OCD Management Success

Client Background

Diego Brown, a 26-year-old master's student in environmental engineering at UCLA, had been dealing with OCD symptoms since he was about 14. By the time he reached out for help, the OCD had become a full-time job on top of his actual full-time coursework. He was spending 4-6 hours every single day on compulsions and mental rituals: washing his hands until they cracked and bled, checking door locks exactly 7 times before leaving (and if he lost count, starting over), spending 3+ hours proofreading simple emails for typos that would "ruin his reputation," and being haunted by intrusive thoughts about his family getting hurt—thoughts he'd try desperately to neutralize through counting rituals or mental prayers.

Despite his academic success (he had a 3.9 GPA, ironically maintained through OCD-driven perfectionism), his quality of life was terrible. His boyfriend had started making comments about the hand washing and the constant need for reassurance ("Are you sure you turned off the stove? Are you sure the door is locked? Do you think my mom will be okay?"). His friends had stopped inviting him places because he'd take forever to leave his apartment or refuse to touch doorknobs in public buildings. He was exhausted.

He'd tried therapy once in undergrad—a campus counselor who did general talk therapy and told him to "try not to worry so much" (not helpful). This time, Diego did his research. He found NOCD, a platform that specializes exclusively in OCD treatment using ERP (Exposure and Response Prevention), which multiple research studies showed was the gold-standard treatment. He was terrified of ERP—the whole concept is deliberately triggering your OCD and then NOT doing compulsions, which sounded like torture—but he was more scared of living like this forever.

Initial Assessment

When Diego filled out NOCD's intake assessment, the scores were pretty stark:

• Y-BOCS (Yale-Brown Obsessive Compulsive Scale): 26 out of 40 (severe OCD—anything over 24 is considered severe)
• OCI-R (Obsessive-Compulsive Inventory): 42 (significant symptoms across multiple OCD dimensions)
• PHQ-9 (Depression): 14 (moderate depression—which makes sense when OCD is eating your life)
• GAD-7 (Anxiety): 16 (severe anxiety on top of the OCD)

During his first video session with Dr. Chen (an OCD specialist who'd worked with hundreds of OCD patients), they mapped out his specific symptom profile:

• Contamination obsessions: Intense fear of germs, illness, "getting sick and infecting others." Would wash hands 40-50 times a day (yes, he counted), wouldn't touch public door handles without a barrier, avoided sitting on public transit seats, showered twice daily for 30+ minutes each time.
• Checking compulsions: Checked door locks 7 times exactly (had to be 7, or the count was "corrupted" and he'd start over), unplugged all appliances before leaving, checked stove burners repeatedly, took photos of the locked door on his phone as "proof."
• Harm-related intrusive thoughts: Graphic, unwanted thoughts about his family members dying or getting hurt—terrifying images that would pop into his head randomly. The thoughts felt so real that his brain convinced him thinking them made them more likely to happen.
• Mental rituals: When intrusive thoughts hit, he'd count to certain "safe" numbers (multiples of 7), mentally recite phrases to "undo" the thought, or pray specific prayers exactly right (if he messed up a word, restart).
• Reassurance seeking: Would text his boyfriend multiple times: "Did you make it to work okay?" "Is your mom feeling okay?" Needed constant confirmation that his fears hadn't come true.

Diego also mentioned that his OCD got way worse during stressful periods—midterms and thesis deadlines would send his symptoms through the roof. He'd developed massive avoidance patterns: didn't use public restrooms (would hold it for hours), limited social activities to "safe" locations he could control, spent so much extra time on schoolwork checking for errors that he was perpetually sleep-deprived.

Treatment Approach

Dr. Chen explained the game plan: 4 months of intensive ERP therapy. The whole premise of ERP is deliberately facing your fears (Exposure) while resisting the urge to do compulsions (Response Prevention). Your anxiety spikes hard during exposure, but if you resist the compulsion, the anxiety eventually comes down on its own—and your brain learns the feared outcome doesn't actually happen. Basically, rewiring the faulty threat detection system in his brain.

Diego was terrified. "So you want me to touch dirty things and then NOT wash my hands? And just sit with the intrusive thoughts without doing anything to fix them? That sounds horrific." Dr. Chen acknowledged yeah, it's uncomfortable—but it works. They'd go gradually, starting with easier exposures and building up to the harder stuff.

Weekly Video Therapy Sessions (50 Minutes)

Every Tuesday at 6 PM, Diego would log into NOCD for his session with Dr. Chen. These weren't just talk sessions—they were working sessions. They'd review his exposure homework from the week, design new exposures, and often do exposures together during the video call (like Diego deliberately writing an email with typos and not fixing them while Dr. Chen watched and coached him through the anxiety).

Daily ERP Homework (The Real Work)

Diego had homework assignments every single day—specific exposures he needed to practice. The NOCD app was crucial here. Each exposure had instructions, and he'd rate his anxiety before, during, and after (0-10 scale). The app tracked everything so he could see his progress over time.

