Influence of Negative Stereotypes and Beliefs on Neuropsychological Test Performance in a Traumatic Brain Injury Population

Abstract

The impact of stereotype threat and self-efficacy beliefs on neuropsychological test performance in a clinical traumatic brain injury (TBI) population was investigated. A total of 42 individuals with mild-to-moderate TBI and 42 (age-, gender-, educationally matched) healthy adults were recruited. The study consisted of a 2 (Type of injury: control, TBI) × 2 (Threat Condition: reduced threat, heightened threat) between-participants design. The purpose of the reduced threat condition was to reduce negative stereotyped beliefs regarding cognitive effects of TBI and to emphasize personal control over cognition. The heightened threat condition consisted of an opposing view. Main effects included greater anxiety, motivation, and dejection but reduced memory self-efficacy for head-injured-groups, compared to control groups. On neuropsychological testing, the TBI-heightened-threat-group displayed lower scores on Initial Encoding (initial recall) and trended toward displaying lower scores on Attention (working memory) compared to the TBI-reduced-threat-group. No effect was found for Delayed Recall measures. Memory self-efficacy mediated the relation between threat condition and neuropsychological performance, indicating a potential mechanism for the threat effect. The findings highlight the impact of stereotype threat and self-referent beliefs on neuropsychological test performance in a clinical TBI population.

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

“…24 Another possible explanation for the inconsistent mTBI DT findings might be sample differences. For example, Kit did not find an effect using a community dwelling sample with mild and moderate TBI, 23 whereas Suhr and Gunstad did find an effect using a mild head injury sample. 11,21 This factor, too, is unlikely to explain the inconsistent effects; even when injury severity is matched across studies, findings are mixed.…”

“…11,21 Since Suhr and Gunstad's most recent study, 21 there have been a handful of mTBI DT studies; however, this research has been unable to replicate the earlier cognitive test findings. [22][23][24] Several methodological differences between the Suhr and Gunstad study and subsequent studies have been suggested to account for these inconsistent findings. For example, Kinkela delivered the stereotyped message through a negatively framed video about mTBI, 22 as opposed to the written instructions used in other studies.…”

“…For example, Kinkela delivered the stereotyped message through a negatively framed video about mTBI, 22 as opposed to the written instructions used in other studies. [21][22][23][24] This difference is unlikely to account for the failure to replicate findings because even with the same instruction format, contrary findings occur. 24 Another possible explanation for the inconsistent mTBI DT findings might be sample differences.…”

“…11,21 This factor, too, is unlikely to explain the inconsistent effects; even when injury severity is matched across studies, findings are mixed. 11,24 A third explanation might be variation in the detail of the instructions used to induce the threat (e.g., whether it includes comparison with a reference group or not); 11,21,23 yet, even with the same instructions, the effect has not been robust. 23,24 A related, and to the best of our knowledge, not previously articulated possible explanation is that the groups with whom participants are asked to identify are different; for example, some threat instructions require participants to identify with the stereotype of a head injured 24 or concussed individual; 21 yet, the negative expectations associated with these terms have been shown to be significantly different.…”

“…11,24 A third explanation might be variation in the detail of the instructions used to induce the threat (e.g., whether it includes comparison with a reference group or not); 11,21,23 yet, even with the same instructions, the effect has not been robust. 23,24 A related, and to the best of our knowledge, not previously articulated possible explanation is that the groups with whom participants are asked to identify are different; for example, some threat instructions require participants to identify with the stereotype of a head injured 24 or concussed individual; 21 yet, the negative expectations associated with these terms have been shown to be significantly different. [25][26][27] While it remains difficult to identify the reasons for these discrepancies in the DT literature, this research could be advanced by further studies that extend the test of this concept and address the methodological limitations of past studies.…”