I'm a Therapist With OCD Who Tried NOCD — Here’s How It Helped

NOCD's sign-up process is different from other therapy companies I've tried: rather than fill out a long intake form online, you're urged to book a call with an intake coordinator. I assume this is to screen for OCD symptoms.

That said, I did not have availability within their intake hours to book a sign-up call, so I messaged customer service to see if I could have a sign-up link. They provided me with one to self-sign up, but only after encouraging me to book a call one last time. While my reason for not booking the call was mostly a scheduling issue, I’m likely not the only one who would be put off by this sign-up process. Calling can be intimidating for people who do not like talking on the phone or who have limited availability due to work or school schedules, are primary caregivers, or have other responsibilities.

During the virtual sign-up, I was asked about what motivates me to get better. I could select from multiple-choice answers that included options like “to enjoy time with family or friends,” or “because I want a healthier lifestyle,” but I was excited to see I could also enter my own option. I feel like it’s rare for online therapy services to offer such personalized approaches to sign-up.

Then NOCD asked what types of therapy I was looking to try, giving me options of CBT, ERP, acceptance commitment therapy, other, or none of the above. This question confused me since NOCD exclusively focuses on ERP. Maybe they meant the question to be a screening to make sure I was open to this type of therapy.

Next, I was asked if I had ever worked with an OCD therapist and whether I wanted to improve OCD symptoms, prevent symptoms from flaring back up, or continue improving after managing symptoms.

After that, I was asked to categorize myself and my experience with OCD. Options included: “Older adults with OCD,” “OCD newbies,” “BIPOC with OCD,” or “NOCD Therapy Alumni.” It also asked what kinds of symptoms of OCD impact me, such as “Harm OCD,” “Postpartum OCD,” “Perfectionism OCD,” or “Health Concern OCD.”

Finally, I was able to check if my insurance plan was eligible for in-network coverage before submitting my answers.

Matching With a Therapist

Patient Portal

After completing the sign-up process and entering my payment information, I was given access to my client portal, which allowed me to access an online message board, various worksheets, session scheduling, and the ability to message my therapist between sessions. Seeing all these tools made me feel excited to start therapy. After selecting a therapist, I could immediately schedule my first session.

Once scheduled, I received my link for my sessions 48 hours in advance and I got a reminder about my session 15 minutes before it was scheduled to start.

All therapy sessions at NOCD take place over Zoom, which means there are no live chat or audio call session options like at other therapy companies I’ve tried in the past. In addition, all therapy sessions used ERP as the therapy modality, which means that your therapist works with you to use exposure, which stirs up obsessive thoughts, and response prevention (teaching you coping strategies) so you can minimize your symptoms.

Intake Sessions

While the company recommended a 60-minute intake session, my intake actually seemed to take more like two sessions.

In my first session, my therapist asked me about my symptoms so we could determine what kind of OCD I experience. Often, the intrusive thoughts and repetitive behaviors of someone with OCD focus on similar themes, such as relationship OCD, perfectionism OCD, or contamination OCD. Identifying the type of OCD can help guide your ERP treatment’s focus.

Next, we discussed how my various behaviors or thoughts could be compulsive in my efforts to relieve anxiety, such as making lists, checking through my thoughts that I didn’t forget anything, or seeking reassurance from others.

For the rest of that first session — and the entire second session — my therapist spent time educating me about the cycle of OCD, which involves the pattern of thinking an unwanted thought, experiencing anxiety, and using a compulsive behavior to alleviate that anxiety. Then the process starts all over again. After that, he explained how ERP can help interrupt the cycle by challenging me to not use compulsive behavior to reduce my anxiety.

My therapist also made sure I was a good fit for ERP treatment by assessing the OCD symptoms I was experiencing and my current ability to cope with them. I really enjoyed the psycho-education piece of these sessions; it helped me feel more in control of my treatment even though it was a structured process.

Scheduling

NOCD states: “The expected duration of the services is a three- to six-month period of once- or twice-a-week therapy sessions.” Once symptom improvement has been achieved, session frequency can decrease.

