Course content – PF23-Deeskalation
The modules of this course – work through them in order.
6. Module 6 · Verbal De-escalation
Calming with words
Verbal de-escalation means calming a person deliberately through language. It builds on the basic stance from Module 5. The key principles are: a calm, friendly voice – speak calmly, warmly and slowly, because the tone often has a stronger effect than the words; active listening – let the person finish and ‘let off steam’ without interrupting; acknowledging and naming feelings (‘I can see that you are very angry’), so that the person feels heard; showing understanding (‘I understand that this makes you uneasy’); simple, clear language with short sentences, because an agitated or confused person cannot process anything complex; offering help (‘I would like to help you – let us find a solution together’); and I-messages instead of reproaches.
Just as important is what you avoid: arguing, contradicting and lecturing – above all, do not correct a person with dementia who perceives reality differently; reproaches, belittling and criticism; threats, ultimatums and shows of power; orders such as ‘You must now …’; irony and condescension; and a hurried, impatient or loud tone. The aim is that the person feels heard, understood, taken seriously and not threatened (NICE, 2015). This is what calms a situation.
Learning objectives of this module
- You know the principles of verbal de-escalation.
- You calm through a calm voice, listening, acknowledging feelings.
- You avoid contradiction, reproaches, threats, lecturing.
- You give the person the feeling of being heard and understood.
Acknowledging the feeling – a powerful de-escalator
Among the verbal techniques, acknowledging and naming feelings is often one of the most effective. An upset person is in an emotional state of emergency, driven by anger, fear, despair, helplessness or hurt (Modules 2 and 3). At that moment their greatest need is often to be heard and taken seriously. Sentences such as ‘I can see that you are very angry’ or ‘I notice that you are worried’ meet exactly this need. The emotional pressure eases, and the person becomes more willing to calm down and talk. Many escalations grow because a person feels ignored; acknowledging the feeling breaks this cycle.
Two points matter. Acknowledging the feeling does not mean agreeing with the person on the matter or meeting a demand. You acknowledge the feeling, which is real. The matter can be clarified, and boundaries set, later when the agitation has subsided. And it is not a trick but genuine empathy (Modules 2 and 5). In practice: perceive the feeling, name and acknowledge it calmly, then listen and offer help.
Verbal de-escalation
| Do | Avoid |
|---|---|
| Calm, friendly voice | Loud/curt tone of voice, bustle |
| Listen, let them ‘let off steam’ | Interrupting, lecturing |
| Acknowledge/name feelings | Contradiction, reproaches, belittling |
| Signal understanding/help | Threats, demonstrations of power, coercion |
Table: What to do and what to avoid in verbal de-escalation. Source: own illustration, AI-assisted.
Not arguing, not wanting to be right
A common mistake in tense situations is arguing and wanting to be right. Faced with an accusation that seems unfair, the natural impulse is to contradict or justify yourself: ‘That is simply not true!’ or ‘You are seeing that wrongly.’ In an acute situation this usually escalates. The upset person cannot take in facts at that moment and experiences contradiction as an attack or as not being taken seriously. A ‘fight about being right’ builds up. In the acute situation the goal is calming, not being right. Clarifying the facts can wait until the agitation has subsided.
This is especially important with delusions, misperceptions or the altered reality of dementia – for example ‘I have been robbed’, or ‘My mother is waiting for me’ about a mother who has died. Correcting the person (‘Nobody has robbed you’, ‘Your mother is dead’) does not help, because they cannot see the reality you see. It increases fear and mistrust, and it hurts. Instead, do not argue or correct: validate the feelings behind the words, give security and, where it fits, distract (BMG, 2007). Holding back the urge to put things right is not easy, but it is decisive for de-escalation.
‘My money has been stolen!’
Mrs L., who has dementia, angrily accuses the care worker of stealing her money. The first impulse would be to contradict: ‘That is not true, nobody has stolen your money!’ – but that would escalate and hurt. Instead, the care worker does not argue. She acknowledges Mrs L.’s feelings: ‘It is annoying and upsetting that you cannot find your money – I understand that you are worried.’ She stays calm, gives security and offers to look for the money together. Mrs L. calms down.
