Cognitive rehabilitation in anxiety disorders: a systematic review and meta-analysis of randomized controlled trials

In this study, we sought to conduct a systematic review and meta-analysis of research that utilized cognitive rehabilitation to enhance cognitive functions and alleviate symptoms in adult patients with anxiety disorders. We selected controlled randomized clinical trials that used cognitive training and remediation interventions and published before June 2024 using search databases including PubMed, ScienceDirect, Scopus, Cochrane, and Proquest. For the meta-analysis, standard differences in means with the random effect model and with a 95% confidence interval of change in outcome measures from baseline to post-intervention between the cognitive rehabilitation and the control groups were calculated. The database search identified 1825 studies of interest, ultimately including eight studies with 242 participants in the cognitive rehabilitation group and 223 participants in the control group. The meta-analysis of the data extracted from these studies shows a small and significant effect on the symptom severity (d = 0.25 (95% CI, 0.02 to 0.47) p-value = 0.02, I2 = 30.12%), and a large and significant effect on the working memory (d = 0.84 (95% CI, 0.07 to 1.13) p-value = 0.02, I2 = 0.00%) of patients with anxiety disorders. However, there was no significant difference between the intervention and control groups regarding attention (d = 0.07 (95% CI, -0.25 to 0.4) p-value = 0.65, I2 = 0.00%). This systematic review and meta-analysis demonstrate that cognitive rehabilitation is an effective intervention for reducing symptom severity and improving working memory in patients with anxiety disorders. Given the significance of achieving complete remission from these disorders and addressing the neuropsychological deficits associated with anxiety, cognitive rehabilitation should be regarded as an essential component of treatment for anxious patients. Further research focusing on different anxiety diagnoses, cognitive deficits, and targeted interventions is necessary.