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From neighborhood therapist to OCD specialist

By Patrick,

Today we’re excited to share this story by Patrick McGrath, PhD, about his journey to becoming an OCD expert. Dr. McGrath is Executive Director of the Foglia Family Foundation Residential Treatment Center.

If you want to stop a party dead in its tracks, tell a room full of people that you run an OCD treatment center. Everyone will turn to you and say they either “have a little OCD” or know someone who does.

I was the neighborhood therapist: think of Lucy and her Psychiatric Help for 5¢ booth in the Peanuts cartoons. But my version was sitting in my basement, on the phone with people I’d never met, talking with them about their problems and offering advice. Most of the time, I never met them — these friends of friends who’d heard I was a good listener.

While this will reveal my age, my parents actually got call waiting because I was on the phone so much and my dad was having trouble getting through to tell my mom he was leaving work and could stop at the store.

Fast forward to college, where I was a psychology major and got a chance to intern at the Anxiety Disorders Clinic at the University of Illinois College of Medicine, under the direction of Dr. Timothy Bruce. I learned about the importance of assessment and data collection, as well as the new treatments that were emerging for panic disorder and other anxiety-based conditions. For my senior thesis, I collected data suggesting that benzodiazepines actually interfered with therapy for anxiety-based disorders.

After graduating, I got my MA in Clinical Psychology from Mississippi State University and then my PhD in Clinical Psychology at Northern Illinois University. Interestingly, I did not work in anxiety disorders at either of these universities. But I did get a solid basis in cognitive behavioral therapy, or CBT, which I still use today.

My internship was at Grand Valley State University in their Career Planning and Counseling Center, and it was the first time I really got to practice using CBT with patients. I’ve gotten a lot better at it since then, I admit, but I do think I was able to help the people who came to work with me.

I went on to complete a postdoctoral fellowship at the St. Louis Behavioral Medicine Institute, under the direction of Dr. C. Alec Pollard. Working with Dr. Pollard changed everything, and one week into my fellowship I knew my career would be in exposure and response prevention (ERP) therapy — it just clicked with me and my personality. I knew this was what I wanted to do for the rest of my professional life.

It’s been a great choice. I’ve been able to work with great colleagues through organizations like the International OCD Foundation, the Anxiety and Depression Association of America, and the Association for Behavioral and Cognitive Therapies. I have had the opportunity to train over 100 students and interns, give over 450 talks and conference presentations, author or co-author over 15 publications, and even appear on television and radio as an expert in the area of anxiety disorders.

But most of all, together with the incredible people I’ve trained, I have been able to help thousands of anxious individuals get the help they need to live their lives without being so intensely influenced by their anxiety, post-traumatic stress disorder (PTSD), obsessive-compulsive disorder (OCD), or substance use disorder (SUD).

I appreciate people like Dr. David Valentiner, who recommended me for my first manager job at Linden Oaks Hospital, where I opened an anxiety treatment center; and Clayton Ciha, who hired me at the Alexian Brothers Behavioral Health Hospital (now part of AMITA Health) to open a partial hospital program for anxiety. Clayton trusted me enough a decade later to name me Executive Director of the Foglia Family Foundation Residential Treatment Center.

Today, I continue to see patients who are anxious and have expanded my role to treat addictions. I look forward to the next decade, as I foresee that technology will be used increasingly often in therapy. We will learn more about the brain and the way it works, allowing us to provide targeted therapies to those who might currently be labeled as “treatment-resistant.”

I would love to help anyone out there who suffers from an anxiety-based disorder. There is help available to you. You don’t need to go through this alone.

Thanks to Dr. McGrath for this great post! It’s always helpful to learn what clinicians 
experience throughout their journey.

Want to learn more about Dr. McGrath and residential treatment at Foglia? Get in touch!

Tackling OCD in College Athletes

By Patrick,

In the midst of March Madness, it’s easy to forget that a vast majority of student-athletes aren’t in the spotlight. There are 460,000 of them in the NCAA across 24 sports, balancing practices, games, and meets with all the other things a college student deals with – studying, friends, life back home, and often jobs.

Big tournaments and national championship games highlight the central role athletics play in many schools’ campus culture. But they also obscure the experience of most student-athletes, who make up 2.3% of the 19.9 million Americans enrolled in college as of fall 2018.

Massive amounts of time and money are poured into athletic programs around the country. For the few, college sports are a bit like an unpaid internship for professional leagues. And for everyone else, they’re hopefully enjoyable and enriching aspects of the college experience, associated with values like determination, teamwork, and honesty. In either case, there’s no detaching American colleges from their athletic programs.

The sports industry is worth $73.5 billion annually in North America, putting ever-growing pressure on teams to win – and push physical boundaries constantly. Sport science and sport psychology focus on helping athletes get better at their sport, but only recently have researchers begun looking at the impact of sports on an athlete’s mindset – not the other way around. Most notably, a breakthrough in our understanding of concussions ten years ago led to a series of studies demonstrating how consistently and traumatically concussions can affect the brains of NFL players. But these concussion studies were abnormal in their subject matter, and the amount of public attention they got.

All of this pressure to achieve trickles down to college athletics, whether a student-athlete is trying to go pro or emulating professional athletes in their never-ending efforts to perform at a higher level. So it’s strange that – as mental health has come to occupy a central place in discussions about our wellbeing, especially on campuses – there’s so little research on the mental health of student-athletes.

One important exception, though, is a 2017 study on obsessive-compulsive disorder (OCD) in college athletes – the first of its kind – conducted by Lisa Cromer, PhD; Emily Kaier, MA; Joanne Davis, PhD; Kathleen Stunk, APRN, CNS; and S. Evelyn Stewart, MD, who published it in the American Journal of Psychiatry.

The researchers screened 269 athletes in NCAA Division I athletic programs and found that 20.1% screened positive for OCD on an initial questionnaire. In year 2, encouraged to investigate further, they offered two questionnaires to 270 student-athletes. 16.7% of these participants screened positive for OCD, and 5.2% met full criteria.

Their average age of symptom onset, consistent with data for the general population, was 14.3 years old. But what’s remarkable about these results is the prevalence of full OCD symptomology. Compared to a general prevalence of around 2.3%, that figure of 5.2% means student-athletes exhibited OCD symptoms at over two times the rate of the general population.

Even more remarkable, though, is that none of the 14 athletes meeting full OCD criteria had ever been diagnosed. The researchers wisely refrain from trying to explain any of these data, but suggest that “physicians should remain vigilant for OCD in athletes given its association with distress and its treatment potential.”

This “association with distress” means student-athletes with untreated OCD are more likely to develop comorbid conditions like depression, panic disorder, and substance use disorders. Studies suggest over 60% of people with OCD have at least one major depressive episode, and about 30% develop a substance use disorder.

As the symptoms of untreated OCD create more and more distress, people are often left hopeless and may turn to self-medication with drugs or alcohol. These comorbid conditions can spiral rapidly, and a college environment might exacerbate them. But by identifying and treating OCD early on, therapists with special training can greatly reduce the likelihood that student-athletes develop comorbidities that diminish their quality of life, put them in danger, and make them at risk of dropping out.

Student-athletes might be determined, hard-working people, balancing an impressive number of things at once. But they’re also prone to the same mental health issues — sometimes, it seems, at significantly higher rates than everyone else. The responsibility doesn’t just lie in physicians’ hands: by remaining vigilant, we can find ways to provide effective care to every college athlete with OCD.

Why it takes more than exposures

By Patrick,

We talk a lot about exposure and response prevention around here. Commonly known as ERP, this form of cognitive-behavioral therapy has two main components. Exposures are exercises that put someone in a situation that causes their unwanted, intrusive thoughts to pop up. Not all intrusive thoughts cause us distress, but exposures are chosen specifically to trigger those that do. By putting someone in a distressing situation– often one they’ve avoided for a long time– exposures aim to gradually desensitize them to it.

The exposure part of ERP is relatively simple: you’ve been avoiding something because it causes you intense anxiety; in order to find ways to respond besides avoidance, you have to put yourself in that situation and gradually learn that you can get through it. (By situation, we mean not only events but also people, places, things, and so on.) Over time, research suggests, ERP exercises not only teach us to get through that distress but can actually help us habituate to it longer-term.

What’s missing from this explanation, though, is the fact that avoidance comes in many different forms. There’s the typical one: I don’t want to do something, so I avoid it. This is a total refusal to put ourselves in a situation and, ultimately, to experience the emotions and sensations it could involve. But even if we’re in that situation we can avoid these emotions and sensations by behaving in certain ways. We all do this, whether we’re staring at our phones in public to avoid eye contact with strangers or keeping quiet during a family party to make sure we don’t say something dumb.

When we’re talking about obsessive-compulsive disorder (OCD), though, avoidant behaviors are more of a concern. Attempts to escape “negative” feelings and sensations become compulsions, meaning we feel like we basically cannot behave otherwise. As a form of behavioral therapy, ERP’s primary goal is to influence behaviors that are harmful or unhelpful. That’s why it can be so effective for OCD, where specific actions performed in the service of avoiding unwanted thoughts and feelings actually strengthen the associated fear.

Exposures make us experience the situations we’d normally avoid altogether. But if we’re still using compulsions to avoid the resulting thoughts and feelings (or at least decrease their intensity), the exposure won’t do us much good. We have to get to the top of the roller coaster and let gravity do its thing. Refusing to get on the ride or shutting our eyes the whole time isn’t going to make the ride any less frightening the next time around.

Finally, we get to the second part of ERP: response prevention. In this context, responses are synonymous with the other terms we’ve used (avoidant behaviors and, to be more exact, compulsions). By preventing our own compulsions, we fully experience the distress caused by our obsessions with the goal of habituating to it. Over time, it becomes clear that responding with compulsions (or even responding at all) is unnecessary and probably unhelpful.

Intuitively, exposing yourself to difficult situations and getting through them without any of the behaviors you’ve developed to avoid distress can be very difficult. And even when there are clear exposures for you and your therapist to plan out based on your obsessions, coming up with strategies for response prevention isn’t easy.

By definition, compulsions feel necessary in the moment. It’s not as simple as just sitting with your anxiety or taking a moment to breathe. Strategies for response prevention need to be robust enough to counter the powerful hold our compulsions have on us.

If ERP is part of your therapy work, it’s important that you and your therapist outline specific ideas for response prevention that you’re confident you might be able to try out. We’ll be back soon with specific examples, because there really aren’t enough good ones out here on the internet.

What has helped you with response prevention in your own experience? Our community members would love any helpful tips. You’ll find them in the NOCD app!

NOCD’s MARS Rating

By Phoebe Kranefuss,


  1. The Mobile App Rating Scale (MARS) is a reliable, multidimensional measure for trialling, classifying, and rating mobile health apps
  2. MARS rates mobile health apps for reliability, quality, scope of information, aesthetics, subjective quality, and perceived impact
  3. The NOCD app received an objective quality score of 4.74/5.00, suggesting excellent quality across all measured categories

How to find the best mental health apps

There are thousands of mobile platforms claiming to improve users’ mental health now available on the iTunes and Google Play stores. Users might not know where to start: which of these are clinically effective? Which are easy to use, reliable, and safe? Are there additional criteria that should be considered in making the choice to use a mobile platform as part of a mental health treatment plan? Early evaluation criteria developed to rate mobile health platforms do exist, but were either too general to provide valuable insight, too complex to make useful information accessible to the average user, or too specific to be applied across all mobile health apps.

The Mobile App Rating Scale (MARS) was developed by a team of researchers at Queensland University of Technology to classify the quality of mobile health apps on a reliable, multidimensional scale. MARS rates app quality by quantifying engagement, functionality, aesthetics, information quality, and subjective quality, offering a comprehensive view of features deemed most important by top clinicians in the field.

NOCD’s MARS Rating

In an independent rating of NOCD, Queensland University and Psyberguide awarded the app a user experience score of 4.74/5.00, tied with Headspace as the third highest user experience score out of 182 ratings overall. Subcategories include a score of 4.90 for engagement, which qualifies the interactivity and customizability of the app; a score of 4.88 for functionality, which qualifies the performance, ease of use, and navigation within the app; and a score of 3.57 in credibility, or evidence-based research.

These scores showcase our continuing efforts to validate the efficacy of the NOCD platform, improve outcomes, and enable research as we work with our Scientific Advisory Board of expert researchers and clinicians. In tandem with the initial results from Columbia University Medical Center’s study of the NOCD app, which suggest that integrated treatment using the app can lead to “significant reduction” in some patients’ OCD symptoms, NOCD’s MARS rating backs NOCD’s incredible user experience. We’re proud of the positive ratings we’ve received, and eager to keep improving NOCD in all of the above criteria!

If you have any ideas as to how we can get better, get in touch!

Columbia University Medical Center’s Study of NOCD 

By Patrick,


  1. An independent team of researchers at Columbia University Medical Center is studying the NOCD app
  2. The study seeks to assess the efficacy of integrated treatment combining in-person therapy and the NOCD app for 30 adult patients with OCD in an 8-week pilot clinical trial, with 5 in-person appointments 
  3. Of the 16 patients eligible thus far, 14 enrolled and 100% would recommend the program to a friend 
  4. Initial results suggest an integrated treatment using the NOCD app can lead to “significant reduction” in some patients’ OCD symptoms

Almost a year ago, the NOCD team was contacted by a research team at Columbia University Medical Center (CUMC) led by Dr. Helen Blair Simpson, MD, PhD, to investigate the potential use of the NOCD app in an integrated model. Lead author Dr. Marina Gershkovich proposed a study ofthe NOCD app as a novel technology in a stepped-care treatment model for obsessive-compulsive disorder (OCD). 

The CUMC team is testing the NOCD app in conjunction with therapist-guided cognitive-behavioral therapy (CBT) for 30 adults in an 8-week pilot clinical trial. Dr. Gershkovich and her team define “therapist guidance” as 5 in-person therapy sessions and weekly phone calls. Using self-report questionnaires and independent evaluation throughout the trial and two months post-trial, the CUMC team measures patients’ symptoms and treatment experience regularly. The study is funded by a New York State Office of Mental Health Policy Scholar Award and a Director’s Pilot Award to Dr. Gershkovich as the principal investigator. 

This November, Dr. Gershkovich and co-authors submitted a poster application for the 2019 Anxiety and Depression Association of America (ADAA) Conference. The submission was accepted, and will be presented in March 2019. In the abstract, CUMC shares exciting preliminary results. Of 16 eligible patients, 14 have enrolled in the integrated treatment trial. All 14 say they would recommend the treatment program to a friend. According to CUMC, “initial results indicate this integrated treatment can lead to significant reduction in OCD symptoms in select OCD patients.” 

The CUMC abstract emphasizes the importance of assessing novel technologies like the NOCD app using three major criteria: acceptability, feasibility, and efficacy. The NOCD team interprets these early results across all three criteria as strong indicators that the NOCD app is well-received by patients, and can give providers greater bandwidth to treat more patients.

The kind of integrated treatment studied here by the CUMC team matches fits seamlessly into NOCD’s stepped-care model, which tailors the type and amount of care someone receives to their level of need. Someone with very severe symptoms may need an inpatient program or more regular outpatient appointments. But a patient with moderate or less severe symptoms benefits greatly from integrated models that offer equally good results while demanding less time, money, and effort. Providers, meanwhile, can see more patients with appropriate symptom severity.

Because the results from this CUMC study suggest the NOCD app could open up opportunities for effective integrated treatment, we’re even more confident about our stepped-care model. The fact that 87% of patients in this small sample decided to enroll shows NOCD’s significant potential to be diffused into the market. 

This independent study at CUMC emerged as part of our continuing efforts to validate the efficacy of the NOCD platform, improve outcomes, and enable research. We have focused throughout the past year on recruiting a Scientific Advisory Board composed of expert researchers and clinicians, and initiating new research projects.

Dr. Blair Simpson is Professor of Psychiatry and Vice Chair of Research in the Department of Psychiatry at CUMC. She also serves as Director of the Center for Obsessive-Compulsive & Related Disorders and the Director of the Translational Therapeutics Programs at the New York State Psychiatric Institute.

Dr. Marina Gershkovich is Assistant Professor of Clinical Psychology at CUMC at the New York State Psychiatric Institute. She is an accomplished clinician scientist and has served as a CBT therapist on a number of clinical trials funded by the National Institute of Mental Health.

Disclaimer: The independent researchers at Columbia University Medical Center did not contribute to this blog post. The above are the NOCD team’s interpretations of a poster submission for the 2019 ADAA Conference. The abstract is available in the public domain. 

When ROCD Tries to Ruin Your Valentine’s Day

By Phoebe Kranefuss,

This week, we’re proud to feature a guest post from Dr. Belinda Seiger, PhD, LCSW. Dr. Seiger has substantial training from the world-renowned Child & Adolescent OCD, Tic, Trich & Anxiety Group (The COTTAGe). She received her PhD from New York University and her Master’s degree from Columbia University. She has more than 20 years of experience providing compassionate, friendly treatment for anxiety, OCD, neurodiversity, mood, and learning issues. Her approach draws upon evidence-based approaches like cognitive behavioral therapy, positive psychology, and neuroscience. 

Dr. Belinda Seiger

Relationship OCD, or ROCD, is a type of OCD characterized by obsessive, unwanted thoughts about intimate relationships. People with ROCD tend to be consumed by doubts about their partner: Do they love me enough? Am I as attracted to them as I should be? Are we compatible enough?

It’s normal for errant thoughts like these to creep into even the best relationships every once in a while. Feeling overwhelmed by constant, persistent doubts, when there’s no rational reason to worry, might be a sign that ROCD is taking over.

Valentine’s Day can be an especially tough holiday for people with ROCD. The societal pressure to be in a “perfect” relationship seems overwhelming in February: we’re surrounded by hearts, candy, greeting cards, and love songs practically everywhere we go. Our friends and family members might be discussing their Valentine’s Day plans or asking about ours. Maybe a partner has high expectations for the holiday.

Whether you’re single or in a relationship, the thoughts and feelings that come with ROCD might feel so intense in February that you’d rather avoid Valentine’s Day altogether! Avoidance can feel like the best option in the moment. After all, why would you purposefully engage in something that will just make you feel anxious? But avoiding situations that might trigger your obsessions and cause distress is actually counterproductive to OCD recovery, and will only serve in the long term to make symptoms more severe. Instead of avoiding the holiday, try planning and practicing exposures around your triggers– whether or not you have an intimate partner.

Let’s say you are in some kind of intimate relationship. If ROCD causes you to feel an immense amount of pressure to make the holiday “perfect” for your partner, you might days picking out a gift or making a card. This involves carefully considering the cost, size, and meaning of the present; then there’s all the repetitive, agitating consideration of whether or not it accurately represents the love you feel (or think you should feel) for your partner.

You might also feel uncertain about how your partner might have spent Valentine’s Day with someone else in the past, imagining all kinds of scenarios. When the anxiety becomes intolerable, you ask about the types of gifts they and their former partner exchanged or the activities they engaged in. It seems impossible not to compare this to your relationship. Was that other person better than me? Did my partner love them more? Have they had more intimate experiences than me? As the questions swirl, you might feel like asking your partner for reassurance in order to just get rid of the anxiety for a while.

Instead of giving into this pressure from OCD to seek reassurance, try using these kinds of situations as inspiration for doing exposures. Try limiting the amount of time you spend picking out a restaurant to twenty minutes, and draw a picture or imagine a scenario in which your partner doesn’t like the restaurant you chose. What would this feel like? What might the consequences be? Write out the worst-case scenario and read it out loud a few times. Leaning into your thoughts can feel scary in the moment, but is the basis for effective exposure and response prevention (ERP). When we’re able to handle discomfort, obsessions lose their power over us.

It’s easy to forget this on Valentine’s Day, but people without intimate partners are often just as deeply engaged in romantic rumination. We see couples walking around, doing the things intimate partners are supposed to be doing, and start to wonder why we’re not in a similar kind of situation. For people with ROCD, these feelings of loneliness and sadness can prompt an onslaught of obsessive thoughts: What if I’m not good enough? How can I be sure that I’ll have something like this one day too?

Because these kinds of thoughts tend to produce a lot of distress, people with OCD turn to compulsions. These behaviors can be a bit sneaky: maybe you find pictures of people on social media who aren’t any more attractive than you but still have partners, maybe tell friends and family you’ll be alone forever in the hope that they’ll say otherwise. No matter what the compulsion, exposures can help you feel better long-term, not just on February 14. If you’re constantly trying to prove to yourself that you won’t be alone forever, try writing out all the reasons you’ll never find an intimate partner. Make sure they’re reasons you really believe, and read them to yourself twice a day. If you want to be sure you’ll be in a relationship one day, record a story about being alone forever on your phone and listen to it a few times a day.

I once worked with a couple where both partners had ROCD. They planned their handmade gifts months in advance. They made a professional film, flew to a foreign country, and even brought in a chef to create a lavish meal! Most people don’t reach this extreme, but this illustrates how ROCD can completely take over when that OCD bully in your brain tries to seek one hundred percent certainty about your relationship or your choice of partner.

If OCD is starting to ruin your Valentine’s Day, try using your triggers to plan effective exposures. By next year, Valentine’s Day could be your favorite holiday!

Thanks to Dr. Seiger for this great guest post!

What’s it like to do residential OCD treatment?

By Patrick,

Getting any kind of help for your mental health is a big step. Whether you’re just exploring options, immersed in therapy, trying medication, or involved in more intensive treatment, the decision to seek change is both courageous and commendable.

We’ve written a good amount about therapy and medication, and we have lots of resources for people looking to educate themselves about OCD. But we haven’t focused too much yet on options like intensive outpatient programs (IOP) and residential treatment centers.

Many people ask us what these programs are like. Because residential programs seem mysterious (or even frightening) to many, we got the inside scoop from the AMITA Health Foglia Family Foundation Residential Treatment Center. Foglia offers holistic treatment for people eighteen and older with OCD, PTSD, anxiety, and addictions.

Residents follow individualized, evidence-based treatment programs in a nonjudgmental environment. Their simultaneous treatment of these disorders is unique, and allows people to confront mental health issues more comprehensively while in residential treatment.

To get a better picture of life in a residential program, we went straight to the source and asked Dr. Patrick McGrath, PhD to tell us about daily life at Foglia, where he’s Executive Director. He shared a sample schedule with us:

Monday- Friday

9AM: Morning check-in

9:30AM– 12PM: Education groups, which are based on CBT principles and might be focused on stopping safety-seeking behaviors, identifying cognitive distortions, or setting up a treatment plan for optimal results.

And/or: Exposure and response prevention (ERP) time. ERP can be done individually or in groups as appropriate. For example, if several residents have panic attacks we might get all of them up in the gym together and do interoceptive exposure exercises.

12PM: Lunch

1PM: Expressive Therapy or Spirituality Groups (not religious– more about dealing with feelings of guilt, shame, etc.)

2– 5 PM: Afternoon ERP

Evenings: A mix of groups including Improv Group, Ask the Expert, Mindfulness Meditation, Unified Protocol Groups (reviews of basic CBT principles). Also gym time, time for being in the community, and a chance to complete ERP homework that was assigned during the day.

Weekend schedule

Saturday: Morning CBT and ERP, and a process/education group with family members in the afternoon. The time after groups is for meeting with family.

Sunday: Morning CBT and ERP, along with Afternoon ERP.

One thing to note: Our residents who have substance use disorders (SUDs) and OCD cross-track between the anxiety side and the SUD side. So, their schedules will depend on their levels of OCD and SUD symptoms. On Sundays we have family day for those with SUDs.

Throughout the week

Residents have meetings with their individual therapist, psychiatrist, and case managers who help them make a plan for getting care after their time at Foglia. Nurses help with medication management, and additional family sessions can take place throughout the week.

Phones and computers are available during free time in afternoons and evenings, and on Friday nights movies and snacks give residents a chance to unwind.

Thanks to Dr. McGrath for this helpful look into the daily life of residents at the AMITA Health Foglia Family Foundation Residential Treatment Center. If you’re interested in learning more about Foglia, which is located in a northwest suburb of Chicago but accepts patients from all over, get in touch with one of their admissions counselors below– 24 hours a day, 7 days a week.

Learn more about treatment options at AMITA Health

Do you have more questions about residential programs? We’ll be focusing more on this treatment option, along with IOP and other programs, in the coming months.

This post is sponsored by the AMITA Health Foglia Family Foundation Residential Treatment Center, a NOCD partner

The images in this post do not depict Foglia. You can learn more about their facilities on the Foglia website

Four “OCD thoughts” you might have had

By Patrick,

Obsessive-compulsive disorder takes on a lot of forms, but everyone has a few common symptoms according to DSM-5, the diagnostic guide for clinicians working with mental illness. There are also recognizable themes in the content of people’s obsessions, and these tend to promote solidarity between those struggling with OCD.

When people talk about “OCD thoughts,” they’re actually practicing a helpful technique called defusion– a deliberate separation from your own thoughts that can help with a number of mental health issues. Defusion can be practiced in a number of ways, like labeling the thoughts (It’s just my OCD) or personifying them (There’s the monster in my mind trying to make me hide from the things I’m scared of again).  

The idea of OCD thoughts also builds community between people struggling constantly with intrusive thoughts. We see a lot of interaction on social media and in the NOCD app between groups of people who’ve all faced similar thoughts. So let’s look into a few common ones and how a few of us on the NOCD team might deal with them.

Please note: These ideas come from NOCD team members with OCD. This post is not intended to diagnose or make therapeutic recommendations.

1. “They might think I’m a horrible person because of what I just said”

Made a mistake in a social setting? Said something jokey to a coworker because you didn’t know their cat just died? When you’ve got what some people call Responsibility OCD, any social misstep seems like a sure sign that you’re a bad person and that everyone probably knows it.

What we might do: Try making social mistakes more often. Once or twice a day, we’d take a risk and see what happens. Not necessarily anything unkind– maybe when a waiter asks you how your food was we can tell them it wasn’t great. The goal is to do this until we can tolerate the idea that someone else is a bit hurt (and might not like us as much).

2. “How can I be sure my life has any meaning?”

We’ve all wondered about that eternal question: what’s the meaning of life? Because none of us have figured it out, there’s nothing conclusive to say about it. But people struggling with Existential OCD think about it a lot. The idea that there might be no resolution seems unbearable; in an attempt to escape this possibility, people will constantly try to prove to themselves that life is both worthwhile and meaningful.

Note: This isn’t the same as true contemplation of life’s meaninglessness. If you’re experiencing thoughts of suicide, call 911 or go to an emergency room. If you’re having trouble differentiating between the two, consult a licensed mental health professional.

What we might do: Write out all the reasons life is meaningless and actually can’t be meaningful. We’d carry it around in our pocket or backpack for a week and read it out loud twice a day.

3. “What if I can never stop noticing my breathing all day?”

We usually think about OCD as a condition of the mind, but it’s closely connected to the body and often involves hyperawareness of bodily sensations. In Somatic OCD, people can’t stop noticing and thinking about their bodily functions or other people’s bodily functions. In most cases, these are “normal” everyday functions like breathing, blinking, swallowing, ringing in the ears, and so on. Unsurprisingly, this hyperawareness of such constant phenomena can get very frustrating and might even lead to a feeling of hopelessness.

What we might do: It sounds strange, but an interesting exposure for this grouping of thoughts is to find ways to watch other people performing these bodily functions. Rather than stare at people in public, we’d find YouTube videos and focus on the specific function, taking note of our anxiety level every 3 minutes and watching videos until our anxiety peaks and then reaches 3 or lower again (on a 10-point scale).

4. “What if I just jumped in front of this train right now?”

Pretty much everyone has had sudden, disturbing thoughts about harming oneself or someone else. But people with Harm OCD don’t feel capable of simply moving on– it seems extremely important to “deal with” the thought in some way by convincing oneself that it would never happen. This subtype of OCD often involves guilt, avoidance, and a nagging sense that one isn’t actually a good person.

Note: This isn’t the same as true contemplation of a suicidal act. If you’re experiencing thoughts of suicide, call 911 or go to an emergency room. If you’re having trouble differentiating between the two, consult a licensed mental health professional.

What we might do: It might not be wise to do exposures at a train station without professional help, so we’d again turn to the sea of online videos we’re lucky (or unlucky) to have at our disposal. By watching a video of trains flying past a station and imagining ourselves jumping in front of one, we’d hopefully begin to get used to those terrifying thoughts and feel more confident in our ability to face them later, in person, with the help of a therapist.

Find more people who’ve had the same OCD thoughts by trying out the NOCD app!

Staying In: Social Anxiety and OCD

By Patrick,

A lot of people are shy, and we all fear public embarrassment. Social convention has such a strong pull on us that we all basically do the same stuff as everyone else most of the time, especially when we’re out in public. Nobody wants to mess up– and you probably know that painful experience of lying awake at night, reflecting on a social blunder you just made. Or maybe one from years back, as if junior high gym class were relevant again.

When social anxiety becomes chronic, though, it starts to shut us down. Joining an intramural sports team? Sharing your opinion with a group? Heading to a party with a few friends? They all sound kind of nice, but there’s way too big of a chance you could do something stupid.

However we label these things, the overlap between worrying excessively about social situations and having constant disturbing thoughts is clear. If you have what psychologists call obsessive-compulsive disorder (OCD), you get intrusive thoughts, images, and urges and deal with them by repeatedly doing specific things that make you feel temporarily better. People with Social Anxiety Disorder (SAD) feel so much fear of being judged by others, even though they usually know it’s irrational, that they might avoid social gatherings altogether.

According to Healthline, SAD has a number of common physical symptoms:

  • blushing
  • nausea
  • excessive sweating
  • trembling or shaking
  • difficulty speaking
  • dizziness or lightheadedness
  • rapid heart rate

These physical symptoms (prompted by extreme worry) and the worry itself work together to make social situations feel so unbearable that people start to avoid restaurants, public restrooms, conversations with strangers, shopping in person, and anything else that involves risk of embarrassment.

People with OCD are more prone to having SAD than the general population, and vice versa. Even though scientists don’t know the exact reason, we can begin to understand how closely linked the two conditions are. In both, persistent worry prompts intense physiological reactions and psychological distress; these lead to behaviors that help someone feel better for a while and are therefore reinforced. In the case of both OCD and SAD, one of the more common behaviors is avoidance.

Luckily, both OCD and SAD are treatable with SSRI medication, cognitive-behavioral therapy, or a combination. Exposure therapy can be particularly helpful for both conditions, because getting used to all of that worry tends to require putting oneself in the situations that cause them.

Many people deal with both SAD and OCD, and working with your clinician to identify what’s going on can help you decide on a treatment plan. The good news is that both conditions can usually be treated at the same time.

Have you dealt with social anxiety and OCD? Talk about it in the NOCD app!

Why is OCD so Often Misdiagnosed?

By Phoebe Kranefuss,

Imagine you’re experiencing OCD symptoms for the first time. You know something is wrong because you’re feeling much more anxious than usual and you have thoughts that won’t go away. Maybe you’re having trouble sleeping, or your mind is constantly overwhelmed by thoughts that seem to run in a never-ending loop. You’re not really sure if you should risk telling your doctor that you lie awake at night repeating mantras and mentally reviewing whether or not you actually locked the front door of your apartment. Should you share with them the intensely disturbing thoughts you keep having about hurting your toddler son?

You’re pretty sure you’d never actually hurt your son. But what if your doctor doesn’t understand? What if he thinks you’re completely crazy? Or, worse, what if he thinks you might be a danger to your son and takes action? It’s too risky, so you decide to wait and see if it’s all temporary. But your anxiety only increases, and begins to affect your everyday activities. Your compulsions make it harder to be around family and friends. They make it almost impossible to get anything done at work, and you start faking sick more often because leaving your home means more risk. These thoughts won’t go away– it seems like they’re taking over your life now.

Recognizing these destructive patterns, you know it’s time to see a mental health provider. But you’ve never gone to therapy and you wouldn’t know how to find a decent therapist. On top of that, your insurance requires that you get a referral from a primary care physician first. It takes a lot of courage, but eventually you feel you’ve reached your limit. You’re suffering enough each day– every minute, it seems– that you decide to pick up the phone and dial your doctor’s office to set up an appointment later in the week.

Arriving at the doctor’s office, you feel almost unbearably nervous. A nurse comes in to check your vitals, which feels a little strange since your symptoms aren’t primarily physical. Then the doctor comes in, surprised to see you back so soon after your recent appointment. You tell him everything you’ve written down, and having bullet points to go through allows you to get through the worst part.

The doctor begins to ask you a whole bunch of questions, and you feel pretty vulnerable talking about your scariest thoughts, which you’ve never discussed with anyone. Out of fear and self-consciousness, you speak as generally as possible, disclosing your intense anxiety but hiding most of your obsessive thoughts. Or maybe you do decide to share some of your most upsetting intrusive thoughts and talk about the compulsions that follow.

Although your doctor listens carefully, and you know they’re well-trained in general medicine, they don’t seem to know a lot about obsessive compulsive disorder (OCD). Instead, they seem these symptoms as typical of general anxiety disorder (GAD) or depression, so he prescribes you an antidepressant or refers you to a therapist who works with these conditions, rather than an expert in evidence-based exposure-response prevention (ERP).

Most primary care physicians are great at what they do. But they’re trained in primary care. Accurate diagnosis and effective treatment of OCD require a mental health professional who’s well-versed in ERP and cognitive-behavioral therapy (CBT). Because of this gap in understanding, the average person with OCD will see three to four doctors and spend around 9 years looking for treatment before receiving a correct diagnosis. As Dr. Jill Fenske, M.D. explains in Physician’s Weekly, OCD is so often underdiagnosed and undertreated not only because people with OCD are often secretive about their symptoms, but also because “a lack of recognition of OCD symptoms by physicians often leads to a long delay in diagnosis and treatment.”

Sometimes this is because the kinds of repetitive thoughts people with OCD experience can come across to the OCD-inexperienced as normal, healthy patterns of identity and value formation. One recent study crafted vignettes about different OCD subtypes, including aggression, contamination, homosexuality, pedophilia, somatic concerns, and symmetry. They presented these vignettes to doctors, surveying their ability to diagnose fictitious patients with OCD. The study found that about 50% of doctors presented with vignettes of rumination patterns typical of people with OCD did not recognize these symptoms as indicative of OCD.

The most commonly misdiagnosed vignettes described obsessions around sexuality: 85% of doctors randomly presented with vignettes on sexual orientation OCD did not associate the ruminations with OCD. The process of coming to terms with one’s sexuality (no matter which part of the spectrum a person identifies with) should certainly be met with understanding and encouragement from doctors and mental health practitioners alike. But extreme and prolonged intrusive thoughts and/or rumination about sexuality– like persistent, constant doubts or constant mental checking– are usually not indicative of true identity formation. These can generally be identified pretty quickly by an OCD specialist as a symptom of the disorder. Like sexuality itself, thoughts about sexual orientation lie on a spectrum. At one extreme is OCD.

Some primary care physicians do diagnose OCD correctly. But in general, when people with OCD are able to get evaluated by a specialist experienced in OCD treatment, they’re much more likely to receive an accurate diagnosis and empirically supported treatment– usually a combination of medications and ERP therapy.

We recognize these difficulties, and we’re certainly not discouraging regular consultation with a primary care doctor as part of your OCD treatment and your efforts to be healthy in general. So, one of the ways we’re helping people get access to proper diagnosis is by making psychiatric evaluations with OCD specialists more readily available to people within the NOCD community. In addition, one of our partners, Biohaven Pharmaceuticals, is offering free psychiatric evaluations to many people who are interested in taking part in their study.

We’re hard at work putting together a directory of specialists trained in OCD, so people who suspect they might have OCD can skip the years of waiting– and probably getting worse– and see a doctor who’ll make an accurate diagnosis and provide effective treatment options.

Could my child have OCD?

By Patrick,

Mental health is never simple, but it can be especially complicated in children, who are always changing and developing new patterns in thought and behavior. Many parents write to us with concerns about OCD. Because we aren’t able to diagnose anyone at NOCD, there’s no definitive answer. But we’ve found some helpful resources– let’s take a look.

Like adults, kids with OCD have obsessions and compulsions and are prone to hiding these symptoms out of embarrassment or a lack of understanding. Compulsions in kids and adults serve the same purpose: getting rid of distress caused by obsessions, which are intrusive and unwanted thoughts, images, and urges. Both symptoms develop (and change) over time.

Parents might be able to spot these symptoms when their kids demonstrate sudden emotional changes, struggle to focus on schoolwork and other activities, and take a long time to make decisions or perform everyday tasks like brushing their teeth. There are plenty of other signs, but most involve excessive carefulness and evidence of resulting discomfort. Kids might also start to demand that their parents or other family members do things in the correct way, as dictated by their own obsessive-compulsive cycle.

Research suggests at least 1 in 100 children around the world has OCD. If you think your child might be among them, it’s important to start with empathy. It can be frustrating and confusing to feel like kids are acting out or unfairly demanding very specific things of their relatives, but try your best to step back and recognize that they’re probably not doing so in an attempt to make your life harder. In fact, they’re most likely acting out of intense fear and debilitating anxiety.

Even as you try to bring empathy to the situation, you don’t need to force yourself not to get frustrated or feel helpless at times. These feelings are common, as is the desire to solve the situation by yourself. But it’s probably unwise to try, considering you’re very close to the situation and don’t have the required expertise. Repetitive behaviors might seem predictable (and therefore simple to approach) after you’ve seen them so many times, but they’re actually complex– especially when you factor in all of the thoughts and feelings underlying them, invisible to you and embarrassing for your child.

The predictable, but most useful, next step is to take your kid to a child psychologist or child psychiatrist for an evaluation. Even the most research-backed, fanciest websites aren’t sufficient for you to make a diagnosis yourself, and a licensed professional will know what to look for. If they suspect a child has OCD, they can rule out physical causes like PANDAS and discuss treatment options with you and your child. Treatment might include therapy, medication, or a combination. It will likely involve some effort by the family as a whole, but your child’s clinician can help you make those changes.

Whether you’re waiting for your child’s first appointment or looking for inspiration during their treatment, check out the documentary UNSTUCK for helpful information and first-hand stories from kids with OCD and their family members.

Looking to discuss the complexities of parenting a child with OCD? Chat with sympathetic, well-informed people around the world in the NOCD app!

Looking for more help?

By Phoebe Kranefuss,

Lots of people in our community have been asking great questions about what they can do when treatment doesn’t seem to be working. What if my weekly therapy sessions aren’t enough? What if the severity of my OCD is leading to severe depression or substance use? What if I’ve tried every option I can think of, but just continue to feel worse?

People whose symptoms are the most severe are often dealing with constant cycles of upsetting thoughts and taxing compulsions, which cause them to feel overwhelmed, scared, exhausted, and depressed. They urgently need high-quality, effective care, but often don’t know where to go or how to get it. Some turn to self-medicating with drugs or alcohol in an effort to drown out the thoughts and get some short-term relief. But using substances to cope with obsessions creates a major health risk, and often makes OCD symptoms far more severe in the long run, driving people into a vicious cycle of OCD and addiction.

This is a major problem, which studies show affects around 25% of people with OCD. And we want to address it. That’s why we’ve decided to provide more support to community members with the most severe symptoms who are also at the highest risk of developing substance use disorders by partnering with experts in OCD and addiction. AMITA Health offers a full continuum of care for OCD, addiction, and comorbid disorders, providing evidence-based, OCD-specific treatment at all levels of care. From outpatient therapy groups and partial hospitalization programs to residential treatment with round-the-clock support and supervision, their options enable people to progress through tiers of treatment that are right for them.

We decided to partner with AMITA because they’re committed to top-notch, evidence-based care. The program is run by world-renowned OCD expert Patrick McGrath, PhD, who has trained clinicians all over the world in cognitive-behavioral therapy (CBT) and exposure and response prevention (ERP) for OCD, and is also the author of The OCD Answer Book and Don’t Try Harder, Try Different. He works in partnership with Sarah Briley, EdD, LCPC, CADC, Clinical Director of the Center for Addiction Medicine at AMITA Health and the Foglia Residential Center.

Dr. McGrath has dedicated his life to helping people with OCD. As he told us, “Working with OCD patients is amazingly rewarding. I have gotten to see people get their lives back, start to smile and laugh again, and re-engage in their families and careers. That people trust me to guide them through this journey is humbling, and continues to inspire me to help all of my patients challenge their fears and live a value-based life again.” So yeah, he gets it.

A common space in AMITA Health’s Foglia Family Foundation Residential Treatment Center

There are tons of reasons to consider OCD treatment options that provide more support than typical one-on-one therapy sessions. If you’re interested in learning more about AMITA’s options, or if you’d like to ask questions about insurance benefits, logistics, or anything else, we’d love to hear from you. Just fill out this form, and AMITA’s program liaison, Shannon, will get in touch with you. (You can inquire on behalf of a loved one, too!)

Why Does NOCD Have Sponsored Posts?

By Phoebe Kranefuss,

OCD treatment has always been a bit of a maze. We know this because many of us at NOCD struggled to navigate the healthcare system for years before getting any better.

Today, research suggests most people with OCD are still navigating this maze. They’re not able to access specialists in exposure and response prevention (ERP), the most effective form of therapy for OCD, due to the high cost of ERP sessions, frequent misdiagnosis, and shortages of ERP providers. And many people with OCD are incorrectly prescribed medication by primary care physicians who don’t have a nuanced understanding of OCD.

Given these challenges, many people with OCD live in constant anxiety or go into free fall, causing them to drop out of school, lose their jobs, and withdraw from relationships. To make matters worse, the lack of support available throughout these intense struggles can increase the likelihood that people self-medicate with illicit substances, become severely depressed, or develop other comorbidities. It can rapidly develop into a cruel cycle.

Facing this string of issues, it’s easy to feel hopeless– but we shouldn’t. NOCD is committed to rapidly realigning the OCD treatment system, using a combination of technology and evidence-based clinical support to make care more effective and more widely accessible.

To start the process, we launched a free OCD treatment app with a built-in support community. The NOCD app helps people with OCD more easily understand ERP and start treatment down the best available path. After tens of thousands started using the app, we realized it was a one-stop solution for some of our members. But for those with more severe symptoms, it was only the start of their journey.

That’s why we recently introduced sponsored posts in the NOCD app: to help every one of our members find more robust care options around them, whenever and wherever a need arises.

We partnered with Biohaven Pharmaceuticals to help members who aren’t satisfied with their current treatment participate in clinical trials. As part of these trials, members may get free psychiatric evaluations. Getting to work with an experienced, innovative psychiatrist can be transformative.

To better support those with OCD and comorbid conditions like depression and substance use, we recently started working closely with two new partners:

Actify Neurotherapies offers additional treatment options for comorbid OCD and depression, including transcranial magnetic stimulation (TMS) and ketamine infusion– which involves supervised administration of low doses at one of their clinics. We’re helping our community learn about these options.

AMITA Health offers unique simultaneous treatment options for OCD, depression, and substance use, ranging from intensive outpatient programs to partial hospitalization and residential programs.  

You’re probably wondering: but aren’t these partners paying you guys?

Yes, but that’s not why we promote them. We pass on most partnership opportunities because they won’t help us get our community members immediate help. We only promote companies that fulfill this purpose and are validated by our clinical team as excellent resources.

If your symptoms are severe and you’re looking for more comprehensive forms of care, some of the partners we work with today might be a great fit for you, a family member, or a friend. Others might not feel quite right (feel free to ignore them!). Later this year, we plan to start offering options for those seeking OCD-specific outpatient therapy and teletherapy.

On average, it takes 10-17 years for people with OCD to get better. We think we can do better. Let’s work together to make it happen.

Check out the NOCD app to keep up with our innovative partners:

Why We’re Partnering With Actify

By Phoebe Kranefuss,

Our mission is to help people with OCD feel better by making care more effective, accessible, and connected. To do that, we’re enhancing our mobile platform’s capabilities while identifying resources for our community members who are severely affected by OCD and co-occurring disorders like depression.

Around 4 million Americans suffer from both severe OCD and depression, but many of these people don’t respond to first-line treatments, given the complexity of their diagnoses. The severity of their symptoms may feed into the cyclical nature of OCD, causing them to feel worse– or even lose hope. They may need help urgently, but it’s often very difficult to know how or where to get it.

To live up to our mission, we committed ourselves in 2018 to finding a partner well-versed in severe depression that hasn’t gotten better despite multiple trials of medication and/or therapy– often referred to as treatment-resistant depression– who could help us serve our community more effectively.

New options for treatment-resistant depression

When we met Dr. Steve Levine, MD and Kyle Snook of Actify Neurotherapies, a mission-centered group of clinics focused on providing safe and effective additional options for treatment-resistant depression, we knew we’d found a great partner.

Dr. Levine, a psychiatrist who values psychotherapy but also knows that medication can be an important part of treatment, founded Actify in 2011 after feeling frustrated by standard medications that offered little to no relief for patients with severe depression but piled on lots of side effects. His passion for helping patients get better led him to commit to making additional treatment options more accessible to people who really needed care for treatment-resistant depression.  And Dr. Levine has been very successful.

On average, it takes 10-17 years for people with OCD symptoms to receive treatment. For those with comorbid depression, treating OCD while also dealing with depression symptoms like low energy and low self-esteem can be an even tougher hurdle to cross. Finding safe, effective, and immediate support can be especially important– even lifesaving.

Working with Actify is another step in our mission to help all of our community members find the treatment options they need.

Any questions or concerns? Email us:

Meet Our Newest Scientific Advisor: Dr. Patrick McGrath

By Phoebe Kranefuss,

At NOCD, we work with experts to develop the most effective self-help tools and push mental health science forward. Our Scientific Advisory Board gathers some of the world’s top experts on OCD and related disorders. Our advisors have spent decades conducting research and treating patients at the highest level, and now they’re bringing their expertise to our work every day.

Today we’re thrilled to announce that we’ve welcomed a new member to our Scientific Advisory Board: Dr. Patrick McGrath, an enthusiastic and dedicated clinician who has provided invaluable guidance to the NOCD team throughout the past few years. He brings genuine energy to our work, not to mention his nuanced understanding of what people with OCD might find helpful.

Dr. McGrath is Assistant Vice President of Residential Services for the AMITA Health Behavioral Medicine Institute, Executive Director of the Foglia Family Foundation Residential Treatment Center, and Clinical Director for the Center for Anxiety and Obsessive-Compulsive Disorders and the School Anxiety and School Refusal Programs at AMITA. He is also a member of the Scientific Advisory Board of the International OCD Foundation and President of OCD Midwest. Dr. McGrath is the author of The OCD Answer Book and Don’t Try Harder, Try Different.

In addition to treating countless patients with OCD, Dr. McGrath has trained clinicians around the world in cognitive behavioral therapy (CBT) and its OCD-specific derivative, exposure and response prevention (ERP). In the words of Dr. McGrath, “Working with OCD patients is amazingly rewarding. I have gotten to see people get their lives back, start to smile and laugh again, and re-engage in their families and careers. That people trust me to guide them through this journey is humbling and continues to inspire me to help all of my patients challenge their fears and live a value-based life again.”

Welcome to the NOCD team, Dr. McGrath!

Harm OCD: Can I trust myself?

By Patrick,

Please note: this post is an exploration of a common question from our community members. It is not intended to diagnose or give treatment advice.

Amy is just hanging out on a Saturday afternoon, trying to entertain her toddler. She’s full of love for this three-year-old. But today, like every other day she can remember, brings a horrible moment. She suddenly thinks about how she could just kill her child if she wanted to.

Amy is launched into a spiral of extreme doubt and anxiety: “Would I ever do that? How could I think such a thing? Do I care about my child at all? What kind of person am I?” As she tries to prove to herself that she wouldn’t hurt her toddler, Amy’s distress only increases. No attempt to answer these questions feels good enough, and Amy starts to feel panic coming on as she fails to fully convince herself that she’ll never lose control and become a murderer.

It may come as a surprise, but it’s very common for people to have disturbing and even graphic thoughts about hurting or killing a loved one, friend, coworker, acquaintance, or stranger. Parents like Amy can experience these thoughts even though they’d do anything to protect their children. Most people, most of the time, brush them off as strange, unexpected, or unpleasant, without seeing them as especially meaningful or feeling like they need to make them go away.

Sometimes, though, the thoughts feel catastrophic and uncontrollable. They seem to signal an urgent need to make sure something bad won’t happen now or in the future. Some people even question whether they’ve already harmed someone and don’t know about it or simply can’t remember. Those who think and feel this way, and end up relying on repetitive behaviors for temporary relief, might be displaying symptoms of obsessive-compulsive disorder, or OCD.

The primary symptoms of OCD are obsessions and compulsions. Obsessions are unwanted or intrusive thoughts, images, or urges. Compulsions are repetitive behaviors performed to provide temporary relief from the anxiety those obsessions generate. These symptoms disrupt daily life and cause significant distress.

We can look at statistics about how rare acts of violence are or read reassuring articles all day long (seeking reassurance and doing research are common compulsions), but they’ll never be good enough to convince us for more than a few moments that there is no risk of us doing harm. In fact, with OCD, these behaviors may cause further distress.

Because we can’t see the future, we’ll never know with certainty what we may or may not do. This sounds a bit cruel, but when it comes to OCD, getting reassurance that we’ll never harm someone isn’t going to help our anxiety decrease in the long run. But we can move in a healthier direction by learning about OCD, practicing ERP, and doing the things we value even despite scary thoughts and unpleasant feelings.

This post is about Harm OCD.  Harm-related obsessions are common but rarely discussed openly. Though intending to harm oneself or someone else is different from experiencing harm obsessions, both can be very confusing and scary.

You don’t need to figure this out alone. We strongly suggest you seek help from a licensed professional. If you believe you have genuine intent to harm yourself or someone else, please seek immediate help by calling 911 or heading to an emergency room.

Looking to discuss Harm OCD and get support from the NOCD community? Download the free NOCD app now.

Compulsions and the Misunderstanding of OCD

By Patrick,

There are few things like the feeling when intense worry lifts. Whatever degree of anxiety you’re feeling– whether your kid still isn’t home three hours after curfew or you desperately want your favorite sports team to win– there’s real relief in its resolution.

These two situations are widely recognized, to varying degrees, as understandable causes of heightened anxiety. But other causes are misunderstood or flat-out rejected: There’s no reason he should be freaking out about the way she’s doing the dishes or Why does this even matter to you so much? Sometimes people are said to be overthinking a situation, or “just coming up with things to worry about.”

People with all kinds of so-called mental disorders are swept to the side because they don’t fit in with accepted expressions of distress. In a way this rejection is self-protective– it can be draining to acknowledge the legitimacy of a depressed friend’s withdrawals, the difficulty a family member has in maintaining a job as they deal with psychotic episodes, and so on. To recognize these things fully is to admit that nobody is really in control of everything they think and feel.

When we think of obsessive-compulsive disorder (OCD), pop culture images of strange people spiraling into increasingly desperate situations might emerge. A more likely situation, though, is that you won’t be able to spot that person unless you’re very close with them. Shame is a powerful motivator, and people tend to be good at hiding things they know will be misunderstood.

Howard Hughes, an aviation magnate who had OCD, played by Leonardo DiCaprio
in The Aviator (Warner Bros., 2004)

Repeated attempts to mitigate distress are called compulsions when they feel unavoidable. They’re not habits, and they don’t feel voluntary. People don’t act compulsively because they enjoy doing so. And, like the withdrawals characteristic of depression, another person’s compulsions can be hard to approach with empathy.

When unpleasant feelings are alleviated by a specific behavior– say, getting checked by a doctor– it becomes more likely that someone will perform that behavior again. This isn’t unique to OCD; it’s a natural human response, and psychologists see it as an example of both negative reinforcement and operant conditioning. In this way, compulsions evolve over time, their temporarily alleviation of anxiety snowballing on itself while they continually shift in their specifics. What starts as a voluntary, controllable behavior can morph into a compulsion through reinforcement.

Someone might start getting a physical exam from a new doctor each month, before they realize that searching for symptoms online allows them to obtain 24/7 relief. They’re responding to obsessions– intrusive thoughts, images, or urges– because those obsessions have latched on and started causing tremendous distress.

Here, the person feels incapable of accepting sudden images of dying from a serious illness whenever something looks or feels a bit different with their body. Getting a physical exam or finding new information online reassures them for a bit: this is normal, nothing bad will happen. But, in doing so, the compulsive behavior seems to legitimize the obsession: good thing I got that checked out. It’s a cruel fact: behaviors that bring temporary relief can generate long-term suffering.

The fact that other people can only witness compulsions– and not the obsessions that fuel them– makes it hard for them to understand OCD, even if they truly want to. This isn’t unique, of course, as nobody can read another person’s mind and know exactly why they’re behaving in a certain way. But we’re able to make assumptions about most behaviors: he’s straightening things before guests arrive so they’re comfortable or even impressed, she’s buying groceries to make a meal later, they’re playing soccer because they enjoy it or want some exercise.

It’s much harder for us to make a guess as to why someone would feel completely panicked until they’re able to loop back while driving to make sure they haven’t run someone over, for example. These behaviors are not rational, so to speak, and the resulting misunderstanding means people with OCD are alone until they seek help.

Compulsions, through their reinforcement of obsessions and the way they steal so much time and energy, are the core of the suffering OCD causes. In learning to resist compulsions, people can free themselves from this vicious circle. This process, called response prevention, helps people learn how to respond to unwanted thoughts without feeling compelled to behave in any particular way.

Because our instinct is to escape suffering, it’s no wonder people tend to hope OCD treatment will get rid of the excruciating thoughts that seem to make their lives so difficult. But, in the end, thoughts may prompt suffering but do not cause it. And the most effective forms of OCD treatment don’t try to change anyone’s thoughts; they aim to help people change their behavior instead. Many find that they experience the exact same thoughts after treatment– these thoughts are, however, drained of their debilitating power.

The goal of the most research-backed type of therapy for OCD, exposure and response prevention (ERP), is to stop using compulsions and get used to distress. All of this hard work is in the service of developing lifelong and widely applicable skills for responding to unwanted thoughts by… not really responding to them.

Get support for compulsions, OCD treatment, and ERP in the free NOCD app!

Does OCD go away?

By Patrick,

This question– one of the most common in our in-app community– often comes from people who are concerned about their thoughts but aren’t yet sure about getting treatment. Some may be looking for reassurance that they’ll improve without treatment, while others are taking a cautious first step toward getting help. So there are really two ways to interpret the question:

1. Does OCD go away on its own (without treatment)?

2. Can people with OCD get better?

Most people probably mean the first option, but we can answer both at once.

Obsessive-compulsive disorder is a chronic condition. This means it won’t fix itself and is generally not cured completely. So to the first question: OCD does not go away on its own, without treatment.

