The Cancer Stroop Task as an Implicit Measure of Cognitive Interference in Head and Neck Cancer Patients

Abstract

Abstract Given the stigmatizing and debilitating nature of head and neck cancer (HNC) and its treatment, patients are at risk of developing trauma symptoms such as cognitive interference (unwanted, disturbing thoughts) that can increase their risk for distress. Most measures of cognitive interference employ a self-report format making them susceptible to self-presentation and defensive biases. To address these limitations, we developed and implemented an implicit measure, a cancer Stroop task (CST), with the goal to establish a link between implicit intrusive cognitions and distress (BSI) and self-reported intrusive cognitions (Impact of Events Scale, IES). As part of an observational spousal support study, 70 patients (87% male) completed self-report measures and then engaged in problem-solving discussions with their spouses about cancer-related concerns in the lab. Afterward, the computerized CST was administered. Participants were instructed to color-name each stimulus word while ignoring word meaning. Slower responses to emotionally salient (cancer) versus neutral words reflect their power to automatically capture attention and become intrusive. Results revealed a significant inverse association between response time to cancer words and distress (P < 0.001) and self-reported cognitive intrusion (P < 0.01) so that individuals who responded more slowly revealed greater distress and cognitive intrusion compared to individuals with faster responses. These findings suggest that the CST is a promising measure of cognitive interference as it is associated with self-report measures of distress and cognitive intrusion. Unlike self-report measures assessing intrusive cognitions over the past 7 days, this implicit measure allows to examine the effects of immediate environmental antecedents on cognitive interference. Thus, our next step in this ongoing study will be to behaviorally code the cancer discussion for supportiveness on the spouse as a predictor of cognitive interference as measured by the CST.