Anxiety And Decision Making: How Worry And Fear Can Affect Cognitive Function
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At times, many individuals who live with anxiety experience overwhelm when it comes to making even simple decisions. In a phenomenon known as decision paralysis, those with anxiety disorders may freeze or become caught up in a cycle of overthinking when faced with a choice, big or small. Here, we’ll explore what the research says about how anxiety can affect decision making as well as strategies that may help those with an anxiety disorder move past this type of mental block.
Symptoms of an anxiety disorder
While occasional anxiety or stress are common in everyday life, experiencing a diagnosable anxiety disorder can be disruptive to daily functioning, relationships, and overall well-being. Examples of anxiety disorders include social anxiety, panic disorder, generalized anxiety disorder, and specific phobias. Symptoms can vary depending on the person and the specific disorder they’re living with, but they generally include things like:
- Persistent worry or fear
- Panic attacks
- Trembling or sweating
- Racing heart rate
- Shallow, quick breathing
- Difficulty concentrating
- Trouble focusing
- Sleep problems
It’s also possible for a person to experience certain anxiety symptoms as a part of another type of disorder, like post-traumatic stress disorder. In addition, anxiety often co-occurs with other types of mental health conditions, such as substance use disorder, attention-deficit/hyperactivity disorder (ADHD), and depression.
How anxiety and decision making are connected
Anxiety is associated with the body’s stress response kicking in when a true threat is not present. When it comes to making decisions, a dysregulated stress response can lead to negative outcomes in a number of ways—especially if it’s connected to fear-related stimuli (e.g., a job interview, a presentation, or a doctor’s appointment).
Using evaluations such as the balloon analog risk task (BART), the Iowa gambling task, prospect theory, and neuroimaging, researchers have found that dispositional anxiety, or trait anxiety, may influence how individuals view negative events and experience risk perception—whether they’re engaging in risky decision making or facing simple choices.
Heightened threat perception due to an anxiety disorder
Those experiencing an anxiety disorder tend to perceive threats (and associated heightened negative emotions) more often than those who do not. This tendency can draw the person’s attention toward the perceived threat, often magnifying it. As a result, this complication can lead people to avoid making specific decisions due to the negative feelings and the perceived high risks associated with them.
Cognitive freezing
Another issue that can affect an individual with anxiety is freezing or feeling stuck when it comes time to make a decision. Because anxiety can make a decision feel more fraught or scary, decision making can become slower, or a person may avoid making a choice altogether. An example of this could be when a person notices a strange physical symptom and, due to fear, they procrastinate about making a doctor’s appointment.
Overthinking
Overthinking can be another result of anxiety. Excessive worry about all the potential negative outcomes of a decision may lead to decision paralysis, or feeling overwhelmed and being unable to make a decision at all. Prospective theory in psychology holds that an individual tends to be more influenced by the possibility of a potential loss than a prospective gain. This can be exacerbated in the mind of a person with anxiety, as the subjective value of a loss can be inflated for them. Therefore, they may end up thinking in circles for a long period as they continue to put off making a decision.
Research on how anxiety and depression can impact decision making
In 2025, researchers at the University of Minnesota medical school studied decision making in two common yet distinctive emotional states: anxiety and apathy. Apathy is a common symptom of major depressive disorder and can impact rational decision making. This and other depressive symptoms often co-occur with anxiety.
The patterns observed through neuroimaging indicate that while both states of mind contributed to challenges with decision making, they were not the same. While individuals living with anxiety experienced greater environmental volatility and explored more options (especially after negative outcomes), individuals living with apathy tended to view outcomes as random and therefore exhibited reduced exploratory behavior.
Researchers hope to use this information to create a new framework around how emotional states affect decision making. Further research on this topic may also help providers tailor specific therapeutic approaches to how a patient perceives and processes uncertainty to ensure greater treatment efficacy.
How individuals with anxiety might improve their decision-making skills
There are some evidence-based practices and techniques that may help a person make decisions. With patience and persistence, practicing these strategies may help a person improve their decision-making capabilities over time.
Challenging thoughts caused by anxiety and depression
Challenging your thoughts can be a powerful way to reduce negative feelings. For example, when faced with a presentation at work, you may initially think “I’m going to mess up and embarrass myself.” When you notice this thought, you might take a moment to reflect on whether it’s based in fact or on assumptions. You can then use cognitive restructuring techniques to make this thought more truthful and helpful, such as: “I understand the information I’m presenting better than anyone else, and I don’t have to be perfect to get it across.”
Remember that treatment is usually required to address symptoms of depression or anxiety disorder, and that a professional can help you learn how to practice cognitive restructuring and other techniques.
Aiming to let go of the fear of what you can’t control
You might also practice sitting with the fact that you can’t control all aspects of life. When you need to make a decision around a specific situation, it may help to identify which factors are within your control and focus on those. It can be empowering to concentrate your energy on areas that you know you can influence while aiming to let go of those that you know you can’t control.
Practicing mindfulness to cope with anxiety and decision-making difficulties
Anxiety can distract and take us out of the present moment. Mindfulness techniques may help bring the mind and body back into the present, which may help establish a state of calm that can allow an individual to better focus on the decision at hand. Examples of mindfulness strategies include meditation, deep breathing exercises, and visualization.
