Making Sense of Non-Response: What Patients Teach Us About Concentrated Exposure Therapy for Obsessive Compulsive Disorder.

Background/

Objectives

The Bergen 4-Day Treatment (B4DT) is a concentrated form of exposure and response prevention for patients with obsessive-compulsive disorder (OCD). Although response rates for the B4DT are generally high, a proportion of patients does not achieve clinically significant improvements. Quantitative measures can identify non-response, but offer limited insight into processes that may hinder change in highly structured, time-limited interventions. To identify factors potentially related to the lack of improvement, this study explored experiences of patients who had not benefitted from B4DT.

Methods

B4DT participants were recruited from an uncontrolled German study. Of 32 patients assessed at three-month follow-up, 12 met the non-response criteria (<35% reduction on the Yale-Brown Obsessive Compulsive Scale), and eight completed semi-structured qualitative interviews 9-14 months after treatment. Interviews were analyzed using grounded theory methods. A brief quantitative comparison examined baseline differences between responders and non-responders.

Results

Participants described benefits from B4DT, including improved understanding of OCD, supportive peer contact, and increased courage for exposure tasks. However, they consistently reported difficulties sustaining self-guided exposure after treatment. Within the B4DT framework, one possible interpretation is that the intended shift toward independently approaching anxiety had not yet been fully consolidated.

Conclusions

Although quantitatively classified as non-responders, participants described meaningful psychological benefits from B4DT. The findings suggest that non-response may reflect incomplete consolidation of the intended shift from symptom control toward approaching anxiety in service of personally meaningful action, rather than an absence of change.