Dorsal and ventral striatum activity in individuals with buying-shopping disorder during cue-exposure: A functional magnetic resonance imaging study.

BACKGROUND AND AIMS: Buying-shopping disorder (BSD) is a clinical condition in which individuals lose control over their buying behaviour and continue buying despite negative consequences such as indebtedness, loss of family and friends. BSD has been considered a behavioural addiction and first studies provide evidence for cue-reactivity and craving as potential pathomechanisms. The current study aimed at investigating neural correlates of cue-reactivity and craving in individuals with BSD using functional magnetic resonance imaging (fMRI). METHODS: A cue-reactivity paradigm comprising individualised shopping-related and control cues was applied in n = 18 individuals diagnosed with BSD and n = 18 gender, age, and handedness matched control participants using fMRI. Outside the scanner, symptoms of BSD and craving reactions towards shopping (before and after the cue-reactivity paradigm) were assessed via questionnaires. FINDINGS: Higher subjective craving reactions towards shopping, prior and after exposure to shopping cues, were observed in individuals with BSD compared to control participants. Consistent with studies in addiction research, we found increased activations in the dorsal striatum for individuals with BSD compared to control participants during exposure to shopping cues. Activity in the ventral striatum was associated with symptoms of BSD in affected individuals, but not in control participants. CONCLUSIONS: Consistent with studies investigating cue-reactivity in substance-use and behavioural addictions, the association between cue-exposure and activities in reward-related brain structures such as the dorsal and ventral striatum in BSD participants may contribute to a neural explanation of why individuals experience irresistible urges to buy and lose control over their behaviour.

Cue-induced craving in pathological buying: empirical evidence and clinical implications.

OBJECTIVE: Pathological buying is associated with marked distress and impaired functioning in important life domains. It is currently under debate whether pathological buying can be considered a behavioral addiction. In analogy to results reported in addicted individuals, craving reactions elicited by addiction-related cues might be an underlying mechanism for the etiology and pathogenesis of pathological buying. METHODS: In the present study, 30 pathological buyers and 30 matched control participants were examined with a cue-reactivity paradigm consisting of shopping and control cues. Skin conductance responses, as well as subjective ratings for arousal, valence, and urge to buy, were assessed. Subjective craving reactions were measured before and after the cue-reactivity paradigm. RESULTS: On a physiological level, skin conductance responses toward shopping cues were higher in pathological buyers (mean [M; standard deviation {SD}] = 0.26 [0.13]) compared with control participants (M [SD] = 0.19 [0.09]; t(58) = 2.29, p = .025, d = 0.60). On a behavioral level, the individuals with pathological buying rated the shopping cues as more arousing and more positive, and reported a greater urge to buy compared with control participants and with control cues. An increase in subjective craving after completing the cue-reactivity paradigm was observed only in the pathological buyers (Mpre [SD] = 1.95 [1.47], Mpost [SD] = 2.87 [1.79]; t(29) = 5.07, p < .001, d = 0.97). CONCLUSIONS: Cue-reactivity and craving might be potential correlates for the development and maintenance of pathological buying. The results demonstrate similarities between pathological buying and substance or behavioral addictions and provide implications for clinical treatment.

Stress and decision making: neural correlates of the interaction between stress, executive functions, and decision making under risk.

Stress and additional load on the executive system, produced by a parallel working memory task, impair decision making under risk. However, the combination of stress and a parallel task seems to preserve the decision-making performance [e.g., operationalized by the Game of Dice Task (GDT)] from decreasing, probably by a switch from serial to parallel processing. The question remains how the brain manages such demanding decision-making situations. The current study used a 7-tesla magnetic resonance imaging (MRI) system in order to investigate the underlying neural correlates of the interaction between stress (induced by the Trier Social Stress Test), risky decision making (GDT), and a parallel executive task (2-back task) to get a better understanding of those behavioral findings. The results show that on a behavioral level, stressed participants did not show significant differences in task performance. Interestingly, when comparing the stress group (SG) with the control group, the SG showed a greater increase in neural activation in the anterior prefrontal cortex when performing the 2-back task simultaneously with the GDT than when performing each task alone. This brain area is associated with parallel processing. Thus, the results may suggest that in stressful dual-tasking situations, where a decision has to be made when in parallel working memory is demanded, a stronger activation of a brain area associated with parallel processing takes place. The findings are in line with the idea that stress seems to trigger a switch from serial to parallel processing in demanding dual-tasking situations.

