Hello, everybody. And welcome to this webinar. I'm gonna be talking today about, comprehensive healthcare and as understanding the concept of the health triad and how it impacts on behaviour.
My name is Sarah Heath. I'm a veterinary specialist in behavioural medicine. I work out of a clinic, based in Chester.
And I am also involved in teaching undergraduate veterinary students at Liverpool University and doing a variety of different, CPD lecturing, et cetera various conferences and and write a little bit in, terms of papers, books, et cetera. So that's me. Welcome.
This is a prerecords. So we won't be doing any interactive, questions and answers. If you do have questions coming from this webinar, please do contact webinar that and they can get in touch with me.
OK, so let's get going. If we look at our learning outcomes for this webinar, we're gonna think about this concept of a health triad. Think about how, this impacts on the delivery of comprehensive healthcare to our patients, our nonhuman animals that we are responsible for providing healthcare for thinking about emotional and cognitive health and the role of both of those when we're offering therapeutic approaches in our patients who have physical disease, and also thinking about how that health triad is important to consider when we're presented with behaviours, which are causing concern for their caregivers.
I wanna start off with a question mark of What do we think of when we think of health? And one place to look is the World Health Organisation and back in 1948 a very long time ago, they defined health as being a state of complete physical, mental and social well being, and not merely the absence of disease or infirmity. So that's a long time ago that we were recognising in the human animal that health was far more than just not being physically unwell.
And they refined their definition in the eighties in 1986 thinking about health as a resource. So this idea that health is not an end point in its own right, but is a resource something you need for everyday life rather than the objective of living. And so that practical effect coming from that assignment in 1986 was to see health as something that was a resource to support functioning of an individual within wider society rather than an end in itself, as I say, and led to the idea of a life worth living.
So a healthful life providing the means to leading a full life with meaning and with purpose. Now, of course, the World Health Organisation is an agency, charged with spearheading international public health efforts for human animals. So it talks about a world in which all peoples human animals attain the highest possible level of health.
But more recently, the WHO has been involved in the initiative of one health which you may well have heard about. And the one health initiative is defined as being an integrated, unifying approach to balance and optimise the health of people. So that for me, is human animals, animals, which would be the nonhuman animals and also, of course, the environment.
So again, thinking about health in this much broader setting, when we think about the individual patient in a veterinary context, what do we mean by health for our patients? Well, in the heath model, talk about the fact that we are guarded with, looking after the health of nonhuman species and that of course comes from the Veterinary Surgeons Act. So we are given this responsibility that we're the guardians of the health of nonhuman species.
The art and science of veterinary surgery and medicine is defined within that act as here, so about diagnosing diseases and injuries, about performing tests, giving advice, doing medical and surgical procedures, et cetera. And very much the emphasis at the time when the Veterinary Surgeons Act was coming into existence in 1966 was thinking about physical health. Now, of course, it doesn't say that.
And when we make our oath, as we become veterinary surgeons, we talk about the health and welfare of our patients being our prime concern. We don't say their physical health. And so the diagnosis of disease and injury doesn't have to be restricted to physical health.
And certainly it doesn't say that there was an assumption. I think in the past that that's what was meant. But if we think more broadly about health and we think about this so called health triad, the idea of a multidimensional process of healthcare, that's what I mean by comprehensive veterinary healthcare.
So this triad is of equally important aspects that are inextricably linked to one another. We have, of course, the physical and the physical is what as we've just said. Traditionally, the veterinary profession has majored its attention on in terms of the undergraduate veterinary curriculum, the veterinary nursing curriculum.
But there are these other two components, the emotional and the cognitive. And if we look at the pictures I've used here to represent those different parts of the triad, you can also see that they're linked to one another. So if we look at the golden retriever, being used as an example of physical health is in a veterinary practise setting.
But you can also see that there's an emotional component to him at this point. So as you can see from his facial expression from the positioning of his ears, et cetera, and we'll touch on that a little bit more as we go through this webinar that he's having an emotional experience. And of course, he's also cognitively forming memories of this veterinary visit.
And we know that that can have an impact of course, on behaviour at future visits. If we look at the little Jack on the other side of this top row of photographs, which I put in as an illustration of cognitive health He's doing Fly ball Fly Ball is a sport based on learning, and so they learn to run at the after the ball and to pick up the ball to run. So it's a cognitively learned behavioural sequence.
But of course it's based on emotion. You need the emotion of desire, seeking to want to chase the ball in the first place. And there's a physical health component as well, to fly ball with that repeated banging against the plate.
And you can see that twisting of limbs that happens during that process that has a potential to impact on their physical health and then in the middle. If we go to the bottom of the middle for the dog picture here showing, illustrating emotional health so we can see the whale eye there, which is a sign of protective emotional bias, we can see the ear position, the furrowing across the the the brow there. But also this dog is in a situation with a visitor in the home.
There's a cognitive component learning about people coming to the house, and also there's a physical health component because this individual also has chronic diarrhoea, So gastrointestinal health issues linked to that emotional health. So we can use the photographs to illustrate each point. But we can also see that they are inextricably linked and comprehensive.
Healthcare, which is the topic that we're talking about today, involves acknowledging and optimising all three of these components, so there are complex interactions between them. Successful healthcare can't be achieved unless all the aspects are considered, and that's where the veterinary discipline of behavioural medicine comes in. Behavioural medicine is a veterinary discipline.
