Risk profiles for poor treatment response to internet-delivered CBT in people with social anxiety disorder

• It is important to investigate the heterogeneity in treatment response.
• In internet CBT of SAD we found a high-problem profile of avoidance and depression.
• Individuals in the high-problem profile showed less remission after treatment.
• People typically remained in the high-problem profile after treatment.
• The profile constituted a risk profile for poor treatment response in people with SAD.

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.