Managing Anger and Agitation at Home

Brain Injury Blog by Janet Cromer

May 6, 2011

Managing Anger and Agitation at Home

Part One – Understand the Problem

Brain injury can cause many changes in areas of the brain that affect a person’s ability to express and regulate emotions and behavior. When family caregivers of persons who have a brain injury get together in a support group, one of their most pressing concerns is how to understand and help manage anger and agitation at home. Sometimes we’re even reluctant to admit how serious the problem is to friends or professionals.

In this week’s blog, I’ll review how to understand the causes of a survivor’s anger. Next week, I’ll offer suggestions for ways to help the survivor manage anger better.

angery manAs a psychiatric RN, I had years of experience working with distraught patients in psychiatric hospitals and community mental health programs. That experience prepared me in many ways to help my husband Alan when he was angry, anxious, or agitated at home. However, it’s always upsetting or frightening to interact with a person you love whose behavior is out of control.

Anger can arise from awareness of losses and skills, changes in job and family roles, inability to be independent, etc. There can be medical causes such as pain, headache, poor sleep, medication reactions, infections, seizures, or problems with vision or hearing.

Some survivors have more serious neurobehavioral challenges including hallucinations, paranoid thinking, or delusions. Consult with a healthcare professional about the cause and suggestions to treat the problem.

It’s important to know that angry behavior serves a purpose, even though it’s not healthy.

In Alan’s situation, a severe anoxic brain injury led to damage in his frontal and temporal lobes, and hippocampus. All of these areas are essential for processing information, mood stability, memory, impulse control, and insight. The injury also damaged the neurotransmitter system that makes and moves chemicals involved in mood, thinking, and memory.

This made Alan vulnerable to angry outbursts, and even occasional rage attacks. When he got very angry, I knew it meant he wanted more control, could not do the task at hand, or was distrustful of what he didn’t understand. . Treatment combined behavioral approaches and careful use of medications for depression, anxiety, and disordered thinking.

Step 1: Figure out the cause

Before you can work on changing a behavior, it’s important to learn as much as you can about the cause. This takes careful observation, tracking with pencil and paper, and some imagination if the survivor can’t tell you his feelings verbally.

Behavior therapists recommend the A-B-C method. A stands for antecedent, which means what happened before the person became angry. For example, was he overstimulated by the crowd at the grocery store? Was she frustrated by the fifth attempt to put her blouse on right? Had you just told him he couldn’t go out alone?

B stands for the behavior in response to the trigger. Does she shout or hit the wall? Does he try to run away or swear? Does the behavior indicate that she needs a better skill to handle the task or communication? Pick one angry behavior to focus on at a time.

C stands for the consequence of the behavior. This is what happens after the behavior or action that either increases or decreases the chance of the problem happening again.

Here’s an ABC example from our experience.

A = While getting dressed, Alan couldn’t figure out which shoes he should wear. He felt frustrated, then embarrassed not to know.

B= He got angry, shouted, and threw the shoes across the room. He yelled, “How am I supposed to know what to wear?”

C= I ran upstairs to calm him down. He got attention and help with selecting shoes, but we were both upset.

We agreed to work on yelling when angry as the problem. I could see that the skill of decision making was also a problem On the skill level, we set up his closet so he only chose between two pair of shoes. He could handle that.

I offered him a better alternative to yelling. He could ask for help in a regular tone. When he did, we talked about which shoes to wear on a rainy day, and his reward was my warm smile and a hug for using a lower voice. Alan liked affection, so that was a good reward.

Next week, I’ll share how to set up a behavior change plan. And some tougher examples from our experience.

3 responses to “Managing Anger and Agitation at Home”

  1. pat walley says:

    Thanks Janet, my son after brain surgery has horrible frustration and anger problems, he has been in residential schools since 11 years old. he has TBI since 8 mos. old, severally beaten by biological parents,did great, enough to go to a school to learn a vocation, and be with kids like himself, but in 2009, he had a brain tumor removed in the same area as the damage area, none of the thing that could have affected him did, but his short term memory is at 25%, became very hard to handle, school called police and he was locked up, that got solved after i asked for him to go back to his first school, as they knew him and helped him the first time, well first off they are changing his meds (i had been asking for that ,as some he had been on since he was 6 now 17), He is now there, bad start, but this school is so good, that after 2 weeks and 5 holds, and much damage, he his learning how to handle it all. has not been held in 2months. the entire staff take every thing they have an use it, just like videos and books from lash publishing, and they have training for all the new staff that comes in. I love this school because they care about the child 100%, My problem is when he comes home, I worry about him all the time if he goes out (we live in small town, most know him but some don’t) that he will lose it over something, so we argue a lot about him going out alone. sorry didn’t mean to write a book .

  2. Judie says:

    I am a brain injury survivor and get totally frustrated with my husband and adult daughter. I am feeling anger towards them and that they seem to pick on me for different things, such as forgetting things, complusive behavor I have and sometimes am quick to judge. They say I tend to want to control everyone and everything. I am always trying to please everyone. I know I am outspoken, but always have been, since my brain injury I am even more outspoken. I get to the point where I am thinking of leaving. I attend the local brain injury society in our town, but it has since closed for the summer. I am not sure if I should go to mental health, I feel I need help and not sure where to go. I look forward to a reply.
    Sincerly
    Judie

  3. Ginger says:

    Janet, this is a very valuable article. Having just let the aides go, and on our own again, the anger at daily tasks is coming back. Since we are in a new apt and for the first time since we moved in, jus tthe two of us, we can begin to set it up to work for us. The closet has been rearranged, but with us the short term memory is a problem we have to work on. We cannot change that, but we can put things away in the same place each time. Thank you. Ginger

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