New ABI Training: Anger and Agression

This is the acquired brain injuries, anger and aggression training module for Arcadia Homecare.

This is a very short module, but it’s probably the most important module you’re going to do. 

We’re going to be talking about the angry and aggressive clients. And how they progress through what it’s called the aggression continuum. We’re going to learn about some of the physical signs the client is escalating through the continuum and we’re going to share some strategies and how to support angry aggressive clients and what specific strategies to use when they’re angry and which to use when they’re calm. Very important guys, pay attention. 

Okay, let’s go through the six steps in the aggression continuum ladder. 

So we start off, person is calm, they’re normal, they’re relaxed, and then something triggers them something upsets them, something gets them agitated. They’re then verbally agitated, so they might start talking a little more quickly. 

Louder, and they start swearing a little bit and then they escalate to being verbally hostile. So now they’re very angry and they’re making it known. They’re louder, swearing, maybe yelling a little bit. 

And then they progressed to verbally threatening. So now they’re still hostile and agitated, but now they’re making threats. Now, they’re going to say, you know, I’m going to do this or that to this person or this thing. 

Then they get to physically threatening so they might be making a fist. They might be posturing. They might be puffing up their chest and spreading their arms out while making verbal threats. At the same time. And then lastly, we get to physically violent, so now they’re throwing punches, now they’re trying to do actual harm. It’s important to note that someone can go through the aggression continuum against another person, so they might get mad at another person and they get verbally hostile with them. They start threatening the other person to become physically threatening, making physically threatening postures, and then they attack the person. But it can also be against a thing or a concept. So maybe the person is playing Playstation, and they’re they’re losing their video game and they become agitated at the game. They start yelling at the game, they start saying that they’re going to smash the PlayStation. They start throwing objects at the screen. And then finally they decide they’ve had enough the PlayStation is cheating, and they physically destroy the PlayStation. It could also be against concept, like someone might get really mad at capitalism, and they might start making verbal threats against capitalism, like I’m going to bring the system down and I’m going to destroy the banks. And then they escalate to physically threatening and maybe they decide they’re going to threaten to smash a bank or burn a bank down and then they get physically violence against the bank. So physical aggression can happen against a thing, or even a concept so it’s important to be aware of these six steps in the aggression continuum, and to try and stop it before it gets to physically violent. Depending on how quickly your client escalates through these steps. You might be able to stop them before they get to verbally threatening you might be able to stop them before they get to verbally hostile. The goal obviously is to stop them before they get to being physically violent, but that might not happen. But it’s important to be aware of these six steps, how your client progressing through them, and what you can do to help calm them down to make sure they do not get the last step which is physically violent. And the next slide we’re going to see a graph of how two different people might progress through the continuum. One person with ABI, one person with no brain injury. 

So here are two graphs illustrating how two different people one with a brain injury one with no brain injury will escalate through the aggression can see the normal person here on the left there. And then something triggers them and they become verbally aggressive, maybe a little hostile, and then they start to calm down. 

And aggressive ABI client however, they’re calm, something triggers them, and they escalate through all five steps of the continuum very quickly. So right here at the top just below violence, they’re right at being physically violent. So they might be throwing stuff. They might be posturing, they might be making a fist, and then it escalates into violence, and then eventually they start to come down. But you can see the difference and escalation. The aggressive client who has a lack of emotional control and lack of impulse control the level of aggression skyrockets, very, very quickly in a short amount of time. 

So here are some strategies you can use to help support and aggressive clients when they are angry, calmly and slowly. Do not place any demands on them. Don’t start shouting orders. at them. Don’t start yelling, calm down, calm down. You need to model appropriate calm behavior for them. You need to keep your calm you need to keep it cool. 

You want to try and remove the client from the situation and any audience. Nothing whips up a situation more like a crowd of people filming you or cheering you on to beat someone to help. You want to remove them from a crowd. You want to take them someplace quiet somewhere where no one’s watching them. 

So you want to try and remove the client from the situation. 

You also want to try and keep a bit of distance from them, I would say about to arm’s length away from them, so that in the event that they do lash out at you, you’ve got enough space that you can sort of see it coming and be prepared to exit the room and get out of that situation as quickly as you can safely don’t try to physically restrain the client. 

This might just agitate them more. They might take it as a sign of hostility and they might attack you. So avoid physical restraints. 

Try not to get yourself cornered. You always want to know where your exits are. So if you’re in the client’s house, and the client is standing in the doorway, and they’re getting agitated, they’re progressing through the progress continuum, and you are in the corner. Well now you’re dropping there. So you always make sure you know where your exits are when you’re working with plants who are angry and aggressive. And you want to try and make sure that you stand in doorways, or stand somewhere where there’s an exit for you to be able to get to so always know where your exits are most important is keep your calm. If you start panicking or raising your voice, it will make things worse. You always want to model calm, appropriate behavior. 

Now, when the client is calm at a later date, you can discuss what their triggers are. What kinds of things anger them, what upsets them, what pisses them off? Discuss what their anger continuum looks like. What are the signs that they’re getting angry and escalating towards violence? Do they start to swear a lot more when they get angry? Do they raise their voice? Do they talk quickly? Do they stand up and pace back and forth? Do they breathe more heavily? All these physical signs that they’re getting angry that they’re getting worked up, the client may not even be aware of them. So you want to help the client be able to recognize those signs that they are getting angry. 

And you want to instruct the client how to remove themselves from the situation. Once they’re able to recognize the signs that they’re getting aggressive, but they’re getting angry. That’s the key moment when they need to remove themselves from the situation. Find a quiet place and just take slow, deep breaths until they’re calm. Really try and encourage that of your clients. slow deep breaths. Allow them to vent allow them to talk about what’s angering them. validate their feelings. Don’t try and fix the problem for them. Just be there to listen to them, support them and get them to take slow deep breaths until they’re calm.