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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