Physiological and endocrine reactions to psychosocial stress in alcohol use disorders: duration of abstinence matters.

BACKGROUND: Recent research findings suggest that heavy alcohol use is associated with alterations of the hypothalamic-pituitary-adrenal axis and autonomic nervous system function and that early abstinence is associated with blunted stress responsiveness. METHODS: This study investigated abstinent alcohol-dependent participants (AADs; n = 31), who had a drinking history of levels about 97 drinks per week (abstinence range: 2 weeks to 24 months), actively drinking problem drinkers (PRDs; n = 23), who reported drinking levels about 47 drinks per week and who were abstinent for at least 24 hours, and healthy control (HC) participants (n = 20). It was investigated how participants responded to a psychosocial stress task. All of them were exposed to a modified Trier Social Stress Test. Salivary cortisol, heart rate, skin conductance levels, and negative affect were assessed as stress indicators. RESULTS: AADs showed stress reactions comparable to HC participants, whereas active PRDs showed increased heart rate and cortisol stress responses. In the AAD group, duration of abstinence was positively related to cortisol stress responses. CONCLUSIONS: Active PRDs showed increased responses to psychosocial stress. Results indicate that duration of abstinence is a key factor when analyzing and interpreting stress responses in alcohol abuse and dependence.

Decision-making under risk conditions is susceptible to interference by a secondary executive task.

Recent research suggests two ways of making decisions: an intuitive and an analytical one. The current study examines whether a secondary executive task interferes with advantageous decision-making in the Game of Dice Task (GDT), a decision-making task with explicit and stable rules that taps executive functioning. One group of participants performed the original GDT solely, two groups performed either the GDT and a 1-back or a 2-back working memory task as a secondary task simultaneously. Results show that the group which performed the GDT and the secondary task with high executive load (2-back) decided less advantageously than the group which did not perform a secondary executive task. These findings give further evidence for the view that decision-making under risky conditions taps into the rational-analytical system which acts in a serial and not parallel way as performance on the GDT is disturbed by a parallel task that also requires executive resources.

Emotion Modulation through Music after Sadness Induction-The Iso Principle in a Controlled Experimental Study.

Music therapy intervention manuals suggest that individuals who suffer from affective disorders benefit from listening to music according to the iso principle. The iso principle comprises listening to music that matches the current mood of patients at first, and then to gradually shift to music that represents a desired mood. Within the current study, we investigate whether the sequence of music with different emotional valence can modulate the emotional state. All participants were healthy adults who underwent a sadness induction via a movie clip. They were subsequently divided into four experimental groups. Each was asked to listen to two pieces of music according to a specific sequence: sad-sad; sad-happy; happy-happy; happy-sad. Participants were prompt to rate their current emotional state at different stages of the experiment: prior to and after the movie clip, as well as after each of the two pieces of music. The frame used for the assessment was the Positive and Negative Affect Schedule and the Self-Assessment Manikin. The results indicate that the movie clip induced sadness. The group of participants who listened to the sad music first and the happy music afterwards ultimately reported a higher positive affect, a higher emotional valence, and a lower negative affect compared with the other groups. However, not all the between-group differences reached significance. We conclude that the sequence of music with different emotional valence affects the current emotional state. The results are generally in line with the iso principle. Directions for future research are presented.

Dissociation of decisions in ambiguous and risky situations in obsessive-compulsive disorder.

Patients with obsessive-compulsive disorder (OCD) often show deficits in everyday decision-making, a phenomenon which is leading to a growing research interest in neuropsychological aspects of decision-making in OCD. Previous investigations of OCD patients demonstrated deficits in the Iowa Gambling Task (IGT), a decision-making task with implicit rules. Results were interpreted as reflecting orbitofrontal cortex dysfunctions observed in OCD. The aim of the present study is to investigate OCD patients' performance on the Game of Dice Task (GDT), a decision-making task with explicit and stable rules. For this purpose, 23 patients with OCD and 22 healthy comparison subjects were examined with the GDT and the IGT as well as with tests of executive functioning. While patients performed worse than comparison subjects on the IGT, they were unimpaired on the GDT and executive functioning tasks. Results further emphasize dysfunctions of the orbitofrontal cortex, but indicate intact functioning of the dorsolateral prefrontal cortex in patients with OCD.

Buying despite negative consequences: Interaction of craving, implicit cognitive processes, and inhibitory control in the context of buying-shopping disorder.

