An fMRI examination of developmental differences in the neural correlates of uncertainty and decision-making

Uncertain world: How children's curiosity and intolerance of uncertainty relate to their behaviour and emotion under uncertainty

Curiosity and intolerance of uncertainty (IU) are both thought to drive information seeking but may have different affective profiles; curiosity is often associated with positive affective responses to uncertainty and improved learning outcomes, whereas IU is associated with negative affective responses and anxiety. Curiosity and IU have not previously been examined together in children but may both play an important role in understanding how children respond to uncertainty. Our research aimed to examine how individual differences in parent-reported curiosity and IU were associated with behavioural and emotional responses to uncertainty. Children aged 8 to 12 (n = 133) completed a game in which they were presented with an array of buttons on the screen that, when clicked, played neutral or aversive sounds. Children pressed buttons (information seeking) and rated their emotions and worry under conditions of high and low uncertainty. Facial expressions were also monitored for affective responses. Analyses revealed that children sought more information under high uncertainty than low uncertainty trials and that more curious children reported feeling happier. Contrary to expectations, IU and curiosity were not related to the number of buttons children pressed, nor to their self-reported emotion or worry. However, exploratory analyses suggest that children who are high in IU may engage in more information seeking that reflects checking or safety-seeking than those who are low in IU. In addition, our findings suggest that there may be age-related change in the effects of IU on worry, with IU more strongly related to worry in uncertain situations for older children than younger children.

Evidence Accumulation and Neural Correlates of Uncertainty in Obsessive-Compulsive Disorder

BACKGROUND

Decision making is frequently associated with risk taking under uncertainty. Elevated intolerance of uncertainty is suggested to be a critical feature of obsessive-compulsive disorder (OCD). However, impairments of latent constructs of uncertainty processing and its neural correlates remain unclear in OCD.

METHODS

In 83 participants (24 OCD patients treated with capsulotomy, 28 OCD control participants, and 31 healthy control participants), we performed magnetic resonance imaging using a card gambling task in which participants made decisions whether to bet or not that the next card would be larger than the current one. A hierarchical drift diffusion model was used to dissociate speed and amount of evidence accumulated before a decisional threshold (i.e., betting or no betting) was reached.

RESULTS

High uncertainty was characterized by a smaller amount of evidence accumulation (lower thresholds), thus dissociating uncertainty from conflict tasks and highlighting the specificity of this task to test value-based uncertainty. OCD patients exhibited greater caution with poor performance and greater evidence accumulation overall along with slower speed of accumulation, particularly under low uncertainty. Bilateral dorsal anterior cingulate and anterior insula distinguished high- and low-uncertainty decision processes in healthy control participants but not in the OCD groups, indicating impairments in anticipation of differences in outcome variance and salience network activity. There were no behavioral or imaging differences relating to capsulotomy despite improvements in OCD symptoms.

CONCLUSIONS

Our findings highlight greater impairments particularly in more certain trials in the OCD groups along with impaired neural differentiation of high and low uncertainty and suggest uncertainty processing as a trait cognitive endophenotype rather than a state-specific factor.

Intolerance of Uncertainty and Emotional Processing in Adolescence: Separating Between-Person Stability and Within-Person Change

Previous research on the relation between Intolerance of Uncertainty (IU) and Emotional Processing (EP) during adolescence is limited. The present study aimed to clarify how IU and EP evolve over time, to what extent they are related, and whether changes in one precede or follow changes in the other. A total of 457 Italian adolescents (53.1% girls) aged 11 to 18 years (M = 14.1 ± 2.27) completed the IU and EP scales on three separate occasions three months apart (T1, T2, and T3). Data were modeled using a Random-Intercept Cross-Lagged Panel Model (RI-CLPM) that separates individual differences between individuals from intraindividual changes. Descriptive analyses showed that IU was relatively stable between T1 and T2 and decreased slightly between T2 and T3. Consistent with the view that emotion regulation improves as adolescents develop, EP difficulties were found to decrease between T1 and T2 and between T2 and T3. The RI-CLPM revealed a strong between-person effect, showing that individual differences in IU and EP remained consistent throughout the study. In addition, significant within-person change was found, with adolescents who increased their IU at T1 and T2 also increasing their EP difficulties at T2 and T3, respectively. The opposite effect had a smaller effect size. In sum, our study showed that IU and EP are intertwined in adolescents and that changes in IU precede corresponding changes in EP. These results suggest a priority of change between IU and EP and confirm the relationship between IU and emotion regulation problems in adolescence.

Intolerance of uncertainty and neural measures of anticipation and reactivity for affective stimuli

Intolerance of uncertainty (IU) is a transdiagnostic construct referring to the aversive interpretation of contexts characterized by uncertainty. Indeed, there is a growing body of research examining individual differences in IU and how these are associated with emotional anticipation and reactivity during periods of certainty and uncertainty, however, how these associations are reflected via neurophysiological indices remain understudied and poorly understood. The present study examined the relationship between self-reported IU and neurophysiological measures of emotional anticipation and reactivity, namely stimulus preceding negativity (SPN) and late positive potential (LPP), and self-report measures of emotional experiences. These measures were captured during an S1-S2 picture viewing tasks in which participants were presented with cues (S1) that either indicated the affective valence of upcoming picture (S2) or provided no information about the valence. Findings here provide evidence for significant associations between SPN amplitude and IU scores during uncertain and certain-positive cueing conditions, and significant associations between LPP amplitude and IU scores during both certain- and uncertain-negative picture viewing conditions that appear driven by prospective IU sub-scores. These positive associations between IU and SPN amplitude are suggestive of heightened emotional anticipation following S1 cues, while positive associations between IU and LPP are suggestive of heightened emotional reactivity following S2 images. These findings are discussed in detail relative to existing IU literature, and potential implications of these findings.

Neural responding during uncertain threat anticipation in pediatric anxiety

Excessive fear responses to uncertain threat are a key feature of anxiety disorders (ADs), though most mechanistic work considers adults. As ADs onset in childhood and confer risk for later psychopathology, we sought to identify conditions of uncertain threat that distinguish 8-17-year-old youth with AD (n = 19) from those without AD (n = 33), and assess test-retest reliability of such responses in a companion sample of healthy adults across three sites (n = 19). In an adapted uncertainty of threat paradigm, visual cues parametrically signaled threat of aversive stimuli (fear faces) in 25 % increments (0 %, 25 %, 50 %, 100 %), while participants underwent functional magnetic resonance imaging (fMRI). We compared neural response elicited by cues signaling different degrees of probability regarding the subsequent delivery of fear faces. Overall, youth displayed greater engagement of bilateral inferior parietal cortex, fusiform gyrus, and lingual gyrus during uncertain threat anticipation in general. Relative to healthy youth, AD youth exhibited greater activation in ventrolateral prefrontal cortex (vlPFC)/BA47 during uncertain threat anticipation in general. Further, AD differed from healthy youth in scaling of ventral striatum/sgACC activation with threat probability and attenuated flexibility of responding during parametric uncertain threat. Complementing these results, significant, albeit modest, cross-site test-retest reliability in these regions was observed in an independent sample of healthy adults. While preliminary due to a small sample size, these findings suggest that during uncertainty of threat, AD youth engage vlPFC regions known to be involved in fear regulation, response inhibition, and cognitive control. Findings highlight the potential of isolating neural correlates of threat anticipation to guide treatment development and translational work in youth.

