Abstract

The Response Bias Scale (RBS) has been found to be a better predictor of over-reported memory complaints than Minnesota Multiphasic Personality Inventory-2 (MMPI-2) F, Back Infrequency (Fb), Infrequency-Psychopathology (Fp), and FBS scales. The MMPI-2-Restructured Form (RF) validity scales were designed to meet or exceed the sensitivity of their MMPI-2 counterparts to symptom over-reporting. This study examined the incremental validity of MMPI-2-RF validity scales and RBS in assessing memory complaints. The MMPI-2-RF over-reporting validity scales were more strongly associated with mean Memory Complaints Inventory scores than their MMPI-2 counterparts (d = 0.22 to 0.49). RBS showed the strongest relationship with memory complaints. Regression analyses demonstrated the incremental validity of the MMPI-2-RF Infrequent Responses, Infrequent Psychopathology Responses, Infrequent Somatic Responses, and FBS-r scales relative to MMPI-2 F, Fp, and FBS in predicting memory complaints. This is consistent with the development objectives of the MMPI-2-RF validity scales as more efficient and sensitive measures of symptom over-reporting.

Introduction

The Minnesota Multiphasic Personality Inventory-2-Restructured Form (MMPI-2-RF; Ben-Porath & Tellegen, 2008) is comprised of 338 of the original 567 items of the MMPI-2 (Butcher et al., 2001). The goal of the MMPI-2-RF was to extend the work that began with the MMPI-2 Restructured Clinical (RC; Tellegen et al., 2003) scales by developing a set of substantive scales that would exhaustively capture the clinically relevant content of the MMPI-2 item pool, but with improved psychometric properties, including reduced scale intercorrelations and equivalent or enhanced discriminant and convergent validity compared with existing MMPI-2 scales. The resulting 42 substantive scales include the Higher-Order scales, RC scales, Specific Problems scales, Interest scales, and revised versions of the Personality Psychopathology Five scales.

The MMPI-2-RF also contains revised versions of seven standard MMPI-2 validity scales: VRIN-r (Variable Response Inconsistency), TRIN-r (True Response Inconsistency), F-r (Infrequent Responses), Fp-r (Infrequent Psychopathology Responses), FBS-r (Symptom Validity), L-r (Uncommon Virtues), and K-r (Adjustment Validity). The F-r, Fp-r, and FBS-r scales were designed to meet or exceed the sensitivity of their MMPI-2 counterparts to over-reporting of general emotional distress, infrequent psychiatric symptoms, and somatic and cognitive symptoms. A new validity scale, Fs (Infrequent Somatic Responses), was designed to identify over-reporting of somatic symptoms by evaluating the endorsement level of somatic complaints made uncommonly by medical patient populations.

The F-r scale consists of 32 items that were endorsed in the keyed direction by 10% or less of the MMPI-2-RF normative sample. Internal consistency of the scale ranges from .69 (men) to .71 (women) in the MMPI-2-RF normative sample and between .85 and .88 in community outpatient and psychiatric inpatient samples. Test–retest reliability was .82 in a subset of the MMPI-2-RF normative sample. The correlations between F-r and F ranged from .76 to .96 in various psychiatric inpatient, medical patient, personal injury/disability, neuropsychological, and under-reporting samples described in the “Technical Manual” (Tellegen & Ben-Porath, 2008).

In restructuring the Fp-r scale, nine items were dropped from the original Fp scale, and three more effective items were added, leading to the 21-item Fp-r. Internal consistency of the scale, as described in the “Technical Manual,” ranges from .41 to .60, with a test–retest reliability of .71. Fp-r and Fp are strongly correlated (.73 to .99) and are considered effective predictors of symptom over-reporting in settings with a high base rate of severe psychopathology (Tellegen & Ben-Porath, 2008). Sellbom, Toomey, Wygant, Kucharski, and Duncan (in press) used a known-group design to examine the utility of the MMPI-2-RF validity scales in detecting malingering, as defined by the Structured Interview of Reported Symptoms (Rogers, Bagby, & Dickens, 1992), in a sample of criminal defendants. F-r and Fp-r were most effective in discriminating between malingering and non-malingering groups (d = 2.37 and 2.34, respectively).

The Fs (Infrequent Somatic Responses) scale introduced in the MMPI-2-RF consists of 16 items describing somatic symptoms that were endorsed by 25% or less of patients in two large medical samples and a chronic pain patient sample (Wygant, Ben-Porath, & Arbisi, 2004). Internal consistency of Fs ranges between .60 and .68 in the “Technical Manual's” community outpatient and psychiatric inpatient samples. In a study of the MMPI-2-RF validity scales using two simulator samples and a personal injury/disability sample, Fs produced large effect sizes (d = 0.90 and 1.97) in comparing head injury and medical simulators to their respective controls, and a similarly large effect size (d = 1.38) in personal injury/disability claimants passing symptom validity tests (SVTs) compared with those failing 2–3 SVTs (Wygant et al., 2009). The authors concluded that Fs and the other MMPI-2-RF over-reporting validity scales demonstrated good sensitivity and specificity in detecting exaggerated emotional, somatic, and neurocognitive complaints in civil forensic settings.

The FBS-r is composed of 30 of the original 43 FBS items retained in the MMPI-2-RF item pool. Internal consistency of the scale ranges from .71 to .76 in the community outpatient and psychiatric inpatient samples described in the MMPI-2-RF “Technical Manual.” Correlations between FBS-r and FBS in the psychiatric and medical over-reporting, personal injury/disability, and neuropsychological samples described in the MMPI-2-RF “Technical Manual” range between .96 and .99. Wygant and colleagues (2009) reported that FBS-r produced large effect sizes in discriminating between medical control and medical simulation over-reporting samples (d = 2.31), and in the personal injury/disability claimants who passed SVTs compared with those who failed 2–3 SVTs (d = 1.42).

