Keep Calm and Carry On - take home messages from our annual conference

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Dr Anne McBride – What is calmness and why do we want it?
The presentation focused on the fact that any ‘Behaviour Modification Plan/Training Plan’ (BMP/TP) are only as good as their implementation – so we need to empower the owner/handler, taking into account their physical and mental capabilities as well as those of the animal. Optimal conditions for learning and performance include calmness – we need to make sure our human clients are in position to give their best performance.
STRESS = a condition resulting from perceived discrepancy and resource availability - to which individuals respond differently, and even 1 person may respond differently at different times
Sensitisation is evolutionarily important as it allows you to respond to any stimulus more vigorously
·         Temperature, play, exercise, pressure on the bladder or anal sphincter, isolation, being in lurve, crowds/social groups, hunger/thirst, pain, sex/anticipating sex, biological drives, perceived/real threats to safety, lack of sleep, fear of failure, uncomfortable floors/chairs/bed,
·         Under-stimulation can be as stressful as over-stimulation
·         NOVELTY – in terms of situation and learning – is a major bio-sensitive stressor
Potential behavioural responses of our clients (the owners/handlers) to stress:
·         Negative emotions
·         Insomnia, irritability, risk-taking
·         Impaired cognitive function, memory reduction
·         Maladaptive disorders – physiological impact
Factors influencing susceptibility to stress:
·         Genetic influence
·         Personality types
·         Lifestyle events/experiences
·         Learned coping strategies
·         Beliefs about stressors
·         Resilience
·         Social support network
·         Management of expectations
·         Our state of arousal
The individual themselves fuels the stressor – we need to help our clients regulate their emotions.
Factors effecting learning:
·         Inspirations
·         Social expectations
·         Place/time in life
·         Attitudes – of family and friends
·         External worries – money, family illness
·         Physical health
The client’s fears, anxiety, frustration about their animal are all valid and important, however may result in poor choices should the client remain highly aroused – so what can help to keep them calm?
Minimising stress in the client (Maslow’s hierarchy of needs):
·         Safety – physiologically calm and secure environment
·         Attachment – need to belong, be respected, affirmation
·         Esteem – the need for confidence, to feel that they can succeed
·         Cognitive – provide knowledge and understanding
·         Aesthetic – the need for order and beauty, to see the achievable goal and appreciate steps towards it
We can help clients by being respectful, empathetic, giving unconditional positive regard, being congruent, giving honest and clear explanations and realistic prognoses, and providing all relevant information (eg: we will be working outside so wear sensible clothing) – BECAUSE WE NEED TO ESTABLISH A TRUSTING RELATIONSHIP IN ORDER TO HELP THE ANIMAL
·         Adapting the BMP/TP for each individual within the household will help – as different care providers might have different concerns and abilities
·         Imaginary role play is useful – allows owners/handlers to practice and gain kinaesthetic muscle memory and understanding of tasks before introducing to the animal
·         Rehearsal in a safe situation empowers owners/handlers
·         Be ambitiously realistic for yourself and others
·         Don’t be limited by stimuli you find stressful
Graham Thompson – Practical options for managing arousal and encouraging calm behaviour in dogs
Common problems seen by behaviour counsellors include attention-seeking, rehearsed barking at targets passing the house, reactivity to fear and frustration – which might involve chasing/barking/chewing/stereotypies and even more stressed owners!
Outcomes following examination of the dog’s wants/needs (useful summary in J. Serpell’s ‘The Domestic Dog’):
·         Crepuscular (active morning/evening)
·         Foraging v rest – foraging is conducted in cooler times of the day (dawn/dusk) where foliage availability increases activity, resting generally occurs during middle of day
·         Hunting/play/exercise – hunting and play are similarly motivated, thwarted hunting is stressful, running increases neuron growth, play post-training improves learning and memory
So an ENRICHING MORNING WALK, involving opportunities to forage, run and play, rather than a purely functional walk for toileting purposes only, is valuable - however some owners might find this difficult to fit into working lifestyles.
