Intervention to Change Attributions That Are Negative (ICAN)

ICAN is the first treatment to target hostile attributions after TBI, making it a novel
anger/ aggression management approach in this population. Since the investigator's prior
research shows that stronger hostile attributions are associated with poorer perspective
taking,39 ICAN employs a unique perspective-positioning technique to train perspective taking
and reduce hostile attributions. After recalling a personal situation in which others'
ambiguous actions led to an unpleasant outcome, participants will explore different
perspectives: sitting or standing in one position, s/he will explore his or her own thoughts
and feelings (self-perspective), then move to a different position to experience the other
person's perspective, eliciting their thoughts and feelings.

In 40 participants with TBI, we will conduct a Phase I, randomized waitlist controlled trial
with 4 data collection points: Baseline; Posttest I (post-treatment for ICAN; post-wait
period for WLC); Posttest II (WLC post-treatment).

Inclusion Criteria

- History of complicated mild to severe TBI (injury due to an external physical force),
with injury severity being defined either by Glasgow Coma Score at time of injury
(≤12), or post-traumatic amnesia (≥1 day), or loss of consciousness (≥30 minutes), or
positive head CT scan consistent with TBI.

- At least 18 years of age or older;

- ≥1 year post-injury;

- Have adequate vision, hearing, and speech/ language skills to participate in
assessments and group therapy (determined based on interaction with the participant at
screening)

- Have adequate reading comprehension (due to the primary assessment involving written
scenarios)

- Have negative attribution bias (above average attribution ratings for intent or
hostility, which will be de-termined during screening).

- Have above average aggression (prescreened on telephone, and confirmed T0 screening).

- No anticipated medication changes for emotions/ behavior during length of study
participation; medica-tions for emotions/ behavior must be stable within last 30 days
prior to consent at T0 (Screening)

- Have reliable mode of transportation

Exclusion criteria:

- Pre-morbid neurological disorders that could affect mood and cognition (e.g. stroke)

- Progressive central nervous system disorders (e.g. dementia, Parkinson's)

- Developmental disability (e.g., autism, developmental delay);

- Major psychiatric disorders (e.g. schizophrenia, Bipolar Disorder, Borderline
Personality Disorder);

- Severe Depression and/or perceived risk to self or others (mental health resources
will be provided and if suicide risk, approved suicide protocol will be utilized);

- Currently receiving active behavioral therapy for anger.

- On drug research study for irritability, anger, aggression