ArticlePDF AvailableLiterature Review

Moving toward Fear-Free Husbandry and Veterinary Care for Horses

Authors:

Abstract

Husbandry and veterinary procedures have the potential to generate fear and stress in animals. In horses, the associated responses can pose a significant safety risk to the human personnel involved in the procedure, as well as to the animal itself. Traditionally, physical restraint, punishment, and/or threat of an aversive, have been the most common strategies used to achieve compliance from the horse. However, from a welfare perspective, this is less than ideal. This approach also has the potential for creating a more dangerous response from the horse in future similar situations. When caring for companion animals, and captive animals within zoological facilities, there has been a steady transition away from this approach, and toward strategies aimed at reducing fear and stress during veterinary visits and when undertaking routine husbandry procedures. This review discusses the current approaches to horse care and training, the strategies being used in other animal sectors, and potential strategies for improving human safety, as well as the horse’s experience, during husbandry and veterinary procedures.
Animals 2022, 12, 2907. https://doi.org/10.3390/ani12212907 www.mdpi.com/journal/animals
Review
Moving toward Fear-Free Husbandry and Veterinary Care
for Horses
Sharon L. Carroll
1,
*, Benjamin W. Sykes
1,2
and Paul C. Mills
1
1
School of Veterinary Science, University of Queensland, Gatton, QLD 4343, Australia
2
School of Veterinary Science, Massey University, Palmerston North 4442, New Zealand
* Correspondence: s.carroll@uqconnect.edu.au; Tel.: +61-412826725
Simple Summary: Attitudes toward animal welfare have changed considerably over recent dec-
ades. Avoiding the experience of undue fear or stress in animals is a goal across many sectors in-
cluding production animals, captive zoo species, and companion animals. Husbandry and veteri-
nary procedures have the potential for generating fear and stress in animals; however, this can be
mitigated through the types of handling techniques used, and by undertaking training to ade-
quately prepare the animal for all aspects of the procedure. The companion animal sector and the
zoo sector have made significant strides towards recognizing and reducing fear during health care.
This review discusses the potential for improving horse experiences during husbandry and veteri-
nary procedures.
Abstract: Husbandry and veterinary procedures have the potential to generate fear and stress in
animals. In horses, the associated responses can pose a significant safety risk to the human personnel
involved in the procedure, as well as to the animal itself. Traditionally, physical restraint, punish-
ment, and/or threat of an aversive, have been the most common strategies used to achieve compli-
ance from the horse. However, from a welfare perspective, this is less than ideal. This approach also
has the potential for creating a more dangerous response from the horse in future similar situations.
When caring for companion animals, and captive animals within zoological facilities, there has been
a steady transition away from this approach, and toward strategies aimed at reducing fear and
stress during veterinary visits and when undertaking routine husbandry procedures. This review
discusses the current approaches to horse care and training, the strategies being used in other ani-
mal sectors, and potential strategies for improving human safety, as well as the horse’s experience,
during husbandry and veterinary procedures.
Keywords: animal welfare; veterinary procedure; husbandry procedure; fear-free; force-free;
training; cooperative care
1. The Horse in Society
The horse’s role throughout history, first as a meat animal and then a working ani-
mal, initially established their place as a “tool” to meet human needs. In more recent
times, the horse’s primary role has shifted to that of an athlete and companion, participat-
ing in racing and a wide variety of sports and leisure pursuits.
This current role has resulted in horses less commonly being referred to as livestock
or farm animals, and more frequently being referred to as companion animals [1,2]. Even
with this more modern classification, welfare concerns remain. Horse welfare has re-
ceived less attention than farmed livestock [1], and their role as a ridden animal exposes
them to specific welfare concerns that do not apply to other companion animals [1,3,4].
Perceptions regarding the impact of factors that affect horse welfare vary between non-
horse owners, horse owners, and competitors, and even vary depending on the discipline
Citation: Carroll, S.L.; Sykes, B.W.;
Mills, P.C. Moving toward Fear-Free
Husbandry and Veterinary Care for
Horses. Animals 2022, 12, 2907.
https://doi.org/10.3390/ani12212907
Academic Editor: Sue M. McDonnell
Received: 18 September 2022
Accepted: 20 October 2022
Published: 24 October 2022
Publisher’s Note: MDPI stays neu-
tral with regard to jurisdictional
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tional affiliations.
Copyright: © 2022 by the authors. Li-
censee MDPI, Basel, Switzerland.
This article is an open access article
distributed under the terms and con-
ditions of the Creative Commons At-
tribution (CC BY) license (https://cre-
ativecommons.org/licenses/by/4.0/).
Animals 2022, 12, 2907 2 of 17
in which an individual competes [5,6], suggesting that the “working” role of horses may
influence decisions about care and welfare.
Most horse owners and caregivers want the best for the horses in their care, despite
this, many of the decisions about housing, handling, care, and training are not welfare-
oriented [7–11]. Decisions relating to horse handling and care are frequently based on the
personal established beliefs of owners, trainers, and caregivers, often influenced by infor-
mation passed to them from previous generations of horse trainers [8]. The specific eques-
trian sector a person aligns with may also influence their beliefs about exactly what con-
stitutes appropriate care and welfare [5].
