Applied Animal Behaviour Science 105 (2007) 311–329 A prospective study of two self-help CD based desensitization and counter-conditioning programmes with the use of Dog Appeasing Pheromone for the treatment of firework fears in dogs (Canis familiaris)§ Emily D. Levine , Daniela Ramos, Daniel S. Mills Animal Behaviour, Cognition and Welfare Group, Department of Biological Sciences, University of Lincoln, Riseholme Park, Lincoln LN2 2LG, UK Available online 8 December 2006 The aims of this study were to evaluate the efficacy of two self-help CD based desensitization and counter-conditioning programmes with the use of Dog Appeasing Pheromone (DAP) for the treatment offirework fears in dogs and to evaluate the training progress and owner compliance. Fifty-four individualswere recruited for an 8-week period of training between August and October 2004. The dogs wereseparated into two treatment groups, each using a different CD based programme. After implementingthe CD programme for the 8-week period without any personalized instruction, two telephone follow-upinterviews were completed after periods during which fireworks are commonly used (November andJanuary). Forty-two individuals completed the first 4 weeks of training and 38 completed the 8-weektraining period. Thirty-six individuals completed the first follow-up interview with 29 completing thesecond follow-up interview. Assessment of efficacy was measured using both owner reports of itsnatural response (i.e. the dog's behaviour in the home) and video footage of behaviour in responseto a novel recording of the problem sound (i.e. the dog's behaviour in the behaviour clinic) pre- andpost-treatment.
The majority of change with respect to the dogs' response to the CD occurred during the first month of training with no significant change during the second month of training. With respect to real exposures, therewas a significant reported improvement at both follow-up interviews in both the total severity scores and theglobal fear scores. There was significant improvement in the mean severity score of all individualbehaviours at the first follow-up with the exception of ‘‘vigilance'' behaviour. Inappropriate elimination § This paper is part of the special issue entitled ‘‘Veterinary Behavioural Medicine'' guest edited by Daniel Mills and Gary Landsberg.
* Corresponding author. Tel.: +44 1522 895453; fax: +44 1522 5328.
E-mail address: (E.D. Levine).
0168-1591/$ – see front matter # 2006 Elsevier B.V. All rights reserved.
doi: E.D. Levine et al. / Applied Animal Behaviour Science 105 (2007) 311–329 was the only behaviour to be completely resolved by the second follow-up. No difference was found in thevideo recordings of fear behaviours occurring in response to a novel CD recording pre-treatment versuspost-treatment.
Although the CD programmes varied significantly from one another with respect to their format and the details given in their accompanying instruction booklet, there were no differences between total severityscores or global scores at follow-up two between the treatment groups.
Eighty-three percent of owners claimed to have read over 90% of the accompanying instruction booklet for their respective CD but only 48% said that the majority of the instructions were clear. Approximately90% reported they would consider using a CD based desensitization and counter-conditioning programmeagain if they were to acquire another dog that was scared of fireworks.
These results suggest that the use of self-help CD based sound desensitization programmes in combination with DAP can produce a satisfactory result for some owners of dogs with fear of fireworks,but compliance may be a problem for a notable proportion of owners.
# 2006 Elsevier B.V. All rights reserved.
Keywords: Dog; Fear; Noise; Owner; Treatment; Welfare Noise fears and phobias among dogs (Canis familiaris) are a commonly reported behavioural problem (with anestimated prevalence of 38% being reported (). There are many noises ofwhich dogs are fearful; however, the most common appear to be thunder, fireworks, and gunshots(). Being able to identifythe fear eliciting situation is essential for successful treatment; however, the specific sensorychannel stimulated by the trigger situation may not always be discernable. For example,thunderstorms consist of several interrelated stimuli to which the dog may be reacting (e.g.
changes in barometric pressure, light intensity and ionization, in addition to the noise) and can beextremely difficult to treat as a result because of the inability to replicate these changes in thehome environment. By contrast, fear of gunshots or fireworks are perhaps a more useful modelfor investigating treatment plans focused on the noise stimulus as many of the potentialconfounding non-sound related stimuli can be more easily controlled and appear less frequentlyimplicated in the problem.
provide a detailed account of the use of incremental changes in the volume of recorded sounds to desensitize systematically and counter-condition two dogs inorder to treat their noise fears, and since that time, the technique has become central to mosttreatment schedules for this problem. An abundance of individual case testimonies provideevidence of the widespread success of this method but there have been remarkably few scientificstudies which have systematically examined the efficacy of other or related treatmentprogrammes. found that, for storm phobic dogs, a combination ofdesensitization and counter-conditioning therapy using sound recordings of storms together withmedication (alprazolam and clomipramine) helped improve the reported behaviour of dogsduring storms. However, there was no consistent evidence of improvement based on videorecordings of the dogs' behaviour in response to the CD recordings in the veterinary hospital pre-and post-treatment. This suggests that the response to the recording in the clinic environmentmay not reflect the perceived response in the home environment to the real event where thebehavioural modification programme has been undertaken. suggested E.D. Levine et al. / Applied Animal Behaviour Science 105 (2007) 311–329 that Dog Appeasing Pheromone (DAP, Ceva Sante´ Animale) was also useful in reducing firework-noise-related fear behaviours, even without the use of systematic desensitization and counter-conditioning, as long as the owners ignored the dog's fearful behaviour. A retrospective study whichexamined the effect of various treatment plans with dogs who had firework fears found that the combination of DAP and a CD recording based programme (Fear of Fireworks, ) provided a stronger therapeutic result than either the recording or DAPalone. The authors also found that owners who used medication (acepromazine, diazepam) to helpin the management of the problem were less compliant with certain aspects of the behaviourmodification programme and tended to report no improvement in their dog's behaviour as a result oftreatment. Such medication is only available on prescription from a veterinarian and the results ofthis latter study emphasize the importance of behaviour therapy in the management of these cases. Itshould be noted that acepromazine is a sedative and not an anxiolytic and that diazepam is mostefficacious as an anxiolytic when administered prior to the noise event. Desensitization andcounter-conditioning can be time intensive, laborious and confusing for inexperienced individuals.
