Jade Abigail Witten
Rudi Coetzer
Oliver H. Turnbull1
- 1School of Human and Behavioral Sciences, Bangor University, Bangor, United Kingdom
- 2The Disabilities Trust, Wakefield, United Kingdom
Uncontrollable anger is common following an acquired brain injury (ABI), with impaired emotion regulation (ER) being one of the main contributors. Existing psychological interventions appear moderately effective, though studies typically include limitations such as small sample sizes, issues of long-term efficacy, and standardization of content. While ER has been a popular research field, the study of ER for anger management after ABI is less well investigated, and contains few interventions based on the widely used Process Model of ER. This review surveys the efficacy of ER strategies in individuals with ABI, and proposes a novel research design for future interventions. Recommendations are made about: strategy number and type, shared decision-making, approaches to data analysis, and mode of delivery.
Introduction
It is estimated that 69 million individuals suffer from a Traumatic Brain Injury (TBI) globally each year (Dewan et al., 2018), making it one of the leading causes of death and disability worldwide1 (Hyder et al., 2007). In addition to the well-known cognitive impairment, survivors of TBIs and other types of acquired brain injuries (ABI), such as cerebrovascular accidents, experience substantial difficulties with social functioning and employment2. These difficulties are further compounded by the presence of aggressive outbursts post-injury (Sabaz et al., 2014).
Uncontrollable anger is common following an ABI (Khan et al., 2003; Caplan et al., 2015; Neumann et al., 2017), with an estimated prevalence of up to 41% during the first 5 years post-injury (Tateno et al., 2003; Baguley et al., 2006; Rao et al., 2009; Roy et al., 2017). Family and loved ones are typically the recipients of uncontrollable expressions of anger, reporting sudden and unpredictable outbursts (Saban et al., 2015). Amongst environmental factors, such responses are likely due to impaired emotion regulation (ER; Arciniegas and Wortzel, 2014; Salas et al., 2014; Caplan et al., 2015; Aboulafia-Brakha et al., 2016; Winter et al., 2018): the ability to modify and control personal experiences and expressions of emotion (Gross, 1998a,2002).
The majority of anger management interventions for individuals with ABI (see Byrne and Coetzer, 2016) or mental health disorders (see Ross et al., 2013), focus on physical manifestations of aggression. This focus excludes an individual’s subjective experience of anger (i.e., emotional outbursts), with important implications for gender differences. An international survey demonstrated equivalent levels of anger for men and women, recognizing that women are less likely to transform subjective anger into acts of physical aggression (Özkarar-Gradwohl and Turnbull, 2021). This may explain why domestic abuse is a gendered crime, with implications for treatment eligibility.
Psychological Interventions for Aggression
Psychological interventions appear moderately effective (d = −0.46) in populations with ABI (see Byrne and Coetzer, 2016; Iruthayarajah et al., 2018) and mental health disorders (see Ross et al., 2013; Lee and DiGiuseppe, 2018). The majority of these interventions are based on cognitive behavioral therapy (CBT), which include several limitations.
Small sample size (e.g., single case studies; n = 1) is a common limitation (Alderman et al., 2013; Ross et al., 2013; Byrne and Coetzer, 2016; Iruthayarajah et al., 2018). Studies in populations with mental health disorders contain larger samples than those with ABI. Ross et al. (2013) reported samples ranging from 3 to 290, while Byrne and Coetzer (2016) and Iruthayarajah et al. (2018) reported ABI samples ranging from 1 to 52. While an adequate sample size is necessary for scientific rigor, the inherent nature of recruiting from clinical populations (and especially those with ABI), makes this a challenging limitation to overcome (e.g., see Armstrong et al., 2020).
The long-term efficacy of interventions is also under-investigated, partly because not all studies include follow-up assessments (Byrne and Coetzer, 2016; Iruthayarajah et al., 2018). The majority of studies that do report follow-up data do not report therapeutic efficacy over time (Ross et al., 2013; Byrne and Coetzer, 2016), meaning that potential gains are not measured.
The standardization of interventions is another issue (e.g., Ross et al., 2013; Byrne and Coetzer, 2016). Ross et al. (2013) report differences in the CBT content across studies (i.e., standard CBT versus additional study-specific components), as well as differences in dosage or intensity (i.e., hours versus days), and modality (i.e., individual versus group), of treatments. Some interventions encourage participant involvement in the rehabilitation process (e.g., see McClain, 2005). Mode of administration varies across settings, with an increase in virtually administered services since the COVID-19 pandemic (Wosik et al., 2020). Lastly, Lee and DiGiuseppe (2018) report that interventions such as CBT may be more effective, however, this field requires further research with non-CBT interventions.
