EFR 801: What is Obsessive-Compulsive Disorder (OCD), Effective Treatments, and What Living with High Anxiety and OCD Really Looks Like with Stephen Smith

00:00 - Speaker 1 The following is an Operation Podcast production.

One in 40 people globally suffer with OCD at some point in their life. That's about 8 million people here in the United States alone.

00:10 - Speaker 2 One in 100 kids suffer, affecting millions of families in the US People think about OCD as a personality quirk right, flicking the lights on and off, washing your hands all the time. You know being particular about a certain thing. It's like a casual, fun term to say, but in actuality what's really going on is totally different from the, you know, colloquial brand defined by many as the silent illness or the secret illness, because it's so prevalent, so crippling but yet so misunderstood. You have people fear about contamination of sexual intrusive thoughts, religious intrusive thoughts, but at the core it's people who have these fears that are, they violate their core values and character. Crippling anxiety from the time they wake up until the time they go to sleep. You may be living your life While that's all happening. You're actually imprisoned in your own head trying to make all these fears stop. Your life's happening, but you're not actually engaging in your life. You're engaging in the OCD, but yet nobody else understands that or knows about it.

01:10 - Speaker 1 Hey friends, welcome back to Ever Forward Radio. I am so glad you are here with me today. I am Chase Tuning, your host, certified health coach, army veteran and all around wellness enthusiast. I am curious about what makes us tick, how we can maintain things that make us feel our best, even get into optimal levels of physical and mental resiliency to keep me moving forward every damn day, to keep living a life ever forward. That is what you can expect on the show If you're new, welcome, if you're returning. It's so good to have you back, no matter which platform you're tuning in on here today. It would mean the world to me and it truly, truly does help the show grow in some really big ways that I can't even explain to you right here. But just trust me when I say, if you're listening on Apple, spotify or any other app, or even on YouTube, tapping that follow button, that subscribe button, it truly does help the show grow. It helps us get even more amazing great guests, helps me level up production and bring you valuable, educational, entertaining content to help you live a life ever forward. So to that I say thank you. But today on the show I've got Stephen Smith, co-founder and CEO of NoCD, and Stephen's story and the work that NoCD is doing was so impactful to me that I actually decided to partner away more educated, more empowered about this information so that hopefully it can help you if this pertains to you or if you know somebody that might be struggling with OCD. I truly believe that what NoCD is doing might bring value and help and aid to you or to them. If you'd like to learn more about NoCD, I'm gonna have it linked for you down in the show notes. But you can always head to their website at treatmyocdcom that's T-R-E-A-T-M-Y-O-C-Dcom to learn more. But Steven is gonna be sharing some really truly staggering statistics revealing that OCD affects one in 40 people globally and has a profound impact on children and, subsequently, their families.

03:28 This episode exposes truly the silent struggle of those imprisoned in their own heads by irrational fears and compulsions, all while challenging the stigma that obscures the disorder's true nature. Today's episode is not only an exploration but a call to action. I actually sat down with Steven in studio here in LA, so if you want to check out the video, I'll have it linked for you in the show notes, as always, just like everything else we talk about on the show. Under episode resources. You can always find it at everforwardradiocom or on YouTube. Just search everforwardradio on YouTube and boom, there you go Find the video. Make sure to smash that thumbs up button. Subscribe to the channel to make sure you never miss another amazing episode. Thank you all so much for tuning in with me here today. Thank you, stephen, for sitting down with me and cracking open your very vulnerable story and sharing it with others, so hopefully no one else has to suffer in silence any longer like you did. Thank you again to NoCD for sponsoring this episode and, without further ado, welcome to Everford Radio.

04:27 This is Stephen Smith. On average, it takes 14 to 17 years for people with OCD to get proper treatment, due to high costs and a shortage of specialists, and even the International OCD Foundation says that our best estimates are about that one in 40 people globally suffer with OCD at some point in their life. That's about 8 million people here in the United States alone. But then children this was probably the most alarming for me. It's estimated that at least one in 100 kids suffer, affecting millions of families in the US. So not only does it affect the children, but then the parents and the families of those children. How are these stats so high, and maybe I've just been living under a rock, but how have we not heard about this? And why is OCD not more on top of mind?

05:12 - Speaker 2 You know it's shocking, honestly. I mean it's something that I uncovered myself personally when going through the experience and had the same epiphany. But from my understanding, from seeing it firsthand as well as from seeing it through the lens of no CD it's this condition has gone so under the radar because of the misunderstanding about it society wide. So people think about OCD as a personality quirk, right, flicking the lights on the off, washing your hands all the time, you know, being particular about a certain thing. It's like a casual, fun term to say.

05:44 But in actuality the condition is totally like what's really going on is totally different from the, you know, colloquial brand and I think that misunderstanding has caused it to go so misunderstood. And I think, if you add on the top the real nature of the condition, the taboo, highly stigmatized nature of the condition that people don't want to talk about that, mixed with the misbranding, has caused this issue to occur. And in fact, the Atlantic did a nice article on it in 27 or 2016, excuse me. That showcased how uh, you know, misunderstood OCD was really like and, as a result, how inaccessible the evidence based treatment for OCD became because of it. And so we're at an OCD changing that. But it is eye-opening and it's defined by many as the silent illness or the secret illness, because it's so prevalent, so crippling, but yet so misunderstood.