-          Some dogs can cope with shift working owners and a potentially inconsistent routine however other dogs may become increasingly frustrated by lack of structure and regularity
-          Inconsistency is a big challenge for dogs that can’t cope with flexible activity v rest times
-          Establishing a plan for activity v calm periods is necessary and this should be agreed amongst the whole family/household
-          Examine the environment/living space as it might be very difficult for some households to manage a dog settling in a different room (if open plan space etc) so you may need to advise on the use of child-gates/pens for example
-          Access to the garden might be over-stimulating for some dogs
-          Windows might be over-stimulating as allow dog to continue being aroused – frost as necessary or block access
-          TV – might need to block visual/audio access if this is over-stimulating
-          Consider location of dog’s bed/resting area – move into a minimally distracting environment
-          Actively teaching a dog how to rest and cope without attention/interaction is vitally important
The calming effect of play – we can use play as an aid to creating calmness overall if we’re careful about how we do this:
·         Bonding with owner – dogs who play with owners remain closer to them
·         Finding the ‘appropriate game for the individual is important’ as dogs have preferences
·         Fetch games – played at the start of a walk can relax a dog for the remainder of the walk
·         Find it games using ‘dropped toys or food trails’ – mentally tiring, begin with short sessions
·         Find it games – making increasingly challenging and creative, especially where access to land is difficult, this also makes it easy for owners but not as easy as simply scatter feeding to give the dog some mental stimulation
-          snuffle mats
-          puzzle toys
-          floating/submerged items
-          buried items
-          hidden behind barriers
-          under mats/pots etc
-          teaching specific/named items
·         Stuff it games – (eg: stuffed kongs) dissecting and chewing is natural for dogs, novel flavour is a motivator so have daily variation, can be frozen in readiness
·         Mind it games – training for mental stimulation
-          need to be careful as we might see frustration initially, we need to prepare owners and teach them how to train (markers, timing, consistency, environmental preparation…)
-          need to build in an expectation that ‘waiting for a reward is normal’ so to build in frustration control with distractions… can be achieved by counting in seconds before rewarding so dog is learning delayed gratification, patience, calmness and control
·         Balance games – offer ability for dog to learn slow control
-          In humans, yoga/pilates/tai chi etc,
-           all improve mental concentration
-          Flexibility, co-ordination, control, balance – dogs can be taught to follow slow movements
-          Natural obstacles/parkour – also increases confidence
If we can understand dogs better we can manage activities better, promote relaxation and self-control and provide the basis for training/behaviour programmes.
Caroline Warnes – Take a Chill Pill: Calming drugs, diets and supplements
Delay in using medication can prolong suffering. Where this might be due to owner-resistance we need to counsel effectively so that the vet – behaviour counsellor – owner become one team in providing appropriate support for the animal.
Drugs can speed up responses to BMP/TPs and improve quality of life, reducing the risk of euthanasia and risk to owner but are not a quick fix and must be used alongside a BMP/TP.
Assessing evidence of efficacy for drugs, supplements and diets:
                                                                                                                                                                 > meta-analysis
                > randomised, controlled trial   
> controlled trial
                                                                                > cohort study  
> case report
                           > Opinion/consensus report           
The lower-down on the staircase = the greater the risk that any beneficial effect was influenced by other factors such as chance or placebo-effect.
Gold-standard = randomised, double-blinded placebo-controlled trial – as increases chances that any findings are truly due to effect of the drug under test conditions.
Calming Supplements:
·         lots of varieties available BUT very limited peer-reviewed evidence
·         generally L-tryptophan, L-theanine led
Calming Diets:
·         only small studies available which focus on levels of receptors in blood and brain but not how this then translated into observed behavioural response
·         generally L-tryptophan, L-theanine led
Calming supplements/diets could be beneficial in mild over-arousal cases where there is a strong contraindication for using drugs – but always alongside a BMP/TP.
Calming Drugs:
Why use calming drugs?
·         Prolonged/frequent over-arousal leads to behaviour problems and inability to learn
·         Physiological effects of prolonged stressors, maladaptive diseases
·         Risk of animal being punished/rehomed/euthanised and the breakdown of the human-animal bond
·         Difficulty in controlling triggers causing arousal eg: environment/location, generalisation of fear/anxiety to a variety of everyday stimuli, sensitisation => no level below threshold for coping
·         Reactive dog-dog or dog-human aggression issues where generalisation is wide and distance of onset lengthy – drug use may help make a difference between an owner managing or not
·         Triggers may not be obvious or may be internal
·         Generalised anxiety
·         Some abnormal repetitive behaviours might have become self-reinforcing so trigger is no longer required
Calming drugs can improve welfare, reduce anxiety, speed up learning and potentially enhance learning through activation of long-term potentiation, as well as motivate owners to start and continue with the behaviour modification and training plan (BMP/TP).
