Does effort-cost decision-making relate to real-world motivation in people living with HIV?

ABSTRACT

Introduction: Low motivation is frequent in older people with HIV, yet poorly understood. Effort-cost decision-making (ECDM) tasks inspired by behavioral economics have shown promise as indicators of motivation or apathy. These tasks assess the willingness to exert effort to earn a monetary reward, providing an estimate of the subjective “cost” of effort for each participant. Here we sought evidence for a relationship between ECDM task performance and self-reported motivation in a cross-sectional study involving 80 middle-aged and older people with well-controlled HIV infection, a chronic health condition with a high burden of mental and cognitive health challenges. Methods: Participants attending a regular follow-up visit for a Canadian longitudinal study of brain health in HIV completed a computerized ECDM task and a self-report measure of motivation. Other brain health measures were available, collected for the parent study (cognition, depression, anxiety, and vitality, as well as self-reported time spent on real-world leisure activities). Results: Contrary to our hypothesis, we found no relationship between ECDM performance and self-reported motivation. However, those willing to accept higher effort in the ECDM task also reported more time engaged in real-world activities. This association had a small-to-moderate effect size. Conclusions: The behavioral economics construct of subjective cost of effort, measured with a laboratory ECDM task, does not relate to motivation in people living with chronic HIV. However, the task shows some relationship with real-world goal-directed behavior, suggesting this construct has potential clinical relevance. More work is needed to understand how the subjective cost of effort plays out in clinical symptoms and everyday activities.

KEYWORDS:

• Reward
• effort
• apathy
• motivation
• measurement
• human

Acknowledgments

We thank Melissa Vu for her assistance with recruitment and Masud Husain, Alexander Soutschek, Philippe Tobler and Todd Hare for helpful discussion in the design phase of this work and for sharing versions of the ECDM task.

Disclosure statement

No potential conflict of interest was reported by the author(s).

Availability of data and material

Data is available only to editors and reviewers upon request.

Additional information

Funding

This work was supported by grants from the Canadian Institutes of Health Research (TCO-125272; HAL-157987), the CIHR HIV Clinical Trials Network (CTN-273), the Velux Foundation Grant No. 981, and the Healthy Brains for Healthy Lives CFREF grant to McGill University.