This document provides information on coping with challenging behaviour, violence, aggression, and de-escalation techniques. It defines violence and aggression, discusses types of aggression and the role of anger. Reasons for violence like expression, manipulation, retaliation, and retaliation are explored. Factors that can escalate situations and signs of potential violence are outlined. The goal of de-escalation to reduce conflict through building rapport is described. Techniques like awareness, assessment, and action are recommended. Non-verbal communication, active listening, and empathy are emphasized when responding. The document cautions against escalating responses and provides guidance on physical intervention only as a last resort.

1. Coping With
Challenging Behaviour
Diane Hanna Snr, Consult Psych

2. Violence, Aggression, and
De-escalation

3. Video

4. Terminology of Violence and Aggression
Violence can be defined as the use of physical force
with the intent to injure or harm another person or
destroy property
A person who is aggressive does not necessarily
act out with violence
Aggression is generally defined as angry or violent
feelings or behaviour
While a person who commits an act of violence may be
acting with aggression, a person with an aggressive
nature will not necessarily engage in violent acts
Although aggression can result in a physical or verbal attack, sometimes the attack may be defensive or impulsive, and
lack harmful intent
Both can have negative effects, on both a societal and individual level

5. Types of Aggression
> Accidental (at play or in a hurry)
> Expressive (intentional, but no intent to
cause harm - it may be frustrating or
cause harm - but causing harm is not
the purpose)
> Hostile (is meant to cause pain)
> Instrumental (to obtain an outcome)

6. The role of anger in
aggression and violence:
A N G E R

8. Anger: an emotion
characterised by
antagonism toward
someone or something
you feel has deliberately
done you wrong (Kazdin,
A.E, 2000)

9. It is normal to feel angry, or
frustrated when you have
been let down or betrayed,
but anger and frustration do
not justify violent action.
Anger is a strong emotion
that can be difficult to keep
in check.

10. > Anger is perhaps the main emotion at the
core of all violent and aggressive behaviour.
> When we think of someone angry -Rage,
hostility, furious, irate, incensed, livid,
murderous are just a few words we may use
to describe them

11. Violence is an extreme form of
aggression, such as assault, rape, or
murder.
Violence

13. Reasons for Violence
Expression
As a release for anger
and frustration. Some
people believe there
are no answers to their
problems and use
violence to express
their out of control
emotions.
Manipulation
Violence is a way to
control others, or used
by certain individuals as
a way to get something
they want.

14. Reasons people use violence:
> Retaliation
> Violence is used to
retaliate against
those who have
hurt them or
someone they care
about
> Violence is a
learned behaviour
> Like all other
learned behaviour,
it can be changed.
This is not easy. No
single cause/no
single solution.
Warning signs/help

15. Factors in Violence
> Static Signs
> Hx of violent/
aggressive
behaviour
> Young age at first
violent incident
> Having been a
victim of bullying
> Hx of discipline
problems/authority
problems
> Early childhood
abuse/neglect
> Having witnessed
violence at home
> Family/parent
condones use of
violence
> Hx of cruelty to
animals
> Having a major
mental illness
> Lack of
empathy for
others
> Hx of
vandalism or
property
damage

17. Other signs present over time/may escalate
or contribute:
Serious drug/
alcohol abuse
Gang membership/
desire to join gang
Access to or
fascination with
weapons, esp guns
Trouble controlling
feelings of anger
Withdrawal from
friends and usual
activities
Regularly feeling
rejected or alone
Feeling constantly
disrespected
Personal space/
facial expression
New OR Active Signs:
Increased loss of temper
Frequent physical fighting
Increased use of alcohol or
drugs
Increased risk-taking behaviour/
s
Declining school performance
Acute episode of major mental
illness
Planning how to commit acts of
violence
Announcing plans/threats to hurt
others
Obtaining or carrying a weapon

18. Escalation
What is it?
and what
causes it…?

19. VIDEO
https://youtu.be/b85Dw0R4ipg

20. Escalation and its causes
> An increase in
hostility, tension,
competitive
behaviour, bringing
personalities into
conflict
> The helper engages in
power struggles, does
not attend to body
language, overreacts to
threats/posturing/
emotional displays, their
own issues become
engaged; the helper
pushes/becomes
provocative - the persons
feels unheard/threatened

21. What else could
escalate matters?
Anything else?

22. Angry/agitated/upset person’s point of view
Angry/
upset
person
‘block’
‘stop’
you
what
they
want -
unmet
need

23. Behavioural
Crisis
Why and when we do De-escalation

24. What is a Behavioural Crisis?
> An episode of mental
and/or emotional
distress that is
creating instability or
danger and is
considered
disruptive to
community or the
person him/her self