The MMPI-2-RF over-reporting validity scales provide information regarding the credibility of the test taker's reported psychological, somatic, or cognitive dysfunction. Impaired memory is arguably the most common cognitive complaint encountered in clinical and forensic neuropsychological practice (Lezak, Howieson, & Loring, 2004). However, claims of memory impairment do not necessarily imply a neuropathological etiology. Indeed, there is a substantial literature documenting that post-concussive symptoms, including memory problems, are commonly reported by non-head-injury personal injury claimants, chronic pain patients, and people with depression (e.g., Iverson, 2006b; Iverson & McCracken, 1997; Landre, Poppe, Davis, Schmaus, & Hobbs, 2006; Lees-Haley & Brown, 1993). Gervais, Rohling, Green, and Ford (2004), in a study of 519 non-head-injury disability claimants, found that 84% of the sample reported that pain interfered with their memory, and 80% reported that memory problems interfered with their ability to work. Concerns with memory in this particular disability-seeking sample were evidently not insignificant. Reports of memory problems and associated functional impairments could be used to advance a disability claim, which underscores the need to conduct systematic assessment of validity as an integral part of the psychological or neuropsychological assessment (Bush et al., 2005; Heilbronner, Sweet, Morgan, Larrabee, & Millis, 2009).

The MMPI-2′s validity scales, by virtue of their ability to detect over-reporting and exaggeration of psychopathology, have contributed to the inventory's prominence as one of the most widely used measures of psychopathology employed by neuropsychologists (Archer, Buffington-Vollum, Vauter Stredny, & Handel, 2006; Lees-Haley, 1992). However, prior to the incorporation of the Symptom Validity Scale (FBS; Lees-Haley, English, & Glenn, 1991) into the test, the MMPI-2 validity scales were considered poor predictors of cognitive symptom exaggeration (Lees-Haley, Iverson, Lange, Fox, & Allen, 2002). More recently, Gervais, Ben-Porath, Wygant, and Green (2007) developed the Response Bias Scale (RBS) specifically to assist in detecting cognitive response bias associated with SVT failure and exaggerated memory or other cognitive complaints.

The RBS was developed using an empirical-keying methodology in which multiple regression analyses were employed to identify a set of MMPI-2 items that predicted failure on the Word Memory Test (WMT; Green, 2003), the Computerized Assessment of Response Bias (Allen, Conder, Green, & Cox, 1997), and the Test of Memory Malingering (TOMM; Tombaugh, 1996). In this respect, the RBS is the only MMPI-2/MMPI-2-RF scale specifically developed using SVT performance from an actual forensic disability clinical sample as the empirical-keying criterion. Internal consistency of the scale was .76 in both the development and validation samples (Gervais et al., 2007). The RBS is conceptually different from the FBS and FBS-r, with which it shares four items. The FBS was derived using a combination of empirical and rational analyses to select items that reflect exaggeration of post-injury emotional distress and minimization of pre-injury emotional or personality problems—in essence, a combination of both “faking bad” and “faking good” (Greiffenstein, Fox, & Lees-Haley, 2007). Although the symptom exaggeration tapped by the FBS and FBS-r also captures poor performance on SVTs, the initial validation of the RBS demonstrated it to be superior in this regard to the FBS, F, and Fp over-reporting validity indicators (Gervais et al., 2007).

Whitney, Davis, Shepard, and Herman (2008) examined the utility of the RBS, the MMPI-2 over-reporting validity scales (F, Fb, Fp, FBS), the Infrequency-Posttraumatic Stress Disorder (Elhai et al., 2002), and the Henry–Heilbronner Index (HHI; Henry, Heilbronner, Mittenberg, & Enders, 2006) scales and indices of the MMPI-2 in predicting failure on the TOMM (Tombaugh, 1996) in a sample of 46 VA Medical Center outpatients referred for neuropsychological testing. The RBS was associated with the largest effect size (d = 0.98) in discriminating between groups who passed and failed the TOMM. The authors used hierarchical regression analyses to examine the incremental validity of the RBS and, based on these results, concluded that the scale was superior to the standard MMPI-2 validity scales, and to some extent, the HHI in predicting SVT failure within the study sample.

In a study examining the diagnostic efficiency of the MMPI-2 and MMPI-2-RF validity scales, Larrabee (2008) found that the FBS, RBS, and FBS-r obtained the largest effect sizes in discriminating between a sample of 41 malingering civil litigants and 54 non-malingering neurological patients (d = 1.99, 1.91, and 1.85, respectively). ROC analysis revealed an AUC of 0.901 for the RBS, which indicates excellent ability to predict SVT failure. Regression analyses found that RBS was the best predictor of SVT performance (R2 = .436).

Gervais, Ben-Porath, Wygant, and Green (2008) examined the sensitivity of the MMPI-2 over-reporting validity scales, FBS, and RBS to memory complaints, as measured by the Memory Complaints Inventory (MCI; Green, 2004). They found that the RBS added incrementally to all MMPI-2 over-reporting scales in predicting memory complaints. The authors also established that there was no significant association between the RBS and performance on the California Verbal Learning Test (CVLT; Delis, Kramer, Kaplan, & Ober, 1987), an objective measure of verbal memory performance. The authors concluded that elevated RBS scores are unlikely to reflect actual memory deficits, but rather suggest symptom over-reporting associated with the report of memory complaints.

The primary purpose of the present study was to extend Gervais and colleagues' (2008) examination of the sensitivity of the MMPI-2 validity scales to over-reported memory complaints using the MMPI-2-RF validity scales and RBS. As noted above, one of the development objectives of the MMPI-2-RF was to provide validity scales that meet or exceed the sensitivity to over-reporting of their MMPI-2 counterparts. Accordingly, we predicted that the MMPI-2-RF validity scales would add to F, Fp, and FBS in the prediction of memory complaints, as one aspect of symptom presentation that is vulnerable to over-reporting. The present study therefore examined the incremental validity of (a) the MMPI-2-RF over-reporting validity scales relative to their corresponding MMPI-2 validity scales, and (b) the RBS relative to the MMPI-2-RF over-reporting scales, in assessing the veracity of memory complaints.

Materials and Methods

Participants

The present study used the archival sample described in Gervais and colleagues (2008) consisting of 1,550 consecutive predominantly non-head-injury disability-related referrals. Excluding people who omitted 18 or more items on the MMPI-2-RF or who obtained TRIN-r or VRIN-r ≥80 T resulted in a final sample of 1,187 cases. The sample was 40.6 (10.9) years of age, 52% men, and had 12.1 (2.5) years of education. Race or ethnicity was not coded in the data set. However, archival data compiled subsequent to the present data set contain the following racial and ethnic statistics coded by the Q Local MMPI-2-RF administration software: White (83.6%), Black (4.4%), Asian (2.7%), Aboriginal (1.1%), Hispanic (0.5%), and other (4.7%). These demographic characteristics are representative of the sample comprising the present data set and also reflect the general population demographics of the province of Alberta (Statistics Canada, n.d.).

