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Environmental enrichment in veterinary practice

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 Clinical
Environmental enrichment in
veterinary practice
Abstract
Most research on environmental enrichment (EE) for dogs and cats has been con-
ducted in shelters and refuges. It is suggested that certain types of visual, sensory,
auditory and olfactory enrichment reduce stress. When incorporated into practice
policy, modifications to everyday husbandry can be used as strategies to create an
EE programme. The benefits of EE, as shown in rescue shelters, can be extrapo-
lated for use in hospitalized patients and could prove to be an effective stress
management tool. Further empirical research within veterinary practice is neces-
sary to evaluate the clinical relevance of EE.
Key words: environmental enrichment, veterinary practice, stress, welfare
F
or many companion animals, a visit to their
veterinary surgeon can be a very stressful and
anxious experience. It frequently represents a
novel environment or may be associated with previ-
ous adverse experiences. Stress factors for pets can
include an unfamiliar environment, separation from
family, the presence of other animals, noise and nox-
ious procedures performed by strangers; they cannot
predict or control what happens to them. By being
aware of the signs of stress and anxiety in hospital-
ized patients and providing structured, evidence-
based approaches to environmental enrichment
(EE), the welfare of patients can be greatly improved.
The degree to which a patient is stressed by a visit
to, or stay at, a veterinary clinic and the degree to
which it suffers because of this depends on the ani-
mal’s experience, genetics and capacity to avoid or
control their situation (Bradshaw and Goodwin, 1998;
BCSPCA, 2004; Hewson, 2008). This article aims to
outline some simple approaches to reducing stress in
hospitalized dogs and cats using both proven meth-
ods and methods with overwhelming anecdotal evi-
dence. A structured programme of EE has benefits to
not only the patient but also the pet owners and the
veterinary practice team.
Rebekah L. Scotney GradCertVetSt AssDipAppSc
CVN is Manger of the Clinical Studies Centre at
the School of Veterinary Science, University of
Queensland, Gatton Campus, Gatton, Queensland,
Australia
140
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The stress factor
Research shows that animals undergo physiologi-
cal changes, including increased heart rate and
cortisol release, that are associated with negative
feelings such as anxiety or fear (Gregory, 2004).
Furthermore, some dogs and cats do experience
extreme stress through being separated from their
owners and kept in a cage (Valsanen et.al, 2005;
Dybdall, 2007; Hewson, 2008). Owners want to see
that their pet is as relaxed and as happy as possible
when hospitalized and so the traditional primary
concern of veterinarians and veterinary nurses re-
garding the health of clients’ pets must be extend-
ed to include how the pet is feeling when in their
care.
An adverse mental health state (especially if pro-
longed) has the potential to exacerbate pain, slow re-
covery and affect an animal’s general health (Hewson,
2008). Secondary to this, a stressed patient (Figure
1) can be difficult to manage and as such is at an in-
creased risk of injuring itself or personnel.
It must be recognized that there is a significant pos-
sibility that animals can experience positive feelings
as well as negative, as acknowledged by those working
in all facets of the animal industry (Hewson, 2008).
Concern for animal welfare has tended to cause veteri-
nary practitioners to overlook the possibility of giving
pleasure to animals that may not be suffering, but that
would enjoy a better quality of life given some, gener-
ally very simple, changes to their husbandry (Fraser
and Duncan, 1998; Duncan, 2006; Hewson, 2008).
Figure 1. A typical stance of an anxious dog:
cowering, lip licking and tail between legs
(Brooks, 2010).
December/January 2010/2011 • Vol 1 No 3 • The Veterinary Nurse
 Clinical

