Emotional Self-Regulation: The Key to Effective De-Escalation in Healthcare
De-escalation doesn’t begin with techniques or strategies—it begins with you. By learning to recognize and regulate your own emotional state, you create the stability that patients, families, and colleagues can lean on during stressful interactions.
For many physicians and healthcare professionals, the threat of workplace violence feels like a reality they are underprepared to manage.
The statistics are sobering. Healthcare is now the most dangerous profession in the United States if you use the metric of nonfatal workplace illnesses and injuries. Rates of violence against healthcare workers consistently exceed those in law enforcement, corrections, and other fields typically seen as “high risk.”
So where does that leave us?
First, it’s important to recognize that the responsibility for violent behavior lies squarely with the person engaging in it—not with the healthcare worker experiencing it.
But while we are not responsible, we can use tools and techniques that help reduce the risk of violence.
One of these important skills is de-escalation.
What De-Escalation Is—and What It Isn’t
De-escalation is often spoken of as if it were a guaranteed solution, a near-magical way to defuse tensions and prevent conflict. In reality, the picture is far more complex. Definitions of de-escalation vary widely, both in practice and in research.
A recent review identified 64 de-escalation training programs over a 40-year period and found no evidence of effectiveness (Engel et al., 2020).
That doesn’t mean we abandon de-escalation. Instead, it points to the importance of understanding what makes it work—and one critical element is emotional self-regulation.
Why Emotional Self-Regulation Matters
Emotional self-regulation is the ability to manage the intensity of your emotions. It doesn’t mean suppressing feelings or pretending everything is fine. It means recognizing your emotional state and intentionally calming yourself so you can respond adaptively.
Here’s why this matters:
- It’s almost impossible to de-escalate someone else if you are escalated yourself.
- If a situation feels personally triggering (someone’s tone, proximity, or aggression), staying calm becomes even more challenging.
- Emotional self-regulation is not just useful in moments of potential violence—it’s a valuable skill across all aspects of life.
The good news is that, unlike many situations we face, self-regulation is something we can control.
Techniques for Emotional Self-Regulation
There are several techniques you can practice to improve your ability to stay grounded in stressful or escalating situations:
1. The 5-4-3-2-1 Exercise
Bring your attention to the present moment by noticing:
- 5 things you can see
- 4 things you can touch
- 3 things you can hear
- 2 things you can smell
- 1 thing you can taste
(If one of these senses isn’t accessible or comfortable for you, simply skip it.)
This technique is most effective when used early, before emotions overwhelm your ability to focus.
2. Find the Peaceful Anchor
Even in chaotic, noisy, or stressful environments, there is usually some element of peace—a still object, a neutral sound, or a calming visual. Focusing briefly on that “mental oasis” can help settle your nervous system.
3. Name What You Feel
Saying “I feel bad” is vague. Instead, name your emotions specifically: sad, angry, anxious, regretful. You may experience several at once, and they may shift quickly. Naming them is the first step to regulating them.
4. The “Just Like Me” Technique
This approach draws on our shared humanity. Add the words “just like me” to your self-talk.
For example:
- “This person is really upset” → “This person is really upset, just like me.”
This reframing helps soften emotional reactivity and reminds us of our common ground.
The Bottom Line
De-escalation is not a magic fix, but it is an important tool in reducing the risk of violence. And at the heart of effective de-escalation lies emotional self-regulation.
By learning and practicing techniques to manage our own emotional intensity, healthcare professionals can better navigate tense situations, protect themselves, and create safer spaces for both staff and patients.
Violence is not “just part of the job.” You deserve safety—and building skills like emotional self-regulation is one way to move closer to that goal.
References:
- Celofiga, A., Kores Plesnicar, B., Koprivšek, J., Moškon, M., Benković, D., & Gregorič Kumperščak, H. (2022). Effectiveness of de-escalation in reducing aggression and coercion in acute psychiatric units: A cluster randomized study. Frontiers in Psychiatry, 13, 856153. https://doi.org/10.3389/fpsyt.2022.856153
- Engel, R. S., McManus, H. D., & Herold, T. D. (2020). Does de-escalation training work? A systematic review and call for evidence in police use-of-force reform. Criminology & Public Policy, 19(3), 721–759. https://doi.org/10.1111/1745-9133.12594
- Goodman, H., Papastavrou Brooks, C., Price, O., Vusio, F., & Gudjonsson, G. (2020). Barriers and facilitators to the effective de-escalation of conflict behaviours in forensic high-secure settings: A qualitative study. International Journal of Mental Health Systems, 14, 59. https://doi.org/10.1186/s13033-020-00388-4
- Johnston, I., Price, O., McPherson, P., Armitage, C. J., Brooks, H., Bee, P., Lovell, K., & Brooks, C. P. (2022). De-escalation of conflict in forensic mental health inpatient settings: A Theoretical Domains Framework-informed qualitative investigation of staff and patient perspectives. BMC Psychology, 10(1), 30. https://doi.org/10.1186/s40359-022-00735-6
- Spencer, S., Johnson, P., & Smith, I. C. (2018). De-escalation techniques for managing non-psychosis induced aggression in adults. Cochrane Database of Systematic Reviews, 2018(7), CD012034. https://doi.org/10.1002/14651858.CD012034.pub2
- Wohlever, A. S. (2019). Incivility in health care: Strategies for de-escalating troubling encounters. Family Practice Management, 26(5), 8–12.