Social anxiety and executive functioning: small but significant links

Social anxiety disorder (SAD) is a common mental health condition involving fear of social judgement and rejection (Morrison & Heimberg, 2013; Stein & Stein, 2008). SAD is associated with substantial social, occupational, and cognitive difficulties (Aderka et al., 2012), and emerging evidence suggests it may also impair executive functioning.

Executive functioning (EF) refers to cognitive processes supporting goal‑directed behaviour; typically working memory, cognitive flexibility, and inhibitory control (Diamond, 2016; Miyake et al., 2000). Several studies have observed EF difficulties in individuals with SAD (Demetriou et al., 2018; Du et al., 2022), and neuroimaging research indicates atypical frontal‑lobe development, which is the area of the brain linked with EF (Haller et al., 2015; Schmidt et al., 2022). However, findings remain inconsistent, potentially due to variability in study design and participants.

A further complication is that individuals with SAD often self-report greater EF difficulties than what they demonstrate behaviourally, and may show processing differences (e.g., typical accuracy but reduced processing efficiency; Derakshan & Eysenck, 2009; Eysenck & Derakshan, 2011). Given these nuanced patterns, and limited research in young people, Harrison and colleagues (2025) conducted a systematic review and meta‑analysis to clarify the relationship between SAD and EF across the lifespan.

Method

Five databases and grey literature were searched, first in June 2024 and then again in June 2025. Studies were included if they:

• Measured at least one EF domain (global EF or core EF: working memory, cognitive flexibility, inhibition) using self‑report or behavioural tasks
• Included a SAD group (clinical diagnosis or high social anxiety scores) and a healthy/low anxiety comparison group
• Used pre‑test EF and SAD measures in correlational, experimental, or quasi‑experimental designs
• Focused on children (8–12 years), adolescents (13–19 years), adults (20–64 years), or older adults (65+ years).
• Were peer‑reviewed and published in English.

Studies were excluded if they included neurological, psychiatric, or if participants had medical comorbidities or combined SAD with other anxiety disorders.

Two independent reviewers screened titles, abstracts and full texts, achieving strong agreement (κ = .82). A random-effects meta-analysis was conducted, with effect sizes reported as Pearson’s r, where negative values indicated poorer EF associated with SAD. EF domains were analysed separately, and moderator analyses were also undertaken.

Study quality was assessed using the MMAT (Hong et al., 2018), with studies rated from 0 (poor) to 5 (high quality). Methodological quality was generally good: 20 studies scored 4 or above out of 5 on the MMAT, and the remaining 29 scored 3. Heterogeneity was assessed using Q and I² statistics, and publication bias was examined using funnel plots, Egger’s test, and trim-and-fill procedures.

Results

Forty‑nine studies with a total of 5,549 participants were included, most involving adults (n = 43) and non‑clinical samples (n = 28). Most studies assessed a single EF domain (67.35%), using a single measure (67.35%), with inhibitory control (38.78%) and working memory (36.73%) most frequently examined. The majority of studies were conducted in North America (34.69%), Asia (26.53%), and Europe (26.53%).

The meta-analysis identified a significant relationship between social anxiety disorder (SAD) and executive functioning (EF) across the lifespan, suggesting that individuals with social anxiety tend to show poorer EF than individuals with low or no social anxiety. However, the effect size was small (r = -0.15, 95% CI [-0.22 to -0.08], p < .001), bringing into question how meaningful this finding is. These findings were robust across analytical approaches.

Moderator analyses

Only assessment type significantly moderated results, with self‑report showing larger effects than cognitive tasks (although both were significant). This suggests that individuals self-reported greater deficits in EF than revealed by cognitive performance.

Domain‑specific findings

Four cognitive domains were examined across studies: inhibitory control (e.g. ability to suppress automatic responses as needed by a task; 19 studies), cognitive flexibility (e.g. ability to shift attention as needed; 15 studies), working memory (e.g. short-term task-related memory; 18 studies), and global EF (overall EF abilities; 17 studies).

• Small but significant impairments were found in:
  • inhibitory control (r = −.18, 95% CI [-0.31 to -0.05], p = .006),
  • cognitive flexibility (r = −.20, 95% CI [-0.31 to -0.09], p = .001), and
  • global EF (r = −.17, 95% CI [-0.30 to -0.03], p = .015), showing that individuals struggled in general EF abilities, suppression of automatic responses, and attention shifting as required by tasks
• Working memory showed a small, non‑significant effect overall, though impairments were larger in children, clinical samples, and self‑report measures.

