Violent Behavior Requires Early Emotional Control
Violent behavior among people experiencing mental health problems can appear through shouting, harsh speech, threatening behavior, clenched fists, destruction of objects, or physical aggression. These responses can place patients, family members, and surrounding communities at risk.
The issue remains important in Indonesia. The article cites the 2023 Indonesian Health Survey, which reported mental health problems among 2.0 percent of Indonesians aged 15 and above, while South Sumatra recorded a prevalence of 0.9 percent. In Lahat Regency, 1,318 people with mental disorders were recorded across 33 community health centers, with most receiving treatment at health centers and others receiving home visits.
The situation is also visible at Usila Primary Health Center. In 2024, the facility recorded 22 patients with mental disorders. Four were identified as being at risk of violent behavior, while others experienced hallucinations, social isolation, low self-esteem, or self-care difficulties. These conditions underline the importance of early strategies to help patients recognize and manage rising emotional tension.
Two Patients Practiced Deep Breathing for Three Days
Farama used a descriptive case-study approach to document the nursing process and patient responses to deep breathing relaxation. The participants were two male outpatients, aged 27 and 29, who had a nursing diagnosis of risk of violent behavior.
Information was collected through interviews, direct observation, nursing assessments, medical records, and the Buss–Perry Aggression Questionnaire (BPAQ). The questionnaire was administered before and after the intervention to identify changes in aggression levels.
The intervention began with a therapeutic relationship between the nurse and each patient. The nurse identified situations that could trigger anger, explained the purpose of deep breathing relaxation, demonstrated the technique, and guided the patients through practice.
During the first session, the patients learned to recognize anger triggers and became familiar with the technique. On the second day, they practiced deep breathing under guidance. By the third session, both patients could perform the technique independently and reported feeling calmer.
Aggression Scores Fell After the Intervention
The most measurable change appeared in the BPAQ scores.
- Patient J: aggression score decreased from 65 to 46, a reduction of 19 points.
- Patient M: aggression score decreased from 61 to 51, a reduction of 10 points.
Both patients remained in the moderate aggression category, but their scores declined after three sessions of deep breathing relaxation.
The numerical changes were accompanied by observable behavioral improvements. Both patients reported reduced anger and irritation and said they felt calmer. They were also able to explain the purpose of the relaxation technique and demonstrate it without assistance.
Patients Showed Different Forms of Aggressive Response
Before the intervention, both patients displayed several similar signs, including tension, restlessness, sharp eye contact, loud speech, clenched hands, and difficulty controlling anger.
However, their aggressive responses differed. Patient J tended to express anger by shouting and damaging objects around him. Patient M had a history of hitting family members and damaging household furniture. Farama noted that differences in emotional triggers, coping mechanisms, previous experiences, and family support may help explain why patients with the same nursing problem can respond differently.
According to Farama, repeated deep breathing practice can give patients an alternative response when emotional tension begins to rise. Rather than immediately responding through aggression, patients can use controlled breathing as a relaxation strategy while managing their emotional state.
A Simple Complementary Strategy for Community Mental Health Care
Deep breathing relaxation has practical advantages because it does not require specialized equipment. Once patients understand the procedure, they can practice it independently. This makes the technique potentially useful as part of community-based psychiatric nursing care.
Farama's findings, however, should not be interpreted as proof that deep breathing alone caused the reduction in aggression. The study involved only two patients and did not include a comparison group.
Both participants were also receiving pharmacological treatment with haloperidol, trihexyphenidyl, and chlorpromazine. Therapeutic communication, family support, previous treatment, and natural changes in emotional condition could also have influenced the results.
This distinction is important. Deep breathing relaxation is presented as a complementary nursing intervention, rather than a replacement for psychiatric treatment, medication, professional supervision, or other appropriate interventions for violent behavior.
Implications for Nurses and Families
The case study suggests that nurses can incorporate deep breathing relaxation into broader emotional-management strategies for patients at risk of violent behavior. Farama recommends combining the technique with therapeutic communication, identification of anger triggers, medication adherence, family involvement, and other psychiatric nursing interventions.
For families, helping patients practice the technique regularly may provide an additional coping strategy when early signs of anger or emotional tension appear. However, safety remains the priority, particularly when a patient shows signs of imminent aggression or poses a danger to themselves or others.
Farama's work therefore provides an initial practical example of how a simple breathing technique can be integrated into mental health nursing at the community level.
“Deep breathing relaxation” can be understood from Farama's findings as a feasible complementary strategy that supports emotional regulation, particularly when patients learn to perform it independently. The author from the Health Polytechnic of Palembang emphasizes that the approach should be integrated with broader psychiatric nursing care rather than used in isolation.
Further Research Is Needed
The researchers identify several limitations. The study involved only two participants, lasted for three intervention sessions, and had no control or comparison group. Consequently, the findings cannot be generalized to patients with different characteristics or clinical conditions.
Future studies should involve larger groups of participants and longer follow-up periods. Farama also recommends quasi-experimental or randomized controlled research to evaluate the effectiveness of deep breathing relaxation more rigorously.
Researchers could additionally examine whether emotional improvements are sustained over time and measure outcomes such as the frequency of aggressive episodes, anger intensity, physiological responses, medication adherence, and family support.
The findings from Lahat offer a promising starting point: a simple breathing exercise was associated with calmer emotional responses and lower aggression scores in two patients at risk of violent behavior. Stronger research will be needed to determine how effective the intervention is across larger and more diverse patient populations.
Author Profile
Dodi Aflika Farama
Affiliation: Nursing Program, Health Polytechnic of Palembang, South Sumatra
Field of expertise: Nursing, particularly psychiatric nursing interventions and emotional control among patients at risk of violent behavior.
The source article does not state Farama's academic degree, so no degree is added here to maintain factual accuracy.
Research Source
Article: “Implementation of Deep Breathing Relaxation for Emotional Control in Patients at Risk of Violent Behavior: A Case Study”
Author: Dodi Aflika Farama
Journal: International Journal of Sustainable Applied Sciences (IJSAS)
Publication: 2026, Volume 4, No. 8, pp. 955–966
DOI: 10.59890/ijsas.v4i8.58
Official Journal URL: http://ijsasjournal.my.id/index.php/ijsas
0 Komentar