Anxiety impairs decision-making: Psychophysiological evidence from an Iowa Gambling Task

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Biological Psychology 77 (2008) 353–358

Anxiety impairs decision-making: Psychophysiological evidence

from an Iowa Gambling Task

Andrei C. Miu a,*, Renata M. Heilman a, Daniel Houser b,*a Program of Cognitive Neuroscience, Department of Psychology, Babes-Bolyai University, 37 Republicii, Cluj-Napoca, CJ 400015, Romania

b Interdisciplinary Center for Economic Science and Department of Economics, George Mason University,

4400 University Drive, MSN 1B2, Fairfax, VA 22030, USA

Received 23 December 2006; accepted 30 November 2007

Available online 10 January 2008

Abstract

Using the Iowa Gambling Task (IGT) and psychophysiological correlates of emotional responses (i.e., heart rate and skin conductance), we

investigate the effects of trait anxiety (TA) on decision-making. We find that high TA is associated with both impaired decision-making and

increased anticipatory physiological (somatic) responses prior to advantageous trials. For both high and low TA, skin conductance responses

preceding advantageous trials predict decisions. At the same time, somatic responses to choice outcomes reflect differences between high and low

TA sensitivities to punishments and rewards. The pattern of impaired decision-making and increased somatic markers that we find in high TA may

have important implications for neuropsychological decision theory. In particular, it offers an example of defective modulation of somatic signals,

coupled with disrupted discrimination of advantageous and disadvantageous choices.

# 2008 Elsevier B.V. All rights reserved.

Keywords: Anxiety; Emotion and decision-making; Somatic markers

1. Introduction

It is by now widely accepted that emotion plays an adaptive

role in human decision-making (for review see Bechara et al.,

2000; Dunn et al., 2006). Discovering the physiological

correlates and neurobiological underpinnings of emotion’s

influence on decision, as well as the role individual differences

might play in this regard, is the ambitious goal of a rapidly

expanding literature (e.g., Kurzban and Houser, 2001; McCabe

et al., 2001; Decety et al., 2004). Here we contribute to this

literature by reporting data from experiments using the Iowa

Gambling Task (IGT) that provide novel evidence on joint

relationships among trait anxiety (TA), somatic signaling and

decision-making.

IGT is a decision-making task simulating uncertainty of

premises and outcomes, as well as reward and punishment in

controlled laboratory conditions (Bechara et al., 1994). IGT has

proven extremely valuable in studies of the effects of

* Corresponding authors.

E-mail addresses: [email protected] (A.C. Miu),

[email protected] (D. Houser).

0301-0511/$ – see front matter # 2008 Elsevier B.V. All rights reserved.

doi:10.1016/j.biopsycho.2007.11.010

personality in decision-making. For instance, some timely

studies that approached the influence of personality on

decision-making found that sensation-seeking positively

correlated with the frequency of advantageous choices (Reavis

and Overman, 2001), whereas negative emotionality negatively

correlated with the frequency of choices from high-punishment

decks (Peters and Slovic, 2000). These studies suggested

personality differences, particularly those associated with

emotional reactivity such as TA, might provide a partial

explanation for the high variance of IGT performance in

healthy volunteers (Bechara and Damasio, 2005).

TA reflects individual differences in sensitivity to threat

(Spielberger, 1966; Endler and Kocovski, 2001; Gray and

McNaughton, 2000/2003, pp. 338). These individual differ-

ences have been functionally translated into attentional,

memory, and interpretative biases towards the preferential

processing of aversive stimuli (e.g., Calvo et al., 2003). The

biological basis of this personality dimension has been

extensively studied from the genetic (Lau et al., 2006; Lesch

et al., 1996; Buckholtz et al., in press) to the neural systems

level (Grachev and Apkarian, 2000; Yamasue et al., 2008;

Paulus et al., 2004). These studies indicated that TA is

considerably supported by additive genetic factors, some of

A.C. Miu et al. / Biological Psychology 77 (2008) 353–358354

which are already known (e.g., variants of the serotonin

transporter and monoamine oxidase A genes), and it is

associated with morphological, neurochemical and functional

brain differences in neural networks (e.g., prefrontal cortex,

amygdala) that were previously related to emotion.