English was spoken as a first language by 90% of the present sample. Reading level was assessed in the comprehensive psychological assessments, or as deemed necessary in the more narrowly focused chronic pain assessments, by means of the Wide Range Achievement Test, Third or Fourth Editions (Wilkinson, 1993; Wilkinson & Robertson, 2006). The mean reading standard score in claimants who spoke English as a second language was 86.8 (SD = 14.6), compared with 94.2 (SD = 11.1) in those who spoke English as a first language. Most individuals (56%) were involved in claims for Workers' Compensation disability benefits and 25% were involved in personal injury litigation. Chronic pain (38%), anxiety-related disorders (33%), and depression (21%) were the primary non-mutually exclusive diagnoses. Diagnoses were determined by the first author at the time of assessment and based on the DSM-IV (APA, 1994) or the DSM-IV-TR (APA, 2000) criteria. The mean MCI (Green, 2004) score in the sample was 28.8 (SD = 18.3). This compares with the mean MCI score of 19.5 (SD = 15) in a sample of patients with moderate to severe brain injuries reported by Green (2004), which indicates substantial concern with reported memory difficulties. Further details of the nature and extent of memory problems endorsed by the sample are contained in Table 1.

Table 1.

MCI rate of endorsement and scores in sample (N = 908)

MCI Scale Percent endorsing memory problems Mean SD Min Max 
GMP 94.2 30.6 22.6 100 
NIP 96.5 34.5 23.1 100 
VSMP 85.5 23.2 20.5 95 
VMP 95.6 43.3 25.6 100 
PIM 88.0 46.6 30.2 100 
MIW 85.1 33.8 27.6 100 
IRM 86.1 17.6 16.1 86 
ACB 86.9 19.7 19.7 92 
AAB 58.7 9.6 14.1 80 
Mean MCI  28.7 18.3 87 
MCI Scale Percent endorsing memory problems Mean SD Min Max 
GMP 94.2 30.6 22.6 100 
NIP 96.5 34.5 23.1 100 
VSMP 85.5 23.2 20.5 95 
VMP 95.6 43.3 25.6 100 
PIM 88.0 46.6 30.2 100 
MIW 85.1 33.8 27.6 100 
IRM 86.1 17.6 16.1 86 
ACB 86.9 19.7 19.7 92 
AAB 58.7 9.6 14.1 80 
Mean MCI  28.7 18.3 87 

Notes: MCI = Memory Complaints Inventory percent of maximum score; GMP = General Memory Problems; NIP = Numerical Information Problems; VSMP = Visuospatial Memory Problems; VMP = Verbal Memory Problems; PIM = Pain Interferes with Memory; MIW = Memory Interferes with Work; IRM = Impairment of Remote Memory; ACB = Amnesia for Complex Behavior; AAB = Amnesia for Antisocial Behavior; Mean MCI = Mean of all MCI scales; Percent endorsing memory problems = Percent of sample endorsing at least one item on the MCI scale in question.

Instruments

All people in this study were administered a psychological assessment battery consisting of a variety of cognitive tests, the MMPI-2, a number of symptom validity or effort tests including the WMT (Green, 2003; Green, Allen, & Astner, 1996; Green & Astner, 1995), and self-report symptom questionnaires, as described in Gervais and colleagues (2008). For the purposes of the present study, the analyses focused on the MMPI-2 and MMPI-2-RF F-family validity scales, FBS/FBS-r, RBS, and the MCI (Green, 2004).

“MMPI-2-RF” (Ben-Porath & Tellegen, 2008). All individuals in this study completed the MMPI-2. However, because the MMPI-2 item responses were contained in the archival data set, it was possible to retrospectively score the MMPI-2-RF and the RBS. MMPI-2-RF scale scores obtained by re-scoring MMPI-2 archival data sets are equivalent to those obtained by direct administration of the MMPI-2-RF. The equivalence of the MMPI-2-RF scale scores derived from both forms of the inventory indicates that the scores are essentially interchangeable, which justifies the use of archival MMPI-2 data sets in MMPI-2-RF research (Tellegen & Ben-Porath, 2008).

The “RBS” (Gervais et al., 2007) is an empirically developed MMPI-2 scale designed to predict failure on cognitive SVTs. The scale's 28 items were retained in the MMPI-2-RF and the non-gendered T-scores presented in Table A1 of Gervais and colleagues (2008) are fully applicable. The scoring key and T-score conversion table for the RBS in the MMPI-2-RF are presented in the Appendix. [The RBS items are identical in the MMPI-2 and the MMPI-2-RF; only the item numbers have changed with the restructuring of the MMPI-2-RF. The name of the RBS has been retained unchanged in the MMPI-2-RF to emphasize the continuity of the scale across both forms of the MMPI. The T-score conversion table presented in Gervais and colleagues (2008) is applicable to the RBS scored from either the MMPI-2 or the MMPI-2-RF. The clinician must recall, however, that the RBS scoring key in the present study is used for the MMPI-2-RF, and the scoring key from Gervais and colleagues (2007) is used with the MMPI-2.]

The “MCI” (Green, 2004) is a computer-administered self-report inventory consisting of 58 items describing a variety of commonplace and implausible memory problems. The inventory has nine scales: General Memory Problems (GMP), Numeric Information Problems (NIP), Visuospatial Memory Problems, Verbal Memory Problems (VMP), Pain Interferes with Memory (PIM), Memory Interferes with Work (MIW), Impairment of Remote Memory (IRM), Amnesia for Complex Behavior (ACB), and Amnesia for Antisocial Behavior (AAB). Internal consistency of the MCI scales is between .79 and .93 (Gervais, Ben-Porath, & Wygant, 2009). The readers are referred to Gervais and colleagues (2008) for a more detailed description of the MCI.

The “CVLT” (Delis et al., 1987) is a widely used measure of auditory verbal learning and memory for a word list presented over five learning trials. The test evaluates efficiency of learning and memory strategies, resistance to interference, and retention over short and long delays.

Results

Examination of Table 1 reveals that one or more items on the NIP scale were endorsed by 96.5% of the sample, followed by VMP (95.6%), GMP (94.2%), and PIM (88%). Mean scale elevations, reflecting the percent of the total possible score on any given scale ranged from 9.6% on AAB to 46.6% on PIM. The mean MCI score of 28.7% (SD = 18.3) was 0.61 SD above the mean of 19.5 (SD = 15) obtained by a sample of patients with moderate to severe brain injuries described by Green (2004).

