How psychological trauma shapes human decision-making: a systematic literature review of cognitive, emotional, and behavioral mechanisms
Jurnal Konseling dan Pendidikan September 20, 2026 Volume 14, Number 1 3 authors
Abstract
sychological trauma is a public-health concern that cuts across emotional well-being and everyday decision-making. Both trauma and decision-making have been studied extensively, yet the mechanisms that connect adverse experiences to altered choice remain scattered across neuroscience, clinical psychology, and behavioral science. In this systematic literature review, we synthesize recent evidence on how trauma shapes human decision-making through cognitive, emotional, and behavioral pathways. The review follows PRISMA 2020. A structured Scopus search targeted English-language research articles published between 2022 and 2026. The search returned 886 records. After full-text assessment of 88 reports, 10 studies met the eligibility and quality criteria. Three convergent findings stand out. First, trauma disrupts value-based and reinforcement learning, which reduces behavioral flexibility and alters feedback sensitivity and belief updating. Second, greater threat appraisal, stronger stress reactivity, and impaired emotion regulation push decisions toward uncertainty avoidance and negative outcomes. Third, these shifts appear in risk-taking, substance-related choices, suicidality, and aggression. Overall, the evidence supports integrative models and trauma-informed, decision-focused clinical care.
Authors
Ifdil Ifdil
Universitas Negeri Padang
Nur Adila Wafiqoh Zulvi
Univrsitas Negeri Padang, Padang
M. Fahli Zatrahadi
Universitas Islam Negeri Sultan Syarif Kasim Riau, Pekanbaru
Aase, D. M., McManimen, S., Holliday, R., Monteith, L. L., & Bryan, C. J. (2025). Concurrent impact of PTSD symptoms and alcohol use on working memory and executive functioning in a U.S. adult sample. Journal of Psychiatric Research, 183, 127–132. https://doi.org/10.1016/j.jpsychires.2025.02.015
Aloi, J., Murray, O. K., Crum, K. I., Aalsma, M. C., Dzemidzic, M., & Hulvershorn, L. A. (2026). Violence and threat exposure is associated with frontostriatal alterations during risky decision-making in children with co-morbid ADHD and disruptive behavior disorders. Frontiers in Psychiatry, 17, Article 1799471. https://doi.org/10.3389/fpsyt.2026.1799471
Arif, M., Homish, D. L., Butler, L. D., Kulak, J. A., Collins, R. L., & Homish, G. G. (2025). The Association of Risk-Related Behaviors and Mental Health Symptomatology on Problematic Alcohol Use Among U.S. Army Reserve and National Guard Soldiers. Substance Use and Misuse, 60(6), 895–905. https://doi.org/10.1080/10826084.2025.2465967
Arslan, H., & Yilmaz, A. E. (2024). Assessing the feasibility, acceptability, and preliminary efficacy of the ‘TraumaRelief’ app for PTSD symptom management in Turkey: Study protocol for a pilot randomized controlled trial. Internet Interventions, 38, Article 100793. https://doi.org/10.1016/j.invent.2024.100793
Ayas, G., Sar, V., Hun Senol, S., & Türk-Kurtça, T. (2025). The Internal Moderation Questionnaire (IMQ): A Novel Measure of Self-Regulation. Journal of Trauma and Dissociation, 26(3), 331–346. https://doi.org/10.1080/15299732.2025.2481030
Babakr, Z., & Fatahi, N. (2023). Risk-taking Behaviour: The Role of Dark Triad Traits, Impulsivity, Sensation Seeking and Adverse Childhood Experience. Acta Informatica Medica, 31(4), 292–299. https://doi.org/10.5455/aim.2023.31.292-299
