B4DT Cognitive Behavioral Therapy Has Sustained Treatment Effects in Patients With Panic Disorders

Research findings published in BMC Psychiatry shows that the treatment effects of Bergen 4-day treatment (B4DT), a form of concentrated exposure-based cognitive behavioral therapy (CBT), appear stable over time and seem to be promising for panic disorders. Confirming these preliminary results in further studies will be necessary, but the findings show promise as a means of treating patients with panic disorders.¹

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The study was a retrospective, naturalistic, longer-term follow-up assessment of patients 18 years and older who had received B4DT CBT for their panic disorders between October 2017 and January 2020 at an outpatient clinic. This built upon a previously published study, which reported initial assessments up to a 3-month follow-up and extended the follow-up duration to 18 months. Additionally, this study included all 30 patients from the original cohort.¹

About 66.7% of patients (n = 20) had at least 1 comorbid disorder, and the most common comorbid disorder was recurring and current major depressive disorder (MDD) (57.7%, n = 17). At treatment initiation, about 60% (n = 18) of patients used some form of psychotropic medication, of which the most used medications were selective serotonin reuptake inhibitors (36.7%, n = 11) and benzodiazepines (26.7%, n = 8). B4DT was administered as part of routine clinical care within Norway’s national public health care system. Patients were referred to the outpatient clinic either by their general practitioner or by other qualified mental health specialists.¹

Additionally, patients were invited to a longer-term follow-up session, where difficulties encountered after the treatment could be addressed. The patients also answered self-report measures either online or on paper during the follow-up session. During the longer-term follow-up portion, patients participated in a Panic Disorder Severity Scale (PDSS) interview, which was conducted at an average of 18 months (range: 12–28 months) following the end of treatment.¹

This study, according to the investigators, was the first study to examine the longer-term effectiveness of B4DT when used in patients with panic disorders. Previously, the short-term effectiveness has been demonstrated in several studies, and the format shows it can yield large clinical changes in patients with panic disorders. Specifically, there were low dropout rates and high treatment satisfaction among patients, reported the authors.¹

The authors observed that treatment effects of B4DT CBT were maintained over time. A significant reduction in symptoms of panic disorders from pretreatment to longer-term follow-up was observed (d = 5.03, 95% CI [18.55, 21.12] to [1.33, 3.87]), with results from the 3-month follow-up assessment proving to be statistically indistinguishable from those at longer-term follow-up. This indicates that the treatment gains were maintained, wrote the authors.¹

Notably, the PDSS mean decreased from 19.83 (SD = 0.64, 95% CI [18.55, 21.12]) before treatment to 4.37 (SD = 0.64, 95% CI [2.98, 5.76]) posttreatment, followed by further decreases at the 3-month follow-up to a mean of about 2.84 (SD = 0.64, 95% CI [1.45, 4.22]), and at the longer-term follow-up to 2.60 (SD = 0.64, 95% CI [1.33, 3.87]). The authors did not observe significant differences in symptom severity between the 3- and 18-month assessments, indicating a sustained improvement (p < .001). Additionally, at the 18-month follow-up, approximately 90% of the patients were classified as being in remission. There were also significant reductions in symptoms of depression (d = 1.44) and generalized anxiety (d = 1.62) that were maintained at the longer-term follow-up assessment.¹

"It turns out that the improvement not only persists, but it actually gets stronger over time for many. With long-term follow-up, patients report that they feel even better than immediately after therapy and at the follow-up 3 months after,” project manager and senior author Kristen Hagen, psychologist and associate professor at Norwegian University of Science and Technology, said in a news release. “The fact that patients get even better over time is simply remarkable.”²

REFERENCES

1. Eide TO, Hansen B, Hjelle KM, et al. The bergen 4-day treatment for panic disorder: a longer-term follow-up. BMC Psychiatry. 2025;25(107). doi:10.1186/s12888-025-06527-7

2. Norwegian University of Science and Technology. Treatment for panic disorder has a good long-term effect. News release. May 7, 2025. Accessed May 8, 2025. https://www.eurekalert.org/news-releases/1082674