Mental health

1. ASSERTIVENESSASSERTIVENESS

3. ASSERTIVENESASSERTIVENES
 PROMOTIG SELF ESTEEMPROMOTIG SELF ESTEEM
WITHOUT DIMINISHING THEWITHOUT DIMINISHING THE
ESTEEM OF OTHERSESTEEM OF OTHERS

4. What is Assertiveness?What is Assertiveness?
 It’s the ability to
honestly express your
opinions, feelings,
attitudes, and rights --
without undue anxiety --
in a way that doesn’t
infringe on the rights of
others.
 It’s not aggressiveness,

5. Assertiveness……………..Assertiveness……………..
 A form of behavior characterized by aA form of behavior characterized by a
confident declaration or affirmation of aconfident declaration or affirmation of a
statement without need of proof; this affirmsstatement without need of proof; this affirms
the person's rights or point of view withoutthe person's rights or point of view without
either aggressively threatening the rights ofeither aggressively threatening the rights of
another or submissively permitting another toanother or submissively permitting another to
ignore or deny one's rights or point of view.ignore or deny one's rights or point of view.

6. ASSERTIVE BEHAVIOURASSERTIVE BEHAVIOUR
(ALBERTI & EMMONS, 2001)(ALBERTI & EMMONS, 2001)
 PROMOTES EQUALITY INPROMOTES EQUALITY IN
RELATIONHIPSRELATIONHIPS
 ENABLING US TO ACT IN OUR OWNENABLING US TO ACT IN OUR OWN
BEST INTERESTSBEST INTERESTS
 STAND UP FOR OURSELFSTAND UP FOR OURSELF
 TO EXPRESS HONEST FEELINGSTO EXPRESS HONEST FEELINGS
 EO EXCERCISE PERSONAL RIGHTSEO EXCERCISE PERSONAL RIGHTS
WITHOUT DENYING THE RIGHTS OFWITHOUT DENYING THE RIGHTS OF
OTHERSOTHERS

8. ASSERTIVE PEOPLE………..ASSERTIVE PEOPLE………..
 They feel free to express their feelings, thoughts, andThey feel free to express their feelings, thoughts, and
desires.desires.
 They are "also able to initiate and maintainThey are "also able to initiate and maintain
comfortable relationships with people"comfortable relationships with people"
 They know their rights.They know their rights.
 They have control over their anger.They have control over their anger.
 ““Willing to compromise with others ... and tend toWilling to compromise with others ... and tend to
have good self-esteem".have good self-esteem".
 "Assertive people enter friendships from an 'I count"Assertive people enter friendships from an 'I count
my needs. I count your needs' position".my needs. I count your needs' position".

9. Why is Assertiveness Important?Why is Assertiveness Important?
 If you don’t know howIf you don’t know how
to be assertive, youto be assertive, you
might experience themight experience the
following:following:
 DepressionDepression. This comes. This comes
from anger turnedfrom anger turned
inward. It can give youinward. It can give you
a sense of beinga sense of being
helpless, hopeless, withhelpless, hopeless, with
no control over yourno control over your
life.life.

10.  Resentment. Anger at
others for manipulating or
taking advantage of me.
 Frustration. Why did I let
someone victimize me?
 Temper/Violence. If you
can’t express anger
appropriately, it builds up
until it blows.

11.  Anxiety. Which leads to avoidance. If
you begin to avoid situations or people
that you know will make you
uncomfortable, you may miss out on fun
activities, job opportunities, relationships,
and lots of other good stuff.

12.  Poor relationships of all
kinds. Non-assertive
people are often unable
to express emotions,
positive or negative.

13.  Physical
complaints.
Headaches, ulcers,
high blood
pressure. We all
know what stress
does to our bodies.

14. How to be Effectively AssertiveHow to be Effectively Assertive
 Use “I” statements.Use “I” statements. ExampleExample: “I’d” like to be able to: “I’d” like to be able to
tell my stories without interruption.” instead oftell my stories without interruption.” instead of
“You’re always interrupting my stories!”“You’re always interrupting my stories!”
 Use facts, not judgments.Use facts, not judgments. ExampleExample: “Your: “Your
punctuation needs work and your formatting ispunctuation needs work and your formatting is
inconsistent.” instead of “This is sloppy work.” orinconsistent.” instead of “This is sloppy work.” or
“Did you know that shirt has some spots?” instead of“Did you know that shirt has some spots?” instead of
“You’re not going out looking like THAT, are you?”“You’re not going out looking like THAT, are you?”

