Behavioral problems, especially fear and aggression in dogs and elimination in the house in both dogs and cats, are a major reason for people to give up or euthanize their pets, so they represent a serious medical condition. There are many methods of treating such disorders with behavioral modification, and medications can sometimes be helpful, though our understand of which medications might help for which problems in which patients is very poor. However, the sad truth is that we have very limited success in alleviating many of these problems.
In the face of serious medical problems for which there are not strikingly effective scientific therapies, more questionable methods can become widely used. Some, like Bach flower essences, such as Rescue Remedy, or homeopathic treatments are clearly useless nonsense. Others are plausible scientifically, but not really shown to work in definitive ways. One such treatment is the use of pheromones.
Pheromones are chemicals animals produce that can affect the behavior of other members of the same species. They are believed to be common and important in coordinating social behavior in animals, especially mammals. The role, if any, that they play in human behavior is less clear, though they may be involved in the synchronizing of menstrual cycles in women living together. In any case, it is clearly reasonable that such substances might have an impact on the behavior of dogs and cats and so might be useful in managing behavior problems. Notice all the “mights” in that statement? The devil, of course, is in the details
It has become quite common for veterinarians to recommend use of synthetic pheromone analogs, that is chemicals made to be structurally natural pheromones, to help treat behavioral problems. The most common products are Feliway, and analogue of the facial pheromone cats leave behind on furniture and people the rub their faces against, and DAP, short for Dog Appeasing Pheromones, a pheromone nursing mothers release which is believed to calm puppies. These are sold with dramatic claims of efficacy for a wide range of conditions, but of course the claims of folks selling the product have to be viewed as perhaps less objective than other forms of evidence.
In the most recent issue of the Journal of the American Veterinary Medical Association, a systematic review was published which evaluated the research evidence for the use of these products.
Frank,D. Beauchamp,G. Palestrini,C. Systematic review of the use of pheromones for treatment of undesirable behavior in cats and dogs. J.Am.Vet.Med.Assoc., 2010, 236, 12, 1308-1316.
The purpose of a systematic review is to evaluate all the published data on the basis of quality, and then evaluate the results of studies that meet a reasonable minimum quality. In this review, studies were excluded that did not meet minimum quality standards or that were conducted by researchers working for the company selling the product under study. This left a total of 14 studies, 7 in cats and 7 in dogs.
In general, as is too often the case in veterinary medicine, the methodological quality of the studies overall was lower than expected in human medicine, with no studies reaching the highest standards. But as the authors wisely note, imperfect information is better than no information, so we must make our judgments based on the best available evidence even if it is prone to errors that better studies would avoid. I will spare you the interesting but complex details of the various study designs and their strengths and weaknesses, though reading the full review is recommended for anyone interested. Having read through the full report, I am convinced that unlike others I have reviewed, the conclusions of the authors of this systematic review are supported by the methods and results they detail elsewhere in the paper.
Of the 7 cat studies, none provided convincing evidence of a benefit. Some decrease in urine spraying occurred in some cats, but the significance of this was muddied by failure to follow up on cats which dropped out of studies, which were probably cats who didn’t improve with the treatment, and other methodological flaws in the studies reviewed. Pheromone therapy also was not clearly of benefit in cats with interstitial cystitis (a condition in which irritation in the bladder causes symptoms much like those of a bladder infection). The pheromone also did not seem beneficial in calming cats in the hospital or facilitating the stressful process of placing IV catheters in hospitalized cats.
In dogs, one study found some evidence that pheromone therapy might reduce anxiety in puppies during training. Other than that, no convincing evidence of benefit was found for anxiety associated with veterinary care, anxiety in shelter dogs, or barking and elimination indoors by recently adopted dogs.
The limitations in the quality of the evidence mean we cannot definitively declare that pheromone therapy doesn’t work. What we can say is that based on the best evidence to date, it does not appear to have a benefit. Further study is certainly reasonable, but as always I question the wisdom and the ethics of widespread sale and use of products which, despite years of testing, don’t seem to have much evidence that they work. These products appear harmless, and if clients wish to spend money rolling the dice on a treatment that is not well supported by the limited clinical research available that is certainly up to them. But when veterinarians recommend such products, it does tend to convey the impression that they are legitimate, validated therapies, and I think we do a disservice to our clients if we make such recommendations without a clear statement of the limitations in the evidence. Thanks to this paper, it is now easier to make such a statement.