·         must ONLY be prescribed by vets
·         contraindications must be understood
·         prescribing cascade must be adhered to
Action of behavioural medicine:
·         aimed at reducing arousal associated with anxiety, fear or frustration
·         achieving calmness without sedation to facilitate learning of more appropriate behaviour
·         most drugs target noradrenaline, Gamma-Amino-Butyric-Acid and/or serotonin
·         can agonise neurotransmission
·         can antagonise neurotransmission
·         can block reuptake
·         can inhibit monoamine oxidase breakdown
Understanding the influence of drugs on neurotransmission to predict their effect on behaviour
Noradrenaline (NA)
-          (when the brain - locus coeruleus- is stimulated) NA increases arousal, triggering the animal to be vigilant and pay attention to stimuli
-          NA plays an important role in memory formation, learning and mood regulation
Drugs that reduce NA
-          Tend to lower arousal
-          Can have a range of effects from reducing anxiety to causing sedation
-          Tend to reduce pain perception, cause muscle relaxation and may have cardiovascular effects including lowering heart rate
Drugs that increase NA
-          Tend to heighten arousal and elevate mood
-          Some drugs used to reduce fear and anxiety in dogs also have some NA-increasing activity which should influence drug choice
Gamma-Amino-Butyric-Acid (GABA)
-          Inhibitory neurotransmitter that reduces nerve cell firing – glutamate is the main excitatory neurotransmitter in the brain
-          GABA pathways regulate many process including arousal, anxiety, muscle tension, epileptogenic activity and memory formation
Drugs that increase GABA activity
-          Will reduce arousal and depending on the degree of effect may have anxiolytic, sedative or hypnotic outcomes
-          May also reduce muscle tension, memory formation, and epileptogenic activity
-          Some classes of drugs both increase GABA activity and reduce glutamate activity (eg: barbiturates and progestins)
-          Influences many aspects of behaviour including mood, impulsivity, social tolerance, aggressive and affiliative behaviour, cognitive function, and memory
-          Individuals have genetic influences that may well influence behaviour
-          Only 1-2% of the 14 different types of serotonin receptors are found within the brain, most are found within the gut
-          Serotonin in the gut may play a hugely as yet not widely understood part in behaviour
-          We need to be careful to target the CORRECT receptors with serotonin drugs as if they act upon post-synaptic receptors they can actually INCREASE ANXIETY!
-          The most commonly used drugs have pre-synaptic effects (fluoxetine, sertraline)
ANXIETY might just be the one thing that has stopped a dog from biting – as he is too anxious to bite… we need to be aware that bites might become a risk with disinhibiting drugs!
Short-acting drugs
·         For predictable, infrequent events (eg: storms, vet visits, fireworks)
·         Can have adverse side effects eg: disinhibition, paradoxical excitement so GIVE A TEST DOSE BEFORE NEEDED
·         Effective dosing is variable
·         Not suitable for long-term use due to interference with memory
·         Potential for physiological dependency – require slow withdrawal
Alprazolam (Xanax) – onset 30-60mins, half-life 3-6hrs
Diazepam (Valium) – onset 30-60mins, half-life 5hrs
Selective alpha-2 adrenoreceptor agonist:
Dexmedetomidine oromucosal gel (Sileo) – onset 30-60mins, lasts 2-3hrs, activity on pre-synaptic receptors to reduce noradrenaline activation, licensed, minimal cardiovascular effects, appears to reduce anxiety without causing sedation (Korpivaara et al 2017)
Long-acting drugs
·         Where experience is chronic and potentially unavoidable, and exposure to triggers frequent and/or highly unpredictable – fears and phobias, compulsive disorders
·         Given daily, often for periods of months to years, sometimes permanently
·         Often take 2-3 months before any observable effect
·         May eventually be possible to withdraw if desensitisation/counter-conditioning is successful – the aim is to withdraw longer-term medication
Tricyclic Antidepressants (TCAs)
Clomipramine (Clomicalm) – licensed for separation anxiety, most selective for increasing serotonin however may result in individual-specific side effects due to adrenergic, antihistamine and anticholinergic effects, due to noradrenaline-releasing effects may not necessarily be best choice for dogs showing impulsivity, poor frustration tolerance or panic
Specific Serotonin Reuptake Inhibitors
·         More specific than TCAs for increasing serotonin and have less adrenergic, antihistamine and anticholinergic effects side effects
·         Most common side effects include reduced appetite and mild sedation, with potential for some initial increased anxiety that subsequently wanes
·         Exert variable effects on other neurotransmitters including noradrenaline and dopamine – which might explain individual-specific efficacy
·         Useful where impulsivity is a feature of the behavioural response
·         None are licensed in UK
Fluoxetine – licensed in USA (not UK) for separation anxiety, most commonly used to treat a wide range of fear and anxiety-related disorders, particularly where impulsivity is a feature
