For many physicians and other healthcare professionals, the threat of workplace violence is something that they feel underprepared to manage.

Statistics consistently show that there is an epidemic of violence in hospital and healthcare settings. In fact, if you use the metric of nonfatal illnesses and injuries, healthcare is the most dangerous profession there is.

So what do we do with that?

The responsibility for violent behavior lies with the individual engaging in it, and not with the individual being confronted with it. 

But there are still tools that we can use to turn down the temperature in volatile and disruptive interactions, in an effort to reduce the risk of violence.

We talked last time about how to practice situational awareness in the non-clinical sense of being aware of the situation in which you find yourself and attuned to potential threats around you. Though there are barriers to successful situational awareness, there are also exercises you can practice to improve it.

Another technique that can help you manage potentially violent or disruptive incidents is de-escalation.

De-escalation is frequently discussed as almost a cure for violence, a guaranteed way to reduce tensions and avert conflict.

These discussions ignore the wide variability around definitions of de-escalation, both in real-world and in research settings. 

Once we agree on a definition of de-escalation, there is still the question of effectiveness. A recent study identified 64 de-escalation training programs conducted over a 40-year period and found that there was no evidence of effectiveness (Engel, et al. 2020).

Nobody is taking that finding and concluding that we should stop using de-escalation. But it does beg the question of how to make the use of de-escalation techniques actually work.

One of those ways is through emotional self-regulation. Emotional self–regulation is the capacity to exercise control over one’s own emotions. We’re really talking about down-regulating or reducing the intensity of the emotions. Feeling strong emotions is healthy, but being led by them can have numerous repercussions. It is virtually impossible to de-escalate a situation when you are escalated yourself.

Just a note that if you are confronted with a situation that is particularly triggering to you — it may be a person’s volume or them coming too close to you — it may be even more difficult for you to regulate your emotions. 

And another note that emotional self-regulation is important across all aspects of your life and not simply in violent or potentially violent situations.  

The good news is that there are many situations we face that are outside of our control, but emotional self-regulation is not one of them.

In addition to counting to 10 or slowing your breathing, there are other techniques you can use to regulate your emotions. 

One effective exercise can be called 5-4-3-2-1. Gently focus your attention on yourself and your environment and identify:

• 5 things you can see;
• 4 things you can touch;
• 3 things you can hear;
• 2 things you can smell; and
• 1 thing you can taste.

If you are unable or prefer not to do one of those steps, simply leave it out. 

Of course, you want to use a technique like this early on in any distressing or escalating situation. You don’t start checking your smoke alarms while an inferno is blazing.

Another effective technique can be noticing what’s peaceful in the environment. The environment may be chaotic, loud, and aversive – but there is almost certainly a peaceful piece to it, a place you can use as a mental oasis.

Naming what you feel can also be helpful. “Bad” is a descriptor, but it isn’t a feeling. Sad, devastated, angry, regretful, and anxious are some examples of feelings. You may, and probably do, feel a combination of feelings. That’s normal and healthy. It is also normal and healthy for emotions to ebb and flow and change, often in a short period of time. Naming your feelings is a first step to managing them adaptively.

Finally, you can use the technique “just like me” to connect with our shared humanity and access emotional self-regulation resources in difficult times. We all have a running narrative of our lives and the situations in which we find ourselves. This is self-talk, our internal monologue. 

To use the “just like me” technique, you add the words “just like me” to your self-talk.

So, for example, you say to yourself: “This person is really getting upset.”

Then you add: “just like me” so that your new self-statement is “This person is really getting upset, just like me.” 

Remember that emotional self-regulation is not emotional suppression or toxic positivity. It is regulating the intensity of your emotions in order to function adaptively. I invite you to begin trying these techniques to see which are most helpful for you. 

References: Engel, R. S., McManus, H. D., & Herold, T. D. (2020). Does de-escalation training work? A systematic review and call for evidence in police use-of-force reform. Criminology & Public Policy, 19(3), 721-759.