1. 1 Anger Management: Recognizing and Managing Swings in Emotions post Brain Injury Kristine Cichowski, MS, Director Judson Paschen, Brain Injury Peer Mentor Rehabilitation Institute of Chicago - LIFE Center Community Life Skills Training Midwest Regional Traumatic Brain Injury Model System at the Rehabilitation Institute of Chicago - 2010

2. 2 Brain Injury: Impact on Emotions  Changes in moods & emotions result from several factors: –Specific injury to a part of the brain that controls emotions and behavior –Increased fatigue – tire easily –Frustrated with changes resulting from brain injury –Increased anxiety –Feeling lonely, depressed or misunderstood

3. 3 Brain Injury: Impact on Emotions  Some emotions and/or behaviors may be triggered by: – something specific – others may occur for no apparent reason

4. 4 Some Changes in Emotions Depression –Hopeless –Unmotivated –Cry easily –Serious or no facial expression Tips:  Force yourself to change your immediate environment – You have to initiate this –Play music - Connect with pets - Call a close friend –Take a walk – Exercise – Take a deep breath  Connect with someone you care about or enjoy

5. 5 Other Changes in Emotion - Anger Temper Outbursts & Irritability  Easily irritated - short tempered  Pre-injury behavior may be multiplied –Hot-headed  enraged  Explosive / unexpected –Zero to 60 in a second  “Quick On” and “Quick Off” –May not realize why or what set you off –May not fully understand impact of behavior on others The front of our brain helps us control behavior

6. 6 Time Out Procedure – for TBI survivor “Time – Out”  Before getting to the point of loosing control, you MUST walk away  Stay away from the situation for at least 15 minutes –Give your emotional system time to really quiet down  Pay attention to cues – tightened jaw, clenched fist, heavy breathing, red face  Practice holding back the flood of emotion  No matter who calls “Time-Out” - Do it

7. 7 Anger Management Strategies  Help others understand what sets you off – provide examples –Apologize and explain that the misbehavior was due to your brain injury –Realize that repeated outbursts even with apologies still leave a mark –Take ownership for your actions  Set a goal to work with your Coach and/or family to help you recognize and change your behavior  Be realistic about your limitations – manage your expectations

8. 8 Time Out Procedure – for Families & Friends  Focus on the behavior, not the person  Try not to take a person’s reaction personally –Irritability / anger is due to the brain injury  Do not argue or restrain – let the person calm down  Request the person to take a “Time Out” –wait at least 15 minutes before discussion situation  Once a person is quiet, gently confront and explain what happened and why it was inappropriate –If person becomes upset again, back off / disengage / ignore –Do not engage with person while he or she is having a temper tantrum, yelling, or throwing things  Once calm, identify how the inappropriate behavior impacts others –Ask – What will anger do for you or anyone else?

9. 9 Anger Management: Coaching Tips Coach / Family members MUST play FAIR  No nagging  Focus on immediate behavior only  Develop a signal to avoid embarrassment when in public or with friends –For example, use the referee football signal “T” or simply hold up a hand  Use a tape recorder to capture what an outburst sounds like –Play the recording back to help illustrate the impact of the episode  If needed, deliver the confrontation with a person who is greatly respected –Parents, in-laws, best friend

10. 10 Strategies & Insights  Realize that once the episode occurs, actions to contain it may likely only escalate the anger  Be mindful of fatigue and its effect on emotions  Become aware of situations or actions that trigger feelings of resentment, irritability, fear, frustration, and anger  Practice taking immediate action to avoid an outburst –Leave the room

11. 11 Moving Forward – Getting out of a Slump  Practice looking in the mirror at yourself – Smile  Pay attention to personal appearance –Neat & Clean –Friendly –Positive Body Language –Eye Contact –Good Listener Work towards embracing who you are now rather than constantly seeking the person prior to injury.

12. 12 Tips for Family & Friends  Speak slowly and clearly, but not demeaning. Use meaningful examples  Focus conversations - one person, one topic, one task at a time  Minimize distractions – it can be hard work to interact with others  Be mindful of fatigue and how it affects thinking, behavior – brain and physical stamina  Be time sensitive and true to your word  Verify that information is understood  Write down information for recall at another time  Use visuals to simplify / clarify  Reinforce use of a to do list or memory book  Identify and communicate with the “Coach” Take time to get to know each other

13. 13 Tips for Family & Friends Coaching Tips  As you observe behavior, give supportive feedback - be fair  Establish a signal to help a person “stop & think” – use the signal in a fair way  Rehearse answers to questions - Keep it simple and positive.  Reach out to others to help them stay connected with you and your loved one  Clarify misinformation and misunderstandings – nurture relationships  Embrace the person for who they are now – refrain from comparisons to the old self  Practice forgiveness

14. 14 Knowledge is Power! LIFE Center http://lifecenter.ric.org OR www.ric.org ~ “Quick Links”- LIFE Center Phone: (312) 238-LIFE(5433) Fax: (312) 238-2860 eMail: lifecenter@ric.org This program is supported in part by a grant from the National Institute on Disability and Rehabilitation Research (NIDRR) and is part of the Midwest Regional Traumatic Brain Injury Model System at the Rehabilitation Institute of Chicago.

15. 15 References:  Johnson, Glen, PhD, Clinical Neuropsychologist, Clinical Director of Neuro-Recovery Head Injury Program, Traumatic Brain Injury Survival Guide. (1998) www.tbiguide.com Traverse City, Michigan.www.tbiguide.com  Brain Injury Association of Washington. (2009). Anger and Depression, Anger Management, Behavior Intervention, Seattle, Washington.  Behavioral management strategies for working with persons with brain injury. (1998). Chicago: Rehabilitation Institute of Chicago Academy.  Brain Injury Association of America, Model Systems Knowledge Translation System. TBI Model System Consumer Information. (2009). Cognitive Problems after Traumatic Brain Injury, Emotional Problems after Traumatic Brain Injury. Washington, DC: Brain Injury Assoc.  Brain Injury Program: Patient and Family Resource Guide. (2009). Chicago: Rehabilitation Institute of Chicago LIFE Center.