At first, this seems disheartening: I’m going to deal with this for my entire life? But the good news is that treatment methods developed over the past few decades have made OCD symptoms manageable.

We’re always talking about a type of treatment called exposure and response prevention (ERP) because it has a particularly strong research backing. ERP is similarly effective to the medications prescribed most commonly for OCD: selective serotonin reuptake inhibitors (SSRIs) and clomipramine. There’s some evidence that a combination of ERP and one of these medications may be more effective than either option alone.

What can you do if OCD isn’t curable?

For starters, you can always hope that a cure will emerge within our lifetime. There are countless dedicated researchers and clinicians working to discover new treatment methods and refine existing ones and repurpose therapies originally developed for other conditions.  

It’s great to keep hoping for a cure and learning about the latest research. But in the meantime, it’s also important to get started with the options available today: ERP and a medication consultation with your PCP or a psychiatrist.

What’s the best someone with OCD can hope for?

Although OCD is generally a chronic condition, you don’t have to feel this bad for the rest of your life. Think of the way your symptoms fluctuate naturally: maybe a certain part of today was extremely hard but there were moments of relief, or you can even remember a whole week last month when you felt pretty decent. Over time, with some hard work and a lot of patience, ERP can help you make changes in your behavior and experience a lot more of these pleasant moments.

In summary:

  1. OCD is a chronic condition, meaning it can’t be cured completely
  2. Researchers around the world are working to identify the cause of OCD and find a cure
  3. But in the meantime, effective treatments like ERP and SRI medications are helpful
  4. Many people with OCD use existing treatments to help them reach a point in their recovery where their symptoms aren’t anywhere near as debilitating

Are you interested in joining a supportive community and getting guided help for OCD?

Introducing NOCD on Android!

By Patrick,

An estimated 2-3% of the US population deals with obsessive-compulsive disorder. Many of them are, of course, Android users. That’s why releasing NOCD on Android has always been one of our main priorities. Community members like you have been enthusiastically involved in this process from the very beginning, motivating our team to move quickly while creating a clinically supported, easy-to-use experience.

And so we’re thrilled to announce the release of NOCD on Android.

Everyone at NOCD was integral to this new release– from UX/UI design, content creation, and clinical validation to development, testing, and marketing– but three team members worked especially closely on the Android app. Ray, Anil, and Larry put innumerable hours into the project, working together on new aspects of the app each day and tying together the efforts of everyone else on our team.

It wasn’t all serious, though. As Ray– a software engineer, Android aficionado, and one of our most enthusiastic team members– put it, “Developing the Android app was an absolute blast! I greatly enjoyed using the latest mobile technologies to create an app that helps people feel better and live life to the fullest.”

NOCD on Android is built to support people through all stages of their journey through OCD, from learning about its symptoms and recognizing which ones they might have all the way through recovery. It is full of helpful tools and centers around three major components: Discussion, Therapy, and SOS.

In Discussion, the NOCD app’s homepage, our community members ask questions and get answers in a supportive, moderated community. We also see a ton of inspiring stories from people around the world who are having a ton of success with exposure and response prevention (ERP) and other treatments. And, of course, we get tons of loved ones and friends getting information about OCD.

When users enter the Therapy section of NOCD on Android, they’ll find a guided tour through OCD. In just a few minutes, you’ll learn the most important things about symptoms, treatment, and more. Then you’ll create a hierarchy of OCD symptoms with the help of hundreds of detailed templates. You can also create your own, of course, because OCD symptoms vary widely from one person to the next.

As Ray said:

Creating the Therapy section of our Android app was a unique and exciting challenge, as it represented a chance to do pioneering work in digital therapy solutions. The amount of thought and care that goes into every aspect of these processes is extraordinary. The NOCD Therapy section represents hundreds of hours of user testing and thousands of hours of clinical expertise. The most exciting part is that we continue to improve and innovate to provide our users with the best tools to manage OCD.

Templates in NOCD Android are a useful tool for creating OCD hierarchies. A hierarchy is a list of obsessions, compulsions, triggers, and exposures ranked by intensity. This isn’t easy to do, so we worked with NOCD’s content team and clinical advisors to create templates for every kind of obsession. This allows people to select from common examples tailored to their symptoms– or even just to see an example of how hierarchies are built. Our goal was to make NOCD Therapy as easy to use and pain-free as possible. Therapy Templates are a big step in that direction.

Ray is right– more than anywhere else in the app, the Therapy section required constant collaboration within our team so we could help make OCD treatment a better, easier experience. Once the user has created their hierarchy using templates and custom inputs, they can begin doing ERP exercises. These guided exposures are paired with helpful tools for responding to obsessions without using compulsions. The Therapy section, which supports our community members in their work with clinicians, is the clinical core of NOCD.

Last, but not least, is the SOS feature, which is a community favorite because it provides guidance when you’re already in a really distressing moment. Therapy and SOS follow the same therapeutic principles, but the former is for planned exercises whereas SOS is intended to help people thorough the exposures they hadn’t planned. The user identifies what they’re going through and uses the NOCD app to get through that episode without turning to compulsions or derailing their hard-earned progress.

We know from speaking with tons of community members and test users that the resources offered in these three major sections (and throughout the rest of the NOCD app) can be really helpful. But what does a NOCD developer like most? According to Ray, “The NOCD app is very feature-rich, so picking one favorite feature is hard. One thing that’s really nice, though, is that many screens throughout the app have hints to help the user out. These explanations and examples are really helpful because both OCD and its treatment can get confusing.”

All of us at NOCD hope that NOCD on Android will help make OCD and its treatment a lot less confusing. Thanks for keeping up on the latest at NOCD, and be sure to try the brand new app for free today!

Experts talk about how to get the best OCD treatment

By Patrick,

When you’re dealing with something difficult or painful– OCD is both– it’s natural to seek the best solutions. That’s why we’re sharing a few of our favorite articles on this topic, written by OCD experts and published on some of the more informative websites on mental health. Let’s get started.

1. “Getting The Right Treatment For An Obsessive-Compulsive Disorder” by Fred Penzel, PhD

“You have the right to assertively question their ability to help you”

In this concise post, Dr. Fred Penzel lays out ten important questions to ask a new behavioral therapist or psychiatrist before starting treatment. We like Dr. Penzel‘s list not only because he has serious credentials– he has specialized in OCD since 1982 and wrote a few formative books on OCD and related disorders– but also because it provides a means to cut through the awkwardness of an initial consultation while helping you understand if the clinician is a good fit. Whether you’re meeting a new practitioner soon or hoping to check in about your progress with someone you’ve seen for a while, bring Dr. Penzel’s list along.

Read this article from BeyondOCD

2. “O.C.D., My Exhausting Best Friend” by Wajahat Ali

“The goal of the treatment is to make the thoughts irrelevant… it’s not to make the thoughts go away”

Even though Wajahat Ali isn’t an OCD expert in the traditional sense, the playwright and lawyer has struggled with the disorder for years. Ali writes eloquently about OCD’s effects and his journey to embrace what he calls “God’s sick joke” while learning about exposure and response prevention (ERP). Equally helpful are the comments from Dr. Steven Phillipson, an OCD expert Ali spoke with. As Ali writes, “Dr. Phillipson said people should first choose to forgive themselves for having O.C.D…. he advised against using negative imagery and instead welcoming our ‘best friend’s warning’ but then choosing to ignore it.'” Dr. Phillipson’s advice is a great reminder that getting treatment for OCD doesn’t mean we need to hate this part of ourselves.

Read more from Ali and the experts on The New York Times

3. “Pure O: An Exploration into a Lesser-known Form of OCD” by Jordan Levy, PhD, and Jan Weiner, PhD

“It is the very act of trying not to have a bothersome thought that guarantees its resurfacing”

Lots of people ask us about Pure-O, which is a subtype of OCD that involves obsessions but not visible compulsions. Other compulsions, like mentally replaying events and reassuring oneself, are still performed in response to unwanted thoughts just like those in any other subtype. In this helpful and thorough outline of Pure-O symptoms and treatment options, Drs. Levy and Weiner illuminate a subtype that many deal with but few understand.

Get more info at Intrusive Thoughts.

Is it Relationship OCD or a Bad Relationship?

By Patrick,

Ah, relationships. Everyone’s talking about them– as we always have. And these discussions have expanded far beyond the intimate relationships we– or our friends– are part of. Though it is by no means the starting point of relationship anxiety, social media has given us access to a far larger field for comparison. If you’re looking to find evidence that you and your partner are (or aren’t) in the right relationship, you’ll have an easier (or more confusing) time than ever before.

Some people probably aren’t in the best relationships. But even in clear cases when they can’t be safe, healthy, or happy, people can have a really hard time leaving an intimate relationship. Often, relationships end when someone moves away or things just fizzle out. But in between the start and end of any relationship, there can be a lot of confusion and torment along with the good feelings.

When people say things like “You just know when they’re the one,” it doesn’t mean they actually know. They might feel a deep and meaningful connection– but that doesn’t mean they have any magical knowledge of billions of other people, allowing them to make a definitive judgment. There is always doubt and ambiguity in human relationships, whether they’re intimate, platonic, or even familial.

This doubt is often most pronounced in intimate connections. Just about everyone wonders how their partner really feels, whether or not they could be happier with someone else, and so on. But what about when these thoughts become debilitating and leave someone feeling like they need to respond to their discomfort whenever doubt emerges?

People dealing with Relationship OCD– as many psychologists and people with OCD call it– struggle with obsessions and compulsions related to relationships and their feelings about them. In this subtype of OCD, the fundamental uncertainty of intimate relationships can feel unbearable, and any hint of imperfection might launch an obsessive-compulsive cycle. Compulsions can consume a lot of time and energy, and they tend to make relationships more, rather than less, difficult.

Here’s an example using a common framework:   

  1. Trigger: Made eye contact with someone attractive
  2. Intrusive Thought: I could be dating someone more attractive
  3. Catastrophic Assessment: The thought feels important, even urgent
  4. Obsession: I could be stuck in the wrong relationship forever
  5. Distress: As obsessions continue, the sense of inner tension increases
  6. Compulsions:
    • Googling “Is it normal to find strangers more attractive than my partner?”
    • Asking a friend if they think you could do better

None of these steps alone is “abnormal” or “unhealthy.” But when they turn into a repetitive cycle that reduces our quality of life by consuming a lot of time and energy, we might be looking at symptoms of OCD.

The line between “good” and “bad” intimate relationships is often unclear. So, how can someone know when they’re actually in a bad relationship?  When someone is disrespected, ignored, abused, or manipulated, these are signs that the relationship is unhealthy. The rest can be murkier, and any broad claim about what constitutes the “right” relationship will quickly prove problematic.  

Everyone wonders about their partner, the other possibilities out there, and the way their partner might see them. These questions emerge even in relationships that both partners perceive as happy and healthy. But when someone feels a need to figure these things out and tries to do so on a consistent basis, it’s worth learning more about Relationship OCD.

Wondering how people with Relationship OCD can feel better?

Please note that this post is an exploration of a common question from our community members. It is not intended to diagnose. 

What people with OCD really obsess about, according to a 2018 study

By Patrick,

This is an exciting update on OCD research conducted by Dr. Jamie Feusner (Chief Medical Officer of NOCD, Professor of Psychiatry at UCLA, Director of the UCLA OCD Intensive Treatment Program) and Dr. Alex Leow (Scientific Advisor at NOCD, Associate Professor of Psychiatry and Bioengineering at the University of Illinois College of Medicine, Attending Physician at the University of Illinois Hospital). Here is Dr. Feusner discussing the research.

Dr. Jamie Feusner

By Dr. Jamie Feusner

If you quiz random people on the street– as Jimmy Kimmel likes to do on his late-night show– and ask them what OCD is, they will mostly say it’s a quirky obsessive fixation with cleanliness and order. They think of Howard Hughes in the 2004 blockbuster The Aviator, or Joan Crawford in the 1981 cult classic Mommie Dearest. Heaven forbid somebody touch Hughes’ food or use wire hangers at Crawford’s house.

Outside of Hollywood, early studies of obsessive-compulsive disorder (OCD) patients suggested that contamination fears are the most prevalent subtype in people with OCD seeking behavioral therapy. A later, larger study of more than 2,000 people suggested that obsessions leading to checking (typically caused by obsessional fear of harm or doubt) are more common than contamination fears (Ruscio et al. 2008).

Obsessions are unwanted, intrusive thoughts that generate intense anxiety. Contamination obsessions center around a fear of dirt or germs, getting sick, or infecting someone else. Harm obsessions involve uncertainty about whether or not one might or already has hurt oneself or others. The feared harm might be of a violent, sexual, religious, or intimate nature, to name only a few.

The results of our recent study of over 4,000 people with OCD in 90 countries using the NOCD smartphone app validates this previous study, defying the conventional portrayal of OCD as being most commonly related to contamination and cleaning. Samples this large are rare in OCD studies, and enable researchers to make conclusions with greater confidence. The study was presented at the American College of Neuropsychopharmacology 57th Annual Meeting in December 2018.

Dr. Alex Leow, who also worked on the research

Our research shows that Harm OCD is by far the most pervasive type of OCD. It’s 66% more common than contamination fears. Our research also supports the case for obsessions about sexual orientation, sexuality, and relationships also being relatively more common than has appeared in previous literature. People with OCD may have been reluctant to share the truth with their therapists, or even researchers in person, perhaps because of shame, fear of being misunderstood as suicidal or homicidal and being hospitalized, fear of being labeled a sociopath, or fear of being judged negatively by others for thoughts concerning their sexual orientation or their relationship. OCD patients might have been comfortable revealing their true obsessions through the NOCD app because they were allowed to do so anonymously.

The NOCD app offers tools for planning and completing exposure and response prevention (ERP) therapy. Over 6,000 words related to obsessions were pulled from de-identified obsession data entered by NOCD users in the app. This means we were able to study a large sample of data entered by NOCD users without seeing any of their personal information.

Key Takeaways From Our Study

Our study analyzed not only the frequency of different types of obsessional thoughts but the relationships between these obsessional words in the English language in order to understand underlying semantic (“meaning”) themes.

  1. Most OCD obsessions are linked semantically by the theme of harm, even ones related to contamination fears.
  2. Sexual and relationship types of obsession are very common and appear segregated from OCD themes related to harm and contamination.
  3. People might be more comfortable sharing their true obsessions through the app thanks to anonymity.
  4. Although OCD patients may perceive that they have multiple different obsessions because they’re triggered by different things, the obsessions are typically variations of the same theme.
  5. In recognizing this, patients may be able to apply the same techniques they learned to overcome one obsession, with any “new” obsessions.

Research Methodology

We used anonymous and de-identified data from 4,073 people, ages 17 and older living in 90 countries, who identified themselves as having OCD, from the words they freely entered into the NOCD app describing their obsessions.

Next, we took this large ad hoc dataset of obsession-related words and analyzed their clustering relationships using natural language processing. We analyzed 100 dimensions of latent relationships through these algorithms – far more powerful for uncovering hidden connections than the human brain can tackle.

Eye-Popping Findings

Individuals entered words related to harm (e.g. kill, die, hurt) almost twice as often as words related to contamination (e.g. disease, germs, sick) and 10 times more than words related to symmetry or order (e.g. right).

Our algorithm grouped the 25 most commonly entered OCD words into clusters to visually display the semantic relationships among the words. One major cluster centered on the theme of harm. A branch of that cluster centered on the theme of contamination while another branch (although more segregated) centered on the theme of sexual and relationship issues.

This suggests that although the most common OCD obsessions involve harm, contamination obsessions have links to harm through their underlying meanings.  

These findings could have important implications for what the medical community must do to help remove the shame and stigma of having OCD. In addition, it may influence how treatment is approached since many obsessions have closely related underlying meanings.

Overcoming Harm Obsessions

Overcoming Harm OCD might seem impossible for some. As soon you feel you have overcome one obsession another comes to take its place. The thought of poking your eye turns into stabbing a stranger on the bus, which then turns into losing important paperwork. You may believe you have multiple obsessions because they’re triggered by different things. But the seemingly disparate obsessions are typically variations of the same theme and are actually all related.

Imagine a group of icebergs the size of Mount Rushmore floating in the ocean. From the surface of the water, you see five or six different mountains of frozen water. But when you dive below the surface, you see those mountains of ice are actually peaks in a single massive island of ice the size of Hawaii.

Now imagine the different OCD obsessions you’ve had being each one of the peaks of the giant iceberg. But like the peaks on the iceberg, they’re all connected to one underlying obsession or compulsion. They’re all part of one large iceberg but just a different peak on it.  


This iceberg analogy suggests the possibility that once you learn to overcome a specific Harm OCD symptom, you can use the same approach on all Harm OCD symptoms. When you encounter a new, unexpected obsession or compulsion, you can use the ERP tools that have worked previously for you to deal with the new symptom. This may also help you recognize that if a new concern comes up and you wonder if it’s a “real” concern or OCD, chances are, if it’s a similar theme, it is just another peak from the same iceberg.

From the NOCD Team

If you are dealing with harm obsessions, contamination obsessions, or any other OCD symptoms, you’re not alone. NOCD is a massive community of people around the world learning how to cope with intrusive thoughts, decrease their reliance on compulsive behaviors, and feel better.

Whether you want to use ERP tools, get guidance in your toughest moments, or just have a safe place to discuss what’s on your mind, you can try the free NOCD app now: 

Why is the NOCD Team working on public health studies?

Our mission is to help people feel better. While we’re always working to provide the best tools given the treatment options available today, another aspect of this mission is to support the best researchers working today through responsible application of de-identified NOCD data.


The study was conducted by NOCD’s Chief Medical Officer (Feusner) and a member of the NOCD Scientific Advisory Board (Leow), along with other members of the NOCD team. No payment was exchanged for this data.

How can you deal with OCD during the holidays?

By Patrick,

We’re already in the midst of the holiday season, and although these celebrations can bring lots of joy, family and friends introduce lots of new variables that can exacerbate symptoms– even the ones we’re managing well in our daily lives. For those who aren’t with family and friends, holidays can create intense loneliness and sadness.

Whether you celebrate any winter holidays or not, it’s worth thinking up a few strategies to cope with more intense symptoms, whenever and wherever they emerge. These apply to holidays throughout the year.

Let’s say you’re at dinner or just sitting around with family, and somebody does something that triggers your obsessions. Maybe they say something about how relationships should feel, or touch a bowl of food before passing it to you. Simply staying in your chair feels almost unbearable. You’ve unwittingly been exposed to one of your triggers, and obsessions quickly flood your mind. These unplanned exposures aren’t a formal part of your treatment plan, but we’re calling them by the same name because they create a similar sequence of thoughts and sensations

When we asked Dr. Marisa Mazza, PsyD, how patients are actually supposed to do response prevention, she shared a helpful exercise with us about using Acceptance and Commitment Therapy (ACT) during an exposure:

  1. Exposures are meant to be a feeling process too, not just a thinking process. You can acknowledge thoughts as they come up by saying or picturing the thought, but then shift your attention to the sensation in your body.
  2. Notice if anything gets in the way of connecting with the feeling or sensation in your body, and see if you can let go of that barrier and refocus on the sensation. Do this each and every time you get pulled away from the feeling.
  3. After doing this for a few minutes, notice any changes that naturally occur with the feelings or thoughts.
  4. In order to reinforce what you learn, you may want to ask yourself these questions post-exposure practice:   

What did I learn or notice about my own abilities from leaning into this experience and doing this exposure?
What did I notice about the feelings or sensations?
What did I notice about the thoughts? Are they true? Can I do more than what my mind says I am capable of?

Mindfulness is a great concept, and it’s increasingly backed by scientific evidence as a helpful tool for the general population. But people with good intentions frequently tell someone to just meditate and accept their thoughts. This is vague and unhelpful. It’s like throwing someone in the deep end and telling them to swim. How? In what way?

Dr. Mazza’s advice is a great start, and ACT offers a lot of other helpful tools for these unplanned exposures. As Dr. Ryan Vidrine, MD, tells us, one of the main goals of ACT is developing cognitive flexibility: “the ability to contact the present moment more fully as a conscious human being, and to change, increase, or continue behaviors such that they move us closer to our values in life.”

The first bit about contacting the present is clearly influenced by mindfulness. And the second part reveals another key aspect of ACT: defining your values so that you can make sure your behaviors are generally oriented toward the things you really care about. Maybe you value family, social life, physical health, learning, and so on. Values are one of the things that can motivate someone to get through an exposure (planned or unplanned) without relying on compulsions in the service of getting used to distress so we can spend our time and energy doing things we value rather than doing compulsions.

Our values can also direct us toward behaviors that benefit our overall mental health. Even when OCD is a primary concern, people may need to  cope with other mental health conditions or simply deal with the difficulties that arise throughout our days. That’s why taking a multifaceted approach is wise, especially during the holidays when maintaining mental health gets tougher. Aiming to maintain holistic wellbeing with a decent diet, smaller quantities of alcohol (if you’re over 21 and planning to drink), and a bit of exercise can never hurt.

Thanks to Dr. Mazza for these helpful tips. You can learn more from her here

Please share this article with anyone who might find it helpful! And let us know what you’re doing to stay healthy during the holidays on Twitter, Facebook, and Instagram– we’re @treatmyocd and we’d love to hear from you.

Ten Times OCD Was Treated Like a Joke But We Weren’t Laughing

By Phoebe Kranefuss,

1. Obsessive Christmas Disorder

There are a lot of reasons to love Christmas: spending time with family, drinking hot chocolate, making cookies, and taking a much needed vacation from school or work. But liking Christmas? That’s not obsessive, and it’s certainly not a disorder. Decorating a tree, opening presents, making a gingerbread house, and spending time with people you love are all really wonderful things. Pretending OCD is funny or quirky not so much.

2. Obsessive Cleaning Disorder

Sure, some people with OCD experience obsessions with cleanliness or contamination, or compulsions involving hand washing or cleaning. But the majority of people with OCD actually suffer primarily from upsetting intrusive thoughts about taboo topics like sexuality and violence. The stereotype that all people with OCD are overly consumed with being clean is inaccurate, and might even prevent people who are experiencing upsetting thoughts from seeking treatment.

3. Obsessive Corgi Disorder

Dogs are the best. And corgis are very cute dogs. Lots of people are obsessed with corgis, because they are 100% good boys/girls and they are great at splooting. I really like corgis, but I can’t think of a single similarity between liking a particularly cute breed of dogs and being constantly plagued by irrational fears. Corgis make you smile. OCD can make you feel unable to go outside, enjoy time with friends, or partake in the things that bring you joy. Like petting corgis.

4. Obsessive Compulsive Decoupaging Disorder

Seriously?? Is it not enough to just enjoy decoupaging?? What even is decoupaging? Why are we talking about it? Just. Decoupage. Without. Buying. This. Mug.

5. Obsessive Cow Disorder

Personally, I find cows smelly and kind of dirty. Not to mention huge contributors to global warming (not their fault, I know). So I may be a little biased when I say I have a hard time understanding how someone could be obsessed with cows in the first place. But I’ll put aside my lack of unconditional love for these ginormous spotted creatures to wonder out loud: is there no better way to express your love for cows than a silly acronym that pokes fun at a debilitating disorder? Is a shirt or mug or poster or billboard in front of your house that says “I REALLY LOVE COWS” not enough?

6. Obsessive Crawfish Disorder

Yeah… I don’t even have anything to say about this one.

7. Obsessive Coffee Disorder

We really like coffee. We wrote a whole article on how coffee isn’t as bad for your mental health as people might think it is, according to recent research. If there were anything on this list that I spend a lot of time of my day thinking about and pursuing, it’d be coffee.

But even the most enthusiastic coffee lovers spend maybe two hours a day with coffee cup in hand, at most. Considering the diagnostic criteria for OCD include up to ?? hours per day focused on obsessions or compulsions, there’s really no parallel. Taking something you really like a lot and comparing it to a disorder characterized by intrusive thoughts that can be disturbing, upsetting, and against one’s values, is kind of absurd.

8 Obsessive Cat Disorder

Whether you’re a cat person or a dog person, I think we can all agree: cats have nothing to do with an OCD diagnosis.

9. Obsessive Crochet Disorder, Obsessive Cycling Disorder….

More objects that pretend OCD means really liking something a lot. If OCD makes you check the lock on your front door over and over again, it’s not because you really love locks. It’s probably because you’re deeply afraid of something and OCD has convinced you that checking the lock will prevent that thing from happening. Liking something has nothing do with the onset of an obsession!

10. Obsessive Compulsive Action Figure

The stereotype of a super clean, neurotic person who can’t shake hands for fear of getting dirty encapsulates just one type of OCD. This sort of image also contributes to society’s misunderstanding of OCD as a “hypochondriac” disorder that only a certain type of person has. The reality is, lots of people you’d never expect to have OCD do indeed suffer from the disorder. Some people with severe OCD keep their homes really messy, and cleanliness has nothing to do with their obsessions. The majority of people with OCD probably suffer in silence– and in secret. 

The goal isn’t to scold people for making these flippant comparisons. It’s to remind us all that tons of people with OCD suffer for a lot longer than they need to because they don’t– or aren’t able to– get help. Inaccurate stereotypes of OCD make it even harder for people who don’t “seem OCD” to seek help, or even know they need it. 


Really liking something doesn’t mean you have a disorder. To meet more people who don’t throw OCD around like a funny acronym, join the NOCD Community in our mobile app.

What’s the strangest OCD riff you’ve seen? Let us know on Facebook, Twitter, or Instagram @treatmyocd. And be sure to share this post with anyone who might find it helpful! 

Guest Post by M Johnson: I Handled Things as They Came

By Patrick,

We’re excited to share a guest post by M Johnson, and grateful for this generous retelling of a difficult story. It’s about the many paths our thoughts can lead us down, the ways they grow into something much larger, and the possibility of getting better despite it all. 

If you’d like to share your story or read more from people with OCD around the world, check out the NOCD app! Without further ado…

I knew something was going on when I was a young child and in the middle of my thoughts I’d picture myself falling into a dark hole in the floor. I’d try and think the thought again without the hole in the floor, but I couldn’t.

My parents were divorced, and when I was with one of them I had to do a long goodnight ritual for the other one– I feared something bad would happen to them.

When a neighbor’s dog was hurt by a car, I played it over in my head for the next year, each time convincing myself a little more that it was my fault.

As I got older, these symptoms morphed into other phobias.

My mom moved us from Montana to Los Angeles before I went into high school. As we drove down the West Coast, I couldn’t look out my passenger side window for fear of seeing a dam along the Columbia River.

After a couple years in high school, my anxiety got to the point where I couldn’t bring myself to go. I begged my mom to stay home with me, afraid to be alone. Once I had missed several days of school, I grew too anxious to go back. I was certain my teachers hated me for not showing up. I became afraid to leave the apartment, in case I’d run into them around town.

Around this time, we got evicted from our apartment, so I needed to switch schools anyway. I enrolled in an online high school, comforted by the thought of staying home.

I had to do placement testing for this new school. I needed a fountain soda to drink during the test– not a can, not a bottle– along with two bottles of Purell, one on each side of my paper. By this time I knew something was wrong, but I was so comforted by my compulsions that I didn’t want to risk losing them by admitting it.

Finally, something showed me I was in over my head. I went to the grocery store with my dad to pick up a few things. While waiting in the checkout line, I began straightening the gum and mints. He paid before I could finish, and one Altoids container remained upside down. I thought about it for a few minutes, trying to convince myself that I had fixed it. I knew that I hadn’t. In the car, I started to lose my breath. By the time we got home, it was lost. The night ended with me hyperventilating in the emergency room, collapsing in the hallway.

My mom brought me to a psychologist and a psychiatrist later that week. The diagnosis came quickly: obsessive-compulsive disorder, or OCD.

I breathed a sigh of relief. There was a reason I acted the way I did. Now that I had a diagnosis, I could start getting better.

Things did get better, for a while. I settled into my fear of germs, my phobia of dams, and the daily worry that occupied my mind. But then the obsessions switched. Suddenly, germs weren’t the problem. Fires were: I was positive a fire would consume the apartment. So I checked the stove, I checked the vents, and I checked them often.

Around this time I started experiencing sensory overload. I would reach a limit of noise or touch. We had friends over one night, and we were all having such a good time– such a good time that everyone was speaking at once. My voice rose above everyone else’s, asking for quiet. The overload became too much, and I locked myself in the bathroom with my prescription.

What followed was a visit to the children’s hospital, an ambulance ride to a psychiatric hospital, and a 72-hour hold when I was labeled as a “Danger to Self.” I was never suicidal, but I was completely overwhelmed.

Once I got out, my treatment was ramped up. I got my GED, went to college, had a great boyfriend, made friends. Things were good. The years that followed were filled with obsessions and compulsions, anxiety, worry, and stress, but nothing as severe as what I’d dealt with before. I handled things as they came.

A couple of years ago, I moved from California to Minnesota. The stress of the circumstances surrounding my move was intense and a new fear emerged: a fear for my health. I became obsessed with my fear of pregnancy. The chances were next to nothing, in fact I was on the pill and even took Plan B on top of it. But the fear stuck. For two months, I bought pregnancy tests three times a week, spent hours a day Googling symptoms and stories, and spent every second thinking I was bound to become pregnant. For the first time, I was tired of being alive.

So I got into counseling again after I was settled in Minnesota. I talked about my fear of pregnancy and how it had evolved into full-blown hypochondria. I’d become convinced that I had more disorders and diseases than I can name.

With time, the obsessions and compulsions have lessened. I still fear that I’ve left things too close to the heating vent, that the door’s not locked well enough, that if I leave clothes on the floor my boyfriend will slip and get hurt. Sometimes I forget that I have obsessions and compulsions until I mention a thought or display a behavior that makes others raise their eyebrows. I have a fear of satellite images, like the ones on Google Earth. I don’t like empty swimming pools. I ask my boyfriend every night, “Are you sure the door’s locked? The oven’s off? The alarms are set?”

I live in constant worry. When I’m not worried about something, I’m worried that I’m forgetting something to worry about. Perhaps worse than that, though, is being treated like a child. People think I need to be careful, need to take it easy. I have had a successful work history and I have a well-paying full time job. I am a full-time student with a 4.0 GPA. I volunteer, I run a blog. I maintain a relationship and keep in touch with friends and family.

My obsessions and compulsions have never impacted my work, my schooling, or my volunteer position as a Crisis Counselor. I’m a fully functioning human being who just happens to worry about things that most others don’t. Including that Altoid container that never got turned right side up.

Thanks again to M Johnson for this courageous and detailed guest post. Interested in more stories about OCD? Try the NOCD app!  

Is there a cure for OCD?

By Patrick,

Plenty of people claim to know the cure for obsessive-compulsive disorder. With a quick search you’ll find stories about yoga, diets, and supplements or medications that all supposedly get rid of your symptoms for good.

While these things can certainly be part of a plan to improve your mental health, there’s no cure for OCD yet. There are plenty of researchers working hard to find one, but the media tends to make much bolder claims than any scientist would. News about scientific research tends to overstate the researchers’ conclusions. 

What does OCD research do for people right now?

Although new research is always sharpening our understanding of the brain, nobody knows exactly what causes OCD. And there’s no way to create a precise cure when we don’t know a precise cause. It’s exciting to watch a bunch of hypotheses emerge, but it’s also helpful to remember where we are now.

This doesn’t mean people can’t get better, though. Most researchers and clinicians aren’t waiting to find that precise cure. They try a bunch of options, because they know people with OCD shouldn’t have to wait. And if something works for a lot of people, researchers can work backwards by trying to understand what’s happening in their brains. That’s how momentum starts to build around investigational OCD treatments like ketamine

How can someone get better if there’s no cure for OCD?

Most of us understand a cure as something that completely and permanently gets rid of symptoms. A cure for cancer, for example, “eliminates all traces of cancer from the body and ensures it won’t come back.” And we think of mental health conditions in the same way: we’re cured when we find a way to erase the problem completely.

But other people consider themselves cured when their symptoms are so minimal that they don’t impact day-to-day living for a sustained period. They feel a lot better, probably for a few months or more. 

Alright, then how can people find relief from OCD symptoms?

We’re always reminding people that exposure and response prevention (ERP) and SRIs (serotonin reuptake inhibitors) have the best data behind them for treatment success. In a 2013 study conducted by Dr. Blair Simpson and colleagues, 70% of patients using a combination of ERP and SRIs responded and one third “got well.”

So, can OCD be cured? Not yet. But many people do recover to the point where their symptoms are well-managed and far less bothersome. A few NOCD team members can attest to this. Nothing works for everybody, but there are plenty of great options to keep trying.

Still have questions about OCD?

This post was edited by NOCD Clinical Director Stephanie Lonsway, PhD, to ensure clinical accuracy. 

Can you tell your therapist everything?

By Patrick,

Because the intrusive and unwanted thoughts, images, urges, and feelings that characterize OCD are often disturbing, it can be very difficult to tell anyone about them. And even once we take the huge first step of starting therapy, it’s confusing to sort out what to share. That’s why lots of people write to us with questions about what they can and can’t tell their therapists. Here are some answers. 

What can I tell my therapist?

The short answer is that you can tell your therapist anything – and they hope that you do. It’s a good idea to share as much as possible, because that’s the only way they can help you. There’s no denying the courage it takes to tell them about your most unwanted thoughts, but their job isn’t to hear only pleasant things. Only by explaining the things that bother you will you be able to work toward solutions.

You should know that therapists are required to keep the things you tell them confidential– with a few exceptions. For example, if they have reasonable cause to suspect you’re a danger to yourself or someone else they may need to involve a third party to ensure everyone’s safety.

Because confidentiality can be complex and laws may vary by state, your therapist should discuss it with you at the start of your first appointment and anytime thereafter. Once you understand the role of confidentiality in your therapeutic relationship, you’re ready to tell them what’s going on.

What shouldn’t I tell my therapist?

There’s not much in this category– as we discussed above, your therapist will be more able to help you when they have detailed information about you.

To put it bluntly, the success of your therapeutic relationship rests on a willingness to disclose information that’s difficult to share. It’s okay to tell them you’re finding it hard to share something. Therapists have been there with other clients, and will work with you to help you feel comfortable.

Are a lot of people in therapy?

Tons of people are in therapy. It’s hard to measure exactly how many, but according to one small survey, 42% of American adults have seen a counselor or therapist at some point and an additional 36% would be open to it.

We wrote a more detailed post in February about the difficult but important process first step in telling your therapist your scariest thoughts. You’ll find lots of tips on how to actually do so:

Where can I find a good online OCD test?

By Patrick,

There are hundreds of OCD tests and “OCD quizzes” online. Some aim to help people self-diagnose; others turn obsessive-compulsive disorder into a joke. Either way, a vast majority of these are not helpful and probably create more problems than solutions.

Whenever we’re struggling, it’s natural to seek clarity.  And because OCD is a diagnosable condition, a lot of quizzes try to provide that clarity.

But online OCD quizzes can make things worse.

1) There’s a lot of bad information out there. Remember that even if someone’s website implies that they have real knowledge on OCD, that doesn’t mean it won’t lead you astray. Always be careful to find out the ultimate source of information about OCD or its symptoms– in other words, who wrote the actual content and what’s it based on? 

2) For many people with OCD, taking online tests can become a compulsion. The internet makes it really easy to keep finding more quizzes whenever and wherever.  If someone is repeatedly taking quizzes to gain a sense of safety (a reassurance-seeking behavior) it may be a sign that taking online tests has become a compulsion.

3) Results from an online quiz should not be taken as a diagnosis. Only a licensed mental health professional (psychologist, social worker, counselor, psychiatrist or other trained medical professional) with relevant experience and training can make this determination. Compared to an online quiz, their diagnostic process involves extended time, a comprehensive assessment, and detailed diagnostic tools that have been validated.  

Are there any free tests of OCD symptoms online that are helpful?

With all of this in mind, we know that it can be extremely hard to know where to start when you suspect you may have OCD. Below are some thoughtful screenings created by licensed professionals (or adapted from their work). These results can be shared with your mental health providers to help you make informed decisions about your health:

The Anxiety and Depression Association of America screening (based on the Yale-Brown Obsessive Compulsive Scale, or Y-BOCS)

A 25-question test for symptoms similar to those of OCD (developed by Professor Wayne Goodman)

Have any questions? We’re listening at @treatmyocd on Facebook, Instagram, and Twitter.  

Our Clinical Director, Stephanie Lonsway, PhD, helped us validate the information in this post. 

Guest Post: Lotus on OCD, Emetophobia, and Recovery

By Patrick,

Today we’re really lucky to share this excellent guest post from Lotus, who volunteered through one of our Instagram stories. She discusses OCD and much more, and talks about what it took to feel much better. Now here’s Lotus…

Hello! My name is Lotus and I have OCD (contamination) and am living in recovery from Avoidant Restrictive Food Intake Disorder (ARFID). Both disorders stem from emetophobia (the fear of vomiting) and I’ve dealt with mental illness for the majority of my life.

My behaviors included handwashing, cleaning, restricting food intake to prevent feeling full, taking toxic doses of immune supplements and anti-nausea medications, isolating myself from enjoyable activities, avoidance of “dirty” items/areas, and many more. After years of talk therapy, misdiagnoses, and living in denial and dishonesty, I knew something had to change.

I’m a BFA Musical Theatre major at a large university in the US. During my second year in the program I stood in rehearsals for our upcoming show. I was being given lines and stage directions I couldn’t retain. I was fatigued, severely underweight, depressed, and constantly succumbing to the pull of compulsions and tempting urges. I decided that once the disorder started intensely affecting areas of my life I had goals and dreams around, that was the red line.

My decision to admit myself into treatment couldn’t have been more voluntary. Over the course of seven months, I went through inpatient, residential, PHP, and IOP at an eating disorder treatment center and an OCD/anxiety center. While both centers were far from home, I met some of the most impactful therapists, dietitians, psychiatrists, and friends.

I found my values through ACT and my strength from ERP therapy. I find it funny how the hardest, most painful times in our lives can wind up being the most valuable. For me, that was my time in treatment. Putting in the hard work in order to feel like myself again was infinitely worth it.

I still see an outpatient team to help keep me accountable, and I’m enjoying getting adjusted to #posttreatment life. There will always be hurdles to jump through, and sometimes I get stuck because OCD is a chronic condition. I don’t let OCD keep me from challenging myself everyday. Through acceptance and self-compassion I know that I’m strong enough to live my life authentically. You can too! Do something that scares you…it may not be as scary as you think.

Can OCD be treated without medication?

By Patrick,

Yes, to give a simple answer.

Although lots of people find medication (usually serotonin reuptake inhibitors or clomipramine) helpful in making their obsessive-compulsive disorder (OCD) symptoms less severe, there are certainly ways to feel better without medication.

Cognitive behavioral therapy (CBT), which helps the patient identify their thought patterns and the ways they affect their feelings and behavior, has been the preferred form of psychotherapy in the US and Europe for decades. It’s fairly effective for a wide range of things. There are also plenty of CBT offshoots, like Acceptance and Commitment Therapy (ACT) and Dialectical Behavioral Therapy (DBT).

For OCD, another CBT offshoot has been demonstrated most effective in a number of studies since the 1980s: exposure and response prevention, or ERP. Most of these studies suggest it’s about as effective as SRIs or clomipramine. A combination of ERP and either SRIs or clomipramine has been shown to be most effective.

We’re always talking about ERP, because it’s helped a number of us and experts still consider it the best non-medication option for most people with OCD. But it’s worth knowing that 1) it’s highly recommended that you first consult with a licensed professional; and 2) like any other option, ERP doesn’t work for everyone. This second point is especially true for some people with comorbid conditions like depression and bipolar disorder, where it can either exacerbate the other condition or just end up less effective because of it. That’s another good reason to check with a therapist first.

There’s a detailed explanation of ERP and other treatment options in our Learn about OCD section. But let’s go through a quick explanation…

ERP is a specific form of CBT that has two simultaneous components: exposure and response prevention. In an exposure, someone faces a situation that’s likely to trigger obsessions and cause distress. The response prevention part means they’re resisting their compulsions so their anxiety level can naturally decrease and they can get used to tolerating distress.

Exposures are planned with a clinician, who will help you identify the triggers that are especially difficult for you–people, places, objects, thoughts, and feelings. We’ll get into this more soon, but by creating a hierarchy of your exposures you can make sure things are challenging but not overwhelmingly so.

Response prevention can be difficult, because the natural urge is to get rid of unwanted feelings. However, when we think about our lives and all the things we’d like to do, it becomes clear that compulsions are getting in the way. Because this is often the most difficult part of ERP for people to understand– what does it mean to just prevent your compulsions from happening?– we’ll do another post on response prevention soon. In the meantime, if you have RP strategies that work well, let us know on Facebook, Twitter, or Instagram at @treatmyocd.

Learning to Drum: How I Used ERP to Feel Better

By Patrick,

In the summer before fourth grade, one of my friends got a drum set. I’d go over and see it sitting there, shiny and red, imagining myself learning to play and becoming a drummer. So I brought it up with my parents one night. I presented my case– wouldn’t it be enriching if I switched from cello to drums, because I’d actually want to practice?– and showed them a few printed-out options ranging from inexpensive to absurd.

They probably didn’t believe that I’d practice for long, but they gave in and I did. I got a serious teacher who came over once a week until I graduated from high school nine years later. I performed with jazz bands, orchestras, and bands with friends that lasted a few days. I loved playing drums, and by tenth or eleventh grade I was thinking about music school.

A few years in, though, something weird started happening. I’d be working through a big book of exercises when a weird thought appeared: If I don’t get this right in the next three tries my family will die. I thought it was strange, and on some level I knew this wouldn’t actually happen, so I tried to push the thought away. As I kept going, though, it stuck. And then it exploded into all these other thoughts. I felt warm, like I’d get sick; I failed on the first try, and the second, and I had to stop before the third. I knew it wouldn’t happen, but I felt like it could. That was the only thing that ended up mattering.

Sometimes I was able to keep going, but other times I put the drumsticks aside and went upstairs to do homework or stare at a computer. I didn’t tell anyone, and I never would have. The idea that other people might have something similar was inconceivable. This was too strange, and whatever variations the thoughts came in I buried them away.

I never talked to anyone about my mind until the spring of twelfth grade, and that was about my mood. Six months later a doctor said I seemed to have some obsessive-compulsive tendencies. I looked back and realized these patterns had infected every aspect of my life. Rumination occupied so much of my time; I was being bullied by my own thoughts into doing certain things in specific ways, all day long.

I didn’t get any treatment yet, but I’d begun to know that although my thoughts were idiosyncratic there were plenty of people facing deeply disturbing, seemingly random thoughts all the time. It seems trite, but I’ve never had a more helpful realization about my mental health. Thoughts about suicide or hurting someone had always seemed like omens: so this was who I really was, and the future had been decided, because I would eventually give in.

Now I learned I didn’t have to deal with thoughts at all. I bought books, read articles, tried to learn.Of course, this realization is helpful but not sufficient. If you’ve ever told someone to just take their most disturbing thoughts less seriously, you probably know how poorly it works.

Eighteen months later I was referred to a specialist in exposure and response prevention (ERP) and acceptance and commitment therapy (ACT). Nothing surprised her. She recognized what I was dealing with, and we got to work.

Because I’ve already talked about drumming, let’s go back to that earlier part of my life and pretend I’m already starting ERP. It’s such a clear example, in retrospect, of obsessive-compulsive thinking.

My parents help me find a psychologist, and I have my first appointment after school. Although I feel nervous, I really do want to tell the psychologist about these thoughts so I can get back to drumming (and living) normally.

When I tell her everything, she nods and takes notes. She tells me about ERP and why it’s important: so I can learn how to encounter these thoughts without responding to them in any special way. She says response prevention basically means these ERP exercises will only work if I’m facing my thoughts head-on, without using compulsions. And she tells me we’ll focus on drumming first, because going after all of my obsessions at once will probably get overwhelming.

Let’s go through this in a structured way, as most OCD specialists would when introducing you to ERP. To flatter myself and self-plagiarize, here’s what I wrote in a recent post:

ERP is a type of behavioral therapy that exposes people to situations that provoke their obsessions and the resulting distress while helping them prevent their compulsive responses.


What good are all these words in a tough moment? In this case the situation is practicing drums. (From my experience and what I’ve heard from other people, distressing thoughts often revolve around things we really care about or enjoy. This is a convenient and fun fact about OCD.)

As I’ve mentioned, practicing drums often provoked my obsessions. Technically the trigger was more specific: whenever I was really struggling with a certain exercise, instead of cruising through it, I would start getting those irrational ultimatums in my head.

The thoughts about my family dying if I messed up were intrusive, meaning they were unwanted and involuntary. Sometimes they were just thoughts (If I don’t get this right in the next three tries my family will die) but they could also be images of bad things happening to my family. Because I’d never wanted my family to get hurt and I felt like my thoughts signaled a catastrophe that I needed to prevent, they caused me extreme distress.

The catastrophic assessment I made turned the intrusive thought into an obsession. Assessment is a term psychologists use, and in a way it sounds too deliberate. You’re not standing there for an hour, clipboard in hand, evaluating your thoughts. Usually it doesn’t feel like you have much of a choice about catastrophizing. But the concept helps us realize that intrusive thoughts only become obsessions if we feel like they’re urgently important and we need to respond to them.

In fact, I first made this assessment a while earlier, and since then the obsession had built on itself as I tried to argue with it. As the obsession intensified and I felt increasingly distressed about my family being harmed, I developed compulsions:

  • I would give in to the content of my thoughts and try the drumming exercise three times.
  • I would reassure myself that there was no way drum practice could be related to my family’s wellbeing (other than any damage to their hearing as I practiced in the basement right below them).
  • And sometimes I would avoid practicing altogether, or skip any exercises that might give me trouble. I’d put on my headphones and play along to Led Zeppelin, because John Bonham was a great drummer but an imperfect one, freeing me up to mess around.

In short, messing up while practicing drums provoked intrusive thoughts of harm coming to my family. Because I felt these thoughts were catastrophic they stuck around and turned into obsessions. In response to my distress I developed compulsions including self-reassurance and avoidance.

It’s our second appointment now. My first ERP exercise is to write down the worst case scenario. What would happen if I didn’t protect my family and my thoughts came true? My psychologist asks me to write down every detail that pops into my head, but I’m hesitant. She asks how anxious I am right now and I tell her maybe 8 out of 10. Then she asks me to read it out loud, and I don’t want to let her down so I mumble my way through it. She tells me to read it out loud twice each day for a week, and make a note in my notebook whenever I end up using a compulsion.

By the time I see her a week later, reading the script no longer makes me anxious. But I noted how many times I tried to convince myself nothing bad could happen– earlier in the week this process could repeat for hours. So she says before we go on to any actual drumming we’ll need to talk about response prevention.

You learn pretty quickly that hardly anyone has clear answers on how to do response prevention in general. Working with an experienced clinician is important in part because every response prevention plan will inherently be different. In this case, she tells me we’re going to confront each of my compulsions. I’ll do any exercises my teacher assigns me (confronting avoidance), remind myself that my family could die and I could be responsible (confronting reassurance), and practice for a set time rather than a certain number of tries (confronting “giving in”).

For a week I practice only 45 minutes at a time, and my exposure is simply to play drums while doing responsive prevention. The next week gets tougher: whenever I start obsessing about getting things right within three tries I’m supposed to deliberately mess up all three attempts. This turns out to be too difficult, so I call her and we decide I’ll start with something easier until I see her again. My goal is to try exercises only once before moving on, no matter what my thoughts suggest, and then I can come back to them the next day if I mess up.

Gradually we build up in intensity until I’m no longer being bossed around by my thoughts. They still appear, and a lot of the time they still bother me. But music matters a lot to me, and I’m motivated to do ERP until I don’t even feel like I need it in this particular situation.

Once we decide that I’m doing well enough with drumming, we move on to other areas I’ve been struggling with. Each time I do ERP for one type of obsession I gain insights I can use with the others. I’m able to think: Hm, I’ve dealt with thoughts like this before. And it wasn’t really worth paying attention.

Telling people how to do ERP is not only ill-advised (you should see a professional for guidance). It’s like telling someone how to deal with any other issue in their life: it can be helpful to offer a framework, maybe even some ideas, but everyone is different and these individual differences end up shaping the whole thing.

The important part, first, is to know that you can enjoy the things you care about more often and feel terrified of your own mind less often. Whether you accomplish this through ERP or any other kind of treatment, your life can get a whole lot better.

What exactly is exposure and response prevention (ERP)?

By Patrick,

You might’ve noticed that exposure and response prevention, or ERP, is the most commonly recommended form of therapy for obsessive-compulsive disorder (OCD). And along with serotonin reuptake inhibitors (SRIs), it has consistently been shown to be the most effective treatment.

OCD is a common psychiatric condition characterized by intrusive, distressing thoughts and repetitive behaviors aimed at reducing that distress.

This means people with OCD do certain things over and over because they’re trying to get rid of really unpleasant feelings– not because they want to behave compulsively, or because they necessarily think their behavior is rational.

What is ERP?

ERP is a type of behavioral therapy that exposes people to situations that provoke their obsessions and the resulting distress while helping them prevent their compulsive responses. The ultimate goal of ERP is to free people from the cycle of obsessions and compulsions so they can live better.

Response prevention is key, because anything that gets rid of distress makes it impossible for us to get used to it. When people don’t turn to compulsions, they learn how to accept their obsessions instead of acting desperately to neutralize them. The thoughts are still difficult sometimes, but they no longer seem like a huge problem.

This process of getting used to something is what psychologists call habituation. As patients habituate to the feelings their obsessions bring up and reduce their reliance on compulsions, they spend less time and energy avoiding pain.

ERP is fundamentally about shifting one’s orientation to unpleasant thoughts and feelings- not about getting rid of them.


When we feel able to handle discomfort, obsessions (which used to create a sense of profound uncertainty) are no longer reinforced by avoidant behaviors that teach them the content of their every thought is both important and reflective of their true nature. And when we don’t feel an overwhelming need to be certain about ourselves, the future, and our standing in the world, we can live with less unnecessary suffering.

Developed in the 1970s, ERP is recommended by the American Psychological Association and many other organizations for its wealth of scientific backing.

Why is ERP the recommended treatment for OCD?

Studies show that everyone experiences some the intrusive thoughts involved in OCD. Maybe you’ve thought I could drive off the road right now or Maybe I’ll jump off this cliff. People without OCD are usually able to write off distressing thoughts as strange and random occurrences, but those with this condition feel compelled to neutralize them. Obsessions and compulsions reinforce one another because it seems like a thought that had to be avoided with a compulsion must have been pretty important (and worthy of more fear). In most cases OCD symptoms do not resolve on their own.

A cognitive approach– traditional CBT, for example– asks patients to challenge their obsessions. This can actually reinforce the belief that thoughts are significant and that we’re morally responsible for the content of our thoughts. Although cognitive interventions can be useful in many ways, recent studies comparing ERP and CBT suggest that ERP is more effective specifically for OCD.

Any behavior that engages with the obsession– e.g. asking for reassurance, avoidance, rumination– reinforces it. By preventing these behaviors, ERP teaches people that they can tolerate their distress without turning to compulsions. It thereby drains obsessions of their power. Especially when paired with medication and other types of therapy, ERP is consistently demonstrated to be the most effective form of treatment for OCD.

How does someone actually do ERP?

There’s a good chance we’ll be writing more about this soon, but the best way to see how ERP works is to check out the NOCD app. We built it from the ground up to provide ERP tools, and worked with top experts to make sure it’s closely aligned with the version you’d get in a therapist’s office.

Isn’t ERP kind of messed up?

You’re not alone if you think therapy that asks people to do things that really bother them is kind of unfair or strange. And this suspicious comes from a place of empathy– why make people go through pain? Isn’t it okay to be anxious about things, and why wouldn’t you be bothered by something as disturbing as a thought about harming your own baby?

Is it strange to think that you could treat a psychiatric condition by doing things like telling yourself over and over that you might lose control and become a pedophile? Yes, and it’s not the kind of thing most of us would like to spend our time doing. But let’s say you’re so bothered by one fleeting thought like “I might be attracted to my 3-year-old nephew” that it makes you physically sick. You think all day about it, write mental lists of reasons you’re a good person, arrange your drive to work so you don’t pass any elementary schools or day care centers. But then the thought pops up when you see a toddler on a billboard, or when a coworker brings their kid in one day. You stop going to visit your sister and nephew, coming up with different excuses every time they ask. The thoughts torture you, and it seems like your whole life revolves around avoiding any thought about how you might have been attracted to a kid.

This is the kind of stuff that gets people into ERP. It’s not really about someone who has one quick thought about pedophilia– we all have thoughts we’d rather not have. Rather, this is a form of treatment for people whose lives are stuck because of their thoughts. That’s why patients are willing to push through the pain and strangeness, and why clinicians are willing to temporarily make the pain worse so things can get better.

In ERP a fair amount of distress in inescapable, and that’s an unfortunate fact. But clinicians and advocates of ERP, like the NOCD team, suggest it because the pain of treatment usually ends up insignificant compared to the drawn-out suffering of untreated people who go through their lives in anguish over thoughts that aren’t actually worth a ton of attention.

ERP is about shorter-term pain for long-term gain. But it has to be done carefully, with an experienced clinician you respect and trust. It’s good to weigh the pros and cons beforehand: What do you value, and how can ERP help you get there? What are your goals? And what are your limits for the amount of distress you’re prepared to go through? How long do you want to be in treatment? How’s your support system outside of therapy? These questions can help guide you as you decide whether or not ERP is the right fit for now.

An important note here: pedophiles are viewed in our society as some of the worst people imaginable, and this shame undoubtedly weighs on people anguishing over their thoughts. But the key separator between a pedophile and someone whose OCD centers around pedophilia is that someone with what therapists call “pedophilia OCD” doesn’t enjoy those thoughts. In fact, they can become the bane of their existence. A pedophile may feel shame too, and may not be without remorse, but probably won’t experience these thoughts as contrary to their values or who they really are. For both people with OCD and the rest of us, it’s important to understand the differences between thinking about something and wanting to do it.

Another important note: although pedophilia obsessions seem like an extreme case, they’re not. OCD takes all kinds of disturbing and difficult forms. Further, there’s no evidence that someone with more typically “disturbing” obsessions (e.g. pedophilia, harming other people) suffers more than another person with something that would seem more trivial to others. In OCD there’s no such thing as an obsession that feels trivial, or distress that isn’t valid.

Announcing Our New Partnership with Actify!

By Phoebe Kranefuss,

A New Partner

NOCD and Actify Neurotherapies are partnering to make more treatment options available to more people who need them. Actify is a leading provider of ketamine, a safe, effective treatment for tough-to-treat mood disorders like major depression.

