Iowa Gambling Task Performance Research Articles

Influence Factors for Decision-Making Performance of Suicide Attempters and Suicide Ideators: The Roles of Somatic Markers and Explicit Knowledge.

Impaired decision-making has been observed in suicide attempters during the Iowa Gambling Task (IGT). Decision-making performance is influenced by somatic markers and explicit knowledge, but it is still unclear of the influencing role on decision-making performance in suicidal individuals. We aimed to investigate whether there is a decision-making deficit in suicide attempters, suicide ideators, as well as the distinct roles of somatic markers and explicit knowledge wherein. Thirteen suicide attempters, 23 suicide ideators, and 19 healthy controls performed the IGT. Both somatic markers (by the skin conductance responses, SCRs) and explicit knowledge (by the subjective experience rating and a list of questions) were recorded. No significant differences were found among the three groups on IGT performance, explicit knowledge, and anticipatory SCRs. IGT Performance of suicide attempters was positively correlated with explicit knowledge index while behavior performance was positively associated with the SCRs in healthy controls. These results indicate that the suicide attempters seem to apply a compensatory strategy by mostly utilizing explicit knowledge to perform normally as healthy controls in the IGT.

The Prominent Deck B Phenomenon in Schizophrenia: An Empirical Study on Iowa Gambling Task.

Background: The Iowa Gambling Task (IGT) was established to evaluate emotion-based decision-making ability under uncertain circumstances in clinical populations, including schizophrenia (Sz). However, there remains a lack of stable behavioral measures regarding discrimination for decision-making performance in IGT between schizophrenic cases and healthy participants. None of the Sz-IGT studies has specifically verified the prominent deck B (PDB) phenomenon gradually revealed in other populations. Here, we provided a global review and empirical study to verify these Sz-IGT issues.Methods: Seeking reliable and valid behavioral measures, we reviewed 38 studies using IGT to investigate decision-making behavior in Sz groups. The IGT, the Wisconsin Card Sorting Test (WCST), and clinical symptoms evaluations were administered to 61 schizophrenia or schizoaffective cases diagnosed by psychiatrists and 62 demographically matched healthy participants.Results: There were no valid behavioral measures in IGT that could significantly identify the decision-making dysfunction of Sz. However, Sz cases, on average, made more choices from disadvantageous deck B relative to other decks, particularly in the later learning process (block 3–5). Compared to the control group, the Sz group was more impaired on the WCST. The high-gain frequency decks B and D showed significant correlations with WCST but no correlation between clinical symptoms and IGT/WCST.Conclusions: Gain–loss frequency (GLF) has a dominant and stable impact on the decision-making process in both Sz and control groups. PDB phenomenon is essentially challenging to be observed on the ground of the expected value (EV) viewpoint approach on the IGT in both populations. Consequently, caution should be exercised when launching the IGT to assess the decision-making ability of Sz under a clinical scenario.

A-148 Executive Dysfunction in Late-Life Depression: Changes and Relationship to Treatment Response in a Clinical Trial

Abstract Objective Executive dysfunction is the core neurocognitive deficit associated with late-life depression (LLD). This study identified changes in executive functioning during a structured behavioural treatment for depression in older adults and ascertained if pre-treatment executive dysfunction predicted treatment response. Method We analyzed data from a large multisite randomized controlled trial of structured behavioral psychotherapies (PST and Engage) for unipolar depression in adults ≥60 years. Participants were diagnosed with major depressive disorder and had Mini-Mental State Examination [MMSE] ≥24. Cognitive measures included the Stroop test, digit span, Iowa Gambling Task (IGT), and Wisconsin Card Sorting Test (WCST). Treatment response outcomes included pre- to post-treatment changes on the Hamilton Depression Rating Scale (HAM-D) and World Health Organization Disability Assessment Schedule II (WHODAS-II). One-way analysis of variance (ANOVA) assessed pre- and post-treatment changes in executive functioning measures across 9 weeks of treatment for 95 participants with complete data. Multiple linear regression models tested whether baseline measures of executive functioning predicted treatment response in (a) HAM-D depression and (b) WHODAS disability scores. Results A one-way ANOVA revealed improvements on IGT performance (Total Money) between baseline and week 9 post-treatment (F(1,186) = 7.00, p < 0.01). No combination of baseline measures of executive functioning significantly predicted change in HAM-D or WHODAS scores across treatment (ps > 0.05). Conclusion Baseline executive functioning did not predict treatment response (change in depressive symptoms or disability ratings). That is, individuals improved on treatment outcomes regardless of baseline executive dysfunction. In addition, results suggest that these approaches may actually improve real-life decision-making.