The profile characteristics of the MMPI-2-RF validity, Higher-Order, and Somatic/Cognitive scales in the total sample and in subgroups passing all SVTs (n = 833) and failing any SVT (n = 354) are presented in Table 2. The fail any SVT group scored significantly higher than the pass all SVTs on F-r, t = 8.93, p < .001; Fp-r, t = 6.39, p < .001; Fs, t = 6.88, p < .001; FBS-r, t = 8.30, p < .001; and RBS, t = 12.54, p < .001. With the exception of the BXD (Behavioral/Externalizing Dysfunction), RC4 (Antisocial Behavior), and RC9 (Hypomanic Activation), the Higher-Order, RC, and Somatic/Cognitive scales were significantly higher in the fail any SVT subgroup compared with individuals who passed all the SVTs. In keeping with the negative response bias associated with SVT failure, the mean scores on F-r and FBS-r in the fail any SVT group were above the clinical cutoffs specified by Ben-Porath and Tellegen (2008) as raising suspicions of symptom over-reporting.

Table 2.

MMPI-2-RF Validity, Higher-Order, Restructured Clinical, and Somatic/Cognitive scale profile characteristics in total sample (N = 1187), pass all SVTs (n = 833) and fail any SVT (n = 354) subgroups

MMPI-2-RF Total sample
 
Pass all SVTs
 
Fail any SVT
 
 Mean SD Min Max Mean SD Mean SD 
VRIN-r 51.3 9.3 34 77 50.9 9.2 52.2 9.5 
TRIN-r 57.2 6.4 50 73 57.2 6.4 57.2 6.3 
F-r 74.8 21.3 42 120 71.3 19.8 83.0 22.5 
Fp-r 56.5 14.7 42 120 54.8 13.4 60.6 16.7 
Fs 68.8 20.9 42 120 66.2 19.4 75.1 23.0 
FBS-r 76.5 14.4 29 115 74.3 13.9 81.6 14.0 
RBS 73.6 18.9 33 120 69.4 17.4 83.5 18.8 
L-r 56.4 11.2 37 105 55.6 11.1 58.1 11.3 
K-r 44.0 10.1 24 72 44.7 9.9 42.5 10.4 
EID 64.3 13.3 30 93 62.8 13.1 67.9 13.1 
THD 57.0 13.6 39 100 55.7 12.7 60.0 15.0 
BXD 51.0 12.0 32 92 51.2 11.9 50.6 12.2 
RCd 64.5 12.3 37 86 63.0 12.2 67.8 11.9 
RC1 74.2 13.2 36 100 72.2 12.8 78.7 13.3 
RC2 64.9 13.8 34 99 63.1 13.2 68.9 14.2 
RC3 51.3 11.4 34 83 50.6 11.2 52.8 11.8 
RC4 52.2 11.9 34 96 52.3 11.7 51.8 12.4 
RC6 58.3 14.2 43 100 57.0 13.5 61.2 15.3 
RC7 58.0 13.8 34 94 56.6 13.2 61.3 14.6 
RC8 57.6 13.2 39 100 56.1 12.4 61.2 14.3 
RC9 48.4 10.5 25 88 48.4 10.5 48.5 10.4 
MLS 75.1 10.2 38 87 73.9 10.6 77.8 8.8 
GIC 66.9 16.9 46 96 65.3 16.8 70.9 16.7 
HPC 69.5 11.7 42 85 68.4 11.6 72.0 11.6 
NUC 71.9 14.3 41 100 69.9 14.0 76.5 13.7 
COG 68.5 15.6 40 96 65.6 15.2 75.2 14.5 
MMPI-2-RF Total sample
 
Pass all SVTs
 
Fail any SVT
 
 Mean SD Min Max Mean SD Mean SD 
VRIN-r 51.3 9.3 34 77 50.9 9.2 52.2 9.5 
TRIN-r 57.2 6.4 50 73 57.2 6.4 57.2 6.3 
F-r 74.8 21.3 42 120 71.3 19.8 83.0 22.5 
Fp-r 56.5 14.7 42 120 54.8 13.4 60.6 16.7 
Fs 68.8 20.9 42 120 66.2 19.4 75.1 23.0 
FBS-r 76.5 14.4 29 115 74.3 13.9 81.6 14.0 
RBS 73.6 18.9 33 120 69.4 17.4 83.5 18.8 
L-r 56.4 11.2 37 105 55.6 11.1 58.1 11.3 
K-r 44.0 10.1 24 72 44.7 9.9 42.5 10.4 
EID 64.3 13.3 30 93 62.8 13.1 67.9 13.1 
THD 57.0 13.6 39 100 55.7 12.7 60.0 15.0 
BXD 51.0 12.0 32 92 51.2 11.9 50.6 12.2 
RCd 64.5 12.3 37 86 63.0 12.2 67.8 11.9 
RC1 74.2 13.2 36 100 72.2 12.8 78.7 13.3 
RC2 64.9 13.8 34 99 63.1 13.2 68.9 14.2 
RC3 51.3 11.4 34 83 50.6 11.2 52.8 11.8 
RC4 52.2 11.9 34 96 52.3 11.7 51.8 12.4 
RC6 58.3 14.2 43 100 57.0 13.5 61.2 15.3 
RC7 58.0 13.8 34 94 56.6 13.2 61.3 14.6 
RC8 57.6 13.2 39 100 56.1 12.4 61.2 14.3 
RC9 48.4 10.5 25 88 48.4 10.5 48.5 10.4 
MLS 75.1 10.2 38 87 73.9 10.6 77.8 8.8 
GIC 66.9 16.9 46 96 65.3 16.8 70.9 16.7 
HPC 69.5 11.7 42 85 68.4 11.6 72.0 11.6 
NUC 71.9 14.3 41 100 69.9 14.0 76.5 13.7 
COG 68.5 15.6 40 96 65.6 15.2 75.2 14.5 

