Self-awareness and self-regulation following acquired brain injury: Conceptualisation, treatment and development of an empirical model

The increased survival rate following acquired brain injury (ABI) has\ua0emphasised the need to understand factors influencing the process of psychosocial\ua0recovery. Researchers suggest that deficits in awareness represent a significant barrier to\ua0recovery and constitute an important factor related to individuals'\ua0long-term\ua0psychosocial outcome. A second factor identified in the literature which influences\ua0long-term outcome involves self-regulation, or an individual's ability to use strategies to\ua0manage their post-injury difficulties. However, understanding of recovery has been\ua0hindered by an inadequate conceptualisation of factors underlying deficits in awareness\ua0and self-regulation. Theoretical models suggest that psychological and\ua0neuropsychological factors each make a relative contribution to deficits in awareness\ua0and self-regulation. Prior to the present research empirical studies had not examined the\ua0role of both psychological and neuropsychological factors within the same\ua0investigation.It is suggested that one main reason for the lack of development in this area is\ua0that standardised measures have not been available to examine levels of awareness and\ua0key self-regulation skills proposed by theoretical models. Study 1 of the present\ua0research addressed this limitation through the development and standardisation of the 'Self-Regulation Skills Interview'\ua0(SRSI). The subjects were a sample of 61 individuals\ua0with long-term ABI and 43 uninjured subjects as a comparison group. An analysis of\ua0the psychometric properties of the SRSI confirmed that it is a valid and reliable measure\ua0with the following three indices: Awareness; Readiness to Change; and Strategy\ua0Behaviour. Each index was also found to be correlated with a number of other\ua0standardised measures of neuropsychological functioning.Following the development of the SRSI, Study 2 (N=61) investigated the\ua0relative contribution of psychological and neuropsychological factors underlying\ua0deficits in awareness and self-regulation. Based upon theories of denial and personality,\ua0the role of psychological factors was assessed using measures of coping-related denial\ua0(SEC), personality-related denial (M-CSDS) and post-injury personality change\ua0(ICHII). Neuropsychological factors were examined using an estimate of general\ua0intellectual functioning and two measures of executive functioning which assess an\ua0individual's capacity for volition (ILS) and purposive behaviour (TTT). The findings\ua0indicated that neuropsychological factors had a more direct effect than psychological\ua0factors in contributing to deficits in self-awareness and self-regulation. Specifically,\ua0individuals with impaired executive functioning were more likely to show deficits in\ua0self-awareness and self-regulation compared to individuals within the normal range of\ua0executive functioning. Furthermore, the impact of high levels of both coping-related\ua0denial and personality-related denial was generally dependent upon level of executive\ua0functioning (i.e., impaired versus normal performance).Study 3 evaluated a group support program designed to enhance self-regulation\ua0skills and psychosocial functioning. Participants were involved in a 16-week group\ua0program with three assessment phases: pre-assessment (N=28), post-assessment (N=28)\ua0and a six months follow-up (N=26). Components of the program included clinically\ua0validated techniques for improving awareness and for self-management of post-injury\ua0deficits. The SRSI and a standardised measure of psychosocial functioning (SIP) were\ua0used to evaluate the program and results indicated that the participants significantly\ua0improved their level of self-regulation skills and psychosocial functioning at postassessment.\ua0Furthermore, such gains were maintained at follow-up.\ua0 \ua0 ....................