Bradshaw JWS Conceptualising the domestic dog – should we start again?. Journal of Veterinary Behavior. 2011; 6:(1)95-6
Bradshaw JWS, Blackwell EJ, Casey RA Dominance in domestic dogs: useful construct or bad habit?. Journal of Veterinary Behavior. 2009; 4:135-44
Carlson R, 6th edn. : University of Massachusetts; 1998
Casey RA, Loftus B, Bolster C, Richards GJ, Blackwell EJ Human directed aggression in domestic dogs (Canis familiaris): occurrence in different contexts and risk factors. Applied Animal Behaviour Science. 2014; 152:52-63
Dehasse J Sensory, emotional and social development of the young dog. Bulletin for Veterinary Clinical Ethology. 1994; 2:(1–2)6-29
Grandin T, Deesing MJ Genetics and the behaviour of domestic animals.California: Academic Press; 1998
Hedges S: CABI, Oxford; 2014
Hsu Y, Sun L Factors associated with aggressive responses in pet dogs. Applied Animal Behaviour Science. 2010; 123:108-23
Huizink A, Mulder E, Buitelaar J Prenatal stress and risk for psychopathology: Specific effects or induction of general susceptibility?. Psychological Bulletin. 2004; 130:(1)115-42
Knol BW Behavioural problems in dogs. Veterinary Quarterly. 1987; 9:(3)226-34
Lord K A Comparison of the Sensory Development of Wolves (Canis lupus lupus) and Dogs (Canis lupus familiaris). Ethology. 2013; 119:110-20
Miklosi A, Kubinyi E, Topal J, Gacsi M, Viranyi Z, Csanyi V A simple reason for a big difference: Wolves do not look back at humans, but dogs do. Current Biology. 2003; 13:763-6
Peterson JB, Shane M The functional neuroanatomy and psychopharmacology of predatory and defensive aggression. In: McCord J Piscataway, NJ: Transaction Books; 2004
There have been ground breaking advances in the field of dog training and behaviour modification in the last 20 years. Traditional theories advocating the use of ‘dominance’ to control dog behaviour have given way to ‘force free’ techniques that rely on understanding and changing the dog's motivation. An entirely hands off approach is not realistic in all cases in veterinary practice. However routine application of contemporary behavioural principles to the approach and handling of dogs in practice can improve welfare and reduce defensive aggression for the benefit of both patient and staff alike.
The world of dog training and behaviour has undergone a transformation in the last 20 years. Traditionally it was believed that dogs live in linear dominance hierarchies and so the way to control dog behaviour was to assert yourself as ‘pack leader’. In its milder form this involved always walking ahead of the dog on walks or through doorways, eating first and not allowing the dog to be higher than you or to sleep on furniture. Harsher approaches suggested correcting or physically punishing the dog for trying to eat first, walk ahead or sleep on a sofa, or any other threatening or non-threatening but unwanted behaviour, as this was believed to be an attempt to challenge for the role of ‘alpha’. At its extreme it often included a recommendation that the owner ‘alpha roll’ the dog by pinning him on his side until he ‘submitted’ (Steinker, 2007).
This theory was based on studies into the behaviour of captive wolves carried out in the 1940s (Schenkel, 1946). However the efficacy of this approach was being questioned as early as the late 1980s (Knol, 1987) and ongoing research into canine behaviour has led scientists to reconsider the whole premise (Bradshaw, 2011). It is now known that dogs have evolved to become behaviourally distinct from their ancestor (Miklosi et al, 2003; Lord, 2013). Studies of wolves are therefore no longer considered relevant to understanding dog behaviour. Studies of feral and captive groups of dogs have failed to show the types of hierarchies or controlling behaviour intended to maintain rank originally proposed (Bradshaw et al, 2009). Accredited behaviourists therefore no longer rely on the dominance hierarchy model.
This sea change in understanding has resulted in an equally far-reaching change in the way canine behaviour is managed and modified. Modern methods rely on better communication, understanding and changing the dog's motivation for unwanted behaviour, and force free training through control of rewards. This new approach offers an opportunity to also review the way dogs are handled in practice.
Understanding the patient
The first step in the application of modern behavioural knowledge to handling in practice is understanding the drives for canine behaviour and how dogs use communication to avoid aggression.
