Anxiety disorders can significantly impact decision-making processes, often leading to a state known as decision paralysis.
When faced with choices, individuals with anxiety may experience overwhelming fear and uncertainty, causing them to freeze or become stuck in a cycle of overthinking.
This heightened emotional state can make even simple decisions feel insurmountable, as the mind becomes preoccupied with potential negative outcomes.
The resulting paralysis can prevent people from making timely choices or taking necessary action, affecting both daily tasks and important life decisions.
How does anxiety influence decision-making?
Various interlinked factors can contribute to the difficulties people with anxiety experience when making decisions as outlined below:
Heightened Threat Perception
Individuals with anxiety disorders often experience heightened negative emotions and perceive threats more often than those without anxiety.
They may have an attentional bias towards threat, meaning their attention is drawn more quickly and held longer by perceived threats.
For example, a person with social anxiety disorder might fixate on the possibility of being judged negatively during a presentation, leading them to avoid public speaking altogether.
This avoidance is a decision driven by an overestimation of the threat and an attempt to minimize potential negative outcomes.
This bias is linked to hyperactivity in brain regions involved in processing emotions, especially concerning perceived threats (the amygdala and insula).
Heightened activity in these brain regions makes anxious individuals more likely to detect and dwell on perceived threats, contributing to their overall anxious state.
Overthinking
Anxiety can result in excessively worrying and overthinking which can make it harder to make decisions.
They may feel overwhelmed by all of the potential negative outcomes of a decision that they find it hard to think about anything else.
Overthinking may affect a person’s ability to effectively inhibit avoidance or engage in approach behaviors, leading to difficulties in decision-making.
For example, someone with panic disorder could be stuck in a cycle of “what if” thinking, fixating on the possibility of having a panic attack which ultimately prevents them from taking the steps required to make a decision.
Feeling stuck
People with anxiety disorders may feel like they “freeze” in response to fearful situations. This can manifest as slower decision-making, avoidance of choices altogether, and excessive rumination.
For example, someone with generalized anxiety may feel anxious about seeing a doctor about a health concern so they procrastinate on the decision about whether to make an appointment but continue to be stuck in a cycle of worry.
Difficulty with Uncertainty
Individuals with anxiety disorders often struggle significantly with uncertainty, which can interfere with their ability to make decisions confidently.
They may have an intense need for certainty and predictability, leading them to seek excessive information or reassurance before making even minor choices.
For example, someone with generalized anxiety disorder might spend hours researching different brands of a simple household item, becoming overwhelmed by the possibility of making the “wrong” choice.
This intolerance of uncertainty can lead to avoidance of decision-making altogether, especially in situations where complete certainty isn’t possible.
Difficulty Regulating Emotions and Attention
Individuals with anxiety disorders often struggle to regulate their attention and emotional responses.
For example, a person with generalized anxiety disorder may find it challenging to disengage from worrying thoughts, even when they are not helpful or relevant to the decision at hand.
This continuous worry can interfere with their ability to focus on the decision-making process and evaluate options effectively.
This difficulty is associated with reduced activity in the prefrontal cortex, an area crucial for executive functions like inhibition and planning.
This area becomes less active when anxious and so decision-making often gets hijacked by fear responses from the amygdala.
Differences in Reward Processing
There are mixed findings on how people with anxiety process positive affect and rewards.
Some individuals may exhibit reduced responsivity to reward, while others may experience hyperresponsivity, possibly due to perfectionistic tendencies or fear of failure.
These fluctuations can lead to unpredictable behavior when it comes to making decisions.
For example, someone with social anxiety disorder may sometimes act in ways that seem to contradict their anxiety, such as impulsively trying to gain social approval or using substances.
However, their brains may not respond as strongly to the anticipation of social rewards compared to those without social anxiety.
This mismatch between their actions and their brain’s response can make it harder for them to make decisions, as they try to balance their desire for social connection with their fear of negative social experiences.
Managing Anxiety Around Decision-making
Below are some ways to help manage anxiety around making decisions:
1. Acknowledge and Normalize Anxiety
It’s essential to recognize that anxiety around decision-making is common, particularly for individuals with anxiety disorders. Acknowledge your feelings of anxiety without judgment.
Remind yourself that anxiety is a natural response to perceived threat or uncertainty, and it doesn’t necessarily mean there’s something wrong with you or your decision-making abilities.
2. Challenge Negative Thoughts and Biases
Since people with anxiety disorder tend to have an attentional bias towards threats, try to become aware of your negative thoughts and biases. This is the first step toward challenging them.
Ask yourself if your thoughts are based on facts or assumptions. For example, if you’re anxious about a job interview, are you assuming the worst-case scenario without considering other possibilities?
Practice cognitive restructuring techniques to reframe negative thoughts into more balanced and realistic perspectives.
For example, instead of “The job interview will go badly and I will fail”, reframe this to “It is normal to feel nervous but I can only try my best.”
3. Break Down Decisions into Smaller Steps
Large decisions can feel overwhelming, especially when anxiety is involved. Breaking down the decision into smaller, more manageable steps can make it feel less daunting.
Create a list of pros and cons for each option to clarify your thinking and reduce uncertainty.
Focus on one step at a time rather than trying to tackle the entire decision at once.
For example, someone with panic disorder may first decide if they feel well enough to leave the house, then choose a comfortable outfit, and finally plan their transportation and arrival time to minimize anxiety.
4. Engage in Relaxation and Mindfulness Techniques
Relaxation techniques, such as deep breathing exercises, progressive muscle relaxation, and guided meditation, can help calm your nervous system and reduce physiological arousal.
Mindfulness practices, such as focusing on your breath or body sensations, can help shift your attention away from anxious thoughts and bring you back to the present moment.
5. Seek Support and Professional Help
If anxiety around decision-making is significantly impacting your life, don’t hesitate to seek support from friends, family, or a mental health professional.
Cognitive behavioral therapy (CBT) is an example of an evidence-based treatment that can help you develop coping skills for managing anxiety and challenge unhelpful thought patterns.
A therapist can provide guidance and support in developing a personalized plan for managing anxiety in decision-making situations.
6. Focus on What You Can Control
While it’s impossible to eliminate all uncertainty and risk in life, focusing on what you can control can empower you in decision-making.
Identify the aspects of the situation within your control and concentrate your energy on those areas.
Accept that some things are beyond your influence and let go of the need to control every outcome.
7. Practice Self-Compassion
Be kind and understanding towards yourself, especially when facing challenging decisions.
Acknowledge that everyone makes mistakes and that you’re doing the best you can with the information available to you.
Remember that decision-making is a process, and it’s okay to take your time and adjust your course as needed.
References
- Aupperle, R. L., McDermott, T. J., White, E., & Kirlic, N. (2023). The neuropsychology of anxiety: An approach–avoidance decision-making framework. In G. G. Brown, T. Z. King, K. Y. Haaland, & B. Crosson (Eds.), APA handbook of neuropsychology: Neurobehavioral disorders and conditions: Accepted science and open questions (pp. 767–787). American Psychological Association. https://doi.org/10.1037/0000307-036
- Hartley, C. A., & Phelps, E. A. (2012). Anxiety and decision-making. Biological psychiatry, 72(2), 113-118. https://doi.org/10.1016/j.biopsych.2011.12.027
