A Novel, Expert-Endorsed, Neurocognitive Digital Assessment Tool for Addictive Disorders: Development and Validation Study.

BACKGROUND: Many people with harmful addictive behaviors may not meet formal diagnostic thresholds for a disorder. A dimensional approach, by contrast, including clinical and community samples, is potentially key to early detection, prevention, and intervention. Importantly, while neurocognitive dysfunction underpins addictive behaviors, established assessment tools for neurocognitive assessment are lengthy and unengaging, difficult to administer at scale, and not suited to clinical or community needs. The BrainPark Assessment of Cognition (BrainPAC) Project sought to develop and validate an engaging and user-friendly digital assessment tool purpose-built to comprehensively assess the main consensus-driven constructs underpinning addictive behaviors. OBJECTIVE: The purpose of this study was to psychometrically validate a gamified battery of consensus-based neurocognitive tasks against standard laboratory paradigms, ascertain test-retest reliability, and determine their sensitivity to addictive behaviors (eg, alcohol use) and other risk factors (eg, trait impulsivity). METHODS: Gold standard laboratory paradigms were selected to measure key neurocognitive constructs (Balloon Analogue Risk Task [BART], Stop Signal Task [SST], Delay Discounting Task [DDT], Value-Modulated Attentional Capture [VMAC] Task, and Sequential Decision-Making Task [SDT]), as endorsed by an international panel of addiction experts; namely, response selection and inhibition, reward valuation, action selection, reward learning, expectancy and reward prediction error, habit, and compulsivity. Working with game developers, BrainPAC tasks were developed and validated in 3 successive cohorts (total N=600) and a separate test-retest cohort (N=50) via Mechanical Turk using a cross-sectional design. RESULTS: BrainPAC tasks were significantly correlated with the original laboratory paradigms on most metrics (r=0.18-0.63, P<.05). With the exception of the DDT k function and VMAC total points, all other task metrics across the 5 tasks did not differ between the gamified and nongamified versions (P>.05). Out of 5 tasks, 4 demonstrated adequate to excellent test-retest reliability (intraclass correlation coefficient 0.72-0.91, P<.001; except SDT). Gamified metrics were significantly associated with addictive behaviors on behavioral inventories, though largely independent of trait-based scales known to predict addiction risk. CONCLUSIONS: A purpose-built battery of digitally gamified tasks is sufficiently valid for the scalable assessment of key neurocognitive processes underpinning addictive behaviors. This validation provides evidence that a novel approach, purported to enhance task engagement, in the assessment of addiction-related neurocognition is feasible and empirically defensible. These findings have significant implications for risk detection and the successful deployment of next-generation assessment tools for substance use or misuse and other mental disorders characterized by neurocognitive anomalies related to motivation and self-regulation. Future development and validation of the BrainPAC tool should consider further enhancing convergence with established measures as well as collecting population-representative data to use clinically as normative comparisons.

General and specific graphic health warning labels reduce willingness to consume sugar-sweetened beverages.

Sugar-sweetened beverage (SSB) consumption is associated with obesity and other severe negative health consequences. The present study examined the effectiveness of two types of health warning labels (HWLs) in modulating dietary choices for SSBs: specific HWLs, presenting health consequences associated with consuming SSBs, and general HWLs, presenting health consequences of an unhealthy diet and obesity. While electroencephalography (EEG) was recorded, 63 participants completed a computer-based task in which they were first randomly allocated to view either SBB-specific, general, or non-warning control HWLs. They then viewed images of a range of SSB products, varying on perceived healthiness and tastiness, and rated their willingness to consume (WTC) each one. Linear mixed-effect model analyses revealed that general and specific HWLs both decreased WTC SSBs perceived as tasty, compared to the control condition. For general HWLs, this effect was reduced for SSBs perceived to be healthy, suggesting that specific HWLs may be more effective at reducing SSB consumption. The EEG data showed that SSBs considered unhealthy elicited greater N1 amplitudes, and tasty SSBs elicited greater late positive potential (LPP) amplitudes, possibly reflecting attentional allocation and craving responses, respectively. However, no strong differences between HWL types were found. Taken together, the results suggest that graphic HWLs, both general and specific, have the potential to reduce SSB consumption, but they do not strongly modulate craving-related neural responses to SSBs.

Neural patterns during anticipation predict emotion regulation success for reappraisal.

The ability to exert control over emotions, termed emotion regulation (ER), is vital for everyday functioning. ER success may be influenced by processes relating to the anticipation (prior to active regulation) and implementation (during active regulation) of ER strategy use. We investigated whether brain activity patterns recorded using electroencephalography (EEG) during the first second of anticipation and implementation of two ER strategies-distraction and reappraisal-were related to regulation success. Participants viewed negative images that evoked disgust and sadness. Before each image was presented, participants were cued to either passively view the image or decrease their emotional responses. ER success scores were calculated from subsequent self-reported disgust and sadness ratings. Using multivariate support vector regression, ER success scores were predicted from spatiotemporal patterns of event-related potentials during the first second of anticipation and implementation phases of each ER strategy. For both sadness and disgust, reappraisal success could be predicted during anticipation, while distraction success could be predicted during implementation. These findings suggest that early anticipatory cognitive processes are a key determinant of reappraisal success, but may not be similarly important for distraction. This may be because reappraisal is more cognitively demanding than distraction, requiring enhanced preparation of mental resources.

