Separation, Confinement, or

N o i s e s : What Is Scaring That Dog?

Kelly C. Ballantyne, DVM*

KEYWORDS
 Canine  Separation anxiety  Noise aversion  Noise phobia
 Behavior modification

KEY POINTS
 Separation anxiety and noise aversions are significant welfare issues that affect many
companion dogs.
 Video is key in the diagnosis of separation anxiety and in differentiating it from confinement
distress and noise aversions.
 Treatment of these conditions using a combination of psychopharmaceuticals and
behavior modification is recommended to improve welfare as quickly as possible.

INTRODUCTION

Separation anxiety and noise aversions are 2 of the most common behavioral disor-
ders of dogs with approximately 17% to 29% reported to have separation anxiety1–3
and 23% to 49% reported to have noise aversion.1,4–6 These conditions can be co-
morbid with each other and with other fear-related behavioral disorders.1,4,7–10 Sepa-
ration anxiety and noise aversions present significant welfare issues for affected dogs;
they cause emotional distress, can interfere with normal functioning, may result in
self-trauma, and increase the dog’s risk of relinquishment or euthanasia. These con-
ditions can also negatively impact the quality of life of the pet owner or owners.11 Iden-
tification and prompt treatment are needed to reduce suffering.
Terminology
The fear emotion is highly conserved across species and evolved to detect threats and
initiate the behavioral and physiologic response needed to survive them. Animals learn
which stimuli to fear through an unconscious process called fear conditioning. Fear
conditioning is highly resistant to forgetting because it is critical to remember which
environmental stimuli are safe and which are unsafe; however, fear conditioning can

Disclosure Statement: The author has nothing to disclose.

Veterinary Clinical Medicine, University of Illinois College of Veterinary Medicine, Urbana,
IL, USA
* 2242 West Harrison Street Suite 101, Chicago, IL 60612.
E-mail address: [email protected]

Vet Clin Small Anim - (2017) -–-

https://doi.org/10.1016/j.cvsm.2017.12.005 vetsmall.theclinics.com
0195-5616/17/ª 2017 Elsevier Inc. All rights reserved.
2 Ballantyne

lead to learning that innocuous or neutral stimuli are unsafe, resulting in chronic
emotional distress.12 Anxieties, fears, and phobias refer to emotional, behavioral,
and physiologic responses to threatening stimuli. Although these terms are sometimes
used interchangeably, they refer to different emotional states and may have different
neurobiological mechanisms.13
 Anxiety is anticipation of a danger or threat. The stimulus for the response is not
always identifiable or present.
 Fear is an emotional, behavioral, and physiologic response to a stimulus that the
animal perceives is threatening.
 Phobia is a persistent and maladaptive fear that is out of proportion to the situ-
ation or stimulus.14

Signs of Fear in Dogs

Signs of fear in dogs can be active or passive and include avoidance or hiding, flat-
tened ears, lowered body posture, low tail position, pacing or excessive activity, visual
scanning/hypervigilance, seeking out contact with humans and other animals, and
aggression. Physiologic signs of fear in dogs include panting, salivation, urination
and defecation, tense muscles, dilated pupils, and anorexia.15,16 Dogs that have
separation-related distress, confinement distress, or noise aversions will show similar
clinical signs, and these conditions can be confused with each other.13,17 Identifying
the stimuli or conditions that elicit these signs is important in differentiating separation
anxiety, confinement distress, and noise aversions from each other and for identifying
comorbidity10,14 (Table 1).

Separation Anxiety
Separation-related behaviors are described with terms including separation anxiety,
separation-related disorder, and separation-related distress. Although this is the
most well studied behavioral disorder in dogs, there is no consensus on diagnostic
terminology.13 The term separation anxiety is used throughout this article to
describe dogs that show signs of distress when separated from the person or per-
sons to whom they are most attached or when left alone without a human compan-
ion. The diagnostic criteria for separation anxiety are that signs occur only when the
dog is alone or cannot access its owner.2,20 Separation anxiety signs may be shown
in the absence or perceived absence of the owner or owners—some dogs will
become distressed if the owner is in an area of the home that the dog cannot ac-
cess.2,14 The most common owner complaints of dogs with separation anxiety are
house soiling, destruction, and excessive vocalization3,8,17,21–23; dogs that experi-
ence distress but whose signs do not leave evidence (ie, pacing, panting, whining)
may go undiagnosed. Having another dog in the house does not prevent separation
anxiety,10 and video analysis shows that affected dogs that live with other dogs
behave similarly to affected dogs that live alone.21 Dogs may show signs of distress
within 10 to 30 minutes of the owner’s departure,21,24 and signs of separation anx-
iety typically occur every time the dog is home alone regardless of the duration of
the owner’s absence.14,20 Some owners may report signs occur only occasionally
or when the dog is left alone outside of its normal routine,24 but these inconsistent
reactions to being left alone may reflect an intensification of the dog’s distress
following routine changes25 rather than inconsistent distress, or may indicate the
presence of a comorbid condition such as noise aversion.19 For example, some
dogs may pace, pant, and whine or remain vigilant whenever home alone but may
bark repeatedly and destroy items when alone off-routine or during storms. Without
Table 1
Signs and triggers

