This is a part of the podcast series from the Model Systems Knowledge Translation Center on Irritability, Anger, and Aggression after TBI. Dr. Sougandhi Backhaus discusses education and prevention of anger after TBI. 

So I want to get some trust with them and I want to validate some of their concerns, and I'm going to what we call normalize. I'm going to teach them about what's happening with them, and I'm going to say, yes, of course. I can imagine that it would be very natural to have a lot of anger through this. I'm also going to be thinking about this in terms of giving a lot of education during this time. I'm going to be educating them about the effects of their injury. I'm going to be educating them about the anger, and what I mean by that is that there's actually a good 50% of the time that the patient is not coming in saying, I'm having problems with anger. It's the family member and other people that know them closely that are saying, oh boy, this is a real problem.  

So I'm getting them to understand and to get to a phase where they're willing to be aware that they're having problems with anger, and I teach them, I give them examples like, when this happened, what were you experiencing? Once the patient is able to get to a stage where they recognize that they are having anger, it sounds silly to say this, but the next stage is actually getting them to be motivated to change it. Because a lot of times when people are very angry, the natural response is, I'm angry and I don't care what happens. So I have to do work with them to get them to say, and I want to change it, and this isn't working for me. This is causing problems in my life, and these are the consequences of my anger. Once I get 'em to that stage, then as I'm going through this detective work to explore this, I'm going to be saying, well, if you're motivated, then here's what's going to happen.  

I'm going to give you strategies, how to prevent yourself from getting too angry. So we're going to look at your triggers and then what are the things that you need to do. So for example, if you start to get more agitated and angry when you go out in public, okay, if you are going to graduation parties, holidays, big family gatherings, that's a big trigger for people. So I'll often say, well, now that we know that, that's a trigger for you, what can we be doing? Are there situations you can avoid? Is it okay to say no? If you can't avoid it? Can you plan an escape route? Can you say a key word? And so we'll think of a key word that's a safe word for them to say to a family member. Then they'll use that and they won't feel guilty. They're going to feel like the family understands them and supports them and is willing to help get them out of that situation when they start to get worked up and feel agitated.

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