Diagnosis threat and underperformance: The threat must be relevant and implicit

Area of Science:

• Neuroscience
• Psychology

Background:

• The diagnosis threat (DT) phenomenon describes how reminders of neurological history can impair cognitive function in individuals with mild traumatic brain injury (mTBI).
• Personal relevance, specifically domain identification, and the nature of the threat (implicit vs. explicit) are potential moderators of this effect.
• Intrusive thoughts have been proposed as a mediator for the diagnosis threat phenomenon.

Purpose of the Study:

• To investigate the moderating roles of personal relevance (domain identification) and threat type (implicit vs. explicit) on cognitive performance in individuals with mTBI.
• To examine the potential mediating role of intrusive thoughts in the diagnosis threat phenomenon.

Main Methods:

• Participants with and without mTBI completed a domain identification questionnaire.
• Participants were assigned to either an implicit or explicit diagnosis threat condition.
• Cognitive performance was assessed using tasks measuring working memory, episodic memory, and executive processing, alongside measures of intrusive thoughts.

Main Results:

• High domain identifiers with mTBI performed worse in the implicit DT condition compared to the explicit condition for working and episodic memory.
• In the implicit DT condition, high identifiers with mTBI scored lower on working memory than low identifiers.
• Conversely, high identifiers with mTBI performed better in the explicit DT condition for both working and episodic memory compared to low identifiers.
• Low identifiers with mTBI unexpectedly showed improved working memory performance in the implicit DT condition versus the explicit condition.
• No evidence was found to support intrusive thoughts as a mediator.

Conclusions:

• Domain identification and the type of diagnosis threat (implicit vs. explicit) are critical factors influencing cognitive performance in individuals with mTBI.
• The findings highlight the impact of diagnosis threat on neuropsychological assessment outcomes for mTBI patients.