Even though humans have a lengthy and close history with horses, there are frequent
gaps in the owner’s/trainer’s/caregiver’s understanding of ethology, horse behaviour, and
indicators of welfare [7,8,12–17]. The science behind how animals learn, how they perceive
the world around them, and the way they respond to that information, is poorly under-
stood by many amateurs and professionals who work with horses [8,12,16,18–21]. In in-
stances where an owner/trainer/caregiver does have appropriate theoretical knowledge,
it still does not always translate into practical application [8,11]. In one survey, most re-
spondents identified that individual housing is a welfare concern for horses, and yet many
respondents in the same survey housed their horses individually [11].
Whilst owners, riders, trainers, and caregivers frequently describe how important the
relationship is between a horse and their human, the human–animal interactions (HAIs)
provided are often negative experiences for the horse, with many common handling and
training techniques focusing on achieving the human’s goal at the time, with limited con-
sideration of the horse’s emotional experience [22,23]. Negative reinforcement and pun-
ishment-based approaches are common in horse training and handling, with the goal be-
ing to generate behaviours that the human desires, with little true choice to the horse, and
limited reward for participation other than the relief from, or avoidance of, an aversive
stimulus [11,12].
2. Attitudes to Animal Welfare Associated with Husbandry and Veterinary
Procedures Outside of the Horse Sector
Attitudes toward animal welfare and the importance of considering the animal’s ex-
perience during a human–animal interaction (HAI) have changed considerably over re-
cent decades. Avoiding the animal’s experience of fear and associated stress responses has
been a key area of focus [24], with some sectors expanding this to include the need for the
animal to be able to express choice and feel a level of control over their participation in a
HAI, including training sessions, and husbandry and veterinary procedures (HVPs) [25].
Human–animal interactions can be negative, neutral, or positive. Minimising or elim-
inating negative HAIs is important for reducing fear and stress, but it has also been sug-
gested that routine incorporation of positive HAIs, such as petting and relaxed treat feed-
ing, is necessary to positively influence health, productivity, and behaviour [26,27].
In the production animal sector, the need to monitor and improve all aspects of wel-
fare has been influenced by evidence of increased handleability, improved human safety,
and increased productivity when animals are less stressed [24,26,28–30]. The behaviour of
livestock handlers and their attitude towards the animals in their care has been shown to
directly influence the animals’ level of fear, which in turn affects the behaviour of the an-
imal around humans [28,29]. Evidence of the influence of negative associations with hu-
man handlers in this sector has guided changes to husbandry and handling procedures,
and has generated recommendations for more positive reinforcement-based training, sys-
tematic desensitization to standard equipment, and active efforts to generate positive
HAIs [31–33].
Unlike the production animal sector, stakeholders in the zoo sector and the small
companion animal sector tend to focus more on the individual animal, rather than the
herd or flock. Changes implemented in these sectors are focused on generating willing-
ness, cooperation, voluntary participation, and a lack of fear and stress in animals during
Animals 2022, 12, 2907 3 of 17
HAIs and HVPs. Within the zoo sector, there is now a strong focus on using training to
reduce fear and stress during HAIs and HVPs. Systematic desensitization protocols and
positive reinforcement-based training have been adopted within zoos as a humane and
effective strategy to facilitate HVPs without the need for sedation or restraint [27,34–39].
The need to reduce fear and stress for small animals during veterinary visits is be-
coming increasingly well-recognized [40–43]. In many practices, clinic layout, staff inter-
actions, and the handling techniques used are focused on delivering a minimal-stress ex-
perience [40,41,43]. Clients are encouraged to routinely visit the clinic with their dog,
purely for the purpose of desensitization and generating positive conditioned emotional
responses (CERs) to the environment and the staff [42,43]. It is also suggested that owners
and caregivers train towards developing positive CERs to such elements as the transport
crate and traveling in a vehicle, so as to reduce the likelihood of the animal arriving at the
clinic already stressed and in a heightened state of arousal [40]. The overall goal of these
strategies is a less stressed and more cooperative animal during veterinary visits, thus,
reducing the likelihood of human injury resulting from defensive aggression, and posi-
tively influencing the animal’s behaviour during future veterinary interventions [44].
3. An Overview of Relevant Horse Traits and Behaviour
Horses are large animals with quick reactions. They are neophobic and claustropho-
bic, and remain acutely aware of their surroundings [22,45–48]; these traits can have a
significant impact when being asked to participate in a HAI or HVP for which they have
not been adequately prepared.
As a prey species, horses rely on flight where possible as a primary method of sur-
vival. When faced with novel situations, physical or psychological pressure, or real or
perceived restraint, fear responses will typically be activated. The observable responses
may be active, manifesting as avoidance or escape behaviours, or defence behaviours
(threat or attack); or passive, manifesting as immobility (freezing) or displacement behav-
iours. The behaviours exhibited are influenced by an individuals coping strategy; the
coping style may be either more proactive or more reactive and will remain constant
across time and contexts [49]. Attempts to exert control over a situation through the per-
formance of defensive behaviours, or efforts to flee from a stressor, are characteristic of a
more proactive strategy, whereas reduced responsiveness, emotional blunting and freez-
ing are characteristic of a more reactive strategy [49,50].
When compared to a horse displaying volatile behavioural responses, a horse dis-
playing reduced behaviours during a HVP may seem preferential; however, this is not
always the case. Despite the reduced behavioural response, reactive coping styles are
linked with a more pronounced physiological response to stress [49,50]. Hence, even
when a horse appears calm and compliant, there may still be concerns for the horse’s emo-
tional well-being [14,49,51]. It should also be remembered that horses displaying behav-
iours associated with reactive coping strategies may remain immobile until they reach a
threshold, and then may suddenly react in a large and volatile way [50]. This sudden per-
formance of volatile behaviours from a horse that previously appeared calm and compli-
ant is sometimes misinterpreted as a horse being ‘unpredictable’ [50].