It's a branch of internal medicine. And it's where we consider all three aspects of the interplay between them, with the aim of delivering comprehensive veterinary healthcare represented here in this idea of this triangle between physical health, which is normal physical functioning, cognitive health, which is the ability of the individual to think, learn and remember, and emotional health, which is about their ability to cope with a range of engaging and protective emotions. And so in behavioural medicine, we are looking at the overall health care of our patients, and the health triad is important in all aspects of veterinary work.
When we have patients presented to general practises. Generally, the main reason for coming for your assistance is physical health, and that is traditional, as we said earlier. But even when they come to you with a physical health presentation, we still want to be considering their emotional and their cognitive health.
In fact, this is the whole basis of cat friendly and dog friendly approaches to veterinary practise. And, I the logos will come up in a minute. Cat friendly practise, run by, international Cat care dog friendly practise run by the British Veterinary Behaviour Association in conjunction with dogs.
Trust both schemes that are looking at this idea that there's more to the veterinary visit than purely the physical. And when we're diagnosing and treating physical health conditions, we can't consider that in isolation. So when you think about the emotional and cognitive health considerations in veterinary practise work being at many different levels, firstly, we think about the contribution of considering these on the impact of the veterinary visit.
And again, these two organisations cap friendly clinic and Dog Friendly Clinic are really giving a lot of information and assistance to veterinary practises about how to make that veterinary visit better for the patient and for the caregiver from an emotional point of view so that the cognitive part, what they learn from that visit is as beneficial as possible with the ultimate aim of providing better physical health care. But there's far more to behavioural medicine and the integration of the health triad than just thinking about the visit itself. Also, we think about it in terms of aetiology.
So there are physical health conditions for whom there is an ecological influence from emotional health. And I gave the example in those photographs earlier of that dog that was showing signs of protective emotional bias and had a history of chronic diarrhoea. So we have things like physical health conditions of gastrointestinal origin, dermatology, bladder disease, which we're very familiar with, maybe in a feline context, where we acknowledge that the emotional component of health has an etiological influence on those health conditions.
But of course, there's also the consequential relationship. So there's the potential for a health condition. Be that a physical health condition, primarily having an impact on the emotional and cognitive health of that individual.
So if they have mobility issues for example, chronic pain that has an emotional dimension to it. And being in chronic pain has an impact on your emotional resilience and on your level of emotional arousal. So there's a consequential relationship, and then we also need to consider the administration of treatment for the physical health conditions that we are dealing with that we give our caregivers advice.
We send them home with, medications to deliver to their patient. Or we say that they need to come back to the veterinary practise on a regular basis for the administration of treatment. And this may have a consequential relationship in terms of their emotional health.
So we have all of these areas where the health triad impacts on our work as veterinary practitioners, be US veterinary surgeons or veterinary nurses. So it's gonna look at that, the different contributions for a minute. Sorry.
That video has come in, too early. Not sure why the, bond isn't there. It's not working.
Sorry. So recent interest in the impact of veterinary experiences on emotion and cognitive health has led to the development of pre veterinary visit medication protocols. That's one area where this acknowledgement that emotional health is important has led to us talking more about the use of medication prior to coming to the veterinary practise or giving medication on arrival.
This protocol here by zero pain philosophy, Doctor MC gurney and myself at behavioural Referrals Limited, we have put together protocols for you to use In general practise. These are freely available, so please do contact either zero pain philosophy or behavioural referrals. Either of us can make these available to you in PDF format for you to use within your practises.
And there are some concerns. I think about pre veterinary visit medication usage and some, misinformation out there. And people using sometimes very, very high doses and multi polypharmacy approaches without justification.
So I think it's something we do really need to think about very carefully. Make sure that we use protocols that are appropriate, and making sure that we're using them for the patients who need them, not as a blanket. We shouldn't need to give pre veterinary visit medication to everybody coming to a veterinary practise, because the dog friendly, cat friendly clinic principles also need to be applied, which is very much emphasised in these protocols.
That's one area where there's an influence. The next is interest in. I'm just gonna see if I can get rid of this video cos you're not gonna be able to see.
No, I can't. So there's an image under here of a puppy. So interest in cognitive preparation of patients through socialisation and habituation is an important thing to think about the sort of advice that we give to our puppy and kitten caregivers so that we prepare patients for the veterinary visit in ways that minimise the potential impact of that visit on them and create more of a positive experience.
And then also, we have, the situation as well, where we give advice, about considering specific emotional and cognitive needs. We're designing our veterinary environments and protocols and again hidden by this video, I'm afraid, is a picture of a cat ward with a sign on the door that just says, to be quiet and to have conversations outside of the ward. This idea that sensory input for our feline patients needs to always be thought about with their species in mind.
But remember, that's equally important for any species. The cat friendly practise has been going for longer than dog friendly and rabbit friendly practise schemes. But it applies to all species that we should make species specific emotional and cognitive decisions when we're designing our environments and our protocols.
And then the video that stubbornly sat there throughout that slide. I'm sorry, is this interest in the concept of consent based care? And this is staff at, RS PC, a New South Wales working on consent based care.
Getting this dog to learn to use a chin rest onto this chair to signal the ability to interact with him so that he is feeling more confident and in control when we touch him rather than it, taking him by surprise and causing emotional challenge for him. So consent based care is something you may have read about and again, not a topic that I'm gonna go into in great detail today. But I just want to touch on it as being one of the aspects of how we can influence the impact of the veterinary visit in terms of emotional and cognitive health moving on.
