APPLIED NEUROPSYCHOLOGY: ADULT

2020, VOL. 27, NO. 6, 558–569

https://doi.org/10.1080/23279095.2019.1576690

Investigating the relationship between decision-making processes and

cognitive processes, personality traits, and affect via the structural equation
model in young adults
Selin Yilmaza and Hatice Kafadarb
a
Department of Psychology, Adana Science and Technology University, Adana, Turkey; bDepartment of Psychology, Abant Izzet Baysal
University, Bolu, Turkey

ABSTRACT KEYWORDS
The purpose of this study was to examine the relationship between decision making and Executive function; Iowa
set-shifting, working memory, planning, selective attention, personality and affect, and to Gambling Test; selective
investigate these relations with the help of the structural equation model (SEM). A total of attention; WCST;
working memory
100 participants, 59 female and 41 male, participated in the study. The mean age of the
participants was 20.42 years (SD ¼ 1.37). Decision making, set-shifting, selective attention,
planning, working memory, personality, and affect were measured via the Iowa Gambling
Test (IGT), Wisconsin Card Sorting Test, Stroop Test TBAG Version, Tower of London Test,
Wechsler Memory Scale-III Letter-Number Sequencing Subtest, Basic Personality Traits
Inventory (BPTI), and Positive and Negative Affect Scale (PANAS), respectively, all of which
were administered individually. Results of the correlation analyses revealed that various IGT
scores were correlated with the four neuropsychological tests as well as the PANAS nega-
tive-affect subscale and the BPTI openness to experience factor. Furthermore, the first SEM
analysis indicated that the independent latent variables of working memory, set-shifting and
planning were significant in predicting the decision making. Finally, the second model of
the Block Net Scores revealed the independent latent variables of set-shifting and planning
as being significant in decision-making prediction.

Decision making is a high-level cognitive process and
can enable a person to make the right choices by
making a profit-and-loss account from many options
(Summerfield & Koechlin, 2009). Particularly, it is
fairly difficult to make a decision under ambiguity, in
which outcomes and probabilities are implicit, in
other words; potential consequences of the choices are
unknown and unpredictable (Smith & Kosslyn, 2016).
As a result, other cognitive processes must be engaged
during decision making under ambiguity; therefore, it
is important to specify their contributions on deci-
sion making.
The Iowa Gambling Task (IGT) has been used as a
behavioral assessment by several studies aiming to
determine that ambiguous decision-making ability is
one function of the frontal cortex [and especially
ventromedial prefrontal cortex (VmPFC) and dorso-
lateral prefrontal cortex (DLPFC)] (Fellows & Farah,
2005; Ouerchefani, Ouerchefani, Allain, Rejeb, & Le
Gall, 2017, 2018). Initially, this test was used to
evaluate changes in the decision-making functions of
patients with VmPFC damage (Bechara, Damasio,
Damasio, & Anderson, 1994). On the other hand,
Steingroever, Wetzels, Horstmann, Neumann, and
Wagenmakers (2013) demonstrated that no study to
date has replicated the seminal findings of Bechara
et al. (1994) with healthy decision-makers. Studies
generally found that from the first block to five block
the healthy people did not display an increasing
momentum (Kjome et al., 2010; Premkumar
et al., 2008).
The IGT consists of disadvantageous A and B and
advantageous C and D card decks and gives informa-
tion about the decision-making patterns of individu-
als. In this test, the rules of gains and loses cannot be
fully specified; therefore, individuals should learn to
avoid disadvantageous desks and chose advantageous
by using feedback (Bechara, 2003). In particular, more
Deck A and B selections and fewer Deck C and D
selections were seen among patients with VmPFC

CONTACT Selin Yilmaz yilmaz-selin@outlook.com Faculty of Humanities and Social Sciences, Department of Pscychology, Adana Science and
Technology University, Sarıcam, Adana, Turkey
ß 2019 Taylor & Francis Group, LLC

