The Effect of Varied Test Instructions on Neuropsychological Performance following Mild Traumatic Brain Injury: An Investigation of “Diagnosis Threat”

Abstract

Diagnosis threat is a psychosocial factor that has been proposed to contribute to poor outcomes following mild traumatic brain injury (mTBI). This threat is thought to impair the cognitive test performance of individuals with mTBI because of negative injury stereotypes. University students (N = 45, 62.2% female) with a history of mTBI were randomly allocated to a diagnosis threat (DT; n = 15), reduced threat (DT-reduced; n = 15), or neutral (n = 15) group. The reduced threat condition invoked a positive stereotype (i.e., that people with mTBI can perform well on cognitive tests). All participants were given neutral instructions before they completed baseline tests of objective cognitive function across a number of domains, psychological symptoms, and PCS symptoms, including self-reported cognitive and emotional difficulties. Participants then received either neutral, DT, or DT-reduced instructions before repeating the tests. Results were analyzed using separate mixed model analysis of variances (ANOVAs); one for each dependent measure. The only significant result was for the 2 · 3 ANOVA on an objective test of attention/working memory, Digit Span ( p < 0.05), such that the DTreduced group performed better than the other groups, which were not different from each other. Although not consistent with predictions or earlier DT studies, the absence of group differences on most tests fits with several recent DT findings. The results of this study suggest that it is timely to reconsider the role of DT as a unique contributor to poor mTBI outcome.

Gender Stereotype Susceptibility

“…For example, it appears likely that in female patients suffering gynecologic oncological diseases, information about disease can block mechanisms supporting recovery processes. This may happen presumably due to “diagnosis threat”, a kind of stereotype threat [59] , [60] , [61] , [62] . Elucidating the specificity of this patient population in coping with disease related negative information would help to work out the strategies of how to inform female oncological patients, and how to support them in health-related decision making.…”

Functional Brain Networks and Alcohol Consumption: From the Naïve State to Chronic Heavy Drinking

“…Alcohol use disorder (AUD) constitutes a global problem and is ranked among the top substance abuse problems in the United States, with over 70% of adults that struggle with substance use disorder estimated to abuse alcohol 1 (SAMSHA 2018). AUD impacts global brain functional networks including the default mode, executive, attentional, salience and reward networks [2][3][4][5][6][7] but the neurocircuitry underlying vulnerability and resilience to alcohol use disorder (AUD) is not clearly understood, making it difficult to establish viable, targeted treatment options.…”

Symptom over-reporting ≠ malingering

“…Likewise, a number of factors have been proposed to affect the size of stereotype/diagnosis threat, including timing of test administration, strength of threat cues, injury severity, group identification, and pre-existing injury expectations. However, so far, no robust support has been found for any of these variables (Blaine et al, 2013;Kit et al, 2008). More importantly, a recent study by study included in our supplementary analysis) yielded only limited support for a diagnosis threat effect on neurological tests in a clinical sample of MHI patients who were either allocated to a threat or a reduced threat condition.…”

“…condition. Some studies also included additional conditions, such as a reduced threat (Blaine, Sullivan, & Edmed, 2013) or gender threat condition (Pavawalla, Salazar, Cimino, Belanger, & Vanderploeg, 2013), or they also looked at diagnosis threat within healthy individuals who had no history of MHI (Ozen & Fernandes, 2011). For our analysis, we focused solely on threat vs. no-threat conditions that included individuals with a history of MHI.…”

“…Pavawalla et al (2013) replicated a diagnosis threat effect for cognitive performance, but only so for males who -in addition to having had a MHI in the past -strongly identified with a diagnosis of MHI. The two most recent studies obtained the least support for diagnosis threat: Trontel, Hall, Ashendorf, and O'Connor (2013) located a decreased performance on only one out of nine cognitive tests (i.e., WAIS-III Information; intellectual ability), whereas Blaine et al (2013) found no significant differences on any measures. The conclusions of all but one study (Blaine et al, 2013) mirror the notion that diagnosis threat is of clinically significant value.…”