Theoretically, the desensitization and counter-conditioning programmes should be applied in astructured manner to maximize the chances of success and avoid exacerbating the fear throughinadvertent noise sensitization. Whilst there are behaviour specialists to help design individualtreatment programmes for their clients, there are also a range of commercially available tape andCD based self-help programmes advertised for the treatment of noise fears in dogs. Theserecordings vary in sound quality, structure, and content, together with the instructions provided. Forexample, Fear of Fireworks () is based on a live recording offireworks, whilst Sounds Scary (Sounds Scary Ltd.) is a more formally structured programme basedon sound segments and sequences. To date, there have been no systematic studies of the efficacy ofthese self-help desensitization and counter-conditioning programmes, nor the problems that mightarise. Therefore the aims of this study were, firstly to evaluate the efficacy of two self-help CD basedbehaviour programmes for the treatment of firework noise fears and secondly, given the lack ofpersonalized instruction, it was of interest to examine training progress and owner compliance andinterpretation of the instructions provided with these programmes in a self-help package. Efficacywould be assessed using both owner reports of the dog's behaviour to live events while the dog wasin the home and video footage of the dog's response to a segment of a firework CD in the behaviourclinic pre- and post-treatment. The latter allows a more objective determination of whether, in thecase of firework fears, the behaviour of the dogs in the clinic in response to a CD recordingcorresponded with their reported behaviour in response to the live event at home. The efficacy of thetwo CD programmes would then be compared using the owner reports as, ultimately, it is theowner's impression of improvement that will dictate if a treatment is deemed useful.
2. Materials and methods 2.1. Participants and animals Participants were recruited via notices at local veterinary clinics and a press release to the local media.
The dates of the study were August through October 2004. Telephone interviews with potential participantswere completed to ensure they met the following inclusion criteria: the dog was at least 6 months old,displayed fear responses identifiable to fireworks, displayed the fear responses in the home, had notgeneralized the fear such that the fear eliciting cues were too numerous to be counted or the dog wasgenerally anxious, and were not receiving any psychoactive medication. In addition, the owner had to bewilling to keep a daily diary, not anticipate a break of more than 15 days away from home over the next 3 E.D. Levine et al. / Applied Animal Behaviour Science 105 (2007) 311–329 months, and be willing to receive weekly phone calls for monitoring purposes. Those that met the inclusioncriteria, were sent a behavioural history form, a baseline firework fear behavioural questionnaire, and a self-addressed and stamped envelope. In August 2004, a general meeting was held at the University of Lincoln'sAnimal Behaviour Clinic for all potential participants who had dogs that appeared to have firework fearsbased on the aforementioned constraints to discuss the objective of the study, review what would be requiredof them throughout the 8 weeks with regards to diary keeping, and to confirm informed consent. Ownerswere not informed about how to implement the treatment programme beyond being told to read theinstruction booklet that accompanied their CD. However, they were told to call the University's behaviourclinic at any time if they had questions about implementing the treatment programme. The participants'regular veterinarian also provided written permission for their clients to participate in the study. Each dogreceived a physical examination prior to trial enrolment to exclude medical differentials that requiredseparate treatment and the examination was administered by the same qualified veterinary behaviourist(DM). Dogs with separation anxiety or aggression directed at veterinarians (which prevented the requiredinitial physical exam without restraint) were excluded from the study. During the initial consultation all dogswere individually videotaped in the University's behaviour clinic while being exposed to a segment of afirework track from the ‘‘Sounds for behaviour therapy CD'' recording (Company of Animals Ltd.). At theend of the 8-week trial all dogs were brought back into the clinic and were videotaped again while listeningto the same recording (i.e. not the one used for training purposes).
Owners were instructed to read and follow the instructions (both of which suggest using DAP) that accompanied their respective CD. The owners were not given any further clarification of the directionsthat accompanied the CD at this time. Half of the participants received a programme called Fear ofFireworks and the other half a programme called Sounds Scary. The distribution of the CDs toparticipants was matched based on initial owner perceived global severity scores. Both programmesrecommend the use of DAP. In order to help ensure even compliance with the use of pheromone therapy,DAP was distributed to all participants free of charge. Owners were provided with diaries to completedetailing aspects of the CD training. Information collected included, but was not limited to, how manytimes a day they played the CD, did they begin the CD when the dog was relaxed, and noting if the DAPdiffuser still contained the liquid. In addition, owners were provided with real exposure diarysupplements in which they noted the behaviours their dogs exhibited and the owner's response tothe behaviour (e.g. did they ignore the dog). Throughout the 8-week study, all participants were calledonce a week and were asked questions pertaining to the use of the CD (e.g. how many times did you playthe CD this week, did you reach full volume) and the dog's behavioural response to the recording (i.e.
frequency and intensity of individual fear-related behaviours). It became apparent at the first telephoneconsult, that owners had variable interpretations of the concept of a ‘‘safe haven'' area which is describedin both sets of instructions and so in order to reduce uncontrolled error and standardize use of a ‘‘safehaven'', so that we could focus the study on the many variable of interest (i.e. the differing properties oftwo products), owners were given specific instructions on what constituted a ‘‘safe haven''. A safe havenwas described as a location in the home in which the dog had only positive experiences. The owners wereinstructed not to use the location to which the dog normally hides when he or she is fearful if in fact thedog still shows signs of anxiety or fear in this location. At the week 4 follow-up, all owners were givenbasic information pertaining to some key principles of using desensitization and counter-conditioningprogrammes with respect to fear of noises in light of commonly identified errors relating to the use of theprogrammes (e.g. explaining what ignoring entails). Two telephone follow-up interviews were com-pleted following times during which fireworks are traditionally used in the UK (5 November, 31December). The first follow-up interview was conducted in mid-November. The second follow-upinterview was conducted in mid-January. During the time between these follow-up interviews, ownerswere not instructed specifically to use the CD or the DAP. Data were only collected on fear-relatedbehaviours and on owner opinions on the efficacy of the CD therapy if the dogs had experienced realexposures during the time frame between follow-up interviews.
Fifty-four dogs with firework fears were initially enrolled in the prospective study and the protocol was approved by the relevant University of Lincoln's Research Ethics Committee.
E.D. Levine et al. / Applied Animal Behaviour Science 105 (2007) 311–329 2.2. Behaviour assessment 2.2.1. Efficacy to real exposures The behavioural questionnaire contained questions pertaining to the behavioural and medical history of the animal and was adapted from the history form used in the University of Lincoln's Animal BehaviourClinic (available upon request from the author). In the firework fear questionnaire, used at baseline and thetwo follow-up interviews, owners identified both the frequency and the intensity of individual fear-relatedbehaviours in which their dogs engaged during fireworks while inside the home. Answer options forfrequencies of behaviours were never (0), rarely (1), frequently (2), and every time (3). Answer optionsabout intensity of a behaviour were numerical ratings from 1 to 5 with 1 being a small amount and 5 being anextensive amount. The severity of individual behaviours was calculated from multiplying the frequency bythe intensity of that behaviour. The total severity score for each dog was calculated by summing theseverities of each behaviour. The total severity scores were then converted into percentages by dividing eachindividual total severity score by the total possible severity score. The owners were also asked to assign aglobal score on a scale from 0 to 10 relating to their perception of their dogs' firework fear. Zero related to amild fear response whereas 10 was the most severe fear response imaginable. An option to say there was nofear present was also provided at follow-up. For both follow-up interviews owners were asked to give aglobal fear score.
