No full-text available
To read the full-text of this research,
you can request a copy directly from the authors.
Decision-making deficits in pathological gambling: The role of executive functions, explicit knowledge and impulsivity in relation to decisions made under ambiguity and risk
Abstract
A variety of cognitive and emotional processes influence the decision-making deficits observed in pathological gambling (PG). This study investigated the role of immediate/delayed sensitivity to reward and punishment, executive functions, impulsivity and explicit knowledge in relation to decision-making performance on the original Iowa Gambling Task (IGT-ABCD) and a variant (IGT-EFGH).
We assessed 131 consecutive patients with a diagnosis of PG by using executive functioning and decision-making tasks, self-report measures of impulsivity and explicit knowledge.
The majority of pathological gamblers (PGs) showed deficits in decision-making, characterized mainly by myopia for the future. Decisions made under risk showed different predictors. Performance on the IGT-ABCD for decisions made under risk was predicted by medium and high levels of explicit knowledge of the task, as well as by scores on the Disorderliness subscale and the degree of Stroop interference. By contrast, IGT-EFGH results were only associated with self-report impulsivity measures.
Decision making in PG involves distinct patterns of deficits, and the predictors differ depending on the reinforcement schedule. Decisions made under risk on the IGT-ABCD are associated with explicit knowledge, executive functions and impulsivity traits related to conscious awareness and control processes. On the IGT-EFGH, however, only impulsivity traits predict decision making. (Am J Addict 2013;22:492-499).
... When it comes to executive functions, response inhibition is affected among PGs (Forbush et al., 2008;Odlaug et al., 2011), influencing delayed discounting (i.e., the way rewards are depreciated based on the time they take to be obtained). More specifically, these individuals tend to choose immediate rewards over larger ones that would take longer to achieve (Da Matta et al., 2012;Kräplin et al., 2014;Mestre-Bach et al., 2020;Ochoa et al., 2013). The differences in executive functions between PGs and NPGs vary across studies, with some reporting no differences between PGs and NPGs (Kapsomenakis et al., 2018;Marazziti et al., 2008), only identifying PGs as more impulsive (Kapsomenakis et al., 2018), or as having higher inflexibility (Marazziti et al., 2008). ...
... Related to the aforementioned factors, decision-making has been shown to be impaired among PGs (Achab et al., 2014;Kräplin et al., 2014;Mestre-Bach et al., 2020;Ochoa et al., 2013), especially under scenarios of uncertainty or risk, with a lack of explicit knowledge about the game (Achab et al., 2014;Ochoa et al., 2013), or in cases of comorbid depression (Rimal et al., 2022). Higher activation of reward pathways among gamblers for wins and NWs can also lead to impairment in decision-making (Achab et al., 2014;Ochoa et al., 2013). ...
... Related to the aforementioned factors, decision-making has been shown to be impaired among PGs (Achab et al., 2014;Kräplin et al., 2014;Mestre-Bach et al., 2020;Ochoa et al., 2013), especially under scenarios of uncertainty or risk, with a lack of explicit knowledge about the game (Achab et al., 2014;Ochoa et al., 2013), or in cases of comorbid depression (Rimal et al., 2022). Higher activation of reward pathways among gamblers for wins and NWs can also lead to impairment in decision-making (Achab et al., 2014;Ochoa et al., 2013). ...
Identification of specific patterns of brain activity related to problem gambling may provide a deeper understanding of its underlying mechanisms, highlighting the importance of neurophysiological studies to better understand development and persistence of gambling behavior. The patterns of cognitive functioning have been investigated through electroencephalography (EEG) studies based on the near-win/near-miss (NW) effect. The main goal of the present study was to evaluate the neurophysiological basis of NWs and their modulation by gambling problems through a systematic review of event-related potentials (ERP) studies elicited by feedback events. The review followed the recommendations of the Preferred Reporting Items for Systematic Reviews and Meta-Analysis Protocols (PRISMA). A total of 15 studies were included, 12 comprising non-problem gamblers (NPGs) and three comparing problem gamblers (PGs) with matched controls. For the P300 component, the win outcome elicited a larger amplitude than the other outcomes (NW and loss), followed by the NW outcome, which elicited a larger amplitude than loss in some studies. For feedback-related negativity (FRN), the loss outcome evoked a more negative amplitude in several studies, despite eliciting a similar amplitude to NW outcomes in others. For PGs, the NW outcome evoked a higher amplitude of P300 than loss, while NPGs showed a similar amplitude to both outcomes. The present review gathered information from different sources and provides a consistent view of the different studies. However, studies lack systematic and robust methodologies, leading to inconsistent results and making it difficult to reach any definitive conclusions.
... • Le Locus Coeruleus, liéà de nombreuses fonctions différentes de par ses projections exhaustives, a une influence sur les rythmes circadiens, l'attention et la mémoire, le comportement et lesémotions [18]. La destruction de ce noyau -jusqu'à 80% [19] -aété associéeà une accélération de la progression de la pathologie dans des modèles murins [20,21]. ...
... Self-report scales can provide valuable information about impulsivity as a stable trait in individuals [19]. Impulsivity is a trait known for being able to influence decision-making performance [20,21], however, the influence of impulsive personality traits on IGT performance remains unclear [22,23]. Although self-report scales can measure relatively stable characteristics, they are subjective and cannot directly measure the biological foundations of impulsivity. ...
... Significant frequency differences (p < 0.05) between each condition are displayed by the black bar.24D. Gabriel et al. / Neurobiology of Learning and Memory 132 (2016)[18][19][20][21][22][23][24][25][26][27][28] was not engendered by the onset of a sound but the offset of music. The N100-Off response occurs at the cessation of sounds longer than 100 ms (Clynes, 1969) and shares many characteristics with the larger and more easily elicited onset response(Hillyard & Picton, 1978). ...
Les difficultés diagnostiques sont fréquentes dans les disciplines neurologiques et psychiatriques, où les cliniciens manquent de marqueurs physiologiques pour caractériser certaines maladies, en particulier dans leurs formes débutantes. Depuis quelques années, le recours à l'électroencéphalographie et plus spécifiquement haute résolution (EEG-HR) devient plus courant dans l'exploration clinique des pathologies cérébrales, telles que la dépression, le coma ou les maladies neurodégénératives comme la maladie d'Alzheimer. L'activité cérébrale est aisément enregistrée avec l’EEG, et l'identification de cette activité permet d'isoler les zones du cerveau et le décours temporel déclenché par des stimuli spécifiques. L’analyse du signal EEG, et donc son traitement, reste relativement complexe en raison d’un faible rapport signal sur bruit. Dans les études conventionnelles, ces problèmes sont surmontés en faisant la moyenne d'un grand nombre d'essais chez des individus différents. Toutefois, ces méthodes sont difficiles à transposer à une approche clinique où un seul sujet doit être examiné, du fait d’une forte variabilité inter-individuelle. Ce constat appelle le développement d'approches plus robustes pour pallier un rapport signal sur bruit extrêmement défavorable. Les méthodes d'apprentissage automatique, en particulier les Machines à Vecteurs de Support (SVM) ont la capacité de distinguer des événements EEG qui sont difficilement, voire non distinguables, avec les techniques conventionnelles. Elles offrent dès lors la possibilité de passer de résultats statistiques au niveau du groupe à un résultat personnalisé et par conséquent à un diagnostic donné. Nous proposons dans ce travail de thèse une exploration de la meilleure façon d'extraire les informations pertinentes des enregistrements EEG. Dans un premier temps, nous présentons une revue systématique de la littérature concernant l’application du SVM à l’EEG. Nous mettons en évidence la nécessité d’explorer l’ensemble des paramètres du SVM et d’extraction des caractéristiques du signal pour une performance optimale et reproductible. Nous établissons ensuite si les neuromarqueurs de l'apprentissage de nouvelles chansons sont affectés ou non par l'appréciation musicale via une analyse de groupe, dans le cadre du diagnostic différentiel dépression et maladie d’Alzheimer. Puis nous appliquons le SVM à nos données pour construire des modèles de classification individuels, et nous étudions l’influence de l’optimisation des hyperparamètres. Enfin, nous examinons la fiabilité d’un algorithme génétique pour optimiser l’extraction des caractéristiques avant une classification SVM, pour le diagnostic différentiel des états de conscience pathologiques.
... The IGT comprises multiple neuropsychological features that provide information on how an individual makes choices when faced with ambiguous contingencies and uncertain consequences. GD populations show disadvantageous performance relative to healthy controls on the IGT, even when controlling for comorbid conditions; performance is characterized by predominant selections from disadvantageous decks, without shifting to advantageous decks over time [6,15,[31][32][33][34][35]. Analyses of task reaction times demonstrate faster responding and less response-shifting after losses in GD populations [6], suggestive of diminished loss sensitivity or reduced feedback processing following a penalty. ...
... Studies applying a variant version of the IGT, in which the punishments occur first (i.e. 'EFGH' version) also report less sensitivity to penalties [34]. One study even reported a trend for performance on this variant to relate to treatment dropout -consistent with the idea of reduced sensitivity to future negative consequences [36]. ...
... As implicit learning occurs across IGT trials, researchers have tried to clarify the conceptual knowledge that individuals attain by the end of the task. During the first two blocks of the task, when deck contingencies are ambiguous, conceptual knowledge about the task does not relate closely to informed decision-making [34]; however, at the end of the task, individuals with GD report less conceptual knowledge and have difficulty in identifying which decks were advantageous and disadvantageous. Reduced conceptual knowledge in turn relates to poorer performance in the last two blocks of the task [6,34], demonstrating how deficient learning or conscious awareness influences decision-making at specific phases. ...
Understanding the neuropsychological features in GD has implications for highlighting addictive mechanisms in the absence of potentially neurotoxic effects of drugs. Several recent meta-analyses both within GD groups as well as across addictive disorders are clarifying broad and unique characteristics through more careful control of demographic and comorbid features. Several neuropsychological studies are also beginning to highlight aspects of self-awareness in GD, including metacognition and interoceptive processes and how they may relate to cognitive distortions and decision-making. Neuropsychological features of gambling products, including ‘near-misses’ and ‘losses disguised as wins’, tap into contextual effects and conditioned win responses and serve as a type of nudging behaviour. More broadly, investigating the neuropsychology of GD and gambling features can help us understand how reward, risk and uncertainty affect the decision-making process.
... Cognitive flexibility is another component of cognitive control [2], responsible for adapting to changing environments [28]. Cognitive flexibility deficits have been shown in addictive disorders [29] and GD [30,31] and linked to clinical outcomes [7,29]. Cognitive flexibility has also been reported to be correlated with decision making in healthy subjects, in individuals with HIV-associated neurocognitive disorders and gambling disorder [5,32,33]. ...
... Similarly, individuals with high cognitive flexibility have also been reported to have better IGT performance [34]. Cognitive flexibility has been measured with the Wisconsin Card Sorting Task (WCST) in GD [30,31]. In respect of the neural substrates of the WCST, various brain areas have been implicated, including bilateral lateral PFC, anterior cingulate cortex, and inferior parietal lobule [35,36] indicating a role for both hemispheres. ...
... In respect of cognitive flexibility, the literature shows no consensus on cognitive flexibility deficits in GD. Despite several negative results [20,21,67,68], cognitive flexibility was found to be impaired in GD in other studies [30,31]. We observed improvement of cognitive flexibility following right anodal/left cathodal stimulation over the DLPFC. ...
Decision making and cognitive flexibility are two components of cognitive control that play a critical role in the emergence, persistence, and relapse of gambling disorder. Transcranial direct current stimulation (tDCS) over the dorsolateral prefrontal cortex (DLPFC) has been reported to enhance decision making and cognitive flexibility in healthy volunteers and individuals with addictive disorders. In this triple-blind randomized sham-controlled parallel study, we aimed to determine whether tDCS over DLPFC would modulate decision making and cognitive flexibility in individuals with gambling disorder. Twenty participants with gambling disorder were administered Iowa Gambling Task (IGT) and Wisconsin Card Sorting Test (WCST). Subsequently, participants were administered three every other day sessions of active right anodal /left cathodal tDCS (20 min, 2 mA) or sham stimulation over bilateral DLPFC. WCST and IGT were readministered following the last session. Baseline clinical severity, depression, impulsivity levels, and cognitive performance were similar between groups. TDCS over the DLPFC resulted in more advantageous decision making (F1,16 = 8.128, p = 0.01, ɳp² =0.33) and better cognitive flexibility (F1,16 =8.782, p = 0.009, ɳp² = 0.35), representing large effect sizes. The results suggest for the first time that tDCS enhanced decision making and cognitive flexibility in gambling disorder. Therefore, tDCS may be a promising neuromodulation-based therapeutic approach in gambling disorder.
