Fear of vets visits

DESENSITIZATION/COUNTERCONDITIONING FOR VETERINARY VISITS
Lore I. Haug, DVM, MS, DACVB
Many dogs experience considerable anxiety and fear while at the veterinary clinic. These dogs
may show aggression, escape attempts, or severe fear reactions. Dogs with these reactions are
more difficult to handle and subsequently are often subjected to heavy restraint techniques to
allow the staff to accomplish the required procedures. Over time these behaviors typically
worsen as the dog has repeatedly more unpleasant experiences. This situation places the
animal, the owner, and the staff at risk for harm, particularly if the dog is showing aggression. In
addition, these dogs often receive sub-optimal medical care due to their inability to be examined
and handled safely. Most of these behaviors can be modified with a well planned desensitization
program.
Depending on the level of the dog’s anxiety, the program can be started at various points. Most
dogs begin showing anxiety before actually entering the clinic. This may occur in the parking lot
or as early as when the dog is put in the car at home, especially if the only rides the dog has in
the car culminate in a veterinary visit. For these dogs, the desensitization process should begin
with the car, not the vet clinic. Once the dog is comfortable riding in the car, the following
program can be implemented.
During the program, your behavior toward the dog will be important in aiding the dog’s success.
At no time should you try to punish or comfort the dog if it shows anxiety, fear, or aggression. If
the dog reacts in any of these ways, calmly abort that trial. Resume the program at a previously
successful level and remain there until the dog is completely comfortable. Only progress to the
next phase when the dog is comfortable (not showing any anxiety or stress) at the current step.
During the modification program, the dog ideally should not undergo any routine veterinary
attention. Vaccination schedules may need to be altered to allow the dog to complete the entire
program before being subjected to “the real thing.”
Step 1: Take the dog to the parking lot of the veterinary clinic. Depending on the level of the
dog’s anxiety, the first several trials you may only need to drive through the lot without
stopping. Alternatively, you can park the car but remain inside. Play with or food reward
the dog in the car for a period of time and then drive home.
Step 2: Drive to the parking lot, and take the dog out of the car. Walk the dog around in the lot
and play with or food reward the dog during this time. When the dog seems relaxed (and
not concerned about entering the clinic), take the dog home.
Step 3: Repeat Step 2, but play with or food reward the dog on the front porch of the clinic, near
the entrance. Remember to not progress to subsequent steps until the dog is very
comfortable with the step at which you are currently working.
Step 4: Take the dog into the waiting room and repeat the reward steps described above. Over
consecutive trials, have the veterinary staff also play with or food reward the dog while in
the waiting room. During each session, these periods of play and/or food reward should
be alternated with short periods where the dog is asked to sit or lay quietly. This helps
teach the dog to be calm and more closely mimics some of the usual waiting process.
Step 5: Repeat Step 4 in the examination room. Do not progress to Step 6 until the dog is
comfortable waiting in the exam room and having both the technical staff and the
professional staff (i.e. veterinarian) repeatedly enter and interact with the dog (playing,
petting, etc.). The staff should periodically assume postures and positions near the dog
that are routinely observed during physical examination and restraint, although no such
procedures should actually be done to the dog at this stage. Small dogs that are
normally handled on the table should undergo an additional step where the
counterconditioning process occurs on the table. The staff eventually should be involved
in this step also.
During the above steps, you should begin handling exercises at home. This involves
conditioning the dog to being handled and manipulated. Handle and gently restrain the
dog’s body, head, legs, and feet. In addition, you should begin gently rolling the skin on
the dog’s neck, back and sides between your fingers. Progressively apply slightly more
pressure (e.g. mild pinching) as you do this. Always reward the dog during these
sessions if it remains cooperative. Remain calm, and do not lose patience with the dog.
This should become a game associated with fun things (e.g. food, play and attention from
you).
Step 6: Have the veterinarian begin a partial physical exam. This should not start with the dog’s
head as many dogs find this phase intimidating. It is typically easiest for the dog to begin
with chest auscultation. Distract and reward the dog with food or a toy during this
process, even if the dog does not stand completely still. The goal at this point is not to
actually do the exam, but to accustom the dog to the procedure in small increments to aid
the dog in overcoming its anxiety. Over subsequent sessions, progress through the
process in a more thorough manner. The staff should repeat the same handling
exercises that you have been doing at home. Make this fun!!
When your dog’s vaccinations are due, have only ONE injection given the first time. If
the dog requires more than one vaccine, schedule another appointment in the future (1-2
weeks away) for the remainder. You may have to schedule a separate appointment for
each injection. During the dog’s first few “real” veterinary visits, it is important to maintain
a fun, relaxed atmosphere and avoid over-taxing the dog’s tolerance level. Over time,
practice doing slightly more aversive procedures with the dog, using food rewards or toys
to distract the dog during the procedure.
Step 7: Once your dog has become comfortable with the above steps, it will be necessary to take
the dog to the clinic for fun visits periodically throughout the year. Many dogs will revert
back to their fearful behavior if they resume going to the vet only once or twice a year for
procedures. The more frequently you and your dog are able to visit the clinic and staff,
the more comfortable your dog will remain when being handled there.