Increased Loss Aversion in Unmedicated Patients with Obsessive-Compulsive Disorder.

INTRODUCTION: Obsessive-compulsive disorder (OCD) patients show abnormalities in decision-making and, clinically, appear to show heightened sensitivity to potential negative outcomes. Despite the importance of these cognitive processes in OCD, few studies have examined the disorder within an economic decision-making framework. Here, we investigated loss aversion, a key construct in the prospect theory that describes the tendency for individuals to be more sensitive to potential losses than gains when making decisions. METHODS: Across two study sites, groups of unmedicated OCD patients (n = 14), medicated OCD patients (n = 29), and healthy controls (n = 34) accepted or rejected a series of 50/50 gambles containing varying loss/gain values. Loss aversion was calculated as the ratio of the likelihood of rejecting a gamble with increasing potential losses to the likelihood of accepting a gamble with increasing potential gains. Decision times to accept or reject were also examined and correlated with loss aversion. RESULTS: Unmedicated OCD patients exhibited significantly more loss aversion compared to medicated OCD or controls, an effect that was replicated across both sites and remained significant even after controlling for OCD symptom severity, trait anxiety, and sex. Post hoc analyses further indicated that unmedicated patients' increased likelihood to reject a gamble as its loss value increased could not be explained solely by greater risk aversion among patients. Unmedicated patients were also slower to accept than reject gambles, effects that were not found in the other two groups. Loss aversion was correlated with decision times in unmedicated patients but not in the other two groups. DISCUSSION: These data identify abnormalities of decision-making in a subgroup of OCD patients not taking psychotropic medication. The findings help elucidate the cognitive mechanisms of the disorder and suggest that future treatments could aim to target abnormalities of loss/gain processing during decision-making in this population.

Effects of context on risk taking and decision times in obsessive-compulsive disorder.

Despite the fact that OCD patients show altered decision making in everyday life, few studies have investigated how patients make risky decisions and what contextual factors impact choices. We investigated cognitive context with the use of the "framing effect" task, which investigates decision making based on whether monetarily equivalent choice options are framed in terms of a potential to either lose (lose $20 out of $50) or gain (gain $30 out of $50) money. In addition, we manipulated social context by providing positive or neutral feedback on subjects' choices. Overall, participants were risk taking for options framed in terms of potential loss and risk averse for options framed in terms of potential gain (the classic framing effect). Although OCD patients were generally more risk averse, the effect of the frame on choices did not differ significantly from healthy participants and choices were not impacted by social context. Within OCD patients, greater self-reported indecisiveness was associated with a larger effect of the frame on choices. OCD patients were also significantly slower to make choices in the loss compared to gain frame, an effect that was not observed among healthy participants. Overall, our results suggest that the framing of choice options has a differential effect on decision times but not the actual choices made by OCD patients, and that patients are not sensitive to social feedback when making choices. The correlation between indecisiveness and the framing effect in OCD suggests that further work interrogating the relationship between specific symptoms and decision making among patients may yield new insights into the disorder.

Functional connectivity with distinct neural networks tracks fluctuations in gain/loss framing susceptibility.

Multiple large-scale neural networks orchestrate a wide range of cognitive processes. For example, interoceptive processes related to self-referential thinking have been linked to the default-mode network (DMN); whereas exteroceptive processes related to cognitive control have been linked to the executive-control network (ECN). Although the DMN and ECN have been postulated to exert opposing effects on cognition, it remains unclear how connectivity with these spatially overlapping networks contribute to fluctuations in behavior. While previous work has suggested the medial-prefrontal cortex (MPFC) is involved in behavioral change following feedback, these observations could be linked to interoceptive processes tied to DMN or exteroceptive processes tied to ECN because MPFC is positioned in both networks. To address this problem, we employed independent component analysis combined with dual-regression functional connectivity analysis. Participants made a series of financial decisions framed as monetary gains or losses. In some sessions, participants received feedback from a peer observing their choices; in other sessions, feedback was not provided. Following feedback, framing susceptibility-indexed as the increase in gambling behavior in loss frames compared to gain frames-was heightened in some participants and diminished in others. We examined whether these individual differences were linked to differences in connectivity by contrasting sessions containing feedback against those that did not contain feedback. We found two key results. As framing susceptibility increased, the MPFC increased connectivity with DMN; in contrast, temporal-parietal junction decreased connectivity with the ECN. Our results highlight how functional connectivity patterns with distinct neural networks contribute to idiosyncratic behavioral changes.

