Anterior insula activity increased by cued risky wins in healthy volunteers

Audiovisual cues ("bells and whistles") are ubiquitous in commercial gambling products. Pairing wins with sound and light cues in laboratory-based gambling paradigms increases risky choice, but the neurocognitive basis of this effect is unclear. Here we compared patterns of neural activation using functional MRI in healthy volunteers (n = 31) while they performed a two-choice lottery task. Reward-paired cues were either present or absent in a mixed-block, event-related design. As predicted, participants made riskier choices on cued trials. Choice latencies were also longer when cues were present, particularly on trials following a win. Activity within the nucleus accumbens and orbitofrontal cortex was greater during the decision phase when participants made risky choices. Nucleus accumbens signal was also greater when participants were anticipating risky outcomes, and in response to risky wins. Contrary to our pre-registered hypotheses, cue condition did not alter patterns of activity across any task phase, in either of these a priori regions of interest. As such, cue-induced risky choice does not appear to be driven by altered representation of risk or value within this canonically reward-sensitive circuitry. Instead, exploratory analyses revealed that the anterior insula was selectively activated by cued, risky wins. Such activation may signal the saliency of these events, or their emotional impact, and may reflect one mechanism through which cue-induced craving develops in vulnerable individuals.