Get to Know OCD Podcast

Episode: The Real Story Behind NOCD: Make-or-Break Moments & the Mission That Drives Us
Host: Dr. Patrick McGrath (Chief Clinical Officer, NOCD)
Guest: Stephen Smith (Founder & CEO, NOCD)
Date: February 12, 2026

Episode Overview

In this special live episode from New Orleans, Dr. Patrick McGrath sits down with Stephen Smith, founder and CEO of NOCD, to explore the untold, behind-the-scenes story of how NOCD was born from Stephen’s personal struggle with severe OCD and grew into a mission-driven organization. The conversation is candid and unscripted, tracing NOCD’s evolution through make-or-break moments, early failures, critical team relationships, and a relentless focus on supporting those living with OCD.

Key Discussion Points & Insights

1. Stephen’s Personal OCD Journey (00:56–05:04)

• Initial Symptoms and Misconceptions:
  • Stephen describes having early OCD symptoms, like a persistent fear of a pen cap being stuck in his throat, and frequent ER visits seeking reassurance.
  • "I kind of had symptoms early on that I now attribute to being related to OCD, but I never really had a severe onset until my sophomore year." (01:33)
• Severe Onset and Treatment Struggles:
  • After sophomore year in college, Stephen’s OCD became severe. He faced distressing, taboo intrusive thoughts, not matching the typical stereotypes of OCD.
  • He visited multiple providers, each offering misguided treatments—including rubber band snapping, thought-challenging techniques, and the blame being placed on family dynamics.
  • "Ended up getting worse, not realizing that that was, in fact, a compulsion." (02:12)
• Isolation and Escalation:
  • Misdiagnosis and ineffective treatments led Stephen to depression and being housebound.
  • He describes compulsions as almost entirely mental: rumination, checking, and reviewing past events, all to disprove his fears.

2. Discovering Community & Accessing ERP (Exposure and Response Prevention) (05:05–07:43)

• Finding Others Like Him:
  • Online, Stephen finds a community of people with similar OCD experiences, a “profound moment” of realization.
  • “There are other people out there who are going through the exact same experience, same fears, same reactions to them, same … life consequences, right?” (05:08)
• Barriers to Treatment:
  • Despite learning about evidence-based care (ERP), Stephen encounters major barriers—long waits, out-of-network costs, and minimal between-session support.
  • With help from family, he eventually begins ERP with a specialist, referencing “Stop Obsessing” by Edna Foa, and slowly starts to make progress.
• OCD as a Hidden Crisis:
  • “One in 40 people could suffer like this, yet there’s available options for care that are actually evidence-based… and that, to me, was an ops issue, not a clinical issue.” (07:29)

3. The Initial Idea for NOCD: Creating Better Support (07:43–12:58)

• The Spark:
  • On a road trip, Stephen sketches the idea for an app offering ERP support between sessions, envisioning integration with a smartwatch for real-time response prevention.
• Early Prototyping & Hustle:
  • Returning to school with no funds, Stephen goes to China to teach English, developing the prototype there and seeking clinician feedback remotely (notably from Taylor Newendorp).
• Securing Initial Funding:
  • Back in the US, he raises ~$80k from “friends and family” to develop the first version, working with engineers in Armenia while juggling school and college football.
• Early Feedback and Pivot:
  • Clinician testers like Laurie Johnson provide crucial feedback, but initial user adoption is underwhelming. Asking users about their biggest needs reveals a strong desire for peer connection, inspiring the creation of the NOCD Community.

4. Building the Team & Surviving “Make-or-Break” Moments (12:58–28:00)

• Team Turbulence & Breakthroughs:
  • After failed engineering partnerships, Stephen turns to Anil Vitla (early Hulu team) and Ilas (data scientist), who stabilize and mature the platform.
• Scraping By:
  • With less than $10,000 in the bank and high server costs, a crucial partnership with San Jose Behavioral Health brings in the first $1,000/month contract, soon growing to $2,500/month.
• Unexpected Breaks:
  • At a bio-conference in San Diego, Stephen networks his way into clinical trial partnerships (e.g., with Biohaven), leading to a $100k/year contract and huge validation.
• Growing Pains:
  • Technical problems like servers crashing due to unexpected publicity (e.g., UK television coverage) underscore the fragile state of the startup.
• Investment and Growth:
  • Larry, a seasoned executive, joins as a key leader; Seven Wire Ventures invests $1 million, marking the transition from scrappy startup to scalable company.

