Disentangling Risk and Uncertainty: When Risk-Taking Measures Are Not About Risk

How do emotions respond to outcome values and influence choice?

Emotions powerfully, predictably, and pervasively influence decision making. The risk-as-feelings hypothesis states that two kinds of emotions are important in decision-making, anticipatory emotions and anticipated emotions. We empirically investigated whether and how anticipatory and anticipated emotions may change as a function of outcome values and whether anticipatory or anticipated emotions may explain the influence of outcome values on risky choice. To study the effects of value on emotions and choice, we offered people hypothetical large amounts ($100, $200, $300, $400) and incentivized moderate amounts ($10, $20, $30, $40) as prospects in gambles over two consecutive studies. Using a representative sample from the US to ensure the generalizability of the findings, each participant in our two studies made choices in gain and loss domains. Overall, anticipatory and anticipated emotions responded very similarly to changes in value for the sure gains in both studies. The findings also indicated that both anticipatory and anticipated emotions explained the effects of the value on choice for the sure gain and sure losses, while both mediated the effect of framing on choice towards the sure and the gamble option. Although anticipatory emotions mediated a larger portion of the effect, anticipated emotions also show some mediation.

Greater Risk Taking in Cosmetic Surgery Acceptance and History: An Experimental and Computational Study

Cosmetic surgery is ever more affordable and accessible, but carries physical and psychological risks. Yet, no study to date has directly examined risk-taking behaviour under controlled conditions, beyond self-report and in relation to cosmetic surgery attitudes. We used the Balloon Analogue Risk Task and advanced computational modelling to measure decision-making behaviour and identify the latent parameters driving behaviour associated with cosmetic surgery attitudes in women with no cosmetic surgery history (N = 265) and a subsample of women with a cosmetic surgery history (N = 24). Risk taking was higher in women with greater acceptance and history of cosmetic surgery. Computational modelling revealed increased risk taking in women with greater acceptance of cosmetic surgery when decisions were made with greater knowledge of loss (risk) and not when the likelihood of loss was unknown (uncertainty). When women with greater acceptance of cosmetic surgery made decisions, they also placed less emphasis on possible losses (reduced loss aversion). Our findings suggest that women seeking cosmetic procedures may be less sensitive to losses and thus make more risky decisions. Greater emphasis should be placed on communicating potential losses rather than just the associated risks to women considering cosmetic procedures.No Level Assigned This journal requires that authors assign a level of evidence to each submission to which Evidence-Based Medicine rankings are applicable. This excludes Review Articles, Book Reviews, and manuscripts that concern Basic Science, Animal Studies, Cadaver Studies, and Experimental Studies. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Religiosity, Financial Risk Taking, and Reward Processing: An Experimental Study

The present study investigated the extent to which financial risk-taking (FRT) perspectives and religiosity influenced an individual's performance on financial decision-making tasks under risk and/or uncertainty. It further investigated the potential to measure this interaction using electro-encephalogram (EEG) assessments through reward-related event-related potentials (P3 and FRN). EEG data were collected from 37 participants undergoing four decision-making tasks comprising the Balloon Analogue Risk Task (BART), Iowa Gambling Test (IGT), Mixed-Gamble Loss-Aversion Task (MGLAT), and MGLA-Success Task (MGLAST). The present study found that BART performance may be affected by an interaction of FRT perspectives and religiosity. The physiological effects of task feedback were also distinguished between religious and non-religious individuals objectively with EEG data. Overall, while religiosity and FRT may not significantly influence IGT and MGLA performance, and interact with BART in a complex way, physiological reaction towards feedback after BART performance appears to be strongly affected by religiosity and FRT perspectives.

Ecological validity of common behavioral decision making tasks: evidence across two samples

BACKGROUND

Clinicians and scholars routinely use behavioral decision tasks to assess real-world decision making capabilities. However, many common behavioral decision making tasks lack data on the extent to which they predict real-world risky behaviors. Across two pre-registered studies, and two timepoints, we assessed decision making abilities using common behavioral tasks and predicted participants' real-world risky decision making from task performance.

METHOD

In Study 1, 918 Mechanical Turk (MTurk) workers completed three decision making tasks in addition to assessments of real-world risk behavior: preventive health behaviors, COVID-19 vaccination status, and virtual social distancing task performance. In Study 2, 221 college student participants completed the Study 1 tasks plus additional assessments of decision making and real world risk and protective behaviors.

RESULTS

Across both studies, the selected behavioral decision tasks rarely predicted real world behavior and, when they did, the relationship was weak at best.

CONCLUSIONS

These data suggest that these behavioral decision making tasks may not be good predictors of real world risky behavior at present, with some evidence that the specificity of the behavior being assessed matters (i.e. the closer the task was to the specific behavior being predicted), calling for additional ecological validity research, with a greater variety of tasks in the future.

Planning hydrological restoration of coastal wetlands: Key model considerations and solutions

The hydrological restoration of coastal wetlands is an emerging approach for mitigating and adapting to climate change and enhancing ecosystem services such as improved water quality and biodiversity. This paper synthesises current knowledge on selecting appropriate modelling approaches for hydrological restoration projects. The selection of a modelling approach is based on project-specific factors, such as costs, risks, and uncertainties, and aligns with the overall project objectives. We provide guidance on model selection, emphasising the use of simpler and less expensive modelling approaches when appropriate, and identifying situations when models may not be required for project managers to make informed decisions. This paper recognises and supports the widespread use of hydrological restoration in coastal wetlands by bridging the gap between hydrological science and restoration practices. It underscores the significance of project objectives, budget, and available data and offers decision-making frameworks, such as decision trees, to aid in matching modelling methods with specific project outcomes.