In the intake, my therapist recommended I start with twice-a-week sessions, but that didn’t always work with my schedule. I attended sessions as often as my availability allowed, which was sometimes twice a week and sometimes once a week. It was important for me to try their recommended frequency, but as a busy working mom, twice a week felt unrealistic. Thanks to my job’s flexibility, I could schedule my sessions during work hours, which I know is not a possibility for many people.

ERP Sessions

During my ERP sessions, I created an exposure plan with my therapist using NOCD’s app.

The “Practice” tab on the app allowed me to set up tiered exposures based on the amount of anxiety I feel from them. For example, one particular obsession I have is that my kids will get hurt. For this obsession, we created exposures such as reading a news article about a child getting kidnapped (a mild distress ranking) or delaying checking in with the family member who was babysitting my children (a moderate-severe distress ranking).

The goal was to practice these exposures first in therapy and then as homework throughout the week. As I practiced them, I was asked to measure my results through how much time it took to relieve discomfort during the exposure as well as my distress level on a 1 to 10 scale. NOCD provides these results as a way for you to see your growth, which always encouraged me while I completed my homework.

Questionnaires Between Sessions

Between video sessions, NOCD utilizes questionnaires in the app to measure your progress. I answered questions after every session, which made the use of NOCD pretty time-consuming.

These assessments included the more common measurements of depression and anxiety as well as questionnaires on life satisfaction, physical and emotional abilities, and obsessive-compulsive symptoms. All questionnaires focused on how intense my symptoms were and how severe their impact was on my daily functioning.

My therapist and I would always review my results in the next session, and he often provided context into what the results meant, which was reassuring.

Because of the work I’d done during the week, and the growth I’d measured in the app, I found myself looking forward to my next therapy session each week. I was excited to discuss how my homework exercises went and eager to learn more about how OCD works from the therapist.

This feeling of excitement is something I haven’t experienced with online therapy services in the past. I could see my progress in the questionnaires and I also gained a lot out of each session (education about OCD, awareness of my own thoughts and habits, and confidence that I could overcome my symptoms).

Additional Resources

NOCD gives you free additional resources in your patient portal, such as an online message board for you to discuss your experiences with other people who have OCD. You can post questions about your experiences, such as “What do you do when you’re triggered and it impacts your partner?” or “Does anyone else experience suicidal OCD?” The online message board appeared to have little engagement, with an average of zero to two comments below most postings.

In addition to the message board, there are also a number of support groups that have sessions on Zoom, and are organized by topic in a calendar format on the app.

The 60-minute group sessions are always moderated by a licensed therapist. Often these group Zooms occur weekly. For example, the “Creative Expression for OCD Management” meets on Mondays, while the “Dealing with Mental Compulsions” meets on Thursdays.

I spent a Thursday evening with about 10 other participants hearing about their experiences with mental compulsions and symptom management. It was helpful to know I wasn’t alone, but it wasn’t something I would do every week as it might get repetitive. That said, there are plenty of groups to choose from, so you should be able to find one relevant to your experience. In fact, there are seven to choose from on Tuesdays alone.

There is also a journal on the app. You can choose between freeform journal entries or a guided prompt, like “What are your therapy goals?” or “How is OCD impacting you today?” It’s important to note that your therapist can view your journal entries, which might dissuade some from using it.

Because NOCD charges per session, a fee of $100 applies if you miss or cancel within 48 hours of your appointment. This must be paid out-of-pocket and is not covered by insurance. I found the 48-hour cancellation policy unusual because most of the policies I see are more flexible, giving you 24 hours, such as at the online therapy platform Brightside Health.

Cancelling NOCD is easy. Because you pay per session, you can stop scheduling future appointments as a means of canceling. Even if you stop attending therapy sessions, you can still access the message board and support groups for free.

While ERP is the gold standard for OCD treatment, it is worth noting that studies show ERP treatment of OCD is more effective when combined with talk therapy and SSRI medications, but NOCD does not offer psychiatric care in-house — which I found disappointing.

