A therapist-led, concentrated exposure-based therapy outperformed unguided, internet-based cognitive behavioral therapy (iCBT) for treating obsessive-compulsive disorder (OCD), according to the
results of a randomized controlled trial issued by
JAMA Network Open.
Why It’s Relevant
Exposure and response prevention is the recommended first-line treatment for OCD, but its use remains limited due to shortages of trained therapists, long wait times, and patient refusal or dropout related to the many months of therapy required. The compressed Bergen four-day treatment (B4DT)—which incorporates a “leaning into anxiety” approach—could improve accessibility, but more evidence for this intervention is needed.
By the Numbers
- Among 119 adults (average age 34, recruited from a single site in Germany) with OCD who were randomized to receive either B4DT for four days or OCD-tailored iCBT for eight weeks, the former was more effective.
- Participants who received B4DT had an eight-point greater reduction on the Yale-Brown Obsessive Compulsive Scale (Y-BOCS) total score at week eight.
- Y-BOCS scores remained six points lower in the B4DT group compared with the iCBT group at a three-month follow-up. The B4DT group also had greater treatment response (61% versus 25%) and remission (42% vs 14%) rates at follow-up.
- B4DT also outperformed iCBT on other outcomes, including quality of life, depressive symptoms, global functioning, and treatment satisfaction.
What’s More
“The B4DT clearly demonstrates that a concentrated [exposure and response prevention] program can be very helpful. But the question of for whom is this approach best suited remains,” Eric A. Storch, Ph.D., and Caitlin M. Pinciotti, Ph.D., wrote in an accompanying
commentary. Just 47% of adults screened met the study requirements and chose to participate; it’s not clear why others were excluded or opted out. “This raises an important question about whether treatment effects may be influenced by the characteristics of those who are ultimately included.”
The Other Side
As with all psychotherapy trials, participants and therapists were not blinded to treatment allocation, which may have introduced expectancy effects, according to the researchers. Furthermore, an exploration of participants’ outcomes beyond three months—now in progress—is needed to determine treatment durability.
Takeaway Message
Integrating iCBT and B4DT within stepped-care frameworks could improve access, optimize resource allocation, and enhance overall treatment outcomes in OCD, the researchers wrote, noting: “iCBT may serve as an accessible first-line treatment, whereas B4DT may offer a more intensive therapist-delivered second-line option for individuals requiring more intensive care.”
Related Information
Source
Lena Jelinek, et al. Concentrated exposure therapy vs internet-based cognitive behavioral therapy for obsessive-compulsive disorder. JAMA Network Open. Published October 19, 2026. doi:10.1001/jamanetworkopen.2026.39281
(Image: Getty Images/iStock/Nadija Pavlovic)