Decision- and feedback-related brain potentials reveal risk processing mechanisms in patients with alcohol use disorder

A meta-analysis of electrophysiological biomarkers of reward and error monitoring in substance misuse

Substance use disorders are characterized by marked changes in reward and error processing. The primary objective of this meta-analysis was to estimate effect sizes for the reward positivity (RewP) and error-related negativity (ERN), two event-related potential indicators of outcome monitoring, in substance users compared to controls. The secondary objective was to test for moderation by demographic, substance type, and EEG experiment parameters. Final PubMed searches were performed in August 2023. Inclusion criteria were substance use disorder/dependence or validated self-report of substance misuse, RewP/ERN means available, healthy control comparison group, non-acute drug study, peer-reviewed journal, English language, and human participants. Selection bias was tested through modified Egger's regression and exploratory 3-parameter selection model tests. The RewP results (19 studies, 1641 participants) did not support an overall effect (Hedges' g = 0.07, 95% CI [-0.44, 0.58], p = .777) and nor effect of any moderators. The ERN results (20 studies, 1022 participants) indicated no significant overall effect (g = 0.41, 95%CI [-0.05, 0.88]). Subgroup analyses indicated that cocaine users had a blunted ERN compared to controls (g = 1.12, 95%CI [0.77, 1.47]). There was limited evidence for publication/small study bias. Although the results indicate a potential dissociation between substance types, this meta-analysis revealed the need for additional research on the RewP/ERN in substance using populations and for better designed experiments that adequately address research questions.

Exploring the impact of smartphone addiction on decision-making behavior in college students: an fNIRS study based on the Iowa Gambling Task

The pervasive use of smartphones, while enhancing accessibility to information and communication, has raised concerns about its potential negative effects on physical and mental health, including the impairment of decision-making abilities. This study investigates the influence of smartphone addiction on decision-making in college students. A sample of 80 individuals aged 17 to 26 was selected and divided into two groups based on their Smartphone Addiction Scale-Short Version (SAS-SV) scores. Participants underwent the Iowa Gambling Task (IGT) to evaluate their decision-making in risky and uncertain conditions, while fNIRS recorded their prefrontal cortex activity. The study found that individuals prone to smartphone addiction tend to make riskier choices in risky situations. However, when faced with decisions based on ambiguity, the smartphone addiction group showed increased brain activity in the dlPFC (specifically in channels 4, 9, and 11) compared to when making risky decisions. Despite this increased brain activation, there was no observable difference in behavior between the addiction-prone and control groups in ambiguous scenarios. Notably, the left dlPFC (e.g., channel 4) exhibited significantly higher activation in the addiction group compared to the control group. Findings suggest that smartphone addiction can detrimentally influence decision-making, behaviorally and neurologically, particularly in uncertain contexts. This study supports the classification of smartphone addiction as a genuine addiction and underscores its significance in psychiatric research. In essence, our research underscores the adverse effects of excessive smartphone use on decision-making processes, reinforcing the necessity to treat smartphone addiction as a pressing public health issue.

Computational markers of risky decision-making predict for relapse to alcohol

BACKGROUND

Relapse remains the major challenge in treatment of alcohol use disorder (AUD). Aberrant decision-making has been found as important cognitive mechanism underlying relapse, but factors associated with relapse vulnerability are unclear. Here, we aim to identify potential computational markers of relapse vulnerability by investigating risky decision-making in individuals with AUD.

METHODS

Forty-six healthy controls and fifty-two individuals with AUD were recruited for this study. The risk-taking propensity of these subjects was investigated using the balloon analog risk task (BART). After completion of clinical treatment, all individuals with AUD were followed up and divided into a non-relapse AUD group and a relapse AUD group according to their drinking status.

RESULTS

The risk-taking propensity differed significantly among healthy controls, the non-relapse AUD group, and the relapse AUD group, and was negatively associated with the duration of abstinence in individuals with AUD. Logistic regression models showed that risk-taking propensity, as measured by the computational model, was a valid predictor of alcohol relapse, and higher risk-taking propensity was associated with greater risk of relapse to drink.