Then, if we think about the etiological influence of emotion and cognition on physical health. You probably immediately think about felon idiopathic cystitis, thanks to the work of Tony Buffington and also many, many colleagues at Ohio State, not just Buffington but Jodie Westrup. Dennis Chu, for example, highlighted this consideration of emotional factors when we are, diagnosing pline idiopathic cystitis and thinking about those challenges, those emotional challenges from an environmental perspective being part of the risk factors associated with F IC.
We also have information about the interplay between emotional health and other physical health conditions. I mentioned gut health with the dog earlier, but also skin disease. So here we have this paper from From Animals from Harvey et al.
Talking about behavioural differences in dogs with at topic dermatitis suggesting that physiological stress. So that's the physiological response to that protective emotional bias influencing their physical health and then going back to something. I also, mentioned in the photographs at the beginning when we were illustrating the types of health systems that there's a connection between activities such as fly ball, which again it developed through cognition training but may be associated with risks of physical through this paper Here, looking at injury risk factors associated with training and competition in dogs engaging in that particular sport.
So these are just examples of how there's an etiological influence between, emotion and cognition. When we think about physical health, what about consequential relationships or physical health conditions? Impact on cognition and emotion.
We have pain related conditions that can lead to cognitive impact. For example, animal like this one that has, pain related condition, meaning it's more difficult to get into the car, and then having issues with its ability to, comply if you like to use that word, with this caregivers instruction to get into the boot of the car, you can't do that because it hurts and then avoiding certain situations potentially because of the presence of pain. So we have a physical health condition, but we have emotional and cognitive impact.
Gastrointestinal disturbance. We've talked about from an etiological point of view from emotion impacting on gut function. But also gastro intestinal disturbance can alter the production of serotonin because of the fact that 95% of the body's serotonin is produced within the gut.
That means that if the gut is disturbed, serotonin, levels can be depleted and that can lead to emotional impact. And we have the potential for physical diseases of many types, particularly skin disease springs to mind. But other physical diseases which interfere with sleep, so disrupt sleep.
And that has an emotional component because of the fact that sleep is such an essential part of what we refer to in the heath model as drainage, so that letting go of emotional input once it's served its purpose. Sleep is a very important part of that mechanism. And when we disrupt sleep through the presence of physical disease, for example, in dermatology through scratch and itch, particularly at night, which then causes disruption, that also has an impact on the emotional health of that patient going forward.
The fourth area was the consequential relationship to treatment of physical conditions. So administration of treatment for the physical health conditions that we identify can have emotional and cognitive consequences, for example, things like eardrops and we're very familiar with reports, I'm sure, from caregivers about the impact of needing to give eardrops to their animals on a regular basis for cat caregivers, particularly. We may hear their complaint and their worry about the fact that they are struggling to give medication and that it is having an impact on their relationship with their pet and on their pets emotional and cognitive health.
And sometimes it can actually limit their ability to treat. It can mean that, yes, we've made a diagnosis of a physical disease. But we may be limited in our ability to actually go through the process of treating that condition if caregivers find it too difficult to administer it because of the emotional and cognitive impact on their pet.
So what's the impact then of the health triad when we think about behavioural rather than physical health presentations, when an individual's presented because their caregiver is worried about some aspect of their behaviour, we also need to be looking at those cases from a health triad perspective. So one of the features is the aim of behavioural medicine is that we identify the underlying cause. If you have signs identified, there can be a range of different factors, the same signs, the same outward manifestation, but different factors involved in why that manifestation is happening and you're very familiar with that.
So when our nonhuman patients vomit or when they have diarrhoea. You don't think of that as one condition. You think of that as a sign as an outward sign of something that could have a myriad of explanations.
And you'll go through a diagnostic process to identify the specific cause so that you can apply the right treatment for that individual. And it's no different when you have a presentation of behavioural change that the caregiver is struggling with, whether that animal is being confrontational towards themselves, towards other animals or towards people outside of the family unit, or whether they're destroying the property in some way and causing damage within the home. Whatever the presentation, it is just a sign and it needs the same approach, the same diagnostic approach of ascertaining what is the underlying reason for this sign?
Because that is gonna be the key to offering any kind of treatment. So we want to think about our patients presenting with behavioural concern in terms of the health triad. We first of all, think about potential physical health contributions to the aetiology of that behaviour.
So has some physical health condition. We talked earlier about pain, so we This is where we said there could be emotional consequences of physical health affecting behavioural output. So have we determined whether this animal is in good physical health, but then gonna consider the emotional bias of the individual?
The bias is when we talk about emotions being either engaging or protective, then it leads to being either optimistic or pessimistic, depending on which is the predominant state, and that will affect the individual's behavioural output. And we talk about the valence of emotion in other words, which type of emotion we're dealing with in terms of engagement or protection. We also need to remember that that emotional health is then impacting on cognition.
So if we look at that animal who was not getting into the back of the car, is there anything wrong with that individual in terms of understanding that getting into the car is what the caregiver wants them to do? No, probably not. But in terms of actually following through with the behavioural response, then they're not gonna be able to do that because of the emotion of the pain and the fear anxiety related to being in pain, which is impacting on their ability to actually process that cue and follow through with the behaviour and there's also a potential that cognition may have influenced the progression of this behaviour.
When we see this behaviour, we're not seeing it usually the day it started. Sometimes we're not seeing it till many months or even years after it started, and during that intervening time there will have also been cognition. This animal will have learned things that have influenced their behavioural response and then finally thinking about him, how emotional health may affect the success of cognitively based behavioural modification.
