Anger Self-Management in Post-Acute Traumatic Brain Injury: Clinic Trial

描述(由申请人提供)：创伤性脑损伤(TBI)后，有问题的愤怒和易怒是常见和持久的，涉及各种损伤严重程度。愤怒症状对情绪健康、社区生活以及家庭和社会关系都有负面影响。创伤性脑损伤后的问题愤怒有许多原因，包括损伤的器质性和非器质性影响或继发性影响。执行功能的特征缺陷，例如自我监控和解决问题的缺陷，也起到了作用。可用的治疗方法包括药物治疗、行为矫正和认知行为干预，但很少有人适应患有脑外伤的社区居民的需求，也几乎没有进行过治疗试验。本研究是一项第二阶段的临床试验，旨在测试一种名为愤怒自我管理训练(ASMT)的新治疗方法的价值，并与提供教育和心理支持(EPS)的对照治疗方法进行比较，后者具有同等的治疗师时间和治疗结构。ASMT是一种基于自我监控和解决问题培训的原则的8节个别心理教育干预。ASMT的一项单中心试点研究显示，从治疗前到治疗后，愤怒和愤怒表达的标准化测量有所改善；本试验的目的是在更大、更多样化的样本中将其与EPS进行比较。有问题愤怒的参与者在复杂的轻度、中度或重度颅脑损伤后至少6个月，如果有显著的其他人(SO)，将被随机分为ASMT或EPS。治疗前后对自我报告的愤怒程度的治疗反应将作为主要结果。共有99名参与者将从3个临床站点招募。次要结果包括治疗反应的轨迹和持久性；所报告的参与者愤怒的变化；情绪和行为状态；以及生活质量。将检查参与者的特征，以确定他们与治疗反应的关联。如果试验证明了对ASMT的进一步研究的价值，这种治疗模式最终可能提供一种容易传播的方法，通过这种方法，脑外伤患者可以学习重新控制有问题的愤怒/易怒。

DESCRIPTION (provided by applicant): Problematic anger and irritability are common and persistent after traumatic brain injury (TBI) across the spectrum of injury severity. Anger symptoms have negative effects on emotional well-being, community living, and family and social relationships. Problematic anger after TBI has numerous causes including organic and non-organic or secondary effects of injury. Characteristic deficits in executive function, e.g. impaired self-monitoring and problem-solving deficits, also play a role. Available treatments include medications, behavior modification, and cognitive-behavioral interventions, but few have been adapted to the needs of community dwelling persons with TBI and few treatment trials have been conducted. The present study is a Phase II clinical trial designed to test the worth of a novel treatment approach called Anger Self-Management Training (ASMT), compared to a control treatment offering education and psychological support (EPS) with equivalent therapist time and therapeutic structure. The ASMT is an 8-session, individual, psycho-educational intervention based on principles of self-monitoring and problem-solving training. A single-center pilot study of the ASMT showed improvement on standardized measures of anger and anger expression from pre to post treatment; the purpose of the present trial is to compare it to EPS in a larger, more diverse sample. Participants with problematic anger who are at least 6 months post complicated mild, moderate or severe TBI, and a Significant Other (SO), if available, will be randomized 2:1 to ASMT or EPS. Treatment response on measures of self-reported anger pre- to post-treatment will serve as the primary outcome. A total of 99 participants will be enrolled from 3 clinical sites. Secondary outcomes include trajectory and persistence of treatment response; change in SO-reported participant anger; emotional and behavioral status; and quality of life. Characteristics of participants will be examined for their association to treatment response. If the trial demonstrates the value of further study of the ASMT, this treatment model may eventually offer a readily disseminable method by which people with TBI can learn to regain personal control over problematic anger/ irritability.