Ketamine has been used for decades as a local anesthetic during routine procedures like stitching up a child’s skinned knee; when delivered in small doses intravenously, it promotes the materials necessary to make repairs to communication systems between areas of the brain responsible for depression, anxiety, pain, and other forms of stress damage.

Steve Levine, M.D., a board-certified psychiatrist, therapist, and the CEO/founder of Actify Neurotherapies, worked closely with patients in his clinical practice who suffered from treatment-resistant depression and anxiety. 

Dr. Steve Levine

A common course of treatment for people who are diagnosed with mental health disorders might include first-line medications like selective serotonin reuptake inhibitors (SSRIs) or serotonin and norepinephrine reuptake inhibitors (SNRIs) combined with cognitive-behavioral therapy (CBT) or one of its variants, like exposure and response prevention (ERP).

Many patients will benefit from a new medication or get the hang of CBT after a few weeks’ time, experiencing noticeably fewer symptoms. Some patients might need to work with their doctor to tweak the prescribed dosage, try a different medication, or practice more intensive therapy before they start to feel better. But about half of people who receive treatment– like a number of Dr. Levine’s patients– won’t achieve a meaningful decrease in symptom severity, even after trying different medications or therapeutic interventions.

Dr. Levine had always considered himself a therapist first and a provider second, so he combined his clinical experience with his research background to learn more about ketamine, which was gaining traction as a safe, proven, and fast-acting solution for treatment-resistant mood disorders– a potential good fit for some of his patients.

Guided by his mission to help his patients and his clinical expertise in treatment-resistant mood disorders, Dr. Levine founded Actify Neurotherapies, which is now the largest group of centers providing ketamine infusions for mood disorders, with 9 locations nationwide, and a track record of treating more than 3,000 patients with over 30,000 infusions since its founding.

Ketamine in the News 

Media headlines have recently and inaccurately called ketamine a “party drug” or “horse tranquilizer.” Dr. Lerner, who leads Actify’s Baltimore site, notes that cautious patients who are mislead by these inaccurate characterizations might feel dissuaded from considering ketamine therapy as an option. False information about ketamine can make treatment inaccessible to the people who need it, which is why we’re working to share accurate, evidence-based information about this type of treatment with the NOCD community.

Some people hear “horse tranquilizer” and assume ketamine is powerful enough to sedate a horse. While many medications that work well on people are also used on animals (Aspirin, Albuterol, and even allergy medications!), the amount of prescribed medication varies drastically based on factors like weight and metabolism. A 150-pound human would be administered a dose of ketamine significantly smaller than what would be necessary for a horse during surgery, much as a 50-pound child would never be given the same dose of ketamine– or another medication– as an adult. These sorts of headlines might be especially hard to read for people who deal with OCD and anxiety disorders, who might worry already about medication safety. With a history of treating more than 3,000 patients, Actify also has a proven track record of 70-80% of patients reporting feeling noticeably better after treatment. Their findings on the efficacy of ketamine are echoed by a research team at Stanford, who we’ve written about before.

NOCD is excited to share Actify’s experience and expertise with our own community. We think it’s important that organizations who offer treatments know firsthand what they’re talking about (our own clinical advisors have dedicated their careers to treating OCD, and many of us at NOCD have OCD ourselves). That’s part of the reason we’ve decided to partner with Actify: their work is heavily informed by their own clinical and personal experience with the disorders they treat.

As we’ve mentioned, Dr. Levine’s years of clinical experience inspired Actify’s founding. And Actify’s COO, Kyle Snook, brings his own experience with PTSD and major depression to Actify: while serving as an Army Captain in Afghanistan in 2010, Kyle sustained a severe injury from a roadside bomb to his leg. He was given ketamine as an anesthetic while being evacuated by helicopter. Healing from his injuries was taxing, but recovering from his subsequent post-traumatic stress disorder and major depression proved even harder. Kyle learned that thousands of veterans suffer from PTSD and depression each year, and too many of these men and women receive ineffective treatment, or no help at all. What if ketamine, which had helped Kyle in the immediate aftermath of his physical injuries, could also help people who suffered from PTSD and other mental health problems long after an injury had occurred? (Spoiler alert: it can!)

We’re so excited to work with Actify, and to help make innovative treatment options available to those who need them! Questions? Comments? Email or reach out on social media: @treatmyocd.

How we’re always learning: NOCD’s Scientific Advisors

By Patrick,

It’s OCD Awareness Week and we’re celebrating the robust community of OCD clinicians, researchers, and advocates that we get to be part of each day. Even more importantly, we’re hoping to show how grateful we are for our community members– people like you.

First, we want to tell you what we’re doing to become more aware about OCD and mental health, since we’re learning all the time along with you.

You might wonder who we are and what we really know about OCD… or anything else. We can’t blame you; we’d probably do the same. But since we’ve already done a few posts about us, we’d like to take a minute during Awareness Week to share some exciting news about our journey to continually expand our own knowledge.

The NOCD Scientific Advisors

We’ve always had our core team of Clinical Advisors, and they remain an integral part of every important decision we make. Now we’re adding a team of Scientific Advisors: some of the world’s top OCD experts, people who spend so much of their time treating patients and conducting research at the highest level.

Our Clinical Advisors bring their therapeutic expertise to everything we design, allowing us to pair technology with clinical efficacy in a unique and dynamic way. Our new group of Scientific Advisors will work in tandem with them, and will be particularly focused on helping us bolster our research capabilities and outcomes.

We’re working each day to answer questions at the core of our mission to help people feel better: In what ways is our platform helping people, and how can we improve? How can our community participate in large-scale research projects that simply haven’t been possible thus far? And how can we employ our wealth of anonymized population data in a responsible way to advance mental health science more rapidly?

Our relationships with these inspiring and ambitious people developed over time, as we collaborated on research projects or asked them to review drafts of our educational content. Their diverse research interests will encourage us to grow in all kinds of ways. And they’re already helping us make our app better, our community stronger, and our work more meaningful for people around the world.

Who’s on the board?

Edna Foa, PhD (Scientific Advisor)

Dr. Foa is Professor of Clinical Psychology in Psychiatry at the University of Pennsylvania and Director of the Center for the Treatment and Study of Anxiety. She has devoted her academic career to studying the psychopathology and treatment of anxiety related disorders, primarily obsessive-compulsive disorder (OCD) and post-traumatic stress disorder (PTSD) and developing targeted treatments for these disorders.

Her work has been recognized with numerous awards and honors, among them the Distinguished Scientific Contributions to Clinical Psychology Award from the American Psychological Association, the Lifetime Achievement Award presented by the International Society for Traumatic Stress Studies, and the Lifetime Achievement Award presented by the Association for Behavior and Cognitive Therapies. Dr. Foa was also one of the TIME 100 most influential people of the world in 2010.

Jamie Feusner, MD (Chief Medical Officer)

Dr. Feusner is Professor of Psychiatry at UCLA and Director of the UCLA OCD Intensive Treatment Program. He is also a faculty advisor for the Brain Research Institute Neuroimaging Affinity Group. His research focuses on body dysmorphic disorder (BDD), eating disorders, OCD, and gender dysphoria. He has conducted research on OCD investigating brain connectivity, predictors of acute and long-term treatment response, and neurometabolites.

An additional focus for Dr. Feusner is the discovery of novel applications for the mobile assessment of affective, interoceptive, and perceptual distortions of appearance using smartphones, tablets, and computers. Although his life’s work is to understand the brain’s many complexities, Dr. Feusner still makes time to snowboard and is an avid fan of Ariana Grande. He recently joined NOCD as Chief Medical Officer.

Michael Jenike, MD
Dr. Jenike is the founder of the Obsessive Compulsive Disorder Institute at McLean Hospital and the Obsessive Compulsive Disorders Clinic and Research Unit at Massachusetts General Hospital. He is also Professor of Psychiatry at Harvard Medical School.

A world-renowned researcher, Dr. Jenike has published over 200 articles on obsessive-compulsive disorder, geriatric psychopharmacology, and neuroimaging in psychiatric disorders. He is currently the principal investigator of a longitudinal family study that seeks to examine the clinical, genetic, imaging and neurocognitive areas of this disorder. His research and clinical interests involve the development, assessment and treatment of OCD and Alzheimer’s Disease.

Alex Leow, MD, PhD

Dr. Leow is Associate Professor of Psychiatry and Bioengineering at the University of Illinois College of Medicine, and an Attending Physician at the University of Illinois Hospital. Her unique multi-disciplinary skill set combines a medical degree with residency training and board certification in adult psychiatry with a PhD degree in applied mathematics.

As a renowned computational neuroimaging researcher, Dr. Leow has published more than 100 scientific articles that have been cited thousands of times. She serves on the program committee of the Society of Biological Psychiatry and the Steering Committee of the Mobile Health Research Technologies working group.

Christopher Pittenger, MD, PhD

Dr. Pittenger, a tenured faculty member at Yale School of Medicine, became director of the Yale OCD Research Clinic in 2007. He is also Assistant Chair for Translational Research in the Department of Psychiatry. His research program seeks to advance our understanding of the neuropathophysiology of OCD and related disorders, especially Tourette syndrome, and to harness that understanding in the development of new strategies for diagnosis, prevention, and treatment.

His research has been funded by the National Institutes of Health, the International OCD Foundation, and other charitable organizations and industry partners. He is the recipient of numerous awards, including the Laughlin Fellowship from the American College of Psychiatrists and a Senior Researcher Award from the American Academy of Child and Adolescent Psychiatry. He is also active in education at Yale, where he is Co-Director of the Neuroscience Research Training Program within the Adult Psychiatry Residency, and nationally, where he has served on the Education and Training Committees of the American College of Neuropsychopharmacology and the Society of Biological Psychiatry.

Dr. Pittenger lives outside New Haven with his wife, four children, three cats, and eleven chickens. Cleaning the coop keeps him grounded.

Barbara Van Noppen, PhD

Dr. Van Noppen is Assistant Professor of Clinical Psychiatry, Assistant Chair of Education, and Co-Director of the OCD Treatment and Research Program at the Keck School of Medicine of the University of Southern California. She is also Administrative Director of the Adult Outpatient Psychiatric Clinic at the Los Angeles County + USC Medical Center.

Internationally known for her development of Multifamily Behavioral Treatment (MFBT) for OCD and her inclusion of family members in CBT, Dr. Van Noppen has published numerous journal articles and book chapters on this topic. She teaches and supervises psychiatric residents in the use of CBT for a number of psychiatric conditions.

We’re very excited to work with these very impressive and generous people, and we’ll be sharing more about what we learn. Thanks for reading!

Asking an OCD Expert: Jamie Feusner

By Patrick,

Today we asked our community members and newsletter subscribers to send in questions for Dr. Jamie Feusner, one of the world’s top OCD experts. Our focus for this Q&A was clinicians. He answered some of those questions here. Download our app for further discussion!

Dr. Feusner is Professor of Psychiatry at UCLA and Director of the UCLA OCD Intensive Treatment Program. His research focuses on body dysmorphic disorder (BDD), eating disorders, OCD, and gender dysphoria. He has conducted research on OCD investigating brain connectivity, predictors of acute and long-term treatment response, and neurometabolites.

Although his life’s work is to understand the brain’s many complexities, Dr. Feusner still makes time to snowboard and is an avid fan of Ariana Grande. He recently joined nOCD as Chief Medical Officer.

1. I was told by my psychiatrist, whom I respect very much, that I should not drink any alcohol because I have OCD and it’s like pouring gasoline on a fire. Is this true?

Alcohol, in general, tends to worsen anxiety and depression, and these are common symptoms for people with OCD. In general, it’s better to avoid or minimize alcohol intake if you have OCD.

2. Do you think it could ever be possible to find a cure for OCD?

I think it is possible to improve the effectiveness of treatments for OCD to the point that symptoms are so minimal or unnoticeable that they cause almost no interference or distress in one’s life. Some would call this a cure, although because OCD is a chronic illness it would not be the same as, for example, a cure for an infectious illness.

3. As a parent really desperate to find help for my son, it’s hard to believe any other options will help. Where can we turn if we’ve tried ERP, CBT, and a bunch of medications?

It sounds like you’ve tried many options, and perhaps the ones that are considered “first-line” for OCD such as medications and ERP. When someone doesn’t respond to regular outpatient ERP, intensive outpatient (daily) treatment programs or residential programs may be effective. Medications may be optimized in terms of doses or combinations, and “second-line” medications can be added. Finally, there are neuromodulation (brain stimulation) treatments available that have FDA approval for those who haven’t responded to all of the above, which include transcranial magnetic stimulation (TMS) and deep brain stimulation (DBS). 

4. Has a cure/therapy been invented so far for OCD that doesn’t involve medication?

There are very effective non-medication therapies for OCD called cognitive-behavioral therapy (CBT) and exposure and response prevention (ERP, a type of CBT). These are considered first-line treatments, along with medications and are as effective or more effective. In addition, there are neuromodulation (brain stimulation) treatments available that have FDA approval for those who haven’t responded to meds and ERP, like TMS and DBS (see question 3).

5. How should we all (patients, loved ones, clinicians) balance the need to try emerging treatments with the fact that there hasn’t been enough research on many of them?

The situations that arise when someone might consider trying an emerging treatment that might not have a lot of research conducted yet to evaluate the efficacy usually involve someone who has tried several different evidence-based treatments and either didn’t respond or couldn’t tolerate the side effects. In these situations, the patient (along with their clinician and loved ones) may really need a treatment to help them, but should carefully weigh the risks and potential benefits.

If a new treatment has low risks associated with it, trying it might result in improved symptoms. In addition, doing so could help the larger scientific community evaluate whether it could be a promising treatment for more people with OCD, particularly in the context of a research study. It is important to make a decision that you feel comfortable with, and to make sure you know all of the potential risks.

6. What do you do when a patient is seeing another clinician (like a psychologist) who has drastically different opinions about what’s best for them?

The best way to try to resolve this, if you are a clinician yourself, is to talk to the other clinician on the phone or in person to have a chance to ask questions and find out the other’s viewpoint as best as you can. This often helps resolve differences, but in some cases it doesn’t, at which point it is good to be transparent with your patient and explain your position and how it’s different from the other’s opinion, while maintaining respect for the other’s opinion so you don’t interfere with the patient’s relationship with them. If the patient is stuck not knowing what to do, suggest that he/she get a third opinion.

7. What is the best way to treat OCD in the form of breathing?  Specifically, a sensation of being unable to take a deep breath.

In many patients, this symptom seems to be a form of “just right” OCD (sometimes called not just right experiences or NJRE). With exposure and response prevention, the patient usually practices intentionally breathing in a way it does not feel right– so they can learn to tolerate the feeling and/or so this feeling decreases in intensity. Medications for OCD can help at least partially too, as they tend to decrease the intensity of the uncomfortable sensation, how often it happens, and how strong the urges are to “get it right.”

8. I’m a practicing family doctor and have a 19-year-old son suffering from pure-O type OCD, which keeps morphing into obsessional ways of thinking, e.g. judging himself for past and current behavior, and makes him think he’s a bad person/doesn’t deserve better.

He is very smart but is struggling in college: procrastinating on the computer, online gambling, etc. His major OCD crisis happened just before final exams: his friends and other sudents accused him of “faking it” to get out of exams,  which has just fed the OCD. His teenage brain is getting in the way of doing the work necessary to rewire his brain. I have encouraged exercise and he has just rejoined the gym and started playing guitar.

Medication hasn’t helped a great deal. My son has seen two psychiatrists, and tried max doses of Prozac (80mg) and Zoloft (200mg). He complained of side effects– with Anafranil too. He has been seeing a very good psychologist. How do I get his teenage brain to engage in the hard work needed to get better? We have suggested some time off, but he says that staying in school is the only thing that gives him a sense of identity at the moment. Any suggestions are welcome– being a health professional, I know how vulnerable young people are and it’s a crucial time in their psychosocial development.

In cases like this where someone has tried a few different treatment options that have not been effective enough, a possible next step could be an intensive exposure and response prevention (ERP) treatment program. As you mention, adolescence is a crucial time in psychosocial development, so it makes getting better imperative to minimize how much OCD interferes. However, for the same reason, he might not want to take time off school in order to do such a treatment.

The treatment might last 4, 6, or 8 weeks, which in the large scheme of things isn’t so much time– it will often pay off in the long run because the rest of his university experience could be much easier and more enjoyable. If there is such a program where his university is, in some cases (e.g. in an intensive outpatient program) he might be able to arrange his schedule to do it without completely taking a semester off, or during a school break.

9. I’m wondering if severe skin picking on all ten fingers of a 17-year-old girl can be cured.

Skin-picking can be a psychiatric disorder (also called excoriation disorder) if it interferes with functioning and/or causes significant distress. It is related to OCD– and is called an obsessive-compulsive and related disorder–  but is not exactly OCD. First-line treatment involves behavioral therapy, specifically habit reversal or acceptance-enhanced behavioral therapy. Medications such as serotonin reuptake inhibitors (SRIs) and N-acetylcysteine can also be effective in some. In some people, the symptoms can completely go away; in others they can be minimized to the point of not interfering.

10. I’m treating an elementary-aged child with OCD contamination fears related to human waste. It would be helpful if you would recommend school accommodations for a 504 Plan. The compulsive behaviors manifest during toileting times at school and peers have observed and questioned my client. Thank you!

An accommodation plan could be helpful to alleviate shame or embarrassment that could happen in the classroom, at least until the child has achieved improvement such that they’re able to use bathrooms without avoidance or compulsions. I would recommend that this accommodation only be temporary, because ultimately the child/parent/therapist should work to get the child to the point of being able to use the bathroom without resorting to avoidant or compulsive behaviors.

11. How much do we know about why some treatments seem to work for certain people and not for others? And what kind of benefits might we see from knowing more?

Unfortunately, the clinical and research fields do not know a lot about why some treatments work well for certain people and not for others, and there’s still a trial-and-error process for many treatments. However, researchers are working on figuring out how to predict who will respond better to some treatments.

This might require very large data sets from many different people, and it might require many different types of data (biological data such as brain activity and genetics, a person’s report of their symptoms, observable/measurable behaviors, demographics, and so on). The benefit of developing better prediction would be a more personalized medicine approach where one can find a much more direct path to the treatments or treatment combinations with the highest probability of success for them, individually. This will save time, suffering, and cost.

12. When you take a step back, what’s the most exciting thing in mental health research right now?

I think the three most exciting movements in mental health research now are the ability to use much larger sets of behavioral and subjective symptom data gathered using mobile technology to understand illnesses better and get better at prediction; our improved ability to understand the brain with improving brain imaging and analysis techniques; and new neuromodulation treatments. Many talented groups are thinking outside of the box to enhance or change the ways treatments are created and to figure out how they can reach more people. As our world has become very interconnected, these developments can happen faster than ever.

Thanks to Jamie for these thorough and very helpful answers. We’ll be doing more Q&A posts soon, so be sure to keep an eye on the Group feed in our app. 


How does coffee affect mental health?

By Patrick,

Coffee is the most commonly consumed drink in the United States. In 2015, Americans spent $72.4 billion on coffee. 64% of Americans over 18 said they’d had a cup of coffee within the past day in a National Coffee Association survey. As of 2010, American coffee drinkers had an average of three 9-ounce cups per day. And although the US is near the top, there are a number of countries that actually consume more coffee per capita.

Just a generation or two ago, coffee had a bad reputation. People didn’t seem to care too much, as they continued to chug coffee each day, but there was an underlying assumption that it wasn’t very healthy. It’s time to revisit this assumption, as beliefs about coffee’s physical and psychological effects have swung noticeably in the past two decades and studies continue to pour in.

A number of myths about coffee persist, though they’ve been debunked– among them the beliefs that coffee dehydrates you, stunts your growth, or is truly addictive. More importantly, new studies suggest a link between regular coffee consumption and a lower risk of conditions like heart disease, type 2 diabetes, and prostate cancer. And it improves exercise performance and endurance. These studies, which are appearing more and more frequently, are usually based on moderate consumption of no more than 4 cups of black coffee per day.

In August 2017, a giant study of over 500,000 people in ten European countries who had been in for regular check-ins since the 1990s revealed a “reduced risk of death from various causes” for coffee drinkers compared to non-drinkers. Similarly, an umbrella review of 218 meta-analyses (that’s a lot of research) from the BMJ concluded:

Coffee consumption seems generally safe within usual levels of intake, with summary estimates indicating largest risk reduction for various health outcomes at three to four cups a day, and more likely to benefit health than harm.


There are always caveats, and certain health factors like osteoporosis and pregnancy are mentioned in multiple studies as a potential reason to avoid coffee. Like anything, coffee has negative effects. It may increase the amount of acid in your stomach, block calcium absorption, and increase blood pressure. It can have you running to the bathroom (for multiple reasons) at higher doses. Withdrawal symptoms are annoying at best, and many people simply find coffee’s effects to be too intense. Plus, coffee can become a pretty expensive habit.

This isn’t as an endorsement of coffee. Don’t try it because of this blog post. It’s always good to check with your doctor if you have preexisting conditions, and to take any negative reactions seriously.

But what about mental health?

Physical and mental health, as we all know, are closely related. It wouldn’t make much sense to think about the effects of coffee on mental health without considering the things above, which can certainly alter our mental state. Mental health is a direct result of our physical condition, and vice versa.

If you’ve had too much coffee or you can remember your first time drinking it, there’s a good chance you know the jittery, anxious feeling it can bring. But what does coffee do to your brain, and do these effects add up to changes in our mental health? Is it bad to drink coffee when you have a mood or anxiety disorder, OCD, schizophrenia, and so on?

We’ll need to start with an understanding of how caffeine affects us. According to the American Psychological Association:

Caffeine is chemically similar to the neuromodulator adenosine, which accumulates through the day and induces drowsiness for sleeping at night. When we consume caffeine, it binds to adenosine receptors in the brain, blocking the effects of adenosine, with the side benefit of allowing dopamine to flow more freely. That can bring on feelings of well-being, energy and alertness.


Although it’s about 98% water, coffee contains over 1,000 chemicals. Most researchers focus on caffeine, which is believed to account for most of coffee’s effects on the brain. Caffeine is a very common stimulant, found naturally in dozens of plants, most notably coffee, tea, kola, and mate. It reduces fatigue and seems to improve performance on some tasks, especially for tired people, while making other tasks harder.

The same BMJ article from above says coffee “consumption had a consistent association with lower risk of depression and cognitive disorders, especially for Alzheimer’s disease.” Although some believe caffeine might encourage depression symptoms, an extended analysis by Chinese researchers suggests an occurrence of under 1% for caffeine-related depression, and concludes that “coffee and caffeine consumption were significantly associated with decreased risk of depression.”

On the other hand, drinking coffee isn’t a treatment for depression. And because it might cause sleep problems in some people, coffee can worsen mood; plus, withdrawal symptoms can exacerbate existing irritability and fatigue. Research on depression and caffeine is still in its early stages, so it’s best not to initiate a coffee habit based on any single study.

Yet another study from the Journal of Alzheimer’s Disease links moderate caffeine intake (fewer than 6 cups of coffee each day) to a lower risk of suicide. But the authors also have this to say:

Conversely, in rare cases high doses of caffeine can induce psychotic and manic symptoms, and more commonly, anxiety. Patients with panic disorder and performance social anxiety disorder seem to be particularly sensitive to the anxiogenic effects of caffeine, whereas preliminary evidence suggest that it may be effective for some patients with obsessive-compulsive disorder.


This last part is counterintuitive, and it seems like the kind of claim that would require more research. Most clinicians (and common sense) would suggest that someone with OCD or an anxiety disorder should limit their coffee intake as much as possible. Other studies point to abnormal caffeine sensitivity in people with GAD, and suggest that coffee increases cortisol levels while creating “behavioral effects… similar to those experienced during panic attacks.”

But in a small study, seven of twelve patients with OCD saw “immediate improvement” on 300 milligrams of coffee daily. The author suggests that caffeine may work better in one concentrated dose each morning than spaced out throughout the day, and reminds us that caffeine remains a “well-known anxiety producer in many people.”

Some clinicians have interesting approaches to addressing the anxiogenic, or anxiety-producing, effects of coffee in their patients: telling them to drink more of it. Norman B. Schmidt, PhD, tells patients with panic disorder who drink coffee and then become anxious to drink more coffee. This isn’t because he thinks it’ll help. He wants these patients to experience a stronger unpleasant effect and learn by feeling that their symptoms are closely tied to coffee consumption.

A few studies suggest that most people self-regulate their coffee consumption, learning to avoid drinking coffee to the point of becoming anxious. A study involving 43 patients suggests that people with anxiety disorders “have increased caffeine sensitivity, which leads to decreased consumption.”

Medication is another complicating factor. There are almost 100 known contraindications between caffeine and prescription drugs, whether it enhances the drug, creates further side effects, or makes the drug less effective. Many anti-anxiety drugs, sleeping pills, and mood stabilizers fall into this last category.

A 2005 Cambridge study found that “psychiatrists rarely inquire about caffeine intake when assessing patients… Caffeine is implicated in the exacerbation of anxiety and sleep disorders, and people with eating disorders often misuse it.” The authors are suggesting that coffee doesn’t cause or constitute a disorder, but can certainly exacerbate one. They go on, with a focus on schizophrenia: “In psychiatric in-patients, caffeine has been found to increase anxiety, hostility and psychotic symptoms.”

The big book of psychiatric disorders, the DSM-5, lists caffeine intoxication disorder and caffeine withdrawal among its hundreds of conditions. Symptoms of caffeine intoxication include restlessness, nervousness, excitement, insomnia, gastrointestinal disturbance, rambling flow of thought and speech, cardiac arrhythmia, periods of high energy, and psychomotor agitation. Importantly, to merit diagnosis, “these symptoms must cause distress or impairment in social, occupational and other forms of functioning, and not be associated with other substance, mental disorder or medical conditions.”

Although it seems like the DSM committee was mostly interested in raising awareness about how common caffeine intake is and the ways it can negatively impact someone’s life, a number of experts were confused about the DSM’s concept of caffeine-related disorders. They pose some good questions: can we consider something a disorder when intoxication lasts less than a day? Can coffee drinking really become a substance use disorder like the other ones? Is it reasonable to create another disorder for people who drank too much coffee?

Matt Collins, a direct support professional working in a group home for individuals with developmental disabilities who also has OCD, says it well in one of his blog posts:

While the verdict is still out on whether caffeine exacerbates OCD symptoms or actually alleviates them, it seems that coffee probably does more harm than good for people with anxiety. The problem is, I love coffee… Sometimes it feels like coffee is the only thing that makes me happy during a flare-up.


If all of this research seems a bit contradictory, it is. Like almost anything in science, there’s no conclusive verdict about coffee. Although it’s worth keeping an eye on all the research that’s sure to emerge in the next few years, there will always be a lot of variance in coffee habits, its effects, and tolerance from one person to the next. We tend to conflate the effects of drinking coffee with the effects of drinking “way too much” coffee, and it’s important to separate these things out when trying to make informed decisions. We know there’s a big difference between drinking one glass of wine and seven glasses; so why do we tend to think in extremes when it comes to coffee?

Is coffee necessarily bad for you? No, not for most people. As with any diet advice, we have to look beyond all the absolute statements with unclear origins telling people to drink a ton of coffee or avoid it completely. But is it good for you? It depends who you are, and what you think is good for you.

Big Announcement: We’re Launching the nocd Network!

By Phoebe Kranefuss,

If you have OCD, you probably already know how persistent and debilitating obsessions and compulsions can be. From disturbing intrusive thoughts and time-consuming rituals, to common misconceptions about what the disorder actually entails, living with OCD can be overwhelming and exhausting.  

OCD is considered chronic, meaning there’s isn’t a cure, but there are effective ways to manage the disorder and experience relief, typically with a combination of first-line medications like SSRIs and exposure response prevention therapy. Unfortunately, many people don’t receive treatment, either because therapy is too expensive, or because they don’t have access to therapists in their area who know how to diagnose and treat OCD. Others might not seek out treatment at all, due to the shame that often accompanies disturbing thoughts or embarrassing rituals. Still others receive incorrect diagnoses from primary care physicians or therapists unfamiliar with the disorder, which might further extend the amount of time it takes for them to access proper care.

At nOCD, our goal has always been to change the way OCD treatment works: where OCD can be isolating, we’ve created an in-app community for people to share their struggles and accomplishments with others who understand their journey. Where traditional treatment has been expensive, infrequent and scarce, we’ve made customizable ERP available to all people with our mobile app, which is also designed to work as an addendum to traditional therapy.

We also know that each person is different. If in-app ERP and a sense of community works well for one OCD sufferer, that doesn’t necessarily mean it will be effective for someone else. Some people will need more intensive interventions in order to feel better, like existing or emerging medications, residential or partial hospitalization, or a combination of therapies tailored to their individual needs.

That’s why nOCD is expanding to partner with all kinds of leaders in the field of OCD research and treatment. We’ve spent a whole lot of time meeting with researchers, like Dr. Rodriguez at Stanford, who’s studying a glutamate modulating agent for OCD treatment that makes us feel hopeful. We’re consistently impressed by the dedication and hard work so many intelligent people we’re working with put into finding effective treatments for OCD, and we’re excited to share these resources with the nOCD community.

OCD treatment has always been a bit of a maze. We know, because many of us at nOCD struggled to navigate OCD treatment for years prior to finding great therapists and effective treatments. That’s why we’re officially launching the nOCD network to help people access the best and most effective treatment, and to help treatment resources find and help more people who are suffering. You can expect information on a range of studies, organizations, and doctors we’ve decided to partner with, some of which may seem like great options for you (or for a family member or friend), and others that probably won’t make sense for you (feel free to ignore them!). You’ll see this information in upcoming posts on our blog, on Facebook, Twitter, and Instagram @treatmyocd, and on our website. On average, it takes 11 years for people who experience OCD symptoms to receive treatment. This is one more step to change that, and help people with OCD feel better.

Check out the nOCD app here

Ten reasons to try therapy

By Patrick,

Ten reasons to try therapy for mental health

1) Therapy is usually effective

People who haven’t tried therapy often imagine it as a loose (and kind of pointless) conversation about all the things that have gone wrong in someone’s life. Occasionally this isn’t far off; but there’s usually a structure too, and a sizable body of research points to the efficacy of therapy in addressing all kinds of concerns. Besides, loose conversation can be pretty helpful sometimes.

2) Even short-term therapy can help

The stereotypical understanding of therapy involves endless hours sunk into a comfortable couch. This goes back to the days of Freud and his pals, when psychoanalysis– which usually involved multiple sessions per week for years– was the predominant form of therapy. Today, many people still spend years or even decades in therapy. But others see their clinician for as few as six to eight weeks and still see lasting results.

3) Sometimes we need another person to help us realize that we’re stuck

Think about the day so far, or try to remember what happened yesterday. How many things have you done that you’ve already done thousands of times throughout your life? We’re all creatures of habit, whether those habits are getting us where we want to be or holding us back.

Because our habits are (by definition) entrenched in our daily lives, it can take an outside observer to point them out. It’s true that friends, families, and romantic partners do this too but that’s not always effective because tons of other emotions are wrapped up in those relationships.

4) You don’t have to feel “messed up” to try therapy

There’s a set of very common misunderstandings about therapy: that it’s for the weak, that it’s for people who can’t deal with their problems, and even that it’s for people who are deeply messed up.

While the concept of mental illness is useful in certain ways, it also convinces people that psychological concerns exist as an either-or. In fact, you don’t have to feel terribly troubled (or wait for more drastic issues to emerge) to try therapy. Think of it this way: therapy is as simple as sitting across from someone who’s trained to provide psychological insights and speaking with them about the things happening in your life. Seems like it could be useful to just about anyone.

We tend to measure our suffering against the hardships of other people, whether we know them well or we’ve only heard about them on the news. It’s true that there will probably always be someone else out there who’s dealing with a bigger catastrophe; but this isn’t the point, and your difficulties are always worth careful consideration, no matter what others are going through. Like eating well and exercising, therapy can be a structured way to care for yourself, even if you feel fine for the most part.

5) You can go to therapy without starting medication

Many people refuse to take any kind of medication. When it comes to medicating the mind, there’s even more wariness. The concerns are quite understandable: is it really appropriate to designate certain minds unhealthy and medicate them? Could these medications be dangerous? What if it’s really hard to get off a certain medication once you start? And aren’t they expensive?

There aren’t really any easy answers to these questions, and everyone should ultimately decide for themselves. The nice part is that therapy doesn’t need to involve medication, and can actually help people who are wary of medication address their concerns without taking pills.

6) Therapy doesn’t have physical side effects

Following from number five, therapy doesn’t have the unfortunate physical side effects that some psychotropic medications can cause. This isn’t to say that people should avoid medication– again, that’s a personal choice, and not everyone gets unpleasant side effects. Many people experience medication as helpful  and even lifesaving. But some side effects can be really bothersome, and if you feel like you have any choice, therapy can be a good way to avoid that risk.

This doesn’t mean therapy can’t have side effects, however, because looking deeply into your mental life can dig up all kinds of unexpected things. These difficulties do emerge, and your therapist will be quite capable of addressing them with you. But therapy is rarely a breeze, especially if you’re working through a more structured treatment for something like OCD or PTSD. It’s important to realize that therapy will complicate your life in interesting and hopefully helpful ways.

7) Therapy is a journey, not one specific way of thinking

Many people fear that therapists are on a mission to convert them to a specific style of thinking, and there are certainly heavy-handed clinicians who earn this fear. But a good therapeutic relationship is characterized by exploration, not attempts to convince. It should be a back-and-forth, as the real benefits come when you’re guided toward discoveries of your own. And if you feel like you’re not allowed to create your own path, be sure to let your clinician know. Their job isn’t to create a different life for you, and they should already know this.

8) It’s really hard to find impartial, confidential conversation outside of therapy

Although it would definitely be nice if we could talk with friends, coworkers, and loved ones without other considerations weighing on these discussions, it’s very unlikely. These people care for us, of course, and they can be great listeners. They’re our major sources of support, and a therapist can never replace that. But there’s something very unique about the therapist-patient relationship that you can’t find anywhere else.

There’s also no guarantee of confidentiality with other people, whereas therapists are required to protect the things you tell them unless they believe you’re a danger to yourself or someone else. Therapists very rarely react strongly or judgmentally to what you tell them, freeing you to say the things you need to say. And because it’s a professional relationship, you don’t need to feel any pressure to impress them. It’s not your loved one’s job to be your therapist; but it’s definitely your therapist’s job.

9) You get to try out different therapists and choose your favorite

Like a doctor or a dentist, therapists vary widely in personality, approach, and effectiveness. While research shows that therapy is effective, it also maintains that efficacy varies widely from one practitioner to the next. So consider the kinds of things that matter to you, and don’t be afraid to ask about setting expectations for the time you work together. If you have specific goals, be sure to mention them.

10) You can become more able to deal with issues in your everyday life

We all have some issues going on in our lives– the sorts of things we’re still thinking about while trying to fall asleep at night. And there’s no reason to stop looking for solutions because we’re able to ignore them or because we’re thriving in other parts of our lives. Therapy can have far-reaching impacts that end up changing our lives. And it’s definitely exciting to look back and realize that we’re doing better than ever.


Announcing The OCD Summit with Stuart Ralph

By Patrick,

Poster for The OCD Summit webinar series

Today we’re bringing you a special announcement about an event with Stuart Ralph, creator and host of The OCD Stories podcast. Stu is tireless in his efforts to help people with obsessive-compulsive disorder, and his podcast is one of the best sources of information about OCD on the internet. Here’s Stu with the details.

What is it?

The OCD Summit is a six-part live webinar series with six OCD experts hosted by Stuart Ralph, who also hosts The OCD Stories podcast. The content of each webinar has been curated by the clinician, and will be the basis of the first 45 minutes of the webinar. The last 45 minutes of each webinar will give you the opportunity to ask questions of the clinician being interviewed. 

Why would I participate? 

Because OCD treatment can always get better. Continued development is important as a therapist, and learning from these six clinicians who have dedicated their lives to OCD treatment is a great way to continue the good work you’re already doing to help those afflicted. 

Great, but I’m pretty busy. When is it?

There will be one webinar each week, starting in October. If you miss one, that’s okay– you will get access to a recording 48 hours after the conclusion of each webinar. This way you can enjoy at your own leisure. We know how busy clinicians are! 

Thanks to Stu for these answers. But why is nOCD involved?

We’ve known Stu for quite a while now, and he’s relentless in his efforts to help people learn about OCD and feel better. He has been one of the most consistently helpful presences in a community that could use more of them. Stu’s podcast has benefitted us greatly in our own journeys, so we’re glad to tell you about his latest effort– which we think will be edifying for all kinds of clinicians. 

If you’re interested in learning more about The OCD Summit and deepening the great work you’re already doing, have a look at the website:


An Update on Android!

By Phoebe Kranefuss,

Last week, we released the beta version of nOCD for Android which was greeted with lots of enthusiasm and great questions. We know you’ve been patiently waiting for this release, and we want to address some common questions about the Android beta, why we released it, and how you can take part.  

What’s a beta?

A beta is a pre-release version of an app or piece of software that’s made available for testing, usually to just a small group of people, so companies can receive feedback before releasing it to everyone.

What functionality is available?

Building an entire app can take months or longer, so we decided to release the functionality in stages.  The first stage of our release plan is the Community feed. It’s a place where users can give and receive support, and share their wins and challenges with other real people with OCD.

Why did you start with the Community feed?

We decided to release the community section first because our therapy section is undergoing some design updates to make it more intuitive to use. We wanted Android users to be part of the supportive community iOS users have access to while we make the rest of the app even better.

When will the Android app be out with the therapy functionality?

Our team is working every single day on getting the Android version ready including the exposure and response prevention (ERP) section. A number of us have OCD ourselves, so it’s particularly hard for us when people want help for OCD but can’t access it yet because the app isn’t available on Android. We’re targeting to release the full Android app by the end of 2018.

How can I get access to the beta?

We’re so glad you’re interested! Please email, and we’ll add you to the list. You’ll receive an invitation to join within 48 hours.

How to Plan for OCD Recovery: Part Two

By Patrick,

Happy man outside

This is a continuation of our first post about making an OCD treatment plan. If you haven’t read that one yet, be sure to start there. Otherwise, read on! 

Last time, we talked about why you should plan out your OCD treatment so that you can face your discomfort in a useful way. Then we looked in some detail at the first two steps in the creation of such a plan: identifying the bothersome symptoms, and putting them in order.

Now we’ll go through steps three and four, where these lists are put to work. As with the last post, the suggestions here are not meant to replace a clinician. If you’re able to look for a therapist, please do so. And if you already have one, make sure to take their advice first. Here goes!

From plan to practice: doing ERP


Once you’re face-to-face with a list of things that scare you a lot, you can start to rank these things. Psychologists, always interested in finding fancier words for things, like to call this ranking a hierarchy. For the obsessions, you might rank them according to the amount of distress they cause you (on a scale of 1-10, for example). It can also be useful to write down the triggers that usually precede those obsessions; this helps you decide how to create the exposures in the next step.

Compulsions are usually tied to one or more obsessions. It’s not as useful to rank compulsions, because they usually give you a temporary sense of relief, not distress. So if you have multiple compulsions for one obsession, try not to fret about ranking them. You’ll probably get to experience the job of confronting them all. Still, writing compulsions down is essential, because you can only do the response prevention part of ERP if you know which responses (compulsions) to prevent.

Following the above example, here’s a possible hierarchy:

Do I really not want to be alive? (9/10)

Triggers: Standing near the train tracks, driving a car, seeing a police officer’s gun. All bring on an intrusive thought of hurting myself.

Could I have done something really bad that I just can’t remember? (7/10)

Triggers: Hearing people discuss a recent crime, seeing police cars nearby, reading a newspaper.

Is it possible there’s someone else out there who is better for me than my current partner?

Triggers: Passing other couples who seem really happy, reading about signs that a relationship is unhealthy, when we argue or don’t enjoy things that were supposed to be fun.

Things get a bit more complicated after this, and even more than the previous steps this next one is best done with the help of a clinician. But now that you have your hierarchy (probably a bit longer than the example above), you have some idea of what’s been bothering you, and which things to prioritize.

Although it can be tempting to go after that 9/10 symptom first, clinicians often suggest you start somewhere in the middle. This allows you to get the increase in anxiety that’s necessary to do exposures, without pushing things too far and putting yourself through too much distress at the start.

This is the place where you’ll rank the different triggers for each obsession, creating another layer to your hierarchy. ERP relies on a gradual progression from less difficult to more difficult exposures; going too far, too fast, drastically increases the risk that someone will be unable to prevent their compulsive responses. And if there’s one single thing to take away from this blog post: exposures are only worth doing if you can successfully (but not perfectly) resist doing compulsions.

Things get more microscopic here, but don’t be too overwhelmed: this kind of therapy takes a while, and requires repetition of each exercise. You won’t be doing all of your exposures at once!

Now, continuing with one of the obsessions from the example above, let’s see how this might look. You’ll see the obsession, and under it are some exposures. They’re pulled from the list of triggers above, because exposures are simply exercises in intentionally triggering the chain of obsessive-compulsive symptoms. For each exposure you’ll find an expected difficulty rating, with 1 being easiest and 10 meaning it’ll be excruciatingly difficult.

Could I have done something really bad that I just can’t remember? (7/10)

Tell myself repeatedly that I’ve done something bad (2)

Write down all the bad things I could’ve done (5)
Watch a show about serial killers on Netflix (7)
Talk with someone about a recent shooting (8)

Listen to the local news, record a crime segment, and watch it repeatedly (9)

At this point, self-treatment gets especially difficult. ERP can be very effective in a relatively short amount of time, but it’s a specific protocol that is hard to manage on your own. A general course of treatment would be to proceed through each exposure until it no longer bothers you, and repeat the exercise a few times. But our minds are complicated, and learning to interact differently with the things that bother us is too. Making your plan is one of the most important steps in OCD treatment, and if you’re able to master these steps you’re well on your way.

We’ll be back soon with more. If you have questions, we’re @treatmyocd on Facebook, Twitter, and Instagram.

Planning to Get Better: Part One

By Patrick,

Once you’ve done the hard work of finding a therapist, figuring out the financial stuff, and securing an appointment, you already know that treating obsessive-compulsive disorder requires a good amount of planning and a ton of determination. And although this work gets more rewarding when you’re seeing a clinician regularly and feeling the results each day, it still requires planning.

We’ve talked a lot about how OCD treatment means getting used to discomfort by spending a lot of time feeling uncomfortable. Most people don’t think of planning as an especially fun activity in any context; even fewer relish the chance to plan out all the times they’ll be intentionally making themselves uncomfortable by facing whatever they fear most. It can be really tedious, so why go through the trouble of coming up with a plan for OCD recovery?

Pain with a purpose: OCD and ERP


Bored man overwhelmed by planning

Most importantly, going through cognitive-behavioral therapy and especially exposure and response prevention (ERP) without a plan can result in a lot of unnecessary distress. These forms of treatment require structure, because they’re about identifying certain sets of symptoms and methodically working through them. Someone should always know why they’re going through a particular exposure, and how it’s intended to help them live better.

The goal isn’t just to put yourself through distress; it’s to target specific obsessions and triggers that have been bothering you, and then confront them until they don’t bother you nearly as much. And this process of habituation to distress (getting used to it) can only occur if someone isn’t using compulsions to escape the discomfort– making it essential that compulsions are identified.

There also needs to be some understanding of how compulsions will be prevented. These are responses that have been reinforced countless times, and it’s not realistic to assume we can suddenly discontinue them. That’s why making decisions before we’re in the midst of an exposure is vital to its success.

Planning also helps you understand how long this process might take. Nobody wants to do behavioral therapy forever, and a plan will help you understand whether or not things seem to be progressing according to your goals.

How to make an OCD recovery plan


Treatment schedule with coffee cup

You’ll follow your own unique plan– everyone’s needs are different, and the following should be understood as an extended example of how things can work, not as a template for your own treatment plan. This isn’t meant to be a stand-in for working with a clinician. So if your clinician’s suggestions differ from these, it’s typically best to go with what they say. But having a sense of how things might progress can be useful because it helps us feel less overwhelmed about the things to come.

We generally assume that we know ourselves well, but when our obsessions and compulsions have been carved for months or even years into the patterns of our life it can be surprisingly hard to tease them apart from other aspects of our day. It’s even hard to imagine, sometimes, that life can be any different from the way it’s been.

That’s why the first, and probably most important, step in creating an OCD treatment plan is simply to identify a number of things that have been bothering you. First, you might ask yourself why you sought therapy in the first place; this will often reveal some of the things that belong near the top of your list.

Then, working with your therapist, you can explore the various aspects of your life– work, school, social life, hobbies, family, relationships, etc.– and explore the behaviors that have been keeping you from doing the things you’d like to do within these categories. Because OCD treatment is fundamentally about learning to behave differently so you can live better despite the thoughts arising in your mind, it’s important to start with a sense of things you’d like to be able to do. What would you do if you weren’t struggling with OCD?

Step Two: Identifying SymptomsA typical next step is to start identifying your obsessions and compulsions throughout the day. This sounds a bit overwhelming, and it might help just to jot bothersome things down throughout the day as they happen. The goal here isn’t to capture a comprehensive list of your symptoms. It’s to get used to the idea that noticing what’s happening is a crucial step in the quest to change what’s happening.

Let’s say I’m at the gym and someone else is lifting a lot of weight. I suddenly have a thought: I could walk over and push the weight down on them. I feel sure this thought must be dealt with urgently. All of this happens so quickly– and suddenly I’m obsessing, wondering if I’m a horrible person and fretting about how it’s only a matter of time until I do something like this. In this case, I would notice what’s happening and take a quick note:

At the gym. Intrusive thought of hurting someone. Obsession: “Is it only a matter of time until I lose control and hurt someone?” Distress 8/10. Compulsion: Repeatedly telling myself I would never do something like that.

Taking out pen and paper whenever something emerges can be both impractical (like in the middle of a gym) and a little embarrassing if you’re around other people. If this process doesn’t work for you, it can be easier and less obtrusive to make a quick note on your phone. The goal is to link together events, obsessions, the amount of distress they cause, and compulsions.

Once you’ve listed a number of situations, you’re off to a great start. It can be tempting to try to write down everything that’s ever bothered you, so just keep in mind that you’ll be revisiting this list regularly– adding or subtracting things to meet your needs.

Here’s how more of that list might look:

At the grocery store. Heard someone saying that someone had robbed a nearby bank last night and suddenly wondered if I might’ve done it even though I didn’t remember. Obsessions: “Could I have robbed them while I was sleepwalking or something? Am I the type of person who would do that? Can I really trust my memory?” Distress 7/10. Compulsion: Looked through my text messages over and over from last night to make sure I wasn’t at the bank, and searching a local news website to make sure they weren’t looking for me.

While waiting for the train Standing near the tracks as the train arrived and suddenly thought about how I could jump in front of the train. Obsessions: “Do I really not want to be alive? Would I do something like that?” Distress 9/10. Compulsions: Stood far away from the tracks while holding on to something, and searched Google on my phone for signs of being suicidal to make sure I don’t fit the description.

Once you’ve identified some of your symptoms, you can begin to make a plan for recovery. We’ll be offering some helpful tips on the second half of this process in part two, which will appear on this blog very soon. In the meantime, keep in mind that maintaining balance is important.

Keep both eyes out for part two! If you have any questions, we’re @treatmyocd on Facebook, Twitter, and Instagram.

OCD Isn’t About Handwashing! And Other Questions from Users

By Phoebe Kranefuss,

This week, we’re answering questions from our users via Instagram (@treatmyocd). We received tons of great suggestions: people wanted more about different subtypes of OCD, including Relationship OCD, Homosexual OCD, Pedophilia OCD, and Rumination. People were also curious about how to talk to friends and family about OCD, and to learn more about comorbid disorders (here’s an article about OCD and eating disorders, but we owe you more, and they’re coming!!).

Thanks for doing my work for me! Just kidding 🙂

This week, we’re talking about that scary fear that OCD might never go away, what to do when people say “I’m so OCD!!!”, mindfulness for when OCD feels out-of-hand, and how to live a value-based life no matter when obstacles land in your path.

Question: I worry I’ll never recover. How do I manage this fear?

During really bad OCD days, tolerating distress for even a few minutes can feel like an overwhelming task, and picturing a future free from OCD can be motivating. But even the most hopeful people can feel discouraged after a particularly hard course of exposure response prevention (ERP) doesn’t provide noticeable results, or when a therapist doesn’t pan out to have the expertise he or she claimed.  If you’re worried about never recovering, rest assured: this worry is normal. But there’s actually a surprising flipside to focusing on an OCD-free future, which can be detrimental to treatment.

ACT, or Acceptance and Commitment Therapy, teaches us to accept how we feel and what we’re going through, while identifying our values, and living our lives accordingly. Acceptance and value-based living contribute to psychological flexibility, or the ability to enter a situation with openness, rather than fear or anxiety. Living in fear of never recovering doesn’t give you a whole lot to actually work towards.  But identifying specific goals and values and moving towards them (as opposed to moving away from what you don’t want) is a more effective way to feel better, and helps you live the type of life you value, even when OCD is present.

Practicing ACT doesn’t mean that prioritizing your values will make your OCD thoughts go away. But over time, it can help you change the relationship you have with your decision making processes. Even if OCD  is present, you can still engage in the activities and relationships that give your life meaning.  Here’s an example: you value helping animals, and have always wanted to be a veterinarian, but your fear of germs has kept you from pursuing your goal.  Contamination exposures are hard, but if you keep in mind not just your interest in recovery, but also your goal of becoming a vet as you practice these exposures, you’ll derive motivation from working towards something you really care about. 

If veterinarians get to cuddle with puppies like this one, count us in!

Question: I really don’t like when people throw around ‘OCD,’ as in: “I’m so OCD!” How do I tell them OCD isn’t just about neatness or hand washing?

When people throw around ‘OCD’ as a synonym for ‘neat,’ they usually do it out of ignorance. It’s likely a well-meaning person who just doesn’t know what OCD is really about, and can you blame them? It’s not like OCD gets talked about a whole lot, which is part of the reason it’s so often misdiagnosed, misunderstood, or mistreated in people who really suffer. This is a great opportunity to contribute to the destigmatization of OCD (and mental illness in general) by educating the offending speaker on what OCD really is. Some people might feel comfortable saying something like: “actually, OCD is a really serious mental disorder, and I’d love to tell you about how it’s affected me and my life.” You might be surprised to hear people’s reactions – sometimes, a little vulnerability opens the conversation about how mental illness has affected all kinds of people in ways you wouldn’t expect.

Some might feel really uncomfortable confronting someone or talking about OCD in public. They might try sharing information about OCD in a different way (through social media, or just with people close to them). Don’t want to share that you have OCD? You can always share facts – like, did you know 1 in 40 people meet the criteria for OCD? Or that the average age of onset is typically childhood, adolescence, or young adulthood? No need to talk about your own experience if you don’t want to. But you have the right to let people know that ‘OCD’ isn’t just a term that means ‘clean.’

Question: How do I calm down when OCD gets out of hand?

I think every single person who struggles with OCD can relate to this challenge. There’s two ways that OCD gets out of hand: in the moment (especially during an exposure), and in a larger sense, affecting daily life for a period of days, weeks, or even months. Mindfulness exercises can be useful in both situations, but in different ways. If you’re experiencing an immediate increase in anxiety, using mindfulness to calmly observe your surroundings can help  you return to the moment. Use all five senses to experience what’s around you. What do you see? Do you smell anything? What colors are around you? Do you hear any noises? What does the temperature feel like? What does your breath sound like? What do your feet feel like on the floor? Make sure you’re breathing as you notice. Over the course of months and years of practice, mindfulness can become a part of your daily life, and you might find yourself incorporating practices like this one into daily activities, like brushing your teeth.  It might not make OCD go away, but it will help you to feel more present and grounded in the moment, changing your reaction to the way OCD makes you feel.

A New OCD Study Adding To Your Current Treatment

By Patrick,

Let’s say, for a moment, that you’ve just realized you might need some help feeling okay on a daily basis. You might still have some reservations about seeing yourself as mentally ill, but it feels like you really need to make a change. So you start looking up your options– not just what kind of doctor or therapist you might see, but also what kind of things they might offer you. At first it seems like you have a lot of options; but as you read more, you realize that many of these choices are, ultimately, really similar to one another.

Still unsure, you go in and get assessed by a psychiatrist. They tell you to come back, and fill out some forms in the meantime. And at the end of your second appointment they diagnose you with obsessive-compulsive disorder, or OCD. They recommend a medication, and you start a small dose. Months later, you’re on a bigger dose, but you’re not really happy with the results. You can’t tell if the medication is working, and this doesn’t seem like a good sign.

Medication options for OCD have been notoriously limited, especially since the 1990s. Or, at least, they seem that way to those of us who haven’t gone to medical school and practiced in psychiatry for years. So the patient experience can feel a bit like putting on a blindfold and being led around a room, with no choice but to trust the person walking with you. The medication options have names like planets in a SciFi movie: Zoloft, Lexapro, Paxil.

Almost all of these are in the same class of drugs: the selective serotonin reuptake inhibitors, or SSRIs. Along with exposure and response prevention (ERP) therapy, SSRIs are the first-line treatment for OCD, many other anxiety disorders, and depression. And even though they give partial relief to 40-60% of OCD patients, they aren’t enough for many people.

When accessible, a combination of medication and behavioral therapy– ERP is the most-researched form for OCD– is more likely to work for many people. But no single strategy will work for everyone, and few people achieve full remission from OCD with current options.

Whether or not full remission is the goal, sometimes we can’t help wondering if there aren’t other worthy options out there somewhere. Luckily there are researchers around the world asking the same question. And that curiosity translates to hard work every day.

Whether a new option is meant to become someone’s primary treatment or a supplement to what they’re already doing, there’s plenty of unexplored territory. Our understanding of the brain is still in its earlier stages, but a few key discoveries have led to groundbreaking change in many other conditions.

One particularly interesting frontier is adjunctive treatment. This is a fancy way of saying it’s added to the primary treatment(s). So if someone on an SSRI who’s doing ERP every week decides to add a small dose of an atypical antipsychotic, that drug is a form of adjunctive treatment. Sometimes doctors take this route when looking for significant impact with minimal side effects.

Adjunctive treatment also tends to mean minimal or no change to someone’s primary treatment, which can be appealing to those who aren’t looking to take on the risk of significant changes in quality of life. Sometimes people end up feeling worse when they discontinue their primary treatment or get withdrawal symptoms after tapering off of higher doses. But adding an adjunctive treatment allows for continuation of the primary treatment, and doesn’t carry these risks.