The Process Model of Emotion Regulation
None of the studies included in previous reviews (Byrne and Coetzer, 2016; Iruthayarajah et al., 2018) used interventions based on a theoretically driven perspective, which relates to impaired ER as the likely mechanism of uncontrollable anger after ABI (Khan et al., 2003; Arciniegas and Wortzel, 2014; Salas et al., 2014; Caplan et al., 2015; Aboulafia-Brakha et al., 2016; Neumann et al., 2017; Winter et al., 2018). Although approaches such as CBT are widely used for anger management, they lack the focus on ER as the primary mechanism for moderating emotions (Salas et al., 2019). The Process Model of ER (Gross, 1998a,2014) is the only model that has informed ER studies after ABI (Salas et al., 2013, 2014; Rowlands et al., 2019, 2021), suggesting five classes of ER strategies: cognitive change, attentional deployment, situation selection, situation modification, and response modulation.
This article has two aims. Firstly, to discuss the efficacy of each strategy in individuals with ABI and/or non-clinical samples. Secondly, to recommend an anger management intervention for individuals with ABI, that includes at least two ER strategies. To demonstrate the difference between strategies, we discuss each in relation to a practical example of “arguing with a partner.”
Reappraisal
This strategy refers to altering the way an event is perceived (Gross, 2014). For example, after the argument, “we discussed practical ways of communicating better.” Reappraisal is one form of cognitive change, and is widely used to regulate discrete emotions in non-clinical samples (e.g., Nezlek and Kuppens, 2008) and individuals with ABI (e.g., Salas et al., 2013, 2014; Rowlands et al., 2019, 2021). A meta-analysis by Webb et al. (2012) investigated the efficacy of cognitive change, attentional deployment and response modulation in non-clinical samples. They reported a small-to-medium effect (d+ = 0.36) for reappraising emotional reactions. In comparison to other strategies such as response modulation and attentional deployment, evidence suggests that reappraisal is more effective when regulating negative emotions (McRae et al., 2010; Webb et al., 2012; Kalokerinos et al., 2015), and is preferred over attentional deployment for lower levels of affect (Gross, 2013; Van Bockstaele et al., 2020).
The few studies investigating reappraisal in ABI suggest that this strategy relies on executive elements that are often impaired in individuals with ABI (Salas et al., 2013, 2014; Dunning et al., 2016; Livny et al., 2017; Rowlands et al., 2019). For example, working memory, verbal fluency, and inhibition affected how long it took individuals with an ABI to produce a reappraisal, and working memory also affected the number of reappraisals produced (Salas et al., 2014; Rowlands et al., 2019).
Thus reappraisal is arguably more cognitively demanding than other ER strategies. However, findings suggest that once produced, they decrease the intensity of anger3 for individuals with ABI, in the same way as they do for neurologically normal individuals (Rowlands et al., 2019). While reappraisal appears challenging for individuals with cognitive impairment (Salas et al., 2014; Rowlands et al., 2019), it may still be a useful strategy, depending on the level of impairment. For example, individuals with milder cognitive sequelae may be suitable candidates, a line of enquiry that is worth exploring. Reappraisal therefore appears to be a suitable ER strategy for individuals with ABI who have cognitive impairment, because it is a widely investigated strategy, and one of the few strategies investigated in ABI, that has also demonstrated effectiveness for regulating negative emotions such as anger. In addition, it would be particularly relevant to compare reappraisal to another strategy that is less cognitively taxing.
Attentional Deployment
This strategy refers to moving attention away from emotion-evoking stimuli (Gross, 2014). For example, after the argument, “we chose to distract ourselves by watching a film.” Webb et al.’s (2012) meta-analysis report no effect size for attentional deployment as a strategy for emotional reactions in non-clinical samples. However, they suggest that the effectiveness of attentional deployment depends on strategy type. Two examples of attentional deployment are distraction (focusing on memories unrelated to the target emotion) and concentration (focusing on a task that elicits positive affect; Gross, 1998b). Findings from Webb et al.’s (2012) meta-analysis suggest that concentration is ineffective for emotional reactions (d+ = −0.26), whereas distraction is (d+ = 0.27).
