School of Clinical Veterinary Science, University of Bristol, Langford, Bristol, UK
The principles of behavioural medicine are an important element of veterinary care in first opinion practice, not just because clients often ask about 'behaviour problems' but because of the impact that emotional state has on handling, disease susceptibility, recovery, and overall quality of life whilst pets are in veterinary care. Incorporating knowledge about companion animal behaviour into practice procedures reduces the stress for pets, makes handling easier and less dangerous for practice staff, and reassures owners that the welfare of their animal is paramount whilst in the care of the practice.
The aim of this presentation is to examine some of the ways in which knowledge about behavioural medicine can have a direct impact on dog and cat welfare and patient management in day to day practice.
Why Is It Important to Reduce Stress for Companion Animals in Veterinary Practice?
1. It will help reduce disease risk and improve recovery rates.
It is now well established in human medicine that stress occurring in response to environmental factors interacts with physical health. Events causing stress can impact on susceptibility to disease, for example. Stress also has an influence on recovering and rehabilitation after disease, injury or surgery. It is also important in the development of some chronic diseases, such as idiopathic cystitis and inflammatory bowel disease. Understanding how dogs and cats respond to their environment is therefore an important element of treating and managing physical disease and injury.
2. It will make it easier for you and your staff to handle dogs and cats.
Animals that are anxious about handling or stressed about being close to other cats or dogs are more likely to be aggressive, difficult to handle and treat. They are more likely to injure staff, and owners may be upset by the necessity for close restraint. How the practice is designed – e.g., having separate waiting and kennel areas for cats and dogs - influences stress levels before procedures. Appropriate care over handling also influences the experience that each animal has of the practice - influencing how they will be behave on subsequent visits.
3. It will improve the welfare of animals in your care, and give their owners a better experience of the practice.
By noticing the signs of anxiety in pets, practice staff can take action straight away to alleviate any stress. This will improve the welfare of animals in the short term, reduce the risk that they will learn a negative association of the practice on subsequent visits and avoid the development of aggression. Recognising where individual pets are worried and addressing this straight away is also appreciated by owners, who are often stressed themselves about their pet - which in turn tends to increase the anxiety of the animal.
How Do I Incorporate Behavioural Principles Into My Practice?
Design and Practice Set-Up
Understanding what is likely to cause different animals to become anxious or stressed, and adapting the practice environment and management to reduce this, can have dramatic effects on dogs and cats. For example, changing the arrangement of the waiting room, so that cat owners do not wait in close proximity to dog owners, and ensuring that both puppies and kittens have a positive first experience of the veterinary practice. Making the routine in the practice as predictable and calm as possible also helps to reduce anxiety. The education of all staff in appropriate handling and housing techniques is also very valuable at improving the welfare of dogs and cats but also reducing the risk of injury.
In general, making the experience of entering the veterinary clinic as positive as possible for dogs and cats whenever they come in helps to prevent negative associations developing when they are in pain or anxious. 'Puppy parties' or socialisation classes are a good way of starting this process, as they will ensure that puppies' first experience of the practice will tend to be a positive one. Even where dogs first visit a practice as adults, ensuring that their first experience is positive, with social attention and rewards, will help prevent subsequent negative associations. It will also help to avoid conducting potentially painful procedures (e.g., microchipping) on the first visit to a practice.
Housing and Handling: Cats
The unfamiliarity and unpredictability of a new environment will cause anxiety in cats. As they start to learn the routine, get to know the staff and know what to expect, levels of anxiety will decline, although this rate of decline varies significantly between individuals. Within the practice, housing cats in such a way that they can show an adaptive hiding response to stress will help them cope better with being in the cattery. Providing somewhere to hide, such as a box, is sometimes considered to make it difficult to check and remove cats from cages. However, having a box with holes on front and side and which can easily be removed from over the top of the cat enables both easy handling and hiding enrichment. Blocking visual access between cats helps to reduce the perceived threat from other cats, for example by designing pens such that they do not directly face each other, or covering over the front of pens when occupied. Although cleaning of pens is important for infectious disease control, some continuity of scent can be achieved by using two vet beds and, if possible, only removing one for cleaning each day, so that the other carries the cat's scent from one day to the next. Having separate cat waiting areas reduces the chance of cats being frightened by dogs whilst in a carrying basket, and separate kennelling areas is also helpful in ensuring a quiet area in which cats will start to adapt to the new environment more rapidly.
Cats may also have varying previous experiences of people. Where cats have limited contact with people during the first weeks of life, they are more likely to show fear behaviour towards people as adult. They may also have had mixed experience of people and show signs of emotional conflict, such as approaching but then becoming tense on closer contact. Handling should therefore be conducted carefully, and signs of anxiety identified before approaching. It is generally better for cats to be encouraged to approach for handling - this ensures that they are positive about interaction and are less likely to learn that handling in the practice is aversive.
Synthetic feline facial pheromones may also be useful to reduce anxiety in cats entering the kennels. However, they should be regarded as an adjunct to environmental considerations, rather than a panacea for dealing with 'stress' alone. Pheromone therapy is more likely to be effective when used as cats arrive in the new environment to help reduce their anxiety, rather than once cats have developed a fear response to specific events.