Trial registration: Clinicaltrials.gov NCT03477799.
... Este tipo de jugador planifica y es consciente de cuándo y cuánto invertir, sin que sea algo necesario y recurrente que implique problemas personales, familiares o laborales. Juega cuando lo desea sin ser esta la actividad que ocupa la mayor parte de su tiempo y concibe el juego como una actividad temporal para compartir y divertirse socialmente (Ochoa et al.,1994;Ochoa et al., 2013;APA, 2014). ...
... También se han realizado correlaciones entre jugadores patológicos (con conductas adictivas no relacionadas con sustancias) y pacientes con conductas adictivas por sustancias y se ha encontrado, en ambos, alteraciones similares a nivel atencional y déficit en el componente de toma de decisiones de la función ejecutiva asociado a inflexibilidad cognitiva (Rugle & Melamed, 1993;Barry & Petry, 2008), especialmente frente a tareas que implican probabilidad, siendo más notoria esta dificultad ante situaciones que suponen recompensas futuras con poco riesgo, en comparación con aquellas que implican recompensas inmediatas con alto riesgo (Bechara et al., 1994;Petry, 2001b;Cavedini, Riboldi, Keller, D' Annucci & Bellodi, 2002;Manes et al., 2002), lo anterior se ha asociado a lesiones o afecciones en áreas como la corteza prefrontal ventromedial y la corteza dorsolateral (Blaszczynski & Nower, 2002;Jameson, Hinson & Whitney, 2004;Clark, Cools & Robbins, 2004;Dretsch & Tipples, 2008;Ochoa et al., 2013). ...
... No obstante, dicha dificultad para controlarse es menor que en el caso del jugador patológico, pero mayor si se le compara con el jugador social. En general, este tipo de jugadores presenta mayor tendencia o predisposición a convertirse en un jugador patológico(Ochoa et al.,1994;Ochoa et al., 2013).En última instancia se encuentra el jugador patológico que, tal como se ha puntualizado en apartados previos, se caracteriza por una imposibilidad para controlar sus conductas en el juego y que conlleva a un malestar significativo y deterioro en las diferentes áreas en las que se desenvuelve el sujeto(Ochoa et al.,1994; APA, 2014). ...
Pese a categorizarse actualmente como un trastorno de adicción, el‘juego patológico’ no se relaciona exclusivamente con el uso y dependenciade sustancia químicas, aunque sus efectos y manifestaciones emocionales, cognitivas y conductuales son claramente similares, de allía que se le considere como el único trastorno de adicción sin drogas clasificadoen el DSM-5. A nivel clínico, es importante considerar variablessociodemográficas, tipología, criterios diagnósticos, posible patología dualy presencia de alteraciones cognitivas, conductuales y neuropsicológicasque permitan realizar un diagnóstico diferencial adecuado y con ello establecerpropuestas de evaluación e intervención eficaces. Respecto a lasafecciones neuropsicológicas, se destacan implicaciones importantes enla toma de decisiones, control emocional, inhibición e iniciativa comportamental,siendo todos estos componentes claves de las funciones ejecutivas.Así mismo, se ha reportado que el déficit de la función ejecutiva en eljugador patológico es similar al evidenciado en pacientes diagnosticadoscon trastorno de adicción por consumo de sustancias psicoactivas e inclusoactivación similar de los sistemas de recompensa neuronales.
... Data from the rGT were compared within each group to determine if animals expressed a significant preference for the advantageous options (P1+P2) or if amphetamine significantly altered decision-making within each group; rGT data were compared between groups using the percent of advantageous choices. During rGT training (sessions 1-40), choice data were analyzed in blocks of 5 sessions and as the average of the last 5 sessions (sessions [36][37][38][39][40]. Planned comparisons were conducted using paired sample t tests to compare data within each group (i.e., saline v. amphetamine dose, advantageous choices v. disadvantageous choices) or 2-sample t tests to compare data between 2 groups. ...
... Animals that responded for reward according to a variable schedule of reinforcement (VR group) or animals that passively received reward (Y group) showed a greater locomotor response to amphetamine than control animals that received CE (FR group). Subsequently, only the VR group showed increased risky decision-making on the rGT, illustrated by a loss of preference for the advantageous options over the disadvantageous options later in training (sessions [21][22][23][24][25][26][27][28][29][30][31][32][33][34][35][36][37][38][39][40]. Although all groups of rats showed greater locomotor activity in response to amphetamine compared with saline following rGT testing, this effect was largest in the VR group. ...
... Performance of participants with gambling disorder on the IGT has been associated with explicit knowledge of the outcomes. 39 Furthermore, patients with gambling disorder prefer riskier options on tasks in which the gains and losses are explicit. 40 Therefore, familiarity with the outcomes of each option may be required before a stable preference emerges. ...
Background:
An animal model of gambling disorder, previously known as pathological gambling, could advance our understanding of the disorder and help with treatment development. We hypothesized that repeated exposure to uncertainty during gambling induces behavioural and dopamine (DA) sensitization - similar to chronic exposure to drugs of abuse. Uncertainty exposure (UE) may also increase risky decision-making in an animal model of gambling disorder.
Methods:
Male Sprague Dawley rats received 56 UE sessions, during which animals responded for saccharin according to an unpredictable, variable ratio schedule of reinforcement (VR group). Control animals responded on a predictable, fixed ratio schedule (FR group). Rats yoked to receive unpredictable reward were also included (Y group). Animals were then tested on the Rat Gambling Task (rGT), an analogue of the Iowa Gambling Task, to measure decision-making.
Results:
Compared with the FR group, the VR and Y groups experienced a greater locomotor response following administration of amphetamine. On the rGT, the FR and Y groups preferred the advantageous options over the risky, disadvantageous options throughout testing (40 sessions). However, rats in the VR group did not have a significant preference for the advantageous options during sessions 20-40. Amphetamine had a small, but significant, effect on decision-making only in the VR group. After rGT testing, only the VR group showed greater hyperactivity following administration of amphetamine compared with the FR group.
Limitations:
Reward uncertainty was the only gambling feature modelled.
Conclusion:
Actively responding for uncertain reward likely sensitized the DA system and impaired the ability to make optimal decisions, modelling some aspects of gambling disorder.
... Specifically, the cognitive domains of impulsivity, compulsivity, and reward processing are compared across BD, OCRDs (i.e., due to similarities with OCD specifically), and substance use disorders (SUDs) and behavioral addictions. These processes were selected given that impulsivity is present in substance-related and behavioral addictions, and is associated with reward-related decision-making deficits (Hanson et al., 2008;Ochoa et al., 2013), and compulsivity in addictions and OCD is associated with impaired reward processing (Figee et al., 2016). In addition, reward, punishment, cue reactivity and craving are reviewed together due to their interconnectivity, such that reward learning contributes to cue reactivity, in which the stimuli triggers rewarding motivations, and therefore craving (Hyman et al., 2006;Kyrios et al., 2018;Tiffany & Wray, 2012). ...
... Impulsivity and compulsivity are transdiagnostic constructs that are involved in the etiology and maintenance of impulse control disorders, OCRDs, SUDs, behavioral addictions (i.e., gambling disorder, Internet addiction, gaming addiction), as well as BD (Figee et al., 2016;Holden, 2001;Karim & Chaudhri, 2012;O'Guinn & Faber, 1989). Impulsivity can be defined as "actions that appear poorly conceived, prematurely expressed, unduly risky, or inappropriate to the situation and that often result in undesirable consequences" (Daruna & Barnes, 1993, p. 23), whereas compulsivity has been defined as "repetitive acts that are characterized by the feeling that one has to perform them while one is aware that these acts are not in line with one's overall goal" (Luigjes et al., 2019, p. 10). ...
Although Buying Disorder (BD) is not a formal diagnosis in commonly used diagnostic systems, this condition can cause significant impairments. Additionally, there is an ongoing discussion about the most appropriate conceptualization and classification of BD. Most often, BD is considered either an obsessive–compulsive and related disorder (OCRD) or an addictive behavior (i.e., substance use disorders or behavioral addictions), and was previously recognized as an impulse control disorder. The present narrative review examines the cognitive processes of impulsivity (i.e., impulsive action, impulsive choice, decision making, and personality), compulsivity, and reward processing (i.e., cue reactivity and craving), in BD, obsessive–compulsive disorder (OCD), and addictive behaviors. Most evidence supports BD having overlapping features with behavioral addictions more so than with OCD due to similar impairments in decision-making and inhibition, as well as similar motivations behind BD. Further, BD demonstrates cue-reactivity and craving similar to behavioral addictions. There were also similar elevations on personality inventories between BD and addictive behaviors, which were less relevant in OCD. Although studies in these specific cognitive domains suggest similarities between BD and behavioral addiction, more studies are needed to further elucidate BD processes, which would in turn assist with the classification of BD. Further, despite similarities across conditions, directly comparing BD to these conditions on the aforementioned processes is needed. In future, study designs should directly compare BD to disorders within each classification to elucidate shared and distinct functions of these processes.
... A more recent work sought to classify decision-making deficits in GDs and investigate distinct features in two types of decision-making; under uncertainty and under risk, with two different versions of the IGT (Ochoa et al., 2013). As key findings, the authors indicated that the majority of GDs had general decision-making deficiencies, which were characterized by myopia for the future rather than aversion to punishment. ...
... Also, GDs mainly showed abnormal choice behaviour in relation to decisions made under risk on the IGT (linked to the explicit understanding of the task, EF, control processes, and impulsiveness) more than decision-making under ambiguity. It is worth noting that the authors highlighted that different pattern of deficits are involved in GD decision-making processes, and the predictors vary depending on the reinforcement schedule (Ochoa et al., 2013). ...
A depth analysis of executive functions (EFs) in the context of pathological gambling disorder was conducted. The need to use different methodologies to investigate the complex phenomenon of pathological Gambling Disorder (GD) arises from a substantial difference in the literature results emerging in this area. Furthermore, investigating the executive functioning of subjects with GD provides important information that can influence the treatment setting of these population. First of all, the diagnostic criteria concerning GD were analysed and then the involvement of EFs in the present disorder was investigated. The cognitive functioning of subjects with GD was deepened, both through the study of the cerebral correlates of executive functioning (with a focus on the frontal lobe) in individuals with GD and through empirical studies that investigate the behavioural deficits of these individuals. An important element to consider concerns the behavioural deficits of patients with GD and the tools used to investigate them: in particular, this chapter analyses the role of the IGT in the assessment of EFs and, specifically, in reward sensitivity. The behavioural aspects of GD, indeed, are multiple, affect the daily life of individuals and include inhibitory control, reduced levels of self-control, and high sensitivity to reward.
... A more recent work sought to classify decision-making deficits in GDs and investigate distinct features in two types of decision-making; under uncertainty and under risk, with two different versions of the IGT (Ochoa et al., 2013). As key findings, the authors indicated that the majority of GDs had general decision-making deficiencies, which were characterized by myopia for the future rather than aversion to punishment. ...
... Also, GDs mainly showed abnormal choice behaviour in relation to decisions made under risk on the IGT (linked to the explicit understanding of the task, EF, control processes, and impulsiveness) more than decision-making under ambiguity. It is worth noting that the authors highlighted that different pattern of deficits are involved in GD decision-making processes, and the predictors vary depending on the reinforcement schedule (Ochoa et al., 2013). ...
Addiction is a chronic relapsing disorder. Despite pharmacological and psychological interventions during rehabilitation, a majority of patients still relapse. In this seventh chapter, we present neuromodulation techniques as a complementary intervention for addiction. Firstly, while deep brain stimulation (DBS) has shown promising results, its cost–benefit–risk ratio is nonetheless too high to be implemented in routine clinical care. Secondly, repeated transcranial magnetic stimulation (rTMS) and transcranial direct courant stimulation (tDCS) over the dorsolateral prefrontal cortex (DLPFC) have shown reduced craving and relapses, but the results are mixed. To improve efficacy, new perspectives envisioned that the insula could be a promising target for rTMS and DBS in combination with cognitive remediation and while participants are exposed to key conditioned stimuli. Additionally, neurofeedback could be a useful tool in teaching patients to actively regulate their neural activity, although better controlled experimental designs and rigorous measures of brain changes are needed. Despite the heterogeneity of studies, neuromodulation techniques as complementary tools to conventional care seem to constitute a turning point in the management of addictions.
... Cependant, de nombreux autres facteurs sembleraient avoir un impact sur les capacités décisionnelles. Plus particulièrement, l'impulsivité est classiquement décrite comme ayant un impact sur les capacités décisionnelles évaluées à l'IGT Ochoa et al., 2013). De nombreux auteurs utilisent dans ce contexte l'IGT comme un test comportemental évaluant la prise de risque (Capone et al., 2016;S. ...