damage, whereas more Deck C and D selections and
fewer Deck A and B selections were seen among
healthy people (Bechara et al., 1994). Thus, the
VmPFC has been considered as a brain structure that
is important for decision making. The more risky and
fewer advantageous choices taken by VmPFC-
damaged patients as compared to healthy people have
led to the use of the IGT as a decision-making test in
various studies (Abel et al. 2016; Sutterer, Koscik, &
Tranel, 2015; Waters-Wood, Xiao, Denburg,
Hernandez, & Bechara, 2012).
Decision-making and cognitive processes
Several studies have shown the impact of different
mental processes on effective decision making under
ambiguous situations. For instance, according to a
study conducted with 97 healthy people between the
ages of 18 and 65, the perseverative and nonpersevera-
tive error response scores of the Wisconsin Card
Sorting Test (WCST) and the IGT Net scores were
negatively associated (Brand, Recknor, Grabenhorst, &
Bechara, 2007). Because the WCST score is important
for some processes such as cognitive flexibility and
set-shifting, decision-making performance is thought
to be influenced by executive functions. However, the
reasoning and decision-making functions of the pre-
frontal cortex are affected by age (Bechara, 2005; Fein,
McGillivray, & Finn, 2007), and because of age-related
declines in those processes, it is considered best to
avoid a wide age range in such studies. But, the find-
ings involving one age group only represent the deci-
sion-making capacity of that age group. Most research
examining the relationship between the IGT and
WCST has yielded contradictory results. According to
some studies, there was no significant relationship
between the two test scores (Denburg, Tranel, &
Bechara, 2005; Overman et al., 2004; Smith, Xiao, &
Bechara, 2012), but another study conducted with
both children and adults reported a significant correl-
ation in the children only (Lehto & Elorinne, 2003).
Focusing attention is thought to be an important
process when making a decision, but very few studies
have analyzed the correlation between attention and
IGT scores in healthy young adults. For instance, a
study conducted with 146 undergraduate students (M
age ¼ 23.43, 18–52 years of age,) revealed that there
was a negative significant correlation between the IGT
and Stroop Test interference scores (Allom, Panetta,
Mullan, & Hagger, 2016). A lower interference score
referred greater self-control; therefore, it was sug-
gested that the decision-making performance had
APPLIED NEUROPSYCHOLOGY: ADULT 559
increased with increasing focusing attention perform-
ance. On the one hand, Del Missier, M€antyl€a, and
Bruin (2012) designed a research with 213 under-
graduate students and found no significant relation-
ship between IGT and selective attention measured by
Stroop Test.
A few studies have analyzed the relationship
between the IGT and working memory and planning
measures and in general, nonsignificant correlations
were reported (Denburg et al., 2005; Hooper, Luciana,
Conklin, & Yarger, 2004; Icellioglu, 2015). However, a
study conducted with healthy samples reported a sig-
nificant correlation between working memory and the
IGT in young adults (Fein et al., 2007). In addition,
one study showed that planning can be important in
explaining decision-making performance (Brand
et al., 2007).
In sum, studies mentioned above tried to understand
the nature of the decision making. Particularly, investi-
gating possible link between these processes is import-
ant to determine which other cognitive processes may
be needed for healthy young adult decision-makers.
Thus, these studies can allow us to understand related
processes in decision-making failures.
Decision making, affect, and personality traits
In the literature, it has been emphasized that the
amygdala and VmPFC are important regions in a
reward-and-punishment-based decision-making pro-
cess and emotions controls (Bechara, Damasio,
Damasio, & Lee, 1999; Bechara, 2005). Recent behav-
ioral studies supported associations between emotions
and decisions under ambiguous. For instance, Suhr
and Tsanadis (2007) indicated that mood, particularly
a negative mood, is related to the IGT performance.
More Deck B selections and fewer Deck C and D
selections were seen among people who were in a
negative mood (Buelow & Suhr, 2013). Moreover, De
Vries, Holland, and Witteman (2008) found that peo-
ple in a positive mood exhibit better performance
than people in a negative mood in the 2nd block of
the IGT. Research findings have generally indicated
that emotions have a significant influence on deci-
sion-making behavior (Simonovic, Stupple, Gale, &
Sheffield, 2017).
Personality may influence how individuals make
decisions in uncertain situations. Some research has
indicated that decision making is impacted by individ-
ual differences (Franken & Muris, 2005; Hooper et al.,
2004). According to the big five (Big-5) personality
theory, people have certain characteristics that affect
560 S. YILMAZ AND H. KAFADAR
emotion, thought, and behavior patterns, and these
characteristics can be classified into five basic dimen-
sions (neuroticism, extraversion, agreeableness, con-
scientiousness, and openness to experience) (McCrae
& Costa, 2003). High levels of neuroticism are associ-
ated with proneness to worry and affective disorders
related to stress. Contrary to neuroticism, extraversion
is characterized by talkativeness, sociability, and posi-
tivity. Individuals having a high score in agreeableness
are characterized as philanthropic, tolerant, sincere,
and sharer. Conscientious individuals are often
described as self-disciplined, hardworking, tidy, and
fussy. People having a high score in openness are
defined as creative, imaginative, and intellectual
(McCrae & Costa, 2003). There are several studies
including IGT and Big-5, which did not find correla-
tions between IGT performance and Big-5 personality
traits (Skeel, Neudecker, Pilarski, & Pytlak, 2007;
Starcke, Agorku, & Brand, 2017; Werner, Jung,
Duschek, & Schandry, 2009). On the one hand, some
studies examining the relationship between Eysenck
Personality Inventory and IGT exist in the literature
(Hooper, Luciana, Wahlstrom, Conklin, & Yarger,
2008; Içellioglu ve Ozden, 2012). These studies only
reported negative association between neuroticism
personality trait and IGT performance in adolescents,
but not adults.
When the literature is examined, studies can be
found that reveal relationships among cognitive proc-
esses, personality and emotions individually, but there
is no research that evaluates all the variables together.
In the light of the aforementioned information, the
present study aimed to investigate the predictive role
of set-shifting, selective attention, planning, working
memory, affect, and personality traits on decision
making in young adults.
The use of all variables together would help to
explain which independent variables have more con-
tribution on decision making. In other words, a struc-
tural equation model has been put forward to
understand which variable is actually more predictive
for decision making. Especially, it is thought that the
current study would help to understand what cogni-
tive abilities should be intervened in decision making
difficulties.
Method
Participants
A total of 100 healthy university students (59 female
and 41 male) participated in this study. Participants
were students from various departments of Abant
Izzet Baysal University (AIBU) in Bolu and Anadolu
University (AU) in Eskisehir, Turkey, numbering 90
and 10, respectively. After necessary permissions were
taken, students were informed briefly about the study
in the classes at AIBU and AU campuses and contact
information was obtained from voluntary participants.
Then these participants were reached from this con-
tact information and appointments were arranged for
test applications.
The participants were studying in 12 different
departments (25% Economics, 22% Psychology, 11%
Medicine, 11% Preschool Education, 10% Business
Administration, 7% Turkish Language and Literature,
5% Psychological Counseling and Guidance, 4%
Mentally Handicapped Education, 2% Sociology, 1%
Education, 1% Mechanical Engineering, and 1%
Mathematics). The mean age of the participants was
20.42 years (SD ¼ 1.37; age range, 18–23 years). Of the
participants, 89 were dominantly right-handed, nine
were dominantly left-handed, and two were
ambidextrous.
Materials
Standard information form
This form gives knowledge about gender, age, contact
information, handedness of participants, and state of
health [whether they have an illness (i.e., neurologic,
psychiatric) or whether they have visual color separ-
ation problem]. Individuals reporting neurological or
psychiatric disturbance stories were not included in
the sample.
Basic Personality Traits Inventory (BPTI)
BPTI was created by Gencoz and Oncul (2012) based
on the Big Five (Big-5) model to measure personality
traits. This inventory includes 45 items with 5-point
Likert type scale and 6 personality traits.
Positive and Negative Affect Scale (PANAS)
PANAS was developed by Watson, Clark, and
Tellegen (1988) and adapted into Turkish by Gencoz
(2000). The scale consists of 20 items rated on 5-point
Likert-type scale and10 positive affective states and 10
negative affective states.
Iowa Gambling Test (IGT)
Bechara et al. (1994) developed the IGT in order to
measure decision making in uncertain situations. In
the test there are four decks of cards (A, B C, D) with
100 cards in each deck. Decks C and D are considered
to be advantageous in the long run, whereas decks A

