Aggression: Treatment Options
Karen L. Overall, MA, VMD, PhD, DACVB, ABS Certified Applied Animal Behaviorist
Using treatment to help test diagnostic hypotheses:
Most behavioral conditions are best represented by non-linear models (i.e., those that represent multifactorial, heterogeneous disorders). Hence, there is no one drug to treat feline spraying: spraying can be a behavioral description, a non-specific sign, or a phenotypic diagnosis. It is caused by a variety of social circumstances and may be the result of the interactions of a variety of neural substrates. Likewise, not all aggression is neurochemically identical either in impetus or outcome. Diagnosis by pharmacological treatment is usually doomed to failure. If the clinician is using a drug that has very specific properties and they are able to monitor very specific behavioral changes, pharmacological treatment can help the clinician reject an hypothesis about underlying an underlying neurophysiological mechanism; however, response to drug treatment, alone, seldom confirms a causal link.
Still, if diagnoses are made using rigorous, repeatable criteria, and if the patient population is sufficiently large, failure of some significant portion of the population to respond to one medication when another significant portion responds well suggests that there is neurochemical and, or molecular variability within the diagnosis. In more simple terms this means that not all patients exhibiting the same phenotypic, phenomenological, or functional diagnosis are affected for the same reasons.
Making it worse
Because dogs affected with aggression have an anxiety disorder and are using provocative behaviors to get information, physical punishment has no role here. If we follow the argument to its logical conclusion, physical punishment will remove any uncertainty and convince these dogs that the person punishing them is a threat. Accordingly, their aggression worsens. Hitting or beating a dog, kneeing the dog, using "alpha-wolf rolls", "wolf rolls", "dominance downs", "hanging" a dog from a leash and a choke collar until he or she is immobile, and "helicoptering" dogs are all excessively rough, abusive, inhumane treatments that have no place in correcting behavior or in behavior modification. The use of these techniques tells us a lot about human anger, makes the relationship with the pet an adversarial one, and shows a keen lack of understanding about what's been learned about aggression and anxiety.
General protocol for the treatment of dogs with dominance and other canine aggressions
The goals of treatment for dominance aggression should include:
(1) humane treatment of the dog;
(2) prevention of injury and minimization of risk of injury to people who associate with the dog and to the dog;
(3) an understanding of the circumstances in which the dog will react and the probability of reacting in those circumstances (e.g., the dog only growls 50% of the time when disturbed while sleeping but snaps 100% of the time if shoved from the bed);
(4) avoidance of circumstances known to "provoke" the dog so that the dog does not continue to experience situations in which he or she reinforces the behavior;
(5) improvement in the dog's behavior so that the family is happy to live with the dog and so that they are able to do so safely.
Accordingly, treatment involves:
(1) avoidance of all circumstances known to provoke the dog (e.g., if the dog reacts when hugged, don't hug the dog; if the dog reacts when sleeping on the bed, don't let the dog sleep on bed; if the dog reacts when pushed from the sofa, but not when called, only call the dog - and reward with a treat for coming);
(2) passive behavior modification to insure that "bad" or undesirable behaviors aren't rewarded (e.g., if the dog stares at you, walk away; if the dog won't let you put on a leash or collar and instead rolls over, tucking in their neck and jaw, walk away); the key here is to avoid getting into a struggle and increasing the reactivity in the situation;
(3) passive behavior modification to encourage seeking cues about the appropriateness of their behavior from the clients;
(4) active behavior modification using desensitization and counter-conditioning to teach the dog a new, less aggressive way to react in the situations he regards as provocative;
(5) the use of anti-anxiety medications.
Passive behavior modification paradigms involve contextual shaping of behaviors; active paradigms involve interactive techniques like desensitization and counter-conditioning. Clients who obtain the best results use both passive and active strategies. Passive behavior modification is a fabulous and under utilized tool that works because it incorporates standard canine signaling that is involved in the maintenance of dog social systems. The following passive behavior modification program is designs for use by clients and follows the pattern outlined for similar programs cited.
Starting out - Passive behavior modification - Encouraging deference
Dogs have social systems that are very similar to those of humans. They live in extended family groups, they have extensive and extended parental care, will work as a group or a family to help care for the offspring, nurse their young prior to feeding them semi-solid, then solid, food, use play as one form of developing social skills, communicate extensively vocally and non-vocally, and -- most importantly -- have a social system that is based on deference to others.
Although we freely use the term, the concept of an "alpha" animal is not useful here. The traditional definition of the "alpha" animal requires control of access to some resource as determined in paired contests; however, in true social groupings such dichotomous sparring is exceptional. Fights for status or control are notoriously rare among wild canids, like wolves. Furthermore, when the "winner" of such pairs has been followed in the context of more normal, complex social groupings or followed through time, the "alpha" animal or the "winner" of the contests does not predict other social relationships or the changes in these relationships with the attainment of social maturity (Willson, 1998). The concept of "alpha" promotes an erroneous and absolute mythology that indirectly encourages compliance with a rank hierarchy. This concept then serves as a springboard to legitimize overly rough and often abusive "training" methods requiring human domination of the dog where the dog is physically compelled to act in the manner the human wishes.
