Life is full of choices. This sentiment is underpinned by both a sense of opportunity and freedom. It contributes to people feeling hopeful about their life and gives them a sense of control. However, the presence of choices in life necessitates decision-making. Depending on the importance of the choice, or the irreversibility of the outcome, decision-making can be difficult and cause people to feel anxious or even paralysed in the face of their choice. Often people at the various crossroads in life, facing difficult decisions, will seek assistance from psychologists.
In assisting people with decision-making, a psychologist may need to focus on the cognitive elements of the person’s decision. More predominantly, the role of the psychologist is to assist their client to navigate their dilemma by resolving the emotional, and at times, existential elements that are preventing the client from making a decision.
How do people make decisions?
Every day, people make an infinite number of decisions. From straightforward life choices such as what they will eat or the route they travel to work, to more complex decisions such as a change in their career direction, the school they send their children to, or whether to remain in a romantic relationship.
A wealth of research has investigated how the decisions people make and the subsequent outcomes affect people’s emotional wellbeing and life satisfaction. Put simply, when people feel empowered and make decisions that result in positive outcomes, they feel better about themselves and their life, and experience greater psychological wellbeing.
Calculating loss and gain
Although the relationship between decision-making and wellbeing has been well established, comparatively less is understood about how people actually make decisions. Intuitively, how a personal feels about potential outcomes will determine their decisions. According to prospect theory, if two equal options are put to a person but one option is described in relation to gains and the other is described according to losses, the person is more likely to choose the first option. The theory asserts that people value gains and losses differently with losses being interpreted by people as causing a greater emotional impact than the equivalent positive gain. For this reason, people are more inclined to make choices based on perceived gains and an avoidance of loss. An implicit assumption of this theory, therefore, is that feelings govern choice (Charpentier et al., 2016).
Neurological components
Little is known about the specific ways that feelings are transformed into decisions. Some contemporary studies have attempted to understand components of decision-making from a neurological perspective. For example, neuroscience research has attempted to understand social decision-making through functional magnetic resonance imaging (fMRI), which measures changes in cerebral blood flow while research participants play interactive social games inside an MRI scanner. The results of this type of research indicate that the prefrontal cortex plays a critical role in decision-making. This is the region of the brain that controls a person’s executive functions such as working memory, flexible thinking and self-control, as well as moderating social behaviour.
Another region of the brain, the dorsal anterior cingulate cortex, activates when people become aware that they are deviating from popular group opinions and norms, or when they are being outperformed by others (Rilling & Sanfey, 2011). These regions of the brain therefore appear particularly influential in people expressing their personality through the choices they make, whether it be by way of conforming to social expectations, being motivated by competitiveness, or dealing with the unpopularity of their decision-making with other people.
In addition to fMRI studies, research has also identified the neurochemical basis of decision-making. Monoamine (e.g., serotonin), neuropeptide (e.g., oxytocin), and steroid hormone (e.g., testosterone) levels have all been experimentally manipulated and tested for effects on decision-making game-based studies. The relationship between neurotransmitters and hormones on decision-making remains unclear, however, it is believed that differences in individual’s density and distribution of neurochemical receptors could explain individual differences in decision-making (Rilling & Sanfey, 2011).
Evidence of the impact of neurochemicals on decision-making is apparent in psychological practice with clients. For example, clients with depression and/or anxiety who may have low levels of serotonin often withdraw from social interactions and can feel paralysed in making decisions regarding their daily routine or life more generally. Similarly, higher levels of testosterone can increase aggression and competitiveness and may influence the decision-making of clients who present with anger management issues or antisocial behaviour.
Identifying and understanding the neurological components of decision-making can assist practitioners to work with clients who are confronting difficult decisions in their life, or help those whose decision-making is impeded due to the presence of a psychological disorder.
What makes decisions difficult?
It is well understood that some decisions in life are easier than others and that certain circumstances enable people to be more decisive. Research regarding decision-making tends to adopt an experimental design and require participants to make simple decisions; for example, to choose between monetary gambles.
However, practitioners would rightly note that their clients often present with more complex and difficult conundrums. Given that people live in highly complex social environments, many of a person’s most important decisions are made in the context of inextricably linked social interactions. Furthermore, the decisions people make in their life are also dependent on the concomitant choices of others (Charpentier et al., 2016).
Social factors
The interconnectedness of social environments results in people making decisions with either self-regarding or other-regarding preferences. At times though, people will experience a conflict between a decision that might be beneficial for others, but come at a cost to them, and vice versa. For example, the supportive phone call that a person makes for their friend who is upset, which causes the person to be late in meeting a work deadline.
