Dysfunctions of decision‐making and cognitive control as transdiagnostic mechanisms of mental disorders: advances, gaps, and needs in current research

Disadvantageous decision‐making and impaired volitional control over actions, thoughts, and emotions are characteristics of a wide range of mental disorders such as addiction, eating disorders, depression, and anxiety disorders and may reflect transdiagnostic core mechanisms and possibly vulnerability factors. Elucidating the underlying neurocognitive mechanisms is a precondition for moving from symptom‐based to mechanism‐based disorder classifications and ultimately mechanism‐targeted interventions. However, despite substantial advances in basic research on decision‐making and cognitive control, there are still profound gaps in our current understanding of dysfunctions of these processes in mental disorders. Central unresolved questions are: (i) to which degree such dysfunctions reflect transdiagnostic mechanisms or disorder‐specific patterns of impairment; (ii) how phenotypical features of mental disorders relate to dysfunctional control parameter settings and aberrant interactions between large‐scale brain systems involved in habit and reward‐based learning, performance monitoring, emotion regulation, and cognitive control; (iii) whether cognitive control impairments are consequences or antecedent vulnerability factors of mental disorders; (iv) whether they reflect generalized competence impairments or context‐specific performance failures; (v) whether not only impaired but also chronic over‐control contributes to mental disorders. In the light of these gaps, needs for future research are: (i) an increased focus on basic cognitive‐affective mechanisms underlying decision and control dysfunctions across disorders; (ii) longitudinal‐prospective studies systematically incorporating theory‐driven behavioural tasks and neuroimaging protocols to assess decision‐making and control dysfunctions and aberrant interactions between underlying large‐scale brain systems; (iii) use of latent‐variable models of cognitive control rather than single tasks; (iv) increased focus on the interplay of implicit and explicit cognitive‐affective processes; (v) stronger focus on computational models specifying neurocognitive mechanisms underlying phenotypical expressions of mental disorders. Copyright © 2013 John Wiley & Sons, Ltd.