Responding to Distress

Trauma can affect any person’s thinking, feelings, and behaviors. Crisis intervention and attending to basic needs should come before any direct questioning.

When distressed, a person may talk loudly, walk away when they haven’t been asked to do so, put their hands over their ears, yell, throw things, or show other unexpected behaviors. Your response can help alleviate their distress. Keep in mind, all behavior is communication.

Be calm, predictable, kind, and empathetic. Keep your posture and facial expression relaxed and non-threatening. Avoid standing over someone sitting down.

Offer direct eye contact unless it makes the person with disabilities uncomfortable. This may be due to the person’s disability or cultural norms.

Pay attention to the needs of people with disabilities and proceed at their pace, not yours. Someone who is calm and comfortable can access their memory and language easier and better respond to you. Be patient and flexible.

Tell them why you are there and what you are going to do, step by step. Use numbers. One, my name is X. Two, I’m here to help you with this. Three, we’re going to do this.

Quiet the environment: sirens, police radios, bright lights, people, or TV. Minimize distractions and chaos.

When people with disabilities are overstimulated, you can redirect to a more calming activity, move to a quieter area with lower lighting and offer fidget items.

If the person with disabilities seems to be sleep-deprived, give them a break. Offering to take a break in a different area or room might also help.

Validate emotions and ask about what’s going on. This can sound like:

Validate: You seem to be feeling __________ (sad, angry, confused, etc.). It makes sense that you might feel that way. Do you want to talk about it?

Step back. Name what you hear. I see and hear that your voice is changing. You have a rough (or angry) tone of voice. Maybe we’re having a misunderstanding. Tell me what you’re seeing or hearing.

If a person is reacting with fear, crying, anger or aggression, ask what is frightening them or what they are most afraid about right now.

Ask the person: Is there something I can do to help? Do not assume you should help.

Instead of telling the person there is no reason to be afraid, try: I understand you are probably afraid. I am afraid sometimes too and don’t like that feeling. Do you know what you are afraid of? Or, what are you most worried about? Understand the person may not know or want to answer.

Instead of repeatedly asking a person if they are OK or continuously talking, ask if they need some time to be quiet.

Wait out negative behavior rather than trying to stop it. Behavior you pay attention to is more likely to be repeated. As much as possible, ignore behaviors like foot-stomping and constantly repeating a request. Avoid saying no, don’t, stop and calm down. These phrases and directives may intensify distress. Give people the opportunity to work through their distress. Say: I see you are upset. I’m here to help when you are ready.

Take a moment to pause before interacting. Notice your own feelings first. Do you feel nervous or anxious? Worried? Regulate your own emotions before interacting with the person. This can help ensure you are not escalating the situation.

Avoid asking why questions because they may be taken as judgment (Why are you upset about that? Why are you so sad?). Knowing why something is upsetting is not as important as knowing what is upsetting. Replace why questions with what questions: What are you most worried about right now? What is making you feel sad, mad, frustrated….? Is there something I can do to help?

Acknowledge and validate without judgment. Rephrase what the person tells you and repeat it back in a calm tone. Remember that the feelings are real whether or not they make sense to other people.

Offer the opportunity to clarify or correct after you rephrase what the person has said. Check in to make sure you got it right. It will also let them know you are really listening.

Don’t be afraid of silence and give long wait times. This allows processing time. Waiting also lets the person know you are not pushing an agenda and they are your priority.

When helping reduce distress, avoid directing the conversation. Allow the person to come up with solutions or ways they could feel better. This is empowering. Remember that all people are likely to be the expert on what will work for them.

When people with disabilities choose an action to move toward a solution, clarify with them what they are going to do and what you can do to help. Again, this is empowering and you are identifying yourself as an ally in a supportive role.

Understand emotions as an expression and attempt to communicate.

Remain calm. Talk softly and slowly. It’s helpful to lower your voice in a chaotic situation.