06:39 - Speaker 1 So let's really dive into what OCD is, maybe what it isn't. We were kind of joking I need to flip on the lights a bunch, I need to clean the house, I need to do a lot of things. That is pretty common in today's vernacular oh, it's just my OCD. We laugh and we joke about it. But it really is a disorder. So, defining our terms obsessive compulsive disorder is a long lasting disorder in which a person experiences uncontrollable and recurring thoughts, images and or urges there's the obsession part and engage in repetitive behaviors, compulsions to make them go away and or alleviate distress. When we really break it down and we define it, that is way more serious than I need to just clean my table one more time.

07:23 - Speaker 2 I'll give you an example. So imagine a mother with a newborn child and she loves her child more than anything, and she has a fear what if I harm my child? And the fears you know, what if I harm my child? That come along with it are very graphic in nature, right? And so, all of a sudden, she has these fears. She doesn't know what to do, she doesn't know what they're called. She thinks she's, you know, you know, just just just at a breaking point and she doesn't feel comfortable describing those fears to her loved ones. She doesn't feel comfortable describing those fears to her primary care physician, to even a therapist, because she doesn't know what's going to happen when she. When she does that, she thinks that maybe, you know, they'll call the police or they'll do something to to not only take her child away but also to confirm that her fears are reality.

08:12 And so and that's the challenge with OCD is, although it manifests in a similar way, people have the recurring unwanted thoughts, images and urges, and then they do the actions to try to alleviate the distress from those thoughts or to make them go away. The subtypes, you know, are infinite in nature, right? So, like you, may have someone who fears. What if I harm my kids? You may have people fear, you know, about the relationship. What if my partner isn't the right one for me? Right, you have people fear about contamination. You have people who have sexual intrusive thoughts, people who have religious intrusive thoughts.

08:41 So there's so many different variations but at the core it's people who have these fears that are oftentimes ego dystonic in nature. They violate their core values and character and they are recurring in their head and they make people, you know, honestly feel crippling anxiety from the time they wake up until the time they go to sleep. And it's a battle that people fight without actually realizing is OCD because of the misbranding that happens today? So, um, I don't want to go on too much of a tangent here, but, honestly, like that's, that's the big challenge today. Just, people don't really know what OCD is like.

09:17 - Speaker 1 One of the most kind of uh eye catching parts of that definition, or in the research I had around OCD is the level to which that it interferes with daily life. Is that really the determining factor when we're looking at maybe it's just a quirk versus actual diagnosable OCD? It's preventing me from living my normal daily life how I want to live it.

09:38 - Speaker 2 Definitely, you know, and so I'll kind of give this example. Sometimes you have thoughts that go in and out of your head. You're like, wow, that was kind of weird, you know. And you have some anxiety. You feel like you may say, wow, that was strange, I'm going to go live on with my life and you can.

09:53 Then there are other times where, for those people with OCD, you have that fear. You think that it actually means something, and then you go down this rabbit hole and you try to do whatever you can to try to make that fear stop. And sometimes those actions could be, you know, going and locking the door if you feel like someone's gonna break into your house and harm your family. Sometimes, you know, the actions may be completely invisible and all in your head and you may spend, you know, considerable amounts of time trying to make those fears stop because they cause you such crippling anxiety. That's OCD. Although I'm not a clinician by training, right, I'm a person who has the condition. We have, uh, clinical leaders at our, on our team, at no cd who define it as the amount of time someone spends, you know, engaging in, you know um, the rituals as well as the the um, just the fears on a daily basis. So it's the time really spent suffering on a on a day-to-day basis.

10:46 - Speaker 1 Yeah, what really stands out there for me is just wondering how much time someone with OCD diagnosed, undiagnosed, might be putting into trying to just alleviate it. There's the consumption time of the thoughts, of the actions, but then, if it's on your mind that much, I feel like you would probably be spending even more time. All right, how do I prepare for this? How do I navigate that? How do I kind of make sure it's not seeping out into my relationships, the public? I feel like a lot of people spend a lot of time no, please correct me if I'm wrong trying to contain it, which then can be that in and of itself, anxiety inducing.

11:21 - Speaker 2 Well, I mean they spend their whole day becomes containing it, inducing. Well, I mean they spend the their whole day becomes containing it, and their whole day becomes trying to alleviate the distress from it. And so what happens is you, you may be living your life right. You may, you know, have a job, you may be going to school, you may be engaged in a sports team, you may have, um, you know, a close family life.

11:38 Well, while that's all happening, you're actually in prison in your own head, trying to make all these fears stop, and no one else can see it. So it's almost like your, your life's happening, but you're not actually engaging in your life. You're engaging in the OCD, but yet nobody else understands that or knows about it. And so that's what makes this condition so crippling. It's not just uh, hey, I'm feeling extreme distress, but you're feeling that alone and you're doing the day to day, you know, just wishing that the day will, will, will just, you know, um, somehow get better, and it doesn't often do that without getting treatment, move on to harm OCD relationship.

12:15 - Speaker 1 Ocd, I think we're two kind of other big ones.

12:17 - Speaker 2 Yeah, okay, so there's. There's harm based OCD when you fear something bad's going to happen yourself, or you're going to be harmed, or you feel that someone else that you love will be harmed, or you'll do that to someone else. Right, and you know it's. It's actually the one of the more prevalent subtypes or subcategories of OCD, and in that you have people who have unacceptable, taboo, intrusive thoughts. It could be violent, sexual, religious, relationship based, existential.

