Cynophobia

Cynophobia (sī'nə-fō'bē-ə, from the κύων, kýōn, "dog" and φόβος, phóbos, "fear") is the abnormal fear of dogs. Cynophobia is classified as a specific phobia, under the subtype "animal phobias". According to Dr. Timothy O. Rentz of the Laboratory for the Study of Anxiety Disorders at the University of Texas, animal phobias are among the most common of the specific phobias and 36% of patients who seek treatment report being afraid of dogs or cats. Although snakes and spiders are more common animal phobias, cynophobia is especially debilitating because of the high prevalence of dogs in the United States (estimated at over 62 million in 2003). The Diagnostic and Statistical Manual of Mental Disorders (DSM-IV-TR) reports that only 12% to 30% of those suffering from a specific phobia will seek treatment. Following is an exploration of the diagnosis, etiology and treatments involved in cynophobia.

Diagnosis
The DSM-IV-TR provides the following criteria for the diagnosis of a specific phobia:
 * the persistent fear of an object or situation
 * exposure to the feared object provokes an immediate anxiety response
 * adult patients recognize that the fear is excessive, unreasonable or irrational (this is not always the case with children)
 * exposure to the feared object is most often avoided altogether or is endured with dread
 * the fear interferes significantly with daily activities (social, familial, occupational, etc.)
 * minor patients (those under the age of 18) have symptoms lasting for at least six months
 * anxiety, panic attacks or avoidance cannot be accounted for by another mental disorder

The book Phobias defines a panic attack as "a sudden terror lasting at least a few minutes with typical manifestations of intense fear". These manifestations may include palpitations, sweating, trembling, difficulty breathing, the urge to escape, faintness or dizziness, dry mouth, nausea and/or several other symptoms. As with other specific phobias, patients suffering from cynophobia may display a wide range of these reactions when confronted with a live dog or even when thinking about or presented with an image (static or filmed) of a dog. Furthermore, classic avoidance behavior is also common and may include staying away from areas where dogs might be (i.e., a park), crossing the street to avoid a dog, or avoiding the homes of friends and/or family who own a dog.

Age
Drs. Timothy J. Bruce and William C. Sanderson, in their book Specific Phobias, concluded that the age of onset for animal phobias is usually early childhood, between the ages of five and nine. A study done in South Africa by Drs. Willem A. Hoffmann and Lourens H. Human further confirms this conclusion for patients suffering from cynophobia and additionally found dog phobia developing as late as age 20.

Gender
Drs. Bruce and Sanderson also state that animal phobias are more common in females than males. Furthermore, Dr. B.K. Wiederhold, a psychiatrist investigating virtual reality therapy as a possible method of therapy for anxiety disorders, goes on to provide data that although prevalent in both men and women, 75% to 90% of patients reporting specific phobias of the animal subtype are women.

Acquisition
A current theory for fear acquisition presented by Dr. S. Rachman in 1977 maintains that there are three conditions by which fear is developed. These include direct personal experience, observational experience, and informational or instructional experience. For example, direct personal experience consists of having a personal negative encounter with a dog such as being bitten. In contrast, seeing a friend attacked by a dog and thus developing a fear of dogs would be observational experience. Whereas both of these types of experiences involves a live dog, informational or instructional experience simply includes being told directly or indirectly (i.e., information read in a book, film, parental cues such as avoidance or dislike, etc.) that dogs are to be feared.

A study was conducted at the State University of New York by Dr. Peter A. DiNardo, et. al., to distinguish the significance of these three conditions upon the development of cynophobia. Thirty-seven women ages 18 to 21 were first screened into two groups: fearful of dogs and non-fearful of dogs. Next, each woman was given a questionnaire which asked if she had ever had a frightening and/or painful confrontation with a dog, what her expectation was upon encountering a dog (pain, fear, etc.), and subjectively, what was the probability of that expectation actually occurring. The results indicated that, while non-fearful subjects had a different expectation of what would happen when encountering a dog, painful experiences with dogs were common among both groups; therefore, the study concluded that other factors must effect whether or not these painful experiences will develop into dog phobia.

Although Rachman's theory is the accepted model of fear acquisition, cases of cynophobia have been cited in which none of these three causes apply to the patient. In a speech given at the 25th Annual Meeting of the Society for Psychophysiological Research, Dr. Arne Öhman proposed that animal fears in particular are likely to be an evolutionary remnant of the necessity "to escape and to avoid becoming the prey of predators". Furthermore, in his book Overcoming Animal/Insect Phobias, Dr. Martin Antony suggests that in the absence of Rachman's three causes, providing that the patient's memory is sound, biological factors may be a fourth cause of fear acquisition—meaning that the fear is inherited or is a throwback to an earlier genetic defense mechanism. In any case, these causes may in actuality be a generalization of a complicated blend of both learning and genetics.

