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.