The problems with delay discounting: a critical review of current practices and clinical applications

Abstract

Delay discounting paradigms have gained widespread popularity across clinical research. Given the prevalence in the field, researchers have set lofty expectations for the importance of delay discounting as a key transdiagnostic process and a 'core' process underlying specific domains of dysfunction (e.g. addiction). We believe delay discounting has been prematurely reified as, in and of itself, a core process underlying psychological dysfunction, despite significant concerns with the construct validity of discounting rates. Specifically, high delay discounting rates are only modestly related to measures of psychological dysfunction and therefore are not 'core' to these more complex behavioral problems. Furthermore, discounting rates do not appear to be specifically related to any disorder(s) or dimension(s) of psychopathology. This raises fundamental concerns about the utility of discounting, if the measure is only loosely associated with most forms of psychopathology. This stands in striking contrast to claims that discounting can serve as a 'marker' for specific disorders, despite never demonstrating adequate sensitivity or specificity for any disorder that we are aware of. Finally, empirical evidence does not support the generalizability of discounting rates to other decisions made either in the lab or in the real-world, and therefore discounting rates cannot and should not serve as a summary measure of an individual's decision-making patterns. We provide recommendations for improving future delay discounting research, but also strongly encourage researchers to consider whether the empirical evidence supports the field's hyper-focus on discounting.

Keywords: Alcohol; RDoC; behavioral economics; construct validity; decision-making; delay discounting; impulsivity; substance use; transdiagnostic.