The Bergen 4-Day Treatment for Obsessive-Compulsive Disorder: Does It Work in a New Clinical Setting?

Sørlandet Hospital in Norway has a history of offering patients with obsessive-compulsive disorder (OCD) cognitive behavior group therapy using 12 weekly sessions of 2.5 h each. A previous evaluation of this treatment has shown that 51.9% did not respond at post-treatment. Recently, a highly concentrated group-treatment format, the Bergen 4-day treatment (B4DT), has been shown to help more than 90% of patients with OCD post-treatment. Based on these positive results, it was decided to explore whether the B4DT could be a feasible format for delivering ERP at another clinic. Thirty-five consecutively recruited patients were included in the current pilot study, and assessed at pre-treatment, post-treatment, and 3-month follow-up. Treatment response rate (35% reduction in OCD-symptom score) was 94% at post-treatment, and 80% at follow-up. Seventy-four percent were in remission at post-treatment and 68% at follow-up. Only one patient dropped out of treatment. The patients were highly satisfied with the treatment content and format. The results indicate that the 4-day treatment could successfully be implemented at a new clinic

Meetings and mismeetings – A qualitative meta-synthesis of clients’ experiences of the therapeutic relationship

Background: The importance of the therapeutic relationship for change in psychotherapy is well established. Understanding the client’s subjective experiences of the interplay with the therapist may sensitize researchers and clinicians to important phenomena, which in turn may enhance clinical effectiveness and improve our understanding of the working mechanisms of psychotherapy. Aim: The aim was to review and synthesize qualitative studies on clients’ subjective experiences of the therapeutic relationship, to highlight their meaning-making in the dyadic context. The focus was how they see themselves as a participant in the relationship and their perception of struggles and resolutions. Method: We conducted a meta-synthesis of literature studying adult clients’ experiences of psychotherapy, using the meta-ethnographic method of Noblit and Hare (1988). Following a literature search in two databases, 2631 studies were systematically screened, resulting in 23 studies that met our inclusion criteria. We extracted findings from the primary studies, which were then systematically compared and synthesized in order to develop higher-level sub-themes, themes and meta-themes. Results: Three meta-themes (as well as seven themes and 20 sub-themes) were developed: (1) If clients sense support, they overcome initial fears and commit to the process, describing needs clients may have that are not disclosed and how they assess their therapist before potentially engaging in therapeutic work. (2) The inner drama and vulnerability of being involved in an asymmetrical relationship reflects how clients may understand and deal with difficulties arising in the dyad. These include distress accompanying perceived rejection and how client-therapist roles could lead to feelings of inferiority. (3) Doing the hard work together concerns how relational tensions may be worked through with a humble therapist; the hard work of exposing oneself which may not be disclosed, and how clients with the help of the therapist may discover new ways of being. Conclusions: The findings show how clients are meaning-making participants in the therapeutic relationship who engage in activities that are not always apparent to their therapists, and shed light on the dynamics of ruptures and power differences. Clinical implications include the importance of seeking feedback from clients and knowledge of how ruptures may be experienced, as this may sensitize therapists and thus enhance their responsiveness. In the future, we recommend investigation of clients’ possible experiences of contribution to resolution, studying client and therapist experiences simultaneously and using methods suited to explore micro-processes in-depth. Involving participants in all phases of the research project seems to have the potential to explore new and important phenomena. The importance of critically considering findings in light of their context is underlined

Present in Daily Life: Obsessive Compulsive Disorder and Its Impact on Family Life from the Partner's Perspective. A Focus Group Study

This focus group study explores the experiences of five partners of patients suffering from obsessive-compulsive disorder concerning how this disorder might influence couples’ relationships in the long-term. We find that the disorder might give rise to power struggles concerning “normality”, deprive couples of opportunities for rewarding fellowship during household chores and leisure time, and persistent analytic processes concerning predicaments of what to do. They also express a need for more help from the health services. The results might be of value to therapists in their daily work, and might have implications for future research on couple’s therapy involving this group

The Bergen 4-day treatment for obsessive-compulsive disorder : Does it work in a new clinical setting?

Sørlandet Hospital in Norway has a history of offering patients with obsessivecompulsive disorder (OCD) cognitive behavior group therapy using 12 weekly sessions of 2.5 h each. A previous evaluation of this treatment has shown that 51.9% did not respond at post-treatment. Recently, a highly concentrated group-treatment format, the Bergen 4-day treatment (B4DT), has been shown to help more than 90% of patients with OCD post-treatment. Based on these positive results, it was decided to explore whether the B4DT could be a feasible format for delivering ERP at another clinic. Thirty-five consecutively recruited patients were included in the current pilot study, and assessed at pre-treatment, post-treatment, and 3-month follow-up. Treatment response rate (35% reduction in OCD-symptom score) was 94% at post-treatment, and 80% at follow-up. Seventy-four percent were in remission at post-treatment and 68% at followup. Only one patient dropped out of treatment. The patients were highly satisfied with the treatment content and format. The results indicate that the 4-day treatment could successfully be implemented at a new clinic

The Bergen 4-day treatment for obsessive-compulsive disorder: Does it work in a new clinical setting?