12:43 So so fears that you're going to there's someone that's going to be harmed because of what you do, or you yourself are going to experience harm, or someone will feel harm because of something that happens to them that's not necessarily in your control, but something that happens unfortunately, and so you spend your time trying to prevent that harm from occurring. So, for example, like you may research compulsively on Google to try to really figure out why you're having your thoughts. So that way, if you can figure out the logic, you then, therefore, will not be harmed. You may spend time reviewing past events in your head just to confirm that everything is okay, so you won't feel the harm, or someone else won't feel the harm, right, and so there, there are many different subtypes that kind of are embedded within that overall harm.

13:35 - Speaker 1 Sure yeah.

13:36 - Speaker 2 And what?

13:37 - Speaker 1 what, then, is the difference between someone wanting to educate themselves on a matter harm prevention, risk mitigation and stepping into the harm OCD category?

13:47 - Speaker 2 Actually? Sure, it's why you're doing the research, so I can tell you this from a personal stance.

13:52 So I'm not a clinician, please please yeah, when I was personally going through my worst times with OCD. It's chronic condition, so you always have it, so I always had to learn to manage it. But when I was going through it, when I would Google search to try to make my fears, my specific obsessions, go away, that was a compulsive behavior. I knew that because the intention behind the research was to try to stop the fears from happening, and that's what a compulsion really is the fears from happening right, and that's what a compulsion really is. It's an attempt to make the fears that you're having, the irrational, unwanted fears, stop and to neutralize that anxiety. When someone is researching to understand the intent behind that research isn't to try to make their thoughts or fears stop. It's actually to try to understand why a condition is occurring right, it's not a different intentionality.

14:40 - Speaker 1 Yeah, another surprising category to OCD, at least to me, was the one of relationship OCD. What does OCD look like in relationship?

14:51 - Speaker 2 So someone who is constantly fearing that they may not have the right significant other, or vice versa, or their significant other may not feel like they're the right fit for them. And then they will consistently review past events in their head. They may seek reassurance, they may try to understand if their significant other, you know, loves them or not. They may try to research what the meaning behind love really occurs, so that they can then confirm that they're in fact in the right relationship for them.

15:21 Really high-end love really occurs, so that they can then confirm that they're in fact in the right relationship for them. Really well, they may actually go and, um, they may, you know, connect with friends and family just to confirm that they are in fact thinking about things correctly in their relationship, more so than others. And so the the fears are all unwanted, recurring, that, hey, this person may not be the right, might not be the right partner for me, but they may, at the in their core, realize that they actually are the right person. They're just, they're just having like excessive doubt, and that's what OCD is really like.

15:50 It's called the doubting disorder. So it's. It's an irrational amount of doubt that comes along with these kind of intrusive thoughts, images and urges, and the actions to make those go away are the reassurance seeking, the checking. You may check in on your significant other to see how they're doing or to just to check the temperature of the relationship or even see where they're going Like. These are typical behavior patterns, and you know, again, the compulsive behavior, though, although in the short term makes the fears go away, in the long term it makes the fears worse and worse and worse, until they kind of overcome one's life right.

16:26 - Speaker 1 If one person has one of these types of OCD, are they then more likely to kind of see it run rampant and to gather all forms of OCD, or is it more? If you have this, this is kind of how it manifests in your life and this is the version that you need to navigate.

16:45 - Speaker 2 Sure, that's a great question. You know, subtypes morph. So if you have OCD, you may at one point in your life have a specific fear about relationship like your relationship, like you may have relationship OCD and you know, two years later that may morph into religious OCD, right, and so your subtypes can morph and that's why it's important to not necessarily focus on the subtype but to focus on the obsessions and the compulsions. If you can recognize that hey, look this, this, this thought, this kind of response feels like OCD, then you can apply treatment and the treatment. The good news is the treatment works across all subtypes. So, even if your subtypes morph, the evidence-based treatment for OCD exposure response prevention is the right treatment for all different types of subtypes.

17:29 - Speaker 1 Well, that's good news, and I want to get into the treatments here in a second. But you mentioned religious OCD a couple of times. Sure, that's very curious to me. What is that?

17:36 - Speaker 2 So it's otherwise known as scrupulosity, where sometimes people feel that they have offended God and so they will do actions to try to, you know, alleviate the distress from offending God.

17:48 For instance, someone may do an action, feel like it might offend God and may then go compulsively to confession if you're practicing Catholic, or you may pray, you know, just to try to make, you know, the fear stop that you've offended God, until the point where you feel like you've prayed enough.

18:06 And then it does cross into the initial question that you had, which was how do you know if this action is OCD or if it's just you practicing your religion or just being interested in a topic? And it's because of why you are actually? You know um, you are um doing the behavior, and it makes it such that different religious leaders in different communities could actually identify this issue more so than others. Because if people, for instance, come into um a, a religious leaders um, or if they, if someone goes to a religious leader for help right, and they keep coming back for help for similar topics and it becomes excessive, there might actually be OCD that's driving that right. So that could be the difference, if a religious leader recognize it. The difference is someone getting treatment right away, versus 14 to 17 years, as you described earlier.

18:59 - Speaker 1 As if pastors didn't have enough on their plate already. Maybe they need to kind of dive into the mental health side of things on the team as well.