The responses that are most dangerous to humans occur when a horse feels the need
to avoid, escape, or defend itself from perceived threat. The specific behaviours that may
result in injury to the human handler in these scenarios include biting, kicking, striking,
rearing, running/trampling/barging, or moving in a way that crushes the human between
the horse and another object. These behaviours may be exhibited immediately at the com-
mencement of a HAI or HVP, or the horse may display these behaviours at some point
during the HAI or HVP as a result of the prolonged exposure to a stressor or the cumula-
tive effect of being exposed to multiple different stressors over a period of time [50,52].
Actions that are undertaken by humans during a HAI or HVP can significantly im-
pact a horse’s behaviour during future HAIs and HVPs [53]. Continuing to expose the
horse to a perceived aversive stimulus past that individual’s reaction threshold;
Animals 2022, 12, 2907 4 of 17
provoking a fear response; reinforcement of an undesirable behaviour; poorly timed rein-
forcement; and/or the use of punishment, particularly noncontingent punishment, can all
play a role in creating unwanted responses in future HAI and HVPs [52–55].
It is important to remember though that many of the behaviours that pose safety con-
cerns to humans during a HAI or HVP are entirely natural behaviours in the horse [56].
4. HVPs with Horses and Traditional Methods for Achieving Compliance
Common HVPs identified for their potential to induce fear or stress in the horse in-
clude clipping, farriery, loading onto transport vehicles, dentistry, injections, oral pasting,
administering eye medications, treating superficial wounds, and veterinary examinations
and procedures.
Horses can respond during a HVP with undesirable and potentially dangerous be-
haviours. This response may be due to confusion, conflict, pain, fear, fear of pain, or may
be the result of previously reinforced behaviours [20,47,49,57,58].
Potentially dangerous behavioural responses may be initiated by the approach from
an unfamiliar person, human contact, the presence of unfamiliar equipment/objects, loud
or unfamiliar sounds, intense or unfamiliar odours, unfamiliar tactile sensations, confine-
ment/restraint, a reduction in perceived options for escape, lack of the presence of familiar
conspecifics, unpleasant or painful sensations, or any stimulus for which a negative CER
has previously been linked [20,50,52,54,59–61]. If the procedure is being undertaken at a
clinic or at a location remote from the horse’s usual environment, then there are additional
aspects that may increase fear or stress, including the need to travel, being in an unfamiliar
space, the presence of unfamiliar terrain/surfaces/structures, and a potentially busy envi-
ronment in terms of human and animal traffic, vehicular movements, and noise.
Pain may occur as an aspect of the HVP itself, may be the result of the behaviours the
horse undertakes in response to the HVP, or the pain may be inflicted by the human as a
response to the horse’s behaviour. Pain is a recognised cause of potentially dangerous
behaviours [58,62–64].
4.1. Traditional Handling, Handler Beliefs, and Influence of Human Emotions
Frequently, the strategies employed by owners, trainers, caregivers, and horse-care
professionals when undertaking HVPs, are heavily focused on “getting the job done” [63].
Approaching a HVP with the primary goal of rapidly completing the task may limit the
consideration that is being given to the horse’s mental well-being, or the impact this en-
counter may have on that horse’s behaviour in future HAIs or HVPs.
Requiring a horse to perform the behaviours the human desires with limited choice,
and often at the threat of an aversive stimulus being applied or intensified if compliance
is not achieved, is not specific to undertaking HVPs; this is the cultural norm within the
horse handling and training sector [19,22,23,54,65,66].
Human injury is common when handling horses [67–69]. Horse trainers, riders, han-
dlers, coaches, farriers, veterinarians, transporters, and other professionals in the equine
sector frequently sustain injuries, and in contrast to other high-risk occupations, there has
been no significant reduction in rates of injury or death over the past decades [69]. To date,
much of the focus for reducing injuries when handling horses has been on the increased
use of personal protective equipment [69]; however, even though helmet use has in-
creased, head injury rates remain high [70]. In other high-risk occupations, addressing the
root cause of the incidents that result in injuries and fatalities is considered more beneficial
than focusing solely on the increased use of protective equipment [69]. In the horse indus-
try, this would equate to looking for strategies to reduce the occurrence of potentially
dangerous horse behaviours.
Whilst handling horses during HVPs, handlers may experience frustration, anxiety
and fear; this heightened human arousal and emotion can be perceived by the horse, and
increases the likelihood that the horse will react in a negative manner [71,72].
Animals 2022, 12, 2907 5 of 17
Professional providers may also perceive that it is the owner’s responsibility, and not
theirs, to train the horse for these interactions [57]; this belief may then contribute to their
feelings of frustration. Horse-care professionals likely feel the pressure of time con-
straints—the next appointment may be scheduled soon, there is a financial cost to “wast-
ing” time, there can be psychological pressure from having their peers or clients watching
the interaction, and there can be an expectation from many owners that these profession-
als “should” be able to manage the horse regardless of its behaviour [57].
Human emotions of fear and frustration can directly lead to the application of aver-
sive stimuli during HVPs [73]—in many instances, punishing behaviours that are natural
and predictable responses from the horse.
Although punishment is quite common in the horse sector, it is not recommended;
punishment not only presents a welfare concern, but frequently leads to horses perform-
ing dangerous behaviours in an attempt to escape or defend themselves against the aver-
sive stimulus [23,53,54,73].