Intolerance of uncertainty and functional connectivity of the anterior insula during anticipation of unpredictable reward

Individuals with high intolerance of uncertainty (IU) tend to display maladaptive cognitive, behavioral, physiological, and/or neural responses during anticipation of uncertain or ambiguous outcomes, both positive and negative in valence. Importantly, high IU has been proposed as a key transdiagnostic phenotypic risk factor for the onset and maintenance of several psychiatric disorders. Within the context of reward processing, high IU has been related to dysfunctional reward anticipation, which may be mediated by hyperactive anterior insula (AIC) response to uncertainty. The present study further investigated the relationship between the AIC and IU by examining the association between individual differences in IU and task-based functional connectivity of the right AIC using functional magnetic resonance imaging (fMRI). Participants (N = 171) completed a self-report measure of IU and a reward anticipation task during fMRI. Generalized psychophysiological interaction (gPPI) analyses were performed with a seed in the right AIC. In the U-threat model, we found that greater self-reported levels of IU were correlated with increased functional connectivity between the right AIC and the dorsal anterior cingulate cortex (dACC) and the right dorsolateral prefrontal cortex (dlPFC). In the P-threat model, we did not find these associations, perhaps indicating that they may be more robust during uncertainty. These preliminary findings suggest that parts of salience and central executive control networks may be impacted by and underlie the expression of IU. Future studies should examine the generalizability of these findings to clinical populations and investigate how disruption of these functional networks may contribute to psychopathology.

Brain networks under uncertainty: A coordinate-based meta-analysis of brain imaging studies

In recent years, uncertainty has been extensively studied as a core factor in anxiety models. However, it remains unclear whether there is a stable brain circuitry to cope with uncertainty. Addressing this yet open question, we first distinguish uncertainty into three different states: risky, ambiguity, and threat anticipation. Then, we performed three meta-analyses of fMRI studies to identify those regions that are commonly activated by the three domains using activation likelihood estimation (ALE). The overlapping analyses of the three ALE maps revealed major conjunctions of the risk decision making, ambiguity decision making, and the threat anticipation in specifically the right insula. Contrast analysis further confirmed this finding. In addition, different uncertainty states also have different brain networks involved. Specifically, a large number of brain regions in the frontal-parietal cortex were recruited under ambiguity state, while subcortical gray matter regions were recruited under risk decision making, and the bilateral insula were closely associated with threat anticipation. Additionally, we assessed the co-activation pattern of identified regions using meta-analytic connectivity modeling (MACM) to investigate the potential network underlying the relationship of three domains. The MACM analysis further confirmed that different uncertain states have specific brain network basis. We concluded that the right insula serves as a convergent brain region for brain regions recruited for different uncertain states, and its co-activation pattern also corresponds to the brain network of the three uncertain states. This study is a preliminary attempt to further uncover the brain circuitry of anxiety models with uncertainty at their core.

Information about others' choices selectively alters risk tolerance and medial prefrontal cortex activation across adolescence and young adulthood

Adolescence is associated with major changes in the cognitive, emotional and social domains. One domain in which these processes intersect is decision-making. Previous research has shown that individuals’ attitudes towards risk and ambiguity shape their decision-making, and information about others’ choices can influence individuals’ decisions. However, it is currently unknown how information about others’ choices influences risk and ambiguity attitudes separately, and the degree to which others’ choices shape decision-making differentially across development from adolescence to young adulthood. The current study used a computational modeling framework to test how information about others’ choices influences these attitudes. Participants, aged 14–22 years, made a series of risky and ambiguous choices while undergoing fMRI scanning. On some trials, they viewed risky or safe choices of others. Results showed that participants aligned their choices toward the choice preferences of others. Moreover, the tendency to align choices was expressed in changes in risk attitude, but not ambiguity attitude. The change in risk attitude was positively related to neural activation in the medial prefrontal cortex. Results did not show age related differences in behavior and corresponding neural activation, indicating that the manner in which adolescents are influenced by peers is not ubiquitous but rather, is highly context-dependent.

Development of a behavioural measure of Intolerance of Uncertainty in preadolescent children: Adaptation of the beads task

BACKGROUND AND OBJECTIVES

Intolerance of Uncertainty (IU) may be important for the development and maintenance of anxiety disorders but research with preadolescent children has relied entirely on questionnaire measures to assess IU. Here we aimed to develop a behavioural measure of IU that was appropriate for preadolescent children by adapting the beads task (Jacoby, Abramowitz, Buck, & Fabricant, 2014).

METHODS

Participants were 51 typically developing children (26 female; 7-11 years). We examined first whether preadolescent participants could understand and complete the task, then how participants responded to varying levels of uncertainty. We also conducted exploratory analyses regarding associations between task measures and questionnaire measures of IU, anxiety and worry.

RESULTS

Overall, the adapted Beads Task appears suitable for preadolescent children and is able to capture reactions to uncertainty. At least some of these reactions are related to questionnaire measures of IU and anxiety. Implications and areas for future research are discussed to provide insights into how behavioural tasks examining responses to uncertainty can improve our understanding of IU.

LIMITATIONS

The sample size was relatively small. There was no control task or condition without uncertainty.

CONCLUSIONS

Overall, the adapted Beads Task appears suitable for preadolescent children and is able to capture reactions to uncertainty. This type of behavioural task would be appropriate for use in future research that aims to improve our understanding of IU in children.

Functional connectivity of the anterior insula associated with intolerance of uncertainty in youth

Intolerance of uncertainty (IU) is a trait characteristic marked by distress in the face of insufficient information. Elevated IU has been implicated in the development and maintenance of anxiety disorders, particularly during adolescence, which is characterized by dramatic neural maturation and the onset of anxiety disorders. Previous task-based work implicates the bilateral anterior insula in IU. However, the association between anterior insula intrinsic functional connectivity (iFC) and IU has not been examined in adolescents. Fifty-eight healthy youth (mean age = 12.56; 55% boys) completed the Intolerance of Uncertainty Scale for Children (IUSC-12) and a 6-minute resting state fMRI scan. Group-level analyses were conducted using a random-effects, ordinary least-squares model, including IUSC-12 scores (Total, Inhibitory subscale, Prospective subscale), and three nuisance covariates (age, sex, and mean framewise displacement). IUSC-12 Inhibitory subscale scores were predictive of iFC between the left and right anterior insula and right prefrontal regions. IUSC-12 Prospective subscale scores significantly predicted iFC between the anterior insula and the anterior cingulate cortex. IUSC-12 total scores did not predict significant iFC of the bilateral anterior insula. Follow-up analyses, including anxiety (MASC Total Score) in the models, failed to find significant results. This could suggest that the associations found between IUSC-12 scores and anterior insula iFC are not unique to IU and, rather, reflect a broader anxiety-related connectivity pattern. Further studies with larger samples are needed to tease apart unique associations. These findings bear significance in contributing to the literature evaluating the neural correlates of risk factors for anxiety in youth.

