Future Directions for Research and Implementation of the Bergen 4-Day Treatment for OCD

By
Eric A. Storch
Caitlin M. Pinciotti
October 19, 2026

Jama Network Open

At a Glance

Category	Detail
Condition	Obsessive-compulsive disorder (OCD)
Key Mechanisms	The Bergen 4-Day Treatment (B4DT) is a concentrated individual exposure and response prevention (ERP) intervention; the comparator was unguided internet-based cognitive behavioral therapy (iCBT).
Target Population	Adults with OCD; the trial enrolled 119 of 253 adults screened.
Care Setting	Intensive treatment and research settings; the appropriate place of B4DT along the continuum of OCD care remains uncertain.

Key Highlights

In a randomized trial of 119 adults, B4DT was statistically superior to unguided iCBT, with a large effect size (g = −1.6).
At 3-month follow-up, response rates were 61.4% with B4DT and 25% with iCBT; remission rates were 42.1% and 13.6%, respectively.
Participants rated B4DT as more acceptable than iCBT, and only 3 of 60 participants were lost to 3-month follow-up.
Only 47% of screened adults entered the trial; 21% were reported as contraindicated for B4DT and 32% declined or were unable to undertake it.
The commentary calls for comparisons with equivalent-dose ERP delivered over a longer period, broader replication, and research in naturalistic settings.

Guideline-Based Recommendations

Diagnosis

Management

The commentary identifies B4DT as a concentrated individual ERP option but states that its role as frontline treatment, treatment for more resistant OCD, or an option where local treatment is unavailable or impractical remains uncertain.
Future studies should compare B4DT with an equivalent dose of active ERP delivered over a longer treatment period.

Monitoring & Follow-up

Future B4DT studies should report screening, eligibility, exclusion, and refusal information clearly.
Research should examine participant motivation, readiness for intensive treatment, and accessibility, and include clinically diverse samples in naturalistic settings.

Risks

The commentary notes uncertainty about how well trial findings generalize to the broader OCD population because many screened individuals did not participate and reasons for refusal were not reported.
The B4DT model was estimated to treat approximately 45–48 patients per therapist annually, fewer than the comparison estimate of approximately 75 patients per year for 16-week outpatient ERP.

Patient & Prescribing Data

Adults with OCD. Of 253 screened, 119 entered the trial; 53 did not meet inclusion criteria and 81 declined, with reasons for refusal unreported.

B4DT was compared with unguided iCBT. The commentary reports higher B4DT response and remission rates at 3 months, but states that the treatment’s optimal patient group and place in care are not established.

Clinical Best Practices

Interpret B4DT trial results in light of the screened and enrolled populations and the limited reporting of reasons for nonparticipation.
Evaluate B4DT through rigorous comparisons with active ERP of equivalent dose and through independent, broad international replication.
Study B4DT in naturalistic settings and clinically diverse samples, including people with differing motivation and engagement.
Consider treatment accessibility and therapist capacity when evaluating B4DT’s role in care.