This article covers the hypothesized development and diagnosis of storm phobia, as well as a step-by-step, multimodal treatment approach. It also discusses the role of pain in noise aversions such as storm phobia. The treatment plan for storm phobia includes environmental management, behavior modification, and medication for immediate treatment. Additional steps for longer-term management, including taking advantage of the winter to begin systematic desensitization and counterconditioning, are also described.<\/p>\n
Take-Home Points<\/strong><\/p>\n <\/div><\/div><\/p>\n Storm phobia is a serious behavior disorder based on a maladaptive fear response that is out of proportion to the level of danger a storm poses to the individual. The resulting impact on the welfare of canine patients is profoundly negative. Some dogs sustain physical injuries such as lacerations to the face and paws and damage to teeth and gums during attempts to hide or escape. Owners are also negatively affected, often reporting sleep deprivation, financial burdens due to property destruction, and emotional suffering as they watch their dog in distress. In this way, storm phobias damage the human\u2013animal bond, increase the risk of relinquishment by the owner, and even lead to behavioral euthanasia.<\/span><\/p>\n This article provides general practitioners with information to confidently diagnose storm phobia and develop a comprehensive treatment plan that is simple enough for most owners to implement.<\/span><\/p>\n Fear is an innate emotional response that helps keep an individual safe from danger. Fear triggers a biological stress response comprising 4\u00a0integrated components: an autonomic component, a behavior component, a neuroendocrine component of the hypothalamic\u2013pituitary\u2013adrenal (HPA) axis response, and an immune component.<\/span><\/p>\n The sympathetic branch of the autonomic nervous system releases norepinephrine and epinephrine, which create an immediate physiologic response and drive behavior changes (<\/span>TABLE 1<\/b><\/span>). Cortisol release by the HPA axis aids in the immediate fight-or-flight response, although chronic or frequent stimulation can lead to medical and behavioral consequences associated with chronic stress. In this way, chronic fear not only impairs the immune system but also contributes to poor welfare.1<\/sup><\/span><\/p>\n In the wild, most fear responses are adaptive, lasting only long enough for the animal to avoid or escape a threat. When a dog cannot escape a trigger or the trigger persists frequently or for extended periods, the fear response can become prolonged and magnified. The result can be a maladaptive fear, which interferes with normal function and is a hallmark of phobias.1<\/sup> Because fear is a necessary, lifesaving emotion, it does not take many repetitions for the brain to quickly associate threatening stimuli with fear and consequent behavior via conditioning. This conditioning can lead the dog to learn that nonlethal stimuli, like thunder and other associated signs of storms, are to be feared. Once the dog has made the negative association, it becomes difficult for the brain to \u201cunlearn\u201d the associated negative stimulus.2<\/sup><\/span><\/p>\n In storm phobia, fear and its consequent stress response occur in close temporal association with the sound of thunder.3<\/sup> The response to thunder may be more intense for dogs due to their superior sense of hearing. Lightning may also induce fear, as bright flashes can cause temporary loss of vision for more than an hour.4<\/sup> Because anticipation of a threatening event can be innately lifesaving, frightened dogs are especially adept at making associations with the environmental conditions that predict an impending storm. This could explain why some dogs with storm phobia display behavioral signs of fear (TABLE<\/b><\/span><\/span>\u00a01<\/b><\/span>) before a storm begins. Contextual clues such as darkening skies, gusts of wind, the scent of ozone, barometric pressure changes, and even rain alone can induce panic in dogs before the storm arrives. Dogs with storm phobia might continue to display fearful behavior for hours to days after the storm has passed.<\/span><\/p>\n Medical conditions such as pain, endocrine disorders, cardiopulmonary disease, neurologic problems, and cognitive dysfunction syndrome can contribute to or exacerbate behavior problems.5<\/sup> Thus, it is critical to systematically work up cases of suspected storm phobia in the same manner as all medical conditions. A detailed history and thorough physical examination are essential. A CBC; serum biochemical profile; urinalysis; and endocrine testing, such as a thyroid panel, should be evaluated to help rule out underlying conditions presenting as, or exacerbating, anxiety and to assess organ function prior to prescribing medications. <\/span><\/p>\n Storm phobia is generally a straightforward diagnosis, based on the <\/span>GLOSSARY<\/b><\/span> definition. Noise aversions commonly begin to manifest as noise sensitivities. This can occur as early as 8 weeks of age, but the typical recorded median onset of phobia is around 2 years of age.7<\/sup> Breed risk associations have been made in some studies, but these often correlate with common breeds in the specific geographic location of the study. Regardless of geographic location, mixed-breed dogs are often listed among the top breeds affected by noise aversions.8,9<\/sup> Results correlating noise aversions to sex or neuter status have been inconsistent.10<\/sup><\/span><\/p>\n Noise aversion<\/strong><\/span> Encompasses the entire range of a dog\u2019s negative emotional and behavioral response(s) to noise. Noise sensitivity, noise phobia, and storm phobia can all fall into this general category. Noises that commonly trigger an aversion include thunder, fireworks, gunshots, vacuum cleaners, and loud vehicle sounds.2<\/sup><\/p>\n Noise phobia<\/strong><\/span> Maladaptive response to a variety of sounds. The response is out of proportion to the level of threat the trigger represents, and the dog remains frightened for an extended period, often described as poor recovery. Noise phobias interfere with the dog\u2019s ability to function normally and pose a significant welfare concern.