In instances where the owner/trainer/caregiver/horse-care professional is motivated
to provide a more positive experience for the horse during a HAI or HVP, it can be chal-
lenging, as behavioural signs of equine stress, pain, and negative emotional states are
poorly recognized by many horse handlers [9,14,15,74]. Hence, even though the human
may be attempting to consider the horse’s emotional state more fully, they still may not
be able to accurately recognise that the horse is fearful or stressed.
4.2. Restraint during HVPs
Restraint of horses for HVPs is common, with a range of tools and techniques being
routinely used and described [21,53,63,75,76]. Physical restraint can be as mild as the use
of a head halter and lead, but can also include physically restricting movement through
confinement in a crush/chute, hobbling, or holding up a leg [10,21,53].
Inducing pain when the horse attempts to move is another common strategy for
achieving stillness and compliance. Some of the tools used to induce stillness in this way,
such as lip chains and lip ropes, are capable of inflicting serious injury to the horse
[10,63,76]. Nose, ear, and neck skin twitching is also common [53]. The exact reason
twitching is effective is unclear, with some evidence suggesting that initially there may be
a calming and potentially analgesic effect from a nose twitch [53,77,78], whereas the ear
twitch appears to be more likely to induce stillness due to pain or fear [78].
There are welfare concerns with regard to using any physical restraint that blocks all
movement, or the application of restraint techniques that result in pain if the horse at-
tempts to move [53,73]. The issues of concern are that the horse has no choice about their
participation in the procedure, the ability to perform natural flight behaviours is removed,
and the horse may still be experiencing fear, stress, and potentially pain but with no op-
tion for relief. These type of extreme restraint procedures allow the ongoing application
of noxious stimuli at a level and duration that is unacceptable from a horse-welfare per-
spective and may contribute to generating associations that will result in worsening be-
haviour in future HAIs and HVPs [53].
Although strategies that involve training are recommended over reliance on restraint
for HVPs [53,73], the application of physical restraint is still very common in the horse
industry, with knowledge of restraint techniques remaining a key component in the train-
ing of equine veterinarians and other horse-care professionals [53,63,76].
One of the primary reasons restraint is still common when handling horses is be-
cause, unlike many other large and potentially dangerous animals, horses are mostly han-
dled in free contact, rather than protected contact scenarios. This exposes the human han-
dlers and horse-care professionals to significant risk of injury if a horse reacts in a rapid
or volatile manner at any time during an HVP. For this reason, it is likely that humane
restraint will remain in use for specific situations, such as when a horse requires urgent
veterinary treatment, but is in pain or is too fearful to comply.
Animals 2022, 12, 2907 6 of 17
Chemical restraint is another commonly used option for reducing the risks associated
with dangerous behaviours occurring during a HVP [21]. The use of these agents is briefly
discussed in the section of this review dedicated to veterinarians.
5. Moving Forward to Improve Horse Experiences during Husbandry and
Veterinary Procedures
Often, the traditional approach to handling and husbandry with horses is considered
‘effective’ as it achieves the human’s goal of completing the HVP. However, when consid-
ering the more modern approach of including the impact of these techniques on the horse,
then there are two distinct progressions away from these traditional approaches.
1. Option 1. In this option, the primary focus remains on “getting the job done” at the
scheduled time. However, significant consideration is given to the impact of the job
on the horse. This may involve providing a quiet, uncluttered environment, and al-
lowing the horse time to become familiar with the surroundings, the personnel, and
the equipment prior to commencing [50,73]. This approach may also require the al-
location of a brief amount of time to implement a simple behaviour modification pro-
gramme, utilizing a mixture of negative reinforcement, positive reinforcement,
and/or classical counter conditioning [57,73]. Depending on the individual horse and
the intensity of the undesirable behaviour, when well-applied, these strategies may
alter the horse’s emotional state and behavioural responses enough to allow the pro-
cedure to be completed at the scheduled time. The British Equine Veterinary Associ-
ation has made available a series of short videos demonstrating the use of reinforce-
ment-based techniques for training horses for HVPs [79]. An essential aspect to com-
pleting a HVP using this approach is to accurately monitor arousal levels throughout
the entire HVP, ensuring the horse is not placed in a position where it feels the need
to escape or defend itself. Taking breaks as needed, using staff who are skilled in low-
stress handling, and providing food distractions and calming tactile contact are all
beneficial to achieving the end goal of this approach [50,57,80]. To ensure human
safety when undertaking a HVP using this approach, some type of physical or chem-
ical restraint may still be necessary in specific cases, but the choice of restraint is im-
pacted by a desire to minimise fear and stress. This type of approach addresses many
welfare concerns, whilst also creating HAIs and HVPs that result in a horse which
does not exhibit worsening behaviour in future interactions.
2. Option 2. In this option, the horse participates in a voluntary capacity. The priority is
the horse’s emotions and its perceived control (agency) during the HAI/HVP. Train-
ing is undertaken prior to the HVP to establish consent cues. This allows the horse to
indicate its consent to commence the procedure; at any time the horse withdraws
consent, the procedure is paused. When working with animals within this approach,
it is accepted that procedures may initially take longer, and that animals may choose
not to participate at that time [25], hence, rescheduling a HVP may be necessary.