Intrinsic Valuation of Information in Decision Making under Uncertainty.

In a dynamic world, an accurate model of the environment is vital for survival, and agents ought regularly to seek out new information with which to update their world models. This aspect of behaviour is not captured well by classical theories of decision making, and the cognitive mechanisms of information seeking are poorly understood. In particular, it is not known whether information is valued only for its instrumental use, or whether humans also assign it a non-instrumental intrinsic value. To address this question, the present study assessed preference for non-instrumental information among 80 healthy participants in two experiments. Participants performed a novel information preference task in which they could choose to pay a monetary cost to receive advance information about the outcome of a monetary lottery. Importantly, acquiring information did not alter lottery outcome probabilities. We found that participants were willing to incur considerable monetary costs to acquire payoff-irrelevant information about the lottery outcome. This behaviour was well explained by a computational cognitive model in which information preference resulted from aversion to temporally prolonged uncertainty. These results strongly suggest that humans assign an intrinsic value to information in a manner inconsistent with normative accounts of decision making under uncertainty. This intrinsic value may be associated with adaptive behaviour in real-world environments by producing a bias towards exploratory and information-seeking behaviour.

The neurocognitive correlates of non-substance addictive behaviors.

Neurocognitive deficits have been implicated as transdiagnostic risk markers of substance use disorders. However, these have yet to be comprehensively evaluated in other, non-substance addictions. In a large, general community sample (N = 475) the present study evaluated the neurocognitive correlates of problem alcohol use and three non-substance-related addictive behaviors: addictive eating (AE), problematic pornography use (PPU), and problematic use of the internet (PUI), to identify potential shared and distinct neurocognitive correlates. A sample of Australian residents (54.4 % female M[SD] age = 32.4[11.9] years) completed a comprehensive online assessment of neurocognitive tasks tapping into eight distinct expert-endorsed domains purportedly associated with addiction. Multiple linear regressions with bootstrapping were used to examine associations among each addictive behavior of interest and neurocognition, trait impulsivity, and compulsivity, as well as key covariates. Neurocognition was differentially associated with each addictive behavior. None of the neurocognitive domains were significantly associated with problematic alcohol use or AE (p >.05), poorer performance monitoring was significantly associated with higher levels of PPU and PUI (ß = -0.10, p =.049; ß = -0.09, p =.028), and a preference for delayed gratification was associated with more severe PUI (ß = -0.10, p =.025). Our findings have theoretical implications for how we understand non-substance addiction and suggest the need for a more nuanced approach to studying addictive behaviors that take into account the underlying neurocognitive mechanisms associated with each type of addiction.

Neurocognitive predictors of addiction-related outcomes: A systematic review of longitudinal studies.

It is well-established that addiction is typically associated with a distinct pattern of neurocognitive functioning with a consensus that it is typified by impaired top-down executive control and aberrant risk-reward processing. Despite a consensus that neurocognition plays an important role in characterizing and maintaining addictive disorders, there is a lack of systematic, bottom-up synthesis of quantitative evidence showing that neurocognition predicts addictive behaviors, and which neurocognitive constructs have the best predictive validity. This systematic review aimed to assess whether cognitive control and risk-reward processes as defined by the Research Domain Criteria (RDoC) predict the development and maintenance of addictive behaviors specifically, consumption, severity, and relapse. The findings from this review expose the substantial lack of evidence for neurocognition predicting addiction outcomes. However, there is evidence that suggests reward-related neurocognitive processes may be important for the detection of early risk for addiction, as well as a potentially viable target for designing novel, more effective interventions.

The neural encoding of information prediction errors during non-instrumental information seeking.

In a dynamic world, accurate beliefs about the environment are vital for survival, and individuals should therefore regularly seek out new information with which to update their beliefs. This aspect of behaviour is not well captured by standard theories of decision making, and the neural mechanisms of information seeking remain unclear. One recent theory posits that valuation of information results from representation of informative stimuli within canonical neural reward-processing circuits, even if that information lacks instrumental use. We investigated this question by recording EEG from twenty-three human participants performing a non-instrumental information-seeking task. In this task, participants could pay a monetary cost to receive advance information about the likelihood of receiving reward in a lottery at the end of each trial. Behavioural results showed that participants were willing to incur considerable monetary costs to acquire early but non-instrumental information. Analysis of the event-related potential elicited by informative cues revealed that the feedback-related negativity independently encoded both an information prediction error and a reward prediction error. These findings are consistent with the hypothesis that information seeking results from processing of information within neural reward circuits, and suggests that information may represent a distinct dimension of valuation in decision making under uncertainty.