remain calm and make good choices

i n t e r v i e w Fear at the Vet: Examining Risk Factors

In the second of this two-part article in their occasional interview series with animal behavior researchers, Susan Nilson and Angelica Steinker continue their conversation with Petra Edwards about her recent investigations into dogs’ experiences at the veterinary clinic in which she aims to identify ways to reduce the fear and distress commonly experienced

Based on the papers Fearful Fido: Investigating Dog Experience in the Veterinary Context and Investigating Risk Factors That Predict a Dog’s Fear During Veterinary Consultations coauthored by Adelaide, Australiabased Ph.D student Petra Edwards, the first part of this interview (see Overcoming Fear of Vet Visits, BARKS from the Guild, No‐vember 2020, pp.32‐36) focused largely on the setup at the veterinarian’s office and looked into ways how environment modification, handling by staff, an awareness by both staff and guardians of an animal’s triggers, and how prioritizing and respecting the animal’s emotional state all play a role in the levels of stress and/or fear they experience.

Now, in this second part, we expand on the conversation to discuss education, pet guardians, puppies and early learning, and canine behavior as potential contributors to fearful behavior and/or distress at the vet.

BARKS: How important is it for veterinary schools to include behavior as part of the curriculum?

Petra Edwards: I would say having an appropriate and comprehensive behavior component in a veterinary degree is vital, but I’m biased of course! I think behavior is equally important to medical knowledge (for safety and welfare, etc.), however, I’m not sure it’s more important than learning every aspect of medicine for every species they’re likely to come into contact with. It would be awesome if they could tack behavior (body language/low stress handling) on to every animal handling and clinical skills practical they have every year.

Pet Guardians

BARKS: I (SN) have seen people berate their dog for barking because he is stressed or fearful, or dragging him into the waiting room or onto the weighing scales, or telling their cat to be quiet if he is meowing continu‐ously. What can be done to educate guardians, who may be unaware, on the signs of stress in their pets?

PE: I think it would be useful for veterinary clinics to have some nice body language infographic posters up on their walls in the waiting room. These could also be referred to during puppy schools. Veterinary staff can help ameliorate that stress by moving pets into consult rooms to await the vet as soon as possible, or by triaging the waiting room in terms of behavior – asking someone to sit somewhere specific, or recommending a dog gets an extra sniffy walk outside for an few minutes while they’re waiting. We shouldn’t underestimate the power of social media. Imagecentric campaigns on understanding body language, identifying stress and appropriate responses to identifying stress/fear are invaluable in reaching and reminding people about their pet’s behavior as well.

© Petra Edwards Petra Edwards trains for cooperative care frequently with her Rottweilers Gus (pictured) and Gwen to build their mutual trust account and help ensure all parties remain calm and confident during a trip to the vet

BARKS: “According to their guardians, 41% of companion dogs displayed mild to moderate fearful behavior when examined by a veterinarian, and 14% exhibited severe or extreme fear. A similar trend was observed with dogs responding fearfully when in unfamiliar situations, including the dog’s first time at the veterinary clinic.” (Edwards et al., 2019b) ‐What can guardians do to address this?

PE: There isn’t enough research (yet) to be confident in an overall strategy to reduce stress in a veterinary context. However, being able to identify and respond to body language appropriately, identify the dog’s triggers for stress or fear at each step of the visit, nonslip mats from home, positive reinforcement training for cooperative care, using lots of reinforcers (food or toy) to help the dog remain calm and focused in the waiting room and during the examination will help.

Guardians of dogs that are experiencing severe or extreme fear in response to veterinary visits could also chat with their vets about the use of shortterm anxiety meds or sedation. I would add that, even if your dog looks as if they’re coping well now, any of the above strategies will likely help prevent any fear from developing as your dog gets older. Let’s not take good behavior for granted.

BARKS: How important is the behavior of the guardian in the context of attending the vet; was this found to have any influence on the dog’s be‐havior/emotional state?

PE: Behavior of the guardian wasn’t investigated in the above study (Edwards et al., 2019b), however Csoltova et al. (2017) found that guardians patting and interacting with their dog in a positive and supportive manner had dogs that showed fewer signs of fear than guardians who did not interact with their dog. I love this because it also beautifully discounts that myth that being kind and empathic to a fearful animal will reinforce their fear.

I believe guardian behavior (positive supportive interactions, good preparation with reinforcers, nonslip mat, arriving with enough time to allow the dog a good chance to sniff before entering the clinic, or pretraining for cooperative care), will have a very large positive impact on their dog’s behavior and emotional state within the clinic. I hope more research in this field can be done to identify the most beneficial interventions.

