Almost winning: Induced MEG theta power in insula and orbitofrontal cortex increases during gambling near-misses and is associated with BOLD signal and gambling severity

Association between endocrine and neuropsychological endophenotypes and gambling disorder severity

BACKGROUND

Neurobiological characteristics have been identified regarding the severity of gambling disorder (GD). The aims of this study were: (1) to examine, through a path analysis, whether there was a relationship between neuroendocrine features, potentially mediational GD variables, and GD severity, and (2) to associate neuroendocrine variables, with GD severity-related variables according to gambling preferences.

METHODS

The sample included 297 outpatients with GD. We analyzed endocrine concentrations of different appetite-related hormones (ghrelin, liver antimicrobial peptide 2 [LEAP-2], leptin, adiponectin), and neuropsychological performance (working memory, cognitive flexibility, inhibition, decision making, premorbid intelligence). Path analysis assessed mechanisms between neuroendocrine features and GD severity, including mediational GD variables (impulsivity traits and gambling-related cognitive distortions). Partial correlations evaluated the associations between neuroendocrine variables, including impulsivity traits, and variables related to GD severity (DSM-5, South Oaks Gambling Screen, illness duration, and gambling-related cognitive distortions).

RESULTS

Lower adiponectin concentrations predicted greater GD severity, while higher LEAP-2 concentrations predicted more gambling-related cognitive distortions. Likewise, better neuropsychological performance directly predicted GD severity, but worse neuropsychological performance was associated with GD severity through the mediational variables of impulsivity traits and gambling-related cognitive distortions. Also, in non-strategic individuals with GD, poor working memory was associated with gambling expectancies and predictive control. In strategic individuals with GD, poor cognitive flexibility was associated with illusion of control, predictive control, and inability to stop gambling.

CONCLUSIONS

These results provide updated information about the comprehension of the interaction between neuroendocrine features, clinical variables, and severity of GD. Thus, neurobiological functions seem to be strongly related to GD severity.

Causal functional maps of brain rhythms in working memory

Human working memory is a key cognitive process that engages multiple functional anatomical nodes across the brain. Despite a plethora of correlative neuroimaging evidence regarding the working memory architecture, our understanding of critical hubs causally controlling overall performance is incomplete. Causal interpretation requires cognitive testing following safe, temporal, and controllable neuromodulation of specific functional anatomical nodes. Such experiments became available in healthy humans with the advance of transcranial alternating current stimulation (tACS). Here, we synthesize findings of 28 placebo-controlled studies (in total, 1,057 participants) that applied frequency-specific noninvasive stimulation of neural oscillations and examined working memory performance in neurotypical adults. We use a computational meta-modeling method to simulate each intervention in realistic virtual brains and test reported behavioral outcomes against the stimulation-induced electric fields in different brain nodes. Our results show that stimulating anterior frontal and medial temporal theta oscillations and occipitoparietal gamma rhythms leads to significant dose-dependent improvement in working memory task performance. Conversely, prefrontal gamma modulation is detrimental to performance. Moreover, we found distinct spatial expression of theta subbands, where working memory changes followed orbitofrontal high-theta modulation and medial temporal low-theta modulation. Finally, all these results are driven by changes in working memory accuracy rather than processing time measures. These findings provide a fresh view of the working memory mechanisms, complementary to neuroimaging research, and propose hypothesis-driven targets for the clinical treatment of working memory deficits.

Gambling and virtual reality: unraveling the illusion of near-misses effect

Introduction

Studying gambling behavior is a crucial element in reducing the impact of problem gambling. Nevertheless, most current research is carried out in controlled laboratory settings rather than real-life situations, which raises concerns about how applicable the findings are in the broader context. Virtual reality (VR) has proven to be a valuable tool and has been utilized in various experimental scenarios. A limited number of studies have employed VR to investigate gambling behaviors, and few have explored them in an older adolescent context.

Methods

This study examined the behavioral and physiological effects of gambling behavior, including problem gambling, gaming addiction, and risk-taking decision-making in a sample of 36 high-school students aged between 18 to 20 years using an ad-hoc constructed VR scenario designed to simulate a slot-machine platform.

Results

The behavioral results highlighted that participants reporting more problem gambling were sensitive to near-misses: i.e., they bet more after near-misses than after losses. This result may reflect the false belief that gamblers, after near-misses, are closer to winning. Physiological data showed that participants exhibited heart rate deceleration during the anticipation of the outcome, which has been suggested to represent a marker of feedback anticipation processing and hyposensitivity to losses.

Discussion

Overall, this study provides evidence for a new VR tool to assess gambling behaviors and new insights into gambling-related behavioral and physiological factors. Implications for the treatment of problem gambling are discussed.

