BACKGROUND:The Bergen 4-Day Treatment (B4DT) is a concentrated cognitive behaviour therapy (CBT) approach that has shown promise in treating panic disorder (PD). However, the effectiveness of the B4DT, particularly regarding long-term outcomes in rural clinical settings, remains underexplored. METHODS:A total of 58 patients were included using a naturalistic open-label trial design. Patients were assessed at 12-month follow-up. Measures included the Panic Disorder Severity Scale (PDSS), the Patient Health Questionnaire-9 (PHQ-9), and the Generalized Anxiety Disorder-7 scale (GAD-7). RESULTS:The study revealed significant and lasting reductions in PD symptoms, with a high rate of remission maintained at 12-month follow-up (82.8%). Regarding the secondary outcomes, significant improvements in symptoms of depression and generalized anxiety were also shown. CONCLUSIONS:The B4DT represents a promising treatment approach for PD, demonstrating stable long-term outcomes in rural settings. This finding supports the potential of concentrated CBT formats in achieving sustained symptom improvement in patients with PD, warranting further investigation and broader implementation. TRIAL REGISTRATION:The study was reviewed by the Regional Committee for Medical Research Ethics Northern Norway, REK North (REK Nord2021/273145).

A large proportion of patients undergoing cognitive behavior therapy (CBT) for obsessive-compulsive disorder (OCD) do not respond sufficiently to treatment. Identifying predictors for change in symptom severity after treatment could inform clinical decision-making, allow for better-tailored interventions, and avoid treatment failure. Prior research on predictors for treatment response has, however, yielded inconsistent findings with limited clinical utility. Here, we investigated the predictive power of nine polygenic risk scores (PRSs) for psychiatric and cognitive traits in 1598 OCD patients (1167 adults and 431 children/adolescents) treated with CBT in Sweden and Norway. We fitted linear mixed models adjusted for age, sex, genotyping batch, and the first five ancestry PCs to estimate associations between PRS and symptom severity change from pre- to post-treatment. The PRS for schizophrenia showed a modestly significant association with symptom change (β = 0.013, p = 0.04, R 2 = 0.10), indicating that a higher PRS for schizophrenia was associated with a smaller decrease in symptom severity. No other PRS were significantly associated with the outcome. While these results await replication and expansion, current PRS for psychiatric and cognitive phenotypes do not seem to contribute meaningfully to symptom severity change in CBT for OCD.

Abstract Introduction Bergen 4-Day treatment (B4DT) is a form of concentrated exposure-based cognitive behavioral therapy (CBT) in which patients receive treatment over four consecutive days. Previous studies have shown B4DT to be a promising treatment format for panic disorder (PD), although the long-term stability of treatment gains requires additional study. Aim The aim of the current study was to evaluate the longer-term effectiveness of B4DT for patients with panic disorder with or without agoraphobia. This study extends a previously published study by providing a long-term follow-up of the same cohort (n = 30), initially assessed at three months post-treatment. Method Thirty patients with panic disorder were consecutively included in a retrospect open trial. The primary outcome measure was the Panic Disorder Severity Scale. The secondary outcome measures were the Generalized Anxiety Disorder-7 and the Patient Health Questionnaire-9. Outcomes were assessed at pretreatment, posttreatment, 3-month follow-up, and longer-term follow-up (with a mean time of 18 months). Results There was a significant reduction in panic disorder symptoms from pretreatment to longer-term follow-up (d = 5.03, 95% CI [18.55, 21.12] to [1.33, 3.87]). The Panic Disorder Severity Scale (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]) post-treatment, followed by further decreases at the 3-month follow-up to a mean of 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]). There was no significant difference in symptom severity between the 3-month and 18-month assessments, indicating a sustained improvement (p <.001). At the 18-month follow-up, 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. Conclusion The results from the current study indicated that the treatment effects of B4DT are stable over time and that the treatment format appears to be promising for PD. Confirming these preliminary results in rigorous study designs is needed. Trial registration The study was approved by the Regional Committee for Medical and Health Research Ethics of Northern Norway (REK Nord-2021/209619).

