Bergen 4-day treatment

Domain II · Behavioural & cognitive · Gerd Kvale, Bjarne Hansen · 2018 · Bergen

What it is

B4DT is concentrated, therapist-assisted exposure (exposure and response prevention, ERP, for OCD) delivered over four consecutive days. Its format is "individual treatment in a group setting": 3–6 patients are each paired 1:1 with a therapist inside one group run by a certified group leader.

Format

• Total contact is about 21–23 hours over four consecutive days, followed by 3 weeks of self-directed exposure and one booster session at about 3 months.
• Each group has a group leader with no patients of their own, often a "second in command" and a logistics person, and one therapist per patient.

Who practises it, and how they are trained or regulated

• Certification: a therapist must have taken part in at least 2–3 groups and been judged competent, in Kvale et al. 2018 by two independent B4DT experts, in some trials from video. A group leader must have worked in at least six groups and be approved by a B4DT expert. A new clinic must train at least three therapists including one certified leader, deliver the manual faithfully, and be supported by certified…
• B4DT is concentrated, therapist-assisted exposure (exposure and response prevention, ERP, for OCD) delivered over four consecutive days. Its format is "individual treatment in a group setting": 3–6 patients are each paired 1:1 with a therapist inside one group run by a certified group leader.

Questions to explore with your client

• What drew you to it, and what are you hoping it will change?
• Is there physical contact? Was it explained beforehand, and do you feel free to say no or stop at any point?
• Does it involve any substance, plant preparation, remedy or supplement? Has your doctor or prescriber been told, especially about any medication you take?
• Does it involve intense or unusual breathing? Have you been told about the medical conditions for which that is not advised?
• Is it a group, retreat or community? How do they respond if someone wants to leave or raises a concern?
• Who runs it, and what training or registration do they hold?
• What actually happens in a session or meeting, and how often?
• What does it cost, and is there pressure to commit to more?
• How do you feel afterwards, in the hours and days that follow?
• Does it fit with, or clash with, the work we do here?

What practitioners of it watch for

• Patients who think they cannot ask for help at all.
• Over time, the patient catching the moment without a prompt.
• Re-emerging avoidance. Help the patient re-plan self-exposure.
• Sitting near exits, keeping a companion close, a phone in hand.
• Comorbid depression is not an exclusion in the published criteria.

When to involve someone else

• New or worsening physical symptoms, or advice to stop or change prescribed medication: involve the client's doctor or prescriber.
• Signs of coercion, isolation from family and friends, escalating costs or secrecy: discuss openly and consider safeguarding.
• A crisis or thoughts of suicide: follow your crisis protocol. In the US, call or text 988; in the UK and Ireland, Samaritans on 116 123.

Drawn automatically from the guide's own sections. Stay curious: neither endorse nor dismiss what the client values, and check anything that matters against the full guide and its sources. Not medical advice.