Ventromedial prefrontal cortex is not critical for behavior change without external reinforcement

Cue-approach training (CAT) is a novel paradigm that has been shown to induce preference changes towards items without external reinforcements. In the task the mere association of a neutral cue and a speeded button response has been shown to induce a behavioral change lasting months. This paradigm includes several phases whereby after the training of individual items, behavior change is manifested through binary choices of items with similar initial values. Neuroimaging data have implicated the ventromedial prefrontal cortex (vmPFC) during the choice phase of this task. However, it still remains unclear what are the underlying neural mechanisms during training. Here, we sought to determine whether the ventromedial frontal cortex (VMF) is critical for the non-reinforced preference change induced by CAT. For this purpose, eleven participants with focal lesions involving the VMF and 30 healthy age-matched controls performed the CAT. We found that at the individual level, a similar proportion of VMF and healthy participants showed a preference shift following CAT. The VMF group performed similarly to the healthy age-matched control group in the ranking and training phases. As a group the healthy age-matched controls exhibited a behavior change, but the VMF participants as a group did not. We did not find an association between individual lesion patterns and performance in the task. We conclude that a fully intact VMF is not critical to induce non-externally reinforced preference change and suggest potential mechanisms for this novel type of behavioral change.