In addition to the general Neurocognitive Brief Assessment, the SFS Test Solutions offer an assessment specifically designed for the evaluation of cognitive deficits in anxiety disorders. Although neurocognitive changes are not among the diagnostic core features of anxiety disorders, numerous studies indicate that certain cognitive functions may be impaired or altered, typically with small to moderate effect sizes (e.g., Millan et al., 2012; Suddell et al., 2023; Majeed et al., 2023).
The Test Solution “Anxiety Disorders – Neurocognitive Assessment” is not intended for diagnosing an anxiety disorder. Instead, its purpose is to make frequently affected functional domains visible, identify individual strengths and weaknesses, and highlight potential targets for intervention or psychoeducation. The selection of dimensions included in the test battery is based on current evidence regarding cognitive deficits associated with anxiety disorders as well as on the diagnostic standards of the DSM-5-TR (American Psychiatric Association, 2022) and the ICD-11 (WHO, 2022).
Among the most consistently described areas in the literature are changes in working memory. A large number of review articles (e.g., Millan et al., 2012; Moran et al., 2016; Gkintoni & Ortiz, 2023; Giomi et al., 2021), as well as recent cross-sectional (Karaca Cengiz et al., 2025) and longitudinal studies (Suddell et al., 2023), report mild but robust impairments across various anxiety disorders, such as generalized anxiety disorder, panic disorder, and social anxiety disorder. However, some reviews reach divergent conclusions. For example, O’Sullivan and Newman (2014) found no differences in working memory among individuals with panic disorder, whereas two other reviews reported poorer working memory performance (Millan et al., 2012; Giomi et al., 2021). Nevertheless, this cognitive domain appears valuable for clarifying specific deficits in individual patients, particularly because it can be significantly improved through targeted interventions, as demonstrated in a recent review and meta-analysis involving patients with generalized anxiety disorder or social anxiety disorder (Mokhtari et al., 2025). Verbal memory is also of interest. The review by Miller et al. (2012) reported mild impairments in individuals with generalized anxiety disorder and panic disorder. This tendency was also confirmed specifically for panic disorder in another systematic review (O’Sullivan & Newman, 2014). In addition, Nyberg (2021) showed that verbal short-term memory, measured by digit span forward, is significantly lower in individuals with anxiety disorders compared to a healthy normative population.
Findings regarding attention in anxiety disorders are heterogeneous. Different disorders show different attention-related patterns. While one cross-sectional study among students with generalized anxiety disorder even reported better attentional performance, review articles tend to indicate slightly reduced attention in generalized anxiety disorder (Millan et al., 2012; Gkintoni & Ortiz, 2023). Panic disorder, in contrast, is often characterized by increased attention toward threatening stimuli, which likely reflects a bias rather than a general performance enhancement (Millan et al., 2012). In children and adolescents with anxiety disorders, a review concluded that there is no evidence for significant deficits (Rabner et al., 2024). Despite inconsistent findings, attentional processes are generally regarded as central in anxiety disorders (Eysenck et al., 1987; Ferreri et al., 2011; Millan et al., 2012; Giomi et al., 2021), making their assessment clinically meaningful. At the same time, results from classical neuropsychological tests conducted under neutral conditions should be interpreted with caution, as they may insufficiently capture threat-specific processing tendencies.
As with attention, findings on executive function in anxiety disorders are mixed. In young adults, one review (Castaneda et al., 2008) summarized both evidence for impairments across anxiety disorders and opposing findings for specific disorders, while another review (Ferreri et al., 2011) identified executive functions as a central domain in anxiety disorders. A longitudinal study (Lindert et al., 2021) reported mild but significant impairments in executive functions. For specific disorders, findings tended toward either no deficits (GAD: Millan et al., 2012; Leonard & Abramovitch, 2019; PD: Castaneda et al., 2008; Giomi et al., 2021; O’Sullivan & Newman, 2014) or inconclusive results (PD: Millan et al., 2012). These heterogeneous findings may be explained by differential impairment across subcomponents of executive functioning. More recent reviews and individual studies suggest that cognitive flexibility may be impaired in children and adolescents with anxiety disorders (Rabner et al., 2024), individuals with panic disorder (Giomi et al., 2021), and adolescents with social anxiety disorder (Karaca Cengiz et al., 2025), whereas there is generally no evidence for deficits in inhibition (Suddell et al., 2023; Rabner et al., 2024). Reviews also suggest that information processing speed may be impaired in some cases (Millan et al., 2012; Rabner et al., 2024). Assessing cognitive flexibility and information processing speed therefore appears useful for the differentiated clarification of potential deficits in anxiety disorders.
Reaction ability represents another relevant variable. A recent meta-analysis (Majeed et al., 2023) reported significant reaction time deficits in executive-function tasks (inhibition, shifting, updating) among individuals with anxiety disorders compared to healthy controls. However, effects vary depending on the specific executive function and the type of anxiety disorder. Reaction time deficits were observed across all three executive domains as well as in individuals with generalized anxiety disorder. In contrast, significantly faster reaction times were found in panic disorder. Notably, accuracy in reaction time tasks was generally higher than in control groups, particularly in shifting and updating tasks and among individuals with panic disorder or selective mutism. A recent study (Huiyong & Xinping, 2025) on lexical processing likewise showed unchanged accuracy but reduced reaction speed under stress conditions in students with higher trait anxiety compared to those with lower levels. Accordingly, systematically assessing reaction ability under stress conditions appears meaningful.
Furthermore, although general cognitive ability in individuals with anxiety disorders is on average not impaired compared to healthy individuals (Rabner et al., 2024), it may still be relevant for individual treatment planning and prognosis, as cognitive performance is associated with short- and long-term treatment outcomes (cf. Knekt et al., 2014). Overall, however, findings remain heterogeneous.
Based on this evidence, the SFS Test Solution “Anxiety Disorders – Neurocognitive Assessment” assesses the following cognitive functions:
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Attention
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Processing speed (TMT-S, Part A)
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Ability to concentrate (Selective attention) (TACO)
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Reactive stress tolerance (DT)
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Executive functions
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Cognitive flexibility (TMT-S, Part B)
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Verbal Working Memory (SPAN, Digit span backward)
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Learning and memory
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Verbal short-term memory (SPAN, Digit span forward)
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Logical reasoning (BMT)
The Test Solution “Anxiety Disorders – Neurocognitive Assessment” thus covers central functional domains that may be impaired across different types of anxiety disorders. However, several additional abilities that may also be relevant for clarifying cognitive deficits are not included, such as memory functions beyond working and short-term memory, attentional biases (Castaneda et al., 2008; Ferreri et al., 2011; Millan et al., 2012; O’Sullivan & Newman, 2014; Rabner et al., 2024; Lindert et al., 2021), language (Millan et al., 2012; Rabner et al., 2024), motor skills (Rabner et al., 2024), or social cognition (Gkintoni & Ortiz, 2023). Depending on the assessment purpose, additional procedures outside the SCHUHFRIED Selection may be added, for example to assess figural long-term memory (FGT) or social cognition (TOM). In addition, the GAD-7 (Generalized Anxiety Disorder-7) is available as a free supplementary questionnaire for assessing anxiety-related symptoms (see Open access tests).
Please note that when configuring the test sequence and adding tests that are not part of the SCHUHFRIED Selection, the combined results overview is no longer automatically available (see Notes on evaluation and interpretation).
The duration of the standard form is approximately 46 minutes.
References can be found here: Literature