With regards to evaluating efficacy using the video recordings, an ethogram was constructed of fear- related behaviours ). The dogs were exposed to the same soundtrack and videotaped over a periodincluding the same 60 s segment of the ‘‘Sounds for behaviour therapy CD''. Focal sampling with one-zerorecording of the behaviours was used every 10 s for the latter 60 s of the recording. There were a total of six10 s periods. This same method was used for both the pre- and post-CD training.
2.2.2. Training progress and owner compliance During the weekly phone interviews, the owners were asked about their dog's behaviour to the recorded firework noises. The owners reported both the frequency and the intensity of the same 17 behaviours askedabout in the baseline firework fear questionnaire. Total severity scores for individual behaviours werecalculated as before from multiplying the frequency score by the intensity score. Two dogs on the trial werenot included in the final analysis as they were not responsive to either CD at normal or high volumes;therefore, their progress could not be evaluated with this methodology.
Multiple questions pertaining to owner satisfaction were asked at each follow-up interview. The answer options for such questions were categorical (e.g. how satisfied are you with the effect you have seen fromthis therapy? Very satisfied, moderately satisfied, mildly satisfied, not satisfied at all). Questions pertainingto owners voluntary continuation of the CD and DAP were asked during the second follow-up interview. Allanswer options were categorical.
Table 1Ethogram used for assessing behaviour of dogs in response to CD recording in the clinic Panting: open mouth breathingShaking: rapid vibration of whole bodyCowering: crouching, lowering of body (not all the way to the ground)Hiding: positioning oneself underneath an objectSeeks owner: moves towards/remains in close proximity to the ownerVigilance: alertness, moving head side to side appearing to scan the environmentPacing: repeated walking locomotion over the same areaBarking: vocalization. Non-continuous sound. Mouth must open and close in order to produce this soundWhining: prolonged vocalization for which the mouth remained closed; a continuous soundRunning: faster locomotion than pacingClawing at door: repeated extension and retraction of forelimbs against the base of the doorFrozen/static: no movement. Dog alert E.D. Levine et al. / Applied Animal Behaviour Science 105 (2007) 311–329 2.3. Data analysis All data were analyzed using Minitab 13.0 (Minitab Ltd.).
2.3.1. Efficacy of treatment programmes to real exposures Data from all subjects were analyzed prior to dividing the subjects into their respective CD groups for comparative analyses. In order to maximize the use of available data, a system of imputation was used wherethere were missing data (). For individuals who neglected to answer one measure (e.g.
either frequency or intensity) for a maximum of two behaviours, data was imputed using the mode of thecorresponding missing value. There were six individuals who met the criteria for data imputation. Five ofthese individuals did not answer one measure for one behaviour. One individual did not answer one measurefor two behaviours. Frequency histograms of these data were compared before and after data imputation toensure that the distribution was not affected.
Total severity scores were calculated for each dog prior to the treatment programme (baseline total severity scores) and at each follow-up interview. The data were not normally distributed and therefore wereanalyzed using non-parametric techniques. The Sign test was used to analyze the difference in pre- and post-treatment total severity scores, global scores, and in individual fear-related behaviours for all dogs. Whenanalyzing severity scores for individual behaviours, the only subjects included were those for whom all thedata were available (i.e. baseline, follow-up one and two). The Wilcoxon–Sign test was used because it is amore conservative test than the Wilcoxon rank test in that it does not take magnitude of change intoconsideration. This was felt most appropriate because these data were collected from owner impression andtherefore the test would minimize bias due to owner differences in scoring. To determine the percentage ofimprovement of each behaviour between baseline and follow-up one and between baseline and follow-uptwo, the population prevalence of a behaviour was also used. Any dog for whom we did not have prevalencedata for the first follow-up was excluded from the baseline ‘‘N'' in order to prevent biasing the data. Thesame procedure was used for measuring percentage of improvement from baseline to follow-up two. Todetermine the level of population improvement, the individual behaviours were then weighted according tothe percentage of dogs that exhibited that respective behaviour at baseline; therefore, commonly exhibitedbehaviours were given more weight. In order to determine if there was correlation between the change inglobal scores with the change in total severity scores from baseline to follow-up one, a Pearson's rankcorrelation coefficient was used. To determine if there was a difference with respect to real exposures foreach CD group, a Mann–Whitney U-test was used. The total number of real exposures for each CD groupwere summed from the daily diaries provided to the owners and compared.
A total recorded frequency score was calculated from analysis of the video footage, for each fear-related behaviour using a one-zero method of sampling This method provides arelatively simple method of quantifying behaviour and is suitable when trying to establish if a behaviour hasbeen eliminated as a result of treatment. Each dog was recorded for 60 s; however the first 10 s of the videofootage was not included due to some owners restraining the dog during this time. Therefore only thebehavioural data from the 20 to 60 s period was used. The possible scores for each behaviour thereforeranged from 0 to 4. To determine if there was a difference between the pre- and post-fear scores for eachbehaviour and to determine if there was a difference between total fear scores (i.e. all behaviours summed)pre-treatment versus post-treatment, a Wilcoxon–sign rank test was used.
2.3.2. Training progress and owner compliance Data from all subjects were analyzed prior to dividing the subjects into their respective treatment groups for specific and comparative analyses. For individuals to be included in the data analysis, they had tocomplete at least the first month of training. This was deemed necessary in order to provide a reasonabletime period during which to monitor the dog's behavioural response to the recordings. Differences betweenthe two groups in the categorical variables gender, age, and breed were assessed using chi-squared tests. Todetermine if there were differences in the reported baseline frequency and severity with which individualbehaviours occurred between dogs receiving the FOF CD and those receiving the SS CD, a Mann–Whitney E.D. Levine et al. / Applied Animal Behaviour Science 105 (2007) 311–329 U-test was used. Total severity scores were calculated for weeks 1, 4, 5, and 8 of the trial (8-week CDtraining) to evaluate the dogs' response to the recording itself. The Wilcoxon–Sign test was used to analyzethe differences between the total severity scores between weeks 1 and 4, between weeks 5 and 8, andbetween weeks 1 and 8. The Wilcoxon–Sign test was also used to analyze differences in severity betweenindividual behaviours after the first and second month of CD training compared to baseline data obtainedprior to the start of the study. Individual behaviours for which the sample was less than or equal to 5 wereexcluded from statistical analysis.
