Anger self-management in chronic traumatic brain injury: protocol for a psycho-educational treatment with a structurally equivalent control and an evaluation of treatment enactment

Abstract

Anger and irritability are important and persistent clinical problems following traumatic brain injury (TBI). Treatment options include medications, behavioral modification, and psychotherapies, but some are impractical and none have proven efficacy with this population. We describe a randomized multi-center clinical trial testing a novel, one-on-one, 8-session psychoeducational treatment program, Anger Self-Management Training (ASMT), designed specifically for people with TBI who have significant cognitive impairment. The trial is notable for its use of a structurally equivalent comparison treatment, called Personal Readjustment and Education (PRE), which was created for the study and is intended to maximize equipoise for both participants and treaters. Fidelity assessment is conducted in real time and used in therapist supervision sessions. The primary outcome is change in self-reported anger on validated measures from pre-treatment to 1 week after the final session. Secondary outcomes include participant anger as reported by a significant other; emotional distress in domains other than anger/ irritability; behavioral functioning; and quality of life. An interim assessment after the 4th session will allow examination of the trajectory of any observed treatment effects, and a follow-up assessment 2 months after the end of intervention will allow examination of persistence of effects. A treatment enactment phase, in which participants are interviewed several months after the last therapy session, is designed to provide qualitative data on whether and to what extent the principles and techniques learned in treatment are still carried out in daily life.

Anger Self-Management Training for Chronic Moderate to Severe Traumatic Brain Injury: Results of a Randomized Controlled Trial

“…Details of inclusion and exclusion criteria are reported elsewhere 20 and in the Supplemental Digital Content (SDC). In brief, we recruited persons who were known to have TBI and some indication of problematic anger via self-, SO-, or clinician report.…”

“…Additional information about the treatment conditions has been published previously. 20,21 All treatment sessions in the current trial were audio recorded. We monitored throughout the trial for adverse events (AE) and serious adverse events (SAE) with the assistance of a Safety Monitor, a psychologist with expertise in the topic who examined unmasked AE and SAE reports to ensure adequate documentation and to alert us to any disproportionate counts in the 2 treatment arms.…”

“…20 Feasibility and initial evidence of efficacy were examined in a pilot trial, which suggested that the protocol was suitable for people with cognitive limitations due to TBI. 21 The ASMT treatment is based on the idea that regardless of the individual contributions of premorbid, organic, and secondary causes, there is a “final common pathway” for the experience and expression of anger linked to 2 deficits in executive function that affect many survivors of TBI: (1) impaired self-awareness, which affects behavioral problems more than cognitive or physical deficits; 22,23 and (2) limitations in problem-solving, particularly in social spheres.…”

Emotional Regulation Following Acquired Brain Injury: Associations With Executive Functioning in Daily Life and Symptoms of Anxiety and Depression

“…In ABI, there may be impairments in self-monitoring and control, in addition to the ability to differentiate emotions, that are revealed through various symptoms of emotional dysregulation, including disinhibited emotion/behavior, and reduced emotional awareness and expression (8,11). Further, emotional regulation is an important aspect of executive functioning (EF) (12,13), broadly described as inter-related top-down processes promoting the control and regulation of cognition, behavior, and emotion (14). In contrast to the view that brain injury is directly responsible for emotional dysregulation, it can also represent secondary reactions to the consequences of ABI (15).…”

Poczucie frustracji i zagubienia w wypowiedziach słownych osób z dysfunkcjami mózgu – mechanizmy neuropsychologiczne. Studia przypadków

“…2015), trudności w wyrażaniu/rozumieniu treści językowych (Ulatowska 2014), poczucie lęku w sytuacjach życia codziennego, poczucie wykluczenia społecznego, bezwartościowości (Ponsford, Kelly, Couchman 2015), złość/irytację z powodu niezdolności radzenia sobie z wymaganiami życia codziennego, które są przyczyną kolejnych problemów (np. w relacjach społecznych) (Hart, Brockway, Fann, Maiuro, Vaccaro 2015), i wiele innych. Negatywne emocje są komunikowane nawet wówczas, gdy pacjent przejawia cechy nieświadomości (anozognozji) własnych ograniczeń (Prigatano 2009).…”