Four-day OCD treatment outperforms self-guided online CBT

Clinical takeaway: Consider concentrated four-day exposure and response prevention for adults with OCD who need substantial symptom improvement and are willing and able to participate in intensive treatment.

Obsessive-compulsive disorder (OCD) affects an estimated 1% to 3% of the population and is often associated with chronic symptoms, functional impairment, and reduced quality of life. Although exposure and response prevention is a recommended first-line treatment, limited access to trained therapists and long wait times can delay care, prompting interest in more scalable treatment models.

In this randomized clinical trial, researchers enrolled 119 adults with OCD and assigned them to either the Bergen 4-Day Treatment (B4DT), an intensive exposure-based intervention delivered over four consecutive days, or an eight week unguided internet-based cognitive behavioral therapy (iCBT) program. Participants were followed for three months after treatment.

OCD symptoms improved in both groups but substantially more with B4DT. Mean Yale-Brown Obsessive Compulsive Scale scores decreased by approximately 45% from baseline with B4DT versus 18% with iCBT at the end of treatment.Benefits were largely maintained at three months. At that follow-up, clinical response rates were 61% with B4DT versus 25% with iCBT, and remission rates were 42% versus 14%.

Improvements in depressive symptoms, quality of life, global functioning, self-esteem, obsessive beliefs, and experiential avoidance also favored B4DT. Participants receiving the intensive intervention reported markedly higher treatment satisfaction than those assigned to iCBT.

The study authors suggested a possible stepped-care approach, with online therapy as an accessible initial option and intensive B4DT for patients needing greater symptom improvement. However, in an accompanying editorial, Eric A. Storch, PhD, and Caitlin M. Pinciotti, PhD, emphasized that comparisons with standard therapist-delivered exposure and response prevention are still needed to determine whether concentrating treatment into four days offers additional benefit.

Source: Jelinek L, et al. (2026 Oct 19) JAMA Netw Open. Concentrated Exposure Therapy vs Internet-Based Cognitive Behavioral Therapy for Obsessive-Compulsive Disorder: A Randomized Clinical Trial