Barden, E. P., Mattson, R. E., Mastroleo, N., & Balderrama-Durbin, C. (2024). The impact of emotion regulation and dyadic coping within posttraumatic stress symptoms and risky drinking patterns on relationship distress among trauma-exposed individuals. Journal of Traumatic Stress, 37(6), 890–900. https://doi.org/10.1002/jts.23057
Barr, N., Atuel, H., Saba, S., & Castro, C. A. (2022). Toward a dual process model of moral injury and traumatic illness. Frontiers in Psychiatry, 13, Article 883338. https://doi.org/10.3389/fpsyt.2022.883338
Barrett, M. E., & Welsh, D. P. (2025). Harnessing the Transdiagnostic Power of ACT: A Case Study in Treating Prolonged Grief and Co-Occurring Symptoms. Clinical Case Studies, 24(5), 333–350. https://doi.org/10.1177/15346501251368809
Ben-Zion, Z., Shany, O., Admon, R., Keynan, N. J., Avisdris, N., Balter, S. R., Shalev, A. Y., Liberzon, I., & Hendler, T. (2022). Neural Responsivity to Reward Versus Punishment Shortly After Trauma Predicts Long-Term Development of Posttraumatic Stress Symptoms. Biological Psychiatry: Cognitive Neuroscience and Neuroimaging, 7(2), 150–161. https://doi.org/10.1016/j.bpsc.2021.09.001
Blais, R. K., Tannahill, H. S., & Cue Davis, K. (2024). Sexual Risk Taking among Survivors of U.S. Military Sexual Assault: Associations with PTSD Symptom Severity and Alcohol Use. Journal of Sex Research, 61(5), 683–690. https://doi.org/10.1080/00224499.2023.2232803
Branson, D. C., Martin, J. S., Westbrook, O. E., Ketcherside, R. J., & Bradley, C. S. (2022). “Why People Gotta be so Judgy?”: The Importance of Agency-Wide, Non-judgmental Approach to Client Care. Alcoholism Treatment Quarterly, 40(1), 65–82. https://doi.org/10.1080/07347324.2021.1955641
Bu, C., Zhang, Q., & Xu, L. (2025). Personalized nursing interventions based on risk factors for post-traumatic stress disorder following intracerebral hemorrhage: an analysis of effectiveness. Frontiers in Psychiatry, 16, Article 1648588. https://doi.org/10.3389/fpsyt.2025.1648588
Cortese, A., Ohata, R., Alemany-González, M., Kitagawa, N., Imamizu, H., & Koizumi, A. (2024). Time-dependent neural arbitration between cue associative and episodic fear memories. Nature Communications, 15(1), Article 8706. https://doi.org/10.1038/s41467-024-52733-4
Croft, J., Teufel, C., Heron, J., Fletcher, P. C., David, A. S., Lewis, G., Moutoussis, M., FitzGerald, T. H. B., Linden, D. E. J., Thompson, A., Jones, P. B., Cannon, M., Holmans, P., Adams, R. A., & Zammit, S. (2022). A Computational Analysis of Abnormal Belief Updating Processes and Their Association With Psychotic Experiences and Childhood Trauma in a UK Birth Cohort. Biological Psychiatry: Cognitive Neuroscience and Neuroimaging, 7(7), 725–734. https://doi.org/10.1016/j.bpsc.2021.12.007
Crombie, K. M., Sato, M., Chatham, S. A., Leri, J., Richardson, M. T., & Cisler, J. M. (2025a). Physical activity moderates the relationship between PTSD symptom severity and approach-avoidance conflict decision-making. Journal of Anxiety Disorders, 116, Article 103075. https://doi.org/10.1016/j.janxdis.2025.103075
Crombie, K. M., Aguiar, E. J., Macdonald, H. V., Lim, S. L., & Greenwood, B. N. (2025b). Physical Activity Is Positively Associated with Model-Based Decision-Making in Pursuit of Reward in Trauma-Exposed Adults. Medicine and Science in Sports and Exercise, 57(10), 2108–2118. https://doi.org/10.1249/MSS.0000000000003754
Curtis, A., Harries, T., Skvarc, D., Guala, T., Enticott, P. G., & Miller, P. G. (2024). Childhood maltreatment and adult aggression: The moderating role of neurocognitive ability and substance use. Child Abuse and Neglect, 158, Article 107094. https://doi.org/10.1016/j.chiabu.2024.107094