15.  Express ownership of your thoughts, feeling,Express ownership of your thoughts, feeling,
and opinions.and opinions. ExampleExample: “I get angry when he: “I get angry when he
breaks his promises.” instead of “He makes mebreaks his promises.” instead of “He makes me
angry.” or “ I believe the best policy is to…”angry.” or “ I believe the best policy is to…”
instead of “The only sensible thing is to…”instead of “The only sensible thing is to…”
 Make clear, direct, requests. Don’t invite theMake clear, direct, requests. Don’t invite the
person to say no. Example: “Will youperson to say no. Example: “Will you
please…? Instead of “Would you mind…?” orplease…? Instead of “Would you mind…?” or
“Why don’t you…?”“Why don’t you…?”

16. Assertiveness among professionalAssertiveness among professional
nurses (1993)nurses (1993)
 determine assertiveness levels of a populationdetermine assertiveness levels of a population
of professional nurses. The results revealedof professional nurses. The results revealed
that this group of nurses was more assertive.that this group of nurses was more assertive.
The oldest group of nurses (60-76 years) wasThe oldest group of nurses (60-76 years) was
significantly less assertive than any of thesignificantly less assertive than any of the
younger groups of nurses. Nurses practisingyounger groups of nurses. Nurses practising
with a diploma as the highest level ofwith a diploma as the highest level of
education were significantly less assertive thaneducation were significantly less assertive than
nurses having a baccalaureate or above.nurses having a baccalaureate or above.

17. Nurses' and midwives' assertive behaviour in theNurses' and midwives' assertive behaviour in the
workplace.(2005)workplace.(2005)
 they were less accomplished at expressingthey were less accomplished at expressing
their own opinions or making requests.their own opinions or making requests.
Assertive behaviours were used moreAssertive behaviours were used more
frequently with nursing/midwifery colleaguesfrequently with nursing/midwifery colleagues
than with management/medical colleagues.than with management/medical colleagues.
Most used assertiveness skills with otherMost used assertiveness skills with other
grades of staff in their own profession.grades of staff in their own profession.
Responsibility to patients/clients emerged as aResponsibility to patients/clients emerged as a
supporting factor for using assertivesupporting factor for using assertive
behaviour. Managers, the work atmospherebehaviour. Managers, the work atmosphere
and fear were viewed as obstacles.and fear were viewed as obstacles.

18. What are the assertive rightsWhat are the assertive rights
You have the right to...You have the right to...
1.1. be treated with respectbe treated with respect
2. express feelings, opinions2. express feelings, opinions
3. put yourself first , for sometime3. put yourself first , for sometime
4. determine your own priorities4. determine your own priorities
5. ask for what you want5. ask for what you want

19.  6. refuse without making excuses or6. refuse without making excuses or
feeling guiltyfeeling guilty
7. make mistakes and be responsible for7. make mistakes and be responsible for
them.them.
8. give and receive information as a8. give and receive information as a
professionalprofessional
9. act in the best interest of the patient9. act in the best interest of the patient
10. be human10. be human

20. Barriers to assertive skills inBarriers to assertive skills in
nurses (1995)nurses (1995)
 The results indicated that the 152 nursesThe results indicated that the 152 nurses
sampled considered themselves to havesampled considered themselves to have
moderate to low assertiveness skills, and amoderate to low assertiveness skills, and a
significant negative correlation was foundsignificant negative correlation was found
between the level of assertiveness and thebetween the level of assertiveness and the
perception of barriers inhibiting assertiveperception of barriers inhibiting assertive
behaviour. The study concluded thatbehaviour. The study concluded that
assertiveness training is needed for qualifiedassertiveness training is needed for qualified
nursesnurses