19:07 - Speaker 2 Well, they're already involved and we've had people come to us pastors come to us and they've said and also religious leaders in other communities. They've come to us and they've said look, I navigate this all the time. I'm so happy you're doing something about it, because you have no idea the number of people that come to me continuously to try to really figure out how to improve their life.

19:30 - Speaker 1 But at the end of the day, they are just, they're compulsing right, I would like to kind of break down the terms a little bit more before we get into treatments. And you have a very interesting backstory as well I want to share with the audience. So obsessions. Obsessions are repeated thoughts, urges or mental images that are intrusive, unwanted and make most people anxious. And some common obsessions I want to share with the audience are fear of germs or contamination, fear of forgetting, losing or misplacing something, even aggressive thoughts towards others or oneself basically unwanted, forbidden or tabplacing something, even aggressive thoughts towards others or oneself basically unwanted, forbidden or taboo. Thoughts involving, like we talked about, religion, sex or harm very intrusive thoughts, is obsession, you think. Is this where most people can start when trying to understand? Is this something that I am navigating?

20:18 - Speaker 2 I think that's the hallmark, right. You typically, as someone with OCD, do not want to talk about the obsessions that bother you most. They're, they violate your core values and character. They're almost opposite from you and that's why they cause so much distress. And so that if you have those recurring fears and it's around certain topics and you try to do whatever you can and make those fears go away, you're really not necessarily focused on the behaviors or actions. You're focused on the fear itself. Like the core of it is the obsessive thoughts, and learning how to live with those obsessive thoughts is the most important part, and that's what treatment involves. We'll get to that in a second. But most of the issues around OCD come across as first the obsessive thoughts and behaviors, then the actions to try to alleviate the fears.

21:04 - Speaker 1 The stress, yeah, and then getting into compulsions, the C in OCD. Compulsions are defined as repetitive behaviors a person feels the urge to do, often in response to an obsession. Common compulsions include excessive cleaning or hand washing, ordering or arranging items in a particular precise way, compulsive counting, praying or repeating words silently. Um, can you kind of unpack the compulsion part to OCD?

21:29 - Speaker 2 sure that's. Those are the behaviors that are that someone with OCD does to make the fears stop. And the challenge behind those behaviors is that they're actually what's driving the obsession, right? So if you think about the term OCD obsessions uh, obsessive compulsive disorder everyone has intrusive thoughts. People with OCD they'll do the actions try to make them stop. And because they find meaning in the thoughts, they can't accept uncertainty. And so the compulsive behaviors are the person with OCD's action to try to find certainty behind and get answers to those really crippling fears. And so if you think about the the term, it's really OCD, is really the compulsion disorder to try to find certainty behind and get answers to those really crippling fears. And so if you think about the term, it's really OCD is really the compulsion disorder, right? Because compulsions drive the fear. And if you can learn to stop doing the compulsive behaviors, what ends up happening is your brain rewires and you learn to accept uncertainty better Do the obsessions, then kind of fall apart.

22:19 Exactly Okay. And the obsessions then start to you, stop having as much. You stop doing the reactions or the actions to try to neutralize the obsessive fears and you just let them occur and then they stop having as much meaning. And then, when that happens, then you're, all of a sudden your life starts to improve because you learn how to accept the uncertainty behind the fears. And then you, you're. You then make that a habit and then all of a sudden, like you know your life, it's just amazing how fast it gets better. That's incredible.

22:45 - Speaker 1 So it's pretty exciting for somebody I think to not be so overwhelmed with. I need to navigate all of this. If I could target and work on and again we're going to get into treatments here in a moment but just target this compulsion aspect by really focusing on that. I will also be focusing on all these other areas that's possibly affecting.

23:04 - Speaker 2 Right. So you want to, and that's why treatment's important, because you have to get special treatment to learn how to accept and study how to stop doing compulsive behaviors, and there's very specific treatments that work for that and we can get into that in a second, as you mentioned, but it's it's the. The challenge with OCD is it's very prevalent. It's extremely severe when untreated, but the good news is it's one of the most manageable serious mental illnesses. Great news, so great news.

23:30 - Speaker 1 Yeah, so before we get into treatments, there are some pretty alarming risk factors, Again, all new to me that I had no idea. I never would have thought something like genetics, biology, temperament or even childhood trauma can actually turn into or be a risk factor for OCD. Let's go to trauma. How can a traumatic event in one's life, particularly childhood trauma and the research I showed here talks about how some studies have reported an association between childhood trauma and obsessive compulsive symptoms. More research is needed to understand this relationship. But in your experience, what's the relationship between trauma?

24:08 - Speaker 2 and OCD. People with OCD often experience trauma. So, people with OCD, they typically experience other issues too, called comorbidities, and those are issues that co-occur with their OCD symptoms, and those are issues that co-occur with their OCD symptoms. So, for instance, someone may have OCD and then, as a result, they may experience anxiety or they may become very depressed, given the impact that OCD has on their life. They may also have trauma too that co-occurs with OCD, which makes their OCD more complex, and sometimes the trauma comes first, sometimes the OCD comes first. There's a lot of research today happening to try to understand the connectivity between those items. Like you know, we know today there's some genetic connection between OCD, because you can see it in the amount of family members who have OCD and, for instance, like you see, a parent who has OCD and then also one of their children has OCD.