Effort Expenditure Increases Risk-Taking for Improbable Rewards

Previous studies have found that exerting effort can lead people to engage in risk-taking behaviors. While effort can be either cognitive or physical, risk-taking can take place in either a risky context with known outcome probabilities or an ambiguous context with unknown outcome probabilities. The goal of the current research is to investigate how effort type and decision context influence risk-taking after effort exertion. Across three experiments, we find evidence that investing effort increases risk-taking at a short timescale. Importantly, this effect is particularly noticeable when the chance of winning is low, rather than when it is uncertain. Furthermore, the increase in risk-taking happens regardless of whether the effort is cognitive or physical. These findings suggest the existence of a cost-invariant but decision context-variant mechanism for the risk-taking after-effect of effort expenditure, which helps to bring the negative emotions caused by effort exertion back to a state of emotional homeostasis.

Uncertainty as a driver of the youth mental health crisis

Mental health problems in young people have been on the rise for over a decade, with that trend accelerating during the pandemic. This review proposes that the catalyst effect of the pandemic offers insights into a key driver of increases in youth depression and anxiety: greater uncertainty. Uncertainty about many aspects of everyday life, including social connections, education, job security and health, increased during the pandemic, and this coincided with increasing rates of depression and anxiety. Lab-based developmental cognitive and clinical neuroscience research on tolerance of uncertainty and adolescent mental health shows that when adolescents fail to show age-typical tolerance of uncertainty, they are at greater risk of mental health problems. Avenues for future research to understand and promote tolerance of uncertainty in adolescents are proposed.

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.

Tools for the Assessment of Risk-Taking Behavior in Older Adults with Mild Dementia: A Cross-Sectional Clinical Study

Diseases such as Alzheimer's cause an alteration of cognitive functions, which can lead to increased daily risk-taking in older adults living at home. The assessment of decision-making abilities is primarily based on clinicians' global analysis. Usual neuropsychological tests such as the MoCA (Montreal Cognitive Assessment) cover most of the cognitive domains and include mental flexibility tasks. Specific behavioral tasks for risk-taking, such as the Balloon Analogue Risk Task (BART) or the Iowa Gambling Task (IGT), have been developed to assess risk-taking behavior, particularly in the field of addictology. Our cross-sectional study aims to determine whether the MoCA global cognitive assessment could be used as a substitute for behavioral tasks in the assessment of risky behavior. In the current study, 24 patients (age: 82.1 ± 5.9) diagnosed with mild dementia completed the cognitive assessment (MoCA and executive function assessment) and two behavioral risk-taking tasks (BART, simplified version of the IGT). Results revealed no relationship between scores obtained in the MoCA and behavioral decision-making tasks. However, the two tasks assessing risk-taking behavior resulted in concordant risk profiles. In addition, patients with a high risk-taking behavior profile on the BART had better Trail Making Test (TMT) scores and thus retained mental flexibility. These findings suggest that MoCA scores are not representative of risk-taking behavioral inclinations. Thus, additional clinical tests should be used to assess risk-taking behavior in geriatric settings. Executive function measures, such as the TMT, and behavioral laboratory measures, such as the BART, are recommended for this purpose.

Mechanisms of adjustments to different types of uncertainty in the reward environment across mice and monkeys

Despite being unpredictable and uncertain, reward environments often exhibit certain regularities, and animals navigating these environments try to detect and utilize such regularities to adapt their behavior. However, successful learning requires that animals also adjust to uncertainty associated with those regularities. Here, we analyzed choice data from two comparable dynamic foraging tasks in mice and monkeys to investigate mechanisms underlying adjustments to different types of uncertainty. In these tasks, animals selected between two choice options that delivered reward probabilistically, while baseline reward probabilities changed after a variable number (block) of trials without any cues to the animals. To measure adjustments in behavior, we applied multiple metrics based on information theory that quantify consistency in behavior, and fit choice data using reinforcement learning models. We found that in both species, learning and choice were affected by uncertainty about reward outcomes (in terms of determining the better option) and by expectation about when the environment may change. However, these effects were mediated through different mechanisms. First, more uncertainty about the better option resulted in slower learning and forgetting in mice, whereas it had no significant effect in monkeys. Second, expectation of block switches accompanied slower learning, faster forgetting, and increased stochasticity in choice in mice, whereas it only reduced learning rates in monkeys. Overall, while demonstrating the usefulness of metrics based on information theory in examining adaptive behavior, our study provides evidence for multiple types of adjustments in learning and choice behavior according to uncertainty in the reward environment.

