Impact of Diagnosis Threat on Neuropsychological Assessment of People with Acquired Brain Injury: Evidence of Mediation by Negative Emotions

Correlates of self-rated resilience following traumatic brain injury

INTRODUCTION

Resilience reflects the capacity of persons to continue to function in a positive way in the context of adverse conditions. Prior research has suggested that resilience may affect emotional adjustment and quality of life after traumatic brain injury (TBI). The purpose of this investigation was to determine to what extent self-rated resilience influences cognitive test performance after TBI.

METHOD

We conducted a retrospective analysis of data collected during routine clinical care over a period of about 3 years at a regional rehabilitation facility. Participants included 100 adult persons with TBI (46% uncomplicated mild injury, 32% complicated mild injury and 22% severe injury). They had been clinically referred and seen for an outpatient neuropsychological evaluation within 1-36 months post injury. Main measures included the Connor-Davidson Resilience Scale-10 (CD - RISC-10), Patient Health Questionnaire-9 (PHQ-9), General Anxiety Disorder-7 (GAD-7), and Trail MakingTest (TMT).

RESULTS

Self-rated resilience, as reflected in CD - RISC-10 ratings, had strong negative correlations with symptoms of depression (PHQ-9) and anxiety (GAD-7). As expected, worse injury severity, older age and lower education level were associated with worse performance on both parts of the TMT (all p's< .03). Importantly, beyond those influences, self-rated resilience was also positively associated with TMT performance. However, this was the case only in those who had threshold levels of normal resilience.

CONCLUSIONS

Across the range of TBI severity, resilience as self-rated on the CD - RISC-10 is strongly related to subjective symptoms of anxiety and depression. It does not have a linear relationship with objective cognitive test performance. Instead, a minimum level of normal resilience is needed in order for it to support cognition after TBI. Findings of sub-threshold levels of resilience would support interventions to boost it and thereby potentially improve outcomes.

The effect of false cognitive feedback on subsequent cognitive task performance

INTRODUCTION

Previous research has found beliefs about oneself and one's own abilities may have the potential to affect subsequent performance on a particular task. Additionally, providing false feedback about a particular characteristic or even about overall cognitive abilities may also affect performance on later tasks. However, it is unclear to what extent false positive or negative feedback about cognition will affect subsequent executive function task performance. In the present series of studies, we examined whether receiving negative false feedback about cognition would affect subsequent decision making and other executive function task performance.

METHOD

In Study 1, the participants (n = 115) received false feedback that they were either high or low in creative intelligence before completing a series of decision making tasks. In Study 2, the participants (n = 146) completed a similar false feedback paradigm before completing assessments of a range of executive functions.

RESULTS

Across studies, we found limited evidence of a consistent pattern of how false feedback affects subsequent cognitive task performance, although receiving positive and negative feedback affected specific tasks.

CONCLUSIONS

Our results indicate that the influence of false feedback on task performance is variable and may depend on factors such as the specific task or executive function assessed. In clinical work, it is important to consider how patients may internalize feedback about their cognitive abilities, as the feedback, coupled with other factors such as level of insight, apathy, disinhibition, or prior perceptions regarding a diagnosis, may influence interpretations.

The Importance of the Morel Emotional Numbing Test Instructions: A Diagnosis Threat Induction Study

OBJECTIVE

Marketed as a validity test that detects feigning of posttraumatic stress disorder (PTSD), the Morel Emotional Numbing Test for PTSD (MENT) instructs examinees that PTSD may negatively affect performance on the measure. This study explored the potential that MENT performance depends on inclusion of "PTSD" in its instructions and the nature of the MENT as a performance validity versus a symptom validity test (PVT/SVT).

METHOD

358 participants completed the MENT as a part of a clinical neuropsychological evaluation. Participants were either administered the MENT with the standard instructions (SIs) that referenced "PTSD" or revised instructions (RIs) that did not. Others were administered instructions that referenced "ADHD" rather than PTSD (AI). Comparisons were conducted on those who presented with concerns for potential traumatic-stress related symptoms (SI vs. RI-1) or attention deficit (AI vs. RI-2).

RESULTS

Participants in either the SI or AI condition produced more MENT errors than those in their respective RI conditions. The relationship between MENT errors and other S/PVTs was significantly stronger in the SI: RI-1 comparison, such that errors correlated with self-reported trauma-related symptoms in the SI but not RI-1 condition. MENT failure also predicted PVT failure at nearly four times the rate of SVT failure.

CONCLUSIONS

Findings suggest that the MENT relies on overt reference to PTSD in its instructions, which is linked to the growing body of literature on "diagnosis threat" effects. The MENT may be considered a measure of suggestibility. Ethical considerations are discussed, as are the construct(s) measured by PVTs versus SVTs.