Descriptive statistics were collected for questions relating to owner ability to understand and apply the training instructions. Data were collected relating to the owners' overall satisfaction with the treatmenttherapy, if they would use this treatment programme again in the event that they acquired another dog thatwas fearful of fireworks. The percentage of owners that continued to use the CD and DAP following thefollow-up interviews was also collected. In order to evaluate if the continued use of these products wereassociated with degree of change from baseline to the first follow-up, a chi-square test was used. The medianpercent change in the total severity score from baseline to follow-up one was used to divide the populationinto two groups. Yes or no variables were than compared to the aforementioned two groups for continued useof the CD and then for continued use of the DAP.
3.1. Population characteristics Forty-two individuals completed the first 4 weeks of training. Of these, 17 of the recruited dogs were mixed breeds and 25 were pure breeds. The breeds represented included Collies (6),Retrievers (4), Terriers (4), German Shepherds (3), Cocker spaniels (2), Greyhound (1),Miniature Schnauzers (1), Shit-zus (1), St. Bernards (1), Staffordshire bull terriers (1), and aWhippet (1). There was no gender (x2 = 0.382, d.f. = 1, p > 0.05), age (x2 = 0.008, d.f. = 1,p > 0.05), or pedigree status (i.e. pure breed versus mixed breed) (x2 = 0.221, d.f. = 1, p > 0.05)difference between the two treatment groups receiving FOF CD versus those receiving SS CDWhilst the median severity score of panting was higher for dogs receiving the FOF CD( p < 0.05), the two groups of dogs were considered to be behaviourally similar as there were nodifferences in the severity ( p > 0.05) of any other behaviours or in the frequency ( p > 0.05) ofany of the behaviours.
Table 2Demographic data for dogs that completed at least 1 month of training Age range (median) 1.5–19 years (6.5 years) 1.5–10 years (6.7 years) 3–19 years (6.5 years) a The two dogs that tried both CDs and were non-responsive are not included in the above table.
E.D. Levine et al. / Applied Animal Behaviour Science 105 (2007) 311–329 In addition, there were no differences between the groups of dogs with respect to the number of real firework exposures that occurred during the training period (W = 339.5, p > 0.05)(median = 1 for both groups).
3.2. Efficacy of treatment to real exposures 3.2.1. All subjects Thirty-six owners completed the first follow-up (mid-November) and 29 completed the second follow-up (mid-January).
Dogs showed significant improvement in their total severity scores at both follow-up one (Sign test, p < 0.001) and follow-up two (Sign test, p < 0.001) when compared to their baselinetotal severity scores but showed no significant change between the follow-up interviews (Signtest, p = 1.0) (The behaviours aggression, self-mutilation, and inappropriate eliminationwere excluded from analysis as they occurred in five or fewer subjects; therefore, 14 specificbehaviours were included in the analysis. With respect to the mean severity scores for theseindividual behaviours, there was significant improvement for 12 of the 14 behaviours at both thefirst and the second follow-up (). Vigilance (i.e. scanning the environment) did not showsignificant improvement until the second follow-up and was the behaviour that was leastimproved. Running around showed significant improvement at the first follow-up but thisimprovement was not sustained by the second follow-up.
At least 70% of the dogs exhibited the following eight behaviours at baseline: hiding, cowering, pacing, panting, owner seeking, vigilance, startling, and shaking (). The level ofgeneral improvement within the population using the weighted prevalence data suggested therewas a median reduction of 59% (mean 54%) in signs shown per dog. There was however greatindividual variation among the different signs and ). The behaviour ‘‘runningaround'' significantly improved during the first follow-up but the improvement was not sustainedby the second follow-up. Owner seeking behaviour was least improved at the second follow-up Fig. 1. Median total severity score percentage at baseline and follow-ups subdivided into CD categories.
E.D. Levine et al. / Applied Animal Behaviour Science 105 (2007) 311–329 Fig. 2. Mean total severity scores of individual behaviours at baseline and follow-ups for all dogs. §: number inparenthesis is the number of dogs showing signs at baseline followed up to January. All levels of significance of differencerelative to August baseline. *p 0.05; +p 0.01; p 0.001.
There was no significant change in the severity of any of the individual behavioursbetween follow-up one and follow-up two (Sign test, p > 0.05 for all behaviours).
The owners reported a significant improvement in their global assessment scores when comparing baseline (median = 8) to follow-up one (median = 5) and follow-up two (median = 6)(Sign test, p < 0.001 for both comparisons). There was no difference between the follow-upinterviews (Sign test, p > 0.1). The changes in the global fear score reflected the changes in thetotal severity score as there was a significant correlation between the improvement in the global Fig. 3. Prevalence of behaviours of all dogs at baseline and follow-ups.
E.D. Levine et al. / Applied Animal Behaviour Science 105 (2007) 311–329 Table 3Percent change in prevalence of individual behaviours from baseline to follow-up one and follow-up two Baseline to follow-up one Baseline to follow-up two a The dogs used to report baseline values were subjects for which there were related data at the respective follow-up.
fear score and the total severity score when measured from baseline to follow-up one (Pearsonr = 0.711, p < 0.001). In addition, there was a correlation between owner satisfaction and thereported change in both the global score (Pearson r = 0.731, p < 0.001) and the total severityscore (Pearson r = 0.591, p < 0.001) at the first follow-up interview. Seventy-eight percent ofowners reported some degree of improvement in their dog's behaviour ). Between thefirst and second follow-up interviews, the owners were not required to use either the CD or the Table 4Percentage of owners that reported various degrees of behavioural improvement, satisfaction with the results from usingthe CD therapy, and reported likelihood that they would use CD therapy again if they were to acquire another dog that wasscared of fireworks Use CD therapy again E.D. Levine et al. / Applied Animal Behaviour Science 105 (2007) 311–329 DAP. Of the 34% of owners who continued using the CD, 80% played it up to four times per weekwith the majority of sessions lasting 15 min ). There was no association betweenpercentage of improvement at the first follow-up interview and the continued use of either the CD(x2 = 0.157, d.f. = 1, p > 0.05) or the DAP (x2 = 2.253, d.f. = 1, p > 0.05).
With respect to the analysis of the video footage, there was no difference in the pre- and post- treatment scores of individual behaviours or between total scores (summed behaviours)(Wilcoxon, p > 0.05 in all circumstances).
