Intervention to Change Attributions that are Negative: A Feasibility Study on Reducing Anger after Brain Injury

Objectives: Explore the early efficacy of a treatment to modify anger, aggression, negative attributions, and perspective-taking in participants with traumatic brain injury (TBI). Design:  Randomized waitlist-controlled trial. Participants: Twenty-four adults with a TBI (³ 1-year post-injury) who had above average aggression and either negative attribution bias or poor perspective-taking. Intervention: Intervention to Change Attributions that are Negative (ICAN). Measures: Epps Scenarios (attributions of intent, hostility, blame; anger and aggression responses); Aggression Questionnaire (AQ); PROMIS-Anger; Interpersonal Reactivity Index Perspective-taking; and Participant Global Impression of Change (PGIC) for anger and perspective-taking. Results: Twenty-one participants completed the study (ICAN = 8; Waitlist control [WLC] = 13).  Post-treatment, ICAN participants had lower anger responses to Epps Scenarios (p = 0.03) compared to WLC participants who had not yet received treatment. Other between-group comparisons were not significant. Analyses comparing pre/post-intervention changes in the pooled sample (n=21), revealed reduced attributions of intent (p < 0.01) and blame (p = 0.05), and anger (p = 0.01) and aggression responses to Epps scenarios (p < 0.01) after receiving treatment. Post-intervention scores on the AQ and PROMIS-Anger were also significantly reduced (p < 0.01). On the PGIC, 83% and 45% reported noticeable changes in perspective-taking and anger, respectively. Discussion: ICAN may reduce anger and negative attributions after TBI and merits further investigation.