The COVID-19 pandemic has necessitated essential modifications to the administration of psychotherapy for patients with panic disorder (PD) through the increased use of videoconferencing. However, the effect of this change on treatment efficacy remains unclear. The current study is a long-term (1.5 years) investigation of the Bergen 4-day treatment (B4DT) for PD delivered as a combination of videoconferencing and face-to-face therapy. This study reported the long-term outcomes of B4DT for PD when delivered in a hybrid format. The B4DT includes multiple components delivered over four consecutive days. As the pandemic unfolded, B4DT was adapted to include different levels of in-person versus videoconference delivery, depending on COVID-19 infection rates and public health recommendations. Outcome measures included clinician-rated illness severity on the Panic Disorder Severity Scale (PDSS) and patient-rated symptoms of PD, agoraphobia, generalized anxiety, and depression. Follow-up treatment, work status, and current medications were assessed. We used multilevel models to estimate whether clinical improvement was maintained over time. Treatment effects achieved at three months were maintained at the 1.5-year follow-up. Patients who completed the PDSS scored M = 14.78 (SD = 3.37) before treatment, M = 5.88 (5.28) at the three-month follow-up (d = 2.01), and M = 5.44 (SD = 5.12) at the long-term follow-up (d = 2.15). The reduction in generalized anxiety and depression symptoms was maintained over time. The current study suggests that B4DT can be delivered successfully in a combination of face-to-face and videoconference therapy sessions. Moreover, long-term effects are maintained, even during the challenging circumstances of the pandemic.

Background Few studies have examined the use of concentrated and intensified cognitive behaviour therapy for treating social anxiety disorder (SAD). The aim of this study was to examine the feasibility of the Bergen 4-Day Treatment (B4DT) for treating SAD. Methods This study adopted an open trial design without a control group. Thirty consecutively referred patients who were diagnosed with SAD were treated and assessed at pre-treatment, at post-treatment, and at the 3-month follow-up. The Liebowitz Social Anxiety Scale was used to assess symptoms of SAD; the Generalized Anxiety Disorder-7 scale was used to assess anxiety symptoms; and the Patient Health Questionnaire-9 was used to assess symptoms of anxiety and depression. The Client Satisfaction Questionnaire-8 was administered posttreatment. Results Overall, patients reported a high level of satisfaction with the B4DT. Large effect sizes were observed for symptoms of SAD ( d = 1.94–2.66) and for the secondary outcomes, i.e., generalized anxiety ( d = 0.86–0.99) and depression ( d = 0.62–0.83). The remission rate was 55.2% at follow-up, while the treatment response rate was 89.7%. Conclusions The B4DT is a promising treatment approach for patients with SAD. In the future, controlled trials should be performed to compare the efficacy of this treatment approach with standard outpatient treatment. Practical consequences, policy implications, and suggestions for future research are discussed herein.

Background Obsessive-compulsive disorder (OCD) is a debilitating mental illness characterized by intrusive thoughts and compulsive behaviors. Although epigenetic mechanisms are known to play an important role in various psychiatric disorders, large epigenome-wide association studies (EWAS) for OCD are lacking. To address this gap, we are conducting both a case-control and a severity meta-EWAS for OCD. These meta-analyses aim to increase statistical power and improve the generalizability of our findings. Methods We will provide an overview of the studies included in the meta-analyses and detail our analytical strategy. Currently, six studies are part of our analysis, encompassing 990 OCD cases and 1,212 controls. Results Furthermore, we will present preliminary results from the largest study within our meta-analysis, which analyzed DNA methylation from saliva samples of 439 OCD patients and 397 age- and sex-matched healthy controls. We will report sex-specific findings and meta-analyzed common effects across sexes. Discussion Our research will offer new insights into the epigenetic signals associated with OCD, enhancing our understanding of its etiology. Identifying specific DNA methylation signals associated with OCD and its severity could lead to potential biomarkers and therapeutic targets.

Obsessive-compulsive disorder (OCD) is a common mental illness causing substantial deterioration in quality of life. Cognitive Behavioural Therapy (CBT), with a specific focus on Exposure and Response Prevention, is the first-line treatment for this condition. Although a concentrated form of it, the Bergen 4-day (B4DT) treatment, has shown considerable success, about one-third of the patients do not recover following the intervention. Mechanisms underlying the response to psychotherapy are unclear; however, preliminary longitudinal studies have uncovered a link between DNA methylation and psychotherapy response in mental disorders such as OCD. Following up on these studies, we aim to better understand response mechanisms and identify key differences between responders and non-responders in the first large epigenome-wide study. Saliva samples and clinical information were collected in 416 OCD patients treated with the B4DT at three time points: before, immediately after, and three months after the treatment. DNA methylation of the samples was obtained using the Illumina Infinium MethylationEPIC v02 array. We use linear mixed-effects models to examine DNA methylation trajectories across the different time points and to investigate associations between DNA methylation changes and treatment outcomes. Additionally, we use linear regression models to identify baseline DNA methylation signatures predictive of treatment response. We will present analyses of DNAm changes associated with treatment and differences between responders and non-responders. Our comprehensive longitudinal epigenetic study will enhance our understanding of the processes underpinning psychotherapy response and treatment failure. This could facilitate the identification of OCD patients who require alternative therapy approaches or are at higher risk of relapse.

