Shared and distinct features of common effort-based decision-making paradigms and their relation to brain structure and neuropsychiatric conditions: An integrated narrative review.

Over the past decades, effort-based decision-making paradigms have become popular and effective tools to assess the neurocognitive mechanisms that support motivated behavior in humans and animals. These paradigms are built on a common neuroeconomic framework that conceptualizes motivation as the result of a cost-benefit decision-making process wherein organisms weigh potential rewards against the effort necessary to obtain them. However, specific effort-based choice paradigms often differ substantially in key design aspects, including the effort domain (physical vs. cognitive), the specific task used to manipulate effort, the presence or absence of rewards, punishments or other decision costs (e.g., time, probability), temporal component (i.e., probing effort/reward evaluation before or after effort exertion), and whether task demand is communicated explicitly or whether it has to be inferred through experience. This methodological heterogeneity may explain inconsistencies in the literature regarding the neural substrates underlying effort valuation and how these processes may be affected by a broad range of neuropsychiatric conditions, limiting the explanatory value of single-task studies. In this review, we provide a detailed overview of widely used effort-based decision-making paradigms, discuss associated advantages and challenges, and integrate key findings regarding neural correlates and observed changes in clinical populations. Finally, we offer practical guidance for selecting paradigms best suited to specific research questions.