Self-awareness is a vital executive function that allows us to recognize our own limitations, monitor our performance, and adjust our behavior. After brain injury or cognitive decline, a person’s insight into their challenges can be impaired, which affects their safety, independence, and willingness to engage in therapy.
This post uses the analogy of adjusting to new glasses to explain the three-tiered model of self-awareness: Intellectual, Emergent, and Anticipatory.
Learning to Use Glasses – The Analogy
Imagine someone whose vision has gradually worsened. At first, they just notice things aren’t as sharp, but they’ve adapted without realizing how much they’re straining. One day, they’re prescribed glasses. The stages they go through to use those glasses reflect the three levels of self-awareness.
1. Intellectual Awareness
Definition: Understanding that a problem exists on a conceptual level.
Glasses Example: “I know I have trouble seeing clearly, and that I need glasses to read.”
OT Example: A client says, “I’ve had a brain injury, and it probably affects my memory.”
2. Emergent Awareness
Definition: Recognizing the problem as it happens in real time.
Glasses Example: While reading, they notice the print is blurry and say, “I can’t see this right now—I need my glasses.”
OT Example: During a task, the client notices they’re skipping steps or forgetting things and asks for help.
3. Anticipatory Awareness
Definition: Predicting that a problem is likely to occur and planning for it.
Glasses Example: Before trying to read small print, they grab their glasses, knowing they’ll need them.
OT Example: A client sets reminders before an activity, anticipating that memory issues might interfere.
Clinical and Care Applications
For OTs:
- Assess which level of awareness a client demonstrates in different tasks
- Use structured error-based learning and guided reflection to build emergent and anticipatory awareness
- Choose interventions based on the client’s insight level (e.g., environmental supports for those lacking insight)
For Students:
- Use the glasses analogy to differentiate the three awareness levels in assessments and case discussions
- Apply it when evaluating stroke, TBI, or dementia-related insight impairments
For Caregivers:
- Understand that a person may not intentionally ignore help—they may not realize they need it
- Recognize that safety risks often come from a lack of insight, not stubbornness
- Support strategy use gently to promote anticipatory awareness (e.g., “Would you like to check your list before starting?”)
Conclusion
Improving self-awareness is not just about making someone admit they have problems. It’s about helping them recognize patterns, notice breakdowns as they happen, and eventually anticipate challenges so they can take action. Like learning to use glasses, it takes time, feedback, and support.
Proceed to Part 4: “Factors Affecting Cognitive Performance – The NEST-A Framework.”
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