- What does trauma mean?
- Trauma and Posttraumatic Reactions in Animals
- Physiology of trauma sequelae
- Diagnosis of trauma sequelae in humans
- Therapy of trauma sequelae in humans
- Dealing with traumatized animals
- The phases of trauma therapy in dogs
- Promotion of the feeling of self-efficacy
- trauma-adapted confrontation exercises
- Sources and further literature
Animals are sentient beings and can react emotionally. They feel pain on a physical as well as on a psychological level and show defensive or avoidant reactions to correspondingly stressful stimuli. Sometimes it can be observed that the behavior in response to a stressor seems inappropriate. Some animals overreact or do not react at all. Could trauma be a reason for this? In emotionally challenging times, it is immensely important to be informed about the relevance of trauma. What is trauma? How does it manifest itself and what can be done at all to alleviate the symptoms associated with it? This raises the question of how trauma manifests itself in animals. This literature study examines findings from trauma treatment in humans as well as from animal behavior therapy. The aim is to find out what traumatized animals need, what we can concretely do for them and how we meet them.
What does trauma mean?
The term trauma is not used uniformly, it comes from the Greek and means wound. A traumatic event can be triggered by existentially threatening situations. In this case, psychological, mental, physical or emotional stressors lead to a feeling of helplessness, excessive demands and powerlessness. Depending on the extent to which this has occurred, the prerequisites of the individual and the stage of life in which it takes place, as well as on the external circumstances, the trauma may be mild or severe.
In 1991, the World Health Organization defined trauma as a "short- or long-term event or occurrence of extraordinary threat of catastrophic magnitude that would cause profound distress to almost anyone." Observing acts of violence can also be traumatizing for the observer, as a traumatic situation is characterized by a discrepancy between subjectively experienced threat to self or others and the lack of an individual coping strategy. Overstress can also lead to such an inadequate individual coping strategy. Massive stress is manifested by a racing heart, rise in blood pressure, sweating, trembling, dizziness or nausea. Amnesia, a failure to remember, may also occur. In addition to emotional reactions such as fear, anxiety, panic, helplessness, hopelessness and even fear of death, emotional numbness can also develop. In this case, the affected person no longer feels any feelings related to the situation.
Events that can lead to trauma are: traffic accidents, natural disasters, violent crimes, assaults, sexual or emotional abuse and others. They are either directly experienced, witnessed personally, affect the own person or other family members, friends or close persons, occur once or repeatedly. Accordingly, a distinction is made between traumas that occur once and multiple traumas that last over a longer period of time. Furthermore, a distinction is made between accidental, unintentional experiences such as accidents and natural disasters and intentional traumas that are deliberately caused by people, so-called relational traumas, developmental traumas and the like. Traumas that affect the relational level are often more profound and more likely to result in change or damage. In addition, traumas caused in the early phase of life are particularly hurtful and often leave deeper, psychological consequences.
Complex Posttraumatic Stress Disorder (CPTD) comprises a symptom picture that is usually caused by particularly severe, prolonged, and repetitive traumatic experiences from which escape is difficult or impossible. The diagnosis includes all the core symptoms of classic PTSD (recollection, avoidance, overexcitement) and in addition three further symptom groups are added: persistent and profound problems of emotion regulation (increased emotional reactivity, flattening of affect, violent breakthroughs), a negative self-concept (impaired self-perception such as the conviction of being inferior, inferior or worthless, feelings of guilt, feelings of shame) as well as problems in interpersonal relationships (difficulties in establishing and maintaining close relationships).
Trauma and Posttraumatic Reactions in Animals
While psychological trauma and its sequelae in humans are now extensively described, although there remains a need for research and assistance in this area, more recently the scientific community has also been addressing the issue of psychological trauma in nonhuman animals, hereafter referred to as animals for simplicity.
One difficulty in assessing trauma in animals is the application of the PTSD criteria adapted to humans. While only meeting the above criteria justifies the designation of post-traumatic stress disorder, there is a gray area that includes only isolated but still distressing symptoms, such as mild post-traumatic anxiety, psychological changes associated with anxiety such as intrusive memories, flashbacks, nightmares, and more. However, a diagnosis of PTSD in humans is only made when a person exhibits a certain number of symptoms from each of the four fairly well-defined symptom clusters over a period of time.
