How Does Trauma Affect Our Ability to Delay Gratification?

What you need to know

• People with posttraumatic stress show a small but consistent tendency to prefer smaller immediate rewards over larger delayed rewards.
• This difficulty delaying gratification may contribute to impulsive behaviors that interfere with recovery from trauma.
• The link between trauma and delay discounting appears similar to that seen in other mental health conditions, suggesting it may be a common factor across disorders.

Understanding Delay Discounting

Imagine you’re offered a choice: you can have $50 right now, or $100 if you wait a month. Which would you choose? This type of decision, weighing an immediate smaller reward against a larger future reward, is what researchers call “delay discounting.”

Delay discounting is a measure of how much we tend to devalue rewards that we have to wait for. People who show steep delay discounting tend to strongly prefer immediate rewards, even if they’re smaller. This can sometimes be viewed as a form of impulsivity or difficulty with self-control.

Researchers have found that greater difficulty delaying gratification is associated with various mental health issues, including addiction, ADHD, depression, and eating disorders. But less was known about how trauma and posttraumatic stress disorder (PTSD) might relate to delay discounting. A team of researchers conducted a comprehensive review of existing studies to find out.

Reviewing the Evidence on Trauma and Delay Discounting

The researchers searched through scientific databases to find all relevant studies on posttraumatic stress and delay discounting. They identified 13 studies with a total of 6,897 participants that met their criteria for inclusion.

These studies used various methods to assess trauma exposure, PTSD symptoms, and delay discounting. Some compared people with and without PTSD diagnoses. Others looked at how PTSD symptom severity related to delay discounting scores across a range of people.

To analyze all these studies together, the researchers used a technique called meta-analysis. This allowed them to calculate an overall effect size - a measure of how strong the relationship is between posttraumatic stress and delay discounting across all the studies.

Key Findings: A Small but Consistent Link

The meta-analysis revealed a small but statistically significant positive association between posttraumatic stress and delay discounting. In other words, people with more severe PTSD symptoms or diagnoses tended to show a slightly stronger preference for immediate smaller rewards over larger delayed rewards.

The overall effect size was r = 0.135. In general, effect sizes around 0.1 are considered small, 0.3 medium, and 0.5 large. So this represents a relatively subtle effect, but one that was consistent enough across studies to be meaningful.

Importantly, this effect size is similar to what’s been found in meta-analyses looking at delay discounting in other mental health conditions. This suggests that difficulty delaying gratification may be a common factor across various disorders, rather than something unique to PTSD.

Understanding the Link Between Trauma and Immediate Rewards

Why might people who’ve experienced trauma show this tendency toward immediate rewards? There are a few potential explanations:

1. Avoidance: A key symptom of PTSD is avoidance of trauma reminders. This focus on avoiding current distress might generalize to a broader preference for immediate outcomes.

2. Altered time perception: Some people with PTSD report a sense of a foreshortened future - feeling like they might not live long. This could make future rewards seem less relevant.

3. Loss of control: Trauma can shake one’s sense of control over life. This might lead to difficulty imagining or planning for the future.

4. Impulsivity: Trauma is associated with increased impulsivity in general, which could extend to financial decision-making.

It’s important to note that the effect found in this study was small. Many people with PTSD don’t show problematic delay discounting, and many without PTSD do. This is just a general trend seen across large groups.

Implications for Treatment and Recovery

Understanding this link between posttraumatic stress and delay discounting could have important implications for treatment:

1. Addressing impulsivity: Treatments that help people manage impulsive urges might be particularly beneficial for some trauma survivors.

2. Future orientation: Therapies that help people reconnect with future goals and plans could potentially improve both PTSD symptoms and decision-making.

3. Financial counseling: Some trauma survivors might benefit from targeted support around financial planning and decision-making.

4. Substance use: Given the link between delay discounting and addiction, this could help explain the high rates of substance use problems among people with PTSD.

Limitations and Future Directions

The researchers note some important limitations of the current evidence:

1. Most studies didn’t account for other mental health conditions. It’s possible that the link between PTSD and delay discounting is partly explained by depression, substance use, or other issues that often co-occur with PTSD.

2. The studies used various methods to measure both PTSD and delay discounting, which could introduce some inconsistency.

3. Most studies focused on adults, so less is known about how trauma might affect delay discounting in children and adolescents.

Future research could address these limitations and dive deeper into questions like:

• Do different types of trauma have different effects on delay discounting?
• How does delay discounting change over the course of PTSD treatment?
• Could interventions targeting delay discounting help improve overall outcomes for trauma survivors?

Conclusions

• People with posttraumatic stress show a small but consistent tendency to prefer immediate smaller rewards over larger delayed rewards.
• This difficulty delaying gratification is similar to what’s seen in other mental health conditions, suggesting it may be a common factor across disorders.
• Understanding this link could inform new approaches to PTSD treatment, particularly around managing impulsivity and reconnecting with future goals.
• More research is needed to fully understand the relationship between trauma and decision-making, especially in children and adolescents.