Neural shifts in alpha rhythm's dual functioning during empathy maturation

INTRODUCTION

Empathy is a social-cognitive process that operates by relying mainly on the suppression of the cortical alpha rhythm. This phenomenon has been evidenced in dozens of electrophysiological studies targeting adult human subjects. Yet, recent neurodevelopmental studies indicated that at a younger age, empathy involves reversed brain responses (e.g., alpha enhancement patterns). In this multimodal study, we capture neural activity at the alpha range, and hemodynamic response and target subjects at approximately 20 years old as a unique time window in development that allows investigating both low-alpha suppression and high-alpha enhancement. We aim to further investigate the functional role of low-alpha power suppression and high-alpha power enhancement during empathy development.

METHODS

Brain data from 40 healthy individuals were recorded in two consecutive sessions of magnetoencephalography (MEG) and functional magnetic resonance imaging (fMRI) while subjects perceived vicarious physical pain or no pain.

RESULTS

MEG revealed that the alpha pattern shift during empathy happens in an all-or-none pattern: power enhancement before 18 and suppression after 18 years of age. Additionally, MEG and fMRI highlight a correspondence between high-alpha power increase and blood-oxygen-level-dependent (BOLD) decrease before 18, but low-alpha power decrease and BOLD increase after 18. Importantly, this neurodevelopmental transition was not revealed by four other measures: self-reported (a) ratings of the task stimuli, (b) ratings of naturalistic vignettes of vicarious pain, (c) trait empathy, or neural data from (d) a control neuroimaging task.

DISCUSSION

Findings suggest that at the critical age of around 18, empathy is underpinned by an all-or-none transition from high-alpha power enhancement and functional inhibition to low-alpha power suppression and functional activation in particular brain regions, possibly indicating a marker of maturation in empathic ability. This work advances a recent neurodevelopmental line of studies and provides insight into the functional maturation of empathy at the coming of age.

Autonomic responses during Gambling: the Effect of Outcome Type and Sex in a large community sample of young adults

Psychological theories consider autonomic arousal to be a reinforcer for problem gambling. Structural characteristics such as near-misses, which are non-win events that come close to a real win, have been shown to elicit win-like responses while increasing motivation and gambling persistence. This study investigated the autonomic and subjective responses of young adults to different gambling outcomes. This study also investigated sex differences in autonomic and subjective responses to different gambling outcomes.Participants from Sweden (n = 270) performed a computerized slot machine task that produced wins, near-misses (before and after payline) and full-misses. Phasic measurements of heart rate (HR) and skin conductance responses (SCR) were recorded during gambling performance and ratings of perceived chance of winning, pleasure and motivation to play were collected following each gambling outcome.Autonomic responses differed across slot machine outcomes as indicated by HR and SCR. Compared with other gambling outcomes, near-misses elicited the largest HR accelerations, and they also elicited larger HR decelerations and SCRs relative to full-misses. Near-misses before and after payline elicited differential psychophysiological responses and subjective reports, suggesting different emotional processing of near-miss subtypes. Females showed increased SCRs and motivation following win outcomes compared with males.In conclusion, wins, near-misses and full-misses generate differential physiological and subjective responses among young adults. Autonomic responses to wins differed between male and female players, emphasizing the need to consider sex differences when investigating the role of autonomic arousal in gambling.

Theta low-gamma phase amplitude coupling in the human orbitofrontal cortex increases during a conflict-processing task

Objective. The human orbitofrontal cortex (OFC) is involved in automatic response inhibition and conflict processing, but the mechanism of frequency-specific power changes that control these functions is unknown. Theta and gamma activity have been independently observed in the OFC during conflict processing, while theta-gamma interactions in other brain areas have been noted primarily in studies of memory. Within the OFC, it is possible that theta-gamma phase amplitude coupling (PAC) drives conflict processing. This study aims to characterize the coupled relationship between theta and gamma frequency bands in the OFC during conflict processing using a modified Stroop task.Approach. Eight epilepsy patients implanted with OFC stereotactic electroencephalography electrodes participated in a color-word modified Stroop task. PAC between theta phase and gamma amplitude was assessed to determine the timing and magnitude of neural oscillatory changes. Group analysis was conducted using a non-parametric cluster-permutationt-test on coherence values.Main results.Theta-low gamma (LG) PAC significantly increased in five out of eight patients during successful trials of the incongruent condition compared with the congruent condition. Significant increases in theta-LG PAC were most prominent during cue processing 200-800 ms after cue presentation. On group analysis, trial-averaged mean theta-LG PAC was statistically significantly greater in the incongruent condition compared to the congruent condition (p< 0.001, Cohen'sd= 0.51).Significance.For the first time, we report that OFC theta phase and LG amplitude coupling increases during conflict resolution. Given the delayed onset after cue presentation, OFC theta-LG PAC may contribute to conflict processing after conflict detection and before motor response. This explanation follows the hypothesis that global theta waves modulate local gamma signals. Understanding this relationship within the OFC will help further elucidate the neural mechanisms of human conflict resolution.

