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

Abstract

Objective Test efficacy of 8-session, 1:1 treatment, Anger Self-Management Training (ASMT), for chronic moderate to severe traumatic brain injury (TBI). Setting Three US outpatient treatment facilities. Participants 90 people with TBI and elevated self-reported anger; 76 significant others (SOs) provided collateral data. Design Multi-center randomized controlled trial with 2:1 randomization to ASMT or structurally equivalent comparison treatment, Personal Readjustment and Education (PRE). Primary outcome assessment 1 week post treatment; 8-week follow-up. Primary outcome: Response to treatment defined as ≥1 standard deviation change in self-reported anger. Secondary outcomes: SO-rated anger, emotional and behavioral status, satisfaction with life, timing of treatment response, participant and SO-rated global change and treatment satisfaction. Main Measures State-Trait Anger Expression Inventory-Revised Trait Anger (TA) and Anger Expression-Out (AX-O) subscales; Brief Anger-Aggression Questionnaire (BAAQ); Likert-type ratings of treatment satisfaction, global changes in anger and well-being. Results After treatment, ASMT response rate (68%) exceeded that of PRE (47%) on TA but not AX-O or BAAQ; this finding persisted at 8 week follow-up. No significant between-group differences in SO-reported response rates, emotional/ehavioral status, or life satisfaction. ASMT participants were more satisfied with treatment and rated global change in anger as significantly better; SO ratings of global change in both anger and well-being were superior for ASMT. Conclusion Anger self-management training was efficacious and persistent for some aspects of problematic anger. More research is needed to determine optimal dose and essential ingredients of behavioral treatment for anger following TBI.

Ecological momentary assessment of affect in context after traumatic brain injury.

“…Information about the cause and severity of the TBI were collected from primary medical records. Because these records did not uniformly include metrics such as Glasgow Coma Scale score, duration of unconsciousness, or posttraumatic amnesia (PTA), we used a standardized interview for retrospective estimation of PTA duration, which has been employed in previous investigations (Hart et al, 2017(Hart et al, , 2010, as a severity measure common to all participants.…”

An Umbrella Review of Self-Management Interventions for Health Conditions With Symptom Overlap With Traumatic Brain Injury

“…While we did not find systematic reviews of self-management studies for persons with TBI, a single study showed effectiveness of anger self-management training (psychoeducation, training in self-monitoring of anger and problem-solving) for reducing self-reported trait anger in persons with TBI. 52 Our umbrella review did yield encouraging findings regarding the effectiveness of self-management interventions in chronic conditions whose symptoms overlap with TBI. Chronic pain is common in the TBI population 53 and therefore self-management of pain symptoms is a priority.…”

Association between uncooperativeness and the glucose metabolism of patients with chronic behavioral disorders after severe traumatic brain injury: a cross-sectional retrospective study

“…Our data show that patients with sTBI have a broad variety of symptoms. In the future, we must consider adding nonverbal assessment such as the visual analogue scale and the face-pain scale for detecting posttraumatic agitation, aggression, irritability, and sleep disorders, because these common symptoms are not included in the BPRS-based classification [ 10 , 16 , 28 – 31 ].…”

“…Most patients with sTBI have difficulty expressing their emotional distress because of disorders of consciousness, disrupted higher brain function, and verbal disturbance such as tracheostomy [ 9 – 13 ]. However, for patients who can communicate at some basic level, emotional explosions and abnormal behaviors are often observed as nonverbal responses over the clinical course following neurorehabilitation [ 9 , 10 , 14 – 16 ]. Consequently, therapists and caregivers are adversely affected by this unsettling patient behavior that is based on insufficient communication [ 1 , 2 , 8 – 10 , 16 ].…”