Anger Self-Management in Traumatic Brain Injury
Condition: Traumatic Brain Injury
MeSH terms: Brain Injuries; Brain Injuries, Traumatic; Wounds and Injuries
Study type: Interventional

Summary: 
      The present study addresses problematic anger and irritability in community dwelling persons
      with traumatic brain injury (TBI). It is designed to test the worth of a novel treatment
      approach called Anger Self-Management Training (ASMT), compared to a treatment offering
      supportive therapy focused on personal readjustment and education, the PRE (Personal
      Readjustment and Education). The project is a 3-center randomized controlled trial employing
      equivalent therapist time and therapeutic structure in the delivery of treatment options. The
      overall aim is to evaluate the relative response rate and correlates of treatment response
      for the ASMT as compared to the PRE.
    

Detailed description: 
      Problematic anger/ irritability is common, persistent, and difficult to treat after TBI, and
      has a broad impact on community and social function. Anger following TBI is related, in part,
      to deficits in executive function including impaired problem-solving and impaired
      self-monitoring. In this 2-group, 3-center clinical trial with masked outcome assessment, we
      will explore feasibility and efficacy of a manualized, 8-session individual treatment, Anger
      Self-Management Training (ASMT), compared to a treatment using non-specific ingredients of
      therapist attention, education, and psychological support (PRE).

      The ASMT was designed to decrease subjective and objective anger and irritability following
      traumatic brain injury (TBI), using theoretically motivated "active ingredients." The ASMT
      focuses on 2 executive deficits implicated in anger post TBI, (1) self-awareness and
      self-monitoring and (2) problem-solving. Participants will be randomly assigned in 2:1
      proportion to ASMT or PRE. The PRE treatment is manualized to the same degree as the ASMT,
      but focuses on educational and personal readjustment to injury rather than anger-specific
      strategy training.

      The overall goals are to examine the effects of the ASMT compared to PRE on self-reported
      problematic anger, both 1 week and 2 months after treatment, and to assess the time course of
      treatment response during the treatment phase.

      Specific Aims

        1. To examine the efficacy of ASMT compared to a control treatment (PRE) as measured by
           improvement from baseline to post-treatment on the State-Trait Anger Expression
           Inventory-Revised (STAXI-2) Trait Anger; STAXI-2 Anger Expression-Out; or the Brief
           Anger-Aggression Questionnaire (BAAQ) (primary outcome).

        2. To examine the trajectory of treatment response within the treatment phase of ASMT/ PRE
           as shown by a change on 1 or more of the target scales halfway through the treatment
           (i.e., after 4 of 8 sessions) for those participants who exhibited a positive response
           post treatment (as defined above).

        3. To examine the persistence of treatment effects 2 months after the end of the treatment
           phase.
    

Intervention name(s): ASMT; PRE
Intervention type(s): Behavioral; Behavioral
Intervention description(s): 8-session, individual, psycho-educational intervention based on principles of self-monitoring and problem-solving training Significant other (friend or relative) invited to participate in 3 of 8 sessions; 8-session, individual, psycho-educational intervention based on principles of education and personal readjustment to TBI Significant other (friend or relative) invited to participate in 3 of 8 sessions
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: Single (Outcomes Assessor)
Primary purpose: Treatment
Keywords: traumatic brain injury; TBI; head injury; brain injury; Psych-educational treatment; Anger; irritability; anger management