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Effects of transcranial direct-current stimulation

(tDCS) of the dorsolateral prefrontal cortex (DLPFC)
during a mixed-gambling risky decision-making task
a b c b d e c
Ludovico Minati , Camila Campanhã , Hugo D. Critchley & Paulo Sérgio Boggio
a
Scientific Department , Fondazione IRCCS Istituto Neurologico Carlo Besta , Milano , Italy
b
Department of Psychiatry , Brighton and Sussex Medical School (BSMS) , Falmer , UK
c
Social and Cognitive Neuroscience Laboratory and Developmental Disorders Programme ,
Centre for Health and Biological Sciences, Mackenzie Presbyterian University , São Paulo ,
Brazil
d
Neurobehavioural Clinic, Sussex Partnership NHS Foundation Trust , Brighton and Hove ,
UK
e
Sackler Centre for Consciousness Science, University of Sussex , Falmer , UK
Accepted author version posted online: 03 Oct 2011.Published online: 11 Jan 2012.

To cite this article: Ludovico Minati , Camila Campanhã , Hugo D. Critchley & Paulo Sérgio Boggio (2012) Effects of
transcranial direct-current stimulation (tDCS) of the dorsolateral prefrontal cortex (DLPFC) during a mixed-gambling risky
decision-making task, Cognitive Neuroscience, 3:2, 80-88, DOI: 10.1080/17588928.2011.628382

To link to this article: http://dx.doi.org/10.1080/17588928.2011.628382

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 COGNITIVE NEUROSCIENCE, 2012, 3 (2), 80–88

Effects of transcranial direct-current stimulation (tDCS)

of the dorsolateral prefrontal cortex (DLPFC) during
a mixed-gambling risky decision-making task

Ludovico Minati1,2, Camila Campanhã3, Hugo D. Critchley2,4,5, and Paulo Sérgio Boggio3
Downloaded by [The University of British Columbia] at 17:28 09 December 2014

1
Scientific Department, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milano, Italy
2
Department of Psychiatry, Brighton and Sussex Medical School (BSMS), Falmer, UK
3
Social and Cognitive Neuroscience Laboratory and Developmental Disorders Programme, Centre for
Health and Biological Sciences, Mackenzie Presbyterian University, São Paulo, Brazil
4
Neurobehavioural Clinic, Sussex Partnership NHS Foundation Trust, Brighton and Hove, UK
5
Sackler Centre for Consciousness Science, University of Sussex, Falmer, UK

Previous studies have led to hypothesizing that right DLPFC activity is related to risk propensity, but the generality
of this relationship remains unclear. Here, we experimentally modulated DLPFC activity in 47 healthy, female
volunteers during a risky decision-making task, where monetary gambles defined by potential win, loss, and
outcome probability were evaluated in the absence of feedback and uncertainty. Three participant groups,
receiving left anodal/right cathodal, right anodal/left cathodal, and sham tDCS, were compared. Overall,
participants performed the task well above chance level and were significantly risk averse, but tDCS did not
affect task performance or risk propensity. However, right anodal/left cathodal tDCS significantly elevated response
confidence, independently of accept/reject response. Our results suggest that the relationship between DLPFC
activity and risk propensity may not be universally valid for all task types and requires further characterization.
Enhancing right and attenuating left DLPFC activity boosts subjective confidence, with potential implications for
understanding pathological gambling.

Keywords: Decision-making; Prospect theory; Transcranial direct current stimulation (tDCS); Dorsolateral prefrontal
cortex (DLPFC).

Many times every day we need to choose between systematically select the one with the highest EV, but
options carrying risks and potential rewards. An obser- living beings display specific adaptive biases
ver optimizing long-term gain would simply calculate (Bernoulli, 1954; von Neumann & Morgenstern,
the expected value (EV) of each option and 1953). An influential account of decisional behavior