Component Processes of Decision Making in a Community Sample of Precariously Housed Persons: Associations With Learning and Memory, and Health-Risk Behaviors.

The Iowa Gambling Task (IGT) is a widely used measure of decision making, but its value in signifying behaviors associated with adverse, “real-world” consequences has not been consistently demonstrated in persons who are precariously housed or homeless. Studies evaluating the ecological validity of the IGT have primarily relied on traditional IGT scores. However, computational modeling derives underlying component processes of the IGT, which capture specific facets of decision making that may be more closely related to engagement in behaviors associated with negative consequences. This study employed the Prospect Valence Learning (PVL) model to decompose IGT performance into component processes in 294 precariously housed community residents with substance use disorders. Results revealed a predominant focus on gains and a lack of sensitivity to losses in these vulnerable community residents. Hypothesized associations were not detected between component processes and self-reported health-risk behaviors. These findings provide insight into the processes underlying decision making in a vulnerable substance-using population and highlight the challenge of linking specific decision making processes to “real-world” behaviors.

Early stages of the acute physical stress response increase loss aversion and learning on decision making: A Bayesian approach

When the cortisol peak is reached after a stressor people learn slower and make worse decisions in the Iowa Gambling Task (IGT). However, the effects of the early stress response have not received as much attention. Since physical exercise is an important neuroendocrine stressor, this study aimed to fill this gap using an acute physical stressor. We hypothesized that this stress stage would promote an alertness that may increase feedback-sensitivity and, therefore, reward-learning during IGT, leading to a greater overall decision-making. 90 participants were divided into two groups: 47 were exposed to an acute intense physical stressor (cycloergometer) and 43 to a distractor 5 min before IGT. The Prospect Valence-Learning (PVL) computational model was applied to the IGT to investigate decision-making components (feedback-sensitivity, loss aversion, learning and choice consistency). There were no differences in the overall IGT performance, but physically stressed participants showed greater loss aversion and higher learning than controls. In addition, this loss aversion was linearly related to the learning and the choice consistency. These results would support the potentially beneficial role that early stages of stress could play in decision-making and suggest the need of studying the components that underlie this cognitive skill, rather than addressing it as a single dimension.

Effects of cocaine and HIV on decision-making abilities.

Our study aimed to understand the impact of cocaine dependence on high-risk decision-making abilities in individuals with the human immunodeficiency virus (HIV) and individuals with cocaine dependence. We recruited 99 participants (27 HIV/Cocaine, 20 HIV Only, 26 Cocaine Only, and 26 Healthy Controls). The Iowa Gambling Task (IGT) was applied to assess decision-making abilities. Independent and interactive effects of HIV status and cocaine dependence were examined using 2×2 factorial ANCOVA with premorbid IQ (WRAT-4: WR) as the covariate. We found cocaine dependence had a significant adverse effect on overall IGT performance (p=0.015). We also found individuals who were HIV-positive tended to have less total money at the end of the game than individuals who were HIV-negative (p=0.032), suggesting individuals living with HIV had less focus on long-term gains and more focus on short-term gains. Our findings highlight the significant impact of cocaine dependence on decision-making abilities and the difficulty individuals with HIV have in adequately weighing the cost and benefits of their decisions and making appropriate changes for the future.

Intermittent Theta Burst Stimulation (iTBS) as an Optimal Treatment for Schizophrenia Risk Decision: an ERSP Study.