The relationship between TA and decision-making has

received attention only very recently. Using self-report

measures of risk perception and a decision-making task

explicitly involving risk evaluation, several studies found that

TA was associated with increased avoidance of risky decision

and pessimistic risk appraisals (Maner et al., 2007; Maner and

Schmidt, 2006; Mitte, 2007). However, we are aware of no

study investigating effects of TA on decision-making using

complex tasks such as IGT, which is thought to involve covert

emotional signals that might adaptively guide decision-making

even before explicit knowledge about the task is available (see

Bechara et al., 1997; and Maia and McClelland, 2004).

Considering that TA has been associated with preattentional

cognitive biases (for review see Mathews and Mackintosh,

1998), investigating the effect of TA on decisions involving

emotional cues that preattentionally guide performance would

be an important empirical contribution.

The present study investigates effects of TA on IGT

performance, and obtains measures on the physiological

correlates of somatic signals that are expected to inform

decision-making (Bechara et al., 1997; Crone et al., 2004). We

design our study to provide evidence on two key related

hypotheses. First, we hypothesize that high TA participants will

show lower IGT performance compared to low TA participants.

Second, wehypothesize that high TA participantswill display this

lower performance concurrently with relatively high task-related

somatic signalling. We discuss below that these two hypotheses,

both of which our data support, are not necessarily inconsistent

with the somatic marker hypothesis (Bechara et al., 2000). The

reason is that the somatic marker hypothesis admits, under certain

conditions, uncoupling of somatic signals and ultimate decisions.

2. Materials and methods

2.1. Participants

Out of an initial cohort of 112 Babes-Bolyai undergraduate students who

agreed to be screened for this study, we selected 11 women and 9 men (mean

Table 1

Scores on the trait portion of State-Trait Anxiety Inventory (STAI) and Zuckerma

Category Women

TA low T

STAI-TA 27.66 W 0.57 5

ZKPQ anxiety/neuroticism 2 W 0.3

ZKPQ aggression/hostility 7.8 � 5.44

ZKPQ activity 12.2 � 2.58

ZKPQ sociability 8.2 � 7.1

ZKPQ sensation-seeking 9 � 4.18

Note: The data are reported as mean � standard deviation. No participant from th

Personality Questionnaire (ZKPQ), which suggests either inattention to the content o

et al., 1993). The unusually high standard deviations of scores other than TA and a

opposing extreme scores of TA and anxiety/neuroticism (bold values).

age � standard deviation [S.D.]: 19.5� 1 years) based on their>1 S.D. above or

below average scores on the trait portion of the Romanian version of Spielberger’s

State-Trait Anxiety Inventory (STAI-X) (Spielberger, 1983; Pitariu et al., 1987),

and the anxiety/neuroticism scale of the Romanian version of Zuckerman–

Kuhlman Personality Inventory (Zuckerman et al., 1993; Opre et al., 2003).

The scores on these scales are reported in Table 1. The low TA group included 5

women and 3 men, and the high TA group included 6 women and 2 men, with no

significant socio-demographic (e.g., education, ethnic origin, native language)

differences between these groups. All the participants gave their informed consent

to participate to this experiment. The experimental procedures complied with the

recommendations of the Declaration of Helsinki and the national and institutional

ethical guidelines for experiments with human participants.

2.2. Behavioral task

We used the standardized manual version of IGT, as described in Bechara

et al. (1994). Briefly, participants were presented face downward four decks of

cards labelled A, B, C, and D, with 40 cards in each deck. The participants

received a loan of 2000 Romanian New Currency (RON) facsimile at the

beginning of the game and they were instructed to play the game so as to lose the

least amount of money and win the most. The total number of trials was set at

100 card selections, without the participant being aware of how many cards he

or she was going to pick. Turning each card from any deck carried an immediate

reward (100 RON for A and B, and 50 RON for C and D). However, A and B

were disadvantageous decks because every 10 cards from decks A and B over

the course of trials not only gain 1000 RON but also carried several unexpected

penalties of 150–350 RON (A) or a single large penalty (B) that raised the total

loss to 1250 RON. C and D were advantageous decks because they gained 500

RON over 10 card selections and carried a total loss of 250 RON either

cumulated from several cards associated with 25–75 RON penalties (C), or

from only one 250 RON penalty card. Thus A and B were equivalent in terms of

total loss over trials, and so were C and D in terms of total gain over trials. The

difference was that while A and C had higher frequency but lower magnitude

punishments, B and D had lower frequency but higher magnitude punishments.

Playing mostly from the disadvantageous decks led to an overall loss, while

playing mostly from the advantageous decks led to an overall gain. The

performance of the participant was indexed by the CD–AB score.

