Predictors of decision-making on the Iowa Gambling Task: independent effects of lifetime history of substance use disorders and performance on the Trail Making Test

Poor decision-making and executive function deficits are frequently observed in individuals with substance use disorders (SUDs), and executive deficits may contribute to poor decision-making in this population. This study examined the influence of lifetime history of an alcohol, cocaine, heroin, or polysubstance use disorder on decision-making as measured by the Iowa Gambling Task (IGT) after controlling for executive ability, demographic characteristics, and current substance use. Participants (131 with lifetime history of SUD and 37 controls) completed the IGT and two neuropsychological tests: the Trail Making Test and the Controlled Oral Word Association Test. Control participants performed significantly better than those with a lifetime SUD history on the IGT, but performance on the neuropsychological tests was comparable for the two groups. A lifetime SUD diagnosis was associated with performance on the IGT after controlling for covariates, and Trail Making Test performance was associated with IGT performance in both SUD and control participants.     

Emotion-based learning and central executive resources: an investigation of intuition and the Iowa Gambling Task

The role of emotion in complex decision-making can be assessed on the Iowa Gambling Task (IGT), a widely used neuropsychological measure that may tap a different aspect of executive function than that assessed by conventional measures. Most notably, the 'feeling' about which decks are good or bad, often described in relation to IGT performance, seems reminiscent of decision-making based on intuition-linked to a long history of research in decision-making contrasting the 'intuition' versus 'reasoning' styles of problem solving. To test the claim that the performance on the IGT relies more on emotion-based learning than conventional executive resources for normal performance, a group of participants completed the IGT simultaneously with one of two secondary-tasks, one of which (random number generation) is known to load executive resources. A third group performed the IGT with no secondary-task. If performance on the IGT requires the properties associated with intuitive operations, then participants should either show no disruption when completing a secondary-task, or at least show no selective disruption on a secondary-task that loads for executive function. The rate of learning in the three groups was not significantly different. This suggests that the sorts of cognitive resources loaded by traditional executive tasks such as random number generation do not overlap, in the cognitive architecture, with the emotion-based learning skills that are required for Iowa Gambling Task performance. The findings of the present study are also consistent with a previous claim of the Iowa group that emotion-based learning and working memory resources are doubly dissociable.     

No evidence of risk-taking or impulsive behaviour in a person with episodic amnesia: Implications for the role of the hippocampus in future-regarding decision-making

Does advantageous decision-making require one to explicitly remember the outcome of a series of past decisions or to imagine future personal consequences of one's choices? Findings that amnesic people with hippocampal damage cannot form a clear preference for advantageous decks over many learning trials on the Iowa Gambling Task (IGT) have been taken to suggest that complex decision-making on the IGT depends on declarative (episodic) memory and hippocampal integrity. Alternatively, impaired IGT performance in amnesic individuals could be secondary to risk-taking and/or impulsive behaviour resulting from impaired episodic future thinking (i.e. prospection) known to accompany amnesia. We tested this possibility in the amnesic individual K.C. using the IGT and the Toronto Gambling Task (TGT), a novel task that dissociates impulsivity from risk-taking without placing demands on declarative memory. K.C. did not develop a preference for advantageous over disadvantageous decks on the IGT and, instead, showed a slight preference for short-term gains and an inability to acquire a more adaptive appreciation of longer-term losses. He also did not display impulsive or risk-taking behaviour on the TGT, despite a profound inability to imagine personal future experiences. These findings suggest that impaired decision-making on the IGT in amnesia is unlikely to reflect a predilection to act in the moment or failure to take future consequences into account. Instead, some forms of future-regarding decision-making may be dissociable, with performance on tasks relying on declarative learning or on episodic-constructive processes more likely to be impaired.     

