Distorted expectancy coding in problem gambling: is the addictive in the anticipation?

Decomposition of Reinforcement Learning Deficits in Disordered Gambling via Drift Diffusion Modeling and Functional Magnetic Resonance Imaging

Gambling disorder is associated with deficits in reward-based learning, but the underlying computational mechanisms are still poorly understood. Here, we examined this issue using a stationary reinforcement learning task in combination with computational modeling and functional resonance imaging (fMRI) in individuals that regular participate in gambling (n = 23, seven fulfilled one to three DSM 5 criteria for gambling disorder, sixteen fulfilled four or more) and matched controls (n = 23). As predicted, the gambling group exhibited substantially reduced accuracy, whereas overall response times (RTs) were not reliably different between groups. We then used comprehensive modeling using reinforcement learning drift diffusion models (RLDDMs) in combination with hierarchical Bayesian parameter estimation to shed light on the computational underpinnings of this performance deficit. In both groups, an RLDDM in which both non-decision time and decision threshold (boundary separation) changed over the course of the experiment accounted for the data best. The model showed good parameter and model recovery, and posterior predictive checks revealed that, in both groups, the model accurately reproduced the evolution of accuracies and RTs over time. Modeling revealed that, compared to controls, the learning impairment in the gambling group was linked to a more rapid reduction in decision thresholds over time, and a reduced impact of value-differences on the drift rate. The gambling group also showed shorter non-decision times. FMRI analyses replicated effects of prediction error coding in the ventral striatum and value coding in the ventro-medial prefrontal cortex, but there was no credible evidence for group differences in these effects. Taken together, our findings show that reinforcement learning impairments in disordered gambling are linked to both maladaptive decision threshold adjustments and a reduced consideration of option values in the choice process.

Digital Being: social media and the predictive mind

Social media is implicated today in an array of mental health concerns. While concerns around social media have become mainstream, little is known about the specific cognitive mechanisms underlying the correlations seen in these studies or why we find it so hard to stop engaging with these platforms when things obviously begin to deteriorate for us. New advances in computational neuroscience, however, are now poised to shed light on this matter. In this paper, we approach the phenomenon of social media addiction through the lens of the active inference framework. According to this framework, predictive agents like us use a 'generative model' of the world to predict our own incoming sense data and act to minimize any discrepancy between the prediction and incoming signal (prediction error). In order to live well and be able to act effectively to minimize prediction error, it is vital that agents like us have a generative model, which not only accurately reflects the regularities of our complex environment but is also flexible and dynamic and able to stay accurate in volatile and turbulent circumstances. In this paper, we propose that some social media platforms are a spectacularly effective way of warping an agent's generative model and of arresting the model's ability to flexibly track and adapt to changes in the environment. We go on to investigate cases of digital tech, which do not have these adverse effects and suggest-based on the active inference framework-some ways to understand why some forms of digital technology pose these risks, while others do not.

Internet/Video Gaming: The Relevance of a New Phenomenon in the Youth

The high level of technological growth in contemporary society, beside benefits, provokes different kinds of damages, especially among the worldwide youth population. World statistics have recognized that video and internet game addiction is a growing problem. In this context, it is supposed that 0.3 to 1.0 percent of the general population might be qualified as a potential sufferer of internet gaming disorder. However, youth between 18-34 years are the highest risk population. New research has shown the need of early identification of at-risk young people for internet addiction. Adverse experience in children of different forms of stress, negative life circumstances and especially negative, hostile parenting can lead to depression, social and cultural problems, together with significant boredom and loneliness levels. These are all confirmed to be related with addictive behaviour. Some neural correlates are discussed as the possible background of game addiction. Finally, therapeutic possibilities are presented.

Gambling and virtual reality: unraveling the illusion of near-misses effect

Introduction

Studying gambling behavior is a crucial element in reducing the impact of problem gambling. Nevertheless, most current research is carried out in controlled laboratory settings rather than real-life situations, which raises concerns about how applicable the findings are in the broader context. Virtual reality (VR) has proven to be a valuable tool and has been utilized in various experimental scenarios. A limited number of studies have employed VR to investigate gambling behaviors, and few have explored them in an older adolescent context.

Methods

This study examined the behavioral and physiological effects of gambling behavior, including problem gambling, gaming addiction, and risk-taking decision-making in a sample of 36 high-school students aged between 18 to 20 years using an ad-hoc constructed VR scenario designed to simulate a slot-machine platform.

Results

The behavioral results highlighted that participants reporting more problem gambling were sensitive to near-misses: i.e., they bet more after near-misses than after losses. This result may reflect the false belief that gamblers, after near-misses, are closer to winning. Physiological data showed that participants exhibited heart rate deceleration during the anticipation of the outcome, which has been suggested to represent a marker of feedback anticipation processing and hyposensitivity to losses.

Discussion

Overall, this study provides evidence for a new VR tool to assess gambling behaviors and new insights into gambling-related behavioral and physiological factors. Implications for the treatment of problem gambling are discussed.

Surfing uncertainty with screams: predictive processing, error dynamics and horror films

Despite tremendous efforts in psychology, neuroscience and media and cultural studies, it is still something of a mystery why humans are attracted to fictional content that is horrifying, disgusting or otherwise aversive. While the psychological benefits of horror films, stories, video games, etc. has recently been demonstrated empirically, current theories emphasizing the negative and positive consequences of this engagement often contradict one another. Here, we suggest the predictive processing framework may provide a unifying account of horror content engagement that provides clear and testable hypotheses, and explains why a 'sweet spot' of fear and fun exists in horror entertainment. This article is part of the theme issue 'Art, aesthetics and predictive processing: theoretical and empirical perspectives'.

Computational modelling of reinforcement learning and functional neuroimaging of probabilistic reversal for dissociating compulsive behaviours in gambling and cocaine use disorders

BACKGROUND

Individuals with cocaine use disorder or gambling disorder demonstrate impairments in cognitive flexibility: the ability to adapt to changes in the environment. Flexibility is commonly assessed in a laboratory setting using probabilistic reversal learning, which involves reinforcement learning, the process by which feedback from the environment is used to adjust behavior.

AIMS

It is poorly understood whether impairments in flexibility differ between individuals with cocaine use and gambling disorders, and how this is instantiated by the brain. We applied computational modelling methods to gain a deeper mechanistic explanation of the latent processes underlying cognitive flexibility across two disorders of compulsivity.

METHOD

We present a re-analysis of probabilistic reversal data from individuals with either gambling disorder (n = 18) or cocaine use disorder (n = 20) and control participants (n = 18), using a hierarchical Bayesian approach. Furthermore, we relate behavioural findings to their underlying neural substrates through an analysis of task-based functional magnetic resonanceimaging (fMRI) data.

RESULTS

We observed lower 'stimulus stickiness' in gambling disorder, and report differences in tracking expected values in individuals with gambling disorder compared to controls, with greater activity during reward expected value tracking in the cingulate gyrus and amygdala. In cocaine use disorder, we observed lower responses to positive punishment prediction errors and greater activity following negative punishment prediction errors in the superior frontal gyrus compared to controls.

CONCLUSIONS

Using a computational approach, we show that individuals with gambling disorder and cocaine use disorder differed in their perseverative tendencies and in how they tracked value neurally, which has implications for psychiatric classification.