Honouring the animal’s choice is considered a representation of improved welfare
[25]. Delaying all non-urgent HVPs until adequate training has been undertaken is
also an important strategy within this approach [81]. This less human-centred ap-
proach is now common when undertaking HVPs within zoo settings, especially
when working with animals in protected contact; however, it is less common in the
horse industry (refer to https://www.equinebehaviorist.ca/post/2019/05/23/start-but-
tons-and-horse-training accessed on 7 October 2022, for a practical example of using
consent cues with a horse). Using this approach for undertaking HVPs requires ex-
tensive training to be undertaken with the animal before the HVP is scheduled. It
also requires that the horse’s choice is honoured during the HVP, and this needs all
human participants to have a shared commitment to the same end goal. One im-
portant point to highlight here is that offering the animal choice does not result in
animals consistently choosing not to participate, as many people imagine would
Animals 2022, 12, 2907 7 of 17
occur. Rather, the animals typically consistently consent even to somewhat invasive
and painful procedures, and only withdraw consent at times when they feel appre-
hensive, fearful, or stressed. The training components required for success with this
approach focus on ensuring that the animal can predict what is about to occur, is
familiar and comfortable with the process/equipment, and has an understanding on
what behaviour constitutes consent.
Regardless of which approach is taken, any effort to reduce stress, fear, and anxiety
is clearly beneficial for the horse’s emotional well-being. There is also an extremely valu-
able sequela—positively impacting the horse’s emotional experience during the HVP di-
rectly reduces the likelihood of injury to the horse and the humans, not only in this HVP,
but also in subsequent HAIs and HVPs. The improved safety is achieved because the
horse does not feel threatened or trapped, and hence, does not need to perform potentially
dangerous defence and escape behaviours. A positive experience during the current HVP
will also result in the horse being more relaxed the next time it recognises a similar HVP
is going to occur, and again, this will result in improved safety for all parties.
5.1. Practical Implementation
When the goal is for the horse to participate in the HVP in a voluntary capacity, then
extensive training prior to the HVP will be necessary. This requires the owner/han-
dler/trainer/caregiver to have an understanding of how to undertake this training and the
desire to dedicate the time and effort required to complete this task.
However, even when this prior training has not occurred, there are still a myriad of
strategies that can be implemented immediately before and during an HVP that can sig-
nificantly improve the experience for the horse. This is discussed in further detail in the
sub-section titled “Management and Training”.
When assessing the benefits of working toward voluntary participation in HVPs and
the advantages of providing agency for the horse, valuable information can be sourced
from several sectors including zoological institutions, small animal veterinary practice,
and paediatric medicine [41]. These sectors have all made substantial changes in recent
decades to more fully embrace the need to reduce fear, stress, and anxiety during health
care procedures [37,40,82–87]. This includes changes to improve patient agency, provide
the patient with predictability where possible, provision of appropriate positive distrac-
tions during procedures, and having a familiar caregiver present in a supporting role dur-
ing the procedure [37,44,82,84,85,88–91].
In developing strategies to improve the horse’s experience during a HVP, it is criti-
cally important to remain aware of human safety and the practicalities surrounding the
implementation of these protocols. The approach taken at the time of the HVP will be
dependent on the prior training the horse has received, the horse’s observable behaviour
before and during the HVP, the facilities available, the skill level of the personnel in-
volved, and owner preferences.
5.1.1. Management and Training
Management and training work synergistically to modify behaviour. Training is
aimed at directly influencing the horse’s future behaviour in a given circumstance through
learning. Some training may be able to be undertaken at the time of the HVP. This would
involve taking some time to reinforce desired behaviours such as standing still or yielding
to head-halter pressure. Again, regardless of whether the goal is simply minimising fear
and stress, or the goal is honouring the horse’s choice, the best overall outcomes will be
achieved if some foundation training is undertaken separately and ahead of time.
Management, however, is utilised to reduce the likelihood of undesirable behaviours
occurring in the moment. Management strategies are essential in all scenarios and serve
to improve the animal’s experience during a HVP by reducing stress and negative emo-
tions. Management is also beneficial as it reduces the rehearsal of undesirable behaviours
Animals 2022, 12, 2907 8 of 17
which can indirectly influence future behaviour by preventing unwanted behaviours de-
veloping into habits. Management strategies include any components that set the stage
for a better outcome. Some examples include:
Undertaking the HVP in a spacious, quiet environment and minimising the move-
ment of people and other horses through the area [50,73].
Ensuring personnel are competent handlers with good skills for interpreting horse
behaviour [20,50].
Considering the order of activities. For example, avoiding weighing the horse as the
first activity if the horse is showing indicators that they are fearful or stressed about
the process of getting onto the scales [50].
Pausing the HVP before arousal has escalated past the response threshold. Taking a
well-timed break in this way allows arousal to lower before continuing [81].
Feeding or using food-based licking products during the HVP if possible. Such a
strategy can help to keep arousal/agitation levels lower and can act as a positive dis-
traction [57,80,81].
Utilising touch that is associated with a positive CER such as wither scratching or
rubbing of the eyes and face. These kinds of touch have been shown to be beneficial
for improving relaxation during a HVP [57,80].
In some cases, effective management may include the use of appropriate restraint
strategies, and/or the use of medication. Although management strategies are an excellent
contribution towards improving the horse’s experience during an HVP, attaining the goal
of having a horse participate in a HVP in a calm and cooperative manner is best achieved
through the addition of training.
Animal training in general is focused on reinforcing desirable behaviours or punish-
ing undesirable behaviours.
Reinforcement-based training is considered preferable to punishment in many ani-
mal training sectors as it focuses on assisting the animal to learn what behaviours are de-
sirable in a given situation, and avoids the many negative outcomes that can result from
a punishment-based approach [47,54,57]. Increasing the frequency of desirable behaviours
can be achieved through positive reinforcement, where a pleasant stimulus is added after
the desired behaviour, or negative reinforcement, where an unpleasant stimulus is re-
moved immediately after the desired behaviour [47].