CONCLUSION

Our study presents new insights into risk-taking measurement and identifies computational markers that provide prospective information for relapse to drink in individuals with AUD.

Adaptations of the balloon analog risk task for neuroimaging settings: a systematic review

Introduction

The Balloon Analog Risk Task (BART), a computerized behavioral paradigm, is one of the most common tools used to assess the risk-taking propensity of an individual. Since its initial behavioral version, the BART has been adapted to neuroimaging technique to explore brain networks of risk-taking behavior. However, while there are a variety of paradigms adapted to neuroimaging to date, no consensus has been reached on the best paradigm with the appropriate parameters to study the brain during risk-taking assessed by the BART. In this review of the literature, we aimed to identify the most appropriate BART parameters to adapt the initial paradigm to neuroimaging and increase the reliability of this tool.

Methods

A systematic review focused on the BART versions adapted to neuroimaging was performed in accordance with PRISMA guidelines.

Results

A total of 105 articles with 6,879 subjects identified from the PubMed database met the inclusion criteria. The BART was adapted in four neuroimaging techniques, mostly in functional magnetic resonance imaging or electroencephalography settings.

Discussion

First, to adapt the BART to neuroimaging, a delay was included between each trial, the total number of inflations was reduced between 12 and 30 pumps, and the number of trials was increased between 80 and 100 balloons, enabling us to respect the recording constraints of neuroimaging. Second, explicit feedback about the balloon burst limited the decisions under ambiguity associated with the first trials. Third, employing an outcome index that provides more informative measures than the standard average pump score, along with a model incorporating an exponential monotonic increase in explosion probability and a maximum explosion probability between 50 and 75%, can yield a reliable estimation of risk profile. Additionally, enhancing participant motivation can be achieved by increasing the reward in line with the risk level and implementing payment based on their performance in the BART. Although there is no universal adaptation of the BART to neuroimaging, and depending on the objectives of a study, an adjustment of parameters optimizes its evaluation and clinical utility in assessing risk-taking.

Individual differences in late positive potential amplitude and theta power predict cue-induced eating

Cue-induced reward-seeking behaviors are regulated by both the affective and cognitive control systems of the brain. This study aimed at investigating how individual differences in affective and cognitive responses to cues predicting food rewards contribute to the regulation of cue-induced eating. We recorded electroencephalogram (EEG) from 59 adults while they viewed emotional and food-related images that preceded the delivery of food rewards (candies) or non-food objects (beads). We measured the amplitude of the late positive potential (LPP) in response to a variety of motivationally relevant images and power in the theta (4-8 Hz) frequency band after candies or beads were dispensed to the participants. We found that individuals with larger LPP responses to food images than to pleasant images (C>P group) ate significantly more during the experiment than those with the opposite response pattern (P>C group, p < 0.001). Furthermore, we found that individuals with higher theta power after dispensation of the candy than of the bead (θCA>θBE) ate significantly more than those with the opposite response pattern (θBE>θCA, p < 0.001). Finally, we found that the crossed P>C and θBE>θCA group ate less (p < 0.001) than did the other three groups formed by crossing the LPP and theta group assignments, who exhibited similar eating behavior on average (p = 0.662). These findings demonstrate that individual differences in both affective and cognitive responses to reward-related cues underlie vulnerability to cue-induced behaviors, underscoring the need for individualized treatments to mitigate maladaptive behaviors.