Notes: All scores are uniform T-scores except for the validity indices, which are linear T-scores (Ben-Porath & Tellegen, 2008). Protocols with invalid VRIN-r/TRIN-r and Cannot Say (CNS) ≥18 were excluded. MMPI-2-RF = Minnesota Multiphasic Personality Inventory-2-Restructured Form. VRIN-r = Variable Response Inconsistency; TRIN-r = True Response Inconsistency; F-r = Infrequent Responses; Fp-r = Infrequent Psychopathology Responses; Fs = Infrequent Somatic Responses; FBS-r = Symptom Validity; RBS = Response Bias Scale; L-r = Uncommon Virtues; K-r = Adjustment Validity; EID = Emotional/Internalizing Dysfunction; THD = Thought Dysfunction; BXD = Behavioral/Externalizing Dysfunction; RCd = Demoralization; RC1 = Somatic Complaints; RC2 = Low Positive Emotions; RC3 = Cynicism; RC4 = Antisocial Behavior; RC6 = Ideas of Persecution; RC7 = Dysfunctional Negative Emotions; RC8 = Aberrant Experiences; RC9 = Hypomanic Activation; MLS = Malaise; GIC = Gastrointestinal Complaints; HPC = Head Pain Complaints; NUC = Neurological Complaints; COG = Cognitive Complaints; SVT = symptom validity test.

Table 3 presents the correlations between the MCI scales and the MMPI-2-RF over-reporting scales and the RBS. We used Steiger's (1980) t-test for dependent correlations to determine whether the correlations between RBS and MCI scales were significantly higher than those for other MMPI-2-RF scales and the MCI. Results showed that the RBS was more strongly associated with the MCI scales relative to the MMPI-2-RF over-reporting scales in nearly all instances. AAB was most strongly associated with F-r (t = 2.60, p = .010). RBS and Fs did not differ on AAB (t = 0.85, p = .396), and F-r and RBS were not significantly different on IRM (t = −0.97, p = .332). FBS-r and RBS did not differ on PIM (t = −0.43, p = .667).

Table 3.

Correlations MMPI-2-RF scales and MCI (N = 908)

MCI F-r Fp-r Fs FBS-r RBS 
GMP .55 .36 .50 .49 .63 
NIP .50 .32 .42 .44 .59 
VSMP .53 .36 .46 .44 .59 
VMP .53 .31 .44 .47 .63 
PIM .37 .18 .29 .42 .43 
MIW .53 .29 .43 .47 .61 
IRM .45 .33 .39 .33 .47 
ACB .60 .40 .56 .49 .65 
AAB .56 .45 .53 .38 .51 
Mean MCI .61 .38 .53 .54 .69 
MCI F-r Fp-r Fs FBS-r RBS 
GMP .55 .36 .50 .49 .63 
NIP .50 .32 .42 .44 .59 
VSMP .53 .36 .46 .44 .59 
VMP .53 .31 .44 .47 .63 
PIM .37 .18 .29 .42 .43 
MIW .53 .29 .43 .47 .61 
IRM .45 .33 .39 .33 .47 
ACB .60 .40 .56 .49 .65 
AAB .56 .45 .53 .38 .51 
Mean MCI .61 .38 .53 .54 .69 

Notes: MMPI-2-RF = Minnesota Multiphasic Personality Inventory-2-Restructured Form; MCI = Memory Complaints Inventory; F-r = Infrequent Responses; Fp-r = Infrequent Psychopathology Responses; Fs = Infrequent Somatic Responses; FBS-r = Symptom Validity; RBS = Response Bias Scale; GMP = General Memory Problems; NIP = Numerical Information Problems; VSMP = Visual Spatial Memory Problems; VMP = Verbal Memory Problems; PIM = Pain Interferes with Memory; MIW = Memory Interferes with Work; IRM = Impairment of Remote Memory; ACB = Amnesia for Complex Behavior; AAB = Amnesia for Antisocial Behavior; Mean MCI = Mean of all MCI scales.

We used linear regression analyses to evaluate the incremental validity of the MMPI-2-RF over-reporting scales in predicting the mean MCI score compared with their MMPI-2 counterparts. In this analysis, we entered the MMPI-2 F, Fp, or FBS scales in the first block and the corresponding MMPI-2-RF scale in the second block. The R2 statistic indicates the additional percent of variance contributed by the scale entered in the second block. The order of entry was subsequently reversed to test the incremental contribution of the original MMPI-2 scale relative to the new MMPI-2-RF scale. Examination of Table 4 reveals that each MMPI-2-RF over-reporting scale added incrementally to its MMPI-2 counterpart, but the converse was not true. F-r contributed an additional 12% of the variance in predicting the mean MCI score, followed by 5% for Fp-r and 2% for FBS-r (p < .001).

Table 4.

Incremental validity of the MMPI-2-RF and MMPI-2 validity scales in predicting mean MCI performance (n = 882)

Model Block Scale Final β R2 forumla Fchange p-value 
−.05 .25    
 F-r .65 .37 .12 172.25 <.001 
F-r .65 .37    
 −.05 .37 .00 .84 .360 
Fp −.00 .09    
 Fp-r .39 .15 .05 55.57 <.001 
Fp-r .39 .15    
 Fp −.00 .15 .00 .00 .968 
FBS .05 .26    
 FBS-r .48 .28 .02 29.89 <.001 
FBS-r .48 .28    
 FBS .05 .28 .00 .37 .545 
Model Block Scale Final β R2 forumla Fchange p-value 
−.05 .25    
 F-r .65 .37 .12 172.25 <.001 
F-r .65 .37    
 −.05 .37 .00 .84 .360 
Fp −.00 .09    
 Fp-r .39 .15 .05 55.57 <.001 
Fp-r .39 .15    
 Fp −.00 .15 .00 .00 .968 
FBS .05 .26    
 FBS-r .48 .28 .02 29.89 <.001 
FBS-r .48 .28    
 FBS .05 .28 .00 .37 .545 

Notes: MMPI-2-RF = Minnesota Multiphasic Personality Inventory-2-Restructured Form. MMPI-2-RF validity scales: F-r = Infrequent Responses; Fp-r = Infrequent Psychopathology Responses; Fs = Infrequent Somatic Responses; FBS-r = Symptom Validity; MCI = Memory Complaints Inventory. Raw scores used for all analyses. In the first part of each analysis, the MMPI-2 scale is entered in the first block and the MMPI-2-RF validity scale is entered in the second block. In the second part of the analysis, the order of entry is reversed. The R2 change statistic indicates the additional or incremental percentage of the variance in the mean MCI score explained by the specific MMPI-2 or MMPI-2-RF validity scale. The final β value is a measure of how strongly the MMPI-2 or MMPI-2-RF validity scale influenced the mean MCI score. n = 882 reflects mutual exclusion of invalid MMPI-2 and MMPI-2-RF protocols.

