Mild stress still matters: what a recent study on α-casozepine tells us about everyday veterinary visits

Most veterinarians don’t need convincing that veterinary visits can be stressful for dogs. Elevated arousal, avoidance behaviours, trembling, lip-licking, freezing, or hypervigilant scanning of the room are everyday sights in consult rooms.

For dogs with severe fear or anxiety, we are increasingly comfortable using pharmaceutical support such as trazodone, gabapentin, or dexmedetomidine, often alongside handling modifications and behaviour plans. These tools are invaluable and often necessary.

But there is a much larger group of dogs who sit in the middle.

These dogs still allow handling. They still “cope.” They still get through the exam. As a result, their stress is often accepted as unavoidable, or simply part of the job.

And yet, the question worth asking is not “Can this dog tolerate the exam?”
It is “How does this dog experience the exam?”

What the evidence shows

A recent randomised, placebo-controlled trial by Schroers et al. (2024) investigated the effect of short-term α-casozepine administration prior to a veterinary examination. Dogs received casozepine or placebo for two days before a standardised clinic visit.

Stress was assessed using a behaviour-based Visual Analogue Scale (VAS) scored by the veterinarian, based on observed posture, avoidance behaviours, and defensive responses during the examination.

The key finding was simple but important:
Dogs receiving α-casozepine showed a statistically significant reduction in stress score at follow-up, while dogs in the placebo group did not.

In the adapted figure from this study (below), this effect is clearly visible as a meaningful reduction in stress score from baseline in the casozepine group (P = 0.0026), compared with no significant change in placebo (P = 0.6567).

Importantly, these were not dogs requiring heavy sedation or emergency anxiolysis. These were dogs who could still be examined — dogs much like those we see every day.

Why mild to moderate stress deserves attention

Mild or moderate stress is often minimised because it does not stop the consult from happening. But repeated experiences of unmanaged stress can still shape a dog’s emotional learning.

A dog who is tense but compliant today may be less tolerant tomorrow.
A puppy who learns that the clinic is mildly aversive may carry that association forward for years.

From a behavioural perspective, emotional state matters even when outward behaviour remains functional. Reducing stress does not just make the consult easier — it can change how the dog encodes the experience.

This is particularly relevant for puppies and young dogs, where even subtle improvements in emotional experience may influence long-term perceptions of veterinary care.

Where α-casozepine fits

α-Casozepine is not a replacement for pharmaceuticals in dogs with significant fear, panic, or defensive aggression. Nor should it be framed as a cure-all.

However, what this study suggests is that casozepine can be a low-risk option for dogs experiencing mild to moderate stress, including those who would not otherwise be offered any support at all.

It can be used:

• across a broad range of patients
• alongside fear-free handling strategies
• without the sedation or behavioural suppression associated with some medications

For many dogs, feeling a little calmer may be enough to make the experience meaningfully better.

A small shift in thinking

As veterinarians, we are trained to prioritise safety, efficiency, and clinical outcomes. But emotional welfare deserves a place in that equation too.

So before shrugging off subtle signs of fear or tension in the consult room, it may be worth asking:
Is this a dog who could benefit from feeling calmer — even if they’re coping?

Sometimes, offering support before stress becomes severe is what changes the trajectory altogether.

Written by Dr Dennis Wormald - behaviour veterinarian and PhD