... Self-report scales can provide valuable information about impulsivity as a stable trait in individuals (Swann, Bjork, Moeller, & Dougherty, 2002b). Impulsivity is a trait known for being able to influence decision-making performance Ochoa et al., 2013), however, the influence of impulsive personality traits on IGT performance remains unclear (Franken, van Strien, Nijs, & Muris, 2008;Goudriaan et al., 2005). Although self-report scales can measure relatively stable characteristics, they are subjective and cannot directly measure the biological foundations of impulsivity. ...
Les altérations des capacités décisionnelles évaluées par l’« Iowa Gambling Task » (IGT) sont connues depuis longtemps dans la population des joueurs pathologiques. Plus récemment, le rôle de la motivation dans l’activité de jeu pathologique a été soulevée. Dans ce contexte, l’objectif de cette thèse est de préciser si les neuromarqueurs décisionnels et motivationnels peuvent constituer des indicateurs fiables du risque de développer une activité de jeu pathologique. Pour répondre à ce questionnement, nous avons inclus des joueurs de poker en ligne dont le niveau de risque de développer une activité de jeu pathologique est contrôlé. Avant de procéder à l’analyse en population spécifique, nous avons inclus des volontaires sains afin de décrire les variations et les intrications des capacités décisionnelles et motivationnelles au sein d’une population exempt de toute pathologie. Nous avons ainsi identifié deux PE indicateurs du niveau motivationnel : le « Stimilus Preceding Negativity » (SPN) et la P300. Cette première étape nous a permis d’établir les liens entre les différents niveaux motivationnels et les performances à l’IGT. Plus particulièrement, la P300 apparait être un excellent indicateur de l’engagement à la bonne réalisation de la tâche, mais aussi un témoin de la sensibilité aux récompenses immédiates. Les données préliminaires issues de notre population de joueur a mis tout d’abord en évidence que plus les joueurs présentent de mauvaises performances à l’IGT, plus ils sont à risque de développer une activité de jeu pathologique. L’ensemble des joueurs montrent de faible niveau de motivation lors de la passation de l’« Effort Expenditure for Reward Task » . Alors que les joueurs à bas risque montrent un profil neurophysiologique en accord avec leurs résultats comportementaux, c’est-à-dire un émoussement de la P300, les joueurs qui présentent un risque élevé de développer une activité de jeu pathologique ont une amplitude de P300 qui témoignent d’un traitement important du résultat immédiat et d’un haut niveau motivationnel. De plus, nous montrons que l’amplitude de la P300 est corrélée au niveau de risque de développer une activité de jeu pathologique. Au terme de ce travail, la P300 semble être un biomarqueur de choix dans l’évaluation du risque de développer une activité de jeu pathologique. La poursuite des inclusions et de nos investigations devrait permettre de confirmer cette hypothèse.
... Among the EF deficits that patients with GD present, deficits in planning (Goudriaan et al. 2006), working memory and decision-making (Ledgerwood et al. 2012) are highlighted. Additionally, poor decision making patterns in GD seem to be characterized by deficits in immediate/delayed reinforcements and reward/punishment as well as myopia for the future and poor cognitive flexibility (Ochoa et al. 2013). Notably, a previous study in GD that we conducted with adults we found that difficulties on decision making are extensive to both the learning process and the whole decision making performance when assessed with the Iowa Gambling Task (IGT; Mallorquí-Bagué et al. 2016). ...
... It also presents more executive function impairment (including poor inhibition, working memory and cognitive flexibility) and lower mean scores on the IGT total score than cluster 1-LIEF. Although group differences with the IGT are not statistically significant, it is important to note that a mean score below ten indicates deficits in the task (Bechara et al. 2002;Ochoa et al. 2013), which means that both groups would present impairments in decision-making as reported in previous studies conducted with individuals diagnosed with GD (Ledgerwood et al. 2012). However, while cluster 1-LIEF would almost reach the minimum score to be considered functional cluster, the cluster 2-HIEF would display a higher impairment. ...
To identify Gambling Disorder (GD) subtypes, in a population of men seeking treatment for GD, according to specific executive function domains (i.e., cognitive flexibility, inhibition and working memory as well as decision making) which are usually impaired in addictive behaviors. A total of 145 males ranging from 18 to 65 years diagnosed with GD were included in this study. All participants completed: (a) a set of questionnaires to assess psychopathological symptoms, personality and impulsivity traits, and (b) a battery of neuropsychological measures to test different executive functioning domains. Two clusters were identified based on the individual performance on the neuropsychological assessment. Cluster 1 [n = 106; labeled as Low Impaired Executive Function (LIEF)] was composed by patients with poor results in the neuropsychological assessment; cluster 2 patients [n = 46; labeled as High Impaired Executive Function (HIEF)] presented significantly higher deficits on the assessed domains and performed worse than the ones of LIEF cluster. Regarding the characterization of these two clusters, patients in cluster 2 were significantly older, unemployed and registered higher mean age of GD onset than patients in cluster 1. Additionally, patients in cluster 2 also obtained higher psychopathological symptoms, impulsivity (in both positive and negative urgency as well as sensation seeking) and some specific personality traits (higher harm avoidance as well as lower self-directedness and cooperativeness) than patients in cluster 1. The results of this study describe two different GD subtypes based on different cognitive domains (i.e., executive function performance). These two GD subtypes display different impulsivity and personality traits as well as clinical symptoms. The results provide new insight into the etiology and characterization of GD and have the potential to help improving current treatments.
... For this purpose, we established a relatively homogeneous population of Online Poker Players, divided into two groups (Low-Risk and Problem Gambling) determined by their CPGI, with the objective of comparing the different configurations of electric sources generated during the completion of the IGT. Impulsivity, known to influence the IGT performance and to be present at a high level in the GD population, was controlled to avoid interpretation biases (Grassi et al., 2015;Logge, Morley, Haber, & Baillie, 2023;Ochoa et al., 2013). We tested the hypothesis that the "problem gambling" group would show different brain activity related to outcomes processing than the one with low risk. ...
Background and aims
Gambling activity evolves along a continuum from recreational to Gambling Disorder (GD) and a particular challenge is to identify whether there are some neurophysiological particularities already present in gamblers at an early stage. Our main goal was to determine whether, in the gamblers' population, neural responses generated during uncertain decisions were different depending on problematic gambling risk defined by the Canadian Problem Gambling Index (CPGI). We tested the following hypothesis, that the Problem Gambling group would show a different brain activity related to outcomes processing than people with low risk.
Methods
For this purpose, we established a relatively homogeneous population of Online Poker Players divided into two groups according to the CPGI (Low Risk and Problem Gambling). By means of high-density EEG, we compared the spatio-temporal dynamics generated during the completion of the Iowa Gambling Task.
Results
One specific topographic map was observed between 150–175 ms after a negative outcome for both groups, whereas it was displayed in the win condition only for the Problem Gambling group. We found that the Global Field Power of this map was negatively correlated with participants' adherence to a strategy. Source localization identified Anterior Cingulate Cortex and Temporal regions as generators of this map.
Discussion and conclusions
Reward hypersensitivity EEG responses identified in the early outcome process could constitute a potential biomarker of problematic gambling.
... Research on risk taking and gambling-related cognition finds that people with GD make more risky decisions (Brand et al., 2005;Brevers et al., 2012;Ligneul, Sescousse, Barbalat, Domenech, & Dreher, 2013;Ochoa et al., 2013;Spurrier & Blaszczynski, 2014), are less loss averse (Gelskov, Madsen, Ramsøy, & Siebner, 2016;Giorgetta et al., 2014;Hoven, Hirmas, Engelmann, & van Holst, 2023) and exhibit higher levels of cognitive distortions about gambling than people without GD (Joukhador, Maccallum, & Blaszczynski, 2003;Ledgerwood et al., 2020). Cognitive distortions about gambling often involve cognitions that minimalize the perceived risk of gambling and encourage gambling (Goodie & Fortune, 2013) (i.e., "the illusion of control" (Langer, 1975)). ...
Background and aims:
People with Gambling Disorder (GD) often make risky decisions and experience cognitive distortions about gambling. Moreover, people with GD have been shown to be overly confident in their decisions, especially when money can be won. Here we investigated if and how the act of making a risky choice with varying monetary stakes impacts confidence differently in patients with GD (n = 27) relative to healthy controls (HCs) (n = 30).
Methods:
We used data from our previous mixed-gamble study, in which participants were given the choice of a certain option or a 50/50 gamble with potential gains or losses, after which they rated their confidence.
Results:
While HCs were more confident when making certain than risky choices, GD patients were specifically more confident when making risky choices than certain choices. Notably, relative to HCs, confidence of patients with GD decreased more strongly with higher gain values when making a certain choice, suggesting a stronger fear of missing out or "anticipated regret" of missing out on potential gains when rejecting the risky choice.
Discussion:
The current findings highlight the potential relevance of confidence and "regret" as cognitive mechanisms feeding into excessive risk-taking as seen in GD. Moreover, this study adds to the limited previous work investigating how confidence is affected in value-based risky contexts.
... One of the hallmarks of GD is an impairment in decision-making, which is biased toward risky choices with high pay-out (see for reviews 2,3). Indeed, relative to controls, patients with GD are found to be more risk-seeking in a number of tasks [4][5][6][7][8][9][10] . Risk-seeking behaviour in GD has also been associated with lower sensitivity to the expected value of choices 11 , and diminished loss aversion 12,13 . ...
... Core executive functions are inhibition (i.e., resisting temptations and impulses), interference control (i.e., selective attention), working memory, and cognitive flexibility (see Diamond, 2013). Problem gamblers display impairments of their executive functions (see e.g., Mallorqui-Bagué et al., 2018;Ochoa et al., 2013;Ledgerwood et al., 2012;Marazziti et al., 2008). Neuroscientific research shows impaired activity in the pre-frontal cortex of problem gamblers (see Moccia et al., 2017) and brain activation patterns different from healthy controls (see Quaglieri et al., 2020). ...
The typical gambler loses money but continues to gamble nonetheless. Why? Research from orthodox and behavioral economics, psychology, sociology, and medicine has offered a wide range of possible explanations. This paper reviews these explanations. The evidence is organized according to the degree of rationality assumed and/or found in the studies. This approach allows research from highly distinctive fields to be integrated within a unified framework. Gambling patterns are so highly dispersed that no satisfying one-fits-all explanation is possible. The findings suggest that the whole spectrum from rationality to highly destructive irrationality can be found within the gambler population.
... A impulsividade, um traço de personalidade multidimensional com uma forte base biológica, consiste num impulso intencional para alcançar estímulos hedônicos e numa diminuição do controlo inibitório (Dawe & Loxton, 2004) que é relevante e frequente entre as dependências, o consumo de substâncias (Di Nicola et al., 2015;Kaiser, Milich, Lynam & Charnigo, 2012;Ochoa et al., 2013;Torres et al., 2013) e as PCA (Claes, Mitchell & Vandereycken, 2012). Esta é um fator risco que predispõe e influencia determinadas fases de iniciação, manutenção e tratamento destas perturbações, tal como contribui para: a gravidade e cronicidade destes problemas (Dawe & Loxton, 2004;Favaro et al., 2004;; resultados mais limitados nos tratamentos (Keel & Mitchell, 1997;Manasse et al., 2016); elevadas taxas de recaída (Miller, 1991;Waxman, 2009); e piores prognósticos (Slof-Op't Landt, Claes & van Furth, 2016). ...
An extensive literature has reported a co-occurrence between maladaptive eating behavior and consumption of substances (alcohol and/or drugs), such as impulsivity, in particular the negative urgency, has been referred to as a risk factor and a predictor for these behaviors. The present study aimed to verify the frequency of attitudes and behaviors characteristic of eating disorders and substance use; assess the differences between the sex of the participants; and to verify the existence of correlations and direct effects between the attitudes and behaviors of eating disorders, the body mass index, the substances consumption and the negative urgency among the university population of portuguese nationality. The results showed: higher frequências than national prevalences, both in attitudes and in certain maladaptive eating behaviors, as well as in substances consumption; that attitudes and the maladaptive eating behaviors and the negative urgency were more frequent in women, while the consumption of substances was more common in men; that there was not significant correlation between the atitudes, the eating behaviors and the consumptions of substances; however, the negative urgency emerged as a predictor of the attitudes of eating disorders, the binge eating disorder and the drug use.