and B are considered to be disadvantageous in the
long run. Advantageous or good deck provide small
gains, but loses are smaller than gains, leading to
overall long term gains. In contrast, disadvantageous
or bad decks offer higher instant rewards, but these
have high losses, leading to overall long term losses.
Various scores can be obtained from the IGT
(Bechara, 2007). The Total Net Score shows the net
profit from the 100 cards selected. A low total net
score may indicate decision making failure. All decks
provide both losses and gains in this test. The Net
Score obtained from the subtraction of the disadvanta-
geous deck choices from the advantageous deck
choices during the entire test [(Deck C þ Deck D) –
(Deck A þ Deck B)]. The Net Score gives information
about advantageous or disadvantageous decisions. A
positive net score indicates advantageous decision
making, while a negative net score indicates disadvan-
tageous decision making. Furthermore, the same pro-
cedure is applied for the 20-card selections and a net
score is calculated for each of five blocks of 20 trials
(1–20, 21–40, 41–60, 61–80, and 81–100). Block Net
Scores (Block 2, 3, 4, and 5) provide a learning curve
showing how quickly participants learn to avoid the
disadvantageous decks and to choose more from the
advantageous decks.
Wisconsin Card Sorting Test (WCST)
The WCST was developed by Berg (1948), revised by
Heaton (1981, 1993) and adapted into Turkish by
Karakas (2006). The test is composed of two card
desks; each having 4 stimulus cards and 64 response
cards of different colors, shapes, and numbers.
Participants should match the stimulus and response
cards through feedback (correct or incorrect) in
accordance with a specific rule. Thirteen scores are
calculated from the WCST. This test is used to meas-
ure set-shifting, reasoning, perseveration, mental flexi-
bility, abstract thinking, and executive functions.
Stroop Test TBAG form
The original form of the Stroop Test TBAG Version
was developed by Stroop (1935) and the adaptation of
the test for Turkish was completed by Karakas (2006).
This test consists of five stimuli cards and for these
five cards total duration, error number and point of
correct number scores are calculated. The test meas-
ures skill of sustaining the task under destructive
effect, behavioral inhibition, and focused attention.
APPLIED NEUROPSYCHOLOGY: ADULT 561
Tower of London Test (TOLDX)
The TOLDX was developed by Culbertson and Zillmer
(2001) in order to measure planning and problem
solving and adapted into Turkish by Atalay (2005).
The test consists of two boards, and each board has
three pegs in different heights. The test administrator
arranges red, green, and blue beads on their pegs. The
goal of participant is to string beads as it is shown
with the minimum number of moves. It is obtained
seven scores from this test.
Wechsler Memory Scale-III (WMS-III) Letter-Number
Sequencing Subtest
WMS-III Letter-Number Sequencing Subtest
(Wechsler, 1997) was adapted into Turkish by Ant
(2005) and Ozdemir (2005). This test was used in
order to measure the capacity of the working memory.
In this test, the participants is read a sequence of
numbers and letters (an increasing number of series
from 1 to 8) and asked to recall the numbers in
ascending order and the letters in alphabetical order.
Participants are given 1 point for each correct trial. In
addition, time scores for each participant were calcu-
lated for this study. The highest score that can be
taken from the test is 21.
Procedure
All information in this research obtained in accord-
ance with Abant Izzet Baysal University Humanities &
Social Sciences Research Ethics Committee. Also, all
participants were informed about the study, their con-
sents were obtained and they voluntarily participated
in the study. Participants were tested individually and
in accordance with standard test instructions. All par-
ticipants first filled out the Standard Information
Form, the PANAS and the BPTI and then, using a
counterbalancing scheme, the five aforementioned
neuropsychological tests were administered. Each par-
ticipant completed all tests in a single session lasting
approximately 1 hour.
Results
In the initial part of the results section, measuring
instruments scores and abbreviations are presented in
Table 1, in order to facilitate the examination of tables
related to statistical findings. The descriptive statistics
(means, standard deviations, range, skewness, and
kurtosis) of the IGT scores are also presented in
Table 2.
562 S. YILMAZ AND H. KAFADAR

Table 1. Measuring instruments scores and abbreviations.

SCORES ABBREVIATIONS
Iowa Gambling Test IGT
1 Total Net Score IGT Total
2 Net Score IGT Net
3 IGT Block Net Score 1 Block 1
4 IGT Block Net Score 2 Block 2
5 IGT Block Net Score 3 Block 3
6 IGT Block Net Score 4 Block 4
7 IGT Block Net Score 5 Block 5
Wisconsin Card Sorting Test WCST
8 Total Number of Responses WCST 1
9 Total Number of Errors WCST 2
10 Total Number of Correct Responses WCST 3
11 Number of Categories Completed WCST 4
12 Total Number of Perseverative Responses WCST 5
13 Total Number of Perseverative Errors Responses WCST 6
14 Total Number of Nonperseverative Errors Responses WCST 7
15 Percent of Perseverative Errors WCST 8
16 Trials to Complete First Category WCST 9
17 Conceptual Level Responses WCST 10
18 Percent Conceptual Level Responses WCST 11
19 Failure to Maintain Set WCST 12
Stroop Test TBAG Version Stroop Test
20 Stroop 1st Part Duration Score Stroop 1st Part Duration
21 Stroop 2nd Part Duration Score Stroop 2nd Part Duration
22 Stroop 3rd Part Duration Score Stroop 3rd Part Duration
23 Stroop 4th Part Duration Score Stroop 4th Part Duration
24 Stroop 5th Part Duration Score Stroop 5th Part Duration
25 Stroop 5th Part Correct Score Stroop 5th Part Correct
Tower of London Test (TOLDX) TOLDX
26 Number of Total Moves Total Moves
27 Number of Total Correct Responses Total Correct
28 Number of Rule Violations Rule Violations
29 Time Violations Time Violations
30 Initiation Time Scores Initiation Time
31 Execution Time Scores Execution Time
32 Total Problem-Solving Time Scores Total Problem Solving
Wechsler Memory Scale-III Letter Number Sequencing Subtest LNS
33 Total Scores LNS Total
34 Time Scores LNS Time
Basic Personality Traits Inventory BPTI
35 Extraversion Extraversion
36 Conscientiousness Conscientiousness
37 Agreeableness Agreeableness
38 Openness to Experience Openness to Experience
39 Neuroticism Neuroticism
40 Negative Valence Negative Valence
Positive and Negative Affect Scale PANAS
41 Negative Affect NA
42 Positive Affect PA

Correlation coefficients (except the Block 1 Score) were significantly corre-

lated with all scores except for the Time Violation
Pearson Correlation Analyses were conducted in order
and Number of Rule Violation Scores of TOLDX.
to examine correlation coefficients for decision mak-
Significant correlation coefficients varied between
ing test (IGT) scores and other test scores. Pearson
0.20 and 0.40. The IGT Total Net, Net and Block 3
Correlation coefficients of the IGT scores and other
Scores were positively correlated with the WMS-III
test scores are shown in Table 3. The IGT Scores were
Letter-Number Sequencing Subtest Total and the
significantly correlated with different measures of the
Time Scores. The IGT and WMS-III Letter-Number
WCST. The IGT and WCST score correlations were
Sequencing Subtest Score correlations were between
between 0.20 and 0.50. Significant correlation
0.21 and 0.39. The IGT Total Net and Block 2 Scores
coefficients were obtained for all scores except for the
were negatively associated with the BPTI Openness to
1st-Part Duration and 2nd-Part Duration Scores of
Experience subscale (r ¼ 0.22, p <.05). Finally, the
the Stroop Test TBAG Form and various IGT scores.
IGT Total Net Score was negatively correlated with
The IGT and Stroop Test TBAG Form score correla-
the PANAS Negative Affect subscale (r ¼ 0.23,
tions were between 0.20 and 0.48. The IGT scores
p <.05).
 APPLIED NEUROPSYCHOLOGY: ADULT 563

