Hart et al.

(2017)

USA

RCT

PEDro=7

N_Start=90, N_End=84

Population: TBI; Severity: Severe. Treatment Group (n=60): Mean Age=30.4yr; Gender: Male=49, Female=11; Median Time Post Injury=69mo. Control Group (n=30): Mean Age=36.2yr; Gender: Male=24, Female=6; Median Time Post Injury=72mo.

Intervention: Participants were randomized to receive anger self-management training (treatment) or personal readjustment and education (control) in 90min weekly sessions for 8wk. Assessments were conducted at baseline, 4wk, 8wk, and 16wk.

Outcome Measure: State-Trait Anger Expression Inventory 2 (STAXI-2); Brief Anger-Aggression Questionnaire (BAAQ).

1.          At 8wk, the proportion of responders on self-reported STAXI-2 Trait Anger was significantly greater in the treatment group than control group for intention-to-treat analysis (68.3% versus 46.7%, p=0.047) and per protocol analysis (71.9% versus 51.9%, p=0.031); these improvements were maintained at 16wk.

2.          There were no significant differences in response rates between groups on self-reported STAXI-2 Anger Expression-Out or BAAQ at 8wk or 16wk.

3.          There were no significant differences in response rates between groups on STAXI-2 or BAAQ as rated by a significant other at 8wk or 16wk.

4.          There were no significant differences between groups in mean scores on STAXI-2 or BAAQ by self-report over time.

Aboulafia-Brakha et al.

(2016)

Switzerland

RCT

N_Initial=24, N_Final=19

Population: ABI: TBI=15, Stroke=4; Gender: Male=16, Female=3; Mean GCS=7.8; Intervention Group (N=8): Mean Age=46.1yr; Mean Time Post Injury=12.7mo; Control Group (N=11): Mean Age=39.3yr; Mean Time Post Injury=19.45mo

Intervention: Patients self-reporting increased anger were randomized to one of two groups (AB or BA). The AB group received an 8-wk anger management programme (60 min, 1x/wk), followed by a 4wk psycho-educational programme. For group BA, the order was reversed. Outcomes were assessed at baseline: 6–12wk prior intervention (T0), second baseline: first session (T1), 4wk after beginning the intervention (T2), 8wk after beginning the intervention (T3), 12wk after the intervention, the final assessment (T4).

Outcome Measures: The Aggression Questionnaire (AQ-12), State-Trait Anger and Expression Inventory (STAXI-2), Multidimensional Anger Reaction Scale (MARS).

1.        AQ-12 scores significantly improved from TI to T4 (p = 0.01).

2.        All STAXI-2 subscales showed significant improvement from T1 to T4 (p < 0.01).

3.        MARS subscales of rumination and

venting showed significant improvement from T1 to T4 (p = 0.01; p = 0.04). Other subscales were non-significant (p > 0.05).

Medd & Tate

(2000)

Australia

RCT

PEDro=5

N=16

Population: TBI; Gender: Male=14, Female=2. Treatment Group (n=8): Mean Age=35.88yr; Mean Time Post Injury=37.25mo; Waitlist Group (n=8): Mean Age=34yr; Mean Time Post Injury=74.25mo.

Intervention: Participants were randomly allocated to either the treatment group or the waitlist group. The treatment group received 5-8 individualized sessions of cognitive behavioural therapy based on the Commonwealth Rehabilitation Service Anger Management Program.

Outcome Measure: State-Trait Anger Expression Inventory (STAXI), Hospital Anxiety and Depression Scale (HADS), Self-Esteem Inventories (SEI), Patient Competency Rating Scale (PCRS).

1.          The treatment group had significantly higher pre-intervention levels of Anger Expression-Out (AX-O) on the STAXI than the waitlist group (p=0.004).

2.          The treatment group showed a greater improvement in AX-O (p=0.006) and trait anger (p=0.054) from pre to post treatment when compared to the waitlist group.

3.          No significant differences were found on HADS, SEI, or PCRS between groups.

Aboulafia-Brakha et al.

(2013)

Switzerland

Pre-Post

N_Initial=10, N_Final=9

Population: TBI; Median Age=47yr; Gender: Male=8, Female=2; Median Time Post Injury=27.5mo; Median GCS=5.

