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gasemi M, Mansouriyeh N. Comparison of Reflexive Saccadic Inhibition, Working Memory, and Cognitive Functions in Patients with Generalized Anxiety Disorder and Healthy Control. TB 2025; 24 (6) :65-79
URL: http://tbj.ssu.ac.ir/article-1-3863-en.html
URL: http://tbj.ssu.ac.ir/article-1-3863-en.html
tabriz , n.mansoreye1984@gmail.com
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Comparison of Reflexive Saccadic Inhibition, Working Memory, and Cognitive Functions in Patients with Generalized Anxiety Disorder and Healthy Control
Mahdi Ghasemi (M.Sc.)1, Nastaran Mansouriyeh(Ph.D.) 2
1.Master of Clinical Psychology, Department of clinical psychology, TaMS.C., Islamic Azad University, Tabriz, Iran.
2.Corresponding author: Assistant Professor, Neuroscience Research center, TaMS.C., Islamic Azad University, Tabriz, Iran. Email:Nastaran.mansourieh@iau.ac.ir Tel:09143167995
Abstract
Introduction: Reflexive saccade inhibition, working memory, and cognitive functioning represent core neurocognitive domains that may distinguish anxious individuals from their healthy counterparts. Therefore, the aim of this study was to compare reflexive saccade inhibition, working memory and cognitive functions in patients with generalized anxiety disorder and healthy individuals.
Methods: This research was a descriptive-cross-sectional study of a causal comparative type. A sample of 90 people from the statistical population of all patients with generalized anxiety disorder and normal individuals in Tabriz city in 2023 was selected through convenience sampling and placed into two groups of patients with generalized anxiety disorder and normal individual. Research tools were anti-saccade task questionnaires, digit recall test and executive function index. The mean and standard deviation were used to describe the data, and the multivariate analysis of variance method was used for analysis, which was performed using SPSS software version 24.
Results: According to the results, there is a difference between reflexive saccade inhibition, working memory, and strategic planning between patients with generalized anxiety disorder and normal individuals (p≥0/01). There is no difference in terms of motivational drive between patients with generalized anxiety disorder and normal individuals (p<0/05). There is a difference in terms of inhibitory control between patients with generalized anxiety disorder and normal individuals (p≥0/05). There is no difference in terms of empathy between patients with generalized anxiety disorder and normal individuals (p<0/05).
Conclusion: Patients with generalized anxiety disorder face deficiencies in reflexive saccade inhibition and working memory; therefore, targeted assessment and interventions in these neuropsychological functions can help improve, diagnose, and treat these patients.
Keywords: Generalized anxiety disorder, Memory, Cognition, Saccades
Conflict of interest: The authors declared no conflict of interest.
References
1-Mokhtari S, Mokhtari A, Saeed F & et al. Cognitive rehabilitation in anxiety disorders: a systematic review and meta-analysis of randomized controlled trials. Sci Rep. 2025;3;15(1):38420.
2-Isakulyan EL, Marachev MP. Features of cognitive functions in generalized anxiety disorder: narrative review. Eur Psychiatry. 2024;27;67(Suppl 1):S424–5
3-Javaid SF, Hashim IJ, Hashim MJ & et al. Epidemiology of anxiety disorders: global burden and sociodemographic associations. Middle East Current Psychiatry. 2023 ;26;30(1):44.
4-Szuhany KL, Simon NM. Anxiety disorders: a review. Jama. 2022; 27;328(24):2431-45.
5-Stawinska-Witoszynska B, Czechowska K, Moryson W & et al. The prevalence of generalised anxiety disorder among prisoners of the penitentiary institution in north-eastern Poland. Frontiers in Psychiatry. 2021 ;14;12:671019.
6-Papola D, Miguel C, Mazzaglia M & et al. Psychotherapies for generalized anxiety disorder in adults: a systematic review and network meta-analysis of randomized clinical trials. JAMA psychiatry. 2024 Mar;81(3):250-9.
7-Gkintoni E, Ortiz PS. Neuropsychology of generalized anxiety disorder in clinical setting: a systematic evaluation. InHealthcare 2023; 11, 2446..
8-Kahlon SK, Ali Z, Pritchard E & et al. Neural abnormalities associated with generalized anxiety disorder: a meta-analysis of functional magnetic resonance imaging activation studies. European Psychiatry. 2023;66(S1):S452.
