Brainwash your veterinary patients

adogslifephoto/stock.adobe.com; darren whittingham/stock.adobe.com

Do you salivate at the sound of an ice cream truck? Cringe when you hear a dental drill? Have heart palpitations when flashing lights appear in your rearview mirror? If so, you're a product of classical conditioning.

Classical conditioning is the process by which a meaningless stimulus (e.g. ice cream truck music) is linked with a meaningful stimulus (e.g. devouring an ice cream treat) consistently enough that the previously meaningless stimulus starts eliciting the same response (e.g. salivation) as the meaningful one.

People aren't the only ones affected by classical conditioning, of course. After all, Russian physiologist Ivan Pavlov first demonstrated the concept of conditioned responses by training dogs to salivate at the sound of a metronome. These dogs were purposely manipulated, but pets are often unconsciously classically conditioned by their owners and by veterinary professionals.

For example, have you ever had a cat attempt to run away upon spying a syringe and bottle of insulin? The bottle itself isn't terrifying, but because the cat has come to associate it with an unpleasant process, it provokes a fear response. You've perhaps also experienced a cat with spinal pain attack your hands before being touched, or a dog go berserk upon hearing the jingling of dog tags in the adjoining exam room.

Conditioned responses can make treatment difficult, unpleasant or just plain impossible for both pet owners and veterinary professionals, but it's not a hopeless situation.

Feeling the steep learning curve?

If you feel your veterinary training didn't prepare you for behavior in practice, you're not alone. Read the latest and greatest in veterinary behavior here, or take a look at these article packages on three common behavior issues:

> canine house training

> feline inappropriate elimination

> separation anxiety

Brainwashing: A two-pronged process

To efficiently change a conditioned response, you will need to use desensitization in conjunction with classical and operant counterconditioning.

Desensitization (AKA graduated exposure) is the process by which a certain stimulus is presented to the learner repeatedly at a carefully controlled intensity so that he or she learns it's not harmful and doesn't respond to it. It begins with identifying the trigger stimulus and then deconstructing it into a hierarchy of progressive approximations that can be used for gradual controlled exposures. This hierarchy must have a nonstressful starting point.

Consider someone with a fear of snakes. A potential desensitization hierarchy might look like the following:

• Person looks at photo of snake 6 ft away.

• Person looks at photo 2 ft away.

• Person touches photo.

• Person looks at decoy snake 6 ft away.

• Person looks at decoy 2 ft away.  

• Person looks at decoy 6 in away.

• Person touches decoy.

• Person looks at small snake in closed container 10 ft away.

• Person looks at snake in container 6 ft away.

• Person looks at snake in container 2 ft away.

• Person looks at snake in container 6 in away.

• Person touches container.

• Repeat process with open container.

• Repeat process with snake behind partition.

As a general rule, the smaller the approximations, the more successful desensitization will be, so I always suggest breaking trigger stimuli into the smallest imaginable increments. When done properly, desensitization attempts will not elicit any significant noticeable response from the learner. It should be about as exciting for the learner as watching paint dry.

If the learner shows no visible response for an approximation, I will increase the stimulus intensity slightly on the next repetition. Because animals can't talk, desensitization is a process of trial and error to some extent. If the learner shows mild stress (and this will happen occasionally, no matter how careful you are), pause the session and return to the most recent successful exposure level. If the learner shows a response to the lessened stimulus, stop the session and try again at a later time.

The most important factor in desensitization therapy is the learner's comfort, so it's important to progress with caution and careful planning. Failing to appropriately modulate the trigger stimulus can result in treatment failure, or worse-sensitization (see sidebar).

What is sensitization?

Sensitization is the process by which the response to a stimulus becomes more intense through repeated exposure. It's an unwanted side effect of repeated exposures to a stimulus that hasn't been properly controlled.

When a learner becomes sensitized, you can present the trigger at lower and lower intensities and still provoke a very intense response. Take, for example, two siblings in the backseat of a car on a long road trip, and one sibling keeps poking the other:

Poke → “Please don't.”

Poke → “Stop it.”

Poke → “Mom! Sam is poking me!” (Mom: “Stop it, Sam.”)

Poke → “STOP IT!”

Poke → Sibling punches Sam in the shoulder.

The stimulus (a single poke) remained unchanged in intensity, but presenting it repeatedly caused stronger and stronger responses in the learner.

If the learner becomes sensitized during your training attempt, desensitization will still be the answer (that's why it's called desensitization!). If you're new to the concept of desensitization and counterconditioning, it's a good idea to seek guidance from a mentor for hands-on help if you accidentally sensitize a learner.

Desensitization alone, even when expertly done, is too slow and unreliable for practical behavioral modification. For this reason, we generally use it in combination with classical and operant counterconditioning.

