Anger management training for brain injured patients and their family members.

Anger dyscontrol is a common occurrence after brain injury. The anger problems of brain injured persons create a burden for their caretakers who most frequently are their family members. Two single-case design studies are presented that demonstrate the efficacy of behavioral interventions for the control of anger problems in brain injured adults. Anger control was accomplished by training the patients in skills to control their own anger, and teaching family members behavior modification principles. In each case, the patient was taught to implement a self-talk method to decrease tension during the escalation period of an anger episode and to execute a time-out when aware of increased anger. Family members were trained in ways to monitor such problems and to identify antecedents to an outburst. They were given feedback and suggestions to modify their communication style with the patient so as to reduce patient irritability, and were taught ways to use a verbal cue to remind the patient to use pretrained self-control methods. Patients and family members were also asked to increase the number of pleasant events in which they engaged as a general means to decrease the patients' anger outbursts. These cases showed evidence that the treatment program reduced the frequency of anger outbursts and, in one case, increased the social participation by the patient immediately after treatment and at one-month and three-month follow-up assessments. The importance of having key family members involved in anger management training for brain injured patients is underscored, particularly when cognitive impairment limits patients' ability to benefit from and to retain the content of psychotherapy.