de Paula, G. G. M., Moreira, J. O., & Santos, A. J. (2023). Complex post-traumatic stress disorder (CPTSD), executive function and attachment. Revista Latinoamericana de Psicopatologia Fundamental, 26, Article e220529. https://doi.org/10.1590/1415-4714.e220529
Dopmeijer, D. M., van Vliet, N. I., van Dijk, M. K., & Alma, M. A. (2026). Patient considerations in trauma-focused treatment decision-making: a qualitative study. BMC Psychiatry, 26(1), Article 490. https://doi.org/10.1186/s12888-026-08125-7
Fares-Otero, N. E., Iversen, A. E., Gutiérrez-Zotes, A., Zarp, J., Jiménez, E., Sánchez-Moreno, J., Pomarol-Clotet, E., Vieta, E., Kjærstad, H. L., Vilella, E., & Miskowiak, K. W. (2026). Mapping behavioural mechanisms linking childhood maltreatment, cognition, impulsivity, and suicidality in bipolar disorder: A network approach. Translational Psychiatry, 16(1), Article 317. https://doi.org/10.1038/s41398-026-04177-1
Gaylord-Harden, N. K., Alli, J., Davis-Stober, C. P., & Henderson, H. (2022). A trauma-informed approach to understanding firearm decision-making among Black adolescents: Implications for prevention. Preventive Medicine, 165, Article 107305. https://doi.org/10.1016/j.ypmed.2022.107305
Giovanniello, J., Bravo-Rivera, C., Rosenkranz, A., & Matthew Lattal, K. (2023). Stress, associative learning, and decision-making. Neurobiology of Learning and Memory, 204, Article 107812. https://doi.org/10.1016/j.nlm.2023.107812
Goldner, L., Shelef, L., Goldstein, B. A., & Scharf, M. (2022). Understanding processes that advance suicidal behavior among Israeli active duty soldiers: A mediation model. Journal of Clinical Psychology, 78(4), 590–601. https://doi.org/10.1002/jclp.23237
Guy, S., Mahon, S., Webb, J., Dudley, M., & Theadom, A. (2026). Pervasive TBI and Inhibitory Control in a Male New Zealand Prison Population. Brain Sciences, 16(6), Article 637. https://doi.org/10.3390/brainsci16060637
Hamer, H. P., Lampshire, D., Thom, K., Sutton, D., MacIntyre, G., & Cogan, N. (2026). Risk Redux? Therapeutic Risk Taking and the Role of Supported Decision Making in Mental Health Settings. International Journal of Mental Health Nursing, 35(1), Article e70234. https://doi.org/10.1111/inm.70234
Jia, R., Ruderman, L., Pietrzak, R. H., Gordon, C., Ehrlich, D., Horvath, M., Mirchandani, S., DeFontes, C., Southwick, S., Krystal, J. H., Harpaz-Rotem, I., & Levy, I. (2023). Neural valuation of rewards and punishments in posttraumatic stress disorder: a computational approach. Translational Psychiatry, 13(1), Article 101. https://doi.org/10.1038/s41398-023-02388-4
Kenézlői, E., Balogh, L., Somogyi, S., Lévay, E. E., Halmai, Z., Nemoda, Z., Unoka, Z. S., & Réthelyi, J. M. (2025). Emotion dysregulation and impulsivity as overlapping symptoms in adult Attention-Deficit/Hyperactivity Disorder and Borderline Personality Disorder: severity profiles and associations with childhood traumatization and personality functioning. Annals of General Psychiatry, 24(1), Article 3. https://doi.org/10.1186/s12991-024-00540-y
Kline, N. K., Prichett, B., McKim, K. G., & Palm Reed, K. (2023). Interpersonal Emotion Regulation in Betrayal Trauma Survivors: A Preliminary Qualitative Exploration. Journal of Aggression, Maltreatment and Trauma, 32(4), 631–649. https://doi.org/10.1080/10926771.2022.2133658
Ko, C. H., Lu, Y. C., Lee, C. H., & Liao, Y. C. (2024). The influence of adverse childhood experiences and depression on addiction severity among methamphetamine users: exploring the role of perseveration. Frontiers in Psychiatry, 15, Article 1382646. https://doi.org/10.3389/fpsyt.2024.1382646
