Can Teletherapy Help People With OCD During the COVID-19 Pandemic?

Whilst the coronavirus pandemic and associated lockdown has taken a toll on everyone’s mental health, the burden has been especially heavy for people living with obsessive compulsive disorder (OCD). For people with compulsions that revolve around cleanliness, the distress that would be caused by an invisible virus is obvious. But OCD is a complex disorder, and is poorly understood by the general public. We spoke to NOCD’s founder Stephen Smith, who has experienced the crippling impact of OCD in his own life, on how his remote counselling service could help people with OCD during the pandemic.

Ruairi Mackenzie (RM): Would you be able to share some of your experiences with OCD and how they led you to found NOCD?

Stephen Smith (SS): Prior to the onset of OCD, life was great. I was the starting quarterback at my university, I had a great social life, I did well academically and I had no health-related issues. Everything changed once I started having recurring intrusive thoughts after my sophomore year of college. These intrusive thoughts caused me to question fundamental elements of my character and in an attempt to make them stop – as well as the crippling anxiety – I would overanalyse them and perform different actions such as using google to search for their meaning. This was a torturous cycle that would last throughout the entirety of the day. After several weeks without improvement, I sought help from my primary care physician. He referred me to an in-network psychologist – a moment that should have ended my suffering but instead marked the beginning of it.

When I explained to the psychologist what was happening, he misdiagnosed me with generalized anxiety, despite having common symptoms of OCD, and advised me to snap a rubber band on my wrist every time an intrusive thought occurred. Given his misdiagnosis and poor clinical guidance, I became worse and found another in-network therapist. She also misdiagnosed me with generalized anxiety and advised me to move away from my family, since she felt they were the “root cause” of my intrusive thoughts. I followed her guidance and moved to Texas, thousands of miles away from my family, but the thoughts followed, and my health worsened. In Texas, I was misdiagnosed and mistreated three more times. This caused me to develop severe depression, leave school and football, and become housebound. I was literally at rock-bottom.

One day, after searching my thoughts online, I stumbled upon a forum populated byothers suffering with the exact same symptoms as me. They described these symptoms as OCD. I thought to myself, “OCD? Isn’t that just an adjective used to describe somebody who’s uptight?” I had no idea OCD was such a troubling chronic condition that results in recurring, unwanted thoughts, images and urges that are often violent, sexual, religious, contamination and relationship-based in nature.  Up to that point, misinformation prevented me from understanding the true prevalence and severity of OCD, which affects 1 in 40 people, ranks as a top 10 most disabling condition by the World Health Organization, causes people to be 10 times more likely to die by suicide and generates three times more medical cost than depression.

After self-identifying with common OCD symptoms, my next step was to search for a therapist who could offer me a diagnostic assessment and potentially provide me with effective OCD treatment. That’s when I stumbled upon exposure and response prevention (ERP). ERP is considered the gold-standard of OCD treatment, and it is administered by a licensed therapist with specialty training in OCD and istailored to each individual and the nature of their OCD. When seeking a licensed therapist with OCD and ERP specialty training, I ran into even more hurdles. There was one therapist in my area, she had a seven-month waitlist, she charged over $300 per session and did not accept insurance. That was my only option to get better. So, I waited my turn on the list and was fortunate to have a family friend cover the cost of these sessions. Although it was an arduous treatment process – since I only saw my therapist for one hour per week and the rest of the time I was forced to manage my condition alone – I slowly got better given the efficacy of ERP treatment for OCD. Six months later, I transferred to Pomona College in Southern California, finished up my football career and completed my degree in economics and Chinese.

The rediscovered success helped me realize that the “OCD problem” wasn’t clinical in nature but mainly operational (given the common misconceptions and lack of access to evidence-based care). That’s when I realized the solution was technology. I created NOCD, so that millions of others with OCD wouldn’t have to suffer as I did. Inside the NOCD telehealth platform, people with OCD can participate in live, face-to-face video therapy sessions with a licensed therapist from our network with specialty-training in ERP and OCD. They can also get continual support between sessions from self-help tools and peer communities.

RM: OCD remains poorly understood in the general population, who largely picture it as a pre-occupation with light switches and hand washing. What can advocates do to improve communication around the complexity of OCD to the wider public?

SS: As advocates, we must focus on educating health insurance companies and their leaders about OCD, the rate at which it’s misdiagnosed, the cost that doesn’t get attributed to it, the common ways in which it manifests and the true prevalence of the condition. By educating payer executives on the problem – people who are at-risk for covering OCD patients once they become severe and costly – specialty programs for identifying and managing OCD will have a higher likelihood of getting implemented.

