Understanding phobia and anxiety in patients

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A dog’s quality of life can be significantly affected by noise phobia and anxiety. However, intervention with a comprehensive approach can be beneficial to the canine patient as well as the client.

In an educational session at the 2025 Fetch dvm360 Conference in Charlotte, North Carolina, Christopher Pachel, DVM, DACVB, CABC (IAABC), owner and lead clinician at the Animal Behavior Clinic in Portland, Oregon, provided an overview of noise phobia and anxiety in dogs. The lecture included intervention strategies that can be used to help mitigate physical and emotional distress.

Patient perceptions

Pachel began his talk describing fear, phobia and anxiety, emphasizing that these emotional responses are not the same and the severity of responses vary. “There's a whole range here, from normal, appropriate fear and anxiety all the way up to significantly pathological, significantly dangerous, both to the individual as well as to others in their immediate vicinity,” Pachel said.

The perception of fear for the patient has an identifiable trigger that causes distress and often results in a survival mode response. This response may reflect the patient’s past experiences.

A phobia is nonadaptive and may prompt persistent or excessive fear. Severity of the response may be out of context to the intensity of the stimulus, according to Pachel. Triggers can be discernible objects or situations such as thunderstorms, fireworks or other sudden and loud noises. In a video example shown during the lecture, a dog reacted to an owner’s sneeze with apprehension, and backed away until realizing there was no threat.

Anxiety is the anticipation of a threat, according to Pachel. The outcome is more unpredictable, and the trigger may be difficult to identify. “We can tell that they're stressed, but there's not really something that we can pin our finger on as to what exactly is eliciting that emotional state. This often happens in scenarios where ‘something bad’ has happened before, or in scenarios where the outcome is somewhat unpredictable, or in scenarios where the animal doesn't have any degree of control or agency over those outcomes or consequences,” he added.

One video example of anxiety Pachel shared with Fetch attendees involved a shaking, visibly apprehensive dog that waited by a window for teen boys in the family to come home from school. He explained that boys were known to “rough house,” frequently causing distress for the dog.

Patient responses

Fear, phobias and anxiety often lead to coping strategies that can be classified as active or passive. “So, the active responders, these are often the animals who are likely to move. They’re pacing. They’re exit-seeking. They're panicking, but that's manifesting as movement and more active strategies,” Pachel said. “We also have some of our animals that engage in more passive strategies, where they essentially freeze, hunker down, and respond more with immobility.”

Escaping the situation, a form of fight or flight for survival, is one form of an active response. Physically, a pet may experience hypertension, tachycardia or other autonomic changes. “These physical responses are actually normal,” Pachel said.

Passive physical responses include autonomic inhibition such as hypotension and bradycardia; and increased neuroendocrine activity such as cortisol secretion. Passive response also includes freezing when a threat is inescapable.

“Individual differences in learning history and experiences, socialization, and stimulus exposure context can significantly influence the development of these and other coping strategy variations,” Pachel said. In helping an animal manage their fear, phobia or anxiety, he noted that “there isn't a one-size-fits-all [solution] here.”

Managing emotions

Medical conditions may be contributing to a patient’s behavior perceived as fear, phobia or anxiety. Once a medical condition has been ruled out or identified, an appropriate treatment plan can be created.

To manage a patient’s emotions and behavioral responses, there are a variety of intervention strategies that can help. Desensitization and counterconditioning can help modify a patient’s response to canine noise phobia, for example. “This involves controlled exposure to noise below the stress response threshold and gradually increasing intensity, paired with positive reinforcement,” Pachel said.

Comfort tactics can include pheromones and nonpharmaceutical products. Use of a pheromone diffuser or products such as Thundershirts or iCalm can help destress an animal. Playing calming music and allowing a pet a safe space with favorite items such as blankets or toys, can also be beneficial.

To comfort a patient experiencing fear, pharmaceuticals can also help. Pachel noted that maintenance medications are most useful for frequent and unpredictable triggers, while quick-acting situational drugs help manage predictable, infrequent triggers.

Takeaways

Overall, Pachel said, a comprehensive approach is needed to manage fear, phobia and anxiety, and timing for an intervention is important for its’ success. Effective treatment for these emotions and their responses can improve the quality of life for the patient as well as the owner.

Reference

Pachel C. Canine noise phobia and the anxiety patient. Presented at: Fetch dvm360 Conference; March 14-16, 2025. Charlotte, NC.