Drinking alcohol by mid-adolescence is related to reduced reward reactivity: Novel evidence of positive valence system alterations in early initiating female youth

Initiation of alcohol use at younger ages is prognostic of later drinking problems. Reward system dysfunction is theorized to contribute to early initiation and escalation of drinking, but existing evidence supports both hyposensitivity and hypersensitivity as risk-markers; research employing effective indices of reward processing is needed for clarification. The reward positivity (RewP) is a well-established neurophysiological index of hedonic "liking," an important aspect of reward processing. Adult research has yielded conflicting findings, with different studies reporting reduced, enhanced, or null associations of RewP with engagement in or risk for harmful alcohol use. No study has examined relations between RewP and multiple indices of drinking in youth. Here, we examined how RewP measured in a gain/loss feedback task related to self-reported drinking initiation and past-month drinking, when accounting for age along with depression and externalizing symptoms, in 250 mid-adolescent females. Analyses showed that (1) compared to not-yet drinkers, adolescents endorsing drinking initiation responded less strongly to monetary gain (RewP) but not loss feedback (FN), and (2) past-month drinking was unrelated to both RewP and FN magnitude. These findings provide evidence for reduced hedonic "liking" as a concomitant of early drinking initiation in adolescent females and warrant further research with mixed-sex adolescent samples exhibiting greater drinking variability.

Uncertainty deconstructed: conceptual analysis and state-of-the-art review of the ERP correlates of risk and ambiguity in decision-making

Risk and uncertainty are central concepts of decision neuroscience. However, a comprehensive review of the literature shows that most studies define risk and uncertainty in an unclear fashion or use both terms interchangeably, which hinders the integration of the existing findings. We suggest uncertainty as an umbrella term that comprises scenarios characterized by outcome variance where relevant information about the type and likelihood of outcomes may be somewhat unavailable (ambiguity) and scenarios where the likelihood of outcomes is known (risk).These conceptual issues are problematic for studies on the temporal neurodynamics of decision-making under risk and ambiguity, because they lead to heterogeneity in task design and the interpretation of the results. To assess this problem, we conducted a state-of-the-art review of ERP studies on risk and ambiguity in decision-making. By employing the above definitions to 16 reviewed studies, our results suggest that: (a) research has focused more on risk than ambiguity processing; (b) studies assessing decision-making under risk often implemented descriptive-based paradigms, whereas studies assessing ambiguity processing equally implemented descriptive- and experience-based tasks; (c) descriptive-based studies link risk processing to increased frontal negativities (e.g., N2, N400) and both risk and ambiguity to reduced parietal positivities (e.g., P2, P3); (d) experience-based studies link risk to increased P3 amplitudes and ambiguity to increased frontal negativities and the LPC component; (e) both risk and ambiguity processing seem to be related with cognitive control, conflict monitoring, and increased cognitive demand; (f) further research and improved tasks are needed to dissociate risk and ambiguity processing.

Risky Decision-Making in Adults with Alcohol Use Disorder-A Systematic and Meta-Analytic Review

Alcohol use disorder (AUD) forms a major health concern and is the most common substance use disorder worldwide. The behavioural and cognitive deficits associated with AUD have often been related to impairments in risky decision-making. The aim of this study was to examine the magnitude and type of risky decision-making deficits of adults with AUD, as well as to explore the potential mechanisms behind these deficits. To this end, existing literature comparing risky decision-making task performance of an AUD group to a control group (CG) was systematically searched and analysed. A meta-analysis was performed to address overall effects. In total, 56 studies were included. In the majority of studies (i.e., 68%), the performance of the AUD group(s) deviated from the CG(s) on one or more of the adopted tasks, which was confirmed by a small to medium pooled effect size (Hedges' g = 0.45). This review therefore provides evidence of increased risk taking in adults with AUD as compared to CGs. The increased risk taking may be due to deficits in affective and deliberative decision-making. Making use of ecologically valid tasks, future research should investigate whether risky decision-making deficits predate and/or are consequential to the addiction of adults with AUD.