Likewise, a self-regarding decision by a person to leave a relationship could come at a significant emotional cost to their partner. The nature of this decisional conflict can weigh on people’s conscience if the person perceives that their decision reflects on their kind-heartedness or selfishness. This suggests that it is not merely the potential outcomes of a decision that complicates the decision-making process. The meaning that people place on their decision and the way it may reflect upon them also contributes to the complexity.
As part of people’s complex social environments the expectations that people have about how others will perceive and interpret their decisions further contributes to the complexity of decision-making. Social approval seems to be rewarding and may motivate norm-abiding decision-making. Some people declare the point in their life when they become less concerned with the opinions of other people. However as noted above, being focused on the approval of other people is not merely a characteristic of development that people outgrow.
Rather, there is a neurological basis to people becoming alert to the potential for a decision they make to put them in conflict with social norms. Individuals’ sensitivity to social approval has a biological basis and may serve a protective function, such as to avoid social rejection.
Reason versus emotion
Challenging decisions, which have implications for a person’s wellbeing or their social relationships, can involve conflict between reason and emotion. Both reason and emotion can provide wisdom in decision-making. Reasoning tends to adopt an intellectual position to the problem and facilitates people anticipating the potential benefits and costs to a problem. Emotions tend to reflect the excitement or fears associated with the possible outcomes of a decision. They also reflect the significance of a decision and the ultimate meaning the decision has for a person’s life. Emotions are also likely to complicate the decision-making process for people. Despite this, the emotions that are generated as part of more complex decisions may assist a person to reach a more adaptive decision than would be possible by intellectual reasoning alone.
In a situation where a person experiences difficulty identifying, acknowledging, or managing the emotions attached to a complex decision, their decision-making is at risk of being reactive, short-sighted, self-defeating, or even harmful to them or others. When a person becomes overwhelmed by the emotions attached to a decision, or a psychological disorder or personality traits negatively impact their decision-making, psychologists can play an important role in assisting the person. Considerations related to the person’s age, and reasons for their emotional reaction to a situation can guide the approach of the practitioner.
Decision-making by young people
It is well-established within relevant literature that the decision-making abilities of young people are not as good as those of adults (e.g., Blakemore & Choudhury, 2006). This is particularly the case when a young person is attempting to make decisions in emotionally demanding situations.
For young children, given their formative cognitive and emotional development, the presentation of choice can be cognitively taxing and overwhelming. For adolescents, who have developed the thinking, language and emotional regulation skills to make increasingly complex choices, there are still circumstances in which they experience difficulty in making decisions. The regions of the brain that contribute to decision-making, including the prefrontal and orbitofrontal cortex, do not finish developing until a person reaches their early-to-mid-twenties.
Risk and psychosocial maturity
The relationship between brain development and the risk of making poor choices, particularly during states of heightened emotional arousal is referred to as psychosocial maturity. Young people aged 12 to 17 years are significantly less psychosocially mature than 18 to 23 year old, who are also less psychosocially mature than adults (24+ years).
In situations where young people are in a calm emotional state, research suggests that the decision-making abilities of young people aged 16 and over is comparable to that of adults. However, as soon as greater emotional demands are placed on young people at the time they need to make a decision, the quality of their decision-making is compromised. This psychosocial immaturity contributes to young people making decisions based on short-terms gains, sensation seeking and peer pressure. They are also more likely to make decisions impulsively and fail to consider the possible consequences of their actions (Johnson et al., 2009).
At the same time as young people are developing their psychosocial maturity and their decision-making abilities, they are also experiencing new situations that present them with choices related to their relationships, their future and their identities. Consequently, young people may present for psychological assistance at times when the choices confronting them are emotionally overwhelming, or when their decision-making is causing issues in their life.
Common presentations of young people related to decision-making can include alcohol and other drug use, social and romantic relationships, anxieties related to sexual behaviour, uncertainty regarding education and career options, or conflict with parents and other family related to the choices the young person is making.
Future impact of decisions
Complex decisions for young people often have implications for their future and their social relationships. The longer term implications of some of their decisions in conjunction with their inexperience in making decisions can cause concern for parents who worry about the decisions young people make. Adding to the complexity is the concern young people have regarding the perceptions of their peers.
At times therefore, young people are attempting to synthesise a lot of information from different sources as part of their decision-making process; their parents, their peers and their own emotional reactions. The role of the psychologist is often to help the young person make sense of this information.
When a young person presents for psychological support, the psychologist needs to take time to understand the nature of the decision confronting the person and the way in which conflict, whether internal or external, is being caused by their expectations, fears or the perceptions of others. This level of analysis not only validates the young person’s experience, but also helps them to gain insight into the causes of their discomfort. In modelling good decision-making, the therapeutic process can explore ways of making decisions that consider both intellectual and emotional perspectives.
