Attenuation of value-to-evidence translation drives biased decision making in anxiety and depression

Abstract

Anxiety and depression are globally prevalent conditions associated with maladaptive decision making. However, whether affective symptoms primarily amplify threat avoidance or dampen motivational drive remains debated, and behavioural studies yield inconsistent findings. Here we show that both anxiety and depression impair the fundamental cognitive process of translating objective value into decision evidence. Across independent cohorts from the US and India, participants evaluated risky gambles while we assessed choice behaviour and the centroparietal positivity, an EEG marker of accumulating decision evidence. Prospect theory parameters, like risk and loss aversion, showed little association with symptom severity. Conversely, hierarchical drift-diffusion modelling revealed that higher symptom scores predicted attenuated value sensitivity during evidence accumulation, whereas decision caution remained intact. This reduction in value sensitivity suggests internalizing symptoms disrupt choice at the value-to-evidence interface, offering a unified mechanism underlying biased decision making in affective disorders.