Analyzing uncertain decision processes in problematic pornography use: ERP insights into decision evaluation and feedback processing

Background and aims: Individuals with Problematic Pornography Use (PPU) continue engaging in excessive pornography use despite awareness of its adverse consequences, suggesting a knowledge-behavior dissociation potentially driven by decision-making deficits. The present study aimed to disentangle decision evaluation and feedback processing as potential contributors to maladaptive decision-making in individuals at risk for PPU using event-related potentials (ERP) during a modified Iowa Gambling Task (IGT). Methods: Eighty male participants (40 PPU risk, 40 controls) completed a pass-play variant of the IGT in which all four decks were presented on each trial, with one deck preselected, requiring participants to decide whether to play or pass that option, while EEG was recorded. Behavioral performance was analyzed using linear mixed models to capture learning trajectories, focusing on changes in approach toward advantageous decks and avoidance of disadvantageous decks across blocks. ERP components indexing distinct decision stages were examined, including decision P3, decision preceding negativity (DPN), feedback-related negativity (FRN), and feedback P3. Results: Behaviorally, individuals at risk for PPU showed a reduced decline in disadvantageous choices across blocks, suggesting slower adaptation to disadvantageous options, while learning for advantageous choices remained intact. At the neural level, the PPU risk group exhibited attenuated P3 amplitudes during both decision evaluation and feedback processing stages, without significant modulation by choice type or feedback valence. Conclusion: These findings suggest that maladaptive behavior in individuals at risk for PPU may arise from inefficient integration of value-related information across decision and feedback stages, providing a neurocognitive account of the dissociation between knowledge and behavior.