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How Stress Affects Health and Behaviour;
Strategies for Prevention and Treatment
G. M. Landsberg DVM, DACVB, Dip. ECVBM-CA
North Toronto Animal Clinic, northtorontovets.com
CanCog Technologies, Director Veterinary Affairs
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Presentation Outline
• Diagnostic dilemma: «behaviour» or «medical»?
• Normal vs. abnormal behaviour
• Fear prevention & enrichment
• Integrated approach to common stress-related
behaviour problems
 Behaviour modification program
 Natural products and drugs
• Case study
• Question period
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Veterinarian’s Role
• Assess behaviour at each visit
• Maintain health, welfare, bond
• Behavior – may be first or only sign of medical issue
 Central nervous system (CNS), metabolic, cognitive dysfunction
syndrome (CDS), sensory, Pain
• Welfare (5 freedoms)
 expression of normal behaviour
 freedom from fear, discomfort, pain, hunger
• Veterinarian’s role to prevent, diagnose, treat
• Do the pet a favour ► ask about behaviour
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Diagnostic Dilemma:
Is it «Behaviour» or is it «Medical»?
• Medical: Behaviour Signs
• Stress: Effects on health / behaviour
• Behaviour: Normal vs. Abnormal / Pathological
• Combined
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Medical Causing Behavioural
• Neurologic / Central / Peripheral / CDS
• Internal medicine
 Endocrine – increase / decrease (e.g. thyroid)
 Metabolic (e.g. encephalopathy)
• Pain / welfare: Behavioural change, mobility
• Sensory: Response to stimuli
• Dermatology (e.g. self – trauma)
• Drug effects (e.g. steroids / irritability)
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Stress
• Altered homeostasis: Affects health and behaviour
 Endocrine, immune, psychological
• Hypothalamic-pituitary-adrenal axis (cortisol)
 acute / chronic effects on behaviour health
• Noradrenergic system
 Acute / chronic
 sympathetic arousal – lack conscious control
• Prolactin: Lower in acute stress, higher in chronic
• Hyperglycemia with stress in cats
• Opioid / beta-endorphin
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Stress Effects on Medical Health
• Acute vs. chronic effects
• Chronic
 Immune: Increased sensitivity to pathogens
 Oxidative damage: stress, disease, age, drugs
• Stress related diseases in human / dogs / cats
 GI, urinary, dermatologic, respiratory, aging
 Feline example: stressful events and skin, GI / appetite, urinary,
respiratory, avoidance (Stella et al, JAVMA)
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Stress: Ingestive and GI Signs
• Humans
 Alter bacterial flora, gastric emptying, heartburn, colonic activity,
intestinal permeability, irritable bowel, ulcerative colitis
• Pets
 Anorexia (particularly problematic in some cats)
 gastrointestinal signs / colitis
 psychogenic polydypsia
 pica (lick, suck, gulp, gorge, coprophagia)
 obesity
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Is it «Medical» or is it «Behavioural»?
• Environmental licking n = 20
(Frank et al, ACVIM 2009)
 Full workup including GI, scope, biopsy
 GI disorders 14/20 dogs / resolved 10 of 18
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Video: LICK3
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Video: CAT01
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Stress and the Urinary Health
• Feline Interstitial Cystitis (FIC) and stress
 Altered bladder permeability, noradrenaline ↑
• MEMO (multi-modal environmental modification)
 reduce FIC, respiratory, fear, nervous, IBD, aggression
(www.indoorpet.osu.edu)
• Feliway diffuser – less bouts
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Stress and the Urinary Health
• FIC – Seawright et al., Cameron et al.
 Higher risk with recent move, recent injury, dogs in home,
movement restricted by other cat
 Improvement over placebo by reducing anxiety, increasing
space, separating resources
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Stress and Dermatology
• Brain-skin connection
• Stress may be a trigger for skin disease
• Psycho-neuro-immuno-endocrinological response
• Human
 Stress and atopic dermatitis, psoriasis, urticaria
 Stress increase cytokines, IgE, eosinophils, vasoactive peptides
in atopic vs. non-atopic
 Stress and increased epidermal permeability
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Stress and Dermatology
• Pets
 Increased severity and frequency of skin disorders in separation
anxiety, non-social fear
 Psychogenic and recurrent pyoderma in dogs
 Psychogenic and pruritus in dogs
 Allergen penetration if increased permeability?