BARKS: What is your opinion on the guardian staying with the pet vs. the pet being taken “to the back” for tests?

PE: Unfortunately there is no peerreviewed literature on the impact of ‘taking the dog out the back’ briefly for tests on their fear or stress levels, although hospitalized isolation was found to increase stress responses (van Vonderen, Kooistra & Rjinberk, 1998; Vaisanen et al., 2005).

Personally, I would prefer that my dog stay with me for everything. I have a great trust account with my dog, we train for cooperative care frequently, and I work very hard to remain calm and confident through the entire situation. I also try to be very respectful of our veterinary care team and do my best to keep out the way. Perhaps some guardians

Csoltova et al. (2017) found that guardians patting and interacting with their dog in a positive and supportive manner had dogs that showed fewer signs of fear than guardians who did not interact with their dog.

get anxious or squeamish enough that it is better to take the dog out the back quickly for some cases, but I’m not convinced it should be the default approach. We should feel empowered to ask if we can stay, but be respectful of the response (it may be clinic policy rather than that vet’s preference). Ultimately, we are part of a care team for our dogs, so it’s important we can be honest, transparent, respectful and empathic with each other – otherwise it’s the dog that loses out.

Canine Behavior

BARKS: “Male dogs were significantly less stressed in a veterinary set‐ting than female dogs.” (Edwards et al, 2019a) – Why is this?

PE: I’m not sure to be honest. The study you refer to (Döring et al., 2009) used five overt behaviors to identify whether dogs were ‘fearful’ or not. The authors suggest it is in keeping with other research on animal behavior. This is a valuable observation to take into consideration, but I believe there is far more at play in causing fear of the vet than simply the sex of the dog.

For instance, the study we published last year found the effect size for demographics like breed or working roles to be quite small (sex wasn’t found to be a major contributing factor at all). That is, some demographics influence fear of the vet more than others, but the impact, even combined, isn’t the thing that causes it (Edwards et al., 2019).

Think of them like a small trigger (or perhaps a very distant antecedent), where in contrast – the current environment or previous experience is much more likely to have a much larger impact on a dog’s experience.

BARKS: How do the individual factors of temperament/sociability, early learning experience/background, bond with guardian, and guardian training methods play into the level of a dog’s level of fearfulness at the vet?

PE: I imagine they all play an important part – where the perfect storm combine to result in a dog that’s fearful at the vet. Science hasn’t yet caught up with how they all interact together in a veterinary setting specifically, but it might be safe to assume positive experiences, confident and calm personalities, great bonds with guardians and positive reinforcement methods would be beneficial in mitigating or preventing fear at the vet. Certainly, anecdotal evidence suggests as much.

BARKS: What about male vs. female, desexed vs. non desexed, age, size, breed – are there any obvious overriding factors that contribute levels of fearfulness at the vet?

PE: The Edwards et al. (2019b) study from a large worldwide sample identified that these factors do play a part in the extent of fear dogs (according to their guardians) display at the veterinary clinic, however the effect size was quite small (7%). This means that there is something (or multiple somethings) that are far more influential in determining the level of fear dogs display at the veterinary clinic.

BARKS: How important are a dog’s genetics to overall fearfulness, and specifically in the context of veterinary visits?

PE: There is some really interesting research into dog genetics and behavior generally happening right now. Phenotype and genotype are inextricably linked (as demonstrated by the Arctic fox experiment). More recently, McGreevy et al. (2013) found an inverse relationship between height and size, and some problem behaviors (e.g. touch sensitivity, fear, attention seeking), where problem behaviors increase as size decreases. Touch sensitivity, separation anxiety or guardian directed aggression were also found to piggyback on some of the same loci that code for small body size in dogs (Zapata et al., 2016). However, as stated above, genetics likely only play a very small part in causing a dog’s fear in a veterinary context specifically.

BARKS: Can you talk a little about single dogs vs. dogs that live in multi‐dog households in terms of the study’s findings, what influence age had on these findings, and why that might be?

PE: Single dog households were slightly more likely to have dogs that were fearful at the vet according to their guardians, in comparison to multidog homes with dogs of different ages – but the contribution to fear was incredibly small. Of the very small effect size for demographics as mentioned above, breed group, history of roles or activities, source and weight were all stronger predictors of fear.

Phenotype and genotype are inextricably linked (as demonstrated by the Arctic fox experiment). More recently, McGreevy et al. (2013) found an inverse relationship between height and size, and some problem behaviors (e.g. touch sensitivity, fear, attention seeking), where problem behaviors increase as size decreases.