For cognitive flexibility, response‑time measures showed greater impairment than accuracy, suggesting individuals took longer to respond, even if accuracy of responses was relatively well maintained. This supports the idea that social anxiety impacts processing efficiency more than performance accuracy.

Age‑related patterns

Although age was a non-significant moderator, patterns appeared different across domains. Adults showed small, significant impairments in cognitive flexibility  (r = −0.225, 95% CI [-0.327 to -0.117], p < .001) and inhibition (r = −0.182, 95% CI [-0.330 to -0.025], p = .023), whereas children showed significant impairments in overall EF (r = −0.230, 95% CI [-0.300 to -0.158], p < .001) and working memory (r = −0.357, 95% CI [-0.485 to -0.213] p < .001), suggesting SAD impairs EF differently across the lifespan.

Conclusions

Social anxiety is associated with small but significant impairments in executive functioning (EF), including in the domains of inhibitory control, cognitive flexibility, and global EF.

Although age did not moderate the overall model, children showed greater working memory difficulties and adults showed more pronounced deficits in cognitive flexibility and inhibitory control, indicating developmental differences. Stronger effects in self‑report measures also reflect the tendency for individuals with SAD to perceive greater EF difficulties than behavioural tasks reveal.

These findings suggest that EF may be worth considering when treating individuals with SAD, and the need for more research to identify how this might be addressed in practice.

Strengths and limitations

Strengths

This systematic review and meta-analysis demonstrates strong methodological rigour. Studies were quality‑rated, screened for bias, and results remained stable across multiple analytic approaches, increasing confidence in the reliability of the results.

The review also examined a wide range of moderators (e.g., age, clinical status, assessment type, etc.) aligning closely with its aims and offering a detailed picture of how different factors shape EF performance in SAD. This breadth helps explain inconsistencies in earlier research and highlights the need for more lifespan‑focused work, particularly given the limited number of youth studies and the differing EF patterns observed across age groups.

Limitations

Despite a comprehensive search strategy, only six youth studies were included, and limited reporting of gender and cultural factors prevented analysis of these variables, reflecting broader gaps in the literature. Although not a methodological shortcoming of this review, these gaps restrict conclusions about developmental, cultural, and gender‑based differences. The overall working memory effect was non-significant, but was significant and more pronounced in youth than adults, suggesting a larger evidence base may clarify this. More research is therefore needed to examine developmental, cultural and gender-based effects.

Additionally, results showed high heterogeneity across studies, perhaps because EF tests varied widely between papers. This is a concern because there was also a limited number of studies per EF domain, reducing statistical power for analyses. There is a need to conduct future research using more consistent measures, and ideally to use multiple measures per EF domain to improve reliability.

Implications for practice

Findings of a relationship between SAD and EF deficits suggest that interventions for social anxiety may benefit from adaptations to support EF, or adjunctive treatment for EF difficulties. For instance, studies have suggested that inhibitory control training could reduce threat bias and emotional reactivity (Chen et al., 2015) and that social anxiety may be partly maintained by inefficiencies in inhibition, shifting attention and working memory (Eysenck & Derakshan, 2011), supporting the idea that adjunctive treatment of EF deficits could improve anxiety outcomes. Youth may also benefit from approaches that target working memory to a greater extent due to the preliminary evidence in this paper, showing greater deficits in this area of EF, although further research is required.

Stronger effects in self‑report measures also suggest that people with SAD judge their cognitive abilities more negatively than behavioural performance indicates, possibly because they must exert greater effort to compensate for reduced processing efficiency (Eysenck & Derakshan, 2011; Derakshan & Eysenck, 2009). This increased effort may contribute to frustration or fatigue, highlighting the value of empathic formulation during assessment and treatment that acknowledges heightened cognitive demands, alongside confidence‑building strategies to address distorted self-perceptions of abilities.

Finally, longitudinal research is essential to clarify whether EF deficits precede social anxiety or emerge as a consequence of it (Zainal & Newman, 2022). High‑quality studies (particularly in young people) are needed to determine whether EF difficulties progress or remain stable over time, and how social anxiety interacts with developing cognitive systems in young people. This will help identify whether early intervention should prioritise reducing anxiety, strengthening EF, or both.

Statement of interests

Ellie Davis has no conflicts of interest to declare.

Edited by

Dr Nina Higson-Sweeney.

