Enhanced Risk Aversion, But Not Loss Aversion, in Unmedicated Pathological Anxiety

Abstract

Background: Anxiety disorders are associated with disruptions in both emotional processing and decision making. As a result, anxious individuals often make decisions that favor harm avoidance. However, this bias could be driven by enhanced aversion to uncertainty about the decision outcome (e.g., risk) or aversion to negative outcomes (e.g., loss). Distinguishing between these possibilities may provide a better cognitive understanding of anxiety disorders and hence inform treatment strategies.

Methods: To address this question, unmedicated individuals with pathological anxiety (n = 25) and matched healthy control subjects (n = 23) completed a gambling task featuring a decision between a gamble and a safe (certain) option on every trial. Choices on one type of gamble-involving weighing a potential win against a potential loss (mixed)-could be driven by both loss and risk aversion, whereas choices on the other type-featuring only wins (gain only)-were exclusively driven by risk aversion. By fitting a computational prospect theory model to participants' choices, we were able to reliably estimate risk and loss aversion and their respective contribution to gambling decisions.

Results: Relative to healthy control subjects, pathologically anxious participants exhibited enhanced risk aversion but equivalent levels of loss aversion.

Conclusions: Individuals with pathological anxiety demonstrate clear avoidance biases in their decision making. These findings suggest that this may be driven by a reduced propensity to take risks rather than a stronger aversion to losses. This important clarification suggests that psychological interventions for anxiety should focus on reducing risk sensitivity rather than reducing sensitivity to negative outcomes per se.

Keywords: Anxiety; Decision making; Emotion; Loss aversion; Memory; Risk aversion.

Figure 1

Trial design. On each trial, participants were first presented with a pair of faces (all happy, all fearful, or all neutral) or objects (light bulbs) and had 3 seconds to memorize it. They then had to decide whether to choose a sure option or a risky gamble. In mixed gamble trials, the sure option was always £0 and the mixed gamble involved a 50% chance to win the amount in green and a 50% chance to lose the amount in red. In gain-only gamble trials, the sure option was a small guaranteed gain, and the gamble involved a 50% chance to win a higher amount and a 50% chance to get £0. Finally, a probe from the first array was presented and participants had to report its position.

Figure 2

Risk and loss aversion parameter estimates. (A) Distribution of log-transformed parameter estimates. Positive values indicate risk aversion and loss aversion, respectively. (B) Mean estimates of loss and risk aversion, plotted separately for anxious and control groups. Error bars represent SEM. *p < .05 (two tailed).

Figure 3

Propensity to gamble and model simulations. (A) The proportion of trials in which the gamble was chosen was calculated for each participant and each gamble type (mixed, gain only), then averaged separately for anxious and control groups (solid-filled bars). Model simulations were calculated in a similar way using each participant’s parameter estimates to calculate the utility difference between the gamble and the sure option on each trial, resulting in a simulated gamble choice if that estimated utility difference was positive and a simulated safe choice if it was negative. These simulated propensities to gamble were also calculated separately for each gamble type and averaged separately for anxious and control groups (grid-filled bars). Error bars represent SEM. *p < .05 (two-tailed t test). (B, C) Sensitivity plots depicting how well the modeled (or simulated) data correlated with the actual data, plotted separately for mixed gamble trials (B) and gain-only gamble trials (C). Each data point represents an individual participant.