Chess in Mental Health: Therapeutic Potential and Neurocognitive Mechanisms—A Systematic Review

Objective Chess is an ancient game with simple rules but high cognitive demands. This review examined chess as a cognitive tool for patients with mental disorders and explored the cognitive mechanisms and neural structures that may underlie its effects. Method A systematic review of studies was conducted following PRISMA guidelines. Searches were performed in PubMed, PsycInfo, and Google Scholar. Eligibility criteria included studies involving human participants and study designs such as narrative texts, case reports, pilot studies, descriptive and analytical observational studies, quasi‐experiments, trials, and meta‐analyses. Studies were classified by level of evidence and assessed for risk of bias using ROBINS‐I and RoB 2. Results Ninety three studies met the inclusion criteria. Chess‐based interventions were implemented in clinical and healthcare settings for therapeutic and assessment purposes. Outcomes mainly targeted cognitive and emotional domains, with recurrent applications in older adults and individuals with ADHD. Across studies, chess‐based activities were associated with changes in attention, executive functions, and emotional regulation, although outcomes and methodologies varied substantially. Neuroimaging evidence points to structural and functional adaptations in chess experts, with reduced gray matter volume but enhanced connectivity of the caudate nucleus, consistent with neural efficiency rather than neural expansion. Conclusion The literature suggests that chess may have potential as a cognitive tool in certain mental health conditions; however, the overall level of evidence remains low. Most studies are limited by small sample sizes, non‐blinded designs, high risk of bias, and the frequent absence of active control groups. Well‐designed, adequately powered randomized controlled trials are required to determine clinically meaningful benefits.