Structural Equation Model analysis functions of frontal lobe, personality traits, and affect
on decision making in frame of a model. This analysis
In the current study, it was used SEM analysis to test
was chosen in order to test the causal relationship
hypothesis the predictive powers of various cognitive
between the latent variables. The SEM analysis was
Table 2. Descriptive statistics of the Iowa Gambling Test conducted using the AMOS 23.0 program. As seen in
(IGT) scores. the Figure 2, the first model included twenty observed
N X SD Range Skewness Kurtosis variables, six independent latent variables and one
IGT dependent variable. According to results of SEM 1,
Total Net 100 2145.25 757.60 3700 .726 .299
Net 100 18.28 22.97 112 .221 .028
working memory (ß ¼ 0.20, p  .05), set-shifting
Block 1 100 1.94 6.01 34.00 .014 1.176 (ß ¼ 0.23, p  .05) and planning (ß ¼ 0.34, p < .01)
Block 2 100 1.07 6.48 34.00 .167 .286 were significant in directly predicting decision mak-
Block 3 100 5.97 7.49 30.00 .332 .573
Block 4 100 6.59 7.55 30.00 .160 .748 ing; but, the influences of selective attention, affect
Block 5 100 7.28 9.67 38.00 .211 .749 and personality on decision making were not signifi-
Note. Means of the IGT Block Net Scores are shown in Figure 1. To ana- cant. That is to say, working memory, set-shifting,
lyze the learning process, the IGT performance of the participants was
divided into five separate blocks of trials (Block 1 ¼ trials 1–20, Block and planning had a significant impact on decision
2 ¼ trials 21–40, Block 3 ¼ trials 41–60, Block 4 ¼ trials 61–80, and Block making. Analysis results demonstrated the compatibil-
5 ¼ trials 81–100). This figure shows that the average Net Scores of the
participants had increased from the first 20 trials of to last 20 IGT trials. ity of data to sampling [X2(146, n ¼ 100) ¼ 225.642,

Table 3. Pearson corelation coefficients regarding Iowa Gambling Test (IGT).

IGT Total IGT Net IGT Block 1 IGT Block 2 IGT Block 3 IGT Block 4 IGT Block 5
IGT Total 1.00
IGT Net 0.76*** 1.00
IGT Block 1 0.12 0.14 1.00
IGT Block 2 0.46*** 0.53*** 0.20* 1.00
IGT Block 3 0.56*** 0.71*** 0.02 0.35*** 1.00
IGT Block 4 0.40*** 0.64*** 0.08 0.19 0.38*** 1.00
IGT Block 5 0.64*** 0.78*** 0.02 0.27** 0.46*** 0.37*** 1.00
WCST 1 0.50*** 0.38*** 0.05 0.21* 0.34** 0.24* 0.40***
WCST 2 0.42*** 0.34*** 0.14 0.22* 0.28** 0.22* 0.42***
WCST 3 0.42*** 0.28** 0.09 0.10 0.28** 0.18 0.23*
WCST 4 0.19 0.10 0.26** 0.14 0.16 0.18 0.20*
WCST 5 0.42*** 0.39*** 0.10 0.27** 0.30** 0.25* 0.44***
WCST 6 0.42*** 0.38*** 0.11 0.25* 0.30** 0.22* 0.44***
WCST 7 0.36*** 0.26** 0.14 0.17 0.22 0.18 0.33**
WCST 8 0.39*** 0.38*** 0.10 0.26** 0.30** 0.22* 0.44***
WCST 9 0.24* 0.24* 0.14 0.12 0.12 0.27** 0.23*
WCST 10 0.34*** 0.20* 0.15 0.10 0.22* 0.16 0.03
WCST 11 0.40*** 0.35*** 0.12 0.17 0.29** 0.23* 0.46***
WCST 12 0.34*** 0.20* 0.01 0.09 0.21* 0.14 0.16
Stroop 1st Part Duration 0.16 0.05 0.14 0.02 0.02 0.16 0.09
Stroop 2nd Part Duration 0.01 0.10 0.03 0.09 0.01 0.03 0.06
Stroop 3rd Part Duration 0.20* 0.08 0.10 0.02 0.02 0.16 0.01
Stroop 4th Part Duration 0.24* 0.14 0.12 0.01 0.03 0.16 0.16
Stroop 5th Part Duration 0.24* 0.15 0.08 0.04 0.05 0.08 0.20*
Stroop 5th Part Correct 0.48*** 0.30** 0.06 0.10 0.18 0.18 0.32**
TOLDX Total Moves 0.35*** 0.35*** 0.19 0.22* 0.20* 0.14 0.31**
TOLDX Total Correct 0.40*** 0.36*** 0.05 0.26** 0.30** 0.17 0.34***
TOLDXRuleViolations 0.12 0.11 0.06 0.08 0.18 0.04 0.06
TOLDXTime Violation 0.15 0.08 0.12 0.04 0.01 0.09 0.14
TOLDX Initiation Time 0.24* 0.24 0.06 0.12 0.20* 0.19 0.12
TOLDXExecution Time 0.24* 0.23* 0.19 0.12 0.10 0.08 0.26**
TOLDX Total Problem Solving 0.14 0.13 0.15 0.07 0.02 0.01 0.20*
LNS Total 0.39*** 0.31** 0.14 0.08 0.30** 0.10 0.30**
LNS time 0.28** 0.21* 0.04 0.12 0.24* 0.06 0.18
Extraversion 0.10 0.09 0.08 0.18 0.06 0.01 0.05
Conscientiousness 0.14 0.14 0.02 0.17 0.10 0.11 0.06
Agreeableness 0.01 0.01 0.06 0.04 0.06 0.01 0.01
Openness to Experience 0.22* 0.18 0.08 0.22* 0.08 0.08 0.12
Neuroticism 0.10 0.14 0.13 0.02 0.04 0.18 0.01
Negative Valence 0.00 0.16 0.08 0.02 0.04 0.11 0.11
NA 0.23* 0.17 0.06 0.19 0.15 0.07 0.12
PA 0.06 0.01 0.02 0.13 0.05 0.04 0.12
Note. IGT = Iowa gambling test; WCST = Wisconsin Card Sorting Test; TOL = Tower of London Test; LNS = Letter-Number Sequencing Test; NA =
Negative Affect; PA = Positive Affect.
Significance of bold values are p<.05, p<.01, p<.001.
564 S. YILMAZ AND H. KAFADAR

Figure 1. Means of the Iowa Gambling Test (IGT) block net scores.

