Posttraumatic stress disorder in the U.S. Warfighter: Sensitivity to punishment and antidepressant use contribute to decision-making performance.

Abstract

Little research has been done to explore the integrity of emotion-based decision-making performance in individuals with posttraumatic stress disorder (PTSD). In the current study, performance on two decision-making tasks with both positive and negative reinforcement, the standard Iowa Gambling Task (IGT) and the variant Iowa Gambling Task (vIGT), and measures of mood symptoms, were compared between U.S. active-duty soldiers diagnosed with PTSD (n = 23) and soldiers with no PTSD (n = 23). The results revealed that the PTSD group, when compared to controls, reported significantly higher anxiety and depression symptoms. The PTSD group showed similar behavioral performance as controls on the standard IGT but failed to choose advantageously on the vIGT, which has been shown to reflect hypersensitivity to punishment. Medicated participants, being treated with antidepressants, showed significantly better overall performance on the IGT but not on the vIGT compared to nonmedicated participants. The results suggest that soldiers being treated for PTSD have a unique decision-making pattern that may be attributed to difficulty in processing delayed reward when presented with immediate punishment.

Reward Processing and Decision-Making in Posttraumatic Stress Disorder

“…Two advantageous decks yield high immediate losses but also higher delayed earning (net gain), and two disadvantageous decks present smaller immediate losses but also smaller gains (net loss). Dretsch et al (2012) found that individuals with PTSD performed similar to nondiagnosed controls on the standard IGT but performed worse than controls on the vIGT.…”

“…Research in reward processing has been extended to find that individuals with PTSD may also have a unique decision-making pattern (Dretsch, Thiel, Athy, Born, & Prue-Owens, 2012). Prior research has found evidence of decision-making impairments in other types of anxiety disorders (e.g., obsessive compulsive disorder; de Rocha, Alvarenga, Malloy-Diniz, & Corrêa, 2011), as well as major depressive disorder (Han et al, 2012).…”

“…One exception is a study that used standard and variant versions of the Iowa Gambling Task (IGT), a task in which U.S. active-duty soldiers were asked to select cards that incur monetary gains or losses (Dretsch et al, 2012). The standard IGT presents four decks of cards, two of which incur high immediate rewards but eventually incur larger losses as the task progresses (disadvantageous decks that lead to a net loss) and two of which yield smaller immediate rewards but also smaller losses (advantageous decks that lead to a net gain).…”

Exploring the Neurocircuitry Underpinning Predictability of Threat in Soldiers with PTSD Compared to Deployment Exposed Controls

“…Indeed, hypersensitivity to threat seems plausible based on prior findings [36, 37, 66]. Prior findings in healthy individuals, have found that diminution of ROI activation to learned-threat is accompanied by diminution of related SCRs [23, 51].…”

“…Only limited evidence implicates the insula in PTSD as indicated by increased activation in response to predictable threat, potentially suggesting hypersensitivity to threats when they are predictable [32]. Behavioral evidence provides some support by showing that active-duty service members with PTSD have compromised emotion-based learning, which appears be attributed to hypersensitivity to threat saliency [36]. Psychophysiology findings also suggest that PTSD is associated with hypersensitivity to threat, which may be moderated by predictability as measured by startle response to aversive auditory stimuli [37].…”