Insula shows abnormal task-evoked and resting-state activity in first-episode drug-naïve generalized anxiety disorder

BACKGROUND

Interoception is associated with neural activity in the insula of healthy humans. On the basis of the somatic symptoms in generalized anxiety disorder (GAD), especially abnormal heartbeat perception, we hypothesized that abnormal activity in the insula was associated with interoceptive awareness in patients with GAD.

METHODS

We investigated the psychological correlates of interoceptive awareness in a sample of 34 patients with first-onset, drug-naïve GAD and 30 healthy controls (HCs). Furthermore, we compared blood oxygenation level-dependent responses between the two groups during a heartbeat perception task to assess task-evoked activity and its relationship with psychological measures. We also examined between-group differences in insular subregions resting-state functional connectivity (rsFC), and its relationship with anxiety severity.

RESULTS

Patients with GAD had significantly higher body perception scores than HCs. They also exhibited greater task-evoked activity in the left anterior insula, left posterior insula, and right anterior insula during interoceptive awareness than HCs. Left anterior insula activity was positively correlated with body awareness in patients with GAD, and rsFC between the left anterior insula and left medial prefrontal gyrus was negatively correlated with somatic anxiety severity.

CONCLUSIONS

Investigating a sample of first-episode, drug-naïve patients, our study demonstrated abnormal interoceptive awareness in patients with GAD and that this was related to abnormal anterior insular activity during both rest and task. These results shed new light on the psychological and neural substrates of somatic symptoms in GAD, and they may serve to establish abnormal interoceptive awareness as a neural and psychological marker of GAD.

Intolerance of uncertainty in youth: Psychometrics of the Intolerance of Uncertainty Index-A for Children

Intolerance of uncertainty (IU) is a cognitive vulnerability for pathological anxiety. The current study adapted the Intolerance of Uncertainty Index-A for Children (IUI-A-C), and created a single-item Intolerance of Uncertainty Clinician-Rated Index (IUCR), both of which assess a youth's general inability to endure uncertainty. Psychometric properties of these two measures were evaluated. Participants were 146 youth aged 7-17 years seeking treatment for anxiety. The IUI-A-C evidenced individual item performance (i.e., correlations between each item and the total remainder score > .40, ps <.001), internal consistency, convergent validity with the IUCR and self-report measures of anxiety and functional impairment, divergent validity with ADHD severity, and retest reliability with a mean interval of over four weeks. The IUCR also evidenced convergent validity with the IUI-A-C and self-report measures of anxiety and functional impairment and divergent validity with ADHD severity. The IUI-A-C predicted composite principal diagnosis severity but did not predict composite GAD diagnosis severity. The IUI-A-C and IUCR have utility as measures of IU in youth. The role of IU in specific anxiety disorders and future research are discussed.

Social distance modulates the process of uncertain decision-making: evidence from event-related potentials

Purpose

Social distance affects risk perception in uncertain decision-making, but how this effect works and the mechanism of how social distance influences the early processing stages of uncertain decision-making are still unclear. This investigation aimed to explore how social distance influences risk-taking during uncertain decision-making using the Iowa Gambling Task with recording of event-related potentials.

Methods

A total of 57 healthy subjects (36 female) participated in the modified single-choice Iowa Gambling Task when they gambled based on three quantified social distances (self, friend, and stranger). The social distance between participant and beneficiary was quantified on a scale of 0–100 points, with 0 representing self, 5 representing a close friend, and 100 representing a stranger.

Results

Three stages of uncertain decision-making were analyzed. Behavioral results showed that social distance worked interactively with choice frame, and high social distance made people choose a more advantageous deck and a less disadvantageous deck than low social distance. The P300 in the choice-evaluation stage, which reflects stimulus discrimination, directly proved this result by showing that gambling for a stranger caused higher P300 when evaluating an advantageous deck and lower P300 when evaluating a disadvantageous deck than for others. Decision preceding negativity in the response-selection stage represents the anticipation of risky choices: this was larger with high social distance when choosing a disadvantageous deck. Feedback-related negativity and feedback-related P300 had motivational significance, showing smaller amplitudes when gambling for a stranger than for oneself.

Conclusion

These results provide evidence that social distance works interactively with choice frames of uncertain decision-making. People at high social distance are more risk-taking in an advantageous frame and more risk-avoid ant in a disadvantageous frame.

Cued for risk: Evidence for an incentive sensitization framework to explain the interplay between stress and anxiety, substance abuse, and reward uncertainty in disordered gambling behavior

Gambling disorder is an impairing condition confounded by psychiatric co-morbidity, particularly with substance use and anxiety disorders. Yet, our knowledge of the mechanisms that cause these disorders to coalesce remains limited. The Incentive Sensitization Theory suggests that sensitization of neural "wanting" pathways, which attribute incentive salience to rewards and their cues, is responsible for the excessive desire for drugs and cue-triggered craving. The resulting hyper-reactivity of the "wanting' system is believed to heavily influence compulsive drug use and relapse. Notably, evidence for sensitization of the mesolimbic dopamine pathway has been seen across gambling and substance use, as well as anxiety and stress-related pathology, with stress playing a major role in relapse. Together, this evidence highlights a phenomenon known as cross-sensitization, whereby sensitization to stress, drugs, or gambling behaviors enhance the sensitivity and dopaminergic response to any of those stimuli. Here, we review the literature on how cue attraction and reward uncertainty may underlie gambling pathology, and examine how this framework may advance our understanding of co-mordidity with substance-use disorders (e.g., alcohol, nicotine) and anxiety disorders. We argue that reward uncertainty, as seen in slot machines and games of chance, increases dopaminergic activity in the mesolimbic pathway and enhances the incentive value of reward cues. We propose that incentive sensitization by reward uncertainty may interact with and predispose individuals to drug abuse and stress, creating a mechanism through which co-mordidity of these disorders may emerge.

Amygdala Functional and Structural Connectivity Predicts Individual Risk Tolerance

Risk tolerance, the degree to which an individual is willing to tolerate risk in order to achieve a greater expected return, influences a variety of financial choices and health behaviors. Here we identify intrinsic neural markers for risk tolerance in a large (n = 108) multimodal imaging dataset of healthy young adults, which includes anatomical and resting-state functional MRI and diffusion tensor imaging. Using a data-driven approach, we found that higher risk tolerance was most strongly associated with greater global functional connectivity (node strength) of and greater gray matter volume in bilateral amygdala. Further, risk tolerance was positively associated with functional connectivity between amygdala and medial prefrontal cortex and negatively associated with structural connectivity between these regions. These findings show how the intrinsic functional and structural architecture of the amygdala, and amygdala-medial prefrontal pathways, which have previously been implicated in anxiety, are linked to individual differences in risk tolerance during economic decision making.