RM: Could you tell us about the ERP treatment model and why it has proved to be effective in reducing symptoms of OCD?

Exposure and Response Prevention (ERP) is a very specialized form of Cognitive Behavioral Therapy (CBT). ERP teaches OCD patients how to respond to their thoughts, images and urges (obsessions) that cause them extreme distress. Instead of doing actions to stop the obsessions, which makes OCD worse, ERP teaches people with OCD to sit with the discomfort caused by their obsessions and to accept the uncertainty behind them. When performing ERP exercises, an OCD specialist therapist will help their patient purposefully trigger their obsessions so that they can practice responding to them in an effective way. NOCD’s technology augments the way ERP is delivered, empowering our therapists to use a model that was proven to help people with OCD manage their condition effectively in 50% less sessions than average.

RM: What impact has the COVID-19 pandemic had on NOCD’s clients?

SS: The COVID-19 pandemic has significantly impacted the OCD community. People with OCD who have contamination and harm subtypes often fear that they’ll either catch the coronavirus or spread it to an immunocompromised loved one. As a result, they’re washing their hands until they bleed and overutilizing emergency room testing resources, despite being asymptomatic. Others with OCD unrelated to contamination and harm are also particularly acute due to the stress of the overall situation. Because of quarantine regulations, many people with OCD have disrupted daily routines and financial challenges, uncertainty that makes their OCD worse. NOCD has really stepped-up to the plate to serve these people. We’ve seen a consistent twofold spike in therapy session growth and our clinical outcomes have been tremendous during this time.

RM: What can we do to relieve the pandemic’s impact on people living with OCD?

SS: The first thing we can do is spread awareness about misunderstood OCD symptoms – which affect the majority of the population – and the manageability of the condition. Because ERP is so effective, OCD is known by many as the most treatable severe mental illness. With the NOCD telehealth platform, now this extremely effective treatment is also affordable and convenient. You can access ERP therapy from the comfort of your home and in a way that is financially reasonable. Many insurance companies across the U.S. have brought NOCD Therapy in-network.

RM: The thought processes and compulsions experienced by individuals with OCD can be extremely distressing and sufferers can have great difficulty in reaching out to healthcare services due to feelings of guilt and shame. Are people really more likely to share these thoughts over the phone as opposed to in face-to-face meetings?

SS: NOCD sessions are all face-to-face with live video appointments. Patients who are shy may feel intimidated in an in-person therapy environment, so teletherapy may open up opportunities for patients who would have avoided therapy due to the nature of the in-person experience. Part of the ERP exercises will be to get them to go out and do more in public exercises, but this is a way to get them started with a specialist.

Prior to signing up, people can anonymously share their stories with others in the community like them, directly inside the NOCD platform’s peer community. This proves to people with OCD that they aren’t alone and that people each day are going through the exact same thing as them – and getting better! Moreover, during the sign-up process, people with OCD can book a free 15-minute phone call with NOCD’s care team – a group of people who work full-time at NOCD and deeply understand OCD and all of its unique manifestations. Given the shame and misunderstanding that surrounds OCD, we’ve found these steps are crucial in helping our members connect to effective care.

There are many benefits of remote therapy. A major benefit is that we are now in the environment where the therapy needs to take place and not in an office. For example, if someone has OCD about their stove being on, a therapist can have them go to the stove and turn it on and off and then have them walk away. A therapist can be a witness to the person doing their therapy exercises in the moment with the patient.

Teletherapy allows us to travel, as well. If a patient needs to go and walk around the block for fear of their home getting broken into – a common OCD theme – then the therapist can go on the walk with them virtually and talk to them about their fears and how to resist doing their compulsions right there in the actual experience.

Teletherapy is also an advantage for people who live in rural areas where there are likely not many specialists. Now, all you need is an internet or cell tower connection and you can be meeting with someone who is specially trained to treat OCD and do ERP Therapy.

Finally, teletherapy allows for decreased time interference in one's day. If you did have to drive to an office, wait to be seen, do the therapy, and drive back home, it could be a three-hour experience for a patient. Now, it is just the time that it takes to do the session. That opens up a few more hours of the day and can even give the patient more time to do their ERP exercises.

Stephen Smith was speaking to Ruairi J Mackenzie, Science Writer for Technology Networks