Behavior, Expectation, and the Meaning of “Effective”

This is a guest post from an author who I hope will become a regular contributer. I’ll let her introduce herself:

“Kyzyl is a Ph.D. candidate in biology at a public university on the west coast and a member of the Association of Pet Dog Trainers.  She has been involved in dog training since childhood and participates in several dog sports including nose work, agility, rally, obedience, and herding with her border collie.”

Recently, I received a call from a woman who had adopted a pit bull mix puppy several months earlier for help with the dog’s many developing behavior problems which were driving the woman quite batty.  The puppy, Ziggy (not her real name), exhibited the typical “cute” puppy behaviors of jumping up and mouthing for attention, which now at 4.5 months old and 35 pounds, had become potentially dangerous for the woman’s elderly mother.  In addition, Ziggy had developed a taste for her mother’s lunch, taken right off her plate, and would leave ‘surprises’ in the form of feces and urine in different rooms of the house. 

I listened to her concerns with the dog over the phone, reassured her that these were all solvable problems, and talked about management and training plans.  When I showed up at her home two days later, the first thing she said to me was, “I think that Ziggy must have overheard our conversation on the phone, because ever since we talked, she hasn’t had any accidents and has been much more cooperative! I’m so relieved!”  I explained to her that dogs were incredibly sensitive to our moods and body language, and just the expectation that help was coming was probably enough to make her, and hence the dog, relax and start getting along a bit better.

Now imagine the same scenario, except when scheduling the appointment I had told Ziggy’s owner to give her a certain homeopathic remedy that would start to relieve stress and help cure behavior problems along with management and training.  If the same result occurred, what would have the improvement been attributed to: the owner’s expectation of relief and the dog’s response to this change in her demeanor, or the action of the homeopathic ‘cure?’

Not long ago, Ziggy’s behavior would have been attributed to her being ‘dominant’ over her family.  Dogs, as dominance theory goes, are nothing more than domesticated wolves in need of a strong leader.  Behavior problems were addressed by making the dog submissive to you and every other member of the family, often by forceful means. The basis of many behavior problems were explained this way, and we know now that dominance theory is wrong.

As the result of scientific study, we know that dogs are not wolves and do not construct strict hierarchical relationships between each other or humans (neither do wild wolves, it turns out).  Today most behavior problems are explained in terms of learning theory, scientific principles derived from systematic study.  A puppy jumps to get attention (not to assert her dominance), and a fearful dog will bark and lunge to keep frightening things away (not as an effort to lead and protect the family). Dogs are now taught alternate, incompatible behaviors to solve problems, and the days of forcing dogs into submission as the result of pseudoscientific dominance theory are, thankfully, coming to an end.

Many trainers and behaviorists have joyfully embraced the modern science of dog behavior and methods of behavior modification based on positive reinforcement because they are more humane, safe, and easier than punitive training techniques often rooted dominance theory. However, some trainers also advocate for decidedly pseudoscientific complementary and alternative medicines as well.  Homeopathy and Bach Flower Essences (BFE), a near-homeopathic preparation, are often recommended for difficult to resolve behaviors such as those associated with fear, separation anxiety, and aggression (Hanson 2006, Wilde 2006).  While these trainers will swear by how effective these treatments are for some of their clients, the treatments find little support in the scientific community.  How can trainers decide what is the best mode of treatment to recommend for difficult behavior problems?

In reality, behaviors are the result of complicated and dynamic brains interacting with complicated, dynamic surroundings.  Great care must be taken to understand and minimize as many confounding factors and biases as possible to systematically study the treatments for behavioral problems.  Having expectations about a treatment outcome allows you to fool yourself into believing that a treatment is effective far easier, whether you are the owner of a dog with behavior problems or a researcher studying those effects.  For the trainer or researcher, expectations based on seeing improvement first-hand or event timing may allow you to convince yourself that patterns between events exist when in reality they do not. For the owner, the impact of expectation of treatment benefits is part of the placebo effect; a phenomenon where treatment with sugar pills, which have no active ingredient, create improvement in a dog’s symptoms.  Dog owners are often desperate to help their distressed animals or find relief from behaviors that cause them distress, and this desperation can lead to unconsciously inflating positive outcomes. Fooling yourself is extremely easy when studying complicated systems, especially when both parties have vested interests in the outcome.  

