A concentrated exposure therapy intervention may be more effective than digital cognitive behavioural therapy in obsessive-compulsive disorder

1. Concentrated exposure therapy was associated with greater and more sustained reductions in obsessive-compulsive disorder symptom severity compared to an established internet-based cognitive behavioral therapy.

Evidence Rating Level: 1 (Excellent)

The Bergen 4-day treatment (B4DT) is a concentrated exposure and response prevention (ERP) intervention for obsessive-compulsive disorder (OCD) that compresses treatment traditionally delivered over several months into 4 days. Although B4DT improves efficiency and accessibility of ERP, it remains unclear how it compares with scalable digital cognitive behavioral therapy (CBT) interventions. This study thus evaluated the efficacy of B4DT compared with internet-based CBT (iCBT) in reducing OCD symptoms. This randomized controlled trial included adults aged 18-72 years with OCD in Germany. Participants were randomly assigned 1:1 to undergo B4DT delivered in small groups by trained therapists or an 8-week self-guided iCBT program. The primary outcome was change in OCD symptom severity, measured by the Yale-Brown Obsessive Compulsive Scale (Y-BOCS). Outcomes were assessed at baseline, 6 weeks, 8 weeks (posttreatment), and 3 months (follow-up). In total, 119 participants were included in the study (mean [SD] age, 33.5 [10.1] years; 79 [66.4%] women). Participants who received B4DT had greater reductions in OCD symptoms (Y-BOCS) than those who received iCBT, with large effects at posttreatment (mean [SE] difference, −7.9 [0.9]; 95% CI, −9.7 to −6.0; Hedges g, −1.6) and sustained effects at 3-month follow-up (mean [SE] difference, −5.6 [1.1]; 95% CI, −7.8 to −3.4; Hedges g, −1.0). Overall, this study found that B4DT was superior to iCBT in reducing OCD symptom severity. These findings suggest that B4DT may be a scalable intervention to improve treatment access for people with OCD.

Click here to read this study in JAMA Network Open

Citation: Jelinek L, Wille L, Scheunemann J, Tegtmeier L, Zapf H, Miegel F, et al. Concentrated Exposure Therapy vs Internet-Based Cognitive Behavioral Therapy for Obsessive-Compulsive Disorder: A Randomized Clinical Trial. JAMA Netw Open. 2026 Oct 1;9(10):e2639281. doi: 10.1001/jamanetworkopen.2026.39281. PMID: 42895747; PMCID: PMC13681233.

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