Housing and Handling: Dogs
Once dogs enter the clinic, or are admitted to kennels, it is good practice to ensure that the routine is predictable for them so that they can learn as quickly as possible what to expect. In practice this may mean having the same one or two people looking after a particular animal and keeping the routine of the day as standard as possible. Finding out from the owner what each dog's normal daily routine would be like may help in the anticipation of possible problems, or periods when the dog is particularly likely to become frustrated. Most owners tend to have a reasonably predictable daily routine for dogs - and as a result they expect things to happen at particular times, and can get anxious or frustrated if things do not happen as normal. A common example of previous learning that might cause anxiety in the kennel situation is that of toilet training. Most dogs have a strong preference for toileting on grass, and many have been punished for toileting on other substrates. Because of this, some will be unwilling to toilet in the kennels or in concrete runs, trying to 'hold on' for considerable periods for a suitable substrate.
The highly social nature of dogs also makes them very good at reading changes in human facial expression, tone of voice or posture. Keeping the kennel area as calm and relaxed as possible is ideal - even on a bad day. Where unpredictable noises occur in other areas of the practice, having a radio to mask sounds may help. Dogs may also learn to avoid situations in which a painful event predictably occurs. However, pain will also have a less specific effect on behavioural responses, generally reducing the threshold for reacting to new events and increasing the likelihood of fear responses, including aggression. Other physiological changes will also influence the threshold for behavioural changes, making dogs appear to behave uncharacteristically. Pyrexia, for example, may lead to heightened sensitivity, or hyperaesthesia, and high levels of oestrogen can result in established behavioural responses occurring at a lower threshold of stimulus.
Giving dogs short spells of interaction throughout the day, so that they are not left isolated for long periods, is generally preferable to fewer longer periods of interaction. Dogs are more likely to learn that someone coming to the kennel predicts a positive event if they get regular fuss and social contact, rather than only seeing people when a painful dressing change is needed, or a drip untangled.
It is important to monitor dogs for behavioural as well as physical signs on a regular basis. It is helpful to ask owners if there are any specific events to which the dog has an existing fear response. For example, a dog that is fearful of unfamiliar dogs would be better placed in an end kennel, or in one where there is no direct visual contact with other dogs. Use of an isolation area may be useful in such a case. Dogs with a fear of noises can be placed in a quieter end of the ward, away from the clanging metal bins. In addition, monitoring how the dog responds to specific events will help identify contexts in which he or she is anxious. Identifying where a dog shows appeasement behaviours as the lead is clipped on to bring the dog out should be noted as a warning that the dog is worried about this situation. Changing its perception of handling at this point, by associating contact with a positive consequence, is much easier and quicker than when the dog starts to develop defensive aggression in this context.
Where dogs show frustration responses, such as whining in the kennel, or banging at the kennel door, it is important to not reinforce this response with attention. Shouting at a dog that is making a lot of noise may appear to reduce the behaviour in the short term, but is counter-productive in the long term. Either the dog will still be motivated to seek attention, and try something else, become anxious about you, or see the shouting as a good consequence, and make more noise next time! The dog needs to learn that its behaviour has no consequence, and that other behaviours (such as sitting quietly) do work to get positive attention. It is a good idea to speak to dogs, or stop briefly to say 'hello' when regularly passing through the kennels, as long as they are being quiet, as this will give them some social contact, and reduce the likelihood of them showing attention-seeking behaviours.
The early environment and experiences of puppies and kittens are very important in formulating their later behaviour. Vets have an essential role in educating both breeders and owners about appropriate socialisation. Educating owners about using their attention to reward appropriate rather than undesired behaviours also has a long-term impact on the development of many problems. For example, many owners reinforce play behaviour directed towards their hands and feet in kittens, which can lead to the development of aggression later in life. In addition, educating owners about the specific behavioural needs of dogs and cats reduces the risk of undesired behaviours. For example, owners commonly misunderstand the social behaviour of cats, often not appreciating the extent to which multi-cat households can be stressful for them. The importance of a controlled programme of interaction can be highlighted where owners discuss adding an adult cat to a household with one or more existing cats.
Considering behaviour as part of the practice routines, management, housing, and staff training has an impact on the welfare of patients, but also makes handling dogs and cats easier, staff safer, and often recovery from disease and injury smoother. In addition, the first opinion vet is ideally placed to give appropriate advice to owners, and contribute to an overall improved understanding of behaviour and welfare needs. Taking the time to give good advice at the right time can have lifelong impacts on the quality of life of clients' pets.
1. Casey RA. Fear, anxiety and conflict in companion animals. In: Lindley S, Watson P, eds. BSAVA Manual of Canine and Feline Rehabilitation, Supportive and Palliative Care. Gloucester, UK: BSAVA; 2010:31–41.
2. Shepherd K. Behavioural medicine as an integral part of veterinary practice. In: Horwiz DF, Mills DS, eds. BSAVA Manual of Canine and Feline Behavioural Medicine. 2nd ed. 2009:10–23.