9-Pokorny L, Biermann L, Breitinger E & et al. Young Adults with Anxiety Disorders Show Reduced Inhibition in the Dorsolateral Prefrontal Cortex at Higher Trait Anxiety Levels: A TMS‐EEG Study. Depression and anxiety. 2024; (1):2758522.
10-Esmaili M, Farhud D, Poushaneh K & et al. Executive functions: inferences from behavior, brain and genetics. 2022. 4(15): 301-311
11-Kenwood MM, Kalin NH, Barbas H. The prefrontal cortex, pathological anxiety, and anxiety disorders. Neuropsychopharmacology. 2022;47:260-75.
12-Majeed NM, Chua YJ, Kothari M & et al. Anxiety disorders and executive functions: A three-level meta-analysis of reaction time and accuracy. Psychiatry Research Communications. 2023;1;3(1):100100.
13-Zainal NH, Newman MG. Executive Functioning Constructs in Anxiety, Obsessive-Compulsive, Post-Traumatic Stress, and Related Disorders. Curr Psychiatry Rep. 2022;24(12):871-880.
14-Wei H, Oei TP, Zhou R. Test anxiety impairs inhibitory control processes in a performance evaluation threat situation: Evidence from ERP. Biological Psychology. 2022; 1;168:108241.
15-Jiang J, Zhu Y, Rodriguez MA & et al. Social anxiety does not impair attention inhibition: An emotion anti-saccade task. Journal of Behavior Therapy and Experimental Psychiatry. 2022;77:101776.
16-Wang YL, Kapoor M, Fielding J & et al. Saccadic eye movements in neurological disease: cognitive mechanisms and clinical applications. Journal of Neurology. 2025 Aug;272(8):539.
17-Basanovic J, Todd J, Van Bockstaele B & et al. Assessing anxiety-linked impairment in attentional control without eye-tracking: The masked-target antisaccade task. Behavior Research Methods. 2023 Jan;55(1):135-42.
18-Basanovic J, Todd J, van Bockstaele B & et al. Assessing anxiety-linked impairment in attentional control without eye-tracking: The masked-target antisaccade task. Behav Res Methods. 2023 Ja;55(1):135-142.
19-Krasovskaya S, Kristjánsson Á, MacInnes WJ. Microsaccade rate activity during the preparation of pro-and antisaccades. Attention, Perception, & Psychophysics. 2023 Oct;85(7):2257-76.
20-Todd J, Notebaert L, Clarke PJ. The association between self-report and behavioural measure of attentional control: Evidence of no relationship between ACS scores and antisaccade performance. Personality and Individual Differences. 2022;184:111168.
21-Opwonya J, Wang C, Jang KM & et al. Inhibitory Control of Saccadic Eye Movements and Cognitive Impairment in Mild Cognitive Impairment. Front Aging Neurosci. 2022;14:871432.
22-Li Y, Ouyang G. What is Working Memory? Can It be Improved? How Would This Go?. Journal of Cognitive Enhancement. 2026; 7:1-23.
23-Ward DM. The Influence of Working Memory and Anxiety in Adolescents.2022.
24-Nguyen L, Walters J, Hutchinson E & et al. Executive functioning in individuals with generalized anxiety disorder: A systematic review and meta-analysis. Journal of Affective Disorders. 2025 ;15;389:119683.
25-Nyberg J, Henriksson M, Wall A & et al. Anxiety severity and cognitive function in primary care patients with anxiety disorder: a cross-sectional study. BMC psychiatry. 2021;21:1-3.
26-Jacobs DS, Bogachuk AP, Moghaddam B. Orbitofrontal and prelimbic cortices serve complementary roles in adapting reward seeking to learned anxiety. Biological psychiatry. 2024 Nov 1;96(9):727-38.
27-Delavar A. Applied probability and statistics in psychology and educational sciences. Tehran: Roshd publication. 2014.
28-Płomecka MB, Barańczuk-Turska Z, Pfeiffer C & et al. Aging effects and test–retest reliability of inhibitory control for saccadic eye movements. eneuro. 2020 ;1;7(5).
29-Mehdizadeh Fanid L, Bayrami M, Sabouri Moghaddam H & et al. Effectiveness of Brainwave Entrainment in Alpha Band on Working Memory, Anti-Saccade and Anxiety Level of Anxious Participants. Journal of Psychological Studies. 2023;19:7-20.
