Understanding and Treating Loss of Sense of Self Following Brain Injury: A Behavior Analytic Approach

Loss of sense of self is a common experience among acquired brain injury survivors. It involves conscious awareness on the part of the survivor that she is somehow not the same person as pre-injury, and is associated with emotionally distressing negative self-evaluations of post-injury changes in functioning. Denial of changes is a relatively common response among survivors who begin to experience loss of sense of self. Relational Frame Theory (RFT) is a modern behavioral approach to language and cognition. From an RFT perspective, there exist three senses of self that are directly knowable by humans: the conceptualized self, self as an ongoing process of verbal knowing, and self as context. Loss of sense of self may be understood as a crisis of the conceptualized self. Treatment involves guiding the survivor both to adjust to post-injury changes in functioning and to develop a new self-concept. Acceptance is the critical factor in this process. Contact with self as context can facilitate acceptance by providing the survivor with an enduring sense of self that is distinct from her psychological content. From self as context, the survivor may know the changes in her functioning and self-concept without fear of psychological annihilation.