So yes, absolutely, when we have an individual with a behavioural response which is incompatible with domestic life that is incompatible sometimes with the welfare of the patient themselves, often also impacting on the welfare of the caregiver. Yes, In order to change output of behaviour, we are going to use behavioural modification. But that relies on cognition.
And if emotional health is out of balance, then they may not be able to cognitively respond to behavioural modification. So let's think about considering this aspect of emotional bias of an individual and how that affects their behavioural output. So we think about emotional motivations they are all about survive the behavioural responses that happen when an individual has an emotional response and are leading them to have a better chance of surviving an overall emotional bias?
Which emotional state is predominant? Is this animal more likely to engage and interact with the world around them as a consequence of this emotion? Or is it more likely to try and protect itself from the world around it?
That is assessed by looking at many factors. So we look at behavioural output, but we also look at their body language and that obviously relies on some species specific knowledge as well. So looking at body language can help us to have a better idea of the emotional bias of that individual.
So we use body postures, facial expressions where their ear and their tail are. All of these can be helpful in assessing that bias. So when we look at these two pictures here, we're gonna look at things like the ear position, tail position, the dog at the bottom.
I'm sure you can see that tail totally tucked under guarding the scent information from the anal region so it doesn't give too much information away. You see a little bit of a carrying posture. We can see the ears back.
We can see a furrow brow. We can see signs of body language that suggest a more P pessimistic bias. But the picture on the top also shows ears back doesn't show that frowning over the brow, it's much looser.
The eyes are much softer. There's some panting going on. The tail is in more of a a, an ambiguous position.
It's neither up nor down. And really, what I put this picture on here to illustrate was that we must think about context as well. The dog on the bottom is in a veterinary consul, waiting room area.
So we have the context of a veterinary visit. The dog on the top is actually in a park and near to its home and has just been playing socially with individuals that this dog is very, very familiar with. So they've engaged in social interaction that's been beneficial to all.
There's panting because of the respiratory effort because of running around. The ears are tilted that way because the activity of both the other dogs and people is behind the dog. And so we can see that in order to interpret body language.
It is absolutely crucial that you always also consider the context before you jump to any conclusions in terms of which emotional bias you're dealing with. So let's go through some of the body language that's useful for us as veterinary practitioners when we have animals coming into our practises. We need to remember that with dogs, particularly where we have a lot of breed variation in their aesthetics and their visual appearance, that also impacts their ability to vision signal.
So if we think about the way they've been bred selectively within many of these breeds for certain colorings, or they've had changes morph logically in terms of their ears or the length of their fur or the amount of Jing they have, whether they have short tails or don't have tails at all, in terms of, having been docked, obviously not in this country other than for sport or working dogs where it is still practised but generally thinking about these morphological differences. Hopefully we can see that sometimes those changes have been quite detrimental to them in terms of visual communication. And it's not surprising, then, that they have problems not only communicating with us but also communicating with other members of their own species.
But not the same breed. And it can also cause problems for us when we're trying to assess emotional bias because we may not be able to get such clear information from their body language. Body posture is important as giving an overall picture of the situation.
So here we have a more relaxed body posture, indicative of a more engaging emotional state. We've got that loose face, ears forward. But looking at the body posture, we can see a more engaging, bias protective emotional state might be associated more lowered or a more tense body posture.
Or also, of course, with body postures, which are species specific, designed to give a A an impression of being confident and capable. Like, for example, this cat with the PLO erection, over its back and its fluffing of its tail. And obviously we look at the body posture in combination with the facial expression as well.
What we also need to remember is many encounters with people socially obligate animals like dogs will often be conflicted because their social obligatory part of their behavioural response means that they are wanting to make contact. They see some potential benefit of that. But sometimes either because of emotional challenge or because of previous cognition and learning.
They may be anxious or apprehensive about making that encounter. And this is more likely in patients, as I say from socially obligate species. So if we think about dogs versus cats, that conflicting interaction may be more likely to occur in our canine patients.
But remember, the domestic cat is a domesticated species and does have slightly more potential to perceive benefit from social contact. So we do sometimes see emotional conflict in our feline patients as well. When we look at our dogs, then this idea of coming forward but their hind legs remaining extended so they're able to hold on to that potential to use avoidance in relation to their protective emotions should the need arise.
And then we have body language such as the raised paw in the dog, a sign of uncertainty. So we see dogs with this sort of posture in the wait in the waiting room or in the consulting room where they're lifting one paw. Then they're showing that they're uncertain that there's some level of potential for conflict, turning our attention then to the face animals that are in an engaging emotional state.
They're gonna have this relaxed facial expression that we hope to see in as many of our patients as possible. But we know that that's not always the case when individuals come into a veterinary context. So we may have anxious or fearful individuals and have more of a tense facial expression.
May have frown lines. They have tightness around the mouth and tense, tension in their ear posture. An engaging emotional state is often associated with a forward ear position.
So again, that's associated with the relaxation of musculature over the top of the head. So that brow becomes more relaxed, the ears come forward, and then a more protective emotional state being associated with this retraction of the ears, both for the because of the tension, muscular tension that drives those ears back. Also, of course, particularly in our feline patients associated with protecting the ears from harm.
And obviously, as you can see in the right ha left hand picture of the cat, there's inappropriate handling going on there as well. There's an inappropriate scuffing interaction, which should not not is not justified and should never be used. So here we see that inappropriate handling, intensifying the protective emotional state.
