Avoidance, Awareness, & Prevention

Note: The material on this page is an excerpt of a chapter from my book on unarmed self defense. I'm making
this chapter and the previous chapter available for free on my site, due to their importance in self defense:

The Short Version:

Avoiding or preventing an attack is easy, and in the vast majority of situations it does not require physical self
defense or martial arts. If you follow these simple guidelines, the chance you’ll ever be attacked is incredibly
small:

 Avoid dangerous places and people.

 Don’t be a good target.
 Be aware of your surroundings.
 Do not argue, provoke, or allow a verbal conflict to escalate.
 Escape or create distance if you feel threatened.
 Give up your money or valuables if bodily harm is threatened and you cannot escape.
 Keep your private areas secure.

What are dangerous places? How can you avoid being a good target? How and when should you attempt to
escape? Read on.

The Detailed Version:

For a predator to attack you, he necessarily needs three things: intent, means, and opportunity. Denying him any
one of those three things makes it impossible for him to attack. The easiest way to do that is to avoid a predator
so completely that he is not only denied the opportunity to attack you, but also the intent as it specifically relates
to you. If you’re not on his radar, he can’t even intend to attack you. You can accomplish this to a very
significant degree simply by avoiding dangerous places. If you’re unable to avoid a predator, making yourself a
bad target is the next best thing.

If a predator does choose you as a target, you can still deny him the opportunity to attack you. By being aware
of your surroundings, paying attention to warning signs, and noticing pre-attack indicators, you can spot a
predator and deny him the close distance he needs to attack you by using space and/or objects in your
environment. And even if you are approached by a predator, you can de-escalate the situation and avoid
physical violence using a variety of measures.

If you’ve taken the steps above, it’s highly unlikely it will go that far. But even when a predator has the intent
and opportunity to attack, we can take away his means or ability through physical self defense.

In the rest of this chapter, I’ll cover avoiding dangerous places, being a bad target, being aware of your
surroundings, warning signs, pre-attack indicators, distance, evasion, de-escalation, pre-positioning, and
physical self defense strategy. In the rest of this book, I’ll cover taking away a predator’s means through
physical self defense.

Avoid Dangerous Places

This is the number one rule of self defense. If you avoid places where violence is likely to occur, you’ll
dramatically decrease the chance you’ll even be considered as a target. These are dangerous places:
High Crime Areas: Some countries, cities, and areas are known for having high levels of crime. Even in
regions that are generally safe, there are often specific geographic locations where high levels of crime regularly
occur. Even if violence in such areas isn’t targeting people like you, it’s possible to get caught in the crossfire.
In your own city, if there are high crime areas, you probably know where they are. Avoid them. Don’t travel to
other cities or countries with high crime rates. If you do enjoy travelling, there is a lifetime of safe destinations
to visit. Travelling to a dangerous city or country is not worth the risk, particularly when there are so many safe
alternatives. Before travelling to a new destination, look into the crime statistics and avoid the high crime areas.

Among Violent People: Violence is more likely to occur in the presence of violent people. Obviously the
former section, high crime areas, ranks at the top of the list for being among violent people. In addition,
violence often takes place where groups of young males hang out, particularly where they’re drinking. If you
avoid bars, parties, and other such locations, the chance you’ll even see such violence is slim. If you’re not a
young male, then these locations won’t pose the same level of risk. Violence is also common in violent groups,
but exposure to it requires being in a group with a propensity toward violence. If you’re not a member of a
violent group, you don’t hang out in the same places as such groups, and you’re not in a relationship with a
violent individual, you’re covered. If you are a member of a violent group, or you’re in a relationship with a
violent individual, there’s only one thing you need to do: Get out now. It may not be easy, but you can do it.

Among People Who Don’t Like You: Places where you’re different from everyone else and where that
difference isn’t well accepted can be dangerous. If you’re a white American male walking around in Tokyo, it’s
highly unlikely you’re going to have a problem, even though you are different and you will stick out. But if
you’re a white American male walking around in Afghanistan...well that’s a different story. Avoid places where
you’ll stick out and people tend not to like your kind.

Verbal Escalations: When two or more people begin to argue, with escalating verbal tension, the likelihood of
violence increases. Some individuals need to psych themselves up in order to become violent, and progress
from talking quietly and being relatively still to yelling and using bigger physical movements before becoming
physically violent. Verbal conflicts can happen in any physical location, but because they require an escalation,
you can avoid that “place”. Avoid arguments, conflicts, and provoking people. And remember, it’s possible for
a person to perceive that you provoked them even if you think otherwise. It’s better to be even nicer and less
provocative than you may think necessary. Tread carefully in places or groups where you don’t know the social
conventions.

In-Between Places: Violence is easier to successfully use and get away with where there are few witnesses. But
there must be someone available to attack. “In-between places” are those where people commonly pass through,
but not too frequently, for example, between parking lots and tourist attractions, on jogging and hiking trails, on
isolated side streets, in parking garages, and on the way to mail rooms from apartment complexes. Attackers can
wait in these places, knowing that victims will pass through, and they’ll likely have some time alone with the
victim. In-between places where people are more likely to have money or valuables are an even better location
for criminals looking for money.

As best you can, avoid these in-between-places. If you’re staying in a hotel that’s several blocks away from
tourist attractions, and getting to the attraction requires a walk down an isolated street, take a cab instead of
walking. If you’re going to a popular area but know you won’t be able to find parking in the vicinity, take a cab
or public transportation if it exists. If you’re going to a shopping mall and have the choice to park in an isolated
parking garage or a visible lot on the street, choose the visible lot on the street. Imagine you need to rob
someone for money, tonight. Think about where you would wait for victims, and avoid those places.

A rapist or serial killer doesn’t need his victim to have money, and may be willing to wait for a longer period of
time. If you were a rapist and wanted to ambush a woman, where would you do it? On a jogging trail near a
college campus, but not too near? On a path between an apartment complex and the mail room, not visible from
the street? Avoid these in-between-places if possible, and when you can’t, be sure to follow the rest of the
advice in this chapter.

Lawless Places: Some countries and areas are relatively lawless, particularly in times of war and internal
conflict. In these places, criminals can get away with nearly anything. Avoid these places. If you chose not to
avoid them, then minimize your time and exposure in them.

Be A Bad Target

Often times a predator will choose his targets based on some conception of risk vs. reward. The predator wants
to get one or more things out of the attack (reward), and minimize his chance of getting injured or caught in the
process (risk). There are exceptions, as some predators may be reckless, mentally ill, without self-worth,
suicidal, or under the influence of drugs. But consider that very few robbers will attempt to rob a policeman in
uniform, but many will rob a well dressed woman with an expensive purse, lots of jewelry, and headphones in
her ears. Anything you can do to increase the risk and decrease the rewards for a potential predator, will
decrease the chance that you’ll be chosen as a target.

Increasing Risks

In general, a predator will choose victims they think they can successfully attack. While you can’t change your
age, height, and gender, there are some things you can do to make yourself a higher risk target. Paying attention
to your surroundings is a big one, which I’ll cover in more detail shortly, but if a predator sees he’ll be unable to
take you by surprise, he’ll probably choose a target who is paying less attention. Walking around with
headphones in your ears, listening to music, talking on the phone, or texting, is a sure sign you’re not paying
attention. Avoid these behaviors, especially in isolated areas. Along similar lines, don’t get drunk in public.
Drunk people make perfect victims.

When people are physically fit, it shows. And attacking a fit person is more risky than attacking one who is
visibly out of shape. Aside from the mental and physical benefits, regular exercise and weight lifting will make
you a higher risk target.

The clothing a person is wearing can inhibit movement. Who would you prefer to attack, a woman in a tight
skirt with high heal shoes, or a woman wearing jeans and running shoes? The clothing and shoes a person wears
can tell a predator a lot about them. Wear clothing that allows you to move well.

One person is easier to attack than two, two people are easier to attack than three, and so on. While groups can
get attacked, the more people you’re with, the lower your chances will be.

If you know how to use it, carrying a visible weapon can significantly increase the risk to a potential attacker.
Would you rather attack a woman with pepper spray in her hand, or one with nothing? Think about the type of
person you’d choose to attack if you needed to get money today, if you were a rapist, or if you wanted to beat
someone up to prove your manhood. What behaviors, qualities, and conditions would make you more likely to
attack them? What behaviors, qualities, and conditions would make you less likely to attack them?

Decreasing Rewards

Again, you can’t change certain aspects of your physicality. But you can change aspects of your behavior that
would be rewarding to a predator. What does wearing expensive clothing and jewellery tell a predator looking
for money? What kind of car do you drive, and what does it tell a potential predator? What does wearing
revealing clothing show a man who is already thinking about rape? (It’s not fair, but it is true.) Think about
what you’d look for in a victim, in terms of rewards, and eliminate those as best you can. When a woman
carries a purse, it wouldn’t be foolish to assume there are objects in it, potentially valuable objects, especially if
it’s an expensive, name-brand purse. If you do need to pass through a high risk area, don’t carry or wear
anything that will appeal to a predator. This includes laptops, smart phones, and any other high value items you
may carry in your hand or wear on your body.

Obstacles & Home Security

The more obstacles a potential predator has to deal with, the more likely he’ll choose an easier target. Would
you prefer to break into a home with a visible camera, motion sensing lights, window bars, a barking dog, and
an obvious alarm system, or one with no sign of preventative obstacles? In addition to the deterrent quality of
obstacles, some can stop an attacker dead in his tracks. If you do have an alarm system, use it!

Keep your home, car doors, and windows locked. Don’t open the door for strangers. A locked door is an
obstacle that requires far more effort to get through than one that is unlocked. And when that locked door has a
sign next to it from an alarm company, and a dog barking behind it, there are very few predators that won’t
leave for another home.

Some predators will walk a neighborhood pretending to be a handyman, knocking on doors to see who is home,
who isn’t, who opens doors, and what’s inside. Again, do not open the door for strangers. Use blinds or curtains
so it’s difficult for a predator to easily see inside your house. Use motion activated lights around your house.
Predators don’t want to be seen, and will avoid getting close to a motion activated light. The more obstacles you
can set up between you and an attacker, the harder it will be for him to reach you, and the more likely it will be
that he’ll chose another victim.

Have a plan for home invasions, and make sure everyone in your home knows that plan. Your plan will vary
depending on the size and layout of your home, where the exits are, how many people live in it, their ages, etc.
When making your plan, remember that the goal isn’t to kill an intruder, but to keep yourself and your family
safe. Escaping may be your first priority, particularly if you know where the intruders are coming in, have
barriers between them and your family, and a safe way to exit. If you do have motion sensing lights, locked
doors and windows, an alarm system, and an alert dog, it’s highly unlikely your home will be chosen. If it is,
each of these barriers will act as layers in your security system, alerting you to the progress of the intruders.

Some people have a philosophical problem with owning or using guns. Although I’d prefer if no one was
violent or used guns, that’s clearly not the world we live in. I once had an instructor in a handgun course explain
that a gun is like a parachute. No one wants to have to use a parachute. But if you were in a plane that was
going down, and you had the opportunity to jump out with a parachute, you sure would be glad you had one. I
feel the same way about guns, and it’s a valid argument, regardless of how you feel about them. If intruders
ignore your motion sensing lights, break through your door or window, continue into your home despite your
alarm going off, and are about to enter the room you and your family are waiting in, having a gun, the ability to
use it, and a plan with a good chance of success would surely beat the alternative.

The use of guns is beyond the scope of this book. But I’ll relate two incidents that happened to friends of mine
here, as a cautionary note.

One friend who was a cop, had a gun on the side of his car seat. He and his fiancée stopped at a drive up ATM
machine to get money, when a man approached the open car window and told my friend to hand over the
money he had just retrieved. My friend went for his gun, was shot in the head, and killed in front of his fiancée.

Another couple I’m friends with was asleep in their home, when my friend woke up and noticed his kitchen
light on in the room next to their bedroom. He had a gun under his bed, right next to him. But before he could
grab it, the door opened up and a man came in with a gun pointed at them. He was smart, and didn’t go for his
gun. Unfortunately their dog began barking at the guy, and the guy shot their dog in the head before robbing
them. My friends left their house that night and never went back in. They put it up for sale and moved out of the
city.

I relate those stories to emphasize that if you do decide to own a gun, you absolutely must learn how to use it,
and you absolutely must have a plan for when to use it and when not to use it. A gun is not a magic weapon. If
someone has a gun pointed at you, and you go for your gun, you’re probably going to get shot. In order to use
your gun, you need to know your attacker is coming BEFORE he sees you or has his gun on you. This is one
reason layers of home security are so important, as they’ll let you know someone is on their way.

Back to home security...

Although you won’t be there to attack, if you go out of town, make sure you have a neighbor pick up your mail
and remove flyers each day. Some predators will place flyers on or in front of doors, or on car windshields, to
see if they get removed. If they don’t get removed, they can assume you’re out of town.

Be Aware Of Your Surroundings

It’s always better to be aware and mindful, not just for self defense. Get into the habit.

Most people do the same things day after day, week after week, month after month. You should be aware of
what’s normal in your neighborhood, where you walk your dog, in and around public transit areas, in and
around your place of work, in the grocery store parking lot, and everywhere else you go. What kind of people
do you normally see? What do they normally wear? What are they normally doing?

When something or someone is out of place, take note.

Why is there an adult man hanging around a children’s playground if he doesn’t have a child? Why is there a
man leaning against a wall or peaking out from a recessed doorway? Why did those three guys split up but keep
walking toward me? Why is that man wearing a jacket in the summer? Why does that kid have one hand behind
his back? I’ve never seen that guy before...what’s he doing in my neighborhood?

People naturally have good instincts, and it’s extremely common for victims of crime after the fact to say they
had a bad feeling about a situation, that something or someone didn’t seem right. But they ignored it. When
you’ve got a bad feeling, pay attention to it!

Predators will use social conventions to their advantage. They know that it’s rude to be rude, and that nice
people don’t want to be rude. They know you’ll feel strange crossing the street when they’re walking toward
you, and that you probably won’t. They know you probably won’t tell them to get out of your face when they
come too close, or that you’ll shake their hand when they put it out for you. The most dangerous predators
won’t seem like predators on the surface, but odds are, you’ll know something isn’t right. They’ll be where they
don’t belong or they’ll be doing something a normal person wouldn’t do. It may be something small, but if
you’re aware and paying attention, you’ll see it. And you don’t have to be paranoid. You simply need to be
aware and pay attention to your feelings.

Warning Signs

Gavin de Becker, in The Gift of Fear covers 7 tactics a predator will commonly use to gain your trust or take
advantage of you. I won’t go into great detail, as you should read the book yourself, but they are worth
mentioning here:
  Forced Teaming: The predator uses the word “we” to establish a relationship or show you have
something in common. It’s abnormal for a stranger to use the word “we” with you.

 Charm: Charm isn’t a natural human trait, it requires an effort. If a stranger is charming, there’s a
reason. He wants something from you.

 Too Many Details: The predator knows he’s lying, even if you don’t. He’ll often give you far too many
details than a normal person would, in an attempt to make his story more believable.

 Typecasting: A predator will often attempt to put you in a group you don’t want to be in, so you’ll bend
over backwards trying to prove you’re not what he says you are - racist, rude, inconsiderate, etc. He’ll
do this to get you to do what he wants.

 Loan Sharking: The predator does something for you, so you feel the need to reciprocate. He may
“help” you put your groceries in your car, open a door for you, etc.

 Unsolicited Promise: This is a big one, and is nearly always a sign of real trouble. A predator says, “I
won’t hurt you, I promise.”, “I’m not one of those crazy people, I promise.” If he’s saying it, he’s
thinking about doing it.

 Discounting the Word “No”: Predators will discount when you tell them “no”. When you tell them you
don’t need their help, they’ll help you anyway. When you tell them no, they’ll disregard it.

