Neural processing of win-contingent audiovisual cues during virtual gambling: an fMRI cross-over study

Abstract Rationale Over the last 30 years, the global incidence and prevalence of gambling disorder (GD) have risen, with particularly high risk associated with slot machine gambling. Win-contingent audiovisual stimuli are considered a key mechanism that may promote risky decision-making during gambling. Objectives This study aimed to investigate whether win‑contingent audiovisual cues modulate risky decision-making and neural responses during a virtual slot-machine task in healthy volunteers. Methods In a randomized cross-over design, N = 20 right-handed healthy volunteers completed a virtual slot-machine paradigm with and without win-contingent audiovisual cues. We compared risky versus safe choices and expected value (EV)-consistent versus EV-inconsistent decisions and examined differential fMRI (functional magnetic resonance imaging) activation during decision and feedback phases using Flexible factorial models. This study was pre-registered in the German clinical trials database: DRKS00021178 on 03.04.2020. Results Win‑contingent audiovisual cues did not significantly affect the frequency of high-risk versus low-risk choices or EV-consistent versus EV-inconsistent decisions. In the feedback phase, wins (vs. losses and near wins) elicited robust activation in hippocampal, parietal, frontal and insular regions. Compared with the uncued version, the cued version was associated with reduced activation in temporal, thalamic, parietal and insular cortices during win feedback, particularly for EV-consistent decisions. Conclusion Win-contingent audiovisual cues modulated neural responses to gambling outcomes in healthy individuals without detectable changes in choice behavior. These neural differences indicate altered processing of gambling-related stimuli, their cognitive and behavioral significance remains uncertain.