The Front Lines of Animal Behavior: Management of Behavior Issues Is in Your Hands

Veterinarians are in a unique position to prevent problem behaviors, detect early and urgent clinical signs, rule out medical contributions, and provide treatment. We can ensure that patients receive high-quality veterinary care throughout their lives in the least stressful way possible, and improve relationships and safety through education on animal body language.

Through veterinary behavior work, we detect and decrease
overt and silent suffering and promote the human-animal bond.

by Stacey Jones, DVM, and Ariel Fagen, DVM, DACVB

Veterinarians are in a unique position to prevent problem behaviors, detect early and urgent clinical signs, rule out medical contributions, and provide treatment. We can ensure that patients receive high-quality veterinary care throughout their lives in the least stressful way possible, and improve relationships and safety through education on animal body language.

If we are not behavior specialists ourselves, we can use direct recruitment of such professionals to shape comprehensive diagnostic and treatment plans. Through veterinary behavior work, we detect and decrease overt and silent suffering and promote the human-animal bond. The ability to advocate for a patient’s behavioral needs can be a life-saving, or quality-of-life-saving, skill. Yet we face obstacles.

Be the Primary Resource

If clients do not perceive veterinarians to be a primary resource for behavioral care, they seek advice elsewhere. Interventions such as pain- or fear-based procedures and aversive training tools continue to be promoted on mainstream media and through some training services. Though aversive techniques and punishment can work to inhibit outward behaviors if applied correctly, these techniques carry risks. New problem behaviors such as escape, avoidance, and behavioral inhibition can develop. The animal does not learn what we do want them to do instead of their problem behaviors.

However, they may learn new, unintended fear associations with people or contexts in which punishment occurs. Aggression can develop, worsen, or generalize to new situations, and aggression toward family members has been shown to be correlated with these training techniques. Even if an intervention does not cause behavioral fallout, if it is not effective, it can damage outcomes when financial, emotional, and time resources are consumed.

The training industry is currently not regulated, and anyone who is not a veterinarian can advertise as a “behaviorist.” The lack of clarity in terminology makes it confusing to find coaching with the many professionals who are on the cutting edge of learning and behavioral sciences, such as board-certified veterinary behaviorists, veterinary technician specialists in behavior, certified applied animal behaviorists, and some highly skilled trainers accredited through rigorous programs.

Even if we refer clients to one of these professionals, physical distance or financial barriers can limit access. Alternatively, a behavior specialty team may be nearby but there may be a delay in availability ranging from weeks to months. Despite the obstacles we face, there are important things that general practitioners can do to improve patient outcomes, foster relationships, and ultimately increase the health of our practices.

Early Awareness

As a general rule, the earlier we intervene with a behavior problem, the better the chance we have at addressing it. Include a behavior-focused screening question in every visit, such as, “Is there a behavior that is bothering you?” or “Is there something that you wish your pet did differently?” Even though it may not be able to be addressed that day, we can acknowledge the importance of the concern, praise the client for bringing it to our attention, convey that there are lots of ways to help, and schedule a follow-up visit to get started.

For Any Behavior Concern, the First Step Is to See a Veterinarian

That’s us! Make sure all husbandry needs are met and screen for underlying medical conditions that may be contributing to or causing a behavior problem. Obtain a detailed history, physical examination, and minimum database (complete blood count, chemistry panel, urinalysis, fecal ova and parasite, and thyroid hormone). Pending results and clinical presentation, additional diagnostics may be warranted.

For example, urinary signs may warrant urine culture and imaging, aggression with body handling may warrant orthopedic radiographs and an empirical pain medication trial, and repetitive behaviors may warrant a neurology consultation.

It is common to identify occult painful, pruritic, or metabolic conditions that decrease a patient’s ability to cope with emotional stressors or directly contribute to behaviors such as reactivity. Sometimes the only clinical sign of a medical condition is behavior change.