As described in the Diagnostic and Statistical Manual of Mental Disorders for humans, the 4 symptom clusters that distinguish PTSD from other post-traumatic mental disorders, in addition to having been exposed to a traumatic event, are as follows:
1. reliving the trauma through intrusive memories, dissociation, flashbacks, and nightmares,
2. avoidance of anything reminiscent of the traumatic event,
3. negative changes in cognition and mood,
4. hyperarousal symptoms such as hypervigilance and heightened startle response (not present before the trauma).
Because of the complexity of this classification and difficulty in applying it to animals, there is consideration of adopting the classification for children up to 6 years of age. These require fewer symptoms in each diagnostic cluster. However, one of the most important findings from the research is that most survivors of single, discrete traumatic events do not develop any form of psychopathology. People who experience even the most harrowing traumatic events are likely to experience at least brief distress but do not develop PTSD or any other post-traumatic psychiatric disorder. Recovery usually occurs over time. Only a minority of those affected develop distress and functional impairment that meet criteria for one or more psychiatric disorders. Another important development in recent years is the recognition that many people who have been exposed to PTSD have enough symptoms of PTSD to cause distress and functional impairment, but too few symptoms to meet diagnostic criteria for PTSD. In fact, research shows that the number of people who fall into this category after trauma is greater than the number who receive a diagnosis of PTSD. Accordingly, numerous researchers believe that the more appropriate term for this continuum of post-traumatic reactions is "post-traumatic stress," or PTS. In this case, PTSD would be the most severe form of PTS.
These considerations play a role when we talk about post-traumatic conditions in animals, where meeting certain PTSD diagnostic criteria is often difficult to confirm, for example, regarding flashbacks and nightmares. By simply applying the criteria for post-traumatic stress, this allows us to refer to animals experiencing PTSD without having to worry about whether they cross the diagnostic threshold for PTSD.
In veterinary medicine, based on current research, there is a strong assumption that animals experience psychological trauma. The question is whether they experience a post-traumatic stress reaction in the same way that humans do. Laboratory research on animals, which are subject to ethical questioning, postulate that animals develop symptoms similar to humans after trauma. Most animal models of PTSD rely on exposure to stressors that the victim cannot control, are unpredictable, or are both. In addition to experimental models of PTSD, some reports of naturally occurring cases of PTSD in animals have been published. However, subjective assessment of the experience, such as flashbacks, nightmares, and intrusive memories, remain unclear to researchers.
Examples of traumatic stress disorder in animals are provided by case reports, such as that of an adult she-wolf born in the wild and then held in captivity. The she-wolf subsequently exhibited generalized anxiety, avoidance behaviors, hypervigilance, agitation, and exaggerated startle responses, so much so that this was thought to resemble PTSD in humans. In another report, two female chimpanzees from a sanctuary and after a long time in captivity were used for biomedical experiments. Hereupon, they developed intense crying, self-injurious behavior, stereotyped rocking, trance-like states, ritualized arranging of each piece of food in a circle around herself/himself, sudden and unpredictable aggression, emotional instability, hypervigilance, attacking their own hand or foot as if they did not belong to her/him, self-isolation, and constant banging on the head. A diagnosis of PTSD was then made. Wild elephants also showed signs similar to PTSD, such as abnormal startle response, depression, unpredictable antisocial behavior, and hyperaggression. Other anecdotal reports describe signs of posttraumatic stress in dogs and cats after Hurricane Katrina. Severe personality and temperament changes occurred; new phobias; chronic chewing and paw licking; depression; tremors; excessive salivation; pacing; aggressive behavior; loose stools; vomiting; loss of appetite; shedding indoors; avoidance of people and twitching during sleep; indelible fear of storms; and nervousness, anxiety, or aggressive behavior in response to events reminiscent of the trauma, such as high winds, rain, or rushing water.
