Predictors of Change in Treatment Response to Group-Based Cognitive Behavioral Therapy for Adolescents with Social Anxiety Disorder

Research indicates that remission rates for social anxiety disorder are significantly lower (35%) than for any other anxiety disorder (54%) following cognitive behavioral therapy (CBT). Nevertheless, CBT remains the recommended treatment for adolescents with social anxiety disorder. The literature shows limited knowledge regarding which adolescents with primary social anxiety disorder respond better or worse to group-based cognitive-behavioral therapy (CBT). The current study aimed to identify baseline predictors of change in treatment response from group-based CBT for 90 adolescents aged 12-17 years with a primary diagnosis of social anxiety disorder. Treatment response was evaluated as changes from baseline to three-month follow-up in self-reported social anxiety symptoms and clinician-rated social anxiety diagnosis. The examined predictors were as follows: Demographic predictors included age, gender, and parents' education level. Clinical predictors included social anxiety symptoms, anxiety symptoms, interference in daily life, depressive symptoms, parents' overall anxiety, depression, and stress level. Theory-derived predictors were based on theoretically maintaining factors of social anxiety disorder and included safety behaviors, self-focused attention, post-event processing, and distorted cognitions. Mixed linear models were applied to analyze the predictor's effect on each outcome variable over time. Results indicated that higher severity of safety behaviors and social anxiety symptoms at baseline predicted larger improvement in self-reported social anxiety symptoms. Moreover, higher severity of social anxiety symptoms and anxiety symptoms predicted less likelihood of being free of social anxiety diagnosis. None of the other variables predicted significant change in either self-reported social anxiety symptoms or clinician-rated social anxiety diagnosis. In conclusion, the findings indicate that adolescents with a high degree of safety behaviors and social anxiety symptoms improved the most from group-based CBT, but also, that high baseline symptom severity remains elevated and have an increased risk of a social anxiety diagnosis at three-month follow-up. However, replication of these findings is needed in more sufficient powered trials.