Treatment
The most common methods for the treatment of specific phobias are systematic desensitization and in vivo or exposure therapy.

Systematic desensitization therapy
Systematic desensitization therapy was introduced by Joseph Wolpe in 1958 and employs relaxation techniques with imagined situations. In a controlled environment, usually the therapist's office, the patient will be instructed to visualize a threatening situation (i.e., being in the same room with a dog). After determining the patient's anxiety level, the therapist then coaches the patient in breathing exercises and relaxation techniques in order to reduce their anxiety to a normal level. The therapy continues until the imagined situation no longer provokes an anxious response.

This method was utilized in the above mentioned study done by Drs. Hoffmann and Human whereby twelve female students at the Arcadia campus of Technikon Pretoria College in South Africa were found to possess symptoms of cynophobia. These twelve students were provided with systematic desensitization therapy one hour per week for five to seven weeks; after eight months, the students were contacted again to evaluate the effectiveness of the therapy. Final results indicated the study was fairly successful with 75% of the participants showing significant improvement eight months after the study.

However, in his book, Virtual Reality Therapy for Anxiety Disorders, Dr. Wiederhold questions the effectiveness of systematic desensitization as the intensity of the perceived threat is reliant on the patient's imagination and could therefore produce a false response in regards to the patient's level of anxiety. His research into recent technological developments has made it possible to integrate virtual reality into systematic desensitization therapy in order to accurately recreate the threatening situation. At the time of publication, there had been no studies done to determine its effectiveness.

In vivo or exposure therapy
In vivo or exposure therapy is considered the most effective treatment for cynophobia and involves systematic and prolonged exposure to a dog until the patient is able to experience the situation without an adverse response. This therapy can be conducted over several sessions or, as Dr. Lars-Göran Öst showed in a study done in 1988, can be done in a single multi-hour session. This study utilized 20 female patients suffering from various specific phobias and ranging in age from 16 to 44. Patients were each provided with an individual therapy session in which Dr. Öst combined exposure therapy with modeling (where another person demonstrates how to interact with the feared object) to reduce or completely cure the phobia. As each patient was gradually exposed to the feared stimulus, she was encouraged to approach and finally interact with it as her anxiety decreased, concluding the session when fear had been reduced by 50% or completely eliminated. Once the session was concluded, the patient was then to continue interaction with the feared object on her own to reinforce what had been learned in the therapy session. Dr. Öst's results were collected over a seven-year period and concluded that "90% of the patients were much improved or completely recovered after a mean of 2.1 hours of therapy".

Self-help treatment
Although most commonly done with the help of a therapist in a professional setting, exposure therapy is also possible as a self-help treatment. First, the patient is advised to enlist the help of an assistant who can help set-up the exposure environment, assist in handling the dog during sessions, and demonstrate modeling behaviors. This should also be someone who the patient trusts implicitly and who has no fear of dogs. Then, the patient compiles a hierarchy of fear provoking situations based on their rating of each situation. For example, on a scale from 0 to 100, a patient may feel that looking at photos of dogs may only cause a fear response of 50, however, petting a dog's head may cause of fear response of 100. This list of situations is then put into order from least fearful (looking at dog photos) to most fearful (petting a dog's head) and the assistant helps the patient to identify common elements that contribute to the fear (i.e., size of the dog, color, how it moves, noise, whether or not it is restrained, etc.). Next, the assistant helps the patient recreate the least fearful situation in a safe, controlled environment, continuing until the patient has had an opportunity to allow the fear to subside thus reinforcing the realization that the fear is unfounded. Once a situation has been mastered, the next fearful situation is recreated and the process is repeated until all the situations in the hierarchy have been experienced.

Recovery timeframe and maintenance
Whether utilizing systematic desensitization therapy or exposure therapy, several factors will determine how many sessions will be required to completely remove the phobia; however, some studies (such as a follow-up study done by Dr. Öst in 1996) have shown that those who overcome their phobia are usually able to maintain the improvement over the long-term. As avoidance contributes to the perpetuation of the phobia, constant, yet safe, real world interaction is recommended during and after therapy in order to reinforce positive exposure to the animal.