Chimpanzees that were separated from their mothers, socially isolated, subjected to biomedical experiments, or exposed to similar traumatic experiences also showed symptoms that researchers compared to diagnostic criteria for PTSD adapted for children. They then found that 44% of chimpanzees in sanctuaries met the alternative criteria for PTSD, compared with 0.5% of chimpanzees in the wild.
Recently, clinical signs in military working dogs have been described in the media and in some scientific reports that are very similar to signs of PTSD in humans. An estimated 5% of military dogs were observed to have extreme behavioral changes after exposure to combat and violent events in Iraq and Afghanistan. Crucial to the diagnoses was that the dogs showed no symptoms before or during deployment to war zones.
According to the study, possible causes of psychological trauma in animals that lead to severe stress and suffering include:
1. abuse - physical or emotional in nature.
2. aversive housing - as described in prolonged housing, including animal shelters
3. multiple placements - involves repeated disruption of life events and social relationships and prevents the establishment of a secure base and a sense of stability
4. hoarding (animal hoarding) - extreme stress due to competition for scarce resources
5. natural disasters - loss of home environment and social bonds, often including physical trauma
6. fights - organized dog fights with abusive treatment, training stress, severe physical injuries, usually treated by the dogs' owners without veterinary assistance
7. racing - greyhounds and racehorses that are often under severe stress
8. forced labor - e.g. some sled dogs, animals in entertainment (circus, film and television, marine animal parks) - can be stressed beyond their limits
9. service and military missions - combat and explosion missions, search and rescue missions, police missions
10. laboratory research and testing - stress from experiments designed to cause stress, and "routine" anxiety associated with laboratory husbandry and manipulations
11. physical trauma and injury - a variety of adverse physical conditions.
Recommendations for the treatment of psychological trauma in animals have not been adequately developed. There is a lack of research evidence. The diversity of trauma suggests that individualized treatment programs are likely to be more effective than a single approach to treating trauma in general. Currently, we have to rely on treating only the signs, such as fears and phobias, with standard behavioral therapy approaches. Future research would reveal which methods will work best for each type of trauma.
Physiology of trauma sequelae disorders
Considering the literature considered so far, among the possible disorders that may occur after trauma, but may also have arisen independently of trauma due to other causes, are:
- Vegetative disorders in the form of hyperexcitability (hyperarousal) and heightened startle response (not present prior to trauma)
- Flashbacks and nightmares, intrusive memories
- specific phobias
- generalized anxiety disorders (including inappropriate fear aggression)
- emotional blunting
The cause seems to be a disturbed hypothalamic-pituitary dysregulation. Fear is the dominant emotion here. In this dysregulation, a distinction between safe and unsafe situation is no longer appropriate to the real situation. Instead of normal alertness and attention, in post-traumatic stress reactions the system is always on alert. The purpose of this is to prepare for another stressful or threatening event. Sometimes almost any place is perceived as unsafe by individuals.
Accordingly, two extremes exist, the exaggerated fear response as an overreaction and the dissociation and numbing of emotions as a slackening response. To understand these two extremes of overexcitement and underexcitement, let's look at the physiological distress response.
The autonomic nervous system responds to situations judged pleasant or unpleasant either with active coping strategies such as defense or flight or with a passive coping strategy.
Between active or passive coping, there is a transitional state, the numbing response. After this, there is a lightning-fast reaction to whether the situation is being actively or passively coped with. Passive coping strategies, as they occur in trauma, include overactivation and dissociation.
Overactivation, as a stress-processing disorder, is more likely to occur with trauma that occurs later in life. Dissociation, which can be further subdivided into derealization and depersonalization, is more a sign of early traumatization.
In hyperactivation (hyperarousal), there is a strong activation of the sympathetic nervous system, resulting in increased blood pressure, increased heart rate, and accelerated breathing. Memory may be impaired by hyperarousal.