Intervention: Participants completed a semi-structured group treatment program for the management of anger and aggressiveness (1 hr, 1 day/wk for 8wk). The program was based on a cognitive behavioural therapy framework as led by a therapist. Inter-session homework was encouraged to apply new strategies. Outcomes were assessed at baseline, immediately after treatment, and at 4-5mo follow-up.

Outcome Measure: Buss and Perry Aggression Questionnaire (AQ-12), UPPS Impulsive Behaviour Scale (UPPS-P), Frontal System Behavioural Scale (FrSBe), Cambridge Behaviour Scale (EQ), Hospital Anxiety Depression Scale (HADS), Quality of Life Assessment (SF-36).

1.        Significant improvement in feelings of aggression on AQ-12 was found from baseline to follow-up (p=0.02).

2.          No significant improvement on AQ-12 was found from baseline to post treatment (p=0.84) or from post treatment to follow-up (p=0.57).

3.          No significant improvements were found for UPPS-P, FrSBe, EQ, HADS, or SF-36 between baseline and post treatment (p>0.05).

Hart et al.

(2012)

USA

Pre-Post

N=10

Population: TBI; Mean Age=43.3yr; Gender: Male=8, Female=2; Range of Time Post Injury=6-243mo; Range of Injury Severity: Moderate to Severe.

Intervention: 8 sessions that consisted of self-monitoring training to build awareness of anger problem and training of specific problem solving skills (anger self-management training).

Outcome Measure: State Trait Anger Expression Inventory 2 (STAXI-2), Brief Anger-Aggression Questionnaire (BAAQ).

1.          Following the intervention, there were significant reductions on self-reported STAXI-2 Trait Anger (p=0.02), STAXI-2 Anger Expression-Out (p=0.002), and BAAQ (p=0.01).

2.          There were no significant improvements on STAXI-2 or BAAQ as rated by a significant other.

Walker et al.

(2010)

Australia

Pre-Post

N=52

Population: TBI; Mean Age=32.3yr; Gender: Male=40, Female=12; Mean Time Post Injury=4.1yr; Injury Severity: Severe.

Intervention: Participants received 2hr sessions of group-based CBT focused on anger management, 1 x/wk for 12wk. Assessments were conducted at baseline, 12wk, and 3-16mo follow-up.

Outcome Measure: State-Trait Anger Expression Inventory (STAXI).

1.          At post treatment, there were significant reductions in trait anger (p=0.002), anger expression-out (p=0.003), and anger control (p=0.005), but not in state anger or anger expression-in.

2.          At follow-up (n=31), the improvements from baseline were maintained, but there were no further improvements from post treatment.

O’Leary

(2000)

USA

Pre-Post

N=5

Population: ABI; Age Range=21-42yr; Gender: Male=5, Female=0; Time Post Injury Range=4 mo-5 yr.

Intervention: Patients attended a 10wk training cognitive behavioural therapy program for anger management and coping skills through the use of written materials, audiotapes, lectures, role-play, and group discussions.

Outcome Measure: Frequency of aggression.

Feeney & Ylvisaker

(1995)

USA

Case Series

N=3

Population: TBI; Mean Age=18.3yr; Injury Severity: Severe.

Intervention: Patients received antecedent interventions, comprised of photographic and written cues, for managing aggression.

Outcome Measure: Aberrant Behaviour Checklist (ABC).

1.          All three patients showed a decrease in aggressive behaviours and ABC ratings indicated decreased intensity.

2.          Two patients showed a mild increase in aggressive behaviours with written cues, which decreased when substituted with photographic cues.

Burke et al.

(1988)

USA

Pre-Post

N=5

Population: TBI; Mean Age=23.2yr; Gender: Male=5, Female=0.

Intervention: Patients received behaviour therapy, with emphasis on reinforcement and antecedent conditions, for managing aggression.

Outcome Measure: Frequency of aggression.

1.          Measurements showed a 97% decrease in aggressive behaviour from baseline levels at 1wk and 100% at 3 wk.

2.          There was a significant reduction in behaviour at all time-points compared to baseline (p<0.001).

3.          No incidents of aggression were recorded during a 6mo follow-up.