Most people will notice these tactics on some level. They’ll feel uncomfortable, but they won’t trust their
instincts. It’s important not only to be aware, but also to trust your feelings. The Gift of Fear is an excellent title,
as fear really is a gift. It was given to us by nature to let us know when trouble is present. When you feel fear,
there is likely a very good reason. Pay attention to it, and do something about it.

Pre-Attack Indicators

In addition to the above warning signs, there are a number of common pre-attack indicators you should be
aware of. One of the most common is the witness check. Before an attack, the perpetrator will know he’s about
to do something illegal. He either wants witnesses to see what he’s doing, in the case of violence for status, or
he wants to be sure there are no witnesses to see what he’s doing, in most other cases. Many of them will do a
witness check right before they launch their attack, looking around to check for witnesses, and some will
continuously look for witnesses as the time of the attack gets nearer. If you have a strange feeling about
someone, if they’re somewhere they shouldn’t be or doing something they shouldn’t be doing, and they’re
looking around frequently, there is likely a problem. If a stranger has approached you, is within striking
distance, and does a witness check, you’re about to be attacked.

Highly skilled predators may operate in groups. Doing so will allow them to hide some pre-attack indicators,
but this often creates others. In a team of two or more, the predator in front of you can avoid the witness check
for example, by relying on his partner(s) as a look out. One may be approaching you from the front while
another walks up from the rear. The man approaching from the front sees what’s behind you, and the man
coming from the rear can signal the one approaching from the front if the coast isn’t clear, removing the need
for the witness check. It’s also possible for two or more predators to use cell phones for this purpose, as
lookouts and to coordinate the timing of their movements.

But when predators operate in groups, they are often all within sight of each other. If you turn a corner and two
men, one in front and one behind, begin walking toward you at the same time, it could be a pre-attack indicator.
If you’re in an isolated area and one man is leaning against a wall with a phone to his ear, and another is
approaching you with a phone to his ear, but neither looks like they’re talking, it may be a pre-attack indicator.

In addition to the witness check, many armed predators will do a weapon check at some distance from the
victim, assuming they’re not already holding the weapon (concealed or not). Obviously, the existence of a
visible weapon in the hand of an approaching stranger is a very reliable pre-attack indicator. But if the weapon
isn’t already being held, the predator may “check” with his hand, touching his weapon (under his clothing or in
his pocket) to make sure it’s in position and ready. This quick pat or weapon check should be familiar to most
people who carry or have carried a weapon.

The third common check is the victim check, where the attacker surveys the victim as he approaches, to make
sure he’s made the right choice and to monitor the victim for a weapon or counter attack. The average,
relatively unskilled predator will be obvious with his victim check, looking the victim up and down nervously.
A more skilled predator will tend to “zone out”, so he can notice everything peripherally without being obvious.
However, the average well-meaning stranger will not approach you in such a manner, so the victim check
should trigger as a pre-attack indicator in most cases.

As always, there are exceptions. If a predator is sure about his location and victim choice, or if he has no regard
for his own safety, he may not do any of the checks.

Some predators may avoid the weapon check by holding a weapon in concealment, in their pocket, behind their
back, under their shirt, etc. Pay attention to where a person’s hands are. If one hand is swinging naturally and
another appears to be unnaturally placed in concealment, for example, this may be a pre-attack indicator.

Location can also be a pre-attack indicator. Watch for people standing or waiting where they don’t belong,
especially in isolated areas. Another key can be in dress. If a person is in a location they don’t fit in, and they’re
wearing something that also doesn’t fit, pay attention. Their clothing may be hiding something, or it may reveal
they don’t belong in the location they’re in.

One of the best pre-attack indicators is position. For a predator to attack you, he’ll need to get close. When there
are few people around, it’s entirely abnormal for a stranger to get too close to you. So when a stranger attempts
to invade your personal space, particularly when there are few people around, it may be a pre-attack indicator.
He may also be testing your boundaries or attempting to establish dominance.

Other pre-attack indicators are obvious. When a person begins raising his voice, yelling at you, turning red,
making big movements, and being otherwise aggressive, he may be gearing up for an attack.

Look, See, and Learn

Warning signs and pre-attack indicators are always there. Once you know what to look for, once you begin
paying attention, you’ll see them. I’m from New Orleans, a city with lots of tourism. For years I lived in the
place were all tourists go, the French Quarter. My family lives there today, and I still spend a significant amount
of time there. Like many other places with large numbers of tourists, there are predators looking for victims.
I’ve often walked the streets or sat on my balcony, watching them operate.
They stand stationary and watch, where the vast majority of people are walking to and from shops, restaurants,
and sights. They position themselves so people will have to walk close to them. Or, they approach strangers
immediately putting a hand out for a hand shake, or putting an arm around a stranger’s back. Once they get
close, they start with a variety of cons, either to get money without physical violence, or to get people to a more
isolated location where they can rob them away from witnesses.

Most people are afraid to say “no” when a hustler puts his hand out for a hand shake. It’s rude not to
reciprocate, and the hustlers rely on that social convention to get close and establish control. For the few people
who do refuse, the hustler usually acts offended, accusing the person of racism. And at that point, he gains
control again as the victim does everything they can to convince the hustler they’re not a racist.

Pay attention to your surroundings, how people behave, what they’re looking at, and where they position
themselves in relation to others. You may be surprised by how much you’re able to see.

How to Prevent the Attack

If you have failed to avoid dangerous places, to increase the risks, and to decrease the rewards enough for a
predator to choose another victim, and you see pre-attack indicators, it’s still not too late to prevent the attacker
from succeeding. What’s essential to realize in order to maintain control of the situation, is that you do have a
choice, and you must make that choice.

In Rob Redenbach’s book, Self Defense In 30 Seconds, he does an excellent job categorizing the choices along
with their pros and cons. I’ve changed the order of the choices in a way that makes more sense to me:

 Ignore or Leave: If possible, you should escape.

 Dominate: Verbally and with body language, you dominate the situation, letting the attacker know he
has made a mistake, and needs to choose an easier target.

 Comply: If your attacker has a weapon, giving him what he wants may be the smartest self defense
move there is.

 Stun and Run: Nail the attacker, and escape to safety as quickly as possible.

 Incapacitate: You attack the attacker until he is completely incapacitated.

 Restrain: You control and restrain the attacker.

By making one of the above choices, even if an attacker has already approached you, even if he has threatened
to use violence, and even if he has pulled a weapon, you can still maintain or regain control. But you must
realize you have that choice, and again, you must purposefully make it. Without making the choice, you give
your attacker control. There’s a great quote from Sun Tzu’s Art of War that applies here:

“To secure ourselves against defeat lies in our own hands, but the opportunity for defeating the enemy is
provided by the enemy himself. Hence the saying: One may know how to conquer without being able to do it.”
Your attacker cannot successfully attack you unless you provide him that opportunity. He cannot control you
without you allowing him to do so. The choice is yours, but only if you know that it is. I can’t overemphasize
how important it is that you remain in control and make purposeful choices, even if the choice is to comply.
Stop, and think about this for a while.

Since this chapter focuses on prevention, I’ll cover the first three choices (leaving, dominating, and complying)
here. The rest of this book will cover the second three, which fall under physical self defense.

Distance Is Prevention

Distance removes opportunity from the attacker’s equation. It can be used to avoid or escape (leaving, in the
previous list of choices) from a potential attack. Maintaining a safe distance, such that a potential threat will
need to take at least a few steps in order to reach you, is crucial. It isn’t realistic to assume you can maintain a
safe distance from all people at all times, but it’s also unnecessary to do so. In the company of friends, there is
no need to maintain a safe distance. In a crowded place, under normal circumstances and where there are no
warning signs or pre-attack indicators, it’s also unnecessary (and impossible) to maintain distance. But when
you’re in an isolated area, see warning signs, pre-attack indicators, or don’t feel right, you should strive to
create as much distance as possible between yourself and any potential threat.

In isolated areas, you should also keep a safe distance from places an attacker may hide in order to surprise you.
Keep your distance from recessed doorways and corners, and walk on the side of the street where there are no
cars. If someone is approaching and on track to cross your path, cross the street or change direction. Run if you
need to.

If you’ve already been approached by a potential attacker, your first choice is still to escape or leave as long as
you can do so safely. The key is to do it under the right circumstances, with the right attitude, and at the right
time. Many predators will “interview” potential victims, asking questions, violating distance, and watching to
see how the target responds. At the interview stage, especially in areas where witnesses are present, where the
predator will need to get you to an isolated area first, leaving can be a sign of uncooperativeness, a sign that you
will not comply or make a good victim. But in an isolated area where the predator already has the opportunity to
attack, leaving may make that opportunity even more attractive. So the key to leaving as a purposeful strategy,
is only to use it during the interview stage, as a sign of active noncompliance.

Another very important point to keep in mind when walking away from a threat, no matter where you are or
how many people are around, is to maintain your awareness of the threat’s position and location. Keep your eye
on the threat to make sure he’s not coming up behind you. Leaving may seem obvious, but if you don’t
purposefully make the choice, you may not do it. Social conventions or fear may stop you from leaving when
you should. Understand that leaving is your first choice, and make it whenever you can. In the coming section
on de-escalation, I’ll cover another element of effective leaving, dominating your opponent verbally and with
body language.

Evasion

Sometimes, creating enough distance to be completely safe is impossible. It may be that you’re far away from
safety, and running will put you in a worse position. In these cases, evasion, a close relative of distance, can be
a viable option. If you see a potential attacker before he sees you, you may be able to hide. Hiding can be easier
than you might imagine. If the potential attacker isn’t paying close enough attention, you can make yourself
disappear by crouching next to a car or hiding behind a tree, for example.

You might be surprised how easy it is to hide in the open. As long as someone can’t see or hear you, you’re
effectively invisible. As a teenager, I went through a phase where I was pursued on numerous occasions by
various people with bad intentions. It wasn’t pleasant, but I’ve been just a couple of feet away from people who
were actively looking for me. The key to hiding successfully is to either be safe and secure in your hiding place,
or to remain mobile, to circle the object you’re hiding behind if the potential attacker is moving such that it
becomes necessary. In isolated areas, where you’ll most likely need to use evasion, it’s even easier, as you don’t
have to worry about anyone else seeing you and revealing your position.

You can use evasion with cover even if your attacker does see you, as long as he doesn’t have a projectile
weapon (gun, pepper spray, etc.) that he is willing to use. If you’re as fast as your attacker and have good
endurance (it is far more tiring than you might imagine), you can play the circle game, circling a parked car for
example, while yelling for help. Few attackers who mean you serious harm will chase you around and around a
car while you’re yelling for help and drawing attention to them.

Unfortunately, evasion may be difficult or impossible if you’re with family or friends who aren’t on the same
page.

De-Escalation

When you can’t avoid a potential attacker through avoidance, escape, or evasion, de-escalation is the next best
option. In terms of the choices you must make when faced with a threat, leaving, dominating, and complying
can all be effective forms of de-escalation.

Every attack requires an escalation of some sort. The escalation may be more or less visible, but it will include a
final closing of distance, it may include a verbal escalation, and it may include an “interview”, where the
perpetrator goes through a process of questioning (verbally and/or non-verbally) the target to confirm his
likelihood of success. The perpetrator may also tell the target to do something, and in some cases, complying
can de-escalate the situation, preventing it from going physical.

Verbal Compliance

Before many attacks, especially when robbery or violence isn’t the primary motive, a verbal escalation may
occur first, where tension is noticeably built up leading to a physical assault. A typical build up many people
will be familiar with is where one male challenges another by saying something like “You got a problem?”, or
“What are you looking at?”. If the answer is “Yeah, you’re my problem.”, or, “I’m looking at you, asshole!”,
then the escalation generally progresses until physical violence occurs. But often, simply saying, “I’m sorry
man, I didn’t mean to stare.”, and following such a course, will be enough to stop the escalation and prevent the
attack. Sometimes, it will take a couple of deflective statements, but by allowing the perpetrator to maintain his
dominant role, there will be no need for violence. This is a form of compliance, as you’re allowing the
perpetrator to maintain or increase his status. Simply leaving can also work in such situations, especially if you
do so in a compliant manner.

In the case of violence for conflict resolution, where an argument usually precedes a physical attack, you can
also comply by letting your opponent win. Don’t participate in escalating the situation further. Saying
something like, “Well, you could definitely be right. I need to think about this a little more.”, for example, can
both end the escalation and the discussion. If you feel a person is beginning to feel provoked by something
you’re doing or saying, reverse course and/or leave.

Verbal and Physical Dominance

If you feel threatened by someone that you think may want to rob, attack, or abduct you, dominating the
situation and leaving can work very well during the interview stage, or as the predator is attempting to close the
distance. One of the best ways to de-escalate an attack using physical and verbal dominance without physical
contact, is to put both hands up as a barrier, create distance, and say in a very loud, commanding voice, “BACK
OFF!”. Doing so absolutely requires practice. I’ll repeat that. Doing so absolutely requires practice. We are not
socially conditioned to yell at a stranger before being physically attacked. Most adults aren’t accustomed to
yelling at all. It takes practice to say “Back off!” in a loud, commanding voice, to mean it without looking
scared or self conscious. If it’s not practiced, and if it’s not meant and done in a dominating way, such an
attempt will come across as weak and fearful. It will have the opposite effect. Practicing establishing distance,
putting your hands up as a barrier, ready to attack, and giving the “back off” command is a valuable exercise.

A loud command can be literally stunning. A potential attacker will not expect you to yell at him before he
attacks. It will be unexpected, and it will shock him. It will serve to show him you’re not a good target, are
unwilling to cooperate, draw attention to what he’s doing, or give you the time to attack while he is taken off
guard.

Physical Compliance

If the threat of violence has already been made, if you were taken unaware and by surprise, especially where
deadly weapons are involved, compliance is one of the safest choices a person can make. If a predator puts a
gun in your face and demands your wallet, your money, your keys, etc., giving him what he’s asking for is
highly likely to de-escalate the situation. This is difficult for many self defense and martial arts practitioners to
accept. They train hard to be able to take out an opponent, and feel that giving a predator what he wants is
giving up, or losing. But the goal of self defense is not to beat up, incapacitate, or take out an attacker. The goal
of self defense is to survive and prosper, minimizing injury or damage. And the best way to do that when faced
with a deadly threat, where giving up a physical object will end that threat, is to comply.

Compliance is an active choice. As hard as it might be to accept, it’s often the smartest choice you can make, far
smarter than resistance. It’s very important to realize this. You should practice giving up your money against a
deadly threat.

Of course, when a predator wants you or your family, compliance is not a good option, especially when the
predator’s goal is the act of violence or murder. You can and should try to escape or use verbal and physical
dominance at the interview stage if possible, but even with the threat of deadly force, complying is not a de-
escalation strategy in such situations. If a predator points a gun at your head and tells you to get in his car, come
with him, go inside your house, etc., it’s highly unlikely to end well. Your chances are probably much better
choosing to sprint away as fast as you can instead of complying. If you can’t safely escape, this is where the line
between de-escalation and physical self defense is crossed. If there is one rule in self defense, it is never to
comply with a predator who wants you.

The OODA Loop

The OODA Loop is a concept developed by US Air Force Colonel John Boyd. OODA stands for Observe,
Orient, Decide, and Act. The concept describes the process humans go through when confronted with a stimulus
that requires action or decision making. First, we observe a stimulus. Second, we orient ourselves to the
stimulus or new situation. Third, we decide what to do based on that observation. And finally, we act. The
OODA Loop has important implications for self defense strategy.

Normal human interactions can be seen as chains of OODA loops, where one person acts, the other observes,
orients, decides, and acts, and the cycle repeats. But in aggressive situations, it’s possible for a person to get
stuck between the first two phases of the loop. When a predator launches a surprise attack and keeps the
pressure on, the victim is bombarded with so much information that they’re stuck observing and continuously
attempting to orient. They can’t even get to the decision phase since the situation is moving and changing at
such a quick and overwhelming pace. The predator is in the action phase, and the victim is stuck two steps
behind, unable to catch up.