I’m using a Feliway infuser for my two cats who fight a fair bit and it’s a real problem. I’ve found it does take the edge off, and they play gentle rather than rough when it’s on. I notice a difference anyway, but it’s difficult to be objective about these things. I found whatever area it states it can cover is exaggerated and you should at least halve that (so if it says it can cover 20 square metres, it’s only really effective for 10
etc). You have to close of the doors and windows, pretty much seal the place shut, and lastly it takes a few hours to build up. If I put it on overnight for example by morning they’re snuggling together, which is something they never do otherwise. I use it PRN. It’s not really practical to use all the time.
http://veterinaryrecord.bmj.com/content/early/2015/08/26/vr.103172.full#F4
What do you think about this study? (besides the missing allocation scheme…)
Interesting, thanks for bringing it up. Overall, it is a reasonable design for the subject. Behavioral signs of anxiety and fear are inherently subjective and difficult to evaluate, but the protocol seemed to be reasonable. Methodologically, the use of placebo controls and blinding of most personnel was encouraging. However, there were a number of methodological issues.
1. It isn’t clear if the subjects actually have clinical thunderstorm phobia. A group of lab beagles was exposed to recorded thunder (27), and all but the 3 least reactive were chosen for the study. However, their scores were quite low (1.25-2.75) on a 6-point scale. These dogs may not be representative of a clinical population that have naturally occurring noise/thunderstorm phobia, so their responses may not fairly represent what would happen with treatment of real patients. In particular, if real patients are considerably more fearful, any small effects that could be detected in this group might be irrelevant or undetectable. Repeating the study with actual noise phobia patients would be a good step.
2. As you point out, alternate allocation was used rather than randomization, and the only person not blinded was responsible for allocation. This introduces a pretty big risk of bias, which requires cautious interpretation of results
3. The placebo group was tested 5-6d after the first thunder exposure and the treatment group 8-9 days after. One might expect the fear induced by the original exposure to diminish with time, so it is possible the treatment group could be less reactive due in part to having had more time to recover from the initial stimulus.
4. The differences between placebo and treatment groups were statistically significant but quite small. Most differences were less than 1 point on a 6-point scale. This raises the question of whether or not these differences would be clinically significant. Would actual patients experience enough improvement to matter?
5. There is, as always, the issue of financial bias to consider. The study was funded by the manufacturer of the product tested, and the test was done by a company that specifically focuses on testing so-called “natural” products and supplements, and which tends to produce positive results (I haven’t yet seen a negative study published by the group, though there may be some out there. Again, this doesn’t mean the results can be automatically dismissed, but it is an additional factor to consider since in human medicine it has been shown that industry funding does influence the likelihood of positive results.
Overall, since there is little reason to think the product does harm, trying it based on relatively weak evidence is reasonable. But I do think this study, while encouraging, would need to be independently replicated, ideally with real thunderstorm-phobia patients, in order to have high confidence in the conclusions regarding efficacy.
I agree with your point here, but what about this unmet medical need of problems with cat behavior? Is the answer for the frustrated owner to actually put the cat down or re-home it?
Behavioral problems are often complex and difficult to resolve, and every individual and situation is unique, so there is unlikely to be a single answer that consistently helps different pets and their people. Ideally, an in-depth consultation with a veterinary behaviorist and a comprehensive behavior modification and environmental management strategy, with the addition of medications in some case, would be possible for everyone, and while even this would not solve all problems, it would give people and their cats the best chance. Unfortunately, this is not available to everyone, for various reasons. I wish something easy and cheap like pheromones was more effective because, as you point out, there are many cats and people who could use something like that, but so far it hasn’t been much help, and the best chance is still out of reach for many. Truly a frustrating situation, but we have to do the best e can with the tools and knowledge we have.
This is an interesting thread. I agree to a certain extent with both viewpoints. I use alternative therapies to treat some chronic conditions eg magnesium for muscle spasms in addition to seeing my doctor for acute medical issues. I do this because in the absence of definitive evidence, and in the face of traditional medicine’s in ability to help me with some things, I say ‘why not’?