5. The NOCD Model: Bridging Community and Clinical Care (28:00–33:00)

• Clinical Research & Scaling:
  • Collaboration with Columbia University shows NOCD plus a therapist is more effective than standard care; this informs the creation of NOCD Therapy (formerly “NOCD Pro”).
• Learning Critical Lessons:
  • Dr. Fiesner’s intervention pushes NOCD away from a messaging-based service toward a clinically effective virtual specialty therapy model.
  • “Again, there’s all these points along the journey where you could have taken the wrong step. But again, with the right team, you take the right step.” (31:13)
• Insurance Obstacles:
  • Insurers initially don’t recognize OCD as a problem due to misdiagnosis and mis-coding; NOCD overcomes this by mobilizing their own user data to prove demand and get covered.
  • Partnerships with major insurers begin in 2019.

6. The Make-or-Break Pandemic Moment (34:06–38:59)

• Crisis and Decision:
  • In early 2020, a major clinical trial partnership abruptly ends, gutting revenue and putting NOCD at a financial cliff—six months from shutting down.
• All-In Commitment:
  • The team, buoyed by family and collective mission, chooses to go all-in.
  • The pandemic accelerates the adoption of virtual therapy, and NOCD grows rapidly, closing a $12 million Series A that summer.
• Reflecting on Mission:
  • “We’re giving not just life-changing care for many people, we’re giving life-saving care and that’s really impactful.” (37:25)
  • Stephen credits persistent, iterative team effort as the key to NOCD’s growth, not “having things handed to us.”

Notable Quotes & Memorable Moments

• On Realizing OCD Is Not Just a Quirk:

  • “I had no idea of such a disabling chronic condition that affected one in 40 people globally that was treated in a really specialized type of way.” (05:16, Stephen)

• On Barriers to Care:

  • “I saw that there was one provider in my area, she was cash pay, charged $400 an hour, and she has seven month wait list. And that was the only chance to actually get better.” (06:07, Stephen)

• On Early User Feedback:

  • “We launched it, thinking everyone’s just gonna come and use it, and no one actually used it. And we were perplexed, right?” (13:55, Stephen)

• On the Power of Team and Mission:

  • “With the right team, you take the right step. ... A good lesson for all of us here going forward too.” (31:13, Stephen)

• On the Pandemic Pivot:

  • “We had two options. Option A was we’d shut down the business. Option B was we’d go all in.” (34:47, Stephen)

• On the Deeper Purpose:

  • “We’re giving not just life-changing care for many people, we’re giving life-saving care, and that’s really impactful.” (37:25, Stephen)

• Dr. McGrath on Being Welcomed to NOCD:

  • “The fact that you took a risk on me knowing what was going on in my personal life and allowed me to be able to work with you and take care of [my wife] at the same time, we’ll always meet a lot.” (39:00, Patrick McGrath)

• On Stephen as a Founder:

  • “You amaze us every day with the work you do. We are honored with what you do, what you represent, what you have taken from a personal side and brought to the world because one person suffering meant no one else should suffer anymore.” (39:47, Patrick McGrath)

Important Timestamps

• 00:56–05:04 — Stephen’s personal journey with OCD and failed early treatments
• 05:05–07:43 — Discovery of the online OCD community and the reality of treatment access
• 07:43–12:58 — Origin of the NOCD app, early prototyping, and funding stories
• 12:58–28:00 — Early product iterations, team building, and the value of community
• 28:00–33:00 — Clinical partnerships, product pivots, and insurance breakthroughs
• 34:06–38:59 — Pandemic crisis, critical choices, and NOCD’s scale-up phase
• 38:59–40:43 — Reflections on mission, leadership, and gratitude for the team

Recurring Themes

• Personal Experience as a Foundation: Stephen’s struggle drives a relentless focus on clinical quality and user-centered design.
• Community as Catalyst: Early user needs and peer connection shaped the platform’s evolution.
• Mission Over Money: NOCD survived on grit and purpose, not on large upfront investment.
• Navigating Uncertainty: Multiple “life-or-death” moments—from financial crises to server meltdowns—were overcome through ingenuity and teamwork.
• Pioneering Virtual Therapy: The journey from community app to evidence-based virtual therapy reflects ongoing adaptation and learning.
• The Unseen Epidemic: A central concern throughout is the misdiagnosis and under-recognition of OCD, both among providers and insurers.

Final Message

NOCD’s mission is rooted in personal experience, strengthened by community, and realized through evidence-based care, innovation, and persistence. The episode is a candid chronicle of how one person’s suffering was transformed into a resource that now changes—and saves—lives worldwide.