Review
Decision making under stress: A selective review

https://doi.org/10.1016/j.neubiorev.2012.02.003Get rights and content

Abstract

Many decisions must be made under stress, and many decision situations elicit stress responses themselves. Thus, stress and decision making are intricately connected, not only on the behavioral level, but also on the neural level, i.e., the brain regions that underlie intact decision making are regions that are sensitive to stress-induced changes. The purpose of this review is to summarize the findings from studies that investigated the impact of stress on decision making. The review includes those studies that examined decision making under stress in humans and were published between 1985 and October 2011. The reviewed studies were found using PubMed and PsycInfo searches. The review focuses on studies that have examined the influence of acutely induced laboratory stress on decision making and that measured both decision-making performance and stress responses. Additionally, some studies that investigated decision making under naturally occurring stress levels and decision-making abilities in patients who suffer from stress-related disorders are described. The results from the studies that were included in the review support the assumption that stress affects decision making. If stress confers an advantage or disadvantage in terms of outcome depends on the specific task or situation. The results also emphasize the role of mediating and moderating variables. The results are discussed with respect to underlying psychological and neural mechanisms, implications for everyday decision making and future research directions.

Highlights

► Stress affects decisions under various degrees of uncertainty. ► Stress alters underlying decision-making mechanisms. ► If stress confers and advantage or disadvantage depends on the specific situation. ► Cortisol responses are closely related to the decisions.

Introduction

Many decisions must be made under stress. Examples of decisions that are made under stress include choosing the correct alternatives in an exam or making the best decision in an emergency. Additionally, many decision situations elicit stress responses themselves. The decision about whether to turn off life-saving machines for fatally ill patients or decisions that have extensive financial consequences are stress-eliciting in and of themselves. Thus, stress and decision making are intricately connected, and the influence that stress has on the quality of a decision is of special interest. The purpose of the present review is to summarize findings from studies that have investigated the impact of stress on decision making. The review indicates that stress alters decision making, suggesting that stress may affect how we make everyday decisions and life-altering choices. There is also a connection between stress and decisions on a neural level. The brain regions that are associated with intact decision making are sensitive to stress-induced changes. Nevertheless, studies that have investigated the effect of stress exposure and stress reactions on decision-making performance are rare compared to the wealth of studies that have investigated memory performance under stress (reviews in Lupien et al., 2007, Wolf, 2009). The present review aims to fill this research gap.

The effects of stress on decisions may be relevant to public health. The detrimental effects of stress on health are well documented. Stress is thought to increase the risk for cardiovascular, psychiatric and psychosomatic diseases, and it also encourages unhealthy lifestyle behaviors, such as smoking, drinking or unhealthy diet (Juster et al., 2010, McEwen, 2008, Schneiderman et al., 2005). Thus, stress may have indirect effects on health, and these effects may be mediated by the individual's suboptimal decisions, which offer immediate reward at the cost of long-term negative consequences.

Section snippets

Method of review

The present review has summarized studies of stress and decision making in healthy humans that were published between 1985 and October 2011. Due to the limited space of this article, the review omitted the effects of stress on the decision processes that underlie perception and attention, such as signal detection (review in Broadbent, 1971), memory (review in Wolf, 2009), executive functioning, such as set shifting and categorization (e.g., McCormick et al., 2007) or operant conditioning (e.g.,

Theoretical approaches to decision making

Decisions play a prominent role in many areas of psychological research. Decision processes cover a wide array of complex decisions, such as making inferences, selecting an alternative with the highest benefit or making social or moral decisions. On a conceptual level, decisions can be differentiated by their relative degree of uncertainty because some decision situations offer more information about the expected outcome than others (see Weber and Johnson, 2009). Each decision can be placed on

Intersections of stress and decision-making behavior

In the following sections, the laboratory studies that used acute stress induction and that fulfilled the inclusion criteria described in Section 2 are summarized. Thereafter, some laboratory studies that measured the relationship between naturally occurring stress levels and decision-making performance in healthy participants are described. In both of these sections, the studies are sorted by the type of underlying decision-making processes into ‘dysfunctional strategy use,’ ‘insufficient

Consistent results

Results from the studies that were included in this review support the assumption that stress affects decision making. If stress confers an advantage or disadvantage in terms of outcome depends on the specific task or situation. Studies that investigated decision-making performance under acute laboratory stress in healthy participants indicated that stress may alter the underlying mechanisms of decision making, such as ‘strategy use,’ ‘adjustment from automated response,’ ‘feedback processing’

Conflict of interest

The authors declare that they have no conflict of interest.

Acknowledgments

This work was supported by the German Research Foundation (BR 2894/6-1). We also wish to thank Andre Kammann for improving the English wording. Finally, we thank Dr. Frank P. Schulte, Jens Hofmann and Tobias Schöler for assistance with the graphs.

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