From the Guidelines
Anger management in patients with brain injuries should prioritize nonpharmacological interventions, including early information and advice, graded physical exercise, and psychological treatment, as these approaches have shown effectiveness in reducing persistent postconcussion symptoms, including emotional and behavioral symptoms such as irritability and quickness to anger. According to a systematic review and meta-analysis published in JAMA Network Open in 2021 1, nonpharmacological interventions can be effective in treating persistent postconcussion symptoms (PPCS) in adults, which include a combination of physical, cognitive, and emotional or behavioral symptoms. The study found that interventions such as early information and advice, graded physical exercise, and psychological treatment can be beneficial in reducing PPCS, including emotional and behavioral symptoms such as irritability and quickness to anger.
Some key points to consider when managing anger in patients with brain injuries include:
- Early information and advice can help patients understand their condition and manage their symptoms more effectively
- Graded physical exercise can help improve physical function and reduce symptoms such as fatigue and headache
- Psychological treatment, including cognitive-behavioral therapy, can help patients manage emotional and behavioral symptoms such as irritability and quickness to anger
- A multidisciplinary approach, including healthcare professionals from different specialties, can help provide comprehensive care and support to patients with brain injuries.
It is essential to note that each patient's experience with brain injury is unique, and treatment should be tailored to their individual needs and circumstances. By prioritizing nonpharmacological interventions and providing comprehensive care and support, healthcare professionals can help patients with brain injuries manage their symptoms, including anger, and improve their overall quality of life 1.
From the Research
Anger in Brain Injuries
- Anger and irritability are common and persistent clinical problems following traumatic brain injury (TBI) 2, 3, 4, 5, 6
- Treatment options for anger in TBI patients include medications, behavioral modification, and psychotherapies, but some are impractical and none have proven efficacy with this population 2
- Studies have shown that psychoeducational treatment programs, such as Anger Self-Management Training (ASMT), can be effective in reducing anger and irritability in TBI patients 2, 6
- These programs often involve teaching patients skills to control their own anger, as well as training family members in behavior modification principles to support the patient's anger management 5
- Emotion regulation strategies, including adaptive strategies such as reappraisal, can also be effective in modulating anger feelings in TBI patients 4
Treatment Approaches
- ASMT is a fully manualized, 8-session, psychoeducational treatment that has shown significant improvement in self-reported anger and large effect sizes 2, 6
- Personal Readjustment and Education (PRE) is a structurally equivalent comparison treatment that can be used to maximize equipoise for both participants and treaters 2
- Behavioral interventions, such as self-talk methods and time-out procedures, can be effective in controlling anger problems in brain injured adults 5
- Group format anger management training can be advantageous for people with acquired brain injury (ABI) 3
Outcomes and Assessment
- Primary outcomes for anger treatment in TBI patients include change in self-reported anger on validated measures, as well as participant anger as reported by a significant other 2
- Secondary outcomes may include emotional distress in domains other than anger/irritability, behavioral functioning, and quality of life 2
- Skin conductance levels and self-report anger questionnaires can be used to assess psychological and psychophysiological correlates of emotion recognition and anger experience in TBI patients 4