What are decision making skills?
Everyday life is full of situations in which we have to make decisions. Some of these decisions are minor, such as what toothpaste we will buy or what we will have for dinner, while others are major, such as whether we choose to stay in a relationships or how we decide to manage our finances.
The ability to make decisions involves many different cognitive (thinking) skills. The mental skills that we use to make decisions are often referred to as ‘executive functions’. It is our executive functions that allow us to deal with problems that arise in everyday life and to cope with new situations.
Memory is a particularly important cognitive skill when making decisions, as it allows us to hold information so that we can think things through, as well as reflecting on choices that we have previously made.
Emotions also help us to assess how important a decision is to us and how the possible outcomes will make us feel.
How decision making can be affected by brain injury
Decision making involves a lot of different processes, and this means that if any one of these processes is affected by brain injury, the ability to make decisions may be impaired.
People can be affected in different ways - some survivors may find it hard to make a decision at all, finding that even simple decisions, such as what to wear, become very difficult to make. Some people become impulsive, making hasty decisions, apparently acting without thinking things through. Some people may find it difficult to think through the consequences of an action and so make decisions that are not in their best interest. Poor judgement in relationships, with money or in business can have devastating consequences for the brain injury survivor and their family.
Some survivors may make a decision and have a plan of action, but it can still be difficult for them to follow through with the plan. It is as if their intention, or goal, becomes neglected. This can sometimes be because they become distracted by other tasks or activities. They may ‘forget’ to do things, not because they have completely forgotten about what needs to be done, but rather that it is difficult for them to keep the task in mind, such as taking medication or passing on a message.
Self-awareness can also be affected by brain injury, so that the survivor is not aware of their problems. This is known as ight. The survivor may fail to achieve important tasks, and others may consider their decisions as bad judgement. One of the first challenges to overcome is therefore related to the survivor achieving a degree of self-awareness and understanding of the problems they are experiencing.
Coping with decision making difficulties
Working out how to improve the ability to make decisions can be challenging. The first step in rehabilitation is understanding the problem, but with something as complex as decision making or problem solving difficulties this may not be straightforward, and may be best done with the help of a professional such as an occupational therapist, clinical psychologist or neuropsychologist. You can speak to your GP about getting a referral to a relevant therapist.
The Headway helpline can also help with directing to therapists in private practice in your local area.
Tips for improving decision making skills after brain injury
Change the way you approach decision making
Stop: think! For some people, improving decision making skills depends on the ability to override impulsive thoughts or behaviours. Developing a habit of often stopping to think about what you are doing, even just briefly, can help to interrupt a tendency to act without thinking. It is important to recognise when you are about to make a decision and tell yourself to ‘stop: think!’ to remind yourself to think through the decision you are about to make.
Give yourself time - it may be that it is not easy to make decisions quickly after a brain injury, so try to ensure that you give yourself time to make a decision. Try not to rush to a decision, even if you feel others are waiting for your decision about something. For important decisions, make sure you set some quiet time aside to think through your options and weigh up the pros and cons of them.
Try not to make decisions when you are feeling tired or emotional, as being in such states will make it harder for you to think through information.
If you are struggling to make a particular decision about something, try to identify what is causing you to have this difficulty. For instance, are there too many options available to you, or do you not have enough information about your options to feel confident about the decision you are making? Identifying such barriers might make it easier for you to reconsider how to approach the decision that needs to be made.
Break larger decisions down into smaller, more manageable ones and tackle one decision at a time.
Plan in advance
Talk yourself through a list of things that needs to be done and decisions you may need to make through the day. You could do this first thing in the morning and make a list that you can refer to through the day whenever you need reminders.
Try not to leave decision making until the last minute. Write down any deadlines that you have coming up for important decisions that need to be made, for instance clearly making dates on a calendar, and try to work towards making the decision well in advance.
If you have time, write down the decision you have made and come back to it a few hours or days later to check that you still feel the same way about it.
Use tools to help
Writing things down may help to make the advantages and disadvantages of the options you have clearer. It can help to write down the pros and cons of possible options that you are trying to decide between. Seeing things on paper can make it easier to choose between options than trying to hold all the information in mind.
Use electronic devices such as mobile phones or smart watches. Diaries, notebooks, wallcharts and calendars are also useful reminder tools.
Boards that you can wipe such as whiteboards can be used to draw up and regularly update a weekly schedule for things you need to remember to do and decisions you need to make.
Consider using audio recordings, pictures or photos to help with making decisions if you find it difficult to write lists or remembering information using words.
Get advice from others
Get advice from people you trust when making a decision. Family and friends can help with making minor day-to-day decisions, but can also help with personal major decisions such as whether or not to stay at a job or in a relationship.
Seek legal advice from professionals such as solicitors when making major decisions such as managing your money.
If you, or a family member or friend, are concerned about a survivor’s capacity to make a decision and feel that decisions need to be made on their behalf for their own safety, seek support from the survivor’s GP or a solicitor.
If you feel you need professional support with your decision making difficulties, talk to your GP about getting a referral to an occupational therapist, clinical psychologist or neuropsychologist, who can offer support such as through Goal Management Training (a technique that helps people to better identify and remember their goals), or similar interventions to help.
The information on this page was produced with expert support from Dr Andrew Bateman and Professor Jonathan Evans.
This information was last reviewed in 2018.
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