The focus of unit 3 is verbal de-escalation.

“Agitation exists on a continuum, eg, from anxiety to high anxiety, to agitation, to aggression.

Agitation is an acute behavioral emergency requiring immediate intervention. Traditional methods of treating agitated patients, ie, routine restraints and involuntary medication, have been replaced with a much greater emphasis on a noncoercive approach.

The traditional goal of “calming the patient” often has a dominant-submissive connotation, while the contemporary goal of “helping the patient calm himself” is more collaborative. The act of verbally de-escalating a patient is therefore a form of treatment in which the patient is enabled to rapidly develop his own internal locus of control. …First, the patient is verbally engaged; then a collaborative relationship is established; and, finally, the patient is verbally de-escalated out of the agitated state.” ¹

By the end of this unit, you will be able to apply verbal de-escalation techniques to diffuse aggression and calm emotionally charged situations.

What is De-escalation?
De-escalation is the process of calming down a tense situation, reducing the emotional intensity of an interaction and guiding the conversation to a more manageable state.

What is Verbal De-escalation?

Verbal de-escalation is de-escalating through language and listening.

De-escalation Language

The language and tone used should be calm, respectful and empathetic.

It should offer solutions and optimism. Use language that focuses on finding a way forward, such as, “Here’s what we can do,” or “I can help you with that.”

It should set boundaries respectfully. Use polite but firm language to establish limits, for example, “I’m afraid I can’t allow that right now, but I can help you with… .”

It should encourage cooperation. Use positive reinforcement language such as “I appreciate your patience” or “Thank you for understanding.”

It should be non-confrontational. Avoid accusatory or aggressive phrases. Instead of saying, “You’re wrong,” use phrases like, “Let’s see how we can work this out together.”

Empathy through words: Think about a time when someone showed you empathy in their words during a stressful situation. How did that make you feel? How can you use similar language to show understanding in your own high-stress interactions?

Stay calm and focused – Keep your voice steady and soft. Speak slowly and clearly.

Acknowledge the patient’s emotions – Use empathetic statements such as, “I can see you’re really upset right now.”

Use active listening – Give the person your full attention, nod occasionally and paraphrase their concerns to ensure clarity.

Empathize and redirect – Redirect the conversation toward potential alternatives.

Set boundaries respectfully – Use assertive but respectful language to set boundaries.

Offer assistance or next steps – This demonstrates a commitment to helping and focuses on solutions instead of conflict.

The power of active listening.

Take a moment to think about how often we listen with the intention of responding, rather than fully understanding the other person. In high-stress situations, active listening can be a game-changer. How can you ensure you are truly listening and not just waiting to speak? How might that shift the dynamic of your interactions?

Key Takeaways

Verbal de-escalation involves empathy, active listening, clear communication and setting boundaries while maintaining respect.

Remaining calm, offering alternatives and setting clear expectations are key strategies in de-escalating tense situations.

Next Steps

• Do the exercises.
• Watch the illustrative videos for Simulation 3.
• Participate in Role-play Simulation 3, practicing verbal de-escalation.
• Share reflections and key takeaways during debrief.

1.       Richmond J.S. et al., „Verbal De-escalation of the Agitated Patient: Consensus Statement of the American Association for Emergency Psychiatry Project BETA”, https://pmc.ncbi.nlm.nih.gov/articles/PMC3298202/