Development and Validation of a Near Miss Scale for Assessing Gambling Tendency

Although near-miss is an important tendency indicator for gambling addiction, no scale has been developed to evaluate these feelings. In this study, the aim is to develop a Near Miss Scale (NMS) to assess the tendency of gambling. In the first step, a 38-item measurement tool was prepared by the first author, which was examined by 8 experts. According to their comments and opinions, a 32-item 5-point Likert-type pre-form was created. The study was conducted with 600 gamblers in Northern Cyprus between December 2018-March 2019 and data from 563 of them were included in the statistical analysis. In the questionnaire, Socio-demographic form, Gambling Craving Scale (GCS), South Oaks Gambling Screening Test (SOGST) and NMS were used. With the SPSS 23 and R Studio statistical programs, after calculating the item-total correlations of the items in the NMS form, items with low item total-correlation values were excluded from the scale and 30 items were analysed statistically. In the study, it was seen that the factor loads of the relevant items in NMS were between .715 and .896. Confirmatory factor analysis (CFA) showed that a single factor model in the scale was valid. NMS had a positive correlation with SOGST (r = 0.601) and GCS (r = 0.752). The 2-week test-retest results of NMS with a Cronbach alpha of 0.981 were determined as 0.972. The validity and reliability results suggest that NMS is a valid and reliable as 30-item, one-dimensional measurement tool for assessing gambling tendency among gamblers.

Neural shifts in alpha rhythm's dual functioning during empathy

INTRODUCTION

Alpha oscillations are unique in their capacity to relay neuronal information through a dual-process named "gating by inhibition": rhythmic enhancement inhibits task-irrelevant regions while rhythmic suppression engages task-relevant regions in the brain. A social-cognitive process that operates by relying on the suppression of the alpha rhythm in the primary somatosensory cortex (S1) is the ability to generate empathy. This phenomenon has been evidenced in dozens of electrophysiological studies targeting adult human subjects. Yet, recent studies on the neurodevelopment of empathy indicate that in younger age, empathy does not involve alpha suppression in S1 but only enhancement. More interestingly, right before adulthood, this rhythm is still enhanced, but in a remarkable shift, a pattern of suppression emerges. In this registered magnetoencephalography (MEG) and functional magnetic resonance imaging (fMRI) study, we will capture frequency-decomposed neural activity particularly at the alpha range and its corresponding hemodynamic response and target subjects at around 20 years old as a unique time-window in development that allows investigating in parallel both low-alpha suppression and high-alpha enhancement. We aim to address two questions: (a) Does alpha power suppression in the S1 region during empathy correspond to BOLD increase in this region? (b) What is the functional role of alpha power enhancement during empathy development (BOLD signal increase or decrease)? Addressing these questions will particularly advance knowledge on the process of empathy in the brain, and the way in which it is underpinned by alpha oscillations. Moreover, examining these experimental outcomes can potentially lay the ground for future studies that would further examine the role of alpha oscillations in empathy during the course of development.

METHODS

Brain data of forty healthy individuals close to 20 years old will be recorded in two consecutive MEG and fMRI sessions while subjects observing physical pain versus neutral stimuli. Besides, each participant's subjective experiences wll be measred by questionnaires, interviews and rating of the stimuli.

EEG response to game-craving according to personal preference for games

Recently, the World Health Organization included ‘gaming disorder’ in its latest revision of the international classification of diseases (ICD-11). Despite extensive research on internet gaming disorder (IGD), few studies have addressed game-related stimuli eliciting craving, which plays an important role in addiction. Particularly, most previous studies did not consider personal preferences in games presented to subjects as stimuli. In this study, we compared neurophysiological responses elicited for favorite game (FG) videos and non-favorite game (NFG) videos. We aimed to demonstrate neurophysiological characteristics according to the game preference in the IGD group. We measured participants’ electroencephalogram (EEG) while they watched FG, NFG and neutral videos. For FG videos, the parieto-occipital theta power (TP_PO) were significantly increased compared with those for NFG videos (P < 0.05, paired t-test). TP_PO also differed significantly between the healthy control and IGD groups only on FG videos controlling covariate (TP_PO on neutral videos) (P < 0.05, analysis of covariance [ANCOVA]). And TP_PO was significantly correlated to self-reported craving score only on FG videos (r = 0.334, P < 0.05). In the present study, we demonstrate that FG videos induce higher TP_PO than that induced by NFG videos in the IGD group and TP_PO is a reliable EEG feature associated with craving for gaming.