Correspondence should be addressed to: Ludovico Minati, Scientific Department, Fondazione IRCCS Istituto Neurologico Carlo Besta, Via
Celoria 11, 20133 Milano MI, Italy. E-mail: lminati@ieee.org
L.M. was wholly funded and employed by Fondazione IRCCS Istituto Neurologico Carlo Besta (FINCB) during the core period of this study.
This research also forms part of a BSMS doctoral dissertation (10/056/MIN) and is based on preparatory work conducted while L.M. was
previously employed by BSMS. C.C. was supported by Fundação de Amparo à Pesquisa do Estado de São Paulo (2009/04694-1). H.D.C. was
supported by a program grant from the Wellcome Trust. P.S.B. was supported by Conselho Nacional de Desenvolvimento Científico e Tecnológico
(305718/2009-6) and by MackPesquisa. The authors are grateful to Karina Di Siervi, Ana Alem, and Nathalia Baptista for excellent operational
assistance in the application of tDCS during data acquisition, to Sylvie Piacentini for useful discussions, and to three anonymous reviewers for
useful comments on an earlier draft. All authors declare under their own responsibility that they do not have any real or perceived conflicts of
interest pertaining to the present study.

© 2012 Psychology Press, an imprint of the Taylor & Francis Group, an Informa business
www.psypress.com/cognitiveneuroscience http://dx.doi.org/10.1080/17588928.2011.628382

is prospect theory, proposed by Kahneman and
Tversky (1979), according to which risky choice
options initially undergo an “editing” phase, integrat-
ing the available decisional parameters (e.g., potential
wins and losses) into more abstract variables such as
EV and outcome variance, followed by evaluation with
respect to a set “reference value.” Prospect theory can
account for pervasive behavioral phenomena such as
risk and loss aversion by introducing nonlinear value
functions that are evolutionarily plausible––for exam-
ple, overweighing potentially fatal losses with respect
to equivalent gains (Wilkinson, 2008).
Human decision-making engages multiple neocorti-
Downloaded by [The University of British Columbia] at 17:28 09 December 2014
cal regions, principally in the prefrontal cortex, as well
as phylogenetically older structures (e.g., Krueger,
Grafman, & McCabe, 2008; Trepel, Fox, & Poldrack,
2005). In particular, the dorsolateral prefrontal cortex
(DLPFC) is heavily implicated in action representation,
executive function, behavioral control and motor plan-
ning (e.g., Hoshi, 2006), subserving decision-making
principally through multi-attribute integration during
EV computation (Kahnt, Heinzle, Park, & Haynes,
2010). Patients with DLPFC lesions perform poorly on
the Iowa Gambling Task, and right-lateralized damage
is especially linked to elevated risk-taking behavior and
poor information integration (Clark, Manes, Antoun,
Sahakian, & Robbins, 2003). Experimental disruption
of right, but not left, DLPFC function by low-frequency
repetitive transcranial magnetic stimulation (rTMS) also
increases risk propensity (Knoch et al., 2006).
Recently, the role of the DLPFC in decision-
making has also been investigated by transcranial
direct current stimulation (tDCS) (Boggio, Campanhã,
Valasek, Fecteau, & Pascual-Leone, 2010; Fecteau,
Knoch, et al., 2007). tDCS involves applying a weak
direct current delivered by a battery-driven, constant-
current stimulator to the scalp through two saline-
soaked, surface sponge electrodes (35 cm2). The effect
depends on the current orientation, whereby anodal
stimulation typically increases cortical excitability
while cathodal stimulation reduces it, and tDCS has
well-established value in exploring working memory,
language, and emotional processing (Nitsche & Paulus,
2000).
Interestingly, findings from tDCS experiments chal-
lenge the view that right DLPFC activity mitigates risk-
taking in general, independently of the population
under study. In early experiments on young partici-
pants, enhancing right DLPFC activity by anodal sti-
mulation promoted the selection of safer choices
(Fecteau, Knoch, et al., 2007). Later investigations,
however, demonstrated that this pattern reverses with
age, arguably reflecting transcallosal functional reor-
ganization (Boggio, Campanhã, et al., 2010). Further
DLPFC STIMULATION DURING DECISION-MAKING 81
evidence for a complex relationship between DLPFC
activity and risk-taking comes from tDCS studies of
drug addicts, who display a markedly different rela-
tionship between stimulation pattern and risk propen-
sity (Boggio, Zaghi, et al., 2010).
Unfortunately, the two most widely used decision-
making tasks (Iowa Gambling Task and the Risk Task)
do not provide information relevant to understanding
the role of the DLPFC in the framework of prospect
theory. In the Iowa Gambling Task, participants pick
cards from four decks characterized by initially
unknown and differing proportions of winning and
losing cards, and need to learn from outcomes which
decks are overall advantageous and which ones are not.
This task has good ecological validity but limited func-
tional specificity: As it involves feedback and uncer-
tainty/ambiguity, performance depends heavily on
intact learning and executive functions (Bechara,
Damasio, Damasio, & Anderson, 1994). During the
Risk Task, on the other hand, participants are presented
with six boxes, colored pink or blue, and are requested
to guess the color of the box containing a “winning
token.” The proportion of pink/blue boxes varies
among trials and determines the available reward,
such that the riskiest choices are always associated
with the largest potential rewards. This task does not
involve ambiguity yet fails to isolate EV computation
from risk sensitivity, since large rewards are preferen-
tially associated with unlikely outcomes (Rogers et al.,
1999).
The aim of this study was to apply tDCS to explore
the role of the DLPFC in a risky decision-making task
designed to index choice-option evaluation only, and
involving the presentation of simple monetary gambles,
where all information was explicitly provided and out-
come feedback was not revealed (Minati et al., 2011). In
light of the hypothesis of a straightforward general
relationship between right DLPFC activity and risk-
taking, predicated on converging results from lesion
studies (Clark et al., 2003), rTMS (Knoch et al.,
2006), and tDCS in healthy young participants
(Fecteau, Knoch, et al., 2007), we hypothesized that
enhancing right and inhibiting left DLPFC activity
with right anodal/left cathodal stimulation would shift
responses toward an overall more conservative
approach, whereas right cathodal/left anodal stimulation
would have the opposite effect. A negative finding, on
the other hand, would go along with previous tDCS
results on elderly controls (Boggio, Campanhã, et al.,
2010) and drug addicts (Boggio, Zaghi, et al., 2010) and
challenge the view that the relationship between right
DLPFC activity and risk-taking reflects a fundamental
feature of the brain that can be generalized to diverse
populations and tasks.
 82 MINATI ET AL.