21. RESPONSE PATTERNSRESPONSE PATTERNS
 ROLE MODELINGROLE MODELING
 REINFORCEMENTREINFORCEMENT
 INVENTING A RESPONSEINVENTING A RESPONSE
 NOT BEING ABLE TO THINKNOT BEING ABLE TO THINK
 NO PROPER SKILLNO PROPER SKILL
 CONSCIOUSLY CHOOSING RESPONSECONSCIOUSLY CHOOSING RESPONSE
STYLESTYLE

22. Three Patterns of CommunicationThree Patterns of Communication
 AggressiveAggressive
 Nonassertive (Passive)Nonassertive (Passive)
 AssertiveAssertive

23. Aggressive BehaviorAggressive Behavior
 Directly standing up for personal rights
and expressing thoughts and beliefs in a
way which is often dishonest, usually
inappropriate, and always violates the
rights of the other person

24. Aggressive BehaviorAggressive Behavior

Goals of Aggressive BehaviorGoals of Aggressive Behavior::
domination and winningdomination and winning
forcing the other to loseforcing the other to lose
 Winning is insured by humiliating, degrading,Winning is insured by humiliating, degrading,
belittling, or overpowering other people so that theybelittling, or overpowering other people so that they
become weaker and less able to express and defendbecome weaker and less able to express and defend
their needs and rightstheir needs and rights

25. Aggressive BehaviorAggressive Behavior
 Nonverbal intend to dominate other
 Eye contact that tries to stare down,
dominate the other
 Sarcastic, loud tone of voice
 Parental body gestures such as excessive
finger pointing

26. Reasons People Act AggressivelyReasons People Act Aggressively
 To get your point acrossTo get your point across
 Don’t know another way to get your pointDon’t know another way to get your point
acrossacross
 For personal gain, controlFor personal gain, control
 To avoid your own personal responsibilityTo avoid your own personal responsibility
 Low self esteemLow self esteem
 Anger related to previous nonassertionAnger related to previous nonassertion
 Don’t have other coping mechanismsDon’t have other coping mechanisms
 Reacting to another’s aggressionReacting to another’s aggression

27. Consequences of AggressionConsequences of Aggression
 The other person gets defensive
 Get rid of anger or other emotions
 Lose friendships, other intimate
relationships, damage relationships
 Affect work, lose job
 Lose respect

28. Nonassertive BehaviorNonassertive Behavior
 Violating your own rights by failing
to express honest feelings, thoughts,
and beliefs and consequently
permitting others to violate you

29. Nonassertive BehaviorNonassertive Behavior
 Goals of nonassertive behavior:Goals of nonassertive behavior:
to appease othersto appease others
to avoid conflict at any costto avoid conflict at any cost
 Message communicated:Message communicated:
My thoughts aren’t important; I don’t countMy thoughts aren’t important; I don’t count
I’m nothing; you are superiorI’m nothing; you are superior
I don’t respect your ability to takeI don’t respect your ability to take
disappointments, handle your own problems. . .disappointments, handle your own problems. . .

30. Nonassertive BehaviorNonassertive Behavior
 Evasive eye contact
 Body gestures such as stepping back from the
other, hunching shoulders, covering the mouth,
nervous gestures
 Voice tone may be singsong or overly soft
 Hesitant speech pattern, nervous laughter
 Gestures which convey weakness, anxiety

31. Reasons People Act NonassertivelyReasons People Act Nonassertively
 Avoid confrontation
 Personality
 Fear of hurting the other person
 Fear of rejection, losing the other person
 Avoid aggression
 Self esteem
 Lack of skills
 Cultural differences

32. Consequences of NonassertionConsequences of Nonassertion
 Not getting your point across
 Nothing changes, problems can get worse
 Damages self esteem
 Can lead to aggressive behavior
 Other people can take advantage of you

33.  Passiveness may involve…
• Flight
• Possibly respecting others’ rights
while ignoring your own rights.
• Not communicating directly when
the situation warrants it.
• Allowing others to “walk on” or
control you.
• Allowing your boundaries to be
violated.