... In addition, studies have shown that the level of satisfaction with the decision taken is an excellent indicator of the quality of decision-making processes [33]. Recent studies [34][35] [36] have highlighted the existence of character determinants that can influence the quality of the decisions, exerting a negative or positive effect on the choice [37][38] [39]. An experimental survey conducted by Wood [35] explored the possible correlation between the decisional style and the personality traits identified with the Big Five. ...
The way individuals make choices and decisions influences their behavior and life style. The choice is not simply based on rational and formal logic, but it's influenced by many emotional and social factors. Starting from this assumption, some studies investigated the way in which emotions influence decision-making processes, while others explored the possibility that decision-making processes are compromised by the onset of psychiatric pathologies and by the presence of prefrontal cortexlesions, which can induce a radical change in basic preferences of the subject. In our opinion, the decision-making style is strictly connected to the normal personality structure while the relationship with psychopathology can be framed within the non-causal and non-linear effects typical of risk or protection factors. The present pilot study, first, intends to explore the relation between decision-making styles, non-pathological personality traits and psychic disorders; second, it intends to propose a psychometric tool administrable via mobile app, aimed at studying the influence of decision-making styles, related to personality, on the quality and effectiveness of decisions. The present pilot study, was developed in a sample of outpatients in a private psychotherapy service made up of subjects diagnosed with personality disorder. The TCI test was been administered to identify the decision-making styles related to the character traits and temperament. Through statistical analyses, five factors were extracted (5 decision-making styles) and only two personality disorders appear to be related to decision-making styles. This results describe a significant but marginal impact of decisional styles on the pathology of personality, with respect to which they play a role of risk or protection factor.
... Usually, people tend to choose the option that allows them to achieve quick satisfaction [35]. This happens both in special circumstances, for example in risky situations as shown by the studies on the pathological gambling [36], both in natural situations of uncertainty in everyday life [37; 34]. Therefore, the waiting time seems to have a strong influence on the resolution of the decision tasks. ...
The scientific evidence found in the literature shows that aggression is innate in humans, in a reactive and proactive form. This work proposes a distinction between an aggressive act and a predisposition to aggression, highlighting how this type of behavior is normative and natural in child's development. Aggressiveness reaches its peak between two and four years old and tends to decrease sensibly and permanently throughout the life. This work traces genetic and temperamental correlates of aggressiveness, highlights the relationship between aggression and decision making and explores the elements that lead to the choice of implementing aggressive behavior. Finally, we discuss the preliminary research proposal for the development of a gaming software, structured with a set of decision tasks, including measurement of reaction times, in order to detect the predisposition to chose aggressive behavior. This will enable the correlation between the collected data and the results obtained from the temperamental tests.
... Self-report scales can provide valuable information about impulsivity as a stable trait in individuals [19]. Impulsivity is a trait known for being able to influence decision-making performance [20,21], however, the influence of impulsive personality traits on IGT performance remains unclear [22,23]. Although self-report scales can measure relatively stable characteristics, they are subjective and cannot directly measure the biological foundations of impulsivity. ...
The aim of the present study was to investigate the relationship between trait impulsivity, risk-taking, and decision-making performance. We recruited 20 healthy participants who performed the Iowa Gambling Task (IGT) and the Balloon Analog Risk Task (BART) to measure decision-making and risk-taking. The impulsivity was measured by the Barratt Impulsiveness Scale. Resting-state neural activity was recorded to explore whether brain oscillatory rhythms provide important information about the dispositional trait of impulsivity. We found a significant correlation between the ability to develop a successful strategy and the propensity to take more risks in the first trials of the BART. Risk-taking was negatively correlated with cognitive impulsivity in participants who were unable to develop a successful strategy. Neither risk-taking nor decision-making was correlated with cortical asymmetry. In a more exploratory approach, the group was sub-divided in function of participants’ performances at the IGT. We found that the group who developed a successful strategy at the IGT was more prone to risk, whereas the group who failed showed a greater cognitive impulsivity. These results emphasize the need for individuals to explore their environment to develop a successful strategy in uncertain situations, which may not be possible without taking risks.
... In addition, studies have shown that the level of satisfaction with the decision taken is an excellent indicator of the quality of decision-making processes [33]. Recent studies [34][35] [36] have highlighted the existence of character determinants that can influence the quality of the decisions, exerting a negative or positive effect on the choice [37][38] [39]. An experimental survey conducted by Wood [35] explored the possible correlation between the decisional style and the personality traits identified with the Big Five. ...
... Usually, people tend to choose the option that allows them to achieve quick satisfaction [35]. This happens both in special circumstances, for example in risky situations as shown by the studies on the pathological gambling [36], both in natural situations of uncertainty in everyday life [37; 34]. Therefore, the waiting time seems to have a strong influence on the resolution of the decision tasks. ...
The scientific evidence found in the literature shows that aggression is innate in humans, in a reactive and proactive form. This work proposes a distinction between an aggressive act and a predisposition to aggression, highlighting how this type of behavior is normative and natural in child's development. Aggressiveness reaches its peak between two and four years old and tends to decrease sensibly and permanently throughout the life. This work traces genetic and temperamental correlates of aggressiveness, highlights the relationship between aggression and decision making and explores the elements that lead to the choice of implementing aggressive behavior. Finally, we discuss the preliminary research proposal for the development of a gaming software, structured with a set of decision tasks, including measurement of reaction times, in order to detect the predisposition to chose aggressive behavior. This will enable the correlation between the collected data and the results obtained from the temperamental tests.
... In addition, studies have shown that the level of satisfaction with the decision taken is an excellent indicator of the quality of decision-making processes [33]. Recent studies [34][35] [36] have highlighted the existence of character determinants that can influence the quality of the decisions, exerting a negative or positive effect on the choice [37][38] [39]. An experimental survey conducted by Wood [35] explored the possible correlation between the decisional style and the personality traits identified with the Big Five. ...
The way individuals make choices and decisions influences their behavior and life style. The choice is not simply based on rational and formal logic, but it's influenced by many emotional and social factors. Starting from this assumption, some studies investigated the way in which emotions influence decision-making processes, while others explored the possibility that decision-making processes are compromised by the onset of psychiatric pathologies and by the presence of prefrontal cortexlesions, which can induce a radical change in basic preferences of the subject. In our opinion, the decision-making style is strictly connected to the normal personality structure while the relationship with psychopathology can be framed within the non-causal and non-linear effects typical of risk or protection factors. The present pilot study, first, intends to explore the relation between decision-making styles, non-pathological personality traits and psychic disorders; second, it intends to propose a psychometric tool administrable via mobile app, aimed at studying the influence of decision-making styles, related to personality, on the quality and effectiveness of decisions. The present pilot study, was developed in a sample of outpatients in a private psychotherapy service made up of subjects diagnosed with personality disorder. The TCI test was been administered to identify the decision-making styles related to the character traits and temperament. Through statistical analyses, five factors were extracted (5 decision-making styles) and only two personality disorders appear to be related to decision-making styles. This results describe a significant but marginal impact of decisional styles on the pathology of personality, with respect to which they play a role of risk or protection factor.
... Mainly, patients with GD display impaired response inhibition (Odlaug, Chamberlain, Kim, Schreiber, & Grant, 2011) and poor self-regulation together with deficits in planning, cognitive flexibility and decision-making (Forbush et al., 2008;Goudriaan, Oosterlaan, De Beurs, & Van Den Brink, 2008;Hodgins, Stea, & Grant, 2011;Ledgerwood et al., 2012;Zhou, Zhou, & Zhu, 2016). The observed decision making difficulties seem to extend to both the learning process and the whole decision making performance when assessed with the Iowa Gambling Task (IGT; Mallorquí-Bagué et al., 2016), and are characterized by myopia for the future, deficits in immediate/delayed reinforcements and reward/punishment, as well as poor cognitive flexibility (Ochoa et al., 2013). It should be noted that poor cognitive flexibility (set-shifting) is robustly associated with high compulsivity and with disordered compulsive behaviours (Potenza, 2007). ...
Background and aims:
Gambling disorder (GD) is a highly heterogeneous condition with high rates of chronicity, relapses and treatment dropout. The aim of this study was to longitudinally explore the associations between trait impulsivity, impulsivity-compulsivity related cognitive domains, and treatment outcome in an outpatient sample of adult patients with GD.
Methods:
144 adult male participants diagnosed with GD undergoing cognitive-behavioural treatment (CBT) at a specialized outpatient service completed a series of neuropsychological tests to assess executive functioning (including cognitive flexibility, inhibition control and decision making) and psychometric questionnaires.
Results:
Trait impulsivity predicted low compliance [UPPS-P negative urgency (B = 0.113; p = 0.019)] and relapse [UPPS-P negative urgency (B = 0.140; p = 0.015)] at 5 weeks of treatment and dropout at the end of treatment [(UPPS-P sensation seeking B = 0.056; p = 0.045)]. Cognitive flexibility performance predicted: dropout rates at the end of treatment [WCST perseverative errors (B = 0.043; p = 0.042)]; dropout [WCST categories completed (B = -1.827; p = 0.020)] and low compliance or relapses at follow-up [WCST perseverative errors (B = 0.128; p = 0.020)]; and time to first relapse [WCST failure to maintain set (B = -0.374; p = 0.048)] and time to dropout [WCST perseverative errors (B = 0.0198; p = 0.019)].
Conclusions:
Our findings indicate impulsivity-compulsivity levels may influence response to GD treatment (i.e.: low compliance and dropout or relapse rates) thus representing a potential target for improving treatment outcomes.
... Prior investigations have shown that loss chasing is linked with impulsivity, sensationseeking, emotional disregulation, hyposensitivity to losses, behavioral disinhibition, and impaired decision-making (Bibby, 2016;Breen Zuckerman, 1999;Linnet et al., 2006;Kim and Lee, 2011;Lister et al., 2016;Nigro et al., 2018;Ochoa et al., 2013;Parke et al., 2016). It is noteworthy to underline that although previous studies clearly indicated that several individual characteristics of gambling addicted individuals are strong predictors of chasing, little effort was made to ascertain to what extent gambling severity and chasing overlap each other, and even less to disentangle gambling severity from chasing. ...
Chasing, or continuing to gamble in an attempt to recoup losses, is a salient feature of problematic gambling. This study, which controlled for gambling severity and alcohol consumption, investigated the association between chasing and maladaptive personality trait domains among habitual gamblers. Participants comprised 126 adult habitual gamblers (73% males) aged between 18 and 69 years. They were administered the South Oaks Gambling Screen (SOGS), the Personality Inventory for DSM-5-Brief Form (PID-5-BF), the Alcohol Use Disorders Identification Test (AUDIT), and a computerized task developed to assess chasing behavior. Participants were randomly assigned to two chasing conditions (Control and Loss). Data were submitted to correlational analysis, univariate and mixed-model ANOVAs, logistic and linear regression analyses. Results showed that the decision to chase was strongly associated with the PID-5-BF Disinhibition domain scores, whereas chasing proneness was related to the Disinhibition, Detachment and Psychoticism domains. Interestingly, chasers scored higher than nonchasers on maladaptive personality dimensions, even after controlling for gender, age, chasing condition, alcohol consumption, and gambling severity. Since these findings support the idea that chasers and nonchasers are different subtypes of gamblers, clinical interventions should take into account the additive role of chasing in gambling disorder.
... In this line, studies implementing delay discounting tasks report that low premeditation is associated with certain cognitive mechanisms. Specifically, GD individuals present more choices based on short-term criteria [52][53][54][55] and their choices are more oriented Bold: good effect size (|r| N .30). to highly rewarding activities [56]. Also high positive UR is commonly associated to high-risk and sensation seeking behaviors [57]. ...
Objectives:
Impulsivity is a construct that is strongly associated with Gambling Disorder (GD). The main objectives in the present study are: 1) to explore the role of sex and age on impulsivity levels in GD patients; 2) to identify the relationship of the different impulsivity facets with comorbid psychopathology and other personality traits in GD patients; and (3) to assess whether impulsivity is a predictor for the severity of GD.
Method:
The final sample consisted of 406 consecutive participants. All of them were seeking treatment for GD (88.4% male and 11.6% female) and completed the South Oaks Gambling Screen (SOGS), the UPPS-P Impulsive Behavior Scale, the Symptom Checklist (SCL-90-R), the Temperament and Character Inventory-R (TCI-R) as well as other clinical and psychopathological measures.
Results:
Results show a negative linear trend between age and lower sensation seeking levels as well as lack of premeditation (the higher the age the lower the UPPS-P scores), and a positive linear trend between age and positive urgency (UR) (the higher the age the higher the UPPS-P score). However, no sex differences were found for the assessed impulsivity dimensions. Lack of perseverance was positively associated with obsessive-compulsive symptoms and harm avoidance trait, and negatively related to persistence and self-directedness traits. Positive UR and negative UR were positively correlated with general psychopathology and the total number of DSM-IV criteria, and negatively associated to the following personality traits: self-directedness and cooperativeness. Finally, only the sensation seeking and negative UR of the UPPS-P showed predictive capacity on the severity of the disorder (the higher the impulsivity scores the higher the illness severity).