Intolerance of Uncertainty, anxiety, and worry in children and adolescents: A meta-analysis

BACKGROUND

Intolerance of uncertainty (IU) has been implicated in the development and maintenance of worry and anxiety in adults and there is an increasing interest in the role that IU may play in anxiety and worry in children and adolescents.

METHOD

We conducted a systematic review and meta-analysis to summarize existing research on IU with regard to anxiety and worry in young people, and to provide a context for considering future directions in this area of research. The systematic review yielded 31 studies that investigated the association of IU with either anxiety or worry in children and adolescents.

RESULTS

The meta-analysis showed that IU accounted for 36.00% of the variance in anxiety and 39.69% in worry. Due to the low number of studies and methodological factors, examination of potential moderators was limited; and of those we were able to examine, none were significant moderators of either association. Most studies relied on questionnaire measures of IU, anxiety, and worry; all studies except one were cross-sectional and the majority of the studies were with community samples.

LIMITATIONS

The inclusion of eligible studies was limited to studies published in English that focus on typically developing children.

CONCLUSIONS

There is a strong association between IU and both anxiety and worry in young people therefore IU may be a relevant construct to target in treatment. To extend the existing literature, future research should incorporate longitudinal and experimental designs, and include samples of young people who have a range of anxiety disorders.

Factor structure of the intolerance of uncertainty scale for children

Intolerance of uncertainty (IU), a dispositional negative orientation toward uncertainty and its consequences, has been studied in adults, but research has only recently examined IU in youth. Despite some advances, little is known about the factor structure of measures of IU in youth. The present study used confirmatory factor analysis to examine the structure of IU as measured by the Intolerance of Uncertainty Scale for Children (IUSC; Comer et al., 2009) in a sample of youth (N=368) 9-18 years of age (M_age=12.47) with and without anxiety disorders and their mothers. Findings demonstrated multiple acceptable factor structures: a correlated factors 2-factor structure and a bifactor model where a general factor underlies all items. While the bifactor model provides better fit and reliability to the data, multivariate analyses indicated that the 2-factor structure distinguishes apprehensive anxiety regarding future events (prospective IU) from present-focused inhibition of behavior due to uncertainty and negative reactions to the presence of uncertainty (inhibitory IU); a total IU score predicted all anxiety domains for self- and parent-reports except for parent-report harm avoidance. Findings are discussed in terms of consistency of IU across adult and youth samples, and how results can inform treatment efforts and etiologic models of IU and anxiety.

Double dissociation between the neural correlates of the general and specific factors of the Life Orientation Test-Revised

In this article, we explore the neural correlates of the general and specific factors assessed by the Life Orientation Test-Revised. These factors have been shown to assess general optimism (GO) and a form of self-enhancement akin to unrealistic optimism (SP). Toward our aim, we used a standardized low-resolution brain electromagnetic tomography (sLORETA), which provides electroencephalographic (EEG) localization measures that are independent of recording reference. Resting-EEG and self-report measures of GO and SP were collected from 51 female undergraduates. EEGs were recorded across 29 scalp sites. Anterior and posterior source alpha asymmetries of cortical activation were obtained by using the sLORETA method. On the basis of previous research findings, ten frontal and six parietal regions of interest (ROIs) were derived. Alpha asymmetry in the posterior cingulate (i.e., BA31) was uniquely associated with GO. In contrast, SP was associated with areas of the inferior frontal gyrus (BA44, BA45) and with the left subcentralis area (BA43). Theoretical and practical implications of the findings are provided and discussed.

Development of a scale to evaluate young children's responses to uncertainty and low environmental structure

Intolerance of Uncertainty (IU), defined as the dispositional interpretation of uncertain or ambiguous events as stressful and problematic, has been linked to excessive worry and other anxiety-related problems in adults and youth. IU has been conceptualized as a vulnerability factor for excessive worry and anxiety, but the historical absence of a supported measure of IU in young children has hampered longitudinal research needed to evaluate temporal relationships between IU and anxiety and the differential developmental pathways of IU leading to different anxiety disorders and depression. The present study evaluated the psychometric properties of a newly developed 17-item parent-report measure of younger children's Responses to Uncertainty and Low Environmental Structure (i.e., the RULES questionnaire). We examined the preliminary structure, reliability, and validity of the RULES within a treatment-seeking sample of children aged 3-10 (N=160) with anxiety. Findings from an exploratory factor analysis supported a one-factor model that retained all 17 items. The RULES demonstrated strong internal consistency, and predictive, convergent, and divergent validity. In this early childhood sample, the RULES also showed stronger associations with anxiety than did a previously supported measure of IU developed for older youth, and showed preliminary sensitivity to treatment-related change. Findings provide preliminary psychometric support for the RULES as a parent-report measure of children's responses to uncertainty and low environmental structure that may inform etiologic models of anxiety.

The Personality Trait of Intolerance to Uncertainty Affects Behavior in a Novel Computer-Based Conditioned Place Preference Task

Recent work has found that personality factors that confer vulnerability to addiction can also affect learning and economic decision making. One personality trait which has been implicated in vulnerability to addiction is intolerance to uncertainty (IU), i.e., a preference for familiar over unknown (possibly better) options. In animals, the motivation to obtain drugs is often assessed through conditioned place preference (CPP), which compares preference for contexts where drug reward was previously received. It is an open question whether participants with high IU also show heightened preference for previously rewarded contexts. To address this question, we developed a novel computer-based CPP task for humans in which participants guide an avatar through a paradigm in which one room contains frequent reward (i.e., rich) and one contains less frequent reward (i.e., poor). Following exposure to both contexts, subjects are assessed for preference to enter the previously rich and previously poor room. Individuals with low IU showed little bias to enter the previously rich room first, and instead entered both rooms at about the same rate which may indicate a foraging behavior. By contrast, those with high IU showed a strong bias to enter the previously rich room first. This suggests an increased tendency to chase reward in the intolerant group, consistent with previously observed behavior in opioid-addicted individuals. Thus, the personality factor of high IU may produce a pre-existing cognitive bias that provides a mechanism to promote decision-making processes that increase vulnerability to addiction.

Intolerance of uncertainty in emotional disorders: What uncertainties remain?

The current paper presents a future research agenda for intolerance of uncertainty (IU), which is a transdiagnostic risk and maintaining factor for emotional disorders. In light of the accumulating interest and promising research on IU, it is timely to emphasize the theoretical and therapeutic significance of IU, as well as to highlight what remains unknown about IU across areas such as development, assessment, behavior, threat and risk, and relationships to cognitive vulnerability factors and emotional disorders. The present paper was designed to provide a synthesis of what is known and unknown about IU, and, in doing so, proposes broad and novel directions for future research to address the remaining uncertainties in the literature.

