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

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
“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. Physiological Signs of Anger
Heart beating faster
Breathing rate increases
Fists clenched
Face feels hot or cold
Hands shaking
Profuse sweating
Higher body temperature
Critical Incidents in the Workplace
Threats and incidents of workplace violence are on the rise.
Downsizing and reengineering are part of the cause.
All of us may be at risk at one time or another. 4

5. Physiological Signs of Anger (con’t)
Sudden dry mouth
Stuttering
Muscles tensing
Goosebumps
Face turns pale or red
Teeth grinding, jaw clenching
Critical Incidents in the Workplace
Threats and incidents of workplace violence are on the rise.
Downsizing and reengineering are part of the cause.
All of us may be at risk at one time or another. 5

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

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

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

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

10. Interpretations . . . for feelings of anger
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
. . . for feelings of anger #2

11. Anger FACTS 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) 11

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 Level 1 - Questions#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. Approriate Intervention for Outburst
Security!
Approriate Intervention for Outburst #1
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
ANGER CYCLE Level 5

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

33. Things that can be used as weapons
Self Protection
Always be aware of
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 33

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