There are two methods in well-designed clinical trials that control for the effects of bias and the placebo effect: placebo-controlled and double-blinding.  Placebo controls consist of using a “sham” treatment with no active ingredient, such as sugar pills or water, in addition to a “real” treatment with the active ingredient being tested.  When neither the doctors nor the patients know who is on which treatment, it is double-blind.    Any difference between the control and treatment groups is likely due to the active ingredient in the treatment being tested, or the treatment is said to have a “specific effect” beyond what is seen with placebo treatment.  This is the definition of effective from the viewpoint of a science: a treatment that has specific, measurable effects beyond that of a placebo.

These are the same standards by which most science-based medical treatments are judged for efficacy, and ideally the standards should also apply to treatments recommended by trainers and behaviorists for behavior problems in pets.  Evidence for  complementary and alternative modalities is often either non-existent or not promising (Overall 2008), and the use of homeopathy and BFE for a variety of behavior problems are not exceptions.  The few double-blind, placebo-controlled trials which have been conducted using homeopathy to treat fear showed no difference between homeopathic preparations and placebo (Cracknell and Mills 2008), even when their owners knew their dogs were receiving the placebo (Cracknell and Mills 2011).  More well-designed trials on homeopathy use for treating fear, anxiety, and stress in people have had similarly negative results (Walach et al. 2001, Halberstein et al. 2007).  Additionally, systematic reviews of many trials using homeopathy and BFE for treating behavior problems have found no meaningful effects of these treatments beyond placebo (Thaler et al. 2009). 

Why is there inconsistency in recommending science-based behavior modification and unsupported complementary and alternative remedies? According to many professionals, these treatments are effective because dogs and owners benefit from a decrease in the unwanted behavior.  Although improvements, apparent or real, are almost certainly a result of the placebo or other non-specific effects, in many cases they make owners feel like they are doing everything they can for their struggling pets. 

While some trainers and behaviorists believe that CAM treatments represent truly effective, superior alternatives to ‘traditional’ medicine, I believe many more doubt their benefits but want to help in any way they believe is safe and might be effective.  For them, recommending something with no side effects that could produce improvement (regardless of the mechanism) to an owner who may refuse pharmaceutical intervention and wants treatment beyond behavioral modification is a reasonable decision.

However, the recommendation to use a CAM treatment has consequences.   First, knowingly recommending placebos for treating unwanted behavior is a sticky ethical issue.  Recommending a treatment that has no specific effects to owners without disclosing these facts is deceptive, even if benefits are ultimately gained through non-specific effects.  Deception damages the professionalism of a trainer or behaviorist and certainly leads to a degradation of trust between professional and client. 

Second, there are indirect consequences in recommending CAM remedies.  Many people treat these remedies as truly alternative and will shun traditional medical and behavioral treatments which are demonstrated to be effective, safe, and reliable. This might be especially problematic for behavioral problems for which behavior modification is a difficult and time-consuming endeavor or is not as effective without pharmaceutical intervention (such as severe separation anxiety and compulsive disorder). 

Third, recommending CAM therapies also reinforces the idea that these treatments are part of a legitimate healthcare regiment and will often accept other advice offered regarding healthcare, such as the rejection of vaccines, which have significant impacts on the health and well being of pets.  These consequences of suggesting CAM treatments should be seriously considered before recommending them to clients desperate for a cure.

