cat to express normal behaviors in an acceptable way (Fig. 17.2).

Studies have investigated disease rates among animals in enriched environments versus those in standard housing. Enriched environments (those that met the needs of the cat) were found to decrease the incidence of gastric ulcers in rats2 and urinary tract disorders in cats³ and to improve the immune functioning of macaques.⁴ 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 lifespan.^5–7

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,⁸ and the same may be true for cats.⁹

Providing for the behavioral needs of the cat may prevent some behaviors that are of concern to owners and decrease stress, which may in turn lessen the chances of stress-related diseases such as interstitial cystitis.^3,10,11

Meeting the cat’s needs may help alleviate boredom, and it may also play a role in preventing obesity and associated medical problems such as diabetes mellitus, hepatic lipidosis, and osteoarthritis. Stress has a negative role in the development of clinical signs of lower urinary tract disease, gastrointestinal disease (e.g., vomiting, diarrhea, decreased food intake), as well as fever, lethargy, decreased activity, and painlike behaviors in cats.^7,12 Addressing the environment of affected cats may play a role in treatment of these problems.

Any changes to a cat’s environment must consider 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. Cats are small, solitary, ambush hunters that have a crepuscular activity pattern. They have complex and highly variable social systems, depending on the distribution and amount of resources such as food and shelter.^13,14 Cats are territorial, with male territories overlapping several female territories. Any devices and activities added to meet behavioral needs must address biological needs as well as 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.15 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 (Fig. 17.3). There are many 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 or letting the cat catch a toy may help 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. Many commercial toys are now available that require varying degrees of batting, rolling, dexterity, and mental activity to release the food.

Wild and feral cats frequently eat grass. Cat grass offers a safe grazing choice for cats kept indoors. 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.16 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 (Fig. 17.4). 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 up high, which can reduce stress. Cats are both predator and prey and may feel more secure in a place where they can watch activities without being watched themselves.

Scratching

Scratching is a normal behavior for cats. A cat’s motivation to scratch includes maintenance grooming of the claws and deposition of an olfactory mark to convey temporal cues regarding the cat’s proximity or passage. Cats often scratch when they are excited (e.g., when their owners come home or during play) and after sleeping. Old and new objects will be scratched, although older, frequently used scratching posts seem to continue to maintain interest for many cats.

Owners should provide suitable outlets for scratching that are easily accessible and attractive and make unacceptable targets, such as furniture, less attractive. When a cat’s scratching appears to be excessive in frequency, location, or duration, the possibility that the marking is related to stress or anxiety (as with urine marking) should be considered. In this case providing more ways to meet the cat’s behavioral needs, identification and removal of potential stressors, and possibly pheromone therapy may be necessary.

It is advisable to have at least one scratching post in the room most frequented by family members and in other well-traveled places in the home. More posts are needed in multicat homes. Ideally, vertical scratching posts should be tall enough for the cat to stand on its hind legs and reach up to scratch (Fig. 17.5). Posts should also be sturdy and stable. Cats have individual preferences regarding the materials and orientation (vertical or horizontal) of the posts. Therefore, owners can be both proactive and reactive in providing scratching posts that appeal to the cat’s tastes in type, texture, orientation, and location.

Cats can be encouraged to scratch by using an interactive toy (e.g., a fishing pole–type toy with feathers) and waving it over the post or attaching a dangling toy to the post. Once a cat’s scent is deposited on the post, the cat is more likely to return. Cats can also be clicker trained to scratch at the posts. Additionally, a synthetic pheromone analogue (Feliscratch by Feliway, Ceva Animal Health) may also be helpful in directing the cat to scratch in the desired location.

Novelty

For cats that have all their basic needs met, exploratory behavior becomes a greater priority. Because most pet cats do not have to spend several hours a day hunting, novelty plays an important role in enriching a well-fed and rested cat’s time and meeting the cat’s behavioral needs. The owner can increase novelty by using different feeding techniques, such as placing food in treat balls, scattering dry food over a wide area for the cat to hunt, and putting food in different locations; offering new toys; and rotating toys every few days. Another option is providing new objects the cat can interact with, such as a box or tunnel (Fig. 17.6). Objects and toys can be moved around the space the cat occupies to create the appearance of a new environment. Cats can become used to hunt-and-chase toys within a few minutes, necessitating the introduction of a few different items within and between play sessions.¹⁵

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