Electrophysiological investigation of reward anticipation and outcome evaluation during slot machine play

Slot machines are a popular form of gambling, offering a tractable way to experimentally model reward processes. This study used a 3-reel slot paradigm to assess psychologically distinct phases of reward processing, reflecting anticipation, and early- and late-stage outcome processing. EEG measures of winning, nearly missing (a losing outcome revealed at the final, third reel), and "totally" missing (a losing outcome revealed earlier, at the second reel) were collected from healthy adults (n=54). Condition effects were evaluated in: i) event-related potential (ERP) components reflecting anticipatory attention (stimulus preceding negativity, SPN) and outcome processing (reward positivity, RewP and late-positive potential, LPP) and ii) total power and phase synchrony of theta and delta band oscillations. Behaviorally, trial initiation was fastest after a near miss outcome and slowest after a winning outcome. As expected, a significant SPN was observed for possible wins (AA) vs. total misses (AB), consistent with reward anticipation. Larger win (AAA) vs. near miss (AAB) amplitudes were observed for the RewP; LPP amplitudes were largest for wins (AAA), intermediate for near misses (AAB), and smallest for total misses (ABC), reflecting significant early (RewP) and late-stage (LPP) outcome processing effects. There was an effect of reel position on the RewP, with larger amplitude in the final reel (AAA-AAB) relative to the 2nd-reel locked difference waves (AA-AB). Across all outcomes, near misses elicited the largest and most phase-synchronized theta responses, while wins elicited larger and more phase-synchronized delta responses than total misses, with delta band measures not distinguishing between near misses and wins. . Phase locking measures contrasting win vs. near miss delta and theta synchronization, within time windows corresponding to ERP measurements, covaried with RewP, but not SPN or LPP, amplitude. Lastly, EEG measures showed differential relationships with age and self-reported consummatory pleasure. In the context of slot machine play, where reward anticipation and attainment place minimal demands on effort and skill, ERP and time-frequency methods capture distinct neurophysiological signatures of reward anticipation and outcome processing.

The Developmental Chronnecto-Genomics (Dev-CoG) study: A multimodal study on the developing brain

Brain development has largely been studied through unimodal analysis of neuroimaging data, providing independent results for structural and functional data. However, structure clearly impacts function and vice versa, pointing to the need for performing multimodal data collection and analysis to improve our understanding of brain development, and to further inform models of typical and atypical brain development across the lifespan. Ultimately, such models should also incorporate genetic and epigenetic mechanisms underlying brain structure and function, although currently this area is poorly specified. To this end, we are reporting here a multi-site, multi-modal dataset that captures cognitive function, brain structure and function, and genetic and epigenetic measures to better quantify the factors that influence brain development in children originally aged 9-14 years. Data collection for the Developmental Chronnecto-Genomics (Dev-CoG) study (http://devcog.mrn.org/) includes cognitive, emotional, and social performance scales, structural and functional MRI, diffusion MRI, magnetoencephalography (MEG), and saliva collection for DNA analysis of single nucleotide polymorphisms (SNPs) and DNA methylation patterns. Across two sites (The Mind Research Network and the University of Nebraska Medical Center), data from over 200 participants were collected and these children were re-tested annually for at least 3 years. The data collection protocol, sample demographics, and data quality measures for the dataset are presented here. The sample will be made freely available through the collaborative informatics and neuroimaging suite (COINS) database at the conclusion of the study.

Abnormal alpha band power in the dynamic pain connectome is a marker of chronic pain with a neuropathic component

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High theta and low gamma activity in the dynamic pain connectome is linked to chronic pain.

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High alpha-band activity is present when neuropathic pain is likely.

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Spectral frequency band strength distinguish neuropathic from non-neuropathic pain.

We previously identified alpha frequency slowing and beta attenuation in the dynamic pain connectome related to pain severity and interference in patients with multiple sclerosis-related neuropathic pain (NP). Here, we determined whether these abnormalities, are markers of aberrant temporal dynamics in non-neuropathic inflammatory pain (non-NP) or when NP is also suspected. We measured resting-state magnetoencephalography (MEG) spectral density in 45 people (17 females, 28 males) with chronic back pain due to ankylosing spondylitis (AS) and 38 age/sex matched healthy controls. We used painDETECT scores to divide the chronic pain group into those with only non-NP (NNP) and those who likely also had a component of NP in addition to their inflammatory pain. We also assessed pain severity, pain interference, and disease activity with the Brief Pain Inventory and Bath AS Disease Activity Index (BASDAI). We examined spectral power in the dynamic pain connectome, including nodes of the ascending nociceptive pathway (ANP), default mode (DMN), and salience networks (SN). Compared to the healthy controls, the AS patients exhibited increased theta power in the DMN and decreased low-gamma power in the DMN and ANP, but did not exhibit beta-band attenuation or peak-alpha slowing. The NNP patients were not different from HCs. Compared to both healthy controls and NNP, NP patients had increased alpha power in the ANP. Increased alpha power within the ANP was associated with reduced BASDAI in the NNP group, and increased pain in the mixed-NP group within the DMN, SN, and ANP. Thus, high theta and low gamma activity may be markers of chronic pain but high alpha-band activity may relate to particular features of neuropathic chronic pain.