In dissociation, conscious behavioral control by the frontal brain is impaired. Survival instincts dominate, such as fight, flight, rigor mortis, and flaccidity, the latter in preparation for dying. The hippocampus, a switching point for stimuli in the brain, is flooded with stimuli. This results in impairment of storage of what has been experienced in correct spatial and temporal relation. Only memory splinters or fragments can be evoked. The release of the body's own painkillers and endorphins help to bear the unbearable. Attempts to bring the experience back to consciousness are often painful and avoided. As soon as memories of the experience are activated, there are usually distraction reactions, defensiveness, or changes in activity. People may also drift out of the present and become momentarily unresponsive.
These reactions, such as hyerarousal or dissociation, serve survival purposes. However, they can in turn promote other secondary disorders such as adjustment disorders, depression, dissociative personality disorders or borderline symptoms. On the other hand, mild forms of derealization are not uncommon in healthy individuals. After intense feelings or strong exhaustion and fatigue, also during meditation or after taking alcohol, cannabis or LSD and even after intensive sports, derealization experiences can occur in healthy people. Here, the environment is perceived as alien, lifeless and unreal. In depersonalization, on the other hand, one's own bodily sensations and feelings are perceived as not belonging to one's self, as alien. This is not caused by external circumstances (such as numbing drugs), but a spontaneous internal state.
Diagnosis of trauma sequelae in humans
An anamnestic questioning about possible triggers as well as a clinical examination for a possible diagnosis of concomitant diseases or causal diseases seems to be indispensable, both in humans and in animals. In order not to overlook other causes for the distressing symptoms and also to avoid retraumatization, the anamnesis and therapy in humans always belongs in professional hands. This also seems to make sense in animals. If there is a strong suspicion of post-traumatic stress disorder in animals due to overexcitability (hyperarousal) or behavior that reacts dissociatively to trigger stimuli, the question arises as to how these can be addressed therapeutically in animals. This will be highlighted in the following.
Therapy of trauma sequelae in humans
We know from trauma therapy in humans that it first begins with a stabilization phase. Only then does the actual therapeutic process begin through trauma-focused psychotherapy, which focuses on processing the memory of the traumatic event and/or its meaning. Therapies include cognitive trauma-focused treatment procedures, in which mental restructuring in relation to trauma-related beliefs occurs through imaginal or narrative exposure. Another trauma-focused treatment method is Eye Movement Desensitization and Reprocessing (EMDR), which leads to an associative process of processing after a structured focusing process. Both are accompanied by rhythmic movements of the therapist's hand.
Although these methods have been proven to lead to a strong reduction of symptoms in PTSD, the PTSD symptomatology does not completely regress in all affected persons. Endurance sports, mindfulness-based methods and creative therapies can be used to support the further healing process.
For Complex Post-Traumatic Stress Disorder (CPTD), psychotherapeutic treatment should include a combination of trauma-focused techniques that emphasize processing the memory of the traumatic experiences and/or their meaning, as well as techniques for emotion regulation and improving relationship dysfunction in terms of working through dysfunctional interpersonal patterns. It remains unclear how long a period of stabilization should precede exposure in an overall treatment plan. Further research is needed in this regard.
Dealing with traumatized animals
So far, there are only isolated publications on the treatment of post-traumatic stress symptoms in animals, mostly in dogs. In the last years the interest and the need seems to increase. In veterinary behavioral therapy, the measures most likely to be used so far are those that are also used for anxiety disorders, such as management modification, desensitization, counterconditioning, and also medications such as antidepressants, tranquilizers, or beta-blockers. However, behavioral veterinarians also question whether these measures are enough to help traumatized dogs? A dog with PTSD suffers not only from phobias, but from other problems. A permanently alarmed stress system, intrusions, flashbacks and loss of agency are all part of the therapy plan. Thus, techniques from human psychology are sought that can also be applied to animals.
At the beginning, the stabilization phase should be emphasized. In addition, the endangerment of humans and other animals is to be avoided by safeguarding measures (spatial separations, muzzles, ect.). Only gradually follows the relearning of problematic behaviors. Especially with traumatized animals, the training of emotions, inner resources and the development of a healthy body feeling are also part of the process. Overall, this process requires a lot of compassion, sensitivity and patience.
