Perandrés-Gómez Ana, Navas Juan F, van Timmeren Tim, Perales José C
Department of Experimental Psychology, Mind, Brain and Research Center (CIMCYC), Universidad de Granada, Spain.
Department of Clinical Psychology, Universidad Complutense de Madrid, Spain; Universitat Oberta de Catalunya, Spain.
Addict Behav. 2021 Jan;112:106534. doi: 10.1016/j.addbeh.2020.106534. Epub 2020 Jul 3.
Behavioral flexibility -the ability to dynamically readjust our behavior in response to reward contingency changes- is often investigated using probabilistic reversal learning tasks (PRLT). Poor PRLT performance has been proposed as a proxy for compulsivity, and theorized to be related to perseverative gambling. Previous attempts to measure inflexibility with the PRLT in patients with gambling disorder have, however, used a variety of indices that may conflate inflexibility with more general aspects of performance in the task.
Trial-by-trial PRLT acquisition and reacquisition curves in 84 treatment-seeking patients with gambling disorder and 64 controls (non-gamblers and non-problem recreational gamblers) were analyzed to distinguish between (a) variability in acquisition learning, and (b) reacquisition learning in reversed contingency phases. Complementarily, stay/switch responses throughout the task were analyzed to identify (c) premature switching, and (d) sensitivity to accumulated negative feedback.
Even after controlling for differences in acquisition learning, patients were slower to readjust their behavior in reversed contingency phases, and were more prone to maintain their decisions despite accumulated negative feedback. Inflexibility in patients with gambling disorder is thus a robust phenomenon that could predate gambling escalation, or result from massive exposure to gambling activities.
行为灵活性——即根据奖励偶然性变化动态重新调整行为的能力——通常使用概率性反转学习任务（PRLT）进行研究。较差的PRLT表现已被认为是强迫性的一种指标，并被理论化为与持续性赌博有关。然而，此前在赌博障碍患者中使用PRLT测量灵活性的尝试，采用了各种可能将灵活性与任务表现的更一般方面混淆的指标。
分析了84名寻求治疗的赌博障碍患者和64名对照者（非赌博者和无问题的娱乐性赌博者）逐次试验的PRLT习得和重新习得曲线，以区分（a）习得学习中的变异性，以及（b）反转偶然性阶段的重新习得学习。作为补充，分析了整个任务中的停留/转换反应，以识别（c）过早转换，以及（d）对累积负面反馈的敏感性。
即使在控制了习得学习的差异之后，患者在反转偶然性阶段重新调整行为的速度仍然较慢，并且尽管有累积的负面反馈，他们更倾向于维持自己的决策。因此，赌博障碍患者的灵活性不足是一种强烈的现象，它可能在赌博升级之前就已存在，或者是大量接触赌博活动的结果。