METHODS also administered prior to stimulation (as in Boggio,

Participants
Forty-seven female participants were recruited by con-
venience sampling among regular university students
and randomly assigned to three groups: sham tDCS,
left anodal/right cathodal tDCS, and right anodal/left
cathodal tDCS. The experiment was undertaken with
the understanding and written, informed consent of all
participants, and approved by the institutional ethics
committee of the Mackenzie Presbyterian University,
registered with the National Ethics Committee of
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Campanhã, et al., 2010). Upon completion of the experi-
ment, all participants rated their perception of the stimu-
lation they had received on a 10-point scale, ranging
from –5 (“I am sure it was sham stimulation”) to 5 (“I
am sure it was active stimulation”). The characteristics
of the participants are summarized in Table 1.
tDCS
The device used, developed in-house, is well suited for
blind stimulation, as a switch enables interruption of

Brazil (SISNEP), and by the Research Governance and
Ethics Committee (RGEC) of the Brighton and Sussex
Medical School (BSMS, PhD project no. 10/056/MIN).
Participants did not receive any money but were awarded
university credits in line with local guidelines.
All participants were right-handed according to the
Edinburgh Handedness Inventory. They were naive to
tDCS and the task under study, were free from neurolo-
gical and psychiatric disorders, and were not taking any
medication acting on the central nervous system
or illicit drugs. They were assessed with the Beck
Anxiety Inventory (BAI) (Beck & Steer, 1993), Beck
Depression Inventory BDI) (Beck, Steer, & Brown,
1996), and the Barratt Impulsiveness Scale (BIS)
(Patton, Stanford, & Barratt, 1995). A visual-analog
scale (VAS) evaluating mood state on 14 axes was
the current flow while maintaining the “ON” display
and showing the stimulation parameters unaltered. The
electrode montage was the same as in previous studies
(Boggio, Campanhã, et al., 2010; Fecteau, Knoch,
et al., 2007), and the sponge electrodes were applied
over the F3 and F4 sites (international EEG 10/20
system). While stimulating the left and right DLPFC
simultaneously with opposite polarities prevents separ-
ating the effects of enhancing activity on one side and
inhibiting it on the other, the choice of this setup here
was motivated for comparability with previous results
obtained on the Risk Task (in Boggio, Campanhã, et al.,
2010; Boggio, Zaghi, et al., 2010; Fecteau, Knoch, et al.,
2007). During active stimulation, participants received a
constant current of 2 mA. Stimulation was enabled
approximately 3 min before starting the task and disabled