Table 1. Some of the more common signs of stress in dogs and cats
Dogs Cats
Increased heart rate √ √
Increased respiratory rate √ √
Dilated pupils √ √
Tense body posture √
Hiding in back of cage or box √ √
Inappetence (loss of appetite) √ √
Lack of interest in the environment √ √
Lack of interest in people √ √
Panting √
Vocalizing √ √
Over grooming √ √
Lack of self care √
Pacing √ √
Circling √
Jumping against cage front √ gests that cats who have shown signs of stress when
Salivating √ √
Coprophagia √ plane for some hours or days after returning home,
(Flannigan and Dodman, 2001; Wells, 2002; Graham et al, 2005; Hewson, 2008; Ellis, 2009;
Segurson 2009)
Literature relating to the positive impacts and effects
of EE on the behaviour and health of cats and dogs re-
lates mostly to animals in shelters, pounds and rescue
centres (Wells, 1998, Wells, 2000; Reinhardt and Rein-
hardt, 2002; Graham, 2005; Tod, 2004; Gourkow and
Fraser, 2006). However, little research has looked at the
benefits of reducing stress within the veterinary clinic.
Proven strategies include human handling (outside of
veterinary procedures), grooming, feeding enrichment
and play therapy, and incorporation of these into an EE
programme as part of practice policy would be an easy
task. EE can be implemented as a preventative meas-
ure for animals that experience stress associated with
hospitalization (Ellis, 2009).
Recognizing stress
Cats and dogs exhibit stress in many ways. For this
reason it is desirable that those working within a vet-
erinary clinic learn to recognize the signs of emotion-
al stress, as being distinct from pain-induced stress,
in hospitalized patients. Table 1 lists some of the com-
mon signs of stress in dogs and cats as extrapolated
from available research (Flannigan and Dodman,
2001; Wells, 2002; Graham et al, 2005; Hewson, 2008;
Ellis, 2009; Segurson, 2009). These signs can be used
as a tool in developing an appropriate EE programme
to suit individual animals’ needs.
McCune (1994) proposed that cats behaviourally
express their negative emotional states either actively
or passively. Table 2 gives a summary of passive and
active behaviours commonly exhibited by cats in re-
sponse to confinement. It is critical to be able to rec-
ognize both types of cats as typically the passive type
cats are thought to be ‘content’ when in fact it is more
likely that they are depressed. Riccomini (2007) sug-
hospitalized can continue on a negative emotional
with cats hiding, not eating and showing aggression.
These behaviours are of particular concern in sick or
convalescent animals as their health is already com-
promised and additional stress may delay healing.
Similarly, exposure to novel environments or previ-
ous negative experiences, together with the processes
of restraint and the perceived inability to escape from a
potentially threatening situation, may provide specific
cues for aggression in dogs (Archer, 1976). Fear, anxiety
and frustration may also result in preparatory arousal
and lower aggression thresholds further (Panksepp,
1998). As a result, some dogs can be extremely difficult
and dangerous to handle at future clinic visits. There-
fore, it is imperative to ensure an animal’s initial visit
to a veterinary surgeon is as stress free as possible. In-
corporating EE into clinic policy and procedures may
contribute to providing a stress free experience.

Table 2. Active versus passive expression of emotional states in cats

Active Passive
• Often at front of cage • Behavioural depression (inhibition of
• Rears on hind legs, attempts to climb cage maintenance behaviours, i.e. feeding,
• Attempts to escape by pawing at exit point drinking, grooming, eliminating)
• Paws anyone passing cage • Immobility, attempting to hide
• Paces at front of cage/exit points • No vocalizations (although may use defensive
• Vocalization (constant yowling/miaowing) vocals, i.e. hissing and growling, if
• Aggressive towards people/animals approached)
• Destructive • Lack of interest in environment and people
• Soiling outside litter tray
(Adapted from Ellis, 2009)