The OODA Loop concept sheds light on why it’s so important to be aware of your surroundings, to have a plan,
and to proactively make choices. By being aware of your surroundings a potential attacker will be unable to act
without you seeing it coming. By making certain choices, you are acting, forcing the predator into the first half
of the loop, where you are now two steps ahead or at least on the same level as the predator.

This is one reason why using the “Back off!” command is so effective. The predator thinks he has the situation
under control. He’s decided what he wants to do to you, is in the middle of his plan/action, and all of a sudden
you break into his loop. It kicks him back into the observe and orient phases and changes the game. You’ve
taken control, the predator feels it, and is likely to back down, at least momentarily. If you’ve done so in a place
where other people are around, when the predator observes the new situation, he’ll quickly realize that all
attention is on him, which is a very uncomfortable prospect if he knows he’s about to try something illegal. At
the least, breaking into the predator’s OODA loop will give you the upper hand if you need to resort to physical
self defense.

In addition to the “Back off!” command, there are a number of ways to break into a predator’s OODA loop,
either making him reconsider his attack or making him miss his opportunity. If you’re carrying a weapon when
you notice a threat, especially in an isolated area, putting your hand on the weapon, drawing the weapon, or
disengaging a safety on the weapon, where the potential threat notices your movement, can make him
reconsider. Faking a weapon check when you don’t have one can also work well.

Recently a friend of mine related the following incident to me: He was in a busy tourist area, and needed to
make a trip to a hardware store that was about four blocks away. The two blocks closest to the hardware store
are relatively deserted, and places where criminals often rob people who park there or transit through them...a
perfect “in-between place”. My friend noticed three young guys who fit the profile for robbers in the area,
walking toward him on the other side of the street, looking around for witnesses, and then looking him over.
Although he didn’t have a weapon, when they looked at him, he looked right back and pretended to put his hand
on a weapon underneath his shirt, as if he was carrying a concealed handgun. He told me they instantly changed
their demeanor, quit looking at him, and continued on their way. He told me he’s used this tactic on multiple
occasions, and it’s always worked well. Of course, a fake weapon check can backfire, and you should be
prepared for that eventuality (to run, to use evasive manoeuvres, to comply, or to fight if necessary). But it’s a
good example of breaking into a predator’s OODA loop and changing his plans without the use of physical
violence.

Another strategy that can work to disrupt an opponent’s OODA loop, is simply to talk to him, to address him or
ask him a question. It’s difficult not to at least quickly consider a question when asked, and this can throw an
opponent off. Maintaining or creating distance is a safer bet, but if a threat is coming near you, confidently
saying “Hey, how are you doing?” can reset his mind and throw off his timing, if not his plan. It’s surprising
how effective a simple question can be at disrupting a physical plan, if used at the right moment. Next time
you’re training with a partner, ask him a question right before you attack, and watch what happens. Even after
you’ve done it once or twice, it can still have a surprising effect.

On the other hand, if a predator is “adrenalized”, focused, and firmly moving in for the attack, he likely won’t
even hear whatever question you’re asking, making it ineffective.

Preventing The Freeze

As mentioned in the previous section, a surprise attack can cause a person to freeze, as a fast, overwhelming
attack can be too much information for the mind to orient to. Fear can also cause the freeze. And the
combination of fear and an overwhelming attack, even worse. In Facing Violence, Rory Miller devotes a
chapter to different types of freezes and how to break them. I don’t have enough experience with freezing or
breaking freezes to go into specific examples and details for each type, but two strategies that have worked for
me follow the solutions Rory offers.

The nature of a freeze is that you’re “frozen”, or not doing anything. And it’s triggered by someone or
something else that is doing something. The key to preventing the freeze (and breaking a freeze) is to actively
do something. This may seem obvious, but there’s more to it, as described below, and it should be a
fundamental part of your self defense strategy.

Pre-Positioning

Most predators will attempt to take their victims by surprise. And when you get nailed by an assault you didn’t
see coming, you will at least momentarily freeze. Everyone will. First, your body and mind will be shocked by
the physical nature of the assault. Second, you’ll either be completely paralysed on a primal level, stuck trying
to figure out what’s going on, or you’ll pause for a moment while you switch from your everyday mind to a
more aggressive state. During this period, you may very well be getting mauled by your attacker. One way to
prevent this from happening is to use what I call pre-positioning.

Pre-positioning requires you to be aware of the threat before the situation goes physical. Ideally, you’ll position
yourself far, far away, and there won’t be a physical attack at all. But when you can’t avoid the threat, (and he’s
closing in on you) pre-positioning involves becoming the predator yourself, mentally and physically. You pre-
position yourself to attack the threat. Mentally switching from being a victim to being a predator, makes all the
difference in the world. Pre-positioning is active. It involves doing something. And doing something is the
opposite of freezing.

Anyone who has sparred just a bit, standing and with strikes, knows that standing flat footed, chest to chest,
with your hands down, and directly in front of your opponent is a very bad idea. But circling to the outside of
your opponent, for example, minimizing his options while maximizing your own, works well. Pre-positioning
involves setting up your position relative to your opponent, and seeing your opponent as your prey rather than
as your attacker. If he moves to attack, he’s giving you something. He’s creating an opening that you will use to
your advantage.

You’ll need to practice pre-positioning in order to understand and use it, but it should be part of your physical
martial arts and self defense training. Sparring will help with your ability to pre-position, and it will be covered
in later chapters on the Fundamental Five and Environmental Applications.

Conditioned Default Responses

The second strategy, conditioning effective default responses to various types of attacks, is a last ditch option
when you are attacked by surprise. If you’ve conditioned yourself to unconsciously respond to a physical
assault, even if you are surprised by the attack, your body will execute the conditioned response. Immediately
after the response, you may freeze as you try to figure out what just happened. Hopefully, your training will
kick in and you’ll continue to act as quickly as possible. I’ll cover conditioned responses in detail in the
chapters on Functional Training and the Fundamental Five.

Violence, Danger, And Paranoia

This chapter and the previous one cover serious topics: The nature of violence and its prevention. The material
isn’t light or nice. It is important however, and it can save your life. With that said, for most people reading this
book, the world is a safe and enjoyable place. Physical violence can happen, but for the majority of people in
first world countries, it’s an exception. The purpose of the material in these two chapters isn’t to have you focus
on danger or become paranoid. It’s to give you the knowledge to avoid or prevent violence without having to
use physical self defense.

At first you may need to practice to modify your behavior and become more aware of your environment. But in
time, these behaviors will become second nature. You won’t need to think about them. Prevention is about
minimizing your risks. And when you’ve done that, when you’re well prepared, there will be little to worry
about.

As always, there are exceptions. Some places are dangerous. And you may live in one of them. I spent seven
years of my adult life living in a neighborhood where physical violence was common. There were multiple
shootings directly in front of my house, bullet holes in my roof on two occasions, and every two or three nights
my wife and I would hear gunshots. There were turf battles with groups of people fighting each other, drug
dealers on two corners within two blocks, a brothel with heavily drugged hookers roaming around, and plenty
of unsavory characters. Just before we moved into our house, one of our neighbor’s sons was murdered. Just
before we moved out, another one was murdered, and then set on fire in his car. Another one of our neighbors,
who my wife used to make brownies for, was jailed for murdering two people.

One of the best decisions we ever made was to move. The feeling of living in a new place, where we could walk
outside at any time, day or night, with no concern for our safety, was indescribable. We immediately felt the
difference in our lives, and it was no small thing. If you’re living in a dangerous place or with a dangerous
person, it doesn’t have to be that way. Leave. It might not be easy, but you can make it work, and you’ll be glad
you did.

Life is too short to be obsessed with violence. Minimize your risks, learn what to watch out for and how to
respond if you do get into trouble, and then forget about it.

The best thing about functional self defense and martial arts practice has nothing to do with violence. The best
thing is that it’s healthy and a great deal of fun. It’s fantastic for exercise, incredible for balance, and a physical
and mental challenge. The variety and range of movement and force is liberating for your body. You can do it
for the rest of your life, and you’ll always have room to improve. Stand up, clinch, ground, striking, grappling,
blunt objects, sharp objects, and projectiles, with a partner, in a group, or alone, indoors and outdoors, there’s a
near infinite amount to practice and enjoy.

Take-Aways

 Avoid dangerous places.

 Be a bad target.
 Be aware of your surroundings.
 Watch out for warning signs and pre-attack indicators.
 Maintain a safe distance from potential threats and places they may wait.
 Create layers of security for your home.
 Escape to safety when you feel threatened.
 Evade a threat when you can’t completely escape.
 Use the “Back off!” command to dominate the situation if a threat gets close.
 Comply: Give in to an argument or give up your money if it will prevent physical violence.
 Never go anywhere with a predator. Never give him privacy and time with you or your family.
 If a threat is closing in, pre-position for your attack. Become the predator, and the predator becomes the
victim.

 TOP: Become Aware, More Skilled, and Happier by Reducing Distractions

 Unaware & Distracted
 Now more than ever, we are bombarded with disruptions that keep us unaware.  If continuous mental
chatter isn’t enough, we’ve got tweets, text messages, emails, phone calls, and urges to check this or that
on our internet-connected devices.  The pace for many people is fast and continuous.
 Humans are wired to pay attention to disruptions.  For most of our existence as a species, these
disruptions were extremely important.  They were usually created by something living, and very often
potentially one of two things: food or danger.  It makes sense that we paid attention to them.  But today,
more often than not these disruptions are addictive, trivial, and rob us of awareness, skill, and maximum
enjoyment.
 One At A Time
 Thinking is linear, and we can’t think about more than one thing in any given moment.  Although many
peoplethink they can multi-task well, they cannot.  In study after study, attempts at completing A, B, and
C are degraded by mixing them…in everyone.  Both the time it takes to complete the tasks and the
quality of the work is decreased when the tasks are mixed.  The best way to complete A, B, and C, is to
do them one after another, with no disruptions.
 In addition to humans being unable to do two things at once, at least things that require concentration or
focus, it also takes our brains time to switch to being fully involved in one task to being fully involved in
another.  Even if you only stop what you’re doing to glance at a tweet, text message, or email, you’ve
just degraded your concentration.
 How To Cultivate Awareness
 Real awareness requires effort.  Try for just a moment to focus only on your breath.  Right now:  Breath
in, and feel it without thought.  Breath out, and feel it without thought.  Do that 4 or 5 times in a row.  If
you’re aware of what’s going on inside your head, you’ll quickly realize how difficult it is to silence
your thoughts.  Your mind will continuously bombard you with this and that, often unnecessarily.
 The next time you’re eating, don’t watch TV, read the paper, work on a computer, talk on the phone,
send text messages, or surf the web on your smart phone.  Just eat.  Empty your mind, and really taste
the food you’re eating.  If you’re eating good food, you’ll enjoy it many times more.  If you’re eating
bad food, you’ll realize it.  Without being mindful and aware of what you’re doing in any given
moment, you’ll miss out on the good and be unaware of the bad.
 These days, it’s common for people in the middle of a real conversation to pull out their phone to read
and send text messages or answer a call.  It distracts both participants of the conversation, and degrades
our ability to be fully considerate, active, and present.
 Whatever you’re doing, be mindful of it.  Eliminate disruptions.  You’ll notice how much richer your
experiences become, and those you live and interact with will also benefit.
 In the Zone: Active Non-focused Awareness
 Eliminating technological disruptions, by giving yourself time to specifically return your messages for
example (but not while you’re doing anything else!), would be easy if we weren’t addicted to these
disruptions.  But many of us are.  However, eliminating them is worth the effort.  You’ll find yourself
able to better focus on whatever you’re doing…to be present in the moment and maximize your
experiences.
 Eliminating mental disruptions, your own thoughts, is a lot harder.  It takes practice.  Find a quiet place
to sit comfortably, feel your breathing, and quiet your mind.  Sit in awareness of the present, with
nothing else.  With practice, you’ll be able to do it.  And you’ll start to notice things.  You’ll notice
sounds and smells you didn’t notice before.  You’ll see things in a new light.  Quieting your mind is the
key to being fully present.
  The longer you practice this active, non-focused awareness, the more it will spill out into your everyday
life.  Instead of walking to your car while checking your text messages, unaware of what’s around you,
you’ll notice both the good and the bad (if it’s present).  The world will open up to you.
 I used the phrase “non-focused awareness”.  It takes focus to achieve it, and that’s what initially makes it
hard for everyone.  First, you’ll have to focus on quieting your mind, and you’ll have to maintain that
focus to keep it quiet.  With that focus in place, you’ll have achieved a non-focused awareness.  It may
be more accurate to call it a “focused, non-focus”, or a focused non-attachment.
 Becoming More Skilled
 Highly skilled practitioners, of anything, are fully aware and hard to distract.  Cultivating an active, non-
focused awareness is the key to noticing what’s going on within and around you, and acting/responding
efficiently and effectively.  With awareness, you’ll be better able to notice and correct your own
mistakes, and to counter your opponents actions.  It’s no surprise that many martial arts place emphasis
on meditation, and most high level athletes have some form of mental training, even if that’s done
through the practice of their sport.
 Start Today
 Stop.  Regularly take time to sit in the present.  Eliminate distractions both internal and external.  You’ll
become more aware, better at everything you do, and more skilled in your art.  You’ll also be able to
fully enjoy the good in your life, and see and eliminate the bad.

Blood Trials: An Experience of Fear, Adrenaline and Unconsciousness

by Josh Nixon, ESP
Honesty is important. This is a key principle of ESP training. We can’t hope to make any useful progress
without our instructors being honest with us, without being honest with them, and (this is absolutely crucial)
being honest with ourselves. One way we can go about doing this is to talk openly about our fears.
Geoff Thompson is well-known as a prominent figure on this topic. His approach of identifying and confronting
our fears in order to overcome them has been adopted by many instructors, myself included, as it is nothing
short of necessary. His book, Fear: The Friend of Exceptional People (Summersdale, 2001 – ISBN 978-1-84-
024193-8) is an excellent resource for those who want to find out more on this topic.
I’ve made some good progress with my fears, especially thanks to the breathing training and awareness of
tension and relaxation I’ve gained from meditation and Systema (Система). There was a time, believe it or not,
when if there was a spider above the shower then I’d have to either wait for it to go away, try to move it
somehow with no risk of it touching me, or ask someone to shift the bugger for me before there was any chance
of me stepping in! This is not the case now, however, and I owe a lot to Geoff Thompson and Rob Poyton for
their influences on my training and thinking.
All my life, however, there has been one issue which never did get better whatever I did. Not yet, anyway. As a
result, I recently had an adrenalised experience that is worth sharing. I personally found it biologically
fascinating, aside from what we can gather from it psychologically about adrenaline and fear. In addition, it was
the closest I’ve ever come to unconsciousness without actually being unconscious.

I had a blood test the other day.

