At the 2023 London Vet Show, Fear Free founder Dr Marty Becker held a joint session on the rapidly expanding Fear Free movement with CASCO Pet. The presentation came hot on the heels of the news that Harrison Family Vets in Reading had become the first practice outside of North America to achieve Fear Free veterinary practice certification. Suffice it to say the movement has officially arrived in the UK.
But what are the principles underpinning the Fear Free movement, and what benefits can it bring to veterinary practices?
The current state of UK companion animal practice
According to current estimates, a combined total of more than 20 million dogs and cats are kept as companion animals in the United Kingdom (Feilberg et al., 2021), with households spending over £5.3 billion on veterinary and other services for their pets (Shahbandeh, 2023).
As anyone working in veterinary practice is acutely aware, these visits can cause significant stress to animals. Research has found less than 50 percent of dogs were observed willingly entering a veterinary practice, and 73 percent of cat owners have reported impaired welfare in the waiting area, which rises to 85 percent during clinical examination (Feilberg et al., 2021).
When distress during veterinary visits is reduced, patient and staff welfare is significantly improved in tandem
When an animal is stressed, a client’s willingness to attend a veterinary practice is reduced – potentially prolonging untreated illnesses. This can result in poor patient welfare and risks incorrect treatment due to misinterpretation of physiological responses to stress (Edwards et al., 2019). Additionally, animals that are stressed during veterinary visits can lead to injury and stress for clinic staff. So, when distress during veterinary visits is reduced, patient and staff welfare is significantly improved in tandem.
From fear, anxiety and stress comes Fear Free practice
Fear Free was founded in 2016 with this objective in mind – to reduce stress, thereby increasing patient and staff welfare. Developed in conjunction with hundreds of experts in animal behaviour, medicine and handling, it is a movement to “prevent and alleviate fear, anxiety and stress (FAS) in pets, by inspiring and educating the people who care for them” (Fear Free, 2023). This is done through online and in-person education certifications for veterinary professionals, educating attendees on strategies to reduce FAS, and promoting calm interactions during a veterinary visit.
How does Fear Free work?
Pre-visit
Creating the right fear-free environment begins before the animal steps foot inside the building. For some animals, this may involve pre-visit medication, which can be used to sedate or reduce anxiety. If the sight of the transport carrier alone sparks an instant negative reaction, it’s recommended that the owner helps the pet become familiar with it at home (Carrozza, 2018). Leaving the carrier out regularly, spraying bedding with appeasing pheromones (Seid, 2022) and adding tasty treats and/or toys as an extra incentive are all useful tools to familiarise pets with their carrier.
Food should be limited prior to a veterinary appointment to increase the effectiveness of treats as rewards within the clinic. Owners should also bring their pet’s favourite treats to support this goal as well as any bedding, bathmats and/or clothing that has the owner’s scent.
Lastly, if driving to the vet, owners should preheat or precool the vehicle to room temperature. The carrier should also be level and covered on three sides to reduce visual stimuli. Hard stops-and-starts and baby-talk should be avoided as much as possible – with either calm music playing or nothing at all.
At the clinic
When it comes to waiting rooms, steps should be taken to minimise stress and create as calm an environment as possible, with separate spaces advised for cats and dogs (Edwards et al., 2019) or no waiting rooms at all. Where this is not possible, patients should be spread out, with visual barriers used or, for cats, shelving/platforms to keep carriers off the floor. Again, covering the carrier can reduce the chances of the pet viewing other animals or people and having increased fear, anxiety or stress.
Veterinary staff and owners should work in tandem to attempt to have patients come through directly to the exam room.
The examination room
The standard use of stainless steel can make for a slippery, cold, reflective and resonant space – heightening a pet’s stress. Add the height of an examination table, and you’ve included another fear: falling – animals’ number one fear from birth (Carrozza, 2018). For practices looking to create a fear-free space, providing stability is important. Slip-free surfaces such as blankets, rubber mats or bathmats that pet parents bring from home (and launder themselves) are great places to start. In some situations, it may be the case that alternative exam locations are necessary – for example, the floor, the pet owner’s lap or even examining a stressed cat within its carrier.
Background noises should be considered as well. Sounds like slamming doors, barking dogs and general chatter can be off-putting and disruptive to staff, as well as causing upset in patients, particularly those in recovery. But there are studies showing that certain types of music – classical and reggae – are calming to companion animals (Lloyd, 2017).
Another element to consider is that of scent. Staff should therefore refrain from using heavily scented lotions, perfumes and aftershave. Instead, prioritise the animal’s superior sense of smell by using diffusers and topical sprays that mimic the naturally calming pheromones in cats and dogs (Edwards et al., 2019).
Handling
Another important principle in fear-free veterinary practice concerns a considerate approach to care. This includes “considerate approach” and “gentle control”: how staff comfortably and safely position the patient to allow administration of care and restraint. The latter is recommended to be limited to what is needed (Martin, 2017).
It also includes advice on “touch gradient”, which teaches veterinary professionals how to touch patients to minimise FAS during procedures. This guidance covers how to maintain continuous, physical hands-on contact throughout the examination when possible, acclimatising a patient to an increasing level of touch intensity while continuously measuring the patient’s acceptance and comfort (Martin, 2017).
Food motivation should be used throughout the examination (Edwards et al., 2019). Treats make a great distraction tool and are beneficial to use before, during and after examination and procedures.
Veterinary housing
Kennelling is an area that may cause high stress in animals (Lloyd, 2017) and should be a key consideration when taking steps to minimise a patient’s stress and anxiety in the clinic. Indeed, the importance of animal housing meeting certain standards is clearly a priority for the sector; CASCO Pet’s own survey at London Vet Show found that over 80 percent of respondents said this was “important” or “very important” to them.
Careful attention needs to be given to an animal’s preferences for lighting, sensory stimulation and temperature (Bloom, 2016a, 2016b), and good kennelling should afford the ability to tailor the environment according to individual needs.
In terms of lighting, brightness can be uncomfortable for pets. Natural lighting is preferable as it supports an animal’s visibility and helps maintain circadian rhythm – dimmable lights are also beneficial (Bloom, 2016a, 2016b). Red lighting should be used during the night to support non-disruptive patient monitoring and aid recovery.
It is also important to consider the materials used in kennelling. While stainless steel cages have traditionally been widely used, alternative modern materials can offer greater benefits. Glass provides animals with a quiet environment that reduces stressful noises and has better insulation and heating control.
Conclusion
When it comes to reducing the adverse effects of veterinary visits on companion animal health and well-being – particularly fear, anxiety and stress – research recommends low-stress animal handling approaches, together with appropriate equipment and housing. Calmer pets make for reduced instances of injury to both pets and people, as well as a quieter space – creating a more enjoyable and stress-free working environment for veterinary professionals.
Calmer pets make for reduced instances of injury to both pets and people, as well as a quieter space – creating a more enjoyable and stress-free working environment for veterinary professionals
Over 99 percent (99.16) of survey respondents who implemented Fear Free practices confirmed that it was worth the time taken to certify staff. It is also beneficial for business results, with 65.55 percent saying it increased client volume and 87.39 percent stating it made them more profitable overall (Hamlin, 2019).
