A Harvard University study published last July found evidence that people with SAD may also have deficits in “theory of mind,” the ability to discern the mental states of others.5 When researchers compared 40 SAD participants with 40 non-SAD controls, they discovered that “people with social anxiety disorder were more likely to attribute more intense emotions and greater meaning to what others were thinking, feeling and intending,” said study co-author Dianne Hezel, a PhD student in the clinical psychology program at Harvard.

“In other words, they seemed to read too much into what others were thinking or feeling, causing them to ‘misread’ different social situations,” she added. This tendency may also link back to the excessive internal focus and imagery effects found in the other studies.

Continue Reading

Hezel said it’s possible that people with SAD imagine how they might feel in a given situation, rather than paying attention to objective cues about how others actually feel (though she and her colleagues did not test this idea directly). If further research finds support for the role of theory of mind impairments in SAD, therapists could begin targeting these deficits in treatment.

“For example, cognitive remediation therapy — computerized tasks focused on improving cognition and social cognition — has been found to be effective in improving theory of mind abilities in individuals suffering from schizophrenia,” Hezel said. “It is possible that some of these tasks would likewise be helpful for people with social anxiety disorder.”

Tori Rodriguez, MA, LPC, is a psychotherapist and freelancer writer based in Atlanta.


  1. Kley H, et al. Safety behaviors, self-focused attention and negative thinking in children with social anxiety disorder, socially anxious and non-anxious children. Journal of Behavior Therapy and Experimental Psychiatry. 2012; 43(1):548-55.
  2. Mörtberg E, et al. Shifting the Focus of One’s Attention Mediates Improvement in Cognitive Therapy for Social AnxietyBehavioural and Cognitive Psychotherapy. 2015; 43(1):63-73.
  3. Donald J, et al. Comparison of attention training and cognitive therapy in the treatment of social phobia: a preliminary investigation. Behavioural and Cognitive Psychotherapy. 2014; 42(1):74-91.
  4. McEvoy PM, et al. Imagery enhancements increase the effectiveness of cognitive behavioural group therapy for social anxiety disorder: A benchmarking study. Behaviour Research & Therapy. 2015; 65:42-51.
  5. Hezel DM and McNally RJ. Theory of Mind Impairments in Social Anxiety Disorder. Behavior Therapy. 2014; 45(4):530-40.