24:57 - Speaker 1 That's what I was finding, really that having a first degree relative, parent or sibling, with OCD is associated with an increased chance of developing the disorder. So it's really kind of like most. I mean, could we really liken it to, you know, diabetics addiction? You know, if my parent or sibling has this disorder, I run a very high risk as well, definitely definitely, and with trauma in particular.

25:20 - Speaker 2 You know we there's actually great research that shows from the VA how there's a strong core comorbidity between OCD and PTSD, where when they analyzed um veterans of PTSD, they found one in four had comorbid OCD and the way they defined it was OCD or PTSD, excuse me, was intrusive thoughts about the past, whereas OCD was oftentimes intrusive thoughts about the past, whereas OCD was oftentimes intrusive thoughts of the future. So you could have some, you know, ocd involving events that happened in the past. But you know that was this. That was kind of how the study um, that's how the study delineated the two, which shows that there's a quite a bit of of um comorbidity and that means that you need really like nuanced treatment to help people who have these kinds of severe issues. So typically just generic talk therapy doesn't always work.

26:08 - Speaker 1 Uh, so let's get into treatments. Um, hopefully we haven't been scaring too many people with all these stats and understanding OCD, but it is very exciting to hear that there are a lot of modalities and there are a couple, particularly one response prevention therapy, or, excuse me, exposure and response prevention therapy. That seems to be really, really helping a lot of people, and I understand that no CD really kind of specializes and focuses on ERP. This seems to be the gold standard OCD treatment, even partnering with insurance plans to make it affordable, which is incredible. So, inside what you all offer, what is ERP and why are you focusing so much on this modality and treating OCD?

26:50 - Speaker 2 Sure. First of all, I want to say that no CD specializes in delivering treatment to people with OCD, and within the OCD, comorbidity is the norm. It isn't the exception, right? So most people have co-occurring conditions and so what we do is we focus on one community and then our goal is to deliver treatment to that community in an effective, affordable and convenient manner. So inside the OCD platform, someone can come in, they can do live face-to-face sessions with a licensed therapist that specializes in OCD and in ERP, which is great. So to face sessions with licensed therapists that specializes in OCD and in ERP, which is great.

27:21 - Speaker 1 So many of us are already used to that.

27:22 - Speaker 2 You know telehealth, you know remote therapy options, so this really isn't a whole new world that someone needs to get used to Totally, totally, exactly, and then between sessions they get the support from different peer communities and self-help tools. But ERP, why? It's important? Right, and it's the treatment that is considered the gold standard for people with OCD, as defined by the International OCD Foundation, dozens of peer-reviewed studies, the American Psychiatric Association. So OCD is a condition that has obsessions and then compulsive behaviors, and the compulsive behaviors end up causing the fears to grow worse and worse over time. So what ERP does is it intentionally exp. It intentionally exposes people to their, their obsessions or their recurring fears and, instead of doing those compulsive behaviors that make the fears worse, people learn how to accept uncertainty and, um, a therapist trained in ERP will teach their their, their patient or their member.

28:15 We call it members in OCD to learn how to specifically respond to their fears such that they don't do the compulsive behaviors Like if then Right so for instance, if you are a mother with a newborn child going back to that initial example and you have fears of what if I harm my child, or, specifically, what if I throw my child out the window Very graphic fear that cripples. You know that can cripple a new mother. We've heard this fear quite a bit. What someone with OCD may do as a compulsion is they may actually avoid their child. They may not be able to hold their child, no, and they may not be able to be in the same room with their child because they're so afraid of this fear.

28:56 So what ERP would entail is they would say okay, step one, we have this fear, we're going to purposely trigger your fear. We want you to be in the same room as your child, okay, as opposed to trying to, you know, go out of the room. We want you to accept the uncertainty and we want you to just stay in this room for the next five minutes, and the therapist is there with that, that patient as they're experiencing this. And so, if you think about it like you're basically, you know, confronting the fear, your worst fear, your worst fear, and so then, that you may be able to do that ever, sometime. Well, you may not be able to hold your child yet.

29:33 So then what happens is the next phase is okay, you're now able to go into the room. Let's go, and let's now hold your child. You want to hold your child for five minutes, and we want you to practice accepting uncertainty so you're not running out of the room. And so what happens then is that the mother holds her child, and she can now hold her child for five minutes eventually, and then you work up further. Now we want you to hold your child, and we want you to stand right next to that window, and we want you to hold your child while you're standing next to that window, and we want you to hold your child while you're doing, while you're standing next to that window, because we know that the mother is experiencing OCD.

30:08 - Speaker 1 You're really getting them as close to that line of their greatest fear as possible.

30:14 - Speaker 2 Exactly, wow. And what then happens is they realize that in that point in time they're able to accept uncertainty. Point in time they're able to accept uncertainty, they're able to manage with these fears, and they're going to, you know, as a result, not do that compulsive behavior which is running out of the room. Well, then you may be able to accomplish something really meaningful. Then you may have other compulsive behaviors, you do. You may actually seek reassurance from a family member. So now we want you to hold your child stand next to the window and we want you to, you know, say to yourself well, maybe I will, you know, be in a harmful, or maybe I will harm my child, I'll accept the uncertainty and move on. So you're accepting your uncertainty behind your deepest, darkest fear, and you're not calling your loved one saying, hey, I'm not sure what to do, I keep having this fear.

31:00 - Speaker 1 There are so many offshoots to this. It seems really hard to kind of contain all of these what ifs.