BACKGROUND: Buying-shopping disorder (BSD) is a severe mental disorder in which individuals lose control over their buying/shopping behavior. It is debated whether BSD shares characteristics with other behavioral addictions. The current study aimed at investigating addiction-related concepts, i.e. cue-reactivity/craving, implicit cognitions, and inhibitory control mechanisms, in the context of BSD. METHODS: An analog sample of 277 participants completed a cue-reactivity paradigm with shopping-related pictures. To assess implicit cognitions (attentional bias and implicit associations) and inhibitory control, a visual dot probe paradigm, an implicit association test, and an affective shifting task, all with shopping-related and control pictures, were administered. The sequence of the three tasks was randomized across participants. Craving was measured prior and after the cue-reactivity paradigm and after completion of the experimental procedure. BSD severity was assessed using the Pathological Buying Screener (PBS). RESULTS: Increases in craving during the cue-reactivity paradigm, but decreases after the experimental procedure were observed. Craving, attentional bias and implicit cognitions were related to BSD severity-but not to inhibitory control. However, we found moderating effects of attentional bias and inhibitory control as well as implicit associations and inhibitory control on the relationship between craving and BSD severity. DISCUSSION/CONCLUSION: Results emphasize the role of cue-reactivity/craving, implicit cognitions and inhibitory control in the context of BSD. In line with models for behavioral addictions (I-PACE; Brand et al., 2019), the interaction of affective and cognitive biases towards shopping cues and dysfunctional inhibitory control mechanisms seems to explain the pathological engagement in buying/shopping despite negative consequences.

Skin conductance responses during decisions in ambiguous and risky situations in obsessive-compulsive disorder.

INTRODUCTION: Patients with obsessive-compulsive disorder (OCD) often have difficulties in everyday decision making. In addition, recent research suggests that patients have reduced performance on the Iowa Gambling Task, a laboratory decision-making task with implicit rules that taps emotional feedback processing. Disadvantageous decision making is accompanied by reduced skin conductance responses (SCRs) generated during task performance. METHODS: The current study investigates behavioural and SCR data during the Iowa Gambling Task (IGT) and additionally the Game of Dice Task (GDT), a decision-making task with explicit and stable rules. We examined 14 patients with OCD and 15 comparison subjects performing the two decision-making tasks while recording accompanying SCR. RESULTS: Patients showed difficulties on the Iowa Gambling Task but not the Game of Dice Task. This was also confirmed by the SCR results. In the Iowa Gambling Task differences in SCR patterns for patients and comparison subjects were observed, whereas SCRs during the Game of Dice Task did not differ between groups. CONCLUSIONS: Behavioural and SCR data indicate that patients with OCD have difficulties in decisions under implicit but not under explicit risk conditions.

Cue-induced craving and symptoms of online-buying-shopping disorder interfere with performance on the Iowa Gambling Task modified with online-shopping cues.

BACKGROUND AND AIMS: Subjects with buying-shopping disorder (BSD) continue to buy offline as well as online despite negative consequences. Previous studies indicate that subjects with BSD show cue-reactivity and craving when exposed to shopping cues and have problems in long-term advantageous decision-making. The current study aimed at investigating the effect of online-shopping cues on decision-making, and whether addiction-relevant concepts such as cue-reactivity/craving and the symptom severity of BSD are related to decision-making. METHODS: A non-clinical sample of 57 participants played a version of the modified Iowa Gambling Task (IGT), with online-shopping-related pictures shown either on the advantageous decks or on the disadvantageous decks (with control pictures on the opposing ones). Symptom severity of online-BSD and the craving to buy were assessed using questionnaires. In addition, the online-shopping pictures were rated concerning arousal, valence, and urge to buy. RESULTS: The participants who played the IGT with the online-shopping pictures displayed on the disadvantageous decks performed significantly poorer than the other group with online-shopping pictures on the advantageous decks. The between-group differences were moderated by craving reactions and the symptom severity of online-BSD: When online-shopping pictures were displayed on the disadvantageous decks, this only interfered with IGT performance in participants who had high craving reactions towards shopping cues and/or high symptom severity of online-BSD. CONCLUSION: Results indicate that exposure to online-shopping cues interferes with advantageous decision-making, especially in individuals with craving reactions and high symptoms of online-BSD. Results contribute to the question of why some people continue to buy despite negative consequences.

