NOCD’s groundbreaking new study of children and adolescents with OCD is the first and largest of its kind. Led by Dr. Jamie Feusner, the study followed 2,173 children and adolescents ages 5-17 over the course of 13 therapy sessions. Results showed that kids and teens with OCD treated with NOCD Therapy had a nearly 40% reduction in symptoms.
NOCD combines face-to-face video therapy with specialty-trained therapists and online tools designed specifically to help young people with OCD and their families to stay on track between sessions, yielding extremely positive results for Members, parents, therapists, and insurance companies alike.
We sat down with Dr. Feusner to learn more about the results of the study, why NOCD’s virtual treatment model is so successful, as well as its impact on the OCD community.
This conversation has been edited for length and clarity.
Why is your latest study of children and adolescents in NOCD Therapy the first of its kind for the OCD community?
It’s very definitive about exposure and response prevention (ERP) therapy and the way we deliver it at NOCD, meaning as video teletherapy, combined with messaging capabilities on the NOCD app, and a customized online support community for both kids and parents to use between sessions. We’ve demonstrated, in this very large sample, really good results in terms of not only decreasing OCD, but decreasing the severity of concurrent symptoms like anxiety, depression, and stress as well. We measured them and saw a statistically significant decrease in symptoms.
One of the other key takeaways of your study is that NOCD Therapy helps children and adolescents with even the most severe forms of OCD. Can you explain why?
We did an analysis and we categorized people into mild, moderate, and severe. What we saw is we got a good degree of symptom reduction from all of them. The children and adolescents who were severe didn’t get quite as good results as mild to moderate cases, but they still got substantially better. This is great news because typically severe patients are told they need intensive treatment programs, like intensive outpatient programs (IOPs) and other forms of treatment that are time consuming, expensive and hard on families. Our data proves that NOCD is convenient, cost-effective and successful for even severe cases.
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Not only does your study show that children and adolescents are getting significantly better from NOCD Therapy, but they’re getting better faster. Can you give us a quick rundown of the data?
We examined the amount of time that it took for people to reach these responses. Time is measured in treatment duration, meaning hours spent seeing a therapist. Our study proves that to get significantly better and reach a 40% reduction in symptoms—it took children and adolescents 11.5 hours with their therapist.
To put that in context, typically, most outpatient ERP therapy for OCD takes more than or about twice as long, about 25 one hour sessions. Because NOCD therapy for kids is a combination of customized ERP teletherapy and specialized in-app features like messaging tools that enable them to immediately reach out to their therapist, it can achieve results in about half of the time for children and adolescents, compared to what we normally see.
That’s impressive. What else makes NOCD Therapy more efficient for children and adolescents?
Well, we encourage all of our members to do the first, typically, six to eight sessions twice a week. By doing ERP therapy more intensely at the beginning, children and adolescents can start to build momentum faster, and learn how to do the treatment more quickly and accurately. In the case of children and adolescents, sometimes it’s the parents learning how to do the treatment along with their kid that helps, so they can really pick up the ball and keep it moving.
So meeting twice a week at the beginning is key to efficient, positive outcomes?
What we’ve seen in our data overall is that doing twice a week therapy increases the likelihood that somebody will reach a full treatment response. And overall, fewer days between sessions is associated with better outcomes. So therapists can get members better symptom reduction if there are fewer days that lapse between sessions.
For example, if a therapist and member only meet once a week at the start of treatment, and the member was assigned therapy homework and they got stuck on something, then the therapist and member have to wait another six days until they meet again. If the therapist and member have twice a week sessions, then they meet every couple days, go over what happened, troubleshoot, and get back on track. So appointments twice a week make the whole process go a bit faster.
As you noted earlier, the NOCD app plays an instrumental part in the successful treatment outcomes you’ve studied. Can you explain why in more detail?
ERP is effective, but there are other factors to the positive outcomes we’re showing at NOCD too. It’s really important that the members and their parents can message their therapist between sessions. If they choose to message them, their NOCD therapist will get back to them within 24 hours. That can really help keep the momentum going too because if somebody gets stuck, they actually don’t even have to wait for the next session. The therapist—all NOCD therapists receive specialty training on how to treat children and adolescents—might be able to help them troubleshoot ASAP and help them do an exposure effectively, or offer support. Also, therapists can message parents and give instruction on how they can help their kid, for example, by not giving reassurance.
So parents often think they’re helping their child but they’re actually giving their kid reassurance and making their child’s OCD worse?
The term for this is family accommodation. It’s quite common that if kids have something they’re concerned about, they’ll ask their parents if it’s going to be okay in some way. Like if they have contamination fears, they might say, “Is it okay if I don’t wash my hands this time?” Or, “Am I not going to get sick if I drink milk that’s close to the expiration date?” Or they might say, “You know, I’m having these bad thoughts that I might do something to the dog. Do you think I’m actually going to do it?” So the parent gives reassurance and then that’s a compulsion because they did a behavior that temporarily made it feel a little bit better for their kid, but then it just perpetuates the OCD.
When parents are aware that they might be getting in the way of their kid’s progress, can they send a message to their NOCD therapist on the app and figure out the right way to respond to their child as quickly as possible?
Yes. And that message can be private between the parent and the therapist. The child can’t see it. Alternatively, the child too can have a private message thread with their therapist. And the therapist can have a linked account with both the parent and the child to monitor all communication with the family that only they can see.
We specifically built our app to include important features like this for our Members.The parent might even in some situations say, “You know, you need to message your therapist about it” and try to get out of the family accommodation loop because sometimes it’s really difficult for parents to remove themselves from it. That’s why we built a tool in the app that allows families to list out the accommodations they’re doing that are getting in the way of the child’s therapy, so that kids, parents and the therapists can track accommodations together if they choose to.
Is it accurate to say that insurance companies are happy with NOCD’s outcomes because not only do their members get better faster, but it’s both cost effective for the member and the insurance provider?
Yes, exactly. Insurance companies are very happy and often pleasantly surprised to see how efficient NOCD Therapy is, that we’re able to get these kids better pretty quickly. We’re able to help families spend half the time needed in therapy to get the same outcomes by leveraging in app tools and messaging between sessions. As I mentioned earlier, insurance companies are pleased that we can get their members with even severe OCD cases better faster with a less expensive form of treatment than they usually see. And now 9 out of 10 families with commercial insurance across all 50 states in the US can use their insurance to access therapy.
What are the most important facts that you want the OCD community to take away from your study of children and adolescents in NOCD Therapy?
It’s critical to note that our study is what’s known as an observational study, not a controlled research study. The data we collected is from people without any exclusion criteria, meaning everyone could participate in the study no matter what kinds of comorbid problems they were dealing with—we didn’t exclude anyone from participating. So our study proves that NOCD Therapy—the #1 largest speciality provider in all 50 states for adolescents, children and adults—is very effective for a wide swath of kids with OCD.
Also, this work really demonstrates in a large way that with NOCD Therapy, children and adolescents can get very effective treatment for OCD that’s accessible to them. They can do it by video teletherapy and they don’t have to live in a major urban area to get access to treatment. And the results show that kids, who are often hard to treat because parents and/or other caregivers can complicate progress, can get better in a relatively short amount of time with our customized therapy program and online tools.
The fact that this very effective treatment, designed specifically for kids, is covered by most major insurance companies means that financially it’s more accessible for families. The most important fact is that if kids and their parents follow the NOCD treatment plan, it doesn’t take a lot of time for them to get better.
Effective, affordable ERP therapy can be life-changing for children with OCD. Read the story of a mother who guided her daughter along her OCD treatment journey while also going through ERP for OCD herself.