Example early exposures:

• Touch doorknob with bare hand, wait 5 minutes before washing (instead of immediate washing)
• Leave apartment after checking lock only 3 times (instead of 7)
• Send an email with one small typo deliberately left in (instead of proofreading 10 times)

Example later (harder) exposures:

• Touch toilet seat in public restroom, don't wash hands for 2 hours
• Leave apartment without checking lock at all, don't go back
• Deliberately think "My mom could get in a car accident" and don't neutralize with counting or prayers

Between-Session Messaging Support

Diego could message Dr. Chen anytime through the app—usually when he was freaking out mid-exposure or struggling with whether something "counted" as a compulsion. Dr. Chen would respond within a few hours with guidance or encouragement.

OCD Education Library

NOCD had a ton of resources about OCD—videos, articles, webinars. Diego watched a webinar on harm OCD that helped him understand his intrusive thoughts were just thoughts, not predictions or desires.

Core ERP Principles They Used

• OCD psychoeducation: Understanding the OCD cycle: obsession → anxiety → compulsion → temporary relief → obsession gets stronger. Compulsions feed the OCD; ERP starves it.
• Building an exposure hierarchy: Diego and Dr. Chen created a list of triggering situations ranked 1-10 in difficulty. Started with 3-4 difficulty, gradually worked up to 9-10 difficulty.
• In-session exposures first: Dr. Chen would guide Diego through an exposure during their video session before Diego practiced it on his own—modeling how to resist compulsions and ride out the anxiety.
• Response prevention is key: The "RP" part—not doing the compulsion—is where the real change happens. This was the hardest part for Diego.
• Mindfulness for intrusive thoughts: Instead of trying to push thoughts away (which makes them stronger), practicing just letting them be there without engaging. "Okay, there's that intrusive thought again. Just a thought. Moving on."
• Cognitive work: Challenging OCD-driven beliefs like "If I think something bad, it's more likely to happen" or "I'm responsible for preventing all harm."
• Partner education: Diego's boyfriend joined a session to learn about "accommodation"—ways he was unintentionally feeding Diego's OCD by providing reassurance. He learned to respond with "I'm not going to answer that OCD question" instead of "Yes, the stove is off."

Progress and Challenges

Weeks 1-2: Understanding OCD and Building the Hierarchy

The first two weeks were all education and planning. Dr. Chen explained the neuroscience of OCD—how Diego's brain's threat detection system was overfiring, sending false alarms about danger. The compulsions were Diego's attempt to fix the false alarms, but they actually reinforced the brain's faulty programming. ERP would teach his brain the alarms were false.

They built Diego's exposure hierarchy together. Rating each feared situation 1-10:

• Level 3: Touch doorknob, wait 5 minutes before washing
• Level 5: Check locks only once before leaving
• Level 6: Send email without proofreading
• Level 7: Touch public toilet seat
• Level 8: Leave apartment without checking locks at all
• Level 10: Deliberately have intrusive thought and don't neutralize

Diego was terrified just looking at the list. Level 10 stuff felt impossible. Dr. Chen reassured him they'd work up to it gradually.

Weeks 3-8: Starting ERP (The Worst Part)

This phase was brutal. Diego started with Level 3-4 exposures, and even those felt excruciating. First exposure: touch a doorknob in a coffee shop without immediately washing his hands. His anxiety shot to 9/10 within seconds. Every fiber of his being screamed at him to wash. But he'd committed to waiting 5 minutes.

He messaged Dr. Chen: "This is torture. My anxiety isn't going down. I feel contaminated. How is this helping?" Dr. Chen responded: "Stay with it. Anxiety will peak then decrease. You're teaching your brain the doorknob isn't actually dangerous."

By minute 4, his anxiety was still at 8/10. At minute 5, it was at 7/10. He washed his hands. The relief was immediate—and that's why OCD is so hard to break. But he'd made it 5 minutes without washing, which was progress.

Over the next few weeks, Diego practiced daily exposures. Some days were okay. Other days he'd "give in" and do the compulsion because the anxiety was unbearable. Dr. Chen said that was normal—ERP isn't about perfection, it's about gradually building your tolerance.

A big challenge during this phase: Diego realized he was doing mental compulsions even when resisting physical ones. He'd touch a doorknob without washing, but then mentally count to 7 or say a neutralizing phrase. Dr. Chen caught this: "That's still a compulsion. We need to resist mental rituals too." That made it even harder.

By week 8, Diego had worked up to Level 5-6 exposures. He was checking locks only 2-3 times (down from 7), sending emails with minor typos (still stressful but doable), and his hand washing had dropped to maybe 15-20 times a day (still high, but progress). His Y-BOCS score dropped to 20 (still moderate OCD, but improvement).