34.  Passive-Aggressiveness
• Fight-Flight pattern.
• Either respecting ONLY your rights
OR other’s rights.
• Not addressing the problem or
behavior.
• Talking about people behind their
back/Gossip
• Fluctuating between violating
others’ boundaries or having your
boundaries violated.

35. Assertive BehaviorAssertive Behavior
 Standing up for personal rights and
expressing thoughts, feelings and beliefs
in direct, honest, and appropriate ways
which do not violate another person’s
rights

36. Assertive BehaviorAssertive Behavior
 Goals of Assertive Behavior--
to get and give respect
to ask for fair play
to leave room for compromise when the
needs and rights of two people conflict
to communicate and develop mutuality
in relationships

37. Assertive BehaviorAssertive Behavior
 Involves respect, not deference
 Two types of respect:
respect for oneself
respect for the other person’s needs and
rights

38. Assertive BehaviorAssertive Behavior
 Basic Message:
This is what I think
This is what I feel
This is how I see the situation
 This message expresses who the person is
and is said without dominating,
humiliating, or degrading

39. Assertive BehaviorAssertive Behavior
 Assertive Behavior is NOT:
simply a way to get what you want
manipulative
aggressive
irresponsible

40. Assertive BehaviorAssertive Behavior
 Nonverbals are congruent with verbals
 Voice is appropriately loud to the
situation
 Eye contact is firm but not a stare down
 Body gestures denote strength
 Speech pattern is fluent, expressive, clear,
and emphasizes key words

41. Behavioral components…..Behavioral components…..
 Eye contact
 Body posture
 Physical contact
 Gestures
 Facial expression
 Voice

42. Continues…..Continues…..
 Fluency
 Timing
 Listening
 Thoughts
 Content

43. Special Techniques for DifficultSpecial Techniques for Difficult
SituationsSituations
 Broken recordBroken record. Keep repeating your. Keep repeating your
point, using a low-level, pleasantpoint, using a low-level, pleasant
voice. Don’t get pulled into arguingvoice. Don’t get pulled into arguing
or trying to explain yourself.or trying to explain yourself.
 Eg: repeatingEg: repeating

44.  Fogging. This is a way to deflect
negative criticism. You agree with
some of the fact, but you retain the
right to choose your behavior.
 Eg: agreeing but not changing

45.  Standing up for one’s basic human
right
 Eg: I have the right
 Assuming responsibility for one’s
own statements
 Agreeing assertively
 Enquiring assertively

46.  Content to Process Shift. When someone
is trying to confuse the issue. Stop
talking about the problem and bring up
how the person is behaving right now.
Example: “You’re getting off the point.
I’m starting to feel frustrated because I
feel like you’re not listening.

47.  Defusing. Letting someone cool down
before discussing an issue. Example: “I
can see that you’re upset. Let’s talk
about this later.” Also, if they try to stay
with it, you have the right to walk away..

48.  Summarization. This helps to make sure
you’re understanding the other person.
Example: “So what you’re trying to tell
me is …”
 Specificity. It’s really important to be
very clear about what you want done.
This helps prevent distractions

49. Thought stopping tehniquesThought stopping tehniques
 Negative thoughts
 Shout loud: STOP

50.  As people practice assertive communication,As people practice assertive communication,
you can almost see that little spark of self-you can almost see that little spark of self-
respect glimmer, flicker, take hold, and burstrespect glimmer, flicker, take hold, and burst
into flame.into flame.
 People can sense it when you respect yourself,People can sense it when you respect yourself,
and they will treat you with respect. And thatand they will treat you with respect. And that
is the ultimate goal of assertiveis the ultimate goal of assertive
communication.communication.