Most of us at nOCD have OCD, so we’re excited about any new research. But because there hasn’t been any new medication for OCD since 1997, the news that a pharmaceutical company was conducting a clinical trial of a novel drug for OCD certainly grabbed our attention.

We ended up partnering with that company, Biohaven Pharmaceuticals, to help them educate people about the clinical trial. They’re investigating BHV-4157, a glutamate modulator. Glutamate is a neurotransmitter, like serotonin and dopamine, but there haven’t been many medications that work on glutamate. Since there’s a growing body of evidence that glutamate dysregulation could be involved in producing some OCD symptoms, Biohaven is conducting a phase 2/3 trial of BHV-4157 for OCD.

It’s always been really difficult for research teams to recruit participants, partly because of the challenges of finding the appropriate participants and partly because there’s always a lot of hesitation around trials of new psychiatric medications. And we certainly understand this hesitation: what, if anything, will change for someone who decides to take this medication? Will there be positive effects, side effects, or both?

Although these questions depend on the individual, another one we keep getting is easier to answer. Lots of people reach wondering whether they’ll have to change their current treatment. What if I feel okay on this SSRI but I have never felt like I’m feeling the best I could? Will I be able to stay in therapy? And do I have to risk going back to the worst place I’ve been at with my OCD symptoms?

Because BHV-4157 is being studied as an adjunctive treatment, it’s added on to the current treatment regimen. In the clinical trial, someone will either get the investigational medication or a placebo (like a sugar pill) added to their primary medication. They won’t need to discontinue the drug they’re already taking, and being in therapy is certainly not a disqualification for the study.

We hope the answer to this common question might help people feel at ease about exploring the clinical trial further. Whether this potential new medication works or not, all participants in this study will be key parts of the journey toward better OCD treatment options for people around the world. If you’re interested in receiving more information from a research site near you, please click below!

Helping Someone on Their OCD Journey

By Alexandria Zaobidny,

If you know of someone suffering from obsessive-compulsive disorder, or OCD, you might feel helpless and frustrated at times, as though there is nothing you can do to help them through their distress. You hate to see your friend, teammate, or daughter suffering, and probably want to help – but caring for someone with OCD can be quite counterintuitive, which adds to its already challenging nature. However, assisting someone on their road to recovery is far from impossible.

We here at nOCD have created some basic guidelines when it comes to walking with your loved one on their journey:



Offer reassurance

A common OCD compulsion is asking a question repeatedly to hear that everything will be okay. For example, a boy dealing with Harm OCD might excessively ask his father: “Are you sure I wouldn’t hurt anyone?” The father’s first instinct is to reassure him and say, “Of course you wouldn’t, kiddo!”

As much as you may want to ease your loved one’s racing mind, know that reassurance will offer them only temporary relief. The sufferer’s compulsion will be fed, and then they’ll most likely fall right back into an obsessive spiral.

Try to relate

People have a natural urge to connect with one another. In certain areas of life, this can be quite comforting! However, if someone is trying to open up about their troublesome obsessions, it’s usually not helpful to say something like “I understand. I am also so OCD. My closet is always color-coordinated!”

A lot of OCD obsessions can be distressing, embarrassing, and taboo. Equating them with surface-level OCD stereotypes might cause the person coming to you for help to feel like you’re belittling their daily struggle.

Suggest they just “try not to think about it”

If people with OCD could stop thinking about their obsessions, they probably would have done so a long time ago! Besides the fact that the implication they haven’t already tried this could upset the person, it’s not good advice. Repressing thoughts usually gives them more power. Whether you have OCD or not, the more you try not to think of something, the more likely you are to start thinking about it. So by avoiding this one you can maintain their trust and encourage them to find better strategies.



Encourage them to find an OCD specialist

As much as people want to help others, sometimes they are simply not trained to do so! Cognitive-behavioral therapy (CBT) in tandem with exposure and response prevention (ERP) is the gold-standard treatment for people with OCD, and typically shows promising outcomes. This condition can be very confusing because its symptoms change frequently and are often hidden. A professional will be able to understand the ins and outs of OCD, offering essential guidance to your loved one.

Help them embrace uncertainty

Most, if not all, of a sufferer’s obsessions are derived from a place of uncertainty. One of the best ways to combat the anxiety of not knowing an answer is by embracing the fact of not knowing that answer! Sounds backwards, huh? For example, when someone asks a question in a quest for reassurance, simply respond with “Maybe, maybe not!” or “Who knows!” Their initial frustration may be difficult to deal with, but in the long run this type of response may help reduce the urgency they feel.  

Educate yourself on the disorder

One of most important moves you can make is educating yourself on OCD. It’s a highly misunderstood disorder, making it that much harder to handle. By understanding its common manifestations, you can help destigmatize the disorder. Also, if you know OCD’s common tricks and traps (like reassurance-seeking), you can help the other person acknowledge and move beyond their urges and compulsions, and help them challenge the black-and-white thinking that OCD encourages.

Urge them to try to live life as normally as possible

Another common compulsion for people living with OCD is avoidance. They may try to sidestep situations that could potentially trigger their obsessions. For example, if someone fears contamination, they might try to avoid spending time in public places, where contracting a disease seems like a possibility. As much as this may feel more comfortable for them in the short term, it’s actually promoting the act of withdrawing, and empowering their OCD to dictate their life choices.

If they usually enjoy hanging out with friends, recommend they hang out with their friends! If they typically do yoga on the weekends, advocate for them to continue attending class! This continuation of their usual, everyday tasks may not seem significant, but may assist in integrating them back into their normal routine.

Remember: All of this being said, it’s important to keep your own mental health a priority as well. Taking care of a loved one who’s struggling can be very stressful at times. Try your best to remain compassionate and patient with your loved one, as well as with yourself. Keep up the great work everyone!

Is there anything you’d add to this list? Get the conversation started on Facebook, Instagram, or Twitter by finding us at @treatmyocd

OCD and Social Media

By Phoebe Kranefuss,

Most of us use social media at least once a day: in the US, 90% of young people and 65% of adults are regular users. And many of those users, including me, are accustomed to opening Facebook or Instagram to see endless filtered images of seemingly perfect lives. I have a long-ago acquaintance who moved to Hawaii, and now seems to spend most of her time taking romantic walks on the beach with her photogenic boyfriend, prompting me to ask: who is taking these photos? And should I move to Hawaii??? I tap ‘like’ on Pinterest-worthy smoothies and quinoa bowls made by tanned, toned strangers, and have considered countless drastic life changes when I see an endorsement by someone I hardly even know.

Being inundated with images of curated perfection feels a lot like being flooded with intrusive thoughts. Logically, I know neither the pictures nor the thoughts are an accurate reflection of reality. But emotionally, I feel overwhelmed by their presence. Sure, I know my acquaintance in Hawaii isn’t always laughing at the beach – but I still can’t help but feel jealous of her life when this is the only part of it I see. If I have an errant thought about harming someone I care about, I know it doesn’t mean I actually want to hurt them, or that I’m a bad person, but in the moment, it’s hard to be logical, and sometimes, I panic.

Because aspects of social media and OCD can be quite similar, sometimes social media usage can exacerbate OCD. Because of this, it is particularly important for people with existing mental health concerns to use the Internet wisely. If we are careful and conscientious users, there’s much to be gained from the community-building power of global communication.There’s even evidence to suggest that social media can be an extremely valuable resource for individuals with OCD and other mental disorders. So many people suffering from mental health issues do so in silence. Sometimes, talking to family and friends about OCD can feel embarrassing and scary. With social media, including nOCD’s group feature (download here!) individuals can share concerns and stories with others who know exactly where they’re coming from. You might not walk through the cafeteria with a sign above your head that says “I HAVE OCD! DOES ANYONE WANT TO TALK ABOUT IT??” (but if you do – more power to you!!). The Internet allows us to anonymously join other people who have identified themselves as dealing with exactly the same kinds of struggles. Especially for people in early stages of recovery, talking about OCD with the anonymity of a screen name can be a very meaningful preliminary step towards destigmatization – especially when it leads to more IRL conversations about mental health.How do you use social media in the context of having OCD? Are certain platforms more triggering than others? Are any of them helpful? Speaking of social media, let us know on Facebook, Instagram, or Twitter at @treatmyocd

The Latest OCD Research: An Interview with Dr. Carolyn Rodriguez

By Patrick,

Dr. Carolyn Rodriguez is a foremost expert on obsessive-compulsive disorder (OCD) and conducts cutting-edge research aimed at improving our understanding of the brain and suggesting new treatment possibilities for people around the world.

She is Assistant Professor of Psychiatry and Behavioral Sciences at Stanford University, Member of the Stanford Neurosciences Institute, and Director of the Rodriguez Lab, which translates neuroscientific discoveries into new therapies.

This interview was conducted over the phone in late May 2018.

Patrick at nOCD: Thanks very much for speaking with us today, Dr. Rodriguez. Let’s start at the beginning. How did you get involved in researching OCD? Can you tell us a bit of your story?

Dr. Rodriguez: My interest in mental health started at an early age. I saw firsthand the impact of mental illness in my extended family, and I became interested in how differences in our brains can shape differences in our behavior. I trained to be a psychiatrist and neuroscientist and seek improved treatments for mental illness.

Early in my career, I met someone with OCD. I was immediately struck not only by his private suffering, but also by all of the physical manifestations that made his life harder. His distressing intrusive thoughts about contamination caused him to always wear gloves when he went outside. He washed his hands excessively. When he took his hands out of his gloves, they were red and raw. His pain made a big impression on me.

I became curious about what might be driving these behaviors. I wondered how an obsession forms, and how it transitions into a disorder. We all have out-of-the-blue intrusive thoughts like “Did I leave the stove on?” And we all have felt compelled to go back and check the stove.

But where along the way do these types of thoughts and behaviors cross a line, becoming the condition we know as OCD? The diagnostic standard is that intrusive thoughts and repetitive behaviors that occupy more than 1 hour a day, cause distress, and interfere with daily functioning cross that line. As I treated more individuals with OCD, I became very frustrated by our current first-line treatments. Medications like serotonin reuptake inhibitors and cognitive behavior therapy using exposure and response prevention (EX/RP or ERP) leave many individuals with residual symptoms. 

There is also often a lag time of 2-3 months before substantial symptom relief is achieved. We urgently need more effective and faster-acting treatments for OCD. The mission of our lab is to innovate targeted, rapid-acting treatments and derive insights into the brain basis of OCD and related disorders in order to relieve patients’ suffering. We collaborate across disciplines to accelerate the discovery of treatments.

nOCD: How, specifically, does understanding the underlying brain mechanisms allow you to help people who are living with these conditions?

Dr. Rodriguez: We don’t know what causes OCD. But we increasingly think of mental illnesses as the result of brain circuits gone awry. OCD symptoms are associated with hyperactivity in the thought control circuit, which is comprised of the orbitofrontal cortex (important for decision-making), the striatum (motor movement), and the thalamus (a relay station back to the cortex). The hyperactivity may be due to imbalances of chemical messengers, called neurotransmitters, like serotonin and glutamate. 

Increasing evidence indicates that glutamate plays a role in OCD symptoms. Ketamine– which at high doses is used primarily as an anesthetic– acts on brain receptors for glutamate, and has shown remarkable therapeutic effects in depression and other disorders. I led the first randomized proof-of-concept clinical trial comparing low-dose intravenous ketamine with placebo in fifteen OCD patients suffering from constant obsessions. 

After a single ketamine infusion, half the patients met the response criterion (35 percent or greater reduction in the Yale-Brown Obsessive Compulsive Scale, or Y-BOCS, one week after infusion). The effect was rapid (within hours), and patients reported remarkable benefit. The effects persisted long past the half-life of ketamine, suggesting that beneficial effects remained long after ketamine had been cleared from the body. In some but not all individuals, the therapeutic effects persisted for two to four weeks.

Although these results are promising, patients did report side effects, including transient dissociation– a temporary experience of detachment from reality. Also, ketamine is a street drug of abuse, often called “Special K.” Because of ketamine’s substance abuse potential, in all our studies, we carefully screen and exclude individuals who may be at risk for addiction.

nOCD: Speaking of response to these novel treatments, I’ve always wondered if reducing the intensity of obsessions would automatically lead to a decrease in compulsions, or if those behaviors can somehow stick around, like a habit.

Dr. Rodriguez: What we heard from patients who benefitted from ketamine was interesting. They reported that even though their obsessive thoughts went away, they still had an inclination to check. Like you, we are curious how obsessions influence compulsions, and we wonder how we can pull apart and understand these differences.

Our lab next seeks to understand the mechanism underlying ketamine’s rapid therapeutic effects. We are conducting a large, randomized NIMH-funded study to examine how ketamine acts on the building blocks of brain function: the receptor, the circuit, and the circuit network. If you or a loved one have OCD and live in the San Francisco Bay Area, you can contact us at to see if you are eligible to participate in this ketamine study, or other ongoing studies.

nOCD: It’s great to know about these really interesting pharmacological discoveries. It makes me wonder, though, how can medication and therapy can work together for someone who is trying to get better.

Dr. Rodriguez: I believe in the benefits of combining medication and cognitive-behavioral therapy– specifically ERP. Sometimes, starting therapy is hard; but medication may help decrease OCD severity enough to allow psychotherapy to begin. This may be an avenue for the use of a single dose of rapid-acting ketamine. If you break your arm, you may need pain medication to help you feel a bit better while your bone heals in a cast. Similarly, ketamine may make entry into therapy more tolerable. Ketamine may also work synergistically with therapy, given its role in learning and memory.

At the same time, ketamine’s effects do not appear to be long-lasting. Our team wondered: could we extend ketamine’s effects by combining it with a brief course of cognitive-behavioral therapy? Our rationale drew from two lines of research: previous studies suggesting ketamine may enhance brain plasticity and extinction learning in animal models, and trials that combined therapy with medications thought to facilitate extinction learning, reporting increased cognitive-behavioral therapy gains.

Our pilot study in ten adults with OCD gave a single intravenous ketamine dose followed by an abbreviated course of ERP (ten one-hour exposure sessions) delivered during the time when ketamine is thought to facilitate extinction learning (two weeks). We found that over 60% of subjects with OCD met the response criterion (35 percent or greater reduction in Y-BOCS score) at two weeks after the single ketamine infusion.

nOCD: Clearly there’s a lot of buzz right now around drugs– like ketamine, psilocybin, and LSD– that are typically thought of as dangerous or taboo. They’re also controlled substances in many countries, including the United States. Do you think it’s important to address these concerns as part of the research process?

Dr. Rodriguez: I do think it is important to address these points as part of the research process. Although our ketamine results are promising, patients did report side effects, as I mentioned. Additionally, enthusiasm must be tempered by what we don’t know. No large-scale studies of the risk of ketamine abuse or its safety with long-term administration have been conducted. 

To find rapidly acting treatments without ketamine’s dissociative and other side effects, my lab is working to identify new compounds that act on the glutamate pathway. Rapastinel, an NMDA glutamate receptor modulator, has rapid antidepressant activity and minimal risk of ketamine-like side effects. It is currently in a large phase III research program that may identify it as a first-in-class FDA-approved treatment for depression.

Does rapastinel have similar effects in OCD patients? I led a team conducting an open-label, proof-of-concept study (n=7). We found that rapastinel (as a 10 mg/kg intravenous dose) decreased symptoms of OCD, anxiety, and depression within hours, and was well-tolerated. Rapastinel did not produce the dissociative or other side effects seen with ketamine administration. The effects of a single rapastinel dose on OCD symptoms did not, however, persist at one week post-infusion. So a next step for developing rapastinel in OCD is to try repeated dosing.

nOCD: So is there something that might be paired with ketamine on a medication front to give longer-term relief?

Dr. Rodriguez: Yes, we are conducting research studies to explore how we can best treat individuals. One study utilizes transcranial magnetic stimulation (TMS). We are focused on how to rapidly help individuals with OCD symptoms, and because current treatments with TMS take months, we would love to be able to create more rapid effects in OCD. One of the advantages of TMS is that it doesn’t have the systemic side effects that many drugs have. And it can be targeted to the brain area that contains the thought control circuit. We’re thinking about a wide range of treatment strategies– medication, therapy, non-invasive brain stimulation– and how we can use the synergy of these different kinds of treatments to make a real impact on patients’ symptoms.

If you or a loved one have OCD and live in the San Francisco Bay Area, you can contact us at to see if you are be eligible to participate in this TMS study.

Photo: Paul Sakuma

nOCD: We’ve definitely been hearing more about TMS lately, and it’ll be exciting to see further studies emerge. More generally, what might you tell someone who’s intimidated by the idea of participating in a clinical trial?

Dr. Rodriguez: I would say you are not alone. Deciding to participate in a study would make anyone anxious. But to feel more comfortable with study participation, you can start by educating yourself. Here are three questions you can ask: 

1) Does the science behind the study interest you? There is a scientific rationale for every research study. Each study is seeking to find the answer to a specific question and advance the field. Is that question clear to you? Are you curious about the answer? Knowing exactly how and why you can contribute to OCD research might be motivating (and inspiring).

2) Do you know what the particular study entails– and do you have the time to participate? 

Every study is different, and they require different levels of involvement. Some studies involve several visits over the course of months; others require one visit. Some request a blood sample; others involve neuroimaging; still others involve ongoing treatment. Make sure you are informed about the timing and the content of the study procedures so that you can decide whether or not you have the necessary time and interest.

3) Do you want to work with the research team? 

Follow-up questions include: Do they have a good track-record of publishing results? Do they have funding from the National Institutes of Health or other peer-reviewed agencies? Do they seem responsive, kind, and knowledgeable? Are they informing you of your rights as a study participant? Do they explain that your participation is voluntary? Do you know who you can contact if any issues come up?

Participating in a research study is a very selfless, altruistic act. I am incredibly thankful to each one of our study participants, who are improving our understanding of OCD for the entire OCD community. Wherever you live, you can find out more about research studies in your area by visiting

nOCD: These are great questions to think about. But we do get some frustration in our community, with people asking why there hasn’t been a new medication option for OCD since 1997. Researchers were talking about glutamate quite a while ago, for example, so why is it taking so long to have new possibilities?

Dr. Rodriguez: I share that frustration. It has lit a fire in me, but I think we are closer than ever. Rapastinel is in phase 3 studies for major depression, and may be approved by the FDA as early as 2021. Our small pilot study that I mentioned earlier will help providers make a case for insurance reimbursement for OCD. 

We are also a study location for a phase II clinical trial comparing the efficacy of a glutamate modulator called trigriluzole (BHV-4157) versus placebo in OCD, sponsored by Biohaven Pharmaceuticals. 

nOCD: That’s great to hear– seems like there’s a lot of research happening right now. Is there anything else you’d like to say today?

Dr. Rodriguez: I am very hopeful about our ongoing research studies, which are identifying new pathways for novel treatments. We are looking forward to not only partnering with people who want to participate in our clinical studies, but also to partnering with nOCD and other organizations like the International OCD Foundation ( and the Anxiety and Depression Association of America ( to raise awareness about OCD treatments and research studies. I see so many people suffering in silence. We are active in the community, co-sponsoring a free OCD awareness day here at Stanford, raising money for the IOCDF each year through the 1 Million Steps 4 OCD walk, and writing articles to connect patients to existing treatment options– and to novel research for those not helped by standard treatments.

I am very humbled and inspired by those who are willing to participate in a research study. We approach treatment development from the science and research sides, but we need partners who are experts in their own symptoms in order to understand if these treatments work. Because of HIPAA and confidentiality, I cannot publicly thank individuals who have donated their time, but I am very thankful for their participation.

nOCD: Thanks very much for your time, Dr. Rodriguez. A number of us have OCD, and we’re really excited about this research. We’re grateful to you and your team for all your hard work.

Click here to get more information about current studies at the Rodriguez Lab.


For the latest news, follow Dr. Rodriguez (@CRodriguezMDPhD) and Rodriguez Lab (@RodriguezLabSU) on Twitter.

nOCD: Finding a Cure for OCD Within 15 Years

By Stephen Smith,

The digital wave that has disrupted countless industries around the world for the better still hasn’t come crashing down on mental healthcare– which is hard to believe given that one in four people suffer from a mental health condition. Useful technology simplifies our lives, so most people use it when given the opportunity. This is why Twitter was able to obtain 50 million users at a rate forty times faster than the telephone. So why hasn’t a tech giant emerged in the mental healthcare space? It’s as simple as this: there has traditionally been a lack of payer reimbursement for mental healthcare services, because payers don’t have the necessary data to see the consequential impact that specific mental conditions have on their patient population’s physical health.

As a result of insufficient payer reimbursement, people with different mental health conditions have a difficult time obtaining insurance coverage for their treatment and major industry stakeholders often forgo investing their resources into augmenting specific mental healthcare services. For example, if you look at the electronic health record (EHR) industry, many behavioral health-focused health systems are just now starting to implement electronic prescribing, a twenty-plus-year delay that resulted from a capital-restrained marketplace. Further, when observing many pharmaceutical companies’ pipelines, it’s clear that a large percentage of them are not invested in psychiatry, since it’s more economically opportunistic to spend on developing drugs for oncology, later-stage CNS disorders, and diabetes. If publicly-traded industry stakeholders like health systems or pharma companies could make a larger return on investment (ROI) in mental health, then they would have an obligation to their shareholders to get more involved.

That’s where new technology can help. Technology designed to effectively treat specific psychiatric conditions, connect patients to personalized resources, and collect data about patient care history has the potential to reach millions of people in months, giving  payers full visibility into their mental health population, especially into the risk level associated with its different sectors. At nOCD, we believe this disruption will cause a paradigm shift, as many payers will realize that they should divert away from homogeneously classifying their entire mental health population as just “behavioral health,” and instead move toward understanding how to manage each psychiatric condition separately. Once payers lean on tech companies to gain insight into their mental health population, new, highly competitive markets focused on preventing people from developing severe comorbidities will form, giving industry leaders a new opportunity to grow faster by finding cures for each mental illness and partnering with tech companies to more effectively deliver care.

Code on a computer

As a team of people who have been personally affected by obsessive-compulsive disorder (OCD)– a condition that represents about 10% of the mental health population and is highly comorbid with both major depression and substance abuse– we couldn’t be more excited to be a leader in this change, starting with our rapidly growing mobile platform. By using our free app and digital content to unite the OCD community, we’ve created a new treatment ecosystem that’s helping payers identify the OCD Problem, informing pharma’s attempts to develop new therapeutics for OCD, and allowing patients to connect with OCD specialists more easily.

The reason? Trends indicate the cure for OCD– an intervention that reduces OCD severity by 90-100%– will most likely be delivered as a bundle of FDA-approved mobile applications, new pharmacologies, and specialized provider-administered treatment. By connecting the industry to nOCD’s community and services, we’ve created the infrastructure to more quickly find and deliver this bundled cure to the 180 million people living with OCD around the world. Now we’re focused on achieving one of our main missions: providing this industry with the tools needed to find a cure for OCD within the next 15 years.

Have hope! The digital wave has hit mental healthcare, starting with nOCD.




When OCD Isn’t Your Only Diagnosis

By Phoebe Kranefuss,

If you deal with OCD on a day-to-day basis, you probably already know that obsessive thinking can really get in the way. At nOCD, many of us have experienced firsthand how OCD can turn any ordinary activity– from grocery shopping to checking email– into a stressful and exhausting ordeal.

OCD is definitely a pain. But for many, the distress caused by OCD might only be part of the picture. A number of people who suffer from OCD deal with a second (and even a third) mental health condition, like depression, anxiety, social phobia, and/or an eating disorder. According to one study, a shocking 74% of patients diagnosed with OCD also met the criteria for at least one other disorder.

Treating OCD in the context of an additional diagnosis can be challenging. Which is the primary concern? Do the disorders exacerbate each other? Is an individual using effective coping mechanisms to tolerate anxiety, or is he or she using one symptom to manage another? And can the treatment methods for one condition make the other one worse?

For the 64% of individuals with eating disorders who also have OCD, the overlap between the two conditions can be hard to manage. Both rely on patterns of obsession, avoidance, and ritualistic behavior, making exposure and response prevention (ERP) exercises particularly difficult. For example, if someone is practicing exposures with the fear foods they normally avoid, they might be tempted to use OCD rituals to mitigate the onslaught of anxious thoughts that result. During an exposure, someone with an eating disorder must sit not only with the anxiety of eating a fear food, but also the anxiety of not partaking in an OCD ritual to calm the anxiety caused by the fear food in the first place.

An individual in treatment for both disorders might also struggle with their different perceptions of their diagnoses. OCD is generally experienced as an ego-dystonic disorder, meaning the disorder and its symptoms are in opposition to an individual’s nature, desires, values, and self-image. Eating disorders, on the other hand – especially anorexia nervosa – are more often experienced as ego-syntonic, meaning they’re congruent with an individual’s personality and values.

Dealing with the symptoms of multiple disorders can be quite challenging. But here’s the good news: because the disorders are so intertwined, participating in effective treatment for one disorder has been shown to diminish the other, too. This doesn’t mean OCD treatment with magically cure an eating disorder, or vice versa – but it does mean that practicing ERP for OCD might make food exposures a little easier, and that food exposures might make ERP for OCD a little bit easier, too. Sure, you deal with more symptoms and distress – but you also get more “bang for your buck” with treatment!

Dealing with comorbid diagnoses? Have any tips or best practices? Let us know on Facebook, Twitter, and Instagram @treatmyocd. We want to hear from you!

Join our app for ERP and treatment-centered community here

Harris Goldberg talks OCD in Hollywood

By Phoebe Kranefuss,

If you’ve laughed out loud during Master of Disguise or Without a Paddle, you might not think to associate director, writer, and producer Harris Goldberg with obsessive compulsive disorder. But speaking with Harris reveals a different history: his experience with anxiety and ineffective therapy reveal a wealth of perspective, knowledge, and candor about OCD. The nOCD team was lucky enough to speak with Goldberg last week, and we’re excited to share his inspiring story with you!

“Turtle Man” from Goldberg’s The Master of Disguise

nOCD: What’s it like having OCD in Hollywood?

Harris Goldberg: I think that if you have any sort of predisposition exacerbated by stress, whether it’s OCD or anxiety or depression, Hollywood and this business can exaggerate it. It’s been amazing here. But there’s a lot of up and down, and a lot of smoke and mirrors. Looking back, I think it was probably the worst business for me to go in, as someone who’s always had these OCD and anxiety issues lurking in the background.

nOCD: What’s been your experience with therapy?

HG: I’ve found that it’s really hard to find [a therapist] who’s really good. It’s really hard to get specific and find the tools you need for recovery. It’s like physical training – there are a lot of bad trainers out there, because they’re training people the wrong way, so they’re giving you exercises that are burning out your joints. I think the same thing holds true for mental illness. If you find someone who really knows what they’re doing, I think you can get better a lot faster, and you can cancel out a lot of the noise.

When I first started doing therapy, there wasn’t a lot of stuff on the Internet. And also, I did this thing where I’d cross the line and become friends with the therapist – in Los Angeles, with therapists, no matter how professional they are, when they found out I was in the entertainment business, they would kind of fall for that, and they would have scripts of their own, or they’d say, “hey, we should collaborate on something,” and it crossed the line from professional therapy to being friendly.  I felt disappointed that they fell for that, and I felt also disappointed in myself for pushing that button.

Harris Goldberg

I didn’t even know my anxiety was fueled by my OCD for years and years – I thought it was two separate things. And OCD, I just accepted as my own little secret thing that kept me comfortable: I have this little thing I do, and these ruminations protect me from bad things happening. But I never realized that the stress from that, and the overload on a daily and hourly basis, was actually making me way more anxious. And the more anxious I would get, the more other symptoms I would get.

When I would bring up OCD to therapists, they would say, “Oh, it’s not that bad, you’re fine, let’s talk about your anxiety, your depression.” But nobody focused on the OCD. It was only that I started to focus on OCD that I realized: that’s the fire I have to put out, right there.

nOCD: You played a lot of tennis growing up. Was your OCD around back then?

HG: I was obsessed with tennis growing up. I loved it because it was black and white. I love sports because the accountability is really easy to measure. To this day, I still feel way more comfortable on a tennis court than I ever would on a movie set, because I know how good I am, I know the outcome, and I know it very well. it’s an anchor for me. Routine and stability directly correlate to how I’m feeling. With tennis, if I had a great topspin down-the-line shot, no one’s gonna go: “that wasn’t a great topspin down-the-line shot.” It just is. But if I write a script, I can have 4 people go, “this is fantastic, we love this,” and I can have another 4 people go, “we don’t get this, we hate this.” In LA, that lack of predictability really started to unravel my feelings of uncertainty. The trick is to accept there’s no such thing as certainty, and somehow find the tools to navigate when you are in those more uncertain moments.

nOCD: It sounds like you’ve gotten more comfortable with vulnerability, which initially really triggered your OCD. And now you’ve learned to sort of find the power in your vulnerability in your writing.

HG: Yeah, like when I started, I was in the comedy world. I have an older brother who was a very successful comedy writer. I was always a funny guy in school; I was always sort of the class clown, but underneath I had my secret of OCD, which I’d mask by being funny, which I learned early on as a defense mechanism. So when i moved to LA, I naturally started following in my brother’s footsteps, and I started writing comedy, and had success with Deuce Bigalow and Without a Paddle and the Adam Sandler movies. But i never really liked these movies.

There was a point when I had – I don’t want to say breakdown – but I really hit a low point with the anxiety and OCD, and that’s when I said I can’t do this comedy anymore because it wasn’t what I wanted to do. So I started to write more into what I was feeling, and tapping into the things that drive the mental situations. And writing about it was really cathartic and helpful, because it made me examine it from a third person point of view, because I’m writing about a character who’s feeling these feelings, but is really not me, and that allows me to analyze it in a way I’d never done before. But I had to make that switch to tap into that stuff, which I’d never really done before, because I was hiding behind laughs, which was an easy thing to do.

nOCD: Is there anyone who looked at you and asked, “What are you thinking?” when you turned away from the successful comedy films?

HG: Everyone. Agents, managers. It was only when I did Numb, this movie with Matthew Perry [that people stopped doubting me]. I had done Without A Paddle, which did really well. And I hated it. I said, I can’t do this anymore. So I locked myself up, and I wrote this very cathartic autobiographical movie. I never thought it would get made in a million years. And then somehow it got financed, and I directed it, and Matthew wanted to do it, and he was in a vulnerable spot in his own life, playing a version of me, so it was very personal. We really got tight. And when that movie came out, the reaction to it was really palpable. I mean, we’d go to film festivals, and we premiered it at Tribeca in New York. And the reaction from people was: Thank you for making this! I have anxiety, I have OCD! I loved that feeling. I felt like, I can’t believe this reaction i’m getting, and that changed everything. But everyone in my camp – agents, lawyers – they thought I was crazy. They said, just do another stupid comedy!

Matthew Perry in Numb

nOCD: Where did you draw the strength to go into your vulnerability and take this more authentic path, especially as other people were telling you this wasn’t a good idea?

HG: I think desperation. In 1992, I was suffering [from anxiety and OCD], and the symptoms wouldn’t let me ignore it anymore. I didn’t feel funny, I didn’t want to write anything funny, and I thought, maybe I’ll quit and go into tennis, because I felt secure in that. And then I thought, well maybe I’ll write how I’m feeling. And I started writing almost a bit of a  journal. Then I thought, well this could make an interesting movie. So it really came out of almost hitting a rock bottom in a way, which forces you to change on a lot of levels.

nOCD: Do you have one or two top tips from your experience, if a new person came to you with OCD?

HG: Go directly to ERP and ACT. Forget everything else. If you want to do talk therapy about your life, do it afterwards. For now, learn what OCD is, and go with someone who really knows what they’re doing, and can nip this thing in the bud, and you can start to develop tools that can deal with the OCD. Find the right person, whatever it takes.  Realize that life is incredibly short, really. There’s no point in going through life unhappy, because it’s not going to change if you don’t change it now. As you get older, you become a caricature of yourself. It only gets worse, so you might as well try to recover now, so you can have as much remaining life as you have, or you’re supposed to have. And have some joy in it.


Introducing nOCD’s Group Feature

By Patrick,

As we’ve always said at nOCD, one of the most important elements of recovery from any struggle with mental health is having a community of people who can support you and ask for your support too. After all, a whole bunch of studies suggest that helping other people is a reliable way to boost your own mood– and your sense of purpose.

In our biggest effort yet to bring these principles to life, we’re announcing the new Group feature in the nOCD app. It’s a robust community of people asking questions, sharing their stories, and making helpful suggestions. And people are already telling us each day how useful it’s been in their quest to feel better.

In these first screenshots, you can see the simple process you follow to get started: create a nickname of your choice, and select from a number of great characters to represent you. We’ve got all kinds of purple people, and a few animals too.

Although you’ll find the usual mix of educational, inspirational, and entertaining content created by the nOCD team, the most important part of Group is all the stuff shared by people like you. Whether you have OCD, you have a friend or family member who deals with the condition, or you’re an expert on mental health, the wisdom you bring to our community is what allows us to help each other.

Along with the social aspect of recovery, we all recognize that feeling better requires daily attention and persistent learning. That’s why the community’s constant, lively flow of questions, stories, and helpful information is another important part of our community members’ journey toward recovery.

In the left screenshot above is the main Group feed. At the top is a place for you to share whatever is on your mind– or whatever you’re struggling with. Below that is a blog post shared by nOCD, written by another one of our term members. Yes, it has a picture of a puppy. And it offers some very helpful thoughts about ERP, value-based living, and the ways metaphors can help us understand our own experience. We’re always sharing new content like this, on the very same feed you’ll be using to share things.

Below that is a sample user post, created by a nOCD team member. People can like these posts and leave replies. So far we’ve seen people sharing their experiences, replying with useful resources, and simply demonstrating that they’re there for the person who posted.

In the other screenshot you’ll find your notifications, which keep you in the loop about new interactions with posts you’ve created or commented on. The nOCD Group is all about sharing, and making back-and-forth discussion easier is central to our goals.

You’ll notice that we also have a short list of important community guidelines that everyone agrees to. These are around just to make sure people are safe, nobody is getting attacked, and nothing of a harmful (or spammy) nature is getting posted. One of our team members is the main moderator in Group, and is keeping a close eye on things. You can check out the guidelines in the image above.

Once you’ve created your profile, chosen your avatar, and had a look around the feed, you’re all ready to be an active member of our in-app community, which we’ve decided to call Group. It’s a simple name that reflects the collective nature of recovery from OCD, and mental health in general. Nobody can do this alone, and we hope this new feature in the nOCD app helps make sure you don’t have to. Group can be accessed at any time by tapping the Group icon in the navigation bar at the bottom of the screen. We’ll see you there!

One quick note: if you have the nOCD app but you haven’t updated it since early June, make sure to update so you’ll have access to Group.

ERP and Value-Based Living

By Phoebe Kranefuss,

OCD can be a little bit like a new puppy.

It follows you everywhere, it requires tons of attention, and when you say “no,” it seems instead to hear: “DON’T STOP!” If you’ve ever trained a puppy, you know how hard it can be to discipline an adorable ball of fluff.

Disciplining a puppy might feel uncomfortable, but it’s crucial. Letting your puppy get away with mischief will turn him into a dog who jumps on the mailman and pees on your carpet. OCD definitely isn’t fluffy or cute, but managing it through exposure and response prevention (ERP) requires a lot of energy, repetition, and patience– kind of like training a dog.

ERP, which the International OCD Foundation identifies as the most effective treatment for OCD today, entails purposely exposing yourself to the thoughts, images, objects and situations that make you anxious and/or start your obsessions, and making a choice to withhold from a compulsive behavior or response once the anxiety or obsessions have been purposefully triggered. This can be distressing, especially during the preliminary stages of treatment when the OCD brain is accustomed to using compulsions to immediately eradicate uncomfortable or anxiety-provoking thoughts. Even people with a lot of experience doing ERP will find that  more challenging exposures trigger a higher level of discomfort.

Purposefully triggering anxiety? That might seem counterintuitive. It also might leave you feeling overwhelmed and exhausted. But giving yourself the opportunity to experience anxiety, and gradually get used to it, is critical, because it sends a powerful message to OCD: it doesn’t get to make the rules around here. You– not your OCD symptoms– are in charge of your life.

Think of it this way: if you’re training a puppy to sit, and you give up halfway through the lesson, rewarding him with a treat despite his inability to follow instructions, then you’ve trained him to see himself as head honcho. Next time, he probably won’t sit, either. Giving up on an exposure by giving in to a compulsive behavior similarly rewards OCD. But the reverse is also true: strengthening your ERP muscles by exercising your ability to practice exposures and ride out the anxiety they induce shows OCD you’re taking a stand.

Let’s say Dan struggles with Harm OCD. Dan isn’t a violent person, but he fears that if he’s given a knife, he’ll use it to hurt someone around him. He has a counting ritual he performs, which temporarily causes the violent imagery to dissipate. Dan’s friend invites him to a cooking class, and Dan knows he’ll be expected to use a knife around other people–  a major trigger for him. But Dan both values his friendship and enjoys cooking, and knows he would enjoy the class if it wasn’t for OCD. Dan has two choices:

  1. Reject his friend’s invitation, empowering OCD to dictate his life choices
  2. Accept his friend’s invitation, and view the class as an opportunity to expose himself to triggers and practice ERP (he might discreetly use nOCD’s app to track ERP during the class – download here!)

Does OCD conflict with your values and interests? How do you take a stand when OCD tries to keep you from participating in the activities and hobbies that give your life meaning? We’d love to hear from you!

Facebook and Instagram: @treatmyocd


Holistic Approaches to Mitigating OCD

By Phoebe Kranefuss,


Ever missed out on something because your OCD decided it was in charge for the moment, hour, or even the whole day? Yeah, us too. In fact, most of us already know what it’s like to feel as if our day-to-day life is ruled by OCD.

If you’ve ever been too distracted by obsessions or compulsions to focus on a good book or enjoy a cup of coffee, then you know what it’s like to have life’s simple pleasures robbed by OCD. Repetition and predictability are integral to a sense of security and groundedness in our daily lives, but when OCD hijacks these choices, usually, more obsessions follow.

Three people cheering with iced coffee and lattes at Verve Coffee

What if we could turn the tables? What if, instead of OCD “choosing” rituals that ultimately lead to increased anxiety, we could make healthy choices to integrate productive daily habits and rituals, which could help control and mitigate rather than contribute to OCD?

Clinicians like Alison Bested, MD, and Richard Brown, PhD, are asking some important questions about our daily habits – specifically how our eating and exercise routines affect mental disorders like OCD, including treatment-resistant cases.

Flat lay of fresh ingredients with avocado, herbs, jalapeno, and egg

Dr. Brown, clinical professor of psychiatry at Columbia University, chose a sample group of fifteen patients currently receiving therapy, medication, or both, who showed significant OCD symptoms despite treatment. He enrolled the patients in a twelve-week aerobic exercise program, and monitored OCD symptoms throughout the trial. At the end of the twelve-week trial, Dr. Brown noted a clinically significant reduction in symptoms. He then re-tested the patients three weeks, six weeks, and six months after the trial had ended, and noted a sustained decrease in OCD symptoms– even though the patients were no longer participating in monitored exercise routines.

In the words of Lena Dunham, who openly struggles with OCD, it can be “mad annoying when people tell… those struggling with anxiety, OCD, [and/or] depression…to exercise.” We get that. Adding exercise into your daily routine probably won’t make your OCD go away, and it doesn’t guarantee a decrease in symptoms, either. But making exercise a part of your daily routine – in addition to practicing ERP, or taking an SSRI if prescribed by your doctor, or both – might still be worth a try.

Even dedicating just a few minutes per day can lead to results. Justin Strickland at the University of Kentucky thinks strength training is the most effective way to treat anxiety through exercise, noting that “resistance training at a low-to-moderate intensity produces the most reliable and robust decreases in anxiety.” That doesn’t mean you need a fancy gym or strict workout regimen to see benefits – here are some exercises that require zero equipment and only nine minutes of your day. If working this routine into your daily schedule helps decrease your OCD symptoms, you might save a lot more than nine minutes per day in the long run!

The way we eat matters, too. The link between gastrointestinal and mental health dates back all the way to 1933, when clinical psychiatrist Joseph Kilman suggested in Psychiatric Quarterly: “We feel justified in recognizing the existence of cases of mental disorders which have as a basic etiological factor a toxic condition arising in the gastrointestinal tract.”

Alison Bested, MD, would probably agree. Dr. Bested is making the gastrointestinal relevant with her research on correlations between dietary choices, gut health, and mental health. She and her team noted that a diet rich in fermented foods, leafy greens, and probiotics can lead to decreased anxiety and depression as well as decreased intestinal permeability, which she correlates to mental health.

Have you noticed any correlation between your physical and mental health? Have you incorporated any routines into your daily life that have decreased your OCD symptoms? Let us know in our new community feature in our free app, available to download here!

Asking an Expert: Dr. Wayne Goodman

By Patrick,

Am I eligible to participate in this study?

Please see this page on our website to learn more about eligibility and sign up today.

If you ask someone in the OCD community, they’ll probably know about Dr. Wayne Goodman, MD. Dr. Goodman was behind many of the things we now take for granted in OCD research and treatment. In the 1980s, he co-developed the Y-BOCS, an assessment of symptom severity that’s used by clinicians all over the world. Dr. Goodman was one of the very first researchers to test SSRIs for OCD treatment, and co-founded the IOCDF in 1986. He has published hundreds of research papers on OCD.

Having established OCD centers at three other respected colleges, Dr. Goodman recently became Chair of the Menninger Department of Psychiatry and Behavioral Sciences at Baylor College of Medicine. Thanks to Dr. Goodman for sharing with us his wealth of knowledge and experience.

nOCD: Thanks for speaking with us. First of all, how did you get involved in researching OCD? Can you tell us a bit of your story? 

DR. GOODMAN: I entered my psychiatry residency program at Yale University with the intention of doing clinical research. Initially, I was interested in Schizophrenia because it seemed to be a clear example of a brain-based disorder. However, I started seeing patients with OCD and realized this disorder also must have a discoverable biological basis. I was both fascinated and puzzled by how someone who was otherwise completely rational and normal in every way could be imprisoned by obsessions and compelled to perform rituals. I stayed on as a faculty member at Yale, started its clinic and research program for OCD, and saw hundreds of patients with OCD. They, and the countless others since, have taught me what I know about OCD.

How might an understanding of underlying brain mechanisms help people who are living with these conditions?

We have two well-established treatment approaches for OCD, namely CBT (specifically exposure and response prevention, or ERP) and serotonin reuptake inhibitors like fluvoxamine and clomipramine. But about one third of patients with OCD fail to achieve an adequate response to treatment with ERP and multiple medications. We need new options for these non-responders, and that will require a better understanding of the underlying brain mechanisms that produce OCD. After identifying the causes of OCD, scientists can develop new treatments– whether behavioral interventions, medications, or devices– that target the areas in the brain responsible for OCD symptoms.

What are some of the most exciting frontiers in mental health research right now?

Twenty years ago, most biological hypotheses about the causes of OCD focused on the role of the brain chemical messenger serotonin. More recently, other brain chemicals such as glutamate have been implicated in OCD, and that is leading to clinical research trials of new medications like trigriluzole. Baylor College of Medicine is one of the sites participating in this study, which has participants add trigriluzole to current medications. Another exciting frontier is viewing OCD as a brain circuit disorder and using devices to modulate nodes in the putative OCD circuit to restore normal brain activity.

What led you to co-found the IOCDF?

In 1986, shortly after starting the OCD program at Yale, I became inundated with requests from around the country for more information about OCD. This was before the internet, and came in the form of many hundreds of letters and nearly non-stop phone calls.

Recognizing that besides their OCD my patients were highly capable and interested in helping, I gathered around ten people to discuss forming an advocacy group. We started meeting at Yale, and later acquired offices in New Haven. I remained chair of the Scientific Advisory Board to the IOCDF for ten years before handing the reins over to Dr. Michael Jenike when the IOCDF moved to Boston.

What led you to develop the Y-BOCS?

In the late 1980s, I was conducting clinical trials of clomipramine (Anafranil) and selective serotonin reuptake inhibitors, or SSRIs, like fluvoxamine (Luvox). The field needed an outcome measure that was specific to OCD, reliable, and valid. My colleagues and I developed the Y-BOCS to fulfill those objectives. It has since become the international gold standard for assessing severity and changes in OCD for all types of treatments, whether CBT, medications, or devices.

You started OCD centers in four prestigious academic settings. What was your experience at each one? What did you learn?

In addition to launching the OCD program at Yale, which is now run by Dr. Chris Pittenger, I established OCD Centers of Excellence at the University of Florida, Mount Sinai, and now Baylor College of Medicine in Houston. One of the most important lessons I have learned is to offer a full range of treatment modalities across the lifespan.

For example, at Baylor I have two nationally prominent CBT experts, Eric Storch and Liz McIngvale, who can evaluate and treat both children and adults. We also offer expertise in medication approaches and the use of devices like Deep Brain Stimulation for cases of severe and treatment-resistant OCD. The other lesson is being able to both provide routine clinical care and conduct research.

If you have OCD, you might be eligible to participate in the study Dr. Goodman mentioned above, involving an investigational medication that would be added on to your current treatment. To learn more, please fill out a quick form and a research site near you will contact you with more information.

Thanks again to Dr. Goodman for his generosity in helping us learn more about OCD, what it’s like to be an expert, and what kind of research comes next.

Reassurance: How it prevents recovery

By Patrick,

Reassurance (noun): the action of removing someone’s doubts or fears; a statement or comment that removes someone’s doubts or fears.

What is reassurance?

You’re walking around and you see a kid riding a bike. The kid falls over, and someone who seems to be the mother runs over and scoops them up, saying things like, “It’s okay. You’re going to be okay. It’s just a scratch.”

Or maybe you’re sitting in a coffee shop when you hear someone at the next table telling their friends about a recent breakup, listing all the reasons life will never be good again. The friends swoop in and say, “You can’t think like that. You’re just in a lot of pain right now. It wasn’t even that great of a relationship anyways.”

These are examples of people giving reassurance to someone else. And they’re so recognizable because reassurance is an everyday part of social interaction: someone expresses a doubt or fear, and you help them feel better by negating that doubt or fear. This happens in infinitely many ways each day. In fact, it’s hard to imagine how one would get through life without reassurance when things get really tough.

Photo: Matthew Henry

Is it normal to want reassurance?

Everybody– from newborn infants to the oldest and wisest adults– feels a strong need to be reassured in situations that provoke fear, guilt, anxiety, stress, sadness, and so on. These tend to be unpleasant feelings, so we usually want to get rid of them. Reassurance often helps, at least in the short term, but it’s not always effective. Someone in grief, for example, is probably not going to hear They’re in a better place now and feel much better.

Barring a huge life change like illness or death, people also tend to learn other responses to stressful situations after some experience with them. After enough trips down the big slide at the park, most kids will stop asking whether or not it will be okay. By testing the world, we learn what is safe and what we should probably avoid. (Even this learning can be skewed by a bunch of factors, but let’s get into that another time.)

Reassurance, like most things we do, isn’t exactly good or bad. It’s certainly normal, and makes up a sizable portion of all the social interactions you’ll observe on a given day. For most people, especially adults, the need for reassurance is strong at times, but not persistently strong. And even when it is strong, it might seem plausible that there are other ways to proceed, besides temporarily getting rid of unpleasant feelings. But excessive reassurance seeking is associated with a number of mental health conditions, including depression, obsessive-compulsive disorder (OCD), and anxiety disorders.

Recovery from OCD requires habituation to the distress caused by uncertainty. And habituation cannot occur when reassurance keeps the person from getting exposure to uncertainty.

Photo: Korney Violin

What does reassurance have to do with OCD?

Because we keep talking about most people, there’s clearly a group that doesn’t mesh with some of the above statements. That would be people with OCD, health anxiety, and a few other psychiatric conditions. Let’s have a look at a 2017 paper written by Drs. Brynjar Halldorsson and Paul Salkovskis:

Excessive reassurance seeking (ERS) is particularly prominent in people who suffer from obsessive-compulsive disorder (OCD) and health anxiety… reassurance seeking functions in a similar way to compulsive checking in OCD with the added potential of transferring ‘responsibility’ for the feared harm to another person (Rachman 2002; Salkovskis 1985, 1999). However, it could also be seen as being a supportive maneuver, and is often considered in this way by sufferers and their loved ones.


They introduce the central complication of reassurance in OCD: on the one hand, reassurance seeking is a compulsive response to the distress caused by obsessions; on the other hand, it’s a very normal way to seek support from others. It’s what everyone else is doing, in other words. But the need for reassurance isn’t a passing thing for people with OCD.

It might help for a little bit, but the urge tends to return quickly. As a result, people with OCD tend to ask for reassurance more often, and with more urgency, than others. And they may feel unable to proceed without it. The distinguishing factor for people with OCD isn’t that they seek reassurance; it’s that their reassurance seeking behaviors get out of their control quickly.

Photo: Dean Hergert

Why do people with OCD seek reassurance?

Because researchers haven’t found a definite cause of OCD, attempts to explain this on a neurological level aren’t going to satisfy. From a psychological perspective, reassurance-seeking behaviors are another attempt by people with OCD to get rid of the uncertainty at the core of the condition. If you feel unsure about something, you might check it repeatedly- or you might try to get someone else to tell you that things will work out just fine.

When you ask for reassurance, you’re basically asking someone else to neutralize the distress of confronting uncertainty, by presenting a different way of viewing the situation. It feels like a big relief to have this distress taken away, but in the long term it guarantees that you won’t learn how to tolerate uncertainty (or even learn that you can tolerate it). You’ll be stuck in a loop of perceiving uncertainty, growing distressed, seeking reassurance. In this way, reassurance-seeking is both a compulsion (a repetitive behavior meant to minimize distress) and a form of avoidance.

Let’s use a metaphor that’s imperfect but hopefully instructive. There are two people next to each other lifting weights. They’re of equal strength, but only one is confident. The other is so full of doubt that– as the more confident one keeps trying, failing, adjusting, even succeeding– they keep calling a friend over to help. After a few months of this, the confident one has grown much stronger. But the less confident one has only become more and more convinced that they need help, and hasn’t become able to lift anything on their own.

Photo: Victor Freitas

Does reassurance keep people from getting better?

People with OCD seem particularly bothered by not having absolute certainty, at least in a few key areas depending on one’s specific symptoms. As countless research papers and personal stories tell us, recovery from OCD requires habituation to the distress caused by uncertainty. And habituation– the lessening of a physiological or emotional response after repeated exposure to a stimulus– cannot occur when reassurance keeps the person from getting that exposure to uncertainty.

Some research suggests that people get worse when they’re getting reassurance because the feared stimulus grows even more fearsome as others help them avoid it. At the very least, getting reassurance doesn’t help people get better. Like other compulsions, reassurance seeking works by negative reinforcement: because it gets rid of an unpleasant feeling, the behavior is strengthened. The result? We just want more and more reassurance.

The insatiable desire for reassurance, always increasing due to operant conditioning, combines with the impossibility of certainty to lock people into the endless quest of trying to make sure things will be alright. Unsurprisingly, this can result in all kinds of unfortunate situations where other people end up resenting the person who is constantly asking for reassurance. Because friends and family might pull away, it’s common for people to end up lonely just because they didn’t know how to avoid asking too much of loved ones.

Photo: Brannon Naito

What can we do instead of reassurance?

Remember that research paper that we discussed above? Later they bring up an interesting concept: reassurance-seeking versus support-seeking.

Here’s how they define reassurance-seeking:

Verbal and/or non-verbal interaction with someone, who you perceive has access to potentially threat relieving information, with the intention of increasing your perceived sense of certainty of safety from harm.

And this is support-seeking:

Interpersonal behaviour, verbal or non-verbal, that is intended to get encouragement, confidence, or assistance to cope with feelings of distress.


The difference is subtle, which points to the confusion most of us face when trying to decide how to help someone. But remember the chain of events: uncertainty -> distress -> behavior. Reassurance-seeking is an attempt to get rid of the distress by getting rid of the uncertainty that underlies it. Support-seeking, however, is an attempt to have someone encourage you while you deal with the distress caused by your uncertainty. It means allowing the uncertainty and distress to exist while also acknowledging that it’s easier to succeed with the support of others.

Photo: Victor Freitas

If we think now of the person on the other end of these interactions, the one offering either reassurance or support, the distinction can be even more subtle. Because of this subtlety, it might require saying something as direct as, “It seems like you’re looking for reassurance, which I understand because you’re dealing with difficult feelings right now. But I know you can get through this, as you have so many times before, and I also know it’s important for you to get through these situations so you can learn to trust yourself and the world a little more. I’m here with you, but I can’t tell you whether or not things will be fine.”

It’s probably worth talking about this process when the person isn’t in the midst of anxiously spiraling or compulsively seeking reassurance. If they’re unconvinced that learning to tolerate uncertainty is going to help them feel a lot better long-term, try showing them this blog post or any resource about ERP and habituation to anxiety. If they already know all this, just tell them, “Because I want you to feel better in the long term, and not just have short-term relief at the expense of your recovery, I’m not going to offer you reassurance when it seems like you’re asking me to get rid of uncertainty for you. But I’ll be happy to spend time with you while you feel this distress.”

If you’ve tried to help the person understand why you’re not giving them reassurance and they decide to look for it somewhere else, that’s out of your control. But hopefully you’ll find that a genuine offer of your emotional support, combined with a calm and nonjudgmental explanation of why you don’t want to reassure them and prevent their recovery, will do the trick.

We’ll be posting again soon with further examples of reassurance-seeking behavior, and strategies for relying less on reassurance. Keep an eye out.
If you want to learn more about OCD, visit our website

Photo: Justin Luebke

A new model for OCD treatment

By Patrick,

Today we’re glad to share this article by Stephen Smith, Founder and CEO of nOCD.

Note: We’ve changed this person’s name to John to protect his privacy. 

It’s a story many of us can relate to.

After struggling with debilitating anxiety for years, and seeing a bunch of therapists in New York City who weren’t really sure how to help, John was finally diagnosed with obsessive-compulsive disorder: a moment of clarity that might’ve made John feel hopeful again.

But instead of enjoying any kind of transformation, he quickly learned that each hour-long appointment with an OCD specialist would cost him about $300 out of pocket. Getting appointments in would force him to take time away from work, or even miss a day, every single week. Worst of all, John knew that even once he’d found a suitable clinician it might take six to eight months before he could get off their waiting list and start making progress.