Signs15,16,18 Triggers
Separation-Related
Active Passive Physiologic Distress Confinement Distress Noise Aversion
 Pacing, running, or  Hiding  Salivation  Owner preparing to  Confinement regardless  Loud noises (ie,
circling  Crouching, cowering,  Tense muscles leave of owner’s presence or fireworks, thunder,
 Digging or clawing tucked tail  Urination or  Owner’s physical or absence gunshots, construction
 Chewing or  Ears turned back defecation virtual absence equipment)
destruction  Alert, vigilant  Panting  Owner’s return home  Stimuli associated with
 Climbing  Lip licking  Trembling loud noises (ie, flashing

Separation, Confinement, or Noises

 Jumping  Foreleg lift  Dilated pupils lights, rain, dark skies)
 Barking  Whining  Anorexia
 Aggression
Owners may note a combination of active, passive, and physiologic When these conditions are comorbid, signs of distress intensify when events
signs combine (ie, separation 1 confinement; separation 1 loud noise event)7,19

3
4 Ballantyne

video, the owner only finds evidence of the more intense responses. Video analysis
of dogs with separation anxiety shows that affected dogs spend most of their time
oriented to the environment—sitting or lying down with head up and looking
around21—whereas unaffected dogs spend most of their time resting or sleeping.26
When destructive behavior occurs, it is often targeted at exit points, and severely
affected dogs can cause significant property damage in their efforts to restore con-
tact with the owner or escape the home (Fig. 1). Many dogs with separation anxiety
show signs of distress as the owner prepares to leave the house8,10,17,24 and show
excessive enthusiasm or increased activity upon the owner’s return.8,17,27 Unaf-
fected dogs may also appear excited when the owner returns home and may greet
more intensely following longer separations,28 but dogs with separation anxiety are
more likely to show excessive greeting behaviors or increased activity regardless of
the duration of the owner’s absence.8,27 Subsets of dogs with separation anxiety
may appear excessively “needy,” remaining within sight of their owner most of the
day,8 but this type of behavior is not seen in all dogs with separation anxiety and
is not a necessary diagnostic criteria.24,29,30 There is no consistent agreement in
risk factors such as age, breed, and owner-related factors among studies that
looked for them.13

Fig. 1. (A–C) The metal doorknob and lock on this door were chewed off by a dog with
separation anxiety.
 Separation, Confinement, or Noises 5

Video analysis of dogs with separation anxiety

A study that used video to analyze separation anxiety found that dogs spent most of
their time oriented to the environment or vigilant, but barking and vigilance decreased
with time, whereas panting tended to increase with time. This study also identified 3
different types of responses to being home alone21:
 Discomfort response: lip licking, yawning, paw raised
 Fearful response: increased motor activity and escape or decreased motor
behavior/behavioral inhibition
 Anxious response: increased attention to environment, vocalization, decreased
exploration
These different response types may represent different underlying emotional states
in the affected dogs and may explain discrepancies in recommendations on how to
treat separation anxiety as well as treatment failures.21

Confinement Distress
Confinement distress is used to describe dogs that show anxiety, fear, or panic when
confined in a crate, kennel, or small room. Although little work has been done to investigate
confinement distress in dogs, one study of dogs with separation anxiety showed that
confined dogs yawned and licked their lips more than unconfined dogs,21 possibly indi-
cating a higher intensity of anxiety in confined dogs. Other studies show no direct correla-
tion between confinement and separation anxiety,10,26,31 which suggests that confinement
distress is a separate disorder. Confinement distress is observed in dogs when they are
confined regardless of the owner’s presence,14,32 but signs may be more intense when
the dog is confined during distressing events (ie, confined while home alone or during fire-
works). Dogs that panic during confinement show intense escape-behaviors, bending
metal crate bars with their teeth, paws, or body or chewing through plastic crates.
Some owners may report coming home to find the dog out of its crate with the crate
door still closed. Dogs with only confinement distress may tolerate separation from their
owners if not confined, but dogs with both confinement distress and separation anxiety
and/or noise aversion may house soil or destroy items when home alone or during noise
events. Owners may increase their efforts to confine the dog to prevent property damage,
purchasing “escape-proof” crates or securing the crates with cords or locks. Forcing
confinement heightens the dog’s panic and escalates intensity of escape-behaviors,
resulting in self-trauma and in severe cases death (Fig. 2). Dogs with either separation anx-
iety or confinement distress may show signs when confined at the groomer, boarding and
daycare facilities, and veterinary hospitals/clinics. Confinement distress is ruled out if the
dog voluntarily seeks out its confinement area for a resting spot.32

Noise Aversions
Noise aversion is a general term to describe anxious, fearful, or phobic responses to
noises. This term is used in lieu of noise phobia throughout this article because many
dogs do not meet the noise phobia diagnostic criteria: a profound, nongraded, and
extreme response to noise.2,7,14,33 Common signs of noise aversions in dogs include
trembling, freezing, panting, social withdrawal, pacing, salivation, urination, defecation,
destruction, hiding, crouching, and escape behaviors.2,5,6,14,33 Destruction and escape
behaviors may cause self-injury.6 The most frequent trigger for noise aversions in dogs
is fireworks, but other common triggers include thunder, gunfire, and noises from motor
vehicles.2,4,5 Noise aversions may be stimulus specific,33 only occurring in response to
one type of noise (ie, fireworks); can generalize to noises with similar characteristics (ie,
fireworks and gunfire)4,5; can generalize to conditions that frequently cooccur with the
6 Ballantyne

