Executive functioning in individuals with generalized anxiety disorder: A systematic review and meta-analysis

While deficits in 'cold' executive functioning (EF) have been linked to Generalized Anxiety Disorder (GAD), no study has systematically examined whether specific EF domains are disproportionately impaired. Addressing this gap is crucial for clarifying the role of EF in the persistence of anxiety and cognitive inefficiencies associated with GAD. This systematic review and meta-analytic investigation synthesized data from 13,084 participants across 32 studies to provide a comprehensive neuropsychological profile of GAD across the lifespan. Studies exploring GAD diagnosis and GAD symptoms/severity revealed similar patterns, such that, GAD was associated with poorer cognitive flexibility and working memory, but not inhibitory control. Effect sizes were similar across youths and young/middle-aged adults; however, studies involving older adults yielded no association between GAD and any EF domain. Furthermore, effect sizes were notably stronger for clinical samples compared to non-clinical samples, and for self-report measures of EF compared to accuracy- and reaction time-based indices. Further exploration revealed that GAD was linked to slower reaction times on working memory tasks and poorer accuracy on both cognitive flexibility and working memory tasks, challenging attentional control theory which suggests that anxiety impacts cognitive performance efficiency (reaction time)-not accuracy. An updated framework specific to GAD is therefore needed to clarify the underlying cognitive mechanisms underlying this condition. These findings have critical implications for treatment, as targeted interventions designed to strengthen impaired EF domains could enhance anxiety management and improve overall cognitive functioning and well-being for individuals with GAD.