In essence, the mental health treatment system was preventing him from getting the help he really needed. Discouraged, feeling unable to deal with all these logistical burdens tacked onto his significant daily distress, John continued to struggle in silence.

It’s a story that sparks anger in many of us.

If John had been diagnosed with a different chronic condition, he most likely would’ve been able to get help faster– including a specialist to direct him, a care team to facilitate treatment compliance, and a community of others with OCD to offer him support.

Take the diabetes treatment industry, for example. People with diabetes can see an endocrinologist, use a service like Livongo through their employers or as individuals, participate in online support communities, and enjoy the support of their health plan in covering care.

Ideally we’d be saying the same thing about OCD, but the unfortunate truth is that the economics of OCD are especially daunting.

It’s a story that raises a whole bunch of questions.

What makes the OCD treatment industry different from that for other chronic conditions?

Why is OCD treatment so expensive for people like John?

Why won’t John’s OCD specialist accept insurance?

Why does John have to wait six months before he can schedule a consultation?

The questions are endless.

It’s a story that’s rooted in broken economics.

In the United States, where things are relatively good compared to almost any other country around the world, there are about 2,000 OCD specialists tasked with treating approximately 8.5 million people with OCD– about 2.5% of the adult population, and 1% of children.

Of course, the miseducation and stigma that keep many of these 8.5 million from recognizing their symptoms and seeking treatment don’t help. But millions do seek help in one way or another, revealing a major shortage of OCD specialists. This is especially disheartening given the fact that OCD is one of the top five most prevalent mental illnesses and was named by the World Health Organization as a top-ten most debilitating condition.

Given the specialized, time-intensive nature of Exposure and Response Prevention (ERP)– the gold standard for OCD treatment– and the lack of effective care coordination, most providers can only see about 40 patients per month, meaning only about 80,000 of the 8.5 million people with OCD in the US would even theoretically have access to the best care.

Further, because OCD specialists work alone in treating their patients and their degree takes years to earn, they charge at least $150-$250 per hour– consistent with other specialized healthcare providers. But payers will often reimburse them only $50 per hour for their services, which means OCD specialists have two options: charge their patients a massive copayment, or go cash-only.

That’s where the conversation shifts to payers. Why are payers reimbursing $50 or less per hour for mental health services? Many say it’s because of the stigma surrounding mental health, but that’s not the whole story. Payers are asked to treat a wide variety of populations, so in order to stay in business (remember that most are for-profit, publicly traded entities) they prioritize the management of populations that cost them the most to treat.

Because 60-90% of mental health-related data isn’t logged in an electronic health record (EHR) and 50% of OCD patients don’t get diagnosed or coded properly, payers today are mostly unaware of the huge clinical and economic impacts of untreated OCD. This makes it difficult for them to see, for example, that up to 40% of people with OCD end up developing severe and costly comorbidities like substance use disorders (SUDs).

Payers are heavily focused on improving the management of SUDs because they see the direct economic impact they have on their costs. So what might happen to their stance on OCD if they were to acknowledge that it’s the cause of millions of Americans’ SUDs, causing untreated people like John to become at-risk? Although public health research continues to make these correlations clearer, the industry needs to collect more population-level data so payers can see the long-term cost savings opportunity associated with reimbursing OCD treatment.

But it’s a story that can have a happy ending.

Is there really a way to align the economics of the OCD treatment system so the 2,000 OCD specialists in the U.S. can help the millions of untreated OCD patients like John get insurance-covered care without having to exert more time and effort?

With technology, the answer is yes, since it will allow the same number of providers to coordinate care more effectively and see a far greater number of patients. Imagine a world where anyone with OCD can see a specialist once a month, talk with a team of OCD teletherapists and peer support specialists every week, enjoy 24/7 access to a digital platform for CBT and ERP, and connect with others who understand their experiences in an online support community. With this tiered model, patients can effectively get care whenever they need it. And it makes sense financially for this treatment model to be covered by payers and promoted by providers.

In a tiered OCD treatment model, payers can save money on treatment both immediately and long-term, as the cost of treating each patient per visit will decrease. Patients would see their specialist provider about half as often, and would get quicker access to care, preventing them from developing severe and costly comorbidities.

In addition, OCD specialists can see more high-acuity patients each hour, as they can refer a larger percentage of their caseload to OCD coaches who manage the middle of the pyramid and help the specialists see six times as many patients per hour, on average. By allowing specialists to see more high-acuity patients, they can generate much more revenue, as a larger percentage of their patients will need more healthcare-related services.

The incentives are aligned in a tiered system, helping patients get better more quickly and more reliably, relieving the intense pressure providers feel today, and limiting costs for providers. 

Here’s an example of the impact that steps-based care could have for people with OCD, like John, in New York City alone.

In the New York City metropolitan area, there are roughly 20.3 million people. By the national average, about 500,000 of them are probably struggling with OCD. Public health research suggests that only about half of the OCD population seeks treatment– about 250,000 people in the NYC area.

Based on nOCD’s data, there are about 200 clinicians in this area who are trained to effectively treat OCD, which indicates that each provider would need to have the ability to see about 1,250 patients per month. That would be about thirty times as many patients as they see today, based on the national average. With a steps-based care model, the cohort of people with OCD whose symptoms are most severe– about 10%, or 50,000 people– would go to appointments weekly. At these visits, they’d see an OCD specialist for about 10 minutes and an “ERP administrator” for the rest of the time.

With this structure, an NYC OCD specialist would see the 250 most severe patients three out of five days each week. Then, the 200 providers would spend the remainder of their week seeing about 1000 patients whose symptoms are less severe– people who can go weeks or even months without seeing an expensive specialist while getting care from a combination of free technology, low-cost peer supporters, and teletherapy-based OCD coaches.


Given the need for more OCD-specific coaches, ERP administrators, peer supporters, and free technology, nOCD is committed to creating this “middle of the pyramid,” aligning the treatment system’s economics in a way that offers people with OCD like John access to care– no matter their age, location, or socioeconomic status. We’re training providers to specialize in OCD, creating innovative technology, and spreading awareness, so people with OCD everywhere can feel better. As 2018 progresses, be on the lookout for updates on nOCD’s work of bringing always-on care to everyone with OCD. Thank you for your support.

Thanks to Stephen for sharing this article with us today.

A Difficult City: Living with OCD in NYC

By Patrick,

As summer 2016 came to an end, the comedy writer Mike Sacks penned a lifestyle piece for the New York Times detailing what it’s like to live with obsessive-compulsive disorder in New York City. On first read, the piece feels like another relatable story laced with the kind of self-deprecating confessional comedy we’ve come to expect from a genre that’s important for obvious reasons but has also verged on cliché over the past few years: the mental health memoir piece whose major statement is “You didn’t know this about me, but I’ve been struggling.”

But, if we look more closely, there’s something of greater interest in Sacks’ piece. It suggests that mental health is a geographical problem as much as anything else: in what ways can the place you live make your symptoms more or less prominent? He writes about OCD, but the implication is that the geographic effect spans all of the feelings and behaviors commonly slapped with the label mental illness. Here is Sacks’ comparison of the years he spent in the suburbs with his time in such a big city:

The ’burbs are not a bad setting for O.C.D. — serene, very few surprises. A stranger is unlikely to vomit near you. Chances are low that a fellow commuter will sneeze in your face.

New York, where I prefer to live, is another story. It’s a difficult city for the handicapped, the elderly, the poor and anyone who lives beyond the reach of public transportation. I am able-bodied and relatively young, and I live close to subway stations and bus stops. I’m lucky.

His acknowledgement of how hard life can be in NYC if you’re handicapped, elderly, or poor is genuine; but it’s also a setup for what he’s about to say. Because, of course, Sacks is unlucky in another way. He’s able-bodied, but his mind is a trickster. He’s stuck, like many of us, between seeing the things he does as symptoms of mental illness and just seeing them as part of who he is– simply the way he likes to do things. Let’s read a bit further:

One of the intoxicating things about living in the city is that it’s forever requiring Da Beast to add new and exciting tics to its arsenal. We’re both out of our element, constantly on guard, wending our way through a barrage of horror triggers. New York has become the setting for free immersion therapy.


The details of Sacks’ daily life reflect a wide range of OCD symptoms, which he semi-lovingly lumps together as Da Beast. (Clinicians would call this defusion, because framing one’s thoughts as a separate entity can help detach them from the emotions that usually follow closely.) Da Beast is immediately recognizable to those familiar with obsessions and compulsions, and probably infuriating to anyone who isn’t. Why can’t Sacks just ride the subway without using a glove to hold on to the rail, or ignore the vomit produced by a nearby kid and keep talking with his friend, like the rest of us?

In what ways can the place you live make your symptoms more or less prominent?


The point isn’t to suggest that it’s easy to live with OCD outside of a city. But for Sacks there are simply more triggers for his obsessions in the uncontrolled environment of a large city. Even the most meticulous routine (studies suggest both that people with OCD are more locked into routines and that these routines are less productive thanks to compulsive behavior) will be interrupted because there are so many more variables. People tend to do things publicly in big cities that they might not do in the suburbs, partly because there’s nowhere else to do them– there’s no such thing as a truly private place in a city. After all, besides furthering racial segregation, one of the original aims of the suburbs was to give people distinct spaces where they wouldn’t have to interact with anyone outside of their household.

Nor is Sacks saying that life in the suburbs is better– he says a few times that he likes NYC a lot, and his overall tone reflects his half-sarcastic statement that the constant addition of new triggers in the city is intoxicating. First of all, everything in OCD treatment suggests that avoiding anxiety is one of the surest ways to make that anxiety worse over time. And being in the suburbs can exacerbate other aspects of mental illness. Unsurprisingly, the social isolation in many suburbs– which tend to have fewer public spaces and a clearer distinction between people’s private domains– fosters loneliness.

Further, some psychologists say that people naturally feel more at ease in cities, which are planned with a certain level of geographic order in mind (whereas suburbs can feel more scattered and detached). Admittedly, these claims feel like they require further investigation, because we could just as easily suggest that the relative anonymity and hectic nature of a city can promote loneliness and agitation. But anyone who has lived in a suburb knows that you can much more easily find yourself cut off from other people.

But, even if living in a city has potential benefits and complications for people struggling in all kinds of ways, what’s special about New York City? It has a ton of people– 8.6 million of them. That’s almost 5 million more than Los Angeles, the second biggest city in the US. But New York City isn’t actually that big in terms of land area. In fact, it’s only the 24th largest city in the United States by square mileage. Why am I listing a bunch of statistics? Just for fun…

And also because they lead to something more interesting: New York City has the 6th highest population density of any city in the US. All of the top 8 densest cities, and 12 of the top 20, are in the New York City metropolitan area. There are tons of people living in small spaces. Though admittedly half-baked, a theory is lingering in the shadows. Of those variables we mentioned earlier that lead to uncertainty, the most prominent is other people. The reason people tend to love visiting NYC is the same reason lots of people who live there feel like they need to move away after a few years: there’s so much going on. Lots of “exciting and new” things for anybody’s beast to feed on.

Many of the things that lift our mood also awaken our anxiety. Being with other people, finally going to the gym after a few lazy weeks, drinking espresso: feeling less down means getting energized, and sometimes getting energized means feeling anxious too. Cities inject all kinds of energy into our daily experience, for better but also for worse. In New York City the scale is that much bigger, the vomit that much more common.

If there’s more to encourage anxious responses, though, there can also be more access to certain kinds of resources. With its high population, abundance of universities, and countless mental health organizations, NYC is one of the nation’s (and the world’s) hotspots for OCD treatment. Unlike in rural areas, just about anyone in NYC is probably within an hour and a half (by public transit, if the trains aren’t stopped) of an OCD specialist.

But even given the significant advantage of relative proximity, cost remains a huge barrier. With a cost of living about 70% higher than the US average, it’s hard enough to make ends meet that adding expensive OCD treatment seems like a distant dream for most people. You might be able to find a clinician charging something near the national average, but that’s still a couple hundred dollars per hour and you probably won’t find cheaper appointments. Still, many clinicians offer sliding scales based on their clients’ income level, and this can be of tremendous help.

Besides the real things we just mentioned, much of this is only theoretical. But whether or not population density has anything to do with it, there’s an undeniable difference in the ways cities and suburbs affect your mental health. Even if you don’t have OCD, or live somewhere else, or rarely spend time in cities, your environment shouldn’t be underestimated as a factor in how you feel. And adopting one aspect of Sacks’ approach might be of use. Let’s read one more section:

I wash my hands up to 25 times per day. I perform intricate routines and complicated movements to avoid becoming contaminated. With what, exactly? Nothing specific, just a murky sense of something bad. But I also perform these tasks so that friends and family members — and even potentially you — don’t become contaminated.

It’s a lot of pressure, but I’m no hero. You can thank me later.


He’s being funny about things, and while it’s not a replacement for treatment, humor is sometimes the best (and most feasible) antidote for a condition that makes you want to take things far too seriously. Sacks calls NYC the “setting for free immersion therapy,” and this is true in a way. But you can be anxious anywhere, and learning to laugh about it is a good way to start gaining a little distance on the beast. It may still be there with you on the subway, but maybe it’ll have to ride in the next car.

Answering your questions about nOCD and Biohaven’s OCD trial

By Patrick,

For this post, we relayed five of the nOCD community’s most common questions about Biohaven’s ongoing clinical trial for OCD to their team in New Haven, Connecticut. They also provided a helpful video, which you’ll find at the end of this post. Thanks to Biohaven for answering these questions, and please contact us anytime if you have more! 

Q: I filled out the pre-screening form. Why haven’t I heard from a study site with more information?

A: The sites for this clinical trial try to follow up within 24-48 hours of receiving a pre-screening form. If you only provided your email, be sure to check your junk folder in case the site’s email was flagged as spam/junk.

Q: How is this investigational medication going to be any different from the medication I’ve tried before? 

A: Many people with obsessive-compulsive disorder– perhaps as many as 40-60%– do not respond adequately to first-line medications (typically the SSRI antidepressants like Prozac and Zoloft). In these cases, it is common to add a second medication, to build on or augment the effects of the first. Antipsychotics, glutamate modulators, and other serotonergic drugs like Buspar (buspirone) and Zofran (ondansetron) have all been studied for augmentation in clinical trials.

The glutamate modulator riluzole has also been studied in this role, and preliminary studies suggest that riluzole may improve OCD symptoms in treatment-resistant patients. We are studying trigriluzole, which acts in the body very similarly to riluzole, as a new way to augment current standard of care response. At Biohaven, we will explore glutamate modulation as a potential treatment option for the 40-60% patients with OCD not helped by first-line medications.

Whereas existing medications for OCD usually target the neurotransmitters serotonin and dopamine, trigriluzole targets the neurotransmitter glutamate, which has been implicated in the pathophysiology of OCD in both animal and human studies. Trigriluzole could provide an alternative to current options for augmentation of standard of care treatment due to its potential to modulate excessive glutamate, which may play a role in some cases of OCD.

Q: Why is this study only happening in the United States?

A: Due to the number of people needed to participate in this clinical trial and the complexities involved in global trials, it was determined that it would be most efficient to complete this trial exclusively in the United States. If additional OCD studies are required, it’s possible that these future studies could be conducted globally.

Q: Why might it be worth taking part in this study?

A: People participate in clinical trials for a variety of reasons. Clinical trial participants might want to try something new, and might be interested in receiving investigational medication, study-related evaluations, and medical care. And some feel that by volunteering they are contributing to science’s forward progress by helping researchers find better treatments for future patients.

Q: I feel stable right now. Why change something and risk getting worse again?

A: Participating in a clinical trial is a personal decision. If you feel your current treatment is working for you, you probably wouldn’t be an appropriate candidate for this trial. But if you don’t think your current treatment is working well enough, you might be interested in learning more.

That said, here’s a bit more information on the overall profile of trigriluzole, the investigational medication in this study. It’s a glutamate-modulating agent that was developed as a prodrug of riluzole. A prodrug is an inactive medication that is converted into the active form of a drug once it has been ingested. After a patient takes trigriluzole, the body converts it into the active drug riluzole, which was approved by the FDA in 1995 for the treatment of ALS (amyotrophic lateral sclerosis) and remains the only FDA-approved drug for this disease. 

Additionally, riluzole has been studied in clinical trials in patients with OCD. As riluzole has been used since 1995 in the treatment of ALS, it has an established safety and tolerability profile. Trigriluzole, which was developed to avoid some of riluzole’s limitations, might offer a number of advantages. Riluzole is dosed twice daily, whereas trigriluzole is dosed just once daily. Additionally, patients need to fast before and after taking riluzole, as food can affect its absorption. Trigriluzole does not require any special meal restrictions. 

Patients who enroll in this study have the option to continue in an open-label phase at the end of the study phase, where every patient can try trigriluzole.

Thanks for your questions! Now here’s a helpful video with Dr. Vlad Coric, CEO of Biohaven:

To learn more about the study, please fill out a pre-screening form:

Learn About OCD On Our New Website

By Patrick,

Screenshot of new website section

It doesn’t take long to realize that there’s a ton of misunderstanding about mental health. Across the internet, people misrepresent other people’s pain or turn it into jokes. And things are no better in the real world, where there are virtually no good ways for people to learn about mental health and misconceptions seem contagious.

In countless discussions with expert clinicians and researchers over the past few years, the nOCD team has confirmed what we sensed during some of our own struggles with mental health: the general lack of awareness creates a whole bunch of problems that make tough situations much tougher. Because they’re not aware of any other way to see it, people struggling with all kinds of symptoms spend years blaming themselves, feeling completely alone in their distress, and believing there’s little to no chance they’ll ever feel better.

Talking about OCD without mentioning specific uncomfortable thoughts is like talking about basketball without mentioning the ball or the hoop. People might understand that there are ten people running around, but they’ll have no idea why.


Meanwhile, too many friends and family members unknowingly add to the problem by giving unhelpful advice, promoting maladaptive behaviors, and blaming the person for their symptoms. And research tells us that doctors– from primary care providers all the way to psychiatrists– misdiagnose these conditions at alarmingly high rates, and shy away from implementing the best treatment options even when they’ve made an accurate diagnosis because those options seem too risky– or simply because they’re not aware of them.

A screenshot of the Treatment section

This therapist has a lot of paper to fill in

Although we like to think things have improved meaningfully in places like the US or the UK, the general public still tends to act out of fear, not understanding, when confronted with what seems like another person’s psychic distress. Do you remember the last time you were out somewhere and you saw someone who was clearly not in a good spot mentally?

Did you and other passersby know what to do, and did anyone stop to ask if that person was alright? Or did everyone steer clear of them, as most of us do? Even if we sense that a person right in front of us might be in trouble, we do whatever we can not to get involved. This often seems like the only choice we have, but only because our social institutions generally do a terrible job of making sure people know how to help one another.

A picture of the section which addresses the best medication options for OCD

Who knew that people take closeup photos of pills?

This doesn’t mean we all have to sew a cape and become superheroes; the decision to act is another thing entirely, but the fact that nobody even knows what they could if they wanted to help is reflective of the near-complete lack of support structures for people with psychiatric conditions.

Before we finally get to the main point, let’s briefly sum up the major ways that mental health misunderstanding makes things worse:

  1. People feel like they’re to blame for their struggle, and don’t seek treatment because they don’t know there’s any way to feel better.
  2. Family and friends inadvertently exacerbate problems because their notions of what’s happening– and the ways they respond to those notions– are based on worry or fear, instead of understanding.
  3. Even doctors tend to have a pretty scattered understanding of these topics, leading to tons of misdiagnosis. People often don’t get the best care possible, and those seeing multiple clinicians can get caught in a swirl of contradictory opinions.
  4. People don’t help each other out very often, because they’re afraid, because they don’t understand.

Now that we’ve gone on about some big, long-term problems, we’d like to introduce what we hope will be a small but important part of the solution. If you’ve been keeping an eye on our website recently, you might’ve noticed a few new words along the top. It says Learn About OCD, and it’ll bring you to a new section of our website that we hope will help us all chip away at the vast misunderstandings people with OCD deal with every day. And although OCD education is only a start– a meaningful start for us because half of our team members have it– we hope that it might also offer some ideas for people looking to understand other conditions.

Another screenshot of the Learn About OCD section of the new nOCD website

Yep, this is also a picture that you can click.

A few quick notes about this new section. Our main goal was to make it a bit less clinical, but also less focused on venting, compared to most of the OCD content you’ve probably seen across the internet. We want it to be mostly about what it actually feels like to have OCD, but we also filled it with the latest and best research. We believe all steps in the mental health journey– from the creation of distinct diagnoses by the people who write those huge manuals, to the hard work people put in with their clinicians– should be in the service of helping people feeling better. The clinical stuff always needs to be a means to an end, and that end is the lived experience.

We still wanted to make sure, as always, that we weren’t saying anything out of line. That’s why we worked closely with two of the finest OCD clinicians in the world, Dr. Michael Jenike, MD and Dr. Christopher Pittenger, MD, PhD. They very generously read our many drafts and helped us hone this new material until it was ready to be seen by other people. We owe Dr. Jenike and Dr. Pittenger a big thank you– a debt we only partially fulfilled by placing purple cartoons of them at the bottom of each page.

This is part of the Symptoms section

You might notice a few places where this section of the website gets intense or even graphic, and that was intentional. The biggest reason OCD is so difficult to live with is that people are deeply disturbed by their thoughts. It’s not a matter of preference– just wanting things to be done a certain way– or a strange personality quirk. It’s a condition of constant inner disturbance, and we know that the general understanding of OCD isn’t going to shift in a useful way if we’re not all clear on what OCD is.

Talking about OCD without mentioning specific uncomfortable thoughts is like talking about basketball without mentioning the ball or the hoop. People might understand that there are ten people running around, but they’ll have no idea why. The thoughts that become obsessions usually aren’t pretty, but they probably wouldn’t bother people much if they were. Still, we thought it’s important to mention that they’re all real. We’re not making things up to shock you; we all know there’s enough shocking and fake stuff on the internet already.A screenshot of the subtypes section of OCD, showing Harm OCD and Homosexual OCD

Of course, we’d be thrilled if you checked out this new part of our website. It was also created in the hope that people would share it with one another whenever the need arises. If you find it helpful, and you’ve got a friend who keeps misusing the term OCD or a sibling who has mentioned similar symptoms, please share it with them. We’ll be continuing to refine this new education section, and adding to it whenever needed. If you want to be a part of getting the word out, we’d be really grateful if you shared it on social media too.

Thanks for reading, and please contact us at @treatmyocd on Facebook, Twitter, or Instagram with any questions or comments.


Avoidance, Anxiety, and OCD

By Patrick,

It was another cold night in Chicago- a bit like saying it was another sandy day at the beach- but it was also St. Patrick’s Day, and I felt a bit like I’d failed when evening arrived and I still hadn’t done much all day. Trying to ignore that particular anxiety and make way for other ones (maybe some joy too), I was on my way to a karaoke place with a friend and a few people I’d never met. We squeezed onto a Red Line train, trading stories of all the drunken absurdities we’d witnessed around the city that day, and headed south toward Chinatown.

At some point, everyone started asking each other what their go-to karaoke song was. I hoped the discussion would fizzle out before it reached me. I didn’t have a song in mind, because I had always refused to do karaoke. Still, I tried hard to think of a song, and nothing came to mind besides a few of Beyoncé’s power anthems, which I obviously couldn’t sing. I would just say I didn’t have a song, and probably wouldn’t be singing anything. And then I would fend off the inevitable protests until everyone became worried about pushing too hard on someone they’d just met.

Photo by Victoria Heath on Unsplash

When someone avoids a person, place, or thing out of anxiety, it usually means they don’t feel comfortable with not knowing what might happen. They might have a strong feeling about what will happen, and it might be based on past experience. To them, this might even feel like certainty: I’ve done that before, I know what’s going to happen. If anxiety reflects a lack of trust in the world, avoidance additionally alerts us to a lack of self-trust. People who pull out of a situation due to anxiety are operating on this core belief:  I don’t have what it takes to tolerate this right now. Avoidance functions based on anticipation: I will not be able to handle whatever ends up happening.

It can be difficult to think of avoidance as a compulsive behavior because it doesn’t seem like a behavior at all. With many compulsions you can identify a specific action: he’s washing his hands so many times, she’s checking the stove again, they won’t stop apologizing. But avoidance is more like a refusal to act: I stayed home from the party, I didn’t try out for the choir, I never ended up speaking my mind during our meeting. And I always refused to do karaoke.

Photo by Ilya Ilyukhin on Unsplash

Avoidance is less noticeable, and so can be easier to hide, than anything besides mental compulsions. It can also blend seamlessly in with the way tons of people behave anyways: Nah, I’m kind of tired, I think I’ll stay in and watch something on Netflix. Further complicating things is the overlap between avoidance and self-care. If you refuse to speak again with someone who has been unkind, are you avoiding it or taking care of yourself? If you’ve had a long week and you feel reluctant about spending Friday night with a struggling friend, would you be avoiding it or taking care of yourself?

Clinician responses to these questions tend to rely either on the case-by-case (you’ll know avoidance when you see it) or on the idea that your values should determine when you’re avoiding things and when you are simply making necessary choices about what to allow into your life. And this last part makes some sense: nobody can do everything, or let everything in. You have to cut things off somewhere, but how do you know where?

Everyone avoids things. But this is sort of like saying everyone washes their hands, or everyone apologizes. The key issue isn’t the existence of a certain behavior, but the frequency with which it’s performed. This frequency usually points to a perceived inability to act in any other way on a consistent basis. In other words, people who avoid things frequently tend to believe this is the only way they can behave: it’s just the way things have to be, unfortunately.

Photo by Ethan Sykes on Unsplash

The precise origin of human behavior (or emotion) is often much murkier than research papers might have us believe. Was I avoiding karaoke because I had tried it before and been booed off the microphone, coping for days afterward with the pain of embarrassment? Not that I can remember, but maybe avoidance isn’t so specific. Perhaps I had felt ashamed in a social situation and didn’t want to risk it again.

As the neuroscientist and New York University professor Joseph LeDoux tells it in a 2013 opinion piece for the New York Times:

Cues associated with a trauma or other stress may start out with a narrow focus— the place where something bad happened— but may widen to include similar places, things or situations.  People with anxiety become very good at avoiding these cues as a way to control anxiety. Avoidance can be so effective that it prevents one from recovering from trauma or otherwise dealing with anxiety.


Interestingly, LeDoux’s op-ed is called “For the Anxious, Avoidance Can Have an Upside.” What’s the upside? LeDoux suggests that, while generally unhelpful, not all avoidance behaviors are created equal. He writes at length about a 2001 study in which rats were subjected to a mild shock after hearing a noise. Although we’ll skip over some of the details here, most rats would respond to that sound every subsequent time they heard it by freezing up completely– an attempt to avoid the shock. But a few rats learned to perform specific actions, like running all the way across their box, that the researchers rewarded by not shocking them.

For social anxiety, according to one of LeDoux’s colleagues, the human version would be to partially avoid things when needed, as long as that partial avoidance is in the service of not avoiding something larger or more important. It’s better to step out of a meeting a few times to take a breath outside, or to focus on your breathing during that meeting, than to skip the meeting entirely. It’s better to let yourself look at your phone a few times during a family gathering than to pretend you’re sick and miss the whole thing.

What LeDoux suggests isn’t the purest form of confronting your anxiety, and it might not work as well for some conditions. But it’s realistic, and it makes more sense than trying to suddenly change everything about your behavior. Plus, learning to constantly adapt your behavior is more important than any specific technique.

Since we’ve talked a bit about compulsions, let’s take a closer look at avoidance in OCD, which can operate differently from other anxiety disorders. In fact, with the 2013 arrival of the DSM-5, OCD is no longer even considered an anxiety disorder. Of course, we know that both OCD and anxiety disorders involve heightened levels of anxiety and stress, specific sets of symptoms, and dysfunction across multiple facets of someone’s life. But, diagnostic pickiness aside, it’s useful to think about the ways in which OCD and something like social anxiety aren’t similar.

Whereas generalized anxiety disorder (GAD) and social anxiety tend to be more diffuse– meaning they tend to involve a more constant level of anxiety in response to a wide variety of stimuli– OCD tends to be highly targeted. People with OCD might also have a higher baseline level of anxiety throughout their lives, but a defining trait of the condition is that particular scenarios cause huge spikes in anxiety.

Because it involves such specific responses to particular situations, OCD often requires more targeted interventions. And unless you work on decreasing those responses, the anxiety fueling them tends to get worse. Since avoidance usually has the same goal as compulsive behaviors, and it’s performed in anticipation of specific scenarios, it basically is a compulsion. This makes things slightly more complicated for people with OCD, because the goal of treatment is to stop performing compulsions when obsessions and the accompanying anxiety arrive.

There’s no straightforward answer, but of course the best option is to try not to avoid things if avoidance has become a compulsive response to anxiety. If you’re working through exposure and response prevention (ERP), treat avoidance like any other compulsion– except for the fact that it’s arising due to your expectations about the future, not your beliefs about the present. So an exposure might involve going to whatever you’re tempted to compulsively avoid. But the distinction about avoidance being an anticipatory act, rather than a reaction, is important because it often makes avoidance trickier to spot. You’re not in the situation yet, so it’s a bit harder to have the self-awareness to tell yourself “Here I am in this same spot again, behaving the same way.”

Photo by Joshua Rawson-Harris on Unsplash

Even for people with OCD, some aspects of LeDoux’s advice can be helpful in tight spots. Progress earned through ERP work, known as the gold standard for OCD, is notoriously quick to slip. That doesn’t mean exposure and related techniques are unimportant. But they’re often not enough, and they need to be paired with other strategies because “recovery” from anxiety disorders and OCD is a constant process, not a destination. Understanding avoidance is key to understanding OCD, but despite the fact that avoidance has the same goal as most compulsions, it may require a more nuanced and flexible treatment strategy.

Whether you’re dealing with social anxiety, OCD, or something else, it makes sense not to avoid things that are in line with your values. So if you value social connection, don’t turn down an invitation to stay home. If that’s too overwhelming, you may need to allow yourself to slowly work your way toward the things you value by performing less significant avoidance behaviors while you’re out doing things. Mental health isn’t all-or-nothing, and small victories are better than spending your life feeling defeated.

I sang a bit of karaoke that night, by the way, but Frank Ocean probably would’ve winced if he heard my version.

How to choose a therapist or psychiatrist

By Patrick,

1. Lay out a few treatment goals for yourself

Maybe you’ve spent the past few years really nervous about trying therapy, or sure that you don’t need it. Or maybe you’ve been in therapy before and you just want to do a bit of psychological touch-up because life is always throwing new situations at you.

Whatever your experience with therapy has been, and whichever diagnosis you might have received, the most important thing is knowing what you want to get out of therapy. There’s no point in going just to go, so while your goals will continually change throughout your time in therapy, try to chart out a few main objectives that you can share with prospective clinicians when you give them an initial call.

You might say something like: “Hello, I’m Bob, and I’m 30 years old. I’ve been really struggling lately with social anxiety, and my main goal is to feel more comfortable meeting people because avoiding social situations just ends up making me lonely. I also feel pretty panicked whenever someone disagrees with me at work, so another goal I have is to tolerate disagreement without taking it so personally and so seriously.”

2. Choose the type of clinician you’d like to meet with

You may or may not have preferences about this. The most obvious choice to make is whether or not you want to see someone who can prescribe medication– if so, the only option among mental health practitioners is a psychiatrist. Of course, other clinicians can always refer you to a psychiatrist, but know that psychologists, social workers, and counselors cannot prescribe. Often people will see a psychiatrist for medication management and a therapist for, well, therapy.

Of these other three, psychologists typically have the most traditional schooling because they’ve had to complete a PhD. This matters to some people, but not to everyone. Social workers and counselors have special licenses, but haven’t always done as much research work as psychologists. The other factors on this list will often be more important as you determine which clinician to schedule an appointment with, but it might help if you do a little research of your own on these different types of clinicians and decide how much the differences matter to you. In the real world, it often barely matters which degree someone has.

It’s perfectly alright not to know yet what kind of mental health professional you want to see, or whether or not you’ll want to try medication. You’ll figure these things out over time, and it’s pretty rare that someone sees just one clinician throughout their treatment. But if I can put my own experience to use here, I’ve found that psychologists tend to be a little more “by the book” and a little more specialized than the others.

Friends who were more interested in generally feeling better often found social workers and counselors quite helpful; but those with more specialized concerns, like obsessive-compulsive disorder, found that psychologists were more likely to have a detailed understanding of them.

3. If there’s a specific type of therapy you want to do, keep that in mind

There’s a bunch of different types of therapy. Cognitive behavioral therapy, or CBT, has been the biggest in the US and most other western countries for a few decades. But a number of other forms of therapy, like ACT and DBT, are also worth looking into.

Once again, the type of therapy might not be as important of a factor for you, especially if you’re just starting out. That’s fine– each type can offer you something useful, and each has its drawbacks. But if you’re looking for something more specialized, like Exposure and Response Prevention (ERP) for OCD, then you might need to look a bit harder before you find someone who’s been trained in it.

4. Decide how far you’re able to travel to see them

This one can be hard to remember when you’re just starting out, but unless you have no choice you’re probably not going to want to travel an hour each way to see your therapist for 45–60 minutes. You don’t want to set up your treatment to fail, so be realistic with yourself, knowing that you’re going to be making the same trip, back and forth, every week for an extended period of time. This also depends on the type(s) of transportation available to you. And the more specialized your needs, the farther you might need to go.

5. Figure out how much you’re able to pay

Unfortunately, mental health treatment is really expensive. And it usually gets more expensive with each layer of additional training. This also varies by location and demand, but many psychiatrists charge at least $400 per hour. Insurance coverage (see #7 below) can also make the cost less overwhelming, but you’ll typically still be paying at least a portion out of pocket.

Therapists are usually a good amount cheaper than psychiatrists, but you’ll probably see them more often, and for longer appointments. So you still end up feeling like you’re paying a lawyer or something. And any kind of specialization tends to make things pricier. Unfortunately, whenever the supply is lower, the price goes up; there are fewer people trained in ERP, for example, so their appointment books tend to be jammed and they can charge a lot.

I wish I could say cost shouldn’t be a determining factor as you consider mental health treatment, but that would be a bit naive. Still, there are ways to make things less expensive- more on that below.

6. Decide when you’re free for appointments

Most clinicians work hours sort of similar to the rest of the 9–5 world. Sometimes they’ll stretch out their day in one direction or another, and a few will see patients over the weekend, but if you can find a few ways to be flexible with your own schedule you’ll have more options.

Don’t worry yet about trying to find a time that will work every single week. But go in with a sense of when you’re usually free, and a specific idea of times you could go in for a first appointment. If you’re only free on Mondays at 7pm, you’ll need to jot down quite a few phone numbers.

Photo by Estée Janssens on Unsplash

7. Take a moment to find your insurance card

Nobody ever wants to talk about insurance– and, to be honest, I don’t really either. But, even for those fortunate enough to have health insurance, it’s a constant battle for people undergoing mental health treatment. Therapists, and especially psychiatrists, can be unaffordable if insurance isn’t footing at least some of the bill, so it’s good to know what to expect in terms of coverage.

If you don’t have insurance, and paying out of pocket isn’t a viable option, it’s worth looking for providers who offer a sliding scale for payment. This is something you’ll need to discuss with them during your initial phone call or first appointment. Don’t be afraid to ask about payment, because you’re certainly not the first person to mention it.

If you need someone who takes a specific kind of insurance, say Blue Cross or Aetna, your insurance provider might have an online portal for finding clinicians. These will limit your choice, but might save you a headache further down the line. Check out the insurance provider’s website or give them a call to find these resources. Otherwise, it’s often possible to pay upfront and submit the bill to insurance for partial reimbursement. Check this ahead of time, or you’ll add a headache on top of your mental health concerns.

8. Find a bunch of clinicians, call them, and narrow it down

Once you’ve considered all these factors, do a lot of Googling, ask people you know for suggestions, use online directories, and use your insurance provider’s portal, if applicable. If one mental health professional tells you they’re all booked, ask them if they wouldn’t giving you a few names of people they’d recommend. Calling a good number of therapists or psychiatrists will make sure you’re not stuck without one when you call the first one and something seems off.

What might you look for during an initial phone call? All the things we’ve addressed so far would be good typical considerations. Also, if you have a strong preference for a mental health professional with specific characteristics (e.g. gender, race, political identity) you might be able to discuss these– or discern them– at this early stage. And just make sure there’s nothing that makes you feel weird about them after just one phone call. I’ve never heard of this happening, but it seems possible.

9. Now do an initial appointment with one or more of your options

If you find someone who seems like a good match and you have mutual availability, go in for an initial appointment. They’ll probably have you fill out a bunch of thrilling forms and inventories, but you should also get a chance to ask them questions. This is a good time to get an overall feel for the way they like to approach treatment. And just be mindful of the way you feel around this person. Your goal is to have them as a collaborator in your journey toward feeling better, learning more about yourself, and meeting the goals you laid out in Step #1 above. They’re not a friend or romantic partner, but you definitely shouldn’t dislike them either.

Does their style of questioning make you uncomfortable? Do they speak too much, leaving you feeling more like you’ve just left a lecture hall? Do they say nothing at all, or do they seem distracted? These could all be red flags for you, and you have no obligation to continue with someone just because you’ve done a consultation, or even a bunch of appointments, with them. The nice part about all of this is you get to make your own decisions, and figure out what works best.

It can be a bit awkward to tell someone you’re going to look for other options instead, and it might even feel like you’re letting them down, but if something really puts you off then it’s not worth going back. The nice part is you can do this whichever way feels easiest: phone, email, in person. Usually none of this happens, because there are countless good clinicians out there. But it’s worth mentioning simply because it’s never helpful to feel stuck with a therapist or psychiatrist who isn’t a great fit.

10. Try it out– you’re allowed to change your mind

If you’ve found someone you like enough, you’ll just have to work out a time to come back and start working on the better stuff– now that those forms and inventories are hopefully a thing of the recent past. As studies of the relative efficacy of different forms of therapy and countless real experiences continue to demonstrate, the “fit” between clinician and patient is the single most important predictor of treatment success. In my experience, you don’t really need to look forward to therapy exactly, but you probably shouldn’t hate it either.

Try to go in with an open mind, because new perspectives on your life can arrive with thrilling frequency. Therapy is never a magic potion, but at its best it can help you help yourself much more effectively. It can open you up to possibilities that you’ve always wanted to realize, but could never quite arrive at. Whether you’re trying out medications, just talking with someone, doing a specialized form of therapy, or combining all of it, there’s a lot to learn, and much to gain.

Find out more about nOCD’s research mission here.

Other thoughts? Tell us in the comments.

Building a genuine life with OCD: Expert tips from Dr. Marisa Mazza

By Patrick,

We’re featuring a series of eye-opening op-eds by clinicians and researchers who are enthusiastic about sharing what they’ve learned through years of working with patients and conducting research.

Today’s post is written by Dr. Marisa Mazza, Psy.D, a clinical psychologist and the founder of choicetherapyin San Francisco. Dr. Mazza has received extensive training in ERP, CBT, and ACT. She’s adjunct faculty at the University of San Francisco. And, as if she weren’t already busy enough, Dr. Mazza is also on the board of OCD SF Bay Area(the IOCDF’s local affiliate) and is Vice President of the San Francisco Bay Area Association for Contextual Behavioral Science, the local ACT chapter.

Dr. Mazza is one of the most dedicated clinicians we’ve met at nOCD, and we’re grateful to her for bringing her expertise to our blog. You can find more information about Dr. Mazza’s work here. Now here’s Dr. Mazza.

Laura is a 28-year-old female who came to see me for Pedophilia OCD (POCD). During our first meeting she was tearful and scared. She muttered the words, “I am scared that I may harm children one day. Are you going to report me to the police?”

Laura believed that she might harm children one day, and this led to her spending a significant amount of time avoiding children and thinking about her fear. She avoided taking buses and walking in or near parks and schools, adding extra time to her work commute. Laura’s OCD also had a negative impact on her relationship. Her boyfriend recently broke up with her because he was tired of her not being present when they were together. Laura was too busy worrying about whether or not he would be with her if he knew she had these thoughts.

As with most people with POCD, Laura’s fears were in direct conflict with her values, like being a loving and kind person. Laura cared deeply about helping vulnerable populations, which included children. When I asked Laura what she wanted in her life she was utterly confused. “I don’t know what my life will look like with these thoughts,” she told me. When I asked about what she wanted for her future, she responded with, “I used to want a family but now I don’t think I am capable of having children. I don’t know what I want.”

Laura spent most of her time trying to escape her thoughts and feelings. In trying to escape these internal experiences, she was also losing connection with who she was and what she wanted in her life. While the drive to engage in avoidance is completely normal, if we choose to avoid our experiences most of the time then we also start to disconnect from who we are and what is meaningful to us.

The gold standard treatment for OCD is Exposure and Response Prevention (ERP). Exposure means the person gradually faces what they are scared of or disgusted by. But exposures need to be paired with response prevention, because the goal is to learn how to face that fear or disgust without resorting to compulsions. For example, Laura’s fear was that she would one day become a pedophile. Her exposure exercises included practicing having thoughts like, I may harm children one day.Her response prevention included cutting back on her typical response: avoiding pictures of kids, parks, schools, and children’s stores. She would also typically avoid her own thoughts by focusing on her work, problem solving, and repeating things like “I am a good person.” So her ERP plan included intentionally bringing on the thought “I may harm children one day” while looking at pictures, being around children, and going to parks.

“If I’m not engaging in a compulsion, then what am I doing?”

This is a question many clients ask when practicing response prevention. It was through learning about Acceptance and Commitment Therapy (ACT) and mindfulness that I was able to answer it. ACT is also an evidence-based therapy for OCD that teaches people to be willing to experience whatever shows up while committing to behaviors that are in line with what is important to them. ACT therapists often use mindfulness to teach people how to be in the present moment rather than caught in thoughts of the future or past. As a psychologist, I integrate ACT and ERP to help people face their fears, learn how to re-connect with their values, and commit to what is important.

The more we fight, suppress, or control our thoughts and feelings, the more stuck we get. It’s similar to being stuck in quicksand. The natural instinct is to fight and get out, but that instinct keeps you stuck. The answer is to surrender, be still or make very slow movements. ACT teaches us how to have (rather than fight, ignore, or suppress) uncomfortable thoughts and feelings while committing to what is important. There’s a saying in ACT: If you don’t want it, you got it.

One way we do this is by teaching people how to change their relationship with feelings. Laura had a similar response to most of my clients, which is that once she was willing to connect with her feelings and the sensations in her body, she began noticing new things. Through the process of slowing down, in exposures and in her day-to-day life, she was able to notice how she felt. By allowing those uncomfortable experiences to exist, she began reconnecting with herself and her values.

Tips for Doing Exposure and Response Prevention

So how do we get into our bodies in order to reconnect with ourselves and live a life that is meaningful to us? Doing exposures is a great first step, but the way in which you do them is also important. Here are some tips:

  1. Pick an exposure that is challenging, but not overwhelming or too easy. Ask yourself which exposure exercise you are willing to do while experiencing whatever thoughts and feelings show up. This means you are willing to lean into or feel the feelings rather than engage in avoidance, compulsions, or distraction.
  2. Don’t rush through exposures. Pick an exposure you are willing to do slowly. The point of exposures is to help you connect to thoughts and feelings. If exposures are rushed, it’s difficult to notice them.
  3. Begin the exposure and notice what the OCD says. Let the thoughts flow through your mind as though they are trains at a train station slowly passing by. You can say the thoughts out loud as they come up if this helps.
  4. Notice what feelings or urges show up by following steps 5–9.
  5. Label the feeling (mad, sad, bored, scared, etc.)
  6. What is the sensation? (tightness, tingles, heaviness, lightness, etc.)
  7. Where exactly is it located? (stomach, chest, face, etc. )
  8. What color would it be? (red, black, grey, etc.)
  9. What form or shape does the sensation have? (a brick, a ball, a knot, a fist, etc.)
  10. See if you can welcome this sensation, by feeling it as much as you are willing. Perhaps that means feeling it fully or taking it more slowly, feeling the outer edges of the sensation.
  11. Notice how long you are willing to lean into the feeling. After a minute or so, go back to noticing the thoughts as they flow through. Then go back to feeling the sensation for a minute or so.
Some helpful things to keep in mind as you are practicing this:
  1. Exposures are meant to be a feeling process, not a thinking process. You can acknowledge thoughts as they come up by saying or picturing the thought, but then shift your attention to the sensation in your body.
  2. Notice if anything gets in the way of connecting with the feeling or sensation in your body, and see if you can let go of that barrier and refocus on the sensation. Do this each and every time you get pulled away from the feeling.
  3. After doing this for a few minutes, notice any changes that naturally occur with the feelings or thoughts.
  4. In order to reinforce what you learn, you may want to ask yourself these questions post-exposure practice:
  • What did I learn or notice about my own abilities from leaning into this experience and doing this exposure?
  • What did I notice about the feelings or sensations?
  • What did I notice about the thoughts? Are they true? Can I do more than what my mind says I am capable of?

Often times, people say they notice how fluid feelings can be. They are always changing. Just like waves in the ocean, sometimes the feelings are more powerful, like a big wave, and other times they are less powerful, like a smaller wave. Sometimes different types of feelings show up. Some people will even notice more than one feeling.

People tend to notice that when they allow themselves to have thoughts they’re less believable. They also often notice that thoughts are frequently wrong, or tend to be the result of catastrophizing. The more they believe the thought, the more powerful it becomes.

In terms of abilities, people often notice they are capable of having the uncomfortable feelings and thoughts while doing something that is meaningful to them. They are capable of not knowing the outcome in situations, but still taking a risk in the service of doing what is important. ACT teaches the application of these techniques in day-to-day life by slowing down, labeling how you feel, and allowing yourself to feel the sensations. Doing this even a couple times a day can be helpful.

The interesting thing about welcoming in uncomfortable thoughts is you begin to notice all your thoughts more. Some of them might even be helpful.

For example, Laura began to notice the thought “I miss working with kids and helping people.” She labeled this thought to be in line with her values, and chose to commit to working with children, even though it was scary. Laura’s openness to her internal experiences and her willingness to do scary things ultimately helped her live a genuine and meaningful life. When we ended therapy she was tutoring children with reading problems, was in a committed relationship, and was hopeful about having her own children one day.

To learn more about ACT and ERP, you can contact Dr. Marisa T. Mazza and her team at choicetherapy or check out the IOCDF website.

nOCD is Partnering with Biohaven on their Clinical Trial for OCD

By Patrick,

Am I eligible to participate in this study?

Please see this page on our website to learn more about eligibility and sign up today.

At nOCD, we all believe that new research on obsessive-compulsive disorder (OCD) is one of the best reasons to be hopeful. Since half of us have OCD, it’s a personal conviction too. That’s why we’re excited to tell you about a new research partnership we’ve just embarked on with Biohaven Pharmaceuticals. We’ll be telling you a lot more about this partnership in the coming weeks, but for now we’d like to quickly introduce Biohaven and tell you about an important clinical trial on OCD that they’re conducting right now.

What is Biohaven Pharmaceuticals?

Based in New Haven, Connecticut, just off the campus of Yale University, Biohaven is a clinical-stage biopharmaceutical company that develops treatment candidates for neurological diseases. Led by Dr. Vlad Coric, whom our CEO Stephen found out about online and met at the IOCDF conference, Biohaven is now conducting a trial on an investigational medication for OCD.

What is Biohaven researching?

We’ve been meeting with the Biohaven team in New Haven and witnessing just how dedicated they are to bringing possible new medication candidates all the way through the clinical trial process. One of the compounds Biohaven is currently investigating, BHV-4157, is a glutamate modulator. Glutamate is a neurotransmitter, like serotonin and dopamine, but there haven’t been as many medications that modulate it. Since there’s a growing body of evidence that glutamate dysregulation could be involved in producing some OCD symptoms, Biohaven is conducting a phase 2/3 trial of BHV-4157 for OCD.

How is nOCD involved?

Because it can be really difficult to get the word out about clinical trials, nOCD is partnering with Biohaven to help get the word out about their ongoing clinical trial. It’s always been really difficult for research teams to recruit participants, partly because of the challenges of finding the appropriate participants and partly because there’s always a lot of hesitation around trials of new psychiatric medications.

This is where nOCD comes in: we can tell our community about a research team that’s mission-driven, and we can help people learn about the trial so that some of their fears might be comforted. We know there’s a lot of skepticism toward pharmaceutical companies, but we wouldn’t have partnered with Biohaven if we hadn’t seen how dedicated they are to trying new things in the hope that one of these new medications really will help.

Why is nOCD involved?

The whole team at nOCD wishes we had more effective treatment options for ourselves and others. While one can never say for sure whether or not a particular clinical trial will be successful, the constant quest to bring new medications from the minds of great researchers out into the real world is exciting and inspiring. And if we can play a role in making this process more efficient and less cumbersome for everyone involved, we’ll make our own future feel more hopeful too.

In addition, the nOCD team believes we should reconsider how we view industry research. When one pharmaceutical company is criticized, the stigma around pharma as a whole grows, making it more difficult for new research to occur. One of our main goals at nOCD is to support researchers in their work, because we believe in their potential to create much-needed change for the OCD community. Research and development of new medications to treat OCD has been lacking. This is why nOCD is excited to partner with Biohaven as they investigate a potential new pharmaceutical agent in patients with OCD in their current clinical trial.

Am I eligible to participate in the study?

Please see this page on our website to learn more about eligibility and sign up today.

Riley’s Week: Helping Others in Need

By Patrick,

This week we’re partnering with Riley’s Wish, a foundation started by Margaret Sisson after her son Riley– who struggled with OCD and a substance use disorder– passed away in September 2014, at age 25, after an accidental overdose. One of our team members saw Riley speak at the 2014 IOCDF Conference, and he was still on our minds when our CEO Stephen saw Margaret a few weeks ago. They hatched a great plan: to join forces and spread awareness with a week for Riley, in the spirit of his devotion to helping other people whenever and wherever possible.

We’re covering Riley’s story this week, and sharing content from the Riley’s Wish Foundation, because of how important it is that we all start doing a better job of caring for one another the way Riley cared for everyone in his life. But we’re also doing so because Riley’s story highlights an extremely important aspect of mental health: the fact that multiple types of symptoms are often overlapping, making things more confusing and, of course, more difficult for someone to confront.

When Riley Sisson was 25 years old, he died of an accidental overdose. Recently enrolled in a Masters of Social Work program, Riley had struggled for years with symptoms of obsessive-compulsive disorder and a substance use disorder. His friends say he was clearly struggling in the weeks before he passed away, but they also insist he never lost his characteristic empathy. Riley’s main concern was always for other people, whether they were his closest friends or strangers he’d never see again.

His sensitivity helped make Riley a crowd favorite at the International OCD Foundation Conference, where he gave speeches that helped people feel understood while making them laugh. But it also manifested in more destructive ways, as his OCD constantly latched on to the possibility that he might have inadvertently harmed someone else. According to Tim Blue, one of Riley’s friends and mentors, Riley was an hour late the last time he came over because he had been unable to leave his apartment.

Riley Sisson

One big part of Riley’s story isn’t unique. Up to 40% of people with OCD also meet criteria for a substance use disorder– meaning their use of a substance has either started to get out of their control or has entirely escaped their ability to control it. In the past few years there has increasingly been awareness of the ways that conditions like PTSD can intersect with substance use, but for some reason we haven’t also recognized the intersection between OCD and addiction. The takeaway: like with those other conditions, there’s a very strong link between OCD and substance use.

Although we don’t know all the details, remarks from Riley’s family and friends suggest he might have followed a familiar pattern: substance use can wax and wane over time, giving observers the impression that someone is doing better or worse, depending how heavy their use is at a given time. But a period of not using as heavily doesn’t equate to recovery, and it’s important that treatment is seen as a long journey, probably with plenty of ups and downs, not as a linear path ending in clear remission of symptoms.

There’s often no clear causal link between one set of symptoms and the other. Although we might be tempted to say that someone’s pain from OCD must be causing their substance use, and this might be true to some extent, the two conditions interact in more complicated ways too. For example, maybe the obsessionality gets worse every time someone sobers up, which leads to further use, and so on.

But it might be true that one condition came first, and in Riley’s case it seems like his OCD symptoms had him convinced that he needed a way out of the daily pain that this condition usually brings– not suicide, as Tim emphasizes in a heartfelt blog post, but just relief. This should remind us not only that there are vast individual differences in the ways people experience and deal with OCD symptoms, but also that those symptoms often become so painful and frightening that the risk of addiction to psychoactive substances (or really anything else) can greatly increase.

Riley with his mother Margaret and their friend

It’s hard to resist the urge to draw simple lessons from Riley’s very complex story, of which all this was only one small part. This much is clear: substance use disorders, like OCD, have no simple solution. As such, we all have a responsibility to make sure that addiction research and treatment are major priorities in our social agenda– especially given the opioid epidemic we now have on our hands.

In 2016, there were 63,600 overdose deaths in the United States, and 66.4% involved opioids. That means more than 115 people died every day of an opioid overdose.

But what’s also clear is that many people do benefit tremendously from the treatment options available today. Riley’s mother, Margaret, was kind enough to share these resources on the treatment of substance use disorders. Please share these with anyone who might benefit:

Substance Abuse and Mental Health Services Administration

Kennesaw State University Addiction and Recovery Center

The Phoenix — Sober Active Community

Skyland Trail — Residential Psychiatric Treatment

Addiction Center — Referral Service

Alexian Brothers — Residential Treatment Center

Special thanks to:

Margaret Sisson, Riley’s mother and Executive Director of the Riley’s Wish Foundation, who gave us everything we needed to tell this very small piece of her son’s story. Margaret also directed us toward the following writers. . .

Shannon Shy, whose blog post provides much-needed context for our attempts to grasp even a few of the many complexities of Riley’s life.

Tim Blue, whose aforementioned blog post offers tragic details about how difficult things often were for Riley, and how caring he remained despite all that difficulty.

Glutamate: Why it might matter for our mental health

By Patrick,

The human brain is the most complicated object in the known universe. The exact number is up for debate, but scientists believe there are something like 86 billion neurons in each of our brains. And those neurons aren’t lonely, either: each one connects to approximately ten thousand other neurons.

Unlike us, our neurons don’t network with handshakes and business cards. They use chemicals called neurotransmitters to communicate with other neurons, muscle cells, and gland cells. This process is important in just about everything we do, and although there’s still a lot that nobody knows about neurotransmitters, it seems like a safe bet that having them function properly is important.

