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.