July 20, 2026
Dear Colleagues,
The National Social Anxiety Center (NSAC) provides information about relevant and current research in service of disseminating and promoting evidence-based treatment. This month’s summary is written by Annika Okamoto, Ph.D., A-CBT of NSAC Santa Barbara. The article, Anxiety and Mentalizing: Uncertainty as a Driver of Egocentrism by Surtees, Briscoe and Todd (2024), examines the relationship between anxiety, social cognition, and the ability to infer the thoughts, feelings, and perspectives of others (mentalizing). The authors propose a bidirectional model for understanding how short-term and longer-term anxiety are related to mentalizing, with uncertainty serving as a central mechanism.
This framework has particular relevance for social anxiety, where distress often arises not only from fear of negative evaluation but from uncertainty about how others are perceiving, interpreting, and responding to us. Socially anxious individuals may frequently be caught in efforts to reduce this uncertainty by closely monitoring social cues, analyzing interactions, and attempting to infer others’ thoughts and intentions: processes that reinforce self-focus and anxiety.
The authors describe two pathways linking anxiety and mentalizing.
1. Anxiety leads to egocentric mentalizing (short-term).
When people are anxious, they tend to temporarily fall back on their own perspective (the “certain” content of their own mind) rather than working out someone else’s (uncertain) mental state. This isn’t fully explained by arousal, self-focus, or general executive-function depletion, but may be triggered by an uncertainty-reduction motive within the anxious appraisal itself. When another person’s thoughts or feelings feel uncertain, relying on one’s own perspective provides a more immediate sense of certainty. In this way, anxiety can temporarily narrow mentalizing and increase reliance on one’s own interpretation of a situation. However, this momentary collapse of the uncertain state into a certain state is not interchangeable with the overall ability to understand others or capacity for empathy.
2. Mentalizing differences contribute to chronic anxiety (long-term).
While much of the research focuses on social anxiety disorder, it is evident that uncertainty underlies the experience of anxiety across many disorders. The research on anxiety and autism is one area that can help us broaden our understanding of the role of mentalization in anxiety disorders. Autistic individuals may experience greater uncertainty due to navigating a social world not designed around their communication style, independent how well or poorly they’d otherwise tolerate ambiguity if the playing field were level. That extra uncertainty comes from two distinct sources, and both feed anxiety over time:
- Being misread by others. Autistic communication styles are often misinterpreted by mainstream communicators (ie. double empathy problem), so the social feedback autistic people get back is less reliable and harder to trust, which is an unstable signal to try to navigate by.
- Knowing your own read might differ from others. Autistic individuals may be aware that their ways of interpreting others’ thoughts, feelings, or intentions may differ from those of others. That awareness can itself become a source of uncertainty and anxiety: the fear of “I might be getting this wrong” when trying to navigate a social situation.
This model may be particularly relevant to social anxiety disorder (SAD), where uncertainty about others’ perceptions and interpretations of social situations plays a central role.
Take-away:
These findings suggest that anxiety, particularly social anxiety, may involve not only fear of negative evaluation but also the ongoing burden of uncertainty when interpreting social situations. For some people, social interactions may require substantial cognitive effort, including piecing together multiple cues, trying to distinguish signal from the noise, and trying to make sense of ambiguous situations. When the need for certainty is high, this effort may contribute to the “overthinking” often seen in social anxiety, particularly when clients attempt to resolve uncertainty by resorting to interpretations. Similar processes may also be relevant beyond formal autism diagnoses, as individuals with heightened sensitivity to details, increased attention to contextual information, or a strong drive to understand social dynamics may become more vulnerable to cycles of analysis and uncertainty.
Clinical Questions:
How can clinicians avoid reducing all socially anxious thinking to “cognitive distortions” and validate the differences that derive from information processing styles? Also, what would be some practical and clever ways to help clients tolerate some ambiguity inherent in social interactions without becoming trapped in efforts to achieve impossible certainty?
Reference:
Surtees ADR, Briscoe H, & Todd AR. (2024). Anxiety and Mentalizing: Uncertainty as a Driver of Egocentrism. Current Directions in Psychological Science, 33 (2), 105–112.
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Annika Okamoto, PhD, A-CBT
Representing NSAC Santa Barbara
(Oceanside Clinics)