Sertraline – particularly effective in panic but potential to disinhibit aggression
Fluvoxamine – less likely to disinhibit aggression but difficult to dose due to restricted tablet size
Pat Tagg – Tracking, some of the key behavioural benefits
·         Every dog that can breathe normally can track! = hedonistic effect – an inclusive and surprising/pleasing experience for the owner
·         Priority is to ensure safety – so owners are not pulled along with risk of injury to either dog or owner
·         The shape of the nasal turbinate bones is massively influential however bracycephalic breeds still have the ability to track
·         Olfactory acuity of the dog remains unknown – suggested that linked significantly to genetic influence of the individual however involves approx. 900 genes coding for different elements required for olfaction
·         Minimal evidence-based research as interference with olfacto-locomotion for measurement would interfere with the behaviour
What is tracking?
·         Part of the foraging sequence of hunting - typically nose-down, travelling-forward, following the densest part of the track
·         3 practical elements
1)      Search phase – dog locates the track < handlers should NOT interfere with dog at this point
2)      Decision phase – cost/benefit/direction is assessed eg: shall I follow it? Is it worth it?
3)      Tracking – following an odour trail, may include elements of searching and trailing (using visual information and scenting circulating air currents rather than specifically discriminating changes in ground matter)
The odour trail – as we walk our weight displaces gaseous and aqueous molecules underfoot, causes crush damage to soils/vegetation, therefore we change to patterns of emissions of volatile organic compounds and we collect and disperse debris as we go; in addition shedding skin cells and particulates from clothing. The dog is also able to identify bacterial decay and repair.
The act of sniffing and tracking
·         Sniffing is specialised breathing behaviour and it is the odour molecules themselves – molecular structure and absorbable behaviour – that influence the way dogs sniff eg: how close to the substrate/frequency/force/pressure/speed….
·         Different olfactory receptors at different locations send action potentials to the brain via the cranial nerve which is an extension of the olfactory bulb
·         Nostrils can be used independently
·         Dog can only follow track at the speed at which he can sniff – 6Hz – and this requires a level of fitness
·         Sniffing enables collection of rising volatile odour samples which the brain decodes and matches to the sample previously inhaled
·         Vomeronasal organ is there for chemosensory reception of conspecifics and non-conspecifics – dogs can detect human pheromones even though these may not fulfil a canine purpose
Tracking in behavioural modification programmes
Tracking (hunting) is a SOCIAL ACTIVITY – bridging a means to appropriate socialisation - ‘nose-down and sniffing’ could be said to be appropriate social behaviour.
·         Teaching tracking also gives owners something to do that keeps them calm and prevents inadvertent interference with the dog
·         Tracking incorporates all four of the accepted elements for developing resilience in dogs
-          occurs outdoors
-          involves locomotion
-          is safe
-          includes social support
·         There is no need for a stooge dog or a subject dog – if we have prepared the environment appropriately and tracked dogs at specific proximity from each other this does not result in antagonistic behaviour.
Puppies and young dogs
·         Ensures that an inherent, appropriate activity is captured into training regimen
·         Puppies will copy maternal foraging strategies – social element to learning
·         Tracking young puppies with adult demonstrators helps puppies to focus around other dogs
·         Very useful for dogs experiencing adolescence and maturation as dogs can learn to engage in reinforcing activity in the presence of other dogs whether gaining proximity/following/being followed as an alternative to manifestations of social anxiety
·         Appropriate provision of outlet for natural behaviour on-lead
Elderly/geriatric dogs
·         Emerging evidence relating to retention of cognitive function and lifelong training opportunities
·         Anywhere from 11y onwards, particularly after 13y, the olfactory neurones are not replaced and olfaction becomes a more challenging and slower process – coupled with age-related neurological changes, an elderly dog will need to spend longer examining odour
·         The anticipation created by the potential to follow a track does not diminish with age – motivation to move may result
·         Techniques are available to aid physical/mental impairment
·         Tracking can become a readily achievable densely packed physical/mental exercise - particularly where space or time are in short supply
·         Take care not to have an elderly dog waiting for prolonged periods and only track if the dog wants to
When the dog is engaged in exploratory olfactory activity, dopamine levels are high which feels good and dogs will work hard to maintain this. The act of tracking is reinforcing in itself.