51. What is the behavior of anWhat is the behavior of an
assertive nurseassertive nurse
-appears self-confident and composed
-maintains eye contact
-uses clear, concise speech
-speaks firmly and positively
-speaks genuinely, without sarcasm
-is non-apologetic
-takes initiative to guide situations
-gives the same message verbally and
nonverbally

52. What are the advantages ofWhat are the advantages of
assertive communication?assertive communication?
 -get what you want when you clearly ask for it-get what you want when you clearly ask for it
-people respect clear, open, honest,-people respect clear, open, honest,
communicationcommunication
-stand up for your own rights and feel self--stand up for your own rights and feel self-
respectrespect
-avoid the invitation of aggression when the-avoid the invitation of aggression when the
rights of others are violated.rights of others are violated.
-more independent-more independent
-you become a decision-maker-you become a decision-maker
-you feel more peaceful and comfortable with-you feel more peaceful and comfortable with

53. What constitutes responsibleWhat constitutes responsible
communication for a nurse?communication for a nurse?
 -focus on the nursing process and problem--focus on the nursing process and problem-
solving processsolving process
-considers the world of the client and the-considers the world of the client and the
client's familyclient's family
-is a client advocate-is a client advocate
-open to trusting intuition-open to trusting intuition
-treats each person as an individual-treats each person as an individual

54. APPLICATION…….APPLICATION…….
Several research studies have identified assertivenessSeveral research studies have identified assertiveness
training as a useful tool in the prevention of alcohol-usetraining as a useful tool in the prevention of alcohol-use
disorders.disorders.[16][16]
Psychological skills in general includingPsychological skills in general including
assertiveness and social skills have been posed asassertiveness and social skills have been posed as
intervention for a variety of disorders with someintervention for a variety of disorders with some
empirical support.empirical support.[17][17]
 In connection with gender theory, "Tannen argues thatIn connection with gender theory, "Tannen argues that
men and women would both benefit from learning tomen and women would both benefit from learning to
use the others' style. ... So, women would benefit fromuse the others' style. ... So, women would benefit from
assertiveness training just as men might benefit fromassertiveness training just as men might benefit from
sensitivity training".sensitivity training".[18][18]

55. Evaluating the effect of self-awareness andEvaluating the effect of self-awareness and
communication techniques oncommunication techniques on
nurses'assertiveness and self-esteem (2012)nurses'assertiveness and self-esteem (2012)
 A significant differenceA significant difference
between assertiveness and self-esteem scores.between assertiveness and self-esteem scores.
There was a positive relationship betweenThere was a positive relationship between
assertiveness and self-esteem. The courseassertiveness and self-esteem. The course
lasted 14 weeks for a total of 3 h per week.lasted 14 weeks for a total of 3 h per week.
The teaching methods focused mostly onThe teaching methods focused mostly on
active student participation, demonstration,active student participation, demonstration,
role play, experience and experience sharing,role play, experience and experience sharing,
homework, constructive feedback, andhomework, constructive feedback, and
watching films.watching films.

56. The effects of assertiveness training in patients withThe effects of assertiveness training in patients with
schizophrenia (2013)schizophrenia (2013)
 (1) assertiveness significantly improved from(1) assertiveness significantly improved from
pre- to post intervention and was maintainedpre- to post intervention and was maintained
until the follow-up; (2) anxiety regardinguntil the follow-up; (2) anxiety regarding
social interactions significantly decreasedsocial interactions significantly decreased
after assertiveness training; and (3) satisfactionafter assertiveness training; and (3) satisfaction
with interpersonal communication slightlywith interpersonal communication slightly
improved after the 12-session intervention andimproved after the 12-session intervention and
at the 3-month follow-up.at the 3-month follow-up.

57. Criticism…………..Criticism…………..
 Some authors stress that assertiveness is not alwaysSome authors stress that assertiveness is not always
practiced in a balanced way, especially by those new topracticed in a balanced way, especially by those new to
the process: "[One] problem with the concept ofthe process: "[One] problem with the concept of
assertiveness is that it is both complex and situation-assertiveness is that it is both complex and situation-
specific. ... Behaviors that are assertive in onespecific. ... Behaviors that are assertive in one
circumstance may not be so in another".circumstance may not be so in another".[19][19]
MoreMore
particularly, while "unassertiveness courts one set ofparticularly, while "unassertiveness courts one set of
problems, over-assertiveness createsproblems, over-assertiveness creates
another."another."[20][20]
Assertiveness manuals recognize that "manyAssertiveness manuals recognize that "many
people, when trying out assertive behaviour for the firstpeople, when trying out assertive behaviour for the first
time, find that they go too far and becometime, find that they go too far and become
aggressive."aggressive."[21][21]