Avoid withdrawing from the person, judging, or taking actions that create more chaos.

Be OK when people with disabilities are not cooperating with your requests and focus on ensuring safety until someone with expertise can join you.

If a person is in an unsafe situation, intervene to keep them safe. Unsafe situations include imminent harm to self or others, property destruction, head banging, or running. If it’s safe, let the situation play out.

If a family member or care attendant must be removed, the person’s behavior can escalate, even if the person is the abuser. Say: I’m here to help. Is there anything I can do to help you feel better right now?

Allow more physical space by moving a few steps back and moving others away. This can support the person to gain or regain some level of control. Be far enough away that you are not threatening, but close enough to monitor.

If the person is really upset at something or someone, remove that thing or person if possible. Explain what you are doing.

For verbal abuse that is directed at you:

Try to ignore it and not feel challenged. It’s really not personal. Sometimes verbal abuse is a way to get others to back off and leave them alone. Some people have learned that being left alone is safer.

The person you are working with is likely to be in a state of crisis and may not feel in control of what they say.

The person may be sleep-deprived, afraid, or may have difficulty trusting based on past experiences.

Help the person connect behavior to a feeling or emotion: For example: I’m guessing you feel very angry or frustrated. Help them describe the emotion. “It seems you feel very angry or frustrated.”

If distress does not decrease, seek help from the person with disabilities’ care attendant or support person. If they are unable to move out of acute distress, accept it may not be the best time and reschedule what you can.

Restraining the person with disabilities or getting physical will most likely make things far worse, particularly for those with autism spectrum disorder, an intellectual disability, or a history of trauma.

If the person is anxious or crying, do not crowd. Reduce the number of people around. Ask if they are OK with another person there to support them and if the answer is yes, include one family member or care attendant you believe can help safely.

Keep your own posture relaxed rather than in emergency mode. Step back from the person with disabilities.

Let the person know that talking about this is difficult for most people. This normalizes their emotions and can reduce feelings of being judged.

Allow the person to move about, pace, rock, or fidget if it helps them self-soothe. If that isn’t helping, introduce another activity, such as drawing and then restart conversation.

Provide fidget items the person can hold or manipulate (stress balls). Some people who are emotionally shut down can benefit from working with kinetic sand.

Have soft pillows, stuffed animals, and/or a weighted sensory blanket available.

A change in scenery can work wonders. Offer to take a walk and ask them if their support person/care attendant can follow. Note: This tip may not apply to people with disabilities like autism spectrum disorder, who may decide to run.

Extreme anxiety and fear can make any person shut down or stop responding. This doesn’t mean they’re uncooperative or disrespectful.

Let people with disabilities talk through their distress as best they can. Remind them that they have people who support them, including yourself and any other people in their support system. If people feel they cannot communicate effectively when their feelings are intense, their behavior will likely escalate.

Focus on being with the person in their distress and offer words that recognize how hard it must be to feel this way, to have experienced what they did.

If the person is crying, offer tissues and water. Say: I’m here to help. We will do our best to make sure you are safe.

Ask the person what they do to make themselves more comfortable. If they don’t know, ask what you can do to help them be more comfortable. You may need to offer concrete choices and let them know what you can and cannot do. Say: We can take a break for 15 minutes. Would you like some water? We can reschedule. Would you like to hold this pillow or blanket?

If the person is not responding to requests or following directions, they may not understand what you are saying or asking. Use clear, one or two steps directions.

If the person with disabilities seems shut down or emotionally frozen, allow time and provide space. Don’t overwhelm them with questions, requests, or stimulation.

Say: I am here when you are ready. This can help a person regain some control.

If the person is frustrated because they have a communication disability, provide other options:

You can show me with a drawing if that is easier than talking.

Let the person know they can take their time to explain and that you can wait. Say: I am here when you are ready to share.

If the person is more settled, gently ask a neutral question and sit near them. Don’t go back to difficult questions right away. Do you need water? Is this where you would like to sit?