For adolescents and younger teenagers, it may also be beneficial to work with parents to explore and manage anxiety they may experience regarding the decision-making of their young person and provide strategies, where appropriate, to enable parents to support autonomous decision-making in their young person. The goal should be to create an environment where the young person becomes increasingly able to identify choices and potential outcomes, discuss the emotions attached to choices and potential outcomes, and to feel supported, yet empowered to make decisions regarding their life.
Gradually increasing the autonomy of young people allows for them to practise independent decision-making; for example, choosing a political party to vote for, making choices regarding their friends, selecting the limits of behaviour they are comfortable with in a romantic relationship, or choosing their own apprenticeship or university course.
This kind of independent decision-making not only assists young people to have a sense of freedom and begin to make choices that cement their sense of identity, but it also teaches them to experience and manage the emotions associated with complex decision-making. As young people make more and more difficult choices in their life, they increase their sense of agency and self-efficacy, particularly if well-supported in the process. They also begin to accumulate wisdom by experiencing the outcomes of the choices they make. Independent decision-making by young people is vital for them becoming confident adults with good emotional and social wellbeing.
Decision-making in adulthood
Adults often seek psychological support when they experience emotional discomfort, particularly if it feels overwhelming. Complex decisions that are confronting to a person can often be the source of this psychological discomfort. That is, the difficult choices a person is either making or avoiding are contributing to emotional disequilibrium.
In practice, some clients in this situation may present as distressed but can accurately name the situation and decision that is causing discomfort. For others, the presentation is less obvious and the client may present as depressed and disempowered with their confronting life choices concealed by a general malaise and sense of hopelessness. Some clients may also have developed maladaptive coping strategies to manage the emotional discomfort associated with complex decision-making, such as excessive alcohol and other drug use.
Although the role of the psychologist will be to reduce the person’s emotional distress and maladaptive behaviours, resolving the difficult decision will likely sit at the core of the therapeutic process.
Due to the neurological basis to decision-making, adults will experience difficulty with decision-making when the potential outcomes of their choice will result in a perceived loss to them or people they are close to, or when their decision is contrary to the norms of their community.
Common yet complex
The types of decisions that cause difficulty for adults and contribute to them seeking psychological support include, but are not limited to, career-related decisions (e.g., leaving a job, starting a new career, retirement), decisions concerning intimate relationships (e.g., leaving a relationship, commencing an affair), decisions concerning other relationships (e.g., parenting decisions, decisions regarding the care of an elderly parent), and decisions regarding self-expression or significant life choices (e.g., how and when a person expresses their gender identity or sexual orientation, whether to have children, undertaking IVF).
A number of the complex decisions that confront adults relate to the person’s sense of identity and purpose. Following the formation of identity through adolescence to young-adulthood, adults often make decisions according to how they perceive themselves and their role in life. They often strive to create purpose in their life to give their life meaning. Consequently, difficult decisions can sometimes represent an existential crossroads for a person (van den Bos, 2009).
For example, the person who is considering changing their career in their forties is often grappling with the notion of starting over versus remaining dissatisfied by their work for the sake of financial security. The person who is struggling over a decision about retirement is often concerned about becoming irrelevant in the community and losing a core component of their identity. The person who is unhappy in their marriage may feel paralysed to leave because they had not imagined being single at a mature age, or not having their children with them on a full-time basis.
What is apparent in these types of concerns is that factor contributing the greatest emotional turmoil is often what the decision means for the individual and the way it challenges their sense of identity or the purpose they have created in life. Therapeutically, much of the work required of a psychologist working with adult clients who are confronted by difficult decisions is to work through the emotional components of the decision. As noted within the neurological literature, a reasoned approach of weighing pros and cons although important, does not adequately resolve the complicating aspects of decision-making. Indeed clients may have already done this prior to seeking assistance.
Not just a list of pros and cons
The value of therapy, rather, is to explore the emotional meaning and existential concerns related to the decision. Therapeutic approaches that explore a person’s values, their sense of identity, and their beliefs about themselves and the world have the greatest utility. Cognitive, schema-focused, emotion-focused, acceptance and commitment, and existential therapies, as well as elements of motivational interviewing all offer therapeutic approaches that provide insight and strategies for managing the emotional meaning attached to decision-making.
Resolving the existential conflicts that arise in complex decisions by assisting the client to make sense of their choices and make choices that are consistent with their sense of identity can help clients to move forward in their decision-making with greater clarity and emotional stability.
Decision-making in life is complicated by the impact our choices can have on our social relationships, and by the way our choices reflect on how we view ourselves and how others perceive us. Decision-making is not only determined by neurological factors, but it is also inextricably linked with our sense of identity and the way we make meaning of our life. Life choices present opportunities that can be met with a sense of optimism. However, for some people in the face of certain life choices, psychologists play a vital role is assisting them to navigate the emotional complexities and existential realities attached to difficult decision-making.
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