A negative emotional context disrupts the framing effect on outcome evaluation in decision making under uncertainty: An ERP study

The framing effect refers to the phenomenon that different descriptions of the same option lead to a shift in the choice of the decision maker. Several studies have found that emotional contexts irrelevant to a decision in progress still influence the framing effect on decision making. However, little is known about the potential role of emotional contexts in the framing effect on outcome evaluation under uncertainty and the related neural mechanisms. The present study measured event-related potentials (ERPs) to capture the time series of brain activities during the processing of gain- and loss-framed choices and outcomes primed with neutral and negative emotional contexts. The results revealed that in the neutral emotional context, the P300 amplitudes following both positive and negative feedback were greater in the gain-framed condition than those in the loss-framed condition, demonstrating a framing effect, whereas in the negative emotional context, this effect was unstable and observed only following negative feedback. In contrast, regardless of whether the feedback was positive or negative, the framing effect on the feedback-related negativity (FRN) amplitudes was insensitive to neutral and negative emotional contexts. Furthermore, the time-frequency analysis showed that the framing effect on the theta power related to the FRN was also insensitive to neutral and negative emotional contexts. Our findings suggest that brain responses to framing effects on outcome evaluation in a later cognitive appraisal stage of decision making under uncertainty may depend on the emotional context, as the effects were observed only following negative feedback in the negative emotional context.

The role of conflict processing mechanism in deception responses

A considerable number of studies have described the potential neural mechanism of deception, but most deception studies have relied upon deception from experimental supervisor instruction. Experimental control (participants follow instructions to deceive without any risk) means that the deception occurs in a way that does not come close to the real deception. In the current study, a neural imaging experiment on deception closer to the real deception was conducted. Event-related potential (ERP) and event-related spectral perturbation (ERSP) techniques were used to explore the neural mechanism of deception. The results showed that deceptive response evoked larger medial-frontal negativity (MFN) and smaller response-locked positivity (RLP) than truthful response. We interpret these findings to indicate that conflict detection and emotional processing are associated with deception. In addition, magnitudes of alpha and beta oscillations after the deceptive response were significantly smaller than those after the truthful response, demonstrating that deception is associated with neural oscillations reflecting conflict adjustment. The results comprehensively characterized the physiological properties of the brain oscillations elicited by a deceptive response and provided a theoretical foundation for detection in practical applications.

Hypersensitivity to negative feedback during dynamic risky-decision making in major depressive disorder: An event-related potential study

BACKGROUND

Patients with major depressive disorder (MDD) exhibit a diminished ability to think or concentrate, indecisiveness, and altered sensitivity to reward and punishment. These impairments can influence complex risk-related decision-making in dynamic environments. The neurophysiological mechanisms mediating MDD effects on decision-making behavior are not well understood.

METHODS

Patients with MDD (N=50) and healthy controls (HC, N=40) were enrolled. They completed a series of psychometric tests. Event-related potentials (ERPs) were recorded during the performance of a well-validated modified version of Balloon Analogue Risk Task (BART).

RESULTS

BART behavior data were similar across the two groups except the MDD patients showed more stability of risk aversion. Neurophysiologically, BART losses generated larger P3 amplitudes than wins, and MDD patients had larger feedback-related negativity (FRN) components than HCs in response to negative feedback (losses). Greater FRN amplitudes in response to losses correlated with higher levels of depressiveness, psychological pain, and anhedonia. A longer FRN latency in MDD patients was associated with more severe suicidal ideation.

LIMITATIONS

The findings are based on cross-sectional data, which are not powerful enough to make causal inferences.

CONCLUSION

MDD patients exhibit enhanced FRNs in the frontocentral region after receiving negative feedback in a risky decision-making task. FRN magnitude is associated with depressive symptom severity. Punishment hypersensitivity may contribute to the maintenance of depressive symptoms in MDD patients, and FRN may be a useful index of such hypersensitivity.

