Anger and Violent Behavior Remain a Nursing Challenge
Violent behavior can pose serious risks to patients, families, and surrounding communities. In psychiatric nursing, aggressive responses may appear through shouting, threatening behavior, restlessness, tense facial expressions, clenched hands, hitting others, or damaging objects.
The issue is particularly relevant in community mental health services, where patients often continue their treatment outside hospitals. The article notes that social rejection, interpersonal difficulties, psychosocial stress, and ineffective coping mechanisms can contribute to difficulties in regulating anger.
Data from Bandar Jaya Public Health Center recorded 90 patients with mental disorders between January and November 2023. Among them, 35 experienced violent behavior, making it the most frequently reported behavioral problem among the mental health cases documented at the facility during that period.
The situation highlights the importance of practical interventions that patients can learn and use in their everyday environment.
Deep breathing relaxation is one such approach. The technique involves slowly inhaling through the nose, allowing the abdomen to expand, briefly holding the breath according to the individual's ability, and gradually exhaling through the mouth.
Unlike interventions requiring specialized equipment, deep breathing relaxation is inexpensive, non-invasive, and can potentially be practiced independently after proper instruction.
Three Patients Practiced Deep Breathing for Three Days
Farama used a descriptive case-study design involving three male outpatients aged 25–65 years who had violent behavior as a psychiatric nursing problem.
The participants received nursing care through assessment, diagnosis, intervention planning, implementation, and evaluation. Nurses first established therapeutic communication and identified situations that triggered anger. Patients were then taught and guided through deep breathing relaxation.
The intervention was conducted over three consecutive days.
On the first day, all three participants needed guidance to perform the breathing technique correctly. On the second day, they required less assistance. By the third day, all three were able to perform the technique independently.
The patients also reported feeling calmer and experiencing less anger after practicing the technique.
Aggression Scores Declined After the Intervention
The study used the Buss–Perry Aggression Questionnaire (BPAQ) as supporting information to compare aggression levels before and after the three-day intervention.
The results showed a consistent decrease in scores:
- Mr. P: BPAQ score decreased from 78 to 71.
- Mr. U: BPAQ score decreased from 82 to 74.
- Mr. C: BPAQ score decreased from 85 to 77, with his classification changing from high to moderate according to the interpretation used in the case study.
The researchers also documented improvements in the participants' behavior. They became better able to recognize situations that triggered anger and demonstrated greater independence in using deep breathing relaxation.
Importantly, the study does not establish that deep breathing relaxation alone resolves violent behavior. The authors interpreted the BPAQ changes descriptively, and all three cases remained within the moderate aggression category after the intervention.
The relatively small reduction was also expected to be interpreted cautiously because the intervention lasted only three days and violent behavior can be influenced by psychological, social, environmental, and treatment-related factors.
Why the Findings Matter for Community Mental Health Care
The main practical value of the case study lies in the simplicity of the intervention.
Patients can practice deep breathing without specialized equipment, making it potentially suitable for community-based nursing services and home-based care. Nurses can teach the technique when patients begin recognizing early signs of anger, such as restlessness, increased muscle tension, clenched hands, shouting, or other signs of emotional escalation.
The intervention can also be incorporated alongside other components of psychiatric care, including therapeutic communication, identification of anger triggers, medication adherence, family involvement, and other appropriate nursing strategies.
This is particularly relevant in communities where patients may have limited access to specialized psychiatric services or where families require practical strategies for supporting continued care at home.
What the Author Says
Farama's findings support the use of deep breathing relaxation as a complementary, rather than standalone, intervention. The case study indicates that repeated practice can help patients develop an alternative response when emotional tension begins to rise.
Ethically paraphrased from the study, Dodi Aflika Farama of the Health Polytechnic of Palembang concludes that deep breathing relaxation is a simple and feasible nursing intervention that can support anger control among patients with violent behavior in community-based mental health care.
The author also emphasizes the need for further research involving larger numbers of participants, controlled study designs, longer intervention periods, and repeated aggression assessments. Such research would provide stronger evidence about whether improvements can be sustained over time.
Author Profile
Dodi Aflika Farama is affiliated with the Nursing Program, Health Polytechnic of Palembang, South Sumatra, Indonesia. The article identifies Farama as the corresponding author and presents the work within the field of psychiatric nursing, with a focus on violent behavior, anger control, and non-pharmacological nursing interventions.
The available article metadata does not specify an academic degree, so no degree is attributed here.
Source
Article Title: Application of Deep Breathing Relaxation for Anger Control in Patients with Violent Behavior: A Case Study
Journal: Indonesian Journal of Interdisciplinary Research in Science and Technology (MARCOPOLO)
Volume/Issue: Vol. 4, No. 4, 2026, pp. 227–244
Publication Year: 2026
Author: Dodi Aflika Farama
Affiliation: Nursing Program, Health Polytechnic of Palembang, South Sumatra
DOI: 10.55927/marcopolo.v4i4.33
Official Journal: https://journalmarcopolo.my.id/index.php/marcopolo
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