TABLE 1.

De-escalation training protocol.

I. Background theory
1. Aggressive behavior in persons with mental disorders
The prevalence of aggressive behavior
Risk factors for aggressive behavior
Characteristics of aggressive behavior
Consequences of aggressive behavior
2. Communication
Basic principles
Verbal communication
Non-verbal communication
3. De-escalation
What is de-escalation
When should de-escalation be used
When to avoid using de-escalation
4. Establishing a safe environment for de-escalation
5. Non-verbal de-escalation techniques
Personal space
Body posture
Eye contact
Face mimic
Movement and gestures
Touch
Speech (tone of voice, volume, and speed of speech)
6. Verbal de-escalation techniques
Establishing verbal contact (one person, respectful communication, honesty)
Concise and clear communication (short sentences, repeating, avoiding complex questions)
Active listening (short non-verbal responses, reflection and paraphrasing)
Identifying patients’ wants and feelings
Limits and rules-setting
Offering choices and alternatives
Time out
Creating an alliance
Agree or disagree (finding something on which to agree)
Distracting, changing subjects
Taking responsibility
Withdrawal strategy
Humor
Praise, apologies, use of words please and thank you
Debriefing
7. Techniques that are better avoided: insincerity, false promises, provocative communication, interruption during speech, use of excessively professional terms, minimizing patient problems, “mind reading,” “why” questions, authoritative approach, global phrases (calm down…) etc.
II. A workshop: presentation of clinical cases and video material, role-playing (based on real scenarios from clinical practice)
1. Demonstration of various de-escalation techniques
2. Appropriate and inappropriate approaches to dealing with an agitated patient
3. Using non-verbal and verbal de-escalation techniques
4. Recognizing and managing one’s own emotional responses