Mentalization and Emotion Regulation Difficulties in Adolescent Girls With Social Anxiety Disorder

Social anxiety disorder (SAD) is a prevalent disorder that often begins during adolescence, leading to considerable challenges in social functioning and overall mental health. Previous studies have demonstrated that mentalization deficits and emotion regulation difficulties are each independently associated with social anxiety. The present study aimed to concurrently examine the associations of emotion regulation difficulties and mentalization deficits with SAD in adolescent girls.

The study sample consisted of 105 adolescent girls, conducted in Türkiye, including 69 treatment-naïve adolescents diagnosed with SAD without psychiatric comorbidities and 36 healthy controls. Mentalization was assessed by the Movie for the Assessment of Social Cognition (MASC) and Reading the Mind in the Eyes Test (RMET). All participants filled in the Social Anxiety Scale for Adolescents (SAS-A) and Difficulties in Emotion Regulation Scale (DERS).

Compared with healthy controls, adolescents with SAD demonstrated lower general mentalizing ability, higher levels of hypermentalizing errors, and greater difficulties in emotion regulation (p < 0.001). Within the SAD group, none of the mentalization measures were directly associated with symptom severity. Lower levels of no-mentalizing were associated with greater emotion regulation difficulties (β = -0.24, p = 0.04), and greater emotion regulation difficulties were associated with higher social anxiety symptoms (β = 0.35, p < 0.01); however, the indirect effect of no-mentalizing on social anxiety symptoms through emotion regulation difficulties was not statistically significant (β = -0.09, 95% CI [-0.21, 0.01]).

The present findings suggest that mentalization and emotion regulation processes may contribute to a more comprehensive understanding and addressing of SAD in adolescents.