Research on self-awareness

This edition’s Research Round Up addresses the very complex area of Self-Awareness. Ciara Brien and Cillian McCormack-Doyle guide us through three relevant pieces of research literature.

In everyday life, if we say that someone has low self-awareness, it can be easy to assume that this is somehow their own fault. But with a brain injury, the very mechanisms that allow us to become aware of ourselves and to gain insight into our own situation can be compromised. So, to what extent does having a brain injury impact self-awareness and what difficulty does this pose for people in their recovery? These pieces of research shed some light on the area.

Dirette, D.K. & Plaisier, B.R. (2007) The development of self-awareness of deficits from 1 week to 1 year after traumatic brain injury: Preliminary findings. Brain Injury. 21 (11), 1131-1136


In the case of brain injury, self-awareness means the ability to accurately recognise the problems caused by the injury. Neural damage after a brain injury can frequently lead to impaired self-awareness. Such deficits in self-awareness can have a negative effect on the achievement of successful rehabilitation. This study aimed to examine the development of self-awareness over time after a traumatic brain injury (TBI).

18 participants who recently experienced a brain injury took part in the research, which involved both the person and their significant other being interviewed 1 week, 1 month, 4 months and 1 year after their injury. The research found that people with a mild TBI displayed an accurate self-awareness throughout the first year after injury. However people with a moderate to severe TBI tended to overestimate their cognitive abilities until one year after their injury, at which point they rate their cognitive functions similar to the ratings of their significant other.

So, the conclusion was that family members of people with moderate to severe TBI require time to develop their own awareness of the person’s difficulties following brain injury but this awareness develops sooner than the person’s self-awareness.

Fotopoulou, A., Rudd, A., Holmes, P. & Kopelman, M. (2009) Self-observation reinstates motor awareness in anosognosia for hemiplegia. Neuropsychologia. 47 (5), 1256-1260.


Hemiplegia is an inability to move the muscles on one side of the body, and can occur after experiencing a brain injury. Situations can arise when a person suffering from hemiplegia will falsely believe that they can move their paralysed limbs. This symptom is termed anosognosia for hemiplegia. Our second article reports a case study which demonstrates the effect of “third person” perspective on a person’s self-awareness of physical limitations.

A 67 year old woman who had suffered a large right sided middle cerebral artery stroke was the subject of this case study. At 22 days after her injury, despite an acknowledgement that her left side was weaker than her right, her lack of awareness of her left upper limb paralysis persisted. She was then shown a 90 second video clip of her answering general questions about her limb functionality and being asked to perform specific actions with her impaired (left-sided) limbs.

This more remote and objective viewing of her own inability to perform the requested tasks resulted in immediate and full self-awareness of her left sided paralysis, with this awareness still intact at a 6 month follow up.

Lundqvist, A., Linnros, H., Orlenius, H. & Samuelsson, K. (2010). Improved self-awareness and coping strategies for patients with acquired brain injury — A group therapy programme. Brain Injury, 24(6), 823-832.


Self-awareness has been proposed to consist of intellectual awareness (being able to describe your difficulties), emergent awareness (being able to notice when you are having difficulty) and anticipatory awareness (being able to predict in advance what situations will be difficult). Anticipatory self-awareness seems to be a prerequisite for developing good coping strategies after a brain injury, as people have to be aware of what type of situations they might find difficult, before they can plan for these situations. The authors of our final article sought to determine if a group therapy programme could help individuals with brain injury to develop anticipatory awareness and coping strategies.

The programme focused on learning to recognize in advance when, and in what situations, the individual’s problems were likely to occur. The programme also aimed to provide the participants with a safe environment to talk about themselves, experience peer support, get feedback from one another and practice strategies. The authors ran three therapy groups and assessed the impact of these groups using questionnaires, interviews and focus group discussions.

The results showed that a structured group therapy programme can help patients with acquired brain injury to understand the consequences of their neuropsychological difficulties, improve awareness of these and develop and implement coping strategies. Attending the group also had a positive effect on their life and work situation and on their self-confidence.

If you would like to learn more about Headway’s peer support group, called the Harbour Group, please contact our Information and Support Line on 1800 400 478, or via email at

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