Figure 2. Structural equation model (SEM) regarding Iowa Gambling Test (IGT) total and net scores. p  .05.
p < .01. p < .001.

p < .001; x2/df ¼ 1.545; RMSEA ¼ 0.07; GFI ¼ 0.84;
AGFI ¼ 0.77; CFI ¼ 0.92; NFI ¼ 0.82].
By performing SEM analyses and comparing differ-
ent alternative models, an investigation was also car-
ried out to determine which model indicated
goodness-of-fit indices between the model and the
data. The second structural model constituted by
Block Net Scores (SEM 2) is shown in Figure 3.
According to these results, set-shifting (ß ¼ 0.40,
p < .01) and planning (ß ¼ 0.37, p < .01) directly
predicted decision making significantly; however, the
impacts of working memory and selective attention
on decision making were not significant. This analysis
results also showed the compatibility of data to sam-
pling [X (67, n ¼ 100) ¼ 73.97, p > 0.05; x2/df ¼ 1.104;
RMSEA ¼ 0.03; GFI ¼ 0.91; AGFI ¼ 0.86; CFI ¼ 0.99;
NFI ¼ 0.92]. These results demonstrated that the fit
indices of the second measurement model were better
than those of the first model.
Discussion
First of all, when examining the average of the IGT
Block Net Scores, it can be said that the average

Figure 3. Structural equation model (SEM) regarding Iowa Gambling Test (IGT) block net scores. p  .01. p < .001.
scores of the participants displayed an increasing
momentum. From the first block to the fifth block,
the healthy individuals learned the disadvantaged
decks and made more choices from the advantageous
decks. In the literature, there were some studies com-
paring the IGT Block Net Scores, which are suscep-
tible to VmPFC damage, of healthy samples with
VmPFC-injury patients. Results showed that these
patients tended to increasingly choose disadvantaged
decks more (Bechara et al., 1994; Fellows & Farah,
2005; Ouerchefani et al., 2018). As a result, the cur-
rent research findings are consistent with the findings
in the literature, and it is believed that Block Net
Scores are important in explaining the decision-
maker’s behavior (Steingroever et al., 2013).
Correlations with variables
On the basis of the results of correlation analysis,
poor planning and problem-solving performance is
related to disadvantaged decision making. A few stud-
ies examining the relationship between neuropsycho-
logical tests which assess planning ability and the IGT
have reported contradictory results. For example,
Icellioglu (2015) found nonsignificant correlation
coefficients between planning and decision making.
However, Brand et al. (2007), in support of the find-
ings of the current study, pointed out that planning
can be important in the decision-making process. In
accordance with the present study, it can be said that
having good strong planning and problem-solving
skills can help in advantageous decision making.
Consequently, making a plan and strategy seems to be
APPLIED NEUROPSYCHOLOGY: ADULT 565
useful for decision makers to develop good decision
making skills.
According to the correlation analysis, the persever-
ation scores of the WCST showed negative correla-
tions with the IGT scores, indicating that the
decision-making performance had decreased with
increasing perseveration scores. Not demonstrating
effective decision-making skills is thought to stem
from not showing mental flexibility in finding wrong
choices and applying right choices. All in all, it can be
concluded that set-shifting difficulties can result in
ineffective decision performance. In other words,
mental flexibility can enable an individual to make
efficient decisions.
Another important variable for decision making
was working memory. There are contradictory find-
ings regarding the relationship between working
memory and the IGT in literature. Some studies con-
ducted with healthy older persons and adolescents
have reported nonsignificant correlation coefficients
between the IGT and working memory tests (Denburg
et al., 2005; Hooper et al., 2004). However, consistent
with the findings obtained from the current study,
Fein et al. (2007) demonstrated a significant positive
correlation between the IGT and working memory in
healthy older adults. This result suggests that deci-
sion-making performance increased with increasing
working memory capacity.
Furthermore, the current study indicated that deci-
sion making performance had decreased with the
increase of the ability to control behavior and selective
attention. Furthermore, as the correct score of the 5th
card, which is important for the Stroop effect,
566 S. YILMAZ AND H. KAFADAR
increased, the IGT score decreased. Similar to these
findings, the previous studies investigating the relation
between attention and the IGT reported that attention
was related to decision making (Allom et al., 2016).
Consequently, the current study indicated that atten-
tion and especially the ability to suppress spontaneous
reactions and respond appropriately, are important
processes in decision-making behavior.
In sum, the associations between the aforemen-
tioned decision making and cognitive functions indi-
cate that decision making is an important function of
the frontal lobe. The relations between frontal lobe
tests and decision making test also support the recent
neuroimaging and lesion studies emphasizing the link
between deficits in PFC and difficulty in decision
making performance (Ouerchefani et al., 2017, 2018).
In the literature, various findings based on the big
five personality theory have indicated that prefrontal
functions (especially, executive functions) and person-
ality traits are not independent (Murdock, Oddi, &
Bridgett, 2013; Schretlen, van der Hulst, Pearlson, &
Gordon, 2010; Williams, Suchy, & Kraybill, 2010).
Likewise, decision making that is believed to be
related to executive functions, such as working mem-
ory, set-shifting would also be associated with person-
ality traits. In that, in contrast to previous studies
(Skeel et al., 2007; Starcke et al., 2017; Werner et al.,
2009), the current study showed that individuals who
are high in openness to experience exhibit relatively
ineffective use of the decision-making skills. Some
studies depended on the Big-5 theory have suggested
that individuals who are high in openness to experi-
ence tend to take more risks (Lauriola & Levin, 2001;
Nicholson, Soane, Fenton-O’Creevy, & Willman,
2005). In addition, Weller, Levin, and Bechara (2010)
showed that IGT scores tended to decrease with the
increase of risk-taking behavior. These results seem to
be important in explaining the negative correlation
between openness to experience and the deci-
sion making.
Finally, one another important variable for decision
making was affect. In particular, instant choices acti-
vate emotion-related brain areas, such as VmPFC,
OFC, and amygdala (Simonovic et al., 2017; Smith &
Kosslyn, 2016).The findings of the current study is in
parallel with a previous study conducted by Suhr and
Tsanadis (2007) suggesting that, although there was
no relationship between positive affect and the deci-
sion making, there was a significant negative correl-
ation between negative affect and the decision
making. On the basis of this behavioral data, it is con-
cluded that individuals can make ineffective decisions
because of their negative affect. Therefore, the influen-
ces of feelings on decision-making behavior should
not be overlooked. In summary, enhancing coping
with negative mood as well as cognitive skills are seen
as important in improving decision-making ability.
Structural Equation Models
The model findings were the key factors in determin-
ing the mental processes related to decision-making
performance in healthy individuals and in understand-
ing a neurological or psychiatric patient whose specific
mental processes have been destroyed. Specifically, the
data indicated that an individual’s poor planning and
problem solving skills, high levels of perseverative
thinking, and low working memory capacity can over-
ride the ability to make effective use of decision mak-
ing skills. Del Missier, M€antyl€a, and Bruin (2012)
described different models examining the relationship
between decision-making competence and executive
functioning and general cognitive abilities. They
reported that monitoring/inhibition, which is a latent
independent variable formed by the Letter Memory
Test, N-Back Test, Stop Signal Test, and Stroop Test,
did not significantly predict the decision-making com-
petence, which is consistent with the present finding
that selective attention measured by the Stroop Test
did not predict decision making significantly. Another
model constructed by Gansler, Jerram, Vannorsdall,
and Schretlen (2011) indicated that the latent inde-
pendent variables of attention (determined by the
Brief Test of Attention, Cannors’ Continuous
Performance Test, and Digit Span) and executive
function (via the WCST) had significantly predicted
the IGT. Therefore, it can be deduced that individuals
who have trouble shifting sets make more disadvanta-
geous decisions. In addition, Evers, Van der Veen,
Fekkes, and Jolles (2007) emphasized the importance
of mental flexibility for the gambling tasks in assessing
decision making. Thus, in the present study, the find-
ing of the WCST perseveration scores significantly
predicted the decision making and clearly supported
the effects of reasoning and mental flexibility
on decisions.
The first SEM analysis results showed that working
memory is related to decision making. Low working
memory capacity in particular has been associated
with impulsive decisions (Finn, Mazas, Justus, &
Steinmetz, 2002). It can be said that individuals who
cannot use working memory capacity effectively are
impulsive and have trouble in making better choices.