And so we're not only have we got the body language associated with it, we're now hearing vocal signals. As you can see from this photograph as well, we may think about pupils so dilated pupils commonly associated with a higher level of protective emotion because of the impact. Of course, of the S AM axis response is a physiological response, causing this dilatation of their pupil whale eye as well, a useful indicator in some canine patients that there is more of a protective bias.
This doesn't mean that protective emotion is the only thing present, but it's telling us that there's a bias towards that protection in that individual at that time. And, of course, we need to remember as well. Whiskers.
Whiskers are very important in our feline patients. They can be very indicative of emotional bias. So when we see them protruded and extended and in this very, sort of hardened state that you can see in this middle picture at the bottom, accompanied, of course, here by facial expression E position, et cetera.
So we never look at one of these things in isolation. We're looking at the combination of information that the individual is giving us. Tail also can be very expressive in terms of emotion.
In our canine patients. There's quite a wide range of tail in terms of morphology because of breed variation. When we have fear anxiety, then that tipping tip that Sorry that tail being tucked between the hind legs so that it's clamped down against the anogenital region reduces the availability of scent information for others stops them giving too much away.
But remember, when we interfere with tails and they are of different lengths, they may be less able to express themselves through the posture of their tail. And one area where we have an issue as well in cats is that, the tail can be held in that lowered position or tightly clamped to the body in association with protective emotion. But they also will use the PLO erection we saw in the earlier photograph, and you can see in this right hand picture they'll use that to fluff up the tail and make it look bigger.
Give a area of confidence. And so it may not be a lowered tail associated with protective emotion, but again, just looking at the situation. With the, image at the top here on the right, we can see a lot of other body language that's leading us to that conclusion.
The cat at the bottom is actually the black and white cat who's, in a more engaged state. Facially could cause some confusion. So we've got some PLO erection over the back and over the tail, but the ears are forward.
The face is forward, the whiskers are forward. This is looking like an engaging situation. And this is likely to be predation, potentially predation in a context where there's some potential for conflict.
It may be that it's a prey, species that's more of a challenge. Or it may be that there are other individuals present, but we're certainly seeing some conflict in this individual tail movement is linked to a level of emotional arousal, So rapidity of tail movement is associated not with the valence of the emotion and not the type of emotion, but more the amount of emotion. So it must always be interpreted in conjunction with other signals.
The fact the tail is moving does not tell us whether this animal is optimistic or pessimistic, engaging or protective. It tells us there's a high level of arousal, but then we must look at the other body. Language signals the context in order to interpret whether that tail movement means that they're protective or engaging.
And this is a particular challenge, I think in dogs, where there's a lot of misperception that dogs always wag their tails when they're happy. And so as soon as there's any tail movement, people jump to the conclusion that the animal is in an engaging bias as happy and enjoying in interaction. But that's not always the case and the wagging of the tip of the tail.
As you can see in this picture, because of the blurring, you can see that the movement is at the tip of the tail, and the the head of the tail is actually quite still. It's not blurred that that preferential wagging of the tip, rather than the whole tail, is actually seen in association with negative or protective emotion, whereas relaxed wagging along the whole length of the tail so the blurring of the whole of the tail is more associated with being in a relaxed, positive or engaging emotional state. So when we're investigating behavioural change, we want to assess that emotional bias.
And we can do that. In the early seconds of our consultation, we can do it used by training also our reception staff to be good at noticing emotional bias so they can pick up while they're watching them in the waiting room as to whether this is more a pessimistic or optimistic individual coming into the practise, and we can use those first few seconds of our time in the consult room when our aim through emotional assessment, is to understand the potential emotional motivations, particularly if they're coming with our presented behavioural challenge, which we're talking about here. But I also would do an emotional assessment of any patient coming into the practise, even if they were coming with a physical health consideration, because how you handle and interact with that patient will be determined by their level of optimism or pessimism.
But when we're looking at trying to understand a presented behavioural concern, certainly we want to identify which potential emotions may be involved, and we want to use that information to decide on management and treatment options. Cos Management and treatment should be tailored not only to the condition but also the individual animal with that condition. So no two individuals are the same, and it's not just the individual animal as well.
The nonhuman animal, our patient. It's also that they live with human animals, too. They live in a home environment, so every individual will have other issues involved with their environment, their social and their physical environment at home.
But emotional bias determines behavioural output, and what an animal does is the result of the predominant emotion. So the predominant emotion will be responsible for the most obvious behavioural response, the one that the caregiver has identified. But there can be more than one emotional system triggered at one time.
Emotions are not mutually exclusive, and we can have input from both engaging and protective emotions at the same time. We talked earlier about the concept of emotional conflict, so engaging emotion is in when we ha enhance engaging emotion. We don't remove pro protect protective emotion, so it's not an either or situation that you give them something like a treat or or play with them with a ball, and they are now only an engaging emotion or protective emotion is gone.
Neither does it mean that if you have a situation where an animal is in a protective emotional bias that that necessarily means there is no engaging emotion, they are not mutually exclusive. When we engage, we enhance engaging emotion, and we talk about that a lot in the veterinary context. In the consult room, we talk about giving treats.
When we're talking about the animal at home, we talk about social, sorry object play using, things like predatory style play for cats that will increase their engaging bias. It alters the relative predominance of emotion and that alters the behavioural output. We think of it a bit like a balancing scale when engaging emotions are predominant.
