Reducing the use of physical restraint in clinical practice, including face-down restraint, is a challenge for professionals. The aim of this literature review was to assess the use of de-escalation techniques to prevent aggressive behaviour or decrease its intensity. A systematic search of electronic databases was undertaken for articles published between 2000 and 2015. Evidence was found for the use of physical and pharmacological interventions to de-escalate aggressive behaviour; limited to no evidence was found to support the use of verbal de-escalation techniques in similar clinical settings. Research is needed to identify evidence-based strategies for the prevention and de-escalation of aggressive behaviour without using restraint.