Anger Self-Management in Traumatic Brain Injury

Inclusion Criteria

• Age ≥ 16 at the time of injury
• ages 18 to 65 at the time of enrollment
• TBI (closed or penetrating) occurring a minimum of 6 months prior to enrollment
• TBI documented as complicated mild, moderate, or severe TBI by any one or more of the following indices:
• post-resuscitation score on Glasgow Coma Scale (GCS) < 13 or GCS Motor < 6;
• loss of consciousness, unresponsiveness or coma attributable to the TBI and persisting ≥ 1 hour;
• post-traumatic amnesia, or disorientation (O x 0, 1 or 2) attributable to the TBI and persisting ≥ 24 hours; or
• neuro-imaging study positive for TBI-related findings such as contusion, hematoma, hemorrhage, diffuse axonal injury, shear injury, and/ or depressed skull fracture
• Able to travel independently in the community (to maximize the probability that participants will be cognitively and physically able to engage in the treatment)
• Indication from self or other report that participant has problematic anger/ irritability that is new since the injury or worse than before the injury
• Self-report of anger ≥ 1 standard deviation above the mean for age and gender on the Trait Anger or Anger Expression-Out (AX-O) subscales of the State-Trait Anger Expression Inventory-2 (STAXI-2), or a score of ≥ 7 on the Brief Anger-Aggression Questionnaire (BAAQ)
• Able to speak and understand English sufficiently to complete the screening and outcome measures and to participate in a verbally based treatment program, which thus far exists only in English
• Informed consent given by participant or legally authorized representative.

Exclusion Criteria

• History of schizophrenia or schizo-affective disorder, as documented in medical records or by self-report that a medical professional has given the diagnosis
• Current psychosis, major depression, or suicidal ideation; or history of manic or hypomanic episode as determined by the Mini-International Neuropsychiatric Interview for DSM-IV (MINI) Current alcohol-l dependence, as determined by the MINI.
• Self-reported use of cocaine or amphetamines "daily" or "almost daily" using the relevant questions from the Alcohol, Smoking, and Substance Involvement Screening Test (ASSIST)
• TBI requiring hospitalization that has occurred within 6 months prior to enrollment
• Involvement in one-to-one counseling or psychotherapy targeted to emotional health issues
• Involvement in another treatment trial that may affect participation or outcomes
• Evidence of severe, intractable anger as indicated by history of violence-related crimes, e.g., charges for assault.