Links

Primary paper

Alexandra Harrison, Lan Nguyen, Karen Murphy, David Neumann (2025). Assessing executive functioning in individuals with social anxiety disorder (SAD) across the lifespan: A systematic literature review and meta-analysis. Journal of Anxiety Disorders, 103056. https://doi.org/10.1016/j.janxdis.2025.103056

Other references

Aderka, I. M., Hofmann, S. G., Nickerson, A., Hermesh, H., Gilboa-Schechtman, E., & Marom, S. (2012). Functional impairment in social anxiety disorder. Journal of Anxiety Disorders, 26(3), 393–400. https://doi.org/10.1016/j.janxdis.2012.01.003

Chen, N. T., Clarke, P. J., Watson, T. L., MacLeod, C., & Guastella, A. J. (2015). Attentional bias modification facilitates attentional control mechanisms: Evidence from eye tracking. Biological Psychology, 104, 139-146. https://doi.org/10.1016/j.biopsycho.2014.12.002

Demetriou, E. A., Song, C. Y., Park, S. H., Pepper, K. L., Naismith, S. L., Hermens, D. F., Hickie, I. B., Thomas, E. E., Norton, A., & White, D. (2018). Autism, early psychosis, and social anxiety disorder: A transdiagnostic examination of executive function cognitive circuitry and contribution to disability. Translational Psychiatry, 8(1). https://doi.org/10.1038/s41398-018-0193-8.

Derakshan, N., & Eysenck, M. W. (2009). Anxiety, Processing Efficiency, and Cognitive Performance. European Psychologist, 14(2), 168–176. https://doi.org/10.1027/1016-9040.14.2.168

Diamond, A. (2016). Why improving and assessing executive functions early in life is critical. In J. A. Griffin, P. McCardle, & L. S. Freund (Eds.), Executive function in preschool-age children: Integrating measurement, neurodevelopment, and translational research (pp. 11–43). American Psychological Association. https://doi.org/10.1037/14797-002

Du, M., Peng, Y., Li, Y., Zhu, Y., Yang, S., Li, J., Zou, F., Wang, Y., Wu, X., Zhang, Y., & Zhang, M. (2022). Effect of trait anxiety on cognitive flexibility: Evidence from event-related potentials and resting-state EEG. Biological Psychology, 170. https://doi.org/10.1016/j.biopsycho.2022.108319

Eysenck, M. W., & Derakshan, N. (2011). New perspectives in attentional control theory. Personality and Individual Differences, 50(7), 955–960. https://doi.org/10.1016/j.paid.2010.08.019

Haller, S. P. W., Cohen Kadosh, K., Scerif, G., & Lau, J. Y. F. (2015). Social anxiety disorder in adolescence: How developmental cognitive neuroscience findings may shape understanding and interventions for psychopathology. Developmental Cognitive Neuroscience, 13, 11–20. https://doi.org/10.1016/j.dcn.2015.02.002

Miyake, A., Friedman, N. P., Emerson, M. J., Witzki, A. H., Howerter, A., & Wager, T. D. (2000). The unity and diversity of executive functions and their contributions to complex “frontal lobe” tasks: A latent variable analysis. Cognitive Psychology, 41(1), 49–100. https://doi.org/10.1006/cogp.1999.0734

Morrison, A. S., & Heimberg, R. G. (2013). Social anxiety and social anxiety disorder. Annual Review of Clinical Psychology, 9(1), 249–274. https://doi.org/10.1146/annurev-clinpsy-050212-185631

Schmidt, L. A., Poole, K. L., Hassan, R., & Willoughby, T. (2022). Frontal EEG alpha-delta ratio and social anxiety across early adolescence. International Journal of Psychophysiology, 175, 1–7. https://doi.org/10.1016/j.ijpsycho.2021.12.011

Stein, M. B., & Stein, D. J. (2008). Social anxiety disorder. The Lancet, 371(9618), 1115–1125. https://doi.org/10.1016/S0140-6736(08)60488-2

Zainal, N. H., & Newman, M. G. (2022). Executive Functioning Constructs in Anxiety, Obsessive–Compulsive, Post-Traumatic Stress, and Related Disorders. Current Psychiatry Reports, 24(12), 871–880. https://doi.org/10.1007/s11920-022-01390-9

Photo credits

• Photo by Tingey Injury Law Firm on Unsplash
• Photo by Vitaly Gariev on Unsplash
• Photo by Andrej Lišakov on Unsplash
• Photo by Andy Quezada on Unsplash
• Photo by Kilimanjaro STUDIOz on Unsplash
• Photo by Daniel Tuttle on Unsplash