Exploration of the relationship between social cognition and PTSD

Student thesis: Doctoral ThesisDoctor of Philosophy (PhD)


Social cognition is the ability to recognise the emotions, actions and intentions in oneself and others, and can be divided into emotion recognition, social knowledge, attribution and mentalization. The social-cognitive hypothesis of PTSD proposes that problems with social cognition occur due to attachment insecurity in childhood, which then predisposes people to developing PTSD. I use three studies (one case-control, two longitudinal) to examine whether problems with social cognition are associated with trauma and PTSD, and whether baseline social cognitive ability is associated with impaired response to PTSD treatments. I also look at the relationship between attachment, social cognition, trauma and PTSD using mediation analyses.

I undertook two preliminary studies (one qualitative, one feasibility) to identify measures that would work well together in a social cognition battery suitable for a clinical population. Main Studies 1 and 2 both examined whether social cognition is associated with trauma and PTSD using different methodologies. Study 1 was a case-control study of 171 participants. Study 2 was a longitudinal study using imputed data from the ALSPAC study, n=4086. Study 3 (ongoing) was a longitudinal study exploring whether social cognitive ability at treatment baseline is associated with response to PTSD treatment using 60 participants.

Study 1: hypomentalization and hypermentalization measures were associated with increased odds of PTSD. Trauma partially mediated the relationship between mentalization and PTSD.
Study 2: two out of three social cognition measures were associated with increased odds of trauma and PTSD. Trauma partially mediated the relationship between mentalization and PTSD.
Study 3: after adjusting for confounders, a measure of mentalization was associated with reduced odds of PTSD remission.

These findings suggest that problems with mentalization increase the likelihood of PTSD. I found little evidence that difficulties with social cognition impair PTSD treatment response, but Study 3 is incomplete.

Date of Award7 May 2024
Original languageEnglish
Awarding Institution
  • University of Bristol
SupervisorStanley Zammit (Supervisor) & Andrew Lawrence (Supervisor)


  • social cognition
  • PTSD

Cite this