Research Reports - To fear is to gain? The role of fear recognition in risky decision making in TBI patients and healthy controls

PLoS One. 2016 Nov 21;11(11):e0166995. doi: 10.1371/journal.pone.0166995.
eCollection 2016.

Visser-Keizer AC(1), Westerhof-Evers HJ(2,)(3), Gerritsen MJ(1), van der Naalt
J(1), Spikman JM(1,)(3).

Fear is an important emotional reaction that guides decision making in situations
of ambiguity or uncertainty. Both recognition of facial expressions of fear and
decision making ability can be impaired after traumatic brain injury (TBI), in
particular when the frontal lobe is damaged. So far, it has not been investigated
how recognition of fear influences risk behavior in healthy subjects and TBI
patients. The ability to recognize fear is thought to be related to the ability
to experience fear and to use it as a warning signal to guide decision making. We
hypothesized that a better ability to recognize fear would be related to a better
regulation of risk behavior, with healthy controls outperforming TBI patients. To
investigate this, 59 healthy subjects and 49 TBI patients were assessed with a
test for emotion recognition (Facial Expression of Emotion: Stimuli and Tests)
and a gambling task (Iowa Gambling Task (IGT)). The results showed that,
regardless of post traumatic amnesia duration or the presence of frontal lesions,
patients were more impaired than healthy controls on both fear recognition and
decision making. In both groups, a significant relationship was found between
better fear recognition, the development of an advantageous strategy across the
IGT and less risk behavior in the last blocks of the IGT. Educational level
moderated this relationship in the final block of the IGT. This study has
important clinical implications, indicating that impaired decision making and
risk behavior after TBI can be preceded by deficits in the processing of fear.

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