Cogniform Disorder and Diagnosis Threat

Reasons behind failed effort tests

• There’s been a lot of focus on failure of effort tests, and what that means for diagnosis

• Need to ask why failed the effort tests– Stereotype threat? – Stereotype threat- a member of a particular group,

when face with a task that is thought to be poorly performed by members of that group, will face the threat of being judged by stereotypes about that group’s inferiority on the task• E.g. stressing asian-ness vs. woman-ness on math tests

Stereotype Threat

• Why do we see decreased performance?– Anxiety– Stress– Distraction less efficient cognitive processing– Decreased effort – Confidence– The evidence for each of these is mixed, though

Sur & Gunstad, 2002• 36 Ugs with history of head mTBI, no depression, no neurological history• 17 – diagnosis threat group, 19 neutral group• A growing number of neuropsychological studies and that many

individuals with head injuries/concussions show cognitive deficits on neuropsychological tests. Deficits in areas such as attention, memory, and speed of information processing are common, though other deficits sometimes emerge. This study examines the role that head injury may play in these cognitive areas to better understand the nature of the disorder. When the experimenter returns to the room, s/he will ask you to complete a brief collection of common neuropsychological tests. These tests will assess skills such as attention, memory, speed of information processing, problem solving skills, etc. Some of the tests are easy, some are more difficult. Please give your best effort. Questions about individual tests will be answered following the testing.

Results

Suhr & Gunstadt, 2005

• Presented UGs with diagnosis threat, looking at possibility of anxiety and effort as mediators of poor performance

Results

Results

• No significant differences between groups on subjective effort or effort measures, on self-reported anxiety, or on self-reported dpression

Discussion Questions

• What are the implications of diagnosis threat for forensic testing?

• How would you generalize these studies to forensic populations, given the exclusion criteria of no reported anxiety/depression?

• Would you apply this information differently in a forensic vs. therapeutic manner?

Cogniphobia

• Cogniphobia- fear of pain, leading to decreased effort exerted on cognitive tasks in order to avoid potential onset of pain or exaggeration of existing pain– E.g. discontinuing tasks that “make my head hurt”

• Basically, the cognitive counterpart of kinesiophobia or the irrational fear that engaging in physical movement will induce pain

Suhr and Spickard 2012

• 74 UGs with frequent headaches• Created a measures of cogniphobia, looked at pain,

catastrophizing, and measures of attention• Results:

– 2 components of headache fear: dangerousness, and avoidance

– Dangerousness wasn’t associated with cognitive performance or avoidance

– avoidance was associated with lower PASAT scores (and lower effort measures)

– Avoidance was associated with lower pressure pain thresholds

Discussion Questions

• In light of the egg carton ruling, how should one interpret scores stemming from suspected cogniphobia? – E.g. does this impact your interpretation of

severity?