Using startle to objectively measure anger and other emotional responses after traumatic brain injury: A pilot study

Dawn Radice Neumann, Flora Hammond, James Norton, Terry Blumenthal

Research output: Contribution to journalArticle

6 Scopus citations


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.

Original languageEnglish (US)
Pages (from-to)375-383
Number of pages9
JournalJournal of Head Trauma Rehabilitation
Issue number5
StatePublished - Sep 1 2011


  • anger
  • emotions
  • modulated acoustic startle reflex
  • physiological responses
  • traumatic brain injury

ASJC Scopus subject areas

  • Rehabilitation
  • Clinical Neurology
  • Physical Therapy, Sports Therapy and Rehabilitation

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