© Can Stock Photo / smrm1977 A guardian’s ability to identify and respond to their dog’s body language appropriately as well as understand the dog’s triggers for stress can play an important role in the reduction of fear and/or stress experienced during a visit to the veterinarian

Perhaps there is some confidence building in the social dynamic of other dogs in the home, or perhaps guardians are more experienced with more dogs and that plays a larger part. We need to do more research on how these factors interact to know for sure, and I want to stress again, all the demographics we tested combined together only accounted for a very small proportion of the variation of fear observed. Other things like the current environment or previous experience are far more likely to have a much larger impact.

BARKS: What age group is most vulnerable in terms of having a nega‐tive vet experience?

PE: At this stage, research hasn’t identified an age at which the fear ‘starts,’ or an age at which dogs are most at risk of developing a fear of the vet. However, I imagine that a dog’s normal developmental periods are the most important. For instance, we can assume it is very important that puppies in their critical socialization period have very pleasant, confidence building experiences in the veterinary clinic and being handled, as well as the adolescent periods where dogs may be predisposed to experience things in a fearful way. However, like anything, an unlucky series of events where dogs have multiple, consecutive painful experiences at the vet may have just as big an impact if they’re adults.

Puppies

BARKS: What do you think can be most damaging to a puppy in terms of their experiences at the veterinary clinic?

PE: Godbout et al. (2007) identified a small proportion of puppies that displayed ‘extreme’ avoidance behaviors in a mock veterinary visit. Which suggests that a percentage of dogs will be fearful of the vet from the start. Other than that, we just don’t know enough about all the different factors that can influence a dog’s veterinary experience, to be able to say for sure.

I would hazard a guess that frequent and painful visits, or visits involving hospitalization (without their guardian) might be factors, but we just don’t know. In any case, we can only try to mitigate the impact of these things as life happens despite our best efforts – a preventative training plan for puppies with lots of positive, fun, safe, confidence building experiences (and even practice of short stints in crates at home or in the hospital before any planned surgeries) would likely be very beneficial.

BARKS: What do you think is the biggest risk factor for fear during a visit to the vet?

PE: I imagine that previous experience and the current environment interact to result in a greater or lesser fear response. Previous experience, because it fuels anticipation of another bad experience this time, and stressors are in the eye of the beholder – individual perception of the stressor causes the stress response, rather than any actual danger in reality. And the current experience, because things can add up quickly if the guardian or veterinary staff aren’t watching the dog closely and responding appropriately. These are educated guesses, based on what the research is suggesting right now. And it would be great if previous experience and current environment were the main factors linked with fear at the vet, because (unlike demographics) there is lots we can do to change them.

BARKS: Do you think negative vet experiences can lead to puppies learn‐ing to bite?

PE: I think there could logically be a tenuous link between fearing aspects of veterinary care like handling or restraint, or greeting strangers, and fear of those things in ‘real’ life. But that doesn’t mean that dogs that are fearful of their veterinary care are more likely to bite.

I believe, although we need more research, that the veterinary

© Can Stock Photo / famveldman Although Godbout et al. (2007) identified a small proportion of puppies that displayed ‘extreme’ avoidance behaviors during a mock veterinary visit, suggesting that a percentage of dogs will be fearful of the vet from the start, we don’t know enough about all the different factors that can influence a dog’s veterinary experience to be able to say for sure which of them may have a negative effect

context is specific enough that dogs can learn the difference, but also that there would be a proportion of dogs that are fearful of the vet and of many other things in life and may be at higher risk of aggression toward humans. However, correlation does not equal causation and I’m not sure that any aggression toward humans would occur solely because dogs are scared of their vet. n

There isn’t enough research (yet) to be confident in an overall strategy to reduce stress in a veterinary context. However, being able to identify and respond to body language appropriately, identify the dog’s triggers for stress or fear at each step of the visit, non-slip mats from home, positive reinforcement training for cooperative care, using lots of reinforcers (food or toy) to help the dog remain calm and focused in the waiting room and during the examination will help.