Conclusions:
These findings highlight the association between impulsivity traits (measured by the UPPS-P) and GD in a large and consecutively recruited clinical sample with GD, taking into account the variables sex and age.
... Furthermore, the fact that more than half gamblers presented an anxiety disorder in the past 12 months, suggests that there may be the underlying mechanism linking anxiety disorders and PG (Desai and Potenza 2008;Kessler et al. 2008;Petry et al. 2005). Impulsivity and difficulty making decisions could also be integral to the mechanisms of these two issues (Gonzales-Ortega et al. 2013;Ochoa et al. 2013). This high comorbidity with mental health problems underlines the necessity of thoroughly assessing the full range of mental health problems whenever someone is seeking help for recovery (Lorains et al. 2011). ...
Abstract
Cocaine use is highly prevalent and a major public health problem. While some studies have reported frequent comorbidity problems among cocaine users, few studies have included evaluation of gambling problems. This study aimed to estimate the prevalence of gambling problems and compare those who were at-risk gamblers with non-problem gamblers in terms of mental health problems, substance use problems, and some risk factors (i.e. family antecedents, erroneous perceptions and coping strategies) among individuals who smoke or inject cocaine. METHOD: A total of 424 smoked or injected cocaine users recruited through community-based programs in Montreal, Quebec completed the questionnaire, including the Canadian Pathological Gambling Index, the Composite International Diagnostic Interview (CIDI), the CAGE, and the Severity Dependence Scale (SDS). RESULTS: Of the sample, 18.4 % were considered at-risk gamblers, of whom 7.8 % had problems gambling and 10.6 % were moderate-risk gamblers. The at-risk group was more likely to have experienced a recent phobic disorder and alcohol problems than the non-problem group. A multivariate analysis showed that, compared to those who were non-problem gamblers, the at-risk ones were more likely to have lost a large sum of money when they first started gambling, believed that their luck would turn, and gambled in reaction to painful life events. These results indicate the need to include routines for screening to identify gambling problem among cocaine users.
... Since impulsivity is an important characteristic common to behavioral and substance addictions (Lawrence et al., 2009;Alvarez-Moya et al., 2011;Kaiser et al., 2012;Jiménez-Murcia et al., 2013;Ochoa et al., 2013;Torres et al., 2013;Di Nicola et al., 2015), heightened levels could also be associated with FA. However, high impulsivity has also been found in ED patients (Davies et al., 2009;Claes et al., 2012bClaes et al., , 2015, wherefore a clarification is needed of whether this correlate is related to ED in general, or if it relates specifically to addictivelike eating. ...
Objectives: The present study aimed to investigate if eating disorder patients differ in specific personality traits depending on a positive screening of food addiction (FA) and to find a model to predict FA in eating disorder patients using measures of personality and impulsivity.
Methods: Two hundred seventy eight patients, having an eating disorder, self-reported on FA, impulsivity, personality, eating and general psychopathology. Patients were then split into two groups, depending on a positive or negative result on the FA screening. Analysis of variance was used to compare means between the two groups. Stepwise binary logistic regression was used to obtain a predictive model for the presence of FA.
Results: Patients with FA had lower self-directedness, and more negative urgency and lack of perseverance than patients not reporting addictive eating. The probability of FA can be predicted by high negative urgency, high reward dependence, and low lack of premeditation.
Conclusion: Eating disorder patients who have more problems to pursue tasks to the end and to focus on long-term goals seem to be more likely to develop addictive eating patterns.
... The problem lied in the lack of deep knowledge of trading mechanisms, which made our patients vulnerable to unpredictable market moves. Their behavior was underpinned by the difficulty of inhibiting automatic responses and of making decisions in risky situations commonly found in disordered gamblers (Ochoa et al., 2013). ...
Introduction:
Trading and gambling appear to share some similarities. Indeed, traders can get professionally involved in high-risk types of trading as if it were gambling. This research explores whether excessive trading can be conceptualized as a subset of gambling disorders.
Objective:
To better acknowledge the existence of an addictive-like trading behavior and to discuss its phenomenological similarities with gambling disorders.
Methods:
The data of 8 excessive traders out of a cohort of 221 outpatients seeking treatment in our Problem Gambling unit were analyzed.
Results:
Our case series revealed important similarities with gambling disorders in terms of diagnosis, trajectory and comorbidities. Like many disordered gamblers, excessive traders of this study experienced a number of small early wins, chased their losses, and ended up losing control over the money they invested. All of them invested in very risky stocks associated with short-term trading leading to potential large gains, but also with very significant losses. The structure itself of the two activities (gambling and trading) is very close.
Conclusion:
Our results tended to support the idea of an addictive-like trading behavior as a subset of gambling disorders. Investing is not a form of gambling, but some people gamble with investments. Several observations and recommendations can be made: (i) conduct researches; (ii) build and validate specific assessment tools; (iii) develop strategies for prevention and treatment; and (iv) conduct more rigorous studies to clarify what we named an addictive-like trading behavior.
... In the decision-making literature (including impulsive decision styles), recent studies have also contributed to the identification of the key processes contributing to poor choices in GD. Several studies report deficits in decision-making as demonstrated by performance on the IGT [16,22,23]. Cognitive decision-making theory posits a dissociation between decisions under ambiguity (when outcomes are not explicit) and decisions under risk (when outcomes are explicit) [24], and individuals with GD have demonstrated deficits in tests of both modalities [15,22]. ...
Gambling disorder shares neurobiological and clinical symptoms with substance use disorders; however, it remains unclear if they share executive functioning deficits that compromise gambling treatments. In this review article, findings from the resurgence in clinical and cognitive neuroscience studies in the past 3 years are considered and their role in clinical decision-making re-appraised. In contrast to early findings, novel studies are suggestive of preserved general executive functions (i.e. working memory, planning, rule shifting), but lend further support for deficits of response inhibition, reward-related switching and value-based decision-making, although evidence of their impact on treatment outcome remains limited. The hallmark characteristic of disordered gambling “cognitive impulsivity” may reflect an underlying core alteration in value coding. Increased attention to wins and blunted attention to losses may serve to maintain maladaptive gambling behaviours (e.g. loss chasing), thus the effectiveness of interventions targeting faulty brain value systems (e.g. cognitive bias modification) warrants investigation with this population.
... At the end of the treatment, the patient presented lower novelty seeking, fewer commission errors, an improvement in decision making capacity, and a decrease in the frequency of the binge eating episodes. Impulsivity is a trait that has often been associated with deficits in decision-making, which is an important factor when studying the mechanisms that underlie the disadvantageous risky choices made in tasks such as in the IGT (Zermatten et al., 2005;Franken et al., 2008;Upton et al., 2012;Ochoa et al., 2013). Decision making is a cognitive function that consists in taking into account the consequences of a particular option before making a choice. ...
Background: Several studies have highlighted the implications of impulsivity and novelty seeking for both the maintenance and the process of recovery from bulimia nervosa (BN). Cognitive behavioral therapy (CBT) is the treatment of choice for BN, but for some cases, this treatment alone might not be sufficient for reducing the high levels of impulsivity. The paper presents a case report of a patient with BN, examining the effectiveness of using a videogame (VG; Playmancer) as an additional intervention designed to address impulsivity.
Design: Psychometric and neuropsychological measures were collected at baseline. After this assessment, Playmancer was applied prior to CBT, following an “A-B-A-C-A” single case experimental design. Impulsivity levels were assessed with the Conner’s Continuous Performance Test II (CPT-II). After the Playmancer treatment, the patient started CBT, and the levels of impulsivity were recorded again. Finally, psychometric and neuropsychological measures were collected after treatment. Weekly frequency of binges and vomiting were also recorded during the entire procedure.
Results: After the VG intervention, psychometric measures such as anxiety levels, impulsivity and novelty seeking decreased. Regarding the neuropsychological measures, impulsivity levels (measured with the CPT-II) progressively decreased throughout the intervention, and an improvement in decision making capacities was observed. Furthermore, the frequency of binges also decreased during and after the VG intervention.
Discussion: This case report suggests that using the Playmancer VG to reduce impulsivity prior to CBT may enhance the final results of the treatment for BN.
... Impairments in both inhibitory control and decision-making processes have similarly been reported among individuals with substance addictions (Bechara, 2005;Goldstein and Volkow, 2011;Verdejo-Garcia et al., 2010). In addition, existing data suggest that impairments in inhibitory control processes may be related to impairments in decision-making among individuals with substance and behavioral addictions, including individuals with alcohol dependence (Noël et al., 2007), heavy drinking adolescents (Field et al., 2007), patients with opiate dependence (Brand et al., 2008), and pathological gamblers (Ochoa et al., 2013). However, the relationship between inhibitory control and decision-making among individuals with IGD remains poorly understood. ...
... Indeed, there is growing interest in developing treatments that effectively target and reduce delay discounting (e.g., Black & Rosen, 2011;Koffarnus, Jarmolowicz, Mueller, & Bickel, 2013). One recently-developed strategy that has shown great promise builds upon the relationship between executive functioning (e.g., working memory, reasoning) and impulse-control (Day, Metrik, Spillane, & Kahler, 2013;Ochoa et al., 2013) and seeks to decrease delay discounting via working memory training. Specifically, Bickel, Yi, and colleagues (2011) found that working memory training reduced delay discounting in individuals in treatment for stimulant use, whereas there was no change in delay discounting among those who received control training (see for a failure to replicate this effect in rats). ...
In recent decades, researchers have integrated measurements of delay discounting, how the subjective valuation of a reward changes as a function of time, into their study of addiction. Research has begun to explore the idea that delay discounting may serve as both a marker for the effectiveness of existing treatments for addiction and a potential target for novel intervention strategies. As this work is in its infancy, many potentially significant connections between the construct of delay discounting and the treatment of addiction have yet to be explored. Here, we present a conceptual review highlighting novel points of intersection between delay discounting and two approaches to treating addiction that have become increasingly popular in recent years: those that focus on the development of mindfulness skills and those that emphasize the use of distraction techniques. Viewing these two techniques through the lens of delay discounting is particularly intriguing because of the very different way that they address the experience of drug cravings in the present moment (nonjudgmentally attending to vs. shifting attention away from subjective cravings, respectively). We propose that these opposing strategies for dealing with cravings may interact with delay discounting in ways that have important implications for treatment effectiveness.
... Additionally, PGs made more choices from the highrisk decks following wins or losses, indicating that decisions might be more based on the directly preceding outcomes, as opposed to e.g. a more general choice strategy. Ochoa et al. (2013) investigated a large sample of 99 pathological gamblers. They applied the original IGT (the ABCD version, Bechara et al., 1994) as well as a modified version, the EFGH version (Bechara et al., 2000). ...
Pathological gambling (PG) is a non substance based addiction that shares many behavioral and neural features with substance based addictions. However, in PG behavioral and neural changes are unlikely to be confounded by effects of acute or chronic drug exposure. Changes in reward based decision-making in particular increases in impulsivity are hallmark features of addictions. Here we review studies in PG that applied three reward-related decision tasks: the Iowa Gambling Task, probability discounting and delay discounting. We discuss the findings and focus on the impact of addiction severity and the relation of effects to impulsivity measures. While there is evidence that PGs differ from healthy controls on all three tasks, there is only little support for a further modulation of impairments by addiction severity. Conceptually, delay discounting is related to impulsivity measures and findings in this task show a considerable correlation with e.g. questionnaire-based measures of impulsivity. Taken together, impairments in PG on these three tasks are relatively well replicated, although impairments appear to be largely uncorrelated between tasks. An important next step will be to conceptualize a process-based account of behavioral impairments in PG.
... Pathological gambling can be conceptualized as a disorder of reward and punishment processing, whereby the gambler selects an immediate but risky opportunity to obtain money over the larger, more probable opportunity to save money (Ochoa et al., 2013). Indeed, gambling is typically conceptualized as a disorder of impulsivity, in which decision-making is rash and relatively uninfluenced by future consequences. ...