Objective: People with schizophrenia have serious impairments in social function, especially in decision-making ability. Transcranial magnetic stimulation modified intermittent theta burst transcranial magnetic stimulation (iTBS) has been shown to regulate the functional connection of brain networks. Our study explored the therapeutic effect of iTBS on decision-making disorders in schizophrenia.Methods: Participants were pseudorandomized and assigned to iTBS (n = 16) or sham (n = 16) group. iTBS group was administered 1,800 pulses on the target of the left dorsol lateral prefrontal cortex (L-DLPFC) per day for 14 consecutive days. We compared Iowa gambling task performance and associated event-related spectral perturbation results (ERSP) among two groups.Results: The results show that participants' performance in the high-lose in the iTBS group had stronger stimulation of theta spectral power than those in the sham group. Specifically, we found that under high-risk conditions, compared with the control group, the iTBS group showed significant activation of the theta spectrum power in the FPZ, FZ, FCZ, and CZ regions after treatment.Conclusions: Our results provide evidence that long-term iTBS stimulation effectively improves the decision-making ability of schizophrenia. After receiving negative feedback, patients can turn to safety options. These findings support that iTBS may be a potential treatment for clinical decision-making disorders.

Heart Rate Variability and Decision-Making: Autonomic Responses in Making Decisions

Decision-making is one of the most crucial cognitive processes in daily life. An adaptable, rapid, and flexible decision requires integration between brain and body. Heart rate variability (HRV) indexes this brain–body connection and appears to be related to cognitive performance. However, its relationship with decision-making is poorly analyzed. This study investigates the relationship between HRV and the decision-making process, assessed through the Iowa Gambling Task (IGT). One hundred and thirty healthy university students (mean age = 23.35 ± 2.50) participated in the study. According to IGT performance, they were divided into high decision-makers (n = 79) and low decision-makers (n = 51). Heart rate variability was measured in the resting, reactivity (i.e., during IGT), and recovery phases. Higher vagally mediated HRV (vmHRV; indexed in frequency domain measures) was evidenced in good decision-makers in the resting, reactivity, and recovery phases. During the task, a higher vagal modulation after a first evaluation was highlighted in good decision-makers. In conclusion, HRV proves to be a valid index of inhibitory circuit functioning in the prefrontal cortex. The relationship with cognitive functions was also confirmed, considering the ability to inhibit disadvantageous responses and make better decisions.

Linking ADHD and Behavioral Assessment Through Identification of Shared Diagnostic Task-Based Functional Connections.

A mixed literature implicates atypical connectivity involving attentional, reward and task inhibition networks in ADHD. The neural mechanisms underlying the utility of behavioral tasks in ADHD diagnosis are likewise underexplored. We hypothesized that a machine-learning classifier may use task-based functional connectivity to compute a joint probability function that identifies connectivity signatures that accurately predict ADHD diagnosis and performance on a clinically-relevant behavioral task, providing an explicit neural mechanism linking behavioral phenotype to diagnosis. We analyzed archival MRI and behavioral data of 80 participants (64 male) who had completed the go/no-go task from the longitudinal follow-up of the Multimodal Treatment Study of ADHD (MTA 168) (mean age = 24 years). Cross-mutual information within a functionally-defined mask measured functional connectivity for each task run. Multilayer feedforward classifier models identified the subset of functional connections that predicted clinical diagnosis (ADHD vs. Control) and split-half performance on the Iowa Gambling Task (IGT). A sample of random models trained on functional connectivity profiles predicted validation set clinical diagnosis and IGT performance with 0.91 accuracy and d′ > 2.9, indicating very high sensitivity and specificity. We identified the most diagnostic functional connections between visual and ventral attentional networks and the anterior default mode network. Our results show that task-based functional connectivity is a biomarker of ADHD. Our analytic framework provides a template approach that explicitly ties behavioral assessment measures to both clinical diagnosis, and functional connectivity. This may differentiate otherwise similar diagnoses, and promote more efficacious intervention strategies.

The Roles of Fluid Intelligence and Emotional Intelligence in Affective Decision-Making During the Transition to Early Adolescence.

