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Using Startle to Objectively Measure Anger and Other Emotional Responses After Traumatic Brain Injury: A Pilot Study

Neumann, Dawn Radice PhD; Hammond, Flora MD; Norton, James PhD; Blumenthal, Terry PhD

The Journal of Head Trauma Rehabilitation: September/October 2011 - Volume 26 - Issue 5 - p 375–383
doi: 10.1097/HTR.0b013e3181f8d52d
Original Articles

Objective: To determine the effectiveness of a modulated acoustic startle reflex paradigm with emotional imagery in studying physiological changes associated with emotional responses in persons with traumatic brain injury (TBI).

Setting: Outpatient rehabilitation hospital.

Participants: Six individuals with moderate to severe TBI. Mean age was 32 years and mean years postinjury were 9.9.

Method: The modulated acoustic startle reflex procedure involved imagery of emotional scripts (joy, anger, fear, and neutral) followed by a startle noise, versus startle noise alone (no script).

Measures: Eyeblink and skin conductance response, subjective arousal and valence ratings of the scripts, and general anger questionnaire.

Results: Startle blink responses following anger imagery were significantly smaller than those following fear (P = .006) and neutral (P = .023) imagery. Skin conductance response did not change significantly based on the content of the scripts (P = .070).

Conclusions: Large startle blink responses indicate avoidance of a stimulus. Our findings suggest that participants with TBI did not have an avoidant reaction to anger-inducing stimuli. Skin conductance response findings may imply arousal impairments. The modulated acoustic startle reflex was effective in measuring emotional responses; however, larger studies comparing persons with TBI with control groups are needed to further explore these findings.

Department of Physical Medicine and Rehabilitation, Carolinas Rehabilitation (Drs Neumann and Hammond), and Cannon Research (Dr Norton), Carolinas HealthCare System, Charlotte, North Carolina; Indiana University School of Medicine, Indiana (Dr Hammond); and Department of Psychology, Wake Forest University, Winston-Salem, North Carolina (Dr Blumenthal).

Corresponding Author: Dawn Radice Neumann, PhD, Department of Physical Medicine and Rehabilitation, Carolinas Rehabilitation, Carolinas HealthCare System, 1100 Blythe Blvd, Charlotte, NC 28203 (

The authors would like to express their appreciation to Biopac Systems Inc ( for lending them some of the equipment used in this project. In addition, the authors would like to recognize that this work was partially supported by the Department of Physical Medicine and Rehabilitation at Carolinas Rehabilitation in Charlotte, North Carolina (part of the Carolinas HealthCare System), that contributed funding for participant stipends.

The authors declare no conflict of interest

© 2011 Lippincott Williams & Wilkins, Inc.