Although findings suggest that decreased cognitive control impedes the execution of attentional deployment in neurologically normal individuals (Lohani and Isaacowitz, 2014; Wirth and Kunzmann, 2018), studies have yet to investigate the influence of executive functions on this strategy’s implementation and efficacy in ABI with cognitive impairment (Salas et al., 2019). Attentional deployment might be another suitable strategy. Firstly, compared to reappraisal, this strategy is preferred for regulating negative emotions in older adults (Scheibe et al., 2015). Secondly, distraction is preferred over reappraisal when regulating high levels of affect (Gross, 2013; Van Bockstaele et al., 2020). One explanation for this preference could be that these individuals find distraction less cognitively taxing. Overall, these findings, coupled with the fact that the majority of individuals who sustain an ABI are older adults (M = 47.8 years for TBI and M = 58.8 years for non-TBI; Colantonio et al., 2011), suggest that distraction is a strategy worth exploring.
Situation Selection
This strategy refers to choosing which situations to embrace or avoid, depending on the desired emotional outcome (Gross, 2014). For example, “we chose to go shopping at quieter times, as shopping during busy times leads to arguments.” Webb et al.’s (2012) meta-analysis does not include data for the effectiveness of situation selection, and this strategy has yet to be investigated in ABI. However, Webb et al. (2018) explored situation selection in two non-clinical samples, and propose two advantages: (1) it may be less cognitively demanding in comparison to other strategies; and (2) it does not require individuals to manage their emotions immediately. In terms of cognitive demand, Salas et al. (2019) suggest that situation selection may not be suitable for individuals with lesions to the ventromedial prefrontal cortex (vmPFC). It therefore seems inappropriate to include this strategy in a comparative anger regulation intervention for ABI, if individuals have sustained lesions to the vmPFC.
Situation Modification
This strategy refers to adapting one’s environment in accordance with a favorable emotional milieu (Gross, 2014). For example, “we agree on a grocery list before shopping, as shopping without one leads to arguments about what to buy.” Webb et al.’s (2012) meta-analysis does not include situation modification, and this strategy has yet to be investigated in ABI. Van Bockstaele et al. (2020) explored situation modification in a non-clinical sample, by allowing participants to choose between modification, distraction or reappraisal. Their findings suggest that situation modification is effective for regulating high levels of negative affect. While Livingstone and Isaacowitz (2015) propose that situation modification is not cognitively demanding, Salas et al. (2019) suggest that it might not be effective for individuals with lesions to the dorsolateral prefrontal cortex or vmPFC. It therefore seems inappropriate to include situation modification as part of a comparative anger regulation intervention for ABI.
Response Modulation
This strategy refers to changing an already elicited emotional response (Gross, 2014). For example, “we agree not to have the argument while we are shopping.” Webb et al.’s (2012) meta-analysis report a small effect for using response modulation for emotional reactions. Suppression, a type of response modulation, refers to purposely inhibiting an emotional reaction (Gross and Levenson, 1997). This strategy is particularly effective for inhibiting emotional expression, in comparison to inhibiting thoughts related to the emotion-inducing event.
Only one study has investigated response modulation in ABI. Salas et al. (2016) found that individuals with lesions to the right PFC and insula struggled to purposely inhibit or intensify the relevant facial expressions associated with positive emotions during a response modulation task. In terms of cognitive demand, they suggest that inhibitory control is associated with effectively suppressing positive emotions. Since response modulation relies on the ability to control the motor expressions associated with emotions, this strategy may not be effective for individuals with right frontal and insula lesions (Salas et al., 2019). Furthermore, evidence suggests that suppression is ineffective for regulating negative emotions (Kalokerinos et al., 2015). Taken together, it seems less optimal to include response modulation as part of a comparative anger regulation intervention for ABI.
Discussion
While ER has been a popular research field (Gross, 2013), the study of ER after ABI is less well investigated (Salas et al., 2019). This article makes some recommendations about subjective experiences of anger, in relation to strategy number and type, shared decision-making, approaches to data analysis, and mode of delivery.
Number of Strategies
The majority of studies investigate a single strategy (see Webb et al., 2012), while only a minority directly compare two or more (e.g., McRae et al., 2010; Kanske et al., 2011; Kalokerinos et al., 2015; Livingstone and Isaacowitz, 2015; Scheibe et al., 2015; Van Bockstaele et al., 2020). While single-strategy studies are noteworthy, good clinical practice would be to directly compare the efficacy of more than one approach, especially since some strategies rely on cognitive abilities often affected after ABI (Salas et al., 2014; Rowlands et al., 2019). In terms of comparative efficacy, the debate remains as to whether approaches stemming from a particular class of strategy are equally effective, or whether approaches from one class may be more effective than another (McRae et al., 2010; Kanske et al., 2011; Strauss et al., 2016).