Except in what humans perceive to be abnormal social conditions, most human social relations are also structured by negotiation and deference to others, rather than by violence. Deference-structured hierarchies mean that the individual to whom others defer may differ depending on the social circumstances. Status and circumstances are not absolute. In the human situation, a child may defer to his parents' requests, but then be the leader on the playground to whom other children defer. Dogs are similar.
Much has been written about dogs viewing their human families as their packs. While the pack comparison is not exact, dogs are social and generally will look to their people for guidance. Dogs often become problems when they cease to do this, or if they never do this. This program is the first step in both PREVENTING such problems and in TREATING all forms of behavioral problems.
All social animals create some form of rule structure. It is what allows them to communicate with each other. Because dogs are similar to us in so many ways, and frequently look like they are hanging on our every word, we assume that they are complying with our rule structure. Puppies actually need guidance in how to do this, and problem dogs need to have a consistent, benign, kind, humane rule structure explicitly spelled out for them. This is a kind of safe and gentle doggie boot camp: if the dog knows a consistent rule or behavior that will get the attention of his or her people, he or she will then be receptive to guidance. What you want the dog to do is to take his or her cues about the appropriateness of his or her behavior from you. In this context, the human's role is provide guidance and protection for the dog. This paradigm represents a form of discipline. People often confuse discipline and violence or abuse. This program should be executed without violence or physical abuse. In fact, for most dogs, withdrawal of attention is a far more profound correction than is physical abuse. Abused dogs, or those consistently mismanaged with physical punishment, will either learn to over-ride the punishment, or learn to seek it, since it may be the most common contact that they get. Abuse includes inappropriate physical punishment such as beating with bats, plastic soda bottles, chains, leashes, whips, towels, sticks, et cetera, extreme physical restraint as discussed in Part I, stepping on dogs toes, kneeing, or kicking dogs, and using devices like cattle prods. People are always horrified when I run through this list, but every technique and device mentioned here and in Part I have been ones listed by my clients as methods that they have tried or methods recommended to them to correct their dog's behavior.
The intent of this plan or program for deference is to set a baseline of good behavioral interaction between the client and pet, and to teach the dog that he or she must consistently defer to his or her people in order to get attention. This is done in a safe, kind, passive manner, and is tougher to do than clients frequently acknowledge. The reasons for this are as follow. First, the clients have to break their own pattern of response which often involves fear, anger, or both. Second, if the clients are talking, reading, or watching TV and the dogs comes up to them and rubs, paws, or leans against them, the clients usually passively reach out and touch or pet the dog. The DOG controlled that entire interaction. Score: dog, 1; human, 0. The people didn't even know that there were any signals other than affection to the dog being conveyed, but the dog was very clear on what happened.
Under no circumstances can the clients touch, love, or otherwise interact with the dog unless the dog defers and awaits their attention. This is done by having the dog sit. The sit does not have to be prolonged (a few seconds) and a very young puppy may not do it perfectly because they are wiggle worms. Regardless, pups as young as 5 weeks of age can learn to sit and attend to the client (look at them for cues, make eye contact, look happy and attentive while being quiet) in exchange for a food treat. As soon as the puppy sits, the person should say "Good girl (boy)!" and give a tiny treat of something special. Also praise and pet the pup.
The behavior modification instructions discussed thus far are largely passive. The set of recommendations presented here involves active behavior modification and builds on the foundations already established by encouraging the dog to attend and defer to the client. If clients have been unable to accomplish the earlier recommendations, they will be unlikely to be successful with these. Fortunately, that is a relative rare occurrence in the population seen at the Behavior Clinic at VHUP. Should clients experience difficulty in encouraging the dog to relax and comply with the instructions listed below, or if the dogs seem to have difficulty in following the patterns outline, using pharmacological intervention as an adjuvant to treatment may be a terrific option. One benefit of drug treatment is to decrease anxiety. Because learning is inhibited or slowed in situations involving anxiety, the use of appropriate medication can help dogs to learn newer, preferred behaviors faster than without medication. No pharmacological treatment should be started in the absence of a diagnosis, without a complete physical and laboratory evaluation, and without discussing the potential risks with the client and advising them that such drug use is invariably extra-label.
Introduction to active behavior modification
The following recommendations for the treatment of canine aggression are the ones used with clients and problem pets at the Behavior Clinic at VHUP. They are designed to redress the patient's problems with control, fear, and anxiety. The focus is one of encouraging and enforcing deference. Because behavior modification approaches involve some behaviors that are commonly encouraged in obedience classes, there is a real risk that clients will assume that they have already tried such approaches and that they have not worked for them. This fundamental misunderstanding about behavior modification needs to be overcome if behavioral approaches are to be implemented. Salient points to make with the clients at the outset follow.