What role do medications play in the therapy of traumatized animals? In the process of recovery, nutritional supplements and herbal and pharmaceutical substances can be prescribed by trained professionals. In severe cases, they are often indispensable. If gradual recovery occurs, however, medications are not a permanent solution and do not replace therapy. In particular, drugs that dampen the animal's state of alertness can also slow down a learning process, since a calm but also alert state of mind is necessary for learning. If an animal poses a significant danger to itself and other animals and humans over a long period of time and even through appropriate trauma-sensitive (!) measures, it is imperative to ensure the safety of all. How to proceed then should definitely be decided with the involvement of professionals trained in trauma and animal behavioral medicine.
Sometimes recovery is not possible because the animal is permanently in contact with the perpetrator of a trauma (certain pet owner, certain veterinarian, certain husbandry conditions or the like). Then also a change of the keeping conditions and a change of place or owner can be useful for the animal.
The phases of trauma therapy in dogs
The process is divided into three phases:
- promotion of the feeling of self-efficacy
- trauma-adapted confrontation exercises
- Establishing safety: First, physical safety must be established for the dog, humans, and other animals in its vicinity so that no one is injured. In addition, for the dog's stress system to recover, a sense of psychological safety is essential. Basic needs such as sleeping, retreat, drinking, eating, loosening up must be able to be satisfied. Other unpleasant situations that lead to stimulus overload (e.g., at the dog park, vet visits, or aversive training) or even highly stimulating positive events (e.g., excessive play, high-motivation training) should be avoided during this phase.
- Development of fixed structures: Anything that is predictable brings a sense of security. This includes that the dog knows what to expect. A regular daily routine can reinforce this feeling. Even events that are important to the dog, such as feeding, approach, touch of any kind, and prompts should always be the same and therefore reliable and predictable.
- Building resilient relationship(s): Dogs and people are social creatures. The presence of a caregiver can lead to the release of the feel-good or cuddle hormone oxytocin, which reduces anxiety and provides a sense of security. A relationship becomes resilient when it is supported by clear understanding and predictability. It is therefore important for dog owners to know that the dog also clearly understands what is being communicated to it.
Promoting the feeling of self-efficacy
Self-efficacy means the inner conviction in one's own abilities. This can be supported by improving body awareness and increasing physical agility. In dogs, this can be indirectly promoted by:
- Increasing curiosity
This willingness to explore and try things out can be encouraged through games. Actively, an interesting toy or object could be left lying around. But also coincidental events can be used. If you notice that the animal independently begins to investigate something interesting, for example, the smell of other animals, this should be immediately encouraged by praise. Also climbing possibilities with the walk or to explore new ways, if this does not overtax the animal, can increase the curiosity. The animal should be relaxed or in a joyful mood when doing this.
- Increasing behavioral variety
Tense dogs often have a monotonous behavioral pattern and show little variety in facial expressions, gestures and body language. If the inner security increases, this is usually shown by an increase in different behaviors. This can be encouraged spontaneously by immediately praising newly emerging, positive behaviors. New behaviors can also be encouraged through new situations or courses, although traumatized animals in particular must not be overburdened or stressed in the process!
- Improvement of self-regulation
Exercises for relaxation are necessary here. Later, transitions between tension and relaxation are trained. If an animal can become calm and relaxed again after a stimulating exercise, this speaks for successful self-regulation. If this is successful, praise should be given immediately, which also positively reinforces self-regulation.
- Consider the limits of the animal
It is extremely important in self-efficacy exercises that the animal's limits are respected and that a "no" from the animal is taken into account. An animal should not be coaxed or forced to behave during exercises. It is important to find ways for the animal to communicate when it does not want something. Only when it learns that people can correctly interpret and also accept early signs of "no" on the part of the animal, a feeling of security, self-efficacy and trust develops in the animal. In dogs, averting the eyes or the head can also be respected, or the attempt to leave the situation. "Freezing" is also a sign of discomfort. You can gently try to figure out beforehand how the animal is communicating a "no," for example, by looking at it, talking to it, suggesting petting it, or stroking it and watching very closely for averting or refusing signals. As soon as this is noticed, the human reacts calmly and calmly by increasing the distance. The distance to the animal is thus increased. It is important that the human being accompanies this inwardly calmly and with gentle posture and, if necessary, voice, always in such a way that the tension does not continue to build up but is reduced. In this way, the animal learns that its discomfort and the signaled "no" have been understood and also accepted. If a confrontation exercise then takes place later, attention should be paid to this type of "no" and this should be answered by ending the exercise.
