I n a gambling task that simulates real life decision

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I n a gambling task that simulates real - life decision - making in the way it factors uncer - tainty, rewards, and penalties, the players are given four decks of cards, a loan of $2000 facsimile U.S. bills, and asked to play so that they can lose the least amount of money and win the most ( 1 ). Turning each card carries an immediate reward ($100 in decks A and B and $50 in decks C and D). Unpredictably, however, the turning of some cards also car - ries a penalty (which is large in decks A and B and small in decks C and D). Playing mostly from the disadvantageous decks (A and B) leads to an overall loss. Playing from the advantageous decks (C and D) leads to an overall gain. The players have no way of predicting when a penalty will arise in a given deck, no way to calculate with precision the net gain or loss from each deck, and no knowledge of how many cards they must turn to end the game (the game is stopped after 100 card selections). After encountering a few losses, normal participants begin to generate SCRs before selecting a card from the bad decks ( 2 ) and also begin to avoid the decks with large losses ( 1 ). Patients with bilateral damage to the ventromedial prefrontal corti - ces do neither ( 1, 2 ). To investigate whether subjects choose correctly only after or before conceptualizing the nature of the game and reasoning over the pertinent knowledge, we continuously as - sessed, during their performance of the task, three lines of processing in 10 normal partic - ipants and in 6 patients ( 3 ) with bilateral damage of the ventromedial sector of the pre - frontal cortex and decision - making defects. These included (i) behavioral performance, that is, the number of cards selected from the good decks versus the bad decks; (ii) SCRs generated before the selection of each card ( 2 ); and (iii) the subject’s account of how they conceptualized the game and of the strat - egy they were using. The latter was assessed by interrupting the game briefly after each sub - ject had made 20 card turns and had already encountered penalties, and asking the subject two questions: (i) “Tell me all you know about what is going on in this game.” (ii) “Tell me how you feel about this game.” The questions were repeated at 10 - card intervals and the responses audiotaped. After sampling all four decks, and before encountering any losses, subjects preferred decks A and B and did not generate signifi - cant anticipatory SCRs. We called this period pre - punishment. After encountering a few losses in decks A or B (usually by card 10), normal participants began to generate antici - patory SCRs to decks A and B. Yet by card 20, all indicated that they did not have a clue about what was going on. We called this period pre - hunch (Fig. 1). By about card 50, all normal participants began to express a “hunch” that decks A and B were riskier and all generated anticipatory SCRs whenever they pondered a choice from deck A or B. We called this period hunch. None of the patients generated anticipatory SCRs or expressed a “hunch” (Fig. 1). By card 80, many normal participants expressed knowledge about why, in the long run, decks A and B were bad and decks C and D were good. We called this
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