Elsevier

Drug and Alcohol Dependence

Volume 84, Issue 3, 1 October 2006, Pages 231-239
Drug and Alcohol Dependence

Psychophysiological determinants and concomitants of deficient decision making in pathological gamblers

https://doi.org/10.1016/j.drugalcdep.2006.02.007Get rights and content

Abstract

Psychophysiological responses are considered to be a mediating factor in the development of pathological gambling (PG) and PG has been associated with differential arousal levels during gambling. Yet little is known about the specific psychophysiological responses to wins and losses in PG. This study investigated heart rate (HR) and skin conductance responses (SCRs) during the Iowa Gambling Task (IGT) in an adult PG group (n = 46) and a normal control (NC) group (n = 47). Anticipatory psychophysiological reactions to disadvantageous and advantageous choices during the IGT and psychophysiological responses to wins and losses were measured. The PG group performed worse than the NC group on the IGT and exhibited lower anticipatory SCRs and HR decreases when pondering choices of disadvantageous card decks during the IGT. The PG group showed a decrease in HR after losses and wins, whereas the NC group showed a decrease in HR after losses, but an increase in HR after wins. Reward and punishment sensitivity as measured by the self-report BIS/BAS scale influenced IGT performance and psychophysiological responses, but in general these effects were similar for the PG group and the NC group. Lower anticipatory psychophysiological responses to disadvantageous choices in PG suggest impaired risk assessment in this group. Absence of a HR increase after wins possibly implies that reward sensitivity is decreased in PG. Because levels of reward and punishment sensitivity were associated with differential anticipatory HR responses to advantageous and disadvantageous decks, it would be advisable to include this taxonomy in studies on psychophysiological responses to rewards and losses.

Introduction

Alcohol and substance abuse and dependence, and pathological gambling (PG) have similarities on both the phenotypcial and endophenotypical level. Both PG and alcohol and substance dependence are disorders characterized by a lack of self-regulation. Diminished self-regulation is displayed when an addicted person is not able to inhibit the urge for a desired drug or behavior, and to shift his or her behavior from the addictive reinforcement to a less self-destructive reinforcement. Although classified as an impulse control disorder, PG is regarded as a ‘behavioral addiction’ by some researchers (Blanco et al., 2001, Marks, 1990), and several DSM-IV-TR criteria for PG resemble those of alcohol and drug dependence, such as loss of control, tolerance, withdrawal, and the experience of negative consequences due to the gambling related behavior (Diagnostic and Statistical Manual IV-Text Revision, American Psychiatric Association, 1994).

Moreover, diminished neurocognitive functions have been found in both substance dependence (Bechara et al., 2002b, Bechara and Damasio, 2002a, Fein et al., 2002, Giancola and Moss, 1998, Pau et al., 2002) and PG (Goudriaan et al., 2005, Petry, 2001a, Petry, 2001b). Neurobiological similarities between PG and substance dependence have been clearly demonstrated (Bolla et al., 2003, Miguel-Hidalgo and Rajkowska, 2003, Paulus et al., 2002, Potenza et al., 2003, Reuter et al., 2005). However, until now, the study of similarities between addiction and PG with regard to psychophysiological parameters has been very limited, partly because a suitable model was not available. The introduction of the somatic marker model has greatly changed this situation on a theoretical level, whereas the development of the Iowa Gambling Task, which is based on the somatic marker model, has provided an ecological valid measurement tool to be used in empirical studies.

The somatic marker hypothesis (Damasio, 1996) provides a relevant theoretical framework for studying decision making processes and the role of psychophysiological reactions when anticipating rewards or losses in PG. This hypothesis postulates that unconscious bodily states (‘somatic markers’) guide our behavior. Somatic markers develop initially due to the experience of pleasurable or aversive stimuli (primary inducers), which generate a somatic response, such as a heart rate (HR) or skin conductance response (SCR). After early learning experiences, these somatic markers can be induced by activations of neural pathways that developed due to these earlier experienced stimuli. These activations (secondary inducers) can be elicited in anticipation of a situation which activates the memory or neural activation pattern of the earlier pleasurable or aversive consequence. Thus, somatic markers function to enable automatic or intuitive decision making, which is especially relevant in complex situations, where somatic markers promote decisions, and prevent profligate rational reasoning (Damasio, 1996). The ventromedial prefrontal cortex is thought to play a crucial role for triggering somatic markers activated by secondary inducers (Bechara et al., 1999, Bechara et al., 2002b).

The role of somatic markers in behavior has been investigated in a number of studies on decision making, using the Iowa Gambling Task (IGT; Bechara et al., 1994). In the IGT, participants play a computerized card test in which they have to learn to select cards from four decks, differing in long-term net wins. Participants have to learn over the course of the task, to choose the advantageous decks instead of the more risky, disadvantageous decks. Studies have shown that participants develop stronger somatic responses (somatic markers) before selecting cards from the disadvantageous decks, compared to responses before card selections from the advantageous decks. These somatic responses occur even before they have conscious knowledge of the difference between the decks. The development of these psychophysiological responses is thus argued to be essential to advantageous behavioral responses on this task (Bechara et al., 1994, Bechara et al., 2000). Patients with ventromedial prefrontal lobe damage and substance dependent individuals show deficits in the generation of somatic markers in anticipation of disadvantageous choices, and perform worse on this task (Bechara and Damasio, 2002a, Bechara et al., 1994, Bechara et al., 2001). However, some studies raised doubt on certain assumptions made in the somatic marker hypothesis. For instance, patients with dorsolateral prefrontal brain damage also performed worse on the IGT (Manes et al., 2002) and the assertion in the somatic marker hypothesis that somatic markers precede conscious knowledge in the IGT is challenged (Maia and McClelland, 2004). However, this last study did not investigate physiological responses, and thus, the role of somatic markers in the development of advantageous choices on the IGT is still undisputed.