Dynamic expectations: Behavioral and electrophysiological evidence of sub-second updates in reward predictions

Expectations are often dynamic: sports fans know that expectations are rapidly updated as games unfold. Yet expectations have traditionally been studied as static. Here we present behavioral and electrophysiological evidence of sub-second changes in expectations using slot machines as a case study. In Study 1, we demonstrate that EEG signal before the slot machine stops varies based on proximity to winning. Study 2 introduces a behavioral paradigm to measure dynamic expectations via betting, and shows that expectation trajectories vary as a function of winning proximity. Notably, these expectation trajectories parallel Study 1's EEG activity. Studies 3 (EEG) and 4 (behavioral) replicate these findings in the loss domain. These four studies provide compelling evidence that dynamic sub-second updates in expectations can be behaviorally and electrophysiologically measured. Our research opens promising avenues for understanding the dynamic nature of reward expectations and their impact on cognitive processes.

Neural fingerprints of gambling disorder using diffusion tensor imaging

Gambling disorder (GD) is a behavioral addiction associated with personal, social and occupational consequences. Thus, examining GD's clinical relationship with its neural substrates is critical. We compared neural fingerprints using diffusion tensor imaging (DTI) in GD subjects undergoing treatment relative to healthy volunteers (HV). Fifty-three (25 GD, 28 age-matched HV) males were scanned with structural magnetic resonance imaging (MRI) and DTI. We applied probabilistic tractography based on DTI scanning data, preprocessed and analyzed using permutation testing of individual connectivity weights between regions for group comparison. Permutation-based comparisons between group-averaged connectomes highlighted significant structural differences. The GD group demonstrated increased connectivity, and striatal network reorganisation, contrasted by reduced connectivity within and to frontal lobe nodes. Modularity analysis revealed that the GD group had fewer hubs integrating information across the brain. We highlight GD neural changes involved in controlling risk-seeking behaviors. The observed striatal restructuring converges with previous research, and the increased connectivity affects subnetworks highly active in gambling situations, although these findings are not significant when correcting for multiple comparisons. Modularity analysis underlines that, despite connectivity increases, the GD connectome loses hubs, impeding its neuronal network coherence. Together, these results demonstrate the feasibility of using whole-brain computational modeling in assessing GD.

Dynamic expectations: Behavioral and electrophysiological evidence of sub-second updates in reward predictions

Expectations are often dynamic: any sports fan knows that expectations are rapidly updated as games unfold. Yet expectations have traditionally been studied as static. Here, using slot machines as a case study, we provide parallel behavioral and electrophysiological evidence of sub-second moment-to-moment changes in expectations. In Study 1, we show that the dynamics of the EEG signal before the slot machine stopped differed depending on the nature of the outcome, including not only whether the participant won or lost, but also how close they came to winning. In line with our predictions, Near Win Before outcomes (the slot machine stops one item before a match) were similar to Wins, but different than Near Win After (the machine stops one item after a match) and Full Miss (the machine stops two or three items from a match). In Study 2, we designed a novel behavioral paradigm to measure moment-to-moment changes in expectations via dynamic betting. We found that different outcomes also elicited unique expectation trajectories in the deceleration phase. Notably, these behavioral expectation trajectories paralleled Study 1's EEG activity in the last second prior to the machine's stop. In Studies 3 (EEG) and 4 (behavior) we replicated these findings in the loss domain where a match entails a loss. Again, we found a significant correlation between behavioral and EEG results. These four studies provide the first evidence that dynamic sub-second updates in expectations can be behaviorally and electrophysiologically measured. Our findings open up new avenues for studying the ongoing dynamics of reward expectations and their role in healthy and unhealthy cognition.

Altered hierarchical organization between empathy and gambling networks in disordered gamblers

BACKGROUND

Despite the demonstrated association between empathy and gambling at the behavioral level, limited neuroimaging research on empathy and gambling disorder (GD) has been conducted. Whether and how the brain network of empathy and that of gambling interact in disordered gamblers has not been investigated. This study aimed to address this research gap by examining the hierarchical organizational patterns, in which the differences of causal interactions of these networks between disordered gamblers and healthy controls were revealed.

METHODS

Resting-state functional magnetic resonance imaging (fMRI) data of 32 disordered gamblers and 56 healthy controls were included in the formal analysis. Dynamic causal modeling was used to examine the effective connectivity within and between empathy and gambling networks among all participants.

RESULTS

All participants showed significant effective connectivity within and between empathy and gambling networks. However, compared with healthy controls, disordered gamblers displayed more excitatory effective connectivity within the gambling network, the tendency to display more excitatory effective connectivity from the empathy network to the gambling network, and reduced inhibitory effective connectivity from the gambling network to the empathy network.

CONCLUSION

The exploratory study was the first to examine the effective connectivity within and between empathy and gambling networks among disordered gamblers and healthy controls. These results provided insights into the causal relationship between empathy and gambling from the neuroscientific perspective and further confirmed that disordered gamblers show altered effective connectivity within and between these two brain networks, which may be considered to be a potential neural index for GD identification. In addition, the altered interactions between empathy and gambling networks may also indicate the potential targets for the neuro-stimulation intervention approach (e.g., transcranial magnetic stimulation).

Metacognition and the effect of incentive motivation in two compulsive disorders: Gambling disorder and obsessive-compulsive disorder

AIMS

Compulsivity is a common phenotype among psychiatric disorders, such as obsessive-compulsive disorder (OCD) and gambling disorder (GD). Deficiencies in metacognition, such as the inability to estimate one's performance via confidence judgments could contribute to pathological decision-making. Earlier research has shown that patients with OCD exhibit underconfidence, while patients with GD exhibit overconfidence. Moreover, it is known that motivational states (e.g. monetary incentives) influence metacognition, with gain (respectively loss) prospects increasing (respectively decreasing) confidence. Here, we reasoned that OCD and GD symptoms might correspond to an exacerbation of this interaction between metacognition and motivation.

METHODS

We hypothesized GD's overconfidence to be exaggerated during gain prospects, while OCD's underconfidence to be worsened in loss context, which we expected to see represented in ventromedial prefrontal cortex (VMPFC) blood-oxygen-level-dependent activity. We tested those hypotheses in a task-based functional magnetic resonance imaging (fMRI) design (27 patients with GD, 28 patients with OCD, 55 controls). The trial is registered in the Dutch Trial Register (NL6171).

RESULTS

We showed increased confidence for patients with GD versus patients with OCD, which could partly be explained by sex and IQ. Although our primary analyses did not support the hypothesized interaction between incentives and groups, exploratory analyses did show increased confidence in patients with GD specifically in gain context. fMRI analyses confirmed a central role for VMPFC in the processing of confidence and incentives, but no differences between the groups.

CONCLUSION

Patients with OCD and those with GD reside at opposite ends of the confidence spectrum, while no interaction with incentives was found, nor group differences in neuronal processing of confidence.

Life Habits and Mental Health: Behavioural Addiction, Health Benefits of Daily Habits, and the Reward System

In this review, the underlying mechanisms of health benefits and the risk of habitual behaviours such as internet use and media multitasking were explored, considering their associations with the reward/motivation system. The review highlights that several routines that are beneficial when undertaken normally may evolve into excessive behaviour and have a negative impact, as represented by "the inverted U-curve model". This is especially critical in the current era, where technology like the internet has become mainstream despite the enormous addictive risk. The understanding of underlying mechanisms of behavioural addiction and optimal level of habitual behaviours for mental health benefits are deepened by shedding light on some findings of neuroimaging studies to have hints to facilitate better management and prevention strategies of addictive problems. With the evolution of the world, and the inevitable use of some technologies that carry the risk of addiction, more effective strategies for preventing and managing addiction are in more demand than before, and the insights of this study are also valuable foundations for future research.