Fig. 2. This dog’s mandible was trapped in the side of this metal crate and firefighters had
to assist in cutting her free. Note the blood and injured forepaw.

loud noise (ie, dark skies, flashing lights, rain, wind), or the location in which the loud
noise was experienced. Dogs with noise aversions may be fearful in novel situations
and may take a longer time to calm down following a stressor compared with unaffected
dogs.4 Owners of dogs with noise aversions will observe signs of distress when they are
with the dog during noise events, but signs may be more intense when the dog is alone
during loud noise events—mimicking separation anxiety.19 Possible factors contributing
to the development of noise aversions include genetics, trauma associated with a noise,
sensitization from the cumulative effect of repeated exposures, and social transmis-
sion.34 Noise aversions present at any age but the risk or severity of signs may increase
with age.4–6 This condition can affect any breed, but sensitive breeds include shep-
herds, collies, and other herding dogs.20 There may be breed-associated behavioral dif-
ferences in the noise response—in a study that investigated behavioral responses to
noises in German shepherds, Australian shepherds, and border collies, German shep-
herds were more likely to pace, whereas Australian shepherds and border collies were
more likely to pant and hide.33
Comorbidity
Separation anxiety, confinement distress, or noise aversion may cooccur with
each other or with other behavioral disorders, such as fear-related aggression or
compulsive disorders. Several studies have reported a positive association between
separation anxiety and noise aversions4,7–9 as well as with other fear-related behav-
iors.1,4 When presented with one of these conditions, it is important for clinicians to
question dog owners about the dog’s response to a range of situations to determine
the presence of other behavioral disorders that may require treatment.

THE BEHAVIORAL HISTORY

Fear and anxiety disorders, like other illnesses, respond best to treatment when identi-
fied early, but many dogs that suffer from separation anxiety and noise aversions are
 Separation, Confinement, or Noises 7

untreated. One study reported that only 13% of owners whose dogs demonstrated
separation-related behaviors sought professional advice.3 As few as 16% to 29% of
pet owners whose pets experience noise aversions may seek assistance.5,6 Unfortu-
nately, many dog owners may not know who to reach out to when their dog engages
in problematic behaviors,11 may not recognize all signs of fear and anxiety,5,35 or may
only reach out once the problem has escalated to the point of crisis. Open-ended ques-
tions, such as “what concerns do you have about your dog’s behavior,” can start a dia-
logue with the pet owner at every veterinary visit while gathering general health history. If
behavioral concerns are noted, focused questions can help the veterinarian establish a
diagnosis. The dog owner should be asked to give an objective description of the
behavior—what the behavior looks like—or gather video to determine the characteristics
of the problem and establish a baseline to measure treatment against. Questions about
specific triggers for the dog’s distress will help to determine the diagnosis as well as the
most effective treatment plan. Goals of the behavioral history are to identify the following:
 An objective description of the behavior or behaviors
 Events or conditions that elicit the behavior or behaviors
 Intensity, duration, and frequency of the behavior or behaviors
 How the behavior resolves and how long it takes the dog to recover
 Owner responses to the behavior or behaviors
Table 2 lists specific examples.

DIFFERENTIAL DIAGNOSES

Medical differential diagnoses for fear and anxiety in dogs include neurologic disor-
ders, conditions that cause chronic pain or discomfort, metabolic disorders, and sen-
sory changes.36 If house soiling is a presenting complaint, any condition or medication
that results in increased frequency or urgency to eliminate, and any condition that
causes pain on elimination, should be considered.36 Detailed reviews of medical dif-
ferentials for fear and anxiety are available.16,37
Separation anxiety, confinement distress, and noise aversions are differential diagno-
ses for each other. Noise aversions are typically straightforward to identify if the owner

Table 2
History questions

Separation-Related and Confinement

Distress Noise Aversion
 What behaviors are observed before the  What does the dog do (what does the
owner’s departure? behavior look like)?
 What does the dog do when home alone?  What noises does the dog respond to?
Video is essential to accurately answer this  What noise-associated stimuli does the
question. dog respond to?
 What does the dog do when the owner  How long does it take the dog to return to
returns home? baseline behavior/recover?
 What does the dog do when the owner  Is the behavior same, better, or worse
is home/what percentage of the time is the when the owner is present or absent?
dog within sight of the owner?
 Where is the dog kept when home alone?  How many noise events occur per week?
 If confinement is used, is the behavior  If confinement is used, is the behavior
same, better, or worse when confined vs same, better, or worse when confined vs
unconfined? unconfined?
8 Ballantyne

witnesses the dog’s response to the noise. Behavioral differential diagnoses for sepa-
ration anxiety include territorial behavior, play/unruly behavior, and cognitive dysfunc-
tion syndrome if the dog is 8 years of age or older. If house soiling is a presenting
complaint, incomplete house training and urine marking should also be considered.14
Decisive Diagnostic Factors
 Separation-related distress: Signs of distress occur only when the dog is alone or
in the perceived absence of the owner.2,20
 Confinement distress: Signs of distress occur when the dog is confined regard-
less of the owner’s presence.14,32
 Noise aversions: Signs of distress occur in response a loud noise or noises.14
If these factors are unclear or mixed, video of the pet home alone will confirm the
diagnosis or diagnoses.