The first research question focused on the role of somatic markers in the behavioral performance of pathological gamblers on the IGT. We hypothesized that pathological gamblers, over the course of the task, would develop diminished somatic responses preceding disadvantageous choices compared to normal controls, similar to the diminished somatic markers of patients with ventromedial prefrontal brain damage, and individuals with substance dependence.

In addition to the study of anticipatory somatic markers in PG, the study of psychophysiological reactions after experiencing wins or losses is relevant, because diminished psychophysiological responses to positive and/or negative consequences are proposed as factors contributing to the development and continuation of PG and alcohol/substance dependence (Blaszczynski and Nower, 2002, Sharpe, 2002, Clark and Robbins, 2002, Koob and Le Moal, 1997). Despite the importance given to psychophysiological processes in theories on PG, the number of studies on psychophysiological responses after separate wins or losses is relatively small. Psychophysiological reactions in pathological gamblers during actual gambling have been shown to be both higher and lower than those of normal controls (for a review, see: Goudriaan et al., 2004). Two studies examined psychophysiological reactions when imagining wins or losses in pathological gamblers. One of these studies indicated no differences in arousal when pathological gamblers imagined a win or a loss situation, whereas higher arousal was present in normal controls when imagining a win situation, in comparison to imagining losing (Sharpe, 2004). Another study reported higher psychophysiological reactions in pathological gamblers who imagined winning when watching a poker machine video compared to high and low frequency gambling normal control groups (Sharpe et al., 1995). No studies were found studying the separate effects of actual experienced wins and losses in a controlled experimental setting. Our second research question thus was whether the PG and NC group would differ in physiological reactions after wins or losses. The study of both anticipatory somatic markers and psychophysiological reactions after wins and losses in pathological gamblers could delineate whether somatic markers and/or psychophysiological reactions after wins and losses play a role in the diminished performance reported in the IGT studies in pathological gamblers.

Finally, reward and punishment sensitivity are known as risk factors in the development of alcohol and substance dependence (Dawe et al., 2004). These personality traits can be measured by self-report scales. Several studies indicate that reward and punishment sensitivity mediate the psychophysiological response to wins and losses (Knyazev et al., 2002, DePascalis et al., 1996, Kilzieh and Cloninger, 1993). Differences in reward and punishment sensitivity have also been reported in pathological gamblers compared to normal controls (Goudriaan et al., 2005, Petry, 2001a), and these factors could thus influence psychophysiological responses when performing the IGT. Therefore, exploratory analyses focused on the role of reward and punishment sensitivity traits on psychophysiological responses in the PG and normal control (NC) group. Fowles’ psychophysiological application of Gray's reward and punishment sensitivity personality theory (Fowles, 1980, Gray, 1987) refers to the influences of reward (influencing the behavioral approach system, BAS) and punishment (influencing the behavioral inhibition system, BIS) on general arousal, approach and avoidance behavior (Gray, 1987). Fowles’ model states that HR variability is sensitive for cues for reward, influencing the sympatic autonomic nervous system (Sturgis and Gramling, 1998, Fowles et al., 1982), whereas skin conductance level (SCL) variability is influenced by cues that signal aversive consequences, reflecting activity of the parasympatic autonomic nervous system (Finn et al., 1994, Fowles, 1988, Fowles, 1980). Our third research question thus examined whether reward and punishment sensitivity accounted for within group variance often encountered within clinical samples, and whether differences in these traits could also explain differences in psychophysiological responses between the PG and the NC group.

Section snippets

Recruitment and screening

The PG group (n = 46) was recruited from outpatients of an addiction treatment center. PG diagnoses were made according to DSM-IV PG criteria, using the Dutch version of section T of the DSM-IV Diagnostic Interview Schedule (DIS; Robins et al., 1998). The Dutch version of the South Oaks Gambling Screen (SOGS, Lesieur and Blume, 1987) was administered to obtain a sensitive measure of gambling severity (Strong et al., 2003). The NC group (n = 47) was recruited through local newspaper advertisements

Results

Table 1 indicates that no differences existed between the PG and the NC group on demographical data, such as age (ANOVA), sex (χ2 analysis), baseline HR and SCL, or estimated IQ (ANOVAs). The PG group had higher BIS punishment sensitivity scores than the NC group, F(1, 90) = 10.0, p < 0.01, η2 = 0.10, and higher BAS reward sensitivity scores than the NC group, F(1, 90) = 13.4, p < 0.001, η2 = 0.13. However, a χ2 analysis indicated no differences in the overall number of participants from the PG group and

Discussion

This study was the first to investigate differences in psychophysiological responses between pathological gamblers and normal controls when anticipating advantageous and disadvantageous choices, and when experiencing separate wins and losses. The findings of disadvantageous decision making on the IGT, in combination with a pattern of both abnormal anticipatory SCR and HR reactivity in pathological gamblers, are consistent with studies showing deficient behavioral decision making in substance

Acknowledgment

This study was funded by the Netherlands Organisation for Scientific Research-Health Research and Development (NOW-ZonMw, Grant 96040000-4).

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