Evaluating and selecting arguments in the context of higher order uncertainty

Human and artificial reasoning has to deal with uncertain environments. Ideally, probabilistic information is available. However, sometimes probabilistic information may not be precise or it is missing entirely. In such cases we reason with higher-order uncertainty. Formal argumentation is one of the leading formal methods to model defeasible reasoning in artificial intelligence, in particular in the tradition of Dung's abstract argumentation. Also from the perspective of cognition, reasoning has been considered as argumentative and social in nature, for instance by Mercier and Sperber. In this paper we use formal argumentation to provide a framework for reasoning with higher-order uncertainty. Our approach builds strongly on Haenni's system of probabilistic argumentation, but enhances it in several ways. First, we integrate it with deductive argumentation, both in terms of the representation of arguments and attacks, and in terms of utilizing abstract argumentation semantics for selecting some out of a set of possibly conflicting arguments. We show how our system can be adjusted to perform well under the so-called rationality postulates of formal argumentation. Second, we provide several notions of argument strength which are studied both meta-theoretically and empirically. In this way the paper contributes a formal model of reasoning with higher-order uncertainty with possible applications in artificial intelligence and human cognition.

Distinct inter-brain synchronization patterns underlying group decision-making under uncertainty with partners in different interpersonal relationships

Humans may behave in different manners when making decisions with friends and strangers. Whether the interpersonal relationship and the characteristics of the individuals in the group affected the group decision-making under uncertainty in the real-time interaction remains unknown. Using the turn-based Balloon Analogue Risk Task (BART), the present study examined the group decision-making propensity under uncertainty with partners in different interpersonal relationships and interpersonal orientations. Corresponding inter-brain synchronization (IBS) patterns at the prefrontal cortex (PFC) were also uncovered with the fNIRS-based hyperscanning approach. Behavioral results identified that dyads in the friend group exhibited the uncertainty-averse propensity when comparing with the stranger group. The fNIRS results reported that feedback-related IBS at the left inferior frontal gyrus (l-IFG) and medial frontopolar cortex (mFPC) during different feedbacks was modulated by interpersonal relationships. The IBS at all channels in the PFC during the positive and negative feedbacks, respectively, predicted the decision-making propensity under uncertainty in the stranger and friend groups based on the support vector machine (SVM) algorithm. The moderating role of the social value orientation (SVO) was also verified in the mediation effect of the dyad closeness on the decision-making propensity under uncertainty via the IBS at the right lateral frontopolar cortex (r-FPC). These findings demonstrated disparate behavioral responses and inter-brain synchronization patterns underlying group decision-making under uncertainty with partners in different interpersonal relationships.

Insular and Striatal Correlates of Uncertain Risky Reward Pursuit in Schizophrenia

BACKGROUND AND HYPOTHESIS

Risk-taking in specific contexts can be beneficial, leading to rewarding outcomes. Schizophrenia is associated with disadvantageous decision-making, as subjects pursue uncertain risky rewards less than controls. However, it is unclear whether this behavior is associated with more risk sensitivity or less reward incentivization. Matching on demographics and intelligence quotient (IQ), we determined whether risk-taking was more associated with brain activation in regions affiliated with risk evaluation or reward processing.

STUDY DESIGN

Subjects (30 schizophrenia/schizoaffective disorder, 30 controls) completed a modified, fMRI Balloon Analogue Risk Task. Brain activation was modeled during decisions to pursue risky rewards and parametrically modeled according to risk level.

STUDY RESULTS

The schizophrenia group exhibited less risky-reward pursuit despite previous adverse outcomes (Average Explosions; F(1,59) = 4.06, P = .048) but the comparable point at which risk-taking was volitionally discontinued (Adjusted Pumps; F(1,59) = 2.65, P = .11). Less activation was found in schizophrenia via whole brain and region of interest (ROI) analyses in the right (F(1,59) = 14.91, P < 0.001) and left (F(1,59) = 16.34, P < 0.001) nucleus accumbens (NAcc) during decisions to pursue rewards relative to riskiness. Risk-taking correlated with IQ in schizophrenia, but not controls. Path analyses of average ROI activation revealed less statistically determined influence of anterior insula upon dorsal anterior cingulate bilaterally (left: χ2 = 12.73, P < .001; right: χ2 = 9.54, P = .002) during risky reward pursuit in schizophrenia.

CONCLUSIONS

NAcc activation in schizophrenia varied less according to the relative riskiness of uncertain rewards compared to controls, suggesting aberrations in reward processing. The lack of activation differences in other regions suggests similar risk evaluation. Less insular influence on the anterior cingulate may relate to attenuated salience attribution or inability for risk-related brain region collaboration to sufficiently perceive situational risk.

Distinct neural dynamics underlying risk and ambiguity during valued-based decision making

Uncertainty can be fractioned into risk and ambiguity psychologically and neurobiologically. However, whether and how risk and ambiguity are dissociated in terms of neural dynamics during value-based decision making remain elusive. The present event-related potential (ERP) study addressed these issues by asking participants to perform a wheel-of-fortune task either during a risky context (Experiment 1; N = 30) where outcome probability was known or during an ambiguous context (Experiment 2; N = 30) where outcome probability was unknown. Results revealed that the cue-P3 was more enhanced for risk versus ambiguity during the anticipatory phase, whereas the RewP was more increased for ambiguity than risk during the consummatory phase. Moreover, the SPN and the fb-P3 components were further modulated by the levels of risk and ambiguity, respectively. These findings demonstrate a neural dissociation between risk and ambiguity, which unfolds from the anticipatory phase to the consummatory phase.

Conceptualisation of Uncertainty in Decision Neuroscience Research: Do We Really Know What Types of Uncertainties The Measured Neural Correlates Relate To?