30-Mehdizadeh Fanid L, Birami, M, Nikzad B & et al. The Effect of Auditory Brain Stimulation on Cognitive Function Improvement: A Study on Working Memory and Cognitive Flexibility in Adults With Early-Stage Alzheimer’s. The Scientific Journal of Rehabilitation Medicine, 2025; 14(5): 762-773.
31-Spinella M. Self-rated executive function: Development of the executive function index. International Journal of Neuroscience. 2005;115:649-67.
32-Ahmadi E, Bafande K, Hassan Dadashi S. Neuropsychological evaluations and cognitive tests. Tabriz: Science and Health Publications. 2016.
33-Baranovichi J, Todd J, Van Bockstaele B & et al. Assessing anxiety-linked impairment in attentional control without eye-tracking: The masked-target antisaccade task. Behavior Research Methods. 2023;55:135-42.
34-Todd J, Notebaert L, Clarke PJ. Does the attentional control scale measure attentional control? Evidence of no relationship with antisaccade performance. 2020; 1-19.
35-Liang CW. Attentional control deficits in social anxiety: Investigating inhibition and shifting functions using a mixed antisaccade paradigm. Journal of behavior therapy and experimental psychiatry. 2018; 60:46-52.
36-Spalding DM, Obonsawin M, Eynon C & et al. Impacts of trait anxiety on visual working memory, as a function of task demand and situational stress. Cognition and Emotion. 2021 2;35(1):30-49.
37-Eysenck MW, Moser JS, Derakshan N & et al. A neurocognitive account of attentional control theory: how does trait anxiety affect the brain's attentional networks? Cogn Emot. 2023;37(2):220-237.
38-Leonard SJ, Santos FH. Diverging roles of domain-specific anxieties in number-space associations. Insights from a multi-directional number line paradigm. Psychological Research. 2025;89(5):149.
39-Gkintoni E, Ortiz PS. Neuropsychology of generalized anxiety disorder in clinical setting: a systematic evaluation. InHealthcare 2023;17: 2446.
40-Orm S, Wood J, Fossum IN & et al. Within-Person Effects of Executive Functioning on Anxiety and Depressive Symptoms in Youth with Neurodevelopmental Disorders: A Longitudinal Study. Advances in Neurodevelopmental Disorders. 2025;9(4):554-67.
Mahdi Ghasemi (M.Sc.)1, Nastaran Mansouriyeh(Ph.D.) 2
1.Master of Clinical Psychology, Department of clinical psychology, TaMS.C., Islamic Azad University, Tabriz, Iran.
2.Corresponding author: Assistant Professor, Neuroscience Research center, TaMS.C., Islamic Azad University, Tabriz, Iran. Email:Nastaran.mansourieh@iau.ac.ir Tel:09143167995
Abstract
Introduction: Reflexive saccade inhibition, working memory, and cognitive functioning represent core neurocognitive domains that may distinguish anxious individuals from their healthy counterparts. Therefore, the aim of this study was to compare reflexive saccade inhibition, working memory and cognitive functions in patients with generalized anxiety disorder and healthy individuals.
Methods: This research was a descriptive-cross-sectional study of a causal comparative type. A sample of 90 people from the statistical population of all patients with generalized anxiety disorder and normal individuals in Tabriz city in 2023 was selected through convenience sampling and placed into two groups of patients with generalized anxiety disorder and normal individual. Research tools were anti-saccade task questionnaires, digit recall test and executive function index. The mean and standard deviation were used to describe the data, and the multivariate analysis of variance method was used for analysis, which was performed using SPSS software version 24.
Results: According to the results, there is a difference between reflexive saccade inhibition, working memory, and strategic planning between patients with generalized anxiety disorder and normal individuals (p≥0/01). There is no difference in terms of motivational drive between patients with generalized anxiety disorder and normal individuals (p<0/05). There is a difference in terms of inhibitory control between patients with generalized anxiety disorder and normal individuals (p≥0/05). There is no difference in terms of empathy between patients with generalized anxiety disorder and normal individuals (p<0/05).
Conclusion: Patients with generalized anxiety disorder face deficiencies in reflexive saccade inhibition and working memory; therefore, targeted assessment and interventions in these neuropsychological functions can help improve, diagnose, and treat these patients.
