The Bergen 4-day Treatment (B4DT)
The B4DT is a practical, evidence-based, focused and deliberate exposure based treatment. It builds on four decades of empirical research and theories about the most effective approach to OCD treatment. The innovation and strength of the work is how it combines the most effective elements of proven treatment into one of the most profound, rapid, and robust treatment approaches that we have seen in recent years.
Who can receive the B4DT?
In Norway you can receive the B4DT if you are entitled to Norwegian public mental health care and live in the uptake area for one of the B4DT teams. Currently, approximately 35 B4DT teams in Norway, Iceland, Sweden are being trained by the Bergen 4-day team and spring 2019 we will start training the team at the Houston clinic, which will serve as an international training site, both for clinics in the US as well as for clinics world-wide.
The core features of the B4DT: Prepare – change - maintain
The B4DT is an concentrated exposure-based treatment delivered during four consecutive days. It can best be described as an individual treatment in a group setting since it is delivered simultaneously to 3-6 patients by the same number of therapists. The 1:1 ratio between therapists and patients ensures individually tailored and therapist assisted exposure treatment, while simultaneously taking advantage of being part of a group with others going through the same process of change.
Prior to the treatment, the patients are thoroughly educated and prepared for the treatment and have made the decision to dedicate four full days to working towards change. The first day is dedicated to psychoeducation and preparation. The two middle days are one prolonged treatment session interrupted by the natural occurrence of sleep. This ensures that the therapist has enough time to assist the patient in the OCD-demanding settings, and to help the patients become aware of all the micro-choices that they face when they are tempted to reduce the anxiety and discomfort by engaging in subtle avoidance strategies or mental/overt rituals. These micro-choices are seen as golden opportunities to make choices that are incompatible with having OCD. In the afternoon of the third day, family and friends are invited to a lecture on how they can best support the patient. This might also be done on Skype. The last day is allocated to preparing the client for the coming three weeks where the focus is to integrate the change into normal living. During these weeks the patient daily report on the progress on-line.
One week after the group each patient receive a phone consultation with a B4DT expert focussed on how to make the change sustainable. This is repeated after three months, and at this time the patients are also invited to a consultation with their local B4DT team.
How is the B4DT received by the patients?
The B4DT is highly sought for, and the drop-out rate is less than 1% (Article). Patients express high to very high treatment satisfaction as goes for the content, quality and amount of treatment, and more than 95% confirm that they will recommend the B4DT to a friend (Article). The 4 days are typically described it as hard but life-changing work.
Bergen 4 Day Treatment: Outcomes
From the start, Gerd and Bjarne ensured independent outcome assessment, and the results show that more than 90% of the patients have reliably improved while 68% have remitted at 12-month follow-up (Article). Furthermore, 69% are recovered at 4-year follow-up (Article). Importantly: Neither OCD severity, the number of co-morbid disorders, indications of personality disorders or presence of sleep disturbance predict treatment outcome. The B4DT is equally helpful for children and adolescents (Article). The clinical effectiveness has also been demonstrated in new clinics in Norway and Iceland (Article 1, Article 2).
In Norway, OCD-patients are entitled to treatment by one of the 30 specialized OCD teams, and the B4DT is now part of that system. Only if a patient is suicidal, actively abusing drugs, experiencing psychosis, in the manic phase of bipolar disorder, or has an active eating disorder is treatment postponed until these issues have been stabilized.
How to erase a wait-list of 100 patients in two weeks?
The development of the B4DT has created unique opportunities to upend mental health treatment delivery as we know it. In early 2017, the B4DT was implemented in Oslo (capital of Norway) where the Anxiety and OCD Clinic at University of Oslo had about 100 patients on their waiting list. Given the normal staffing practice of the clinic, it would have taken them 18 months to treat these patients. Thus, Gerd and Bjarne suggested that they treat the entire wait list by treating 45 patients during two 4-day interventions. A total of 90 patients with OCD were treated during two 4-day periods, thus effectively eliminating the wait list in a novel and creative way. At the three-month follow-up, 84% of patients had achieved clinically relevant change, and 68% were in remission (Article).