Instead, it refers you to local providers within your state that offer in-person or virtual medication management. NOCD encourages you to sign a release between your NOCD therapist and your psychiatrist so they can share notes about your treatment and diagnosis with the goal of enhancing your quality of care.

NOCD stands out in its ability to prioritize one mental health diagnosis, OCD, and improve its treatment through specialized providers, online accessibility, and availability of self-help tools. I also never experienced a single technical issue during my eight weeks at NOCD, which was awesome (and not the case at many other companies I’ve tried).

While NOCD's exclusive focus on ERP treatment of OCD sets it apart, it’s not the only online therapy service that specializes on one modality. For example, Online-Therapy.com and Brightside Health emphasize using only traditional CBT, which is also proven to be effective in treating OCD since ERP is a type of CBT.

While ERP is the gold standard for OCD treatment, it isn’t effective for everyone, and oftentimes, therapists might utilize a variety of therapeutic modalities when treating their patients with OCD. If you think you might prefer to sign up for a company that doesn’t specialize in only one modality — or testing just one mental health condition — Talkspace, BetterHelp, or Innerwell might all be more appropriate for your needs.

NOCD’s out-of-pocket cost is higher than its online therapy competitors. NOCD charges you $150 per 45-minute session and often recommends two sessions per week. In comparison, Brightside Health offers four video sessions for $299 per month ($74.75 per weekly session), while Online-Therapy.com provides therapy for $80 per weekly session. However, unlike BetterHelp or Online-Therapy.com, NOCD accepts insurance. Often, a lack of insurance coverage can be a barrier for those wishing to access mental health services.

That said, NOCD does not offer medication management like Brightside Health and Talkspace do, allowing you to receive talk therapy and psychiatric care within one company if necessary. Talkiatry focuses on providing psychiatry and mental health medication for a variety of diagnoses, including OCD, and can refer you to a talk therapist at the company if your provider deems it appropriate.

NOCD is a great choice for anyone with OCD seeking accessible, virtual ERP treatment. The company prioritizes training its providers effectively in ERP while creating an online community for therapy seekers. Its use of support groups, informational webinars, and blog posts helps patients learn more about OCD, which is vital in a society that mostly believes OCD solely involves compulsions around cleaning. Few other online therapy companies are brave enough to center themselves on a single mental health diagnosis, yet NOCD successfully achieves this. For instance, Talkspace and Brightside Health mention an ability to treat OCD, but the companies do not exclusively focus on it (or any other single specific diagnosis).

Additionally, NOCD’s higher-than-average out-of-pocket cost and time commitment may be prohibitive for some therapy seekers. ERP treatment itself is time-intensive, whether it’s received online or in person. That doesn’t negate NOCD’s strongest selling point: its specialized focus on treating OCD through virtual therapy. If it weren’t for the high out-of-pocket rate, I would be continuing to use NOCD after writing this review on a weekly or biweekly basis due to its ability to provide me personalized treatment, education about my diagnosis, and accountability in my progress.

Everyday Health works to honestly review over 65 online therapy services by using testers from a variety of demographics, backgrounds, and professions. Testers try the services themselves for a period of four to eight weeks, collecting data on the sign-up and intake process as well as the overall therapeutic experience.

The personal experiences of testers contribute qualitative data to the quantitative data we gather through user surveys. We evaluate online therapy services on the following factors: user experience, the sign-up process, whether it allows you to choose or change your therapist, additional resources offered, therapist credentials and quality, the company’s commitment to ethical care, customer service, therapy modalities, average cost, and whether it accepts insurance.

My experience as an individual who has attended therapy for the past 11 years as well as a therapist who offers telehealth services enhanced my ability to evaluate NOCD’s effectiveness in a variety of ways. While testing NOCD, I considered the following:

• The ease of sign-up
• User experience in navigating the website and the app
• Transparency with pricing and insurance coverage
• Whether I experienced technical issues during therapy sessions
• Average cost per session
• Variety and quality of resources available between sessions
• Ability to schedule based on my availability
• Qualifications of the therapists
• Number and demographics of therapists to choose from
• Customer service features
• Ability to switch therapists as I saw fit
• Efficiency of ERP in treating my symptoms