Agitation is an acute behavioral emergency requiring immediate intervention. De-escalation is highly effective and has been identified as the preferred intervention in calming a person experiencing agitation. This technique is key to avoiding violent or abusive problems which can be traumatizing to both patients and staff. The goal in verbal de-escalation is to help the person regain control so that he or she can better communicate needs with health care providers.

Signs of distress and agitation

  • Anger/Irritability
  • Fear
  • Depression –Hopelessness & Helplessness
  • Guilt
  • Difficulty concentrating
  • Insomnia


These symptoms represent an emotional reaction to

  • A threat (loss of a sense of safety and control– unsafe, disempowered)
  • Loss of something that was important


What not to say (most of the time)

  • I understand
  • Calm down
  • Overt invalidation (“This is no big deal!”)

What to say to someone who is in distress

Empathize and validate with their current thoughts and feelings (even if you do not agree)

  • I can see that you are feeling…
  • This situation feels very terrifying
  • I can imagine how scary it feels to not have control