What is Bergen treatment for panic disorder?

From the Guidelines

The Bergen treatment for panic is a highly effective cognitive-behavioral therapy approach that focuses on interoceptive exposure, and it is recommended as a first-line treatment for panic disorder, particularly when combined with medication such as selective serotonin reuptake inhibitors (SSRIs) for severe presentations or when quality CBT is unavailable, as suggested by the American Academy of Child and Adolescent Psychiatry 1.

Key Components of the Bergen Treatment

• The treatment typically consists of 8-12 weekly sessions where patients learn about the nature of panic attacks and how avoidance behaviors maintain anxiety.
• Patients create a hierarchy of feared sensations and gradually expose themselves to these sensations through exercises like hyperventilation, spinning, or breath holding.
• The treatment includes homework assignments where patients practice these exposures daily between sessions.
• Unlike some other approaches, the Bergen method doesn't emphasize cognitive restructuring or relaxation techniques, instead focusing primarily on helping patients learn that the physical sensations they fear are harmless and manageable.

Effectiveness of the Bergen Treatment

• This approach is effective because it directly addresses the core mechanism of panic disorder: the fear of bodily sensations and catastrophic misinterpretations of these normal physiological responses.
• Patients typically see significant improvement within the treatment period as they build tolerance to previously feared sensations.
• Combination treatment (CBT and SSRI) may be a more effective short-term treatment for anxiety in children and adolescents than either treatment alone, as suggested by the Journal of the American Academy of Child and Adolescent Psychiatry 1.
• The American Academy of Child and Adolescent Psychiatry suggests that combination treatment could be offered preferentially over monotreatment to patients with social anxiety, generalized anxiety, separation anxiety, or panic disorder 1.

From the FDA Drug Label

The effectiveness of clonazepam in the treatment of panic disorder was demonstrated in two double-blind, placebo-controlled studies of adult outpatients who had a primary diagnosis of panic disorder (DSM-IIIR) with or without agoraphobia In these studies, clonazepam was shown to be significantly more effective than placebo in treating panic disorder on change from baseline in panic attack frequency, the Clinician’s Global Impression Severity of Illness Score and the Clinician’s Global Impression Improvement Score.

The treatment for panic disorder using clonazepam is effective, as shown in two double-blind, placebo-controlled studies.

• The studies demonstrated a significant reduction in panic attack frequency.
• The mean clonazepam dose during the optimal dosing period was 2.3 mg/day.
• At endpoint, 62% of patients receiving clonazepam were free of full panic attacks, compared to 37% of placebo-treated patients 2.

From the Research

Bergen Treatment for Panic

There is no direct mention of "Bergen treatment" for panic disorder in the provided studies. However, the studies discuss various treatment options for panic disorder, including:

• Medications such as selective serotonin reuptake inhibitors (SSRIs) 3, 4, 5
• Cognitive-behavioral therapy (CBT) 6, 4, 7
• Benzodiazepines 4, 5
• Other antidepressants and anticonvulsants 4

Treatment Options

The studies suggest that:

• SSRIs are effective in treating panic disorder and are considered a first-line treatment 3, 4
• CBT is also an effective treatment for panic disorder and can be used as a first-line treatment or in combination with medication 6, 4, 7
• Benzodiazepines can be used to treat panic disorder, but may have more adverse effects than SSRIs 5
• Other treatment options, such as anticonvulsants and atypical antipsychotics, may be considered for patients who do not respond to first-line treatments 4

Key Findings

• Sertraline, an SSRI, has been shown to be effective in reducing the severity and frequency of panic attacks 3
• CBT has been shown to be effective in eliminating the patterns that underlie and perpetuate panic disorder 6, 7
• A meta-analysis found that SSRIs cause more adverse events than benzodiazepines in short-term treatment of panic disorder 5