Growth is Continuous: Interview with Stephen Smith, Co-Founder and CEO of NOCD
I recently went one on one with Stephen Smith, co-founder and CEO of NOCD.
Adam: Thanks again for taking the time to share your advice. First things first, though, I am sure readers would love to learn more about you. How did you get here? What experiences, failures, setbacks, or challenges have been most instrumental to your growth?
Stephen: I was very fortunate to grow up in a big, loving family in the Chicagoland area. I am the second oldest of five children, so I was tasked with many responsibilities while growing up, which taught me how to work hard from a young age. That learning was coupled with the strong work ethic my parents instilled in me, which led me to become a high-achiever in the classroom and a powerful student-athlete, playing several sports at an elite level. Each sport subsequently taught me both the importance of persevering while simultaneously navigating adversity, as well as the value of having amazing mentors, friends, and coaches. I carried these lessons over to college and later, the real world.
I’d like to emphasize that growth is continuous, so, although I have grown from past experiences, I continue to grow from current experiences, too. When I got to college, one of my early challenges was playing quarterback. After beginning my freshman year as the 7th-string quarterback on our team’s depth chart, I eventually worked my way up to becoming the starter during my sophomore year. I realized that becoming the starter meant that every week, I was essentially at risk of losing my job. I had to perform well or be replaced—it was a level of pressure that I was unaccustomed to feeling.
College is where I also experienced one of the greatest challenges of my life. Even my experience with football’s high-pressure environment wasn’t anything like my OCD onset, which also happened during those years. Having an onset of OCD is like experiencing a major earthquake in your brain. Your foundation as a person feels like it becomes completely altered, and no matter how hard you try to fix it, you feel stuck in misalignment. The only way forward is to accept the state of affairs and move on. For me, this was incredibly difficult to do. Six months after my OCD onset, I hit rock bottom: I was forced to leave school, I stopped playing football, and I became housebound. It was through this struggle that I later developed the idea for NOCD.
Adam: How did you come up with your business idea? What advice do you have for others on how to come up with great ideas?
Stephen: My personal experience with OCD led me to start NOCD. Like many others with OCD, I was misdiagnosed five or six times before receiving effective treatment. The condition is frequently misunderstood by society at large, with most people recognizing the term “OCD,” but not fully grasping its implications. It's often casually used, with people saying phrases like "I'm so OCD," not realizing that it's a chronic and debilitating condition that causes unwanted and often taboo fears, results in constant anxiety, and sometimes can even lead to suicide.
After a lot of suffering, I finally learned the name of my condition, and I was desperate to get proper help. Instead, I hit more roadblocks: I struggled to get the most effective treatment for OCD, Exposure and Response Prevention (ERP) therapy. ERP is the gold standard, evidence-based treatment for OCD. The lack of availability of OCD specialists who provided ERP along with the high treatment costs where it was offered made it difficult to access the help I needed. After nearly six months of searching, I was finally able to find a specialist in my area who officially diagnosed me with OCD and started me on ERP therapy. However, I faced yet more obstacles when my therapist was unavailable between my therapy sessions; a time when help is often needed the most.
Despite these challenges, I continued ERP, and I persevered. When I started feeling better, I realized that the issues I faced were operational rather than clinical, as ERP therapy itself had been so effective. This realization sparked the idea to rebuild the OCD treatment system in the United States, which led to the creation of NOCD—and I am proud to say that NOCD has succeeded in doing just that. Our platform allows people with OCD to get live face-to-face video sessions with licensed therapists who specialize in ERP, as well as receive support from peer communities and self-help tools between sessions, all completely virtually. We have reduced the average wait time to see an OCD specialist from nearly a year to just seven days on average. Furthermore, 130 million Americans now have access to NOCD therapists through their insurance as a covered benefit, whereas previously, this treatment was out-of-network for nearly everyone. Instead, the cost of ERP was typically paid out-of-pocket and was around $300 to $500 per session.
Each week, make a list of problems you personally face and create a solution for each problem. Then, once you identify 100 problems, stack-rank the list.
Adam: How did you know your business idea was worth pursuing? What advice do you have on how to best test a business idea?
