A systematic review of neuropsychological performance in social anxiety disorder

Abstract

Background: Over the past few years, there has been an increasing interest in the neuropsychological performance of patients with anxiety disorders, yet the literature does not provide a systematic review of the results concerning adult patients with social anxiety disorder (SAD). Aims: The primary aim of this paper is to review the literature on neuropsychological performance in adult patients with SAD. Methods: This paper is a systematic review of empirical studies investigating neuropsychological performance as assessed by cognitive tests. Results: 30 papers were located comprising a total number of 698 adult patients with SAD. The review revealed indication for decreased performance regarding visual scanning and visuoconstructional ability as well as some indication for verbal memory difficulties. Conclusion: The impact of possible confounding variables on the neuropsychological performance is discussed. It is suggested that the decreased performance should be attributed to an increased level of situational anxiety, and an engagement in disorder-related, cognitively costly activities rather than trait-like cognitive dysfunctions. Future experimental studies are needed to explore the causal relationship between these constructs. Knowledge from such studies is important in order to improve the understanding of why SAD is such a disabling disorder, both educationally and interpersonally, and could assist in the planning and evaluation of psychotherapeutic treatment.

• Cognitive dysfunction
• Cognitive therapy
• Neuropsychological performance
• Social anxiety disorder
• Social phobia

Acknowledgements

The authors would like to thank Patrick O'Toole, Associate Professor Thomas Nielsen and Professor Esben Hougaard for helpful comments on drafts of this paper.

Declaration of interest: The authors report no conflicts of interest. The authors alone are responsible for the content and writing of the paper.

Authors’ contributions

Both authors participated in planning of the literature search. The corresponding author drafted the manuscript, which in its final format received approval from both authors.

Notes

¹The study was presented on the American Psychiatric Association's 145th annual meeting in Washington DC. The authors have not been able to provide a copy of the manuscript, neither has the library of American Psychiatric Association.

²The categorization of tests according to cognitive domain could be perceived as rather arbitrary, since several cognitive abilities and often more than one domain are implicated in a test. However, the categorization is following that of Lezak and colleagues's (12) based on the function primarily assessed.

³It should be noted that other neuropsychological studies have found visual impairments in patients with PAD as well (6, 69), and that the vast majority of studies examining cognitive functions in OCD have not included a group of individuals with SAD.

⁴Note that Graver & White (18) experimentally manipulated the level of anxiety in the situation and thus did not rely on a purely correlational design.