The second model was constituted of the IGT
Block Net Scores (Block 2, 3, 4, and 5). This model
examining the relations between neuropsychological
tests and the IGT exhibited high fit indices and high
structural coefficients. As a result of the SEM analysis,
it can be concluded that IGT Block Net Scores are
important in measuring decision-making and learn-
ing ability.
According to results of the Pearson correlation
coefficient analysis, it was found that all tests were
related to the IGT. On the other hand, with regard to
the SEM, results showed that decision making was sig-
nificantly predicted only by set-shifting, planning, and
working memory. This study sheds light on the con-
current validity of the IGT in terms of examining the
relationship between frontal lobe tests and the IGT in
a healthy group. Due to the lack of number of studies
related to IGT validity, it is recommended that studies
be conducted concerning the ability of the IGT to dis-
tinguish clinical groups from healthy groups for vari-
ous conditions such as obsessive-compulsive disorder,
alcohol dependence, and schizophrenia.
In this study, the correlation analysis showed that
affect and some personality traits are related to decision
making; however, SEM analysis indicated that affect
and personality did not significantly predict decision
making. Results of the correlation analysis only partly
supported that decision making, affect, and personality
are not independent, and for this reason, future studies
should be conducted on personality and mood disor-
ders. In particular, on the basis of the significant rela-
tionships between decision making and openness to
experience personality trait and negative affect, it is
deduced that personality and mood assessment should
be performed in the neuropsychological assessment.
Limitations
The current study had some limitations. Age and educa-
tion level variables were kept constant because they can
affect mental processes. It may be possible to limit the
ability to generalize the findings. Therefore, researchers
should consider conducting future studies with different
age and education groups in order to contribute to the
body of literature. Moreover, an examination of the
effect of the gender variable on decision making may
also provide a valuable contribution.
Conclusion
The aim of this study was to investigate the associ-
ation between decision-making and other cognitive
APPLIED NEUROPSYCHOLOGY: ADULT 567
processes, affect and personality traits, and to explain
the relationships with one another via the SEM. This
study is important in terms of providing information
about healthy and normal cognitive processes.
Particularly, a holistic model can enable us to under-
stand the relationship between decision making and
other processes and which independent variables con-
tribute more than other variables to the decision mak-
ing in healthy individuals. In addition, it is suggested
that practical benefits would be obtained from the
results regarding decision making that is vital for
everyday life. As a result, findings would provide
which cognitive processes should be developed to
improve the decision-making abilities of individuals.
Consequently, the results would provide valuable
information regarding what other mental processes
would deteriorate on neurological and psychiatric
patients whose specific mental processes (such as deci-
sion making) have destroyed.
From an applied neuropsychological perspective,
the current study findings indicate that decision-mak-
ing difficulties experienced by various psychiatric dis-
orders (i.e., schizophrenia, substance abuse, obsessive
compulsive disorder) may be, to a large extent, from
planning and set-shifting problems. Therefore, it is
suggested that cognitive rehabilitation programs based
on improving decision-making performance are pre-
dominantly focused on enhancing these cogni-
tive processes.
Finally, this study conducted with neuropsycho-
logical tests should be supported by neuroimaging
studies and an investigation into the association of the
IGT with neurotransmitters.
Disclosure statement
No financial support was granted for the conduct of this
research. There were no conflicts of interest in this study.
References
Abel, T. J., Manzel, K., Bruss, J., Belfi, A. M., Howard III,
M. A., & Tranel, D. (2016). The cognitive and behavioral
effects of meningioma lesions involving the ventromedial
prefrontal cortex. Journal of Neurosurgery, 124 (6),
1568–1577. doi:10.3171/2015.5.JNS142788
Allom, V., Panetta, G., Mullan, B., & Hagger, M. S. (2016).
Self-report and behavioural approaches to the measure-
ment of self-control: Are we assessing the same con-
struct? Personality and Individual Differences, 90,
137–142. doi:10.1016/j.paid.2015.10.051
Ant, E. S. (2005). The pilot study for the reliability and val-
idity of the third revise of Wechsler memory scale verbal
paired association and auditory recognition delayed
568 S. YILMAZ AND H. KAFADAR
subtests (Unpublished Master’s Thesis). Anadolu
University, Eskisehir.
Atalay, D. (2005). Planning in adults: The study of validity
and reliability of the Tower of London test (Unpublished
Master’s Thesis). Istanbul University, Istanbul.
Bechara, A., Damasio, A. R., Damasio, H., & Anderson,
S. W. (1994). Insensitivity to future consequences follow-
ing damage to human prefrontal cortex. Cognition,
50(1–3), 7–15. doi:10.1016/0010-0277(94)90018-3
Bechara, A., Damasio, H., Damasio, A. R., & Lee, G. P.
(1999). Different contributions of the human amygdala
and ventromedial prefrontal cortex to decision-making.