Then we'll have interactive behaviours like this little kitten exploring this flower. But if we swap it the other way round, so it's the protective emotions that are predominant. Then we'll see protective behavioural responses, and they are quite complex.
We have lots of options for the animals to how they display that protective emotion and we can categorise those into four main areas. So we have here. I hope you can see the cursor.
So this, in this group of four pitches, we have the top left hand P. We have a kitten using avoidance, so staying back from something that it perceives to be potentially challenging or harmful or unknown. So it's in a protective state using avoidance on the bottom left, we have repulsion.
So we have an individual that is in a protected bias, using its behaviour to get rid of something. And then on the other side, on the right hand side at the top. We have inhibition where this animal is protecting itself by gathering information from the world around it and then at the bottom, we have appeasement exchanging of information in order to resolve a potential concern.
So we've got a range of different behavioural responses that indicate that that protective emotion is the bias that that's the predominant emotional state. So, of course, when we are dealing with an animal displaying a behaviour that is unwanted, we want to alter that emotional bias. But we sometimes do that on a temporary basis, and otherwise we do it on a long term basis, and when we do it on a temporary basis, this we can use this principle that behavioural output results from predominant emotional motivation.
And we can use things like food or play. And we can trigger those engaging emotional systems to make them more predominant. And that might be very beneficial in terms of changing behavioural output.
And you're very familiar with this. I'm sure in a veterinary context where you have an individual showing repulsion behaviour here, we offer them a licky mat, and we alter that behavioural output such that, in this case, in a veterinary context, we can get our job done and do our examination or give our booster or whatever it is we're aiming to achieve. And we can also use that sometimes in management of behavioural responses at home or at a training environment.
So here we have a dog that has a problem with cars, so it shows often, behaviour towards the car that the caregiver finds difficult. It maybe lunges at the car, barks at the car, or maybe even uses avoidance and Shies away from the car. The caregiver is giving treats by dropping them to the floor that triggers or turns on their desire seeking engaging emotion.
The behavioural output is that the dog's engaged with the food on the floor that has changed the behavioural output, but it hasn't changed the perception of the car. It's purely a temporary alteration of emotional bias. And we need to be very aware of this in a veterinary consult room that when we do these behavioural changes through offering emotional triggering, so we trigger engaging emotions that it's temporary, the other emotions are still present.
So if you have an animal who has a protective emotional response to the veterinary practise, is fearful or anxious or in pain, that when you give this licky mat in front of this dog, so it's licking, so its behavioural output is what we want it to be. It's engaging with the food, but actually, if you look at the body language, you look at the eye, you look at the ear, you look at the forehead, you can see that protective emotion is still present. It hasn't gone away.
It's just temporarily not the predominant emotion, and that's great in terms of getting our job done. But what we mustn't, fool ourselves into thinking is that there's no fear in this animal. That fear has gone away, that we've got rid of fear we haven't.
We've just managed that emotional state temporarily in order to make it easier for us to do our job and better from a welfare perspective for the patient. But the misunderstanding of this temporary alteration of bias has led to things like this on the Internet. And you may have seen this, as an Internet challenge and, teaching people to put cling film around their head, put peanut butter on it, so that they can clip the claws of their dogs that are frightened.
Well, if you look at this picture on the far right, you see the whale eye, you see the ear position. Yes, there is engagement with the peanut butter and a temporary alteration of bias. But you can see very clearly in this dog and in the Dane on the left hand side here that there is protective emotion present, and having an animal with protective emotional triggering that close to your face is very dangerous.
So understanding what we're doing is crucial. So Let's move on, then to think about long term change Long-term association of that engaging emotion with the problematic trigger. If we're going to actually affect behavioural change in the long-term, we need to go through this extra pressure.
The aim is to go through cognitive process of classical conditioning, where we associate that engaging emotional bias with the context that we want them to feel more comfortable in, such as the veterinary practise. But you can't do that in a consultation. So when you're using food in that individual consultation that this is not what you're doing.
When you want to do this, you have to take a much longer term approach. You need to set up visits to the practise over time, and it's a process that is cognitively monitored and cognitively processed, also as well as classical conditioning. We may also want to use operant conditioning, a different form of learning where we actually get a consequence for the individual of behaving in a certain way, which increases the probability they will select that in the future.
And this is much more long-term. So using your food treats on your individual appointment basis is your short-term temporary alteration. It's not causing this long-term change, so to say, you know, give them treats on the table and suddenly they'll love.
The veterinary practise is very misleading. So there's an interplay between cognitive and emotional health in this aspect. We need them to be able to learn if we're going to get into this long term change.
So this is something they have to go through cognition with and emotional health impacts on cognition. So when we're using cognition, we have to be aware of those influences. If they have emotional health disturbances that can influence their learning, it can make it harder for them to form these longer term changes in their emotional connections.
So we need to always make sure that when we're trying to get into the process of cognition, the animals in a suitable learning environment, that it's a positive environment, that it an environment that doesn't favour protective emotions. It's not scary. And anyway, and remembering that that's species specific, so make sure it's not too loud, it's not too bright.
It's not all these sensory inputs that we often underestimate in these other species, but they can influence the perception of that environment From their perspective, high levels of sensory input then can increase as well. Emotional arousal. So, yes, it's about the bias that if you have high levels of sensory input, which are perceived as challenging and potentially threatening, that that will make them more protective.
