Using food in behavior therapy interventions: Applications in clinical behavioral medicine and feline mental health care
As previously explained in this chapter, diet and food intake have a role not only in general health but also in mental and emotional well-being. Specific nutrients cause changes in brain structure, chemistry, and physiology, leading to behavioral changes77. Besides the usefulness of food as a tool in veterinary behavior therapy, this understanding allowed for the production of prescription diets that are part of mental health treatments for animals, including cats78. Besides providing precursors to important mood-regulating neurotransmitters (such as tryptophan for serotonin synthesis), food ingestion regulates receptors and causes release of neurotransmitters associated with pleasure and calmness.
Overall, food is a fundamental aid in three main types of interventions commonly used in veterinary psychiatry and psychological care: the application of environmental enrichment and meeting basic behavioral needs, counterconditioning therapy, operant conditioning, and differential reinforcement of alternative behaviors. These interventions are of benefit not only to owned cats but also to cats living in shelters and laboratories79,80. The efficacy of these tools is generally related to food value81, with more palatable reinforcers leading to increased response82.
The literature citing benefits of environmental enrichment for brain health is extensive and beyond the scope of this chapter. Benefits can be externally measured and are part of assessment, treatment evaluation, and prognosis of feline patients (such as increases in behavioral diversity, presentation of normal species-specific behaviors, utilization and exploration of the environment, ability to cope with stressors, reductions in the frequency and intensity of abnormal and pathological behaviors, and decreased clinical signs of anxiety)27,52. However, benefits at the neuroanatomical and neurochemical levels are also well-known (from changes in cortical thickness, size of synaptic contacts, number of dendritic spines and dendritic branching, to increased brain weight)83.
In 2013, the American Association of Feline Practitioners and the ISFM published their Feline Environmental Needs Guidelines that recommended, among other techniques, the use of food puzzles for feline well-being84. This recommendation has been supported by several other publications and studies. Consequently, in behavioral medicine and veterinary psychiatry, environmental enrichment in the form of food toys, puzzles and games are an important aid for all feline patients regardless of their diagnoses. However, it can be particularly helpful for specific conditions such as separation anxiety disorder (e.g., by giving the cat options of rewarding and stimulating activities not related to interacting with and the presence of the owner), generalized anxiety disorder (e.g., by decreasing clinical signs of hypervigilance and arousal) and for cases of inter-cat conflict (e.g., by taking the cats’ focus away from each other and towards a rewarding and relaxing activity, which might also promote counterconditioning between cats)25,85.
Counterconditioning therapy is commonly used as part of the treatment and management of fear, phobias and other anxiety disorders. It is based on classical conditioning (i.e., learning through association) which is involved in the development of fear responses86. Classical counterconditioning does not require a specific response from the animal, but instead depends on changing an animal’s emotional or motivational state in the presence of a conditioned stimuli. Because food affects neurophysiology and neuroendocrinology and therefore the cat’s emotional state, the association of high value food and/or food toys and puzzle with specific situations and conditioned stimuli (e.g., another animal, sounds) can decrease stress, fear and anxiety (Figure 9).
Counterconditioning is ideally paired with systematic desensitization (i.e., progressive exposure) and it is tailored for every individual cat with gradual steps based on the cat’s body language, facial expression and emotional responses. A few examples of this type of therapy are to decrease fear of veterinary visits, the carrier and car rides, people, appliances and other animals87. Counterconditioning is key when integrating or re-integrating cats in a multi-cat household25,88.
Differential reinforcement of alternative behaviors (DRA) is based on both classical conditioning and operant conditioning. This type of therapy replaces dysfunctional behaviors with actions that are more appropriate for a situation. The general guidelines involve removing the reinforcers for unwanted behaviors when possible/applicable, teaching acceptable alternative behaviors in the same context, and using positive reinforcement to maintain desired behaviors long term. Again, food (especially when high value) is a powerful reward for most cats, as the changes achieved are not only external (behavioral) but also happen at a neurochemical level. When applied properly and consistently, these interventions can lead to long lasting behavioral and emotional change. This form of therapy is fundamental for the treatment and management of cats whose stress response escalates into aggression. For example, DRA is used to teach avoidance to replace or substitute threatening signals and aggression between cats88. Differential reinforcement is also effective for the treatment of obsessive-compulsive disorders, by modifying stereotypical behaviors while reinforcing other, functional responses85. Details on the use of food rewards, food puzzles and toys for veterinary mental health and behavioral care is covered extensively in the most current literature.