Strategy Type
Reappraisal is widely investigated, and the only strategy explored in ABI. Despite its cognitive demands, it has demonstrated evidence of regulating negative emotions by decreasing their intensity (e.g., Salas et al., 2013; Rowlands et al., 2019). Thus, it appears sensible to include reappraisal as one of the investigated strategies. A strategy that is less cognitively taxing, such as distraction, would present a good comparison, especially for regulating high levels of affect in older adults (Gross, 2013; Scheibe et al., 2015; Van Bockstaele et al., 2020). It is likely that the same lesion sites implicated in situation selection and modification are also implicated in reappraisal and distraction. However, evidence supports the efficacy and preference of the latter two strategies, and encourages prioritizing the investigation of these first. Furthermore, experimental conditions for strategies such as situation selection and modification might be challenging for individuals with ABI and cognitive impairment, if they are required to independently maintain their concentration during a computer-based task.
Patient Agency and Choice
Shay and Lafata’s (2015) meta-analysis suggests that shared decision-making produced better affective-cognitive outcomes. Although the collaborative setting of treatment goals in neuro-rehabilitation has been considered in the literature (see e.g., McClain, 2005), active treatment choice by patients has, to our knowledge, not been empirically investigated in individuals with ABI. A novel intervention would give individuals with ABI the agency to choose a strategy that suits their strengths and circumstances.
Data Analysis
The majority of studies in Webb et al.’s (2012) meta-analysis used quantitative measures, but a few used qualitative approaches. We suggest the use of a well-established quantitative measure of anger, with an additional qualitative component. An example of the former would be the State-Trait Anger Expression Inventory-2 (Spielberger, 1999), or the Overt Behavior Scale (Kelly et al., 2006), both of which include verbal and physical aggression subscales. An example of the latter would be semi-structured interviews on anger and the use of ER strategies. This combination is useful for two reasons: (1) it could yield insights into mechanisms behind the efficacy of interventions; and (2) it provides an alternative way to analyze data from underpowered clinical studies.
Telemedicine
In light of the COVID-19 pandemic, delivery of many clinical services has shifted from in-person to virtually (Wosik et al., 2020), and telehealth has demonstrated advantages over in-person care4 (see Molini-Avejonas et al., 2015). Although there are limitations to virtual service delivery5 (Shaw et al., 2018; Cole et al., 2019; Mubaraki et al., 2021), evidence for the clinical effectiveness of telemedicine across a range of health sectors (see Bensink et al., 2006) supports virtually administered over in-person interventions (e.g., Rietdijk et al., 2020).
Furthermore, while evidence for telehealth in ABI is still emerging, results are encouraging, and show promise for future service delivery. For example, a patient with an ABI, who has been identified by their General Practitioner as someone with difficulties regulating anger, could be referred to an ER-based virtual intervention program. This program would consist of one-to-one Zoom meetings that focus on practical application of one or more ER strategies, with a homework component.
Conclusion
The field of ER has grown dramatically over the last three decades, highlighting its importance for understanding emotions in both clinical and non-clinical populations. While there has been tremendous progress in certain areas of the field, ER as a rehabilitative tool after ABI remains under-developed. ER interventions have the potential to help individuals with ABI manage their lives, in areas where they and their loved ones have substantial difficulties. These interventions can also contribute to the understanding of the brain basis of managing anger, and the underpinning mechanisms of change.
Author Contributions
JAW wrote the first draft of the manuscript. OHT and RC contributed to the writing, revising, and editing of the manuscript. All authors contributed to the design of the manuscript, and read and approved the submitted version.
Funding
This work was supported by The Oppenheimer Memorial Trust and Bangor University (JAW).
Conflict of Interest
The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.
Publisher’s Note
All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article, or claim that may be made by its manufacturer, is not guaranteed or endorsed by the publisher.
Footnotes
- ^ The Global Burden of Disease Study (2017) identified stroke and road injuries as two of the top ten leading causes of early death worldwide (Institute for Health Metrics and Evaluation [IHME], 2018).
- ^ These difficulties include problems with relationships and social interactions, decreased social contact, loss of old friendships or difficulty creating new ones, and unemployment or issues with returning to work (Morton and Wehman, 1995; Shames et al., 2007; Benedictus et al., 2010; Grauwmeijer et al., 2012; Ma et al., 2014; Ponsford et al., 2014; Stocchetti and Zanier, 2016; Ruet et al., 2018; Salas et al., 2018).
- ^ As well as other negative emotions such as fear and sadness.
- ^ Such as access to services, greater outreach for individuals living in rural areas, and reduced to no travel and wait times (Molini-Avejonas et al., 2015).