Now for many this simple procedure is short and painless. For me it was something of an ordeal. At least it
proved to be an interesting one. Let me begin by explaining my relationship with blood and its weird effects on
me.
Most people I know are either fine with blood or can’t deal with it. I don’t really fall into either of these boxes.
I’ve been hit and bled (quite a bit once or twice – noses don’t like fists or heads) in my time, and never has the
blood itself bothered me in the moment of a violent encounter. I’ve also made others bleed and that too has not
bothered me (in terms of the blood having an effect; of course violence is inherently horrible which goes
without saying). I’ve tasted my own blood and even that of others (not on purpose) and experienced no negative
effects. I can watch the goriest, most horrifically violent and graphic movie you can think of and be fine. I can
also watch footage of real violence, witness violence or an accident and be fine, aside from the obvious
negativity of such a situation.
At other times, however, the mere smell of blood or mention of an artery can start me feeling light-headed and
provoke an adrenalised response. Sometimes you can take my pulse and I’ll be fine, and other times you’ll have
me squirming and feeling sick for no apparent or rationalised cognitive reason. I have no idea why, and the
deciding factors as to whether or not ‘the effects’ will happen have yet to be found!
At school in particular I lost consciousness a few times due to blood – mentions of it, thoughts of it, the smell of
it, the sight of it… The list goes on. There’s some very funny stories I can tell you about my head doing various
amounts of damage to various pieces of school property on the way to the floor (and many other things besides),
but I’ll leave that for another time! In short, I gained something of a reputation for it which wasn’t always a
source of bullying but often a source of collective amusement.
Anyway, back to the blood test. As I’m sure you can appreciate, I wasn’t looking forward to it! ‘Tough guy’
self-protection and martial arts instructor that I am, I’m not ashamed to say I was terrified of the prospect. When
the doctor said it, within a couple of moments I’d thought of and dismissed more ways to avoid having the
blood test than I care to count. I’ll lay out the event in chronological stages as it’s interesting to see the
differences between them.

Stage One: Anticipation:

Long-Term Anticipation: So for a week or so after the doctor told me I should have a blood test I experienced
a common phenomenon – long term anticipation. This was a period in which I wasn’t completely fixated on
fearfully anticipating the event, but I often thought of it and felt rather unpleasant when I did! This period was
more cognitive than biochemical; more concerned with unpleasant thoughts of how bad it might be (I had one a
few years before and it was not pleasant). I even found myself thinking of excuses to not have one but they were
all ridiculous so I dismissed them. It’s interesting how in this stage the struggle is more with conflicting
thoughts and feelings than the effects of adrenaline; the dichotomy between confrontation and avoidance.
Short-Term Anticipation: In the car on the way there, I noticed adrenaline start to take hold with its effects. I
felt colder than I did before and started to shake slightly. Using slow, deep rhythmic breathing, I kept this at
bay. At this stage I wasn’t thinking of anything specific most of the time; I was dealing mostly with the
thoughtless feeling of intense unease. Sitting in the waiting room, more formed thoughts began to enter my
mind. Memories of hearing the blood hit the end of the bottle last time, imaginations of the feeling of blood
rushing out of my arm, etc all flashed through my mind every time someone said ‘blood test’ to the receptionist.

Stage Two: Adrenaline:

The moment the phlebotomist came out and called my number, I felt a surge of adrenaline. I knew it was all
completely ridiculous at the time, but that didn’t lessen the effect the situation had on me! I used the energy it
gave me by standing up immediately and trying to ‘walk it off’ as I followed her. I also wanted to keep a cool
exterior until I exited the waiting room in case I made someone else who was waiting feel worse.
When I got into the room and saw the desk full of needles and bottles, a secondary adrenaline surge hit me. I
explained, slightly falteringly as my body began to shift focus to survival-necessary processes and away from
speech, how I felt and why as I took off my coat and lay down, and the phlebotomist engaged me in
conversation to try and help distract me. This worked well, and I felt a little better as I lay down. It was still
more to do with thought processes than actual biochemical issues.
This changed when the needle went in! Immediately a number of effects took hold simultaneously:
 An electric feeling of paraesthesia (akin to ‘pins and needles’) all over; more intense in limbs and digits.
 A sweeping sensation of cold, accompanied with slight shaking.
 Instant urge to hyperventilate, which I overcame with forceful, slow, controlled breathing (I think this is
how I stayed conscious).
 Intense lightheadedness and dizziness.
A few moments later, it was as though the adrenalised reaction intensified somewhat. The above sensations
became more intense, and then the following occurred:
 Physical Appearance: Immediately, I went pale and cold with hypotension as my blood pressure
dropped. As adrenaline dilated my blood vessels, my blood pressure dropped suddenly and in an attempt to
raise it back up, the blood vessels around my extremities constricted, moving the blood away from my skin
and towards my core.
 Loss of fine motor skills: The feeling was as though I had very intense ‘pins and needles’ sensations
through my hands, but also that something was pressing hard into my fingertips. I was advised to wiggle my
fingers in order to help with the sensations, however I found this unbelievably difficult at the time! My
fingers were moving very slowly, as though they were clawing through jelly! It was as though the joints had
gone too stiff to move with any speed. This was of course not the case, but I’m merely describing the feeling
here.
 Sense alteration: Sounds that were normally quiet or distant became loud and close-seeming. Sounds
that were normally loud or close sounded quiet; as though the phlebotomist talking to me was far away and
yet the person who coughed a room or two away sounded as though they were right in there with us. There
was widespread loss of sensation (or loss of attention paid to it; I’m not sure which). My vision had small
lights dancing in it, and my field of perception greatly narrowed as tunnel vision set in. Eventually, I
remember opening my eyes and only dimly seeing the edge of the bed I was on as a vague shape. I could
hardly see; it was just the vague outline – light and dark. I think this could have been an indicator of how
close to unconsciousness I was, but I’m not an expert so I’m not sure.
 Time dilation: (Not in terms of a huge gravitational anomaly; psychological!) I thought this whole
process took between 40 minutes and an hour. At one point I said to the phlebotomist that I could make my
way to another room if needed so that room could be used in the meantime, thinking I was getting in their
way loads. I thought she’d gone and had her lunch break at one point. Nearer the end, I was getting bored of
being there for so long and feeling the way I did, as it had been such a long time and I was just lying there
feeling out of sorts. In actuality, she’d only nipped out momentarily to tell the other phlebotomist to use the
secondary room while I recovered! The whole thing only lasted around 5 minutes.
 Speech impairment: As my adrenalised state intensified, I realised that speaking had become difficult.
This was the most interesting effect for me, as it was something I’d never experienced before in my life. As I
was trying to answer the phlebotomist’s questions, I found that not only did it take a little while to think of
the words and get them out of my mouth but I was slurring! It was as though my tongue was moving slower
than I was sending the words to it! It really was absolutely surreal.

Stage Three: Aftermath:
Short-Term Aftermath: This stage was, in this case, quite boring really. Aftermaths can have a whole host of
effects, and they can be dramatic, but for a few minutes after I was merely cold. That’s all really. I shivered
quite a lot and felt much colder than I did before, though it was a cold day regardless. The only interesting point
was a few minutes afterwards, when I was halfway back to the car. Suddenly I felt momentarily nauseous, and
on discussion with my father found that this is often a sign of the moment that the digestive system kicks back
into action after being shut down temporarily in an adrenalised situation. Aside from that, the only effect I
experienced was a feeling of tiredness for the rest of the day.
Long(er)-Term Aftermath: I thought I should just mention this for those who don’t know about adrenaline
and stress or their effects. With a more stressful situation than this, such as violence, there is often a longer-term
aftermath which can have effects as serious as fear, paranoia or even guilt. There were no such issues for me
from this situation but I just wanted to make you aware of the possibility.
I decided to write this little article for a few reasons. Initially it was just simply an amusing share of my recent
experience of fear, adrenaline and unconsciousness so that it could become a source of discussion on the topic.
Most instructors write about fear, adrenaline and unconsciousness (as you might expect) from the perspective of
a violent encounter, but I thought it would be amusing and perhaps even interesting to share my experiences of
some of the effects that stress and adrenaline can have in a violent encounter from the perspective of one that
was completely nonviolent. More importantly, to those who’ve never experienced these effects, who have never
been unconscious or have never come close to it, I hope the descriptions of them have been useful or interesting
to you.
If anyone has any questions, I’m happy to answer them! If anyone who knows more about fear, adrenaline and
unconsciousness wants to expand on anything here then please also feel free to open up discussions in the
comments. As soon as it had happened, I thought to myself that discussion of this could be a learning
opportunity for us all, myself not least.

MODERN COMBATIVES: FUNDAMENTAL COMBATIVE PRINCIPLES

By David Armstrong

I sat down and worked out the other day that I have been involved in what is loosely called close quarter combat
for just over 20 years.

Scary!!

I threw my first “Tiger claw” when I was fifteen; this was followed by tutelage in a whole range of close
combat skills and techniques over the following years.

I have never been what you might call a “traditionalist” preferring the more practical approach to close combat
rather than studying the intricacies of an art or style. 

Since that time combatives has been turned into an industry by some and has become the most overused word in
the self protection dictionary.

I’ve (sadly) seen the rise of the celebrity instructors, internet “gurus” and their groupies. 

Individuals who have re-invented the wheel by re-hashing techniques that existed anyway and passing them off
as groundbreaking or the next evolution of self protection systems. 

Its nonsense mostly as people were doing them years ago (and better in some cases) and most certainly there
were people doing them WAY before we ever came onto the scene. 

Good marketing and advertising does not necessarily make revolutionary or effective techniques. As WW2
close combat instructor E.A. Sykes stated; “It is true that every so often a man will think out or discover by
accident something hitherto unknown to himself and his immediate associates but the probability is that
somewhere someone else knows about it already."

Which is why whenever I see someone advertising a new self protection/martial art revolutionary system or
"secret fighting techniques" DVD - it always makes me smile as the chances are its all been done before.

One of the best lessons to learn is to take the core skills and put our own spin on them. Don’t become bogged
down with “tactical technique” overload. 

Now explore by all means, learn, YES – but anyone who needs THAT much training to throw an elbow strike
(or whatever) should probably stop what they’re doing now and try something a little less demanding!!! 

Have the ability and the courage to discover what works best for you – after all it will be YOU dealing with the
attacker not some instructor.

Close combat is not doctrinal, it’s not regimented, and it doesn’t have to be done “just so” – it’s just
FIGHTING!! That is its strength its simplicity and its greatest asset.

From my own point of view my personal close combat system has changed little over the past two decades; the
evolution has been mainly in the field of weapons skills, scenario training techniques and interactive assailant
fighting such as the padded man attacker. 

But, importantly, the things that I have changed or no longer use, have been removed because I recognised that
they no longer benefited me or what I was trying to achieve. 

Evolution and experience are the main bedfellows of what you are trying to attain. There can be no free rides in
a self protection scenario - if it works use it - if it doesn’t BIN it! Good technique should not be just a museum
piece

Despite this my main principles of close combat have stayed steadfast. The techniques may have evolved but
the strategy has not. If we leave aside the principles of personal security for the moment (awareness, avoidance,
etc) and just concentrate on the immediate pre and “in-fight” applications. 

With this article I wanted to get back to basics and regain the core of some personal combative principles for the
street, principles which should remain constant regardless of your chosen personal combat system, and which
can easily become “lost” in the overload of techniques. 

So let’s have a look at an overview of our fundamental combative strategy and the applications we need to
consider.

COMBATIVE ATTITUDE 

For me mental combative attitude is the engine room of combative application. Get the mindset right and it
provides an easier transference of gross motor skills. There are numerous ways to instil that “flick switch”
aggression needed to win through in combat, many of which we cover on our modern combatives seminars and
training programs. 
Good combative mindset is 90% attitude backed up with 10% techniques. 
Dave Spaulding, a noted US firearms trainer and law enforcement officer, classify’s good combative attitude as
a combination of awareness and willingness (the NESS brothers in popular parlance). 
Awareness to spot and evaluate a potential problem, and willingness to take that figurative step over the
threshold and go forward to engage in a physical action. 

FORWARD AGGRESSION: 

Adjacent to combative attitude is the forward aggressive drive – the mental and physical action of actually
taking the fight TO the enemy. A third I would submit would be intensity – keeping up the pace and drive until
the individual is no longer a threat. 
I’ve seen this tactic work at first hand where with the correct mindset and attitude, a determined smaller person
can literally place a larger attacker on the back foot and turn the situation around. 
Forward drive wins fights – remaining static or going completely defensive is a recipe for losing or being badly
beaten!!

BATTLE FIT: 

For me fitness is the glue that bonds together good MINDSET and realistic TECHNIQUE. Good close combat
fitness should consist of strength and endurance training, and be headlined with that sudden BURST of the
energy/aggression mix that finishes the fight in a matter of seconds. We won’t have minutes to warm up or get
our body ready, and we don’t want to engage in minutes of skilful fighting. 
It’s a flick of the switch, zero to hero application and if the fight has gone on for anything longer than 30
seconds, well…..be prepared for the long haul of gouging, biting and ripping!!! 

Now some individuals are going to be better than others at certain levels of fitness – that’s just life. But we
should endeavour to “push” ourselves as much as we can. A 30 second street fight can leave even the fittest
people panting and wheezing due to the effects of fear and chemical responses of adrenaline. So maybe it
wouldn’t do some people any harm to up the level of their personal fitness training once in a while – an extra
mile, an extra 10 reps.
For combative training – less is more, especially in the training of techniques. 

It’s the quality of the reps rather than the quantity of the reps that is important. 

For new people who train with us there is always a tendency to blast through techniques. We slow them down
and tell them we would prefer five quality strikes rather than twenty-five half hearted below par strikes.

PRE-EMPTIVE EVALUATION: 

Ht them first, hard and fast!! 

When should we go pre-emptive? Who knows? It’s an individual judgement call.

However, I would like to bring up one part of the personal security pyramid (awareness, evaluation and
avoidance), namely - evaluation – as it is one that is often overlooked or not completely understood.

You hear people banging on about "oh you've got to have awareness, awareness is everything, etc".
And it is - Awareness is vital to a good self protection plan. But aware of what? Bad men, nasties, meanies!
Well bloody hell what do they look like then. I've known bad men dressed in $800 suits, and I've seen real gents
dressed like refugees. Go figure?

If we haven't worked on our evaluation skills, i.e. how to "read" people and assess the probability of their "bad
attitudes" towards their fellow human beings, then that can be as much of a hindrance as NO awareness.

The potential for that is that you could end up jumping at shadows at every stranger that crosses your path. I
think its all about perspective. Read the situation correctly and the weapon stays in its holster - read it
incorrectly and you'd end up drawing a weapon every five seconds in some places!

Once we are aware of an individual entering our "awareness radar" we then have to evaluate; from there we can
decide whether the situation has deteriorated enough to start a pre-emptive assault or to go further down the
force continuum scale by using verbal de-escalation techniques to “talk them down.”

POWER OVER SPEED 

At “bad breath” distance power takes precedence over speed. This goes back to the old truism whoever hits first
will be the winner. If I am 10 inches from an individual who is fronting me and I can touch him – then it’s not
speed that I need its power. So how do we get power into our strikes?

For this there are various methods that can be used – we work from two. The drop step and the double hip
system. The drop step is an old boxing technique utilised in the past by the legendary Jack Dempsey, and is a
way of leaning power forward at short distances. The striking hand connects with the target at the same time as
the lead foot takes a step forward. 

The double hip, as advocated by Peter Consterdine, centres on a rotation of the body via hip movement and
coupled with the “whip” effect of the delivery system, usually the arm. Both these methods of power delivery
have merit and we encourage people who train with us to try them both out and see which benefits them the
most.
At this distance the fundamental rule is that we should not telegraph our intent by “drawing back” our arm or
blading our body into what some would call a traditional stance. Our stance may be an everyday casual position,
but nevertheless we have to go from nothing to everything in the power delivery stakes in the flick of an eye.

WEAPONS RULE! 

If you are in honest fear from serious injury or death from an attacker on the street, a weapon can give you an
advantage! I don’t want to fight him/them fairly I just want to get to an implement and STOP them. That
weapon can be an improvised/expedient tool or a purpose carried implement depending on your job (LEO or
military). 

Either way we want that edge – both physical and mental – over an attacker as soon as possible. Even the most
basic item can have merit. Not everything has to be a purpose bought tactical weapon. In most cases it will be
whatever is in your immediate environment – chair, brick, stick. It is simply a tool to do a job, nothing more and
it doesn’t have to be the latest gizmo fashion accessory - you just have to know WHAT you’re doing with it to
make it count.

