A Bergen 4-Day Treatment Success Story: Gunnar Rolland

Gunnar Rolland remembers the exact age, he was 13 years old, when his OCD symptoms first appeared. He tried numerous treatment approaches and finally, 59 years later, at age 72 everything changed!

“I had tried so many different therapies, and I had tried over and over to do exposure myself. The result was most often discomfort without change, and I had nearly started thinking that I just had to accept and to adapt my life to the OCD. During the 4 days I learnt how to make real and lasting change. It was hard work, but changed my life.” – Gunnar Rollan

Gunnar Rolland lived nearly his entire life with OCD and after 4 days in February, he was “free.” The video shows his story…

Video courtesy of Dr. Bjarne Hansen


Congratulations Dr. Kvale and Dr. Hansen on Being Selected to TIME Magazine’s 50 Most Influential People in Health Care for 2018

On the heels of last week’s OCD Awareness Week, the Houston OCD Program, is still feeling the excitement. We were especially honored to co-host, along with Peace of Mind, “The Bergen 4-Day OCD Treatment: The USA Journey Begins in Houston,” presented by Drs. Gerd Kvale and Bjarne Hansen, and former B4DT patient Kathrine Mydland-Aas.

Drs. Kvale and Hansen shared the wealth of impressive findings from their research and how this new model is reinventing how we approach OCD treatment. While Kathrine Mydland-Aas provided a moving personal testimony of her journey through recovery and now living an OCD free life.

On October 18, 2018 Drs. Kvale and Hansen were selected as two of TIME Magazine’s 50 Most Influential People in Health Care for 2018. This list is curated by TIME’s health reporters and editors and recognizes 50 people who changed the state of health care this year, and bear watching for what they do next.

“We both think Houston is a perfect place to launch the B4DT since the infrastructure is there and also a highly competent, caring and dedicated community of therapists who wants to ensure that the patients will have access to treatments that work. The openness and readiness combined with scientific rigor is a perfect starting point. At the moment the international demand is substantial:  Results from Iceland are ready, Sweden has started, Finland will start, Brazil has asked for it – so has Germany. Houston is at the moment at the top of our list.” – Gerd Kvale, Co-Founder B4DT

The B4DT founders were received with enthusiasm in the Houston community and we are looking forward to continued collaboration to bring this innovative approach to Houston in 2019!

To read more about Drs. Kvale and Hansen’s amazing accomplishment click here.


By Andrea Petersen (Article originally appeared on nytimes.com)

Aug. 13, 2018

Six middle- and high-school students sat around a table on a Monday afternoon, watching a psychologist write three letters on a whiteboard:

O-C-D.

“What does O.C.D. stand for?” the psychologist, Avital Falk, asked the group.

“Obsessive-compulsive disorder,” answered a timid 12-year-old boy wearing a blue blazer and red tie.

“What makes it a disorder?” Dr. Falk asked.

“Because it’s messing up our lives,” said Sydney, a chatty 14-year-old with long red hair.

These young people have O.C.D., an illness characterized by recurrent, intrusive thoughts and repetitive behaviors, or other problems with anxiety. They also are participants in a novel treatment program at Weill Cornell Medicine in New York.

Typically patients with O.C.D. see a therapist once a week for an hour over several months, but this program consists of two-hour group meetings three times a week, plus up to four additional hours of individual therapy per week. Some patients complete the treatment in just two weeks.

The program, which began in 2016, is part of a new wave of concentrated, intensive therapy programs for psychiatric disorders. The Child Mind Institute in New York launched a two-day “boot camp” for teens with social anxiety last year. The Houston O.C.D. Program in Texas operated its first weeklong treatment program for adolescents during spring break for local schools.

In Atlanta, Emory University is in its third year of a two-week therapy program for veterans with post-traumatic stress disorder, funded by the Wounded Warrior Project. Similar offerings for veterans are now available at U.C.L.A. Health in California, Rush University Medical Center in Chicago and Massachusetts General Hospital in Boston.

The approach is gaining popularity in part because of new research showing that for both adults and children, the concentrated approach is generally just as effective, and in some ways more effective, as treatment that is spread out over several months. A meta-analysis of randomized, controlled trials published last year in the journal Behaviour Research and Therapy found remission rates of 54 percent for children in intensive, concentrated cognitive behavioral therapy (C.B.T.) for anxiety disorders and 57 percent for those in standard C.B.T., a difference that was not statistically significant.