The current study mainly explored the influence of fluid intelligence (IQ) and emotional intelligence (EI) on affective decision-making from a developmental perspective, specifically, during the transition from childhood into early adolescence. Meanwhile, their age-related differences in affective decision-making were explored. A total of 198 participants aged 8–12 completed the Iowa Gambling Task (IGT), the Cattell’s Culture Fair Intelligence Test and the Trait Emotional Intelligence Questionnaire-Child Form. Based on the net scores of IGT, the development of affective decision-making ability did not increase monotonically with age, and there was a developmental trend of an impaired IGT performance in early adolescence (aged 11–12), especially in the early learning phase (first 40 trials) of the IGT. More importantly, IQ and EI played different roles for children and early adolescents: IQ and EI jointly predicted the IGT performance for 8–10 years old children, whereas only EI contributed to the IGT performance of 11–12 years old early adolescents. The present study extends the evidence how cognitive processing and emotional processing interact in affective decision-making from the developmental perspective. Furthermore, it provides insights of future research and intervention with early adolescents’ poor affective decision-making.

Risky decision-making in suicide attempters, and the choice of a violent suicidal means: an updated meta-analysis

BackgroundStudies showed disadvantageous decision-making in suicide attempters. The present meta-analysis aims to examine the stability of these findings and related questions. MethodsEMBASE and Pubmed databases were searched for studies published between 01/01/2000 and 01/01/2020 with an additional search through bibliographical references. English or French articles published in peer-reviewed journals, reporting quantitative task-based measures of decision-making in suicide attempters were included: 3,582 records were identified, 33 full-text articles screened, and 21 articles finally included. ResultsAll studies were conducted in mood disorders; 18 used the Iowa Gambling Task (IGT) and 3 the Cambridge Gamble Task (CGT). With the IGT, suicide attempters showed riskier choices than patient controls (Hedges’ g=-0.28 95%CI (-0.44 – -0.12)) and healthy controls (g=-0.54 (-0.83 – -0.25)) with no significant difference between control groups. The difference between suicide attempters and patient controls was not related to age group, mood disorder type, author, or research center while an effect of time of publication was found (p=0.006). Poorer performance was also found in suicide attempters compared to patient controls when using the CGT (g=-0.57 95%CI (-0.82 – -0.31)). Suicide attempters who used a violent means showed poorer IGT performance than those who used a non-violent means (3 studies). LimitationLimited number of studies outside mood disorders. No data to calculate a gender effect. ConclusionThe present meta-analysis confirmed riskier decision-making in suicide attempters. Although group differences appear to be of modest effect size in general, they were particularly marked in the subgroup of those who used a violent suicidal means.

Autonomic responses to choice outcomes: Links to task performance and reinforcement-learning parameters

Previous work has shown that autonomic responses to choice feedback can predict subsequent decision-making. In this study, we tested whether skin conductance responses (SCRs) and heart rate (HR) decelerations following the presentation of choice outcomes predict Iowa Gambling Task performance in nonclinical participants (n = 64). We also examined how these signals related to parameters of a reinforcement-learning (RL) model. Feedback SCRs and HR decelerations were greater following outcomes that included losses and choices from the bad decks defined by their negative expected value. In addition, SCRs predicted task performance. A hierarchical Bayesian RL model indicated that greater feedback SCR for the bad decks compared to good decks was associated with stronger loss aversion and a lower learning rate, both of which predicted higher performance. These results suggest that feedback-related SCRs are linked to individual differences in outcome evaluation and learning processes that guide reinforcement-learning.

Decision-Making, Impulsiveness and Temperamental Traits in Eating Disorders.