Toni Shelbourne – Tellington Ttouch Training: the perfect training partner to preventing, managing and reducing over-arousal in dogs
·         Ttouch is NOT a therapy - it is a training method
·         Can enhance Behaviour Modification Programmes/Training Programmes (BMP/TPs) and gives owners a practical activity to engage in
·         Influences parasympathetic nervous system via patent effect on neural pathways
·         Stimulates the tactile, proprioceptive and vestibular systems
·         Promotes co-operation, co-ordination and concentration
·         Re-programmes muscle memory and influences cellular awareness and function
·         Lowered stress levels – powerful influence on response and mood
·         Our bodies remind us to be a little bit frightened in order to keep ourselves safe…
Influences on the body
·         A pressured touch = calming and comforting, just skin-deep not muscular
·         Stimulates neurotransmitters to release endorphins dopamine and serotonin
·         Non-habitual movements = enhance learning and memory
·         Allow the animal to remain ‘rational’ and make own choices rather than exploding
·         Shifting the animal from a state of arousal or fear to a state of calmness
Posture effects behaviour – physical/mental/emotional – if one is out they’re all out…
·         Being out of balance – we hold tension within our bodies and become stuck in fear responses
·         Consider:
-          How the animal moves
-          Weight-bearing when standing
-          Nail and pad wear
-          Calming signs
-          Self-carriage
-          Muscle spasms
Tension Patterns appear as:
·         Skin temperature changes
·         Areas where the skin feels tight
·         Areas where the animal is reluctant to be touched
·         Hair changes – as tension held within the body affects blood flow
·         Areas of scurf/dandruff
·         Muscling differences/spasms
TTouch can help with a variety of behaviour problems but also training issues such as ‘habitual pullers-on-lead’ who are just out of balance.
HIGH AROUSAL DOGS – because TTouch gives them CHOICE:
-          Begin to listen in arousing situations
-          Concentrate
-          Gain confidence
-          Offer alternative behaviours
-          Recover quicker after arousal
3 elements to TTouch
1)      Bodywork – non-habitual movements, circles/lifts/strokes, generally done slowly but needs to be speeded up in high arousal dogs as we need to meet the needs of the nervous system where its already at and then slow down, can do random Ttouches to grab dog’s attention, continually examining posture. Equipment to teach body awareness = bodywrap (portable hug/security blanket) – helps to calm down a highly-aroused dog immensely, thinking cap - a new piece of equipment which covers the head and ears but allows dog to see through, facewrap/calming band – influences mouth and head
2)      Leadwork – helps posture and balance, balance leash influences body from the chest, bringing the point of gravity back into balance. 2nd leashes and a 2nd person leading the dog can be introduced. B-lines = ropes that go just goes through the back of a harness so a dog can choose to move closer to or further from the person leading him on either side if slightly worried by people. Freedom handles – slide along lead so again dog can choose to alter distance from the person leading.
3)      Groundwork – confidence course/playground of higher learning. Moving in a non-habitual way, moving through/onto/over different surfaces. Releases dopamine and serotonin. Can be done before a walk. Can use natural obstacles when out on a walk. Can be used in close proximity to something a dog needs NOT to focus on eg: a car, another dog, a new person etc
Training sessions must be short (>5mins) with play/rest in between.
TTouch can and should be done when dogs are high-arousal situations, as well as preparing them for training BUT within threshold for coping – it can also aid dogs calming down after scary situations or times of high arousal.
