Final Project: Enhancing Decision-Making in Depression

Problem Statement

Contemporary Problem

Decision-making is a complex cognitive process that influences virtually every aspect of daily life, from personal choices to professional responsibilities. The neuropsychological complications of major depressive disorder affect many areas in which the capacity of the patient to make decisions is affected. Depression is one of the diseases that impact the lives of millions of people worldwide, and the most visible sign is the mood of constant sadness, the loss of interest in things that were once considered enjoyable, and the lack of ability to do even the simplest thing: Final Project: Enhancing Decision-Making in Depression.

Nevertheless, the cognitive aspect of depression is the most devastating, as it disrupts some of the important decision-making processes. This kind of depression, therefore, means that individuals who are affected have slow decision-making processes, churn out bad decisions, and have every reason not to take risks (Rinaldi et al., 2020).

The increased rumination—excessive and repetitive thoughts about negative events—exacerbates these problems, causing individuals to become trapped in a cycle of overthinking and delayed action. Specifically, the prefrontal cortex, which is a part of the cerebral cortex associated with decision-making, is affected by depression. The alterations in decisional processes affect its value in the ability to assess the choices made, the capacity to weigh the pros and cons of a decision, and to regulate the emotional responses to the choices involved in decision-making (Ehring, 2021). Thus, actions that other people decide quickly and effectively might become incredibly tiresome for depressed people and result in avoidance or inability to act.

This contemporary issue is of major concern, not only for the severity that reduces quality of life but also for the worsening of the clinical picture of depression. Decision-making difficulties imply lost chances, reduced ability to execute normal social tasks, and augmented psychosocial strain, which may further worsen the depression, leading to a vicious cycle. Therefore, it is imperative to work toward rectifying this cognitive element from a therapeutic perspective for those diagnosed with depression.

Selected Area

The scope of the proposed topic is narrowed down to understanding decision-making within the context of cognitive psychology with special reference to the computational impairment in depressed people. This proposal focuses only on two cognitive theories: the theory of dual-process and the theory of cognitive control. According to the dual-process theory by Kahneman (2011), there exist two broad systems that are at work during the decision-making process, namely, System 1 and System 2. System 1 is autonomous and impulsive, being characterized by making quick heuristic decisions.

In contrast, System 2 is comparatively slower, purposive, deliberate, and postdictive in nature, calling on resources such as attention and effort. In the case of depression, there is a conflict between System 2 and System 1, and System 2 begins overworking to overthink and waste time in reflecting on matters. Consequently, there is decision-making deadlock and helplessness in the ability to make any move (Gronchi et al., 2024).

Cognitive control theory is also applicable in decision-making, specifically where depression impairs cognitive processes such as attention, working memory, and executive functions of the prefrontal cortex. This theory states that patients with depression exhibit a change of negative cognition as a result of a reduced ability to shift from one cognitive set to the other (Gronchi et al., 2024). This causes less willingness to adapt decision-making when given fresh information, further aggravating the situation.

Performance Issues and Limitations

Major depressive disorder leads to marked impairments in cognitive components, which influence the executive control system for decision-making. One of the key cognitive limitations is that of cognitive flexibility, which implies the inability to be much more adaptable when it comes to thinking. Among the executive functions that are impacted in depressed people is the function of cognitive flexibility, which is important in processes such as updating and switching between the decision-making modes.

This means that people always remain rigid and continue with wrong decisions even if the environment calls for change (Friedman & Robbins, 2021). Lack of flexibility in thinking may compel such a person to repeat poor choices over and over again.

Another major issue is decision paralysis. In depressed people, System 2 (the analytical thinking system) is hyperactive. Though this analysis is useful for complicated situations, in daily choices, it is detrimental since overthinking results in indecision. Depressed people overanalyze, consider all possible consequences, and are also afraid of making the “wrong” choice, thus immobilizing themselves and not taking action (Bellini-Leite, 2022).

Additionally, depression also relates to heightened risk aversion. Depressed people will hesitate to make risky choices even when the reward is greater than the risk. This is because impairment in reward processing and risk calculation brain regions causes a rise in avoidant decision-making (Friedman & Robbins, 2021). Individuals are, therefore, deprived of life and career opportunities.

Finally, depression is marked by decreased reward sensitivity, where individuals are less responsive to positive stimuli. A neuroimaging study by Martin-Soelch et al. (2021) indicates that there is reduced activity of the ventral striatum, a structure responsible for reward in depressed people. This reduced reward sensitivity results in a poor appreciation of the gains accruing from decisions made, exacerbating the avoidance of decision-making. These cognitive changes collectively put people with depression at a disadvantage in decision-making processes by making them make mediocre decisions with little confidence.