Classical counterconditioning is the process by which a classically conditioned stimulus is reconditioned to provoke a new preferred involuntary response. Operant counterconditioning (also called response substitution) produces a replacement voluntary response.

To combine desensitization with classical counterconditioning, first determine the desensitization stimulus hierarchy. Next, identify stimuli that already produce the desired emotional response. For example, if you want an excited, happy learner, common stimuli are high-value foods, toys, forms of play, increased distance from triggers and verbal praise.

To begin training, present the trigger stimulus at the lowest level (as planned in the previously determined stimulus hierarchy) before introducing a stimulus provoking a positive emotional response. So for a cat with a fear of its carrier, for example, the client might walk to the closet where the carrier is kept and then produce the cat's favorite treat. Then the client might touch the doorknob or open the door before giving the cat another treat, and so on.

An FYI on operant conditioning

I only use operant counterconditioning for husbandry with savvy clients and animals. The novice client tends to focus too much on the operant behavior and too little on changing the emotional response. The exception is when we're going fully operant from the start, which is described as “level three training” in Cooperative Veterinary Care.

Once the stimulus can be presented at a reasonable working level, you can incorporate operant conditioning by asking the learner to perform a preferred behavior such as sitting, lying down, relaxing or stepping away. When the learner responds accordingly, immediately provide it with the positive stimulus (e.g. treat, toy, talk, touch, attention). When done correctly, the trigger stimulus becomes the cue for the new emotion and the new desirable behavior.

Let's look at some examples of how to put it all together.

Unwanted behavior: barking at bicycles on walks

Approximations:

• Place a bicycle 50 ft away from the dog.

• Decrease distance between the bicycle and dog in small increments.

• Decrease distance and encourage the dog to glance at the bicycle.

• Keep the distance the same and move the bicycle slightly.

• Keep the distance the same and increase the bicycle's movement.

• Gradually decrease the distance between the dog and moving bicycle in small increments.

• Eventually the dog and bicycle will pass within a few feet on the sidewalk.

Classical counterconditioning: Each approximation predicts and results in the dog receiving pieces of steak.

Operant counterconditioning: Once the learner can tolerate a bicycle being within 5 to 10 ft and is eagerly anticipating the steak, introduce the cue for sit and watch.

> The bicycle appears and the handler gives the learner the command for sit and watch and immediately produces steak.

> Gradually decrease the distance between the dog and the moving bicycle, with each exposure predicting delicious steak.

Unwanted behavior: Fear of insulin injection

Approximations:

• Touch the drawer where the syringes are kept.

• Open the drawer.

• Make the syringe visible.

• Make the insulin bottle visible.

• Approach the dog while holding the syringe and bottle.

• Approach the dog while the opening syringe wrapper.

• Draw up the medication from the bottle into the syringe

• Approach the dog with the syringe while touching the pet (progress through the side, shoulder, injection site, tenting skin, lightly pinching skin and firmly pinching skin).

• Hold the syringe while performing touch, glide, tent and pinch in real-time sequence.

• Repeat the touching regimen and add a simulated injection with a capped syringe.

• Pinch with your fingernail or use a blunt cannula to more closely simulate injection.

• Show syringe, touch, glide, tent, pinch, inject and rub. 

Classical counterconditioning: Each approximation predicts something desirable like a piece of chicken or an opportunity to chase the tennis ball.

The dog will eventually learn to show up to participate (and earn something it loves) when the owner simply touches the drawer where the syringes are kept.

Preventive classical conditioning: Classical conditioning may seem like the enemy so far, but you can make it your friend by using it to develop strong, desirable emotional responses in pets. Common target stimuli include cat carriers, nail clippers, ear cleanser bottles, toothbrushes, grooming tools, syringes, thermometers, physical exam components and restraints. 

Using feline nail trimming as an example, you could try the following approximations:

• Present the nail clippers.

• Present the nail clippers while lifting the cat's paw. (Progress through the shoulder, elbow, mid-limb, carpus, toe, exposed toe and exposed nail).

• Touch the nail clippers to the cat's toe.

• Touch the nail clippers to the cat's toenail.

• Encircle the cat's nail with clippers.

• Clip a nail.

Each of these approximations predicts something wonderful, like a favorite treat or play with a favorite toy. Eventually, the cat will come running to participate when the owner gets out the nail clippers.

Go mold some minds!

Proper “brainwashing” is an investment that can pay huge dividends in the long run. Patience and planning are the keys to success, which is why it can be helpful to write out a plan and stick to it. Download our free brainwashing worksheet here.

Monique Feyrecilde is a certified veterinary technician specialist in behavior and the former president of the Society of Veterinary Behavior Technicians. She is a Fetch dvm360 conference educator and the co-author of Cooperative Veterinary Care. You can learn more about Feyrecilde and her behavior consultation services at teachinganimals.com.