Summary: New research from Edith Cowan University indicates that acute stress can temporarily disrupt core brain functions responsible for emotion regulation, especially in people experiencing distress-related conditions such as depression, anxiety and borderline personality disorder. The review found that key executive functions—working memory, impulse control, and cognitive flexibility—are more likely to be compromised during high-stress moments in individuals with these symptoms, which may reduce their ability to manage emotions and limit the effectiveness of cognitively demanding therapies.
These findings highlight the possibility that standard treatments like cognitive behavioural therapy (CBT), which require intact executive functioning, may be less effective when clients are under acute stress. The research suggests a need for more adaptive treatment approaches or preparatory strategies to strengthen executive skills before engaging in emotionally challenging therapy work.
Key Facts:
- Working memory vulnerable: Acute stress appears to disrupt working memory performance in people with depressive symptoms.
- Impulse control affected: Response inhibition, which supports self-control, can be impaired under stress in those with borderline personality disorder.
- Therapy implications: Stress-induced deficits in executive functions could reduce the benefit of therapies that rely on cognitive control, such as CBT.
Source: Edith Cowan University
Overview of the ECU study
Researchers at Edith Cowan University, led by Masters student Tee-Jay Scott and Professor Joanne Dickson, reviewed the international literature to examine how acute stress affects executive functions in people with symptoms of depression, generalized anxiety and borderline personality disorder. Contrary to the common notion that stress sharpens focus, the review indicates that short bouts of acute stress may instead disrupt the brain’s executive control processes—those used for planning, problem solving and regulating emotion.
“Executive functions are crucial for managing emotional responses in difficult situations,” said Tee-Jay Scott. “Our review suggests people with distress-related symptoms are particularly vulnerable to disruption of these cognitive processes during acute stress, even when their symptoms do not meet full diagnostic criteria.”
How stress undermines emotional-control mechanisms
Executive functions include working memory (the ability to hold and manipulate information), response inhibition (the capacity to suppress impulsive actions) and cognitive flexibility (the ability to shift strategies or perspectives). These skills enable people to regulate emotions, make adaptive decisions and follow through with coping strategies.
The ECU review synthesized 17 studies published internationally that measured how acute stress affects these executive functions in individuals with symptoms associated with depression, anxiety and borderline personality disorder. Patterns emerged indicating specific vulnerabilities: working memory showed consistent susceptibility to stress in those with depressive symptoms, while response inhibition was more likely to break down under stress in people with borderline personality disorder. Evidence for cognitive flexibility was less consistent across studies.
Implications for therapy and clinical practice
Professor Joanne Dickson noted that these stress-related changes in executive functioning may help explain why some clients do not benefit fully from standard psychotherapies, particularly those that are cognitively demanding such as CBT. “If acute stress is undermining the cognitive tools needed to learn and apply new emotion-regulation strategies, therapy sessions delivered during periods of high distress may be less effective,” she explained.
This insight suggests clinicians might need to consider timing and format when delivering therapy—either by building executive function capacity first, adapting interventions to be less cognitively demanding during high-stress periods, or incorporating stress-management techniques to stabilize cognitive function before tackling intensive therapeutic tasks.
Recommendations and next steps
The authors argue for research and clinical innovation focused on individualized approaches that account for stress-related cognitive vulnerabilities. Future studies should explore which patients are most at risk of stress-induced executive dysfunction, identify reliable markers of vulnerability, and test interventions that either protect executive function during stress or strengthen it beforehand.
“Improving mental health outcomes depends not only on selecting the right therapy but also on delivering it at the right time and in the right way,” said Tee-Jay Scott. Further work is needed to refine treatment strategies and better tailor therapy to clients who are likely to experience acute stress and cognitive disruption.
About this research
Author: Joanne Dickson
Source: Edith Cowan University
Contact: Joanne Dickson – Edith Cowan University
Image: Credit to Neuroscience News
Original Research: Closed access. “Effects of acute stress on executive functions in depression, generalised anxiety and borderline personality disorder” by Joanne Dickson et al., Journal of Affective Disorders Reports.
Abstract
Effects of acute stress on executive functions in depression, generalised anxiety and borderline personality disorder
Background: Acute stress alters executive functions that underpin emotion regulation. Modern dimensional models of psychopathology, including the Hierarchical Taxonomy of Psychopathology (HiTOP) and Research Domain Criteria, emphasise mechanisms shared across disorders. Distress disorders—a HiTOP subfactor including major depression, generalized anxiety disorder and borderline personality disorder—are associated with altered stress reactivity, emotion-regulation problems and limited responsiveness to some first-line psychotherapies. This systematic review examined whether distress disorders and related symptoms increase vulnerability to transient executive-function impairment during acute stress.
Methods: A comprehensive search of ProQuest, PsycINFO, PubMed, Scopus and Web of Science through December 31, 2022 identified 17 studies that tested stress-related changes in working memory, inhibition and cognitive flexibility among people with distress-disorder symptoms.
Results: The review found greater susceptibility to stress-induced working-memory impairment in depressive presentations and to stress-related inhibition deficits in borderline personality disorder. Some evidence showed these effects even for subclinical symptom levels. Results for cognitive flexibility were inconsistent. Heterogeneity in study designs precluded a formal meta-analysis.
Conclusions: Altered stress reactivity appears to disrupt executive functions during acute stress, undermining adaptive emotion-regulation strategies. These disruptions may partly explain reduced responsiveness to therapies that rely on intact cognitive control. The findings point to the need for treatment approaches that consider stress-related cognitive vulnerabilities and, where appropriate, build executive capacities before engaging in demanding therapeutic work.