Effect of transcranial direct current stimulation on decision making and cognitive flexibility in gambling disorder


Decision making and cognitive flexibility are two components of cognitive control that play a critical role in the emergence, persistence, and relapse of gambling disorder. Transcranial direct current stimulation (tDCS) over the dorsolateral prefrontal cortex (DLPFC) has been reported to enhance decision making and cognitive flexibility in healthy volunteers and individuals with addictive disorders. In this triple-blind randomized sham-controlled parallel study, we aimed to determine whether tDCS over DLPFC would modulate decision making and cognitive flexibility in individuals with gambling disorder. Twenty participants with gambling disorder were administered Iowa Gambling Task (IGT) and Wisconsin Card Sorting Test (WCST). Subsequently, participants were administered three every other day sessions of active right anodal /left cathodal tDCS (20 min, 2 mA) or sham stimulation over bilateral DLPFC. WCST and IGT were readministered following the last session. Baseline clinical severity, depression, impulsivity levels, and cognitive performance were similar between groups. TDCS over the DLPFC resulted in more advantageous decision making (F1,16 = 8.128, p = 0.01, ɳp2 =0.33) and better cognitive flexibility (F1,16 =8.782, p = 0.009, ɳp2 = 0.35), representing large effect sizes. The results suggest for the first time that tDCS enhanced decision making and cognitive flexibility in gambling disorder. Therefore, tDCS may be a promising neuromodulation-based therapeutic approach in gambling disorder.

Trial registration: Clinicaltrials.gov NCT03477799.

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Fig. 1
Fig. 2



Balloon analog risk task


Beck depression inventory


Barratt Impulsivity Scale-11


Dorsolateral prefrontal cortex


Diagnostic and statistical manual of mental disorders-5


Functional magnetic resonance imaging


Gambling disorder


Iowa gambling task


Pathological Gambling Severity Index


South oaks gambling screen


Transcranial direct current stimulation


Ventromedial prefrontal cortex


Wisconsin card sorting test


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The authors would like to thank all the participants who have kindly taken part in this study. The authors gratefully acknowledge the assistance of Mustafa Çetinkaya for referring participants and Göktuğ Aşçı for the preparation of the equipment.

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Correspondence to Serkan Aksu.

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The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest. This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.

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Soyata, A.Z., Aksu, S., Woods, A.J. et al. Effect of transcranial direct current stimulation on decision making and cognitive flexibility in gambling disorder. Eur Arch Psychiatry Clin Neurosci 269, 275–284 (2019). https://doi.org/10.1007/s00406-018-0948-5

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  • Addictive disorders
  • Gambling disorder
  • Transcranial direct current stimulation
  • Decision making
  • Executive functions
  • Cognitive functions