3.2.2. Individual treatment programmes FOF. Seventeen owners completed follow-up 1 and 14 completed follow-up 2. Dogs showed significant improvement in their total severity scores at both follow-up one (Sign test,p < 0.001) and follow-up two (Sign test, p < 0.001) when compared to their baseline totalseverity scores (); however, there was no significant change between the follow-upinterviews (Sign test, p > 0.1). Regarding individual behaviours, there was a significantimprovement in seven behaviours at follow-up one [running around ( p < 0.05), hiding( p < 0.01), cowering ( p < 0.001), panting ( p < 0.05), bolting ( p < 0.01), shaking( p < 0.01), and startled ( p < 0.001)] and an improvement in eight behaviours [drooling( p < 0.05), hiding ( p < 0.01), cowering ( p < 0.001), pacing ( p < 0.05), panting ( p < 0.05),bolting ( p < 0.01), shaking ( p < 0.05), and startling ( p < 0.001)] at follow-up two with nosignificant change in any individual behaviours between the follow-ups (Sign test, p > 0.1 forall behaviours). In this group of dogs the behaviour ‘‘running around'' improved only for thefirst follow-up whereas, the behaviours drooling and pacing did not show significantimprovement until the second follow-up. There was no significant improvement with respectto the global scores when comparing baseline (median = 8) to follow-up one (median = 7)(Sign test, p > 0.05); however, owners reported a significant improvement in global scoreswhen comparing baseline scores to the second follow-up scores (median = 6.5) (Sign test,p < 0.05). In addition, no difference was found in global scores between the follow-upinterviews (Sign test, p > 0.1).
Sixty-two percent of owners stated that there was some degree of improvement in their dog's behaviour and nearly all individuals stated that they would consider using firework CDs as a Table 5Decisions of individuals to continue the use of DAP and the use of the CD between follow-up one and follow-up two andcharacteristics of the CD use percentages, for those who did continue the use of the CD, expressed as a proportion of thatsubpopulation Length of time the CD was played per Five to eight times Fear of fireworks Five to eight times Five to eight times a Some individuals reported that the DAP ran out at some point between the follow-up one and follow-up two interviews; therefore, the percentages reported are only for those who either used the DAP consistently between follow-upone and follow-up two or those who did not use at all within this time frame.
E.D. Levine et al. / Applied Animal Behaviour Science 105 (2007) 311–329 method of helping other dogs they acquire that may have firework fears (). Twenty-threepercent of individuals continued the use of the CD after follow-up one ().
SS CD. Nineteen owners completed follow-up one and 15 completed follow-up two. Dogs showed significant improvement in their total severity scores at both follow-up one (Sign test,p < 0.001) and follow-up two (Sign test, p < 0.001) when compared to their baseline totalseverity scores (). There was no significant change between the follow-up interviews (Signtest, p > 0.1). With respect to individual behaviours, there was significant improvement in sixbehaviours [hiding ( p < 0.05), cowering ( p < 0.01), pacing ( p < 0.01), panting ( p < 0.05),shaking ( p < 0.01), and startled ( p < 0.001)] at follow-up one and an improvement in sixbehaviours [cowering ( p < 0.001), pacing ( p < 0.05), owner seeking ( p < 0.05), bolting( p < 0.01), shaking ( p < 0.05), and startled ( p < 0.01)] at follow-up two when compared tobaseline scores. Hiding and panting behaviour significantly improved at follow-up one, but didnot show significant improvement at follow-up two. The behaviours of ‘‘seeking the owner'' and‘‘bolting'' did not show significant improvement until the second follow-up. There was nosignificant change in any individual behaviours between follow-up one and follow-up two( p > 0.1 for all behaviours). Owners reported significant improvement with respect to the globalscores compared to baseline (median = 8) for both follow-up one (median 5) and follow-up two(median = 5) (Sign test, p < 0.001 for both comparisons). There was no difference in globalscores between the follow-up interviews (Sign test, p > 0.1).
Ninety-three percent of owners stated that there was some degree of improvement in their dog's behaviour and nearly all owners stated that they would consider using firework CDs as amethod of helping other dogs they acquire that may have firework fears ). Forty-sevenpercent continued to play the CD in between follow-ups ( 18.104.22.168. Comparison of FOF and SS programme. Whilst there was no overall differencebetween the SS and FOF CD in the improvement from baseline to follow-up one (W = 353.0,p > 0.1) or follow-up two (W = 221, p > 0.1), more behaviours (i.e. 8 versus 6) were reported tohave decreased at the second follow-up for those dogs using the FOF programme. There was nodifference between changes in owner reported global scores from baseline to follow-up one(W = 370, p > 0.1) or follow-up two (W = 240, p > 0.1) between the two groups of dogs.
3.3. Training progress and owner compliance 3.3.1. All subjects With an initial population of 54 individuals, 42 (78%) completed the first 4 weeks of training and 36 (67%) completed the 8-week training period. Reported reasons for owners not completingthe study varied but included lack of time to play the CD and family or personal health reasons.
One individual strongly disagreed with the idea of giving treats as a method of counter-conditioning. There was no significant difference between the drop out rates for the CD groups ateither week 4 (x2 = 0.324, d.f. = 1, p > 0.05) or week 8 (x2 = 1.836, d.f. = 1, p > 0.05) and thereasons for dropping out appeared similar between the groups.
With respect to the total severity scores, which included all behaviours, dogs exhibited a significant reduction in their behaviour towards both CDs after the first month of training (Signtest, p = 0.0001) No further change was noted during the second month of training(Sign test, p > 0.05). Six specific behaviours were excluded from statistical analysis due to smallsample size. These behaviours included drooling (n = 4), destruction (n = 3), aggression (n = 0),vomiting/urination/defecation (n = 0), bolting (n = 3), and self-harm (n = 0). Of the remaining 11 E.D. Levine et al. / Applied Animal Behaviour Science 105 (2007) 311–329 Fig. 4. Median and interquartile range for total severity scores for dogs at the end of weeks 1, 4, 5, and 8 of the CD trainingperiod for all dogs (a), dogs in the FOF treatment group (b), and dogs in the SS treatment group (c). Key. Box and Whiskerplots: the data represented within the box represents the middle 50% of the population with the horizontal line within thebox representing the median score. TOTSEV: the total severity score and *: outliers analyzed behaviours, a significant reduction during the first month of training was found in 7 ofthe behaviours. These behaviours included hiding (Sign test, p < 0.05), cowering (Sign test,p < 0.001), panting (Sign test, p < 0.05), owner seeking behaviour (Sign test, p < 0.001),scanning ( p < 0.01), exaggerated response when startled (Sign test, p < 0.001), and shaking(Sign test, p < 0.001).