Scratch Card Near-Miss Outcomes Increase the Urge to Gamble, but Do Not Impact Further Gambling Behaviour: A Pre-registered Replication and Extension

Scratch card near-misses, outcomes in which two out of three required jackpot symbols are uncovered, have been shown to erroneously increase the urge to continue gambling. It remains unknown if and how these outcomes influence further gambling behaviour. Previous studies examining the influence of near-misses on purchasing behaviour offered a low-stakes gamble to participants after experiencing a near-miss or a regular loss. We sought to investigate the influence of these outcomes on scratch card purchasing behaviour with a stronger test of participants’ gambling behavior by having them either “cash out” or risk all of their winnings to purchase another card. Additionally, we sought to test an original hypothesis that endorsement of the illusion of control might influence the decision to purchase additional scratch cards. We pre-registered our hypotheses, sample size, and data analysis plan. 138 subjects experienced two custom-made scratch card games that included a win on the first card (for all participants) and either a regular loss or a near-miss in the final outcome position on the second card (between-subjects manipulation). Although near-miss outcomes increased the urge to continue gambling relative to regular losses, no differences in the rates of purchasing were found between the conditions. Additionally, no support for our hypotheses concerning the influence of the illusion of control in near-miss outcomes was found. These results are discussed in terms of previous studies on scratch card gambling behaviour and subjective reactivity.

The Near-Miss Effect in Slot Machines: A Review and Experimental Analysis Over Half a Century Later

In games of chance, a near miss is said to occur when feedback for a loss approximates a win. For instance, obtaining “cherry–cherry–lemon” on a slot machine could be considered a near miss. Sixty-six years ago, B.F. Skinner first proposed the idea that near-miss events might reinforce continued play in slot machines, and despite some inconsistencies in the experimental literature, belief in this “near-miss effect” has remained strong. In the present manuscript, we will review this literature and present experimental assessments of the near-miss effect on the frequency of the gambling response. Experiment 1 used a tightly controlled resistance-to-extinction procedure in pigeons to evaluate the putative reinforcing effect of near misses relative to a control “far-miss” reel pattern. Experiment 2 extended Experiment 1’s procedure to human participants. The results of both experiments failed to support the near-miss effect hypothesis. Experiment 3 used a further simplified procedure to assess the validity of the resistance-to-extinction paradigm when a probable conditional reinforcer was present on the reel stimuli. Although a clear conditional response was obtained from the reel, subsequent testing in extinction revealed no conditionally reinforcing function of this stimulus on operant response frequency.

Neuroimaging of reward mechanisms in Gambling disorder: an integrative review

Gambling disorder (GD) was reclassified as a behavioral addiction in the DSM-5 and shares clinical and behavioral features with substance use disorders (SUDs). Neuroimaging studies of GD hold promise in isolating core features of the addiction syndrome, avoiding confounding effects of drug neurotoxicity. At the same time, a neurobiologically-grounded theory of how behaviors like gambling can become addictive remains lacking, posing a significant hurdle for ongoing decisions in addiction nosology. This article integrates research on reward-related brain activity (functional MRI) and neurotransmitter function (PET) in GD, alongside the consideration of structural MRI data as to whether these signals more likely reflect pre-existing vulnerability or neuroadaptive change. Where possible, we point to qualitative similarities and differences with established markers for SUDs. Structural MRI studies indicate modest changes in regional gray matter volume and diffuse reductions in white matter integrity in GD, contrasting with clear structural deterioration in SUDs. Functional MRI studies consistently identify dysregulation in reward-related circuitry (primarily ventral striatum and medial prefrontal cortex), but evidence is mixed as to the direction of these effects. The need for further parsing of reward sub-processes is emphasized, including anticipation vs outcome, gains vs. losses, and disorder-relevant cues vs natural rewards. Neurotransmitter PET studies indicate amplified dopamine (DA) release in GD, in the context of minimal differences in baseline DA D2 receptor binding, highlighting a distinct profile from SUDs. Preliminary work has investigated further contributions of opioids, GABA and serotonin. Neuroimaging data increasingly highlight divergent profiles in GD vs. SUDs. The ability of gambling to perpetually activate DA (via maximal uncertainty) may contribute to neuroimaging similarities between GD and SUDs, whereas the supra-physiological DA effects of drugs may partly explain differences in the neuroimaging profile of the two syndromes. Coupled with consistent observations of correlations with gambling severity and related clinical variables within GD samples, the overall pattern of effects is interpreted as a likely combination of shared vulnerability markers across GD and SUDs, but with further experience-dependent neuroadaptive processes in GD.