- ^ Such as access to efficient internet, technical difficulties, diagnostic challenges due to the lack of physical contact, and negative perceptions about telecare (Shaw et al., 2018; Cole et al., 2019; Mubaraki et al., 2021).
References
Aboulafia-Brakha, T., Allain, P., and Ptak, R. (2016). Emotion regulation after traumatic brain injury: distinct patterns of sympathetic activity during anger expression and recognition. J. Head Trauma Rehabil. 31, E21–E31. doi: 10.1097/HTR.0000000000000171
Alderman, N., Knight, C., and Brooks, J. (2013). Rehabilitation approaches to the management of aggressive behaviour disorders after acquired brain injury. Brain Impair. 14, 5–20.
Arciniegas, D. B., and Wortzel, H. S. (2014). Emotional and behavioral dyscontrol after traumatic brain injury. Psychiatr. Clin. North Am. 37, 31–53. doi: 10.1016/j.psc.2013.12.001
Armstrong, E., McAllister, M., Hersh, D., Katzenellenbogen, J. M., Thompson, S. C., Coffin, J., et al. (2020). A screening tool for acquired communication disorders in Aboriginal Australians after brain injury: lessons learned from the pilot phase. Aphasiology 34, 1388–1412.
Baguley, I. J., Cooper, J., and Felmingham, K. (2006). Aggressive behavior following traumatic brain injury: How common is common? J. Head Trauma Rehabil. 21, 45–56. doi: 10.1097/00001199-200601000-00005
Benedictus, M. R., Spikman, J. M., and van der Naalt, J. (2010). Cognitive and behavioral impairment in traumatic brain injury related to outcome and return to work. Arch. Phys. Med. Rehabil. 91, 1436–1441. doi: 10.1016/j.apmr.2010.06.019
Bensink, M., Hailey, D., and Wootton, R. (2006). A systematic review of successes and failures in home telehealth: preliminary results. J. Telemed. Telecare 12, 8–16.
Byrne, C., and Coetzer, R. (2016). The effectiveness of psychological interventions for aggressive behavior following acquired brain injury: a meta-analysis and systematic review. Neurorehabilitation 39, 205–221. doi: 10.3233/NRE-161352
Caplan, B., Bogner, J., Brenner, L., Bailie, J. M., Cole, W. R., Ivins, B., et al. (2015). The experience, expression, and control of anger following traumatic brain injury in a military sample. J. Head Trauma Rehabil. 30, 12–20. doi: 10.1097/HTR.0000000000000024
Colantonio, A., Gerber, G., Bayley, M., Deber, R., Yin, J., and Kim, H. (2011). Differential profiles for patients with traumatic and non-traumatic brain injury. J. Rehabil. Med. 43, 311–315. doi: 10.2340/16501977-0783
Cole, B., Pickard, K., and Stredler-Brown, A. (2019). Report on the use of telehealth in early intervention in Colorado: strengths and challenges with telehealth as a service delivery method. Int. J. Telerehabil. 11, 33–40. doi: 10.5195/ijt.2019.6273
Dewan, M. C., Rattani, A., Gupta, S., Baticulon, R. E., Hung, Y. C., Punchak, M., et al. (2018). Estimating the global incidence of traumatic brain injury. J. Neurosurg. 130, 1080–1097. doi: 10.3171/2017.10.JNS17352
Dunning, D. L., Westgate, B., and Adlam, A. L. R. (2016). A meta-analysis of working memory impairments in survivors of moderate-to-severe traumatic brain injury. Neuropsychology 30, 811–819. doi: 10.1037/neu0000285
Grauwmeijer, E., Heijenbrok-Kal, M. H., Haitsma, I. K., and Ribbers, G. M. (2012). A prospective study on employment outcome 3 years after moderate to severe traumatic brain injury. Arch. Phys. Med. Rehabil. 93, 993–999. doi: 10.1016/j.apmr.2012.01.018
Gross, J. J. (1998a). Antecedent- and response-focused emotion regulation: divergent consequences for experience, expression, and physiology. J. Pers. Soc. Psychol. 74, 224–237. doi: 10.1037//0022-3514.74.1.224
Gross, J. J. (1998b). The emerging field of emotion regulation: an integrative review. Rev. Gen. Psychol. 2, 271–299.
Gross, J. J. (2002). Emotion regulation: affective, cognitive, and social consequences. Psychophysiology 39, 281–291. doi: 10.1017/s0048577201393198
Gross, J. J. (2013). Emotion regulation: taking stock and moving forward. Emotion 13, 359–365. doi: 10.1037/a0032135
Gross, J. J. (2014). “Emotion regulation: conceptual and empirical foundations,” in Handbook of Emotion Regulation, ed. J. J. Gross (New York, NY: Guilford Press), 3–20.