E.D. Levine et al. / Applied Animal Behaviour Science 105 (2007) 311–329 At the start of the training period, 83% of the participants reported reading greater than 90% of the accompanying instruction booklet with only 48% stating that the majority of the booklet wasclear to understand. Fifty-five percent of individuals believed that the majority of the programmewould be easy to follow.
3.3.2. Individual treatment programmes FOF. Twenty-one dogs (78%) completed the first 4 weeks of the training and 17 (63%) completed the 8 weeks of training. Dogs in this group exhibited a significant reduction (Sign test,p < 0.05) in their total severity scores in response to the CD during the first month of training butno further change during the second month of training (Sign test, p > 0.1) (Despite thesignificant change in the total severity scores, only three of the nine behaviours showed asignificant reduction: cowering (Sign test, p < 0.05), panting (Sign test, p < 0.05), and scanning(Sign test, p < 0.05).
At the start of the training period, 90% of the participants reported reading greater than 90% of the accompanying instruction booklet with only 52% stating that the majority of the booklet wasclear to understand. Fifty-two percent of individuals believed that the majority of the programmewould be easy to follow. At the end of training week 8, when asked how easy the treatment planwas to follow, 82% responded easy, 12% responded difficult, and 6% responded in between easyand difficult.
SS. Twenty-one (84%) completed the first 4 weeks of the training and 20 (81%) completed the 8 weeks of training. Dogs in this group exhibited a significant reduction (Sign test, p < 0.01) intheir total severity scores in response to the CD during the first month of training but no furtherchange during the second month of training (Sign test, p > 0.1) (c). Five of the ninebehaviours showed significant reduction in this group of dogs: hiding (Sign test, p < 0.05),cowering (Sign test, p < 0.001), panting (Sign test, p < 0.01), owners seeking behaviour (Signtest, p < 0.01), and shaking (Sign test, p < 0.05).
At the start of the training period, 76% of the participants reported reading greater than 90% of the accompanying instruction booklet with only 42% stating that the majority of the booklet wasclear to understand. Fifty-seven percent of individuals believed that the majority of theprogramme would be easy to follow. At the end of training week 8, when asked how easy thetreatment plan was to follow, 71% responded easy, no one responded difficult, and 29%responded in between easy and difficult.
4.1. Efficacy of CDs to real exposures These results describe the potential value of using sound recordings of fireworks with the use of DAP as a treatment plan for dogs with firework fears. Behaviours that occurred mostcommonly (i.e. >70% of the dogs) to real fireworks included hiding, cowering, pacing, panting,seeking the owner, shaking, vigilance, and having an exaggerated response when startled. This issimilar to findings in an earlier study using owner reported information regarding fear behavioursexhibited by dogs exposed to real fireworks In a study by Crowell-Davis and colleagues, the most common fear-related behaviours exhibited by dogs with stormphobia (>70%) appear similar to those shown in dogs with firework fears, but cowering andstartle responses were not evaluated. Although direct comparisons between the studies are oflimited value due to differences in methodology and complexity of the fear eliciting stimuli, there E.D. Levine et al. / Applied Animal Behaviour Science 105 (2007) 311–329 are some similarities in the outcomes, such as the rate of improvement that should not beoverlooked. In the present study, the total severity scores significantly improved by the firstfollow-up (day 60) and were maintained at the second follow-up (day 120). reported in thunder phobic dogs the fear scores decreased over a 120-day period.
Together, these results suggest that significant improvement can be seen as soon as 60 days, butencouraging owners to continue the treatment for at least 4 months could further decrease thefear-related behaviour. It is important to highlight the trend in both studies that the dogs had agreater percentage of improvement in individual behaviours across a 120-day time period.
Further studies are needed to investigate the ideal length of time that treatment should continueand/or to measure the duration of efficacy after owners have ceased treatment.
Although the changes in global scores from baseline to both follow-ups showed significant improvement, it is worth noting that the median global score at baseline was 8 and at the firstfollow-up was 5, but rose to 6 at the second follow-up. A difficulty in the interpretation of theseparticular scores is the potential lack of validity in using owner reported global scores asmeaningful measures of improvement. However, given that the change in global scorescorrelated with the change in total severity scores, it appears that, for this study, the global scoreshad some validity as a measure of behavioural improvement; however, they may or may notreflect the magnitude of improvement. It is possible that the global assessment scores may beidentifying components of the fear behaviour (e.g. overall emotional state of the animal) that arenot revealed by simply scoring individual behaviours. Thus, it may be that the global score gives amore accurate picture of the animal's overall fear or anxiety. have recentlyargued that reliable global measures of emotional state may be more sensitive measures oftreatment response than specific behaviours in studies such as this. If this is the case, the efficacyof the CD based programme may not be as great at reducing the dogs' fear of fireworks as thebehavioural score changes may indicate. Alternatively, it could be argued that the owners' reportof the global assessment may be influenced by external factors such as ease of understanding,implementation of the programme, or owner expectation about behavioural changes andtherefore, may not be reflecting accurately the dog's behavioural improvement. Further researchis needed to validate the use of owner reported global scores.
With respect to the prevalence of behaviours, approximately 60% of initially reported behaviours were no longer exhibited; however, there was variation with respect to whichbehaviours ceased; therefore, which behaviours an individual dog shows may affect the overallnumber of behavioural signs stopped. With respect to the severity of individual behaviours, allbehaviours assessed with the exception of ‘‘vigilance'' improved significantly by the first follow-up. Vigilant behaviour improved by the second follow-up. The delay of improvement in‘‘vigilance'' may be related to the potential function of this behaviour. Vigilance may be relatedto the orienting response. Identifying the source of a potentially threatening sound would beevolutionarily advantageous, as locating the source of the sound would give the animalinformation to help execute the most appropriate behaviours, e.g. running in a direction awayfrom the source. Therefore, it may be expected that this particular behaviour will take longer todissipate than behaviours such as panting and trembling which do not have the potential toprovide information to the animal but are an expression of a more intense emotional response.
Although the severity of ‘‘inappropriate elimination'' behaviour could not be analyzedstatistically due to the small sample size for which all follow-up information was available(n = 5), it should be noted that all five dogs stopped the behaviour by the second follow-up.
However, the dog with highest severity score for inappropriate elimination dropped out of thetraining programme. All dogs which showed inappropriate elimination in the Crowell-Davis E.D. Levine et al. / Applied Animal Behaviour Science 105 (2007) 311–329 study ceased the behaviour completely by day 120 but it should be noted that in this latter studyall subjects were also treated with anxiolytic medication.
