Have you ever encountered a situation where a person living with Alzheimers or another form of dementia was in acute distress and terrified of one or more people?

Original article by Teepa Snow, MS, ORT/L, FAOTA, with minor updates by Valerie Feurich, PAC Team Member

By Valerie Feurich

Did you want to help calm the situation, but weren’t sure how?

Here are the 10 steps Teepa used to de-escalate a crisis:

1. Remove the threat

If you encounter a situation where a highly distressed person is surrounded by one or more people, similar to the situation Teepa describes in the video, ask the other people to step back. That way you’re removing the perceived threat to the person.

If you are the one being perceived as a threat, you’ll want to back off. Trying to push through your agenda when the person living with dementia is in a highly agitated state could result in harm to you, them, or the relationship that you both share.

2. Create space

If there are people standing around watching, tell them to back off and go away. This will create visual space for the person in distress and make the situation appear less threatening.

3. Take her/his side


When in a scary or stressful situation, most of us would likely appreciate having a friend nearby; someone that is by your side to help and support you. The same applies to a person living with dementia in acute distress.

4. Crouch down to get at or below the person’s eye level

By positioning yourself on the person’s side, at or below eye level, you give the person much more visual space. This in turn is perceived as non-threatening, as it gives the seated person a perceived way out.

Try to remember that standing and directly hovering over someone can be perceived as threatening. This can trigger a fight or flight response, which, considering that you’re physically blocking the flight option, may lead the person to lash out physically.

Instead, position yourself beside them so they can feel supported and not threatened.

5. Use Hand-under-Hand®

What is HuH, you may wonder?

Hand-under-Hand® (HuH) is an evidence-based, research-proven, care technique that was developed by Teepa Snow. It utilizes the remaining muscle memory of a person living with dementia to offer comfort, initiate activity, and assist them with activities of daily living, such as eating, drinking, or personal care.

In the situation we’re describing here, connecting with the distressed person using HuH will help calm them down. By offering your hand and gently positioning your hands into HuH, you’re automatically applying gentle pressure to the person’s palm, which has a calming effect on a person’s sensory system.

6. Take a deep, audible breath to start breathing in sync


As humans, when we observe another person take deep, audible breaths, we tend to match them. So, by taking several deep breaths yourself, the person you’re connected with may do the same. This in turn has been shown to slow a person’s heartbeat, lower stress, and lower or stabilize blood pressure.

Tip: If the person isn’t looking at you, apply a very gentle pump to their hand that you’re holding. This will likely get them to turn and look at you.

7. Calm your voice

By turning down the volume and tone that you’re using, you can help the other person slowly calm down as well.

8. Relax your body

Humans often unconsciously mirror one another’s behavior, so by visibly transitioning into a calmer posture, you can help calm and relax your love one as well.

9. Communicate openly and tend to the person’s needs

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If you find yourself in this position, letting the person know what you are about to do, and why, may help decrease resistance and tension. Try to see if the person may have any unmet physical needs, such as being cold or being thirsty, and see if you can offer comfort by meeting that need (offering a blanket, a glass of water, etc.).

10. Be willing to go where she/he is at that moment

Try to signal to the person in acute distress that this is as upsetting to you as it is to them. In addition, try and help them understand that you are on their side to help calm them and the situation overall.


De-escalating a crisis situation is not easy. It can be challenging to know how to help. Teepa is an expert in reading and solving situations similar to this. But even without being an expert, there may be things you can do to help.

By removing the perceived threat and signaling to the person that you are just as upset as they are, you may help the person no longer feel alone. In addition, by helping them calm down and building their trust, you may be able to help de-escalate the situation. Further, by following some of these steps, you may be able to build or protect the relationships that are so critical and precious in dementia care.

If you’d like to read more content like this, please visit www.teepasnow.com/blog.

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