Gross, J. J., and Levenson, R. W. (1997). Hiding feelings: the acute effects of inhibiting negative and positive emotion. J. Abnorm. Psychol. 106, 95–103. doi: 10.1037//0021-843x.106.1.95
Hyder, A. A., Wunderlich, C. A., Puvanachandra, P., Gururaj, G., and Kobusingye, O. C. (2007). The impact of traumatic brain injuries: a global perspective. Neurorehabilitation 22, 341–353.
Institute for Health Metrics and Evaluation [IHME] (2018). Findings from the Global Burden of Disease Study 2017. Available online at: http://www.healthdata.org (accessed March 7, 2022).
Iruthayarajah, J., Alibrahim, F., Mehta, S., Janzen, S., McIntyre, A., and Teasell, R. (2018). Cognitive behavioural therapy for aggression among individuals with moderate to severe acquired brain injury: a systematic review and meta-analysis. Brain Inj. 32, 1443–1449. doi: 10.1080/02699052.2018.1496481
Kalokerinos, E. K., Greenaway, K. H., and Denson, T. F. (2015). Reappraisal but not suppression downregulates the experience of positive and negative emotion. Emotion 15, 271–275. doi: 10.1037/emo0000025
Kanske, P., Heissler, J., Schönfelder, S., Bongers, A., and Wessa, M. (2011). How to regulate emotion? Neural networks for reappraisal and distraction. Cereb. Cortex 21, 1379–1388. doi: 10.1093/cercor/bhq216
Kelly, G., Todd, J., Simpson, G., Kremer, P., and Martin, C. (2006). The Overt Behaviour Scale (OBS): a tool for measuring challenging behaviours following ABI in community settings. Brain Inj. 20, 307–319. doi: 10.1080/02699050500488074
Khan, F., Baguley, I. J., and Cameron, I. D. (2003). 4: rehabilitation after traumatic brain injury. Med. J. Aust. 178, 290–295. doi: 10.5694/j.1326-5377.2003.tb05199.x
Lee, A. H., and DiGiuseppe, R. (2018). Anger and aggression treatments: a review of meta-analyses. Curr. Opin. Psychol. 19, 65–74. doi: 10.1016/j.copsyc.2017.04.004
Livingstone, K. M., and Isaacowitz, D. M. (2015). Situation selection and modification for emotion regulation in younger and older adults. Soc. Psychol. Pers. Sci. 6, 904–910. doi: 10.1177/1948550615593148
Livny, A., Biegon, A., Kushnir, T., Harnof, S., Hoffmann, C., Fruchter, E., et al. (2017). Cognitive deficits post-traumatic brain injury and their association with injury severity and gray matter volumes. J. Neurotrauma 34, 1466–1472. doi: 10.1089/neu.2016.4598
Lohani, M., and Isaacowitz, D. M. (2014). Age differences in managing response to sadness elicitors using attentional deployment, positive reappraisal and suppression. Cogn. Emot. 28, 678–697. doi: 10.1080/02699931.2013.853648
Ma, V. Y., Chan, L., and Carruthers, K. J. (2014). Incidence, prevalence, costs, and impact on disability of common conditions requiring rehabilitation in the United States: stroke, spinal cord injury, traumatic brain injury, multiple sclerosis, osteoarthritis, rheumatoid arthritis, limb loss, and back pain. Arch. Phys. Med. Rehabil. 95, 986–995. doi: 10.1016/j.apmr.2013.10.032
McClain, C. (2005). Collaborative rehabilitation goal setting. Top. Stroke Rehabil. 12, 56–60. doi: 10.1310/ELB1-EGKF-QUQC-VFE9
McRae, K., Hughes, B., Chopra, S., Gabrieli, J. D. E., Gross, J. J., and Ochsner, K. N. (2010). The neural bases of distraction and reappraisal. J. Cogn. Neurosci. 22, 248–262. doi: 10.1162/jocn.2009.21243
Molini-Avejonas, D. R., Rondon-Melo, S., de La Higuera Amato, C. A., and Samelli, A. G. (2015). A systematic review of the use of telehealth in speech, language and hearing sciences. J. Telemed. Telecare 21, 367–376. doi: 10.1177/1357633X15583215
Morton, M. V., and Wehman, P. (1995). Psychosocial and emotional sequelae of individuals with traumatic brain injury: a literature review and recommendations. Brain Inj. 9, 81–92. doi: 10.3109/02699059509004574
Mubaraki, A. A., Alrabie, A. D., Sibyani, A. K., Aljuaid, R. S., Bajaber, A. S., and Mubaraki, M. A. (2021). Advantages and disadvantages of telemedicine during the COVID-19 pandemic era among physicians in Taif, Saudi Arabia. Saudi Med. J. 42, 110–115. doi: 10.15537/smj.2021.1.25610
Neumann, D., Malec, J. F., and Hammond, F. M. (2017). Negative attribution bias and anger after traumatic brain injury. J. Head Trauma Rehabil. 32, 197–204. doi: 10.1097/HTR.0000000000000259
Nezlek, J. B., and Kuppens, P. (2008). Regulating positive and negative emotions in daily life. J. Pers. 76, 561–580. doi: 10.1111/j.1467-6494.2008.00496.x
Özkarar-Gradwohl, F. G., and Turnbull, O. H. (2021). Gender effects in personality: a cross-cultural affective neuroscience perspective. Cult. Brain 9, 79–96.
