Behavior medicine: Easing patient fear

A behavioral method of curbing patient anxiety in the hospital
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Oct 01, 2009


Defusing anxiety: If the dog is trained to wear one, use of a head halter can help minimize stress in the waiting room.
Many dogs are fearful when they visit the veterinary hospital. Fearful and anxious pets require a gentle approach by you and your staff to minimize and hopefully reduce the pet's fear and prevent escalation. Interactions should focus both on safety and remaining calm and positive. Where necessary, management products and pharmacological intervention may be required for increased safety of veterinary personnel and owners, as well as to enhance a dog's emotional well being.

Canine communication of anxiety or fear


Muzzles: can offer safety to staff and help keep the animal calm during the examination.
Observation and detection of signs of conflict and anxiety are necessary to understand the dogs underlying emotional state so that precautions can be implemented to ensure safety and prevent further aggravating the problem. Dogs rarely react without warning; they just communicate in a way that humans may fail to recognize. Watch your patients closely for subtle signs such as licking, yawning, drooling, ears held back, looking away, trembling, tail low and tucked, or trembling. Some dogs freeze or stiffen. This absence of movement may not be easy to appreciate but may be the last warning before a serious bite is inflicted. Signs such as crouching, exposing the belly, submissive urination, mouthing, urine marking, lip lifting, raised hackles, escape attempts and growling may indicate a higher level of anxiety and distress. Some dogs display attention-seeking behaviors such as whining, barking, climbing on family members and even mounting.

Do no harm


Reducing visual stimuli is an effective means of controlling anxiety.
When pets exhibit fear and anxiety, the response of the veterinarian, staff and pet owner can further aggravate or lessen the pet's fear. Dogs are keen observers and quick learners, especially when the outcome is unpleasant. If the client is tense or worried, the fear can be heightened by their owner's response. Some clients harshly reprimand or punish fearful behaviors, which only serves to intensify the dog's fear and could even lead to defensive aggression. Another concern about punishment is that it might suppress the fearful behavior such as growling, but does not address the underlying motivation.

The veterinarian or staff can further aggravate the problem by their own fear, anxiety, frustration or anger. These may be natural, uncontrollable, reflexive or necessary responses to a dog's threatening behavior, but they "validate" the dog's anxiety. Confrontational restraint and painful procedures further condition a fearful association with the veterinary visit. In addition, while retreat and avoidance may be necessary for safety, they teach the dog that aggression is successful at removing the threat (negative reinforcement).


Sedation protocols for difficult dogs
In short, if every time a person with a "white coat" enters the room a family member tenses, tightens on the leash or scolds the dog, or you or your staff show fear or anxiety, this communicates to the dog that the white-coated person is a threat. Furthermore if the growling has been suppressed by punishment and the aggression has successfully caused you or your staff to retreat, the dog may learn to bite without warning. This is not a control or pack leadership problem or due to the dog being "spoiled" – educate about learning principles and methods to alleviate the dog's fear.