MINIMALIST STRIKING TECHNIQUES: 

Adapt your techniques don’t adopt is a good benchmark to work from. Play to your strengths and work on the
techniques that work for you!!
Whichever technique you utilise – try to keep its application gross motor and uncomplicated. Work on an
arsenal of a few easy to retain and use skills. 
People will always counter with the point about having more choice of techniques to work from, and that is OK
if the student has the time and inclination to carry on with the training over an extended period. But if it’s for an
expedient situation (say working overseas in a rough environment) then the student needs something that works
NOW. 
The phrase "What you learn in the training hall this afternoon, you should be able to use for real in the car park
on the way home" springs to mind.

From my own experience the techniques to discard as unworkable or unrealistic pretty much stick out anyway
and trying to make a failing technique work in mid-fight (that is obviously failing for whatever reason) is a bit
like taking the long route home in the pouring rain – pointless.

HURT DON’T JUST HIT! 

I was having a conversation with one of our seminar attendees recently in relation to low-line kick attacks. He
was putting in kicks to the knee/shin bone area. At the end of each technique he was retracting the leg – making
impact minimal. 
When we stopped and talked about it I made the point that his mindset should not just be to strike the leg but to
crush it. That is a vital visual/mental gear change.

There is a Russian underworld phrase; “zomochit” which means to smash, break and pulverize. That is the end
result that we are after – we are not scoring points or counting hits – we are going out to make him non-
ambulatory. 
Take away a man’s fighting tools (arms, legs) and you’ve broken down his weapon system, once he’s at that
point we can start to work on more prominent targets.

This also applies to any strike that we offer. Why waste time “softening him up” – in a real time violent assault
we should be striking to mainline targets and creating maximum damage as quickly as possible. This is never
more so than in the combination conundrum of “Do combinations work? 

There are people who will tell you yes, others will say no. The problem lies in the training application of them
versus the reality of a fully functioning human adversary. 
I submit that hitting a bag, pads, etc, you have that restrictive impact movement and in many cases people
sacrifice the first strike for that big barnstormer second or third strike hoping for that blockbuster KO. 

This however goes against the basic principle of hit first, hard and fast, and they tend to sacrifice power for
speed (as we have noted above). 
However when hitting a human target it tends to go away (funny that!!) due to impact and the transference of
kinetic energy. What I think you can do is hit the same target SEPERATELY multiple times. A strike to the
head will result in movement. From there we need to correspond to the target again, reassess and regain a
physical connection. 

Hit, regain/flag, hit regain/flag, this linked with forward aggression is the key to a successful multiple striking
system. 

This is nothing new and most of the noted combat specialists of the 20th Century have come to this conclusion
and used this method in times gone past.

EXPECT THE UNEXPECTED: 

This is true of every “situation” I’ve ever been in – armed and unarmed – it’s not necessarily how you think its
going to be. 
The fluidity and dynamics of a fight can throw up some very strange situations, reactions and occurrences and
the old colloquialism of Murphy’s Law (i.e. if it can go wrong it will go wrong) usually comes into force at this
point.

The strike that you’ve done a hundred times in training has no effect against the guy about to rip your head off
and the choking technique that your instructor told you was “a death lock” is seemingly not working no matter
how hard you crank it on.

This unfortunately is the reality of a FIGHT; no one said it was going to be easy, after all a fight by its very
nature is a physical struggle. So how can we override these X-Factor situations?

Well for us the best method has been to run plausible and high probability self protection applications in a
variety of scenarios. 

This type of training helps us to deal with the “shock and awe” factor when it all comes on top and we have to
be able to function effectively in a high stress situation of a physical assault. It’s the chance to step outside of
the comfort zone and feel the hot sweaty reality of close combat. 

After all we would rather make life or death situational mistakes in a training scenario than in the reality of a
combative street situation.

CONCLUSION:

Throughout this article, I hope the overriding factor that is coming through is that SIMPLE IS GOOD. This is
never more relevant than for the individual with limited unarmed skills or combative experience. In the fullness
of time the technique skill-set can be expanded upon to create a personal combat system relevant to what works
uniquely for them. From a technique point of view keeping it low-tech (for want of a better phrase) and with
realistic expectations of what can be achieved is a positive step forward. 
This is not the time to go into James Bond mode –but it IS the time to bring on your neanderthal man persona
and go all cave-man on your aggressor. 

A fundamental combative strategy may be crude, yes….. but boy it IS effective!

Copyright - Modern Combatives Group – 2008

Conflict Resolution
Pam Marshall, RN, LLB, LLM (ADR), Conflict Resolution Specialist, and Director, Patient Relations,
The Scarborough Hospital
Dr. Rob Robson, MDCM, FRCP(C), Healthcare Mediator and System Safety and Accountability
Advisor, HSSA Canada
Table of Contents
The Nature of Conflict and Some Common Myths
The Origins of Conflict
The Importance of Communication and the Role of Emotion
Other Factors that Contribute to Conflict in the Health Care Environment
How Facilities Can Develop Conflict Management Processes
Understanding and Recognizing Individual Approaches to Conflict
Conflict and Patient Safety
Strategies to Increase Individual Conflict Management Competence
Methods for Conflict Resolution
Conclusion
References

The Nature of Conflict and Some Common Myths

In thinking about the nature of conflict, there are many myths that inform and often confuse the discussion.

Myth 1: Conflict can be avoided

Conflict is inevitable. It is one of the energetic forces that drives and often damages the social engine. To fully
take part in social life is to desire, invite and initiate human contact—and contact begets conflict. Most human
beings seek interaction and connection with others. The absence of such interest indicates pathology and is
treated as abnormal. People want to relate to others, to know and be known and to be understood. This innate
desire to be connected to others, to be with, rather than alone, is a source of much of life’s great experiences and
frequently the source of friction.1
In going about our daily personal and professional lives, all of us come into contact with numerous other
individuals. In both of these spheres, the private and the public, conflict and disputes will arise. Though the
nature or substance of the dispute may differ, and the emotional context may change, disputes must be dealt
with; they must be resolved in order for people to move forward. One of the questions that confronts the people
involved in a dispute is how to deal with conflict in the most positive way possible. Conflicts in health care
have some unique characteristics and originating factors, which we will discuss later; however, they are similar
to all other conflicts in that they are unavoidable and inevitable. What is avoidable is escalation and negative
outcomes.2

Myth 2: Conflict is bad

As health care professionals and conflict resolution professionals, the authors have experienced firsthand the
reluctance of health care professionals, administrators and clients to acknowledge and admit that unresolved
conflict is pervasive in today’s health care system. Health care professionals are not alone in avoiding conflict;
most people fear conflict and do their best to keep out of it and away from it, despite the fact that conflict is an
inevitable factor in our daily personal and professional lives.3
However, the fact that people disagree should be seen as a healthy and integral part of human interaction.
Regardless of whether we call them disagreements, disputes or arguments, these situations are part of the
normal ebb and flow of life and they often present an opportunity for learning about another person’s point of
view. Not every disagreement will escalate into a situation that requires intervention. Most everyday problems
are resolved simply and easily by the people involved, and life and work go on as usual.
This primer focuses more on those problems that are not dealt with and end up escalating into something that
interferes with a practitioner’s professional life.

Myth 3: Conflict is impossible to resolve

Conflict is a normal result of interacting with our fellow humans. And yet most of us have never learned how to
prevent it, keep it from escalating when it starts or manage it when it develops. Most of us are loath to admit we
are in the middle of conflict. We suggest that we are having a “discussion,” a “disagreement” or a ”difficult
situation,” and insist that we will work it out. Many health care facilities are quite prepared to hire people to
facilitate meetings, assist with teambuilding or work on organizational strategic planning. Few are willing to
admit that they need help in managing the conflict in their organization.4
When asked, most people would likely acknowledge that conflict is an inevitable factor in their daily personal
and professional lives. They might go on to say that it is not so much the fact that conflict exists that challenges
them, but rather that they just do not know how to deal with it. While most of us would admit that conflict is
unavoidable, at the same time we do not want to admit that we are in conflict with someone. For most of us,
acknowledging that we are in conflict is to admit a failure and to acknowledge the existence of a situation we
consider hopeless. Clearly, we are all rather conflicted about conflict. We provide some strategies for conflict
management later in this paper.

Myth 4: We need a lawyer

Since most people see conflict as negative, something to be avoided, to be ignored if possible, they think that if
it must be dealt with, it should be dealt with quickly and by someone else. People often prefer to resolve serious
conflict with as little personal involvement as possible. Clearly this is why people seek assistance with their
problems, whether it be from doctors, therapists, lawyers, accountants or whomever. Many people feel
inadequate to the task of handling both personal and public disputes. This avoidance reaction informs and
shapes people’s negative reactions to conflicts and results in the perceived (and occasionally real) need to seek
help to resolve them.
The result is cyclical: people feel inadequate to the task of dispute resolution; they make an attempt to deal with
a problem and have little or no success; and they feel inadequate and seek help from “experts,” often lawyers,
who reinforce the notion that dispute resolution requires special intervention.5 The outcome is often an
escalation of the original conflict, a separation of the disputants from each other and a sharp rise in emotional
and financial costs, with a concurrent decrease in a quick and satisfactory resolution. People come to believe
that conflict is difficult, painful and costly to resolve.
Whether a solution is sought from “experts” or attempted individually, the common methods of dispute
resolution for both private matters and public conflicts range from the most basic (one-to-one discussions or
negotiation) to the most complex, expensive and time consuming (the courts). Of course, there is much in
between these two extremes that can be helpful—particularly mediation, which is a form of assisted negotiation
that includes help from a neutral third party.6

Myth 5: All disagreements escalate into conflicts

Disagreements do not spring to life as full-blown disputes; their development is more gradual. During their
development, disputes are variously called quarrels, problems, disagreements, concerns, issues or troubles. As
noted above, the parties themselves often settle many disagreements quickly and easily. Sometimes
disagreements are avoided in the hope that they will go away, and occasionally they do.
Frequently, what begins as a quarrel or minor disagreement is not resolved easily or quickly and escalates,
becoming a full-blown dispute. For this to occur the situation must be seen as important enough that it cannot be
ignored; that is at least one person is unwilling to “let it go.” For the escalation to continue, the conflict must
have more than a minor effect.7
Disputes follow a typical pattern. They begin as disagreements or grievances. At least one of the people
involved believes that they are entitled to some kind of resolution or solution to the dispute. Therefore, for
something to grow from a disagreement into a dispute, it must have moved past the private belief of one person
to a mutual recognition of the problem with at least one other person. While the parties may not agree on the
nature of the dispute, its origin or its substance, they must—at a minimum—agree that there is a dispute. If only
one person sees a problem, it is not yet a dispute. However, a dispute may arise specifically because the other
party does not recognize the existence of a problem or does not perceive that the other party is entitled to any
redress. It is only when there is partial or total rejection of the other party’s claim that a dispute is born.
It is always best to seek to resolve a problem at the earliest point. In all conflicts, there is a point at which the
situation has become recognized by the parties as a dispute and yet the matter has not escalated to the stage
where it is impossible to resolve through negotiation or mediation. As mediators, we refer to this as the point at
which a conflict is “ripe for resolution.”8

Top

The Origins of Conflict

At the centre of all conflicts are basic human needs. Conflict occurs because our needs are unmet or because our
needs are inconsistent with or in opposition to the needs of others.8
One of the first steps in helping health care professionals to manage conflict is to remind them that conflict is
normal and common. Once we understand that conflict is natural, the next step is to look at where conflict
comes from to better appreciate how we might start the process of resolving them.
Conflict arises from a clash of perceptions, goals or values in an area where people care about the outcome. The
breeding ground for conflict may lie in confusion about or disagreement with a common purpose and how to
achieve it while also achieving individual goals. In addition, and in health care particularly, the competition for
limited (internal and external) resources as well as the interdependency of health care professionals feeds the
development of conflict.2
Our ability to accomplish our goals and objectives depends on the cooperation and assistance of others, which
increases the opportunity for conflict. In health care, no one can do their job without the input of someone else.
When the other person is late, has different priorities, misunderstands directions, challenges our decisions or
values outcome over process, conflict is created. Recognizing and addressing the factors that give rise to the
potential for conflict can have a positive impact on the health care working environment.

Factors that create conflict

Conflicts are often multi-layered and complex and have various origins that overlap and interweave. Most
conflicts involve the same factors to a greater or lesser degree.8,9 We do not often recognize this because we are
focusing on one or two factors that are foremost in our minds or hearts.
For example a physician may state “I deserve more money.” This declaration would lead others to believe that
the conflict is about resources, or the lack thereof. However, there are many other factors underneath the stated
position of “I deserve more money.” These include the following:
History: “I have never been adequately compensated.”
Relationship: “The Chief has never really respected me.”
Emotions: “I feel unvalued by this organization.”
Structures: “This public health care system does not work for physicians.”
Needs: “I have responsibilities to my family that I need to meet.”
Communication: “How can the Chief just send me an e-mail about this issue? He never talks to me
directly.”
Understanding the various factors that contribute to conflict helps us begin to work toward resolution. Since
communication is such a vital factor in the development and resolution of conflict, we will discuss it in more
detail in the next section.

Top

The Importance of Communication and the Role of Emotion

Engaging in good communication

It has been noted that communication is at the heart of both conflict and conflict resolution.8 The lack of
effective, open and honest communication creates conflict and creates environments of misunderstanding,
mistrust and hostility. Open and effective communication is the means by which disagreement can be
prevented, managed or resolved. The health care workplace is a fertile breeding ground for conflict because of
the dynamics and interdependency of the various relationships that exist, including those between physicians
and other physicians; physicians and nurses; physicians and administrators; and physicians, patients and family
members. While it seems obvious that good communication is an essential tool for successful relationships,
communication is a skill that many of us do not excel at and yet, at the same time take, for granted. After all, we
all know how to talk. However, most of us do not know how to talk so that others will listen, or how to listen so
that others will talk.
Listening for understanding is more than just taking in information; it is a multi-layered technique that entails
listening without judgment, without planning a response and without devising solutions or offering advice.
Truly attempting to understand what is happening for another person requires centring, focus and presence.
Taking in information that includes facts, emotions, body language and context enables the listener to develop
an understanding of the needs, interests and values of the speaker.10 Listening at this level enables the listener to
fully assess the problem before trying to diagnose or treat the situation.
When another person is speaking, we are usually gathering our arguments and thinking up a rebuttal to the
points we think the speaker are making. Since we are not really listening, we do not really hear what the other
person is saying. As soon as there is a break, we jump in to make the points we have been carefully planning in
our heads. Because we have not really heard what the other person has said we are not responding to what
he/she said, but rather trying to make points of our own. We cannot listen and think at the same time!
Effective communication should proceed in the following manner:
Listen fully to what is being said. Do not plan your response.
While the other person is speaking, listen for insights into what is important to the speaker. What values
and beliefs is he/she expressing? At what points does the speaker get energized, upset, angry or sad? What
matters to the speaker?
Check in with the speaker to ensure that you got the message right. Say something like, “I think I heard
you say … Is that correct?”
Pause and think about what else you might need to know.
Ask further clarifying questions.
Respond to the speaker.