Negative reinforcement is common in the horse sector [47,92], for example, maintain-
ing pressure on a head halter and then immediately relaxing the contact when the horse
yields to the pressure. Negative reinforcement is extremely effective for creating desired
behaviours, such as the behaviours that are needed for a horse to comply with the require-
ments of an HVP, and for behaviour modification via reinforcement of alternative behav-
iours to replace undesirable behaviours. However, the use of negative reinforcement tech-
niques can initially increase stress responses in the horse, which may result in increased
risk to human safety if not well managed [93]. Another significant problem that can arise
when using negative reinforcement to achieve compliance during an HVP is that the horse
is often fearful of performing the desired behaviour, due to environmental factors or prior
learning. This fear may underlie the animal’s initial resistance to comply with the han-
dler’s request. Using an aversive stimulus to motivate the horse to comply in order to
remove that aversive presents the animal with a conflicting situation in which it must
choose between escape or avoidance of two unpleasant sets of stimuli—the fear-provok-
ing behavioural request, or the aversive being applied by the handler in order to bring
about compliance with that request. Furthermore, as a result of the horse not complying
with the human’s wishes, the aversive stimulus being utilised is frequently intensified,
and may reach intensity levels that are inappropriate from a welfare perspective [54].
Positive reinforcement-based training is less common in the horse industry than in
many training sectors, but has experienced a dramatic rise in popularity in recent years
[47,94]. One of the significant benefits of positive reinforcement is that it has the potential
Animals 2022, 12, 2907 9 of 17
to improve the horse’s feelings about humans and provides positive HAIs [95–98]. Much
of the current evidence in horses suggests that positive reinforcement is not superior to
negative reinforcement in terms of achieving desired behaviours faster or more reliably
[99–101]. Indeed, in some circumstances, it may be that behaviours are more reliable when
trained using negative reinforcement; this is because a horse that is experiencing fear or
stress may still act to avoid an aversive stimulus, where they may be less likely to perform
behaviours in order to access a positive reward [47,101]. However, there are potential ben-
efits associated with the use of well-applied positive reinforcement over negative rein-
forcement; these include lower arousal levels, less fear, less performance of avoidance be-
haviours, greater performance of investigative behaviours, increased human safety, and
the provision of a positive HAI, thus, potentially contributing to overall better welfare
[95,97–100,102,103]. Commonly cited concerns over the risk of increased nipping of hands
or biting of clothes when using positive reinforcement-based approaches appear un-
founded [104].
Positive reinforcement-based training has proven to be successful for generating re-
liable, voluntary, cooperative participation in HVPs in many settings and across a wide
variety of species [27,34,35,38,105–108]. This success has not been limited to mammals, but
also includes reptilian species [109,110], avian species [108,111] and fish [37,112].
Studies using positive reinforcement to train horses to cooperatively participate in
HVPs are limited in the academic literature [66,92,113–115]. Nonetheless, evidence from
a wide range of other species including prey species and ungulates would suggest that
this approach would be highly effective in horses, and anecdotally, it is already routine
practice for some horse trainers and behaviour professionals [115]. The reinforcer is typi-
cally food, however, tactile stimulation such as wither scratching has also been used
[57,94,116–118]. Studies comparing horse preferences between food and human contact
indicate food is preferable in most instances, regardless of the horse’s previous training
history [116,117], but tactile contact may be a more appropriate reinforcer in some circum-
stances, such as when working with foals [118].
Many training programs in other species that focus on cooperative participation in
HVPs utilise positive reinforcement to produce stationing and targeting behaviours
[34,105,106,109]. Stationing reinforces the behaviour of remaining in contact with a “sta-
tion”, often a slightly raised platform designed for either two feet or four feet. When vol-
untary participation is a goal of the care protocol, then, once trained, making contact with
the station is used as an indicator of consent to undertake the HVP. If the animal moves
away from the station, then this is read as the animal removing consent, and the procedure
is stopped until the animal feels comfortable enough to again offer consent to continue.
Even once the initial training is complete, the intermittent delivery of a primary reinforcer
continues whilst the animal remains on the station, to ensure the behaviour remains reli-
able.
“Targeting” reinforces the behaviour of choosing to make contact with a target, such
as a hand, the end of a stick, or an object mounted on a wall. The contact can be made by
the animal’s nose, but also by other parts of the body, such as a shoulder or hip [37]. Train-
ing such behaviour can be useful for moving an animal from place to place, or for posi-
tioning the animal. For example, a shoulder target can be used to ask the animal to move
only its shoulder in a particular direction in order to make contact with a person’s hand,
or a hip target can be used to begin to ask for voluntary compliance with an injection
procedure. Targeting that involves the upper and lower lip and jaw can also be used in
conjunction with other cues to shape an open mouth behaviour. Targeting can be very
useful for cueing horses to voluntarily move their head, shoulders, or quarters to facilitate
aspects of an HVP. As targeting is trained using positive reinforcement, the cued move-
ment is driven by a desire to access reward, as opposed to being motivated by a desire to
avoid an aversive (as would occur if the horse was responding to a cue trained via nega-
tive reinforcement). Published studies describing target training in horses are still ex-
tremely limited at this time [59,66,92,114,115,118,119].
Animals 2022, 12, 2907 10 of 17
Many horses initially respond to novel objects, sounds, and smells with varying in-
tensities of avoidance or escape behaviours [47,50,120]. The same behavioural response
will occur if the stimulus has previously been paired with a negative experience [50,121].