高低行为激活系统个体在赌博任务下的决策模式

为考察不同行为激活系统/行为抑制系统下的个体在Iowa赌博任务反应模式下的决策行为,本研究采用人格问卷与行为实验相结合的方式,探讨了人格、冲动和行为决策间的关系。结果发现:(1)行为激活系统三个维度与行为决策存在显著负相关,行为激活系统低分组的IGT得分较高,行为激活系统高分组的IGT得分较低,而冲动特征与IGT得分相关不显著;(2)行为激活系统高、低分者在IGT任务上差异显著,且行为激活系统高分组者在收益-风险并存情境中表现出"即时收益优先"的决策模式。结果提示,在收益-风险并存情境中,高行为激活的人格特征者倾向风险决策模式。     

Instructional cues modify performance on the Iowa Gambling Task

The current study investigated whether acute alcohol intoxication produces impaired decision-making on tasks assessing ventromedial prefrontal (VMF) cortex functioning and impulsive responding. Participants completed the Iowa Gambling Task (IGT), a decision-making test targeting the VMF, and the Newman Perseveration Task (NT), a measure of impulsivity. Personality measures of impulsivity were assessed using the Barratt Impulsiveness Scale (BIS). To encourage natural responding on both tasks, participants were falsely informed that the study was examining the effects of alcohol on memory; the impulsivity tasks were presented as 'distractor' tasks. Advantageous performance on the IGT was related to specific instructional cues as well as to knowledge about the experimental purpose. Performance of intoxicated and sober participants did not differ. A subsequent study in which the true purpose of the experiment was revealed confirmed that alcohol does not affect IGT performance. Most importantly, the instruction-sensitivity of the IGT emphasizes the importance of salient cues for decision-making.     

A validation of a computerised task of risk-taking and moral decision-making and its association with sensation-seeking,impulsivity and sociomoral reasoning

The aim of this study was to investigate the reliability and validity of the computer based application of the Secret Agent (SA) task of risk-taking and moral decision-making. The participants were 100 male patients in a maximum security hospital (50 with severe mental illness and 50 with personality disorder) and 50 community based healthy controls. All participants completed the SA task, the Iowa Gambling Task (IGT), and measures of IQ, antisocial personality traits, sensation-seeking, impulsivity and sociomoral reasoning. The SA risk-taking and moral decision-making scales had satisfactory levels of reliability (Cronbach’s alpha). Risk-taking correlated significantly with sensation-seeking across all three participant groups. In contrast, risk-taking only correlated with impulsivity among the severe mental illness group. Moral decision-making correlated with sociomoral reasoning among the personality disorder group. No correlation was found between the SA scores and the IGT score and the IGT did not correlate with sensation-seeking or impulsivity. IQ and antisocial personality traits did not correlate with the SA or IGT scales. The study highlights the importance of context, the nature of the risk-taking task, and ‘problem framing’ of the instructions in their relationship with individual differences.     

Orbitofrontal dysfunction in multiple sclerosis: Iowa Gambling Task

Cognitive dysfunction has been widely studied in multiple sclerosis (MS), however decision-making has been less investigated. The current study examined the decision-making processes of patients with multiple sclerosis (MS) using a computerized version of the Iowa Gambling Task (IGT). This task was applied to 18 patients with clinically diagnosed MS and 18 healthy control subjects matched for age, sex, and years of education. The results showed that IGT scores differ significantly between patients with MS and the healthy control subjects: the patients with MS made significantly less advantageous decisions than the controls in the IGT. Possible causes of impaired decision-making in multiple sclerosis are discussed.     

Impulsivity in borderline personality disorder: reward-based decision-making and its relationship to emotional distress

Impulsivity in Borderline Personality Disorder (BPD) has been defined as rapid and unplanned action. However, a preference for immediate gratification and discounting of delayed rewards might better account for the impulsive behaviors that appear to regulate emotional distress in BPD. To investigate this, a delay discounting task was administered to 30 outpatients diagnosed with BPD and 28 healthy community controls (all aged 15-24) before and after a mood induction. Trait impulsivity was measured with the Barratt Impulsiveness Scale. The results showed that the BPD group had a greater preference for immediate gratification and higher rate of discounting the delayed reward than the control group. Although the mood induction resulted in increased feelings of rejection and anger in all participants, and the rate of delay discounting changed significantly in the control group, the rate of discounting did not change for the BPD group. There was no evidence of rapid decision-making in the BPD group as response times were similar between the two groups during both trials. Finally, greater general impulsiveness and nonplanning impulsiveness were associated with greater rates of discounting in the BPD group. Together these findings suggest that BPD is characterized by a preference for immediate gratification and tendency to discount longer-term rewards. This characteristic appears to exist independent of feelings of rejection and anger, rather than being reactive to this, and to be related to trait impulsivity.     

