Research Reports - Anger self-management training for traumatic brain injury

J Head Trauma Rehabil. 2017 Sep/Oct;32(5):319-331. doi:

Hart T(1), Brockway JA, Maiuro RD, Vaccaro M, Fann JR, Mellick D, Harrison-Felix
C, Barber J, Temkin N.

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. 

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