Past Presentations by Our Staff and Affiliates
Thröstur Björgvinsson, PhD, ABPP and Bjarne Hansen, PhD co-chaired a symposium titled: Concentrating treatment for rapid improvement and durable gains: Status and Outcomes of the International Dissemination of the Bergen 4-Day Treatment Approach
at the 2024 Association for Behavioral and Cognitive Therapies (ABCT) Annual Convention that took place in November 14 to 17, 2024 in Philadelphia, Pennsylvania.
This symposium features four presentations highlighting advances made in the Bergen 4-day treatment, international dissemination efforts as well as the initial national implementation of evidence-based OCD treatment in Norway. The symposium is co-chaired by Drs. Björgvinsson and Hansen; the discussant is Michael Wheaton, PhD. Below is the symposium abstract as well as the abstracts for the four presentations given by Drs. Björgvinsson, Hansen, Hagen, and Thorsen.
The main abstract: The Bergen 4-day treatment (B4DT) is a concentrated exposure treatment (cET) for OCD that was developed in Bergen, Norway, just over 10 years ago. The state of care for OCD prior to that was dire. A national research study, evaluating current status, found that OCD patients received treatment on average for 14 months (and this treatment was ongoing), with 88% reporting the absence of evidence-based treatment by providers. Fortunately, mental health care delivery was transformed in Norway to be more evidence-based, and the B4DT was developed in the wake of these efforts. The approach builds on five decades of empirical research, particularly in CBT and ERP. Since its creation, the B4DT has been shown to be highly effective in treating OCD. Despite its short duration, gains appear durable: About 70% of patients are meaningfully improved at the 12-month and 4-year follow-up. The B4DT approach has received tremendous attention around the world. For example, in October 2018, Dr. Bjarne Hansen (the developer of B4DT) was selected by Time magazine as one of “The Health Care 50: Fifty People Transforming Health Care in 2018.” Given its time efficiency, B4DT represents a potentially transformative treatment, with the potential to meaningfully improve health care delivery in the U.S. and other countries where it is being implemented.
Over 3000 patients with OCD have been effectively treated with the B4DT in Norway, Sweden, Iceland, Germany, Finland, Singapore, and the USA. All studies strongly support the effectiveness of this 4-day approach. Given the promise of this approach to deliver time-limited treatment with lasting effects, international dissemination plans are actively being implemented. Teams from Australia, Kenya, and Ecuador have signed up and will be trained in the B4DT, completing OCD treatment pilots in 2024.
In this symposium, we will report on these international dissemination efforts as well as the initial national implementation of evidence-based OCD treatment in Norway. We will discuss cultural dissemination challenges, clinical treatment outcomes, and key factors/techniques used in B4DT. We will report how this concentrated format provides a unique opportunity for collecting biological samples and conducting biological research studies; to highlight this, we will present findings from functional and structural MRI, genetics, and epigenetics studies already conducted utilizing the B4DT format. Furthermore, we will highlight how this framework has uniquely facilitated clinical training, as well as clinical development and research.
Order of Presentations:
1 – Transformation of Norwegian mental health delivery: the development of the Bergen 4-Day Treatment for OCD Bjarne Hansen, PhD; Thröstur Björgvinsson, PhD; Kristen Hagen, PhD
Abstract:
Despite evidence-based treatments for obsessive-compulsive disorder (OCD) being recognized since the mid-1960s, a significant issue has been the frequent unavailability of such treatments to those in need. When available, the quality often fails to achieve the optimal effect of the methods. In 2009, Bjarne Hansen initiated a project to ensure that everyone affected by OCD in Norway could access evidence-based treatment. This was based on studies showing the average duration of ongoing treatment was 14.2 months, with 88% of cases reporting the absence of evidence-based treatment by providers. It was proposed that 30 specialized OCD teams be established nationally to ensure evidence-based treatment availability regardless of patient location. Following collaboration with key politicians and media, this was approved by the health minister and launched as a 4-year, nationally funded project, with Hansen as the project leader. These teams now ensure national access to such treatment.
The national infrastructure provides excellent opportunities to gather clinical data and biological samples from large patient cohorts receiving treatment, facilitating clinical development and the efficient implementation of new methods. This initiative has fueled significant research efforts, leading to the establishment of the Bergen Center for Brain Plasticity, which has received substantial funding for research on clinical variables, genetics, epigenetics, and imaging. Through this network, the innovative Bergen 4-day Treatment (B4DT) has been implemented and evaluated, demonstrating significant treatment outcomes across multiple studies.
This presentation will present the background, process, and experiences related to the national implementation of evidence-based OCD treatment through the creation of 30 OCD teams (15 for adults and 15 for adolescents). Additionally, it will showcase how this framework has uniquely facilitated clinical development and research. Furthermore, an overview of the theoretical foundation of The Bergen 4-day Treatment (B4DT) and how its principles can be applied to other treatment formats and disorders will be discussed.
