Which of the following are signs that the client is in the triggering phase of the aggression cycle?

Most situations involving aggressive behaviour and potential violence can be broken into a series of phases. Prevention of aggression and violence is best approached through analysing and assessing the phases of an incident and implementing appropriate risk-reduction measures to manage the situation effectively.  If handled well, all incidents are an opportunity for learning and development for all concerned. The primary concern for practitioners during an incident is to restore circumstances to a pre-incident baseline in a way that results in the least possible degree of harm for everyone involved including staff, clients and the person/s being aggressive.

The series of phases that an incident involve all concerned but follow the experience of the aggressor. The 5 phases are:

Phase 1: Triggering event(s)
When anger is provoked through one or more triggering events (see aspect 5 of this module), it can escalate into aggressive behaviour and potentially violence.  Triggering events vary between individuals (and in some cases groups) and can occur in the presence of practitioners or can relate to an incident outside the service.

Phase 2: Escalation
The escalation stage can occur very quickly or gradually develop over a period of time depending on the individual, the nature of the triggering event and the setting. During the escalation phase, in response to triggering events, the potentially aggressive young person is affected physiologically in preparation for 'flight or fight'. Adrenaline is released, the muscles tense, breathing becomes rapid and blood pressure rises.

Phase 3: Crisis
The crisis phase involves the young person behaving in an aggressive manner, either physically or verbally, towards another person, an object or themselves. This may include shouting, throwing or hitting an object and/or striking a person. Where clients are emotionally dysregulated and highly aroused their ability to process information and understand or care about consequences will be extremely limited. As is the case with the escalation stage, the crisis phase may be reached very quickly or gradually depending on the individual, the nature of the triggering event and the setting. Depending on what occurs for the aggressor during the crisis phase (including how it is handled by practitioners) further escalation can occur. The length of time that the crisis lasts will also vary accordingly.

Phase 4: Recovery
Once the crisis has peaked and is abating, the aggressor enters a plateau or recovery stage where anger begins to subside. It takes time for the body to return to normal. During this stage it is easy for anger and aggressive behaviour to be retriggered and to again escalate to crisis point. This is because the person is still partly aroused, and the feelings that accompany this phase are likely to leave the person feeling vulnerable and confused.

Phase 5: Post crisis depression
Following a post crisis period of recovery the person that has been aggressive and violent will often experience a period of ‘post-crisis depression’ before equilibrium is restored and their feelings return to baseline.  During this phase, the person that has been aggressive and violent might feel tired, unhappy, guilty or ashamed about the incident and their behaviour. This can confirm negative core self-beliefs and create a sense of hopelessness. This can potentially lead to self-destructive behaviour and there is an increased suicide risk. Clients who use substances and/or self injury as a coping strategy will potentially turn to these behaviours. 

When dealing with someone who is becoming aggressive in a Youth AOD service setting, it is important to understand the underlying reasons for the person feeling anger and potentially becoming violent.

People become angry for a multitude of reasons that are often interrelated. Anger can arise for young people and potentially be expressed as aggressive behaviour when they are:

• Exposed to a physical threat
• Something valued is lost or destroyed (relationships and possessions)
• Self esteem and identity is threatened
• Injustice is experienced (young people are very sensitive to inconsistent application of boundaries and rules)
• Frustrated and confused
• Experiencing uncomfortable physical states (eg: tiredness, hunger, headaches, withdrawal)

Young people and families can become frustrated when their expectations of a service are not being met. This can occur when clients are not adequately informed or in some cases have prejudice based on previous interactions with other services. It can also stem from a real or perceived:

• Lack of attention and/or a slow response from a service
• Inefficient and inconsistent service responses

A young person’s behavioural repertoire, including how they deal with anger, is shaped by their life experiences and influenced by social learning. The following is a list of factors that can also underlie anger and influence the way it is expressed:

• AOD related issues (eg: Unable to obtain / intoxication / hang over - coming down  / withdrawal)
• Level of irritability associated with tiredness, hunger and other physical states like headache
• Health issues or medical conditions (eg: Chronic pain, diabetes, hypoglycaemia, acquired brain injury-ABI, etc)
• Mental health conditions (eg: Psychosis, Post traumatic stress disorder)
• Level of psychological and emotional distress including anxiety, fear and grief
• Degree to which a person has learned emotional regulation skills (particularly anger management skills)
• Personal temperament, cognitive ability and problem solving skills
• Systems of belief (core self beliefs and world view)
• Language difficulties that lead to misunderstanding and frustration
• Confusion stemming from difficulty understanding how the service and service system operates (particularly for people from different cultural backgrounds and young people and families with limited or no previous experience with AOD and related services)
• Health (and mental health) literacy- Degree to which a person understands what is going on for them and how to negotiate for assistance

Adapted from: Centre for Social Health (1997) Managing Violent & Potentially Violent Situations

People might also have learned to use aggression and violence to manipulate or control a situation through intimidation and threats.

Prevention and early intervention are the most effective strategies to help stop a situation escalating ‘out of control’ and into a crisis situation when a physical attack is most likely. Understanding the reasons and recognising the signs why a person is becoming aggressive are important features in early intervention.

Physical signs that a person may becoming aggressive and potentially violent include:               

• Huffing and puffing
• Pacing up and down - rapid movements
• Facial indicators: staring - frowning - rubbing forehead - reddened complexion
• Raised voice
• Aggressive body language/actions - pointing - clenched fists hitting things – throwing magazines, pens and other objects down in frustration
• Words expressing threats - including swearing
• Argumentative and belligerent - won’t follow advice

The following acronym ‘S.T.A.M.P.’ can be used to best describe the behaviours exhibited by a person who is becoming agitated and potentially aggressive and violent:

S - STARING -prolonged glaring at staff

T - TONE -sharp, sarcastic, loud, argumentative

A - ANXIETY -flushed face, heavy breathing, rapid speech, reaction to pain

M - MUTTERING -talking under breath, criticising staff to self or others, mimicking staff

P - PACING -walking around in confined space, walking into areas that are off limits

What are the signs to look for that a client might be becoming aggressive?

What are the stages of aggression?

Which phase of the aggression cycle is defined as occurring when an event or circumstance in the environment initiates the client's response?

Which personality trait is associated with aggressive behavior?