ObjectiveTo explore decision-making, impulsiveness and temperamental traits in patients suffering from eating disorders (EDs), as compared with healthy controls (HC).MethodFifty-one patients affected by ED (fourteen with anorexia restricting subtype, AN-R; fourteen with bulimia, BN; thirteen with anorexia bingeing/purging subtype, AN-BP; ten with binge-eating disorder, BED) and twenty-eight HC. The patients, recruited at the Section of Psychiatry of the University of Pisa (Italy, were evaluated with a battery of neuropsychological questionnaires, including the IOWA Gambling Task (IGT), the Barratt Impulsiveness Scale (BIS-11), the Temperament and Character Inventory (TCI), the Frontal Assessment Battery (FAB) and the Hamilton Depression Rating Scale (HAM-D).ResultsThe results indicated that AN-R, AN-BP and BN patients showed poorer IGT performances than HC (p < .05), while BED performances were similar to those of HC. IGT scores suggested the existence of similarities in decision-making performances of AN-BP and BN patients, as they performed differently from HC starting from block 3 (F(16.2)=1.7). In addition, differences between AN-BP/BN and AN-R patients were detected, given that they performed differently starting from block 4. As far as BIS-11 is concerned, AN-BP and BN patients reached the highest BIS total scores, when compared with the other groups. Further, they shared similar temperamental and impulsiveness profiles, as demonstrated by their BIS-11 ‘motor impulsiveness’ scores, and by their TCI ‘novelty seeking’, ‘reward dependence’ and ‘persistence’ dimensions. The post-hoc analyses revealed that both AN groups (namely, AN-R and AN-BP) scored significantly lower than HC on the FAB. No patients fulfilled the criteria for the diagnosis of a current major depression.ConclusionsDecision-making deficits are common in EDs. In AN-R these seem related to cognitive styles, while in AN-BP and BN patients with temperament features and impulsiveness traits.

Kaygı, Belirsizliğe Tahammülsüzlük ve Karar Verme Arasındaki İlişkilerin İncelenmesi

The aim of this research is to investigate the relationships among trait anxiety, intolerance of uncertainty, and decision-making behavior. In this research, a descriptive research design was used. The research was conducted with the participation of volunteer university students who were enrolled in the undergraduate programs at Ege University Faculty of Education. Convenient sampling method was used and the data obtained from 105 participants (43 male and 62 female) were analyzed. Data collection instruments in the research were a Demographic Information Form, Trait Anxiety Inventory, Intolerance of Uncertainty Scale (long form), and Iowa Gambling Task. Correlational analysis was used to analyze the research data. As a result of the analysis, there was no statistically significant relationship between university students’ trait anxiety level and Iowa Gambling Task performance. Also, there was no statistically significant relationship between the students’ intolerance of uncertainty level and Iowa Gambling Task performance. However, it was concluded that there was a significant positive correlation between trait anxiety level and intolerance of uncertainty level of the students. The research findings were discussed in the light of the literature and some recommendations were made for future studies.

Functional Cerebral Specialization and Decision Making in the Iowa Gambling Task: A Single-Case Study of Left-Hemispheric Atrophy and Hemispherotomy.

The Iowa Gambling Task (IGT) is a decision-making task that preferentially involves the right prefrontal cortex (PFC). However, the performance of the task is driven by two attributes: intertemporal (long vs. short-term) and frequency-based processing of rewards-punishments, and differs over the two phases of uncertainty (early trials) and risk (later trials). Although intertemporal decision making involves the right PFC, the extent of hemispheric specialization in attribute and phase-specific decision making is unknown. Therefore, the current study assessed decision making in a patient with a uni-hemispheric disease, who underwent hemispherotomy surgery, comparing pre-surgical IGT performance (3 days prior to surgery) with post-surgical performance (1 month, and 12 months post-surgery). The patient’s pre- and post-surgical IGT performances were analyzed to examine changes in attribute and phase-specific decision making, including the widely reported deck B phenomenon. The results for the two attributes of deck selection at the pre- and post-surgical assessments suggested marked changes in the two IGT phases of risk and uncertainty. Pre-surgery, the patient made more intertemporally disadvantageous choices, and task-progression contributed to it; within 1 month of surgery, intertemporal disadvantageous deck choices were contingent on task progression, after 1 year, disadvantageous choices were independent of task progression. Intertemporal attribute alteration was unresponsive to uncertainty and risk phase. The effect of task progression on frequency attribute remained unchanged before and immediately after the surgery, and preference for infrequent decks was observed only after 1 year. Further, pre and post surgery alteration in frequency attribute was phase-specific: within 1 month of surgery, infrequent deck choices decreased in uncertainty and increased in risk, whereas the reverse was observed after 12 months. Deck B choice increase was in the uncertainty phase. Results are discussed in reference to valence-linked hemispheric specialization and its potential role in attribute and phase-specific IGT decision making.

