Cognitive Inflexibility in Gamblers is Primarily Present in Reward-Related Decision Making.

Michiel Boog,Matthijs C Boog,Anna E Goudriaan,Ben J M V D Wetering,Paul Hã¶Ppener,Ingmar H A Franken

doi:10.3389/fnhum.2014.00569

Abstract

One hallmark of gambling disorder (GD) is the observation that gamblers have problems stopping their gambling behavior once it is initiated. On a neuropsychological level, it has been hypothesized that this is the result of a cognitive inflexibility. The present study investigated cognitive inflexibility in patients with GD using a task involving cognitive inflexibility with a reward element (i.e., reversal learning) and a task measuring general cognitive inflexibility without such a component (i.e., response perseveration). For this purpose, scores of a reward-based reversal learning task (probabilistic reversal learning task) and the Wisconsin card sorting task were compared between a group of treatment seeking patients with GD and a gender and age matched control group. The results show that pathological gamblers have impaired performance on the neurocognitive task measuring reward-based cognitive inflexibility. However, no difference between the groups is observed regarding non-reward-based cognitive inflexibility. This suggests that cognitive inflexibility in GD is the result of an aberrant reward-based learning, and not based on a more general problem with cognitive flexibility. The pattern of observed problems is suggestive of a dysfunction of the orbitofrontal cortex, the ventrolateral prefrontal cortex, and the ventral regions of the striatum in gamblers. Relevance for the neurocognition of problematic gambling is discussed.

Highlights

A gambling disorder (GD) is characterized by a lack of selfregulation (Goldstein et al, 2001; APA, 2013)
Reward-based cognitive inflexibility can be studied using the principles of reversal learning, which is dependent on the capacity to perform flexible behavior when stimulus-reward contingencies alter (Clark et al, 2004; Franken et al, 2008)
The present study investigated the nature of the presumed relationship between GD and cognitive inflexibility

Summary

Introduction

A gambling disorder (GD) is characterized by a lack of selfregulation (Goldstein et al, 2001; APA, 2013). Patients suffering from this disorder are not able to inhibit their urge to gamble, and are unable to shift their behavior (Goudriaan et al, 2008). One specific process related to the lack of self-regulation suggested to underlie GD is cognitive inflexibility associated with reward learning. Reward-based cognitive inflexibility can be studied using the principles of reversal learning, which is dependent on the capacity to perform flexible behavior when stimulus-reward contingencies alter (Clark et al, 2004; Franken et al, 2008). The concept of reward-based cognitive inflexibility is closely related to the concept of reward sensitivity (Boog et al, 2013) and the concept of impaired decision making under conflicting contingencies (Goudriaan et al, 2008)

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Conclusion