But the other thing that can happen through sensory input is that there's just a lot of emotion. And when we have high levels of arousal that can compromise the individual's ability to learn, and that can even be engaging emotion, that can be difficult. So if we look at these individuals and we we're trying to engage them in some training, these two individuals who are just very interested in something else so have desire, seeking motivation, maybe to go and socially engage with their other caregiver who's sitting, watching.
Or maybe it's a social play motivation cos they've seen another dog that they want to go and engage with in the form of social play. But that high level of engaging emotion. So yes, it's optimistic.
But if there's too much emotion that can compromise your ability to learn and to process, so a dog that's highly motivated by either desire seeking or social play wants social interaction or an individual where there's a potential for prey which wants to engage. Not only are they less likely to be able to be cognitively competent, but the other emotion of frustration, which is the emotion that increases when you can't achieve an expected outcome, is also likely. So if we put them into a context where they cannot fulfil any emotional drive that they are having at the time, we have the potential to push them into a state of frustration, and that also will limit their ability to learn.
So in these contexts, the dog can find it difficult to stay focused on what it is that there is to be learning. And then the problem with that in terms of them not being focused and not processing and not laying down those learning pathways effectively is that that can often be misinterpreted as a lack of compliance. And because humans are humans, they often respond to what they perceive as a lack of compliance with confrontation.
So when these individuals are not listening when they're not engaging in the training exercise, it can be seen as bad behaviour, naughty behaviour and these things can lead to confrontation. If we shout at them or we force them into complying with the what we want them to do, we can increase their frustration. So that's a protective emotion.
It can induce a perception of threat and thereby increase the levels of fear, anxiety and that will have a detrimental impact on their ability to learn. So frustration and fear, anxiety limit learning rather than, make it easier. So an increase in their protective emotional bias can influence as well the differential laying down of memory.
So when you're in a pessimistic bias, you remember the things that were threatening with more acuity than the things that were good. And that's very important not only in a situation of training and behavioural modification classes or behavioural modification techniques, but also in the veterinary practise. You have an animal in your consulting room who's in a pessimistic bias.
Then their memories will be of whatever it was that they perceived to be threatening and the other things that happened while they were there. For example, you offering them treats or their caregiver being present, or anything that could be potentially, engaging will be less likely to be remembered. So common scenarios in which behaviour modification through cognition is not successful are those where we have individual animals who are hyper vigilant.
So they're using a lot of sensory gathering and those that are using appeasement because of protective bias. So those individuals who want to gather information to resolve their protective bias and both hypervigilance and appeasement are often misinterpreted. So a hyper vigilant individual is often thought to be excited, happy, exuberant.
So it's associated with this, increased need to process sensory information. And it's often a sign of anxiety but misinterpreted as enthusiasm as being, you know, on the lookout. Always wanting a job always wanting something to do may be associated with a more protective state than individual caregivers or even veterinary professionals realise, and then also appeasement.
This desire to exchange information in order to make an uncertain environment feel safer to increase that mutual benefit that also can be misinterpreted often as pleasure. Are we so happy at the vets are he's so happy at the training course, that we see this animal as being exuberant and being very interactive, and we misinterpret those signs and forget or or overlook that protective component to their emotion. And when they're not responding to behavioural modification through cognition, it is really important we ask some questions.
The quality of education is the first. So whenever learning does not take place in the way we expect, we should be questioning the education but also questioning the dog's ability to respond to that education, however good it is. So it may be that the education being used is good, that the techniques that are being used are appropriate.
But if the dog's emotional health is compromising its ability to learn, then they won't be able to actually, show progress from that behavioural modification. Also thinking about the behavioural modification environment is it taking place in an inappropriate environment where that animal's emotional health is temporarily compromised? So if we did it in a different environment, it would be much more successful.
Is it better to do a home visit, or is it better to see them in the car park, for example, if it's for veterinary interaction, we may change the venue or change the technique, and that can vastly improve the effectiveness of the process and the process may actually remain the same often times. We're questioning the process as well. We may make tweaks to that, too.
I want to just finish by thinking about arousal, because arousal as opposed to Valence. So we talked a lot about Valence. That's the whether the emotion is protective or engaging.
The other thing that impacts is on learning is arousal. And from a physiological perspective, arousal is about activation of the reticular activating system and the autonomic system. And the endocrine system is getting that body ready for action, and it causes physiological arousal.
So an increased heart rate increased blood pressure that, sensory alertness, mobility, readiness to respond all of those things, getting you ready to take action. And all of those effects have some potential benefits. So they enable the individual to succeed and gives them a biological advantage, particularly in relation to short term arousal.
But when that arousal is maintained, when we keep that arousal in an elevated state over long periods of time, then the benefits can become negated. We can lose those benefits. There's something called the Yurks Dobson's Law, which states that arousal level affects problem solving in an inverted U relationship.
So with optimal performance being reached at the intermediate levels of arousal so represented here in this diagram. So when we have low arousal, so we're not having much interest and we have weak performance. As we increase that attention and interest, we reach a peak in the middle in that middle ground of arousal, of optimal arousal and performance.
And then, as we go into higher levels of arousal, we start to impair that learning ability or that performance ability. But the other thing that's important to remember is that there is a difference in the optimal level of arousal for performance, depending on what sort of task it is you're trying to learn. So if it's a difficult or intellectually demanding test, you really want to be in that lower level of arousal so you can concentrate.