2 – National Implementation of Bergen 4-Day OCD Treatment across multiple clinical settings in Norway Kristen Hagen, PhD; Bjarne Hansen, PhD; Thröstur Björgvinsson, PhD
Abstract:
Objective: This study evaluates the efficacy, feasibility, and patient satisfaction of the Bergen 4-Day Treatment (B4DT) for Obsessive-Compulsive Disorder (OCD), employing a concentrated cognitive-behavioral therapy approach, across various clinical settings in Norway.
Method: A cohort of 2000 consecutively referred OCD patients received the B4DT across over 20 specialized teams. OCD severity was assessed using the Yale-Brown Obsessive Compulsive Scale (Y-BOCS) at pre-treatment, post-treatment, and at a 3-month follow-up. Secondary symptoms were evaluated using the Generalized Anxiety Disorder 7-item scale (GAD-7) for anxiety and the Patient Health Questionnaire (PHQ-9) for depression. Patient satisfaction was measured with the Client Satisfaction Questionnaire (CSQ-8). Treatment feasibility was gauged through completion rates and adherence to the protocol.
Results: Significant reductions in Y-BOCS scores were observed from pre-treatment to post-treat, underscoring its feasibility across different clinical settings.
Conclusion: The B4DT is an effective, feasible, and well-received treatment approach for OCD, significantly reducing symptoms of OCD, anxiety, and depression, with high levels of patient satisfaction across multiple clinical settings in Norway.
3 – Harnessing clinical psychology, neuroimaging, genetics and epigenetics to understand response to B4DT for OCD and anxiety disorders Anders Thorsen, PhD; Bjarne Hansen, PhD; Kristen Hagen, PhD
Abstract:
The neurobiological aspects of obsessive-compulsive disorder (OCD) and anxiety disorders have been investigated for decades using neuroimaging and genetics, but relatively few studies have investigated how neuroimaging and genetics tracks or predicts response to psychological treatment. Importantly, large studies and integration across different biological levels are lacking. The Bergen Center for Brain Plasticity (BCBP) aims to bridge clinical psychology, functional and structural MRI, genetics, and epigenetics to study response to B4DT for OCD and anxiety disorders and uncover predictors of long-term relapse and recovery. Importantly, we recruit individuals with OCD or anxiety disorders who are receiving B4Dt as part of standard treatment in a public mental health setting, which may improve the relevancy of our findings to a larger context.
We are currently finishing the largest study of psychological therapy for OCD and anxiety disorders, and have collected saliva samples for genetic and epigenetic investigations from more than 2400 adult individuals with OCD or anxiety disorders, where 140 also have been measured using magnetic resonance imaging (MRI) and heart rate variability. We also recruited 50 demographically healthy controls with repeated MRI. This unique dataset will allow us to investigate how measures of autonomic nervous system, brain structure and function, and epigenetics, track and predict response to treatment over time. We will report and discuss some of the key findings from these biologically based research studies.
Finally, we are also collaborating with other organizations providing large-scale biological data to understand OCD, including Enhancing NeuroImaging Genetics through Meta Analysis (ENIGMA), Psychiatric Genomics Consortium (PGC), OCD Brain Imaging Consortium (OBIC), and the Adolescent Brain Cognitive Development (ABCD) study. Together, we aim to bridge clinical psychology and neurobiological perspectives on OCD and anxiety disorders, resulting in understanding why some patients don’t recover and how we can improve treatment in the future.
4 – International Dissemination of B4DT: Outcomes, clinical training opportunities, and future directions Thröstur Björgvinsson, PhD, ABPP; Bjarne Hansen, PhD, and Kristen Hagen, PhD.
Abstract:
Over 3000 patients with OCD have been effectively treated with the B4DT in Norway, Sweden, Iceland, Germany, Finland, Singapore, and the USA. All studies strongly support the effectiveness of this 4-day approach. Post-pandemic international dissemination plans are actively being implemented. Teams from Australia, Kenya, and Ecuador have signed up and will be trained in the B4DT and will complete OCD treatment pilots in 2024. The challenges unique to each country/continent are highlighted, and we will share some examples of lived experiences from therapists and patients in different teams across the various continents. All of this is intended to underscore the importance of providing a culturally sensitive adaptation of the westernized ERP approach. We will report on these efforts, including cultural dissemination challenges, therapist training challenges, treatment outcomes, and key factors/techniques used in B4DT.
To highlight specific challenges, a pilot study of 48 adults with OCD who completed the B4DT in the USA will be described. On the main outcome measure, the clinician-administered Yale-Brown Obsessive Compulsive Scale, the patients scores went from severe range to mild range; specifically, the average scores of 27.04 (pre-treatment) fell to 11.67 (post-treatment), 12.73 (3-months follow-up) and 13.67 (6-month follow-up). Further, 80% of patients demonstrated 35% reduction in the OCD symptom severity. The B4DT was rated as highly acceptable by the US patients. For example, over 95% of the patients stated that they would recommend the treatment to a friend and 86% stated that the treatment met either “almost all” or “most” of their clinical needs. These findings provide the first evidence for the generalizability of the B4DT to patients with OCD in the United States. Cultural and context-dependent issues that affected this dissemination pilot study are discussed in addition to future clinical and research directions.