In the article "What are neural correlates neural correlates of?" published in the journal BioSocieties, Gabriel Abend points out that neuroscientists cannot avoid philosophical questions concerning the conceptualization and operationalization of social-psychological phenomena they deal with at the physiological level. In this article, we build on Abend's thesis and, through a systematic literature review of decision neuroscience studies, test it with the example of the social-psychological phenomenon of uncertainty in decision making. In this paper, we provide an overview of studies that appropriately attempt to conceptualise uncertainty, and then use these studies to analyse papers looking for neural correlates of uncertainty. Based on a systematic review of studies, we investigate what types of uncertainty authors in the field of decision neuroscience address and define, what criteria they use to distinguish between these types, what problems are associated with their conceptualization, and whether the neural correlates of different types of uncertainty can be accurately identified. The paper concludes that, particularly in the economic context, a collaboration between the natural and social sciences works well, and neuroscience studies use economic conceptualizations of uncertainty that are further developed by sophisticated decision tasks. However, the paper also highlights problematic aspects that obscure the understanding of the phenomena under study. These include the lack of criteria for distinguishing between different types of phenomena, the unclear use of the general concept of uncertainty, and the confusion of phenomena or their erroneous synonymous use.

Deterministic and probabilistic regularities underlying risky choices are acquired in a changing decision context

Predictions supporting risky decisions could become unreliable when outcome probabilities temporarily change, making adaptation more challenging. Therefore, this study investigated whether sensitivity to the temporal structure in outcome probabilities can develop and remain persistent in a changing decision environment. In a variant of the Balloon Analogue Risk Task with 90 balloons, outcomes (rewards or balloon bursts) were predictable in the task's first and final 30 balloons and unpredictable in the middle 30 balloons. The temporal regularity underlying the predictable outcomes differed across three experimental conditions. In the deterministic condition, a repeating three-element sequence dictated the maximum number of pumps before a balloon burst. In the probabilistic condition, a single probabilistic regularity ensured that burst probability increased as a function of pumps. In the hybrid condition, a repeating sequence of three different probabilistic regularities increased burst probabilities. In every condition, the regularity was absent in the middle 30 balloons. Participants were not informed about the presence or absence of the regularity. Sensitivity to both the deterministic and hybrid regularities emerged and influenced risk taking. Unpredictable outcomes of the middle phase did not deteriorate this sensitivity. In conclusion, humans can adapt their risky choices in a changing decision environment by exploiting the statistical structure that controls how the environment changes.

Uncertainty in individual risk judgments associates with vulnerability and curtailed climate adaptation

Risk assessments are key for the effective management of potential environmental threats. Across probabilistic phenomena, climate change is an exemplar of paramount uncertainties. These uncertainties have been embraced in supporting governments' decisions; yet receive scarce attention when studying individual behavior. Analyzing a survey conducted in the USA, China, Indonesia, and the Netherlands (N=6242), we explore socio-economic, psychological, and behavioral differences between individuals who can subjectively assess risks, and those who are risk-uncertain. We find that risk-uncertain individuals are more likely to belong to societal subgroups classically considered as vulnerable, and have reduced capacities and intentions to adapt to hazards-specifically floods. The distinctions between risk-aware and risk-uncertain individuals indicate that ignoring differences in individuals' capacity to assess risks could amount to persistent vulnerability and undermine climate-resilience efforts. While we use floods emblematically, these finding have consequences for the standard practice of dropping or bootstrapping uncertain responses, irrespective of the hazard, with implications for environmental management.

Risk-taking in the human brain: An activation likelihood estimation meta-analysis of the balloon analog risk task (BART)

The Balloon Analog Risk Task (BART) is increasingly used to assess risk-taking behavior and brain function. However, the brain networks underlying risk-taking during the BART and its reliability remain controversial. Here, we combined the activation likelihood estimation (ALE) meta-analysis with both task-based and task-free functional connectivity (FC) analysis to quantitatively synthesize brain networks involved in risk-taking during the BART, and compared the differences between adults and adolescents studies. Based on 22 pooled publications, the ALE meta-analysis revealed multiple brain regions in the reward network, salience network, and executive control network underlying risk-taking during the BART. Compared with adult risk-taking, adolescent risk-taking showed greater activation in the insula, putamen, and prefrontal regions. The combination of meta-analytic connectivity modeling with task-free FC analysis further confirmed the involvement of the reward, salience, and cognitive control networks in the BART. These findings demonstrate the core brain networks for risk-taking during the BART and support the utility of the BART for future neuroimaging and developmental research.

Does boredom affect economic risk preferences?

Previous literature and conventional wisdom have led researchers to believe that boredom increases economic risk taking, but the evidence in support of this conclusion is limited and has important shortcomings. In four experiments (including more than 1,300 subjects), we systematically studied the effects of boredom on economic risk preferences. Across different risk elicitation tasks, boredom inductions, incentive schemes, subject pools, and using both reduced form and structural analyses, we consistently failed to find an effect of boredom on risky decisions. Our results disprove that boredom leads to even small increments in risk taking in one-shot elicitation tasks, and small to medium increases in multiple-choice elicitations. These findings question an important established belief, contribute to better understand the consequences of boredom, and have substantive implications for experiments on economic decision making.