Depending how you count, we have approximately 100 neurotransmitters. But, sort of like the elements that make up the universe, a couple of these neurotransmitters are much more abundant than others. Unless you’re a neuroscientist, most of the peptide neurotransmitters probably won’t ring a bell. But some of the small-molecule neurotransmitters might be familiar:

epinephrine (adrenaline)

These are the ones that people talk about, and sometimes misuse in overconfident assessments of various phenomena. It felt good when I looked at my cell phone? Must have been a spike in my dopamine levels. I’m feeling a bit sad lately? I really must be lacking in serotonin.

Although our society continues to race ahead of our scientists, using neurotransmitters as explanations without any deeper understanding of them, there can also be bits of truth in these explanations. For example, many researchers and clinicians still believe that serotonin has something to do with depressive episodes, even though pretty much everyone has agreed that a simple lack of serotonin isn’t their cause. And dopamine is probably related to reward and pleasure, even though this mechanism isn’t as simple as it was originally made out to be.

So what about the other neurotransmitters on that short list above? At the bottom are GABA and glutamate, respectively the main inhibitory and excitatory neurotransmitters in our brain. You can find some good explanations of the excitatory vs. inhibitory thing online, but for now it’s good enough to know that an excitatory neurotransmitter makes it more likely that the receiving neuron will fire; an inhibitory one does the opposite.


For a number of years, it’s been hypothesized that the interplay between GABA and glutamate has had something to do with anxiety and mood. GABA has gotten a good amount of attention as far as potential treatments are concerned, most notably with benzodiazepines like Klonopin and Valium, which offer short-term relief of anxiety by enhancing the effect of GABA at a receptor.

But the role of glutamate has been recognized more slowly, and only recently has this rather abundant neurotransmitter taken on a central role in research. For anxiety more generally, and OCD in particular, there’s strong preliminary evidence that dysregulation of glutamate could play an important role in creating some of those unpleasant symptoms.

This, of course, leads researchers to believe that treatments which get glutamate activity back to normal might help people feel better. That’s why many of the investigational drugs being studied right now do exactly that. For example, there’s exciting new research on a compound called BHV-4157, a tripeptide prodrug of the glutamate modulating agent riluzole. A tripeptide is just three amino acids linked together. And a prodrug is basically a precursor to a drug that needs to be metabolized into an active drug.

BHV-4157 is being developed for the potential treatment of OCD as adjunctive therapy to standard of care treatments in those who have experienced an inadequate response to standard pharmacotherapy. In other words, these researchers are hoping it might help people who are already trying the widely accepted treatment options for OCD (like Prozac or Anafranil) but aren’t getting the desired results from them.


Although riluzole was originally used to treat ALS, it had promising results for augmentation of OCD treatment in a study at Yale University. Now more research is needed on compounds like BHV-4157 to see if they bear out the hypothesis that dysregulation of this excitatory neurotransmitter could be a contributing factor in OCD.

We’ll be following closely for more results from studies of glutamate modulators, hoping along with everyone in our community that promising new treatment options might be on the way sometime soon. There are few things more exciting (but not necessarily excitatory) than new research on mental health, so please feel free to let us know what you’ve been hearing about lately.

If you have OCD, you might be eligible to participate in a study involving an investigational medication that would be added on to your current treatment. To learn more, click here.

Why OCD recovery isn’t about fighting

By Patrick,

Having obsessive-compulsive disorder can be pretty tough. For some people, it becomes so severe that it can shut down their lives completely. So it makes sense that many of us are extremely focused on getting better. But is there a point at which this focus becomes fixation, and we start to see everything that happens in our lives as just another manifestation of OCD?

A survey of related posts on social media– including, ahem, a few of our own– shows you what people tend to associate with OCD. Here’s a small sample of the phrases I found in recent Facebook, Twitter, and Instagram posts:

always worrying
constant worry
constant struggle
just as hard as physical illness
other people have no idea
I can guarantee you that you don’t have OCD
I am a fighter battling an invisible illness

Along with the misinformed jokes that we all know aren’t helpful and a handful of genuinely helpful posts, this is the same stuff that’s on social media every single day. Even though social media isn’t representative of everybody, it’s the best non-academic sample we have. And it might tell us something interesting about the way many people with OCD view their own mental health.

Nothing to prove: getting the OCD label

A few years ago, I was searching online for something to help me understand OCD. Instagram wasn’t a big deal yet, but I was on Facebook and Twitter. I don’t remember looking in these places though, because to me they seemed like the last place I’d want to find OCD content. It might be unreliable, it wouldn’t be private, and I simply wanted to keep these places separate from mental health concerns because I saw them as places to talk with friends and look at photos. I didn’t want OCD to dig into every part of my life; the more things I had in my life that were completely free of it, the better.

I tried to learn from experts by going to therapy and reading books. I did a few sessions of group therapy, but I sensed a very dark form of cynicism underlying the things many people said in those groups. The gist seemed to be: we are the people who have really gone through it because of our OCD, and because of this curse we’re uniquely qualified to tear apart everyone and everything else.

Toward both of these things– the online sharing and the aggressive cynicism– I felt a certain amount of empathy. I was just beginning to see some really painful and destructive things in my own life as the result of having OCD, and it didn’t take long to start hating the fact that I was spending my time in high school stuck in these obsessive-compulsive cycles while my friends seemed to worry only a “normal” amount. They worried when they had an exam coming up, when a family member was sick, or when they had hatched a plan to ask someone on a candlelit date to the local Steak & Shake.

My anxiety had detached from the things people were supposed to worry about, filling most of my time with a dread that didn’t make sense– to me or anyone else. But although other people would’ve told you that I was intense or liked to brood or something like that, they probably wouldn’t have seen me as anxious. That’s either because I hid things convincingly, or because I really did experience the anxiety as a kind of darkness that existed in life and had to be dealt with.

Although I always wanted to feel better, and worked hard to make that happen, I never really saw the OCD symptoms as something outside of me, or something to fight. I was only 17 at that point, but I had made changes in lots of different areas– sleeping a bit more (but never enough), eating better, learning to deal with big social gatherings even though they overwhelmed me, and so on. The OCD felt like part of me, albeit a sort of unfortunate part, and I didn’t see why getting this part to feel better would be any different from the other changes I had made. It wasn’t a fight, a battle, or a quest to convince everyone else that they just didn’t get it. But it would be a never-ending process, often tiring and frustrating, to learn what would help me get closer to the things I really cared about.

What’s the problem with fighting?

A few years on, I think I was right in some ways and wrong in many others. The main point has stuck with me: all of these things that we call symptoms and group into OCD are part of me, and part of my experience. They originate in my brain, and have an impact all throughout my body. I don’t enjoy it (who would?), but I also don’t believe that adopting a mentality of constantly fighting so hard to banish part of yourself is ultimately going to do much good for you. This aggression directed at your own mind is more likely to alienate you from yourself– and distance you from things that might help– and keep you stuck right where you are, day after day, frustrated at other people for failing to understand.

This doesn’t mean you’ll just lie back and let yourself feel bad. But by respecting this part of your brain (and body) that feels a constant need for certainty, and becoming curious about how you might be able to live without that certainty, you’ll begin to see a life beyond the patterns your OCD symptoms have forced you to live within. It does take determination, grit, and sometimes even frustration with all the troubles you’ve gone through. It also requires very concrete changes, repeated every day until they’re fully part of your life. These might be any combination of therapy, medication, exercise, diet modification, sleep changes, and so on.

However, it doesn’t require constantly trying to convince other people that our lives are harder than theirs. There are countless variables that can make life more or less difficult, and it’s all way too complex to boil down into OCD vs. not OCD. It’s also not a competition to see who has it hardest. So talk to anyone who is willing to listen, and find the people who help you feel less alone. But if someone doesn’t want to understand your experience, you can’t make them. Don’t add to your pain by trying.

What works instead?

Besides the self-distancing that might occur with the warrior mentality and the unending frustration that can result when you try to convince absolutely everyone that they should not only understand but also respect your experience with OCD, there’s another compelling reason to take a more balanced, holistic approach.

Even once the OCD symptoms let up, life isn’t easy. (Of course you already know this, but I’m just trying to make a point.) You’ll want to use the same stuff that you worked so hard to develop while dealing with OCD: curiosity, creativity, determination, flexibility, self-awareness, self-care. So you might as well work on developing those things while the OCD is flaring up.

You can view OCD recovery as a fight or a battle or a constant struggle, just like you can view your life in this way. But, in my experience, it’s going to keep you stuck right where you are. Respect yourself, avoid suffering more than you already do, and build the skills you’ll need anyways throughout your life. You don’t have to be a warrior to feel determined about getting better. If that concept really helps you, keep it around. If it’s just making you feel more trapped or more aggressive, ditch it. Keep the things that serve you well; leave the rest behind.

If you’re interested in learning more about the nOCD app, a platform for treating your OCD and finding a community of other people dealing with anxiety disorders, check out our website.

Asking an OCD Researcher: Dr. Blair Simpson at Columbia University

By Patrick,

Learning about new research– and the hardworking people making it happen– is one of our favorite things at nOCD. It’s easy to get bogged down in the daily realities of living with mental health conditions, and we can forget that there’s this enormous, unceasing global effort to come up with more helpful solutions. So we’re talking with top researchers to get a better sense of what’s next.

Today we’re very excited to talk with Dr. Helen Blair Simpson, MD, PhD, Professor of Psychiatry at Columbia University Medical Center and Director of the Center for Obsessive-Compulsive and Related Disorders. Dr. Simpson also somehow finds time to be Director of the Anxiety Disorders Clinic at the New York State Psychiatric Institute. One of the foremost experts on OCD, her research is focused on improving treatment options for people with OCD and related disorders so they can live more productively. Without further ado, here’s our interview.

nOCD: What inspired you to conduct research on OCD?

The suffering I saw in my patients. It was an incredible experience to treat them and witness them master their OCD.

nOCD: What’s the most exciting thing you’ve worked on in your research thus far?

As a psychiatrist, it has been both intriguing and exciting to observe the power of cognitive behavioral therapy (CBT).

nOCD: What’s the biggest thing that’s currently missing in OCD treatment? In OCD research?

While there is substantial evidence for effective first-line treatments for OCD, many individuals fail to sufficiently respond. We need to better understand why these treatments work for some and not others, and which treatment may work best for each individual.

Butler Library at Columbia University, by JSquish under CC BY-SA 4.0

nOCD: What’s one big misconception about OCD that you’d like to challenge?

That we all have some OCD. Yes, we all have occasional intrusive thoughts (e.g., did I just say the wrong thing?). Many endorse some type of ritual or repetitive behavior (such as double-checking to make sure the door is locked). Most of us also have habits (like taking the same route to work). Some of us are very rigid in our views and perfectionistic. This is not OCD.

OCD is a specific illness characterized by obsessions (repetitive thoughts, images or urges) that generate significant distress and by compulsions (repetitive thoughts or acts) that the person feels driven to perform. To be OCD, these symptoms must cause impairment and be highly distressing and time-consuming (taking up more than an hour a day). Many OCD patients obsess and ritualize on and off all day.

Although most people with OCD have both obsessions and compulsions, the specific content can vary between individuals. The result is that different patients can have very different symptoms. Some common themes include: intrusive thoughts about harm with checking rituals; taboo (usually sexual, religious or violent) thoughts; concerns about symmetry and exactness with ordering and arranging behaviors; and obsessions about contamination with washing rituals.

Importantly, not all repetitive thoughts or behaviors are OCD. For example, people with depression can ruminate, those with generalized anxiety disorder can incessantly worry, and people with trichotillomania can repeatedly pull their hair. The point is that we do not all have OCD. Some people do, and they suffer.

nOCD: Sometimes it’s tough to feel hopeful about OCD. Could you share one or two things that might help people with OCD feel better about the future?

Up to half of people can achieve minimal symptoms with our current treatments. There are two effective treatments for OCD: medications called serotonin reuptake inhibitors (like Prozac, Zoloft and their siblings), and a specific form of cognitive-behavioral therapy (CBT) that includes exposure and ritual prevention. Either alone or in combination, these treatments help up to half of patients keep their symptoms to a minimum within eight to 12 weeks, even in adults who have been ill for decades. Additionally, researchers around the world, including our research group, are studying the brain mechanisms of OCD, with the goal of identifying new targets for treatment development. This offers hope to many individuals who may not get well with traditional first-line treatments.

nOCD: How can people find out more about your work?

For more information about our clinic, please visit our webpage.

If you have OCD, you might be eligible to participate in a study with Dr. Simpson involving an investigational medication that would be added on to your current treatment. To learn more, send a quick email to

Dr. Simpson’s team at the Center for Obsessive-Compulsive Treatment and Related Disorders helped us coordinate this interview, which was conducted over email and on the phone. They’ve gathered an impressive group of people, and learning about their work makes us feel hopeful for the future of OCD treatment. We’re grateful in particular to Dr. Marina Gershkovich and Rachel Middleton for making this interview possible.

Reading for recovery: Books that help us understand mental health better

By Patrick,

1. The Noonday Demon by Andrew Solomon

You might think calling your book “an atlas of depression” is a bad case of exaggeration, but with his huge tome on depression Solomon earns it. He looks at depression from every imaginable angle, and ties it all together with stories of his own severe episodes over the years. Meticulously organized and eloquently written, this book is full of research– and Solomon’s hard-earned opinions on that research. It’s not an easy read because of its length and its intricate style, but if you want to advance your understanding of depression with just one book, this is your best bet. It’s at the top of this list because it’s just about as good as a book about mental health can get. Here’s a brief excerpt:

Perhaps depression can best be described as emotional pain that forces itself on us against our will, and then breaks free of its externals. Depression is not just a lot of pain; but too much pain can compost itself into depression. Grief is depression in proportion to circumstance; depression is grief out of proportion to circumstance. It is tumbleweed distress that thrives on thin air, growing despite its detachment from the nourishing earth. It can be described only in metaphor and allegory.

2. An Unquiet Mind by Kay Redfield Jamison

As far as there’s a canon of books about mental health, Kay Redfield Jamison’s “memoir of moods and madness” has been near the top for over twenty years. It was one of the first books blending experiential and scientific takes on bipolar disorder (a term she actually dislikes because the idea of two poles draws too strong a distinction when things are much more murky). Jamison has a unique dual perspective on the condition: she has a severe case herself, and she’s a professor of psychiatry at Johns Hopkins School of Medicine. People like to call this book brutally honest, and it is. Jamison is interested in the in-between moods that weren’t really discussed in clinical literature (and still isn’t, except by a few researchers interested in what they call mixed states). This line is characteristic of Jamison’s unflinching self-awareness, which so many people have found relatable: “I had been simply treating water, settling on surviving and avoiding pain rather than being actively involved in seeking out life.”

3. Reasons to Stay Alive by Matt Haig

The title of Matt Haig’s memoir/guidebook on severe depression (and suicidality) makes things sound pretty drastic– and in a way they are. Haig, who advocates constantly for mental health online, has made it through some tough times, and tells us about them in a relatable way. This book has the opposite goal of Solomon’s, preferring practical advice to encyclopedic knowledge. But don’t let its small size fool you, because this tightly written book is full of wisdom you can start applying to your own experience right away. It’s a great one to keep around in case things get tough again for you or somebody you know. The lists in this book are particularly useful. Here’s part of one:

Here are things I wish someone had told me at the time:

1. You are on another planet. No-one understands what you are going through. But actually, they do. You don’t think they do because the only reference point is yourself. You have never felt this way before, and the shock of the descent is traumatising you, but others have been here. You are in a dark, dark land with a population of millions.

2. Things aren’t going to get worse. You want to kill yourself. That is as low as it gets. There is only upwards from here.

3. You hate yourself. That is because you are sensitive. Pretty much every human could find a reason to hate themselves if they thought about it as much as you did. We’re all total bastards, us humans, but also totally wonderful.

4. So what, you have a label? ‘Depressive.’ Everyone would have a label if they asked the right professional.

5. That feeling you have, that everything is going to get worse, that is just a symptom.

6. Minds have their own weather systems. You are in a hurricane. Hurricanes run out of energy eventually. Hold on.

7. Ignore stigma. Every illness had stigma once. Stigma is what happens when ignorance meets realities that need an open mind.

8. Nothing lasts forever. This pain won’t last. The pain tells you it will last. Pain lies. Ignore it.

4. Imagine Me Gone by Adam Haslett

This is the first work of fiction on our list, and as a warning it’s also the first in which suicide plays a central role– this makes it tougher to recommend, but the way Haslett’s novel explores suicide’s effects on everyone close to the victim makes the tragic event much more than a cheap plot point exploiting a difficult topic. Still, it’s a heavy book, and one that might inspire a good bit of sadness. A family contends with their father’s depression throughout their childhood, and deals with its legacy once he’s gone. But it reads quickly, has a ton of beautiful moments, and does a good job complicating our ideas about mental health. If we only read non-fiction we can start to slip into very one-sided views of “the way things are.” Luckily we’ve got fiction to remind us of how varied, and how nuanced, actual manifestations of mental illness can be. Here are a couple memorable quotations from the book:

“It struck me then, for the first time, how unethical anxiety is, how it voids the reality of other people by conscripting them as palliatives for your own fear.”

“Against the monster, I’ve always wanted meaning. Not for its own sake, because in the usual course of things, who needs the self-consciousness of it? Let meaning be immanent, noted in passing, if at all. But that won’t do when the monster has its funnel driven into the back of your head and is sucking the light coming through your eyes straight out of you into the mouth of oblivion. So like a cripple I long for what others don’t notice they have: ordinary meaning.”

5. My Age of Anxiety by Scott Stossel

Scott Stossel’s 2014 book got a lot of buzz, partly because it’s good and partly because the editor of a major magazine, The Atlantic. Stossel describes the intense anxiety he’s felt throughout his life, and all the things he’s tried to feel better. You can tell that he’s been interested in learning about mental health for a while (and that he’s a journalist) because he seamlessly weaves research, interviews, and other people’s stories into his own tale. He has a lot of interesting stories to tell– like the time he lived on Cape Cod with the extended Kennedy family while researching one of his books, and flooded their toilet after a bout of “gastric distress” while Arnold Schwarzenegger was visiting. Here’s a lengthy excerpt.

6. The Man Who Couldn’t Stop by David Adam

Also a journalist, David Adam developed his first obsessions about HIV/AIDS as a college student in the 1990s. It’s been fairly common for people with obsessive-compulsive disorder to fixate on this possibility since the start of the AIDS crisis in the early 1980s. For Adam, the thoughts took over completely. He tells us that everyone working at the National AIDS Helpline knew his voice because he called so many times each day. It didn’t matter that he wrote for Nature, a major science journal, and knew that his risk wasn’t nearly high enough to merit all this anxiety. All that mattered– and this might be familiar to those with OCD– was that there was a risk. Like the other books on our list, this isn’t a simple memoir; it’s full of useful research and helpful information on what might help other people get better too.

Here’s a review of the book written by… none other than our last author, Mr. Stossel.


The OCD research that makes me hopeful

By Stephen Smith,

It was a cold winter day in early 2015, and I remember sitting in a dimly lit coffee shop in Liuyang, China researching medications that might improve my obsessive-compulsive disorder (OCD) symptoms. The wifi was spotty, and my VPN disconnected often, but I was in the zone. Nothing could break my focus– not even the waitress asking me, “Nǐ xiǎng hē gèng duō de kāfēi ma?” or “Would you like to drink more coffee?”

I was looking to either find a medication with minimal side effects or see if researchers had plans to produce one in the near future, since I was tired of suffering. Although Exposure and Response Prevention (ERP), the major type of Cognitive Behavioral Therapy used to treat people with OCD, had empowered me to “get back in the saddle” and re-immerse myself in the activities I once loved, a dull anxious feeling would still constantly tighten my chest, grip my throat, and stiffen my face– my body’s way of preparing itself for an intense OCD episode that could strike at any moment. I’m sure many of you can relate.

Doing ERP alone helped me learn to manage my OCD in weeks, enabling me to leave my house and travel to China as an English teacher, but it didn’t reduce my anxiety all at once. The reason: it often takes people with OCD months, or even years, to feel the physiological benefits of ERP, which is why so many are prescribed one of the Selective Serotonin Reuptake Inhibitors (SSRIs) in addition to their ERP therapy. SSRIs are prescribed to reduce the sting of enduring ERP, and the combination of ERP and SSRIs has been clinically proven to be one of the most effective ways to treat OCD today.

However, research shows that the current “gold standard” treatment approach is not always golden for OCD patients. First, SSRIs are antidepressants, designed primarily to treat depression. Even though OCD patients can benefit from SSRIs, research suggests it sometimes takes a significant amount of trial and error before people experience improvement.

Many people try a variety of SSRIs and dosages before finding the medication that works best for them. Second, they sometimes come with a variety of side effects that cause discomfort. A few typical side effects are weight gain, sexual dysfunction, fatigue, and agitation. Third, ERP therapy is widely inaccessible and tough to manage. OCD specialists charge extremely high rates for their service, and they often don’t take insurance. And, after seeing a specialist, people with OCD are often asked to manage their condition alone, without any additional resources.

For these reasons, and because ERP was already working well for me, I decided to pass on SSRIs while going through OCD treatment. As much as I wanted to feel better, I felt the risk of experiencing harsh side effects and managing haphazard results on top of the difficulties of ERP was not worth it. People with OCD can suffer quite a bit, so we want to get results fast, and in today’s world we should have the ability to get actual “gold standard” treatment in just minutes. At that coffee shop in Liuyang, I dreamt of a world where people with OCD could access better ERP and OCD-specific medication in minutes– not only to help myself improve, but also to help millions of others who were sharing their difficult experiences online.

When I read about Dr. Vlad Coric, CEO of Biohaven Pharmaceuticals, I felt for the first time as if someone else shared that dream. Defying the pharma stereotype, Dr. Coric cares deeply about the well-being of OCD patients all over the world, and his past work proves it. Prior to starting at Biohaven, Dr. Coric worked on the OCD research team at Yale University for decades, and his research on the neurotransmitter glutamate has encouraged researchers to explore alternative OCD treatment methods, like ketamine administration, that work on glutamate. Dr. Coric isn’t just a pharma executive; he has recognized major problems within the OCD treatment industry and is doing meaningful work to try to address them.

Flash forward to July 2017: Meeting Dr. Coric

China was great, but I missed huge pancake breakfasts. After conquering my OCD and working with my team to make nOCD the most widely adopted OCD treatment platform in the world, I decided to attend the International OCD Foundation Conference in San Francisco, mainly to have the opportunity to meet Dr. Coric in person. Before our meeting, I was both nervous and excited, because I knew I would be meeting one of the most dedicated OCD researchers in the world, and I wanted to make sure that I made a good impression.

The meeting went better than I ever could have imagined. Dr. Coric was humble and friendly, and brought up many amazing points about how we could enhance the nOCD platform to augment research and provide access to care more quickly. In addition, I could feel his genuine passion for helping people dealing with OCD and related conditions, and his desire to innovate psychiatric pharmacology with new technology and ideas. Leaving the conversation, I told Dr. Coric that I’d love to do whatever I could to enhance his research. That’s where our collaboration began.

With the recent partnership between Biohaven Pharmaceuticals and nOCD, I think we’ve just taken a major step forward toward creating a better world for OCD patients. If you have OCD or a related condition, or you’re concerned about a family member or friend, have hope! You have two new companies working nonstop to make this part of your life a lot easier. And now, because you’re the community we want to help, we need your voice. Let us know in the comments what you envision for a world with accessible, effective, and affordable behavioral therapy and medication.

Disclaimer: Biohaven Pharmaceuticals and CEO Vlad Coric, MD, did not contribute to the content of this blog post.

Eight mental health myths that make us feel worse

By Patrick,

Sorry, it’s just that Shakespeare is the only author I could think of.

You would hope that all this confusion in the news over what’s true would stay far away from topics like health and wellness, but unfortunately these are just as prone to miscommunication and misinformation. In an effort to prevent people with mental health issues from struggling more than they already do, let’s debunk some common myths about mental health. We’ll also look at something closer to the truth for each one, so you can go around helping your family, your friends, and even your very worst enemies see things differently. Here goes!

1) Myth: People struggling with their mental health are more likely to be violent

Not only are people with mental illness no more likely to be violent than anyone in the general population, they’re ten times more likely to be victims of violent crime. If you’re walking around your school or office, or taking public transportation at night, or whatever else you do, consider keeping an eye out for people who are visibly struggling with their mental health instead of just avoiding them.

2) Myth: Depression is caused by low serotonin levels

Although the serotonin hypothesis became the dominant explanation for depression in the 1960s, the scientific community has shifted and no longer believes that depression is caused by anything as simple as a lack of serotonin. SSRIs and SNRIs are still the most widely used psychiatric treatment for depression, and the medical community still seems to believe that some kind of change in the way serotonin interacts with neurons can help people feel better. But the nature of this change– and the reason people get depressed in the first place– remains unknown.

3) Myth: Mental health problems are rare

About 20% of people in the United States have a mental health condition. For comparison, 16.6% of Americans have blue eyes. Although eye color varies significantly depending on the part of the world you’re in, mental illness incidence probably doesn’t. (Although it’s important to acknowledge that mental illnesses are diagnosed and treated in very different ways around the world.) The exact percentage doesn’t matter; this one is probably an underestimate anyways, because most people try to hide what they’re going through. The Rare Diseases Act of 2002 defined a rare disease as one that affects fewer than 200,000 people in the United States. Even if you take each form of mental illness individually, they don’t fit into this category.

4) Myth: People will be happy if they just choose to see the world more positively

This is a particularly painful one. We love to tell people who are struggling things like Just think more positively and the world will respond positively. But this isn’t true; your brain is not, in fact, in control of the world. It’s not even really in control of itself. Although there’s always a degree of intentionality that needs to go into the treatment of mental illness– you do need to choose to do things differently at some point– positive thinking is not a treatment. A number of studies have found differences in thinking and emotion in depressed patients, leading many to speculate that attempts by unhappy people to force themselves to think positively actually make things worse.

5) Myth: Kids have mental health problems because of bad parenting

We don’t know what causes psychiatric disorders– it’s that simple. While it’s believed that stressful home environments and difficult relationships with parents contribute to mental illness in children, saying that they cause mental illness is dishonest. To do so is to ignore the complexities of the brain and its illnesses, which are thought to come from some nuanced combination of genetics and environment. Of course, you should still treat children as well as possible. The point is more about the way we assess parents: don’t assume that they’ve somehow “ruined” their child if the kid is struggling.

6) Myth: Kids are overmedicated and shouldn’t be put on medication

Taking a broad societal issue (all those headlines about the overmedication of children) and applying it to specific cases is rarely a good idea. Yes, it’s bad to dispense a few of your extra Prozac to your kid like Tylenol in the hope they’ll feel better. But if you’re taking them to a psychiatrist, the psychiatrist should be doing a thorough examination and making a careful evaluation of all the options. Every treatment decision is a balance of potential pros and cons, and we don’t really know what most medications do to children or long-time users. But the same is true of adults: seeing as most of these medications have been around for just a few decades at most, we don’t really know what’s going to happen to people who take them throughout their lives.

We can address the broader societal implications later on, but for now it’s worth saying: if your child is working closely with an experienced professional who believes that medication would be a good treatment option for them, you should probably trust them and not the person on your Facebook feed posting repeatedly about how psychiatric drugs are turning children into zombies.

7) Myth: All therapists are basically the same

A lot of friends and family members have told me they don’t really like therapy, or therapy just isn’t for them, or something else like that. While there are real problems with therapy today (like financial and geographical inaccessibility), saying you don’t like therapy is a lot like saying you don’t like traveling because you had a bad experience in one place. More likely you saw one therapist, or a couple therapists, and decided that the whole thing was silly because you didn’t like how it went. There are tons of different approaches to therapy and different types of clinicians. And then there are the countless individual differences between therapists that can determine– much more than the type of therapy or the amount of education they’ve completed– whether or not you enjoy meeting with them on a regular basis.

Back when I was looking for a clinician, it was important that they had a good sense of humor, were always staying updated on the latest research, and were willing to draw from multiple different types of therapy as needed, instead of insisting on seeing everything through one methodological lens the whole time. If you don’t like your therapist, don’t stick with them; unlike most relationships in life, walking away from your therapist should be relatively uncomplicated (though not free of guilt or sadness). But try not to write off therapy as a whole, because you’ll risk missing out on really helpful stuff.

8) Myth: You need to have a diagnosis to start thinking more about your mental health

The times, they are a-changin’. Very slowly. And maybe not. But we’ve all been stuck for a long time thinking in terms of distinct mental health conditions, as listed in the Diagnostic and Statistical Manual of Mental Disorders (or the ICD, for those of you in Europe). The DSM has had its fair share of controversies since the first edition was published in 1952, like its inclusion of homosexuality as a “sociopathic personality disturbance” until 1974 and the fact that it seems intent on eventually classifying every deviation from contentment as a treatable disorder. But, in large part due to the pressures created by our daunting bureaucracy of insurers, pharmaceutical companies, and clinicians, the DSM has stuck around.

Another concern about diagnostic manuals is the difficulty of defining specific criteria for each disorder. If you spend three weeks feeling really down, are you depressed? How about four weeks? What does it mean to be really down? Then are you depressed, or just dysthymic? Do you have an anxiety disorder, or a psychiatric condition like OCD that has a lot in common with some of the anxiety disorders?

These aren’t the questions that people trying to feel better really need to spend time thinking about. Diagnosis can help people get the best possible treatment for their unique struggles, but it can also become a distraction for patient and clinician alike. Especially with anxiety disorders and OCD, many people end up fixated on their diagnosis, to their own eventual detriment.

Many clinicians and researchers have stopped thinking much of the DSM’s classification system, though they have to keep dealing with it in one way or another. In fact, some of them are proposing an entirely different system called the Hierarchical Taxonomy of Psychopathology. The HiTOP assesses people’s place in a bunch of different categories and takes a close look at the specific ways these categories come into play. Whether or not this new system is substantially different, the point remains: you don’t need to wait for a diagnosis to start improving your mental health, and any diagnosis you receive is going be a “best guess” based on your symptoms. Clinging to a diagnosis might help you find other people and new information that you can relate to and benefit from. But it won’t make you better.

Final thoughts: What can we all do to become better informed?

Drinking coffee while you look for studies saying coffee is good for you? Validation.

Health information has always spread in a way that makes it prone to misunderstanding: by word of mouth, based mostly on anecdotal evidence, credible only because someone you trust is telling you about it. If you’re interested in losing weight, and a close friend tells you that eating 30 almonds per day has been shown to make you lose weight, you’ll likely try it.

Further complicating things, the media tends to present all research as if it’s conclusive. People in media are evaluated based on the number of readers or viewers that their content attracts, because ad revenue comes from quantity. This means there’s constant pressure to make articles feel urgent so that more people want to click on them. I’ve done something similar in the title of this blog post, telling you these myths make us feel worse in an attempt to get people reading it. Nobody wants to feel bad; whether or not an article actually provides something that can help people feel better, the promise that it will do so generates a lot of interest. Look below: which of these two articles is going to get more readers?

Number 2 is more enticing because it offers a clean takeaway; Number 1 is more specific and speculative

The point isn’t to suggest that the media is evil; rather, it’s about understanding an author’s motivation and being more cautious when health news is promoted as conclusive information rather than as an impressive new step toward some unknown destination. Some media outlets are more responsible than others about the way they present health news, and even an article that seems like clickbait can deliver on the promise in its title.

But you can also help yourself. Let’s say you see a headline claiming coffee is bad for your mental health. Listening to that healthy skepticism in your gut, you look for the link to the actual study. There you see that the study never says coffee is bad for your mental health. Instead, it points to a more specific finding that might indicate some negative effects of coffee on the mental health of one subset of the population. (For the record, this isn’t a real study. And if it is, I don’t want to see it. I’m drinking coffee right now.)

Always try to read just a bit of the study that an article is based on. Most people don’t have time to read a bunch of scientific studies, but you only have to read a few paragraphs. The abstract and conclusion are usually quick reads, and will help you understand what really happened in the study. Almost every study will conclude with some thoughts about all the additional research that’s needed on its topic. This is the kind of humility that we all should bring to discussions of health, given how little we actually know.

As if health information weren’t already convoluted enough, mental health also has to deal with stigma and with the (related) fact that people have only been even trying to understand mental health for a few decades. People are afraid of what they don’t understand, and mental illness appears unknowable because we as a society have invested so little in trying to understand it better. Even more than the way media overstates new findings, our culture of fear creates mental health miscommunication. So you’ll have to be the first step for many people around you. Tell them all the things you know, but remember that all of our so-called knowledge could be flipped on its head at any moment.

That’s all for now. What other mental health myths do you want to dispel? Tell us on social media!

We are @treatmyocd on Twitter, Facebook, and Instagram.

The Inflexible Mind: Three Ways To Get Freedom Back From OCD

By Patrick,

“I know but one freedom and that is the freedom of the mind.” — Antoine de Saint-Exupéry

One of the cruelest things about obsessive-compulsive disorder is the way your need to control things actually ends up controlling you. If we take a step back, this makes sense: there are way too many things in our lives that exist entirely outside of our control. Life isn’t a problem you can solve, but OCD will make you try. So you end up trying to climb a mountain that’s always shifting under you. You wear yourself out, without even getting to a good spot to take photos.

Without getting into any of the philosophical questions or parsing through every exception, we know there are some things we do have control over. You generally can’t control your thoughts; but you typically can control your behavior. And, while none of these strategies will cure you of OCD, a few small shifts in your behavior can snowball into lots of other meaningful changes. These can impact your mood, your thoughts, your habits, and so on.

The part to remember is that there is never one single right way to get better. You can try a million things with no progress, then make one more change and feel a lot better quickly. And so, as you might predict, the important thing is to keep trying different things all the time. Because life is constantly shifting, you’ll have to get good at shifting with it too.

For all the talk about strength in mental health– how strong someone is for coping with bipolar disorder or dealing with PTSD each day– we ought to be talking about flexibility just as much. OCD makes mental flexibility seem like a distant possibility, but you still have it in you. So let’s look at a few ways you can try to find it again.

1. Find a creative pursuit that you like, and pursue it

Although Bob Ross never said anything about having OCD, he did talk about painting as an alternative to all the angry tendencies he developed during his military career. His television series The Joy of Painting has been helpful to many people struggling in all sorts of different ways. There’s an effortlessness to his method, even if the results aren’t your favorite.

But the point wasn’t really to talk about Bob Ross– just to use painting as one example of a creative pursuit that might help you explore the world in a different way. First, creative work allows you to expand your thinking beyond the very narrow boundaries that OCD places around it. It also allows you to enjoy a limited degree of control over something while still facing risks like messing up or never being as good as someone else. Lastly, it gives you something to focus on and keep getting better at. Building a sense of mastery at something contributes positively to mood and overall wellbeing.

So whether it’s writing, art, music, dance, or something else, find a creative outlet you can dedicate some time and energy to. This way you can start to develop mental flexibility again. In case you’re wondering: no, you don’t have to be good at the thing you’re doing. You just have to be doing it.

2. Expose yourself to the absurdity, even the comedy, of your obsessions

Although most of your obsessions probably seem like the furthest thing from funny, they can usually be taken to a place where you’ll see that there’s a certain humor to them. That’s because they end up seeming a little bit ridiculous once we take them outside their usual patterns. Let’s think up a few examples:

Usual obsession 1: “I could probably be happier in another relationship. I might be wasting my time in the wrong relationship. I might be stuck in this forever. I’ll probably never be happy.”

Attempt at comedy 1: “I’m definitely in the wrong relationship. Everybody can see it. In fact, earlier when we were out to dinner everyone was thinking it. The waiter was so shocked by how bad our relationship is that he went home and told his girlfriend, who is much better than mine in every way. Even that dog we saw on our way out of the restaurant could tell that we’re in the worst relationship– that explains why it barked at me.”

Usual obsession 2: “I’m probably a pedophile. I’ve just been fooling everyone thus far. I’m definitely a pedophile deep down, and everyone knows it.”

Attempt at comedy 2: “I’m probably a pedophile. In fact I’m definitely a pedophile. I shouldn’t be allowed near a single kid the rest of my life. I should start telling everyone I know that they need to keep their children away from me. I might as well tell my family I’m going to be all over the news soon when I do something horrible, because I’m definitely going to, sooner or later.”

These don’t exactly make for side-splitting comedy, but there is something funny about them. The inability to accept uncertainty comes from the assumption that the worst case will always come true unless we’re making sure it doesn’t. But if you consciously follow through on your obsessions by taking them to ridiculous extremes, you start to see the holes in this way of thinking. Using techniques like this one to gently undermine the stuff your anxiety is telling you can help you start to open up some space between you and your obsessions.

You can do this in your mind, write it down, or record it on your phone. It’s similar to an exposure, and in certain cases can be an exposure. You might find that, for certain obsessions, things become more intensely dark than funny. That’s okay, too, as long as you’re moving toward your thoughts and “doing something with them” other than turning to compulsions. If you follow up on them and end up laughing at their absurdity, that’s great; if you chase them to their extreme and end up more anxious, that’s a good basis for exposure.

3. Get really interested in things

You know that annoying thing when someone talks about how looking up at the night sky puts things in perspective because it reminds them how small all of our problems are? It never made all that much sense to me, because you still have to find a way to deal with all the same problems, even if Jupiter is out there looking great. It’s not like you can choose to just worry about space instead, simply because it’s much vaster and more timeless.

But at the same time, there is something to be said for tapping into the ridiculous amount of incredible things about the world and learning as much as you can. I don’t think it’s about finding out how small our problems are, but rather about filling our minds with stuff that’s much more dynamic than the extremely narrow content of our obsessions and compulsions. And in doing so we might gently bring a bit of perspective to the obsessions.

The OCD symptoms will make it feel like there are only a few things that really matter. Find what you matters a lot to you and prove them wrong.

This is only the start of many posts on practical, non-theoretical, easy-to-use strategies. The most important part is getting out there and experiencing things, because only by breaking free of the obsessive-compulsive routine will you start to get that mental flexibility back again.

Please let us know in the comments how these are working, and what other strategies you’ve found helpful!

If you’re looking for a great way to treat OCD, take a look at the free nOCD app. It features treatment strategies from ERP, CBT, and ACT– the most clinically supported forms of therapy for this condition. It’s available now for iOS and coming soon to Android. Tell your friends, show your family, use it yourself, ask your clinician about it! And let us know at if you have any questions.

A Pretty Spectacular View: Keeping OCD in Perspective

By Patrick,

A guest blog post by Cara Rothenberg

Today we’re lucky to share this story from Cara Rothenberg, who writes film scripts, articles, personal essays, and just about everything else. She has a unique ability to write things about her own experience with obsessive-compulsive disorder that are viscerally relatable for anyone with OCD. Her stories blend honest accounts of how difficult things can become with a hopeful insistence that they can get always get better. Now I’ll let Cara introduce herself:

“I’m a 27-year-old pizza enthusiast navigating the world with OCD and trying to laugh as much as possible along the way. I’ve found that the only thing harder than talking about my mental health is not talking about it. We don’t have to hide. Not anymore.”

OCD might be part of you– but it’s not who you are

By Cara Rothenberg

Labels are inescapable. Every single one of us uses them, whether we mean to or not. It starts off simple enough: Mom. Dad. Boyfriend. Girlfriend. Best friend. Good. Bad. Right. Wrong. But the labels get more nuanced as we get older. I’ve been in situations where I’m catching up with friends or family and someone’s name will come up, and to remind each other who this person is we’ll say something like, “You know, that guy who lost his mom in a car accident?” or “Remember? The girl who went to rehab in high school?” Why do we do this? Is it simply because labeling people makes it easier to distinguish one person from another?

It makes you doubt everything you know, everyone you love, and everything you are. But it also tries to reduce you to a label– and never a positive one.

Or is it a lot more twisted than that? Do we do it because, deep down in the depths of our souls that we’re too afraid to explore, we point out the darker side of someone else’s life so that we can deflect attention from our own demons? We reduce people to the worst part of their lives when our biggest fear is the same thing being done to us. None of us want to be defined by the most “troubling” thing about us. Maybe it’s an addiction, a past mistake, a family tragedy, a bad relationship, a mental health disorder. Our traumas and mistakes and afflictions are certainly part of us, and denying their existence is dishonest and unhealthy. But I simply have to believe we’re all more than that.

OCD is known as the “doubting disease.” It makes you doubt everything you know, everyone you love, and everything you are. But it also tries to reduce you to a label– and never a positive one. You just thought about cheating on your spouse: you are a philanderer. You just wondered if you’d ever be able to harm someone: you’re a violent psychopath. OCD tries to place you into a category based on events that, more often than not, never even happened. Even if they did happen, OCD dramatizes and exaggerates them so much that you barely have a hold on what’s true and what isn’t. Your own mind becomes unreliable, and that’s really scary.

Reason and logic don’t work with this disorder.

I’ve done this my whole life. Oh, the places OCD has taken me! I’ve been a sociopath, a cheater, a liar, a deviant, a bad friend, a disappointing daughter, a terrible sister, an all-around awful person. These thoughts pierce your heart and your brain until you succumb to the idea that maybe it’s all true. If you don’t have the proper help and support, it’s very easy to fade away into those concocted labels. I almost did. Not once, but approximately 3,652 times. Here’s an example of one of those times:

Last year I wrote an article where I basically “came out” as having OCD. It was featured on a pretty well-known website, and the obsessive and neurotic side of me was absolutely sure I’d receive backlash from it. Why was I so certain? Well, as my therapist would say, “It’s not you who was certain. It was your OCD.” Reason and logic don’t work with this disorder. But really, it made no sense how unbelievably anxious I was that this article would break the internet. It was actually a little (a lot) narcissistic. I’m not even remotely well-known. I have virtually no internet presence (unless you count my tweets to Survivor host Jeff Probst, which went unanswered– still a tough pill to swallow).

I wasn’t saying anything slanderous or scandalous. But even still, my OCD manufactured this “gut feeling” that there’d be some kind of fallout. Not from the people closest to me — most of them knew about my OCD and were unbelievably supportive. It was everyone else. I waited for the whispers from my past to surface: old classmates, colleagues, teachers, coaches, general acquaintances. I waited for the nasty comments from complete strangers declaring either that OCD is made up or that I should stop complaining because some people have “real problems.” Worst of all, I’d get slapped with the label of “crazy.”

(As my mom always says, “No one is thinking about you as much as you think they are.” I could devote another ten paragraphs to how OCD warps your sense of reality and people’s perception of you…but I’ll save that for a rainy day. You probably hate me now for getting so off track. You hate me, don’t you? I knew it. Shit. I did it again. I digress).

The day of reckoning never came. In fact, the response was overwhelmingly positive. People I hadn’t spoken to in years, as well as complete strangers, reached out to me, thanking me for writing it. I was blown away by how many people could relate to the article. That’s when I realized that the only person, at least in that moment, who was labeling me…was me. I was preemptively and internally labeling myself as “the crazy, attention-seeking OCD chick” because I wanted to beat people to the punch. I wanted to inflict the pain before they could.

Writing that article was one of the most cathartic experiences of my life, and I almost didn’t do it because of how fearful I was of the labels that might come my way. It was so humbling to see how decent and understanding people could be. I really wish I could say that was the last time I ever let OCD define me, but it wasn’t. It wasn’t because OCD isn’t curable and it will always be there. But you know that dark, twisted part of us I mentioned earlier?

Well, I think that next to that tiny dungeon in our souls covered in cobwebs and dead bugs and other sinister accoutrement is a really good part filled with light and goodness and — dare I say, hope. We all have that part of us too. That’s where we store our love for other people and ourselves. It’s where we keep the parts of us that make us good and kind and complicated and flawed and beautiful and a whole list of other adjectives that make up who we are as people. Nothing, not even OCD, can touch that. So I say we try as hard as we possibly can to visit that part of ourselves more. It’s a pretty spectacular view.

Cara is @caranotkaren on Instagram, and also has a cool website. Both mention pizza at least once.

Thanks very much to Cara for bravely taking on OCD every day and sharing this part of her story with us. This blog is better when I’m not the only person (or even the main person) writing on it. So, if you’d also be willing to share your story with us, please fill out a quick form. We’ve received a bunch recently, so it might take a few weeks for us to get back to you. But rest assured– we read all of them and we’ll be in touch soon.

Lastly, if you’re looking for a great way to treat OCD, take a look at the free nOCD app. It features treatment strategies from ERP, CBT, and ACT– the most clinically supported forms of therapy for this condition. It’s available now for iOS and coming soon to Android. Tell your friends, show your family, use it yourself, ask your clinician about it! And let us know at if you have any questions.

Getting Support From Those Who Really Understand: A Post by Chrissie Hodges

By Patrick,

As we at nOCD have explained in a few of our recent posts, we’re always interested in getting more voices on our blog. So today we’re very excited to share an original blog post from one of mental health’s most active and engaging voices, Chrissie Hodges.

Chrissie is dedicated, full of energy, and well-versed in the latest and greatest OCD treatment techniques; we’re lucky to count her as a key part of the OCD community. She’s an advocate, speaker, author, blogger, vlogger, and licensed Peer Support Specialist.

And now, without further ado, here’s Chrissie telling us about peer support and the value of having experienced people alongside you during your journey to recover from obsessive-compulsive disorder and other mental health disorders.

The Power of Peer Support in OCD Recovery

By Chrissie Hodges


Peer support is a term heard more often in the last few years in relation to supplemental support for mental health recovery. It is a form of support where someone who lives with a mental illness and understands the complexity of recovery can help provide hope and motivation for those in crucial stages of recovery. Peer support specialists are trained professionals certified through their state or working toward certification in the state where they reside and practice.

My journey to becoming a peer support began when I saw a real need for OCD sufferers to know they are not alone in their symptoms or the grief of mental illness. I quickly found out that helping others with their recovery actually became a positive turning point in my own recovery. I had achieved symptom management with OCD, but the emotional turmoil was still plaguing me. I struggled with questions of Why me? and What did I do to deserve this? I lived with the sadness, the anger, and the stigma of being someone who lived with mental illness, and trying to find my place in a society that didn’t look fondly on that label.

Mental illness is traumatic in so many stages of its development and existence in the lives of those who suffer. And I believe many of us underestimate the impact trauma has on us in relation to our journey of mental illness. Each time we experience trauma, our physical brain can change, our worldview can change, and the ways we relate to the world can change.

This trauma is prevalent in onset of symptoms, prolonged suffering, diagnosis, and even treatment. Even after successful treatment of OCD, the trauma can linger, and the stigma and fear of expressing those emotions are often kept silent. Therapy is available to help people work through trauma, stress, and even emotional regulation. But what I found in my recovery, and while helping others in theirs, is that a crucial element of recovery is getting support from those who really understand what it is like to walk in the shoes of OCD. There is power in the words “me too.”

In the depths of emotional turmoil during my own recovery, I believed I was the only person floating in that abyss of judgment, rejection, and isolation with the weight of stigma surrounding my mental illness. It wasn’t until I began working with a peer support who helped empower me to give myself permission to feel these emotions. I didn’t know how to feel okay about being angry. I didn’t know how to embrace that I was a victim of my illness. I feared that the other side of that negative emotion would be the loss of myself. I assumed I needed to just be grateful I got treatment and deal with it.

Little did I know, I would have been heading down a path of loss and separation from myself. My peers reminded me that I was actually just like everyone else on this journey to recovery, that I wasn’t alone, and that it was necessary to grieve. It validated me. It made me feel important. It gave my emotions value. It made me feel like the things I had been through really mattered. My peers made me feel like my story mattered, like it had a place of importance in my life and maybe the lives of others.

When I began working as a peer support, I found that walking alongside people and supporting them in the midst of their traumatic emotions and came natural to me. I had been there before, so I could easily understand and empathize. I wanted clients to know that if I had been able to get through it, they could too. I don’t answer the questions of Why? or What does it all mean? I don’t give advice. I don’t provide reassurance. I don’t tell them that it will be easy. I am just a presence with them that has walked the same difficult path to recovery, and just being there helps them feel less alone and hopeful. My job is to hold hope for my clients when they can’t hold it for themselves.

There was a time in my life when I hated the illness of OCD and everything it had brought into my life. I saw it as the ultimate stain on a life that could have been great. But, in the last four years of working as a peer support specialist, I can truly say the suffering and torture I endured from the illness feels rectified by the people I am lucky enough to support in my everyday work. I get to offer them what I believed would have been so beneficial in the darkest of my days. And the most beautiful part of being a peer support is that it is symbiotic. I learn as much from my clients about myself and my recovery as they do from my experience and support.

Peer support is a valuable, supplementary resource in helping those living with OCD to move toward recovery. It helps individuals to sustain hope and to know they are not alone. It helps restore value, importance, and a sense of normalcy to an individual’s experience in the midst of suffering and turmoil. Peer support will hopefully continue to grow and to be implemented in every person’s therapeutic plan in the future.

If you are interested in becoming a Peer Support Specialist, please check with your state credentialing body for license and certifications for more information. If your state does not have a certification in place, other states may accept out-of-state trainees upon inquiry.

If you are interested in receiving peer support on your journey to recovery, please visit my website or email me for more information about my services and rates.

Thanks to Chrissie for taking time out of her busy schedule to write this great blog post. If you’d like to submit your own blog post, or an idea of what we should write about, please fill out this quick form. We’d love to hear from people with OCD, their friends, their family members, clinicians, researchers, and anyone else. Check out the form! Do it now! (Please.)

Lastly, if you’d like to learn about the nOCD app, another great way to get the support we all need along the way to recovery from OCD, check out our very cool website!

Getting Unstuck: How to Help a Child with OCD

By Patrick,

Why parenting a child with OCD feels counterintuitive — When exposures are more harmful than helpful — On the benefit of getting professionals involved — A personal story from the producer of a documentary about kids with OCD

Other than inquiries about the status of our Android app, questions from concerned parents about how to help their children with obsessive-compulsive disorder might be most common in our inbox. So this will be the first in a series of posts highlighting strategies for helping kids with OCD and real perspectives from parents at various stages in this journey.

Today, after some preliminary thoughts, we’ll hear from Chris Baier, producer of UNSTUCK: An OCD Kids Movie, a unique and impactful documentary film that we recently reviewed. Chris is based in New York, where he seems to be always involved in a bunch of creative projects. He’s a copywriter, film producer, and mobile app creator. Find out more about Chris here.

Many parents of children with obsessive-compulsive disorder (OCD) feel stuck. Watching your kids suffer is horrible, so you want to help. But many of the more intuitive strategies for alleviating your child’s suffering– reassuring them, giving them what they want, trying to take away their pain– end up making their OCD symptoms worse.

It can be really difficult to understand– and even more difficult to tolerate– the need to let your child endure pain in service of their long-term well being. Because of the way OCD works, they will never get better if the whole family shapes itself around the child’s anxieties and allows them to rule. Getting better will usually look more like getting worse at first, because learning to tolerate the extreme unpleasantness of OCD is not easy.

There’s always a lot of nuance to someone’s distress, and no single strategy should be applied to every situation. It’s essential that you learn to recognize when your child is suffering in the service of getting better and when they’re just suffering. For example, when we talk about exposure and response prevention (ERP), any exposure that’s done without response prevention will cause unnecessary pain– and will probably launch the family into one of those moments of utter turmoil (you know the ones). Consider an example:

Let’s say a parent reads about exposure online and says to their child, “You’ve been extremely afraid of the school cafeteria because you might get sick there. We can’t live like this anymore. You are going to the cafeteria today and that’s it.” The child, seeing no other option, goes to the cafeteria and becomes extremely anxious. This is an exposure, but it’s not going to do them any good if they just start doing compulsions when they get there. They’re going to be suffering unnecessarily, because there was no plan in place for how the child was going to expose themselves to their anxiety and prevent any compulsive responses that would make habituation to their anxiety (the goal of ERP) impossible. Add to that the fact that they might get bullied for their compulsions by other kids and you’ve got a recipe for even worse situations.

To avoid this sort of misunderstanding it’s best to get professional help whenever possible. Although you’ll naturally want to be the main person helping your kid get better, this can be a setup for disaster because treatment strategies like ERP feel instinctively wrong to a caring parent. It’s also easy to let your frustration boil over when things aren’t getting better– and OCD treatment includes a whole lot of steps back along with the leaps forward.

The ideal scenario is one in which you’re learning along with your child, because the whole family needs to be involved in the treatment process. Once a professional has taken the time to explain the condition and their treatment rationale, you’ll be more prepared to help your child learn how to manage their own symptoms. As a parent, you will be a huge part of their recovery process; but getting a clinician involved will help ensure this journey isn’t marred by frustration, misunderstandings, and misplaced blame.

Now, for a perspective from a real life parent, we’ll hear from Chris Baier. For Chris, obsessive-compulsive disorder isn’t just another topic. He’s the father of Vanessa, who has OCD and starred in UNSTUCK, the documentary film he produced. Many of the insights that fill the documentary clearly arrived through the trial-and-error process of learning how to help Vanessa. He has been kind enough to share some thoughts on that process with us today.

The Baier family, stars of the documentary film UNSTUCK: An OCD Kids Movie

A Lesson Learned Parenting a Child with OCD

by Chris Baer

When my daughter, Vanessa, started to have strange and odd fears a few years ago, the first thing my wife and I did was try to get help. After she was diagnosed with obsessive-compulsive disorder (OCD), our initial response was to search for a cure. We thought we had the power to fix her.

In this way, we did a lot of things wrong. We accommodated. We participated in OCD rituals. We gave in.

We initially approached OCD like it was a virus and told her to “Get plenty of rest” or “Try to relax.” We thought that distracting her — turning on the TV, letting her sleep in our bed — would help. But treating a mental disorder like a physical one did not work.

What really happened was that we allowed OCD to take control of our lives. OCD didn’t stop there– it started to monopolize our entire family. But as we started to read about OCD, understand symptoms and therapy, and learn about how effective OCD treatment works, we shifted our approach.

We thought that distracting her would help. But treating a mental disorder like a physical one did not work.

We pulled back from accommodating. We made Exposure and Response Prevention (ERP) the most important activity we did with Vanessa every day. More important than homework, playdates, or after-school activities. We treated OCD as an unwelcomed invader.

Slowly we realized that we couldn’t fix or cure anything. We had to give up control because beating OCD was something Vanessa had to do herself. (Yeah, not an easy thing for a parent to accept.) Turns out, our role in all of this was not to be the miracle workers. We were better suited to be her cheerleaders, advocates, teachers and, sometimes, disciplinarians.

This is a role we still play today.

Vanessa is more aware of how OCD affects her and has better tools to fight it. But if a worry floods her mind, we know our role is to help her focus, make a hierarchy of her fears, and encourage her to do exposures so she stays strong.