TABLE 1
Participant data for the three groups. Values are given as mean
SD. p value refers to ANOVA across the groups. See text for details

Left anodal/right Right anodal/left

Sham tDCS (n ¼ 16) cathodal tDCS (n ¼ 16) cathodal tDCS (n ¼ 15) ANOVA

Age (years) 21.8
2.5 22.3
3.2 20.9
1.0 p ¼ .3

Education (years) 15.8
2.5 16.3
3.2 14.9
1.0 p ¼ .3
Beck Anxiety Inventory (BAI) 8.2
5.0 6.1
5.3 7.7
4.8 p ¼ .3
Beck Depression Inventory (BDI) 7.7
5.5 5.2
4.5 6.1
3.9 p ¼ .4
Barratt Impulsiveness Scale (BIS) 68.6
7.5 68.5
4.8 70.1
5.9 p ¼ .7
Visual analog scales (VAS)
Alert / drowsy 5.4
2.2 6.1
2.4 5.4
2.8 p ¼ .7
Calm / restless 4.5
2.3 4.2
1.5 4.2
1.9 p ¼ .9
Strong / weak 4.6
2.2 5.4
1.9 4.6
2.3 p ¼ .4
Confused / lucid 7.5
1.8 7.3
1.8 6.8
2.3 p ¼ .6
Sharp / blunt 4.9
2.4 4.7
1.5 4.8
2.0 p ¼ 1
Apathetic / dynamic 7.6
2.1 6.8
1.8 7.3
1.8 p ¼ .5
Satisfied / unfulfilled 5.2
2.5 4.2
2.3 4.4
2.0 p ¼ .4
Worried / unconcerned 5.8
2.8 5.5
3.0 5.0
2.2 p ¼ .7
Slow-minded / fast-thinking 6.8
1.5 7.2
1.4 6.5
1.3 p ¼ .4
Tense / relaxed 6.8
2.4 5.4
2.7 5.8
2.2 p ¼ .3
Attentive / neglectful 4.1
2.1 4.4
1.7 4.6
2.2 p ¼ .8
Inept / competent 8.1
1.4 7.5
1.7 8.0
1.8 p ¼ .6
Happy / sad 4.4
2.1 3.9
2.2 3.9
2.2 p ¼ .8
Hostile / friendly 7.8
1.5 8.0
1.5 7.8
1.9 p ¼ .9
Stimulation perception 1.1
3.3 0.8
3.3 0.9
2.8 p ¼ 1