Cognitive neuroscience can support public health approaches to minimise the harm of 'losses disguised as wins' in multiline slot machines

Video slot machines are associated with both accelerated transition into problematic forms of gambling, as well as psychosocial harm above and beyond other forms of gambling. A growing body of evidence is uncovering how key design features of multiline slot machines produce an inflated experience of reward, despite the fact that these features offer no overall financial benefit to the player. A pernicious example of this are 'losses disguised as wins' (LDWs), which occur when simultaneous bets placed on multiple lines result in a winning combination that returns an amount greater than zero, but less the total wager. These events are usually accompanied by the same celebratory sounds and animations that accompany true wins. We argue that LDWs may leverage neuropsychological phenomena that underlie reinforcement learning and contribute to extended or repetitive use and gambling-related harm. While other characteristics of slot machine gambling have been examined by cognitive neuroscientists, this feature has not yet received attention. Neuroscientific methods can be used to assess the impact of LDWs on the human reward system, to assess the claim that these events are a reinforcing and contributing factor in the development of harmful play. Positive findings would provide further persuasive evidence in support of strategies to minimise gambling harm through the regulation of machine design.

The Effect of Losses Disguised as Wins and Near Misses in Electronic Gaming Machines: A Systematic Review

Near misses and losses disguised as wins have been of interest to gambling researchers and policymakers for many years (e.g., Griffiths in J Gambl Stud 9(2):101-120, 1993). This systematic literature review describes the behavioural, psychological, and psychobiological effects of near misses and losses disguised as wins (LDWs) in an effort to evaluate their precise influence on the player and to highlight areas requiring further investigation. A systematic search for relevant studies was conducted using Scopus, PubMed, PsycINFO, ProQuest Sociology databases, and the Gambling Research Exchange Ontario Knowledge Repository. A total of 51 (from an initial pool of 802) experimental peer-reviewed studies using human participants were found between 1991 and 2015. The systematic review revealed that near misses motivate continued play, but have varying effects on the emotional state or betting behaviour of the player. Near miss events were also shown to be associated with elevated skin conductance levels and diffuse activity across the brain, most consistently in areas processing reinforcement and reward. Re-examination of the studies of near misses events after classifying the type of game feedback suggested that the effectiveness of near misses is related to the phenomenology of a near miss itself rather than as a response to auditory or visual feedback provided by a slot machine. In contrast to near misses, the presence of LDWs was found to relate to an overestimation of how much a player is actually winning and was consistently viewed as an exciting event. The effect of LDWs appears to be driven by the presence of visuals and sounds most often associated with a true win. Practical implications and directions for future research are also discussed.

An Overview of Structural Characteristics in Problematic Video Game Playing

PURPOSE OF REVIEW

There are many different factors involved in how and why people develop problems with video game playing. One such set of factors concerns the structural characteristics of video games (i.e., the structure, elements, and components of the video games themselves). Much of the research examining the structural characteristics of video games was initially based on research and theorizing from the gambling studies field. The present review briefly overviews the key papers in the field to date.

RECENT FINDINGS

The paper examines a number of areas including (i) similarities in structural characteristics of gambling and video gaming, (ii) structural characteristics in video games, (iii) narrative and flow in video games, (iv) structural characteristic taxonomies for video games, and (v) video game structural characteristics and game design ethics. Many of the studies carried out to date are small-scale, and comprise self-selected convenience samples (typically using self-report surveys or non-ecologically valid laboratory experiments).

SUMMARY

Based on the small amount of empirical data, it appears that structural features that take a long time to achieve in-game are the ones most associated with problematic video game play (e.g., earning experience points, managing in-game resources, mastering the video game, getting 100% in-game). The study of video games from a structural characteristic perspective is of benefit to many different stakeholders including academic researchers, video game players, and video game designers, as well as those interested in prevention and policymaking by making the games more socially responsible. It is important that researchers understand and recognize the psycho-social effects and impacts that the structural characteristics of video games can have on players, both positive and negative.

Mixed Emotions to Near-Miss Outcomes: A Psychophysiological Study with Facial Electromyography

Near-misses occur across many forms of gambling and are rated as unpleasant while simultaneously increasing the motivation to continue playing. On slot machines, the icon position relative to the payline moderates the effects of near-misses, with near-misses before the payline increasing motivation, and near-misses after the payline being rated as aversive. Near-misses are also known to increase physiological arousal compared to full-misses, but physiological measures to date have not been able to dissociate positive and negative emotional responses. The present study measured facial electromyography at the corrugator (brow) and zygomaticus (cheek) sites, as well as electrodermal activity (EDA), following gambling outcomes on a two-reel slot machine simulation in 77 novice gamblers. Behavioral data was collected using trial-by-trial ratings of motivation and valence. Wins were rated as more pleasant and increased motivation to continue playing, compared to non-win outcomes. Wins were also accompanied by increased EDA and zygomaticus activity. Near-misses after the payline were rated as more aversive than other non-wins, and this was accompanied by increased EDA and zygomaticus activity. Near-misses before the payline increased motivation to continue playing, and were accompanied by increased EDA. Thus, both subjective and physiological responses to near-misses differ for events falling either side of the payline. The 'near-miss effect' is not a unitary phenomenon. Facial EMG has differential sensitivity to positive and negative valence and may be a useful measure for future studies of gambling behavior.

