Problematic anger and irritability are common and persistent after traumatic brain injury (TBI) across the spectrum of injury severity. Anger symptoms have negative effects on emotional well-being, community living, and family and social relationships. Problematic anger after TBI has numerous causes including organic and non-organic or secondary effects of injury. Characteristic deficits in executive function, e.g. impaired self-monitoring and problem-solving deficits, also play a role. Available treatments include medications, behavior modification, and cognitive-behavioral interventions, but few have been adapted to the needs of community dwelling persons with TBI and few treatment trials have been conducted. The present study is a Phase II clinical trial designed to test the worth of a novel treatment approach called Anger Self-Management Training (ASMT), compared to a control treatment offering education and psychological support (EPS) with equivalent therapist time and therapeutic structure. The ASMT is an 8-session, individual, psycho-educational intervention based on principles of self-monitoring and problem-solving training. A single-center pilot study of the ASMT showed improvement on standardized measures of anger and anger expression from pre to post treatment;the purpose of the present trial is to compare it to EPS in a larger, more diverse sample. Participants with problematic anger who are at least 6 months post complicated mild, moderate or severe TBI, and a Significant Other (SO), if available, will be randomized 2:1 to ASMT or EPS. Treatment response on measures of self-reported anger pre- to post-treatment will serve as the primary outcome. A total of 99 participants will be enrolled from 3 clinical sites. Secondary outcomes include trajectory and persistence of treatment response;change in SO-reported participant anger;emotional and behavioral status;and quality of life. Characteristics of participants will be examined for their association to treatment response. If the trial demonstrates the value of further study of the ASMT, this treatment model may eventually offer a readily disseminable method by which people with TBI can learn to regain personal control over problematic anger/ irritability.

Public Health Relevance

Traumatic brain injury (TBI) is a major health problem with widespread effects on cognitive, emotional and behavioral function. Problematic anger and irritability are common and persistent after TBI and have negative effects on work, family and friendships. This project will examine a new method of teaching people with TBI to regain control over problematic symptoms of anger/ irritability, with expected benefits on their emotional well-being and ability to cope with community living.

National Institute of Health (NIH)
Eunice Kennedy Shriver National Institute of Child Health & Human Development (NICHD)
Research Project (R01)
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Pediatrics Subcommittee (CHHD)
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Ansel, Beth
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Albert Einstein Medical Center (Philadelphia)
United States
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