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 techniques for managing anger after TBI. 

When we are trying to help individuals manage their anger. We talked about examples of prevention strategies. Now we're talking about examples of management strategies. What do I do when I'm already feeling angry and when we might give what we call in the moment strategies and those in the moment, strategies can include things like depending on the circumstance. Some people use accounting technique, so they might say, I don't care, Dr. B, I'm just going to count backwards from 10 to one and I'm just going to do it in my mind. Believe it or not, there's a lot of neuroscience that supports the idea of doing a cognitive task in your head, and it's sort of a working memory strategy, and that actually from a neuroscientific standpoint, deescalates a person to use a working memory strategy like that. It's not just buying time. So we'll give them certain working memory strategies on what they can do in their head, other things that they can do.  

We teach them deep breathing techniques. Now, I'm not saying that in the middle of a situation, a person can go and meditate for 30 minutes, but there might be very quick slow breathing techniques that a person really takes a hold of and says, oh my gosh, this works wonderfully for me. There might actually be certain mottoes that a person ends up saying to themself very frequently, examples of common mottos that people will use. I have had people say things like, it isn't worth it. It isn't worth it, right? I've had people say, don't sweat the small stuff, which is kind of like it isn't worth it. I have had people use a strategy that we teach them in one of our other groups we do, and we call it the so what strategy and the so what strategy is so what? Is that the worst thing that can happen to you?  

Is it really worth it? Right? Is it really the most horrible thing? So we're getting individuals to really see that things aren't quite as catastrophic as they might react to. There are a ton of strategies. Another one actually that's really common is it is what it is. This idea of radical acceptance, and I think a lot of people use a lot of these mottoes with or without an injury, but the individuals with injury are having to use those models a whole lot more, and you'd be surprised if they really attach themselves to their top two or three mottos. And quite honestly, if that's all that takes, if that's what it takes to they're at a seven or eight and they feel themselves escalating and they don't want to go past that, it is what it is, or they're not worth it, or this isn't worth it, then that's what they'll do.  

And because many individuals with brain injuries sometimes can get almost stuck on certain themes, and in this case that's actually helpful to get those models kind of stuck in your head. So that might be another example of sort of the in the moment strategy, whether it's a motto, a deep breathing technique, and sometimes people will actually use what we call retreat strategies. When I work with couples who are very accustomed to, of course, they're together all the time, they know each other. So it's not like just somebody that you're speaking with that work,  you know your spouse. So I think retreat strategies are often nice to use within a family context because what you can do is you can have family meetings, you can have meetings with your spouse, and what you can be doing is taking a proactive approach to saying, yeah, so okay, this week I am going to try something new.  

And so they're now prepping, it's the prep work, and they're telling their spouse, I'm going to try something new. I know that I have a tendency to go off and get angry real quick. So you know what? When I start to get to a six or seven, I am just going to put my hand up, and when I put my hand up, that means I got to stop it. You need to stop. I need to stop. You don't want me going there. So when I do that, I put my hand up and that's the cue that I need to get out of here and I need to go. That can work really, really well. When you prep the family member, obviously when you don't prep 'em and you're in a heated conversation or not even heated and you put your hand up like this and walk out, it makes it worse. But actually the spouse will actually end up saying, no, I know now. People can make significant improvements in their behaviors and how they respond to things just by these very small steps, and the more concrete we can make it for them. We're very big on metaphors, and so when we say things like tools in the toolbox or tools in your tool belt or whatever, metaphor works for them, that's what they need is a very concrete way of saying, I'm using this tool for this issue. 

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