31:07 - Speaker 2 Exactly, there are many different types of behaviors that people do as safety seeking behaviors, and that's why you need to see a specialist, because what a specialist will allow you to do is a specialist will allow you to understand all the specific actions that you do to try to neutralize, neutralize or or reduce distress, and by identifying those compulsive behaviors and by learning how to manage your fears such that you don't do those compulsive behaviors, you'll then regain your life. Wow, and that's what is most powerful behind treatment. And so the challenge with now going to the alternative, the challenge with talk therapy, is that oftentimes, with OCD, you have these fears, right. Well, when you go to talk therapy, you're often taught to challenge the fears, which is a compulsive behavior, right? So in certain cases, if you go to see the wrong therapist without understanding yet you have OCD, you'll not only do treatment that's ineffective, you'll do treatment that's actually causing you to do more compulsive behaviors.

32:04 - Speaker 1 Yeah, this part completely blew me away. Not to discredit anyone taking charge of their life and their mental health, I think anyone choosing to go see a therapist to work on whatever they feel they need to work on is incredible. But to hear that working with a therapist that is maybe not trained in certain ways to help navigate true OCD can not only be not the best use of your time and money but potentially harmful.

32:27 - Speaker 2 Yes, it's a blatant failure of the healthcare system. It's because you have so many people today with this issue. They're oftentimes doing whatever they can to try to make their fears stop Right and then, as a result, they're trying to seek help. Well, when they seek help, if they don't get a comprehensive assessment to understand what they're going through, then they'll get treatment. Sometimes that's not only ineffective but harmful, and you know what then happens is people with OCD become severely depressed. Right, I mean, there's a high rate of suicide within this population and my guess is, from seeing the research, you could probably prevent quite a few people from becoming suicidal with if you get them the right treatment earlier on in the journey. Similarly, when people going back to that example we talked about, sometimes people self-medicate to make their fear stop.

33:16 - Speaker 1 Like what? What are examples of self-medication for people with OCD that aren't yet getting professional help?

33:20 - Speaker 2 So an example is going back to the mother with a newborn child. I'm going to just focusing on it because it's the example we've used. That mother may end up drinking excessively to try to alleviate the distress from her fears, because she loves her child more than anything and she fears that she may actually harm her child. So it's again ego-dystonic, violating her core values and character. And then she doesn't know what to do to make the fear stop and to make the anxiety stop because it's crippling her. She may then drink and then over time that may lead to additional issues.

33:50 - Speaker 1 In your experience and all the work through NoCD, are you finding that substance abuse is probably the most common and most dangerous self kind of coping mechanism?

34:01 - Speaker 2 Well, our chief clinical officer is a world-renowned expert in both OCD and substance use disorders and the treatment of them. At the same time, it's very common comorbidity, right? So people with OCD can develop substance use disorders when they go untreated, and I think the research shows it's about one in four people with OCD suffer with a substance use disorder, and it's because of the high prevalence of misidentification up front. So you could simply fix this problem if there was national awareness and national screening for this issue. And because it's so treatable, it's actually a solvable problem. So there is a high rate of correlation between those two issues. And the problem is, too, when you go and you don't talk about what's going on in your head because you're embarrassed, right? People then define you by the downstream issue.

34:47 - Speaker 1 So you may get defined by your substance use disorder, but it's actually being driven by undiagnosed OCD, which I would even make the statement most people, majority of people, who suffer with a substance abuse disorder, it's not the alcohol, it's not the substance, it's not the drug, it's not whatever abuse disorder, it's not the alcohol, it's not the substance, it's not the drug, it's not whatever it is, it are these underlying mental health concerns.

35:08 - Speaker 2 There's a lot of, there's a lot of that. So I mean from our, from our clinical team that's. It's a very, it's very common. That's what they mentioned.

35:15 - Speaker 1 And to all his credit when I was kind of diving more into no CD. You all have an incredible stat about how you really help people through especially ERP, and your therapy is clinically proven to reduce OCD symptoms and over 90% of members. That's outstanding.

35:34 - Speaker 2 So and I would say you know that's just a function of ERP what no city does. So so when we started no CD, we the the goal was to make this extremely effective treatment more accessible. We realized that the treatment wasn't getting delivered to people, not due to clinical issues, but due to operational issues. So we tried to fix that, and what we did is we created a model that more efficiently delivers this super, super effective treatment. So it's harder to get more effective than ERP today for OCD, given it's so effective. So our goal was then to really figure out ways to make it more efficient so we can reach more people who have this issue, knowing that there are millions and millions of Americans suffering right now who are not getting it right.

36:19 - Speaker 1 I mean to combine the most effective treatment model currently known for a rampant disorder with on-demand service. That I'm even understanding can be covered financially. Which I think is one of the biggest barriers to most people healing and advancing and moving forward in their life is cost and access to care. But to now see that you have the best treatment on a streamlined platform that is, if I'm understanding correctly covered or can be covered a lot by insurance, I'm assuming, through what HSA, fsas, I mean that's, that's incredible.