With respect to the individual CD programmes, there was no significant difference between the number of behaviours that improved at either follow-up one or follow-up two.
All of the behavioural data reported thus far have been collected using owner reports which may not be the most accurate method of assessment; therefore video footage of the animals wasalso assessed. No improvement in fear-related behaviours was seen post-treatment when theanimals were exposed to a segment of a firework track while in the behaviour clinic. This is asimilar finding to that of Crowell-Davis and colleagues in which storm phobic dogs showed noimprovement to storm recordings in the clinic but showed significant owner reportedimprovement in the home setting (). The reasons for improvement inthe home and not in the behaviour clinic may be that the dog's fear abated only in theenvironment in which he or she was trained, i.e. in the owner's home It is possiblethat simply changing the context in which the fearful stimuli is presented (i.e. the behaviourclinic) could reinstate the original fear response (). It seems unlikelythat the subjects had simply become desensitized to the recording used in the training given theirapparent improvement to real events, but this hypothesis cannot be excluded without moreobjective data on the response to the live event given recent findings about how dogs discriminatesome live sounds from their recording ). Based on the above findings itdoes not appear useful to play the CD in the behaviour clinic for follow-up sessions as a means tomonitor therapeutic progress, but an initial assessment using a CD may be useful as it may give anaccurate prediction of response to the recording in the home and is unlikely to give false positivesof the real response.
4.2. Training progress and owner compliance Thirty-three percent of owners did not complete the training period. The drop out rate was higher for the FOF programme than for the SS programme (37% versus 20%); however, the mostcommon reason given for dropping out for both programmes was a lack of time. Ownercompliance is essential if a behavioural programme for noise fears is to be effective. The highdrop out rate in this particular study is concerning as this was a highly motivated group of self-selected individuals. In addition, those who did complete the official 60-day training period weregiven the option to continue playing the recording prior to the next follow-up interview, but only34% of the participants did. This raises the concern that the average dog owner who purchases aself-help firework CD programme for a ‘‘quick-fix'' may be unlikely to complete the entireprogramme. Perhaps owner compliance would be increased if the owners could be informed of aminimum ‘‘time period'' for which they should commit to the training that will maximize thechances of seeing behavioural improvement in their dog. Based on current findings a minimum of60 days should be recommended.
Perhaps one of the most interesting aspects of lack of owner compliance during the training period relates to the instructions on how to use the CD recording itself. It is clearly written in bothsets of instructional booklets that the CD should be played at a level in which no anxious and orfear-related behaviours are exhibited. It is clear from the early total severity scores (thatthe CDs were being played at levels which did elicit fear or anxiety related behaviours. Despitethis lack of compliance, all dogs clearly showed a reduction in the severity of behaviours inresponse to the CD at the end of the first and second month of training. This finding is importantboth clinically and theoretically as the literature varies with recommendations on how to E.D. Levine et al. / Applied Animal Behaviour Science 105 (2007) 311–329 implement noise desensitization and counter-conditioning programmes. Some advocate elicitingno fear-related behaviours (whereas others recognize thata treatment option may include letting an animal who is showing signs of mild anxiety habituate tothat level of volume The authors would like to emphasize that elicitingfearful behaviours is not being advocated here but rather recognize the potential practical value ofallowing a mild response so owners are aware of a change during training. Telling owners that noanxious signs should be elicited at any point may lead people to abandon a potentially usefultreatment programme due to lack of perceived benefit or change during training. Two dogs wereremoved from this study as they showed no response to the CD recording at any volume level eitherin the clinic or in the home. To date there has been no study examining the general effect of playingrecordings at a sub-respondent level on clinical behaviour problems in dogs. Ideally guidelines ondesensitization programmes should distinguish between behaviours that indicate fear versus thosethat indicate a dog that may be becoming slightly anxious; however there are several difficulties inaccomplishing this. Firstly, the distinction between behaviours which indicate fears versus anxietymay not be very clear as many of the signs (e.g. panting) may indicate either fear or anxiety butdiffer in their intensity. Furthermore, not all dogs will exhibit anxiety in the same manner (). Secondly, a dog that shows signs of low level anxiety, may or may not be amenable tocounter-conditioning which is also an important component of the treatment plan. Even when a verylow level of volume is played on a stereo, not all dogs may be able to exhibit manageable levels ofanxiety let alone no anxiety at all, as indicated by one participant in the present study. By week 4,Dog X which had been in the SS treatment group had become sensitized and was generalizing thefear. This dog was given personalized behavioural advice including administration ofpsychopharmacological medication which was not administered until after the study due to theowner's reluctance to use medication. After implementing anxiolytic therapy, the owner reported areduction in the dog's fear to real firework exposures.
Despite some lack of compliance, the majority of owners reported that they read the majority of the instruction booklet that accompanied the CDs with more people completing the reading ofthe instruction booklet that accompanied the FOF CD; however, at the end of the study 12%participating in the FOF programme stated implementation of the programme was difficultwhereas, no one reported that the SS programme was difficult to implement. This discrepancymay be due to the nature of the instruction booklets that accompanied the CD. The FOF bookletwas much shorter with less background information on noise fears and less detailed instructionson how to use the CD, e.g. ‘‘Reward your pet for remaining calm and relaxed while the CD isplaying. You can use food treats, but also don't forget to talk to them and make a fuss as well''compared to the SS instruction booklet, e.g. ‘‘. . play the tape at a very low level while your dogis doing something he really enjoys, such as eating or playing. With the CD set at the lowestvolume level to give signs of recognition . . you should switch the player on. As soon as youbegin to hear noises you should put the food down for your dog, or start the game. If he continuesto eat or play you should leave the CD playing, but remember if he reacts to the noise you haveproceeded too quickly. As soon as your dog finishes eating or playing the CD must be switchedoff immediately.'' Given that no one considered the SS programme difficult to implement andthat there was a significant change with respect to global scores in the first follow-up, neither ofwhich occurred for the FOF CD, perhaps the way in which the instructions are written is just asimportant if not more important than the actual quality or format of the recording itself or thesound equipment on which the recording is played. Supporting the latter hypotheses is the factthat there were no differences in the total severity scores between CD programme despite obviousaudible differences in quality of recordings and in the way in which the noises were formatted E.D. Levine et al. / Applied Animal Behaviour Science 105 (2007) 311–329 (e.g. random versus graded intensities). In addition, the two dogs who did not respond fearfully toone firework CD, did not respond to any of the three CDs involved in this study. Both of thesedogs heard at least two of the CDs on different qualities of stereo equipment and in differentenvironments (home and the behaviour clinic). Despite the differences in the recordingthemselves, both CDs elicited a similar group of fear behaviours in over 50% of the dogs. Thesebehaviours included hiding, cowering, panting, owner seeking, and vigilance which are amongstfive of the most commonly occurring behaviours to real firework exposures.