Table 5 presents the results of linear regression analyses comparing the MMPI-2-RF over-reporting scales and the RBS in predicting the mean MCI score. In each instance, the RBS added incrementally to the MMPI-2-RF scale with the R2 statistic indicating a contribution of 12%–33% of the variance (p < .001). When the order of entry was reversed, the F-r, Fs, and FBS-r added up to 2% of the variance beyond the RBS, which indicates that these scales also have some incremental validity in predicting the mean MCI score.

Table 5.

Incremental validity of the RBS and MMPI-2-RF over-reporting scales in predicting mean MCI performance (N = 908)

Model Block Scale Final β R2 forumla Fchange p-value 
F-r .23 .38    
 RBS .52 .50 .12 219.95 <.001 
RBS .52 .48    
 F-r .23 .50 .02 41.03 <.001 
Fp-r .05 .15    
 RBS .67 .48 .33 569.57 <.001 
RBS .67 .48    
 Fp-r .05 .48 .00 2.62 .105 
Fs .16 .28    
 RBS .59 .49 .21 373.07 <.001 
RBS .59 .48    
 Fs .16 .49 .02 26.50 <.001 
FBS-r .12 .29    
 RBS .61 .48 .20 342.77 <.001 
RBS .61 .48    
 FBS-r .12 .48 .01 13.82 <.001 
Model Block Scale Final β R2 forumla Fchange p-value 
F-r .23 .38    
 RBS .52 .50 .12 219.95 <.001 
RBS .52 .48    
 F-r .23 .50 .02 41.03 <.001 
Fp-r .05 .15    
 RBS .67 .48 .33 569.57 <.001 
RBS .67 .48    
 Fp-r .05 .48 .00 2.62 .105 
Fs .16 .28    
 RBS .59 .49 .21 373.07 <.001 
RBS .59 .48    
 Fs .16 .49 .02 26.50 <.001 
FBS-r .12 .29    
 RBS .61 .48 .20 342.77 <.001 
RBS .61 .48    
 FBS-r .12 .48 .01 13.82 <.001 

Notes: MMPI-2-RF = Minnesota Multiphasic Personality Inventory-2-Restructured Form. MMPI-2-RF validity scales: F-r = Infrequent Responses; Fp-r = Infrequent Psychopathology Responses; Fs = Infrequent Somatic Responses; FBS-r = Symptom Validity; RBS = Response Bias Scale; MCI = Memory Complaints Inventory. Raw scores used for all analyses. In the first part of each analysis, the MMPI-2-RF scale is entered in the first block and the RBS is entered in the second block. In the second part of the analysis the order of entry is reversed. The R2 change statistic indicates the additional or incremental percentage of the variance in the mean MCI score explained by the RBS or the specific MMPI-2-RF scale. The final β value is a measure of how strongly the RBS and the MMPI-2-RF scale influenced the mean MCI score.

Finally, we conducted partial correlations between the MMPI-2-RF over-reporting validity scales and RBS and the CVLT while controlling for cognitive effort, as measured by the mean of the WMT Immediate Recall, Delayed Recall, and Consistency scores. Examination of Table 6 indicates that there was no significant association between the MMPI-2-RF over-reporting indices and objective memory performance, as measured by the CVLT. However, as noted in Table 7, the MMPI-2-RF over-reporting validity indicators and RBS were positively correlated with subjective memory complaints, as rated by the mean MCI score, despite controlling for potential symptom exaggeration and cognitive effort by using mean WMT as a covariate.

Table 6.

Partial correlations between MMPI-2-RF over-reporting validity indicators and RBS and CVLT controlling for effort

 F-r Fp-r Fs FBS-r RBS 
CVLT Trial 1–5 −.04 −.02 .00 .05 .00 
Trial 1 −.04 −.06 −.03 .04 −.01 
Trial 5 −.02 −.02 .00 .06 .03 
Short Delay Free Recall −.02 −.01 .01 .03 −.01 
Long Delay Free Recall −.01 .00 .01 .05 .01 
Recognition Hits −.04 −.02 −.04 −.05 −.04 
 F-r Fp-r Fs FBS-r RBS 
CVLT Trial 1–5 −.04 −.02 .00 .05 .00 
Trial 1 −.04 −.06 −.03 .04 −.01 
Trial 5 −.02 −.02 .00 .06 .03 
Short Delay Free Recall −.02 −.01 .01 .03 −.01 
Long Delay Free Recall −.01 .00 .01 .05 .01 
Recognition Hits −.04 −.02 −.04 −.05 −.04 

Notes: MMPI-2-RF = Minnesota Multiphasic Personality Inventory-2-Restructured Form; RBS = Response Bias Scale; CVLT = California Verbal Learning Test. Raw scores used for all correlations. Partial correlations controlling for effort (mean of Word Memory Test Immediate Recognition, Delayed Recognition, and Consistency). Subset of sample containing CVLT and WMT data (n = 773). All correlations were non-significant (p = .097 to .950).

Table 7.

Partial correlations between MMPI-2-RF over-reporting validity indicators and RBS and mean MCI controlling for cognitive effort

Scale F-r Fp-r Fs FBS-r RBS 
r .58 .34 .51 .50 .63 
Scale F-r Fp-r Fs FBS-r RBS 
r .58 .34 .51 .50 .63 

Notes: MMPI-2-RF = Minnesota Multiphasic Personality Inventory-2-Restructured Form; RBS = Response Bias Scale. Raw scores used for correlations. Partial correlations controlling for effort (mean of Word Memory Test Immediate Recognition, Delayed Recognition, and Consistency; n = 828).