Potential Improvements

The primary research question that this proposal will seek to answer is, “How do therapeutic interventions, such as cognitive behavioral therapy and pharmacotherapy, improve decision-making in patients with major depressive disorder?” This question calls for an explanation of how such interventions work at the level of cognitive processes and emotional regulation.

Another weakness is the absence of decision-making ability or deciding paralysis points to the inability to make a decision. Depression is associated with the fixation of System 2, which is the analytical thinking system in the brain. Although this analytical thinking is useful for solving intricate problems, it is detrimental to daily decisions since the overly analytical process results in hesitation. Depressed people tend to think too much, contemplate every possible angle and adverse scenario that could occur, and are overly anxious about getting things wrong, hence do not act (Nakao et al., 2021).

Moreover, depression is often associated with increased risk aversion. One of the decision-making problems associated with depression is that the subject has very low uncertainty tolerance, even if the potential gains will outweigh the costs. There is also a correlation between these decision-making patterns and compromised brain areas that are responsible for the assessment of rewards and risks, making avoidance even worse (Nakao et al., 2021). Consequently, people do not actively pursue chances in their personal and or employment industries.

Finally, mindfulness-based interventions incorporated with CBT may reduce rumination and decision paralysis. Through mindfulness techniques, the focus is taken out from being on thoughts and made to stay in the present. This has the added advantage of quick decisions since one gets into action without being hemmed in by many issues.

Contemporary Relevance

Utility of Theories

The dual-process theory and the cognitive control theory are highly relevant to understanding the cognitive deficits in decision-making associated with depression. According to the dual-process theory, depressed people use one system more than the other; specifically, a person becomes over-involved in thought processes (System 2). It also demonstrates the possibilities for equal collaboration between viscerosensory and rational processes through individual approaches to treatment and explains the need for improved and faster decision-making. However, the thinking used in System 1 mode is not utilized in depressed patients; hence, it has to be reintroduced in the decision-making process to enhance cognitive flexibility.

Cognitive control theory provides a more direct framework for understanding cognitive dysfunctions related to depression. It emphasizes the different parts of the prefrontal cortex, which is in charge of attention, working memory, and decision-making, therefore highlighting why depressed individuals have difficulty in flexibility and rigidity. Both theories are hence important when it comes to treatment planning to address impairment and improve decision-making.

Apply

Among the two theories, cognitive control theory offers the greatest utility for practitioners working with individuals with depression. Since executive functions and cognitive flexibility are amenable to training, CBT and pharmacotherapy can be particularly useful in enhancing the capacity of patients to make decisions and avoid being excessively risk-averse due to depression. Furthermore, pharmacogenomic testing can supplement the usage of antidepressants by selecting a drug that would not impact cognition adversely and would improve decision-making abilities.

Interpretation of Research Findings

Question

How can therapeutic interventions, such as CBT and pharmacotherapy, improve decision-making abilities in individuals with major depressive disorder?

Support

Research findings support the effectiveness of both CBT and pharmacotherapy in improving decision-making in individuals with depression. CBT enhances cognitive flexibility and reduces rumination, which are key factors that influence decision-making. CBT and pharmacotherapy can be beneficial in enhancing the applicability of the approach that is needed to identify and apply the most appropriate solutions regarding executive dysfunction and cognitive flexibility impaired in depression, stipulated by decisional conflict and risk-aversive behaviors. Additionally, pharmacogenomics also may help in improving the effectiveness and safety of antidepressant medications since it reduces the consequences of side effects affecting the cognition of the patients as well as assisting them in decision-making.

Selective Serotonin Reuptake Inhibitors (SSRIs), a widely used class of antidepressants, serve to normalize risk evaluations in depressed people. They decrease the risk-averse tendency so that people become more willing to take necessary risks and achieve a better balance between caution and action. Such an adjustment is essential to enhance decision-making, especially in tasks that entail uncertainty (Nakao et al., 2021).

In addition, Martin-Soelch et al., (2021) neuroimaging research offers strong support that these treatments play a part in neuroplasticity of the brain regions responsible for decision-making. Rearrangement of the neural associations in the brain’s prefrontal cortex makes proper, quick thinking and effective decision-making possible. Therefore, the application of CBT and pharmacotherapy is a good strategy to treat depression’s dysfunctional cognitive models and improve decision-making outcomes.

Methodological Principles

Strategies and Techniques

Cognitive-behavioral interventions play an important role in improving decision-making among people with depression. Rumination and cognitive inflexibility are held to be post-intervention foci in cognitive-behavioral interventions regarding decision-making. In this regard, CBT enhances the positivity of thoughts and self-esteem hence improving decision making. Thus, people obtain more favorable conditions for decision-making compared to a greater level of uncertainty and decision-making time.

