Iowa Gambling Task (IGT): twenty years after - gambling disorder and IGT

Abstract

The Iowa Gambling Task (IGT) involves probabilistic learning via monetary rewards and punishments, where advantageous task performance requires subjects to forego potential large immediate rewards for small longer-term rewards to avoid larger losses. Pathological gamblers (PG) perform worse on the IGT compared to controls, relating to their persistent preference toward high, immediate, and uncertain rewards despite experiencing larger losses. In this contribution, we review studies that investigated processes associated with poor IGT performance in PG. Findings from these studies seem to fit with recent neurocognitive models of addiction, which argue that the diminished ability of addicted individuals to ponder short-term against long-term consequences of a choice may be the product of an hyperactive automatic attentional and memory system for signaling the presence of addiction-related cues (e.g., high uncertain rewards associated with disadvantageous decks selection during the IGT) and for attributing to such cues pleasure and excitement. This incentive-salience associated with gambling-related choice in PG may be so high that it could literally "hijack" resources ["hot" executive functions (EFs)] involved in emotional self-regulation and necessary to allow the enactment of further elaborate decontextualized problem-solving abilities ("cool" EFs). A framework for future research is also proposed, which highlights the need for studies examining how these processes contribute specifically to the aberrant choice profile displayed by PG on the IGT.

Keywords: Iowa Gambling Task; decision-making; dual-process model; gambling disorder; willpower.

Figure 1

(A) A framework for advantageous deck selection in healthy controls. Pathway (a): Impulsive motivational processes directed at options featuring short-term salient rewards. Pathway (b): The moderation of impulsive processes by “hot” reflective processes involved in the reduction of impulsive-incentive reactions and in the ability to anticipate the potential outcomes of a given decision on an emotional basis. Pathway (c): The ability to control emotional reactions and inhibit basic behavioral impulses by “hot” executive/reflective functions allows rational and cognitive determinations of risks and benefits associated with options (only during the last trials of the IGT, that is, when participants have experienced the different winl/loss contingencies enough and become aware of which decks are more at risk than others), which further reinforce the efficiency of reward anticipation processes (e.g., to weigh short-term gains against long-term losses on both emotional and rational bases). Pathway (d): Adequate sensitivity to loss and reward and accurate assessment of the quality of the decision, which would bias advantageously forthcoming deck selections. (B) A framework for disadvantageous deck selection in pathological gamblers. Pathway (a): Hyperactive impulsive motivational processes directed at options featuring high, short-term rewards (as evidenced with attentional bias and implicit association toward gambling-related cues in PG; see Hyperactivity of impulsive processes toward gambling-related cues in PG). These impulsive processes could possibly interfere with or “hijack” the top-down “hot” reflective mechanisms necessary for triggering alarming signals about futures outcomes (as evidenced by fMRI studies which showed that, during disadvantageous lGT choice or during gambling·-related choice, PG exhibit increased activation in brain regions encompassing both impulsive-amygdala, ventral striatum, caudate nucleus, medial pulvinar nucleus - and “hot” reflective·- orbitofrontal cortex - processes; see Hyperactive impulsive processes and impaired IGT performance in PG). As a result, disadvantageous deck options may be flagged as salient and preferred to advantageous decks. Pathway (b): The “hijack” by impulsive incentive processes of the “hot” reflective resources would hamper further elaborated decontextualized problem-solving abilities (suggested by the absence of correlation between PGs' impairments in “cool” executive functioning and their lowered IGT performances, at either the early or the latter stages of IGT; see Hyperactive impulsive processes and impaired IGT performance in PG). Pathway (c): Hyposensitivity to loss and reward in PG (as evidenced by fMRI studies which observed a diminished ventral striatal response in PG after receiving monetary rewards and losses; see Gambling disorder and post-decision appraisals during the IGT) and failure at correctly assessing the quality of their already poor decision (evidenced by studies which observed a dissociation between PGs' subjective assessment of performance and objective performance; see Gambling disorder and post-decision appraisals during the IGT). As a result, PG might fail at properly integrate the outcomes of their actions over time, which could lead them to persist in taking high-risk choices, despite suffering large losses.