Executive Functioning in Gambling Disorder: Cognitive Profiles and Associations with Clinical Outcomes

Verdejo-Garcia, Antonio; Manning, Victoria · 2015 · Crossref

DOI: 10.1007/s40429-015-0062-y

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Summary

This review article examines the cognitive profiles associated with gambling disorder (GD) and their relationship to clinical treatment outcomes. Motivated by the neurobiological and clinical similarities between GD and substance use disorders, the authors investigate whether GD shares specific executive functioning deficits and if these deficits predict treatment response. The paper synthesizes findings from clinical and cognitive neuroscience studies published primarily within the three years preceding its publication, aiming to refine the understanding of GD’s cognitive phenotype beyond early, broader assessments. The authors analyze literature utilizing refined cognitive assessment methods, including dissociative task batteries, cognitive modeling, and appropriately matched control groups to isolate GD-specific deficits from confounding factors like comorbidities or IQ. The review also incorporates neuroimaging evidence to interpret behavioral findings. Regarding treatment outcomes, the authors evaluate studies assessing whether baseline cognitive performance predicts abstinence, relapse, or treatment dropout, noting methodological limitations such as small sample sizes and varying operational definitions of recovery. The findings indicate that individuals with GD exhibit preserved general executive functions, including working memory, planning, and rule shifting. However, significant deficits are observed in response inhibition, reward-related switching, and value-based decision-making. Cognitive modeling reveals that these decision-making deficits stem from a core alteration in value coding: heightened attention to gains and blunted attention to losses. This "attention to gains" bias drives maladaptive behaviors, such as loss chasing, and explains deficits in delay discounting and response inhibition tasks where approach tendencies conflict with avoidance requirements. Neuroimaging supports this, showing functional abnormalities in the dorsomedial prefrontal cortex and striatum, regions implicated in reinforcement learning and reward processing, while the dorsolateral prefrontal cortex remains intact. Regarding clinical implications, the evidence linking cognitive profiles to treatment outcomes is limited and often negative. Most studies failed to find that standard measures of impulsivity or decision-making predicted long-term abstinence or relapse. However, some data suggest that disinhibition and perseveration for reward may relate to treatment outcomes, and that loss aversion increases with prolonged treatment. The authors conclude that the hallmark of GD is "cognitive impulsivity" driven by faulty value coding. They propose that future interventions should target these implicit motivational processes, specifically through cognitive bias modification (CBM) training to reduce approach biases toward gambling cues. Such neurocognitive interventions may help restore balance in the brain’s value system and reduce relapse liability, representing a priority for future research and clinical practice.

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• cognitive impairment