四天集中暴露疗法在强迫症治疗中优于网络自助CBT

一项针对治疗可及性的对照试验

强迫症的推荐一线治疗是暴露与反应阻止（ERP），但训练有素的治疗师短缺、等待时间长，加上疗程往往持续数月，患者拒绝或中途退出的情况并不少见。这项研究要检验的，是一种把治疗压缩到四天的方案能否成为可行的替代路径。

被比较的两种干预分别是：治疗师带领的卑尔根四天集中治疗（B4DT），采用“迎向焦虑”的思路；以及针对强迫症定制的、无指导的网络认知行为疗法（iCBT），持续八周。研究由Lena Jelinek等人完成，发表在《JAMA Network Open》上，发表日期为2026年10月19日。

主要结果与数据

119名成人强迫症患者被随机分配到两组，平均年龄34岁，全部从德国单一站点招募。以耶鲁-布朗强迫量表（Y-BOCS）总分为主要指标，B4DT组在第8周的分数比iCBT组多下降8分；到三个月随访时，B4DT组的分数仍比iCBT组低6分。

在随访时，B4DT组的治疗反应率为61%，iCBT组为25%；缓解率为42%对14%。此外，B4DT在生活质量、抑郁症状、整体功能与治疗满意度等指标上也优于iCBT。这些数字说明，在短期内，集中、面对面、由治疗师带领的暴露治疗在这批参与者中效果更强。

谁能从中获益仍是开放问题

随附评论中，Eric A. Storch与Caitlin M. Pinciotti指出，B4DT清楚表明集中式ERP项目可以非常有帮助，但“这一方法最适合谁”仍待回答。研究筛查的成人中只有47%符合条件并选择参与，其他人为何被排除或退出并不清楚，评论者认为这提示治疗效果可能受到最终入组者特征的影响。

这一点关系到结果的外推：如果参与者本身在动机、症状严重程度或其他方面与一般临床人群不同，那么试验中的优势未必能原样复制到日常诊疗中。

方法上的限制

与所有心理治疗试验一样，本研究无法对参与者和治疗师设盲，研究者承认这可能引入期望效应。此外，三个月之后的效果数据仍在收集，治疗能否持久尚需进一步观察。

研究者提出的实践思路是把iCBT与B4DT纳入分步治疗框架：iCBT作为较易获得的一线选择，B4DT作为需要更强治疗强度者的二线、由治疗师实施的高强度选项。这一框架能否真正改善资源分配与整体结局，还需要更多证据。

10/21/26, 3:15 PM

A therapist-led, concentrated exposure-based therapy outperformed unguided, internet-based cognitive behavioral therapy (iCBT) for treating obsessive-compulsive disorder (OCD), according to the results of a randomized controlled trial issued by JAMA Network Open.

Why It’s Relevant

Exposure and response prevention is the recommended first-line treatment for OCD, but its use remains limited due to shortages of trained therapists, long wait times, and patient refusal or dropout related to the many months of therapy required. The compressed Bergen four-day treatment (B4DT)—which incorporates a “leaning into anxiety” approach—could improve accessibility, but more evidence for this intervention is needed.

By the Numbers

• Among 119 adults (average age 34, recruited from a single site in Germany) with OCD who were randomized to receive either B4DT for four days or OCD-tailored iCBT for eight weeks, the former was more effective.
• Participants who received B4DT had an eight-point greater reduction on the Yale-Brown Obsessive Compulsive Scale (Y-BOCS) total score at week eight.
• Y-BOCS scores remained six points lower in the B4DT group compared with the iCBT group at a three-month follow-up. The B4DT group also had greater treatment response (61% versus 25%) and remission (42% vs 14%) rates at follow-up.
• B4DT also outperformed iCBT on other outcomes, including quality of life, depressive symptoms, global functioning, and treatment satisfaction.

What’s More

“The B4DT clearly demonstrates that a concentrated [exposure and response prevention] program can be very helpful. But the question of for whom is this approach best suited remains,” Eric A. Storch, Ph.D., and Caitlin M. Pinciotti, Ph.D., wrote in an accompanying commentary. Just 47% of adults screened met the study requirements and chose to participate; it’s not clear why others were excluded or opted out. “This raises an important question about whether treatment effects may be influenced by the characteristics of those who are ultimately included.”

The Other Side

As with all psychotherapy trials, participants and therapists were not blinded to treatment allocation, which may have introduced expectancy effects, according to the researchers. Furthermore, an exploration of participants’ outcomes beyond three months—now in progress—is needed to determine treatment durability.

Takeaway Message

Integrating iCBT and B4DT within stepped-care frameworks could improve access, optimize resource allocation, and enhance overall treatment outcomes in OCD, the researchers wrote, noting: “iCBT may serve as an accessible first-line treatment, whereas B4DT may offer a more intensive therapist-delivered second-line option for individuals requiring more intensive care.”

Related Information

Source

Lena Jelinek, et al. Concentrated exposure therapy vs internet-based cognitive behavioral therapy for obsessive-compulsive disorder. JAMA Network Open. Published October 19, 2026. doi:10.1001/jamanetworkopen.2026.39281

(Image: Getty Images/iStock/Nadija Pavlovic)