When Trauma Affects Decision Making

This post is also available in Dutch.

Trauma-related associations prompt people with post-traumatic stress disorder (PTSD) to make decisions differently than adults without PTSD.

Survivors of war, those who’ve experienced near death experiences, or victims of sexual assault have one thing in common: post-traumatic stress disorder (PTSD). U.S. Air Force illustration by Master Sgt. William VanceCreative Commons Zero (CC0) license.

Traumatic events are difficult to heal and can leave scars for life. People with PTSD are afraid to form new relationships, and find it difficult to express their needs or their creative potential. They have vivid flashbacks of traumatic events, and will therefore try to avoid any cues that relate back to the trauma.

Research has shown that people with PTSD differ in the function and structure of the amygdala, hippocampus and ventromedial prefrontal cortex – regions that regulate and influence our response to stress. Therefore, people with PTSD perceive stress differently than people without. Researchers have also proposed that trauma may even change the way a person makes decisions.

The associations we live (and act) by

Our actions have consequences, some are positive and some negative. Consequently, we associate our actions with their outcomes, and quickly learn to seek reward and to avoid punishment.

By default, the things that give us more “wins“ are associated with taking action (e.g., cooking, exercising, meeting new people, etc.), while the things that bring us “losses” are associated with taking no action (e.g., not falling off a cliff, not eating something poisonous, etc.). These “default” options are called Pavlovian biases: they stem from us wanting to take action in order to gain a ‘win’, or wanting to not take action to avoid a ‘loss’. This bias therefore triggers ‘confusion’ when the following two scenarios occur: 1) when we want to take action because we associate that action with winning, but it results in a loss; and 2) when we do not want to take action because we associate that action with loosing, but it results in a win.

We face these conflicting situations daily, and to solve them, additional effort is needed, or cognitive control. Food, for example, is a source of pleasure for most humans (here’s the “win” we’ve just mentioned), however it takes some effort to stop eating late, when dieting. On the other hand, studying hard for an exam is associated with hard work (“loss” in a way), and it takes additional cognitive control to study hard, because in the long term it brings a “win’’.

What goes wrong
In the experiment carried out by Ousdal and colleagues, survivors of the 2011 Norwegian terror attack were asked to perform a task along with non-traumatized participants. All participants had to learn rules while playing a game, where the purpose was to win as much money as possible. Trauma survivors performed much worse than non-traumatized participants when a ‘response’ was needed in order to not lose money, and a ‘no-response’ was needed in order to win money.

These findings show how trauma survivors seem to have stronger associations between taking actions to gain “wins” and not taking actions to avoid “losses”, in other words a greater Pavlovian bias. Ultimately, this bias makes decision making less adaptable for people with traumatic experiences.

Trauma affects many aspects of our cognition, and decision making is one key aspect that becomes affected. Understanding the effects of trauma on other aspects such as working memory, planning and attention may help researchers better describe the complexity of PTSD, and ultimately find a better treatment for survivors of trauma.

Written by Lara, edited by Marpessa.

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