Intolerance of uncertainty, anxiety sensitivity, health anxiety, and anxiety disorder symptoms in youth

Intolerance of uncertainty (IU) - difficulty coping with uncertainty and its implications - is traditionally studied in adult populations, but more recently has been explored in children and adolescents. To date, the association between IU and health anxiety has not been explored in a child or adolescent sample. Further, it is unknown whether the relationship between IU and health anxiety may be mediated by anxiety sensitivity (i.e., fear of anxiety-related sensations) in this population. We sought to extend the existing research and expand our understanding of IU as a transdiagnostic construct by exploring the association between IU and health anxiety, anxiety sensitivity, and DSM-IV anxiety disorder symptom categories in 128 youth (M age=12.7years, SD=0.82, range 11-17 years). Participants completed measures of IU, health anxiety, anxiety sensitivity, and anxiety disorder symptom categories. Results demonstrated significant positive associations between IU and all measures. Mediation analyses supported the direct and indirect importance of each IU subscale on health anxiety. Future directions and implications are discussed.

Outcome Uncertainty and Brain Activity Aberrance in the Insula and Anterior Cingulate Cortex Are Associated with Dysfunctional Impulsivity in Borderline Personality Disorder

Uncertainty is recognized as an important component in distress, which may elicit impulsive behavior in patients with borderline personality disorder (BPD). These patients are known to be both impulsive and distress intolerant. The present study explored the connection between outcome uncertainty and impulsivity in BPD. The prediction was that cue primes, which provide incomplete information of subsequent target stimuli, led BPD patients to overrate the predictive value of these cues in order to reduce distress related to outcome uncertainty. This would yield dysfunctional impulsive behavior detected as commission errors to incorrectly primed targets. We hypothesized that dysfunctional impulsivity would be accompanied by aberrant brain activity in the right insula and anterior cingulate cortex (ACC), previously described to be involved in uncertainty processing, attention-/cognitive control and BPD pathology. 14 female BPD patients and 14 healthy matched controls (HCs) for comparison completed a Posner task during fMRI at 3T. The task was modified to limit the effect of spatial orientation and enhance the effect of conscious expectations. Brain activity was monitored in the priming phase where the effects of cue primes and neutral primes were compared. As predicted, the BPD group made significantly more commission errors to incorrectly primed targets than HCs. Also, the patients had faster reaction times to correctly primed targets relative to targets preceded by neutral primes. The BPD group had decreased activity in the right mid insula and increased activity in bilateral dorsal ACC during cue primes. The results indicate that strong expectations induced by cue primes led to reduced uncertainty, increased response readiness, and ultimately, dysfunctional impulsivity in BPD patients. We suggest that outcome uncertainty may be an important component in distress related impulsivity in BPD.

Psychophsyiological reactivity during uncertainty and ambiguity processing in high and low worriers

BACKGROUND AND OBJECTIVES

Intolerance of uncertainty (IU) has been linked to Generalized Anxiety Disorder (GAD), but studies experimentally manipulating uncertainty have mostly failed to find differences between GAD patients and controls, possible due to a lack of distinction between uncertainty and ambiguity. This study therefore investigated reactivity to ambiguity in addition to uncertainty in high worriers (HW) and low worriers (LW). We hypothesized an interpretation bias between the groups during ambiguity tasks, while uncertainty would facilitate threat processing of subsequent aversive stimuli.

METHODS

HW (N = 23) and LW (N = 23) completed a paradigm comprising the anticipation and perception of pictures with dangerous, safe, or ambiguous content. Anticipatory cues were certain (always correct information about the following picture) or uncertain (no information). Subjective ratings, reaction times and skin conductance responses (SCRs) were recorded.

RESULTS

HW rated particularly ambiguous pictures as more aversive and showed longer reaction times to all picture conditions compared to LW. SCRs were also larger in HW compared to LW, particularly during uncertain but also safe anticipation. No group differences were observed during perception of stimuli.

LIMITATIONS

All participants were female. HW was used as subclinical phenotype of GAD.

CONCLUSIONS

Intolerance of ambiguity seems to be related to individual differences in worry and possibly to the development of GAD. Threat-related interpretations differentiating HW and LW occurred particularly for ambiguous pictures but were not accompanied by increased autonomic arousal during the picture viewing. This disparity between subjective rating and arousal may be the result of worrying in response to intolerance of uncertainty, restraining physiological responses.

Neural basis of uncertain cue processing in trait anxiety

Individuals with high trait anxiety form a non-clinical group with a predisposition for an anxiety-related bias in emotional and cognitive processing that is considered by some to be a prerequisite for psychiatric disorders. Anxious individuals tend to experience more worry under uncertainty, and processing uncertain information is an important, but often overlooked factor in anxiety. So, we decided to explore the brain correlates of processing uncertain information in individuals with high trait anxiety using the learn-test paradigm. Behaviorally, the percentages on memory test and the likelihood ratios of identifying novel stimuli under uncertainty were similar to the certain fear condition, but different from the certain neutral condition. The brain results showed that the visual cortex, bilateral fusiform gyrus, and right parahippocampal gyrus were active during the processing of uncertain cues. Moreover, we found that trait anxiety was positively correlated with the BOLD signal of the right parahippocampal gyrus during the processing of uncertain cues. No significant results were found in the amygdala during uncertain cue processing. These results suggest that memory retrieval is associated with uncertain cue processing, which is underpinned by over-activation of the right parahippocampal gyrus, in individuals with high trait anxiety.

The dual systems model: Review, reappraisal, and reaffirmation

According to the dual systems perspective, risk taking peaks during adolescence because activation of an early-maturing socioemotional-incentive processing system amplifies adolescents' affinity for exciting, pleasurable, and novel activities at a time when a still immature cognitive control system is not yet strong enough to consistently restrain potentially hazardous impulses. We review evidence from both the psychological and neuroimaging literatures that has emerged since 2008, when this perspective was originally articulated. Although there are occasional exceptions to the general trends, studies show that, as predicted, psychological and neural manifestations of reward sensitivity increase between childhood and adolescence, peak sometime during the late teen years, and decline thereafter, whereas psychological and neural reflections of better cognitive control increase gradually and linearly throughout adolescence and into the early 20s. While some forms of real-world risky behavior peak at a later age than predicted, this likely reflects differential opportunities for risk-taking in late adolescence and young adulthood, rather than neurobiological differences that make this age group more reckless. Although it is admittedly an oversimplification, as a heuristic device, the dual systems model provides a far more accurate account of adolescent risk taking than prior models that have attributed adolescent recklessness to cognitive deficiencies.