Discussion

The present study is an extension of Gervais and colleagues' (2008) research, which examined the incremental validity of the RBS and MMPI-2 over-reporting validity scales in assessing memory complaints. In this study, we examined the incremental validity of the MMPI-2-RF over-reporting validity scales relative to their MMPI-2 counterparts and the RBS in assessing memory complaints. Although the RBS was more strongly associated with the mean MCI score and all subscales of the MCI (with the exception of AAB) than the MMPI-2-RF over-reporting validity scales, these MMPI-2-RF validity scales generally exceeded their MMPI-2 counterparts in their sensitivity to memory complaints. This is consistent with the development objectives of the MMPI-2-RF, which sought to provide revised validity scales that would perform at least as well, if not better, than the original MMPI-2 validity scales. Hierarchical regression analyses confirmed the superiority of the MMPI-2-RF F-r, Fp-r, and FBS-r scales in predicting memory complaints compared with their MMPI-2 counterparts. These findings support the use of the MMPI-2-RF as an efficient measure of psychopathology whose over-reporting validity scales are more sensitive to potentially exaggerated memory complaints than the original MMPI-2 F, Fp, and FBS scales. A second series of hierarchical regression analyses demonstrated that the incremental contribution of the RBS in predicting memory complaints ranged from 12% to 32% above the MMPI-2-RF F-r, Fp-r, Fs, and FBS-r scales in predicting memory complaints.

Gervais and colleagues (2008) demonstrated that the RBS is a sensitive measure of negative response bias characterized by exaggerated cognitive complaints, among which over-reported memory problems are a central feature. The study also demonstrated that elevated RBS scores were not associated with objective memory functioning, as measured by the CVLT. In the present study, we examined the association between the MMPI-2-RF over-reporting validity scales and the CVLT, while controlling for cognitive effort by using the mean of the WMT effort measures as a covariate. The correlation between the over-reporting scales and CVLT performance was non-significant and approaching zero. This parallels earlier findings with the RBS, as discussed in Gervais and colleagues (2008). We therefore propose that subjective memory complaints in the context of elevated scores on RBS or the other MMPI-2-RF over-reporting scales are unlikely to indicate objective memory deficits, but rather suggest exaggerated memory or other cognitive complaints.

It might be argued that the present sample, consisting primarily of non-head-injury disability claimants, would be unlikely to report any significant memory problems. However, review of the MCI endorsement rates contained in Table 1 clearly indicates that various types of memory problems were a common concern in the sample. This observation is consistent with studies describing the ubiquitous nature of memory complaints and other “post-concussive-like” symptoms in various non-head-injury samples (e.g., Iverson, 2006b). The prevalence of such symptoms across multiple settings and diagnostic groups underscores the relevance of formally assessing memory functioning as a routine component of clinical or forensic disability psychological or neuropsychological evaluations. Furthermore, as emphasized by Bush and colleagues (2005), Iverson (2006a), and Heilbronner and colleagues (2009), assessment of the validity of claimed symptoms and obtained test data is an essential element of a thorough and competent assessment, particularly where the presence of disability incentives could influence clinical presentation. Although formal cognitive SVTs are generally considered the primary means of assessing cognitive effort and validity of performance on formal cognitive testing, the findings of this study support the utility of the MMPI-2-RF over-reporting validity scales and the RBS in evaluating the validity of claimed memory problems and potential exaggeration of such claims in non-head-injury disability assessment settings.

Implications for MMPI-2-RF Interpretation

Results of this study demonstrate the incremental validity of the RBS in predicting subjective memory complaints compared with the existing MMPI-2-RF over-reporting validity scales. The magnitude of this contribution (12%–33% of the variance accounted for) indicates that the RBS can play an important role in evaluating the significance and validity of self-reported memory complaints in the context of forensic disability neuropsychological and psychological assessments and potentially in other clinical settings.

Gervais and colleagues (2008) proposed interpretive guidelines for the RBS at various T-score levels. Table 8 presents revised guidelines for the RBS and the MMPI-2-RF. These interpretive guidelines are similar to those applicable for the MMPI-2; however, slight modifications have been made to account for the T-score cutoffs specified by Ben-Porath and Tellegen (2008) and incorporation of the new Fs scale. Assuming content non-responsiveness is within acceptable limits (VRIN-r/TRIN-r < 80 T), the RBS score provides the clinician with information regarding the validity of self-reported memory complaints and the probability of SVT failure. As noted in the interpretive guidelines, RBS scores lower than 65 T suggest minimal to minor memory or other cognitive complaints and low probability of SVT failure. However, depending on the scores on F-r, Fp-r, Fs, or FBS-r, the possibility of exaggerated psychological dysfunction, somatic symptoms, and non-credible cognitive complaints must nonetheless be considered. Elevated scores on the MMPI-2-RF Cognitive Complaints (COG) scale reflect subjective reports of cognitive dysfunction, regardless of elevated scores on F-r, Fp-r, Fs, or FBS-r. COG scale elevations occurring in the context of RBS <65 T suggest that self-reported cognitive symptoms are primarily emotionally based, but not necessarily the result of systematic symptom over-reporting (Gervais et al., 2009). However, as the RBS approaches and exceeds 80 T, there is an increasing probability of SVT failure and exaggerated memory or other cognitive complaints associated with active negative response bias, which may be accompanied by elevated COG scores. When RBS and the other MMPI-2-RF validity scales are elevated, generalized over-reporting across emotional, somatic, and cognitive dimensions is likely.

Table 8.

