Implementing the 4-Day Treatment for Anxiety and OCD Globally: South America is Next!

Clinical Psychologist and Specialist Bjarne Hansen and his team continue their efforts to make the 4-Day Treatment (Bergen 4-Day Treatment/B4DT) for anxiety and OCD available worldwide. Recently returned from the United States and Ecuador, he is more optimistic than ever about the future of OCD treatment globally. Read his latest report from the journey and the work funded by the Kavli Trust.

Text: Bjarne Hansen

After fantastic days in South and North America: Is it possible to make the 4-Day Treatment available globally? Yes! After the last 12 days, I am even more convinced!

In Norway, there are now more than 50 clinics offering the 4-Day Treatment, and it is also provided in Germany, Sweden, Finland, Singapore, Iceland, and the USA.

Together with co-director Kristen Hagen (BCBP and HMR) and Professor Thröstur Björgvinsson (McLean/Harvard), we are moving beyond the COVID fog!

The work in the USA is ready to be taken to the next level, and there is strong potential for further expansion in Europe, the USA, and Asia.

At the same time, there is also strong potential to start training and lay the groundwork for significant efforts in South America and Africa. I look forward to continuing the work to establish this and feel that this journey has taken us many steps in the right direction.

The support from Kavli Trust has made this possible, and we see the difference it can make in an increasing number of countries! I hope many will take the time to learn more about Kavli Trust and the good work they do!

While it’s great that new clinics in new countries receive training, one of the most important things is to ensure that we collaborate with clinics and institutions that are ready to take on a significant part of the responsibility for training in their local area. Through this, we get a sustainable model where our efforts can be multiplied many, many times.

Kristen Hagen, clinical psychologist specialist and associate professor, leads the anxiety and OCD research group at Helse Møre og Romsdal and co-leads the international rollout of the 4-Day Treatment alongside Bjarne Hansen from the Bergen Center for Brain Plasticity. This photo was taken at the OCD clinic in Los Angeles. — Clinical psychologist specialist and associate professor Kristen Hagen leads the anxiety and OCD research group at Helse Møre og Romsdal and co-leads the international dissemination of the 4-Day Treatment, led by Bjarne Hansen from the Bergen Center for Brain Plasticity. Pictured here at the OCD clinic in Los Angeles.

We have also seen a very encouraging development: There appears to be an international shift in the field, with more and more people choosing to provide brief, intensive, and quality-assured treatment for anxiety and OCD. When we receive feedback that we have contributed to this, it truly warms our hearts!

So, what goals have we set?

Expansion: Achieve a global presence (on all continents) with a sustainable model that ensures continued growth from central hubs to a large network of national and local clinics. Within the next two years, I believe the number of clinics offering the 4-Day Treatment will have surpassed 100. This is not an end goal, but what we in Southern Norway call “a reasonably good start.”
Thematic broadening: When clinics adopt the method for OCD, we see that it takes little effort to expand it to other areas and disorders. We will facilitate and support this so that a significant portion of clinics can multiply their impact by reaching a much larger target group. This requires little effort but benefits many!
Professional development: We have not been idle when it comes to professional development and evaluation. This fall, we will present and publish the results of this work (if you are reading this, I hope you are a little curious and excited—there’s more to come).

Every person helped is worth the effort, so as the number grows, all you can do is pinch yourself, enjoy the moment briefly, and keep pushing forward!

I would love to mention everyone who has contributed, but the list would be too long! Still, I must highlight Kristen Hagen, who has been with us all along and has now stepped up as co-director at BCBP, and Trine Myklebust, who currently leads the clinic in Bergen and practically knows everything and manages most things.

As for me, I have been fortunate to receive outstanding support from skilled supervisors, colleagues, and employers at Helse Bergen and the University of Bergen, as well as from the Norwegian OCD and Anxiety Association, Ananke. Collaboration with the Trond Mohn Foundation (TMS) and especially Kavli Trust has also opened entirely new doors and opportunities to help people in more and more countries.

Right now, it feels a bit like being in an international bubble, and without bothering those reading this too much, it has been a little too long away from family. I miss my daughters and Anneli, who once again has held the fort while I’ve been out on expeditions.

Bjarne Hansen together with colleague, Professor Thröstur Björgvinsson (on the right), who leads the OCD clinic in Los Angeles and collaborates with the OCD clinic in Houston to provide training in the 4-Day Treatment in the USA. Here, the two are posing in front of a lake and lush mountains. — Professor Thröstur Björgvinsson (on the right) leads the OCD clinic in Los Angeles and collaborates with the OCD clinic in Houston to provide training in the 4-Day Treatment in the USA. He is also a professor at Harvard Medical School and McLean Hospital (Harvard’s psychiatric teaching hospital) in Boston, Massachusetts. Previously, he led training of healthcare professionals in his home country Iceland, one of the first countries to offer the treatment after Norway.

Facts: This is Bergen 4-Day Treatment (B4DT)

Bergen 4-Day Treatment (B4DT), also called the 4-Day Treatment for anxiety and obsessive-compulsive disorders (OCD), was developed by Bjarne Hansen and Gerd Kvale, both professors and clinical psychologists at the University of Bergen and Haukeland University Hospital.
B4DT is based on cognitive behavioral therapy and consists of four days of individually tailored, intensive exposure therapy in groups, with one therapist per patient.
Patients can maintain regular contact with their therapist after the treatment period.
Several studies have shown that around 90 percent of patients experience significant improvement after four days, while 70 percent are free of their OCD and living normal lives four years after treatment.
These results have been further confirmed in a randomized controlled trial (Launes et al., 2019b).
Hansen and Kvale have also developed effective training modules to rapidly and cost-effectively disseminate the treatment across borders.
Health authorities and institutions worldwide are requesting the treatment.
In 2018, Kvale and Hansen were named two of the world’s 50 most important people in health by Times Magazine for their work with B4DT.

35 million NOK for international dissemination

In 2018, Kavli Trust awarded 35 million NOK for the international dissemination of B4DT.
The project is planned over several years and is currently led by Bjarne Hansen, based at the Bergen Center for Brain Plasticity at Haukeland University Hospital.
The center was established as a collaboration between the Trond Mohn Foundation, the University of Bergen, Haukeland University Hospital, and Kavli Trust.
The Trond Mohn Foundation funds further development of B4DT to adapt the treatment for patients who currently do not benefit from it.
Kavli Trust has previously funded dissemination of B4DT in underserved areas within Norway, as part of the foundation’s focus on mental health for children and youth.
Bjarne Hansen and his team provide training to healthcare teams and then supervise them in patient treatment. This approach combines training with practical implementation and the opportunity to collect data for research.
The data is used as a research basis to gain more knowledge about how the treatment works, who it does not work for, and why.
In this way, the dissemination effort is also part of the ongoing development of new treatment variants to help those who do not get sufficient help from the 4-Day Treatment.
The international dissemination project is the largest single research project Kavli Trust has ever supported.

Read more: All articles about Bergen 4-Day Treatment