Korgaonkar, M. S., Felmingham, K. L., Malhi, G. S., Williamson, T. H., Williams, L. M., & Bryant, R. A. (2023). Changes in neural responses during affective and non-affective tasks and improvement of posttraumatic stress disorder symptoms following trauma-focused psychotherapy. Translational Psychiatry, 13(1), Article 85. https://doi.org/10.1038/s41398-023-02375-9
Law, K. C., O'Connell, K. L., Jacobson, S. V., Baer, M. M., Baker, P. M., & Tull, M. T. (2024). Influences of sleep, cortisol reactivity, and risk/reward-based decision-making on suicide. Journal of Behavior Therapy and Experimental Psychiatry, 85, Article 101975. https://doi.org/10.1016/j.jbtep.2024.101975
Lawn, W., Hao, X., Konova, A. B., Haney, M., Cooper, Z. D., Van Dam, N., Glimcher, P., & Bedi, G. (2025). Value signals guiding choices for cannabis versus non-drug rewards in people who use cannabis near-daily. Psychopharmacology, 242(4), 681–691. https://doi.org/10.1007/s00213-025-06746-6
Leichsenring, F., Fonagy, P., Heim, N., Kernberg, O. F., Leweke, F., Luyten, P., Salzer, S., Spitzer, C., & Steinert, C. (2024). Borderline personality disorder: a comprehensive review of diagnosis and clinical presentation, etiology, treatment, and current controversies. World Psychiatry, 23(1), 4–25. https://doi.org/10.1002/wps.21156
Liberati, A., Altman, D. G., Tetzlaff, J., Mulrow, C., Gøtzsche, P. C., Ioannidis, J. P. A., Clarke, M., Devereaux, P. J., Kleijnen, J., & Moher, D. (2009). The PRISMA statement for reporting systematic reviews and meta-analyses of studies that evaluate health care interventions: Explanation and elaboration. PLoS Medicine, 6(7), Article e1000100. https://doi.org/10.1371/journal.pmed.1000100
Lim, L., & Shafritz, K. M. (2025). Atypical Neural Activation During Emotional but Not Nonemotional Response Inhibition in Healthy Young People Exposed to Childhood Maltreatment and Peer Victimization. Biological Psychiatry Global Open Science, 5(4), Article 100497. https://doi.org/10.1016/j.bpsgos.2025.100497
Lloyd, A., McKay, R. T., & Furl, N. (2022). Individuals with adverse childhood experiences explore less and underweight reward feedback. Proceedings of the National Academy of Sciences of the United States of America, 119(4), Article e2109373119. https://doi.org/10.1073/pnas.2109373119
Marazziti, D., Carbone, M. G., Arone, A., Gurrieri, R., Dell’osso, L., & Crowther, L. F. (2025). Fueling the cycle: Attachment, cognition, and emotion in substance-using incarcerated young adults. Clinical Neuropsychiatry, 22(4), 261–278. https://doi.org/10.36131/cnfioritieditore20250401
Marques da Rocha, M. C., Malloy-Diniz, L. F., Romano-Silva, M. A., Joaquim, R. M., Serpa, A. L. D. O., Paim Diaz, A., de Paula, J. J., Costa, D. S., Silva, A. G. D., Pinto, A. L. D. C. B., & de Miranda, D. M. (2023). Decision-making styles during stressful scenarios: The role of anxiety in COVID-19 pandemic. Frontiers in Psychiatry, 14, Article 1105662. https://doi.org/10.3389/fpsyt.2023.1105662
McManimen, S. L., Hay, J., Long, C., Bryan, C. J., & Aase, D. M. (2024). Associations among posttraumatic stress disorder symptoms, suicidal ideation, suicide attempts, and reward discounting. Stress and Health, 40(4), Article e3370. https://doi.org/10.1002/smi.3370
Mittler, B., Cambi, X., Biskach, M., Reisman, J., Wang, Y., Berlowitz, D., Morin, P., Miller, D. R., Brandao-Viruet, K., Clare, S. J., Xia, K. Z., Tahami Monfared, A. A., Irizarry, M., Zhang, Q., & Xia, W. (2025). Patient journey and decision processes for anti-amyloid therapy in Alzheimer’s disease. Journal of Neurology, 272(5), Article 341. https://doi.org/10.1007/s00415-025-13059-3
