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Biological Psychology 77 (2008) 353358

www.elsevier.com/locate/biopsycho

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 personality in decision-making. For instance, some timely

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 emotions
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: andrei_miu@emcoglab.org (A.C. Miu),
dhouser@gmu.edu (D. Houser).
0301-0511/$ see front matter # 2008 Elsevier B.V. All rights reserved.
doi:10.1016/j.biopsycho.2007.11.010
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
354 A.C. Miu et al. / Biological Psychology 77 (2008) 353358
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, we hypothesize that high TA participants will 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 ZuckermanKuhlman Personality Inventory of participants included in this study
Category Women
TA low
STAI-TA 27.66 W 0.57
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 this sample scored above 3 on the Infrequency scale of ZuckermanKuhlman
Personality Questionnaire (ZKPQ), which suggests either inattention to the content of the items and acquiescence or a very strong social desirability set (Zuckerman
et al., 1993). The unusually high standard deviations of scores other than TA and anxiety/neuroticism are justified by the specific selection of the participants for
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 Spielbergers
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 150350 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 2575 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 CDAB 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 the value of an
Men
TA high TA low TA high
58.83 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
 A.C. Miu et al. / Biological Psychology 77 (2008) 353358 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

CDAB 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).
Fig. 1. Iowa Gambling Task performance (A), anticipatory skin conductance
3.2. Anticipatory somatic responses responses (SCRs) (B) and heart rate (HR) (C) in high and low trait anxiety (TA)
participants. *P < 0.01.
The analyses of anticipatory HR and SCRs indicated that
before making a selection, participants generally displayed
cardiac deceleration and higher SCRs. The amplitude of We investigated whether anticipatory effects developed
anticipatory SCRs was generally higher for disadvantageous during the task by analyzing the effect of TA on physiological
compared to advantageous trials (F[1,18] = 4.5, P < 0.05). measures in advantageous trials for each block of 20 trials. The
However, only anticipatory SCRs in advantageous trials effect of TA on anticipatory HR reached statistical significance
predicted the CDAB scores in IGT (r2 = 0.087, P < 0.008). in the second block of trials (F[1,18] = 4.17, P < 0.04), and its
We obtain significant effects of TA on physiological measures magnitude increased until the last block (F[1,18] = 19.23,
made before advantageous trials, high TA being associated with P < 0.0001). Similarly, the effect of TA on anticipatory SCRs
increased physiological responses in anticipation of advanta- was marginally significant by the end of the first block of trials
geous trials. In contrast, TA had non-significant effects on (F[1,18] = 3.29, P < 0.07), and its magnitude increased until
anticipatory HR and SCRs in disadvantageous trials. Specifi- the last block (F[1,18] = 10.29, P < 0.004).
cally, in comparison to low TA participants, high TA participants
displayed increased cardiac deceleration (F[1,18] = 16.04, 3.3. Somatic responses to outcomes
P < 0.0001) and SCR amplitude (F[1,18] = 7.07, P < 0.008)
before advantageous trials. Our data also reveal a significant The analyses of physiological responses to reward and
interaction of TA  sex on anticipatory HR deceleration and punishment indicate that HR is sensitive to the emotional
SCRs in advantageous trials (P < 0.05). valence of the behavioral outcome, with higher cardiac
356 A.C. Miu et al. / Biological Psychology 77 (2008) 353358
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 studys 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) 353358
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, 58
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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