Don't drink and chill: Effects of alcohol on subjective and physiological reactions during music listening and their relationships with personality and listening habits.

Recent research indicates that favorite music can induce chills and alters physiological reactions. People frequently listen to music when they drink alcohol, for example in bars or discotheques. Alcohol has numerous effects on emotions, peripheral physiological and neural reactions. We investigated whether alcohol intake influences chill experiences and physiological reactions during music listening. 39 participants took part in the study and were tested twice: Once in a sober condition and once when they had drunken alcohol. Participants listened to two pieces of music in each of the two conditions: A favorite self-selected song and a control-song that was selected by the research group. Participants had to indicate when they experienced a chill and electrodermal activity and heart rate were measured during music listening. In addition, participants filled out questionnaires concerning the big five personality dimensions, music listening habits and general chill experiences. Results indicate that participants experienced most chills when they were sober and listened to their self-selected song. Electrodermal activity was highest when participants were sober. In addition, alcohol intake led to a dedifferentiation in heart rate activity. After alcohol intake, participants had similar heart rates, no matter whether they listened to their self-selected song or to the control-song. Extraversion was negatively related with physiological reactions, while openness to experiences was positively related with physiological reactions. Music listening habits also showed various relationships with chill experiences and physiological reactions, while general chill experiences did not. We conclude that alcohol intake reduces subjective chill experiences during music listening and alters the physiological reactions to music. Music listening habits and personality seem to influence these effects.

Anticipatory stress influences decision making under explicit risk conditions.

Recent research has suggested that stress may affect memory, executive functioning, and decision making on the basis of emotional feedback processing. The current study examined whether anticipatory stress affects decision making measured with the Game of Dice Task (GDT), a decision-making task with explicit and stable rules that taps both executive functioning and feedback learning. The authors induced stress in 20 participants by having them anticipate giving a public speech and also examined 20 comparison subjects. The authors assessed the level of stress with questionnaires and endocrine markers (salivary cortisol and alpha-amylase), both revealing that speech anticipation led to increased stress. Results of the GDT showed that participants under stress scored significantly lower than the comparison group and that GDT performance was negatively correlated with the increase of cortisol. Our results indicate that stress can lead to disadvantageous decision making even when explicit and stable information about outcome contingencies is provided.

Cue-reactivity in behavioral addictions: A meta-analysis and methodological considerations.

Background and aims Recent research has applied cue-reactivity paradigms to behavioral addictions. The aim of the current meta-analysis is to systematically analyze the effects of learning-based cue-reactivity in behavioral addictions. Methods The current meta-analysis includes 18 studies (29 data sets, 510 participants) that have used a cue-reactivity paradigm in persons with gambling (eight studies), gaming (nine studies), or buying (one study) disorders. We compared subjective, peripheral physiological, electroencephal, and neural responses toward addiction-relevant cues in patients versus control participants and toward addiction-relevant cues versus control cues in patients. Results Persons with behavioral addictions showed higher cue-reactivity toward addiction-relevant cues compared with control participants: subjective cue-reactivity (d = 0.84, p = .01) and peripheral physiological and electroencephal measures of cue-reactivity (d = 0.61, p < .01). Increased neural activation was found in the caudate nucleus, inferior frontal gyrus, median cingulate cortex, subgenual cingulate, and precentral gyrus. Persons with gambling, gaming, or buying disorders also showed higher cue-reactivity toward addiction-relevant cues compared with control cues: subjective cue-reactivity (d = 0.39, p = .11) and peripheral physiological and electroencephal measures of cue-reactivity (d = 0.47, p = .05). Increased neural activation was found in the caudate nucleus, inferior frontal gyrus, angular gyrus, inferior network, and precuneus. Discussion and conclusions Cue-reactivity not only exists in substance-use disorders but also in gambling, gaming, and buying disorders. Future research should differentiate between cue-reactivity in addictive behaviors and cue-reactivity in functional excessive behaviors such as passions, hobbies, or professions.

Role of the amygdala in decisions under ambiguity and decisions under risk: evidence from patients with Urbach-Wiethe disease.