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Current research
Traditionally, research investigating stress in dogs
and cats has been primarily focused on shelter en-
vironments. While the length of stay for animals in
a shelter can be very much longer than a patient’s
stay in hospital, many of the recommendations
that arise from these studies can be extrapolated
for use in the veterinary clinic. One particular
study (Gourkow and Fraser, 2006) compared stress
in cats housed in traditional cages (Figure 2) with
those housed in enriched cages (Figure 3) at a shel-
ter. Stress was measured using the well-document-
ed Cat-Stress-Scores (Kessler and Turner, 1997;
Gourkow and Fraser, 2006). The traditional cages
contained food, water, a litter tray, newspaper on
the floor and a towel for bedding, coupled with in-
consistent interaction with various caregivers. The
enriched cage was similar but had a shelf attached
half way up the cage door with a towel draped over
it in order to allow cats to perch on top of the shelf
or hide under it. Cats in these cages also had ac-
cess to toys and had the same caregiver for feeding,
cleaning and social interaction.
The results showed that cats housed in the tradi-
tional cages were significantly more stressed than
The Veterinary Nurse • Vol 1 No 3 • December/January 2010/2011
Clinical
those housed in the enriched cages. They exhibited
the most fearful behaviour as indicated by a higher
score in the Cat-Stress-Scores (Gourkow and Fraser,
2006). The clinical component of this study, which
was undertaken secondarily, measured the develop-
ment of illness. Data showed that more animals (14%)
housed in the traditional cages were moved to isola-
tion because of illness when compared with animals
housed in the enriched cages. While this is not defini-
tive it is certainly consistent with research on the ad-
verse effects of persistent stress on health in humans
and laboratory animals (Connor and Leonard, 1998;
Moberg, 2000; Dobson et al, 2001; Hewson, 2008).
Other studies have looked at the influence of au-
ditory and olfactory stimulation on the behaviour of
dogs (Wells et.al, 2002; Graham et al, 2005). Wells
(2002) reported that the behaviour of kennelled dogs
was significantly influenced by the type of auditory
stimulation provided to them. Dogs in this study
were exposed to classical music, heavy metal, pop
and human conversation (radio programme with no
music), and although the specific effect of classical
music is unknown it resulted in dogs spending more
time resting and less time barking. Heavy metal ap-
peared to agitate the dogs and neither pop nor human
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 Clinical
Figure 2. Traditional cat cage.
conversation had any obvious effect. It is common in
both shelter environments and veterinary clinics for
staff to listen to general radio programmes and this
may contribute to the apparent lack of response to
this stimulus. Wells (2002) suggests that the reac-
tions to both classical and heavy metal are due to the
novelty factor of these types of music. However, the
reactions to each form of novelty music were quite
different, with heavy metal music resulting in in-
creased barking and more arousal and activity. This
is consistent with studies with human subjects where
heavy metal music has an arousing effect (Gowen-
smith and Bloom, 1997).
More recently, a study has been carried out in-
vestigating the effect of ‘dog-laughter’ (pronounced
breathy forced exhalations from a dog) which had
been recorded and played back to shelter dogs (Si-
monet et al, 2005). This study revealed significantly
Table 3. Separation-related behaviours
Destructiveness Excessive licking
(scratching or chewing bars to escape)
Vocalization Anorexia
(frequent whining, barking and howling)
Elimination Gastrointestinal problems (vomiting
(frequent urination and defecation) and diarrhoea)
Vigilance Hyper-salivation
Trembling Pacing
(Adapted from Kim et.al, 2010)
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Figure 3. Enriched cat cage.
less behavioural signs of distress (lunging, growling,
barking, pacing, salivating and avoidance) in dogs
exposed to dog-laughter compared with those who
were not exposed. While no known studies have been
carried out to date using dog-laughter in a veterinary
clinic, it is believed that the same stress-reducing
benefits could be achieved in hospitalized dogs as
seen in shelter dogs.
Additionally, the significance of odours for psy-
chological well being is well recognized in human
literature and as such has prompted research into the
value of olfactory stimulation as a means of EE for
animals (Wells et al, 2002; Pageat and Gaultier, 2003;
Graham et al, 2005). Pheromone enrichment is the
provision of synthetic pheromone products within
an animal’s environment in order to improve welfare
(Ellis, 2009). There have been a number of empirical
studies conducted in this area that suggest the use of
pheromones is successful in reducing anxiety, stress
and associated behaviours as well as facilitating
positive interactions both intra and inter specifically
(Pageat and Gaultier, 2003; Graham et al, 2005; Tod et
al, 2004; Mills et al, 2006; Kim et al, 2010).
Dog appeasing pheromone (DAP) (CEVA Santé
Animale) is designed to imitate the secretions of
sebaceous glands in the intermammary sulcus of
bitches shortly after parturition. DAP is a synthet-
ic mixture of fatty acids formulated as a spray or a
diffuser. It has been reported that DAP has calm-
ing effects in dogs in a range of stressful situations
including separation from their owner (Pageat and
December/January 2010/2011 • Vol 1 No 3 • The Veterinary Nurse
 Clinical

Gaultier, 2002). A study by Mills et al (2006) con-

cluded that initial exposure to DAP in the veterinary
clinic appeared to help reduce the signs of anxiety
associated with the less aversive aspects of a visit to
the veterinary clinic.
A study of 43 hospitalized dogs in South Korea,
housed for more than 4 days, evaluated the effect of
DAP on ten typical separation-related behavioural
signs (Kim et al, 2010) (Table 3). A control group of
19 dogs was evaluated first; these dogs were exposed
to placebo (empty) diffusers that were covered with
opaque tape to avoid visual identification and in-
stalled 1.8 m high on the wall of the sickroom. A fur-
ther 24 dogs received DAP through diffusers placed
as the placebo diffusers. All diffusers were changed
Figure 4. Food enrichment is a simple yet
once a month. While this study had limitations with
effective tool in reducing boredom.
methodology and standardization, when comparing
baseline and final assessments, there was overall im- Feliway (F3) and Felifriend (F4) (CEVA Santé Ani-
provement in separation-related behavioural signs in male) are synthetic facial pheromones. Observations
the DAP-treated group, in particular elimination, ex- of cats treated with Feliway have shown not only a de-
cessive licking and pacing (Kim et al, 2010). crease in urine marking and scratching, but also an

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 Clinical

Figure 5. Conspecific enrichment with house

mates may alleviate stress in hospitalized
cats.
improvement in feeding, scanning and playing; there
is a direct correlation between the use of F3 and a de-
crease in anxiety (Pageat and Gaultier, 2003). There is
evidence that F3 does have an anxiolytic effect when
used in a clinical situation; it has been shown to calm
cats before intravenous catheterization (Mertens,
2001) and prevent stress-induced anorexia in hospi-
talized cats (Griffith et al, 1999). Furthermore, F3 has
been shown to have a great emotional stabilization
effect (Pageat and Gaultier, 2003).
Figure 6. Tactile interaction such as
massage can help calm stressed or anxious
animals.
F4 facial pheromone is marketed primarily for use
as an aid in intra- and inter-specific interactions. It
helps reduce the risk of aggression caused by han-
dling and facilitates peaceful introduction of unfa-
miliar animals (Pageat and Gaultier, 2003). The suc-
cess of the treatment is determined by the willingness
of the cat to mark (facial rubbing) unfamiliar people
or animals.