Body image disturbance in patients with borderline personality disorder: Impact of eating disorders and perceived childhood sexual abuse

Body image disturbances occur in women with borderline personality disorder (BPD). Systematic research on these characteristics in well-defined BPD groups is lacking. It is unknown, if the disturbances are related to eating disorders and childhood sexual abuse (CSA), which frequently co-occur in patients with BPD. In the present study, cognitive-affective and behavioral components of body image for 89 female patients with BPD (49 with lifetime eating disorders) and 41 healthy participants were assessed via Body Image Avoidance Questionnaire (BIAQ) and Multidimensional Body-Self Relations Questionnaire (MBSRQ). Within the BPD group, 43 patients reported a history of CSA. Compared to healthy controls, BPD patients reported significantly more negative scores in the BIAQ and the MBSRQ. Both a history of CSA and a comorbid eating disorder were independently associated with an even more negative body image. Results suggest a disturbance of cognitive-affective and behavioral components of body image in female BPD patients.     

Relationships between executive function,working memory,and decision-making on the Iowa Gambling Task: Evidence from ventromedial patients,dorsolateral patients,and normal subjects

The results of previous studies are inconsistent in regard to the relationship between the Iowa Gambling Task (IGT), working-memory (WM), and executive tasks, and whether these cognitive processes could be considered as mechanisms underlying a decision-making deficit. Moreover, the relationship between the IGT and executive measures is examined based on a limited number of executive tasks, within different populations showing diffuse damage. In addition, there are fewer studies carried out within control participants, with those studies also being inconclusive. It is also suggested that the association of the IGT performance with executive tasks depends on whether the IGT was running under ambiguity or under risk. In this work, all of these issues are studied. Results showed that both patients with ventromedial (VMPFC, N = 10) and dorsolateral (DLPFC, N = 10) prefrontal cortex lesions are significantly impaired on almost all executive tasks, WM tasks, and the IGT. Furthermore, when the IGT is run under risk, there are significant correlations between executive measures and the IGT for the DLPFC patients and the control participants (N = 34) but not the VMPFC patients. No correlation was found between WM tasks and the IGT for both frontal subgroups and control participants. These findings suggested that the mechanisms underlying the IGT deficit differ according to the lesion locations.     

Borderline Personality Disorder and Deliberate Self‐Harm: Does Experiential Avoidance Play a Role?

The theory that borderline personality disorder (BPD) is associated with experiential avoidance, and that experiential avoidance mediates the association between BPD and deliberate, nonsuicidal self-harm was examined. Female inmate participants (N = 105) were given structured diagnostic assessments of BPD, as well as several measures of experiential avoidance. There was a high lifetime prevalence of past self-harm (47.6%). Higher dimensional scores representing BPD severity were associated with higher self-harm frequency and greater experiential avoidance. Structural equation modeling analyses indicated that experiential avoidance did not mediate the association between BPD and self-harm, although thought suppression was associated with self-harm frequency.     

Skills Practice in Dialectical Behavior Therapy for Suicidal Women Meeting Criteria for Borderline Personality Disorder

Dialectical Behavior Therapy (DBT) is an evidence-based practice for borderline personality disorder (BPD) and suicidal behavior that has been replicated with a variety of populations. Patients’ practice of behavioral skills taught in the group skills training component of DBT may be partly responsible for the positive treatment outcomes according to the skills deficit model of BPD that underlies DBT. This study was designed to examine the type and frequency of skills practiced by DBT patients. Participants were 49 women, who met criteria for BPD and current and chronic suicidal behavior, receiving 1 year of standard DBT as part of a clinical trial. Skills were recorded on the daily diary cards completed by participants each week and reviewed by their individual therapists. Results indicated that the majority of participants reported practicing skills most days throughout treatment. Crisis survival and mindfulness skills were practiced most frequently in our sample. Hierarchical linear modeling demonstrated that skills practice increased as a function of time in therapy. Directions for future research are discussed.     