An influential model suggests that dopamine signals the difference between predicted and experienced reward. In this way, dopamine can act as a learning signal that can shape behaviors to maximize rewards and avoid punishments. Dopamine is also thought to invigorate reward seeking behavior. Loss of dopamine signaling is the major abnormality in Parkinson's disease. Dopamine agonists have been implicated in the occurrence of impulse control disorders in Parkinson's disease patients, the most common being pathological gambling, compulsive sexual behavior, and compulsive buying. Recently, a number of functional imaging studies investigating impulse control disorders in Parkinson's disease have been published. Here we review this literature, and attempt to place it within a decision-making framework in which potential gains and losses are evaluated to arrive at optimum choices. We also provide a hypothetical but still incomplete model on the effect of dopamine agonist treatment on these value and risk assessments. Two of the main brain structures thought to be involved in computing aspects of reward and loss are the ventral striatum (VStr) and the insula, both dopamine projection sites. Both structures are consistently implicated in functional brain imaging studies of pathological gambling in Parkinson's disease.
... When deciding between two goods presented in a different manner, individuals choose based on effort to obtain reward, amount of outcome and chance of win. A growing body of evidence has demonstrated individual differences on choice pattern (Penolazzi et al., 2013) and that proneness to choose high or low risk options are affected by several neuropsychiatric disorders such as schizophrenia (Heerey et al., 2008), obsessive compulsive disorders (Starcke et al., 2010), depression (Smoski et al., 2008), attention deficit and hyperactive disorder (Ernst et al., 2003;Drechsler et al., 2008), addictive disorders (Bechara, 2003) and pathological gambling (Ochoa et al., 2013). Similar observations were obtained using animal paradigms of decision-making that resemble features of those described for humans (for instance, Floresco and Whelan, 2009). ...
This paper presents a novel rodent decision-making task that explores uncertainty, independently of expectation and predictability. Using a 5-hole operating box, adult male Wistar rats were given choices between a small certain (safe) food reward and a large uncertain (risk) food reward. We found that animals strongly preferred the safe option when it had a fixed position or was cued with a light in a random placement scheme, but had no preference for safe or risk options when the latter were associated with light. Importantly, when the reward was manipulated animals could perceive alterations in the outcome value and biased their choice pattern to the most profitable option. In addition, we found that the D2/D3 agonist quinpirole biased all decisions toward risk in this paradigm. Finally, a c-fos analysis revealed that several brain areas known to be involved in decision-making mechanisms, including the medial prefrontal cortex, the orbitofrontal cortex, the nucleus accumbens and the striatum, were activated by the task. In summary, this paradigm is a useful and highly reliable tool to explore decision-making processes in contexts of uncertainty.
Background
Gambling disorder (GD) and bulimic spectrum eating disorders (BSDs) not only share numerous psychopathological, neurobiological, and comorbidity features but also are distinguished by the presence of inappropriate behaviours related to impulsivity and compulsivity. This study aimed to emphasise the differences and similarities in the main impulsivity and compulsivity features between GD and BSD patients, and to analyse the potential influence of sex in these domains.
Methods
Using self-reported and neurocognitive measures, we assessed different impulsive–compulsive components in a sample of 218 female and male patients (59 with BSD and 159 with GD) and 150 healthy controls.
Results
We observed that GD and BSDs exhibited elevated levels of impulsivity and compulsivity in all the dimensions compared to healthy controls. Moreover, these disorders showed differences in several personality traits, such as high novelty seeking in GD, and low persistence and high harm avoidance in BSDs. In addition, patients with BSDs also displayed a trend towards greater impulsive choice than GD patients. Regarding sex effects, GD women presented higher overall impulsivity and compulsivity than GD men. Nevertheless, no sex differences were found in BSDs.
Conclusions
Clinical interventions should consider these deficits to enhance their effectiveness, including adjunctive treatment to target these difficulties. Our findings also provide support to the relevance of sex in GD, which should also be considered in clinical interventions.
Gambling disorder (GD) is a behavioural addiction characterized by impairments in decision-making, favouring risk- and reward-prone choices. One explanatory factor for this behaviour is a deviation in attentional processes, as increasing evidence indicates that GD patients show an attentional bias toward gambling stimuli. However, previous attentional studies have not directly investigated attention during risky decision-making. 26 patients with GD and 29 healthy matched controls (HC) completed a mixed gambles task combined with eye-tracking to investigate attentional biases for potential gains versus losses during decision-making under risk. Results indicate that compared to HC, GD patients gambled more and were less loss averse. GD patients did not show a direct attentional bias towards gains (or relative to losses). Using a recent (neuro)economics model that considers average attention and trial-wise deviations in average attention, we conducted fine-grained exploratory analyses of the attentional data. Results indicate that the average attention in GD patients moderated the effect of gain value on gambling choices, whereas this was not the case for HC. GD patients with high average attention for gains started gambling at less high gain values. A similar trend-level effect was found for losses, where GD patients with high average attention for losses stopped gambling at lower loss values. This study gives more insight into how attentional processes in GD play a role in gambling behaviour, which could have implications for the development of future treatments focusing on attentional training or for the development of interventions that increase the salience of losses.
En la actualidad, el juego de apuestas está generando alarma social debido al incremento de su uso, especialmente en los menores. Esta situación está obligando a los poderes públicos a adoptar medidas dirigidas a su regulación, y al diseño de políticas públicas de intervención comunitaria, especialmente dirigidas al colectivo de los jóvenes. El juego responsable es una estrategia preventiva incluida en la prevención selectiva dentro de las políticas públicas en adicciones. Para elaborar un programa adecuado es necesario conocer la situación real de la conducta que queremos abordar desde diferentes perspectivas, los factores individuales de las personas que juegan, los factores sociales e interaccionales y los factores contextuales, además de elementos de gran relevancia como es el estado de la norma y la influencia de la publicidad, entre otros. Analizando la ludopatía se pueden extraer factores preventivos para el desarrollo de programas. El programa apuesta por tu vida es un ejemplo de programa basado en el estudio científico para el desarrollo de los objetivos y las acciones que se enmarcaran en el mismo. Las políticas públicas deben desarrollarse en base a dos elementos: el conocimiento científico y la realidad social.
Background:
Research on problematic internet use has greatly increased over the last decade. Although there were many studies related to problematic social networking sites (SNS) use, there is limited empirical research yet focused on exploring the relationship between problematic SNS use and Executive Functions (EF).
Aim:
This study set out to determine whether problematic SNS use is associated with cognitive flexibility and inhibitory control aspects of EF.
Method:
A total of 284 individuals participated in the study. A sociodemographic data form, Bergen Social Media Addiction Scale (BSMAS), and Wisconsin Card Sorting Test (WCST) were administered.
Results:
Group comparisons revealed no difference in WCST performance between problematic and non-problematic SNS use groups. Categories achieved (WCST-CA) and perseverative errors (WCST-PE) subtests were correlated with “relapse” subtest and “total score” of BSMAS in problematic SNS use group. Regression analysis revealed that WCST-CA and WCST-PE were associated with “relapse” subtest of BSMAS in problematic SNS use group.
Conclusion:
Our findings yielded a possible association between EF and problematic SNS use. Enhancing cognitive flexibility and inhibitory control may be beneficial in mitigating problems related to relapse in excessive SNS use.
Impulsivity is a multidimensional construct. Although gambling disorder (GD) has been associated with high impulsivity, impulsivity across multiple domains has not been thoroughly investigated in this population. We first aimed to examine whether associations between three facets of impulsivity (response impulsivity, choice impulsivity and impulsive tendency) varied between GD patients and healthy controls (HC). We next aimed to evaluate relationships between these three types of impulsivity, as proposed by theoretical models of impulsivity, and their associations with GD severity. The sample included 97 treatment-seeking adult men with GD, diagnosed according to DSM-5 criteria, and 32 male HCs recruited from the general population. Greater impulsivity in all three domains was found in men with GD in comparison to men without GD. Associations between impulsivity facets were found in both groups, with response impulsivity being the only domain associated with GD severity. Our findings confirm that multiple domains of impulsivity are relevant in GD. Future studies should examine the extent to which treatments aimed at targeting specific aspects of impulsivity improve outcomes.
Background
Compulsivity can be seen across various mental health conditions and refers to a tendency toward repetitive habitual acts that are persistent and functionally impairing. Compulsivity involves dysfunctional reward-related circuitry and is thought to be significantly heritable. Despite this, its measurement from a transdiagnostic perspective has received only scant research attention. Here we examine both the psychometric properties of a recently developed compulsivity scale, as well as its relationship with compulsive symptoms, familial risk, and reward-related attentional capture.
Methods
Two-hundred and sixty individuals participated in the study (mean age = 36.0 [SD = 10.8] years; 60.0% male) and completed the Cambridge-Chicago Compulsivity Trait Scale (CHI-T), along with measures of psychiatric symptoms and family history thereof. Participants also completed a task designed to measure reward-related attentional capture ( n = 177).
Results
CHI-T total scores had a normal distribution and acceptable Cronbach’s alpha (0.84). CHI-T total scores correlated significantly and positively (all p < 0.05, Bonferroni corrected) with Problematic Usage of the Internet, disordered gambling, obsessive-compulsive symptoms, alcohol misuse, and disordered eating. The scale was correlated significantly with history of addiction and obsessive-compulsive related disorders in first-degree relatives of participants and greater reward-related attentional capture.
Conclusions
These findings suggest that the CHI-T is suitable for use in online studies and constitutes a transdiagnostic marker for a range of compulsive symptoms, their familial loading, and related cognitive markers. Future work should more extensively investigate the scale in normative and clinical cohorts, and the role of value-modulated attentional capture across compulsive disorders.
Sumario/Sumari/Summary
La psicología y las adicciones. Wilma Penzo ……………………………………………………………pg 2
La psicologia i las addiccions. Wilma Penzo …………………………………………………………….pg 3
Conductas adictivas. M.Neus Aymamí i Sanromà…………………………………………………… pg 4
Conductes addictives. M.Neus Aymamí i Sanromà …………………………………………………pg 5
Juego patológico. M.Neus Aymamí i Sanromà ...........................................................pg 6
El trastorn de joc. M.Neus Aymamí i Sanromà…………………………………………………………pg 9
Adicción a los videojuegos. Susana Jiménez Murcia..................................................pg 16
Adició a videojocs Susana Jiménez Murcia,...............................................................pg 17
Las adicciones comportamentales: Adicciones tecnológicas paralelismo con las adiciones a sustancias. MªJosé Vilches Jiménez,……………………………………………………pg 20
Les addiccions comportamentals: Addiccions tecnològiques paral•lelisme amb les addicions a substàncies………………………………………………………… ….pg 21
Los nuevos estimulantes en la sociedad de la cultura del éxito. Maria Antonia Obrador Mas, Mercedes Sanz Laburda, Aida de Arriba Arnau...............................................pg 23
Els nous estimulants en la societat de la cultura de l'èxit. Maria Antonia Obrador Mas, Mercedes Sanz Laburda, Aida de Arriba Arnau........................................................pg. 25
The new stimulants in the culture of success society. Maria Antonia Obrador Mas Mercedes Sanz Laburda Aida de Arriba Arnau..........................................................pg 27
REFLEXIONES EN TORNO A LA ADICCIÓN. Juan Manuel Blanqué López……..pg 29
REFLEXIONS AL VOLTANT DE L’ ADICCIÓ Juan Manuel Blanqué López…..pg 30
REFLECTIONS ON ADDICTION. Juan Manuel Blanqué López…… ………….pg 33
Sumaris/Sumarios/Summaries……………………………………………………....pg 36
Various therapeutic approaches are available for the treatment of gambling disorder (GD), especially cognitive behavioral therapy (CBT; the most widely used treatment). However, CBT has high dropout and relapse rates as well as non-compliance issues, which may be partly due to resistance to changing core characteristics, such as executive functioning, attention, and emotional regulation abnormalities. Finding new therapeutic approaches to treat GD is thus a key challenge. Cognitive remediation (CR) interventions represent a promising approach to GD management, which has recently been demonstrated to have efficacy for treating other addictive disorders. The objective of this review is to describe the possible benefits of CR interventions for GD management. Two systematic searches in MEDLINE and ScienceDirect databases were conducted up until January 2017. Potential neurocognitive targets of CR interventions for GD were reviewed, as is the use and efficacy of such interventions for GD. While there is evidence of several neurocognitive deficits in individuals with GD in terms of impulsive, reflective, and interoceptive processes, the literature on CR interventions is virtually absent. No clinical studies were found in the literature, apart from a trial of a very specific program using Playmancer, a serious videogame, which was tested in cases of bulimia nervosa and GD. However, neurocognitive impairments in individuals with addictive disorders are highly significant, not only affecting quality of life, but also making abstinence and recovery more difficult. Given that CR interventions represent a relatively novel therapeutic approach to addiction and that there is currently a scarcity of studies on clinical populations suffering from GD, further research is needed to examine the potential targets of such interventions and the effectiveness of different training approaches. So far, no consensus has been reached on the optimal parameters of CR interventions (duration, intensity, frequency, group vs. individual, pencil-and-paper vs. computerized delivery, etc.). Although no firm conclusions can be drawn, CR interventions represent a promising adjunct treatment for GD. Such a novel therapy could be associated with common interventions, such as CBT and educational and motivational interventions, in order to make therapies more effective and longer-lasting and to decrease the risk of relapse.