1. Behavior modification exercises are NOT, repeat NOT, obedience exercises. At the very outset clients should be disabused of the notion that this is fancy obedience. First, while sitting is part of obedience training, the goal of these programs is not just to have the dog sit, but to relax and be receptive to changing his or her behavior while doing so. It is critical that clients understand and appreciate this difference. Dogs that are stressed or anxious cannot successfully learn a more appropriate behavior and they certainly cannot associate that behavior with having fun or with good things happening. Second, if the client perceives that all we are doing is trying to teach the dog what he or she has already learned in training class they will not see the need to comply. If we offer nothing different, what is the point of behavior modification? It is the practitioner's job to teach the client that behavior modification. Obedience training, while sharing many similarities with behavior modification, differs in the premise, interactive reward structure, goal, and outcome. Most of the dogs that undergo behavior modification have been through some form of training and most know how to sit. For a dog to do this successfully in a class (or even a show) situation, the dog does not have to be relaxed. That is not true for behavior modification.
2. The biggest problem that the client is going to have is with appropriate timing of rewards and corrections. Dogs read non-vocal or body language far better than do most humans. It is easy for them to subvert the exercise and shape the behavior of the client. Problem dogs have been doing this already. Someone from the outside of the relationship needs to be able to comment on timing problems and to instruct the clients when to change their posture, their tone, or their quickness of praise or reward. Most clients are quite good at learning to do this, but they need help. After the initial demonstration they may even need to be able to show you what they are doing to see if it is correct, or if you can make recommendations. This can be done in a quick 10-15 appointment (and support staff can be responsible for this), or the client can send a video, and an appointment - in person or by telephone - can be set for a critique. If the clients are not seeing an improvement, or are having an actual problem either:
a. they are pushing the dog too hard, too fast (very common in today's hi-tech, faster-is-better world),
b. they are giving confusing signals, or
c. their timing is wrong.
This is hard work -- it is not magic. The practitioner will need to help along the way.
3. The practitioner must work WITH the client. In the case of a very fearful or very aggressive dog the practitioner may not be able to demonstrate the exercises or fit a halter during the first visit. In such cases, after fully cautioning the client about possible risks, the practitioner can ask if the client feels comfortable attempting the first round of the behavior modification protocols while the practitioner talks them through it. For reasons of liability it is important to explain that this is not the desired technique; however, if the client cannot eventually work with the dog, or if the client is perpetually afraid of the dog, the situation will be hopeless.
If the practitioner is able to work with the dog, they should do so both to teach the dog the appropriate behaviors and to demonstrate to the clients what is desired. Again, taking a video that can be played back and critiqued after the session can help. When the dog works well with the practitioner, it is the client's turn. It is of no use if the dog is perfect for the practitioner, but a horror for the client. It is not sufficient to demonstrate the behavior modification without then giving the client the chance for emulation. It doesn't matter if that dog is perfect for the practitioner -- the practitioner does not have to go home and live with the dog. The clients must be able to accomplish the suggested modification, hence it is inappropriate to just send them home with sheets of paper.
4. Finally, if there is the potentially for a dangerous behavior that will need to be corrected or avoided, it would be optimal if the client doesn't discover this when there is no one to help them. A run-through of the program will minimize, but not ablate, this chance.
Most commonly used behavior modification programs employ praise and food treats or rewards. The approach to behavior modification discussed here does not use hand signals. Hand signals are commonly used in obedience and can be useful for dogs and clients. These Protocols are for use with problem dogs or young pups. They need every bit of help that they can get. Hand signals, here, will be a needless distraction. Once the dogs master the programs, they will have no problems coupling the learned vocal cues to visual ones. Until then, these dogs should work in calm, quiet circumstances, without distraction, for vocal cues, and a consistent reward structure. Dogs can learn all the words for the commands that they will need for these programs. Hand signals at this stage will only ask them to distract their attention from the behavior modification process, and, for very aggressive dogs, such signals will put the person using them at risk. Without exception, dangling body parts in front of an aggressive dog is not recommended, and will make the animal more anxious. In a worst-case scenario, hand signals can be seen by the dog as threats. Sample protocols are found in the section on "Practical behavior modification in action".
No discussion of the treatment of canine aggression would be complete without discussing modern pharmacological intervention. Veterinarians who are general practitioners are committed to providing total patient care. They should be in the position to evaluate deviations from normal behavior and to suggest solutions before the problem worsens. Behavioral modification, alone, can be sufficiently efficacious that no medication is needed if treatment occurs very early in the course of the development of dominance aggression. Behavioral modification protocols also help prevent behavior problems, and may change the course of the development of dominance aggression, if used as a preventative for puppies. This paradigm is no different than that used in many other "medical" conditions where early intervention is considerably less complicated and involves fewer medications than does delayed or later intervention.
Regardless, while management may play a role in both the expression of behavioral diagnoses and their resolutions, it would be inexcusable and irresponsible to advance poor management as the primary etiology of behavioral disorders. The vast majority of animals with behavioral diagnoses are not poorly or misbehaved; they are abnormal or are responding to an abnormal social system. In this context these problems are "organic" in nature: the concept of "organic cause" is changing, and now encompasses disorders of serotonin metabolism that underlie many, if not most, behavior problems. Other neurochemicals are likely to interact with alterations in serotonin in pathological behavioral conditions, but the majority of neuropsychopharmacological agents commonly used interact with serotonin metabolism.
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