Decompressing aggressive inpatients: Breaking the aggression cycle to enhance positive outcome

Prolonged seclusions can result in exacerbation of psychotic symptomatology, self-injurious behavior, and increased likelihood of subsequent aggression. A patient's aggression can be contextualized as an interpersonal and cyclic series of events in which both the staff and the patient can play a contributing role. If this cycle can be interrupted, the likelihood of aggression decreases. The authors describe this aggression cycle and some strategies for interrupting it via a “decompression” treatment modality. Four case examples illustrate the range of outcomes achieved with patients who had been secluded for between 2 to 5 years due to their chronic history of aggression. The authors offer suggestions for developing a decompression treatment program.