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Anger and Brain Injury - Fact Sheet
 Anger is a common reaction experienced when coming to terms with how a brain injury has changed one’s life.
Following a brain injury, there is often damage to the area of the brain that controls our more basic impulses such as anger. Impulses to shout or hurt others are usually controlled and more appropriate actions occur. The individual with a brain injury has often lost this control and may experience rage in situations they used to tolerate or ignore completely.
There can be an ‘on-off’ quality to this anger too. The person with the brain injury may be calm minutes later while those around are stunned by the angry outburst and may feel hurt or shocked for hours, if not days, afterwards. Family members and partners often struggle to understand these angry outbursts, with resentment and bitterness often building up over time. Once they understand that their loved one feels unable to control their anger, they can often begin to respond in ways that will help to manage outbursts.
In some cases, the individuals with a brain injury have problems with self-awareness. They may not even acknowledge they have trouble with their anger, and will blame others for provoking them. Again, this can create enormous conflict within a family or relationship. It may take carefully phrased feedback and plenty of time for the person to gradually realise they have a problem at all.
The next step is for the survivor to re-learn anger management skills they used to take for granted. A good place to start is identifying a pattern in how the outbursts are related to specific frustrations. Such triggers may originate from the environment, specific individuals or internal thoughts.
Common Causes of Anger
- Being confronted with tasks the person is no longer capable of doing.
- Other people’s behaviour e.g. driving, insensitive comments.
- Inaccurate thinking e.g. falsely believing that people are laughing at them.
- Unrealistic self-expectations.
- Barriers getting in the way of goals or routines e.g. queues.
- Build up of stress.
Identifying the cause of anger can be a challenge. It is important to consider all possible influences relating to:
- The environment e.g. too much stimulation, lack of structure, change of routine.
- The person’s physical state e.g. pain, tiredness.
- The person’s mental state, e.g. existing frustration, confusion.
- How well the person is treated by those around them.
Recommended Strategies for Coping with Anger
Steps to successful self-management of anger include:
Becoming motivated
The person identifies why they would like to manage anger more successfully. They identify what benefits they expect in everyday living from improving their anger management.
Self-awareness
A person becomes more aware of personal thoughts, behaviours and physical states which are associated with anger. This awareness is important for the person in order for them to notice the early signs of becoming angry. They should be encouraged to write down a list of changes they notice as they begin to feel angry.
Awareness of situations
The person becomes more aware of the situations which are associated with them becoming angry. They may like to ask other people who know them to describe situations and behaviours they have noticed.
Levels of anger and coping strategies
As the person becomes more aware of situations associated with anger they can keep a record of events, triggers and associated levels of anger. Different levels of anger can be explored (e.g. mildly annoyed, frustrated, irritated and higher levels of anger).
Develop an anger management record
The person may keep a diary or chart of situations that trigger anger. List the situation, the level of anger on a scale of one to ten and the coping strategies that help to overcome or reduce feelings of anger.
A simple and effective technique for reducing levels of anger is the Stop – Think technique.
STOP - THINK Technique
A person notices the thoughts running through their mind.
- Stop! and think before reacting to the situation (are these thoughts accurate/helpful?)
- Challenge the inaccurate or unhelpful thoughts
- Create a new thought.
A plan can also be developed to help a person avoid becoming angry when they plan to enter into a situation that has a history of triggering anger. An example of a personal plan is using the Stop - Think technique when approaching a shopping centre situation that is known to trigger anger.
My goal: to improve my ability to cope with anger when I am waiting in long queues.
Typical angry thoughts: ‘The service here is so slack. Why can’t they hurry it up? I’m going to lose my cool any moment now’.
Stop thinking this!
New calmer and helpful thoughts: ‘Everyone is probably frustrated by the long line – even the person serving us. I could come back another time, or, I can wait here and think about pleasant things such as going to see a movie’.
Coping with High - Extreme Anger
It is hoped that people with brain injury can make use of the strategies previously described when they notice themselves becoming angry and therefore avoid feeling high - extreme anger. However, this is clearly not always possible.
For situations where people feel they cannot control their anger they can have a personal safety plan.
Possible steps in a personal safety plan
- Plan ways to become distracted from the stressful situation e.g. carry a magazine
- Explain to another person how they can be of help to solve the problem
- Leave the situation if possible
- Phone a friend, Lifeline or a crisis centre to talk about the cause of anger
- Avoid situations which are associated with a high risk of becoming angry
- Make changes to routines and surroundings e.g. avoid driving in peak hour traffic
- With a general practitioner or psychiatrist explore the benefits of using medication.
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Anger and brain injury 
