Hart Tessa, Maiuro Roland D, Fann Jesse R, Vaccaro Monica J, Chervoneva Inna
Moss Rehabilitation Research Institute, Elkins Park, Pa. (Hart, Vaccaro); private practice, Seattle (Maiuro); Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle (Fann); Department of Pharmacology and Experimental Therapeutics, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia (Chervoneva).
J Neuropsychiatry Clin Neurosci. 2023 Spring;35(2):158-164. doi: 10.1176/appi.neuropsych.21110279. Epub 2022 Aug 22.
The investigators examined predictors of treatment response to anger self-management training (ASMT) among patients with chronic moderate-severe traumatic brain injury (TBI).
A multicenter randomized clinical trial comprising 90 participants with moderate-severe TBI was conducted. Fifty-four participants who were randomly assigned to receive active treatment and provided complete data were included in the current secondary analysis. Model averaging was used to examine the relative importance and significance of pretreatment variables for predicting change during treatment. Dependent variables were pre- to posttreatment changes in trait anger (TA) and anger expression-out (AX-O) subscale scores of the State-Trait Anger Expression Inventory-Revised. Predictors included demographic, injury-related, and neuropsychological variables, including both objective and self-reported measures of executive function, as well as readiness to change and participation of a significant other in treatment.
Change in both dependent variables was predicted by higher baseline anger. Greater change in TA was additionally predicted by White race, higher education, shorter posttraumatic amnesia, and worse self-reported (but not objectively measured) executive dysfunction; the latter predictor may have indicated better self-awareness. Greater change in AX-O was additionally predicted by better episodic memory and, paradoxically, lower readiness to change.
Further research should focus on adapting psychoeducational anger treatments to better serve the diverse populations affected by moderate-severe TBI. These findings suggest that providing memory aids to support the use of learned strategies after treatment cessation would be beneficial. Further research should also examine the construct of readiness to change and specific aspects of executive function that may affect treatment response in psychoeducational treatments. These findings were derived from only one model of anger intervention, and the relevance to other treatment approaches cannot be assumed.
研究人员调查了慢性中重度创伤性脑损伤（TBI）患者对愤怒自我管理训练（ASMT）治疗反应的预测因素。
开展了一项多中心随机临床试验，纳入90名中重度TBI患者。本项二次分析纳入了54名被随机分配接受积极治疗并提供完整数据的参与者。采用模型平均法来检验治疗前变量对预测治疗期间变化的相对重要性和显著性。因变量为状态-特质愤怒表达量表修订版中特质愤怒（TA）和愤怒表达-外向（AX-O）分量表得分从治疗前到治疗后的变化。预测因素包括人口统计学、损伤相关和神经心理学变量，包括执行功能的客观测量和自我报告测量，以及改变的意愿和重要他人对治疗的参与情况。
较高的基线愤怒水平可预测两个因变量的变化。白人种族、较高的教育程度、较短的创伤后遗忘期以及较差的自我报告（而非客观测量）的执行功能障碍（后者可能表明自我意识较好）可额外预测TA的更大变化。情景记忆较好以及矛盾的是改变意愿较低可额外预测AX-O的更大变化。
进一步的研究应聚焦于调整心理教育性愤怒治疗方法，以更好地服务于受中重度TBI影响的不同人群。这些发现表明，提供记忆辅助工具以支持在治疗结束后使用所学策略将是有益的。进一步的研究还应考察改变意愿这一概念以及可能影响心理教育治疗中治疗反应的执行功能的具体方面。这些发现仅来自一种愤怒干预模型，不能假定其与其他治疗方法的相关性。
