Does metacognitive strategy instruction improve impaired self-awareness in adults with cognitive-communication disorders following an acquired brain injury?

Purpose: To investigate if a metacognitive goal-based intervention (IMPACT) improves self-awareness (SA) in adults with cognitive-communication disorders (CCDs) following acquired brain injury (ABI). It was hypothesized that following the intervention, participants would exhibit improved SA and thus would perceive a higher frequency of communication difficulties.Method: A post-hoc analysis of two pre–post pilot trials was conducted in this study to investigate changes in the level of SA in 16 community-dwelling adults with CCDs following ABI. The treatment, IMPACT, contained three components: individual goal-based therapy, group therapy and significant other facilitated home practice.Results: Whilst the intervention programme did not elicit a significant change in participants’ self-assessment of communication ability (p = .310), it did produce a statistically significant improvement in overall SA (p = .021) and emergent awareness (p = .034). Changes in participants’ level of intellectual awareness approached statistical significance (p = .059). Participants achieved a statistically significant improvement in GAS T-score (p< .001), with the majority of participants achieving all of their individualized treatment goals.Conclusions: Metacognitive strategy instruction (MSI) appears effective at improving impaired self-awareness (ISA) in adults with CCDs following ABI. To strengthen the conclusions of the current investigation, further research involving a standardized treatment protocol, a stable measure of communication ability, a larger sample size and the inclusion of participants with more significant ISA is recommended.