immediately upon completion; the current was ramped
up and down with slopes of 10 s. For the sham condition,
the current was slowly ramped down after 30 s of stimu-
lation with random polarity, preserving the initial tingling
sensation often associated with active tDCS. For safety
reasons, the experimenter remained in the room for the
whole duration of the experiment, away from the parti-
cipant’s visual field. The overall effective duration of
stimulation was 20.5
4.1 min across participants. The
stimulation protocol and parameters complied with
accepted safety guidelines (Nitsche et al., 2008).
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Gambling task
The study task has been previously employed to assess
decision-making in patients with Parkinson’s disease
and Huntington’s disease (Minati et al., 2011). As
shown in Figure 1a, each gamble consisted of three
parameters: potential loss (thereafter referred to as
kLOSE), potential win (kWIN), and probability of winning
(p, not to be confused with statistical test probability).
These were presented simultaneously, in white Arial
font (size 36 points) over a black background, on a 17-
inch screen positioned at about 1 m from the head. The
task was written using the Cogent 2000 Toolkit
(Wellcome Laboratory of Neurobiology, London, UK).
Within each session, 240 gambles were shown,
interspersed with three evenly spaced pauses of arbi-
trary duration determined by the participant (<2 min
each). The task was self-paced; i.e., a new gamble
appeared immediately after each response. The first
60 gambles (corresponding to approximately 4 min)
were discarded from analysis, allowing for practice and
stabilization of the neuromodulation; the first five gam-
bles after each pause were also ignored.
Participants were instructed to give equal weight to
the three parameters, carefully consider the
Figure 1. Gamble pool characteristics. (a) Presentation format. (b–d) Scatter plots for EV as a function of kWIN, kLOSE and p. (e–h) Cumulative
distributions of EV, kWIN, kLOSE and p. See Methods section for description.
DLPFC STIMULATION DURING DECISION-MAKING 83
convenience of each gamble by means of their “gut
feeling” without any mathematical computation, and
decide whether to accept or reject as rapidly as possi-
ble, within a maximum of 6 s. In other words, choice
was between a zero-expected value option (EV ¼ 0)
and an option with EV ¼ p  kWIN–(1–p)  kLOSE.
They were informed that no feedback would be
provided after each gamble, but the computer would
keep track of their responses in the form of a virtual
bank account, starting from a balance of zero and
updated with the amount won or lost each time.
Participants were also informed that the outcomes of
the gambles were not predetermined, but generated
by the computer only at the time of pressing the
response button. Further, they were told that their
overall aim was to earn as much money as possible,
imagining they were playing with real money, that
they would be able to see their final balance at the
end of the experiment, and that the usefulness of their
participation would depend on how much money they
earned.
Across all gambles, the EV was nearly normally
distributed in the range R$ [–300, 300] (Brazilian
national currency), having mean R$ –1.2
46.7,
Kolmogorov–Smirnov Z ¼ 1.4, p ¼ .04, skewness 0
and kurtosis 1.3 (i.e., symmetric and mildly leptokur-
tic). The range for kWIN and kLOSE was R$ [(–300,
300], while p was in [.1, .9]. The linear correlation
coefficient with respect to EV was similar across the
three parameters displayed, namely r ¼ .29 for kWIN,
r ¼ .32 for kLOSE and r ¼ .32 for p. There was no
significant difference between the distributions of kWIN
and kLOSE, Mann–Whitney Z ¼ –0.3, p ¼ .7. This
balancing is relevant to ensure that, if decisional beha-
vior is purely driven by EV, no preferential effects
related to kWIN, kLOSE or p will emerge. Scatter plots
and histograms of the gamble characteristics are shown
in Figure 1b–h.
 84 MINATI ET AL.

Participants responded according to a four-level
scale––i.e., “confident reject,” “unsure reject,” “unsure
accept,” and “confident accept” They were informed that
there was no difference between the consequences of
confident and unsure responses, but that they should
attempt to make use of all four levels throughout the
task. This four-level scale suggested in Tom, Fox,
Trepel, and Poldrack (2007) was utilized to promote dee-
per processing––i.e., to prompt participants to reflect on
subjective advantageousness instead of using a fixed rule.
Statistical analysis
Downloaded by [The University of British Columbia] at 17:28 09 December 2014
All the parameters above were entered in between-
subject ANOVAs, having one factor with three levels
(sham, left anodal/right cathodal, and right anodal/left
cathodal tDCS). To avoid potential bias, Welch’s cor-
rection for the number of degrees of freedom was
applied, adjusting the F value to account for unequal
variance across the three stimulation conditions. Post-
hoc comparisons were performed with Games–Howell
tests, which are moderately conservative and do not
assume homoscedasticity. Accounting for multiple
comparisons across nine parameters (see below), we
set α ¼ .006 according to Bonferroni’s criterion. One-
sample t-tests were also performed to demonstrate

overall features of the behavioral responses.

Data analyses were performed with custom scripts
written under MATLAB 7.4 (Math Works, Inc.,
Natick, MA, USA) and SPSS 17.0 (SPSS, Inc.,
Somers, NY, USA). The reaction times (RT)s were
z-normalized at individual level, and gambles for
which these fell outside 3 SD (1.2% overall) from the
average were removed.
For each participant, the accuracy, i.e., the proportion
of positive EV gambles accepted and negative EV gam-
bles rejected, was computed. The overall proportion of
gambles accepted (subsequently referred to as accep-
tance) and the proportion of confident responses (sub-
sequently referred to as confidence) were calculated.
The equivalent amount earned was also computed,
assuming a gain/loss equal to EV (positive or negative)
for each gamble taken and zero for each gamble rejected.
In order to probe the relative weight of each gamble
parameter on decisional behavior, four logistic regres-
sions were performed, separately modeling gamble
acceptance in terms of kWIN, kLOSE, p, and EV.
Power analysis
We estimated effective power from the effect size
of previous tDCS studies on the Risk Task––i.e.,
f , 1.7 between Boggio, Campanhã, et al. (2010) and
Boggio, Zaghi, et al. (2010). Using G*Power 3 soft-
ware (University of Kiel, Kiel, Germany), assuming
α ¼.006 and sample size n ¼ 47 with three groups, we
found the effective power (1 – β) to be 0.99.
RESULTS
The effects of stimulation on behavioral responses and
corresponding statistics are reported in Table 2, and
scatter plots are shown in Figure 2. As indicated in
Table 1, participants in the three groups were matched
on all scales (BAI, BDI, BIS, and VAS), and could not