PHYSICAL EXAMINATION AND DIAGNOSTICS

If signs of fear, anxiety, or distress are identified, a physical examination, complete

blood count, chemistry profile, T4, and urinalysis should be performed to investigate
for medical issues that may be causing or contributing to the problem. Dogs with sep-
aration anxiety, confinement distress, and noise aversions may present with injuries
from escape attempts or destructive behavior, such as fractured crowns, broken nails
on forepaws, and cuts and abrasions around muzzle, nose, or paws.

TREATMENT GOALS

Treatment of separation anxiety, confinement distress, and noise aversions is focused

on reducing the intensity of dog’s distress and improving its ability to function in its
home environment.14 Depending on the condition’s severity or complexity, total reso-
lution may not be possible and management may be a more realistic goal.14,38

PHARMACOLOGIC STRATEGIES

Separation anxiety and noise aversions often require pharmacologic treatment in

addition to behavioral management strategies.14 The goal of pharmacologic treatment
is to reduce fear and anxiety as quickly as possible to improve the dog’s welfare.22,23
Although medications can help to relieve suffering and improve both the pet and the
owner’s welfare, there are several important issues to consider before prescribing a
medication. In addition to evaluating the patient for physical conditions that may be
causing or contributing to the behavioral problem—or may contraindicate certain
medications—the animal’s physical and social environment needs to be addressed
with behavioral management strategies. Without addressing these issues, the pa-
tient’s response to medication may be inadequate.19,20,39 It is also important to
discuss realistic expectations with the client when prescribing psychopharmaceuti-
cals. Psychopharmaceuticals can reduce fear and arousal—resulting in a decrease
in the severity, frequency, or intensity of the problem as well as improvement in recov-
ery times—but complete elimination of fear or anxiety is unlikely.
Pharmaceutical Treatment of Separation Anxiety
Antidepressants
Fluoxetine (a selective serotonin reuptake inhibitor) and clomipramine (a tricyclic an-
tidepressant) are effective for the treatment of separation anxiety with comparable
results in placebo-controlled clinical trials.22,23 The full therapeutic effects are
 Separation, Confinement, or Noises 9

achieved in 4 to 6 weeks, with some patients demonstrating signs of improvement as

early as 1 week into treatment.9,22 In one study that analyzed clomipramine treatment
effect using video, dogs showed an increase in passive behavior (ie, resting) as early
as week 1, with further increased passive behavior and reduction in barking in sub-
sequent weeks and following an increase in clomipramine dose.9 Fluoxetine also
improved owner-rated separation anxiety severity scores when administered without
a formal behavior modification plan.40 Some investigators question whether these
medications have an affect beyond their potential sedative side effects.41 To inves-
tigate this issue in dogs treated for separation anxiety, a spatial cognitive bias test
was used to determine if treatment with fluoxetine and behavior modification resulted
in an improvement of the dog’s emotional state or general motor inhibition.42 Cogni-
tive bias tests are used to investigate animals’ affective (ie, emotional) states based
on findings that an individual’s background affective state biases its decision-
making; individuals in negative states make more negative judgments about ambig-
uous stimuli than individuals in positive states.43,44 In spatial cognitive bias tests,
dogs are trained to discriminate between bowls placed in 2 different locations, one
with food (positive location: P), and one without food (negative location: N). Once
dogs learn to discriminate the 2 locations, placing bowls in ambiguous locations be-
tween the P and N locations tests their bias. An “optimistic” bias is rated in moving
faster to the ambiguous locations, and a “pessimistic” bias is rated by moving slower
to the ambiguous locations.45 Dogs with separation anxiety showed a pessimistic
bias compared with unaffected control dogs before treatment, but these differences
disappeared by weeks 2 and 6—their cognitive bias normalized. Improvement in
cognitive bias was also correlated with improvement in clinical measures of separa-
tion anxiety. This suggests that fluoxetine’s treatment effect is related to an underly-
ing improvement in affective state—its antidepressant effect—rather than behavioral
inhibition.42

Rapidly acting anxiolytics

Rapidly acting anxiolytics may be used in severely affected pets when immediate con-
trol of separation anxiety is needed,14 such as cases where the owner cannot avoid
leaving the dog alone.
 Trazodone and clonidine may be administered 1 to 2 hours before owner’s de-
partures as needed.46,47 Doses may be repeated with a minimum of 6 hours be-
tween doses of clonidine47 and 8 hours between doses of trazodone.48
 Benzodiazepines, such as alprazolam and diazepam, may be administered situ-
ationally 1 hour before owner departure.14 The frequency of redosing depends on
the specific benzodiazepine prescribed.49