Moret, R. M., Alacreu-Crespo, A., Molins, F., Olié, E., & Courtet, P. (2026). Decision-making impairments according to history of suicide attempt in depression: A computational model analysis. Progress in Neuro-Psychopharmacology and Biological Psychiatry, 147, Article 111732. https://doi.org/10.1016/j.pnpbp.2026.111732
Nan, J., Jaiswal, S., Ramanathan, D., Withers, M. C., & Mishra, J. (2025). Climate trauma from wildfire exposure impacts cognitive decision-making. Scientific Reports, 15(1), Article 11992. https://doi.org/10.1038/s41598-025-94672-0
Nomamiukor, F. O., Suresky, R. E., May, C. L., & Wisco, B. E. (2022). Understanding Internalizing and Externalizing Symptoms in Trauma Exposed Community Members. Psychological Trauma: Theory, Research, Practice, and Policy, 16(1), 98–106. https://doi.org/10.1037/tra0001388
Nowakowski-Sims, E. (2022). Integrative Body, Mind, and Spirit Interventions used with Parents in the Child Welfare System. Journal of Child and Adolescent Trauma, 15(1), 121–129. https://doi.org/10.1007/s40653-021-00388-4
Olson, E. A., Ahmad, S., Granger, S. J., Ashraf, A., Pizzagalli, D. A., & Rosso, I. M. (2024). Anhedonia and Delay Discounting: Differing Patterns of Brain-Behavior Relationships in Healthy Control Participants Versus Individuals With Posttraumatic Stress Disorder. Biological Psychiatry: Cognitive Neuroscience and Neuroimaging, 9(1), 80–90. https://doi.org/10.1016/j.bpsc.2023.07.013
Page, M. J., McKenzie, J. E., Bossuyt, P. M., Boutron, I., Hoffmann, T. C., Mulrow, C. D., Shamseer, L., Tetzlaff, J. M., Akl, E. A., Brennan, S. E., Chou, R., Glanville, J., Grimshaw, J. M., Hróbjartsson, A., Lalu, M. M., Li, T., Loder, E. W., Mayo-Wilson, E., McDonald, S., … Moher, D. (2021). The PRISMA 2020 statement: An updated guideline for reporting systematic reviews. BMJ, 372, Article n71. https://doi.org/10.1136/bmj.n71
Pluck, G. (2024). Executive function and adult homelessness, true impairment or frontal lobology?. Frontiers in Human Neuroscience, 18, Article 1359027. https://doi.org/10.3389/fnhum.2024.1359027
Rheude, C., Nikendei, C., Stopyra, M. A., Bendszus, M., Krämer, B., Gruber, O., Friederich, H. C., & Simon, J. J. (2025). Two sides of the same coin? What neural processing of emotion and rewards can tell us about complex post-traumatic stress disorder and borderline personality disorder. Journal of Affective Disorders, 368, 711–719. https://doi.org/10.1016/j.jad.2024.09.110
Seasons, M., & Morrongiello, B. A. (2024). Returning to sport after injury: the influence of injury appraisals and post-traumatic stress symptoms on adolescent risk-taking intentions post-injury. Journal of Pediatric Psychology, 49(3), 175–184. https://doi.org/10.1093/jpepsy/jsae001
Selbing, I., Sandberg, D., Olsson, A., Lindström, B., & Golkar, A. (2024). The Transfer of Social Threat Learning to Decision Making Is Robust to Extinction. Emotion, 24(7), 1689–1696. https://doi.org/10.1037/emo0001392
Selloni, A., Bhatia, G., Ranganathan, M., & De Aquino, J. P. (2022). Multimodal Correlates of Cannabis Use among U.S. Veterans with Bipolar Disorder: An Integrated Study of Clinical, Cognitive, and Functional Outcomes. Journal of Dual Diagnosis, 18(2), 81–91. https://doi.org/10.1080/15504263.2022.2053264
Sloan, A. F., Kittleson, A. R., Torregrossa, L. J., Feola, B., Rossi-Goldthorpe, R., Corlett, P. R., & Sheffield, J. M. (2025). Belief Updating, Childhood Maltreatment, and Paranoia in Schizophrenia-Spectrum Disorders. Schizophrenia Bulletin, 51(3), 646–657. https://doi.org/10.1093/schbul/sbae057
Strazdiņa, E., Perepjolkina, V., Upmale-Puķīte, A., Akmane, E., Duhovska, J., & Mārtinsone, K. (2026). Developing a Protocol-Based Expressive Therapies Continuum Assessment Profile (ETC-AP): Current Achievements and Future Perspectives. Behavioral Sciences, 16(5), Article 640. https://doi.org/10.3390/bs16050640