Identification and treatment of contributing factors may markedly decrease the behavioral symptoms and, occasionally, completely eliminate the problematic behavior. Addressing common problems such as dental pain, osteoarthritis, and otitis can have a meaningful impact in some cases, even if the problem is initially judged to be unrelated or mild. A comprehensive management, medication, and behavioral therapy plan may still be indicated with a behavioral specialty team, but a detailed medical workup is the foundational piece. Additionally, laboratory profile baselines are important for behavioral drug choice and monitoring trends over time.

Every interaction is a learning experience that
can affect future behavior, in and outside
the hospital setting.

Control Learning Experiences Within the Veterinary Hospital

We need a medical workup, but patients with behavioral needs may have difficulty coping with the hospital setting or touch. This may actually be the primary behavioral concern. Every interaction is a learning experience that can affect future behavior, in and outside the hospital setting. We want to do our best to avoid learning experiences that may make it even harder or jeopardize the ability of the pet to receive future care.

The good news is that we are experts in providing analgesia and anxiolysis that can mitigate the stress of the necessary medical handling. Anxiolytic and/or sedation plans are imperative for patients who communicate their need for distance and their fearful emotional state through escalating body language.

We increase our chances for anxiolytic medications and sedation to be successful if they are administered before a patient has mounted a sympathetic nervous system response. The more we fiddle around with strategies that don’t work and increase arousal, the less effective our drugs may be when we do reach for them; we may have to try again on a different day. We can start at home with pre–veterinary visit medication support, but it may be indicated to plan a sedated visit from the beginning. Drugs are often most effective when administered and allowed to take effect in a quiet place, with clients present.

Include the Client

Clients may be physically, emotionally, and financially stretched, and nervous about the veterinary experience themselves. We change the way clients experience veterinary care, and shape their learning experiences going forward, by acknowledging how difficult it may be for them and mindfully incorporating them into the team.

The client’s understanding can be improved through coaching—for example, by saying, “We need to gather information to rule out underlying medical or pain contributions, and we need to do it in the least stressful way possible, for everyone. We want you to be present for as much as possible if you feel comfortable.” Then, review the body language you will be watching for, the recommended plan, the framework for their involvement, your expectations, and the possible need to stop and try an alternate strategy.

Involve them in distraction or classical conditioning plans by having them rapidly deliver high-value treats for the duration of the uncomfortable handling. When clients are present, we are able to coach them on patient body language in real time, so if we need to convert to an alternate plan because of escalating stress, the client has seen why. We bypass having to explain that a patient is not coping, or having the client wonder what we did to their pet “in the back.”

But what about those patients who are “better” in the back? All too often, veterinary teams attribute increased reactivity in the presence of their people to a protective response. The vast majority of patients who do exhibit reactivity at the veterinarian’s are doing so out of fear—fear for themselves and self-protection, not protectiveness over the clients. For these pets, even though a patient may seem “fine” away from the client, the underlying emotional state has not changed, and may actually have worsened. Animals with sympathetic nervous system activation enter “fight, flight, or freeze” mode. A patient in the back may be in freeze mode instead of fight mode, like they are with their people present. This outward behavioral inhibition may be associated with the same fear—or potentially greater: you just took away their person!

This can be more dangerous because staff not trained to read subtle body language cues may not be able to predict impending aggression, or a patient may truly inhibit normal escalation signs and erupt in full-blown self-defense, causing injury. Furthermore, while the patient may be behaviorally inhibited this time around, they still are having a learning experience, which can influence their level of fear the next veterinary visit and thus escalate behaviors over time.

There are times when it can be helpful to separate a patient from the client—e.g., a client’s punishing behavior or heightened anxiety is escalating the patient’s anxiety. Then, ask the client to wait in the lobby if needed and moving forward; a new plan can be developed to improve everyone’s experience.

Refer Early

Because every interaction is a learning experience, there is urgency to incorporate behavior specialists for all behavior problems, even if it is not a behavioral emergency. Refer for a team approach from the beginning, instead of considering referral a last resort. Our best opportunity to influence positive behavior change is now!