Any equipment used in an HVP may elicit these responses. Through graduated exposure
alone, or through the use of systematic desensitization and counter-conditioning proto-
cols, these responses can be reduced and eventually eliminated [53,55]. Undertaking ef-
fective desensitization protocols requires a thorough understanding of horse behaviour
and keen observation skills [121]. During the training process, the goal is for the fear-
evoking stimulus to be incrementally presented but reduced/removed while the horse is
calm and prior to the horse feeling the need to undertake substantial behaviours associ-
ated with avoidance, escape, or defence [47]. These larger unwanted behaviours typically
occur when subtle pre-cursor behaviours fail to be detected by the human [14,50], result-
ing in the handler continuing to increase the intensity of the stimulus at a time when re-
ducing or removing the stimulus is more appropriate.
When implementing a force-free approach to training, the skill lies in ensuring that
gradual desensitization occurs without the horse experiencing fear or stress during the
protocol. This approach also assures the horse that they have control over the interaction,
thus, removing the need for a horse to panic, attempt to escape, or utilise aggression to
feel safe. In turn, this improves safety for the horse, as well as the human/s involved in
the interaction.
5.1.2. Additional Considerations for Veterinary Practices and Veterinary Professionals
Equine veterinarians are frequently exposed to horses displaying potentially danger-
ous behaviours. In one survey, 95% of veterinarians reported working with a ‘difficult’
horse on at least a monthly basis [21].
Due to undesirable horse behaviour, risk of injury is high in the equine veterinary
profession, with many injuries involving the head, and some incidents being fatal
[21,53,67,79,122–125]. In one survey of veterinarians, 80% of respondents had received a
work injury from a horse in the past 5 years [21]. Another study indicated that equine
veterinarians can expect to sustain one significant work-related injury for every 3 years
and 9 months spent in practice [126]; over a third of the injuries reported in this study
required hospital admission and many of the most significant injuries reported occurred
whilst undertaking common procedures. These injury rates are higher than other civilian
occupations and appear to occur throughout a veterinarian’s working life, indicating that
time in practice alone does not prevent injuries. Training to improve the understanding
of learning theory and to increase a veterinarian’s ability to recognize subtle behavioural
indicators of arousal and affective state may be highly beneficial in avoiding situations
that may lead to human injury [15,21,91]. The high rates of injury within the veterinary
profession would suggest that any changes that could reduce the frequency and severity
of injuries warrant further consideration.
Beyond reducing human injury rates, improving animal welfare is likely to also be a
driver for change to traditional approaches during HVPs. The increased use of approaches
that minimise fear and stress will likely be given greater consideration as more awareness
develops regarding the potential for iatrogenic behavioural injury due to providing vet-
erinary care to a horse that is experiencing fear, anxiety, and stress during the interaction
[41]. Even a single fear-inducing interaction can generate a conditioned fear response that
may negatively impact the horse’s behaviour during future handing and HVPs [50]. The
importance of this phenomenon should not be dismissed, as choices made by veterinary
personnel during every interaction have the potential to increase the risk of injury to per-
sonnel in future HAIs and HVPs [53]. For long-term clients, the benefit of providing low-
stress HVPs include easier and safer interactions during future appointments. This not
only has the potential to improve the client-veterinarian relationship, but also to contrib-
ute to the ongoing safety of clinic personnel.
Animals 2022, 12, 2907 11 of 17
Whilst many equine veterinarians are very good at identifying behaviours associated
with a proactive coping mechanism, some personnel may be inaccurate at identifying be-
haviours associated with a reactive coping style [50]. This may lead to human injury as
the behaviours performed may be erroneously identified as behavioural evidence of a
horse who is calm or relaxed [14,50]. To provide the best overall care for patients, and to
improve human safety, it is important that all veterinary personnel are able to accurately
identify the behavioural indicators of fear and stress [14,50,127]. The larger avoidance,
escape, and defensive behaviours are obvious, but a range of less volatile behaviours may
be performed prior to these larger responses; these include increased muscle tension, tri-
angulated or wide eyes, eye wrinkles, tail swishing, elimination, fidgeting, scratching,
ears pulled back, vigilance, increased tension in the face/jaw/mouth, elongation of the up-
per lip, dilated nostrils, raised head, head tossing, foot stomping, pawing, mouthing ob-
jects, snorting, trembling, jerky movement, vocalisation, stillness with fixed gaze, unre-
sponsive to touch, resistance to human cues, rigid stance with fixed ear position, perfor-
mance of abnormal repetitive behaviours, and attempts to reposition away from the
stressor [48,50,52,57,127].
Beyond monitoring and managing a horse’s emotional state, appropriately managing
physical pain remains an essential aspect of providing quality veterinary care. Pain may
be an aspect of the reason for veterinary intervention, or pain may occur due to the pro-
cedure itself. Pain is a recognised cause of potentially dangerous behaviours during a HVP
[58,62–64]. Implementing strategies to reduce pain, including administering pain-reliev-
ing agents when required, will improve the horse’s experience during the HVP, in turn
reducing behaviours that occur in response to pain, ultimately improving personnel
safety.
Even when consideration is given to providing low-stress environments and appro-
priate handling, it may not reduce fear and anxiety enough in some instances to complete
a procedure in a manner that is safe, and in a way where the horse is not exposed to a
negative experience. In these cases, behavioural medications are beneficial [63,128,129].
