In last week’s webinar with Dr Marty Becker, the founder of the Fear Free initiative, we learnt a great deal about the ways in which we can reduce Fear, Anxiety and Stress (FAS) in our patients. As rehab therapists, we’re all familiar with the reasons why it is so important to prevent and counter FAS in our treatments.
Recently, we discussed fear in our patients on our Small Animal Vetrehabbers Facebook group. Fear is obviously not something that applies in Veterinary practices only – it’s a big issue for Vetrehabbers, too.
Long-term anxiety and fear in a dog can lead to the development of chronic illnesses and behavioural challenges like aggression. Even simple separation anxiety can make life hard for both owner and dog. While not our primary role, we can help to educate and guide owners through these behavioural challenges by the example we set, and by equipping ourselves with the knowledge and skills necessary to help prevent, reduce, and retrain these behaviours.
Fear, Anxiety and Stress
Fear is an emotion that causes an animal to avoid a situation or activity that may be dangerous. This emotional response can occur whether or not the environment is truly dangerous. Anxiety is the anticipation of future danger that may be unknown, imagined or real, and can result in similar responses to fear. These could include
- increased heart rate, blood pressure and respiratory rate,
- avoidance behaviours such as hiding or aggression, and
- loss of bladder or bowel control, or the expression of the anal glands.
Stress is defined as any chemical, physical or emotional force that threatens an animal’s homeostasis. Fear, anxiety and stress (FAS) are all responses to the animal’s perception of reality. Perception is therefore our key to reducing or preventing these responses. If we change the animal’s perception of reality, creating a new association with a place or circumstance, we will reduce or eliminate FAS.
Preference and choice
A large body of research has been conducted to investigate FAS in animals and how best to address it. Along with Dr Marty Becker’s webinar, all of my information comes from Fear in the veterinary clinic: History and development of the Fear Free Initiative by Breanna Demaline.
Demaline includes a comprehensive review of the literature on fear in animals. Of all the articles she cites, those that most caught my attention were the ones that investigated preference and choice. Some puppies showed a strong preference to being assessed on the table, some preferred the ground. Some wolves preferred training, some preferred a specific environment. What the authors of these two papers concluded is that preference is individual, and that when an individual is presented with a choice, they will have a strong preference for their choice.
In a third article investigating preference, dogs preferred treats over being petted, even when their owner was the one doing the petting. So that is worth remembering! A treat will hold more power than a cuddle or some petting.
Establishing Fear Free practices
From our Small Animal Vetrehhabers discussion on Facebook, it became clear that the number one time when fear is a challenge for us is during the first consultation. The first time a dog arrives at our door, they may already be in a fearful state, perhaps triggered by a recent history of trips to the vet and surgical trauma, so that FAS is present before they even walk in. What are the things we can do to ensure that our patients walk into that initial consult feeling at ease, and continue to relax and enjoy our interaction as it occurs?
Laying a foundation
If the patient arrives in an already fearful state, changing that state is so much more challenging. There are a few things the owner can do to ensure their dog arrives at the practice in a calm and relaxed mindset. For instance, they could use a pheromone on themselves or in the car, and they could play some relaxing canine or feline tunes as they travel. Dr Marty Becker suggests iCalmPet. When the patient arrives at the practice, encourage the owner to keep the dog in the car instead of in the waiting area, or encourage them to have a walk and sniff around the garden while they wait for their appointment.
Good first impressions
The first impression the dog forms of your practice arises from its look, feel and smell. A practice layout that reflects a home environment as far as possible, with the addition of some pheromone diffusers or other calm and pleasant smells, will help reduce ‘white coat syndrome’ – the increase in blood pressure that occurs when an animal enters a medical facility. Try to aim for warm and soft surfaces, rather than cold and hard ones, wherever you can.
Offer the dog choices
Offer your patients choices, so that you can establish their preferences. Would they like to sit on the mat or on the couch? Close to the owner, or further away? Would they like a treat – maybe you could offer one of two kinds. Find ways to incorporate a few choices into the first few minutes of your consult to establish where the patient will be most comfortable, and in what position.
The owner’s emotional state
The emotional state of the owner plays a big role in the emotional state of the patient. Take a few minutes while you are establishing the dog’s preferences to reassure and calm the owner, too. Ask things about the dog: Where does his name come from? What are his favourite activities? Establish a connection with the owner and make sure they feel comfortable, safe and calm.
Be gentle and non-threatening
Avoid eye contact with the dog, practise gentle control and not restraint, give treats often and in abundance, and use gentle massage around the lips, chin and ears if necessary.
Take the time it takes
Most importantly, take the time it takes. Be flexible with these fearful dogs, perhaps allowing them to come in for a few social visits before their consult if you know fear is a problem. Just lavish them with treats and let them go home again! By the time they come for their consult, fear will be far less of a problem.
Really, the key with fearful dogs is not to rush things, to observe and respond to their preferences, and to introduce as many positive associations into their experience as you can. Spend a little time chatting to the owner, which will take the pressure off the dog and give it time to relax. Dogs, like children, can feel intimidated when a stranger overdoes the attention.
Fear can be overcome. We just need to give the animal the opportunity and the space in which to do it.