Role of contingency in striatal response to incentive in adolescents with anxiety

This study examines the effect of contingency on reward function in anxiety. We define contingency as the aspect of a situation in which the outcome is determined by one's action-that is, when there is a direct link between one's action and the outcome of the action. Past findings in adolescents with anxiety or at risk for anxiety have revealed hypersensitive behavioral and neural responses to higher value rewards with correct performance. This hypersensitivity to highly valued (salient) actions suggests that the value of actions is determined not only by outcome magnitude, but also by the degree to which the outcome is contingent on correct performance. Thus, contingency and incentive value might each modulate reward responses in unique ways in anxiety. Using fMRI with a monetary reward task, striatal response to cue anticipation is compared in 18 clinically anxious and 20 healthy adolescents. This task manipulates orthogonally reward contingency and incentive value. Findings suggest that contingency modulates the neural response to incentive magnitude differently in the two groups. Specifically, during the contingent condition, right-striatal response tracks incentive value in anxious, but not healthy, adolescents. During the noncontingent condition, striatal response is bilaterally stronger to low than to high incentive in anxious adolescents, while healthy adolescents exhibit the expected opposite pattern. Both contingency and reward magnitude differentiate striatal activation in anxious versus healthy adolescents. These findings may reflect exaggerated concern about performance and/or alterations of striatal coding of reward value in anxious adolescents. Abnormalities in reward function in anxiety may have treatment implications.

P300 and Decision Making under Risk and Ambiguity

Our study aims to contrast the neural temporal features of early stage of decision making in the context of risk and ambiguity. In monetary gambles under ambiguous or risky conditions, 12 participants were asked to make a decision to bet or not, with the event-related potentials (ERPs) recorded meantime. The proportion of choosing to bet in ambiguous condition was significantly lower than that in risky condition. An ERP component identified as P300 was found. The P300 amplitude elicited in risky condition was significantly larger than that in ambiguous condition. The lower bet rate in ambiguous condition and the smaller P300 amplitude elicited by ambiguous stimuli revealed that people showed much more aversion in the ambiguous condition than in the risky condition. The ERP results may suggest that decision making under ambiguity occupies higher working memory and recalls more past experience while decision making under risk mainly mobilizes attentional resources to calculate current information. These findings extended the current understanding of underlying mechanism for early assessment stage of decision making and explored the difference between the decision making under risk and ambiguity.

Fear of the unknown: uncertain anticipation reveals amygdala alterations in childhood anxiety disorders

Children with anxiety disorders (ADs) experience persistent fear and worries that are highly debilitating, conferring risk for lifelong psychopathology. Anticipatory anxiety is a core clinical feature of childhood ADs, often leading to avoidance of uncertain and novel situations. Extensive studies in non-human animals implicate amygdala dysfunction as a critical substrate for early life anxiety. To test specific amygdala-focused hypotheses in preadolescent children with ADs, we used fMRI to characterize amygdala activation during uncertain anticipation and in response to unexpected stimuli. Forty preadolescent (age 8-12 years) children, 20 unmedicated AD patients and 20 matched controls completed an anticipation task during an fMRI scan. In the task, symbolic cues preceded fear or neutral faces, such that 'certain' cues always predicted the presentation of fear or neutral faces, whereas 'uncertain' cues were equally likely to be followed by fear or neutral faces. Both AD children and controls showed robust amygdala response to faces. In response to the uncertain cues, AD children had increased amygdala activation relative to controls. Moreover, in the AD children, faces preceded by an 'uncertain' cue elicited increased amygdala activation, as compared with the same faces following a 'certain' cue. Children with ADs experience distress both in anticipation of and during novel and surprising events. Our findings suggest that increased amygdala activation may have an important role in the generation of uncertainty-related anxiety. These findings may guide the development of neuroscientifically informed treatments aimed at relieving the suffering and preventing the lifelong disability associated with pediatric ADs.

Age differences in the impact of peers on adolescents' and adults' neural response to reward

Prior research suggests that increased adolescent risk-taking in the presence of peers may be linked to the influence of peers on the valuation and processing of rewards during decision-making. The current study explores this idea by examining how peer observation impacts the processing of rewards when such processing is isolated from other facets of risky decision-making (e.g. risk-perception and preference, inhibitory processing, etc.). In an fMRI paradigm, a sample of adolescents (ages 14-19) and adults (ages 25-35) completed a modified High/Low Card Guessing Task that included rewarded and un-rewarded trials. Social context was manipulated by having participants complete the task both alone and while being observed by two, same-age, same-sex peers. Results indicated an interaction of age and social context on the activation of reward circuitry during the receipt of reward; when observed by peers adolescents exhibited greater ventral striatal activation than adults, but no age-related differences were evinced when the task was completed alone. These findings suggest that, during adolescence, peers influence recruitment of reward-related regions even when they are engaged outside of the context of risk-taking. Implications for engagement in prosocial, as well as risky, behaviors during adolescence are discussed.

Children do not exhibit ambiguity aversion despite intact familiarity bias

The phenomenon of ambiguity aversion, in which risky gambles with known probabilities are preferred over ambiguous gambles with unknown probabilities, has been thoroughly documented in adults but never measured in children. Here, we use two distinct tasks to investigate ambiguity preferences of children (8- to 9-year-olds) and a comparison group of adults (19- to 27-year-olds). Across three separate measures, we found evidence for significant ambiguity aversion in adults but not in children and for greater ambiguity aversion in adults compared to children. As ambiguity aversion in adults has been theorized to result from a preference to bet on the known and avoid the unfamiliar, we separately measured familiarity bias and found that children, like adults, are biased towards the familiar. Our findings indicate that ambiguity aversion emerges across the course of development between childhood and adolescence, while a familiarity bias is already present in childhood.

Emotional and effortful control abilities in 42-month-old very preterm and full-term children

BACKGROUND

Very preterm (VP) infants are at greater risk for cognitive difficulties that may persist during school-age, adolescence and adulthood. Behavioral assessments report either effortful control (part of executive functions) or emotional reactivity/regulation impairments.

AIMS

The aim of this study is to examine whether emotional recognition, reactivity, and regulation, as well as effortful control abilities are impaired in very preterm children at 42 months of age, compared with their full-term peers, and to what extent emotional and effortful control difficulties are linked.

STUDY DESIGN

Children born very preterm (VP; < 29 weeks gestational age, n=41) and full-term (FT) aged-matched children (n=47) participated in a series of specific neuropsychological tests assessing their level of emotional understanding, reactivity and regulation, as well as their attentional and effortful control abilities.

RESULTS

VP children exhibited higher scores of frustration and fear, and were less accurate in naming facial expressions of emotions than their aged-matched peers. However, VP children and FT children equally performed when asked to choose emotional facial expression in social context, and when we assessed their selective attention skills. VP performed significantly lower than full terms on two tasks of inhibition when correcting for verbal skills. Moreover, significant correlations between cognitive capacities (effortful control) and emotional abilities were evidenced.