Ponsford, J. L., Downing, M. G., Olver, J., Ponsford, M., Acher, R., Carty, M., et al. (2014). Longitudinal follow-up of patients with traumatic brain injury: outcome at two, five, and ten years post-injury. J. Neurotrauma 31, 64–77. doi: 10.1089/neu.2013.2997
Rao, V., Rosenberg, P., Bertrand, M., Salehinia, S., Spiro, J., Vaishnavi, S., et al. (2009). Aggression after traumatic brain injury: prevalence and correlates. J. Neuropsychiatry Clin. Neurosci. 21, 420–429.
Rietdijk, R., Power, E., Attard, M., Heard, R., and Togher, L. (2020). A clinical trial investigating telehealth and in-person social communication skills training for people with traumatic brain injury: participant-reported communication outcomes. J. Head Trauma Rehabil. 35, 241–253. doi: 10.1097/HTR.0000000000000554
Ross, J., Quayle, E., Newman, E., and Tansey, L. (2013). The impact of psychological therapies on violent behaviour in clinical and forensic settings: a systematic review. Aggress. Violent Behav. 18, 761–773.
Rowlands, L., Coetzer, R., and Turnbull, O. (2021). This time it’s personal: reappraisal after acquired brain injury. Cogn. Emot. 35, 305–323. doi: 10.1080/02699931.2020.1839384
Rowlands, L., Coetzer, R., and Turnbull, O. H. (2019). Good things better? Reappraisal and discrete emotions in acquired brain injury. Neuropsychol. Rehabil. 30, 1947–1975. doi: 10.1080/09602011.2019.1620788
Roy, D., Vaishnavi, S., Han, D., and Rao, V. (2017). Correlates and prevalence of aggression at six months and one year after first-time traumatic brain injury. J. Neuropsychiatry Clin. Neurosci. 29, 334–342. doi: 10.1176/appi.neuropsych.16050088
Ruet, A., Jourdan, C., Bayen, E., Darnoux, E., Sahridj, D., Ghout, I., et al. (2018). Employment outcome four years after a severe traumatic brain injury: results of the Paris severe traumatic brain injury study. Disabil. Rehabil. 40, 2200–2207. doi: 10.1080/09638288.2017.1327992
Saban, K. L., Hogan, N. S., Hogan, T. P., and Pape, T. L. B. (2015). He looks normal but challenges of family caregivers of veterans diagnosed with a traumatic brain injury. Rehabil. Nurs. 40, 277–285. doi: 10.1002/rnj.182
Sabaz, M., Simpson, G. K., Walker, A. J., Rogers, J. M., Gillis, I., and Strettles, B. (2014). Prevalence, comorbidities, and correlates of challenging behavior among community-dwelling adults with severe traumatic brain injury: a multicenter study. J. Head Trauma Rehabil. 29, E19–E30. doi: 10.1097/HTR.0b013e31828dc590
Salas, C. E., Casassus, M., Rowlands, L., Pimm, S., and Flanagan, D. A. J. (2018). “Relating through sameness”: a qualitative study of friendship and social isolation in chronic traumatic brain injury. Neuropsychol. Rehabil. 28, 1161–1178. doi: 10.1080/09602011.2016.1247730
Salas, C. E., Castro, O., Yuen, K. S. L., Radovic, D., d’Avossa, G., and Turnbull, O. H. (2016). “Just can’t hide it”: a behavioral and lesion study on emotional response modulation after right prefrontal damage. Soc. Cogn. Affect. Neurosci. 11, 1528–1540. doi: 10.1093/scan/nsw075
Salas, C. E., Gross, J. J., Rafal, R. D., Viñas-Guasch, N., and Turnbull, O. H. (2013). Concrete behaviour and reappraisal deficits after a left frontal stroke: a case study. Neuropsychol. Rehabil. 23, 467–500. doi: 10.1080/09602011.2013.784709
Salas, C. E., Gross, J. J., and Turnbull, O. H. (2014). Reappraisal generation after acquired brain damage: the role of laterality and cognitive control. Front. Psychol. 5:242. doi: 10.3389/fpsyg.2014.00242