Emotion-based learning on a simplified card game: the Iowa and Bangor Gambling Tasks

The Iowa Gambling Task (IGT) has been widely used in the assessment of neurological patients with frontal lesions. Emphasis has been placed on the complexity of the task (i.e., four decks of varying contingency pattern) with the suggestion that the participant must use emotion-based learning to deal with a complex decision-making process. The present study used a single deck card game (the Bangor Gambling Task, BGT), matched in many respects with the Iowa Gambling Task, in which the contingencies varied over time (gradually becoming worse for the participant) rather than across deck (as in the IGT). Forty participants performed both tasks. Performance on the tasks showed many similarities, with participants showing a comparable pattern of incremental learning on both tasks, reaching an analogous final level of performance. More importantly, there was a high correlation (r(2) = .93) in performance between the two tasks, the most salient feature of which was that virtually every participant who fell below categorisation of impaired IGT performance, also did very poorly on the BGT. These findings bear on the question of whether arguments about the 'complexity' of the Iowa Gambling Task necessarily explain why it appears to require emotion-based learning. The Bangor Gambling Task might also be a useful tool for clinical neuropsychologists, in the assessment of patients with executive dysfunction-given that the task is easier and quicker to administer than the Iowa Gambling Task, but appears to share the same performance features.     

Examining the relationship between emotion regulation deficits and borderline personality disorder features: A daily diary study

This study used a six-day daily diary methodology to precisely specify the nature of emotion regulation deficits associated with borderline personality disorder (BPD) features. Three possibilities were explored: that BPD features are associated with (1) the overall underuse of emotion regulation strategies; (2) the overuse of dysfunctional and the underuse of functional strategies; and (3) the lower perceived effectiveness of emotion regulation strategies. One hundred and fifty-four undergraduate participants completed self-report measures of BPD feature severity, and then reported their daily negative emotional intensity, whether or not they used various emotion regulation strategies, and whether or not the strategies that they used were effective across a six-day period. Higher BPD features were associated with (a) higher total frequency use of emotion regulation strategies; (b) higher frequency use of dysfunctional and functional emotion regulation strategies; and (c) less self-reported effectiveness of functional strategies. BPD features may be characterized by increased attempts to regulate emotions, without corresponding increases in perceived effectiveness.     

Age-related variance in decisions under ambiguity is explained by changes in reasoning,executive functions,and decision-making under risk

Previous literature has explained older individuals’ disadvantageous decision-making under ambiguity in the Iowa Gambling Task (IGT) by reduced emotional warning signals preceding decisions. We argue that age-related reductions in IGT performance may also be explained by reductions in certain cognitive abilities (reasoning, executive functions). In 210 participants (18–86 years), we found that the age-related variance on IGT performance occurred only in the last 60 trials. The effect was mediated by cognitive abilities and their relation with decision-making performance under risk with explicit rules (Game of Dice Task). Thus, reductions in cognitive functions in older age may be associated with both a reduced ability to gain explicit insight into the rules of the ambiguous decision situation and with failure to choose the less risky options consequently after the rules have been understood explicitly. Previous literature may have underestimated the relevance of cognitive functions for age-related decline in decision-making performance under ambiguity.     