Combination therapy for separation anxiety

Combination therapy involves using medications with different pharmacologic
mechanisms, dosing intervals, and onsets of effect. Combination therapy is used
when49
 A rapid response to treatment is needed
 The patient does not respond sufficiently to one medication
 Side effects are noted as the dosage is increased
 Particularly panic-inducing situations are predicted
One strategy used early in separation anxiety treatment is using medications with
complementary effects—administering a rapidly acting anxiolytic as needed before
owner departures while administering the slower-onset antidepressant daily
10 Ballantyne

regardless of owner departures.14 This strategy may reduce the dog’s distress quickly
before the antidepressant and behavior modification can take effect. In severely
affected dogs, combination therapy may provide the most effective control of the
dog’s distress throughout treatment.46,47 Although combination therapy is sometimes
necessary in the treatment of separation anxiety and may help to prevent erosion of
the human-animal bond, relinquishment or euthanasia combinations should be used
cautiously. Clinicians should consider potential drug interactions as well as health
risks before using combination therapy. During treatment, patients should be moni-
tored closely for desired effects and side effects.49,50 If the patient is not responding
to treatment as expected, its health status should be reassessed along with the man-
agement and behavior modification plan.
Pharmaceutical Treatment of Noise Aversions
The type of medication selected for treatment of noise aversions will depend on the
frequency of noise events in the dog’s environment as well as the intensity of the
dog’s response to the noise.20
 Dogs that experience infrequent noise events and whose signs are consistent
with fear or anxiety may respond well to treatment with rapidly acting anxiolytics
administered before predicted events.51
 Dogs that experience frequent noise events, dogs that exhibit signs of panic or
phobia, or dogs with comorbidities such as separation anxiety or generalized
anxiety benefit from treatment with an antidepressant, such as fluoxetine or clo-
mipramine, in combination with rapidly acting anxiolytics.14,20,34,38
 For best effect when treating storm aversions, owners should be coached to
monitor the weather and administer event medications when there is 50%
chance of storms. It is better for the dog to receive the medication and not
need it than need the medication and not get it and experience further sensitiza-
tion to storms.34

Rapidly acting anxiolytics

As noted above, several as-needed medications are available to treat anxieties
and fears. Sileo (dexmedetomidine oromucosal gel) is US Food and Drug Administration
approved for the treatment of noise aversions in dogs. In a randomized, double-blind,
placebo-controlled trial, Sileo demonstrated an excellent to good effect in 75% of
treated dogs compared with an excellent to good effect in 33% of placebo dogs.51
 Sileo is administered situationally 15 to 60 minutes before a predicted noise
event, at the first sign of fear, or when the owner detects a typical noise stimulus
(eg, fireworks).
 The dose may be repeated up to 5 times in 24 hours, with a minimum of 2 hours
between doses.
 Benzodiazepines may be administered situationally 30 to 60 minutes before a
predicted noise event.14 The frequency of redosing depends on the specific
benzodiazepine prescribed.49
 Alprazolam (Xanax) is a good choice for noise aversions because of its rapid
onset of effect (30 minutes), and anxiolysis is achieved at doses below those
that result in sedation and ataxia.38,49
 Trazodone and clonidine may be administered situationally 1 to 2 hours before a
predicted noise event.46,47 Clonidine may be repeated with a minimum of 6 hours
between doses,47 and trazodone may be repeated with a minimum of 8 hours be-
tween doses.48
 Separation, Confinement, or Noises 11

NONPHARMACEUTICAL TREATMENTS: BEHAVIORAL MANAGEMENT

Behavioral management strategies focus on avoidance of triggers, environmental

modification to improve the dog’s comfort, modification of dog-owner interactions,
and behavior modification exercises to improve the dog’s response to feared stimuli.
Table 3 provides examples on how to use these techniques for separation anxiety and
noise aversion.

Compliance with Behavioral Management Strategies

Client compliance with treatment recommendations is a significant issue in veterinary
behavior medicine.24,52,53 Compliance may decline with the number of tasks
assigned53 or for methods that require a significant owner lifestyle change.24,53
Although several behavior modification strategies are proposed for treatment of sep-
aration anxiety and noise phobia, it is important to update behavior modification stra-
tegies as evidence of effectiveness becomes available54 (Box 1). Even efficacious
techniques will be ineffective if they are too difficult or time consuming for the client
to implement. Focusing efforts on easy-to-implement strategies may improve compli-
ance. When counseled on separation anxiety prevention via brief preadoption ses-
sions or generic written advice, owners showed excellent compliance with leaving

Table 3
Behavioral management strategies for separation anxiety and noise aversions