The factors that influence how a dog perceives and reacts to a situation, such as being examined or handled in the veterinary practice, are complex. Genetics, development in utero, early experiences and lifelong learning can all impact on the dog's interpretation of and responses to any given situation. Their behaviour is also affected by their current physical state, including illness, pain, hunger, hormonal status and the effects of medications, and how emotionally aroused or distressed the dog is at the time (Dehasse, 1994; Grandin and Deesing, 1998; Huizink et al, 2004; Hsu and Sun, 2010; Norwegian School of Veterinary Science, 2010; Casey et al, 2014). Therefore in some cases a single trigger, such as having a painful limb handled, may be sufficient to make the dog react defensively in isolation (Figure 1). In others this may only happen when multiple triggers combine (Figure 2). Behaviourists refer to this as trigger stacking (Hedges, 2014). Recognising how even minor triggers can stack together to influence behaviour can enable staff to take preventative steps.
Figure 1. A single trigger can be sufficient to push a dog to behave defensively in some cases (reproduced with kind permission from the Association of Pet Behaviour Counsellors).Figure 2. Less intense triggers can combine to push the dog to behave defensively (reproduced with kind permission from the Association of Pet Behaviour Counsellors).
If the dog does perceive a situation as threatening his first response is normally ‘flight’, i.e. increasing the distance between himself and the source of the threat. This can be achieved either by moving away or, if the trigger is a person or another dog, by using appeasing signals to ask the target to move away or to diffuse the threat. Initial appeasing signals may be very subtle and so are often over looked (Figure 3). If these fail to make the target withdraw, the dog may then opt for more obvious appeasing signals (Figure 4). These are less likely to be missed, but can still sometimes be misunderstood or ignored and so fail to make the target withdraw. If appeasing fails some dogs may then try using threat instead. Dogs that have learned in the past that appeasing will not work, such as during previous visits to the veterinary practice, or that feel the threat is too high for them to risk appeasing, may skip this step and escalate to using threat without appeasing first. Low level threat signals are again quite subtle and not always recognised (Figure 5). If they fail the dog may then try using higher level threat signals. These are typically more familiar and include behaviours such as aggressive barking, growling, snarling or snapping. It is only when these warnings also fail that a dog tends to resort to biting in defence (Shepherd, 2009). Dogs vary in the signals they use and escalation from low level appeasing to higher threat or even biting can be very fast. Therefore, recognising and responding to the very first signs that a dog is worried offers the best opportunity for prevention.
Figure 3. Toddy is gently appeasing by turning his head and body away from the handler, avoiding eye contact and narrowing his eyes. There is also clear tension in his face. Other subtle appeasing signals include licking the lips, yawning or chomping (like chewing a toffee), leaning away or lifting a paw.Figure 4. Copper is showing stronger appeasing by backing away, tucking her tail and pulling her ears back. She is also showing a crescent of sclera due to a fearful facial expression. Other stronger appeasing signals include lowering the head or body, rolling onto the side or back, and involuntary urination.Figure 5. This dog is showing mild threat (to another dog out of the picture). See how his bodyweight is forward as he stands over the other dog, his tail is erect, he has tension in his face and he is staring at the other dog. Other subtle threat signals include mounting or the dog placing his head over the other dog's neck.
Using the trigger stacking model in practice
Applying the trigger stacking model in the veterinary setting enables potential triggers to be identified and controlled. This prevents them combining and triggering a defensive response. Reducing defensive behaviour improves staff welfare, safety and morale. It is also important to recognise that when a dog shows defensive aggression this indicates activation of the amygdala (the fear centre) and displeasure centres of the brain, alongside the sympatho-medullary axis controlling the fight or flight response (Carlson, 1998; Peterson and Shane, 2004). Preventing defensive aggression is therefore also important for the protection of the dog's welfare. Triggers that may increase distress or fear in the veterinary practice are summarised in Table 1.
Trigger
Explanation
Management
Fear of strangers
Dogs with an established fear of strangers will find all handling and interventions threatening
Identify and avoid any specific types of people the dog is fearful of
Avoid handling where possible
Consider use of medication
Refer to an accredited behaviourist to address the underlying problem
Staff behaviour
Human behaviour can mimic canine threat
Modify behaviour to ensure this does not appear threatening — see text
Painful interventions
Pain is a natural trigger for defensive behaviour
Avoid handling painful body parts
Use analgesia, sedation or anaesthesia
Past experience
Dogs may behave pre- emptively defensively if they have had past negative experiences
Prevent development of negative associations to the practice
Refer to an accredited behaviourist to address the underlying problem
Confinement
Confinement removes the ‘flight’ option and so increases the likelihood of ‘fight’. Confinement includes physical restraint
Modify behaviour when approaching and handling to ensure this does not appear threatening — see text
Minimise restraint — see text
¾ cover kennels to reduce the sense of being trapped or vulnerable
Presence of other dogs
Established fear of other dogs can cause stress in their presence
Take a moment to release personal body tension
Move calmly, quietly and confidently
Avoid exposure to other stressed animals
Use ventilation to remove stress pheromones from previous patients
Use calming pheromones (AdaptilTM, Ceva)
The emotional state of others
Dogs are a social species and so intuitive to any indication of threat that other's emotional state may suggest
Avoid exposure to other dogs
Provide hiding places in the waiting room (Figure 6)
¾ cover kennels or site fearful dogs away from others
Refer to an accredited behaviourist to address the underlying problem
Noise/stimuli the dog is fearful of
Established fear of other stimuli can cause stress in its presence
Avoid or manage the triggers, e.g. take to a quiet area
Refer to an accredited behaviourist to address the underlying problem
Novelty
Some dogs do not cope well with new experiences
Avoid or manage the triggers
Refer to an accredited behaviourist to address the underlying problem
Figure 6. See how much more relaxed this little dog is with something to hide behind.
