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Anger Self-Management Training for Chronic Moderate to Severe Traumatic Brain Injury: Results of a Randomized
Tessa Hart1, Jo Ann Brockway, Roland D Maiuro
1Moss Rehabilitation Research Institute, Elkins Park, Pennsylvania (Dr Hart and Ms Vaccaro); Department of Physical Medicine and Rehabilitation (Dr Brockway), Department of Psychiatry and Behavioral Sciences (Dr Fann), Department of Neurological Surgery (Mr Barber), and Departments of Neurological Surgery and Biostatistics (Dr Temkin), University of Washington, Seattle; Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle (Dr Maiuro); and Craig Hospital, Englewood, Colorado (Mr Mellick and Dr Harrison-Felix).
Objective:
To 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:
Ninety people with TBI and elevated self-reported anger; 76 significant others (SOs) provided collateral data.
Design:
Multicenter randomized controlled trial with 2:1 randomization to ASMT or structurally equivalent comparison treatment, personal readjustment and education (PRE). Primary outcome assessment 1 week posttreatment; 8-week follow-up.
Primary Outcome:
Response to treatment defined as 1 or more 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/behavioral 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:
ASMT 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 after TBI.