TABLE 2
Effects of stimulation on behavioral responses. Values are given as mean
SD. ANOVAs included Welch’s correction, and
post-hoc comparisons were performed with Games–Howell tests (see Methods). RT: reaction time; Acceptance: proportion of
accepted gambles; Accuracy: proportion of negative EV gambles rejected and positive EV gambles accepted; Confidence: overall
proportion of confident responses; β(kWIN), β(kLOSE), β(p), and β(EV): logistic regression coefficients for reject/accept response.
See also Figure 2

Sham tDCS Left anodal/right cathodal Right anodal/left cathodal

(n ¼ 16) tDCS (n ¼ 16) tDCS (n ¼ 15) ANOVA

Mean RT 3780
760 ms 3660
880 ms 3200
870 ms p ¼ .2

Acceptance 0.41
0.14 0.43
0.14 0.41
0.10 p ¼ .9
Accuracy 0.78
0.07 0.76
0.10 0.76
0.07 p ¼ .9
Confidence 0.40
0.19 0.50
0.27 0.64
0.17 F(2, 28.7) ¼ 6.9, p ¼ .004, η2p ¼ .18
Right anodal vs. sham p ¼ .002
Amount earned R$1660
1000 R$1380
510 R$1410
410 p ¼ .6
β(kWIN) 0.01
0.009 0.009
0.004 0.013
0.004 p ¼ .1
β(kLOSE) -0.012
0.009 -0.009
0.006 -0.013
0.005 p ¼ .06
β(p) -0.4
3.2 0.4
2.1 -1.6
3.2 p ¼ .1
β(EV) 0.037
0.01 0.037
0.017 0.032
0.014 p ¼ .5
 DLPFC STIMULATION DURING DECISION-MAKING 85
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Figure 2. Group comparison scatter plots. Acceptance: Proportion of accepted gambles. Accuracy: Proportion of negative-EV gambles rejected
and positive-EV gambles accepted. Confidence: Overall proportion of confident responses. β(kWIN), β(kLOSE), β(p) and β(EV): Logistic regression
coefficients for reject/accept response. See Methods section for description and Table 2 for statistical results.

distinguish between active and sham stimulation. No
participant reported any adverse effect.
Overall, participants performed the task significantly
above chance level (0.77
0.08 vs. 0.50, t(46) ¼ 22.5,
p < .001), earned significantly more than zero (R$1410

470 vs. R$0, t(46) ¼ 20.7, p < .001), and were
significantly risk-averse; i.e., they accepted less than
50% of gambles (0.42
0.13 vs. 0.50, t(46) ¼ 4.2, p
< .001). Accuracy, equivalent amount earned, and over-
all risk propensity were clearly not modulated by stimu-
lation (p  .6). There was a strong main effect on
response confidence, F(2, 28.7) ¼ 6.9, p ¼ .004,
η2p ¼ .18, and post-hoc comparisons indicated that par-
ticipants receiving right anodal/left cathodal tDCS were
more confident than those receiving inactive stimulation
(0.64
0.17 vs. 0.40
0.19, p ¼ .002); these effects
survived correction for multiple comparisons, for which
α ¼ .006. Additional analyses performed separating
confidence for accept and reject responses revealed no
significant interaction (p ¼ .3). Further, inserting the
BAI, BDI, BIS, and VAS scores as covariates did not
reveal any significant main effect or interaction.
Right anodal/left cathodal tDCS was also associated
with slightly reduced RTs (3200
870 ms vs. 3780