Background The Bergen 4-day treatment (B4DT) is a concentrated exposure-based therapy that has been shown to be effective in the treatment of anxiety disorders. The current study sought to examine the effectiveness of B4DT for panic disorder (PD), when delivered with a combination of face-to-face sessions and videoconferencing. Methods Treatment was delivered to 50 patients from April 2020 to May 2021. Because of regulations during the pandemic, a significant portion of the treatment was conducted via videoconference. The primary outcome measure was the clinician-rated Panic Disorder Severity Scale (PDSS), and secondary measures included patient-rated symptoms of panic disorder, agoraphobia, generalized anxiety, depression, and treatment satisfaction. Changes in symptom levels over time were estimated using multilevel models. Results Patients showed a significant reduction in clinician-rated symptoms of panic disorder (Measured by PDSS) from before treatment to post treatment (d = 2.18) and 3-month follow-up (d = 2.01). At three months follow-up 62% of patients were classified as in remission, while 70% reported a clinically significant response. We also found a reduction in symptoms of depression and generalized anxiety, and the patients reported high satisfaction with the treatment. Conclusion The current study suggests that B4DT delivered in a combination of videoconference and face-to-face meetings may be a useful treatment approach. As the study is uncontrolled, future studies should also include more strictly designed investigations.

IntroductionThe Bergen 4-Day Treatment (B4DT) is a concentrated treatment with individually tailored exposure exercises. The format has shown promising results in the treatment of panic disorder.AimThe aim of the current study was to investigate the effectiveness of the B4DT in a large sample in a rural clinical setting.MethodFifty-eight patients with panic disorder were consecutively included using an open trial design. The primary outcome measure was the Panic Disorder Severity Scale. The Generalized Anxiety Disorder-7 and the Patient Health Questionnaire-9 were used as secondary outcome measures. Assessments were conducted at pretreatment, posttreatment, and 3-month follow-up. Treatment satisfaction was measured at posttreatment using the Client Satisfaction Questionnaire-8.ResultsThere was a significant reduction in symptoms of panic disorder from pre- to posttreatment (d = 3.36) and from pretreatment to follow-up (d = 3.63). At posttreatment and follow-up, 72.4% and 81.0% of patients, respectively, were classified as in remission. Patients reported high treatment satisfaction, and there were significant reductions in symptoms of generalized anxiety and depression.ConclusionThe results from the current study replicated the findings from previous studies using a larger sample size. The findings indicate that the B4DT is a promising treatment format for panic disorder. The study also demonstrated that the treatment format can be successfully implemented in new rural clinics.

Background Bergen 4-day treatment (B4DT) is a concentrated exposure-based treatment (cET), where the patient receives concentrated, individually tailored cognitive behavioral therapy (CBT) during four consecutive days. Previous findings have indicated that B4DT could be a promising treatment for panic disorder (PD). Aim The aim of the present study was to evaluate the implementation of B4DT for panic disorder with- and without agoraphobia, at a new clinic. This is the first replication study for B4DT on panic disorder. Method Thirty consecutively recruited patients with PD were included in an open trial design. Assessment of symptoms of panic disorder were measured with Panic Disorder Severity Scale (PDSS), while symptoms of generalized anxiety were assessed by Generalized Anxiety Disorder-7 (GAD-7) and depressive symptoms by Patient Health Questionnaire (PHQ-9) pre-treatment, post-treatment and at 3-month follow-up. Treatment satisfaction was measured with Client Satisfaction Questionnaire (CSQ-8) post-treatment. Results The results showed a significant reduction in symptom severity from pre-treatment to post-treatment (d = 4.32), and at 3-month follow-up (d = 4.91). The proportion of patients classified as fulfilling the criteria for remission was 80.0% at post-treatment and 86.7% at follow up. There was a significant reduction in symptoms of depression and generalized anxiety. Treatment satisfaction was high and none of the patients dropped out. Conclusion The current study replicated the results from the original study and indicate that the treatment can be successfully implemented at new clinics. B4DT may be a promising treatment for panic disorder and comorbid symptoms of generalized anxiety and depression. Larger and more controlled studies are needed to establish the efficacy of B4DT for panic disorder.