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Sunday, March 19, 2023

The role of attention in decision-making under risk in gambling disorder: an eye-tracking study

Hoven, M., Hirmas, A., Engelmann, J. B., 
& van Holst, R. (2022, June 30).


Gambling disorder (GD) is a behavioural addiction characterized by impairments in decision-making, favouring risk- and reward-prone choices. One explanatory factor for this behaviour is a deviation in attentional processes, as increasing evidence indicates that GD patients show an attentional bias toward gambling stimuli. However, previous attentional studies have not directly investigated attention during risky decision-making. 25 patients with GD and 27 healthy matched controls (HC) completed a mixed gambles task combined with eye-tracking to investigate attentional biases for potential gains versus losses during decision-making under risk. Results indicate that compared to HC, GD patients gambled more and were less loss averse. GD patients did not show a direct attentional bias towards gains (or relative to losses). Using a recent (neuro)economics model that considers average attention and trial-wise deviations in average attention, we conducted fine-grained exploratory analyses of the attentional data. Results indicate that the average attention in GD patients moderated the effect of gain value on gambling choices, whereas this was not the case for HC. GD patients with high average attention for gains started gambling at less high gain values. A similar trend-level effect was found for losses, where GD patients with high average attention for losses stopped gambling with lower loss values. This study gives more insight into how attentional processes in GD play a role in gambling behaviour, which could have implications for the development of future treatments focusing on attentional training or for the development of interventions that increase the salience of losses.

From the Discussion section

We extend the current literature by investigating the role of attention in risky decision-making using eye-tracking, which has been underexplored in GD thus far. Consistent with previous studies in HCs, subjects’ overall relative attention toward gains decreased in favor of attention toward losses when  loss  values  increased.  We  did not find group differences in attention to either  gains or losses, suggesting no direct attentional biases in GD. However, while HCs increased their attention to gains with higher gain values, patients with GD did not. Moreover, while patients with GD displayed lower loss aversion, they did not show less attention to losses, rather, in both groups, increased trial-by-trial attention to losses resulted in less gambling.

The question arises whether attention modulates the effect of gains and losses on choice behavior differently in GD relative to controls. Our exploratory analyses that differentiated between two different channels of attention indeed indicated that the effect of gain value on gambling choices was modulated by the amount of average attention on gains in GD only. In other words, patients with GD who focused more on gains exhibited a greater gambling propensity at relatively low gain values. Notably, the strength of the effect of gain value on choice only significantly differed at average and high levels of attention to gains between groups, while patients with GD and HCs with relatively low levels of average attention to gains did not differ. Moreover, patients with GD who had relatively more average attention to losses showed a reduction in gambling propensity at relatively lower loss values, but note that this was at trend level.  Since  average  attention  relates  to  goal-directed or top-down attention, this measure likely reflects one’s preferences and beliefs.  Hence,  the  current  results suggest  that  gambling  choices  in  patients  with GD, relative to HCs are more  influenced by their preferences for gains. Future studies are needed to verify if and how top-down attentional processes affect decision-making in GD.

Editor's note: Apparently, GD focusing primarily on gains continue to gamble.  GD and HC who focus on losses are more likely to stop.  Therefore, psychologists treating people with impulse control difficulties may want to help patient's focus on potential losses/harm, as opposed to imagined gains.