The relationship between maternal smartphone use, physiological responses, and gaze patterns during breastfeeding and face-to-face interactions with infant

Smartphone use during parent-child interactions is highly prevalent, however, there is a lack of scientific knowledge on how smartphone use during breastfeeding or face-to-face interactions may modulate mothers’ attentive responsiveness towards the infant as well as maternal physiological arousal. In the present study, we provide the first evidence for the influence of the smartphone on maternal physiological responses and her attention towards the infant during breastfeeding and face-to-face interactions. Twenty breastfeeding mothers and their infants participated in this lab study during which electrodermal activity, cardiograph impedance, and gaze patterns were monitored in breastfeeding and face-to-face interactions with three conditions manipulating the level of maternal smartphone involvement. We report that mothers’ gaze toward their infants decreased when breastfeeding while using the smartphone compared to face-to-face interaction. Further, we show that greater maternal electrodermal activity and cardiac output were related to longer maternal gaze fixation toward the smartphone during breastfeeding. Finally, results indicate that mothers’ smartphone addiction levels were negatively correlated with electrodermal activity during breastfeeding. This study provides an initial basis for much required further research that will explore the influence of smartphone use on maternal biobehavioral responses in this digital age and the consequences for infant cognitive, emotional, and social development.

Aberrant orbitofrontal cortex reactivity to erotic cues in Compulsive Sexual Behavior Disorder

BACKGROUND AND AIMS

Compulsive Sexual Behavior Disorder (CSBD) is characterized by increased reactivity to erotic reward cues. Cue-encoded reward parameters, such as type (e.g. erotic or monetary) or probability of anticipated reward, shape reward-related motivational processes, increase the attractiveness of cues and therefore might enhance maladaptive behavioral patterns in CSBD. Studies on the neural patterns of cue processing in individuals with CSBD have been limited mainly to ventral striatal responses. Therefore, here we aimed to examine the cue reactivity of multiple key structures in the brain's reward system, taking into account not only the type of predicted reward but also its probability.

METHODS

Twenty Nine men seeking professional help due to CSBD and 24 healthy volunteers took part in an fMRI study with a modified Incentive Delay Task with erotic and monetary rewards preceded by cues indicating a 25%, 50%, or 75% chance of reward. Analyses of functional patterns of activity related to cue type and probability were conducted on the whole-brain and ROI levels.

RESULTS

Increased anticipatory response to cues predictive of erotic rewards was observed among CSBD participants when compared to controls, in the ventral striatum and anterior orbitofrontal cortex (aOFC). The activity in aOFC was modulated by reward probability.

DISCUSSION AND CONCLUSIONS

Type of anticipated reward (erotic vs monetary) affects reward-related behavioral motivation in CSBD more strongly than reward probability. We present evidence of abnormal aOFC function in CSBD by demonstrating the recruitment of additional subsections of this region by erotic reward cues.

Measuring Gambling Outcome Expectancies in Adolescents: Testing the Psychometric Properties of a Modified Version of the Gambling Expectancy Questionnaire

The Gambling Expectancy Questionnaire (GEQ; Gillespie et al. 2007a) is a 23-item scale assessing three positive outcome expectancies (Enjoyment/Arousal, Money, Self-Enhancement) and two negative outcome expectancies (Over-Involvement, Emotional Impact) related to gambling. It is the most used instrument to assess gambling outcome expectancies in adolescents and it has good psychometric properties. To allow a greater and more useful application of the scale, the present study aimed to modify the GEQ to make it usable with all adolescents, regardless of their gambling behaviour and to verify its psychometric properties. To that aim, the items were modified and the response scale was reduced from a seven-point to a five-point Likert scale. To verify the adequacy of the modified scale, two studies were conducted among Italian adolescents. In the first study (n = 501, 75% males, Mage = 16.74, SD = .88), after having removed four items and relocating another through explorative factor analysis, the original five-factor structure of the scale was confirmed by applying a confirmatory factor analysis. Reliability and validity evidence were also provided. The second study (n = 1894, 61% males, Mage = 15.68, SD = .71) attested its invariance across gambling behaviour status and gender. The modified version of the GEQ (GEQ - MOD) can be profitably used for research and preventive purposes with youth.

Increased brain reactivity to gambling unavailability as a marker of problem gambling

The unprecedented development and ubiquity of sports betting constitute an emerging public health concern. It is crucial to provide markers that could help to better identify people experiencing sports betting-related harms. The current study investigated whether problem gambling status, sports betting passion, and trait-self-control modulate brain reactivity to sports betting cues. Sixty-five frequent sports bettors (35 "nonproblem bettors" and 30 "problem bettors") were exposed to cues representing real upcoming sport events (with varying levels of winning confidence) that were made available or blocked for betting, during functional magnetic resonance imaging (fMRI) recording. Sports betting passion and trait-self-control were assessed using self-report scales. Sport events nonavailable for betting elicited higher insular and striatal activation in problem bettors, as compared with nonproblem bettors. Within a large cluster encompassing the ventral striatum, hippocampus, and amygdala, lower trait-self-control was associated with increased brain reactivity to sport events with high levels of winning confidence that were nonavailable for betting. No significant effect of sports betting passion was observed. These findings suggest that sports bettors' brain reactivity to gambling unavailability might be a relevant marker of sports betting-related harms, as well as of blunted trait-self-control.

The Predictive Utility of Reward-Based Motives Underlying Excessive and Problematic Social Networking Site Use

Compulsive seeking of reward is a hallmark feature of drug addiction, but the role of reward is less well understood in behavioural addictions. The present study investigated the predictive utility of ten reward-based motives, which we identified in the literature, in explaining excessive and problematic use of social networking sites (SNSs). These motives were examined in a cross-sectional survey of 411 young adults, revealing that prolonged use and excessive checking were predicted by distinctly different motives. More frequent checking of SNSs was most closely associated with motives related to obtaining social rewards (impression management/social comparisons/fear of missing out) and the desire to find/consume enjoyable content. In contrast, the amount of time an individual spends on SNSs was predicted by the desire to engage in negative social interactions or to fulfil personal needs (self-expression/documentation of life events). Problematic SNS use was best explained by the motivation to obtain social rewards and to a lesser extent by enjoyment and negative social potency (e.g., trolling) motives. Our results highlight the importance of social reward in explaining excessive and problematic SNS use, suggesting that a focus on reducing the desire to obtain social reward (e.g., through likes, social comparisons, continual connection) may be most beneficial in tackling problematic SNS behaviours.

Attenuated Directed Exploration during Reinforcement Learning in Gambling Disorder

Gambling disorder (GD) is a behavioral addiction associated with impairments in value-based decision-making and behavioral flexibility and might be linked to changes in the dopamine system. Maximizing long-term rewards requires a flexible trade-off between the exploitation of known options and the exploration of novel options for information gain. This exploration-exploitation trade-off is thought to depend on dopamine neurotransmission. We hypothesized that human gamblers would show a reduction in directed (uncertainty-based) exploration, accompanied by changes in brain activity in a fronto-parietal exploration-related network. Twenty-three frequent, non-treatment seeking gamblers and twenty-three healthy matched controls (all male) performed a four-armed bandit task during functional magnetic resonance imaging (fMRI). Computational modeling using hierarchical Bayesian parameter estimation revealed signatures of directed exploration, random exploration, and perseveration in both groups. Gamblers showed a reduction in directed exploration, whereas random exploration and perseveration were similar between groups. Neuroimaging revealed no evidence for group differences in neural representations of basic task variables (expected value, prediction errors). Our hypothesis of reduced frontal pole (FP) recruitment in gamblers was not supported. Exploratory analyses showed that during directed exploration, gamblers showed reduced parietal cortex and substantia-nigra/ventral-tegmental-area activity. Cross-validated classification analyses revealed that connectivity in an exploration-related network was predictive of group status, suggesting that connectivity patterns might be more predictive of problem gambling than univariate effects. Findings reveal specific reductions of strategic exploration in gamblers that might be linked to altered processing in a fronto-parietal network and/or changes in dopamine neurotransmission implicated in GD.SIGNIFICANCE STATEMENT Wiehler et al. (2021) report that gamblers rely less on the strategic exploration of unknown, but potentially better rewards during reward learning. This is reflected in a related network of brain activity. Parameters of this network can be used to predict the presence of problem gambling behavior in participants.

