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Get The Facts

Impaired self-awareness & brain injury

Information Services

Cognitive effects

Impaired self-awareness & brain injury

Lack of self-awareness is a common outcome for people with injury to the frontal lobes which is common after a traumatic brain injury.

Impaired self-awareness is a lack of insight in assessing one's abilities and limitations, and the resulting implications. There are various degrees of impaired self-awareness after a traumatic brain injury (TBI). For example, someone may know they have a problem, but has trouble detecting when it occurs and how to respond. In other cases, a person may refuse to acknowledge there is a problem at all, and believe that family members are lying or exaggerating the problems.


Lack of self-awareness can lead to unrealistic goals such as returning to work despite a severe brain injury. Rehabilitation can be difficult as a person is unlikely to apply themselves or be cooperative if they don't believe a problem exists.


In some cases, insight can develop over time if the person encounters numerous setbacks -  periods of despair at not being able to regain skills and abilities can lead to an improvement in self-awareness.


Any techniques used to help increase self-awareness will depend on why there is a problem with insight in the first place. The main causes are:

  • an inability to assess and monitor one's performance and abilities
  • concentration and memory problems are reducing insight
  • an inability to set goals and put strategies into action. 


Techniques for increasing self-awareness

 In a rehabilitation setting, common techniques include (Fleming & Ownsworth2006)


  • selecting key tasks and environments to highlight difficulties
  • providing clear feedback and structured learning opportunities
  • promoting habit formation through procedural learning
  • specifically training for application outside the learning environment
  • involving clients in group therapy
  • educating family and enhancing social environment supports


Families can provide effective support by working the rehabilitation team to provide a consistent response to any problems arising from a lack of self-awareness. Some practical tips include:

  • provide non-judgmental feedback on their performance
  • provide positive feedback as well as pointing out issues
  • encourage them to analyze their own performance
  • link rehabilitation to personal goals (e.g. returning to work)
  • minimize potential risks such as driving and cooking
  • avoid arguments. 


Self-awareness & challenging behaviours

The inability to self-monitor and self-correct behaviour can lead to challenging behaviours after a TBI. These can be very frustrating for partners and family members if the person denies there is a problem, can't recognize when it occurs or doesn't know how to use any strategies to monitor their behaviour. Where possible, the family should work with the rehabilitation team to respond consistently to challenging behaviour. If rehabilitation has finished, contact your local Brain Injury Association for support and see our range of fact sheets on challenging behaviour.


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