Social closeness and feedback modulate susceptibility to the framing effect.

Although we often seek social feedback (SFB) from others to help us make decisions, little is known about how SFB affects decisions under risk, particularly from a close peer. We conducted two experiments using an established framing task to probe how decision-making is modulated by SFB valence (positive, negative) and the level of closeness with feedback provider (friend, confederate). Participants faced mathematically equivalent decisions framed as either an opportunity to keep (gain frame) or lose (loss frame) part of an initial endowment. Periodically, participants were provided with positive (e.g., "Nice!") or negative (e.g., "Lame!") feedback about their choices. Such feedback was provided by either a confederate (Experiment 1) or a gender-matched close friend (Experiment 2). As expected, the framing effect was observed in both experiments. Critically, an individual's susceptibility to the framing effect was modulated by the valence of the SFB, but only when the feedback provider was a close friend. This effect was reflected in the activation patterns of ventromedial prefrontal cortex and posterior cingulate cortex, regions involved in complex decision-making. Taken together, these results highlight social closeness as an important factor in understanding the impact of SFB on neural mechanisms of decision-making.

When Pinocchio's nose does not grow: belief regarding lie-detectability modulates production of deception.

Does the brain activity underlying the production of deception differ depending on whether or not one believes their deception can be detected? To address this question, we had participants commit a mock theft in a laboratory setting, and then interrogated them while they underwent functional MRI (fMRI) scanning. Crucially, during some parts of the interrogation participants believed a lie-detector was activated, whereas in other parts they were told it was switched-off. We were thus able to examine the neural activity associated with the contrast between producing true vs. false claims, as well as the independent contrast between believing that deception could and could not be detected. We found increased activation in the right amygdala and inferior frontal gyrus (IFG), as well as the left posterior cingulate cortex (PCC), during the production of false (compared to true) claims. Importantly, there was a significant interaction between the effects of deception and belief in the left temporal pole and right hippocampus/parahippocampal gyrus, where activity increased during the production of deception when participants believed their false claims could be detected, but not when they believed the lie-detector was switched-off. As these regions are associated with binding socially complex perceptual input and memory retrieval, we conclude that producing deceptive behavior in a context in which one believes this deception can be detected is associated with a cognitively taxing effort to reconcile contradictions between one's actions and recollections.

What if I Get Busted? Deception, Choice, and Decision-Making in Social Interaction.

Deception is an essentially social act, yet little is known about how social consequences affect the decision to deceive. In this study, participants played a computerized game of deception without constraints on whether or when to attempt to deceive their opponent. Participants were questioned by an opponent outside the scanner about their knowledge of the content of a display. Importantly, questions were posed so that, in some conditions, it was possible to be deceptive, while in other conditions it was not. To simulate a realistic interaction, participants could be confronted about their claims by the opponent. This design, therefore, creates a context in which a deceptive participant runs the risk of being punished if their deception is detected. Our results show that participants were slower to give honest than to give deceptive responses when they knew more about the display and could use this knowledge for their own benefit. The condition in which confrontation was not possible was associated with increased activity in subgenual anterior cingulate cortex. The processing of a question which allows a deceptive response was associated with activation in right caudate and inferior frontal gyrus. Our findings suggest the decision to deceive is affected by the potential risk of social confrontation rather than the claim itself.

The production and detection of deception in an interactive game.

This experiment tests how people produce and detect deception while playing a computerized version of the dice game, Meyer. Deception is an integral part of this game, and the participants played it as in real life, without constraints on whether or when to attempt to deceive their opponent, and whether or when to accuse them of deception. We stress that deception is a complex act that cannot be exclusively associated with telling a falsehood, and that it is facilitated by hierarchical decision-making and risk evaluation. In comparison with a non-competitive control condition, both claiming truthfully and claiming falsely were associated with activity in fronto-polar cortex (BA10). However, relative to true claims, false claims were associated with greater activity in the premotor and parietal cortices. We speculate that the activity in BA10 is associated with the development of high-level executive strategies involved in both types of claim, while the premotor and parietal activity is associated with the need to select which particular claim to make.

Detecting deception: the scope and limits.

With the increasing interest in the neuroimaging of deception and its commercial application, there is a need to pay more attention to methodology. The weakness of studying deception in an experimental setting has been discussed intensively for over half a century. However, even though much effort has been put into their development, paradigms are still inadequate. The problems that bedevilled the old technology have not been eliminated by the new. Advances will only be possible if experiments are designed that take account of the intentions of the subject and the context in which these occur.