Anger

Some brain injury survivors have more difficulty with managing anger and may have more frequent outbursts. This page discusses how brain injury can affect anger management. It also shares tips for coping and discusses professional support if you are affected by this issue.

Why might brain injury survivors have problems with managing their anger?

There are many reasons why brain injury survivors may feel more anger after their injury or have difficulties with controlling their anger. You can explore some of these below.

How to cope with anger after brain injury

Anger is a normal human emotion experienced by everyone, so the tips below are about managing it rather than completely taking it away. Many of these have been suggested by brain injury survivors themselves.

Change your approach to anger

• Try to become aware of the physical signs of your anger building up, such as rapid breathing, feeling hot and clenching fists. If you learn to recognise these changes in your body, you might be able to calm yourself down before the anger becomes an issue.

• Anger can be caused by stress and anxiety. Learning ways to manage these can help you to feel more relaxed and less likely to have an outburst of anger. Consider relaxation techniques such as mindfulness and meditation to help with managing stress and anxiety.

• Learning to gradually accept the ‘new you’ by identifying your new strengths, interests and opportunities, can help to feel more positive after brain injury.

Identify your triggers

• Being uncomfortable can cause frustration, for example feeling too hot or cold, or feeling overstimulated by bright lights or loud noises. If possible, try to modify your environment, or move somewhere else so that you are more comfortable.

• Try to have a regular sleep routine and plenty of good quality sleep.

• A brain injury survivor might be quicker to develop feelings of irritation or anger under the influence of alcohol. Try to cut down on drinking or stop drinking alcohol altogether as this is generally discouraged after brain injury.

• Try to keep your routine gently paced and spread activities out across time to avoid becoming overwhelmed or stressed.

• Try to be well prepared for outings and have back-up arrangements made in advance to lessen the chances of getting frustrated if things don’t go according to plan.

Talk to others

• Talk to others about how you feel when you get angry or after you have calmed down. Being open and honest can help you to process your emotions and find new ways to think about managing your anger, while also allowing others around you to be more aware of how you feel.

• If you are in public, consider explaining to others that you have had a brain injury and showing them your Headway Brain Injury Identity Card.

• Teach others about your brain injury and how it has affected you.

• Discuss your triggers with family, friends and colleagues so that they are also aware of situations in which you may start to feel angry.

• Ask for help when you need it.

Coping when you are feeling angry

• Move away from a situation that is causing you to feel angry, for example leave the room or end a conversation. If you are with someone, explain that you are leaving because you need time to calm down and will return when you feel better.

• Use the analogy of a thermometer to explain how you are feeling. This is used by some rehabilitation teams to describe and visualise anger, with the different levels of anger being different points on the thermometer. It can start at the bottom with irritation, and move up to higher intensities of annoyance, frustration, anger and fury. This can help to explain how you are feeling in the moment.

• Try to use calming techniques such as focusing on your breathing or practicing mindfulness.

• Express how you are feeling through art, music or writing.

• If possible, go for a walk or do some gentle exercises.

• Use your Headway Brain Injury Identity Card to let others know about your brain injury and its impact on your ability to manage your anger.

• Think of someone who normally calms you down when you feel angry. Imagine what they would say to you and what they would do to make you feel better.

• If your anger was directed at someone, say sorry to them afterwards and explain how you felt. It might be difficult, but it can help to clear up misunderstandings and often makes both people feel better.

Getting professional help for anger after brain injury

• If you feel like your anger is getting difficult to control, talk to your GP. They might be able to get you a referral to be seen by a suitable professional such as a neuropsychologist or a cognitive behavioural therapist.

• Counselling might be suitable if you need to talk to someone about how you are feeling, and any underlying issues that are causing the anger.

• If appropriate, consider getting professional support together with a partner or your family so that you can work together towards managing your anger

Guidance for family, friends and others

• Try to identify what triggers the brain injury survivor’s anger, for example certain environments or topics of conversation. Be prepared by having a strategy ready, such as encouraging the survivor to breathe deeply, changing the topic of conversation or suggesting they move away from the situation until they feel calmer.

• Discuss triggers that you have noticed with the survivor and encourage them to identify and discuss triggers themselves.

• Try not to get into arguments with the survivor if you disagree on something. Instead, make an effort to be calm and speak to them gently, even if you think they are wrong or they have misremembered information.

• Never trivialise the survivor’s anger, even if it is over something that seems insignificant to you. Remember that sometimes simple things can remind survivors of how much their life has changed, which can be upsetting.

• Remove yourself from the area if the anger is being directed at you. Explain to the survivor that you are leaving because you think it will help them to calm down, rather than just walking away with no explanation.

• Try not to take anger outbursts personally and remember that it is a common effect of brain injury.

• Agree on a prompt or sign that you can use when you believe the survivor is getting wound up. For example, you could blow over your shoulder, indicating “blow away your anger”. You can also encourage the survivor to think of their own signs to show that they are starting to get angry.

• Remember that our nurse-led helpline is available to partners, families, friends and carers of brain injury survivors as well as the survivor themselves.

Keeping safe

If an episode of anger becomes violent, abusive or causes a risk of harm to anyone, there may be a need to seek intervention through a safeguarding team, domestic abuse services or the police.

If you are in immediate danger or you are in an emergency, call 999.

Other services to contact include:

• If you are in England, Wales or Northern Ireland: your local neighbourhood policing team (visit www.police.uk or call 101)

• If you are in Scotland: Scotland’s Domestic Abuse and Forced Marriage Helpline on 0800 027 1234

National services that can advise include:

• Refuge’s National Domestic Abuse Helpline: 0808 2000 247 or visit www.nationaldahelpline.org.uk.

• Our nurse-led helpline for information and advice on supporting someone with managing anger after brain injury.