The ability to manage our emotions plays a vital role in interpersonal relationships. For survivors of acquired brain injury (ABI), impairments in emotion regulation (ER) are the most influential contributor to uncontrollable anger, where targeted interventions are needed. Existing interventions have their merits, however there are still gaps relating to their design and delivery. In addition, considering the impact of unmanaged anger on family members and loved ones, the design of emotion elicitation tools would benefit from the application of different categories of relationship. This thesis aimed to address these gaps through two primary objectives.
The first objective was to establish a personally relevant tool that could effectively elicit anger, using five relationship categories (Family, Partner, Friend, Stranger, Abstract). This was investigated in the first empirical study (Chapter Two) with 52 neurologically healthy adults. In this repeated measures design, participants took part in a single experimental session of 90-minutes, that was administered one-to-one over a videoconferencing (VC) platform. During the session, they completed a series of anger elicitation and regulation tasks, several measures of cognitive ability, and questionnaires on attachment styles and the use of ER techniques. The main finding was that most relationship categories selectively elicited anger, with some categories (i.e., Stranger) eliciting especially high levels.
The second objective was to establish whether two ER techniques (i.e., reappraisal and distraction) could effectively reduce anger. This was first investigated in Chapter Two, in the same empirical study described above. The main finding was that both techniques reduced anger intensity across all relationship categories. However, distraction was particularly effective for strangers, especially for those who use this technique in daily life, have a certain attachment style, and are older in age. Notably, cognitive abilities were not influential.
Given these promising findings, a theoretical article considered some of the design principals for developing an ER-based intervention for post-ABI anger (Chapter Three). This review focused on key issues such as the number and type of strategies, patient choice, and mode of delivery.
These design principles informed the second empirical study (Chapter Four), which implemented reappraisal and distraction in an ER-based intervention with 24 survivors of ABI. In this pre-post intervention design, participants took part in five 60-minute individually administered sessions, over a VC platform, for a period of approximately four months. In addition to the baseline, post-treatment, and three-month follow-up assessments on anger and mood, session content included anger awareness, cognitive functioning, and ER strategy use. The intervention session focused on a series of anger elicitation and regulation tasks (viz. Chapter Two), where the participant applied reappraisal (Talk) and distraction (Chalk) to personal stories of past-anger-inducing events. The main findings demonstrated short-term improvements in the experience, control, and expression of anger, which were maintained at follow-up. Furthermore, intervention gains were associated with readiness to change, anxiety, and the use of a homework diary, whereas cognitive abilities were not related.
The empirical work of this thesis has clinical implications for post-ABI anger and advances the field of emotion rehabilitation in several notable ways. This brief, feasible and initially efficacious ER-based intervention presents a promising alternative to existing approaches, allowing clinicians to tailor its content to their patients’ strengths and weaknesses. In addition, its virtual delivery facilitates increased accessibility, catering to otherwise excluded populations for reasons such as physical location, disability, and time constraints. These implications may contribute to personally relevant, meaningful, and long-lasting changes in the lives of survivors of ABI and their loved ones.