Effort-cost decision-making in psychosis and depression: could a similar behavioral deficit arise from disparate psychological and neural mechanisms?

Psychol Med. 2018 Apr;48(6):889-904. doi: 10.1017/S0033291717002525. Epub 2017 Sep 11.


Motivational impairment is a common feature of both depression and psychosis; however, the psychological and neural mechanisms that give rise to motivational impairment in these disorders are poorly understood. Recent research has suggested that aberrant effort-cost decision-making (ECDM) may be a potential contributor to motivational impairment in both psychosis and depression. ECDM refers to choices that individuals make regarding the amount of 'work' they are willing to expend to obtain a certain outcome or reward. Recent experimental work has suggested that those with psychosis and depression may be less willing to expend effort to obtain rewards compared with controls, and that this effort deficit is related to motivational impairment in both disorders. In the current review, we aim to summarize the current literature on ECDM in psychosis and depression, providing evidence for transdiagnostic impairment. Next, we discuss evidence for the hypothesis that a seemingly similar behavioral ECDM deficit might arise from disparate psychological and neural mechanisms. Specifically, we argue that effort deficits in psychosis might be largely driven by deficits in cognitive control and the neural correlates of cognitive control processes, while effort deficits in depression might be largely driven by reduced reward responsivity and the associated neural correlates of reward responsivity. Finally, we will provide some discussion regarding future directions, as well as interpretative challenges to consider when examining ECDM transdiagnostically.

Keywords: Cognitive control; depression; effort-cost decision-making; psychosis; reward responsivity; schizophrenia..

Publication types

  • Review

MeSH terms

  • Decision Making*
  • Depressive Disorder / diagnosis
  • Depressive Disorder / physiopathology*
  • Humans
  • Motivation*
  • Neuropsychological Tests
  • Psychotic Disorders / diagnosis
  • Psychotic Disorders / physiopathology*
  • Reward*