The Bergen 4-Day Treatment (B4DT) is an intensive exposure and response prevention (ERP) therapy with unique characteristics and impressive outcomes at 3 months, 6 months, and long-term follow-up from 34-60 months for the treatment of obsessive-compulsive disorder.

The treatment concentrates individual ERP sessions with a 1:1 therapist-patient ratio in a group format. Therapists may switch clients on subsequent days to allow more experienced therapists to work with patients who have made the smallest gains. The B4DT emphasizes the LEan into The Anxiety (LET) technique, which encourages patients to expose themselves to as many anxiety-provoking scenarios as they can during the intensive treatment.

In Hansen, Kvale, Hagen, Havnen, and Ost (2018), therapists were well trained in ERP and had extensive experience treating patients with OCD. Dropout rates were very low.

How the four days work

Day 1 focuses on psychoeducation, preparing patients for exposure and establishing treatment expectations.

Days 2 and 3 can range from 8-10 hours per day and utilize therapist-assisted exposures using the LET technique in a variety of settings. Between exposures, group meetings are held where patients share how the exposures are going using a scale from 1-6, with 6 indicating fully leaning into the exposures. Loved ones are invited to attend a psychoeducational meeting to learn how they can be supportive.

Day 4 focuses on how patients can continue independently to conduct exposures after treatment to maintain or improve gains, and how to record their exposure practice for the next three weeks.

Outcome highlights

  • Design: 77 OCD patients, Y-BOCS, follow-ups at 3 months, 6 months, and 4 years.
  • Results: Y-BOCS decreased from 25.9 at pretreatment to 9.9 at long-term follow-up.
  • Recovery: 69% of patients were classified as recovered at long-term follow-up.
  • Implication: B4DT demonstrates long-term effectiveness in significantly reducing OCD symptoms with a concentrated 4-day treatment.

While more studies are welcome, incorporating B4DT into practice could offer clients a powerful tool to overcome anxiety and improve quality of life. The model provides improvements during treatment and trains clients to continue acting as their own therapist with support from loved ones.

Reference

Hansen, B., Kvale, G., Hagen, K., Havnen, A., & Ost, L. G. (2018). The Bergen 4-day treatment for OCD: Four years follow-up of concentrated ERP in a clinical mental health setting. Frontiers in Psychology, 9, 2111.