Applied strategy in the Iowa Gambling Task: Comparison of individuals with Parkinson’s disease to healthy controls

ABSTRACT Introduction Decision-making impairments in Parkinson’s disease (PD) have frequently been measured using the Iowa Gambling Task (IGT), though results have been inconsistent. At present, task performance has primarily been evaluated based on the total IGT score, and there is a need for further analysis of the strategy of older individuals with PD and healthy control (HC) participants in IGT. Objective The present study aims to explore possible impairments in IGT performance in individuals with PD compared to healthy controls using strategy analysis, extending previous results on this subject, and to discuss potential effects of medication on task performance. Methods 67 individuals with PD and 29 HC participants completed the IGT. Results were analyzed to evaluate impairments, applied strategies, presence of subgroups, and potential effects of medication on performance. Results Both groups obtained a low overall IGT score and individuals with PD had significantly lower total IGT scores compared to HC participants. Regression analysis showed a small, but significant relationship between levodopa and dopamine agonist dosage and total IGT score, indicating that medication level could be a marker of level of executive functions. Subgroups of advantageous and disadvantageous choosers differed significantly in deck preferences for both groups. Conclusion Individuals with PD were significantly impaired in IGT performance, both in overall scores and in detailed analyses, and they utilized an inefficient strategy during task performance. However, HC participants also presented with a suboptimal strategy and results suggest the presence of subgroups in both individuals with PD and HC participants, which may reflect age-related changes. These results are in line with previous research on performance of older individuals and alternative deck preferences in the IGT and underline the importance of considering the applied strategy in the evaluation of IGT performance.

Ventral tegmental area dysfunction affects decision-making in patients with myotonic dystrophy type-1

The clinical manifestations of Myotonic Dystrophy type-1 (DM1) are associated with a complex mixture of multisystem features including cognitive dysfunctions that strongly impact on patients' social and occupational functioning. Decision making, a function controlled by dopaminergic circuitry, is critical for succeeding in one's social and professional life. We tested here the hypothesis that altered connectivity of the ventral tegmental area (VTA), one of the major sources of diffuse dopaminergic projections in the brain, might account for some higher-level dysfunctions observed in patients with DM1. In this case–control study, we recruited 31 patients with DM1 and 26 healthy controls who underwent the IOWA Gambling task and resting-state functional MRI (RS-fMRI) at 3T. Functional connectivity of the VTA was assessed using RS-fMRI. VTA connectivity was compared between 25 DM1 patients and all the controls, and the presence of associations between VTA connectivity and IOWA Gambling task performance was also investigated. DM1 patients performed significantly worse than controls at the IOWA Gambling task. A significant increase of functional connectivity was observed between VTA and the left supramarginal and superior temporal gyri in DM1 patients. Patients' IOWA Gambling task net-scores were strictly associated with VTA-driven functional connectivity in the bilateral supplementary motor area and right precentral gyrus. This study demonstrates a prominent deficit of decision-making in patients with DM1. It might be related to increased connectivity between VTA and brain areas critically involved in the reward/punishment system and social cognition. These findings indicate that dopaminergic function is a potential target for pharmacological and non-pharmacological interventions in DM1.

Decision-Making Under Ambiguity or Risk in Individuals With Alzheimer's Disease and Mild Cognitive Impairment.

