Very few empirically validated interventions for improving
metacognitive skills (i.e., self-awareness and self-regulation) and
functional outcomes have been reported. This single-case experimental
study presents JM, a 36-year-old man with a very severe traumatic brain
injury (TBI) who demonstrated long-term awareness deficits. Treatment at
four years post-injury involved a metacognitive contextual intervention
based on a conceptualization of neuro-cognitive, psychological, and
socio-environmental factors contributing to his awareness deficits. The
16-week intervention targeted error awareness and self-correction in two
real life settings: (a) cooking at home; and (b) volunteer work. Outcome
measures included behavioral observation of error behavior and
standardized awareness measures. Relative to baseline performance in the
cooking setting, JM demonstrated a 44% reduction in error frequency and
increased self-correction. Although no spontaneous generalization was
evident in the volunteer work setting, specific training in this
environment led to a 39% decrease in errors. JM later gained paid
employment and received brief metacognitive training in his work
environment. JM's global self-knowledge of deficits assessed by
self-report was unchanged after the program. Overall, the study provides
preliminary support for a metacognitive contextual approach to improve
error awareness and functional outcome in real life settings.
(JINS, 2006, 12, 54–63.)