At this point you are probably thinking that this sounds tremendously formal, as well as impossible and time
consuming, and that in our busy health care environment there is no time for this level of interaction. In fact,
this technique can be applied to every interaction without an additional commitment of time. This approach may
feel uncomfortable at first and it will probably take longer that your usual communication style. However, you
will actually understand the underlying issues, which will enable you to address the correct problem rather than
solving the wrong one. You will also understand what others are saying and they will understand you. You will
ultimately save time, decrease misunderstandings, errors and conflicts, and have better relationships.11

The role of emotion and moral distress in conflict

Unresolved emotion is a critical contributor to the development and exacerbation of conflict between health
care professionals and between providers and patients.8 Research has found that residents often experience
conflicts because of their inexperience and their place in the hierarchy of the medical care team, particularly
when there is disagreement between trainees and senior staff. It has been reported that the ability to deal and
cope with these issues changes as physicians proceed through their training. Residents express more frustration
and confusion around ethical conflicts in their early years of training, and have reported that support from peers
and other residents was most effective in helping them to deal with and resolve these situations.12
While more senior physicians may become accustomed to dealing with ethical issues, the difficulty in handling
the emotional tension surrounding ethical dilemmas remains a constant for all health care professionals. The
emotional weight of decision-making is not shared with colleagues and is certainly never a topic for discussion
at morbidity and mortality conferences, which routinely focus on the medical facts rather than the feelings of
the patient or physician.
It is incumbent upon those responsible for postgraduate medical training to include study areas related to
recognizing and effectively managing the emotional turmoil involved in ethical decision-making in the
curriculum, as well as educational sessions and practical experience related to conflict resolution skills.
Just as crucial is the need for the topics of emotional responses to ethical dilemmas, the resulting moral distress
and dealing with the conflict that arises from these issues to be understood and dealt with by those in positions
of power within health care facilities and organizations.
We have come to understand that moral distress occurs when health professionals know or think they know the
ethically appropriate action to take, but are unable to carry it out for various reasons. Continuing to provide care
to a terminally ill patient because the family is refusing to stop treatment is a common situation that creates
moral distress for caregivers. There are frequently conflicting views within the health care team, based on
differing values and beliefs in what is the “right” or “moral” thing to do for the patient.13 Conflict is the natural
result of the collision of these differing values and beliefs. Improving collaboration and communication
between and amongst care providers will allow for the positive management and resolution of these difficult
situations. Providers may not agree at all times, and yet they can and must learn how to respect and support each
other.
Conflict is also created when medical errors occur. Albert Wu has identified the significant impact that critical
incidents can have on health care providers. He notes that practitioners rarely receive the kind of support that is
needed when an error is made.14 This lack of support, as well as covert or even overt criticism also occurs in the
absence of an identified error. Health care professionals have difficulty providing emotional support to
colleagues because they feel a need to stay dispassionate and detached. Empathizing with a distressed colleague
makes people feel exposed and vulnerable to criticism from others. In addition, as Wu has pointed out, learning
of the failings of others allows physicians to transfer or divest their own past errors, thereby making them feel
less exposed.14

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Other Factors that Contribute to Conflict in the Health Care Environment

In addition to the factors noted above, there are other may other unique issues and situations within the health
care environment that generate conflict.
 Health care is a classic example of a complex adaptive system. Such systems are prone to generate
errors on a regular basis; they are also capable of achieving innovation if the correct conditions are created.
The complexity of the health care system means that misunderstandings and conflict usually occur on
multiple levels at the same time.15
The health care system involves a wide disparity of knowledge, power and control experienced by
various players. While most conflicts involve some disparity between parties, it is unusual for this to be as
markedly institutionalized, as is the case in health care.
The ethnic diversity of both consumers and providers of health care services in many communities is
striking and can generate potential barriers to helping parties create solutions. In addition, gender inequalities in
health research and the provision of health care are widely acknowledged.
Health care involves people interacting with other people to repair and preserve the health and personal
integrity of patients. Often this involves issues about which people may have strongly held personal or religious
values that may seem to be, and often are, irreconcilable.
Health care professionals face ethical challenges and dilemmas that are not easily or simply resolved.
Health care professionals are expected to possess values such as compassion, respect and integrity. They are
expected to be patient, non-judgmental and tolerant of those who may make choices in their personal lives that
negatively affect their health. They are expected to be understanding when patients and/or their families
disagree with the recommended treatment plan, even when the choice or decision to be made in the best interest
of the patient is, in the physician’s view, clear.
Such behaviour on the part of patients often creates strong negative emotional responses such as
frustration and anger. Health care professionals must consciously monitor and control their behaviour so that
their patients’ needs remain the principal motivation for their actions at all times. In dealing with the anger and
frustration that many experiences as a result of unsatisfactory interactions with patients, health care workers
often unleash these negative emotions on their colleagues. This is somehow seen as “better than yelling at the
patient.”
Another area that creates conflict within health care workplaces is when colleagues openly criticize each
other in front of patients or other colleagues. At all times, health care professionals must project a respectful
working relationship with their colleagues. Discussing colleagues in a negative manner in front of patients is
clearly unacceptable behaviour and unnecessarily creates a feeling of anxiety and distrust of all health care
providers in the patient.
Expressing negative comments about colleagues also places other health care professionals in a difficult
position. They are torn between their desire to avoid conflict, to defend their colleague and to identify that the
speaker is behaving in an in appropriate manner. This dilemma is increased if the speaker is in a superior
position within the health care hierarchy, for example when one physician criticizes another in front of a nurse
or when the Chief of the department criticizes another physician. As Sir William Osler said, “From the day you
begin practice never under any circumstances listen to a tale told to the detriment of a brother practitioner …
Never let your tongue say a slighting word of a colleague.”16
Research indicates that when facing conflict situations, especially ethical conflicts, physicians are faced
with potentially competing goals. As in many other situations, one of the main goals is to avoid conflict. In
pursuit of that goal, physicians may seek assistance in determining that their treatment decisions were
supportable. The purpose of seeking such assistance is to protect the integrity of their conscience and reputation,
as well as the integrity of the group of people who participated in the treatment discussions and decisions.
Clearly the goals of avoiding conflict, seeking support and protecting one’s own integrity and reputation, as
well as the integrity and reputation of others, could conflict with each other or with ethical goals in problematic
ways. Being aware of these potentially conflicting goals may help physicians to resolve ethical difficulties more
effectively and encourage them to seek ethical consultation more frequently in assisting with the management
and prevention of conflict.17
All of these factors combine to make health care environments particularly prone to conflict. It is therefore
important for health care professionals and administrators to understand the origins of conflict and to develop
strategies to manage the conflicts that they will experience.2
In health care, the use of alternative approaches to conflict resolution has been slow to take hold.2 That situation
is beginning to change as people recognize that the conflict resolution methods used to date have largely failed.
By and large, these methods have been variations on an adversarial theme, with the result that many parties,
including patients, have been left out of the process. Most health care facility risk management efforts adopt the
classic “self-protective” stance encouraged by the insurance industry. While concern with the institution’s
“bottom line” is not unreasonable, in most cases this approach results in practices that alienate patients and their
families, creating major barriers to effective communication.
Many organizations are able to identify the direct costs of conflict, and consider them to be one of the costs of
doing business. However, the indirect costs of conflict that exist in health care are hidden and often not
recognized. The table below suggests just some of the indirect costs of conflict that are rarely quantified,
although they are always in play.
Table: Costs of conflict
Direct costs Indirect costs
Litigation (e.g., lawyer’s fees, expert Team morale effects (e.g., motivation for organizational change,
testimony depositions, lost work time, workplace relationships damaged, ongoing tensions that lead to
transcripts, document production) future conflicts)
Management productivity: time spent on
Lost opportunities for pursuing capital purchases, expanding
resolving conflicts keeps managers from other
services, enhancing purchases
work
Recruitment Customer satisfaction programs neglected
Training new staff Staff leaders ignored
Patient condition can deteriorate due to delays in traditional
Sick time dispute resolution approaches, creating increased costs for care
than if disputes were handled more expeditiously
Cost to reputation of organization and of health care
Disability/stress claims
professionals
Worker’s compensation claims Negative publicity, media attention
Regulatory fines for non-compliance Increased incidence of disruptive behaviour by other staff
Culture of poorly managed conflict causes fear; fear leads to
Loss of contracts
non-disclosure and repeat errors; no learning takes place
Increased insurance Emotional costs for those involved
Increased care for patients harmed  
Sabotage, theft, damage to facilities  

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How Facilities Can Develop Conflict Management Processes
Clearly, the ideas discussed above can be useful in improving health care environments and culture.6 However,
organizations may still experience difficulty in putting these ideas into practice. A multi-faceted approach is
often needed. The following steps can build conflict management strength within organizations.2,4
Conduct an organizational conflict assessment
Determine how your organization currently deals with conflict. Most organizations deal with conflict through
avoidance, power plays, resorting to higher authorities or, less commonly, collaboration. An organization needs
to determine which method or option is encouraged and rewarded. High-reliability organizations, that is, those
with low rates of medical error, are more likely to use collaboration as the preferred problem-solving method.
Organizations need to determine where they are now and where they want to be. They must also identify the
current resources available to assist with culture change and decide what extra resources will be required to
move toward a culture of conflict management and positive collaboration.
Design a conflict management system that incorporates prevention and early intervention as key
components
Staff and patients should have multiple entry points into the conflict resolution process; that is, there should be
various ways in which a problem can be handled, including direct contact between individuals, access to senior
management or human resources assistance and via identified internal conflict resolution mentors.

The process should be designed with loop-backs throughout. For example, if a patient has an issue with a
physician, he/she may wish to first discuss it with the nurse manager. The nurse manager would encourage the
patient to loop-back and discuss the matter directly with the physician. If this is unsuccessful, the patient could
then access an internal mediator who could bring the parties together to discuss the situation.18,19
Provide training in conflict prevention and management
To ensure that staff, management and physicians are adept at managing conflict, organizations must commit
resources to train everyone in basic conflict resolution and communication skills. This training must include
opportunities for role playing and group exercises that give individuals practice in dealing with difficult
situations. In addition, yearly “touch-ups” should be held so that everyone can renew their skills. Talented
internal individuals should be identified to receive additional training to act as internal conflict coaches and
mediators. Maintain a roster of these individuals and ensure that their availability is widely known by staff and
patients.
Provide ombudsperson services
External ombudsperson services that can be easily accessed should be provided for those situations that cannot
be resolved internally. Again this process should provide for a loop-back to the internal conflict coaches to
complete the process if the external ombudsperson is able to resolve some of the outstanding issues. From a
purely practical point of view, smaller facilities may find an external ombudsperson an economically preferable
solution to trying to provide this service in-house.
Provide external mediation services as necessary
A well-developed internal conflict management process should be able to handle most of the conflicts that arise.
However, there will still be situations that require the assistance of trained, experienced health care mediators.
The goal should always be that disputes will be handled internally, but people should also know that there is
expert assistance available if required.

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Understanding and Recognizing Individual Approaches to Conflict

We have looked at some of the myths that exist about conflict and identified realities of the nature of conflict.
We have also identified where conflict comes from and the unique characteristics of health care that serve to
generate conflict, and we have reviewed the direct and indirect costs of conflict to organizations. Now we turn
our attention to the various ways in which individuals react when faced with conflict.
Each of us responds to conflict in a number of ways, and we all use various responses in different ways at
different times and with different people. For example, we rarely respond to conflict at work in the same way
that we respond to conflict at home. Our approach to a dispute with a colleague is often far different to our
approach to a disagreement with a loved one. Once we understand the various approaches and responses that we
may have to conflict, we can determine the approach that may work best and try to moderate those approaches
that may not be effective.
Various experts have identified the ways that people respond to conflict. One tool that is widely used is the
Thomas–Killman Conflict Mode Instrument, which identifies five ways in which people respond to conflict:
competition, avoidance, compromise, accommodation and collaboration. In general, peoples response to
conflict are determined by whether they are more concerned with maintaining or improving relationships with
others or whether they are more concerned about themselves and their ability to win.
Each of the various styles is discussed below, with tips on when each should be used and the disadvantages of
each approach.

The competing style

These are the “my way or the highway” people.
This approach is highly aggressive and minimally cooperative.
When to use
When it is more important to win than to consider what others may want.
When quick action is needed.
For protection in a situation where cooperative behaviour can be exploited.
Disadvantages
Issues will resurface because people do not feel heard.
There may be silent acquiescence and a possibility of sabotage.
It can create an environment of fear and lack of transparency.
There may be reduced learning.
Feedback from colleagues is unlikely (surrounded by “yes” people).

The avoiding style

These are the “head in the sand” people.
This approach is low on assertiveness and cooperation.
It is unlikely to satisfy anyone’s concerns.
When to use
 When an issue is of low importance and delay is of no consequence.
To buy time.
control of the situation.
Disadvantages
Results in a low level of input.
It is decision-making by default.
Issues will fester and people will become frustrated at the lack of action.
Communication breakdowns can result.

The compromising style

These are the “let’s split the difference” people.
This approach is moderately assertive and moderately cooperative.
It moderately satisfies everyone’s concerns.
When to use
When an issue is of low importance and time-sensitive.
When both parties are equal and their relationship is not important.
When temporary solutions are needed.
Disadvantages
Creative, collaborative options remain undiscovered.
This approach can be seen as feeble or indecisive.
Real issues are unresolved, so solutions are short-lived and fragile.

The accommodating style

These are the “whatever you want” people.
This approach is low on assertiveness and high on cooperation.
It satisfies other’s concerns and while foregoing one’s own.
When to use
When you want to show you are reasonable and to create goodwill.
In situations of little or no long-term importance.
Disadvantages
One’s input risks being ignored.
People who uses this style frequently may have a restricted level of influence.
Giving in often may build resentment later.

The collaborating style

These are the “let’s work it out together” people.
This approach is highly assertive and highly cooperative.
It satisfies all parties equally.
When to use
As often as possible.
This is the preferred method of conflict resolution.
It leads to creative, durable outcomes.
It supports open discussion of issues and equal distribution of work.
It creates learning positive environments.
Disadvantages
It can take time to develop mutually agreeable outcomes.
This approach can be overused and lead to frustration for those who need a decision.
Why is collaboration the preferred method?
In most situations, the best outcomes are achieved when the parties involved in the problem work toward
resolution in a collaborative way. Using collaboration means that the parties who are in conflict focus on the
interests or needs that lie beneath the conflict, rather than focusing on the positions that individuals may be
proclaiming. The goal is to work toward a resolution that allows everyone to get what they need, not to try to
win or defeat the other person. This approach was popularized in the book Getting to Yes written by Harvard-
based professors Roger Fisher and William Ury.20
Interest-based or collaborative approaches include negotiation, mediation and, to a lesser extent, arbitration.
You may be familiar with the terms “alternative dispute resolution” or “appropriate dispute resolution,” also
known as ADR. When people speak of ADR they are usually referring to processes such as negotiation,
facilitation and mediation, as opposed to the legalistic and adversarial approaches that are found in litigation.
In addition to being more timely and cost-effective, using a collaborative, interest-based approach also allows
the parties to maintain their relationships and create long-lasting, mutually satisfying outcomes.

