Trauma-Informed De-escalation in the Moment
When tensions rise and emotions run high, knowing how to respond effectively can prevent a situation from spiraling out of control. This article draws on insights from experienced professionals who specialize in crisis intervention and trauma-informed care. Learn practical techniques for recognizing emotional distress and providing appropriate support when it matters most.
Acknowledge Emotions Then Offer Help
"Validation of the Feeling, Not the Behavior" is a helpful de-escalation step for trauma-informed care. When patients or families are upset, the "fight or flight" response can be activated because of an experience when they sensed (perceived) that they lost control of their safety and security. Instead of correcting their outburst in order to provide assistance, let them know you can see they are very overwhelmed and want them to know that you have heard them, and then provide a solution that will help them.
For example, you can use this technique when dealing with a family member of a patient who might be yelling in the hallway due to a delay in a procedure. Instead of immediately calling security or telling him to be quiet, step into view at a safe distance and say something like, "You clearly love and are concerned about your loved one. I can see how exhausting this wait is for you. What is your biggest issue right now that I can help you address?" By first acknowledging his feelings, exhaustion, love, and concern rather than his yelling, he may immediately change his posture, lower his voice, and move from confrontation to a productive discussion regarding the clinical timeline.
Reduce Stimuli Create Calm
Lower the noise and light to help the body settle. Move to a quieter spot, or reduce voices and background sounds. Limit sudden touch and fast movements, which can spike fear.
Remove extra people and distractions so the person has more space to breathe. Offer a slow, grounding cue like noticing feet on the floor. Create a calmer space now.
Give Simple Choices Restore Control
Choice gives a sense of safety when things feel out of control. Offer two clear options that are both safe and easy, such as sitting or taking a short break. Respect a no, and keep the choices simple and direct.
Avoid power struggles by sticking to the options and giving time to decide. Praise any step toward a choice to build trust and agency. Give a simple choice now.
Set Clear Next Steps Define Timeframes
Predictability lowers panic by reducing the unknown. State what will happen next and about how long it will take. Share what will not happen, such as no punishments or no restraints, when that is true.
Check for understanding in simple words and invite questions. Repeat the plan if stress rises, and keep it steady. State the next small step now.
Signal Safety Show Open Relaxed Posture
Body language can signal safety or threat. Keep hands visible with open palms and relax the shoulders. Stand at an angle and give enough space so the person does not feel trapped.
Do not block exits, and ask before moving closer. Match the person's pace and keep eye contact soft and brief. Adjust your stance now.
Adopt Steady Tone Provide Clarity
Voice and words can either fuel or ease stress. Use a calm tone that is steady and low. Speak in short, clear phrases without blame or labels.
Give one message at a time and leave space for a reply. Reflect back key words to show understanding and reduce fear. Speak in a steady voice now.