The Guide

This module on the “SAFEMEDIC” platform includes: 

• The coursebook "Psychology of Aggression"

• pptx presentation

• Materials from Module 1-1 and 1-2 available to download

Course summary

Psychological definition of aggression and a review of psychological theories of aggression. Features of a non-violent person and the global distribution of non-violent societies. Non-violence as the normative. Stages of conflict.

Objectives of the course

Upon completion of the course “Violence and aggression – psychological perspective”, the course participant:

• understands the concept of aggression as the result of social conditions or sequences of events;

• understands the concept of human aggression as social interaction;

• understands the differences between aggression and violence;

• understands the psycho-social factors influencing the appearance of aggression, including aggression in healthcare;

• defines the possible causes of patient aggression;

• defines the differences between enemy and instrumental aggression;

• recognizes biological, drive motivated, and social sources of aggression;

• knows the components of a non-violent personality;

• knows the stages of conflict development;

• develops sensitivity to a patient's perspective.

Upon completion of the course “Violence and aggression – anthropological perspective”, the course participant will be able to:

• foresee and recognize the conditions for a conflict in contact with the patient and react at the initial stage of the conflict development;

• understand the psychological drivers of abusive behaviour;

• understand the difference between aggression and violence;

• identify the psychological factors leading to violent behaviour;

• communicate with patients taking into account their psychological and social background.

Contents of the course

1. Introduction

2. Theoretical background

3. Definition

4. Models and theories

4.1 Two-factor model of aggression

4.2 Biological theories

4.3 Drive theories

4.4 Social learning theories

5. Self-control

6. Components of the non-violent personality

7. Non-violence as the normative

8. Conflict factors in conflict resolution

9. Anthropology

Bibliography

Lukas, E. (2001). Tudi tvoje trpljenje ima smisel. Celje: Mohorjeva družba.

Musek, Janek (2006): Osebnost, samopodoba in psihično zdravje. Anthropos 1–2: 51–75.

Frankl, V.E. (2015). Zdravnik in duša. Celje: Mohorjeva družba.

Barton, A. R., 2007. Evolution of the Social Brain as a Distributed Neural System. In: The

Oxford Handbook of Evolutionary Psychology, ed. Dunbar, R. I. M., Barrett, L., New York:

Oxford University Press, pp. 129-144.

Bateson, G., 1972. Steps to an Ecology of Mind. Chicago: The University of Chicago Press.

Berkowitz, L., 1993. Aggression: It's Causes, Consequences and Control. New York:

McGraw-Hill Press.

Berkowitz, L., 1998. Affective Aggression: The Role of Stress, Pain, and Negative Affect. In: Human Aggression: Theories, Research, and Implications for Social Policy, ed. Geen, G. R.,

Donnerstein, E., San Diego: Academic Press, pp. 49-72.

Bromley, D. G., Melton, G. J., 2002. Cults, Religion and Violence. Cambridge: CUP

Class based on online material

“Violence and aggression – a psychological perspective”

Theoretical background

Definition

Quotations come from the “Psychology of Aggression” coursebook

Aggression is:

"Social interaction between two or more people with the intention of causing damage or accomplishing something by harmful methods."

"A reaction that provides harmful stimuli to another organism."

"Not only physical aggression should be considered here, but also verbal assault, sexual harassment, humiliation, etc.”

“Aggression can lead to emotional effects such as anger, anxiety, helplessness, irritability, resignation, sadness, depression, shock, apathy, suspicion, guilt, sleep disturbance, headaches, body tension and soreness, fear of patients, fear of returning to the site of attack and difficulty in returning to work. "

“Aggression: Many researchers prefer to use the word" violence ". Violence is usually used in an institutional or group context, aggression is then an individual manifestation.”

Models and theories

Possible causes of aggression in a patient - three basic models:

1. Internal model: aggression is connected with mental illness, age or gender of the aggressor. The aggressor is usually a young male with a history of violence and drug or alcohol abuse.

2. External model: highlights the influence of environmental factors on the aggression, for example: limited space, overcrowding, changes in hospital organisation or insufficient patient information. In this model, gender and age do not play a significant role as such cases mainly concern local conditions.

3. Situational model: this model tries to combine internal and external factors. However, it is difficult in many cases to clearly distinguish between external and internal factors.

Group work

Divide the following statements from one shift at an A&E department into 3 models of the causes of patient aggression: internal model, external model, and situational model. Write I, E or S next to each statement. 

A two-factor model of aggression

In this behavioural model, hostile aggression and instrumental aggression are examined:

Hostile aggression (also called reactive, emotional or affective aggression) is motivated by anger and its intention is hurting another individual.

Instrumental aggression (also known as proactive, predative or premeditated) is motivated by the achievement of a goal.

Discussion

"It is also important to separate aggressive behaviour from assertive behaviour, the evaluation of which very often depends on conventional forms in a particular society - for example, a woman's assertive behaviour may be considered aggressive, while the same behaviour by a man can be considered assertive."

The origin of aggression

Is aggression biologically programmed or is it learned?

In order to be able to answer these questions, various theories have been developed: biological, drive theory and social learning theory.

Biological theories

Aggression is biologically programmed into our genes; aggression plays a positive role in increasing our chances of survival, contributes to sexual selection and competition; proactive aggression results from the need to influence others. It also corresponds to Darwin's theory of evolution.

Drive theories

These theories concentrate on motivation and its strength which increases when the factors influencing this motivation (e.g. hunger) are not dealt with.

Frustration is the source of aggression; frustration does not always lead to aggressive behaviour.

Zillmann’s excitation-transfer theory 

Agitation from successive annoying situations accumulates. 