A voxel-wise meta-analysis of task-based functional MRI studies on impaired gain and loss processing in adults with addiction

BACKGROUND

Disturbances in gain and loss processing have been extensively reported in adults with addiction, a brain disorder characterized by obsession with addictive substances or behaviours. Previous studies have provided conflicting results with respect to neural abnormalities in gain processing in addiction, and few investigations into loss processing.

METHODS

We conducted voxel-wise meta-analyses of abnormal task-evoked regional activities in adults with substance dependence and gambling addiction during the processing of gains and losses not related to their addiction (mainly monetary). We identified 24 studies, including 465 participants with substance dependence, 81 with gambling addiction and 490 healthy controls.

RESULTS

Compared with healthy controls, all participants with addictions showed hypoactivations in the prefrontal cortex, striatum and insula and hyperactivations in the default mode network during gain anticipation; hyperactivations in the prefrontal cortex and both hyper- and hypoactivations in the striatum during loss anticipation; and hyperactivations in the occipital lobe during gain outcome. In the substance dependence subgroup, activity in the occipital lobe was increased during gain anticipation but decreased during loss anticipation.

LIMITATIONS

We were unable to conduct meta-analyses in the gambling addiction subgroup because of a limited data set. We did not investigate the effects of clinical variables because of limited information.

CONCLUSION

The current study identified altered brain activity associated with higher- and lower-level function during gain and loss processing for non-addiction (mainly monetary) stimuli in adults with substance dependence and gambling addiction. Adults with addiction were more sensitive to anticipatory gains than losses at higher- and lower-level brain areas. These results may help us to better understand the pathology of gain and loss processing in addiction.

The neural basis of gambling disorder: An activation likelihood estimation meta-analysis

Previous imaging studies suggested that impairments of prefrontal-striatal and limbic circuits are correlated to excessive gambling. However, the neural underpinnings of gambling disorder (GD) continue to be the topic of debate. The present study aimed to identify structural changes in GD and differentiate the specific brain activity patterns associated with decision-making and reward-processing. We performed a systematic review complemented by Activation likelihood estimation (ALE) meta-analyses on morphometric and functional studies on neural correlates of GD. The ALE meta-analysis on structural studies revealed that patients with GD showed significant cortical grey-matter thinning in the right ventrolateral and ventromedial prefrontal cortex compared to healthy subjects. The ALE meta-analyses on functional studies revealed that patients with GD showed a significant hyperactivation in the medial prefrontal cortex and in the right ventral striatum during decision-making and gain processing compared to healthy subjects. These findings suggest that GD is related to an alteration of brain mechanisms underlying top-down control and appraisal of gambling-related stimuli and provided indications to develop new interventions in clinical practice.

Gambling disorder is associated with reduced sensitivity to expected value during risky choice

BACKGROUND AND AIMS

Individuals with gambling disorder display increased levels of risk-taking, but it is not known if it is associated with an altered subjective valuation of gains and/or losses, perception of their probabilities, or integration of these sources of information into expected value.

METHODS

Participants with gambling disorder (n = 48) were compared with a healthy comparison group (n = 35) on a two-choice lottery task that involved either gains-only or losses-only gambles. On each trial, two lotteries were displayed, showing the associated probability and magnitude of the possible outcome for each. On each trial, participants chose one of the two lotteries, and the outcome was revealed.

RESULTS

Choice behaviour was highly sensitive to the expected value of the two gambles in both the gain and loss domains. This sensitivity to expected value was attenuated in the group with gambling disorder. The group with gambling disorder used both probability and magnitude information less, and this impairment was greater for probability information. By contrast, they used prior feedback (win vs loss) to inform their next choice, despite the independence of each trial. Within the gambling disorder group, problem gambling severity and trait gambling-related cognitions independently predicted reduced sensitivity to expected value. The majority of observed effects were consistent across both gain and loss domains.

DISCUSSION AND CONCLUSIONS

Our results provide a thorough characterization of decision processes in gain and loss domains in gambling disorder, and place these problems in the context of theoretical constructs from behavioural economics.

Outcome expectancy and suboptimal risky choice in nonhuman primates

Animals will favor a risky option when a stimulus signaling reward bridges the choice and the outcome. The present experiments investigated signal-induced risky choices and reward-outcome expectations in rhesus and capuchin monkeys. Risky choice was assessed by preference for a large-probabilistic reward over a modest-certain reward. Outcome expectancy was assessed by providing a truncation-response to shorten the delay period. In Experiment 1 both species generally favored the risky option compared to a safe option when the outcomes were signaled and generally shortened the delays except when a signaled-loss stimulus was presented. The use of the delay-truncation response suggested that the monkeys were sensitive to the information conveyed by the stimulus. Experiments 2 and 3 were designed to investigate whether the delay-truncation response used by capuchin monkeys was strategically used reflecting explicit decision-making versus a conditioned response to reward stimuli. A perceptual judgment task was included and the selective use of the delay-truncation response on unsignaled correct trials may suggest the involvement of metacognitive processes. The capuchin monkeys generally truncated the delays except under conditions where reward would not be expected (risky-loss or incorrect-judgment). When the outcomes were unsignaled during the delay some capuchin monkeys were less likely to truncate the delay following an incorrect task response. Overall, the monkeys: (1) made more risky choices when the outcomes were signaled - consistent with gambling-like behavior. (2) selectively truncated the unsignaled delays when rewards could be anticipated (even when metacognitive-like awareness guided anticipation) - suggesting that delay truncation responses reflect explicit outcome expectancy.

Brain Network Underlying Executive Functions in Gambling and Alcohol Use Disorders: An Activation Likelihood Estimation Meta-Analysis of fMRI Studies

Background: Neuroimaging and neuropsychological studies have suggested that common features characterize both Gambling Disorder (GD) and Alcohol Use Disorder (AUD), but these conditions have rarely been compared. Methods: We provide evidence for the similarities and differences between GD and AUD in neural correlates of executive functions by performing an activation likelihood estimation meta-analysis of 34 functional magnetic resonance imaging studies involving executive function processes in individuals diagnosed with GD and AUD and healthy controls (HC). Results: GD showed greater bilateral clusters of activation compared with HC, mainly located in the head and body of the caudate, right middle frontal gyrus, right putamen, and hypothalamus. Differently, AUD showed enhanced activation compared with HC in the right lentiform nucleus, right middle frontal gyrus, and the precuneus; it also showed clusters of deactivation in the bilateral middle frontal gyrus, left middle cingulate cortex, and inferior portion of the left putamen. Conclusions: Going beyond the limitations of a single study approach, these findings provide evidence, for the first time, that both disorders are associated with specific neural alterations in the neural network for executive functions.

Common neurobiological and psychological underpinnings of gambling and substance-use disorders

Both psychological and neurobiological studies in gambling disorder have increased in the past 10-15 years. This review examines the current state of the literature, with a focus on recent magnetic resonance imaging (MRI) studies in gambling disorder. The review compares and contrasts findings across gambling and substance-use disorders. Additionally, features with arguably particular relevance to gambling disorder (e.g., "near-miss" processing) are described, as well as their relationship to choice behaviors. More broadly, the review informs on how these studies advance our understanding of brain-behavior relationships relating to decision-making and key features of addictive disorders.