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Conflict and Patient Safety

Throughout this article we have discussed the importance of recognizing the inevitability of conflict and the
advantages of understanding the nature of conflict and its origins. We have discussed the role of
communication, provided some examples of the types of conflict that physicians are likely to experience and
offered some strategies to enable physicians to become more competent in managing personal and professional
conflicts.
If none of the information presented here has created an interest in understanding more about how to manage
conflict, perhaps discussing the unquestionable connection between unresolved conflict and the risks to patient
safety will provide the impetus needed.
Despite the fact that most health care professionals are dedicated to providing high-quality, effective patient
care, the predominating culture of most health care organizations is not one of safety but of fear. Health care
professionals fear litigation, professional discipline and coroner’s inquests. Patients fear becoming one of the
statistics of the unsafe system that they hear about in the media. Administrators fear bad publicity, lawsuits and
increased insurance premiums.21
What this really means is that health care professionals fear being blamed and punished for making a mistake
and, most of all, they fear being seen as incompetent. Fear creates anxiety and mistrust, which lead to
communication failures and a lack of collaboration and teamwork. The inevitable result is high levels of conflict
among and between health care professionals. However, while conflict is a daily, often hourly experience for
most health care professionals, it is rarely acknowledged and even more rarely dealt with. As a result, mistrust
persists, anxiety grows and conflict increases—creating and perpetuating an unsafe culture.
In this climate of fear, doctors and nurses are loath to report their errors or even their close calls.22 The result is
that patient care suffers not only because of error, but also because of what health care professionals do, or do
not do, as a result of fear. In a recent study, 76% of physicians reported believing that their ability to care for
patients had worsened as a result of medical malpractice fears. Nearly half of all nurses (43%) said they felt
prohibited or discouraged from doing what they thought was right for the patient because of rules or protocols
set up for legal liability protection. Only one-quarter or fewer of physicians, nurses and hospital administrators
said that their colleagues were “very comfortable” in discussing adverse events or uncertainty about proper
treatment with them.23 Other research has shown that organizational and individual barriers to communication
create underreporting and self-blame as a response to error rather than system improvement.24,25 Fear creates
shame, which leads to silence and missed opportunities for learning, change and improvement.
All of this unspoken fear and anxiety creates an environment of disarray and dysfunction. This dysfunctional
state leads to conflict within disciplines, between teams and between clients and care providers. We know that
poor-quality work environments lead to an increase in errors. On the other hand, we also know that positive
working relationships within health care teams have a significant effect on the safety and efficacy of the care
given to patients.26,27
While the experts in the field of patient safety have identified the need for culture change in order to improve
patient safety, little has been written about the fact that a significant contributor to unsafe cultures is the
presence of unacknowledged and unresolved conflict.28,29 Ignoring the real and inevitable conflicts that arise in
health care is not only costly in terms of personal and professional impacts on health care professionals, but it
also creates unsafe organizations and teams and situations that may lead to increased harm and death for the
patients we have pledged to help and protect.25,29–32

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Strategies to Increase Individual Conflict Management Competence

Get education and training in conflict and conflict management

We have ample and longstanding evidence that communication, collaboration and respect among health care
team members are vital components of providing safe, quality care to patients. Yet health care professionals
have little or no training in—or understanding of—the factors that can help to prevent and manage conflict.
Health care facilities do not routinely include conflict management as a required competency when hiring staff.
Training and education in conflict resolution can provide health care professionals with skills to help them deal
with workplace conflict and, in turn, allow them to provide a safer environment for patients. Conflict resolution
education and skills training should be part of all health care professional programs and the continuing
education programs of all health care facilities. Training should include an overview of basic conflict principles
and approaches, as well as practical skills training in negotiation, mediation and facilitation.
Improve your communication skills
Stephen Covey’s well-known maxim “Seek first to understand, then to be understood”33 may be intuitively
logical, but most of us ignore or forget its sensible and sensitive approach, especially when we are in highly
charged emotional situations.11 Practise the techniques for good communication outlined in the earlier section
“Engaging in good communication” and assess how differently your conversations proceed.
Recognize that men and women have different communications styles and responses to conflict
Over the past few decades, women have made great gains to ensure equality in their personal and professional
opportunities. In working hard toward these goals, many have tried to ensure and maintain equality by insisting
that men and women are the same.34 While there is no doubt that men and women should have equal
opportunities and access to jobs and services, there are some fundamental differences in the way men and
women communicate. In the area of conflict resolution particularly, research has indicated that while men adopt
the “fight or flight” response to stressful situations, women are more likely to “tend and befriend.”35 In general,
women seek each other’s company in times of stress to discuss and share their experiences. Women tend to turn
outward, whereas men tend to turn inward.36 It is important for physicians to be aware of and understand the
affect gender may have on communication styles and approaches to conflict.
Adopt an AVID approach to others
Health care professionals are not alone in being surrounded by stressful, conflict-laden situations on a daily
basis. Our 21st-century lives are packed with commitments and busy schedules; we are all dealing with various
demands and requests from employers, colleagues, clients, family and friends. As we have discussed throughout
this primer, conflict is inevitable as we attempt to interact and communicate with others. In order to deal with
the stress of everyday life, the following simple method of thinking about situations may help you to stay
focused and positive in your interactions with others.
A: Assume the positive about others and their behaviour. Assume that they are reasonable and are not trying to
cause you grief or pain. Assume that if someone is difficult to deal with, that they have something problematic
going on in their life. Assume it is about them and not about you.
V: If you cannot assume the positive then you must Validate the unknown. Talk to the individual and find out
what is going on with them. Remember to seek to understand others before you angrily tell them what you think
of their behaviour. Validate your negative assumptions about the other person by talking directly to them.
I: If you are unable to assume the positive and you are unable (or unwilling) to validate the unknown by talking
to the individual, you must Ignore the unchangeable and let it go. Sometimes, despite our best efforts, we
cannot think positively about a person, maybe due to past experiences. There are also times when we can’t talk
to a person directly, for example a patient who has been discharged or is deceased. In other situations, we might
not want to take the risk of talking to the person, especially if that person is a “difficult” colleague. In these
situations it is imperative that you consciously decide to let the matter go. We all pick the battles we will engage
in, and there are many times when avoidance is a perfectly acceptable option to choose. One important caveat,
however, is that you cannot continually choose to avoid and ignore situations that repeat themselves over and
over. At some point you must decide to take action.
D: If you cannot think positively, if you cannot or will not validate the uncertain and if you can no longer ignore
the unchangeable, you must Do something productive. If you do not act, the stress of an unresolved situations
will build up and inevitably be detrimental to your health and the health of those around you. We can all think
of examples of angry, bitter individuals who constantly carry the burden of past hurts and injuries with them,
whether these are real or perceived. These are not pleasant people to be around. Do not be one of them! There
are a number of things you can do in this situation. Not all of these involve resolving the conflict, but may
instead help you to cope with its results.
Do debrief the situation with a trusted friend and ask for their advice.
Do discuss the situation and your response with a therapist.
Do drink something healthy and calming (e.g., herbal tea or a glass of wine), remembering that
moderation is key. The overuse of alcohol will only exacerbate problem situations, not help them.
 Do introduce relaxing activities and techniques into your lifestyle. Try walking, riding a bike, hiking,
canoeing, yoga or other non-competitive activities.
Do consider meditation as a way to become more self-aware and positively focused.

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Methods for Conflict Resolution

Before looking at specific examples of conflict it is important to examine three basic questions:
Who is affected by the conflict (and, therefore, who should be sitting at the table when efforts are made
to resolve the conflict)?
What are the main issues underlying the conflict? (There are usually more than one.)
What are the origins of the various issues (e.g., rule-based, interest-based or values-based)?

Who should be sitting at the table?

This is an important question. If the involved players are not all participating in efforts to resolve the conflict
then it is unlikely that a satisfactory and durable solution will be reached. However, ascertaining who should be
sitting at the table usually requires some reflection on who might have an interest in the various issues
underlying the conflict. Frequently, only the obvious “suspects” are included in resolution efforts. This can lead
to frustration, wasted time and energy and, ultimately, loss of faith in the process.9
What are the main issues?
This is equally important question with an often equally unclear answer. It is useful to apply our “differential
diagnosis” techniques to conflict situations in the same way that we apply them to clinical questions. Once
again, the obvious “suspects” often tell only part of the story. Part of the preparation phase of efforts to resolve
conflict should include a careful survey of the various issues that may be at stake.
Once the issues have been identified it is important to establish an order of priority, since it is extremely
difficult to successfully negotiate more than one issue at a time. The priority of issues may be one of the first
items to be negotiated (after collaboratively establishing ground rules for the resolution efforts) by the parties.
What are the origins of the various issues?
Once the parties have established a list of the main issues and reached consensus on the priority listing of the
issues, it is helpful to pause and consider the broad basis of the issues. Are the issues primarily centred on
disagreement about rules? Do they involve more profound disagreement based on divergent values? Are the
issues primarily reflective of differing interests of the parties? The answers to these questions will often involve
some overlap. It is nonetheless useful to ask them.
Values-based conflicts or conflicts that raise ethical issues are often challenging to resolve and it may be wise to
seek help from a neutral third-party from the outset. Surely all health care providers believe that meeting the
needs, values and preferences of the person receiving care should be the primary consideration in the provision
of quality health care. However, disagreements frequently occur about the goals of care as well as the route to
take to achieve those outcomes. When there are limited resources as well as organizational priorities that must
be taken into consideration, it may be difficult to meet patients’ and families’ needs and values. It is precisely
because people’s values and preferences are different, and that as a result conflict and disagreements can arise
from many sources, that facilities must ensure that they enact flexible and multi-faceted policies for managing
conflict.
Rule-based conflict may appear to be simple to resolve by referring to the rules that govern particular situations.
Of course, that assumes that all parties feel the rules are relevant and equitable. A purely rule-based conflict
may be fairly easy to resolve if all the parties subscribe to the rules.
Finally, interest-based conflict is common and often underlies the other forms of conflict. Resolution requires
some understanding of the basics of conflict as well as some experience in the techniques and skills of
managing and resolving disputes.28

Examples of Health Care Situations that Can Escalate into Conflict

Values-based conflict
Example: Challenges in the ICU
ICU beds in a tertiary-care referral centre are urgently needed. One of the patients presently
occupying an ICU bed is a 62-year-old man in acute respiratory failure following surgical drainage
of an abscess that had caused a bowel obstruction—possibly related to the metastatic spread of an
aggressive colon cancer with multiple liver metastases. It is possible that aggressive treatment of the
respiratory failure, including intubation, will help the patient to survive for several months.
In preparation for discussing treatment options with the 62-year-old man’s family, the ICU physician
urges some “tailoring” of the discussion with emphasis on the probable future discomfort that will be
experienced by the patient as his metastatic colon cancer progresses. The surgeon is content to leave
the ICU physician to discuss this matter with the family. The nursing staff in the ICU are concerned
that this is not entirely correct and want the ethics service involved.
This is an example of a multi-faceted, multi-layered ethical conflict. Everyone involved has a point
of view or position that they will argue should take priority. The situation also illustrates the power
imbalance between patients and their families and care providers: the ICU physician can adjust the
information that is provided in order to increase the likelihood that the patient and his family will
make the choice that the physician favours.
In order to resolve this matter in an ethical and fair manner, collaboration between all the parties is
advisable. All interested parties, including the patient, family members, nurses, the surgeon, ICU
physicians, an ethicist, and a senior administrator, should be at the table. This kind of collaborative
discussion will be very emotional and difficult for all parties. It would be helpful to have someone
from the ethics service involved as well as a neutral facilitator. Of course, in the real world, there is
often not the time or inclination to have this kind of collaborative discussion. This can create
unexpressed conflict from other care providers, as well as later difficulties if the family comes to
realize there were other options available that had not been offered.

Physician–physician conflict
Physician–physician conflicts are commonly reduced to clashes between strong personalities or may even be
presented as the playing out of a “dysfunctional personality disorder” on the part of one of the players. While
these may be contributing factors, they rarely tell the whole story.
Example: Are we really arguing about 24 square feet of office space?
Three sub-specialty physicians in a large community hospital are unable to resolve a dispute that has
been brewing for more than two years. Ostensibly, the conflict originates in the fact that two of the
physicians have offices of 400 square feet in size, while the third has an office of 376 square feet.
The hospital is concerned about the impact the conflict is having on patient care.
The three physicians are a 59-year-old who has practiced in the community for 26 years, a 50-year-
 old who has partnered with the original physician for the past 15 years and a 34-year-old who has
joined the group in the past two years. The younger physician is perceived as being “unwilling to fit
in.”
After extensive one-on-one discussions between the mediator and the physicians, it is clear that the
issues include remuneration, call schedules, vacation schedules, access to patients, willingness to
incorporate newer treatment modalities into the practice, relative status within the hospital hierarchy
and the nature of the contract describing relations within the group. These are more challenging
issues to resolve than disputes about 24 square feet of office space. The physicians are also less
comfortable putting these issues on the table.
This example illustrates an interesting web of power and knowledge imbalances. Clinically the three
seem to be on a par, all respected sub-specialists. Professionally, the older physician may appear to
have more credibility and power related to his many years of service in the community. From a
knowledge perspective, the younger physician may bring more current knowledge and practical
experience with newer techniques. Ultimately the issues that are feeding this conflict will probably
be resolvable by uncovering all of the interests of the parties, and especially finding those areas
where the interests converge and common ground can be found. It is quite possible that at the end of
the resolution process the three will not become friends. However, that is not the goal of conflict
resolution efforts.

Physician–resident/trainee conflict
On the surface physician–resident/trainee conflicts may appear to be conflicts with a significant imbalance of
power, weighted in favour of the staff physician. A careful examination will usually reveal that the residents
and trainees in fact have more influence than they might imagine. The circumstances of the conflict may vary,
and will often engender significant frustration because they are played out within a framework that has many
“unwritten rules” and loaded assumptions. The role of conflict resolution efforts is to bring these elements to the
surface so the parties can begin to deal with them openly. This is also a situation where it is easy to “forget”
about some parties—such as the postgraduate training institution—whose absence from negotiation efforts may
be much like the metaphorical “dead moose on the table.”
Example: Call schedule during an elective
On the request of her residency director, a PGY3 resident is helping with a sub-specialty clinic for
two weeks in an area unrelated to her specialty interest. On arrival in the unit she is told she will be
on-call one night in three, plus two weekend nights. This is clearly in contravention of the negotiated
agreement covering all trainees in that province. The resident points this out and is told very curtly
that “In my day we did one in two and got along just fine.” Aside from being “old school,” the staff
physician is also on the residency training evaluation committee.
In this example, there is a basis for considering this a rule-based conflict—there is a contract that
clearly stipulates what is appropriate. However, underlying the reaction of the staff physician is a
strong sense of professional devotion and pride—the basis for a values-driven conflict. Ultimately,
gathering more information and involving a third party may lead to an understanding of the interests
that are really driving this situation. This is also an example in which the various Thomas–Killman
Conflict Mode Instrument options can be tested, both in theory and in practice.

Conflicts with other health care providers

Physicians frequently underestimate or are unaware of the extent to which there is perceived conflict in their
relations with other health care providers, particularly those who are part of the same clinical unit or team.
While there is growing awareness of the importance of the complex care being provided by several members of
a team, acting in a coordinated and planned manner, there is still relatively little active training available to
physicians about the optimal way in which to participate as a member of a treatment team. This inevitably leads
to conflict, and patient outcomes have been shown to be linked to the degree of conflict that exists within a unit
and between members of different units as patients move through transition and transfer points in large
facilities.37
Example: Drug-seeking behaviour—or not?
A fundamental difference in the assessment of a patient’s request for narcotics during a visit to an
emergency department for flank pain leads to a formal complaint by an emergency department nurse
about a physician’s prescribing habits. This is countered by a formal complaint about the nurse’s
insubordination and refusal to follow physician orders. By all accounts the perceptions are not new
and the differences have been apparent for more than a year. It is not clear why this particular patient
encounter has become the straw that threatens to break the camel’s back.
Using formal dispute resolution mechanisms (appealing to higher authorities who will make a
decision about who is right and who is wrong) is unlikely to result in any significant change in the
beliefs or behaviour of either party. This is the kind of situation in which colleagues are inclined to
become exasperated and advise the parties to “Get over yourself, already.” However, this kind of
persistent irritant has an impact on unit functioning, absenteeism, sick time and patient outcomes. If
the conflict is not dealt with and is allowed to fester then the impact will be felt by more than a
single patient or a single pair of caregivers. What seems like a simple situation may end up involving
a much wider group and result in reconsideration of treatment protocols, performance evaluation
processes and even the way in which facility bylaws encourage early resolution of differences that
on the surface seem to be matters purely of clinical judgment.
The range of conflict that may develop between physicians and other caregivers reflects in a
significant way the “uneven table” (in terms of knowledge, power and control) that is such an
inherent characteristic of health care as a complex adaptive system. It is a major challenge for
physicians to understand how they are perceived by others who work side by side with them;
understanding the inequality that is built into hierarchical organizations is a necessary first step to
entering into meaningful dialogue with a goal of resolving conflict in the health care workplace.
Effective communication between physicians and other health care workers is built on a foundation
of recognizing the different perceptions of other members of the team. In the same way that
physicians tend to underestimate the extent of conflict within a clinical team, they also tend to
overestimate the extent of effective communication. This complicates the other imbalances that
exist, and makes conflict resolution of issues involving team members more challenging.