Veterinary behaviorists are experts in using their toolboxes of medicine, behavioral, and learning science to:

  • Set up the environment to increase safety, make it easier for the patient to learn and succeed, prevent unintended negative learning experiences, and prevent the patient from practicing problematic behavior and getting even better at it
  • Maximize psychological wellbeing with appropriate lifestyle and management recommendations
  • Teach the patient something else to do instead, a new skill to replace the problem behavior, or a better coping skill
  • Condition the patient to feel differently about the world by teaching a new emotional response to stimuli that have elicited the problematic behavior in the past
  • Improve learning and mitigate emotional distress
  • Address underlying psychiatric disorders with deft neurotransmitter support when indicated through nutrition, supplement, or pharmacological intervention
  • Provide guidance on prognosis, expectations, and fit: We cannot cure most behavioral disorders, but we can often achieve a functionally significant improvement. Sometimes this means adjusting expectations or acknowledging there is a mismatch with what the client and the patient need or can provide

Get to know veterinary behaviorists in your area to develop a referral network. Be clear and direct about what the patient needs. For trainers, vet them thoroughly and be specific—if you are not sure, don’t refer.

When referring a client to a veterinary behaviorist, convey confidence in the specialty team’s expertise just as you would with a preferred neurologist, internist, or cardiologist. Then follow up! Even if the client does not consult them in person, many veterinary behaviorists have creative ways to increase access to care through vet-to-vet and telehealth consultations, as well as extension services with traveling team members. Advise clients that if they hit a barrier, they should report back before seeking out another trainer or “behaviorist” on their own.

You don’t need to have a thorough behavioral background to make a life-changing difference in everyday practice. We relieve silent suffering and increase the likelihood of successful outcomes when we intervene early, become medical detectives for behavioral clinical signs, educate and guide learning experiences in and out of the hospital, and refer to trusted behavior specialty teams.

Recognize an Emergency

Through observation or client surveys, we may become aware that there is a behavioral emergency. In the cases below, the patients need immediate intervention:

  • The human-animal bond is at risk or already broken: a client is considering rehoming or euthanasia, or is using aversive or fear-inducing interventions
  • A client is afraid of their own pet
  • A client’s livelihood, family unity, or living situation is at risk because of the pet’s behavior
  • A pet is exhibiting aggression toward members of the household, especially children, elderly, or otherwise medically compromised people
  • A major life change is about to occur that could drastically alter household stability with a behavior problem, e.g., a move, the birth of a child, etc.
  • The patient is exhibiting extreme distress
  • A legal proceeding is under way that could threaten the pet’s life or position in the home
  • A pet has significantly harmed or killed another pet or person or is otherwise a public health risk
  • A pet has significantly harmed themselves
  • Aggression is occurring in a puppy or kitten

For More Information

American Veterinary Society of Animal Behavior

American College of Veterinary Behaviorists

 

Stacey Jones, DVM, is a veterinarian specializing in behavior at the Veterinary Behavior Center in Boulder, Colorado. Jones graduated from Colorado State University’s College of Veterinary Medicine in 2003. After graduation, she completed a one-year internship in emergency medicine and critical care at New England Animal Medical Center in Massachusetts. Returning to her native state of Colorado, Jones cultivated a special interest in greyhound medicine, anesthesia, behavior, and pain management. She also serves on the executive board of the American Veterinary Society of Animal Behavior as a member at large. Jones, her husband, and their two children share a home with numerous dogs, horses, chickens, and aquatic creatures.
Ariel Fagen, DVM, DACVB, is a board-certified behaviorist at the Veterinary Behavior Center in Boulder, Colorado. Fagen graduated from Tufts University Cummings School of Veterinary Medicine in 2013. She went on to complete an intensive one-year rotating small-animal internship at Wheat Ridge Animal Hospital. In 2018, Fagen became a diplomate of the American College of Veterinary Behaviorists, making her one of only two board-certified behaviorists in Colorado.
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