The influence of incidental emotions on decision-making under risk and uncertainty: a systematic review and meta-analysis of experimental evidence

Emotions influence human decisions under risk and uncertainty, even when they are unrelated to the decisions, i.e. incidental to them. Empirical findings are mixed regarding the directions and sizes of the effects of discrete emotions such as fear, anger, or happiness. According to the Appraisal-Tendency Framework (ATF), appraisals of certainty and control determine why same-valence emotions can differentially alter preferences for risky and uncertain options. Building upon this framework of emotion-specific appraisals, we conducted a systematic review and meta-analysis of 28 experimental studies on the effects of discrete incidental emotions on decision-making under risk and uncertainty. We evaluated potential moderators at the task and study levels. We find emotion-specific, moderately heterogeneous effects partially in line with the expectations of the ATF. The framing and financial consequences of choices, the type of choices, and the presence of other participants during the task do not moderate the effect. Our meta-analytic results support the differential influence of discrete, incidental emotions on decision-making under risk and uncertainty depending on appraisals other than valence. We discuss limited sample sizes and heterogeneity as reasons for the absence of significant moderators and encourage experimental investigations of individual differences in the susceptibility to incidental affective influences.

(Re)Conceptualising 'good' proxy decision-making for research: the implications for proxy consent decision quality

People who are unable to make decisions about participating in research rely on proxies to make a decision based on their wishes and preferences. However, patients rarely discuss their preferences about research and proxies find it challenging to determine what their wishes would be. While the process of informed consent has traditionally been the focus of research to improve consent decisions, the more conceptually complex area of what constitutes 'good' proxy decision-making for research has remained unexplored. Interventions are needed to improve and support proxy decision-making for research but are hampered by a lack of understanding about what constitutes decision quality in this context. A global increase in conditions associated with cognitive impairment such as dementia has led to an urgent need for more research into these conditions. The COVID-19 pandemic and subsequent necessity to conduct research with large numbers of critically ill patients has made this need even more pressing. Much of the empirical research centres on the desire to improve decision accuracy, despite growing evidence that authenticity is more reflective of the aim of proxy decisions and concerns about the methodological flaws in authenticity-focused studies. Such studies also fail to take account of the impact of decision-making on proxies, or the considerable body of research on improving the quality of healthcare decisions. This paper reports a concept synthesis of the literature that was conducted to develop the first conceptualisation of 'good' proxy decisions about research participation. Elements of decision quality were identified across three stages of decision-making: proxy preparedness for decision-making which includes knowledge and understanding, and values clarification and preference elicitation; the role of uncertainty, decisional conflict, satisfaction and regret in the decision-making process; and preference linked outcomes and their effect. This conceptualisation provides an essential first step towards the future development of interventions to enhance the quality of proxy decision-making and ensure proxy decisions represent patients' values and preferences.

Younger adults tolerate more relational risks in everyday life as revealed by the general risk-taking questionnaire

A range of self-report questionnaires were developed to quantify one’s risk-taking (RT) tendency. Exploring people’s perceived risk level associated with negative risk behaviors is essential to develop a better understanding and intervention policies for RT. In the present study, we proposed a 2 × 10-item scale, namely, the general risk-taking questionnaire (GRTQ), to evaluate RT tendency and risk attitude among the general population by measuring people’s engagement in and perceptions toward 10 commonly known risky behaviors. A total of 2984 adults residing in 10 prefectures in Japan (age range = 20–59, 53.12% female) provided valid responses to an online survey. Apart from the factor analysis procedures, multivariate negative binomial regression models have been applied to investigate the relationship between RT engagement and perception. We obtained two identical factors, namely, personal risk and relational risk, for both scales of the GRTQ. Increased levels of RT engagement were found in younger, male, nonmarried, nonparent and urban respondents. Despite an overall negative correlation between RT engagement and perception, our model revealed a weaker linkage in the younger population for relational risk behaviors. Overall, we showed evidence that the GRTQ is an easy-to-administer, valid and reliable measure of RT for future clinical research.

Appropriately Tuning Stochastic-Psychometric Properties of the Balloon Analog Risk Task

The Balloon Analog Risk Task (BART) allows to experimentally assess individuals’ risk-taking profiles in an ecologically sound setting. Many psychological and neuroscientific studies implemented the BART for its simplicity and intuitive nature. However, some issues in the design of the BART are systematically unconsidered in experimental paradigms, which may bias the estimation of individual risk-taking profiles. Since there are no methodological guidelines for implementing the BART, many variables (e.g., the maximum explosion probabilities, the rationale underlying stochastic events) vary inconstantly across experiments, possibly producing contrasting results. Moreover, the standard version of the BART is affected by the interaction of an individual-dependent, unavoidable source of stochasticity with a trial-dependent, more ambiguous source of stochasticity (i.e., the probability of the balloon to explode). This paper shows the most appropriate experimental choices for having the lowest error in the approximation of risk-taking profiles. Performance tests of a series of simulated data suggest that a more controlled, eventually non-stochastic version of the BART, better approximates original risk-taking profiles. Selecting optimal BART parameters is particularly important in neuroscience experiments to optimize the number of trials in a time window appropriate for acquiring neuroimaging data. We also provide helpful suggestions to researchers in many fields to allow the implementation of optimized risk-taking experiments using the BART.

