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Levels of Awareness and it's relationship to Psychological Therapy

Updated: Nov 16, 2023

There’s a theory within neuropsychology that we have 3 different levels of awareness when it comes to acquired brain injuries. According to Crossen et al. (1989), these are:

  • Intellectual awareness – a surface-level awareness of the difficulty but perhaps struggle to give more detail such as examples or recognising how this difficulty shows itself in a variety of scenarios.

  • Emergent Awareness – able to recognise a problem when it is happening/in the moment.

  • Anticipatory Awareness – anticipate when a problem will occur and plan for the use of a particular strategy or compensation that will reduce chance that the problem occurs, or the impact that it has.



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However, I also believe this format can be really helpful when thinking more generically about mental health, psychological therapy and how we interact with the world. For example, I commonly hear that people are aware they have difficulties with their mental health (intellectual awareness), such as anxiety, low mood or unhelpful coping strategies, but can’t identify when or why it’s happening. Through therapy we are then aiming to move them up the awareness levels, so that they can begin to actively notice what they are feeling in the moment, or when these feelings/behaviours are occurring (emergent awareness). From here, we would then be thinking about anticipatory awareness – being able to anticipate what emotions or behaviours may occur in a situation, reflect on if that is how they want to respond (based on what is important to them in terms of how they interact with the world), and if necessary, plan a strategy or approach that will reduce the chance of the emotions or behaviour being problematic.


Let’s apply this to a more tangible example:

  • Intellectual awareness – you’re aware that you feel anxious, you’re getting headaches/stomach aches and feel very tense in your muscles, or your friend/partner/family has mentioned that you’ve not your usual self.

    • Together in therapy we then try to identify more specific scenarios where this is happening more and where it is happening less.

    • We work together to help you connect more to your emotions and practice identifying them in hindsight and in the moment.

  • Emergent Awareness – You spend the time between therapy reflecting on your emotions and connecting with them. You notice that this feeling of anxiety is more common when in specific settings. (e.g., social settings, work meetings etc). You notice that in these scenarios, you are more quiet/reserved, feel queasy and struggle to find your words or the “right” thing to say.

  • Anticipatory Awareness – Through therapy, you understand where you anxiety comes from and what it looks like. You are able to predict scenarios where it will be more present, and you think with your therapist about what maintains that anxiety, and what makes it better (short term and long term). You come up with a plan together of a alternative way to cope or respond in these scenarios.


One of the metaphors I always think about is the idea that you can’t stop the storms from coming, but you can think about how you’re going to get through it. For example, what floats are you going to put in? Where is your respite? Who is going to support you through it? This is part of anticipatory awareness – knowing what periods of your life or activities will cause you discomfort or stress, and putting a plan in place in advance.


Is this something you think would be helpful for you or are interested to know more? Please feel free to reach out and book an initial consultation (it’s free!) to find out about how we can support your needs with psychological therapy and work together towards your goals.

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