Just 2.3 percent of patients who did the concentrated therapy dropped out during treatment, compared with 6.5 percent for standard C.B.T. At Emory, only 5 percent of veterans in the two-week PTSD program left before finishing, according to a paper published in the fall of 2017.

Another meta-analysis (this one of both randomized, controlled trials and studies without a control group), published in 2015 in the Journal of Obsessive-Compulsive and Related Disorders, found that O.C.D. patients who were treated with intensive, concentrated therapy were more improved after treatment ended than those who received traditional weekly or twice weekly C.B.T. At a follow-up point of about three months, both groups were equally improved.

The intensive treatments seem to work best for anxiety-related disorders. They usually consist of C.B.T., in which patients repeatedly expose themselves to the very situations they fear.

Supporters of the approach said that while it may involve a similar number of total hours as weekly therapy, relief is quicker. Thomas H. Ollendick, a psychology professor at Virginia Tech, who helped pioneer a one-day treatment for phobias and has studied a one-week treatment for O.C.D., said this can be crucial for people whose illnesses are preventing them from attending school or work.

And with concentrated treatment, Dr. Ollendick said, “you don’t have a week in between to unlearn what you learned in the session or have additional experiences that can lead you to think, ‘Oh, I better be afraid.’”

The concentrated format allows therapists to deliver evidence-based treatment to more people, since it’s easier for patients who live in places without access to high-quality therapy to travel for a one- or two-week program, said Donna B. Pincus, director of the Child and Adolescent Fear and Anxiety Treatment Program at Boston University, which runs five- to eight-day intensive treatment programs for panic disorder, separation anxiety disorder and phobias.

Even patients who live nearby may find it easier to take off a week of work or plan treatment during a school break, rather than deal with the logistics of weekly therapy.

“People are pulled out of their everyday lives for two weeks — they are not dealing with work and spouses and kids,” said Barbara O. Rothbaum, a professor of psychiatry and behavioral sciences at the Emory University School of Medicine. “It really is a kind of a bubble for them to do this work.”

The intensive, concentrated approach also has downsides. The price tag for the Houston spring break program, for example, was $2,500 for the week. Many programs don’t accept insurance. Sometimes insurance companies will reimburse for only a small portion of treatment or will require patients to first prove that less intensive therapy has failed before coverage kicks in.

Patients also need to be motivated and ready and willing to move quickly into exposure work, noted Boston University’s Dr. Pincus.

Some patients use the concentrated therapies to kick-start treatment or as an adjunct to longer-term therapy.

Christina Uzzi, 14, of Fair Haven, N.J., usually does weekly therapy via Skype with her psychologist at the Child Mind Institute. She also did two of the two-day social anxiety “boot camps” at the institute last summer before starting eighth grade at a new school.

The long days gave her hours to practice things that are hard for her, like asking strangers for directions and public speaking, with the help of her therapist and a group of other teenagers with similar fears.

The boot camp “was a big boost all at once,” said her mother, Jennifer Uzzi. “I think she definitely improved to be able to chitchat with people and order in a restaurant.”

Going through Emory’s two-week PTSD program with a small group of fellow veterans helped Detrice Burriss, 52, stick with therapy and stay motivated, she said. Each day, her group would meet for breakfast or coffee before therapy.

“It was almost like I’ve got to be in formation at nine o’clock. I’ve got to go, or they are going to be looking for me,” said Ms. Burriss, who developed PTSD after an I.E.D. hit a vehicle in front of the one in which she was riding in Iraq in 2009.

Several researchers in the United States point to the work of scientists in Norway, led by Gerd Kvale and Bjarne Hansen, as the source of much of the American surge in excitement around intensive, concentrated treatment. Therapists there have treated more than 700 patients with O.C.D., panic disorder and social anxiety disorder with a four-day protocol.

Patients meet in small groups, but each works with his or her own therapist. The core of the treatment is two eight- to 10-hour days of “exposure and response prevention,” in which patients actively approach the situations that induce their anxiety and avoid engaging in any behavior to reduce the anxiety.

In the mornings, therapists travel with patients to their homes, to stores and all around their communities so they can encounter as many situations as possible that spur anxiety, a method that has been shown to increase the therapy’s effectiveness. Patients continue to do exposures on their own in the afternoons and evenings.