Table 4. Classification of environmental enrichment strategies

Category Sub-section Examples of potential enrichment strategies
Cats Dogs
Animate Intra-specific Feline companions Canine companions
Inter-specific
— human Play therapy, handling, grooming, Structured play (ragging, frisbees,
massage, training sessions retrieval games, training sessions
Inanimate Physical space
— vertical Shelving and hammocks Platform or plinth
— materials Bedding, litter material, grass Bedding, sand bowl, grass bunches
bunches
— structures Boxes, scratch posts/natural Tunnels, sand pits
wood, tunnels
Feeding Hiding food : activity balls, Hiding food, scatter feeding,
plastic bottles, food pyramids, activity balls, plastic bottles, kongs,
treat puzzles treat puzzles and frozen blocks
Toys Wire-based toys, bird bells and Raggers, balls, tugs, squeak’s, soft
mirrors, fishing rod toys toys

Sensory
— visual Other animals, TV, window, visual Other animals, TV, window,
access to staff, blocking visual blocking visual stimulus may also
stimulus may also be enriching be enriching
— auditory Classical music, running water, Classical music, dog-laughter
— olfactory Catnip, essential oils Essential oils, prey odours
— pheromone F3 and F4 facial pheromones Dog appeasing pheromone
(Adapted from Ellis, 2009)

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 Clinical

(Figure 5). Whatever the strategy used, it is important

Key Points
zzA visit to the veterinary surgeon can be a very stressful and anxious experience
for some companion animals.
zzIt is important for veterinary staff to be able to recognize the signs of ‘emotional’
stress in hospitalized animals.
zzIt is suggested that incorporation of environmental enrichment (EE) into prac-
tice policy may reduce stress associated with hospitalization and separation
from owners.
zzEE programmes may utilize different types of visual, sensory, auditory and
olfactory enrichment.
zzEnrichment such as food balls and activity cubes or the use of pheromones such
as Dog Appeasement Pheromone (DAP) or Feliway are examples of simple yet
effective ways to integrate EE in practice policy.
zzFurther investigations into the effects and benefits of EE in veterinary practice
are warranted.
Further studies have been conducted on olfactory
stimulation using certain odours (Wells and Egli,
2004; Graham et al, 2005). Many of these studies
report changes in the behaviour and/or physiology
of animals exposed to a variety of aromas including
herbs, spices, essential oils and the excrement, or
body odour, of potential prey. As Graham (2005) apt-
ly points out, the findings from such work and their
implications for animal welfare are not conclusive.
However, the results in terms of positive changes in
behaviour and physiology cannot be denied.
Turning information into action
EE in the context of veterinary clinical practice can be
as simple as adding a new CD to your collection or as
elaborate as providing food dispensers that operate
in response to particular behaviours (Figure 4). Com-
municating with clients and making arrangements
for house mates to be hospitalized together, where
appropriate, can also provide beneficial enrichment
to remember that for an environmental intervention
to be considered enriching, the changes produced
must be linked to an improvement in the welfare of
the animals (Ellis, 2009).
Feliway diffusers used as standard protocol in feline
wards can enhance the mental wellbeing of hospital-
ized patients. This, together with soft music and the
use of Felifriend sprayed on hands before interacting
with a cat or even a small amount sprayed on bedding
will contribute to ensuring an animal’s stay in clinic is
as stress free as possible.
Additionally, it should be remembered that human
tactile interaction (Figure 6) provides highly valued
enrichment to companion animals. The majority of
domesticated pets are gregarious animals who relish
human company. It is important that human contact
with hospitalized patients is not restricted to moni-
toring and treatment only. To prevent negative asso-
ciations with human contact in the veterinary clinic,
all personnel should heed the ‘three-to-one’ rule: for
every unpleasant or invasive experience, three posi-
tive experiences should follow (Shaffran, 2005)
Strategies can be classified as animate or inani-
mate, and within these classifications are subsections
as summarized in Table 4.
Conclusion
EE is the process of adding one or more factors to an
animal’s environment in order to improve the physi-
cal/psychological welfare of the animal (Ellis, 2009).
Integration of a simple yet effective stress manage-
ment programme for hospitalized dogs and cats pro-
vides holistic care within the veterinary practice.
Moreover, further studies are warranted on the ef-
fects and benefits of EE in veterinary practice. VN
Conflict of interest: none.

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