A metacognitive contextual intervention to enhance error awareness and functional outcome following traumatic brain injury: a single-case experimental design

Very few empirically validated interventions for improving metacognitive skills (i.e., self-awareness and self-regulation) and functional outcomes have been reported. This single-case experimental study presents JM, a 36-year-old man with a very severe traumatic brain injury (TBI) who demonstrated long-term awareness deficits. Treatment at four years post-injury involved a metacognitive contextual intervention based on a conceptualization of neuro-cognitive, psychological, and socio-environmental factors contributing to his awareness deficits. The 16-week intervention targeted error awareness and self-correction in two real life settings: (a) cooking at home; and (b) volunteer work. Outcome measures included behavioral observation of error behavior and standardized awareness measures. Relative to baseline performance in the cooking setting, JM demonstrated a 44% reduction in error frequency and increased self-correction. Although no spontaneous generalization was evident in the volunteer work setting, specific training in this environment led to a 39% decrease in errors. JM later gained paid employment and received brief metacognitive training in his work environment. JM's global self-knowledge of deficits assessed by self-report was unchanged after the program. Overall, the study provides preliminary support for a metacognitive contextual approach to improve error awareness and functional outcome in real life settings.

Convergent validity of self-awareness measures and their association with employment outcome in adults following acquired brain injury

PRIMARY OBJECTIVE

To examine the convergent validity of three measures of self-awareness and their correlation with employment status in 38 adults with acquired brain injury.

RESEARCH DESIGN

A cross-sectional study examining correlations between standardized measures of self-awareness and employment outcome.

METHODS AND PROCEDURES

Self-awareness was assessed using the Self-Awareness of Deficits Interview (SADI), the Self-Regulation Skills Interview (SRSI) and the Awareness Questionnaire (AQ). Employment outcome was classified using a five-point work status rating scale and work items from the Sydney Psychosocial Reintegration Scale (SPRS).

MAIN OUTCOMES AND RESULTS

Significant correlations were found between the SADI total score and the AQ discrepancy score and between the total SADI score and the SRSI indices. The work status rating scale was significantly correlated with the SADI and SRSI scores but not the AQ.

CONCLUSIONS

The findings support the convergent validity of the three measures of self-awareness and highlight the need to address self-awareness deficits in vocational rehabilitation.

The relative importance of metacognitive skills, emotional status, and executive function in psychosocial adjustment following acquired brain injury

OBJECTIVES

To examine the interrelationships between metacognitive skills and measures of emotional status and executive function following acquired brain injury (ABI), and examine their relative importance to psychosocial outcomes.

DESIGN

A cross-sectional multicentre study employing correlational and multiple regression analyses.

PARTICIPANTS

Sixty-seven adults with ABI living in the community, on average 4.4 years (SD = 4.7) postinjury.

MEASURES

Sydney Psychosocial Reintegration Scale, Self-Awareness of Deficits Interview, Self-Regulation Skills Interview, Hospital Anxiety Depression Scale, Beck Hopelessness Scale, and standardized measures of executive function.

RESULTS

Metacognitive skills correlated with level of hopelessness and executive measures of idea generation and error self-regulation. The best predictor of psychosocial outcome was depressive symptoms, with specific outcomes additionally related to error self-regulation and intellectual awareness.

CONCLUSIONS

The findings highlight the need to evaluate interventions targeting depression and metacognitive skills to improve psychosocial outcomes.