Behavior Management
Strategies Separation Anxiety Noise Aversions
Avoidance  Avoid leaving the dog home  Avoid leaving the dog home
alone when possible alone during noise events
 Avoid cues that predict  Avoid taking the dog outdoors
departure during noise events
 Avoid confinement if the dog  Avoid confinement if the dog
does not tolerate it does not tolerate it
 Encourage the dog to rest in
an interior, windowless room
Environmental  Use a combination of white  Use white noise, calming
modification noise and music to decrease music, and consider
intensity of noises that may soundproofing to decrease the
cause agitation (ie, neighbors intensity of noises
returning home)  Establish a safe and comfort-
 Establish a safe and comfort- able resting area for the dog
able resting area for the dog
Modifying  Keep departures and arrivals  Provide comfort (physical
interactions low key contact and speaking in calm
 Avoid direct interactions (play, tones) if this helps to soothe
training, walks) the dog
15–30 min before departures  Do not punish
 Do not punish
Behavior  Provide a long-lasting  Provide a long-lasting
modification interactive treat 5–10 min interactive treat during noise
before departures events
 Relaxation training  Follow any loud noises imme-
 Cue-response-reward diately with a small high-value
food treat
 Relaxation training
 Cue-response-reward
12 Ballantyne

Box 1
Complex versus simple behavior modification plans
Treatment protocols for separation anxiety in several texts recommend changing the predictive
value of predeparture cues (ie, picking up keys, putting on shoes) by practicing these departure
routines without leaving the house14,19; this exercise has been part of behavior modification
protocols in several clinical trials for the treatment of separation anxiety.23,24,42,55 This exercise
uses the classical conditioning technique of extinction by presenting the conditioned stimulus
for the dog’s anxiety (departure cues) without presenting the unconditioned stimulus for the
dog’s anxiety (owner absence).56 Extinction can diminish anxiety elicited by the conditioned
stimulus; however, this may take many trials and may be difficult to practically implement if
several owner activities have become conditioned stimuli for departures. This technique also
has the potential to increase anxiety19,57 and shows poor compliance,53 possibly because of
these challenges. In the author’s practice, extinction of departure cues is rarely recommended
in the treatment of separation anxiety.
Desensitization and counterconditioning to fear-eliciting triggers is a behavior modification
technique used to treat a range of behavioral disorders.58 The desensitization and countercondi-
tioning procedure involves identifying all stimuli that elicit the fear response, arranging these
stimuli on a gradient from lowest to highest intensity, and starting exposure sessions at the
lowest stimulus intensity. The stimulus is paired with something that elicits an automatic positive
emotional response, such as food (classical counterconditioning), or with a cue for an alternative
behavior that is then reinforced (operant counterconditioning). The intensity of the stimulus is
gradually increased during subsequent sessions.58 Throughout this process, it is essential that
the intensity of the stimulus is never presented at a level that elicits the fear response or sensiti-
zation to the stimulus, and worsening of the fear response rather than desensitization will occur.
This technique is effective in the treatment of fear and anxiety, but application for the treatment
of separation-related distress and noise aversions presents several practical challenges. The fear-
eliciting triggers for separation anxiety may be elements of the owner’s departure routine or an
absence of any duration, and it can be difficult or impossible for many owners to completely
avoid these triggers throughout the desensitization process. The fear-eliciting triggers for noise
aversions, especially those related to thunderstorms, may be so complex that they are difficult to
replicate during desensitization sessions.38 These stimuli are often unpredictable and uncontrol-
lable, so dogs may be exposed to the full intensity of the stimulus before desensitization is
completed, further prolonging the process. In addition to these challenges, compliance is
poor,24,53 and these techniques may intensify the dog’s fear and anxiety if used incorrectly (ie,
the intensity of the stimuli are too rapidly increased beyond the dog’s tolerance).20
Although there are no direct comparisons of behavior modification programs available, less
complicated behavior modification plans that focus on creating consistent interactions
between owners and their dogs, eliminating the use of punishment, and rewarding desired be-
haviors have successfully treated separation anxiety in combination with medical therapy.9,25,59
These protocols may prove easiest to implement in the clinical setting.

their dog a food-filled toy before departures.10,24 Other studies using direct consulta-
tion with a veterinarian reported that clients complied with recommendations not
to punish their dogs for house soiling or destructive behavior23,53,55; however, when
this advice was relayed in written form only, owners continued to punish their dogs
in response to house soiling or destructive behaviors.24 This finding highlights the
need for direct veterinary-client communication that gives the client an opportunity
to ask questions about recommendations. Direct consultation also provides the clini-
cian opportunity to modify the treatment plan based on the client’s needs and abilities.

Separation Anxiety
Avoidance
Avoidance, when possible, is critical in reducing the intensity of the dog’s distress as
well as preventing further injury, property destruction, noise complaints, fines, or
 Separation, Confinement, or Noises 13

eviction. Options include placing the dog in daycare, taking the dog to work, hiring a
pet sitter, or having a friend stay with the dog. These options may not be available to
some clients due to owner- or dog-related factors.