The anticipatory dopamine response in addiction: A common neurobiological underpinning of gambling disorder and substance use disorder?

The dopamine system is associated with reward processes in both gambling disorder and substance use disorder, and may constitute a common neurobiological underpinning in addiction. The present review examines differences and similarities of dopaminergic reward processes in gambling disorder and substance use disorder. First, it is suggested that baseline binding potentials of the dopamine system may not be a common pathway, since substance use disorder is associated with reduced binding potentials, whereas gambling disorder is not. Second, it is suggested that dopaminergic reward response may be not a common pathway, since substance use disorder is associated with a blunted dopamine response toward drugs, while conflicting findings of reward response has been reported in gambling disorder. Instead, it is suggested that the anticpatory dopamine response may constitute a common underpinning of gambling disorder and substance use disorder, which may be associated with increased dopamine activity in both types of disorder, and does not involve the intake of substances. The notion of the anticipatory dopamine response as a common underpinning of gambling disorder and substance use disorder is consistent with dopaminergic models of addictions such as the incentive-sensitization model, the ingrative neurodevelopmental model of vulnerability toward addiction and the reward prediction error model.

Basolateral amygdala - nucleus accumbens circuitry regulates optimal cue-guided risk/reward decision making

Maladaptive decision making is a characteristic feature of substance use disorder and pathological gambling. Studies in humans and animals have implicated neural circuits that include the basolateral amygdala (BLA) and nucleus accumbens (NAc) in facilitating risk/reward decision making. However, the preclinical literature has focussed primarily on situations where animals use internally-generated information to adapt to changes in reward likelihood, whereas many real-life situations require the use of external stimuli to facilitate context-appropriate behavior. We recently developed the "Blackjack" task, to measure cued risk/reward decision making requiring rats to chose between Small/Certain and Large/Risky rewards, with auditory cues at the start of each trial explicitly informing that the probability of obtaining a large reward was either good (50%) or poor (12.5%). Here we investigated the contribution of the BLA and its interaction with the NAc in guiding these types of decisions. In well-trained male rats, bilateral inactivation of the BLA induced suboptimal decision making, primarily by reducing risky choice on good-odds trials. In comparison, pharmacological disconnection of the BLA and NAc-shell also induced suboptimal decision making, diverting choice from more preferred option by reducing or increasing risky choice on good vs. poor odds trials respectively. Together, these results suggest that the BLA-NAc circuitry plays a crucial role in integrating information provided by discriminative stimuli. Furthermore, this circuitry may aid in guiding action selection of advantageous options in situations to maximize rewards. Finally, they suggest that perturbations in optimal decision making observed in substance abuse and gambling disorders may be driven in part by dysfunction within this circuitry.

Neural and neurocognitive markers of vulnerability to gambling disorder: a study of unaffected siblings

Psychological and neurobiological markers in individuals with gambling disorder (GD) could reflect transdiagnostic vulnerability to addiction or neuroadaptive consequences of long-term gambling. Using an endophenotypic approach to identify vulnerability markers, we tested the biological relatives of cases with GD. Male participants seeking treatment for GD (n = 20) were compared with a male control group (n = 18). Biological siblings of cases with GD (n = 17, unrelated to the current GD group) were compared with a separate control group (n = 19) that overlapped partially with the GD control group. Participants completed a comprehensive assessment of clinical scales, neurocognitive functioning, and fMRI of unexpected financial reward. The GD group displayed elevated levels of self-report impulsivity and delay discounting, and increased risk-taking on the Cambridge Gamble Task. We did not observe impaired motor impulsivity on the stop-signal task. Siblings of GD showed some overlapping effects; namely, elevated impulsivity (negative urgency) and increased risk-taking on the Cambridge Gamble Task. We did not observe any differences in the neural response to win outcomes, either in the GD or sibling analysis compared with their control group. Within the GD group, activity in the thalamus and caudate correlated negatively with gambling severity. Increased impulsivity and risk-taking in GD are present in biological relatives of cases with GD, suggesting these markers may represent pre-existing vulnerability to GD.

Examining neural reactivity to gambling cues in the age of online betting

Purpose of Review

The goal of this review is to provide new insights as to how and why functional magnetic resonance imaging (fMRI) research on gambling cue reactivity can contribute to significant progress towards the understanding of gambling disorder. After having offered a detailed description of experimental paradigms and a comprehensive summary of findings related to gambling cue reactivity, the present review suggests methodological avenues for future research.

Recent Findings

The fMRI literature on problem gambling has identified the main neural pathways associated with reactivity to gambling cues. Yet, the current knowledge on the key factors underlying cue reactivity in gambling is still very incomplete. Here, we suggest that the recent expansion of online sports betting calls for a new line of research offering a fine-grained and up-to-date approach of neural cue reactivity in gambling disorder.

Summary

Experimental designs that investigate individual-specific and study-specific factors related to sports betting have the potential to foster progress towards efficient treatment and prevention of gambling disorder.

Altered orbitofrontal sulcogyral patterns in gambling disorder: a multicenter study

Gambling disorder is a serious psychiatric condition characterized by decision-making and reward processing impairments that are associated with dysfunctional brain activity in the orbitofrontal cortex (OFC). However, it remains unclear whether OFC functional abnormalities in gambling disorder are accompanied by structural abnormalities. We addressed this question by examining the organization of sulci and gyri in the OFC. This organization is in place very early and stable across life, such that OFC sulcogyral patterns (classified into Types I, II, and III) can be regarded as potential pre-morbid markers of pathological conditions. We gathered structural brain data from nine existing studies, reaching a total of 165 individuals with gambling disorder and 159 healthy controls. Our results, supported by both frequentist and Bayesian statistics, show that the distribution of OFC sulcogyral patterns is skewed in individuals with gambling disorder, with an increased prevalence of Type II pattern compared with healthy controls. Examination of gambling severity did not reveal any significant relationship between OFC sulcogyral patterns and disease severity. Altogether, our results provide evidence for a skewed distribution of OFC sulcogyral patterns in gambling disorder and suggest that pattern Type II might represent a pre-morbid structural brain marker of the disease. It will be important to investigate more closely the functional implications of these structural abnormalities in future work.

Transdiagnostic variations in impulsivity and compulsivity in obsessive-compulsive disorder and gambling disorder correlate with effective connectivity in cortical-striatal-thalamic-cortical circuits

Individual differences in impulsivity and compulsivity is thought to underlie vulnerability to a broad range of disorders and are closely tied to cortical-striatal-thalamic-cortical function. However, whether impulsivity and compulsivity in clinical disorders is continuous with the healthy population and explains cortical-striatal-thalamic-cortical dysfunction across different disorders remains unclear. Here, we characterized the relationship between cortical-striatal-thalamic-cortical effective connectivity, estimated using dynamic causal modelling of resting-state functional magnetic resonance imaging data, and dimensional phenotypes of impulsivity and compulsivity in two symptomatically distinct but phenotypically related disorders, obsessive-compulsive disorder and gambling disorder. 487 online participants provided data for modelling of dimensional phenotypes. These data were combined with 34 obsessive-compulsive disorder patients, 22 gambling disorder patients, and 39 healthy controls, who underwent functional magnetic resonance imaging. Three core dimensions were identified: disinhibition, impulsivity, and compulsivity. Patients' scores on these dimensions were continuously distributed with the healthy participants, supporting a continuum model of psychopathology. Across all participants, higher disinhibition correlated with lower bottom-up connectivity in the dorsal circuit and greater bottom-up connectivity in the ventral circuit, and higher compulsivity correlated with lower bottom-up connectivity in the dorsal circuit. In patients, higher clinical severity was also linked to lower bottom-up connectivity in the dorsal circuit, but these findings were independent of phenotypic variation, demonstrating convergence towards behaviourally and clinically relevant changes in brain dynamics. Effective connectivity did not differ as a function of traditional diagnostic labels and only weak associations were observed for functional connectivity measures. Together, our results demonstrate that cortical-striatal-thalamic-cortical dysfunction across obsessive-compulsive disorder and gambling disorder may be better characterized by dimensional phenotypes than diagnostic comparisons, supporting investigation of quantitative liability phenotypes.

