NOK 35 million to scale up anxiety and OCD treatment internationally

Kavli Trust is awarding NOK 35 million for the international dissemination of the Bergen 4-Day Treatment (B4DT), the intensive treatment for anxiety and obsessive-compulsive disorder developed by Gerd Kvale and Bjarne Hansen in Bergen.

“This is fantastic. The opportunity that the Kavli Trust is now providing for a quality-assured international dissemination of the 4-Day Treatment is something entirely new,” says Gerd Kvale, who will serve as the project’s academic and administrative director, with Associate Professor Bjarne Hansen as deputy director.

Both are employed at Haukeland University Hospital and the University of Bergen. Together they have developed the “Bergen 4-Day Treatment” (B4DT).

Around 70 per cent recover

The treatment is an intensive method for anxiety disorders and obsessive-compulsive disorder. In total, around 1,200 patients in Norway have received it, and the remarkable results have drawn international attention:

• After four consecutive days of treatment, 90 per cent of patients achieve significant improvement, while 68 per cent are in remission 12 months later.
• At four-year follow-up, 68 per cent have recovered.
• There is almost no dropout among those receiving the treatment. This stands in contrast to traditional psychological treatments, where around 15 per cent decline treatment and 15 per cent discontinue before completion.
• B4DT has also shown strong results for people with depression and helps patients return to work.
• Outcomes are equally positive for children and adolescents.

These strong results form the backdrop for the new research centre established by Haukeland University Hospital together with the University of Bergen, the Bergen Research Foundation and Kavli Trust: the Bergen Centre for Brain Plasticity. It is from here that the treatment will be disseminated internationally.

Read more: A unique collaborative effort in Bergen for mental health

A disease of the young

More than three-quarters of those who develop obsessive-compulsive disorder (OCD) or anxiety disorders do so before the age of 25.

“That is why the disorder is often referred to as ‘the disease of the young’,” says Gerd Kvale.

“Without effective treatment, these disorders often become chronic, with profound consequences for everyday life. The personal and societal gains from helping each individual affected are extremely significant.”

People with anxiety disorders are overrepresented among the growing number of young adults on disability benefits in Europe and the United States in recent years.

Kavli Trust has financed the work of making the treatment available to children and young people throughout Norway. Public health teams across the country have been trained in the method and can also use it with adult patients.

“It has been remarkable to follow the successful dissemination of the treatment in Norway. In addition to the strong results, Kvale and Hansen have developed an effective and cost-efficient training system,” says Inger Elise Iversen, General Manager of Kavli Trust.

“This is a model that provides life-changing help to many people and saves society considerable costs. It is with great pleasure and high expectations that we are now also funding efforts to spread it to other countries,” says Inger Elise Iversen.

International dissemination following the ‘Norwegian model’

Since 2012, Gerd Kvale and Bjarne Hansen have ensured the training of around 40 Norwegian teams.

“Based on the OCD Clinic in Bergen, we first trained four clinics in Norway: Solvang District Psychiatric Centre (DPS) in Kristiansand, Molde Hospital, Nidaros DPS and the OCD Spectrum Clinic at Gaustad Hospital. These now also serve as training clinics.”

The international rollout will mirror the Norwegian one. During the project period, training centres will be established that follow the same principles of training, certification and quality assurance within their own programmes. This will enable robust, large-scale dissemination of B4DT.

Awards and international recognition

In 2015, B4DT received the “Innovation of the Year Award” from the Norwegian Psychological Association.

In the past year, the treatment and its researchers have received major international attention. In October 2018, Time Magazine named Gerd Kvale and Bjarne Hansen among the fifty most influential people who have transformed health care internationally.

Read more: The Health Care 50: Fifty people transforming health care in 2018

The increased attention has also generated rising demand for the treatment.

“There is strong national and international demand for B4DT—from patients as well as from clinics wanting to offer the treatment. It is embraced not only because it is effective, cost-efficient and flexible, but also because the assessment of clinical change is an integrated part of the treatment format,” says Gerd Kvale.

A large number of clinics in the United States have expressed interest in training.

“The list includes clinics in Singapore, Spain, Brazil, Finland, Canada, Italy, Germany, Australia and the United Kingdom, and with the extensive international media coverage of B4DT, new clinics are contacting us every week,” says Gerd Kvale.

Collaboration with McLean Hospital

The dissemination work will take place in collaboration with three selected institutions:

• McLean Hospital/Harvard Medical School, ranked for the second consecutive year as the leading mental health institution in the United States. The American rollout will begin here in spring 2019. The main centre for training and dissemination in the US will therefore be the Houston OCD Centre, which will also serve as an international training unit, as it can receive clinicians proficient in either English or Spanish.
• Karolinska University Hospital, Northern Unit, Stockholm, Sweden, one of Sweden’s leading OCD research and treatment environments. The aim is to start in the second quarter of 2019. The treatment will be publicly funded.
• Kvíðameðferðarstöðin (KMS), Reykjavik, Iceland, has already certified a team for adult treatment, and a child and adolescent team is now in training. KMS has conducted a pilot study for adults with OCD, and the results are as strong as the Norwegian ones. Once the research protocol is approved by the Icelandic ethics committee, the team will be ready to begin.

Read more: Interview with Gerd Kvale in Scientific American

Controlled studies throughout

Controlled studies will be conducted systematically throughout the project.

“Dissemination will not take place unless the clinical results are acceptable,” emphasises Gerd Kvale.

“This will ensure that patients receiving treatment at newly certified clinics and units receive care that maintains the same standard as the 4-Day format as originally developed.”

The project period runs from 1 January 2019 to 31 December 2024. Of the NOK 35 million allocated, NOK 7 million will be provided in 2019.