The possible role of the insula in the epilepsy and the gambling disorder of Fyodor Dostoyevsky

Background The retrospective diagnosis of Fyodor Mikhailovich Dostoyevsky's (1821-1881) neurological and psychiatric disease proves to be particularly interesting. Recent neurobiological data suggest a solution to the questions regarding the writer's retrospective diagnosis, claiming the insular cortex to be the origin of the rare ecstatic seizures. Regarding Dostoyevsky's pathological gambling, this hypothesis is consistent with another finding from recent neuroscience, namely that the malfunction of the insula could be an important underlying pathology in gambling disorder. Case study Literary and scientific overview (1928-2015) on the subjects of Dostoyevsky's epilepsy and gambling disorder. Discussion and conclusion Taking Dostoyevsky's neurological (ecstatic seizures) and psychiatric (pathological gambling) disease and the crossroads into consideration, these two disciplines make regarding the underlying pathology, we would like to suggest a speculative theory that these two disorders have a common insular pathomechanism, namely, the malfunctioning of the risk prediction-risk prediction error coding system. Furthermore, based on Dostoyevsky's case, regarding gambling disorder in general, we would like to hypothesize that the three common gambling-related cognitive distortions (near-miss effect, gambler's fallacy, and the illusion of control) can be all attributed to the impairment of the anterior insular risk prediction-risk prediction error coding system.

Behavioral addictions in addiction medicine: from mechanisms to practical considerations

Recent progress has been made in our understanding of nonsubstance or "behavioral" addictions, although these conditions and their most appropriate classification remain debated and the knowledge basis for understanding the pathophysiology of and treatments for these conditions includes important gaps. Recent developments include the classification of gambling disorder as a "Substance-Related and Addictive Disorder" in the 5th edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) and proposed diagnostic criteria for Internet Gaming Disorder in Section 3 of DSM-5. This chapter reviews current neuroscientific understandings of behavioral addictions and the potential of neurobiological data to assist in the development of improved policy, prevention, and treatment efforts.

Games in the Brain: Neural Substrates of Gambling Addiction

As a popular form of recreational risk taking, gambling games offer a paradigm for decision neuroscience research. As an individual behavior, gambling becomes dysfunctional in a subset of the population, with debilitating consequences. Gambling disorder has been recently reconceptualized as a "behavioral addiction" in the DSM-5, based on emerging parallels with substance use disorders. Why do some individuals undergo this transition from recreational to disordered gambling? The biomedical model of problem gambling is a "brain disorder" account that posits an underlying neurobiological abnormality. This article first delineates the neural circuitry that underpins gambling-related decision making, comprising ventral striatum, ventromedial prefrontal cortex, dopaminergic midbrain, and insula, and presents evidence for pathophysiology in this circuitry in gambling disorder. These biological dispositions become translated into clinical disorder through the effects of gambling games. This influence is better articulated in a public health approach that describes the interplay between the player and the (gambling) product. Certain forms of gambling, including electronic gambling machines, appear to be overrepresented in problem gamblers. These games harness psychological features, including variable ratio schedules, near-misses, "losses disguised as wins," and the illusion of control, which modulate the core decision-making circuitry that is perturbed in gambling disorder.

Monetary reward suppresses anterior insula activity during social pain

Social pain after exclusion by others activates brain regions also involved in physical pain. Here we evaluated whether monetary reward could compensate for the negative feeling of social pain in the brain. To address this question we used the unique technique of intracranial electroencephalography in subjects with drug resistant epilepsy. Specifically, we recorded theta activity from intracranial electrodes implanted in the insular cortex while subjects experienced conditions of social inclusion and exclusion associated with monetary gain and loss. Our study confirmed that theta rhythm in the insular cortex is the neural signature of social exclusion. We found that while monetary gain suppresses the effect of social pain in the anterior insula, there is no such effect in the posterior insula. These results imply that the anterior insula can use secondary reward signals to compensate for the negative feeling of social pain. Hence, here we propose that the anterior insula plays a pivotal role in integrating contingencies to update social pain feelings. Finally, the possibility to modulate the theta rhythm through the reward system might open new avenues of research for treating pathologies related to social exclusion.

Human oscillatory activity in near-miss events

Near-miss events are situations in which an action yields a negative result but is very close to being successful. They are known to influence behavior, especially in gambling scenarios. Previous neuroimaging studies have described an 'anomalous' activity of brain reward areas following these events. The goal of the present research was to study electrophysiological correlates of near-misses in the expectation and outcome phases. Electroencephalography was recorded while participants were playing a simplified version of a slot machine. Four possible outcomes (gain, near-miss, loss and no-information) were presented in a pseudorandom order to ensure fixed proportions. Results from the time-frequency analysis for the theta (4-8 Hz), alpha (9-13 Hz), low beta (15-22 Hz) and beta-gamma (25-35 Hz) frequency-bands presented larger power increases for wins and near-misses compared with losses. In the anticipation phase, power changes were lower than in the resolution phase. The current results are in agreement with previous studies showing that near-miss events recruit brain areas of the reward network. Likewise, the oscillatory activity in near-misses is very similar to the one elicited in the gain condition. In addition, present findings suggest that oscillatory activity in the expectation phase does not play a crucial role in near-miss events.