2.3. Electrophysiological recordings

During IGT, we recorded electrocardiography (ECG) and skin conductance

(SCR) using a Biopac MP150 system (Biopac Systems, CA, USA). ECG was

recorded with a sample rate of 500 Hz, from three EL258RT Ag-AgCl electro-

des filled with isotonic GEL101 gel, positioned in a modified lead-2 placement.

SCRs were recorded via two TSD203 electrodermal response electrodes also

filled with isotonic gel and attached to the volar surfaces of the index and medius

fingers. All the recordings were screened for physiological artifacts (e.g.,

motion) and analyzed offline using AcqKnowledge 3.5. The peak of the R-

waves were used for the calculation of heart rate (HR) in beats per minute

(BPM) in each of the intervals of interest, from which we subtracted thevalue of an

n–Kuhlman Personality Inventory of participants included in this study

Men

A high TA low TA high

8.83 W 4.26 26 W 3.74 57.5 W 4.94

18 W 1.41 0.8 W 0.2 11

9.5 � 2.58 4.33 � 3.05 8.5 � 2.12

8.33 � 3.82 13.33 � 1.15 6.5 � 4.94

8.5 � 5 9 � 3.6 5.5 � 6.36

11 � 3.74 9.33 � 1.15 10 � 1.41

is sample scored above 3 on the Infrequency scale of Zuckerman–Kuhlman

f the items and acquiescence or a very strong social desirability set (Zuckerman

nxiety/neuroticism are justified by the specific selection of the participants for

Fig. 1. Iowa Gambling Task performance (A), anticipatory skin conductance

responses (SCRs) (B) and heart rate (HR) (C) in high and low trait anxiety (TA)

participants. *P < 0.01.

A.C. Miu et al. / Biological Psychology 77 (2008) 353–358 355

individual functional baseline estimated from recordings made during a relaxed

state before the experiment. We made sure that the HR functional baseline was not

contaminated by anticipatory stress mainly by simultaneously monitoring SCRs,

which are a reliable index of emotional arousal. From SCR recordings, we

extracted the area under the curve (mS/s) of SCRs in the intervals of interest,

after the downdrift in the SCR waves was eliminated using the ‘‘difference’’

function of AcqKnowledge, as described in Bechara et al. (1999). It is noteworthy

that the effect of time differences between intervals of interest, particularly

anticipatory intervals (see below), was controlled by estimating SCRs per unit

of time. All the participants included in this study displayed SCRs during the IGT.

The intervals of interest were of two kinds, comprising (i) 5 s intervals after each

card was turned, which, depending on the type of the card, were of the reward or

punishment type; and (ii) ‘‘anticipatory’’ intervals between the end of each 5 s

reward or punishment interval and before the next card selection.

2.4. Data analyses

The behavioral and electrophysiological data were statistically processed

using analysis of variance (ANOVA) followed by Scheffe post hoc tests,

corrected for repeated measures as necessary. All analysis was conducted using

SPSS. The effect of sex on HR and SCR is supported by physiological

mechanisms independent of this task. Consequently, we focused on the main

effects of sex on behavioral performance, and the effects of TA � sex inter-

actions on physiological outcome measures.

3. Results

3.1. Behavior

A 2 (TA: high vs. low) � 2 (sex: men vs. women) ANOVA of

CD–AB scores indicates that TA (F[1,18] = 4.44, P < 0.05)

has a statistically significant effect on IGT performance

(Fig. 1A). High TA participants show decreased IGT

performance compared to low TA participants (Scheffe test:

mean difference = 5.09; criterion difference = 4.44, P < 0.05).

We find no statistically significant main effect of sex or

interaction of TA � sex on behavioral performance. Also,

neither TA nor the interaction of TA � sex is significantly

related to the time required to complete 100 trials in IGT

(mean � standard deviation: 11.00 � 1.09 min).

3.2. Anticipatory somatic responses

The analyses of anticipatory HR and SCRs indicated that

before making a selection, participants generally displayed

cardiac deceleration and higher SCRs. The amplitude of

anticipatory SCRs was generally higher for disadvantageous

compared to advantageous trials (F[1,18] = 4.5, P < 0.05).

However, only anticipatory SCRs in advantageous trials

predicted the CD–AB scores in IGT (r2 = 0.087, P < 0.008).

