How Creyos Cognitive Assessments Reveal the Impact of Anxiety

By Dr. Douglas Cowan, Psy.D., MFT

The most common complaint I hear from anxious clients — after they describe the worry, the sleeplessness, the physical tension — is this: I can't think straight anymore.

They forget things they should remember. They have trouble making decisions. They start tasks and can't finish them. They read a paragraph three times and still can't absorb it. They sit in meetings and realize their mind was elsewhere for the last ten minutes without their permission.

People assume this is a character problem — distraction, laziness, weakness. They rarely connect it to their anxiety. But the connection is direct and measurable.

Anxiety doesn't just change how you feel. It changes how your brain works. And when we use validated cognitive assessments to look at an anxious brain performing under cognitive load, what we see confirms what anxious people experience: the system is running under significant handicap.

What's Happening in the Brain

Chronic anxiety triggers three simultaneous neurological events that impair cognitive function.

The first is elevated cortisol. The stress hormone cortisol, chronically elevated in anxiety, is neurotoxic in sustained concentrations. It preferentially damages the hippocampus — the brain's memory-consolidation center — impairing the ability to encode new information and retrieve stored memories accurately. This is why anxious people forget things they should know and misremember conversations they've had.

The second is amygdala hyperactivation. The amygdala, when in high-alert mode, competes for the brain's attentional resources. It is, in effect, continuously scanning for threat — a background process that consumes cognitive bandwidth. This leaves less attentional capacity for the task at hand. The anxious person is simultaneously trying to do the work in front of them and manage a threat-detection system that won't stop running. Something has to give, and it's usually the work.

The third is suppression of prefrontal cortex function. The prefrontal cortex — the brain's executive control system, responsible for planning, decision-making, impulse inhibition, working memory, and cognitive flexibility — loses regulatory authority when the amygdala is dominant. Under high anxiety, the prefrontal cortex is functionally compromised. Executive function declines. Working memory narrows. Response inhibition weakens.

The result is a brain that is intelligent, capable, and experienced — but cognitively constrained by its own alarm system.

Now You Understand Why

Creyos (formerly Cambridge Brain Sciences) offers a battery of twelve validated cognitive tasks that assess a specific set of cognitive domains: working memory, episodic memory, attention, response inhibition, processing speed, and spatial reasoning. These are not general intelligence tests. They are precision tools that measure the specific functions most vulnerable to anxiety's effects.

When I use Creyos assessments with anxious clients, the patterns are consistent and clinically revealing.

Double Trouble (response inhibition) — Anxious individuals often show slower response times and more errors on tasks that require suppressing an automatic response. Racing thoughts and emotional interference slow the decision to override the habitual pattern.

Feature Match (sustained attention) — Anxiety degrades sustained attention. The anxious brain is not fully present on the task because it is simultaneously monitoring for threat. Errors increase and response times slow in ways that don't reflect the person's actual cognitive capacity — they reflect the cost of divided attention.

Spatial Planning — Analysis paralysis is real and measurable. Anxious clients show hesitation, second-guessing, and excessive caution on planning tasks. They know what to do but can't commit to the sequence.

Paired Associates (episodic memory) — Encoding and retrieval are both impaired when attention is divided and cortisol is elevated. Anxious clients frequently show memory deficits on this task that resolve significantly when their anxiety is treated.

Reaction Time — May go in either direction: slowed by caution and inhibition, or accelerated and error-prone when the nervous system is in hyperdrive. Both patterns are clinically meaningful.

The overall picture in anxiety tends to be a mild depression of scores across multiple domains — not the dramatic, domain-specific pattern typical of ADHD, but a global dampening of cognitive performance that reflects a brain operating under burden. This is meaningfully different from ADHD, and the distinction matters for treatment.

Anxious individuals tend to be slower but more consistent — perfectionistic, cautious, avoiding errors even at the cost of speed. ADHD produces more variable, impulsive patterns — inconsistent accuracy, errors of commission, dramatic within-session variability. When both are present (and they frequently are — anxiety and ADHD co-occur in roughly 50% of cases), the Creyos profile becomes more complex and the clinical interpretation requires careful attention to which pattern is driving which scores.

Combining Creyos data with the GAD-7 (the validated anxiety symptom scale available as a tool on this site) gives a clearer clinical picture: the GAD-7 quantifies the subjective anxiety experience, and the Creyos profile reveals its cognitive footprint. A client reporting a GAD-7 score of 10 and showing depressed Feature Match and Paired Associates scores isn't just anxious — they're showing us exactly where the anxiety is costing them cognitively, which helps prioritize treatment and track improvement over time.

What Wisdom Looks Like Here

The clinical wisdom in using cognitive assessments with anxious clients is that it removes the ambiguity from the conversation about cognitive symptoms.

When an anxious person tells me they can't think clearly, I can now show them what that looks like in measurable terms — and more importantly, I can show them when it improves. Watching their Creyos scores move as their anxiety responds to treatment is motivating in a way that subjective self-report alone rarely achieves. It converts the vague experience of "feeling less anxious" into visible evidence that the brain is working better.

It also provides specificity. Not all anxious brains look the same on cognitive assessment. Someone whose primary impairment is attention will benefit most from approaches that directly reduce sympathetic arousal — breathing practices, neurofeedback, CES. Someone whose primary impairment is memory encoding may need more aggressive intervention on sleep and cortisol regulation. The cognitive profile informs the treatment priority.

For athletes, business leaders, students, and professionals — people for whom cognitive performance is professionally critical — this specificity matters enormously. These are people who can feel the cost of anxiety in their performance, who want objective data about what's happening, and who respond well to the performance-based frame: we're going to measure where you are now, apply the right interventions, and track improvement. That is exactly what the Creyos assessment combined with targeted anxiety treatment allows.

What To Do Starting Today

• If you are a clinician working with anxious clients, add cognitive assessment to your intake process. A Creyos battery at intake provides a baseline that serves as both a diagnostic tool and a treatment benchmark. Re-assessment after eight to twelve weeks of treatment quantifies improvement objectively — often revealing cognitive gains that the client hasn't fully noticed yet because they emerged gradually.

• If you are an anxious person experiencing cognitive symptoms, name them specifically when you talk to your provider. "I can't think clearly" is too vague to drive treatment planning. "I forget conversations from the previous day, I can't sustain attention for more than ten minutes in meetings, and I'm making more errors in decision-making than I was a year ago" — that is specific. That gives your provider something to work with.

• Understand that cognitive impairment from anxiety is reversible. This is the most important thing to know. The cognitive costs of anxiety are not permanent. As anxiety is treated — through whatever combination of approaches is appropriate for the individual — cognitive performance recovers. The brain that was running under a burden runs better when the burden is lifted. I have watched this happen consistently across forty years of clinical practice.

• Track your cognitive symptoms alongside your anxiety symptoms. The same weekly self-check that tracks anxiety level (0 to 10 scale) can include specific cognitive markers: "How many times did I forget something I should have remembered? How often did I find myself unable to sustain focus? How confident was I in my decisions?" This builds an objective record that complements clinical assessment.

• Don't mistake anxiety's cognitive cost for an intelligence deficit. The anxious brain is not less intelligent than the calm brain. It is more burdened. The intelligence is there. The access to it is temporarily blocked by the alarm system. Treating the alarm treats the access problem. The capacity was always there.

What anxiety costs cognitively is real. What treatment returns is equally real. Those two facts together are the foundation of a credible reason to get help — and to keep going until you find the combination that works.

The brain you were born with is still in there. Let's clear the interference and let it work.

References

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