The impact of a defensive response set on the relationship between MMPI and cognitive tests among heart transplant candidates

John D. Putzke, Mark A. Williams, Cheryl L. Millsaps, Harry J. McCarty, Richard L. Azrin, Judith A. LaMarche, Thomas J. Boll, Robert C. Bourge, James K. Kirklin, David C. McGiffin

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17 Citations (Scopus)


Examination of the relationship between self-reported psychological symptoms (e.g., depression and anxiety) and cognitive tests assumes individuals are highly motivated to both openly disclose psychological symptoms and to extend best-effort on cognitive tests. Situations that change this ideal motivational state on either self-report questionnaires or cognitive tests attenuate the validity of this assumption. To illustrate this problem, this study examined the emotional-cognitive correlation in a clinical series of 136 cardiac patients undergoing psychosocial and cognitive evaluation as part of a standard protocol for entry into a cardiac transplant program. The evaluative nature of the psychosocial assessment motivates some candidates to respond in a defensive manner, thereby decreasing the validity of self-report psychological measures. This same situation likely promotes high performance motivation on cognitive tests. It was hypothesized that a defensive response set on the Minnesota Multiphasic Personality Inventory (MMPI), as measured by the F-K (Frequency-Correction) Gough Dissimulation Index, would attenuate the strength of the emotional-cognitive relationship. Cognitive factor scores were generated and correlated with the MMPI state clinical scales (i.e., scales 2, 7, and 8) for both nondefensive and defensive (F-K ≤ -15) groups. Results show increased emotional distress was reliably associated with decreased cognitive functioning (rs = -.22 to -.27) among the nondefensive group, but was unrelated in the defensive group. The importance of considering the influence of performance contingencies within research and clinical settings is discussed.

Original languageEnglish
Pages (from-to)365-375
Number of pages11
Issue number4
Publication statusPublished - Dec 1997
Externally publishedYes

Cite this

Putzke, J. D., Williams, M. A., Millsaps, C. L., McCarty, H. J., Azrin, R. L., LaMarche, J. A., Boll, T. J., Bourge, R. C., Kirklin, J. K., & McGiffin, D. C. (1997). The impact of a defensive response set on the relationship between MMPI and cognitive tests among heart transplant candidates. Assessment, 4(4), 365-375.