Keywords: Generalized anxiety disorder, Memory, Cognition, Saccades
Conflict of interest: The authors declared no conflict of interest.
References
1-Mokhtari S, Mokhtari A, Saeed F & et al. Cognitive rehabilitation in anxiety disorders: a systematic review and meta-analysis of randomized controlled trials. Sci Rep. 2025;3;15(1):38420.
2-Isakulyan EL, Marachev MP. Features of cognitive functions in generalized anxiety disorder: narrative review. Eur Psychiatry. 2024;27;67(Suppl 1):S424–5
3-Javaid SF, Hashim IJ, Hashim MJ & et al. Epidemiology of anxiety disorders: global burden and sociodemographic associations. Middle East Current Psychiatry. 2023 ;26;30(1):44.
4-Szuhany KL, Simon NM. Anxiety disorders: a review. Jama. 2022; 27;328(24):2431-45.
5-Stawinska-Witoszynska B, Czechowska K, Moryson W & et al. The prevalence of generalised anxiety disorder among prisoners of the penitentiary institution in north-eastern Poland. Frontiers in Psychiatry. 2021 ;14;12:671019.
6-Papola D, Miguel C, Mazzaglia M & et al. Psychotherapies for generalized anxiety disorder in adults: a systematic review and network meta-analysis of randomized clinical trials. JAMA psychiatry. 2024 Mar;81(3):250-9.
7-Gkintoni E, Ortiz PS. Neuropsychology of generalized anxiety disorder in clinical setting: a systematic evaluation. InHealthcare 2023; 11, 2446..
8-Kahlon SK, Ali Z, Pritchard E & et al. Neural abnormalities associated with generalized anxiety disorder: a meta-analysis of functional magnetic resonance imaging activation studies. European Psychiatry. 2023;66(S1):S452.
9-Pokorny L, Biermann L, Breitinger E & et al. Young Adults with Anxiety Disorders Show Reduced Inhibition in the Dorsolateral Prefrontal Cortex at Higher Trait Anxiety Levels: A TMS‐EEG Study. Depression and anxiety. 2024; (1):2758522.
10-Esmaili M, Farhud D, Poushaneh K & et al. Executive functions: inferences from behavior, brain and genetics. 2022. 4(15): 301-311
11-Kenwood MM, Kalin NH, Barbas H. The prefrontal cortex, pathological anxiety, and anxiety disorders. Neuropsychopharmacology. 2022;47:260-75.
12-Majeed NM, Chua YJ, Kothari M & et al. Anxiety disorders and executive functions: A three-level meta-analysis of reaction time and accuracy. Psychiatry Research Communications. 2023;1;3(1):100100.
13-Zainal NH, Newman MG. Executive Functioning Constructs in Anxiety, Obsessive-Compulsive, Post-Traumatic Stress, and Related Disorders. Curr Psychiatry Rep. 2022;24(12):871-880.
14-Wei H, Oei TP, Zhou R. Test anxiety impairs inhibitory control processes in a performance evaluation threat situation: Evidence from ERP. Biological Psychology. 2022; 1;168:108241.
15-Jiang J, Zhu Y, Rodriguez MA & et al. Social anxiety does not impair attention inhibition: An emotion anti-saccade task. Journal of Behavior Therapy and Experimental Psychiatry. 2022;77:101776.
16-Wang YL, Kapoor M, Fielding J & et al. Saccadic eye movements in neurological disease: cognitive mechanisms and clinical applications. Journal of Neurology. 2025 Aug;272(8):539.
17-Basanovic J, Todd J, Van Bockstaele B & et al. Assessing anxiety-linked impairment in attentional control without eye-tracking: The masked-target antisaccade task. Behavior Research Methods. 2023 Jan;55(1):135-42.
18-Basanovic J, Todd J, van Bockstaele B & et al. Assessing anxiety-linked impairment in attentional control without eye-tracking: The masked-target antisaccade task. Behav Res Methods. 2023 Ja;55(1):135-142.
19-Krasovskaya S, Kristjánsson Á, MacInnes WJ. Microsaccade rate activity during the preparation of pro-and antisaccades. Attention, Perception, & Psychophysics. 2023 Oct;85(7):2257-76.
20-Todd J, Notebaert L, Clarke PJ. The association between self-report and behavioural measure of attentional control: Evidence of no relationship between ACS scores and antisaccade performance. Personality and Individual Differences. 2022;184:111168.
