Desensitization/ Counter Conditioning for Veterinary Visits
By Lore I. Haug, DVM (Reprinted with permission)

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, the dog often receives suboptimal medical care due to his or her 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, expecially if his or her only car rides culminate in veterinary visits.  For such 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 to aiding the dog's success.  At no time should you try to punish or comfort the dog if he or she 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.  Progress to the next phase only 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. During the first several trials, and depending on the dog's anxiety level, you may only be able 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 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 lie 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 who are normally handled on the table should undergo an additional step where the counterconditioning process occurs on the table.

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 he or she 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 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 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 one to two weeks later 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 imporant to maintain a fun, relaxed atmosphere and avoid overtaxing 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 neccessary to take the dog to the clinic for fun visits periodically throughout the year.  Many dogs will revert 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.