Salas, C. E., Gross, J. J., and Turnbull, O. H. (2019). Using the process model to understand emotion regulation changes after brain injury. Psychol. Neurosci. 12, 430–450. doi: 10.1017/pen.2020.10
Scheibe, S., Sheppes, G., and Staudinger, U. M. (2015). Distract or reappraise? Age-related differences in emotion-regulation choice. Emotion 15, 677–681. doi: 10.1037/a0039246
Shames, J., Treger, I., Ring, H., and Giaquinto, S. (2007). Return to work following traumatic brain injury: trends and challenges. Disabil. Rehabil. 29, 1387–1395. doi: 10.1080/09638280701315011
Shaw, S., Wherton, J., Vijayaraghavan, S., Morris, J., Bhattacharya, S., Hanson, P., et al. (2018). Advantages and limitations of virtual online consultations in a NHS acute trust: the VOCAL mixed-methods study. Health Serv. Deliv. Res. 6:21. doi: 10.3310/hsdr06210
Shay, L. A., and Lafata, J. E. (2015). Where is the evidence? A systematic review of shared decision making and patient outcomes. Med. Decis. Mak. 35, 114–131. doi: 10.1177/0272989X14551638
Spielberger, C. D. (1999). STAXI-2: State-trait Anger Expression Inventory-2. Professional Manual. Odessa, FL: Psychological Assessment Resources.
Stocchetti, N., and Zanier, E. R. (2016). Chronic impact of traumatic brain injury on outcome and quality of life: a narrative review. Crit. Care 20:148. doi: 10.1186/s13054-016-1318-1
Strauss, G. P., Ossenfort, K. L., and Whearty, K. M. (2016). Reappraisal and distraction emotion regulation strategies are associated with distinct patterns of visual attention and differing levels of cognitive demand. PLoS One 11:e0162290. doi: 10.1371/journal.pone.0162290
Tateno, A., Jorge, R. E., and Robinson, R. G. (2003). Clinical correlates of aggressive behavior after traumatic brain injury. J. Neuropsychiatry Clin. Neurosci. 15, 155–160. doi: 10.1176/jnp.15.2.155
Van Bockstaele, B., Atticciati, L., Hiekkaranta, A. P., Larsen, H., and Verschuere, B. (2020). Choose change: situation modification, distraction, and reappraisal in mild versus intense negative situations. Motiv. Emot. 44, 583–596.
Webb, T. L., Lindquist, K. A., Jones, K., Avishai, A., and Sheeran, P. (2018). Situation selection is a particularly effective emotion regulation strategy for people who need help regulating their emotions. Cogn. Emot. 32, 231–248. doi: 10.1080/02699931.2017.1295922
Webb, T. L., Miles, E., and Sheeran, P. (2012). Dealing with feeling: a meta-analysis of the effectiveness of strategies derived from the process model of emotion regulation. Psychol. Bull. 138, 775–808. doi: 10.1037/a0027600
Winter, L., Moriarty, H. J., and Short, T. H. (2018). Beyond anger: emotion regulation and social connectedness in veterans with traumatic brain injury. Brain Inj. 32, 593–599. doi: 10.1080/02699052.2018.1432895
Wirth, M., and Kunzmann, U. (2018). Age differences in regulating negative emotions via attentional deployment. Psychol. Aging 33, 384–398. doi: 10.1037/pag0000254
Keywords: acquired brain injury (ABI), anger, emotion regulation (ER), process model of emotion regulation, strategies
Citation: Witten JA, Coetzer R and Turnbull OH (2022) Shades of Rage: Applying the Process Model of Emotion Regulation to Managing Anger After Brain Injury. Front. Psychol. 13:834314. doi: 10.3389/fpsyg.2022.834314
Received: 13 December 2021; Accepted: 28 February 2022;
Published: 18 March 2022.
Edited by:
Robert Perna, University of Michigan Medical Center, United StatesReviewed by:
Xin Feng, The Ohio State University, United StatesCopyright © 2022 Witten, Coetzer and Turnbull. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
*Correspondence: Jade Abigail Witten, andpdHRlbjg5QGdtYWlsLmNvbQ==