Environmental modification
The goal of environmental modification is to make the environment as peaceful and
comfortable for the dog as possible. Options include using a combination of white
noise and music to muffle sounds that may cause agitation (ie, neighbors returning
home, traffic noises) Establishing a safe, comfortable, and secure resting area for
the dog can help. This “safe space” may be a crate, closet, or other location the
dog feels safe, but the dog should not be forced to remain in a crate or small room un-
less it is comfortable with confinement.2,19

Modifying interactions
Owners should keep departures and arrivals as low key as possible and avoid direct
interactions—such as play, training, or walks—immediately before departures.2 In
addition, owners should not punish the dog verbally or physically for destruction or
house soiling that occurs in their absence, because this will not prevent reoccurrence
of unwanted behaviors and will escalate the dog’s distress. Although compliance with
this advice is generally good,23,55 some owners may argue that these punishments are
justified because the dog appears “guilty” when they return home, suggesting that the
dog knows it did something wrong. Rather than an admission of guilt or knowledge of
wrongdoing, “guilty-look” behaviors are signs of appeasement used to diffuse con-
flicts. A few studies have investigated the “guilty look” in dogs and demonstrate
that dogs’ appeasement behaviors are in response to the owner’s body language
and possibly the context in which punishment has previously been administered,
not a response to the “forbidden” behaviors.60,61

Behavior modification
Behavior modification exercises focus on improving the dog’s association with the
owner’s absence as well as teach the dog how to be relaxed:
 Provide a long-lasting interactive treat (eg, Kong filled with palatable food) 5 to
10 minutes before owner’s departure. This treat may distract the dog from the
owner’s departure as well as improve its emotional state.14
 Reinforce relaxation may be achieved by reinforcing the dog with a small treat
whenever it is observed relaxing in the owner’s presence, ideally several feet
away from the owner.14,25 Alternatively, relaxation can be taught in regular short
training sessions (Box 2).
 Use a cue-response-reward pattern of interactions to improve consistency
and teach the dog a calm way to ask for everything. Dogs are asked to sit
before any interaction, including petting, play, feeding, going outdoors, or
coming indoors. The sit response is followed by food, petting, attention, or ac-
cess to the desired consequence. This exercise teaches the dog that a simple
behavior (sit) always results in a positive outcome and can decrease
anxiety.9,14,25

Confinement Distress
Dogs with confinement distress may show minimal or no signs of distress when home
alone and not confined. These dogs can be identified via video, and treatment may be
as simple as leaving the dog loose when home alone. The owners can close off certain
rooms or areas of the home to restrict the dog’s access. Streaming live video is ideal
14 Ballantyne

Box 2
Relaxation training step by step
This exercise uses the technique of shaping. Once the goal behavior is defined, training begins
by reinforcing some behavior the dog already does that is an approximation to the goal and
then gradually reinforcing behaviors that are successively closer to that goal.62 In relaxation
training, the trainer/owner will mark and reinforce the dog as he or she gets closer to lying
in a relaxed posture on the mat. A marker is used to clearly communicate to the dog which
behavior is reinforced.62 Markers commonly used in dog training include specific words
(ie, yes) or sounds (ie, clicker) that have been repeatedly paired with food.
Example training plan:
1. Place the training mat down
2. Mark/treat the dog for looking at or turning toward the mat. *For steps 2 to 7, toss the
treat away from the mat so the dog has to return to the mat to get reinforced again.
3. Mark/treat the dog for any movement toward the mat.
4. Mark/treat the dog for placing a paw on the mat.
5. Mark/treat the dog for standing with all 4 paws on the mat.
6. Mark/treat the dog for sitting on the mat.
7. Mark/treat the dog for lying on the mat.
8. After the dog has learned to lie down on the mat, extend the time he or she stays down
before the mark/treat. *Once the dog is approaching the mat and lying down
consistently, transition to rewarding the dog on the mat to promote a relaxed position.
9. Mark/treat any relaxed behaviors, including head on paws or mat, hip rocked to one side,
hind legs extending from body, rolling to one side.
10. If the dog gets stuck at any step, return to a previously successful step where it was
reinforced frequently. Slowly introduce small steps toward the goal behavior.
Tips:
 Keep training sessions to 2 to 3 minutes.
 Remove the training mat between sessions.
 If there are 2 or more dogs in the house, train with each dog separately.
 Once the dog is consistently lying in a relaxed posture on the mat, move the mat to various
locations around the house to teach the dog the mat may be available anywhere and he or
she will always be rewarded for relaxing on it.

for evaluation if the dog has a history of destruction or escape behaviors so that the
owner can monitor in real time and return immediately if signs of distress are observed.
If the dog experiences a combination of confinement distress and separation anxiety,
confinement to a cage or crate should be avoided and treatment of separation anxiety
should be initiated.

Noise Aversions
Avoidance
Complete avoidance of noise triggers related to weather or fireworks is often impos-
sible, but dogs should not be taken outdoors during storms or fireworks. Encouraging
the dog to rest in an interior windowless room may reduce perceived noise intensity.
Environmental modification
The goal of environmental modification is to make the environment as peaceful and
comfortable for the dog as possible during noise events. Acoustic tiles may be set up
 Separation, Confinement, or Noises 15

in the dog’s hiding space to soundproof the area, and black-out window coverings can
be used to minimize the sight of flashing lights that may accompany fireworks or elec-
trical storms. The intensity of outdoor sounds may be diminished by increasing the level
of white noise in the house through use of white noise machines or fans, and increasing
the level of noise in the home by playing music or TV. The use of music or TV should be
based on the dog’s tolerance, because some dogs may show fear in response to these
stimuli.

Modifying interactions
Owners should be coached to avoid punishing the dog or forcing confinement
because these methods will escalate the dog’s distress. Opinions vary on whether
to comfort dogs with noise aversions (Box 3).