trauma-adapted confrontation exercises
In the therapy of traumatized animals it is especially important to avoid retraumatization. A key stimulus (trigger) can cause uncontrollable re-experiencing of feelings from the original traumatizing situation. If this occurs particularly violently, the animal can be completely overwhelmed by it and behaves as if it were back in the exact traumatic situation. This must be avoided during exercises with traumatized animals. It is therefore helpful to write down all known triggers and triggering situations. However, especially with complexly traumatized animals, this is often not completely possible. Therefore, special care should be taken during the confrontation phase and safety precautions such as muzzles or similar should be observed for the protection of all present.
The process of traumatization and the associated behavioral abnormalities are very individual depending on the dog. Therefore, behavioral veterinarians emphasize that there is no standard program for therapy. To a large extent, work should be individualized, they say.
Often traumatized animals are burdened with several phobias such as fear of noises, strange situations, certain people or some objects. Sometimes complaints and fears improve independently, as soon as the animal becomes more stable and calm. This concerns in particular the noise sensitivity. A desensitization takes place spontaneously in the normal everyday setting, favored by the inner peace of the animal. In this context, the relevance of the stabilization phase (see previous sections) should be pointed out again!
Other persistent and recurrently stressful trigger situations require trauma-sensitive training. Here, the same training methods and learning theories are used as in other behavioral therapies. However, special aspects must be taken into account:
- Resilience of the animal: Is the animal ready for the training? If overexcitement is still present, then confrontation therapy should not yet be used. Then the training should be postponed to a later time and more attention should be paid to the overexcitement.
- Safety: Triggering can occur even with well-planned training. In particular, attention should be paid to the excitation limit of the animal. This must not be exceeded. Leash, muzzle and barriers can be used for safety.
- One exercise is enough: There should only be one confrontation exercise per day and training session. This should be planned so that it can be successfully managed by the animal.
- Consider the animal's limits
As soon as the animal communicates a "no", this should be accepted and the exercise stopped. Everything happens only at the animal's pace.
- Allow and train the ability to act: Trauma is characterized by the fact that escape or attack was not possible in a potentially life-threatening situation. There was no solution and no room for agency, which is why freezing occurs. In confrontation exercises, it is therefore extremely important that the animal experiences that its own actions are effective after all. Already the acceptance of the "no" represents such a successfully mastered action. New options for action should also be encouraged and trained. It is important here to train at a level of arousal where the animal is awake, calm and responsive.
Time and patience are indispensable in the treatment and care of traumatized animals! It takes time so that the animal can develop piece by piece out of the traumatized state. This process is supported by stabilization, resource promotion and possibly by careful confrontation exercises.
All of this is done at the speed the animal needs!
Sources and further reading:
- Franklin D. McMillan (2018) Psychological Trauma in Animals, World Small Animal Veterinary Association Congress Proceedings.
- Hallgren (2020) Stress, anxiety, and aggression in dogs.
- Hense (2021) PTSD in the dog? - Therapy and training of a traumatized dog, available online 04.04.2022 at https://www.atm.de/blog/redaktionelles/ptbs-beim-hund-therapie-und-training-eines-traumatisierten-hundes
- Hildegard Nibel and Kathrin Fischer (2020) Neurogenic tremor
- Markus J. Pausch and Sven J. Matten (2018) Trauma and trauma sequelae disorder.
- Posttraumatic stress disorder S3 guideline of the German-speaking Society for Psychotraumatology (DeGPT) (lead professional society) Version: 12/19/2019.
- Zurr and Hense (2022) Effectively helping traumatized animals in small animal practice, benefit seminar for veterinarians and veterinary staff, akademie-vet (04/05/2022).