Being right instead of calming. Mrs L. makes the same accusation. This time the care worker contradicts at once: “Nobody has stolen anything! You have put it somewhere yourself, as always.” Mrs L. becomes louder, calls her a thief and a liar, refuses all help for the rest of the morning and phones her daughter in tears.
How to classify it: The care worker may even have been right about the facts. But the correction ignored Mrs L.’s fear, and “as always” was a reproach. In an acute situation, and especially with dementia, contradiction escalates. A real loss must still be taken seriously: once Mrs L. is calm, the team checks whether money is actually missing, without accusing anyone, follows the home’s procedure if necessary and agrees with the relatives how money is kept.
| Aspect | Case study: validating | Version B: contradicting |
|---|---|---|
| First reaction | acknowledges worry and annoyance | contradicts and corrects at once |
| Message received | “You are taken seriously.” | “You are wrong and forgetful.” |
| Facts | looked for together, clarified later | argued about in the acute situation |
| Outcome | Mrs L. calms down | escalation, care refused |
| Relationship | trust strengthened | trust damaged |
Table: Comparison of the two versions of the case. Source: own illustration, AI-assisted.
Exercise: Do you de-escalate verbally – with a calm voice, listening, acknowledging feelings and understanding – or do you sometimes escalate with contradiction, reproaches or lecturing? Can you hold back the urge to be right? Do you validate instead of correcting when a person with dementia perceives reality differently?
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Choose two typical situations from your work, for example a complaint about waiting time and an accusation by a person with dementia. For each, write down: 1. What would your first, spontaneous sentence be? 2. Which feeling is behind the other person’s words (anger, fear, worry, helplessness)? 3. A sentence that names this feeling, for example “I can see that you are worried about your money.”
Then check your first sentence: does it contain contradiction, a reproach or a lecture? If so, replace it with the acknowledging sentence plus an offer of help. Note what can be clarified later, once the person is calm.
- A calm, friendly voice, listening and short, clear sentences calm a person more than arguments do.
- Acknowledging and naming the feeling is often one of the most effective verbal de-escalators.
- Acknowledging the feeling does not mean agreeing with the demand – the matter can be clarified later.
- With dementia or delusions, do not correct: validate the feeling, give security and, where it fits, distract.
Self-reflection (voluntary)
Voluntary · not assessed – your thoughts are not saved or evaluated. Think about each question first, then open the prompt.
1. Which sentence do you catch yourself saying when someone accuses you unfairly?
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2. How easy is it for you to name another person’s feeling out loud?
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3. In which situations is the urge to be right especially strong for you?
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References for this module
Bundesministerium für Gesundheit [Federal Ministry of Health] (Ed.). (2007). Rahmenempfehlungen zum Umgang mit herausforderndem Verhalten bei Menschen mit Demenz in der stationären Altenhilfe [Framework recommendations on dealing with challenging behaviour in people with dementia in residential care]. https://www.bundesgesundheitsministerium.de/fileadmin/Dateien/5_Publikationen/Pflege/Berichte/Bericht_Rahmenempfehlungen_zum_Umgang_mit_herausforderndem_Verhalten_bei_Menschen_mit_Demenz_in_der_stationaeren_Altenhilfe.pdf
Deutsche Gesellschaft für Psychiatrie und Psychotherapie, Psychosomatik und Nervenheilkunde (DGPPN). (2026). S3-Leitlinie Verhinderung von Zwang: Prävention und Therapie aggressiven Verhaltens bei Erwachsenen [S3 guideline: Avoiding coercion – prevention and treatment of aggressive behaviour in adults] (Version 3.0, AWMF register no. 038-022). https://register.awmf.org/de/leitlinien/detail/038-022
National Institute for Health and Care Excellence. (2015). Violence and aggression: Short-term management in mental health, health and community settings (NICE guideline NG10). https://www.nice.org.uk/guidance/ng10