Seeking cognitive behavioral therapy for an anxiety disorder
For those living with an anxiety disorder (like generalized anxiety disorder or panic disorder) or another mental illness that causes anxiety (such as obsessive-compulsive disorder or posttraumatic stress disorder), symptoms are unlikely to resolve without treatment. Talk therapy is usually the first-line approach for treating anxiety-related disorders.
Therapy with a licensed professional can offer guidance, emotional support, and practical tools for managing anxiety symptoms, including improving decision-making skills. Cognitive behavioral therapy (CBT) in particular focuses on cognitive restructuring techniques that can be effective in shifting patterns of thought and behavior in individuals experiencing anxiety disorders.
Exploring online treatment for fear and anxiety
For those who may not be able to regularly commute to and from in-person therapy sessions or would feel more comfortable engaging in treatment from home, online therapy can be a convenient alternative. With an online platform like BetterHelp, you can fill out an online questionnaire to get matched with a licensed therapist according to your needs—and you can switch providers at any time as needed for no additional cost. You can then meet with your therapist via video, phone, and/or in-app messaging from the comfort and convenience of your own home or anywhere you have internet.
What the research says about online therapy for anxiety
People who are interested in exploring online therapy can generally feel confident in the effectiveness of this method of treatment. Research suggests that online therapy can often be just as effective as in-person therapy for treating anxiety and other mental health conditions.
Takeaway
Do people with anxiety struggle to make decisions?
Anxious individuals tend to experience cognitive symptoms alongside their anxiety, such as difficulty concentrating. Cognitive functioning can be slower, causing slower response times when being asked to make a decision. This confusion or lack of focus can alter decision-making abilities in brain regions responsible for this ability. Grounding oneself and using evidence-based techniques, like taking a deep breath, may improve task performance, psychological functioning, and decision-making abilities.
Is indecisiveness a symptom of anxiety?
Some people become indecisive when anxious. Although it is not an official symptom of anxiety disorders, higher trait anxiety is often associated with this trait and confusion, lack of concentration, and difficulty taking steps toward one’s goals. Emotional responses to anxiety can cloud judgment, causing anxiety and depressive symptoms that make it difficult to focus on ambiguous stimuli and requests.
What do people with anxiety struggle with the most?
Every person with an anxiety disorder is different. For example, socially anxious individuals may struggle most with social interactions and making friends. People with specific phobias may only fear the stimuli that remind them of their phobia but not struggle with meeting a reasonable deadline like someone else might. Personality traits in people with anxiety also vary, and everyone requires different types of support based on these group differences.
What is the root cause of indecisiveness?
Indecisiveness can occur for various reasons, including but not limited to state anxiety, more significant risk aversion, monetary loss aversion, and a more laid-back or submissive personality. People may also struggle to make decisions if they typically rely on others to do so for them throughout their lifetime and in childhood. Being a decision-maker is often associated with traits like confidence, dominance, and comfort.
What therapy helps with decision-making?
Several therapeutic modalities may increase one’s decision-making abilities and skills, including cognitive-behavioral therapy (CBT), dialectical behavior therapy (DBT), and other popular options. When seeking a therapist, seek a provider who works with evidence-based practices based on what neuroimaging studies suggest about the human brain, prospect theory, and other theories regarding decision-making, cognition, and anxiety. An ethical therapist will ask you for written informed consent before treatment and be licensed.
What is the sneaky red flag of high-functioning anxiety?
If you have high-functioning anxiety and can complete your tasks and work regardless of symptoms, you may have a propensity to ignore or avoid your symptoms and emotions. Over time, avoiding emotions can significantly impact your health and well-being, potentially leading to burnout, stress, and health challenges. For this reason, treating your anxiety can still be helpful, even if you’re able to function without support.
What type of person is more prone to anxiety?
People that may be more prone to anxiety disorders can include but aren’t limited to the following categories:
- Those with a family history of anxiety disorders or other mental illnesses
- People who have experienced a traumatic event or had a traumatic childhood
- Those who have another mental illness, such as a depressive disorder
- People who have high stress in their lives, such as intensive jobs or pressure to succeed from family members
- Those who struggle to form healthy relationships
- People with insecure attachment styles
How do you make a decision when you have anxiety?
Making a decision with anxiety can be difficult, especially if you second-guess yourself. When doing so, try to note the facts of the situation only instead of emotion-driven thoughts. For example, if you’re thinking, “I’m going to fail this test,” you can reframe it with the facts by saying, “I don’t know what grade I’m going to get on this test. I’m anxious about failing. Due to this anxiety, I’m going to spend extra time studying so I have more of a chance of succeeding. I can’t change the outcome, but I can do my best to prepare.”
Can anxiety make you incompetent?
Anxiety can make you have difficulty making decisions, learning new skills, or working through problems. However, anxiety doesn’t make you incompetent, stupid, weak, or any other unkind label. You are a human being struggling with a real mental health symptom. If anxiety makes you feel self-loathing, consider working with a therapist to pinpoint the origin of these negative thoughts and reframe them.
Can a therapist help you make decisions?
A therapist can be helpful in making decisions. They can guide you through evidence-based practices like mindfulness, journaling, and making a pros and cons chart. They can help you identify thoughts that are based on emotions and thoughts that are based on facts.
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