Stephen: On a road trip in 2014, I knew the business was worth pursuing. As someone who has experienced the isolation and difficulties of doing treatment homework between therapy sessions, I recognized that utilizing a smartphone would be a convenient and confidential way to access treatment exercises and receive support during OCD episodes. Additionally, using a smartphone allowed for the collection and sharing of data with my therapist, eliminating the need for awkward explanations later during therapy sessions. As the idea developed and I tested it on myself, I shared it with clinicians in the community and gained their approval. With a functional beta version of the platform, I knew it was time to invest more resources into turning it into a fully-fledged product.
It’s important to first get 50 paying customers; once you have those 50 customers, they will provide you with enough honest feedback in order to see if your business idea is viable long-term. This data that you gather will provide you with information on what to do and what not to do before investing in your idea further.
Adam: What are the key steps you have taken to grow your business? What advice do you have for others on how to take their businesses to the next level?
Stephen: Our journey towards growing our business involved several key steps: First, we had to gain quantitative proof that we were offering clinical value to people with OCD—our members. Once we had established the clinical promise of our platform, we raised capital to build a team in order to find product-market fit. Our initial team spent two years working day and night to figure out how to grow a business, while continuously tweaking our product. By mid-2019 we had proven product-market fit, and it was time to raise more capital to develop the operational and economic infrastructure needed to scale the business successfully to a generational level. We reached this point in early 2022. Now, we’re scaling on top of our infrastructure and looking to end the OCD crisis.
My advice to other founders is to focus on creating a product experience that your main stakeholders don’t just like, but one that they love. If you can do that, the rest will fall in line.
Adam: What are your best sales and marketing tips?
Stephen: Overall, my best sales and marketing tip is to over-invest in sales and marketing after finding clear product-market fit. To sustain, it’s critical to identify scalable, low-cost growth levers. Raise venture capital to make such investments and hire an analytics team to build the reporting infrastructure needed to observe real-time insights into what’s working and what isn’t.
Adam: In your experience, what are the defining qualities of an effective leader? How can leaders and aspiring leaders take their leadership skills to the next level?
Stephen: There are several qualities that people must embody if they want to lead; the first being perseverance. Leading people is not easy, and when times are tough, it’s critical for leaders to know that they will make it through the day, regardless of what happens. Next, leaders must have self-awareness. A good leader will focus their time in the places where they are strongest, and they’ll backfill their weaknesses with great talent. Third, good leaders are authentic. Direct reports of the leader should know how they are viewed at all times, as a result of candid communication. Sometimes candor takes courage, but long-term direct reports are appreciative of it.
Adam: What is your best advice on building, leading, and managing teams?
Stephen: Hire functional leaders who make it easy to delegate. A good functional leader will operate as a partner, own key metrics, create strategies to achieve key metrics and work with teams to help them grow professionally. After six months, if it’s still difficult to delegate to an individual for either cultural or operational reasons, then hire a new functional leader for the department. It will be tough, but these situations rarely improve.
Adam: What are your three best tips applicable to entrepreneurs, executives, and civic leaders?
Stephen: The three best tips I could recommend are the following:
The team is most important. If there’s ever any reservation about hiring someone, do not hire them. Further, only hire for roles that you are 110% certain that you need.
Ensure there’s always enough cash on the balance sheet for at least 12 months. Don’t get caught fundraising flat-footed.
It’s amazing how many problems are solved by candid, face-to-face, communication. When at odds, communicate.
Adam: What is the single best piece of advice you have ever received?
Stephen: The best piece of advice I’ve ever received is to focus on helping others, and everything else in life will work out.
Adam Mendler is an entrepreneur, writer, speaker, educator, and nationally-recognized authority on leadership. Adam is the creator and host of the business and leadership podcast Thirty Minute Mentors, where he goes one on one with America's most successful people - Fortune 500 CEOs, founders of household name companies, Hall of Fame and Olympic gold medal-winning athletes, political and military leaders - for intimate half-hour conversations each week. A top leadership speaker, Adam draws upon his insights building and leading businesses and interviewing hundreds of America's top leaders as a top keynote speaker to businesses, universities, and non-profit organizations. Adam has written extensively on leadership and related topics, having authored over 70 articles published in major media outlets including Forbes, Inc. and HuffPost, and has conducted more than 500 one on one interviews with America’s top leaders through his collective media projects. Adam teaches graduate-level courses on leadership at UCLA and is an advisor to numerous companies and leaders. A Los Angeles native, Adam is a lifelong Angels fan and an avid backgammon player.
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