Self-other discrepancies in electrophysiological response to outcome evaluation in the Balloon Analogue Risk Task

The topic of self-other differences in decision-making has gained considerable attention in recent years. Despite a broad range of behavior studies that have shown self-other discrepancy in decision-making, few neuroimaging studies with event-related potentials (ERPs) have directly compared decisions made for oneself with those made for others. It remains controversial whether self-other differences of outcome evaluations in gambling tasks can also be shown in brain potentials. In this study, we used event-related potentials with a Balloon Analogue Risk Task (BART) paradigm, a sequential, dynamic decision-making task to examine the effects of self-other differences on evaluation outcome in brain activity. Feedback Related Negativity (FRN) and P300 components were analyzed with respect to feedback valence (win vs. loss) and beneficiary (self vs. stranger). The ERP results showed that when making decisions for oneself, the negative outcome feedback evoked a larger P300 compared to making decisions for a stranger. However, there was no significant effect of self-other differences when the outcome feedback was positive. In contrast, regardless of whether the feedback was positive or negative, the FRN amplitude was insensitive to the self-other manipulation. Furthermore, we found that both components were modulated by the valence of the feedback. More pronounced FRN and P300 were induced when the feedback was negative, relative to when the feedback was positive. Our findings indicate that brain responses to outcome evaluation on the BART may be divided into an early semi-automatic processing stage and a later cognitive appraisal stage and that the self-other differences in sequential, dynamic decision-making tasks under uncertainty mainly affect the allocation of attention resources in the late cognitive processing stage.

Overclaiming is not related to dark triad personality traits or stated and revealed risk preferences

The tendency to be overly confident in one’s future and skills has long been studied. More recently, a correlate of this overconfidence, the tendency to overclaim knowledge, has been in the focus of research. Its antecedents and downstream behavioral consequences are still in question. In a sample of undergraduate students (N = 168), we tested whether a set of characteristics of the person (e.g., age, gender) and personality traits (i.e., the Dark Triad) is related to overclaiming knowledge. Moreover, we investigated whether overclaiming, in turn, predicts risk preferences. To this end, we asked individuals to rate their confidence in solving a set of different math problems and their familiarity with a set of math concepts. Some of these concepts were nonexistent, thereby allowing participants to overclaim knowledge. Participants then stated their general risk preference and performed three tasks revealing their general, financial, and social risk preferences. We demonstrated the hypothesized relationship between overclaiming and confidence. Furthermore, we observed that the assessed characteristics of the person were not correlated with overclaiming. If anything, height and digit ratio, a phenomenological correlate of hormonal differences during development, tended to be associated with overclaiming. Surprisingly, overclaiming was not at all related to risk preferences or personality traits. This set of results shows the need for relevant theoretical and methodological refinements.

Towards a Functional Neuromarker of Impulsivity: Feedback-Related Brain Potential during Risky Decision-Making Associated with Self-Reported Impulsivity in a Non-Clinical Sample

Risk-taking is part of the multidimensional nature of impulsivity, consisting of an active engagement in behaviors or choices with potentially undesirable results, with probability as the cost for an expected reward. In order to understand the neurophysiological activity during risky behavior and its relationship with other dimensions of impulsivity, we have acquired event-related-potential (ERP) data and self-reported impulsivity scores from 17 non-clinical volunteers. They underwent high-resolution electroencephalography (HR-EEG) combined with an adapted version of the Balloon Analogue Risk Task (BART), and completed the Barratt Impulsiveness Scale (BIS-10) and the Urgency, Premeditation, Perseverance, Sensation Seeking, Impulsive Behavior Scale (UPPS). The ERP components were sensitive to valence (FRN, P300) and risk/reward magnitude (SPN, RewP). Our main finding evidenced a positive correlation between the amplitude of the P300 component following positive feedback and both the global UPPS score and the (lack of) perseverance UPPS subscale, significant for several adjacent electrodes. This finding might suggest an adaptive form of impulsive behavior, which could be associated to the reduction on the difference of the P300 amplitude following negative and positive feedback. However, further investigation with both larger clinical and non-clinical samples is required.