CONCLUSIONS

Compared to their FT peers, 42 month-olds who were born very preterm are at higher risk of exhibiting specific emotional and effortful control difficulties. The results suggest that these difficulties are linked. Ongoing behavioral and emotional impairments starting at an early age in preterms highlight the need for early interventions based on a better understanding of the relationship between emotional and cognitive difficulties.

Obsessive-compulsive disorder is associated with broad impairments in executive function: A meta-analysis

Obsessive-compulsive disorder (OCD) is a serious and often chronically disabling condition. The current dominant model of OCD focuses on abnormalities in prefrontal-striatal circuits that support executive function (EF). While there is growing evidence for EF impairments associated with OCD, results have been inconsistent, making the nature and magnitude of these impairments controversial. The current meta-analysis uses random-effects models to synthesize 110 previous studies that compared participants with OCD to healthy control participants on at least one neuropsychological measure of EF. The results indicate that individuals with OCD are impaired on tasks measuring most aspects of EF, consistent with broad impairment in EF. EF deficits were not explained by general motor slowness or depression. Effect sizes were largely stable across variation in demographic and clinical characteristics of samples, although medication use, age, and gender moderated some effects.

The role of the anterior insula in adolescent decision making

Much recent research on adolescent decision making has sought to characterize the neurobiological mechanisms that underlie the proclivity of adolescents to engage in risky behavior. One class of influential neurodevelopmental models focuses on the asynchronous development of neural systems, particularly those responsible for self-regulation and reward seeking. While this work has largely focused on the development of prefrontal (self-regulation) and striatal (reward processing) circuitry, the present article explores the significance of a different region, the anterior insular cortex (AIC), in adolescent decision making. Although the AIC is known for its role as a cognitive-emotional hub, and is included in some models of adult self-regulation and reward seeking, the importance of the AIC and its maturation in adolescent risk taking has not been extensively explored. In this article we discuss evidence on AIC development, and consider how age-related differences in AIC engagement may contribute to heightened risk taking during adolescence. Based on this review, we propose a model in which the engagement of adolescents in risk taking may be linked in part to the maturation of the AIC and its connectivity to the broader brain networks in which it participates.

Decision-making after continuous wins or losses in a randomized guessing task: implications for how the prior selection results affect subsequent decision-making

Background

Human decision-making is often affected by prior selections and their outcomes, even in situations where decisions are independent and outcomes are unpredictable.

Methods

In this study, we created a task that simulated real-life non-strategic gambling to examine the effect of prior outcomes on subsequent decisions in a group of male college students.

Results

Behavioral performance showed that participants needed more time to react after continuous losses (LOSS) than continuous wins (WIN) and discontinuous outcomes (CONTROL). In addition, participants were more likely to repeat their selections in both WIN and LOSS conditions. Functional MRI data revealed that decisions in WINs were associated with increased activation in the mesolimbic pathway, but decreased activation in the inferior frontal gyrus relative to LOSS. Increased prefrontal cortical activation was observed during LOSS relative to WIN and CONTROL conditions.

Conclusion

Taken together, the behavioral and neuroimaging findings suggest that participants tended to repeat previous selections during LOSS trials, a pattern resembling the gambler’s fallacy. However, during WIN trials, participants tended to follow their previous lucky decisions, like the ‘hot hand’ fallacy.

Linking neuroscientific research on decision making to the educational context of novice students assigned to a multiple-choice scientific task involving common misconceptions about electrical circuits

Functional magnetic resonance imaging was used to identify the brain-based mechanisms of uncertainty and certainty associated with answers to multiple-choice questions involving common misconceptions about electric circuits. Twenty-two scientifically novice participants (humanities and arts college students) were asked, in an fMRI study, whether or not they thought the light bulbs in images presenting electric circuits were lighted up correctly, and if they were certain or uncertain of their answers. When participants reported that they were unsure of their responses, analyses revealed significant activations in brain areas typically involved in uncertainty (anterior cingulate cortex, anterior insula cortex, and superior/dorsomedial frontal cortex) and in the left middle/superior temporal lobe. Certainty was associated with large bilateral activations in the occipital and parietal regions usually involved in visuospatial processing. Correct-and-certain answers were associated with activations that suggest a stronger mobilization of visual attention resources when compared to incorrect-and-certain answers. These findings provide insights into brain-based mechanisms of uncertainty that are activated when common misconceptions, identified as such by science education research literature, interfere in decision making in a school-like task. We also discuss the implications of these results from an educational perspective.

Altered frontocingulate activation during aversive interoceptive processing in young adults transitioning to problem stimulant use

Problems associated with stimulant use have been linked to frontocingulate, insular, and thalamic dysfunction during decision making and alterations in interoceptive processing. However, little is known about how interoception and decision making interact and contribute to dysfunctions that promote the transition from recreational drug use to abuse or dependence. Here, we investigate brain activation in response to reward, punishment, and uncertainty during an aversive interoceptive challenge in current and former stimulant (cocaine and amphetamine) users using functional magnetic resonance imaging (fMRI). Young adults previously identified as recreational users (n = 184) were followed up 3 years later. Of these, 18 individuals progressed to problem stimulant use (PSU), whereas 15 desisted stimulant use (DSU). PSU, DSU, and 14 healthy comparison subjects (CTL) performed a two-choice prediction task at three fixed error rates (20% = reward, 50% = uncertainty, 80% = punishment) during which they anticipated and experienced episodes of inspiratory breathing load. Although groups did not differ in insula activation or subjective breathing load ratings, PSU exhibited lower right inferior frontal gyrus (IFG) and bilateral anterior cingulate (ACC) activation than DSU and CTL during aversive interoceptive processing as well as lower right IFG in response to decision making involving uncertainty. However, PSU exhibited greater bilateral IFG activation than DSU and CTL while making choices within the context of punishing feedback, and both PSU and DSU showed lower thalamic activation during breathing load than CTL. Findings suggest that frontocingulate attenuation, reflecting reduced resources devoted to goal maintenance and action selection in the presence of uncertainty and interoceptive perturbations, may be a biomarker for susceptibility to PSU.

Medial frontal cortex and anterior insula are less sensitive to outcome predictability when monetary stakes are higher

Prior research links greater activation of posterior medial frontal cortex (pMFC) and anterior insula (AI) with decreasing outcome predictability during decision making, as measured by decreasing probability for the more likely outcome out of two or increasing outcome variance. In addition to predictability, much work indicates that the magnitude or 'stakes' of the outcome is also important. Despite the interest in the neural correlates of these decision variables, it is unknown whether pMFC and AI are differentially sensitive to predictability when magnitude is varied. This study examined brain activity during decision making in relation to decreasing outcome predictability for low as compared with high magnitude decisions. For low magnitude decisions, reduced predictability of the outcome was associated with greater activity in pMFC and bilateral AI, replicating prior studies. In contrast, there was no relationship between predictability and brain activity for high magnitude decisions, which tended to elicit greater pMFC and AI activity than low magnitude decisions for more predictable outcomes. These data indicate that the relationship between outcome predictability and pMFC and AI activity during decision making depends on magnitude, and suggest that these regions may be responding to the motivational salience of the decision rather than predictability information per se.