Conflict involving patients and families

The ultimate challenge for physicians is the dissatisfied, even combative patient or family member. Strangely
enough, the initial source of the conflict is often a disarmingly simple issue—a request for information, an
expectation of compassion in the face of difficult life choices, a desire for respect and dignity during treatment.
These are not difficult issues to comprehend on a human level and, to their credit, most physicians do an
excellent job in dealing with these issues, even when they themselves are coping with severe resource
constraints and stresses related to competing priorities within the health care system resulting in inadequate
support for patient needs.
When a lack of training and support (e.g., how to conduct difficult conversations with patients) is combined
with pressured working conditions and insufficient resources, it is not difficult to understand why simple
requests from patients can be misunderstood. Once established, the misunderstanding leads to a lack of trust on
one side and defensiveness on the other, and minor irritants are magnified into major challenges that quickly
require some expertise to sort out. When these circumstances are then combined with significant patient harm,
the tension and stress can be extremely overwhelming for both patient and physician. Simple conflicts that are
not resolved lead to resentment at a minimum followed by dissatisfaction and complaints, which may then be
followed by more formal escalation of the patient’s unhappiness.
Example: A sore throat that won’t go away
A couple in their twenties visits an active polyclinic. The woman is seen for a vaginal discharge and
the man is seen by a physician for a sore throat. A throat swab is taken and the man is advised to
wait for the results. He returns within 18 hours because of persistent pain and sees another physician,
who prescribes an antibiotic after noting purulent exudates on examination of the throat. The patient
returns two days later because of no improvement and is told by a third physician that the antibiotic
was unnecessary as the throat swab indicated no bacterial infection. The patient asks who will pay
for the rather expensive and unnecessary prescription. A flippant answer is unsatisfactory to the
patient.
The woman is called on the fifth day and told that her cultures indicate a Chlamydia infection and
that she and her partner require treatment. Prompted by this information, the (male) patient meets
with a fourth doctor and an angry exchange occurs between the physician and patient. A formal
complaint is made to the licensing body and proceeds for several months through a multi-stage
review. Eventually, the polyclinic contacts the patient and suggests a mediated discussion. This is
successful, and the complaint is set aside after the patients write a letter expressing satisfaction with
the process and the discussion that occurred.
It is not surprising that physicians often inadvertently contribute to misunderstandings when patients
are seen as questioning their clinical judgment or expertise. That is probably not the intention of the
patient, but it may be perceived that way by physicians who lack formal training in conducting
difficult, stressful or emotionally charged conversations. Physicians #1 and #2 might well have
unwittingly contributed to the situation by providing unduly brief or succinct information for a
common clinical circumstance which seemed quite straightforward. Physician #3 was now in an
uncomfortable position of responding to the patient’s complaint about the cost of the “unnecessary”
antibiotic. Disclosure discussions after harm to a patient, end-of-life decision-making for a patient’s
family and a range of circumstances that understandably are accompanied by emotional overlay for
patients constitute major challenges for physicians.37
Even though physicians experience a similar gamut of reactions when they themselves are patients,
it seems very difficult for those memories to be recaptured by physicians when dealing with stressed
patients who are making demands on their time, personal self-esteem and professional self-image
with a series of “pesky” questions. This is the essence of an “uneven table” in terms of the
knowledge differential, and the fact that most of the initiating events centre on relatively
straightforward requests for information makes the subsequent conflict that develops even more
paradoxical.9
One of the factors that appears to be behind physician hesitation about fuller disclosure or more
transparent and honest discussions with patients is the fear of litigation. As has been pointed out by
Lucian Leape, there is no evidence that disclosure, or even an apology when appropriate, leads to
increased risk of litigation.21,38 In Canada, the more serious challenge for those who would urge
caution when it comes to a more robust process of conflict resolution in health care (which
necessarily involves honest exchanges between patients and physicians) is the steady drop in the
total number of law suits naming physicians to levels previously seen in the early to mid-1980s.29

Common themes
The theme that links the various scenarios outlined above is skilful communication, or lack thereof.8 When
dealing with patients, the misunderstandings that arise from less than ideal communication lead to a breakdown
in trust and eventually to conflict, which, if neglected, will fester like an occult pathogen, both for the physician
and the patient. The trust relationship (which in legal terms is known as the fiduciary relationship) is at the heart
of the healing exchange that occurs in providing treatment to patients. When poor communication undermines
trust it also undermines the possibilities for optimal treatment and outcomes. All of this leads to conflict, which
in the main is avoidable.
When less than optimal communication involves a physician’s colleagues or other health care providers, the
result is similar misunderstandings, fuelled by an imbalance in power and control, leading to breakdowns in the
bonds that make for good teamwork. The patient suffers directly and the care providers suffer indirectly. Harm
is not restricted to the direct participants (the patient and care providers). What is less well appreciated is the
tragic harm inflicted on the patient–provider relationship—harm that has consequences far into the future.32
In virtually all of these cases, conflict is avoidable and in all cases it is manageable, if physicians are provided
with the knowledge and skills needed to respond to conflicts that arise in health care.

Top

Conclusion
Conflict resolution skills are perfectly suited to the health care field and are easily understood and adopted by
health care professionals once they have been explained, demonstrated and practised.
Administrators and academics often doubt that seemingly simple measures such as effective communication,
positive collaboration and the involvement of the affected parties can have any measurable effect on health care
culture, patient outcomes and job satisfaction. Many health care organizations resist the need to design and
implement conflict management processes, and argue that there are already well-defined processes within union
agreements, individual contracts or human resources policies.
However, conflict management processes are not used in place of already existing contracts and policies, but as
complementary additions. In many instances, conflict resolution processes allow for the early resolution of
issues so that other, more adversarial options are not required.
The conflict resolution skills, processes and approaches that are discussed here may appear simple and obvious
to many, and yet they are skills that require ongoing education, training and practise. Most people do not
communicate effectively, especially when under stress.
Collaboration is often ignored in favour of individual decisiveness, even though such decisions may not create
the optimum results. Furthermore, getting all of the parties to the table is avoided for fear of emotional reactions
and time-consuming discussions.
Most organizations do not have well-developed conflict management systems in place, even though addressing
the issue of conflict management is inherent in improving the culture of health care organizations. Moving away
from hierarchical, secretive, blame-focused structures to create cultures of learning and openness requires all of
the skills that we have discussed. High-reliability organizations have generally incorporated effective conflict
management processes and principles into their fabric and culture. Health care cultures must adopt strategies to
manage conflict positively and place a priority on continuing education and training in conflict resolution.
Conflict assessment, management and prevention are essential elements for successful culture change within
health care.
 Verbal self-defense, also known as verbal judo[1] or Verbal Aikido, is defined as using one's words to
prevent, de-escalate, or end an attempted assault.[2]
It is a way of using words as a way to maintain mental and emotional safety. This kind of "conflict
management" involves using posture and body language, tone of voice, and choice of words as a means for
calming a potentially volatile situation before it can manifest into physical violence. This often involves
techniques such as taking a time-out, deflecting the conversation to less argumentative topics, and/or redirecting
the conversation to other individuals in the group who are less passionately involved.

Contents
  [hide] 

 1 Overview
 2 Key components
 3 Controversy
o 3.1 Persuasion vs. self-defense
o 3.2 Consequences
 4 Common approaches
o 4.1 Avoidance
o 4.2 Withdrawing
o 4.3 Deflecting
o 4.4 Compromise
o 4.5 Verbal Aikido
 5 Applications
o 5.1 Workplace bullying
o 5.2 School bullying
o 5.3 Cyber-bullying
 6 Influential contributors
 7 See also
 8 References
 9 Further reading

Overview[edit]
Verbal-self-defense experts have widely varying definitions of what it is and how it is applied. These include
everything from a person simply saying no to someone else or repeatedly refusing a request to telling someone
who has violated a personal boundary what they want. It could even entail a more complicated scenario in
which a person is called on to refuse to engage verbally with someone manipulative, to set limits, and to end the
conversation.[3]
In any definition it is always agreed that verbal self-defense is necessary as a means of enforcing personal
boundaries and limits. Part of learning these skills includes learning how to identify communication triggers
which cause a person to experience negative feelings and, in some cases, what those triggers represent with
regards to what personal values the other person are violating.
The abusive types of communication that verbal self-defense is designed to acknowledge and deal with also
vary greatly. This includes indirect forms of abuse such as backhanded comments, and backstabbing or two-
faced behaviors. As well, verbal self-defense is meant to address more commonly recognized forms of abuse
such as yelling, belittling, and name calling. Going beyond verbal attacks, abusive behaviors also recognized in
the field of verbal self-defense are aggressive posturing (taking a threatening posture or making a threatening
gesture), physically interfering with personal belongings, and inappropriately intruding on one's personal space.

Key components[edit]
Most experts who write and publish articles and books on the subject of verbal self-defense identify several key
elements to strong verbal-self-defense skills.

 Being able to identify people, situations, and/or behaviors that induce hurtful feelings  – such as fear,
inadequacy, and shame – is important in order to know when a person needs to apply verbal tactics of
defense.
 Controlling how a person responds to conflict, both mentally and emotionally, is key to applying verbal-
defense skills efficiently and appropriately.
 Having a general knowledge of what to say in advance offers a significant advantage for anyone using
verbal self-defense. Some authors have even gone so far as to provide actual statements for people to use as
a way to deal with verbally aggressive communicators.[4]

Controversy[edit]
Authors and professional instructors offering seminars and workshops have differing views with regard to
whether or not verbal self-defense is a form of "persuasion" and if "consequences" for the attacker should be
considered a key component.
Persuasion vs. self-defense[edit]
In the field of verbal self-defense the one element not entirely agreed upon is the concept that verbal-defense
tactics include the art of persuasion. Several authors clearly proclaim that verbal self-defense is designed as a
means for persuading others; however, more recent books on the subject have denounced this commonly
accepted fact.
The newer definition of verbal self-defense divides persuasion into a category of its own and states that verbal-
defense tactics should be more in line with the concept of physical self-defense. This idea, taken from
ideologies of martial arts, puts forth the belief that verbal self-defense should only be used with respect to
maintaining one's mental and emotional well-being. The position regarding self-protection in a verbal conflict
and the further intention to protect the verbal assailant is posited in Verbal Aikido, which aims at proposing a
balanced or collaborative result wherein the attacker may save face.[5]
Just like a martial artist would not use their skills against someone who was not threatening them, verbal-self-
defense artists should not confuse their skills with being a means for influencing others. The concern is that
verbal self defense and "verbal manipulation" are not one and the same. Proponents of verbal self-defense as a
way to influence and guide others, however, believe that skills of persuasion can be used as a way to ensure
one's mental and emotional safety.
Consequences[edit]
The requirement for having a means to enforce "consequences" on people as a pre-requisite for effective verbal
self-defense still remains questionable. Almost every author on the subject includes ways of handling non-
physical aggression without having any repercussions for the attacker in the event the conflict is not solved
amicably.
With specific regard to verbal self-defense in schools the concept of having consequences for bullying is
considered by some to be key, where others are less focused on punishment and choose, instead, to put more
emphasis on dealing with the aggressor in more positive ways.[6] Although this topic has only recently begun
being addressed by experts in this field it remains to be seen to what degree the importance of consequences
will have in handling interpersonal conflicts using verbal self-defense.[7]

Common approaches[edit]
Leading authors in the area of verbal self-defense and defensive-styles communications offer several different
techniques for defusing potentially volatile and/or abusive situations of conflict.
Avoidance[edit]
Being aware of situations that will likely lead to verbal conflict or abuse and making an effort to avoid them.
Withdrawing[edit]
Once engaged in an argument, situation of conflict, or when being verbally attacked, making an excuse and
exiting the area.
Deflecting[edit]
Changing topic or focus on the interaction as a means of avoiding any disagreement or negative reaction on the
part of the aggressor.
Compromise[edit]
Openly offering ideas and seeking ways to placate the attacker and/or their reasons for the abusive
communication.
Verbal Aikido[edit]
A means of communication that is based on the aikido philosophy and martial way, created and propagated
by Morihei Ueshiba during the 20th century. It is a style of conflict managementand resolution that involves
treating the 'attacker' as a partner rather than an adversary. The techniques practised by Aikidoists aim at
restoring a balanced interpersonal dynamic and/or reaching a positive emotional result in an exchange.[8]
In a common teaching of this communication style, developed by Luke Archer,[9] the approach is simplified into
three steps:[10]

1. Receiving the attack with an 'Inner Smile'[11] (a serene inner-confidence)

2. Accompanying the attacker with verbal Irimi until destabilization[12]
3. Proposing Ai-ki (an energy balance)[13]

Through the methods and exercises taught in Verbal Aikido training, the practitioner works on developing a
sense of self-control, an assertive style of communication, and the practice of deliberate intention. [14]

Applications[edit]
Websites and news stories stating the rise in bullying in the workplace[15] and on the playground[16] has led to a
recent increase in awareness of the art of verbal self-defense. Considered a form of communication, verbal self-
defense has become a sought after skill in schools and workplaces around the world as a way to counter this
unhealthy trend.
Incidents of school and workplace shootings have put strong emphasis on being more aware of bullying, and
consequently the need for a means to respond to such events have led to a growth in the field of verbal self-
defense. Today, more and more individuals are presenting themselves as verbal-self-defense experts and
offering individual and corporate training, both on and off line, as a way to battle bullying at school, in the
workplace and on the Internet.
Workplace bullying[edit]
Main article: Workplace bullying
With the increased awareness of bullying in the workplace, it has become necessary for companies and
organizations to ensure they meet the requirements of due diligence with regard to maintaining a safe work
environment. U.S. and international laws have even gone so far as to recognize workplace bullying as its own
form of harassment. Today, it is becoming common for businesses in almost every industry around the world to
start providing their staff and employees with training designed to address and minimize the effects from
incidents of workplace bullying.
School bullying[edit]
Main article: School bullying
Since the school-shooting incident in Columbine there has been greater emphasis on stopping acts of school-
yard bullying. Many educational institutions around the world have implemented anti-bullying campaigns with
great success. In each of these campaigns it is common to find at least one of the anti-bullying tactics
specifically addressing the need for victims of bullying to say something as a way to verbally defend
themselves.
Cyber-bullying[edit]
Main article: Cyber-bullying
In written form, verbal self-defense is meant to address concepts such as cyber-bullying. This includes
addressing hostile and hurtful messages posted on social networks such as Facebookand MySpace, as well as in
online forums and chat rooms. With ongoing investigations into teen bullycides (a suicide caused as the result
of depression from bullying, especially children) finding more than ever before the link directly to cyber-
bullying by classmates, the need of verbal-self-defense skills for teens has led to a number of new books
specifically addressing this subject.

Influential contributors[edit]
Several people are considered to be significant contributors to the field of verbal self-defense. These include
people who were early pioneers to advocates for the importance of verbal defense skills, developers of new
techniques for verbally defensive tactics, and nationally recognized and known trainers.

 Suzette Haden Elgin, the author of The Gentle Art of Verbal Self-Defense, was one of the earliest writers
to use the term. She states that verbal self-defense defends against the eight most common types of verbal
violence, and redirect and defuse potential verbal confrontations.[17]
 George Thompson (1941–2011), author of Verbal Judo, advanced the field of verbal self-defense by
breaking down how to apply the techniques for de-escalation and defusing used by professionally trained
 police officers. He was one of the leading experts in verbal self-defense tactics and trained law-enforcement
agencies around the world.[18]
 Daniel Scott, author of Verbal Self Defense for The Workplace, more recently combined self-defense
concepts with the language patterns of neuro linguistic programming in order to develop a new form of
verbal self-defense. His new six-step model for verbal self-defense includes all the main components
necessary for people to defend themselves against bullies and aggressive people in the work place and
elsewhere.[19]