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Variations in awareness, psychological distress and executive function have been shown to impact on rehabilitation potential. In addition, following an acquired brain injury (ABI) risk of suicide is increased. Recently there has been an emphasis on improving awareness of disability as it has been shown to improve rehabilitation potential. However, increased awareness has been associated with increased psychological distress. If focus is on improving awareness following an ABI, increased psychological distress is likely to be observed, increasing the risk of disengagement and also suicide. In this study, the interaction of psychological distress, awareness and executive function was investigated with 64 participants who had sustained an ABI. Measures used included the BADS; DEX; HADS; and PCRS (for 19 out of the 64 participants). Awareness was positively correlated with psychological distress, depression and anxiety. It was also negatively correlated with behavioural ratings of the dysexecutive syndrome and with two of the subtests from the BADS. No significant correlation was found between psychological distress and executive function. Finally, a model is proposed suggesting how behavioural ratings of executive function and self report of psychological distress can predict awareness. It was concluded that for some individuals with poor awareness, focusing on improving awareness can be helpful. For those with good awareness, this approach may be detrimental to their emotional well being. In addition, it is concluded that awareness can not be predicted by test of executive function.

The current literature suggests that neurorehabilitation can benefit people diagnosed with acquired brain injury (ABI); however the presence of behaviour deemed challenging (CB) may constrain access to services and attainment of rehabilitation potential. Following a systematic search, a narrative review of the literature concerning the cognitive concept of 'Attribution Theory' is presented in terms of its theoretical and clinical findings, and methodological limitations. An alternative approach to the literature is then considered according to a discursive view of traditional psychology. Instead attributions are considered as something speakers perform in their accounts as a form of social action. This discursive consideration of language informed a Social Constructionist Grounded Theory methodology. Eleven clinical staff from a specialist brain injury rehabilitation hospital participated, eight in one-to-one interviews and three in a focus group. Within their accounts, participants were observed to make attributions relating to CB. Three central categories of talk were found: attributions about internal location and about external location in relation to CB, and combinations of the two. Participant accounts were considered according to specific attributions, as well as the actions performed by these attributions. The conclusions are discussed in relation to the literature, the study's methodological limitations and a critical reflection. This study reflects the capacity of talk as more than mere description of inner experiences or outside observations. The findings open up the possibility of these attributions being apparent in relation to behaviour deemed problematic. This has implications for individual members of staff and services, and consequently for patients, where language might be rarely considered beyond its apparent content. It is proposed that the position of often taken-for-granted attributions produced within clinical settings in relation to patients classified as 'challenging' needs to be acknowledged, and such reflection needs to be integrated into training, intervention planning and supervision.

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