Diagnostic terminology, athlete status, and history of concussion affect return to play expectations and anticipated symptoms following mild traumatic brain injury.

"Mild traumatic brain injury" (mTBI) and "concussion" are terms often used interchangeably. However, "mTBI" is frequently seen as representing a broader injury that encompasses the construct of "concussion," which often conveys transience or decreased severity. The present study examined the influence of varying diagnostic terminology on acute injury expectations in an undergraduate population (N = 105). Participants were presented with an mTBI vignette and were randomly assigned to one of two conditions in which the term "mTBI" or "concussion" was used to describe the injury. There were no significant differences between the two conditions on anxiety, symptomatology, timeline, or consequence scales. However, participants in the "mTBI" group allocated more days to return to play than participants in the "concussion" group, suggesting that terminology has an effect on perceptions of the severity of the injury. Varsity athletes allocated fewer days to return to play than nonathletes. Individuals with a history of concussion, both athletes and nonathletes, indicated fewer days to return to play, but greater symptomatology than individuals with no history of concussion. Clinicians should consider the influence of diagnostic terminology, athletic background, and history of concussion on perceptions of the severity of an injury because expectations can influence injury outcomes and compliance in a recovery process.

Placebo sleep affects cognitive functioning.

The placebo effect is any outcome that is not attributed to a specific treatment but rather to an individual's mindset (Benson & Friedman, 1996). This phenomenon can extend beyond its typical use in pharmaceutical drugs to involve aspects of everyday life, such as the effect of sleep on cognitive functioning. In 2 studies examining whether perceived sleep quality affects cognitive functioning, 164 participants reported their previous night's sleep quality. They were then randomly assigned to 1 of 2 sleep quality conditions or 2 control conditions. Those in the "above average" sleep quality condition were informed that they had spent 28.7% of their total sleep time in REM, whereas those in the "below average" sleep quality condition were informed that they had only spent 16.2% of their time in REM sleep. Assigned sleep quality but not self-reported sleep quality significantly predicted participants' scores on the Paced Auditory Serial Addition Test and Controlled Oral Word Association Task. Assigned sleep quality did not predict participants' scores on the Digit Span task, as expected, nor did it predict scores on the Symbol Digit Modalities Test, which was unexpected. The control conditions showed that the findings were not due to demand characteristics from the experimental protocol. These findings supported the hypothesis that mindset can influence cognitive states in both positive and negative directions, suggesting a means of controlling one's health and cognition.

Neuropsychological testing for sports-related concussion: how athletes can sandbag their baseline testing without detection.

Neuropsychological baseline testing is commonplace in the assessment of concussion; however, claims of "sandbagging" the baseline have led neuropsychologists to ask to what extent athletes can perform intentionally poorly on baseline testing without reaching threshold on the test validity indicators. Seventy-five undergraduate athletes were re-administered the ImPACT neurocognitive battery, which they had previously taken to establish baseline functioning, but were instructed to perform more poorly than their baseline without reaching threshold on the test validity indicators. Eight participants were able to successfully fake significantly lower scores without detection by validity indicators. Concussion history was not related to performance. Successful fakers did not perform significantly worse on the Reaction Time Composite and Three Letters Total Letters Correct, questioning the utility of these measures for detecting "sandbagging." Successful fakers reported using less purposeful faking strategies which naturally facilitated errors. The data suggest that "sandbagging" the baseline, even under conditions involving motivation, instruction, and experience with the test, is difficult to accomplish without being detected.

Attitudes about depression and its treatment among mental health professionals, lay persons and immigrants and refugees in Norway.

BACKGROUND: Internationally, depression is a common psychological disorder whose treatment depends upon its identification by treating professionals as well as patient utilization of mental health care systems; the latter often being hampered by cultural differences between patients and health professionals. METHOD: The current study used vignettes of depressed patients which varied the culture and/or social circumstances of the patient to assess whether these variables influenced the conceptualization of depression and its treatment. Participants (N=722) included mental health professionals, lay people, immigrants, and refugees in Norway. RESULTS: We found that immigrants and refugees, particularly those of non-western origin, endorsed different types of depression treatments from native Norwegians and mental health professionals, and judged who deserved treatment and who was overreacting based on the patient's culture and social circumstances, while native Norwegians did not. LIMITATIONS: While widely used cross-culturally, vignette methodology is limited in its generalizability to real clinical situations. Acculturation was not evaluated, which may have influenced the results. CONCLUSIONS: Findings support the integration of cultural competency ideals not only into treatment, but also into public health promotions of mental health services for lay people.

Why one fakes a head injury affects how one fakes a head injury.

Identifying suspect effort in neuropsychological assessments has been investigated in clinical samples and experimental simulation paradigms. While patients' incentives, such as compensation, are commonly thought to impact motivation, other motivational influences, such as attention-seeking, have been largely unexplored. To this end, undergraduates (n=202) were asked to fake a head injury on the Dot Counting Test, California Verbal Learning Test, and Benton Visual Retention Test. Participants were assigned to one of four Motivation conditions (no motivation, avoiding blame, compensation, attention-seeking). Analyses revealed that those with compensation- and attention-seeking motivations performed significantly worse than those with blame avoidance and no motivations, suggesting that type of motivation affects performance on neuropsychological assessment. The relative similarity between compensation-seekers and attention-seekers, however, suggests that the two groups would be difficult to differentiate. Preliminary findings suggest that compensation-seekers may favor errors of omission and attention-seekers may favor errors of commission in their performance; however this finding requires replication.

The effects of motivation, coaching, and knowledge of neuropsychology on the simulated malingering of head injury.

Two student groups, introductory psychology (n=91) and advanced neuroscience (n=34) undergraduates, were asked to malinger a head injury on Rey's 15-Item Test (FIT) and Dot Counting Test (DCT). The participants were randomly assigned to one of three motivation conditions (no motivation given, compensation, avoidance of blame for a motor vehicle accident) and to one of three coaching conditions (no coaching, coaching post-concussive symptoms, coaching symptoms plus warning of malingering detection). Analyses revealed a MotivationxStudent Group interaction on the FIT, indicating that the advanced neuroscience students, particularly when in the compensation condition, malingered the most flagrantly. On the DCT, main effects for motivation and coaching on the qualitative variables and a MotivationxCoaching interaction on the accuracy variables indicated that those in the compensation condition performed the most poorly, and that coaching plus warning only tempers malingering on memory tasks, not timed tasks.