De-escalation techniques in various settings

Introduction. Severe mental disorders represent a risk factor for violent episodes. Aggressiveness and violence can be expressed verbally or behaviorally, and aggression events may occur in different clinical settings during any stage of mental disorder’s course. We sought to define a set of communication techniques and guidelines in order to improve prevention and reduce aggressive and violent episodes’ damage risk in mental healthcare. De-escalation is conceived as a process comprising the ability to gradually resolve a potentially violent situation. It consists of different steps of communication, both verbal and nonverbal, aimed to defuse a potentially violent situation. Neurobiological correlates. De-escalation acts on potential aggressive manifestations which are influenced by common neurophysiological underpinnings: these neurobiological correlates involve the HPA axis (hypothalamic-pituitary-adrenal axis) which is strongly associated with stress reaction, leading to a profound cortisol release and activation of neurotransmitter pathways and hormonal systems. Techniques and methods. Structured procedures involving different communication techniques, based on specific clinical needs, are required. De-escalation is intended to interrupt emotional activation, to establish a relationship with the agitated individual, and to provide the opportunity to resettle a functional emotional management. Conclusions. Dysfunctional conducts and aggressive behaviors may arise from mental health issues. Mental health operators should develop communication techniques and de-escalation abilities aimed to effectively manage critical situations and prevent critical interactions or physical aggression.