760 ms), but the effect was clearly not significant
(p ¼ .2). Throughout the task, the RTs decreased on
average by 18
16% between the first and the last 30
gambles taken into consideration for analysis.
Stimulation did not significantly affect the logistic
regression coefficients.
 86 MINATI ET AL.
DISCUSSION
Irrespective of polarity, tDCS of the DLPFC did not
affect overall response accuracy, equivalent amount
earned, RTs, and logistic regression coefficients. In
particular, there was clearly no effect on risk propensity
(p ¼ .9): As the attained power was 0.99, this is unlikely
to be a false negative. However, right anodal/left cath-
odal tDCS significantly increased response confidence,
and the effect survived stringent Bonferroni correction.
Importantly, the stimulation protocol was analogous to
that employed in previous studies on the Risk Task, in
which clearly significant modulation of risk propensity
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was engendered, and the number of participants (47) was
larger than all previous studies in this area (i.e., 27 in
Knoch et al., 2006; 36 in Fecteau, Knoch, et al., 2007; 28
in Boggio, Campanhã, et al., 2010).
Our results are at odds with a mechanistic view that
attenuating right with respect to left DLPFC activity
generally leads to increased risk-taking, whereas
enhancing it promotes the selection of safer options.
This hypothesis was advanced on the basis of conver-
ging results from lesion studies based on the Iowa
Gambling Task (Clark et al., 2003) and brain stimula-
tion experiments using the Risk Task (Boggio,
Campanhã, et al., 2010; Fecteau, Knoch, et al.,
2007). Existing literature, however, already included
findings casting doubt on the hypothesis of a straight-
forward relationship. For instance, tDCS in older
adults and marijuana users appears to yield a “paradox
effect”, enhancing risk-taking irrespective of stimula-
tion polarity (Boggio, Campanhã, et al., 2010;
Boggio, Zaghi, et al., 2010). In another study, using
the Balloon Analog Risk Task (BART), tDCS
decreased risk propensity, again irrespective of polar-
ity, but not when unilateral stimulation was applied
(Fecteau, Pascual-Leone, et al., 2007).
The influence of task type draws attention to defini-
tions of risk propensity, which is not a unitary construct
but depends on specific real-life situations and experi-
mental settings, such as go/no-go versus multiple-choice
tasks (e.g., Botella, Narvaez, Martinez-Molina, Rubio, &
Santacreu, 2008). Risk propensity emerges from com-
plex, nonlinear interactions that are task-dependent––
hence, the observation that modulating DLPFC activity
influences risk propensity in some tasks does not imply
that this role is universal. From an anatomical perspec-
tive, decision-making under uncertainty and risk overlap
only partially, as individual regions assume different
roles depending on the type of decision (Krain, Wilson,
Arbuckle, Castellanos, & Milham, 2006). It is therefore
not surprising that task-specific differences in the “edit-
ing” phase, such as whether choice is between two EV Þ
0 options (e.g., in the Risk Task) or between EV ¼ 0 and
EV Þ 0 options (as in our task), influence the effect of
stimulating the DLPFC.
Right anodal/left cathodal tDCS boosted response
confidence, while the opposite polarity had no signifi-
cant effect. While we are unable to definitely conclude
to what extent this effect was due to enhanced right
rather than attenuated left DLPFC activity, this finding
is in agreement with and extends previous work suggest-
ing a link between DLPFC activity and subjective con-
fidence. In an early object recognition study, right
DLPFC activity correlated positively with decision con-
fidence independently of recognition judgment itself
(Henson, Rugg, Shallice, & Dolan, 2000). This associa-
tion was confirmed in another investigation, where early
(i.e., 100 ms post-stimulus) magnetoencephalographic
responses in the right DLPFC were enhanced for trials
receiving confident responses during a task involving the
presentation of trivia questions (Camchong, Goodie,
McDowell, Gilmore, & Clementz, 2007). Recent work
indicates DLPFC involvement in determining the posi-
tive emotional bias associated with effective problem-
solving, as when assembling sentences from scrambled
words (Viviani, Lo, Sim, Beschoner, & Stingl, 2010).
Interestingly, there is evidence that gambling-related
cues elicit larger right DLPFC activity in problematic
gamblers with respect to controls, potentially reflecting
the high level of subjective confidence and illusion
of control typically observed in these individuals
(e.g., Crockford, Goodyear, Edwards, Quickfall, & el-
Guebaly, 2005; Delfabbro, 2004). Our results suggest a
causative role; i.e., augmenting right and attenuating left
DLPFC activity through neuromodulation exaggerated
confidence in decision-making. Unfortunately, we are
unable to exclude a general motivational effect, since
mood questionnaires were not administered after stimu-
lation. There was no significant interaction between con-
fidence and decision (accept or reject) and no
corresponding change in risk propensity, suggesting that
it is unlikely that the effect represents a nonspecific
“optimism” bias related to the perceived likelihood of
gamble outcome. Further, given that task performance
was clearly unaffected, increased confidence does not
seem to be related to an objective boost in cognitive
performance. Rather, our data point to an effect primarily
related to the subjective perception of the quality of one’s
decisions, paralleling observations in pathological gam-
blers who are deluded that their decisions will eventually
enable them to beat the odds and earn or recoup money
(Delfabbro, 2004). Interestingly, spiking models of sen-
sory discrimination and subsequent choice predict faster
and larger synaptic responses on easy versus difficult
choices, offering a framework to explore the effects of
neuromodulation and the relationship between neuronal
excitability and subjective confidence (Rolls et al., 2010).