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Stress and Mental Health
• Enrichment, behavioural needs / time budget
• Undesirable may fill void
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Stress and Mental Health
• Conflict: Competing motivation
• Frustration: Unable to achieve goal
• Displacement: Lick, circle, yawn, suck, drink
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Video: GREETCIRCLE
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Video: CIMG6542
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Contributing Factors
• Medical complications
• Owner response
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Stress and Mental Health
• Recurrent / Chronic stress
 Cope vs. unable to achieve homeostasis
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Stress and Mental Health
• Correlates to humans
 phobia, generalized anxiety disorder, compulsive behaviour
 post traumatic stress, impulsivity, panic
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Behaviour Pathology
• Deprivation: Prenatal / neonatal / maternal
• Insufficient early socialization / habituation
• Genetics
 Abnormal serotonin and aggression
 English Cocker Spaniel, Springer Spaniel
 Compulsive – outside situations of conflict
 Repetitive, exaggerated, sustained
 Attention to particular goal
 Self-trauma, neurologic, ingestive
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Compulsive Behaviour
Doberman exhibiting obsessive flank-sucking.
Photo: Tufts University.
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Video: P1000025
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Is it «Behavioural» or «Medical»?
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Evaluation of 21 Cats with a Presumptive
Diagnosis of Psychogenic Alopecia
• Non-seasonal, no primary lesions, no scratch
• Exam, blood / urine, derm assessment
• Revolution (3 tx), food (Feline z/d - 8 weeks)
 Response assessed – food challenge if improved
• Methylprednisolone acetate at 8 / 11 weeks
 Response to therapy assessed
S. E. Waisglass, G. M. Landsberg , J.A. Yager, J. A. Hall, JAVMA 2006
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Polling question
Of the 21 cats referred with psychogenic alopecia, how
many had an entirely medical cause?
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•
•
•
•
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0
4
8
16
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Results
• Medical: 16/21 (76.2%)
 Food 57% / Multifactorial 52%
• Psychogenic + Medical: 3/21 (14.3%)
• Psychogenic alopecia (PA): 2/21 (9.5%)
• Histology not confirmatory
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Diagnosis - Behaviour Problems
• Normal?
 Inappropriate / undesirable: Time / place / target
 No drugs indicated but natural products may help
• Abnormal?
 Fear / anxiety, attention deficit, hyperactivity disorder (ADHD),
panic, phobia, compulsive
 Rule out medical
 Drugs and/or natural products are indicated
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Feline Behaviour
• Normal behaviour
 Eliminate /mark
 Climb / explore
 Scratching
 Play / nocturnal
 Vocalize
 Predation
 Mating
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• Common problems
 Eliminate /mark
 Climb / explore
 Scratching
 Play / nocturnal
 Vocalize
 Predation
 Mating (neuter)
Canine Behaviour
• Normal behaviour
 Age, breed, Individual
 Hunt / scavenge
 Eliminate / mark
 Social / object play
 Territorial – vocal
 Sexual
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• Common problems
 Eliminate /mark
 Climb / explore
 Scratching
 Play / nocturnal
 Vocalize
 Predation
 Mating (neuter)
Fear, Anxiety, Stress
• Fear: Response to perceived threat
• Anxiety: Anticipation of threat / danger
• Genetics / development / socialization / experience
• Insufficient outlets / enrichment
• Unpredictable consequences
• Lack of environment control
• Punishment – owner emotional state
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Signs of Fear, Anxiety
• Behavioral – anxiety, stress, fear
 Fight / threat, flight (avoid), freeze
 Ears, eyes, lips, tail, posture
 Autonomic: Heart and respiratory rates, salivation, trembling
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Video: Snapping dog on table - no GL
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Fear Prevention
• Socialize/Habituate: 7-9 wks. cats, 12-14 wks. Dogs
• Reward desirable, not punish undesirable
• Provide outlets – enrichment
• Environmental control
• Natural products to adapt
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Canine Enrichment
• Understand normal behaviour
• Age/breed/health appropriate
• Social intraspecific
• Social interspecific – pets, people
• Object play – work for food
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Canine Enrichment - Humain
• Social time, play, exercise, train for rewards
• Consider canine, breed, individual needs
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Canine Object Play
• Explore, scavenge, chew
• Provide outlets
