In a new paper “Evidence-based paradigm shifts in veterinary behavioral medicine,” published in the April 2019 issue of Journal of the American Veterinary Medical Association, Karen L. Overall, MA VMD, PhD, DACVB, editor-in-chief of Journal of Veterinary Behavior: Clinical Applications and Research, and a senior research scientist in the Biology Department, University of Pennsylvania, reviews the recent literature on veterinary behavior medicine.

Overall, chair of the 2015 AAHA Canine and Feline Behavior Management Guidelines task force, says that there is rich new research being done in the field, but pet owners are missing out on the benefits because it’s often published in journals that may not be available to veterinarians in private practice. Overall believes this research is shifting existing paradigms of veterinary care, and would change the way veterinarians treat patients—if they knew about it.

Overall’s review focuses on four main topics:

The unmet need for behavioral medicine in veterinary practice

Because most vet schools lack full training in behavioral medicine, many new graduates worry that they aren’t adequately prepared to address clients’ behavioral concerns regarding their pets. In one study,  veterinarians stated that they felt handicapped by their lack of training in behavioral medicine. Behavioral problems occur frequently in dogs and are a leading cause of both dog abandonment and euthanasia; they currently pose the single largest threat to the health and longevity of pet dogs.

In one study, at least one behavioral problem was recorded for 40% of relinquished dogs.

Behavioral problems threaten the bottom line, too. Overall writes: “A lack of treatment of behavioral problems poses the single largest threat to general veterinary practices in terms of development and growth of services offered, intellectual and emotional fulfillment of staff, and income.”

The veterinary experience as a contributor to fear and distress in dogs and cats

Just visiting a hospital can trigger behavior problems in some pets, and staff need to be more aware of this.

In one practice in Germany, 18 of 135 dogs observed had be dragged or carried into the practice, and 106 showed fear on the examination table. Fewer than half the dogs entered the practice calmly. In another study, of 45 dogs observed in a hospital waiting room, more than half exhibited at least two signs of stress: panting and nose licking. In a Swedish study, 75% of all dogs were uncomfortable on the examination table, and approximately a third attempted to jump from the table.

Cats exhibited similar stress patterns while visiting hospitals. Of particular concern is one study’s finding that of 1,111 cats observed, 650 (58.5%) continued to display impaired welfare at home after the visit in the form of stunned, scared, nervous, or aggressive behaviors.

These studies suggest that distress may be masking some disease states and illustrate how behavioral responses can complicate physical examination of dogs and cats, making it difficult to interpret the findings.

Overall says the implications are clear: we should strive to reduce or remove factors that trigger stress in veterinary hospitals.

Social signaling in dogs and the ongoing “dominance” debate

Overall writes: “The assumption that dogs’ relationships with each other are defined by a threat-based, social-dominance system . . . is widely accepted and incorporated into dog-training philosophies that are based on the idea that dogs must be ‘dominated’ by humans to maintain the type of natural control of dogs that a canine social group would provide.”

But recent studies of how dogs interact in social situations don’t support that assumption. Instead, these studies indicate that canine social and signaling systems are more complex than previously reported, and that behaviors traditionally associated with “submissive” behavior (e.g., low posture and rolling onto one’s back) may actually indicate the presence of stress rather than behaviors intended to reduce it.

And depending on the situation, those same behaviors can indicate deference, appeasement, or an attempt to calm. When one dog reacts this way to an aggressive dog, it may not be a case of submitting to a dominant “alpha,” but rather a nuanced attempt to calm a fearful, frightened dog in the name of social cohesion.

Context matters. In studies of dogs at play, behaviors traditionally thought of as “submissive” signals instead appear to act as maneuvers to continue a play sequence, meant to convey “That was fun! Let’s do it again!”

Together, these data suggest that canine social interactions are inadequately described by a simple dominant-versus-submissive characterization, and many of the behaviors used as measures of dominance are also well-established behaviors associated with stress in dogs. Overall says that misapplication of this concept is at the core of most punishment-based training.