BackgroundMaking advantageous decisions is essential in everyday life. Our objective was to assess how patients with mild cognitive impairment (MCI) and Alzheimer’s disease (AD) make decisions under conditions of ambiguity or risk. In addition, the study also aimed to examine the relationship between decision-making competence and memory and executive function.MethodsPatients with MCI (n = 36) and AD (n = 29) and healthy elderly controls (HC, n = 34) were recruited from the memory clinic. All subjects were administered a comprehensive neuropsychological battery test. We used the Iowa Gambling Task (IGT) to measure decision-making under ambiguity and the Game of Dice Task (GDT) to measure decision-making under risk. Pearson’s correlation was used to examine the relationship between the performance of IGT and GDT with delayed recall and the Stroop test.ResultsIn the GDT, MCI and AD patients presented similar performance but showed different patterns when compared with the HC group. The proportion of those making advantageous choices was lower in the AD group than in the HC group (p = 0.01), while the MCI and HC groups did not differ (p = 0.14). Meanwhile, concerning the ratio of accepting negative feedback, the AD (p < 0.01) group was significantly different from the HC patients, but the MCI (p = 0.06) and HC groups did not differ. In the IGT, MCI and AD patients selected randomly from advantageous and disadvantageous decks (p = 0.94 and p = 0.54), showing no significant change in performance over time. In contrast, the HC group made increasingly frequent advantageous selections over time (p = 0.04). Furthermore, the proportion of advantageous decision-makers for the GDT had a linear relationship with delayed recall of the Hopkins Verbal Learning Test and Stroop color words (p < 0.01 and p < 0.01, respectively).ConclusionOur findings suggest that decision-making ability under ambiguity is compromised in MCI and AD, and the decision-making under risk is only impaired in AD. Reduced decision-making performance under risk is closely correlated with lower executive functions and memory.

Decision-Making by Patients With Methamphetamine Use Disorder Receiving Contingency Management Treatment: Magnitude and Frequency Effects.

BackgroundIndividuals with substance use disorders exhibit maladaptive decision-making on the Iowa Gambling Task (IGT), which involves selecting from card decks differing in the magnitudes of rewards, and the frequency and magnitude of losses. We investigated whether baseline IGT performance could predict responses to contingency management (CM) by treatment-seeking individuals with methamphetamine use disorder (MA Use Disorder) in Cape Town, South Africa.MethodsTwenty-nine individuals with MA Use Disorder underwent an 8-week, escalating reinforcement, voucher-based CM treatment in a study on the suitability of CM therapy for the South African context. Along with 20 healthy control participants, they performed a computerized version of the IGT before starting CM treatment. Seventeen participants maintained abstinence from methamphetamine throughout the trial (full responders), and 12 had an incomplete response (partial responders). Performance on the IGT was scored for magnitude effect (selection of large immediate rewards with high long-term loss) and for frequency effect (preference for frequent rewards and avoidance of frequent losses). Group differences were investigated using linear mixed-effect modeling.ResultsPartial responders made more selections from decks providing large, immediate rewards and long-term losses than healthy controls [p = 0.038, g = -0.77 (-1.09: -0.44)]. Full responders showed a greater, nonsignificant preference for frequent rewards and aversion to frequent losses than partial responders [p = 0.054, g = -0.63 (-0.95: -0.29)].ConclusionsA predilection for choices based on the size and immediacy of reward may reflect a cognitive strategy that works against CM. Pretesting with a decision-making task, such as the IGT, may help in matching cognitive therapies to clients with MA Use Disorder.

Transcranial direct current stimulation improves risky decision making in women but not in men: A sham-controlled study

Behavioral and anatomical sex-related differences have been traditionally found in decision-making processes assessed by Iowa Gambling Task (IGT). So far, the administration of transcranial direct current stimulation (tDCS) over orbitofrontal regions has shown an enhancing effect over decision-making. However, it is unknown whether there is a sex-dependent effect of stimulation in decision-making, a key question considering previous differences between men and women in IGT and the influence of individual differences in tDCS. The present study examines, at first time, the interaction between sex and tDCS in decision-making. For that aim, in a first experimental phase, ninety-two healthy participants performed the IGT. In a second phase, sixty-one participants received 20 min of anodal or sham tDCS over the right orbitofrontal cortex (rOFC) in a single-session pre-post sham-controlled study. To support the focality of the montage, a Stop Signal Task (SST) was used as a control task and also a numerical simulation of current flow distribution was performed. According to literature, in the first phase, results showed that men outperformed women in the IGT. In the second phase, the stimulation varied the IGT performance according to a sex specific manner: anodal tDCS increased the IGT performance in women, while in men; the stimulation did not produce any effect. Results were mediated by sex-specific morphological differences. These results highlight the necessity to consider the interaction of sex with the effect of the stimulation in future tDCS protocols, specifically in future clinical studies.