We obtain significant effects of TA on physiological measures

made before advantageous trials, high TA being associated with

increased physiological responses in anticipation of advanta-

geous trials. In contrast, TA had non-significant effects on

anticipatory HR and SCRs in disadvantageous trials. Specifi-

cally, in comparison to low TA participants, high TA participants

displayed increased cardiac deceleration (F[1,18] = 16.04,

P < 0.0001) and SCR amplitude (F[1,18] = 7.07, P < 0.008)

before advantageous trials. Our data also reveal a significant

interaction of TA � sex on anticipatory HR deceleration and

SCRs in advantageous trials (P < 0.05).

We investigated whether anticipatory effects developed

during the task by analyzing the effect of TA on physiological

measures in advantageous trials for each block of 20 trials. The

effect of TA on anticipatory HR reached statistical significance

in the second block of trials (F[1,18] = 4.17, P < 0.04), and its

magnitude increased until the last block (F[1,18] = 19.23,

P < 0.0001). Similarly, the effect of TA on anticipatory SCRs

was marginally significant by the end of the first block of trials

(F[1,18] = 3.29, P < 0.07), and its magnitude increased until

the last block (F[1,18] = 10.29, P < 0.004).

3.3. Somatic responses to outcomes

The analyses of physiological responses to reward and

punishment indicate that HR is sensitive to the emotional

valence of the behavioral outcome, with higher cardiac

A.C. Miu et al. / Biological Psychology 77 (2008) 353–358356

deceleration in the trials associated with punishment (mean

difference = 4.96) than in those associated with rewards (mean

difference = 2.95). Moreover, the analyses of physiological

measures as a function of trial (advantageous vs. disadvanta-

geous) and outcome (reward vs. punishment) indicate several

significant differences associated with TA. High TA partici-

pants display higher cardiac deceleration in advantageous trials

associated with punishment than those associated with rewards

(F[1,18] = 4.55, P < 0.05). There is also a statistically

significant interaction of TA � sex on punishment HR in

advantageous trials (P < 0.01). Low TA participants show

higher reward SCRs compared to punishment SCRs in both

advantageous (F[1,18] = 10.32, P < 0.001) and disadvanta-

geous trials (F[1,18] = 12.74, P < 0.0004). Low TA partici-

pants also display higher HR in disadvantageous trials

associated with rewards compared to those associated with

punishment (F[1,18] = 7.51, P < 0.006).

4. Discussion

This study yields two main findings consistent with our

predictions. We find that high TA is associated with impaired

decision-making in IGT, and that this is apparently uncoupled

from the increased and potentially adaptive anticipatory

somatic signals in high TA.

There are at least four mechanisms that might explain the

association between high TA and impaired decision-making.

One is related to the previously demonstrated relationship

between anxiety and the tendency to use fewer cues and

inefficiently select relevant from irrelevant cues in reasoning

tasks (Leon and Revelle, 1985). Indeed, high TA participants

may have attended to a more limited set of data, with the

‘‘blinders’’ caused by their high anxiety (see also the third

mechanism described below) making them focus mostly on the

easily understood rewards, which are the same for every choice

from a given deck. This could have led them to choose from the

high-reward disadvantageous decks more often.1

A second possible mechanism relates to the tendency of

increased declarative elaboration on choices, which has been

associated with high TA (e.g., Calvo et al., 2003). This tendency

would be counterproductive in a complex decision-making task

like IGT in which declarative cues on the optimum gambling

strategy typically become available between trials 50 and 80 in

healthy volunteers (Bechara et al., 1997).

A third mechanism potentially underlying the positive

association between impaired decisions and high TA could

involve distraction by emotions unrelated to the task, which is

more likely to occur in high TA participants (Spielberger, 1966;

Endler and Kocovski, 2001). One such emotion is anticipatory

stress, which has been previously shown to impair IGT

performance (Preston et al., 2007), and to which high TA

participants may be predisposed. This is consistent with the

idea that ‘‘emotion is not one thing’’ (Davidson and van

1 We acknowledge the suggestion made by one of the reviewers in regard to

this mechanism.

Reekum, 2005), allowing that some emotions may have

detrimental consequences to decision outcomes. To the extent

this is true, it might be possible to improve decision-making

through psychological and even pharmacological interventions

(e.g., beta blockers to reduce anxiety interference in high TA).

