Feasibility and initial efficacy of a cognitive-behavioural group programme for managing anger and aggressiveness after traumatic brain injury

Abstract

This study assesses the feasibility of a cognitive-behavioural group programme for treating anger and aggressiveness after a traumatic brain injury (TBI). Five feasibility criteria were considered: demand, implementation, practicality, acceptability and initial efficacy. A self-report questionnaire of aggressiveness (AQ-12) was administered before the intervention (T1), one week following the intervention (T2) and at a four months follow-up (T3). Ten patients with moderate to severe chronic TBI completed the programme through eight once-a-week sessions. The analysis of the feasibility outcomes suggests that:Correspondence should be addressed to Tatiana Aboulafia Brakha Neuropsychology Unit, Department of Neurology, Geneva University Hospitals, rue Gabrielle-Perret-Gentil 4, CH-1211 Geneva 14, Switzerland. E-mail: Tatiana.Aboulafia@hcuge.chThe study was partly supported by the Swiss National Science Foundation (32-138497 to JMA). We would like to thank Blaise Christe and Ann Travis for their comments on the manuscript as well as the Clinical Research Centre of the Geneva University Hospitals for their statistical advices (T Perneger).Published in " " which should be cited to refer to this work.http://doc.rero.ch(1) The recruitment, the process of grouping participants and the characterisation of anger and aggressiveness at baseline need to be re-evaluated and improved for future designs. (2) The use of specific strategies for bypassing cognitive and other behavioural dysfunctions related to TBI is crucial for the success of this intervention and merits special attention. (3) The high retention rate, the convenient meeting schedule, cost advantages and the good acceptability by participants are positive arguments for the implementation of a larger trial. (4) The significant reduction of AQ-12 scores at T3 and the high effect size constitute a change in the expected direction and support the initial efficacy of the programme.

Cognitive–behavioural group therapy improves a psychophysiological marker of stress in caregivers of patients with Alzheimer's disease

“…Furthermore, the frequency and intensity of neuropsychiatric symptoms such as aggressiveness, hallucinations and delusions tend to increase at sunset (an effect termed the 'sundown syndrome') and are often correlated with caregiver's burden (Allegri et al, 2006;Khachiyants, Trinkle, Son, & Kim, 2011). CBT reduces anger and aggressiveness in patients with brain injury (Aboulafia-Brakha, Greber Buschbeck, Rochat, & Annoni, 2013), and the frequency of these symptoms also decreases in AD patients following psychosocial interventions for their caregivers (Stella et al, 2011). In line with this finding, in the current study caregivers reported a significant reduction of neuropsychiatric symptoms of their AD relatives, with a large effect size and high statistical power.…”

Effects of group psychotherapy on anger management following acquired brain injury

“…The AQ-12 shows acceptable levels of internal consistency and good test-re-test reliability (Cronbach's alpha coefficient of 0.80 for the French version). This same questionnaire was used in a previous study with TBI participants [9].…”

“…This 8-week programme with 60-minute sessions held oncea-week is described in a previous study assessing its feasibility and initial efficacy carried-out with 11 patients [9]. The protocol is composed of four main modules and covers (1) Identification of emotions/self-awareness; (2) Managing emotion in emergency situations (relaxation techniques, behaviour interruption); (3) Cognitive restructuring; and (4) Prevention strategies such as identifying vulnerable situations and promoting pleasant activities.…”

“…A prior study assessed the feasibility of a cognitive-behavioural anger management group programme for patients with traumatic brain injury [9]. Although some aspects regarding recruitment and implementation required improvement, the protocol showed good acceptability and practicality.…”

“…A few studies have reported the use of individual [7,8] and group [9,10] psychotherapeutic programmes for anger management following ABI [11]. Interventions mainly focused on psychoeducation, self-awareness, relaxation techniques, problemsolving and cognitive restructuring (identifying and changing thought patterns).…”