Various neuropsychological studies have shown that decision-making deficits can occur in a wide range of patients with brain damage or dysfunctions. Decisions under ambiguity, as measured with the Iowa Gambling Task, primarily depend on the integrity of the ventromedial prefrontal cortex and the amygdala, as well as on further brain regions such as the somatosensory cortex. However, little is known about the specific role of these structures in decisions under risk measured with tasks that offer explicit rules for gains and losses and winning probabilities, for example, the Game of Dice Task. We aimed to investigate the potential role of the amygdala for decisions under risk. For this purpose, we examined three patients with Urbach-Wiethe disease--a rare syndrome associated with selective bilateral mineralisation of the amygdalae. Neuropsychological performance was assessed with the Iowa Gambling Task (decisions under ambiguity), the Game of Dice Task (decisions under risk), and an extensive neuropsychological test battery focussing on executive functions. Furthermore, previous studies found relationships between generating skin conductance responses and deciding advantageously in the Iowa Gambling Task. Accordingly, we recorded skin conductance responses during both decision tasks as a measure of emotional reactivity. Results indicate that patients with selective amygdala damage have lower scores in both decisions under ambiguity and decisions under risk. Decisions under risk are especially compromised in patients who also demonstrate deficits in executive functioning. In both gambling tasks, patients showed reduced skin conductance responses compared to healthy comparison subjects. The results suggest that deciding advantageously under risk conditions involves both the use of feedback from previous trials, as required by decisions under ambiguity, and in addition, executive functions.

Exposure to Unsolvable Anagrams Impairs Performance on the Iowa Gambling Task.

Recent research indicates that external manipulations, such as stress or mood induction, can affect decision-making abilities. In the current study, we investigated whether the exposure to an unsolvable task affected subsequent performance on the Iowa Gambling Task. Participants were randomly assigned to a condition in which they were exposed to unsolvable anagrams (n = 20), or a condition in which they worked on solvable anagrams (n = 22). Afterwards, all participants played the Iowa Gambling Task, a prominent task that measures decision making under uncertain conditions with no explicit rules for gains and losses. In this task, it is essential to process feedback from previous decisions. The results demonstrated that participants who worked on unsolvable anagrams made more disadvantageous decisions on the Iowa Gambling Task than the other participants. In addition, a significant gender effect was observed: Males who worked on unsolvable anagrams made a more disadvantageous decisions than the other male participants. Females who worked on unsolvable anagrams also made more disadvantageous decision than the other female participants, but differences were small and not significant. We conclude that the exposure to unsolvable anagrams induced the experience of uncontrollability which can elicit stress and learned helplessness. Stress and learned helplessness might have reduced the ability to learn from the given feedback, particularly in male participants. We assume that in real life, uncontrollable challenges that last longer than a single experimental manipulation can affect decision making severely, at least in males.

Effects of stress on decisions under uncertainty: A meta-analysis.

[Correction Notice: An Erratum for this article was reported in Vol 142(9) of Psychological Bulletin (see record 2016-39486-001). It should have been reported that the inverted u-shaped relationship between cortisol stress responses and decision-making performance was only observed in female, but not in male participants as suggested by the study by van den Bos, Harteveld, and Stoop (2009). Corrected versions of the affected sentences are provided.] The purpose of the present meta-analysis was to quantify the effects that stress has on decisions made under uncertainty. We hypothesized that stress increases reward seeking and risk taking through alterations of dopamine firing rates and reduces executive control by hindering optimal prefrontal cortex functioning. In certain decision situations, increased reward seeking and risk taking is dysfunctional, whereas in others, this is not the case. We also assumed that the type of stressor plays a role. In addition, moderating variables are analyzed, such as the hormonal stress response, the time between stress onset and decisions, and the participants' age and gender. We included studies in the meta-analysis that investigated decision making after a laboratory stress-induction versus a control condition (k = 32 datasets, N = 1829 participants). A random-effects model revealed that overall, stress conditions lead to decisions that can be described as more disadvantageous, more reward seeking, and more risk taking than nonstress conditions (d = .17). In those situations in which increased reward seeking and risk taking is disadvantageous, stress had significant effects (d = .26), whereas in other situations, no effects were observed (d = .01). Effects were observed under processive stressors (d = .19), but not under systemic ones (d = .09). Moderation analyses did not reveal any significant results. We concluded that stress deteriorates overall decision-making performance through the mechanisms proposed. The effects differ, depending on the decision situation and the type of stressor, but not on the characteristics of the individuals. (PsycINFO Database Record

Stress influences decisions to break a safety rule in a complex simulation task in females.

