• Tamara Ownsworth Tamara Ownsworth
  • Jenny Fleming Jenny Fleming
  • Jenny Desbois Jenny Desbois
  • Jenny Strong Jenny Strong
  • Pim Kuipers Pim Kuipers

Very few empirically validated interventions for improving metacognitive skills (i.e., self-awareness and self-regulation) and functiol 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 prelimiry support for a metacognitive contextual approach to improve error awareness and functiol outcome in real life settings. (JINS, 2006, 12, 54-63.)