Turns out, our role in all of this was not to be the miracle workers. We were better suited to be her cheerleaders, advocates, teachers and, sometimes, disciplinarians.

I do not care that it wasn’t a cure. I’m content knowing that I am one of the reasons she was, and is, able to fight.

If you’re feeling generous enough to submit your own story, or to suggest a topic for us to write about, please fill out a quick form. And if you’d like to learn about the free nOCD app, which helps you use ERP and other techniques, we invite you to check out our website.

Big News at nOCD!

By Stephen Smith,

Today is a great day! When the new year began we set ourselves the important goal of keeping the nOCD community updated on major events. So now I bring you some very exciting news.

I’m honored to announce that nOCD has just completed a $1 million fundraising round with 7wire Ventures, a premier venture capital firm in Chicago that strategically invests in promising new healthcare technology initiatives. With this new financing and strategic direction, nOCD will have an opportunity to provide more effective treatment to people struggling with obsessive-compulsive disorder (OCD) all around the world. It will help us every day as we continue our work of helping people take charge of their symptoms, regain mental freedom, and say no to OCD.

If you aren’t familiar with OCD, it’s a debilitating psychiatric condition that affects around 1 in 40 adults and 1 in 200 children. Unlike the way it’s constantly stereotyped, OCD is not synonymous with being too neat or uptight. It’s a mental illness that causes people to have specific, torturous thoughts called obsessions that repeat nonstop in their heads. To alleviate the extreme anxiety caused by their obsessions, people with OCD often perform specific actions, or compulsions, which give them short-term relief but exacerbate the anxiety over time. Clinical evidence suggests that people can drastically reduce the negative impact OCD has on their lives by confronting those situations that trigger their obsessions while preventing themselves from turning to compulsions. So, naturally, you might ask, “Why don’t more people with OCD do that?”

The answer: retraining oneself to tolerate distress without resorting to compulsions usually requires extensive treatment. But the OCD treatment system today is broken. It takes the average person 14–17 years to get effective treatment for OCD, and most specialists operate completely out of network, charging $200-$400 per visit. Because effective treatment is so inaccessible, comorbidity abounds: for example, 27% of people with OCD develop a substance use disorder, and 33% end up with major depressive disorder.

Our personal experiences dealing with this condition brought the nOCD team together, and continue to help us relate to the people using our treatment platform. We’re unique in that we combine this first-hand knowledge of OCD with real experience in software development, digital marketing, and data science. Given the urgency we feel to make effective treatment more accessible, and the fact that we have the skills to make it happen, we believe the future of OCD treatment must incorporate always-on treatment resources, giving people the freedom to live more and worry less.

This type of model can also exemplify a new age of mental healthcare, since its always-on, low-cost, and community-centered. That’s why we’re even more motivated to scale nOCD, because we know our hard work will lead to real change for millions of people with OCD and other conditions.

Most importantly, your support has been crucial in helping us build nOCD, and we’d like to wholeheartedly thank you. A little bit of positivity goes a long way, so on behalf of the nOCD team I hope you can celebrate with us during this exciting time.

Thank you,


How to Tell a Therapist Your Scariest Thoughts

By Patrick,

running car off the road
insulting strangers
hurting strangers
fatally pushing a friend
jumping in front of train/car
causing a public scene
stabbing a family member
choking a family member
getting a fatal disease from strangers
giving a fatal disease to strangers
exposing yourself to strangers

Have you ever thought about doing one of these things?

These come from a well-known inventory of the intrusive thoughts faced by 293 “normal” students. Just about everyone deals with some of these thoughts. Most people either don’t really notice the thoughts or don’t spend much time worrying about them. They’re just part of the passing strangeness of everyday life in a confusing world.

But for people with obsessive-compulsive disorder (OCD), some of these thoughts will stick, launching an agonizing cycle of questioning oneself and trying desperately to get rid of the unpleasant feelings that result. OCD isn’t about the content of your thoughts, because everyone has strange and unpleasant thoughts. It’s about the amount of distress you feel in response to those thoughts, and the ways you try to get rid of (or avoid) that distress. People with OCD tend to have a few types of thoughts that they feel completely unable to ignore. And those thoughts can start to dominate their life.

(A brief pause to note that not everyone with OCD deals with this same experience of having certain thoughts and trying to convince themselves things are alright. Studies suggest a majority do, but there are other types of OCD that don’t involve these exact symptoms. More on these in future posts, but telling your therapist about symptoms might be tough even if they’re not linked to specific thoughts so most of this should still apply.)

At this point you might be thinking: Yeah, but my thoughts are much worse than the ones you listed. The examples above are just a few of the thoughts from one study, and research studies probably don’t dive into the strangest or most disturbing thoughts we can experience. (Another pause: When I say strange or weird throughout this article, I’m trying to capture the experience of having those thoughts, not saying people who have them are strange or weird.) We tend to avoid talking about it, but your brain will throw just about anything at you– and it’s often at the worst times, like when you’re with family, at a funeral, in a meeting, around kids, and so on.

Nobody is quite sure what causes it, but something about OCD makes it much harder for people to accept the uncertainty at the core of these thoughts:

Would I really do something like that?
Am I the type of person who might do that?
What’s wrong with me?
How can I make sure I don’t do that?

All four of these questions are troubling, but it’s the last one in particular that drives people to compulsive behavior. Making sure of something means getting rid of any uncertainty, and if we think about it for a minute we’ll realize this is an impossible task. Let’s look at what Dr. Jonathan Grayson, a leading expert on OCD, has to say about this in his helpful book Freedom from Obsessive-Compulsive Disorder:

For some of you, the failure of logic and the resulting vicious circle of endless questioning and anxiety have left you feeling that you are no longer able to discern whether or not something is safe: that not washing your hands really may harm your family, that you did run someone over on the way to the office, or that you don’t know whether or not the door you are staring at is locked. You know what you are feeling, but you don’t understand why… It is hard to separate how you feel from what you know, when you don’t have the language to communicate what is happening inside.

If you think about it, nobody is ever completely sure that they won’t do any of the things that pop into their mind. How do you know that you won’t spontaneously “lose it” and hurt someone you care about? How can you be sure you won’t contract a fatal disease from someone you meet? Nobody gets to have total certainty, but most people are able to tolerate this lack because telling themselves “I’m pretty sure it won’t happen” is good enough. So how does someone with OCD start to learn how to accept uncertainty as an inevitable part of our lives that can be tolerated, and even appreciated?

One of the best places to start is in therapy. As Dr. Grayson explains, just having the language to tell someone what you’re going through can open up a life-changing separation between you and the “vicious circle of endless questioning” that you’ve found yourself in.

But, of course, this involves telling your therapist about the thoughts that have been bothering you. So many people get stuck on this because they’re afraid their therapist will be disgusted by them. Because this is such an important first step if you’ve chosen to try therapy, here are a few things to keep in mind:

1. Your therapist isn’t a friend or family member

Or at least they shouldn’t be. All the hangups you understandably have about disclosing your most frightening or disturbing thoughts to someone in your personal life don’t need to apply here. It helps to remember that your therapist is a professional whose job is to help you as best they can. Your therapist will know better than to judge you for your thoughts, but the goal is not for them to like you or see you in a certain light anyways. Whatever is bothering you, tell your therapist. That’s the whole point of working with them.

It might also help you to know that your therapist can’t tell anyone what you tell them, unless they think you’re going to harm yourself or someone else. A trained clinician will be able to tell the difference between thoughts and intentions, so you needn’t worry that they’re going to tell anyone else or report you to the police. Not that you’ve done anything wrong by thinking.

2. This isn’t the first time your therapist has heard it

It may seem like you’re a uniquely horrible person for having thoughts like I could hurt these kids I’m babysitting, but as your therapist will likely explain to you, they’re pretty normal. And not just for people with OCD, as we saw above. The difference is that people with OCD might latch onto these strange thoughts and start asking themselves unanswerable questions about them. Don’t quit your babysitting job. Tell your therapist about your thoughts, because they’ve heard much “stranger” and “more alarming” things before. (There are quotation marks because they probably won’t think you’re strange or see any reason to become alarmed.)

3. It’s the only way to start getting proper treatment

Whatever your therapist doesn’t know about, they can’t help you with. Unless you go rogue and start treating yourself, you’re not going to be doing exposures to one of your obsessions unless you work your therapist to come up with them. Lots of people are afraid that acknowledging their thoughts will make something bad happen, or will mean that things will never be the same once they start along the whole path to treatment. These are understandable concerns, and they might be good things to mention to your therapist. Know that having extra violent or “messed up” thoughts doesn’t mean your OCD is more severe, so try not to avoid your most alarming thoughts simply because it feels like admitting them means you’re a worse person or a more difficult case for your therapist.

Not to be too repetitive, but remember that the difference between someone with OCD and someone without OCD is not the thoughts you experience but the way they respond to them. So tell your therapist about your thoughts and the way you’ve been responding to them, and you’ll be on your way to becoming less burdened by OCD.

4. Your therapist can help you see your thoughts differently

If you look back at Dr. Grayson’s quotation from above– don’t worry, I forgot it too– he talks about the importance of having “the language to communicate what is happening inside.” The clinical approach your therapist takes will help you reframe what’s been happening to you. You might arrive at your first therapy session telling yourself that you’re a horrible person, bound to eventually act out the horrible things that pop into your head.

Your therapist will listen, and then they’ll tell you about things like thought-action fusion, a fancy psychological term for the belief that thinking about something is basically the same as doing it, or that thinking about it means a specific behavior will inevitably follow. This isn’t an especially adaptive belief, because it tends to make people take their thoughts far too seriously.

Let’s say you’re cruising along on the highway and you suddenly think I could just drive off the road into that barrier. When thought and behavior are fused it feels like you’ve already done something as bad as driving into the barrier: even considering it. Or it can feel like you’re bound to actually drive into the barrier now that you’ve thought about it. Maybe you can hold out for now, but eventually it will really happen, right?

In this scenario, your therapist might help you learn to react differently whenever the thoughts appear. You might tell yourself “Wow, there goes that thought again. It’s really bothering me.” This is using language to distance yourself from the bothersome experience. And the more you do that, the more natural it will become over time.

We’ll have more on all these topics soon, but in the meantime please leave some tips for your fellow readers in the comments. Thanks for reading!

Today’s post was suggested by one of our readers– thanks to our anonymous friend for the great idea. If you want to submit an idea, or even a completed blog post of your own, we’d love to hear from you.

The Latest at nOCD: Android Update

By Stephen Smith,

Because I know how it feels to have OCD, it tears me apart every time I have to tell someone that the Android version isn’t ready. So today I’d like to apologize for all the vague explanations we’ve been giving, and tell you why the Android version has been delayed. Then I want to tell you about our plans to release nOCD for Android in 2018.

In the past few years, management of our iOS app has fully occupied our part-time development team and pushed back any plans we had made for Android. We knew we would need full-time developers, so we focused on growing our business to make this financially possible. But the most important thing we have at nOCD is our community, and we should have been more transparent with you throughout this process.

In 2018, we’re committed to offering you nOCD on Android. We started the new year by hiring two full-time engineers who will be working to build a great experience for you. We’re working hard to learn from any issues our iOS users have faced so that the Android app will be the best nOCD experience we’ve ever offered. And we’re building a great community every day by creating the best resources for OCD awareness and treatment.

As you probably know, half of our team has obsessive-compulsive disorder. We know how difficult it is to cope with frightening thoughts all the time, and we’ve all endured the isolation of having nobody understand what you’re going through. To make sure we’re not leaving anybody stranded, we plan to give you more regular updates on our progress.

Your enthusiasm about nOCD motivates us every day, and your willingness to trust us on your path to recovery from OCD means more to us than anything else. Thank you for your continued support as we enter another productive year with lots of exciting plans. Please continue to check back for more nOCD news updates on those plans, from the Android app and innovative new resources on our website to exciting collaborations with people doing the latest OCD research. We’ll all need to work together to come up with better solutions to mental health issues, and we look forward to sharing the next part of that journey with you.

Love, Poetry, and Team Sports: How to Build Community and Deal with OCD

By Joseph Antonellis,

How community makes unbearable things better

It’s hard to find a silver lining for the most difficult things in life. I remember earlier this year, during the first week of college football training camp, I couldn’t have felt more alone. The anxiety of not knowing anyone, sleeping in a new place, being judged all day by unknown coaches — what did they think of me? What did the other players think? Every night when I tried to sleep all I could imagine was their voices. Why did we even recruit him? Who does he think he is? What’s his problem? I couldn’t even sleep because the thoughts were endless. No matter what I did during the day, how positive or negative the experiences were, these anxious questions would always find their way into my mind. I couldn’t really do anything about it, because this is just how my mind operates in these sorts of uncomfortable situations.

As the season wore on, love is what cured my anxieties. I felt love for the game of football. I felt love from my teammates, my coaches. I’ll always remember what one senior said to me: “We’re a team. We’ll love you no matter who you are, what you do, what you say. It’s a family.” Without this feeling of compassion, I would have stayed lonely, and my obsessions might have continued to overtake me on a day-to-day basis. But I found that silver lining. The 7 a.m. wake-ups, the long and tense meetings, the hours of practice in the 100-degree heat — it was all worth it. I had experienced how bad my anxiety could get, but now I was rewarded with knowing, through perseverance, that there were eighty other players who supported me no matter what I did, giving me the ability to fight my inner struggles with a greater confidence than ever before.

What’s love got to do with it?: Acceptance and OCD

I’m sure many of you had already seen Neil Hilborn’s 2013 performance of “OCD” at the Rustbelt poetry slam, and if you hadn’t, I hope you enjoyed watching it above. Hilborn’s performance inspires bravery in all of us. To go up on stage and talk about heartbreak is one thing, but telling a bunch of strangers about specific OCD symptoms is one of the bravest things I’ve ever seen.

As I mentioned in a previous article, I often worried that I shouldn’t start writing for nOCD because of the possible triggers I might experience while exploring my past experiences. I thought it would bring everything back in full force. Even reading about OCD scared me! But, after all, I’ve experienced the opposite. After finishing my first article, I let out a huge sigh of relief, as it was almost like a barrier I had yet to cross was finally broken, and I was finally allowed to be open with myself and the world. I sense this same feeling in Hilborn’s work.

“I have been wondering, mostly, if love and sanity are the same thing. When I say I am in love I am also saying the world makes sense to me right now” ― Neil Hilborn, Our Numbered Days

Just like being part of a loving football team, Hilborn’s experience of falling in love allowed him to feel comfortable in his own mind. “How can it be a mistake that I don’t have to wash my hands after I touch her?” Hillborn asks. This person loves and accepts him for who he is: for all his obsessions and all the compulsive behaviors he turns to. Her acceptance is a beautiful denial of all the times other people have told Hilborn to change; it allows him to feel comfortable with who he is, and to open himself up more completely in a way he’s never risked doing before.

Opening up often allows people to feel less lonely about their situation, as it can strengthen connection and make a relationship more meaningful. This is often missing in our society: true, unconditional love, no matter what someone is struggling with. Even though this was missing toward the end of Hilborn’s relationship, it was clearly an important breakthrough for him. This type of genuine interpersonal acceptance can only occur in a society that takes mental health awareness more seriously.

Creating compassion: knowledge comes first

So, why is the nOCD team working so hard to try and help people with obsessive-compulsive disorder? Because of its immense relevance in today’s society, and the fact that so many people are still out there struggling. We want to create a more loving and accepting society, where people like Neil Hilborn can feel genuine human compassion every single day. A society where you don’t need to be in love or on a football team to feel accepted for who you are. In Hilborn’s poem, the woman eventually could not handle being with someone dealing with that type of symptoms, and left him. My goal is to help create a society in which Hilborn’s girlfriend doesn’t feel like she has to leave him– where mental illnesses are understood, and people have the necessary skills to help their partners or friends without overreaching their capacity and hurting their own mental health.

Often mental illnesses are clumped together into one muddled group, but the first step to creating a general understanding of mental health is to distinguish each illness from the others. OCD is classified as an anxiety disorder, but it is often put in a category of its own due to the variety of ways it can affect your mental health. If you’re diagnosed with OCD, it might mean you’re especially susceptible to other mental illnesses, like mood disorders, eating disorders, personality disorders, ADHD, and a variety of related conditions.

The fact that OCD is so often accompanied by another condition is part of what makes it so difficult to understand, diagnose, and treat. There are also many different subtypes of OCD, making the term OCD more of a larger category for a multitude of more specific types. For example, when analyzing the Neil Hilborn poem, you can pick out multiple different subtypes.

Checking — “Did I lock the doors? Yes.”

Contamination — “Did I wash my hands? Yes.”

Ruminations — “I can’t go out and find someone new because I always think of her.”

Symmetry and Orderliness — “On our first date, I spent more time organizing my meal by color than I did eating it, or talking to her.”

These are just a few of the many complexities OCD has to offer, as we are just scraping the surface of the disorder. Gaining a new perspective on OCD and mental health is a great first step to developing an acute sense of mental awareness. We can always learn more; these issues are always more complicated than they seem. Even having gone through it myself I haven’t come close to developing a complete understanding of the disorder, but everyday I strive to learn about it on a deeper level. Trying is the key, as even the slightest attempt at learning more could markedly help those around you, preventing them from also having to cope with the intense loneliness of dealing with OCD around people who don’t understand it.

Build the structures you’ll need if things get tough

None of this means you need to be in love or on a football team to start feeling better. But it’s also vital that you don’t view recovery as a solitary quest– a simple matter of gritting your teeth and fighting through things until you’re well enough to wander your way back to society. Even if you’re not in love or part of a supportive team, developing a sense of community will make the almost unbearable parts of having OCD or another mental health issue much more bearable. It will also give you a reason to get better.

I believe we can all find a silver lining for any of our struggles. I remember times in my life when I didn’t even want to exist; these became the memories that fueled the moments when I lived largest. Although it can be almost impossible to see how in the world concepts like community or acceptance might help you at the lowest of your lows, if you can store away an aspiration to pursue them it might help you when things start to get really tough. In Hilborn’s poem, it was his girlfriend that gave him hope. For me, it was being part of a football team. Where do you think you might find the love and nourishment that everyone– dealing with mental illness or not– needs to live well? The question seems tacky; the answers you might find are anything but.

Looking for a great (and free!) way to learn how to cope with thoughts that bother you? Click here.

Review– Unstuck: An OCD Kids Movie

By Patrick,

In an effort to bring attention away from misinformed memes and joke posts toward those rare good things being made about OCD, we’re starting a new series that will highlight movies, books, podcasts, and anything else.

UNSTUCK: An OCD Kids Movie (Documentary, 2017, 22min)
Kelly Anderson (Director), Chris Baier (Producer)
Country: USA
Language: English
Rating: Not Rated

A journey with kids and teens who really have OCD

There’s so much nonsense across the internet about obsessive-compulsive disorder– from social media stars using misinformed depictions to get attention to countless ridiculous listicles– that it’s hard not to notice when something sensical arrives to provide new insights into the lived experiences of people with OCD.

In the case of the documentary film UNSTUCK: An OCD Kids Movie, those people are, of course, kids. An estimated 1 in 200 children has OCD in the United States, and the brief but moving UNSTUCK puts six of them in front of a camera to take you through their journey, from the extremely confusing first symptoms through their eventual diagnosis and treatment with Exposure and Response Prevention.

Vanessa showing part of her plan for exposures

The movie begins with Vanessa, who stands out as especially self-aware even in this group of six young people who never miss a beat. The voice of director Kelly Anderson prompts Vanessa to introduce herself. Vanessa says she’s ten years old and lives in Brooklyn, New York. Then, pausing for a second and leaning back in her chair, Vanessa says, “And I have OCD.” It’s the first sign of many that these kids have come to accept their obsessive-compulsive symptoms as part of their daily reality.

But how did that reality look before those symptoms were recognized as OCD? The film, adopting its pattern of cutting between brief interviews with each of its six stars, gives them a chance to tell us. Holden’s obsessions had him convinced he would suddenly become a bodybuilder if he interacted with anything related to bodybuilding or strength. The avoidance spiraled: he couldn’t look at the Hulk, which meant he couldn’t wear the color green; if he saw a strong character in a cartoon he would have to blink or breathe in a certain way and then turn off the TV, which would be contaminated from that point on. As Holden tells it, “And then I couldn’t use any of the electronics. So I literally just sat around all day.”

Holden and his sister Tatum talking about difficult times

The whole family gets involved

Some of the most compelling moments in this documentary are when the kids talk about how their symptoms gradually roped in their entire family. Jake tells us his parents would try to discourage his rituals by doing his chores, hiding things from him, and otherwise enabling him to avoid the emotional distress that would normally lead to compulsions. Jake says, “I felt really bad for them, because they were basically stuck in the rituals with me.”

Sarah, who remembers feeling like her conscience was telling her that things had to be just right, would ask her parents to say or do things repeatedly until they felt perfect. She reveals another tragedy of being a young person with OCD: “And at that time my parents didn’t know it was OCD, so they thought it was just me being disobedient. And so, yeah, it was hard.”

Charlotte, Sarah, Ariel, Sharif

Most powerful are the scenes when other family members are brought on camera. In one of these, Vanessa and her sister Charlotte sit across from one another. Charlotte looks at her intently, and Vanessa asks, “What do you think the hardest thing was?”

Charlotte replies, “Well, at first the hardest thing was you didn’t tell me about it. I didn’t even know something existed called OCD. It was also very hard when you were kind of a little afraid of me.” She explains that her frequent stomach aches made Vanessa avoid her out of fear she might get sick. Then she continues, “It’s kind of like, what did I do to make her feel like this?”

Demonstrating as always an impressive amount of maturity and self-awareness, these kids keep getting straight to the point about what’s so difficult about mental health conditions, whether you’re the person who has one or someone who cares a lot about them. The camera lingers on them just long enough after each statement, but keeps us moving quickly through the six stories until the film’s twenty-two minutes have suddenly slipped away.

Jake hard at work drawing a past self, stuck in compulsions

Getting better

Their first forays into therapy don’t go too well. Ariel, whose mom surprised her by taking her to see a psychologist one night, says, “I was just really upset from my mom taking me there. I didn’t want to talk to her about anything. I didn’t want her to think I was crazy.” She’s touching on one of those key barriers to treatment that we often forget to consider: wanting your clinician to see you in a certain way. Sharif was skeptical: “How can she know anything better than I do when I’m the one that’s been coping with this?”

But then, in various ways, each of the kids found treatment that worked. They all talk about this process, and part of the educational value of this movie is hearing them discuss when they learned what OCD was, how they were taught to see their thoughts differently, and what did or didn’t work for them. Jake started out in a group, where he learned that other people had similar symptoms. Ariel started out doing intensive treatment six hours a day, but quickly got better. And Sharif began purposely doing things imperfectly until he could habituate to the anxiety. There’s a wealth of information about each person’s hierarchy and exposures, but the film does seem to rush the part about treatment a little bit. It would have been interesting, for one thing, to hear from the same siblings again about how treatment ended up making things easier.

One thing that really stands out near the end is Vanessa saying, “I don’t think it ever really goes away. It’s always in you. It can just happen out of nowhere, where you’ll just get a blast and you just kind of have to work through it.” I’m not sure whether or not OCD forces kids to become wiser a lot younger than they normally might, but this kind of readiness to accept life’s difficulties without lashing out at them seems pretty uncommon among ten-year-olds.

“Learn about overcoming OCD from the experts”

Ariel showing us some highlights from her treatment binder

The filmmakers’ most important choice, and the crux of the film, is to reposition the six kids as the real experts. In most mental health media, the patient perspective is entirely absent. When it’s not absent, it feels canned or at least formulaic as people feel compelled to talk about their experiences in the same narrow terms, over and over. This creates a vacuum for people who are trying to figure out why they’re struggling so much and only finding the same old ideas everywhere.

As for the usual experts, there’s a ton of content out there from clinicians and researchers, and that stuff is always important. But we don’t hear often enough in unfiltered terms about mental health from the people who have struggled with it. This is especially true of kids, whose experiences tend to get trivialized or silenced by parents whose worry comes to eclipse their own.

By leaving the explanatory work to the kids instead of always cutting away to a team of experts, as most documentaries would, UNSTUCK gives us the clinical background and the real personal stories all wrapped into one. We get mental health in motion, not in the controlled environment of a research study. The movie is clearly informed by all of the necessary science, and a few clinical advisors appear in the credits, but the experiential stuff never feels dominated by clinical concerns.

It’s refreshing to hear these precocious young people courageously examine their own journeys, but this doesn’t mean the movie is full of unstructured venting about how hard it is to deal with OCD. Even more common than the overly clinical stuff about OCD is the kind of disorganized, repetitive internet content that never seems to lead anywhere. UNSTUCK stays away from this the same way it stays away from being too cold and clinical: by trusting the kids to relay their own stories, instead of imposing certain lessons or motifs (these emerge naturally as similar symptoms and treatment decisions are discussed).

The kids are insightful and well-informed, and have a well-earned sense of humor about their own symptoms. Sometimes the amount of clarity and honesty they bring to their assessment of how their behavior has affected them and their families is almost jarring; it makes me wonder why it took so long for someone to make a movie like this.

Sharif taking some time to practice– even if practice never makes completely perfect

Final Thoughts

UNSTUCK is a moving and informative short documentary that will be a great help to anyone hoping to understand OCD, particularly in children and adolescents. If you want to teach other people about OCD and some of its many manifestations, showing them this movie would be a great choice. It’s also a great antidote to the endless toxic stuff about OCD across the internet and in our culture more generally. And as a supplement to reading clinical perspectives, it offers a much-needed experiential take on mental health.

If you’re worried about this kind of thing, there are parts of the movie that can be sad. You’re watching kids talk about emotionally trying experiences, so that’s sort of a given. But the overall tone is hopefulness, and it comes from a firm commitment to the belief that feeling better is quite possible.

As a self-help tool, this movie will help you understand OCD and will give you some hints about how to get better, but it isn’t a treatment method. This isn’t the goal of the film, but it’s worth mentioning that you shouldn’t go into it hoping your own symptoms will improve. At the same time, learning about other people’s struggles can be cathartic. It’s worth noting that the struggles that OCD creates for these kids are barely different, if at all, from those that adults with OCD face. This is not really, in the end, a movie about kids with OCD. It’s a movie that sees kids as the best spokespeople for what it’s like to have OCD, and it makes a powerful case.

The movie is available now for educators and groups, and will be released soon for everyone else. In case you haven’t seen them already, the trailers are compelling. Here’s one of them:

The close attention evident in each shot of this film can be explained in part by the fact that both its director (Kelly Anderson) and its producer (Chris Baier) are parents of kids with OCD. Kelly and Chris began to work on the film after meeting at a support group in New York, and clearly carried their determination to help their own children into their work on this film. Their care in bringing awareness to a disorder affecting hundreds of millions around the world is admirable.

And then we have the real stars of UNSTUCK: the eight young people (six with OCD and two siblings) who bravely tell us about all aspects of life with obsessive-compulsive disorder. You can’t watch this movie without admiring how they’ve responded to their condition by learning about it and committing to dealing with it differently.

Be sure to keep an eye on the film’s website for updates on how to watch it as an individual. If you’re lucky enough to catch it at a festival or community screening, let us know what you think. You can also check out UNSTUCK on Facebook.

And, as a bonus, check out Chris Baier and his daughters talking about the documentary (and life with OCD) on Stuart Ralph’s The OCD Stories podcast.

Some of the cast enjoying newfound fame


Depression and OCD: Why Many People Have Both

By Patrick,

In a way, it seems like anxiety and depression should be opposites: one makes you way too revved up about things, and the other leaves you completely unable to care. This would be comforting for many, because you’d only have to deal with one set of symptoms at a time. Unfortunately, it’s far from the truth. Anxiety doesn’t always rev you up, and depression can make you care a lot.

There’s a whole lot of anxiety mixed into depression, and depressive symptoms are very common in people dealing with anxiety. In fact, the rate of comorbidity– one person having both disorders– could be as high as 60%. And, as we’ll find out below, the two aren’t so different at all. You might think of anxiety and depression as a venn diagram… one with very weak lines dividing it.

The Diagnostic Dilemma: What’s what?

The idea of mental illness is a tricky one. What really separates someone who’s been diagnosed with a mental health condition from everyone else? In certain cases it seems more obvious: when someone is psychotic or manic, or has become so depressed they cannot leave their bed, there must be something wrong. But most of us live pretty close to the boundary between “normal” and “in need of treatment.”

We can take the mental illness debate up at a later time, but for now let’s assume that someone is seeking treatment because they’ve been feeling bad for a while. They go to a psychiatrist, psychologist, or social worker who asks them a bunch of questions, listens for an hour or two, and then provides a diagnosis by matching up what they’ve said with the criteria in a big book of psychological conditions called the DSM-5. (In the United States, at least.)

Here are some of the DSM-5 criteria for Major Depressive Disorder, which we often simply call depression:

A. 1. Depressed mood most of the day, almost every day, indicated by your own subjective report or by the report of others. This mood might be characterized by sadness, emptiness, or hopelessness.
2. Markedly diminished interest or pleasure in all or almost all activities most of the day nearly every day.
3. Significant weight loss when not dieting or weight gain.
4. Inability to sleep or oversleeping nearly every day.
5. Psychomotor agitation or retardation nearly every day.
6. Fatigue or loss of energy nearly every day.
7. Feelings of worthlessness or excessive or inappropriate guilt (which may be delusional) nearly every day.
8. Diminished ability to think or concentrate, or indecisiveness, nearly every day.
9. Recurrent thoughts of death (not just fear of dying), recurrent suicidal ideation without a specific plan, or a suicide attempt or a specific plan for committing suicide.

B. Symptoms cause clinically significant distress or impairment in social, occupational, or other important areas of functioning

And here are some of the criteria for Generalized Anxiety Disorder, or GAD, chosen as an example because it’s the least specialized of the anxiety disorder diagnoses:

1. Excessive anxiety and worry (apprehensive expectation), occurring more days than not for at least 6 months, about a number of events or activities (such as work or school performance)

2. The worry is experienced as very challenging to control. The worry in both adults and children may shift from one topic to another.

3. The anxiety and worry are associated with at least three of the following physical or cognitive symptoms (In children, only one symptom is necessary for a diagnosis of GAD):

Edginess or restlessness

Tiring easily; more fatigued than usual

Impaired concentration or feeling as though the mind goes blank

Irritability (which may or may not be observable to others)

Increased muscle aches or soreness

Difficulty sleeping (due to trouble falling asleep or staying asleep, restlessness at night, or unsatisfying sleep)

As you can see, there’s a good amount of overlap between the two. Both cause a wide range of physical and emotional symptoms that range from being significantly slowed down to really revved up. Neither side of the spectrum is pleasant, but it’s notable that two different disorders have many of the exact same effects.

The point of all this? Diagnoses are always best guesses, not exact matches. Anxiety and mood disorders have a lot in common, so if you’re feeling lethargic and down but you also worry a lot you might receive both diagnoses to account for the slight variation. That doesn’t mean mood disorders don’t already involve worry most of the time– of course people become worried when they can’t enjoy most things or they’re having thoughts of suicide.

A few key symptoms can push clinicians in one direction or another, and many disorders like OCD have much more specific criteria. But other than that it’s more about trying to get at what’s bothering you most– and this often means offering multiple diagnoses in order to explain any symptoms you have that aren’t included in your primary diagnosis.

Psychological Crossover: What does research tell us?

The many similarities in diagnostic criteria offer one possible explanation for why so many people are diagnosed with both anxiety and depression, but there are other possible reasons the two tend to co-occur.

One study from 2015 looks at different psychosocial models for anxiety and depression. In one model, called the Avoidance Model of GAD, worrying is “a poor attempt to solve problems and deal with a perceived threat while avoiding the aversive somatic and emotional experiences that occur when confronting the feared stimulus.” In other words, when you worry you’re trying to fix some situation without dealing with the difficult parts of that situation– how it makes you feel, either physically or emotionally. Because you’re not going through those feelings, two things happen: the anxiety itself is reinforced because it helped you get off easy, and you don’t develop the ability to process the feelings involved. You become more likely to avoid similar situations, and to use anxiety as a way of doing so.

And one possible model for depression, the study says, is behavioral activation. This model suggests that depressed people avoid activities that might bring about positive feelings; in doing so, they end up more depressed and even less likely to seek out positive events. It’s easy to see how this vicious circle would perpetuate itself and make it increasingly hard for depressed people to experience any positive feelings at all.

Although the author doesn’t explicitly make this link, it makes sense to compare the models for anxiety and depression. If anxiety creates avoidance, and avoidance can reduce mood quality, we can easily see how the two would feed one another. Further, the negative feelings associated with depression are obviously undesirable, which means most people would try to avoid them in one way or another. One way is to worry about the negative feelings you’re encountering, instead of trying to accept them. In this scenario, reduced mood quality might encourage people to worry more, because it feels like you can “figure out” why you’re down and avoid the unpleasant feelings altogether.

These are only a few quick examples, but the bigger point is this: when you feel bad in one way, you’re likely to try to fix it. Sometimes “fixing” anxiety leads to depressive symptoms, and vice versa. Plus, anxiety can get so discouraging that we become depressed. And when we feel depressed we’re more likely to worry about ourselves, others, and the world.

Smarter Solutions: Feeling better with both depression and anxiety

The good news? In many cases, the best treatment for anxiety is also the best treatment for depression.

Anxiously avoiding some experiences because of depression? That avoidance isn’t going to help either the depression or the anxiety, so while it might feel extremely difficult in the short term, make a plan to participate in experiences and stick to it, no matter how depressed or anxious you feel. This is what many therapists call behavioral activation– doing more things now, so your mood can follow.

Feeling like you’re trying to worry your way through unpleasant feelings instead of just experiencing them? This is a really tough one, but mindfulness and acceptance exercises can help with both the worry and those unpleasant feelings. It’s understandable that you’d try to figure out why you’re feeling bad and make it better, but you’d do well to let go of the belief that worrying is going to help you get there. It’s just going to make you feel worse. Stick to doing things you care about, even when you feel anxious or depressed.

Taking medication for depression or anxiety? With some important exceptions, most drugs used for either of these conditions are also used for the other. Sometimes doses need to be higher for anxiety, and if you find that a medication is making you either more anxious or more depressed you should tell your doctor right away. But for many people the same medications will help with both.

Feel like anything that helps your depression also makes your anxiety worse, or vice versa? This is pretty normal, especially when you’re just starting treatment. Maybe going out with friends really helps your mood but also makes you anxious because you’re trying to figure out what everyone else is thinking about you. Perhaps exposing yourself to a night alone at home is great for your anxiety but also makes your mood worse. Sometimes you do need to make choices about what must come first, and (if you have one) your therapist or doctor can help you make those decisions. Other times, the negative effect will only be temporary. If going out with friends is usually making you really anxious, that anxiety sounds like something that could benefit from treatment too. And avoiding the event that makes you anxious will only reinforce the anxious avoidance, making you worse long-term.

Let’s look quickly at a few major points:

  1. Lots of people who have anxiety also have depression, and vice versa
  2. Because of diagnostic similarities, it can just take a few additional symptoms to receive both diagnoses
  3. Whether or not they’re really two distinct things, anxiety and depression can feed one another in a number of different vicious circles
  4. Sometimes treating one will treat the other, even when it feels bad short-term; other times, you’ll need to be more careful with your treatment and work closely with your clinician.

That’s all for now!

Until next time,

The nOCD Team

Mindfulness Practices for OCD: 5 Reasons They‘ll Help You Feel Better

By Joseph Antonellis,

Today’s story is written by Joe Antonellis, a student-athlete at Pomona College in California. Joe has the kind of enthusiasm about writing that makes you want to sit down and write too, and brings all this passion to his work writing about mental health and personal journeys.

Mental health is the most important aspect of living a happy and fulfilled life, but it’s often overlooked in our media and society, making it very difficult to reach out to others in times of suffering. This fear of judgement can cause many to hide their afflictions, masking their true emotions in a happy façade just to get through the day. In these moments, it’s good to develop strategies for overcoming mental issues, whether you have OCD or you’re simply looking to improve your mental health and live better.

Recently, in my immersive research at Pomona College, I have delved deeply into the intricacies and effects of mindfulness practices. These practices often relate very closely to Buddhism, a religion that emphasizes meditative and mantric practices. In the context of Buddhism, techniques like these are meant for a lay person or monastic to practice in pursuit of enlightenment, or the “end of all suffering.” Although for a slightly different purpose, the medical field has used these mindfulness techniques successfully in treating mental illness, specifically OCD. Not only have these practices proven to drastically help those with mental illness, they’ve also helped people who don’t have a diagnosis but still want to improve their daily lives.

The Russinova Study: Effectiveness in varying cases

In the majority of cases, the effect of these mindfulness practices on the human brain is markedly positive. The American Journal of Public Health (2002) published a study analyzing the effectiveness of alternative medical therapies on patients with serious mental illnesses, finding intriguing results. 86% of patients identified multiple practices that proved beneficial to their mental health. These included meditation and guided imagery– both practices essential to Buddhism.

Another category of therapy used by the study was called religious/spiritual activities, which included spiritual recitation of scriptures. Not only did these practices help patients manage their mental illness, but the study concluded that they “promote a recovery process beyond the management of emotional and cognitive impairments by also enhancing social, spiritual, general, and self-functioning” (Russinova). This suggests that these practices have the potential to not only manage mental illness like prescription medication, but also give patients hope that one day they could cure their disease. With these religious practices resulting in such a high medical success rate, there must be some scientific backing to support them. . .

The Curious Connection Between Science and Buddhism

Buddhism is often viewed as a way of life rather than a “religion.” Although Buddhism includes various rituals, amulets, prayers, and worship, it is very different from other religions like Judaism, Christianity and Islam in the fact that there are no definitive religious texts, creator deities, or divine prophets (Barash, 2014). Biologist David Barash believes Buddhism to be the religion most compatible with science, due to its emphasis on personal experience, rather than a reliance on sacred texts, as the gateway to knowledge. The empirical nature of Buddhism is very similar to the investigative foundation of science, allowing the two to mesh fluidly.

Buddhism, much like science, often defines its teachings through simple observations of the world. The Pali Canon, one of Buddhism’s foundational texts, lists countless reasons for why life is suffering. For example, Buddha’s saying that life is like a dew drop, that it will vanish at sunrise and not last long, is analogous to the pleasurable times of our lives and their impermanence, which causes a lot of suffering (Bodhi, 2005, p.206). Because of its insistence on constant observation and reasoning, Buddhism can easily coexist with science. This suggests there’s a good chance that Buddhist practices like meditation would also mesh well with “scientific” approaches to mental health.

The Neuroscience of Mindfulness: A positive change in brain chemistry

Neuroscience is the quickest path to understanding the true effect Buddhist practice has on mental illness. A study published by the National Library of Medicine (2011) examined the effects on the actual biology of the brain, looking closely at grey matter concentration in the left hippocampus. Grey matter is critical to a functioning brain, including regions of the brain responsible for memory, self-control, decision making, and emotions. Patients were put through a common 8-week mindfulness training program, and had their brains examined throughout. The mindfulness program included guided meditation and imagery, slightly different from traditional Buddhist meditation in purpose, but basically the same in principle. After analyzing the results, the researchers found that mindfulness practices increase the concentration of gray matter in areas of the brain important to “learning and memory processes, emotion regulation, self-referential processing, and perspective taking” (Holzel).

These areas are very similar to those affected by mental illnesses like OCD. In fact, these biological findings add evidence to the testimonies of those affected by serious mental illnesses in the previous study. Patients said that the mindfulness practices “helped focus their thoughts” (Russinova), and stopped panic attacks, mental effects explained by an increase in gray matter. Now, there may be an obvious correlation between the two studies in the effectiveness of Buddhist meditation practices on the brain, but it’s not clear whether these studies are comparable to the original intentions of the practices themselves.

Testimony from an OCD Specialist: How a healing process can begin

Meditation and mindfulness practices have a known beneficial effect on those with mental illness. Part of the reason why is that they gives the ability for “one to view their thoughts and self impartially” (Rojas, 2013). Dr. Jeffrey Schwartz, an OCD specialist, is famous for applying mindfulness practices when dealing with the disease. He believes it is possible, given the science of neuroplasticity, that humans can rewire their brains through the force of will and applied thought (Rojas, 2013). Therefore, under these guidelines, Schwartz believes that mindfulness can be used to completely cure some mental illnesses. He is not only saying these practices can be as effective as prescription drugs, but suggesting that they are simply superior. Training your brain to act with control is almost impossible to achieve when afflicted with OCD, but with the right techniques, the process can begin.

This sort of “self directed neuroplasticity” (Rojas, 2013) can be applied through meditative mantric and visual practices as well. In Buddhist practice, it is commonplace to recite a sutra as a mantra. For example, chanting the Heart Sutra over and over again will keep one mindful of the teachings, planting the knowledge of the dharma in one’s subconscious, even if what is being chanted is not consciously understood. Mantric practices can be extremely beneficial to those afflicted with OCD, helping in times of panic and obsession. Although those afflicted are usually not chanting Buddhist scriptures, the focus and concentration on any one repeated phrase holds a similar effectiveness.

Some struggling with OCD would even argue that mantric practices are more beneficial specifically for an obsessive mind. One testimony states that “negative thinking often comes from meditations on my anxiety” (West, 2014). Contrary to the previously discussed research, this patient suffers from OCD more when attempting to meditate because they more susceptible to obsessions when they are on their own and their brain is allowed to think freely. This view shouldn’t give meditation a negative connotation though, as the same patient recommended Mantric practices, which is basically a different form of meditation where one focuses on their chanting instead of their breath. Focusing on a mantra can also give meaning to a meditation practice, as the words being recited can be beneficial to the recovery of a patient. For example, a patient would repeat over and over again in their head “Do I have to do this right now? I’m in control” allowing them to stay grounded during the most persistent obsessions.

A Possible New Future of Mental Health

Alternative medical practices are becoming more and more popular in modern society, with many going away from traditional prescription drugs to pursue a more natural treatment. Specifically, in the field of mental health, there is a large debate on if it is necessary or healthy for those diagnosed with a mental illness to take certain prescription drugs. In turn, a large market of research has opened up on alternative practices, and Buddhist meditation has filled the void effectively. With a slew of research supporting its mental benefits, meditation has been biologically proven to help patients, and even provide an opportunity to not just manage the illness, but defeat it.

These practices can certainly be more challenging than taking prescription drugs, but the challenge is worth it in terms of the potential mental progress one can achieve. There’s the added benefit that these techniques don’t really have side effects. Science and Buddhism’s combined empirical relationship with nature gives mindfulness practice a true medical legitimacy, providing hope for those afflicted with mental illness that there are other options for recovery besides prescription medications.

Until next time,

The nOCD Team

We’re interested in sharing more stories like this one. To talk with us about submitting your story to the nOCD blog, please email

And if you’re interested in learning more about the nOCD app, a platform for treating your OCD and finding a community of other people dealing with anxiety disorders, click here.  

First Steps Toward OCD Recovery: What’s Going On With These Thoughts?

By Patrick,

When I was in junior high school, one of my best friends lived across the street. He always had the latest video games, his parents were more easygoing than the other adults I knew, and he had younger siblings to boss around– something that fascinated me, because I was the youngest in my extended family.

We’d flop down on their massive couch and watch a bunch of TV while his little brothers and sister came over and smacked us with various objects. Their house was so different from mine, and when I’d had enough of the chaos I could cross the street and go home to be the youngest again.

One night nobody else was around and we were watching reruns of Man vs.Wild, wondering why Bear Grylls would sleep inside dead animals if he didn’t really have to. When the episode ended, another show started right up. I don’t remember what the show was, but it was about someone caught in the wilderness who ended up cutting herself with a knife. I had no idea why anyone would do that, and the show was making me really uncomfortable. Not wanting to say anything to my friend and reveal my fear, I got up to grab some water from the kitchen.

I started to look around while I waited for the glass to slowly fill. Next to the fridge was a counter, and on the counter was a big block of kitchen knives– I had never noticed those before. But now they were the only full-color objects in a room that had gone black and white. I thought: I should grab one of those knives and use it to hurt myself. I was suddenly in more immediate danger than ever before; this wasn’t the half-tolerable fear that I’d felt while walking through haunted houses or playing drums in front of a crowd, but something more like complete fear, because now I knew that one of the things I feared most was bound to happen soon.

Heading back to the living room to avoid being asked what was wrong, I sat down and pretended to watch the show while a bunch of terrible thoughts and feelings filled me up. Everything mixed together: I tried to convince myself mentally that I would never grab a knife and do something like that, but then another thought about self-harm emerged and I felt even more ashamed, and the shame led me to thoughts like I’m so pathetic I might as well hurt myself like that. As long as I was having thoughts about self-harm I was convinced I might actually do it; and as long as I was convinced of this possibility I knew I needed to find a way to protect myself from myself.

When all of this only made me feel worse, I tried to insult myself away from the thoughts: What kind of sick person thinks like that? Don’t be so weird. This didn’t work, so I tried the old guilty thoughts: Imagine how disappointed my family would be if I did something like that. Any momentary replacement of this intense anxiety with slower, more familiar feelings like guilt and sadness was a welcome reassurance.

Eventually none of this worked and I ran away, across the street to my own house where everyone was asleep and there was also a knife block on the counter. Seeing that one didn’t help, of course, and by the time I’d run upstairs to my bed I felt like I had the flu. I hoped for morning to come, because it would mean I’d made it through the night without letting the thoughts take over; but I also couldn’t imagine facing my family in the morning, with this new knowledge that I might be the type of person who would harm myself with a kitchen knife.

At the time I didn’t know I had stumbled– thanks to a nice pairing of bad television and well-placed kitchen knives– across another manifestation of the the way my brain vastly overestimates the significance of thoughts I don’t like and gets stuck on them. I had no reason to suspect these thoughts of self-harm were anything but idiosyncratic: something that was wrong with me, and only me. Without any context, it was extremely difficult to place any limits on my thoughts, and so they took over.

If you’re feeling the way I felt then– no matter what the bothersome thoughts are about, and whether or not you have been diagnosed with OCD or are even interested in a diagnosis– knowing a few first steps toward feeling better can be really helpful. So, enough of my story; on to yours.

1. Notice what’s been happening

As soon as you’re able to take a step back and shift from engaging with your thoughts to noticing your thoughts, you’ve made one of the most important moves. Here’s the key: OCD recovery is never about getting rid of certain thoughts. It’s about changing your relationship with those thoughts. It’s hard to accept at first, but you will always experience thoughts like the ones that bother you now. What’s yours to change is the way you react to them– and, ultimately, whether or not they bother you much at all.

First you’ll need to identify patterns in your thought and behavior. You might notice that you’re always fine until a certain thing happens, or that every time someone says this specific thing you find yourself behaving differently from those around you. It’s not always great to use comparison with others as a primary method of gauging yourself, but in OCD recovery it can be helpful at times. When you’re the only one doing something and it’s making your life more difficult, it’s probably one of the things you could work on.

You’re looking for a few things: what sets you off, what thoughts and feelings arise when you’re set off, and how you respond to it. Don’t worry about how you’re going to fix things yet. Just observe, track, examine, notice, etc. If it helps to write things down, do that too.

2. Learn to recognize what’s what

Contrary to popular depictions, people with OCD aren’t bothered by everything. They might also be generally anxious, or especially sensitive, but obsessive-compulsive disorder is not a generalized tendency to be uptight about things. That’s why people can have OCD and still use a public restroom without washing their hands after, or constantly forget to clean up after themselves.

Only you know what really bothers you– and with untreated OCD we’re not talking about being kind of bothered by something. Usually the obsessions will revolve around one or a few themes: every time you’re near train tracks, or each time you’re with kids, or whenever you’re with your significant other and you walk past another couple, and so on.

Think of these as your triggers. What do they trigger? Usually an intrusive thought: I could jump on the train tracks, I could hurt these kids, Isn’t that couple more attractive than us? This intrusive thought, together with the ones that follow, form the obsession. Am I the type to hurt kids? I might be the type to hurt kids. Am I similar to other people who hurt kids? I heard a story about this person in my town who hurt some kids and we have some things in common.

The easiest way to tell obsessions from compulsions is that obsessions increase the amount of anxiety you feel. Compulsions are an attempt to decrease the amount of anxiety you feel. Although compulsions do backfire sometimes, if you’re doing something to get rid of anxiety caused by an obsession it’s probably a compulsion.

Compulsions come in many varieties: repeated actions like counting or touching things in the same order, checking, reassurance-seeking behaviors like asking other people or using Google, mental behaviors like thinking through things or reassuring yourself, and avoiding situations altogether.

Often people with OCD already know that their compulsions are strange or don’t make any sense but don’t know how to stop. But they don’t know that they can let down their guard and stop with the compulsions because they haven’t seen their obsessions for what they are: thoughts that don’t require any more attention than all those other thoughts we get throughout each day.

3. Behave differently to make the thoughts less scary

As you’ve probably noticed, arguing with your thoughts isn’t going to make them go away. In fact, this type of self-argument often becomes a compulsion in itself. This stuff doesn’t work because in most cases obsessions latch onto things that are fundamentally uncertain. Your brain is looking to be certain you won’t get sick, but you’ll never have that certainty. In fact, nobody ever lives a single day sure that they won’t catch a deadly illness. So you’ve got to stop trying to achieve a certainty that’s in fact impossible to reach.

This applies to all those other obsessions too: could you one day lose control of your own mind and jump on the train tracks, hurt some kids, or use a kitchen knife to hurt yourself? Is it possible that you might leave the stove on accidentally and cause injury to others? Yes, of course, because life is vulnerable and uncertain, and your brain can never change that. You’ll end up exhausted, frustrated, even panicked, and everything will still be uncertain.

So what can you do? Change your behavior in response to these thoughts and you’ll find that they begin to shrink. They won’t control you any longer, and eventually you’ll look at them every time they appear with only a vague memory of how much they used to bother you.

But it will get harder first. If you change your behavior and eliminate compulsions, you’ll still have the thoughts and all the bad feelings they cause in you. You’ll really want to use one of your compulsions to tap out and just be done with the pain, but in order to get to a point where the thoughts are just thoughts you’ll have to stick with it, finding different ways to keep yourself from using a compulsion. And only by making it through this pain without using a compulsion will your mind and body learn that they can tolerate uncertainty. Your brain can only be in distress for so long before it starts to habituate and realize that it’s alright. The tough part is that you’ve got to “sit through” this distress and let the habituation happen.

I’ll be writing more soon on specific strategies for staying away from compulsions, but these first steps are a good start. The main takeaway: OCD recovery is not about getting rid of thoughts, but about giving yourself a chance to learn how to tolerate them.

Please feel free to share with anyone who might find this helpful. Thanks as always for reading!

Until next time,

The nOCD Team

Wondering what to do about thoughts that really bother you? If you’re curious about the nOCD app, a free treatment option, have a look at

Note: This story talks about thoughts of self-harm. Even though this exact uncertainty is a key part of self-harm obsessions, if you suspect your thoughts might cross over into actual self-harm please contact a professional (like a therapist or your doctor) so they can assess your symptoms and help you make a plan. If you’re already engaging in self-harm, please get in touch with a professional immediately. And if you’re ever considering suicide, please call 1–800–273–8255, or your local suicide hotline if you live outside the US.

Defusion and OCD: Useful techniques that are easy to try

By Ryan Vidrine, MD,

We’re launching a series of op-ed pieces by clinicians and researchers who are enthusiastic about sharing what they’ve learned through years of working with patients and conducting studies.

Today’s post is written by Ryan Vidrine, MD, an Interventional Psychiatrist at TMS Health Solutions in San Francisco who specializes in OCD, BDD, anxiety, depression, and brain stimulation treatments. Ryan is a good friend of nOCD and a tireless supporter of people with OCD.

You can find Ryan here:

Why, when it comes to OCD, defusion techniques are actually “Sooo fetch!”

Doctor: “What worked?”

Patient: “Like you told me… to give a character to my OCD or BDD obsessions. It totally works!”

Doctor: “That’s awesome. So, who did you pick as the character? Darth Vader? The Joker?…It’s not me, is it?”

Patient: “I just imagine that Regina George from Mean Girls is the one behind all of my obsessions. I picture her talking to me in that super snobby, plastic way or writing down my thoughts in her burn book. She’s suuuuch a bitch — so at first I kind of want to laugh and then I start to think how ridiculous everything she is saying is, and sometimes even picture the scene in the lunchroom where everyone starts acting like animals and throwing food. It gives me just enough space to remember it is just the OCD or BDD talking, and choose to do something else more important.”

Our brain is a thought machine — its job is to churn out thought after thought. Many of these thoughts are just random things. Many others are often negatively-skewed or fear-based thoughts about “what if’s” and other possible catastrophes– often hypothetical, and often things we don’t have control over and thus cannot do anything about. But that, in many ways, is the brain’s job.

Remember, we evolved for survival — to pay attention disproportionately to the dangerous and negative aspects of life. The problem is that these parts of the brain that sound the alarms of danger evolved prior to the development of consciousness and the ability to think, plan, hold perspectives, imagine, and worry about the future. It’s like we are using the latest iPhone X, but still running the iOS from the original iPhone. In the world we live in now, our iPhone X brains are bombarded with notifications, pop-ups, and individually targeted ads, but the old operating system we are running doesn’t have all the fancy new ways to know what is relevant, what can wait, or how to filter or turn the notifications off. And so our iPhone 1 brains are constantly buzzing and telling the rest of our mind and body that these thoughts are real and important and need attention, or else we won’t survive.

Lucky for us, our higher & newer brain parts are sort of like the Apple Genius Bar — they can employ patches, updates, training, and modifications over time to help us improve our user interface and experience… but it takes a little time, effort, and intention. If we aren’t intentional and aware of how we relate to our thoughts, we can find ourselves in a state of Cognitive Fusion, where we treat every thought we have as true, important, not up for debate, and reason enough to send our body into fight-or-flight mode…all in the name of survival.

Cognitive Fusion is a common pitfall that many of us can fall into. This is the idea that “because we think it, it must be so.” For example, have you ever found yourself saying something like, “I can’t go that party… I would die… I’m way too socially anxious.” You might even notice that as you are even describing how you CANNOT go to the party, your body is already responding as if you did go — spooning a giant heap of adrenaline right onto your plate, with all the standard sides of racing heart, sweating, skin crawling, and so on.