The current study examines the effects of acutely induced laboratory stress on a complex decision-making task, the Waste Water Treatment Simulation. Participants are instructed to follow a certain decision rule according to safety guidelines. Violations of this rule are associated with potential high rewards (working faster and earning more money) but also with the risk of a catastrophe (an explosion). Stress was induced with the Trier Social Stress Test while control participants underwent a non-stress condition. In the simulation task, stressed females broke the safety rule more often than unstressed females: χ(2) (1, N=24)=10.36, p<0.001, V=0.66. In males, no difference between stressed and unstressed participants was observed. We conclude that stress increased the decisions to break the safety rule because stressed female participants focused on the potential high gains while they neglected the risk of potential negative consequences.

Effects of Acute Laboratory Stress on Executive Functions.

Recent research indicates that stress can affect executive functioning. However, previous results are mixed with respect to the direction and size of effects, especially when considering different subcomponents of executive functions. The current study systematically investigates the effects of stress on the five components of executive functions proposed by Smith and Jonides (1999): attention and inhibition; task management; planning; monitoring; and coding. Healthy participants (N = 40) were either exposed to the computerized version of the Paced Auditory Serial Addition Test as a stressor (N = 20), or to a rest condition (N = 20). Stress reactions were assessed with heart rate and subjective measures. After the experimental manipulation, all participants performed tasks that measure the different executive functions. The manipulation check indicates that stress induction was successful (i.e., the stress group showed a higher heart rate and higher subjective responses than the control group). The main results demonstrate that stressed participants show a poorer performance compared with unstressed participants in all executive subcomponents, with the exception of monitoring. Effect sizes for the tasks that reveal differences between stressed and unstressed participants are high. We conclude that the laboratory stressor used here overall reduced executive functioning.

Pathological Buying Online as a Specific Form of Internet Addiction: A Model-Based Experimental Investigation.

The study aimed to investigate different factors of vulnerability for pathological buying in the online context and to determine whether online pathological buying has parallels to a specific Internet addiction. According to a model of specific Internet addiction by Brand and colleagues, potential vulnerability factors may consist of a predisposing excitability from shopping and as mediating variable, specific Internet use expectancies. Additionally, in line with models on addiction behavior, cue-induced craving should also constitute an important factor for online pathological buying. The theoretical model was tested in this study by investigating 240 female participants with a cue-reactivity paradigm, which was composed of online shopping pictures, to assess excitability from shopping. Craving (before and after the cue-reactivity paradigm) and online shopping expectancies were measured. The tendency for pathological buying and online pathological buying were screened with the Compulsive Buying Scale (CBS) and the Short Internet Addiction Test modified for shopping (s-IATshopping). The results demonstrated that the relationship between individual's excitability from shopping and online pathological buying tendency was partially mediated by specific Internet use expectancies for online shopping (model's R² = .742, p < .001). Furthermore, craving and online pathological buying tendencies were correlated (r = .556, p < .001), and an increase in craving after the cue presentation was observed solely in individuals scoring high for online pathological buying (t(28) = 2.98, p < .01, d = 0.44). Both screening instruments were correlated (r = .517, p < .001), and diagnostic concordances as well as divergences were indicated by applying the proposed cut-off criteria. In line with the model for specific Internet addiction, the study identified potential vulnerability factors for online pathological buying and suggests potential parallels. The presence of craving in individuals with a propensity for online pathological buying emphasizes that this behavior merits potential consideration within the non-substance/behavioral addictions.

Impaired decision making under ambiguity but not under risk in individuals with pathological buying-behavioral and psychophysiological evidence.

Pathological buying (PB) is described as dysfunctional buying behavior, associated with harmful consequences. It is discussed whether decision-making deficits are related to PB, because affected individuals often choose the short-term rewarding option of buying despite persistent negative long-term consequences. We investigated 30 patients suffering from PB and 30 matched control participants with two different decision-making tasks: the Iowa Gambling Task (IGT) measures decisions under ambiguity and involves emotional feedback processing, whereas the Game of Dice Task (GDT) measures decisions under risk and can be solved strategically. Potential emotional and cognitive correlates of decision making were investigated by assessing skin conductance response (SCR) and executive functioning. In comparison to the control participants, the patients showed more disadvantageous decisions under ambiguity in the IGT. These data were supported by the SCR results: patients failed to generate SCRs that usually occur before disadvantageous decisions. The physiological and behavioral performance on decisions under risk and executive functioning did not differ between groups. Thus, deficits in emotional feedback processing might be one potential factor in etiology and pathogenesis of PB and should be considered in theory and treatment.