36:51 - Speaker 2 Well, it's covered through commercial insurance. So we have. So let me, let me give you the, let me set the stage for a second. So, before no CD and this is an issue I personally faced, that many others face too, you know you and this was before virtual care you were only able to access a licensed therapist that specialized in both OCD and ERP. In very specific areas of the country. They charge about 250 to about $400 a session the Atlantic wrote an article on this was not covered by insurance and those therapists would have eight months to two year long wait lists. So if you were lucky enough to realize what you were going wait lists. So if you were lucky enough to realize what you're going through is OCD and you're lucky enough to understand that you need to get ERP therapy, even if you were at that point, the treatment was widely inaccessible. So that was that's a major, major problem for me personally. When I realized I had OCD, I need to get ERP, I had to wait on a wait list for seven months. I had to find a family member who helped me cover the cost of care and that was the difference If I was able to get, because I got to that treatment. That was a difference for me in regaining my life. If I didn't get that treatment, I would not have regained my life. I don't know what would have happened. Right, and so the the the point, though, is that we made a.

37:57 We made a direct, intentional effort to change that problem or to solve that problem, and what we've done at NoCD is we. First of all, we said, okay, let's give people the right support between their ERP therapy sessions. That was step one, and we did that. With the NoCD platform, we help people do their treatment homework more easily, which then allowed other therapists to help you know more people, because people get better faster. Then we realized people weren't able to get to treatment, so we built the largest specialty network in OCD and ERP. So we had the largest ERP specialty network that we built. We built it in all 50 states, so we would bring in therapists, we would train them in ERP with our clinical leadership team, and then we would allow people in our community online to access those therapists, and then, between sessions, they would use a supportive platform we built out.

38:44 - Speaker 1 And you all have been doing this for quite a while. I mean, when did you found an OCD or, excuse me, an OCD?

38:49 - Speaker 2 Sure, so I I um start, had the idea in late 2014,. Started working it right after that. So it's been almost 10 years. Personally, Wow, but we were, we became. We became a an accredited uh venture capital backed company in early 2018. So an accredited venture capital backed company in early 2018. So it's been a little over six years, but I'll say this. So now, because of our national network, we've been able to partner with many leading insurance companies across the country. There are about 140 million Americans now that can access ERP specialty care through NoCity with just a copay. Amazing.

39:22 - Speaker 1 So we brought the price down for those people from $250 to $400 a session.

39:24 - Speaker 2 city with just a copay Amazing. So we brought the price down for those people from, you know, 250 to 400 session down to a simple copay Wow, we have. You know. We've reduced the wait time from between seven months to two years to less than seven days on average. Outstanding, and you know we have more progress to be made. We want to get to a point where every American is covered and then do the same thing internationally.

39:45 - Speaker 1 Now. Is this something that, if I'm listening to this right now and I feel compelled to reach out and I want to learn more about what NoCD has to offer, I'm taking this episode as a call to action for my life, my health. Do I need to go to my primary care provider and get a referral, or can I just get started right away?

40:03 - Speaker 2 So you can book a free 15-minute phone call on our website and then from there what we typically do is we try to connect you to one of our licensed therapists who we train. We take them through a comprehensive training process. Actually, they have to test into our network too.

40:16 So not only do they get trained, but then they have to verify their understanding and everything related to ocd and then from there they can start seeing people in our community, our members. So then you can book a call, you can learn to see if this is covered by your insurance. If it is great, if it's not, we have different payment plans and they help make it a little bit more affordable. And then you can connect one of our clinicians and get started. In certain cases, some health plans, health insurance companies will require you to have what they call a prior auth, meaning you have to first get authorized by, for instance, a psychiatrist in their network or a primary care physician. So there's one health plan in particular that's like that Kaiser Permanente.

40:57 - Speaker 1 Okay, well, steven, can you please kind of take us back to your story a little bit? I want to really drive this home for the audience that this is not just somebody that created a platform and is connecting some dots. That no doubt is helping a lot of people. It's because you needed this help yourself. Can you take us back to your story and where this all came from?

41:14 - Speaker 2 Sure, sure so. So I didn't have any real major concerns growing up with with my health. Um, you know, I had a pretty normal childhood from the Chicagoland area and I had, you know, one of five kids and so grew up with with the same old things that most kids go through. Right, um, had fortunately had some great parent support. Right and, uh, you know, went to school. After after, um, after two years or so in school, I played college football at a small school down in Texas. Everything was going well. There Came home for summer break and started having the hallmark OCD symptoms, the intrusive thoughts had no idea what was going on, like why can't I find answers to these fears?

41:59 The fears were crippling. They violated my core values and character. They attacked what I love most. They specifically attacked my relationship. They attacked me personally, my, you know my values, who I thought I was as a person. And, um, I didn't know what to do.

42:13 So I went to see a provider in my area that was a psychologist by training. Was um in network? Right Cause, again, that's that's what you typically do. And the psychologist said look, what you're going through is just anxiety. I want you to take a rubber band, I want you to snap it across your wrist every time you have a thought.

42:31 So I started doing that and, like we talked about before, that not only was ineffective, it was harmful, it's a compulsive behavior and it didn't make any sense. So it got worse and I saw another provider, similarly misdiagnosed, mistreated. So a third. He said okay, your family is the issue. I want you to move back down to school. So I moved back down to school. I drove, packed up my bags, drove back down to try to figure out if that was going to help, in hopes that I would be able to go back to school and keep playing football. And then got down to school and, because I was getting worse and worse, I started developing severe depression and then became housebound. So I had to stop going to school. I stopped playing footballs, I was stuck.

43:01 Now you're detached from your family.

43:02 - Speaker 1 You're away from that support system, getting worse, right, exactly.

