The Bergen 4-day treatment (B4DT)

Within the public specialist mental health care system in Norway, Gerd Kvale and Bjarne Hansen has developed a concentrated exposure treatment (The Bergen 4-day treatment) that within 4 days helps more than 90% of the patients with severe anxiety disorders and obsessive-compulsive disorder (OCD).

​The B4DT is best described as an individual treatment delivered in a group setting; 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 training, while simultaneously taking advantage of the group setting. The therapists are working as a team, which means that a given patient typically works with more than one therapist. Prior to undergoing the treatment, the patients are thoroughly educated and prepared for what to expect, and have made the decision to dedicate four full days to working towards change. 

Patients express high to very high treatment satisfaction after treatment, and typically describe it as hard and life-changing work.
When the B4DT was piloted, the reimbursement system in Norway was based on 45-minute sessions just like in the U.S. and the B4DT lost money for the treatment providers. As a consequence of the clinical success of the B4DT, the reimbursement system in Norway has changed; it now covers the concentrated format! We sincerely hope that the same will happen in the US.

The B4DT approach has received tremendous attention around the world. In October of 2018, Drs. Gerd Kvale and Bjarne Hansen were selected by Time Magazine as two of The Health Care 50: Fifty people transforming health care in 2018. They were the only honorees representing psychological treatment; truly a remarkable acknowledgement of recent advancement of OCD treatment. In addition, the B4DT was awarded the 2015 Innovation of the Year award by the Norwegian Psychological Science Association.


Before treatment is administered, all patients are thoroughly prepared and committed to the change prosess they will engage in during the four days. Patients report being very satisfied with the treatment, and virtually no patients drop out. So far, over 1200 patients has been treated in one of the 30 clinics that either is certified or is under certification by the B4DT-team in Ber gen.

How is the setup of the four days? 

  • The first day is allocated to education 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.  The exposure sessions are interspaced with group meetings, focused on patients progress and providing support.
  • At the end of the third day, family and friends are invited to a lecture on how they can best support the patient.
  • The fourth and last day is allocated to preparing the client for the coming three weeks; integrating the change into normal living.

 

One of the most crucial aspects of the 4-day format is that patients recieve therapist assisted exposure treatment in their community. Because of this, we are working hard to establish teams offering the treatment throughout the entire country. The treatment combines the best elements from individual treatment protocols with the inspiring and supportive effects of working alongside other people working towards the same goal. 

Read more about the evidence behind the 4-day treatment 

The Bergen 4-day treatment (B4DT) where 90% of the patients can expect to respond, and where 68% are recovered four years later (Hansen, Kvale, Havnen, et al. 2018). The results have been demonstrated in a number of effectiveness studies and replications, both for adults (Davíðsdóttir et al. In press; Hansen, Hagen, et al. 2018; Havnen et al. 2013; Havnen et al. 2017; Havnen et al. 2014; Kvale et al. 2018; Launes et al. In review) and adolescents (Riise et al. 2016; Riise et al. 2018). Also, the B4DT has been implemented at a new site (Launes et al. In review), and in a new culture (Davíðsdóttir et al. In press). The first randomized controlled trial (RCT) on the B4DT, comparing the 4-day format to self-help and a wait list control, also showed comparable results (Launes et al. Submitted).  Also, we have demonstrated an ability to upscale, with 90 patients treated during eight days by more than 60 therapists, with just as effective results (Kvale et al. 2018). Furthermore, we have demonstrated basically the same results in a pilot study on the B4DT for Panic Disorder (PD) (Hansen, Kvale, Hagen , et al. 2018). Even though our focus has not been to demonstrate superiority of the B4DT to other CBT/ERP approaches, a comparison with published results of standard ERP is promising (Öst, Hansen, and Kvale Unpublished manuscript).

 


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