The relationship of borderline personality disorder, life events and functioning in an Australian psychiatric sample

Studies have documented poor functioning and higher rates of negative life events in association with personality disorders (PDs), in particular with borderline personality disorder (BPD). The current study investigated the impact of recent life events, daily hassles and uplifts on psychosocial functioning in patients with PDs, while extending previous research by examining the role of perceived coping effectiveness and perceived stress of recent life events. Ninety-seven participants (Axis I group, N = 30; BPD group, N = 23; Other PD group, N = 44) completed measures of functioning, recent life events, daily hassles and uplifts. Results indicated that the BPD group reported the poorest levels of functioning, especially interpersonal functioning. The BPD group also reported more negative life events, particularly in the interpersonal relationships, personal health, crime, and financial domains. The BPD group experienced less uplifts, more hassles and found employment circumstances particularly stressful and difficult to cope with. Intensity of hassles was a predictor of functioning independent of a BPD diagnosis. A greater frequency of life events was closely associated with a non-BPD diagnosis in predicting a decrease in psychosocial functioning.     

Emotional intelligence,cognitive ability and information search in tactical decision-making

Emotional intelligence (EI) may promote more effective decision-making under stress. In the present study, 167 participants completed a situation judgment test for EI, and performed a decision-making task based on an Antarctic rescue scenario. Participants were assigned to either a negative or neutral feedback group. Negative feedback significantly increased distress and impaired decision-making. EI failed to moderate the impacts of negative feedback, but higher EI was associated with greater information-search activity irrespective of feedback condition. It is concluded that ability EI may have a motivational component that may support more exhaustive analysis of both social and non-social stimuli.     

Heightened sensitivity to facial expressions of emotion in borderline personality disorder

Individuals with borderline personality disorder (BPD) have been hypothesized to exhibit significant problems associated with emotional sensitivity. The current study examined emotional sensitivity (i.e., low threshold for recognition of emotional stimuli) in BPD by comparing 20 individuals with BPD and 20 normal controls on their accuracy in identifying emotional expressions. Results demonstrated that, as facial expressions morphed from neutral to maximum intensity, participants with BPD correctly identified facial affect at an earlier stage than did healthy controls. Participants with BPD were more sensitive than healthy controls in identifying emotional expressions in general, regardless of valence. These findings could not be explained by participants with BPD responding faster with more errors. Overall, results appear to support the contention that heightened emotional sensitivity may be a core feature of BPD.     

Paradoxical effects of education on the Iowa Gambling Task

Suitable normative information on the Iowa Gambling Task (IGT) is not currently available, though it is clear that there is great individual variability in performance on this assessment tool. Given that the task is presumed to measure the emotion-based learning systems that are thought to form the biological basis of 'intuition,' there is some reason to think that education (especially tertiary education) might explicitly de-emphasise the role of emotion-based learning in decision-making. This suggests the paradoxical finding that better-educated participants should show poorer performance on the IGT. We recruited 30 participants (all female, all aged 18-25) to participate in a 'real money' version of the IGT. There was no significant difference in performance in blocks 1-3 of the task (trials 1-60). However, there was a substantial effect of education on the final two blocks (trials 61-100), such that the less-well-educated participants produced twice as much of an improvement over baseline as did their university-educated colleagues. A range of possible explanations for this remarkable finding are discussed. The most likely appears to be that tertiary education specifically discourages the use of emotion-based learning systems in decision-making. These findings bear on the extent to which education has a role to play in our reliance on cognition and emotion in decision-making, including the likely role of education in the generation and maintenance of false beliefs.     

Effects of decision-phase time constraints on emotion-based learning in the Iowa Gambling Task

Research employing the Iowa Gambling Task (IGT) has frequently shown that learning is impaired in various clinical populations. However, precisely what constitutes "unimpaired" control group learning remains unclear. In order to understand some of the possible factors underlying variability in control group IGT performance, the present study sought to manipulate features of the task to intentionally disrupt learning. Specifically, the present study investigated the effects of time constraints on emotion-based learning during automated administration of the IGT. For two groups of participants, a time-constraint of either 2-s or 4-s was implemented during the critical decision making period, while a control group received no time constraint. We also evaluated participants' subjective experience after every block of 20 trials. Results demonstrated that the 2-s group differed significantly from the control group. Subjective experience measures revealed rapid development of awareness of the advantageous and disadvantageous decks among all three groups. Overall, our findings demonstrate, for the first time, the effects of decision-phase time constraints on emotion-based learning and indicate that the IGT reward/punishment schedules are to some extent cognitively penetrable.