The Journal of Neuroscience, 19(13), 5473–5481. doi:
10.1523/JNEUROSCI.19-13-05473.1999
Bechara, A. (2003). Risky business: emotion, decision-mak-
ing, and addiction. Journal of Gambling Studies, 19(1),
23–51.
Bechara, A. (2005). Decision making, impulse control and
loss of willpower to resist drugs: a neurocognitive per-
spective. Nature Neuroscience, 8(11), 1458–1463. doi:
10.1038/nn1584
Bechara, A., (2007). Iowa gambling task professional manual.
Boca Raton, FL: PAR.
Berg, E. A. (1948). A simple objective technique for measur-
ing flexibility in thinking. The Journal of General
Psychology, 39 (1), 15–22. doi:10.1080/00221309.1948.
9918159
Brand, M., Recknor, E. C., Grabenhorst, F., & Bechara, A.
(2007). Decisions under ambiguity and decisions under
risk: correlations with executive functions and compari-
sons of two different gambling tasks with implicit and
explicit rules. Journal of Clinical and Experimental
Neuropsychology, 29 (1), 86–99. doi:10.1080/
13803390500507196
Buelow, M. T., & Suhr, J. A. (2013). Personality characteris-
tics and state mood influence individual deck selections on
the Iowa Gambling Task. Personality and Individual
Differences, 54 (5), 593–597. doi:10.1016/j.paid.2012.11.019
Culbertson, W. C., & Zillmer, E. A. (2001). Tower of
London Drexel University (TOLDX): Technical manual.
North Tonawanda, NY: Multi-Health Systems
Incorporated (MHS).
Del Missier, F., M€antyl€a, T., & Bruin, W. B. (2012).
Decision-making competence, executive functioning, and
general cognitive abilities. Journal of Behavioral Decision
Making, 25 (4), 331–351. doi:10.1002/bdm.731
Denburg, N. L., Tranel, D., & Bechara, A. (2005). The abil-
ity to decide advantageously declines prematurely in
some normal older persons. Neuropsychologia, 43 (7),
1099–1106. doi:10.1016/j.neuropsychologia.2004.09.012
De Vries, M., Holland, R. W., & Witteman, C. L. (2008). In
the winning mood: Affect in the Iowa gambling task.
Judgment and Decision Making, 3 (1), 42–50.
Evers, E. A. T., Van der Veen, F. M., Fekkes, D., & Jolles, J.
(2007). Serotonin and cognitive flexibility: neuroimaging
studies into the effect of acute tryptophan depletion in
healthy volunteers. Current Medicinal Chemistry, 14 (28),
2989–2995. doi:10.2174/092986707782794032
Fein, G., McGillivray, S., & Finn, P. (2007). Older adults
make less advantageous decisions than younger adults:
cognitive and psychological correlates. Journal of the
International Neuropsychological Society, 13 (3), 480–489.
doi: 10.1017/S135561770707052X
Fellows, L. K., & Farah, M. J. (2005). Different underlying
impairments in decision-making following ventromedial
and dorsolateral frontal lobe damage in humans. Cerebral
Cortex, 15 (1), 58–63. doi:10.1093/cercor/bhh108
Finn, P. R., Mazas, C. A., Justus, A. N., & Steinmetz, J.
(2002). Early-onset alcoholism withconduct disorder: Go/
no go learning deficits, working memory capacity, and
personality. Alcoholism. Alcoholism: Clinical and
Experimental Research, 26 (2), 186–206. doi:10.1111/
j.1530-0277.2002.tb02524.x
Franken, I. H., & Muris, P. (2005). Individual differences in
decision-making. Personality and Individual Differences,
39 (5), 991–998. doi:10.1016/j.paid.2005.04.004
Gansler, D. A., Jerram, M. W., Vannorsdall, T. D., &
Schretlen, D. J. (2011). Does the Iowa Gambling Task
measure executive function? Archives of Clinical
Neuropsychology, 26 (8), 706–717. doi:10.1093/arclin/acr082
Gencoz, T., & Oncul, O. (2012). Examination of personality
characteristics in a Turkish sample: development of Basic
Personality Traits Inventory. The Journal of General
Psychology, 139 (3), 194–216. doi:10.1080/00221309.2012.
686932
Gencoz, T. (2000). Positive and Negative Affect Schedule: A
study of validity and reliability. Turkish Journal of
Psychology, 15 (46), 19–28.
Heaton, R. K., (1981). Wisconsin card sorting test manual.
Odessa, FL: Psychological Assesment Resources, Inc.
Heaton, R. K., (1993). Wisconsin card sorting test. Computer
version 2. Odessa, FL: Psychological Assessment Resources.
Hooper, C. J., Luciana, M., Conklin, H. M., & Yarger, R. S.
(2004). Adolescents’ performance on the Iowa Gambling
Task: Implications for the development of decision mak-
ing and ventromedial prefrontal cortex. Developmental
Psychology, 40 (6), 1148–1158. doi:10.1037/0012-1649.
40.6.1148
Hooper, C. J., Luciana, M., Wahlstrom, D., Conklin, H. M.,
& Yarger, R. S. (2008). Personality correlates of Iowa
Gambling Task performance in healthy adolescents.
Personality and Individual Differences, 44 (3), 598–609.
doi:10.1016/j.paid.2007.09.021
Icellioglu, S., & Ozden, M. S. (2012). Personality effect on
decision-making among normal university students and
comparing gambling task performances of normal univer-
sity students with a group of normal adults. Procedia-
Social and Behavioral Sciences, 46, 1010–1014. doi:
10.1016/j.sbspro.2012.05.240
Icellioglu, S. (2015). Iowa Gambling Test: Normative data
and correlation with executive functions. Dusunen Adam:
The Journal of Psychiatry and Neurological Sciences, 28
(3), 222–230. doi:10.5350/DAJPN2015280305
Karakas, S., (2006). Handbook of BILNOT Battery: Studies of
research and development for neuropsychological tests.
Ankara, Turkey: Dizayn Ofset.
Kjome, K. L., Lane, S. D., Schmitz, J. M., Green, C., Ma, L.,
Prasla, I., … Moeller, F. G. (2010). Relationship between
impulsivity and decision making in cocaine dependence.
Psychiatry Research, 178(2), 299–304. doi:10.1016/
j.psychres.2009.11.024
Lauriola, M., & Levin, I. P. (2001). Personality traits and
risky decision-making in a controlled experimental task:

An exploratory study. Personality and Individual
Differences, 31 (2), 215–226. doi:10.1016/S0191-8869(00)
00130-6
Lehto, J. E., & Elorinne, E. (2003). Gambling as an executive
function task. Applied Neuropsychology, 10 (4), 234–238.
doi:10.1207/s15324826an1004_5
McCrae, R. R., & Costa, P. T., (2003). Personality in adult-
hood: A five-factor theory perspective. New York, NY:
Guilford Press.
Murdock, K. W., Oddi, K. B., & Bridgett, D. J. (2013).
Cognitive correlates of personality links between execu-
tive functioning and the big five personality traits.
Journal of Individual Differences, 34 (2), 97–104. doi:
10.1027/1614-0001/a000104
Nicholson, N., Soane, E., Fenton-O’Creevy, M., & Willman,
P. (2005). Personality and domain-specific risk taking.
Journal of Risk Research, 8 (2), 157–176. doi:10.1080/
1366987032000123856
Ouerchefani, R., Ouerchefani, N., Allain, P., Rejeb, M. R. B.,
& Le Gall, D. (2017). Contribution of different regions of
the prefrontal cortex and lesion laterality to deficit of
decision-making on the Iowa Gambling Task. Brain and
Cognition, 111, 73–85. doi:10.1016/j.bandc.2016.06.010
Ouerchefani, R., Ouerchefani, N., Allain, P., Ben Rejeb,
M. R., & Le Gall, D. (2018). Relationships between execu-
tive function, working memory, and decision-making on
the Iowa Gambling Task: Evidence from ventromedial
patients, dorsolateral patients, and normal subjects.
Journal of Neuropsychology, 1, 30. doi:10.1111/jnp.12156
Overman, W. H., Frassrand, K., Ansel, S., Trawalter, S.,
Bies, B., & Redmond, A. (2004). Performance on the
IOWA card task by adolescents and adults.
Neuropsychologia, 42 (13), 1838–1851. doi:10.1016/
j.neuropsychologia.2004.03.014
Ozdemir, D. (2005). The plot study for the reliability, valid-
ity of the third revise of Wechsler memory scale, logical
memory and auditory recognition delayed subtests
(Unpublished Master’s Thesis). Anadolu University,
Eskisehir.
Premkumar, P., Fannon, D., Kuipers, E., Simmons, A.,
Frangou, S., & Kumari, V. (2008). Emotional decision-
making and its dissociable components in schizophrenia
and schizoaffective disorder: A behavioural and MRI
investigation. Neuropsychologia, 46(7), 2002–2012. doi:
10.1016/j.neuropsychologia.2008.01.022
Schretlen, D. J., van der Hulst, E. J., Pearlson, G. D., &
Gordon, B. (2010). A neuropsychological study of per-
sonality: Trait openness in relation to intelligence, flu-
ency, and executive functioning. Journal of Clinical and
Experimental Neuropsychology, 32 (10), 1068–1073. doi:
10.1080/13803391003689770
Simonovic, B., Stupple, E. J., Gale, M., & Sheffield, D. (2017).
Stress and risky decision making: Cognitive reflection,
emotional learning or both. Journal of Behavioral Decision
Making, 30(2), 658–665. doi:10.1002/bdm.1980
Skeel, R. L., Neudecker, J., Pilarski, C., & Pytlak, K. (2007).
The utility of personality variables and behaviorally-based
measures in the prediction of risk-taking behavior.
Personality and Individual Differences, 43 (1), 203–214.
doi:10.1016/j.paid.2006.11.025
APPLIED NEUROPSYCHOLOGY: ADULT 569
Smith, D. G., Xiao, L., & Bechara, A. (2012). Decision mak-
ing in children and adolescents: Impaired Iowa Gambling
Task performance in early adolescence. Developmental
Psychology, 48(4), 1180. doi:10.1037/a0026342
Smith, E. E., & Kosslyn, S. M. (2016). Cognitive psychology:
Mind and brain. (M. Sahin, Trans.). Istanbul, Turkey:
Nobel Akademic.
Starcke, K., Agorku, J. D., & Brand, M. (2017). Exposure to
unsolvable anagrams impairs performance on the Iowa
Gambling Task. Frontiers in Behavioral Neuroscience, 11,
114.doi:10.3389/fnbeh.2017.00114
Steingroever, H., Wetzels, R., Horstmann, A., Neumann, J.,
& Wagenmakers, E. J. (2013). Performance of healthy
participants on the Iowa Gambling Task. Psychological
Assessment, 25(1), 180. doi:10.1037/a0029929
Suhr, J. A., & Tsanadis, J. (2007). Affect and personality cor-
relates of the Iowa Gambling Task. Personality and
Individual Differences, 43 (1), 27–36. doi:10.1016/j.paid.
2006.11.004
Summerfield, C., & Koechlin, E. (2009). Decision-making
and prefrontal executive function. In The Cognitive
Neurosciences, M.S. Gazzaniga, ed. (MIT Press), pp.
1019–1030.
Sutterer, M. J., Koscik, T. R., & Tranel, D. (2015). Sex-
related functional asymmetry of the ventromedial pre-
frontal cortex in regard to decision-making under risk
and ambiguity. Neuropsychologia, 75, 265–273. doi:
10.1016/j.neuropsychologia.2015.06.015
Stroop, J. R. (1935). Studies of interference in serial verbal
reactions. Journal of Experimental Psychology, 18 (6),
643–662. doi:10.1037/h0054651
Waters-Wood, S. M., Xiao, L., Denburg, N. L., Hernandez,
M., & Bechara, A. (2012). Failure to learn from repeated
mistakes: Persistent decision-making impairment as
measured by the Iowa gambling task in patients with
ventromedial prefrontal cortex lesions. Journal of the
International Neuropsychological Society, 18(05), 927–930.
doi:10.1017/S135561771200063X
Watson, D., Clark, L. A., & Tellegen, A. (1988).
Development and validation of brief measures of positive
and negative affect: the PANAS scales. Journal of
Personality and Social Psychology, 54 (6), 1063–1070. doi:
10.1037//0022-3514.54.6.1063
Wechsler, D., (1997). WMS-III Administration and Scoring
Manual (1st ed). London, UK: The Psychological
Corporation.
Weller, J. A., Levin, I. P., & Bechara, A. (2010). Do individ-
ual differences in Iowa Gambling Task performance pre-
dict adaptive decision making for risky gains and losses?
Journal of Clinical and Experimental Neuropsychology, 32
(2), 141–150. doi:10.1080/13803390902881926
Werner, N. S., Jung, K., Duschek, S., & Schandry, R. (2009).
Enhanced cardiac perception is associated with benefits
in decision-making. Psychophysiology, 46 (6), 1123–1129.
doi:10.1111/j.1469-8986.2009.00855.x
Williams, P. G., Suchy, Y., & Kraybill, M. L. (2010). Five-
factor model personality traits and executive functioning
among older adults. Journal of Research in Personality,
44(4), 485–491. doi:10.1016/j.jrp.2010.06.002
Copyright of Applied Neuropsychology: Adult is the property of Taylor & Francis Ltd and its
content may not be copied or emailed to multiple sites or posted to a listserv without the
copyright holder's express written permission. However, users may print, download, or email
articles for individual use.