Another promising strategy is pharmacogenomic testing, which matches antidepressant treatments to an individual’s genetic profile. In this way, the medications do not only reduce such side effects but also enhance the risks of cognitive improvement or decision-making capacity. Personalizing not only deals with the medical part of the depression problem but also positively impacts the cognitive aspect and rationality of decision-making.

Furthermore, mindfulness interventions may be incorporated into CBT to also minimize rumination and enhance decision-making. Mindfulness training that encourages the individual to be present and avoid thinking too much breaks the chances of getting locked in cycles of indecision. Increased awareness helps people to make faster decisions as it assists them in overcoming some of the mental barriers that are characteristic of depression.

Such treatments have far-reaching effects. Therefore, cognitive flexibility enables people to make the right options more quickly and confidently. Addressing the psycho and neuro underpinnings of depression leads to improvements in mental health. Additionally, these interventions promote autonomy in social, professional, and interpersonal decision-making, which leads to an empowered quality of life.

Implications

The implications of these strategies are profound. Improved cognitive flexibility means individuals can make decisions with more efficiency and confidence instead of being full of hesitation or indecisiveness. These also enhance mental health because they not only treat the state of mind but also the state of the brain about depression.

In particular, these strategies operate on cognitive activities such as rumination and cognitive inflexibility; consequently, they enhance cognitive functioning. Also, the quality of life of the people rises as individuals gain better decision-making capacity in individual and social or business domains. In general, one can build up the resilience needed to address any directions, goals, or programs successfully.Top of FormBottom of Form

Conclusion

In summary, CBT, the pharmacogenomic test, and the mindfulness-based approach are helpful strategies that enhance decision-making on the part of a patient with depression. Future investigations should consider the durability of these positive changes, neural substrates that underpin such changes in cognitive flexibility, and efficacy and training effects of these interventions transferring to different groups of individuals with depression across cultures.

References

Ehring, T. (2021). Thinking too much: rumination and psychopathology. World Psychiatry, 20(3), 441–442. https://doi.org/10.1002/wps.20910

Friedman, N. P., & Robbins, T. W. (2021). The role of the prefrontal cortex in cognitive control and executive function. Neuropsychopharmacology, 47(47), 1–18. https://doi.org/10.1038/s41386-021-01132-0

Gronchi, G., Gavazzi, G., Viggiano, M. P., & Giovannelli, F. (2024). Dual-Process Theory of Thought and Inhibitory Control: An ALE Meta-Analysis. Brain Sciences, 14(1), 101. https://doi.org/10.3390/brainsci14010101

Martin-Soelch, C., Guillod, M., Gaillard, C., Recabarren, R. E., Federspiel, A., Mueller-Pfeiffer, C., Homan, P., Hasler, G., Schoebi, D., Horsch, A., & Gomez, P. (2021). Increased Reward-Related Activation in the Ventral Striatum During Stress Exposure Associated with Positive Affect in the Daily Life of Young Adults With a Family History of Depression. Preliminary Findings. Frontiers in Psychiatry, 11(78). https://doi.org/10.3389/fpsyt.2020.563475

Nakao, M., Shirotsuki, K., & Sugaya, N. (2021). Cognitive–behavioral therapy for management of mental health and stress-related disorders: Recent advances in techniques and technologies. BioPsychoSocial Medicine, 15(1), 1–4. https://doi.org/10.1186/s13030-021-00219-w

Rinaldi, R., Lefebvre, L., Joachim, A., & Rossignol, M. (2020). Decision-making of patients with major depressive disorder in the framework of action control. Cognitive Neuropsychiatry, 25(1), 71–83. https://doi.org/10.1080/13546805.2019.1685481

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Final Project Milestone Three: Rough Draft of Final Proposal: Decision-making

A rough draft of your proposal is due at the end of this module. Please use theFinal Project Template to complete your draft. This draft submission represents an opportunity to receive targeted instructor feedback that you can use to improve your final proposal (due in Module Nine).

For additional details, please refer to the Milestone Three Guidelines and Rubric.

Also, please be sure to post a copy of your rough draft to the 7-1 Milestone Four Peer Review of Rough Draft.

RESOURCES: 

• Textbook: Cognitive Psychology Interactive eBook, Chapter 7,8 & 10
• Library Article: Locating Object Knowledge in the Brain: Comment on Bowers’s (2009) Attempt to Revive the Grandmother Cell Hypothesis
• Video: What Is Schema Theory in Psychology?