Sian Ryan – Managing the madness in multi-dog households
Restoring calm
·         Audit space/routines anywhere the dogs are together (house/garden/car)
·         Prioritise flash points where dogs become over-excited or which activities/situations owners find stressful
Strategies for establishing/maintaining calmness:
NAMES (priority for introduction of a new dog into the home)
-          Each dog learns his own name and that this applies specifically to him
-          Useful for each dog to feel comfortable taking treats on close proximity to the others, for waiting calmly, for manners around food/toys/resources/attention, to avoid anxiety over potential loss of anything valued
To teach – starting in pairs with newest dog on lead or behind child-gate and distance between dogs, name the dog and feed a treat directly into his mouth. Repeat with the other dog. Move closer at both dogs’ pace – introducing any other dogs to the group as appropriate. Repeat as often as you are able. Then generalise by practising in different environments/situations. Can also implement specific stations or places for each individual dog – particularly during food preparation or potential arousing times.
To teach with food – new dog should be fed behind child-gate, or in separate room, waiting for a moment of calm behaviour before the food is placed down. Progress to a default ‘sit’ (or controlled calmness) before releasing the dog to eat. Approach dog while eating and add food to the bowl, and again once dog has finished eating – this will encourage him to remain by his own bowl. As the dog relaxes open the gate.
To teach with toys – use the same toys and offer to the ‘named dog’ when he is calm. Use a treat to reward the other dog who did not get the toy. Progress to being able to throw the toy, play tuggy with the named dog while the others remain calm.
STATIONS (if dogs are comfortable with food being thrown towards other dogs without trying to take it themselves then can work with multiple dogs present – if not then teach individual initially)
-          Use visual marker for each dog (mats on the floor)
-          Name the dog and throw a piece of food to the relevant mat
-          Repeat with all dogs, quickly enough for the dogs to keep themselves on their own mats
-          Practice first without dogs if your aim is poor!
-          If a dog leaves their mat then don’t throw a treat until they take themselves back to their specific mat – guide them by moving towards their mat yourself if you have to
-          Pick up all the mats after the session
-          Use of food toys on mats can be useful during times when prolonged calmness is required – eg: cooking or visitors
Invest in making specific behaviours rewarding right from day one. Anything which removes uncertainty and allows dog to predict environment helps to maintain calmness.
-          Establish individual sleeping areas, feeding stations etc
-          Feed in same order/same places
-          Specific places within car/furniture
-          Use food to reward calmness when attaching the lead.
-          Use a release cue when allowing off-lead so dog has to demonstrate calmness before being allowed to run free as a consequential reward.
-          Decide if you: need a group recall/will reward any dog for coming to another dog’s recall cue/you will only reward individual specific recalls > there are pros and cons to each outcome however if you decide you need a group recall you need to teach it in a way that the newest dog cannot ignore it.
‘ENOUGH CUE’ – taught as a positive interrupter this informs the dog to ‘stop whatever you’re doing and come to me for a treat’ (a recall from distractions)
-          Very specific cue for specific contexts such as play so easier to maintain 100% success
-          Tone of voice is light, non-threatening, fun
To teach – condition the word first in a minimally distracting environment where all dogs are paying attention. Say “enough” in loud, happy voice and give a treat to each dog. Repeat whenever and wherever possible. Once primed then progress to using the cue when two dogs are playing gently and at low levels of arousal. Progress to increasing arousal levels. Keep the cue very specifically play-related.
‘BIG TROUBLE’ CUE – a warning cue that interrupts behaviour by informing the dogs that if they do not respond to this cue they will be gently removed from the situation by the owner/be placed on lead as necessary. This removes the need to shout and offers the dog an opportunity to remove himself in response to the cue. It is a conditioned punisher however is useful to reinforce the body language of the dogs under harassment and to alleviate growing tension within a highly-aroused situation. It also prevents a dog rehearsing undesirable behaviour. Ownes also need to heavily reinforce appropriate choices and any decisions to move away in response to signals from the other dog rather than waiting for the owner to step in with the “big trouble” cue.
To teach – use the cue “big trouble” immediately before calmly and quietly stepping in to remove/place a dog onlead who is over-aroused/harassing another dog. Wait for everyone to be calm before releasing the removed dog and simply calmly repeat if the harassment continues.
Owners of multi-dog households
·         Can often feel overwhelmed, especially where each dog has an individual-specific need or variety of needs
·         Need to feel empowered by workable and realistic solutions not daunted by unachievable objectives
·         Likely to require frequent follow-ups to maintain momentum and understanding – once a week to begin with
·         Management strategies – would a dog-walker help? Can layouts be changed with child-gates etc to provide each dog with more space/security to reduce arousal in the short term?
·         The plan should include priorities for the family – quick wins! Once we have a plan we feel more in control – even if we never implement the plan!