SINGAPORE – After almost a decade of being trapped in a cycle of fear because of his obsessive-compulsive disorder (OCD), Bryan was finally able to begin breaking free of it.
It took him just four days using a form of therapy
that has become a standard service
at the Institute of Mental Health.
Bryan (not his real name), a 25-year-old graduate student, knew he had turned a corner when he could let go of rituals that he had followed religiously for years.
Observing rituals is characteristic of people with OCD, a mental health condition marked by obsessions. Unwanted, intrusive thoughts, images, or urges trigger intensely distressing feelings and compulsions in people with OCD to try to get rid of the obsessions and/or decrease the distress.
According to the International OCD Foundation, a diagnosis of OCD requires that the cycle of obsessions and compulsions must be so extreme that it consumes a lot of time (more than an hour every day), causes intense distress, or gets in the way of important activities that the person values.
To neutralise his anxiety, it was crucial that Bryan did not depart from the rituals to keep his mental and physical spaces “clean”.
His bedroom was divided into clean and dirty spaces, and he could never let himself “contaminate” the clean space, no matter how tired he was.
But in early 2025, not long after he had been through the four-day treatment for OCD, Bryan went home tired from school and lay down in his bed.
His heartbeat rose at the thought of contaminating his bed, but he had planned for this and was confident that he could cope with the distress.
For most people, this would be a trivial matter, but for him, it was a battle won as he began a new chapter of living with OCD.
He is among over 100 people whom IMH has helped using the Bergen 4-day Treatment (B4DT), an intense form of exposure and response prevention therapy that crunches once-a-week OCD therapy sessions into four consecutive days of therapy.
The therapy includes psychoeducation, exposure sessions and relapse prevention.
IMH ran B4DT as a pilot from October 2022, and rolled it out as a clinical service in November 2023.
More than 60 per cent of patients showed significant improvement in their OCD severity scores, along with improvements in their mood and quality of life.
Crucially, less than 2 per cent of the patients dropped out of B4DT, which is consistent with the findings from other countries, including Norway, where the treatment originated, said IMH principal clinical psychologist, Dr Jackki Yim, who helped get the programme started after learning about it.
According to the Singapore Mental Health Study done in 2016, the lifetime prevalence of OCD among adults in Singapore is 3.6 per cent, meaning one in 28 people aged 18 and above will have OCD at some point in their life.
In 2025, IMH saw more than 2,000 patients aged 18 and above diagnosed with OCD. Of these, 550 were new cases.
Though Bryan never put a name to what ailed him, he began developing mental rituals around the age of 16.
He created a magical pure inner world populated by people with superpowers and removed from the real world, where bad things could happen. This was a world to which he would retreat.
“Sometimes, I would just have a thought that I needed to do something or things would get bad,” he said.
“For instance, I refused to drink water for 24 hours and would then drink two litres at one go. I did that for about a week.”
Because of his OCD, he stopped listening to his favourite songs to keep them from being sullied by bad thoughts that could arise while he was listening to them.
In 2020, during the Covid-19 pandemic, Bryan began separating his living area into clean and dirty zones. His bed, table and chairs, for instance, were in the clean zones, while a small area near the door was the dirty zone.
Every day, he would sanitise his laptop, phone and everything else that he needed to touch when he got home.
As part of his treatment in late 2024, two psychologists (one of whom was there as an observer) went into his room and sat on his bed.
Bryan had agreed to this, but the emotions still hit him in the gut.
“It felt terrible,” he said.
“They made everything messy, and I just felt that my world with all my rules had been turned upside down.”
The psychologists did not stop there. They touched his belongings and hugged his soft toys.
“When they contaminated my plushies, my brain told me that it was totally wrong,” he said. At the same time, however, he could see the funny side of it.
By demolishing his clean zone, the psychologists removed the need to have one. “I had much less fear of breaking the rule after that because it was already broken,” he said.
During his treatment, Bryan learnt that when the alarm in the OCD brain goes off, people go into panic mode trying to silence it, which manifests as obsessions and compulsions.
“We were taught to just let the alarm go off, and then we can ignore it and do the complete opposite of what the alarm tells us to do.”
BD4T has been shown to be successful because participants are taught to lean into their anxiety in the intense exposure sessions.
As it is delivered in a group setting for up to six patients, with one therapist to each patient, they do not feel like they are the only ones struggling with OCD, said Dr Yim, who is also the deputy head of anxiety service at IMH.
“The most magical part of that treatment is where you can see them supporting one another,” she said.
Ms Tammie Kwek, a senior clinical psychologist at IMH, who works mainly with OCD patients, said a crucial part of B4DT is the preparatory stage, when they help patients develop sufficient insight into their condition as well as address the fears that they have about the treatment.
Patients must be committed to completing the entire treatment, so some patients might prefer other treatments.
After a course of B4DT, each patient’s progress is assessed on day 10 and again at the three-month mark. Their therapist will work with them to address any difficulties they face. Booster sessions are offered to those who need them.
Bryan worked on 10 obsessions-compulsions he listed in the preparatory stage.
He had to perform “weird stuff” like scattering staples in certain high-traffic areas at IMH to confront his fear of accidentally harming others, he said with a laugh.
The psychologists also went with him to Chinatown. Seeing smokers gathered there using foul language had previously distressed him and forced him to think bad thoughts to neutralise the feelings.
As part of his treatment, he was tasked with asking these strangers for directions and to stand near them listening to his favourite music, which meant sharing it with them.
“Some of them looked very rude, but when I asked them for directions, they responded quite politely,” he said.
Bryan (not his real name) outside People’s Park Complex on Jan 9. As his treatment, Bryan was tasked with asking strangers in Chinatown for directions, and to stand near them listening to his favourite music.
ST PHOTO: KEVIN LIM
Bryan did not know he had OCD until 2024, when he sought help from a university coach after his mental and physical compulsions left him unable to function as a graduate student. He eventually went to a psychiatrist, who diagnosed him with OCD and referred him to B4DT at IMH.
B4DT is currently offered only at IMH, but there are plans to train other people to conduct it in the community, said Ms Kwek.
The IMH psychologists said OCD is treatable, even if the person has been engaging in ritualistic behaviours for decades, provided he or she is ready to break out of the cycle.
Today, Bryan no longer has indoor and outdoor zones. He washes his hands the way most people do, instead of going through a handwashing ritual.
“I am finally able to do the things that I like. I can share the music that I like with my friends, I can enjoy going to a movie or concert that I like. Previously, if I knew that I might like a certain movie, I wouldn’t go in order to not contaminate it,” he said.
“The anxious thoughts will still come, but they come less often and when they come, they bother me less because I have trained myself to not respond to the thoughts with a ritual.”