The treatment seems to have a long-term impact. In a study published this month in the journal Cognitive Behaviour Therapy involving 77 people with O.C.D., 53 of them (or 69 percent) had recovered from their disorder four years after the treatment. Only one person dropped out of the therapy.

Before treatment, 70 percent of patients were classified as having severe O.C.D., and nearly three-quarters had previously been in therapy. Some 42 percent were taking antidepressants. The study did not have a control group.

At the Weill Cornell program, the participants, ages 10 to 15, practice exposures in a mock class. Dr. Falk gives them assignments to induce anxiety based on their individual triggers. She told the 12-year-old in the red tie and blazer — who is petrified of not acting “right” out of fear it will cause something bad to happen — to “be really inappropriate and rude, and eat in the middle of class and make a mess.”

She instructed a 12-year-old girl in a Harry Potter “Butterbeer” T-shirt to write about what she did on her recent birthday. The child has many compulsive behaviors involving writing and often has to erase and rewrite, something that causes problems in school.

For a 10-year-old with braces and a purple streak in her hair whose O.C.D. is triggered by not knowing certain things, Dr. Falk instructed the other kids to “tell me something secret and rude” that she couldn’t hear.

As class got underway one day, the boy, at Dr. Falk’s urging, ditched his tie and blazer. He was eating an orange. “Make fun of me,” encouraged a 14-year-old who has spent most of the session doodling.

The girl with the writing compulsion put down her pen and wailed. “Oh my god. It looks like an ‘I’ with a top hat on it,” she said, staring at her paper.

Dr. Falk looked it over. “I can understand it perfectly,” she said. “Let it go, which is going to be better for you long-term.”

Before the kids left, Dr. Falk wrote a new homework assignment on a colorful notecard for each of them, more exposures to complete before the next group meeting — the very next day.


4 Days of Intensive Therapy Can Reverse OCD for Years

Two Norwegian Psychologists developed a method of treating the condition that is gaining international attention for its efficiency and effectiveness

By Diana Kwon (Article originally appeared on scientificamerican.com)

November 29, 2018

For almost a decade, cleaning rituals ruled Kathrine’s life. The middle-aged resident of Bergen, a coastal town in the southern tip of Norway, was consumed by a fear of germs and contamination that led to endless cycles of tidying, vacuuming and washing. “I realized that I was facing a catastrophe,” Kathrine Mydland-aas, now 41, recalls. “I couldn’t help the kids with homework, couldn’t make dinner for them, couldn’t give them hugs. I didn’t do anything but cleaning. I tried to quit, but the rituals always won.”

Last year, around nine years after Mydland-aas’s cleaning rituals began, a psychologist diagnosed her with obsessive-compulsive disorder (OCD) and referred her to a clinic at the Haukeland University Hospital in Bergen. There, a team was administering a behavioral therapy for the condition that, to Mydland-aas’s surprise, was only four days long. “I thought, what can they do in four days?” she says. “[But] it changed my life.”

Mydland-aas is one of more than 1,200 people who have received the Bergen four-day treatment for OCD, a concentrated form of exposure therapy designed by two Norwegian psychologists, Gerd Kvale and Bjarne Hansen. The four-day protocol has recently gained international attention for its effectiveness and efficiency—last month Time magazine named the pair, who are both currently affiliated with the Haukeland University Hospital and the University of Bergen, as two of this year’s 50 most influential people in healthcare.

“It’s amazing that you can so get much done in such a small amount of time,” says Avital Falk, a clinical psychologist who directs an intensive treatment program for OCD and anxiety at Weill Cornell Medicine and NewYork Presbyterian. OCD treatment regimens typically involve weekly hour-long sessions spread out across several months, but more clinicians are adopting concentrated therapy. “Intensive treatment in general has been getting a lot more attention in different formats that can be anywhere from three hours a week,” Falk says. “Ten to 12 hours a week, all the way to the Bergen method, which does everything in four days.”

Kvale has been practicing intensive therapies for various disorders, including phobias and chronic fatigue, since the early 1990s. Over the years, she noticed a lack of effective psychological treatments for people with OCD in Norway, which spurred her interest in creating a concentrated therapy for the disorder. In 2010, she asked executives at her employer, the Haukeland University Hospital, to open a new clinic where she could develop this method—and they agreed. Kvale immediately recruited Hansen, who had spent many years practicing the so-called “LEan into The anxiety” or LET-technique—a method of encouraging individuals with OCD to focus specifically on anxiety-eliciting moments—which eventually formed the core foundation of the Bergen treatment. The duo completed the design of the four-day protocol by fall 2011, and tested the first group of patients in June of the following year. “It worked out exactly the way the we expected it to,” Kvale recalls. “The change we saw during those four days was really immense.”