Trainers are often the first line of professionals contacted when their pet’s behavior problems become too much to bear.  The stakes are high: many dogs are euthanized in the US for severe behavior problems, and many more are surrendered to shelters with the same ultimate result.  Most of these problems can be treated effectively with behavior modification and traditional pharmaceuticals administered by a veterinarian or veterinary behaviorist, and trainers have a responsibility to know about and explain the possible options to distressed owners. We also have a responsibility to advocate treatment plans which have a solid basis in science, treatments that rise to the same definition of effective as treatment for medical conditions.

Cracknell, N.R., and D.S. Mills. 2008. A double-blind placebo-controlled study into the efficacy of a homeopathic remedy for fear of firework noises in the dog (Canis familiaris). Vet. Journal 177, 80–88.

Cracknell, N.R. and D.S. Mills. 2011. An evaluation of owner expectation on apparent treatment effect in a blinded comparison of 2 homeopathic remedies for firework noise sensitivity in dogs. J. Vet. Behavior 6: 21-30.

Halberstein, R., L. DeSantis, A. Sirkin, V. Padron-Fajardo and M. Ojeda-Vaz. 2007. Healing With Bach® Flower Essences: Testing a Complementary Therapy. Comp. Health Practice Review 12: 3.

Hanson, D. 2006. An overview of the Bach Flower Essences. APDT Chronicle of the Dog. March/April issue.

Overall, K.L. and A.E. Dunham. 2009.  Homeopathy and the curse of the scientific mind. Vet. Journal 180: 141-148.

Thaler, K., A. Kaminski, A. Chapman, T. Langley, and G. Gartlehner. 2009. Bach Flower Remedies for psychological problems and pain: a systematic review. BMC Complementary and Alternative Medicine 9:16.

Walach, H., C. Rilling, and U. Engelke. 2001. Efficacy of Bach-flower remedies in test anxiety: A double-blind, placebo-controlled, randomized trial with partial crossover. Anxiety Disorders 15: 359-366.

Wilde, N. 2006. “Ch. 43: Flower Power,”  Help for Your Fearful Dog: A Step-by-Step Guide to Helping Your Dog Conquer His Fears. Phantom Publishing, 1st ed.

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8 Responses to Behavior, Expectation, and the Meaning of “Effective”

  1. v.t. says:

    Great article, hope to see more.

    I wasn’t aware that homeopathy was commonly purported as therapeutic in training specifically, although the use of BFE, (or things like Rescue Remedy) have been touted for just about every imaginable condition, including physical, mental and everything in between. BFE should be classified as homeopathy if it isn’t already, but I believe Rescue Remedy contains traces of alcohol (perhaps other substances). I know that owners use it not only for their pets, but for themselves as well. Perhaps half of those poor dogs – or their owners – are just too drunk to learn 🙁

  2. Kyzyl says:

    Thanks, v.t.!

    To my understanding, they don’t consider BFE truly homeopathic because it’s not diluted enough, but it is basically the same thing. I see it recommended all over the place for behavior problems, especially in the training circles I frequent. The APDT just recently had a webinar dedicated to CAM modalities including using BFE and homeopathy. It seems like a case of being so open-minded that your brain falls out. 🙂

  3. Rita says:

    Great stuff, look forward to more!

  4. v.t. says:

    Kyzyl (welcome, by the way!) – that was my understanding as well, maybe because there’s some trace of a plant/leaf/bud/whatever still in the mix (other than alcohol does anyone really know) – still, the claims are the same and non-effects are the same as homeopathy, I wish they would just admit it already!

  5. Yvette says:

    Two paws up…way up. Even a broken clock is right two times a day. Just because some people are convinced a treatment “worked,” does not mean we should attribute the cause to specific product or protocol without research.

  6. Sheena says:

    Can you recommend a book on training? Specifically, I’ve adopted a dog who might and might not have been blooded. I want her to socialise but I don’t want to put her, or any other dogs, at risk.

  7. skeptvet says:

    I don’t have any recommendations for training guides. Perhaps someone else will have a suggestion.

  8. Art Malernee dvm says:

    A EBM training guide ? I would like to see one for training grandchildren. Psychology and psychotherapy guides even in humans is lacking.

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