Northcoast Polytechnic Institute

1. Northcoast Polytechnic Institute • Crisis behaviors • Verbal and Non-verbal tactics • De-escalation skills Recognize/Identify

2. Instructional Objectives • Identify general physiological signs of anger • Identify common triggers to anger • Recognize the levels of anger • Learn appropriate interventions for each level of anger • Tips to manage your own anger • Self- protection tips

3. “Anyone can become angry. That is easy. But to be angry with the right person, to the right degree, at the right time, for the right purpose and the right way… that is not easy.” Aristotle

4. Heart beating faster Breathing rate increases Fists clenched Face feels hot or cold Hands shaking Profuse sweating Higher body temperature Physiological Signs of Anger

5. Sudden dry mouth Stuttering Muscles tensing Goosebumps Face turns pale or red Teeth grinding, jaw clenching Physiological Signs of Anger (con’t)

6. Losing power Losing status Losing respect Being insulted Not having things turn out the way you expected Prompting Events . . . for feelings of anger

7. Experiencing physical pain Experiencing emotional pain Being threatened with physical or emotional pain by someone or something Prompting Events . . . for feelings of anger

8. Having an important or pleasurable activity interrupted, postponed or stopped Not obtaining something you want Prompting Events . . . for feelings of anger

9. Expecting pain Feeling that you have been treated unfairly and unjust Believing that things should be different Rigidly thinking “I am right” Interpretations . . . for feelings of anger #1

10. Judging that the situation is illegitimate, wrong or unfair Ruminating about the event that set off the anger in the first place, or in the past Interpretations . . . for feelings of anger #2

11. Follows a predictable pattern of levels Levels have observable characteristics Opportunities for intervention are present at every level May be about something other than situation at hand (lack of sleep, work problems, fight with significant other, illness, etc) Anger FACTS FACTS

12. The Anger Cycle Levels overview 5. Outburst 4. Challenge 3. Refusal 2. Back Talk 7. In Control 1. Questions 6. Quiet Period Anger Cycle by Chuck York

13. Anger Cycle #1 Level 1 - Questions Description • May be legitimate questions about an activity, missed information, etc • “What are we suppose to be doing now?” • “Why do I have to go?” • “How does this stuff help me?” #1

14. Anger Cycle Level 1 - Questions #2 • May be an attempt to question your authority • “Why do I have to listen to you?” • “Who died and made you boss?” #1

15. Approriate Intervention for Questions • The easiest way to prevent escalation from this point is simply to answer the question • Assume that questions are real. Do not assume the person is trying to “start something” or be manipulative by asking questions • Use “Reflective Listening” to maintain clear communication ANGER CYCLE Level 1

16. Approriate Intervention for Questions (con't) Reflective listening • Let the person do the talking • Focus on what the person is saying • Focus on the person’s emotions (look at body language, sound of voice, etc.) • Restate what the person is saying to you to show you understand • Keep your answers short and clear ANGER CYCLE Level 1

17. Anger Cycle Level 2 - Back Talk Description • Person is showing their anger and trying to incite you to be angry • “You’re always telling me what to do! Why don’t you do it?” • “You don’t know what you are talking about” • “This is all just stupid” #1

18. Approriate Intervention for Back Talk • Stay calm and in control • Be aware of your facial expressions, your posture, and how your voice sounds • Keep a distance of at least 3 feet between you and the person • Speak slowly and be civil • Do not cross your arms or make yourself look “closed • Redirect the person back to the topic of the discussion ANGER CYCLE Level 2

19. Anger Cycle Level 3 - Refusal Description • The person is challenging your control of the situation by refusing to comply with a direction • “I’m not going” • “I’m not going to do that” • Crossing arms, turning head, ignoring you • “Do it yourself” #1

20. Approriate Intervention for Refusal • Stay calm, cool and collected • Your behavior impacts the situation. • If you are responding to the person’s anger, the person will become more angry • Give the person two clear choices that are reasonable and appropriate. Explain the consequences for each of the choices ANGER CYCLE Level 3

21. Anger Cycle Level 4 - Challenge Description • The person is attempting to directly challenge your authority • “You can’t make me do it!” • “I don’t have to do that!” • “Pick on somebody else!” #1

22. Approriate Intervention for Challenge • Try to remove either the person or the audience • The person may escalate faster if the others are watching • Seek help if you think this will escalate further • Check your own behavior and make sure you are in control ANGER CYCLE Level 4

23. Approriate Intervention for Challenge (2) • Increase distance between the person and yourself • Restate choices ANGER CYCLE Level 4

24. Anger Cycle Level 5 - Outburst Description • The person is no longer able to maintain control • May take 2 forms: Verbal or Physical • Verbal Outburst - screams, yells, shouts profanity, cries, etc • Physical Outburst - attacks, kicks, throws, breaks, runs, etc #1

25. Approriate Intervention for Outburst If the outburst is verbal • Keep a space between the person and yourself • Allow the person to vent • Do not attempt communication at this point • Wait for the episode to progress naturally to the next level; the “Quiet Period” ANGER CYCLE Level 5

26. Security! Approriate Intervention for Outburst If the outburst is physical • Remove the other bystanders from the room • Exit the room yourself, and attempt to maintain visual contact with the person #1 ANGER CYCLE Level 5

27. Security! Approriate Intervention for Outburst #2 • If your organization has a Crisis Response Team (CRT), call the team and implement Non-Violent Physical Crisis Intervention • If your organization does not have a CRT, maintain observation and wait for the person to move into the next level; the “Quiet Period” ANGER CYCLE Level 5

28. Anger Cycle Level 6 - Quiet Period Description • After every outburst, the person will reach a “quiet period” in which their emotional status is below their average state • Usually represented by being quiet, lack of energy, sometimes crying, moving to a protected area, etc. #1

29. Approriate Intervention for Quiet Period • Give the person space and time to calm down • Quietly offer support ANGER CYCLE Level 6

30. Anger Cycle Level 7 - In Control Description • The outburst is over, and the person has regained control • Still a sensitive time, and care should be given not to re-escalate the situation #1

31. Approriate Intervention for In Control • Invite the person to rejoin communication • Ask the person to join clean up of any messes or damage caused • Ask the person which of the choices they have selected ANGER CYCLE Level 7

32. Stethoscopes around your neck Badge lanyards that are not “break-away” Long necklaces Dangling earrings Long hair (always pull back) Men’s ties Self Protection Always be aware of

33. Things that can be used as weapons Scissors, Hemostats, Eating utensils (even plastic), plates, plate warmer, water pitchers, vases, anything glass or ceramic Belts, robe ties, tubing (IV, 02, etc) Sheets, pillowcases, gowns Pens/pencils Furniture Self Protection Always be aware of

34. REVIEW #1 1. Anger follows a predictable and observable pattern 2. There are appropriate interventions for each level of the anger cycle 3. You are an active participant in the cycle, and can escalate or de-escalate the behavior with your actions

35. REVIEW #2 4. When a person reaches the outburst level, they are no longer in control of their actions 5. The key point during an outburst is to create the safest environment possible to prevent injury 6. NEVER attempt a physical intervention unless you have received proper training and it follows your organizational policies and guidelines