So why wouldn’t I do the same for my pets? My 13 year old dog, who has CCD, was attacked recently by a much larger dog. She recovered physically but became extremely aggressive around my other two dogs, which was affecting their quality of life. My vet suggested trying a DAP collar which she has been wearing for two weeks now. I wasn’t expecting much, however within just a few days she seemed happier and after two weeks she is a great deal better.
I appreciate this may be due to the passage of time but do feel the improvement in the first week points to some level of effectiveness. As someone else commented above, peace has been restored in my home, which is worth a few dollars to me. It may have been the collar or it may have been something else. In the end, having rock solid proof doesn’t seem that important.
I have a slightly different question. My dog, and his sister who lives with a friend, both display unusual behavioral responses, that I believe are prompted by anxiety. Both dogs can be protective of personal space, certain toys, certain areas of the home, special treats and food, and, with my dog: me. They have both been in very loving and positive environments since they were 8 weeks old when we adopted them. Sometimes their reactions seem understandable given the situation and their proclivities, but sometimes their “aggressive” behavior seems to be completely unexplainable. We are using qualified behaviorists to help us through these issues. Regarding the pheromones, I tried using a pheromone collar twice, and had the same reaction with my dog (male) both times: he seemed to become more aroused, hyperactive, and possibly more anxious. Does anyone have any thoughts on this reaction? Because both dogs are from the same litter (rescue, found on the streets with their mother, father unknown), and seem to exhibit the same maladaptive behavior at almost the same time, we are wondering if there is a chemical imbalance in their brains. Both families welcome any suggestions on how to improve the situation. We love our dogs immensely, and don’t see giving them up as an option. Please no suggestions of use of aversives or punishment of any kind.
I wouldn’t expect the pheromone to worsen anxiety, and there isn’t any suggestion of that in the research. It might simply be the collar itself, or it might be unrelated. One of the great challenges to characterizing and solving behavior problems is that our observations of such associations aren’t very reliable.
Anxiety is always, of course, a matter of brain chemistry. Unfortunately, our understanding of the details of the relationship between individual differences in brain chemistry and behavior is very poor. Treatment with medication, as a n adjunct to behavioral modification, is often very helpful, but there is a lot of trial and error involved, and we can’t predict very accurately how any given patient will react. It sounds like you are on the right track, and I hope you find a good solution.
This is in response to Anna’s comments. I’m happy that you found something that seems to work for your situation. I’ve become frustrated with the way my various pets (cats and dogs) behave towards each other and me and my mom who lives with me.
On the one hand, I am looking for answers to my own situation. On the other hand – economics major here – part of the scientific method is to determine if there are any flaws – logic, process, data, etc. – biases, or other extraneous explanations that have not been considered.
I’d like to point out that it is frequently said that correlation does not imply causality. In your case, the cause of the improved behavior could simply be a collar of any kind – pheromone or plain – could be the explanation for the improvement in behavior. I believe I see this with my male (neutered) chihuahua. His behavior changes dramatically – for the better – when he is wearing a collar, a handkerchief, or a doggie T-shirt. It could be the object placed on his neck/body, which isn’t there all of the time, that is the cause of the change.
Further, I have yet to determine if this is a positive change or a negative one over the long term as I am inclined to think it feels more like a straight jacket – punishment – than a bridle and saddle – something he was trained to be comfortable with. This at least for me, is a simple observation based on my understanding of my situation.
Bottom line: if it works, it works. Further, I want to be sure that any “fix” I implement does no harm and also doesn’t create further (bigger) problems down the road.
I have extensive training and over 20 years experience in multi-species rescue, especially with “problem” cats. I get pretty irritated with people who don’t try or even want to understand their pet’s issues, so I appreciate the need for pheromone type products as well as am disgusted by the desire for quick fixes. When I rescued my last cat Felix, he had been severely abused by previous owners and though desperate for physical affection, he was terrified to be touched. Three years later, he is an affectionate and loving boy but can’t bear more than 3 or 4 pets and less than half a minute of being held before he has to bolt. When I had to move, despite my best efforts, he devolved significantly to the point where I was desperate to try anything. The local store only had Bach’s Rescue Remedy, so I tried it. Felix responded right away, which shocked me. On the 4th day, the response was so amazing, I emailed pictures to all my friends. Felix asked to be picked up and lay in my arms, totally relaxed, purring like a freight train and enjoying a full half hour of pets and kisses. So I know you say the stuff is useless nonsense and that was certainly the opinion I had in the past, but I have no explanation for the sudden and total change in my sweet but very emotionally damaged kitty. He’s been on Rescue Remedy for a week now, recognizes his other 3 cat buddies, doesn’t cower, hide, hiss or growl when someone comes near–these and severe anxiety were results of the move. But he is also night and day different already on issues we worked hard on for three years. I know cats, I know how they communicate with each other, and as I said, I’ve been the “expert” at every rescue I’ve worked with for 2 decades when it came to the maladjusted or problem cats. I hate to eat crow when it comes to this Rescue Remedy stuff because I have no explanation why it should or does make such a huge difference for my cat, but it does. Please don’t throw it out as nonsense.