If we want something with stamina and persistence, we want them to be able to maintain that response. Then that may be performed better with higher levels of arousal. So you increase that motivation, and so the shape of the curve is a bit more variable, depending on which task it is that we're thinking about so positive role of arousal differs depending on what you're trying to achieve, and we can think of it here in this diagram, where when we're in a situation of a simple or a well learned task, so something that's familiar, maybe so.
It's already been introduced. Then in that situation, we may want to be able to keep that arousal relatively high, so they will maintain that interaction because it's simple and because it's something that's easy to learn. But if we're learning complex, unfamiliar, difficult tasks, then we have this problem of this reversal after that point, where performance starts to decline and often when we're changing behavioural responses in an individual with behavioural concerns, this is what we're doing.
We're doing difficult tasks. We're trying to get them to learn more complex, unfamiliar behaviours and so increasing that arousal, getting it to too high a state, even though you're doing that through, maybe play or food. So you're using the positive or engaging in motion.
But you're increasing arousal to very high levels, then it may be detrimental to the ability to comply with the the therapy, the modification, and to have, a beneficial outcome. The other thing that happens is that arousal affects memory. So when you have elevated levels of glucocorticoids, it enhances memory for the emotionally arousing event.
So whatever it is that has caused that increased arousal, that is what you remember. But it leads to poor memory for anything that's unrelated to the source of arousal, and this is quite important if you're using something like food or play that they may be enhancing their memory of the fact that the food and play is is a good thing, but they may not learn what else you're trying to teach them. So if you're trying to teach them a behavioural response at the same time, then you may not get as much, increase in the learning of that behavioural response.
So within the context of behavioural modification, it means that forming detrimental associations with protective emotions increases as emotional arousal increases. So the more aroused the animal is in the veterinary practise, for example, the more likely we are to get detrimental associations. The use of engaging emotional arousal during counter conditioning is also something that's affected by this.
So yes, we do want to increase arousal. But if we're counterconditioning, we're wanting to learn a change in that emotional association. We don't want to be straying into those very high levels of arousal.
So we want to really be using those positive cues or engaging cues in a low level of arousal. So little and often tiny pieces of food rather than massive pieces of food. Lower value food because we won't want to stimulate that high level of arousal.
Also thinking about toys, for example, not increasing arousal too much through play. And remember, here we're talking about the long term changes. When you're dealing with the short term temporary alteration of bias, then you do want those higher levels of, higher levels of value.
But still, arousal can be detrimental to the memories that the individuals forming of the veterinary practise and also the use of distraction as well that we need to remember that sometimes we're using things that are more distracting. We may not be having the impact we thought we were having on memory, and then finally, I'm gonna just introduce you to this concept of a arousal bias competition theory. It's quite complex.
I've written it out on this slide. A lot of information about it the idea that if you have an arousing item, so that's something that increases emotional input, whether it's protective or engaging, that has no effect on associative memory between whatever you're using and whatever else is present in the same situation. So, in other words, you get learning associated with the trigger, the food, the toy, but not necessarily any learning associated with any other item.
The other dog, the child, the noise, whatever else is happening. And that's because of this thing idea of focused attention. So the emotionally salient target enhances associative memory for within item.
So the focus, the food, the toy you get good learning. But it doesn't give any memory enhancement for between item associations. The dog, the person, the noise, whatever and an emotionally salient stimulus has high priority and often therefore, wins attention.
So the animal's very has a lot of attentional resources focused on the salient stimulus that's being the food or the toy, so they're less less aware of or paying less attention to the thing that you may be wishing to change association. Of course, they need to be aware of it. They need to be attending that if you're gonna make permanent change, so this can be useful for temporary change but can be detrimental when we're trying to get that more long term change.
So let's look at the implications of this. So if we have play or food leads to physiological arousal, so we've got elevated glucocorticoid levels. That dog's gonna learn that delivery of that food or that toy is good.
They're going to have a an engaging association. But they may not be learning anything about the trigger that you were working on. The vacuum cleaner, the car, the people, the dogs and delivery of triggers for high arousal.
But those that are associated with engaging emotion can increase their positive perception of the trigger, but not the target and result in them being in a heightened state of arousal. So because they're in that heightened state of arousal, they're more focused on the trigger for their engaging emotion. Now, one of the difficulties with that can be that you're more likely to startle them because they're so focused on the trigger and not so aware of what else is happening around them that they may startle.
And that may induce a protective emotional response to these other stimuli, so you can actually be slightly counter productive. So what's really important when we're thinking about dealing with behavioural change is that we're always thinking about it from an emotional and a cognitive component. It's not just about operant conditioning, training, et cetera.
It's about comprehensive healthcare and understanding the interplay between emotion and cognition and not forgetting that that physical health component also needs to be investigated. So it's not only the emotional valence that's of importance. It's also about the level of emotional arousal if they have a high resting level of arousal.
Even if we add something that is engaging, it may not have the desired effect. So we started the comp, the webinar today thinking about the health triad, and that considering the health triad is the key to delivering comprehensive health care. And when we're dealing with behavioural change as the presentation, it's really important to remember that we should be thinking in terms of all three parts of the triad physical, emotional and cognitive.
But don't forget that that is equally important when you're dealing with a physical health issue that we need to remember that cognition and emotion is potentially impacting on that and also may be impacted by it in terms of that etiological and consequential relationship. So I hope you found that presentation helpful for you that you can take some of those, principles. Apply them to your work in a your general practise setting.
And because it's a Precor. Unfortunately, as I say, there's no live Q and a session today. But if you do have questions, please contact Webinar vet and they will contact me.
Thank you.