Assertiveness Training & Management of Emotional

Aggression

BY:- FIROZ QURESHIDEPT. PSYCHIATRIC

NURSING

Self AssessmentAre you comfortable starting a conversation with a new patient?

Do you express your true feelings to your patient?

Can you accept criticism without being defensive?

Assertiveness QuizAnswer the questions honestly. They will help

you gain some insights about your current level of assertiveness. 

Assign a number to each item using this scale: 

Always     5     4     3    2     1     Never 

HOW ASSERTIVE ARE YOU? Scor

eCategory Behaviour

≥ 60 Consistently Assertive

Handle most situations well

45-60

Fairly Assertive Assertive in some situations, need improvement

30-45

Seem to be Assertive, But Nonassertive or Aggressive

You may want to change some perceptions and practice new behaviors

15-30

Nonassertive Need to practice and allow yourself time to grow and change

Assertiveness Definition

Assertiveness is the ability to express your emotions and needs without violating

others rights and in the same time without being aggressive.

Why am I not assertive?Assertiveness is not something that is inherited. Lack of assertiveness is only rooted to the way of

dealing with others you got used to. You just step on yourself in order to make others

feel happy or in order to avoid being rejected.To become assertive, only one thing is

required……..

Your decision!

Assertive Rights1. To have your own values, beliefs, opinions,

and emotions.

2. To justify or refuse to justify your actions to others.

3. To put yourself first, sometimes.

4. To say: "no," “I don't know”, “I don't understand," or even “I don't care."

5. To take the time to formulate ideas before expressing them.

Assertive Rights Contd….

6. To make mistakes and accept its responsibility.

7. To stand up for yourself and for what you want.

8. To be treated with respect.

9. To set your own priorities.

10.To change your mind.

What will be the choice of your behavior in the following situation?

The student nurse is collecting History of Mr Mathew.

Behavioral Response Patterns

1.Nonassertive 2. Assertive 3. Aggressive 4. Passive-

Aggressive

Nonassertive BehaviourBehaviorual Characteristics

PassiveDoes not express true feelingsSelf depreciatingDenies own rights

Goals To please others,To be liked by others

Feelings AnxiousHurtDisappointed with selfAngry & Resentful

Compensations Able to avoid unpleasant situations & confrontations with others

Outcomes Goals not met; others meet their goals at their expenseDevelopment of anger Feels violated and manipulated

Assertive BehaviuorBehaviorual Characteristics

Stand up for own rightsProtects the rights of othersHonestDirect & Appropriate

Goals To communicate effectivelyTo be respected by others

Feelings ConfidentSuccessfulProudSelf respecting

Compensations

Increased self confidence, self respect &respect for othersSatisfying interpersonal relationships

Outcomes Goals metDesires most often fulfilled while defending own rights as well as others

Aggressive BehaviourBehaviorual Characteristics

Violates rights of othersExpresses feelings dishonestly & inappropriately

Goals To dominateTo humiliate others

Feelings Self righteousControllingSuperior

Compensations

Release of angerIncreased feeling of power and superiority

Outcomes Goals may be met but at the expense of othersOthers feel hurt and vengeful

Passive-Aggressive BehaviorBehaviorual Characteristics

Defends own rights with passive resistanceCritical & SarcasticOften expresses opposite of true feelings

Goals To dominate through retaliation

Feelings AngerResentmentManipulatedControlled

Compensations

Feels self righteous and in control

Outcomes Goals not met; nor others’ due to retaliatory nature

Behavioural Components of Assertiveness

1. Eye Contact

2. Body Posture

3. Physical Contact

4. Gestures

Behavioural Components of Assertiveness Contd…

5. Facial expression

6. Voice

7. Fluency

8. Timing

Behavioural Components of Assertiveness Contd…9. Listening

10.Thoughts

11.Content

Techniques to promote Assertiveness

1. Stand up for human rights

2. Assume responsibility for statements

3. Respond as a broken record

4. Agree assertively

5. Inquire assertively

Techniques to promote Assertiveness Contd…

6. Shift from content to process

7. Clouding

8. Defusing

Techniques to promote Assertiveness Contd…

9. Be Direct

10.“Own” your message

11.Ask for feedback

12.Stop apologizing all the time

Techniques to promote Assertiveness Contd…

13.Learn to take a compliment

14.Don’t be self depreciating

15.Act confident even if you don’t feel confident

Techniques to promote Assertiveness Contd…

16.Prepare and use good open questions

17.Have faith that your own abilities

18.Read inspirational things that reinforce your faith

Aggression

Aggression is defined as a behaviour

characterized by the intention of

inflicting unpleasant

stimulation on another individual.

Types of AggressionEmotional aggression: with the main

intention of harming someone

Instrumental aggression: with some other objective, such as to obtain something rewarding

Direct aggression: Verbal or physical aggression

Indirect aggression: Inflicting harm in covert ways

Risk factors for AggressionFrustration

Anger

Aggressive cues

Alcohol

Heat

Ways to Manage AngerPositive self talkChange of environment

Think of consequences

Listen to musicWatch televisionDeep breathing exercise

Take a walk

Count to 50Comfort wrap with a blanket

Relaxation exercisesWrite/talk about own feelings

Reading Being aloneMeditation

Techniques to Tackle Verbal Aggression1. Delaying assertively

2. Know the facts and have them to hand

3. Anticipate - other people's behaviour

4. Feel sympathy rather than fear towards bullies

5. Responding assertively with irony

6. Re-condition and practice your own new reactions

Risk factors for Aggression among Psychiatric Patients

1. H/o Violence2. H/o Aggression3. H/o Aggression in family of

origin4. Substance Abuse 5. Paranoia/Hostility6. Impulsivity7. Agitation8. Sensorium

Management of Aggression

I. Preventive Strategies

II. Anticipatory Strategies

III.Containment Strategies

I. Preventive StrategiesAssessment

Self Awareness

Patient Education

Assertiveness Training

Patient EducationHelp the patient to identify anger

Permit to express angry feelings

Practice expression of anger

Apply the expression of anger to a real situation Identify alternative ways to express anger

Confrontation with a person who is the source of anger.

II. Anticipatory Strategies

1. Communication

2. Environmental Change

3. Behavioural Strategies

4. Psychopharmacology

1. Communication Strategies to Prevent Aggressive Behaviour

Present a calm appearance

Speak softly

Speak in a non-provocative and non-judgmental manner

Speak in a neutral and concrete way

Put space between you and patient

Show respect

1.Communication Strategies to Prevent Aggressive Behaviour

Contd…Avoid intense direct eye contact

Demonstrate control over situation without authoritarian stance

Facilitate the patient’s talk and listen to it

Avoid early interpretations

Do not make promises you can not keep

2. Environmental ChangeProvide a structured milieu

Avoid too much structure and stimulation

Allow Room program for agitated patients

Encourage Cathartic activities

3. Behavioural StrategiesLimit setting

Behavioural Contracts

Time-out

Token Economy

4. PsychopharmacologyAnti-anxiety & Sedative hypnotics

Anti Depressants

Mood Stabilizers

Anti-psychotics

III. Containment Strategies

Crisis Management

Seclusion

Restraints

Physical RestraintsRestraining in different positions:

Sitting

Walking

Supine

Transporting

Thank You