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Anxiety

How Anxiety and Depression May Interfere With Decision-Making

Those with emotional disorders may resolve uncertainty in less adaptive ways.

Key points

  • A new study finds that individuals with greater symptoms of anxiety and depression make fewer information-seeking choices.
  • Individuals with greater symptoms of anxiety and depression also displayed less reflective thinking.
  • Those displaying less reflective thinking also made fewer information-seeking choices.
  • Less information-seeking and less reflective thinking may each promote avoidance behavior and maintain symptoms of depression and anxiety.

Dealing with uncertainty is an unavoidable part of life, and for many, it can be a major source of stress and anxiety. However, not everyone handles this challenge in the same way—and some strategies may be better than others.

Recent research suggests that anxiety and depression may be associated with less adaptive approaches to resolving uncertainty. Take a second to consider how you tend to deal with uncertain situations. What types of strategies do you use? How effective do you think they are?

These questions relate to two important concepts in recent research: reflection and information-seeking.

Reflection involves “stepping back” before making a decision to consider how much information you actually have and how confident you should be that you know the best course of action.

If you don’t have enough information, you might find ways to increase your level of confidence before committing to a choice. For example, imagine I put two boxes in front of you and told you to pick one. You don’t know which, but one box has a new laptop computer. The other has a new book that, while nice... isn’t a laptop computer. Suspiciously, one box is shaped like a laptop, but both boxes could fit both prizes. What do you do? One option would be to “go with what you know” and pick the box shaped like a laptop. The other option would be to stop and reflect on the fact that both boxes could still fit the laptop and then devise a plan to gain more information. For example, perhaps you could pick up each of the boxes to check their weight.

This strategy of first checking the weight of each box is an example of what scientists call “information-seeking.” Specifically, information-seeking is when a person comes up with a strategy to figure out the best way to achieve their goals. In this case, the goal is to figure out which box they should choose if they want to take home the laptop.

This two-step process of reflecting on your own uncertainty and then finding ways to gain more information will often pay off by increasing your chances of getting what you want. In contrast, inadvertently “jumping to conclusions” and making a decision before taking time to reflect can have its costs.

Recent studies in psychology and neuroscience are helping to improve our understanding of reflective thinking and information-seeking, and how they may be affected by emotional disorders.

In the lab, reflection is sometimes measured by simply asking people to rate how much they agree with statements such as: “I like to gather many different types of evidence before I decide what to do.”

Other approaches ask people questions designed to have intuitive answers that are incorrect. Correct answers require stopping to “think it through” first. An example question could be: “If it takes 20 people 20 minutes to make 20 gadgets, how long would it take 100 people to make 100 gadgets?” (Intuitive answer: 100 minutes; correct answer: 20 minutes.)

Experimental measures of information-seeking often use decision-making games where individuals must learn from trial-and-error about which of two options will lose them the least amount of money (or win them the most money). By showing individuals more past wins/losses from some choices than others, we can examine whether they choose the options they know less about, or whether they “jump to conclusions” and base their choices only on previous outcomes. For example, pretend I gave you $500 and then showed you the following losses:

Option 1: -$50, -$55, -$61

Option 2: -$60

You can now choose between these two options six more times. Which option would you choose next? You could stick with Option 1 since it looks like it might lose less money on average. On the other hand, choosing Option 2 would provide more information, since you’ve only seen one outcome. For example, what if the next loss from Option 2 was only -$19? Seeing what happens could be helpful in guiding your next five choices.

Using similar measures, a recent study in our lab found that individuals with greater symptoms of anxiety and depression displayed less information-seeking and less reflection [1]. Another recent study found that information-seeking was reduced specifically by the bodily aspects of anxiety, such as a racing heart, fast breathing, and muscle tension [2]. These and other studies showing reduced information-seeking under stress are helping us to better understand the ways anxiety and depression may interfere with healthy decision-making [3; 4; 5].

In a kind of vicious cycle, too little information-seeking may play an important role in maintaining emotional disorders. This is because individuals with emotional disorders are often very confident that bad things will happen if they enter specific situations, and so naturally they avoid those situations. However, reflection can sometimes suggest that this confidence is based on insufficient information. For example, such individuals may have only had one or two bad experiences in the situations they avoid. In some cases, they may even have no prior experiences in a situation at all, but still imagine strong negative outcomes. The vicious cycle arises because, without seeking more information, one cannot learn that outcomes will be more positive than expected.

For example, individuals with social anxiety disorder often avoid social events for fear of intolerable embarrassment or social rejection. Yet, in exposure-based psychotherapies, such individuals make plans to attend social events specifically to gain information about whether their expectations are correct. Oftentimes, this information-seeking exercise helps individuals learn that they actually can enjoy themselves at social events, that embarrassment is less common than expected, and that any discomfort they may feel is tolerable.