An issue with this and previous studies (e.g., Boggio,
Campanhã, et al., 2010; Boggio, Zaghi, et al., 2010;
Fecteau, Knoch, et al., 2007; Knoch et al., 2006) is
that participants did not play with real money. While
we cannot make inferences on how financial remunera-
tion could have modified the effect of tDCS, a recent
investigation has found that the effect of endowment on
task performance is not straightforward––i.e., small
rewards may decrease performance and introduce con-
founds related to the relative importance of financial
compensation (Gneezy & Rustichini, 2000). Further
work is also needed to address potential effects of
response instructions, as expressing the degree of sub-
Downloaded by [The University of British Columbia] at 17:28 09 December 2014
jective confidence could have altered the decisional
behavior with respect to a simple accept/reject situation.
It appears motivated to investigate whether this task is
sensitive to the modality of presentation of the economic
parameters––e.g., for example, whether they are exactly
provided as numbers instead of visual analogs. While
the RTs changed only marginally throughout the experi-
ment, we cannot exclude a difference in motivational
status related to the absence of feedback, motivating
further exploration introducing outcome feedback.
Further, we cannot exclude outright that different results
would have been obtained with male participants. Yet,
in previous studies using the Risk Task, the effect of
tDCS was independent of gender (Boggio, Campanhã,
et al., 2010; Fecteau, Knoch, et al., 2007), and recent
large-scale studies of real financial markets found no
difference in the investing behavior of males and
females (Barasinska, 2010).
It is important to recognize that the anatomical
specificity of neuromodulation is potentially limited.
First, the prefrontal cortices are strongly interconnected
and interdependent, and transcallosal connections typi-
cally inhibit the contralateral homolog when a region is
stimulated (e.g., Ongür & Price, 2000; Voineskos et al.,
2010). Second, even though recent imaging studies
have demonstrated the local effects of tDCS on cortical
excitability, complex current distributions may be gen-
erated that extend beyond the regions immediately
underneath the electrodes (e.g., Paquette, Sidel,
Radinska, Soucy, & Thiel, 2011; Sadleir, Vannorsdall,
Schretlen, & Gordon, 2010).
In conclusion, our study shows that tDCS of the
DLPFC does not significantly affect the evaluation of
risky choice options characterized by EV determined
by explicitly indicated potential loss, gain, and out-
come probability. This extends previous work with
the Iowa Gambling Task and the Risk Task, challen-
ging the mechanistic view that risk propensity can be
universally modulated through DLPFC stimulation,
and motivates further research aimed at better charac-
terizing the exact involvement of this region across
DLPFC STIMULATION DURING DECISION-MAKING 87
different types of decision-making tasks. Enhancing
right and attenuating left DLPFC activity leads to
more confident responses, corroborating previous evi-
dence of an association between this region and sub-
jective confidence. This effect warrants further
confirmation and investigation, especially with regard
to its potential relationship to biases observed in patho-
logical gamblers.
Original manuscript received 15 June 2011
Revised manuscript accepted 27 September 2011
First published online 11 January 2012
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