Decision-Making for Risky Gains and Losses among College Students with Internet Gaming Disorder

January Decision-Making for Risky Gains and Losses among College Students with Internet Gaming Disorder Yuan-Wei Yao 0 1 2 Pin-Ru Chen 0 1 2 Song Li 0 1 2 Ling-Jiao Wang 0 1 2 Jin-Tao Zhang 0 1 2 Sarah W. Yip 0 1 2 Gang Chen 0 1 2 Lin-Yuan Deng 0 1 2 Qin-Xue Liu 0 1 2 Xiao-Yi Fang 0 1 2 0 1 School of Psychology, Beijing Normal University , Beijing , China , 2 School of Mathematical Science, Beijing Normal University , Beijing , China , 3 State Key Laboratory of Cognitive Neuroscience and Learning and IDG/ McGovern Institute for Brain Research, Beijing Normal University , Beijing , China , 4 Center for Collaboration and Innovation in Brain and Learning Sciences, Beijing Normal University , Beijing , China , 5 Department of Psychiatry, Yale University School of Medicine , New Haven, CT , United States of America, 6 Scientific and Statistical Computing Core, National Institute of Mental Health, National Institutes of Health, Department of Health and Human Services , Bethesda , Maryland, United States of America, 7 Faculty of Education, Beijing Normal University , Beijing , China , 8 School of Psychology, Central China Normal University , Wuhan , China , 9 Key Laboratory of Adolescent Cyberpsychology and Behavior (CCNU), Ministry of Education , Wuhan , China , 10 Institute of Developmental Psychology, Beijing Normal University , Beijing , China , 11 Academy of Psychology and Behavior, Tianjin Normal University , Tianjin , China 1 Funding: This study was supported by the National Natural Science Foundation of China (No. 31170990 and No. 81100992), the fundamental research funds for the central universities (No. 2012WYB01), and the National Innovative Foundation Programs for College Students of China (No. 201310027028). SWY re- ceived salary support from the grant from NIDA (T32 DA007238-23). The funders had no role in the study design, collection and analysis of the data, or prepa- ration of the manuscript 2 Academic Editor: Ingmar H.A. Franken, Erasmus University Rotterdam , NETHERLANDS Individuals with Internet gaming disorder (IGD) tend to exhibit disadvantageous risky decision-making not only in their real life but also in laboratory tasks. Decision-making is a complex multifaceted function and different cognitive processes are involved in decisionmaking for gains and losses. However, the relationship between impaired decision-making and gain versus loss processing in the context of IGD is poorly understood. The main aim of the present study was to separately evaluate decision-making for risky gains and losses among college students with IGD using the Cups task. Additionally, we further examined the effects of outcome magnitude and probability level on decision-making related to risky gains and losses respectively. Sixty college students with IGD and 42 matched healthy controls (HCs) participated. Results indicated that IGD subjects exhibited generally greater risk taking tendencies than HCs. In comparison to HCs, IGD subjects made more disadvantageous risky choices in the loss domain (but not in the gain domain). Follow-up analyses indicated that the impairment was associated to insensitivity to changes in outcome magnitude and probability level for risky losses among IGD subjects. In addition, higher Internet addiction severity scores were associated with percentage of disadvantageous risky options in the loss domain. These findings emphasize the effect of insensitivity to losses on disadvantageous decisions under risk in the context of IGD, which has implications for future intervention studies. - Competing Interests: The authors have declared that no competing interests exist. Internet gaming disorder (IGD) is defined as excessive and uncontrolled gaming online despite the experience of negative consequences, including insomnia, poor academic performance, and social isolation [1,2]. IGD is increasingly recognized as a mental health issue worldwide [3], as highlighted by its recent including in Section III of the DSM-5 as a topic deserving more future studies [4]. Moreover, since Internet is freely available in campuses, majority of college students play Internet games for recreations, which, however, make them as one of the most susceptible populations to IGD [5,6]. Maladaptive decision-making is one of the key symptoms of addition [79]. Previous findings suggest that individuals with substance abuse or dependence have impaired performance on a range of decision-making tasks [1014]. Recent studies indicate decision-making deficits in IGD. For instance, researchers found that individuals with IGD made more disadvantageous choices on the Game of Dice Task relative to healthy non-playing comparison subjects [15], and that such impairments may be partly a result of a failure to utilize feedback [16]. Evidence also suggests that individuals with Internet addiction are impaired in decision-making under ambiguity measured by the Iowa Gambling Task [17,18]. Neuroimaging studies using other paradigms (e.g., guessing task, probability discounting task) also suggest alterations in neural responses among individuals with IGD during decision-making processes, involving anticipating and processing rewards and punishments [1921] and evaluating risks [22]. Decision-making is a complex cognitive function, and accumulating evidence suggests that different processes are involved in decision-making for gains and losses [2326]. Some researchers have found that individuals with addiction-related disorders made significantly more disadvantageous choices primarily in the gainas compared to lossdomain [27,28], whereas existing data also suggest that insensitivity to losses play an essential role in decision-making deficits among individuals with substance dependence [29,30]. However, the extent to which impaired decision-making among IGD subjects is attributable to alterations in gain versus loss processing remains poorly understood. Separately investigating the characteristics of reward seeking and loss avoidance among individuals with IGD will advance current understanding of the mechanisms underlying decision-making deficits in this population, and may be help in the development of more effective interventions for IGD. In the current study, we sought to separately evaluate decision-making for gains and losses among college students with IGD. For this purpose, we adopted the Cups task [26], which isolates decision making for the gain and loss domains. In addition, we further sought to examine the effects of two essential components, outcome magnitude and probability level, on decisionmaking related to risky gains and losses. Based on previous studies [15,16,21], we hypothesized that: (1) IGD subjects, compared to matched healthy controls (HCs) would make significantly more risky choices overall; (2) IGD subjects, in comparison to HCs, would perform worse on risk disadvantageous trials in both the gain and loss domains; (3) decision-making deficits among IGD subjects were associa (...truncated)