As another example, individuals with depression are often confident that they will not feel better (and may feel worse) if they leave the house and engage in physical or social activities. As a result, they may simply remain home alone, preventing opportunities for exercise and social connectedness. Yet, within behavioral activation therapies, such individuals will often make plans to leave the house and engage in physical or social activities—specifically to test these expectations (e.g., taking a walk in a park, or visiting a friend). Often, contrary to what was expected, they do feel better as a result.

Additionally, some individuals who were treated poorly in childhood may learn to expect that others they meet in the future will treat them the same way. If so, this could understandably lead such a person to avoid new friendships or romantic relationships—limiting their opportunities for social connection and support. However, there are many people they meet in adulthood who would, in fact, be friendly and supportive. In this case, there can be great benefit from reflecting on the fact that one’s current environment could be very different from their previous experience. After considering this, if such a person were then willing to seek more information by seeing what happens if they pursue a new friendship or romantic relationship, they might find that some people are much kinder and more trustworthy than expected. This could allow them to form new relationships that greatly improve their quality of life.

In each of these examples, individuals can be seen as “jumping to conclusions” about what would happen if they took certain actions, leading them to avoid situations that would, in fact, improve their wellbeing. Reflecting on their level of confidence, the individuals in each example realized they needed more information, and sought it out. This allowed them to learn what they needed to know to make better choices for their wellbeing. Therapy can be a method for this process: helping individuals reflect on the limited evidence they may have for certain expectations and then helping them make plans to gain more information.

What might this mean if you are currently struggling with anxiety or depression? One thing these results suggest is that it might be helpful to reflect on whether there are any situations (or thoughts or emotions) you are avoiding, and on what you expect might happen if you stopped avoiding them. Then, you might ask yourself whether you have enough information to trust those expectations. Would it perhaps be worth checking a few times to see what actually happens? Even if you find yourself in uncomfortable situations, you might be surprised to find you can handle them better than you expected. You might also find that approaching these situations makes other aspects of your life better (e.g., getting more time with friends, getting more exercise, getting more work done, etc.). This reflective, information-seeking process is a big part of what people learn to do in therapies like cognitive-behavioral therapy (CBT; [6]) and acceptance and commitment therapy (ACT; [7]).

The studies mentioned above now offer a better understanding of these processes, in controlled lab environments. But it's important to stress that there is still a lot we do not know. For example, not everyone with depression and anxiety symptoms showed reduced reflection or information-seeking in these studies. So, it’s likely that some people with emotional disorders struggle with different aspects of decision-making. It’s also possible to reflect too much in some situations or to seek too much information before making decisions. In other words, remaining too uncertain for too long can also cause problems. What’s probably most important is finding a good balance.

Overall, we hope that this line of research will help us better understand the mechanisms that lead to healthy and unhealthy decision-making and to uncover new ways we might increase healthy decision processes in those struggling with emotional disorders.

References

[1]. R. Smith, S. Taylor, R.C. Wilson, A.E. Chuning, M.R. Persich, S. Wang, and W.D.S. Killgore (2022). Lower Levels of Directed Exploration and Reflective Thinking Are Associated With Greater Anxiety and Depression. Frontiers in Psychiatry 12.

[2]. H. Fan, S.J. Gershman, and E.A. Phelps (2021). Trait somatic anxiety is associated with reduced directed exploration and underestimation of uncertainty. PsyArXiv: https://doi.org/10.31234/osf.io/yx6sb.

[3]. J.K. Lenow, S.M. Constantino, N.D. Daw, and E.A. Phelps (2017). Chronic and Acute Stress Promote Overexploitation in Serial Decision Making. J Neurosci 37, 5681-5689.

[4]. S.V. Biedermann, D.G. Biedermann, F. Wenzlaff, T. Kurjak, S. Nouri, M.K. Auer, K. Wiedemann, P. Briken, J. Haaker, T.B. Lonsdorf, and J. Fuss (2017). An elevated plus-maze in mixed reality for studying human anxiety-related behavior. BMC Biol 15, 125.

[5]. N. Walz, A. Muhlberger, and P. Pauli (2016). A Human Open Field Test Reveals Thigmotaxis Related to Agoraphobic Fear. Biol Psychiatry 80, 390-7.

[6]. D.H. Barlow, L.B. Allen, and M.L. Choate (2016). Toward a unified treatment for emotional disorders - republished article. Behav Ther 47, 838-853

[7]. S. Hayes, and S. Smith, Get Out of Your Mind and Into Your Life: The New Acceptance and Commitment Therapy (2005).

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