Managing Anger After Encephalitis

By Prof. Huw Williams, Clinical Neuropsychologist, Associate Professor in Clinical Neuropsychology, University of Exeter and reviewed by Dr. Bonnie-Kate Dewar, Clinical Neuropsychologist

“I used to deal with all kinds of hassle…now I fly off the handle.”

“There’s little warning and then an explosion, over trivial things.”

“I just can’t tolerate the kids’ noise and all the rest of it at home.”

Overview

Encephalitis may lead to emotional and behavioural changes, including problems managing anger. These changes can be a direct consequence of damage to the emotional and behavioural control centres in the brain or an indirect psychological reaction to the other difficulties (e.g. cognitive, fatigue, epilepsy). Difficulty controlling anger may reflect an exaggeration of an individual’s pre-illness personality or it may be totally new for the person affected.

Managing anger

It is important to gain a better understanding of an individual’s anger management problems with a detailed assessment with a clinical psychologist or clinical neuropsychologist. This assessment can identify possible internal triggers of anger outbursts, such as any cognitive difficulties, mood or anxiety issues. A complete assessment of an individual’s difficulties will take into account the relationship between physical, cognitive, emotional and social changes post-encephalitis.

With professional support, anger may be managed by:

• identifying trigger situations and the signs of anger
• putting in place brief strategies such as breathing or distraction, leaving the situation safely
• reflecting and learning after the episode

Some people may find a course of psychotherapy with a counsellor or psychologist helpful to manage their anger.

The following acronym may be helpful to manage anger outbursts:

A

Anticipate situations that trigger anger. Record where, when, why, with whom it happens. A structured approach to problem-solving may then help to diffuse the anger that occurs with these situations.

N

Notice signs of anger building. Early tell-tale signs may include irritation, feeling tense, heart racing, breathing more rapidly.

G

Go through a ‘temper routine’ which may include:

• distraction (e.g. counting to 10)
• taking three deep slow breaths
• a personal self-statement (e.g. “let it go”, “these feelings will pass”)

E

Extract yourself from the situation. Have a set place to go to or take a quick walk outside if possible.

R

Record how you coped, note what worked, keep a record to chart any change in behaviour over time.

It is also useful to develop strategies to manage general levels of stress and frustration. This may include regular exercise, psychotherapy, meditation, listening to music or relaxation training. Change in communication style may also help to manager anger outbursts. For example, role plays, anticipation of trigger situations and the use of cue cards may help a person to stop, listen and not misinterpret what is being said to them. Professional support may help an individual to express their needs without acting inappropriately through anger.