Gambling disorder

Gambling disorder is characterized by a persistent, recurrent pattern of gambling that is associated with substantial distress or impairment. The prevalence of gambling disorder has been estimated at 0.5% of the adult population in the United States, with comparable or slightly higher estimates in other countries. The aetiology of gambling disorder is complex, with implicated genetic and environmental factors. Neurobiological studies have implicated cortico-striato-limbic structures and circuits in the pathophysiology of this disorder. Individuals with gambling disorder often go unrecognized and untreated, including within clinical settings. Gambling disorder frequently co-occurs with other conditions, particularly other psychiatric disorders. Behavioural interventions, particularly cognitive-behavioural therapy but also motivational interviewing and Gamblers Anonymous, are supported in the treatment of gambling disorder. No pharmacological therapy has a formal indication for the treatment of gambling disorder, although placebo-controlled trials suggest that some medications, such as opioid-receptor antagonists, may be helpful. Given the associations with poor quality of life and suicide, improved identification, prevention, policy and treatment efforts are needed to help people with gambling disorder.

Amygdala volume is associated with risky probability cognition in gambling disorder

Gambling disorder (GD) is characterized by continual gambling despite negative consequences. Risky decision-making is a hallmark of the disorder. We applied a tool from behavioral economics for assessing probability cognition in both gain and loss domains to GD. We aimed to examine the alteration of probability cognition and its relationship with brain structure in GD. Forty-six GD patients and 52 age-matched healthy controls (HCs) conducted a risky choice task in which subjects should choose between a sure and a risky option in both loss and gain domains. The distortion and elevation parameters of the probability weighting function were estimated. We compared the parameters between GD and HC and examined their relationships with the striatum and amygdala volumes in GD. GD showed greater elevation parameter in the gain domain and smaller regional gray matter volume in the left amygdala than HC. The elevation parameter in the gain domain showed a negative correlation with the left amygdala volume in GD. Altered probability cognition in the gain domain but not in the loss domain might be more relevant to risky decision-making in GD. Our findings indicate that alteration in the amygdala might play a significant role in risky decision-making of GD. Longitudinal studies are recommended to examine the causal relationship between brain abnormalities and risky decision-making in GD.

Neuroimaging of reward mechanisms in Gambling disorder: an integrative review

Gambling disorder (GD) was reclassified as a behavioral addiction in the DSM-5 and shares clinical and behavioral features with substance use disorders (SUDs). Neuroimaging studies of GD hold promise in isolating core features of the addiction syndrome, avoiding confounding effects of drug neurotoxicity. At the same time, a neurobiologically-grounded theory of how behaviors like gambling can become addictive remains lacking, posing a significant hurdle for ongoing decisions in addiction nosology. This article integrates research on reward-related brain activity (functional MRI) and neurotransmitter function (PET) in GD, alongside the consideration of structural MRI data as to whether these signals more likely reflect pre-existing vulnerability or neuroadaptive change. Where possible, we point to qualitative similarities and differences with established markers for SUDs. Structural MRI studies indicate modest changes in regional gray matter volume and diffuse reductions in white matter integrity in GD, contrasting with clear structural deterioration in SUDs. Functional MRI studies consistently identify dysregulation in reward-related circuitry (primarily ventral striatum and medial prefrontal cortex), but evidence is mixed as to the direction of these effects. The need for further parsing of reward sub-processes is emphasized, including anticipation vs outcome, gains vs. losses, and disorder-relevant cues vs natural rewards. Neurotransmitter PET studies indicate amplified dopamine (DA) release in GD, in the context of minimal differences in baseline DA D2 receptor binding, highlighting a distinct profile from SUDs. Preliminary work has investigated further contributions of opioids, GABA and serotonin. Neuroimaging data increasingly highlight divergent profiles in GD vs. SUDs. The ability of gambling to perpetually activate DA (via maximal uncertainty) may contribute to neuroimaging similarities between GD and SUDs, whereas the supra-physiological DA effects of drugs may partly explain differences in the neuroimaging profile of the two syndromes. Coupled with consistent observations of correlations with gambling severity and related clinical variables within GD samples, the overall pattern of effects is interpreted as a likely combination of shared vulnerability markers across GD and SUDs, but with further experience-dependent neuroadaptive processes in GD.

A Reward-Based Framework of Perceived Control

Perceived control can be broadly defined as the belief in one's ability to exert control over situations or events. It has long been known that perceived control is a major contributor toward mental and physical health as well as a strong predictor of achievements in life. However, one issue that limits a mechanistic understanding of perceived control is the heterogeneity of how the term is defined in models in psychology and neuroscience, and used in experimental settings across a wide spectrum of studies. Here, we propose a framework for studying perceived control by integrating the ideas from traditionally separate work on perceived control. Specifically, we discuss key properties of perceived control from a reward-based framework, including choice opportunity, instrumental contingency, and success/reward rate. We argue that these separate reward-related processes are integral to fostering an enhanced perception of control and influencing an individual's behavior and well-being. We draw on select studies to elucidate how these reward-related elements are implicated separately and collectively in the investigation of perceived control. We highlight the role of dopamine within corticostriatal pathways shared by reward-related processes and perceived control. Finally, through the lens of this reward-based framework of perceived control, we consider the implications of perceived control in clinical deficits and how these insights could help us better understand psychopathology and treatment options.

Two Lifestyle Risks Intertwined: Parental Smoking Predicts Child Gambling Behavior at Age 12 Years

BACKGROUND

Parental smoking can create a toxic environment for child development. A parental smoking lifestyle can predispose children to executive deficits, influencing precocious risk activities. Using a prospective birth cohort design, we examine the association between 2 lifestyle factors by estimating the relative contribution of long-term parental household smoking in predicting subsequent precocious child gambling behavior.

METHOD

Parents reported on the amount of household smoke exposure from ages 1.5 to 7.5 years for children from the Quebec Longitudinal Study of Child Development. The main outcome measure was children's self-report of gambling behavior (at age 12 years).

RESULTS

Sixty percent of parents reported that their children were never exposed to secondhand smoke in the home, while 27% and 13% reported transient and continuous levels of secondhand smoke, respectively. Overall, 16% of children reported gambling participation. When compared with never-exposed children, children exposed to secondhand smoke had 18% more chances of having participated in gambling at age 12 years (odds ratio = 1.18; 95% CI = 1.080-1.293). These results are adjusted for competing explanations and possible individual and family confounders.

CONCLUSIONS

Higher levels of early childhood household smoke exposure are associated with greater odds of reporting gambling participation at age 12 years, which is more than several years before it is normative youthful behavior. By connecting the neurotoxic influence of one lifestyle factor on another, we show a nontrivial link between 2 public health issues (smoke exposure and precocious gambling) associated with considerable individual and societal costs that are amenable to community information campaigns.