A review of risky decision-making in psychosis-spectrum disorders

The investigation of risky decision-making has a prominent place in clinical science, with sundry behavioral tasks aimed at empirically quantifying the psychological construct of risk-taking. However, use of differing behavioral tasks has resulted in lack of agreement on risky decision-making within psychosis-spectrum disorders, as findings fail to converge upon the typical, binary conceptualization of increased risk-seeking or risk-aversion. The current review synthesizes the behavioral, risky decision-making literature to elucidate how specific task parameters may contribute to differences in task performance, and their associations with psychosis symptomatology and cognitive functioning. A paring of the literature suggests that: 1) Explicit risk-taking may be characterized by risk imperception, evidenced by less discrimination between choices of varying degrees of risk, potentially secondary to cognitive deficits. 2) Ambiguous risk-taking findings are inconclusive with few published studies. 3) Uncertain risk-taking findings, consistently interpreted as more risk-averse, have not parsed risk attitudes from confounding processes that may impact decision-making (e.g. risk imperception, reward processing, motivation). Thus, overgeneralized interpretations of task-specific risk-seeking/aversion should be curtailed, as they may fail to appropriately characterize decision-making phenomena. Future research in psychosis-spectrum disorders would benefit from empirically isolating contributions of specific processes during risky decision-making, including the newly hypothesized risk imperception.

Decision-Making Under Risk and Uncertainty by Substance Abusers and Healthy Controls

Cognitive impairment characterized by high impulsivity and risk-taking has been correlated with substance-related disorders. However, it is unclear if the decision-making process is well known upon consideration of factors such as uncertainty environments, risk, and time manipulation in different decision-making procedures. The main objective of this study was to identify behavioral differences between substance abusers and healthy control participants in a behavioral test battery, including (1) two uncertainty decision-making tasks, the Balloon Analog Risk Task (BART) and the Iowa Gambling Task (IGT, trial 1-40); (2) three risk-taking tasks, the Columbia Card Task Hot version (CCT-hot), Columbia Card Task Cold version (CCT-cold), and the IGT (trial 41-100); and (3) an impulsivity task, the Delay Discounting task (DD). The second objective looked at how the six behavioral tests correlate. We worked with a sample of 54 adult participants (Substance abusers: n = 28; Healthy controls: n = 26). An anonymous survey website was created to execute all the cognitive tasks. The results showed no statistically significant differences between the groups in any of the tasks. However, the results showed an upward trend of impulsive (i.e., steeply discounting curve) and risk-taking behaviors (i.e., a low learning curve in IGT) in substance abuse participants. The factor analysis results showed four different main factors: (1) risk-taking task in the IGT (trial 40-100), (2) uncertainty task in BART, (3) impulsivity in DD, IGT (trial 1-40), and (4) deliberate process in the Columbia card task (cold and hot). We conclude that factors such as the uncertainty tasks in the BART and the first block of IGT trials, the risk cues in the CCT tasks (i.e., number of loss, number of gains, and loss cards), and the time to delivery in the DD task, can affect the complex decision-making process in both clinical and healthy groups.

Best Medical Advice: Providing Medical Leadership in Uncertain Times

Military physicians must often balance medical and operational priorities when providing advice to operational commanders. This case describes how a Navy Medical Corps Officer serving with a Marine Corps helicopter squadron during the initial stages of the COVID-19 pandemic helped manage risk.

From motivation, decision-making to action: An fMRI study on suicidal behavior in patients with major depressive disorder

OBJECTIVE

We explored the neural mechanisms underlying disadvantageous risk decision making in un-medicated major depressive disorder patients who had recent suicide attempts.

METHODS

53 patients with major depressive disorder (MDD), including 23 with a history of suicide attempts (SA) and 30 without (NS), and 30 healthy controls (HCs) completed pertinent psychometric assessments, and the dynamic decision making balloon analogue risk task (BART) under fMRI. We also built a 4-parameter Bayesian computational modeling for decision making analyses.

RESULTS

Several distinct findings emerged. First, SA patients had no depression intensity difference but higher pain avoidance in psychometrics, and more risk aversion in the BART when compared to the NS patients, with computational modeling confirming such reduced risk-taking propensity. Second, SA patients showed smaller left insular cortex activation than NS patients during the high risk, decisional phase of BART, and the modulation correlated with pain avoidance in both SA and NS groups. Third, during feedback phase of loss trials of the BART, SA patients had greater activation in the left dorsolateral prefrontal cortex (dlPFC) than NS patients.

CONCLUSION

Taken together, we present novel findings and propose interpretations that the differential insula activation likely relates to high uncertainty-aversion in SA patients, contrary to the typical view that they are impulsive and risk prone. The differential left dlPFC activation likely suggests hypersensitivity to loss, contributing to conservative decision-making at large, and extreme choices such as suicide when value estimations are compromised and emotionally overwhelmed. The interactive interpretation places a renewed focus on psychological pain avoidance as a robust motivator for suicidal behavior.

Problems with Social Cognition and Decision-Making in Huntington's Disease: Why Is it Important?

Huntington’s disease starts slowly and progresses over a 15–20 year period. Motor changes begin subtly, often going unnoticed by patients although they are typically visible to those close to them. At this point, it is the early non-motor problems of HD that arguably cause the most functional impairment. Approximately 65% of gene carriers will experience a reduction in their occupational level, and just under half will feel unable to manage their finances independently before a clinical diagnosis is made. Understanding what drives this impairment in activities of daily living is the key to helping people with HD to live more independently for longer, especially in early disease. Early cognitive decline is likely to play a contributory factor although few studies have looked directly at this relationship. Recently, it has been shown that along with the well documented dysexecutive syndrome seen in HD, changes in social cognition and decision-making are more common than previously thought. Furthermore, some of the early neuropathological and neurochemical changes seen in HD disrupt networks known to be involved in social functioning. In this review, we explore how HD changes the way individuals interact in a social world. Specifically, we summarise the literature on both classical and social decision-making (value-based decision-making in a social context) along with studies of theory of mind, empathy, alexithymia, and emotion recognition in HD. The literature specific to HD is discussed and supported by evidence from similar neurodegenerative disorders and healthy individuals to propose future directions and potential therapeutic avenues to be explored.