21-Opwonya J, Wang C, Jang KM & et al. Inhibitory Control of Saccadic Eye Movements and Cognitive Impairment in Mild Cognitive Impairment. Front Aging Neurosci. 2022;14:871432.
22-Li Y, Ouyang G. What is Working Memory? Can It be Improved? How Would This Go?. Journal of Cognitive Enhancement. 2026; 7:1-23.
23-Ward DM. The Influence of Working Memory and Anxiety in Adolescents.2022.
24-Nguyen L, Walters J, Hutchinson E & et al. Executive functioning in individuals with generalized anxiety disorder: A systematic review and meta-analysis. Journal of Affective Disorders. 2025 ;15;389:119683.
25-Nyberg J, Henriksson M, Wall A & et al. Anxiety severity and cognitive function in primary care patients with anxiety disorder: a cross-sectional study. BMC psychiatry. 2021;21:1-3.
26-Jacobs DS, Bogachuk AP, Moghaddam B. Orbitofrontal and prelimbic cortices serve complementary roles in adapting reward seeking to learned anxiety. Biological psychiatry. 2024 Nov 1;96(9):727-38.
27-Delavar A. Applied probability and statistics in psychology and educational sciences. Tehran: Roshd publication. 2014.
28-Płomecka MB, Barańczuk-Turska Z, Pfeiffer C & et al. Aging effects and test–retest reliability of inhibitory control for saccadic eye movements. eneuro. 2020 ;1;7(5).
29-Mehdizadeh Fanid L, Bayrami M, Sabouri Moghaddam H & et al. Effectiveness of Brainwave Entrainment in Alpha Band on Working Memory, Anti-Saccade and Anxiety Level of Anxious Participants. Journal of Psychological Studies. 2023;19:7-20.
30-Mehdizadeh Fanid L, Birami, M, Nikzad B & et al. The Effect of Auditory Brain Stimulation on Cognitive Function Improvement: A Study on Working Memory and Cognitive Flexibility in Adults With Early-Stage Alzheimer’s. The Scientific Journal of Rehabilitation Medicine, 2025; 14(5): 762-773.
31-Spinella M. Self-rated executive function: Development of the executive function index. International Journal of Neuroscience. 2005;115:649-67.
32-Ahmadi E, Bafande K, Hassan Dadashi S. Neuropsychological evaluations and cognitive tests. Tabriz: Science and Health Publications. 2016.
33-Baranovichi J, Todd J, Van Bockstaele B & et al. Assessing anxiety-linked impairment in attentional control without eye-tracking: The masked-target antisaccade task. Behavior Research Methods. 2023;55:135-42.
34-Todd J, Notebaert L, Clarke PJ. Does the attentional control scale measure attentional control? Evidence of no relationship with antisaccade performance. 2020; 1-19.
35-Liang CW. Attentional control deficits in social anxiety: Investigating inhibition and shifting functions using a mixed antisaccade paradigm. Journal of behavior therapy and experimental psychiatry. 2018; 60:46-52.
36-Spalding DM, Obonsawin M, Eynon C & et al. Impacts of trait anxiety on visual working memory, as a function of task demand and situational stress. Cognition and Emotion. 2021 2;35(1):30-49.
37-Eysenck MW, Moser JS, Derakshan N & et al. A neurocognitive account of attentional control theory: how does trait anxiety affect the brain's attentional networks? Cogn Emot. 2023;37(2):220-237.
38-Leonard SJ, Santos FH. Diverging roles of domain-specific anxieties in number-space associations. Insights from a multi-directional number line paradigm. Psychological Research. 2025;89(5):149.
39-Gkintoni E, Ortiz PS. Neuropsychology of generalized anxiety disorder in clinical setting: a systematic evaluation. InHealthcare 2023;17: 2446.
40-Orm S, Wood J, Fossum IN & et al. Within-Person Effects of Executive Functioning on Anxiety and Depressive Symptoms in Youth with Neurodevelopmental Disorders: A Longitudinal Study. Advances in Neurodevelopmental Disorders. 2025;9(4):554-67.
Type of Study: Research |
Subject:
Psychology
Received: 2025/10/31 | Accepted: 2025/12/2 | Published: 2025/09/1
Received: 2025/10/31 | Accepted: 2025/12/2 | Published: 2025/09/1
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