Tuesday 10 December 2013

Behavioural Medication

Animals, just like people, can sometimes find themselves unable to cope with aspects of their life, either temporarily or long-term. This may be because they have been subject to a traumatic experience, chronic stress, panic attacks, ongoing states of anxiety, or it may be more complicated than that. Like some people, some pets may just find everyday events difficult to cope with, have trouble controlling their responses to things, or tend to over-react or be overwhelmed. They may be particularly sensitive or have phobias that prevent them from functioning normally at times. But pets, like people that have these problems, don't have to suffer. We can treat them, and sometimes psychotropic medication is a very appropriate way to do that and will improve their quality of life. Sadly, it seems there is a stigma around mental illness in humans, and something similar exists for animals. Many people consider this medication to be an absolute last resort, as if there are many options they should try first. This is interesting when you consider how readily we often accept medication as a first port of call for physical ailments. Why the leery avoidance of behavioural medication, in some cases even after a veterinary behaviourist has diagnosed an anxiety disorder, phobia, or other emotional illness? Here are a few reasons that seem to come up regularly.

1) I don't want to change my dog or cat's personality. Are you your moods? Your pet's personality is not something set in stone as it is a beautifully complex and adaptable thing, but it is not so affected by brain chemistry that making a small adjustment to how the brain functions is going to completely change who your pet is so that they are unrecognisable. Rather, you are clearing the way for their personality to shine through their anxiety, phobias, or compulsive behaviour. If they are zonked out and not very responsive, the dose or medication is not right.

2) Medication doesn't teach them anything; it just treats symptoms. This assumes the animal is often in a state where they CAN learn. This is not necessarily true. It also assumes the problem can be solved by simply training the correct behaviour. Also not necessarily true. Emotional responses are not isolated from each other. There is ongoing emotional feedback that influences mood and how the animal sees the world. See the articles on emotional states in training for more information. Strong emotional responses override attempts to train behaviours. The medication will help address the emotional response so that training can be effective. It's not one or the other. They should go hand in hand.

3) Behavioural medication is over-prescribed, often used by people who can't handle the animal they have. This shifts the focus unfairly away from the animal, who may not be able to handle the life they have. Why should they suffer more than everyone else when there is medication available that can make them feel better? Most likely some animals are prescribed medication as a management measure because their owners can't cope with them. This may not be the disaster it sounds like. After all, this is about their welfare, not pet owner abilities.

Erik is a great dog, highly trained, very obedient. He is on fluoxetine (Prozac) as he is prone to getting overwhelmed, which makes life for him stressful. The medication helps keep his emotional responses moderate so he can be his best and happiest self. 

The psychological reasons why we might avoid behavioural medication may be more significant, and many of these may come down to cognitive dissonance. Cognitive dissonance is when our ideals contradict reality. It makes us feel icky and conflicted. We don't like it and strive to resolve it. We resolve it either by justifying our ideals and beliefs in this new context, for example, with reasons not to medicate, or we discard those old ideals and beliefs and adopt new ones based on new experiences and information. The latter is extremely difficult for many people! See the article on cognitive biases to understand why. We are just not wired to discard beliefs we have held for a while. Here are some possible sources of cognitive dissonance related to behavioural medication in pets.

1) Surely my pet is not THAT sick. This comes up with people with mental illnesses as well. Perhaps we feel that we should be in control of our own behaviour and so should our animals, yet if we medicate a behavioural problem, are we taking their control away? It must be really serious for medication. But this has been going on for months. Maybe years. You pride yourself on being a good owner and taking your pet to the vet right away when they are unwell. It's okay! You are not a bad owner. You just don't know everything. Focus on the future. You are going to overcome all your reservations and hang-ups so you can give your pet this extra help. That makes you a good owner.

2) I'm a good trainer. A good trainer would be able to fix this with training. This is a big one for some dog owners. There is some confusion about what training can and can't do. As above, their ability to learn may be compromised without the support of the medication. Furthermore, your skill as a trainer is really a moot point. However skilled or unskilled you are, you are all your dog has. If that is not enough, your job is to recognise that so you can get your dog help now. You could be the best trainer on the planet and still not be 'good enough' to train an animal to alter their brain chemistry. If the medication helps, not only will training be much easier and more effective, but what training you have already done will come to the fore more often. Your dog is trying to be a good dog. They're just up against emotional states that are bigger than the both of you. When the medication is making that emotional problem much smaller and more manageable, your training will emerge like a beach when the tide recedes.

Like the tide coming in, heightened emotions will swamp your training.

3) He's been much better lately. I think we are making progress. Don't think, know. See the end of the bias article. Be very careful with this one. It is so easy to accept a very high baseline for 'normal' behaviour because that is what you usually see. If the animal is typically anxious and highly emotionally reactive, does this mean that if you see a small improvement the animal is no longer struggling to cope?

So when should you consider behavioural medication? Well, that's something you should discuss with a veterinary behaviourist. As a general rule, I would recommend a veterinary behaviourist when the animal is significantly stressed on a daily basis, when they are having panic attacks related to phobias or separation, and when they are engaging in behaviours so obsessively that it is impacting on their ability to function normally or is causing them harm. In short, when your animal's quality of life is diminished because of what they are going through. Remember that behavioural medication is not an exact science. If one medication doesn't work as hoped, don't be afraid to discuss adjusting doses or changing the medication. Just like people, individual dogs and cats can respond differently to the same psychotropic medication. Give it a proper chance.

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