Understanding adolescence as a period of social-affective engagement and goal flexibility

Research has demonstrated that extensive structural and functional brain development continues throughout adolescence. A popular notion emerging from this work states that a relative immaturity in frontal cortical neural systems could explain adolescents' high rates of risk-taking, substance use and other dangerous behaviours. However, developmental neuroimaging studies do not support a simple model of frontal cortical immaturity. Rather, growing evidence points to the importance of changes in social and affective processing, which begin around the onset of puberty, as crucial to understanding these adolescent vulnerabilities. These changes in social-affective processing also may confer some adaptive advantages, such as greater flexibility in adjusting one's intrinsic motivations and goal priorities amidst changing social contexts in adolescence.

Neural mechanisms of decision making in hoarding disorder

CONTEXT

Hoarding disorder (HD), previously considered a subtype of obsessive-compulsive disorder (OCD), has been proposed as a unique diagnostic entity in DSM-5. Current models of HD emphasize problems of decision-making, attachment to possessions, and poor insight, whereas previous neuroimaging studies have suggested abnormalities in frontal brain regions.

OBJECTIVE

To examine the neural mechanisms of impaired decision making in HD in patients with well-defined primary HD compared with patients with OCD and healthy control subjects (HCs).

DESIGN

We compared neural activity among patients with HD, patients with OCD, and HCs during decisions to keep or discard personal possessions and control possessions from November 9, 2006, to August 13, 2010.

SETTING

Private, not-for-profit hospital.

PARTICIPANTS

A total of 107 adults (43 with HD, 31 with OCD, and 33 HCs).

MAIN OUTCOME MEASURES

Neural activity as measured by functional magnetic resonance imaging in which actual real-time and binding decisions had to be made about whether to keep or discard possessions.

RESULTS

Compared with participants with OCD and HC, participants with HD exhibited abnormal activity in the anterior cingulate cortex and insula that was stimulus dependent. Specifically, when deciding about items that did not belong to them, patients with HD showed relatively lower activity in these brain regions. However, when deciding about items that belonged to them, these regions showed excessive functional magnetic resonance imaging signals compared with the other 2 groups. These differences in neural function correlated significantly with hoarding severity and self-ratings of indecisiveness and "not just right" feelings among patients with HD and were unattributable to OCD or depressive symptoms.

CONCLUSIONS

Findings suggest a biphasic abnormality in anterior cingulate cortex and insula function in patients with HD related to problems in identifying the emotional significance of a stimulus, generating appropriate emotional response, or regulating affective state during decision making.

Translational application of neuromodulation of decision-making

Recent cognitive neuroscience studies indicate that noninvasive brain stimulation can modulate a wide spectrum of behaviors in healthy individuals. Such modulation of behaviors provides novel insights into the fundamentals and neurobiology of cognitive functions in the healthy brain, but also suggests promising prospects for translational applications into clinical populations. One type of behavior that can be modulated with noninvasive brain stimulation is decision-making. For instance, brain stimulation can induce more cautious or riskier behaviors. The capacity of influencing processes involved in decision-making is of particular interest because such processes are at the core of human social and emotional functioning (or dysfunctioning). We review cognitive neuroscience studies that have successfully modulated processes involved in decision-making with transcranial direct current stimulation (tDCS) or transcranial magnetic stimulation (TMS), including risk taking, reward seeking, impulsivity, and fairness consideration. We also discuss potential clinical relevance of these findings for patients who have still unmet therapeutic need and whose alterations in decision-making represent hallmarks of their clinical symptomatology, such as individuals with addictive disorders.

Subjective uncertainty and limbic hyperactivation in obsessive-compulsive disorder

Obsessive-compulsive disorder (OCD) is often associated with pathological uncertainty regarding whether an action has been performed correctly or whether a bad outcome will occur, leading to compulsive "evidence gathering" behaviors aimed at reducing uncertainty. The current study used event-related functional magnetic resonance imaging to investigate neural functioning in OCD patients and controls as subjective certainty was rated in response to sequential pieces of evidence for a decision. Uncertainty was experimentally manipulated so that some decisions were associated with no "objective" uncertainty (all observed evidence pointed to one correct choice), whereas other decisions contained calculable but varying levels of objective uncertainty based on displayed probabilities. Results indicated that OCD patients differed from controls on decisions that contained no objective uncertainty, such that patients rated themselves as more uncertain. Patients also showed greater activation in a network of brain regions previously associated with internally-focused thought and valuation including ventromedial prefrontal cortex, parahippocampus, middle temporal cortex, as well as amygdala and orbitofrontal cortex/ventral anterior insula. In the patient group, a significantly greater number of positive intersubject correlations were found among several of these brain regions, suggesting that this network is more interconnected in patients. OCD patients did not differ from controls on decisions where task parameters led to uncertainty. These results indicate that OCD is associated with hyperactivation in a network of limbic/paralimbic brain regions when making decisions, which may contribute to the greater subjective experience of doubt that characterizes the disorder.

Assessing the latent structure of the intolerance of uncertainty construct: an initial taxometric analysis

Researchers have increasingly suggested that people with anxiety disorders share a common fear that the uncertain future will be catastrophic. Intolerance of uncertainty (IU) - the tendency to consider possible negative events as unacceptable and threatening, irrespective of probabilities - is representative of such fears. A key role has been indicated for IU in several anxiety and mood disorders; however, the present study appears to be the first latent structure examination of IU. Responses were obtained from a large sample (n=977; 65% women) unselected with regard to IU level, comprising anxiety disorder outpatients (i.e., putative taxon members), and community residents (i.e., putative complement class members). MAXEIG, MAMBAC, and L-Mode were performed with indicator sets drawn from the Intolerance of Uncertainty Scale-12. Assessments also included objective Comparison Curve Fit Indices. Results yielded converging evidence that IU symptoms have a dimensional latent structure. Comprehensive findings, implications, and future research directions are discussed.

Updating beliefs for a decision: neural correlates of uncertainty and underconfidence

Some decisions are made after obtaining several pieces of information, whereas others are reached quickly. Such differences may depend on the quality of information acquired, as well as individual variability in how cautiously evidence is evaluated. The current study examined neural activity while subjects accumulated sequential pieces of evidence and then made a decision. Uncertainty was updated with each piece of evidence, with individual ratings of subjective uncertainty characterizing underconfidence when observing evidence. Increased uncertainty during evidence accumulation was associated with activity in dorsal anterior cingulate cortex, whereas greater uncertainty when executing a decision uniquely elicited lateral frontal and parietal activity. Greater underconfidence when observing evidence correlated with activity in ventromedial prefrontal cortex. These results suggest that neural mechanisms of uncertainty depend on the stage of decision-making (belief updating vs decision) and that greater subjective uncertainty when evaluating evidence is associated with activity in ventromedial brain regions, even in the absence of overt risk.