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.

Adaptation to recent outcomes attenuates the lasting effect of initial experience on risky decisions

Both primarily and recently encountered information have been shown to influence experience-based risky decision making. The primacy effect predicts that initial experience will influence later choices even if outcome probabilities change and reward is ultimately more or less sparse than primarily experienced. However, it has not been investigated whether extended initial experience would induce a more profound primacy effect upon risky choices than brief experience. Therefore, the present study tested in two experiments whether young adults adjusted their risk-taking behavior in the Balloon Analogue Risk Task after an unsignaled and unexpected change point. The change point separated early "good luck" or "bad luck" trials from subsequent ones. While mostly positive (more reward) or mostly negative (no reward) events characterized the early trials, subsequent trials were unbiased. In Experiment 1, the change point occurred after one-sixth or one-third of the trials (brief vs. extended experience) without intermittence, whereas in Experiment 2, it occurred between separate task phases. In Experiment 1, if negative events characterized the early trials, after the change point, risk-taking behavior increased as compared with the early trials. Conversely, if positive events characterized the early trials, risk-taking behavior decreased after the change point. Although the adjustment of risk-taking behavior occurred due to integrating recent experiences, the impact of initial experience was simultaneously observed. The length of initial experience did not reliably influence the adjustment of behavior. In Experiment 2, participants became more prone to take risks as the task progressed, indicating that the impact of initial experience could be overcome. Altogether, we suggest that initial beliefs about outcome probabilities can be updated by recent experiences to adapt to the continuously changing decision environment.

Better safe than wealthy: Dysfunctional risk avoidance in spider-fearful individuals

Previous research has documented that fearful individuals avoid fear-relevant cues even if they incur costs in doing so. Paradigms that were previously used to study avoidance in the lab, manipulated reward contingencies in favor of selecting either fear-relevant or neutral cues, e.g., spiders versus butterflies. We, thus, developed a paradigm where the chance of monetary gains was linked with increasing probability of a fear-relevant or a neutral outcome. To this end, we modified the well-established Balloon Analogue Risk Task (BART) to include fear-relevant outcomes. Individuals with and without fear of spiders (N = 35) were offered the chance to inflate balloons, with more pumps resulting in larger gains. However, if the balloon exploded, this resulted in a loss of money - and at the same time in the presentation of a picture, either a fear-relevant spider or a neutral butterfly (emotional Balloon Analogue Risk Task; eBART). We operationalized risk aversion as the number of pumps and dysfunctionality of decision strategy as the amount of money that participants earned. In addition, decisional conflict was measured by response times for each decision. The data indicate, that spider-fearful individuals were generally more risk-averse and much more so in trials with fear-relevant stimuli as part of the negative outcome. Overall, this resulted in smaller amount of money that spider-fearful individuals earned compared to spider non-fearful individuals. Interestingly, spider-fearful compared to spider non-fearful individuals generally responded more hesitantly on all trials, and more so when they feared to encounter a spider. This research introduces a new paradigm and provides ecologically valid evidence for costly avoidance behavior in spider-fearful individuals. The eBART may be a promising new research tool to examine risk avoidance with emotionally relevant stimuli.

Investigating executive functions in youth with OCD and hoarding symptoms

Executive functions (EF) deficits are hypothesized to be a core contributor to hoarding symptoms. EF have been studied in adult hoarding populations, but studies in youth are lacking. The current study compared multiple EF subdomains between youth with obsessive-compulsive disorder (OCD) and youth with OCD and hoarding symptoms. Forty youth (8-18 years old) with a primary diagnosis of OCD were recruited. Participants were divided by hoarding severity on the Child Saving Inventory (CSI) into either the "hoarding group" (upper 33.3%) or the "low-hoarding group" (lower 66.7%). Groups were compared on EF tasks of cognitive flexibility, decision-making, and inhibitory control. Youth in the hoarding group exhibited significantly higher cognitive flexibility and lowered perseveration than the low-hoarding group. Hoarding and low-hoarding groups did not differ in any other EF subdomain. Hoarding symptoms in youth with OCD were not associated with deficits in EF subdomains; instead, youth who hoard exhibited higher cognitive flexibility compared to youth with low hoarding symptoms.

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.

A cognitive modeling analysis of risk in sequential choice tasks

There are many ways to measure how people manage risk when they make decisions. A standard approach is to measure risk propensity using self-report questionnaires. An alternative approach is to use decision-making tasks that involve risk and uncertainty, and apply cognitive models of task behavior to infer parameters that measure people’s risk propensity. We report the results of a within-participants experiment that used three questionnaires and four decision-making tasks. The questionnaires are the Risk Propensity Scale, the Risk Taking Index, and the Domain Specific Risk Taking Scale. The decision-making tasks are the Balloon Analogue Risk Task, the preferential choice gambling task, the optimal stopping problem, and the bandit problem. We analyze the relationships between the risk measures and cognitive parameters using Bayesian inferences about the patterns of correlation, and using a novel cognitive latent variable modeling approach. The results show that people’s risk propensity is generally consistent within different conditions for each of the decision-making tasks. There is, however, little evidence that the way people manage risk generalizes across the tasks, or that it corresponds to the questionnaire measures.