Background:
Continued, persistent gambling to recover accumulating losses, or 'loss-chasing', is a behavioral pattern linked particularly closely to gambling disorder (GD) but may reflect impaired decision-making processes relevant to drug addictions like cocaine-use disorder (CUD). However, little is known regarding the neurocognitive mechanisms of this complex, maladaptive behavior, particularly in individuals with addictive disorders.
Methods:
Seventy participants (25 GD, 18 CUD, and 27 healthy comparison (HC)) completed a loss-chase task during fMRI. Engagement of functional brain networks in response to losing outcomes and during decision-making periods preceding choices to loss-chase or to quit chasing losses were investigated using independent component analysis (ICA). An exploratory factor analysis was performed to examine patterns of coordinated engagement across identified networks.
Results:
In GD relative to HC and CUD participants, choices to quit chasing were associated with greater engagement of a medial frontal executive-processing network. By comparison, CUD participants exhibited altered engagement of a striato-amygdala motivational network in response to losing outcomes as compared to HC, and during decision-making as compared to GD. Several other networks were differentially engaged during loss-chase relative to quit-chasing choices, but did not differ across participant groups. Exploratory factor analysis identified a system of coordinated activity across prefrontal executive-control networks that was greater in GD and CUD relative to HC participants and was associated with increased chasing persistence across all participants.
Conclusions:
Results provide evidence of shared and distinct neurobiological mechanisms in substance and behavioral addictions, and lend insight into potential cognitive interventions targeting loss-chasing behavior in GD.
Purpose:
To test the prediction that poor decision-making would predict poor eating-related behaviours, which in turn would relate to elevated body mass index (BMI) percentile.
Methods:
Associations among decision-making ability, eating behaviours, and BMI percentile were examined in a sample of 311 healthy male and female adolescents, aged 14-18 years. Structural equation modelling was used to test the proposed relationships.
Results:
The predicted model was a good fit to the data and all paths between latent and indicator variables were significant. Impulsive responding significantly predicted poor food choice and overeating. No significant relationships emerged between eating-related variables and BMI percentile.
Conclusions:
Findings from this study extend the existing research in adults and offer a more comprehensive understanding of factors that may contribute to eating behaviours and weight status in teenagers.
Objective:
The purpose of the present study was to test whether individuals with Internet addiction disorder (IAD) presented analogous characteristics of working memory, executive function and impulsivity compared with pathological gambling (PG) patients.
Methods:
The subjects included 23 individuals with IAD, 23 PG patients and 23 controls. All of the participants were measured with the digit span task, Wisconsin Card Sorting Test, go/no-go task and Barratt Impulsiveness Scale-11 (BIS-11) under the same experimental conditions.
Results:
The results of this study showed that the false alarm rate, total response errors, perseverative errors, failure to maintain set and BIS-11 scores of both the IAD and PG groups were significantly higher than that of the control group. In addition, the forward scores and backwards scores, percentage of conceptual level responses, number of categories completed and hit rate of the IAD and PG groups were significantly lower than that of the control group. Furthermore, the false alarm rate and BIS-11 scores of the IAD group were significantly higher than those of PG patients, and the hit rate was significantly lower than that of the PG patients.
Conclusions:
Individuals with IAD and PG patients present deficiencies in working memory, executive dysfunction and impulsivity, and individuals with IAD are more impulsive than PG patients.
Suicide is the first cause of non-natural death in Spain. Among addictive disorders, pathological gambling is one the most significant independent risk factors for suicidal behavior. The objective of this study is to describe and compare the sociodemographic traits, comorbidity and attempt characteristics, between suicide attempters who fulfill diagnostic criteria for pathological gambling and those who do not.
Previous studies by questionnaires have demonstrated that lottery gamblers who have not meet the criteria of pathological gambler show greater gambling acceptability. However, few empirical evidence of whether such nonpathological lottery gamblers (NPLGs) display the same impairments of decision making with pathological gamblers has been found so far. In present study, NPLGs and matched controls (MCs) were asked to perform the Iowa Gambling Task (IGT) and inter-temporal choice task (ICT). We found that compared to MCs, NPLGs displayed much lower IGT scores, net gains and proportions of advantageous decks in the IGT task and much higher percentages of trials during which smaller-but-sooner rewards were chosen in the ICT. These findings indicate that NPLGs display much more risky and impulsive decision makings, just like pathological gamblers in the previous studies. Next, the Go/NoGo task was employed to explore the role of response inhibition in the impairment of decision making in NPLGs. We found that NPLGs did show much higher commission errors compared to MCs. Moreover, IGT scores, net gain and proportions of advantageous decks were significantly negatively correlated with commission errors, which indicates that poor response inhibition might be involved in the impairments of decision making in NPLGs. To our knowledge, we provided the first empirical evidence of impairment of decision making and its cognitive mechanisms in NPLGs.
High trait anxiety has been linked with risk-avoidant decision-making, though little is known regarding the specific facets of anxiety contributing to this negative association. Anxiety sensitivity (AS), a transdiagnostic vulnerability factor for anxiety-related pathology, may be particularly relevant to risk decision-making given that risk-taking behaviors generate heightened somatic arousal and produce many of the sensations feared by individuals with high AS. Two studies were conducted to investigate the relation between AS and risk decision-making. In the first study, 268 undergraduate students completed a series of questionnaires that included measures of AS and gambling behaviors. Significant negative correlations were observed between AS and several gambling-related risk-taking activities, and hierarchical multiple regression analyses indicated that AS scores added significant incremental validity in predicting risk-taking over and above demographic variables, negative affect, and trait anxiety. In the second study, 43 participants who had screened for high (n = 20) or low (n = 23) AS completed the Iowa Gambling Task, a behavioral measure of risk-taking. Results indicated that, when placed under conditions of risk, individuals with high AS engaged in significantly less risk-taking than their low AS counterparts. The implications of these findings and potential directions for future research are discussed.
Impairments in self-regulatory behaviour reflect a deficit in executive functioning and decision-making, as well as higher levels of self-reported impulsivity, and may be involved in the development and maintenance of addictive disorders. We sought to explore the association between self-reported impulsivity and neurocognitive measures, and their association with treatment outcome in pathologic gambling.
We assessed patients with pathologic gambling using executive functioning and decision-making tests and self-report measures of impulsivity. Patients underwent cognitive-behavioural therapy (CBT) for pathologic gambling.
We included 88 patients (8% women) in our study. High self-reported extravagance was associated with poor performance in the Iowa Gambling Task (IGT)-ABCD version. High impulsiveness, low disorderliness, high exploratory excitability (trend), poor backward block span and poor IGT-EFGH scores (trend) predicted dropout. We observed no self-reported or neurocognitive predictors of relapse or number of treatment sessions attended.
Most participants were slot-machine gamblers seeking treatment. No follow-up data and no control group were included in the study. The missing sample (i.e., individuals who were recruited and assessed in the pretreatment stage but who chose not to begin treatment) had higher extravagance scores than the final sample.
Neurocognitive reward sensitivity was related to self-reported overspending behaviour. Self-regulatory impairments (especially rash impulsiveness and punishment sensitivity) and executive dysfunction predicted only dropout of CBT in participants with pathologic gambling. Different neurocognitive processes and personality traits might mediate treatment response to psychological therapy of pathologic gambling according to the specific target variable assessed.
Based on brain imaging findings, we present a model according to which addiction emerges as an imbalance in the information processing and integration among various brain circuits and functions. The dysfunctions reflect (a) decreased sensitivity of reward circuits, (b) enhanced sensitivity of memory circuits to conditioned expectations to drugs and drug cues, stress reactivity, and (c) negative mood, and a weakened control circuit. Although initial experimentation with a drug of abuse is largely a voluntary behavior, continued drug use can eventually impair neuronal circuits in the brain that are involved in free will, turning drug use into an automatic compulsive behavior. The ability of addictive drugs to co-opt neurotransmitter signals between neurons (including dopamine, glutamate, and GABA) modifies the function of different neuronal circuits, which begin to falter at different stages of an addiction trajectory. Upon exposure to the drug, drug cues or stress this results in unrestrained hyperactivation of the motivation/drive circuit that results in the compulsive drug intake that characterizes addiction.
Substance dependence is associated with executive function deficits, but the nature of these executive defects and the effect that different drugs and sex have on these defects have not been fully clarified. Therefore, we compared the performance of alcohol- (n = 33; 18 women), cocaine- (n = 27; 14 women), and methamphetamine-dependent individuals (n = 38; 25 women) with sex-matched healthy comparisons (n = 36; 17 women) on complex decision making as measured with the Iowa Gambling Task, working memory, cognitive flexibility, and response inhibition. Cocaine- and methamphetamine-dependent individuals were impaired on complex decision making, working memory, and cognitive flexibility, but not on response inhibition. The deficits in working memory and cognitive flexibility were milder than the decision-making deficits and did not change as a function of memory load or task switching. Interestingly, decision making was significantly more impaired in women addicted to cocaine or methamphetamine than in men addicted to these drugs. Together, these findings suggest that drug of choice and sex have different effects on executive functioning, which, if replicated, may help tailor intervention.
The 3 studies reported here were designed to clarify the nature of the personality trait of impulsivity. Two types of impulsivity were distinguished. Dysfunctional impulsivity is the tendency to act with less forethought than most people of equal ability when this tendency is a source of difficulty; most previous work on impulsivity appears to have focused on this trait. Functional impulsivity, in contrast, is the tendency to act with relatively little forethought when such a style is optimal. The present work indicates that these two tendencies are not highly correlated and that they bear different relations both to other personality traits and to the manner in which certain basic cognitive processes are executed.
The South Oaks Gambling Screen is a 20-item questionnaire based on DSM-III criteria for pathological gambling. It may be self-administered or administered by nonprofessional or professional interviewers. A total of 1,616 subjects were involved in its development: 867 patients with diagnoses of substance abuse and pathological gambling, 213 members of Gamblers Anonymous, 384 university students, and 152 hospital employees. Independent validation by family members and counselors was obtained for the calibration sample, and internal consistency and test-retest reliability were established. The instrument correlates well with the criteria of the revised version of DSM-III (DSM-III-R). It offers a convenient means to screen clinical populations of alcoholics and drug abusers, as well as general populations, for pathological gambling.
Studies of the neurobiological processes underlying drug addiction primarily have focused on limbic subcortical structures. Here the authors evaluated the role of frontal cortical structures in drug addiction.
An integrated model of drug addiction that encompasses intoxication, bingeing, withdrawal, and craving is proposed. This model and findings from neuroimaging studies on the behavioral, cognitive, and emotional processes that are at the core of drug addiction were used to analyze the involvement of frontal structures in drug addiction.
The orbitofrontal cortex and the anterior cingulate gyrus, which are regions neuroanatomically connected with limbic structures, are the frontal cortical areas most frequently implicated in drug addiction. They are activated in addicted subjects during intoxication, craving, and bingeing, and they are deactivated during withdrawal. These regions are also involved in higher-order cognitive and motivational functions, such as the ability to track, update, and modulate the salience of a reinforcer as a function of context and expectation and the ability to control and inhibit prepotent responses.
These results imply that addiction connotes cortically regulated cognitive and emotional processes, which result in the overvaluing of drug reinforcers, the undervaluing of alternative reinforcers, and deficits in inhibitory control for drug responses. These changes in addiction, which the authors call I-RISA (impaired response inhibition and salience attribution), expand the traditional concepts of drug dependence that emphasize limbic-regulated responses to pleasure and reward.
The somatic marker hypothesis formulated by Damasio (e.g., 1994; Damasio, Tranel, & Damasio, 1991) argues that affective reactions ordinarily guide and simplify decision making. Although originally intended to explain decision-making deficits in people with specific frontal lobe damage, the hypothesis also applies to decision-making problems in populations without brain injury. Subsequently, the gambling task was developed by Bechara (Bechara, Damasio, Damasio, & Anderson, 1994) as a diagnostic test of decision-making deficit in neurological populations. More recently, the gambling task has been used to explore implications of the somatic marker hypothesis, as well as to study suboptimal decision making in a variety of domains. We examined relations among gambling task decision making, working memory (WM) load, and somatic markers in a modified version of the gambling task. Increased WM load produced by secondary tasks led to poorer gambling performance. Declines in gambling performance were associated with the absence of the affective reactions that anticipate choice outcomes and guide future decision making. Our experiments provide evidence that WM processes contribute to the development of somatic markers. If WM functioning is taxed, somatic markers may not develop, and decision making may thereby suffer.