• Work / train for food
 Stuff, freeze, manipulate
 Search and find
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Dog playing with Konk toy
Video: CIMG9745
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Feline Enrichment – Indoor Housing
• Understand normal behaviour
• Multiple small meals / play sessions – mouse size
 Predation 8-10 mice per day – 2 of 3 missed
• Object play / explore
• Social: intraspecific / interspecific
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Enrichment – Social (human)
• Play: Novelty wears off but interest heightens
• Individual: Movement, texture, food, size
• Play: Increase with hunger, end with food
• Reward train
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Video: cattrain
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Video: play2CIMG5043
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Object Play / Explore
• Food toys: Hunt / work for food
 Hunt independent of kill
• Explore: Climb, perch, scratch
• Rest / comfort / security
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Set Up to Succeed
• Provide outlets - reward use
• Prevent – positive confine
 Control, security
• Supervise – inhibit - deterrents
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Cat on counter - deterrrent
Video: Case39part3
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Fear, Anxiety, Stress
• Adoption – new home – moving – change
• Boarding, confinement, travel
• Unfamilar people / pets
• Veterinary clinic, groomer
• Urine marking
• Separation related problems
• Noise / Storm / Fireworks
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Fear, Anxiety, Stress - Treatment
• Physiologic, emotional, behavioral outcomes
• Identify fear stimuli: Avoid
• Expose below threshold: Desensitize (DS)
• Response substitution (RS)
 Train / reward behavior
• Countercondition (CC)
 Positive association
• Natural products / drugs: Start early!
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Confrontation and Punishment
• May decrease behaviour: Avoid / retreat
• Does not decrease fear or train desirable
• Herron et al, AABS, 2009
 Confront – alpha roll, yelling «NO» can increase aggression
expecially if aggressive to family
• Blackwell et al, JVB – 2008
 Punish: Increase fear / avoidance
 Punish + reinforce: higher risk of aggression
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Natural Products / Drugs
• Start early!
• Build confidence, reduce stress
• Reduce arousal – anxiety
 Low: Conscious control – allows for learning
 High: Immediate response vs. learning
• Alter neurotransmitters / receptors
• Natural products
 Safer? Adverse effects?
 Standardization?
• Show me the evidence!
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Behaviour Therapeutic Trials
• Randomized Control Trial – Placebo Effect up to 50%
• Clinical trials – owner measures – subjective?
 Time / expense – inclusions / exclusions
 Placebo effect - No one wants placebo
• Laboratory trials – lab measures – objective?
 Standardized population - Less time / expense
 Need to validate model – does it predict clinical
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Polling question – Check all that apply
Which of these natural supplements have you
already used for anxious pets?
• Bach’s flower remedies
• L-theanine (Anxitane)
• L-tryptophan
• Pheromones (DAP, Feliway)
• Alpha-casozepine (Zylkène)
• None
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Evidence-Based Products
• Natural products
 Veterinary labelled: Zylkène, Anxitane, DAP/Feliway,
Harmonease (USA)
 Tryptophan/low protein, aromatherapy, melatonin
• Drugs
 Veterinary labelled: Reconcile, Clomicalm, Anipryl
 Buspirone, benzodiazepines, propranolol, trazodone, clonidine,
carbamazepine, memantine
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Zylkène®
• Tryptic hydrolysis of milk as in newborn
 Bovine milk hydrolysate - alpha S-1 casein
 Calming - Safe – Crosses blood-brain barrier
 Affinity for GABA receptors – inhibitory, anxiolytic
• Dose > 15 mg/kg
 Cat: Open into food sid / Dog: Sid or divided
 Up to 30 mg/kg for situational (e.g. travel, noise)
• Trial: 2 weeks to 2 months. May be used long term if
successful
• Alone or combine with other natural / drug
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Indications – Dogs / Cats
• Social stress, development, age related stress
• Environmental stress
 change, moving, adoption
• Fear: Animate, inanimate, situations
• Urine marking (cats)
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Effects of Alpha-Casozepine on Anxiety
Disorders in Dogs
• JVB 2007– Beata et al.
• 38 dogs, 56 days trial – alpha-casozephine
vs. Selegiline
• Evaluation of Dog's Emotional Disorder (EDED)
 Feed, drink (pu/pd), groom, sleep, explore
 Aggression, social, learning, stereotypic / acral lick dermatitis
 Physical: HR, RR, gastrointestinal, obesity
• Comparable in improving EDED score
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Effects of Alpha-Casozepine on Anxiety
Disorders in Cats
• JVB 2007 – Beata, Beaumont-Graff, Coll et al.
