The influence of negative stereotypes and beliefs on neuropsychological test performance in a traumatic brain injury population




Kit, Karen Anne

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Objectives: Most researchers have attributed observed cognitive differences between individuals with a traumatic brain injury (TBI) and ‘normal’ individuals to physiological changes to the brain. Lacking exploration has been the role of social context/environmental variables. One of the variables investigated in the social psychology literature is stereotypes. Research has shown that the presence of stereotypes in testing environments negatively interferes with test performance (called stereotype threat theory). This concept appears relevant to the TBI population given that empirical research has demonstrated that individuals tend to believe that traumatic brain injuries lead to cognitive deficits, as well as the fact that reminders of potential cognitive deficits are oftentimes present in neuropsychological testing settings (e.g., in pre-test instructions, etc.). It is argued that these cues exacerbate pre-existing negative beliefs regarding cognitive functioning for individuals with a mild-moderate TBI, thereby affecting neuropsychological test performance. Method: The sample consisted of 42 individuals who sustained a mild-to-moderate TBI at least 6 months earlier and 42 age-, gender-, and education-matched healthy adults below the age of 60. The study, similar to other stereotype threat research, consisted of ‘reduced threat’ and ‘heightened threat’ conditions. The purpose of the former condition was to reduce negative stereotypes and emphasize the notion of personal control over cognitive abilities. Questionnaires and neuropsychological tests were administered subsequent to the experimental manipulation. Results: TBI participants endorsed greater levels of anxiety, motivation, and dejection, but reduced feelings of memory self-efficacy compared to the control group. The most pivotal results to the research study revealed that the TBI heightened threat group displayed lower scores on the Initial Encoding and Attention composite variables (which were comprised of neuropsychological test measures) than the TBI reduced threat group. Furthermore, the head-injured heightened threat condition reported lower memory self-efficacy than the reduced threat condition, and the non-head-injured heightened threat group endorsed a greater degree of negative beliefs/stereotypes regarding TBI than the non-head-injured reduced threat group. The construct of memory self-efficacy was found to mediate the relation between threat condition and performance on encoding/attention measures. Conclusions: The findings highlight the role of negative stereotypes and expectations/beliefs to cognitive test performance in individuals who have sustained a mild/moderate TBI. To date, there have been few attempts to integrate social cognition with neuropsychology. Applying the information gleaned from previous stereotype threat studies to a TBI population bridges this gap and provides a prosperous avenue for future research.



neuropsychology, traumatic brain injury, stereotype threat