The influence of fear on risk taking: a meta-analysis

A common finding in the study of emotion and decision making is the tendency for fear and anxiety to decrease risk taking. The current meta-analysis summarises the strength and variability of this effect in the extant empirical literature. Our analysis of 136 effect sizes, derived from 68 independent samples and 9,544 participants, included studies that experimentally manipulated fear or measured naturally varying levels of fear or anxiety in both clinical and non-clinical samples, and studies measuring risky decision making and risk estimation. A multilevel random effects model estimated a small to moderate average effect size (r = 0.22), such that fear was related to decreased risky decision making and increased risk estimation. There was also high heterogeneity in the effect sizes. Moderator analyses showed that effect sizes were greater when risk tasks used tangible (e.g. monetary) outcomes and when studies used clinically anxious participants. However, there also remained considerable variability in effect sizes, the sources of which remain unknown. We posit several potential factors that may contribute to observed variability in this effect for future study, including factors concerning both the nature of fear experience and the risk taking context.

Non-Clinical Autistic Traits Correlate With Social and Ethical but Not With Financial and Recreational Risk-Taking

Previous research into uncertain and risky decision-making in autism spectrum disorder (ASD) has been inconclusive, with some studies reporting less uncertain and risky decisions by persons with ASD compared to neurotypicals, but other studies failing to find such effects. A possible explanation for these inconsistent findings is that aberrant decision-making in ASD is domain-specific, and only manifests itself in domains related to autism symptomatology. The present study examines this premise by correlating self-reported autistic traits to individuals' intention to engage in risky behaviours, their perception of how risky these behaviours are, and the amount of benefit they expect to obtain from engaging in them; all for five separate domains of decision-making: social, ethical, recreational, health/safety, and financial. In line with the hypotheses, persons with higher autistic traits reported reduced intention to engage in risky social behaviours and increased intention to engage in risky ethical behaviours. Furthermore, a positive correlation was found between autistic traits and risk perception in the social domain, indicating that persons with higher autistic traits perceive social behaviours as riskier than do persons with lower autistic traits. Correlations between autistic traits and individuals' intention to engage in risky recreational and financial behaviours were small, and supported the null hypothesis (as shown by Bayes Factors). Given that most studies on uncertain and risky decision-making take place in a financial context, the present results could explain previous inconsistent findings on decision-making in ASD. Therefore, future studies should also examine decision-making outside the financial realm.

Behavioral and Electrophysiological Arguments in Favor of a Relationship between Impulsivity, Risk-Taking, and Success on the Iowa Gambling Task

The aim of the present study was to investigate the relationship between trait impulsivity, risk-taking, and decision-making performance. We recruited 20 healthy participants who performed the Iowa Gambling Task (IGT) and the Balloon Analog Risk Task (BART) to measure decision-making and risk-taking. The impulsivity was measured by the Barratt Impulsiveness Scale. Resting-state neural activity was recorded to explore whether brain oscillatory rhythms provide important information about the dispositional trait of impulsivity. We found a significant correlation between the ability to develop a successful strategy and the propensity to take more risks in the first trials of the BART. Risk-taking was negatively correlated with cognitive impulsivity in participants who were unable to develop a successful strategy. Neither risk-taking nor decision-making was correlated with cortical asymmetry. In a more exploratory approach, the group was sub-divided in function of participants’ performances at the IGT. We found that the group who developed a successful strategy at the IGT was more prone to risk, whereas the group who failed showed a greater cognitive impulsivity. These results emphasize the need for individuals to explore their environment to develop a successful strategy in uncertain situations, which may not be possible without taking risks.

Event-related potentials in response to feedback following risk-taking in the hot version of the Columbia Card Task

Given the importance of risk-taking in individuals' personal and professional life, several behavioral tasks for measuring the construct have been developed. Recently, a new task was introduced, the Columbia Card Task (CCT). This task measures participants' risk levels and establishes how sensitive participants are to gains, losses, and probabilities when taking risk. So far, the CCT has been examined in behavioral studies and in combination with several (neuro)biological techniques. However, no electroencephalography (EEG) research has been done on the task. The present study fills this gap and helps to validate this relatively new experimental task. To this end, n = 126 students were asked to complete self-reports (reward responsiveness, impulsiveness, and sensation-seeking) and to perform the CCT (and other risk tasks) in an EEG setup. The results show that feedback appraisal after risky decision-making in the CCT was accompanied by a feedback-related negativity (FRN) and a P300, which were stronger in response to negative than positive feedback. Correlations between the FRN and P300 difference wave on the one hand and risk-related self-reports and behavior on the other were nonsignificant and small, but were mostly in the expected direction. This pattern did not change after excluding participants with psychiatric/neurological disorders and outliers. Excluding participants with reversed (positive > negative) difference waves strengthened FRN correlations. The impact such individuals can have on the data should be taken into account in future studies. Regarding the CCT in particular, future studies should also address its oddball structure and its masking of true values (censoring).