43:06 - Speaker 2 And so then, um was in a situation where, you know, didn't have anything. I was trying just to make ends meet and then eventually couldn't even do that and so, out of desperation because I was so embarrassed but I was going through, I couldn't really verbalize it I was searching online for help and certain that help was not just hey, help me with what I'm going through, but more so like trying to figure out myself what I was going through, so I could figure that out and I could find answers to these fears. Then I'd therefore be able to, you know, have an answer that was good enough to prove the fear wrong and then regain my life, was constantly finding that answer and trying to find that answer, and that's what OC really is, um, and then regained my life. I was constantly finding that answer and trying to find that answer, and that's what OCD really is.

43:45 And then that process, I stumbled upon a forum of other people literally doing the same thing, and they defined their symptoms as OCD, and I was like OCD, you know, I thought that just a personality quirk or an adjective used to describe someone who's type A. I had no idea it was such a disabling condition that affected one in 40 globally, and had symptoms as such as we described. And then from there I was like well, where do I go get help? So I tried to find help and saw the whole problem. I could either see a provider in my area that there was one, she specialized in OCD.

44:16 - Speaker 1 One One. You had access to one health care provider for the OCD in your area One health healthcare provider.

44:22 - Speaker 2 The alternative was drive to Houston, three hours away, which I did. I couldn't afford to do or couldn't even physically do given the severity of my symptoms and um you know. So that was the only option and she was out of network cash pay. She charged 300 session seven month wait list. So I got on the wait list, fortunately got off the wait list, found a way to cover the cost of my treatment thanks to a great family member, started doing treatment. She diagnosed me, said it's a hallmark case. You know this issue is caused by the fact that there's so many people with this condition that are suffering in silence and they're just not enough specialists that can treat it. And that's because of the supply demand and that's because of really, at the end of the day, not having the right reimbursement for ocd, because people are misdiagnosed and therefore, as an industry, you can't see the true cost of the population so which unfortunately.

45:09 - Speaker 1 How rampant do we see that kind of? Take that same model.

45:11 - Speaker 2 Apply it to so many other disorders, physical, mental, totally exactly and so did the treatment, though you know it's a chronic condition, ocd but I was able to get help between sessions. I was. You know it was a tough process, but I was able to get help between sessions. I was. You know it was a tough process, but I was able to get through it. Did the ERP therapy and it completely changed my life. Learned how to accept uncertainty, learned how to manage the challenges that come with OCD. And when, when eventually went back to school, finished up my degree, finished up playing football, actually here in Southern California, at Florida.

45:40 - Speaker 1 College.

45:41 - Speaker 2 And then at that point in time, I was like man, this is not a clinical issue. Treatment's super effective for people with OCD. It's really an operational issue. We just haven't done a good enough job identifying folks who have this issue, building trust with them to take their first steps into treatment and then bringing evidence-based, affordable treatment directly to them in the settings where they feel the most comfortable doing it. So we did that man.

46:03 - Speaker 1 I can only imagine what you went through and I can only imagine what so many people with OCD try to navigate every day. I just want to commend you again. Thank you so much for coming on and sharing your story, being so open and vulnerable. Hopefully this is going to resonate with at least one person out there that can hear their life, their struggles and yours.

46:21 But now to know that we can get help through a very accessible, potentially very affordable platform like NoCD is incredible, commendable and is exactly what I love to highlight most on the show People that I love how this kind of works so well with OCD and the Ever Forward mantra is accepting uncertainty. You know we have to accept it, but that doesn't mean we can't do anything about it. And to move forward in life, to move ever forward, that's exactly what we have to do. So I want to ask you directly and your story definitely embodies it but to move ever forward, those two words, what does it mean to you? How do you live a life ever forward, steven?

46:59 - Speaker 2 I think it's a great question To move ever forward. I think you have to realize the best value you can offer someone is the gift of knowledge of what to do. Right, like you could do something for someone. But you can also teach someone to do something, and that's what, for instance, no City is about. We want to teach people to basically have the tools needed to live their own life where they don't have to worry about OCD. They can focus on the actual elements of their life that are important, right? Not the OCD.

47:33 Ocd isn't important. What's important is being available for your family. What's important is being able to grow as a person, and having an ability to teach someone to do that is is critical, and so the goal for many of us at no City not just me, but others who have this issue have joined the company, Some of them have actually gone through no City Therapy is to be able to empower others to have that exact same um, you know that they have that same experience and you know, honestly, that's what makes, that's what pushes me ever forward. Right is to figure out how to best get people to know what to do and to teach them how to eventually get better so they can focus on their life and the positive attributes of it.

48:14 - Speaker 1 Well, stephen, thank you. There's never a right or wrong answer, it's just the one that you keep choosing every day and, whether that's through OCD or our own struggles in life, we have to choose to accept uncertainty but, like I said, we have to also choose to take action. Sometimes action is our own work, but many times it means getting help, and there's no shame in getting help and I encourage everyone to please get help, for whatever you need, I get help, we all need help. We all need help. So NoCD and all the information on how they can get help and get connected to the platform is all going to be linked in the show notes and video notes.

48:49 You guys, please, if you or a loved one is struggling or think you're struggling, the best thing you can do in any area of your life and your wellness is to just better educate yourself. So, please, better educate yourself, learn about resources that are available to you and take action. Totally Great. Thank you so much, stephen. Thank you For more information on everything you just heard. Make sure to check this episode show notes or head to everforwardradio.com