25. Recognising & Responding
> Mental (mental
illness? Are they
anxious? Paranoid?
Angry/confused?)
> Medical ( is there a
medical issue? Are
they hurt/injured?)
> Alcohol and or other
drugs (are they
under the influence?)
> Situational stress
(relationship/
marriage breakdown/
$/job loss/gender of
baby)

26. Crisis
Intervention:
> A process to assist
individuals in finding
safe and productive
outcomes to
unsettling events

27. De-escalation
Reduction In The Level Of
Conflict

28. The goal of de escalation is to
build rapid rapport and a sense of
connectedness with an agitated
person to reduce the likelihood of
escalation to physical violence.
This sense of connectedness is
established via specific verbal,
psych, and non verbal techniques
that emphasise control over ones
own emotional response to threat
while guiding communication.

29. De-escalation
> The 3 As of De-escalation:
> Awareness, Assessment, and Action.
> Awareness and Action = the total sum of
all info collected about the nature,
circumstances, stages, and dynamics of
various forms of escalation

30. > Action = Verbal and Non Verbal behaviour +
strategies we use to guide communication,
de escalation techniques used to resolve
the crisis without the use of force.

31. > Helps identify:
precipitating
factors
> Our own ability for
self control
> Interventions &
timing

32. How we react in return determines
whether the situation escalates, de
escalates, or becomes mutually or
individually tolerable

33. Before we De-
escalate:
Know Thyself

34. What Are Your Hot Buttons?
> Need to be right?
> People pleasing?
> Control issues? (power struggle)
> Burn Out?
> Personalising? (it’s not about you)
> Tendency to compete? (power struggle)
> Tendency to blame? (arguing)
> Response to threat/s (tell your boss/report you)

36. Your Physiological Reactions
> Increased
heart rate
> Adrenaline
> Increase in
body temp
> Face Flushed
> Shaking
> Nervous
Laughter
> Sweaty Palms
> Clenched Fist
> Licking Lips
> Blinking
> Breathing
faster
> Teary
> Stutter

37. De-escalate yourself first (Grounding)
> Breathe
> Act Calm (fake it)
> Neutral face
> Relaxed Body
(muscles)
> Reassure yourself/
positive self talk
> Hold something non
threatening (pen)
> Maintain eye contact
(don’t stare)
> Keep gestures
minimal
> Position yourself for
safety (safe
presence exercise

38. Telephone Call (Admin)
> Pitch, pace, tone of your voice
> Focus, on their tone, pace
> Ask information questions?
> LISTEN, CHECK, REPEAT, WRITE DOWN
> Reassure, no power struggle
> If very aggressive, try signal staff member
> Direct threat TOWARDS YOU - hang up and alert
security
> Threats to self harm/kill themselves or others try to stay
on the line and get another relevant staff member, take
notes, call police if necessary

39. BREATHE…!
Slow down and listen.
Ask questions and
take notes

40. Reception Area (Admin)
> Counter height/glass screen/situational
Awareness
> Potential objects to be thrown
> Keep sharps - scissors/letter openers in drawers
> LISTEN, LOOK UP, CHECK FOR SIGNS,
INFORM
> If escalating, call staff member and/or security
> Direct threat TOWARDS YOU - exit area as best
you can
> If there is a weapon, try and remain calm

41. 3 As Awareness, Assessment, Action
> Individual
> Risk Factors for Violence
> Action: NVB first, followed by VB

42. Individual
> Safety
> Substance issues
> Hx Violence/Abuse
> Paranoid
> Medication
> Physically Ill/Pain
> Diff with comm/lang
> Social Stressors

43. Violence Factors
> History of
Violence
> Suicidal
tendency/threats
> Individual triggers
(divorce/major
loss/life change)

44. Environment
> Audience
> Crowded - no space
> Noisy
> Behaviour of others
> Potential weapons
> Escape path
> Use of natural
barriers

45. Action
Non verbal

46. Action - Non Verbal
> Appearance:
> Calm (even if you don’t feel like it)
> Centered/self-assured (anxiety is
transferred)
> Maintain eye contact (loss of leads to
misinterpretation as lack of interest/
respect or fear - too much can be seen
as a threat or challenge

47. Non verbal
> Neutral facial
expression
> Relaxed/alert posture
- Safe Presence
> Feet shoulder width
apart, weight evenly
balanced
> Minimise all body
movements
> Body movements -
pacing, fidgeting,
excessive gesturing etc
are indicators of anxiety
and may increase
agitation
> Same eye level at all
times
> Hands down by side,
palms up, wrists
exposed