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Study Article References

Edwards, P.T., Smith, B.P., McArthur, M.L., & Hazel, S.J. (2019a). Fearful Fido: Investigating dog experience in the veterinary context in an effort to reduce distress. Applied Animal Behaviour Science (213) 142 Edwards, P.T., Hazel S.J., Browne, M, Serpell, J.A., McArthur, M.L., & Smith, B.P. (2019b). Investigating risk factors that predict a dog’s fear during veterinary consultations. PLoS ONE 14(7)

About Petra Edwards Petra Edwards holds the Professional Canine Trainer accreditation through the Pet Professional Accreditation Board and has a Bachelor of Science (Hons), with a specialization in animal behavior. She is also a Fear Free certified professional and has her CAP 1 and 2 qualifications in clicker training.

She has been involved in the dog training industry since she was 12, when her mother, Mim Edwards, started Adelaide Pet Dog Training. She is passionate about animal behavior and welfare and the amazing achievements and relationships that force‐free training facilitates. She is currently undertaking a Ph.D, analyzing how dogs experience veterinary clinics and looking at strategies to reduce or prevent stress.

She and her partner share their home with their Rottweilers, Gus 41) and Gwen.

References

Csoltova, E., Martineau, M., Boissy, A., & Gilbert, C. (2017). Behavioral and physiological reactions in dogs to a veterinary examination: owner-dog interactions improve canine well-being. Physiology and Behavior 177 270–281 Döring, D., Roscher, A., Scheipl, F., Kuchenhoff, H., & Erhard, M.H. (2009). Fear-related behaviour of dogs in veterinary practice. The Veterinary Journal 182 38-43 Godbout, M., Palestrini, C., Beauchamp, G., & Frank, D. (2007). Puppy behavior at the veterinary clinic: a pilot study. Journal of Veterinary Behavior: Clinical Applications and Research 2 126–135 McGreevy, P., Georgevsky, D., Carrasco, J., Valenzuela, M., Duffy, D., & Serpell, J. (2013). Dog behavior co-varies with height, bodyweight and skull shape. PLoS One 8(12) 1–7 Vaisanen, M.A.-M., Valros, A.E., Hakaoja, E., Raekallio, M.R., & Vainio, O.M. (2005). Pre-operative stress in dogs – a preliminary investigation of behavior and heart rate variability in healthy hospitalized dogs. Veterinary Anaethesia and Analgesia 32 158-167 Van Vonderen, I.K., Kooistra, H.S., & Rijnberk, A. (1998). Influence of Veterinary Care on the Urinary Corticoid: Creatinine Ratio in Dogs. Journal of Veterinary Internal Medicine 12 431-435 Zapata, I., Serpell, J., & Alvarez, C. (2016). Genetic mapping of canine fear and aggression. BMC Genomics 17 572–591 DOI: 10.1186/s12864016-2936-3

Resources

Nilson, S., & Steinker, A. (2020, November). Overcoming Fear of Vet Visits. BARKS from the Guild (45) 32-36

Susan Nilson BA (Hons) DipCABT PCBC-A is editor of BARKS from the Guild and a Reuters-trained journalist with over 10 years’ experience in print journalism in Europe, Asia and the Middle East. She also studied feline behavior at the Centre of Applied Pet Ethology (COAPE) in the United Kingdom and completed her diploma in companion animal behavior and training with COAPE in 2005. She is also an accredited professional canine behavior consultant through the Pet Professional Accreditation Board. In 2018, she co-authored Pet Training and Behavior Consulting: A Model for Raising the Bar to Protect Professionals, Pets and Their People. Angelica Steinker M.Ed PCBC-A, president and founder of Courteous Canine, Inc., has specialized in dog training methods that create “Results the Fun Way” for more than 20 years. Using consent testing and empowerment training, she and her team have successfully trained thousands of puppies and adult dogs in basic manners/obedience, trick training, problem behavior modification, agility, dock jumping and other skills, all while increasing the bond of trust between dogs and their human companions. She is also a published author in the field of dog training and agility. Her books, Agility Success: Training and Competing with Your Dog in the Winning Zone and Click and Play Agility, address the handler of the agility team and the use of clicker training techniques in the sport respectively, and emphasize the importance of playing and bonding in order to train agility behaviors to the highest level. Her newest project is on dog aggression, something she is particularly passionate about. Her current book Play Therapy for Dogs is due to be published this year and addresses how to use play to create optimum behavior change. She a former member steering committee and founding member of the Pet Professional Guild, and co-founder and former faculty of DogNostics Career College. She has been published in the Journal of Applied Companion Animal Behavior and the Journal of Veterinary Behavior, and as a regular columnist in BARKS from the Guild, the Association of Pet Dog Trainers’ Chronicle of the Dog, and Clean Run. She is also a former advisory board member and faculty at the Companion Animal Sciences Institute (CASI) and a CASI dog behavior program graduate.