Interpretive guidelines for the RBS at five T-score ranges

T < 50 (Raw 0–4) Minimal memory or other cognitive symptoms reported. Consider denial or “fake good” attitude, if cognitive testing reveals deficits. SVT failure is unlikely. If SVT(s) failed, consider passive factors such as disengagement or disinterest rather than active negative response bias 
T = 50–64 (Raw 5–8) Minor memory or cognitive symptoms may be reported, consistent with cognitive test results. If F-r < 79 T, Fp-r < 70 T, Fs, and FBS-r < 80 T, consider emotional factors contributing to memory complaints. SVT failure is unlikely. If SVT(s) failed, consider passive factors such as lack of engagement in testing. If F-r ≥ 79, Fp-r > 70, Fs, or FBS-r < 80 T, rule out possible MND (Slick, Sherman, & Iverson, 1999
T = 65–79 (Raw 9–11) Increasing memory complaints. If F-r < 79 T, Fp-r < 70 T, Fs, and FBS-r < 80 T, complaints are probably related to emotional factors. If F-r ≥ 79, Fp-r > 70, Fs, or FBS-r < 80 T, or SVT(s) failed, consider volitional symptom exaggeration. Rule out possible or probable MND 
T = 80–99 (Raw 12–16) Exaggerated memory complaints are likely. T-score range is associated with mean MCI score 1.5 SD above moderate to severe brain injury. Probability of SVT failure as high as 67%. If F-r < 79 T, Fp-r < 70 T, Fs, and FBS-r < 80 T, memory complaints may be related to emotional factors. If F-r ≥ 79, Fp-r > 70, Fs, or FBS-r < 80 T, exaggerated psychopathology and somatic/cognitive symptoms are possible. If SVT(s) failed, exaggerated memory complaints are probable. Rule out probable MND 
T = 100+ (Raw 17+) Memory complaints are exaggerated. T-score range is associated with mean MCI score 2 SD above moderate to severe brain injury. Probability of SVT failure is 77%–100%. If F-r, Fp-r, Fs, or FBS-r >100, malingered psychopathology is probable. If SVT(s) failed, exaggeration of memory complaints is confirmed. If SVT(s) passed, rule out coaching. Rule out probable or definite MND 
T < 50 (Raw 0–4) Minimal memory or other cognitive symptoms reported. Consider denial or “fake good” attitude, if cognitive testing reveals deficits. SVT failure is unlikely. If SVT(s) failed, consider passive factors such as disengagement or disinterest rather than active negative response bias 
T = 50–64 (Raw 5–8) Minor memory or cognitive symptoms may be reported, consistent with cognitive test results. If F-r < 79 T, Fp-r < 70 T, Fs, and FBS-r < 80 T, consider emotional factors contributing to memory complaints. SVT failure is unlikely. If SVT(s) failed, consider passive factors such as lack of engagement in testing. If F-r ≥ 79, Fp-r > 70, Fs, or FBS-r < 80 T, rule out possible MND (Slick, Sherman, & Iverson, 1999
T = 65–79 (Raw 9–11) Increasing memory complaints. If F-r < 79 T, Fp-r < 70 T, Fs, and FBS-r < 80 T, complaints are probably related to emotional factors. If F-r ≥ 79, Fp-r > 70, Fs, or FBS-r < 80 T, or SVT(s) failed, consider volitional symptom exaggeration. Rule out possible or probable MND 
T = 80–99 (Raw 12–16) Exaggerated memory complaints are likely. T-score range is associated with mean MCI score 1.5 SD above moderate to severe brain injury. Probability of SVT failure as high as 67%. If F-r < 79 T, Fp-r < 70 T, Fs, and FBS-r < 80 T, memory complaints may be related to emotional factors. If F-r ≥ 79, Fp-r > 70, Fs, or FBS-r < 80 T, exaggerated psychopathology and somatic/cognitive symptoms are possible. If SVT(s) failed, exaggerated memory complaints are probable. Rule out probable MND 
T = 100+ (Raw 17+) Memory complaints are exaggerated. T-score range is associated with mean MCI score 2 SD above moderate to severe brain injury. Probability of SVT failure is 77%–100%. If F-r, Fp-r, Fs, or FBS-r >100, malingered psychopathology is probable. If SVT(s) failed, exaggeration of memory complaints is confirmed. If SVT(s) passed, rule out coaching. Rule out probable or definite MND 

Notes: SVT = symptom validity test; MND = Malingered Neurocognitive Dysfunction; MMPI-2-RF = Minnesota Multiphasic Personality Inventory-2-Restructured Form; RBS = Response Bias Scale. MMPI-2-RF validity scales: F-r = Infrequent Responses; Fp-r = Infrequent Psychopathology Responses; Fs = Infrequent Somatic Responses; FBS-r = Symptom Validity; MCI = Memory Complaints Inventory.

Limitations and Future Directions

The present study used a single self-report memory complaints measure, which could limit the generalizability of our conclusion that the RBS is sensitive to negative response bias associated with over-reported memory complaints. Further studies investigating the relationship between the RBS and other self-report memory inventories used in clinical and forensic settings (e.g., “Memory Functioning Questionnaire,” Gilewski, Zelinski, & Schaie, 1990) will further develop our understanding of the RBS and how it can best be employed as a measure of the validity of self-reported memory dysfunction.

Another limitation is that the present study used only the CVLT as an objective measure of verbal auditory memory. Examining the relationship between the RBS and performance on other formal measures of verbal and visual memory, such as the Wechsler Memory Scale-III (Wechsler, 1997), Warrington's Recognition Memory Test (Warrington, 1984), and Rey Complex Figure Test (Meyers & Meyers, 1995), would broaden our understanding of the types of memory complaints tapped by the RBS and the extent to which the scale's lack of association with objective memory performance noted in this study can be generalized to other measures of verbal and non-verbal memory.

The composition of the present sample was predominantly white English-speaking Canadians (83.6%). Although the racial/ethnic composition of this sample is representative of the demographics of the general population in Alberta, further research is needed to determine the extent to which the findings of this study will generalize to other samples derived from populations with different racial/ethnic and linguistic characteristics.

Finally, the sample utilized in this study was composed primarily of non-head-injury disability claimants seeking compensation for work-related injuries or other personal injuries or medical conditions. In this type of assessment setting, the presence of external disability incentives can influence client motivation and clinical presentation and contribute to symptom exaggeration and other forms of negative response bias. Such factors must be considered when interpreting the results of the MMPI-2-RF and RBS in a forensic disability setting. Further studies are needed to validate the present findings in different clinical and non-clinical samples, including other disability claimants with traumatic brain injury or other conditions implicating memory function, as well as in non-disability medical and psychiatric conditions.

Conflict of Interest

ROG acknowledges being the first author of the RBS, from which he does not earn royalties. YSB-P is a paid consultant to the MMPI-2-RF publisher, the University of Minnesota Press, and distributor, Pearson. He receives royalties on sales of MMPI-2-RF materials.

Appendix

Scoring key for the Response Bias Scale (RBS) in the MMPI-2-RF 
 True: 6, 24, 26, 31, 68, 74, 79, 92, 101, 106, 120, 132, 136, 137, 159, 242, 252, 268, 273 
 False: 11, 21, 53, 59, 125, 131, 156, 219, 325 
Scoring key for the Response Bias Scale (RBS) in the MMPI-2-RF 
 True: 6, 24, 26, 31, 68, 74, 79, 92, 101, 106, 120, 132, 136, 137, 159, 242, 252, 268, 273 
 False: 11, 21, 53, 59, 125, 131, 156, 219, 325 

© Roger O. Gervais, 2008. Excerpted from the MMPI-2-RF® Manual for Administration, Scoring, and Interpretation. © 2008 by the Regents of the University of Minnesota.  Used by permission of the University of Minnesota Press.

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Author notes

Portions of this study were presented at the 28th Annual Conference of the National Academy of Neuropsychology, October 22–25, 2008, New York.