An in-depth study on what it takes—and what we should all be doing—to minimize and mitigate the fears, stress, and anxiety of veterinarian visits for every pet, and pet parent.
Veterinary care is an essential element of maintaining good welfare of companion animals. However, studies indicate that a great majority of dogs and cats show signs of fear when visiting the veterinarian [1,2,3], making veterinary visits stressful also for their owners . Indeed, 28% of cat owners and 22% of dog owners reported that they would consult the veterinarian more often if the visit was not associated with so much stress for their pet .
Animals’ stress associated with the veterinary visit can distort physiological measurements, hamper the physical examination and, in case of aggression, pose a risk to the veterinary team . Veterinarians are thus faced with the challenge of carrying out important medical procedures, some of which may be painful, while also considering the emotional well-being of their patients.
Vets are faced with the challenge of carrying out important medical procedures, some of which may be painful, while also considering the emotional well-being of their patients.
Although a classic paper investigated fear-related behaviour in dogs at a veterinary clinic already in 1981 , awareness on how individual animals experience veterinary visits and how negative experiences can be counteracted has been increasing only relatively recently [7,8]. Here, we provide a comprehensive review of causes for and measures to reduce, or ideally prevent, fear and subsequent aggressive behaviour in dogs and cats at the veterinarian, based on controlled studies and—in the absence of such studies—peer-reviewed guidelines or expert texts.
1.1. Fear, Anxiety and Stress—Evolutionarily Adaptive
From a biological point of view, fear, anxiety and stress reactions are highly adaptive, as they organise behavioural responses to avoid or cope with threat [9,10]. In dangerous situations, two major behavioural patterns can be distinguished. The “fight-or-flight response” constitutes an active coping strategy, while “freezing” is a passive coping strategy . Which behavioural reaction the animal chooses when it feels threatened depends on the one hand on its personality , and on the other hand, on the situation, for example the distance to the alleged threat, the availability of an escape route and the perceived degree of danger [11,13].
Both fear and anxiety are unpleasant emotional reactions to the presence (fear) or potential presence (anxiety) of a threat ; however, there is no empirical data on distinguishing expressions of anxiety vs. fear in dogs and cats (c.f. [15,16]). Therefore, and since anxiety promotes fear and vice versa [13,17], we subsequently use the term “fear” to denote both fear and anxiety responses.
The term stress refers to the organism’s response to a stimulus or event, often referred to as “stressor”, that poses a potential threat and triggers a physiological and behavioural response, including activation of the sympathetic adrenal medullary axis and the hypothalamic-pituitary-adrenal cortex axis [18,19].
For example, in cats, the transport to the veterinary practice and routine visits for vaccinations can elicit significant physiological changes, including elevations in blood pressure, rectal body temperature, pulse, respiratory rate and blood glucose, as well as a change in the cortisol-creatinine ratio [5,20,21,22].
In some healthy dogs, the urinary corticoid:creatinine ratio increased following a veterinary visit to a level that would be consistent with hyperadrenocorticism . A reduced effectiveness of sedation  and an increased risk of anaesthetic complications  are to be expected in stressed animals.
A stress-free veterinary visit benefits all involved parties—the animals, their owners, as well as the veterinary team.
High-value food (unless an animal needs to be fasted) or toys should be used generously throughout the visit. In the interaction with the animals, low-stress handling methods, brief pauses and adjusting the procedure based on the animal’s body language help them to feel secure.
Distractions can be used to minimise perceived pain such as from injections. If a known painful area needs to be treated, pain killers are advised. For animals that are very fearful, several medication options are available that can be given prior to the veterinary visit to help them with their fears. With reward-based training, animals can learn to accept veterinary procedures. A stress-free veterinary visit benefits all involved parties—the animals, their owners, as well as the veterinary team.