Approach and interaction
First impressions are as important to animals as they are to people. Therefore, how a staff member initially approaches and interacts with a patient establishes the basis for all future interactions. Steps that will ensure the dog sees this as a positive and non-threatening experience are as follows:
Allow the dog to explore his environment before approaching. If there is any risk the dog may behave aggressively this can be managed through the use of a loose lead and/or cage muzzle. The time this takes can productively be used to take the medical history or prepare equipment. It can also be used to take a summary behavioural history so potential triggers can be identified pre-emptively
Dogs can suddenly feel out of their depth if they are approached too quickly. They may then become defensive. Allow the dog to approach you rather than the other way round if possible. This ensures he is not pressured into closer contact than he yet feels ready for. If using treats, toss these behind the dog rather than using them to lure him closer to you
Be aware of your own body language and how this may appear to the dog. Leaning over, staring at, approaching directly and reaching out to touch the back of a dog's head or neck can all imitate canine threat. Stand at an angle to the dog and either stand up straight or crouch down when in close proximity to him. If crouching, keep at least one foot flat on the floor so you can move away if needed and lean away as you stand up again
Always look to one side of the dog's head rather than directly into his face or eyes
Avoid cornering the dog so he feels he always has the ‘flight’ option
Touch under the chin or on the bib rather than the back of the head or neck. Touch briefly then move your hand slightly away to assess the dog's response
Allow the dog to greet any new member of staff that you ask to assist (Box 1).
Key points to consider when approaching and handling dogs in practice
Be aware of the dog's body language and respond accordingly
Be aware of how the dog may be reading your body language
Be aware of the ‘trigger stacking’ principle and try to minimise individual stressors and triggers
Allow the dog to read and respond to his environment
Allow the dog to set the pace for approach
When holding, place hands gently in strategic positions that enable you to take a firmer hold if needed
Always support the body when moving or manipulating, and only move the dog's body in ways it is naturally designed to go
Never physically punish, intimidate or use correction or dominance methods to control behaviour in practice. Even if it is effective at the time, it may contravene the Animal Welfare Act 2006 and trigger heightened defensive behaviour at subsequent visits
Keep in mind that emotional distress carries equal threat to the dog's welfare as physical pain. Preventing such distress can therefore be considered an equal justification for the use of anxiolytic medication, sedation or general anaesthesia to facilitate examination or carry out procedures
Consider forced restraint a last resort where the force free approach is insufficient
Modified handling
Many procedures require a degree of manipulation so the dog is in the required position. If the approach and greeting has been uneventful then gentle manipulation may be possible without the risk of causing the dog unnecessary duress or triggering defensive aggression. When manipulating or positioning bear in mind the following:
Avoid manipulating and handling injured or painful parts of the body. Even if the dog tolerates this at the time there is a risk they may then become defensively aggressive on future occasions. Analgesia, sedation or anaesthesia can facilitate handling as required
Avoid lifting if possible. This forces the dog to be closer to the handler than he may feel comfortable with and many dogs feel worried when lifted off the floor. Try examining or carrying out procedures with the dog positioned on the floor, or lower an electric or hydraulic lift table to allow the dog to step on. The table can then be elevated again. Observe the dog as you do so as some may find this unsettling
Use commands where possible. Clients can be encouraged to teach basic commands in preparation for handling. Teaching a dog the names for various parts of the body and using rewards as he is touched on them can also reduce defensive aggression by enabling practice staff to let the dog know what they are going to do and motivating him to accept it
Use food lures, where not contraindicated, to encourage the dog to voluntarily adopt various positions. The dog should not be expected to hold the position for more than a few seconds without being given the treat. A new treat can then be presented to encourage the dog to maintain it. Avoid using lures to distract the dog, as he may suddenly snap once he realises what is happening. Ensure he sees and is aware of all handling and is choosing to accept this and follow the lure instead
If the dog needs to be held lay hands on gently in strategic places that enable you to take a firmer hold if needed (Figure 7).