<\/p>\n Storm phobia<\/strong><\/span> Maladaptive fear response specifically to storms. It is distinct from noise phobia because the dog often begins to display clinical signs consistent with fear from the appearance of contextual clues before the arrival of a storm. Not all dogs that have noise phobia have storm phobia, although many dogs with storm phobia also have noise phobia.6<\/sup><\/div><\/div>\n Musculoskeletal pain can contribute significantly to noise aversions and fears in dogs, including those with storm phobia. When the sympathetic nervous system responds to a fear-inducing trigger, muscles tense for fight or flight. Tensing muscles and joints that are already painful due to musculoskeletal disease in response to unexpected noise, such as thunder, can cause the brain to associate the noise with exacerbated physical pain.<\/span><\/p>\n One study reported that dogs with musculoskeletal pain were more likely to present with fear occurring in the presence of a wider range of sounds and environments and to avoid other dogs.11<\/sup> The researchers also noted that dogs with concurrently diagnosed musculoskeletal pain were identified at a later age (mean age, 6.5 years) than dogs without identified musculoskeletal pain (fear identified at a mean age of 2 years, 8 months).11<\/sup> Although the study was small, it highlights the importance of evaluating for subtle signs of musculoskeletal pain in dogs older than 6 years presenting for noise aversion. Treating the inciting cause of pain along with the behavior complaint could very well improve noise aversion and reduce generalization to fear of other noise stimuli.10-13<\/sup><\/span><\/p>\n Noise phobia, storm phobia, confinement distress, and separation anxiety are often comorbid behavioral conditions.2<\/sup> There is evidence that the occurrence of 1\u00a0problem affects the likelihood of the occurrence of others.14<\/sup> However, this finding is not consistent among all studies.5,8,15<\/sup> Because of the canine biologic stress response (TABLE<\/b><\/span><\/span>\u00a01<\/b><\/span>), many of the clinical signs owners report for noise phobia, separation anxiety, and storm phobia are the same, making it difficult to discern which problem is the inciting cause.2,14<\/sup><\/span><\/p>\n Accurate diagnosis of storm phobia relies on asking specific history questions about the timing of the dog\u2019s behavior surrounding noises and storms and during the owner\u2019s presence and absence. Reviewing video recordings of the dog when it is alone during noise events and without them will help discern if separation anxiety is also present. <\/span><\/p>\n To be effective, treatment must address all comorbid conditions, which may make it complex.16<\/sup> Treatment of these more complicated cases can often benefit from the guidance of a board-certified veterinary behavior specialist (<\/span>dacvb.org<\/span>).<\/span><\/p>\n Treatment of storm phobia aims to change the dog\u2019s emotional state during storms; to teach the dog more adaptive coping strategies during the event; and, long-term, to teach the dog to pay less attention to stimuli associated with the storm. To accomplish this, the dog\u2019s environment must be adapted to reduce visual and auditory stimuli associated with storms, behavior modification exercises must be implemented, and medications often need to be prescribed to address the fear-induced stress response. <\/span><\/p>\n Treatment plans during storm season differ from those during nonstorm season. Immediate treatment during storm season includes managing the environment to reduce trigger exposure, behavior modification in the form of counterconditioning, and fast-acting psychopharmaceuticals. However, additional treatment steps can be added outside of storm season to help prevent recrudescence in the spring. These include (systematic) desensitization and counterconditioning (DSCC) and, often, longer-term antidepressant medications.14<\/sup> <\/span><\/p>\n The steps below follow a commonly utilized 5-step treatment plan.17<\/sup><\/span><\/p>\n Step 1.<\/b><\/span> Trigger Avoidance<\/b><\/p>\n Avoiding triggers enhances safety, reduces stress for dogs and their owners, and helps prevent the development of undesirable associations. During storm season, since exposure is unpredictable and often unavoidable, the focus is on modifying the environment to reduce sensory input from the storm. This can be accomplished by creating a \u201csafe spot\u201d or modifying the dog\u2019s preferred hiding location. The goal is to create a calm, secure environment that minimizes exposure to storm-related sights and sounds. To accomplish this, the owner can block the sight of lightning flashes and the sound of thunder by utilizing increased lighting; adding curtains, blankets, or covers; and adding ambient sound (see <\/span>Step 3 <\/b><\/span>for more details).<\/span><\/p>\n Step 2.<\/b><\/span> Relationship Building <\/b><\/p>\n Consistent, positive interactions and predictability are keys to building a strong human\u2013animal bond and trust between dogs and their owners. However, it is very natural for owners to be frustrated when a frightened dog keeps them up at night or destroys property, and it is common for them to try to control the dog through punishment, use of aversive tools (e.g., shock collars), and negative interactions (e.g., yelling at the dog). These actions can intensify the fear surrounding storms, as the dog will learn that storms also predict punishment.18<\/sup> Therefore, although the situation is challenging, the owners must not take their frustration out on the dog.<\/span><\/p>\n\n
The Role of Fear<\/h2>\n
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<\/a><\/p>\nDiagnosing Storm Phobia<\/h2>\n
Signalment<\/h3>\n
The Role of Pain<\/h3>\n
Comorbidities<\/h3>\n
The 5 Steps of Treatment<\/h2>\n
Immediate Treatment During Storm Season<\/h3>\n