Finally, it is known that TA correlates with neural activity in

structures including the amygdala, specifically when emotional

stimuli are preattentionally processed (Etkin et al., 2004). IGT

also probably relies on preattentionally processed emotional

cues. Consequently, we speculate that high TA may be

associated with distinct patterns of neural activation triggered

by secondary inducers of somatic signals (i.e., entities

generated by the recall of a personal or hypothetical emotional

event; see Bechara et al., 2000) in structures such as the

amygdala and ventromedial prefrontal cortex. If so, IGT

decisions could be affected.

The effect of TA on IGT performance is also informed by a

previous interesting study by Peters and Slovic (2000) who

report an inverse relationship between negative emotionality

and choices from high-punishment decks. This is particularly

noteworthy in light of the theoretical and empirical work that

connects TA and behavioral inhibition measures (see, e.g., Gray

and McNaughton, 2000/2003 for the former; and Carver and

White, 1994; Zinbarg and Mohlman, 1998, for the latter). The

present study’s results are potentially reconciled with Peters

and Slovic (2000) by noting that we selected extreme TA

participants for our study, while the median split approach was

used by Peters and Slovic (2000) as well as in other recent

studies of TA and decision (Maner et al., 2007; Maner and

Schmidt, 2006; Mitte, 2007). The implication is that it would be

useful to conduct additional research to determine whether the

effects we identify are robust to those with less extreme TA.

In our study high TA was not only associated with impaired

IGT performance but also with increased anticipatory

physiological responses prior to advantageous trials. Moreover,

these physiological responses were evidently acquired during

the task since the magnitude of this effect developed over trials.

This set of results is important for at least three reasons. First, it

seems to support the importance of somatic markers to

decision-making by indicating that advantageous trials were

preceded by increased HR deceleration, a psychophysiological

index of orientation (see, e.g., Bradley, 2000), and an increase

in SCR amplitude. Moreover, anticipatory SCRs in advanta-

geous choices predicted IGT performance. However, since we

did not control the level of declarative knowledge in the task in

this study, these results cannot exclude the involvement of

declarative knowledge in IGT performance (Maia and McClel-

land, 2004).

Second, at least for high TA, these results seem to provide an

example of uncoupling between decision-making performance

and somatic markers. This is in line with a previous suggestion

that some healthy volunteers may override the adaptive

influence of their somatic markers by higher cognitive

processes (Bechara et al., 2000). Indeed, this is consistent

with the pattern of high autonomic reactivity (e.g., Gonzalez-

Bono et al., 2002; Zahn et al., 1991; Cornwell et al., 2006) and

increased tendency to declaratively elaborate on emotional

A.C. Miu et al. / Biological Psychology 77 (2008) 353–358 357

stimuli (Calvo et al., 2003), which has been previously

associated with high TA.

Finally, it is noteworthy that this is the second study (see also

Crone et al., 2004) in which cardiovascular measures of somatic

signals were collected. HR was found to be not only sensitive to

the emotional valence of the behavioral outcome (reward vs.

punishment), with higher cardiac deceleration to punishment,

but it also provides convergent evidence for increased

sensitivity of high TA participants to punishment (see Gray

and McNaughton, 2000/2003). More specific indices of cardiac

autonomic regulation (e.g., heart rate variability) may be used

in future studies of the involvement of somatic signals in

decision-making.

It is worthwhile to reiterate that we did not observe a

significant effect of sex on IGT performance, although two

previous studies reported that men outperformed women in IGT

(Reavis and Overman, 2001; Bolla et al., 2004). Explanations

for our non-finding could include our relatively small sample

size, or the fact we selected participants with extreme TA

scores.

In summary, our data suggest that high TA is associated

with both impaired decision-making in IGT as well as

increased and potentially adaptive anticipatory somatic

signals connected to emotion. This pattern is consistent with

a defective modulation of somatic signals coupled with

disrupted discrimination of advantageous and disadvanta-

geous choices in high TA.

Acknowledgements

This study was supported by the Romanian Ministry of

Education and Research through grants CEEX 124/2006 and

54/2006. We are grateful to Alina Zlati for help with the

analyses of electrophysiological data, and Drs. Adrian Opre and

Horia D. Pitariu for allowing us to use the Romanian versions of

the ZKPQ and STAI questionnaires. This paper was partially

presented at the IAREP-SABE Conference, Paris, France, 5–8

July 2006.

Contributors: A.C.M., R.M.H. and D.H. designed the

research; A.C.M. and R.M.H performed the research;

A.C.M. and R.M.H. analyzed the data; A.C.M. and D.H.

wrote the paper.

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