To make things more complicated, in OCD we often see Thought-Action Fusion— where a “bad” thought is then followed by an expectation that some sort of “bad” action or outcome is on the way. In severe cases, people believe that just having certain thoughts will directly cause specific actions to happen. I often see this in my OCD patients as intense fear that they might actually do the thought that pops into their head. One new mom’s OCD flared up just after she gave birth and, as a congratulatory gift, gave her thoughts of throwing her baby out the window. She was so scared and tortured by this that she began increasingly avoiding time alone with her child. More and more she started passing the baby off to her husband because she couldn’t see her thoughts as just thoughts — she treated them as true and capable of automatically causing action simply because she had them.

As it turns out, you CAN go the party… it’s just that this idea makes you anxious. You WILL NOT die…You WILL NOT throw your baby out the window… but your mind will certainly tell you these things, and try its best to make you feel like you might. And lastly, you ARE NOT a ball of some substance called “social anxiety.” You ARE NOT a “bad person” because your brain had a thought. You are a human being, with a brain that makes thoughts…because that’s what brains do. You are a human being with a vast array of qualities, only one of which may be that you feel anxious in some social situations. Lucky for you, you have several other resources, qualities, or skills that you can employ to “survive” situations like the above.

The general goal of Acceptance-Commitment Therapy, or ACT, is to increase psychological flexibility: the ability to contact the present moment more fully as a conscious human being, and to change, increase, or continue behaviors such that they move us closer to our values in life. Cognitive Defusion is one of the core principles of ACT– and one of the best software upgrades for your faltering operating system. Defusing from your thoughts (breaking that thought-action fusion) means using any number of strategies to create some space or distance from your thoughts, giving you the chance to remember that our brains are simply first-generation thought machines and that those thoughts are simply thoughts. Almost anything can be used as a defusion technique if it helps to break the tension, give you pause, make you laugh, or any other manner of momentarily getting you out of your own head.

As demonstrated at the start of this piece, one of my favorite defusion techniques with OCD or BDD is to have patients assign a character to their brain’s obsessions or nasty critiques. It can be anything, although in my experience, something cheeky and outrageous tends to work best, as humor is one of the best known defusion techniques. I have one patient who imagines all of his OCD thoughts coming from Kellyanne Conway and Donald Trump, telling me he finds their voices grating enough to get him out of his head– plus, it reminds him that his thoughts are “fake news.” A different patient prefers South Park characters, usually Mr. Garrison or Cartman. Another person likes to imagine that each domain of her obsessions is a different Golden Girl. She imagines the snarky, critical ones coming from Sophia, yelling at her from the confines of Shady Pines. Her sexual obsessions take the form of Blanche, her perfection obsessions are Dorothy, and her social anxiety and fear of looking stupid to others are delivered by Rose.

Other defusion techniques include singing all of your obsessions to various tunes until they lose power, repeating or imagining your obsessions in funny or exotic accents, or even some visual techniques such as imagining your thoughts as leaves floating down a stream or words on an Etch-a-Sketch that can be shaken and erased whenever needed. If these techniques sound absurd to you, try them anyway… they still might work, and they’re likely no more absurd than many of the obsessions you are having all day long.

If these strategies don’t work, or if they just aren’t your thing, there are more subtle ways of training your brain to defuse from its thoughts over time. One trick is to pay attention to the language you use. Instead of saying “I’m going to throw my baby out of the window!” or “I am going to make a fool of myself at the party!” try to practice saying, “My brain gives me the thought that I could throw my baby out of the window” or “My brain gives me the thought that I will make a huge fool of myself.”

I’m a brain nerd so I like using the term brain, but some people prefer to say, “My mind” or “The OCD” or “The OCD part of my brain.” Whatever you choose is fine. The idea is that language is super important to our brains, and even slight changes in the language we use can have a powerful impact in how we feel and how we relate to our thoughts. These subtle changes can create a little more space and act as a reminder that our thought isn’t a fact and isn’t actually happening. It’s just a thought.

Don’t get me wrong– these techniques will not cure you. They aren’t replacements for exposure therapy or medications or support from family, but they’re one more simple tool that you can use day-to-day to get a few more minutes outside of your own head, a few more minutes connected to the world around you. And, who knows: if you have a little fun with it, you might find out that regardless of what your Regina, Kellyanne, or Sophia actually tells you, defusion really can be “sooo fetch.”

Thanks once again to Ryan Vidrine, MD, for contributing this op-ed piece. If you’re willing to share your expertise with readers on our blog, please send an email to And for more on Ryan’s work, find him on Facebook:

Lastly, if you’re a clinician or researcher looking for a new tool to make your work easier and more effective, have a look at the ways the nOCD app might help: click here.

OCD Around The World: An Infographic

By Patrick,

Because it’s daunting enough just to understand the state of mental health in your own country (or even your town), we often lose sight of the fact that people are struggling with similar issues all around the world. To make sure we keep everyone’s mind in mind, here’s an infographic about the effects of OCD across the globe.

We’re looking for stories from people dealing with OCD around the world. If you live outside the United States and are interested in having your story featured on our social media accounts, or even writing a guest blog post, please let us know by messaging @treatmyocd on Twitter, Instagram, or Facebook. Thanks for your willingness to tell us about your life.

Also, whether you’re feeling stuck with OCD, concerned about someone you care about, or just curious what a global community of people working together to improve their mental health looks like, feel free to check out the nOCD website for more: click here.

Why is OCD so misunderstood?

By Patrick,

Don’t like marker lines left over on the whiteboard when someone erases it?
Need to have your books in a certain order on your bookshelf?
Never really like to touch a toilet seat in the public restroom?

Then you must be a little OCD, right?

Because so many people say this kind of stuff, it can sometimes be hard to tell what people mean when they say “I have OCD.” Is it a serious statement meant to let you in on their own troubles, or another offhanded attempt to explain away their behaviors in a vaguely self-deprecating way? I once saw a roommate move in with a bunch of cleaning supplies and mentioned that I was glad to be living with someone else who did a bit of cleaning now and then. He responded, “Yeah, well I have OCD.”

OCD is like the Boy Who Cried Wolf of mental health conditions: so many people claim to have it that it’s lost its original meaning.

Why are OCD jokes offensive?

I still don’t really know if my roommate was serious, or trying to make a joke. Joke isn’t always the right word for people’s remarks about OCD– they’re often more like offhanded statements by a person who doesn’t have OCD using the condition as an excuse for some personality trait or behavior. But I’ll keep calling them jokes anyways for a few reasons:

  1. They’re based on a failure to understand OCD
  2. They’re usually meant to create a sense of good-natured or chummy connection with the person they’re being told to
  3. Some people find them funny, others find them offensive, and still others don’t really find them either funny or offensive

Of course, people make OCD jokes because they don’t really understand it, not because they’re evil. The sad reality is that people rarely take the time to really understanding something unless it affects them or someone they care about. People also make jokes about mood disorders (“Sorry, I’m a little bipolar today”), eating disorders (“She’s looking a little anorexic”), and everything else. But still, OCD is still the subject of a disproportionate number of jokes about mental health conditions. Why are there so many jokes about OCD?

Actually, before we proceed, it might make sense to quickly address why people with OCD might be offended by these jokes and joke-like statements. One problem is that offhanded statements about OCD gradually make people less likely to acknowlege that it’s a serious, chronic condition affecting 1 in 40 adults and 1 in 100 children in the US. As I mentioned above, constant jokes about OCD make it unclear who is really in need of help and who is just messing around. They also make it harder for people to know what OCD really is, meaning they might be less likely to seek help even when they’re really suffering. People who are already in treatment feel even more alone because it seems like other people could never understand how bad they feel. Lastly, offhanded remarks can erode what little cultural understanding there is of OCD, making it more likely that people will make jokes, and so on.

Why are there so many jokes about OCD?

When the average person thinks of OCD, they think of two things: neatness and fear of germs. These depictions aren’t wrong, exactly, because many people with OCD do have these symptoms. But TV shows, movies, and the internet pick up on these compulsions without investigating the obsessions and the intense distress that lead people to use those compulsions. And OCD symptoms are much more varied than these stereotyped images suggest.

The behavior itself might seem kind of funny: okay, there’s someone washing their hands over and over, and we don’t know why. There’s another person who spends the entire day cleaning the same surfaces over and over. But once you know that they’re doing these things because they feel sure something bad will happen if they stop, it becomes less humorous.

For a very short summary, obsessive-compulsive disorder (OCD) makes it very hard for people to tolerate certain forms of what we call intrusive thoughts: those unwanted thoughts that pop into your head throughout the day. People with OCD feel unable to move on from the thought, and might start to ruminate about it. The result of getting stuck on intrusive thoughts is what we call an obsession. Most people have certain “themes” of thought they always get stuck on, like the possibility of getting sick or harming someone else. Because the obsessive stuff causes a lot of distress, people with OCD will often turn to a compulsion in order to reduce that distress.

Source: Hofer, Helene & Frigerio, Susanna & Frischknecht, Eveline & Gassmann, Daniel & Gutbrod, Klemens & Müri, René. (2012).

Sometimes the compulsion is directly related to the obsession, and other times it isn’t. For instance, a person might wash their hands repeatedly (compulsion) because of thoughts about how they must’ve touched contaminated surfaces recently (obsession). In this case, the two are directly related. But they might also wash their hands repeatedly (compulsion) because they’re having thoughts about how they could’ve unknowingly run someone over on their way home from work (obsession) and the hand-washing relieves the distress the obsession causes.

You might say: okay, I would never make a joke about someone who fears they’re going to die of a serious illness, but what about the people who just like things to be really neat? This is another important point: the type of OCD someone has does not determine the amount of distress they feel. It seems like a pedophilia obsession would be more difficult to tolerate than a religious obsession, but there’s no equation for the amount of distress someone will experience. Besides, as mentioned above, the type of obsession and the particular compulsion often aren’t a clear match. Someone persistently reordering their books might be doing that to avoid how terrified they feel in response to an obsession like: I could go over there and suffocate my child.

With all of this in mind, here are a few theories about why there are so many jokes about OCD:

  1. Obsessions are mostly invisible, so people only see the (sometimes strange) coping mechanisms used to dispel the distress they cause. Unfortunately, most people aren’t taking the time to wonder why someone would behave compulsively. Instead, they observe the behavior and it makes them uncomfortable so they tell jokes.
  2. An “obsession” in our wider culture has a different meaning than an obsession in OCD. More widely, an obsession is simply something we’re intensely interested in. People with OCD are not “interested in” their obsessions, and would do anything to get away from them. Others might hear “obsession” and think that those with OCD have some say in what they’re obsessing about. But people with OCD aren’t obsessed with Rihanna; they’re usually very anxious about important aspects of their lives.
  3. People assume that certain types of OCD must be worse than others, because the content of the thoughts themselves seems worse. They might know not to make jokes about “more severe” types, while also assuming that people with less severe types are somehow fine with being joked about.

Perhaps the most important takeaway is this: people are always engaging in compulsions in an attempt to reduce their level of distress. Nobody enjoys washing their hands over and over, and nobody wakes up saying “I’m glad to spend another day forcing my family to put stuff back exactly the way they found it.” It’s pretty simple: people with OCD are often in a ton of pain, and making jokes about people in pain is sort of messed up.

That leaves the offhanded remarks about having OCD. If you’re not feeling a crippling amount of anxiety before you do the behavior, and if you haven’t found yourself doing it before, it’s probably untrue that you’re doing it because you’re “a little OCD.”

You can help reduce the negative effect of OCD misconceptions by spreading good information around the internet, and by educating your friends and family when they say something like “I’m just so OCD about my furniture.”

By the way, if you ever hear someone who’s truly struggling with OCD say something like these…

I’m so OCD
I’m a little OCD
It’s one of my OCD things
That’s such an OCD _____

…Then please let us know, because we will be very surprised.

Until next time,

The nOCD Team

Before Bed: An Unwanted Date with OCD

By Joseph Antonellis,

Today’s story is written by Joe Antonellis, a student-athlete at Pomona College in California. Joe has the kind of enthusiasm about writing that makes you want to sit down and write too, and brings all this passion to his work writing about mental health and personal journeys.

Alone time is the worst. When you are alone, with nobody else there to pull you back into reality, OCD can kick your brain to the curb and grab control of your mind in an instant. Being alone with your obsessions somehow makes them more real, resistant, and powerful, enabling them to ambush you with ease.

When are these anxiety attacks most likely to occur? Right when your mind is meant to be at its quietest and most tranquil: sleep time. Even if you’re with a partner at this time, you’re forced to avoid interacting with them, as it would be rude to risk waking them up. This makes the time right before bed one of the most frightening times for people with OCD, invoking a deep and interesting relationship between the two very opposite factors.

I remember I would always dread going to sleep when I was suffering with OCD in my younger years. I would avoid bedtime, partaking in various other activities to put off the eventual loneliness of sleeping. I was terrified of being alone with my brain, as I didn’t have the confidence to deal with my OCD on my own when no other activity preoccupied me. Some nights it never struck, and I was able to sleep peacefully, but other nights, obsessions lingered until the I heard the birds singing at dawn. This led to a lack of sleep, of course, resulting in a very unhealthy lifestyle, which contributed negatively to my mental health in addition to my struggles with OCD. It’s not like I was distracting myself with beneficial activities either. Most of the time, the late nights were filled with binge eating, mindless TV shows, and violent video games.

In other cases, my bed would be the getaway place I would try to escape to when an obsession came on. Although torturous at times, it could also serve as a safe haven where I knew none of “my ideas” would come to fruition. It was the perfect excuse when I was younger. Whenever an activity or event came up that I knew would trigger my OCD, I could always say I wanted to take a nap or pretend I was sick to try and get out of it. This was just another defense mechanism to avoid the mental barriers instead of busting through them, and “sleeping,” although difficult due to the imminent loneliness associated with it, allowed an easy escape from my fears. As I said above, OCD is not only a mental condition, but an idea that creates fear in the brain, making those afflicted try to avoid confrontation with it at all costs. Sleep and OCD have a significant duality in the effects of the two on each other, which must be explored further.

The Unwanted Cup of Coffee

Imagine you were forced to drink a full cup of coffee before going to bed every night. You would sit there in bed and stare at the ceiling, with distracting thoughts whirling in your mind for hours. You would never get a good night’s sleep this way, and would never feel rested the next day. Now, I’m sure many of you have experienced this feeling after accidentally having caffeine before bed, or when trying to work or study late into the night– but imagine feeling this way every night. This is what it is like for those suffering with OCD. Research has shown that those with OCD have higher than normal rates of insomnia, and even other sleep issues like delayed sleep phase disorder. These issues are shown to be caused by obsessive thoughts, which keep victims up all night, trapped in their thoughts.

As mentioned before, bedtime is the loneliest part of the day, but also one of the most important times of the day. Sleeping efficiently has many different contributing factors, one of the most important being your “sleep environment.” It takes time every night to get into the ideal sleeping position and get your surroundings all set. This includes factors like outside noise, lighting, bedding, and temperature. If you have OCD, though, one compulsion can disrupt all of this, resetting the sleeping process and delaying your much-needed time in dreamworld. For example, I would often run out of bed to check if the downstairs lights were off, and this alone would set my sleeping process back 20 minutes– assuming I only checked one time. Compulsive behaviors and the obsessive mental processes mentioned above make the ultimate combination standing in the way of a good night’s sleep, but other complexities muddle this process even more.

The Vicious Cycle: OCD and Reduced Sleep

Let’s assume that your OCD is taking away an hour’s worth of sleep from your night, at minimum. Whether it’s a constant stream of obsessive thoughts or compulsions, you never get to bed by the time you wanted to. This lack of sleep is not only affecting the sharpness of your brain and the fatigue of your body the next day, though. It’s probably increasing the severity of your OCD as well. Studies have shown that a lack of sleep can cause an increase in the commonality and duration of obsessions the next day. Thus, the relationship between sleep and OCD is not only causal, but by nature circular. First, OCD causes you to lose sleep, then this lack of sleep causes your OCD symptoms to arise more frequently. If you suffer with this OCD-related insomnia, this seemingly exponential relationship can seem very daunting and undefeatable, much like a runaway train, impossible to stop. The first issue is viewing the problem as the entire thousand-ton train. You must stop the train one gear at a time, picking off one little piece any chance you get, in order to stop it. The cycle can be stopped, and the first real step is to truly believe in your mind that it can be, recognizing that it will not be easy but can be done.

Combating the Sleep-Stealing Obsessions and Compulsions

When it comes to OCD and sleep, it is best to start off by gaining a few small victories. First, I would like to address the in-bed compulsions that could cause you to wreck your sleeping environment and set back your sleep cycle. Let’s say you feel a strong urge to check something in your house. Getting up and checking it is self-defeating, so the main goal is to not perform the compulsion. If you have strategies that work during the daytime (like counting backwards from 200 by multiples of seven, or observing 10 things in your immediate environment) then you can try those at night too.

If you don’t have any strategies yet, or they’re not working, distraction is your next best bet. Try something that won’t keep you awake, like journaling, reading, or listening to quiet music. As long as it won’t ultimately be harmful to your health, anything you can come up with will be better than giving in to your compulsions. Try new things, especially if they’re things you’re actually interested in. And don’t be discouraged if things don’t work out too well at first: the goal is improvement, not perfection.

Although reassurance-seeking is not an ideal strategy, and can be another compulsion in itself, in extreme cases the need for sleep might outweigh your OCD treatment goals in the immediate short term. Let’s say you have a final exam tomorrow, and you just can’t get yourself to sleep. Maybe, for one night only, it might make sense to put yourself at ease. For example, if you always have to double-check that the lights are off in the house, a strategy to allow yourself to relax could be taking a picture of the dark room, to reassure yourself on your own without any outside help. Again, reassurance is not a great strategy because it tends to strengthen the obsessive-compulsive circles in the long run. It always feels good to get reassurance in the immediate, but for your long-term recovery it’s important to work on strategies to for diffusion or distraction, not reassurance. But we won’t pretend like there are never nights when it’s better to sacrifice this treatment objective and get some sleep.

Although these are steps to help you prevent compulsive behaviors, it is harder to deal with the obsessive thoughts that plague your brain for hours when you’re alone in bed. Meditation practice often helps me in these situations, combined with a form of self-questioning. If you ever find yourself obsessing all night, it is best to start taking deep, slow breaths, trying to focus all your attention on the rising and falling of your chest. This will allow for at least an attempt to clear your mind of the obsession for a moment. Next, after calming down your stream of thought, try to question the validity of the obsession. Why am I thinking this? Why is this important? Do I have to think this? Note that if one of your compulsions is to try to figure out the answer to these questions, this particular strategy probably won’t help you. Otherwise, these questions might help put your obsession in perspective, and perhaps this combination will help you drift off to sleep faster than you previously would have.

Sleep is the quiet force that allows us to keep living. All humans need it, but much like everything else in the world, everyone’s ability to attain it varies. I would like to conclude with Walt Whitman’s famous poem In Midnight’s Sleep, a recount of the horrors he saw in the Civil War, and how they constantly reappeared in his dreams and disrupted him in the middle of the night. I want you all to visualize OCD as a war going on in the mind. Just like in the poem below, there is hope of ending the war, but this hope is not there without the existence of hard-fought battles. This hope is not there without the recognition of beauty in the struggle. And finally, this hope is not there without dreams. I encourage you to keep fighting these battles everyday, no matter how small. Be resilient in your efforts, and be strong, because no matter what you think, it is inside each and every one of you.

In Midnight Sleep

IN midnight sleep, of many a face of anguish,

Of the look at first of the mortally wounded — of that indescribable


Of the dead on their backs, with arms extended wide,

I dream, I dream, I dream.

Of scenes of nature, fields and mountains;

Of skies, so beauteous after a storm — and at night the moon so

unearthly bright,

Shining sweetly, shining down, where we dig the trenches and gather

the heaps,

I dream, I dream, I dream.

Long, long have they pass’d — faces and trenches and fields;

Where through the carnage I moved with a callous composure — or away

from the fallen,

Onward I sped at the time — But now of their forms at night,

I dream, I dream, I dream.

By Walt Whitman

We’re interested in sharing more stories like this one. To talk with us about submitting your story to the nOCD blog, please email

And if you’re interested in learning more about the nOCD app, a platform for treating your OCD and finding a community of other people dealing with anxiety disorders, click here.  

Infographic: OCD at Work

By Patrick,

Have you ever wondered how to help coworkers or employees with OCD? Felt hopeless watching people perform compulsions or hide their symptoms in the office because you didn’t know what to do? Here are some important facts, and ideas of what to do with them.

Thanks for reading, and until next time!

-The nOCD Team

Whether you’re feeling stuck with OCD, concerned about someone you care about, or just curious what a global community of people working together on their mental health looks like, feel free to check out the nOCD website for more:  click here

How did nOCD come to be?

By Patrick,

Whether you’ve been following us on social media for a while, found out about the nOCD app from a friend, or just stumbled across our blog, you might be a bit confused about what nOCD is and where it came from. We’ve already covered some of the basics in our post about the nOCD team, but we’d like to give you a clearer picture of why all of this exists in the first place, and where it’s headed next.

The Beginning: From Worried to Worse

Stephen grew up in suburban Chicago, playing football and frequenting the local Italian restaurants with his family. As a kid he sometimes suffered bouts of intense worry about becoming sick, or even getting cancer, but mostly things were fine. When he finished high school in 2012, things were looking up: not only was he heading to college in Texas, but he’d be the quarterback of their football team.

By the time he was a sophomore in college, Stephen’s anxiety had only gotten worse. His old compulsions of looking things up for reassurance– the old WebMD Symptom Checker trick that many of us know too well– were no longer keeping the daily worry at bay. He made it home for a break from school, and then his symptoms reached their peak. Stephen could barely leave the house, suddenly reduced from performing at his best to simply getting through the pain and making it to the end of each day.

In Therapy: Good Treatment Is Hard to Come By

The distress became so bad that Stephen felt he wouldn’t be able to stand it much longer, so he set out to figure out what was going on and get it treated. He looked online first, and connected with psychologists who told him he would just need to fight the thoughts, or maybe move away from home. These clinicians gave him a lot of advice, but nobody really taught Stephen any strategies for getting better.

Even once he finally secured an appointment with an expensive OCD specialist, Stephen didn’t learn everything he needed to know. And he found that the symptoms he experienced in between his therapy sessions could quickly become overwhelming. It was extremely difficult to complete ERP (exposure and response prevention) homework while already in the midst of a crisis, and an hour of treatment per week wasn’t enough to prepare for the 167 other difficult hours he would face alone.

The Solution: OCD Treatment on a Smartphone

Finding that there was nothing else out there, Stephen came up with his own solution: an application on his phone that would allow him to do ERP exercises and get help during an OCD episode, while tracking data on where he was when the symptoms hit, how severe the symptoms were, and how long they took to subside. His phone was always with him, and his friends never asked why he was using it.

While working on something for his own treatment, Stephen knew that it would benefit lots of other people who were struggling to get treatment for their OCD symptoms. The app would make it much easier, and much cheaper, for people to find treatment, stick with it, and get better. No longer would it take 17 years on average for people to even get the right diagnosis and start on what would likely be a long journey through OCD treatment.

Team Building: Talented People with Close Ties to OCD

From then on, Stephen has worked tirelessly to build the nOCD app and the community around it. But a big part of nOCD’s success has been Stephen’s decision to surround himself with other people who are driven to help people with OCD and highly skilled at what they do. Because around 1 in 40 American adults has OCD, most people have some association with OCD through friends or family. nOCD is no exception: all of its team members either have OCD themselves or know someone who does. And when you’re close to this disorder, it doesn’t take long for you to wish there were more ways you could help.

From summer 2014 through fall 2016, the nOCD team grew as Stephen invited people from around the country to take on different roles. While Stephen focused on meeting researchers, clinicians, and business partners, developers in California and Texas began helping him build the app from the ground up. From UI/UX design to concerns about cybersecurity, nOCD’s talented developers worked with Stephen over this period to get the app ready for release. Meanwhile, nOCD’s team of clinical advisors vetted the app to make sure it adhered to the same treatment standards they would use in their own practices.

Community Building: That’s All Of You

Around the time the app was released in late 2016, we also began to focus more on bringing people of all sorts into our community. Through social media, a new website, and most recently this brand new blog, we’re working toward our goal of giving everyone a place to learn about OCD and mental health. At 80,000 people and counting we’ve already gathered the largest OCD community in the world, and we’re just getting started. It’s bad enough dealing with OCD, and people shouldn’t have to face the added nightmare of going through it alone.

We can see everything from up here!

A few months ago we moved to a brand new office in a tall building on Michigan Avenue in Chicago. We continue to add team members, allowing us to focus more closely on a bunch of things. Here are three of the main things we’re focusing on:

  1. Continuously improving the nOCD app so it’s more helpful to everyone using it (Also: Yes! There is an Android version in the works.)
  2. Growing our community around the world, and providing the best educational content so misconceptions about OCD fade and people realize it’s a common, treatable mental health condition and not an annoying personality trait
  3. Partnering with more of the best, most knowledgeable people in mental healthcare, business, and tech so we can reach more people around the world and improve what we offer to them

Getting nOCD to where it is today has required constant testing, meaning we would still be at square one without all of our active community members like you who choose to get involved, offer feedback, and help us grow in the right directions. In other words, your constant support is the single most important thing we have at nOCD. Thanks for being a part of this, and for working hard along with us each day to make OCD treatment better for everyone.

Do you have any questions about nOCD or suggestions about what we could be focusing on? Please let us know in the comments!

Well, that’s all for now.

-The nOCD Team

Whether you’re feeling stuck with OCD, concerned about someone you care about, or just curious what a global community of people working together on their mental health looks like, feel free to check out the nOCD website for more: click here.

The latest in OCD research

By Patrick,

What causes OCD, and how can we treat it?

Even though an estimated 70% of people with OCD find them helpful according to the IOCDF, both medication and behavioral therapy fail for many people. If you (or a loved one) haven’t experienced recovery yet, it’s possible that existing treatment methods haven’t been optimized for you. It’s also possible that the treatment you need… hasn’t been invented yet.

Luckily, there are tons of researchers out there working hard every day to find new treatment options for OCD. Some of these potential new treatments begin with attempts to understand the cause of OCD. Others ask: why aren’t the treatment methods available today working for lots of people? Let’s fly through a few new treatment developments and what they might offer for the future of OCD.

First, a new study from Duke University found that overactivity of one single type of chemical receptor in the brain is responsible for symptoms closely resembling OCD in mice. When researchers gave the mice something to block those receptors, their OCD symptoms let up in under one minute. Now, unless you’re a very smart mouse reading this, these findings don’t necessarily translate to an easy fix. But this provides hope that further research on the mGluR5 receptor could translate to better options for humans too.

Another recent study looked critically at two different options for augmenting, or adding to, first-line serotonin reuptake inhibitor therapy: the antipsychotic medication risperidone, and Exposure and Response Prevention (ERP) therapy. Researchers found that ERP was a more effective augmentation strategy, especially for younger people and those with more severe OCD symptoms.

Coming up next is a very recent study published by the Centre for Addiction and Mental Health. A few ambitious researchers found what seems to be a strong correlation between OCD symptoms (measured on the Yale-Brown Obsessive Compulsive Scale) and inflammation in the parts of the brain believed to be responsible for those symptoms. Though the amount of inflammation varies, this finding provides a basis for many possible treatment developments.

Ketamine, an anesthetic sometimes used recreationally, has been getting a lot of buzz as an emerging treatment for depression and other conditions. It’s now also in early trials for OCD, led by people like Dr. Carolyn Rodriguez at Stanford, and they’re getting promising results. As in the depression trials, researchers are still working to figure out how to reduce the side effects and extend the positive effects of ketamine.

Lastly, researchers around the world have been looking more closely at the role of glutamate, a neurotransmitter like serotonin, that they believe plays a role in the compulsivity part of OCD. One review looked at a number of drugs that act on glutamate and concluded that OCD is the best candidate of all disorders for successful treatment by glutamate modulators. As always, the study concluded that further studies will be needed to determine anything else.

We’ll be sure to keep an eye out for the latest on OCD research. And if you see or hear anything, please be sure to let us know in the comments.

Until next time,

The nOCD Team

If you’re interested in learning more about the nOCD app, a platform for treating your OCD and finding a community of other people dealing with anxiety disorders, check out

Let’s Break Barriers Together: A Personal Story of OCD Recovery

By Joseph Antonellis,

Today’s story is written by Joe Antonellis, a student-athlete at Pomona College in California. Joe has the kind of enthusiasm about writing that makes you want to sit down and write too, and brings all this passion to his work writing about mental health and personal journeys.

Never even glanced at the colorful fires setting to the west.

My family gathered around the table, full of jokes, laughter, and smiles. The balmy weather, combined with the picturesque view of the golden Arizona sunset, created an observed inner peace amongst my surroundings. From the upper balcony of the restaurant the desert panorama exuded a dangerous trust to its inhabitants. An owl perched on a Saguaro cactus seemed to smirk at me, laughing at the pain in my eyes.

Too bad that day I never enjoyed the warm presence of my loving family. Never even glanced at the colorful fires setting to the west. Never enjoyed the once-in-a-lifetime view that opened up the desert environment to my senses. I was too busy trapped in my own mind, OCD taking over my twelve-year-old body like it always did, controlling my every facet, pushing me to the brink of insanity.

The knife to the right of my plate beckoned me. “Take me and cut yourself.” Over and over again in my head I fought the internal battle. No, you don’t have to do this. Please don’t do it. The knife was relentless though, grinding into my head its constant message.

“Honey, do you know what you want to order?”

I stared at her with a blank expression. All I could think about was the knife. I had to get away from it before it was too late. I feared the next time I laid eyes on the knife, it would be protruding from my skin.

“I have to go to the bathroom,” I quietly stated, avoiding eye contact with my family as I scampered out of the dining area.

I will never forget the way I felt when I was locked in the bathroom that night. I felt I had disappointed my entire family, confused them, made them scared. I was too terrified to open up to them about how I felt. Helpless, I had no answer to what was going on in my head, and didn’t even know what was causing it or what it was. Tears filled with uncertainty flooded down my face, covered in anguish. All I knew is that I had to get away from that knife, or else I would lose all control.

It wasn’t only the knife though. The compulsions didn’t stop there. They followed me everywhere I went. There was no safe place for me with OCD, with my mind creating a new obsession the moment I got over the old. Throughout my entire childhood, I struggled with this torturous disease, with no clear path to liberation in sight. I never knew what it was until I was brave enough to talk to my mom about it. Opening up was the first of the two-step process that led me to defeat OCD, and I would like to expound upon the first steps I took in my long battle with the evil disease.

Opening Up and Finding the Root of the Issue: Experiences in Therapy

Fear that I would ride off the trail and hurt myself on purpose

I was so afraid to disappoint my parents that I held in all the turmoil that was going on in my brain for years. Eventually, it got to the point where my life was an actual living hell. Happiness was a thing of the past, as every good moment quickly turned into another whirling obsessive tirade in my head. I remember one day on a mountain biking trip with my family when I sat behind at the trailhead all day waiting for them to come back, in fear that I would ride off the trail and hurt myself on purpose. My brothers always thought I was crazy, and my parents viewed these incidents with fear and confusion. I knew I had to tell them why, and eventually that time did come.

When I told my mom about the way my brain worked, and how I couldn’t control my thoughts, she immediately knew it was OCD. Before I told her, I expected her to immediately outcast me as the freak, the child that didn’t live up to expectations. But, it was quite the opposite. Right away, she tried everything in her power to help me. Reluctantly, I agreed to go to therapy. After having a few OCD panics before the first couple sessions and skipping them, I finally made it to one, and it was the first step to my eventual freedom from the disease.

The feeling of being and talking with a stranger has a calm and free beauty to it. You know that you will never see them in the context of your daily life, and that whatever you say to them will not affect your life no matter how they view you for it. These therapy sessions allowed me to explain in entirety what I was going through on an everyday basis. I felt safe to say things I didn’t want to say in front of my family members, knowing I couldn’t scare them or make them change the way they look at me. Through the first few sessions, I often wasn’t honest with myself or the therapist. This, of course, was useless, and I quickly realized that. A voice in my head would encourage me to keep everything inside. Eventually, I was able to conjure enough strength to break this barrier, which leads me to the main strategies I used to beat my OCD.

OCD hits with you obsessions constantly, and to beat it, you have to use all of your mental strength to ward them off. After working with my therapist for months, we were able to come up with a mantra I would ask myself in my head whenever I would feel like doing a compulsion. Do I have to do this right now? Do I have to think this right now? Who’s making me? I’m in control. As the popular phrase goes, sometimes you need to “fake it to make it.” Whenever I would start obsessing, I would just focus on these phrases, and truly ask myself these questions in my head, providing myself with honest answers. Almost always, I would repeat, No, I don’t have to do anything I don’t want to. I don’t have to think anything I don’t want to. I’m in control. This mantra helped me stay grounded, and it was always there to fall back on. It was my first defense mechanism against OCD, but often it wasn’t enough. I had to create something more physical to pair it with in my fight against the full-body disease that OCD is.

Breaking Barriers: Getting past obsessions for the first time

Breaking an OCD barrier is much like solving a math problem that has stumped you for hours. It seems impossible to solve, no matter how much effort you put into it, but eventually you get that lightbulb moment. Suddenly, the answer just comes to your head, and you realize what you were doing wrong the whole time and come to a speedy conclusion. With OCD, it is like being trapped under the ice of a frozen lake. Suffering and drowning, you pound on that ice as hard as you can with your fists, but the effort is futile because your fists are simply not hard enough to the break the ice. But once you are equipped with the right tools, you can smash right through the ice, pull yourself up, and take a deep breath of fresh air.

One of my most common compulsions can be observed when I’m walking down city sidewalks. In my head, it is absolutely essential that I step on each crack on the path in front of me. If I miss one, I often “have to” go back and step on it, and then go catch up with the people I am walking with. Whenever I catch myself doing this now though, I break the barrier. I ask myself, Do I have to do this? I’ll say No, and I will force my body to keep walking. The further I get away from the crack, the less I think about it. The first time you break the barrier of a compulsion is always the hardest, but once you accomplish it, it gives you immense confidence. Everytime you get that recurring obsession, you can think back to the time you beat it, and it will give you the innate willpower to overcome it again. Much like a pianist practicing a piece, the more you break the barrier the easier it becomes to do on an everyday basis, allowing yourself to master the practice.

Although my OCD was most present when I was younger, I still apply these strategies every day. Instead of my attacks lasting hours or even days, they just last a few minutes, because I have built up the skillset to both recognize and kill off any attachments to these obsessions quickly. But, they still do exist in my mind, and I find myself doing things compulsively on an everyday basis. There is still a fear in my heart that it could come back and haunt me like it used to, as those memories still persist in my brain today.

Even starting to write for nOCD has scared me, as I thought that rehashing all of the old memories and thinking about OCD in detail again could bring it back in full power. But, all of this is just fear and lack of confidence. Once a barrier is broken, it can never be unbroken, and it will always be wedged in your brain that it can be accomplished. I hope I have inspired all of you to open up about your OCD, question it, and break those barriers, no matter where you are in your journey of recovery. Have confidence in yourselves, and know that millions have fought OCD and succeeded before. You are just the next to overcome those obsessions and start living free.

We’re interested in sharing more stories like this one. To talk with us about submitting your story to the nOCD blog, please email

And if you’re interested in learning more about the nOCD app, a platform for treating your OCD and finding a community of other people dealing with anxiety disorders, check out

If You Build It: Learning UX/UI Design From Scratch

By Stephen Smith,

When I was in middle school, I regrettably had little appreciation for my mom’s cooking efforts. I would come home from school every day anticipating to see Mrs. Fields in the kitchen baking me cookies. This unrealistic expectation led to a series of disappointments and a decade’s worth of scoldings. I would often ask myself, sometimes out loud, “How hard can it be to actually make a good meal? It looks so easy.”


I realized years later that, in fact, it’s very hard to cook well, especially under the time constraints my mom regularly faced. My mom had the responsibility of feeding me and my four siblings: five equally obnoxious children who each had unique nutritional needs and taste preferences — and this was just one of her many responsibilities. When we offered unsolicited feedback on her food, although obviously frustrated, my mom listened, researched other recipes, and continuously improved her cooking until my house became known for its food.

Learning to design user-friendly software is similar to learning how to cook- it takes time. In fact, unlike in the movie Field of Dreams, “if you build it, they will most likely not come.” Just like someone learning to cook for the first time, beginner UX/UI designers often have little idea “where to start” when designing an interface, so they just use whatever design feels most intuitive, without doing much research. This often leads to blunt negative feedback, the kind that bratty kids give their parents who are trying to hone their cooking skills on top of a seemingly endless amount of other tasks.


We had a similar experience at nOCD two years ago when I started building our first UI. Because I didn’t know much about UX/UI design at the time, I created a design that I felt was intuitive, paid a firm to make it look more professional, and shipped it to our users. They hated it with a burning passion, as they expected the app to flow as well as other popular mental health apps like Headspace and Pacifica. I quickly felt a level of frustration similar to what my mom must have felt when my siblings and I gave her grief for her cooking ability. I put all my effort into making a product that I thought people would like, and they spat it back in my face with distaste. It was YEARS worth of work, verbally ripped to shreds in a matter of seconds.

The old nOCD app

I quickly realized I had to do something to avoid losing the company, so I decided to learn UX/UI design myself. I came to the decision while I was at my parents house eating a delicious bowl of chili that my mom made. I thought, “If my mom can learn to cook, then I can learn UX development from trial and error.” In retrospect, the challenge forced me to think through the problem intuitively. Here’s what I did:

1. I created a clean system for collecting “event” data and went through each of the app’s “event funnels”, to objectively understand how users navigated nOCD.

When building any kind of software, it’s crucial to have a clear system in place for collecting event data, since it will allow you to understand which screens get the most traffic and which ones don’t. For example, if you have an app and it logs 10,000 events on your first onboarding scene and 7,000 events on your last, then you can deduce about 30% of your users “bounced” in the onboarding flow.

Here’s the data from the testing period

Taking the time to establish a clean system for tracking event data enabled me and my team to learn about our users quickly- they simply weren’t coming back to the app. This data forced us to ask questions like, “Do we really need this one feature, if it’s not gaining traction? Is the current app providing enough value for our users? Is the app’s user interface too complicated?” From a high level, we noticed a deep UX problem, which required us to take a deep dive into our product.

2. I reached out to people with OCD in our social media community to better understand the problems they faced, in hopes of figuring out how to solve them and improve nOCD.

Finding “Product Market Fit,” the answer to premier UX, is not just about asking questions, it’s about asking the right questions in a manner that will engage your audience enough to reveal deeper levels of meaning. We came to this epiphany when we asked our users via Instagram, “If you could wave a magic wand and fix three things related to OCD treatment, what would you fix?” This question sparked a dialogue that encouraged people from all over the world to not only answer, but also support others who shared their story. From this dialogue, we realized the power of the question, as it revealed a need for people to talk and share their story, the real value proposition.

The Instagram post for feedback

3. I used Sketch to create multiple UI prototypes of a 24/7, in-app community support feature. Then, I created an Invision prototype to get market validation.

The Annotated Sketch wireframe

The Invision prototype

No matter how confident you are in an idea or a new direction, it’s essential to get market validation first using UI mockups. An idea is only an assumption, and making UI mockups is significantly cheaper and more efficient than coding it and releasing it to a user base. There are some phenomenal tools that you can use to build and test UI mockups, such as Sketch and Invision. In Sketch, you can design your UI mockups and easily export them into Invision, a free prototyping service that enables you to turn your mockups into a clickable prototype. After making a clickable Invision prototype, you can then show it to users or videotape yourself going through the flow in QuickTime.

For the nOCD community feature, I created the mockups in Sketch, dropped them into Invision where I made a clickable wireframe, and videotaped myself navigating the feature’s flow in QuickTime to show our user base the feature from a high level. Then we dropped this video into a Google Form, and got over 150 people with OCD to analyze the video and give pointed feedback. Over 90% of the respondents rated the feature a 9/10 or higher, and left incredible feedback. We then had data to support our assumption- proving that a community feature would enhance nOCD’s usability, allowing us to hand off the problem to our brilliant engineers. Our dev team implemented the UX enhancements, and now the app’s two-month retention rate is 25% higher than what it was prior to testing.

The UX mods helped nOCD become the largest online platform for OCD treatment in the world and the highest-rated platform for social cause by UX/UI Awards 2017. We still have a lot of work to do, but if I could thank one person for nOCD’s success outside of my brilliant team, it would be my mom, who taught me to summon the gusto needed to compartmentalize my frustration and improve. Might I add, she is now one of the best cooks around.


When you’re just the way you are… and when you might benefit from treatment

By Patrick,

We hear from lots of people who aren’t sure whether or not they really need treatment. They ask questions like: Isn’t this just how I am? Does it really matter if I do that? Would my life really be better if that were different? So what does it mean to have a mental disorder/condition/illness? And where’s the boundary between “We just are the way we are” and “It may be time to talk to someone about that?”

You’ll probably be unsurprised to hear there isn’t really an easy answer to these questions. We can go through the specific symptoms for each condition. But even with those symptoms there’s a missing piece: in most cases, symptoms become a diagnosable mental health condition when you feel like it’s a big problem in your life. There are certainly exceptions, like when a mental disorder causes someone to do something drastic and they find themselves in treatment without any choice, or when someone’s family steps in and forces them to get treatment. But because most mental health conditions can’t be easily detected by other people, there’s a greater burden on most patients to recognize that their life is being negatively impacted and find help.

We’re not always great at deciding for ourselves whether or not something is negatively impacting our lives, and even when we do make this decision it can be difficult to find treatment. It might take someone we trust letting us know that we seem to be suffering unnecessarily for us to finally seek change. Or sometimes we end up in one of those “breakdown moments” when it becomes impossible to ignore the problem any longer.

Instead of rambling on further, here are a few scenarios:

  1. It’s important to me that things are really neat and tidy

A lot of people like to keep things clean, and in most cases it’s not a bad thing. Here’s the thing: it’s not really the behavior (cleaning or tidying up) that’s the problem. It’s the motivation behind that behavior.

Are you doing it because you like having things clean or because there’s a need to have them clean (for example, if you’re having family visit soon and you don’t want the recycling bin to spill over on them)?

Again, things start to look more like “disorders” or “conditions” when there’s a lot of distress involved. If you’ve already tidied up and you still feel like things are not right, it begins to seem like a compulsion. And if it feels like there’s something much larger at stake (to use a common example, if it feels like something bad will happen to someone you love if things are not just right), it’s likely that the behavior is associated with– or will soon be associated with– significant distress.

2. I just hate using public restrooms or anything like that

Public restrooms can indeed be sort of nasty. So can the many subtypes of public restrooms: tiny airplane bathrooms, dark porta-potties, those weird bathrooms on the back of buses that everyone hates you for actually using.

Most people decide to use them anyways… because they sort of need to. Other people find ways to avoid public bathrooms altogether. It’s kind of abnormal to do so, but whether or not it’s a “problem” again requires further investigation.

When you’re afraid, the feared result seems like a certainty, not a small possibility. If you really refuse to do something that most people do, in most circumstances, there’s a decent chance it’s a problem that might benefit from treatment.

People who decide they cannot use public restrooms under any circumstances are likely motivated by an irrational fear of something bad happening to them if they were to use one. But, once again, ultimately you have to decide whether or not there even is a problem.

3. I’m always apologizing and worrying that I messed up

Does it always feel like you’ve messed up in social situations? Do you find yourself lying in bed regretting something hours after everyone else seemed to forget about it?

This level of fear that you’ve done something wrong can really start to come between you and the things you want in life. For instance, you might shut down in social situations instead of talking with people, out of fear that you might mess up and hurt someone’s feelings. In doing so, you miss countless opportunities to meet people and enjoy their company.

A number of conditions can underlie this level of guilt and worry about other people. The point, at least for now, isn’t what condition you might have. Instead, ask yourself: why am I so afraid of bothering or hurting someone that I’m talking with? What assumptions am I making when I assess these situations?

If you can think through all of this, you’re already well on your way to developing a healthier relationship with the risk of “messing up” socially. If you’re not sure where to go next, or you can’t approach this sort of reasoning because there’s too much fear or anxiety involved, you might benefit from speaking with a therapist soon.

This is a very small sample of all the different things you can worry about (hooray!), but hopefully they give you a sense of the way you can start to figure out whether your type of worrying is “normal” or “pathological” (and, yes, these are loaded terms that should be looked at more carefully).

A few themes we can notice from these scenarios:

  1. If you feel like your worry is a problem, it’s a problem
  2. If your worrying bothers you, it’s a problem
  3. If your worry keeps you from doing things you want to do, it’s a problem
  4. If people close to you tell you that your worry is a problem, it might be a problem
  5. If you seem to worry a lot more about certain things than most people, it might be a problem
  6. Worrying about some things, or even most things, is not a problem in itself
  7. Knowing what is motivating you to worry (and behave in a worried way, like avoiding bathrooms or apologizing a ton) is important, but it sometimes it takes a professional to figure out your motivation with you

As always, these thoughts don’t apply to everyone, and you should consult a doctor or therapist about your particular case.

For now, whether you’re feeling calm or anxious, we hope some parts of your day are great!

Until next time,

The nOCD Team

Whether you’re feeling stuck with OCD, concerned about someone you care about, or just curious what a global community of people working together on their mental health looks like, feel free to check out the nOCD website for more:

Good things from around the internet

By Patrick,

Everyone knows there’s a lot of nonsense on the internet. Unfortunately, topics like OCD and mood disorders are particularly prone to internet nonsense. You’ll find hundreds of misinformed blogs concealing the good ones, thousands of people angry at other people who are spreading mental health misconceptions, and countless companies trying to capitalize on the frenzy.

But there’s a lot of good stuff on the internet, too. We follow a lot of great people on social media as @treatmyocd. And we’re hoping to share some things we’ve found on Twitter and Tumblr lately that are good models for how these difficult, tangled, heavy topics can best be discussed online.

  1. This post from @secretillness on Twitter

The Secret Illness calls itself “a global creative arts project that explores the realities of living with obsessive compulsive disorder.” And here they look unflinchingly at one of 36-year-old OCD blogger Catherine’s more difficult symptoms: an obsession about hurting her son. This post calls attention to the extreme anxiety that emerges when one’s OCD latches onto what matters most. Follow the link in the caption to learn more. Thanks @secretillness.

2. This Tumblr post from bipolar-in-boots

In this great Tumblr post, bipolar-in-boots reminds us not to dismiss “neurotypical advice.” By this she means: just because the things “normal” healthy people do won’t cure you of your mental illness, doesn’t mean you shouldn’t still try to do those things. Yes, it’s annoying and unhelpful when you’re really struggling and someone cluelessly says, “You should try jogging, and your problems will go away.”

But the things listed here–water, sleep, nature, running, yoga– are all things that will probably help, in most cases, if you’re able to do them. And sometimes it’s very important to think less about curing something (making it go away) and more about living the best life you can while you have it. Thanks to bipolar-in-boots for keeping us on track.

3. This Tweet from Jacob (@TryingNotToLurk)

Sometimes the best social media posts, when you’re scrolling through your feed in need of a quick reminder that things will be alright, are the simple ones. In this well-designed text post, Jacob reminds us that sometimes simply getting through the day is enough. And on our toughest days that’s about all we can manage.

There’s a lot of pressure to be doing a bunch of stuff, and keeping up with the people around us (or the people we went to high school with). But this game of comparison becomes impossible pretty quickly– there will always be someone working longer hours, running faster miles, raising higher-achieving kids. The daily work of surviving can be really tough at times, and we should try to recognize that. Thanks to Jacob for keeping the reminders coming.

4. Last but not least, this Tweet from @MelGonzalezz

This super cool post from @MelGonzalezz is a simple reminder that you don’t have to feel better every single day in order to be on a trajectory toward feeling better. Sometimes, when we’re recovering from any form of physical or mental illness, we can become hyper-focused on our recovery, to the point that it becomes our only frame of reference. This kind of intense focus on questions like “Am I getting better? But am I really getting better?” can become destructive too.

It’s also important that we step back every now and then and remember that there’s much more to the world than just us and our recovery. In doing so, we open up tons of other possibilities for things to focus on and learn from. We also ease the pressure on ourselves to get better in a linear way, every single day. That doesn’t happen to anyone, and it’s alright. Thanks Mel!

Thanks to these people for keeping the mental health discussion lively and helpful. If you see any other mental health- or OCD-related posts that deserve more attention, please let us know. We’re @treatmyocd on Twitter, Instagram, and Facebook. Or you can comment on this post!

Until next time,

The nOCD team

Whether you’re feeling stuck with OCD, concerned about someone you care about, or just curious what a global community of people working together on their mental health looks like, feel free to check out the nOCD website for more: click here

Where OCD jokes go wrong

By Patrick,

OCD: it’s difficult to think of an acronym– or a condition– more prone to parody. There was the infamous Target sweater incident, and there’s even an Obsessive Compulsive Action Figure sold on, complete with sanitary mask and moist towelette.

Don’t people take these things too seriously, though? And shouldn’t people be able to take a joke? Maybe. But try making an action figure or a sweater caricaturing another chronic and often debilitating condition– say, diabetes or Parkinson’s– and see how lightly people take it.

It’s not just big companies selling OCD products. There are also thousands of memes about OCD. Let’s look at a few of them.

What’s the problem with all this? I know, they’re just memes. And we’ve been through this type of discussion before, whether on the Huffington Post, in The Atlantic, or in online comics.

The problem is that people keep making the same jokes about OCD, while millions of people keep suffering. Although the prevalence of OCD can vary slightly, in the United States it’s 1 in 40 adults and 1 in 100 children. By that estimate, 6 million adults are struggling with OCD in the United States alone. People should know, when they make their memes or design their sweaters, that they’re making fun of a condition that haunts some of their friends, coworkers, and family members.

This isn’t to say that all our conversations about mental health have to be humorless– in fact, at least in the case of OCD, humor is one of the best ways to deal with the unpleasant thoughts and feelings constantly hammering away at you. But before you try to be funny, you have to know what you’re talking about. And OCD is not the desire to have things neat or clean.


There are countless great resources online for you to learn what OCD is, and for now I’ll let them cover the basics. In the interest of discovering more specifically what OCD is like for those who live with it, let’s quickly go through a few subtypes of OCD and how they affect people.

Researchers and clinicians talk about subtypes because OCD is what they call a heterogeneous condition: although all cases of OCD share certain traits (obsessions and compulsions), one case is usually quite different from the next, and treatment should be tailored to individual symptoms.

Relationship OCD

People with this subtype can spend hours every day ruminating over unwanted thoughts about their intimate relationships and partners. Unsurprisingly, it can end up making those relationships more difficult. It can also leave people feeling irritable and exhausted.

Obsession examples: “Is this the right relationship for me?”; “How can I be sure this is the person I should be dating?”; “Couldn’t there be someone better out there?”

Compulsion examples: Replaying feelings and memories (“Did we really have a good time together on that vacation?”); Asking other people if you seem like a good couple; Looking up past romantic interests on Facebook for evidence they’re no longer attractive to you

Harm OCD

Those dealing with Harm OCD are terrified that they will hurt someone in one way or another. They may constantly feel like they’ve already harmed someone. Usually these thoughts center around people very important to them, but sometimes people also worry they’re being harmful in everyday interactions with strangers or acquaintances.

Obsession examples: “I will lose control and kill my kid”; “I just ran over someone back there”; “I might walk right over to that person and push them off this bridge” ; “I offended them in that conversation we just had”

Compulsion examples: Telling yourself one hundred times that you love your kid and would never hurt them; Driving back and checking if you ran over someone; Avoiding bridges entirely so you won’t push someone off; Apologizing repeatedly, asking if the person is mad

Sexual Orientation OCD

People with Sexual Orientation OCD are in constant doubt about who they’re actually attracted to. Their mind seems to look for any sign that they might be attracted to someone of the same gender. They doubt the stability of their sexual orientation, as if they could “turn gay” if they’re not careful enough

Obsession examples: “I’m turning gay, I was attracted to that person back there”; “Other people can tell that deep down I’m not straight”

Compulsion examples: Avoiding people of the same gender to eliminate occasions for doubt; Watching videos of people of the same gender to test yourself for attraction to them

Pure Obsessional OCD (Pure-O)

People with Pure-O can have obsessions from any other subtype, but the key thing distinguishing them is that they don’t have any externally observable compulsions. They do have compulsions, but only they know it because the compulsions take place within their own head.

Obsession examples: “I left the stove on when I walked out the door, I’ll be responsible for killing everyone”; “What I just did was a sin and proves I’m not a good person”; “Nothing is worth doing and there’s no purpose to life”

Compulsion examples: Repeatedly thinking back through the steps you took when leaving the house; Forcing yourself to count to 200 in your head as penalty for your “sin”; Trying endlessly to think of something that is worthwhile


There are more subtypes to explore soon, and please let us know in the comments if you want us to talk about specific ones.

With all these subtypes, it’s not the thoughts themselves that are abnormal. In fact, pretty much everyone experiences these thoughts from time to time. What makes it OCD is:

1) The person experiences a lot of distress because of the thoughts, and because of the way they assess those thoughts

2) The person feels the need to do something to get rid of this distress

3) These attempts to get rid of distress can take up hours every day, interfering with core aspects of the person’s life

The second point is where most OCD jokes go wrong. People see the compulsion, like hand-washing or rearranging, and think it’s “so OCD.” They don’t realize that, in people with OCD, the compulsion is driven by a strong urge to get rid of something deeply unpleasant. What exactly is so unpleasant varies a good bit, as we’ve seen in these subtypes, but anyone resorting to compulsions is doing so because they feel very bad.

You might like things very clean or extremely neat, but that doesn’t mean you have OCD. And, by the way, OCD isn’t an adjective. You can’t “be OCD.”

We’ll be looking at many more subtypes here in the future, and investigating these ones more closely too. In the meantime, please leave us a comment with your own thoughts!

Want to learn more about OCD?

Click here

Introducing the nOCD Blog

By Patrick,

Hello! This is Bob checking in from nOCD.

Welcome to our blog. We’re planning to provide the basics, the more advanced stuff, and the very latest research on OCD. We’ll also be glad to answer any questions you might have about nOCD. Our goal is to provide information that is easy to read and sometimes makes you laugh. We hope to help OCD patients worry less and live more.

To get started, here are a few topics we’ll write about:

  1. Personal stories of life with OCD
  2. Subtypes of OCD
  3. How OCD is diagnosed and treated
  4. The history of the nOCD team

If you have any questions or comments, or you’d like to suggest a topic, please leave a note below. We look forward to hearing from you!

Until next time,

The nOCD Team

Whether you’re feeling stuck with OCD, concerned about someone you care about, or just curious what a global community of people working together on their mental health looks like, feel free to check out the nOCD website for more: click here.