title: Risk profiles for poor treatment response to internet-delivered CBT in people with social anxiety disorder.
abstract: In social anxiety disorder (SAD) co-morbid depressive symptoms as well as avoidance behaviors have been shown to predict insufficient treatment response. It is likely that subgroups of individuals with different profiles of risk factors for poor treatment response exist. This study aimed to identify subgroups of social avoidance and depressive symptoms in a clinical sample (N = 167) with SAD before and after guided internet-delivered CBT, and to compare these groups on diagnostic status and social anxiety. We further examined individual movement between subgroups over time. Using cluster analysis we identified four subgroups, including a high-problem cluster at both time-points. Individuals in this cluster showed less remission after treatment, exhibited higher levels of social anxiety at both assessments, and typically remained in the high-problem cluster after treatment. Thus, in individuals with SAD, high levels of social avoidance and depressive symptoms constitute a risk profile for poor treatment response.
authors.affiliation: Center for Health and Medical Psychology, JPS, Psychology, Örebro University, Sweden. Electronic address: maria.tillfors@oru.se.
authors.forename: Maria
authors.initials: M
authors.lastname: Tillfors
authors.affiliation: Department of Psychology, Uppsala University, Sweden.
authors.forename: Tomas
authors.initials: T
authors.lastname: Furmark
authors.affiliation: Department of Psychology, Stockholm University, Sweden.
authors.forename: Per
authors.initials: P
authors.lastname: Carlbring
authors.affiliation: Department of Behavioural Sciences and Learning, Linköping University, Sweden; Department of Clinical Neuroscience, Psychiatry Section, Karolinska Institutet, Stockholm, Sweden.
authors.forename: Gerhard
authors.initials: G
authors.lastname: Andersson
mesh_terms: D000328:Adult; D001362:Avoidance Learning; D016000:Cluster Analysis; D015928:Cognitive Behavioral Therapy / Q000379:methods*; D003863:Depression / Q000150:complications / Q000523:psychology / Q000628:therapy; D005260:Female; D006801:Humans; D020407:Internet; D008297:Male; D010698:Phobic Disorders / Q000150:complications / Q000523:psychology / Q000628:therapy*; D011446:Prospective Studies; D011569:Psychiatric Status Rating Scales; D016032:Randomized Controlled Trials as Topic; D012307:Risk Factors; D016896:Treatment Outcome
keywords: Cluster analysis; Depressive symptoms; Guided internet-based CBT; Risk factors; Social anxiety disorder; Social avoidance