Weeks 9-14: Tackling the Hard Stuff (And a Setback)

The last phase ramped up to Level 8-10 exposures—the stuff Diego had been avoiding. Week 9: he deliberately allowed intrusive thoughts about his mom getting hurt and didn't do any neutralizing rituals. The anxiety was off the charts—10/10, shaking, sweating, convinced something bad was going to happen. He messaged Dr. Chen in a panic. She talked him through it, reminded him intrusive thoughts are just mental noise, not predictions.

The next day, his mom was fine. The intrusive thought didn't cause anything. His brain started learning.

Week 11 brought a major setback. Diego had a thesis deadline, stress went through the roof, and his OCD symptoms came roaring back. He went back to checking locks 7 times, washing hands constantly, seeking reassurance from his boyfriend. He felt like he'd failed.

Dr. Chen reframed it: "This is a learning opportunity. OCD flares during stress—that's normal. The key is to keep doing your ERP even when symptoms spike." They adapted his exposures to address the stress-triggered symptoms specifically. Within two weeks, he'd regained his progress.

By week 14, Diego had made huge strides: he could leave his apartment without checking locks (still felt weird, but he did it), was using public restrooms without extensive washing rituals, had stopped seeking reassurance from his boyfriend, and was spending maybe 45 minutes to 1 hour per day on OCD-related stuff (down from 4-6 hours). His Y-BOCS score was down to 10—mild OCD.

Outcomes and Results

In Diego's Words

"Before NOCD, I genuinely couldn't imagine living without OCD running my life. It had been there since I was 14—it felt like part of my identity. The idea of ERP terrified me—deliberately triggering my worst fears and then not doing anything to fix it? It sounded like masochism. And yeah, it was incredibly hard. There were days I wanted to quit, days I gave in and did compulsions anyway, days I felt like I was failing. But having a therapist who actually understood OCD—not someone who just said 'think positive' or 'have you tried meditation'—made all the difference. Dr. Chen knew exactly what I was dealing with because she specialized in OCD. The app was crucial too; being able to track my exposures and see my anxiety ratings go down over time kept me motivated when it felt hopeless. I still have intrusive thoughts—probably always will—but now I know they're just brain noise. I don't spend hours trying to neutralize them anymore. For the first time in over a decade, I feel like I'm in control of my life, not my OCD."

Follow-Up and Maintenance

After finishing the intensive 4-month treatment, Diego switched to monthly check-in sessions with Dr. Chen. They'd review any OCD flares, do refresher ERP for new triggers, and make sure he was maintaining his progress.

At his 3-month follow-up, Diego had not only maintained his gains but continued improving:

• Y-BOCS Score: 9 (still mild OCD—some residual symptoms but minimal interference)
• OCI-R Score: 18 (non-clinical range)
• PHQ-9 Score: 5 (minimal depression)

Diego reported that he'd successfully navigated several high-stress situations—final exams, his thesis defense, a family member's illness—without major OCD relapse. When symptoms did flare up, he'd pull out his ERP toolkit and work through it. He'd even started going to the gym (something he'd avoided due to contamination fears about gym equipment).

His relationship with his boyfriend improved dramatically—no more constant reassurance-seeking, no more avoiding plans because of OCD rituals. His boyfriend mentioned that Diego seemed "lighter, like a weight was lifted."

Key Takeaways from This Case

• OCD needs specialized treatment: Diego's previous experience with general therapy was useless. OCD responds to specific interventions (ERP), not generic talk therapy. Having a therapist who specialized in OCD made all the difference.
• Digital tools make ERP sustainable: The NOCD app was critical—structured exposure tracking, anxiety ratings, progress graphs. It held Diego accountable and showed him concrete evidence of improvement.
• Therapist expertise is everything: Dr. Chen understood OCD's nuances—the subtle mental rituals, the reassurance-seeking, the accommodation dynamics. She knew how to guide Diego through the hardest exposures.
• Between-session support prevents dropouts: Being able to message Dr. Chen when Diego was panicking mid-exposure helped him push through instead of giving up. OCD treatment has high dropout rates; support makes a difference.
• ERP is structured and concrete: The clear framework—hierarchy, daily exposures, measurable progress—worked well for Diego's brain. He could see exactly what he needed to do and track whether it was working.
• Setbacks are part of recovery: Diego's week 11 relapse during thesis stress was normal. The key was treating it as a learning opportunity, not a failure.

Platform-Specific Benefits

NOCD features that made Diego's treatment effective:

• Specialized matching with OCD therapists—Dr. Chen had treated hundreds of OCD cases, understood the disorder deeply
• Mobile app designed specifically for ERP—exposure instructions, anxiety tracking, progress visualization
• OCD-specific assessment tools (Y-BOCS, OCI-R) that accurately measured symptoms
• Secure messaging for crisis moments during exposures—critical for preventing dropout
• Educational library focused exclusively on OCD—helped Diego understand his disorder and normalize his experience
• Video sessions with screen sharing—Dr. Chen could pull up Diego's exposure tracker, review data together, design new exposures collaboratively
• Partner involvement resources—educating Diego's boyfriend about accommodation behaviors helped the whole system change