TOPLINE

The Bergen 4-day treatment (B4DT), a concentrated exposure-based intervention, outperformed internet-based cognitive-behavioral therapy (iCBT) in reducing symptoms among adults with obsessive-compulsive disorder (OCD), with the results sustained at 3 months, a trial showed.

METHODOLOGY

• This single-center randomized controlled trial included 119 adults with a diagnosis of OCD (mean age, 33.5 years; 66.4% women) in Germany between 2024 and 2025 who were randomly assigned to receive either B4DT (n = 60) or an 8-week self-directed iCBT program (n = 59).
• B4DT consisted of two preparatory individual sessions followed by 4 days of concentrated exposure and response prevention administered to small groups with a 1:1 patient-to-therapist ratio.
• Researchers primarily assessed a change in the severity of OCD symptoms from baseline to 3-month follow-up, measured using the Yale-Brown Obsessive Compulsive Scale (Y-BOCS).
• Secondary outcomes included changes in self-reported OCD symptoms, depression, quality of life, global functioning, obsessive beliefs, self-esteem, and experiential avoidance, along with treatment satisfaction.

TAKEAWAY

• B4DT was linked to significantly greater reductions in Y-BOCS scores than iCBT at about 8 weeks (mean difference, -7.9; P < .001 for group × time interaction) and at the 3-month follow-up (mean difference, -5.6; P < .001 for group × time interaction).
• Rates of response (a reduction of ≥ 35% in the Y-BOCS score) at 3-month follow-up were higher with B4DT than with iCBT (61.4% vs 25%), as were rates of remission (total Y-BOCS score ≤ 12; 42.1% vs 13.6%).
• Secondary outcomes, including self-reported OCD symptoms, depression, quality of life, and global functioning, all persistently favored B4DT.
• Treatment satisfaction scores were significantly higher for B4DT than for iCBT at about 8 weeks (mean, 30.77 vs 19.44; P < .001) and at 3 months (mean, 29.45 vs 19.51; P < .001).

IN PRACTICE

"Rather than representing competing approaches, these findings suggest the complementary roles of the 2 interventions within stepped-care frameworks. iCBT may serve as an accessible first-line treatment, whereas B4DT may offer a more intensive therapist-delivered second-line option for individuals requiring more intensive care," the authors wrote.

"Integrating the 2 approaches has the potential to improve access, optimize resource allocation, and enhance overall treatment outcomes in OCD," they added.

SOURCE

The study was led by Lena Jelinek, PhD, University Medical Center Hamburg-Eppendorf, Hamburg, Germany. It was published online on October 19 in JAMA Network Open.

LIMITATIONS

The study was limited by its single-center design, short follow-up, lack of blinding of participants and therapists, limited assessment of selection bias, varied adherence to iCBT among participants, and lack of assessment of how concomitant treatment as usual contributed to the outcomes.

DISCLOSURES

The study was funded by the Peter Möhrle Foundation, and open access publication was funded by UKE-Universitätsklinikum Hamburg-Eppendorf. Disclosure information for the study investigators is available in the original study publication.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.