• 34 cats, 56 day trial – placebo trial
• Anxious disorders – emotional scale for cats
 Tolerance of contact familiar people
 Contact with strangers
 Aggression, fear
 Physical signs / autonomic signs
• Significant improvement in global score
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Evidence - Pheromones
• Feliway: Feline facial pheromones (F3)
 Marking, scratching, transport, moving
 Idiopathic cystitis
• DAP (Adaptil) – Lactating bitch sebaceous pheromones
 Separation anxiety, storm / fireworks
 New home, socialization
 Travel, veterinary clinic
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Evidence – Other Natural Products
• L-theanine (Anxitane) – JVB - Laboratory trial
(CanCog) – fear of unfamiliar human
• Magnolia / Phellodendron (Harmonease, USA)
JVB - Laboratory trial (CanCog) – induced thunder
• L-tryptophan / low protein diet – JAVMA –
canine territorial and aggression
• Aromatherapy – lavender – JAVMA – travel
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Drugs
• Fluoxetine – RCT – separation anxiety – ongoing
 Compulsive, marking (feline), generalized anxiety
• Clomipramine – RCT - separation anxiety – ongoing
 Compulsive, marking (feline), storms
• Buspirone / benzodiazepines / propranolol
• Trazodone, Clonidine, Carbamazepine, Memantine
 Adjunctive or as needed
• Could combine with natural
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Positive Adoption
• Control, reward train, predictable, enrich, routine
• Set up to succeed / safe area
• Puppy – second dog, other dogs
• Age of adoption, puppy class, socialize
• Avoid fear evoking stimuli
• Anxiety: DS / CC / RS
• Natural products / drugs
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Positive Veterinary Visits
• Positive from outset:
 Car – reception – exam
 Owner – staff – DVM
 Treats, toys - avoid negative
• Fear / anxiety: DS / CC – safety – natural / drugs
• www.abrionline.org
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Positive Car Travel
• Positive association with restraint / carrier / car
 Secure restraint – head halter
 Other pet – owner - treats / toys
• Fear / anxiety: Avoid till DS / CC / RS
• Natural products early
• Drugs – as needed
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Feline Urine Marking
• Reactive – Anxious – Territorial – Hormonal
• Identify stimuli
 Prevent / block / deter stimulus access to cat
 Prevent / block / deter cat access to stimulus
• Determine cause – resolve (e.g. conflicts)
• Evidence - pheromones, fluoxetine, clomipramine
• Other natural products
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Separation Distress
• Anxiety / distress panic during departure, not spite
• Destructive, soil, vocal, ANS signs (pant, salivate)
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Separation Distress
• Behaviour Modification Program (BMP)
 Reward relaxed / settled behaviour - safe location
 Structure interactions: No attention on demand
 Avoid punishment
 Habituate to cues - departure exercises
 Schedule – enrich – toys / settle pre-departure
• Natural product if mild / early / adjunctive or
labelled drug (e.g. fluoxetine, clomipramine)
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Noise Sensitivity / Aversion
• 40-50% of dogs - increases with age
 Fireworks 32 %, Thunder 31%, Gunshots 18%
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Environmental Modification
• Safe haven
• Visual (home, pet)
• Reduce sound
• Static
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Behavior Modification
• Reward train settle / relax – comfort location
• DS / CC and RS with recordings
• Products: Head halter, anxiety wrap, thundershirt
• Natural products / Drugs – ongoing +/- as needed
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Maggie the Anxious Wheaten
• 13.5 yr F(S) soft coated Wheaten Terrier – 15 kg
• Recent stressors: Divorce – shared custody – in two
homes - loss of dog housemate of 12.5 years
• No health issues – ruled out cognitive dysfunction
• Increasingly nervous – shakes, trembles, pants
• Sensitive to noises - wind, coffee maker, ice maker
• Worst in car – shake, drool, climb on owner
• Jumps on owner or anyone for comfort
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Maggie
• Can’t continue to see Maggie this way
• Numerous previous products with no effect
• Rx Zylkène – 225 mg tablet daily (15 mg/kg)
• Effect within few days
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Follow-up
• 2 months - More relaxed / calm (not perfect)
 Car rides – biggest relief – lies down, no shaking / panting but
does not yet enjoy
• Medication discontinued
 Immediate recurrence of nervous, noise fear
• 6 month follow-up – well controlled
• Happier dog – happier owner
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The Happy Ending
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Question Period
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