Choosing Through Fear: Trauma-Related Symptoms and Biased Decision-Making in Aversive Contexts

Abstract

This study investigated how trauma-related symptoms influence decision-making under aversive conditions. Eighty-seven participants completed a modified two-armed bandit task that included unpredictable exposure to aversive screams, with emotional intensity manipulated across trials. Trauma symptoms were assessed using the International Trauma Questionnaire (ITQ), capturing dimensions of PTSD and Complex PTSD (CPTSD). Bias persistence was assessed via choice behavior and belief updating, while anticipatory skin conductance responses (SCRs) indexed physiological arousal. Higher PTSD symptom severity was associated with greater bias persistence and reduced belief updating, reflecting impaired cognitive flexibility. In contrast, higher levels of Disturbances in Self-Organization (DSO), a CPTSD symptom cluster, were linked to greater adaptability. Emotional intensity did not moderate these effects, and trauma symptoms did not predict SCR responses. These findings suggest that PTSD symptoms contribute to rigid decision-making, while CPTSD may involve distinct cognitive response patterns.