Many brain injury survivors experience a lack of awareness of the cognitive, psychological, emotional and behavioural changes that their brain injury has resulted in.
This can be particularly difficult as it often leads to the brain injury survivor behaving inappropriately or dangerously without recognising the possible consequences.
It is important to manage lack of insight properly and support brain injury survivors with understanding how their injury has affected them.
We've included 8 top tips for dealing with the issue below, and you can get more detailed information on the issue by downloading our factsheet (PDF)
There are a number of reasons that a person may have a lack of insight. It is important to identify these, as this may determine how you intervene or approach the problem.
Try to relate activities and tasks to the person’s own goals and plans, to attempt to increase motivation and participation. For example, “we are working on these memory strategies so that you are able to live on your own.”
Try to avoid directly confronting or challenging the brain injury survivor’s ideas about their capacity - this can lead to conflict, disagreements and anger. If the person insists on there being no change in their behaviour, allow the conversation to drop for the time being.
Later, when the person is calmer, give general information about brain injury and the kind of difficulties that can be experienced. This can shift the focus from being a personal problem to something more general.
For example, “people with a brain injury sometimes have trouble with their anger or temper. Do you think you might have any problems like that?”
Try to encourage the brain injury survivor to talk to you about how they are feeling. Giving them time and the opportunity to reflect on their own experiences might make it easier for them to identify and accept any changes themselves rather than being told about them.
Providing frequent, non-critical feedback about performance or behaviour can be one way to improve insight and awareness.
When directing the brain injury survivor’s attention to specific areas of difficulty, it is important not to dwell on the problem so much that they become distressed. Direct attention to any improvements, strengths or changes made; this is equally as important so that the survivor does not become de-motivated.
The most important thing in this case is to obtain support from an outside source; preferably someone who is not directly involved, but who has experience of the effects of brain injury. Carer support groups are often effective for this purpose. Getting support from the outside helps provide an independent view of the person’s lack of insight and can help to develop effective strategies to deal with problems. It can also prevent the feelings of isolation that carers or relatives may feel.
You can contact your local Headway group or branch for details of their carer support services. Alternatively, the Headway helpline can help with locating carer support services that are local to you. More information about support available for carers is available in the Caring section.
Be sensitive to any risks or dangers that the brain injury survivor may place themselves or others in as a result of their lack of insight. For instance, if they do not recognise that they have a memory problem, be mindful of issues such as leaving a cooker unattended or forgetting to lock doors before they leave the house. Or if they do not recognise that their driving skills are affected, make them aware of the legalities of driving after brain injury.
If appropriate, explain the issue of lack of insight to other key people in the brain injury survivor’s life, such as close friends. This will help them to accommodate for any changed behaviour that the person displays. You might find it useful to share our factsheet with them.
Our new factsheet Lack of insight after brain injury (PDF) contains more information on this issue, including more detailed guidance on these tips and the legal frameworks that protect people who lack insight.
You can get more details on the effects of brain injury and caring for someone with a brain injury on this website, or browse the information library to download our range of factsheets and e-booklets.
Contact the Headway helpline or your local Headway group or branch if you'd like further support.
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