Cognitive neuroscience can support public health approaches to minimise the harm of 'losses disguised as wins' in multiline slot machines

Video slot machines are associated with both accelerated transition into problematic forms of gambling, as well as psychosocial harm above and beyond other forms of gambling. A growing body of evidence is uncovering how key design features of multiline slot machines produce an inflated experience of reward, despite the fact that these features offer no overall financial benefit to the player. A pernicious example of this are 'losses disguised as wins' (LDWs), which occur when simultaneous bets placed on multiple lines result in a winning combination that returns an amount greater than zero, but less the total wager. These events are usually accompanied by the same celebratory sounds and animations that accompany true wins. We argue that LDWs may leverage neuropsychological phenomena that underlie reinforcement learning and contribute to extended or repetitive use and gambling-related harm. While other characteristics of slot machine gambling have been examined by cognitive neuroscientists, this feature has not yet received attention. Neuroscientific methods can be used to assess the impact of LDWs on the human reward system, to assess the claim that these events are a reinforcing and contributing factor in the development of harmful play. Positive findings would provide further persuasive evidence in support of strategies to minimise gambling harm through the regulation of machine design.

Brain PET substrate of impulse control disorders in Parkinson's disease: A metabolic connectivity study

Impulse control disorders (ICDs) have received increased attention in Parkinson's disease (PD) because of potentially dramatic consequences. Their physiopathology, however, remains incompletely understood. An overstimulation of the mesocorticolimbic system has been reported, while a larger network has recently been suggested. The aim of this study is to specifically describe the metabolic PET substrate and related connectivity changes in PD patients with ICDs. Eighteen PD patients with ICDs and 18 PD patients without ICDs were evaluated using cerebral 18F-fluorodeoxyglucose positron emission tomography. SPM-T maps comparisons were performed between groups and metabolic connectivity was evaluated by interregional correlation analysis (IRCA; p < .005, uncorrected; k > 130) and by graph theory (p < .05). PD patients with ICDs had relative increased metabolism in the right middle and inferior temporal gyri compared to those without ICDs. The connectivity of this area was increased mostly with the mesocorticolimbic system, positively with the orbitofrontal region, and negatively with both the right parahippocampus and the left caudate (IRCA). Moreover, the betweenness centrality of this area with the mesocorticolimbic system was lost in patients with ICDs (graph analysis). ICDs are associated in PD with the dysfunction of a network exceeding the mesocorticolimbic system, and especially the caudate, the parahippocampus, and the orbitofrontal cortex, remotely including the right middle and inferior temporal gyri. This latest area loses its central place with the mesocorticolimbic system through a connectivity dysregulation.

Relating neural processing of reward and loss prospect to risky decision-making in individuals with and without Gambling Disorder

Neuroimaging studies demonstrate alterations in fronto-striatal neurocircuitry in gambling disorder (GD) during anticipatory processing, which may influence decision-making impairments. However, to date little is known about fronto-striatal anticipatory processing and emotion-based decision-making. While undergoing neuroimaging, 28 GD and 28 healthy control (HC) participants performed the Monetary Incentive Delay Task (MIDT). Pearson correlation coefficients assessed out-of-scanner Iowa Gambling Task (IGT) performance with the neural activity during prospect (A1) processing on the MIDT across combined GD and HC groups. The HC and GD groups showed no significant difference in out-of-scanner IGT performance, although there was a trend for higher IGT scores in the HC group on the last two IGT trial blocks. Whole-brain correlations across combined HC and GD groups showed that MIDT BOLD signal in the ventral striatum/caudate/ventromedial prefrontal cortex and anterior cingulate regions during the prospect of winning positively correlated with total IGT scores. The GD group also contained a higher proportion of tobacco smokers, and correlations between neural activations in prospect on the MIDT may relate in part to gambling and/or smoking pathology. In this study, fronto-striatal activity during the prospect of reward and loss on the MIDT was related to decision-making on the IGT, with blunted activation linked to disadvantageous decision-making. The findings from this work are novel in linking brain activity during a prospect-of-reward phase with performance on a decision-making task in individuals with and without GD.

Facing temptation: The neural correlates of gambling availability during sports picture exposure

Nowadays, sports betting has become increasingly available and easy to engage in. Here we examined the neural responses to stimuli that represent sporting events available for betting as compared to sporting events without a gambling opportunity. We used a cue exposure task in which football (soccer) fans (N = 42) viewed cues depicting scheduled football games that would occur shortly after the scanning session. In the "betting" condition, participants were instructed to choose, at the end of each block, the game (and the team) they wanted to bet on. In the "watching" condition, participants chose the game they would prefer to watch. After the scanning session, participants completed posttask rating questionnaires assessing, for each cue, their level of confidence about the team they believed would win and how much they would enjoy watching the game. We found that stimuli representing sport events available for betting elicited higher fronto-striatal activation, as well as higher insular cortex activity and functional connectivity, than sport events without a gambling opportunity. Moreover, games rated with more confidence towards the winning team resulted in greater brain activations within regions involved in affective decision-making (ventromedial prefrontal cortex), cognitive inhibitory control (medial and superior frontal gyri) and reward processing (ventral and dorsal striatum). Altogether, these novel findings offer a sensible simulation of how the high availability of sports betting in today's environment impacts on the reward and cognitive control systems. Future studies are needed to extend the present findings to a sample of football fans that includes a samilar proportion of female and male participants.

Hypernatural Monitoring: A Social Rehearsal Account of Smartphone Addiction

We present a deflationary account of smartphone addiction by situating this purportedly antisocial phenomenon within the fundamentally social dispositions of our species. While we agree with contemporary critics that the hyper-connectedness and unpredictable rewards of mobile technology can modulate negative affect, we propose to place the locus of addiction on an evolutionarily older mechanism: the human need to monitor and be monitored by others. Drawing from key findings in evolutionary anthropology and the cognitive science of religion, we articulate a hypernatural monitoring model of smartphone addiction grounded in a general social rehearsal theory of human cognition. Building on recent predictive-processing views of perception and addiction in cognitive neuroscience, we describe the role of social reward anticipation and prediction errors in mediating dysfunctional smartphone use. We conclude with insights from contemplative philosophies and harm-reduction models on finding the right rituals for honoring social connections and setting intentional protocols for the consumption of social information.

Differential Contributions of Nucleus Accumbens Subregions to Cue-Guided Risk/Reward Decision Making and Implementation of Conditional Rules

The nucleus accumbens (NAc) is a key node within corticolimbic circuitry for guiding action selection and cost/benefit decision making in situations involving reward uncertainty. Preclinical studies have typically assessed risk/reward decision making using assays where decisions are guided by internally generated representations of choice-outcome contingencies. Yet, real-life decisions are often influenced by external stimuli that inform about likelihoods of obtaining rewards. How different subregions of the NAc mediate decision making in such situations is unclear. Here, we used a novel assay colloquially termed the "Blackjack" task that models these types of situations. Male Long-Evans rats were trained to choose between one lever that always delivered a one-pellet reward and another that delivered four pellets with different probabilities [either 50% (good-odds) or 12.5% (poor-odds)], which were signaled by one of two auditory cues. Under control conditions, rats selected the large/risky option more often on good-odds versus poor-odds trials. Inactivation of the NAc core caused indiscriminate choice patterns. In contrast, NAc shell inactivation increased risky choice, more prominently on poor-odds trials. Additional experiments revealed that both subregions contribute to auditory conditional discrimination. NAc core or shell inactivation reduced Pavlovian approach elicited by an auditory CS+, yet shell inactivation also increased responding during presentation of a CS-. These data highlight distinct contributions for NAc subregions in decision making and reward seeking guided by discriminative stimuli. The core is crucial for implementation of conditional rules, whereas the shell refines reward seeking by mitigating the allure of larger, unlikely rewards and reducing expression of inappropriate or non-rewarded actions.SIGNIFICANCE STATEMENT Using external cues to guide decision making is crucial for adaptive behavior. Deficits in cue-guided behavior have been associated with neuropsychiatric disorders, such as attention deficit hyperactivity disorder and schizophrenia, which in turn has been linked to aberrant processing in the nucleus accumbens. However, many preclinical studies have often assessed risk/reward decision making in the absence of explicit cues. The current study fills that gap by using a novel task that allows for the assessment of cue-guided risk/reward decision making in rodents. Our findings identified distinct yet complementary roles for the medial versus lateral portions of this nucleus that provide a broader understanding of the differential contributions it makes to decision making and reward seeking guided by discriminative stimuli.