Punishment as an intervention to change behavior

Misapprehensions about the evolutionary history of dogs and about the criteria for evaluating various types of dominance have resulted in the conclusion that human-canine relationships must be structured by “dominance” and force. But Overall writes that “Contrary to popular belief, efficacy data for aversive, punishment-based interventions are lacking.”

However, studies have demonstrated that adverse behavioral outcomes are associated with punitive training methods among dogs in the general population and dogs seen at specialty behavioral practices.

In one study, owners who used only positive reinforcement reported significantly fewer undesirable behaviors and had significantly fewer dogs that reacted badly to other dogs or to unfamiliar people.

The association between aversive training methods and problematic canine behaviors is important for veterinarians to understand, Overall says, because veterinarians should be a primary resource for information about early training of puppies and kittens.

Overall concludes her review by saying all these studies show how behavioral medicine can play an important role in routine veterinary examinations, and she recommends that all patients be assessed for deviations from normal behaviors during every exam, at regular intervals—that way, if any concerning behaviors arise, interventions can take place as early as possible.

But veterinarians need to know the research exists before they can act on it.

NEWStat talked to Lynn Honeckman, DVM, owner of Veterinary Behavior Solutions, a behavior-only veterinary practice in Orlando, Florida. We wanted her perspective on Overall’s paper as both a practicing veterinarian and a behavior specialist who deals with behavioral issues in pets on a daily basis.

Honeckman says getting veterinarians to understand the medical component of behavior has always been a struggle and recalls her experiences as a freshly minted associate 25 years ago: “It was super hard to convince my employers about the time that was needed for behavior cases,” she remembers. “They couldn’t understand why I would spend an hour in a consultation room just trying to get the history of a behavior problem when I could have done three surgeries in that time.”

It boils down to a lack of education on the importance of behavior.

“Because they’re not taught much about behavior in school, veterinarians are coming to the table with their own preconceived notions just based on dogs they’ve had in their life and things they see on Animal Planet, so they’re still holding on to dominance theory myths,” Honeckman says. “And that’s actually what they’re teaching their clients. It’s extremely harmful and not science based.”

Because the new research isn’t getting to the practitioner, Honeckman adds, “a lot of the information they’re giving their clients is not standard of care.”

Honeckman explained how that relates to Overall’s talk of a paradigm shift: “[she’s] writing that veterinarians play a big role in the recognition and treatment of behavioral problems. It needs to be part of standard practice,” she says. “When we’re doing our general physical exam, just as we ask if there’s any vomiting, diarrhea, coughing, sneezing, we should be asking every client if there are any behavior changes.”

Currently, that’s the exception when it should be the rule, Honeckman says. “The 2015 AAHA Canine and Feline Behavior Management Guidelines encourage and emphasize that behavior should be part of every single patient visit,” she notes. “I don’t see that that has happened yet. There is a shift and things are changing, but it hasn’t happened yet,” Honeckman added. “The AAHA Guidelines helped quite a lot with that. Sofia Yin’s work [in the area of low stress handling] was instrumental in understanding how to handle our patients more compassionately.”

Honeckman says the challenge is convincing convince general-practice veterinarians that behavior can be more data driven.

“We need more research, more data. Most of the veterinarians I talk to, they want to see the data,” Honeckman says. “They certainly don’t want anecdotal studies and they don’t want just word of mouth. They want to see the numbers; they want to see that what we’re recommending is effective.”

Honeckman believes that once more researchers start doing actual data-driven, double-blind, placebo-controlled studies, then that research will start making it into the bigger journals “like Journal of the American Veterinary Medical Association and Journal of Veterinary Behavior.”

NEWstat reached out to Overall, who had her own ideas about how the veterinary profession can work together to get the word out.

“Someone has to fund positions by researchers who are veterinarians—not clinicians—at veterinary schools,” Overall said. “And someone needs to fund the effort to get information out to veterinarians and trainers.” She suggests some possible avenues of distribution: “A series of webinars, a YouTube channel, putting a series of required questions on veterinary boards, reaching out to every state veterinary medical association [to ensure] that pieces like that are in every veterinarian’s hand with links to the others.”

“Without this, we slip into pseudoscience,” Overall said. “And we are mostly there.”

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