Whilst any type of sedation may reduce potentially dangerous behaviours, and
hence, improve human safety, thoughtful selection of the sedating agent is critical for ad-
dressing the horse-welfare aspect [130]. Using agents for chemical restraint during poten-
tially fear-inducing procedures without ensuring the agent is anxiolytic has the potential
to cause further fear, stress, and aversive learning [128].
An agent that remains common in the equine veterinary sector requires mention here.
Traditionally, acepromazine was considered useful for reducing apprehension and dis-
tress in animals. However, in recent years, it has been highlighted that this agent simply
blunts behaviours and has no anxiolytic effect [40,131,132]. Instead of reducing anxiety, it
has been suggested that acepromazine can lead to further psychological trauma as the
animal may remain fearful and/or anxious but be unable to make sense of the experience
cognitively, and/or is less capable of performing the behavioural response they would
otherwise perform if unmedicated [40]. Acepromazine is no longer recommended in the
treatment or management of anxious or aggressive animals in a number of other species
[40,131,132], and for welfare reasons, the use of acepromazine as a stand-alone agent for
managing horse behaviour during a HVP is questionable.
Although many participants in the horse sector consider physical restraint to be a
normal aspect of horse management, it should no longer be assumed that all equine clients
are comfortable with the use of restraint that entirely blocks the horse’s movement, or the
application of aversive stimuli that may cause pain or induce fear. Many clients struggled
with traditional handling and restraint protocols in small animal practice and are now
relieved to be able to find clinics that consider the emotional experience of the animal, and
the ramifications of the HVP on future behaviour [40,133,134]. Horse owners too have
suggested that some veterinarians create or exacerbate behavioural aversions to HVPs
through their handling and management [73], and many suggest that they are looking for
veterinarians to demonstrate more welfare-oriented approaches when handling horses
Animals 2022, 12, 2907 12 of 17
[135]. This does not directly indicate though that these same clients have the skills or
knowledge to undertake the training required to improve their horse’s experience during
these HVPs. Importantly, the undesirable behaviours may not be limited to veterinary
visits—many owners struggle with their horse’s behaviour at home, and may seek out
behavioural advice from their veterinarian. One study reported that over 77% of respond-
ent veterinarians considered owner complaints of “difficult” or “uncooperative” horses
to be common (57.1%) or extremely common (20.4%) [130].
Where clients are interested in longer-term solutions to address their horses undesir-
able behaviours, but do not have the time or knowledge required to undertake the training
themselves, clinics could consider offering a fee-paying service for undertaking the train-
ing if suitably qualified staff are available [73]. Another option is to refer owners/caregiv-
ers on to a suitably experienced equine behaviour professional for assistance with training
the new behaviours, or the modification of existing challenging behaviours [73,81,136].
For the owners who are committed to pursuing voluntary participation in HVPs and
have spent considerable time building foundation behaviours and honouring their horse’s
consent cues, it is necessary to locate a veterinarian who is willing and capable of provid-
ing veterinary care using this approach. Anecdotally, owners in this position are prepared
to pay a premium to have access to this service, yet finding suitable clinics/veterinarians
can be difficult in some regions. This highlights a gap in the industry that can only be
filled by veterinarians trained in the application of this approach.
Providing non-urgent veterinary care to a fearful, anxious, or stressed animal can
create a challenging ethical dilemma for veterinarians [137]. The horse is likely to suffer
emotionally, and the human personnel involved may be at an increased risk of injury;
however, the client may not want to be inconvenienced by re-scheduling, and/or they may
be unwilling or incapable of undertaking the training the horse requires in order to safely
cooperate during the HVP. To prevent veterinarians being placed in a position where their
safety is at risk, where they feel their team’s safety is at risk, or they feel it is unnecessary
or inappropriate from a horse-welfare perspective to undertake a non-urgent HVP with a
horse before further training has been undertaken, it can be beneficial for veterinary prac-
tices to actively develop policies and guidelines about equine care as it pertains to non-
urgent HVPs.
There is no doubt that the safety of veterinarians and horse-care professionals must
remain paramount when undertaking HVPs on horses. One of the most effective ways to
achieve this is to aim towards horses being trained to safely participate in common HVPs.
6. Conclusions
The potential impact of HAIs or HVPs from the perspective of the emotional experi-
ence of the horse at the time, the potential for long-term behavioural injury, and the impact
on that horse’s future emotional experience and behaviour in similar scenarios, should
always be given serious consideration.
Welfare needs to be at the forefront of every interaction with a horse, including each
HVP. Continuing to use methods that focus on just “getting the job done” without con-
sidering the horse’s emotional state and well-being are no longer appropriate in today’s
society.
Improving the horse’s experience during a HVP can be achieved through human ed-
ucation, thoughtful planning, active welfare-oriented management, and effective horse-
training protocols. This approach improves horse welfare, whilst also reducing the risk of
injury to owners, trainers, handlers, and horse-care professionals.
Author Contributions: Conceptualization, S.L.C., B.W.S. and P.C.M.; methodology, S.L.C.; writ-
ing—original draft preparation, S.L.C., B.W.S. and P.C.M.; writing—review and editing, S.L.C.,
B.W.S. and P.C.M.; supervision, B.W.S. and P.C.M. All authors have read and agreed to the pub-
lished version of the manuscript.
Funding: This research received no external funding.
Animals 2022, 12, 2907 13 of 17
Institutional Review Board Statement: Not applicable.
Informed Consent Statement: Not applicable.
Data Availability Statement: Not applicable.
Conflicts of Interest: The authors declare no conflicts of interest.
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