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Treating OCD: Four Days at a Time

Sk Zafar Ali

Like most mental disorders, Obsessive Compulsive Disorder (OCD) is very different for the person living with it as compared to how it is perceived in popular culture. Memes on OCD are frequently shared on social media and it’s not uncommon to see people proudly proclaiming “I am OCD about this stuff.” This article aims to clear the air around OCD and discusses a revolutionary treatment program.


The National Institute of Mental Health defines OCD as a “common, chronic and long-lasting disorder in which a person has uncontrollable, reoccurring thoughts (obsessions) and behaviors (compulsions) that he or she feels the urge to repeat over and over.”[1] Though most people occasionally double check things, people with OCD are generally unable to control their thoughts and obsessions, and spend a significant part of their day obsessing or compulsively doing the same thing. Moreover, tic disorders, either motor, or vocal, are frequently co-reported with OCD. If left untreated, it will significantly interfere in all aspects of life.

While OCD is quite common and affects people across lines of race, class, age, and gender; most people are diagnosed by the age of 19, with boys showing their symptoms slightly before girls. Researchers are yet to identify what causes OCD but several risk factors have been identified:
1. Genetics: Twin and family studies have shown that if you have a parent or a sibling with OCD, you run a higher risk of developing it yourself.
2. Brain Structure and Function: It has been observed that the frontal cortex and some subcortical structures of the brain are different in people with OCD. Although the connection hasn’t been fully understood.
3. Environment: People who have been subjected to abuse or other trauma (including some streptococcal infections) run a higher risk of developing OCD.

While treatment for OCDs has traditionally involved therapy (psychotherapy including Cognitive Behaviorial Therapy and other related forms) and medication (SRIs and SSRIs), research is paving the way for new approaches. These include augmentation treatments and brain stimulation therapies among others.

Within the last year, two Norwegian psychologists at Haukeland University Hospital, Gerd Kvale and Bjarne Hansen, have come into the limelight for their four day treatment plan for OCD, which has garnered international attention for its efficiency and efficacy. TIME magazine listed both in this year’s 50 most influeintial people in healthcare, and rightly so, because the Bergen method is nothing short of revolutionary for a condition whose treatment traditionally involved weekly therapy sessions for months.

Kvale, who has decades of experience working in therapy for various disorders, came up with the idea when she noticed that the healthcare system in Norway doesn’t provide effective treatment options to people with OCD. In 2010, Kvale, along with Hansen, who had experience with the “lean into the anxiety (LET)” technique for OCD, opened a clinic and started work on concentrated therapies. The duo started trials by 2012; and right off the bat, they could tell that their therapy was working. As of 2018, the Bergen method has helped over 1200 people deal with OCD. So why was it so effective?

The Bergen method has three simple parts to it:
1. The first day is spent informing the patients about OCD and preparing them for the exposure tasks that they’ll go though in the following days.
2. For the next two days, the patients are encouraged to confront their thoughts – a person who’s afraid of contamination is urged to make contact with objects that make them anxious or uncomfortable. The patients are told to look for moments where they think they can take control and use them to overpower their feelings of obsession or compulsion.
3. The fourth day is used to make plans so that the behavioural changes gained in the last two days can be maintained.

Kvale and Hansen believe that a big reason behind their therapy’s effectiveness is due to the two middle days working like a single prolonged session. Moreover, the use of the LET techniques along with other techniques ensures that each patient receives the care they need. In a paper they published earlier this year,[2] Kvale and Hansen revealed that 72% patients were in remission even four years after treatment, and among those, 73% had recovered completely. This is big news, especially in light of the fact that the results were independent of previous therapies, including, but not limited to, SSRIs. Moreover, this therapy’s design makes it ideal to study the brain as it learns emotional processes over a very short period of time.

Some researchers, however, are skeptical of Kvale and Hansen’s claims – they point out that lack of a control group means that the patients who were treated could have been more likely to respond to therapy. Furthermore, there are concerns regarding how this will work out in the United States where the lack of universal healthcare results in intensive treatment programs being very expensive. But there is optimism as the duo start working towards implementing this therapy in Iceland and Sweden, with plans to begin work in Houston by 2019.


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