Concentrated Exposure Therapy Reduced OCD Symptoms More Than Self-Guided iCBT

The Bergen 4-day treatment (B4DT), a concentrated exposure-based therapy, reduced obsessive-compulsive disorder (OCD) symptoms more than an unguided internet-based cognitive behavioral therapy (iCBT) program, according to a randomized clinical trial published in JAMA Network Open.

The single-center trial (DRKS00034236) at University Medical Center Hamburg-Eppendorf in Germany randomized 119 adults with OCD (mean age, 33.5 years; 66.4% women) to B4DT (n = 60) or an 8-week unguided iCBT program (n = 59). B4DT consisted of 2 preparatory individual sessions followed by 4 consecutive days of treatment in small groups, including individually tailored exposure exercises, with 1 therapist per patient. Both groups could continue usual care, including medication and outpatient psychotherapy. The primary outcome was change in Yale-Brown Obsessive Compulsive Scale (Y-BOCS) score from baseline to 3-month follow-up, rated by masked assessors.

In intention-to-treat analyses, B4DT produced a greater reduction in Y-BOCS score at 3 months (mean difference, −5.6 points; 95% CI, −7.8 to −3.4) and at 8 weeks (−7.9 points). Among participants assessed at 3 months, 61.4% receiving B4DT and 25.0% receiving iCBT met response criteria, and 42.1% and 13.6%, respectively, were in remission. Secondary outcomes, including depressive symptoms, quality of life, and global functioning, also favored B4DT, but these analyses were exploratory and not adjusted for multiple testing.

The authors noted that the comparator was unguided digital self-help rather than therapist-delivered CBT, so head-to-head trials against standard face-to-face exposure therapy are needed. Other limitations included the single-center design, 3-month follow-up, lack of participant and therapist blinding, variable iCBT adherence, and concomitant treatment. Adverse effects were assessed but not included in this efficacy analysis. Several authors disclosed roles with BergenNet, a nonprofit organization devoted to raising awareness of B4DT.

The authors suggested that iCBT may serve as an accessible first-line treatment and B4DT as a more intensive second-line option within stepped-care models.

Source: Jelinek L, Wille L, Scheunemann J, et al. Concentrated exposure therapy vs internet-based cognitive behavioral therapy for obsessive-compulsive disorder: a randomized clinical trial. JAMA Netw Open. 2026;9(10):e2639281. doi:10.1001/jamanetworkopen.2026.39281