Unfortunately, anecdotes like this are far more emotionally persuasive than they are reliable. Using this kind of approach, there is no treatment ever used that doesn’t work for somebody. For thousands of years, we relied on trial-and-error, and we accomplished very little in terms of improving health and life expectancy. Using science instead has reduced suffering and death tremendously, but the benefits require accepting that our personal experiences can’t be trusted and often don’t mean what we think they mean. Here are some more detailed discussions of why, along with a relevant bit of humor:
Why Anecdotes Can’t Be Trusted
@Rebecca Koole ,
Moving, relocating are stressful for all cats – Rescue Remedy most likely didn’t do a thing for Felix. I suspect it was merely time and adjustment, and your one-on-one attention. Or, a possible large percentage of diluted brandy in the rescue remedy (if they still include that). If there is actually brandy or any alcohol base in the product you’re using, please cease it’s use – it’s toxic to the liver among other health issues.
https://www.ncbi.nlm.nih.gov/pubmed/12635462
and…
https://www.ncbi.nlm.nih.gov/pubmed/20734279
I have 2 French bull dogs (female)one is an angel! Which is attack every day by the older 8 year old Gina. It is jealousy issue. My daughter and 2 grand daughters all live together. She wants all the attention!! Lucy the sweet one has tried submission but did not work!!! I am just LOST at what to do!!! We have to rip them apart and put Gina in crate and cover. I would appreciate any help!
Wow! I am shocked at the number of people who seem to be so invested in this product having worked that they get worked up when they’re told there is zero scientific evidence for this product being the thing that actually made a difference! Makes me wonder how many of these commenters may be paid “reviewers”. I’m curious if you looked at the IP addresses of those who commented for some similarities.
Nonetheless, I just wanted to say I very much appreciate this article. I was trying to figure out what made up the “pheromone analogue” and there wasn’t a single article I could find until yours popped up buried in the results.
Thanks for doing the good work of a good skeptic and scientist. It’s appreciated.
astrobiosociety.org/category/pheromones/ this site says it gets paid to review human pheromones.
I would like to see a paid for review by a cat.” My owner sprayed Feliway, I walked by the chair, thought about giving it a squirt, resisted, and then my owner,who was watching me, gave me a treat made in China. “
I think it is odd to dismiss Rescue Remedy is such. way. I used it on my cat during a cross country road trip, he was in the front of a haul with my husband and my dog from Montana to Eastern Canada. He was a mess, meowing and throwing up for the first day. Then I gave my cat Rescue Remedy (for pets, no alcohol) and he slept the whole way after that. It took days, and it was not a fun trip for the humans, I wish I could have slept.
It is not an anecdote, it is a fact.
Actually, a story that one believes proves something when it doesn’t is exactly what anecdote is. That is literally what the word means, and unfortunately such anecdotes don’t prove medical treatments are effective.
Here is more about why anecdotes don’t tell us the real story.
Why Anecdotes Can’t Be Trusted
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Thanks so much for this article! I was wondering if there was any update to the evidence given that it’s been a decade since the review was published? My vet has recommended Adaptil (DAP) for my senior dog who’s likely in the early stages of dementia – she’s recently become reactive and anxious specifically around one of our other dogs, but I’m skeptical of this option vs other medications given the lack of evidence that I can find. I’d love your (non-diagnostic!) thoughts on any potential changes in the evidence that might be directing my vet’s recommendation, or if I should be looking to other options for mitigation (besides the behavioral training and separation ones we already do!)
I have written several subsequent posts reviewing updates to the evidence. No overall change in the conclusions, though.
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