REVIEW ARTICLE published: 07 February 2012 doi: 10.3389/fnins.2012.00015 A neuropsychological approach to understanding risk-taking for potential gains and losses Irwin P. Levin1*, Gui Xue 2, Joshua A. Weller 3, Martin Reimann2, Marco Lauriola4 and Antoine Bechara2,5,6* 1 Department of Psychology, University of Iowa, Iowa City, IA, USA 2 Department of Psychology, University of Southern California, Los Angeles, CA, USA 3 Decision Research, Eugene, OR, USA 4 Department of Developmental and Social Processes, University of Rome, Rome, Italy 5 Department of Psychiatry, McGill University, Montreal, QC, Canada 6 Clinical Research Division, Douglas Mental Health University Institute, Montreal, QC, Canada Edited by: Kerstin Preuschoff, University of Zurich, Switzerland Reviewed by: Bruno B. Averbeck, National Institute of Mental Health, USA Philippe N. Tobler, University of Zurich, Switzerland Anna Van Duijvenvoorde, University of Amsterdam, Netherlands *Correspondence: Irwin P. Levin, Department of Psychology, University of Iowa, Iowa City, IA 52242, USA. e-mail: irwin-levin@uiowa.edu; Antoine Bechara, Department of Psychology, University of Southern California, Los Angeles, CA 90089, USA. e-mail: bechara@usc.edu Affective neuroscience has helped guide research and theory development in judgment and decision-making by revealing the role of emotional processes in choice behavior, especially when risk is involved. Evidence is emerging that qualitatively and quantitatively different processes may be involved in risky decision-making for gains and losses. We start by reviewing behavioral work by Kahneman and Tversky (1979) and others, which shows that risk-taking differs for potential gains and potential losses. We then turn to the literature in decision neuroscience to support the gain versus loss distinction. Relying in part on data from a new task that separates risky decision-making for gains and losses, we test a neural model that assigns unique mechanisms for risky decision-making involving potential losses. Included are studies using patients with lesions to brain areas speciﬁed as impor- tant in the model and studies with healthy individuals whose brains are scanned to reveal activation in these and other areas during risky decision-making. In some cases, there is evidence that gains and losses are processed in different regions of the brain, while in other cases the same region appears to process risk in a different manner for gains and losses. At a more general level, we provide strong support for the notion that decisions involv- ing risk-taking for gains and decisions involving risk-taking for losses represent different psychological processes. At a deeper level, we present mounting evidence that different neural structures play different roles in guiding risky choices in these different domains. Some structures are differentially activated by risky gains and risky losses while others respond uniquely in one domain or the other. Taken together, these studies support a clear functional dissociation between risk-taking for gains and risk-taking for losses, and further dissociation at the neural level. Keywords: decision neuroscience, risky decision-making, gain/loss domain differences INTRODUCTION The combination of methods from the behavioral decision- making literature such as risky decision-making tasks derived from the classic work of Kahneman and Tversky (1979), and methods of neuroscience such as functional magnetic resonance imaging (fMRI) and lesion studies has led to breakthroughs in both ﬁelds. Examples include how impairment in speciﬁc brain functions translate into disadvantageous decision-making inside and outside of the laboratory (Bechara et al., 1994, 1996, 1997, 1999) and how common decision-making biases and heuris- tics can be understood at the neural level (Sanfey et al., 2003; Hsu et al., 2005; Kuhnen and Knutson, 2005; De Martino et al., 2006; Huettel et al., 2006; Tom et al., 2007). New areas of study have emerged with titles such as neuroeconomics and decision neuroscience. A major contribution of this work has been a better under- standing of how emotion, in combination with cognition, guides our decisions, particularly in the realm of risky decision-making where conﬂicts often arise in balancing the lure of reward and the fear of loss. Evidence is accumulating that emotional reac- tivity differs in response to risky gains and risky losses. Logical questions are whether risk-taking for gains and risk-taking for losses can best be understood as separate psychological processes, and ultimately, whether they rely on different brain structures. In this paper, we integrate ﬁndings from our own work and that of others to come to conclusions that have some gener- ality but also allow for differences between studies based on methodology. In order to frame this investigation, we start with a model put forth to support the ﬁndings from two studies we conducted with patients with lesions to areas of the brain known to be critical to risky decision-making, namely the ventromedial pre- frontal cortex (VMPFC), the amygdala, and the insula (Bechara et al., 1999; Clark et al., 2008). As summarized in Figure 1 (from Weller et al., 2007), we propose that risky decision-making is inﬂuenced by the opposing forces of lure of gain and fear of www.frontiersin.org February 2012 | Volume 6 | Article 15 | 1