Alterations in the Emotional Regulation Process in Gambling Addiction: The Role of Anger and Alexithymia

This study aims at the assessment of alexithymia and anger levels in 100 treatment-seeking pathological gamblers compared with controls, who were matched for age, gender and education. Furthermore a positive correlation between alexithymia, anger and severity of gambling disorder and a relationship between gambling behaviour and anger after controlling for alexithymia, are investigated. Finally the role that gender plays in anger in pathological gamblers was also evaluated. Psychological assessment includes the South Oaks Gambling Screen, State-Trait Anger Expression Inventory-2 and the twenty-item Toronto Alexithymia Scale. Statistical analysis of the results shows a higher level of anger in pathological gamblers than in controls, together with alterations in emotional processing. Severity of gambling behaviour positively correlates with alexithymia scores, state-anger and trait-anger. Moreover, a significant contribution of anger in predicting gambling behaviour was suggested after controlling for alexithymia. In conclusion, anger and alexithymia must be regarded as relevant components of the assessment of pathological gamblers, in order to select the best therapeutical strategies to prevent self-defeating behaviours and to reduce drop-out from treatments.

White matter integrity between left basal ganglia and left prefrontal cortex is compromised in gambling disorder

Pathological gambling (PG) is a behavioral addiction characterized by an inability to stop gambling despite the negative consequences, which may be mediated by cognitive flexibility deficits. Indeed, impaired cognitive flexibility has previously been linked to PG and also to reduced integrity of white matter connections between the basal ganglia and the prefrontal cortex. It remains unclear, however, how white matter integrity problems relate to cognitive inflexibility seen in PG. We used a cognitive switch paradigm during functional magnetic resonance imaging in pathological gamblers (PGs; n = 26) and healthy controls (HCs; n = 26). Cognitive flexibility performance was measured behaviorally by accuracy and reaction time on the switch task, while brain activity was measured in terms of blood oxygen level-dependent responses. We also used diffusion tensor imaging on a subset of data (PGs = 21; HCs = 21) in combination with tract-based spatial statistics and probabilistic fiber tracking to assess white matter integrity between the basal ganglia and the dorsolateral prefrontal cortex. Although there were no significant group differences in either task performance, related neural activity or tract-based spatial statistics, PGs did show decreased white matter integrity between the left basal ganglia and prefrontal cortex. Our results complement and expand similar findings from a previous study in alcohol-dependent patients. Although we found no association between white matter integrity and task performance here, decreased white matter connections may contribute to a diminished ability to recruit prefrontal networks needed for regulating behavior in PG. Hence, our findings could resonate an underlying risk factor for PG, and we speculate that these findings may extend to addiction in general.

Evidence for GABA-A receptor dysregulation in gambling disorder: correlation with impulsivity

As a behavioural addiction, gambling disorder (GD) provides an opportunity to characterize addictive processes without the potentially confounding effects of chronic excessive drug and alcohol exposure. Impulsivity is an established precursor to such addictive behaviours, and GD is associated with greater impulsivity. There is also evidence of GABAergic dysregulation in substance addiction and in impulsivity. This study therefore investigated GABA_A receptor availability in 15 individuals with GD and 19 healthy volunteers (HV) using [¹¹C]Ro15‐4513, a relatively selective α5 benzodiazepine receptor PET tracer and its relationship with impulsivity. We found significantly higher [¹¹C]Ro15‐4513 total distribution volume (V_T) in the right hippocampus in the GD group compared with HV. We found higher levels of the ‘Negative Urgency’ construct of impulsivity in GD, and these were positively associated with higher [¹¹C]Ro15‐4513 V_T in the amygdala in the GD group; no such significant correlations were evident in the HV group. These results contrast with reduced binding of GABAergic PET ligands described previously in alcohol and opiate addiction and add to growing evidence for distinctions in the neuropharmacology between substance and behavioural addictions. These results provide the first characterization of GABA_A receptors in GD with [¹¹C]Ro15‐4513 PET and show greater α5 receptor availability and positive correlations with trait impulsivity. This GABAergic dysregulation is potential target for treatment.

Effectiveness of two web-based cognitive bias modification interventions targeting approach and attentional bias in gambling problems: study protocol for a pilot randomised controlled trial

BACKGROUND

Disordered gamblers have phenotypical and pathological similarities to those with substance use disorders (SUD), including exaggerated automatic cognitive processing of motivationally salient gambling cues in the environment (i.e., attentional and approach bias). Cognitive bias modification (CBM) is a family of computerised interventions that have proved effective in successfully re-training these automatic cognitive biases in SUD. CBM interventions can, in principle, be administered online, thus showing potential of being a low-cost, low-threshold addition to conventional treatments. This paper presents the design of a pilot randomised controlled trial exploring the effectiveness of two web-based CBM interventions targeting attentional and approach bias towards gambling cues in a sample of Dutch and Belgian problematic and pathological gamblers.

METHODS/DESIGN

Participants (N = 182) are community-recruited adults experiencing gambling problems, who have gambled at least twice in the past 6 months and are motivated to change their gambling behaviour. After a baseline assessment session, participants are randomly assigned to one of four experimental conditions (attentional or approach bias training, or the placebo version of the two trainings) and complete six sessions of training. At baseline and before each training session, participants receive automated personalised feedback on their gambling motives and reasons to quit or reduce gambling. The post-intervention, 1-month, and 3-month follow-up assessments will examine changes in gambling behaviour, with frequency and expenditure as primary outcomes, and depressive symptoms and gambling-related attentional and approach biases as secondary outcomes. Secondary analyses will explore possible moderators (interference control capacity and trait impulsivity) and mediators (change in cognitive bias) of training effects on the primary outcomes.

DISCUSSION

This study is the first to explore the effectiveness of an online CBM intervention for gambling problems. The results of this study can be extremely valuable for developing e-health interventions for gambling problems and further understanding the role of motivational implicit cognitive processes underlying problematic gambling behaviour.

TRIAL REGISTRATION

Netherlands Trial Register, NTR5096 . Registered on 11 March 2015.

Gambling-like behavior in pigeons: 'jackpot' signals promote maladaptive risky choice

Individuals often face choices that have uncertain outcomes and have important consequences. As a model of this environment, laboratory experiments often offer a choice between an uncertain, large reward that varies in its probability of delivery against a certain but smaller reward as a measure of an individual’s risk aversion. An important factor generally lacking from these procedures are gambling related cues that may moderate risk preferences. The present experiment offered pigeons choices between unreliable and certain rewards but, for the Signaled group on winning choices, presented a ‘jackpot’ signal prior to reward delivery. The Unsignaled group received an ambiguous stimulus not informative of choice outcomes. For the Signaled group, presenting win signals effectively blocked value discounting for the large, uncertain outcome as the probability of a loss increased, whereas the Unsignaled group showed regular preference changes similar to previous research lacking gambling related cues. These maladaptive choices were further shown to be unaffected by more salient loss signals and resistant to response cost increases. The results suggest an important role of an individual’s sensitivity to outcome-correlated cues in influencing risky choices that may moderate gambling behaviors in humans, particularly in casino and other gambling-specific environments.