Following brain injury it is important that those supporting the person have knowledge of a range of interventions to reduce challenging behaviour. However if significant behavioural episodes occur, the following de-escalation approaches may be helpful:

  • Requesting that the person ‘stop’ the behaviour may be effective. To do this you must know the person well and have a good therapeutic relationship.
  • Providing the person with opportunities to express the reasons for anger/frustration/distress in a calm and safe manner.
  • Assisting the person to identify alternative and more appropriate ways of expressing anger/frustration/distress.
  • Always communicate respectfully, using an assertive but gentle tone. A confrontational approach is unhelpful.
  • Communication is best facilitated by using clear and simple language.
  • Withdrawing from an escalating situation can at times diffuse the behaviour but may also inadvertently reinforce it. Therefore it is important to re-engage with the person once they are calm.
  • Where safe to do so, downplay behaviours in order to avoid reinforcing them.
  • Use distraction techniques: do not focus attention on the behaviour but instead do something to distract the person’s attention away from it such as tell a joke/story, draw their attention to something else, do something surprising (e.g. ‘accidently’ drop something).
  • Use redirection techniques: provide an alternative activity to the behaviour e.g. turn on T.V. offer a walk, offer coffee, play a game of cards etc.
  • Encouraging the use of basic anger management strategies at the time of a behavioural episode may be helpful for some people.

Management of High Risk Situations
Some challenging behaviours may present such a significant risk to the brain injured person and/or other people that the basic management strategies described above are not appropriate due to the immediate danger. In these situations safety is a priority and specialist support is essential i.e. the use of sedative medication and/or control and restraint techniques may be required. If control and restraint techniques and/or intramuscular sedative medication are being used on a regular basis to manage episodes of challenging behaviour, then consideration should be given to detaining the person under the Mental Health (Care & Treatment)(Scotland) Act 2003.  In these circumstances expert advice should be sought from a Consultant Psychiatrist.