Sørlandet Hospital in Norway has a history of offering patients with obsessive-compulsive disorder (OCD) cognitive behavior group therapy using 12 weekly sessions of 2.5 h each. A previous evaluation of this treatment has shown that 51.9% did not respond at post-treatment. Recently, a highly concentrated group-treatment format, the Bergen 4-day treatment (B4DT), has been shown to help more than 90% of patients with OCD post-treatment. Based on these positive results, it was decided to explore whether the B4DT could be a feasible format for delivering ERP at another clinic. Thirty-five consecutively recruited patients were included in the current pilot study, and assessed at pre-treatment, post-treatment, and 3-month follow-up. Treatment response rate (35% reduction in OCD-symptom score) was 94% at post-treatment, and 80% at follow-up. Seventy-four percent were in remission at post-treatment and 68% at follow-up. Only one patient dropped out of treatment. The patients were highly satisfied with the treatment content and format. The results indicate that the 4-day treatment could successfully be implemented at a new clinic

Internet-assisted cognitive behavioural therapy for non-cardiac chest pain: a pilot and feasibility study

Nearly half of patients with non-cardiac chest pain (NCCP) experience significant complaints after a negative cardiac evaluation, at considerable costs for society. Due to the lack of treatment capacity and low interest for psychological treatment among patients with somatic complaints, only a minority receive effective treatment. The aim of this study was to assess the feasibility and usefulness of internet-assisted cognitive behavioural therapy (I-CBT), including encouragement of physical activity for this condition. Ten patients with NCCP received a six-session I-CBT intervention with minimal support from a therapist. Questionnaires assessing cardiac anxiety, fear of bodily sensations, depression, interpretation of symptoms, frequency of chest pain and impact of chest pain symptoms were collected at baseline, post-treatment and at 3-month follow-up. Semi-structured interviews employing a phenomenological hermeneutic approach assessed the participants’ experience of the intervention. Quantitative results showed clear improvements in several measures both at end of treatment and at 3-month follow-up. The retention rate was 100% and client satisfaction was high. The intervention was feasible to implement in a cardiac setting. This setting made it easier for patients to accept a psychological approach. Qualitative interviews revealed that the participants felt respected and taken care of, and they obtained a better understanding of their chest pain and how to cope with it. This pilot study yielded promising results regarding feasibility, clinical effect and patient satisfaction from a brief I-CBT intervention for NCCP in a cardiac setting. These results indicate that a randomized controlled trial with a larger sample size is warranted

A randomized controlled trial of concentrated ERP, self-help and waiting list for obsessive- compulsive disorder: The Bergen 4-Day Treatment

Background: The Bergen 4-day treatment (B4DT) is a concentrated exposure-based treatment for patients with Obsessive-Compulsive Disorder (OCD) delivered during four consecutive days. The B4DT has in a number of effectiveness studies demonstrated promising results as approximately 90% of patients gain reliable clinical change post-treatment and nearly 70% are recovered on a long-term basis. Methods: The current study is the first randomized controlled trial evaluating the effects of the B4DT. Forty-eight patients diagnosed with OCD were randomized to B4DT, self-help (SH), or waiting list (WL) with 16 patients in each condition. All participants randomized to the B4DT underwent the treatment without any attrition. Results: The B4DT yielded significantly better effects than control conditions on measures of OCD, depression, and generalized anxiety. The response rate (≥35% reduction of the individual patient’s pre-treatment Y-BOCS score) was 93.8% in B4DT, 12.5% in SH and 0% in WL, while remission rate (response criterion is fulfilled and the post-treatment Y-BOCS score is ≤12 points) was 62.5%, 6.3%, and 0%, respectively. Furthermore, patients who had received the B4DT, showed improved work- and social functioning. None of the patients treated with B4DT showed signs of deterioration. In comparison, one patient in the SH condition was in remission, and one showed significant clinical improvement, whereas the remaining showed no change. Conclusion: The results indicate that the B4DT is an effective treatment for patients suffering from OCD

A randomized controlled trial of concentrated ERP, self-help and waiting list for obsessive- compulsive disorder: The Bergen 4-Day Treatment

Background: The Bergen 4-day treatment (B4DT) is a concentrated exposure-based treatment for patients with Obsessive-Compulsive Disorder (OCD) delivered during four consecutive days. The B4DT has in a number of effectiveness studies demonstrated promising results as approximately 90% of patients gain reliable clinical change post-treatment and nearly 70% are recovered on a long-term basis. Methods: The current study is the first randomized controlled trial evaluating the effects of the B4DT. Forty-eight patients diagnosed with OCD were randomized to B4DT, self-help (SH), or waiting list (WL) with 16 patients in each condition. All participants randomized to the B4DT underwent the treatment without any attrition. Results: The B4DT yielded significantly better effects than control conditions on measures of OCD, depression, and generalized anxiety. The response rate (≥35% reduction of the individual patient’s pre-treatment Y-BOCS score) was 93.8% in B4DT, 12.5% in SH and 0% in WL, while remission rate (response criterion is fulfilled and the post-treatment Y-BOCS score is ≤12 points) was 62.5%, 6.3%, and 0%, respectively. Furthermore, patients who had received the B4DT, showed improved work- and social functioning. None of the patients treated with B4DT showed signs of deterioration. In comparison, one patient in the SH condition was in remission, and one showed significant clinical improvement, whereas the remaining showed no change. Conclusion: The results indicate that the B4DT is an effective treatment for patients suffering from OCD