A simple example to illustrate it:

 Mr. X experiences an unpleasant situation on his way to work, but because he is behind the wheel, he does not express his anger right away. The first person at work to make even a minor mistake receives a reprimand from Mr. X that is disproportionate to the person’s fault.

Discussion

Social learning theories

According to Bandura, social learning consists of the following stages: attention, retention, duplication and motivation.

Stages of learning according to the theory of social learning.

1. Attention. To learn an action, we first need to observe it.

2. Retention. We don't remember every action we pay attention to. Our memory cannot retain that much information.

3. Reproduction. We perform an action or behaviour that we have observed.

4. Motivation. This is where the theory of social learning intersects with behaviourism - we have to be willing to learn. We observe the consequences of behaviour for our models. 

“According to reports, the number of aggressive patient behaviours is increasing. Aggression and violence are recognized as significant occupational risks for healthcare professionals ”. Brin et al. (2004)

“To produce violence, it is not necessary to promote it actively. All that is necessary is to stop restraining or preventing it. " Baumeister (1999)

Discussion

The General Model of Affective Aggression (GAAM)

“This model covers all the aspects and approaches mentioned above and also includes biological aspects such as genetic and hormonal influences - not only psychological issues focusing on cognitive processes and socialization.

This model explains how certain input factors combine to trigger aggressive behaviour. GAAM assumes that the starting point of an aggressive interaction is an individual disposition, such as character traits and external conditions that meet in a specific situation and trigger the violent interaction.

The difference between drive and social learning theories is also that drive theories try to explain emotional aggression, while social learning theories focus on instrumental aggression.

Social Identity Theory (SIT)

“This theory focuses on social identity as a result of awareness of being a part of a particular group. A human seeks membership in a certain part of society, thus increasing his separateness from other groups. Social identity theory assumes that there is a tendency to categorize the people you meet and divide them into us and them.”

Pair/group work

Self-control

Self-control (also called self-regulation) is a very powerful weapon against aggressive impulses such as frustration, provocation or unpleasant situations. The time factor is important here because the longer self-control is used, the faster its resources are depleted.

Some people show remarkable resilience in coping with difficult situations in life. Kobasa has identified three factors typical of such people:

1. Change: they see change as a challenge and a natural process, show a willingness to adapt and do not see it as a threat

2. Commitment: such people find what they are doing is important and useful

3. Control: they are confident about their inner strength.

Components of a nonviolent personality

“Goldberg stated in the concept of BIG FIVE (1990): 

1. Openness: It refers to information-seeking and intellectual curiosity. A high scorer on this factor is curious, broad minded, imaginative and non-traditional. 

2. Conscientiousness: Involving self-control, it refers to one's tendency to carry out the tasks at hand. High scorers are those who are reliable, disciplined and motivated. 

3. Agreeableness: It refers to one's range from compassion to antagonism. High scorers tend to be those who are trusting and forgiving, helpful and straight -forward. 

4. Neuroticism: This factor measures the emotional stability involving adjustment to distress, cravings and self-satisfaction. High scorers tend to be calm, hardy, and relaxed. 

5. Extraversion: It assesses one's interpersonal interaction and need for stimulation. High scorers are usually sociable, optimistic and fun-loving.”

Non-violence as a normative situation

“We know that there have been and there are cultures that are non-violent. Children in such societies are brought up without violence and learn to live without violence. There are currently 23 non-violent cultures around the world, including the Amish, Balinese, Birbons (nomadic tribesmen in central India), Ladakhis (also in India), followers of Buddhism, and the Hutterites of the plains of the central United States.

 Although nonviolent attitudes vary, they all involve similar practices: children learn to love and respect others, play games without competition or aggression, contain their aggression and learn not to be assertive but sensitive to the needs of others. Individual achievement is very often deprecated in these cultures - if a child is praised for his achievements, it is a source of shame among the Hutterites. Cooperation and interdependence are strongly supported.”

This map is also included in the pptx presentation.

NONVIOLENT AND NONWARRING CULTURES

(data points from Box 7.1 - D. Fry — The Human Potential for Peace)

The dots on this map show the distribution of non-violent, non-warring cultures. Children in such societies are raised without violence and are taught to stay nonviolent. Today, there are 23 cultures around the world that are nonviolent, among others such as the Amish people, the Balinese, Birbor, a nomadic tribe located in the central part of India and also in India Ladakhis, following Buddhism, then Hutterites of the central plains in the USA.

Conflict resolution - conflict factors

“Each conflict goes through five stages:

1st latent stage (there is a potential for conflict development)

2nd stage of noticing (negative aspects begin to be noticed - deficiency, frustration)

3rd stage of intent to act (if the conflict is not resolved it comes to a stage where something must be done to stop it)

4th stage of demonstration (only when both sides cannot agree, the conflict enters the open phase)

5^th stage - consequences (consequences are a direct consequence of the adopted strategy).

It is clear that managing conflicts in the earlier stages reduce emotions before reaching the stage of full hostility. Keep in mind that we generally tend to explain the negative behaviour of others as a result of their personal inclinations, while we perceive our negative behaviour as caused by situations beyond our control (bias).

Another factor influencing conflict situations are stereotypes - a cognitive framework consisting of beliefs (generalisations) about specific social groups. Stereotypes make people pay attention mainly to information about the stereotype.

Our cognition is also often influenced by temporary moods and emotions, and our judgments are then guided not only by rationality. Consequently, it seems that it is better to resolve the conflict by managing emotions (recognition and understanding) than by trying to suppress them. Very often, the inability to look for alternatives is the main obstacle to conflict resolution - it is necessary to focus on interests, not positions, and look for options.”

Discussion

What are the most common stereotypes of patients?