The Bergen method works in three stages: On the first day, therapists provide patients with information about OCD and help them prepare for the exposure tasks they will engage in over the next two days. During the exposure part of the protocol, people face their fears head-on—for example, if someone is frightened of contamination, therapists suggest that they choose an object or surface that might trigger anxiety or discomfort, and then touch it. “We encourage patients to pay attention to the moments when they feel the urge to start taking control to reduce anxiety or discomfort,” Kvale explains. “And to use these as turning points for change.” Participants set aside the last day for planning how to maintain the behavioral changes gained during therapy after leaving the clinic.

The two middle days serve as a single prolonged therapy session, one of several aspects that makes the Bergen method effective, according to Kvale and Hansen. Other key features include the usage of the LET-technique during exposure sessions and the format of the treatment, in which a group of three to six therapists work as a team with the same number of patients. This setup is important, Kvale says, because it provides tailored care for each individual while also letting patients observe others going through the same process of change.

Earlier this year, Kvale, Hansen and their colleagues reported findings from a long-term analysis of the treatment’s effects. The study, published August in Cognitive Behaviour Therapy, revealed that 56 of 77 patients remained in remission four years after treatment—and that 41 of the 56 had fully recovered. Treatment outcome was independent of whether participants had previously undergone therapy or were on selective serotonin reuptake inhibitors (SSRIs), such as Cipralex, commonly used medications for OCD. When the team members compared their findings to published analyses of other less-intensive exposure treatments, they found that the Bergen technique led to significantly higher rates of remission and recovery.

“I was very impressed [with the results],” says Martin Franklin, a clinical psychologist at the University of Pennsylvania who is one of the Norwegian psychologists’ close collaborators but was not involved in this study. “The follow-up data [showing] that people are maintaining their gains four years out is really interesting.” However, Franklin notes that it is too early to say whether the Bergen method is more effective than other, longer, forms of exposure and response prevention (ERP) therapies. For one thing, the team’s analysis lacked an untreated control group, so one cannot rule out the possibility that patients examined were simply more likely to respond to therapy. In addition, this study only compared the Bergen method with prior OCD studies with long-term follow-up assessments. As a result, “you’re not necessarily comparing to the best trials done,” Franklin adds.

Whether the Bergen method will work for patients in the United States or other countries with significantly different cultures, is another open question, Franklin says, but one that may soon have answers. Kvale and Hansen have already started training groups in Iceland and Sweden, and will begin working with teams in Houston next year. The pair notes that before disseminating this treatment on a large scale in different countries, they will conduct randomized controlled trials to assess how well it works in the new cultural settings.

Falk notes that differences in health care systems may pose a challenge to expanding use of the Bergen technique. In Norway, the government covers the Bergen treatment through a universal health care system, which is not present in the U.S. Intensive treatment programs at American clinics can be expensive—often in the thousands of dollars range—and insurance companies do not always help cover the costs. Even if a patient undergoing concentrated therapy receives the same number of total treatment hours as someone who opts for more long-term, once-a-week care, “paying for that all upfront can be a barrier to access,” Falk adds.

As the treatment is used more widely, the Norwegian pair will also be working with researchers from several countries to investigate the genetic, epigenetic and neurobiological changes that occur when patients undergo the Bergen four-day treatment. The Bergen protocol’s concentrated structure makes it an ideal paradigm to examine how the brain can rapidly learn new emotional processes, says Kerry Ressler, chief scientific officer at McLean Hospital in Massachusetts and one of the scientists involved in this project. Other goals of this work, he adds, include identifying biological markers—in blood, saliva or through neuroimaging—that can pinpoint patients who will best respond to this type of treatment and to gain new insights to help inform future therapies.

In the meantime, for Mydland-aas and many other patients, the Bergen four-day treatment has proved to be a transformative experience. Mydland-aas says her OCD is gone; she is no longer occupied by extensive cleaning rituals and is able to engage in family activities, such as swimming in public pools, that she was unable to before. “Before my life was a struggle, it was about surviving every day,” she says. “I now enjoy all the things I can do, and I have a very healthy relationship with my family and friends.”


B4DT & Houston OCD Program Featured in the Winter Edition of the IOCDF Newsletter!