March 18, 2024

Dear Colleagues,

The National Social Anxiety Center (NSAC) provides information about relevant and current research in service of disseminating and promoting evidence-based treatment. This month’s summary is written by Suma Chand, PhD, representing NSAC St. Louis, and examines the 2024 article by Hansen et al: The Bergen 4-day treatment for social anxiety disorder: a pilot study.

Intensified and concentrated CBT formats in the treatment of anxiety disorders have been found to achieve treatment outcomes comparable to standard CBT. Few studies have examined the use of concentrated and intensified cognitive-behavioral therapy for treating social anxiety disorder (SAD). The Bergen 4-day treatment (B4DT) is a form of concentrated CBT that has been showing promise as a treatment option for obsessive‒compulsive disorder (OCD) and panic disorder. To date, no studies have examined the effectiveness of the B4DT for SAD. In this study, the authors examined the feasibility of the B4DT for treating SAD.

This study used 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 post-treatment.

The B4DT for SAD was developed based on the B4DT model for OCD and the B4DT model for panic disorder. This treatment approach involves exposing patients to specific anxiety provoking social situations aimed at facilitating the acquisition of new strategies for effectively managing emotional discomfort. Another central element of the B4DT is the use of the Leaning in Technique (LET) which involves identifying and relinquishing their safety behaviors and also leaning into the anxiety. Group sessions are conducted to practice activities such as giving presentations, being the focus of attention, and speaking assertively. Individual exposure tasks, such as simulating a job interview, engaging in small talk, answering phone calls, and participating in shopping scenarios, are assigned to address individual fears. Regular group meetings are scheduled where patients can report their progress and receive feed-back from other members of the group.

Overall, patients reported a high level of satisfaction with the B4DT. The treatment demonstrated large effect sizes when comparing symptoms between pretreatment and posttreatment individuals as well as when comparing symptoms between individuals at pretreatment and the 3-month follow-up. Large effect sizes were also reported for the secondary symptoms of generalized anxiety and depression. The remission rate was 55.2% at follow-up, while the treatment response rate was 89.7%. These findings suggest that the B4DT is a promising treatment option for individuals with SAD. The low dropout rate (only one patient discontinued due to illness) and high treatment satisfaction score indicate that the treatment was well received by patients.

These results are consistent with previous research on the effectiveness of the B4DT in treating OCD and PD. The results of this study are also consistent with the findings of previous studies indicating that concentrated or intensified CBT is an effective treatment for anxiety disorders. The authors have pointed out the limitations of their study such as the fact that it was an open trial and lacked a control group. Additionally, this study did not assess long-term outcomes.

One can conclude from this study that the B4DT is a promising treatment approach for patients with SAD. There is, however, a need for controlled trials to compare the efficacy of this treatment approach with standard outpatient treatment and also have studies with longer follow up.

Questions for clinicians:
In your experience, do you think that an intensified approach would be more suitable for some SAD patients more than others? Do you see practical problems that could impede the application of an intensified approach like B4DT?

Hansen, B, Eide, TO, Reiråskag, MA, Tjelle, KA, Solem, S, and Hagen, K. The Bergen 4-day treatment for social anxiety disorder: A pilot study. BMC Psychiatry, vol. 24, no. 145, Feb. 2024.


Suma Chand, PhD, A-CBT
Representing NSAC St. Louis
(The Cognitive Behavior Therapy Program of SLUCare Adult Psychiatry Services)