It is worth noting that all of the behaviours that significantly improved in response to the CD recording showed significant improvement in response to real exposures. There were somebehaviours (i.e. freezing and pacing) that did not show significant improvement to the CDrecording but did improve during real exposures.
One must take into consideration that whilst behaviourists in practice routinely judge the efficacy of behavioural programmes on owner reports, this method of assessment has not beenvalidated with respect to firework fears in dogs. Therefore, although it appears that these self-helpprogrammes can reduce fear-related behaviours of dogs to firework noises; it is possible thatowners may not be reporting the behavioural changes accurately. Videotaping dogs' responses tofirework recordings in the home before and after treatment remains the ideal method to measureobjectively the efficacy of such programmes.
Self-help desensitization and counter-conditioning programmes for firework fears in combination with the use of DAP appear to be a potentially effective way of reducing ownerreported fear-related behaviours in dogs, but compliance may be expected to be poor. If ownersapply the treatment for 60 days an overall reduction of approximately 60% in the number of signsexhibited may be expected on average but this depends on the specific signs being shown. Mostsigns, even if they are not eliminated, appear to decrease in their severity. This appearssatisfactory to the majority of owners.
It appears that the clarity of the instructions is critical for clients to perceive the programme as easy to implement. Given the variation in the sound systems used by owners, the recordingquality of the CD does not, in this study, appear to be such an important factor in the success oftherapy. All programmes should carry a clear warning about the role of sensitization, with arecommendation to stop treatment and seek specialist veterinary attention if this should occur, inorder to safeguard the welfare of animals being treated.
The authors would like to thank both the Fear of Fireworks and Sounds Scary companies for providing the CD programmes free of charge. The authors would also like to than CEVA forproviding the Dog Appeasing Pheromone free of charge.
Beaver, B., 1999. Canine behavior of sensory and neural origin. In: Beaver, B. (Ed.), Canine Behavior: A Guide for Veterinarians. WB Saunders Co., Philidelphia, USA, pp. 43–105.
Crowell-Davis, S., Seibert, L.M., Sung, W., Parthasarathy, V., Curtis, T.M., 2003. Use of clomipramine, alprazolam, and behavior modification for treatment of storm phobia in dogs. J. Am. Vet. Med. Assoc. 222, 744–749.
E.D. Levine et al. / Applied Animal Behaviour Science 105 (2007) 311–329 Fukuzawa, M., Mills, D., Cooper, J.J., 2005. More than just a word: non-semantic command variables affect obedience in the domestic dog (Canis familiaris). Appl. Anim. Behav. Sci. 91, 129–141.
Hothersall, D., Tuber, D., 1979. Fears in companion dogs: characteristics and treatment. In: Keehn, J.D. (Ed.), Psy- chopathology in Animals: Research and Clinical Implications. Academic Press, New York, USA, pp. 239–255.
Landsberg, G., Hunthausen, W., Ackerman, L., 2003. Fears and phobias. In: Handbook of Behavior Problems of the Dog and Cat, 2nd ed. Saunders, Toronto, Canada, pp. 227–268.
Longford, N.T., Ely, M., Hardy, R., Wadsworth, M.E., 2000. Handling missing data in diaries of alcohol consumption. J.
Roy. Stat. Soc.: Ser. A 163, 381–402.
Martin, P., Bateson, B., 1993. Measuring Behaviour. Cambridge University Press, UK.
Miller, N.E., 1960. Learning resistance to pain and fear: effects of overlearning, exposure, and rewarded exposure in context. J. Exp. Psychol. 60, 137–145.
Mills, D., Gandia Estelles, M., Cleshaw, P.H., Shorthouse, C., 2003. Retrospective analysis of the treatment of firework fears in dogs. Vet. Rec. 153, 561–562.
Mills, D.S., Ramos, D., Gandia Estelles, M., Hargrave, C., 2006. A triple blind placebo controlled investigation into the assessment of the effect of Dog Appeasing Pheromone (DAP) on anxiety related behaviour of problem dogs in theveterinary clinic. Appl. Anim. Behav. Sci. 98, 114–126.
Overall, K.L., 1997. Fear, anxieties, and stereotypes. In: Clinical Behavioral Medicine For Small Animals, 1st ed. Mosby, St. Louis, Missouri, pp. 209–250.
Overall, K.L., 2002. Noise phobias in dogs. In: Horwitz, D., Mills, D., Heath, S. (Eds.), BSAVA Manual of Canine and Feline Behavioural Medicine. BSAVA, Gloucester, UK, pp. 164–172.
Schwartz, B., Robbins, S., 1995. Psychology of Learning and Behavior, 4th ed. Norton & Company, New York.
Sheppard, G., Mills, D., 2003. Evaluation of dog-appeasing pheromone as a potential treatment for dogs fearful of fireworks. Vet. Rec. 152, 432–436.
Shull-Selcer, E., Stagg, W., 1991. Advances in the understanding and treatment of noise phobias. In: Marder, A.R., Voith, V.L. (Eds.), Vet. Clin. North Am. [Small Anim. Pract.] 21 (2), 353–367.
Tuber, D.S., Hothersall, D., Peters, M.F., 1982. Treatment of fears and phobias in dogs. In: Voith, V., Borchelt, P. (Eds.), Vet. Clin. North Am. [Small Anim. Pract.] 12, 607–623.
Voith, V., Borchelt, P., 1996. Fears and phobias in companion animals. In: Readings in Companion Animal Behavior, Veterinary Learning Systems, Trenton, New Jersey, pp. 140–153.
The Experiences of Massachusetts Families in Obtaining Mental Health Care for their Children Health Care For All and Parent/Professional Advocacy League Written by: Ariel Frank, Josh Greenberg and Lisa Lambert October 2002 The Experiences of Massachusetts Families in Obtaining Mental Health Care for their Children
ARTICLE IN PRESS Contents lists available at Materials Science and Engineering B Depth dependent properties of ITO thin ﬁlms grown by pulsed DC sputtering A. Sytchkova , D. Zola , L.R. Bailey , B. Mackenzie , G. Proudfoot , M. Tian , A. Ulyashin a ENEA Optical Coatings Laboratory, via Anguillarese 301, 00123 Rome, Italy b Oxford Instruments Plasma Technology, Yatton, Bristol, BS49 4AP, UK