Executive Functioning Constructs in Anxiety, Obsessive–Compulsive, Post-Traumatic Stress, and Related Disorders

Abstract

Purpose of Review We synthesize theories proposing complex relations between cognitive functioning and anxiety-related concepts. We evaluate vulnerability theories suggesting that deficits in various cognitive functioning domains predict future anxiety-associated concepts. We examine scar theories asserting the opposite direction of effects (i.e., anxiety predicting cognitive dysfunction). Furthermore, we examine more novel frameworks on this topic. Recent Findings Reliable evidence exists for the scar and vulnerability theories. This includes mounting data on diverse anxiety symptoms predicting cognitive dysfunction (and conversely) unfolding at between- and within-person levels (dynamic mutualism theory). It also includes data on the stronger effects or central influence of anxiety (versus non-anxiety) symptoms on executive functioning (EF; i.e., higher-order cognitive control governing myriad thinking and action repertoires) versus non-EF domains and vice versa (network theory). In addition, it reviews emerging evidence that enhanced cognitive control can correlate with higher anxiety among children (overgeneralized control theory). Summary The generally inverse relations between anxiety symptoms and cognitive dysfunction are bidirectional and complex within and between persons. Plausible mediators and moderators merit more attention, including immune, metabolism, and neural markers and the social determinants of health.

Investigating Cognitive Control and Repetitive Thinking in Clinical Groups With Major Depressive Disorder and Generalized Anxiety Disorder

“…The results revealed that the level of cognitive control, rumination, and worry was not significantly different in both groups of MDD and GAD. Defects in the cognitive control of this group of patients can indicate common mechanisms in the development and continuation of emotional disorders (Zainal & Newman, 2022). This dysfunction in cognitive control can make a person more vulnerable to repetitive thoughts of rumination and worry (Bartholomay et al, 2022).…”

Treatment condition as a moderator and change in trait mindfulness as a mediator of a brief mindfulness ecological momentary intervention for generalized anxiety disorder

“…These patterns consistently manifested in daily life across different situations, with worry initiating and maintaining anxiety while predicting a decreased likelihood of significant increases in negative emotions in future periods [22, 23, 83, 84]. Cognitively, GAD has been associated with increased focus on threats [85], the tendency to interpret ambiguous material negatively [86], and executive dysfunction [87]. In summary, targeting reduction in reactivity to inner experience could enhance the effectiveness of brief MEMIs for GAD by honing specific skills to mitigate emotional or stress reactivity across multiple biopsychosocial dimensions.…”

Testing the Efficacy of a Brief, Self-Guided Mindfulness Ecological Momentary Intervention on Emotion Regulation and Self-Compassion in Social Anxiety Disorder: Randomized Controlled Trial

“…First, all putative mediators and clinical outcome measures relied on web-based self-reports. Future RCTs should incorporate diverse measures of related constructs and evaluate crucial yet understudied factors believed to drive change, such as attentional bias toward threats [114,115], executive functioning [102,116,117], and physiological anxiety indices [118,119]. Second, we did not evaluate the sustainability of mindfulness skill use after the 2-week intervention duration.…”