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

Abstract

Objective: Some studies have shown that diagnosis threat (DT) could negatively impact the cognitive performance of undergraduate students who had sustained a mild traumatic brain injury. This study was designed to examine DT in people with acquired brain injury (ABI). As a second goal, we investigated the effect of stereotype lift as a way to overcome DT's harmful impact. The purpose of this study was also to examine the mechanisms mediating stereotype effects. Method: People with ABI and control participants were assigned to one of three conditions DT, cognitive-neutral (in which the cognitive status of participants with ABI and the cognitive characteristics of the tasks were deemphasized), and stereotype lift (in which a downward comparison was made with another neurological group). Participants then completed neuropsychological tasks. Negative emotions, intrusive thoughts, task expectancy, and self-efficacy were assessed for mediation analyses. Results: Instructions impacted the performance of people with ABI, but not control participants. Compared to the cognitive-neutral condition, participants with ABI in the DT condition performed worse on memory and executive tasks (but not on attention tasks). These effects were mediated by negative emotions. There was no increase in performance in the stereotype lift condition compared to the DT condition. Conclusions: This study showed that DT can aggravate the cognitive difficulties of people with ABI during neuropsychological assessment. The mediating role of negative emotions and the selective impact of DT on tasks that rely heavily on executive functioning are discussed in the light of the stereotype threat model.