49. Allow them to vent

50. > De-escalation
Process:
> Active listening
> Empathy
> Rapport
> Provide info/
support
> Follow up/Staff
Debrief

51. Before ANY Verbal Action
> LISTEN: 3 Main Skills
> Attending - physical/mental attention to
other person
> Following - use eye contact to engage,
nod, saying ‘ok’, ask infrequent question
> Reflecting - paraphrase/reflect using
feelings of the other person

52. Empathic Listening
> Do NOT be judgemental
> Do NOT ignore the person/pretend to listen
> Listen to what is being said
> Restate the message
> Clarify the message
> Repeat the message
> BE EMPATHIC…! Validate their feelings

54. Phrases for Miscommunication
> Ordering: You must…you have to…
> Threatening: If you don’t…then…
> Preaching: You really should…
> Lecturing: Heres why you are wrong…
> Judging: You’re lazy…you’ll never change
> Excusing: It’s not so bad…
> Labelling: Well, you’re just being unrealistic…

55. Other unhelpful Phrases
> Calm Down…!
> Chill Out…!
> Not this again…
> Whataboutism…
> How dare you…!
> We don’t want your rudeness here…!

56. Approaching the Person
> Use their name to address them (admin
phone)
> Introduce yourself - Hello I am….the….
> Explain your intentions/convey your
expectations clearly
> Any requests simple/specific
> Be an active and reflective listener

57. Put yourself on
their side of
finding a solution
to the problem

58. VIDEO CLIP
McD

59. DO NOTS:

60. > Lean on counter
> Put hands in pockets
> Fold your arms
> Place hands on hips
> Touch the person
> Offer them a hot drink
> Stand over them
> Raise your voice
> Point/shake finger
> Do not turn your back
> Do not walk away

61. Tips Before De-escalation
> If you have time - out
of sight from the
person - remove
hanging ID tags/other
items like chains with
keys etc
> Ladies remove any
jewellery/chains, big
earrings; tie hair back
> Men - remove ties

62. Your aim is to
bring the level
of arousal
down to a
safer place

63. Action
> Align yourself with person (Triangle)
> Redirect attention
> Feedback (only if not highly agitated)
> Change the immediate environment
> Ask them to sit down/offer water
> Be careful of using humour

64. Action continued DO NOTS
> Do Not be defensive
> Be assertive but do NOT justify/defend
> Do not try to argue or convince
> Use modulated monotones, lower voice
> (Voice tightens and sounds higher when
scared)
> Do NOT get loud or try to yell over the other
person - wait for a breath then speak

65. Group Exercise
Role Play

67. Action continued
> Speak calmly/average volume
> Be respectful when limit setting or calling
for help - the agitated person is sensitive
to feeling shamed and disrespected as
already on the defensive
> They need to know we treat everyone
with dignity and respect

68. Respond Selectively
> Answer
information
seeking
questions only
- NOT abusive
ones

69. “Why do I have to
fill out these stupid
forms…”??

70. “Why are all
nurses such
idiots…?”

71. Continued
> Be honest - DO NOT lie, as tempting as it
may be - the consequences could be fatal
> Do not give out information which may
further upset the person (if you came
yesterday it would have been free…)
> Explain the limits/rules respectfully, give
choices where possible (continue calmly or
come back later when things can be more
relaxed)

72. Continued
> Empathise with feelings but NOT the
behaviour - I understand your anger but it
is not ok to threaten our staff
> Trust your instincts…!!! If you sense that
the process is not working - STOP! Get
help (be creative if you need to be)

74. Group Exercise
Role Play

75. Physically Threatening/Physically Violent
> If physically threatened - discreetly get
into defensive stance/weaker side
> If they physically attack you or another
person, your response changes to a
self-defence/survival mode
> Protect yourself - goal is not to fight, but
to control the situation

76. It is important to remember
your responsibility to the
safety of others in the area
and to also keep yourself
safe -
RETREAT, IF YOU NEED
TO…!

77. > Summary:
> Align with person
> Redirect Attention
> Communicate
Clearly
> Be Honest/
Responsible
> Trust Your
Instincts

78. Learn to Practice
Self - Care
> Healthy balance home/work life style - it
is ok to cry and de-stress, take some time
- 10-20 mins just for you to release
tension and stress (hobby, interests)
> Engage with friends, get rest, exercise,
plenty of fluids, and take meal breaks -
you are not a robot…!

79. Questions and
Discussion

80. Thank You