Behavior modification
Behavior modification exercises focus on changing the dog’s response to noise trig-
gers as well as teaching the dog how to be relaxed.
 Providing a long-lasting interactive treat (eg, Kong filled with palatable food) dur-
ing the noise event. This treat may distract the dog from the event as well as
improve its emotional state.14
 Classical counterconditioning: In this exercise, the unpleasant stimulus (ie, thun-
der) is followed immediately by something that elicits a strong positive emotional
response from the dog (ie, small piece of favored food). With regular practice, the
dog learns that the loud noise predicts the pleasant event (food) and its fear and
anxiety may diminish.58
 Reinforcing relaxation: This may be achieved by reinforcing the dog with a small
treat whenever it is observed relaxing in the owner’s presence. Alternatively,
relaxation can be taught in scheduled training sessions (see Box 2).

Treatment Recommendations for Comorbidity

Patients presenting with a combination of separation anxiety, noise aversions, and/or
confinement distress will benefit from the techniques described above in addition to
the following:

Box 3
To comfort or not to comfort?
Opinions on whether to comfort frightened dogs vary among veterinary behaviorists,2,21,39,63,64
and there are no controlled studies to evaluate the effectiveness or harm of comforting behaviors
in the treatment of noise aversions. A survey of New Zealand pet owners showed that higher
severity of noise fear was associated with owner-comforting behavior; however, a causal relation-
ship cannot be made with this type of study, and it is possible that owners are more likely to com-
fort animals that show more intense signs of fear.5 Another laboratory-based study investigated
the behavioral and physiologic responses of beagles to a familiar person’s 3 styles of greeting be-
haviors following a short absence. Results showed that dogs who were greeted with calm positive
interactions, including physical touch, showed elevated levels of oxytocin even after the interac-
tion ended and a more pronounced decrease in cortisol compared with dogs that were greeted
verbally without physical touch and to dogs that were ignored upon reunion. These findings sug-
gest that reciprocal physical contact between dogs and humans has beneficial calming effects,65
although results cannot be directly extrapolated to companion dogs with behavioral disorders.
Until more is known, whether to comfort a frightened dog should be based on the dog’s response.
If the dog appears comforted by owner attention, the owners can be encouraged to soothe their
dog when distressed. If the dog does not appear comforted by these interactions, other behavior
modification techniques should be attempted to assist the frightened dog.
16 Ballantyne

 Avoid leaving the dog home alone during storms

 Avoid confining the dog when home alone or during storms
 Use rapidly acting anxiolytics with a longer duration of effect (ie, trazodone, clo-
nazepam) if storms are predicted and the owners have to be out of the house

FOLLOW-UP

Regular communication via follow-up appointments, phone calls, and electronic

methods should be scheduled based on individual patient and client needs as well
as the severity and complexity of the issue. Regular follow-up communication is rec-
ommended for separation anxiety, confinement distress, and noise aversions to
monitor response to treatment and make modifications as needed. The use of video
and behavioral diaries can help the clinician and owner to objectively monitor treat-
ment response and highlight where to focus treatment efforts.

Video Monitoring for Separation Anxiety

Monitoring dogs with separation anxiety via video when home alone in a range of con-
ditions, such as during the owner’s typical workday as well as off-routine departures
(ie, evenings or weekend outings) or when the owner leaves the dog more than once in
a 24-hour period, can provide objective information on the dog’s progress and indi-
cate areas that need further work. If a dog walker is used to taking the dog out during
the owner’s workday, video should include the dog walker’s arrival and departure to
ensure this event is not contributing to or escalating the dog’s distress. Based on client
videos in the author’s practice, many dogs cope better when left alone undisturbed for
several hours than when they have a “break” midday. Dogs may show signs of
improvement first during the owner’s routine absences and may be slower to improve
during off-routine absences or when the owner leaves more than once per day.

TREATMENT ADJUSTMENTS

Treatment modifications may include trials with other anxiolytic medications as well as
adjustments in the behavioral management plan. Some patients may need long-term
treatment with psychopharmaceutical drugs. In these cases, physical examination
and laboratory evaluations performed at 6- to 12-month intervals will help to monitor
for changes in the dog’s health status that may affect response to treatment and the
prescribed medications. In addition, if a sudden or unexplained illness occurs while a
patient is on a psychopharmaceutical drug, physical and laboratory evaluations
should be pursued.20

SUMMARY

Separation anxiety, confinement distress, and noise phobias are welfare issues
affecting many companion dogs. Despite their prevalence, clients may not recognize
or report these issues, and many dogs go untreated. Clients should be asked about
behavioral concerns at every veterinary visit to identify and address issues early.
Although clinical signs are nonspecific and these disorders can be comorbid, a be-
havioral history and video can assist in accurate diagnosis. If clients report predepar-
ture and postdeparture distress in the absence of destruction, vocalization, and house
soiling, video of the pet while home alone should be gathered to rule in or rule out
separation anxiety. Treatment of these conditions using a combination of psychophar-
maceutical and behavior modification is recommended to improve welfare as quickly
as possible.
 Separation, Confinement, or Noises 17

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