Systematic review and classification of: The Bergen 4-Day Treatment (B4DT) (1. ed.)
DOI:
https://doi.org/10.7557/25.7343Keywords:
Anxiety, Depression, OCD, cognitive behavioural therapy, exposure therapy, Systematic reviewAbstract
Background: The aim of this article is to review and rate the evidence for the Bergen Four Day Treatment (B4DT) as an intervention for obsessive compulsive disorder (OCD) in children aged 11 – 18 years when applied in a regular practice setting in Norway.
The goal of the intervention is to reduce symptoms and functional impairment related to OCD. The intervention is based on cognitive behavioral therapy, specifically exposure with response prevention, where youth confront the stimuli or situations that provoke fear or distress, while refraining from performing compulsive behaviors. The intervention is provided over a 4-day period and is characterized as a concentrated treatment. B4DT is offered within the specialist mental health services. It is delivered in a group setting with youth and their parents participating, and one therapist for each patient. Haukeland University Hospital (Helse Bergen HF) and the Clinic for 4-day treatment at Haukeland University Hospital are responsible for disseminating the intervention in Norway.
Method: This review is based on a systematic literature search on the B4DT in the databases Embase, Medline and Psyk Info, NORART, Cochrane, Cristin, NORA, SCOPUS, SweMed, Cambell, NREPP, NICE, Blueprint and CEBC and material provided by the intervention owners. The review was searched for Nordic effect studies, international reviews, and other relevant information about the intervention. Two Nordic papers were identified for the targeted age group and were included in this review.
Resultats: The results include descriptions of the intervention and the included studies, as well as assessments of the methodological quality and the quality of implementation. B4DT is based on theory well described in the literature on OCD. Target groups and aim of the intervention is described, but there is no manual available describing the implementation of the intervention session by session. Well established measures are used, and the intervention is delivered in ordinary clinical practice. The included studies both used a pre-post-design with no control condition and did not report use of checklists or video-analysis for quality assurance. Comprehensive training and certification requirements are described, as well supervision to maintain quality if results fall below an expected standard. Results are positive with large effect sizes for reduction in OCD symptoms reported for youth aged 13 to 18 years. Due to small sample sizes, the precise magnitude of the treatment effect is highly uncertain.
Conclusion: B4DT for tvangslidelse hos barn og unge i alderen 11–18 år klassifiseres på evidensnivå 3: Tiltak med noe dokumentasjon på effekt.
This classification is based on a solid theoretical foundation with positive treatment effect as indicated in two uncontrolled studies of youth aged 13 – 18. There is a need for randomized controlled trials where B4DT in compared to another active treatment. Furthermore, future studies should examine the effect of the treatment for younger children (below 13 years).
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