Author: Stephen Smith

Founder and CEO of nOCD

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.

 

 

 

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.

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,

Stephen
Founder/CEO

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.


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.”

(Yum)

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.

#FieldOfDreams

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.

#NuffSaid