A Systematic Review of the Balloon Analogue Risk Task (BART) in Alcohol Research

Risk-taking propensity has been crucial to the investigation of alcohol use and consequences. One measure, the balloon analogue risk task (BART), has been used consistently over the past two decades. However, it is unclear how this measure is related to alcohol outcomes. This paper systematically reviews the literature on the BART and alcohol outcomes. First, direct associations between the BART and alcohol use are reviewed including correlations, group comparisons, the BART's prediction of alcohol outcomes and BART performance after consuming alcohol. Then, potential moderators that explain when and for whom the BART is related to alcohol outcomes are reviewed. Finally, potential mechanisms that explain how the BART and alcohol outcomes are related are reviewed. This review reveals patterns in the BART suggesting risk-taking propensity may be related to changes in alcohol use over time; however, there is little evidence to suggest BART scores increase after consuming alcohol. Yet, additional research suggests adjusted average pump scores may be too simplistic for the amount of information the BART captures and understanding individual's patterns of responses on the BART is important for investigating its relation to alcohol outcomes. Finally, this review opens up several future directions for research to understand how risk-taking propensity is related to alcohol outcomes.

Feedback-Related Brain Potentials Indicate the Influence of Craving on Decision-Making in Patients with Alcohol Use Disorder: An Experimental Study

INTRODUCTION

Alcohol craving is a key symptom of alcohol use disorder (AUD) and a significant cause of poor treatment outcome and frequent relapse. Craving is supposed to impair executive functions by modulating reward salience and decision-making.

OBJECTIVE

The present study sought to clarify this modulation by scrutinizing reward feedback processing in an experimental decision-making task, which was accomplished by AUD patients in 2 conditions, in the context of induced alcohol craving and in neutral context.

METHODS

AUD inpatients (N = 40) accomplished the Balloon Analog Risk Task, while their EEG was monitored; counterbalanced across conditions, the tasks were preceded either by craving induction by means of imagery and olfactory alcohol cues, or by neutral cues. Decision choice and variability, and event-related potentials (ERPs) prior to (stimulus-preceding negativity [SPN]) and following (P2a) reward feedback upon decisions, and the outcome-related feedback-related negativity (FRN) were compared between conditions and between patients, who experienced high craving upon alcohol cues (N = 18) and those who did not (N = 22).

RESULTS

Upon craving induction (vs. neutral condition), high-craving AUD patients showed less adjustment of decision choice to preceding reward experience and more variable decisions than low-craving AUD patients, together with accentuated reward-associated ERP (SPN and P2a), while outcome-related FRN was not modified by craving.

CONCLUSIONS

Results support orientation to reward in AUD patients, particularly amplified upon experienced craving, which may interfere with (feedback-guided) decision-making even in alcohol-unrelated context. Craving-accentuated ERP indices suggest neuroadaptive changes of cognitive-motivational states upon chronic alcohol abuse. Together with altered reward-related expectancies, this has to be considered in intervention and relapse prevention.

Diminished cortical response to risk and loss during risky decision making in alcohol use disorder

BACKGROUND

Risky decision-making is an important facet of addiction. Individuals with alcohol dependence show abnormalities in gambling and other risk-taking tasks. In one such measure, the Balloon Analogue Risk Task (BART), participants sequentially choose to pump a virtual balloon to increase potential reward while the risk of explosion increases, or to cash-out and take earnings. In a prior study, alcohol-dependent participants differed from controls in brain activation during decision-making on the BART, but the relationship between risk/reward magnitude and brain activation was not studied, nor were participants compared to controls. Here we compared the degree to which risk and magnitude of reward influenced brain activation in alcohol-dependent participants vs. controls during decision-making on the BART.

METHODS

Thirty-two participants (16 alcohol-dependent, 16 control; 5 females/group) performed the BART during fMRI. A parametric analysis tested for a relationship between risk/reward magnitude and activation in rDLPFC and bilateral striatum regions of interest when participants chose to take risk or to cash out. An exploratory whole-brain voxel-wise analysis of mean activation during pumping, cash-out, and explosion events was also conducted.

RESULTS

Compared with controls, alcohol-dependent participants displayed less modulation of activation in the rDLPFC when taking risk. Exploratory analyses found that alcohol-dependent participants showed less activation than controls during explosions in a cluster including the insula. No differences were seen in striatal activation.

CONCLUSIONS

Insensitivity of the rDLPFC to risk and of the insula to loss may contribute to decision-making deficits in alcohol dependence.