Tafti, A. F., Mohammadi, S., Dehghan, M., & Shahmaleki, M. (2025). Dimensions of childhood trauma and identity disturbance in male adolescents: Examining affected experiences and mediating cognitive functions. Child Abuse and Neglect, 169, Article 107720. https://doi.org/10.1016/j.chiabu.2025.107720
Thomas, J., & Harden, A. (2008). Methods for the thematic synthesis of qualitative research in systematic reviews. BMC Medical Research Methodology, 8, Article 45. https://doi.org/10.1186/1471-2288-8-45
Tranfield, D., Denyer, D., & Smart, P. (2003). Towards a methodology for developing evidence-informed management knowledge by means of systematic review. British Journal of Management, 14(3), 207–222. https://doi.org/10.1111/1467-8551.00375
Verfaellie, M., Patt, V., Lafleche, G., & Vasterling, J. J. (2024). Associations between PTSD and temporal discounting: The role of future thinking. Journal of Behavior Therapy and Experimental Psychiatry, 85, Article 101978. https://doi.org/10.1016/j.jbtep.2024.101978
Verfaellie, M., Patt, V., Lafleche, G., Jones, D., & Vasterling, J. J. (2025). Choosing certainty over risk: Associations of PTSD symptom severity with memory sampling during experiential decision making. Journal of Anxiety Disorders, 110, Article 102979. https://doi.org/10.1016/j.janxdis.2025.102979
Weber, S., & Lynch, S. (2026). Interpersonal Violence, Emotion Regulation, and Trauma-Coping Self-Efficacy as Predictors of Posttraumatic Stress Disorder, Substance Use, and Risk Engagement Among Women in Jail. Journal of Interpersonal Violence, 41(1-2), 26–47. https://doi.org/10.1177/08862605241307227
Webermann, A. R., Bonnes, S. M., Rupcic, S., Holliday, R., Monteith, L. L., Rosen, M. I., Portnoy, G. A., & Murdoch, M. (2026). “A Lot of Gray”: Ambiguity, Beliefs, and Discretion in Veterans Benefits Administration Military Sexual Trauma-Related Posttraumatic Stress Disorder Disability Claims. Journal of Clinical Psychology, 82(1), 55–64. https://doi.org/10.1002/jclp.70042
Çikrikçili, U., Yildirim, E., Buker, S., Ger, C., Erözden, O., Gürvit, H., & Saydam, B. (2025). Decision Making, Emotion Recognition and Childhood Traumatic Experiences in Murder Convicts Imprisoned with Aggravated Life Sentence: A Prison Study. Noropsikiyatri Arsivi, 62(1), 20–26. https://doi.org/10.29399/npa.28778
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Ifdil Ifdil; Nur Adila Wafiqoh Zulvi; M. Fahli Zatrahadi (2026). How psychological trauma shapes human decision-making: a systematic literature review of cognitive, emotional, and behavioral mechanisms. Jurnal Konseling dan Pendidikan, 14(1), 1012-1029. https://doi.org/10.29210/1227900
Ifdil Ifdil; Nur Adila Wafiqoh Zulvi; M. Fahli Zatrahadi. "How psychological trauma shapes human decision-making: a systematic literature review of cognitive, emotional, and behavioral mechanisms." Jurnal Konseling dan Pendidikan 14, no. 1 (2026): 1012-1029. https://doi.org/10.29210/1227900
Ifdil Ifdil; Nur Adila Wafiqoh Zulvi; M. Fahli Zatrahadi (2026) 'How psychological trauma shapes human decision-making: a systematic literature review of cognitive, emotional, and behavioral mechanisms', Jurnal Konseling dan Pendidikan, 14(1), pp. 1012-1029. https://doi.org/10.29210/1227900
Ifdil Ifdil; Nur Adila Wafiqoh Zulvi; M. Fahli Zatrahadi. "How psychological trauma shapes human decision-making: a systematic literature review of cognitive, emotional, and behavioral mechanisms." Jurnal Konseling dan Pendidikan, vol. 14, no. 1, 2026, pp. 1012-1029. https://doi.org/10.29210/1227900