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Table 2 Essential elements of a verbal de-escalation technique [20]

From: Protocol for the management of psychiatric patients with psychomotor agitation

• Talk with the patient in a gentle, relaxed, assured tone  
• Answer calmly, maintaining a firm attitude  
• Offer food, beverages and blankets  
• Be flexible in the dialogue  
• Reserve your own judgement regarding what the patient should or should not do  
• Do not seek confrontation of ideas or reasons, only simple partnerships that calm and reinforce the patient  
• Use simple language and short sentences, repeating as many times as necessary  
• Be honest and accurate  
• Clearly communicate that the patient is expected to maintain self-control and that the staff can help him/her achieve this  
• Redirect the conversation when disruptive questions are asked  
• Paraphrase what the patient says  
• Reassure the patient that you have understood him/her well  
• Use open-ended questions  
• Establish limits whilst at the same time offering the patient acceptable and realistic opportunities to improve their symptoms  
• When faced with imminent violence:
 • Warn the patient that violence is not acceptable
 • Propose a resolution to any problem through dialogue
 • Offer pharmacological treatment
 • Inform them that you will rely on physical restraint if necessary
• Consider a mild/moderate show of force in the form of an increased number of medical staff and even security guards ready to act if necessary