The Problem of Insight: An Interpretive Phenomenological Approach to Understanding Awareness Following Acquired Brain Injury

Context: Acquired brain injury (ABI) can result in executive impairments that can detrimentally impact an individual’s level of insight into the changes in functioning caused by their ABI. This, along with the difficulty professionals have in identifying executive impairments and relating these to functional changes, can lead to wrongful assumptions of functional abilities among those affected. Objective: This study aimed to explore the experience of individuals with ABI who demonstrate an impairment of insight with a view to documenting specific examples of impaired insight. Method: Four participants took part in a semi-structured interview analysed using interpretive phenomenological analysis (IPA). Feedback on the interviews was provided by professionals who worked closely with the participants. Findings: The Crosson et al. (1989) model of awareness was used as a framework for understanding the three emergent themes: 1) understanding of brain injury, 2) recognition of the impact of brain injury (with the sub-theme insight into the origin of impairment), and 3) planning for the impact of impairment. These demonstrate that while individuals with ABI often have a good understanding of brain injury, they can struggle to recognise, or plan for, the impact of their brain injury on daily functioning. Limitations: The study was unable to explore issues of executive impairment across a range of individuals due to the small sample size employed to provide rich, detailed data. Implications: The findings highlight the need for changes to the way in which assessments of need are conducted with individuals with ABI.