Negative Attribution Bias and Related Risk Factors After Brain Injury

J Head Trauma Rehabil. 2021 Jan-Feb;36(1):E61-E70. doi: 10.1097/HTR.0000000000000600.


Objective: In participants with traumatic brain injury (TBI) and peer controls, examine (1) differences in negative attributions (interpret ambiguous behaviors negatively); (2) cognitive and emotional factors associated with negative attributions; and (3) negative attribution associations with anger responses, life satisfaction, and participation.

Setting: Two TBI outpatient rehabilitation centers.

Participants: Participants with complicated mild to severe TBI (n = 105) and peer controls (n = 105).

Design: Cross-sectional survey study.

Main measures: Hypothetical scenarios describing ambiguous behaviors were used to assess situational anger and attributions of intent, hostility, and blame. Executive functioning, perspective taking, emotion perception and social inference, alexithymia, aggression, anxiety, depression, participation, and life satisfaction were also assessed.

Results: Compared with peer controls, participants with TBI rated behaviors significantly more intentional, hostile, and blameworthy. Regression models explained a significant amount of attribution variance (25%-43%). Aggression was a significant predictor in all models; social inference was also a significant predictor of intent and hostility attributions. Negative attributions were associated with anger responses and lower life satisfaction.

Conclusion: People with TBI who have higher trait aggression and poor social inferencing skills may be prone to negative interpretations of people's ambiguous actions. Negative attributions and social inferencing skills should be considered when treating anger problems after TBI.

Publication types

  • Research Support, U.S. Gov't, Non-P.H.S.

MeSH terms

  • Aggression
  • Brain Injuries*
  • Cross-Sectional Studies
  • Hostility*
  • Humans
  • Risk Factors
  • Social Perception