Sunny shakes and whines during thunderstorms. Lately she has started to whine if she just hears rain. Last night was the worst. There was a bad storm at midnight and she kept the family up for hours. What can I do to help?
Fear of strange and loud noises is a common phenomenon among dogs and cats. It originates from a natural and adaptive behavior. Alerting to sudden, unfamiliar noises is important for the survival of animals in the wild, while seeking shelter in the face of very loud noises, such as thunder, also facilitates survival. Therefore, this behavior is only a problem when noises that should not elicit intense fear responses do so consistently. A combination of genetics, early experience, and specific learning can all influence the development of this problem. Diagnosis is usually easily made when the patient consistently exhibits intense fear responses to specific noises, such as popping or crackling sounds, certain appliances operating, thunder, planes passing overhead, fireworks going off, babies crying, or cars backfiring.
Other Anxiety Problems
Some noise-phobic pets have other anxiety problems, including separation anxiety and generalized anxiety disorder. If this is the case, these problems must be addressed in addition to the noise phobia. Treatment consists of three major components; environmental management, behavior modification, and medication.
Addressing Noise Phobias
First, for some noise phobias, it may be possible and desirable to avoid exposing the pet to the noise during the initial phases of treatment. For example, if the dog becomes fearful when the electric mixer is used, one member of the household can take the dog on a walk while another member of the household is preparing cake batter. If the pet is afraid of the sound of fireworks, it should be placed in the basement or an interior, windowless room, if feasible, during celebrations in which fireworks are likely to be used. If it has separation anxiety in addition to noise phobia, someone will need to stay with the pet. Additionally, "white noise" can be played, in the form of music or a television show, to further assist in obscuring the sounds of the fireworks. Collars containing dog appeasing pheromone (DAP; Veterinary Products Laboratories, www.vpl.com) may also be useful in some cases.
The primary behavior modifications used in the treatment of noise phobias are desensitization and counterconditioning. In desensitization, the pet is exposed to the stimulus that induces fear, but at such a low level that fear responses do not occur. For counterconditioning, a response is induced that is both behaviorally and physiologically incompatible with the undesirable response. Pets vary in what functions as a good counterconditioner. For many pets, the offering of highly palatable food is very useful, while others are quite uninterested in food. Play, petting, and massage, inducing either playful or relaxation responses incompatible with fear, can be very useful for some pets.
Desensitization and Counterconditioning
To desensitize the pet, the owner must be able to expose it to the sound it is afraid of, but at a controlled and lowered volume. Recordings of many sounds that pets fear are commercially available, but in some cases, making recordings of the specific local sound that induces fear is necessary, eg, the exact way thunder sounds as it bounces off a nearby mountain. When this is done, the owner can play the recording at a very low volume that does not induce fear while engaging in whatever counterconditioning works best for the particular pet, (eg, playing Frisbee, having a massage, or practicing ‘sit' for pieces of ham). In other cases, the owners can effectively manipulate either the volume of the sound generated or the distance of the pet from the sound. If the pet becomes fearful of the sounds made by bags being vigorously shaken open, the owner can start with shaking bags open slowly and more quietly than they usually do. If a dog is afraid of the sounds of gunfire, it can be taken into a woods or field at a substantial distance from where someone will be firing a gun and gradually brought closer, probably over a series of several sessions.
What Doesn't Work
Attempts at flooding, in which the pet is exposed to the sound at full volume until it ceases showing fear is generally inadvisable and, in practice, can make the problem worse. First, the pet's fear response may be intense and initially escalate, resulting in its causing harm to itself, a handler, or the environment as it becomes panicked. Second, if a flooding session is initiated, it must be continued until the animal discontinues exhibiting fear, which may take hours. Third, a single treatment session is unlikely to be effective in the long term, and many treatment sessions of several hours each are necessary. Finally, there are humane considerations: because treatment can be effectively accomplished with desensitization and counterconditioning, in which inducing fear is specifically avoided; then it is inappropriate to use techniques that cause sustained periods of fear.
Use of Anxiolytic Medications
To achieve a rapid response to treatment and, in some cases, any response, the use of anxiolytic medications may be beneficial (Table 1). Use of anxiolytic medications in the treatment of noise phobias constitutes extralabel use (ELU), and the client should be informed of this. ELU is defined as the use of a drug product in a manner that is not consistent with what is indicated on the label, package insert, or product monograph. While some clients may be reluctant to use medication, the physiologic consequences of the stress of chronic and recurring fear can be detrimental to the pet's health, as well as its well-being.1 If the noises that cause fear occur only on an occasional and predictable basis, benzodiazepines such as alprazolam, clonazepam, and diazepam-which have a rapid onset of action and last for a few hours-may be sufficient. If the noise occurs frequently and unpredictably, as is the case with thunderstorms in some regions; then a medication with anxiolytic activity that lasts 24/7 may be desirable. This would include selective serotonin reuptake inhibitors (SSRIs) such as fluoxetine and paroxetine, tricyclic antidepressants (TCAs) such as clomipramine, and azapirones, of which buspirone is the only one commercially available in the United States. In severe cases, with pervasive exposure to fear-inducing stimuli, it may be necessary to use a combination of long- and short-acting anxiolytic medications. For example, a combination of clomipramine and alprazolam, with behavior modification, has been shown to result in improvement in over 90% of storm-phobic dogs and totally cured one dog that was extremely storm-phobic after surviving being in a house that was hit by a tornado.2
Acepromazine is an antipsychotic with sedative properties. However, it is not a good anxiolytic and is probably the most commonly misused medication for the treatment of noise phobias. The animal may move extremely slowly because it is sedated, but that does not mean its fear is alleviated. Acepromazine is suitable only as a supplement to a true anxiolytic in patients that engage in such violent behavior, (eg, jumping through windows), that they are likely to harm themselves.
Start at a low dose and increase as necessary. Benzodiazepines should be given only as needed, but no more frequently than the schedules indicate. SSRIs, TCAs, and azapirones should be given daily; they may take a month or longer to take effect. For further information, see Veterinary Psychopharmacology.3
Environmental management, behavior modification, and medication that is adjusted to the individual needs of each patient and family will usually result in improvement and sometimes full resolution of noise phobias.
TX at a glance
• Isolate pet from the fear-inducing noise during the initial phases of treatment, if possible.
• Desensitize and countercondition the pet's response to the fear-inducing sound, using a program tailored to the individual pet.
• Don't flood the pet, ie, deliberately expose it to the fear-inducing noise at full volume for extended periods.
• Give anxiolytic medications as needed.