The associations between posttraumatic stress disorder and delay discounting, future orientation, and reward availability: A behavioral economic model

Abstract

The theoretical framework of behavioral economics, a metatheory that integrates operant learning and economic theory, has only recently been applied to posttraumatic stress disorder (PTSD). A behavioral economic theory of PTSD reflects an expansion of prior behavioral conceptualization of PTSD, which described PTSD in terms of respondent and operant conditioning. In the behavioral economic framework of PTSD, negatively reinforced avoidance behavior is overvalued, in part due to deficits in environmental reward, and may be conceptualized as a form of reinforcer pathology (i.e., excessive preference for and valuation of an immediate reinforcer). We investigated cross‐sectional relationships between PTSD severity and several constructs rooted in this behavioral economic framework, including future orientation, reward availability, and delay discounting in a sample of 110 military personnel/veterans (87.2% male) who had served combat deployments following September 11, 2001. Total PTSD severity was inversely related to environmental reward availability, β = −.49, ΔR2 = 0.24, p < .001; hedonic reward availability, β = −.32, ΔR2 = 0.10, p = .001; and future orientation, β = −.20, ΔR2 = 0.04, p = .032, but not delay discounting, r = −.05, p = .633. An examination of individual symptom clusters did not suggest that avoidance symptoms were uniquely associated with these behavioral economic constructs. The findings offer support for a behavioral economic model of PTSD in which there is a lack of positive reinforcement as well as a myopic focus on the present.

Delay discounting in individuals with anxiety and related disorders compared to healthy controls.

“…Similarly, steeper discounting was found among trauma-exposed adults reporting high levels of PTSD symptoms (Bryan & Bryan, 2021) and PTSD diagnoses (Morris et al, 2020) compared to those with low levels of PTSD symptoms or no diagnosis. In contrast, Olin et al (2022) did not find a significant relation between DD and PTSD symptom severity among military personnel/veterans. However, the authors note that they used an abbreviated measure of delay discounting, which may have impacted their ability to detect systematic discounting choices (Olin et al, 2022).…”

“…In contrast, Olin et al (2022) did not find a significant relation between DD and PTSD symptom severity among military personnel/veterans. However, the authors note that they used an abbreviated measure of delay discounting, which may have impacted their ability to detect systematic discounting choices (Olin et al, 2022). Thus, while this small body of research has begun to see steeper discounting in some anxiety and related disorders, to the best of our knowledge, there are no studies that have investigated DD among individuals with GAD, or PD.…”

Posttraumatic stress and delay discounting: a meta-analytic review

“…For example, in a large sample of community adults, Levitt et al (2022) reported statistically significant correlations between posttraumatic stress symptom severity and delay discounting (rs = 0.14 to 0.16). In contrast, using a smaller sample of active or retired military personnel, Olin et al (2022) found a non-significant negative association between similar variables (r = −0.050). Using a case-control design, Morris et al (2020) found that delay discounting was significantly elevated among individuals with PTSD relative to those without (d = 0.32), whereas Peck, Nighbor, and Price (2021) found non-significant elevations in delay discounting among individuals with PTSD (without opioid use disorder) relative to healthy controls (d = 0.14) (calculated based on information provided in text).…”

“…thoughts, feelings, physiological sensations) and/or external stimuli associated with the trauma. Short-lived reductions in distress contribute to a negatively reinforced cycle that promotes increasing reliance on avoidance, while simultaneously limiting engagement in activities that are positively reinforcing, disconfirming of trauma-related cognitions, or that may foster habituation or extinction of trauma-related emotions (Foa & Cahill, 2001;Foa, Hembree, Rothbaum, & Rauch, 2019;Olin et al, 2022;Rauch & Foa, 2006). Thus, like delay discounting, avoidance in PTSD is a short-term strategy to maximize the immediate smaller reward of distress reduction at the expense of long-term symptom recovery.…”

A pilot study of how the past, present, and future are represented in three-dimensional space

“…How an individual views one’s past, present, and future has been shown to be associated with human behaviors and mental health ( Strathman et al, 1994 ; Routledge et al, 2013 ; Turner et al, 2013 ; Sedikides et al, 2015 ; Lyu and Huang, 2016 ; Li et al, 2019 ; Burzynska and Stolarski, 2020 ; Drew et al, 2020 ; Newman et al, 2020 ; Zhi et al, 2021 ; Dennis et al, 2022 ; Olin et al, 2022 ). Researchers who were interested in the relationships between mental health and time perspective have tried to describe the types of time perspectives in various ways.…”