Disordered gambling: the evolving concept of behavioral addiction

The reclassification of gambling disorder within the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) addictions category marks an important step for addiction science. The similarities between gambling disorder and the substance use disorders have been well documented. As gambling is unlikely to exert actively damaging effects on the brain, the cognitive sequelae of gambling disorder may provide insights into addictive vulnerabilities; this idea is critically evaluated in light of recent structural imaging data. The second part of the review analyzes a fundamental question of how a behavior can become addictive in the absence of exogenous drug stimulation. The relative potency of drug and nondrug rewards is considered, alongside evidence that cognitive distortions in the processing of chance (for example, the illusion of control and the gambler's fallacy) may constitute an important added ingredient in gambling. Further understanding of these mechanisms at neural and behavioral levels will be critical for the classification of future behavioral addictions, and I consider the current research data for obesity and binge eating, compulsive shopping, and internet gaming disorder.

Near-wins and near-losses in gambling: a behavioral and facial EMG study

This study investigated responses to near-wins (i.e., nonwin outcomes that were close to a major win, and their counterpart, near-losses (nonwin outcomes that are proximal to a major loss) in a decision-making task, measuring (a) luck ratings, (b) adjustment of bet amount, and (c) facial muscle reactivity at zygomaticus and corrugator sites. Compared to full-misses, near-wins decreased self-perceived luck and near-losses increased self-perceived luck, consistent with the effects of upward versus downward counterfactual thinking, respectively. Wins and losses both increased zygomaticus reactivity, and losses selectively enhanced corrugator reactivity. Near-wins heightened zygomaticus activity, but did not affect corrugator activity, thus showing a similar response pattern to actual wins. There were no significant facial EMG effects of near-losses. We infer that near-wins engender some appetitive processing, despite their objective nonwin status.

Striatal connectivity changes following gambling wins and near-misses: Associations with gambling severity

Frontostriatal circuitry is implicated in the cognitive distortions associated with gambling behaviour. 'Near-miss' events, where unsuccessful outcomes are proximal to a jackpot win, recruit overlapping neural circuitry with actual monetary wins. Personal control over a gamble (e.g., via choice) is also known to increase confidence in one's chances of winning (the 'illusion of control'). Using psychophysiological interaction (PPI) analyses, we examined changes in functional connectivity as regular gamblers and non-gambling participants played a slot-machine game that delivered wins, near-misses and full-misses, and manipulated personal control. We focussed on connectivity with striatal seed regions, and associations with gambling severity, using voxel-wise regression. For the interaction term of near-misses (versus full-misses) by personal choice (participant-chosen versus computer-chosen), ventral striatal connectivity with the insula, bilaterally, was positively correlated with gambling severity. In addition, some effects for the contrast of wins compared to all non-wins were observed at an uncorrected (p < .001) threshold: there was an overall increase in connectivity between the striatal seeds and left orbitofrontal cortex and posterior insula, and a negative correlation for gambling severity with the connectivity between the right ventral striatal seed and left anterior cingulate cortex. These findings corroborate the 'non-categorical' nature of reward processing in gambling: near-misses and full-misses are objectively identical outcomes that are processed differentially. Ventral striatal connectivity with the insula correlated positively with gambling severity in the illusion of control contrast, which could be a risk factor for the cognitive distortions and loss-chasing that are characteristic of problem gambling.

Damage to insula abolishes cognitive distortions during simulated gambling

Gambling is a naturalistic example of risky decision-making. During gambling, players typically display an array of cognitive biases that create a distorted expectancy of winning. This study investigated brain regions underpinning gambling-related cognitive distortions, contrasting patients with focal brain lesions to the ventromedial prefrontal cortex (vmPFC), insula, or amygdala ("target patients") against healthy comparison participants and lesion comparison patients (i.e., with lesions that spare the target regions). A slot machine task was used to deliver near-miss outcomes (i.e., nonwins that fall spatially close to a jackpot), and a roulette game was used to examine the gambler's fallacy (color decisions following outcome runs). Comparison groups displayed a heightened motivation to play following near misses (compared with full misses), and manifested a classic gambler's fallacy effect. Both effects were also observed in patients with vmPFC and amygdala damage, but were absent in patients with insula damage. Our findings indicate that the distorted cognitive processing of near-miss outcomes and event sequences may be ordinarily supported by the recruitment of the insula. Interventions to reduce insula reactivity could show promise in the treatment of disordered gambling.