According to Damasio's somatic marker hypothesis, affective reactions ordinarily guide and simplify decision making. In an earlier study, we used a modified version of the gambling task developed by Bechara and colleagues so that we could explore the relations among decision making, working memory (WM) load, and formation of somatic markers. This prior work found that an increased WM load produced by secondary tasks interfered with the development of somatic markers and led to poorer gambling task performance. In the present study, we tested whether secondary tasks affect the executive functions of WM, verbal buffering, or both. Our findings indicate that verbal buffering alone does not interfere with gambling task performance or the development of somatic markers. Interference with the executive functions of WM is necessary to disrupt gambling performance and somatic markers.
Bechara, Damasio, and coworkers [Bechara, A., Damasio, H., Tranel, D. & Damasio, A. R. (1997) Science 275, 1293-1295] have reported that normal participants decide advantageously before knowing the advantageous strategy in a simple card game designed to mimic real-life decision-making. Bechara et al. have used this result to support their view that nonconscious somatic markers can guide advantageous behavior. By using more sensitive methods, we show that participants have much more knowledge about the game than previously thought. In fact, participants report knowledge of the advantageous strategy more reliably than they behave advantageously. Furthermore, when they behave advantageously, their verbal reports nearly always reveal evidence of quantitative knowledge about the outcomes of the decks that would be sufficient to guide such advantageous behavior. In addition, there is evidence that participants also have access to more qualitative reportable knowledge. These results are compatible with the view that, in this task, both overt behavior and verbal reports reflect sampling from consciously accessible knowledge; there is no need to appeal to nonconscious somatic markers. We also discuss the findings of other studies that similarly suggest alternative interpretations of other evidence previously used to support a role for somatic markers in decision-making.
By analogy to drug dependence, it has been speculated that the underlying pathology in pathological gambling is a reduction in the sensitivity of the reward system. Studying pathological gamblers and controls during a guessing game using functional magnetic resonance imaging, we observed a reduction of ventral striatal and ventromedial prefrontal activation in the pathological gamblers that was negatively correlated with gambling severity, linking hypoactivation of these areas to disease severity.
The purpose of the present study was to explore the links among the four facets of impulsivity (urgency, lack of premeditation, lack of perseverance, and sensation seeking) proposed by and decision-making processes. Thirty undergraduate students completed a self-report questionnaire evaluating impulsivity as well as a task measuring decision-making processes, the Iowa Gambling Task. Zero-order correlations and multilevel analysis revealed that only lack of premeditation was specifically linked to disadvantageous decisions on the Gambling Task. This suggests that premeditation is related to decision making influenced by somatic (or emotional) markers.
Obsessive-compulsive disorder (OCD) is clinically heterogeneous. The authors examined how specific OCD symptom dimensions were related to neuropsychological functions using multiple regression analyses. A total of 39 OCD patients and 40 controls completed the Iowa Gambling Task (IGT; A. Bechara, A. R. Damasio, H. Damasio, & S. W. Anderson, 1994), which is a test of decision making, and the Wisconsin Card Sorting Test (R. K. Heaton, 1981), which is a test of set shifting. OCD patients and controls showed comparable decision making. However, patients with prominent hoarding symptoms showed impaired decision making on the IGT as well as reduced skin conductance responses. OCD patients had poorer set shifting abilities than controls, and symmetry/ordering symptoms were negatively associated with set shifting. These results help explain previous inconsistent findings in neuropsychological research in OCD and support recent neuroimaging data showing dissociable neural mechanisms involved in mediating the different OCD symptom dimensions.
Disinhibition and decision-making skills play an important role in theories on the cause and outcome of addictive behaviors such as substance use disorders and pathological gambling. In recent studies, both disinhibition and disadvantageous decision-making strategies, as measured by neurocognitive tests, have been found to influence the course of substance use disorders. Research on factors affecting relapse in pathological gambling is scarce.
This study investigated the effect of both self-reported impulsivity and reward sensitivity, and neurocognitively assessed disinhibition and decision-making under conflicting contingencies, on relapse in a group of 46 pathological gamblers.
Logistic regression analysis indicated that longer duration of the disorder and neurocognitive indicators of disinhibition (Stop Signal Reaction Time) and decision-making (Card Playing Task) were significant predictors of relapse (explaining 53% of the variance in relapse), whereas self-reported impulsivity and reward sensitivity did not significantly predict relapse. Overall classification accuracy was 76%, with a positive classification accuracy of 76% and a negative classification accuracy of 75%.
Duration of the disorder and neurocognitive measures of disinhibition and decision-making are powerful predictors of relapse in pathological gambling. The results suggest that endophenotypical neurocognitive characteristics are more promising in the prediction of relapse in pathological gambling than phenotypical personality characteristics. Neurocognitive predictors may be useful to guide treatment planning of follow-up contacts and booster sessions.
Impaired decision-making is a key-feature of many neuropsychiatric disorders. In the present study, we examined task performance in a healthy population consisting of those whose scores indicated high and low impulsivity on several behavioral decision-making tasks reflecting orbitofrontal functioning. The measures included tasks that assess decision-making with and without a learning component and choice flexibility. The results show that subjects high on impulsivity display an overall deficit in their decision-making performance as compared with subjects low on impulsivity. More specifically, subjects with high impulsivity show weaknesses in learning of reward and punishment associations in order to make appropriate decisions (reversal-learning task and Iowa Gambling Task), and impaired adaptation of choice behavior according to changes in stimulus-reward contingencies (reversal-learning task). Simple, non-learning, components of reward- and punishment-based decision-making (Rogers Decision-Making Task) seem to be relatively unaffected. Above all, the results indicate that impulsivity is associated with a decreased ability to alter choice behavior in response to fluctuations in reward contingency. The findings add further evidence to the notion that trait impulsivity is associated with decision-making, a function of the orbitofrontal cortex.
Introduction. The revised version of the Temperament and Character Inventory (TCI-R), a tool designed by C. R. Cloninger for the evaluation of the seven dimensions defined in his psychobiological model of personality, was translated and adapted to Spanish. The aim of the study was to obtain normative data and scales with T-scores in a incidental sample of the general Spanish population. Methods. After adaptation to Spanish, the tool was administered to 400 subjects from several areas of Spain. The sample is stratified according to age and gender according to the year 2001 Spanish population census. We have studied the differences between men and women and the association between age and dimensions. We have checked the normal distribution of the traits, and proceeded with the standardization and normalization of the scores. Results. We present the mean and standard deviation according to sex for each of the main dimensions and subscales. The scores of the main dimensions obtained for general population according to gender show a normal distribution that has allowed us to standardize them into T-scores. The reliability of the dimensions is high. There are differences in the means depending on gender: women scored higher in Harm Avoidance, Reward Dependence and Cooperativeness. Men scored higher in Persistence. There were no high correlations between age and the dimensions. Conclusions. The Spanish version of the new TCI-R is an adequate tool for the study of personality dimensions of normal population.
The revision of the Wechsler-Bellevue Adult Intelligence Scale retains the type of item categories but has numerous changes in the items. Standardization is based on a stratified sample of 1700 adults ages 16 to 64. Additional norms are given for ages above 64 based on a different group of subjects. Reliabilities for verbal, performance and full scale IQ's are .96, .93, and .97, and for the subtests range from .65 to .96. Manual includes directions for administering, IQ tables, and scaled score tables. Officially the title is to be abbreviated WAIS. (PsycINFO Database Record (c) 2012 APA, all rights reserved)
"The Trail Making Test was administered to 200 patients with clear evidence of brain damage and to 84 Ss without anamnestic or clinical evidence of brain damage. The groups were comparable with respect to sex, CA, and… education. The results showed… significant differences in the performances of the two groups for Parts A and B of the test individually as well as for their total. Frequency distributions were given that may serve as preliminary norms for use in evaluating results obtained with individual Ss. Some comments were offered regarding possible reasons why the Trail Making Test differentiated the groups so well, relating known aspects of brain function to the structure and requirements of the test." (PsycINFO Database Record (c) 2012 APA, all rights reserved)
This work investigates whether inhibition impairments influence the decision making process in pathological gamblers (PGs). The PG (N=51) subjects performed the Iowa Gambling Task (IGT as the measure of the decision making process) and two tests of inhibition: the Stroop (interference inhibition), and the Go/NoGo (response inhibition), and were compared with demographically matched healthy subjects (N=57). Performance in the IGT block 1 and block 2 did not differ between the groups, but the differences between the PGs and healthy controls began to be significant in block 3, block 4 and block 5. PGs learned the IGT task more slowly than the healthy controls and had non-optimal outcomes (more disadvantageous choices). Impaired IGT performance in PGs was not related to an inhibition ability measured by the Stroop (interference response time) and the Go/NoGo (number of commission errors) parameters. Further controlled studies with neuroimaging techniques may help to clarify the particular brain mechanisms underlying the impaired decision making process in PGs.
The Iowa Gambling Task (IGT) is sensitive to decision making impairments in several clinical groups with frontal impairment. However the complexity of the IGT, particularly in terms of its learning requirements, makes it difficult to know whether disadvantageous (risky) selections in this task reflect deliberate risk taking or a failure to recognise risk. To determine whether propensity for risk taking contributes to IGT performance, we correlated IGT selections with a measure of propensity for risk taking from the Balloon Analogue Risk Task (BART), taking into account potential moderating effects of IGT learning requirements, and trait impulsivity, which is associated with learning difficulties. We found that IGT and BART performance were related, but only in the later stages of the IGT, and only in participants with low trait impulsivity. This finding suggests that IGT performance may reflect different underlying processes in individuals with low and high trait impulsivity. In individuals with low trait impulsivity, it appears that risky selections in the IGT reflect in part, propensity for risk seeking, but only after the development of explicit knowledge of IGT risks after a period of learning.
Studies using the Iowa gambling task (IGT) have shown that patients with Parkinson's disease (PD) make disadvantageous choices characterized by immediate large rewards and delayed larger punishments. These results can be interpreted in two ways: either PD patients are hypersensitive to immediate outcomes and/or insensitive to delayed consequences or PD patients are hypersensitive to rewards and/or insensitive to punishments. In this study, we used a modified IGT in which selection of cards from the disadvantageous decks leads to immediate, small punishments and delayed, smaller rewards and selection of cards from the advantageous decks leads to immediate, large punishments and delayed larger rewards. We then compared the results obtained using this modified IGT with those obtained using the original IGT. If the PD patients were hypersensitive to the immediate outcomes of decisions, they would make disadvantageous choices in both the original and the modified IGTs. Differences between the results of the original and modified tasks would indicate impairments in balancing reward and punishment. In our analysis, PD patients selected advantageous decks and gained as much as normal subjects during the modified IGT, but they selected disadvantageous decks during the original IGT. These results indicate that the decision-making difficulties of PD patients are caused by their inability to balance reward and punishment and their hypersensitivity to reward and/or insensitivity to punishment.
The Iowa Gambling Task (IGT) has been used to study decision-making differences in many different clinical and developmental samples. It has been suggested that IGT performance captures abilities that are separable from cognitive abilities, including executive functions and intelligence. The purpose of the current review was to examine studies that have explicitly examined the relationship between IGT performance and these cognitive abilities. We included 43 studies that reported correlational analyses with IGT performance, including measures of inhibition, working memory, and set-shifting as indices of executive functions, as well as measures of verbal, nonverbal, and full-scale IQ as indices of intelligence. Overall, only a small proportion of the studies reported a statistically significant relationship between IGT performance and these cognitive abilities. The majority of studies reported a non-significant relationship. Of the minority of studies that reported statistically significant effects, effect sizes were, at best, small to modest, and confidence intervals were large, indicating that considerable variability in performance on the IGT is not captured by current measures of executive function and intelligence. These findings highlight the separability between decision-making on the IGT and cognitive abilities, which is consistent with recent conceptualizations that differentiate rationality from intelligence.
The purpose of this review is to gain more insight in the neuropathology of pathological gambling (PG) and problem gambling, and to discuss challenges in this research area. Results from the reviewed PG studies show that PG is more than just an impulse control disorder. PG seems to fit very well with recent theoretical models of addiction, which stress the involvement of the ventral tegmental-orbito frontal cortex. Differentiating types of PG on game preferences (slot machines vs. casino games) seems to be useful because different PG groups show divergent results, suggesting different neurobiological pathways to PG. A framework for future studies is suggested, indicating the need for hypothesis driven pharmacological and functional imaging studies in PG and integration of knowledge from different research areas to further elucidate the neurobiological underpinnings of this disorder.