Many dogs will accept handling and manipulation more readily than their owner than from a stranger
Reduce worry when stepping onto walk on scales by steadying them with a foot so they do not rock and clang. Make sure the dog has a clear exit from them. Food lures can help encourage the dog to step on where not contraindicated
Allow the dog to explore equipment before it is used. Familiarisation will lessen fear linked to novelty (Figure 8).
If the dog becomes distressed or is known to act defensively then the use of medication to reduce anxiety or facilitate handling should be considered. The Animal Welfare Act 2006 places equal weight on the prevention of physical, emotional and behavioural suffering so medication is equally justified for the prevention of emotional distress as it is for physical pain
There may be occasions when traditional methods of forced restraint and manipulation are unavoidable, even if only for the administration of such medication. However the best approach is to consider this a last resort.
Figure 7. See how much more relaxed Rufus is with gentler restraint. The position of the registered veterinary nurse's hands enables her to quickly take a firmer grip if needed.Figure 8. Allowing Copper to explore the equipment before it is used makes her less worried when it is then placed on her body. Food lures can make this a positive experience where not contraindicated.
Safety
Not all dogs will respond to or can be safely managed using the approach discussed above. Where a dog is known to behave defensively that may be a justification for pre-emptive use of anxiolytics, sedatives or general anaesthesia. Where the risk of defensive aggression is less clear the use of a muzzle is not only safer but may also be less stressful to the dog than the use of physical restraint. The gentler approach can then be safely attempted. Key points to consider when using muzzles are outlined in Box 2.
Key points to consider when using a muzzle
Cage muzzles are less stressful for the dog that tight fabric muzzles
Check the muzzles integrity before using
Check the muzzle is correctly fitted by attempting to pull the muzzle over the nose after all the straps are secured
Encourage clients to teach their dogs to be happy wearing a muzzle away from the practice. The Blue Cross has an excellent video demonstrating how to do this at http://www.bluecross.org.uk/99144-109679/muzzle-training.html
If using a muzzle for the first time in practice encourage the dog to voluntarily place his nose in using something sticky such as peanut butter, if not contraindicated
Bear in mind a dog can still cause bruising while wearing a muzzle and can still learn to be fearful in the practice, increasing defensive behaviour at the next visit. It is therefore important to still follow the above advice while the dog is wearing the muzzle
Referral
Where the dog's level of threat or aggression is severe or the problem behaviour extends beyond the veterinary practice the client may benefit from specialist behavioural advice. If the practice does not have a suitably qualified behavioural specialist in house referral may be required. There is currently no statuary regulation of the training and behaviour industry, or the numerous representative bodies associated with it. Veterinary professionals therefore need to take great care when choosing who to make referrals to, both to protect their clients and patients and to ensure they fulfil their professional obligations. The Animal Behaviour and Training Council has been established to provide a central point for finding qualified, accredited and accountable dog trainers and behaviourists and is supported by BSAVA and BVNA.
Additional resources
PracticallCaninelBehaviourlforlVeterinarylNursesl andlTechnicians by Stephanie Hedges
Fridge magnets depicting the principle of trigger stacking in the veterinary practice available from www.apbc.org.uk/shop/general
Practice posters depicting modern approaches to low stress handling in practice available from www.apbc.org.uk/shop/general
Low Stress Handling, Restraint and Behavior Modification of Dogs and Cats: Techniques for Developing Patients Who Love Their Visits by Sophia Yin (available as hardcopy or online at http://drsophiayin.com/lowstress/online)
Animal Behaviour and Training Council for identifying reliable dog trainers and behaviourists (www.abtcouncil.org.uk).
Key Points
The application of modern dog training and behaviour modification principles to the handling of dogs in practice improves welfare and safety for all concerned.
Understanding canine communication, the factors that may make a dog fearful and how they may combine to trigger defensive aggression enables preventative steps to be taken.
The Animal Welfare Act 2006 gives equal weight to the welfare implications of physical pain and emotional distress. Prevention through the use of medication is therefore equally valid in both cases.
Little extra time is needed to read and respond to a dog's signals, yet doing so can save a great deal of time trying to manage the dog once he has learned to fear the practice or has become defensive.
Forced restraint should be considered a last resort.
